How Nurse Staffing Models Have Evolved: 6 Post-Covid Trends

How Nurse Staffing Models Have Evolved & Why It Matters

As every leader knows, the healthcare industry faces constant change. New tech, new patient preferences, new reimbursement models and new care standards all present challenges as well as opportunities. And risks like natural disasters, cybersecurity and even international pandemics factor into the mix, too. In response, managers have had to develop newer and better nurse staffing models.

To help leaders get a handle on their best options, here’s a look at the most prevalent nurse staffing models from the past, present and (likely) future. We’ll also explore each one’s strengths and benefits, and how they can help meet today’s biggest workforce and financial challenges.

Why Do Nurse Staffing Models Matter?

Nurse staffing models serve as the foundation for both quality of care and cost control. Using the right model helps “support the delivery of safe, high-quality, and cost-effective patient care,” as the experts at Advisory Board have pointed out.

According to a systematic review of staffing models conducted by Elizabeth Ndidi Ubochi of Walden University, effective nurse staffing models help:

  • Improve patient care, particularly in complex cases
  • Reduce medical errors
  • Decrease mortality rates
  • Improve patient satisfaction with care
  • Decrease nurse burnout
  • Increase nurse job satisfaction
  • Reduce staff turnover

In addition, nurse staffing models help leaders set budgets and larger operational strategies by making it clear just how and when certain personnel are needed.

Why Have Nurse Staffing Models Changed?

In the past, nurse staffing models were created manually and somewhat inflexibly, with managers setting schedules at the beginning of each fiscal year. Based more budget than patient care concerns, this method did little to promote positive outcomes or staff morale. It also made it tough to fill vacant shifts, which created gaps in care (and headaches for managers).

Even more to the point, these traditional methods provide little help in meeting today’s shifting patient needs. Spikes in patient acuity and surges in volume have always factored into healthcare delivery. However, they’re a bigger concern today than ever before, for a variety of reasons such as:

  • Changes to reimbursement. Both as a result of the Affordable Care Act (ACA) and part of a general effort to rein in costs by shifting to value-based care, the Centers for Medicare & Medicaid Services (CMS) now rewards the ability to achieve positive outcomes rather than how many patients it treats or procedures it performs.
  • Covid-19. The recent pandemic clearly (and sometimes shockingly) showed how traditional nurse staffing models failed to meet unexpected crises. It also shifted the labor market, making skilled nurses scarcer — and more expensive. 

Related: What’s the staffing ratio in your state? Find out with our exclusive guide to nurse staffing ratios.

Nurse Staffing Models: Today’s Emerging Shifts

The upshot? Today’s healthcare leaders more clearly understand the need for flexibility and adaptability, and have evolved a variety of nurse staffing models to meet those needs. And, while that’s good news, it also creates some new problems.

For instance, it can be hard to understand the difference among some of the different models, which may have similar names but different requirements for successful execution. In addition, many facilities need to implement not just one model, but a variety of them, to best serve each department, floor, unit, and patient population.

Determining what model will work best in every situation requires understanding all the available options. With that in mind, let’s take a closer look at some of today’s leading examples.

From In-House to Flexible Staffing Models

Perhaps the most basic way to begin is by classifying nurse staffing models as either in-house or flexible staffing. In the first model, an organization builds, and then fully relies upon, an internal team. A subset of this is the system-wide float pool model, which uses an internal pool of workers to support other care teams.

Although these models eliminate the need for outside resources, they also come at a steep price. For instance, they require standby workers to be available to fill in when needed. They also usually cause significant overtime. Managers must also perform their own sourcing and onboarding — a task requiring real expertise given today’s labor shortages.

For those reasons, in-house models are usually only practical for large organizations with vast resources to drawn upon. Most other providers now usually embrace the flexible workforce staffing model.

Based on the use of contingency workers like per diem and travel nurses to support regular staff, flexible staffing keeps organizations nimble and ready for spikes in utilization or acuity. And, while it does come at a cost, that expense is more easily managed with innovations in technology that enable better sourcing, onboarding and scheduling. A reliable third-party staffing provider will provide a pool of contingency workers as well as the expertise, tools and technology to use them to their fullest potential.

Related: Looking for a hand finding the nurses you need? Learn how CareerStaff can help!

From Budget-Based to Patient-Based Staffing Models

Another way to categorize nurse staffing models is the budget-based versus patient-based models. The former allocates staff according to nursing-hours-per-patient-day (NHPPD). In this model, managers use nurses based on what’s available in their budget and the number of current patents.

Similar to this are the leadership model and unit-based expert model. In these methods, one RN serves as the leader who assesses patients and communicates with other nurses and members of the care team, as well as patients and families.

However, these legacy models usually lack the flexibility to meet new ratio rules or sudden shifts in volume and acuity. That’s where patient acuity models enter the picture. These newer, patient-centric models are designed to be more fluid. But because they focus on patient needs rather than available staff, they can be expensive. They can also be a challenge to put in place without flexible staffing resources.

Rise of the Team-Based Nursing Model

The team nursing model uses elements of the leadership models above, but in a new context. This nurse staffing model focuses on teamwork among nurses with different skills, education and training. Team members share responsibility for the delivery of care while also meeting NHPPD and nursing ratios.

In its most basic form, this model places one or two RNs in charge of a team of support staff. Usually, one serves as charge nurse and another as primary nurse. They and their team of support nurses, aides and techs are then assigned to specific groups of patients.

Studies have strongly suggested that this nursing model can improve outcomes, particularly in acute care inpatient settings. It’s also believed to reduce labor costs, improve efficiency and boost job satisfaction among staff. In addition, the team nursing model can lead to improvements in the patient experience by fostering a more positive nurse/patient relationship.

How the Team Staffing Model Is Evolving

Although its use has surged since the pandemic, the team model has been around for decades. As such, it’s had time to evolve into new forms. Newer versions include the expert-led care team, dedicated clinical support and role-based team nursing models. The first two emphasize the expertise of the charge nurse. The latter, however, places less emphasis on leadership and more on the equal distribution of tasks among nurses. All three help improve efficiency by offering nursing support that’s specialized and adaptable.

Top-of-License Model

Similarly, the top-of-license model emphasizes team-based care that’s structured to make the best use of each staff member. This model helps maximize care quality by assigning workers to the role that best matches their training and skills. It also keeps the cost of labor low by making sure more skilled workers avoid repetitive administrative tasks — a feature that can also help boost job satisfaction and retention.

Cross-Train Model

In addition, the cross-train model uses a team system to boost training and mentorship opportunities. This can help elevate the value of recent grads and give all workers the chance to expand their skills in other settings. And the retention model focuses on keeping employees satisfied in their jobs with opportunities for training and growth. It also emphasizes a positive workplace culture.

Virtual Expert Nurse Model

Finally, the virtual expert nurse model (or hospital-at-home model) extends the team-based model to remote care delivery. Using telehealth technology, it enables one lead nurse to oversee a large number of patients at home. This model gives nurses the opportunity to develop valuable tech skills, among other important clinical advantages like cutting down on readmissions.

Implement New Nurse Staffing Models with CareerStaff

Whether you need temporary workers for flexible staffing, or permanent hires to support a top-of-license model, we have the Joint Commission-Certified workforce solutions to meet your needs. Learn more about what CareerStaff can do for your organization: Contact us today to request more info, or request staff now.

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