Flexible Staffing Could Be Coming to Hospital Near You

• A new healthcare leadership survey found that leaders plan to increase flexible staffing options in the years ahead. 
• Of the leaders surveyed, most indicated they planned to increase their use of flexible workers between 26% and 50%. 
• Some hospitals like the Cleveland Clinic and Mercy have already begun using flexible staffing models. 

Nearly all healthcare leaders plan to increase use of flexible work options in the next year. 

This was among several findings in Hallmark’s “2025 Survey Results: Emerging Healthcare Workforce Trends” report, which included more than 1,200 leaders, 58.4% of which were from the nursing sector. 

“Burnout, rising labor costs, and pervasive staffing shortages are forcing healthcare leaders to rethink traditional workforce strategies,” Hallmark CEO Bruce Cerullo stated in a news release. “This survey underscores the growing need for and value of gig-style staffing models to not only boost nurse satisfaction but also maintain exceptional patient care and operational efficiency.” 

Some hospital systems already have implemented flexible staffing models, which have seen positive returns to the bottom line and nurse satisfaction. 

Rethinking Staffing Strategies 

Most healthcare leaders who indicated they planned to increase their use of flexible workers expect to see increases between 26% and 50%, the Hallmark survey found. At the same time, nearly 90% of respondents reported feeling pressure to reduce staffing costs.  

“Rethinking our staffing strategy is crucial, as relying on travel and contract nurses to fill shifts is a costly and unsustainable solution,” one respondent stated. “In contrast, investing in our permanent staff and exploring flexible scheduling models can help reduce labor costs and improve staff morale.” 

Cost savings emerged as the largest barrier to offering “flexible or gig-style roles,” the survey found. Despite this, 96% of survey respondents also said they see “gig-style work” as a significant element of their staffing strategy in the next five years. 

“The financial squeeze is real: with labor costs escalating by 20%-30% for every shift filled by travel or contract nurses, we’re facing a budget crisis that demands innovative solutions to our staffing woes,” another respondent said. 

Nearly all respondents also said they were concerned that staffing shortages and burnout could impact quality of care. 

Per Diem, Travel Staffing Not a New Phenomena

Hallmark’s survey isn’t the first to reveal increasing interest in per diem, or travel nurse, roles. Last spring, the Voices of Care survey from Medical Solutions found that a majority of nurses who choose travel roles do so for the increase in pay compared to full-time nurses.  

Market research also shows that the per diem nursing industry could reach $3.63 billion by 2031. 

Establishing Flexible Staffing Environments 

A Nurse Leader study published in August 2024 found that despite the agreement from nurses and hospital leadership that flexibility is needed, “implementation challenges continue to create a barrier to execution.” But at least two health systems have had success with establishing a flexibility-based staffing model. 

Mercy’s approach included developing a platform called Mercy Works on Demand (MWOD), with the foundational idea coming from Uber and Lyft models. 

“As the demand goes up to get the supply of Uber drivers to drive, the rate goes up,” Betty Jo Rocchio, DNP, CRNA, CENP, Mercy’s senior vice president and chief nurse executive, told the American Association of Critical-Care Nurses. “If the demand is low on a Saturday morning at 9 o’clock, they’re going to get less money for working, but that may be the time they want to work. So that flexibility in offering those Uber drivers to work as many hours as they want, they turn their app on, they turn it off to pick up work, and they pick when they work, how they work, they pick what area they work in.” 

Prior to its launch in 2022, Mercy established “workforce layers” — core nurses, flex (local and regional float pools) and gig nurses — that allowed helped guide the staffing algorithm. 

“We now have more than just our nursing staff on the platform. It can be a hospital strategy. It came up only in nursing across Mercy, because there was so much to do. Now everybody’s on that same platform,” Rocchio said. “Even if you’re just paying people premium labor to come in and do extra shifts, you can still benefit from that algorithm in the platform. You’re going to save money and you’re going to get a higher pickup, which is your goal. That way you can get more hands to the bedside.” 

In Ohio, the Cleveland Clinic’s Nursing Workforce Flexibility Taskforce reviewed systemwide flexibility initiatives to determine which could be implemented for nursing, along with a resource guide and guidelines to help establish new staffing options. 

“There is not a one-size-fits-all approach,” said Dusty Burke, MSN, RN, C-EFM, Cleveland Clinic director of nursing operations and co-leader of the Nursing Workforce Flexibility Taskforce. “Each caregiver is unique, and each nursing unit has unique needs.” 

Cleveland Clinic nurse leaders offered the following advice for others looking to implement flexible scheduling: 

• Be open to new and nontraditional ideas. 
• Engage in multidisciplinary collaboration. 
• Ensure the flexible options align with the “needs of designated care areas.” 
• Be open to revising scheduling options as needs change. 

The Bottom Line

A new workforce survey found that flexible staffing options are viewed as a high priority among healthcare leaders.  This supports previous studies and market research that showed rising interest in per diem and travel nursing industries. Some hospitals, like the Cleveland Clinic and Mercy, have already begun using flexible staffing models. 

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