Previous posts (see "Making Healing Safe at Night") by my colleagues have referenced operational and planning solutions to help improve caregiver functions at night. There are also engineering components that help create a successful night-time healing environment for patients and caregivers. 

The environmental systems, like lighting and air conditioning, in a healthcare facility are abundant and very complex. They are designed to facilitate patient and staff safety, and promote healing.

However, one area of concern is the way those environmental systems relate to the night shift staff that comprises up to 30% of the healthcare workers often working 12-hour shifts. 

Medical errors related to sleep deprivation are gaining attention because of the non-stimulating environment that the night shift staff must experience. After all, the environment at night should be quiet with subdued light levels to promote healing and to provide the proper circadian rhythm for the patients.

Unfortunately, the circadian rhythm for the patient doesn’t match the circadian rhythm of the night shift worker resulting in decreased cognition and alertness. 

Engineers need to be aware of this issue and take steps to provide an environment that not only meets the needs of the patient, but also promotes the alertness of the staff. A few areas of consideration that can improve nighttime staff alertness are: 

  • Provide an excessive amount of outside ventilation air to staff lounges, nurses' stations, and staff work areas to promote good respiration. Good respiration and increased oxygen improve alertness. In many climates, the night time air is cool and clean, and the extra energy used to condition the air can be minimal.
  • Provide good task lighting in staff work areas in order to give the proper lighting levels that don’t affect the patient lighting level. Task lighting also is energy-efficient and cost-effective.
  • Design the lighting systems to have the proper lighting circuit switching and dimming to allow lower lighting levels for the patient at night, while providing adequate lighting for the staff.
  • Design using the proper light color (like cool white) for staff lighting to promote alertness. 

The environmental systems of a healthcare facility are designed to facilitate patient and staff safety, and to promote healing. Part of patient safety is the reduction of medical errors by the night shift staff. If designed with this in mind, the environmental systems can be a mitigating factor.

John Sauer, PE, LEED AP, is Senior Director Engineering Design at BSA LifeStructures in Indianapolis. John is a strong advocate for sustainability and the use of energy-efficient design in traditionally high-consuming healthcare environments. John has leveraged his knowledge of heating, ventilation, vacuum, air conditioning, steam distribution, energy centers, and piping design to identify cost efficient and sustainable solutions for all types of healthcare facilities. He can be reached at For more information, please visit