The Effect of Neonatal Intensive Care Unit Design on the Distance Walked by Nurses

Background: The intent of this paper is to compare the impact of neonatal intensive care unit (NICU) design upon nursing staff by investigating the number of footsteps walked per shift and complaints of physical distress following the relocation of a NICU from a traditional open-bay design, where many babies receive care in one large room, and a new single-family room NICU in which each baby receives care in a private room. Methods and findings: Staff nurse and expanded role neonatal nurse practitioner volunteers wore a pedometer for twelve-hour shifts in the open bay and single-family room NICUs. Data were analyzed by the severity of the nursing caseload and by shift for nurses, and by shift for neonatal nurse practitioners. For staff nurses, there was a significant increase from 5689 steps/shift (4.50 km) in the open bay NICU to 6523 (5.16 km) steps in the single-room unit. No differences were found in comparisons by shift. Nurse practitioners had a significant increase from 4025 (3.19 km) to 5157 (4.09 km) steps per shift. The number of steps at night increased from 2385 to 5982 steps; however, this difference was not significant due to the small sample size. Comparisons of nursing surveys for items specifically related to work-related musculoskeletal disorders demonstrated no significant differences. Conclusions: A statistically significant increase in footsteps per shift was found among neonatal nurses and neonatal nurse practitioners in the single-family room NICU as compared with the open bay facility. Although the results were statistically significant, the physical impact for distances walked were minimal. The number of steps in the single-family room NICU were 1⁄2 of the number reported for nurses on medical-surgical units. It should be emphasized that nursing administration anticipated the potential for the need for increased walking in the single-room NICU and additional support personnel were added to assist in supporting the nursing staff.