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Complete StoryThe $19-million, four-story, 71,200-gsf building opened in May 2006, and has since received numerous accolades, including being named a Laerdal Center of Educational Excellence. The new facility has increased enrollment and graduation rates in nursing and health sciences, serves the needs of the larger healthcare community, and has become an important public resource.
“This building plays a very significant role of outreach within the community not only for the College of Health Sciences and Nursing, but other University purposes,” says Wendell Brown, project designer for Earl Swensson Associates, Inc.
Part of Nashville’s vast and diverse healthcare community, Belmont University and its 62-acre campus are in an urban setting, a few blocks from Vanderbilt University and Music Row. While the University’s nursing program enjoys a good reputation, the school’s facilities were lacking and spread out across the campus. Facilities included a cramped modular building and classrooms shared with a local church.
There was also a need in the wider healthcare community for more facilities that simulate a realistic environment. Although Nashville’s numerous hospitals provide clinical (real-world) experiences, there’s no guarantee every student will have the same experience and preparation, explains Debra Wollaber, Belmont professor of nursing and founding dean of the College of Health Sciences and Nursing.
“There is no standardization of experiences,” she says. “With standardized clinical scenarios where we use simulation equipment as ‘surrogate’ patients, we can determine those nursing clinical situations that are critical for all students to know, and have the students show competency by successfully completing the scenarios.”
Of course, the widespread shortage of healthcare professionals, especially nurses, was also a factor. A new facility with practical training could potentially attract more people to the profession.
Because the project met a community-wide need, Belmont was able to obtain funding from a variety of sources. The facility’s namesake, Tennessee entrepreneur Gordon Inman, was a key supporter who recognized the need and contributed $10.5 million. The Hospital Corporation of America (HCA), headquartered in Nashville, contributed $7.5 million, and $950,000 came from federal appropriations. Other sources included $750,000 in grants and $250,000 in donations.
An academic consortium that included Trevecca Nazarene University, Volunteer State Community College, Free Will Baptist Bible College, and Nashville State Community College became partners in the venture. Buy-in from the other institutions was important to make the financial model work, explains Brown. Belmont alone didn’t have enough students to justify the expense.
“Relying only on Belmont students, there were not enough to make this a reality, so we needed to bring these other institutions together,” says Brown. The combined enrollment estimate was 600 nursing students by the 2007-08 school year.
Designing a Facility
The facility’s designers went to the drawing board with four main goals: provide a real world learning environment; create deliberate partnerships between practice and education; design a building that supports innovation and adaptability; and provide an integrated, multidisciplinary approach.
“One of our goals was to make it as close to reality as possible. We wanted to be able to prepare our students in the labs prior to them going to the clinical side,” explains Wollaber.
They designed a building for the year 2050 by projecting maximum enrollment, looking at class sizes and how many students would cycle through the laboratories, and researching what types of common spaces were needed. Planners also considered the needs of different types of students, from the traditional to second career.
Belmont is dedicated to small class sizes, but had to redefine this in terms of clinical experiences with the anticipated enrollment increases. Every lab is designed for 16 students and two instructors, and totals about 1,200 sf.
Planners also looked closely at national data from various sources when considering the interdisciplinary curriculum and accreditation issues. Labs were designed to meet National Patient Safety Goals. Improving communication was a goal, so they installed telephones in every room and computers at bedsides. Students can engage in real-life scenarios of assessing patients then making a phone call to “physicians” (faculty stand-ins) and document their care using the hospital information system used by Hospital Corporation of America.
“Our students are much more comfortable when they come out of our program being able to communicate,” notes Wollaber.
Preventing medication errors and improving medication administration was another goal, so the design incorporated infection control and using lifts to prevent patient falls. Maternal infant pediatric labs are scarce in the area, so Belmont’s design includes one such lab.
Nurses’ stations were not included, since institutions are moving toward on-site, close-patient care. To maintain flexibility, designers used portable screens instead of walls and rooms. The facility has four nursing labs, four occupational therapy labs, an Activities of Daily Living lab, and a computer testing lab for on-line licensures and certifications.
The Facility in Action
Each one of the Inman School’s laboratories functions like it would in a hospital setting. Headwalls contain the plugs and suction equipment used in a hospital setting, so students learn how to use real-world equipment.
“It sounds like minutiae, but it’s not. We don’t typically figure that out when we’re teaching in a clinical area,” explains Wollaber.
Oxygen isn’t part of the labs because of expense, but the building has simulated medical gas so students can practice applied oxygen and nebulizer treatments. There’s functioning suction in all labs and lift equipment in both bottom floor labs. For consistent demonstration of proper medication dispensing, all four of the nursing labs are equipped with Pyxis®, a pharmaceutical distribution system used in many healthcare facilities. Belmont contracts with HCA on a bedside hospital information system, so documentation is part of the scenarios.
Every laboratory has two different types of sinks, a combination of pedal sinks, elbow sinks, single barrel sinks, or scrub sinks.
“We want our students to get into the habit of washing their hands,” says Wollaber. “Since handwashing continues to be a primary intervention in preventing infection, creating habits of health hand hygiene in students is essential.”
Designated occupational therapy (OT) labs are also used by physical therapists (PTs) and nurses. The school needs the space to incorporate all the different learning styles into labs, explains Wollaber. The OT/physical therapy/pediatric lab will be used by both nursing and therapy programs in the near future, and an Activities of Daily Living lab for nursing, social work, and OT. One side of the Daily Living lab is set up like a typical house. The other side is universally designed so students can see what adaptations would be required if someone were to have a stroke, for example.
Classrooms are designed with Belmont’s pedagogy in mind--small class sizes and a more interactive/collaborative style instruction, rather than lecture-style teaching. Classrooms are flat, not tiered, and come in three sizes. Small classrooms seat 24, medium classrooms seat 32, and two large classrooms seat 48.
“We have trapezoid tables so we can reconfigure. We are moving completely away from ‘sage on the stage’ to ‘guide on the side,’” says Wollaber. “It’s not uncommon for our students to reconfigure the tables in the middle of class and engage in addressing patient care scenarios.”
Every classroom contains standardized equipment such as overhead projectors, SmartBoards, one-touch A/V controls, PC/DVD/VCRs, and wireless and wired Internet access. Overhead speakers feature high fidelity sound.
“When you’re teaching breath sounds, lung sounds, heart sounds, arrhythmias, etc., the tinny little computer sound system just doesn’t cut it,” says Wollaber.
As a cost savings strategy, old rehabilitated computers were placed in the classrooms and labs initially, so they could be replaced as they failed instead of replacement costs coming at one time.
Four full-time offices surround the adjunct faculty space, a design Belmont’s planners discovered on a benchmarking trip.
“We were concerned about being able to have conversations with students about patient care. This configuration allows students to talk behind closed doors without being worried about confidentiality,” explains Wollaber.
Fast-tracking the Construction
Construction of the new school building was fast-tracked. Instead of design–bid–build, where the general contractor bids the drawings, the contractor came on board early with a contract for his fee and general conditions. The trades bid the documents as they were produced. Construction started prior to completion of the drawings and before a guaranteed maximum price (GMP) had been approved.
“This process occurs more and more often these days. It shortens the design and construction duration because the two overlap, and with a shorter schedule, the project costs less,” explains Brown. “The building and its academic program are up and running quicker.”
The Belmont building also includes a four-level, 350-space underground parking garage. Nashville soils are solid bedrock, so several months of excavation took place before construction began. While the contractor was digging the garage, the design team finished the drawings. The project began in February 2004 with groundbreaking that October. Drawings were completed in March 2005, and move-in was May 2006.
“This project is a great success story in the management of construction dollars, as well as the schedule, by the contractor. We stayed in budget throughout the project design and construction,” adds Brown. “It was one of the smoothest projects I’ve been involved with.”
Lessons Learned
There were a few items that Belmont’s administration would have handled differently. They had made the assumption students would move to a nearby building’s lounge area, but they didn’t. Health profession students tend to arrive at 8 a.m. and leave at 4 p.m., and Belmont should have programmed additional informal spaces.
“We aren’t as effective in being able to work in teams. Our students have figured out ways around it,” says Wollaber.
One suggestion Wollaber proposed was the establishment of an endowed equipment fund, where the interest generated pays for acquiring additional equipment as well as maintenance of installed equipment. Belmont established the fund following building construction and it has been a successful strategy for directing alumni giving.
Wollaber emphasizes that working closely with practice partners throughout the planning stages is essential, as is close collaboration with the design team.
A Positive Impact on the Community
The Inman Center has impacted the school and community in a variety of ways. Since the facility opened, Belmont has initiated a new School of Pharmacy based on the needs of the healthcare community. The school has also increased enrollment in the health sciences, especially nursing, to meet the growing demand for healthcare professionals.
“Prior to the Inman building our enrollment was constrained significantly by our physical facilities. You can’t grow when you are teaching nursing in Sunday school rooms and only have a double-wide trailer for laboratory space,” notes Wollaber.
The fourth floor of the new facility is community space where Belmont now sponsors a variety of educational programs for the community and healthcare professionals, such as dialogues on America’s healthcare dilemma and nursing educator conferences.
“We have had real success bringing the community into our classrooms. That is a very exciting thing for Belmont. We would have never been able to do that without this facility.”
By Taitia Shelow
This report is based on a presentation Brown and Wollaber gave at Tradeline’s Academic Medical and Health Science Centers conference held in October 2008.
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ISSN: 1096-4894
Fig. 1
Inman Center - exterior
The Gordon E. Inman Center aesthetically integrates into the fabric of the campus and neighboring residential community. Photo by Scott McDonald © Hedrich Blessing.
Fig. 2
Inman Center - interior lab
Within Inman Center’s learning environment, labs simulate acute care and maternity units and are equipped with advanced technology to create real-life spaces and clinical situations. Photo by Scott McDonald © Hedrich Blessing.
Fig. 3
Former facility
Facilities formerly housing Belmont’s School of Nursing were tight, uncomfortable and scattered in back-of-campus and off-campus locations. Photo courtesy of Belmont University.
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about Wendell Brown and Debra Wollaber
