How often do you receive emails or calls from nursing staff informing you that they cannot work their scheduled shifts?
Unfortunately, nurse call outs are relatively common. As the term indicates, staff call outs or call offs are when nurses call or communicate with their supervisors to get out of working a scheduled shift. This may be due to illness or personal reasons.
Regardless of the cause, staff call outs significantly impact patient care, facility operations, and staff morale. Therefore, facilities should employ strategies to prevent and overcome call outs.
The impact of nursing staff call outs
It may seem like one staff call out during a shift is no big deal. Other staff members can share the extra work. It may be a hectic and tiring shift, but it’s possible. It can be done. While this reasoning is not completely inaccurate, there are costs to nurse absenteeism.
Patient care
Numerous studies have found that an adequate nurse-to-patient ratio is crucial to patient safety. Nurse understaffing often leads staff to make safety‐related shortcuts in order to get work done.
Understaffing also impacts continuity of care—the logical and timely delivery of healthcare services.
Furthermore, understaffing forces remaining nurses to take on heavier workloads, which may lead to burnout. Nurses feeling overworked and burned out may impact patient care in the following ways:
- Less time spent with their patients
- Delays in care delivery and diagnoses
- More medical errors
- Lower quality of care
- More hospital-acquired infections among patients
Facility operations
Staff absences also tangibly impact facility operations. From added costs due to unexpected overtime work to patient readmissions, even a single call out can affect a healthcare facility's day-to-day operations and impact staffing ratios. Here are some ways that unexpected call outs can negatively impact a healthcare facility:
Overtime
When a nurse calls in sick, facilities must try to fill vacant shifts. This often results in nurses working overtime to "share the burden" and facilities incurring elevated staffing costs.
The U.S. Department of Labor enforces labor laws to protect the rights of workers. According to these laws, non-exempt employees must receive 1.5 times the regular pay rate after 40 hours of work in a seven-day workweek. Therefore, although paying overtime may seem like the simplest solution, it is not the most cost effective.
Penalties
On the other hand, if a facility does not adequately staff shifts when a nurse calls out, it may be subject to penalties for violating staffing minimums.
Extended stays and readmissions
A hospital or other healthcare facility may also have to deal with extended lengths of patient stays and readmissions, both of which increase when facilities are understaffed.
Staff morale
Staff morale may seem intangible and, therefore, easier to ignore. However, high turnover rates and the associated costs are very real. The pressure placed on the shift manager to manage the consequences of a staff call-off and the time spent looking for a replacement, whether it means rearranging nurse assignments or calling off-duty nurses, comes with a financial and emotional cost.
The combined challenges of nurse staffing shortages and burnout should not be taken lightly. Healthcare facilities must prioritize nurses’ wellbeing and job satisfaction to increase retention rates and guarantee the smooth functioning of their operations.
5 Strategies for addressing call outs
Healthcare facilities should simultaneously address call outs on two fronts: preventively and reactively.
Much can be done to prevent call outs from occurring in the first place. However, when inevitable call outs occur, facilities must also have a plan to provide emergency coverage.
1. Review your time-off policy
Some staff call outs and even no-call/no-shows may be preventable.
Could it be that staff members resort to calling out when a time-off request is rejected?
Consider getting feedback from staff on your facility’s current time-off policy and redesigning it into a shared agreement that allows for flexibility and open communication. Open communication and greater schedule flexibility can reduce harmful call outs.
2. Update your scheduling practices
Do scheduling practices in your facility allow staff to choose their schedules and shift lengths?
Are nurses involved in any way in the scheduling process?
If not, it may be time to start.
Nurses crave flexibility, control over their schedules, and freedom to craft their ideal version of work-life balance. Interestingly, having this freedom and flexibility does not translate to nurses working less.
In 2024, Nursa conducted an electronic survey of its national clinician user base and found that the PRN clinicians who pick up shifts on the platform work 1.5 times the number of shifts that employed clinicians do.
Here’s the lesson of the story: Allow staff to have a say in when and how much they work; you may find they are more willing to work than you thought.
3. Cross-train staff
Cross-training staff is an investment that pays off.
Having a larger pool of clinicians able to take on specific responsibilities and carry out specialized tasks allows facilities to respond effectively to call outs. Cross-trained staff can seamlessly transition from one unit to another, covering schedule gaps and providing necessary skills.
4. Leverage contingent staff
Healthcare staffing platforms are also invaluable in maintaining safe clinician-to-patient ratios. When internal staff members call out, contingent staff can step in and help shoulder the work. For example, Nursa offers facilities contingent staffing solutions by allowing them to post and fill open shifts within minutes.
This strategy offers advantages over having nurses on call. The unpredictability of the on-call scheduling can cause nurses significant stress. On the other hand, contingent staffing is based on nurses’ availability and desire to work at a given moment: a win-win situation for facilities and clinicians.
5. Incentivize attendance and responsibility
Encouraging staff to be responsible for their work duties and patients does not have to imply ignoring their personal needs and family responsibilities.
If staff follow the established protocols for requesting time off or schedule changes—and facility administrators are understanding and flexible—they can reduce call outs to true emergencies.
Staff members with the lowest number of call outs could be rewarded with bonuses or other prizes. Even thanking these individuals during meetings can go a long way toward incentivizing staff members to follow the facility’s call out policy.
Example: How Hillsboro Health fixed their call out problems
Hillsboro Health and Rehabilitation Center is a skilled nursing and rehabilitation care center in Hillsboro, Oregon.
The facility used to rely on a staffing agency to cover schedule gaps. However, the facility’s administrator found that nurse staffing agencies required too much emailing back and forth to offer effective solutions for last-minute call outs or staff who left halfway through shifts.
Now, the facility successfully uses Nursa to cover weekend shifts, holidays, and last-minute call outs.
“Nursa helps keep us going. It's such a quick and flexible process. It's rare that we post a shift and it doesn't get picked up.”
- Grenika Soysa, Nursing Home Administrator at Hillsboro Health and Rehabilitation
Partner with a trusted platform to get urgent shift coverage
Hospitals and other healthcare facilities should strive to reduce call outs to the absolute minimum by opening lines of communication with staff and re-evaluating their policies. However, facilities still need a backup plan to address inevitable staff call outs.
When call outs occur, facilities can maintain safe nurse-to-patient ratios, reduce costs, and protect internal staff from burnout by implementing per diem staffing solutions.
Is your facility struggling to cover last-minute call outs? Fill open shifts in minutes with per diem clinician staffing.
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