The success of a healthcare construction project requires many participants and viewpoints. One voice that’s getting more recognition is coming from nurses.

“They have a very unique perspective on patient and family needs, therefore their informed voice at the design table is absolutely critical,” says Jaynelle Stichler, professor emerita at San Diego State University, research consultant for Sharp Metro Campus, and co-editor of HERD Journal.

A new book from the Nursing Institute for Healthcare Design (NIHD) and Herman Miller Healthcare, Nurses as Leaders in Healthcare Design: A Resource for Nurses and Interprofessional Partners, will be published this fall to inform and guide nurses through the design process with practical information and case studies. In it, more than 20 contributors touch on a range of topics, including nurse-led innovations and trends that will affect design.

Nurses Stichler and Kathy Okland, president of NIHD and a senior healthcare consultant at Herman Miller Healthcare, serve as executive editors on the book and recently spoke with Healthcare Design on the value of the clinician’s point of view in the planning and design of healthcare facilities.

Healthcare Design: How has nurses’ role in healthcare design changed in the last 10 years?

Jaynelle Stichler: More nurses have been actively involved in the design process as agents of the hospital where they work. Healthcare architectural firms have also begun adding nurses as staff members of their firms to translate the needs of the healthcare environment to the architects and the design language back to the clinical providers. (For more on “How Healthcare Facility Design Can Improve Nurse Productivity,” read here.)

Design has now become a career option for nurses, which actually is very appropriate since Florence Nightingale was the first healthcare architect, if you will, who brought in a lot of the attributes of the healing environment.

Kathy Okland: I think that with the advent of evidence-based design (EBD) and the correlation between design attributes and outcomes, nurses became a natural player in those discussions, to translate the environment and to interpret patient experiences and outcomes.

Nurses are very familiar with evidence-based practices based on their experience in evidence-based medicine, so it’s a natural alignment for them to step into EBD and interpret that for others who may have found that science to be rather new.

Why is nurses’ input important at the design table?

Stichler: There’s no other healthcare provider who’s in the environment as much as the nurse, with the exception of some of the therapists. It’s the nurse who understands the needs of patients and families as well as other providers in the patient care setting.

Architects who have lots of experience in healthcare design make assumptions frequently about what’s needed in the clinical environment, and I think many times those assumptions are based on their experience. But every hospital has unique attributes and a unique culture, therefore it’s important that the nurse be at the design table.

What’s the downside of not having staff representation on design projects?

Stichler: When the nurses’ point of view is absent from the design table, serious mistakes have been made. For example, there was a trend to eliminate the centralized communication hub when designing decentralized nursing stations.

Unfortunately that was a huge mistake because both centralized and decentralized work stations are needed. The centralized station is where the nurse and other healthcare providers congregate, discuss the activities of the unit and the patent’s acuity, meet and greet the family, and conduct care coordination.

When that centralized space was eliminated, workarounds were developed. Folding tables were put into a space to be able to accommodate the interprofessional communication that goes on. So you can see how important it is to have a nursing voice that can speak up and say, “Wait, I don’t think you understand what goes on in that space, let me describe it to you.”

How do you encourage more nursing staff to get involved in the design process?

Okland: The first step is creating awareness. Although the last 10 years have brought more of the nurses’ voice to the table, there’s still room for a lot more involvement. Secondly, it’s creating competencies and arming nurses with the information, resources, and support that they need to be informed participants in the process. Then, finally, creating a sense of urgency about how essential the input of those clinicians is in these conversations.

What do architects, designers, and owners need to know about working with the nursing staff on a project?

Stichler: Hopefully they value the nurse as the content expert on the needs of the patients in a healthcare setting. But they also need to know that nurses are becoming more skilled and knowledgeable about the design process. It’s important for owners to value and realize that nurses have a unique perspective about patient care and family needs. No one else can provide that same input.

What’s one trend in healthcare design that you think nurses need to be aware of?

Stichler: There’s a common thread through some of the perspectives that we will be publishing in the book: the move of healthcare delivery outside of the traditional hospital setting. Many of the authors, and I would agree, recognize that patients that are cared for in a hospital will be more and more acutely ill.

Hospitals will look more like intensive care environments than medical/surgical environments. We’re seeing that most of the diagnostic testing and even medical interventions are being done in different kinds of healthcare settings including surgical centers, as well as in the home.  So we’re going to see a metamorphosis of the hospital.

Okland: And what’s going to facilitate that is technology.

During the Healthcare Design Expo & Conference, November 14-17, Kathy Okland and Jaynelle Stichler will lead the interactive discussion “Planning and Design for Healthcare Design: A Nurse’s Perspective.” The 1-hour session will share insights on their book and discuss nurse-led design initiatives that have positively impacted healthcare design. For more information, visit