Key takeaways
- Over 90 days at a health system in Illinois, respiratory therapy filled 48% of its urgent shifts internally. Registered nurses filled 10.6%. Patient care technicians filled 5.5%. Same hospital, same 24-hour window, same tool.
- One number for the whole building hides that spread. A hospital-wide urgent fill rate of about 11% describes none of the three roles.
- The data shows the gap is concentrated by role. It does not yet say why. That makes role-level measurement the first step, before any policy is set.
Most hospitals track open shifts, if they track them at all, as one number: how many were posted, how many filled. At a health system in Illinois, that number for shifts posted inside 24 hours was about 11% over 90 days. Split it by role and the single number falls apart.
Three roles, three different problems
Respiratory therapy filled 48% of its urgent shifts. Registered nurses filled 10.6%. Patient care technicians filled 5.5%.
That is not a small spread. A last-minute respiratory therapy shift at this system was more than four times as likely to be picked up by an employee as a nursing shift, and nearly nine times as likely as a PCT shift. Everything else was held constant: the same hospital, the same 24-hour window, the same way of posting the shift and reaching staff.
Read it as one hospital and the urgent window looks like a 90% failure. Read it by role and one role is filling nearly half of its emergencies while another is filling one in twenty. Those are not the same problem, and they will not respond to the same fix.
Why the difference matters more than the average
A hospital that uses one urgent-shift policy, one incentive tier, one broadcast rule, one escalation path, is treating fundamentally different staffing needs as if they were the same. It is too generous for the role that is already filling and not nearly enough for the role that is not. The building-wide average of 11% is the number that gets reported upward, and it is the least useful of the four.
So, the role with the fewest people to draw from nationally (about 142,000 respiratory therapists against 3.5 million registered nurses, per the Bureau of Labor Statistics) posted the best urgent fill rate. Pool size does not explain the difference, at least not in the way most people would expect.
What the data does not say
The Illinois data shows a clear gap, but it does not explain what is driving it. Several factors could be contributing, and the data does not support isolating any one of them.
Respiratory therapists typically float across a whole hospital, so an urgent RT shift is visible and eligible to every therapist in the building. A nursing shift is usually tied to a unit, and a unit-specific credential narrows who can take it. PCT shifts may be posted in higher volume, at lower incentive, or later in the day. A role with a large PRN pool behaves differently from one without. Any of those factors could be contributing, and tracking performance by role and unit should make the pattern clear within a schedule period or two.
Department-level numbers from the first seven weeks of the pilot point in the same direction. Respiratory therapy filled its urgent shifts with a median time to fill of under an hour. Surgical acute filled fast once it filled, about 5.6 hours, but most postings never found a taker. Intermediate care posted the most shifts and took the longest, a 93-hour median. Three departments, three outcomes.
What to do with it
Measure by role first. Pull 90 days of urgent shifts and split the fill rate by role. If your spread looks like the one above, the building-wide number has been hiding your best and worst performers from you.
Then set policy where the gap is. The role filling nearly half of its urgent shifts probably does not need a higher premium; it may need nothing. The role filling one in twenty needs something, and the question of what, whether it is reach, eligibility, incentive, or posting time, is answerable once the measurement is in place. The incentive data covers the money side of that question; the two-problems argument in Hospitals Have Two Open Shift Problems. They Manage Them Like One. covers the time side.
Report the spread, not the average. A COO who sees 48%, 10.6%, and 5.5% asks a better question than one who sees 11%.
Where we come in
Gigly is how the Illinois system saw the urgent window by role in the first place. Employees see open shifts on their phones and pick them up, before those shifts turn into overtime or agency, and every posting, acceptance, and incentive is recorded by role and by unit. That is what makes the spread visible, and it is what lets a hospital test a change on one role without touching the others.
If you want to see your own spread, pull 90 days of urgent shifts and split the fill rate by role. If one role is above 40% and another is below 10%, you have two different problems, and you now know which one to work on first.
Frequently Asked Questions
Why would respiratory therapy fill urgent shifts so much better than nursing?
The data shows the gap, not the cause. Likely candidates are that respiratory therapists float hospital-wide, so every therapist can see and take an urgent shift, while nursing shifts are often tied to a unit and a credential. A hospital that measures by role and by unit can test which explanation holds.
Should incentives be set by role?
The data suggests one policy across all roles is the wrong policy. A role already filling nearly half of its urgent shifts may not need a premium; a role filling one in twenty may need something else entirely. Measuring by role is the step that tells you which.
What is a good urgent-shift fill rate?
There is no single benchmark, because the rate varies more by role than by hospital. At this system it ran from 5.5% to 48% across three roles in the same 24-hour window. Compare each role to itself over time, not the hospital to a national number.