Opening a hospital, tower or clinic? Learn when to start workforce planning, how to forecast headcount and which roles to hire first for a smooth launch.

<p><strong>TLDR: </strong>A new facility opens on the strength of its workforce plan rather than its construction schedule. Recruiting one experienced registered nurse takes 78 days on average, and credentialing and orientation add months on top of that. This guide covers when to begin planning, how to convert projected volume into headcount, which roles to recruit first, how to run hiring and credentialing as one connected schedule, and how to build flexible coverage that protects opening day.</p>

<p>A new hospital, tower or clinic is only as ready as the people inside it. Construction can finish on schedule and pass every inspection, and if units are not covered on day one, beds stay closed and the investment sits idle.</p>

<p>Scale depends on bed count and service mix. A full new hospital opening calls for a far larger hiring effort than a single new service line, and registered nurses usually make up the largest single share in either case. The planning discipline is the same at either end of that range.</p>

<p>Those requirements meet a tight labor market. The U.S. Bureau of Labor Statistics projects about 180,800 openings for registered nurses each year through 2035.<sup style="vertical-align: super; font-size: smaller;">1</sup> The 2026 <a href="https://www.nsinursingsolutions.com/documents/library/nsi_national_health_care_retention_report.pdf" rel="noopener noreferrer">NSI National Health Care Retention and RN Staffing Report</a> found that it takes an average of 78 days to recruit one experienced registered nurse, and 87 days for telemetry, the longest time to fill of any specialty the report tracks.<sup style="vertical-align: super; font-size: smaller;">2</sup></p>
<p>This guide gives healthcare leaders a practical workforce planning framework for opening a new facility or expanding an existing one. It covers when to start, how to forecast headcount, which roles to hire first, how to sequence credentialing and onboarding, and how to build contingency coverage so launch day stays on track.</p>

<h2> When Should Workforce Planning Begin for a New Facility?</h2>
<p>Workforce planning for a new facility should begin 12 to 18 months before opening, at the same time as major construction milestones. Waiting until the building is nearly finished leaves too little time to recruit, credential and train a full team.</p>
<p>The timeline math explains why. Recruiting an experienced registered nurse takes about 78 days.<sup style="vertical-align: super; font-size: smaller;">2</sup> License verification, certification checks, background screening and competency validation add several more weeks. Orientation adds another six to eight weeks. Stack those steps together and a single clinical hire can take six months or more from job posting to independent practice.</p>
<p>That math sets the sequence. Senior nursing and operational leaders need to be in place a year or more before opening, and high-volume hiring belongs in the final months, timed to the capacity of the educators and preceptors who will train it.</p>

<h3> A Sample Pre-Opening Workforce Timeline</h3>

<table>
  <thead>
    <tr>
      <td data-row="1"><strong>Months Before Opening</strong></td>
      <td data-row="1"><strong>Workforce Milestone</strong></td>
    </tr>
  </thead>
  <tbody>
    <tr>
      <td data-row="2">18 to 12</td>
      <td data-row="2">Set the workforce model, budget and service line mix. Hire the executive and nursing leadership team.</td>
    </tr>
    <tr>
      <td data-row="3">12 to 9</td>
      <td data-row="3">Finalize headcount by unit and shift. Launch recruitment for hard-to-fill nursing and allied specialties.</td>
    </tr>
    <tr>
      <td data-row="4">9 to 6</td>
      <td data-row="4">Begin license verification for early hires. Recruit charge nurses, educators and department managers.</td>
    </tr>
    <tr>
      <td data-row="5">6 to 4</td>
      <td data-row="5">Run high-volume hiring for registered nurses, allied professionals and support roles. Put contingent labor agreements in place.</td>
    </tr>
    <tr>
      <td data-row="6">4 to 2</td>
      <td data-row="6">Complete licensing checks and credentialing. Start orientation in cohorts.</td>
    </tr>
    <tr>
      <td data-row="7">2 to 0</td>
      <td data-row="7">Run mock patient days and go-live drills. Place flexible professionals in the roles still open.</td>
    </tr>
    <tr>
      <td data-row="8">Opening to 6 months after</td>
      <td data-row="8">Track volume against forecast. Rebalance the labor mix as permanent hires reach full productivity.</td>
    </tr>
  </tbody>
</table>

<p>For a hospital expansion, such as a new tower or service line, the same sequence applies on a compressed scale. The advantage is an existing workforce you can promote or transfer. The caution is that every internal move opens a new vacancy that needs a plan of its own.</p>

<h2>How Do Healthcare Organizations Forecast Workforce Needs Before Opening?</h2>
<p>Healthcare organizations forecast pre-opening workforce needs by starting with expected patient volume, converting it into hours of care by unit, and then adding a buffer for turnover and ramp-up. A clear forecast answers three questions: how many people, in which roles and by what date.</p>

<h3>Start With Volume and Service Lines</h3>
<p>Build the forecast from projected census, emergency visits, surgical cases and outpatient volume for each phase of the opening. Many facilities open in stages, so the workforce plan should match the number of beds and services live at each step rather than the building's full capacity.</p>

<h3>Convert Volume Into Headcount</h3>
<p>Apply target hours per patient day or coverage ratios to each unit, then translate those hours into full-time positions across all shifts, weekends and holidays. Include non-productive time such as paid leave, education and orientation. Emergency departments often need the most positions, because patient volume there can swing widely from day to day.</p>

<h3>Plan for Turnover From Day One</h3>
<p>New teams lose people too. NSI reports that 22.7% of newly hired registered nurses leave within their first year, and that hospital registered nurse turnover averaged 17.6%.<sup style="vertical-align: super; font-size: smaller;">2</sup> Build those losses into the forecast so the facility is not short of coverage three months after opening.</p>

<h3>Model Slow, Expected and Fast Ramp-Up</h3>
<p>Volume rarely matches the pro forma exactly. Create coverage scenarios for slower and faster ramp-up, and decide in advance which roles will flex with contingent labor. <a href="https://www.crosscountry.com/technology/insights-analytics" rel="noopener noreferrer">Workforce analytics</a> help leaders compare actual volume against the forecast and adjust week by week rather than quarter by quarter.</p>

<h2>Which Clinical Roles Should Be Recruited First for a New Facility?</h2>
<p>Recruit leaders first, then the roles with the longest lead times, then high-volume frontline positions. That order gives each wave of hires someone to report to and enough runway to get through credentialing and orientation.</p>

<h3>Clinical and Operational Leadership</h3>
<p>Chief nursing officers, nurse managers, allied department directors and clinical educators shape the culture, policies and workflows every later hire will follow. They also help recruit their own teams, which makes early leadership hiring a recruiting strategy as much as an organizational one.</p>

<h3>Hard-to-Fill Nursing and Allied Specialties</h3>
<p>Some roles take far longer to fill than others. NSI found that telemetry nurses take an average of 87 days to recruit and medical surgical nurses 83 days.<sup style="vertical-align: super; font-size: smaller;">2</sup> That is why nursing, imaging, laboratory and pharmacy roles often need the earliest start. Specialized areas such as the intensive care unit, operating room, labor and delivery and the neonatal intensive care unit also need experienced professionals who can precept newer staff.</p>

<h3> Physician and Advanced Practice Coverage</h3>
<p>Physician and advanced practice coverage deserves its own timeline, particularly outside metro markets. The Health Resources and Services Administration projects that by 2038 nonmetro primary care physician supply will meet 61 percent of demand, compared with 83 percent in metro areas.<sup style="vertical-align: super; font-size: smaller;">3</sup> Where a new facility sits in that picture should shape how early physician recruitment begins and how much locum coverage is planned for the first year.</p>

<h3>High-Volume Frontline and Support Roles</h3>
<p>Staff registered nurses, patient care technicians, certified nursing assistants, environmental services and patient transport roles make up the largest share of headcount. Hire them in cohorts timed to orientation capacity, usually four to six months before opening. Plan carefully here, because patient care technicians and certified nursing assistants carried the highest hospital turnover rates in the NSI report, at 33.8% and 32.5%.<sup style="vertical-align: super; font-size: smaller;">2</sup></p>

<h3>Educators and Preceptors</h3>
<p>Clinical educators and experienced preceptors are easy to overlook, and they set the pace for everyone else. Without enough of them, orientation becomes the constraint no matter how fast recruiting moves.</p>

<h2>How Should Hiring, Credentialing and Onboarding Timelines Be Coordinated?</h2>
<p>Hiring, credentialing and onboarding should be planned backward from opening day as one connected schedule rather than three separate projects. A delay in any one step pushes back every step after it.</p>

<h3>Work Backward From Each Start Date</h3>
<p>For every role, set the date the person must be practicing independently, then subtract orientation time, credentialing time and recruiting time. If an intensive care unit nurse must be working independently on opening day, subtract six to eight weeks of orientation, a few weeks for license verification and onboarding, and about 78 days of recruiting.<sup style="vertical-align: super; font-size: smaller;">2</sup> That search should start six months out or earlier.</p>

<h3>Run Credentialing in Parallel, Not in Sequence</h3>
<p>Start license verification, certification checks, background screening and competency validation as soon as an offer is accepted. Assign a dedicated credentialing lead for the opening so applications do not queue behind routine work at existing facilities.</p>

<h3>Onboard in Cohorts Sized to Your Capacity</h3>
<p>Plan for six to eight weeks of onboarding and orientation for most new team members. Group hires into start-date cohorts that match the number of educators, preceptors and simulation slots available. Staggered cohorts prevent a flood of new hires in the final month that no one has time to train.</p>

<h3>Rehearse Before Go-Live</h3>
<p>Mock patient days, equipment walkthroughs and electronic health record practice sessions let teams find gaps before real patients arrive. These drills also reveal where extra coverage will be needed in the first weeks of operation.</p>

<h3> Keep One Source of Truth</h3>
<p>Track every requisition, offer, credentialing file and orientation date in one system. A <a href="https://www.crosscountry.com/technology/beyond-vms" rel="noopener noreferrer" >vendor management system</a> can bring permanent and contingent hiring into the same view, so leaders see progress against the opening plan as it happens rather than in a monthly status report.</p>

<h2> How Can Flexible Workforce Capacity Support a Facility Launch?</h2>
<p>Flexible coverage protects the opening date when permanent hiring falls behind, when volume ramps faster than expected, or when new hires need time to reach full productivity. It works when it is designed into the workforce model in advance rather than added in a rush the week before go-live.</p>

<h3>Bridge Gaps While Permanent Hires Ramp Up</h3>
<p>Even a well-run recruitment campaign leaves some roles open on day one. <a href="https://www.crosscountry.com/staffing-services/travel-nursing-allied" rel="noopener noreferrer">Travel nurse and allied professionals</a> can cover those positions for a defined period while permanent staff finish orientation. Experienced travelers also bring knowledge from other openings, which helps steady a team that has never worked together before.</p>

<h3> Flex With Unpredictable Volume</h3>
<p><a href="https://www.crosscountry.com/staffing-services/per-diem-local" rel="noopener noreferrer">Local and per diem professionals</a> let leaders add or reduce shifts as census changes, without locking in permanent headcount before the volume is proven. The same approach works for the <a href="https://www.crosscountry.com/staffing-services/non-clinical" rel="noopener noreferrer">nonclinical roles</a> that keep operations running.</p>

<h3>Keep Specialty Services Open</h3>
<p>When a search for experienced operating room nurses, imaging technologists or respiratory therapists runs long, flexible professionals can keep that service line open so patients are not turned away during the first months.</p>

<h3> Build an Internal Resource Pool for the Long Term</h3>
<p>Once the facility stabilizes, an internal float pool adds a lower-cost layer of flexible coverage across units. The goal is the right balance between permanent staff, internal float and external flexible labor, with each channel carrying the demand it is suited to carry. <a href="https://www.crosscountry.com/workforce-solutions/internal-resource-pool" rel="noopener noreferrer">Optimizing your internal resource pool</a> is how leaders set that balance deliberately instead of by default.</p>

<h3> Plan the Transition From Launch Coverage to Steady State</h3>
<p>Define in advance how and when launch-period contingent roles convert to permanent hires, flex down, or remain in place as planned flexible capacity. NSI puts the annual cost difference between one travel registered nurse and one staff registered nurse at $66,081, which is why that transition belongs in the budget from the start rather than being worked out after launch.<sup style="vertical-align: super; font-size: smaller;">2</sup> A deliberate labor mix protects the opening date and the operating budget at the same time.</p>

<h2>Build Your New Facility Workforce Plan With Cross Country Healthcare</h2>
<p>Opening a new facility or expanding an existing one is among the largest workforce challenges a health system will take on. Cross Country Healthcare is a technology-driven healthcare workforce solutions company, and we work with leaders from the first headcount forecast through the first year of operations.</p>

<p>Our workforce solutions for new facilities and expansions include:</p>

<ul>
  <li>Workforce planning and advisory support to build headcount forecasts, hiring timelines and contingency plans.</li>
  <li><a href="https://www.crosscountry.com/workforce-solutions/msp-solutions" rel="noopener noreferrer">Managed service programs</a> that bring every supplier, rate and requisition into one program.</li>
  <li><a href="https://www.intellify.com/" rel="noopener noreferrer">Intellify</a>, our workforce intelligence platform, for visibility into hiring progress, fill rates and labor spend.</li>
  <li>Travel nurse and allied, local and per diem and permanent placement across clinical and nonclinical roles.</li>
  <li>Internal resource pool design for lower-cost flexible coverage once the facility stabilizes.</li>
</ul>
</br>

<p>Your building has a ribbon-cutting date, and your workforce plan should have one too. <a href="https://www.crosscountry.com/workforce-solutions-request" rel="noopener noreferrer">Connect with Cross Country Healthcare</a> to talk through a workforce plan built around the right healthcare talent, a quality program and clear visibility into how it is performing.</p>

<h2>References</h2>
<ol>
  <li>U.S. Bureau of Labor Statistics. "Registered Nurses." Occupational Outlook Handbook, 2025 to 2035 projections. <a href="https://www.bls.gov/ooh/healthcare/registered-nurses.htm" rel="noopener noreferrer" target="_blank">https://www.bls.gov/ooh/healthcare/registered-nurses.htm</a>. Accessed 12 October 2026.</li>

  <li>NSI Nursing Solutions, Inc. "2026 NSI National Health Care Retention and RN Staffing Report." March 2026. <a href="https://www.nsinursingsolutions.com/documents/library/nsi_national_health_care_retention_report.pdf" rel="noopener noreferrer" target="_blank">https://www.nsinursingsolutions.com/documents/library/nsi_national_health_care_retention_report.pdf</a>. Accessed 12 October 2026.</li>

  <li>Health Resources and Services Administration, National Center for Health Workforce Analysis. "State of the Primary Care Workforce, 2025." December 2025. <a href="https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/State-of-the-Primary-Care-Workforce-2025.pdf" rel="noopener noreferrer" target="_blank">https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/State-of-the-Primary-Care-Workforce-2025.pdf</a></li>
  </ol>



How to Build a Healthcare Workforce Plan for a New Facility or Hospital Expansion