Hourly Changes In Patient Census

Hourly changes in patient census and acuity require hospitals to update their staffing needs on a continuing basis. This paper discusses the problem that management faces several times a day as the demand for nursing services departs from the planned schedule. Prior to the start of each shift, the number of nurses who are scheduled to be on duty over the next 24 hours is compared with the number actually available, and if shortages exist a series of decisions have to be made to ensure that each unit in the hospital has sufficient coverage. These decisions involve the use of overtime, outside nurses, and floaters. To address this problem, we have developed an integer programming model that takes the current set of rosters for regular and pool