Will new hospitals have nap rooms?
Will new hospitals have nap rooms?
Draft guidelines give space for rest
The hospital of the future may have small rooms on each floor for night shift staff to take energizing naps. With an eye on fatigue as a major safety concern, the new draft version of hospital construction guidelines includes a requirement for “staff rest areas,” or nap rooms.
According to the proposed 2014 Guidelines for Design and Construction of Hospitals and Outpatient Facilities, released by the Facility Guidelines Institute for public comment, single-occupancy staff rest areas would need to be convenient for every unit and separate from on-call rooms. (See box, below.)
The proposed guidelines cite research studies that show the impact of fatigue on worker and patient safety:
“There are confirmed relationships among fatigue, impaired attention and cognition, psycho-motor and clinical performance. Results of laboratory and field studies, multiple clinical trials, and meta-analysis support use of napping to increase alertness during extended periods of night-work and prolonged periods of wakefulness. On-unit dedicated space for strategic napping supports the health and safety of nurses as well as improved clinical performance.”
To become part of the final construction guidelines, the nap room requirement must be approved by two-thirds of the FGI Health Guidelines Revision Committee, which includes clinicians, architects, builders, designers, safety engineers, and representatives from the Joint Commission and Centers for Disease Control and Prevention.
Even if it is not a requirement in this version, it may remain as a suggestion in the appendix. Guidelines are revised every four years. More than 40 states and the Joint Commission accrediting body rely on the guidelines, many of them using it as the minimum standard for design, construction and renovation of hospitals.
Other changes in the draft document include updated guidance for emergency department security, environmental surfaces, operating room design, and pre- and post-operative patient care areas.
‘It’s really very tough’
Maurene Harvey, RN, a nurse educator and consultant from Lake Tahoe, NV, has been a critical care nurse for 45 years. She knows the stresses encountered by nurses and the toll of long work hours.
“It’s really very tough. It’s tough emotionally, physically, mentally, sometimes spiritually,” says Harvey, who promoted the nap rooms as a member of the guidelines revision committee. “Oftentimes you see nurses who are so busy they don’t even take time for meal time or a break. They struggle to stay awake. The night nurses seem to have learned that a power nap helps them feel and function a lot better.”
Harvey pushed for the nap rooms to create a space for fatigued nurses — and to promote acceptance of naps as an effective fatigue management strategy. The American College of Occupational and Environmental Medicine (ACOEM) recently issued guidance on establishing a fatigue management system. (See HEH, May 2012, p. 51.)
“But when I bring this up in many facilities, I get huge pushback from supervision and administration,” she says. “In a lot of units, nurses get written up if they’re found sleeping, so they kind of protect each other. Instead of being against the rules, it should be something they encourage. What is the harm in taking part of your one-hour meal break for a 20-minute nap?”
Harvey knows that change often comes slowly. The body of scientific evidence is building on the need for better fatigue management in health care, she says. And she’s confident that the nap rooms will eventually be a standard part of hospital design.
“It’s a group that really wants to do the right thing,” she says of FGI. “It wants to build facilities that are safe and this is really a safety issue.”
Editor’s note: A copy of the draft revisions is available at www.fgiguidelines.net/comments. Comments are being accepted through November 22.
Proposed requirement for staff nap rooms
A draft version of 2014 Guidelines for Construction and Renovation for Healthcare Facilities, released by the Facilities Guidelines Institute for public comment, includes these requirements for staff nap rooms:
A2.2-220.127.116.11 Staff rest areas. Staff rest areas should be provided for every unit that has overnight patient care activities. These rest areas should be independent from staff on-call rooms, located proximate to the work unit, and meet the requirements in paragraphs a-g below.
a. Staff rest areas should be quiet areas. Any audible background noise should be of a constant tone and pitch.
b. Staff rest areas should be free of vibrations.
c. Light levels in staff rest areas should be capable of being controlled by the occupant.
d. Staff rest areas should be provided with independent temperature controls.
e. Staff rest areas should be single-occupancy rooms.
f. Doors to staff rest areas should be capable of being locked from the inside using hardware that does not require the use of a special key or tool to exit the space.
g. Staff rest areas should be provided with a telephone (hard wire or cellular) or other suitable means for summoning the occupant. A speaker connected into the overhead paging system should not be installed.
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