Organizational Assessment & Design

Many organizational factors impact nurse scheduling and staffing, making design assessment essential. The assessment should cover overall structure and how scheduling and staffing work is currently performed, then compare results against best practices to identify refinements.

Organizational Assessment

Questions that should be part of an organizational assessment include the following:

Is the hospital a part of a health system? If so, are there shared resources such as a float pool with other hospitals in the system?
Who makes the schedule and manages the timecard?
Is there a central staffing office?
Does the organization have system policies for staffing, scheduling, open-shift recruitment, incentive programs?
Is shared governance in place for monitoring, trending, and evaluation?
Is there a staffing committee?
Is there a per diem or gig program?
Does the organization use a scheduling and staffing technology platform? If so, is it being used effectively?
What is the process for requesting and onboarding agency/contract labor?
Does the organization use technology (such as a vendor management system) for agency management?

Who Does the Work?

Who makes the schedule and does the staffing work — a nurse, a manager, a secretary, an educator? Many organizations lack dedicated scheduling and staffing teams. Instead, various people share the work, which — however well-intentioned — leads to fragmentation, errors, and duplication.

A dedicated team provides the support needed for successful scheduling and staffing operations. Those on the dedicated team need good communication skills, problem-solving abilities, basic math skills, and proficiency with technology.

Best Practice

An effective dedicated scheduling and staffing team has formal job descriptions, titles, and defined responsibilities. The scheduler/staffer role should be a clerical professional—not a nurse—who works closely with frontline nurses and nurse managers and is managed by the nurse director or manager.

Nurse managers own accountability for their units but shouldn't get caught in the minutiae of schedule moves, open-shift recruitment, or daily coding entries. Likewise, frontline nurses shouldn't be pulled from patient care for clerical scheduling tasks — their training is better spent practicing at the top of licensure.

Staffing and Scheduling Team

Here are suggested scope, responsibilities, and accountability parameters for those on the scheduling and staffing team:

Scheduler/Timekeeper (1 FTE to support 250–300 employees):

Creates and edits schedules
Maintains employee scheduling templates
Approves and denies schedule requests
Assigns specialty roles
Fills open shifts
Updates schedule with changes such as staff shift trades
Responsible for timecard management and daily schedule maintenance up to 24 hours before the start of the shift

Staffer (1 FTE to support 150–300 employees):

Mobilizes clinical staff through employee recruitment to meet daily needs less than 24 hours before the start of shift
Manages unplanned shift vacancies due to factors such as sick calls
Firms up the staffing plan by matching the number of people to actual census and acuity
Updates daily unit/department schedules with staffing changes in the electronic system

What Do Policies Contain?

Organizational policies should address both scheduling and staffing. Check for these core elements.

Scheduling Policy Core Elements

Schedule length and timing: Whether the schedule is posted for a 4, 6, or 8-week rotation and guidance for the timing of scheduling events.

Best Practice

The optimal length for a schedule is 6 weeks.

Shift lengths and times: Day, evening, night, or mid shifts that range from 4 to 12 hours long.

Best Practice

Make sure the variety of shift lengths offered provides the right coverage for caring for patients while promoting work-life balance for staff.

Skill mix is identified as needed.

Best Practice

Identify specific needs for each unit, for example, a charge nurse or chemotherapy administration certification.

Weekend coverage is set at the system, hospital, or unit level.

Best Practice

The goal is to support better work-life balance, so provide the most weekend flexibility possible. Every third weekend is the optimal target.

Shift trades are a like-for-like trade regarding hours, skill set, and pay.

Best Practice

Automate shift trading when possible by using electronic scheduling systems.

Holiday and vacation recommendations are set at the organizational level per human resources policies.

Best Practice

Maintain appropriate staffing levels for units while promoting time off.

Self- or patterned scheduling is at the unit level when a schedule is being created.

Best Practice

Shared governance should determine the type of scheduling.

Staffing Policy Core Elements

Nurse floating parameters are outlined, including requirements for rotation and who is responsible for tracking.

Best Practice

Identify the right floating groups/clusters. For example, a medical-surgical nurse can float to all medical-surgical units but not step-down units, but a step-down nurse can float to both step-down and medical-surgical units.

Maximum continuous work hours are defined.

Best Practice

Establishing maximum hours worked is a safety element for the nursing workforce. Typically, no more than 16 hours of continuous work is supported in most organizations. Also be mindful of consecutive 12-hour shifts, and work towards no more than three shifts in a row, when possible, to reduce fatigue and risk for error.

Low census cancelation parameters are defined with an algorithm for who is canceled first.

Best Practice

Cancelation should be completed at least 1.5 hours before the start of a shift.

Sick call responsibilities are defined for the nurse and for those responsible for receiving and recording sick calls.

Best Practice

Sick call should be no later than 3 hours before the start of the shift to allow enough time to recruit and finalize staffing plans.

Incentives for extra and open shifts are defined with timing guidelines.

Best Practice

Offer incentives early. This proactive approach reduces the number of last-minute needs, which typically cost more in the long run.

Is Shared Governance Engaged?

Shared governance is essential for successful scheduling and staffing. The shared governance council, which should be led by a frontline nurse and the nurse manager, evaluates programs, policies, and outcomes.

Shared governance doesn't only apply at the unit level. Hospital or system shared governance councils can assess and analyze trends and modify operations to optimize scheduling and staffing. Representatives from human resources and information technology can be helpful to the council's work.

AI Readiness

As AI-powered scheduling and staffing tools mature, the organizational assessment should also evaluate readiness for AI adoption:

Data infrastructure — Does the scheduling system capture the data AI needs (shift history, preferences, availability, workload coverage)? Is data clean and standardized?
API-capable systems — Can the current workforce management platform exchange data with external AI tools via APIs? Integration capability is a prerequisite.
Change management capacity — Is leadership willing to pilot AI-assisted scheduling? Are managers open to reviewing AI-generated recommendations rather than building schedules entirely by hand?
Governance for AI — Who will oversee AI tool adoption, validate outputs, and ensure the system respects organizational rules and union contracts?

Best Practice

Organizations don't need to be "AI-ready" before building a flexible workforce — but assessing AI readiness early ensures the foundation supports intelligent tools when the time comes.

Once the assessment is complete, the next step is choosing a scheduling and staffing model.