Central Staffing Resources - University of Michiganioe481/ioe481_past_reports/f9802.pdf · Central Staffing Resources Analysis of Inpatient Unit Scheduling ... Floyd, our client,

Central Staffing ResourcesAnalysis of Inpatient Unit Scheduling

Prepared for:Lisa Floyd, Central Staffmg Resources Manager

December 15, 1998

Program and Operations Analysis Department

Matthew 3. AndersonBrenda M. NewtonCatherine A. Zinser

Coordinator:Richard 3. Coffey, Director of Program and Operations Analysis)

TABLE OF CONTENTS

Executive Summary 2

Introduction and Background 3

Approach and Methodology 4

Current Situation 7

Hypotheses Considered 7

Findings and Conclusions 8

Recommendations 12

Action Plan 14

AppendicesANSOS Schedule Development Calendar AInpatient Unit Interview Questions BInpatient Unit Survey CInpatient Unit Survey Results DLiterature Search Results EFlowchart of Scheduling Process F

Program and Operations AnalysisUniversity Of Michigan

• Have units provide suggestions to CSR for ANSOS features that they wouldlike to have upgraded.

We have developed all of these recommendations with hopes to improve the overalleffectiveness of the CSR organization. These suggestions were designed to reduce theshortages of nurses throughout the University of Michigan Hospitals that result fromvariations in demand and staffing levels. It is important to realize that theserecommendations will only be effective if all inpatient units are committed to theirimplementation.

Introduction and Background

The Central Staffing Resource (CSR) department is currently responsible for thescheduling of over 870 permanent float staff spanning 29 inpatient nursing unitsthroughout the hospital and several outpatient clinics. There are six clusters of nursesthat staff all of the units and a nurse manager/scheduling lead determines the requiredshift coverage for the following types of nurses: Adult Medical, Adult Surgical, AdultIntensive Care, Pediatric General Care, Pediatric Critical Care, and Ambulatory Care. Atthe beginning of each scheduling period, which occurs every 4 weeks, the schedulinglead takes the staff’s requests and tries to make an appropriate schedule. Any unfilledpositions must be filled by the unit’s own staff or the CSR’s float staff. The schedulinglead for each inpatient unit submits to CSR their requested number of additional shifts tobe filled by CSR staff. From this requested number, CSR attempts to fill every position.However, this is not always possible since every open slot cannot be filled due to limitedCSR staff, uncertainty in demand and ambiguities in the scheduling process. As a result,some nursing units may be short-handed while other units may have requested an amountin excess of their actual need.

There are different scheduling processes among the inpatient nursing units. To optimizethe use of the temporary float staff throughout the various units of the hospital, and toimprove CSR scheduling, there needs to be an improved method by which schedulingleads determine the true number of requested shifts.

There also appears to be differences in how the scheduling coordinators use ANSOS.Few units use ANSOS’s full capabilities for scheduling. Many use ANSOS just to inputnurse’s requests and print the schedule.

The purpose of this project is to create a standardized process for nursing units to use inorder to determine the appropriate number of staffing requests to place with the CSR.Another outcome of the study is to determine the criteria that units believe CSR shouldconsider when prioritizing requests. In addition, recommendations will be maderegarding the utilization of the ANSOS scheduling system.


Approach and MethodoloRy

All inpatient nurse managers and/or inpatient scheduling coordinators were interviewedin order to learn the differences that exist in the scheduling processes between units. Theinterviews also provided an opportunity to discuss issues and concerns that nursemanagers have with CSR service. These people were later asked to complete a surveywith questions that arose after compiling the information from the interviews. Our groupdeveloped questions that were asked in both the interviews and surveys. Some of theinterview questions include:

• What is your process for scheduling?• How reliable is ANSOS?• What is your percentage of temporary vs. full time employees?• Have you had problems with being understaffed?• How often do you over-request?• Do you feel that you are receiving adequate shift coverage from CSR?• Criteria and Process used to determine:

- Requested number of CSR staff- Cancel requests

This list is not all-inclusive. A copy of the interview questions can be found in AppendixB.

The approach we followed consisted of several key phases. The methodology andprocess for obtaining information needed to complete the analysis is as follows:

Activity 1: Scheduling meetings with client and coordinator once per week.

Activity 2: Placing a phone call to the nurse managers of the 25 inpatient units. lisaFloyd, our client, gave us these names and numbers and suggestions for the first people tobe contacted for the most assistance. We scheduled an interview with each nursemanager and/or scheduling coordinator depending on who was responsible for creatingthe unit’s schedule.

Activity 3: Preparing interview questions for the individual inpatient nurse managersand/or scheduling coordinators.

Activity 4: Interviewing the nurse managers/scheduling coordinators from the 25different inpatient units. If possible the two were interviewed together. The interviewslasted approximately 60 minutes each.

Activity 5: Compiling all data from the results of the interviews to assess similarities,differences, and problems.


Activity 6: Meeting with Pat Williams, the ANSOS Computer Consultant, to view theANSOS computer software program and study its internal workings.

Activity 7: Preparing a survey with questions found when reviewing interview results.The purpose of the survey was to quantify differences in scheduling between units andcollect additional useful information for developing recommendations.

Activity 8: Distributing the survey to all schedule coordinators. The coordinators wereasked to complete the survey to the best of their ability and return in within a one-weekperiod. This data was then compiled and evaluated.

Activity 9: Performing a literature search of past documentation. This consisted of pastschedules, each unit’s anticipated and unanticipated CSR requests and CSR fills, previouscancelation data, and the nurse’s contract. This was done from June 1997 until June1998.

Activity 10: Preparing a flowchart of the scheduling process used. See Appendix F forthe flowchart.

Activity 11: Developing recommendations to improve the scheduling process forinpatient units and CSR.

Activity 12: Reviewing our results with lisa Floyd, the client. We modified ourrecommendations based on this feedback.

Program and Operations Analysis 5University Of Michigan

Project Activity Flowchart

Schedule meetings with clientand coordinator

Schedule interviews with nursemanagers

Prepare interview questions

Interview nurse managers

Compile interview data

Meet with Pat Williams

I Prepare survey IConduct survey

I Literature search IPrepare flowcharts of

scheduling process

Develop recommendations toimprove scheduling processfor inpatient units and CSR

Review and modify results

Program and Operations Analysis 6

University Of Michigan

Current Situation

According to plan, our group interviewed each of the 25 inpatient unit nurse managersand/or schedulers. Unfortunately, the nurse managers were very busy preparing for thehospital audit making it very difficult to schedule these interviews. As a result of thisaudit, we were forced to push back the completion of the interviews by over a week. Wegathered and reviewed the information from these interviews in order to prepare thesurvey that each unit was required to complete. Since a couple of the nurse managersschedule for more than one unit, we distributed a total of 23 surveys. We gave each unitone week to complete the survey and return it to Lisa Floyd. Nurse managers were givenseveral reminders if they did not turn in the survey by the deadline; however, only 18surveys were returned after two weeks.

In contrast to our original plan, we did not observe the schedulers from each unitphysically creating their schedules using the ANSOS system for several reasons. First,each interview required one full hour to complete since each unit used a slightly differentprocess for nurse scheduling. Hence, we used all of our weekly budgeted time to conductthese lengthy interviews. Furthermore, we discovered from the first several interviewsthat most units do not use the ANSOS scheduler since they would rather use some formof self-scheduling. Most of the units only use ANSOS to print out the plan sheets and toinput the different versions of the schedule to view the total number of nurses on eachshift. We did not feel that simply observing the schedulers inputting the data intoANSOS would be a value-added task. However, our group did meet with Pat Williams,the ANSOS coordinator, to learn about the different features of ANSOS. Following thismeeting, we were able to include questions in the survey that allowed us to determinewhich features of ANSOS each unit uses.

From the interviews, our group quickly determined that each unit uses a slightly differentscheduling process. In addition, each unit has its own method for deciding how manyrequests to place with the CSR and makes this decision at a different time within theirscheduling time-line. Most units do not use the ANSOS system for its intended purpose:to create a schedule given requirements for each nurse. Many of the nurse managers haveused some form of self-scheduling for many years and do not feel that the nurses in theirunit would easily accept this impersonal form of scheduling.

Hypotheses Considered

During the interviews conducted with nurse managers, it became evident that a standardprocess for inpatient nurse scheduling does not exist. Since all units have their ownapproach, several inconsistencies result in problems with CSR being able to fill theirrequests. From the information collected from the interviews, some preliminaryhypotheses that we developed are as follows:



1. Some units place requests to CSR at different times in their own scheduling process(i.e. before or after making scheduling adjustments).

2. Some units place requests to CSR in abundance of what they really need in order toincrease their chances of full shift coverage.

3. Most units do not cancel requests that CSR is initially unable to fill. When a unitdoes fill this position with their own staff, CSR is left with inadequate time to relocate float staff.

4. Most units do not cancel filled requests placed to CSR in advance of the 3 hourrequired notice if they know they are over-staffed. These units keep this buffer CSRstaff on their schedule in case of unanticipated circumstances.

5. Most units do not fully utilize the ANSOS scheduling software program. For thisreason, many units spend unnecessary time using some form of self-scheduling.Furthermore, some of these self-scheduling methods lead to over-requesting CSRstaff.

6. A lack of communication between some inpatient units and CSR exists. For example,some units spend a significant amount of time trying to obtain CSR shift coveragewhen few, if any, CSR staff are actually available.

Findings and Conclusions

Most of the conclusions we developed are based on the survey results. The first sectionof the survey examined each unit’s scheduling process. Eighty-three percent of the unitsallow nurses to sign up for a preferred schedule for each scheduling period. This showsthat more than half of the units use self-scheduling as opposed to the ANSOS schedulingprogram. The units that did use some form of self-scheduling have been using thatsystem for three to ten years. The average number of years using self- scheduling is sixyears. All units that used self-scheduling said that they planned on continuing using thismethod. When the units use self-scheduling, they allow a certain number of requests pernurse per period. Seventy-six percent allow four requests and the other twenty-fourpercent allow other requests, such as three, six, or eight. When using self-scheduling, theaverage number of drafts created before the final schedule is six drafts. However, unitsthat used ANSOS only created approximately four drafts. On average, it takes fourbusiness days for a unit to complete a schedule. Units that use ANSOS said it only takesone day, while units that do not use ANSOS take five days to create a schedule. It isobviously taking units that use self-scheduling a lot longer than units who use ANSOS.

The units all use a slightly different combination of methods to determine core staffingnumbers when developing the schedule. Seventy-two percent of the units use annualbudgeted patient days, sixty-seven percent use historical data, fifty-five percent usecensus data, seventy-two percent use acuity data, and eighty-nine percent use personal



judgment. These methods are not independent, as each unit was asked to respond to allthat applied. Ninety-four percent of the units (all but one) schedule/staff up to theirbudgeted number of RN FTE’s whenever possible. Fifty-five percent of the units said thenumber of staff that are scheduled vary depending on the day of the week to account forchanges in unit patient population.

Different staff members among units are responsible for preparing the initial schedule.Seventeen percent of the units said the nurse manager was responsible, seventeen percentsaid unit nurses, sixty-one percent said administrative assistants, and thirty-three percentsaid a special scheduling staff prepared the schedule. In addition, different staff membersamong units are responsible for making adjustments to the schedule before it is finalizedand posted. Nurse managers are responsible for seventy-seven percent of the units, unitnurses for eleven percent of the units, administrative assistants for fifty-five percent ofthe units, and a special scheduling staff for seventy-two percent of the units. Again, thesurvey asked to respond to all that applied.

Survey results indicate that almost eighty percent of the inpatient units schedule UnitBased Temporary RN’s within their unit. This tends to make it easier for the nursemanagers or schedulers to create a schedule with even coverage across all shifts. Aboutninety percent of these units fit the Unit Based Temporary RN’s into the schedule prior toplacing requests with the CSR. This practice is beneficial to both the units and the CSRsince the Unit Based Temporary RN’s can oftentimes fill the gaps within the schedulewhere the Regular RN’s alone cannot meet the needs of the unit.

Although most units attempt to include all Regular and Temporary RN’s into theirschedule before placing CSR requests, the survey reveals that more than half of the unitsdo not make efforts to finalize their schedules beforehand. Fifty-three percent of theunits place CSR requests prior to making final schedule adjustments. Furthermore, thesesame units wait until the CSR responds with the shift coverage available beforesmoothing out the schedule. Many of the nurse managers indicated that this practicereduces time spent making the schedule because the float nurses fill shifts that areinitially difficult to cover. This manner of scheduling may alleviate the task of coveringshifts within units; however, it also depletes the CSR resources required to meet the truevariations in demand for hospital as a whole.

The CSR responds to units with the shift coverage that they will provide for the unit onthe day before the schedule is posted. CSR is often unable to initially fill all of therequests for each unit, but will continue to search for nurses to fill these requests after theschedule has been posted. Each unit will also attempt to fill these shortages internally,and do not usually cancel the outstanding CSR requests. In fact, the survey demonstratesthat only six percent of the units always cancel these requests, fifty-six percent sometimescancel, and thirty-eight percent replied that they never cancel these requests. Many nursemanagers indicated in the interviews that they do not remember to cancel these requests.As a result, the staff within the CSR is spending a significant amount of time attemptingto fill requests that have already been filled within the units.


The inpatient units are able to wait until three hours before a shift begins to cancel a CSRnurse with no penalty. It would seem logical that units would cancel CSR shift coverageprior to this three-hour deadline if they are over-staffed for a shift; however this is not thecase. Sixty-one percent of the units did claim to always cancel CSR nurses that were nolonger needed for a particular shift in advance, but thirty-nine percent of the units onlycancel before the deadline sometimes. Several nurse managers indicated in theinterviews that they would hold onto the additional float staff in case an unforeseenincrease in demand should arise. This strategy makes it difficult for the CSR to fill realneeds in other units, and also leaves them with a short amount of time to find anotherassignment for the cancelled CSR nurse if one even exists.

Fortunately, the survey results indicate that ninety-four percent of the units do not requestover their amount of total non-productive time as calculated on the CSR request form.This means that the units are not attempting to schedule more nurses in their unit than theworkload requires on a regular basis. Most of the nurse managers said that they try toschedule according to the exact needs of their unit in order to meet their staffing budget.Fifty-six percent of the units surveyed are currently below the five percent overtimetrigger. Some of the nurse manages explained that the demand for FTE’ s had recentlyincreased within their unit above their budgeted number which has caused them to exceedthe overtime trigger.

The survey results make it clear that the nurse managers and/or schedulers are not allsatisfied with the shift coverage that they receive from the CSR. Fifty percent of theunits are satisfied with anticipated shift coverage from the CSR, and only seventeenpercent of the units surveyed are satisfied with coverage received for unanticipatedrequests. Furthermore, seventy percent of the units indicated that CSR should allocatemore nurses to cover unanticipated needs even if this practice means less anticipated fillson the original schedule.

The various inpatient nursing units all place different weight and considerations onrequests for time off by the nurses in the units. The survey attempted to address this issueby asking each nurse manager/scheduling lead to number a set of criteria in order ofimportance from 1 to 15, with 1 being the most important and 15 the least, for anticipatedrequests. The survey yielded the results displayed in Figure 1 on the following page.



Figure 1: Priorities for anticipated requests

It is observed that the nurse managers/scheduling leads who participated in the survey feltthe highest priority for anticipated requests should be given to the number of unfilledshifts on a unit during the scheduling period. In contrast, the least priority, as determinedby the nursing units, should be given to the nurses who request time off for educationalleave of absence.

A similar question was asked of the nurse managers/scheduling leads in regards tounanticipated requests. Again the schedulers were asked to number a set of criteria inorder of importance from 1 to 17, with 1 having the most importance and 17 the least.The survey yielded the results displayed in Figure 2 on the following page.


Priorities for Anticipated Requests

12

10

8

3 6U)

4

2 zEiEt1Ei±”””0

Figure 2: Priorities for unanticipated requests

The last section of the survey regarded ANSOS. Thirty-nine percent of the units said thatthey used the “Create” function in ANSOS. The main reasons for not using the “Create”function include that they prefer self-scheduling or that ANSOS is not user-friendlyand/or too slow. When asked if the nurse managers would like to see ANSOS upgraded,seventy-nine percent said that they would, but they would want to know what was beingupdated and give their input.

Recommendations

The survey results demonstrate that more than half of the units do not make finalschedule adjustments prior to placing CSR requests. For this reason, many units areplacing requests before they have determined the true needs within their unit for thatscheduling period. This practice can easily lead to over-requesting CSR shift coverage.We think that each unit should complete their schedules to the best of their ability beforethey seek assistance from the CSR. The CSR could enforce this policy by requiring thateach unit attach their completed plan sheets for each scheduling period to their requestform. This way, the CSR could visualize the needs within each unit and verify that a trueneed accompanies each request. This is not a foolproof method for monitoring the

12Program and Operations AnalysisUniversity Of Michigan

Priorities for Unanticipated Requests

0U

U)

12

10

8

6

4

2

0

scheduling efforts of each unit, but it strongly encourages the units to make scheduleadjustments before CSR requests are due.

Most of the units do not routinely cancel unfilled CSR requests that they subsequently fillwithin their unit according to the survey results. Consequently, the CSR staff spends asignificant amount of time trying to fill requests that are no longer necessary. Werecommend that the CSR erases these unfilled requests and requires the units to re-submitrequests if they are unable to fill them within their unit. This would not only save theCSR staff time in finding unnecessary shift coverage, but would also encourage the unitsto make an effort to fill these shift shortages internally.

The survey results show that an overwhelming majority of the units are not currentlysatisfied with the shift coverage that they receive for unanticipated requests. Moreimportantly, most of these units would be willing to sacrifice the shift coverage that theyreceive for anticipated requests to increase the CSR resources devoted to unanticipatedrequests. We feel that the purpose of the CSR should be to supplement staffing levels inthe hospital to meet the variable demand. If most of the CSR shift coverage available isallocated to cover the initial requests of each unit, adequate resources will not exist tocover the unforeseen variability in demand among units. For example, a unit could beforced to operate very short-handed if the acuity and census is very high for a certain shiftand this situation could be worsened if a nurse calls in sick. In addition, if the nursesknow that sufficient resources do not exist within the CSR to cover their unanticipatedrequests, it is to their benefit to over-request anticipated shift coverage. They can use thisanticipated CSR shift coverage as a buffer to alleviate unanticipated circumstances.

After having reviewed and studied the ANSOS scheduling process it is ourrecommendation that the nursing units use the ANSOS scheduling feature on a trial basis.Data from the survey indicates that nurse managers/scheduling leads who do not use theANSOS scheduling program to develop their schedules spend on averageS days creatingand modifying a typical schedule. Nurse managers/scheduling leads who do utilize thescheduling feature of ANSOS throughout the scheduling process spend approximately 1day. In order to show the benefits of using the ANSOS program in terms of saving timethroughout the entire scheduling process we feel that the nurse managers/schedulingleads who do not currently use the scheduling feature of ANSOS should use the programfor at least two scheduling periods. Requiring the schedulers to use the program for twoperiods allows them to become acclimated during the first period while reaping thebenefits of the program in the second period.

In addition to using the ANSOS scheduler for a trial period, a training class for the nursemanagers/scheduling leads is recommended so that they feel more comfortable with thissystem. The training class is intended to remove the stigma placed on the ANSOSscheduling system. Currently, the ANSOS scheduler is equipped with an on-line helpsystem. However, many people are intimidated by the thought of going on-line for help.The training class will provide answers to many commonly asked questions to avoid theneed for unanticipated on-line help. The training class will also be the place where thenurse managers are shown the benefits of using ANSOS.



Recently, the ANSOS system has been reviewed, and the possibility of upgrading thesystem has been explored. In order to only upgrade necessary features, an in depthsurvey should be conducted throughout the inpatient nursing units. This survey willquestion the nurse managers/scheduling leads on the effective and noneffective featuresof the ANSOS scheduling program. From this survey, recommendations will be madefor the upgrading of the system.

From the flowchart found in Appendix F there are two distinct processes that a nursemanager may perform. When designing a schedule the nurse manager/scheduling leadmay either use the ANSOS scheduling feature or some form of self-scheduling. Whenobserving the flowchart one can see that the path using the ANSOS scheduling feature isquite simple and uniform, whereas the self-scheduling path contains many loops andvariations throughout the process. By following the ANSOS scheduling path ambiguityamong the unit scheduling processes would be greatly reduced. This observation is notmeant to show that there would be a significant reduction in scheduling time, but rather toindicate that using the ANSOS scheduling system would create a more uniformscheduling process throughout the nursing units. The recommended flowchart process isfound in Appendix F.

A final recommendation to be considered relates to the prioritization of different types ofrequests that is summarized in the findings and conclusions section of this report. It issuggested that CSR analyze this information to determine what the nursemanagers/scheduling leads feel is most important in terms of receiving anticipated andunanticipated shift coverage. CSR may want to consider this information whenprioritizing requests for the inpatient units.

Action Plan

1. Immediately require all units to attach completed plan sheets to CSR request forms.

2. Immediately have CSR implement the “wipe the slate clean” policy after initialrequests are filled. Units will have to submit their requests again if they do not fillthem within their unit.

2. From the literature search conducted which covered 13 scheduling periods, it wasfound that 90% of anticipated requests were filled while 69% of unanticipatedrequests were filled. The survey indicated that the nurse managers would prefer theallocation of more CSR staff to unanticipated requests at the expense of anticipatedrequests. To address this problem we suggest that 30% more CSR staff be allocatedto unanticipated requests. The 30% should be gradually implemented over a 6-monthperiod. For example, CSR could increase nurses allocated to unanticipated requestsby 10% every two months until the 30% increase has been achieved. A subsequentsurvey should be distributed to each unit in order to determine if the nurse managersare satisfied with the change.


3. Immediately plan for an ANSOS training class to better acclimate nurses to theprogram. Conduct a 1-day session, preferably in January, where all nursemanagers/scheduling leads attend and receive close instruction on how to use thecomputer program.

4. All units use ANSOS for 2 scheduling periods. Following the training session inJanuary, the nurse managers/scheduling leads should use the ANSOS system todetermine their schedule. This should occur sometime in February in preparation forthe March and April scheduling periods.

5. After using the ANSOS scheduling feature for two periods, a survey should bedistributed among the nurse managers/scheduling leads asking them what features ofANSOS should be improved and upgraded.



APPENDIX AANSOS Schedule Development Calendar

Program and Operations Analysis AUniversity of Michigan

University of Michigan Hospitals and Health CentersAutomated Nurse Staffing Office Scheduling System ProgramPolicy, Standards, and Guidelines Manual

ANSOS SCHEDULE DEVELOPMENT CALENDAR1998 - 1999

Update ProcessDate

Scheduler movesPosting of to Current

Period 4 Week Schedule Requests Due Schedule Staffer

1 6/14-7/11/98 5/15/98 5/29/98 6/5/98

2 7/12-8/8/98 6/12198 6/26/98 7/2/98

3 8/9-9/5/98 7/10/98 7/24/98 7/31/98

4 9/6 - 10/3/98 8/7/98 8/21/98 8/28/98

5 10/4 - 10/31/98 9/4/98 9/18/98 9/25/98

6 11/1 - 11/28/98 10/2/98 10/16/98 10/23/98

7 11/29 - 12/26/98 10/30/98 11/13/98 11/20/98

8 12/27-1/23/99 11/27/98 12/11/98 12118/98

9 1/24-2/20/99 12/24/98 1/8/99 1/15/99

10 2121 - 3/20/99 1/22/99 2/5/99 2/12/99

11 3/21 - 4/17/99 2/19/99 3/5/99 3/12/99

12 4/18 - 5/15/99 3/19/99 4/2/99 4/9/99

13 5/16-6/12/99 4/16/99 4/30/99 5/7/99

1999-20001

6/13-7/10/99 5/14/99 5/28/99 6/4/99

• Prior to entering schedule requests and creating the Next period Schedule, the unit Skeletonsare RESET by the manager/designee. RESETI1NG moves current Scheduling data from theCONTROLLER database into the SCHEDULER.

• 10 Days prior to the beginning of the next schedule, a CENTRAL UPDATE is done bysystem administrators. The UPDATE process moves the new schedule to the CURRENTSTAFFER. This clears the SCHEDULER (Next Period and Period After Next) so that a newSchedule can be developed.

©1998 University of MichiganHospitals and Health Centers , Department of Nursing98-99ca1.doc

APPENDIX BInpatient Unit Interview Questions

Program and Operations Analysis BUniversity of Michigan

CSR Interview

Name:_____________________________________________

Department:__________________________________

Date and Time:__________________________________

1. What is your process for scheduling?

2. How reliable is ANSOS?

3. What is your percentage of part time vs. fbll time employees?

4. Have you had problems with being understaffed?

5. How often do you over-request?

6. What do you feel are the most important requests for receiving time off?

7. What type of priority system do you believe CSR should use?

8. Do you feel that you are receiving adequate shift coverage from CSR?

9. What is your criteria and process used to determine:- Requested number of CSR staff?

- Cancel requests with CSR?

10. Do you cancel prior to the 3 hour deadline if you know you are overstaffed?

11. How do you feel about floating within your unit?

12. Do you think that CSR should dedicate more needs to unanticipated requests?

13. Are you below your overtime trigger?

APPENDIX CInpatient Unit Survey

Program and Operations Analysis CUniversity of Michigan

MEMORANDUM:

INPATIENT UNiT NURSE SCHEDULING SURVEY

TO: UMHS Inpatient Unit Nurse ManagersInpatient Unit Schedulers

FROM: Lisa Floyd, RN, BSNCentral Staffing Resource Department - Clinical Nurse Manager

Brenda NewtonIndustrial and Operational Engineering Student

Matt AndersonIndustrial and Operational Engineering Student

Cathy ZinserIndustrial and Operational Engineering Student

DATE: November 2, 1998

SUBJECT: Inpatient Unit Nurse Scheduling Survey Purpose and Requirements

Recently each of you met with one of the above JOE engineering students to discuss individualinpatient unit scheduling practices. The students have compiled the attached survey as a follow-up to those interviews. The survey results will be used to develop strategies for schedule processimprovement.

It is important that the students receive complete and accurate information from each unit.Please take the time to complete the survey, and return it to CSR no later than Monday,November 9. The survey information will be kept anonymous.

Thank you very much for your cooperation with this project. Hopefully the information gatheredwill help CSR improve service and satisfaction.

Scheduling Survey

Unit Scheduling Process

1. Which unit/s do you schedule for?_____________________________

2. Do you allow nurses to sign up for a preferred schedule each ANSOS period (i.e. do your

nurses engage in some form of self-scheduling)? Y N (Circle One)

3. If your response to question # 2 was yes, how long have you been using self-scheduling?

________________

Do you plan to continue using this method? Y N (Circle one)

4. Is there a certain number of requests allowed per nurse/per period? Y N (Circle one)

Ifyour response was yes, how many requests?________________________

5. On average, how many drafts or stages does each schedule go through before it is

finalized?_______________________

6. Approximately how many business days does it take to complete the schedule from start to

finish?______________________

7. How do you determine your core staffmg numbers when developing the schedule?

(Circle all that apply)

Annual Budgeted Patient Days Historical Data Census

Acuity Personal Judgment (i.e. staff mix, staff experience etc.)

8. Do you schedule / staff up to your budgeted number of R.N FTE’s whenever possible? Y N (Circle

one)

9. Does the number of staff scheduled per shift vary depending on the day of the week to account for

changes in unit patient population? Y N (Circle one)

10. Who is responsible for preparing the initial schedule draft? (Circle all that apply)

Nurse Manager Unit Nurses Administrative Assistant

Charge Nurse Specific Scheduling Staff

II. Who is responsible for making adjustments to the schedule before it is finalized and posted? (Circle

all that apply)

Nurse Manager Unit Nurses Administrative Assistant

Charge Nurse Specific Scheduling Staff

II. Central Staffing Resource Requests

12. Do you schedule Unit Based Temporary RN’s on your unit? Y N (Circle one)

If your response was yes, do you schedule these employees before requesting CSR coverage?

Y N (Circle one)

13. Have you made the final adjustments to your unit schedule before placing CSR requests?

Y N (Circle one)

14. If your response to question #13 was no, do you wait until CSR requests have been filled to make final

unit schedule adjustments? Y N (Circle one)

15. Do you routinely cancel unfilled CSR requests if you are able to fill them with unit staff? (Circle the

most appropriate choice)

Always Sometimes Never

16. Do you cancel CSR coverage in advance of the 3 hour cancellation deadline when you know that you

are over staffed for a shift? (Circle the most appropriate choice)


17. Are you satisfied with CSR shift coverage for the following type of requests:

• Anticipated requests Y N (Circle one)

• Unanticipated requests Y N (Circle one)

I 8. Do you request OVER your amount of total non-productive time as it is calculated on the CSR request

form? Y N (Circle one)

19. Are you currently below the 5% Overtime Trigger? Y N (Circle one)

2

20. In your opinion, should CSR set aside more nurses to cover unanticipated needs even if this practice

means less anticipated fills on the original schedule? Y N (Circle one)

21. How satisfied are you with the ability of CSR to fill requests for unanticipated leaves? (Circle the

most appropriate choice)


III. Priorities

22. Should a unit that schedules under budget and requests CSR staff to supplement the numbers be given

lower priority on the original schedule than a unit that schedules to budget and requests CSR to

account for variability? Y N (Circle one)

23. Number the following criteria in order of importance from Ito 15 for anticipated requests. (1 is

most important and 15 is least important. Note: you may give two or more criteria the same value of

importance)

_Number of unfilled shifts on unit during scheduling period

_Number of unfilled shifts on unit for particular shift

_Open Positions

Extended Sick

Medical LOA

FMLA

Orientation

Scheduled PTO

_Unscheduled PTO

Dependent Care (as part of PTO)

_Educational LOA

Union Time

_Hospital Business

Funeral

Jury Duty

3

24. Number the following criteria in order of importance from I up to 17 for unanticipated requests. (1

is most important and 17 is least important. Note: you may give two or more criteria the same value

of importance)

_WorkloadiNurse Index

_Acuity, Census

_Number of unfilled shifts on unit for particular shift

_Open Positions

Extended Sick

Medical LOA

FMLA

Orientation

Scheduled PTO

_Unscheduied PTO

_Dependent Care (as part of PTO)

_Educational LOA

Union Time

_Hospital Business

Funeral

_Jury Duty

IV. ANSOS

25. Do you use the Create function in ANSOS scheduler? Y N (Circle One)

26. If your response to #25 was no, for which of the following reasons do you opt not to use the create

function? (Circle all that apply)

• Prefer individualized self-scheduling

• Lack of knowledge about the create function

• Have never used the create function / do not feel comfortable using it

• ANSOS is not user friendly and / or too slow

27. Should UMHS Nursing invest in upgrading the ANSOS system? Y N (Circle one)

4

APPENDIX DInpatient Unit Survey Results

Program and Operations Analysis DUniversity of Michigan

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APPENDIX ELiterature Search Results

Program and Operations Analysis EUniversity of Michigan

Literature Search Results

AnticiDated Requests UnanticiDated Requests Filled RequestsRequests Filled Requests Filled Cancelled

CTU 109 91 83% 146 115 79% 124ICU 136 119 88% 149 121 81% 1045E 82 75 92% 87 55 63% 345W 58 51 89% 62 38 61% 216M 70 59 84% 73 44 61% 457M 73 67 91% 66 40 61% 29HOLD 113 99 87% 138 96 70% 78WBC 108 106 98% 37 23 63% 104B 33 31 92% 83 60 72% 344C 85 81 95% 123 93 76% 555A 39 36 92% 73 50 68% 375B 39 37 96% 61 40 65% 305C 35 30 84% 64 41 64% 446A 39 34 88% 101 64 64% 446B 41 40 96% 86 60 69% 466C 38 37 97% 62 41 67% 297A 5 4 77% 21 12 56% 67C 16 15 99% 32 19 59% 108A 18 16 89% 70 48 69% 288B 35 33 94% 83 60 72% 398C 81 79 97% 87 64 74% 47TBAC 55 48 87% 49 30 61% 244DC 22 19 87% 65 51 79% 354DR 33 25 76% 83 64 77% 395D 104 92 89% 140 107 77% 856D 56 48 85% 114 91 80% 747D 66 59 89% 105 84 80% 60TBIC 129 114 88% 112 88 78% 71Average 90% 69%Partial Average 90% 69%(Units that completed survey)

APPENDIX FFlowchart of Scheduling Process

Program and Operations Analysis FUniversity of Michigan

Start

Enter RN’s with fixedschedules into ANSOS

Post Blank

_______________

Plan Sheets

ANSOSScheduler

Nurses enter requestsoff

‘iT

ANSOS createsschedule

‘ii

Scheduling Leadmanually smooths

schedule

LF

Scheduling Lead entersL reauests into ANSOS

Scheduling Lead enterscore coverage

reauests I to ANSOS

Enter searchparameters into

ANFfl5

1

Unit pces requests

Post O.T. requests

Enter O.T.coverage into

AN

6 Days

“F

Unit receives CSRshift coverage

zz:EEInput CSR shiftcoverage into

ANOS

1

Further schedulemodifications

required

CoverageMet?

Place CSR

Regular RN’s write inoptimal schedule &

reauets off

Scheduling Lead entersshift coverage &requests off into

ANOS

Fched1+/’<>N

QL<7schedN(ES

Make schedulea dj us t men ts

Make scheduleadjustments

Input revisedschedule into

ANSOS

Input revisedschedule into

ANSOS

Monitor shiftcoveraae

Scheduleadjustments

rea’ ired

YESStaff according

to currentschedule

verstaffedon certain

hifts

YES

Cancel shiftcoverage according

to contract

Remove cancelledshift coverage from

_________

requests

YESPost O.T.? Post O.T. requests

rrj Input O.T. coverageinto ANSOS or daily

Unit receives CSRshift coverage

Cancel shiftcoverage

according tocontract

Removecancelled shiftcoverage fromANSOS or daily

plan sheets

Input CSR shiftcoverage into AN SOS

daily sheets

YES

0

Input shiftStaff accordingcoverage into

_______________

to currentANSOS/dailyscheduleplansheets

Documents

Central Staffing Resources - University of Michiganioe481/ioe481_past_reports/f9802.pdf · Central Staffing Resources Analysis of Inpatient Unit Scheduling ... Floyd, our client,