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20 August 2019

Nurse Self-Scheduling Brief Case Study

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Amsterdam, August 9th, Lia de Ruijter, marketing manager Déhora Consultancy Group


Eighteen months ago, things were a lot different in the nursing units at SANQUIN blood donor and analysis center in The Netherlands. Like so many care institutions, SANQUIN was having staffing problems that forced their own analysts to float between units when they didn't want to. The care institution also had to pay a lot in incentive payments to cover extra shifts and rely on expensive agency analysts to fill in the gaps. That needed to change and the called in the help of Déhora, workforce planning & optimization consultancy group.

That's when based on the recommendations of Déhora they it decided to put scheduling into the analysts' own hands. First a 6 month pilot was done with a group of 24 analysts. This was to set up the methodology and try out the internal rules that were defined. The pilot was successful so after 6 months all the analysts could start planning their own shifts.

Implementing self-scheduling has paid off, according to William Van de Burgh, nurse manager. Without hiring any additional employees, SANQUIN Care institution no longer has holes in its schedules, he says.

"We haven't had any agency analysts since we started," Van de Burgh tells Déhora. "We don't pay incentive pay anymore." Van de Burgh says the success of self-scheduling boils down to one major factor: autonomy for the analysts. "The staff have more input into their schedules," agrees staffing assistant Tammie Lenoir. "And if they can see open shifts in other units they're picking up a lot of shifts outside of their units."

Analysts Take Control

Van de Burgh says it's not that analysts don't want to pick up extra shifts; they just want to control over when and how they do it. "You just see a whole different change in the attitude," he says. "We went from having agency analysts, which are expensive, to analysts who are not only picking up the shifts that we need when we need them to, but they do it willingly, and they're excited about it."

Van de Burgh says floating between units isn't popular with analysts, and although it isn't quite a thing of the past, it happens far less frequently. Now, when analysts do have to float, they're not as worried about it as they have been in the past. "Because they've been picking up shifts on other floors, there's less anxiety when they float," Van de Burgh says.

A Reward System

There are several different self-scheduling software options for care institutions to choose from—SANQUIN uses one that not only allows for self-scheduling, but also includes a system where analysts earn points for picking up extra shifts. Analysts can accumulate points and cash them in to earn rewards, such as gift cards for gas or coffee, or even designer purses, says Van de Burgh. "Little rewards that they may not have given to themselves if this system wasn't in place," he adds. "They're earning little bonusses for themselves."

Because the system is Web-based, analysts can plug in their schedules anywhere they have an Internet connection. "I actually had a nurse that was on vacation in China, and she logged in and put her schedule in," Van de Burgh says. Additionally, when someone calls out sick, the program sends a text message, phone call, or email to analysts who said they would be available to work that day or interested in picking up extra shifts. "I would just have to start going down the list of analysts to start calling to see if they would come in for the day or night," Lenoir says, but since they moved to self-scheduling, "people that would never come into work before will work extra."

Of course, for all of the positives associated with self-scheduling, there can be pitfalls as well. Van de Burgh, "if analysts see [self-scheduling] as an individual entitlement instead of a balance between individual and unit benefit, everyone loses. Miscommunication of rules and lack of adherence to self-scheduling guidelines can bring forth mixed feelings of tension and anxiety to the nurse manager as well as the nursing staff."

Not a Free-for-All

In other words, although it's called "self-scheduling," but it's not a free-for-all. The self-scheduling must occur with limitations and guidance, says Van de Burgh. For example, SANQUIN still has policies in place that require nurse to work a certain number of weekends and holidays. After analysts schedule themselves, managers go into the program and balance out the schedule. "You can't just schedule yourself for every Tuesday, Wednesday, and Thursday," Van de Burgh says. "Full time staff goes in first, then the manager goes in and balances it, then they can pick up overtime." If done right, self-scheduling can help organizations strike the right balance between giving analysts more control over their schedules and allowing the care institution to fill every shift. And according to Lenoir and Van de Burgh, it's a change that's affected more than simply the schedule.

"It's like a whole different culture," Van de Burgh says.

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