Bryan Langlands and Teri Langlands, hospital design experts, discuss ways to improve nurses’ experience in hospitals.
Mount Carmel Health Systems East Campus, Columbus, Ohio. Open core design
Two years after the Covid-19 pandemic began, frontline nurses report feeling better. Overworked and exhaustedThe United States is currently facing a nursing crisis. The pandemic has undoubtedly caused stress and fatigue in nurses, but the nursing population is not like other people, and the factors that contribute to the staffing shortfall are unique. A large portion of the nursing population is approaching retirement ageAs the population ages, so does the need for nurses to care for an aging community. While there is a positive trend in nursing school applications, it is not enough to meet projected demand. The highest turnover rate in the medical profession is nursing. 16.5% of nurses working in hospitals quit within the first year. Hospitals spend $4-$6 million annually.
As the persistent pandemic continues, healthcare delivery systems across the country are overwhelmed. Nurses are exhausted and frustrated. This long-standing problem cannot be solved by nurses alone. Ernest Grant, president of American Nurses Association, stated that we must value the invaluable contributions of nurses and urge HHS to use all available resources to address this problem.
Even though we designers are not allowed to make decisions about policy or administrative matters, we can design environments that improve efficiency, work conditions, and operations. Here are four things to think about when designing and planning for better work environments for nurses, and other staff at inpatient beds units.
Plan for Efficiency
A nursing unit should have a focus on the number, type, and location of each room; adequate support space; planned layouts and groupings for patient rooms that are compatible with nurse-topatient ratios; and space and features that encourage and welcome non-dedicated personnel.
A better care environment can be created by understanding the work of nurses and allowing them to influence the layout of a unit. On average, Nurses spend 31% of their time with patients.The rest of their time is used to wait for lab data results, patient transfer, searching and obtaining documentation. To allow nurses to spend more time with patients, it is important to ensure that nurses have access to medication, clean, and soiled rooms.
An effective nursing unit design solution is called open core.Patient rooms in an open core hospital design are located on either side of a central corridor. This eliminates physical impediments in the areas of direct care. Anything not directly related to patient care (such a toilets, elevators, mechanical shafts and stairs, electrical closets, offices and offices) is removed from the banks of patient rooms. This leaves an area that can be used to create a care team workspace. The standard eight-foot corridor found in many hospitals is now extended to sixteen feet. This creates a circulation zone, which houses decentralized team workstations and supply and equip alcoves with the most frequently used items for staff. This layout allows caregivers to locate nursing staff near patient rooms or supplies, which gives them greater visibility and access.
Select Finishes, Fixtures, and Equipment that Improve Working Conditions
The Covid-19 pandemic demonstrates the limitations of many design elements which have been around for decades and supports design innovations on newer nursing units. One example is the superiority of glass over solid doorways. Nursing staff from older units with traditional solid wooden swing doors to patient rooms have reported that these doors lead to isolation and poor communication. Full-height glass doors can be swing or sliding and allow for greater situational awareness. They also allow for nurses to see outside the room and maintain sight lines to patients. This allows them to improve visual communication, natural light, social isolation, and increase their ability to communicate with the support areas.
Another option is to include motorized overhead patient ceilinglifts at the beginning. These lifts are often one thing that is removed when construction projects are not on budget. Although these pieces of equipment may save money initially, it can end up costing hospitals more long-term. According to a 2018 article published in the Bureau of Labor StatisticsOverexertion and bodily reaction due to excessive physical effort (bending and twisting, lifting and repetition) account for 45.6%. In the private sector, 8,730 days were lost due to work-related Musculoskeletal Disorders. Ceiling lifts are an ideal way to reduce occupational hazards and improve the health of nurses, patients, and the healthcare system. Another solution is to provide the infrastructurestructural support and tracksso ceiling lifts can be added in the future.
Use technology to save time and improve communication
Service robots, also known as automated guided vehicles, are a great way to make the lives of nurses and staff on units easier by performing simple tasks such as delivering supplies directly to the unit, room, and patient. Many nurses have robots that meet them outside patient rooms. The robots unload the nurse carts and place them away. When they are done, new robots quickly pick up the carts and flip them over for the next use. They can also transport supplies to areas where there is a risk of infection, which is an added benefit that was discovered during the pandemic. Other healthcare technologies such as radio frequency identification (RFID) and real-time locator systems can be used to reduce time spent looking for equipment, and may result in a reduction in inventory.
Nurse call systems now have digital wall staff terminals that allow nurses and housekeeping staffs to indicate if a room needs servicing, or if it has been serviced before. All they need is to tap a screen. Patients and their families can also control the situation with similar technology using digital tablets. These tablets can be used for controlling temperature and window shades in patient rooms. They also allow patients to order meals and educational material that is customized to their needs.
Finally, nurses can communicate with their patients using wearable devices. This allows them to request help faster and more accurately. These communication devices can reduce noise and disruption for patients by eliminating the need to use overhead intercom systems.
To reduce stress, add amenities to the unit
Airports offer a variety in dining and seating options. Wi-Fi and computer access are available right next to the gate. Nursing staff can also use the amenities to relax and regroup off-stage. In a Virtual roundtableParticipants in the meeting with healthcare leaders in the U.K. & U.S. noted that having on-unit staff support spaces, easy access to things such as showers, lactation room, and healthy food made a significant difference in the quality and life of frontline caregivers. These amenities are easily scalable and require very little space or cost. For example, small scale solutions such as creatively using small alcoves or leftover space, such stairwells or corridors to make improvements to shared spaces, such a bathroom or common area, or healthy food delivery or grab and go options, or installing rest pods are often easier to implement than a large centralized caf, gym, or wellness space.
Recent changes have seen institutions offer other concierge services to their staff in an effort to increase employee happiness and satisfaction, as well as improve retention and recruitment. Although amenities such as staff retail pharmacies have been around for years, healthcare institutions now offer services such as day care, pet care and salon services.
America’s nursing crisis is complex. It may seem like the situation is getting worse, especially with the Omicron surge, the ongoing exhaustion of nurses and healthcare workers, and the current staffing shortage. Technology and design solutions that improve work conditions, prioritize efficiency, well being, and satisfaction can help nurses and staff attract and retain talent.
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