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Nurse Scheduling Software Helps Reduce Use of Agency Nurses

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   January 05, 2010

A couple of weeks ago, I wrote about the troubling exposé in the Los Angeles Times regarding temporary nursing agencies in California that fail to perform thorough background checks on nurses they add to their roster of staff, and even ones who repeatedly send nurses out for jobs, despite those nurses being banned from facilities for poor behavior, incompetence, or stealing.

Since then, I've been thinking about ways hospitals can reduce their dependence on temporary and travel nurses, which led me to learn a lot about the complicated world of nurse scheduling, an onerous task that usually falls to the unit's nurse manager.

Nothing causes more arguments among staff nurses on a unit than the schedule. Filling the shifts is a task that causes many new nurse managers to wonder what on earth they have got themselves into when they tackle it for the first time. Nurse managers have to deal with issues such as whether seniority means having to work fewer weekends, or how far in advance staff must plan vacations to ensure they get the time.

While nurse managers on every unit have to work out the scheduling criteria that work best for them, one issue remains constant: there will always be holes in the schedule, and it's their job to fill them.

In most hospitals, the process goes something like this: the nurse manager gets on the phone and begs and pleads his or her staff to take on more shifts. With the gaps that remain, they turn to options such as float pools or agency staff, or traveler nurses for long-term shortages.

Using agency staff is expensive, requires effort to organize, and can sometimes lead to resentment among the permanent staff, who question why their hospital is willing to pay twice as much to agency nurses to fill open shifts as it pays to its own loyal staff.

Many organizations use new technology to solve this problem, investing in software that allows them to offer open shifts to staff, decreasing nurse managers' workloads and increasing flexibility for nurses.

Different systems are available from a variety of companies. In August, University Health Systems of Eastern Carolina implemented a management program called ShiftSelect, developed by Concerro, Inc., at six of the system's eight hospitals.

UHS calls the program Flexwork, and it allows nurse managers to post open shifts online. Nurses system-wide can view and request available shifts. They see only the shifts that they're qualified to fill.

Linda Hofler, interim CNO of the system's flagship facility, Pitt County Memorial Hospital, says the software is extremely easy to use for the system's nurses and they enjoy the flexibility it gives them in planning their work schedules.

"People are giving us more hours than they were in the past because they have this tool," says Hofler. "They can wake up today, decide they want to work tomorrow, sit in their pajamas, and request an open shift. They don't even have to make a phone call. It's so much more convenient for people."

One of benefits of the system, according to Betty Jo Tetterton, manager of OB/antepartum in the Women's Center of Pitt County Memorial Hospital, is that managers, or their designees, make the decision about who takes the shift. They view the nurses who requested the shift and can look at experience level, whether they have the necessary orientation for that unit, and pick the nurse who has the best fit for patient care on that unit.

"The manager knows what it takes to keep our patients safe," says Tetterton. "If we have someone come in to work, we need to know something about them and whether we feel safe working on their unit."

Tetterton says the fact that the software connects all the hospitals in the system increases the likelihood that shifts will be used and agency staff won't be needed. "It's building great rapport between the units," says Tetterton. "We have found that when we get in high census and need extra people, we have other people right there in our own division who are raising their hands ready to come help you, which is something we haven't had before."

Hofler concurs. "In most organizations, your biggest expense is your labor costs. We wanted to make certain that you have become as efficient in the management of labor as possible. This is a tool that we can put in managers' hands and it seemed like one that was well worth the investment to help us use the resources we have at hand."

And nurse managers no longer have to spend time on the phone begging, cajoling, and pleading. They can fill their schedule holes with just a few clicks of the mouse.

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Rebecca Hendren is a senior managing editor at HCPro, Inc. in Danvers, MA. She edits and manages The Leaders' Lounge blog for nurse managers. Email her at

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