CHANGE ON A GRAND SCALE.

Byline: Tim Christie The Register-Guard

SPRINGFIELD - No one said opening a 1.2-million-square-foot hospital was going to be easy.

Bringing Sacred Heart Medical Center at RiverBend online required orienting and training thousands of employees, adding new staff and working out numerous technological glitches, all while caring for hundreds of sick and injured patients.

Now, two months after the hospital opened on Aug. 10, the union representing nurses at RiverBend is raising concerns about the design of the new building. They say the sheer size of the building, and its long, linear hallways, combined with unanticipated high patient volume, is putting undue stress on nurses and their ability to care for patients.

Many nurses have found working conditions at RiverBend "to be the greatest challenge of their lives," said Sue Davidson, assistant director of nursing practice, education and research for the Oregon Nurses Association.

Hospital administrators say they're listening to the nurses' concerns and are continually refining hospital processes. They also say that it will take months to fine-tune some of the new technology and processes, and for the staff to become accustomed to a new work environment.

Moving an entire staff to a new hospital is "an incredibly challenging transition and transformation," said RiverBend Administrator Jill Hoggard Green.

If administrators were hearing nothing from nurses, "I'd be very concerned," said Kitty Schiffer, vice president of patient care services. "Specific complaints are a good thing."

Both nurses and administrators say increasing staffing may help address some of the issues. Sacred Heart has added about 210 nurses, including 80 new graduates, to work at RiverBend, for a total of 1,350, the ONA said. But those new nurses have to be trained and oriented. In the meantime, veteran nurses are still getting used to their new workplace.

Nurses were stressed almost from the day the new hospital opened, some said. The first day, when 122 patients were transferred from University District to River-Bend, went smoothly. But hospital officials and nurses weren't prepared for the number of patients that would descend on the facility in the days that followed.

"Forty-eight hours later, we had more than 350 patients," said Pam VanVoorhis, a charge nurse in the Neonatal Intensive Care Unit and chairwoman of the union's bargaining unit.

Sacred Heart officials say they know the past few months have been stressful for nurses and other staff members. They say they're hopeful that, as things settle down, nurses can get rested, take vacations and "return to a sense of normalcy," Schiffer said.

"To see the growth rate (in patients) we saw was very eye-opening," she said. "We needed to ask them (nurses) to do more than they had been doing."

Nurses found themselves caring for the un expected crush of patients in an un familiar work environment that was experiencing its own start-up problems.

In the first few days after RiverBend opened, "We lost hot water. We lost the call system. We lost the phone system. The pharmacy robot didn't work. The (pneumatic) tube system went down," said Lynda Pond, a charge nurse in the labor-and-delivery unit and co-chairwoman of the hospital's staffing committee.

"On Aug. 10 we picked up 3,000 employees and dumped them into a facility and asked them to work," VanVoorhis said. "There was no one to go to to ask questions."

For several weeks after RiverBend opened, the hospital operated in incident command mode, as it would during a disaster.

Administrators staffed a conference room in the hospital 24 hours a day, using computers to track and prioritize every problem that arose. They focused on patient safety, while other, less critical issues were put on the back burner, Hoggard Green said. As a result, "Staff felt disconnected," Schiffer said. "It's not the ideal way to operate."

The issue of greatest concern to the nurses' union, and perhaps the hardest to resolve, is the design of the hospital. Its patient floors have long, straight hallways, and every room is a single-patient room. Nurses say that makes it harder for them to keep an eye on their patients, and it requires miles of walking every shift.

Nurses who wear pedometers say they're walking a minimum of 4' miles per shift and sometimes more than nine miles in a single shift, Pond said.

The time spent walking between rooms, entering doctors' orders into a computer, and going to a fetch supplies takes away the time they spend with patients at bedside, she said.

Hoggard Green said that when hospital officials made the decision to make all patient rooms private, it significantly increased the space requirements, and necessitated long hallways. Other designs, such as crisscrossing, triangular or figure-eight hallways, work only in smaller hospitals and don't allow for future expansion, she said.

Kirk Hamilton is an associate professor of architecture at Texas A&M University, and a board member of the Center for Health Design. He toured RiverBend before it opened and liked much of what he saw with one notable exception. "The patient units are not particularly effective," he said.

There are alternatives to long, straight corridors, he said. "The long ones are not that common. Frankly I'm not that fond of them."

Nurses accustomed to congregating around a central nursing desk now are more spread out. That makes it harder for more experienced nurses to mentor younger nurses, Davidson said.

The nurses' union also is unhappy with the carpeted hallways on the patient floors. Carpeted floors are quieter than many hard-surface floors, which benefits patients. But it can be difficult for nurses to push gurneys and wheelchairs on carpet, nurses said. Once or twice a week, janitors clean the carpets with machines that make a racket, and leave a harsh chemical smell, Pond said.

Hoggard Green said Sacred Heart, University District, also has carpet in its hallways. But finding the right carpet that dampens sound, is easy to clean and has low rolling resistance is "incredibly hard," she said. Sacred Heart occupational therapists are studying the carpet and, if they find that there are areas in the hospital where carpet is not working and doesn't meet ergonomic guidelines, "we'll pull it up," she said.

The hospital also is testing power-assist gurneys and wheelchairs, she said.

The emergency room at RiverBend is one of the departments that saw the most drastic change from Sacred Heart, University District. The new ER, at 44,000-square-feet, is four times larger than the old one. Instead of a central desk with exam rooms arrayed along the perimeter, the new ER is a rectangle with four parallel hallways. Doctors and nurses are assigned to teams that cover hallways within the ER.

Denise Levings, an emergency nurse with 5' years of experience, said the new working environment, particularly the extra walking required, "was rough to get used to."

"Change is always hard," she said.

But she said working in teams with doctors and other nurses "works really well for me." She said she can keep an eye on patients and their vital signs from small nursing stations located in alcoves between rooms.

A patient access specialist who works in the ER and asked not to be identified said the new department is "very different" from the University District ER. "Everyone seems very far apart," she said. "There's a lot of phone communication, looking for doctors and nurses. It took away some of the camaraderie."

Nurses on the seventh-floor surgical unit wearing pedometers found that the perimeter measured a quarter-mile, said charge nurse Janie Fischetti.

"They're frustrated," she said. "It is a lot of walking. Everything is far away. ... We're trying to come up with ways to make it better."

Staff nurses are trying to take the new work environment in good humor, tracking the miles they walk on a world map, Fischetti said.

And there's much to like about the new hospital, she said. "It's a brand-new, beautiful facility," she said. "Patients like it. ... The views are fabulous."

Sarah Erslev, a staff nurse on the surgical unit, said nurses are definitely walking more than they used to. But overall, she likes working in the new hospital.

"I think it's great for patients," she said. "When life is good for them, then it's a little better for us."