Visiting hours and quality of care: an unscientific study

[86toronado]

I work at a medium sized community hospital, on a mixed unit; meaning we have several intensive care beds on our floor, and several more stepdown/med-surg beds. We have had a change of leadership lately, and one of the changes that this new leadership has instituted has been to restrict visiting hours significantly. In the past it has always been up to the discretion of the RN who can visit, for how long, etc. There were policies in place, but they were very loosely enforced. Now it is expected that we adhere to these policies with no flexibility whatsoever (the only allowable exception being a hospice/comfort care patient).

Let me tell you how this is working out: the day nurses love this system. The get to get all of their work done, and not deal with visitors until the very end of their shift. The night nurses on the other hand hate the system. We are the ones who come in to work with family members breathing down our necks for the first hour of our shift, and then we are forced to be the ones who tell them they have to leave. When a post-operative patient in horrific pain is crying because you're telling her that her mother has to leave, you don't feel like you are providing good patient care. We as night nurses agreed to speak to said leadership today regarding how these policies are affecting us on nights, and were met basically with a stone wall. "These are the policies and you have to enforce them."

What is bothering me the most is that we are not being given any facts or evidence to back up these policies. I have been doing some research on my own, and most of what is out there seems to point to the opposite: less restrictive visiting policies seem to improve quality of care, as well as patient satisfaction. My research, as well as discussions with other RN's at other facilities in the area seems to point to a national trend in the opposite direction of that in which my institution is headed.

So, my question to all of you is what have you experienced in this respect? What visiting policies are in place where you work, and how strictly are they enforced? Are you allowed to use your nursing judgement at all in deciding who stays and who goes, or is it completely out of your hands? How have you seen these policies affect patient outcomes, and satisfaction?

P.S. It would help me if when you answer the above questions that you provide me with the type of unit that you work on, as well as the geographic location (you don't have to be specific, northeast, etc would be fine.)

[Pappilli0n]

They will not hear your words unless you say them! Believe me, try letting the

family memberS know that only ONE member may represent the patient and make requests from the nurse or care partner (NA). PLUS, let them know you have other patients to care for. After that, your Head Nurse needs to get involved to resolve any issues that arise. The nurse is the patient's advocate, therefore, if the family are not adding a positive "feel" to the situation, then the nurse has the right and ther responsibility to deal with them. A good way

is to "give the visitor a break." Surprisingly many family members appreciate

that but have been hesitant to suggest. Words go a long ways with most, but

of course not all. Like I said, your Head Nurse has a job to do and that is to

assist you when needed!! Really, she/he does, it's in their job description!!

[Pappilli0n]

They will not hear your words unless you say them! Believe me, try letting the

family memberS know that only ONE member may represent the patient and make requests from the nurse or care partner (NA). PLUS, let them know you have other patients to care for. After that, your Head Nurse needs to get involved to resolve any issues that arise. The nurse is the patient's advocate, therefore, if the family are not adding a positive "feel" to the situation, then the nurse has the right and ther responsibility to deal with them. A good way

is to "give the visitor a break." Surprisingly many family members appreciate

that but have been hesitant to suggest. Words go a long ways with most, but

of course not all. Like I said, your Head Nurse has a job to do and that is to

assist you when needed!! Really, she/he does, it's in their job description!!

[Pappilli0n]

Can't totally agree with you but can't disagree 100% either. Remember the cliche, "It takes a village to raise a child," well, a patient's family is their

strongest support source. When they go home, unless you've volunteered

to go with them, the family will be there and sometimes that can dwindle

unless encouraged and shown positive reinforcements from the nurse.

I never said it was easy. I was on a cardiac/thoracic/vascular step down

for nearly 20 years. Believe me, family was more positive than negative

in seeing that a patient was compliant with meds and pt and procedures!

Get "in" with the family members and you'll have a much easier time of it.

By the way, YOU are the care giver and YOU can make the rules of the day.

Encourage breaks for the family members....they will appreciate your giving

them "permission" to get away for a bit. Plus, encourage the family members

take care of themselves by being at home more often than not and getting

rest for upcoming responsibilities.

[Pappilli0n]

:nurse:Can't totally agree with you but can't disagree 100% either. Remember the cliche, "It takes a village to raise a child," well, a patient's family is their

strongest support source. When they go home, unless you've volunteered

to go with them, the family will be there and sometimes that can dwindle

unless encouraged and shown positive reinforcements from the nurse.

I never said it was easy. I was on a cardiac/thoracic/vascular step down

for nearly 20 years. Believe me, family was more positive than negative

in seeing that a patient was compliant with meds and pt and procedures!

Get "in" with the family members and you'll have a much easier time of it.

By the way, YOU are the care giver and YOU can make the rules of the day.

Encourage breaks for the family members....they will appreciate your giving

them "permission" to get away for a bit. Plus, encourage the family members

take care of themselves by being at home more often than not and getting

rest for upcoming responsibilities.

[Ruby Vee, BSN]

well said. i think the perspective (and well being) of the patient can sometimes get lost among all the hospital protocols and procedures. nurses are obviously overworked and anything that can help them to ease their load is great but only if it's in the patients' best interests. i'm am sure that some family get in the way and cause problems but many are helpful and are there to help support, comfort, and care for their family members. as a nurse you might think about what a good job you do and not understand their concerns but family want to be involved, understand what's going on, and make sure that their loved one is getting excellent care. they do not know you or whether you are an excellent nurse or not.

i have no problem with family who want to help support, comfort and care for their family members and make sure their loved one is getting excellent care. unfortunately, those family members are rare where i work.

we get the kind of family members who want to sue for every little thing (didn't get the blood cultures on the first stick; housekeeping used cleaning chemicals to clean the bathroom, etc.) in the hopes of living high on the hog for the rest of their lives from a hefty settlement. or the kind of "family" who want to finish the job they started when they shot or knifed "my brother." or the kind who want us to keep grandpa alive until the first of the month because all six of his worthless kids are living in his house off of his social security check. or the family who doesn't want pop getting pain meeds for his burns because "then he's sleepy when i come to visit."

a lot of it has to do with geopgrphy, i'm sure. but i really would like to see those nice, concerned and helpful family members you're talking about.

[Rnandsoccermom]

Hmmm... we still restrict visiting hours where I work (9am-8pm). Extended hours are on a case by case basis. It is up to the supervisors discretion.

I being a supervisor see no need for a visitor to come strolling in at 1 am on a Saturday night to visit someone who is not critically ill. If it wasn't that important to visit at a reasonable hour than it isn't at 1 am either.

I also don't see why a "sick" patient needs to stay up all night. Then they sleep all day and everyone thinks something is wrong-NO they were up socializing all night! We unfortunately have had visitors try to "live" with us overnight-having no where else to go-it's sad but it isn't the free motel either.

I'm old school

[llerkl, ADN]

Visiting hours cause a lot of division (among Nurses) I think. While I agree "the village" needs to be at bedside and supportive to the patient.....some families are just over the TOP! I think families need limits once in awhile.....they are stressed out too, possibly dealing with a scary diagnosis (with an unclear/ uncertain outcome), and maybe there is drama going on within the family itself (in fighting). All people deal with stress in different manners, some folks may not even realize they are being unreasonable.

BOTTOM LINE= Patient's best interest comes first! ie....If family member's presence is causing unsafe rise in blood pressure, maybe the patient needs rest. I might be asking them to take a break. I resent families getting on the internet, researching diseases and care, then becoming the expert. I have been educated, have passed a test, and obtained a license......I MIGHT know something!!!! I also HATE climbing over bodies around the patient bedside in a dark room, to get to the equipment and perform the assessment I need. YES, I might turn the light on, because I need to do my job and keep you safe!

Not really sure what the best solution is.....give and take on both sides. Nursing judgement should prevail. Anybody with me??

[Up2nogood RN, RN]

Recently a pts son was just thrilled when I told him he could stay the night. We have large chairs that fold out into a cot and it usually only takes one night on that terrible cot to send visitors home the next night.

What was funny though is the surgeon told the son that the nurses run the show up on the floor and that we're the bosses so he'd have to listen to us!

I do tell visitors that one person may stay overnight, I need access to all sides of the pt (some will push the cot right next to the pt bed), they cannot use the pt's bathroom, and don't be surprised if I flip the lights on and wake you up with no warning in the middle of the night.

I think in my setting visitors aren't usually an issue since all rooms are private. But on floors with shared rooms and critical care units there definitely should be visitor restriction.

[akrn2]

In my critical care unit, we restrict visiting for 2 hours at each change of shift...mostly so we can get our assessments and work done! When you have someone in critical care, often times their families are operating in a crisis mode and need "permission" to attend to their ADL's and business of life that continues no matter what. They can go get a meal, take a nap, etc. We do make exceptions for the dying patient, pt's going to OR, new arrivals in the unit, or family just arriving from out of town. We try to be fairly strict or consistent with the times, since it creates huge issues for some folks when asked to step out. The other rationale we use for asking visitors to step out is to allow their loved ones to rest, let pain meds, work, or to minimize stimulation (especially in the brain-injured pts). We do not allow sleeping in the room. The general population of the hospital has a visiting policy that is not enforced. I can't tell you how many times I have had to clear a path to the coding floor patient....sleep chair, suitcases, computers, bags of food, coats, linens, pillows etc. I can't imagine trying to deal with that on a daily basis!

[merrywhiterose]

Most patients would prefer to have family members around when they are under stress. However, there needs to be a limit at times. I've seen a group of about 20 visiting one young teen for several hours, and the nurses never said anything. This teen had possible minor brain damage, with brain swelling. Aren't you supposed to limit stimulation in this case? Anyway, I can understand having a few family members visiting as long as they aren't bothering the roommate, and are allowing the patient to get rest. I don't understand being so rigid on the rules. Every patient has different needs, including emotional needs.

[Gluteus Maximus]

Most patients would prefer to have family members around when they are under stress. However, there needs to be a limit at times. I've seen a group of about 20 visiting one young teen for several hours, and the nurses never said anything. This teen had possible minor brain damage, with brain swelling. Aren't you supposed to limit stimulation in this case? Anyway, I can understand having a few family members visiting as long as they aren't bothering the roommate, and are allowing the patient to get rest. I don't understand being so rigid on the rules. Every patient has different needs, including emotional needs.

I would NEVER allow 20 at once; that is insane. They can come in 2 or 3 at a time during visiting hours only. I've seen virtually entire families camped out outside the rooms, obstructing the hallway and impeding the work of the staff. They are immediately asked to leave. If they don't comply, the we call security and they DO comply.

[MunoRN, RN]

no flames here; i agree with you! visitors are the number one obstacle to good patient care!

family/friend involvement in patient care produces better patient outcomes.

wouldn't improved patient outcomes be a major indicator of "good patient care"?