Unit managers between fluctuating demand and fixed staffing: a quantitative study in psychiatric nursing

Balancing patient demand with nurse staffing remains a central challenge in inpatient care. In psychiatric settings, patient-side fluctuations create variability that is difficult to reconcile with fixed rosters and limited staffing flexibility. This study quantifies temporal variations in unit capacity utilization in psychiatric inpatient care and explores how unit managers respond to fluctuations and perceive flexible working arrangements. We combined routine inpatient data with a survey of unit managers from Swiss psychiatric hospitals. Routine data were used to describe temporal variability in capacity utilization, while the survey assessed management strategies, causes of workload fluctuations, and attitudes toward flexible working arrangements. Routine data from 116 units across 13 hospitals revealed substantial temporal fluctuations in occupancy. Most unit managers reported maintaining planned staffing levels despite changing demand, relying primarily on individual nurse-level adjustments such as overtime or calling in off-duty staff. Patient-side or structural strategies, including transfers or bed closures, were rarely used. Flexible working arrangements were viewed positively for nurse retention but deemed difficult to implement within shift-based operations. Psychiatric inpatient care illustrates the challenge of aligning fluctuating demand with staffing systems designed for stability. Current responses rely mainly on reactive measures that strain staff and may affect treatment continuity and safety, while opportunities for structural flexibility remain underused. Future research should develop data-driven tools to anticipate workload peaks and evaluate interventions that support flexible staffing and staff well-being. Organizational and policy efforts are needed to strengthen nurse manager capacity, improve working conditions, and support workforce planning that safeguards patient care.