Designing and constructing hospitals is extremely challenging. The services performed inside hospitals are technically complex and can result in catastrophic consequences if mistakes occur. It is difficult to imagine any type of building in which its users-patients, family, and staff-are under more stress than in a hospital. Hospitals are intimidating, scary places. No one goes to a hospital to have fun. Hospitals need to be designed to help relieve the stress of the people that use them as well as to facilitate safe practices and efficient processes.
Several factors underscore the importance of understanding the impact of hospital facility improvements on nurses: An acute nursing shortage; an aging population of nurses (by the year 2010, 40% of registered nurses are expected to be 50 years of age or older); and deepening concern about the quality and safety of care delivered to patients. These factors lead to the critical need to understand the potential influence of the physical design of hospitals on nurse recruiting, retention, productivity, and effectiveness (Becker, 2007; Buerhaus, Staiger, & Auerbach, 2000).
In addition, hospitals are expensive to construct and operate, and once constructed they remain in use for many years, heightening the importance of effective design. American healthcare is in the midst of a hospital construction boom spurred by relatively low capital investment in new and replacement hospitals in the 1990s; the aging of the population; and the growing number of hospitals experiencing capacity bottlenecks and bed shortages (Berry et al., 2004). For example, in 2004 in the United States, 199 complete hospitals, 590 expansions, and 1,136 renovations were designed, representing more than $37 billion in construction costs (http://modernhealthcare.com/chart.cms ?id=380&type=surveys). Healthcare construction is expected to rise to nearly $54 billion by 2010 (FMI's Construction Outlook, 2006).
Healthcare facility design is increasingly guided by research that links hospital physical environments to patient outcomes (Hamilton, 2003; Ulrich, Quan, Zimring, Joseph, & Choudhary, 2004). Physical elements such as cleanliness, patient room spaciousness, natural light, and privacy have been linked to positive patient outcomes (Beauchemin & Hays, 1996; Rubin, Owens, & Golden, 1998; Ulrich, 1991). Considerably less research exists on the effects of facility design on staff, yet what does exist suggests that healthcare environments do indeed affect staff (Ulrich et al., 2004). Furthermore, little research has explored how improvements in the workscape impact the staff who do not directly benefit from it. This issue applies to hospital expansions and renovations in which only some of the nurses work in new or upgraded facilities, while others remain in unchanged facilities. The potential impact of facility design on hospital staff such as nurses who do essential work and are in short supply clearly merits additional investigation. Given the cost and duration of use of hospital buildings-and the high-stakes nature of what goes on inside them-it is important to design them well using the best available evidence.
The cooperation of a hospital that was adding a new wing to its existing building was secured. This enabled the researchers to: (1) study nurses' perceptions of their job, the organization, and the building before the new wing opened and afterwards; (2) compare the perceptions of nurses who moved to the new wing with those who remained in the original facility; (3) assess the impact on nurses left behind in an old facility when a new wing is occupied, and consider options to address any concerns; and (4) consider ways that the nurses most affected could better contribute to facility design. A pre-move/post-move, quasi-experiment in a natural setting was conducted to investigate these issues (Cook & Campbell, 1979). The quasi-experiment was followed by focus group sessions. …