Nurse Scheduling Strategies that Drive Employee Engagement

While the COVID-19 pandemic has illuminated the critical value of nurses across the globe, nursing has always been the backbone of the healthcare system. It’s simultaneously a high-pressure and stressful profession, due in large part to notoriously long shifts. 

Healthcare organizations face a clear tension between maintaining a high-level of patient care and nurse satisfaction and engagement. They seek to provide quality care both when and where it’s needed, but doing so often leads to premature nurse burnout and high levels of turnover. The problem is only exacerbated in home healthcare—an industry that continues to see considerable growth—where organizations must contend with an extra layer to the complexity of scheduling. 

Here, we’ll dive into the most common nurse schedules and where they’re most effective. We’ll also take a realistic look at the strategies healthcare operations managers can leverage for a dynamic, adaptable scheduling system that drives both employee engagement and patient care.

Typical Nurse Schedules

While every healthcare organization is unique in size, priorities, resources, objectives, and more, there are four primary nurse schedules that dominate the industry. Each works differently and offers specific advantages and disadvantages to both nurses and management. 

It’s important to note that with any of the scheduling options described below, nurses also typically work a rotation of morning, afternoon, and night shifts. This means they’ll complete each type of shift set in a three week period, which contributes to the pros and cons of each scheduling structure. 

Three 12 hour shifts per week

Long-term care facilities, hospitals, and healthcare organizations that operate 24/7 generally schedule their nurses for three 12 hour shifts per week. Nurses benefit from this type of schedule because they have more days off, which means fewer days needed for childcare and the ability to tend to personal matters. If rescheduling is needed, they’re able to easily trade shifts with other nurses. 

However, 12 hour shifts are both physically and mentally draining, and staggered scheduling can make it difficult for nurses to recharge after caring for certain patients. Since nurses spend so many hours in a single shift caring for patients, there’s a significant amount of information to share with the next caregiver at handoff. Plus, they often require nurses to work more weekends, which can lead to a suboptimal work-life balance for staff. 

For healthcare businesses, three 12 hour shifts mean the ability to serve more patients around the clock. Mobile and home healthcare companies face fewer reimbursement expenses, too, since nurses don’t travel as frequently. 

But companies that use this structure also must deal with higher levels of burnout and turnover, since long shifts can easily translate into exhausting circumstances for their nursing staff. And if they don’t have the proper systems of record to quickly and easily document patient details, information can fall through the cracks at handoff—leading to miscommunications, errors, and, ultimately, unhappy clients.

Four 10 hour shifts per week 

It’s common for hospitals, private healthcare practices, and other facilities to schedule their nurses using four 10 hour shifts per week. Nurses find this structure advantageous because it offers more free time for recharging on leisure on their work days than the 12-hour shift alternative. Because another provider takes the reins mid-shift, nurses have fewer end-of-shift duties to complete as they clock out. This type of schedule generally results in three-day weekends for nursing staff, so they’re able to tend to personal matters more easily.

But it doesn’t come without its challenges: 10 hour shifts are long, and thus potentially draining, especially since some may run closer to 11 or 12 hours by necessity. It’s also a rather inflexible scheduling model, since each nurse is only available to work four days of the week.

Healthcare organizations that utilize four 10 hour shifts generally maintain a happy workforce, though, because the longer weekends allow for a strong work-life balance, even on working days. They’re also still able to deliver care to more patients than companies based around an 8-hour work day. 

But the lack of schedule flexibility can become burdensome to their staff, increasing the risk for burnout and turnover. Mid-shift changes can lead to errors and inadequate patient care, which impacts productivity, efficiency, and employee and patient satisfaction. 

Five 8 hour shifts per week 

School nurses and private medical practices often use five 8 hour shifts per week to deliver care to their patients. Shorter shifts allow nurses to acutely focus on their work without the risk of burnout. It’s a stable, consistent scheduling model that enables nurses to sufficiently recharge during their free time. 

On the other hand, higher costs of gas, parking, and other travel expenses can weigh heavily on nursing staff, since they move to-and-from their jobs so frequently. They have limited ability to change their shifts and find coverage, too, since everyone works the same schedule.

The business sees happier, more fulfilled employees, less turnover, and limited burnout (though burnout is ever-present in the high-stress field of healthcare). Their nurses are focused on their career development and patients, and are more satisfied with schedule stability and a good work-life balance.

They’re not able to serve as many patients throughout the days and weeks, though, since they only operate during “normal”, 9-5 business hours. For home health companies that offer travel reimbursements to their nursing staff, reimbursement expenses tend to mount. Plus, if a nurse calls in sick or has car trouble, they often struggle to find coverage, which can lead to missed or canceled appointments and diminish the patient experience. 

PRN or “pre re nata”  

PRN (pre re nata) or as-needed nurses have no set schedules. They work via pre-established agreements with hospitals and medical facilities, and are available to take on shifts in periods of labor shortages. This offers nurses more flexibility and freedom during the work, and enables them to work at a variety of interesting locations.

PRN nurses typically find it difficult to build rapport with their patients and co-workers, since they’re constantly moving from one site to another. They struggle to find consistent professional growth while working for so many different employers. Plus, shift instability means inconsistent outcomes, which can increase stress and frustration.

Healthcare businesses that hire PRNs benefit from the flexibility of employing as-needed staff, particularly when running short on hands. They can find specialty care for certain patient circumstances without hiring the caregiver for a full-time position—which can be a more cost-effective solution in particularly complex care situations. 

But since they can’t provide stability to PRNs, businesses may find it difficult to keep them happy and engaged. The fact that they can’t offer career development opportunities or growth to these types of nurses doesn’t help either, as this doesn’t foster a relationship of loyalty, trust, or connectedness.

Strategies for Optimal Nurse Scheduling 

Setting schedules for nurses is often a bit of a balancing act between shifting business priorities, caregiver preferences, and patient demand. No matter which structure your organization selects, it’s important to follow these key strategies for success:

Communicate with your workforce 

To remain engaged, productive, and fulfilled in their work, nurses need high levels of communication from managers and supervisors. Healthcare businesses should strive to create and send schedules well in advance to their staff for increased stability and planning—both of which impact nurse satisfaction.

They should quickly communicate any changes to schedules, policies, procedures, and more, so everyone is always on the same page. This helps nurses to get their work done as seamlessly as possible and to deliver patient care with complete confidence. Regardless of the schedule type your organization chooses, make sure you’re transparent with staff. It can never hurt to explain to them why the shifts you’ve adopted best suit your business, your employees, and your patients. 

Look for tools that enable management to communicate with staff regardless of where they are. A centralized platform can help, since it doesn’t require nurses to toggle between various communication tools (like Slack, text messages, email, etc.) to communicate with supervisors and colleagues. 

Pay close attention to patient feedback

Patient feedback will give you deep insights into what’s working, what’s not, and how well your workforce is serving their needs. Due to the consumerization of healthcare, patients have a whole slew of options when it comes to choosing their care providers; so failing to understand and address their feedback could greatly cost you business.

Today’s patients want to take an active role in their care rather than be treated as passive recipients. They’re consumers, after all, and thus their expectations are high. Take the time to listen closely to their pain points, desires, and intended outcomes, or risk losing them to a competitor. Using their feedback, build your schedules in a way that best serves their needs. It’s a patient-first strategy that’ll set you apart from other healthcare providers. 

Implement real-time updates

Workforce schedules are ever-changing, especially in the complex world of healthcare. Nurses and patients both need real-time updates to feel well-supported and satisfied. Your staff should be empowered to do their best work with seamless access to up-to-date information (e.g. scheduling changes, patient details, policies, procedures, and more). 

This is particularly true for mobile healthcare organizations, since nurses in the field find it even more difficult to remain in-the-know. Without the right tools for support, they lack crucial information about schedule adjustments and upcoming appointments—which can diminish their productivity and ability to deliver quality care. They need a single, reliable place in which to access and modify their daily schedules. 

Patients, too, need real-time information regarding their appointments, last-minute changes, and accurate caregiver arrival times. When they have seamless access to information, options, care, appointment bookings, and more, patients are more engaged in their healthcare, which results in improved satisfaction and outcomes.

Match shifts and workers by level of experience

Each nurse brings a unique experience, skill set, and certifications to the table; and they should be matched to patients based on those details. Again, this is especially vital for mobile and home healthcare companies, where proper prover-patient matching impacts productivity, efficiency, and patient care and satisfaction.

Healthcare organizations should carefully consider shift lengths versus nurse preferences and experiences, as well as patient demand. By creating schedules that serve the needs of both your workforce and your clients, you’ll increase satisfaction and quality of care. This helps to avoid premature burnout and high turnover rates—which is no joke in home healthcare, where turnover rates reached 22.18% in 2020. 

And remember: staffing shortages have given nurses the upper-hand in terms of evaluating potential employees, so it’s vital to provide them with work that allows them to adequately utilize their expertise. 

Use automated scheduling software

Manual scheduling processes and tools are time-consuming and error-prone, which can be extremely problematic in the high-stakes healthcare environment. Yes, it’s important to properly schedule workers for optimal productivity and customer satisfaction in any field, but poor scheduling practices can put patient care and outcomes at risk. 

Automated software can help businesses overcome the bottlenecks that often occur in healthcare scheduling. Intelligent solutions match the right nurse to the right job (based on location, availability, skill sets, certifications, patient preferences and history, and more), so  they always arrive well-prepared to care for their patients. They also optimize the process by handling the complexities of healthcare scheduling while maximizing patient flow. 

A centralized scheduling platform offers seamless, real-time, mobile-first communication between schedulers, nurses, and even patients; giving them better access to resources, up-to-date patient details, schedules, and more. They instantly generate the best route from one appointment to the next, too, so home health providers don’t have to waste time switching between apps (which is frustrating and inefficient).

What’s more, some automated scheduling software even enables mobile data collection, so nurses can capture key details—like contactless patient signatures, care information, patient history, and more—without missing a beat. This ensures everyone always has up-to-the-minute information regarding their patients, which is critical for excellent care delivery.

Modern tools are also equipped to integrate with country-specific regulations. Healthcare businesses in Australia, for example, can integrate their automated scheduling solution with Awards Interpreters to ensure their nurses are working within the government-outlined safe hours. This can help them better manage overtime shifts and other award violations. 

Powerful Scheduling Software for Improved Nurse Engagement

Engaging your nursing staff is vital for retaining talent, ensuring patient satisfaction, and providing consistently excellent care. This requires operational efficiency, which depends heavily on the strength of your scheduling process. 

Skedulo’s automated scheduling solutions help healthcare organizations manage the complexities of their workforce with ease. With tools for intelligent job matching, optimized routing, seamless communication, mobile data collection, and more, your business can automatically build schedules that boost nurse productivity, satisfaction, and engagement—all of which contribute to better patient care.

Learn more about how successful home healthcare organizations schedule their workforce, or book a demo today.