Reexamining the Nurse Scheduling Problem: Staffing Ratios and Nursing Shortages*

Abstract

Legislators at the state and national levels are addressing renewed concerns over the adequacy of hospital nurse staffing to provide quality care and ensure patient safety. At the same time, the well-known nursing shortage remains an ongoing problem. To address these issues, we reexamine the nurse scheduling problem and consider how recent health care legislation impacts nursing workforce management decisions. Specifically, we develop a scheduling model and perform computational experiments to evaluate how mandatory nurse-to-patient ratios and other policies impact schedule cost and schedule desirability (from the nurses' perspective). Our primary findings include the following: (i) nurse wage costs can be highly nonlinear with respect to changes in mandatory nurseto-patient ratios of the type being considered by legislators; (ii) the number of undesirable shifts can be substantially reduced without incurring additional wage cost; (iii) more desirable scheduling policies, such as assigning fewer weekends to each nurse, have only a small impact on wage cost; and (iv) complex policy statements involving both singleperiod and multiperiod service levels can sometimes be relaxed while still obtaining good schedules that satisfy the nurse-to-patient ratio requirements. The findings in this article suggest that new directions for future nurse scheduling models, as it is likely 39 40Reexamining the Nurse Scheduling Problem that nurse-to-patient ratios and nursing shortages will remain a challenge for health care organizations for some time.

Integrated decision making in healthcare : an operations research and management science perspective

“…In most cases, to compose a roster for each individual, first sensible combinations or patterns of shifts are generated (cyclic or non-cyclic), called 'lines-of-work', after which individuals are assigned to these lines-of-work [166]. Sometimes, staff-to-shift assignment is integrated with staff-shift scheduling [74,525]. 'Self-scheduling' is an increasingly popular concept aimed at increased staff satisfaction which allows staff members to first propose individual schedules, which are taken as starting point to create a workable schedule that satisfies the staffing level requirement set on the tactical level [423].…”

“…The objective is to meet the required shift staffing levels set on the tactical level, while satisfying a complex set of restrictions involving work regulations and employee preferences [44,74,99,273,289,483]. Night and weekend shifts, days off and leaves have to be distributed fairly [399,451,525] and as much as possible according to individual preferences [44,166]. In most cases, to compose a roster for each individual, first sensible combinations or patterns of shifts are generated (cyclic or non-cyclic), called 'lines-of-work', after which individuals are assigned to these lines-of-work [166].…”

“…Methods: computer simulation [222], heuristics [309], mathematical programming [32,127,507,525], queueing theory [463], literature review [74,166,231,289,399,451].…”

“…Methods: heuristics [44,483], mathematical programming [44,273,423,483,525], literature review [74,99,166,289,399,451].…”

“…The second step is to translate the forecasted demand in workable shifts and in the number of nurses to plan per shift, taking into account the staff resources made available at the strategic decision level [507]. Often, nurse-to-patient ratios are applied in this step [222], which are assumed to imply acceptable levels of patient care and nurse workload [525]. To improve the alignment of care demand and supply, shift scheduling is preferably coordinated with scheduled admissions and surgeries [399], which also helps avoiding high variation in nurse workload pressure [32].…”