NSG/547 Week 3: Scheduling and Staffing Decisions, sample paper

Call Every Fourth Weekend or a Dedicated Night Team? Redesigning Perioperative Call and Staffing With Patient Safety, Fatigue and Fairness in the Balance

[Student Name]

University of Phoenix

NSG/547: Human Resources Management

Week 3 Assignment

[Instructor Name]

[Date]

The hospital, its department and all figures are a composite written for a model paper.

Exit interviews from the perioperative department, summarized in Week 1, named call burden as one of three main reasons nurses leave. This paper examines the department's call and staffing system and proposes a redesign. Scheduling is often treated as clerical work, but in a department that operates around the clock, it determines how tired the nurses are when patients are most vulnerable.

The Current System

The operating rooms run scheduled cases from 0700 to 1730 on weekdays. After hours, two operating room nurses and one recovery nurse are on call from home each night and weekend, required to be in the hospital within 30 minutes. Each nurse takes call about every fourth weekend and five weeknights a month, and after a night of call nurses are still expected to work their scheduled day shift unless they were in the hospital past 0300. Over the past six months, on-call nurses were called in on 71% of weeknights, averaging 3.4 hours in the hospital, and on almost every weekend night. In 38 instances, a nurse worked a full day shift after being in the hospital for more than three hours overnight.

Decision Criteria

The redesign is judged against four criteria. Patient safety: nurses should not care for patients while dangerously fatigued. Nurse well-being and retention: the schedule should be sustainable. Fairness: burdens should be shared equitably and transparently. Cost: the solution must fit the budget or show a return.

The Evidence on Hours and Outcomes

The safety criterion rests on evidence. In a study linking nurse survey data with hospital outcomes, schedules with long work hours were associated with higher odds of pneumonia deaths, and lack of time away from work was associated with higher odds of pneumonia and abdominal aortic aneurysm deaths, after accounting for staffing and hospital characteristics (Trinkoff et al., 2011). A nurse who circulates for a trauma case at 0200 and then scrubs a scheduled case at 0730 is working exactly the kind of schedule these findings describe.

Alternative 1: Keep Call but Add Protection

Keep the current call rotation but guarantee that any nurse in the hospital for more than two hours after 2300 is relieved of the next day's first four hours, with a float nurse covering. Safety: improved, though nurses would still work after short rest. Well-being: modestly improved. Fairness: unchanged. Cost: about $140,000 a year in float coverage.

Alternative 2: A Dedicated Evening and Night Team

Create a team of four operating room nurses and two recovery nurses who work scheduled evening and night shifts, 1500 to 0300 and 1900 to 0700, handling after-hours cases in person, with call reduced to backup only. Safety: much improved, since after-hours nurses are awake and scheduled rather than called from sleep, and day staff are rarely called. Well-being: greatly improved for day staff; the night team must be staffed by nurses who choose nights, with a differential. Fairness: clear, since the burden is chosen and paid. Cost: six additional positions, about $690,000 a year, partly offset by eliminating call pay and some overtime.

Alternative 3: Hybrid Model

Staff a scheduled evening shift of two operating room nurses and one recovery nurse from 1500 to 2300, which covers most after-hours cases, and keep call from home after 2300 with the relief rule from Alternative 1. Safety: improved, since most emergency cases occur before 2300 and would be handled by scheduled staff; late-night calls would be less frequent and would trigger relief. Well-being: substantially improved; call frequency falls. Fairness: evening shifts filled by volunteers with a differential; call shared among day staff at a lower frequency. Cost: three additional positions, about $345,000, plus float coverage for relief, partly offset by lower call pay.

Comparison and Recommendation

Alternative 1 is the cheapest but leaves the core problem, nurses called from sleep and working the next day. Alternative 2 is safest but costly and depends on recruiting a night team. Alternative 3 captures most of the safety and retention benefit at half the cost of Alternative 2. The department's after-hours case log shows that 64% of after-hours cases start before 2300, so the evening shift would absorb most of the call burden. I recommend Alternative 3, with a review at 12 months to decide whether to extend to a full night team.

What Earlier Research Adds

A logbook study of hospital staff nurses found that errors were significantly more likely on shifts longer than twelve hours, on overtime and in weeks above forty hours (Rogers et al., 2004). Call shifts that follow full day shifts combine all three conditions. The department's own data, 38 instances of a full day shift after more than three hours overnight in six months, show that these conditions are routine rather than rare.

Retention Effect

The call burden is also a retention problem. With first-year turnover above the national figure for new nurses (Kovner et al., 2014), and exit interviews naming call, a schedule that cuts call frequency is part of the recruitment and retention strategy, not only a safety fix.

Rules That Protect Rest

Whatever model is chosen, rules make it safe. No nurse will work more than 16 consecutive hours. A nurse in the hospital after 0100 will be relieved of the next day's scheduled shift until 1100. Nurses will have at least 10 hours off between shifts. Call will be capped at one weekend in five and four weeknights a month. Trading shifts is permitted but tracked, so trades do not defeat the limits.

Fairness and Transparency

Call and evening assignments will be posted six weeks in advance using a published rotation, and self-scheduling will be used for the rest of the schedule within unit rules. Requests for exemption, for example under a medical accommodation, will be handled through human resources with a consistent process.

Involving Staff

The staff council reviewed the alternatives before the recommendation. Staff favored Alternative 3, with one concern: that evening positions might be filled by requiring junior staff to take them. The plan responds by filling evening positions with volunteers first and offering a differential, and by rotating evening shifts among volunteers if not enough volunteer.

Measures

The redesign will be measured by the number of instances of nurses working a day shift after more than three hours overnight, with a target of zero; call-backs per nurse per month; overtime hours; staff satisfaction with scheduling; turnover; and after-hours case delays waiting for staff.

Conclusion

The current call system regularly sends nurses back to the operating room after a night of emergency cases, a pattern research associates with worse patient outcomes and one that contributes to turnover. A hybrid model with a scheduled evening shift and protected rest rules captures most of the benefit of a full night team at half the cost, with fairness built into assignment and measures that will show whether it works.

References

Kovner, C. T., Brewer, C. S., Fatehi, F., & Jun, J. (2014). What does nurse turnover rate mean and what is the rate? Policy, Politics, & Nursing Practice, 15(3-4), 64-71. https://doi.org/10.1177/1527154414547953

Rogers, A. E., Hwang, W.-T., Scott, L. D., Aiken, L. H., & Dinges, D. F. (2004). The working hours of hospital staff nurses and patient safety. Health Affairs, 23(4), 202-212. https://doi.org/10.1377/hlthaff.23.4.202

Trinkoff, A. M., Johantgen, M., Storr, C. L., Gurses, A. P., Liang, Y., & Han, K. (2011). Nurses' work schedule characteristics, nurse staffing, and patient mortality. Nursing Research, 60(1), 1-8. https://doi.org/10.1097/NNR.0b013e3181fff15d