The role of physical design and informal communication

Because patients on 6N have a particularly high physical need, the new NM saw a
need for more assistive staff than licensed staff. Accordingly she changed the staffing
matrix to 4 NAs on the day shift, 4 on the evening shift, and 2 on the night shift.
However, the benefits of this change in staffing were not realized until after the
completion of data collection because the hospital needed to hire employees to satisfy
the new matrix, and this process that took months to complete.
6N is known hospital-wide as being a noisy, chaotic unit, and this impacts
both staff turnover as well as graduate nurse (GN) recruitment. The turnover on this
unit is the highest among the medicine units in the hospital. Poor staffing as well as
having an inappropriate mix of staff were cited by nurses as two causes for low
employee satisfaction. It has been difficult to recruit nursing school graduates to 6N
because they are leery of the high turnover reputation. One nurse hypothesized about
the reason that GNs don’t want to work on the unit:
“A lot of people don’t want to do this because you could be on a
floor where you’re not running all the time.”
The RNs’ (n=8) responses to the culture section of the survey indicated a
generally positive perception of their working environment (Figure 17; see Appendix
E for complete survey). The inter-item reliability of the culture section was
calculated after the survey had been administered and found to be acceptable (n= 22;
α = .91). The mean rating for all questions was 5.0 (σ=1.4) (on a 1-7 scale, where
7=strongly agree); four questions had a mean rating below 5. Of those four, the two
questions with the lowest mean ratings were “Nurses on my unit who learn new skills
are rewarded” and “Doctors show respect for nurses on my unit,” with mean ratings
of 3.38 ((σ=1.4) and 4.25 (σ=1.2) respectively. Responses to four of the five
questions with the highest mean ratings indicate a culture that embraces learning and
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