Fighting Caregiver Fatigue

This story, written by Ana Pinto-Alexander, first appeared in the Jan/Feb 2021 edition of Medical Construction & Design. It is reprinted here with their permission.

For years, hospitals have made a push to improve the experiences of patients and their families, not just when the doctor is in the room with them, but every step from check-in to discharge. Designers have ushered sunlight into lobbies, furnished patient rooms to enhance the comfort of visitors and woven art, color and nature into patients’ journeys to distract them from stressful situations and maybe even spark a smile.

The healthcare industry has done a lot of soul-searching since the 1970s, when a traumatic hospital stay in California inspired Angela Thieriot to start Planetree, an international movement to humanize the way healthcare providers treat patients and their families. But even though hospital leaders have become more attuned to the needs of patients and visitors, they sometimes overlook the needs of their own staff, even though research shows the well-being of doctors and nurses is tied to the quality of patient care.

This was the impetus of the provocatively titled book “Patients Come Second,” published in 2013 by Paul Spiegelman and Britt Berrett, executives of two leading healthcare organizations.

Spiegelman and Berrett explain the point is not to rank patients and staff but to shake up the industry and improve how caregivers are treated so they can deliver the best care to patients.

The book quotes a former president of New York-Presbyterian Hospital: “Focusing on employee engagement is akin to being on an airplane and putting your oxygen mask on first, before attending to your kids. How can our people help their patients when they, too, are suffering?”

As designers, we can improve the conditions under which nurses and doctors do their work. These caregivers, whose physically demanding jobs also require them to make life-and-death decisions in a matter of seconds, sometimes don’t have adequate spaces to collaborate, whether treating patients or decompressing during breaks.

Designing better spaces

It is critical to design better spaces for caregivers — not only because they deserve the same compassion demanded for patients, but also because the way their workplace is designed has the potential to lessen burnout in the health care field. A 2019 study by academics from Clemson and Texas A&M universities showed that 27 design factors — from workstation types to outdoor connections to break area aesthetics — reduce or contribute to physical and mental fatigue in nurses.

The study authors note that the cumulative effect of fatigue is what leads some nurses to quit the profession. “As stated by one [survey] participant, ‘It is the multiplicity of everything. It is not just one thing. It is the collective of everything in the course of a shift, numerous days in a row, and over a career.’”

Designers can help mitigate problems that provoke nurse fatigue by reviewing two key areas created for caregivers: the break room and the nurses’ station. 

The break room

Nurses’ lounges have traditionally been squeezed into floor plans, wherever space could be found, which has led to many cramped break rooms with no windows. Although the purpose of the spaces is to provide nurses with a rest area where they can have a cup of coffee or heat up a meal, many of these lounges have doubled as locker rooms and team conference areas, giving caregivers little room to relax or retreat.

Yet, in the past decade, nurses’ lounges have become prime real estate. Healthcare designers are locating the staff lounges where they can have access to windows, and are carving individual rooms for other caregiver needs, like separate locker rooms and rest areas where nurses can have a moment of respite on recliners between shifts. These rest areas also should have windows, to let in natural light and provide access to nature. Designers and hospital officials can also allocate spaces for “quiet rooms” where caregivers can enjoy a few minutes of privacy.

With deliberate design decisions, even small spaces can offer choice and comfort. At UConn John Dempsey Hospital in Connecticut, the break room has floor-to-ceiling windows that wash the space with natural light. The opposite wall is a few steps away, lined with elegant wood cabinets and decorative backsplash with glass tiles in a cheery shade of green. The space transitions from a small table with chairs to share a meal with colleagues to lounge chairs for solo time or one-on-one conversations. The finishes here are as refined as those in patient and visitor areas. All these details create a pleasant and dignified environment and signal to the caregivers that they matter.

The nurses’ station

Nurses’ stations typically look like reception desks, with counters serving as barriers be-tween the nurses and patients or visitors. A couple of nurses might be perched in front of their monitors while facing corridor traffic. Behind them, likely are cabinets, printers and other equipment, and maybe an extra workstation or two.

The nurses’ station can be reimagined to allow nurses and doctors to work better. These caregivers need to constantly exchange sensitive information about patient care but, in many cases, they end up talking in crowded nurses’ stations or huddling in the hallway.

The nurses’ station at Sidney and Lois Eskenazi Hospital in Indianapolis is an open area with collaborative furniture. Cabinets and noisy pieces of equipment were placed against a wall on one end to avoid distractions.
Near the nurses’ station at Sidney and Lois Eskenazi, one space was transformed into a small conference area. Enclosed in fritted glass, it offers privacy for information exchange, while allowing nurses and doctors to see into the floor.

Sidney and Lois Eskenazi Hospital in Indianapolis made a bold decision to try something different. Instead of counters, the hospital chose to make the nurses’ station an open area with collaborative furniture — a collaboration station. This area was designed with a furniture setup that resembles a long one, with rounded, standing-height touchdown stations on either end to facilitate quick conversations between caregivers and easy access to information. Between these two surfaces is a double row of desks — the “bone shaft” — featuring four workstations for individual use. Cabinets and noisy pieces of equipment, such as printers or water dispensers, were purposely placed against a wall on one end of the collaboration station to avoid distractions, similar to what might be seen at an office.

While this is not a typical nurses’ station, the design helps patients understand this is hospital staff working space. Placed between a double-sided corridor lined with patient rooms, the nurses’ station is carpeted, making it stand out against the vinyl floors on the corridors. A bulkhead also delineates the area.

The hospital went further by turning another space on the floor into a small conference area near the nurses’ station. This conference area is enclosed in fritted glass, offering privacy for information exchange, while allowing nurses and doctors to see into the floor.

No doubt, being a nurse is exhausting. Many manage heavy workloads under chaotic circumstances. The physical work environment alone can’t fix all that ails the nursing profession, but it should free nurses from unnecessary frictions and provide them with spaces to rest body, soul and mind. Hospital executives and designers must remember that caring for the patients means caring for the caregivers, too.