Healing by Design
RN architects draw from their experiences on the floor to design warm, efficient environments for nurses that reduce stress and replenish the spirit — and for patients to heal in comfort

By John Leighty
April 23, 2003

When Froedtert Memorial Lutheran Hospital in Milwaukee decided to tackle the nursing shortage by hiring 100 RNs in 100 days, a big selling point was the innovative design of its new North Tower that took into account the physical and psychological needs of caregivers.

Creating a nurse-friendly environment with warm lighting, easy access to supplies and mobile charting stations was a job perfectly suited to Karen Jones, RN, a health care design specialist at the architectural firm of Hammel, Green & Abrahamson Inc. She developed features that helped attract and retain RNs at the five-story, 118-bed addition to the teaching hospital.

"A lot of focus has been centered on spaces that promote patient wellness and satisfaction, which is necessary, but we also have to look for ways to retain the nursing population within hospitals," said Jones, who earned her nursing degree from the College of San Mateo (Calif.) and spent more than 10 years in clinical bedside positions in hospitals before going into design.

Part of her role as a designer is to find out what nurses need and then improve operational processes. She's also expected to be a patient and hospital staff advocate for the design firm. "I'm in a position to advocate for what nurses need in work processes and to look critically at their wish list," Jones said.

For the North Tower project that opened in September, a patient room was converted into the nurse work area to give nurses access to a window for daylight. The space was designed as a quiet place for nurses to retreat and regenerate.

Jones said mobile supply stations are used so nurses can decide where to place them for the greatest efficiency on their shifts, which run 10 hours for seven straight days, followed by seven days off. Since a new model of caregiving is emerging with electronic bedside charts and summoning technology, there is no longer a need for a centralized station for monitoring patients.

The campaign to hire 100 nurses was successful and the vacancy rate at the 338-bed tertiary facility is less than 5 percent, according to John Balzar, vice president of facility planning and development. "Part of the effort involved letting the nurses tour the new North Tower to see what the work environment would be like."

Healing environment

Other hospitals across the nation are experimenting with similar approaches to making spaces appealing, comfortable and soothing for patients and staff. Some of these, such as Froedtert Hospital, are associated with the Pebble Project, whose purpose is to create a ripple effect in the health care community by providing researched and documented examples of projects that have created life-enhancing environments for patients, families and staff.

Creating a total healing environment is a long-term design goal of many facilities, including the 181-bed St. Charles Medical Center in central Oregon, where patients can relax by a cozy lava rock fireplace, enjoy a piano concert in the lobby and even fish for bass in a well-stocked pool.

The emphasis isn't only on patient comfort, it's also on creating a warm, efficient environment for nurses that reduces stress and replenishes their spirit, according to Kerrie Cardon, RN, who said a new attitude has developed in the design of 21st century acute care units.

"With every project, I can envision myself in the spaces I'm designing and really draw on my nursing experience to assure that the needs of nurses are met," said Cardon, who worked in med/surg at a Bozeman, Mont., hospital before becoming a health care architect.

"I understand what nurses need," said Cardon of Seattle-based Callison Architects. "I've walked in the white shoes."

At St. Charles, which is undergoing an $82 million, seven-year renovation, Cardon worked closely with staff nurses, involving them in the design process. This resulted in many innovations, such as making sure busy nurses had a space of their own to retreat and rejuvenate-an idea that is being incorporated at other hospitals around the country.

One solution to reducing walking distances and increasing efficiency was to incorporate mobile charting carts that can be moved about and docked at "charting islands" to give caregivers flexibility and easy access to supplies.

Open inner court areas at St. Charles allow nurses to look across and see other units and not feel isolated, Cardon said. The hospital also provides private spaces in rooms so that family members can stay 24/7 and actively participate in a patient's care, which Cardon said has significantly reduced the incidence of patient falls.

"When you provide spaces in rooms for family members, this eases the workload of nurses and helps reduce some of the stress," Cardon said. "It also gives family members the confidence and competence to help take care of the patient when discharged."

In a time of nursing shortages, designing thoughtful spaces for nurses should be a priority for hospitals administrators who want to recruit and retain the best caregivers, said Cardon, who is helping to create new and innovative units for nurses in several other facilities in the Northwest.

A new health plan

Nancy Moore, Ph.D., RN, senior vice president of clinical and healing services at St. Charles, said the emphasis on a healing health care environment is beneficial for patients, their families and caregivers. She said cutting travel time for nurses, adding natural light, providing a room for a retreat and a giving a sense of openness in the work spaces does wonders for nurses' attitudes and performance.

"I feel really blessed to be part of this dedicated vision of creating an environment conducive to healing on all levels," Moore said.

At Bronson Methodist Hospital, a $181 million redevelopment of the downtown campus provided an opportunity to use new design elements to their fullest potential. This has resulted in dramatic improvements in patient and staff satisfaction and a nurse turnover rate that is consistently below the national average.

Jackie Wahl, RN, director of operation improvement for Bronson, said nurses took part in the design process, helping to conceptualize the optimum environment. "They were involved in the whole journey of getting the new hospital built."

A major mobility issue was addressed by designing units for one-stop service. The surgery services, for example, are on the same level, including general surgery exam rooms, physician offices and surgical recovery spaces.

"Staff nurses and physicians who have to see patients before and after surgery can easily do so without having to go to another floor or hospital area," Wahl said. "The whole area connects along a service line and the same is true for the trauma, ER, and rehab units."

Wahl said the hospital's open, airy environment gives nurses space to work without bumping into things. The patient rooms are private and made large enough to accommodate family members with foldout furniture for overnight stays. There is also no distracting overhead paging system and nurses are connected via pagers or wireless phones, creating a quieter healing atmosphere for patients and nurses.

Susan Ulshafer, senior vice president of human resources, said the use of natural light, soothing music, art and gardens has resulted in a pleasant, healing environment, but added the physical amenities come second to the well-being of patients.

"A beautiful new building doesn't make a good hospital-it's the people in the building," Ulshafer said. "A main part of the healing environment is making sure the patient is the center of all experiences."

Stamp of approval

Patient satisfaction rates, she said, have been high throughout the hospital system and-for the third year in a row-received the highest ranking in a comparison with similar-sized hospitals (200 or more licensed beds) in Michigan, Indiana, Ohio and Illinois. Survey questions probed patients' satisfaction with areas such as parking, wait time, interactions with staff, pain relief, treatment with respect and dignity, sensitivity to ethnic, cultural or religious needs, physical surroundings, billing and meals.

Data have been gathered showing that since Bronson's inpatient and outpatient pavilions opened in April and November 2000, nursing vacancy rates have fallen and are about half the state average. The survey also found that:

Private patient rooms have resulted in decreased patient transfers and an increase in patients' sleep quality.

Private rooms, location of sinks and air inflow design have resulted in a decrease of nosocomial infections to six or fewer per month.

Market share has increased 1 percent.

Another study is under way looking at the effects of design on the culture of the organization, Ulshafer said.

Wahl, who has been at Bronson for almost 24 years, said nurses who usually work 12-hour shifts find ways to relieve stress by taking short retreats in the garden areas and even by eating in the natural light of the ceilingless "Sky Court Cafe" in the medical office pavilion. There are also no blaring TVs in public areas-they've been replaced by aquariums.

"This is a hospital that nurses enjoy working in," Wahl said. "There's satisfaction in knowing you're coming to a bright and cheerful environment that is contributing to patient improvement and healing."

Contact John Leighty at johnsan@aol.com