Nurse staffing and scheduling is dynamic and complex. There are three primary nurse staffing and scheduling models to consider: centralized staffing, decentralized staffing, or a hybrid of centralized and decentralized staffing. Each has its own advantages and disadvantages and the best management model varies based on a healthcare organization’s unique structure and culture.  

The optimal nurse staffing and scheduling model improves patient outcomes, cuts costs for the health system and improves nurse satisfaction. In this guide, we break down considerations for healthcare leaders weighing the pros and cons of centralized vs decentralized staffing and scheduling and working to design the best model for their organization. 

What is centralized staffing and centralized scheduling?

Centralized staffing is a staffing approach in which a single department or team of staffers manage nurse staffing across an organization. Similarly, centralized scheduling refers to a system where nurse scheduling is handled by one person or a team of schedulers organization wide. 

There are a couple of ways to build a centralized model. If a hospital is part of a health system, centralized staffing and scheduling could be built at the system level to manage multiple facilities. Or centralization can be built for one hospital to handle all scheduling for that single hospital. 

In either centralized nursing model (either system-wide or hospital-wide), a single team of staffers and schedulers works in parallel with all nurse managers to build a balanced schedule based on staffing needs, patient volumes, acuity levels and other factors that may impact staffing requirements. This requires working closely with hospital leadership teams and building knowledge available workforce resources. 

Nurse scheduling and staffing functions work in tandem. Scheduling includes the work that goes into building the six-week nurse schedule eight weeks before the shift. Staffing comes into play when staffers are filling any unfilled shifts remaining once a schedule is published.  

Staffing involves shoring up the nursing schedule to match true demand. For example, a centralized staffer may be responsible for staffing six units for a hospital and find that two units are overstaffed by two and four units are understaffed by 10. That staffer can move four nurses from the overstaffed to understaffed units and recruit or pull a float pool in to cover the extra needs.  

Both nurse scheduling and staffing require a careful balance of meeting patient care needs and balancing an organization’s staffing budget. 

How does it differ from decentralized staffing and scheduling?

In a decentralized nurse staffing and scheduling model, staffing decisions are made by individual units or departments within the healthcare facility. This means each unit or department is responsible for managing their own staffing needs and making decisions about how many healthcare professionals are needed to cover staffing requirements.  

There are pros and cons to both centralized and decentralized staffing models. Centralized scheduling in nursing can help healthcare facilities reduce costs and ensure consistent staffing levels but may be less flexible and responsive to individual unit or department needs. Decentralized staffing can provide greater flexibility and autonomy but may result in inconsistent staffing levels, less standardization and unnecessary incentive or overtime spending across an organization. 

The choice between a centralized or decentralized staffing model will depend on the specific needs and priorities of each healthcare facility. Factors such as organizational size, complexity and patient volume may influence the decision to adopt a centralized or decentralized staffing model. 

What are the benefits and drawbacks of a centralized nursing model?

As referenced in the previous section, centralized scheduling and staffing models in healthcare facilities have both benefits and drawbacks. Let’s dive into some specific benefits and drawbacks of centralized scheduling in nursing.  

Benefits of a centralized model may include:

• Consistent staffing levels: Centralized scheduling in nursing can help ensure consistent staffing levels across the organization, which helps maintain patient safety and improves quality of care. ‍
• Scalability and efficiency: Centralized staffing makes it easier to scale and standardize staffing and scheduling practices than a decentralized model. For example, in a centralized model, one staffer can support more than 500 nurses across 16 units vs a half dozen decentralized managers scheduling for 80 people each. A centralized approach streamlines staffing processes and reduces duplicative administrative tasks, improving efficiency and reducing costs.  ‍
• Increased transparency: Centralized nursing provides greater visibility into staffing levels across an organization, making it clearer to see where additional staff may be needed. Rather than a decentralized, siloed approach, centralized staffing allows staffers to easily identify any gaps or areas where they are overstaffed, which gives them better ability to manage workforce deployment and resource management pertaining to cost.  ‍
• Cost savings: The previous three benefits all add up to cost savings for healthcare facilities. For example, when a manager builds a schedule in the decentralized model and they're short-staffed, they will try and recruit a nurse to fill that shift. Often, they will pull from what they know, which is their own team and their own resources. That may involve offering overtime or an incentive shift. On the other hand, when staffing and scheduling is managed at a central level, it is easier to curb unnecessary overtime and incentive spend because staffers have visibility to leverage resources from overstaffed units or available float pools rather than offering incentives or overtime.  ‍
• Standardization: A centralized staffing model can help standardize staffing practices and ensure that best practices are followed consistently across the organization. For example, a centralized model empowers nurse staffers and schedulers to standardize rates and scheduling policies (such schedule publishing timing and PTO and trade administration). When all units are speaking the same language and moving in the same scheduling cadence, it allows for better operational management with less resources than a decentralized model.  

Drawbacks of a centralized staffing model may include:

• Lack of flexibility: A centralized staffing model can be less flexible and responsive to the needs of individual units or departments within the organization.
• Increased bureaucracy: A centralized staffing model may require additional layers of bureaucracy and decision-making, which can slow down staffing processes. ‍
• Resistance to change: Some healthcare professionals may resist centralized scheduling in nursing, particularly if they feel that it takes decision-making power away from them. ‍
• Higher cost: Implementing a centralized staffing model may require additional resources and investment, which can increase costs in the short term. However, in the long term, it can help healthcare facilities save money though greater visibility into staffing needs and resources.  

Overall, a centralized scheduling and staffing model can provide many benefits to healthcare facilities, including improved consistency, efficiency and transparency. However, it may also come with some drawbacks, including reduced flexibility and increased bureaucracy. Healthcare facilities must carefully consider their needs and priorities when deciding whether to adopt centralized scheduling in nursing.

No matter which model you choose, two case studies published by our Chief Nursing Officer Danielle Bowie, DNP, RN, NE-BC and her colleague Kathy Baker, PhD, RN, NE-BC examining centralized vs. decentralized staffing found common nurse staffing and scheduling principles that will improve the effectiveness of any nurse staffing and scheduling model.  

1. Include nurse input: When nurses have input into an organization’s staffing and scheduling processes, nursing and department needs are considered during process development and implementation.  

2. Ensure Flexibility: Staffing and scheduling flexibility allows an organization to adapt quickly to changing patient needs, including changes in patient census and acuity and varying available staff levels.  

3. Prioritize Transparency: Transparency and collaboration increase trust in the system and maximize staffing and scheduling issue solutions.

Data and technology requirements for the centralized model

Centralized scheduling in nursing requires specific data and technology capabilities to build an effective staff mix, strategically schedule staff to ensure that less-desirable shifts have coverage and reduce unnecessary overtime and excessive floating across multiple units.  

The key piece of tech needed is a powerful staffing platform that can manage staffing levels, schedules and labor costs by automating staffing processes and providing real-time visibility into staffing levels across the organization. This system should contain:  

• Analytics and reporting tools that track KPIs related to staffing, such as overtime costs, nurse-to-patient ratios and staffing variances. Analytics and reporting data can help healthcare facilities identify areas for improvement and make data-driven decisions.  
• Predictive analytics and machine learning capabilities to help healthcare facilities forecast staffing needs based on patient volumes and acuity levels. This can help reduce staffing variances and ensure optimal staffing coverage at an optimal price.  
• A robust time and attendance tracking system to help healthcare facilities manage labor costs, ensure accurate payroll processing and help track attendance and time-off requests.  

How Works can help

The Works staffing platform supports healthcare facilities operating under centralized, decentralized and hybrid nurse staffing models. No matter a healthcare facility’s staffing model, Works can help scale nurse workforce design, offset administrative burden and expand workforce visibility across the hospital or health system. Works bidirectionally integrates with leading nurse scheduling solutions like UKG Dimensions, Smart Square, Shift Wizard and Avantas to give nurse managers, staffers and schedulers full visibility into available internal and external workforce resources and shift gaps. Our tool includes an app that allows nurses to claim shifts and automated recruitment powered by artificial intelligence (AI). Our recruitment tool aligns with each organization's goals, limits overtime and incentive spending and ensures the right nurse is placed in the ideal-fit shift for the best rate. This dynamic model significantly reduces nurse manager and staffing office workload and burnout and improves nurse, staff and patient satisfaction. Learn more at https://works.trustedhealth.com.