Understand how we got here — and how to move forward.


Case Study

How to Flex RNs Across Sites of Care Using Blended Roles

5 Minute Read


The challenge

Many millennial nurses want to build their early careers by gaining a variety of different experiences. As a result, acute care hospitals aren’t just competing against each other as they try to be an employer of choice. They are also competing against ambulatory surgical centers, retail clinics, and outpatient offices.

The organizations

  • Greenwich Hospital, a 206-bed regional hospital in Greenwich, Connecticut, and part of Yale New Haven Health System, introduced blended roles to manage high patient volumes.
  • Cincinnati Children’s Hospital Medical Center, a 621-bed pediatric hospital headquartered in Cincinnati, Ohio, introduced blended roles to give nurses a broader understanding of the care continuum.

The approach

Frontline nurses split their time between two units or sites of care. The goal is to enable staff to expand their breadth of experience without altogether leaving their role—or the organization.

The result

Participants in both programs report improved job satisfaction as well as appreciation in forming connections with patients and families outside of their home unit.



Staff rotate between two units

The first option for implementing blended nurse roles is to have frontline staff split their time between two units. Greenwich Hospital did so by creating a “transition” role across its Mother Baby and Labor and Delivery (L&D) units. These nurses work most of their shifts on Mother Baby, but they work up to three shifts a month on L&D caring for newborns immediately post-partum.

Although leaders originally piloted this role to assist L&D nurses after patient volumes spiked, the role is now permanent. Patient and staff satisfaction both improved, and more than 90% of Mother Baby nurses opt into the transition shifts. Young nurses are particularly eager to fill transition roles.

Staff rotate between two care sites

At Cincinnati Children’s, blended nurses split their time between an inpatient and outpatient care site. Leaders pair two nurses within the same service line—one works half the week in an inpatient setting and the other works the same schedule in an outpatient setting. For the second half of the week, they switch sites.

This practice can be applied across any service lines that have corresponding inpatient and outpatient care sites. Participating sites at Cincinnati Children’s include inpatient neurosurgery, nephrology with dialysis unit, pulmonary clinic with IP trach unit, cardiology step-down with cardiology clinic, NICU with high-risk infant follow-up clinic, and gastroenterology with hematology.

Key considerations for introducing blended nurse roles

  1. When staff rotate, they take on a predetermined set of responsibilities. Leaders should set aside sufficient time for nurses in blended roles to train on new required skills and to stay up to date on competencies in both rotation areas.

  2. Nurses rotating between care sites should rotate within a single service line so they are already familiar with the general characteristics of the patient population.

  3. Ensure that staff rotate regularly between units or care sites so they are consistently exposed to other parts of the organization.

  4. Managers from both units or care sites must be equipped to coordinate scheduling and performance reviews for nurses in blended roles.


The initial goal of these roles was to give nurses a broader understanding of the care continuum and help manage high patient volumes in certain units. But the new roles have proven to be particularly appealing to newly graduated nurses eager for different experiences, and nurses at Cincinnati Children’s shared how much they appreciate connecting with patients and families outside of the hospital. This tactic also has the potential to fill acute or chronic vacancies, as nurses in the corresponding care site can be called on to fill open shifts when needed.

"Allowing our younger nurses to mix it up—even interacting with the same population, but in a different context that enables them to acquire new skills—on a regular basis makes a big difference."

Patricia Basciano, Nurse Manager
Greenwich Hospital

"This role helped me understand what happens after the inpatient stay and prepare patients for care beyond the hospital."

Cincinnati Children’s Medical Center

Have a Question?


Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.