The quality of clinical workers in nursing homes has improved in 2026 as more temporary workers have transitioned into permanent roles, driven by higher wages, better benefits and greater career opportunities, according to leaders at these organizations.
At the same time, as the skilled nursing workforce has stabilized over the past year, major providers have reduced their reliance on agency staffing this year. For workers who value scheduling flexibility – a key priority for many in the long-term care nursing workforce – this shift could mean fewer opportunities for such workers.
Not necessarily, say providers who anticipated this demand for flexibility and are now reaping the long-term benefits. Meanwhile, temporary staffing organizations catering to a different type of nurse, part of what they call “the shadow workforce,” have also emerged during this period, aided by technology. All in all, these trends have contributed to higher-quality care while boding well for the future.
One provider that has long been proactively adapting to the changing labor market is Monarch Healthcare Management. Monarch Healthcare Management has consistently been more effective than many providers at leveraging its float pool, often converting temporary staff into permanent employees by offering attractive benefits, flexible scheduling and work hours that align with the needs of this workforce, according to Dan Strittmater, vice president of innovation and bench strength at Monarch.
Monarch offers not only career advancement opportunities for its clinical staff but also funding for skill development and education by offering scholarships and flexibility in scheduling that allows nurses to work fewer, more varied hours while they pursue their long-term goals.
“Many float pool and agency staff need flexible schedules because they are in school, and realize Monarch gives out over $1 million a year in scholarships – that is often the reason they sign on with Monarch,” Strittmater told Skilled Nursing News. “This is a culture set by the owners from day one and has grown to be a competitive advantage, where you see CNAs who have become Administrators, Directors of Nursing, Licensed Social Workers, and even Doctors and Nurse Practitioners. Some started as float-pool or agency workers. This strategy is especially important in building Bench Strength in rural Minnesota.”
In addition to having over 5,000 members of its own staff, Monarch relies on its own float pool, using external agency whenever needed.
“Monarch float-pool employees often want flexibility in schedule more than anything, and a percentage of them try us out [as temps] and later transfer to a facility for a permanent position,” Strittmater said.
And the same pattern is repeated with external agency staff, he added, explaining that external agency workers are often recruited to work for Monarch long-term.
Annually, anywhere from 10% to 30% of Monarch’s agency staff and around 30% of its float pool staff transition to full-time positions within Monarch facilities, he said.
Monarch operates more than 46 nursing homes throughout the state of Minnesota, and 17 assisted living facilities, with locations in urban and rural communities.
‘The shadow workforce’
But aside from nurses who are actively transitioning away from entry-level positions to more skilled positions and therefore need flexibility, there are workers, who may have stepped away from performing bedside care not because they aren’t passionate about it, but because the demands of nursing no longer fit their needs or desires for flexible work.
CEO Curtis Anderson of Nursa, a digital healthcare staffing marketplace and mobile app that connects hospitals, clinics and skilled nursing facilities (SNF) with licensed nurses, calls this type of pool of workers “the shadow workforce.”
While temporary workers are often associated with reduced care quality and higher expenses, the shadow workforce can help providers avoid the usual pitfalls associated with on-call, or PRN nurses, according to Anderson.
Recruitment and retention are a “funnel problem,” Anderson told SNN, with many people looking to the top of the funnel – nursing schools – to solve the shortage. But, he said, that’s not really where providers should be looking.
“Nurses are voting with their feet,” explained Anderson. “Flexibility is no longer an optional add on, as much as it is a requirement for their career. It’s not a numbers problem. It’s an engagement problem.”
Nursa assists in staffing for more than 6,000 skilled nursing facilities, hospitals, and surgery centers in 31 states, Anderson shared with SNN. The platform currently hosts around 600,000 nurses looking for enhanced flexibility in their work.
One of the reasons skilled nursing is attractive to the temporary nurse pool is that it allows more flexibility in staffing compared with other areas of health care, Anderson said. And though nursing homes see their share of call outs and no shows, Nursa or other staffing apps can help agencies prepare for that.
Moreover, administrators can also plan better by taking their schedules and listing 5% to 7% on Nursa to account for call outs, Anderson advised. While the two-hour notice can make finding the right fit for a team more difficult, if providers have already posted the job, they will have a better chance of finding the right fit.
From the clinician’s perspective, apps like Nursa allow providers to look at their total availability and only take the shifts that work for them. Around 80% of the nurses on the platform are using Nursa as a side gig, Anderson said, filling PRN shifts when they can, and either maintaining full-time employment or managing family obligations.
Around 53% of open shifts on Nursa fill within 24 hours of shift start, he said, while the other 47% are posted and filled within two to 180 days of need, further providing flexibility for longer term planning.
How the nursing gig economy is different
That said, there has been criticism of the model, especially around consistency of care.
“Patients have indicated they prefer continuity [of care],” Anderson said. “They want to see the same name and faces. The counter to that is that turnover and burnout are real, so then it becomes a conversation about opportunity.”
Also, because of the Nursa app’s geographic restrictions, the nurses deployed by Nursa aren’t exactly traveling nurses, Anderson said. Nursa is able to maintain continuity of care by keeping the geographical area small: Clinicians on the platform are connecting with facilities in their area. And, nurses on the platform have landed full-time jobs at facilities they enjoyed working for, he added.
The platform is credentialed and accredited, Anderson said. Nursa holds clinicians to high standards around reliability and their own licensing.
“Unreliability is always a risk,” Anderson said. “We get a chance to see and help match directly with the people who can fill those holes. The notion is more broadly that flexibility is becoming a conversation.”
Anderson said there are fewer nurses letting their licenses lapse as they step away from the bedside. This means that there are greater opportunities to recruit new, already licensed nurses to skilled nursing.
“I think it’s easier to reengage those who have been here, and have experience,” Anderson said.
As for Monarch, which is all about keeping their nurses happy for the goal of long-term retention — and actively drawing nurses from temporary pool of workers – Strittmater agrees that scheduling flexibility isn’t the only reason nurses seek agency work.
Many float pool and agency workers initially choose temporary roles for flexibility but often seek long-term stability and a sense of belonging, he said. As they build relationships with local teams, many transition into permanent roles after finding a community they want to call home.
“Often they might enter the field working the short-term gigs with Monarch and realize that a long-term commitment is why they got into long-term care in the first place and they latch on to a local community,” Strittmater said. “Float pool and agency workers have less of an opportunity to feel like a part of a local Monarch community, and often the teams at our facilities win over these float pool and agency workers. And, they realize, they can stop searching because they are home.”
Kristin Carroll contributed to the reporting of this story.
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