Budgeting Costs of Nursing in a Hospital

Abstract

This paper examines issues in building decision support models for budgeting nursing workforce requirements in a hospital. We determine regular-time, overtime, and agency workforce levels for various skill classes in a budget cycle. We introduce a family of eight models ranging from a single-period, aggregate and deterministic model to a multiperiod, disaggregate and probabilistic model. In a single-period model, we ignore the time-varying nature of demand for nursing hours. Aggregation is done over the nurse skill class mix. For probabilistic models, we consider demand uncertainty. Using empirical data, we evaluate the effects of level of sophistication in model building and in information requirements on their relative performances. The results suggest that ignoring the time-varying nature of demand does not induce gross errors in budget estimates. However, ignoring demand uncertainty produces underestimates (about five to six percent) of budget needs—a consequence of a Madansky (Madansky, A. 1960. Inequalities for stochastic linear programming problem. Management Sci. 6 197–204.) inequality. It also induces added costs to the system due to implementing nonoptimal regular-time workforce levels. Finally, we find that a simple formula using a single-period demand estimate gives excellent approximations to the budget estimates obtainable from the more precise models.