Optimizing Care: A Guide to Nurse Staffing Models

Written by , Healthcare Workforce Trends
April 26, 2024

As a hospital administrator, you are faced with navigating a complex and ever-changing landscape of nurse staffing. Retaining qualified nurses, combating staff shortages, and accurately gauging census levels have been extremely difficult to juggle. 

The stakes are high in nursing. So, effectively managing nurse staffing is critical for a hospital administrator to get right.

In this article, we will provide a comprehensive understanding of nurse staffing models in modern healthcare settings. We will delve into the factors driving recent changes, explore various staffing models, and discuss strategies for optimizing nurse staffing to ensure high-quality patient care.


Table of Contents

What Are Staffing Models in Nursing?

Nurse staffing models are guidelines dictating the number and scheduling of nurses required for patient care. They vary based on patient needs and healthcare settings, considering factors like nurse-to-patient ratios. 

These models are crucial for aligning nursing resources with service demands, ensuring quality patient care, and controlling costs effectively.


nurse staffing model examples


Why Do Nurse Staffing Models Matter?

With nurses as a cornerstone of healthcare, it’s not surprising that nurse staffing models profoundly impact patient outcomes as well as operational efficiency within hospitals and healthcare facilities. 

A literature review published by the American Journal of Nursing highlights the critical relationship between nurse staffing levels and healthcare outcomes. The study revealed:

  • Improved patient outcomes: Higher nurse staffing levels correlated with improved outcomes for patients including:
      • Shorter length of stay for patients
      • Reduced mortality
      • Lower rates of adverse events
  • Nurse burnout reduction: Understaffed nursing units often lead to increased burnout and higher job dissatisfaction. 
  • Medical error reduction: Optimal nurse staffing levels are associated with lower rates of mistakes. Overtime, duration of the shift and number of hours worked per week all impacted the rates of medical errors. 
  • Nurse retention: Adequate staffing levels and manageable workloads are critical for nurse retention. Hospitals with effective nurse staffing models are more likely to retain experienced nursing staff. 

Effective nurse staffing not only ensures quality patient care but also is important in cost management strategies. 

One study looked at the financial implications of nurse staffing levels for hospitals. While one may assume a reduction in nurse staffing levels may lead to cost savings, this study found that hospitals with optimal nurse staffing levels achieve better cost-effective operations in competitive markets. The reduction in adverse events, shorter length of stays, and better nurse retention can lead to better financial outcomes.


Why Have Nurse Staffing Models Changed?

The landscape of healthcare has undergone significant changes in recent years, with nurse staffing models as one of the focal points of change. These changes in nurse staffing models have been driven by several factors:

  • COVID-19: The pandemic not only highlighted the inadequacies of traditional nurse staffing models but also exacerbated the pre-existing nursing shortages. The pandemic exposed how traditional staffing models in nursing were often inflexible and were not based on real-time patient needs.
  • Reimbursement changes: The Affordable Care Act and the changes by the Centers for Medicine and Medicaid Services (CMS) incentivized positive patient outcomes which have changed the landscape of nurse staffing models. These changes reward facilities for better patient outcomes and penalize those with higher rates of adverse events. 

Technology advancements: From the implementation of electronic medical records to the use of predictive analytics for patient forecasting, technology has influenced nurse staffing models.


models of nurse staffing


Traditional Nurse Staffing Models

Several approaches have been used by hospital systems to dictate how nurse resources are allocated within units. The traditional nurse staffing models include:

  • 1:1 Model: Each patient is assigned a dedicated nurse allowing for personalized care and attention. While this approach is ideal, it is usually impractical and not feasible in most settings. 
  • Ratio-based models: In this model, a set number of patients are assigned to a nurse (i.e., 4 patients to 1 nurse). While they provide structure, they may not account for fluctuations in patient volume or acuity. 
  • Unit-based models: Nurses are assigned to specific units based on their skill set. This promotes specialization and continuity of care but may limit flexibility.


The Shift to Current Nurse Staffing Models


In-House Staffing Models 

This model prioritizes employing nursing staff directly by the healthcare facility. While this method offers consistency in care and ensures nurses are familiar with the facility’s protocols and procedures, it comes at a cost. 

This model can face challenges in adjusting staffing levels to match fluctuating patient volumes. It also typically comes at an increased labor cost. 

Factors contributing to higher costs of maintaining an in-house nursing workforce include:

  • Employee benefits expenses
  • Employee training and onboarding expenses
  • Administrative expenses


Flexible Staffing Models 

Flexible staffing models offer a dynamic solution to traditional in-house staffing. This approach utilizes contingency workers to fill in gaps in coverage to support permanent staff. 

These models prioritize adaptability, while also offering a cost-effective way to manage labor costs. Flexible staffing models offer these key benefits:

  • Reduce overhead costs associated with maintaining a full-time workforce
  • Minimizes expenses related to benefits, training, and administrative overhead
  • Offers flexibility to adjust staffing levels based on fluctuating patient volumes

Managed Service Providers (MSPs) like Trusted Managed Services offer healthcare systems to implement and manage flexible staffing solutions. With Trusted Managed Services, healthcare systems can ensure efficient and effective utilization of flexible staffing models.


nurse staffing models


Float Pool Model

The float pool model refers to a staffing strategy where nurses are trained to work across various units or departments within a healthcare facility. Nurses in the float pool are flexible and can work in different areas based on the census, acuity levels, or staffing needs. 

This model encourages flexibility, improves staff utilization, and ensures optimal staffing across the organization.


Cross-Train Model

This staffing strategy involves providing nurses with training across units and departments, enabling them to perform multiple roles within a facility. While it is similar to the float pool model, the cross-train model emphasizes teamwork and skill development.  

This model encourages mentorship opportunities and allows nurses to expand their knowledge and skills in different settings. 

MSPs can help hospital systems implement and manage this nurse staffing model effectively. MSPs offer healthcare facilities access to a diverse pool of nurses, who can be cross-trained to fill multiple roles as needed.

By partnering with Trusted Managed Services, we can streamline the training process and optimize workforce utilization.


The Retention Model

The cost of high turnover in nursing has severe impacts on healthcare organizations. 

According to a survey, the average cost of replacing a nurse is $37,000. This encompasses expenses such as job postings, interviewing, and training and certification requirements. 

The retention model emphasizes creating a positive workplace culture and increasing compensation to retain nurses effectively. By prioritizing strategies to prevent burnout and support nurses’ well-being, healthcare organizations can reduce turnover rates and promote long-term retention.


staffing models nursing


The Top-of-License Model

In this model of nurse staffing, healthcare organizations focus on optimizing current staff. This involves staffing decisions that assign nurses that align with their highest level of education and experience.  

This model has several benefits including:

  • Lower labor costs by avoiding assigning entry-level duties to experienced providers
  • Improved job satisfaction
  • Enhanced retention
  • Increased efficiency and productivity


Hospital-at-Home Model

COVID-19 certainly accelerated the adoption of telehealth services — revolutionizing the way healthcare is delivered. Among the emerging trends is the hospital-at-home model where nurses remotely access and monitor patients from their homes. 

This innovative approach provides wider accessibility to healthcare services and reduces the burden on healthcare facilities. By leveraging technology, healthcare organizations can:

  • Expand access to healthcare
  • Improve patient satisfaction
  • Optimize resources


Optimizing Your Current Nurse Staffing Model

It has become increasingly important for healthcare organizations to prioritize efficient resource allocation and operational efficiency while maintaining the highest level of patient care in light of the many changes healthcare is facing.

With the support of MSPs, healthcare companies can implement tailored solutions to enhance their staffing needs and address specific challenges effectively, with MSPs helping to employ contingent staff. 

Whether it’s implementing a float pool model for increased flexibility or adopting a flexible staffing model to adjust for fluctuating patient volumes, healthcare MSPs offer resources and technology solutions to ensure simple hiring and reduce costs.


nurse staffing models


Find and Implement the Right Nurse Staffing Model With Trusted Managed Services

At Trusted Managed Services, we understand the difficulties healthcare organizations have faced in recent years — from managing staffing shortages to controlling labor costs while maintaining high-quality patient care. 

We specialize in providing contingent healthcare workers to meet your staffing needs. Our services at Trusted Managed Services can alleviate the burden on your permanent nursing staff by providing skilled contingent workers with unique skill sets. 

If you’re considering a flexible staffing model, our contingent workers offer flexibility to adapt to fluctuating patient volumes and diverse patient needs. 

In addition to sourcing contingent workers, we simplify the staffing process through: 

  • Streaming the onboarding process
  • Providing detailed reporting on staffing headcounts and spending utilization
  • Centralizing contingent staffing

If you’re ready to optimize your nurse staffing model with contingent workers and maximize operational efficiency, let Trusted Managed Services help.


nurse staffing models

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