How CNOs can Achieve Scheduling Fairness at the Enterprise Level

How CNOs can Achieve Scheduling Fairness at the Enterprise Level

Shane Parker, RN
Co-founder and Chief Nursing Officer

The dynamics of staff scheduling change on a moment-to-moment basis in most hospitals. Take this example.

Three orthopedic surgeries got canceled one morning for various reasons, which lowered the census on the ortho floor upstairs. Charge nurse Annie realized one of the nurses needed to be sent home early, but which one? Whose turn was it this time?

“Oh, pick me!” part-time nurse Sarah said. “It would let me watch my son’s soccer game for a change.”

“I’m never allowed to leave early,” full-time nurse David said. “Sarah has been sent home early the last three times in a row!”

Meanwhile, agency nurse Jennifer strode down the hallway to attend to an imaginary patient. As she walked, she muttered, “I hope I can disappear before someone tells Annie it’s my turn to get sent home. The last thing I need is to lose these hours this week.”

Four Intractable Challenges in Scheduling Fairness – and How to Fix Them

In the end, Annie sent David home early because he advocated the loudest for it. But that’s hardly fair, is it?

Figuring out who should be flexed early due to low census isn’t the only fairness issue hospitals face. Nurses complain about never seeming to find preferred shifts available to them, about their peers who refuse to take their fair share of call or holiday shifts and about charge nurses who seem to wield their scheduling power as a punishment and reward system: please me and receive overtime shifts; annoy me and find yourself scheduled all nights for six weeks.

Fortunately, no matter your organization’s specific challenges, you can fix them all with ShiftWizard. Here’s how.

1. Playing favorites when a nurse needs to be sent home early

The situation above could have played out differently if Annie’s hospital used ShiftWizard for nurse scheduling. When the census dropped and triggered a need for one nurse to be sent home early, Annie would not have had use her own discretion to choose which nurse to flex.

Instead, Annie could have logged on to her ShiftWizard dashboard to instantly view a chronological list of nurses whose turn it was to float, go home or be placed on call. Even better, this “flex log” feature could have been customized to the organization’s scheduling policy to provide consistency when flexing nurses off a shift.

For example, if the organization’s policy mandated that agency nurses be sent home early prior to any full- or part-time staff, then Jennifer’s name would have appeared first in the flex log. Or, if the organization policy stated that part-time staff should get flexed first, then Sarah’s name would have appeared above either David’s or Jennifer’s.

No matter the specific policy, ShiftWizard’s flex log would have provided absolute, unbiased fairness in determining which nurse Annie should choose to flex. Not only that, but choosing from the flex log would have created a persistent record in the system so if any questions arose later, the data would be preserved for review – instead of setting up a “he said, she said” scenario.

2. Nurses signing up for shifts that have already been filled

You may remember the pen-and-paper days of scheduling (in fact, you may work for a facility that still handles shift sign-up this way). It goes like this: on a particular date every six weeks or so, the charge nurse or manager tapes a piece of paper up on the break room cabinet with the open shifts for the next scheduling period. On a first-come-first-served basis, nurses write their names into the open slots.

But, inevitably, some nurses create their own shifts by simply squeezing their name in between the lines – which might leave you with, for instance, eight nurses signed up for a daytime shift that only requires five staff.

Traditionally, the charge or department manager would then be required to adjudicate the situation by deciding who signed up first and reassigning those who squeezed their names in. That places a stressful, unnecessary burden on managers who could be using their time for more important tasks. It also can create hard feelings among the staff nurses if they perceive the manager to be “playing favorites.”

ShiftWizard eliminates this scheduling frustration by removing an available shift from the schedule as soon as the maximum number of nurses have signed up for it. When the new schedule become available in the app or online, nurses can click to choose that shift on a first-come, first-served basis. If the shift requires five staff nurses, that particular shift literally disappears from the calendar the moment the fifth nurse claims it. Your charge nurses no longer have to devote time or energy to deciding who’s actually getting the shift – and who’s getting reassigned.

3. Eliminating the problems with first-come, first-served scheduling

Of course, self-scheduling that employs the first-come, first-served approach creates a host of other scheduling fairness issues. It rewards off-duty nurses who can jump online the moment a new schedule opens and grab all the best shifts, for one thing. And sometimes first-come, first-served won’t work because of requirements imposed by outside entities.

If your nurses are unionized, for example, you may think you can’t possibly allow self-scheduling because there’s no way to that will work with the union’s requirements that shift selection follow a seniority protocol. Some unions require that seniority always be considered in scheduling, whether in initial sign-up or when flexing someone off a shift.

But ShiftWizard handles these situations – and others like it – with ease.

ShiftWizard allows your organization to group nurses in any way you desire for purposes of shift sign-up or flexing. For example, if you need to follow a union’s seniority protocol, you can configure ShiftWizard to make this happen – even while enabling self-scheduling. In this scenario, the app would open the new schedule to the most senior nurses first, giving them an exclusive scheduling window before less-senior nurses were able to view and choose shifts based on order of seniority.

This orderly method of self-scheduling also works for very large departments, like an ED with hundreds of nurses and other licensed staff. Opening a schedule to 300 nurses and CNAs all at the same time creates its own kind of chaos, with some nurses hovering on their phone app to snatch the best shifts the instant the schedule becomes available while others who can’t log on until later open the schedule to find the best shifts gone.

To eliminate those types of fairness issues, you can break up the workforce into smaller groups that receive the new schedule in rotation. For instance, if you have four groups – A, B, C, D – Group A would get 24 hours to choose shifts before the schedule opens to Group B, and so on. The next time, Group B would get first choice, while Group A rotated to the bottom. It’s hard for nurses to complain about scheduling fairness when they have a chance every fourth schedule to choose their preferred shifts.

4. Refusing to sign up for call or holidays

Some nurses manage to successfully fly under the radar when it comes to taking their fair share of call or holiday shifts. A big department like that ED mentioned above might include several managers that may or may not communicate as effectively as hoped, and it can take months for any of them to realize that a particular nurse hasn’t taken call within recent memory.

But you can be sure the other staff nurses know. And this sort of behavior, when it goes unaddressed, can breed resentment that leads to poor morale.

ShiftWizard solves this problem by enabling charge nurses or anyone responsible for scheduling to automatically assign each nurse to a fixed call or holiday shift on a rotating basis. Even if your facility takes advantage of ShiftWizard’s self-scheduling feature, you still can designate certain shifts to pre-populate in any nurse’s schedule before she or he is allowed to choose the other shifts to work during the scheduling period. This makes it impossible for a nurse to refuse to sign up for call or holiday shifts.

Yet ShiftWizard also offers the flexibility to reduce any complaints over being automatically scheduled for certain shifts. Most facilities enable ShiftWizard’s shift swap feature, so that a nurse who hates taking call can still avoid it – if she finds someone else to take it for her. This allows nurses to feel empowered over their schedules, which improves morale.

Beyond Software: Creating a Policy for Scheduling

While ShiftWizard can solve any issue of scheduling fairness, your first step as a CNO should be to formalize scheduling policy in a written document. You can convene a committee of affected stakeholders to hammer out a policy that outlines how scheduling will be handled enterprise-wide. Typically, these policies cover:

  • Identification of who is in charge of scheduling at the unit level and above
  • Locations covered by the policy
  • Time period of standard nursing schedules
  • How paid time off and vacation requests will be handled
  • Who must sign off on overtime requests

A formal scheduling policy codifies how your hospital will use ShiftWizard’s features in fairness to everyone. We can even provide you with a helpful template for drafting your own policy.

Empower Your Nurses, Improve Morale and Stop the Schedule Squabbling

ShiftWizard solves schedule fairness problems because the software was designed by nurses who have lived through these exact situations and possess intimate knowledge of the delicate issues that can be involved. We use our expert understanding of healthcare scheduling problems to provide you with a solution that empowers your nurses to take control of their scheduling while giving you all the tools you need as a CNO to ensure every shift gets covered, every day.

Call us today for a no-obligation demonstration of ShiftWizard to discover how it can help end the schedule squabbling, elevate morale throughout the organization and relieve your nurse managers’ stress in dealing with these concerns day in and day out.

Healthcare Staff Scheduling. Developed by Nurses for Nurses.

ShiftWizard makes nurse scheduling and communication easy, so you can focus on what really matters---improving patient outcomes.