Memorial Hospital is a 265-bed regional health care facility located in the mountains of western North Carolina. The mission of the hospital is to provide quality health care to the people of Ashe County and the six surrounding counties. To accomplish this mission. Memorial Hospital's CEO has outlined three objectives: (1) maximize customer service to increase customer satisfaction, (2) minimize costs to remain competitive, and (3) minimize fluctuations in workforce levels to help stabilize area employment.

The hospital s operations are segmented into eight major wards for the purposes of planning and scheduling the nursing staff. These wards are listed in Table 10.3. along with the number of beds, targeted patient-to-nurse ratios, and average patient census for each ward. The overall demand for hospital services remained relatively constant over the past few years even though the population of the seven counties served increased. This stable demand can be attributed to increased competition from other hospitals in the area and the rise in alternative health care delivery systems. such as health maintenance organizations (HMOs). However, demand for Memorial Hospital's services does vary considerably by type of ward and time of year. Table 10.4 provides a historical monthly breakdown of the average daily patient census per ward.

The director of nursing for Memorial Hospital is Darlene Fry. Each fall she confronts one of the most challenging aspects of her job: planning the nurse-staffing levels for the next calendar year. Although the average demand for nurses has remained relatively stable over the past couple of years, the staffing plan usually changes because of changing work policies changing pay structures, and temporary nurse availability and cost. With fall quickly approaching, Fry is collecting information to plan next year's staff inc levels.

The nurses at Memorial Hospital work a regular schedule of four 10-hour days per week. The average regular-time pay across all nursing grades is $12.00 per hour. Overtime may be scheduled when necessary However, because of the intensity of the demands placed on nurses, only a limited amount of overtime is permitted per week. Nurses may be scheduled for as many as 12 hours per day, for a maximum of 5 days per week. Overtime is compensated at a rate of $18.00 per hour. In periods of extremely high demand, temporary part-time nurses may be hired for a limited period of time. Temporary nurses are paid $15.00 per hour. Memorial Hospital's policy limits the proportion of temporary nurses to 15 percent of the total nursing staff.

Finding, hiring, and retaining qualified nurses is an ongoing problem for hospitals. One reason is that various forms of private practice lure many nurses away from hospitals with higher pay and greater flexibility. This situation has caused Memorial to guarantee its full-time staff nurses pay for a minimum of 30 hours per week, regardless of the demand placed on nursing services. In addition, each nurse receives 4 weeks of paid vacation each year. However, vacation scheduling may be somewhat restricted by the projected demand for nurses during particular times of the year.

Table 10.3 Ward Capacity Data

Yearly average per day ? The hospital employs 20 surgical nurses. Routine surgery is scheduled on Tuesdays and Fridays; five surgeries can be scheduled per day per operating room (bed) on these days. Emergency surgery is scheduled as needed. *Daily equivalents are used to schedule nurses because patients flow through these wards in relatively short periods of time. A daily equivalent of 5 indicates that throughout a typical day, an average of five patients are treated in the ward. At present, the hospital employs 130 nurses, including 20 surgical nurses. The other 110 nurses are assigned to the remaining seven major areas of the hospital. The personnel department informed Fry that the average cost to the hospital for hiring a new full-time nurse is $400 and for laying off or firing a nurse is $150. Although layoffs are an option, Fry is aware of the hospital's objective of maintaining a level workforce.

After looking over the information that she collected, Darlene Fry wants to consider staffing changes in all areas except the surgery ward, which is already correctly staffed.

TABLE 10.4 AVERAGE DAILY PATIENT CENSUS PER MONTH

Expalin the alternatives available to Dariene Fry as she develops a nurse-staffing plan for Memorial Hospital. How does each alternative plan meet the objective stated by the CEO?

Ward Intensive Care 20 Cardiac Maternity Pediatric Surgery Post-Op Emergency Number of Beds Patients per Nurse Patient Census* General 25 30 40 15 10 120 2 4 + 01 5 3 8 10 15 10 22 8 (T-F daily equivalent)+ 5 (daily equivalent) 98 MONTH Ward Cardiac Intensive Care 13 10 8 7 7 6 11 13 9 10 12 14 Pediatric J F M Surgery* Maternity 8 8 18 General A M J J A S O 16 15 13 14 12 13 12 13|15| N D 20 18 18 18 20 12 13 10 8 13 13 14 10 8 7 22 23 24 24 25 21 22 24 25 21 22 20 18 20 21 19 17 16 16 22 21 17 18 20 22 21 17 18 Post-Opt 10 8 7 7 6 6 10 10 7 8 9 10 Emergencyt 6 4 4 7 8 5 5 4 4 3 4 6 110 108 100 98 95 90 88 92 98 102 107 94