Integrating Nurse Preferences Into AI-Based Scheduling Systems: Qualitative Study.

Background: Nurse scheduling is a complex challenge in health care, impacting both patient care quality and nurse well-being. Traditional scheduling methods often fail to consider individual preferences, leading to dissatisfaction, burnout, and high turnover. Inadequate scheduling practices, including restricted autonomy and lack of transparency, can further reduce nurse morale and negatively affect patient outcomes. Research suggests that participative scheduling approaches incorporating nurse preferences can improve job satisfaction. Artificial intelligence (AI) and mathematical optimization methods, such as mixed-integer programming (MIP), constraint programming (CP), genetic programming (GP), and reinforcement learning (RL), offer potential solutions to optimize scheduling and address these challenges. Objective: This study aims to develop a framework for integrating nurses' preferences into AI-supported scheduling methods by gathering qualitative insights from nurses and supervisors and mapping these to mathematical and AI-based scheduling techniques. Methods: Focus group interviews were conducted with 21 participants (nurses, supervisors, and temporary staff) from Swiss health care institutions to understand experiences and preferences related to staff scheduling. Qualitative data were analyzed using open and axial coding to extract key themes. These themes were then mapped to AI methodologies, including MIP, CP, GP, and RL, based on their suitability to address identified scheduling challenges. Results: The study revealed key priorities in nurse scheduling. Fairness and participation were highlighted by 85% (18/21) of interview participants, emphasizing the need for transparent and inclusive scheduling. Flexibility and autonomy were preferred by 76% (16/21), favoring shift swaps and self-scheduling. AI expectations were mixed: 62% (13/21) saw potential for improved efficiency and fairness, while 38% (8/21) expressed concerns over reliability and loss of human oversight. Mapping to AI methods showed MIP as effective for fair shift allocation, CP for complex rule-based conditions, GP for handling unforeseen absences, and RL for dynamic schedule adaptation in hospital environments. A preliminary AI implementation of MIP in a training hospital unit (35 staff members) showed how to design a system from a mathematical perspective. Conclusions: AI-supported scheduling systems can significantly enhance fairness, transparency, and efficiency in nurse scheduling. However, concerns regarding AI reliability, adaptability to individual needs, and human oversight must be addressed. A hybrid approach integrating AI recommendations with human decision-making may be optimal. Future research should explore the broader implementation of AI-driven scheduling models and assess their impact on nurse satisfaction and patient outcomes over time.