Unit managers between fluctuating demand and fixed staffing: a quantitative study in psychiatric nursing.

Area of Science:

• Healthcare Management
• Nursing Workforce Studies
• Psychiatric Care Operations

Background:

• Nurse staffing and patient demand balance is a persistent challenge in inpatient care, particularly in psychiatric settings where demand variability complicates fixed staffing.
• Limited staffing flexibility and fixed rosters struggle to accommodate fluctuating patient needs in psychiatric hospitals.

Purpose of the Study:

• To quantify temporal variations in unit capacity utilization in psychiatric inpatient care.
• To explore how unit managers respond to demand fluctuations and their perceptions of flexible working arrangements.

Main Methods:

• Combined routine inpatient data from 116 units across 13 Swiss psychiatric hospitals with a survey of unit managers.
• Analyzed temporal variability in capacity utilization using routine data and assessed management strategies and attitudes toward flexibility via survey.

Main Results:

• Substantial temporal fluctuations in occupancy were observed across psychiatric inpatient units.
• Unit managers primarily used individual nurse-level adjustments (e.g., overtime) to manage demand, rarely employing structural strategies like transfers or bed closures.
• Flexible working arrangements were viewed positively for nurse retention but challenging to implement in shift-based settings.

Conclusions:

• Psychiatric inpatient care faces difficulties aligning fluctuating demand with stable staffing systems, relying on reactive measures that impact staff and potentially patient care.
• Underutilized structural flexibility and reactive staffing strategies strain nurses and compromise treatment continuity and safety.
• Future research and organizational efforts should focus on data-driven tools for workload prediction, flexible staffing interventions, and enhanced staff well-being and workforce planning.