Decentralized nurse units can create care challenges

Researchers hypothesized that decentralized nursing alcoves may have decreased collaboration among staff.

Photo courtesy of the Lawrence Group Inc.

Does a decentralized nursing unit design help nurses to do their jobs better? Are patients at hospitals with that design more satisfied? And what exactly is a decentralized nursing unit? 

Finding answers to those questions is the challenge undertaken by Hui Cai, assistant professor, and her colleagues Kent Spreckelmeyer and Frank Zilm at the Institute for Health + Wellness Design (IHWD), University of Kansas School of Architecture and Design.

A multiphase research project by Cai and her team, as well as prior research on decentralized nurse unit design, show that the trend overall has not solved the challenges and may contribute to the complexity of nurses’ work. In the first phase of the project, architecture firm Lawrence Group, St. Louis, an IHWD affiliate, engaged the research team to perform a post-occupancy evaluation of a newly built orthopedic unit at SSM Health St. Mary’s Hospital in Jefferson City, Mo., for use at a second facility.

The team looked at how the unit’s layout impacts nurse workflow and patient satisfaction. Questions about the renovated space itself showed a marked increase in scores, while results for patient care questions stayed about the same. A question related to nurses’ response time to patient calls dropped slightly. 

Cai says the researchers hypothesized that the decentralized nurse station contributed to decreased communication and collaboration among nurses because of the increased physical distance, decreased visual connections and limited their visibility of unassigned patients. In turn, the design caused perceived delayed responses to patients’ calls for assistance. 

Cai says research shows that workplace efficiency is only one part of the equation for nurse satisfaction; the need for interaction and collaboration are critical.  

“Decentralized nurse units were designed out of good intention from a Lean perspective, from an efficiency perspective. But we tend to overlook that nursing is a teamwork-based profession,” Cai says.