Policies in L2??

NICU_Nurse, BSN, RN · Aug 18, 2003

My first question is WHY???!!!????

Why on earth would your manager suggest this? Did he/she give you a rationale for leaving the windows open to the hallway? If not, I would certainly ask before complying with such a request!

First of all, seeing babies splayed out underneath a radiant warmer is not a pretty picture- I don't know if everyone passing by the window would be able to handle it well. I anticipate a nice little traffic jam with nosy faces pressed against the glass straining to get a better look. How will that seem to the parents who are inside the nursery attempting to bond with their baby and cope with their personal situations? How will the parents feel as they leave to go home, knowing that their child is being stared at by a bunch of strangers? They already feel horrible enough having to deal with leaving their child behind every time they go home, and the stresses of having an infant hospitalized in the first place. This only compounds that and makes them feel more helpless- they can't protect their child in ANY way, and apparantly, neither can the hospital in their absence.

Secondly, the fact that their crib card is going to be visible to all that pass by seems like a HUGE privacy violation to me, though I attempted to look it up on the internet and had some difficulty finding something that applied specifically to such a situation. In every nursery I've ever seen, the windows were closed, even in the Well Baby nurseries, unless the parents or family were outside asking to see in. Does this manager give a flying hoot about infant security? Did it occur to this manager that you may have crazy infant abductors out there peering in trying to get a name to place with a baby, making it that much easier for them to do God knows what?

A newborn IS entitled to the same right to privacy that any other patient is, pediatric or adult. Period. We are there to PROTECT these babies, not expose them as science projects to gawking eyes, or make them MORE vulnerable than they already are to the risk of being abducted. Infant abduction is a very serious and real issue and it seems like your manager is not taking this into consideration.

Your arguments about putting a 5 year old on display for others to stare at is sound and justified- you should most DEFINITELY present this to your manager, and if he/she has an unsatisfactory response (i.e., if he/she fails to admit that they are a complete idiot and were mistaken) I would take it immediately to someone higher. What possible benefit could there be to suggesting this? What if the patient were 50 instead of 5? Does that make it any different? Hell no!

Furthermore, if nothing is done about this, I would simply ask the parents if they mind exposing their child and his/her illness or physical condition to every Tom, Dick, and Harry that decides to stroll on by the newborn nursery. I doubt that any of them would agree with your manager, and you know if the parents complain, the hospital will jump because there are serious legal issues at stake here, and as far as I know, it is perfectly within a parent's right to contact a lawyer and initiate legal action secondary to a violation of their child's privacy, whether it's substantiated or not. Patient confidentiality is a hot issue right now, and I doubt that your hospital feels so strongly about those windows being open that it would be willing to go to court over it.

If you don't want to put yourself out there as the lone protester, why don't you make an anonymous phone call the the hospital's privacy policy coordinator, or the hospital legal representative?

Does your unit have a "Patient's Bill of Rights?" Every hospital has these, and most pediatric units have one as well, as far as I know. Get a copy of this ASAP (we had one hanging by the entrance to the unit) and check it for relevant passages.

This is a time when I would insist on being a thoughtful advocate for your patients! I would throw a FIT if my child was in a nursery that allowed this, and I doubt I'm alone.

You know, in my previous facility, we had some preemie pictures on the wall near the door to the unit. I cannot tell you how many times I saw family gathered in the hallway staring at those pictures and making comments on how small the babies were and how flat their heads were and how THANK GOD their sister's cousin's baby didn't look like THAT and saying it right in front of parents leaving the NICU from a visit with their baby who DID look like that. It was horrible, and eventually they took those photos down because it was causing extra grief for the parents.

Please let us know what you do about this! Advocate! Our babies can't speak for themselves. That's why we're there. :)

RN-NICU · Aug 18, 2003

I agree 100% with every word you say. I have seen some nurseries write only the first 3 letters of the last name on the crib card; and I wonder if this is what she will suggest we do. And how often do we see people straining their necks toward another warmer or isolette," Oh my gosh! She is soooo small! How much does she weigh?"

I have spoken to a couple of other nurses in the unit about how I feel (we are a very small unit: 12 LDRPs, sometimes no L2 babies, sometimes 2 or 3, and 2 baby nurses on shift at a time, L2 or otherwise) and I half-joked that this may ultimately get me fired because I will not let this go. As you said, these babies can't speak for themselves, but I can. Would a nonverbal adult in ICU be subjected to the same thing just because he can't complain?

Thanks for listening. I'll keep you updated.

Mimi2RN, ASN, RN · Aug 18, 2003

Our PCM would not allow us the have a shade on a narrow window by a back door. Much of the time we keep a screen in front of it....and when necessary tape a baby blanket over the top part. We don't need to be in a zoo, either!

nurseiam · Aug 21, 2003

Can we say HIPPA!!!!!

RN-NICU · Aug 21, 2003

Okay, friends; what do I say when my mgr says we will only put the first 3 letters of the name on the crib card, then leave the blinds open? Also, for any of you who work in a strictly well baby nursery, what are your policies as far as blinds on the windows and crib cards?

NICU_Nurse, BSN, RN · Aug 22, 2003

I have experienced two hospitals. The first had blinds on the outside windows that WERE ONLY OPENED FOR FAMILY MEMBERS. If they were just open for no reason, they got closed, simple as that. My second facility has pods with curtains (2 babies max per pod) so that doesn't really apply, but generally the curtains are closed unless we're not in the room and need to see in. The way the unit is set up, we are closed and locked so there are no gawking parents unless they're already admitted into the unit to visit their own baby- since there are only 2 per pod, we don't really have much of a problem here.

In my old facility, which is more like the ones you've described, even the Well Baby nursery had blinds that stayed closed unless family was visiting. They could roll the crib to the window for FAMILY ONLY, but the card was covered with a blanket while the baby was being displayed.

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Now. This is NOT just an issue of the crib card being exposed, but I'll get to that in a second. As far as putting the first 3 letters of the name on the crib card, what happens when you have more than one baby with a similar last name? What if you have a White or a Whitman or a Whitaker? Or a Johnson or a Johannes? Two baby Brown's? Two Smith's? One easy way to fix that problem is to get new cards made up that fold in half, like greeting cards (or place-card sized cards...I don't know how big yours are). That way, on the inside you have all of the personal information, but you have a flip-down cover to keep it from being exposed. If you think the MD's will not want to flip the cards up, draw a floor-plan (rudimentary) design of the unit with bed spaces, photocopy it, and fill a new one out each morning with the baby's name in the bedspace, and then keep it visible or tacked up where Doc's and staff can see it but parents can't (ie, if you have an assignment clipboard or something like that).

And I have to ask again, did she say ANYTHING as to WHY she wants to keep the blinds open? I mean, what in the good green earth is the point of that? I still don't understand.

Finally, she still doesn't seem to understand that there is more than one factor to consider here. It is not JUST the name being exposed, which is a legitimate concern, but it is the PRIVACY of these babies and their families that has to be taken into consideration. This is not PT Barnum's traveling show of neonatal freaks here, these are babies who are PATIENTS and who deserve and legally have the right to privacy just like EVERY SINGLE other patient in that hospital.

What is WRONG with your manager?????

And please forgive me; I'm easily riled this morning. Hope this doesn't come out too harsh- it just rubs me the wrong way.

pengland1965 · Aug 23, 2003

We were just faced with a similar situation. Our manager was just told that she was to keep nursery windows open because people love to see the cute little babies in the nursery. We were told the babies promote our labor delivery unit. What a crock! Anyway, it was orders from headquarters so to speak, so we compromised. Parents must sign a consent to photograph. We place their namecards at the lower end of their crib so that the public cant read it. If the baby is exposed in any way, or if we are performing a procedure, the window is closed. No exception. this even includes diaper changes.

NICU_Nurse, BSN, RN · Aug 24, 2003

So you have to close the window for every diaper change? Does that actually work? It seems like you'd be running back and forth to the window all the time...?