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Environmental design Rx for RN workplaces

Recruiting and retaining nurses might be easier if hospital workplaces were more hospitable, reports a team of environmental design specialists who offer a 10-point prescription for those hardworking medical professionals.

“Appropriate environmental and organizational conditions are critical for nurses to be able to do their job best – and also stay healthy and happy,” says Rana Zadeh, assistant professor of design and environmental analysis in Cornell’s College of Human Ecology. She led the project in collaboration with Laura Kennedy ’13 and two colleagues at Texas A&M University and WHR Architects. She adds: “Nurses are the front line of care, and their work directly affects each patient’s safety and recovery.”

When the researchers asked 80 day-shift and night-shift nurses in large- and small-sized facilities what they wanted in their work environment to make them less physically and mentally exhausted and better able to care for their patients, they got an earful: Adequate work space, appropriate lighting, and better furniture and ergonomics topped the list. Not to mention user-friendly amenities; aids to organization and preparedness; forethought to physical access, location and layout; noise control; privacy and security; windows and ventilation; and line-of-sight views to places where nurses are needed.

Many nurses asked for room to circulate, and workstations where they aren’t interrupted while working on patient charts.

“Adequate lighting” for one nurse meant natural lighting “to keep me from getting depressed,” while another said: “I would like to be able to see well when working on patient charts and retrieving medications.” Several asked for relief from the “institutional atmosphere” of fluorescent lighting.

High on the wish list was an ergonomically designed workplace. For some nurses, “amenities” meant easily accessible phones, computers, printers, fax machines and power outlets. Others hoped for better access to bathrooms and refreshments, and at least one nurse said music “could help the day pass.”

From the organizational perspective, some nurses wanted designated spaces for the hospital’s registered nurses, doctors, social workers and other staff to work with no interruption. Some simply wanted better management of storage and supplies to ensure that they “are easy to reach and visible.” And how about specific areas in or near nurse stations for frequently used equipment, such as vital-signs machines?

Hospital patients sometimes suffer from constant noise during their stays – and so do nurses who work there. The environmental designers called (softly) for “acoustic surfaces and physical barriers, such as glass, to control noise and ensure that nurses can concentrate on their work.”

Regarding privacy and security, one nurse said the workspace hub should be “surrounded by glass windows above the countertop, with easy access points; this will reduce noise and help keep patient records private.”

 Day-shift nurses yearned for windows, with a “view to the outside or nature” and “pleasant scenery.” Night-shift nurses would settle for artwork on the walls or soothing, stress-reducing artifacts “like a fish tank, flowers or trees.”

Having their patients’ safety in mind, many nurses asked for better visual access. “Enable nursing staff to see the patients, with the least amount of walking,” one requested, and provide views of the hallways and rooms.

Said Kennedy, a specialist in evidence-based design solutions in Cornell’s Health Design Innovations Lab: “By gathering opinions of those who know the space the best, this project highlights key issues existing in the nursing environment – and simple changes that will have a large impact on nurse satisfaction, productivity and retention.” 

The study, “Design Characteristics of Healthcare Environments: The Nurses’ Perspective,” was published in the online journal World Health Design, January 2014. Support came from a New Investigator Award by the Center for Health Design.

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Melissa Osgood