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BMC Med Inform Decis Mak. 2018 Jun 28;18(1):53. doi: 10.1186/s12911-018-0638-2.

A computational application for multi-skill nurse staffing in hospital units.

Author information

CMAF-CIO, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal.
Departamento de Informática, Faculdade de Ciências, Universidade de Lisboa, Bloco C6, Piso 3, 1749-016, Lisboa, Portugal.
ISEG and CMAF-CIO, Universidade de Lisboa, Lisbon, Portugal.
Pavilhão Pereira Filho, Santa Casa de Misericórdia Porto Alegre and Universidade Federal de Ciências da Saúde de Porto Alegre, Hospital São José, Porto Alegre, Brazil.
Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.



Approaches to nurse staffing are commonly concerned with determining the minimum number of care hours according to the illness severity of patients. However, there is a gap in the literature considering multi-skill and multi-shift nurse staffing. This study addresses nurse staffing per skill category, at a strategical decision level, by considering the organization of work in shifts and coping with variability in demand.


We developed a method to determine the nursing staff levels in a hospital, given the required patient assistance. This method relies on a new mathematical model for complying with the legislation and guidelines while minimizing salary costs. A spreadsheet-based tool was developed to embed the model and to allow simulating different scenarios and evaluating the impact of demand fluctuations, thus supporting decision-making on staff dimensioning.


Experiments were carried out considering real data from a Brazilian hospital unit. The results obtained by the model support the current total staff level in the unit under study. However, the distribution of staff among different skill categories revealed that the current real situation can be improved.


The method allows the determining of staff level per shift and skill depending on the mix of patients' illness severity. Hospital management is offered the possibility of optimizing the staff level using a spreadsheet, a tool most managers are familiar with. In addition, it is possible to evaluate the implications of decisions on workforce dimensioning by simulating different demand scenarios. This tool can be easily adapted to other hospitals, using local rules and legislation.


Decision support; Multi-skill staffing; Nurse staffing; Shift work; Spreadsheet staffing model

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