Skilled Nursing facilities tend to have the design of 1940’s hospital model—a spoke and hub layout, with the main hub being the nurses’ station or command central where all of the charting and observation takes place and the spokes being the views down multiple hallways of the patient rooms for “safety.” Nurse call systems and pull stations are typically tied to signal lights above patient doors so that command central can easily view who is in need of attention. The difficulty with this system is when the nursing staff is busy in the hub with charting or other activities their view is of the charts instead of down the corridors.
Most assisted living projects have eliminated the nurses’ station in an effort to be more homelike. Acute care “hospitals” have decentralized nurses’ stations and now have fold-down wall charts. So the question bears asking, why do skilled nursing facilities need nurses stations in 2010, an age of ever advancing technology where call lights can alert a staff member via cell, pager, or central dispatcher? Closed Circuit TV systems offer views of all corridors without being smack in the middle of the hall. These both lead to opportunities for the design professional to create soft space for the patients or residents.
Yet while assisted living and acute care designs have incorporated these design changes, charting needs and visiting doctors and social workers kept these designs from making the same changes. Charting and medication carts are the biggest issue as they need a home, and the staff using these feels the need to have a private area, away from patients and their families, while entering data. This is compounded by codes that require medication rooms to be adjacent to the nurses’ station, even though most meds are now on carts. Electronic charting could change the attitude of the must have command central station, but the cost is usually too high to change to a paperless system. Unfortunately, for the time being, it seems that we are caught between code and costs.