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Nobody Asked Me

Gregory, Debbie BSN, RN

AJN The American Journal of Nursing: December 2009 - Volume 109 - Issue 12 - p 11
doi: 10.1097/01.NAJ.0000365161.48600.0f

Why nurses should take an interest in workplace design.

Debbie Gregory is cofounder and health care design director of the Nursing Institute for Healthcare Design, Brentwood, Tennessee.

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Imagine moving into a new health care facility—the excitement, the anticipation of a new workplace. It's beautiful, clean, and "state of the art." You begin your shift and notice that the beds must be maneuvered backward and forward several times before they fit around the corners. The ice machine is right in the heart of the nursing station and when it cranks up you can't hear a thing. And where do these extra IV poles and bedside commodes go—in the hallway?

Who designed this? you wonder. Nobody asked me.

The United States will spend tens of billions of dollars on hospital construction this year. But are these new health care facilities being built to meet the needs of patients, nurses, and physicians—or according to the latest design fad?

As early as the mid-19th century, Florence Nightingale conducted studies linking aspects of the hospital environment, such as lighting, ventilation, and sanitary conditions, to improved patient outcomes. In 2004, having articulated a six-part goal to make patient care safe, effective, patient-centered, timely, efficient, and equitable, the Institute of Medicine published Keeping Patients Safe: Transforming the Work Environment of Nurses, in which each aspect of the nurse's work environment—"the related issues of management practices, workforce capability, work design, and organizational safety culture"—was researched and evidence-based design solutions proposed.

Such initiatives have led health care design professionals to consult nurses about the design of their future work environments. Nursing involves problem-solving processes such as assessment, diagnosis, planning, implementation and intervention, and evaluation. Detailed input from nurses about these processes can help designers make better, safer work environments for both nurses and their patients.

Figure. Debbie

Figure. Debbie

Since workplace design is not taught in nursing school and most health care design resources are created for design professionals, my colleague and I founded the Nursing Institute for Healthcare Design ( to provide inspiration and education for nurses involved in the renovation or new construction of their health care facility.

We recommend that interdisciplinary teams be involved from the earliest stages of the design process. We recently conducted an online poll to determine the value and impact of nursing participation on a design and construction project. Although 72% of the architects and designers who responded believed that nurses aren't educated in health care design and construction, nearly 93% of them agreed that if they were, it would benefit the outcome of a project. When respondents were asked, "Whose opinion do you value the most for design decisions related to nurse and patient environments?" the results were as follows: nurse managers, 33%; staff nurses, 30%; nurse executives, 22%; members of the design team, 15%; and the CEO, 3%.

Challenges remain. In design discussions I've witnessed, architects and nurses aren't always on the same page. Our institute's mission is to bridge this communication gap and to equip nurses to actively participate in important planning discussions. Architects and nurses have told us more than once that they're intimidated by each other. Architects have expressed frustration when they've set up meetings for nurses to look over new designs and the nurses haven't shown up. Nurses may be unable to envision a space by looking at a set of architectural plans and reluctant to give input on a project.

Architecture firms, construction firms, furniture and equipment makers, and others are increasingly asking nurses for their perspective on their work environment. We challenge nurses to learn about what other nurses are doing to influence hospital design, to research design trends, and to speak up, using their experience and problem-solving skills to improve their work surroundings.

© 2009 Lippincott Williams & Wilkins, Inc.