Cyclical Nurse Scheduling

ITB J. Sci., Vol. 43 A, No.
3, 2011, 151-164 151

Received April 14
th
, 2010, Revised March 11
th
, 2011, Accepted for publication April 13
th
, 2011.
Copyright 2011 Published by LPPM ITB, ISSN: 1978-3043, DOI: 10.5614/itbj.sci.2011.43.3.1
A Cyclical Nurse Schedule Using Goal Programming
Ruzzakiah Jenal
1,*
, Wan Rosmanira Ismail
2
, Liong Choong Yeun
3
&
Ahmed Oughalime
4

1
School of Information Technology, Faculty of Science and Information Technology,
Universiti Kebangsaan Malaysia, Selangor, Malaysia
2,3,4
School of Mathematical Sciences, Faculty of Science and Technology,
Universiti Kebangsaan Malaysia, Selangor, Malaysia
*Corresponding author: ruzza@ftsm.ukm.my

Abstract. Scheduling is a very tedious task in organizations where duty is
around the clock. Constructing timetable for nurses in hospital is one of the
challenging jobs for the head nurse or nurse manager. It requires a lot of time to
spend for generating a good and fair timetable. Thus, in this study, we propose a
cyclical nurse scheduling model using a 0-1 goal programming that would help
the head nurse or nurse manager to have less effort on building new schedules
periodically. The proposed model satisfies the stated hospitals policies and the
nurses preferences. The result obtained from this model gives an optimal
solution where all goals are achieved. The model also provides an unbiased way
of scheduling the nurses and thus leads to an overall higher satisfaction and
fairness to the nurses and the hospital management.
Keywords: cyclical scheduling; goal programming; nurse scheduling.
1 Introduction
Scheduling problems are found in many different types of organizations and
industries including transportation, call centres, health care, protection and
emergency services, civic services and utilities, venue management, financial
services, hospitality and tourism, retail and manufacturing. This paper will
focus on the health care industry and in particular on nurse scheduling. Besides
nurse scheduling [1,2]; other scheduling in the health care industry includes the
physicians [3]; the emergency medicine residents [4]; and the master surgery
scheduling [5].
The nurse scheduling problem involves generating a schedule of working days
and days off for each nurse. The nurse scheduling is the most highly constrained
and difficult personnel scheduling problems. Scheduling is the process of
constructing work timetables for the staff so that an organisation can satisfy the
demands for their services. The people involved in developing schedules need
decision support tools to help provide the right employees at the right time and
at the right cost while achieving a high level of employee job satisfaction.
152 Ruzzakiah Jenal, et.al.
The study on nurse scheduling has been revised over 30 years ago. There are a
few approaches introduced by the past researchers in order to solve the nurse
scheduling problem such as using the mathematical programming, goal
programming, constraints programming, artificial intelligence, heuristics and
meta heuristics [6-8]. A goal programming is one of the techniques that has
been studied and used widely because of its capability to solve and seek the
optimum of multi objectives problem that occurred in nurse scheduling [3,4,8-
14]. It defines a target level for each objective or goal and relative priorities to
achieve these goals. This technique is flexible enough to cope with relative
ranking assigned to various goals.
The research on modelling nurse scheduling using goal programming has been
studied by Arthur & Ravidran [9] which focused on two phases. Phase 1 is to
assign the working days and days off for each nurse while phase 2 is to assign
the shift types of their working days. Arthur & Ravidran [9] limits the scope
with small set of constraints and restricts the problem dimensions with the size
of nurses is 4. Musa & Saxena [15] have used a 0-1 goal programming that
applied to one unit of a hospital with the considerations of the hospital policies
and nurses preferences. However, the complexity of the problem is rather low
with a two week planning period and just one single shift.
In Ozkarahan & Bailey [13], the nurse scheduling modelling showed the
flexibility of goal programming in handling various goals which fulfilled the
hospitals objectives and the nurses preferences. The problem defines three
basic goals and divides the work into two phases. The 0-1 goal programming
model in nurse scheduling has been applied in Berrada, et al. [11] with
administrative and union contract specifications has been considered as hard
constraints while work patterns and nurses preferences has been formulated as
soft constraints. The outcome shows satisfactory result by combining goal
programming approach and tabu search technique.
Azaiez & Al Sharif [10] and Wan Rosmanira, et al. [14] also used the 0-1 goal
programming approach with the considerations of hospitals objectives as hard
constraints and the nurses preferences as soft constraints to develop the
schedules. Both models solved by Azaiez & Al Sharif [10] and Wan Rosmanira,
et al. [14] are measured to execute reasonably well. Nevertheless, the models
limit to one off schedule where they have to build new schedule for each
planning period. The models are not the cyclical scheduling. Hence, in this
paper, the authors deal with the cyclical nurse scheduling problem with a 0-1
goal programming approach that includes several objectives or goals to achieve
subject to both several hard and soft constraints.
A Cyclical Nurse Schedule Using Goal Programming 153

There are few studies done in cyclical scheduling problem. A cyclic schedule
consists of a set of work patterns which is rotated among a group of workers
over a set of scheduling horizon. At the end of the scheduling horizon each
worker would have completed each pattern exactly once. Harvey and Kiragu
[16] presented a mathematical model for cyclic and non-cyclic scheduling of 12
hours shift nurses. The model is quite flexible and can accommodate a variety
of constraints. In spite of this, the model deals with small requirements which
are not appropriate to embed in real situations. Chan and Weil [12] studied the
context and the use of work cycles with various constraints to produce
timetables of up to 150 people. Therefore, this study is carried out to highlight
the new model of the nurse scheduling problem. A cyclical nurse scheduling
with multiple objectives and subject to various constraints is developed. The
schedule will rely on fairness among nurses and will consider nurses
preferences to maximize their satisfaction. This will help the nurses to provide
adequate quality of service.
2 Problem Descriptions
This work is catered in one ward that has 18 nurses with the number of nurses
required for morning shift is at least 4 nurses, evening shift is at least 4 nurses
and night shift is exactly 3 nurses. The planning period for the problem is 4-
week or 28 days with 3 different shifts. There are morning shift starting from 7
a.m. till 2 p.m. for 7 hours, evening shift starting from 2 p.m. till 9 p.m. for 7
hours, and night shift starting from 9 p.m. till 7 a.m. for 10 hours.
On the other hand, this work was focused on solving the cyclical nurse
scheduling problem. Thus, there is an adjustment to the planning period for the
problem. The length of the cyclical schedules for this problem is 21 days. As
the staff requirement per shift is homogenous, the minimum required number of
days to assign to each nurse is calculated as follows:
( ) Minimum Required Numberof Days MRND
number of nurses
number of consecutive night shift
staff requirement per night shift
| |
(
|
(
|
(
\ .
=

In this case, the number of nurses is 18 while the staff requirement per night
shift is 3 and the number of consecutive night shift is 3. Thus, MRND = 18/3(
3= 18. For ergonomic purposes, the schedule length would be measured in
weeks. Therefore, the schedule length chosen is 21 days (3 weeks) where a
nurse would have to work 3 consecutive night shifts twice in 3 weeks. The
cyclical schedules would however have the same set of constraints but with
small changes due to the new length of the schedule.
The model considers the hospitals objectives as the hard constraints which
must be satisfied and the nurses preferences as the soft constraints. The
schedules would satisfy the following objectives set by the management of the
hospital:
1. Each unit is covered by 3 shifts for 24 hours a day and 7 days a week.
2. Minimum staff level requirement must be satisfied.
3. Each nurse works at most one shift a day.
4. Avoid any isolated days patterns of off-on-off.
5. Each nurse must have three days off after having three consecutive night
shifts.
6. Each nurse works between 12 to 14 days per schedule.
7. Each nurse works not more than 6 consecutive days.
8. Evening shift constitutes at least 25% of total workload.
9. Morning shift constitutes at least 30% of total workload.

Meanwhile the nurses preferences are as follows:
1. Avoid working in an evening shift followed by a morning shift or a night
shift the next day.
2. Avoid working in a morning shift followed by an evening shift or a night
shift the next day.
3. Each nurse has at least one day off in one weekend.
4. All nurses have the same amount of total workload.
3 Formulations
The development of nurse scheduling model is based on the hospitals
objectives and the nurses preferences. The hospitals objectives are a set of
hard constraints that must be satisfied while the nurses preferences are a set of
soft constraints that may be violated. The model will attempt to minimize the
violations of the soft constraints.
The scheduling problem contains 13 sets of constraints. It is not expected
however that a feasible solution may be obtained while satisfying all sets of
constraints. Therefore, these sets are divided into two groups: one group
consists of sets of hard constraints that must be satisfied. The other group
consists of remaining sets of soft constraints, which if could not be fulfilled, the
model will reduce to at least the violations of these constraints. The hospitals
policies will be considered as hard constraints while the nurses preferences will
be considered as soft constraints.

3.1 Notations
The following notations are used to specify the model:
n = number of days in the schedule (n = 21)
m = number of nurses available for the unit of interest (m = 18)
i = index for days, i = 1n
k = index for nurses, k = 1m
P
i
= staff requirement for morning shift of day i, i = 1n
T
i
= staff requirement for evening shift of day i, i = 1n
M
i
= staff requirement for night shift of day i, i = 1n
3.2 Decision Variables
The decision variables are defined as follows:

3.3 Hard Constraints
The hard constraints of the formulation are given below.
Set 1: Minimum staff level requirement must be satisfied:

,
1
, 1, 2,...,
m
i i k
k
X P i n
=
> =
(1)

,
1
, 1, 2,...,
m
i i k
k
Y T i n
=
> =
(2)

,
1
, 1, 2,...,
m
i i k
k
Z M i n
=
= =
(3)

Set 2: Each nurse works only one shift a day:

, , , ,
X Y Z C 1, 1, 2,..., and 1, 2,...,
i k i k i k i k
i n k m + + + = = = (4)

,
1 if nurse is assigned a morning shift for day
0 otherwise
i k
k i
X

=
,
1 if nurse is assigned an evening shift for day
0 otherwise
i k
k i
Y

=
,
1 if nurse is assigned a night shift for day
0 otherwise
i k
k i
Z

=
,
1 if nurse is assigned a day off for day
0 otherwise
i k
k i
C

=
Set 3: Avoid any isolated days patterns of off-on-off:

, 1, 1, 1, 2,
C X Y Z C 2, 1, 2,..., 2 and 1, 2,...,
i k i k i k i k i k
i n k m
+ + + +
+ + + + s = =
(5)
Set 4: Each nurse works 3 consecutive days of night shift and followed by 3
days off. Each nurse will be assigned to their night shifts and off days as follow:

1, 2, 3, 4, 5, 6, 19, 20, 21,
Z Z Z C C C Z Z Z 9, 1,7,13
k k k k k k k k k
k + + + + + + + + = =

(6)

1, 2, 3, 16, 17, 18, 19, 20, 21,
C C C Z Z Z C C C 9, 2,8,14
k k k k k k k k k
k + + + + + + + + = =

(7)

13, 14, 15, 16, 17, 18,
Z Z Z C C C 6, 3,9,15
k k k k k k
k + + + + + = =

(8)

10, 11, 12, 13, 14, 15,
Z Z Z C C C 6, 4,10,16
k k k k k k
k + + + + + = =

(9)

7, 8, 9, 10, 11, 12,
Z Z Z C C C 6, 5,11,17
k k k k k k
k + + + + + = =

(10)

4, 5, 6, 7, 8, 9,
Z Z Z C C C 6, 6,12,18
k k k k k k
k + + + + + = = (11)
Set 5: Each nurse works between 12 to 14 days per schedule:

( )
, , ,
1
12, 1, 2,...,
n
i k i k i k
i
X Y Z k m
=
+ + > =
(12)

( )
, , ,
1
14, 1, 2,...,
n
i k i k i k
i
X Y Z k m
=
+ + s =
(13)
Set 6: Each nurse works not more than 6 consecutive days:

, 1, 2, 3, 4, 5, 6,
C C C C C C C 1,
1, 2,..., 4 and 1, 2,...,
i k i k i k i k i k i k i k
i n k m
+ + + + + +
+ + + + + + >
= =
(14)

6
, , 1
1
1, 0,1,...,5; 1, 2,..., 1
n v
i k i k
i n v i
C C v k m
+
= =
+ > = =

(15)

6
, ,1
1
1, 0,1,...,5
n v
i m i
i n v i
C C v
= =
+ > =

(16)
Set 7: Evening shift constitutes at least 25% of total workload:

,
1
3, 1, 2,...,
n
i k
i
Y k m
=
> =
(17)
Set 8: Morning shift constitutes at least 30% of total workload:

,
1
4, 1, 2,...,
n
i k
i
X k m
=
> =
(18)

3.4 Soft Constraints
The soft constraints of the formulation are given below.
Set 1: Avoid working in an evening shift followed by a morning shift or a night
shift the next day:

, 1, 1,
Y X Z 1, 1, 2,..., 1 and 1, 2,...,
i k i k i k
i n k m
+ +
+ + s = = (19)

, 1, 1 1, 1
Y X Z 1, 1, 2,..., 1
n k k k
k m
+ +
+ + s = (20)

, 1,1 1,1
Y X Z 1
n m
+ + s (21)
Set 2: Avoid working in a morning shift followed by an evening shift or a night
shift the next day:

, 1, 1,
X Y Z 1, 1, 2,..., 1 and 1, 2,...,
i k i k i k
i n k m
+ +
+ + s = = (22)

, 1, 1 1, 1
X Y Z 1, 1, 2,..., 1
n k k k
k m
+ +
+ + s = (23)

, 1,1 1,1
X Y Z 1
n m
+ + s (24)
Set 3: Each nurse has at least one weekend off:

7, 14, 21,
1, 1, 2,...,
k k k
C C C k m + + > = (25)
Set 4: All nurses have the same amount of total workload:

( )
, , ,
1
13, 1, 2,...,
n
i k i k i k
i
X Y Z k m
=
+ + = =
(26)
3.5 Goals
The soft constraints are incorporated in the model as the goals and formulated
as follows:
Goal 1: It avoids assigning a nurse to have an evening shift followed by a
morning shift or a night shift the next day. Here 1
k
(respectively 1
k
) is the
amount of negative (positive) deviation from goal 1 for nurse k. Only positive
deviations are penalized.

, 1, 1, , ,
Y X Z 1 1 1, 1, 2,..., 1 and 1, 2,...,
i k i k i k i k i k
i n k m q
+ +
+ + + s = = (27)

, 1, 1 1, 1 , ,
Y X Z 1 1 1, 1, 2,..., 1
n k k k n k n k
k m q
+ +
+ + + s = (28)

, , , 1,1 1,1
Y X Z 1 1 1
n m n m n m
q + + + s (29)
Goal 2: It avoids assigning a nurse to have a morning shift followed by an
evening shift or a night shift the next day. Here 2
k
(respectively 2
k
) is the
amount of negative (positive) deviation from goal 2 for nurse k. Only positive

, 1, 1, , ,
X Y Z 2 2 1, 1, 2,..., 1 and 1, 2,...,
i k i k i k i k i k
i n k m q
+ +
+ + + s = = (30)

, 1, 1 1, 1 , ,
X Y Z 2 2 1, 1, 2,..., 1
n k k k n k n k
k m q
+ +
+ + + s = (31)

, , , 1,1 1,1
X Y Z 2 2 1
n m n m n m
q + + + s (32)
Goal 3: It ensures that each nurse has at least one day off on weekend in the 3-
week schedule. Here 3
k
(respectively 3
k
) is the amount of negative (positive)
deviation from goal 3 for nurse k. Only negative deviations are penalized.

7, 14, 21,
3 3 1, 1, 2,...,
k k k k k
C C C k m q + + + > = (33)
Goal 4: It ensures that all nurses are scheduled to have 13 days as possible in
the 3-week schedule. Here 4
k
(respectively 4
k
) is the amount of negative
(positive) deviation from goal 4 for nurse k. Both negative and positive

( )
, , ,
1
4 4 13, 1, 2,...,
n
i k i k i k k k
i
X Y Z k m q
=
+ + + = =
(34)
Thus, the preemptive goal programming for this model is

( )
, ,
1 1 1 1 1 1
Minimize 1 , 2 , 3 , 4 4
n m n m m m
i k i k k k k
i k i k k k
q q
= = = = = =
| |
|
\ .
+

Subject to
Equations (1)-(18);
Equations (27)-(34);

0 1; 0 1; 0 1; 0 1;
1, 1, 2, 2, 3, 3, 4, 4 0.
X or Y or Z or C or
q q q q
= = = =
>

4 Results and Discussion
The 0-1 goal programming model was implemented in one ward that has 18
nurses with the number of nurses required for morning shift is at least 4 nurses,
evening shift is at least 4 nurses and night shift is exactly 3 nurses. The model

was solved using preemptive method where the priority ordering used is
1 2 3 4 G G G G . The model is optimized using one goal at a time such that
the optimum value of a higher priority goal is never degraded by a lower
priority goal.
Before running the model using LINGO software, a computer code has been
developed. A few models has been developed and adjusted in order to get a
good solution. Nevertheless, the model presented here is the best model for the
nurse scheduling. Table 1, Table 2 and Table 3 summaries the result of the
model using the Lingo software.
Table 1 The schedules pattern using 0-1 goal programming technique.
Day
Schedule's Pattern
S1 S2 S3 S4 S5 S6 S7 S8 S9 S10 S11 S12 S13 S14 S15 S16 S17 S18
1 E

A M A M E

A

M E

A M
2 E

A M

M E

A

E

A M A M
3 E

A

M

E

M M A

E

A M A

4

A

M E

M M M A E

A

A E
5

A M M

E

M M

A E

A A A

E
6

A M M

E

M M

E

A A A

E
7 A A

M E

M M

M E

A

A E

8 A

A

E

M M

M E

M A M A E

9 A M A

E

M

A

E

M A M

E

10

M

E

M M A A E

A

M E

A
11

M

E

M

A A E

A

M M E

A
12 M M

E

M

A

E

A A M

E

A
13 M M E

M

A E

A A M E

A
14

M E

M M

A E

A A M E

A
15 M

E

M M A

E

A A

E

M A
16 M E

A M

A E

A A

M E

M

17

E

A

A A E

A

M M E

M

M
18

E

A A A

E

A M M

E

M M M
19 E

E A A A E

A

M M E

M

20 E

E

A

E

A M M

E

A A M

21 E

E A

E

A M M

E

A A M

(M=Morning, E=Evening, A=Afternoon)
Table 1 shows the patterns of the shift of the working day and the day off for
the 3-weeks (21 days) planning period that resulted from the model. The
schedule satisfied all the hard constraints and soft constraints where all goals are
achieved. Table 1 shows that both goals 1 and 2 are fulfilled. Thus, there is no
evening shift followed by morning shift or night shift the next day and also,
there is no morning shift followed by evening shift or night shift the next day is
assigned to each schedules pattern.
Table 2 Summary of the number of shifts and weekend off for each schedules
pattern.
Number
of
Schedule's pattern
S1 S2 S3 S4 S5 S6 S7 S8 S9 S10 S11 S12 S13 S14 S15 S16 S17 S18
Morning
4 6 5 5 6 7 4 5 4 6 4 4 4 4 4 4 6 4
Afternoon
3 4 5 5 4 3 3 5 6 4 6 6 3 6 6 6 4 6
Evening 6 3 3 3 3 3 6 3 3 3 3 3 6 3 3 3 3 3
Total 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13
Weekend 1 1 1 1 1 2 1 1 1 1 1 2 1 1 1 1 1 2

Table 2 shows the summary for the number of shifts and weekend off for each
schedules pattern. Here, goal 3 where all nurses in each schedules pattern must
have at least one weekend off in 21 days is satisfied. Goal 4 is also satisfied
where all schedules pattern have the same 13 days of total number of shifts in
21 days planning period. Table 3 shows the summary for the number of shifts
for each day. The distributions of shifts for each day is also seem in balance for
each day in the 21 days of planning period. The total nurses on duty for the 21
days varied between 11 to 12 nurses per day.
Table 3 Summary of the number of shifts for each day.
Day Morning Afternoon Evening Total
1 4 4 3 11
2 4 4 3 11
3 4 4 3 11
4 4 4 3 11
5 4 5 3 12
6 4 4 3 11
7 4 4 3 11
8 5 4 3 12
9 4 4 3 11
10 4 4 3 11
11 4 4 3 11
12 4 4 3 11
13 4 4 3 11
14 4 4 3 11
15 4 4 3 11
16 4 4 3 11
17 4 4 3 11
18 5 4 3 12
19 4 4 3 11
20 4 4 3 11
21 4 4 3 11


Table 4 The cyclical schedules pattern for each nurse.
Schedule
(week)
Nurse
J1 J2 J3 J4 J5 J6 J7 J8 J9 J10 J11 J12 J13 J14 J15 J16 J17 J18
1 (1-3) S1 S2 S3 S4 S5 S6 S7 S8 S9 S10 S11 S12 S13 S14 S15 S16 S17 S18

The head nurse will allocate each schedules pattern to each nurse as
shown in Table 4. For schedule 1,...,18 i = , nurse j works according to
pattern
j
n
S ; where
( ) 1 mod18
j
n j i = + if 1 18 j i + = , and 18
j
n = if
1 18 j i + = . The cyclical scheduling for each nurse is as shown in Table
4. The pattern will be rotated among the nurses and each nurse will be
working according to each schedules pattern at the end of week 54, or
18 schedules. After completing 18 schedules, then each nurse will revisit
the starting schedule. In Table 4, it shows that the cyclical nurse
scheduling rotates equally through the desirable and undesirable work
stretches among the nurses and requires relatively less scheduling effort
of the head nurse.
The schedule satisfies the factors of completeness and continuity. While the
fairness factor is dealt with since the schedules pattern is going to rotate among
the nurses. All nurses will have the opportunity to work with the satisfactory
and unsatisfactory schedules patterns. The nurse will have the least satisfactory
schedules pattern when they have the pattern S6 with total number of morning
shift is 7 as shown in Table 2. While the most satisfactory schedules pattern is
when they have the patterns S6, S12 and S18 with the total number of weekend
off is 2 days (see Table 2). Each nurse will also have a long days off (3 days off
after 3 consecutive evening shifts followed by 2 days off) when they have the
schedules pattern S8 followed by schedules pattern S9, then schedules pattern
S11 and S17. The more weekend off and a long days off are good for nurses to
plan any activities with their families and social life. This implies unbiased of
the schedule to all nurses. Furthermore, with this cyclical scheduling, it gives
nurses more control over their work life because they know the type of shift
schedule in the future which should have a positive effect on their job
satisfaction.
5 Conclusions
Modeling nurse scheduling using a 0-1 goal programming has shown its
capability of generating schedules considering all the hard and soft constraints
in the scheduling environment. The developed scheduling has been found not
only to satisfy hospitals objectives but also nurses preferences. Both parties
obtained higher satisfaction when all goals are achieved. All the nurses
preferences or goals on having an evening shift not followed by a morning shift
or a night shift the next day; having a morning shift not followed by an evening
shift or a night shift the next day, having at least one day off on weekend in 21
days of planning period; and having the same total number of shifts are fulfilled
with the optimum solution.
The 0-1 goal programming technique has been proved to solve the multiple
objectives problem effectively and aided the decision maker on making a wise
and appropriate decision of the schedule. The developed model with various
constraints and goals using the 0-1 goal programming technique gives the
optimum solution that showed both the hard constraints and soft constraints are
satisfied. The optimum solution gathers when all the goals are achieved with the
objective function value is equal to zero and thus there is no penalty.
The cyclical scheduling for the developed model help the head nurse to have
less effort on building the new schedules. All nurses have 18 patterns of
schedule in periodicity of 378 days (54 weeks) or approximately 12 months or a
year. Then they meet the first schedules pattern again. The nurses will go
through the satisfactory and unsatisfactory schedules pattern without feeling
biased among them and thus lead to an overall higher satisfaction of the nurses.
New schedule will only need to be produced when changes occur in its average
daily staff requirements.
For further research, one of possible work is to embed the model into user-
friendly software that would be easy to use and reliable. The cyclical nurse
scheduling should be considered to improve the ways of developing the
schedule and save more time. The model also should be extended to account for

other important scheduling aspects such as requested day off in order to being
acceptable to all parties.
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ITB J. Sci., Vol. 43 A, No.

3, 2011, 151-164 151

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