Bill Klaproth (Host): This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. And with me is Khaled Nasr, COO of Medely, as we talk about Understanding the Illusion of "Fully Staffed." Khaled, welcome.

Khaled Nasr: Thank you for having me, Bill. I'm excited to be on.

Host: Absolutely. Good to talk with you. So, I know that you've worked closely with nurse leaders for years. Many say they're fully staffed, yet still feel behind or over budget. Why is the traditional definition of fully staffed no longer working?

Khaled Nasr: I think, traditionally, being fully staffed meant having enough full-time employees on the schedule. But the issue is that healthcare demand itself doesn't work that way anymore, you have patient census, you have seasonality, and you have these last-minute callouts that create constant fluctuations that a static staffing model really can't absorb. So even when the schedule looks full, teams still feel stretched. And the leaders still feel like they're playing defense every day. And what happens is that staffing model becomes based on headcount instead of actual demand. And when demand spikes, the only lever that these leaders have left is to stretch the full-time team through overtime. And then, that creates the idea or the cycle where fully staffed becomes more of a staffing illusion than a true operational reality. And then, the end result is higher labor costs. You get more burnout and less predictability even when you believe that you have a strong-looking roster.

Host: So then, what are the hidden costs of relying mainly on full-time employees to cover all staffing needs?

Khaled Nasr: I think it ties to what I just mentioned above, and one of the biggest hidden costs is that full-time labor is fixed, but the demand itself is not. So when volumes drop labor costs, they don't come down. You still have those benefits, you have guaranteed hours, and you have other fixed expenses. And when volume rises, the easiest solution becomes overtime, which is expensive and hard to unwind once it becomes a normality at the company or at your location. So when you do it once, overtime stops being a short term solution and turns into a recurring operational expense, then the bigger cost is what happens to your workforce.

As you get burnout, it builds more and more, and then you get less engagement and you get more turnover at your facility. And we all know that replacing experienced nurses costs more than organizations even realize, not just in the cost of recruitment, but in the training time, the loss of productivity, and even the time of the leadership that's involved. And when turnover rises, that unit itself becomes less stable, which puts even more pressure on the nurses who are remaining.

Host: Yeah, absolutely. So, I'm curious, how can nurse leaders balance continuity of care with a diversified workforce model then?

Khaled Nasr: Continuity of care is often misunderstood as only coming from full-time staff. And we see that a lot at Medely. But in reality, it comes from strong leadership, clear standards, and a reliable set of systems. So, core staff still have to anchor the unit. They set the expectations, they set the culture, and then they set the clinical norms of the facility. And that part itself should never be compromised, and it's what keeps the quality consistent. So, a diversified workforce is about adding flexibility around that core and not replacing it. So when flexible clinicians are integrated the right way, they can actually support the continuity by reducing stress on the overall core team.

And if workflows, for example, documentation expectations and unit readiness are consistent, the patient experience stays consistent also. So really, the key is to build this trusted, repeatable pool like our Medely platform provides, which we call the Favorites List, which thousands of facilities use every day and honestly burned out full-time staff are often a bigger risk to continuity than supplemental clinicians who are set up for success.

Host: So, that's really interesting. You're talking about building that trusted repeatable pool. Are there technologies then or workforce practices that can help leaders more effectively deploy diverse staffing resources?

Khaled Nasr: You know, I think you nailed it with that question. And I think the key word there is technology. You have organizations that need to move away from paper and pen as well as these static schedules and move more towards demand forecasting technologies that account for census, acuity, and historical trends, and then ties that to your workforce and their schedules in the most efficient way.

And I think that's a major shift, because it allows leaders to staff proactively instead of reacting at the last minute. So, for example, at Medely, our customers are using our Talent Fusion platform, and that allows them to use these tiered staffing workflows that prioritize their internal staff first, then they can waterfall to their Medely favorites pool that I mentioned, and then ultimately to the broader marketplace of healthcare talent when needed.

So, the key is really having one centralized system like Talent Fusion to manage all the labor sources, both internal and external. It's becoming more important because those staffing decisions are way too complex and hard to manage across spreadsheets and these disconnected tools that far too often facilities are using. So, the real-time insight into the labor costs before the shifts are filled allows those leaders to make really smart decisions earlier on in the process itself.

Host: So, managing a workforce and staffing decisions, obviously, that takes a lot of time, and this is a big topic. We talk about this a lot and we hear about flexibility in scheduling. So, what are the biggest mistakes organizations make when they try to introduce flexibility into their staffing model? We know it's for the right reasons, but sometimes it might not work out right. Is that correct?

Khaled Nasr: Absolutely. And I think a common mistake is treating flexibility as a last minute fix rather than a deliberate strategy itself. So if flexibility only shows up when the unit is already in crisis mode, it will always feel chaotic and expensive.

I think another big mistake is leaning too heavily on full-time staff and the overtime aspect of it. Instead of building those true flex capacity. Often, overtime feels like the easiest solution in the moment, but it's one of the fastest ways to drive burnout and long-term instability within the facility.

I think also a lot of organizations don't define really clear guidelines for when and how flexible staff should be used. So, every unit ends up doing it very differently. Some use flex labor either too late, some use it really early, and it becomes inconsistent and really hard to manage. So, using multiple disconnected labor sources can also create these fragmentation, and it hurts continuity. It also increases administrative work for a team that's already stretched thin, and it makes it hard to measure true performance.

But a product, again, like I mentioned, Talent Fusion, as I mentioned earlier, uses your inputs that you established early on. And it allows the technology to actually orchestrate the proper staffing ratios and the staffing mix.

And I think one last thing is I think success is often measured by fill rate alone, but it's more important to look at whether labor costs are improving and whether burnout is decreasing and if the staffing model is becoming more stable over time.

Host: Yeah. Really good thoughts on that. So for someone listening to this, Khaled, can you give us a few immediate steps that leaders can take maybe after this episode to begin shifting their staffing strategy?

Khaled Nasr: Absolutely. I think the first step is to start within, you know, understand where the variability actually exists, which units, which days, which seasons are driving the most stress within the staffing. I think most leaders already feel it, but mapping it makes it measurable and actually actionable. From there, it's important to identify how much of that variability is currently being absorbed through overtime. And that's usually the clearest signal that full-time staff are being used as the buffer itself.

And then, next, instead of waiting for shortages or surges, you use technology like Medely to build small, intentional groups of flexible conditions to cover the predictable peaks and then manage your internal staff. So even a modest flex strategy can reduce overtime and instability and improves the stability within the facility schedule fairly quickly. And I think it's important to align nursing and finance and staffing leaders around a shared success metric. Because if it's only one team really that's optimizing the cost and another team is optimizing for coverage, you'll stay stuck in the same cycle. So, the whole goal really is to build a model that protects care quality while making staffing more sustainable.

Host: I love that. So start within, identify over time, use technology, manage your internal staff, and then align around shared success. So, really good advice, Khaled. This has really been fascinating and an important issue. Before we wrap up, I'd love to ask you, is there anything else you want to add?

Khaled Nasr: Yeah, I think one of the most important things is really embrace technology. I know sometimes it's harder for facilities to start embracing technology the way it's supposed to be done. But I think, by mapping some of the inefficiencies within the facilities and then seeing what's out there that's there to support them, not change the way they do things, but really optimize and make the facilities a lot more efficient, it's a critical aspect of healthcare today. Far too many facilities held back on it, and technology is really taking over at this point. And you have to start embracing it as soon as possible. And I know even stuff like AI is scary. But if you map it out the right way, if you find really quality solutions, you'll be shocked and surprised and amazed that the lift that it can do in terms of the workload, where you can now start focusing more on what's more important to you, which is the patient.

Host: Yeah, that's really good. Embrace technology, mapping out inefficiency is always a good idea. And it'll help you find those quality solutions. Khaled, thank you so much for your time today. This has really been interesting.

Khaled Nasr: Absolutely. Bill, thank you so much for having me. I really appreciate it.

Host: You bet. And once again, That is Khaled Nasr. And this episode is supported by Medely, a workforce orchestration solution designed to help healthcare leaders align staffing with real-time demand. Medely enables visibility across internal and flexible staffing resources, assisting organizations to improve coverage decisions while managing labor costs more effectively, just like those things we were talking about on this podcast.

To learn more, just go to medely.com. That's M-E-D-E-L-Y.com to get started. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you at aonl.org. This is Today in Nursing Leadership. Thanks for listening.