Why Is Nurse Scheduling Stuck In The Dark Ages?


Nurse schedulers have a higher percentage of migraines than any other industry. I have no peer-reviewed evidence of that statement, but it’s not hard to imagine when you look at the daunting task assigned to them. Creating a perfect schedule for your nursing department is like cooking a buffet for one hundred people, each with their own set of food allergies. Schedulers are required to collect everyone’s preferences and assign and balance the schedule based on those preferences, all while taking into account FTE status, seniority, hours scheduled, meetings, education days, and about ten or twenty other factors.

Collecting staff preferences and availability is simple in theory, but difficult in practice. Years ago as a new nurse, I was tasked with creating the schedule for our night shift nurses, a team of about twelve. With such tiny numbers, you’d assume I had it easy; but the process was still time-consuming and manual. In the end, people gave me their preferences via email, paper, and I think a crumpled up napkin at one point. Then I, like many others, built an Excel spreadsheet to help me manage the process. But it wasn’t exactly an intuitive delight to use–and for larger departments, it’s even more labor-intensive.

Some nursing departments are equipped with self-scheduling technology that records their staff’s preferred shifts. Staff members are asked to place some random code in the box next to the date they want (like an “n” or a parenthesis) to submit their requests for various shift types. Nurses consistently report that these systems are unintuitive and frustrating, which leads to poor adoption rates. The systems are also resource-intensive on the scheduler side, often leaving holes that require more follow-up and information gathering. The alternative is a white board, paper print out, emails, or a stack of napkins–hopefully, for your sake, not all of the above.

Once preferences are gathered and consolidated, assigning shifts and balancing the schedule is where the real work begins. Nurse schedulers are tasked with staffing each shift up to the core assigned by the CFO, sometimes (or, as is increasingly the case, often) without enough staff to do it. Schedulers must ensure that everyone is working their appropriate weekends and getting their appropriate hours based on FTE status, while making tough decisions about who to move off or onto a day. Once you think you have it right, you realize that you scheduled Jenny for six twelve-hour shifts in a row and moved George onto his son’s birthday, a day he specifically requested off. Moving one of those shifts is like removing a Jenga piece, and your whole beautiful schedule comes crashing down. Back to the napkins.

The pressures of accounting for one hundred nurses’ preferences– including one-off birthdays and visits from the in-laws– can be overwhelming, and can take already limited time away from patient care and staff engagement priorities. Even when you do finally finish that schedule, print it out, and post it, the fun isn’t over. First, most departments don’t have a modern way to distribute the schedule to staff along with new events and shift changes as they happen; that means the manager or scheduler has to rely on staff accurately entering their schedules into their phone or preferred calendar from one line on what is often (or at least resembles) a complex Excel spreadsheet. And staff are understandably frustrated that they don’t have easy access to the up to date department schedule away from work as things change. Second, you inevitably see a handful of shifts that are not staffed up to core because, well, the resources just aren’t there. That begins a whole separate cycle of filling those open shifts so you don’t end up short-staffed for a future day, which many departments handle with phone trees and mass texts, both time-consuming and ineffective methods when nurses are overwhelmed by irrelevant communications and therefore less likely to respond.

Starting to understand why nurse schedulers take so much Excedrin Migraine? Let’s just be happy they aren’t on Protonix yet for a stomach ulcer from “schedule-induced stress”!

NurseGrid Manager schedule management and distribution tools for nursing departments

NurseGrid Manager schedule management and distribution tools for nursing departments

As the VP of Nursing at NurseGrid, now I get to use my own experience as a nurse and the experience of nurses, managers, schedulers, and administrators we speak with to help build technology solutions that give nursing departments a painless, efficient way to distribute and manage the schedule and communicate updates to staff, and nurses easy access to and more control over their schedules.

How do you schedule your nurses and fill open shifts? What difficulties does your current process pose to you? We’d love to hear from you!

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Zach Smith

Zach Smith, RN, BSN is Vice President of Nursing at NurseGrid. With years of experience as a nurse in hospitals across the Northwest prior to joining NurseGrid, he is now responsible for ensuring the voice of customer is integrated across all of the company's efforts so it stays relentlessly focused on solving the problems of nurses and nurse leaders.

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4 Responses to Why Is Nurse Scheduling Stuck In The Dark Ages?

  1. schoedr

    In addition to being a direct supervisor of 23 nuses, inventorying and coordinating respiratory and enteral supplies for 53 clients, troubleshooting care for medically fragile dd patients, I do staffing by hand in pencil for 3 shifts of nurses a month at ahead of time, making changes weekly and daily for call ins, vacations, etc. It’s like a daily game of sudoku on each shift! Only 1 LPN and 1 RN is allowed to have projected leave on a shift, leading to a lot of call-ins. I call people at home every day for voluntary overtime to avoid burnout from mandatory overtime. It’s a crazy and antiquated system! Again, no computer, it’s all done by hand in pencil. Ughhhh!

  2. achapman763

    I’m a staffing coordinator and I am frustrated with how much of my time is taken up by creating the 6 week staffing schedule and how little time I have being able to address the immediate needs of specific units. Anyone have experience with software that automatically generates a roster so I can get on to the more urgent matters?

  3. giddie2

    I scheduled for large units, specialty units, small units, acute care & long term care over my management career. It is always a challenge, but I did find a few tips that helped some. 1. Job sharing. The job share partners agree to cover each others shifts when their partner was on scheduled vacation, requested extra day off, scheduled sick time (surgery, mat leave), etc. (Not for sudden illnesses, in which case a call-in was used.) Because the majority of one FTE was covered without use of the part time pool, this eased a lot of the load off the already over-worked part time pool. 2. A master rotation for all full time staff. This repeated itself over a set period of time, so each staff could predict as far in advance as they wanted what shift they would be booked for on a given date. They could make their requests for time off far in advance in most cases. 3. For peak periods, summer vacation time, Christmas etc, time sheets were completed & posted well in advance. requests for replacements during these time periods were to be given in advance. 4. Once the time sheets were posted (and the requirements for this was dictated by the collective agreement) any requests for shift changes had to be done by the staff themselves, and required approval by their manager to insure the change was according to the collective agreement & wouldn’t leave another shift short. This lightened the load on the staffing clerk who only had to replace shifts to cover sudden illness, emergencies etc. It was still a major chore, but these things did help.

  4. Nanciris

    I work for a company that requires the employee to cover herself when she wants time off!! I spent my time in the waiting room at my doctor’s office when I was sick calling fellow employees to work my shift.
    I hope this practice doesn’t catch on elsewhere.