Self-scheduling practices are making a comeback amid the rise of electronic scheduling systems and heightened calls for flexibility from front-line staff members at hospitals and health systems.
Mountain View, Calif.-based El Camino Health is one such system exploring the use of self scheduling after encountering increasing demands from nurses in recent years for more autonomy and flexibility with their work schedules.
In the early 2010s, the system transitioned from a paper-based system to an electronic staffing and scheduling system that allowed staff to put in vacation requests and access their schedules and time cards. Now, El Camino Health is working with its technology vendor to support self-scheduling capabilities and aims to pilot the practice in two units this fall.
"One of the advantages to moving to a self-scheduling system is not only that autonomy for our nurses and transparency so the nurses can see their schedules as they built it, but also to reduce the administrative burden for admins and management," said Alicia Potolsky, DNP, RN, associate chief nursing officer of El Camino Health. "We want to schedule people for the dates that they'd like to work, as long as it's obviously meeting our patient care needs in that department."
Self-scheduling can be a powerful tool to retain employees and free up managers' time, but experts advise hospital leaders to develop the right framework for their systems that includes proper guardrails.
Four key considerations for leaders:
1. Co-create your self-scheduling framework with front-line staff. Hospital and health systems seeking to pilot self-scheduling should partner with direct-care nurses via staffing committees to design and implement self-scheduling policies that align with unit workflows, according to Jennifer Mensik Kennedy, PhD, RN, president of the American Nurses Association.
"This is a great opportunity to utilize shared leadership, shared governance, and let these unit nurses in the organization …. have a voice in building this process," she said.
In January, El Camino Health formed a multidisciplinary work group to develop a shared vision and parameters for nurse self-scheduling after agreeing to implement the practice during contract negotiations with its nursing union in summer 2023. This working group included nurse union leaders, nurse manager representatives and administrative secretaries who build schedules and time cards for nurses.
The team developed and agreed upon an end vision for self-scheduling in which nurses can request the shifts they wanted to work via an HR-based tier system. They also agreed upon a set of guardrails for the process, including allowing for managers and administrators to balance the schedule based on nurse skill sets if needed to maintain a safe patient care environment.
The system is also working with management to put in core staffing numbers for each unit. This measure will prevent nurses from signing up for a shift if the maximum number of nurses needed have already signed up ahead of them, according to Dr. Potolsky.
2. Avoid traditional seniority structures. Self-scheduling often works the best when organizations do not take a seniority approach, according to Dr. Mensik Kennedy.
In a previous hospital administrator role, she set up a nurse self-scheduling process in which the hospital published a staffing schedule six to eight weeks in advance. Full-time nurses had priority in choosing shifts, followed by part-time nurses and then per diem nurses. Nurses could make changes to the schedule themselves within predefined limits, with final approval by managers. This approach allowed for quicker adjustments and ensured that staffing needs were met efficiently across departments while giving nurses of all tenures fair access to the schedule within each pool.
Currently, El Camino Health allows nurses to say which days they do not want to work, with more senior nurses getting to put these requests in first before opening up on a first-come, first-serve basis. Under the new tiered system, the schedule will open up to nurses at different periods of time, depending on experience level rather than tenure. For example, if a nurse is new to the system but has many years of experience, they may be put on a higher tier to reflect their previous workplace experience.
"We didn't want to lock out newer staff," Dr. Potolsky said. "If you had been in the organization only a few years, you didn't get optimal schedule options, which is kind of our current state right now."
3. Be strategic with holiday planning. To ensure fairness around holiday time off, Dr. Mensik Kennedy recommended health systems sort units into two groups of nurses and two groups of holidays. One year, group A nurses take off group B holidays. The next year, group B nurses take off group A holidays. She also encouraged leaders to consider non-sanctioned holidays such as Mother's Day, Father's Day or Halloween when setting guardrails for self-scheduling. For example, in units with a higher proportion of men, Father's Day might be a popular day that workers want off. It is important to plan ahead for such occasions before opening the schedule to staff, Dr. Mensik Kennedy said.
4. Pilot self-scheduling across diverse units. El Camino Health is planning to pilot self-scheduling in two units this fall: its float pool, which is currently scheduled by its staffing office, and its critical care unit at Mountain View Hospital, which is a closed unit that oversees its own staffing. Dr. Potolsky said these units were selected to test self-scheduling in both a dynamic environment with the float pool and a complex critical care unit requiring diverse skill sets.
The system is working with its vendor in making changes to its existing time, attendance and scheduling electronic system to ensure all the rules and guardrails developed by its working group are included.
"While it runs on our pilot units, we'll monitor, make any necessary changes and adjustments, and then we will start rolling out to the other units," Dr. Potolsky said. One metric leaders will watch closely is how many times a nurse's requested schedule changes.
"Ideally, we want that to be a very low percentage so nurses can trust that when they make their schedule, they know it will be honored," she said. "The pilot will help decide what the right goal post is."