Mandatory Flex Time for Nurses

In most industries, ‘flex-time’ is an employee’s best friend. Flex time is typically a scheduling policy that allows workers to determine their own hours based on personal preference.

For nurses, however, the term has an entirely different meaning.

When faced with a decline in patients, some Ohio hospitals have turned to mandatory shift cancelations known as flex time. When flex time is utilized, scheduled nurses receive little to no compensation for their scheduled hours.

“There comes a time when hospital administrators have to make a tough call about calling nurses off of their shifts,” said Kelly Trautner, deputy executive officer, Ohio Nurses Association.

“This is a hard decision from a public relations perspective and from an emotional perspective,” she said. “However, expecting nurses to stay committed to shifts that are later withdrawn eliminates their ability to work elsewhere to recover lost wages.”

The economic downturn has prompted many nurses to push back their retirement dates. In turn, this delay in retirement has pushed back a long-expected nursing shortage.

“With the economy, it is up in the air the way it is; it will be hard to predict when the nursing shortage will occur,” Trautner said. “Until it stabilizes and we get a better picture, we will not know when the mass exodus of baby boomer nurses will happen.”


Patient Acuity Ratios

Nurse staffing model adjusts to severity of patients’ illness and injury.

Patient Shortage or Nursing Shortage?

As economic instability shows no signs of letting up, both hospitals and nurses will need to work together to find unique staffing solutions.


According to the Ohio Hospital Association (OHA), the vacancy rate for Ohio nurses was 4 percent in 2010, the most recent year for which data was available. The previous year, 2009, the statewide vacancy rate was 6.2 percent.

Nevertheless, there is a nursing shortage lingering in the distance.

“A recent report from the Institute of Medicine indicated 20 percent of nurses plan to retire within 5 years; 48 percent plan to retire within 10 years; and 32 percent plan to continue working for 15 years or more,” said John Palmer, director of media and public relations for OHA.

“Obviously, with the bulk of Ohio nurses planning to retire within the next 10 years, there will be a tremendous shift in nursing vacancies,” he said.

Although comforting for nurses seeking stable employment, statistics such as these are constantly fluctuating. In the midst of economic instability, trying to pinpoint exactly when nursing vacancy levels will rise is difficult at best.

“Hospitals have been trending patient volumes for a long time. They know that there is an uptick during flu season. Still, the healthcare industry is very volatile right now because of the economic instability. Things that were once predictable are no longer certain,” said Trautner

Viable Staffing Options

Although future staffing needs are unclear, it is clear hospitals and nurses need to find unique solutions to fluctuating patient levels.

“Hospitals operate very differently from one another. There is not a single manual for how best to run a hospital,” Palmer said.

“A great deal depends on the services provided and the community in which the hospital is located.”

Calling nurses at the last second letting them know that they cannot work that day is perhaps the worst solution to instances of overstaffing.

“If there is a 3-month stretch in which nurses are working a third of their scheduled hours, a hospital cannot expect them to stay around too long,” Trautner said.

“Flex time and last-second call-offs should not be at the core of your staffing toolkit.”

Although flex time offers hospitals a short-term solution to balancing staff-to-patient ratios, its long-term effects on the nursing industry are grievous.


“If the risk of instability becomes too great for nurses and they do not know if or when they will work, a decrease in qualified individuals augmenting the workforce will occur,” Trautner said.

“Talented nurses will soon begin looking for other professions. Hospitals need to be mindful of this reality.”

Viable staffing solutions do exist. Both temporary agency nurses and interdisciplinary cross training allows greater staffing flexibility for hospitals.

“We offer a program called OHA Staffing Solutions. Through this resource, we assist Ohio hospitals in filling short- and long-term staffing needs through one of 89 participating medical staffing agencies,” said Palmer.

Agency nurses offer more than just flexibility; short-term staff can be used when a hospital begins offering new medical services.

“Frequently, hospitals will develop a new service and bring in temporary nurses in order to see how the service is received. If it is successful, then the hospital will look at full-time nursing staff,” said Palmer.

Rather than using itinerant nursing staff, hospitals can work to diversify the skills of their existing staff nurses.


The Politics of Staffing

Demand at the state level for safe staffing legislation continues to rise. But will there ever be a national law for nurses?

“Ideally, more nurses can be cross-trained in many disciplines in order to accommodate for fluctuations in demands. Hospitals with cross-trained nurses can take care of many different patient needs with a smaller work force,” said Trautner.

Nursing Involvement

Offering high-quality patient care is the goal for hospitals. To meet this goal, facilities must be considerate of not only their finances, but also their nursing staff.

“Staffing issues translate into quality patient care. Nurses have an obligation to their patients and hospitals have an obligation to their nurses. Registered nurses should always have a say in staffing policies and scheduling protocol,” said Trautner.

By placing nurses on staffing and scheduling committees, hospitals can be acutely aware of their nurses’ unique needs and talents. And, with the help of nurses, knee- jerk staffing corrections such as flex time can be avoided.

A. Trevor Sutton is a frequent contributor to ADVANCE.

About The Author