23. Environmental impact

Lancashire West Branch

(MFD) That this meeting of RCN Congress considers how the design of work places affects the working practices and health and safety of nursing staff

Debate report

“Nurse knows best” stated Kirk Panter of Lancashire West branch who proposed this matter for discussion, when talking about how nursing staff must be involved prior to the design of any health care environment to ensure that it is fit for purpose.

He stated that a well functioning building is essential for the health and wellbeing of staff and their ability to effectively carry out their role.

A bad design can also have severe cost implications as elements that do not function efficiently are changed at a later date following a series of trial and error.

Mike Travis, who is a safety rep, stated that the elements that need to be looked at prior to designing a building are: lighting, uniforms, floors, ventilation, occupancy rates, IT systems, rest facilities, and space.

Congress heard of the impact on the health and wellbeing of staff that if people work in an unsuitable environment they will inevitably experience environmental stress.

Background

Nursing can be a physically and emotionally demanding occupation and staff are exposed to a number of physical and psychological hazards at work.

The Boorman review of NHS health and wellbeing (Department of Health, 2009) found that health care workers have a greater propensity for incurring a work related illness or accident than other comparative groups of workers, and are more likely to be absent through illness than other workers.

A poorly designed work environment can increase the risk of injury and ill health. For example, a lack of space to manoeuvre can increase the risk of back injuries,and poor lighting and cramped working conditions can increase the risk of sharps injuries. Poor ventilation, lack of natural light and temperature control can also impact on wellbeing.

Good workplace design can improve morale, reduce the risk of injuries and ill health and promote productivity. However, good design is wider than the physical working environment incorporating the design of processes, equipment and systems and how people interact and work within these systems (a science known as ergonomics).

In the Commission for Architecture and the Build Environment’s Healthy hospitals survey of 2004, directors of nursing reported that hospital design was a very important factor in recruiting, retaining nursing staff and improving morale. In the survey, 56 per cent of nurses who took part strongly agreed that working in a poorly designed hospital contributes to increased stress levels.

A number of studies have shown how workplace design can play an important role in reducing the risk of violence and physical assaults. A Design Council project, which was supported by the RCN and NHS Protect, and funded by the Department of Health, recommended design solutions including the layout of the environment and the provision of information to reduce the risk of violence and aggression.

UK wide initiatives such as Secured by Design have also helped to address security and safety of staff in NHS premises.
One of the key lessons learnt was the importance of engaging with frontline staff affected by violence, seeking their views on improvements. Furthermore, there is a legal duty on employers to consult with trade union safety representatives before implementing any changes that could affect the health and safety of members. This would include changes to the design and layout of the working environment.

References and further reading

Commission for Architecture and the Built Environment (2004) The role of hospital design in the recruitment, retention and performance of NHS nurses in England Belfast:PriceWaterHouseCoopers. Available at: http://webarchive.nationalarchives.gov.uk/20110118095356/http://www.cabe.org.uk/files/the-role-of-hospital-design.pdf (accessed 22/03/13) (Web).

Department of Health (2009) NHS health and well-being review: interim report, Leeds: DH (Lead Reviewer: Steven Boorman). Available at: www.nhshealthandwellbeing.org/InterimReport.html (accessed 14/03/13) (Web).

Design Council (no date) Reducing violence and aggression in A & E [online]. Available at: www.designcouncil.org.uk/our-work/challenges/health/ae/ (accessed 14/03/13) (Web).