Cost-effectiveness of clustered unit vs. unclustered nurse floating

This study evaluated costs and staffing balance outcomes comparing unrestricted unit floating (UUF) with cluster [by related patient population or technical requirements] unit floating (CUF) practices. Researchers used a computer simulation model with data from a 400 bed VA hospital. Literature suggested a high nurse turnover rate associated with dissatisfaction engendered by forced floating to unfamiliar units. Direct wage cost differences were negligible when UUF and CUF floating patterns were compared, so absolute costs were not the defining issue. UUF staffing patterns produced significantly fewer understaffed shifts (by nursing hours) than CUF floating permitted. The essential quality of care trade-off is between the UUF pattern that provided sufficient nursing hours of care vs. the CUF pattern that provided less absolute availability in hours of nursing care, but a better oriented staff. The author suggests seeking staff input when deciding which of these two floating patterns would be most acceptable in a particular institution.