CASE: MEMORIAL HOSPITAL (CHAPTER 10)

A. Synopsis
Memorial Hospital is a 265-bed regional hospital serving western North Carolina.
The hospital is segmented into eight major care areas for the purpose of allocating
nursing staff. Darlene Fry, Director of Nursing, is facing the annual problem of
planning the nurse staffing levels for the upcoming year. Information pertaining to
average patient census across the eight care areas as well as target patient-to-nurse
ratios are presented. Students are also provided with sufficient cost data to help
Darlene develop for next year a staffing plan that conforms to the mission and
objectives of the hospital

B. Purpose

The primary objective of the case is to have students develop a nurse staffing plan for
Memorial Hospital next year. Parameters and data to allow students to use both
demand and supply options to developing a feasible staffing plan are provided in the
case. Available options that you should expect students to use and discuss in them
plan include:
 Hiring and firing/layoff
 Overtime and undertime
 Use of temporary nurses (i.e., subcontracting)
 Use of vacations
 Cross training to be able to assign nurses across different care areas
 Offering new services such as HMOs for preventive medical care to keep skilled
nurses employed.

Also to address the trade-offs presented by the hospital’s

stated objectives, the costs of different options, and the projected demands for nursing
services.

Different analysis Stages:

Darlene faces several trade-offs to meet her three key objectives:

- Maximizing customer service
- Minimizing cost
- Minimizing workforce fluctuations

Important to note Darlene has major objective to maintain level workforce of Nurse so we
need to do analysis with Level workforce only.

Details from Case Study:

Total 130 nurses available: 110 for 7 section other than surgery and surgery section
had 20 nos.
Hiring cost: $400/nurse Firing Cost: $150/nurse
 Don’t need to consider surgery ward as of now as per case study
Nurse working 10 hrs per day -4 days a week.
Pay $12 /hrs
Maximum 12 hrs /day Nurse can work, max 5 days a week
Overtime $18/hr
Temporary nurse paid $15/hr
Temporary nurses can be hired 15% of total regular staff.
4 weeks’ vacation per year
1) ANS: Darlene Fry has several alternatives available as she develops a nurse-staffing
plan for Memorial Hospital:
1. Maintain Current Staffing Levels: The current staffing level is 110 nurses. If we
distribute these nurses according to the targeted patient-to-nurse ratios and the
average patient census, we find that we need 35 nurses. This leaves us with 75 extra
nurses, which suggests that the current staffing levels might be higher than
necessary.
This is what best we can have recommended for a while by level workforce
strategy
2. Hire More Full-Time Nurses: If we were to hire more full-time nurses, we would
need to consider the cost of hiring, which is $400 per nurse. If we assume that we
need an additional 10 nurses, the cost would be $4000. We would also need to
consider the ongoing cost of salaries.
This option also not workable for long run
3. Use More Temporary Nurses: Temporary nurses are paid $15.00 per hour. If we
assume that a temporary nurse works 40 hours per week for 4 weeks, the cost would
be $2400 per month per nurse. However, the hospital’s policy limits the proportion of
temporary nurses to 15% of the total nursing staff, which is approximately 16
Nurses-Limitation is there
We are paying regular way $12 / hr and in temporary it will be $15/hr so extra $3 /hr
we need to pay

Hire/layoff versus temps

$400 hire temp = $3/hr premium
$150 layoff
Total =$550 total
$550 ÷ $3/hr = 183 hours or 4–5 weeks
It is less expensive to hire a new nurse than to use a temporary nurse for over
FIVE weeks

4. Implement Flexible Scheduling: To analyse this alternative, we would need data on

the variation in demand throughout the day and week. However, based on the data
given, we can see that there is variation in demand throughout the year, which
suggests that flexible scheduling could be beneficial as with help of spare 75
workforce (more details in 2nd answers in case study)

Calculation for Level work force done in Excel sheet same also added
2) Nurse shifting plan

To develop a nurse-staffing plan for Memorial Hospital, we need to consider the targeted
patient-to-nurse ratios, the average patient census for each ward, and the monthly variation
in patient census. We also need to consider the hospital's policies on overtime and
temporary nurses.

First, let's calculate the number of nurses needed for each ward based on the targeted
patient-to-nurse ratios and the average patient census:

Intensive Care: 10 patients / 2 patients per nurse = 5 nurses

Cardiac: 15 patients / 4 patients per nurse = 4 nurses
Maternity: 10 patients / 4 patients per nurse = 3 nurses
Pediatric: 22 patients / 4 patients per nurse = 6 nurses
Post-Op: 8 patients / 5 patients per nurse = 2 nurses
Emergency: 5 patients / 3 patients per nurse = 2 nurses
General: 98 patients / 8 patients per nurse = 13 nurses

This gives us a total of 35 nurses needed based on the average patient census. However, we
know that the hospital currently employs 110 nurses (excluding the 20 surgical nurses), so 75
nurses can be allocated to other wards or kept as a buffer to handle fluctuations in demand.

Next, let's consider the monthly variation in patient census. Looking at Table 10.4, we can see
that the patient census varies by ward and by month. To handle this variation, we could
allocate 75 extra nurses to the wards that have the highest increase in patient census each
month. This would require a flexible scheduling system that allows nurses to move between
wards as needed.

Finally,
we need to consider the hospital's policies on overtime and temporary nurses.
If the demand for nurses exceeds the number of available full-time nurses in any given
month, we could schedule overtime or hire temporary nurses, keeping in mind the
restrictions on overtime and the limit on the proportion of temporary nurses.

Remarks for case study:

This plan aims to maximize customer service by ensuring that there are enough nurses
to meet demand at all times, minimize costs by efficiently allocating nurses based on
demand, and minimize fluctuations in workforce levels by using a flexible scheduling
system.