The U.S. health care system faces a looming workforce crisis: By 2026, experts have predicted the system will be short 3.2 million workers. Nurses are leaving the profession at a rapid rate, with approximately 100,000 nurses exiting between 2021 and 2023 — and an additional 63,000 projected to leave by 2030. Health care workers who fall into the “deskless workers” category have the highest turnover rate of all front-line workers at 31%.
HR leaders in health care have an urgent role to play in stemming this crisis by rethinking staffing practices. Traditional staffing models — characterized by rigid shifts, mandatory overtime, and a heavy reliance on agency staff — compound burnout and accelerate attrition among physicians, nurses, and front-line support staff.
A redesign has to be rooted in stronger workforce planning — not just filling today’s shifts, but anticipating future needs and building a sustainable talent pipeline.
Here’s a look at how practical staffing innovations can directly address workforce strategies while improving retention and stability.
The Problem: Burnout and Outdated Staffing Models
Rigid shifts and mandatory overtime are two outdated staffing models that contribute to burnout and ultimately lead to turnover.
“Looking through the lens of health care staffing, there is a lot of literature that it's not just the number of staff,” said Myles Parilla, a registered nurse (RN) who oversees emergency services at a hospital. “It’s also about having the right skill set mix [and] level of workload based on complexity of care — and that staff feel like they have some level of autonomy.”
Systemic recruitment and retention challenges exacerbate these issues, according to Stacie Baird, the chief people officer at Community Medical Services (CMS), a network of addiction treatment service centers headquartered in Scottsdale, Ariz. For example, volatile patient volumes and traditional transactional recruiting practices — job fairs and job boards — are not built to meet today’s staffing needs.
“We’ve shifted our recruiting to think more about how to create an internal workforce, rather than rely just on external sources, so we can create a more reliable talent pipeline,” Baird said.
Flexible, People-Centered Solutions
Scheduling practices — such as involving employees in scheduling, offering predictable flexibility, and — are identified as low-cost, high-impact retention tools that can reduce turnover and improve satisfaction among deskless workers.
Here are four strategies HR leaders in health care are using now:
Internal float pools
Health care systems assign staff to different units or departments on a rotating, as-needed basis, providing workforce agility.
“You can hire people directly into the float pool, and they can be floated to five different hospitals in the system,” Parilla said. “Or they can have specialties and get floated to different departments, like from the ICU to the Medical Surgical Unit or the Ambulatory Surgery Clinic.”
When executed well, an internal float pool strategy takes into account how many hours a staff person has clocked for the week so you’re not asking them to stretch and work longer hours. Baird noted that CMS regionalized itsr float pools so staff can remain closer to home and maintain continuity of team relationships, which drives enhanced patient care.
On the other hand, Parilla noted that float pools can make it challenging to ensure staff remain compliant with required competencies.
Shift bidding
Shift bidding boosts retention because it provides autonomy. Allowing staff to participate in a transparent shift bidding process enables workers to feel a sense of control.
“The transparent bidding process drives autonomy and communicates fairness and equity,” Baird said. “There are pros and cons — let’s be honest, no one loves to work holidays — but we offer incentives and think it creates more autonomy for people.”
Team-based care
Parilla has seen a team-based approach, in which two or more health care providers coordinate care to help stabilize the patient before transferring them to a single nurse, work well.
“This really promotes collaboration,” he said. “It really helps with shifting resources more effectively and builds that team morale, which, when we're talking about burnout, is really important.”
Career pathways
Baird said that implementing career laddering has been a game-changer for CMS. Investing in and encouraging staff to progress from medical assistants to licensed practical nurses to RNs has boosted retention by showing staff they have a path forward.
“Through tuition assistance and reimbursement programs, we help staff advance while filling critical shortages,” she said. “Equally important for us is investing in mental health. Our staff and their dependents have access to 24 counseling or coaching sessions annually during work hours. That support can steer people away from burnout, which is one of the biggest factors driving turnover.”
HR Leaders’ Role in Addressing Staffing Shortages
According to Baird, HR's biggest responsibility is to show data and the impact of not investing in some of these programs. Parilla agreed that clear data collected through technologies such as scheduling and timekeeping platforms, as well as geocaching, provides HR leaders with an advantage in changing the staffing crisis dynamic.
“Clear data provides insights into where the opportunities are and helps us see shift holes in particular times of day and days of the week,” he said. “If there is a pattern or a trend, we can spot it and create a plan to mitigate that in a way that fits our organization.”
Parilla also added that HR leaders need to make leadership development training available to team leaders, especially when an individual is promoted from the front line to a manager of operations.
“Oftentimes, clinical leaders are handed a budget and are responsible for the outcomes from a clinical standpoint, but unless they have a business or finance background, how are they supposed to know how many FTEs [full-time equivalents] are budgeted for and if what is budgeted meets patient care demand?” Parilla said. “So, the right training on how to evaluate a budget, if it's appropriate or not, is important.”
A Look Ahead
Rethinking staffing is not just an operational adjustment, it’s a strategic lever for retention and workforce stability.
Redesigning staffing models is not without its challenges — such as Drug Enforcement Administration and other federal and state regulations and stakeholder audits — but HR leaders are central to aligning staffing redesigns with patient care needs and organizational strategy.
“Stability of staffing has great ramifications,” Parilla said. “With stable staffing, you can prevent burnout, have a team achieve better patient outcomes, and provide safer care. And safer care is more cost-efficient.”
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