Discussion

Visiting Hours

Jun 4, 200521 yr

What are everyone's policy on visiting hours say on med surg? We have it 11am to 830pm everyday. It used to be if people stayed later as long as they were not loud and not bothering the neigbor we'd let it slide by. They ususally would stay 30min over then leave. And of course someone not doing well let them stay try to get a private room and almost any time a private room let them stay.

Anyway right now we are out of control now. The families know now they can stay past meaning just demand to stay we call the supervisor and they ok it. Now it's several members staying all the way to 10pm at night. If they were loud we get them to leave. Also one time a family member left his 3 year old with his sedated mother and left to get coffee and she was running all over and the mom a pt was totally out of it!!! What finally did it was a dying pt who had hoards of family like 6 that came in 2 people shifts that would ask questions constantly and if you didn't cover a glucose in 2 min since it was taken call you on it and literally i'd be walking down the hall to yes ANOTHER pt and they would yell not even my name NURSE NURSE NURSE what the heck am i suppose to do i wish i had the balls to ignore them but want to be polite. Then they ask ALL the staff the same question. Pt has nurses and lawyers for family. The pt is terminal and yet everything is being done. The staff is quite ticked at it all supervisor aware and the family is staying past visiting hours WAY late on cell phones. They also say goodnight then come back in an hour as if to CATCH you not doing something right. ONe held the phone toward my face as i was talking to the son facing it to us back and forth and it FINALLY clicked what the heck was going on. They are asking all these questions to several staff members and all different realatives wanting to personally know the info despite being told they need ONE contact person, watching everything: they are stocking on witnesses to sue us if anything happens. My coworker is like yeah they're going to close the unit so each of us could be called in as witnesses. Wow i'm really venting but it's ridiculous we can't do our job. I can't even see the pt it's the family period. The thing that kills is the people doing it are nurses too!!! I feel like we're being betrayed in a way and totally disrespected and above all this pt is being torturred!

What i'm finding out is we need a set policy to deal with this. See exceptions should be made. I'd just hate to force out exceptions for rare occasions but to prevent such out of control things we need to set some policy and stick by it. IN icu there is only several 15 min visits you can do. My mom was in icu for 3-4 months (crohns diease, kidney problems, 41 years old) and the nurses loved my dad. He would stay out of the way leave for certain procedures and was quiet. And it was just him. He'd let him do there job and they'd let him stay for 3 hours! See i find nothing wrong with that and he needed that and my mom too so it disgusts me that tha one family can ruin this but at the same time something needs to be done. Ok the one thing my father did make a comment was when a nurse pulled back on the ngt then put the residual back in! He's like THAT"s dirty!!! They explained it then he stayed back. And it was comment not stepping forward with several relatives armed with camera phones!!!

A doctor started complaining now. I asked the family to leave the relative said yeah he'd mind just came in from nyc so it's like ok understandable but you can't stay so long! Find out he was there for 45min. Oh and pt not severaly ill. Anyway now i'm sucked into a meeting by this one doctor's request to report this to the CEO IKES!!! I feel like i'm bakc in junior high but will do it to try and get something started!

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Jun 4, 200521 yr

Author

oops also it's not just staying over anymore it's as we are doing our care complaining about it or critisizing it like oh he's in pain we need something right away (and you know there is hx drug abuse ect) or covering a glucose when you have 6 other pts and prioritize that that can be done after something else these family members hunt you down as if their relative is the only pt and if you explain this just get infuriated or looks like it there eyes pop out to me it looks like!

Jun 4, 200521 yr

Expert

For those who might be reading this. . .nursing is not all that glamorous a profession of service all the time. This is the downside. I think I've experienced just about every situation you've mentioned mysticalwaters1. I don't know how long you've been in nursing, but I've been at it for 30 years. Some of the "customers" are really difficult to deal with. However, we have no control over who we get to take care of in the hospital. Time and experience will help you deal with these things. Just be aware that your frustration and building anger in these situations is due to your helplessness in dealing with them.

Get your supervisor involved with the kid whose running loose on the unit.

I would take the medicine cart with me when I checked that patients glucose so I had the insulin and the syringe right at my fingertips so the patient would get their coverage right then and there. Sometimes you have to put on a performance for the family in order to earn their trust so you can get on with the rest of your work and keep them out of your hair. (The squeaky wheel gets the grease theory.)

Murphy's Law is always ready to bite you in the you-know-where. The minute you ignore the ones yelling NURSE-NURSE-NURSE you can be sure something bad is probably happening. You gotta check it out.

For the constant question askers I would try stopping by their "room" everytime I was in their vacinity and ask if everything was OK and was there anything you could do for them.

Don't worry about the threats of lawsuits from family who are lawyers. No one is going to sue you for giving good care.

We would all love it if all our patients were "good patients", but, truth be told, they are not. I always tried to keep my professional face on, tried to keep a sense of warmth in my voice when I spoke to these "difficult" people, smiled and tried very hard to make them think that I had all the time in the world to attend to them. Sometimes that works because they just need proof that you're paying attention to them. Other times it doesn't so you just have to shrug your shoulders, grit your teeth and be glad when your shift is over. I believe in 24 hour visitation. Families are our patients too whether we like them or not.

I always felt that everyone should have an opportunity to be a nursing supervisor. When I did that job I learned so much about dealing with people in these situations, doctors included! When you are feeling overwhelmed call your supervisor and tell him/her that you need their help in handling ___'s family so you can get your other work done.

Jun 4, 200521 yr

When I give the visiting ours of 11:00AM until 8:00pm to families they presume I couldn't possibly mean them. When I remind them it's 8:30 and time to say goodnight that visiting hours are over "yeah I know visiting ours are over..." I'm thinking WHY THE HECK DON'T YOU LEAVE! LOL. Then there's the "I'm coming at 6:00 tomorrow morning." "DID YOU NOT JUST HEAR ME SAY 11:00AM!!!!".

Unfortunately we have a new vice president of nursing that wants to become more visitor friendly (His background is administration and respriratory therepy, not nursing) and while we are to give the visiting hours we are not allowed to enforce them. So it's a free-for-all.

Jun 4, 200521 yr

I haven't had much problem with families, actually. I always try and act like a hostess. If someone wants to spend the night, we'll try and accomodate them. Most of our rooms are usually private, so it's not a problem. Yes, some people are more demanding than others, that's true. I try and be diplomatic.

My politically correct term for the very assertive family members is "proactive". Actually, when my husband was dying of cancer, there were a lot of deficiencies in his care and I really regret not having been a bit more proactive myself, so I always give them the benefit of the doubt.

Jun 4, 200521 yr

I think there needs to be a limit on both amount of visitors and visiting hours....people lose sight that these people are SICK, they need rest...they need to get better, not have a family reunion...Of course there are some situations that it needs to be modified...ie actively dying pt....there could definitely be an exception to the rule...

Jun 4, 200521 yr

Author

I think there needs to be a limit on both amount of visitors and visiting hours....people lose sight that these people are SICK, they need rest...they need to get better, not have a family reunion...Of course there are some situations that it needs to be modified...ie actively dying pt....there could definitely be an exception to the rule...

The issue with the pt with family of lawyers and nurses it was nothing i've ever seen (been in nursing 2 years). the one relative would TOUCH all the equipment take the bipap off to give water and would not listen to not touch it period. there was a medicine issue as well that the family caught (actually dietary source that in the whole entire scheme of things did not matter whatsoever because all her systems were failing) and the family comes to me about the others put one drop and i put 3 and called dietary i was right and they were like when was this "error" fixed. Omg!!! I had a dr order for the relative not to touch equipment. She was the one not in medical health care obviously. Tell the supervisor and nothing was done. The one thing about my unit we've had 2 managers and neither were good. I'm still deciding if our new one is just thrown in a huge mess and still trying to dig her way out but I'm starting to have my doubts after i told her people needed fit testing for tb iso masks and she told me outright what's the big deal just put on small or regular. I sent the info to infection control employee health and back to the manager and they're or rather infection control working on making appts to make it happen.

Even nurses for 10-15 years started refusing this pt and I had to get the manager because we all had to take turns. Sounds like i'm a goody goody here but no we have lots of issues going on. I guess just take time and experience. I allways act polite. I tried 1x to hint I have other pts and boy did it back fire they looked as if they were going to strangle me!!!

Jun 4, 200521 yr

Dear Mystical,

If I had a situation like that, I would document like crazy and probably consult my superior.

Jun 4, 200521 yr

The visiting hours where I work are 11AM to 8PM. If someone is in a private room the number of visitors and time they come and go doesn't matter. We make exception if someone is going to surgery or is very ill. Many are very inconsiderate of staff and other patients (roommate). I try to think of what I could tolerate if I was the roommate when I decide to say something to visitors. As a patient I would not want someone extra staying overnite in the room. Doesn't afford much privacy. I am one of the more vocal nurses that asks visitors to take turns visiting when there are alot of visitors. I had someone get offended when I asked them to move to the other side of the bed - his chair was actually touching the bed of the other patient. Think of the roommate - they deserve their privacy and space also.

Jun 4, 200521 yr

Expert

the one relative would TOUCH all the equipment take the bipap off to give water and would not listen to not touch it period. I had a dr order for the relative not to touch equipment.
there was a medicine issue as well that the family caught (actually dietary source that in the whole entire scheme of things did not matter whatsoever because all her systems were failing) and the family comes to me about the others put one drop and i put 3 and called dietary i was right and they were like when was this "error" fixed. Omg!!! She was the one not in medical health care obviously. Tell the supervisor and nothing was done.

In the case of relatives monkeying around with the equipment and not following instructions to leave it alone you have no choice but to document what they are doing. Document what you've seen them do. What interventions you have taken. And specifically chart what kind of teaching you've given them regarding the consequences to the patient of their tampering with the equipment. And, name names if you can get them. Also, document that you have notified the nursing supervisor or the nurse manager and that they have been made aware of the situation. In this way you have covered yourself because you cannot be in the room every minute of the day. If this continues for some days I would also check with the nurse manager about whether or not risk management has been involved. If not, I would ask her permission to contact them about this if she doesn't want to do it--and document that you have done this. Unfortunately, with these kinds of relatives you have to spend a lot of very valuable time documenting everything. It's the only way you have of covering yourself.

With regard to them picking up on a potential medication error. . .you just shrug your shoulders and say "I don't know what the other nurses are doing, I can only tell you that this is what was ordered and what I am giving." You do not have to account for your co-workers mistakes. Suggest to the family that it would be more appropriate to take their concerns up with the nurse manager or supervisor.

You need to keep throwing problems like this that are inhibiting you from doing your other work to the manager and supervisors. That is part of their function. Let them know that these people are putting such a burden on you that you cannot get any of your other work done. It's interesting that your mangement is not responding to your requests on this. Send the patients relatives looking for the supervisors and managers and give them their names. They can't refuse a request from a relative who wants to speak with them. When I was in supervision I occassionally got pages from units that family members wanted to speak to the supervisor, so I went I did some PR or damage control. It was part of the job. If I was in your shoes and things were exactly as you've described them I'd just page the supervisor and tell her that the family in roomXX wants to talk to the supervisor NOW and let her go in and figure it all out. Actually, I'd probably escort her to the patient's room and introduce her myself to the family and then excuse myself saying I had some things to do. Kind of a sneaky thing to do, but it takes the target off your back for awhile and puts it on the back of the supervisor.

Does that give you some direction to go with this? These kinds of "visitors" are very exhausting and consume so much more of our time than the other patients. Kind of makes you wonder who the real patients are in these situations. I learned to always try to be extra accomodating and extra nice to these kinds of relatives. If they don't perceive any negative feelings in you sometimes they lay off you a little. Part of the reason they are so hostile is because of the cumulative effect of the hostility they are getting back from the rest of the staff.

Jun 4, 200521 yr

In the case of relatives monkeying around with the equipment and not following instructions to leave it alone you have no choice but to document what they are doing. Document what you've seen them do. What interventions you have taken. And specifically chart what kind of teaching you've given them regarding the consequences to the patient of their tampering with the equipment. And, name names if you can get them. Also, document that you have notified the nursing supervisor or the nurse manager and that they have been made aware of the situation. In this way you have covered yourself because you cannot be in the room every minute of the day. If this continues for some days I would also check with the nurse manager about whether or not risk management has been involved. If not, I would ask her permission to contact them about this if she doesn't want to do it--and document that you have done this. Unfortunately, with these kinds of relatives you have to spend a lot of very valuable time documenting everything. It's the only way you have of covering yourself.
With regard to them picking up on a potential medication error. . .you just shrug your shoulders and say "I don't know what the other nurses are doing, I can only tell you that this is what was ordered and what I am giving." You do not have to account for your co-workers mistakes. Suggest to the family that it would be more appropriate to take their concerns up with the nurse manager or supervisor.
You need to keep throwing problems like this that are inhibiting you from doing your other work to the manager and supervisors. That is part of their function. Let them know that these people are putting such a burden on you that you cannot get any of your other work done. It's interesting that your mangement is not responding to your requests on this. Send the patients relatives looking for the supervisors and managers and give them their names. They can't refuse a request from a relative who wants to speak with them. When I was in supervision I occassionally got pages from units that family members wanted to speak to the supervisor, so I went I did some PR or damage control. It was part of the job. If I was in your shoes and things were exactly as you've described them I'd just page the supervisor and tell her that the family in roomXX wants to talk to the supervisor NOW and let her go in and figure it all out. Actually, I'd probably escort her to the patient's room and introduce her myself to the family and then excuse myself saying I had some things to do. Kind of a sneaky thing to do, but it takes the target off your back for awhile and puts it on the back of the supervisor.
Does that give you some direction to go with this? These kinds of "visitors" are very exhausting and consume so much more of our time than the other patients. Kind of makes you wonder who the real patients are in these situations. I learned to always try to be extra accomodating and extra nice to these kinds of relatives. If they don't perceive any negative feelings in you sometimes they lay off you a little. Part of the reason they are so hostile is because of the cumulative effect of the hostility they are getting back from the rest of the staff.

Great advise!!!

Jun 5, 200521 yr

Author

In the case of relatives monkeying around with the equipment and not following instructions to leave it alone you have no choice but to document what they are doing. Document what you've seen them do. What interventions you have taken. And specifically chart what kind of teaching you've given them regarding the consequences to the patient of their tampering with the equipment. And, name names if you can get them. Also, document that you have notified the nursing supervisor or the nurse manager and that they have been made aware of the situation. In this way you have covered yourself because you cannot be in the room every minute of the day. If this continues for some days I would also check with the nurse manager about whether or not risk management has been involved. If not, I would ask her permission to contact them about this if she doesn't want to do it--and document that you have done this. Unfortunately, with these kinds of relatives you have to spend a lot of very valuable time documenting everything. It's the only way you have of covering yourself.
With regard to them picking up on a potential medication error. . .you just shrug your shoulders and say "I don't know what the other nurses are doing, I can only tell you that this is what was ordered and what I am giving." You do not have to account for your co-workers mistakes. Suggest to the family that it would be more appropriate to take their concerns up with the nurse manager or supervisor.
You need to keep throwing problems like this that are inhibiting you from doing your other work to the manager and supervisors. That is part of their function. Let them know that these people are putting such a burden on you that you cannot get any of your other work done. It's interesting that your mangement is not responding to your requests on this. Send the patients relatives looking for the supervisors and managers and give them their names. They can't refuse a request from a relative who wants to speak with them. When I was in supervision I occassionally got pages from units that family members wanted to speak to the supervisor, so I went I did some PR or damage control. It was part of the job. If I was in your shoes and things were exactly as you've described them I'd just page the supervisor and tell her that the family in roomXX wants to talk to the supervisor NOW and let her go in and figure it all out. Actually, I'd probably escort her to the patient's room and introduce her myself to the family and then excuse myself saying I had some things to do. Kind of a sneaky thing to do, but it takes the target off your back for awhile and puts it on the back of the supervisor.
Does that give you some direction to go with this? These kinds of "visitors" are very exhausting and consume so much more of our time than the other patients. Kind of makes you wonder who the real patients are in these situations. I learned to always try to be extra accomodating and extra nice to these kinds of relatives. If they don't perceive any negative feelings in you sometimes they lay off you a little. Part of the reason they are so hostile is because of the cumulative effect of the hostility they are getting back from the rest of the staff.

Thanks yes great advise! The management did speak to them and it just kept happening and then the 3-11pm supervisor talked to them and tried a pt care rep to get involved. I would tell the one pt's relative not to touch and she needed o2. One time she took the bipap off and complained the pulse ox was 82% came out and my manager was with me (GREAT) and we went in and of course my manager is like "why'd you take it off!" then we explained why she needed yet kept doing it told an md got an order in the chart for the family not to touch anything then just documented. Maybe it's a combination of grief and desperation. She removed the o2 mask to do incentive spirometry she said. Oh boy. Yeah my note was so long. My management however has a bad habit of brushing things off that i'm seeing and i hate it. ex problems with other floors you tell the supervisor and it's "i know" but nothing done that i'm aware of. And outright lying about getting admissions when they say you won't and other things. I'm learning how to play the game of interacting with the supervisors. In some ways very frustrating but at least i know i'm trying to do the right thing. Thanks for all the good advice on this board it's so hard!

Jun 5, 200521 yr

Author

IOne time she took the bipap off and complained the pulse ox was 82% came out and my manager was with me (GREAT) and we went in and of course my manager is like "why'd you take it off!"

ooops sorry at that time NOT bipap it was a NRB mask at THAT point.

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