Don’t Just Outsource—Insource: How Nurse Leaders Are Reimagining Nurse Staffing and Workforce Flexibility
At AONL 2025, Hallmark’s Sunrise Session explored how forward-thinking health systems are tackling nurse staffing, budget strain, and talent shortages with float pools built for the future.
Nurse burnout is at an all-time high. Labor costs are surging. And nearly 45% of early-career nurses are considering leaving the profession. Sound familiar?
If you missed AONL 2025—or our Sunrise Session, Don’t Just Outsource – Insource: Flexibility, Float Pools and the Future—we broke down exactly how health systems are meeting the moment by building flexible, cost-effective float pools using an insourced approach. Spoiler: It’s not just about solving staffing issues. It’s about future-proofing your entire workforce strategy.
The Staffing Pickle No One Escapes
Traditional staffing models and reactive outsourcing aren’t cutting it anymore. Hospitals are overpaying for contingent labor, nurse morale is sinking, and DIY scheduling solutions can’t keep up with rising demand or changing generational expectations around flexible work.
Veteran nurses are leaving. New nurses are burning out. And the next generation is saying, “No thanks.” The result? Disengagement, safety risks, and quality concerns across the board.
Inside the AONL Sunrise Session
At our AONL Sunrise Session—Don’t Just Outsource – Insource: Flexibility, Float Pools and the Future—two seasoned leaders shared how they tackled these problems head-on:
- Bruce Cerullo, Board Member at Hallmark
- Kristin Wolkart, RN, MHA, NEA-BC, FACHE, former EVP and CNO at Franciscan Missionaries of Our Lady Health System, now CEO of H.O.P.E. Healthcare Consulting
Together, they walked through the playbook for building a flexible float pool model that:
- Recruited 400 nurses in just four months
- Delivered significant cost savings
- Boosted nurse satisfaction and retention
- Improved scheduling efficiency and reduced friction
What Makes a Float Pool Work?
Creating a high-performing Internal Resource Pool (IRP) isn’t just about hiring more nurses—it’s about designing the right structure for your system. Here are four key insights Wolkart outlined that helped her establish a successful program:
- Know your model: Regional vs. systemwide vs. specialty-based float pools
- Make it nurse-friendly: Flexible scheduling, shift transparency, mobile-first tools
- Balance cost and care: Align rates and incentives without overpaying agencies
- Track impact: Real-time data, platform integration, and outcome-driven reporting
One key insight to remember above all: Flexibility doesn’t mean chaos. With the right model and technology, hospitals are gaining control—not losing it.
Flexible Nurse Staffing Results You Can Feel (and Measure)
As a CNO at a multi-state hospital system, Wolkart proved that float pools don’t just work—they scale. They were able to recruit 400+ nurses recruited into their IRP in under four months, power double-digit percentage reductions in contingent labor costs, improve moral and scheduling satisfaction across nursing teams while driving stronger nurse retention tied to greater autonomy and flexibility. Here’s how:
Tell us about the system you worked at, and what you struggled with before partnering with Hallmark. What prompted your organization to rethink its approach to contingent labor and move toward a more insourced, flexible workforce strategy?
Before partnering with Hallmark, Wolkart’s health system struggled with a fragmented approach to contingent labor. Each hospital operated independently, leading to 40 different vendor contracts with varying rates, terms, and payment structures. There was no centralized oversight, making it impossible to track key workforce metrics like fill rates, credentialing, and overall spending. When they transitioned into the system CNO role, I quickly realized the lack of visibility and control was a major issue.
A conversation with a CNO from Trinity Health introduced her to Hallmark, and their structured approach to insourcing contingent labor was eye-opening. With Hallmark’s support, Wolkart and her organization undertook a significant shift—auditing their spending, standardizing contracts, and implementing a centralized workforce model. The transition was challenging at first, but it was necessary to break down silos and create a more collaborative system-wide approach.
Within a year, they had established a more structured contingent labor strategy, supported by operational policies and the right technology. This shift not only improved transparency and cost control but also empowered us to take ownership of their workforce.
The key lesson was clear: to build a sustainable staffing model, organizations must first quantify their labor challenges, establish strong policies, and leverage technology to drive efficiency.
What team members or departments should support this effort?
Wolkart’s support team was instrumental in driving the transition to a more centralized and strategic approach to contingent labor. At the core of this effort was her CHRO, a counterpart who worked closely with her to bring together key stakeholders, including the system’s CNOs, Hallmark, and the finance team. One of the first steps was analyzing the data—understanding where their spending was going, identifying inconsistencies in contract terms, and uncovering inefficiencies across our different locations. Finance played a crucial role in this process, especially given the complexity of managing multiple hospitals with distinct operational practices. Having their expertise ensured we had a clear financial picture and could make informed decisions based on real numbers rather than assumptions.
As they gained clarity, they broadened our scope, bringing in senior directors and engaging our nursing leadership. Since frontline nursing teams are most directly impacted by staffing decisions, their input was essential to shaping a model that would work in practice, not just on paper. This collaborative approach helped Wolkart and team bridge gaps between departments, align goals across the system, and create a workforce strategy that was both financially sustainable and operationally effective.
Where did you start? How did you go about building your contingent labor platform, VMS and IRP?
Wolkart’s advice here: start small, but start somewhere and most importantly, start.
She recognized the importance of taking the first step toward building a more strategic contingent labor platform. Initially, they focused on normalizing data collection, with each CNO managing their own spreadsheets to track spending and workforce needs. As she gained a clearer picture, we expanded our efforts beyond nursing to include radiology and other departments. One of the biggest challenges was the lack of visibility across multiple states, making it difficult to understand what orders were active and how our spend compared across markets.
Partnering with Hallmark, we began by implementing a Vendor Management Solution (VMS), which was a game-changer. The best part? The VMS didn’t cost anything—agencies covered the fees—yet it provided the transparency the health system needed to assess their contingent labor usage effectively. Through this process, they identified significant disparities in contracts and restructured them under the health system’s standardized terms. Hallmark also helped them introduce contract language that removed non-compete clauses, allowing Wolkart and team to internally recruit high-performing contract nurses instead of losing them after their assignment ended. Ultimately, the key to success was control—of their data, strategy, contracts, and labor force.
How did you determine the right type of float pool for your organization, and what factors influenced that decision?
Designing the right float pool model wasn’t about reinventing the wheel—it was about making it roll smoothly across our entire system. Wolkart and team started by bringing together our top nursing leaders to map out a flexible yet structured approach. The guiding principle? Start small but start. They knew a one-size-fits-all solution wouldn’t work, so we built a tiered model that gave nurses control over how much flexibility they wanted.
- Those who preferred consistency could stay on the PRN model.
- For those open to floating, we created Level 1, where nurses could move between units within a single hospital.
- Then came Level 2—true system-wide flexibility—allowing nurses to float between hospitals and locations as needed.
Of course, even the best plans hit speed bumps. Change, especially in staffing models, naturally comes with some resistance. Early on, they realized we hadn’t explained the benefits clearly enough, and skepticism crept in. People don’t just embrace change because it sounds good on paper—they need to see the “why.”
So Wolkart took a step back, communicated more effectively, and focused on securing buy-in. Over time, as nurses experienced more schedule control and saw how the model improved staffing balance, the hesitation turned into momentum. It wasn’t just a policy shift—it was a cultural shift.
Did you experience any bumps in the road creating your float pool? How did you overcome those challenges?
Building the IRP wasn’t just a logistical challenge—it was a cultural shift in nurse staffing. While external contracts were easy for leaders to let go of (after all, the process was simple—submit an order, get multiple agency bids, and pick the best option), transitioning to an internal system like Wolkart’s required a different level of trust. It wasn’t just about filling shifts; it was about leaders feeling like they were losing control over “their” people. Initially, she underestimated just how hard it would be for managers across different hospitals to embrace this change. That was a key lesson learned: change management isn’t just about processes; it’s about people.
The biggest pushback came from frontline managers who felt like they were losing their staff to a system-level entity. Many nurses had been on in-house contracts, floating within their units for higher rates, and some full-time nurses took internal contracts occasionally. The shift to a centralized float model made some leaders feel like they had less autonomy. At first, she struggled to understand the frustration—why wouldn’t they want a more streamlined, flexible workforce? But Wolkart soon realized that they hadn’t done enough grassroots communication before rolling it out. Staff and managers needed to be brought into the conversation early, not after the decision had been made.
Once they changed their approach and engaged people directly—listening to their concerns, validating their frustrations, and inviting their feedback—the resistance started to shift. Managers who had initially resisted the change started to see the benefits. They no longer had to scramble to fill last-minute gaps, and the burden of managing short-term contracts was lifted. More importantly, they felt heard. By celebrating their successes rather than focusing on cost savings, the system was able to reframe the narrative.
One of the best success stories came from a unit that had relied on external contract labor for a decade, always staffing at least 8–10 contractors at any given time. Through the IRP, they worked closely with the unit, refining the model and addressing concerns, until they reached a point where they were fully staffed using only IRP nurses and full-time employees. Not only did it eliminate the constant churn of contract labor, but it also streamlined credentialing and evaluations into one system, making management significantly easier.
Why is that important? You won’t always know what’s going to be a sticking point for your staff until you’re in the thick of it. That’s where having the right partner makes all the difference. Hallmark helped Wolkart anticipate these challenges and navigate them with a structured approach to change management. By keeping communication open, focusing on collaboration, and adjusting along the way, they turned initial resistance into lasting success.
Tell us about the results. What measurable impact has this workforce transformation had on nurse staffing, retention, cost savings, and scheduling efficiency?
The workforce transformation had a profound impact, not just on costs but on the overall culture of nursing. Nurses felt empowered again, and leaders finally had a sustainable staffing model rather than a series of temporary fixes. The implementation of the VMS in May 2023 allowed them to gain full visibility into their contract labor spend, and by October, when the system launched the IRP, they started to see a clear shift. As the number of IRP hires increased, reliance on external VMS contracts steadily declined. What started as a nursing-focused initiative quickly expanded—other departments like ultrasound and radiology reached out for help when they faced sudden staffing gaps, leading us to integrate ancillary staff into the IRP as well.
The financial impact was even more striking. By shifting from expensive travel nurses to IRP employees that were on average 30% less expensive, they redirected millions from staffing agencies back into patient care. At the height of COVID, their contract labor spend had ballooned to $80 million annually. When the system launched this initiative, they hoped to save at least $10 million. In the first year alone, Wolkart and team saved over $20 million. Two years later, they had reduced overall contract labor costs from that $80 million peak down to $20 million—a staggering $60 million savings. Some of this was a natural rebound as nurses returned post-pandemic, but much of it was a direct result of fundamentally rethinking how we staffed their hospitals. This wasn’t just about cost-cutting—it was about building a smarter, more resilient workforce model.
Are nurse travelers really traveling?
Advice from Wolkart: If there’s one takeaway from this, it’s this: run a zip code search on your travelers. You might be surprised how many actually live within 50 miles of your system—meaning they’re not really “traveling” at all. Instead, agencies are recruiting your local nurses, marking up their rates, and selling them back to you. That needs to stop.
Wolkart and her system made a firm decision—if you live within 50 miles, you either join us directly or work for your agency at other hospitals, but not ours. And they enforced it with their agencies too, ensuring they could no longer send the system their own local talent under traveler contracts. It’s a simple step, but one that can save millions while strengthening your internal workforce and nurse staffing strategy.
Other than the obvious financial success pictured on this slide, what other impacts did it have on your staff in terms of their scheduling efficiency, reporting, morale, etc.?
Beyond the financial wins, the impact on the health system’s staff was just as significant. Nursing turnover dropped to 11.3%, placing Wolkart and team in the top decile of performance nationwide. For reference, turnover had been as high as 23-24% during COVID. The reason? With an IRP, these nurses are employed by the system—not just temporary workers passing through. They’re connected to the system’s mission, vision, and values, which wasn’t always the case with external contractors. During COVID, they saw firsthand how some travelers simply didn’t align with their culture or standards. By building an internal, flexible workforce, they’re not just filling shifts—they’re strengthening their teams with people who truly belong.
What are some lessons you learned along the way—things you wish you had known when you first started this transition?
One of the most important lessons from this transition is the need to engage the right stakeholders from the very beginning. Managers and schedulers, who are responsible for filling shifts and calling PRN or float staff, are the ones most directly impacted. It is essential to communicate the value of the new model to them early on, ensuring they understand that this change is not just another administrative shift, but a practical solution designed to streamline their workflow. Without their buy-in, resistance can slow the adoption process significantly.
Another key insight was recognizing the anxiety that comes with shifting control from unit-based staffing decisions to a centralized staffing office. Many managers initially struggled with the idea of calling an unfamiliar resource rather than reaching out directly to their usual staff. This hesitation underscores the importance of early education and clear communication. When managers understand that this change simplifies scheduling rather than complicating it, they become more open to the transition.
Ultimately, the shift to a centralized staffing model is not about taking control away but about improving efficiency and effectiveness. Organizations that implement this approach successfully see increased patient engagement scores, improved quality metrics, and reduced infection rates. Once these benefits become clear, initial skepticism fades, and the positive impact of the new system speaks for itself.
Looking Ahead—What Nurse Leaders Should Know to Fuel the Future of Nurse Staffing
With her new role in consulting, Wolkart shared what she sees coming next and advice for nurse leaders moving away from traditional staffing models toward a flexible, insourced float pool:
- Communication is key. For healthcare leaders considering a shift from traditional staffing models to a flexible, insourced float pool, the key to success lies in clear communication and strong leadership. While executives can champion the initiative from the top, real buy-in happens at every level. A simple email won’t cut it—leaders need to have direct conversations, explain the “why” behind the change, and involve frontline staff in the design process. When employees feel like they have a stake in shaping the model, their sense of ownership grows, making the transition much smoother.
- Planning for growth from the outset is equally critical. Many organizations start small, but the demand for a well-structured float pool often scales quickly. Instead of adding staff reactively, leaders should anticipate expansion and secure the necessary resources early. Half measures don’t work—commit fully, be bold, and advocate for the support needed to build a sustainable program from the start.
- Focus on staff engagement. Beyond financial benefits, the real impact of an insourced float pool is felt in workforce engagement, patient safety, and overall operational stability. The post-COVID landscape saw widespread dissatisfaction, high turnover, and organizational chaos. A well-managed IRP brings predictability, improves morale, and ultimately enhances care quality. When employees feel supported and valued, they stay—simple as that.
- Understanding the importance of flexibility is also crucial. Nurses aren’t just employees; they’re parents, partners, and individuals with lives outside of work. The next generation of healthcare workers demands autonomy, preferring to work on their own terms. Organizations that recognize and accommodate this shift will gain a competitive advantage in attracting and retaining top talent. If a nurse wants a four-hour shift, the right system should make it possible.
- Looking ahead, the future of nurse staffing is about leveraging technology, AI, and operational innovation to create true workforce flexibility. An insourced float pool isn’t just about filling shifts—it’s about building a staffing model that meets both workforce needs and patient care demands. It should be flexible enough to accommodate your needs, like four hour shifts or union specifications. Leaders who embrace this change and leverage the right technology won’t just see financial wins; they’ll create a resilient, engaged, and satisfied workforce ready for the future of healthcare.
Her advice to leaders: Start now. Start small. But start—because this isn’t just a staffing strategy. It’s a workforce transformation. And the first step to that start is quantifying the problem.
Staffing doesn’t have to be a constant crisis. As AONL 2025 made clear, insourcing your labor strategy with a centralized float pool isn’t just innovative—it’s essential. Missed the session but want the insights? Download the full presentation or get in touch to learn how Hallmark can help you design your own float pool strategy.
And most importantly, next time you’re stuck in a staffing pickle—don’t just outsource. Insource.