Building the future of nurses in design

The Krail File

CV

• Health care consultant and transition advisor at Krail Advisory, a New York state-certified women’s enterprise.
• Senior associate and project manager at NBBJ.
• Chief nursing officer at the former Long Beach (N.Y.) Medical Center.
• Vice president and chief operating officer at Nassau-Suffolk Hospital Council in Hauppauge, N.Y.

Accomplishments

• Current president at the Nursing Institute for Healthcare Design.
• Project Management Professional at the Project Management Institute.
• Fellow at the American College of Healthcare Executives.
• Nurse Executive Advanced certified by the American Nurses Credentialing Center.

Education

• Master of Public Health and Health Administration at Columbia University Mailman School of Public Health in New York City.
• Bachelor of Science in nursing at William Paterson University in Wayne, N.J.
• Certificate in project management at Hofstra University in Hempstead, N.Y.

Kristina Krail, R.N., NEA-BC, FACHE, PMP, EDAC, current president of the Nursing Institute for Healthcare Design (NIHD), has served in health care for more than 30 years, transitioning from a bedside nurse into administrative roles. Today, she uses her leadership experience as a design industry health care consultant.

What was your journey like in bringing the disciplines of nursing and health care design into one career?

Nursing was my chosen career and what I received my baccalaureate in. Although I very much enjoyed nursing, I also loved the business aspect of patient care. I went back to school to get a graduate degree in public health and administration. After that, I embarked on becoming a nurse administrator, which was my life’s work for the first half of my career.

There was this other aspect of me that also enjoyed design. I like the physical environment. When I was a kid, I liked playing with my dollhouse. When I became a nurse, I liked drawing pictures of floor plans. As a nurse administrator, I was associated with a lot of building projects. It was the ‘90s, and all these organizations were in a growth mode.

One pivotal project for me was a new patient care tower. It was apparent that we needed many operational changes to be ready on Day 1, but the planning and construction department didn’t give it much consideration until the nursing department brought it up. There were unit sizes and numbers that would need to change. In some cases, staff would be working in a different place, maybe for a different person and maybe taking care of different specialty patients. So, the nursing department took that on as the building project was underway.

Another influential project was an intensive care unit (ICU) expansion. The nurse manager came to me and said, “This space just isn’t big enough. It’s not going to work.” We decided to figure out if that was true. We got some cardboard boxes and made them into the size of a ventilator and a nightstand. We wheeled a patient bed into the half-built ICU room, and sure enough, they all didn’t fit. But we figured these things out because nursing stepped in, not because the project manager said, “OK. Now it’s time to do the cardboard mock-up.” That idea came around 25 years later for many designers.

I didn’t know it then, but the other nurses I worked with and I were pretty forward-thinking. So, when an opportunity came to work for a design firm as a consultant on health care projects, it was literally a dream come true.

What can health care designers do to ensure nurses are involved in new building projects?

There’s more talk now about getting clinicians involved in design, which is good, but it’s more than just inviting them to a user group meeting. We have to help them become effective end users in that group. There’s a certain amount of education that has to take place. People talk about the medical field having all these acronyms, but there are just as many in the field of architecture and design. It’s not in everyone’s skill set to read a floor plan or to have a concept of square footage. Have we educated those end users who we expect to help us by educating them on what we’re trying to accomplish?

We also have to think of new and different ways to extract the information that we need from them. The days of thinking that 40 people can just leave their work units to attend a two-hour meeting are over. We are in the middle of a nursing shortage, and they are unable to leave their patients. So, we who organize these groups have to make it easy for nurses to contribute. Build those meetings around their timetables. What can be done virtually versus what has to be done in person? And how are we making these meetings interesting and engaging? Gaming, for instance, is a perfect vehicle for design feedback. Get creative. Create mock-ups or use game pieces on a floor map to figure out adjacencies and workflows.

How is NIHD working to strengthen nurses’ voices in health care design? 

NIHD is a relatively young organization. We’ve only been around for about 15 years, and our membership has grown organically by word of mouth. It has hovered around 225 members, with about 10% to 15% turnover, because some people would join when they embarked on a new construction project but drop off once it was completed. However, we realize now that if we really want to make an impact for nurses and the design industry, then our membership needs to expand. It’s for anybody who believes in our mission: “To engage and integrate clinical expertise into the planning and design of health care environments.”

We realize there are hundreds more who would benefit from joining our community. We recently formed a membership committee and have developed some initiatives around it. For instance, committee members have committed to a “Five for ‘25” campaign, where each member is aiming to recruit five new members in 2025. We know that our strength and our value is in the collective wisdom and knowledge of our members, so the more we have, the better. If you are a nurse employed by an organization that is currently going through a building project that you are involved in, that’s a no-brainer in my estimation. But there are others, like me, who work in a design or consulting firm who also would benefit. It could be an engineer, interior designer, someone who may or may not have an R.N. or M.D. after their name but is committed to this as their life’s work. Those people are an important and growing component of our membership.

What other projects is NIHD working on to grow its knowledge base?

We are in the beginning stages of publishing our second book. Our first book, Nurses as Leaders in Healthcare Design, was published in 2015 with our partner at the time, Herman Miller Inc. This new book won’t be an updated edition. We are planning for what will be a go-to resource that captures and documents our entire body of knowledge. We want this to be the bible of our field, and it will take a while to make sure it’s done right. We have formed a committee of about 20 people, and we are in the early stages of selecting a publisher and brainstorming which topics to address in the book.

What do you envision for the future of NIHD and its members? 

There are many dreams that we have for this field, and one of them is for this to be an accredited specialty in the nursing profession in the same way that I am certified in nursing administration. Everyone in NIHD holds this vision to develop a certification for nurses in health care design that’s sanctioned by a professional credentialing center because nurses in design is truly its own specialty.

It will take time to get to that level and require the expertise of many different subject matter experts, but that is the goal. We will have to develop requirements, such as time spent in the field. We will have to create a certifying test and have it validated. Additionally, educational programs that allow people to be successful in the specialty will need to be developed. We will also need to formalize what this role looks like in the field. It is a big deal, but it’s not impossible.

Twenty years ago, for example, there was no such thing as nursing informatics, but today there is a body of knowledge and jobs dedicated to that specialty. There are educational programs. There are specific jobs. There are roles dedicated to nursing informatics. We hold this same goal for nurses in design.

Jamie Morgan is senior editor of Health Facilities Management.