Open plan nurses’ station

[Booboostwo]

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.

At our place the nurses' stations have all been made open plan after managers decided that the nurses were hiding behind the nurse's station. Also people were hiding cups of coffee there which is against the rules.
Sigh

We also had a wonderful stint on a children's ward the other year where mostly the staff were lovely - but for whatever reason they had an agency nurse (I know he's an agency nurse because he discussed everything about his pay, conditions of employment and shoe size loudly across the ward to a colleague) one night who was like Brian Blessed's Slightly Louder Long Lost Brother. Honestly - after about the 3rd time of him having a conversation walking along the ward in the dead of night and yelling beside DD2's bed and waking her up I was faintly murderous and ended up flagging another of the staff (who was lovely and had a similar sense of humour to me) down and telling them I was beginning to feel faintly murderous here and didn't really need to know which pub he liked in Burton upon Trent at full volume and now be having to get DD2 back to sleep yet again! She laughed and told me not to murder him as the paperwork would be hell on and told him to turn the volume down.

The guy was seriously just continuing on a conversation with someone who was 2 ward bays down the way and saw nothing wrong with it!

We are the only childrens ward in my children's hospital that has an open plan nurses station. All the others have an office right behind. We hate it for exactly the reasons you describe. However there is very useful to be able to see the children. I think I know which hospital you mean. I looked at working there and decided against it. One of the reasons was the way the wards were designed.

I spent a month in hospital a few years ago. On one ward there was no privacy: they wanted the curtains open all the time but it was a mixed wars. In addition they left the lights on all night. Poor man across from me had dementia and woke up every hour very distressed: no nurses to be seen, so I had to escort him back to bed and calm him down.
Loud questions being asked meaning everyone heard your questions (are you pregnant? Are you sure your not ? Why are you sure you’re not?)

Curtains have to be open all the time so we can see the patients. Only allowed to be closed for breastfeeding and personal cares.

I can understand that. But I wasn’t massively comfortable as it was a mixed sex ward

It sometimes feels in NHS hospitals that you should leave your dignity and privacy at the door

I would put a complaint into PALS, and I would include in that the fact that these were personal / trivial conversations as well as confidential ones, so that it can't be brushed off as 'nurses have to discuss their patients'. I get what you're saying about your Dd being a regular visitor, but in that case you don't want this happening every time, do you? You're in the right here. Don't feel bad about asking for change.

When I had my little one it was like this but the ward did have doors on that they closed at night. They were mainly glass though so they could still see us all. I didn't hear them a peep.

Rumour is that the hospital where I work was designed by a company that usually builds prisons, the layout is awful and it obviously wasn't designed by someone who has any idea of working in healthcare.

You can complain/provide feedback anonymously via the care opinion website, you have to login but you can chose any user name you want and you can provide feedback about the situation leaving out any identifying details about yourself.

Its an independent site a bit like tripadvisor for NHS hospitals/health care, however most trusts have liaison from each ward/area who gets the feedback about their hospital and will reply on your review and see if they can resolve the issue. Often they will invite you into hospital to meet and discuss it but you dont have to do this, you can just leave your review and not have further contact, even anonymous feedback may make them think about their practice/take measures to improve things.

www.careopinion.org.uk/info/about

Go to the site above and type your hospitals name into the search bar top right and you can read others reviews of your hospital to get an idea of how it works and what the replies look like, if you also type in the ward number you can see if anyone else has said similar about that ward specifically.

Thanks for that link Straycatblue, that might be a good compromise.

During our stay if I had said anything I think my anger would have come through. At one point I was woken up four times in one hour so there comes that middle of the night feeling where you have just lost the plot and is best not to say anything to anyone. The website seems like a good compromise for providing some feedback in a measured way.

I read an article once that said the average patient is disturbed 56 times per night in hospital! Imagine that means some are more, for example if they need hourly obs! Yes you can raise it retrospectively if it’s easier.

It may be worth mentioning in your feedback that there is a growing body of nurses and doctors who, aware of how important sleep is to healing and wellbeing (esp for longer stay patients) have begun implementing better sleep initiatives in their wards.
It may not be something your ward has thought of (as crazy as that sounds) so you could ask them have they thought of implementing better sleep initiatives.

These initiatives involve for example (and obvs dont apply during an emergency or another safety reason)

• Lights off at a certain time and nursing staff are provided with portable torches and small lamps at the nurses stations.

• Alarm volumes on monitors and pumps reduced by 10% on nightshift (not all infusion pumps have this option)

• Screen brightness on monitors & infusion pumps are dimmed to reduce ambient light if possible , other sources of ambient light reduced as much as possible.

• Sleep masks and ear plugs offered to all applicable patients (not always suitable for dementia etc as would increase confusion to awake "blind" with no hearing)

• Noise monitors with readings taken throughout the day and night. Our ward also has silent subtle lights at the nurses station that flash different warning colours to alert us to high noise levels.

-Non emergency care is grouped into "bundles" to prevent getting woken up for several things one after the other, ie patient turns are scheduled for same time as observations and oral hygeine etc and no non urgent medication after midnight so that there hopefully at least a 4 hour window where patients are undisturbed overnight (they still get observed just not woken)

• Care is taken that noisy bin lids/trolley wheels etc are reported and fixed as during the night they sound even noisier

• Longer stay patients are offered melatonin (if not contraindicated) to assist sleep

• During the day there is also designated "Rest/Quiet time" where efforts are made to remain hands off patient for an hour and lights are dimmed/tvs off etc, visitors are asked to leave and no interventions take place to allow rest during the day. (obvs urgent treatment is not stopped for this) This is esp helpful in wards with open visiting where the patients get no rest during day due to a sucession of nursing/medical interventions and one visitor after another.

These initiatives are all audited and certainly in our hospital are hopefully going to be rolled out in other areas.
Many nurses embrace these initiatives as they want whats best for their patients but unfortunately many nurses still wish to be noisy and have a carry on overnight and it needs a strong charge nurse/nurse in charge to prevent this.
The flip side is that it makes staff sleepy too, staying awake for a 12 hour nightshift in the dark/quiet can be not just challenging but potential safety aspect also.

These are great ideas Straycatblue. DD’s obs and pump and painkillers were all done at different times, so that added a lot more wake ups. I remember post birth I had hourly obs, four hourly painkillers plus the baby and I was out of it after just one night. If some of these had been grouped together it would have helped a lot. A quiet time during the day would also be great because DD naturally got tired in the afternoon but the noise levels were so high she couldn’t sleep at all.

I know, it seems so simple but it really has a massive positive impact on patients and their healing.

It can be dependent on staffing levels however as it means that for the nurses some interventions take longer to do when all grouped together and its just not possible to do it, but certainly the talking at the nurses station, esp the confidential information being shared within earshot is not appropriate and serious breach of confidentiality and the nurses fighting amongst themselves and talking badly of relatives is a disgrace to the profession.

Some patients have found wearing earphones and listening to white noise/relaxation music can help block out the noise,I don't know if that is an option for you and your daughter.
I hope you get some sort of positive response to the issues you have raised and that future stays are improved