The nurses' station is the fulcrum of activity on the inpatient hospital floor. At some point, virtually every hospital function intersects at this critical junction, often simultaneously, via impromptu meetings among a wide cross-section of hospital staff. This intensive and varied use presents a set of complex and challenging issues for hospitals and the people that help them effectively plan for new or renovated facilities.
Over the past three years, members of our current Nurture by Steelcase team have conducted detailed ethnographic research at leading health facilities to evaluate a wide variety of nurses' station interactions—especially how caregivers perform their duties and how patients receive their care.
Nurture's research and design approach is built around the user experience. We undertake five steps to provide specific solutions to our healthcare clients: Understand, Observe, Synthesize, Realize, and Pilot/Test.
After analyzing the issue—through business concerns, technology trends, and what's new and how it affects the organization—Nurture's research team goes on-site to build a first-hand understanding of the user's day-to-day work life. The Nurture design research team—consisting of researchers, designers, and product specialists—then synthesizes these findings into design principles, criteria, and concepts that feed into the product development process. Finally, Nurture shares all of this information with architects, designers, and clients.
Building on existing research on nurses' stations, our research process has allowed Nurture to more fully understand the nurses' station and to come up with what we believe to be better design concepts.
Many kinds of work happen in the nurses' station, but traditional designs try to force-fit them into a single, rigid configuration—typically with a fortress-like counter and an enclosed room behind it. This assumes that work happens in neat, defined silos. In reality, there's chaos and crowding, with many different behaviors colliding in the space.
First and foremost, nurses' stations need to be considered in the context of providing patient care and as a functional work space. Sharp aesthetics are nice, but this space, maybe more than any other in the hospital environment, needs to be highly functional.
Through our observations, we have seen examples of different types of nursing station organizational models: centralized, decentralized, and various combinations of the two. Each has its own set of benefits and trade-offs relative to patient care and work.
Centralized. In this model (figure 1), the nurses' station is a central hub on the unit—all workstations are located here, as are the unit assistant and most office machines.
An example of a centralized nurses' station.
Pros: Nurses and clinical staff work together in a central location; quick access to peers paves the way for learning, mentoring, and efficient communication; resources can be consolidated.
Cons: Less proximity to patients; increased congestion and noise.
Decentralized. There is no central hub in this model (figure 2). Nursing stations are located throughout the unit outside each patient room, and the unit assistant is typically located near the entrance to the unit.
An example of a decentralized nurses' station.
Pros: Nurses are closer to patients; possibly fewer distractions; each nurse has his or her own work space.
Cons: Fewer opportunities for informal learning with peers; sense of isolation; less proximity to control center for the unit assistant.
Also On Healthcare Design Magazine...