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I have recently left a big teaching hospital where the NICU visitation policy was very liberal, and started working at a small, rural hospital where visitation is much more limited. Currently, families are only allowed to visit one hour at a time, with no visitation from 6-8:30, am and pm. Now, my manager wants to implement a new visitation policy where parents can only visit for 30 minutes a a time, with no visitation allowed between 6:00-9:00, both am and pm. What are your current NICU visitation hours and how long at a time can families visit?
Unfortunately, our nurse manager is who came up with this idea of changing the already horrible visitation policy, and to be honest, does not care any more about developmental care than the next person in this hospital. I feel like I have stepped into a really bad dream at this place! Our nurse director of perinatal services is actually leaving, and she is the second or third in about four years (do you see a theme here?) and we only have one neonatologist. Even if he did agree about kangaroo care, he would say it's a nursing decision, and you know how that will end. I know it seems like I'm justfying why I'm not going up the chain of command, but I have on other things, and it's only gotten me "blackballed". This kind of behavior is stuff we only talked about in nursing school, and while I'm not naive, I guess I got lucky at my first job in a big teaching hospital. Nurses were respected and valued. I feel I am the lone nurse when it comes to patient advocacy or even just good standards of care in this unit. Some of the other nurses agree with me on different policies and procedures, but they won't say anything. In fact, they've told me not to say anything at all, because it will only make it worse on me from my nurse manager. I know, some real professionalism going on in this place, huh? I am newly married (my husband had better love me!) and Dallas Fort Worth is over two hours away so changing jobs is not really an option. I have applied at hospitals in the DFW area because I dislike this hospital that much, and have been turned down because of the traveling distance. Moving is not an option for at least two more years, because of my husband's job. I really want to make a difference at this place, but there is such resistance for change. The whole 30 minutes at a time visitation has just about sent me over the edge, and so that's why I have gone online trying to find articles and policies regarding visitation in NICU's. It is nice to vent here online because even the kindest of coworkers are tiring of my "try to make a change" personality and I feel that it's best if I "lay low" for a bit because in the end, it only makes the few people who agree with me, shy away even more. Do you see this horrible cycle? Somebody pinch me so I can wake up!
Our nurse director of perinatal services is actually leaving, and she is the second or third in about four years (do you see a theme here?) and we only have one neonatologist. Even if he did agree about kangaroo care, he would say it's a nursing decision, and you know how that will end.
I can totally appreciate your wanting to lie low.
If the director of perinatal services is leaving, that may be because she is frustrated with current practice or with something. Not a good sign. :uhoh21: Could you perhaps schedule some time to talk with her? Have you seen her? What do you think of her?
What about your VP of Patient Care, your director of perinatal services' BOSS?
I think even though you have one neonatologist, it would still be worth it to talk to him about the visitation policy and get his thoughts on it. He's right - the decision for kangaroo care, etc is within nursing's authority however he does have an opinion on it. And if anything, he may be able to take it to the Medical Director and unfortunately, take control of nursing practice there and compell the NICU manager to abandon her horrible policies.
I don't mean to slap you with all these options and make it seem like it's all on you, but I feel so horrible for your patients and their families and you have such a passion to do so much.....
Problem being if she does go over the NM's head, that will not make her more popular w/said NM.
So. Is there anything else in that facility or community you might want learn or do? You're really in a no-win situation. Can you afford to stay home and persue an educational goal of some sort?
It does indeed sound like a nightmare!
Do your 30 minutes actually happen? Do you have timers on for each family? If not, don't worry about it. Are your other staff nurses going to complain if parents stay longer? With they write you up if you don't set the clock? Maybe your manager should be kicking parents out herself, if that's what she wants.
I only have a problem with visitors when they sit at the bedside and watch and listen to everything that is happening in the unit, instead of paying attention to their baby. Also, nurses sometimes forget that parents are not pieces of furniture, and say things that should not be heard by outsiders.
I only have a problem with visitors when they sit at the bedside and watch and listen to everything that is happening in the unit, instead of paying attention to their baby. .
What difference does that make, I guess?
There have been many times where I sat holding my daughter and after staring at her for about 4 hours, turned my attention to the goings-on of the unit; just watched nurses, etc, kind of half paying attention.
The point is that I'm sitting here holding my child - what difference does it make whether I'm looking at her or looking at you?
What difference does that make, I guess?There have been many times where I sat holding my daughter and after staring at her for about 4 hours, turned my attention to the goings-on of the unit; just watched nurses, etc, kind of half paying attention.
The point is that I'm sitting here holding my child - what difference does it make whether I'm looking at her or looking at you?
I think she's talking about people being busybodies in the unit, not just glancing around. You might be surprised at how many parents get inappropriately involved with OTHER babies and nurses in the NICU. We have parents like that pretty frequently. They think they are being helpful to the other parents when they are eavesdropping on the nurses and docs discussing other babies, craning their necks to try to observe procedures on other babies, etc. I had one mother ask us to move the screen so she could see us put a chest tube in another baby!!! They are generally the same parents that take it upon themselves to "orient" new parents to the unit ("Oh, make sure you don't let Sally look after your baby cause she's a b^& and that doctor over there doesn't know what he's doing and you have to make sure and watch the nurses really closely or they won't remember to feed the baby")
I definitely think I am in a no win situation. However, I did talk to my Neo the other night and told him how I felt, what other hospitals were doing, I even brought up articles, etc. He said he appreciated my concern, but he thought it would be helpful to the nurses if we limited visitation because "it seems like you guys are always running around, answering phones, putting in orders, running labs, etc. and trying to assess patients, all at the same time." So I replied, "well then we need a secretary, not a limitation on visitation". He said he would speak with our nurse manager, but by the end of the conversation, I really don't feel I had gotten anywhere with him. As for the person who asked if there was going to be timer on, ready to go off and boot parents out, the answer would be no. Night shift is extremely lenient with visitation, but we always tell parents, "the rule is currently one hour at the bedside, however, we tend to be a little more lenient. If you tell on us, then we will have to go back to making you leave at one hour". It's bad that we do that, but the parents are always appreciative. Since the Neo did say he would speak with the nurse manager (and I think he will, because he usually stays true to his word), I'm going to see how this pans out, but in the meantime, thanks for everyone's input. Unfortunately, I am in love with NICU nursing and don't see my heart anywhere else.
Q.
2,259 Posts
You could try pulling up some current literature on the benefits of kangaroo care; I kangaroo cared both of my twins. I couldn't imagine not doing so. The benefits for ALL of us are too great to name.
What about the NICU manager? Or your Chief Nursing Exec? Or one of the neonatologists? Take it up the chain or get a physician champion. I know it's tempting to leave such an archane place but those poor babies and parents need someone like you there.