Nurses are still leaving jobs in search of schedules they can control, and facilities are left to cover the gap. Some clinicians exit healthcare entirely. Others move to as-needed work and pick up shifts around the rest of their lives.
Either way, the result inside a facility looks the same: open shifts, stretched permanent staff, and demand that shifts faster than a hiring cycle can respond to.
Flexible staffing is how facilities absorb that volatility without permanently overbuilding headcount. Whether you are a hospital's chief financial officer (CFO), a healthcare administrator, or a staffing manager, the 5 options below cover the realistic ways to fill an opening, along with what each one costs you.
Is there still a nursing shortage?
The short answer is yes, though the shape of it has changed. High turnover, burnout, and an aging patient population continue to drive the nurse staffing shortage, and the pressure falls unevenly across settings. Rural hospitals, skilled nursing facilities, and specialty units often feel it more sharply than large urban systems.
A Nursa study of 203 hospital executives found that 86% of hospitals and health systems saw 10% or more of their nursing staff quit in a single year. The same study found that 63% of health system executives believed they could offer their existing staff greater flexibility if they had a larger pool of nurses to draw from.
That second number is the more useful one. It reframes flexible staffing as something you do for your permanent team, not just something you do instead of hiring.
What is flexible staffing?
Flexible staffing is a strategy for scaling your clinical workforce up and down with demand rather than holding it at a fixed level. It fits healthcare settings especially well because labor needs there are rarely stable. Census fluctuates, acuity climbs without warning, and call outs land on the shifts you can least afford to lose.
A flexible staffing model lets a facility pay for clinical coverage only when needed, while giving clinicians more control over when they work.
How facilities benefit from flexible staffing
Flexible staffing comes in several forms, and most facilities end up running 2 or 3 at once. The following benefits hold across all of them.
Building resilience
Schedulers can contract clinicians ahead of projected gaps instead of scrambling after a call out. Booking per diem staffing in advance keeps enough licensed clinicians on the floor to hold safe ratios, and the same model works in reverse for emergencies, when a facility needs nursing clinicians within days rather than weeks.
Reducing total staffing costs
Facilities running flexible models cut recruiting, administrative, and payroll overhead. The savings are clearest with 1099 clinicians, who are not on facility benefit plans, and with any model in which a facility pays only for shifts actually worked rather than carrying idle capacity.
Supporting your full-time staff
Contracting clinicians pulls some of the weight off of permanent employees.
When a unit runs short, staff nurses pick up extra hours and longer shifts, which is the fastest route to burnout and the next resignation. Flexible coverage lets a facility protect vacation time, sick leave, and paid time off (PTO) requests rather than quietly asking the same 6 people to absorb them.
5 Flexible nurse staffing options
The following are the most common ways facilities close gaps today, roughly ordered from most flexible to least.
1. Per diem staffing
Per diem clinicians work on an as-needed basis, shift by shift. Facilities can post open shifts directly to a marketplace and have credentialed clinicians claim them, removing the intermediary from the transaction and compressing the timeline from days to hours. Nursa's Shift Marketplace works this way, with license verification, geofenced check-in, and no subscription or hire-away fees.
Pros:
- It is the most flexible option available, priced per shift.
- Total cost to maintain coverage levels stays lower than employed equivalents.
- Facilities carry no long-term commitment to any individual clinician.
- Scheduling moves quickly, often same-day or next-day.
Cons:
- Continuity of patient care is harder to maintain across many individuals.
- Onboarding and orientation have to be repeatable and fast.
- Team cohesion takes deliberate effort from unit leadership.
Per diem works best for facilities that need qualified clinicians quickly and want to stop paying overtime premiums to cover predictable shift gaps.
2. Local contract nurses
Local contracts sit between per diem and employment. A clinician commits to a defined block of time at a single facility without relocating. Facilities source them through agencies or job boards, though the job board route tends to consume human resources time.
Pros:
- Coverage is stable, since many local contract nurses commit to longer terms.
- Contract terms improve retention through the length of the assignment.
- Coverage is reliable through known busy periods.
Cons:
- Associated costs run higher once agency fees and termination clauses are factored in.
- Contract clinicians start with less familiarity with your equipment and policies.
- Continuity still breaks at the end of every contract.
Local contracts suit a facility that knows it will be short for the next 3 months and would rather solve it once than 40 times.
3. Travel contract nurses
Travel nurses relocate for assignments, typically 13 to 26 weeks, and are often the only realistic answer for hard-to-fill specialties or geographies. They adapt quickly to new settings because adapting is the job.
Pros:
- Facilities reach clinicians with specialized skills, which matters most in rural markets.
- Assignment lengths cover extended absences, such as parental or medical leave.
- Turnover and hiring costs stay below what onboarding a permanent hire requires.
Cons:
- Termination costs apply if the census drops and the need disappears.
- Familiarity with facility systems and policies starts at zero.
- Cross-state licensing can delay a start date.
Travel coverage earns its cost during peak season, for specialty roles requiring specific credentials, and for known long absences you can schedule around.
4. Staffing agencies
Agencies are the traditional intermediary model, and they still solve real problems, particularly for facilities without internal recruiting capacity. An agency handles sourcing, screening, and often onboarding on your behalf.
Pros:
- Facilities get access to a wide pool of clinicians across credential types.
- The hiring process is simplified by outsourcing screening.
- Agencies can fill difficult positions that internal recruiting has stalled on.
Cons:
- Facilities have less control over who reaches the floor.
- Finding the right candidate can take longer than expected.
- Skill levels vary considerably between clinicians from the same nurse staffing agency.
- Rates are often higher than other flexible options once markup is included.
Agencies make sense when a facility's human resources team does not have the bandwidth to review resumes, interview, and onboard, on top of everything else.
Facilities don’t have to go to a traditional agency for contract-length coverage. Block booking on Nursa lets a facility post a full block of shifts as a single posting, which clinicians apply to all at once rather than shift by shift. The facility gets committed coverage across a defined stretch of the calendar, and the clinician gets a run of guaranteed work without signing a 13-week travel contract.
5. Traditional full-time staffing
Permanent staff remain the backbone. Employed clinicians know your patients, your systems, and each other, and no flexible model replaces that.
Pros:
- Facilities keep full control over hiring decisions.
- A committed permanent core improves the work environment and teamwork.
- Staff carry deep familiarity with facility equipment, policies, and practices.
- Continuity of care is strongest with employed clinicians.
Cons:
- Costs are highest across onboarding, benefits, and turnover.
- Employment is impractical for short-term or seasonal needs.
- It is the least flexible option when demand drops.
- Recruiting is hands-on and resource-intensive.
- Burnout risk climbs on permanent staff whenever the facility runs short.
Permanent hiring is easier than ever
Two things have made permanent hiring easier than it was:
First, facilities can post full-time jobs to the same platform they use for shift coverage, which means the per diem clinician who already knows the unit can convert into an employee.
Nursa's Central Staffing service goes further, running scheduling and staffing operations on a facility's behalf so that the permanent core, the float pool, and the contracted coverage are managed as one system rather than three.
Second, clinical placements have become a viable recruitment pipeline. Facilities that host nursing students through Nursa Study get an extended look at clinicians before an offer is ever made.
Students who complete rotations in a facility they liked are a far warmer hiring pool than an applicant-tracking system. It is the cheapest recruiting a facility can do, because the clinician has already worked your floor.
How to manage fluctuating labor demands
Most facilities land on a mix rather than a single model.
- A permanent core sets the floor.
- Full-time nursing staff hold continuity and institutional knowledge.
- Per diem clinicians act as an external float pool that incurs no cost when idle.
- Block-booked or contracted clinicians cover known stretches of elevated demand.
- Agencies fill in where internal capacity runs out.
The practical work is deciding which category each gap belongs to before you fill it. A 3-day gap from a call out is a per diem problem. A 14-week maternity leave is a contract problem. A vacancy on nights that has been open for 8 months is a recruiting problem, and filling it with contracted coverage forever is the most expensive way to avoid solving it.
Facilities that get this right treat flexible staffing as infrastructure rather than emergency response. They know their seasonal curve, they post ahead of it, and they build relationships with the same returning clinicians so that continuity survives the flexibility.
Are you a healthcare administrator looking to reach a network of credentialed clinicians? Learn how facilities post shifts, blocks, and full-time roles on one platform.
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