Innovation in Action: Flexible Workforce Programs

August 9, 2022
Dani Bowie, DNP, RN, NE-BC

Work flexibility is the new currency of the nursing workforce and is just as important as competitive hourly pay, compensation packages, and incentive programs in attracting and retaining staff. It is imperative for health systems to dedicate time and resources to build flexible workforce programs that will help meet staffing expectations. The beauty of these different programs is that the design itself is flexible: Health systems can use a variety of innovative approaches to ensure the organization’s specific needs are met.

In the article “Innovative Staffing Solution: The Internal Travel Agency”, I discussed how health systems are building their own internal agencies to offer competitive pay and work experience to a segment of the workforce that desires this option. Of course, not all workforce members will want to join an internal travel agency or even a float pool program, but many still want flexible work options based in their “home” hospital and don’t require travel. Here are some flexible workforce programs not associated with travel that health systems can implement, followed by how you can take steps to make them as effective as possible.

Innovative Flexible Workforce Programs

1. Internal PRN/Per Diem/Gig

Internal PRN/per diem/gig programs are cost-effective ways health systems can fit staffing demand with flexibility for both the system and the front-line nurse. Those who participate in these programs should not receive benefits or any commitment for full-time work; however, they should have maximum and minimum work hour requirements and guidelines that outline their eligibility for incentive pay. These guidelines should note that those participating in this type of program should meet the minimum hours for work before being eligible for incentive shifts. For example, the gig nurse should work a minimum of 24 hours per pay period before being permitted to pick up incentive shifts.

Best practice tip: Ensure a gig nurse works at least one shift every month to maintain competency but does not consistently exceed 30 hours per week because those hours align with a traditional part-time role that should also receive benefits. Mobile technology is vital for powering the gig workforce: It operationalizes picking up extra shifts in a nimble and transparent manner.

2. Weekend Program

Weekend programs aren’t new, but it’s important to remember that they are versatile options health systems can use to staff hard-to-fill weekend shifts and offer a break from rigid “every other weekend” expectations for full-time staff. The program typically defines the weekend for day- and night-shift employees, offers part-time employment with a set schedule for weekend shifts, and pays a higher hourly rate for the employee to compensate for the every weekend commitment.

Best practice tip: Use the weekend program to move from requiring staff to work every other weekend to requiring them to work every third weekend. This strategy allows you to offer work-life balance to the frontline nurses who want to work fewer weekends. 

3. Resource Nurse and Break Nurse

Resource nurses and break nurses ease hospital staff stress and workload by providing time away from the bedside and performing tasks such as changing wound vac dressings, administering conscious sedation at the bedside, or placing a nasogastric tube. In states with minimum staffing requirements, break nurses are often essential to “cover” for frontline nurses who are temporarily away from the bedside. The parameters for both roles should be defined so they complement the workload of traditional shifts. For instance, nurses working the 7 AM to 7 PM shift would benefit from resource nurse and break nurse support starting at 9 AM through the 7 PM shift change. 

Best practice tip: Fill these positions based on competency, experience, and work performance to ensure they attract and retain high performers who are self-starters and good communicators and who will maintain high levels of visibility through rounding with charge nurses and work productivity. These roles also are an opportunity to retain experienced nurses looking for new options for work and alternatives to traditional shift offerings. 

4. Telehealth 

With COVID-19, more health systems turned to nontraditional models of care and explored telehealth offerings to augment the workforce. It’s important to remember that telehealth models will not reduce the number of nurses needed, but they do require clear delineation of work and job responsibilities for the on-site nurse and the virtual nurse. The onsite nurse may not be responsible for care coordination or discharge education, but still needs to conduct physical assessments and provide daily care. The virtual nurse is responsible for care coordination and education and can consult with the onsite nurse who has clinical assessment questions or concerns. 

Best practice tip: Consider telehealth models of care as a strategy for retaining staff who are near retirement and thinking of leaving the bedside due to long hours and the inability to meet the physical demands of the job. 

5. Career Pathways

A career pathways program is essential for the development, retention, and rapid upskilling and cross training of the workforce. It’s well-known that nurses enjoy variety and options within the life cycle of their career, and this type of program helps a nurse understand how to move through different career options with clearly defined goals and objectives. Career pathways programs also benefit the health system by building a healthy pipeline of nurses who can move from the bedside into leadership roles or change their specialties to meet hard-to-fill demands such as the operating room or women’s health.  

Best practice tip: Define four to six key career pathways for the bedside nurse to consider. Examples include transitioning from the medical/surgical specialty to critical care or emergency department, from direct care nurse to nurse educator, from direct care nurse to nurse informaticist, and from direct care nurse to nurse manager. Within the pathways, note competencies, experiences, and classes that can be offered to help nurses start the transition. Embed career pathway material into the nurse manager's check-in with frontline nurses to help the nurse manager bring structure to career conversations, awareness of the offerings, and how to apply to the program. 

6. Nurse Mentor and Preceptor

Precepting and mentorship are key offerings health systems need to build the next generation of nurses. Precepting a new graduate nurse without a structured residency program can be very taxing for a health system to support. Structured preceptor programs and roles provide the best experience for the new nurse and combat 90-day and first-year turnover; preceptors also are essential for nurses new to the organization and those changing specialties. In addition to preceptors, who focus more on the transfer of tactical skills, effective mentors offer a more holistic nursing experience to nurses who are seeking help with professional growth and development. If possible, create a combined nurse mentor and preceptor program for new graduate nurses and new hires to provide support. Those in the preceptor and mentorship roles can have a range of experience from 1-year to near retirement age, which will help in closing the experience gap and transferring knowledge.

Best practice tip: Offer mentorship opportunities both to nurses who want to give back by being a mentor and to nurses who want to be mentored. Remember that mentorship coexists with other roles, so consider cross training. For example, someone could be a gig nurse and a mentor or a break nurse and a mentor. Cross training in mentorship promotes not only practice relevance, but also a non-traditional work experience that offers variety and flexibility to retain experienced nurses or nurses nearing retirement. 

Operationalizing Flexible Workforce Programs

As with any operational program, you’ll need to build policies and procedures that support each flexible workforce program and to provide education for managers and staff. You’ll want to analyze the effectiveness of each program by reviewing retention and recruitment metrics; staffing, vacancy, and productivity metrics; and qualitative results on a quarterly or bi-annual basis from managers and front-line nurses through surveys and meetings for the first year. After the first year, move to annual or bi-annual evaluation of the programs. 

In addition, you’ll need to invest in upskilling and cross-training to deepen the expertise of your workforce, while providing a variety of clinical experience and work options. For example, rapid upskilling and cross-training should be considered for highly specialized areas with common patient populations and acuity/care provision activities to build a sustainable pipeline supply. Look for areas of practice similarity to promote rapid training. For example, post-anesthesia care unit and critical care staff care for patients who need close monitoring, so may be good candidates for cross-training

Also look for areas to upskill and cross train in both inpatient and outpatient settings. For instance, would staff in an inpatient rehabilitation or medical/surgical unit like exposure to outpatient settings to diversify their work experience? 

Best practice tip: Keep an electronic record of training. The record should be embedded in staffing technology, so it’s easy to identify those qualified to be offered extra shifts in a particular area. This will reduce the need for external agency staff and = the likelihood of not having the necessary staff for a shift.

A Multi-Program Approach

Solving the nursing workforce challenges is not a one-size-fits-all approach. It’s best for the health system to take a multi-program approach when building a comprehensive workforce strategy. Start simple with one or two programs, evaluate success, gain frontline feedback, and continually innovate and analyze workforce trends to find the best programs for your health system.