People and Technology in the Workplace (1991) / Chapter Skim
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Operations Research in Nurse Scheduling
Operations Research in Nurse Scheduling
Pages 189-226
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From page 189... ...
This is because work schedules impose far-reaching constraints on the nurses' professional and social lives [Choi et al., 1986, 19891. So from 1983 to 1985, Rochester Methodist Hospital in Minnesota con(lucted an experiment with nurse schecluTing to assess how various schedules might affect the retention of nurses.
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From page 190... ...
ROCHESTER METHODIST HOSPITAL In many ways Rochester Methodist Hospital was an ideal site for such an experiment. Rochester Methodist Hospital, affiliated with the Mayo Clinic, was founded in 1954 as an acute-care facility.
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From page 191... ...
This was not an immediate problem for Methodist Hospital, since its nurse turnover rate in 1983 was only 12 percent. However, there were undeniable signals that suggested a likely recurrence of a nursing shortage; one which would be of much longer duration than the cyclical shortages of the past.
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From page 192... ...
The idea of a research project related to retention first appeared in the Research Advisory Task Force Minutes of October 1, 19817 when it was listed as a priority for study selection at Rochester Methodist Hospital. In 1982 the hospital's nursing service departments to which all nurses belong identified scheduling, continuity of care, and research as areas requiring attention.
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From page 193... ...
and the Nursing Executive Committee [nurse managers) regarding those 20 work schedules.
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From page 194... ...
The Nursing Executive Committee and the Research Project Committees then selected three schedules to be implemented during the experiment: straight shifts, computerized schecluTing ;compfIex)
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195 CC o .~, o ._, Cal o o CO ._, o Lo ¢ o .
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From page 196... ...
Because of these strong reactions, an unplanned facet to the research was adclec3, which was to allow head nurses and staff the opportunity to submit anonymous comments about their schedules. The research coordinator on the experiment assembled the comments and shared them with the Nursing Executive Committee.
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From page 197... ...
about nurse scheduling. The implication of conducting an opinion survey was that the employees could expect immediate action in response to their comments; therefore, a scheduling experiment could have been seen by staff nurses as an unnecessary delay.
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From page 198... ...
Figure 1 shows how disappointments and discrepancies between what nurses expect and experience of their work schedules are strong predictors of nurses' intent to resign jChoi et al., 1989~. Intention to resign has also been shown to have a direct and significant effect on turnover tWeisman et al., 1981~.
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From page 199... ...
Key: Scale 06: Discrepancy concerning work schedules creating a climate for ideal professional nursing. Scale 10: Discrepancy concerning work schedules allowing freedom for personal business.
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From page 200... ...
To make the experiment as realistic as possible, none of the stations in the three experimental groups was allowed to exceed the normal budget; thus, results of the experiment did not involve a cost increase. Under the straight-shift schedule, virtually all staff members of nursing units worked straight days, evenings, or nights.
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From page 201... ...
This intervention was primarily intended to monitor nurses on a station; thus random sampling was used for stations, not specific individuals. Three general types of nursing units were identified through hierarchical cluster analyses of some 37 characteristics of each unit that were judged by heat!
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From page 202... ...
The sampling frame consisted of 18 medical and surgical nursing units stratified by general type of unit (clusters of 4, 7, and 7 units of types A, B and C, respectively)
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From page 203... ...
The select-a-plan scheduling group was significantly different from the control in four of the 36 scales: expectation of a work schedule that allows for communication with day department Scale TABLE 2 Significant Differences Across 36 Scales Relative to the Control Group: RNs and LPNs Before Treatment After Treatment Straight shift Compflex Select-a-plan Scale 1 (+J Scale 2 ~ + J Scale 3 t-J Scale 2 t+J Scale 3 t-J Scale 4 t-J Scale 5 (-J Scale 6 t_Ja Scale 7 {_Ja Key: Scale 1 = experience of a work schedule that allows privacy at work; Scale 2 = sense of one's own marketability; Scale 3 = experience of a work schedule that fosters staff teamwork and friendship on the unit; Scale 4 = expectation of work schedule that allows communication with key departments; Scale 5 = expectation of being able to control one's schedule; Scale 6 = discrepancy concerning work schedules creating a climate for ideal professional nursing; and Scale 7 = discrepancy concerning work schedules that are predictable. (+J = scored higher than control (-J = scored lower than control.
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From page 204... ...
in a key variable discrepancy concerning work schedules creating a climate for ideal professional nursing {scaTe 61. This particular scale was shown previously to have a direct and significant effect on the intention to leave nursing See Figure 1~.
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From page 205... ...
Scale 5 I-) Scale 7 {_;a Key: Scale 1 - experience of a work schedule that allows privacy at work; Scale 5 = expectation of being able to control one's schedule; Scale 7 - discrepancy concerning work schedules that are predictable; Scale 9 = expectation of a work schedule that fosters relationships at and outside of work; Scale 10 = discrepancy concerning work schedules allowing freedom for personal business; and Scale 11 = expectation of a work schedule that allows privacy at work.
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From page 206... ...
DISCUSSION Overall, the experiment was effective in that varying work schedules produced different consequences. Virtually no difference existed between the study groups fall ran~lomly selected)
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From page 207... ...
the nurses' own sense of marketability also returned to the normal level. Over time, straight shifts could not be kept in the strictest sense at this acute-care hospital because nursing management desired experienced nurses on all shifts.
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From page 208... ...
to rotate to fill in for vacancies. The intended effect of the entire experiment was, in part, to reduce discrepancies between nurses' experiences and expectations of their jobs, root causes of turnover.
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From page 209... ...
However, the following reasons may account for the less-than-expected turnover: the scheduling task force became a permanent scheduling advisory committee with representation from all service areas; units felt there was a more flexible attitude in the scheduling department despite limited changes in policy; nurses were aware of a scheduling task force between the two merged hospitals and their efforts to fine] means of implementing new schedules; and some staff energy was diverted away from schecluTing to the ongoing merger.
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From page 210... ...
Hence, the changes may have greater impact on LPNs than RNs. POLICY IMPLICATIONS From the perspective of hospital administration and policy, it should be clear that the experiment did not cause significant nurse turnover.
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From page 211... ...
However, two factors have delayed the implementation. First, federal wage and hour regulations have been tightened for nonexempt employees2 so that the desired select-a-plan schedule would cost, for the entire nursing department fRNs, LPNs, and ward secretaries)
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From page 212... ...
The head nurses, as first-line managers, are the necessary link for the following reasons. The new schedules, especially select-a-plan, reflected clecentraTization, which made frequent communication all the more necessary between management and staff nurses.
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From page 213... ...
It is possible then to have a large variety of schedules at the hospital rather than the standard two before the experiment started. The other anticipated change is an increasingly stronger role for head nurses in schedule selection.
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From page 214... ...
Most nurses at Rochester Methodist Hospital are of nonexempt status. But they are eligible for exempt status, which is generally, though not always, represented by executive nurses or nurses with a certain level of education E.g., RNsJ.
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1969. Radial nursing units prove best in controlled study.
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6. Quality of care: Estimates were made of the scores on six scales that wouIc3 be used to measure quality of care on nursing units after the schedules were implementecI.
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From page 217... ...
Mayo Clinic support services 217
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From page 218... ...
Scale 6: Discrepancy concerning work schedules creating a climate for ideal professional nursing Reliability = .91 Scale 7: Discrepancy concerning work schedules that are predictable Reliability = .80 Scale 8: Expectation of a work schedule that allows continuity of care Reliability = .70 Scale 9: Expectation of a work schedule that fosters relationships at and outside of work Reliability = .88 Scale 10: Discrepancy concerning work schedules allowing freedom for personal business Reliability = .8 7 Scale 11: Expectation of a work schedule that allows privacy at work Reliability = .95 * Reliability coefficient, using Cronbach's alpha, less than .70; but single factor solution was obtained through factor analysis.
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From page 219... ...
OPERA TI ONS RESEAR CH IN NUR SE SCHED ULING 219 Scale 12: Expectation of a work schedule that creates a climate for ideal professional nursing Reliability = .96 Scale 13: Experience of a work schecluTe that creates a climate for ideal professional nursing Reliability = .88 Scale 14: Experience of a work schedule that allows common cation with key departments Reliability = .92 Scale 15: Discrepancy concerning work schecluTes allowing communication with key departments Reliability = .91 Scale 16: Expectation of a work schedule that allows freedom for personal business Reliability = .92 Scale 17: Experience of a work schedule that allows freedom for personal business Reliability = .93 Scale 18: Discrepancy concerning work schecluTes allowing privacy at work Reliability = .90 Scale 19: Expectation of a work schedule that is ideal for what I want Reliability = .80 Scale 20: Expectation of a work schedule that fosters communi cation and teamwork on the unit Reliability = .90 Scale 21: Discrepancy concerning work schedules fostering communication and teamwork on the unit Reliability = .86 Scale 22: Experience of a work schedule that fosters relation ships outside of work Reliability = .84 Scale 23: Discrepancy concerning work schedules fostering relationships outside of work Reliability = .88 Scale 24: Expectation of a work schedule that does not get in the way of social activities outside of the hospital Reliability = .85 Scale 25: Experience of a work schedule that allows social activities outside the hospital Reliability = .83
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From page 220... ...
nurses on my unit b. the head nurse on my unit
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From page 221... ...
Scale 3. Experience of a Work SchecluTe That Fosters Staff Teamwork ant!
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From page 222... ...
by the exchanges I make with my co-workers than by the scheduling department c. a level of satisfaction, while working on my unit, that is clepenclent more on day-to-clay staffing than on the work schecluTe assignee!
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From page 223... ...
good supervision even if my head nurse is not there n. a work schedule that facilitates the opportunity to communicate directly with other nurses regarding the plan for my patients o.
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From page 224... ...
Expectation of a Work Schedule That Fosters Relationships at and Outside of Work Reliability = .88) I currently expect this from a first-rate hospital: A work schedule that fosters relationships outside of work that are a positive influence on my personal life and make me happy A work schedule that fosters relationships outside of work that a.
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From page 225... ...
getting the house/apartment repaired/refurnished Scale 11. Expectation of a Work Scheclule That Allows Privacy at Work Reliability = .95 )
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