The Nurse as Provider, Planner, and Provocateur.

Abstract

A place will express itself through the human beingjust as it does through its wild flowers. Lawrence DurrellA building cannot heal on its own ([Evans & Waggener, 2015]). The same is true that as a nurse, it is innately understood that no single aspect of the caregiver role stands alone. We serve patients and families amid a complex set of influencers--all of which can impact the human experience, either positively or negatively. We research cause and effect, measure process and performance, and design environments as extensions of the therapeutic interplay in an ever-changing enterprise. This healthcare enterprise is more monitored, more regulated, and therefore more exposed than before in the 40 years of my practice experience. The domain of healthcare and thus healthcare architecture is a specialty, which, at its very core, exists to remedy the extremes of human vulnerability. The deeper understanding of the subtleties expressed and exchanged in caregiving is the domain of nurses, and therefore distinguishes how a nurse can uniquely inform design. The empathic nature of nurses has earned the trust of patients and families, the recognition as the most honored profession, and admiration as the voice that can translate the intimacy of care few experience and/or understand. How then, can this perspective not be central to the planning and design of healthcare settings?The domain of healthcare and thus healthcare architecture is a specialty, which, at its very core, exists to remedy the extremes of human vulnerability.The ethos of nursing practice is both art and science. It stands apart as perhaps the only discipline as a constant across the care continuum: from outpatient to inpatient; admission to discharge; public health to parish health; and from illness, wellness, intervention, and prevention. Furthermore, nurses serve in diverse roles: from caregivers to providers, administrators and facility managers, and care coordination to continuous improvement. As healthcare moves from the institutional model to our communities and homes, the nurse remains as the common denominator and the coordinator of care and services irrespective of the setting. Meanwhile, the patients in these settings are not a constant. Patient acuity is increasing. Patients present with more chronic, comorbid, and complex conditions. This patient profile demands a combination of resources and support that require astute clinical coordination and customization. The translation, representation, and interpretation of these practice realities are the domain of nurses that can and must inform planning and design.The current state provides a compelling case for nurse involvement. A look to the future further justifies a nurse's voice at the design table. Technology, nanoscience, and analytics are advancing the science of medicine and transforming the very settings where care is delivered and received. The cadence of these changes and resulting obsolescence is compressing the capacity of providers and leaders alike in a time of operational constraint. A day in the life in healthcare operations is the ever present expectation to do more, better, faster, and with less. The care delivered today will not be the care of tomorrow--nor will the environments be the same to support both. If enormity is the enemy of imagination and lack of imagination is the enemy of innovation--how do we plan the environments for this unknown future state without leveraging clinical intelligence?Nurse-informed architecture is a concept whose time has come. Planning and design of environments have long been assumed as the domain of architects and presumed as such by nurses. As every element of the healthcare experience is being examined for optimization, who is better than a nurse to question, clarify, and inform design? The previous lack of nurse involvement in planning and design may explain why many facilities upon completion are at the same time, retrofitting the space before its occupation. …