Visual Management of Nursing Staffing to Improve Workforce Balance and Reduce Overtime Coverage: A Longitudinal Quality Improvement Study

Abstract Background Hospitals face increasing pressure to maintain safe staffing while controlling labour costs. Nursing absenteeism, vacancies, turnover and day-to-day demand variation often generate overtime coverage and additional staffing expenditure. Visual management may improve operational transparency, but its application to nursing workforce balancing remains underreported. Methods We conducted a single-centre quasi-experimental before-and-after quality improvement study using interrupted monthly time series in a private tertiary hospital in Brazil. The intervention began in September 2025 and combined a visual Kanban-based workforce board with a managerial redeployment process. Scheduled staffing availability was used as an operational input, while absenteeism, occupancy, redeployment, overtime coverage events and related expenditure were monitored. Monthly data from January 2024 to August 2025 were compared with September 2025 to May 2026 using descriptive statistics and segmented regression. Results The nursing workforce comprised 160 professionals across 64 monitored beds and related clinical areas. Before implementation, mean monthly overtime coverage was 108.8 events and mean monthly expenditure was BRL 22,221.69. After implementation, mean monthly overtime coverage decreased to 23.4 events and mean monthly expenditure decreased to BRL 6,071.42, representing reductions of 78.4% and 72.7%, respectively. Segmented regression showed an immediate level reduction of 132.4 monthly events (95% CI -196.7 to -68.1) and BRL 29,540.46 in monthly expenditure (95% CI -42,581.39 to -16,499.53). During follow-up, 459 staff redeployments were recorded, with estimated avoided expenditure of BRL 99,916.00. Mean post-implementation occupancy was 82.27%, weighted absenteeism was 1.35% and mean staff redeployment rate was 3.39%. Conclusion Visual workforce management was temporally associated with fewer overtime coverage events and lower staffing-related expenditure while occupancy remained sustained. These findings support continued local refinement of the visual staffing routine as part of nursing workforce governance. Controlled or multicentre studies should determine whether similar routines reduce overtime while preserving patient safety, care quality and staff experience.