The nursing industry faces ongoing challenges with staff shortages, long shifts, an influx of patients, and a focus on patient satisfaction above all else. In practical situations, this may lead to nurses sacrificing proper technique and safeguards in exchange for faster service and moving onto the next patient.
The safety of nurses is crucial for many reasons – including patient well-being. Overworked and overwhelmed nurses are at an increased risk of making errors, as well as risks to their own safety. It’s important for healthcare facilities to foster and maintain safe workplaces that reduce nurse burnout, minimize staff stress, and improve patient outcomes.
Florence Nightingale’s Environmental Theory
Florence Nightingale’s Environmental Theory defined nursing as “the act of utilizing the patient’s environment to assist him in his recovery.” Her intention was to ensure the patient’s environment was configured to support the gradual restoration of the patient’s health and acknowledge that external factors – the surroundings – affect the biologic or physiologic processes and development involved in healing.
Based on her observations during the Crimean War, Nightingale wrote Notes on Matters Affecting the Health, Efficiency, and Hospital Administration of the British Army, a report that analyzed her experience and proposed reforms for military hospitals. This revolutionary work drove the restructuring of the War Office’s administrative department, including establishing a Royal Commission for the Health of the Army in 1857.
Throughout her career, Nightingale considered design for nursing efficiency and for the safety of the nurses themselves. She also addressed concepts like sexual harassment and abuse – though those terms didn’t exist yet – and emphasized a safe working environment for nurses and nursing students.
She understood that nursing required long working days but recognized that good design would offer respite to take a break and refresh before returning to the floor.
Her insights led to many architects consulting her for guidance on hospital plans, beginning in 1859 when Prince Albert requested advice about the project for Lisbon Children’s Hospital. She was instrumental in many hospitals during her time, including the Royal Victoria Hospital, King’s College Hospital, and Johns Hopkins University Hospital.
Crucial Safety Concerns for Nurses and Patients
Nurses face countless hazards every day while on assignment. Based on research from the Bureau of Labor Statistics, the rate of occupational injuries among nurses is 53.1 cases per 10,000 full-time workers, leading the Occupational Safety and Health Administration (OSHA) to put stricter rules and regulations into place.
According to OSHA, the highest rates of personal injury among nursing workplace settings happen in healthcare facilities. The top concerns are:
One of the most common injuries for RNs is musculoskeletal disorders, which may occur when nurses lift patients to get them out of bed or turn them. Strains and sprains are the most common, particularly in the back and shoulders. Approximately 20% of nurses leave direct care positions because of their strenuous nature.
Nursing is a demanding position that often requires double shifts or other grueling schedules, often with consecutive stressful scenarios. Burnout is common, which can negatively impact patient outcomes.
Exposure to Disease
Healthcare workers have an inherent exposure risk with bloodborne pathogens like HIV and HCV, as well as airborne infectious diseases like tuberculosis. According to the Centers for Disease Control and Prevention (CDC), about 385,000 injuries to nurses and other healthcare personnel occur due to needle sticks each year. Sharps injuries may also include stab wounds from a scalpel that exposes the nurse to bodily fluids.
According to the American Nursing Association (ANA), workplace violence includes any physical or psychologically damaging actions that may take place on the job, which can come from an array of sources.
Violence in healthcare facilities may occur when nurse staffing is low, leading nurses to work in a remote location in a high-crime area. The emergency room has a high rate of violence as well. The Emergency Nurses Association (ENA) reports that over one in 10 emergency room nurses have experienced some degree of violence on the job throughout their careers.
Nurses are exposed to drugs, sterilization solutions, disinfectant solutions, and other hazardous chemicals that may lead to burns, rashes, or serious illness. The ANA advocates for safer work environments and reduced chemical exposure through chemical component testing, labels, and safer cleaning solutions.
Cause and Effect: Nurses and Patient Outcomes
There’s a causal relationship between nurse-to-patient ratios and patient outcomes due to burnout, workload, and stress. Nursing is high-intensity work, leaving nurses at risk of errors while providing even routine care.
Human factors engineering principles state that when is nurse is attempting a task, such as providing medication to a hospitalized patient, the work environment should be conducive to completing that task effectively.
However, hospitals and other healthcare facilities often have operational failures, such as equipment failures, that may affect a nurse’s ability to effectively perform their job duties. In fact, studies reveal that these types of disruptions are often commonplace in a nurse’s day-to-day work. When disruptions are a regular part of nursing work, these deficiencies can directly affect patient safety.
Longer shifts and overtime are also linked to an increased risk of error, including the high-profile case in which a nurse working a double shift was criminally prosecuted due to a critical error. Mistakes like this are more likely when nurses are working long shifts and experiencing extreme fatigue, which causes inattention, poor judgment, and poor concentration.
Another concern is missed nursing care, a phenomenon of omission that occurs when the right action is delayed, only partially completed, or unable to be performed at all. Missed nursing care errors are common and universal, but secondary to systemic factors, leading to medication errors, infections, falls, pressure injuries, readmissions, and failure to rescue. One of the most consistent predictors of missed nursing care is work environment.
Designing a Safe Environment for Nurses and Patients
Healthcare facility design goals and targeted safety outcomes – reduction of infections, falls, and medication errors – promote better safety for nurses and patients.
Some of the contributing factors are related to design, such as noisy, cluttered, or crowded patient rooms, leading to adverse events like falls or medication errors. For example, poor placement of a sink for washing hands can negatively impact hand-washing compliance, in turn increasing care-associated infections.
With nursing, the design of the nursing unit to provide a space for nurses may limit their visual and physical access to patients, affecting their response times in an emergency.
Evidence-based design considers how the physical design of healthcare environments affects patients and staff. Some of the key features include single-patient rooms, use of noise-reducing construction materials, accessible workstations, and an improved layout for patients and staff.
Evidence-based design elements can prevent patient falls, hospital-acquired infections, and medication errors – three issues that are closely related to nursing environments.
Patient falls can lead to injury and extended stays that drive up the cost of care. These can be avoided, however, with measures like properly placed handrails, large door openings, ergonomically designed patient rooms, and decentralized nursing stations that give nurses better access to at-risk patients.
Hospital-acquired infections can be managed with single-bed rooms and improved air filtration systems that reduce the transmission of pathogens. Another intervention is providing multiple locations for staff to wash their hands, encouraging better hand-washing compliance.
Poor lighting, interruptions, and distractions often lead to medication errors. Providing quiet, well-lit, private spaces can reduce the risk of medication errors among nursing staff.
Patient satisfaction is a key aspect of positive health outcomes. Noise reduction, privacy, and wayfinding all contribute to patient satisfaction, yet most hospitals have overhead announcements, alarms, pages, and noisy equipment that can disrupt rest and recovery.
A single-bed room with sound-absorbing ceilings and limited overhead announcements provides a healing environment. This also allows family to spend more time with patients, which contributes to better outcomes.
Better wayfinding improves the overall care experience and increases satisfaction by reducing stress, anxiety, and helplessness. Better navigation can be achieved architecturally with signage and intuitive corridors.
Improved Quality Outcomes
Design elements can dramatically improve quality outcomes for patients. Along with improving satisfaction, reducing the noise in a healthcare facility promotes better sleep and recovery. Increased natural light, artwork, music, and nature views reduce patient stress levels and depression, which promotes healing.
Nursing Staff Satisfaction and Retention
Staff shortages and turnover are problems for all healthcare workers, but nursing is particularly dire. Much of the turnover in the healthcare industry is related to stress, which can be alleviated by reducing the demands on nurses.
Healthcare architecture can help by providing improved workflows. For example, using adaptable rooms limits the need to transfer patients, improving nurse productivity and reducing the risk of musculoskeletal injury.
Nurses’ stations and supply areas that are more intuitively designed and decentralized improve the workflow and allow nursing staff to spend less time walking and more time treating patients.
Architecture to Improve Nursing Safety
Nurses are the front-line workers in most healthcare settings, bearing the burden of low staffing and high patient demands as well as the consequences when the systems fail. Healthcare design and architecture can aid in improving nursing safety and satisfaction, directly influencing positive patient outcomes.
At Given Design Group, our decades of experience enable us to provide practical safety measures for nurses. For example, in hospitals, nurses need to make a rapid assessment of a patient’s condition at intake, dictating how quickly the patient is seen and where the patient is directed. It is very common for a patient to not be in stable condition or of sound mind during this time. Placing nurses in a fast-track rapid evaluation room alone with such a patient puts the staff at risk, especially when the unstable patient can overpower the nurse and block the door. Knowing that this is a real threat to nurses, the GDG team started adding a second door to these fast-track rooms.
Likewise, we also implemented the addition of a room near the emergency department for police officers and first responders to gather when officers or gang members are brought to the facility for treatment. These first responder areas allow for greater police presence on campus when needed.
Given Design Group proudly maintains its membership with the International Association of Healthcare Security & Safety (IAHSS) working to ensure support for highly critical conversations with hospital staff and leadership about effective ways to manage and direct security and safety programs in healthcare facilities.
With decades of combined experience designing and planning world-class healthcare facilities, Given Design Group offers a personal, hands-on approach to designing healing environments that are efficient and streamlined. Contact us today to discuss your project.