Resources for Achieving Sustainable Labor Cost Savings in Nursing

Rising Above the Bottom Line Toolkit

Unit Outcomes

Health care organizations around the world are faced with increasing financial pressures, with no end in sight. As a consequence, hospital executives often turn to the largest portion of their budget—nursing labor—when making cuts. Yet, evidence shows that cutting costs through elimination of nursing positions comes with great risk to patient safety and quality of care.

This toolkit is designed to help nursing leaders find quality-conscious answers to the cost cutting mandate. It includes best practices, resources, and tools to better match staffing to patient demand and reduce labor costs while safeguarding nursing personnel.

Download the toolkit overview

Note: This toolkit was originally created for members of our Global Centre for Nursing Executives. While it was developed with an international audience in mind, the tools and practices are applicable to U.S. organizations.



4 steps to achieve sustainable, nurse-led cost savings


The tools below are structured into four steps to help nurse executives better match staffing to patient demand and reduce labor costs. Each step includes a brief introduction along with relevant tools and templates, implementation guidance, case studies, and other resources to help nurse executives achieve each of the steps.

  1. Establish Cost-Effective Safe Staffing Targets
  2. More Precisely Match Staffing to Predicted Demand
  3. Embed Flexibility to Respond to Unexpected Mismatches
  4. Fully Leverage the Skills and Training of Each Care Team Member


Step 1: Establish Cost-Effective Safe Staffing Targets


Budgeting and Staffing Introduction

Measure Patient Demand

Understand Patient Turnover and Workload Demands

  • Tool: ADT calculation sheet
    Use our calculation sheet to measure patient ‘churn’ or turnover and the workload associated with it.

  • Toolkit: Review our ADT Efficiency Toolkit
    Access this toolkit for resources on more efficiently managing patient throughput while addressing workload concerns of frontline staff.

  • Resource: Overview of nursing workload assessments
    Review this overview for our recommendations on implementing a workload assessment tool and a summary of key factors that an effective workload assessment tool should measure.

Calculate HPPD and Labor Costs



Step 2: More Precisely Match Staffing to Predicted Demand


Improve Current Scheduling Practices

Embed Flexible Shift Structures and Patient Placement Practices

  • Case Study: Flexible Shift Patterns
    Learn how one organization in the United States reduced wasted staff capacity by re-structuring their process for patient allocation and assignment.

  • Tool: Patient Placement Algorithm Cheat Sheet
    Follow the guidance in our cheat sheet to develop and utilize patient census goals to avoid the “partial people” math that leads to wasted staff capacity.


Step 3: Embed Flexibility to Respond to Unexpected Mismatches


Equip Managers to Track and Calibrate Daily Staffing Levels

Build Robust In-House Alternatives to Premium Labor

  • Case Study: “Floater” support system
    Learn how one organization in the United States built a robust nursing float pool and developed a comprehensive support system to help retain float pool staff.

  • Tool: Float Pool Calculation Sheet
    Use this calculation sheet to determine the number of staff you will need to recruit to your float pool.

Improve Float Pool Support System



Step 4: Fully Leverage the Skills and Training of Each Care Team Member


Optimize Skill Mix Based on Unit-Level Needs

  • Case Study: Unit-level modelling
    Learn how one organization in the United States used a time-and-motion study and computer simulation technology to determine the appropriate skill mix for their units.

Better Utilize Support Staff to Fully Leverage RNs



Reinforce Top-of-License Prioritization

  • Resource: Achieving Top-of-License Nursing Practice
    Read our 20 best practices for ensuring frontline nurses have the time and interprofessional support they need to practice to the full extent of their training and skills.

  • Case Study: Customized care teams
    Learn how one organization in Canada took a structured approach to re-defining their staffing model and embedding bundled practices to prevent staff from slipping back into old habits.

Download the toolkit overview

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