Dear Hospital Administration...

Long Term Care Columnist / Guide · Jul 24, 2012

Preach it, sister!!! I've long wondered about these same issues, and I haven't worked in acute care in YEARS. Some things never change.... :uhoh3:

Tragically Hip · Jul 24, 2012

" High patient satisfaction scores OR semi-private rooms?"

From a patient perspective, I couldn't agree more. I remember reading an article in the New York Times a while back that those who study human factors and architecture in health care settings finally came to the realization that shared rooms are a very bad idea, sometime around the late 90's. I spent three weeks post-surgical in a hospital that was built just after that time, where everyone had a private room, and the stay was horrible.

Some months later I spent a couple of weeks in a world-class hospital sharing a room, and it was among the the worst experiences of my life. While the medical and nursing care were excellent, I felt like I was going to die having to deal with very sick roommates, one who regurgitated blood like a lawn sprinkler, and another who had profound sleep apnea. The first had his extended family in the room at all hours. The staff was very lenient about visitors. I had a spinal headache and could hardly move or think, after having major surgery. I hardly slept. I don't know how I got out of there without an MI.

Anything other than private patient rooms should be banned. It's not just a matter of comfort. It's also a matter of infection control.

Do-over, ASN, RN · Jul 24, 2012

At the risk of straying from the topic at hand...

I believe that semi-private rooms can sometimes be beneficial to the patient(s). we have a mixture of privates and semis. When possible, a thoughtful matching of the roommates help. Some people actually seem to enjoy the company and not being "alone" while in the hospital. Also, pairing two patients that require close observation can save resources.

That being said, I do think the majority of rooms should be private.

Somewhat agree with the "quiet at night" thing, but patients aren't very happy about hanging out on an ER gurney all night either.

RNsRWe, ASN, RN · Jul 24, 2012

I believe that semi-private rooms can sometimes be beneficial to the patient(s). we have a mixture of privates and semis. When possible, a thoughtful matching of the roommates help. Some people actually seem to enjoy the company and not being "alone" while in the hospital. Also, pairing two patients that require close observation can save resources.

While I agree with this in theory, in my experience it was always the rare exception that had patients honestly enjoying each other's company, to the point that they preferred to be roommates instead of having a private room. In my experience, I often found people who clearly pretended to like the roommate so as to avoid making it "worse". In other words, saying it was perfectly fine to have the roommate chat late into the night on the cell phone, or keep the TV on all night long--when in fact they whispered to me to "see if you can get her to stop that".

Nope, definitely can't have it all!

All4NursingRN · Jul 24, 2012

I swear alot of these problems we face in the hospital are amplified in the ER.

-Major HIPAA violations -ER and privacy, nope, atleast not the ER I work in!

- Belligerent , agitated, disgruntled (sorry just got off work, spelling is off) patients all mixed up together

- Patients coming, going, to this test to that test. Ooops this patient lost her spot to a new critical patient

- I can go on FOREVERRRRRRRRRRRRR!!!!!!!!!!!!!!

CrunchRN, ADN, RN · Jul 24, 2012

I would never be a happy camper if I had to share a room no matter how good the nursing care. They need to realize the impact on satisfaction scores and take responsibility........ yeah, right!

Aeterna, BSN, RN · Jul 24, 2012

I work in an older part of the hospital I work at, so we still have ward roomes (3-4 beds to a room). UGH. I hate hate hate ward rooms. They are noisy, crowded, and there is only one bathroom for all of the patients in that room. And, from a nursing perspective, I call them the "black holes" - once you're in there, you can't get out! (Because if you go in for one patient, at least one other will grab your attention when you're done, and then another after that...and so on and so forth)

It is also crummy for infection control purposes. Our floor does not have nearly enough private rooms. When we were having rampant diarrhea on our our floor, we ended up closing beds because we were converting semi-private rooms (2 beds to a room) to private rooms due to having so many people requiring isolation.

That being said, there are some patients who like the company. I've had a few actually tell me they preferred having at least one roommate because they were afraid of being alone. Also, last night, I worked in one 4-bed female ward room where all four of them get along quite well. It's actually a great room with the four of them in there right now - they sit and chat and keep each other occupied.

xoemmylouox, ASN, RN · Jul 24, 2012

I can see having 2 in a room, but 3-4? That is ridiculous in today's world. I cannot believe patients tolerate that. So many here would call Congress if we told them they would have to share a bathroom with 3 other people. I think admin's expectations are always unreasonable and unrealistic. We have cut so many staff members, but yet our satisfaction scores better be 95% or better. That is NEVER gonna happen.

mrTibbs · Jul 24, 2012

I used to work in a hospital with all semi private rooms. It was built in the fifties. Every day we would spend pushing beds in the hallway due to a large amount of fighting between roommates and their family members. Eventually the patient would either go home or go or get moved to another unit. We rarely had "lifer's" (pt's who stay for several months) Now we have a brand new spanking clean hospital. All private rooms. I must say its quite a change for the patient. Here is the big problem FALLS!!! OMG it is out of control. We have bells buzzers gait belts bed alarms chair alarms. We have sitters We chart in the room with the pt. We have Fall meetings team huddles and safety rounds. A whole new culture has emerged with the advent of the private room. It leads me wonder what will be next ????

Not_A_Hat_Person, RN · Jul 24, 2012

LTC should be all private rooms, unless the resident chooses otherwise. You lose enough independence moving into a nursing home, why compound that by living with a stranger who may not want you there?

My mother died in a nursing home. She died around 7 pm, and the funeral home finally arrived around midnight. Her roommate, whose husband was in a room down the hall, wasn't allowed in the room until Mom's body had been removed.

The facility was full, so there was no private space for the family to gather (so they said). When I was in Nursing Home Hell, a dying patient was moved to a therapy room so the family could gather and mourn in privacy.

You also have to consider med safety, infection control, quality of life (TV volume), and thieving family members.

Aeterna, BSN, RN · Jul 24, 2012

LTC should be all private rooms, unless the resident chooses otherwise. You lose enough independence moving into a nursing home, why compound that by living with a stranger who may not want you there?

Agreed.

Also, nursing homes have their fair share of dementia residents. My grandmother, because she/we couldn't afford a private room, was in a ward room when she was placed into a nursing home. I'm not sure what caused the incident, but she was slapped by one of the residents, so she was moved into another room. My grandmother was one of the sweetest women you could ever meet but could be a bit overbearing when trying to help people, plus there was a language barrier present. I believe the resident who hit her had dementia, as did my grandmother. It's really a recipe for disaster.

This happens in hospitals, too. We once had a geri-psychiatric patient on our floor - when he first came to us, the man was known to be quite aggressive and could be aggravated with little warning and with any triggers. Our private rooms tend to be for people who need to be isolated and/or our palliative patients - we rarely have any extra private rooms to accommodate anything else. He was neither of these, so he was in a semi-private room. It took a lot of deliberation deciding who to room him with. In the words of one nurse, "His roommate will either have to be able to run fast or be really good at self-defense!"