Nurse shortages have plagued hospitals across the country for years. It’s a trend experts predict will only get worse through the end of the decade. Float pools are a common strategy used by hospitals to mitigate the effects of shortages and cover gaps in nursing schedules. Since hospitals often heavily rely on float pool nurses to keep the organization running, unstable float-pool nurse performance has widespread and highly detrimental effects on operations and patient care. In this blog post, you’ll get a refresher on what nurse float pools are and an overview of their benefits and potential challenges. Most importantly, you’ll learn what you can do to address underperformance in float pools and cultivate excellence across your nurse workforce.   

What is a float pool?

Float pools, also known as internal resource pools, are a staffing method used to minimize nurse shortages. Float pools consist of skilled, adaptable registered nurses—often with several years of experience—who have the knowledge and proficiency necessary to work in various departments and clinical settings. Note that float pool nurses are not travel nurses who work assignments at various different organizations; they are hired by a single hospital or health system on a full-time, part-time, hourly, or per diem basis.  

Float pools serve as a flexible staffing solution to address fluctuations in patient census, acuity levels, and unit-specific staffing needs.

What are the general benefits of relying on nurse float pools?

Nurse resource pools are not the only option available to address nurse staffing challenges, but hospitals tend to rely on internal pools heavily due to the additional benefits they offer. These advantages include: 

1. Real-time support for fluctuations: Patient census and acuity levels can vary across different units within a healthcare facility. Float pools help address these fluctuations in real time by allowing nurses to move between units as needed. This ensures that units with higher patient volumes or complex cases receive additional staffing support while maintaining appropriate nurse-to-patient ratios. 

2. Continuity of care: Float-pool nurses are typically permanent fixtures in a facility or system. Despite shifting assignments and units, they are often able to form strong working relationships, enhance collaboration across departments, and adapt easily to unit-specific protocols, routines, and patient care plans. This enables float nurses to provide consistent, high-quality care and contribute positively to the overall performance of the units they support. 

3. Top-of-license practice: Nurse resource pools allow for efficient utilization of nurse skills and expertise. Nurses in float pools are typically trained and competent in multiple specialties or units, and floating gives them the opportunity to practice at top-of-license. This variety and professional growth can also enhance job satisfaction and engagement among float pool nurses. 

4. Reduced reliance on agency staffing: By having a pool of nurses who can float between units, healthcare facilities reduce reliance on temporary agency nurses. Minimizing reliance on external agency staffing in favor of internal resources unlocks cost savings and operational efficiencies.  

To fully enjoy these advantages, however, hospitals must be aware of and attentive to the potential challenges of using a float pool.

What issues can arise with float pools?

1. Staffing imbalances: Overreliance on float pools without appropriate planning and monitoring can lead to staffing imbalances. If there is an insufficient number of float pool nurses available or if they are disproportionately assigned to certain units, it can result in either understaffing or overstaffing in specific areas. This imbalance can negatively impact patient care, staff workload, and overall unit efficiency. 

2. Inefficient processes that prevent desired healthcare outcomes: Float pool nurses may not be as familiar with specific unit routines, workflows, or patient populations compared to regular staff members. This lack of familiarity can lead to slower processes, miscommunications, and clinical errors—all of which can have negative effects on patient experience and patient health.  

3. Failure to attract new staff from outside the organization: With float nurses continually coming and going, it can be difficult to establish the camaraderie, workflows, and culture that a unit needs to function smoothly and successfully. Nurses may want to avoid hospitals that rely on internal pools, so it could be harder to recruit new full-time, unit-specific staff.  

4. Inability to adequately meet urgent staffing needs: Float nurses often have more control over their schedules. Hospitals that are heavily reliant on float pools may have difficulty predicting staffing levels and filling urgent staffing needs. 

5. Lack of growth opportunities: Float pool nurses, despite being able to flex many different skills across assignments, can struggle with a lack of growth opportunities as well. For example, they typically have fewer opportunities to hone advanced, specialized skills or rise into leadership positions. 

6. Cost considerations: While float pools can provide cost savings compared to external agency staffing, there are still costs associated with managing and maintaining the float pool. Float nurses are typically paid more per hour and require additional training and orientation to work across various departments. Given the challenges of switching units frequently, float nurses can also contribute to inefficiency. 

These challenges are not insurmountable. A well-run float pool can bring all the benefits with limited drawbacks.

What can facility stakeholders do to address underperforming float pools?

To proactively act on potential issues with float pools, healthcare facilities should:

1. Establish effective communication protocols: Enhance communication and collaboration between float pool nurses and regular staff members. Implement clear communication channels, standardized handoff procedures, and effective documentation practices to facilitate seamless transitions and ensure continuity of care. 

2. Provide thorough orientation and training: Reduce inefficiency and boost morale by conducting thorough orientation and ongoing training for float pool nurses. While these nurses are typically very clinically skilled, they may not have experience working in a float situation. Ensure onboarding programs adequately prepare them with the technological and operational knowledge necessary to work across various units and address the specific situations they may encounter.  

3. Regularly reassess staffing needs: Review your staffing needs to ensure your approach is still the right one. This includes reassessing the float pool scheduling processes to ensure adequate coverage and equitable distribution of workload. Consider workload management strategies, such as adjusting shift assignments or nurse-to-patient ratios, to prevent excessive workload on float pool nurses or regular staff members. 

4. Offer ongoing support and development opportunities: To combat concerns about growth opportunities, offer ongoing support, mentorship, and professional development for float pool nurses. This can include access to educational resources, skill enhancement programs, and opportunities to specialize or gain expertise in specific units. By investing in the development of float pool nurses, their confidence, performance, and satisfaction can be improved. 

5. Closely monitor patient care and staff satisfaction: Utilize analytics to gain data-driven evidence of the float pool’s efficacy. Closely track metrics including patient satisfaction, productivity, readmissions, clinical errors, length of stay, and staff turnover to understand the greater impact of the nursing float pool. Apply this feedback to either improve, maintain, and or change your staffing approach.  

How technology can help

With the right people and a strong infrastructure, float pool nursing can be a highly effective strategy for addressing staffing shortages and adapting to organizational needs in real-time. Works is a single platform that some of the nation’s leading hospitals and health systems use to predict staffing needs, create a unified supply pool, and fill open shifts in the most cost-efficient way. With technology like Works, organizations can strategically incorporate and implement nurse float pools into their overall workforce management strategy. To learn more about cultivating a best-in-class contingent nurse workforce, explore How to Build an Effective Contingent Nurse Workforce—a guide to optimizing the way nurse resources are sourced and balanced. 

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