Some of the most widely accepted planning approaches used by healthcare design professionals focus on the use of operational scenarios, patient flows, and clinical processes. From this information, additional planning and design criteria is integrated into the concept and schematic design phase through evidence-based design, research, and Lean design principles.

Over the last decade there have been many advances in the effectiveness and sophistication of healthcare planning and design. However, as my colleague Terry Thurston previously wrote about, there is one specific operational scenario we have not fully acknowledgedthe unique characteristics of the third shift for nursing units. 

Of course, this scenario is significant because every inpatient healthcare organization has a nursing team working the third shift every day of every year.

When considering this operational scenario, there are a number of specific planning and design responses that address night shift issues. These responses are directly related to the reduced number of nursing staff on the unit and their physical and psychological well being.

Below are some planning and design recommendations to improve nursing conditions on the third shift.

  • Plan and create caregiver work areas with adequate lighting at night. This includes careful design of the view windows, soffits, and areas adjacent to patient rooms as well as the actual design of the patient rooms.
  • Provide maximum visibility for caregivers, with special consideration for views at night when there are limited nursing staff on the unit. This includes views of the patient room doors, entrances to the nursing unit, and elevators if they are located near the unit.
  • Reduce the distance from the staff lounge to the nursing center. Limiting the number of steps the caregiver takes is very important, particularly for the night shift.  
  • Plan special comfort features for the respite areas of the staff lounge. These should include the floor plan design, furniture lighting, exterior windows, and other features.  
  • Consider locating related nursing and clinical services near each other. The collaboration and operational flexibility can provide positive results for everyone.

Gary Vance is the Director of National Healthcare for BSA LifeStructures.Gary is a recognized thought leader in healthcare planning and design, providing hospitals with creative solutions to their facility problems. He also collaborates with various healthcare constituent groups to develop innovative solutions to operational, facility and organizational problems. He can be reached at For more information, please visit