Abstract
Global Pandemic
Most recently, the COVID-19 outbreak has drawn international attention to the pivotal role nurses play in the care of patients. Scenes and stories have emerged from this crisis reflecting nurses across the globe on the front lines. Stories of nurses using Face Time to visit family in the final hours of their loved one’s life. Images of nurses with scars on their face from long hours of wearing a face mask. Nurses praying on the rooftop of a hospital for hope and peace during this traumatic time. Some claim that this international pandemic is a tipping point for nursing that has created a call to action and accountability for healthcare systems to recognize, acknowledge, and to reward the true contributions of nurses and their role in our healthcare ecosystem. Nursing organizations across the world, such as the International Council of Nurses and the American Nurses Association (ANA), are uniting together in advocacy and education for those on the front lines. They are joining together in solidarity and gratitude for nurses who are working long hours and making personal sacrifices to deliver critical care in very difficult circumstances. From letters of endorsement to letters of advocacy, nurse leaders are sending strong messages to national leaders. Scope of practice laws are changing as nurses’ practice across state lines, as well as support primary care, disaster recovery, and community care.
Nursing Roles in Healthcare Design
This pandemic has also brought to light the value of nurses in the design of healthcare environments. As healthcare systems struggled to convert any and every space in the hospital to critical care units, healthcare design nurses across the nation stepped in to support critical decisions regarding patient care, infection control, and critical care. Healthcare design nursing has emerged as a specialty within the nursing profession over the last decade. Nurses are making an impact as leaders in the planning and design of healthcare environments, and their contributions have created evidence to guide decisions for future health facilities. Design nurses serve in unique roles throughout the healthcare industry. Some have obtained degrees in both disciplines such as nurse-architects or nurse-interior designers. Other nurses serve as consultants or project managers on construction projects to help communicate between the design and construction teams and the clinical staff. During this time of crisis, healthcare design nurses are being called upon to help in the problem-solving and response to the current challenges for space, capacity, and environmental safety.
A Personal Perspective
In April, I received a call from several colleagues who had been asked to help convert the Nashville Music City Convention Center to a surge hospital. They asked whether I would join them as a subject matter expert on space design, operational planning, and staffing. We all put on our face masks and gloves and headed downtown. I had been reviewing the literature and reading about how other facilities were handling these similar issues and created an informational resource packet. The Army Corp of Engineers, a construction team, hospital administrative staff from a local hospital who had been called on to serve as the administration for the facility, and representatives from pharmacy schools and nursing schools were all present. There were crude plans laid out, and the discussion focused on the number and acuity of patients, separate toileting facilities for staff and patients, provision for a morgue, staffing (using students, volunteers, and paid staff), ventilator and oxygen use, and much more. It was a surreal experience not knowing how the virus would impact our city, but I was encouraged to see the preparation and strategy being planned. We were able to discern and discuss many items that day that created a great starting point for the team. I thought about other design nurses around the country and wondered how they were responding in their cities and firms. On a whim, I sent out an online survey to around a dozen colleagues and got some interesting data.
Healthcare Design Nurses Responding in Crisis
Eleven nurses from across the country responded, and all have been involved in responding to the crisis. Six nurses work in a healthcare facility and five work in architectural firms. All are in healthcare design and planning roles such as Director of Planning, Design, and Construction; Clinical Operations/Design Specialist; and Executive Director of Strategic Management. Every nurse responding to the survey said their organization was involved in responding to the pandemic. When asked to describe their role, consultant and space planning were among the top functions of their position. Subject matter expert, data development, and boots on the ground were identified as additional roles. Other duties included, policy writing, coordinating efforts to distribute 3-D printed face shields to local healthcare organizations, and equipment planning and equipment procurement. Those nurses working within the health systems were tasked to repurpose spaces and create safe and optimal workspaces. Those nurses working within architectural firms provided overall support, guidance, and best practices.
Lessons Learned
Not much time has passed yet to process all that has taken place during this global crisis. Over time, I’m sure many best practices and lessons will emerge. Based on this short query, here are some thoughts and comments from those helping and designing in real time.
Collaboration and communication were the important first themes that surfaced. With so many professions coming together, an interdisciplinary approach is vital. Valuing each person’s role and expertise helped to quickly create solutions. State and federal representatives, healthcare professionals, and design and construction companies instantly became partners in designing emergency solutions in this crisis. One architectural firm deployed a crisis management team. Being proactive in the healthcare design and construction field with an emergency response team proved to be a great resource. One nurse working within a hospital described the importance of a chain of command for collaboration and quick decision making. She suggests daily check in with teams and disseminating the ongoing plan out to the team daily.
Community coordination was another topic that emerged. Creating a combined community response and effort was a necessity for procuring needed ventilators, medical equipment, masks, and so on. At one facility, the equipment planning team coordinated efforts across the region to bring oversight and organization to the borrowing, procuring and placement of additional equipment ensuring that equipment returns to its owner and tracking of equipment costs. Also, health systems with multiple hospitals across a state or nationally, coordinated maximum use of diverting Covid-19 patients to the best facility for their care. For example, within a health system, one hospital became the regional center for all Covid care ensuring a safe and optimal environment for staff and patients.
Flexibility and adaptability of space was a third critical conversation. Those nurses who worked in hospitals were tasked with surge planning and converting lobbies, operating rooms, exam rooms, and other areas to patient care spaces. Two design nurses stated that their background in critical care helped them provide recommendations for critically ill patients as well as what equipment would be essential. Discussions regarding air exchanges, negative pressure, infection control, access, egress, bed modeling, staffing, and donning and doffing personal protective equipment were all topics requiring flexibility and adaptation. In looking at the future of healthcare planning, it is likely that this subject will be a theme and a standard for any and every project going forward.
Caring for the caregiver became a fourth and final theme. Recognition emerged regarding the importance of considering the needs of caregivers. In such a physically and emotionally taxing environment, how can caregivers be protected and endure such intense work conditions? Respiratory therapists, anesthesiologists, nurses, physicians, pharmacists, nutrition specialists, housekeeping, and supply chain workers all became frontline workers demonstrating true heroics in this time of crisis. One nurse designer commented that designing staff spaces will forever be changed. She believes the voice of the frontline staff will be louder than ever in the design of their work environment. Topics such as staff safety, staff respite, and staff breakrooms will be significant moving forward. Another nurse is confident that this experience will create new inventions, new relationships, and new systems. She perceives that life will not be the same for the healthcare worker or the healthcare culture.
Many thanks to those healthcare design nurses who stepped in to help in this time of crisis and provided me with their insight. (Note: With permission, I have turned their stories over to the ANA where they will be featured.)
Heartfelt Thanks to the Heroes
2020 is the year of the nurse. This was established long before we heard of Covid-19, but the prophetic declaration has truly been highlighted. 2020 is certainly the year of the nurse and all in the healthcare professionals fighting on the frontlines of Covid-19. Stories of heroism and heartbreak will continue to emerge as this pandemic progresses. I am confident that we as a global community will come together as political leaders, healthcare professionals, public health officials, and healthcare designers to study and consider the implications of this historic event. Out of this crisis will come research and evidence to prepare and improve our healthcare delivery system and the importance of health for all. Empathy for healthcare frontline workers is at an all-time high.
As healthcare design researchers and professionals, we have an opportunity to listen, understand, simulate scenarios, and test new innovative prototypes from this healthcare crisis to improve healthcare delivery for the future. As we navigate a new normal, the faces of those exhausted caregivers will forever be etched in our minds. Our gratitude for their unwavering care and commitment to their patients will be at the center of every future design meeting. Thank you to all the frontline nurses and other healthcare providers and support persons for your tireless effort and caring spirit.