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CASE MEMORIAL HOSPITAL

CASE
MEMORIAL HOSPITAL.jpg”>

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
health care to the people of Ashe County and the six surrounding counties. To
accomplish this mission, Memorial Hospital’s CEO has outlined three objectives:
(1) maximize customer service to increase customer satisfaction, (2) minimize
costs to remain competitive, and (3) minimize fluctuations in workforce levels
to help stabilize area employment.

The hospital’s operations are segmented into eight
major wards for the purposes of planning and scheduling the nursing staff. These
wards are listed in Table C11.1 along with the number of beds, targeted
patient-to-nurse ratios, and average patient census for each ward. The overall
demand for hospital services has remained rela-tively constant over the past
few years even though the population of the seven counties served has
increased. This stable demand can be attributed to increased competition from
other hospitals in the area and the rise in alternative health care delivery
systems such as health maintenance organizations (HMOs). However, demand for
Memorial Hospital’s services does vary considerably by type of ward and time of
year. Table C11.2 provides a historical monthly breakdown of the average daily
patient census per ward.

The director of nursing for Memorial Hospital is Darlene
Fry. Each fall she confronts one of the most chal-lenging aspects of her job:
planning the nurse staffing levels for the next calendar year. Although the
average demand for nurses has remained relatively stable over the past couple
of years, the staffing plan usually changes because of changing work policies,
changing pay struc-tures, and temporary nurse availability and cost. With fall
quickly approaching, Fry has begun to collect information to plan next year’s
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 day for a maximum of five days per week. Overtime is
com-pensated at a rate of $18.00 per hour. In periods of extremely high demand,
temporary part-time nurses may be hired for a limited period of time. Temporary
nurses are paid $15.00 per hour. Memorial Hospital has a policy that limits the
proportion of temporary nurses to 15 percent of the 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
higher pay and greater flexibility. This situation has caused Memorial 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, each nurse
receives a four-week paid vacation each year. However, vacation scheduling may
be somewhat restricted by the projected demand for nurses during particular
times of the year.

At present, the hospital employs 130 nurses,
including 20 surgical nurses. The other 110 nurses are assigned to the
remaining seven major areas of the hospital. The Personnel Department has told
Fry that the average cost to the hospital for hiring a new full-time nurse is
$400 and for laying off or firing a nurse is $150. Although layoffs are an
option, Fry is aware of the hospital’s objective of maintaining a level
workforce.

TABLE C11.1 Ward Capacity Data

WARD

NUMBER
OF BEDS

PATIENTS PER NURSE

PATIENT CENSUS*

Intensive care

20

2

10

Cardiac

25

4

15

Maternity

30

4

10

Pediatric

40

4

22

Surgery

5

†

†

Post op

15

5

8

(T–F 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 of 5
indicates that, throughout a typical day, an average of five patients are
treated in the ward.

continued

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continued

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

14

Cardiac

18

16

15

13

14

12

13

12

13

15

18

20

Maternity

8

8

12

13

10

8

13

13

14

10

8

7

Pediatric

22

23

24

24

25

21

22

20

18

20

21

19

Surgery*

20

18

18

17

16

16

22

21

17

18

20

22

Post op†

10

8

7

7

6

6

10

10

7

8

9

10

Emergency†

6

4

4

7

8

5

5

4

4

3

4

6

General

110

108

100

98

95

90

88

92

98

102

107

94

* Average surgeries per day.

† Daily equivalents.

After looking over the information that she has
col-lected, Darlene Fry decides that it is time to roll up her sleeves and get
started. She wants to consider staffing changes in all areas except the surgery
ward, which is already 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 for this plan.

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

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