Flexible personnel resources in nursing care - an overview of working models
Knowledge database Organisation Framework conditions & resources Human Workload & well-being D.3: Demand-orientated flexible personnel capacity management in hospitalsThe flexible organisation of staff deployment in nursing plays a decisive role, not only in terms of capacity management, but also in increasing the satisfaction of nursing staff. A holistic approach is essential, but this often fails due to a lack of basic knowledge. This article provides an overview of the various flexible working models in nursing and their characteristics.
Problem description, research question and relevance
In the past, temporary nursing staff have been deployed in hospitals to cover higher staffing requirements or shortfalls. A phone call to the temporary office was often enough to cover the existing demand. A new dynamic has emerged in recent years due to the increasing shortage of skilled staff, digitalisation and the changing requirements of nursing staff.
The emergence of digital solutions for the placement and administration of flexible working models reduces the coordination effort and increases agility. On the other hand, these solutions (e.g. the Careanesth platform) offer carers themselves the opportunity to participate by defining their own availabilities and recording them via the platform. This corresponds to the long-standing demand for more self-determination in the organisation of working hours by care professionals. While this demand is not new in itself, it is becoming increasingly important due to the shortage of skilled labour.
In order for the use of flexible working models to be successful in practice and the potential to be utilised, a common understanding of the models and their characteristics is necessary. This article lays these foundations and, among other things, forms the basis for the articles that build on it.
Methods and procedures in the project
As part of the project, a literature review was carried out to compile relevant findings from international research. It became clear that expertise from the Swiss healthcare system is required, as legal frameworks, for example, vary from country to country. The existence and functionality of digital platforms also varies from country to country. In addition, researchers from an SNSF project on the topic as well as experts from Careanesth and were interviewed. An overview was jointly compiled (see Figure 1 below). Careanesth is an implementation partner in the D.3 SHIFT project and a major provider of a digital placement and booking platform for temporary workers in the Swiss healthcare sector.
Results and findings
Research shows that flexible working models in nursing are to be understood as a collective term and combine various models (e.g. pool & jumper models or flexible working models in addition to permanent employment). The various models can differ with regard to various aspects (Gan, 2019, 2020).
- Employment relationship: In the case of internal employment, the nurse is employed directly by a hospital. This can also include flexible working models such as pools. External employment relationships, on the other hand, provide for nurses to be employed by a temporary agency and placed with hospitals. This involves various fees for the hospitals, such as remuneration for the placement work and surcharges for social and insurance benefits.
- Assignmentduration: The duration of the assignment can vary from a single shift to assignments lasting several months. Assignments lasting several months are typically replacements for temporary staff absences, such as maternity cover. On the other hand, stand-in assignments are short-term replacements for individual shifts when staff are absent at short notice.
- Location: With flexible working models, the location can be limited to one or more departments of an institution. However, there are also models, such as the "stand-in" model, which enables assignments across different institutions.
- Scheduling: Depending on how the flexible working time model is organised, the institution can either have control over the scheduling of the nursing staff or give them the authority to decide whether they wish to accept a work assignment.
Although there are other flexible working models internationally (see here), Figure 1 summarises the relevant models for Switzerland. The models and their characteristics form the basis for successful optimisation of workforce scheduling. It should be noted that a wide variety of mixed forms of working models can now be observed in Swiss hospitals. For example, a nurse may be permanently employed for a certain workload, but also work in a pool or jumper model (Liberatore et al., 2023).
Recommendations for practice
- Increase in flexible working models. Flexible working models will continue to be developed and established in the care sector in the future.
- Homogeneity. Despite the diversity of flexible working models, it is of central importance to develop a common understanding and a standardised definition. This enables targeted application of the models, even across organisational boundaries.
- Opportunity. By being integrated into capacity management systems, flexible working models offer an optimal adjustment of personnel resources to forecast personnel requirements. They also enable shift staffing to be adjusted to actual requirements at short notice.
Literature and other sources
Gan, I. (2019). How do nurse managers describe clinical nurses' work arrangements? A qualitative study. Nursing Open, 7(1), 160-169. doi.org/10.1002/nop2.374
Gan, I. (2020). A scoping review of the nursing workforce's changing demography: Supporting Baby-Boomer nurses. Journal of Nursing Management, 28(7), 1473-1480. doi.org/10.1111/jonm.13132
Liberatore, F., Schmelzer, S., & Berger, S. (2023). Management challenges of flexible working models in nursing. Nursing Law, 2023(3), 128-134.