Implementation of A Self-Scheduling System For Hospital Nurses: Guidelines and Pitfalls
Implementation of A Self-Scheduling System For Hospital Nurses: Guidelines and Pitfalls
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Table of Contents
Abstract
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Questionnaires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Table 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Table 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Table 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Appendix I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
Appendix II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
Appendix IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
© 2005. Lotte Bailyn, Robin Collins, Yang Song. All rights reserved. This paper is for the
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Abstract
Implementation of a Self-Scheduling System for Hospital Nurses: Guidelines and Pitfalls
Aim
To describe a model of self-scheduling by hospital nurses and the difficulties involved in imple-
mentation.
Background
A self-scheduling program was implemented on one nursing floor for a year. The researchers
encountered pitfalls that are not covered in current self-scheduling research literature. A number
of modifications were made, which are detailed.
Findings
While the nurse manager relayed the directions of the self-scheduling program to the nurses,
some did not adhere to the rules of the program, which caused tension and stress for the
manager and the nurses alike. Although self-scheduling did increase morale and gave nurses
more control over their personal schedules and enhanced their ability to give good patient care,
the attempt floundered.
Conclusion
Self-scheduling can be used positively to offer nurses more control over their schedules and to
enhance patient care. But if nurses see this as an individual entitlement instead of a balance
between individual and unit benefit, everyone loses. Miscommunication of rules and lack of
adherence to self-scheduling guidelines can bring forth mixed feelings of tension and anxiety to
the nurse manager as well as the nursing staff.
Introduction
The idea of self-scheduling is not a new one and was first documented in 1963 by
Jenkinson, who initiated a self-scheduling program at St. George’s Hospital in London (Hung
2002). Most present literature on self-scheduling agrees to its benefits including some of the
1) Empowering nursing staff and increasing their control to balance their personal and
schooling
2) Increasing predictability and flexibility of the nursing schedule and at the same
However, in some cases, unfavorable conditions might develop such as complaints of peer
pressure, favoritism and unavailability of staff (Teahan 1998). Under these circumstances one
suggests, the nursing staff must participate in each aspect of the change to self-scheduling in
One particular suggestion that several literature state is to make a guideline early on in
the implementation process. The best idea would be to draft a guideline at one of the first
committee meetings and have relevant short- and long-term goals developed immediately after
in order to keep the focus of the self-scheduling concept (Beltzhoover 1994). Furthermore,
implementation should not be rushed and should be explained carefully and thoroughly to the
staff.
The staff should agree to further detailed guidelines to determine the number of days the
staff has to fill in the requested shift. Also, maximum and/or consecutive shifts should be set at
use of a computerized rostering system mentioned in Ball’s article “Shifting the control” (1997).
Nurses would first enter the hours they wished to work into a time rostering software system,
the computer program would then process their requested shift times and produce a ‘best-fit’
schedule, which would incorporate as many of the desired shifts as possible. The rostering
software system also rated each hour on the nursing schedule according to popularity. Nurses
who chose to work the unpopular hours were awarded with high scores. The nurses with the
highest scores were the ones least likely to have to work any unfulfilled hours in the schedule,
Before the implementation of the self-schedule, the nursing staff should attend a unit
meeting to clarify the rules and guidelines that perhaps are unfamiliar. Surveys in some self-
scheduling implementations have shown that nurses would have liked more preparation on the
topic, underlining the enormity of the cultural shift that is involved in introducing a change to
Method
The unit consists of 70 RNs who oversee 31 total beds, of which 12 are step-down beds
that require extra patient care from the TICU nurses. The signup sheet that the nurse manager
prepares lists all the nurses down the column and 28 days across the top. In each cell there is a
letter corresponding to the shift of that nurse on that day, or whether she is on vacation or on a
day for education, jury duty, or whatever. Nurses on fixed schedules (some of the senior ones)
would always be assigned to the same times. Other nurses knew the overall pattern of their
schedule (e.g. 3 12-hour days or 2 12-hour and 2 8-hour days per week), but did not know on
which specific days these shifts would fall. There were guidelines about Fridays and
evening/night rotations, depending on seniority, based on union contract. These guidelines are
shown in Appendix I. The schedule gets posted one month in advance of the starting day. If
Our first attempt was to duplicate this format in the self-scheduling mode. But this
turned out to be unworkable, since it was not clear when a full roster for any particular time
period was met. We tried keeping track by both addition and subtraction, but without success.
We then devised the format shown in Appendix II. Into this template, the nurse manager
entered the fixed schedules, therefore showing clearly where there are places available. In order
to give everyone a chance to sign up early, the nurses were divided into three groups, with each
group having a one-week period for sign up before the schedule was opened to the other groups.
(1984).
Findings
During the time of the self-scheduling experiment from January 4, 2004 to January 1,
2005, we closely monitored the number of change requests and sick calls, as well as the
annoyance level and hours spent on scheduling by the nurse manager. These data are shown in
Appendix III. We also received feedback and comments about the self-scheduling program and
its progress through four questionnaires that were distributed as the program went on.
The number of change requests decreased dramatically after the first month of the self-
scheduling implementation but then reverted somewhat but generally decreasing except for the
last two months in the year due to the scheduling of Thanksgiving and Christmas (see Table 1).
While the number of change requests decreased over time, the number of sick calls per
We also recorded the time the nurse manager used to make the monthly nursing
schedules. Compared to her annoyance, the time spent on the schedule decreased while her
annoyance eventually rose (taken into account the annoyance level of scheduling nurses to work
frustrated at the miscommunication between the nursing staff and herself. Several nurses did
not follow the directions laid out in the self-scheduling program, including sign-up times and
shift restrictions. Some of the nursing staff did not fully understand that self-scheduling did not
provide guaranteed times for nurses to work but rather allowed for more control and flexibility
in one’s schedule. But it could only reap these benefits if everyone followed the guidelines.
Questionnaires
Four questionnaires were handed out during the year, the first one before the experiment
started. The responses from the questionnaires guided the researchers in determining the
Table 3):
1) Nurses’ reported need for control and flexibility both decreased gradually as the
2) At the same time self-scheduling gave the nurses more time to spend with their
families as well as providing what they felt was better patient care.
In addition to the questions, comments provided by the nursing staff on the benefits and
problems of self-scheduling are useful. Here are some of the benefits that were commented on:
“I don’t like day/night rotation but love self-scheduling because it gives
me the best opportunity/chance to get a good schedule as am/pm
scheduling.”
“Better than someone making schedule; gives you options for day off and
some flexibility.”
Nearly all the nurses commented that self-scheduling offered them more flexibility at the
workplace. However some comments were more cautious, stipulating conditions on self-
“Good: Being able to schedule days off for more events, doctors appoint-
ments, etc. without filling request forms is good – scheduling myself to
work days that fit my life (like every Friday) and not worry about
protocol. Bad: When the shift you scheduled yourself for has to change to
meet staffing needs.”
“I do not like the fact that others can sign up before you if you are not
scheduled to work for a while when the new sheets come out. It should be
on a rotating basis.”
“I have been able to pick the shifts/days off I want but the schedule I
choose compared to the final schedule is completely different. This is
very frustrating. I will be paying closer attention to my schedule in the
future and requesting the final schedule reflect what I request.”
would insert their names, even though a particular time period was already full, and leave large
shifts without realizing the consequences or sign up for more shifts than they were scheduled to
work. When the nurse manager then shifted people around in order to fulfill the staffing needs,
they became annoyed that their wishes were not honored. In the end the nurse manager stopped
the experiment.
In a follow-up two months after the experiment ended, we asked the nurses how they felt
about self-scheduling. In the 10 nurses that we questioned, we found that 7 of them were
indeed sorry that self-scheduling ended. They liked the control and freedom in their personal
lives that self-scheduling allowed. However, if a nurse was in the third and last group to sign
up for the schedule or just got back from vacation, the nurse became frustrated at the choice
selection of shifts left over. On the other hand, the nurses did acknowledge that the three groups
rotated for the sign up schedule, making the process the fairest possible.
We also asked why the nurses thought that self-scheduling did not work in this particular
case. The answers were quite interesting and varied. Some believed the only reason that self-
scheduling did not work was because it created too much work for the nurse manager. Others
believed that a few nurses were ruining self-scheduling for everyone, that is, a few nurses did
not follow the rules as they were supposed to. Furthermore, one nurse commented that the
nurses who did not follow the sign up rules thought they could get the best schedule and try to
“slide by” the nurse manager. This perception that only a few occasionally broke the rules does
not agree with what actually happened. The ending of this experiment is not because only a few
To understand what happened one has to consider what underlies such an experiment. It
means bringing together the needs of the individual nurses with the needs of the unit to the
benefit of both. The data that show that both nurses’ personal lives and their patient care
improved with self-scheduling show the advantage of such an approach. But it is necessary,
also, that everyone keeps both sides – both the individual employee and the need of the unit –
continuously in mind; what has been called a dual agenda (Rapoport et al., 2002) must be
ignored by the nurses who put their personal needs ahead of unit requirements. They began to
see the schedules they signed up for as an entitlement, not as one part of a joint agreement to
enhance both their lives and the functioning of the floor. And thus the experiment was stopped
and everyone lost. They lost some of the control they had over their own time, which they had
valued highly, and the benefits of self-scheduling – e.g. bringing nurses together, easing the
burden of the nurse manager, enhancing morale and patient care – were lost.
Why this happened in this case is difficult to say. Because of the pressures of the work
on this floor it was not possible to get all the nurses together to plan the experiment. The
researchers met in individual groups with some of the nurses, but this may not have been
sufficient. Also this was a large roster of nurses – more than 70 – and most successful
experiments in the literature had been done with many fewer nurses. Finally, the nurse manager
felt that perhaps the union environment made nurses more conscious of their particular duties
and hence felt that the kind of cooperation needed to make this work was beyond their duties. It
should be said, however, that the union representatives approved of the experiment.
accrue both to the nurses and to the patient care of the unit. But to make it work it requires
collective commitment to both sides of the dual agenda. Engaging such commitment in a large
unit is not easy, as this example shows. Although the nurse manager continuously inquired
about the progress and adaptation of self-scheduling throughout the experimental period via
regular emails, staff meetings, and impromptu discussions on the floor, in retrospect, we
probably should have spent more time with more of the nurses even before starting the
experiment.
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Scheduling Guidelines
I – Number of Nurses
Sunday
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Evening 3 6 5
Night 3 6 4
2 Fridays/month
III – Rotation
*Nurse Manager’s annoyance level was 10 if taken into account for scheduling around the
holiday season.
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schedul e my ti me per sonal and f ami l y needs my schedul e me to gi ve good pati ent car e condi ti ons of my cur r ent j ob
Quest ion
Phillips, H., and Brunke, L. (1990). “Self-scheduling helps nurses balance their personal &
professional lives.” RNABC News (Jul-Aug): 15-16.
Rapoport, R., Bailyn, L, Fletcher, J.K., and Pruitt, B.H. (2002). Beyond Work-Family Balance:
Advancing Gender Equity and Workplace Performance (San Francisco: Jossey-Bass).