1. Virkstis, Katherine ND
  2. Herleth, Anne MSW, MPH
  3. Langr, Madeleine MA
  4. Rewers, Lauren BA
  5. Fennell, Eileen BS


The COVID-19 pandemic exhausted the nursing workforce, casting doubt that future supply will meet demand. To preserve their workforces, nursing leaders are offering emotional support to the frontline. Although these efforts are essential, leaders are overlooking an untapped opportunity to safeguard staffing levels: creating a more flexible nursing workforce. In this article, the authors discuss flexible nurse staffing and suggest 4 key opportunities for improvement.


Article Content

Before the COVID-19 pandemic, the Health Resources and Services Administration projected that the United States would have an excess of nurses by 2030.1 Today, future nursing supply is far from certain. This is for 2 reasons. First, a growing percentage of nurses are burnt out from the COVID pandemic,2,3 leading many mid- and late-career nurses to leave the workforce earlier than expected.4-6 Second, disrupted clinical rotations and licensure for nursing students caused short-term supply gaps that may continue with future COVID surges.7


Preserve the Future Workforce With Flexible Staffing Solutions

This uncertainty has not gone unnoticed by nursing leaders. To preserve their workforces, leaders have largely focused their efforts on providing emotional support to frontline staff.8,9 These efforts are critical and should be continued. But leaders are missing an untapped opportunity: creating a more flexible nursing workforce, in which nurses adapt how, when, and where they work to demand. Flexibility could help organizations achieve 2 goals: staffing more efficiently using their current resources and offering employees schedules and roles that better meet their needs. Moreover, this work builds on staffing innovations piloted during COVID surges. Some of these innovations should be reserved exclusively for emergency response. But as the industry moves beyond the acute crisis, organizations can build on this momentum to lock in key flexibilities long-term.


Flexible Options Should be Mutually Beneficial

Today, flexible staffing is typically limited to inpatient float pools. Although these have worked well, organizations need to embed flexibility more broadly among their nonfloat workforce to achieve further gains. To make flexibility a lasting fixture of the nursing enterprise, it must be mutually beneficial for both the organization and staff. Crafting a strategy that is beneficial only to the organization may dangerously increase turnover. At the same time, a strategy that is beneficial only to staff may leave organizations unable to provide safe, efficient staffing levels. Thus, organizations should only consider permanently adopting staffing innovations that both improve productivity and meet staff needs (Supplemental Digital Content 1, and this dual mandate.


4 Strategies to Create a More Flexible Nursing Workforce

To identify flexible staffing opportunities, researchers reviewed existing literature on care model innovations, shift patterns, engagement, and turnover and conducted more than 30 qualitative telephone interviews with nurse executives from the United States, Canada, and Australia. We propose 4 strategies nursing leaders can implement to meet both organizational needs and staff preferences.


* Provide shorter shifts and nontraditional roles to keep experienced RNs at the bedside. Traditional 12-hour shifts do not work for many nurses. Late-career nurses can find the long hours too physically demanding, and mid-career nurses may struggle to balance work and family obligations. To keep these experienced nurses in the workforce, leaders should create a subset of nontraditional roles that meet the unique needs of these nurses.


* Pool nurses with similar technical skills to address experience and specialty shortages. It is difficult for nurses to float in and out of settings where highly specialized technical skills are required, leaving leaders with fewer resources to adapt to fluctuating volume. But by proactively creating larger pools of specialized staff or blended roles, leaders can enable nurses to practice in multiple highly technical settings.


* Scale RN experience with expert-led staffing models. All nurses are equally valuable, but bring different skills and expertise based on their experience. By elevating the skills of expert nurses, organizations can extend nursing expertise farther during shortages. In doing so, it is critical that leaders clearly define roles and tasks.


* Enable nonfloat RNs to regularly practice across multiple settings. Nurses can be resistant to practicing outside of their home unit or facility because of the many real barriers making it difficult to do so, including a lack of familiarity and support in other settings. Rather than doubling down on mandates to float, leaders should proactively address these barriers and hardwire appropriate supports.




COVID-19 is disrupting what was once thought to be a healthy pipeline of nurses. In the short-term, creating a more flexible nursing workforce can mitigate the effects of anticipated supply shortages. Leaders can then leverage this flexibility to become an employer of choice by offering roles that are more attractive to evolving staff preferences. For more information, JONA readers can request a copy of the Advisory Board publication, Building a Flexible RN Workforce. This report provides strategic guidance and real-life examples of how leaders can embed flexibility in the nursing workforce.




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