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How Healthcare Facilities Can Benefit From Implementing Nursing Float Pool Models

Written by , Healthcare Workforce Trends
February 27, 2024

Nursing float pools allow facilities to fish from other pools of internal or external talent to fill units where core staff is scarce. 

Creating and implementing in-facility nurse float pools can take valuable time and resources. Despite some obstacles and hindrances, the benefits outweigh the possibility of nursing shortages caused by regular or irregular staffing disparities. 

Alternatively, the external nursing float pool model offers the same benefits while allowing administrators to focus on other opportunities to improve staffing conditions, patient outcomes, and financial performance. 

In this article, we will be comparing the two basic nursing float pool models, examining the benefits of both, and offering a solution to supplement your nurse float pool. 


Table of Contents


Why Do Healthcare Facilities Utilize Nurse Float Pools?

Nurse float pools, also referred to as resource pools, are a contingency solution comprised of designated clinicians who work in various departments on an as-needed basis. 

For decades, the implementation of float pools has been a cost-effective measure to help healthcare facilities cope with inadequate and variable staffing issues. Float pools help ensure that core nurses remain in their chosen departments, as opposed to using core nurses to “float” from unit to unit to meet patient-to-staffing ratios. 

  • Floating can be difficult for core nurses who are used to their home units. These difficulties are often associated with unfamiliarity
  • Lack of confidence in performing non-regular procedures; and 
  • Feelings of isolation from the other core staff in the floated unit 

Since some healthcare facilities base floating off of seniority, newer nurses may be more often required to float, which may exacerbate these issues. Research suggests that 44% of nurses are unhappy with working in facilities that require them to float away from their usual units.

Using core nurses for floating may be a motivator for low morale, lack of perceived organizational support, decreased morale, and dissatisfaction in the workplace. Floating is often perceived as an organizational disparity, making it a constant source of disagreement between core staff and management. 

Float pools not only help bridge gaps between inequalities in staffing but also organizational inequalities that may form between healthcare staff and leadership. 


The 2 Basic Nursing Float Pool Models

The two basic nursing float pool models consist of internal or external resource pools. This means that float pool departments are managed by the facility or through a third-party staffing provider and management system. 


Model 1: Internal Nursing Float Pool

The internal nursing float pool model may typically be used by larger healthcare networks that have the resources to employ and move float nurses between separate facilities. 

Generally, internal nurse float pools are considered to be their own unique department consisting of highly trained nurses coordinated by a leadership team as well as clinical aides, educators, and technicians. These nurses are pre-vetted and credentialed to work in multiple departments and/or facilities. 

Float pool managers utilize these nurses on an as-needed basis, but some also look at expected absences throughout departments and supplement them with float nurses. This helps the core staff managers avoid overscheduling or denying leave for other permanent staff in a given unit. 

Internal float pool nurses may be considered full-time, part-time, or per diem employees depending on the facility and their float pool program. Although they may be floated to a unit as needed, most float pool departments have an independent scheduler that schedules and rotates float staff to keep their skills up and retain familiarity with different units. These schedules are weeks in advance, but may sometimes rely on staffing plan meetings with nurse directors to assess staffing needs for the day. 

For example, if a float nurse isn’t needed in a specific unit for that day they may be assigned to another. If the float nurse isn’t needed elsewhere, permanent management has the option to give a core nurse the day off and use the float nurse instead. Two or more float nurses may be kept unassigned for the day so that they may be used to fill in for last-minute call-offs. 


model for nursing float pool


Challenges of the Internal Nursing Float Pool Model

Internal nurse float pools require a large amount of dedication and resources toward supplying, maintaining, and organizing float staff. 

With many variables involved in implementing an internal nursing float pool model, facilities may have to throw even more time, money, and manpower into resolving challenges such as:

  • Recruitment: Since a float nurse’s assignments may be changed on short notice, the inconsistency may ward off some nurses looking for more stability in their daily roles. Even if facilities have enough available staff who volunteer to work as float nurses, recruiting may be a continual effort considering the average float pool has a turnover rate of 40%.
  • Long-term staffing imbalances: Float pools are used to fill short-term staffing gaps; they are not very successful at meeting staffing shortages caused by long-term leaves of absence or open positions. 
  • Lack of oversight and communication: Managing and directing float staff relies on direct supervision and coordination across all units and float nurses. As mentioned earlier, there are times when a float nurse’s schedule may change based on how and where they are needed. Sophisticated levels of communication and tracking must be available so that internal float pool managers can aptly direct float nurses to where they are needed. 
  • Specialization: Float departments may require nurses to have specific specialization so that they can float to other units. This means either raising the pay rate to attract nurses with high levels of specialization or spending time and money educating, certifying, and training available float nurses. 


Model 2: External Nursing Float Pool

The external nursing float pool model refers to the utilization of a third party, such as a healthcare managed service provider (MSP), to recruit, manage, and deploy float nurses. 

Like an internal nursing float pool, external float pools coordinate nurses based on the staffing demands of each unit in a facility. Contingent float nurses may receive tentative assignment schedules weeks in advance or may be told which unit assignment they will be working on shortly before their scheduled time. 

Instead of the facility internally managing these contingent float nurses, the facility is in charge of their credentialing, filling, scheduling, deployment, and reporting. This can help facilities cut down on time and costs spent on maintaining necessary and adequate float pools and provide other benefits, such as:

  • Accessing more specialized talent
  • Utilizing technology for more intuitive deployment and scheduling
  • Making more data-driven decisions on contingent staffing needs

Even if your facility has its own internal float system, by using a healthcare MSP you can gain access to experienced, credentialed nurses who have unique specializations. By supplementing your float pool with labor resources from an MSP, like Trusted Managed Services, you can ensure that all of your units are adequately staffed with highly trained nurses. 

Our services simplify and centralize every step of the hiring process so that you have quick access to a large, qualified pool of talent. Our dedicated professionals can help you find specialized talent to help meet your specific float pool needs. Contact us today to learn more


nursing float pool models


7 Benefits of Implementing Nurse Float Pools at Your Facility 

Float pools were designed to help hospitals meet adequate staffing standards across all units. While they fulfill their designed purpose, nurse float pool models benefit healthcare facilities in numerous ways. 


#1: Preserve Quality of Care Standards

Adequate patient-to-nurse ratios are needed to preserve standards that promote quality care. The National Database for Nursing Quality Indicators estimates that the standard nurse-to-patient ratio for quality care is 1:4-5 in med-surg units, 1:3-4 in intermediate units, and 1:2 in ICUs. 

Inadequate nurse-to-patient ratios impact quality of care standards for:

  • Perceived experience: A cross-sectional and longitudinal study found a significant correlation between appropriate staffing ratios and good Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores.
  • Patient outcomes: An examination of patient outcomes in 114 Pennsylvania hospitals found that hospital mortality increased 7% for each additional patient exceeding a 1:4 nurse-to-patient ratio and an 8% increase in mortality for every additional patient added to a med-surg nurse’s workload. The examination also found that readmission rates increased by 2% per additional medical patient and 4% per additional surgical patient added to a nurse’s workload. 
  • Missed care: One study found that each increase of an additional patient per nurse was associated with a 6% increase in the likelihood of missed care. This study’s findings corroborated with a previous study that found a 39% increase in missed care in units that had poor staffing and resource adequacy scores. 

Internal and external float pool models act as a responsive safety net that ensures staffing fluctuations do not compromise patient care. 

Staffing needs can be variable. By supplementing your float pool with contingent staff, you can ensure that you have an available amount of staff to float at all times, without having to float your core staff from their usual units. 


#2: Cover Both Planned and Unplanned Absences

Core nurses need time off to maintain a healthy work-life balance. The average nurse gets 12-26 PTO days per year. Internal and external float pool models allow core nurses to take this time off without compromising nurse staffing ratios or needing other core nurses from different units to float. 

Illness is also an occupational hazard in the healthcare field. Data from a survey on sick leave among nurses found that the most common type of sick leave was one to three short incidences lasting less than eight days in 44.9% of all nurses surveyed. 

Employee absences are an expected part of any industry whether they are planned or unplanned. Float pools ensure that these absences do not negatively impact operations and outcomes. 


#3: Adjust To Patient Census With Ease

Patient census fluctuation is not unusual and may be expected depending on the season. For example, cardiac mortality is the highest between Christmas and New Year’s Day. Float pools can help redirect float staff to necessary units in the event that the amount of possible scheduled staff may not be enough. 

Conversely, patient census can fluctuate unexpectedly due to surge capacity events like mass casualty incidents or infectious disease outbreaks. Where the internal float pool model cannot supplement surge capacity situations, external float pools may be able to quickly outsource float nurses to mitigate poor outcomes associated with poor surge capacity response. 


#4: Increased Workforce Satisfaction and Lower Turnover Rate

Multiple studies have found that adequate nursing workloads lead to better staff satisfaction and reduced rates of burnout and turnover. By supplementing variable and expected staff shortages with internal and external float pools, your facility can avoid staffing shortages that compromise low morale and foster an environment for increased rates of burnout. 


nursing float pool model


#5: New Hires May Find Dedicated Float Pools Appealing

Research suggests that nurses tend to oppose floating. One study explored the effects of floating nurses outside of their home units during the 2020 COVID-19 pandemic. In it, floating was identified as a major factor in nurses’ mental anguish. 

By having a dedicated internal or external float team, your facility’s nurses will be relieved from the stress caused by floating. 

Contrarily, internal float pools may be an excellent opportunity for nurses who are looking to change their primary specialty. By floating through different units, these nurses can experience the policies and procedures used in each unit to find a department that may best suit them. 


#6: Allows Administration To Dedicate Less Time and Resources To Sourcing Staff

Dedicated nurse float pools reduce the time and money associated with obtaining and training permanent staff. 

Hiring and onboarding new nurses may take up an enormous amount of time and resources. 

A review examining the economic impact of nursing turnover found that:

  • The cost per nurse by phase of employment was $1,635 to hire and $15,825 to train
  • The cost of reduced productivity for nurses was $6,027 (based on a Pareto learning curve) and $14,026 (based on a linear learning curve)

Insight from Statista revealed that the average time needed to recruit and onboard a RN is 95 days and 75 to 105 days for experienced nurses. 


#7: Cost-Effective

Nurse float pools may help reduce costly morbidities associated with poor nurse-to-patient ratios. According to the Agency for Healthcare Research and Quality, the total cost of hospitalizations ending in death across the nation was $17.6 billion in 2007. 

Float pools also reduce costs associated with high turnover rates. The cost of an RN turnover ranges between $40,200 and $64,500, with the average RN costing facilities $52,350. 


Optimizing Your Nursing Float Pool Model

The success of float pools relies on:

  • Clear communication: Though float pool schedules are tentative and tend to change shortly before assignment times, clear channels of communication will successfully help your float pool managers coordinate float nurses while reducing frustrations.
  • Consideration of preferences: While you may not always ensure your float nurses have a status schedule, you can pay attention to which days and units they prefer most. By addressing their preferences, your float staff will feel heard and appreciated. 
  • Take qualifications into account: Remember to consider the qualifications of your float staff to keep them engaged or from feeling overwhelmed. More specialized nurses may feel underutilized if they’re constantly working below their qualifications. 
  • Use the right tools: Implement software that makes scheduling and recruiting simple. Vendor management services are web-based software that allows you to streamline the contingent staffing process so you can fill your float pools with qualified talent. 

Trusted Managed Services can help you supplement your nursing float pool through our recruitment process outsourcing (RPO). 

Instead of hiring and dedicating administrators toward your float pool staffing, you can get immediate access to experienced recruiters who are already trained without even needing to pay for their health insurance, employer taxes, paid time off, and other benefits. 

Through partnering with our RPO services, your facility will also have access to industry-specific job boards and databases at no cost to your facility, allowing you to have a direct line to qualified clinicians seeking temporary and permanent employment in your area. 


Find the Right Model for Your Nursing Float Pool With Trusted Managed Services

Trusted Managed Services can help your facility build a float pool consisting of per diem/on-demand part-time contingent staff. We ensure that all of the candidates will be Joint Commission compliant and fully licensed to work at your location. 

We design our service to provide optimized flexibility and decreased contingent labor spending. 

Trusted Managed Staffing has broad visibility in the industry. This means we are able to successfully negotiate rates with staffing vendors so that your facility maintains a pool of top talent at reasonable rates. 

Your facility can also take advantage of our superior analytics and customizable reports. By keeping track of your contingent workforce and making decisions to keep your staffing budget in line with your organization’s goals. 

If one of the per diem float nurses fits well in your nursing float pool, we can help you negotiate conversion fees for nurses after 26 weeks of assignment. 

Trusted Managed Services does all of this and more at no expense to your facility. 

Supplement your nursing float pool models out of a large pool of valuable talent with Trusted Managed Services. Book a demo today. 


nursing float pool models

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