Flexibility in rostering shifts in healthcare can transform the workforce. Flexible work environments, alternate shift lengths, job sharing, and even remote work (previously almost unheard of in nursing prior to Covid) are some ways staffing challenges can be mitigated. This article presents the ways healthcare organisations can incorporate flexible schedules into nursing and the benefits of flexibility to the healthcare workforce.
Need for change in healthcare
The COVID-19 pandemic accelerated the need for workforce change in the healthcare sector. The lack of PPE, stressful working conditions, long hours, and increasing workload made it difficult for healthcare professionals to treat COVID-19 patients and safeguard their own health. Technology proved to be a silver lining in those challenging times and enabled some healthcare staff to work remotely for the first time in their careers. Remote work proved an effective strategy for managing infection rates and maximising resources. For healthcare talent, it was a way to access quality care, stay healthy and reduce the chances of getting sick. Healthcare staff could continue working and offer support to covid patients even under quarantine.
Technology has been supporting people to work remotely, regardless of their location, for years. However, healthcare was slow to adopt the growing trend. The pandemic gave new urgency to this shift – and the use of and need for telehealth saw an exponential increase, enabling the continuation of quality patient care, and providing an opportunity for many nurses to work from home while applying their nursing skills and experience for the first time in their careers.
Flexible work arrangements are the new normal. They are the key aspects of contemporary recruitment and employee retention strategy. Very few employees considered remote work prior to 2020. The thought process has changed now with the pandemic, triggering a successful experiment that is now the new normal.
Now, people are not only more likely to opt for, and even demand jobs offering flexible work arrangements. Six in ten workers want more flexibility over how they structure their working time according to research by ADP Research Institute’s People at Work 2022: A Global Workforce View.
Incredibly, 41% of people would be happy to take a pay cut to get more career flexibility.
Employers have no option but to innovate and act on these changing trends, and in some European countries (Spain, Iceland, Scotland, Ireland, and Belgium), progressive employers have risen to the occasion to accommodate these needs, trialling options such as a four-day work week.
To date, only 9% of Australians have been offered a chance to work 4 days a week. But that needs to be changed quickly, considering 62% of workers are contemplating a career change. While nurses continue to work 12-hour days, a 4-day work week is very achievable, but what is the long-term cost of working such long shifts, and does it always work for every nurse?
Healthcare is not untouched by this phenomenon. The pandemic has exposed the challenges nurses face. It has created a desire to innovate and reform a broken system. In these changing times, healthcare needs to be more agile than ever. This shouldn’t be a problem for the healthcare sector if it swiftly adopts technology, new medical discoveries and regulatory guidelines.
Healthcare is constantly growing to better meet the patient’s needs, balancing the needs of the staff, budget and regulations. There’s no reason we shouldn’t consider a change for healthcare practitioners. After all, they are frontline workers and exposed to extreme stress and compassion fatigue.
Benefits of incorporating flexible work schedules
Flexibility is a win-win for both healthcare organisations and nurses. Employee satisfaction improves with a supportive and inclusive workplace. There’s better work-life balance and decreased stress and burnout.
For the hospitals, it means:
- Lower nurse attrition
- Happy nurses – team members are more likely to feel valued and will have a greater sense of loyalty
- Increased productivity
- Reduced employee absenteeism
- Better patient outcomes
- Great organisation reputation
- Improved workplace safety
- Reduced capacity constraints
New approaches for making healthcare agile
So, how can healthcare change? We are glad you asked!
With rapidly increasing nursing shortages, retaining current staff and attracting new nurses is critical.
How do you offer flexible hours?
Start by asking your nurses how they want to work.
“Offer job sharing in a set roster. A lot of older nurses like me don’t necessarily want full-time hours but are happy to do a few set shifts over a week. I’m more than happy to extend my semi-retirement to give a helping hand, but I’m not prepared to do full-time work. In addition, if I knew what my shifts were, for example, 3-afternoon shifts on Monday, Tuesday and Wednesday each week, I would be available and raring to go.”
We have seen above how traditional work schedules are disappearing. More professionals are asking for flexibility in their workplace, and nurses are catching up on the trend, asking for work-from-home positions, more casual work options, and shorter shifts. While we may think nurses must work the long 12-hour shifts that they have had for the past 30 years, there’s still plenty of room for flexibility.
Target high-risk groups
Why do nurses have an intent to leave or leave the profession altogether? We already know nurses suffer from burnout and compassion fatigue. Over time, it can lead to mental and physical health issues like depression, post-traumatic stress disorder and chronic diseases. Burnout can stem from organisational and/or individual issues. Workplace problems, long working hours, high patient ratios, and job satisfaction are just some issues nurses face. This occupational stress can hinder their ability to identify patient distress and reduce the quality of care.
Nurses aged 45 or more are more likely to stay in the workforce while nurses aged 25-35 years are more likely to move on in search of regular and more sociable hours (Chan et al 2013).
Men are also more likely to quit to find a better-paying job or the need for career progression.
For some nursing specialities, the rate of burnout is higher than in others. For example, ED and ICU nurses have higher rates of burnout and attrition. 30-50% of new nurses are more likely to change positions or leave nursing completely within 3 years of practice. 33.5% of nurses resign after 2 years and 17.5% work for only 1 year (PressGaney, 2018). The message is crystal clear- nurses are willing to leave the profession, and they are doing so at alarming rates.
- Tackle burnout – Improve workplace culture, offer mentoring sessions, listen to your staff and offer them opportunities to upskill. One size doesn’t fit all. Every person and their situation is unique.
- Stay empathetic – Nursing is not everyone’s cup of tea, but those who do nurse often feel it is their calling. Reconnecting them to their ‘Why’ can help them stay engaged and motivated.
- Engage with your staff – Listen and connect with them meaningfully. Build a great workplace culture with regular meetings, team-building activities and one-on-one discussions to hear the feelings of, and respond to the needs of nurses.
- Take feedback – A NUM told us how he takes regular feedback from his colleagues on how to improve. According to him, it was a great way to change his management style and improve. It was difficult at the beginning for all concerned. After all, giving feedback to a supervisor can be hard! However, his constant attempts to get genuine feedback helped immensely. His colleagues started giving him quality feedback and voicing their concerns. Taking constant feedback helped him improve and changed the way his team worked. This strategy can keep your staff motivated and engaged. And we know, when staff are happy, they are more likely to stay loyal and remain longer in the company.
Offer shorter shifts
Long work hours can affect nurses’ well-being and lead to job dissatisfaction. Overtime and long working hours also put nurses at a risk for chronic diseases, sleep deprivation and reduced job performance, which could harm patients. In such cases, nurses will either leave their job or reduce their employment duration.
Approximately half of the Australian nurses are working part-time. Studied from 200 reported that the motivation to move to part-time nursing included the need to preserve health because of the impact of shift work, work intensification and ageing, financial considerations, the need to be able to manage multiple life roles and attempting to gain some level of ‘control’ in one’s life (Jamieson et al 2008).
Extensive studies from Europe, the UK and the US report that when nurses work shifts of 12 hours or longer, they are more likely to report poor quality nursing care and reduced patient safety. (Griffiths et al, 2014; Stimpfel and Aiken, 2013; Stimpfel et al, 2013). Interestingly, 12-hour shifts were not the norm in Australia 30 years ago, and innovative healthcare employers could look to varying shift lengths.
Solution – Having different shifts, stretching from 4 to 8 hours may increase the uptake of harder-to-fill shifts.
- Personal commitments – It would help the nurses balance their personal commitments. Nurses are predominantly female. Statistically, they are more likely to work on a casual or part-time basis due to their role as a carer and balancing family commitments.
- Patient satisfaction – Shorter shifts improve patient satisfaction. According to a National Institute of Nursing Research (NINR) study, patients were more satisfied when nurses worked 11 or fewer hours. Shorter shifts would also ensure patients have better outcomes, as the nurses would be more productive and less tired.
- Engaged staff – Shorter shifts can decrease burnout and compassion fatigue. NINR research confirms that nurses who work shifts 10 hours or longer are 2.5 times more likely to experience burnout and job dissatisfaction.
- Self-care – shorter shifts promote work-life balance. Nurses would be able to manage their daily routine, self-care, and sleep well. Sleeping well for a few days and working long hours for 2-3 days can disrupt the sleep cycle and promote a negative work-life balance.
Job sharing enables people to share the workload by making arrangements with their peers. For example, John Hopkins Medicine’s community division is piloting a job-sharing program for nurses at three community hospitals. It will allow nurses who want to work part-time to make arrangements with others to complete the full-time equivalent requirement.
Cross-training nurses in different departments can help fill up staffing shortages better. Hospitals with float teams can cover staffing shortages and let nurses take time off when needed.
The pandemic proved nurses can work from home. Many nurses did and still provided timely care to patients – for example, uPaged supported many triage nurses and nurse practitioners with telehealth work throughout Covid. We have seen that healthcare practitioners with flexibility have higher productivity and they report more job satisfaction.
Provide nurses with flexible work schedules and the option to work from home whenever needed. Nurses can do administrative tasks from home with just a reliable internet connection and laptop. This would not just benefit your staff, but also your facility. Low turnover, decreased recruitment costs and more building space can free up your budget for things your facility really needs!
Learn about flexibility from a nurse’s perspective –