Nurse Absenteeism and Staffing Strategies for Hospital Inpatient Units

Inpatient staffing costs are significantly affected by nurse absenteeism, which is typically high in U.S. hospitals. We use data from multiple inpatient units of two hospitals to study which factors, including unit culture, short-term workload, and shift type, explain nurse absenteeism. The analysis highlights the importance of paying attention to heterogeneous absentee rates among individual nurses. We then develop models to investigate the impact of demand and absentee rate variability on the performance of staffing plans and obtain some structural results. Utilizing these results, we propose and test three easy-to-use heuristics to identify near-optimal staffing strategies. Such strategies could be useful to hospitals that periodically reassign nurses with similar qualifications to inpatient units in order to balance workload and accommodate changes in patient flow. Although motivated by staffing of hospital inpatient units, the approach developed in this paper is also applicable to other team-based and labor-intensive service environments.

[1]  Antonio Alonso Ayuso,et al.  Introduction to Stochastic Programming , 2009 .

[2]  A. Müller,et al.  Comparison Methods for Stochastic Models and Risks , 2002 .

[3]  Dennis E. Blumenfeld,et al.  Impact of Absenteeism on Assembly Line Quality and Throughput , 2009 .

[4]  J. Faucett,et al.  Job strain among registered nurses and other hospital workers. , 1997, Journal of Nursing Administration.

[5]  Srinivas Bollapragada,et al.  Myopic Heuristics for the Random Yield Problem , 1999, Oper. Res..

[6]  Victor P. Il'ev,et al.  An Approximation Guarantee of the Greedy Descent Algorithm for Minimizing a Supermodular Set Function , 2001, Discret. Appl. Math..

[7]  Brigitte Maier,et al.  Supermodularity And Complementarity , 2016 .

[8]  C. Fletcher.  Hospital RNs’ Job Satisfactions and Dissatisfactions , 2001, The Journal of nursing administration.

[9]  J. Anema,et al.  The history of registered sickness absence predicts future sickness absence. , 2011, Occupational medicine.

[10]  Liwan Liyanage,et al.  Allocation through stochastic Schur convexity and stochastic transposition increasingness , 1992 .

[11]  Dean G. Smith,et al.  The Effects of Nurse Staffing on Adverse Events, Morbidity, Mortality, and Medical Costs , 2003, Nursing research.

[12]  J. Lehoczky,et al.  Supply management in assembly systems with random yield and random demand , 2000 .

[13]  L. Aiken,et al.  Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. , 2002, JAMA.

[14]  Ioana Popescu,et al.  Media Revenue Management with Audience Uncertainty: Balancing Upfront and Spot Market Sales , 2010, Manuf. Serv. Oper. Manag..

[15]  G. Cummings,et al.  Predictors of nurse absenteeism in hospitals: a systematic review. , 2009, Journal of nursing management.

[16]  T. Wilt,et al.  The Association of Registered Nurse Staffing Levels and Patient Outcomes: Systematic Review and Meta-Analysis , 2007, Medical care.

[17]  Jac J L van der Klink,et al.  Leadership styles of nurse managers and registered sickness absence among their nursing staff , 2011, Health care management review.

[18]  L. Aiken,et al.  Hospital restructuring in the United States, Canada, and Western Europe: an outcomes research agenda. , 1997, Medical care.

[19]  Lynn Unruh.  Nurse staffing and patient, nurse, and financial outcomes. , 2008, The American journal of nursing.

[20]  Stochastic Orders , 2008 .

[21]  Jae San Park,et al.  Do types of organizational culture matter in nurse job satisfaction and turnover intention , 2009 .

[22]  Peter Buerhaus,et al.  Nurse-staffing levels and the quality of care in hospitals. , 2002, The New England journal of medicine.

[23]  J. Faraway.  Extending the Linear Model with R: Generalized Linear, Mixed Effects and Nonparametric Regression Models , 2005 .

[24]  D. Makuc,et al.  Health, United States, 2010; with special feature on death and dying , 2011 .

[25]  F. Dominici,et al.  Seasonal and regional short-term effects of fine particles on hospital admissions in 202 US counties, 1999-2005. , 2008, American journal of epidemiology.

[26]  A. Jawad,et al.  Hospital Restructuring and Its Impact on Outcomes: Nursing Staff Regulations are Premature , 2001, The Journal of nursing administration.

[27]  Yigal Gerchak,et al.  Multiple Lotsizing in Production to Order with Random Yields: Review of Recent Advances , 2004, Ann. Oper. Res..

[28]  Ward Whitt,et al.  Staffing a Call Center with Uncertain Arrival Rate and Absenteeism , 2006 .

[29]  Deirdre M Baggot,et al.  Improving Staff Nurse Satisfaction and Nurse Turnover: Use of a Closed-Unit Staffing Model , 2009, Journal of Nursing Administration.

[30]  Yigal Gerchak,et al.  Manufacturing to Order with Random Yield and Costly Inspection , 2000, Oper. Res..

[31]  Jan Vondrák,et al.  Maximizing a Monotone Submodular Function Subject to a Matroid Constraint , 2011, SIAM J. Comput..

[32]  S. Dziegielewski,et al.  The nurse manager: job satisfaction, the nursing shortage and retention. , 2005, Journal of nursing management.

[33]  Zeynep Akşin,et al.  The Modern Call Center: A Multi‐Disciplinary Perspective on Operations Management Research , 2007 .

[34]  Amin Saberi,et al.  Stochastic Submodular Maximization , 2008, WINE.

[35]  K. Basu,et al.  Working conditions of nurses and absenteeism: is there a relationship? An empirical analysis using National Survey of the Work and Health of Nurses. , 2010, Health policy.

[36]  K Y Liang,et al.  Longitudinal data analysis for discrete and continuous outcomes. , 1986, Biometrics.

[37]  Hau L. Lee,et al.  Lot Sizing with Random Yields: A Review , 1995, Oper. Res..

[38]  Sergei Savin,et al.  "Nursevendor Problem": Personnel Staffing in the Presence of Endogenous Absenteeism , 2013, Manag. Sci..

[39]  Anneliese M Gerland,et al.  Hospitals' responses to nurse staffing shortages. , 2006, Health affairs.

[40]  Kurt M. Bretthauer,et al.  Real-Time Work Schedule Adjustment Decisions: An Investigation and Evaluation , 2009 .

[41]  I. Olkin,et al.  Inequalities: Theory of Majorization and Its Applications , 1980 .

[42]  John R. Birge,et al.  Introduction to Stochastic programming (2nd edition), Springer verlag, New York , 2011 .

[43]  J. A. N. Eedleman,et al.  Nurse-Staffing Levels and the Quality of Care in Hospitals , 2002 .

[44]  Ingram Olkin,et al.  Inequalities: Theory of Majorization and Its Application , 1979 .

[45]  T. Morton,et al.  A periodic review, production planning model with uncertain capacity and uncertain demand—optimality of extended myopic policies , 1994 .

[46]  M. Parlar,et al.  Periodic Review Production Models With Variable Yield And Uncertain Demand , 1988 .

[47]  Richard L Kravitz,et al.  Nurse–Patient Ratios: A Systematic Review on the Effects of Nurse Staffing on Patient, Nurse Employee, and Hospital Outcomes , 2004, The Journal of nursing administration.

[48]  H. Laschinger,et al.  The influence of personal dispositional factors and organizational resources on workplace violence, burnout, and health outcomes in new graduate nurses: a cross-sectional study. , 2012, International journal of nursing studies.