Healthcare Staffing Layers 101: Core vs. Contingency

Within healthcare, staffing and scheduling is a perpetual balancing act as patient volumes rise and fall. And, as provider organizations have ideal ratios or caregiver-to-patient ratios they adhere to based on specialty, having several layers of staffing resources is a good strategy. Facilities with a multi-layer staffing plan will fare better when scheduling to patient demand.

When looking at an organization’s staffing plan, there are two categories of staff: core and contingency. Core staff members hold a schedule commitment (FTE), either full or part time, and are assigned to a particular work area. Generally, individuals hired into core positions enjoy the predictable nature of their schedules and the environment in which they work, which is typically why they dislike being floated to other areas and having to step outside the comfort of their home base.

Contingency staff includes all other individuals – internal float pools (with or without FTE commitments), PRN staff, agency employees, and all staff working above their FTE or in overtime. This last detail is an important one, and often leads to confusion when looking at productivity and where the hours worked actually came from. A core staff member working in overtime or above their FTE commitment should be considered a contingency resource and treated accordingly.

Characteristically, contingency employees are different from core staff individuals. Contingency staff members typically prefer flexibility and variation. Therefore, they enjoy working on a variety of units. Contingency resources are often motivated by a higher wage or a schedule that fits easily into their lives.

The starting block to staffing correctly is having the right number of core employees. As hospital systems and units within a facility vary, there is no magic number or ratio of core staff that can be applied across the board. The key for the right amount of core staff is to consistently keep employees working within their FTE commitments with little overtime or cancellations. Core staff should be scheduled based on census data and volume trends, not a level pattern. It is important to keep in mind that core staff will have a portion of their FTE not available for patient care due to the demand elements such as PTO, FMLA, education, and orientation time. Contingency staff is then used to cover for these scenarios.

The size of the organization as well as the fluctuation in volume it experiences will determine the number of layers of contingency resources and how many for each layer is needed to provide effective coverage. Depending on the variables just mentioned, an organization could have as many as seven different layers of contingency in addition to their core staff.

Using a common-sense approach to contingency layering, including utilizing agency staff in line with an organization’s budget, provides the flexibility needed to meet patient volume in a manner that is effective and orderly. It also keeps core staff members engaged and happy as a solid contingency strategy will reduce the need for core staff floating, recruitment for last-minute staffing needs, and overtime.