At Durham, N.C.-based Duke University Health System, nurses have the option to pick up gig work or be traveling nurses without ever leaving the system. It is all part of the flexible scheduling Duke offers.
"We've shifted from a culture of work-life balance to work-life integration," Terry McDonnell, DNP, senior vice president and chief nurse executive at Duke, told Becker's. "What we're finding is we have staff that really depend upon our ability to support their flexibility needs."
Many of these flexibility programs started at the end of the COVID-19 pandemic and have since grown.
Gig work
Duke harnesses technology to allow gig staffing within its organization. Hospitals, clinics and units that are short staffed post their needs to an internal platform, and staff nurses who match the qualifications can schedule themselves into that shift.
"We have limited ability for gig work for our staff, but we want to go deeper and broader," Dr. McDonnell said. The program's limitations stem in part from the complex technology required to operate it.
The gig program is run by a single leader. Currently, about 100 staff participate in gig work.
Internal travel nurses
During the pandemic, Duke had approximately 500 external travel nurses. Around 2022, the system launched its own internal travel nurse program as the solution to reduce external travelers while also providing options for nurses who did not want to be tied to a specific unit but wanted to have some stability in employment.
Today, the program touts about 200 internal travel nurses. They operate in a similar fashion to external travel nurses but with a different rate of pay and short assignments across various units and clinics.
"I think the value and benefit for this program is it allows flexibility for our existing staff," Dr. McDonnell said. "If they want to move between specialties and have the competencies and training, they can do so. It allows them flexibility to use all of their skills without having to relocate to a new area."
The program is overseen by its own set of administrators within the system.
Shift float schedules
Staff in the shift float program commit to a set number of hours per week or month, but like internal travel nurses, they float to areas in need.
A separate department schedules and manages the float pool for all units, mobilizing float staff when there are callouts or units that need more nurses to ensure safe staffing ratios. Currently, about 300 nurses participate in shift float schedules.
Some staff have been in the float program for more than a decade, and the turnover is not statistically significantly different from more traditional schedules, Dr. McDonnell said.
Outcomes
These three flexible staff programs have allowed Duke to minimize bed closures, serve the community in the way it needs and provide staff with the flexibility they desire, Dr. McDonnell said.
"I think gone are the days where someone enters a job and they expect to retire from that job," she said. "As a health system, the question in front of us is: How do we meet those needs by keeping staff engaged in growing within our own system?"
Part of keeping staff engaged in meeting their needs. Nurses with more seniority can find the last few years before retirement fatiguing. Flexible schedules can help them find different opportunities and scale back; the system is also finding nontraditional roles, such as virtual nursing, care coordination, and mentorship and coaching opportunities, that allow experienced nurses to leverage their skills in a less demanding way.
"The thing that I focus on is what program will meet the needs of the patient and also meet the needs of our staff," Dr. McDonnell said. "And when those two things align, that's the work you focus on."