Visiting hours and quality of care: an unscientific study

Nurses General Nursing

Published

I work at a medium sized community hospital, on a mixed unit; meaning we have several intensive care beds on our floor, and several more stepdown/med-surg beds. We have had a change of leadership lately, and one of the changes that this new leadership has instituted has been to restrict visiting hours significantly. In the past it has always been up to the discretion of the RN who can visit, for how long, etc. There were policies in place, but they were very loosely enforced. Now it is expected that we adhere to these policies with no flexibility whatsoever (the only allowable exception being a hospice/comfort care patient).

Let me tell you how this is working out: the day nurses love this system. The get to get all of their work done, and not deal with visitors until the very end of their shift. The night nurses on the other hand hate the system. We are the ones who come in to work with family members breathing down our necks for the first hour of our shift, and then we are forced to be the ones who tell them they have to leave. When a post-operative patient in horrific pain is crying because you're telling her that her mother has to leave, you don't feel like you are providing good patient care. We as night nurses agreed to speak to said leadership today regarding how these policies are affecting us on nights, and were met basically with a stone wall. "These are the policies and you have to enforce them."

What is bothering me the most is that we are not being given any facts or evidence to back up these policies. I have been doing some research on my own, and most of what is out there seems to point to the opposite: less restrictive visiting policies seem to improve quality of care, as well as patient satisfaction. My research, as well as discussions with other RN's at other facilities in the area seems to point to a national trend in the opposite direction of that in which my institution is headed.

So, my question to all of you is what have you experienced in this respect? What visiting policies are in place where you work, and how strictly are they enforced? Are you allowed to use your nursing judgement at all in deciding who stays and who goes, or is it completely out of your hands? How have you seen these policies affect patient outcomes, and satisfaction?

P.S. It would help me if when you answer the above questions that you provide me with the type of unit that you work on, as well as the geographic location (you don't have to be specific, northeast, etc would be fine.)

Specializes in Psych, Med/Surg, LTC.

I don't have a problem with visitors so much. I just wish there was a way to enforce not requesting anything near the start or end of a shift, and saving their questions until after report is done and rounds/meds have been done. Give us an hour before/after report, please! Many times I have no idea who "Mom" is, since I have yet to meet them. I don't want to deny anyone getting to see their kids/grand kids. I would be a wreck if I couldn't see my little kids if I were hospitalized. I don't want to set strict time limits or # of people visiting. I just don't want the room so packed that patient and their room mate can't get to the bathroom and can't rest at all b/c there is someone always there and interacting with them. There are just 2-3 chairs in a patient room for a reason. Can't family rotate in and out? Does it really have to be a family reunion in the patient room? It really isn't good to have the room packed full of people. The staff can't get around everyone and it disturbs the room mate. I wish people/visitors used common sense. If the patient or their room mate is looking tired or having issues, be kind and limit your visit. If the nurse comes in and needs to do personal care/remove any kind of clothing/gown on the patient or room mate, or basically anything other than give them a cup of pills or take vitals, please be kind and step out for it. Please do not ask the nurse to come back and do it later. :uhoh3: I don't really care if people want to stay for part or even all of the night shift, but do not expect me to do more than bring you a blanket. And if you are there, be helpful. You can fill moms water pitcher and fluff her pillow just as well as I can. And please be QUIET past 9pm so other patients can REST! Staff wakes them up enough, they don't need family waking them too!

Specializes in acute care med/surg, LTC, orthopedics.

I posted earlier in this discussion that nurses at my facilities do push for compliance with the visiting hours and this applies to overnight visitors as well. We don't allow visitors to stay overnight especially if the patient is in a semi or ward; this is unfair to the other patient(s), and if I was that other patient, I'd be pretty mad if the nurse allowed some unnecessary person to sleep over. Not to mention there just isn't enough room in these rooms to house another body, if I have to crawl over someone to get to my patient, I'm going to be p!ssed.

I can never quite understand what the point is of a visitor wanting to stay overnight. The patient is in a hospital so obviously well taken care of and nothing bad is going to happen to them. They're going to be sleeping, not socializing, and if the visitor plans on sleeping, then why are they even there? I just don't get it.

Specializes in pulm/cardiology pcu, surgical onc.
I posted earlier in this discussion that nurses at my facilities do push for compliance with the visiting hours and this applies to overnight visitors as well. We don't allow visitors to stay overnight especially if the patient is in a semi or ward; this is unfair to the other patient(s), and if I was that other patient, I'd be pretty mad if the nurse allowed some unnecessary person to sleep over. Not to mention there just isn't enough room in these rooms to house another body, if I have to crawl over someone to get to my patient, I'm going to be p!ssed.

I can never quite understand what the point is of a visitor wanting to stay overnight. The patient is in a hospital so obviously well taken care of and nothing bad is going to happen to them. They're going to be sleeping, not socializing, and if the visitor plans on sleeping, then why are they even there? I just don't get it.

Your patients sleep at night? If you didn't know bad things do happen in hospitals. If I had a close family member (dh or child) sick in the hospital you bet I'd be there all night.

It's simple, we politely ask you to leave. If you are still there 15 minutes late, we call security.

Our buildings doors are locked at 22hr. The only way into the hospital is then through the ER. You have to pass security to get to the acute floors. If the unit tells security "No", you have to come back tomorrow at 11.

I've found visitors sleeping in the bed with the patient. I mean sheesh, infection control would have a fit and do you really want to snuggle up to someone with multiple drains?

And yes, we still have four bed wards and we do get the other patients reporting the loud groups.

If you're not dying and communicate in English or French you don't need overnight "help". Allowances are made for the terminal and for those that require translators (but usually we have to wake them up every time we need to work with their family member, so after two nights they go home and don't send in another relative because we expect them to translate)

Your patients sleep at night? If you didn't know bad things do happen in hospitals. If I had a close family member (dh or child) sick in the hospital you bet I'd be there all night.

Not in Canada, you wouldn't.

Specializes in pulm/cardiology pcu, surgical onc.
Not in Canada, you wouldn't.

A parent can't stay with their young child overnight in the hospital?

Specializes in acute care med/surg, LTC, orthopedics.
A parent can't stay with their young child overnight in the hospital?

We make exceptions for children and those who are terminally ill. It's up to the staff.

I think the difference lies in the whole customer service concept that exists in the States but not here; some of you nurses feel you have to jump through hoops to accommodate everyone and their brother, for fear of getting fired. We don't. That's not to suggest that we aren't customer service focused, just that we have the ability to be autonomous with our decisions w/o concern of repercussion.

Specializes in Psych, Med/Surg, LTC.

When my son was 15 months old, he was in the hospital for gastroenteritis/dehydration. A parent was REQUIRED to stay with him. I guess nursing staff doesn't like baby sitting toddlers and changing explosive diapers. :lol2: What do hospitals do with kids that are too young to be left unattended if a parent is to not stay overnight? Sure, they should be sleeping... But kids wake up a lot when they are sick. Does staff sit and rock them back to sleep?

Specializes in PICU.

In August I broke both my arms in a horse riding accident. My left arm was badly injured, had to have a closed reduction to reduce the ulnar dislocation, then surgery was scheduled the next am to insert a plate for the radius fractures. We got to my hospital room about 1am. Knowing my husband was tired, I tried to get him to go home. I thank GOD he didn't listen to me. I had the most miserable night of my life, was in near constant pain and vomiting. I couldn't do anything for myself obviously. The poor fellow got next to no sleep for taking care of me, replacing ice packs, grabbing my emesis basin just in time, calling for the nurse, etc, etc.

Yes, I realize this isn't common but I can't even imagine what I'd have been like the next morning had he not stayed. My poor floor nurse was swamped and couldn't be in there much, though she did the best she could.

Just my 2 cents from an all too recent (and painful) experience. I know that visitors aren't always helpful but very often they are.

I posted earlier in this discussion that nurses at my facilities do push for compliance with the visiting hours and this applies to overnight visitors as well. We don't allow visitors to stay overnight especially if the patient is in a semi or ward; this is unfair to the other patient(s), and if I was that other patient, I'd be pretty mad if the nurse allowed some unnecessary person to sleep over. Not to mention there just isn't enough room in these rooms to house another body, if I have to crawl over someone to get to my patient, I'm going to be p!ssed.

I can never quite understand what the point is of a visitor wanting to stay overnight. The patient is in a hospital so obviously well taken care of and nothing bad is going to happen to them. They're going to be sleeping, not socializing, and if the visitor plans on sleeping, then why are they even there? I just don't get it.

Specializes in PICU.
We make exceptions for children and those who are terminally ill. It's up to the staff.

I think the difference lies in the whole customer service concept that exists in the States but not here; some of you nurses feel you have to jump through hoops to accommodate everyone and their brother, for fear of getting fired. We don't. That's not to suggest that we aren't customer service focused, just that we have the ability to be autonomous with our decisions w/o concern of repercussion.

Wow, frankly, I find this insulting. What a way to twist family centered care to suggest that Canadian nurses are superior. I missed the logic where being family centered means a lack of autonomy.

Curious, have you ever been through a serious illness with a family member? I would hope that being able to see the perspective of the patient and family member might help you be more understanding.

Specializes in Med/Surg.

I work on a busy med-surg-ortho unit in the Southwest. We have very large private rooms and encourage family centered care, meaning we have no visiting hours. I understand that in our ICU it is up to the discretion of the nurse. I really have no problem with one person staying 24/7 with the patient. I did once have a patient that had his wife and four children stay with him 24/7. The wife slept on the couch, the oldest in the recliner and the three youngest in sleeping bags on the floor. Now that was a bit much :uhoh3:

Specializes in acute care med/surg, LTC, orthopedics.
Wow, frankly, I find this insulting. What a way to twist family centered care to suggest that Canadian nurses are superior. I missed the logic where being family centered means a lack of autonomy.

Curious, have you ever been through a serious illness with a family member? I would hope that being able to see the perspective of the patient and family member might help you be more understanding.

Not suggesting that at all; maybe you missed the hundreds of posts from American nurses citing their fears at being fired for any little thing. You will be hard pressed to find similar posts from Canadian nurses. Why? Because our publicly funded system means "the customer is always right" approach is not prevalent here. Therefore, the inherent fear of being fired is not commonplace with every decision we make.

I have no problem with visitors; when visiting hours are respected. They exist for a reason and nurses have the liberty to enforce them as they wish.

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