Identifying good nursing levels: A queuing approach

Natalia Yankovic*, Linda V. Green

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

89 Scopus citations


Nursing care is arguably the single biggest factor in both the cost of hospital care and patient satisfaction. Inadequate inpatient nursing levels have also been cited as a significant factor in medical errors and emergency room overcrowding. Yet, there is widespread dissatisfaction with the current methods of determining nurse staffing levels, including the most common one of using minimum nurse-to-patient ratios. In this paper, we represent the nursing system as a variable finitesource queuing model. We develop a reliable, tractable, easily parameterized two-dimensional model to approximate the actual interdependent dynamics of bed occupancy levels and demands for nursing. We use this model to show how unit size, nursing intensity, occupancy levels, and unit length-of-stay affect the impact of nursing levels on performance and thus how inflexible nurse-to-patient ratios can lead to either understaffing or overstaffing. The model is also useful for estimating the impact of nurse staffing levels on emergency department overcrowding.

Original languageEnglish
Pages (from-to)942-955
Number of pages14
JournalOperations Research
Issue number4
StatePublished - Jul 2011
Externally publishedYes


  • Emergency room overcrowding
  • Finite capacity model
  • Hospital applications
  • Nurse staffing
  • Queueing model


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