The ‘Robust’ roster: exploring the nurse rostering process

The impact of electronic and self-rostering systems on healthcare organisations and healthcare workers: A mixed-method systematic review

AIM

To synthesise evidence from studies that explored the impact of electronic and self-rostering systems to schedule staff on healthcare organisations and healthcare workers.

DESIGN

Mixed-method systematic review.

METHODS

Studies were screened by two independent reviewers and data were extracted using standardised data extraction tables. The quality of studies was assessed, and parallel-results convergent synthesis was conducted.

DATA SOURCES

Academic Search Complete, CINAHL, ERIC, MEDLINE, PsycINFO and PsycARTICLES were searched on January 3, 2023.

RESULTS

Eighteen studies were included (10 quantitative descriptive studies, seven non-randomised studies and one qualitative study). Studies examined two rostering interventions including self-rostering (n = 12) and electronic rostering (n = 6). It was found that the implementation of electronic and self-rostering systems for staff scheduling impacted positively on both, healthcare workers and healthcare organisations. Benefits included enhanced roster efficiency, staff satisfaction, greater control and empowerment, improved work-life balance, higher staff retention and reduced turnover, decreased absence rates and enhanced healthcare efficiency. However, self-rostering was found to be less equitable than fixed rostering, was associated with increased overtime, and correlated with a higher frequency of staff requests for shift changes.

CONCLUSION

The impact of electronic and self-rostering systems to schedule staff on healthcare organisations and healthcare workers' outcomes was predominantly positive. Further randomised controlled trials and longitudinal studies are warranted to evaluate the long-term impact of various rostering systems, including electronic and self-rostering systems.

IMPLICATIONS FOR HEALTHCARE

Rostering is a multifaceted responsibility for healthcare administrators, impacting patient care quality, workforce planning and healthcare expenditure.

IMPACT

Given that healthcare staffing costs constitute a substantial portion of global healthcare expenditure, efficient and strategic resource management, inclusive of healthcare staff rostering, is imperative.

REPORTING METHOD

The 27-item Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Giving nurses a voice through 'listening to staff' conversations to inform nurse retention and reduce turnover

Health and social care employers in the UK cannot afford to lose nurses given the current nursing workforce crisis. A variety of staff engagement initiatives aim to improve employee retention. This article describes how Listening to Staff (L2S) events were used as part of a service review to inform nurse retention strategies in one acute hospital trust. Over a 3-year period, 576 nurses took part in L2S events that examined nurses' perspectives of teamworking and support as well as career plans in areas with high nurse turnover rates. Comparative content analysis was used to analyse narrative data, which informed managers' retention plans. Examination of retention data before and after L2S events showed nursing turnover decreased, suggesting a variety of strategies to retain staff may have improved nurse retention. Findings imply capturing nurses' perceptions through staff engagement events may offer solutions for nurse retention.

Compliance with Recommendations on Work Schedule for Shift Nurses in South Korea

Background

A well-designed shift schedule has been reported to have a positive effect on improving health problems associated with shift work. This study aimed to identify compliance with the 17 recommendations on work schedule (WSRs) for shift nurses and related factors.

Methods

The descriptive study was conducted with 182 nurses who worked in three shifts for more than 1 year at superior general and general hospitals in three regions. Data were collected with self-administered questionnaire and 13-week work schedule tables, and analyzed with both person- and cycle-based compliance.

Results

Person-based compliance was 11.77 among 17 items in total. However, no one completely complied with WSRs of “no work on weekends” and which showed the lowest cycle-based compliance (22.3%). Compliance with some WSRs was related to hospital type, proportion of nurses in school and having standards on work schedule at institutional level.

Conclusion

Compliance with WSRs of shift nurses in Korea is still unsatisfactory, and one day off after night shift and work on weekend are quite common. Hospitals should keep the standards on work schedule, monitor compliance with standards, and try to introduce modified shift systems to improve the current problems.

Work-family conflict, health status and job satisfaction among nurses

OBJECTIVE

Research studies have demonstrated that nurses face difficulty balancing family roles and responsibilities with work. This study aimed to explore the relationship between work-family conflict and health status and job satisfaction among nurses.

METHODS

This was a cross-sectional study of 426 nurses working in high-dependency and general settings in a large referral hospital in Brunei Darussalam.

RESULTS

Work-family conflict inversely affects health status and job satisfaction for nurses working in high-dependency and general settings. However, general nurses experienced higher work-family conflict albeit better job satisfaction and health status compared to high-dependency nurses. Older, single and non-smoker nurses reported higher job satisfaction.

CONCLUSION

This study further informs healthcare and nursing administrators and policymakers, who should foster effective strategies and interventions to support the balance of nurses' work and family life.

Staff unavailability and safe staffing: are headroom allowances 'realistic'?

BACKGROUND

'Hours per patient day' (HPPD) is an internationally recognised resourcing metric used to measure direct nursing care hours. However, hospitals often underestimate indirect time (unavailability) and specify unrealistic targets for planned unavailability ('headroom').

AIMS

To investigate the disparities between planned unavailability ('headroom') and actual staff unavailability.

METHODS

Data were collected from the e-rostering systems of 87 NHS trusts. This was compared with published data from 35 roster policies.

RESULTS

Many hospitals use headroom as a key performance indicator (KPI) and set targets for its components in their roster policies. This research highlights large variations in unavailability (15.8% to 33.6%) and lower variations in headroom (16-26%).

CONCLUSION

Hospitals operationalise headroom around an idealised 'target' value. This may be detrimental. Compelling a unit with unavailability of between 28% and 30% to adopt an institution-wide headroom of 22% (for example) may, at best, increase spending on bank/agency staff, or, at worse, jeopardise patient safety.

NHS managers’ use of nursing workforce planning and deployment technologies: a realist synthesis

Background

Policy and reviews of health-care safety and quality emphasise the role of NHS managers in ensuring safe, good-quality patient care through effective staffing. Guidance requires that NHS managers combine professional judgement with evidence-based workforce planning and deployment tools and technologies (WPTs). Evidence has focused on the effectiveness of WPTs, but little is known about supporting their implementation, or the impact of using WPTs across settings.

Objectives

The review answered the following question: ‘NHS managers’ use of workforce planning and deployment technologies and their impacts on nursing staffing and patient care: what works, for whom, how and in what circumstances?’.

Design

A realist synthesis was conducted. A programme theory was formulated and expressed as hypotheses in the form of context, mechanisms and outcomes; this considered how, through using WPTs, particular conditions produced responses to generate outcomes. There were four phases: (1) development of a theoretical territory to understand nurse workforce planning and deployment complexity, resulting in an initial programme theory; (2) retrieval, review and synthesis of evidence, guided by the programme theory; (3) testing and refinement of the programme theory for practical application; and (4) actionable recommendations to support NHS managers in the implementation of WPTs for safe staffing.

Participants

NHS managers, patient and public representatives and policy experts informed the programme theory in phase 1, which was validated in interviews with 10 NHS managers. In phase 3, 11 NHS managers were interviewed to refine the programme theory.

Results

Workforce planning and deployment tools and technologies can be characterised functionally by their ability to summarise and aggregate staffing information, communicate about staffing, allocate staff and facilitate compliance with standards and quality assurance. NHS managers need to combine local knowledge and professional judgement with data from WPTs for effective staffing decisions. WPTs are used in a complex workforce system in which proximal factors (e.g. the workforce satisfaction with staffing) can influence distal factors (e.g. organisational reputation and potential staff recruitment). The system comprises multiple organisational strategies (e.g. professional and financial), which may (or may not) align around effective staffing. The positive impact of WPTs can include ensuring that staff are allocated effectively, promoting the patient safety agenda within an organisation, learning through comparison about ‘what works’ in effective staffing and having greater influence in staffing work. WPTs appear to have a positive impact when they visibly integrate data on needs and resources and when there is technical and leadership support. A collaborative process appears to be best for developing and implementing WPTs, so that they are fit for purpose.

Limitations

The evidence, predominantly from acute care, often lacked detail on how managers applied professional judgement to WPTs for staffing decisions. The evidence lacked specificity about how managers develop skills on communicating staffing decisions to patients and the public.

Conclusions and recommendations

The synthesis produced initial explanations of the use and impact of WPTs for decision-making and what works to support NHS managers to use these effectively. It is suggested that future research should further evaluate the programme theory.

Study registration

This study is registered as PROSPERO CRD42016038132.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Does longer roster lead-time reduce temporary staff usage? A regression analysis of e-rostering data from 77 hospital units

AIMS

Use of temporary nursing staff is contentious and expensive. Using e-rostering data from 77 hospital units, this research investigates whether longer roster lead-times reduce temporary staff usage.

BACKGROUND

It is commonly assumed that longer roster approval lead-times, the time from when a roster is approved, to when it is worked, result in better, more cost-effective rosters. Consequently, many hospitals target lead-times of 6 weeks, a figure recommended for the UK National Health Service in a recent governmental review. This contrasts with the minimum lead-time advocated by New South Wales Ministry of Health, which advises a shorter lead-time of 2 weeks. Using data from 77 hospital units, this paper explores this assumed relationship.

DESIGN

Using data extracted from the e-rostering system of an NHS Acute Foundation Trust, this study uses linear regression analysis to explore the relationship between roster approval lead-time and temporary staff usage. The data were captured over a period of 9 months from 15 February 2016-23 October 2016, a total of 693 rosters.

RESULTS/FINDINGS

This research suggests that late roster approval may contribute to as much as 37% of temporary staff usage, while approval 4-6 weeks prior to the roster being worked reduces this to approximately 15%. However, this is only relevant under specific conditions. Importantly, this should be considered before mandating lead-times across all units.

CONCLUSIONS

This research implies that the optimum approval lead-time lies between 4-6 weeks; however, given other challenges, achieving this in practice may prove difficult.

e-Roster policy: Insights and implications of codifying nurse scheduling

Following a decade of dissemination, particularly within the British National Health Service, electronic rostering systems were recently endorsed within the Carter Review. However, electronic rostering necessitates the formal codification of the roster process. This research investigates that codification through the lens of the 'Roster Policy', a formal document specifying the rules and procedures used to prepare staff rosters. This study is based upon analysis of 27 publicly available policies, each approved within a 4-year period from January 2010 to July 2014. This research finds that, at an executive level, codified knowledge is used as a proxy for the common language and experience otherwise acquired on a ward through everyday interaction, while at ward level, the nurse rostering problem continues to resist all efforts at simplification. Ultimately, it is imperative that executives recognise that electronic rostering is not a silver bullet and that information from such systems requires careful interpretation and circumspection.