Designing an effective nurses' station for behavioral healthcare environments involves striking a delicate balance. Although openness is critical to breaking down an us-vs.-them atmosphere, the space also must make staff feel safe. While there is no one perfect solution, there are common elements that should be considered:
Creating an open portion of the nurses' station that encourages interaction between staff and patients
Creating a separate area where staff can retreat, if needed, and where administrative activities can be conducted
Placing key therapy spaces close to the nurses' station
Ensuring the staff is behind the design concept so it becomes part of the operating culture
Functions surrounding nurses' stations
The design process begins with studying the functions adjacent to the space and the function of the space itself. Patients residing on a unit or wing spend the majority of their time in activity rooms or therapy spaces. A thoughtfully designed healing environment will address each of the functions of these spaces carefully.
For example, a dayroom is created for noisy activities, such as watching TV, playing games, or even eating (for those too sick to come off the unit). A quiet activity room is provided for reading or studying. A group therapy room is arranged with comfortable seating to encourage patients to share and assist one another in their treatment. Outdoor activity patios provide patients with access to nature and fresh air. Individual therapy offices as well as cooldown rooms or seclusion rooms also are needed.
Caregivers are most effective when they are in the midst of patient activity, and designers are obligated to support this model by creating nurses' stations that encourage patient interaction and discourage remote observation. Yet patient needs must be balanced with staff members' needs. Patients can exhibit dangerous behaviors and staff need a safe place to fall back to and reestablish order if necessary. While these two needs may seem opposed, an experienced designer can reconcile them with a successful solution ( figures 1 and 2).
Note the location of the nurses' station in these two patient unit plans. Key: 1 = unit clerk station, 2 = quiet activity room, 3 = noisy activity room, 4 = treatment planning area, 5 = medication distribution room, 6 = group therapy room, 7 = outdoor activity area
Onstage and offstage areas
Key therapy spaces need to be within eyeshot and earshot of the nurses' station. Staff need a simple desk that serves as a home base-the “onstage” area of the nurses' station. The desk can have a high counter to imply a boundary but be positioned in the middle of a corridor to provide easy views of patient rooms and therapy spaces. The desk may have one computer monitor but often contains only a phone so that no work material is exposed to outside observation or tampering.
The main work desk should give patients limited opportunities to pick at its surface. Outside corners must be eased or rounded. Since the desk is ideally situated in the middle of the corridor (the corridor really is offset around the nurses' station), the designer must be careful to not create sharp edges. The desk's size should limit the number of staff who can reside behind it, since staff should be spending most of their time in therapy spaces.
In an ideal setup, the working functions of the nurses' station are in a treatment planning room-the staff's offstage hub. This room should have a door and windows onto the unit that offer the same direct views to key therapy spaces. The windows must be glazed with shatterproof material. The choice of material often is determined by a client's budget or patients' acuity level, but 1/2″-thick laminated safety glazing is recommended. Polycarbonate sheeting (Lexan) is effective as well but can be scratched easily and clouds over time.
In this room we include a large table used for conferences and shift-change reviews, dictation booths, worktables, computers, phones, and chart storage. The medication room is accessed from this space and has a roll-up window so staff can serve medication to patients in the corridor (see room 5 on figures 1 and 2). Staff lockers and a bathroom also are accessed from this space, which includes controls for security monitoring, fire alarm, water shutoff, and room temperature.
By pulling onstage observation into one area and offstage work into another, we are able to provide an open desk to encourage staff to be among patients but also give them a space for offstage work (figure 3).
Critical to a successful nurses' station design is operational support. Staff must fully understand the thought process behind the design and be keenly vested in its success.
An open desk allows staff and patients to interact. There is no glass barrier where notes and cartoons can be taped up or that conveys the message, “This is my office, and you can't reach me.” This helps to break down the us-vs.-them mentality. But if this concept is not understood and encouraged in the staff's culture, the open space will not be reinforced and may even be considered a nuisance.