The present configuration of the nurses’ station is open on three sides to resident corridors. It has no isolated dictation or staff discussion/briefing areas.

At times the resident lounge at the opposite end of the wing has been used for staff meetings. This lounge addresses the privacy issue, but from this location supervision is essentially non-existent. Furthermore, such use of the lounge can disrupt the residents’ quality of life.

We have looked at the possibility of enclosing the nurses’ station with window panels and doors to provide privacy, but there is insufficient space for the other requested changes. Additionally, such a change could reduce supervision by limiting visibility through the mirrors due to the glare factor.

Another alternative is to enclose the nurses’ station, as described above, and provide closed circuit television to the "blind" areas of the corridor. This would require two monitors to be placed in the corners of the nurses’ station, which would require counter space that is already in short supply.

The present nurses’ station is constructed in such a way as to only provide direct visibility to 12 of the 22 bedrooms. Eight additional bedroom doors are partially visible through mirrors. The remaining two bedrooms are not visible.

We have tried to find ways of reconstructing the nurses’ station to provide this visibility, but have been unsuccessful.

When the other suggested changes are considered, the visibility problem becomes even greater.

At present there is no break room on the nursing unit. Ideally, such a break room should be located adjacent to the nurses station with windows to allow for supervision. There is insufficient physical space to permit this change to be made.

Ideally, the nurses’ toilet should be located in or immediately adjacent to this room. At present the nurses’ toilet is located inside the nourishment station, which is far from ideal.

Section 713-1.2 (c) (2) of the New York State Department of Health Code requires a lounge and toilet room for nursing staff.

The present supervisor’s office is a six-foot wide converted closet, which is totally inadequate. This converted closet is also fifty-six feet away from the nurses’ station, with no line of sight to provide for any supervision.

There is no physical space within the nursing unit to provide for this change.

This conclusion is addressed in other areas of this section of this report.

The physical constraints of the present nursing unit do not allow for expansion of the medication room.

The present residents’ lounge is located at the opposite end of the nursing unit from the nurses’ station, and is out of direct visibility.

The three corridors immediately adjacent to the nurses’ station are crowded with residents in wheelchairs and geriatric chairs. This poor condition has developed over the years out of necessity to provide continual supervision of some residents, and because other residents want to be where the "activity" is.

This solarium/lounge situation could be corrected by eliminating two 2-bed rooms adjacent to the nurses’ station. One of these bedrooms could then be relocated into the existing resident lounge. The other bedroom would have to be located in an addition to the wing, which would be "blind" to the nurses’ station unless closed circuit television was provided.

When the nursing unit was designed and constructed more than 30 years ago, the need for equipment was far less than resident acuity requires today. The existing storage area is much too small to accommodate today’s needs.

The physical constraints of the present nursing unit prohibit further expansion of the existing storage area.

This is another problem that has been created by the increasingly higher resident acuity. Physical space limitations in the present nursing unit prohibit expansion to accommodate this needed change.

If we refer to the above comments concerning enclosure of the nurses’ station, and do so in a manner that is aesthetically pleasing from the corridor, we could address the privacy issues and lessen the institutional appearance of the present nurses’ station.

Again, such construction within the physical constraints of the present nursing unit would require closed circuit television to provide supervision. If the cameras could supervise only the corridors, then such monitoring would most likely not infringe on resident privacy.