Studies on stress within the nursing workforce, an issue that has long been a cause of concern to healthcare staff, have found that one of the major causes of this is work environment. This work stress, in turn, had influenced nurses’ job satisfaction and ultimately, increased their desire to switch jobs, affecting staff retention rates.
The issue of poor work environment for nurses is a globally prevalent one, and a major factor that has been oft discussed is that of nursing stations. An efficient and functional nursing station is crucial in promoting a healthier nursing work environment,so it is important to weigh the positive and negative aspects of centralised and decentralised nursing stations.
Comparing centralised and decentralised nursing stations
Patient care timeSince a centralized nursing station is placed at one single area, monitoring all patients simultaneously can be considered more time-consuming, and thus just that little bit harder. Decentralized nurses' stations, on the other hand, if strategically situated e.g. outside patient rooms, can improve nurses' visibility of patients and reduce the time spent walking (Hellman, 2017). This in turn allows nurses to interact more closely with patients, eventually increasing direct patient care time.
Administration taskStudies have found that more time was spent on phones, computers and paper-based administration when centralized stations were used, because when all tasks were concentrated at one point, it was more difficult to disseminate these, especially administrative tasks. In contrast, these tasks were successfully decreased in terms of redundancy and redistributed more evenly in decentralized nursing stations (Parker, Eisen & Bell, 2012).
Call bellsWhen Singapore hospitals introduced the paper clock system as a decentralized approach (Cheong, 2015), it was found to significantly reduce the number of call bells pressed by patients, by one-fifth on average.
Social interaction among staff membersIn this, centralized nursing station doubtlessly offer greater social interactions among the staff as they would be seated together. Conversely, fewer opportunities for staff consultations and social interactions in hospitals adopting the decentralized units were seen to decrease social support and increase stress among nurses.
WorkflowThe centralized nursing station provides space for collaboration among caregivers, thereby maintaining the workflow and be an ideal setting for frequent formal and informal teaching and learning (Hellman, 2017). Due to poor staff consultation and collaboration in decentralized, workflow becomes less efficient. Plus, informal teaching and learning in decentralized nursing station are unlikely.
TeamworkNurses working in decentralized units reported feeling more isolated from their colleagues, and a loss of team connection. Nurses in the centralized unit reported a greater sense of teamwork and camaraderie. These findings were consonance with other findings that staff who worked in decentralized nursing units reported less satisfaction with their jobs and a weakened sense of teamwork (Zeit, 2014). The majority of nurses felt the centralized floor plan was more beneficial for professional and social communication.
NoiseThe decentralized unit design has made considerable improvements to one inherent problem of the central station: A noisy environment due to an abundance of continuous interactions. However, as reported by Topf (1985), although the decentralized nursing station is close to patients, the tendency of nurses and physicians who choose to meet and/or consult in hallways also were high, which resulted in the increase of noise at those locations instead, leading to patients claiming that staff talking in the hallways were 'one of the most distressing sources of noise' (Topf, 1985).
Nursing staff need to be supported through an operational, conducive and safe physical work environment. The design for nurse units does not specifically need to concentrate on a centralized versus a decentralized model, but could instead be a balanced combination of both, taking the strengths and removing the weaknesses as much as possible. The ideal nursing station should support efficient patient care delivery, stress mitigation, and job satisfaction, and still be a platform of effective communication, collaboration and social support between healthcare team members. MIMS
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Parker, F.M., Eisen, S., & Bell, J. (2012). Comparing centralized vs. decentralized nursing unit design as a determinant of stress and job satisfaction. Journal of Nursing Education and Practice, 2(4), 66-76
Cheong, K. (2015). Proactive care of patients reduces call bell usage by 20%. Retrieved from http://www.straitstimes.com/singapore/health/proactive-care-of-patients-reduces-call-bell- usage-by-20
Hellman, R. (2017). Does decentralized nursing unit design work? Retrieved from http://news.ku.edu/2017/01/03/does-decentralized-nursing-unit-design-work
Zeit, K.D. (2014). Study On Decentralized Nurses’ Stations Yields Surprising Results. Retrieved from http://www.healthcaredesignmagazine.com/news/awards-events/study-decentralized-nurses- stations-yields-surprising-results/#sthash.yv5hTlcp.dpuf