Memorial Hospital is a 265-bed regional health care facility located in the mountains of western North Carolina. The mission of the hospital is to provide quality health care to the people of Ashe County and the six surrounding counties. To accomplish this mission, Memorial Hospital’s CEO has outlined three objectives: (1) maximize customer service to increase customer satisfaction, (2) minimize costs to remain competitive, and (3) minimize fluctuations in workforce levels to help stabilize area employment.
The hospital’s operations are segmented into eight major wards for the purposes of planning and scheduling the nursing staff. These wards are listed in Table 10.3, along with the number of beds, targeted patient-to-nurse ratios, and average patient census for each ward. The overall demand for hospital services remained relatively constant over the past few years even though the population of the seven counties served increased. This stable demand can be attributed to increased competition from other hospitals in the area and the rise in alternative health care delivery systems, such as health maintenance organizations (HMOs). However, demand for Memorial Hospital’s services does vary considerably by type of ward and time of year. Table 10.4 provides a historical monthly breakdown of the average daily patient census per ward. The director of nursing for Memorial Hospital is Darlene Fry. Each fall she confronts one of the most challenging aspects of her job: planning the nurse-staffing levels for the next calendar year. Although the average demand for nurses has remained relatively stable over the past couple of years, the
staffing plan usually changes because of changing work policies, changing pay structures, and temporary nurse availability and cost. With fall quickly approaching, Fry is collecting information to plan next year’s staffing levels. The nurses at Memorial Hospital work a regular schedule of four 10-hour days per week. The average regular-time pay across all nursing grades is $12.00 per hour. Overtime may be scheduled when necessary. However, because of the intensity of the demands placed on nurses, only a limited amount of overtime is permitted per week. Nurses may be scheduled for as many as 12 hours per day, for a maximum of 5 days per week. Overtime is compensated at a rate of $18.00 per hour. In periods of extremely high 

1. Explain the alternatives available to Darlene Fry as she develops a nurse-staffing plan for Memorial Hospital. How does each alternative plan meet the objective stated by the CEO?
2. Based on the data presented, develop a nurse-staffing plan for Memorial Hospital. Explain your rationale for this plan.

TABLE 10.3 WARD CAPACITY DATA Ward Number of Beds Patient Census" Patients per Nurse Intensive Care 20 10 25 Cardiac 4 15 4 Maternity 30 10 Pediatric 40 4 22 t Surgery 8 (T-F daily equivalent)* 5 (daily equivalent)* Post-Op 15 Emergency General 10 3 98 120 TABLE 10.4 AVERAGE DAILY PATIENT CENSUS PER MONTH MONTH Ward Intensive Care 13 10 6. 11 13 9. 10 12 14 Cardiac 13 14 13 12 15 18 16 15 12 13 18 20 13 13 Maternity 12 10 13 14 10 Pediatric 22 23 24 24 25 21 21 22 20 18 20 19 Surgery 20 18 22 21 17 18 17 16 16 18 20 22 10 8 9. Post-Opt Emergencyt 10 6. 10 7 10 8 4 3 6. 4 4 4 General 108 95 90 88 102 94 110 100 98 92 98 107 E