One of the inpatient nursing units in Regional Hospital Center anticipates difficulty in meeting its staffing needs in the next several months. The current scheduling is cyclical, on a 8/40 pattern, with little flexibility. You are assigned to help the nurse manager of this unit. She asks you for your input on whether some challenges might be alleviated by changing the staff scheduling model. Based on your preliminary assessment, she will decide if she should do further formal analysis.
You learn the following facts about this unit, which may or may not pertain to the issue at hand:
This is a 30-bed nursing unit that cares for medical and surgical patients. Patient volume and acuity can change within +/- 20% on any given day.
The average daily patient census is 25 patients seen daily, with an average stay of 4–6 days. The daily census is usually based on the number of patients counted while in bed at midnight. This includes an average of 8 patients who are admitted and/or discharged or are transferred in or out of the unit on a daily basis.
The unit currently has 27 RNs, 10 other patient-support staff (LPNs, aides), 5 non-patient-support staff, and 1 manager. There are two vacancies for RNs that are filled by agency staff at a premium cost of 250% of the current staff’s average pay level. Upper management has mandated reduction in use of agency staff wherever possible.
A new information system (electronic nursing documentation system) is planned for implementation within the next few weeks. Current staff members will require 6–8 hours of uninterrupted training on the new system.
One current staff member is scheduled to be on maternity for 90 days beginning sometime in the next 8 weeks.’
Patient satisfaction scores for the nursing unit have never exceeded 70% satisfaction; the organization’s aim is at least 80%.
Staff morale is also low, as shown by a gradual, but significant decrease in employee satisfaction scores obtained from annual surveys.
Which scheduling models, beside the current one, would you advise the nurse manager to consider for this unit, and why?
Prepare for the Application by completing the following:
Review the scenario carefully and consider it in light of the five factors of staff scheduling—coverage, schedule quality, stability, flexibility, and cost. How do you think the unit is currently performing in terms of these factors? How are they likely to change over the next few months if nothing is done to the schedule model or to other aspects of this unit?
Review the various shift patterns (e.g., 8-, 10-, and 12-hour shifts) and types of schedule (cyclical and flexible) as discussed in Chapter 8 (Ozcan). Weigh the pros and cons of these models—both shift patterns and schedules—in light of these factors. Based on these considerations, which options would you expect to be most appropriate for this unit, and why?
With these thoughts in mind, write a 3- to 4-page paper in which you address the following:
Based on what you know of this unit, which scheduling models should be considered for planning purposes? Discuss the pros and cons of shift patterns and schedules for this particular unit, and provide a rationale for your recommendations.
What barriers or challenges should be considered when implementing any changes in staff scheduling?
Describe two performance measures (for example, involving staff, patients, or quality outcomes) that should be monitored to help determine if any scheduling changes have been positive, and explain why these measures are appropriate.
In addition to changing the scheduling model, identify at least one other operations-related strategy that might help this unit address the challenges described in the scenario.