The Impact of Facility Improvements on Hospital Nurses
Berry, Leonard L., Parish, Janet T., HERD : Health Environments Research & Design Journal
Objectives: The primary purpose of the research was to assess differences in nurses' perceptions of their job, hospital, and building features following the opening of a new hospital wing. Secondary purposes included assessing the impact on nurses left behind in the existing facility after the new wing opened and considering ways that nurses could more effectively contribute to facility design decisions that directly affect them.
Background: Research related to the design of healthcare facilities is growing, yet studies of the impact of facility features on hospital staff is far less common than studies of the impact on patients.
Methods: Survey data were collected from a hospital's nurses six months before (N=235) and six months after (N=238) some of the nurses (N=65) moved to a new wing. Response rates were 49% and 55% for rounds 1 and 2, respectively. A test study also was conducted two months post-move (N=206) to enable assessment of a novelty effect. Focus groups also were conducted following the completion of round 2 data collection.
Results: Significant differences were found between the round 1 and 2 samples for quality of patient rooms, safety, pleasantness, quality of workspace, job stress, job satisfaction, and service quality. Findings from the test study held up in round 2.
Conclusion: The design of the hospital impacts nurses and may impact their job satisfaction and stress, even the decision whether or not to remain a hospital nurse. A well-designed hospital is not only important to patients; it also is important to those who serve them.
Key Words: hospital facility design, hospital nurses, safety, job satisfaction, job stress, service quality
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). …