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Computerized Self-Scheduling Tool for Nurses

Monday October 2, 2000
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If you've ever worked on a unit's staff schedule, you're probably familiar with the usual complaints heard from nurses - "that's the fifth Friday night I've worked in the last two months; I simply can't rotate from nights to days without at least two days off."
This was the case on my unit in a large teaching hospital in East Baltimore, MD. In search of a solution to our scheduling dilemma, my unit turned to technology. In the process, we became involved in the development of the Nightingale Nursing Information System.
The Scheduling Nightmare
The monthly process of manually generating an equitable schedule for a staff of 50 clinical professionals had become unmanageable. We were spending nearly 40 hours of clinical nursing resources just to create a schedule that rarely met the needs of our unit or the desires of our employees. We were using expensive agency resources while our staff worked on scheduling itself.
With the strong job market enabling nurses and other clinical professionals to easily move from one employer to the next, managers need to do everything in their power to retain their staff. In this environment, self-scheduling has become as common an employee benefit as health insurance or paid leave.
Nursing literature backs up the claim that effectively implemented self-scheduling programs reduce turnover. However, it is very difficult to implement an effective self-scheduling process. Manually balancing staff requests with the coverage needs of the unit is a nearly impossible task. The scheduler must inherently know his or her staff's qualifications, personal needs, contract or labor laws, and last minute preferences.
Searching for Scheduling Solutions
To increase staff satisfaction and to reduce the time spent away from patient care, we searched for a solution. We examined scheduling software packages available on the market, but we couldn't find a software solution that managed online self-scheduling, or a product that was flexible enough to meet the individual unit's or staff member's scheduling requirements. With a limited budget, we turned to a local software company and proposed a joint development project for the Nightingale Nursing Information System, a program that would address our unique operational challenges.
While our software partner was an expert in creating systems to solve challenging business problems, they knew very little about clinical staff scheduling. As the functional experts for this project, it was the nurse's responsibility to educate the developers. The software company began by interviewing nurse managers, schedule coordinators, nurse educators, and staff nurses throughout the hospital. During this phase, they gathered requirements for the system from the most general to the most intricate details of the scheduling process.
The nursing staff reviewed the detailed "requirements document" - much like a homebuyer would review a blueprint before approving the construction of a house. The programmers visited us regularly during development in order to collect feedback from us as to the system's functionality and ease-of-use. By reviewing their progress regularly, we were able to effectively influence the design of the system. Within six months, the initial version of the software was complete and installed in our unit for live beta testing.
Nightingale - Nuts and Bolts
Over the three years since beta testing began, Nightingale has become a valuable nursing tool, expanding its functionality to include the related tasks of staff scheduling, credential tracking, and payroll reporting. As always, nurses continue to be an essential part of the developmental process.
Staff Scheduling. To make staff scheduling as much of a win-win experience as possible, we match the vacant shifts with personnel available to work. As staff coordinator, my first task is to tell the system everything about the vacant shifts I need to fill. I use the Nightingale "shift profile" window to do this - specifying the required qualifications, time periods, and payroll hours for each shift. Next I use the "staff profile" window to enter information about each staff member, including their weekly rotations, qualifications, regularly scheduled shifts, recurring conflicts, and hour rules.
Once the system is configured, I can create a new schedule for any time period and open it to the staff for self-scheduling. Nurses and other clinical employees on the unit then log in to Nightingale to enter their preferences into their own personal calendar. With the latest version of Nightingale, they can do this at home through the Internet.
After all the preferences have been collected, the system generates a staff schedule in just a few seconds, following the rules that I have specified for my unit. I can then easily make adjustments to the schedule using a variety of tools available to me and produce reports to display the schedule in a variety of formats.
Credential Tracking. Classes that I schedule for employees are automatically recorded in the Credential Tracking component of Nightingale. This eliminates the duplication of effort that we once encountered. Staff members may also edit their professional credentials and managers may approve training and verify licenses to provide an audit trail for the accreditation process. The system will also generate automatic e-mails to warn staff members as credentials near expiration.
Payroll Submission. Nightingale automatically translates the shift codes that we use into base pay and premium hours. It also provides several mechanisms for easily modifying these numbers as staff members work hours that do not match their schedules.
Simpler Schedules - Happy Nurses
With Nightingale, we have reduced the amount of time it takes to create a schedule by approximately two-thirds. Doing the weekly payroll report nowadays takes minutes instead of hours. The credential tracking component has improved compliance with JCAHO guidelines. Most importantly, Nightingale's scheduling capabilities have restored the perception of fairness to the scheduling process and helped us more efficiently and equitably staff our unit.
The influence of nursing on the design of Nightingale has made this a powerful tool for healthcare settings. Because of our input, only a quick demonstration is necessary to show the utility of Nightingale to other nurses. Nightingale was recently selected for installation throughout the hospital and is now being utilized in a variety of healthcare settings.