MMHA-6235 Walden University – One of the inpatient nursing units in Regional Hospital Center anticipates difficulty in meeting its staffing needs in the next several months.

QUESTION

Application: Scheduling Models for an Inpatient Nursing Unit

Optimal scheduling models for patient-care units are important, not only to help ensure that patients get adequate coverage and continuity of care, but also to accommodate staff preferences, which in turn can lead to higher staff retention.

In this Application you will analyze a scenario involving an inpatient hospital unit and propose ways that it can improve its performance by adjusting its scheduling model.

Scenario: Staff Scheduling at an Inpatient Nursing Unit

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 caresfor 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?
• 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.

With these thoughts in mind, write a 3- to 4-page paper in which you address the following:This 3- to 4-page Application Assignment is due by Day 7 of this week.

Your written assignments must follow APA guidelines. Be sure to support your work with specific citations from this week’s Learning Resources and additional scholarly sources as appropriate. Refer to the Essential Guide to APA Style for Walden Students to ensure your in-text citations and reference list are correct.Submit your assignment by Day 7.
Please proceed to the Self-Study.

ANSWER

Optimizing Scheduling Models for an Inpatient Nursing Unit

Introduction

Efficient staff scheduling is crucial for maintaining quality patient care and staff satisfaction in an inpatient nursing unit. In this paper, we will assess the current scheduling model and propose alternative models that can address the challenges faced by the nursing unit. We will evaluate the unit’s performance in terms of coverage, schedule quality, stability, flexibility, and cost, and consider various shift patterns and schedule types (Clarke, 2008). Additionally, we will discuss barriers to implementation, suggest performance measures for monitoring the effectiveness of scheduling changes, and recommend an operations-related strategy to address the identified challenges.

Current Performance Assessment

Coverage: The current scheduling model may struggle to meet staffing needs due to its rigidity and limited flexibility. The cyclical 8/40 pattern may not adequately accommodate fluctuations in patient volume and acuity, resulting in understaffing or overstaffing situations.

Schedule Quality: The current model’s schedule quality may be suboptimal as it fails to consider staff preferences and work-life balance (Carayon, 2008). This can lead to decreased staff morale and satisfaction, negatively impacting the quality of patient care.

Stability: The current model lacks stability due to its inflexible nature. Staff may experience frequent changes in their work patterns, leading to increased stress and reduced continuity of care for patients.

Flexibility: The current scheduling model offers little flexibility for staff to adapt to personal needs or unexpected circumstances. This can result in increased absences and a heavier reliance on costly agency staff.

Cost: The current model incurs high costs due to the use of agency staff to fill RN vacancies. Reducing agency staff utilization is a priority set by upper management.

Alternative Scheduling Models

Considering the unit’s specific needs and challenges, the following scheduling models should be considered:

Flexible Scheduling with Variable Shift Lengths: Implementing flexible scheduling with variable shift lengths, such as 8-, 10-, or 12-hour shifts, can enhance coverage and schedule quality. This approach allows staff to have more control over their work schedules, accommodating personal preferences and improving work-life balance.

Self-Scheduling Model: Introducing a self-scheduling model empowers staff to select their shifts within predefined guidelines. This model can improve schedule quality, flexibility, and staff satisfaction. It also enables better coordination between staff and patient needs, leading to enhanced continuity of care.

Barriers and Challenges

Implementing changes in staff scheduling can face several barriers and challenges, including resistance to change from staff, limited resources for training and system implementation, and potential conflicts in accommodating staff preferences (National Academies Press (US), 2004b). Resistance to change can be mitigated through effective communication, involving staff in the decision-making process, and highlighting the benefits of the new scheduling model. Adequate training should be provided to ensure a smooth transition to the new system, and clear guidelines should be established to address any conflicts in scheduling preferences.

Performance Measures

Staff Satisfaction: Regular surveys can measure staff satisfaction and identify changes in perception after implementing the new scheduling models. Higher staff satisfaction is likely to correlate with improved retention rates and better quality of care.

Patient Satisfaction: Continuously monitoring patient satisfaction scores can determine if changes in the scheduling model positively impact the quality of care. Higher patient satisfaction scores indicate improved continuity of care and increased patient engagement.

Operations-Related Strategy

In addition to changing the scheduling model, implementing a decentralized decision-making process can empower frontline staff and improve communication and collaboration. This strategy allows staff to contribute ideas, share concerns, and suggest improvements, fostering a positive work environment and enhancing overall unit performance.

Conclusion

By considering the unit’s performance in terms of coverage, schedule quality, stability, flexibility, and cost, it is evident that the current scheduling model needs improvement. Flexible scheduling with variable shift lengths and a self-scheduling model are recommended alternatives that can address the challenges faced by the nursing unit. To ensure successful implementation, barriers and challenges must be carefully considered, and performance measures related to staff and patient satisfaction should be monitored. Furthermore, adopting an operations-related strategy, such as decentralized decision-making, can complement the scheduling changes and contribute to overall performance improvement in the unit.

References 

Carayon, P. (2008, April 1). Nursing Workload and Patient Safety—A Human Factors Engineering Perspective. Patient Safety and Quality – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK2657/

Clarke, S. P. (2008, April 1). Nurse Staffing and Patient Care Quality and Safety. Patient Safety and Quality – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK2676/ 

National Academies Press (US). (2004b). Transformational Leadership and Evidence-Based Management. Keeping Patients Safe – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK216194/