Nurse-Centered Shift Planning

A shift planning approach focused on nurses’ well-being and fairness.

Shift work causes many problems in the lives of nurses. It leads to several health issues, such as insomnia, digestive problems, and burnout. In addition, shift work disturbs nurses’ social life. They often have to work on weekends or public holidays, when other people spend time with friends and family. I have worked myself in such a setting for a year, which gave me a glimpse into the everyday reality of nurses.

Previous research indicated that some of these negative effects can be avoided if we give nurses more control in shift planning, so they can better integrate their work and leisure times. This can have positive effects, but often at the cost of efficiency. Many systems that give nurses more control rely on mostly manual planning. In contrast, automatic, computer-based approaches can be more efficient, but they usually exclude nurses from planning. So in the past, healthcare teams had to choose between either nurse control or efficiency. They could not have both.

In the “GamOR” project, we developed a nurse-centered shift planning system to combine the two. Our design process was focused on maintaining or increasing nurses’ subjective well-being and fairness in a computer-supported planning system. Most of my research focused on understanding the nurse perspective in specific planning situations. Computer support was only integrated where it seemed meaningful and did not interfere with the primary goals: well-being and fairness.

We have described the overall process in detail in one of our publications. But briefly put, in our nurse-centered shift planning approach, nurses can submit “wishes” for free shifts that are directly integrated in the shift plan. Unlike in other systems, however, they are not considered as “suggestions”, but as top priority requirements. Of course, sometimes not all wishes can be integrated, for example on Christmas or other unpopular shifts where many nurses want time off. In such cases, our system relies on a direct, in-person negotiation process between everyone involved. This way nurses have all the flexibility to find a workable solution that we directly include in the shift plan. Everything else, such as all wishes that do not collide, and days without wishes, are planned automatically. This reduces nurses’ workload.

This partially manual process acknowledges three findings from our research. First, nurses want to be involved in the decision-making about their schedules, which means that such important decisions should not be fully automated. Second, nurses can find manual solutions that in some cases have higher quality than everything a computer can find automatically. And third, it assures that nurses agree on the solution. Automatic decisions that nurses’ do not agree with can cause other problems later on. The nurses may look for ways around a bad “official” plan. They may call in sick, make informal agreements among each other, or start to use the system in unintended ways. They may also be less willing to stay in their job much longer. In that sense, giving high priority to nurses’ needs and wishes makes sense not only from the worker perspective, but also for the management.

In contrast, the partial automation is also helpful. Nurses know that they work in shifts, and they accept some flexibility on regular days. Our findings indicate that they usually do not need to control every single shift in a month, but they care about certain shifts that are important to them. With our system, they have control about everything they consider important, but the rest is done automatically with all sorts of considerations (e.g., general preferences for morning/afternoon shifts, regular appointments such as sport clubs, individual contracts etc.).

Our nurse-centered shift planning system was a finalist for the UX Design Awards 2019. It led to several presentations and publications (see below), including my PhD Thesis. I currently continue to work on this project on the side in Japan.

Further Reading