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CASE

MEMORIAL HOSPITAL

Memorial Hospital is a 265-bed regional health care facility 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 Hospitals
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 hospitals 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 relatively 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
Hospitals 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 challenging 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 structures, and temporary nurse availability and cost. With fall
quickly approaching, Fry has begun to collect information
to plan next years staffing levels.

The nurses at Memorial Hospital work a regular schedule of four 10-hour days per week. The average regulartime 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 compensated 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 hospitals objective of
maintaining a level workforce.

TABLE C11.1 Ward Capacity Data

WARD

NUMBER OF BEDS

PATIENTS PER NURSE

Intensive care
Cardiac
Maternity
Pediatric
Surgery
Post op
Emergency
General

20
25
30
40
5
15
10
120

2
4
4
4

5
3
8

PATIENT CENSUS*

10
15
10
22

8 (TF daily equivalent)

5 (daily equivalent)
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 operating 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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TABLE C11.2 Average Daily Patient Census per Month

MONTH
WARD

Intensive care
Cardiac
Maternity
Pediatric
Surgery*
Post op
Emergency
General

13
18
8
22
20
10
6
110

10
16
8
23
18
8
4
108

8
15
12
24
18
7
4
100

7
13
13
24
17
7
7
98

7
14
10
25
16
6
8
95

6
12
8
21
16
6
5
90

11
13
13
22
22
10
5
88

13
12
13
20
21
10
4
92

9
13
14
18
17
7
4
98

10
15
10
20
18
8
3
102

12
18
8
21
20
9
4
107

14
20
7
19
22
10
6
94

* Average surgeries per day.

Daily equivalents.

After looking over the information that she has collected, 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.

2. Based on the data presented, develop a nurse staffing

plan for Memorial Hospital. Explain your rationale for
this plan.

Questions
1. Explain the alternatives available to Darlene Fry as she
develops a nurse staffing plan for Memorial Hospital.
How does each meet the objectives stated by the CEO?

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