Creating Coherence-Based Nurse Planning in the Perinatology Care System.

The combination of increasing demand and a shortage of nurses puts pressure on hospital care systems to use their current volume of resources more efficiently and effectively. This study focused on gaining insight into how nurses can be assigned to units in a perinatology care system to balance patient demand with the available nurses. Discrete event simulation was used to evaluate the what-if analysis of nurse flexibility strategies and care system configurations from a case study of the Perinatology Care System at Radboud University Medical Center in Nijmegen, the Netherlands. Decisions to exercise nurse flexibility strategies to solve supply-demand mismatches were made by considering the entire patient care trajectory perspective, as they necessitate a coherence perspective (i.e., taking the interdependency between departments into account). The study results showed that in the current care system configuration, where care is delivered in six independent units, implementing a nurse flexibility strategy based on skill requirements was the best solution, averaging two fewer under-/overstaffed nurses per shift in the care system. However, exercising flexibility below or above a certain limit did not substantially improve the performance of the system. To meet the actual demand in the studied setting (70 beds), the ideal range of flexibility was between 7% and 20% of scheduled nurses per shift. When the care system was configured differently (i.e., into two large departments or pooling units into one large department), supply-demand mismatches were also minimized without having to implement any of the three nurse flexibility strategies mentioned in this study. These results provide insights into the possible solutions that can be implemented to deal with nurse shortages, given that these shortages could potentially worsen in the coming years.