Nurse station design - current thinking

The basic thought process behind the design of Nurse Stations for Behavioral Healthcare facilities has evolved over the last 30 years.  This is still a matter of much discussion and there is no clear consensus on what is the “right” way to design them.   The solutions are as varied as the facilities in which they are located.  For the purposes of this discussion, Nurse Station will include the front desk as well as the charting areas of the staff work area.

The major forces at play are as follows:

-        Safety of staff working in the Nurse Station

-        Security of information contained in the Nurse Station

-        Security of equipment present in the Nurse Station

-        Amount of accessibility of staff by patients

-        Appearance of Nurse Station with regard to non-institutional therapeutic environment.

Many facilities report that they have had serious incidents of patients climbing over Nurse Station counters to physically attack staff members.  This often leads to enclosing them with something that looks like a bullet-proof bank teller glass enclosure.  This provides a rather severe looking separation between the staff and patients and many feel is actually counter-productive to the attempts to create a therapeutic environment.

Other facilities have had difficulty with patients reaching over the counter to grab items that they are not supposed to have in their possession such as clip boards, letter openers, pens, computer monitors, etc. 

Some patients like to hang around the Nurse Station to try to obtain confidential information by reading papers on the desk, observing information on computer monitors or overhearing conversations between staff members or phone conversations.  All of these might involve violations of the federal Health Insurance Portability and Accountability Act, commonly known as HIPAA.

Since the onset of HIPAA in 1996, many activities that had been done in the open Nurse Stations that involve verbal communication and some written information have been moved into Chart Rooms or other areas away from patients.  This has resulted in smaller traditional Nurse Stations and larger Chart Rooms or other enclosed rooms.  This addresses some of the issues, but basic security for staff sitting at the Nurse Station remains an issue.  Some facilities say their staff is supposed to be up walking around the unit interacting with patients and not sitting behind the desk and don’t feel this is an issue.  This may be valid for first and second shifts, but the third shift staff may have a need to sit down and do some work while still having the ability to observe patients that may be awake.  

Other facilities feel that some degree of physical separation is required.  One facility went so far as completely sealing up everything from floor to ceiling to the extent that the staff could not hear what was happening on the unit.  They then installed microphones on the outside of the glass walls with speakers inside the Nurse Station so that they could hear what the patients were doing.  Another facility installed three foot wide vertical strips of hurricane rated glass with 6 inch spaces and no frames from the countertop to a ceiling soffit at seven feet above the floor.  This provided a visually non-intrusive  separation that has resistance to patients jumping or reaching over the counter while allowing conversations and passing of small objects through the openings.  Staff members need to be aware that anything less than completely sealing off the work area will not provide much sound separation.  Even the smallest opening will act like a speaker and pass the conversation through to the patients on the other side.

What is the right solution for your hospital or your project?  The answer to that question will be as varied as the facilities and personalities involved in the discussion.  The trend is toward smaller counters and larger charting rooms in new construction and, when possible, in remodeling projects.  The amount of physical separation will probably continue to be the full range from fully enclosed to completely open depending on the needs and desires of individual facilities.