1. Hader, Richard RN, PhD, CNA, CHE, CPHQ, Editor-in-Chief

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If employees voted on health care leadership positions, I'm sure most candidates would find themselves addressing visiting hours. Whether your viewpoint is liberal, moderate, or conservative, be assured of one thing: others will disagree. Next to patient visitation rules, few practice topics polarize the nursing community and incite nurses to such passionate debates. Though visiting hour policies and levels of enforcement vary among institutions, of greater importance is reconciling the divergent opinions and actions of nurses.


Disparate guidelines

Some institutions operate on restrictive visiting polices, allowing only a specific number of family members to visit the patient during controlled periods. Most frequently, facilities implement more moderate practices, such as restricting the number of visitors during defined periods. Some hospitals don't impose restrictions, encouraging loved ones to participate in patient care.


How, as a nurse leader, do you negotiate discrepant practices and appropriately advocate for the patient? Remember, your greatest resource is the patient. It's vital that nurses employ keen physical and psychological assessment skills to determine the patient's visitation needs. When appropriate, ask patients about their visiting preferences and how you can best communicate their needs to family and friends. Commonly, visitors will yield to the patient's preference if they're aware that the patient retains control over the decisions being enforced.


Of paramount importance is ensuring the safety of the patient's environment in relation to visiting policies on an individual basis. Is the number of bedside visitors impeding the nurse's ability to administer effective patient care? Are visitors contributing to the patient's care and comfort or are they disrupting a therapeutic milieu? Is the nurse's own bias regarding visitation practices inhibiting his or her ability to objectively determine safety?


One with care delivery

The nurse's responsibility for delivering care extends beyond the bedside and encompasses meeting the emotional needs of the patient's family and friends. Consider developing a coordinated patient care delivery system that involves other members of the health care team, including patient liaisons, volunteers, clergy, and social services.


During my tenure as a nurse administrator, I'm frequently asked to arbitrate decisions about visitor restrictions. I've concluded that rules regarding visitation are guidelines, not authoritative or prescriptive in implementation. It's not acceptable for health care institutions to arbitrarily mandate or restrict visitation. When patients seek assistance to optimize their health, don't bar them from those who care the most.