By Katie Weeks

Forget the cubicle or the executive office: When it comes to designing personal workspaces, a nursing station may be one of the most complex. Not only must these areas address the everyday needs of nurses themselves, but also those of other healthcare practitioners like physicians or therapists who may use the station, patients who are receiving treatment nearby, and patients' family members who are increasingly involved in the delivery of care today. Add in the sanitation conditions that must be address along with the fact that whatever design a facility chooses will mostly likely be in use for 50 to 60 years (judging by the current life span of healthcare facilities in the United States), and there's a lot of pressure to get things right.

Just as treatment varies by illness and patient, there is no one prescription to fulfill all of these users' needs. Designers, however, are embracing the challenge, seeking to answer the question: How can nurses' station design be maximized to improve not only the delivery of care and the experience of the patients themselves, but also to better the working life of healthcare practitioners?

In the past, facilities mostly toggled between centralized nurses stations and decentralized configurations, both of which offered their own advantages and disadvantages. "For the most part, older hospitals have a centralized unit and that creates spaces where nurses spend a lot of time walking as well as hunting for and gathering supplies. It adds up to a lot of miles," notes Lou Bunker-Hellmich, research associate at Ellerbe Becket in Minneapolis. "Decentralized units aim to reduce this walking time to allow for more time spent with patients." And while these arrangements do increase patient visibility and proximity, they may decrease the spontaneous communication among staff. "When stations are decentralized, charting occurs away from a core where a lot of consultation was occurring, and a frequent complaint is that while decentralized nursing stations improve visibility and patient supervision, nurses feel more isolated from their colleagues."

Today, in addition to tweaking the centralized and decentralized arrangements, facilities are playing with hybrid models that aim to offer the benefits of both settings. This was the exact goal of Watkins Hamilton Ross (WHR) in working with Meridian Health System on its flagship hospital, the Jersey Shore University Medical Center in Neptune, N.J. Scheduled to open in August 2009, the project's 36-bed floors are divided so that there are three clusters of 12 single-patient rooms, with each cluster organized around its own nursing station, creating, in essence, what the design team has dubbed "nursing neighborhoods." Each neighborhood is essentially a self-sufficient entity that can accommodate eight nurses or up to 15 caregivers. The arrangement cuts down hunting and gathering time by placing all of a practitioner's essential tools and technologies within easy reach near the patients, while also maintaining a sense of community among the practitioners that allows for consultation or support. "We're calling it controlled decentralization," says Tushar Gupta, principal at WHR in Houston.

Recognizing that not all facilities can afford new construction, Omaha, Neb.-based HDR partnered up with Nurture by Steelcase to create SYNC, which aims to offer workstations that can fit into older floor plates. "If you don't have a workstations where people need them, people will create makeshift ones," Cyndi McCullough, RN, MSN, vice president at HDR, says of the impetus behind creating a system that can be placed where people need it most—and then can also be adjusted years down the road should these needs change. With this flexibility in mind, SYNC, which launched at NeoCon® 2008, is floor-mounted and independent of architectural walls, allowing for easy installation, and workstation shapes are crafted to work within hallway niches. "It was a challenge to make something that could fit into really tight spaces and have a minimal footprint," says McCullough. HDR also sought to create a flexible, universal workstation that can support users of different heights, body types and job functions, can accommodate changing technology, and uses a minimal footprint, among other attributes. As a result, worksurfaces are height-adjustable, allowing users to sit, stand, or perch as they desire.

No matter what the organization—centralized, decentralized or a combination of the two—there are a number of overriding workplace concerns for nurses' stations. Maintenance and cleanability all major factors, as is durability. "These stations often get a lot of traffic, which challenges you to find a way to protect high-design against so much wear and tear. You have to be carefully of what you specify and how the client's maintenance budget will affect the long-term picture," says Karen Mensing, a healthcare interior designer at Ellerbe Becket. So too is flexibility a concern, not only in regards to a range of users/practitioners, but also in terms of being able to support ever-changing technology, and with it comes wire management, power supple issues, and storage concerns for digital and paper components and medical supplies and tools.

Privacy and noise issues also come into play. In a research study done in collaboration with Knoll, Ellerbe Becket examined six nursing stations (a mix of centralized and decentralized units in various facilities) and found that all of the configurations during all shifts had noise levels greater than the recommended decibel levels. Stations must provide areas where practitioners can quickly discuss a case without others overhearing the private details.

And finally, but not least important, aesthetics factor in, as the role of patients' family in the delivery of care increases. "You also have to look at it as a wayfinding destination, which allows you to play with floor patterns, lighting, and color," says Mensing. Bunker-Hellmich agrees,  "The old stations seem like barriers and people want them opened up so they are more accessible by patients and their families. Remove the barriers and facilitate interaction."