Sanders' story—part logic, part luck—is echoed by RNs at architecture firms around the country. Some arrived there with a lifelong interest in building design, but others— probably most—got involved in a renovation or expansion at the hospital where they worked, and realized, Hey, I like this, and I'm good at it. Some have pursued architectural licensure, but the majority have not. Most concentrate on “front-end” planning and space programming, although a few do design work. And a number, like Sanders, are vice presidents or principals, proof that solid nursing and managerial experience can trump years of detailing hospital bathrooms.

Three or four times during her 30-year nursing career, recalls Lynne Shira of Seattle, she was asked to participate in the planning of hospital projects with architects. “I found it very exhilarating, very challenging,” she says. Then her father was diagnosed with Alzheimer's, and she decided that the stress of being a hospital administrator and supervising hundreds of employees was too much. She knew that a leading healthcare-focused firm, NBBJ, was headquartered in Seattle, so she gave them a call. Seven years later, she's a principal in the firm's healthcare consulting practice.

Likewise, Joyce Durham, a licensed architect in the Detroit-area office of HKS, discovered her latent interest in architecture by chance. As a surgical nurse at Duke University Hospital in North Carolina, she volunteered to lead staff members on orientation tours of Duke's new hospital building. “I would ask why things [in the building] were done a certain way: ‘Why is this like this? It doesn't make sense,' ” she says. “I knew at that point I wanted to study architecture.” Durham went on to get a B.Arch. and then an M.Arch. from the University of Michigan, nursing part time through five years of school.

  • Four of NBBI's seven nurses, from left to right: Tammy Felker, Teri Oelrich, Lynne Shira, and Jane Loura. Says Shira, a principal at the firm: My role is operations lead-- I'm making sure what we design is operationally efficient. That's my passion, making sure that form follows function.

    Credit: William Anthony

    Four of NBBI's seven nurses, from left to right: Tammy Felker, Teri Oelrich, Lynne Shira, and Jane Loura. Says Shira, a principal at the firm: "My role is operations lead-- I'm making sure what we design is operationally efficient. That's my passion, making sure that form follows function."

The route from floor nurse to floor plan may take different twists, but one thing is clear: It's increasingly well-traveled. Nurses have long parlayed their clinical experience into second careers in healthcare consulting, working either independently or for consulting companies. But in the past decade or so, more and more have signed on as full-fledged employees at architecture firms. (This is in large part due to poaching: Firms realize that although a smart consultant can help them, she might help their competitors, too, unless she's on staff.) These nurses now work as, or alongside, architects on most big healthcare projects in the United States, and their ranks seem destined to keep growing.

“The number of nurses who do this [i.e., start a second career in architecture] is increasing significantly,” says George Tingwald, until this fall the director of healthcare design at Skidmore, Owings & Merrill (he has since become director of medical planning for Stanford University Medical Center). Tingwald himself earned a medical degree before getting his M.Arch. He used to keep a list of nurses and others with clinical experience (like doctors and radiation therapists) who were working in architecture, but when the number passed 50 several years ago, he started to lose track.

  • Barbara Anderson
Zimmer Gunsul Frasca
In the late '80s, I didn't meet another nurse doing what I was doing.

    Credit: William Anthony

    Barbara Anderson Zimmer Gunsul Frasca "In the late '80s, I didn't meet another nurse doing what I was doing."

“We're talking in the low 100s right now,” he guesses, quipping, “If we had a convention of healthcare architects who are clinical architects, we could go to a very small resort.” (The AIA and other national architecture organizations do not tally how many architects have transitioned from a previous career, and the American Nurses Association did not respond to requests for comment.)

How Nurses Can Give Firms an Edge

Driving the influx of nurses into architecture is the fact that healthcare is big business for U.S. firms. According to the AIA's 2006 firm survey, conducted every three years, healthcare projects accounted for 14 percent of all billings in 2005, making healthcare the top sector served by architects that year (trailed by the office sector at 12 percent). As the demographic bulge of baby boomers nears old age, analysts predict that America's over-65 population will triple by 2030, with chronic ailments and hospital admissions increasing steadily—spurring yet more healthcare construction.

With more construction comes more competition. Ten or 15 years ago, savvy firms discovered that bringing an experienced nurse with them to client meetings could help land a big project and lay the groundwork for a long, profitable relationship. The trend seems to have started in Seattle. As early as 1981, Barbara Anderson, now an associate partner at Zimmer Gunsul Frasca, was scanning the newspaper want ads in that city and spotted one that intrigued her: Architect looking for registered nurse. “It wasn't any longer than three lines,” Anderson says. She got the job and spent the next four years helping a local architect with marketing. In the process, she learned all about architecture and construction.

  • Joyce Durham
HKS
Research and evidence-based design are changing the way things are done.

    Credit: William Anthony

    Joyce Durham HKS "Research and evidence-based design are changing the way things are done."

Anderson then began to freelance for NBBJ. In 1989, that firm hired Teri Oelrich, a registered nurse with an MBA and a passion for statistics. Now a principal, Oelrich has seen NBBJ's healthcare consulting practice grow into a nurses' powerhouse—there are currently seven nurses employed firmwide and five in the Seattle office, one of whom, Tammy Felker, is a licensed architect. “Every healthcare studio at NBBJ has a nurse,” says Oelrich.

Today it's de rigueur for firms that do healthcare work to have an RN on staff or even a number of RNs in a dedicated healthcare-consulting arm. “I think the past couple of years, it's really become kind of the norm,” says RN and registered architect Kerrie Cardon, a former NBBJ employee who is currently a healthcare consultant for Herman Miller. “If you work on healthcare projects, you need to have a nurse be part of your healthcare team. It's almost expected now.” Merle Bachman, president of HDR Architecture, agrees. When the company recruited Sanders and other RNs, he says, “We did it for selfish reasons, obviously: We wanted a differentiator. Being [one of the] first out there to do it, it helped a great deal. It's not quite as unique as it once was.”