Kicking out visitors during report

ComeTogether, LPN · Jan 17, 2015

Whenever I've needed family to leave the room (which was often, since I'm a CNA and I did a lot of changing, turning etc.), I've simply said

"I"m sorry to interrupt, but I need to ask you to step outside for a few minutes while I get auntie/uncle/grandma comfortable"

guest769224 · Jan 17, 2015

I am surprised your unit allows children inside. We sure don't in our ICU.

When we need people to exit the room I have heard-

"I need you guys to leave for a moment while we get your loved one cleaned up"

Or more commonly, "if mrs XYZ wouldn't feel comfortable with you here during her clean up, then I'll need you to step out."

It is annoying when family members don't respect what the nurse is asking.

That One Nurse · Jan 17, 2015

We kick out family during shift change- including POAs/spouses/etc. I prep them towards the start of the shift if spending the night. And if people come in to visit close to shift change I give them a heads up so it doesn't blindside them. Our scripting usually involves "In order to protect the privacy of all of our patients we close to visitors during shift change. The front doors to the unit will be closed but open again at 8:30. This allows information to be handed off and for the oncoming shift to develop a plan of care. Let me make sure that we have the correct phone number if for some reason we needed to get a hold of you during that time." Everyone needs to enforce it though or it goes to poop pretty quickly. We don't enforce it in certain scenarios-comfort care, patients that only stay in bed when their spouse is there, etc. but it's rare.

Editorial Team / Admin · Jan 17, 2015

We have signs posted at the entrance to the unit stating it is closed for two hours twice a day. This information is also included in the family orientation to the unit. The only exceptions are for actively dying patients who are expected to pass during that two hour closure. Nurses are proactive about preparing the family/visitors for when they will be asked to leave and have a lot of support from the nurse manager in enforcing the policy.

llg, PhD, RN · Jan 19, 2015

I think telling people from the moment of admission is the way to go. It's part of the "orientation to the unit" routine. We encourage families to use that time to "freshen up," use the restroom, get something to eat, update other family members, etc. Reminding them of that policy 30 minutes or so beforehand also helps so that they can make plans.

When the time comes, we simply announce that hand-off rounds will be starting in 5 minutes and the unit will be closed to visitors at the time. It will re-open for visitors at xxxx.

Nienna Celebrindal · Jan 20, 2015

We have signs, we tell this to families upon meeting them and we do an announcement 10 minutes prior. Sometimes we do have to go in and kindly boot them out. I have found that saying passing on a proper report is essential to the care of your loved one usually does the trick with most people.

Susie2310 · Jan 20, 2015

I think that the title of your thread "Kicking out visitors during report" could have been more respectfully phrased, for example: "Requesting that visitors leave during report." It always seems unnecessary to me, when our job as nurses is to take care of patients and their families/significant others, and when the nurse-patient-family relationship is built on trust, to refer to patients visitors on a public web site as though they are stray dogs that need to be kicked out of the way.

HIPAA actually does make an allowance for patient information that is accidentally overheard by visitors, etc., if I recall correctly.

As far as restricting visiting hours, it's easy to proclaim how reasonable it is to exclude visitors from their loved ones sides "for just a few hours." However, given how sick a patient has to be today to be hospitalized, and how acutely ill and critically ill many patients are; I don't believe it's really that reasonable. Studies show that patients benefit from unrestricted visitation. Yes, of course visitors should behave reasonably. There's a good chance that a patient can take a turn for the worse during the visitor exclusion time, even if they weren't "actively dying" to begin with. Think about how you'd feel receiving a phone call telling you that your family member's condition had deteriorated, or worse, while you'd been sent off to the cafeteria, or to "freshen up." Think about how the patient who becomes sicker without their loved one by their side to support and help them may feel.

I often read on AN where some people express shock at how different the situation is when they are the family member, visiting their loved one, or when they are the patient in the bed, and how different it all is then.

SubSippi · Jan 28, 2015

Just to add to the other posts...

Most people are okay, but sometimes they get irritated when we tell them it's so we can give report and protect patient privacy, especially when they're in the room with the door closed or far away from the nurse's station. I find it helpful to add that it's important for us to get our first assessments in quickly without any distractions, because we need to be familiar with the patient's baseline.

Here.I.Stand, BSN, RN · Feb 2, 2015

I generally say something like "We need ___ minutes for us to turn him/her and change the sheets. Do you have the code to the waiting room?" We don't allow families to mill around in the hallways for privacy and crowd-control reasons. Maybe legally, the privacy issue would be considered incidental disclosures, but if they wait in the waiting room there won't be ANY disclosure. :yes:

caliotter3 · Feb 2, 2015

At one facility we ran into resistance to a new policy of including the nursing assistants in report. Nurses complained because sometimes they had to "edit" some of their comments, and no one was dealing with the deluge of inter-shift call lights. Some CNAs took the new policy as a green light to sit at the nurses station at their discretion, to listen in on the nurses more often than usual, and to access the charts. Finally someone was able to return the procedure back to providing the necessary CNA information at the beginning of report so the CNAs could go on about their business and stop wasting time listening to all the information that did not necessarily impact their duties.

delphine22 · Feb 3, 2015

At one facility we ran into resistance to a new policy of including the nursing assistants in report.

What a horrible idea! I can't think of a single reason why someone would think that was helpful. In fact, in most places I've worked the CNAs start work 15-30 minutes before or after the RNs do, so they are always available and not in report while we are.