Health systems are rethinking nurse employment models to meet growing demands for flexibility and improve retention.

The post-pandemic nursing workforce has largely stabilized, and systems have shifted to a focus on retention and long-term pipeline development. In 2024, turnover rates for staff registered nurses decreased by 2.4%, resulting in a national average of 16.4%.

This stabilization has come due to a number of changes hospitals have made to nurse employment.

Expanding support for nurses

Systems are investigating new ways to help nurses practice at the top of their license and move tasks off their plate. One of the most popular methods is by creating more support roles.

Aurora-based UCHealth University of Colorado Hospital has invested in several support roles, including mobility technicians, patient care assistants, STEP nurses that focus on patient flow and discharge, and behavioral health specialists that lead safety huddles and help create a calm environment for agitated patients.

One of the newest support roles is patient technology tech.

“They help manage all the technology needs on the unit, whether it’s replacing dead batteries in monitoring devices, answering phones, fixing printers, managing telemetry boxes or even locating equipment,” Jennifer Rodgers, DNP, NP, chief nursing officer of the academic medical center, told Becker’s. “That role came directly from nurse feedback, and it’s been a big support.”

These support roles have freed up nurses to do more direct patient care, meet complex clinical needs and perform tasks that require their unique skill set, Dr. Rodgers said.

Improving education opportunities

Hospitals are using nurse education and career development as a way to retain new and experienced nurses.

In recent years, more hospitals have launched nurse residency programs that combine skills training, mentorship and support in the first year on the job. More systems are also encouraging nurses to become educators to help train the next generation.

Inside hospital walls, more organizations are offering professional development and mentorship programs to help new nurses advance their careers.

Chicago-based Northwestern Medicine has implemented a night-shift clinical educator. Traditionally, these educators work during the day, but many new graduates end up on night shifts after orientation, Christopher McLarty, DNP, ACNP-BC, chief nurse executive for Northwestern’s Academic Medical Center, told Becker’s. To meet needs of night nurses, Northwestern Memorial Hospital has launched a pilot program that places one clinical educator on the night shift to provide education and support during the hours they work.

“For now, it looks very similar to their day-shift counterparts,” Dr. McLarty said. “At its core, the principles are the same: supporting clinicians, whether they’re new hires or experienced staff; supporting preceptors; and providing ongoing education, in-services and development for the entire night-shift workforce.”

More flexibility

Scheduling flexibility is a big draw for many nurses who want more work-life balance.

“Health systems are increasingly rethinking the traditional 12-hour shift,” Brad Goettl, DNP, APRN, chief nursing officer of the American Nurses Enterprise, told Becker’s.

Rethinking shifts comes in a number of ways, including offering gig models, virtual nursing and four- or eight-hour shifts. Some systems are even bringing back weekend-only models that can pay the same as a full-time role, he said.

Durham, N.C.-based Duke University Health System is just one system that is increasing nurse workshift flexibility. In 2022, it launched a hybrid model that integrates virtual care, process improvement and technology as core competencies. Nurses are cross-trained in virtual care delivery, including telehealth and remote patient monitoring, making it easy for them to alternate between two in-person shifts and one virtual shift, Theresa McDonnell, DNP, RN, chief nursing executive and senior vice president at Duke, told Becker’s. Nurses are also able to adjust their schedules as needed up until their planned shift.

Flexible scheduling at the system has reduced nurse turnover by more than 8%.

Flexible staffing also benefits more than clinicians. Many systems have invested in AI-driven scheduling tools that predict staffing needs for future shifts, giving hospitals better management of staff resources. At Duke, its AI-scheduling tool reduced overtime by 23%, Dr. McDonnell said.

Innovating employment models

Some hospitals are pushing what was thought possible in nurse employment models.

Hartford, Ky.-based Ohio County Hospital has saved more than $40,000 a year by converting all of its nurses to salaried employees. To improve retention, Athena Minor, MSN, RN, chief nursing and clinical officer at Ohio County Healthcare, created a seven-days-on, seven-days-off model that allowed nurses time to spend with family and recharge. She also created a system whereby weekday nurses do not work weekends, and weekend nurses are paid well enough to cover every other weekend. The new structure requires nurses to be salaried so overtime rules do not apply.

“Factoring in benefits, we discovered we could actually double the staff needed to cover shifts and still save $20,000 a year,” she told Becker’s. “Our CEO and CFO were skeptical, but the math held up.”

A six-month pilot for night nurses eventually developed into every nurse at the system shifting to a salaried pay structure. In the first year of having salaried nurses, the hospital saved more than $40,000 due to reduced overtime. This model also cut the need for agency nurses during COVID, and it cut night shift turnover from 50% to 2%. Today, weekday nurses earn around $60,000 to $68,000 annually, weekend nurses around $35,000, and nurses who pick up both can make close to $100,000 a year.

“What I’ve learned is this: You need support to try something new,” Ms. Minor said. “When I first suggested doubling staff and saving money, people thought it was impossible. But they were willing to let me try. And it worked — better than we imagined. This model may not translate exactly to larger organizations, but the principle is universal: Don’t be afraid to innovate. Pilot ideas, measure results and be willing to pivot. Sometimes, the solution that looks impossible on paper is the one that truly changes everything.”

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