"Insanity is doing the same thing over and over and expecting different results"
Despite continued nursing shortages, high turnover rates, and nurse burnout, many health systems continue to address nurse staffing as they have for decades. According to Albert Einstein, this approach is nothing short of insane.
As healthcare demands increase and clinician supply remains insufficient, nurse staffing practices must evolve to meet current needs.
Traditional staffing is ill-equipped for current needs
Traditional staffing practices typically involve drawn-out formal application processes, including paperwork, interviews, and negotiations that can take months to bear fruit.
The ongoing nursing shortage, coupled with high nurse turnover and burnout, makes nurse staffing increasingly challenging.
In this context, traditional nurse staffing strategies are insufficient to maintain adequate clinician-to-patient ratios, leaving healthcare facilities scrambling to fill gaps in coverage.
In late 2023, Nursa conducted a research survey of 203 hospital executives, offering the following insights:
- Of the chief financial officers (CFOs) surveyed, 98 percent considered nurse staffing a significant challenge for their health systems even after the pandemic.
- To attract and retain nurses, 77 percent of CFOs surveyed stated they have increased the starting wages for nurses by at least 20 percent in the past two years.
- Despite salary increases, many hospitals and health systems (86 percent) saw 10 percent or more of their nursing staff quit in 2023.
Since traditional staffing methods and clinician retention strategies are not satisfying current needs, health systems should consider a hybrid staffing approach.
Facilities need to adopt a hybrid approach to staffing
Healthcare facilities don’t need to discard traditional staffing strategies. However, they should incorporate innovative methods and tools in their nurse staffing process.
The previously mentioned survey found that over half of health systems are using four or more strategies to tackle the nurse staff shortage.
One notable strategy is relying on contingent or per diem nurse staffing. The numbers speak for themselves: The volume of contract nurses more than doubled from 2019 to 2023.
Although some still avoid relying on temporary nursing staff, 93 percent of health system leaders do not believe nurses employed by health systems are necessarily more valuable than independent contractors.
What does a “hybrid staffing” strategy look like?
The term “hybrid staffing” can have different meanings, including using telehealth nurses. However, this article uses hybrid staffing to refer to the integration of complementary staffing strategies and sources, namely hiring long-term internal staff and contracting temporary clinicians as needed.
In addition to relying on internal staff, healthcare facilities that apply hybrid staffing strategies extend their talent pools to include independent contractor clinicians from per diem staffing platforms and other temporary staffing sources.
Reactive and proactive solutions
Using hybrid staffing systems can help healthcare facilities be efficiently proactive as well as reactive.
During times of unexpected patient surges or employee leaves of absence, contingency staff can help facilities seamlessly adapt to changing staffing needs.
In addition to providing these reactive benefits, a hybrid staffing approach can help facilities proactively increase retention and job satisfaction among nursing staff. For instance, two-thirds of health system executives believe relying on a larger pool of nurses can help them offer greater flexibility to their internal staff.
Cost-effective solutions
The flexible staffing solutions that per diem nursing platforms provide are also cost-effective.
During low census periods, facilities pay only for the coverage they need. When contingency staff is required, facilities pay per diem staff only for the hours worked—no overtime or employee benefits.
Implementing a hybrid staffing strategy at your facility
Just as hybrid cars can switch between relying on electric motors or gasoline engines based on their needs, facilities that use a hybrid staffing strategy can rely on internal staff during low census periods with a backup of contingency staff when additional clinicians are needed.
Internal staff
Internal staff members are undoubtedly the backbone of any healthcare facility.
They are familiar with the establishment and its protocols. Furthermore, they have experience working with other healthcare team members, which facilitates teamwork, coordination, and continuity of patient care.
In addition to permanent staff in each department, healthcare facilities benefit from the flexibility and adaptability of internal float pool staff. Float pool nurses are often cross-trained and can effectively jump in to support temporarily understaffed areas.
That said, during high census periods or leaves of absence of internal staff, external staff are often needed as well.
External staff
External per diem or PRN staff can fill in when internal staff are insufficient to meet current demands. Facilities may need additional staff due to increased patient census or reduced availability of internal staff.
They can work when needed without requiring a long-term commitment from the facility in need.
Accessing qualified clinicians on demand allows facilities to maintain safe nurse-to-patient ratios at all times and protect internal staff from burnout. A satisfied nursing workforce, in turn, results in lower turnover rates and better patient outcomes.
These per diem clinicians can address both short- and long-term needs. They provide much-needed coverage one shift at a time.
Additionally, a clinician who has satisfactorily worked PRN shifts at a facility is an ideal candidate for a long-term internal staff position. The facility can assess the clinician’s knowledge, experience, soft skills, and attitude before offering a long-term position. Likewise, the clinician can make an informed decision based on their experience working at the facility.
What will healthcare staffing look like in the future?
The future of nursing is an ever-changing landscape, and nurse staffing must evolve and adapt to meet current needs and possibilities.
In the same way that people turn to online platforms for everything from grocery shopping to dating, nurse staffing will increasingly rely on digital solutions to source independent contractor clinicians to cover healthcare needs.
A hybrid staffing approach—facilitated by technology—offers the innovative and flexible staffing solutions that facilities need in 2025.
This article is part of the HealthManagement.org Point-of-View Programme.