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Indiana University Bloomington

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Journal Articles

Reexamining the Nurse Scheduling Problem: Staffing Ratios and Nursing Shortages

2006, Decision Sciences

P. D. Wright, Kurt M. Bretthauer, M. Côté


Legislators at the state and national levels are addressing renewed concerns over the adequacy of hospital nurse staffing to provide quality care and ensure patient safety. At the same time, the well-known nursing shortage remains an ongoing problem. To address these issues, we reexamine the nurse scheduling problem and consider how recent health care legislation impacts nursing workforce management decisions. Specifically, we develop a scheduling model and perform computational experiments to evaluate how mandatory nurse-to-patient ratios and other policies impact schedule cost and schedule desirability (from the nurses' perspective). Our primary findings include the following: (i) nurse wage costs can be highly nonlinear with respect to changes in mandatory nurse-to-patient ratios of the type being considered by legislators; (ii) the number of undesirable shifts can be substantially reduced without incurring additional wage cost; (iii) more desirable scheduling policies, such as assigning fewer weekends to each nurse, have only a small impact on wage cost; and (iv) complex policy statements involving both single-period and multiperiod service levels can sometimes be relaxed while still obtaining good schedules that satisfy the nurse-to-patient ratio requirements. The findings in this article suggest that new directions for future nurse scheduling models, as it is likely that nurse-to-patient ratios and nursing shortages will remain a challenge for health care organizations for some time.


Wright, P. D., K. Bretthauer, and M. Côté (2006), "Reexamining the Nurse Scheduling Problem: Staffing Ratios and Nursing Shortages," Decision Sciences, Vol. 37, pp. 39-70.


Winner of Stan Hardy Best Paper Award, 2007. Nominated for Decision Sciences Journal Best Paper Award, 2006