Flexible scheduling has not been the norm in acute health care settings. Most traditional models have bedside nurses working three consecutive 12-hour shifts per week. However, nurses on both ends of the career spectrum are seeking more flexibility. Young nurses must balance their careers with family life while nurses at the end of their careers often want less physically demanding shifts.
Texas Children’s Hospital started flexible scheduling for nurses 10 years ago. In that time, the Houston-based hospital has seen the program expand to include patient care assistants, patient sitters, emergency medical techs, respiratory therapists, and some members of the radiology and central sterile teams.
“We want to make sure we have scheduling models to support a work-life balance while making sure we’re prepared for our scheduling needs,” says Natashia Bush, MSN, RN, director of nursing.
When the schedule opens each month, staff sign up for shifts based on their personal schedules and preferences. As the schedule comes together, staff work together to ensure shifts are covered. Leaders step in if needed, but Bush says the process is largely self-governed.
Texas Children’s also employs retention specialists to help nurses find roles that work for both their scheduling needs and clinical interests.
“Nurse retention specialists work with nurses if they feel their current role isn’t the best fit for them. Instead of losing a nurse altogether, their leader may contact the nurse retention specialist who will help them find the right position,” says Chief Nursing Officer Jackie Ward, DNP, RN. “We’re a large, complex organization with more than 100 locations across the city and now in Austin. We can find what you’re looking for–it’s just having that intentionality to say we will not lose a nurse.”
Linda Cole, RN, MBA, FACHE, chief nursing officer at Children’s Healthcare of Atlanta, echoes the sentiment.
“We have three campuses and multiple ambulatory locations. Many of our nurses didn’t know what the options were,” she says.
For instance, the hospital’s emergency department offers staggered shifts, allowing nurses flexibility beyond a 7 a.m.-7 p.m. shift, and some general patient care units schedule nurses for four-hour shifts concentrated around active times like lunch and discharges.
Children’s Healthcare of Atlanta’s Career Center helps nurses grow their careers through coaching and connections with internal opportunities. Since 2020, the center has helped 1,000 employees find growth opportunities.
“No matter what you want to do, there’s really no reason to leave our hospital. We probably offer it, but you just don’t always know what’s out there,” Cole says.
Nurses seeking more flexibility can find it in the hospital’s five-tiered float pool. Instead of committing to full-time positions, float-pool nurses work on an as-needed basis. The pool’s bottom tier is for nurses who work occasional shifts. The middle tiers are designed for nurses to work a few days a week. At the top end are nurses who float between the hospital’s campuses and day and night shifts, essentially working full-time hours but in various settings.
The flexible float pool has grown to account for 11% of Children’s Healthcare of Atlanta nursing staff since implementation in 2022. Cole says the number of travelers at the hospital decreased from 200 to fewer than 25 during that time.
