A nurse meeting with an elderly patient in a hospital room.

Have you been working in healthcare administration or nurse management for a while? If so, you probably have fond memories of when nurses came to work, sick calls were replaced, patient loads were reasonable, and overtime costs were manageable.

Unfortunately, the impending nursing shortage collided with the COVID pandemic to create the perfect storm—or rather, an unfortunate storm of nursing staff turnover that continues to plague the nation.

Exhausted nurses are abandoning the profession they love, leaving heavier workloads for those who stay. Hospitals and skilled nursing facilities nationwide now have nursing jobs they can't fill and many other healthcare staffing challenges. And finding a solution to maintain an adequate supply of qualified nursing professionals remains elusive because nursing schools can't meet current demand.

However, the current shortage of nurses is not the first staffing crisis in nursing history, and it probably won't be the last. When you look at the history of the profession, there have been cyclical shortages from the start of the occupation.

So, what does the future of healthcare staffing hold? This article explores how your facility can use reliable on-demand nursing staff to return to a time when shift fulfillment was easy and nurses came to work happy.

A nurse meets with a mom and baby in a hospital room.

A History of Ebb and Flow in Nursing

Like a sine wave, the nursing profession fluctuates between abundance and scarcity. As a registered nurse, I've seen a lot happen over the past 20 years, both from a bedside and management perspective.


When I started my pediatrics job in the early 2000s, nursing was just tipping over the top edge of the curve and heading downwards. My colleagues told me stories of carrying pagers so management could reach them for available shifts at any time—but the competition for nursing jobs was already mellowing out. It was several more years before the edginess of budget cuts turned into a free fall.

Nurses had to prove their value by tracking each chore and recording it on computer programs. Facilities set an allotted time for task completion (as if bed baths and toileting fit into neat boxes where people didn't fall, vomit, or have a heart attack during the procedure). If we couldn't prove our worth—we lost a nursing position on the unit. And the workloads got heavier.

Nurses began to feel undervalued, and the profession became less of a calling and more of a job. Nurses were told what to do, work schedules were changed without explanation, and many began to leave their positions. The critical care unit where I worked had a nursing staff turnover of almost 50%.


I started a management job during the pandemic—and staffing reliability became my responsibility. It was next to impossible to find qualified nursing professionals. Costly travel nurses became a necessary but unreliable staffing solution—with nurses coming for a few weeks and then moving on.

There was a lot of jealousy between travel nurses and regular employees because of the pay difference. Our on-site nurses helped orientate travel nurses but failed to make them feel welcome.

Students accepted into government programs filled in some gaps while awaiting their schooling. Nurse aids were offered free education, bridging programs for licensed practical nurses were being developed, and nursing seats increased.

Little did I know that my story was a repeat of history—beginning with the abundance of nurses—to budget restraints despite an increasing need for nurses—to federal funding for more nursing seats and bridging programs.

Looking back at those days, I wish there would have been an alternative to using travel nurses to fill scheduling gaps and maintain continuity of care. Luckily, today's nurse managers have more staffing options to choose from.

A nurse wearing a mask is getting ready to give a patient with a mask a vaccination.

A Shift in Nurse Behavior

The increased workloads and prolonged work hours brought on by the staffing shortage continue to take a toll on nurses, with many thinking about leaving the profession.

In 2022, ShiftMed® and Wakefield Research conducted an online survey to determine the state of the nursing occupation. It was a little surprising when 65% of nurse respondents (CNAs, LPNs, and RNs) said they would likely leave the profession within the next two years because of the staffing shortage.

What do nurses want? According to the ShiftMed online survey, 93% of nurse respondents want control over their schedules, while one in four want to choose their shifts.

Part-time job searches have rebounded from the COVID-19 pandemic, while full-time job searches continue to lag. This shift in job-seeking behavior presents a unique opportunity for healthcare facilities to adapt and thrive by embracing flexible work opportunities for nurses.

A Modern Approach to Healthcare Staffing

Modern healthcare staffing technology, such as gap shift management technology and on-demand healthcare workforce marketplaces, has the potential to put nursing on a path to revitalization. However, healthcare facilities need to be willing to turn the tide and meet nurses where they're at by providing a better work-life balance.

Many nurses now use nursing jobs apps, such as ShiftMed, to choose when, where, and how often they work. The ShiftMed app makes it easy for them to claim shifts on their terms and manage their work schedules right at their fingertips.

A desk with a stethoscope, medication, and a phone with the ShiftMed app pulled up on the screen.

"I love the flexibility and the ability to create my schedule with ShiftMed. It makes me feel free! I can switch up facilities or work at the ones I enjoy the most." —Stevens Desvallons, ShiftMed Nurse

ShiftMed recently surveyed more than 100 healthcare executives across the United States for a 2023 Healthcare Workforce Trends Report to see what factors currently influence their staffing decisions.

As traditional staffing methods prove ineffective in meeting adequate staffing ratios, 98% of executives said they're using or considering at least one of the following alternative staffing models: a workforce marketplace, an internal labor pool, or a third-party staffing agency.

A Look at Flexible Work Arrangements

By embracing on-demand workforce marketplaces, such as ShiftMed, healthcare facilities can create a more sustainable and supportive work environment.

Protecting Full-Time Staff: Providing part-time or per diem opportunities helps distribute the workload evenly among nursing staff, putting less strain on full-time nurses.

Enhancing Continuity of Care: With a pool of per diem nurses to draw from, facilities can better manage scheduling gaps and unexpected absences, ensuring patients receive consistent, uninterrupted care.

Attracting and Retaining Talent: Flexible work options are highly desirable to many nurses, especially those with family or continuing education commitments. Offering flexibility makes a facility more appealing to a broader range of qualified nursing professionals.

Adapting to Changing Circumstances: Flexible staffing arrangements and real-time scheduling allow healthcare facilities to quickly respond to fluctuating patient needs, seasonal variations, and unforeseen challenges.

Cost-Effective Solution: Flexible staffing models can help control labor costs by aligning staffing levels with patient demand, resulting in financial stability and high-quality care standards.

A nurse gives a child patient high fives.

Myths Surrounding On-Demand Healthcare Staff

Some healthcare facilities hesitate to use external labor pools on demand because they mistakenly believe that per diem nurses are unreliable and lower the continuity of care. But that thought process doesn't add up when you think about it.

Today's nurses want more job flexibility. So, when you give them control over their schedules, they achieve the work-life balance they crave and have no reason not to show up for the shifts they choose (unless there is an emergency, of course).

There's also the myth that per diem nurses cost more than full-time staff. It doesn't. A lot of times, healthcare facilities fail to track or calculate the fully burdened cost of care. It's essential to look beyond employee wages, payroll taxes, and health insurance when evaluating the cost of care. Facilities must also factor in turnover, overtime pay, and all benefit expenses.

Evaluating External Staffing Reliability

As healthcare facilities continue to face scheduling gaps because of the staffing shortage, it’s more important than ever to find an external source of healthcare staffing that’s reliable and understands the challenges and regulations of the healthcare industry.

The staffing source must also be innovative and forward-thinking to help facilities quickly build, maintain, and manage an efficient, cost-effective staffing strategy that promotes continuous, high-quality patient care.

By choosing ShiftMed for your external healthcare staffing, your facility has access to the following:

Healthcare Workforce Marketplace

ShiftMed's W-2 workforce marketplace provides facilities with direct access to a vast pool of local credentialed nurses (CNAs, LPNs, and RNs) ready to fill shifts on demand.

  • W-2 status protects facilities from legal and financial risks.

  • Non-monetary incentives fill shifts fast and eliminate surge pricing.

  • Hire nurses without paying recruitment costs.

Workforce Management

ShiftMed's platform has advanced tools that revolutionize the way facilities manage internal and external staff, including:

  • An AI dashboard that recommends staffing solutions for hard-to-fill shifts.

  • Predictive analytics and business intelligence that optimizes labor spending.

  • Feedback loops that enable staffing decisions based on cost and staff seniority.

  • Clean, consolidated data automates reporting and streamlines invoicing.

Human-Centric Staffing Approach

ShiftMed counteracts the stress of the profession by providing nurses incentives that keep them thriving while doing the work they love. The synergy these incentives create translates into faster shift fulfillment, higher show rates, and better patient outcomes.

ShiftMed nurses have access to:

  • Job flexibility that lets them work when, where, and how often they want.

  • Quality, affordable medical, dental, and vision insurance after one shift.

  • Discounted Uber Health Rides to and from work in the ShiftMed app.

  • Free ShiftMed Instant Pay™ for financial flexibility and security.

  • Reduced pricing on training and upskilling opportunities.

High Show Rates

ShiftMed holds nurses accountable for every shift they claim. When nurses fall short of show rate standards, the company takes swift action to improve their attendance, which includes putting nurses on a 14-day suspension. If a nurse fails to boost their show rate, they put themselves at risk for termination.

But ShiftMed doesn't stop at accountability. The company also recognizes and rewards nurses with consistently high show rates. The ShiftMed Platinum Rewards program celebrates nurses (also known as Platinum Shifters) who show up for shifts like clockwork by giving them first dibs on holiday pay rates, entry into monthly $5,000 sweepstakes, and gift card giveaways.

Platinum Rebate Program

ShiftMed currently has over 13,000 Platinum Shifters. During the first quarter of 2023, these top-notch nurses improved the company's overall arrival rate by 20%.

ShiftMed Platinum Shifters boast an 88% show rate.

Because the company has a lot of confidence in these nurses, they created a Platinum Rebate Program that pays healthcare facilities if a Platinum Shifter fails to show up for work.

When healthcare facilities opt into the Platinum Rebate Program, ShiftMed will credit them for half of the claimed shift at the applicable hourly rate if the Platinum Shifter fails to show up for a claimed shift. Facilities must opt into the program to be eligible to be paid for shifts when a healthcare professional does not show up. The program is available in select markets for select facilities. 

Healthcare Staffing Reliability Summary

Over the decades, the cyclical history of the nurse staffing crises proves that the healthcare system needs something new and different.

Today's nurses are ready to take back control. They love scheduling flexibility and want a work-life balance that enables them to thrive personally and professionally.

The future of healthcare staffing reliability lies in nurses getting what they want and healthcare facilities embracing innovative and advanced technology—such as what ShiftMed offers.

Want to know more about how ShiftMed can take your healthcare staffing to the next level? Book a demo today!

Alice Blackmore, MN, RN, Content Writer

Alice is a registered nurse and healthcare writer. She has more than 20 years of nursing experience, which ranges from labor and delivery to long-term care, with pediatrics, community nursing, and critical care sandwiched in the middle.

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