Looking to add to the body of research on nursing station design and the effects of different models on nurse communication, care processes, and patient outcomes, researchers and staff at the University of Kentucky teamed up with University of Kentucky Medical Center in Lexington, Ky.
The hospital was transitioning its cardiovascular services from a unit split between two floors with centralized nursing stations to a larger, more centralized unit on the eight floor of two patient towers with a connecting corridor. The new unit would house decentralized stations outside each pair of private patient rooms and teaming spaces near the ends of the corridors.
The idea, said Kevin Real, associate professor of communications at the University of Kentucky, was to see how structures influence networks and communications and how the physical environment can shape communications. Starting in 2014 through 2015, pre- and post-move data were collected from patients, nurses, and focus groups, including 41 nursing staff members, through such methods as behavioral mapping, focus groups, and patient surveys.
Real and colleague Allison Carll-White, a professor at the University of Kentucky, shared some of their findings during their session, “Centralized and Decentralized Nurses’ Station Design: A Pre/Post Study of Nurse Communication, Patient Care Processes, and Patient Outcomes,” on Sunday, Nov. 13, at the Healthcare Design Expo & Conference in Houston.
Patient satisfaction scores are a driving force in healthcare design these days and researchers used patient surveys to measure if perception of care changed after the unit’s move to a new floor with decentralized nursing stations. However, patient feedback showed no change—positively or negatively—in getting help from staff or the information they needed and their overall satisfaction with communication with staff members remained the same.
On the other hand, nurses reported several perceived changes post-move, including a decline in communication between coworkers, increased feelings of isolation, and having a harder time asking questions and finding help. Another outcome, Carll-White said: “We found there was more time spent in the med room.”
Others issues on the new unit included more conversations between nurses, doctors, and clinicians done in the hallways, potentially impacting privacy and noise levels on the unit. Also, while the new decentralized stations had two chairs, potentially offering an opportunity for collaboration and support among nurses, staffing scheduled had only one person assigned to those stations, meaning nurses had to walk down the hallway to another decentralized station to discuss care or call a colleague on the new phone-based communication system.
Another surprise was how infrequently the teaming stations were used in the new unit. Carll-White attributed this to their location at the ends of the corridors away from the decentralized stations, requiring extra time and steps by staff members to utilize these spaces.
Ultimately, the goal is to find a set-up that increases staff communication, staff efficiency, and staff and patient satisfaction. The speakers said they’d like to look into a hybrid nursing station model, which includes centralized staff hub spaces with decentralized work stations outside patient rooms.
“However it’s not one size fits all in healthcare,” Carll-White said, adding that each facility will need to consider its own setting, culture, and organizational structure to find the best nursing station model.
The bottom line, she added, was that the industry needs more research. “We’re not there yet with decentralized being the perfect [nursing station] model.”