Table 4.

Organizational Patterns of Schedule Patching.

		Implementation of patching approaches
		Formalized	Improvised
Types of patching adjustments
Proactive	Day shifting	Share-the-pain (Facilities A, B, E, F, G) “Workers have a schedule change form. If they need the day off, somebody will work for somebody else. [The form] goes through the nursing department, supervisors down to certified nursing assistants … and then to the scheduler.”—Director of Nursing, A Workers have to “work with a scheduler [and management] … If I say, ‘I might need the day off and somebody said they’ll switch with me’ … if they can get somebody to agree to switch with them, then signatures in writing from both people [will] get the switch done.”—Administrator, G	Share-the-pain (Facility H) “We have self-scheduling … so there’s a book where staff put in the days that they want to work … And if we want to make changes, we can make changes.”—Supervisor, H Work-life-needs (Facilities C, D) “Some preferences are considered, you know, ‘I don’t have child care on Tuesdays and Thursdays, so I need those 2 days off’. So, if the scheduler is able to do it, she’ll accommodate.”—Unit Manager, D
Proactive	Hourly shifting	Share-the-pain (Facilities E, F, G) “When we hire somebody, we hire them for a certain amount of hours … everybody has a set schedule. If they want to change hours, they have to put it in writing, and they have to give at least 2 weeks….One nurse wanted to work different hours, but it wasn’t available, so it would be the next available time.”—Director of Nursing, E “All [workers] have to work it out so [they] can be here when the normal start of the shift is … We tried accommodating early/late hours in the past … for school. We’ve tried it for daycare situations, but it doesn’t fly … it just, it’s too much of a hardship for the facility and for the other employees.”—Administrator, F	Work-life-needs (Facilities A, B, C, D, H) “We are pretty flexible in our scheduling … change isn’t just about the residents, it’s also about the staff. And some of them have children and childcare issues. So, we’re sometimes flexible with making someone’s time in at 7:30. Or they have more than one job and the job that they’re leaving ends at 3:00 and they can’t get here until 3:30, so we’ll—we try to be flexible with that.”—Director of Nursing, D “Because of child care issues, we’ve made some people 8 to 2, and we’ve bent as much as we could for people … we really try.”—Director of Nursing, C
Reactive	Callouts	Share-the-pain (Facilities B, D) “We’ll kind of enforce that somebody’s got to stay. And (the facility) offers, if you stay, we can give them another day off. If we still have no takers, then the [employees] names go in the hat.”—Director of Nursing, D Reverse-status-rotation (Facilities A, B, C, D, E, F, G, H) “All the managers are on-call … but they know the on-call schedule for a whole year, so (they) plan around it … the only people that will ever be (expected to come) in would be somebody in a supervisor’s position.”—Unit Manager, B	Share-the-pain (Facilities A, E) “There’s not an on-call rotation for staff. It’s just you call and if someone’s available, they can come in”; “the callouts are all treated the same. We try to be fair about it.”—Unit Manager, A Work-life-needs (Facilities C, H) “If there’s a callout … then (the scheduler or supervisor) will have to start calling around trying to find somebody … we have a phone list of employees phone numbers and … it’s really up to the staff if they want to give a mobile phone number or not. I don’t (give my number), I don’t feel like I have any availability if I am not on the schedule already.”—Supervisor, H
Reactive	Time off	Share-the-pain (Facility E) “If they need to request time off, there is always a procedure to. They would fill out a form. And then it would go to director of nursing (DON) or the assistant DON, and then when it’s approved, it will go back to the scheduler and they take them off.” … “You put in a request slip and if you have the time, they give it to you.”—Nurse, E	Share-the-pain (Facilities B, D, F, G, H) “We try to encourage staff to give us notice for time off requests. But we understand that things happen sometimes, so (we) really encourage them to find their own coverage. And if they can’t, we do what we can to accommodate. Sometimes they’ll get calls in the middle of their shift, it’s a problem or emergency … we’ll work around trying to get them out so that they can go take care of whatever the problem is.”—Director of Nursing, D Work-life-needs (Facilities A, C) “If somebody dies. If a parent dies, a spouse dies, then they get the day off … they’re given an amount of time off….My sister planned a surprise birthday party for my niece and I had to go, because she’s my goddaughter, that’s a lot different … it becomes the employee’s responsibility to find somebody to work for her … it should be (the employee’s) responsibility to find somebody … (the scheduler) realizes that some people will just call in and then we’re still stuck, so she … helps look for someone.”—Unit Manager, A

Note. Schedule patching adjustments: Proactive: planned time shifting of days/hours. Reactive: last-minute hole-filling (callouts, time off). Scheduling patching approaches: Share-the-pain: allocating schedule patching consistently across employees regardless of need/status. Work-life-needs: patching based on employees’ personal needs. Reverse-status-rotation: occurs to handle callouts, based on job status hierarchy. Schedule patching implementation procedures: Formalized: use of formal, processes or procedures. Improvised: ad hoc decisions made informally on the ground. DON = director of nursing.