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.)

[zoebaily]

My hospital's ICUs have some single rooms-mostly used as isolation rooms. So most of the rooms are double rooms. These rooms are small and were not designed for large sleeper-chairs or to store a large collection of visitors' belongings. Family sleeping at the bedside has gotten out of control, I can see one person staying overnight in the room; but 2 or more becomes an obstacle. Even during the day many families refuse to convert the sleepers to chairs and leave their food and half empty soda bottles strewn about the room, at times a nurse cannot even get to the patient's bedside. I used to take pride in working as an ICU nurse, now it feels like I'm working in a cheap motel. We are supposed to give change of shift report at the patient's bedside to improve "patient safety"; but if family is sleeping then we don't have to, so we "don't disturb your (the family) rest". So family rest trumps patient safety? Next I expect to see "Do Not Disturb" signs hanging from the patient doors. I have to laugh when a family member complains that they were woken up during the night when the ICU nurse came in to provide care for their loved one. Families now consider it a hardship that they have to go to the cafeteria to get food and why doesn't the hospital deliver free meal trays to the family? My hospital provides "Joint Commission centered-care" and is also Press Ganey centered. If next year TJC said no family sleeping at bedside, that would become the policy. :paw:

[General E. Speaking, RN, RN]

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.

haven't read all the posts, so forgive me if this has been discussed. we have all private rooms at my (10yr old) hospital.

[General E. Speaking, RN, RN]

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. [/i]

OP: There are NO visiting hours during the dayshift (until late)?

My hospital (deep South) has unlimited visiting hrs between 9a-9p (exception: none between 6:30-7:30 am or pm for shift change/report). I'm in ICU and we have a 2 person limit. No children under the age of 12yrs. Of course, depending on the situation of the patient, we make exceptions. Absolutely no overnight visitors. If the patient is critical and/or family doesn't want to leave, they can sleep in the waiting area and come back and forth (briefly) during the night if the night nurse agrees.

However, if the nurse feels that the visitors are interfering with the patient care, ie: patient getting more agitated on the vent or the patient simply has had too many visitors, needs to rest/sleep, or the visitors are too loud or disruptive, we have no problem telling them (politely) to get out. Usually they comply. If not, we call security.

[Tina, RN]

Just as a side note to Ruby Vee...

If you wrote a book about your experiences with nursing, I'd buy and read it in a heartbeat! LOL I find your posts to be so interesting, I really enjoy reading them. My hospital doesn't seem to be like yours at all, but your posts provide such a different perspective to me.

[steelydanfan]

A friend of mine has been battling leukemia since february of this year. Shes my age, 24, and when she was in the hopsital for extended periods of time a group of our friends would make the hour trip to see her. We'd stay until midnight sometimes. Nurses, CNA's, dietary techs would come in and out doing what they needed to do and never said a word. Some even stopped to talk to us. I think it helped my friend tremendously b/c we were able to visit at our speed without having to count down minutes. and when you're making an hour long trip to see her, it was nice to have all the time we wanted to see her.

Your post said what we have been thinking in a very clear way.

"We were able to visit at our speed". You "deserved a visit because you made an hour trip to see her".

You never ackowledged the fact that she MIGHT have been too tired to see you, but since you have come such a loooong way, she felt obligated.

This is what makes me nuts about visitors. They ALL have a freakin' excuse about why THEY should be allowed in. Multiply that by 20 and you can see why pt's get no rest and nurses want extremely limited visiting hours to ensure thier pt.s sleep.

[Ruby Vee, BSN]

my hospital's icus have some single rooms-mostly used as isolation rooms. so most of the rooms are double rooms. these rooms are small and were not designed for large sleeper-chairs or to store a large collection of visitors' belongings. family sleeping at the bedside has gotten out of control, i can see one person staying overnight in the room; but 2 or more becomes an obstacle. even during the day many families refuse to convert the sleepers to chairs and leave their food and half empty soda bottles strewn about the room, at times a nurse cannot even get to the patient's bedside. i used to take pride in working as an icu nurse, now it feels like i'm working in a cheap motel. we are supposed to give change of shift report at the patient's bedside to improve "patient safety"; but if family is sleeping then we don't have to, so we "don't disturb your (the family) rest". so family rest trumps patient safety? next i expect to see "do not disturb" signs hanging from the patient doors. i have to laugh when a family member complains that they were woken up during the night when the icu nurse came in to provide care for their loved one. families now consider it a hardship that they have to go to the cafeteria to get food and why doesn't the hospital deliver free meal trays to the family? my hospital provides "joint commission centered-care" and is also press ganey centered. if next year tjc said no family sleeping at bedside, that would become the policy. :paw:

my hospital also provides joint commission centered care except when that conflicts with press gainey centered care, and the conflict is resolved by the date of the next joint commission visit compared to the date of the next pg report. i long for the days when we took care of patients, not clients, and visitors actually visited rather than moved in!

[Ruby Vee, BSN]

haven't read all the posts, so forgive me if this has been discussed. we have all private rooms at my (10yr old) hospital.

where are you -- i'd love to be a patient there instead of where i work!

[canoehead, BSN, RN]

i want to point out that the resources in hospitals vary. so the hospital with enough resources to fund and complete a study about visitors probably has a different breed of patient/visitor. hospitals that are just keeping their heads above water with patient care are less likely to be involved in research. so the studies are skewed towards the populations with more resources (and coping skills- ya i said it.).

a study done in suburbia doesn't mesh with reality in the inner city.

""[color=sienna]we were able to visit at our speed". you "deserved a visit because you made an hour trip to see her".

you never ackowledged the fact that she might have been too tired to see you, but since you have come such a loooong way, she felt obligated."

exactly what i was thinking. when i'm ill i don't want to see or speak to anyone for more than 20minutes, let alone entertain until midnight.

[General E. Speaking, RN, RN]

where are you -- i'd love to be a patient there instead of where i work!

texas... right to work state.