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HealthStream’s 2026 Trends in Nurse Scheduling report examines how healthcare organizations are managing nurse staffing in an increasingly complex clinical environment, highlighting key gaps in visibility, flexibility, and system integration. Based on survey input from more than 400 professionals involved in nurse staffing and scheduling decisions, the report provides a grounded view of current practices and where they are falling short. It points to persistent challenges such as fragmented scheduling processes, difficulty filling shifts, and the growing impact of burnout and turnover on workforce stability.
During this webinar, HealthStream leaders walk through these findings, framing the report as a reflection of real-world experiences rather than just a set of metrics. The discussion emphasizes how common practices — like department-level scheduling and reliance on manual processes — limit coordination across units and create inefficiencies that strain both nurse leaders and staff. At the same time, presenters highlight areas of progress identified in the report, including the widespread adoption of self-scheduling and the shift toward more flexible, blended staffing models that account for patient acuity and real-time needs.
The conversation then turns to what these trends mean in practice. Speakers explore the operational and human impact of scheduling challenges, particularly the ongoing difficulty of building and filling shifts, which remains one of the most pressing issues for organizations. They also address the expanding role of float pools, the need for better data integration across systems, and the cautious but growing interest in AI-supported scheduling tools. Throughout the session, the focus stays on how organizations can move beyond reactive, unit-level approaches and begin to treat scheduling as a coordinated, system-wide effort that supports retention, efficiency, and high-quality patient care.
Click here to access the full webinar.
[00:01:06] Webinar Tools and Downloading the Report
[00:01:56] Meet the Speakers
[00:05:16] Six Key Findings
[00:07:12] Poll: Staffing Visibility
[00:08:12] Finding One: Managing the Schedule
[00:11:40] Finding Two: Self-Scheduling
[00:16:47] Poll: Acuity in Staffing
[00:18:14] Finding Three: Blended Models
[00:20:08] Finding Four: Filling Shifts
[00:24:20] Poll: Float Pool Structure
[00:25:35] Finding Five: Managing Float Pools
[00:27:16] Finding Six: AI and Scheduling
[00:33:36] Three Big Takeaways
[00:36:25] Final Poll: What Resonates
[00:39:00] Audience Q and A
Disclaimer: This transcription was written by AI, thanks to‚ÄØDescript, and has not been edited for content.‚ÄØ
[00:00:00] Sandra Kent: Hello, and welcome to our 2026 Trends in Nurse Scheduling webinar, where we will be reviewing what 450 nursing professionals have told us about the current state of nurse staffing. We're so glad you've joined us today for this thought leadership webinar.
[00:00:29] Here at HealthStream, we're the leader in healthcare workforce solutions. We help organizations work better through varied products focused on scheduling, credentialing, learning, and clinical development, along with our hStream platform that connects everything through our HealthStream ecosystem.
[00:00:50] My name is Sandra Kent Kent, and I am the senior product marketing manager here at HealthStream, and your moderator today.
[00:01:06] Sandra Kent: Just a few little things. At the top of your console are buttons to display or hide various panels. You can use the reaction buttons, so if you see something you like, let us know with your reaction buttons. You can also download the nurse scheduling report that we'll be discussing today by clicking on Get the Report button listed. And then if you would like to see a demo of any of our HealthStream products, you can also hit the Request a Demo form, and one of our awesome representatives will reach out to you.
[00:01:29] You will also see Ask a Question box on your console, so if you have any questions, feel free to put them in there. And if we have time at the end of today's webinar, we'll be going through them as much as time allows. So we are recording today's webinar, and we will be sending out a link to the recording and a link to the report as well after today's webinar is over.
[00:01:56] Sandra Kent: And I'm excited to introduce you today our speakers, Dr. Emily Brooks. She's a highly respected healthcare leader with a strong background as a nurse leader. She's a former chief nursing officer and currently our VP of onboarding and success here at HealthStream. She brings deep expertise in clinical leadership and driving operational improvements along with, across all -- I'm sorry, across healthcare organizations. Also joining us is Catherine Musclow. She is a registered nurse with a background as nurse manager in critical care and ICU, along with managing and supervising nurse supervisors for a 600-bed hospital. And now she's our editorial director here at HealthStream. Welcome, ladies. And Catherine, I am going to turn it over to you to get us started.
[00:02:49] Catherine Musclow: Thank you, Sandra. Excited to be here. As Sandra mentioned, I'm Catherine Musclow. I'm a registered nurse by background, and I've spent years in critical care at the bedside and in nursing leader. Today, I get to bring all of that experience into my role here at HealthStream as editorial director. And really what that means is I have the privilege of digging into research like this, that we're going to share today and more importantly, connecting the dots. So translating what it really means for the people doing this work every single day. So let's dive in. First, a quick look at where this data that we're going to talk about comes from.
[00:03:27] So in the fall of 2025, we surveyed healthcare professionals across the continuum. So we looked at nurse leaders, executives, nurses, educators, and operations team. And for today's conversation, we're really going to zero in on the over 400 respondents who directly, who are directly involved in both staffing, scheduling, and operational decisions.
[00:03:52] So this group that we surveyed it's broad. It spans acute care, long-term care, ambulatory settings, you name it. We're looking at really these findings in really a narrow slice. So looking at it from a meaningful industry-wide snapshot of what's happening right now. I also want to be transparent though about this data.
[00:04:14] It's self-reported. It reflects perceptions and lived experiences not just audited or not audited metrics. So here's the thing, this is important because those perceptions really matter. Data is super important, and those metrics are really important, but also these experiences. What nurses and leaders share in surveys like this, it's real. It really aligns with what we hear in conversations with amongst each other every single day. So that consistency to me is exactly what makes these insights so powerful but also so actionable. Emily Brooks why don't you talk about the key findings from this study?
[00:04:54] Emily Brooks: Absolutely. Thank you. Hi, everyone. I'm Emily Brooks. I'm the vice president of onboarding and success here at HealthStream. Like Catherine, I'm a nurse, and I'm a nurse with a critical care background, nursing education, nurse leadership, and was a CNO before coming to HealthStream. As a disclaimer, Catherine and I have actually worked together in a hospital before, so we know each other well and we share a lot of the same stories, but not all.
[00:05:16] Emily Brooks: So before we dig into each finding individually, let's take a step back and look at the bigger picture so that you can see all six together, and then the story really becomes clear. And this isn't a story about just technology or staffing ratios. It is a reality about a workforce that's stretched thin, but as we know, incredibly resourceful.
[00:05:36] And it's about the gap between where scheduling practices are today and where they need to go. So our first finding, 57% of organizations are still managing scheduling at the department level, and that sounds like an operational detail, but it's actually the root cause of a lot of other problems because when everyone's managing their own silo, nobody can see the big picture.
[00:05:57] Finding two, 77% of organizations now offer self-scheduling, and that's up from 68% just last year. So nurses are getting much more control over their schedules, and that certainly matters for retention. Finding three, 60% are using a blended approach to staffing decisions, combining ratios, acuity, and manual adjustments for flexibility.
[00:06:20] So we're moving away from the one size fits all, and we are making progress. Finding four, building and filling shifts is still the hardest part of the job, and I'm pretty sure that resonates with everybody. It scores 6.5 out of 10 on difficulty, and with the cost of replacing one RN well over $50,000, it's not just a scheduling problem anymore, it is a financial one.
[00:06:43] Finding five, 81% of organizations manage floating across departments. And finding six, less than 10% of organizations have implemented AI for any scheduling use case. The interest is there, the readiness isn't quite yet. So Catherine and I will walk through these six findings, and we have some interactive polling discussions throughout, so please read them carefully and click directly in your screen, and we look forward to your feedback.
[00:07:12] Emily Brooks: And we're going to start with our first polling question. How visible is your staffing picture across units today? Scale of one to 10, with one being low visibility and 10 being high visibility. And I'll give you some time to ponder, a few minutes, a few seconds, and we'll move ahead then.
[00:07:36] Click right in your screen, on the number there. Okay, looks like we're at about 50% of respondents. Okay, Catherine.
[00:08:12] Catherine Musclow: All right. Thank you. So let's dive a little deeper into finding one that Emily mentioned before. So department-level scheduling leaves blind spots. This is where we really want to start and focus because it's the foundational challenge that makes everything else harder. So here's the picture.
[00:08:29] So there's 57% of the organizations that we surveyed are primarily managing schedule at the department level. Only 17% have a centralized scheduling system, and 21% are using more of a hybrid approach. So now department-level scheduling is probably how most of us have learned to do it. It gives unit managers control, it's familiar, and it works up to a point.
[00:08:55] The problem is that when every unit's managing its own schedule in isolation, nobody has a clear view of the whole organization. Actually, when we surveyed these nurses, we, or the nurses in our report, they found that there was a 5.4 out of 10 visibility score. And I think back to myself, as a nurse leader, one of the things that we often found was that I was on my own island, right? I was worried about my own staff and how I was going to schedule and have enough nurses to schedule and meet my patient needs sometimes even in four-hour increments, while in reality the person or the unit across the hall could have had enough nurses and maybe a low acuity or a low census, and they were getting ready to flex their nurses home.
[00:09:41] Without having that full visibility, it put us in a little bit of a -- it did a disservice to us. And that's really the consequence. Leaders don't know if the unit next door is overstaffed while they're scrambling to fill a hole, and I feel like I can attest to that wholeheartedly.
[00:09:57] Only 38% of respondents said that their scheduling system integrates with other systems. And then when they looked at EHR integration, less than 20% said that they integrated with EHR. So think about what that means. You're making staffing decisions without access to real-time patient acuity data. You're basically flying partially blind. And the downstream effects are pretty costly, so there's excess overtime greater reliance on staffing agency, and burnout all which ultimately chip away at retention We see this play out with health systems all the time. The good news is that organizations don't really have to choose between unit level autonomy and system-wide visibility.
[00:10:41] A hybrid enterprise model can really give you both. Think of it as really like a centralized control tower with local landing strips. House supervisors and service line leaders can see everything, but unit managers would still have the flexibility to manage their teams. So when you tie in float pools, self-scheduling, and incentives into a single integrated platform, you can really fill shifts faster, you can spend less hopefully on premium labor, and frankly, your charge nurse has to stop having to make a 15-minute or 15 phone calls at 5 a.m., or if you're the nurse leader, staying late or working on a Saturday to try to fill those last minute holes.
[00:11:23] I think though the practical first step is to invest in a single source of truth for workforce data, one that will help us integrate our scheduling system with time and attendance credentials, and hopefully HR.
[00:11:40] Catherine Musclow: So for finding two we found this is probably, not really any news to us nurse leaders, but that self-scheduling is really the new standard. It's pretty exciting. Seventy-seven percent of organizations now offer self-scheduling, which like Emily mentioned before, is up from 68% last year, and that's a pretty significant jump in just a year. So when we look at why this really matters, I think the research is pretty clear. Flexible nurse-driven scheduling is directly linked to higher job satisfaction and retention. So when nurses feel like they have a say in their schedule, they're most likely to stay. What's interesting though is the method split.
[00:12:20] So about 49% of organizations are using a healthcare-specific app for self-scheduling, while 46% are still relying on manual spreadsheets or paper. And I feel like I could raise my hand to that. We relied a little bit on both when I was a nurse leader. We had our paper that would sometimes go missing in the middle of the night or go missing the next day.
[00:12:41] And then we would also have an application that we used to help us with our schedule. So both get the job done but they create very different experiences for staff and also have the risks for leaders. One finding that I find really telling is that 70% of the respondents were satisfied with their scheduling operations overall, but only 46% were satisfied with their scheduling software.
[00:13:08] So that gap told me that scheduling processes are ultimately evolving faster than the technology being used to support them. And I think, like we do in nursing we figured out workarounds that, the tools just haven't caught up to. So what I think, my biggest takeaway, is for our nurse leaders today was about self-scheduling, is that offering it is really not enough.
[00:13:31] I think the fairness piece is what really matters just as much as the access piece. And in our conversations with nurses, one of the recurring frustrations that we saw was that yes, it's not that self-scheduling exists, it's that the rules sometimes felt inconsistent or they weren't really clear. Who gets first pick of the prime shifts? Are holiday assignments equitable? When a manager overrides a nurse's selection, is there a clear reason? Because I'm sure all of us nurse leaders could attest to the fact that your nurses are paying close attention to that schedule, and they know who works how many weekends, and they know who worked the last holiday even when we might not pay as close of attention to it.
[00:14:13] In, we do in paper format sometimes but it's not a solid representation and there's definitely some room for error. Organizations doing this though have typically published transparent scheduling rules. So some rotate who gets first access to shifts, or I should say, organizations that are doing this well have published transparent scheduling rules. So who gets first access to shifts, some set like a skill mix constraints that run in the background. And I think for me, if you're going to choose a self-scheduling or a scheduling application, the policy matters just as much as the platform does
[00:14:54] Emily Brooks: So Catherine Musclow, you're making me think back to 25 years ago. When you first start nursing and you get the binder, and it's X'd out certain days where there's enough nurses signed up. And then fast-forward to a hospital where I worked recently, and it was self-scheduling, and we did make workarounds. It was all on paper, but then we had a weekend makeup shift on a piece of paper. We had holidays priorities on a shift of paper or on a piece of paper. We had this on paper, that on paper, and all of it was posted above where you had to sign up for your shifts. So fairness, equitability, yes, we were absolutely trying very hard to incorporate that, but with a very antiquated system and without a whole lot of visibility.
[00:15:36] There was a lot of people pulling it down so that they could see, what is my holiday this year? Somebody else can't see it. So that, that really resonated pretty strong still in, 2026, the use of manual and paper. But then having all those rules and having visibility in a system and how much easier that could make it, so that you could go in and see, hey, I was sick last weekend with a stomach bug. I have to make up my weekend here. Perfect. That's done. I don't need to worry about it. It's already assigned. That flexibility, especially for nurse leaders then, so that we're not doing the firefighting an hour before a shift when we realize we don't actually have any nurses on the unit, which is also a very real reality
[00:16:18] Catherine Musclow: Yeah I was thinking, Emily, you said 25 years ago the paper was X'd out, but I would guess that people are probably still using that same practice.
[00:16:26] Emily Brooks: I would think so, yes. Yeah.
[00:16:47] Emily Brooks: Okay, our next poll question, and this time we will get an answer. Which model most accurately describes how your organization incorporates acuity into your scheduling and staffing decisions? So you've got a lot of answers here. We'll take a few minutes, read through it carefully and, give your best, honest answer that you can.
[00:17:49] Okay, it looks we're at, it looks like we're just above 50%. And so a mixture of ratios, acuity, and manual seems to have won. And that's actually pretty consistent with what our nursing trends report showed as well, especially with ratios and acuity, and then the mixture of ratios only coming in close behind
[00:18:14] Emily Brooks: So let's talk about finding three and our blended schedule models, and they're rising. 60% of organizations, and we just saw this in the poll, are now using what we're calling a blended approach. That means we're combining patient ratios, acuity data, and manual adjustments to really figure out how many people, how many nurses we need on a shift.
[00:18:32] And 47% have specifically implemented acuity-based patient assignments also represented in our poll. So that's progress. That's real progress because we've known for years that acuity-based staffing definitely leads to better outcomes for patients and better experiences for nurses. It's good to see that actually happening in real life, but here's the thing, and here's the reality. Even a well-designed ratio model is static. It's built for the average shift. It doesn't know that you had three unexpected admissions at 11 on a busy med surg floor, or that suddenly you need a patient in the ICU with ECMO, or that your patient population has gotten significantly more complex over the past six months.
[00:19:13] So yes, ratios matter, but readiness, the right skills, right place, right time are really what's needed for the best nurse experience and patient care. And so regulatory bodies are catching up to this. We know there's a lot of scrutiny around the link between staffing and patient safety, and that is only increasing. So this is no longer just a conversation about workforce. It is also becoming a conversation about compliance. And so look at your models in your hospital. Reflect a little bit on those poll answers. Which shifts consistently feel understaffed even when you're technically at ratio? And that's your signal.
[00:19:48] That's where a blended approach could and would make the biggest difference. And what does that blended approach look like for your organization? So that's the thought process that we really need to continue to advance our scheduling models and our scheduling practices.
[00:20:08] Emily Brooks: So finding four, building and filling shifts is the biggest challenge, and this one I think is very familiar to everybody. So we asked leaders to rate their biggest scheduling challenges on a scale of 1 to 10. The overall difficulty of billing and building and filling shifts came in at about 6 1/2. And do you know, I'll be honest, when we were discussing this, I think that number is really conservative because what's underneath is completely exhausting.
[00:20:34] The back and forth, the last minute scrambles, the firefighting, the charge nurse, like Catherine said, who's making 15 calls before 6 a.m. trying to find coverage for the 7 a.m. shift, that night shift nurse who went home to sleep and their phone is just constantly vibrating or dinging. You're on vacation and your work bestie is calling, begging you to come work, forgetting that you're on vacation.
[00:20:57] And so there's a lot of feelings here. There's a lot of emotion. And every leader I talk to knows exactly what this looks like, just as every nurse knows exactly what it feels like. And so here's the financial reality. It costs on average about $60,000 to replace one registered nurse, one. And so for every one-point drop in turnover rate, organizations then save close to $300,000.
[00:21:21] So when we're talking about this as a scheduling problem, and we're trying to make it a strategic problem, we're also talking about it as a very real financial problem. And the thing that we don't often talk enough about is why people leave. And, Catherine mentioned this in the very beginning, a lot of this traces back to the schedule.
[00:21:38] When nurses feel like they're being called in at the last minute, guilted into overtime, either by their nurse manager or their bestie, or floated without their input where they may not feel they have the best competency, that's where disengagement starts. And that's, that schedule then is often where respect shows up or doesn't.
[00:21:57] So practically thinking, we know three things that would make the biggest difference. We know these, and we know them well. Number one, post schedules further out. That gives people greater visibility and greater control over their lives. And two, be transparent with shift incentives. People are more willing to pick up when they know what's in it for them.
[00:22:15] Three, invest in predictive data. If you can see and you know which shifts are likely to go unfilled a week in advance, you're then in a proactive state rather than reacting in a panic. So think about visibility, think about predictability, but also we can't forget burnout, because we always have that one nurse who will always pick up whenever asked, driving towards burnout.
[00:22:38] And so this is why nurse leaders are telling us that this is one of the biggest scheduling challenges.
[00:22:46] Catherine Musclow: Emily Brooks, I was just thinking before you jump to that poll question that, that last piece, the burnout piece, it's, as a nurse leader, I think post-COVID, we're probably all thinking about burnout and the mental health and the wellness of our nurses.
[00:23:00] But I think even pre-COVID, while we were still thinking about the burnout and, how our nurses are feeling and, where their kind of mental state is, it wasn't as much, at least in my opinion, at the forefront our, of our minds. So having a tool that would give me some type of data to say, "Hey, Emily has worked consistently, 60 hours a week or 50 plus hours a week every week for the last three months," like you need to check in on that person. Because I think oftentimes we're so bombarded as nurse leaders with just our day-to-day that we're -- not the last thing, the schedule's extremely important, but it's another thing on our plate that we have to manage.
[00:23:42] So having just the visibility of understanding where and how many hours a week your nurses are working, I think is super important and also can help with that burnout piece.
[00:23:54] Emily Brooks: And yes and yes, and it's the burnout piece with the nurses. It's also the burnout piece with our nurse leaders, and not having the tools at hand to be able to be proactive with scheduling. Maybe not having, I can see in the comments, an acuity tool to really help build that schedule with ratios, with acuity, and then being able to flex appropriately. So yes, we have very real burnout with our clinical nurses at the bedside, but we also have a compounded burnout with our nurse leaders, so 100%.
[00:24:20] Emily Brooks: And here is our poll question. I'm glad we stopped here, gave people a little bit of a jump to start putting their answers in. So how are your float pools organized? System-wide; by care setting, think med-surg, ICU, labor and delivery; region-wide; or maybe you don't have a float pool.
[00:25:04] Fifty percent is my magic number. Okay, the results are in. Looks like care setting wins, followed by system-wide, followed by no float pool, and region-wide. So this is a little bit different. This is very interesting that when I had a group of HealthStream users in a room, we talked all about this. So this is why it's so important to actually do these polls and then have some discussion around them. So what did our report tell us?
[00:25:35] Emily Brooks: Finding five is all about float pools, and there's a lot of good news here. But there's also a few numbers that actually made me step back and think a little bit. So 81% of organizations manage floating across departments. Sixty-two percent in our Nursing Trends poll have centralized float pools, and 39% run them out of a central staffing office.
[00:25:55] And so all of that seems to be heading in the right direction. But, here's the thing. Only 34% of organizations automatically exclude staff from a shift when their credentials or competencies have expired. So that's nearly one in three said they weren't even sure if their system does this. So suddenly, yes, we don't just have a scheduling issue, but now we have a patient safety issue, a liability issue.
[00:26:19] We want to be, and we need to be confident that we have the right nurse at the right time with the right patients. And so more broadly, think about whether your float pool governance has kept pace with how much that float pool has grown or changed over the years. Scaling the pool is the easy part.
[00:26:36] Maintaining visibility, competency standards, and safeguards, that's the harder work. And so a good starting question is, do you know today which of your nurses in your float pool have credentials or competencies that may be expiring in the next 60 to 90 days? And if that answer isn't a quick yes, then that's where I would start investigating. Do you have the technology? Do you have the scheduling system with those competency standards, visibility, and safeguards? And how are we driving towards that very best nurse experience delivering safe patient care?
[00:27:16] Catherine Musclow: So now I'm going to bring it to our last finding, which was AI integration. So AI integration is growing, but adoption is still lagging. I want to be transparent. In my opinion, AI is only as good as the data behind it, and really the people using it. So what we found was that right now less than 10% of organizations are actually using AI for scheduling in any meaningful way.
[00:27:42] So that includes everything from building the initial schedule to predicting open shifts rebalancing based on patient needs or acuity supporting fair scheduling, and then even making recommendations based on competencies. So Emily was just mentioning do we have visibility into our floor nurses? Do we know if their competencies are up to date, or am I scheduling someone that I think might be or think is ECMO certified but actually is not, or maybe they didn't recertify or they're not up to date on their competencies? So all of that showed us that still we have under 10% of our organizations using AI.
[00:28:23] So when we asked leaders really why the answers were pretty clear. About 77% pointed to immature AI tools. 47% said that cost was a concern, and then 40% cited that there was regulatory uncertainty. And in my opinion, those aren't just excuses, they're real valid concerns.
[00:28:46] But what's interesting was that when we asked those same leaders about their priorities, so improving scheduling so one of the questions we asked, sorry, was improving scheduling efficiency, and that scored three point nine out of five. And then using technology to reduce workload came in at three point seven.
[00:29:04] So what we saw there was that the desire is there but the readiness just hasn't quite caught up yet. So the question we ask ourselves really, or we can ask ourselves, is: where does that leave us? And I think there's a really practical, responsible path forward. It doesn't mean going all in on AI tomorrow. It starts with data, because the truth is, like I mentioned before, that AI is as good, it- or is only as good as the data it has access to. So if our scheduling system isn't connected to your time and attendance system or your HR platform or your credentialing data it's missing that critical context, so it can't really see that full picture.
[00:29:45] So I think that step one if you were going to try to adopt AI, it's really that integration piece. Step two is starting small with a very specific measurable use case. So maybe it's using AI to help you predict open shifts a week out or identifying fairness gaps in how schedules are assigned. Start there and then measure the impact. Look at your hour saves your reductions in premium labor costs. But also that will all
