Parents required at bedside?

meanmaryjean, DNP, RN · Nov 1, 2014

We do not require parents to stay. How is that even legal?

Of course, many do, but some people have to work, care for other children or are incapacitated themselves (I'm thinking of our newborn cardiac population whose mothers are still hospitalized).

And in answer to your other question (honestly, no snark, I just don't know how else to phrase it) how we 'handle it' is to have the nurses care for the patients.

Nepenthe Sea · Nov 1, 2014

I understand what you are saying. That is just the policy here. I can see how it makes it hard for the families. I was just wondering if that is the norm. What do you do with the younger kids who have a hard time staying in a room by themselves? We don't have any kind of help at night, in terms of a tech or even a HUC. If you have five or six patients like we do in the busy season, what do you do (I'm talking floor patients, in this case - I get floated to the floor on a fairly regular basis)? No snark intended on this end, either. I am just imagining what we would do when all the nurses are in the treatment rooms, trying to draw a.m./admission labs, and there's not even anyone available to answer the phone or the door, and a kid is alone and trying to get out of bed with an IV.

meanmaryjean, DNP, RN · Nov 1, 2014

I guess our PICU patients are much, much sicker than yours (much larger unit- specialty children's hospital) because we have very few who even could get out of bed. Our infants/ toddlers are in cage-type cribs. Our staffing ratio is 1:1 or 2:1 and our rooms have glassed fronts and stations in between each set of two rooms.

Pediatric Critical Care Columnist · Nov 1, 2014

Those are really good questions. On my unit we're facing some of the same dilemmas - we have two separate physical spaces and often have only a UC and CNA on one side of the hallway (the side with the smaller number of beds). We don't insist that parents stay with their children; in fact we encourage them to take care of themselves and let us take care of the child. We don't have the room to have a parent sleeping at every bedside without them creating a serious hazard in an emergency situation. With staffing challenges being what they are we've had some predictable events, such as self-extubations, central lines pulled out, gastrostomy buttons pulled out, post-pyloric feeding tubes lost... the typical while-my-back-was-turned sort of events that all conspire together to lower our standard of care. Our outcomes are sure to follow. I'm not sure what the solution is, but I think it starts with better staffing for all disciplines.

Nepenthe Sea · Nov 1, 2014

I guess our PICU patients are much, much sicker than yours (much larger unit- specialty children's hospital) because we have very few who even could get out of bed. Our infants/ toddlers are in cage-type cribs. Our staffing ratio is 1:1 or 2:1 and our rooms have glassed fronts and stations in between each set of two rooms.

Yes. We sometimes have a unit full of vents/very sick kids, and sometimes we have one sick kid and some floor overflow. Our acuity is not as high as the other hospital here. We also tend to keep our ICU patients there until discharge, unless we need their bed, and then we put them on the floor. We are usually 1:2 or 1:3, so yeah, a little different from your unit.

Nepenthe Sea · Nov 1, 2014

Those are really good questions. On my unit we're facing some of the same dilemmas - we have two separate physical spaces and often have only a UC and CNA on one side of the hallway (the side with the smaller number of beds). We don't insist that parents stay with their children; in fact we encourage them to take care of themselves and let us take care of the child. We don't have the room to have a parent sleeping at every bedside without them creating a serious hazard in an emergency situation. With staffing challenges being what they are we've had some predictable events, such as self-extubations, central lines pulled out, gastrostomy buttons pulled out, post-pyloric feeding tubes lost... the typical while-my-back-was-turned sort of events that all conspire together to lower our standard of care. Our outcomes are sure to follow. I'm not sure what the solution is, but I think it starts with better staffing for all disciplines.

I think we are trying so hard to be "family friendly" that we try to accommodate people as well as we can. There is only room in our ICU rooms for one fold-out bed, so if both parents are staying, one will stay in the recliner. It does get pretty crowded, but again, our acuity is not as high, so we don't have the tons of equipment that some of you guys do in the room.

meanmaryjean, DNP, RN · Nov 1, 2014

Ah- we only keep ICU kids until they can go to the floor. We almost NEVER discharge kids- in fact, I've never discharged anyone from PICU.

Pediatric Critical Care Columnist · Nov 2, 2014

In theory, our PICU/PCICU patients are high-acuity, very critical kids who don't move unless we move them. But lately there has been a serious bed crunch on our peds floors to the point where we've had to start discharging kids home. It's not ideal and everyone is upset by it. Even the ICUs are finding it hard to staff the beds and we've resorted to more and more 1:2 assignments, whether they're appropriately doubled or not. When you have RNs whose assignments are kids on extracorporeal life support and they're being routinely expected to cover each other for breaks, it's a problem. As for space at the bedside... well. The Critical Care Medicine group has standards for the amount of space a patient in the ICU should have in their rooms. The minimum is 250 square feet. Most of our spaces in the open unit are nowhere close to that and our single rooms are short about 50+ square feet. We sometimes have an ECLS circuit, a CRRT circuit, a ventilator,NIRS monitor, 2 dozen IV pumps, 1 work station on wheels along with a wall-mounted terminal, 2 supply carts, 2 large biohazard boxes and a laundry bag all crammed into a small space. Back in the days when we were participating in a Norwood study we also had a mass spectrometer and a gas chromatograph at our bedsides.

LoveMyBugs, BSN, CNA, RN · Nov 3, 2014

We encourage parents to stay, but do not require them.

Ours is a 24 bed PICU, with 1:2 or 1:1 ratio.

Same with the floors parents are encouraged to stay but not required.

Many times we have a parent wanting to spend the night and they want the younger sibling to spend the night too, which we do not allow

brownbook · Nov 7, 2014

I never understood hospitals insisting parents had to stay. Just to use the parent as an extra helper ???? an unpaid CNA because the hospital wouldn't hire enough staff for a peds unit?

I always figured the parents would so badly need a good nights rest in their own bed after dealing with an ill child?

Later I thought...well maybe it has something to do with if an unexpected intervention is needed and the parents consent is needed? I guess that could happen but then again in an extreme emergency consent is implied you don't wait for parents consent in a life and death situation. And even less severe situations a phone call with two health care providers listening and agreeing with what has been asked for and the parents answer should hold up in a court of law?

umcRN, BSN, RN · Nov 17, 2014

I work in a peds CICU but also float to the picu and nicu (and used to work there). No where in my hospital are parents required to stay, even on the floors where nurses have much less visibility of their patients. At my hospital kids can stay in the ICU for weeks to months and there's no way parents can afford to stay 24/7, they have to work and take care of other children, we even encourage the parents of our post ops to go home and get some real sleep the nights after the kiddos have their surgeries. There are VERY few children who could try to get out of bed and if they are they're either headed out to the floor or in a caged/covered crib. If they're really a risk to themselves (pulling lines/tubes etc) then they buy themselves restraints and/or in severe cases a one to one sitter.