REPORT: July/August 2006

SHHH! Is Big Brother listening?

Hospitals try to hasten healing by reducing noise

by Diane Pineiro-Zucker

Hospital noise is so pervasive and constant that most nurses stop noticing it. But— whether it is a paging system, a noisy cart, a pill banger, or the sound of a patient’s chart sliding into a metal sleeve — hospital noise is more than just a harmless annoyance.

A Johns Hopkins University study released late last year found that, over the past five decades, hospital noise levels have grown steadily. Other studies have indicated that noise can slow healing and contributes to burnout and stress among healthcare workers. Science Daily reported in November 2005 that noise is the chief complaint of hospital patients.

Some hospitals, and the nurses who staff them, are attempting to address the problem. However, at least one of these noise abatement programs is causing nurses to wonder whether administrators have more in mind than sound levels.

Reducing noise...

The Montefiore Medical Center in the Bronx generated considerable publicity recently when it acknowledged that excess noise is harmful to patients and announced the Silent Hospitals Help Healing (SHHH) initiative.

At the outset of the program, sound meters were used to record ambient noise levels during shift changes, at midday, and in the evenings in patient care areas, including medical floors, surgical units, and emergency departments. The printouts revealed that Montefiore patients were being subjected to noise levels roughly equal to those in a busy subway station.

At Montefiore, a combination of simple fixes has resulted in a significant reduction in noise levels and improvement in patient satisfaction, according to Nalina Brijmohan, a staff nurse at the hospital.

The solutions range from a lube job and new wheels for the glucometer carts to encouraging staff to wear rubber-soled shoes. Pill bangers have been replaced with much quieter pill grinders, beepers are set to vibrate, intercom calling is limited and set to a lower volume, and nurses use phones or page one another rather than calling out requests in the corridors. Even doctors are on board, according to Brijmohan, “We found that, as this program was implemented, everyone was eager to become a part of the team.”

The results of the program? “Overall, it’s helped patients get better rest,” Brijmohan said. She added that RNs now make rounds every hour, reducing the need for patients to press call buttons.

...or tracking RNs?

But the use of a tracking system to locate nurses and contact them quietly has some nurses worried, according to Latha Catlin, associate director of NYSNA’s Economic and General Welfare program.

“This program was never negotiated with NYSNA and nurses fear administrators could use it to monitor their movements,” Catlin said. “We don’t want this to turn into something that management will use to discipline nurses.” The length of time a nurse spends in a patient’s room, for instance, is a matter of the nurses’ judgment and should not be imposed by management, she said.

Red light, green light

Another noise-reduction program, initiated at Olean General Hospital in the southwestern part of the state, has not received any publicity.

According to staff nurse Stephanie McNeil, administrators installed a “stop light” system on hospital units. “When it started getting noisy, the green light would go on. As the volume increased, it would go to yellow, then red,” said McNeil. When the light turned red, the system would sound a loud alarm.

It soon became apparent that the system was defeating its own purpose, McNeil said, and it was discarded. Although Olean’s first attempt at noise reduction had its drawbacks, there has been a continued effort to reduce noise at the hospital.

McNeil said the staff has tried to be more cognizant of noise levels and does not use the overhead paging system between the hours of 11 p.m. and 7 a.m. Nurse managers on every shift carry pagers so staff can reach them without using the public address system.

Some tasks are just plain noisy

At Franklin Hospital Medical Center in Valley Stream, patient surveys confirmed staff concerns — the noise level was too high. On Marie Sweeney’s medical-surgical unit, signs remind staff and visitors to keep the noise to a minimum.

The Franklin Hospital staff refrains from using the public address system and many wear rubber-soled shoes.

Despite their best efforts, however, Sweeney is skeptical. “Everyday things you do in nursing make noise. Phones ring. There are 50 million visitors. I don’t know how it’s going to work when we’re going about our business,” she said.

Elodia Mercier, the administrative nurse manager who instituted Montefiore’s SHHH program, acknowledged that daily nursing routines can be noisy and that change is difficult. “Our goal is not to eliminate noise but to reduce it whenever possible,” she said.