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.