Caring for caregivers: Designing environments for recruitment and retention Part 1

August 9, 2009
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Designing efficient and sustainable healing environments can improve the caregiver experience and influence the quality of care delivery.
Caring for caregivers: Designing environments for recruitment and retention Part 1
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.
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