Which means that not having a nurse on the team can be a major liability. “If you're marketing a project, going to a healthcare facility to talk about programming and how you interact with physicians and nurses—if two of the firms have clinicians there, the other two firms are sunk,” Tingwald says.
What nurse–architects and –facility planners bring to the table, above all, is the ability to translate between two professions with very different skill sets—to “fill in the Grand Canyon,” in the words of Rebecca Hathaway, an RN who is vice president of healthcare services at California firm HMC. “Architects can be intimidating [to clinicians],” contends Oelrich. “They use great words, but sometimes no one wants to say, ‘How far do I have to walk? I can't tell from the plan.' We never ask architects to read an EKG.” Bachman says that “97 percent of the time,” bringing a nurse to client interviews has been a “very positive” step. Still, he points out, nurse-consultants can't act as if they have all the answers—hospital staff don't want their own expertise challenged. “It's a little bit of a tightrope,” he concedes.
Credit: William Anthony
When Teri Oelrich was studying for her MBA, she thought she'd work for a big management consulting firm like McKinsey or Bain. But an internship at Kaiser Permanente prompted Oelrich, a registered nurse, to consider staying in healthcare, just in a different capacity. "The first day I walked in [to NBBI], I thought, "I want to do this--to help plan hospitals.'"
By acting as interpreters, nurses in design firms feel they can make hospitals safer, more comfortable places for both patients and the clinicians treating them. Improving work environments for nurses who are run off their feet is cited as a motivation by most of the subjects of this article. “I've worked in facilities that are dark, that don't provide respite spaces for staff to recharge,” recalls Shira. A colleague at NBBJ Seattle, registered architect and former critical-care nurse Felker, argues that patient-centered design—a current buzz phrase in healthcare architecture—should not come at the expense of hospital staff. “They're there 24/7, 365 days a year,” Felker says. “Anything we can do to make a better environment, so they provide effective healthcare, is critical.”
When seen through a nurse's eyes, seemingly insignificant design decisions take on new, surprising weight. Hathaway cites the example of electrical outlets. As the nursing workforce grows older, “Why do we put electrical outlets next to the floor, with nurses bending over constantly?” she asks. Or, as Oelrich puts it, “Have you ever hauled laundry 500 feet? Look where you put the utility room!”
“Burnout” is a term that crops up frequently when speaking to RNs. Oelrich stresses that she tries not to worsen an already severe nursing shortage by hiring straight off the hospital floor: The RNs she recruits need to have administrative experience first. Ultimately, Oelrich hopes, “by having nurses design [nursing] units, we can make them more efficient, which will off set the shortage.”
Credit: William Anthony
Herman Miller for Healthcare
"Having walked in white shoes, I could see how staff would use those spaces."
For others, the focus of their design and planning efforts is firmly on the patient. Sharon Woodworth, an architect and former nurse (though not an RN) who is an associate principal at Anshen + Allen in San Francisco, spent much of her childhood as a patient in Texas Children's Hospital. After graduating from nursing school, she went to work for the medical team that had cared for her and “had some illusions shattered.” An aptitude test pointed her towards law or architecture, and she went on to get an M.Arch. from the University of Texas, Austin.
Even after 15 years in nursing and 12 in architecture, Woodworth stresses that her perspective is still that of a patient. She laughs as she describes the first hospital project she worked on as an architect, when a naïve younger team member tried to cram two unisex patient showers into a small space under a stair. “I said, ‘That's not going to work. You [the patient] have got a tube coming out of your body and no room to maneuver!'”
“For me,” she continues, “hospitals are our most powerful buildings. They are a metaphor for life. I don't think nurses necessarily bring that to the table—but those who experience hospitals fully [as patients] do.”High Demand, Short Supply
Today, as state-of-the-art robotic devices revolutionize the operating room, hospital architects must learn how to design around new equipment and procedures. Evidence-based design—an approach that draws on quantitative research to reduce the rate of medical errors and improve patient outcomes—continues to gain ground, but the definition of “evidence” remains slippery. There is a more urgent need for specialist healthcare architects and planners than ever before.
Credit: William Anthony
"People [at client meetings] have come up and said, `I'm really glad they have someone like you.' "
And yet only two architecture schools in the United States offer specialized healthcare programs. “One of the biggest mysteries of my life is that there aren't 20 programs like ours,” says George Mann, who helped to create Texas A&M's Certificate in Health Systems & Design. (The other program is at Clemson University.) Mann has seen an uptick in interest from students, but not enough to meet demand: He estimates that graduates of his program receive an average of eight job offers.
With national shortages, then, of healthcare architects and nurses, and given the fact that many nurses are nearing retirement, who will provide the expertise to navigate medicine's next wave of change? It's a question that's bound to tax architecture firms (not to mention the hospitals that hire them) as they look to the future.
But for now, the dedication of the nurses in their ranks remains unabated. Anderson of Zimmer Gunsul Frasca, who was perhaps the first nurse to go to work for an architecture firm back in 1981, had a total hip replacement at Seattle's Swedish Hospital over the summer. “Boy, did I get to see the other side of what nurses do again,” she says. “They are running so hard. We need to really listen to them and act as their advocate.”