Nursing Unit Space Per Bed Can Vary Significantly

Have you ever wondered why there is significant variation in the nursing unit space per bed from project to project? Particularly when the number of beds is the same. Historically, this variation was attributed to the mix of private, semiprivate, and multiple-bed patient rooms. However, even today when most hospital building projects in the U.S. have all private patient rooms, the nursing unit space per bed continues to vary. Contributing factors include the size and layout of the private patient room and adjoining toilet/shower room, the specific grouping of the patient rooms within the unit, and the overall design and layout of the floor itself. The amount of family, visitor, and staff amenities provided on the floor and the extent of point-of-care clinical and support services are also factors.

BACKGROUND

A comparison of two different hospital building projects — each with the same number of beds — illustrates the factors that influence space allocation and the resulting nursing unit space per bed. Although each project accommodates 48 acute medical/surgical patients in private rooms, Hospital A has a low space allocation of 550 department gross square feet or DGSF (51.1 department gross square meters or DGSM) while Hospital B has a high space allocation of 800 DGSF (74.3 DGSM) per bed. Key differences in the planning approach for each project are as follows:

  • Hospital A was programmed and designed to accommodate the 48 private patient rooms in two 24-bed nursing units with traditional patient rooms accompanied by a combined toilet/shower room. The two 24-bed nursing units share a family/visitor reception area and there are limited clinical and staff support services on the floor.
  • Hospital B was programmed and designed to accommodate the 48 private rooms in eight-bed pods — decentralizing the nursing staff and some support space closer to the patient. The goal is to provide increased flexibility to accommodate different types of patients and levels of acuity. The private patient rooms are sized to provide ample space for family members and care providers. Additional support spaces and amenities are provided on the patient care floor for families, patients, and staff.

REVIEW OF THE ACTUAL NURSING UNIT SPACE PER BED

A review of the actual space allocation for each of the two projects reveals the sensitivity of various programming and design decisions to the corresponding nursing unit space per bed. As shown in the following diagram, the size of the patient room module has the greatest impact on the overall nursing unit space per bed followed by the net-to-gross space conversion factor.

Comparison of Space Per Bed for a 48-Bed Nursing Unit

Chart comparing low and high nursing unit space per bed

Specific variances between the space programmed for Hospital A versus Hospital B are as follows:

Patient room module. The private patient rooms in the Hospital A project provide code-compliant patient care space along with a recliner chair for a family member or visitor. A combined toilet/shower room provides a wheelchair accessible toilet room with the ability to use the room as a shower when required. The larger private patient room at Hospital B includes an expanded area for family and visitors and slightly more space around the patient bed. A separate roll-in shower stall is provided as part of the toilet room and the entrance vestibule to the patient room provides a charting area for the care provider. As a result, Hospital A requires 280 NSF (26.0 NSM) per bed to accommodate the patient rooms compared to 340 NSF (31.5 NSM) per bed at Hospital B.

The size of the patient room module alone — which is replicated multiple times — has the greatest impact on the unit size.

Other assignable space. In addition to the patient room module, other assignable space includes nursing unit support space, common staff support space, and common family/visitor amenities:

  • Nursing unit support space. At Hospital A, the nursing unit support space — such as the nurse station and common clinical support spaces — accounts for 63 NSF (5.9 NSM) per bed compared to 95 NSF (8.8 NSM) per bed at Hospital B. At Hospital B, the patient rooms are organized into eight-bed pods whereby each pod has a decentralized nurse sub-station and alcoves for linen, medication, and emergency response carts. A larger multipurpose room with a contiguous toilet room is provided for each group of 24 beds at Hospital B. Point-of-care laboratory and respiratory care satellites are programmed along with more generous space for the care team work area and staff lounge/break room. Additional support spaces are also provided at Hospital B.
  • Staff support space. At Hospital A, most of the staff offices, staff lockers, and on-call and conference/education facilities are provided off of the patient care floor which reduces staff support space to 13 NSF (1.2 NSM) per bed. These spaces are located on the patient care floor at Hospital B and integrated with the 48-bed nursing unit resulting in 44 NSF (4.1 NSM) of staff support space per bed.
  • Family/visitor amenities. A small family/visitor lounge, consultation room, and toilet room are provided on the patient care floor at Hospital A resulting in 9 NSF (0.84 NSM) per bed. At Hospital B, a more generous lounge and consultation/grieving room are provided along with a family kitchenette resulting in 21 NSF (2.0 NSM) per bed.

IMPACT OF THE NET TO GROSS CONVERSION FACTOR

The layout and configuration of beds at Hospital A results in minimal non-assignable space. About 185 NSF (17.2 NSM) per bed is required to accommodate the nursing unit circulation corridors and the width of the walls and partitions (net to department gross space conversion factor of 1.50). This ratio increases to 1.60 at Hospital B where the nursing unit layout necessitates additional corridor space. Non-assignable space at Hospital B amounts to 300 NSF (27.9 NSM) per bed. The variance in the net to department gross space conversion factor alone results in a need for an additional 115 DGSF  (10.7 DGSM) per bed for Hospital B compared to Hospital A.

The variance in the net to department gross space conversion factor results in a need for an additional 115 DGSF  (10.7 DGSM) per bed for Hospital B compared to Hospital A.

WHAT IF SOME SEMIPRIVATE PATIENT ROOMS ARE PROVIDED?

Sometimes it is not possible to provide all private patient rooms due to site constraints, the project budget, or other factors. In this case, one approach is to provide enough patient rooms to accommodate the average daily census such that the semiprivate patient rooms only need to be deployed for two patients during high census periods. Alternately, a hospital may place several two-bed rooms closest to the nurse station to facilitate the observation of higher-acuity patients. If Hospital A and Hospital B were to each provide 16 private rooms and four two-bed rooms per 24-bed unit, the space per bed would decrease to 502 DGSF (46.6 DGSM) and 742 DGSF (68.9 DGSM), respectively.

UNDERSTANDING FLOOR GROSS SQUARE FEET (METERS)

Beyond the nursing unit space per bed, additional space is required for common floor elements — such as shared lobbies, elevators, stairs, mechanical shafts, and the space occupied by the building’s exterior wall — to arrive at the overall size of a floor or building footprint. An additional 20 to 30 percent (or a factor of 1.20 to 1.30) is generally used to estimate the floor gross square feet or FGSF (floor gross square meters or FGSM). To read more about net and gross space factors see the related article on how confusing net and gross space can be disastrous.

CONCLUSION

This analysis is not meant to suggest that less nursing unit space per bed on a patient care floor is more efficient or necessarily the goal. Many factors influence decisions on the size of the patient room, nursing unit support space, and staff and family amenities to be provided on a nursing unit. These include the types and acuity of the patients, planned staffing ratios, operational processes and procedures, site constraints, and market dynamics. In particular, the size of the patient room module alone — which is replicated multiple times — has the greatest impact on the unit size. However, when making preliminary estimates of the space per bed during facility master planning or as part of a feasibility study, it is important to understand that these ranges can vary significantly. More detailed information can be found in the SpaceMed Guide.

SpaceMed Essentials includes a variety of additional posts related to inpatient care.