A recent survey found that 41% of nurses would not want a loved one who is ill to receive treatment in the facility where they work.

This sobering statistic is only one of many red flags being raised by caregivers in the United States. Fifty-four percent of nurses surveyed say they wouldn't recommend nursing as a profession. Another 54% say they are suffering from burnout. In a separate study, more than a third of new RNs surveyed had already left their first jobs due to stressful work conditions, and over a quarter of the same sample reported that lack of supplies and equipment make it difficult or impossible to do their jobs.

Current conditions

America's chronic nursing shortage—at the 2008 annual meeting of the American Organization of Nurse Executives, economist Peter Buerbaus projected a shortfall of 285,000 nurses by the year 2020—receives plenty of attention. But one of the main issues driving nurses from the profession is consistently overlooked: the condition of the environments in which they are expected to work.

Providing healthcare in the 21st century is a radically different proposition than it was 25 to 50 years ago, when many of the hospitals still in use today were designed and built. Medical complexity, models of care, work processes, technology, and communications have all undergone significant change. Nurses care for patients who are more acutely ill, considerably heavier (obesity rates are climbing), and in their care for much briefer periods of time. The physical and emotional stress of the job has grown proportionally; occupational injury incidence rates among nursing care workers are higher than those of mining or construction workers.

New technologies have added to the complexity even as they have improved productivity and response times. Mobile communications devices save steps and provide real-time information, but also require a stressful level of multitasking and coordination with constantly changing electronic equipment.

But little has changed in the physical environments in which caregivers are expected to work with the new technology and care for higher acuity patients who are transferred or discharged at rates of 40 to 70% per day. Nursing unit configurations typically limit visibility, increase isolation, and add travel time and distance—all of which conflict with efficient and collaborative nursing care. Charting stations have not evolved to support changing technology, proper ergonomics, and team work processes. Even where decentralized stations have been incorporated to bring caregivers closer to their patients, they often result in staff being more isolated from their colleagues.

Future opportunities

The healthcare industry is currently experiencing a construction boom. Fifty-eight percent of hospitals plan to add beds in the next several years, and $31 billion in new healthcare construction is currently in the planning phase. These numbers add up to a significant opportunity to design safe and efficient healing environments that support caregivers and their changing work processes.

In addition to developing facilities that support patient-focused and family-centered care, design professionals need to provide work environments that are staff-sustainable, that help to improve staff satisfaction, and reduce absentee and vacancy rates.

Staff-sustainable spaces encourage communication and consultation among caregivers and create opportunities for peer support and mentoring. They support efficient work processes and provide physically and emotionally overtaxed workers with places where they can rest and reenergize.

Flexible coordination centers

Creating a truly supportive work environment for caregivers begins with redefining the areas traditionally referred to as "nurses' stations" or "charting stations." These terms are limiting in their description of places where doctors, nurses, pharmacists, respiratory and physical therapists, social workers, case managers, and dietitians interact and perform a variety of complex tasks. Today's care teams require flexible coordination centers that provide options for collaboration, consultation, and concentration.



The concept sketches presented here provide an example of what such a center could look like. Located in an open area defined by demountable glass walls, the center balances the desire for visibility throughout the unit with the need for acoustical privacy that allows comprehensive discussions of patient care plans. The collaborative spaces are large enough to accommodate in-services or conferences, yet can be subdivided with moveable screens and partitions to support smaller groups. Overall, the amount of physical space dedicated to the coordination center is appropriate and provides the team with a comfortable work space.



The concept also includes spaces where two to four people can meet for a quick, discrete consult among caregivers or between caregivers and family members. These consultation spaces can provide crucial support for mentoring; seasoned nurses can use them for on-the-fly meetings with newer nursing staff. These versatile spaces can also serve as offices or ancillary work areas, adapting to the changing needs of the unit.



Another essential component of the coordination center concept provides single-occupant spaces where caregivers can focus on individual tasks that require a high level of concentration. These spaces are designed to support all members of the care team who need to access and retrieve information from both electronic medical records and paper charts.

Sanctuaries for respite

Caregiving is hard work, and the hours are long: 40% of nurses today work shifts of 12 hours or more. The resulting stress and fatigue can lead to absenteeism, staff turnover, and higher medical error rates. In order to better care for their patients, caregivers need spaces designed to help them care for themselves, to recharge their bodies, and replenish their spirits.



Lounges where staff can meet for peer support and camaraderie need to be thoughtfully programmed to give caregivers room to breathe. Access to natural light and adjacent outdoor spaces promote rest and rejuvenation. Small, single-occupant respite rooms—with amenities such as lounge furnishings, warm colors, nature imagery, music, and adjustable lighting—provide solitary sanctuaries for over-stimulated caregivers.

A staff-sustainable environment that cares for and responds to the needs of caregivers gives them time and energy that they can give back to doing what they want to do: care for patients. Environments designed to support efficient and effective work will go a long way toward recruiting and retaining caregivers who love their work and who can heartily recommend their profession and the healthcare facilities in which they work.

In Part 2 of this two-part series, the author discusses processes for planning and developing staff sustainable healthcare environments.

A healthcare consultant with Herman Miller Healthcare, Kerrie Cardon worked as a registered nurse for 14 years before becoming an architect specializing in healthcare design.