Centralized nurses’ stations were the go-to model for hospitals in the past. Then the pendulum swung the other way, and decentralized designs proliferated. But it’s still not a black-and-white debate: There are benefits and drawbacks to both models, and a lot of times, it comes down to the most human level of connection. While more numerous decentralized stations may arguably create better, more frequent connections between nurses and their patients, there’s another side to that coin. Nurses want—and need—connection with their peers, as well.

This is what HOK and Knoll Inc. found in a recent study of nurses from six nursing units across three hospitals. The hospitals ranged from 300 to 800 beds, with 15 to 35 beds per unit, and each one included both centralized and decentralized nurses’ stations. Knoll’s senior director of workplace research, Mike O’Neill, shared the study’s findings in a Healthcare Design webinar titled “Destination Bedside: A Design-Research Program for Effective Nursing and Patient Spaces.”

The goal of the study was to determine which type of unit—centralized or decentralized—had a better effect on nurses’ stress levels and job satisfaction. The answer: Neither. “One wasn’t clearly superior over the other,” O’Neill says, “especially in supporting psychosocial health.”

What the study did do, he continues, was lead to some thoughtful recommendations for design. Most nurses felt that a combined approach would be ideal, with a centralized area supported by a few satellite stations in the hallways. In addition, nurses were keen on putting some effort into clearly marked entry areas with a can’t-miss reception desk. The hope is that such a set-up would provide better guidance for visitors—making them less likely to stop nurses in the hallway, asking for directions and disrupting their work.

These kinds of disruptions are no small problem, O’Neill says: On average, nurses are distracted seven times per hour, and there’s a significant cost associated with that. The error rate for prescriptions administered with one interruption is 6.6 percent, he says; 7,000 annual deaths can be attributed to interruptions/distractions.

Other key recommendations for nurses’ station design focused on the balance of privacy and connection. Nurses want strong visual access to patients—to be able to see easily into rooms—but they also want to be able to see each other. That social connection with peers and psychosocial support, O’Neill says, is critical. On possible solution, he suggests, is a hybrid centralized/decentralized station model in which the central space is a circle or half-circle with an open feel, and satellite stations might be semi-enclosed with translucent material for privacy without sacrificing visibility.

Nursing is a tough job, O’Neill stresses, and issues like these can be important for staff retention. “They need connection,” he says, “but also control over that connection.”