The nurse rostering problem : from operational research to organizational reality?

Aim - To examine the practical applicability of the ‘hard’ and ‘soft’ constraints associated with the ‘nurse rostering problem’ as defined in operations management research literature and thereby investigate the objectivity of the rostering process. Background - In practice, rostering nursing staff is often unrecognized, unrewarded and undervalued; yet, despite four decades of research, operations management has little to offer in terms of faster, safer, fairer or more effective rosters. This paper contrasts the theoretical perceptions of roster ‘constraints’ with the subjective, often political, rules governing practical rosters. Design - Using both qualitative and quantitative data, this inductive study compares the practical process of rostering with that theorized in the nurse rostering problem. Methods - This research spanned 4 years examining the rosters from 28 wards in 14 hospitals. Interviews with senior nursing staff regarding staff levels and with ward managers regarding rules defining the roster were complemented by analysis of actual roster data to establish the number and type of unfilled shifts and rule breakages. Interviews were analysed using thematic content analysis and roster data were evaluated using the HealthRoster™ e-rostering system. Findings - Often the rules governing how nursing staff are scheduled are undocumented, tacit and informal. Furthermore, the roster process can be highly politicized, leading to forms of ‘information anarchy’ or ‘information feudalism’ on the ward. Conclusions - Hospital managers must understand that roster design has a major impact on ward performance and must develop clear roster policies that define staff levels, skill mix, shift patterns and the rules used in preparing the roster.