Blog Contribution by Joyce Durham RN, AIA, EDAC, Director of Facilities Strategic Planning at NewYork-Presbyterian.
I still remember how excited I was to graduate with my BSN and start working on an adult surgical floor. After a couple of years, even though I loved my job, I realized I desired a career that provided the opportunity to create things and work on projects. This revelation was insightful, but the solution wasn’t apparent at that time.
While working at a large, academic medical center, I was given the opportunity to assist with the transition of our unit, which was located in a very old and antiquated hospital, to a state-of-the-art new building. This experience was interesting, challenging, and made me very aware of the impact of the physical environment on the delivery of care.
After that experience, I stopped thinking about pursuing a master’s degree in nursing and instead went back to school to earn a bachelor’s degree and master’s degree in architecture. All the while, I was working part-time as a nurse in a different antiquated hospital building.
After graduating from architecture school, I began working in a series of jobs where I integrated my nursing knowledge into the design of hospitals, primarily in the pre-design phase of planning. I started working for a small architectural firm (emphasis on small, as I was the second employee). Next, I moved to a healthcare consulting firm and became more involved in integrating strategic and operational planning with facility planning. Then, I changed course and joined a large architectural firm. Finally, an opportunity arose to pursue my dream of planning hospitals in developing countries at an international healthcare development firm, so I jumped into that and spent five years focused on Vietnam and Ethiopia. Most recently, I pursued the opportunity to work in-house at a large, academic healthcare system as the Director of Facilities Strategic Planning. I have had several different jobs, but my focus has always been on defining how facilities can support the most effective and efficient delivery of healthcare.
So, what do you do for work?
As a member of our internal facilities strategic planning team, we are responsible for facilities planning for our ten hospitals. This includes assisting with the development of the system capital plan, preparing master plans for each of our hospitals, providing strategic and facility planning services for major projects, completing detailed functional and space planning for selected projects, and coordinating projects with outside consultants, primarily architects.
On a daily basis, my personal activities include a lot of meetings to seek input, present potential solutions, review ideas, coordinate activities, and work with consultants. When I am not in meetings, I am doing research on new ideas, documenting best practices, contacting other organizations to see how they are handling specific issues, analyzing data, preparing presentations, and compiling reports. Although this may seem similar to the work completed in a consulting or architectural firm, here are the key differences in a healthcare organization role:
We set individual professional development goals, but we do not focus on marketing or sales.
Safety, patient satisfaction, and operational costs, particularly staffing, are top priorities, but we still appreciate beautiful, elegant design solutions.
More strategic and operational solutions are considered as opposed to solely architectural solutions. If a facility project is considered, significant time is spent investigating potential facility solutions before a project is identified and it moves forward.
We have a long-term commitment to the organization that doesn’t end when a project is complete.
What do Nurses in Design need to succeed?
Roles for nurses in design are new, and each position seems to be unique, so I haven’t observed a single path to this career. My informal polling over the years suggests that most nurses move into design roles by somehow getting involved in a facility project. In particular, it seems that most nurses involved in the planning, design, and construction of new healthcare facilities started in a leadership position (e.g., nurse or department manager) then became involved in a facility project.
Now, I was different and pursued an architectural education. This was not common when I did it, but in recent years, there are more academic programs available, so that is certainly another path.
Many think education in design and construction is important for a nurse to bring to the table, but I disagree. I think some education is desirable, but the three unique qualifications a nurse working in design brings to the team are:
1. Knowledge of how care is delivered, how the environment should be designed to maximize efficacy and efficiency, and how to accommodate changes anticipated in the delivery of care (e.g., new clinical procedures/care, technology, etc.).
2. An understanding of how each department in the hospital works and the interrelationships between departments. This involves staff relationships as well as how materials and services are provided to departments.
3. An understanding of the patient’s needs and desires.
I believe that the above qualifications are essential in the design of a healthcare facility and are best provided by a nurse or other clinician on the planning team.
What excites you about your work every day?
I enjoy developing creative, innovative solutions to solve operational or facility problems. Nothing is more rewarding to me than studying a problem extensively, then coming up with a brilliant solution. The brilliant part doesn’t happen that often, but when it does, it is greatly satisfying.
I also enjoy interacting with end-users and working with teams to optimize patient care delivery. In my role, I definitely spend more time on people and processes as opposed to the product. I enjoy working with end-users to help them understand how the design of facilities affects the delivery of care and identifying ways we can use the facility design to optimize the delivery of care.
Finally, I work with incredible people. The people at our organization are incredibly devoted to excellent patient care, which is demonstrated by all of our facilities in the process of or having achieved magnet status. In addition, there is so much cutting-edge research here that results in so many miracles. It is inspiring and makes me proud to show up for work every day.
How Training and Experience as a Nurse Helps in my Role.
Many people may not realize that experience in nursing is excellent training for work in healthcare facilities planning and design. My nursing education taught me a systematic problem-solving process that is essential in the facility planning process. My nursing experience taught me how to assess and prioritize my workload, plan my time, work and communicate within a team, and assess and evaluate my patients. These nursing experience-based skills are exactly the qualifications needed to execute a facility study or project.
My ten years of working at the patient bedside helps me understand patient needs, how care is delivered, and which components of the environment make the delivery of care very difficult. In addition, working as a nurse helps you understand the caregivers’ needs. Very few design professionals are familiar with how physically challenging delivering care can be, so I am happy to help project teams understand this. I am also grateful that significant research is being conducted in this area and look forward to more research findings.
Will you share advice for someone interested in this career path?
The five things that I would tell someone interested in pursuing a nursing career in the planning, design, and construction of new healthcare facilities are:
Join.
Join professional organizations as they are a great way to meet colleagues, network, and learn about the industry. If you are looking for a job, these connections will help you find jobs and write letters of recommendation.
Volunteer.
After joining, volunteer as a way to meet others and learn new things. If you are shy and introverted like me, volunteer to work the door at events and you will meet everyone attending. I had to be pushed to run for an office, but serving on a board forced me to develop leadership and communication skills and did wonders for my self-confidence. Remember, what you get out of a professional organization is proportional to what you put in.
Say Yes.
As your career grows, say yes to new opportunities. Do not be like my former self and come up with a list of excuses to justify saying no (e.g., too busy, too young/old, not challenging enough, etc.). Even if it doesn’t go anywhere, every opportunity is a chance to meet people and develop your skills. (Suggested reading: Year of Yes: How to Dance it Out, Stand in the Sun, and Be Your Own Person by Shonda Rhimes)
Speak.
Learn to speak in public. Start small and practice, practice, practice. The more you do it, the easier it will be. I started with my grandmother’s funeral eulogy, which was not exactly easy in a room full of family and friends, but it certainly made speaking in front of a group of strangers easier. Refer to #3 and say yes to every opportunity to speak in front of people (e.g., staff meetings, PTA meetings, introducing speakers at professional meetings, etc.). You will lose the nerves and improve quickly. And, if you are as lucky as me, you will be consistently called upon to deliver family eulogies for the rest of your life.
Write.
For me, writing followed speaking. Theoretically, it should be easier than speaking, but it can be hard to get writing done without the deadline associated with a speaking engagement. My key recommendation is to write about something you know. Once you have a topic, ask people what they would like to know about the topic. Their input will help you form your outline, and they also ask you frequently when the article will be complete, thereby forcing accountability. Just like speaking, start small (e.g., company newsletters, blogs, reports) and then move on to larger assignments. Nursing involvement in design is new, so we need to share our knowledge and experiences with each other as well as the larger healthcare and design community.