Redefining the nurses station.

When working with the codes and regulations that apply to nurses stations, one tends to encounter phrases like "Direct Supervision" and Visual Control." This jargon encourages the design of the traditional nursing station that we see in almost every nursing home we visit. And yet the ultimate goal of today's nursing home is to create a residential setting that is familiar to the "surrounding community" and it provides flexible space for all residents. We therefore need to redefine our terms when referring to nurses stations. In conceptualizing how they really should appear, we should use phrases like, "focal point for residents" and "a comforting residential environment."

Changing the Look

The first step is to hire a design professional who has experience in working with the regulators who have jurisdiction over the facility. The existing codes and regulations written for nursing homes appear to be based on the hospital model, even though -- as we've noted -- these facilities have quite different functions. These codes and regulations definitely should not be the determining influence on the final layout of a nursing unit.

The process for change must begin with dialogue among the regulator, the architect and the owner, and a partnership formed. Our experience has shown that if you start by getting the regulators involved early in the process, they will become an integral part of the team and help obtain the desired goals. The intent is not to try to beat the code, but to develop equivalencies that satisfy regulators' safety requirements and administrators' operational needs. Working toward the intent rather than the letter of existing codes is challenging, but is worthwhile, because the result can change the look of the nursing station and, at the same time, meet the needs of staff and residents.

Redesign Improves

Function

A good design solution for a nursing station develops the desired residential environment but remains an efficient space for nursing staff operations. Rethinking of the nursing station is easily accomplished by taking apart its functions and providing specific spaces that accommodate each task. Such redesign will improve results. For example, by moving the CNAS' stations and placing equipment/supplies closer to where they are needed most -- the resident wings -- the CNAS are able to provide a higher level of care to the residents.

Moving Workspaces

Behind the Scenes

It helps, in keeping with a more home-like environment, to move the business and nursing functions of the nurses station behind the scenes. They can be relocated to a room off of the corridor where the nurses and doctors can perform their duties, such as charting and inservicing, in an environment supporting their everyday business needs, e.g., without interruption. Instead of furnishing the area with built-in casework made of plastic laminate, which tends to be very difficult to change, modular health care furniture can be easily specified to provide versatility as staff needs change from year to year. By removing all of the clytter of charts and business supplies from residents' routine line-of-sight, this approach permits them to enjoy a comfortable, homelike environment.

Redesigning the Existing Station

Moving the nursing station to a specialized room and the CNAs into the resident wings raises the question of what is to become of the area once occupied by the traditional nursing station. By virtue of its location, this area remains a pivotal hub for residents, staff and visitors. One option is to design an area modeled after a homelike setting. For example, replacing the nurses station with a table that traditionally resembles one that you would find in a dining room or a kitchen, where most activity in the home takes place, can encourage resident relaxation and family participation.

Something like this was done at the Presbyterian Home in Evanston, IL. The nursing station area was remodeled to resemble the dining area of a home, largely by replacing the nursing station with a table. Several duties are conducted at the table: it is a place, for example, where nursing staff can be seated while doing some charting while at the same time keeping an eye on residents. The residents have a place to sit in lieu of hanging out at the nursing station and can and conduct some activities there. The lighting was changed from the fluorescent office lights to residential-looking fixtures that give off a much warmer light, which provides a more familiar visual environment. In keeping with the "behind the scenes" approach, the nurses' business functions were relocated to a room behind this new area.

Another example of a progressively designed nursing home is the Warren Barr Pavilion in Chicago -- a nursing home that believes in the new approach to nurses stations. At Warren Barr, the traditional nurses station was replaced with a concierge desk, with a concierge positioned to greet visitors as they get off the elevator. This desk also serves as a CNA station at night. The nursing and business functions were, again, moved to a nurse station behind the scenes.

So, don't let the nurses station get in the way of your plans for a more homelike environment. There are options that are not difficult and, in the end, often make good business sense, as well.

John Peacock, AIA, is with the firm of O'Donnell, Wicklund, Pigozzi and Peterson, an architectural firm with offices in Deerfield and Chicago, IL.