Key takeaways.
Treat tonight’s shift and a recurring gap as two problems. The first needs speed; the second needs a cause.
An available clinician isn’t automatically ready. In a hospital, every licensed nurse follows the hospital’s policies and is supervised and evaluated by the nursing service, whatever the staffing arrangement1.
Before choosing a staffing model, separate vacancies from schedule design, orientation capacity and skills gaps.
Compare options on full cost and fit, including the orientation and supervision your own team gives.
A nurse called out for tonight. How can you find coverage?
Work through the routes you have already approved, in the order your policy sets. Start with people who already know the unit.
The last step matters most. A hospital’s nursing service must supervise and evaluate the clinical work of every nurse it uses, including contracted and agency staff, and those nurses must follow the hospital’s policies1. Have the unit’s orientation checklist ready before the nurse arrives.
Why are you still short-staffed when fewer people are leaving?
Turnover is only one cause. A unit can keep losing shifts because positions stay open, because the schedule doesn’t match when patients need care, because new hires can’t yet work on their own, or because too few staff have the skills a shift needs. Each has a different fix.
| Cause | What it looks like | Where to look |
|---|---|---|
| Open vacancies | The same shifts go uncovered until a hire starts. | Open positions, and how long each hire takes from offer to first shift. |
| Schedule mismatch | Overtime clusters on certain days or shifts while others are fully staffed. | Scheduled hours against patient demand by day and shift. |
| Orientation capacity | New hires are on the roster but can’t yet work on their own. | Preceptor availability and how long orientation runs. |
| Skills gap | Shifts are staffed but lack someone with a needed skill or certification. | Skill mix per shift against what the patients need. |
| Leave and absence | Gaps follow leave, sick calls or seasonal patterns. | Absence patterns over a full year. |
To tell whether overtime comes from vacancies, training gaps or scheduling, line up overtime hours by unit and shift against open positions, staff still in orientation and the schedule. The cause usually shows in where the overtime falls.
How do agency, per diem, travel, locum and permanent hiring compare?
| Option | Suits | Watch for |
|---|---|---|
| Internal float pool | Short gaps across units that share skills | Float staff need orientation to each unit they cover |
| Your own per diem staff | Regular short gaps, by people who know you | They may not be free when you need them |
| Per diem apps and shift services | Filling single shifts quickly | Clearing each new nurse for the unit, and who orients them |
| Agency contracts | Short-term cover for a known gap | Fees, contract terms, and supervision by your team |
| Travel contracts | Cover for weeks or months | Orientation time against contract length |
| Locum tenens | Physician and advanced practice cover | Credentialing and privileges still apply |
| Permanent hire | A gap that is really an open position | Time to hire and start; the gap needs cover meanwhile |
Put your own numbers next to each option: rates and fees, the orientation and supervision your staff give, and how long each takes to arrange.
Where can a medical practice find temporary physician coverage?
Look at locum tenens agencies, physicians in your network or nearby groups, and telehealth cover where the physician holds the license the patient’s state requires. Credentialing and privileges still apply to temporary cover; see locum tenens credentialing and telehealth cross-state licensing.
How do you build a workforce that needs fewer gaps covered?
Fix the cause you found. Open positions need a faster path from offer to first shift. Schedule mismatches need a schedule built around patient demand. Orientation limits need more preceptor time. Skills gaps need training or hiring for the skill.
Each gap you cover tells you something: which units, which shifts, which skills. Rōvn is built to keep that context, so clinicians’ preferences and availability can be matched to the gaps that keep returning, rather than treating each vacancy as new.
Next step
Have a staffing gap that keeps coming back? Review it with us.
Questions.
Why are we still short-staffed when fewer employees are leaving?
Turnover is only one cause. Open positions that take long to fill, a schedule that doesn’t match demand, new hires still in orientation and skills gaps can all leave shifts uncovered.
How do we tell whether overtime is caused by vacancies, training gaps or scheduling?
Line up overtime by unit and shift against open positions, staff still in orientation and the schedule. Overtime that follows open positions points to vacancies; overtime on certain days points to the schedule.
A nurse called out for tonight. How can we find coverage?
Confirm the need, offer the shift to your own staff and per diem pool, then call approved partners. Confirm license, certifications and unit orientation before the shift starts.
Which nursing staffing services can cover a shift in Atlanta?
This guide doesn’t list or rank services. Ask each one whether it can supply the role and unit type, how it confirms Georgia licensure or a multistate license, and how quickly it confirms a nurse. See how to verify a Georgia RN license and how the compact works in Georgia.
What are the alternatives to a staffing agency for recurring nursing vacancies?
Your own per diem pool, an internal float pool, schedule changes, more orientation capacity, and a faster path from offer to first shift for permanent hires.
How do I compare a per diem staffing app with hiring a permanent nurse?
Compare what you get, who orients and supervises, what you track and when each fits. A per diem app fills shifts; a permanent hire fills a position. Use your own rates and team time for the cost.
Where can a medical practice find temporary physician coverage?
Locum tenens agencies, physicians in your network or nearby groups, and telehealth cover where licensing allows. Credentialing and privileges still apply.
Sources
- 142 CFR 482.23, Condition of participation: Nursing services, paragraph (b)(6) (Legal Information Institute, Cornell Law School)
Medicare hospital rule: licensed nurses follow hospital policies, and the nursing service supervises and evaluates all nursing staff, whether employed, contracted, leased or volunteer.
Accessed Oct 24, 2026
Not Rōvn results
This guide is practical advice built on public sources. It contains no figures from Rōvn’s own work with organizations, and it doesn’t list or rank staffing services.
