By Debra Wood, RN, contributor
July 30, 2014 - Architecture, interior design and other physical aspects of nurses’ hospital work environments can influence early-career nurses’ job satisfaction, according to a new study conducted by the Robert Wood Johnson Foundation’s RN Work Project.
Maja Djukic, PhD, RN, said the physical environment matters, and urges leaders to include nurses’ perspectives when designing new hospital spaces.
“We were able to demonstrate physical work environment matters,” said Maja Djukic, PhD, RN, assistant professor at the New York University (NYU) College of Nursing, who led the research team.
Nursing job satisfaction has been identified as a key factor in nurse turnover, patient satisfaction, and nurse-sensitive patient outcomes, including pressure ulcers and falls, which can result in higher health care costs and penalties for hospitals receiving Medicare reimbursement.
“You cannot have a good patient experience unless you have a good employee experience,” said Kelly Hancock, MSN, RN, NE-BC, chief nursing officer at Cleveland Clinic in Ohio. She explained that at Cleveland Clinic, when caregiver engagement increased, so did quality outcomes and patient experience scores.
“We want to make sure our nurses are satisfied and engaged, because when you have engaged caregivers it is much easier to transform the way we deliver care,” Hancock added.
Kelly Hancock, MSN, RN, NE-BC, said work environment is very important to nurses’ job satisfaction, which correlates with patient experience and better quality outcomes.
Hancock said nurses value the ability to practice in a safe environment and appreciate when their voices are heard and are able to influence the culture.
“This study supports our previous findings, which indicate that investing in improving nurses’ work environments is extremely worthwhile,” said co-author Christine Kovner, PhD, RN, FAAN, professor at the NYU College of Nursing, in a statement.
For the new study, the RN Work Project team conducted a nationwide survey of registered nurses and included questions to assess the physical environment based on the architectural, ambient and design features of the workspace, including crowdedness, ventilation, lighting, arrangement of furniture, colors and decorations, aesthetic appearance, and the need for remodeling. The questions were added on to the traditional RN Work Project survey.
“[Physical environment] had support in the literature as being a factor impacting satisfaction,” explained co-author Carol Brewer, RN, PhD, FAAN, professor at the School of Nursing at the University at Buffalo in New York.
The researchers found the physical environment had no significant direct effect, but rather a positive indirect effect on other job place factors, such as workgroup cohesion, nurse–physician relations, workload, organizational constraints, promotional opportunity and other factors associated with nurses’ job satisfaction.
“What indirect means is we were able to explain the processes in which environment affects job satisfaction,” Djukic said.
Carol Brewer, RN, PhD, reported the last survey of the RN Work Project will go into the field in January.
Brewer offered as an example that not having a break room on the floor could interfere with cohesiveness, because nurses would not have a casual place to gather and get to know each other.
The study showed environment affected whether nurses could complete tasks without interruptions, communicate easily with other nurses and physicians, and/or do their jobs efficiently.
“We know there is a high risk for medication errors when nurses are constantly interrupted, so in our organization we have put forth strategies to prevent interruptions,” said Hancock, who also pointed out the importance of having the equipment and supplies where they need to be and functioning properly.
“It’s inefficient when they are running around and looking for things,” Hancock reported.
The researchers found that patients’ preferences and nurses’ preferences do not always jive. Patients prefer single-occupancy rooms, yet nurses believe they impair their ability to work in teams and communicate effectively. Djukic suggested that better electronic communication could help hospitals overcome this problem.
“Generally little thought is given to how rooms are designed for nurses,” Djukic said. “There hasn’t been a lot of dialogue and a lot of it can be resolved with communication.”
In some cases, that’s already happening. When Suffolk Construction of Boston built the new Lawrence + Memorial Hospital Cancer Center in Waterford, Conn., it employed a target-valued design process, involving frontline staff to design the center from the ground up. Their efforts resulted in not only a more functional workspace, but a building built at less cost, reported Josh DiGloria, senior project manager at Suffolk.
The RN Work Project study did not measure what individual aspects of physical environments, such as lighting or noise, matter most, and that provides an opportunity for future research. The 10-year project has one more survey to take place in January. The researchers have accumulated a wealth of data that has and will continue to benefit the profession.
“I’ll be sorry when it’s over,” Brewer said. “We’re interested in continuing something additional.”
© 2014. AMN Healthcare, Inc. All Rights Reserved.