help me figure out how to say...

[all4schwa]

i have a hard time asking people to leave...if it's totally not necessary that they be there, i don't beat around the bush. but we do get a lot of trauma patients, broken up and mangled. this often means young people with parents, aunts, brothers, cousins. and what about when they come from out of town and dont arrive till night time? also, we get alot of the icu step down syndrome. mostly they are still very sick and the family thinks they should be in the icu. they have all night visiting privledges with private rooms over there, and it really it one of the most beautiful units. ours is in the oldest, smallest part of the hospital, no privates. i reassure that i'm going to take very good care, i check and chart on my pts hourly, yada yada yada...i some of them just can't tear them selves away. we do tell them they can hang out in the waiting room and check on their loved one periodically, and i understand why the rules are in place. i still feel awkward and cold asking them to leave!! i'm wondering if anyone can offer some of their 'lines' used in these situations.

p.s. when i came back from lunch last night the waiting room looked like a homeless shelter with everyone sacked out with bath blankets, fully dressed and crammed together. sheesh, i'm gonna have to start using the back elevators.

[outcomesfirst, BSN, RN]

Why do you want them to leave?

[all4schwa]

i guess i left the obvious out, duh. it's policy...they have roomates is mostly the reason. last night i let people come up because they had supposedly come whatever distance to see her. and the NM realized they were there and told me to they had to go. also, at the last staff meeting it was discussed pretty heavily.

[AnnieOaklyRN, BSN, RN, EMT-P]

If you were in their shoes you would probably feel differently. Having a family member critically injured or ill is not an easy thing to go through, and a lot of people do not want to leave because they are afraid their family member may worsen or die without them there, and when you leave you aslo feel like you have no control over what is happening with that family member and their care. YOU may not feel that they need to be their, but THEY want and feel THEY need to be their and it is important to try and allow that to happen. You can tactfully ask them to leave the patient's room when the need arrises, but they should not be banned from visiting.

Swtooth

[all4schwa]

well, i didn't mean to sound callous. of course i realize why they need to be there. i wish we had private rooms, and it's not that i dont like being involved with families. they like me as well. in fact, that's why what i'm trying to ask is how can i ask them to abide visiting hours when it makes me feel bad to do so?

[jojotoo, RN]

Yes, they should be allowed to visit - during visiting hours. Then it's time to go home. Many times the patient himself is reluctant to ask visitors to leave because he doesn't want to hurt their feelings. Even if he is exhausted, nauseated, has dirty hair and bad breath, and tubes coming out of every orifice. So, as the patient advocate, it is up to you to ensure that your patient has enough privacy and time to sleep and recuperate.

And that also applies to the roommate. There's nothing like being in a skimpy hospital gown and having to wade through vsitors in the middle of the night to get to the bathroom.

[RunnerRN, BSN, RN]

The OP isn't asking our opinions on whether it is right to ask family members to leave....she is asking how to be tactful and still facilitate the family's needs as well as the patient's.

I work in the ER, so we obviously have pretty open visitor policies. But there are times when we need to ask family members to leave for a procedure, or just because there are too many people in the room. (We actually "enforce" a 2 visitor per pt policy, but it is pretty fluid depending on the nurse and behavior of the pt/family). Anyway, I would suggest explaining to the family members and patients on admission to your unit that because this is a different unit than the ICU (with regards to acuity, roommates, etc) there are visiting hours in place. Explain that due to the fact that these are not private rooms visitors must be limited out of respect for their loved one's roommate. When it comes to the point that you actually must ask people to leave, start by apologizing and also emphasize that you know it is difficult to leave a loved one while they are in the hospital. Tell them they can feel free to stay in the WR, or even leave, and you will let them know of any changes. Also emphasize that their loved one is in the hospital to get better, not for social hour. I would assume exceptions would be made when the pt is actively dying, when family just drove all night and it is 3am, etc.

I know this is one of the more difficult things I struggle with. Good luck!

[miko014]

I work on a busy heme/onc/hospice/palliative care/gen med overflow unit and we have mostly private rooms (there are 4 doubles but we only do roomies as a last resort). Because of the private rooms and the type of pts we are supposed to have on our unit, we have no restrictions on visitors. I think that's great, having family there is usually not a problem. What I can't stand is when you have so many family members and friends there that you can't even get to the pt, and when you walk past the waiting room, you see 20 people sleeping on the couches and even the floor. I think the hours we have are fine, but we need to set a limit on how many people can stay between, say 8:30pm and 7am or something. Seriously, when there are so many visitors that they can't fit into the room, then there are too many visitors.

I have asked people to leave, but only on the pts request. Until my NM decides on limiting visitors, I can't really ask someome to leave unless they are being a problem. Not that I would normally even want to do that. Most of the time our visitors are fine. MOST of the time...

[outcomesfirst, BSN, RN]

i guess i left the obvious out, duh. it's policy...they have roomates is mostly the reason. last night i let people come up because they had supposedly come whatever distance to see her. and the NM realized they were there and told me to they had to go. also, at the last staff meeting it was discussed pretty heavily.

Sounds like you and all staff need to review the policy to be sure it is meeting the needs of patients and staff. Because of the different needs/capabilities in your facility versus ICU open policy, all of the organization needs to work on this. Exceptions will need to be made, consistently by all staff. I agree with runners ideas, but would avoid the "this is not a social ...." comment. Maybe this is an opportunity for you to step up. Talk with your NM about forming a team (you lead) to review (so you have authority and support for your initiative), address and educate on organizational visitation policy and making it work for everyone. Do your research, educate, plan, discuss etc. Maybe a new and improved policy is needed. Maybe ask for a patient or visitor to participate. Maybe signs, pamphlets, a guide for exceptions etc. Who knows...maybe this can be a PI for the hospital, satisfy a JCAHO, clinical ladder, skills building, raise booster activity for you and team buiding/de-stressing/improving patient care for everyone. Good Luck!

[meownsmile, BSN, RN]

I think it is completely right to ask family members to please observe the visiting rules. No more than 2 visitors at a time and to please limit their time because other family would like to reassure themselves that the patient is ok. After everyone has been in to see "whoever" then nicely suggest that one stay and the rest go home for some needed rest. The patients situation will be easier for them to adjust to if they have a needed nap. The one that remains can be contacted for information and maybe they could do a tag team type thing where one stays for a few hours, then leaves when another comes in to take their place.

Ive seen this happen a few times where the family members come out of the woodwork when someone isnt well. As much as i would like to believe that they all truely have deep feelings for the patient ive found 98 % of the time they want a couple days off work and thats a easy way of getting it. Ive had famiily members come to me for notes for work!!! Of course unless they are the POA or a direct family member(living in the same household) i wont go there.

[RNfromMN, BSN, RN]

Is this kinda the same thing? I struggle with asking family members to leave when it's time for assessments...or getting their loved on on the commode...or changing them...What do you seasoned nurses say to family when this comes up?

[RunnerRN, BSN, RN]

I wouldn't call myself "seasoned" but I like the privacy word a lot. "Mr Jones, it is time for your AM assessment." (smile and look at family) "Can I ask you guys to step out to the WR/hall for a moment so we can give Mr Jones some privacy?" If they pitch a fit, or Mr Jones wants his family to stay, then fine. But the first person who answers a cell phone or talks gets kicked out! :)

When I worked on the floor, I would kick a roomie's visitors out if the other pt needed to get on the BSC. I had a few families give a little bit of attitude, but the privacy word worked there too...."Ms Jones, I'm asking you to step out for Mr Smith's privacy. It is what I would do for your father as well."

The privacy word is wonderful.....:)