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

ABSTRACT

Legislators at the state and national horizontals are addressing renewed concerns above the adequacy of hospital supply with nourishment staffing to provide quality care and render certain patient safety. At the same time, the well-known nursing shortage remains an ongoing enigma To address these issues, we reexamine the supply with nourishment scheduling problem and consider in what manner recent health care legislation impacts nursing workforce management decisions. Specifically, we exhibit a scheduling model and perform computational experiments to evaluate by what means mandatory nurse-to-patient ratios and other policies impact schedule require to be paid [i]or[/i] undergone and schedule desirability (from the nurses' perspective). Our primary findings include the following: (i) nurture wage costs can be highly nonlinear with defer to to changes in mandatory nurseto-patient ratios of the stamp being considered by legislators; (ii) the number of undesirable shifts can be substantially reduc without incurring additional wage cost; (iii) more desirable scheduling policies, of that kind as assigning fewer weekends to each nurture have only a small impact upon wage cost; and (iv) manifold policy statements involving both singleperiod and multiperiod service horizontals can sometimes be relaxed while still obtaining advantageous schedules that satisfy the nurse-to-patient ratio requirements. The findings in this article intimate that new directions for subsequent time nurse scheduling models, as it is likely that nurse-to-patient ratios and nursing shortages will remain a challenge for health care organizations for more [i]or[/i] less time.

Subject Areas: Health Care Policy, Labor and Staff Planning, Mathematical Programming/Optimization, supply with nourishment Scheduling, and Planning and Scheduling.

INTRODUCTION

Labor shortages and quality of care in the nursing profession have been the subdue of considerable discussion for many years (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002; Berliner & Ginzberg, 2002; Clarke, 2004; Institute of Medicine, 2004; Stanton, 2004) nourishs commonly cite unattractive schedules and high workloads as sum of two units reasons for their discontentment (Stamps, 1997; Aiken et al., 2002; Cline, Reily, & Moore, 2003; Schaffner & Ludwig-Beymer, 2003) newly law-makers at the state and national horizontals have decided that this issue be worthy ofs serious consideration. For example, California lawmakers have instituted mandatory nurse-to-patient ratios that are awaited to cost California hospitals almost $1 billion in labor take away froms by 2008 (California Department of Health Services, 2004) Beyond the direct labor require to be paid [i]or[/i] undergones the opportunity costs also are significant as hospitals may be forced to make go round away patients to avoid violating the ratios. The implementation of the ratios has caused many difficulties for hospitals. For example, the ratios combined with the nursing shortage have contributed to several hospitals closing critical departments of that kind as emergency rooms and other hospitals closing their doors altogether (California Department of Health Services, 2004)

These actions by dint of California have prompted other state and national lawmakers to examine the issue. According to the Health Policy Tracking Service (2005) 21 states will address the use of mandatory nurse-to-patient ratios and 41 states will consider nourish staffing patterns. In addition, 39 states plan to consider other legislation concerning nursing shortages. At the same time, there are bills upon the floor of the U Senate that move national staffing ratios (Artz, 2005; Gonzalez, 2005) Adoption of these laws will require hospitals to reexamine the way they determine staffing horizontals to ensure compliance.

Another issue related to high nursing turnover and dissatisfaction is the amount of mandatory overtime that is commonly scheduled. commonly 9 states have restrictions upon the use of overtime and 14 more states are popularly considering comparable actions (www.seiu.org). Health care managers face significant challenges as these and other similar laws advance at a time when managers are beneath increasing pressure to control require to be paid [i]or[/i] undergones while simultaneously ensuring the delivery of high-quality care.

To address the issues described above, we reexamine the supply with nourishment scheduling problem and consider the impact of mandatory nurse-to-patient ratios and other policies upon workforce planning and scheduling decisions for hospital nourishs The efficient management of employee is vital to any organization's overall succes because labor require to be paid [i]or[/i] undergones often represent a relatively large portion of the pack For example, nursing labor require to be paid [i]or[/i] undergones typically represent over 50% of a hospital's total bag (Kazahaya, 2005). In addition, service organizations require effective workforce management because they rely heavily upon employees to provide continuing high horizontals of customer service.

The scheduling of nourishs has been studied for many years (Warner & Prawda, 1972; Hershey, Abernathy, & Baloff, 1974; Miller, Pierskalla, & Rath, 1976; Warner, 1976; Easton, Rossin, & Borders, 1992; Downsland, 1998) and continues to be of interest to the academic community (Mullinax & Lawley, 2002; Cheang, Lim, & Rodrigues, 2003; Bellanti, Carello, Croce & Tadei, 2004; Bard & Purnomo, 2005) In addition, other important policies related to the use of health care personnel have been addressed, including staffing an appointment scheduling center (Agnihothri & Taylor, 1991) staff mix (Bordoloi & Weatherby, 1999) cross-training policies (Campbell, 1999) nurture budgeting (Kao & Queyranne, 1985) and float loch nurse allocation (Trivedi & Warner, 1976)