Digital Repository Masters Theses Spring 2026 Policy Creation for Safe Scheduling Practices for Nurses Anastasia Chaus Weber State University Follow this and additional works at: https://dc.weber.edu/collection/wsudoctoral Chaus, A. 2026. Policy Creation for Safe Scheduling Practices for Nurses. Weber State University Doctoral Projects. https://cdm.weber.edu/digital/collection/WSUDoctoral This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact archives@weber.edu. WSU REPOSITORY MSN/DNP Policy Creation for Safe Scheduling Practices for Nurses Project Title by Anastasia Chaus Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY Ogden, UT 4/19/2026 Date Anastasia Chaus, BSN, RN, MSN Student 4/25/26 Student Name, Credentials (electronic signature) Date 5/28/26 MSN Project Faculty (electronic signature) Date 6/9/26 Anne Kendrick (electronic signature) DNP, RN, CNE MSN Program Director Note: The program director must submit this form and paper. Date 1 Policy Creation for Safe Scheduling Practices for Nurses Anastasia Chaus Annie Taylor Dee School of Nursing Weber State University Dr. Amber Fowler MSN Project April 19th, 2026 2 Abstract Purposes/Aims: The purpose of this project is to create an organizational policy supported by evidence-based research for nursing professionals to utilize safe scheduling practices. By doing so, registered nurses can support patient and caregiver safety initiatives, avoid unnecessary fatigue related to extended hours and sustain a more well-rounded work-life balance. The project aims to avoid overtime, cap consecutive shifts worked, and limit extended work hours. Rationale/Background: Healthcare professionals face increased exposure to extreme fatigue, burnout, and risk for adverse safety events due to unsafe scheduling practices. These include working extended hours beyond 12-hour shifts, working too many consecutive shifts without proper periods of reprieve, and additional overtime hours. Lacking safe scheduling practices contributes to poor work-life balance, increased turnover, and increased patient safety concerns such as medication errors. Methods: This project follows the ADKAR change management model to provide a supportive approach for the policy to be implemented. It also includes a literature review including evidence-based scheduling practices, framework for execution, and pre and post assessments for data collection. Results: The literature review showed a few main themes: the need for safe scheduling reform is vital, nurses prefer participating in an autonomous schedule process, and there is a direct relationship between patient safety and caregiver schedule patterns. Conclusions: The safe scheduling policy creation is crucial to caregiver satisfaction and patient safety. The project outcomes include improved caregiver satisfaction, decreased safety events and minimal burnout. Keywords: scheduling, patient safety, caregiver satisfaction, burnout, and fatigue. 3 Policy Creation for Safe Nurse Scheduling Practices As the nursing profession continues to evolve, so does the need for safe scheduling practices for inpatient registered nurses. Larger demands are being placed on employees at the bedside and the need for safe scheduling parameters continues to grow for nurses as a shiftwork population. Shift workers are among the greatest risk for occupational hazards such as workplace injury, attendance issues, workplace errors, and car accidents (Booker et al., 2024). The healthcare profession revolves around shift shortages that cause a greater need for open shift coverage, resulting in overtime hours for caregivers. The gap of safe scheduling was exposed further after the COVID-19 outbreak, as caregivers left the bedside due to lack of staffing support and high stress workloads (Morse et al., 2024). Safe scheduling continues to flounder post-pandemic, as working over 36 hours per week has been normalized with a lack of regulation and best practice tools to support an overworked population (Morse et al., 2024). Scheduling parameters are essential and need prioritization to maintain a high caliber of patient care, promote caregiver wellness, and ensure patient safety. Additionally, the structure and process of safe scheduling of staff must include a culture of safety that is integral to achieving quality and efficiency goals (ANA, 2020). Effective scheduling and leadership support for a work-life balance approach will directly contribute to achieving these initiatives and breed a successful working environment for caregivers. Statement of Problem The practice gap identified is a lack of policy surrounding several safe scheduling practices for registered nurses. This is a unique problem for healthcare organizations that do not have guidelines or policies surrounding scheduling practices for maximum hours in a shift, shifts completed in a row, or maximum amount of overtime that a caregiver can work within a week. 4 As a result, facilities are faced with daily challenges related to safe scheduling for nurses including decreased job satisfaction, lack of work-life balance, and concern for nurse retention (Epstein et al., 2023). Literature shows that unfavorable scheduling aspects lead to increased burnout within a unit, resulting in mandatory overtime for others to fill the needs at the bedside leading to further safety concerns (Scott-Marshall, 2024). These shift patterns have been found to result in shortened amounts of sleep, leading to performance and safety deficits (Honn, 2020). As the need for regulation of hours worked increases, this project aims to reduce nurse fatigue and improve patient and caregiver safety by implementing evidence-based recommendations to the scheduling process. Framework The framework model used for this project is the ADKAR model. This model is composed of steps that help support organizational change. The ADKAR model has been shown to be particularly helpful in policy implementation in the healthcare setting (Prosci, n.d.). When using the ADKAR model, the change management process is evaluated in stages to help facilitate adjustment periods. According to the ADKAR model (Prosci, n.d.), the five stages include Awareness, Desire, Knowledge, Ability, and Reinforcement. The identified framework supports this project by applying a methodical process that facilitates policy reform. The steps of the ADKAR model directly align with the different components that best support change management. Awareness involves bringing education to caregivers and leadership teams on the implications of working an excess of six consecutive shifts and extended working hours beyond 12-hours in a day furthers the comprehension of the need for reform. Desire is a piece of the process where leadership can use motivational techniques to encourage participation, utilizing early adopters to help engage the team to 5 participate in change (Prosci, n.d.). Knowledge is accomplished through the education of the process and the providing of information on how it will change. As a result of providing an educational environment for caregivers to learn about the implications related to safe scheduling, nursing teams can better advocate and participate in change management. Ability is used to demonstrate to teams that there is value in using the organization’s scheduling software can enhance functionality, ensure ongoing scheduling support, and promote safe scheduling practices within a department. The scheduling software can be designed to limit unsafe scheduling. For example, it can limit caregivers from signing up for more than a certain number of shifts in a row. It can also identify day and night shifts to where caregivers can be scheduled with ample recovery time before flipping from nights to days. Lastly, reinforcement can help track compliance among units and unveil possible adjustments needed to make the policy change successful. Unit leadership may consider implementing incentives for caregivers to sign up for a safe schedule; potential enticements could include attendance forgiveness and holiday work preferences. Involving the caregivers in identifying positive reinforcements will help to identify those most likely to succeed. The scheduling coordinator for the units can help with monitoring and accountability for team support during schedule building processes. While many management projects focus on the steps necessary for organizational change, ADKAR emphasizes that successful organizational change occurs when each person can transition successfully (Khan & Hashmi, 2019). Strengths and Limitations The ADKAR model shows both strengths and weaknesses. Some of the strengths include a people center approach, a sequential model of framework, sustainability, and adaptability (Strategies for Managing Change, n.d.). Perhaps the most influential of these strengths is the 6 sequential model where a step-by-step approach is used to slowly help with change management among staff. When rolling out any type of change it must be thoughtful and organized. The ADKAR model allows nurses to participate in the change process, adapt to new expectations and can provide an opportunity for caregivers to offer feedback. This feedback can help navigate different iterations of the proposed change as needed. Some of the limitations for the ADKAR model include lack of usage for large scale changes, a narrow scope of dynamics within any given department, and unsuitability for time sensitive change implementation (Strategies for Managing Change, n.d.). The ADKAR model relies heavily on communication for success. Without a strong leader communicating the different steps of the change process and how caregiver’s expectations could potentially change may deter the project from progressing in a positive way. This model may not be the best solution for all situations needing change management, especially those that need to be completed quickly. It is important to work through the steps and implement each phase individually. Search Strategies An in-depth search for literature was conducted using CINAHL, Google Scholar, and EBSCOhost databases. These databases provided reliable, peer-reviewed journals and accessible published materials. Articles published within the last five years were prioritized for the most recent evidence and reliable usage of data sourcing. Keywords used within the search process included: “safe scheduling”, “scheduling satisfaction”, “nurse scheduling”, “nurse safety” “extended shift work hours”, “improving shiftwork”, “nursing optimization”, “nursing fatigue”, and “scheduling policies”. A variation of these keywords was used to search for relevant peer reviewed articles. 7 Synthesis of the Literature This literature review aims to present evidence related to ways to improve scheduling practices and how these practices correlate with caregiver and patient safety. The literature review was conducted to find evidence-based research associated with safe scheduling practices to propel policy change for the organization. Three themes were identified in the literature: a.) safe scheduling practices for shift work employees, b.) nursing autonomy and involvement with scheduling, and c.) scheduling to prevent safety events. Scheduling To Reduce Risk Safe staffing practices are vital for functionality within the healthcare industry. Appropriate staffing guidelines are also necessary for the overall outcomes related to productivity in the workplace. Some literature suggests that there are related factors between certain aspects of shiftwork functionality and safe scheduling. One of the factors is the disruption between extreme fatigue after working too many consecutive shifts and the lack of recovery cycles in between being scheduled to return to work (Gifkins et al., 2020). While other factors are prevalent within the nursing profession in regard to scheduling, patient and caregiver safety continues to outweigh the competing concerns when evaluating the level of functionality for a department. Other processes that measure functionality include amounts of overtime, caregiver turnover, and nursing burnout, as these factors contribute to an overall evaluation of scheduling and promoting workplace efficiency (Abdalkareem et al., 2021). Improvement in nurse scheduling and parameters on working hours with mandatory overtime are desperately needed. Changing hospital policies to specifically outline working parameters regarding overtime hours will help prevent nurses from leaving their positions. In one study, both nurse scheduling and nursing turnover were significant factors evaluated in 8 scheduling practices; however, only mandatory overtime was significantly related to intent to leave (Bae, 2024). By addressing the safety of scheduling, mandatory overtime shifts could be reduced, resulting in safer care at the bedside with a nurse that has had the time to rest and recharge. Sustainable working hours are necessary to prevent adverse outcomes in the nursing profession. It is a popular practice for nurses to try and group their shifts together to work six consecutive shifts in a row, resulting in an intensive schedule pattern (Bae, 2024). The reason behind this method is that they then receive the benefit of having an increased number of days off in a row. According to Min et al. (2022), this has often been questioned as a safety concern as the nurse may experience chronic and acute fatigue without proper recovery periods of rest. The requirements for sustainable working hours, as identified by previous research, are that the shift schedule should limit the number of consecutive shifts, limit the length of shifts, and enable sufficient rest time after night shifts before changing to daytime hours (Epstein et al., 2023). One of the main concerns in the lack of safe scheduling is the effect it can have on patient safety. By shifting to more appropriate scheduling for nurses, the risk for lack of sleep, impairment, and increased fatigue can be mitigated. One study showed that too many consecutive shifts with associated overtime were contributing factors of significant fatigue in nursing staff over a full scheduling cycle of eight weeks (Min et al., 2022). Modifying nursing shift schedules to reflect safe patterns can help decrease the risk of lack of sleep or extreme fatigue in caregivers (Gifkins et al., 2020). In turn, this can reduce the risk for health and safety for nurses. Errors evaluated as a result of unsafe nurse scheduling practices include patient falls, medication errors, and early identification of safety risk (Booker et al., 2024). Patient safety is of the utmost importance as nurses perform various activities throughout a 12-hour shift that 9 necessitate a distraction free setting. Medication administration makes up about 40% of clinical nursing activity, making it one of the most likely scenarios for a nurse to make an error during a shift (Di Muzio, 2019). With this data and prolonged fatigue because of poor scheduling practices, nursing staff is at an even higher chance of making a mistake at the bedside, increasing the amount of safety related occurrences for any given department. At times, caregivers may be required to stay for extended hours past their scheduled shift end time. When a caregiver is required to stay due to unforeseen circumstances such as short staffing or patient acuity, this can result in prolonged fatigue for the caregiver (Bae, 2024). According to Gobel et al., (2019), nurses working more than eight hours a day and 40 hours in a week are at high risk for severe chronic illness, injury, and adverse health outcomes. Although many efforts are made to encourage work-life balance among caregivers, often patient care takes prioritization above the caregiver’s well-being. Promotion of a healthy lifestyle and safe scheduling for healthcare providers can prevent negative effects for caregivers and should be evaluated by nursing leadership (Peršolja, M., 2023). Healthcare providers are among those considered as a population susceptible to negative impacts on their health and well-being due to shift scheduling. Far too long, these unfavorable health impacts have gone unaddressed. Support exists showing a direct link between shift work and future development of chronic diseases including diabetes, heart disease, and cancer (Epstein et al., 2023). As nurses risk their health status to maintain high levels of performance, there are many adverse reactions that occur because of the type of work being performed. Additional health complications directly related to working too many shifts consecutively are circadian rhythm disruption, neuropsychological disorder, mental health complications, and gastrointestinal diagnoses (Reisinho et al., 2021). 10 Nursing Autonomy and Involvement Nursing autonomy and involvement in scheduling practices is crucial to the overall model of shift work scheduling. The nursing profession is singularly one of the biggest proponents for scheduling best practices. According to Barker et al., (2025), nursing staff reported four primary themes important to them for their scheduling processes, including balanced choice, consistency, predictability, and flexibility. Based on the information found in the literature, a lack of autonomy and nurse involvement in scheduling practices can lead to errors and safety concerns (Wynendaele et al., 2021). Managers continue to struggle with the delicate balance of meeting the needs of a department and staff satisfaction. The building of a schedule for a complex department can take hours trying to coordinate employee preference and shiftwork balance. Many managers have opened the process for their staff to participate in self-scheduling to mitigate time constraints. It has been determined that there is a correlation between nursing involvement and time savings for managers after transitioning to a participatory scheduling model (Morse et al., 2024). One key theme found within the literature is that safe staffing practices are necessary for functionality. Two main contributing factors to increased productivity and decreased overtime are a consistently balanced schedule by department leadership and continued strategies to optimize staffing usage (Morse et al., 2024). By giving nurses more autonomy in creating their schedules, staff morale and retention was also shown to improve (Wynendaele, et al, 2021). Bae posits that policy surrounding nurse staffing should be implemented to improve overall caregiver job satisfaction and there should be further evaluation to avoid mandatory overtime (Bae, 2024). Several factors studied show that there are more positive outcomes among shift working healthcare employees when they can participate in the scheduling process (Epstein et al., 2023). 11 As the needs for more balanced schedules increase for healthcare providers, so do the challenges within bedside continuity. Scheduling challenges including turnover, scheduling flexibility, equity, and nursing inclusion were evaluated to identify ways to potentially increase nurse retention and satisfaction (Stimpfel et al., 2025). In opposition to the majority, one study suggested that concerns have been raised when employees have influence over their own scheduling that it could result in working too many shifts in a row, potentially impairing their health and sleep recovery between shifts (Epstein et al., 2023). Safe Scheduling Solutions Safe and effective nurse scheduling is vital for caregiver and patient safety, as well as workflow sustainability. The literature states that there are detriments to poor scheduling processes that are preventing growth within this area of healthcare. These include poor adherence to unit scheduling processes, increased caregiver fatigue, and increased risk for patient safety due to errors (Di Muzio et al., 2019). On the other hand, the literature shows that several components of scheduling have been identified as best practices. These include nurse autonomy in scheduling participation, limiting excessive overtime and extended hours during a shift, and optimizing the usage of the scheduling software promotes success for nurses (Epstein et al., 2023). Additionally, there have been studies that suggest that limits on time worked should be evaluated extensively. According to Scott-Marshall (2024), shifts should be capped at 12 hours worked to reduce fatigue and potential patient errors. Another study showed that a constant exceeding of 40 hours a week worked produced greater incidence of chronic fatigue among nurses (Gobel et al., 2019). Lastly, consecutive shifts in a row were examined and it was found that anything greater than six shifts in a row worked did not provide adequate recovery periods between shifts for caregivers to return to work in a healthy state (Min et al., 2022). There are 12 various links between these scheduling techniques and the well-being of the caregivers as well as the number of potential safety events for a unit. By mandating standards of safe scheduling within shiftwork for nurses, we can preserve the wellness and longevity of healthcare professionals as well as patients (Honn, 2020). Summary of Literature Review Findings and Application to the Project The literature and evidence found strongly suggests that safe scheduling practices for nurses improve caregiver well-being and decrease rates of error and burnout (Bae, 2024). It is also suggested that caregiver autonomy in scheduling is a key contributing factor of successful team dynamic for healthcare professionals. Staff nurses and leadership individuals have identified barriers throughout the schedule build process and have expressed the need for optimization (Barker et al., 2025). Staff nurses reported that scheduling challenges compromised their health and well-being, caused work family conflict, and influenced turnover intentions (Stimpfel et al., 2025). By making the necessary adjustments in scheduling patterns by limiting nursing shifts to 12 hours as well as decreasing consecutive shifts worked, healthcare systems can positively impact the lives of caregivers as well as patient safety (Scott-Marshall, 2024). The evidence that has been reviewed provides the framework to implement this project with the most up to date information for scheduling practices. By standardizing nurse scheduling assignment processes, gaining autonomy during the schedule building phase, and setting parameters for safe schedule patterns, a new expectation can be supported. With department safety and caregiver well-being at the forefront of most leadership initiatives, safe scheduling practices are a relevant and necessary topic to pursue for future transformation. The overall health and well-being of caregivers working these designated hours is dependent on safely structured parameters. 13 Project Plan and Implementation Safe scheduling practices are a necessary and vital piece in the workflows of healthcare operations. Caregiver scheduling can have a direct impact on staffing sustainability, patient safety, and staff engagement. As shown in the literature, working too many consecutive shifts and extended hours are contributing factors to nursing fatigue, burnout, intent to leave, and increases in patient safety events (Bae, 2024). Despite best efforts, there is still a lack of organizational policy to support safe scheduling regulations for caregivers. This policy proposal provides a sound recommendation in the development of a sustainable set of guidelines that can be standardized and followed within the organization. By creating a Safe Staff Scheduling Policy, an expectation can be aligned for all unit leaders and their teams within the healthcare system. This policy will include evidence-based support to communicate parameters regarding maximum amounts of hours worked during a shift, maximum shifts worked consecutively, and maximum overtime hours worked in a pay period. The policy created will outline key safe scheduling parameters. The recommended maximum number of hours worked during a shift would not exceed 16 total hours in a 24-hour day. The recommended maximum number of shifts worked consecutively would not be greater than six. Lastly, the maximum number of overtime hours accrued in a pay period should not exceed 40 hours above the caregiver’s standard scheduled hours that they were originally hired to work. These recommendations per policy will be introduced and developed throughout the organization using the ADKAR change management model. The policy will also be posted within the organization’s policy library where it can be accessed by all employees. Human resources will be the primary contact for questions and concerns regarding the policy wording and interpretation. 14 Plan and Implementation Process The plan for the implementation of the project will follow a systematic approach where key individuals will meet to create the framework needed. The first phase of assessment will take place by acknowledging current process and reviewing the need for change. A review of safety occurrences, rates of turnover, and caregiver scheduling satisfaction will also be evaluated during this time. After reviewing these items, the first draft of the policy will be created with assistance from human resources. Once these meetings occur and the initial wording of the policy is drafted, a committee will be formed to proceed with publication of the document. The committee will include policy authors, human resources, unit-level nurses, and executive leadership. The purpose of this small group is to create a final draft that aligns with the vision and values of the organization. After this is complete, the policy final draft will be prepared to be distributed to tiered leaders. In the next phase of implementation, the ADKAR change management model will be used to prepare departments for policy change. In this phase, communication plays a significant role in how change is perceived. The nursing managers will prepare their teams for future scheduling adjustments by communicating the need for change and providing the reasoning behind the policy creation. Leaders can also utilize this time to field questions from their caregivers prior to the policy rollout. Following this, the inpatient medical unit will be selected as a pilot unit to do a preemptive trial run to uncover areas of concern that may have been overlooked. Lastly, an organization-wide rollout will take place where the policy will be in full implementation throughout the company. Continuing education and compliance reinforcement through unit leadership and support from the scheduling coordinator for ongoing monitoring would follow as a final phase of operability to complete the project. 15 Interdisciplinary Team The healthcare professionals included in this project include executive nursing leadership, department managers, nursing staff, scheduling coordinators, and human resources. Collaboration of ideas among the interdisciplinary team is crucial to achieving successful policy creation. By involving key stakeholders, the organization will agree on terms and regulations from all perspectives. Executive Nursing Leadership. Nursing leaders hold a high-level role in supporting policy change within healthcare settings. They will provide feedback in creating and publishing the new policy for the company. Their responsibility will be to strategize methods in which the workflow of change management and communication of the new policy can be most successful within the organization. Executive nursing leaders will ensure that the policy aligns with the priorities of the caregivers within the organization. Some of these priorities may include efficient operating metrics, caregiver satisfaction, and patient safety. They are also responsible for providing the ‘why’ behind the change to caregivers to ensure the significance of the change is understood. They will achieve this by sending out thorough communication via frequent updates that may be done via email, townhall, or in-person rounding with varying intervals of time, allowing updates to be received by multiple different platforms potentially aligning with the caregivers individual learning style. They will also provide evidence-based practice metrics regarding patient safety occurrences and caregiver burnout. Department Managers. The leaders on the individual units are responsible for cascading the change from upper management and relaying the information in an effective way to their teams. This level of management takes the task of translating the policy and helping staff understand how it impacts their positions as caregivers. Department leaders also monitor the 16 temperature of caregiver reaction and offer suggestions for potential future iteration. Most importantly, managers are responsible for completing the tasks listed in the policy change, in this instance, practicing safe scheduling techniques and holding the team compliant to the new process. Nursing Staff. The caregivers are the frontline employees being affected by the policy change. They are the population that are most essential to the project’s success as they directly influence peers and have valuable feedback on operational changes. With this experience, nursing staff become the best advocates for other caregivers’ wellbeing. The caregivers will be engaging in the new expectations of revised scheduling practices when they participate in the schedule sign up process for their unit. With the support of the scheduling coordinator assigned to the department, they will be guided in the new process of selecting shifts within the new expectations of the policy. Their participation and adherence to new scheduling expectations paves the path for the credible experience needed to promote future positive changes. Scheduling Coordinators. The scheduling coordinators are the clerical employees that support the department scheduling and timekeeping functions. These individuals will assist in carrying out the action of complying with the new parameters of safe scheduling. Along with the unit managers, the scheduling coordinators can uphold policy changes in their daily workflow by supporting caregivers when signing up and adjusting scheduled shifts. The scheduling coordinators support the unit leaders by carrying out the action of the policy parameters and help enforce caregiver compliance. Human Resources. Human resource employees are involved in the creation of the policy to ensure that laws and regulations for the state are being abided by. They ensure that the framework follows labor laws and standard practices within healthcare organizations. They also 17 serve as a hub for caregivers to submit questions and gain clarification on the policy and what it entails. Description and Development of Project Deliverables Safe Scheduling Practice Policy. The first deliverable of this project is the safe scheduling practice policy for publication into the policy library for the organization. The policy states exactly what will be expected to be followed going forward in relation to the caregiver scheduling process. The policy will serve as the guideline for safe practices and adherence for organizational standard processes (see Appendix A). The policy itself will serve as the main reference point for caregivers or leaders that have questions pertaining to the new safe scheduling requirements. Caregiver Infographic. The next deliverable of this project is the unit flyer that will be posted for review within the departments. Additionally, this handout will be dispersed via email to all caregivers within the organization as a reference sheet (see Appendix B). This handout will be of the utmost importance to provide a visual representation for caregivers to review when they are working or during their own time reviewing their emails. Pre & Post Assessment Questionnaire. The last deliverable of this project is a questionnaire to adequately assess the caregiver’s understanding of scheduling practices and how they affect their workflow prior to the change and following the new policy implementation (see Appendix C). This questionnaire consists of eight statements for the caregivers to respond to in a yes or no style format. The length and content of the questionnaire was built for simplicity and with sensitivity for time spent by the caregiver providing feedback. This tool will provide data that is measurable according to experience directly from frontline caregivers whom this policy affects the most. 18 Timeline The proposed timeline for implementing this change is over the course of three months. By using this approach, the timeline for the scheduling process changes can align with the company standard scheduling process and requirements. The change will begin to be communicated at the beginning of a scheduled sign-up cycle for the upcoming eight-week schedule. The change will proceed over three phases to ensure thoroughness and alignment. Phase one will include the first four weeks of implementation. During the first two weeks, the first draft of the policy will be finalized, meetings with key stakeholders will be complete, and communication efforts will begin to be organized. During weeks three and four, final small group meetings will be held with stakeholders to complete final reviews of policy verbiage and incorporate and feedback needed. The future implementation date for the policy will be determined during this phase. During phase two, the focus will shift from preparation and design to communication dispersal through the organization platforms such as email chains providing caregiver updates. The next four weeks will be comprised of announcing the change coming to the hospital including an implementation date. Managers will attend meetings with the scheduling coordinators to coordinate understanding of verbiage and compliance with the new policy. Caregivers will be provided with the pre-assessment questionnaire prior to going live with the change. During the third and final phase, the last four weeks of the timeline will consist of identifying any barriers to proceeding with policy changes and holding question and answer sessions available for caregivers to attend. Finally, the policy will be announced as live, and caregivers will use the schedule sign up cycle as the first attempt at implementation. Post implementations assessment questionnaire will be conducted for future policy compliance (see Appendix D). 19 Project Evaluation To evaluate the effectiveness of the project, the focus will rely heavily on the pre-andpost implementation assessments measuring scheduling satisfaction, fatigue awareness, and caregiver voice (see Appendix C). Based on the responses to these questions, a baseline can be determined for whether the implementation of the policy will address the original concerns and enhance caregiver well-being, patient safety and nursing autonomy. Implementation strategies must be evaluated using measurable tools such as an assessment type format to ensure reliable data collection (Fontaine at al., 2024). The pre assessment forms will be dispersed to the pilot departments via email as an electronic document in the acute care setting prior to the go live date. Unit leaders will then evaluate the completed forms with the continuous improvement team to create graphs trending the data collected from the responses electronically. There will be no caregiver information attached to these electronic documents ensuring caregiver anonymity. The data from the responses will be collected before the policy is published. The same process described above will be repeated after the policy is implemented to create a comparable database of responses and a comprehensive understanding of how the policy influenced caregiver scheduling. This data will include descriptive statistics to measure changes and evaluate success. The firsthand caregiver feedback will provide supportive evidence to show if the implementation process went smoothly and if the training received was adequate. Ethical Considerations Ethical considerations will be addressed through maintaining respect for nondiscriminatory practices in pursuing feedback. This means that feedback on the pre and post assessment will be disseminated to caregivers without bias. Ethical nursing data driven practices require strict protection of confidentiality, transparency, and explanations that prevent misuse or 20 discrimination (McGonigle & Mastrian, 2022). All caregiver feedback will maintain confidentiality as it will be administered electronically without requesting the name of the caregiver and will be voluntary to complete without retribution. Additionally, the policy created will be the expectation for the entirety of the organization in an all-encompassing manner for all employees. Training materials and communication will be provided to all caregivers and accessible within the organization’s website landing page. Leadership will ensure that any additional supportive measures are applied as needed regarding language or interpretation barriers. The project in its entirety will follow ethical pathways by preserving equity and inclusion. To achieve this, all caregivers will receive the same format of pre and post assessments, responses are submitted anonymously. Bias will be minimized by collecting responses from multiple groups of people including caregivers, members or leadership, organizational participants and other key stakeholders. This maintains a broad sample of caregivers to provide a large scope of data. Discussion The information in the following sections reflect the evidence-based approach that is taken to discern solutions regarding unsafe scheduling practices. The findings outlined clearly show the need for intervention and standardization to address ongoing concerns including excessive and consecutive shifts, caregiver fatigue and increased frequency in patient safety events (Bae, 2024). Working consecutive shifts and longer hours than necessary directly contribute to increased turnover within healthcare organizations (Bae, 2024). Additionally, caregiver fatigue soars to high levels directly influencing the likelihood of errors including patient falls and incorrect medication administrations (Booker et al., 2024). These findings further solidify the need for safe scheduling practices and rapid intervention. By establishing 21 common goals and clear policy outline for caregivers to follow by creating limits for shift lengths, consecutive shifts, and caps on overtime we can minimize the concern and improve safety outcomes (Epstein et al., 2023). Evidence-Based Solutions for Dissemination The deliverables will be presented to leaders within the organization to determine if implementation of a new policy is achievable. The project findings will be disseminated by also presenting to all inpatient acute care leaders to show the need for change. The ADKAR model will further illuminate the pathway for the process changes and how they can effectively be implemented within the department. This project will also be presented in a poster format to a group of master’s level students and faculty in the final semester of the NRSG 6802 course. Significance to the Advancement of Nursing Practice This project can benefit and support the well-being of healthcare professionals as it relates to their schedules and safety within the hospital setting. It can also directly influence caregiver turnover and burnout by providing a healthy work life balance with ample time to recharge between shifts (Peršolja, 2023). The root of the problem is lack of regulation and written policy to guide caregivers during the scheduling process. The concerns are also fueled by nurses that are trying to take advantage of monetary incentives by working consecutive shifts incentivized by extra pay. Oftentimes, these issues primarily surface when the hospitals are consistently short staffed leaving a gap of disregard for safety for caregivers and patients. As scheduling remains the forefront of caregiver satisfaction levels, it is imperative to address the problems and keep caregiver autonomy with their schedules intact (Barker et al., 2025). By creating a policy for caregivers to abide by, the risk for patient safety events related to extreme caregiver fatigue can be mitigated. Caregivers can still have autonomy in creating their 22 schedules. With a set of guidelines to align the organization, standard practices can be implemented to benefit the employees, patients, and the organization in a meaningful way. Implications The overall trajectory of safe scheduling practices has been a challenge for many healthcare organizations. The strengths of this project include creating a set of inclusive parameters that can standardize scheduling for caregivers as well as impacting potential patient safety events. The relevance that this topic provides affects a large population of employees on a grand scale. By using the ADKAR model to support change management, caregivers will have a solid understanding of the past, present and future of the issue at hand. The project follows evidence-based scheduling practices to show that limits on consecutive shifts, hours worked in a day, and caps on overtime are sustainable solutions for an enhanced work environment. The deliverables created for this project include the written policy, educational handouts, and assessments that are easily measured to gain valuable caregiver feedback for future adjustments if needed. Limitations to this project include poor compliance with such a large group of caregivers causing concern for a successful implementation process. Within the nursing profession, long hours and expected overtime when departments are short staffed has become the normal function, making it difficult to break past patterns. Caregivers could view this policy change as punitive and resist the change in large groups making it difficult to gain buy in or trust. Another limitation is that not all units are created the same way with scheduling. For example, surgical services nurses require an entirely different layout of shift start times and lengths. This is one area that functions very differently in comparison to inpatient acute care, making the scheduling processes difficult to have a one size fit all solution. Other limitations may include the pilot unit 23 being too small, or not scalable due to different operational needs. Lastly, the cooperation from all leaders managing units is critical to the success of this change being meaningful. Without full support from midlevel management, there is potential for some caregivers to not be held to the same level of accountability as others in scheduling safely according to policy. To reduce these barriers, meaningful communication is key. The key stakeholders will provide transparent updates throughout the process to managers and participating groups to keep them informed and involved. Leaders will also provide time set aside to specifically ask questions or express concerns prior to the policy going live for the corporation. Some of these initiatives may include email updates, small group huddles, or caregiver town halls to help them better understand the repercussions with the current scheduling system. By addressing these challenges early on with the support of leadership that is engaged, caregiver involvement will enhance the potential success of the policy implementation and promote longevity within the organization. Recommendations Some recommendations that may provide strength to this project include more frequent communication throughout the transition; this could look like the incorporation of digitized education with a mandatory expectation to be completed by each caregiver for accountability. There could be more presence of senior leadership communicating the change up front rather than filtering down through unit leaders so that caregivers are hearing about the change straight from them. There could also be formal meetings with the scheduling coordinator for the departments to show solidarity and commitment to supporting the caregivers according to the new policy. Additionally, long-term evaluation of compliance would need to be addressed to understand if caregivers are abiding by the new rules. Tracking this data and trending it with 24 patient safety occurrences along with evidence-based literature could strengthen the message of why the policy is necessary. Turnover rates on the departments are another metric that unit managers could follow before and after implementation to see if there is correlation between the new expectations and caregiver intent to stay. By continuing on the path to refine the policy with caregiver feedback and data gathered through the assessments, the organization can confidently provide an evidence-based approach to providing safe scheduling practices to all caregivers. Conclusions The overall concept of safe scheduling practices within the healthcare system are vital to support the well-being of healthcare professionals and prioritize patient safety. The evidence provided in this project clearly shows that when caregivers are working extended hours, too many consecutive shifts and/or an excess of overtime it can lead to detrimental outcomes such as nursing burnout and patient safety occurrences (Bae, 2024). By taking the time to commit to creating a clear outline of safe scheduling guidelines in the form of a policy we are addressing a crucial gap within the organization with the support of evidence-based literature. By using the ADKAR change model, the implementation of the policy into practice can be formally adopted into each nursing unit in a structured and phased approach. The ADKAR model steps provide an approach that is thoughtful and structured to ensure caregivers feel supported throughout the transition (Prosci, n.d.). Furthermore, the project implementation plan consists of an elaborate group of different specialties that can contribute expertise from all angles. This interdisciplinary team consists of leadership, caregivers, human resources, scheduling timekeeping coordinators, and more. With these key stakeholders collaborating as outlined in the project, the level of success of implementing the project in a productive way increases by including all perspectives. 25 This project can offer a sustainable pathway forward for this ongoing challenge within the healthcare profession. Safe scheduling practices have been prioritized as a caregiver satisfaction topic, but not as prevalent as an attempt to reduce safety occurrences (Wynendaele et al., 2021). The creation of the safe scheduling policy has the potential to improve work-life balance of healthcare professionals. By putting caregivers first, we can align the evidence and apply it to a large population of caregivers while still leading the charge by supporting the workforce of the organization. In conclusion, these efforts may lead to a high level of quality care for caregivers and the patients they serve. By taking strides forward to promote positive change, the healthcare profession may find effective and innovative ways to influence caregiver scheduling. This will result in a predominantly satisfied workforce with the tools to remain successful for years to come. 26 References Abdalkareem, Z. A., Amir, A., Al-Betar, M. A., Ekhan, P., & Hammouri, A. I. (2021). 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