The role of physical design and informal communication

nursing unit ecosystem and its web of interacting components and not by factors that
operate mutually exclusive of one another.
4.8 Study Limitations
The small sample size of one GN limits the extent to which conclusions can be
generalized to other GNs and settings. It is important to note that the original
methodology for this study included a sample of 10-12 GNs to be shadowed on
nursing units with differing layouts. However, because the available pool of incoming
graduate nurses was much smaller than expected, it was possible to shadow only one
GN. Despite this limitation, the study’s value lies in the fact that it is an exploration of
the nursing unit ecosystem as an integrated workplace with diverse care providers, not
of a single graduate nurse. The validity of these findings are also strengthened, as
noted earlier, by other research reporting similar results.
In order to protect patient privacy, data was not collected in patient rooms.
Therefore, unique interaction patterns that perhaps did not occur outside of the patient
room could have been missed. One significant daily event that was never captured
was unit rounds, where the care team gathers in each patient room to share
information, address patient concerns, and formulate or revise the care plan. Manias
and Street (2001) cite many studies involving nurse–doctor interactions during the
ward round that have identified nurses' passivity and their lack of confidence about
asserting themselves in discussions. Not only could rounds have been prime occasions
for GN on-the-job learning interactions, which would have been missed, but they also
would have provided insight into GN-doctor interactions and the extent to which these
progressed, if at all, over the course of orientation. CWM data shows that only two
percent of all interactions occurred with doctors, yet there is no way of knowing if this
small percentage was offset by those taking place inside patient rooms or elsewhere,
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