Different Approaches Of Nurse Rostering Nursing Essay

This chapter will focus on the information, which is relevant to this topic. All of the information was gathered from the sources and medium such as journals. Quality on facts is very important to show the understanding of this topic. The facts are then reviewed to act as guidelines for this study.

2.1 Definition of Roster

According to Wren (1996), rostering is “the placing, subject to constraints, of resources into slots in a pattern. One may seek to minimize some objective or simply to obtain a feasible allocation. Often the resources will rotate through a roster”. In this project, the term nurse rostering is the allocation of nurses over period of time to perform required work.

2.2 Different Approaches of Nurse Rostering

There are two generic approaches towards staff scheduling which were fixed rostering and flexible rostering. Fixed rostering is where staff is allocated a fixed shift pattern over a long or even indefinite time period. According to Hung (1992) the limitation of this approach is that it can operate only under conditions of relatively stable demand and low variability, and that it assumes that sufficient workers can be recruited to staff the unpopular shifts. Flexible rostering is where each rostering period is planned individually. Shifts are allocated on the basis of nurses requirements which reflect demand patterns. It is also based another rostering constraints, including staff’s preferences for off-duty. The changes made in demand and resource constraints have made flexible rostering is far more common than fixed rostering. There are three flexible methods in nurse rostering:

2.2.1 Centralised Scheduling

Centralised scheduling is a term that is sometimes used to describe the situation where one administrative department in a hospital carries out all the personnel scheduling (Easton, Rossin, and Borders, 1992; Siferd and Benton, 1992; Smith-Daniels, Schweikhart, and Smith-Daniels, 1988; Warner, 1976). Head nurses feels relieves from the time consuming task to construct the schedule on a very regular basis. The major advantage in centralised scheduling is the opportunity for cost containment through better resources. However, centralised scheduling has a disadvantage where staff feels that local ward requirements are not fed into the procedure, the rosters are unfair, or there might be favoritism. (Silvestro and Silvestro, 2000).

2.2.2 Unit Scheduling

Unit scheduling or departmental scheduling is when head nurses or unit managers are given the responsibility to generate the schedules locally.(Aickelin and Dowsland, 2000; Bradley and Martin, 1990;Dowsland, 1998; Sitompul and Randhawa, 1990).

2.2.3 Self Scheduling

Self scheduling is a term sometimes used to describe the situation when the personnel roster is generated manually by the staff themselves. The term “interactive scheduling” is also sometimes used for the term self-scheduling (e.g. Miller, 1984; Ringland Dotson, 1989). In general, creating schedules manually has been adopted in hospital wards.

Self-scheduling is more time consuming than automatic scheduling but it has the advantage that the nurses cooperate and are asked for advice. In Silvestro and Silvestro (2000), it is said that the process can easily lead to over or understaffing, that the schedule is made for the convenience of staff, and there are no formal procedures for conflict solving. Hung (1992) identified more effectives benefits in self-scheduling. He states that it leads to greater staff satisfaction and commitment, improves cooperation and team work and reduces the staff turnover. He founds that self-scheduling is more effective rosters because the staff know that their personal preferences are taken into account and consequently they are more willing to cooperate.

To summarize, the different advantages and disadvantages are given in the next Table 2.1:

Table 2.1: Advantages and disadvantages of centralised-scheduling

Article

Advantage

Disadvantage

(Silvestro and Silvestro, 2000).

Opportunity for cost containment through better use of resources.

Local ward requirements are not fed into the procedure

Rosters are unfair

Table 2.2: Advantages and disadvantages of self-rostering

Article

Advantage

Disadvantage

(Silvestro &

Silvestro, 2000)

Increased morale

Ability to integrate work patterns with home life

Improved team spirit

Informal procedures for conflict solving

Cannot cope with complex rostering problems

(Hung, 1992)

Increase staff satisfaction

Enhance team spirit and cooperation

Nurse manager spends less time to do a roster

It can be concluded that in hospital Kuala Kubu Bharu, flexible rostering has been adapted to construct the nurse roster. The duty of nurse roster may change each time the roster is released. It caused by different preferences had been requested in distinct time. Moreover fixed rostering is towards a traditional approach compared to flexible rostering. It is because the same roster had produced every month.

Based on the three dominant methods in nurse rostering, unit scheduling has been used by the stakeholder. Head nurses are responsible to manage the schedule. However, nurses are able to determine whom to swap with their shift. It means, they still have a chance to change their shift with head nurses approval. While centralised scheduling is not suitable to apply because some of the staff feels that the roster is unfair because the closest friends may take an advantage of the scheduler.

The choice of rostering approach should depend on the terms of ward size and rostering system complexity. The survey of rostering practices in 50 National Healthcare Services (NHS) wards in the United Kingdom revealed that each of the three rostering approaches has benefits and limitations.

The most common approach adopted by the sample of 50 wards is departmental rostering or unit rostering. It is because the roster is planned individually and it is possible to have a greater control over the rostering process. For instance, a clear beginning and end can be set for the production of a new roster and new rosters are more easily evaluated against previous rosters. Departmental rostering has disadvantages that when one single person is relied to do the rostering process by the managers exposes the individual criticisms of favoritisms and autocracy. Most of junior staff felt that they have little appreciation of the complexity of the rostering problem. They will judge that the capability of roster planner depends on her ability to meet the individual request. It can lead to anger and uncooperative behavior for junior staff to understand and accept it. Therefore, the role of roster planner is essential to the success of departmental rostering. The characteristics of the individual is not only intellectual skills but also strong interpersonal skills and fair-minded.

Some negative effects in small wards and with agreeable from the ward manager that departmental rostering was governed by a single individual and in fact staff had made frequent request to implement self rostering. However, ward manager was not agreeing as she feared and believed skill mix will suffer. According to Hawley et al (tahun) observations, when assigning responsibilities to staff on rostering planning would result in staff requirements taking priority over the demands of ward management and patient care. In medium wards, the departmental rostering is unpopular with staff. However in largest ward, the staff seems to understand the rostering is a complex problem and need to coordinate by one person.

Self rostering has been used in small wards and medium wards and the manager had claimed that staff morale had improved and this lead to the increased responsibility and ability to integrate work pattern with home life. They felt the team spirit had improved because the need for staff to cooperate and negotiate the allocation of shifts. There is no disadvantage to implement self rostering in small wards. However, manager received a report that junior staffs were given considerably less discretion over shift allocation than a senior staff nurse.

A preliminary study of rostering practices had been done based on a relatively small sample of wards. (Silvestro & Silvestro, 2000). However, the analysis appears to produce the following suggestion:

In large wards of over 70 staff, where the complexity of the rostering problem is high, departmental rostering is likely to be appropriate. Self-rostering is unmanageable in these wards.

Medium sized wards of between 35 and 70 staff usually have rostering problems of medium complexity where self-rostering may be difficult to manage. Departmental rostering may well be effective but may be unpopular with staff, and self-rostering had been adopted if the ward was smaller.

Small wards of under 35 staff are suitable for self-rostering, which increases staff motivation and commitment, but the roster is simple enough to be fully and quickly evaluated by the manager. They are also easily agreed to approve the roster.

Thus the research concludes with conditions under which each of the three rostering approaches should be adopted. Table 2.3 summarizes the differences of staff rostering in the health service.

Table 2.3: The differences of staff rostering in the health service

Ward size and rostering problem complexity

Self-rostering

Departmental-rostering

>70 staff; high complexity

Inappropriate: complexity

too great

Effective

35-70 staff; medium complexity

Ineffective: skill mix

Suffers; complexity too great

Appropriate: but

unpopular with staff

<35 staff;

low complexity

Effective

Inappropriate: too

autocratic

(Source: Silvestro & Silvestro, 2000)

Based on the rostering approach above, it can be concluded that the hospital performs around the clock every day and need care services for patients. They have to be ready for any cases happen anywhere and anytime. It means, the nurse management is ought to manage their staff appropriately with the nurses preferences. Based on the preliminary study of rostering in United Kingdom it is appropriate for the hospital to apply the departmental rostering. However, it can be done in another way by combining the method of rostering to construct the roster. At first part head nurses will allocate nurses based on their request that it is called departmental rostering. This was done because head nurses do not want staff to take priority their requirement over the demands of ward management and patient care. After the roster has released, nurses are able to change their shift but still coordinate by head nurses of each ward. It is called as self rostering. Besides it can help the staff management as well as nurses to be able to manage their schedule conveniently.

2.3 Nurse Roster

Nurses must be available 24 hours at health care organizations. This means that shift working is a must for all nurses. A nurse can work in three shifts which are morning shift, evening shift and night shift. Morning shift starts from 7.00 a.m. to 3.00 p.m., evening shift start from 3.00 p.m. until 10.00 p.m .and lastly is night shift begin from 10.00 p.m. to 7.00 a.m. (Burke et al., 2004). However, available nurses cannot easily rostered to shifts. Nurse rostering management must accommodate the constraints on allocated shift and other constraints. The responsible person whom considered as head nurse will fill the roster for each and every nurse due to the constraints and request from nurses.

According to Nottingham University Hospitals (2010) staff will be required to work a variety of shifts and shift patterns as agreed by their Ward Manager. In order to meet hospital requirements, staff can work in extended shifts, short shifts or a combination of both. The diversity within the shifts may be working, but it must be approved by the ward Manager. The ward manager will record the variations of this shift in the document.

There are several roles involve in rostering mentioned by Northern Health and Social Care Trust (2010). First is a ward manager. The ward manager is responsible for the safe staffing of each ward. Secondly is lead nurse, head nurse or nurse manager. The head nurse is responsible to monitor and approve wards off duty on completion, produce reports, and approve all shifts when each nurse request to leave based on policies. Bonner et al (1996) suggests that rostering staff is one of the most complex and important functions performed by the Nurse Manager. The final role is staff that has a responsibility to abide by the principles and procedure guidelines. The Nurse Rostering: A Guide for Nurse Managers within the DHHS (Department of Health and Human Services, 2010) is constructed to provide the Nurse Manager and staff with a comprehensive guide to rostering.

The need for a 24-hour nursing care requires most nurses to work a variety of shifts in their work. Bonner et al (1996) suggests that the effects of shift work impacts on the health and safety of nurses and their ability to provide optimal patient care. It is also that poorly designed roster can lead to over or understaffing of a ward or unit. It is important for the Nurse Manager to construct an effective roster to ensure staff attitude and staff presence in hospitals. Staff dissatisfaction can increase absenteeism and staff turnover (Silvestro &Silvestro, 2000).

According to Northern Health and Social Care Trust (2010) there are seven steps to better roster management. The 7 steps should create a roster that is safe, cost effective and provide a good working life.

Gather all necessary information

Be familiar and comprehend the policies and best practice for planning rosters

Arrange the roster

Obtain authorization for the roster

Produce roster on each ward

Review and adapt the roster in a timely manner by taking into account of the commitments staff have made around the published off duty

Record changes to the roster

2.3.1 Staff Requests

Nurses can make several requests. Each ward should use a request sheet to make requests for all types of leave. These requests will be considered in terms of service needs. Staff is needed to indicate if their request is essential or desirable. Staffs that make few requests should have high priority than staff that makes numerous requests. In order to prepare the roster, the request form that is sent to Ward Manager must have a closed date and no requests are accepted when the due date is closed. If staff wishes to change their duty, it should be made with a fair swap among nurses of the same skill that meets the head nurse’s approval. In here, the roster is prepared by the ward staff and head nurses usually will authorize the final roster. Miller (1984) has mentioned that “Self-scheduling increases perceptions of autonomy among staff nurses, reduces time spent by the head nurse in scheduling, virtually eliminates the special request book, and becomes an effective tool in the recruitment and retention of staff nurses”.

2.3.2 Changes to Published Rosters

The requests made must keep to a minimum after the roster is produced. If staff insisted to leave, they must negotiate with other staff. These changes must be approved by the Head Nurses in their absence. All changes should be made with consideration of the skill when shifts are being changed (Northern Health and Social Care Trust, 2010).

2.4 Roster System

A Roster System is defined as a tool to generate a schedule which consists of a group of individual who take part in a regular basis. Usually, they will rotate to complete the task given in a period of time. It is essential for nurses to have a roster to ensure their services run smoothly everyday. The existence of rostering system could be easy for the head nurses and nurses can access the system through an Internet-based system while they are at home, office or while travelling. A roster system allows allocation of various shifts and duties by head nurses as well as a flexible option for staff to alter, view details of roster and allocate shifts. According to Chun et al (2000), in 1997, the Hospital Authority started to work with the City University of Hong Kong to design and develop their Staff Rostering System. Ward managers use the Staff Rostering System (SRS) to schedule, reschedule and manage different types of staff such as nurses, student nurses and clinical supporting staff.

2.5 Requirement Analysis

The crucial part in software development project is when precise and correct requirements are met because requirements drive almost every activity, task, and deliverable in a software development project (McEwen, 2004). Poorly defined requirements result in one of the failures of requirement analysis.

This lead to increasing of cost in software development project and the expected quality is not commensurate. Without good quality of specifications the people charged with developments will have no firm idea of the needs of the would-be users of the system (Liu, 1992).

2.5.1 Definition of Requirement Analysis

Some people separate “requirement analysis” from “analysis” (The Object Agency, 1995). Thus, requirement analysis is defined as establishments of system and/ or project requirements. Analysis is defined as a solution that satisfies the established requirements. It is the separation of a thing into an element of which it is composed. Analysis often begins with the recognition of a need or want, and goes no deeper than the “user interface” of the delivered product (The Object Agency, 1995).

2.5.2 Purpose of Requirement Analysis

A requirement is defined as what a system performs. According to Technology Blueprint, requirements are enumerated specifications that list characteristics that identify the accomplishment levels needed to achieve specific objectives for a given set of conditions. Requirements include business goals, objectives, processes, and all other business and system requirements whose purpose is to alter the “as is” view of the world in some way (Bleistein, et al., 2006). A requirement is an essential to help clients clarify their need, to understand the purpose of business and what is the proper method required to achieve that need.

However, the requirement must precisely actionable, measurable, testable, related to identified what is the business requirement and can be used more detail in system design.