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Nursing Unit Design and Communication Patterns: What Is “Real” Work?

Originally Published:
Key Point Summary
Key Point Summary Author(s):
Schechtman, Suzanne
Key Concepts/Context
With billions of dollars spent each year on new hospital construction and an ever-growing shortage of nurses, more attention is being paid to the way in which design of new facilities and, more specifically, nursing units might better support nurse recruitment, their work process, and retention. There is growing concern about the quality of hospital environments and the impact on staff, which inherently impacts quality of care. While much research on nursing unit design has focused on reducing fatigue and increasing visual access to patients, an equally relevant but understudied area of interest is the impact on informal communication between caregivers. There has recently been a push toward decentralized nursing stations, yet there is a lack of research confirming how this impacts communication patterns. As many adverse events in hospital environments are connected to communication difficulties that are largely avoidable, this topic requires further study. The author discusses an agenda to study nursing unit design and its impact on communication, interaction, on-the-job learning opportunities, and the resulting speed to competency for new nurses, job stress, job satisfaction, and quality of care. He proposes that these variables all be considered within the organizational ecology of the hospital.
The purpose of this paper was to review research literature on nursing unit design and communication patterns both between nurses and with other caregivers to suggest a research agenda to study the impact of nursing unit design on nurses’ communication, interaction patterns, and on-the-job learning, within the larger context of a systems-based, organizational ecology framework.
Design Implications
This paper discusses a proposed research agenda geared toward understanding the impact of nursing unit design on staff communication, on-the-job learning, and resulting stress, job satisfaction, and quality of care. Preliminary findings suggesting that decentralized pods decrease desired interaction between staff indicates that decentralized units may not be a best practice after all. Ultimately, though, more research is needed to determine how healthcare facilities’ nursing units may be most effectively designed to encourage informal interaction and learning between staff, while at the same time accommodating other requirements such as maintaining visual access to patients’ rooms.
Preliminary data suggest that decentralized nursing stations decrease interaction among nurses as well as interaction between nurses and doctors. This requires further research to better understand the interplay of a complex set of factors at play in hospital settings. The author describes this as the organizational ecological framework, including the physical design, technological infrastructure, staffing, culture, work processes, and the inherent interdependent relationships that exist.
Key Point Summary Author(s):
Schechtman, Suzanne
Primary Author
Becker, F.