The Right to Rest in Healthcare
A Crisis of Care
Working in healthcare can be incredibly taxing on medical staff, both physically and psychologically. Not only patients but also medical staff can experience exposure to traumatic situations that leave them feeling extremely vulnerable. This is only intensified by the compounding layers of stress that New Zealand’s struggling healthcare system and rising staffing shortages add, and it has become imperative that measures are put in place to retain and attract new staff.
According to ASMS's most recent report on New Zealand healthcare, titled "Anatomy of a Health Crisis," in the past three years, there have been significant numbers of healthcare staff quitting, leaving an 8,000-plus workforce shortage. In the 2023 ASMS Exit Survey, working conditions and poor relationships with management were cited as the main reasons for leaving.
The Right to Rest and Respite
Medical staff frequently highlight their “right to respite” and the need for private spaces that are dedicated not just to work but also to rest. Medical staff need to know that the healthcare environments they work in have been designed with due consideration given to their personal and professional needs, including their need for areas of rest and respite. Designating areas that are dedicated to staff wellbeing is key for both mental and physical wellness, and studies have shown there are economic benefits through cost savings by boosting staff productivity and attracting and retaining talent.
“Workplace quality of life for medical staff is indissociable from successful patient experiences….We need to rethink the spaces dedicated to the medical staff’s quality of life.”
-Pr. Philippe Gabriel STEG, Interventional Cardiologist and Director of the Coronary Care Unit of Hôpital Bichat, in Paris, France
Challenges
After a challenging few years battling COVID-19 and the pressures of an overburdened healthcare system, medical staff are simply worn out. The skew in staff-to-patient ratios often leads to situations where they are caring for more than the minimum 1:3, staff-to-patient, ratio that is considered to be safe by the New Zealand Nurses Organisation. This in turn means that the physical demands on staff increase, for example, walking the length of seven rooms instead of four, in addition to working longer shifts.
A Ministry of Health 2018-19 assessments report of 19 ward blocks over 20 years old commented, “All units reported excess demand, which has implications for increased staff stress and risks to the quality of care.” And ASMS states, “In many hospitals around New Zealand, bed occupancy rates are frequently close to – and regularly over – 100 percent when the widely accepted safety limit is about 85 per cent occupancy.”
Accessing funding for renovations can be a challenge, especially in healthcare. With ageing medical equipment and escalating construction costs, it is often hard to justify expenditure designated for spaces that can, on the surface, appear to have little impact on patient outcomes. However, these dedicated spaces for respite provide vital support to a medical workforce that is already stretched thin, leading to better patient care. The ability to rest and recharge promotes safer, more efficient operations, resulting in better outcomes and fewer medical errors. On top of this, quality respite spaces greatly increase staff satisfaction and are an effective tool for employee recruitment and retention.
Key Considerations for Thoughtfully Designed Areas for Rest and Respite
Before undertaking any renovation work on existing facilities, management and design teams should engage in a thorough staff consultation process. Identifying the real and present needs for rest and gathering diverse insights into what kinds of respite spaces would best serve employees.
Prioritise Wellbeing
Employees who are using a respite space are usually tired, stressed, hungry or thirsty. Having a quiet place that is separate from the demands “on the other side of the door” is invaluable to staff members who need to feel that their wellbeing is a priority, even if just for a few moments during their shift. Having even a modest staff respite area can serve as an effective recruitment tool. These spaces serve as tangible evidence that a facility's leaders make employee wellbeing a priority and have heard and responded to staff concerns.
Separate but Proximate
While the need to switch off and find a moment's relief from the stresses of the job is imperative, these spaces still need to be easily accessible. If the path from workstations to a respite area is inefficient, then the space won’t be used. At the same time, in a busy healthcare setting, staff often have indeterminate amounts of time in which they can eat, rest, and recharge, and many medical staff need to be reachable in case of emergencies. In terms of workflows, respite areas need to be optimised and coordinated with patient care areas. In new facilities, workflow for these areas should be incorporated into the initial design.
Interdependent Goals
For years, the focus in healthcare has been almost exclusively placed on patient outcomes, and the majority of expenditure has been directed toward patient-centred spaces. When funding is limited, it is usually allocated to patient areas rather than staff spaces, but recently, there has been a shift in thinking where everyone – staff, patients, and visitors – is considered in the design of the facility. It is essential to adopt the understanding that in healthcare, everyone’s goals intersect and interweave. Patients want access to the right care at the right time in a safe and reassuring environment, from providers who listen and respect their needs; they don’t want to get an infection or be improperly diagnosed because a provider is tired or caring for too many patients. The goal for patients is to go home healthy with no complications. On the other side of the coin, the goal for staff is to provide the best quality care. For this to happen, they need to be alert, rested, and focused, with access to the tools and equipment necessary to care for their patients. Medical staff want an environment that allows them to perform at the highest level, prioritising patient care without compromising their own wellbeing. Complementary to this, hospital leadership wants the same outcomes as both patients and staff while maintaining the bottom line and retaining employees. These respite spaces are a small investment with big returns for patient quality of care, staff wellbeing, recruitment/retention, and employee satisfaction.
Other key considerations for designing rest and respite areas:
- Incorporate lots of natural light.
- Conveniently situate spaces within walking distance from patients' rooms and staff-only bathrooms, reducing walking times and ensuring spaces are easily accessible. In some cases, having several smaller respite areas may prove to be more practical than a singular, central location that would require some staff to walk a considerable distance to reach.
- Design for multi-functionality. By orientating the space to allow areas for staff to socialise as well as areas where they are able to find solace and a moment of alone time is key. Providing multiple seating options that include eating areas and, where possible, an outdoor space and a private room to rest can further facilitate opportunities for respite.
- Design for respite. The environment should feel vastly different from the corridors, patient rooms, and clinical spaces staff work in. The goal is to create a space that temporarily transports them out of the working environment. Thoughtful use of colour can enhance this effect.
- Providing control of lighting levels, temperature, and seating configurations gives employees the ability to customise the space at any time.
- Incorporate natural elements, such as wood-look flooring, soft furnishings, and soothing colour palettes to create calming spaces for staff to unwind.
Sources:
1. https://www.nzdoctor.co.nz/article/undoctored/budget-2024-budget-leaves-health-system-struggling-keep
2. https://asms.org.nz/wp-content/uploads/2024/04/ASMS-Anatomy-of-a-Health-Crisis-210416.pdf
3. Determining Nurse to Patient Ratios in New Zealand
PSQH: Revisiting Staff Respite Spaces
NCBI: Importance of Rest Spaces for Medical Staff
Financial Express: Nurse Shortage in New Zealand
A Small Investment with Significant Returns, By Steven M. Alby, NCARB, LEED AP
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