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Flexible Scheduling Helps Attract and Retain Nurses

New options benefit caregivers, nursing units and patients


The U.S. Bureau of Labor Statistics projects employment of registered nurses to grow 6% between 2021 and 2031, with more than 200,000 job openings each year, on average, during the decade. Like many healthcare systems, Cleveland Clinic has expanded its flexible scheduling options to help recruit talented caregivers.


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“As the healthcare industry continues to evolve in complexity, now more than ever it is incumbent upon us to innovate and embrace flexibility to address the needs of our caregivers, working toward the goal of attracting and retaining them,” says Julie Fetto, MBA, BSN, RN, NE-BC, Chief Nursing Officer of Cleveland Clinic Medina Hospital.

Variety is key

One of the main benefits of a flexible schedule for nurses is the work-life balance it provides.

Melissa Buser, RN, a surgery nurse at Cleveland Clinic Medina Hospital who is also going to school to earn her BSN, switched to 12-hour OR team flexible shifts this year. She works opposite days from a colleague, who wanted 12-hour shifts to accommodate her childcare needs.

“I love my 12s so far,” says Buser. “I can make appointments and plan things in advance. I have more time for homework and spending time with family.”

That’s just what Cleveland Clinic nursing leaders intended when they created the Nursing Workforce Flexibility Taskforce. The group assembled all the flexibility initiatives developed by groups throughout the healthcare system looking at workforce optimization, established a process to evaluate them and made recommendations on which ones to implement for nursing. It also created a flexible workforce resource guide for leaders to provide scheduling options, as well as guidelines for selecting options and conducting unit and caregiver needs assessments.

The Cleveland Clinic health system offers many options for clinical nurses. These include:

  • Staggered shifts starting at nonconventional times, such as 9 a.m. to 9 p.m. and 11 a.m. to 11 p.m.
  • Flexible shift lengths that split shifts into shorter scheduled times
  • Team scheduling with a group of caregivers working the same block of time throughout a six-week schedule
  • Split RN positions, where inpatient nurses divide time between care areas, such as critical care and post-anesthesia care or an adult emergency department and a pediatric emergency department


“There is not a one-size-fits-all approach,” says Dusty Burke, MSN, RN, C-EFM, Director of Nursing Operations at Cleveland Clinic and co-leader of the Nursing Workforce Flexibility Taskforce. “Each caregiver is unique, and each nursing unit has unique needs.”

Advice for developing flexible scheduling

As nurse manager of the progressive care unit at Cleveland Clinic Medina Hospital, Chad Ziegler, BSN, RN, NE-BC, appreciates having flexible scheduling options to offer caregivers. He has hired four clinical nurses in split RN positions – one between the progressive care unit (PCU) and intensive care unit and three between a medical-surgical unit and the PCU.

“Current recruitment for medical-surgical areas has been challenging over the last two years, and this creates an enticing position for new grad nurses,” he says. “This opportunity gives registered nurses the opportunity to learn in different acuity environments. It also allows for dynamic teamwork between units. When a nurse floats it can be uncomfortable, and these positions help ease the transition.”

Cleveland Clinic nurse leaders offer advice for peers who are considering or developing flexible scheduling options:

  • Be open to new, nontraditional ideas. “Traditional staffing and workforce models may not meet the needs of our changing workforce,” says Burke. One of Cleveland Clinic’s unconventional flexible options is specialized assignments, scheduling nurses to work admission/discharge or lunch/breaks, for example.
  • Collaborate with multidisciplinary partners to create the right model. This includes business operations managers, human resources directors and others. “We need to learn from one another, fully understand the needs of our workforce and strive to meet those needs,” says Burke.
  • Ensure that flexible options align with the needs of designated care areas. Nursing units at Cleveland Clinic conduct needs assessments prior to implementing new scheduling options. This includes reviewing hours per patient day, census trends and peaks, staffing ratios, potential roles/tasks and more.
  • Continue to adapt scheduling options. What works today might not work next year. Keep an open mind to changing or adding options. For instance, the Nursing Workforce Flexibility Taskforce is considering seasonal roles for registered nurses.

“We are challenged daily to meet the needs of our patients, our caregivers and our organization in a market like we have never seen,” says Burke. “Building a culture and workforce that is adaptable and that embraces opportunities that come with change is essential.”


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