Memorial Hospital is a 265-bed regional health care facil-ity located in the mountains of western North Carolina.The mission of the hospital is to provide quality healthcare to the people of Ashe County and the six surroundingcounties. To accomplish this mission, Memorial HospitalsCEO has outlined three objectives: (1) maximize customerservice to increase customer satisfaction, (2) minimizecosts to remain competitive, and (3) minimize fluctuationsin workforce levels to help stabilize area employment.

The hospitals operations are segmented into eightmajor wards for the purposes of planning and schedulingthe nursing staff. These wards are listed in Table C11.1along with the number of beds, targeted patient-to-nurseratios, and average patient census for each ward. Theoverall demand for hospital services has remained rela-tively constant over the past few years even though thepopulation of the seven counties served has increased. Thisstable demand can be attributed to increased competitionfrom other hospitals in the area and the rise in alternativehealth care delivery systems such as health maintenanceorganizations (HMOs). However, demand for MemorialHospitals services does vary considerably by type of wardand time of year. Table C11.2 provides a historical monthlybreakdown of the average daily patient census per ward.

The director of nursing for Memorial Hospital isDarlene Fry. Each fall she confronts one of the most chal-lenging aspects of her job: planning the nurse staffinglevels for the next calendar year. Although the averagedemand for nurses has remained relatively stable over thepast couple of years, the staffing plan usually changesbecause of changing work policies, changing pay struc-tures, and temporary nurse availability and cost. With fallquickly approaching, Fry has begun to collect informationto plan next years staffing levels.

The nurses at Memorial Hospital work a regular sched-ule of four 10-hour days per week. The average regular-time pay across all nursing grades is $12.00 per hour.Overtime may be scheduled when necessary. However,because of the intensity of the demands placed on nurses,only a limited amount of overtime is permitted per week.Nurses may be scheduled for as many as 12 hours per dayfor a maximum of five days per week. Overtime is com-pensated at a rate of $18.00 per hour. In periods ofextremely high demand, temporary part-time nurses maybe hired for a limited period of time. Temporary nurses arepaid $15.00 per hour. Memorial Hospital has a policy thatlimits the proportion of temporary nurses to 15 percent ofthe total nursing staff.

Finding, hiring, and retaining qualified nurses is a problem that hospitals have been facing for years. One reason is that various forms of private practice are luring many nurses away from hospitals with higherpay and greater flexibility. This situation has causedMemorial to guarantee its full-time staff nurses pay for a minimum of 30 hours per week, regardless of the demand placed on nursing services. In addition, eachnurse receives a four-week paid vacation each year.However, vacation scheduling may be somewhat restrictedby the projected demand for nurses during particular timesof the year.

At present, the hospital employs 130 nurses, including20 surgical nurses. The other 110 nurses are assigned tothe remaining seven major areas of the hospital. ThePersonnel Department has told Fry that the average cost tothe hospital for hiring a new full-time nurse is $400 andfor laying off or firing a nurse is $150. Although layoffsare an option, Fry is aware of the hospitals objective ofmaintaining a level workforce.

CASE MEMORIAL HOSPITAL

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TABLE C11.1 Ward Capacity Data

WARD NUMBER OF BEDS PATIENTS PER NURSE PATIENT CENSUS*

Intensive care 20 2 10Cardiac 25 4 15Maternity 30 4 10Pediatric 40 4 22Surgery 5 Post op 15 5 8 (TF daily equivalent)Emergency 10 3 5 (daily equivalent)General 120 8 98

* Yearly average per day. The hospital employs 20 surgical nurses. Routine surgery is scheduled on Tuesdays and Fridays; five surgeries can be scheduled per day per oper-ating room (bed) on these days. Emergency surgery is scheduled as needed. Daily equivalents are used to schedule nurses because patients flow through these wards in relatively short periods of time. A daily equivalent of5 indicates that, throughout a typical day, an average of five patients are treated in the ward.

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After looking over the information that she has col-lected, Darlene Fry decides that it is time to roll up hersleeves and get started. She wants to consider staffingchanges in all areas except the surgery ward, which isalready correctly staffed.

Questions

1. Explain the alternatives available to Darlene Fry as shedevelops a nurse staffing plan for Memorial Hospital.How does each meet the objectives stated by the CEO?

2. Based on the data presented, develop a nurse staffingplan for Memorial Hospital. Explain your rationale forthis plan.

Source: This case was prepared by Dr. Brooke Saladin, Wake ForestUniversity, as a basis for classroom discussion.

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TABLE C11.2 Average Daily Patient Census per Month

MONTH

WARD J F M A M J J A S O N D

Intensive care 13 10 8 7 7 6 11 13 9 10 12 14Cardiac 18 16 15 13 14 12 13 12 13 15 18 20Maternity 8 8 12 13 10 8 13 13 14 10 8 7Pediatric 22 23 24 24 25 21 22 20 18 20 21 19Surgery* 20 18 18 17 16 16 22 21 17 18 20 22Post op 10 8 7 7 6 6 10 10 7 8 9 10Emergency 6 4 4 7 8 5 5 4 4 3 4 6General 110 108 100 98 95 90 88 92 98 102 107 94

* Average surgeries per day. Daily equivalents.

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