Open plan nurses’ station

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DD has been in hospital fairly frequently this past year. It’s a brand new ward (looks impressive but nothing works) at a specialist children’s hospital.

The ward has mainly private rooms on a main corridor, two mini-wards with four beds each that open directly onto the corridor and open plan nurses’ stations on the corridors. We have had a few stays so have been in the min-ward, in private rooms further away from the station and private rooms right by the station.

I assume there is some reason for the open plan design (any nurses on here that could explain?) but from my perspective it doesn’t work at all.

It is very noisy, because nurses, understandably, need to discuss patients, socialize, etc. The rooms just off the station are impossible to stay in. We could hear everything that was being discussed, not just a murmur but the actual words. At 11:30pm there was still giggling and socializing by the night shift. I am not saying nurses should not giggle and socialize, they have an extremely stressful and demanding job, they should get down time, but The corridor of the patient rooms in just not a practical place for this. The noise continued all day long, DD burst into tears because she couldn’t sleep.

Because I can hear everything, I heard a lot of things I didn’t want to hear and some I shouldn’t have heard. There was a spat between three nurses over some texts which apparently slagged one off to the other. Two nurses discussed the parent of a patient and said she was awful (with more details which I won’t go into). Worse of all I heard a phone call arranging palliative care for a patient, which included the child’s name and bed number. I’ve heard all this on different visits, staying either in the rooms by the station, on the min-ward with no doors or just walking down the corridor (no other way around, you have to walk effectively through the nurses’ station for the exit, to pick up food, to go to the playroom, to go to the parents’ room). The only quiet rooms are the private ones further down the corridor but obviously there aren’t many of those and you don’t get any choice in bed allocation in the first place.

AIBU to think this is an awful design error? The confidentiality breaches alone are inexcusable.

It’s open plan because they need to be able to see what is going on in the ward and be easily accessible.

Normally the rooms nearest the nurses station are for the patients who are going to need more care/observing.

I found it quite comforting when I was in hospital, it made me feel a little bit less alone.

They cannot see what is happening in either min-ward from the corridor.

DD needed obs but they were basic and were all carried out by a student nurse. Even if a child needs higher levels of observation, they still need sleep to recover. Does the access to patient so justify the breach in confidentiality?

When dd1 was born I could hear every word of what the nurses were saying on that long first night on the ward - and they were slagging me off as the new nightmare patient who was going to be in for a long stay (I had incurred the wrath of a nurse on the previous ward by asking for 5 minutes with dh to process some news while she was yelling at me for an immediate answer - wasn't a time vital decision - and she had labelled me as a bad patient as a result).

I am actually anything but a nightmare patient and think I shocked them the following morning by ever so politely letting them know I had heard every word and while I appreciated that you needed to vent and let off steam in the job - I didn't want them to fall foul of a patient who would be liable to complain so I was just letting them know how far the sound of conversation was carrying.

I think that you need to speak to someone (ward manager or matron) about this. It's not OK at all and the nurses need to keep their voices down to stop disturbing patients and to maintain confidentiality.

Open plan is so we can see the patients. We spend a lot of time on the computer where all paper work is done now so being off the ward wouldn't work.
Nurses are meant to be very quiet during the night so as not to keep patients awake. And especially not loud gossiping. I would speak to the sister if I was you. It is not acceptable at all and most certainly not professional. If you don't fancy complaining to the sister get in touch with PAL's.
This is very poor behaviour on the part of the nurses as we all know to be quiet!

It's better then them being holed away!

I worked on a ward where we didn’t have an open plan nurses’ station but small ones in each bay and it was a nightmare, you couldn’t see the patients, couldn’t do discrete telephone calls. Not a good alternative. However they do sound unprofessional and I would be complaining to the ward manager about the volume and also the content of those conversations.

Nurse here. The open plan style would presumably be for the sicker patients so that they can be visualised at all times, not just by the nurse looking after a particular patient, but all of the nurses in case of a deteriorating patient. I work in an intensive care unit in a major hospital and we have a similar style. It would also be so relieving each other for tea breaks is easier too.

However, the lack of professionalism and breaches of confidentially here are absolutely unacceptable. If anything the open plan style should make the nurses more aware of the volume of their voice and what could be overheard by patients and relatives. It’s one thing to vent when you’re on a break in the tea room but to hear sensitive patient information is really bad.

I’d be livid with them if I was in charge there. Another factor to consider is letting the poor patients get some sleep and establish a decent day/night routine, which would be quite hard if you’re hearing the ward gossip at volume at all hours.

I would strongly suggest you speak to the nurse manager (or UK equivalent, I’m not in the UK) and let them know exactly what you’ve heard and how disruptive it’s been. I appreciate that you’ve taken a moment to acknowledge that nurses are allowed a laugh etc but there’s a time and place and they’re definitely taking the piss.

I'd definitely mention to the ward manager that you're overhearing things. That's a calamity waiting to happen. They can't be silent all night running a ward but they need to be discreet and conscientious.

I've stayed in similar wards briefly and totally agree! The noise of nurses voices/the phone etc during the night was awful and made sleep impossible

Nurses need to be able to see and hear patients, esp on a children's ward. Not every child will have a parent / guardian who's able to be there 24/7.

The issue is nurses not being quiet or respecting where they are.

My DC was very ill last year and he was put as close as possible to the nurses station. They didn't disturb us too much.

My DF was on a similar ward for some time and as he was very poorly he was directly opposite the nurses station. We stayed with him a few nights (he was on palliative care) and the nurses were very discrete all the time, no excessive noise, chatting etc. Phone calls made in the corner facing the wall so less intrusive.
I would be speaking to the staff nurse on the ward to express your concerns, particularly about the lack of confidentially.

I’ve tried to do a diagram. From the station you cannot see any of the beds in the mini-wards. You can see inside some private rooms if the doors are open but that could be achieved with a better layout.

I strongly suspect someone made a huge mistake with the layout. There are loads of problems with the new ward. The lights come on on their own or if someone presses the buzzer in another room - this has been going on for a year now since the ward opened and they can’t fix it. It sounds like a small thing but they are very bright lights (obviously needed) and they can come on multiple times during the night. Some of the automatic windows open by themselves and won’t close again either!

I am very reluctant to make a complaint as we are ‘frequent visitors’ and I don’t want the nurses to know I have complained next time DD is admitted.

Having recently stayed in hospital in a similar set up your DD has my sympathy. I too was crying with exhaustion because I had no sleep. I didn’t need to hear about how “he was going out with Jenny F.....how rubbish was that school?.....oooh Felicity W & Andrea ...” blah blah blah every single conversation and no nurse lowered their voice at night, they just spoke at normal volume, add in the ringing phone at all hours & the call bells, the disturbance when visitors arrived/left all stopping at the desk to ask room numbers/directions-it was torture. How anyone is expected to recover in those conditions is beyond me.
The fact that you heard details of patients is awful and you definately should make someone aware that you can hear confidential information.

i think it's possible to mention it without it being a complaint. Can you chat to the nurses about it, if it's fairly new ask how they feel about it, and then sympathise if they say it's too open - 'oh yes I know, not having privacy to make phone calls/have personal conversations like xxxx' Not perfect, but less confrontational?

I work in a hospital (not a dr/nurse/therapist) and I can never find a member of staff on the wards if I need to as they are all holed up in offices - they can't win!

Agree with PP, I bet if you just went and had a chat with them and quietly mentioned that you heard XYZ and would they mind keeping at down during night time hours, I bet they would be mortified!

That being said, I think a word to the manager or at least whomever is in charge on the floor is absolutely warranted, they all need to give their heads a good wobble and realise the impact they are having on patients

Tell them to keep their voices down. As a nurse I would prefer to be told as they have not realised obviously.

We have a very similar setup, actually pretty much identical to your drawing.
My dd stayed in a high dependency room which they had two of just up from the nurse station.
We heard talking but nothing at that time that was as bad as what you heard.
Dd was getting obs every hour so not much sleep anyway.
But it's the content they were discussing, also having arguments about texts is very very unprofessional.

I would try to maybe have a chat with them? Maybe they can move your daughter if possible?

I think you should speak to the ward sister today and just say you can hear everything that’s said at night inc confidential information about patients, and that your daughter cant sleep with the noise. Often the ward sister doesn’t work at night so might not necessarily be aware of the problem with the lights system or the actual impact it’s having. I’m sure you’ll see an improvement quickly if you do this. If you don’t feel comfortable doing this then speak to your nurse on the night shift tonight instead. Or you could go to PALS today who will keep your complaint anonymous if asked to do so.

We’ve been discharged now. I didn’t post about when it was happening because I was so sleep deprived I couldn’t trust myself to be reasonable about it!

Everyone knows about the lights, it’s a huge issue and the contractor couldn’t care less. On our first visit the air con didn’t work at all but they fixed that. The lights and the windows has been ongoing for a year now. The windows are a really weird choice, they are automatic louvres, they have big signs on them warning not to put fingers in them as they close automatically but I am not sure how effective a sign is in a children’s hospital!

Every hospital ward I've been on recently has an open plan nurses station. I can't think of any that don't - well the old nightingale wards didn't but they were redeveloped a long time ago. Due to various family illnesses I've spent time at several hospitals