The role of physical design and informal communication and learning in gaining competency and reducing stress among graduate nurses

High turnover is a prime cause of today?s nursing shortage, and is often the result of job dissatisfaction and burnout. At particular risk are Graduate Nurses (GN), who struggle to feel competent as they transition from the academic environment to the hospital environment. Using an exploratory case-study research design utilizing a multi-method approach, this study explored the relationships between the design and layout of the physical environment, GN interaction patterns, opportunities for informal learning and support, stress, and the gaining of necessary competencies. The five data collection methods used were shadowing the GN using the Clinical Work Measurement Tool, a registered nurse and GN survey, GN blood pressure measurements, GN weekly competency ratings, and focused interviews. Results showed a correlation between increasing competency ratings and decreasing blood pressure. The results also demonstrated the importance of ?backstage? areas such as break rooms and med rooms for informal learning, social support and the unit?s cohesion. The GN interacted infrequently with doctors in any area, however, which supports previous research on the work patterns of nurses. This research suggests that formal approaches to GN Orientation, which focus on the effective one-on-one interaction with a designated mentor, can and would benefit by insuring a supportive unit culture and purposeful design interventions that increased the likelihood of more interaction across disciplinary boundaries. Future research should explore in greater depth the role played by backstage (vs. frontstage) areas in facilitating informal learning and social support among both GNs and caregivers generally, and the effect of these opportunistic interactions on multi-disciplinary teamwork