Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Principles and Strategies for Effective Workplace and Staffing Practices

Principles for Effective Staffing and Workload Practices

Staffing levels and schedules will support the delivery of safe, effective and ethical nursing care, including:

  • Providing sufficient levels of appropriately skilled nurses to meet client care requirements.
  • Maximizing continuity of care and of caregiver.
  • Enhancing the stability of the nursing profession by maximizing the number of permanent (full- and part-time) positions.
  • Developing schedules and rotations to meet the baseline workload requirements.
  • Providing mechanisms and staffing to meet fluctuating patient/client acuity and workload and replacement requirements.
  • Responding to staff work-life considerations and their impact on recruitment and retention.
  • Acting in a fair and equitable manner toward all categories of nursing staff.

Adapted and used with permission from London Health Sciences Centre, London, Ontario, Canada. June, 2007.
Strategies for Effective Staffing & Workload Practices Rotations and length of shift

  • The choice of rotations and shift lengths available on units should be predicted on finding a balance of patient requirements for care, unit characteristics, administrative policies and the needs and desires of staff.
  • Openness to offering a variety of shift lengths within one schedule and staggering start times of shifts to meet peak workflow periods are examples of creative initiatives.
  • Twelve-hour shifts are popular with many nurses, as they provide opportunities to compress the work week and gain more days off.
  • The risks of errors has been shown to increase significantly when shifts are longer than 12 hours, when nurses work overtime, or when work is ≥forty hours per week.
  • Rotating shift work can have a detrimental effect on health and wellbeing, particularly with older workers.
  • Weekend workers are another relatively new strategy, which, while slightly more expensive, may support organizations in providing adequate staffing on weekends without relying on costly short-notice replacement.

Self-scheduling Self-scheduling is an approach whereby the nurses on a unit or team collectively decide and implement the nursing schedule. It is the responsibility of individual nurses to select their shifts in a manner consistent with organizational policies and collective agreements, and negotiate with their colleagues to make any changes or accommodations, balancing the need to provide appropriate shift coverage with individual choice.

Parameters to consider in self-scheduling

  1. Assign shifts to maximize continuity of care and caregiver.
  2. Use visual cues on draft schedules to guide appropriate assignment of staffing levels, including knowledge and skill, on a shift to shift basis.
  3. Self scheduling occurs against a master schedule with a predetermined number of shifts to be filled on a daily and shift by shift basis
  4. Weekend time periods are clearly defined.
  5. Full time and part time staff must work their budgeted complement and their required percentage of weekend and shift.
  6. Staff will have equal access to preferred tours on a rotational basis.
  7. Written scheduling guidelines includes a process to reach consensus on the length of time available to each rotational group to choose to preferred shifts and negotiated exchanges.

Top reasons to consider a new schedule

  1. Casual staff are being pre-booked on a regular basis
  2. High overtime hours
  3. Frequent staff requests for changes
  4. Staffing levels are uneven by day of week and do not match workload
  5. Significant program change
  6. Regular scheduling of unbudgeted positions
  7. Insufficient flexibility to provide coverage on short notice
  8. Increased time spent on daily replacement
  9. High vacancy /turnover rate
  10. High staff complaints regarding scheduling
  11. Increased workload grievances

Adapted and used with permission from London Health Sciences Centre, London, Ontario, Canada. June, 2007

Vacation scheduling considerations

Nurse Managers must review and plan for staff vacation requirements on a regular basis. The first step is to establish a quota for the maximum number of staff that can be granted time off at any one time.  This quota should be established early in the fiscal year, and be reviewed with input from staff on an annual basis. The following factors should be considered when establishing a quota:


  • Number of permanent staff
  • Total vacation entitlement of permanent staff
  • Number of vacant lines (actual and predicted)
  • Estimated daily replacement requirements (absenteeism, stats, education, etc.)
  • Minimum number of required permanent staff on daily and shift basis
  • Ability to replace (i.e. consider number of casual hours likely to be available)
  • Experience level of staff

Adapted and used with permission from London Health Sciences Centre, London, Ontario, Canada. June, 2007

Parameters to consider in self-scheduling

  1. Assign shifts to maximize continuity of care and caregiver.
  2. Use visual cues on draft schedules to guide appropriate assignment of staffing levels, including knowledge and skill, on a shift to shift basis.
  3. Self scheduling occurs against a master schedule with a predetermined number of shifts to be filled on a daily and shift by shift basis
  4. Weekend time periods are clearly defined.
  5. Full time and part time staff must work their budgeted complement and their required percentage of weekend and shift.
  6. Staff will have equal access to preferred tours on a rotational basis.
  7. Written scheduling guidelines includes a process to reach consensus on the length of time available to each rotational group to choose to preferred shifts and negotiated exchanges.

Assessing Your Staffing Level and Composition

How do you know if you have the “right” staffing level and composition?

  • Workload measurement systems: Organizations with workload measurement systems can use the data to assess variance between actual and required levels of staffing.
  • Benchmarking with like organizations or programs:  Benchmarking exercises are usually voluntary, and occur when an organization seeks to compare itself with others in order to identify opportunities they may not have otherwise recognized. To achieve the greatest benefit from benchmarking for staffing, nurse leaders need to determine if the focus of the benchmarking exercise and best practices identified centre on efficiency or on quality. If the focus is on efficiency more than quality, results may not address staffing that contributes to quality outcomes for patients and nurses.
  • Quality outcomes: The growing body of evidence linking nurse staffing (in particular increased numbers and an increased proportion of RN staff) to client outcomes suggests that one way to improve quality is to alter staff complement and type. In fact, the patient safety movement and the relationship between nurse staffing decisions and adverse patient outcomes demonstrates the value of a strong, stable, regulated nursing staff complement.