Visiting hours and quality of care: an unscientific study

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    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.)
    Last edit by brian on Nov 22, '10 : Reason: added paragraph breaks for easier reading
    lindarn likes this.

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  2. 80 Comments...

  3. 13
    Well, I know I'm going to get flamed over this but here goes anyway.
    I would love to be able to restrict visiting hours a lot more than we do now. We are suppossed to have visiting hours from 11:00 - 20:30, but visitors show up whenever they want. We (nurses) really have no power to make them go. I hate having to do am care with visitors in the room. They get in the way.
    We try to inforce visiting hours but management won't back us up. When we tell visitors to wait until 11:00 to come in we get so many excuses and complaints that it just isn't worth our time to inforce it.

    Durings the SARS outbreak, we were shut down to visitors (with a few exceptions) and it was wonderful! We could get care done. Pts went to therapy without any problem. The psych unit said they saw a real differance in pt care and compliance with therapy because there were no visitors interfering with therapies. "Oh please Ms PT - come back in 1/2 hour because my daughter is here". None of that.

    I don't want to go back to SARS with no visitors, but I would really like to see visitors inforced more than we do now.

    OK. Flame away.
  4. 5
    Pepper I am with you 100%. I work in the West and we have no visiting hours, meaning pts can have visitors 24/7. I find it hard to provide care with family/ friends breathing down my back. I have also noticed some very weird family dynamics going on. The Pt will be fine all day 1/10 pain the second thier spouse come they are in 10/10 pain screaming and crying. I just want to deal with my pt's acute medical problem not all the baggage.
    dbscandy, Fiona59, sicushells, and 2 others like this.
  5. 4
    I'm more concerned about the reaction to your new boss. Do we work in a autocracy? Oh wait, this is America. Your boss seems to believe it though. I would wait to see if they were going to make it or not, then look for a new job. Life is too short to work under those conditions. Maybe you could copy a few pages from "The Adult Learner" by Malcolm Knowles. He says that adults need to know the "why". Perhaps she would love some feedback on how to improve her management style. Good luck with that.

    You're right, having visitors at the start of the night is a disaster.

    I work nights in ICU in CO. We have unrestricted access. One benefit is that visitors are usually spread throughout the day. We do limit to three in the room and no little kids. They can rotate from the waiting room. The enforcement is largely left up to the nurse but I have no problem enforcing when there are so many people you can't see the patient. Our charge nurses always back us up and will handle if asked.

    The interference from family ranges widely from no trouble at all, to taking up all your time. I think on busy units visiting hours must exist and be enforced. To enforce them, just close the doors to one access point. I think many patients benefit from getting a break from some family who basically bother them nonstop.
  6. 1
    Quote from nurse2033
    I'm more concerned about the reaction to your new boss. Do we work in a autocracy? Oh wait, this is America. Your boss seems to believe it though. I would wait to see if they were going to make it or not, then look for a new job. Life is too short to work under those conditions. Maybe you could copy a few pages from "The Adult Learner" by Malcolm Knowles. He says that adults need to know the "why". Perhaps she would love some feedback on how to improve her management style. Good luck with that.
    Actually, I am starting my little research project with the possible intention of submitting it to her boss in hopes of showing what a well thought out argument looks like. Other things that this new manager has done (I won't go into detail for fear of being recognized online and burned by co-workers) lead me to believe that her management style is in fact non-existent. Having been in a management role myself in the past, I have some idea of various characteristics required by a decent manager, and she has none of them.
    lindarn likes this.
  7. 3
    Yikes, unrestricted visiting? Perish the thought!

    At my hospitals nurses can and do enforce visiting hours, however whether visitors comply is a whole other bag of worms. Most people are okay about it but the odd ones take a hissy fit; I just ignore them.

    The exception of course is for palliative patients and children.

    As for patient outcomes; hospitals may not be a place of rest but it is a place for healing, and this is very hard to do with a steady stream of visitors coming in/out. The worst is with the elderly confused who can't speak up for themselves; visitors get them all riled up then go home leaving us to pick up the pieces.

    If someone gets in my way when I'm doing care, I simply ask them to leave then close the curtain; they usually get the message. So far no real problems to complain about.
    Fiona59, Scrubby, and lindarn like this.
  8. 5
    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.
  9. 4
    Off topic ... my pet peeve is when patients delay care because they are on their cell phone "well I'll just come back when I have time" 9 am meds @ 11!
    elizabethgrad09, Fiona59, Scrubby, and 1 other like this.
  10. 2
    If a patient is in a private room, I don't mind family/friends staying an extra hour...but if it is a 2 or 4 bedroom then I make sure patients and families are aware of the visiting hours are only until 8:30pm.
    Fiona59 and Chaya like this.
  11. 3
    We have private rooms and unrestricted visitor access on my surg oncology floor. Most patients really appreciate it to have someone their when they need them. If a visitor is in my way I will tell tell if they need to step back and leave the room. I've had fresh post ops and a group of 15 people waiting and I've been my patient's advocate and turned them away. They may be *issy about it at 1st but I don't care, just what's good for the pt. We can get a lot of younger pts who def act different when mommy is around though. Yeah whatever it's too late to fix that now but no I'm not giving their dilaudid and phenergan 'a liitle early'!
    dbscandy, Fiona59, and 86toronado like this.


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