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Reexamining the Nurse Scheduling Problem: Staffing Ratios and Nursing Shortages

机译：重新检查护士排班问题：人员比例和护理短缺

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摘要

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.
机译：州和国家两级的立法者正在解决有关医院护士人员配备不足以提供优质护理和确保患者安全的新问题。同时，众所周知的护理短缺仍然是一个持续的问题。为了解决这些问题，我们重新检查了护士的安排问题，并考虑了最近的医疗法规如何影响护理人员管理决策。具体来说，我们开发了一个调度模型并进行了计算实验，以评估强制性的护士与患者的比率以及其他政策如何影响调度成本和调度的可取性（从护士的角度来看）。我们的主要发现包括以下几个方面：（ⅰ）护士的工资成本在立法者考虑的强制性护士与患者比率的变化方面可能是高度非线性的； （ⅱ）可以大幅度减少不良轮班的次数，而不会产生额外的工资成本； （ⅲ）更可取的日程安排政策，例如给每个护士分配较少的周末，对工资成本的影响很小； （ⅳ）有时可以放宽涉及单周期和多周期服务水平的复杂政策声明，同时仍然可以获得满足护士对患者比率要求的良好计划。本文的研究结果为未来的护士日程安排模型提供了新的方向，因为在一段时间内，护士与病人的比例和护理短缺可能仍将对医疗机构构成挑战。

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