Our Take

Reinventing the Inpatient Float Pool

10 Minute Read

Traditional nurse float pools are critical to hospitals’ abilities to staff efficiently amid fluctuating volume—while offering staff roles with more flexible scheduling.

Yet while systems grew exponentially, their float pools have been static. By updating float pool strategy to reflect their organization’s changing needs, nurse leaders can leverage the principles underlying float pool success to address new workforce challenges.

The float pool of the future isn’t a small inpatient team. It’s a cross-continuum enterprise that stands to address goals at the heart of system strategy.


The conventional wisdom

A float pool is a team of nurses who typically practice across inpatient units within a hospital, rather than specializing in a single unit. Nurse leaders deploy float nurses to staff surges or cover long-term vacancies, reducing the organization’s reliance on agency labor. In the past few years, hospitals created specialized float pools, such as critical care and medical teams, to better match float staff skill to patient acuity.

This success hasn’t come easily. Float pools can be particularly difficult teams to recruit for and retain staff. They typically contain experienced nurses, who are in short supply. And leaders have traditionally struggled to create a supportive work environment, or to connect float teams to the larger nursing workforce. These struggles resulted in high turnover.

But, in the past decade, nurse leaders made progress in reducing float nurse turnover and vacancies. Many organizations have also increased the number of float roles in their workforce. But overall, the fundamental structure and function of float pools has changed little since their inception—because they’ve been working as intended for inpatient facilities.


Our take

While float pools haven’t changed much in the last decade, health care organizations and the larger nursing workforce changed significantly. This has led to three staffing challenges, which could be addressed by float pools.

  • First, many organizations are struggling with a growing experience-complexity gap, making it more important than ever to retain mid- and late-career staff. But full-time roles with 12-hour shifts do not work for many of these staff, who may find the shifts too physically demanding or difficult to juggle with family responsibilities.

  • Second, most organizations have much larger nursing workforces today because of mergers and acquisitions, which should in theory equip them with greater flexibility to solve staffing challenges. Yet systems struggle to leverage their scale to address regional surges or vacancies.

  • Finally, systems have a much more diverse portfolio of services beyond hospital care. This translates into a higher number of nursing specialties within the organization (working in infusion clinics, procedural areas, physician offices, etc.). Often, these roles don’t have back up staffing coverage besides agency labor.

Leaders can leverage the same principles underlying their inpatient float pools to address all three problems. A cross-continuum approach to float staff can also introduce a layer of staffing back up coverage across the entire system that better equips ambulatory leaders to respond to fluctuating patient volumes.


4 options to expand your float pool strategy

The four options for expanding your float pool strategy all solve specific staffing challenges. Some organizations could benefit from implementing one or more of these, depending on their specific situations. Others—particularly independent hospitals—may not need to update their float pool structure at all. But those hospitals can still create a more flexible nursing workforce by embedding more flexibility among their non-float staff.

Read on for more details on the options below.

  • Option

    Short-shift float pool

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  • Option

    Ambulatory float pool

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  • Option

    System-wide float pool

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  • Option

    Internal travel agency

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Parting thoughts

Float pool innovations can help organizations dramatically reduce agency labor costs, among other benefits. Yet float staff still make up a small portion of the overall nursing workforce. If organizations want to make larger gains in creating a more flexible RN workforce, they’ll have to target their non-float staff as well.

We’ve identified four opportunities to embed flexibility among non-float staff:

  • Provide shorter shifts and nontraditional roles to keep experienced nurses at the bedside. With an impending nursing shortage, organizations need to take every reasonable step to retain experienced staff—many of whom are leaving because common shifts and roles don’t align with their growing demands at home.
  • Cross-specialize nurses with similar technical skills to address experience and specialty shortages. Rather than trying to recruit the scarce experienced nurses in their market, organizations need to cross-specialize already employed nurses with similar technical skills so they can be redeployed to other units and care sites when needed.
  • Scale experience with expert-led staffing models. Organizations should be prepared to use team-based approaches more regularly to address experience and specialty shortages during crisis.
  • Enable non-float RNs to regularly practice across multiple settings. The biggest opportunity organizations have to meet changing staff needs and address staffing demands is to extend the principles of the float pool to the entire workforce—moving from flexibility for a few to flexibility for all.

For more information, see our research report on building a more flexible nurse workforce.

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