Why Now: Rethinking Nurse Scheduling in 2025

It’s Sunday night. You’ve brewed your second cup of coffee and you’re three tabs deep into last month’s schedule. You’re calculating whether assigning three new grads to a Monday night shift will be too much for the charge nurse to oversee. You’re wondering if Leah can handle back-to-back shifts again, and how you’ll navigate the three overlapping PTO requests stacked on Labor Day weekend. You're trying to remember if Emily’s speciality care certification is still valid, whether Jacob still needs Thursdays off to bring his daughter to ballet lessons, and how many times you’ve asked Marina to work 3 weekends in a row already this year.
Then your inbox pings. Two nurses swapped shifts—without telling you.

If you’re nodding along because this sounds familiar, you’re not alone.
In fact, you’re facing one of the most complex and least-supported puzzles in healthcare today: nurse scheduling.

This challenge has a name. It’s a studied, documented, mathematically complex problem. It’s called the Nurse Scheduling Problem — and it’s been around for decades.

Academic papers have modeled it. Software vendors have promised to solve it. Hospital teams have built workaround after workaround.
And yet, here we are. Still juggling preferences, policies, and PTOs by hand.

The Problem Has Been Here All Along — So Why Now?

The Nurse Scheduling Problem isn’t new.

It’s a well-documented challenge, known for its complexity and the toll it takes on staff well-being and retention. Hospitals have lived with their consequences for decades, relying on the effort and intuition of individual managers to hold things together.

Because the patient care environment is ever-shifting.

Units are larger. The average number of staff per scheduler has increased. 

Turnover is surging. Nearly 1 in 4 newly hired RNs (23.8%) leave within their first year, a crisis-level attrition rate in many health systems, and scheduling is often cited as a top contributor to dissatisfaction and burnout.

The gap between expectations and reality is growing. Nurses want to be heard. They want transparency. They want a schedule that reflects their life—not just their license. And they should.

Nurse managers are younger than ever. Many are stepping into leadership roles with enormous responsibility, but without the tools or institutional memory their predecessors may have had.

We’ve reached a point where “making it work” isn’t enough.
And more importantly: we finally have the tools to do better.

It’s Time for a New Approach

Experienced nurse managers have been making scheduling work for years, holding countless preferences, constraints, and variables in mind, as they plot the course for the next 6-weeks into a spreadsheet. But this old-school process comes with significant costs in time, stress, and burnout.

This critical juncture leads us to essential questions:

• Is scheduling truly the best use of a nurse manager's valuable time and expertise?
• What happens when the next generation inherits complexity without adequate experience, guidance or tools?
• How do we address the reality of increasing nurse shortages and rising expectations for transparency and flexibility?

To provide meaningful help, we must first deeply understand how and why experienced managers navigate these intricate scheduling decisions. We need to unravel the complexity behind their strategies: what makes scheduling decisions so challenging, how successful nurse managers balance conflicting priorities and implicit preferences, and why adapting to constant changes is so demanding.

By thoroughly examining and learning from these experienced decision-makers, we can develop sophisticated AI-driven tools tailored specifically to support and enhance scheduling practices. Our aim isn't to replace the invaluable expertise of nurse managers—but to extend it, amplify it, and ensure it continues to thrive even as circumstances evolve.

In our upcoming articles, we’ll explore:

• The Big Picture: Why defining an "ideal" nurse schedule is so elusive and how shifting priorities create constant trade-offs.
• Revealing True Preferences: The challenges of capturing authentic nurse preferences, why traditional methods often miss the mark, and how understanding these nuances can significantly improve schedule outcomes.
• The Human Limits: Exploring cognitive overload, why even experienced nurse managers struggle with managing complexity, and the impact of this on scheduling effectiveness and team morale.
• Fair Algorithms: Why purely algorithmic approaches to scheduling often fail to account for the nuanced human elements, and how AI can learn from expert managers to create genuinely supportive tools.
• Future AI-Agents: How could we solve this problem?  Blue Sky - ideas

Together, let’s leverage AI and turn nurse scheduling from a persistent burden into an empowering opportunity to foster better patient care, happier healthcare teams, and healthier work environments.

‍