Centralized nurse scheduling to simultaneously improve schedule cost and nurse satisfaction

Nursing managers are faced with rising turnover and shortages of qualified nursing staff. At the same time they are under increased pressure to simultaneously increase patient care and satisfaction while reducing costs. In this study, we examine the impact of centralizing scheduling decisions across departments in a hospital. By pooling nurses from multiple units and scheduling them in one model, improved costs and reduced overtime result. Reduced overtime improves schedules for nurses. Improved satisfaction levels can positively impact turnover rates among nurses. Our results show that by using a centralized model, nursing managers in hospitals can improve the desirability of nurse schedules by approximately 34% and reduce overtime by approximately 80% while simultaneously reducing costs by just under 11%.     

Centralized nurse scheduling to simultaneously improve schedule cost and nurse satisfaction

Nursing managers are faced with rising turnover and shortages of qualified nursing staff. At the same time they are under increased pressure to simultaneously increase patient care and satisfaction while reducing costs. In this study, we examine the impact of centralizing scheduling decisions across departments in a hospital. By pooling nurses from multiple units and scheduling them in one model, improved costs and reduced overtime result. Reduced overtime improves schedules for nurses. Improved satisfaction levels can positively impact turnover rates among nurses. Our results show that by using a centralized model, nursing managers in hospitals can improve the desirability of nurse schedules by approximately 34% and reduce overtime by approximately 80% while simultaneously reducing costs by just under 11%.     

Strategies for Addressing the Nursing Shortage: Coordinated Decision Making and Workforce Flexibility

In this article, we present strategies to help combat the U.S. nursing shortage. Key considerations include providing an attractive work schedule and work environment—critical issues for retaining existing nurses and attracting new nurses to the profession—while at the same time using the set of available nurses as effectively as possible. Based on these ideas, we develop a model that takes advantage of coordinated decision making when managing a flexible workforce. The model coordinates scheduling, schedule adjustment, and agency nurse decisions across various nurse labor pools, each of differing flexibility levels, capabilities, and costs, allowing a much more desirable schedule to be constructed. Our primary findings regarding coordinated decision making and how it can be used to help address the nursing shortage include (i) labor costs can be reduced substantially because, without coordination, labor costs on average are 16.3% higher based on an actual hospital setting, leading to the availability of additional funds for retaining and attracting nurses, (ii) simultaneous to this reduction in costs, more attractive schedules can be provided to the nurses in terms of less overtime and fewer undesirable shifts, and (iii) the use of agency nurses can help avoid overtime for permanent staff with only a 0.7% increase in staffing costs. In addition, we estimate the cost of the shortage for a typical U.S. hospital from a labor cost perspective and show how that cost can be reduced when managers coordinate.     

Job satisfaction and occupational stress in UK general hospital nursing staff

This study investigated factors associated with the perceptions of stress reported by nurses in a general hospital environment in the UK. The levels and sources of stress experienced by nursing staff were examined in relation to the type of ward or department, and nursing grade. The association between reported stress and job satisfaction was also examined. By means of a self-completion questionnaire survey, data were collected from 234 nurses from 24 wards in a single general hospital. The Brayfield and Rothe job satisfaction index was used to provide data for analysis. Factor analysis, analysis of variance, and Pearson product moment correlation procedures were performed on these data. The factor analysis identified two main factors concerned with sources of stress: interpersonal relations and resource problems, and dealing with death. Although there were no differences found across wards, the analyses of variance revealed that reported stress varied over different nursing grades. It was also found that job satisfaction was correlated with nursing experience and negatively related to stress.     

Managerialist Professionalism: The Destruction of a Non-conforming Subculture

This paper explores the complex relationship between professionalism and managerialism in the National Health Service (NHS) in the UK and argues that professional aspiration now embraces the managerial paradigm. More specifically, it describes a subculture – that of permanent night nurses – which endures a schematic difference from the now dominant day nurse culture, and is in imminent danger of extinction. It is held in contempt by many nursing professionals and managers whose agendas converge to form the unified template which informs their action. It is suggested that night nurses, marginalized and powerless, are a subculture with distinct native-view characteristics. Ward-based, like their day colleagues, but separated by a temporal divide, permanent night nurses recognize their difference, largely reject the new managerialist professionalism, feel unappreciated and cling to their perceived camaraderie and close patient-relationships.
This research explores the nature and origins of the new managerialist nursing profession and examines the basis of its claims of professionalism. The ethnographic methodology and research design are outlined and considerable data are presented. The paper draws upon the arguments of fellow professionals and managers who seek to deny the right of existence to this group. It is argued that 'atrocity stories' and other discourse, are evidence of evolving closure criteria, which exclude this apparently non-conforming subcultural group.     

Nurses: Training for new job demands

This paper argues that both the present and future job demands faced by nurses are likely to exceed the resources of the training which is currently provided for them. This argument will be supported by reference to the authors' studies of stress in nursing, as well as a variety of other sources. The common themes underlying reactions to both present and future demands include first, awareness of high stress levels to be found amongst nurses, and second, an emphasis on communication as both the problem and as the proposed solution. Common responses to these two themes are outlined, including training in stress management, and communication training. Some of the problems and unexamined assumptions (for example that hospital management actually wants to lower stress levels and improve communication in nursing) are examined. Some suggestions are made for developing training in health care contexts, to deal more adequately with likely future demands.     

人文关怀在护理工作中的体会

目的:探索人文关怀在护理工作中的体现。方法:通过加强自身的专业知识的掌握,学会以恰当的方式与患者沟通,从而了解人文关怀在护理中的体现。结果:护理工作者在护理工作中对患者的人文关怀主要体现在让病人感受到护士的关心与照顾,使护患关系更融洽。结论:人文关怀对临床护理质量的提高和整体护理的发展有着重要的作用,较高的护理技术与人文关怀的精神是护理中人文关怀的重要体现。     

ANALYSIS OF ALTERNATIVE SCHEDULING POLICIES FOR HOSPITAL NURSES

The persistent shortage of nurses adversely affects the productivity, quality of care, and operating costs in most acute care hospitals. Aggravating the shortage are high nurse turnover rates, approaching 200% in some institutions. Policies to ensure adequate staffing levels and provide more attractive work schedules are alleged to improve nurse retention. However, their cost is seldom discussed. We compared expected nursing expense and workforce requirements to staff eight medical and surgical nursing units of a large hospital for 1 month, under 12 different scheduling policies alleged to improve turnover. Using simulation and an integrated staffing and scheduling methodology, we found that the expected nursing wages and workforce requirements for some policies differed by as much as 33%. In this hospital, the expected labor costs for certain policies could erode the benefits expected from improved retention. In contrast, other policies appear to allow high utilization of nursing resources, enhancing the expected benefits of reduced turnover with significant reductions in expenses for labor, recruiting, training, and fringe benefits.     

Nurses: Training for new job demands

Abstract

This paper argues that both the present and future job demands faced by nurses are likely to exceed the resources of the training which is currently provided for them. This argument will be supported by reference to the authors' studies of stress in nursing, as well as a variety of other sources. The common themes underlying reactions to both present and future demands include first, awareness of high stress levels to be found amongst nurses, and second, an emphasis on communication as both the problem and as the proposed solution. Common responses to these two themes are outlined, including training in stress management, and communication training. Some of the problems and unexamined assumptions (for example that hospital management actually wants to lower stress levels and improve communication in nursing) are examined. Some suggestions are made for developing training in health care contexts, to deal more adequately with likely future demands.     

Work satisfaction, health, and stress: A study of Dutch nurses

A study was conducted to compare nurses' work satisfaction and feelings of health and stress in five different nursing departments: a cardiac care unit and a general surgical ward in a general hospital; and an admissions department, a short-stay department, and a long-stay department in a psychiatric hospital. One hundred nurses took part in the study: the instruments used were questionnaires and structured interviews. The main results showed that:

(1) nurses in the cardiac care unit had the most positive satisfaction scores

(2) nurses in the general surgical ward had the most positive scores on the health and stress variables

(3) feelings of dissatisfaction and stress were most prominent in the short-stay department and, to a lesser extent, in the long-stay department.

The findings are interpreted in terms of the different work situations and die implications for hospital management are discussed.

Dr J. A. Landeweerd graduated in industrial and organizational psychology in 1968 (PhD in 1978). He has worked at Eindhoven University of Technology (Department of Industrial Engineering) and now holds a position as senior lecturer at Limburg University (Department of Health Sciences), where he is project-leader for a number of research projects on the relationships between work and health.

Nicolle Boumans, MA, graduated in health sciences in 1985 (specialization: nursing science) and is now a research assistant. She is working on a PhD thesis concerned with the relationship between task characteristics of nurses and their reaction in terms of job satisfaction, health and stress.     

结构式团体在临床护士心理压力调解中的应用

目的探讨应用结构式团体在临床护士心理压力调解中的改善效果。方法选择临床护士60例,均为2020年06月~2020年12月间我院在册在岗内科病区护士,依据护士入科先后顺序采取分组,即前期入科护理人员30例采取自我调节方式应用心理压力,观察组为后期入科护理人员30例,采取结构式团体干预模式进行心理压力调节,对比护士不同调节方式下,情绪分值变化及对自我职业的倦怠评分、心理健康状态评分,并采取科室设计的满意度问卷展开评估。结果由自评量表结果所示,观察组护理人员在干预前焦虑、抑郁分值均无明显变化(P>0.05),干预后观察组护理人员焦虑、抑郁分值有所下降,与对照组呈鲜明对比(P<0.05)。职业倦怠量表测评结果所示,观察组护理人员情绪衰竭、工作态度、个人成就感三个维度的分值均低于对照组,差异显著(P<0.05)。由科室自我设计满意度问卷所示,观察组对自我工作满意度较高,与对照组比值差异明显(P<0.05)。两组在SCL-90量表测评下,观察组护理人员各项指标得分低于对照组(P<0.05)。结论结构式团体在临床护士心理压力的调解中的应用效果值得肯定,可改善职业倦怠感,提高工作效率。     

Work satisfaction,health, and stress: A study of Dutch nurses

Abstract

A study was conducted to compare nurses' work satisfaction and feelings of health and stress in five different nursing departments: a cardiac care unit and a general surgical ward in a general hospital; and an admissions department, a short-stay department, and a long-stay department in a psychiatric hospital. One hundred nurses took part in the study: the instruments used were questionnaires and structured interviews. The main results showed that:

(1) nurses in the cardiac care unit had the most positive satisfaction scores

(2) nurses in the general surgical ward had the most positive scores on the health and stress variables

(3) feelings of dissatisfaction and stress were most prominent in the short-stay department and, to a lesser extent, in the long-stay department.

The findings are interpreted in terms of the different work situations and die implications for hospital management are discussed.

Dr J. A. Landeweerd graduated in industrial and organizational psychology in 1968 (PhD in 1978). He has worked at Eindhoven University of Technology (Department of Industrial Engineering) and now holds a position as senior lecturer at Limburg University (Department of Health Sciences), where he is project-leader for a number of research projects on the relationships between work and health.

Nicolle Boumans, MA, graduated in health sciences in 1985 (specialization: nursing science) and is now a research assistant. She is working on a PhD thesis concerned with the relationship between task characteristics of nurses and their reaction in terms of job satisfaction, health and stress.     

Identifying the causes of nurses' stress: A survey of New Zealand nurses

Abstract

A nationwide survey of 2500 general and obstetric nurses identified five potential sources of stress. These included work overload, difficulties relating to other staff, the difficulties involved in nursing the critically ill, concerns over the treatment of patients, and dealing with difficulty or helplessly ill patients. These findings support earlier work which suggested that a number of stressful situations are commonly encountered by all nurses. In terms of intervention strategies these results point to a number of important issues which are discussed in this paper. They include the difficulties and conflicts inherent in the nurses' role, the multidimensional nature of the different stressors, aspects of the work environment which give rise to different stressors and the relationship between stressors.     

COMPARISON OF NURSE ALLOCATION POLICIES-A MONTE CARLO MODEL*

Many hospitals have historically used a fixed staffing policy for allocating nursing personnel, in which the daily demand in each ward is met by nurses who are permanently assigned to the specific wards. In recent years, the concept of variable staffing has been proposed as a means of increasing manpower efficiency. A variable staffing policy is one which provides for staffing adjustments to meet work load through the use of a common pool of cross-trained nurses. In this paper, a model is formulated to evaluate the relative benefits of variable and fixed staffing policies. Results from a Monte Carlo evaluation of the model demonstrate how the hospital administrator can assess the sensitivity of savings to changes in policy and operating parameters. Several criteria which an administrator might adopt for equating levels of patient care under alternative staffing schemes are suggested and studied. The proposed method of analyzing benefits of alternative allocation procedures shows promise for evaluating policy choices in hospitals, as well as other service organizations with similar characteristics.     

Evaluation of an intervention programme based on empowerment for eldercare nursing staff

This study evaluated the impact of an intervention programme at individual, worksite, and organizational level, for eldercare nursing staff at 12 eldercare units. The project aimed at empowering auxiliary nurses and nursing assistants, thus promoting good working conditions, health and well-being of eldercare staff, and improving their evaluation of the quality of nursing care. Questionnaire responses from the nursing staff (n=200) before and after an 18-month intervention programme evaluated the effects using ANOVA, repeated measures for the statistical analyses. Although the improvements were limited, the intervention seemed to impact on work conditions and on the perceived quality of nursing rather than on the health and well-being of staff. Work at nursing homes or at home-care was shown to modify the outcome due to different needs and priorities for work unit improvements. Staff turnover and multiple reorganizations are discussed as inhibiting factors for performance as well as for the evaluation of workplace interventions. The sharing of power between occupational groups or organizational levels must be carefully considered. The study emphasizes the importance of involving the middle management in early project planning and decisions.     

Evaluation of an intervention programme based on empowerment for eldercare nursing staff

Abstract

This study evaluated the impact of an intervention programme at individual, worksite, and organizational level, for eldercare nursing staff at 12 eldercare units. The project aimed at empowering auxiliary nurses and nursing assistants, thus promoting good working conditions, health and well-being of eldercare staff, and improving their evaluation of the quality of nursing care. Questionnaire responses from the nursing staff (n=200) before and after an 18-month intervention programme evaluated the effects using ANOVA, repeated measures for the statistical analyses. Although the improvements were limited, the intervention seemed to impact on work conditions and on the perceived quality of nursing rather than on the health and well-being of staff. Work at nursing homes or at home-care was shown to modify the outcome due to different needs and priorities for work unit improvements. Staff turnover and multiple reorganizations are discussed as inhibiting factors for performance as well as for the evaluation of workplace interventions. The sharing of power between occupational groups or organizational levels must be carefully considered. The study emphasizes the importance of involving the middle management in early project planning and decisions.     

Determinants of personal resilience in the workplace: nurse prescribing in an African work context

This article explores the determinants of personal resilience using the case of nurse prescribing in the North West Region of Cameroon. Nurse prescribing has long been identified as a practical solution to the severe shortage of well-trained doctors and high incidence of diseases in developing countries. However, the working conditions of nurses are risky and vulnerable due to major constraints, such as inadequate training, poor reward systems, limited access to medical facilities/equipment, and high workloads. Building on the resilience concept and using narrative analysis of in-depth interviews with nurses and nursing managers in public, private, and faith-based hospitals, the article develops a framework depicting three interrelated determinants of personal resilience, namely organisational plans and procedures, personal work context, and personal perception of an individual employee. The determinants are discussed further, and implications for human resource development theory and practice are critically examined.     

Sequential and Simultaneous Decision Making for Optimizing Health Care Resource Flexibilities

Health care administrators commonly employ two types of resource flexibilities (demand upgrades and staffing flexibility) to efficiently coordinate two critical internal resources, nursing staff and beds, and an external resource (contract nurses) to satisfy stochastic patient demand. Under demand upgrades, when beds are unavailable for patients in a less acute unit, patients are upgraded to a more acute unit if space is available in that unit. Under staffing flexibility, nurses cross‐trained to work in more than one unit are used in addition to dedicated and contract nurses. Resource decisions (beds and staffing) can be made at a single point in time (simultaneous decision making) or at different points in time (sequential decision making). In this article, we address the following questions: for each flexibility configuration, under sequential and simultaneous decision making, what is the optimal resource level required to meet stochastic demand at minimum cost? Is one type of flexibility (e.g., demand upgrades) better than the other type of flexibility (e.g., staffing flexibility)? We use two‐stage stochastic programming to find optimal resource levels for two nonhomogeneous hospital units that face stochastic demand following a continuous, general distribution. We conduct a full‐factorial numerical experiment and find that the benefit of using staffing flexibility on average is greater than the benefit of using demand upgrades. However, the two types of flexibilities have a positive interaction effect and they complement each other. The type of flexibility and decision timing has an independent effect on system performance (capacity and staffing costs). The benefits of cross‐training can be largely realized even if beds and staffing levels have been determined prior to the establishment of a cross‐training initiative.     

Nurses' representations of the perceived causes of work-related stress: a network drawing approach

This paper reports a study, involving a network drawing approach, that examined how nurses perceive the interrelationship between causes of workplace stress. Network analysis originated in sociology as a method of examining the relationship between people, objects or events. It has recently been adapted to examine participants' perceptions of the relationships between causes of a phenomenon, either by asking participants to complete a grid rating the strength of all the possible links between causes or by getting them to draw a diagram of the links that they think are important. The network drawing technique, in which participants are asked to draw a diagram indicating perceived causal links between nominated causes of stress and also to indicate the strength of these links, was employed in this study. The causes of stress were taken from a previous study in which nurses kept a diary for one week detailing stressful events and their causes. There were 48 participants in the present study and the main results confirmed the importance of staffing levels and inadequate support as perceived direct causes of stress. The study also revealed the importance of indirect links between staffing levels and other causes of stress. The networks illustrate how direct and mediating causes of stress are connected and lie largely outside nurses' control. The results are discussed in relation to other recent work on the causes and experience of stress by nursing staff.     

Nurses' representations of the perceived causes of work-related stress: A network drawing approach

This paper reports a study, involving a network drawing approach, that examined how nurses perceive the interrelationship between causes of workplace stress. Network analysis originated in sociology as a method of examining the relationship between people, objects or events. It has recently been adapted to examine participants' perceptions of the relationships between causes of a phenomenon, either by asking participants to complete a grid rating the strength of all the possible links between causes or by getting them to draw a diagram of the links that they think are important. The network drawing technique, in which participants are asked to draw a diagram indicating perceived causal links between nominated causes of stress and also to indicate the strength of these links, was employed in this study. The causes of stress were taken from a previous study in which nurses kept a diary for one week detailing stressful events and their causes. There were 48 participants in the present study and the main results confirmed the importance of staffing levels and inadequate support as perceived direct causes of stress. The study also revealed the importance of indirect links between staffing levels and other causes of stress. The networks illustrate how direct and mediating causes of stress are connected and lie largely outside nurses' control. The results are discussed in relation to other recent work on the causes and experience of stress by nursing staff.