Saturday, September 16, 2006

Rounds

Should parents be present when doctors do rounds in the NICU? That question came up in the comments section a couple of posts ago. Traditionally, NICU's haved kicked parents out during rounds, but some NICU's now have them stay in.

I was a bit wary of the idea when we started allowing parents in on rounds at another hospital about fifteen years ago, but I soon found that I liked it- a lot. It was a good way for parents to hear what was going on with their baby. It was a good way for parents to hear us going through a lot of data about their baby, to hear that some of the problems were quite complex. It was good, I think, for them to see that not everything is black and white, and what sometimes we struggled with decisions we weren't sure about.

Some doctors, though, aren't wild about having parents present. Doctors with less experience, like the residents, might feel a little insecure having parents hear them present on rounds. Some doctors might not like it that we can't use derogatory terms like "gork," but the truth is , we shouldn't be using terms like that even when parents aren't around. Some might worry, with some legitimacy, about patient confidentiality, but that can usually be maintained by speaking in measured tones away from the direction of people who shouldn't hear about a given patient. And the real truth is, there is hardly any patient confidentiality in the NICU anyway. All the parents tell each other about their babies' problems in the waiting room or hallway.

What bugs me is that I can't get the nurses to do report with the parents in the NICU. Twice a day, everyday, from 7 to 7:30, the nurses kick all the visitors out for their report. It's so archaic, so twentieth century. Sometimes parents get a little ticked off because they have to wait outside for half an hour. What the nurses don't seem to understand is that the information they give each other in report belongs, ultimately, not to the nurses, but to the babies and their parents. I've brought this up at least half a dozen times with nursing management, but to no avail. I think they fear a revolt by the nurses if they let the parents in.

33 Comments:

Anonymous Kris said...

*sigh* I am a nursing student (graduating in December) and the mommy of two premies (now healthy, active and developmentally on track 4 and 6 year olds) and I found your comments regarding report and the presence of parents interesting. I recall reading my daughters daily progress notes, which I had to PRY from the attending nurse even though it is the parents RIGHT to read any part of that chart and reading the following: "Parent is not spending adaquet time with her infant."
I can understand that class of nurse not wanting parents present during rounds. I was horrified and humiliated.
There will always be the separation of objectivity vs. emotion when physicians/nursing staff and parents are present together. Each must respect the others view and gain as much as possible to foster the health of the baby involved.

11:44 PM  
Blogger Awesome Mom said...

I agree 100% let the parents in and let them hear. You are very right that we tell each other everything any way. We form a bond with parents that are in the same situation as we are. It drives me nuts to be kicked out especially when I have an opinion too and need to be heard. We are the ones that have to give consent and I think that being there for rounds helps us make a more informed decision.

11:48 PM  
Anonymous Anonymous said...

I just can't believe it when I hear that parents can't or shouldn't be included in the rounds. I receive the bills for the attendings fee and it can run from $300 to $500 a day. If I am getting billed for that, I expect to hear what is going on with my child, first hand, during the rounds. I want to know what tests are being done, where we are at, what the diagnosis and prognosis is, etc. I expect to be part of that "team". I do not care to hear about the care plan from a nurse, period. It has nothing to do with the nurses, but the doc is running the show, and that's who I expect to speak with.

I think it is unrealistic to think that it's o.k. to bill for an office visit and to discuss what is going on with a patient during an office visit and yet, exclude the parents in the rounds? Why should the patient/parents be included in one and not the other?

I know when Dear Son was in the PICU with the MRSA pneumonia and the first time the residents rounded and didn't include me, I had a conversation with them. To say that I was upset would be a huge understatement. I was enraged that this could even occur.

I had a conversation after the fact and said that I thought it was not only rude but disrespectful not to be included in the rounds. I said that I was being billed for their services and I was staying with Dear Son nearly round the clock. I expected to be informed and I wanted to be included in the rounds. I can't even begin to tell you how strongly I feel that this should happen (although I am guessing that you have probably picked that up by now:). They never excluded me again.

Physicians want parents who are involved, who care and who good advocates for their children. How can a parent be any of those things, when they are not involved in the care plan or not allowed to hear about it?

There are times when I can't believe the things that are happening or happen in healthcare. This is one of those things. All parents should be included in the rounds period. That doesn't mean all parents will participate, but it doesn't hurt to ask.

I would also be willing to bet, that if you included them in the rounds, that they might do the follow up tasks-like giving the kids their meds, returning for a follow up visit, etc. a little better.

Finally, I have spent many years in the hospital rooms sleeping on a not so great cot as a bed. There have been many years over the past few years that billed charges have exceeded $100k and in 2004, the billed charges were over $400k and this year the billed charges exceeded $300k. Most will be covered by insurance. Now I ask you, how would you feel about being excluded from the rounds, when you have to process over a hundred different claims for these visits and pay out of your pocket for them? Do you think it's fair to pay for a service and not get to hear the plan?

Dream Mom

11:58 PM  
Blogger Kelly said...

You are right, the info DOES belong to the parents! Doctors have nothing to say that isn't MY right to know.

But what I think is a problem for the professionals, is that they want to be able to get the job done and move along. Yet, how many parents will understand the jargon? How many will be ABLE to be a part of the team?

I know Dream Mom can, and I certainly can too. But I think docs just don't want to deal with rounds taking 45 minutes per patient, just because the parent is constantly interrupting from lack of understanding. That makes sense to me.

I personally want to be involved, and chided our doc for leaving me out. But I can handle rounds. I know how to take notes and save big questions for when the attending comes in later. I "get" the way things work. How to not be a wrench in the works.

Not everyone does.

1:29 AM  
Blogger Flea said...

It makes no difference to me. In my experience, a docs delivery on rounds is better if a parent/patient is present. I'm not sure what to think about nurse rounds. My experience with NICU nurses suggests it's better not to cross them.

best,

Flea

6:32 AM  
Blogger jennifer said...

Hello Doc!

What a wonderful post. Thank you for writing "the information belongs to the babies and their parents." It never once, in my seven weeks in the NICU, felt that way. It seemed instead that I was an inconvenience; a potential mess-maker or carrier of germs. It was such a difficult position to be in, as a parent. And I hated it.

Just reading your post, and knowing that somewhere there is a doc who feels parents have a right to understand what is happening to their children, gave me a great lift.

Thank you.

9:59 AM  
Blogger Betsy said...

Thank you for your post. I have had two preemie babies with entirely different experiences. My youngest child was in two different hospitals...the first hospital was wonderful, the nurses were very forthcoming and willing to share all information. Parents were allowed to be there for rounds, and I found it incredible educational. The second hospital, no one was allowed in during rounds....the nurses were very cold, and I RARELY saw the doctors.

Unfortunately, I went from the first hospital to the second and was blown away by the difference. In dealing with a very sick child, it was not a pleasant feeling. The NICU experience is so intimidating and while there are alot of parents that may not understand the terms, I know many would find solice in the attention they and their infant/s are receiving. Also, in my experiences, some of the parents chose not to be there often, because it was too difficult for them. I do believe that an environment that fosters learning, tenderness, and patience would encourage families entirely, which would and can only help in the infant's overall well being.

Thank you to those of you who are encouraging change and education. It is a parent's right to have the opportunity to choose. Because of my experience with hospital number 1 I was able to see that my daughter was more than just a number or statistic.

10:26 AM  
Anonymous Anonymous said...

The daily progress notes of the nurses and the physicians do not belong to the parent. So all mothers who annoyingly try to snoop around and try some 'extra'information, why dont you spend that time with your baby instead.
That nurse who said the mother was not spending enough time with the child was probably right....if you would spend less time being a detective and spend time with your child, maybe she wouldnt have to write that in her report.
You think you can understand a progress note written by a physician?
Be a mother and let the doctor be a doctor.
If you need to know anything, just ask for the doctor taking care of your child....and if you are high maintenence (meaning stupid, rude and meddlesome), then ask for the attending physcian.
But please, just lay off and the doctors do their job. They have more important things to do than cater to your neurotic whims....like take care of the babies!!!!

12:22 PM  
Blogger Betsy said...

Anonymous 12:22 PM - I am going to assume that you are having a rough moment and that perhaps you are not so quick to judge. Until you have been (God forbid) in a similar circumstance you do not know what emotions or thoughts you will have. As a mother, you look for answers, not only to "will they get better", "what are they going through" - but also "why" - - more than anything else that has come up in my work with hospitals and families over the last year after the near loss of my youngest, is that most people encounter this as a life changing experience and come to do things, say things, and behave in ways that they may not normally. A little respect for what the family is going through would be greatly appreciated. And in return I think you would find that what most mothers and fathers have to offer in many ways is invaluable.

12:58 PM  
Anonymous Anonymous said...

I had a good experience in the NIUC. I was there for rounds lots of times. The nurses never kicked out during the rounds. I looked at my daughters chart all the time. The nures never said anything.I didn't know I was not sopose to look at it. I was also there when they did the rounds in the PIUC and the floor. The nurses always told me what was going on with my daugher.If i was there during rounds the dr. would ask me if I had any questions. They also premited me to go on any test that my daughter had.I thought all the hospitals were like that.

1:56 PM  
Blogger Amy said...

I think my daughter's cardiologist said it well, when he told me, "You know Maddy better than all of us doctors put together. I value your imput and observations as much as any attending/resident around".
Yes, the information gleaned at rounds was valuable and I wanted to be included..but also the questions asked of me, and the information I could provide was a valuable tool in making sure she had the best care possible. They didn't know her history as intimately as I did, and the nuances of her care.
I think residents are the most guilty in barging in and, in trying to find thier "voice" as doctors, they often disregard the parents and their knowledge of their own child.
It's a two-way street.

Amy

2:18 PM  
Anonymous Jen said...

My son was in a NICU for 6 months. I was invited to be a part of rounds but after a while I invited myself. I think if parents are taught proper etiquette (not the time for a lenghty discussion or asking who the people are) it is fine. After a while, the docs would be worried if I didn't show up in time for rounds. It was very helpful for me to feel part of the team. They did ask my opinion on various treatments. If he was really, really sick, I knew to back out and let them do their job. I'm not exaggerating, in a 36 bed NICU, there were only 2 of us mothers that were their daily, for rounds.

3:55 PM  
Anonymous Anonymous said...

I think in your post you were making two points, which many of the commentators have missed. There are two issues here- first physician rounds and then nurse-to-nurse report.

I work in a PICU where the parents are encouraged to be completely involved in the physician rounds. They listen to the residents present the case, discuss it with the attending and then are encouraged to ask questions about their child's care. The patient's nurse is also present (or should be!- sometimes the physicians get started on rounds when we're busy in another room). The only parents who get left out tend to be the ones who do not speak English- sometimes it is difficult to coordinate the arrival of an interpreter with the timing of physician rounds. But we attempt to do so if the parents are present.

Then there is nurse to nurse report, usually every 12 hours when off-going nurses inform the on-coming nurse about the patient. This usually involves the immediate status of the patient- vent settings, lines, meds, drips, etc. I see your point that it's not fair that parents should be kicked out of the NICU during this time (we do not remove parents at this time- we just talk softly at the nurses station, away from the parents) but I do not feel that this report should be shared with parents. First, most of it is about the immediate status of the patient. A good nurse should inform and educate the family througout his/her shift so that the parents are already aware of their child's current status. So technically nursing report should not have any more information in it than the parents don't already know, except perhaps for details- types of lines, vent settings, etc- that is too complex for most parents and not necessary for them to know in full. The plan of care is discussed, eg, "patient is going for CT today", but again, the parents should already be aware of that. In occasional cases, we know something that the parents do not- a tumor has been found for example- and the drs have not yet had a care conference to tell the parents, or the radiologist has not confirmed the finding and so we inform the other nurse of this fact. This is not the time and place to have parent's hear this sort of news.

Second, nurses need to be able to talk freely about how they view the family situation, eg, "mom is very tired but refuses to go home" or "mom has been here only for the past fifteen minutes and plans to leave again soon". These are statements that might bother the family if they heard them, but I feel they are needed to provide a quick picture of the situation. Yes, unfair judgements are sometimes passed on, but a good nurse will seek to take them with an open mind and form his/her own opinion of the situation as they work with the family. Nursing report is not charted- our care sheets (or "brains") are not part of the medical record- and so it does not technically belong to the families.

In addition, some facilities tape nursing report, or leave it on a telephone system. Should the parents be woken at 5:30AM to sit down with the nurse as she/he records report in the nursing louge?

Sorry I wrote a lot! I enjoy your postings.

5:24 PM  
Anonymous Anonymous said...

With my baby in the NICU due to prematurity, Trisomy 21, and Hirschprung's disease, a tramuatized 2-yr. old at home after mommy suddenly disappeared for a week to the hospital, recovering from a c-section, trying to balance time in the NICU and time with baby's big sister, desperately working to make breastfeeding successful, prying a crying 2-yr. old away to make it to the hospital on time for the feeding so that I could attempt to breastfeed, finally arriving, and having a nurse (not my baby's nurse) literally pull the chair out from under me as I was about to sit down at the bedside and tel me I had to leave because the drs. were doing rounds, even though it was OK with my baby's neo. for me to stay...needless to say I agree with you. Thank you for speaking up for the parent's right to be there.

And to the anon. bitter nurse...perhaps it is time for you to find another career.

8:31 PM  
Blogger jennifer said...

What is interesting to me is that these posts, taken as a whole, almost exaclty mirror my NICU experience. There were some docs who were kind, others patronizing; some nurses were generous, others Generals; and the parents on this post speak of all the feelings I've had. So what I thought was one big mess is, in fact, common.

It gave me the feeling of being a prisoner in a prison camp...keep my head down, say yessir and yesma'am, cause no problems, and get the h--- out of there as fast as I could. I know this is an unfair and biased account, and is an affront to the very people who are trying to help my family. But it didn't feel like help, often. It felt very confrontational, like we were on opposite sides of a situation. Why that is, I don't know. Any words of wisdom, Neonatal Doc?

8:41 PM  
Blogger neonataldoc said...

Thaks to all for the comments. I'm glad to see that many places allow parents in on rounds. Flea, you made me laugh. I, too, try not to cross NICU nurses!

Dream mom, I have also looked at the amount of money we charge and then think, we don't have time to talk to parents?

I don't want to get too down on the residents. I'm a lot more comfortable with parents on rounds now, when I know what I'm doing, than I was when I was still learning as a resident. They have a tough job. Anonymous 5:24, I don't agree that parents shouldn't be there for nursing report. If you have something a concern about a parent, say it in front of them or deal with it later.

Jennifer, no words of wisdom. It's funny how some places get it right and some don't. Or is it the parents' percepton that's different?

9:15 PM  
Blogger jennifer said...

Of course my first thought was that it was me. That as a parent, I was somehow responsible for the varying attitudes of the attendings, the nurses, the docs.

But again, I point to your posts. Some of the responses by the anons are aggressive. I assume they are medical people, maybe I am wrong in that assumption.

It was a difficult time, and I tried not to be a difficult parent. I don't know if I succeeded but I will leave it at that.

It IS confusing. We are all there for a common purpose, and yet as I mentioned, it didn't often feel that way. Again, I wonder why. No answers. I just appreciate your blog. Thank you for at least asking the questions.

10:02 PM  
Anonymous Anonymous said...

This topic has been so interesting to me, as a mom of two preemies who've spent a combined 17 weeks in NICU. Our NICU is one of those that kicks you out from 7-7:30, and the docs and NNPs round in a private room, then come out for updates to parents who are present.........sometimes. Honestly, I found our NNPs more willing and likely to come and seek me out at DS's bedside for an update, more likely than a resident to do so. Just my experience.

I'm not a medical person at all, and what I know I learned from being at my children's bedsides every single day of their hospitalization. But I must ask a question.....the comments others have made here about the kind of judgments nurses must make about the family, like "mom's only been here 15 minutes today", etc. Why is this needed? I'm not being sarcastic, I really want to know. How can a nurse know or understand the reasons why a parent is or is not present in the unit "enough" to suit them? Do the parents have older children at home? Do they live hours away from the hospital, do they have unforgiving work hours, etc?

"Jennifer" said it well, you sometimes feel like you'd better just keep your head down, cause no waves, follow the rules and MAYBE they'll allow you to hold or even touch YOUR OWN CHILD that day. MAYBE. If the child's health prohibits it, then of course, I would never think of asking. But many, many times I felt nervous and uncomfortable even asking to do so on days I knew he was well enough to handle it.......because if I had one of "those nurses" then they'd act as if what I asked was just too much trouble, messing up their schedule etc.

Look, don't get me wrong, NICU docs and nurses are truly miracle workers in my eyes, and I owe both of my sons to their care. However, there were aspects of our experiences in NICU that could have been more "family centered" if some of the attitudes and policies were better, if that makes any sense. Thanks for listening.

11:20 PM  
Blogger PaedsRN said...

Wow, lots of commentary on this one.

We have all handovers, medical and nursing, at the bedside although there is a quick run-through in a separate room before going out onto the unit. If I have anything to pass on regarding the family I'll either work it into a direct comment,

"...and I've been trying to encourage his Mum to go and get some rest," with a meaningful look and a smile in her direction, "but so far no luck in that department!"

or else if I feel it's particularly critical, I will take my colleague out of the room for that part of the handover. Usually it's a safety issue when that's necessary.

I do sympathise with this though:

"Second, nurses need to be able to talk freely about how they view the family situation, eg, "mom is very tired but refuses to go home" or "mom has been here only for the past fifteen minutes and plans to leave again soon". These are statements that might bother the family if they heard them, but I feel they are needed to provide a quick picture of the situation."

as it really is something that most medical handovers need not cover in depth, but is important for outcome, discharge, even length of stay and overall quality of care.

1:22 AM  
Anonymous Anonymous said...

Very interesting stuff. I would probably not want to know the things said about me during my daughters first 5 or so days in the NICU. Cried all the time. She has T21, and they made the decision to put her on ECMO. I was horrified and terrified and afraid of our future if there was to be one. But over the next 6 weeks, I really came to feel like I knew those docs and nurses, and I bet that my "reviews" got better too once I was in a better emotional state.

I was there during rounds many times, but they kicked us out during change of shift.

11:35 AM  
Blogger Ex Utero said...

Sorry, I'm a little late with this comment.

I generally prefer having parents present on rounds. They self select. Those that want to be there come. Those that don't or can't, get their information at other times or sometimes not at all. I think the more face time I get with parents, the better they'll understand the reality of their child's care.

In some cases, when parents are difficult, often for reasons that are intrinsic to their personalities (now pushed to the edge by the stress of a premature child), a daily dose of physician contact on rounds can do wonders for the nursing staff by providing that parent(s) with concrete goals and directions (and sometimes limitations - as in "you are handling your child too much and over stimulating her at a time when she just needs to grow and not develop chronic lung disease").

Nurses do not always have the same capacity to direct parents in their conversations during sign out and so I am a bit sympathetic about their desire for a shroud of secrecy. They also work shifts and thus do not have the luxery of extended time for prolonged conversation with parents during shift change.

Parents can have those discussions with the nurses mid-shift when they often are more than willing. Nurses have other lives and do not get paid overtime to stay and talk to parents. Conversely, nurses are present and participate in attending rounds (at least at our institution) so parents get all parties involved at one shot if they can attend those.

Last comment: I don't know who the anonymous person was, but they need anger-management couseling.

12:54 PM  
Blogger WendyLou said...

Our NICU... We were kicked out from 3:30-5 every day, twice a day. I really hated that. Simply put, I was ok being there for EVERYTHING they needed to do to my daughter. I observed enough procedures to know that if I wanted someone to be there to comfort and say kind words to her, then I better buck up and deal. I'm not criticizing the nurses, they have a job to do, and I have mine. I don't want a nurse trying to put in an NG tube or IV focused on anything but that, which is why I as mommy wanted to be there.

I as a mom do have the right, to see what is in her chart. If there is something which would offend the family, either don't write it, or write it in a tactful manner.

And to NeoDoc... Once I got my first EOB, seeing that the Neo were getting $740 from my insurance company A DAY, my attitude changed. I went from being grateful and deferential to becoming a more assertive consumer. Not rude or high maintenance, but rather determined to be kept in the loop. I put a note in the chart requesting a daily phone call at minimum. Seriously, if you can't make a 2 minute phone call when you are getting that much for ONE patient.....

If parents need education, perhaps someone should sit down with them and explain how the NICU works, what abbreviations mean, etc.

An to anon 12:22 it is my RIGHT to see what is in the chart.

"So all mothers who annoyingly try to snoop around and try some 'extra'information, why dont you spend that time with your baby instead."

How much time can you spend staring in awe and wonder at your baby sleeping quietly in the isolette? Really. I don't think we are playing detective, rather we are trying to be informed about our children's condition so we may be educated and ask questions.

I hated having to leave. Basically that made the 3:00 feeding a bust. By the time we were all set up, if DD was going to eat, well she barely had time before we had to leave. Some nurses were much better at keeping their voices lowered hence keeping confidentiality, while others were not. I tried very hard to not make more work for the nurses, namely I would do all diaper changes and bedding changes while I was there. I would do whatever I could while I was there to care for DD.

NeonatalDoc... Your post brought up some emotions I had ignored. About 3 weeks into DD's stay, I was told I could no longer look at DD's chart. I never snuck looking, I was open about doing so. What I mean by that is I looked while the curtains were open, rather than when closed so I could pump. No one could give me an answer about how I could look at the chart. The Neo's said it was a hospital thing, the hospital said it was a neo thing. Picking my battles, I dropped this. However, I just called the hospital and made an appointment to see what is in her chart. The woman asked "why?". I replied, I want to know what is being hidden in the chart. Basically until I was told I could no longer look at her chart, I had no concerns, and after, well, I began to get suspicious. I've read that being open lowers lawsuit rate.... I have no plans to sue, I just want information which I have the right to see. When I confronted the social worker on looking in the chart, she told me I could not possibly understand what I am reading. I replied to her that I have been the social worker for a nursing home, and a child welfare social worker for many years, and I do understand what I am reading. If I did not, I asked the nurse, when they were not busy.

When I started with my OB, she let me know that if I wanted copies of anything, I needed to just fill out the form. I thanked her for this. I'll be honest, I enjoy reading medical reports, especially when they were about me. OB and I went line by line through one U/S report on the babe, because I had tons of questions. What is wrong with that? Why are medical personnel intimidated by people who are educated and informed?

Anyway, good topic. Why do medical personnel feel we need to be protected from information which we have the right to?

12:54 PM  
Blogger neonataldoc said...

I don't understand why people worry about parents reading the chart. What are they writing in there that they are afraid to have parents read?

8:15 PM  
Blogger WendyLou said...

My question exactly.

Just to answer you... I don't know what they fear. In my documentation at work, I can ALWAYS figure out a better way to say something. Example:

Father stomped into the office. He made a complete ass of himself and ranted and screamed. The police came and hauled him to jail.

Rewrite: Father came into the office. He is very concerned about his children. He got very upset and agitated. Law enforcement were called to ensure office safety. While there, they effected a outstanding warrant.

Same thing written differently. I always chart assuming that the parents will pull my records. I have nothing to hide, warts and all.

When I was told to not look at the chart, honestly, I felt that there was something to hide. I believe that is because of how I operate in my employment.

I hate that. I saw every perinatolgy report on DD during the pregnancy. I knew that bed rest was coming long before my OB recommended it. How else are people supposed to give informed consent if they are not informed?

10:31 PM  
Blogger Ex Utero said...

I agree. It's a legal document and if parents want to see it they're going to see it one way or the other. Better to write our notes in a way that a) they can understand them (minus the reality that some medical terminology is an absolute necessity) and b) we use a tone that is non-judgemental even in the worst of circumstances. If we go through them with parents, I think we're a lot less likely to have to go through them with a lawyer.

10:54 PM  
Anonymous Anonymous said...

OK folks, for the flip side,
can you give us nurses 60 minutes in a 24 hour period to communicate to each other? ie.."he had to be hand bagged for 20 minutes on the nitric when the HFOV failed?". Consider the rest of that report, it will take at least 30 min to cover the meds, resusc measures, prenatal hx, tests done, consults, etc... We have 30 min to give report, and overtime is STRONGLY discouraged. If we have to stop for parent's questions during this time, how will we ever get done? We have 23 other hours for parents, can't we have an alone time twice a day?

10:10 PM  
Blogger Marcia said...

As far as shift change/nurse to nurse report, I have three words for you: HIPAA, HIPAA, HIPAA.

I work in a small unit where there is no way to not hear what is being said.

You can not have parents present while discussing other patients. End of story.

If it is made a point to tell parents this right up front, they will know and plan not to be there for those two 30-minute periods a day. If they are not told, of course they are going to be upset when they arrive and are not let in. It's a matter of communication.

Interesting blog, by the way.

7:51 AM  
Blogger Judy said...

We used to have parents present for change of shift report, but the decision was made to exclude them when we realized that it was not uncommon for one parent to know more about another's child than that child's parent. HIPAA, IOW was the issue that had us close the unit. If we had more space between beds it would not be an issue.

We're in the process of redesigning the unit to have separate spaces for each patient -- I hope that parents will be welcomed at change of shift again once that's done.

I never had an issue with a parent interrupting nursing change of shif report. It was not uncommon for them to have questions afterwards, but that's not a problem. If there is something they need to know that they didn't get for one reason or another, I'm always glad to share that with them.

As for information that the physician or nurse practitioner has not had time to share yet, you do have to be very careful about how you transmit that sort of information when parents are in the NICU. It's one thing for them to hear it from the nurse instead of the physician. It's another thing entirely for them to hear it from another child's parent who was present at change of shift when they weren't.

1:57 AM  
Anonymous Rae said...

I know I'm months late on this post...

I was shocked when I learned that at some hospitals parents are kicked out during rounds.

Our daughter was at a level 4 NICU with PPHN (it was suspected cardio condition which is why she was transferred to level 4 being surgical). We were not only permitted, but encouraged to be at rounds. We made a point of being there every rounds. Often the info wasn't new but when you have no idea what is happening and if your baby is going to be ok hearing the info repeated is precious.

We were always treated like we were part of the team. When she had her neuro consults (as a result of seizure type behaviour) they would start by asking us to tell them what we'd observed, etc. We were very much treated as partners in our daughters care.

4:52 AM  
Anonymous Rae said...

The only time we were asked to leave the NICU was for 15 mins while they performed a cardiac procedure on the baby across the room - they put up screens, etc but asked us to leave while the carried out the surgery

oh. and they always called her by name which I really liked.

5:03 AM  
Blogger Jody said...

At Yale-New Haven in 2001, they asked parents to leave from 9 to 11ish during rounds, and during the three different half-hour nurses' hand-overs. The effect was to cut 3 hours (I'll concede that I wasn't going to be present for the 11pm shift change) from an already stressed day, limiting my time with my babies.

Not only that, but they closed the ENTIRE WARD, so you couldn't even be in the pumping rooms.

Here's the real question: how is life different in the NICU from the PICU, and WHY?

I'm always struck by the considerably greater access that PICU parents are given. Especially because NICU parents rarely formally admit their children until the parents themselves are discharged. There's a strong aura of "this baby is ours until we say otherwise."

I agree with Jennifer -- this comment thread exactly replicates my impressions of NICU care in the States today.

(I should add: I couldn't care less about hearing what the nurses have to say. I just don't want to lose my limited daytime hours with my babies. After all, we haven't even discussed how PICU parents are allowed to stay overnight, but NICU parents are NOT.)

11:47 AM  
Anonymous Momof2andoneontheway said...

By the looks some nurses but not all nurses seem to find interest in the fact parents have must be researched as if they are the patient as well as there baby. Compassionate nurses are angels from God. I did meet a few but they were as rare as a blue moon. One of a kind nurses! Some older some young. The rest just common grumpy and down right rude registered nurses! I found the younger nurses had really good hearts and did well with there job. My full term 7 pound healthy daughters final diagnosis had been TTN due to a rapid birth on her discharge notice for her fast breathing that only lasted less then 24 hours. I was born as fair as my daughter was at birth and went home the same day I was born and I never had an infection. My daughter was put on 5 days of iv antibiotics and 2 days of thigh needles. They were going to put ain iv in her scalp they said it was best for her as the thigh needles would hurt her more so we agreed wih the scalp iv then they went and did the thigh needles instead. My daughters NNU information was right next to her open crib as I spent time with her. The same nurse who yelled at me not to look at the information that I had to ask the doctor to look at the information. Also told me off for putting booties on my daughter in winter when all she wore was a white hospital gown. Incase I made her to warm. This same nurse also failed to do the hearing test correctly on my newborn. My daughter passed with flying colors the 2nd time. I was never to dress my own baby in her clothes not even a sleeveless outfit of my own with an iv in her arm for antibiotics. As a mom told nothing about what they did to my daughter but asked by nurses to watch her have ivs put in when they leaked. I had a right to look. I know my daughter was already suffering through enough endless blood tests each day to try to prove an infection that never existed. Each test coming back negative for infections. All they had gone by was a high white cell count on the day she was born as to put her through so many tests for nothing. Doctors telling the nurses that my daughter belonged at home. Knowing she demanded every 4 hourly feed guzzling each meal with fast cherry teat and the doctor seeing me and my daughter had fair skin which is still fair and always be. A nurse waiting for the doctor who said my daughter could go upstairs then go home with me the next day. to come back and lie to me and tell me the doctor had changed his mind about us letting our girl go upstairs incase we bump her iv,
Below is a video of my daughter aftr her 1st bath befor they wanted to put a iv in her scalp. My daughter had screamed and thrashed about at all the failed iv attempts on her limbs so they wanted to try the scalp vein for easier access.

http://youtube.com/watch?v=HRAEg4wQlnI

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1:59 AM  

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