Holiday Nurse Staffing: How to Cover Callouts From Thanksgiving to New Year

Key Takeaways

• Plan the whole stretch from the Wednesday before Thanksgiving to New Year’s Day, and not only the three holidays. A study of anesthesia staff at one hospital found more unplanned absences on Mondays, Fridays and the days next to a holiday.
• Your per-diem nurses will cover fewer holiday shifts than usual, because they want the holidays off too. Ask each one in writing, by early November, which holiday dates they can work.
• Build a holiday volunteer list with the extra pay written next to each name. Let your charge nurses offer that pay on the first call, without waiting for your approval.
• In Texas, Health and Safety Code Chapter 258 bars a hospital from requiring a nurse to work extra hours or extra days beyond her schedule. Your holiday plan has to rest on volunteers.
• Do not plan late December as a slow month. CDC says flu activity usually peaks between December and February. If you do elective surgery, one study of a large anesthesia practice in Texas and Florida found December elective cases about 20% above the rest of the year.

Table of Contents

• Why Are Holiday Callouts Harder to Cover at a Small Hospital?
• Do Nurse Callouts Really Go Up Over the Holidays?
• Is Late December a Slow Time to Run Lean on Nurses?
• When Should You Start Planning Holiday Nurse Staffing?
• How Do You Build a Holiday Volunteer List?
• Who Should You Call First When a Nurse Calls Out on a Holiday?
• What Do Federal and Texas Rules Require for Holiday Nurse Staffing?
• How Does SimpleScheduleAI Help With Holiday Coverage?
• What to Do This Week
• Frequently Asked Questions

Holiday nurse staffing at a 25-bed hospital comes down to one question. When a nurse calls in sick on Christmas morning, who do you call, and will they say yes? This post is about answering that question in October, while you still have time. It covers the five weeks or so from Thanksgiving to New Year’s Day.

This post does not cover who works which holiday in the first place. That is a separate decision, covered in how to set up a fair holiday rotation. This post starts after the rotation is set, and deals with the sick calls that arrive anyway.

Why Are Holiday Callouts Harder to Cover at a Small Hospital?

A holiday callout is harder to cover at a small hospital because the usual backup people are busy too. Per-diem nurses travel and see family over the same weeks as everyone else. Most small hospitals have no float pool, meaning a group of nurses who move between units to fill gaps. On a holiday night, the whole backup list may be three or four people, and each of them already has plans.

For most of the year, a callout at a Critical Access Hospital gets covered by a per-diem nurse or by a full-time nurse taking an extra shift. Over the holidays, both groups shrink at once. A per-diem nurse who will work Christmas may also be on the call list at another hospital nearby. If that hospital calls first, or pays more, your call goes to voicemail. Our guide to coverage options for hospitals too small for a float pool covers the alternatives in more depth.

The numbers are tight too. Say your holiday night shift runs with two licensed nurses and one calls out. You are down to one, with fewer people than usual to call.

Do Nurse Callouts Really Go Up Over the Holidays?

Nobody publishes a reliable number for how much nurse callouts rise over the holidays. As of September 2026, we found no government or peer-reviewed figure. One study of anesthesia staff found more unplanned absences on Mondays, Fridays and the days next to a holiday. Your own last-year callout records are the most useful number you have.

You may have seen a figure like “callouts rise up to 30% over the holidays.” We traced it back to a staffing agency blog post that cites no data. Keep it out of your budget and your board reports.

The research that does exist is narrower. A 2020 study by Dexter and colleagues looked at two years of unplanned absences, meaning sick calls and other no-notice absences, among anesthesia staff at the University of Iowa. The study counted Mondays, Fridays and days next to holidays as one group. That group had more unplanned absences than Tuesdays, Wednesdays and Thursdays. Because the days were grouped, the study cannot tell you how much the holidays add on their own.

The study also counted the Wednesday before Thanksgiving as a day next to a holiday. That is why this post starts the holiday stretch on that Wednesday. An earlier study at the University of Miami found only minor differences by day of the week, or on the day before or after a holiday. So treat the pattern as something to check against your own records.

To check it, pull last year’s callout records from November 20 to January 5 and count the callouts by date. If you have no callout log, use last year’s posted schedule and the changes made to it, plus any texts you kept. Then start a log this year with four columns: date, shift, who called out, and who covered.

Is Late December a Slow Time to Run Lean on Nurses?

Late December is usually not a safe time to run lean on nurses. CDC says flu activity usually peaks between December and February. If you do elective surgery, one large study found December elective caseloads about 20% higher than the rest of the year. Plan December from your own census history, meaning how many patients you had each day.

The first piece of evidence is flu. In the 2024-25 season, CDC reports that activity started rising in mid-November and peaked in early February 2025. Flu season brings sick patients to your beds and sick nurses to the phone over the same weeks.

The second is elective surgery. Piersa and colleagues studied about 3.5 million adult elective anesthesia cases at the Texas and Florida locations of one large anesthesia practice, from 2017 to 2019. In December 2017, the daily caseload was “a 20% increase over the January-to-November baseline.” The next two Decembers showed the same rise. If your hospital does elective surgery or procedures, expect a busier December.

Neither study tells you how busy your unit will be on December 28. Your census from the last two Decembers does. Pull it before you decide which days to staff up.

When Should You Start Planning Holiday Nurse Staffing?

Start planning holiday nurse staffing in early October. Nurses book holiday travel early, and per-diem nurses commit to other hospitals early. By mid-November, many of the people you would call are already spoken for. A plan built in October gives you a list of names who have said yes.

Here is a simple timeline to adapt. The dates are suggestions. The first row assumes you already know who works each holiday, from your holiday rotation or however your hospital decides it.

The first row matters most. Nurses who know their holiday schedule in October can plan around it. Nurses who find out in late November are more likely to ask for changes.

How Do You Build a Holiday Volunteer List?

A holiday volunteer list is a short written list of nurses who have agreed to pick up extra holiday shifts. Each name has the dates they can work, the shifts they will take, and the extra pay you agreed. It sits apart from your normal callout list. When a holiday shift opens up, the charge nurse calls this list first.

Split the list into two groups, because each group answers the phone differently.

Signed up for a shift. These nurses agreed to a specific date and shift, at a specific extra pay. They expect the call and have kept that day open.

Open to a call. These nurses said they might be free on some dates but did not commit to a shift. They can say no when you call, and saying no should not count against them. A per-diem nurse who only sent you dates goes in this group.

For each nurse, write down:

• Name and phone number
• The holiday dates they can work
• Day shift, night shift, or either
• The extra pay you agreed for each date
• Anything that limits them, such as a shift they already work the day before

How much extra pay? We cannot give you a dollar figure, because it depends on your budget and on what nearby hospitals pay. Ask your charge nurses and per-diem nurses what nearby hospitals offered last year. Then take one number per holiday to your CEO or CFO for approval in October. It can be a flat amount per shift or a higher hourly rate. Pick one and write it down. Our guide on how to reduce nurse overtime covers how extra shifts add to your overtime bill.

The sign-up itself can be one short message. For example: “We need extra help on these holiday shifts. The extra pay for each is listed. Reply by November 10 with the dates and shifts you can take.” List the dates, shifts and pay below it.

Watch for the same two or three nurses taking every extra shift. That is how holiday coverage turns into nurse burnout by January. If you are not sure how your per-diem nurses are paid or scheduled, see what per diem nursing is.

Who Should You Call First When a Nurse Calls Out on a Holiday?

When a nurse calls out on a holiday, call the nurses who signed up for that shift first. Then call the rest of the holiday volunteer list. Then use your normal callout list, meaning the order you call nurses for a sick call during the rest of the year. Call an agency last. Write this order down before Thanksgiving, so that at 5 a.m. on Christmas the charge nurse reads it off a page.

Two changes to your normal callout process make the holiday version work.

Let charge nurses offer the holiday pay on the first call. On a normal night, a charge nurse may need your approval before offering overtime. On a holiday, waiting for that approval can cost you the nurse. Set the extra pay in October, write it on the volunteer list, and tell charge nurses they can offer it right away.

Call the volunteer list before the normal callout list. The volunteers already said they are willing to work. They are the people most likely to pick up. If you run a three-group holiday rotation, where nurses take turns working each holiday, your volunteers come from the per-diem nurses and the nurses who are off that holiday.

Requiring a nurse to work is not a step in this order. Texas Health and Safety Code Chapter 258 bars a hospital from requiring a nurse to work extra hours or extra days beyond her schedule, and a nurse may refuse. That covers ordering an off-duty nurse to come in on a holiday. The law has four narrow emergency exceptions. Under the one for an unforeseen emergency, the hospital must still make a good-faith effort, as far as possible, to cover the shift with volunteers. Other states set different rules, compared in mandatory nurse overtime by state.

Keep a short note of each holiday callout: who called out, who you reached, who covered, and the time. If a nurse later asks why someone else got the extra shift, you will have the answer. The full callout process is in how to handle nurse callouts, and night callouts are covered in after-hours callout coverage.

What Do Federal and Texas Rules Require for Holiday Nurse Staffing?

No federal or Texas rule sets special staffing levels for holidays. The federal rule for Critical Access Hospitals applies every day of the year. A registered nurse, clinical nurse specialist or licensed practical nurse must be on duty whenever the hospital has one or more inpatients. Texas sets no nurse-to-patient ratio, but it does require a nurse staffing committee and a staffing plan.

The federal rule is 42 CFR 485.631(a)(5), where CAH means Critical Access Hospital. The rule holds on holidays, so you cannot leave a holiday shift open while you have inpatients. It says “a registered nurse, clinical nurse specialist, or licensed practical nurse is on duty whenever the CAH has one or more inpatients.”

Under Texas Health and Safety Code 257.004, each hospital has a nurse staffing committee. At least 60 percent of its members must be direct-care registered nurses, meaning nurses who spend at least half their work time caring for patients. The committee recommends a staffing plan to the hospital’s board. Bring your holiday call order and volunteer list to that committee in October, so the nurses who will work the holidays see the plan first.

Staff your holidays to your staffing plan. If the plan sets a higher number than the federal rule, the plan’s number is the one to meet.

How Does SimpleScheduleAI Help With Holiday Coverage?

SimpleScheduleAI is an AI-native nurse scheduling service for Critical Access Hospitals. The AI builds each draft schedule, our scheduling team checks it, and the nurse manager approves it. For the holidays, that means three things. We set up your hospital’s holidays at the start. Each draft spreads holiday shifts evenly across your nurses. And when a nurse calls out, you get a short ranked list of who to call.

Here is what each piece does.

• Holiday shifts are spread evenly. When a draft is built, the AI scheduling engine counts holiday shifts per nurse against the team average. That way the same few nurses do not keep drawing them.
• Per-diem nurses are only scheduled on dates they offered. Our team keeps per-diem availability current from what you tell us, and flags any per-diem nurse who has not sent theirs.
• A ranked shortlist when someone calls out. The list puts nurses who would not go into overtime pay ahead of those who would. It compares each nurse’s skill level, which you set for each nurse at setup, with the nurse who called out. If the nurse who called out was your charge nurse and no one on the list can take charge, the list says so.
• A timestamped record of every schedule change. When a holiday shift changes, the change and its time are logged.

Here is what it does not do. The service does not know about your holiday volunteer list or the extra pay you agreed, so keep that list yourself. It does not track pay rates or dollar costs. It does not forecast your December census. It does not place the phone calls, and it does not record who you phoned or what they said. Your charge nurse still makes the calls and writes the short note.

SimpleScheduleAI is not the right fit if you need holiday pay calculated in the same system as the schedule. That belongs in your payroll system. See how it works for the full cycle, or watch it build a schedule and rank a callout shortlist in the interactive simulator.

What to Do This Week

1. Pull last year’s callouts from November 20 to January 5. Count them by date. Mark the days with the most callouts. Those days go in your plan along with the holidays.
2. Pull your census for the last two Decembers. Check whether late December was actually slow. Staff to what you find.
3. Decide the extra holiday pay for each date. Ask what nearby hospitals paid last year, and get your number approved now so charge nurses can offer it on the first call.
4. Draft the holiday volunteer sign-up. List the dates, the shifts and the pay. Plan to send it by October 31. Keep a printed copy with your scheduling downtime kit, in case the scheduling system goes down over the holidays.
5. Ask each per-diem nurse for their holiday dates. Get the answer in writing. A per-diem nurse who has not answered by early November is not on your list.

Frequently Asked Questions

Q: How much do nurse callouts go up during the holidays?

No reliable figure exists for nurses, as of September 2026. One study of anesthesia staff found more unplanned absences on Mondays, Fridays and days next to holidays than midweek, and an earlier study found little difference. The “up to 30%” figure online traces to a staffing agency blog that cites no data. Your own callout records from last November and December are the best number to plan with.

Q: When should a small hospital start planning holiday nurse staffing?

Start in early October. Post the holiday schedules by mid-October, send the volunteer sign-up with the extra pay by October 31, and give charge nurses the volunteer list and call order by mid-November. Per-diem nurses commit to other hospitals early, so a plan started in late November has fewer names on it.

Q: How do you cover holiday callouts when per-diem nurses are not available?

Use a holiday volunteer list built in October. It names nurses who agreed to pick up extra holiday shifts, with dates and extra pay. The charge nurse calls this list first and can offer the agreed pay without calling the manager. After that comes the normal callout list, then an agency.

Q: Can a Texas hospital require a nurse to cover a holiday shift?

Generally no. Texas Health and Safety Code Chapter 258 bars a hospital from requiring a nurse to work extra hours or extra days beyond her schedule, and a nurse may refuse. That includes ordering an off-duty nurse in on a holiday. The four exceptions are narrow emergencies. If you think one applies, ask your hospital’s legal counsel before relying on it.

Q: Do Texas Critical Access Hospitals have special holiday staffing rules?

No. Under 42 CFR 485.631(a)(5), a registered nurse, clinical nurse specialist or licensed practical nurse must be on duty whenever the hospital has at least one inpatient, every day of the year. Texas sets no ratio. It requires a nurse staffing committee and a staffing plan, and holidays should be staffed to that plan.

Sources

1. Dexter F, Epstein RH, Marian AA. Comparisons of unscheduled absences among categories of anesthesia practitioners, including anesthesiologists, nurse anesthetists, and anesthesia residents. Perioperative Care and Operating Room Management, 2020;21:100139. PubMed 33102816.

2. Earlier study of unscheduled absences among anesthesia practitioners at the University of Miami. PubMed 30149226.

3. Piersa AP, Tung A, Dutton RP, Shahul S, Glick DB. Study of December adult elective anesthesia caseload across Florida and Texas locations of a large multistate practice, 2017 to 2019. Anesthesiology, 2021;135(5):804-812. PubMed 34525169.

4. Centers for Disease Control and Prevention. About the flu season: timing of peak activity. CDC.

5. Centers for Disease Control and Prevention. Influenza Activity in the United States during the 2024-25 Season and Composition of the 2025-26 Influenza Vaccine. CDC.

6. Texas Health and Safety Code Chapter 258, mandatory overtime for nurses prohibited. Justia.

7. CMS Conditions of Participation for Critical Access Hospitals, licensed nurse on duty. eCFR, 42 CFR 485.631(a)(5).

8. Texas Health and Safety Code 257.004, nurse staffing committee. FindLaw.

Pradeep Pandey is the co-founder of SimpleScheduleAI, an AI-native nurse scheduling service built for Critical Access Hospitals in Texas. He serves as Deputy General Manager of Operations at Apollo Hospitals and holds an MBA from IIM Trichy. LinkedIn →