David Coppins

Nursing homes trying to eliminate their reliance on staffing agencies need to move their hiring in-house and manage the changing needs of a bigger workforce. A PRN float pool is one way to recruit more caregivers by offering them flexibility. 

But managing a PRN float pool presents new challenges. 

The flexibility of a float pool means more people on the payroll, more changes to schedules, and faster communication. Using existing tools, facilities sometimes have to hire an additional scheduling administrator just to manage an active float pool. But that defeats the goal of eliminating their reliance on staffing agencies, which is to cut costs.

While most healthcare facilities rely on scheduling platforms to manage their full-time workforce, a PRN float pool has different requirements, which makes it hard for facilities to schedule the way they always have while also leveraging an on-demand, in-house staff.

Very few facilities successfully apply their existing tools, sometimes just a spreadsheet, to recruiting and coordinating a large and active float pool. PRN staff are often treated as second-class citizens by existing scheduling software, which gives them little transparency and choice. In my years in the long-term care industry, I have seen many facilities try to set up PRN themselves, and months later, I’ve seen them give up. 

Managing a PRN workforce requires a different approach and different tools than managing full-time healthcare workers. Here are a few things that facilities need to do differently:

Data-driven differential pay

One of the most common reasons that in-house PRN initiatives fail is that facilities don’t adjust pay to fill the most difficult shifts. If all shifts are paid the same, the float pool has no incentive to work through the weekend. 

Lots of nursing homes already rely on bonuses or differential pay in a pinch, but this is usually a manual, ad-hoc process. With active PRN float pools, pay differentials have to be implemented systematically to make sure all the hard-to-fill shifts are booked. If those shifts stay open, then facilities will turn to agencies to fill them. At my organization, we rely on AI to predict the pay differential necessary to fill a shift, and we’ve been surprised by the impact that even small pay differentials can make. 

Cherry-picking remedies

A related pitfall is that the float pool cherry-picks the best shifts. Some shifts are harder to fill than others, and good PRN tools steer the pool toward those shifts, both with pay and by defining who sees which shifts first. 

If facilities want to eliminate agency staffing, then they’ll need to provide systematic incentives to their in-house PRN staff, especially because PRN typically doesn’t get benefits or PTO. And they’ll have to keep their full-time in-house staff happy by not letting the float pool cherry-pick the shifts that are easy to fill. Giving bad hours or inflexible schedules to full-time staff is a good way to push them to the agency. 

Deeper engagement

By definition, the float pool moves from one floor to another or from one facility to another at the same parent company. That flexibility requires more transparency, more collaboration and better, faster communication. 

Eliminating silos among departments in a single long-term care facility, and among facilities managed by the same provider is the first step to improving how a PRN workforce is managed. 

Both full-time and part-time staff in adjacent departments and facilities can deepen the float pool, and that float pool can then be shared to fill in the most urgent gaps. PRN management tools need to give schedulers real-time notifications, messaging, and other engagement tools in order to coordinate large teams under changing demands. 

Finally, remember that the flexibility of PRN is not just an approach to workforce management. It’s a benefit that nursing homes can offer in order to attract and retain talent. COVID changed what caregivers expect, and many of them will never go back to the rigid schedules they worked before the pandemic. 

I believe many facilities can reduce their reliance on agency staff by 70% with the right PRN management tools. With many facilities acutely short-staffed and facing budget shortfalls, the time has come to rethink in-house scheduling so that they can keep many of their best workers, tap deeper pools of caregivers, and provide the care and access that America needs. 

This post is the second in a series on PRN workforce management. The first post is here

David Coppins is the Co-Founder & Chief Executive Officer of IntelyCare. As IntelyCare’s CEO, David is dedicated to empowering the long-term care industry to manage its workforce better through access to technologies such as PRN float pool management tools. Under his leadership, IntelyCare has helped healthcare facilities fill over 10 million nursing shift hours.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.