Letter to the Editor

Abstract

We appreciated reading the article in Nurse Leader (August 2021) entitled, “Exploration of the Meaning of Healthy Work Environment (HWE) for Nurses.” The article brought out many relevant relationship and communication ideas using the American Association of Critical-Care Nurses standards as a framework. Collectively, we work in the health care design field as nurse researchers, designers, and consultants. It is our mission and goal to advocate for the clinical voice at the design table to create optimal healing environments. We are seeing a host of published articles on the HWE but rarely see the physical environment mentioned as a criterion for assessing a HWE. As nurse designers, it is important for us to advocate for the nursing profession to include the domain of the physical environment as a major influence in the well-being of the nurse as well as the outcome of the patient. Historically, nursing has a long and rich heritage in health care design. Florence Nightingale was a pioneer in linking the physical environment to the outcome of her patients. Observing the deplorable conditions of the hospital as well as the mental and emotional status of the soldiers, Florence chronicled her thoughts in Notes on Nursing (Nightingale, 1860/1946a)1Nightingale F. Notes on Nursing: What It Is, and What It Is Not. 1860. Dover Publications, Inc., Mineola, NY1969Google Scholar,2Nightingale F. The Art of Nursing. Morris, London1946Google Scholar regarding the connection between hygiene, clean water, light, fresh air, and sanitation on the soldier’s outcomes. Somewhere along history, nurses have become silent in taking a leadership role and advocating for the importance of the physical environment in the HWE. Florence Nightingale’s legacy provides us with a strong foundation for leading the design of HWE from the physical environment as well as the caring environment. Nurses need to reclaim the physical environment as part of the domain of caring. A resource that nurse leaders might find useful when exploring the design of the built environment is the Nursing Institute for Healthcare Design (NIHD) (www.nursingihd.com). Nurse designers have created a supporting structure to expand their leadership role, expertise, and professional practice in the design of healthy work environments. NIHD is a professional organization that promotes the collaboration, engagement, and integration of clinical expertise into the planning and design of health care environments. Through education, advocacy, and leadership, nurses are promoting the clinical perspective and knowledge in designing and building healthcare spaces, just as Nightingale did. The science of health care design is a growing science as well that continues to validate the observations and changes Florence made in improving the caring environment. The principles around evidence-based design align with our nursing research models and the nursing process to create new knowledge that can be applied to practice. Nightingale pioneered this practice through environmental alteration, where she put the patient and staff in optimal conditions and created the HWE. Nurse leaders should engage in all aspects of creating HWE where “form follows function.” In other words, the physical environment should support nurses to fully function within their abilities to provide quality care to patients. As stated in the HWE article, creating, and supporting a HWE is the responsibility of all nurses. This environmental theory or adaptation theory relies on the nurse to give feedback and insight on the physical work environment to carry out the care and clinical workflow to deliver care. We know that the physical work environment has the potential of being a barrier to nurses' healthy work lives. Long cluttered hallways, poor documentation areas without regard to ergonomics, inadequate or a lack of respite areas, and challenging unit layouts can all contribute to nurse fatigue, distraction, injury, and work dissatisfaction. The pandemic has brought even more of a focus on the work environment, and we would respectfully propose the inclusion of the physical environment as part of the development of a HWE. Jaynelle F. Stichler, DNS, RN, NEA-BCr, EDAC, FACHE, FAAN, is founding co-editor emerita of HERD Journal, research consultant at Sharp Caster Institute for Nursing Excellence, and professor emerita at the School of Nursing, San Diego State University in San Diego, CA. Debbie Gregory, DNP, RN, is senior clinical consultant at SSR in Nashville, TN. Terri Zborowsky, PhD, RN, EDAC, CPXP, is design researcher at HGA in Minneapolis, MN.