I met an Uber driver recently who left his job as a nurse — not because he lost his passion for nursing but because he didn’t feel valued for the hours he was putting in.

Another nurse I’ve spoken with struggled to balance the demands of a full-time nursing position with her responsibilities as a caregiver to a sick parent. She ultimately chose contract work over employment while she took care of parents through end-of-life care.

These are signs that the full-time, all-in commitment employment model of past decades doesn’t work for a growing majority of nurses. Contract work can offer nurses the flexibility they need while ensuring healthcare facilities can fill vacancies and support high-quality patient care.

As shift openings occur quicker than hospitals can respond to them all, some organizations are exploring exclusivity agreements with contract nurses to help close the gap. That’s an approach health system leaders may wish to reconsider as they look for ways to strategically respond to nurse workforce gaps.

The Downsides of Exclusivity Arrangements

The pressure healthcare leaders face to close nursing workforce gaps remains intense. Most US states have fewer than 10 nurses per 1,000 people, and a recent survey shows nearly one out of three nurses plan to leave their jobs. The expense of finding a qualified bedside nurse to fill an opening also is climbing. In 2023, the cost of turnover of a hospital-based registered nurse totaled $56,300, on average.

So perhaps it’s no surprise that some hospitals are trying to lock in contract nurses by asking them to sign an exclusivity agreement to work with their organization. Unfortunately, the urge to implement this approach could put off the very nurses a hospital is trying to attract. It could also limit hospitals’ ability to fill bedside nursing shifts quickly.

Exclusivity agreements directly compromise nurses’ desire for greater flexibility. Nurses have one of the most emotionally draining jobs in any industry, yet they struggle with a lack of power over their working conditions and even their own schedules. It’s also important to note that contract nursing shifts don’t just appeal to gig workers.

Most short-term staffing needs occur within 48 hours of a shift start time (55%, in our experience). What happens when a hospital is unable to find the right match among contract nurses who have signed exclusivity agreements? That leaves the hospital in the unenviable position of reaching out to nurses who may have heard about the hospital’s exclusivity arrangements and aren’t certain the organization would be a good match.

Developing a Strategic Nurse Staffing Response

The truth is that when a contract nursing arrangement works for both sides, no one will need an exclusivity agreement to keep a nurse coming back. Rather than trying to solve for short-term conditions of volatility with exclusivity agreements, hospital leaders might instead find value in diversifying their staffing pools. Here are two pragmatic approaches to consider.

The most effective nurse staffing models recognize that there isn’t a one-size-fits-all model to attract the right talent to meet patient needs. Think about flexible labor as an investment. We’ve found that filling 10 to 15% of open nursing shifts with 1099 nurse support over the course of six months not only reduces turnover rates and the risk of burnout but also decreases nurse vacancy rates by 27%. That is meaningful cost reduction for teams that are constantly searching, retaining, hiring and training new nurses.

Hospital leaders should consider posting open shifts and allowing available nurses to select what best suits their needs and interests, according to their expertise. This approach holds stronger appeal for nurses than signing on for a series of shifts over a specific time period. It allows for changes in personal schedules, like when a child’s choir concert falls in the middle of the week, schools close for teacher conferences or an elderly parent’s specialist visit requires an afternoon of travel. Ultimately, expanded flexibility gives nurses a feeling of greater control over their schedules—key to personal satisfaction and reduced feelings of burnout.

By viewing nurse staffing plans with more elasticity as opposed to requiring exclusivity, hospital leaders can better position their organizations to close inevitable nursing workforce gaps while generating better outcomes for patients, staff and their organization’s bottom line.