The role of physical design and informal communication

nurses and pharmacists and dispenses patient medication. When it’s time to
administer meds to the patient, the nurse must input his or her code, and the machine
will allow access to one of the many drawers containing the correct medication for
that patient.
Narcotics are not located in the Pyxis machine. Instead they are kept in a
locked cabinet in the medication room. Nurses do not have their own key to this
cabinet, and observation revealed that when a patient needed a narcotic, nurses often
had to search for the one nurse who had the key at that time.
3.1.3 Organization and Unit Culture
6N is a “medicine” unit which means that, as one nurse described, “We get a
little bit of everything. Pneumonia, cardiac problems...” While the unit experiences a
wide patient age range, the average age of patients on the unit is around 70, and they
often get a lot of confused, elderly people who sometimes yell at and hit the nurses.
Most of the patients on 6N also have a high physical need, meaning that many are bed-
ridden patients who need assistance getting up and being mobile. Most patients
require total care, and many body systems are failing at once. The unit experiences a
consistent high average census of 33 patients 7 days per week. The Goal is a RN to
patient ratio of 1:5, however this goal is rarely met and is realistically often 1:7.
During observation, the researcher could not help but notice the noisy, chaotic
nature of the unit when compared to other units in the hospital. One cause for this
type of atmosphere is that the range of diagnoses that the unit sees is so broad and the
patients have such a wide variety of healthcare needs that the unit requires more and
more varied types of staff (different types of doctors and allied health). These higher
staff numbers produce a much noisier environment that creates an overall feeling of
chaos on the unit. One nurse reported that the high noise level creates an environment
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