Short-Term nurse schedule adjustments under dynamic patient demand

We study two-stage short-term staffing adjustments for the upcoming nursing shift. Our proposed adjustments are first used at the beginning of each 4-hour nursing shift, shift t, for the upcoming shift, shift t + 1. Then, after observing actual patient demand for nursing at the start of shift t + 1, we make our final staffing adjustments to meet the patient demand. We model six different adjustment options for the two-stage stochastic programming model, five options available as first-stage decisions and one option available as the second-stage decision. We develop a two-stage stochastic integer programming model, which minimizes total nurse staffing costs and the cost of adjustments to the original schedules, while ensuring the coverage of nursing demand. Our experimental results, using the data from an urban Children’s Hospital, indicate that the developed stochastic nurse schedule adjustment model can deliver cost savings up to 18% for the medical units, compared to alternative no short-term adjustment scheduling models. The proposed stochastic adjustments model successfully keeps average understaffing percentages under 2% throughout the staffing horizon.