“Scheduling is everything”: nurses offer insights, solutions for optimal shift schedules

Scheduling practices significantly impact job satisfaction for nurses at all levels, with flexibility, transparency, equity, and autonomy key factors for scheduling success, according to a new study led by researchers at NYU Rory Meyers College of Nursing. 

The study, published in the Western Journal of Nursing Research, also describes nurses’ pragmatic solutions for improving scheduling processes.

“Nurses are innovators by nature, and scheduling is one less-considered area where they can innovate, which may help to increase satisfaction and retention,” said Amy Witkoski Stimpfel, assistant professor at NYU Rory Meyers College of Nursing and the lead author of the study.

In hospital settings, nurses care for patients around the clock, often working 12-hour shifts. Scheduling nurses is a complex process driven by ever-changing patient needs and the availability of staff. 

Shift work and scheduling are major contributors to occupational stress for nurses and can lead to job dissatisfaction, burnout, and risk of turnover. These stressors were exacerbated by the COVID-19 pandemic’s intense working conditions that drove many nurses from their jobs, stretching an exhausted workforce even thinner.

To better understand nurses’ perspectives of job and scheduling satisfaction, researchers conducted a qualitative study with both staff nurses and nurse managers, interviewing 16 nurses in total.

The overarching theme that emerged from the nurses interviewed was “Scheduling is everything,” reflecting the importance of scheduling for nurses’ satisfaction in and outside of work. Nurses described the interconnectedness between their schedules and their physical and mental health, job satisfaction, and intention to stay in their roles.

Nurses reported that they were satisfied with their schedules when the process involved having some control over the shifts they worked, including preferences for days off or working consecutive days; flexibility for unit-specific needs and not overly relying on organization-wide policies; equity among staff; and transparency. 

When staff nurses faced scheduling challenges, they noted that it could cause conflict in their home lives, influence whether they intended to stay in their jobs, and compromise their health, sleep, and wellbeing. However, both staff nurses and managers recognized the tensions between scheduling for staff and patient care needs, with vacancies contributing to these tensions.  

“When nurses’ schedules don’t meet their needs or preferences, this dissatisfaction can lead to turnover, which can then lead to greater dissatisfaction and intent to leave among the nurses still on the unit who are left with less desirable schedules,” said Witkoski Stimpfel. “Collaborating with nurses to find schedules that work for them can help to interrupt this cycle.”

The staff nurses and nurse managers interviewed provided pragmatic ideas—which, in some cases, need little investment from organizations—for improving scheduling practices: 

• Involving staff nurses in the process, including trusting nurses to work out innovative and flexible solutions to scheduling challenges (e.g., piloting a schedule in which nurses work four 10-hour shifts per week, rather than five 8-hour shifts)
• Expanding the scope of staff preferences considered in the scheduling process (e.g., preferences for working consecutive days versus non-consecutive days)
• Enabling nurses to request planned time off for medical appointments and other self-care activities

The findings also suggest that technology may be useful for improving scheduling practices and nurse satisfaction. For example, computer or AI-assisted scheduling programs could allow for customized staff preferences to be considered, reducing some of the work of nurse managers and other staff. 

“To date, much of the research on the use of AI in scheduling has been focused on patient scheduling, but there is potential to leverage technology for staff scheduling as well,” said Witkoski Stimpfel. 

Additional study authors include Kathryn Leep-Lazar and Maile Mercer of NYU Rory Meyers College of Nursing and Kathleen DeMarco of NYU Langone Health. The research was supported by the National Institute for Occupational Safety and Health (T42 OH008422).