Nurse Scheduling

Nurse scheduling
Outlines:
 Introduction
 Definitions of nurse scheduling
 Goals of nurse scheduling
 Dimensions of nurse scheduling
 Five factors to consider when scheduling
 Consequences of nursing schedules
 Influences on nurse scheduling
 Nursing schedule planning
 Systems of nurse scheduling
 Nurse scheduling types for working hours
 Nurse scheduling patterns for working shift hours
 References
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Nurse scheduling
Introduction
Many hospital wards need to be staffed by nurses around the clock
every day of the week, and because of that, many nurses have to work
irregular hours and according to schedule that have a great impact on their
personal lives. Today there is a shortage of nurses in many countries, and in
order to make the nursing profession more popular and to ensure high
quality health care delivery, it is urgent to try to improve the working
conditions for nurses. One possible and already ongoing improvement is that
more flexibility and adaptation to personal requests is introduced in the
scheduling.
Scheduling for staff and resources are recurring and time consuming
tasks for health care managers. If not done skillfully, scheduling of either
can waste resources and reduce the revenue of the health care organization.
The scheduling choice can affect turnover, absenteeism, and overall job
satisfaction.
Definitions of nurse scheduling

Nurse scheduling: Is the process of determining when each nurse of
a nursing unit will be on or off duty, which shift will be worked, by whom,
and how weekends, the number of consecutive days worked, requests, and
vacations will be accounted for.
Nurse scheduling: Is the procedure for providing nursing care by

assigning shifts to nursing personnel to be more specific.
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:Goals of scheduling
1. Achievement of divisional , departmental , and unit objectives , related
to patient care
2. Accurate match of unit needs with staff abilities and numbers.
3. Maximum use of manpower
4. Equity of treatment to all employees
5. Optimization on use of professional expertise.
6. Satisfaction of personnel
7. Maintenance of flexibility to meet care needs while still giving
employees maximum ability to know work hours, ahead
8. Consideration of unique needs of staff as well as patients.
9. To organize work in the unit and prevent confusion by avoiding
periods of understaffing and overstaffing.
10. To define responsibilities of personnel
11. To maintain staff moral.
12. To utilize experience and skill to the best advantage.
13. To provide adequate staffing to meet patient care needs.
Nurse scheduling involves three dimensions

The first dimension
Concerns the nursing staff, members of this nursing staff might differ
concerning their professional category (e.g. registered nurses, licensed
practical nurses, nursing assistants, and student nurses or trainee nurses), or
their labor contract e.g. full time or part time.
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The second dimension
Concerns the days of the schedule period. These days can be divided
into two types:
1. Special working days (i.e. public holidays or weekends)
2. Regular working days (i.e. all remaining days).
The third dimension

Concerns the shifts to be assigned to a member of the nursing. Staff on
a particular day of the schedule period. These shifts can be divided into two
groups:
1. Productive’ shifts (i.e. day shifts, evening shifts, and night shifts)
2. Unproductive’ shifts (e.g. day off or special leave).
In the case of the nurse-scheduling problem, each (productive) shift’s
beginning and duration is fixed.
The five factors to consider when scheduling are:

1.Coverage
2.Schedule quality
3.Stability
4.Flexibility
5.Cost
The consequences of nursing schedules are divided into

:three parts
1.The effectiveness in providing nursing care.
The main consequences of nursing schedules concern the
effectiveness in providing nursing care. The effectiveness is mostly specified
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as the continuity in nursing care, because this continuity is an important
requirement for the provision of high-quality nursing care. Nursing
schedules determine this continuity in this nursing care.
2.The job satisfaction of the nursing staff.

Other consequences of nursing schedules concern the working hours of
the nursing staff. A nursing schedule determines when each nurse will be on
or off duty and which shift will be worked. This determination of the nurses’
working hours strongly affects their social and family life. As an impairment
of social and family life decreases job. Nursing schedules affect the job
satisfaction of the nursing staff.
3. The efficiency of a nursing unit.

The remaining consequences of nursing schedules concern the nursing
unit. Nursing schedules determine both the number of nurses and the amount
of nursing expertise present in the nursing unit at each time of day. These
numbers of nurses and amounts of nursing expertise strongly influence the
cost of providing the daily nursing care. In addition, because the salaries
paid to nursing personnel constitute the largest single cost element in
hospitals. Nursing schedules strongly affect the efficiency of a nursing unit.
Figure 1.3 Shows this division of the consequences of nursing schedules for
the performance of the nursing unit.
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Influences on nurse scheduling:
The actual process of nurse scheduling is influenced by
1. The scheduling skill of the nurse scheduler.
2. The method of scheduling applied to arrange nursing schedules.
3. All kinds of scheduling regulations.
4. All kinds of scheduling support.
Each of these four influences on nurse scheduling can be used to

increase the quality of the resulting nursing schedules.
Figure 1.4 Shows these four influences on nurse scheduling.
Nursing schedule planning is divided based on these

three levels.
A.Strategic nurse scheduling
Concerns scheduling decisions involving a period of about a year,
covering, for example, the planning of each nurse’s vacations.
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B.Tactical nurse scheduling
Involves determining those days and shifts when each member of the
nursing staff is to report for work in the predetermined scheduling horizon.
In general, the length of this predetermined scheduling horizon varies from
two to six weeks. This tactical nurse scheduling is mostly referred to as the
'nurse scheduling problem.
C.Operational nurse scheduling

Concerns rescheduling caused by illness, on a daily basis.
Systems of nurse scheduling:

1.Centralized scheduling:
The schedule done by the upper manager for all nurses in all departments.
2.Decentralized scheduling
When managers are given authority and assume responsibility, they
can staff their own units through decentralized scheduling.
3.Self-scheduling
Is a system that is coordinated by staff nurses. Staff may negotiate
before, after work, and during break and lunchtime. They may also write
notes to each other and waite for responses.
Types of scheduling for working hours:

1- Block scheduling:
Means that the work schedule for a unit is planned in a "block" of

weeks, i.e., days to be worked by staff are blocked together.
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Block scheduling is done for 4-8 weeks at a time. It can be
calculated easily and has flexibility in that the next block of time not
necessarily need to follow the pattern of the proceeding block. This type of
scheduling does not provide for maximum level of care seven days a week.
Example of block time scheduling:

X: days worked
O: days off in the week
2- Cyclical scheduling:-
Is an improvement on block scheduling in that it has repetitive work

pattern assigned to personnel. A fixed cycle of usually (4 to 6) weeks is
repeated. The employee may have a different schedule for each of the
weeks contained in the cycle, but the pattern repeats without change.
This type of scheduling is desirable to many nurses since they can

calculate even month in advance when they will be on – duty and off. This
type also provide for coverage of professional nurses and allow each
employee to have at least one full weekend off every 4 weeks cycle and it
never has the nurse working more than five consecutive days . This type is
developed once per staffing pattern .Also there are never less than 2RNs on
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duty ,there are never more than 2 persons [RN and LPN considered
together] off on the same day.
There is never a day without at least one LPN on duty. Because it

repeats without change, the only schedules that need attention are those in
which exception occur, as in a week containing a holiday.
Example of cyclic Schedule
D: day shift
E: evening shift
N: night shift
.. : Off duty
3. Computerized scheduling
This type enables the user to devise a plan, which considers more
variables than schedules done by individuals. Computerized scheduling
allows for maintaining the patterns to be used and the choice of employee
and the planning of holidays, days off and vacation. All data necessary for
time planning are fed to the computer and a program for scheduling is
designed based on the fed data. The computerized scheduling is more
effective than the other types, it saves the nurse's time spent working out
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schedules and it reduces interpersonal conflicts between staff and
supervisors created by changes made in scheduling.
Scheduling patterns for working shift hours:

1- Straight shift:
This traditional pattern uses 8 hours shifts for time planning for the
[24 hours] period. The pattern may be as such:
This pattern allows

each employee to work 8 hours a day five days a week. This is mostly a
block hour system and thus allows for underutilization (poor) of staff on
weekends. It cannot meet patient care needs seven days a week.
2-The 10 hours shift:
This pattern allows staff to work 10 hours a day for 4 days a week
and three days off. This is a 6 week cyclical pattern that has advantage over
the 8 hours/ day. Shifts developed for the 10 hours day are:
The 10 hours shift has the disadvantage of not falling evenly into a
24 hours day, but it can be planned so that the overlaps occur in peak
10
(heavy) work hours. This pattern is very effective in staffing ICU. Nurses
are satisfied they can give comprehensive continuous care can get a longer
weekend and an extra day off.
3- The 12 hours shift:
This pattern consists of working 12 hours a day with 2 days off prior
to a change of shift. The shift hours are usually …
This pattern was

introduced due to inadequate staffing, but it proved to be appropriate in ICU
and modified ICU. It strengthens the relationship between the nurse, the
doctors, and the patient and time is saved in personnel shift change over.
4- Irregular hours scheduling pattern:
Nurses work a number of hours each week and the hours of work may
vary depending on patient care requirements or service demands. Nurses
may work 10 hours, 12 hours or other irregular length shift. This system is
implemented for the services of highly trained clinical nurse specialist or for
nurses in service training or supervision programs. It can be useful in
increasing productivity but it is often costly because it ends up increasing the
number of required staff.
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References
 Wise - Patricia, (2007), staffing scheduling, leading and managing in
nursing, fourth edition, chapter 13 p 279.
 Barnum. B, (1995), Staffing and scheduling, The Nurse as Executive,
fourth edition, Chapter 19, p 153 – 155.
 Huber.D, (1996), leadership and nursing care management, 1st edition,
W.B.Saunders Company, p.425.
 Bailyn .L, ( 2005),Implementation of a Self-Scheduling System for
Hospital Nurses: Guidelines and Pitfalls, p.6, 7.
 Eight, C. (n.d.), Chapter 8 Scheduling In, 177-194.
 Boom, V. Den. (n.d.), Chapter 1 Quality of Nursing Schedules In, 190–
192.
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What are the goals of nurse scheduling?

What are the goals of nurse scheduling?

What are the three dimensions of nurse scheduling?

What are the three dimensions of nurse scheduling?

Nurse scheduling

Definitions of nurse scheduling

Nurse scheduling: Is the procedure for providing nursing care by

Nurse scheduling involves three dimensions

The third dimension

The five factors to consider when scheduling are:

The consequences of nursing schedules are divided into

2.The job satisfaction of the nursing staff.

3. The efficiency of a nursing unit.

Each of these four influences on nurse scheduling can be used to

Nursing schedule planning is divided based on these

C.Operational nurse scheduling

Systems of nurse scheduling:

Types of scheduling for working hours:

Means that the work schedule for a unit is planned in a "block" of

Example of block time scheduling:

Is an improvement on block scheduling in that it has repetitive work

This type of scheduling is desirable to many nurses since they can

There is never a day without at least one LPN on duty. Because it

Example of cyclic Schedule

Scheduling patterns for working shift hours:

This pattern allows

2-The 10 hours shift:

3- The 12 hours shift:

This pattern was

4- Irregular hours scheduling pattern:

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