Nursing unit design and communication patterns: What is “real” work?

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.