Visiting hours and quality of care: an unscientific study

[86toronado]

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.)

[Ruby Vee, BSN]

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.

i've been through several serious illnesses with family members, and a week in the hospital myself. and i agree with ottowarn. perhaps she's not the one who needs more perspective.

[Gluteus Maximus]

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.

You obviously have a poor understanding of how the Canadian health care system works. Although American nurses may practice in fear of getting fired with every decision they make, Canadian nurses do not. Patients will continue to flood the hospitals irregardless of how good our customer service techniques are. Without this barrier of fear, we have the ability to be more autonomous and free-willed with our decisions. Visiting hours exist for a reason: because vistors tend to get in the way more than anything impeding a nurse's ability to do her job. If you don't trust your loved one to stay overnight safely in the care of hospital staff, then you should be nursing them yourself in the confines of your own home.

[indigonurse]

The only time a visiting policy does not have to be followed is if a pt condition is one where the pt. is not expected to live, or critically unstable. It helps if family is given advanced notice that they need to leave by a certain time and all efforts are made to keep the pt. comfortable. If pts. are sharing a room it can be very disturbing to their roomates to have visitors in the room while they are trying to sleep. Legally nurses are obligated to follow the written policies and procedures. If they don't it can be used as a basis for disciplinary action. However if you strongly disagree with a policy calling a meeting to discuss the issue is a good start. The issue can also be presented to the board of directors at a meeting.

[ObtundedRN, BSN, RN]

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)...

I don't think we have much of a problem in the states with patients being in semi-private or wards since most hosptials are all private rooms. The only place in my hospital that has a ward is the recovery units (PACU and CVRU). And as I mentioned in my previous posts, these are the only places in my hospital that actually has enforced visitation restrictions. No visitors in the PACU, and visitation is highly limited in the CVRU. Most of the US went to all private rooms because of integration of blacks and whites. Private hospital rooms was racially motivated, not due to privacy reasons.

[Ruby Vee, BSN]

i don't think we have much of a problem in the states with patients being in semi-private or wards since most hosptials are all private rooms. the only place in my hospital that has a ward is the recovery units (pacu and cvru). and as i mentioned in my previous posts, these are the only places in my hospital that actually has enforced visitation restrictions. no visitors in the pacu, and visitation is highly limited in the cvru. most of the us went to all private rooms because of integration of blacks and whites. private hospital rooms was racially motivated, not due to privacy reasons.

i can't help but wonder where you're getting your information. i've been working for the past three decades in the us, and have yet to encounter a hospital -- as a nurse, patient, or family member of a patient -- that has all private rooms.

[OCNRN63, RN]

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.

Not only do I totally get you, I want to come work with you. The customer service angle is making life so difficult here; it's a sword hanging over every nurse's head here.

[Scrubby]

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.

It's the same here in public hospitals in Australia. We don't have the whole customer service mindset here thank goodness. If a patient or their relatives start getting unreasonable we have every right to set them straight that they are in a hospital and there are certain behaviours that will not be tolerated.

And you can't fire someone very easily here as well.

[TheOldestNurseOnUnit]

I don't think we have much of a problem in the states with patients being in semi-private or wards since most hosptials are all private rooms. The only place in my hospital that has a ward is the recovery units (PACU and CVRU). And as I mentioned in my previous posts, these are the only places in my hospital that actually has enforced visitation restrictions. No visitors in the PACU, and visitation is highly limited in the CVRU. Most of the US went to all private rooms because of integration of blacks and whites. Private hospital rooms was racially motivated, not due to privacy reasons.

Oh my dear God---RACIALLY motivated???? Where are you getting your information?? Hospitals are converting to private rooms to help stem the spread of nosocomial infections AND for compliance with HIPAA!! Why on earth would you make such a statement??

I work in a community hospital that has very few private rooms--they are mostly double (except Peds/ICU/CCU/OB & CVU). I have had patients of all races, religions, everything except sex in the same room; no one has EVER complained to me about the person of a different race being in the bed next to them. The only thing I hear about is that the rooms are crowded when there are 2 people in them and there is no privacy behind the curtains!

Please don't make everything about race--we have enough problems in this country with our healthcare systems without bringing that into the mix any more than it already is!

[Pepper The Cat, BSN, RN]

Not only do I totally get you, I want to come work with you. The customer service angle is making life so difficult here; it's a sword hanging over every nurse's head here.

Yeah - we don't worry too much about customer service. If a family threatens to move their loved one to another hospital we just smile say "buh-bye, don't the door hit your ass on the way out!". Well, maybe not that, but you get the idea!

I am always amazed about the US nurses talking about Press Garney scores, pt satisfaction scores etc. It must be difficult to work in such an environment.

[Gluteus Maximus]

I don't think we have much of a problem in the states with patients being in semi-private or wards since most hosptials are all private rooms. The only place in my hospital that has a ward is the recovery units (PACU and CVRU). And as I mentioned in my previous posts, these are the only places in my hospital that actually has enforced visitation restrictions. No visitors in the PACU, and visitation is highly limited in the CVRU. Most of the US went to all private rooms because of integration of blacks and whites. Private hospital rooms was racially motivated, not due to privacy reasons.

What?? You mean blacks and whites are segregated at your hospital?

[Fiona59]

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.

Believe it or not. Yes, my parents and one of my children have had serious illnesses.

I don't want to go into details but a nurse from one service is usually useless on another. My area of expertise does not cover oncology and respiratory ailments. When the end came, we were there, quality care was given. I live over 1000kms away from my family and nobody cared if I was a nurse. Quality care was given to all, whether or not the family was "advocating" for the relative or not (and btw, I really loathe the Readers Digest and their rants about patient advocacy, patient advocacy doesn't mean standing there questioning every med and it's purpose, it's about ensuring that the system is working for the patient in question)

I have enough trust in my fellow healthcare professionals to entrust them with the lives of my loved ones. Whenever my family heads south to the US, I double up on the travel insurance and keep fingers and toes crossed not to experience your healthcare system.

I shouldnd't have to stay overnight to ensure that care is given, that medications are on time, that basic hygiene needs are met. Our system isn't perfect but from what I read here about yours, it makes me thank the powers abouve for universal healthcare.

[BelleNscrubs04]

Your new boss sounds behind the times. The shift is towards family centered care, not away from it....

Yes, sometimes it does make things a little harder on the nursing staff, but then, it's not about us.

Well said. I think the perspective (and well being) of the patient can sometimes get lost among all the hospital protocols and procedures. Nurses are obviously overworked and anything that can help them to ease their load is great but only if it's in the patients' best interests. I'm am sure that some family get in the way and cause problems but many are helpful and are there to help support, comfort, and care for their family members. As a nurse you might think about what a good job you do and not understand their concerns but family want to be involved, understand what's going on, and make sure that their loved one is getting excellent care. They do not know you or whether you are an excellent nurse or not.