Hospital design experts Teri Oelrich and Bryan Langlands explore ways to improve the efficiency and experience for nurses in hospital settings.
Teri OelrichContributor Coronavirus FrontlinesContributor Group Healthcare I am a Partner, Clinician and Healthcare Design Strategist with NBBJ.
Bryan LanglandsContributor Coronavirus FrontlinesContributor Group I am a Principal and Senior Medical Planner with NBBJ.
An open core design at Mount Carmel Health System’s East Campus in Columbus, Ohio.
NBBJ/CHUCK CHOI
Two years into the Covid-19 pandemic, frontline nurses report feeling overworked and burned out—and the U.S. is in the throes of a nursing crisis. While the pandemic has undoubtedly contributed to nurses’ stress and fatigue, the nursing population is unique, as are the factors contributing to the staffing shortage. A significant segment of the nursing population is nearing retirement age, while changing demographics signal a need for more nurses to care for an aging society. And while nursing school applications are up—a positive trend—enrollment is still not growing fast enough to meet the projected demand. Lastly, nursing has one of the highest turnover rates in the medical profession, with 16.5% of all nurses employed in hospitals quitting their jobs within the first year, costing hospitals $4 to $6 million annually.
“The nation’s healthcare delivery systems are overwhelmed, and nurses are tired and frustrated as this persistent pandemic rages on with no end in sight. Nurses alone cannot solve this longstanding issue. If we truly value the immeasurable contributions of the nursing workforce, then it is imperative that HHS utilize all available authorities to address this issue,” says American Nurses Association President Ernest Grant.
While we as designers are removed from administrative or policy decisions, we can create environments that improve operations, efficiency and working conditions. Here are four ideas to consider when planning and designing better work environments for nurses and other staff on inpatient bed units.
Plan for Efficiency
To achieve an efficient nursing unit, it is important to focus on the number, type and location of specific rooms; provide adequate support space; plan layouts and grouping of patient rooms that align with nurse-to-patient staffing ratios; and provide space and features that support and welcome non-dedicated staff.
Understanding how nurses work and allowing that to inform the layout of a nursing unit results in a better-functioning care environment. On average, nurses spend only 31% of their time with patients, while the remainder of their time is dedicated to activities such as waiting for lab data responses, patient transfer, searching for required equipment and documentation. For example, aside from patient rooms, the rooms most frequently accessed by nurses are medication, clean and soiled rooms—so, the number and placement of these rooms are critical to allowing nurses to spend more time with patients.
An effective nursing unit design solution is called “open core.” In an open core hospital design, patient rooms are located on both sides of a central work zone corridor, eliminating physical impediments within the areas of direct care. Between the banks of patient bedrooms, anything not related to direct patient care (such as elevators, mechanical shafts, stairs, electrical closets, offices, and toilets) is removed, leaving an unobstructed area to create an effective care team workplace. The standard eight-foot-wide corridor seen in many hospitals is doubled to sixteen feet. This accommodates circulation a clinical zone that houses decentralized team workstations, and supply and equipment alcoves stocked with the most frequently accessed items by staff. In addition, this layout creates neighborhoods for caregivers that locate nursing staff near patient rooms and supplies, with greater access and visibility to both.
Select Finishes, Fixtures and Equipment That Improve Working Conditions
The Covid-19 pandemic highlights the limitations of many design elements that have been used for decades, and positively reinforces design advancements introduced on newer nursing units. One example is the advantages of glass over solid doors. Feedback from nursing staff on older units with traditional solid wood swing doors to patient rooms indicates that these types of doors contribute to staff isolation and compromised communication. Full-height glass doors, whether swing or sliding, allow for greater situational awareness, the ability to nurse from outside the room, maintain sight lines to patients, improve visual communication, increase natural light to the support areas, and reduce social isolation.
Motorized overhead patient ceiling lifts are another example of a solution that can be included at the beginning of a project. However, these lifts are often one of the first things to go when construction projects are over budget. While removing these pieces of equipment results in initial savings, injured staff and days away from work may end up costing hospitals far more in the long run. According to a 2018 article published by the Bureau of Labor Statistics, overexertion and bodily reaction as a result of excessive physical effort (bending, twisting, lifting and repetitive motion) accounts for 45.6% of all injuries occurring to nurses, and work-related musculoskeletal disorders resulted in 8,730 days-away-from-work among nurses in the private industry. To reduce occupational hazards and benefit nurses, patients and the healthcare system, keeping ceiling lifts in the project is optimal. Another solution is to provide the infrastructure—structural support and tracks—so ceiling lifts can be added in the future.
Embrace Technology to Save Time and Enhance Communication
Service robots, or automated guided vehicles, can make life better for nurses and staff working on units by performing simple yet time consuming tasks like delivering supplies directly to the unit, the room and even the patient. On many nursing units, technicians meet robots outside patient rooms, where they unload nurse carts and put away supplies, while new robots pick up the empty carts and quickly flip them for their next use. They can also keep workers safe by transporting supplies in areas where pathogens are a risk—an added benefit discovered during the pandemic. Other healthcare technologies like radio frequency identification and real-time location systems minimize time lost looking for equipment and can lead to an overall reduced inventory need.
In addition, nurse call systems now offer digital wall staff terminals which enable nurses and housekeeping staff to indicate whether a room needs servicing or has already been serviced—and what specifically is needed—by simply tapping a screen. Similar technology puts the control in the hands of patients and their families with digital tablets. These tablets can be used to control lights, temperature and window shades in patient rooms while also allowing patients to order meals, watch educational material customized to their ailment and recovery, and even FaceTime with friends or family members.
Finally, wearable devices allow nurses to communicate without having to leave the patient room, and more easily and accurately request help. These types of communication devices can also contribute to reduced noise and disruption to patients as they eliminate the need for overhead intercom systems.
Bring Amenities to the Unit to Reduce Stress
Like airports—which provide a variety of dining and seating options, Wi-Fi and computer access, and amenities like massages or yoga immediately adjacent to the gate—bringing amenities onto nursing units allows nurses and other staff to refresh and regroup “off-stage” without the stress of leaving their post. In a virtual roundtable with leaders from healthcare systems in the U.K. and U.S., participants noted that on-unit staff support spaces and convenient access to things like lactation rooms, showers and healthy food made a tremendous difference in quality of life for frontline caregivers.
These amenities are also scalable, with some requiring little added space or cost. For example, small scale solutions like the creative use of small alcoves or leftover spaces such as the informal opportunity areas off stairwells or corridors, improvements to shared spaces like bathrooms or common areas, healthy food delivery or grab-and-go options, or the installation of rest pods are easier to implement than a large, centralized café, gym or wellness space—and are often more useful given the close proximity to nursing units.
Recently, institutions have started providing other concierge services to staff with the goal of increasing employee happiness and satisfaction and improving retention and recruitment. While amenities like staff retail pharmacies have been in existence for years, healthcare institutions are now incorporating services like day care, pet care, dry cleaning, salon services and made-to-order food to take home after a shift.
America’s nursing crisis is complex, and the staffing shortage may seem dire, especially amid the Omicron surge and the continued exhaustion felt by nurses and healthcare workers alike. Design solutions, technology and services that improve working conditions and prioritize efficiency, well-being and satisfaction can help to attract and retain nursing talent and create a better experience for nurses and staff.
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