Agency and contract staffing exist for good reasons. They cover vacancies, fill gaps during surges and keep buildings safely staffed when permanent hiring cannot keep up. But heavy, long-term reliance on agency staff can affect cost, continuity of care and team morale. Leaders who want to reduce it need to understand why they use it before they decide how.
Start with a clear picture of use
Gather a few months of data and look at:
- Agency hours by role and department
- Agency hours by shift and day of week
- Share of total worked hours that come from agency
- Agency cost per hour, compared with employed staff cost, including overtime
- Duration of use, such as how many weeks a given gap has been covered
- Which units depend on agency most
This view separates short-term fill-ins from chronic dependence.
Ask why before asking how
Agency use usually reflects one or more underlying causes.
- Open positions that have not been filled. Recruiting speed, pay competitiveness and local labor markets all play a role.
- Turnover. Positions open up repeatedly. Look at when people leave, such as in the first ninety days, and what they say.
- Scheduling design. Schedules that are inflexible or poorly matched to demand create gaps.
- Call-offs and absences. Gaps arise day by day.
- Census and acuity changes. Demand rises faster than permanent staffing can adjust.
The data can show where and when agency is used. It cannot, by itself, tell you why people left, why applicants declined or what a unit's culture feels like. Pair the numbers with conversations.
What the data can do
- Quantify the dependence, so the conversation is based on facts.
- Show patterns, such as agency use concentrated on weekend nights.
- Compare options, such as the cost of additional per-diem staff against agency hours for a given gap.
- Track progress, by showing the trend as recruiting and retention efforts take effect.
What the data cannot do
- Explain motivation. Exit interviews, stay interviews and frontline conversations fill in the story.
- Account for quality and fit. Some agency staff are excellent and some placements are better than others.
- Guarantee a result. Reducing reliance takes time and depends on the local labor market.
Build a realistic reduction plan
Prioritize by impact and feasibility
Start with the gaps that are both costly and fixable, such as a recurring weekend shift or a unit with a handful of open positions. A focused effort on a few areas can show results.
Combine several levers
- Recruiting and onboarding: speed up hiring steps and make onboarding supportive.
- Retention: conduct stay conversations, recognize contribution and look at schedule preferences.
- Internal flexibility: build a per-diem or float pool.
- Scheduling: offer more predictable and preferable shift options.
- Shared resources: in a multi-building group, share staff where feasible.
A hypothetical example
Imagine a hypothetical building where agency hours are concentrated on overnight shifts on two units. The data shows the same shifts have been covered by agency for months. The leadership team talks with night staff, learns that several would take more regular hours if the schedule were more predictable, and offers a fixed rotation. They also post the open night positions with clear information about the schedule. Over the following months, they track agency hours on those shifts and the number of regular night staff.
Measure progress without creating a cliff
An abrupt cut in agency use without enough permanent staff creates risk for residents and staff. Set gradual, realistic targets, and monitor care signals such as call-light response and overtime alongside agency hours so you see the effect on the floor.
Pitfalls
- Judging agency use only by cost. Continuity and care also matter.
- Ignoring overtime. Cutting agency can raise overtime, which has its own costs.
- Setting targets without a plan.
- Overlooking onboarding for agency staff, which supports safety and continuity.
Share the story
Let the team know how the building is working to reduce reliance and what it will mean for them: more stable teams, better continuity for residents and more predictable schedules.
Where CarePulse fits
CarePulse can combine agency, overtime and employed hours with call-light and census data so leaders see the full staffing picture. If a clearer view of agency use would help, a demo with your own data is a good starting point.