Nurses call for rebuilding Juravinski Hospital
Why nurses find Juravinski Hospital’s old sections so challenging
Hamilton Health Sciences (HHS)’ Juravinski Hospital (JH) is a collection of buildings constructed over the last century and connected by a patchwork of hallways, walkways and tunnels.
Nurses Sam Jennings, Kyla Forbes and Angela Dekker stand outside the oldest section of Juravinski Hospital, built about 100 years ago.
HHS plans to tear down a large stretch of JH facing the escarpment – the M, L, H, E sections — and the F section which adjoins E, and replace them with a state-of-the-art patient-care addition. The redevelopment of JH is the single-largest health infrastructure investment in our organization’s history and will also make JH the largest acute inpatient hospital in our region.
We asked three nurses to share their experiences working in the old versus new sections of JH, to better understand why this redevelopment project is vital for delivering the very best and safest patient care. But first, some background.
The ABCs of Juravinski Hospital
The hospital’s sections are named for letters of the alphabet, with the oldest area, M wing, built nearly a century ago. It’s located at the hospital’s west side, backing onto the mountain brow. Built in the 1930s, it’s where inpatients needing rehabilitation receive care, including older adult rehabilitation patients and patients recovering from prolonged hospitalization due to surgery or cancer-related illnesses.
Patients recovering from surgery stay in the E wing, built in the 1960s. This wing also includes acute medicine units for inpatients with medical conditions such as diabetes, angina, heart attack and stroke recovery, pneumonia, and chronic obstructive pulmonary disease. The F wing, also dating back to the 1960s, provides care for patients with similar needs. This section also houses the Breast Assessment Centre on the lower level. The L and H sections, built in the 1980s and 90s, are used for non-patient care, such as office space.
Since many hospital rooms in the older sections are too small for walkers, wheelchairs and medical equipment, these items line the already narrow hallways. Patients may also find themselves cared for in hallways where there aren’t enough beds.
Hospital rooms in JH’s old wards are small, cramped, and mostly shared with up to four people to a room. On most units, there is only one shower for about 40 patients. Nursing stations are poorly located and inefficiently designed; there’s a shortage of storage space; elevators break down and some are even too small to fit stretchers. And none of these older sections have air conditioning.
None of the older sections have central air, making for an uncomfortable, hot and sweaty environment for patients, as well as staff like nurses who are constantly on the move.
By contrast, JH’s newest sections on the hospital’s east side were constructed over the last 15 years and feature larger patient rooms, wider hallways, generous elevators and modern, efficiently-designed nursing stations.
The most recent upgrade in 2020 serves hematology inpatients, all cared for in spacious private rooms, each with a washroom and shower – the gold standard for infection prevention and control. Plans for the JH redevelopment project include all single-patient rooms, each with a washroom and shower, wider hallways, large elevators and efficiently-designed wards for the very best patient care.
A foot in both worlds
Angela Dekker is a registered practical nurse (RPN) in JH’s emergency department. But before joining the ED full-time, she spent six years on the nursing resource team, filling in for RPNs at various HHS hospital sites who needed time off for reasons like illness.
Older wards offer a mix of cramped single, double and four-bed patient rooms. Some double rooms were originally built as singles, so they’re especially small.
“Everyone always wanted to work in the newer sections of JH,” recalls Dekker. “It made your day to work there because these areas are much better designed to meet our patients’ and teams’ needs.”
Inpatient hallways in the older wards are up to 100 metres long, the length of almost six bowling lanes. “A nurse can walk about 15,000 steps in one shift, going back and forth, because some rooms are so far from the nursing station,” says Dekker.
Some nursing stations are so small, only about half the nurses working a shift can comfortably update patient information there. The others work at makeshift stations in halls.
Nursing stations are in the middle of these hallways and some stations are so small, only about half the nurses working a shift can comfortably update patient information. The others work at makeshift stations in halls, where interruptions are constant. And since patient rooms are too small to accommodate wheelchairs, walkers and various pieces of medical equipment, these also end up lining the already narrow halls.
Inpatient hallways in the older wards are up to 100 metres long, the length of almost six bowling lanes. A nurse can walk about 15,000 steps in one shift, going back and forth, because some rooms are so far from the nursing station.
The hospital’s newer sections, by comparison, are spacious and designed in a hub-and-spoke model for improved efficiency, with multiple nursing stations surrounded by shorter wings. While this design makes for a much better work environment, there’s still room for improvement when planning for the future, says RPN Sam Jennings. For example, communication among nurses at multiple stations could be better, he says, adding that more efficient storage solutions would also be welcome in the new build. “It’s a great opportunity to make a space that’s even better for our patients as well as our teams,” Jennings says.
Dialing down the heat
“A big plus when it comes to working in the newer sections is air conditioning,” adds registered nurse Kyla Forbes. None of the older sections have central air, making for an uncomfortable, hot and sweaty environment for patients, as well as staff like nurses who are constantly on the move.
Forbes worked in old and new sections before returning to an older ward, where she’s now a clinical manager. Experiencing the old and new sections firsthand has given Forbes additional empathy for her patients, their families and her team. “I can definitely relate to their concerns with the older wards, and appreciate their frustrations,” she says.
“Rooms” for improvement
Older wards offer a mix of cramped single, double and four-bed patient rooms. Some double rooms were originally built as singles, so they’re especially small, with little space for walkers, wheelchairs, medical equipment and for nurses to manoeuvre around patients’ beds.
“It’s really challenging to get patients in shared rooms in and out for things like medical tests elsewhere in the building,” says Jennings. For example, in double occupancy rooms, both patients’ beds need to be moved in order to get the patient furthest from the door in and out on a stretcher.
Washrooms in the old section’s rooms are so small, patients using walkers need to back in. “Nurses can’t fit in with them, so we’re leaning over their walker, trying to get them into the washroom safely,” says Dekker.
In some units, washrooms are too small for a standard door, so they have an accordion style door instead. But accordion doors can’t stand up to a patient’s weight if leaned on. “I remember one patient accidentally leaning on the door and it collapsed,” recalls Dekker. “The poor patient ended up on the floor, pants around his ankles.”
And not all washrooms include showers, with most units having only one shower for 40 patients. Nurses end up negotiating shower times with each other for their patients. “And if a patient in isolation needs a shower, that washroom could be closed for at least an hour afterwards for a special isolation cleaning,” says Dekker.
All rooms in the new build will be for single patients. Rooms will be spacious, with a washroom and shower, like this room in one of the hospital’s newer sections.
In the newer sections, patients have rooms large enough for visitors, with storage space for personal items, as well as a washroom with a shower, so nurses can easily assist. Since rooms are spacious enough to accommodate wheelchairs, walkers and medical equipment, these items aren’t crowding rooms or overflowing into hallways.
“It’s safe and easy for team members to move around these rooms and units,” says Jennings, who spent nine years working in the newer area and currently divides his time between JH and HHS Urgent Care Centre. “In the new sections, we’re not tripping over walkers, wheelchairs and IV poles.”
Highlights of the new JH will include:
- Room for 100 patients more than today, with 70 per cent more space for care
- All patient rooms will be single occupancy, with private washrooms that include a shower
- Single rooms provide privacy for conversations between patients and their health-care team
- More room for walkers, wheelchairs, and other equipment
- Larger hallways, and elevators that can easily accommodate a stretcher
- Modern ventilation, heating and air-conditioning systems
The JH redevelopment project is expected to take place in phases, over several years. The longer we wait, the farther we will fall behind.
The Province of Ontario agrees that the oldest hospitals need to be replaced. But in order to get provincial investment, we need the City of Hamilton to financially commit to the project as well.
Add your name to a petition in support of a new Juravinski Hospital.
