Complete Guide to Nurses’ Schedules in Healthcare

HR professionals in the healthcare industry face significant nursing staff scheduling challenges.

You need to balance your requirement for nursing staff available and scheduled 24/7 around the clock with the individual needs of your workforce.

To avoid your nurses burning out, you need to invest time into creating the best schedule for your unique workplace and staff needs.

In this guide, we’ll walk you through the different types of nurse schedule examples available to you. Look at the pros and cons of each and answer the most important questions you’ll have when you’re working on your nursing staff schedules.

Table of Contents

• How many hours a week does a nurse work?
• Common types of nurse schedules
• Self-scheduling for nurses: pros and cons
• FAQ

How many hours a week does a nurse work?

The number of hours per week that a nurse works will depend on their contract and the type of workplace.

For example, a nurse in a general hospital will typically work longer shifts and more total hours per week than a nurse working in a small private healthcare facility.

That said, the majority of nurses work on either 8, 10, or 12-hour shifts for 3, 4, or 5 days per week.

Most full-time nurses will work for around 35-48 hours per week, depending on your unique workplace.

Common types of nurse schedules

Why nurse staff schedules differ from other industries

Employee scheduling in healthcare is a significant challenge.

Nurses are expected to commit a large number of hours, and, because it’s care-related, hours can vary due to urgent situations that can’t be left without a member of staff managing them.

This has led to a wide variety of nurse schedules being adopted by healthcare companies, each with its benefits and drawbacks.

Let’s look at some of the most common nurse schedule examples below:

1. 12-hour shifts

The first common nurse schedule example is 12-hour shifts 3 days a week. You might also see it referred to as “three-twelves” for short, or a 3 on 3 off schedule.

12-hour shifts 3 days a week is a standard nursing schedule for practices that need to serve patients 24/7 because you can have one team work from 6 AM until 6 PM, then have a night shift team come into work from 6 PM until 6 AM.

That shift repeats continuously, so there’s always a full team at work.

After three days at work, the teams that worked can take three days off, and another shift of nurses will work for the next three days to replace them.

If you think a 12-hour shift is right for you, you can use our free template to help create your shift pattern.

Benefits:

• Your team gets to have multiple days off in a row, which is good for work-life balance and avoiding burnout.
• It’s simple to manage as you know who will be working on each shift.

Drawbacks:

• A 12-hour day can quickly extend into working 13+ hours because nurses in the middle of urgent work can’t clock off the moment their 12-hour shift ends, which can negate some of the work-life balance benefits.
• Nurses will need to work weekends so it can be an issue if many of your team have children or weekend commitments that they need to take care of.

2. 4 on 4 off 12-hour schedule

A 4 on 4 off 12 hour schedule is a shift pattern where nurses work for four consecutive days (or nights) on 12-hour shifts.

After working four days in a row, they have four days off in a row.

The shift pattern rotates, so one week someone may work Monday, Tuesday, Wednesday, and Thursday. Then, they’ll be off work until Tuesday, when the four days in a row restarts.

It’s a common nurse schedule example and manufacturing employee schedule example with some unique pros and cons. 

Benefits:

• Nurses get four consecutive days off, which gives them time to reset after four days at work.

Drawbacks:

• It can be hard to have a good work-life balance due to long days at work.
• The schedule means the days at work are regularly changing, so it’s hard to build a good routine.

3. Four 10-hour shifts per week

Four 10-hour shifts per week or “Four tens” for short, is a schedule that offers some flexibility as the shifts can either be consecutive or spread apart over the week.

For example, a nurse might work on Monday and Tuesday, have Wednesday off, then work on Thursday and Friday before taking the weekend off.

You can have nurses working this shift pattern on day shifts, or on night shifts.

Benefits:

• More manageable days than a 12-hour shift which may increase staff motivation when they’re on the job.
• Nurses get multiple days off per week so they can have a healthy work-life balance, so it’s often preferable to a standard five-day workweek.

Drawbacks:

• You can’t easily rotate between two shift teams on four tens, as you’d have hours without staff.
• The reduced hours per day mean nurses need to work for an extra day compared to nurses on 3 on 3 off schedules.

4. Five eight-hour shifts per week

This is the traditional work schedule for ‘nine-to-five roles.
It’s often used in private healthcare practices rather than in large or busy hospitals.

Most five days, eight-hour shifts per week schedule don’t require nurses to work on the night shift either, making it an excellent option for nurses with families who want a predictable schedule.

Benefits:

• Allows nurses to work on a regular schedule without any long days.
• Doesn’t require teams to work the night shift or regularly rotate.
• Gives your team predictability and stability.

Drawbacks:

• Requires nurses to be at work for five days per week which can reduce their work-life balance.

5. PRN shifts

PRN stands for Pro Re Nata – Latin for “as the circumstance arises”.
In a nutshell, this means nurses work as and when they are needed and don’t have a fixed schedule.

It’s commonly used by hospitals or healthcare groups with multiple locations as nurses on a PRN schedule can be called in by any of the locations to address staffing shortages or short-term capacity challenges. 

Benefits:

• Gives nurses who can’t work a full-time role more flexibility and a way to earn income.
• Gives HR teams a way to address potential staffing shortages with on-call employees.

Drawbacks:

• Unpredictable for nurses because they’re never certain of when they’ll be working.
• Hard to plan ahead.
• You may reach out to someone and discover they’re unavailable at the requested time.

Self-scheduling for nurses: pros and cons

Self-scheduling for nurses is a system that allows your team of nurses to have control over the shifts they choose to work, as long as they fit within certain guidelines set by the HR or management team.

For example, the HR team might set guidelines around hours someone can choose, and the qualifications required to work on a particular shift. But from there, individuals can pick and choose when they work as long as they fit the guidelines.

HR will then approve the shift and the schedule is set.

There are pros and cons to self-scheduling for nurses. Let’s take a look at them.

Pros of self-scheduling include:

1. Flexible scheduling that works for everyone

Self-scheduling gives nurses flexibility that’s hard to emulate in fixed or assigned schedules.

This makes it empowering for employees, as they can proactively build their own schedules around their life. 

For example, Evolia’s auto staff scheduling means a nurse can quickly see what shifts are available, check their calendar, and pick the ones that suit them. 

In the long run, this added flexibility can lead to reduced cases of burnout and improve employee engagement.

2. Lowers absenteeism as nurses can proactively choose shifts

If nurses are forced into working shifts that they can’t manage, you’re going to see high rates of absenteeism and burnout.

The nursing industry sees average turnover rates of 8.8 % to 37.0% depending on the location and skills required, so it’s a serious problem for employers. 

Source: Statista – Registered nurse turnover rate

Self-scheduling can reduce absenteeism because nurses who choose their own hours will feel more committed to working those hours.

It’ll also reduce burnout because your nursing team won’t be cornered into working long hours that they can’t manage to balance with other commitments.

3. Reduces scheduling friction as the process can be automated with software

Even when nurses are working on fixed and predictable shifts, people will still need days off for personal reasons.

This is a common scheduling problem, and there’s no simple solution to it.
When a nurse needs to swap a shift, they’ll need to call their manager, request time off, and wait for someone to confirm that they can replace them.

 If the replacement is approved, the manager will let the nurse know they can take their requested time off.

With an online workforce management platform like Evolia, nurses can easily request or swap a replacement based on their own custom set of rules.

4. Saves time for both HR and employees when scheduling

Managing a nursing schedule at a busy hospital or clinic is a time-consuming process for HR teams.

If you don’t have a clear process in place you’ll spend hours managing shift schedules each week.

Self-scheduling removes some of the burden of that from the HR team and empowers employees to control their own schedules.

This frees up HR managers to focus on higher-impact and high-priority tasks.

Cons of self-scheduling include:

1. Adjustment time is needed as your team switches to a new platform

Migrating to an employee scheduling platform requires teaching your team a new way to manage their schedules.

No matter how intuitive a platform is, training will be required and that takes time and investment from HR and employees.

Expect your team to have questions about how the process works during the first couple of weeks.

However, as they learn the platform the number of questions will drop off and your team will appreciate the newfound control they have over their schedules. 

2. Feelings of unfairness if some employees have less flexibility

Your team of nurses will be made up of individuals with varying qualifications and skills.

Some may be required to work more hours than others, or be needed on shift at specific times to fill skill gaps.

That can lead to members of your team feeling like they’re being unfairly treated, as they don’t have the flexibility that other team members have.

The main way to overcome this is with clear communication. You may also need to consider additional compensation for employees with in-demand skills that are required to work on a fixed schedule. Otherwise, they may look to move to a new company.

Bottom line

Despite some cons, it’s safe to say that the pros greatly outweigh them. 

A recent study on nurses reveals how self-scheduling options increase job satisfaction and promote a healthy work/life balance.

In the long run, decreases absenteeism and increases retention.

With the implementation process being the main challenge, finding a self-scheduling platform that offers free weekly onboarding sessions like Evolia can help you and your team each step along the way.

Conclusion

Nurse schedules in healthcare can be challenging to manage for an HR team.

For starters, you have a workplace that requires potentially 24/7 staffing. Then, you have a large team with different needs both at work and out of work.

Finally, there’s a lack of best practices because all healthcare facilities have different requirements, so you need to work out your scheduling problems for yourself.

The nurse schedule examples we’ve looked at in this guide are an excellent starting point.

If you combine these with a self-scheduling system through a platform like Evolia, it won’t be long before you’re managing your nursing schedules with ease.

Frequently Asked Questions (FAQ) About Nurse’s Schedules in Healthcare

What is block scheduling in nursing?

Block scheduling is a schedule that’s set in advance that provides a nurse with the days and hours they’ll need to work.

The main benefit to block scheduling in nursing is that an HR team can forecast staff availability with a 1-2 week head start.

If any staffing gaps come up, they can reach out to staff on a PRN contract who might be able to step in.

Alternatively, they could let their team know that there are open shifts available and if someone is free, they can book extra hours in their self-scheduling software.

Do nurses have weekends off?

The answer to this depends on your location and local laws.

In some countries, regions, and cities, it’s required that nurses get a certain number of weekends off in a certain time period.

For example, in Quebec, nurses are required to have one weekend off every two-week period.

Wherever your company is based, make sure to review your local regulations before choosing a shift pattern that can affect your staff’s weekends.

Either way, the most common nursing scheduling patterns will usually rotate on a weekly basis, which inevitably means that your nurses will get at least one or two weekends off per month. 

Do nurses pick their schedules?

Nurses can pick their schedules, in some cases.

For example, if their employer uses a self-scheduling system, nurses will have a degree of flexibility and the ability to choose their own schedules.

If self-scheduling isn’t available, nurses might still have the option to decide if they want to work day or night shifts and good employers will make an effort to cater to individual needs.

What are on-call shifts?

On-call shifts are any shift that someone is required to work that falls outside a nurse’s regular schedule.

For example, if a nurse is working on a 3-on-3 off schedule but then gets a call to come into work after only having two days off, that would be an on-call shift.

Not all nurses work on-call shifts. It depends on the employer, the employment contract in place, and the type of schedule that a nurse is on.

Nurses working a PRN schedule will typically work on-call shifts as they don’t have fixed hours.