Nurses' Caps, Ballgames, and Hard Hats

Abstract

What do nurses' caps, ballgames, and hard hats have in common? Not much, but there is a common theme among the three. Nurses' caps represent an image of nursing that has long since faded away. Nursing as a profession and nurses themselves are different these days. Ballgames represent an example of teamwork among players, each with a different skill set and role to play to ensure an optimal outcome for the game. Hard hats conjure up an image of construction and are used for safety, protection, and in some cases identification of the person wearing the hard hat and his or her company. Putting these three things together creates an image of the contemporary nurse as a critical member of a design team from the beginning of the planning process until construction is completed.From Nurse's Cap to Design Team MemberThe nurse's cap is a remnant of a time when nurses were part of a religious order serving in hospitals to care for the sick and dying. In this role nurses wore a veil as a symbol of servitude and submission to a higher order in the church. Later, nurses were subordinate to physicians who gave doctors' orders to direct the nurse's work in patient care and to create the boundaries of nursing practice. Critical thinking, autonomy, and self-direction in clinical practice were not deemed appropriate, and in fact, would be considered poor performance (D'Antonio, 2007). These same behaviors today are regarded as critical to ensure optimal patient outcomes (Institute of Medicine, 2003) and role satisfaction for nurses (Sengin, 2003). In magnet designated hospitals, noted for their exemplary work environments, healthcare leaders strive to ensure the empowerment of nurses through collaborative governance structures and shared leadership, and clinical as well as nurse leaders are involved in all aspects of decision making related to patient care and the professional practice of nursing (Laschinger & Finnegan, 2005; Manojlovich, 2005).In a hospital setting, no one is closer to the point of service in most patient care issues than nurses, who are with the patient 24/7. It goes without saying that physicians and other healthcare professionals are also critical to patient outcomes, but most move in and out of the hospital-and specifically, the patient room-in contrast to the nurse, who experiences the patient room and the patient care unit as a constant work environment. Given the perception of the contemporary nurse as a critical thinker who is informed, empowered, self-directed, and autonomous in practice, does it not seem logical that this same nurse could contribute significant information and perspectives as a design team member?Although many nurses are actively involved in major decisions related to patient care and healthcare delivery, they may be excluded from participating in facility design decisions that will affect how they deliver care, interact with each other, and collaborate with other disciplines. Some healthcare executives and architects remain confused and uncertain regarding the value of including nurses in the design team process. For several years, the Healthcare Design Conference (HCD) has included topics related to nurses' roles in facility design, yet questions remain about when to include nurses in the process, what their role as internal or external consultants should be, and how to engage clinical nurses when they are invited to participate on design teams.Some questions recently posed by designers at one of the HCD round table discussions included:* Based on the changing environment of patient room and unit design, how do we as designers best engage and challenge seasoned nurses in the design process?* How do designers best communicate with nurses during the design process, or know whether they understand the design discussions that affect what they are going to get in the end?Contrast these questions with those of the nurses at the round table discussion:* How can we help designers understand how we can best influence the design process rather than assume the role of token nurse? …