Eighteen months ago, things were a lot different in the nursing units at St. Francis Hospital in Columbus, Georgia. Like so many hospitals, St. Francis was having staffing problems that forced their own nurses to float between units when they didn't want to. The hospital also had to pay a lot in incentive payments to cover extra shifts and rely on expensive agency nurses to fill in the gaps.
That's when it decided to put scheduling into the nurses' own hands.
Implementing self-scheduling has paid off, according to William Reynolds, RN and nurse manager. Without hiring any additional employees, St. Francis Hospital no longer has holes in its schedules, he says.
"We haven't had any agency nurses since we started," Reynolds tells HealthLeaders Media. "We don't pay incentive pay anymore."
Reynolds says the success of self-scheduling boils down to one major factor: autonomy for the nurses.
"The staff have more input into their schedules," agrees staffing assistant Tammie Lenoir. "And if they can see open shifts in other units they're picking up a lot of shifts outside of their units."
Nurses Take Control
Reynolds says it's not that nurses don't want to pick up extra shifts; they just want to control over when and how they do it.
"You just see a whole different change in the attitude," he says. "We went from having agency nurses, which are expensive, to nurses who are not only picking up the shifts that we need when we need them to, but they do it willingly, and they're excited about it."
Reynolds says floating between units isn't popular with nurses, and although it isn't quite a thing of the past, it happens far less frequently. Now, when nurses do have to float, they're not as worried about it as they have been in the past.
"Because they've been picking up shifts on other floors, there's less anxiety when they float," Reynolds says.
A Rewarding System
There are several different self-scheduling software options for hospitals to choose from—St. Francis uses one that not only allows for self-scheduling, but also includes a system where nurses earn points for picking up extra shifts. Nurses can accumulate points and cash them in to earn rewards, such as gift cards for gas or coffee, or even designer purses, says Reynolds.
"Little rewards that they may not have given to themselves if this system wasn't in place," he adds. "They're earning little kudos for themselves."
Because the system is Web-based, nurses can plug in their schedules anywhere they have an Internet connection.
"I actually had a nurse that was on vacation in China, and she logged in and put her schedule in," Reynolds says.
Additionally, when someone calls out sick, the program sends a text message, phone call, or email to nurses who said they would be available to work that day or interested in picking up extra shifts.
"I would just have to start going down the list of nurses to start calling to see if they would come in for the day or night," Lenoir says, but since they moved to self-scheduling, "people that would never come into work before will work extra."
Of course, for all of the positives associated with self-scheduling, there can be pitfalls as well. According to a paper by the MIT Workplace Center, "if nurses see [self-scheduling] as an individual entitlement instead of a balance between individual and unit benefit, everyone loses. Miscommunication of rules and lack of adherence to self-scheduling guidelines can bring forth mixed feelings of tension and anxiety to the nurse manager as well as the nursing staff."
Not a Free-for-All
In other words, although it's called "self-scheduling," but it's not a free-for-all. The self-scheduling must occur with limitations and guidance, says Reynolds. For example, St. Francis still has policies in place that require nurse to work a certain number of weekends and holidays. After nurses schedule themselves, managers go into the program and balance out the schedule.
"You can't just schedule yourself for every Tuesday, Wednesday, and Thursday," Reynolds says. "Full time staff goes in first, then the manager goes in and balances it, then the PRNs can pick up overtime."
If done right, self-scheduling can help organizations strike the right balance between giving nurses more control over their schedules and allowing the hospital to fill every shift. And according to Lenoir and Reynolds, it's a change that's affected more than simply the schedule.
"It's like a whole different culture," Reynolds says.
Alexandra Wilson Pecci is an editor for HealthLeaders.
