A DECISION MODES FOR SHIFT SCHEDULING OF NURSES

The day-to-day scheduling of nursing staff in an acute care hospital c auses many problems for nursing administrators, one of which is the de termination of very short-term changes in needs for staff. The difficu lty lies not only in determining the number of patients for whom care must be provided, but the level of care that will be required by the p atients. In this paper we refer to the level of care required as the a cuity of care. We define acuity mathematically, for an individual pati ent, as the number of nurses in the unit needed by one patient during one shift. We represent the number of nurses needed in the unit during the shift as a multiplicative model of mean patient acuity, number of patients, and the mean rate of change in patient acuities. We show th at changes in these factors can interact to cause wide swings in the n umber of nurses needed to staff the next shift. We derive conditions n eeded for level staffing under certainty, then introduce changes in th ose conditions in order to study the effect on the number of nurses re quired. Finally, a simulation model enables us to study the stochastic interaction between the alternative experimental factors for patient acuity, number of patients, and the rate of changes in acuity.