I agree it's the design of the building combined with not having enough staff. I work on a unit almost exactly like the one you describe. We have 24 beds on our side, it's rectangle shaped with no central nursing station, and med rooms and supply rooms in the middle of the rectangle. The difference is that I work peds, and we have 3-4 patients per nurse, not your higher number that you carry. So we have probably 5-7 nurses on the unit depending on acuity level and census. We have one nurse's aide, too. So when two nurses are in a room together holding a patient down for labs or something, there are still enough nurses to keep an ear and eye out. It really sounds like you need some extra nurse's aides or something.