It is important that the best substitute gets the substitute position.

This article is written from a Swedish perspective. Hopefully, it can inspire interested parties from other countries as well.

Staffing a nursing home in the best possible way is not easy. Often, substitutes have to jump between different units in the nursing home and do not have time to fully understand the needs of the residents. By having good support systems and routines, the nursing home can organize the substitute staffing in a way that ensures that the best suited substitutes can step in during short-term absences and thus offer high-quality care and attention to the residents.

Foto: Mostphotos

Staffing via SMS

A care worker tells us that staffing via text message is a disaster and one of the biggest obstacles to increasing the quality of care for the elderly. The system disadvantages committed and competent temporary workers who actually work and do their utmost for the residents, while those who prefer to spend time with their mobiles during working hours benefit from the system and get all the passes. The system also means that it is not the work performance but the ability to quickly respond to a text message that is rewarded.

Another problem is that in the end the employer may be forced to employ substitutes that they do not really want, as those with extensive service are given priority over vacant positions. With poorly trained substitutes, the regular staff also wears out and both job satisfaction and quality decrease.


There are significant differences in the recruitment of staff to various nursing homes. Some nursing homes have many applicants for each vacant position, while others have none at all. There is a strong correlation between continuity and patient safety as well as regarding work environment and patient safety. Staff who enjoy their work stay, but the skilled employees also want colleagues who deliver. Here, clear leadership is fundamental to creating a good work culture where skilled employees thrive and help to develop the operation.


It is not easy to staff a nursing home. Those who work are not entirely replaceable. It's about doing the best possible. Proper planning of staffing significantly affects the quality. It's simpler when dealing with planned absence and long-term absence. Then it is possible to choose the substitute who is most suitable. For late sick leaves, it often ends up being the one who responds by phone or SMS who gets the substituting job.

Substitutes often work at various nursing homes to make ends meet for the month. It's an uncertain existence and also means there is competition for the best substitutes. To retain good substitutes, we must care for them and show them that they are appreciated.

Some units have systems for staffing support where those trained as substitutes can input which work shifts they would be willing to work. With good systems and ways of planning staffing, the conditions for getting the right substitute for the right shift are much better.

Many nursing homes also have schedules where working hours between different shifts vary between the different rounds. It also matters who handles the staffing and on what grounds. Both good staffing planning can help create continuity so that substitutes get to know the residents well, and the operation can keep many substitutes instead of a few working more than full time.

There are also operations that create conditions for participation in activities through "golden edge shifts" where some employees are not involved in direct care but instead can arrange activities with the residents. A well-thought-out model of planning staffing and activities that interact has significance for the quality of the nursing home.

Planning for short-term absence

Substitute pool and staffing tools: Most nursing homes have some form of substitute pool. A system where substitutes can note where they are available facilitates. Make the permanent staff involved in finding good substitutes. Some form of SMS function where substituting jobs can be offered is also good.

Match competence and experience When you have a pool of substitutes, make sure you carefully evaluate their competence and experience. Create a list of the various tasks and care needs that can arise at the nursing home. It's good if there is some form of sorting which floor the substitute is familiar with the residents on and preferably some form of grading on the substitutes so that the substitutes who deliver the best care are booked first.

Communication with the substitutes: Have a good dialogue with the substitutes both when it comes to praise and potential needs for improvements. Create a simple material for substitutes and new hires when it comes to expectations, requirements, and important routines in the operation. Regularly evaluate the substitutes' work effort with other employees and the residents of the unit.

Offer continuous training: Keep in mind that even substitutes need to have continuing education. The quality and patient safety are no stronger than the weakest link.

Good work environment A good work environment is important for keeping staff. This also applies to substitutes. By showing appreciation and caring for your substitutes, the best ones will want to continue working in your operation.

Reflection questions about staffing and supply
Care staff:
• Does scheduling and staffing work well at your residence?
• Do you have well-functioning substitutes?
• How do you keep the best substitutes?
• Do you give those who staff any feedback on how different substitutes work at the unit?

Manager, nurse, occupational therapist, and physiotherapist:
• Do you have a good system for assessing how your substitutes work?
• Do you bring in the most skilled ones, or is it more about who responds or someone likes?
• Is the scheduling adapted to the residents' needs?

Residents and relatives:
• Is there turnover on who works at the unit?
• Does the residence seem to have good substitutes?

Erland Olsson
Specialist Nurse
Better care every day

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