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Health Policy Institute wins grant to study nurse scheduling

Better timing of surgeries may soften pain of nursing shortage

Eugene Litvak, SMG professor of health care and operations management and MVP director

On May 24, after a decadelong struggle, the Massachusetts House of Representatives voted to pass a bill requiring the state to set a limit on the number of patients that a single nurse can care for. The bill, which must be approved by the state Senate to become law, follows a path set by California and watched carefully by legislatures in several states, all of which are grappling with legal remedies for the growing nationwide shortage of nurses. At the same time, researchers at Boston University are hoping that some of the pain of the nursing shortage can be relieved by more carefully planned scheduling of elective surgeries, which often require the assistance of many nurses.

The University’s Health Policy Institute Program for Management of Variability in Health Care Delivery (MVP) recently received a $290,000 grant from the Robert Wood Johnson Foundation to study the effect that scheduling elective surgeries has on nurse staffing and quality of patient care. The aim of the study is to prevent peaks in nurse-to-patient ratios from occurring by making the patient intake process more efficient.

“The ratio of nurses to patients has been one of the number-one health-care issues being debated in the legislature,” says Eugene Litvak, a School of Management professor of health care and operations management and MVP director, the lead investigator of the yearlong study. “We believe that peaks which put strain on nurses are driven by hospital scheduling, not by patients. What we’re hoping to do is smooth the process and prevent both overuse and waste in the utilization of nurses.”

The project, which will involve four hospitals around the country, is expected to shed light on whether variations in hospital admissions affect the care nurses are able to give patients and to what extent those variations are caused by scheduled elective admissions. BU researchers are convinced that unnecessary swings in patient admissions create a more stressful work environment for nurses, and a growing number of studies report that inadequate nurse staffing is associated with increased risks for patients. At the same time, efforts to hire more nurses are constrained by the limited supply of available nurses, making it more important than ever to increase the efficiency with which patients are admitted.

Peter Buerhaus, co–principal investigator of the project and senior associate dean of research at Vanderbilt University School of Nursing, which is participating in the study, says the research “is particularly important because we will concentrate on better understanding the factors that affect the demand for nurses and whether and how hospitals can better manage the workloads of nurses.”

The Management of Variability Program is widely recognized as a leader in the effort to demonstrate, promote, and advance the benefits of applying operations management and variability methodology to health care. Through its research and policy analysis, MVP has made substantial contributions to understanding how hospital emergency departments get overcrowded, and in linking the cost and quality of health care to how that care is delivered.