Steps to Create the Optimal Nursing Unit

Using simulation to develop a consensus on the ideal nursing unit

Investigators at Ascension Health and Kaiser Permanente led a multisite study designed to explore how nurses use their time and whether the design of their workplace has an impact on patient care.

The investigators then convened a "summit" conference of nurses, researchers, and other experts in the field to discuss their findings and issue a series of "principles" to guide design decisions in creating optimal nursing units.

Key Findings

  • The investigators reported their findings in an article published in The Permanente Journal (12[3], 2008).

    • Nurses devote 19.3 percent of nursing practice time to patient care activities.
    • Most of nursing practice time is taken up by documentation (35.3%), medication administration (17.2%), and care coordination (20.6%).
    • Nurses spend 38.6 percent of their time at the nursing station and 30.8 percent in the patient room.
    • Nurses walk between 2.4 and 3.4 miles per 10-hour daytime shift—a level of physical activity the project team said is among the most strenuous of any industry.
    • No consistent, statistically significant relationship was found between various unit designs and nursing time spent with patients.

Key Recommendations: Summit conference participants made a number of recommendations in the conference report: Time & Motion: Transforming the Hospital Patient Care Environment. A Proclamation for Change. In order to transform the hospital-patient care environment and improve the delivery of safe, high-quality, patient-centered care, participants agreed on the need for:

  • Patient-centered design. Hospital and technology design should be organized around patient needs—helping patients and their families feel engaged in the caregiving process rather than removed from it—and be tailored to address unique factors and diverse patient populations.
  • System-wide, integrated technology. Architects and technology vendors should work closely with nurses, physicians and personnel in other caregiving departments (i.e., those in pharmacy, lab, housekeeping and admitting departments) in all aspects of designing workspace and technologies in order to ensure a system-wide approach to meeting patient needs.
  • Seamless workplace environments. To consistently provide the highest quality care to patients, the physical design of medical-surgical units should be completely integrated with caregiver work processes and the technologies they use, so caregivers always have the right medication, materials and information, in the right place, at the right time.
  • Vendor partnerships. The design and operation of technology devices should be intuitive and error free and part of interoperable systems—so that health care providers can access information in hospital or outpatient settings—and not waste time serving as human bridges that link multiple technology devices in different locations.

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