In nearly every conversation I’ve had with unit-level nursing leaders about insourcing — regardless of health system size or type — one truth frequently prevails: on the surface, most would rather avoid working with per diem staffing companies or internal resource pools.
It’s not because they don’t value flexibility — they do. In fact, most believe flexible staffing pipelines are a great idea in theory. But the operational friction and loss of control they associate with these models often outweigh the benefits, leading to poor adoption and underutilization.
When this happens, health systems question whether the model is effective, and many fail to scale their internal contingent workforce to a size that creates meaningful impact.
What’s Really Going On?
When you’re accountable for patient outcomes, staff engagement, and budget performance, every staffing decision has ripple effects.
The aversion to additional operational complexity is so strong that I’ve seen nurse managers:
- Advocate to keep an expensive travel nurse for as long as possible
- Push executives to meet inflated bill rate demands in a supply-driven market
- Lean heavily on core staff for overtime — even at the risk of burnout
Why? Because those options, while imperfect, preserve a temporary sense of commitment and control.
By contrast, relying on internal resource pools in a scarce-resource environment — where float staff can be reassigned to another unit at a moment’s notice — feels like hanging your unit’s operations out on a very high & flimsy limb. For many managers, that risk is unacceptable.
The Perceptions — and the Psychology Behind Them
- Time-Sucking Processes That Add Zero Value
Traditional per diem and float pool workflows are clunky. Managers chase down availability, navigate disconnected scheduling systems, use multiple channels of communication and deal with incomplete confirmations. Research shows nurse managers already spend 40–60% of their time on admin work, mainly scheduling, so adding yet another, different path to watch is a hard sell. -
- Psychology: Loss of Decision-Making Power and Increased Cognitive Burden. Staffing isn’t just filling a slot — it’s matching skill, personality, and team dynamics. When a third party dictates who shows up, managers lose one of their most critical levers for success. Coupled with known issues the role faces with span of control creep leading to chronic overwhelm, nursing leaders triage additional operational channels to the bottom of their priorities list, even if it will provide relief.
- Unreliable Coverage That Creates More Work
Ghosted shifts are the fastest way to kill buy-in. A no-show forces the manager to scramble — often stepping in to cover themselves. -
- Psychology: Uncertainty Equals Risk. Unknown staff, unfamiliar workflows, or spotty reliability are all perceived risks to patient safety and performance. Faced with uncertainty, managers default to “I’ll just fill it myself.”
- Lack of Unit-Level Fit
Staff arrive with no familiarity with unit workflows, EMR systems, or culture. One mismatch can tank a shift’s productivity and morale. -
- Psychology: Accountability Without Authority. Managers are still responsible for quality, satisfaction, and budget — yet have no influence over who’s assigned.
- Zero Continuity
Many per diem agencies and internal pools function like revolving doors, attracting the disengaged who seek maximum pay for minimal commitment. Staff are transactional, not embedded. -
- Psychology: Emotional Ownership of the Team. Managers see their unit as their team. Outsiders risk disrupting the culture they’ve worked hard to build.
How HWL’s LIFT Model Changes the Game
HWL built LIFT — Local Insourced Flex Team — to solve these problems head-on. LIFT isn’t just a staffing program; it’s a trust-building, workload-reducing approach designed around the nurse manager’s need for control and predictability.
- Embedded Talent, Not Strangers – LIFT clinicians are trained and oriented as part of the health system. Our operational leaders work with each client to create tools and workflows, so LIFT staff arrive with a clear understanding of patient population, culture, and processes. No rolling the dice on fit.
- Centralized Coordination That Works for Managers – Our central scheduling office manages availability, assignments, and confirmations, eliminating administrative drag so managers can focus on leading their teams.
- Unit Preferences Baked into Scheduling – We capture and honor unit-specific skill mix, personality fit, and prior performance so staffing decisions feel tailored, not imposed.
- Reliable Coverage, Fewer Fire Drills – Predictive scheduling, tiered pay incentives, and optional committed coverage agreements significantly reduce last-minute cancellations. If LIFT fills the slot, it’s filled.
- Continuity That Builds Trust – We engage our float team differently — as full partners and team ambassadors. This approach delivers an 85–90% retention rate and 70% of hires from direct referrals. The same LIFT team members return to units where both sides see a strong fit, fostering cohesion and trust over time.
- Cost Containment with Strategic Value – Built from a proprietary blend of staffing models, LIFT costs less than agency while serving as a strategic flex layer that reduces burnout, improves retention, and supports safe staffing.
Bottom Line
Frontline nursing managers don’t resist flexibility — they resist chaos. Their hesitation toward per diem and internal pool models isn’t a rejection of innovation; it’s a defense of the levers that determine their success.
LIFT restores those levers. It gives managers influence over who’s on their team, preserves unit culture, and delivers flexibility without undermining authority.
When friction is reduced and trust is intact, change isn’t forced — it’s championed.
That’s the LIFT difference.