The role of physical design and informal communication

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1.3 Nursing Shortage The healthcare construction boom will undoubtedly prompt administrators to search for new and innovative ways to attract and retain staff through evidence-based design. The Registered Nurse (RN) workforce in the U.S. has been dwindling for the last decade. Fewer are pursuing nursing as a profession due to a negative image of the career that dominates society as well as an increase in alternative career opportunities for women (Goodin, 2003). And according to Dr. Peter Buerhaus and collegues (2008), there is no sign of relief in the future if trends continue with an estimated deficit of 500,000 RNs by the year 2025. While the U.S has experienced surpluses and shortages of RNs throughout its history, the current shortage can be characterized distinctly from the rest. Specifically, the current workforce is an aging one. Because fewer young nursing graduates are entering the workforce, the average age of RNs is 47 (Health Resources and Services Administration (HRSA), 2004). The deficit is anticipated to worsen when this baby boomer cohort of nurses retires around 2015 (Gabriel, 2001). Society is experiencing the burden of the nursing shortage through negative patient outcomes. Due to a lack of adequate staffing, those who are working experience heavy workloads to compensate for the gap between supply and demand. One study found that over 90% of RNs report major difficulty in having enough time to maintain patient safety, detect complications in advance, and collaborate with team members (Buerhaus, Donelan, Ulrich, & Norman, 2005). Another study, which examined nurse staffing levels and quality of care, has drawn a direct link between the nursing shortage and serious complications. The findings revealed that a higher number of hours of nursing care was associated with lower rates of urinary tract 7
infections, pneumonia, cardiac arrest, and even death (Needleman, Buerhaus, Mattke, Stewart, & Zelevinsky, 2002). 1.4 Job Stress in Nurses Given the current shortage of nurses, consideration of the factors that influence voluntary nurse turnover is crucial. Job stress is of particular concern when it comes to understanding why nurses intend to leave the profession. According to a survey of registered nurses, the primary reason why nurses leave healthcare, other than for retirement, is to find a job that is less stressful and physically demanding (Peter D. Hart Research Associates, 2001). In addition to the physical demand associated with standing for long periods and lifting patients, nursing is emotionally taxing as well. French, Lenton, Walters, and Eyles (2000) have identified workplace stressors that could potentially affect nurses including problems with peers, coping with dying patients, workload, and uncertainty concerning treatment, to name just a few. In addition, inter-professional conflict between nurses and physicians has been found to be a significant source of stress (Hillhouse & Adler, 1997; Bratt et al., 2000; Ball et al., 2002). Although the intensity of these work-related stressors may vary between practice areas (McVicar, 2003), the literature is consistent in identifying stress as a major factor contributing to job dissatisfaction and burnout. A number of studies have investigated the reasons that RNs intend to quit, and job stress is consistently among the most frequently reported (Gardulf, 2005; Daily, 1990; Stolte & Myers, 1995; Collins et. al, 2000). In an exploration of predictors of turnover in RNs., Shader, Broome M., Broome C., West, & Nash (2001) found a correlation between high job stress and greater intention to quit. Considering the large body of literature establishing the reality of significant job stress in nurses and its relationship to 8
Page 1 and 2: THE ROLE OF PHYSICAL DESIGN AND INF
Page 3 and 4: ABSTRACT Graduate nurses experience
Page 5 and 6: Dedicated to my parents, John and L
Page 7 and 8: TABLE OF CONTENTS Biographical Sket
Page 9 and 10: LIST OF FIGURES Figure 1. 6N floor
Page 11 and 12: LIST OF TABLES Table 1. Overall per
Page 13 and 14: extraordinary opportunity to apply
Page 15 and 16: into the topic of nature as a thera
Page 17: tiles with sound-absorbing ceiling
Page 21 and 22: try to gain a better understanding
Page 23 and 24: 1.6.3 Graduate Nurses’ Sense of B
Page 25 and 26: formal face-to-face communication n
Page 27 and 28: interactive and interpersonal learn
Page 29 and 30: • Evidence-based design has the p
Page 31 and 32: concluded that high visibility work
Page 33 and 34: Joseph (2006) cites anecdotal evide
Page 35 and 36: informal learning and communication
Page 37 and 38: 2.3 Site Description Crouse Hospita
Page 39 and 40: primarily composed of the nursing s
Page 41 and 42: o Nursing Students The following no
Page 43 and 44: Meetings were held over a three mon
Page 45 and 46: Figure 2 6N floor plan showing colo
Page 47 and 48: equirements, organizational require
Page 49 and 50: study by Vrijkotte, van Doornen, an
Page 51 and 52: graduate nurse’s strengths and ac
Page 53 and 54: 2.8 Data Analysis Focused interview
Page 55 and 56: CHAPTER 3 RESULTS 3.1 Organizationa
Page 57 and 58: ecause as a visitor entered the uni
Page 59 and 60: Figure 3 6N Floor Plan 48
Page 61 and 62: Figure 6 View of island work surfac
Page 63 and 64: Kitchen Locker Room Desk B1 at nurs
Page 65 and 66: Figure 13 Existing layout prior to
Page 67 and 68: Figure 15 Wall-mounted chart organi
Page 69 and 70:
3.1.2 Information Management and Te
Page 71 and 72:
nurses and pharmacists and dispense
Page 73 and 74:
Because patients on 6N have a parti
Page 75 and 76:
There is encouragement to learn new
Page 77 and 78:
There is encouragement to learn new
Page 79 and 80:
“Validation,” at five times per
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Average Frequency/8hr 60 50 40 30 2
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3) shows that all interactions were
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Table 4 Overall percent & frequency
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Transit” - 2:59:48. However, the
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Time (hh:mm:ss) 0:02:53 0:02:36 0:0
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Patient Room 28% Nurses Station 25%
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3.3.4 Analysis of Task, Person and
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However, when asked if all of this
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Frequency (%) 50.0 45.0 40.0 35.0 3
Page 99 and 100:
Frequency (%) 45.0 40.0 35.0 30.0 2
Page 101 and 102:
Table 14 Frequency of person by loc
Page 103 and 104:
occurred in equal amounts with the
Page 105 and 106:
experienced by many GNs. Figure 33
Page 107 and 108:
conditions in laymen’s terms. The
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• According to the GN, the greate
Page 111 and 112:
Not enough staff to adequately cove
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Table 16 Change in GN stress rating
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Blood Pressure (mmHg) 121.0 119.0 1
Page 117 and 118:
3.6 Overall Summary of Findings •
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on validation, discussing patient c
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found that a major stressor for nur
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opportunities for informal learning
Page 125 and 126:
unit suggests that designers and ho
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usually leads to expensive renovati
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including off the nursing unit or a
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APPENDIX A Memo Describing Study 12
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APPENDIX B Graduate Nurse Consent F
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• Members of the Cornell research
Page 137 and 138:
_____________________________ _____
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Informed Consent Form for Staff Cro
Page 141 and 142:
Committee on Human Subjects (UCHS)
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Modified Categories for the Clinica
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134
Page 147 and 148:
136
Page 149 and 150:
APPENDIX F Survey Items Pertaining
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APPENDIX G Survey Items Pertaining
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APPENDIX H Survey Items Pertaining
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APPENDIX I Blood Pressure Recording
Page 157 and 158:
APPENDIX J Competency Evaluation Fo
Page 159 and 160:
APPENDIX K Competency Category Defi
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o Expert - interprets labs; consult
Page 163 and 164:
14. Care Plan delegate (using the r
Page 165 and 166:
APPENDIX L Interview Guides 154
Page 167 and 168:
3. Does the current patient:nurse r
Page 169 and 170:
Interview Guide - Orientor Learning
Page 171 and 172:
c. Did staffing levels affect the a
Page 173 and 174:
5. What unique challenges do staff
Page 175 and 176:
CWM Tool Task Category Definitions
Page 177 and 178:
REFERENCES Adams, A., & Bond, S. (2
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Buchanan, J., & Considine, G. (2002
Page 181 and 182:
Godinez, G., Schweiger, J., Gruver,
Page 183 and 184:
Lumsdon, K. (1993). Baby boomers gr
Page 185 and 186:
Stolte, K., & Myers, S. t. (1995).
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