Parkin Blog

Designing the Built Environment to Alleviate Fatigue and Burnout in Nurses

Recently, nursing burnout made the news when the Registered Practical Nurses Association of Ontario (WePRN) reported that 1 out of 3 nurses in Ontario has considered quitting the profession due to burnout over the past year. Similarly, a much larger study in 2010 found that 26% of those considering leaving the profession cited fatigue as one of the key reasons that they are thinking about quitting.

Long hours, a looming nursing shortage, and shift rotation can all take their toll on nurses over the long term. Burnout manifests as emotional exhaustion, dissatisfaction in their personal and work achievements, and depersonalization or an impersonal response to the people under their care. One of the many solutions that can help offer more support for nurses is building and working space design.

When it comes to patient care, evidence-based design elements such as access to natural views and daylight, noise control, room layout, and barrier free environments have proven to promote patient wellbeing, including reductions in the need for medication and decreased recovery times. Designers are now asking how we can better leverage these same elements to benefit the wellbeing of the nursing staff.

Making Walking Easier

It is estimated that nurses walk as many as six kilometers over the course of a 12-hour shift. That works out to about 1250km per year, or 3 pairs of running shoes. Constant movement, and endless hours on one’s feet result in tiredness, aches and pains and injuries. A thoughtful design that takes these into consideration can provide solutions that will support nurses by helping reduce redundant walking time.

Reconfiguring the layout of in-patient floors by positioning nursing stations closer to patient bedrooms can help decrease travel time. Keeping supplies closer to patient rooms can also help.

Interior materials like impact resistant flooring can lessen stress on the feet and joints. Slip resistant flooring and fixtures such as splash-free sinks can also help reduce accidental slips and falls for both patients and staff.

Acoustics

Noisy work environments not only contribute to staff stress, irritability and exhaustion, they  can also cause distraction, which has been shown to be a major factor in medication errors.

The WHO suggests that ambient continuous background noise in hospitals should be around 35db during the day and 40db at night in patient bedrooms. Building materials can help to dampen noise and distraction to alleviate stress in both patients and staff. Designers can specify the addition of acoustically absorbent materials on ceilings, or vertical surfaces to reduce ambient noise. Sound masking, which could be an ambient continuous noise, or the sound of airflow can help to dampen distracting noises.

Lighting

Light plays a critical role in human functioning and our sense of wellbeing.  Nursing staff have unique needs due to the long shifts that they work and the nature of their shift rotations. Shift work disrupts circadian rhythms, which can in turn impact mood and perception and directly impact capacity to undertake complex visual tasks.

Exposure to natural daylight can increase staff satisfaction. Designs that provide nursing stations with direct light through a window or that is borrowed from another room can have a positive impact on staff.

When it comes to artificial lighting, a number of technologies can be used to promote staff and patient wellbeing. For instance, Circadian lighting is used for some nursing care desks to support nursing staff. This lighting mimics the light signals to the brain that we would receive from the sun if we spent more of our time outdoors. Multiple studies indicate circadian lighting helps regulate nurses’ moods, as well as their capacity to undertake tasks with increased alertness.

Staff rest spaces

Taking time out to relax during breaks while on a shift is another key strategy that nurses can take to promote their own wellbeing. Providing a discrete space for healthcare workers where they have the choice to have a quiet time or be social is key. Breaks can provide restorative benefits, but in many cases nurses lounges are underutilized because they are poorly located. With meal breaks averaging about 27 minutes and regular breaks at just 7 minutes, lounge spaces that are located off the unit in a centralized location means more walking for nurses. This makes it impractical for nurses to take breaks at all.

Break spaces can be designed to provide more specific supports for staff. Quiet spaces with a computer where someone can check their emails; social spaces where several people can chat; and refrigerators and freezers sized to accommodate staff lunches and dinners are as important as windows to the exterior. EBD research demonstrates that access to outdoor respite spaces with seating, landscaping and acoustic privacy from patient areas have positive implications for reductions in medication errors, improved staff morale and reduced staff injuries.

Care desk areas

Care Desk areas should be planned to provide a variety of work zones that offer privacy for tasks that require more focus. Dedicated charting and medication prep areas should be designed and located to provide suitable privacy and acoustic control. Providing ergonomic desks and chairs that can be adjusted for the user’s preferences can also help alleviate stress and prevent injuries.

If the unit care station is a shared and open space, designers can provide touchdown pods for charting or phone calls so that anyone doing those tasks does not cause distractions for other staff. Patient Monitoring Equipment can be stored in decentralized alcoves, eliminating the need for staff to continually disrupt the central care station. Decentralized alcoves also decrease the travel time between patient rooms and equipment areas.

Optimized care station location

The location of the nursing station is key to creating a working environment that promotes staff wellbeing. In the examples below, two scenarios for care station location in a 12- to 15-bed inpatient unit are given with these two main aims in mind: a) to reduce travel distance for staff; and b) to provide access to natural daylight and view to the exterior from the care station.

In example 2, the care station is in closer proximity to the window. This results in a longer travel distance from the station to the patients’ rooms, but distances between patient rooms and support and supply spaces are improved. The care station also provides direct visibility to a greater number of rooms, potentially reducing travel to each of those rooms.

This layout offers better access to direct daylight and views, improving the overall quality of the work environment.

Retaining a healthy and happy nursing staff is more important than ever for hospital administrators. By using evidence-based design research, modern hospital architecture and unit layout can help to promote health and well-being for staff, while reducing stress, fatigue, and injuries.

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