A Comprehensive Guide to Staffing Flexibility Models
Staffing flexibility is no longer a nice-to-have in healthcare—it's a must. As patient demand rises and falls, hospitals must pivot quickly to keep care quality high without burning out their staff. More and more organizations are leaning into flexible staffing models as an innovative, sustainable way to manage these shifts. This guide provides a clear look at today’s most effective staffing flexibility strategies—what’s working, why it matters, and how to make it work in your healthcare organization.
The Need for Staffing Flexibility in Healthcare
The healthcare industry faces a staffing crisis, with a significant shortage of nurses and other healthcare professionals. Traditional staffing methods, often rigid and slow to adapt to changing needs, are increasingly proving inadequate, resulting in heightened turnover rates, increased staff burnout, and escalating labor costs due to the reliance on expensive travel nurses and other contingent labor.
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During a recent AONL webinar titled “Unlock Nursing Operational Success with Flexible Staffing,” industry experts discussed the urgency of addressing these staffing challenges and the role of flexible staffing models. Jessica Potts, the System Senior Director of Strategic Workforce Operations at SSM Health, and Jay Sundheimer, Chief Nurse Executive at Presbyterian Rust Medical Center, shared their experiences and success stories in implementing on-demand staffing solutions.
SSM Health Flexible Staffing Strategy
SSM Health’s labor strategy is multifaceted, with on-demand staffing playing a key role in accessing new talent pools. During the pandemic, the system relied heavily on high-cost contingent labor, including 1099 contractors—an approach that made post-pandemic recovery challenging.
To address these financial and legal hurdles, SSM Health partnered with ShiftMed in July 2023 to access local W-2 nurses on demand. Since then, thousands of ShiftMed clinicians have worked across SSM Health’s acute care ministries. In January 2024 alone, they filled nearly 6,000 shifts. As Potts put it, “Where would we be if ShiftMed didn’t help us fill those shifts?”
SSM Health uses credentialed ShiftMed RNs, LPNs, CNAs, and respiratory therapists to support critical care, med-surg, behavioral health, emergency departments, and even some post-acute facilities. “We treat our on-demand ShiftMed nurses as an extension of our regional float pools,” said Potts. “We can reassign them across ministries based on real-time needs.”
Potts also noted the growing importance of flexibility: “One of the biggest labor market shifts we’re seeing is the demand for flexibility—and on-demand staffing is central to our response.”
Presbyterian Healthcare Services Flexible Staffing Strategy
Despite implementing nurse residencies, fellowships, and strategic school partnerships—including innovative programs like “school in a box”—Presbyterian Healthcare Services still faced challenges filling every shift.
That changed in September 2023 when Presbyterian partnered with ShiftMed. Within four months of onboarding its first cohort, over 200 ShiftMed nurses were working across four facilities, with plans to integrate ShiftMed into additional locations over time.
“On-demand is helping us build the workforce sustainability we need,” said Sundheimer. “With adequate staffing, it’s amazing how many patients we can care for in unique settings.”
ShiftMed has also helped Presbyterian reduce its reliance on travel nurses, eliminating the need for travelers in inpatient operations. By offering flexible scheduling through an app, the organization engages a new pool of local nurses who were previously unwilling to commit to traditional PRN roles.
As Presbyterian continues integrating ShiftMed across facilities, it's learning and evolving. One key insight: internal staff want the same scheduling flexibility ShiftMed offers. “We’re now exploring ways to build that flexibility into our workforce,” said Sundheimer.
5 Types of Staffing Flexibility Models in Nursing
Flexible staffing isn’t a one-size-fits-all solution—it’s a blend of strategies that help hospitals stay agile. Each model serves a unique purpose, from internal float pool staff who step in during patient surges to per diem workers who fill in for absent team members. While every approach has pros and cons, when used thoughtfully, any can significantly enhance workforce efficiency and patient care.
1. Internal Float Pools
Float pools are like your internal rapid response team. These cross-trained healthcare pros aren’t tied to one unit—they can jump in wherever needed. Whether it’s a sudden spike in patient volume or last-minute callouts, float pools allow hospitals and health systems to shift staffing in real-time without always turning to outside agencies. It’s a flexible, cost-effective way to stay covered and keep things running smoothly. However, coordinating float pool schedules across departments can become complex and time-consuming without the right workforce management technology. Not to mention, regular training and upskilling opportunities are necessary to keep float staff competent across different units.
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2. Per Diem Staffing
Per diem staffing is a flexible solution that helps hospitals stay covered without long-term commitments. These healthcare professionals provide clinical support on demand. Consider them your backup team when employees are out or patient volume spikes. Paid by the day and ready to jump in when needed, per diem staff help maintain care standards without overextending your full-time team or budget. However, per diem workers tend to have higher hourly rates than internal staff, and their unpredictable availability can leave coverage gaps during critical times.
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3. Contract Staffing
Contract staffing is where hospitals use external healthcare professionals on fixed-term contracts to cover shifts, typically through staffing agencies. These contracts, lasting from a few weeks to several months, are ideal for covering long-term absences, handling seasonal surges, or bringing in specialized expertise for specific projects. This staffing flexibility model provides a stable workforce for the contract period, ensuring continuity of care while helping hospitals fill staffing gaps. However, long-term contracts can become costly, especially during periods of low patient census. Plus, relying too much on staffing agencies limits internal control over staffing.
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4. Temporary Staffing
Temporary staffing involves bringing in healthcare professionals on a short-term basis, usually through staffing agencies, to meet urgent needs. Whether it's covering for absent staff, managing patient surges, or handling seasonal demand, temporary staff—including nurses and allied health professionals—can step in quickly. This staffing flexibility model helps keep hospitals fully staffed during critical times without the hassle of recruiting and onboarding permanent employees. However, frequent changes in temporary staff can disrupt continuity of care and affect patient outcomes.
5. Hybrid Staffing
Hospitals nationwide are boosting staffing by adding virtual nursing alongside bedside teams, tapping into experienced nurses looking to reduce hours or retire. While virtual nursing enhances care, seasonal spikes and surges still challenge hospitals due to bedside nurse shortages. Per diem staffing best fills this gap, supporting a hybrid care model that balances in-person and virtual care to meet fluctuating demands and ensure continuous, high-quality care. Keep in mind, however, that virtual nursing relies heavily on technology, which can lead to technical issues and requires a robust infrastructure to function smoothly.
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3 Factors for Choosing the Right Flexible Staffing Model
When evaluating staffing flexibility models for your facility, aligning your approach with operational priorities and long-term goals is important. Here are a few key factors to consider:
1. Budget Alignment
Every staffing model has different financial implications. For instance, while per diem staffing may have higher hourly rates, it offers flexibility without long-term commitments, helping you dynamically manage labor costs.
2. Volume and Demand Fluctuations
Examine current staffing patterns and patient volumes over time. Facilities experiencing seasonal or unpredictable demand often benefit from flexible models like float pools or temporary staffing. These options allow you to scale your workforce in real-time, ensuring optimal coverage without overextending your resources.
3. Access to Specialized Talent
Your core staff may not always have the specific expertise needed. Contract staffing can help bridge that gap—bringing in specialized clinicians quickly and maintaining high standards of care during critical periods or for hard-to-fill roles.
Staffing Flexibility Matrix
This framework helps match staffing strategies with workforce challenges—such as budget pressure, demand volatility, or the need for specialized skills. Using one or more of these flexible staffing models can give your hospital or health system the agility it needs while staying aligned with care and cost goals.
Float Pool | Per Diem | Travel | Temporary | Hybrid | |
|---|---|---|---|---|---|
Cost Control | High | Medium | Low | Medium | High |
Scalability | High | High | Medium | Medium | High |
Specialized Skills Access | Medium | High | High | High | High |
Deployment Speed | High | High | Low | Medium | High |
Best Use Cases | Fluctuating Patient Volumes, Admission Surges | Admission Surges, Vacation Coverage, Last-Minute Needs | Long-Term Gaps and Rural Assignments | Short-Term Specialty Care Gaps, Hard-to-Fill Weekend Shifts | Admission Surges, Fluctuating Patient Volumes |
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9 Tips for Implementing Staffing Flexibility Models
Implementing flexible staffing models requires a strategic evaluation of existing workforce structures and a clear understanding of the facility’s operational and clinical demands. Here are some key tips:
1. Start With Clear Goals
Clearly define what your organization hopes to achieve—whether it’s reducing labor costs, easing staff burnout, improving patient coverage, or all of the above. These goals should align with the organization’s broader workforce and operational strategies to ensure flexible staffing supports your overall mission and performance objectives.
2. Gain Leadership Buy-In
It’s important to ensure that executives, department heads, and HR leaders fully understand the long-term value these models bring, from cost savings to improved patient care. Presenting data and results from pilot programs can effectively demonstrate the return on investment (ROI) and the positive impact on patient outcomes, helping to secure the support needed for broader adoption across the organization.
3. Identify Priority Units
To ensure a smooth transition, identify priority units that experience high fluctuations in patient volume or face chronic staffing gaps, such as med-surg, emergency departments, or critical care. These areas are often the most in need of flexible staffing solutions. A phased rollout approach will help manage the change effectively, allowing for gradual implementation and adjustments based on real-time needs and feedback from these key departments.
4. Use the Right Technology
Adopting user-friendly platforms, such as ShiftMed, is essential for streamlining the process of picking up shifts, tracking hours, and enabling real-time communication between staff. These platforms simplify the logistics of flexible staffing, ensuring that nurses and other healthcare professionals can easily access shifts and stay connected. They must also integrate with your existing scheduling and electronic health record (EHR) systems, creating a seamless workflow that minimizes disruptions and ensures smooth operations across the facility.
5. Establish Clear Processes
Develop well-defined onboarding, credentialing, and shift approval protocols tailored to your flexible staffing model. By doing so, you can ensure all external clinicians meet the required standards and are ready to contribute seamlessly. Setting clear expectations for performance, accountability, and communication is essential for maintaining care quality and ensuring all full-time and flexible staff align with organizational goals and patient care standards.
6. Communicate With Internal Staff
Transparency is essential when integrating flexible staffing into your operations. Internal staff should understand that external workers aren't replacements but valuable support to manage patient demand and fill coverage gaps. Address concerns early and emphasize the benefits—reduced burnout, better work-life balance, and consistent coverage—to build trust and foster a collaborative, supportive environment.
7. Track and Analyze Data
Analyzing data is crucial for optimizing flexible staffing models. Regularly monitor key metrics, such as fill rates, cost savings, patient outcomes, and staff satisfaction, to assess the effectiveness of the staffing strategy. This data provides valuable insights into what’s working and where improvements are needed. By analyzing these results, healthcare leaders can refine their approach, make data-driven decisions, and expand successful practices to enhance staffing efficiency and patient care across the organization.
8. Foster a Culture of Flexibility
It’s important to normalize flexible staffing as a strategic asset rather than viewing it as a temporary fix. By integrating flexible staffing into the core operational strategy, healthcare organizations can ensure its sustainability. Additionally, training leaders to effectively manage hybrid teams—comprising internal and external staff—will help optimize the use of talent and ensure seamless collaboration across the workforce. This approach empowers leaders to make the most of flexible staffing while maintaining high standards of care.
9. Celebrate Internal Wins
Celebrating early wins is crucial for building momentum and ensuring the success of flexible staffing models. Highlighting success stories internally—such as reductions in overtime, improvements in nurse morale, and higher patient satisfaction—helps demonstrate the tangible benefits of the approach. Showcasing positive outcomes builds enthusiasm and support, creating momentum to drive broader adoption and motivate teams to embrace flexible staffing.
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Conclusion: Embracing Flexible Staffing for Workforce Stability
Flexible staffing is essential for healthcare organizations to manage fluctuating patient volumes, reduce nurse burnout, and improve care. By adopting flexible models that involve internal float pools, per diem staffing, and hybrid solutions, hospitals and health systems can enhance operational efficiency, drive significant labor savings, and improve patient outcomes.
ShiftMed offers a flexible staffing solution that unites internal and external resources to help hospitals optimize workforce strategies, cut costs, and ensure quality care in any situation. Reach out today to discover how we can revolutionize your workforce management.