Distance to the Nurses
The question of distance is almost self-explanatory. Whenever I see a hospital floor that has the nurses' station at one end of a long corridor, it is obvious that the architect did not get input from nurses in creating such a design. The farther away a patient is from the nurses' station, the less attention the patient will get. Someone should have asked the planners, "If you or someone you love is in the hospital, how far would you want the nurse to walk to get to you in case of an emergency?" One might also have asked, "If you had to scream for help, would you want no one to be able to hear you?"
The prudent charge nurse will assess how much attention you will need in deciding whether you should be placed nearby or far off. If the floor is full and everyone needs frequent observation (high acuity), there is a problem. About a third of the patients will be lacking some measure of prompt attention to their needs. I have reviewed dozens of cases over the last eighteen years in which a staff member found the patient dead and no one could tell when the poor soul stopped breathing. These unfortunates were always more than five doors away from the nurses' station.
However, even though tearing down and rebuilding is often not feasible, a viable solution to this problem exists. There is no reason why the nurses have to all sit in one central area. With a moderate amount of interior remodeling, the hospital carpenters and maintenance workers can reduce the large central office area and create substations so that no bed is more than five doors away from a nurse's desk. Every patient should be within earshot of a nurse or an ancillary staff member at all times. Any hospital executive who says that is impossible is accepting occasional patient neglect as "unfortunate but unavoidable."
One occurrence that illustrates the perils of housing patients at an unsafe distance from the nurses' station is the case of the nineteen-year-old woman who hanged herself using the privacy curtain in a room of one of the city hospitals in New York a few years ago. She was a psychiatric patient hospitalized for severe depression. The psychiatrist cleared her for transfer to a regular hospital room because of a kidney infection. The young woman's need for intravenous antibiotics made the medical-surgical floor more expedient. She was in a semiprivate room that was too far away for anyone to hear her roommate yelling for help-the result being that the nurses were too late to save her. Even if the roommate had thought of using the call button in the middle of watching someone hanging herself by the neck, the room was too far away for a timely response.
Another case in point related to distance is a fifty-three-year-old man who stopped breathing after the nurses overmedicated him with morphine and sleeping pills. He had been complaining of severe pain after abdominal surgery. His wife discovered his body during visiting hours approximately two hours after he died. He was at the end of the corridor away from the nurses' station, and no one made rounds to check his condition for that period. Although there was the issue of being overmedicated followed by wanton neglect, this scenario exemplifies that being out of sight and out of earshot increases the likelihood of a less-than-diligent staff forgetting and neglecting the patients.