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Hospital Expansion

Specializes in Med/Surg.

My hospital is starting a six story expansion to be completed, hopefully, within the next three years. I am taking part in a committee that will try to make the new tower as "user-friendly" for staff and patients as possible. As I only have experience working where I do now, I came here for some input.

What are the things that stand out on your unit as far as things you would want included in a possible expansion?

What about centralized vs. decentralized nursing stations?

Would you rather have all of your patients headboards on the left/right side of the room or have them head/head with the wall in between

(Hopefully this makes sence, basically laying O-->---------

Is there anything that doesn't work on your unit that you'd caution against?

Since im at work i can only add this tidbit. Head to head beds. That way if you have a hearing or vision impaired person that only has the disability on one side, you can put them in a room with their "good" side toward the door. That way they can see or hear you come in. No one likes to be startled that someone has walked into their room and they didnt even know it.

blondy2061h, MSN, RN

Specializes in Oncology. Has 15 years experience.

Power outlets! 'Nuff said.

LouisVRN, RN

Specializes in Med/Surg.

Since im at work i can only add this tidbit. Head to head beds. That way if you have a hearing or vision impaired person that only has the disability on one side, you can put them in a room with their "good" side toward the door. That way they can see or hear you come in. No one likes to be startled that someone has walked into their room and they didnt even know it.

And this is exactly why I posted here! I would have NEVER even thought about that. :yeah:

Elvish, BSN, DNP, RN, NP

Specializes in Community, OB, Nursery.

I am a big fan of decentralized nursing stations - that way nurses can be near their patients, assuming they are all (or mostly) in the same 'pod'. The floor I currently work on has two wings - one with a centralized nursing station, one that's decentralized. I find the decentralized stations to be much more efficient - a computer at each one for looking up labs etc/checking orders, all the charts for the that pod in that area, and less nurses/doctors/social workers/lactation consultants fighting over the same crowded area.

Apart from that - I would want a room that has space for an IV pole that has an unencumbered path between the bed and the bathroom. Doesn't particularly matter (at least not to me) where it's located, as long as I don't have to wrangle it around a chair, a bedside table, or other equipment (including the bed itself).

If only all managers or hospital designers actually asked bedside nurses...:)

Edited by ElvishDNP

At our brand new facility the thought is to have the pt facing a "nonclinical" wall: nothing in view on the wall that looks like a hospital. Therefore, the sharps containers and gloves are at the head of the bed. Fine unless the pt is up in a chair and the chair is in front of those "clinical" items. I agree with the vote for outlets...more the better!

roser13, ASN, RN

Specializes in Med/Surg, Ortho, ASC. Has 17 years experience.

Flat thresholds! Nothing to boost the IV pole over as you take your patient to the bathroom.

Pepper The Cat, BSN, RN

Specializes in Gerontology. Has 34 years experience.

I would have all private rooms. No more moving beds to accomadate isolation, or the correct sex. It never fails - if the empty bed is female, they want to send a male and we move beds. Next day, empty bed is a male, we need female. We move beds.

Or Pt A doesn't like Pt B. We move beds.

Pocket doors on the bathrooms so you don't have to manover around a door when taking a pt to the bathroom.

Blinds on the windows, not curtains that gather dust.

And if I am really dreaming - each room can control its own heat/cooling! (yeah- like THAT will ever happen!)

RNperdiem, RN

Has 14 years experience.

Here is what I like.

Enough computers to go around if computer charting is used.

Plenty of outlets (I work ICU and need all I can get)

Doorways wide enough to fit a regular bariatric bed through.

Enough room to move a stretcher for transfer without having to take half the furniture out of the room to fit the stretcher in.

Some sinks located outside patient rooms.

Enough horizontal space to rest a chart and med book on.

LouisVRN, RN

Specializes in Med/Surg.

For anyone that can answer, other than the closer proximity to other co-workers WHAT IS THE ADVANTAGE to a centralized nursing station? We have three nursing stations on our 27 bed floor. I think that is perfect considering how many confused patients we get. Our "main" nursing station doesn't even face a patients room, how are we supposed to keep "an eye" on our confused patients with this setup.

Other than that, I must say I am very lucky to work on the unit I do, all of our rooms are large, I'd say about 500 sq feet with the iso rooms being larger and having a staging area, private, all rooms have blinds, recliners, some have flat screens, paintings, crown molding, and they have their own thermostats. Yet I feel this sometimes lends to the patients forgetting they are in a hospital and that their goal is to go home at some point, especially for our indigent and lower socioeconomic patients.

I totally agree with the flat thresholds especially working on an ortho floor! And doors that will open 180 degrees will be a must in my opinion as well.

Turtle in scrubs

Has 10 years experience.

For the most part I prefer decentralized. We have a little alcove w/ computer b/n every two rooms w/ windows so we can see the patients while outside of the room charting. Puts the nurse closer to the patient and further away from the gossip. We do have 3 workstations that are for everyone. During the day they are flooded with SW, doc's, PT... etc. Although nursing does use them some it's not all that much. On nights however this is where the nurses all hang out. The only problems I see with the decentralized concept are:

1. supplies - it is hard to keep staplers and tape in each little alcove and a pain to get up in the middle of charting to go get tape to post rhythm strips, etc. Even though we are 98% computerized charting, there are still some forms that we keep in a centralized place and it is time consuming to run back and forth.

2. It can actually put me further away from some of my patients. For example if I am charting outside of room 2 form my patients in room 1&2, I'm further away form my patients in room 10 & 11 then I would be if I were at a central station. But this also is an assignment issue too.

Still... overall I much prefer decentralized.

Sensors for lights in the bathroom, so that they come on when the patient steps in.

Outlets.... lots and easy to get to.... absolutely!

Sinks that don't splash. We have a beautiful new hospital and the sinks splash, causing the area around the sink to always be wet. Because there are often supplies there, they get ruined and thrown out. Lots of $ down the drain. As much as we try to keep supplies away from the sink they always seem to gravitate there and it is a mess. As I was trying to think of how I would describe our sinks I found this link and thought it was interesting. Actually the website looks like it may have some good info.

Faucet and Sink Design Contribute to Splashing, ICU Outbreak with Resistant Organism and 12 Deaths | News | News | Healthcare Design

blondy2061h, MSN, RN

Specializes in Oncology. Has 15 years experience.

For anyone that can answer, other than the closer proximity to other co-workers WHAT IS THE ADVANTAGE to a centralized nursing station?

We have video monitors and cardiac monitors. I can't imagine them getting multiples of all of these so they can be seen by all. They're at the nurses station. Ditto the radio ;)

LouisVRN, RN

Specializes in Med/Surg.

For the most part I prefer decentralized. We have a little alcove w/ computer b/n every two rooms w/ windows so we can see the patients while outside of the room charting. Puts the nurse closer to the patient and further away from the gossip. We do have 3 workstations that are for everyone. During the day they are flooded with SW, doc's, PT... etc. Although nursing does use them some it's not all that much. On nights however this is where the nurses all hang out. The only problems I see with the decentralized concept are:

1. supplies - it is hard to keep staplers and tape in each little alcove and a pain to get up in the middle of charting to go get tape to post rhythm strips, etc. Even though we are 98% computerized charting, there are still some forms that we keep in a centralized place and it is time consuming to run back and forth.

2. It can actually put me further away from some of my patients. For example if I am charting outside of room 2 form my patients in room 1&2, I'm further away form my patients in room 10 & 11 then I would be if I were at a central station. But this also is an assignment issue too.

Still... overall I much prefer decentralized.

Sensors for lights in the bathroom, so that they come on when the patient steps in.

Outlets.... lots and easy to get to.... absolutely!

Sinks that don't splash. We have a beautiful new hospital and the sinks splash, causing the area around the sink to always be wet. Because there are often supplies there, they get ruined and thrown out. Lots of $ down the drain. As much as we try to keep supplies away from the sink they always seem to gravitate there and it is a mess. As I was trying to think of how I would describe our sinks I found this link and thought it was interesting. Actually the website looks like it may have some good info.

Faucet and Sink Design Contribute to Splashing, ICU Outbreak with Resistant Organism and 12 Deaths | News | News | Healthcare Design

Excellent Link!! I'm going to print it and take it to my next committee meeting! Thank you :D

fitRNpic

Specializes in NICU, PICU, Pediatrics. Has 10 years experience.

I would have all private rooms. No more moving beds to accomadate isolation, or the correct sex. It never fails - if the empty bed is female, they want to send a male and we move beds. Next day, empty bed is a male, we need female. We move beds.

Or Pt A doesn't like Pt B. We move beds.

Pocket doors on the bathrooms so you don't have to manover around a door when taking a pt to the bathroom.

Blinds on the windows, not curtains that gather dust.

And if I am really dreaming - each room can control its own heat/cooling! (yeah- like THAT will ever happen!)

My first hospital job (as a nurse Tech), we were able to control the temp setting in each room. It was done through the phone. We would call the number, dial in the room number, and it would tell you what the current setting was and then you could change it. It is very nice for the patients to be able to control the temperature of their room!

Up2nogood RN, RN

Specializes in pulm/cardiology pcu, surgical onc.

I think our rooms are around 500 sq ft, plenty of room to get around. One of the big chairs folds out for visitors, no more stupid cots. Each private room has a large window with huge bathroom and shower. A computer in each room, 'alcoves' between pt rooms for another computer with chair and the pt chart. 3 med rooms and pods with more computers. Our rooms are similar to a 3 sided square with the equipment, nourishment rooms, pods in the middle, much less walking than centralized I believe. Oh and more than enough outlets. Our beds have outlets to plug the scds into, no more tripping over cords. Now if we can just get rid of the old huge nasty pca machines we'd have it made. We also have locking cupboards in each pt room that we can keep supplies in. Much handier than stuffing pockets with crap.

ETA: we also have windows with a blind to peek into pt rooms from the hallway or close for privacy. The bathroom door is made of a frosted glass that still provides privacy plus it's a huge whiteboard of sorts that nursing uses.

Edited by Up2nogood RN

abbaking

Specializes in Telemetry, Med-Surg, ED, Psych.

Here are some of my idea's for the perfect medical/surgical patient room.

1. At least a minimum of 16 power outlets for each bed

2. No more than two patients per room

3. Keeps beds at least 4 to 5 feet away for eachother

4. Flat-Screen Televisions -

5. No more use of oxygen/suction "Splitters" (double headed attachment used when only one O2/Suction set-up is available)

6. Wall mounted BP/Vital signs monitors with PERMANENT oxisensor - (Easier to disinfect and more cost effective than those sticky ones)

7. A hospital I used to work at had a unique call light system where by the signal could be de-activated from the outside of the room - you'd push the cancel button and it was done. This will save the staff from breaking there backs trying to reach the cancel button on the headwall.

8. Private room: have available 2 sets of O2/Suction (left and right of patient) Semiprivate room: Have available 4 sets of O2/Suction (also to the left and right of the patient)

9. Large bathrooms with a toilet and sink easily accessable to wheelchair confined patients

10. Smaller chairs/Recliners - The ones we have now are way to big and take up WAY to much space.

Unit Ideas

1. DEMAND for a circular patient tower - It is an older type design but I have worked in 2 different hospitals with round towers - They are the best design for patient care - the nursing station is close to patients, and as the healthcare provider - you can see all the rooms.

2. Ensure that MD's, Medical Students, Residents and Attendings have there own laptop or IPad-like device. The nursing staff does not have time or patience to have a MD log them off only to redo all there charting.

3. Storage Space - If you think you have enough - Add more just to be safe.

4. Nurse Manager offices should NOT be on the nursing unit itself.

5. Ideally, have 2 fire escapes

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