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A Comparison of 4, 6, and 8-Week Schedule Periods

Scheduling Nurses and Other Clinicians for Maximum Efficiency

In this white paper, we compare the relative costs of staffing nurses and other clinicians at three common schedule periods, including 4, 6, and 8-weeks. We also compare fill rates and other metrics associated with these schedule periods.

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Four, Six, and Eight Week Schedules

Analyzing the impact of nurse and other clinician schedule lengths is a key step in achieving labor optimization, ensuring staff retention and enhancing quality of care. Hospitals across the country typically utilize a mix of 4, 6, and 8-week schedule periods for nurses, technologists, support services, and other types of clinicians.

Departments within the hospital choose one or more of these schedule periods for a variety of reasons. Some hospitals may choose longer 8-week periods to limit the number of times they must repeat the scheduling process. Others use 6-week periods because they more easily facilitate a cyclic pattern for employees with a commitment to work every third weekend. Hospital departments or units might choose 4-week patterns because they prefer to track/manage commitments in shorter increments.

Tracking Data at 600 Hospitals

To assess the impact of various clinician schedule periods, research was conducted incorporating data from inpatient nursing units at 600 hospitals between 2014-2024. Data collected from these facilities tracks how various clinician scheduling periods impact four important financial factors associated with clinician staffing. These factors include:

  1. FTE Leakage
  2. Incidental Worked Time
  3. Overtime Costs
  4. Turnover Costs

The research also examines the amount of core staff floating, the number of shift changes, and fill rates associated with the three schedule periods. In addition, surveys were gathered from 7,270 hospital clinicians at the 600 different facilities in September 2024 across various skills within inpatient departments to understand their length of schedule preferences and their satisfaction with schedule change requests. Some of this data is referenced in this white paper.

FTE Leakage

The hours a staff member has not worked but should have based on their FTE commitment. For example, an RN with an FTE of 0.8 who only works 50 hours every two weeks yields an FTE leakage of 14 hours (64-hour commitment – 50 hours worked).

Incidental Worked Time

This refers to additional time a staff member is on the clock before or after the start or end of their original shift or during a scheduled meal break. Generally, in nursing, diagnostics or therapies, there is sound clinical justification for 40 percent of incidental worked time.

Healthcare Enterprise Labor Management (HELM) Methodology

HELM combines the science of workforce planning, demand forecasting, and operational best practices with a scheduling solution to provide sustainable long-term quality and financial gains.

Change to Shift

Change to shift constitutes any updates made to a scheduled shift following schedule submission. Examples of shift changes include trades, late PTO requests, etc.

FTE Leakage1

The chart below tracks annualized FTE Leakage costs associated with various schedule periods, by employee, by unit and by facility:

Schedule
Period

4 Week

Leakage Per
Employee

0.05

Annualized Cost Per Employee

$912

Annualized Cost Per Unit

$17,332

Annualized Cost Per Facility

$225,310

Schedule Period

6 Week

Leakage Per
Employee

0.06

Annualized Cost Per Employee

$1,118

Annualized Cost Per Unit

$21,240

Annualized Cost Per Facility

$276,115

Schedule Period

8 Week

Leakage Per
Employee

0.11

Annualized Cost Per Employee

$1,972

Annualized Cost Per Unit

$37,467

Annualized Cost Per Facility

$487,069

1FTE Leakage Calculations and Definitions:
  • Leakage per Employee: This is the average amount of hours below an employee’s commitment that they worked during a pay period converted into FTEs. A 0.9 FTE would be expected to work 72 hours. If they worked 70 hours they would have 2 hours of leakage.
  • Annualized Cost Per Employee: This is the Leakage per Employee multiplied by 2,080 (80 hours per pay period * 26 pay periods per year) multiplied by the industry standard replacement cost ($8.99).
  • Annualized Cost Per Unit: This is the Annualized Cost Per Employee multiplied by the average employees per unit (19).
  • Annualized Cost Per Facility: This is the Annualized Cost Per Unit multiplied by the average units per facility (13).
FTE Leakage Calcs

Costs by FTE Leakage

As the data indicates, FTE leakage costs increase with schedule length. However, the only statistically significant difference between schedule periods was between 4 and 8 weeks. Facilities utilizing 4-week schedules save over $250,000 annually in FTE leakage costs versus those utilizing 8-week schedules.

Incidental Worked Time (IWT)2

The chart below tracks annual incidental work time costs associated with various schedule lengths per employee, per unit, and per facility.

Schedule
Period

4 Week

IWT

0.25

Annualized Cost Per Employee

$20,777

Annualized Cost Per Unit

$270,102

Annualized Cost Per Facility

$3,511,328

Schedule Period

6 Week

IWT

0.21

Annualized Cost Per Employee

$17,363

Annualized Cost Per Unit

$225,722

Annualized Cost Per Facility

$2,934,383

Schedule Period

8 Week

IWT

0.30

Annualized Cost Per Employee

$24,533

Annualized Cost Per Unit

$318,934

Annualized Cost Per Facility

$4,146,146

Costs by Incidental Work Time
2 IWT Calculations and Definitions:
  • IWT: This is the average amount of hours an employee works before/after their shift ends or during scheduled meal breaks during a pay period converted into FTE’s. An employee who worked 20 hours before/after their shift and during scheduled meal breaks would have an IWT of 0.25 FTE (20 hours / 80hours per FTE).
  • Annualized Cost Per Employee: This is the IWT multiplied by 2,080 (80 hours per pay period * 26 pay periods per year) multiplied by the average wage rate ($39.70).
  • Annualized Cost Per Unit: This is the Annualized Cost Per Employee multiplied by the average employees per unit (19).
  • Annualized Cost Per Facility: This is the Annualized Cost Per Unit multiplied by the average units

Costs by Incidental Work Time

As data indicates, units utilizing 6-week schedules experience the least amount of IWT, saving over $1.2 million annually per facility compared to facilities utilizing longer 8-week schedules. Facilities utilizing 4-week schedules experience a cost savings of more than $500,000 compared to those utilizing 6-week schedules.

Core Staff Floating3

The chart below tracks core staff floating associated with various schedule lengths.

Schedule Period

4 Week

Core Staff Floating

0.96

Core Staff Floating Per Employee

0.08

Schedule Period

6 Week

Core Staff Floating

1.61

Core Staff Floating Per Employee

0.09

Schedule Period

8 Week

Core Staff Floating

0.75

Core Staff Floating Per Employee

0.09

3Core Staff Floating Calculations and Definitions:

  • Core Staff Floating: This is the average amount of hours CORE employees worked outside of their home cost center during a pay period converted into FTE’s.
  • Core Staff Floating Per Employee: This is the Core Staff Floating divided by the number of employees who worked in that cost center.
  • Average Employees: This is the average employees per cost center per pay period and is used to normalize the Core Staff Floating metric to account for cost center/unit size.

Core Staff Floating Per Employee

Units with 4-week schedules have the least amount of core staff floating per employee, although the difference between schedule periods is minimal.
Core Staff Floating Calcs and Definitions

Changes to Shift4

This chart tracks the number of requests to change shifts submitted by employees associated with various schedule periods.

Schedule Period

4 Week

Shift Change Requests Per Employee

2.42

Schedule Period

6 Week

Shift Change Requests Per Employee

2.67

Schedule Period

8 Week

Shift Change Requests Per Employee

2.63

Period: 5/13/2014 – 5/12/2024

4Change to Shift Calculations and Definitions:
• Transactions per Employee:
This is the average number of shift changes requested by employees per pay period.

Shift Change Requests by Schedule Period

As data in the chart above indicates, units utilizing 4-week schedules had the fewest schedule change requests per employee per pay period, leading to less work for managers adjusting schedules. Of over 7,200 clinicians surveyed, 75% were either satisfied or very satisfied that their schedule preferences and requested days off were respected. Once schedules are submitted, 41% of clinicians surveyed rarely submit change requests and 14% never do, with 8% stating they often submit changes and 3% saying they always do. (see chart below):

How Often do you Submit Changes After the Schedule is Posted?

How often do you submit changes after the schedule is posted

Overtime Cost5

The chart below tracks annual overtime costs associated with various schedule periods, per employee, per unit and per facility.

Schedule
Period

4 Week

Cost Per
Employee

$94.47

Annualized Cost Per Employee

$2,456

Annualized Cost Per Unit

$46,668

Annualized Cost Per Facility

$606,678

Schedule Period

6 Week

Cost Per Employee

$100.82

Annualized Cost Per Employee

$2,621

Annualized Cost Per Unit

$49,805

Annualized Cost Per Facility

$647,468

Schedule Period

8 Week

Cost Per Employee

$88.10

Annualized Cost Per Employee

$2,291

Annualized Cost Per Unit

$43,523

Annualized Cost Per Facility

$565,795

5Overtime Cost Calculations and Definitions

  • Cost Per Employee: This is the average overtime cost per employee per pay period.
  • Annualized Cost Per Employee: This is the Cost Per Employee * 26 (pay periods per year).
  • Annualized Cost Per Unit: This is the Annualized Cost Per Employee multiplied by the average employees per unit (19).
  • Annualized Cost Per Facility: This is the Annualized Cost Per Unit multiplied by the average units per facility (13).

Overtime Costs by Schedule Period

As data in the chart above indicates, units utilizing 8-week schedules have the least amount of annual overtime costs. Those units utilizing 4-week schedules have less annual overtime costs than those utilizing 6-week schedules. Those utilizing 6-week schedules have the highest per-unit and per-facility annual overtime costs.

Turnover Cost7

The chart below tracks annual turnover costs associated with various schedule periods per employee, per unit, and per facility.

Schedule
Period

4 Week

Cost Per
Employee

$429.17

Annualized Cost Per Employee

$2,456

Annualized Cost Per Unit

$46,668

Annualized Cost Per Facility

$606,678

Schedule Period

6 Week

Cost Per Employee

$463.15

Annualized Cost Per Employee

$2,621

Annualized Cost Per Unit

$49,805

Annualized Cost Per Facility

$647,468

Schedule Period

8 Week

Cost Per Employee

$454.15

Annualized Cost Per Employee

$2,291

Annualized Cost Per Unit

$43,523

Annualized Cost Per Facility

$565,795

7Turnover Cost Calculations and Definitions

  • Cost Per Employee: This is the total turnover cost per cost center per pay period divided by the number of employees who were home to that cost
    center during the same pay period (PRN and Agency sources excluded).
  • Annualized Cost Per Employee: This is the Cost Per Employee * 26 (pay periods per year).
  • Annualized Cost Per Unit: This is the Annualized Cost Per Employee multiplied by the average employees per unit (19).
  • Annualized Cost Per Facility: This is the Annualized Cost Per Unit multiplied by the average units per facility (13).

Turnover Costs by Schedule Period

As the data in the chart above indicates, units utilizing 4-week schedules have the least amount of annual turnover costs, potentially due to employees seeking more consistent monthly schedules in order to balance work-life priorities. Units utilizing 4-week schedules save between $150,000 – $200,000 annually per facility compared to units utilizing 6 or 8-week schedules.

Fill Rate8

The chart below tracks annual fill rates associated with various schedule periods across all skills.

Schedule
Period

4 Week

Fill Rate Actual

74.10%

Fill Rate at Posting

76.72%

Schedule Period

6 Week

Fill Rate Actual

84.65%

Fill Rate at Posting

81.79%

Schedule Period

8 Week

Fill Rate Actual

55.39%

Fill Rate at Posting

61.92%

8Fill Rate Calculations and Definitions:

  • Fill Rate Actual: This is the ratio of scheduled hours to demand hours.
  • Fill Rate at Posting: This is the ratio of scheduled hours to demand hours on the day schedules were posted.
  • Fill Rate Scope: Gathered across all units and all skills for the specified schedule period.
Fill Rates by Schedule Period
As data in the chart above indicates, units utilizing 6-week schedules have fill rates closest to 100%, while those using 8-week schedules have the lowest fill rates, suggesting that shorter schedule periods are generally more appealing to clinicians than longer, 8-week schedules.

Summary – Annualized Costs Per Facility

The chart below tracks annual clinician staffing costs as calculated by four different metrics per 4, 6, and 8-week scheduling periods.

Schedule
Period

4 Week

FTE
Leakage

$225,310

Incidental Worked Time

$3,511,328

Overtime

$606,678

Turnover

$2,756,107

Total
Annualized

$7,397,525

Schedule Period

6 Week

FTE Leakage

$276,115

Incidental Worked Time

$2,934,383

Overtime

$647,468

Turnover

$2,974,322

Total Annualized

$8,625,445

Schedule Period

8 Week

FTE Leakage

$487,069

Incidental Worked Time

$4,146,146

Overtime

$565,795

Turnover

$2,916,569

Total Annualized

$8,236,854

By Schedule Period

By utilizing a 4-week schedule, clients can save over $1.2M per facility compared to 6-week schedules and approximately $800,000 compared to 8-week schedule periods when all metrics are taken into consideration.

Based on the significantly greater savings generated, a recommendation to reduce schedule periods to 4 weeks is appropriate. Additionally, the enhanced savings driven by a 4-week schedule period directly align with stronger adoption of the HELM methodology, demonstrating the critical benefits of a more strategic scheduling approach for our highly engaged clients.

Staffing Cost Comparisons

Research based on clinician staffing costs at 600 hospitals as calculated by four different metrics suggests that 6-week staffing periods are more cost effective than 4 or 8-week staffing periods.

Hospitals utilizing 6-week staffing periods save over $1.2 million annually per facility compared to those utilizing 8-week schedules and save approximately $270,000 annually compared to those utilizing 4-week schedules.

In addition, hospitals utilizing 6-week schedules experience considerably higher clinician fill rates than those utilizing 8-week schedules.

Clinician Scheduling Period Preferences

Data was collected from over 7,200 RNs, LPNs, CNAs, technicians and other clinicians from 600 hospitals regarding their scheduling period preferences. As the chart below indicates, clinicians express higher satisfaction rates with 4 and 6-week schedules than with 8-week schedules.

How Satisfied Are You With Your Current Schedule?

The chart below tracks annual clinician staffing costs as calculated by four different metrics per 4, 6, and 8-week scheduling periods. (All numbers rounded to the nearest full digit.)

Satisfaction with schedule

Very Unsatisfied

4 Weeks

5%

6 Weeks

4%

8 Weeks

0%

Satisfaction with schedule

Unsatisfied

4 Weeks

6%

6 Weeks

5%

8 Weeks

13%

Satisfaction with schedule

Neutral

4 Weeks

23%

6 Weeks

21%

8 Weeks

28%

Satisfaction with schedule

Satisfied

4 Weeks

41%

6 Weeks

43%

8 Weeks

28%

Satisfaction with schedule

Very Satisfied

4 Weeks

25%

6 Weeks

28%

8 Weeks

31%

Sixty-six percent of clinicians on 4-week schedules said they are satisfied or very satisfied with their schedule periods, as did 71% of those on 6-week schedules. By contrast, only 54% of clinicians on 8-week schedules said they are satisfied or very satisfied with their schedule periods.

The general consensus gleaned from the data is that 8-weeks is too far out to allow clinicians to plan for life events. However, there are some outliers who prefer the longer 8-week schedules, with many requested schedules following one calendar month at a time.

Recommendations

Data and analysis referenced in this white paper support hospital adoption of 6-week schedules for nurses, technicians and other clinicians. However, 4-week schedules are a close second choice. Shorter schedules can both generate cost savings and help to increase clinician fill rates. Shorter, 4-week schedules also generate fewer clinicians change of shift requests
than longer schedule periods, reducing the time nurse and other leaders spend on adjusting schedules. Further, units utilizing 4-week schedules have the least amount of core staff floating per employee.

As data cited in this white paper show, clinicians themselves prefer shorter schedules, which can enhance clinician job satisfaction and retention.

In addition, enhanced savings driven by 6-week schedule periods directly align with stronger adoption of Health Enterprise Labor Management (HELM) Methodology. HELM combines the science of workforce planning, demand forecasting, and operational best practices with a scheduling solution to provide sustainable long-term quality and financial gains.

It should be noted that each hospital or health system should conduct an internal analysis of its staffing costs to determine optimal clinician scheduling periods.

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