The nursing unit of the future
About five years ago, Janet Faulkner, AIA, LEED AP, and John Jex, AIA, both design leaders at Seattle-based Callison, were sitting and chatting in an airport lounge between flights. They found themselves perturbed by the same healthcare design-related question: Why does architecture seem to get in the way of nurses doing their jobs? Fixed nursing stations were crammed with spaces for charting, record keeping, administrative work, and storage, with little room to maneuver, and usually had little direct visualization of the patient rooms under their care. The recent move toward decentralized nursing stations did at least get nurses closer to their patients and relieved them of some of the central nursing station encumbrances. Nevertheless, nurses were still somewhat isolated from each other and were a considerable distance from centralized support spaces and storage for supplies and equipment. What design approach, the two architects asked, would solve these problems? Out came the pencils and napkins and, before long, a new concept in nursing units was sketched out. Early this year the concept was realized in the nursing unit design at a new patient tower at the St. Charles Medical Center in Redmond, Oregon. Recently Faulkner and Jex discussed their ideas and their fruition in an interview with HEALTHCARE DESIGN Editor-in-Chief Richard L. Peck
Peck: What was the basic thinking that went into this redesign of the nursing unit?
Faulkner: John and I let go of everything we've ever seen in nursing units and went back to the fundamentals: What does it take for all users of this space to achieve their goals? We programmed the space from a fresh perspective and used the tenets of evidence-based design. Nurses need to be close to three essential things to be effective: supplies, a place to work on charts, and a patient. So we studied designs that reduced the length of the pathways between these three things so that nurses would be able to spend more time in direct patient care.
Jex: The main factor tying this together is the visibility among the decentralized components. The central core, using Herman Miller's Ethospace furniture system, supports the care team with an environment that promotes focused work in an ergonomically correct setting. It also allows for maximum flexibility for patient and family interaction, while the semitransparent glass dividers permit maximum visibility throughout the unit.
Faulkner: It feels remarkably open and calm. We've eliminated the traditional central core of the nursing unit because it was an obstruction to visibility, collaboration, and care-team efficiencies. The openness is emphasized by the clerestory windows on the top floor.
Jex: In place of the traditional core, we have flexible furniture modules that accommodate care-team charting activities, equipment, storage, and families
Faulkner: An important consideration governing privacy was the acoustical properties of the space. The ceiling tiles, carpeting, even the furniture upholstery were all conducive to sound absorption and enhancing the sense of privacy
Peck: How has nursing staff reacted to this new work environment?
Faulkner: The leadership was very open to change from the start. They felt a need for change and were eager to test the new concepts. We walked them through the concept and tailored it to their needs. This represented a jump in design concepts from the 1950s hospital to the 21st century, and was a huge cultural shift for the staff—in some ways, it was difficult for them to handle.
Jex: As it turned out, the new nursing unit has gained the highest staff and patient satisfaction ratings ever achieved at the hospital, and the administration has been pleased with the fact that physicians were referring more cases to the medical center.
Faulkner: Patients have responded well—for example, I heard one woman say she wishes someone could “reinstall” her gall bladder so that she could stay in the new space. In general, we'll be following this unit in some detail to document any improvements that result in enhanced patient safety, medical outcomes, and care-team effectiveness.HD
Janet Faulkner, AIA, LEED AP, is Principal, and John Jex is Director of Medical Planning at Callison, a Seattle-based architecture, planning, and design firm