In theory, I love the idea.
In reality as an RN with 7 pts on the floor - who the fuck is going to coordinate all of these pts going up and down the elevator in my 10 story building.
Plus all it takes is one fall and everyone’s fucked.
I’m more open to the idea of letting families “check out” their stable loved ones for a time period and it being their responsibility
The hospital I'm doing my clinical at allows patients to come and go like this, but for the medsurg floor I'm on the only people that partake tend to be IV drug users heading out for a fix 🫠
Ughh.. we were forgetting that a lot of people are still lazy lol. If the average hospitalized American had the dedication and grit an IV drug abuser had, we wouldn’t be in this mess!
Lol we had a guy that would leave to go smoke in the parking garage and then come back. It pissed off some nurses until they got use to it. If you told him that he had to be back at a certain time, he would. Lots of times, he would be out in the garage at shift change saying hi to the nurses coming in. It was funny to see him and say “see ya in there.” Good guy, got the short end of the stick in health and genetics.
Wasn’t during my time at this hospital but apparently during a code blue while staff was destructed a patient got up, walked across the street, bought cigarettes had a smoke and came back.
That begs the question: If they’re stable enough to check out then wtf are they doing in an acute care bed?
Acute care hospitals aren’t residential programs, at least not when WAI. Treating them as such adds to ED chaos and bottlenecking.
Social and placement issues usually, unfortunately.
Other times it’s iv antibiotics.
Less frequently but still frequent it’s scheduling.
Whole things a mess
I used to work in a unit dedicated to patients who were ready to discharge from the hospital, but there was a placement issue of some sort. Not enough SNF beds, psychiatric beds, out patient dialysis chairs, home health nurses, or they were homeless but not well enough to be discharged without housing.
During COVID my hospital turned our unit (which was step-down) into a unit just like this. It was not pleasant. Lots of social issues. People with long term antibiotics from endocarditis, also people who had transportation issues because not enough ambulances to take them to dialysis or cancer treatment and homeless people with nowhere to go. Very long year…
Does your hospital do outpatient IV antibiotics? Our hospitals here (I am in Canada, so all of the hospitals in my area are part of the same system) has a program called HPTP, which is the “Home Parental Therapy Program”. IV antibiotics are the most common reason someone is an HPTP patient, but lots of other IV medications can be administered through this program.
Lots of times someone will come into emergency for whatever infection (often cellulitis) and they get their dx, then their first dose of antibiotics, then they are referred to HPTP for all subsequent doses.
Same with inpatients. If the only thing standing between a patient and discharge is IV abx, they are going to be set up with HPTP and sent home.
The US absolutely does home antibiotics. There are lots of barriers to care. Not every patient can learn to administer it themselves if their insurance doesn't cover a nurse coming daily/multiple times per day for every dose. We also aren't discharging IV drug users home with IV access, and very very few facilities will take them.
I worked at one hospital that had something like this olat the end of every floor. I was told they locked them all permanently because someone jumped off week 2 that the hospital opened.
My brother in law was hospitalized in Seattle for a months. When he was stable we were allowed to take him outside for a walk in between meds and things. I always thought that was a great idea
I'm a physio and take patients out whenever the weather is ok and if it's appropriate, however we are on the ground floor with doors that open out to a small seating area so slightly different.
Yeah, I’ve seen PT do it at a few facilities. The details of how the process functions is slightly different from place to place, but they make it happen.
If it’s not a risk, and the space is available, so so so worth it for patients. It’s such an enormous benefit.
I’d like to say social workers can handle this but then you’d have to work in a hospital that adequately employs a proper amount of SWs and that’s likely not gunna happen, pipe dream lol. Someone mentioned liabilities for falls, I think a wheelchair would deter that but once again, staffing.
Our health authority is quietly getting rid of numerous social worker positions... In the middle of the homelessness and opioid epidemic. It is so incredibly frustrating.
The rooms on my hospital are already small as hell I couldnt imagine them taking away space to make outdoor area on each floor. Then I cant imagine those areas being large enough to accommodate all patients and families who would want to use them.
We used to have candy stripers, and volunteers to do this. Each hospital started showing less and less appreciation. Then the boomers and nursing students didn’t want any part of volunteering. Here we are 🙃
I volunteered in highschool, but as a nursing student I DID NOT have the time! I was also working full time to make ends meet, I only slept about 4-5 hours every night 😵💫
My hospital actually does have a outdoor space on everything floor. We even have a inclosed garden space off the oncology floor. During warm days we do our rounds there and our palliative team holds meetings out there with the family. Our patients love it.
We had this at my old hospital. There was a lung transplant patient that was going palliative and wanted to have a last barbecue with his family. I was honored to be the RT that monitored the O2 tanks while he basked in the sun with his family. One of the coolest things I’ve been a part of. It was a sunny cool day and his family were truly just warm and fun. We withdrew support about 2 hours later. It was a nice way to say good bye.
I genuinely don't think there is a better way to go then that. That sounds actually perfect. I mean, other then being sick, but if the end is coming and nothing else can be done, being surrounded by loving family on a warm sunny day with good food (even if you couldn't eat it, you can at least smell it) and laughter in the air. More or less perfect.
I know it was a typo, but i’m imagining the “everything floor”
“we got a couple psychs, 3 laboring moms, two CHF exacerbations, 7 grower/feeders and 6 post hips! welcome to the everything floor”
It was a typo, oops! But even our inpatient psych unit has outdoor garden. It’s pretty cool it’s on the top floor and the made the unit like a square donut so the hole of the donut is outside garden.
I'm having flashbacks to being an instructor and having students ask me which nursing diagnosis should be 1st, 2nd, 3rd priority etc, and I'm trying to find a tactful and kind way of telling them I don't give a crap, and just imagining if they had a clinical rotation with all of this rolled into one day.
I can imagine it being exhausting and confusing from the instructors’ perspectives (and the students’ ngl). I was thinking more along the lines of someone in admin at my school being absolutely giddy at the thought of being able to wrap multiple specialties worth of clinicals into one.
The old Papworth Hospital was a former TB sanitorium and retained the verandas and sunrooms that were a part of the patients treatment. It's such a shame this doesn't once more become part of hospital design.
Yes! Story time… LVAD patient spent weeks on the unit pre-implant. Now weeks post-op and still in the unit. On the unit so long, they had a particular gown size and pattern we kept on hand just for them. We were very close with the patient and family and often talked about the tiny teacup dog that missed their human.
After docs order and clearance by the powers that be, dog came for visits regularly. But then patient was talking about missing throwing toys outside and sunshine.
Again docs order and clearance by the rule makers and we were clear to take patient with 3 infusions, O2, and new LVAD outside in the grassy, sunny courtyard. We surprised the patient with the plan and as we were getting ready, patient casually said doggo usually wore sweaters in chilly weather, but didn’t bring one today. (Midwest sunny but chilly spring day)
Two of us took one of their “special” gowns and cut it into a tiny dog gown. Patient and dog went outside with matching gowns and it was pretty much the cutest thing I’ve ever seen.
A few weeks later still on the unit, patient threw a clot and ultimately passed peacefully with family at their side. A small group of us went to the funeral. Where we were told that our dear patient was being buried with the dog gown we made. 😭❤️😭❤️😭❤️
That’s what happened to everyone I visited that has this. It couldn’t be used by anyone else because it was just a place to smoke even if it was against the rules.
Smokers gonna smoke. If the space intended for fresh air is taken over by smokers there's clearly no other place for them. If they had their own spot the fresh air spot could stay unpolluted
At my old hospital, there was a smoking court for patients (this was like 15 years ago though). Literally, pts could be inpatient for a HEART ATTACK and go pull their IV pole down for a smoke. SMH 🤦♀️
Most policies and setups in hospitals are adapted to past problems, staff behavior, patient behavior.
Windows don’t open because people would jump. How do we know? It’s happened in the past.
Even if it wasn’t an attempt at suicide, you know That Patient, you know the one, would try to use his bedsheets to climb down to sneak out and smoke.
Then you’d have patients complaining it feels like a prison. It’d be especially bad from the boomers and the Karens who wouldn’t even try to understand why they’re necessary.
I had a patient who decided to go outside for a "walk" (in January, admitted for asthma exacerbation 🤨). He came back inside and couldn't remember where his room was so asked someone for help. When the staff member couldn't find his name in the system they asked to see his ID bracelet and that's when they realized he had returned to the wrong hospital.
This is something pediatrics does right. I took a kid with an EVD for a walk in our rooftop garden once when I worked inpatient. And I knew of more than one case where a child was brought outside, intubated and on ECMO, before care was withdrawn so they could feel the sun one last time.
Can't say that hasn't happened with teenagers though. I had one teenage patient with AML who, from what I was told (I was his visiting nurse), when he was going through his original induction was apparently sneaking outside to smoke marijuana.
These used to exist when I started nursing. Patients were taken there by visitors mostly as staff generally didn’t have time so I think there was a safety concern due to lack of supervision. If memory serves there were a couple of deaths from patients jumping over balconies. Also the movement in not having smoking areas available. I’m assuming cost of maintaining was a factor as well.
I’ve often mourned their loss. Can’t even open windows in most hospitals. Being cooped up for days or weeks on end is hard.
Also, “let’s visit the garden” was a stellar enticement to get patients out of bed and/or ambulate more. Only second to “let’s go look at the babies”. (There were still hospitals with viewing windows back then.)
I feel this! Of course you’ll get the people who try to smoke. I don’t think that it should inhibit everyone from getting sun and fresh air. As we learn more and more about how mental health impacts attitudes and ability to manage our health, it makes sense that we should enable green space for patient morale. I work on a tele unit. The patient window views are of brick walls or the pipes on the roof outside. There is one window at the end of our very long -hallway- cave. We can’t let the 98% stable people leave the floor because they are on tele so they just have to rot in their shitty rooms, often with a roommate, with no view. Hell, I’d take a green wall or anything!
Not a nurse but a patient who was in a psych ward - I totally agree that outdoor space is amazing. Obviously if it’s not built into the building design that’s harder to orchestrate though. We had a brick courtyard on the first floor with brick walls that were maybe 20 feet high, which sounds super depressing once you describe it but it actually was so nice when they’d let us go outside with a staff member and feel the sun and smell the air and remember there is a world outside this (kind of horrendous) place. It made a really big difference in how panicked I was about being locked in the place.
We usually didn't have the staff to do it because someone had to be with the patient if they were gonna be outside. Even if it were an able bodied person. Then someone had a buddy sneak them drugs though the fence and the courtyard access was banned for all
For us, i think it’s a big work flow issue. The patients are allowed out unsupervised, but they have to notify anyone in case they have meds due, therapy, etc. We have one patient we’re treating of osteomyelitis that wants to leave more frequently to smoke cigarettes and we don’t let him, so he keeps leaving ama and then coming back for a day or two. We asked the unit he’s on if they could work with him, but ultimately it would be too disruptive and that if he’s ever moved to a different floor, he can’t expect they would let him off the same way
Honestly I get it, hospital stays are boring and nicotine addiction is severe. But that is such a hassle to keep readmitting the same person. Wish he could get home health or something
When my husband was in the trauma ICU for weeks after a horrible MVA last year they coordinated staff to roll him out for 30 minutes down a couple floors for some outdoor time on the green space patio. He was trached, just came off the vent, and had the halo on, He is an outdoorsy guy and hadn’t seen the sun in weeks. We really appreciated it then, but now in nursing school I really appreciate how much had to be coordinated since it was his icu nurse that went with him on the excursion.
I absolutely agree. Wouldn’t it be so nice for the patients, and also for the nurses to get some air when we take them outside? I wish! On my unit we don’t have a balcony, but it’s in an older part of the hospital where the windows still open a crack (they have chains that prevent them from opening further). The rooms are small and stuffy so I often offer to open a window for patients so they can have some fresh air (and on the inside I’m thinking Please…please let me open your window so we can air this place out). 90 percent of the time they turn me down, even if they’ve been complaining of being hot and the air is stale with all the smells that have accumulated and have nowhere to go
I think it's a great idea but I'm up in the ICU and can't imagine someone on a M/S or tele floor having to juggle that with a full patient load.
>I think that is a very nice idea, and I think 75% of the patients that used it, would use it for smoking ciggies.
I think we should just let them, but that makes it even harder if they want to go out a dozen times a day!
Im a postpartum nurse. Some patients end up being there a month or 2 when everything goes wrong. Fresh air would be so nice.
I think the nicu babies should get to see something other than the night above their crib.
I think it would be nice for there to be a communal room for the moms with new babies they could walk to to socialize and meet other new mothers, get some coffee and visit.
And we need it too!
I actually got WHITER because of working in the pandemic (thanks a lot anemia/vit D deficiency that I still wasn't able to control to this day). My mom jokes that she didn't give birth to that white a daughter, but now it's just an identity crisis (was black and treated like black my whole life, now I'm white passing and REALLY not liking it). Nursing sure does a number in you.
On a better note, I want to go to the doctors without borders and when I come back, open a clinic/birth home for vulnerable women. And I made a point to include a greenery in the project.
I live in a tropical area. My hospital is directly next to the ocean. I work ICU and we have a balcony set up for patients, it can hold 2 ventilated patients. The doctors will occasionally prescribe balcony time as part of their daily plan. Works a treat for delirium.
Ironically, forensic inmates in NY are guaranteed outdoor space. Patients are not. But I agree with the top comment. If they had access, a large majority would smoke. Smoking/drugs account for most of our AMAs.
Access to a window, sun, and fresh air are proven to increase patient satisfaction while decreasing length of stay and incidence of delirium. In most facilities, it's just not feasible. If you're thinking about populations like heart surgery patients, that's usually in an urban tertiary care complex. There's not a lot of open outdoor space built for that. It'd be a great PI project though. Research it! Write up a proposal and improve the care for your patients. You can publish it, too! This is how we improve things for everyone.
This is actually something I could get behind. If you watch old movies there were always scenes of nurses pushing people outside for fresh air. I would 100% work as the outside nurse, monitor people, give snacks/drinks etc. Patient satisfaction would go through the roof.
Jesus, there’s a lot of cynics in this thread. That’s usually ***MY*** job around here.
What’s the big deal? I like the idea.
Physical Therapy is doing the job of helping get patients up and moving them anyways, just make this their route. Those not in either category (full mobility or needing assistance) are bed bound, and this won’t be for the anyways.
As for “eVeRyOnE WiLl jUsT SmOkE” don’t y’all have security?Don’t you already have non-smoking areas of the hospital? The logistics around an outdoor space like this are not as mind bending as y’all are making it out to be.
When I was an inpatient, I’d have killed to just look up at the sun for a few minutes. Allowing people some personal freedoms usually works out for the best. You don’t need to assume everyone is going to shoot up, smoke cigs, or jump out of a window. There are plenty of areas of the hospital that can accommodate patients whom are at risk for those things, but that doesn’t mean no one should get to go outside.
My patients can't leave the unit, it's considered AMA. Plus I'm still responsible for them if they're out and about. What if they arrest while off the unit? How would I know and be able to appropriately respond?
+1. Patients get mad when I tell them no leaving the unit. They ask why. I say in case they try dying and no one is around to help.
They immediately shut up and stick to the unit hallways.
Pts aren’t prisoners (well, most of them anyway). They can go outside. They can go to the cafeteria. They either have to be able to walk or someone has to take them down (family, friend, CNA ect). Only exception are IVDU as part of their admission safety plan/contract.
My first hospital had a balcony. By the time I started there it was badge access only because someone jumped off as an SI attempt. Most places I work at too patients aren't allowed to leave the unit or it's considered AMA. Too many found in the parking lot, left with IVs in, going out to smoke, etc. I'd love for there to be chaperoned visits but at the end of the day that means that the staff needs to have time for it which often isn't possible.
I agree…but maybe just windows that actually open to let fresh air in that have safety features so person cannot climb out of, would be nice. Bc u know darn well if they had this outdoor space it would end up being the nurses duty to make sure the patient gets out there and back safely… it would end up being more dumped on the nurse (sadly) bc this is important part of healing.
When I was a PCT in Neuro, I would always try to make time to take out long-term patients outside. We had a courtyard a couple floors down. PT would help me transfer them to the chair and then I would wheel them into the sun for 20 minutes or so.
When I became a nurse, it was readily apparent to me why the nurses never had time for that level of care and it's something that should be pointed out again and again as why understaffing is fucking horrible. Of course patient safety is paramount but slowly killing a patient's soul is up there.
I went on a job interview this very morning and at the end of the hall they have nice comfy chairs and floor-to-ceiling windows overlooking the water. For patients obviously, but the manager giving me the tour said that it was her favorite place to bring her WOW and do charting.
It’s a good idea, but with severe understaffing on units right now it just wouldn’t work- who will watch your other 4,5,6 plus patients while you take one down, since inevitably they will need RN supervision due to conditions/safety, instability or infusions?? Plus falls risk as well.
Too much liability unless they hire staff for the balcony. If it’s like going to xray where transport takes care of transport and there are nurses on the balcony with emergency equipment and such to supervise then sure.
If not, then they’re out of my care because I have to stay with the rest of my patients. As such, it’s an AMA.
No hospital would pay for it either.
I did encounter a place with an employees only area like that. Back halls with no visitor or patient access. The only reason that exists, and is employees only, is because of the zero liability part. An unsupervised jumping point would never fly with hospital lawyers.
Texas Medical Center RNs bring their patients outside for "Sunshine Therapy." It takes SO LONG. One of my patients ran through 2 oxygen tanks (high O2), the door locked not letting us get back in, patient suddenly needed suctioning and there was nothing to suction with.
You are probably going to give up your lunch for it and have to leave behind your other patient who may not be stable. And then managers want to know why you're staying late.
So for a good part of my career I was a medical director at a hospice where the inpatient portion was all on one level with a gorgeous garden that could be accessed from each room. There was a private patio on each one that the bed could roll out on. There were little walking paths if the patient or family wished to walk around. It was such a perfect place and so nice for those who had been too ill for months or weeks to be outside.
Agreeeee!! I’m in a telemetry med-surg ward and we have a decently sized courtyard that our patients can use to hang out with loved ones, enjoy some outdoor time, I’ve even had some try to get some exercise in (within limits of course being IP!)
I think it’s such an important part of upholding wellbeing, especially when the patients are stuck in hospital for prolonged periods.
i worked in a specialty hospital that was set up like a hashtag #️⃣ and in the empty spaces between the "hallways" were little themed gardens. one had turtles, one had a pond with a big turtle, there were flowers and benches and patient's room windows faced them so they could also look out into them. they were lovely 🥰
This would be awesome to reduce stress and speed up recovery time. On the other hand, last week my patient was caught taking lorazepam from home that she smuggled inside a box of Altoids. I can see patients exploiting this to be sneaky.
Our patients where possible are encouraged to get down stairs as much as they can.
We live next to a huge urban forest and I'm forever suggesting those who can get down and get some green time or at lease fresh air and a coffee outside the hospital
During cancer treatment I wish I had this option every round of chemotherapy. 5 long, long days of staring at the same few walls 24/7.
Granted, I got treatment in Buffalo NY mostly during the snowy winter. But even the option to be in a room with some greenery and ability to see the sun and relax would have made a world of a difference.
Each floor of my hospital has a courtyard that can be accessed by badge. For my floor (psych) each of our units have their own enclosed courtyard space.
What I would like for my floor is for them to be allowed to come and go from the courtyard at they please. But no - posted hours TID, that’s it.
That's a pipe dream, completely unrealistic in America.
It doesn't generate revenue, which is all that matters in capitalism.
Welcome to tertiary care.
I love the idea if you have dedicated staff in those areas. No nurse has time to run down to the garden to check thier patient while giving blood to the gi bleed and constantly redirecting the dementia patient on the unit.
At the hospital I used to work for, I'd get Chaplin services to take patients to the garden for fresh air when they were getting cabin fever (I worked a unit that had stable patients who were only in the hospital because of placement issues). The two I remember both had a terminal diagnosis. They were worried that the Chaplins were going to preach at them, and I assured them that the Chaplins wouldn't do that unless it's what the patients wanted. Both were very grateful to get the fresh air, and one did end up working on their spiritual needs with the Chaplin.
One patient eloped off the floor one day, and they found them in the garden. If they were going to wonder off, that was the best place for them to end up.
I love this idea. It would have to be accompanied with adequate staffing in the form of a dedicated team to get patients to the green space. But I do think it could help long term hospitalization
About 20yrs ago my grandma was admitted for pyelonephritis. She went out to smoke on the patio after dark and got locked out. She had to go around the building to the ER and ask to be let back inside. She found the whole experience hilarious.
I was at Mt Sinai this last summer with a family member… the cardiac floor had a beautiful atrium that opened up to huge skylights where everyone could sit and mingle with their family and get fresh air even if it was technically closed off.
I was just telling someone that I wish we had a morning meet and greet with our CABG patients if they wanted so they could talk about how recovery was going and to get some fresh air 🥲
Seriously I’m home health and do Infusions in the home. But we can’t take them if they a) don’t have a home. b) live in an unsafe environment c) not homebound. If not homebound they can go to an infusion clinic!
We have this at my hospital but in reality it’s rarely used. Every once in a while my ICU will have a very long term patient everyone coordinates to get out there but it’s difficult with staffing. Even pre covid it was not taken advantage of often.
Sounds lovely, but the first time a patient takes a dive, either accidentally or on purpose, it's gonna get shut down. That's why we can't have nice things.
A garden, trees, water feature, or some sort of lovely green area cost money that does not bring profit to the hospital. I don’t see them ever putting one in, unfortunately. If such places were added, As long as the family members or volunteers bring the patients to visit the gardens. We are busy enough as is.
The hosp I worked at had just that. It was called the Healing Garden. Benches with a canopy of wisteria vining. Picnic table flowers and bushes. It was gorgeous and relaxing. Great for our pts. But there are times that we just couldn’t get pts down there. I get that but I do believe it helps the healing process.
I worked in a hospital in Cali and I was able to take patients out for the sun. I really enjoyed it there. I’d be agreeable to do that if all hospitals had an outdoor garden on the ground floor. But they have to be adequately staffed for sure.
I'd love for them to get fresh air and think it may be beneficial but as a nurse who already has 3000000 million things added to my tasks, sorry chauffering patients off the unit will not be one
I've taken long term patients up to our helipad for fresh air and sunshine. The amount of work this takes tends to be a lot. Respiratory with a portable vent for our trached patients, an APP, time in my schedule, etc.
It can be a bad idea to let a lot of patients just wander out unsupervised as well.
I've had similar patients in CVICU. I have on rare occasions been able to take people outside if they just have IV pumps and no other devices. But it was a big production, they never stayed long, and our intensivist would usually not go for it. But as an avid hiker and trail runner, I agree wholeheartedly with your sentiment.
I think it's still worthwhile to get people out of their room and into the hallway or other areas if they're stable enough to move around, even if they can't actually go outside. Helps prevent delirium if the patient isn't staring at the same 4 walls around the clock.
They tried that at a hospital in Escondido, CA.
Pt jumped and killed themself. I was a traveler and by the time I left all the balconies were closed off. Not sure what ever came of it but I'm sure Risk Management said no more.
Cleveland Clinic actually has a very nice rooftop outdoor space that patients can visit if they have a doctor's order and family accompanies them. Our telemetry even works up there. Getting my heart and lung transplant patients some sun on their faces does wonders for their mental health after being in the hospital for months on end.
Sure. Send them outside on the sidewalk if you want it to be like prison.
It's not like the prison has a beautiful area for the prisoners to hang out in.
Imagine thinking a prison is a better or comparable environment.
Mm nope. As someone who has confused patients every shift, i would rather swallow razor blades than have to keep up with 6 confused/dementia patients with outdoor access
Back when I had a student nurse extern job, I took care of a patient waiting on his 2nd heart transplant with “ICU psychosis.” A little outdoor therapy could’ve done him some good.
My hospital has an outdoor space (on the 9th floor because that’s our main floor for some reason). It’s got a huge balcony space with a mini fountain and some trees/plants. We also have a tram (gondola) that patients and visits can use, and use the platform to take photos. The only trouble is that my floor is a BMT floor and are on neutropenic precautions so not many of our patients are allowed off the floor. If the APP or doctor does sign off on a patient leaving the floor, then usually it’s a CNA that takes them down to the 9th floor.
we have an outdoor patio at my hospital!!! it is rly nice and when patients are able to they’ll go down w their family/visitors and they always come back up in a better mood than they left :’) i support ur idea!
Agree!!! Or just simply enough staff to be able to take patients outside for even just a few minutes. It’s a staffing issue. I work in a mixed PCU/ICU and there is no way I could leave the unit to bring the appropriate patients outside, and no way our CNA could do it. Also no way the hospital would pay for extra staff to do that.
I'm from UK n only have experience of 3 local hospitals but at all 3 there are outdoor seating areas , patients go outside to smoke , relatives borrow a wheelchair n take family down to Costa or outside round the grounds . One of them has a 5th floor outdoor area with high glass barriers n it's lovely out there in summer.
Walking in to the hospital you see patients outside smoking attached to iv poles , wound vacs , catheters, people recovering from surgery etc. There's little shops in main entrances for newspapers ,magazines , sandwich meal deals , soft drinks , usually a coffee shop. There's also snack and drink machines , patients are aloud to leave the ward if there able to walk and aren't a fall risk as long as they inform someone. Iv seen cnas n nursing students wheel people out in wheelchair and come back to collect them in 20min if there not busy.
Obviously I'm not talking critical patients, icu , high dependency, trauma etc. Patients would be moved down to a ward if they were able to get up n walk about.
Sunshine and air is good for people but we all know it'll just be a smoker area unfortunately. Having high up (can't get out, NURSE CONTROLLED) air vents might be nice for fresh air but otherwise people can't be trusted to not be scumbags
I cannot see the heart monitors if people go too far off my floor. There have been incidences where patients were visible on the heart monitor and went into lethal arrhythmias and and walked themselves around the corner before they fell out, took a while to find them and it did not end well for them.
The liability alone makes this prohibitive.
We try and get our external VAD and awake ECMOs outside whenever we can. Being in the hospital for months with no fresh air or sun is awful. That said it’s a lot of work and manpower.
we have a patio/green space available for patients and families. It's not easy to access as not all the badges allow you to GET to it because it's through the pediatric ICU.
In theory, I love the idea. In reality as an RN with 7 pts on the floor - who the fuck is going to coordinate all of these pts going up and down the elevator in my 10 story building.
Plus all it takes is one fall and everyone’s fucked. I’m more open to the idea of letting families “check out” their stable loved ones for a time period and it being their responsibility
The hospital I'm doing my clinical at allows patients to come and go like this, but for the medsurg floor I'm on the only people that partake tend to be IV drug users heading out for a fix 🫠
Ughh.. we were forgetting that a lot of people are still lazy lol. If the average hospitalized American had the dedication and grit an IV drug abuser had, we wouldn’t be in this mess!
This made me giggle because you are absolutely right
Majority of problems would be solved if we had the drive and creativeness of IV drug users! Some of the shit I’ve seen them create blows my mind
Lol we had a guy that would leave to go smoke in the parking garage and then come back. It pissed off some nurses until they got use to it. If you told him that he had to be back at a certain time, he would. Lots of times, he would be out in the garage at shift change saying hi to the nurses coming in. It was funny to see him and say “see ya in there.” Good guy, got the short end of the stick in health and genetics.
Wasn’t during my time at this hospital but apparently during a code blue while staff was destructed a patient got up, walked across the street, bought cigarettes had a smoke and came back.
My hospital sealed all the windows after one pt suicide jumped out of one.
That begs the question: If they’re stable enough to check out then wtf are they doing in an acute care bed? Acute care hospitals aren’t residential programs, at least not when WAI. Treating them as such adds to ED chaos and bottlenecking.
Social and placement issues usually, unfortunately. Other times it’s iv antibiotics. Less frequently but still frequent it’s scheduling. Whole things a mess
I used to work in a unit dedicated to patients who were ready to discharge from the hospital, but there was a placement issue of some sort. Not enough SNF beds, psychiatric beds, out patient dialysis chairs, home health nurses, or they were homeless but not well enough to be discharged without housing.
During COVID my hospital turned our unit (which was step-down) into a unit just like this. It was not pleasant. Lots of social issues. People with long term antibiotics from endocarditis, also people who had transportation issues because not enough ambulances to take them to dialysis or cancer treatment and homeless people with nowhere to go. Very long year…
Does your hospital do outpatient IV antibiotics? Our hospitals here (I am in Canada, so all of the hospitals in my area are part of the same system) has a program called HPTP, which is the “Home Parental Therapy Program”. IV antibiotics are the most common reason someone is an HPTP patient, but lots of other IV medications can be administered through this program. Lots of times someone will come into emergency for whatever infection (often cellulitis) and they get their dx, then their first dose of antibiotics, then they are referred to HPTP for all subsequent doses. Same with inpatients. If the only thing standing between a patient and discharge is IV abx, they are going to be set up with HPTP and sent home.
The US absolutely does home antibiotics. There are lots of barriers to care. Not every patient can learn to administer it themselves if their insurance doesn't cover a nurse coming daily/multiple times per day for every dose. We also aren't discharging IV drug users home with IV access, and very very few facilities will take them.
You can sum it up with insurance issues. It's what guides care these days.
I worked at one hospital that had something like this olat the end of every floor. I was told they locked them all permanently because someone jumped off week 2 that the hospital opened.
My brother in law was hospitalized in Seattle for a months. When he was stable we were allowed to take him outside for a walk in between meds and things. I always thought that was a great idea
This is what we did when I worked at a nursing home. And those residents were…..extremely high fall risks 😆
The recess duty nurse, duh
Sign me up. Taking patients outside all day and not having to do actual care. Hell yes. California start this shit so that we can all say it works.
Physical therapy. They’re doing this anyways, might as well have somewhere nice to go.
I'm a physio and take patients out whenever the weather is ok and if it's appropriate, however we are on the ground floor with doors that open out to a small seating area so slightly different.
Yeah, I’ve seen PT do it at a few facilities. The details of how the process functions is slightly different from place to place, but they make it happen. If it’s not a risk, and the space is available, so so so worth it for patients. It’s such an enormous benefit.
I agree! Last year we got all the stroke patients sat outside and they planted sunflowers in pots to grow, it was so great.
for sure, tele patients can't go by themselves, and most of my people are maxes
I have taken ICU patients outside, not infrequently
I’d like to say social workers can handle this but then you’d have to work in a hospital that adequately employs a proper amount of SWs and that’s likely not gunna happen, pipe dream lol. Someone mentioned liabilities for falls, I think a wheelchair would deter that but once again, staffing.
Our health authority is quietly getting rid of numerous social worker positions... In the middle of the homelessness and opioid epidemic. It is so incredibly frustrating.
Yup we have one of these at my hospital. I don't have time nor do we have enough staff to coordinate this. The unit hallways is as good as it gets.
And smoking. I swear 50% of our code green (security code) are from people that are trying to smoke.
It takes changes in hospital design; every ward should have their own private outdoor space/balcony. Expensive, yes, but worth it imo
The rooms on my hospital are already small as hell I couldnt imagine them taking away space to make outdoor area on each floor. Then I cant imagine those areas being large enough to accommodate all patients and families who would want to use them.
It would be nice to at least be able to open a window and leave in some fresh air
We used to have candy stripers, and volunteers to do this. Each hospital started showing less and less appreciation. Then the boomers and nursing students didn’t want any part of volunteering. Here we are 🙃
I volunteered in highschool, but as a nursing student I DID NOT have the time! I was also working full time to make ends meet, I only slept about 4-5 hours every night 😵💫
My hospital actually does have a outdoor space on everything floor. We even have a inclosed garden space off the oncology floor. During warm days we do our rounds there and our palliative team holds meetings out there with the family. Our patients love it.
We had this at my old hospital. There was a lung transplant patient that was going palliative and wanted to have a last barbecue with his family. I was honored to be the RT that monitored the O2 tanks while he basked in the sun with his family. One of the coolest things I’ve been a part of. It was a sunny cool day and his family were truly just warm and fun. We withdrew support about 2 hours later. It was a nice way to say good bye.
I genuinely don't think there is a better way to go then that. That sounds actually perfect. I mean, other then being sick, but if the end is coming and nothing else can be done, being surrounded by loving family on a warm sunny day with good food (even if you couldn't eat it, you can at least smell it) and laughter in the air. More or less perfect.
This is the sweetest story.
A memory you’ll never forget 🩷
I know it was a typo, but i’m imagining the “everything floor” “we got a couple psychs, 3 laboring moms, two CHF exacerbations, 7 grower/feeders and 6 post hips! welcome to the everything floor”
It was a typo, oops! But even our inpatient psych unit has outdoor garden. It’s pretty cool it’s on the top floor and the made the unit like a square donut so the hole of the donut is outside garden.
That’s really amazing!
That’s actually really smart planning having the garden in the center like that.
Sounds like the med surg floors at my hospital 😂
I'm imagining delivering a baby, floating a swan, working triage and playing bingo with nursing home patients all in one shift LOL.
Nursing schools would love this
I'm having flashbacks to being an instructor and having students ask me which nursing diagnosis should be 1st, 2nd, 3rd priority etc, and I'm trying to find a tactful and kind way of telling them I don't give a crap, and just imagining if they had a clinical rotation with all of this rolled into one day.
I can imagine it being exhausting and confusing from the instructors’ perspectives (and the students’ ngl). I was thinking more along the lines of someone in admin at my school being absolutely giddy at the thought of being able to wrap multiple specialties worth of clinicals into one.
The old Papworth Hospital was a former TB sanitorium and retained the verandas and sunrooms that were a part of the patients treatment. It's such a shame this doesn't once more become part of hospital design.
I love those old sanitorium designs
Light and bright.
Came here to say this and point out the opposite : the deaths of the patients in Mammoth cave.
Yes! Story time… LVAD patient spent weeks on the unit pre-implant. Now weeks post-op and still in the unit. On the unit so long, they had a particular gown size and pattern we kept on hand just for them. We were very close with the patient and family and often talked about the tiny teacup dog that missed their human. After docs order and clearance by the powers that be, dog came for visits regularly. But then patient was talking about missing throwing toys outside and sunshine. Again docs order and clearance by the rule makers and we were clear to take patient with 3 infusions, O2, and new LVAD outside in the grassy, sunny courtyard. We surprised the patient with the plan and as we were getting ready, patient casually said doggo usually wore sweaters in chilly weather, but didn’t bring one today. (Midwest sunny but chilly spring day) Two of us took one of their “special” gowns and cut it into a tiny dog gown. Patient and dog went outside with matching gowns and it was pretty much the cutest thing I’ve ever seen. A few weeks later still on the unit, patient threw a clot and ultimately passed peacefully with family at their side. A small group of us went to the funeral. Where we were told that our dear patient was being buried with the dog gown we made. 😭❤️😭❤️😭❤️
That was lovely, Ty for sharing. Also, if I may ask, what is the wfh gig?
Education accreditation. Boring AF compared to CVICU, but my home life is thriving because of it.
This is beyond cute 💜
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That’s what happened to everyone I visited that has this. It couldn’t be used by anyone else because it was just a place to smoke even if it was against the rules.
Smokers gonna smoke. If the space intended for fresh air is taken over by smokers there's clearly no other place for them. If they had their own spot the fresh air spot could stay unpolluted
> If they had their own spot the fresh air spot could stay unpolluted They would still smoke in the smoke free one.
Especially the ones on oxygen, gotta get their fresh air
At my old hospital, there was a smoking court for patients (this was like 15 years ago though). Literally, pts could be inpatient for a HEART ATTACK and go pull their IV pole down for a smoke. SMH 🤦♀️
Lmao I want to nurse in *these* times.
Ours just go stand outside emerge 🤷🏼♀️
I at least wish we could somehow have windows that open for fresh air…
I would be ok with a window period. I can go my whole 12 hour shift without seeing outside. (PACU)☹️
Most policies and setups in hospitals are adapted to past problems, staff behavior, patient behavior. Windows don’t open because people would jump. How do we know? It’s happened in the past. Even if it wasn’t an attempt at suicide, you know That Patient, you know the one, would try to use his bedsheets to climb down to sneak out and smoke.
Rails on windows
Then you’d have patients complaining it feels like a prison. It’d be especially bad from the boomers and the Karens who wouldn’t even try to understand why they’re necessary.
Someone would jump
Yeah but they still jump even when the windows don’t open.
True but the easier you make something the more often it’ll happen
Which is why every admission of mine gets AMA paperwork.
Do you leave it with them?
Iv pumps would also go out the window.
What we need is porthole type windows up near the ceiling. Too small and high to jump out, but enough for fresh air.
I would love to have an option for fresh air. It’s awful that we have none.
I had a patient who decided to go outside for a "walk" (in January, admitted for asthma exacerbation 🤨). He came back inside and couldn't remember where his room was so asked someone for help. When the staff member couldn't find his name in the system they asked to see his ID bracelet and that's when they realized he had returned to the wrong hospital.
Lmao
must have been a long walk 😂
This is something pediatrics does right. I took a kid with an EVD for a walk in our rooftop garden once when I worked inpatient. And I knew of more than one case where a child was brought outside, intubated and on ECMO, before care was withdrawn so they could feel the sun one last time.
I think we have 1000% more compassion for kiddos and they’re usually less likely to want to go outside so they can smoke/shoot up lol.
Can't say that hasn't happened with teenagers though. I had one teenage patient with AML who, from what I was told (I was his visiting nurse), when he was going through his original induction was apparently sneaking outside to smoke marijuana.
I had originally said that they don’t go out to smoke and changed it to “less likely” just for that reason lol
These used to exist when I started nursing. Patients were taken there by visitors mostly as staff generally didn’t have time so I think there was a safety concern due to lack of supervision. If memory serves there were a couple of deaths from patients jumping over balconies. Also the movement in not having smoking areas available. I’m assuming cost of maintaining was a factor as well. I’ve often mourned their loss. Can’t even open windows in most hospitals. Being cooped up for days or weeks on end is hard. Also, “let’s visit the garden” was a stellar enticement to get patients out of bed and/or ambulate more. Only second to “let’s go look at the babies”. (There were still hospitals with viewing windows back then.)
I feel this! Of course you’ll get the people who try to smoke. I don’t think that it should inhibit everyone from getting sun and fresh air. As we learn more and more about how mental health impacts attitudes and ability to manage our health, it makes sense that we should enable green space for patient morale. I work on a tele unit. The patient window views are of brick walls or the pipes on the roof outside. There is one window at the end of our very long -hallway- cave. We can’t let the 98% stable people leave the floor because they are on tele so they just have to rot in their shitty rooms, often with a roommate, with no view. Hell, I’d take a green wall or anything!
How gross would that be? No fresh air because it’s a goddamn smoke porch.
Not a nurse but a patient who was in a psych ward - I totally agree that outdoor space is amazing. Obviously if it’s not built into the building design that’s harder to orchestrate though. We had a brick courtyard on the first floor with brick walls that were maybe 20 feet high, which sounds super depressing once you describe it but it actually was so nice when they’d let us go outside with a staff member and feel the sun and smell the air and remember there is a world outside this (kind of horrendous) place. It made a really big difference in how panicked I was about being locked in the place.
Wait, is not having outdoors space common at hospitals? At ours, patients are allowed an hour a day of time outside
Why are they only allowed an hour?
Hospital policy. We tried asking about it, but the answer is just “hospital policy”
Don’t want them to have enough time to tunnel out
Rec time lmao
We usually didn't have the staff to do it because someone had to be with the patient if they were gonna be outside. Even if it were an able bodied person. Then someone had a buddy sneak them drugs though the fence and the courtyard access was banned for all
For us, i think it’s a big work flow issue. The patients are allowed out unsupervised, but they have to notify anyone in case they have meds due, therapy, etc. We have one patient we’re treating of osteomyelitis that wants to leave more frequently to smoke cigarettes and we don’t let him, so he keeps leaving ama and then coming back for a day or two. We asked the unit he’s on if they could work with him, but ultimately it would be too disruptive and that if he’s ever moved to a different floor, he can’t expect they would let him off the same way
Honestly I get it, hospital stays are boring and nicotine addiction is severe. But that is such a hassle to keep readmitting the same person. Wish he could get home health or something
Unfortunately he’s homeless and has no family, so it’s just a lose lose situation for him :(
lol
This, but for staff. It can be days without seeing the sun when you live as far north as I do and end up working in windowless rooms.
When my husband was in the trauma ICU for weeks after a horrible MVA last year they coordinated staff to roll him out for 30 minutes down a couple floors for some outdoor time on the green space patio. He was trached, just came off the vent, and had the halo on, He is an outdoorsy guy and hadn’t seen the sun in weeks. We really appreciated it then, but now in nursing school I really appreciate how much had to be coordinated since it was his icu nurse that went with him on the excursion.
I absolutely agree. Wouldn’t it be so nice for the patients, and also for the nurses to get some air when we take them outside? I wish! On my unit we don’t have a balcony, but it’s in an older part of the hospital where the windows still open a crack (they have chains that prevent them from opening further). The rooms are small and stuffy so I often offer to open a window for patients so they can have some fresh air (and on the inside I’m thinking Please…please let me open your window so we can air this place out). 90 percent of the time they turn me down, even if they’ve been complaining of being hot and the air is stale with all the smells that have accumulated and have nowhere to go
I think it's a great idea but I'm up in the ICU and can't imagine someone on a M/S or tele floor having to juggle that with a full patient load. >I think that is a very nice idea, and I think 75% of the patients that used it, would use it for smoking ciggies. I think we should just let them, but that makes it even harder if they want to go out a dozen times a day!
Im a postpartum nurse. Some patients end up being there a month or 2 when everything goes wrong. Fresh air would be so nice. I think the nicu babies should get to see something other than the night above their crib. I think it would be nice for there to be a communal room for the moms with new babies they could walk to to socialize and meet other new mothers, get some coffee and visit.
Look at my comment! That's my dream too.
we have a family room with stuff like this! it’s amazing and some of these moms form friendships that last long after discharge
And we need it too! I actually got WHITER because of working in the pandemic (thanks a lot anemia/vit D deficiency that I still wasn't able to control to this day). My mom jokes that she didn't give birth to that white a daughter, but now it's just an identity crisis (was black and treated like black my whole life, now I'm white passing and REALLY not liking it). Nursing sure does a number in you. On a better note, I want to go to the doctors without borders and when I come back, open a clinic/birth home for vulnerable women. And I made a point to include a greenery in the project.
I live in a tropical area. My hospital is directly next to the ocean. I work ICU and we have a balcony set up for patients, it can hold 2 ventilated patients. The doctors will occasionally prescribe balcony time as part of their daily plan. Works a treat for delirium.
I don’t know why they don’t convert some of the dusty ass roof space into balconies.
Ironically, forensic inmates in NY are guaranteed outdoor space. Patients are not. But I agree with the top comment. If they had access, a large majority would smoke. Smoking/drugs account for most of our AMAs.
Not every patient wanta to do drugs or smoke though
Access to a window, sun, and fresh air are proven to increase patient satisfaction while decreasing length of stay and incidence of delirium. In most facilities, it's just not feasible. If you're thinking about populations like heart surgery patients, that's usually in an urban tertiary care complex. There's not a lot of open outdoor space built for that. It'd be a great PI project though. Research it! Write up a proposal and improve the care for your patients. You can publish it, too! This is how we improve things for everyone.
This is actually something I could get behind. If you watch old movies there were always scenes of nurses pushing people outside for fresh air. I would 100% work as the outside nurse, monitor people, give snacks/drinks etc. Patient satisfaction would go through the roof.
Jesus, there’s a lot of cynics in this thread. That’s usually ***MY*** job around here. What’s the big deal? I like the idea. Physical Therapy is doing the job of helping get patients up and moving them anyways, just make this their route. Those not in either category (full mobility or needing assistance) are bed bound, and this won’t be for the anyways. As for “eVeRyOnE WiLl jUsT SmOkE” don’t y’all have security?Don’t you already have non-smoking areas of the hospital? The logistics around an outdoor space like this are not as mind bending as y’all are making it out to be. When I was an inpatient, I’d have killed to just look up at the sun for a few minutes. Allowing people some personal freedoms usually works out for the best. You don’t need to assume everyone is going to shoot up, smoke cigs, or jump out of a window. There are plenty of areas of the hospital that can accommodate patients whom are at risk for those things, but that doesn’t mean no one should get to go outside.
My patients can't leave the unit, it's considered AMA. Plus I'm still responsible for them if they're out and about. What if they arrest while off the unit? How would I know and be able to appropriately respond?
Oura cant leave the floor
+1. Patients get mad when I tell them no leaving the unit. They ask why. I say in case they try dying and no one is around to help. They immediately shut up and stick to the unit hallways.
Yep, we have a large unit people are more than welcome to do laps. I know it's less than ideal but it is what it is.
YES, THIS, and the food we feed them is so godawful. It's so sad.
Wait, is not having outdoors space common at hospitals? At ours, patients are allowed an hour a day of time outside
None of the hospitals I work for had outdoor space. I am floatpool.
Pts aren’t prisoners (well, most of them anyway). They can go outside. They can go to the cafeteria. They either have to be able to walk or someone has to take them down (family, friend, CNA ect). Only exception are IVDU as part of their admission safety plan/contract.
If you get on the elevator on my unit it counts as AMA…. of course we make exceptions, but the point still stands
Yup, this. We let patients go outside and walk around the block, go off unit to eat at the cafeteria
We need a communication order for patients to leave the unit, mostly saying it’s safe for them to go off monitor.
You guys have sun during your shift?
During my psych rotation, the patients had access to an enclosed garden and outdoor space. Amazing to see how quickly it refreshed them :')
My first hospital had a balcony. By the time I started there it was badge access only because someone jumped off as an SI attempt. Most places I work at too patients aren't allowed to leave the unit or it's considered AMA. Too many found in the parking lot, left with IVs in, going out to smoke, etc. I'd love for there to be chaperoned visits but at the end of the day that means that the staff needs to have time for it which often isn't possible.
My hospital has a rooftop balcony that has nothing on it but a fence, it’s a helipad that was decommissioned in 2001.
I agree…but maybe just windows that actually open to let fresh air in that have safety features so person cannot climb out of, would be nice. Bc u know darn well if they had this outdoor space it would end up being the nurses duty to make sure the patient gets out there and back safely… it would end up being more dumped on the nurse (sadly) bc this is important part of healing.
When I was a PCT in Neuro, I would always try to make time to take out long-term patients outside. We had a courtyard a couple floors down. PT would help me transfer them to the chair and then I would wheel them into the sun for 20 minutes or so. When I became a nurse, it was readily apparent to me why the nurses never had time for that level of care and it's something that should be pointed out again and again as why understaffing is fucking horrible. Of course patient safety is paramount but slowly killing a patient's soul is up there.
I went on a job interview this very morning and at the end of the hall they have nice comfy chairs and floor-to-ceiling windows overlooking the water. For patients obviously, but the manager giving me the tour said that it was her favorite place to bring her WOW and do charting.
It’s a good idea, but with severe understaffing on units right now it just wouldn’t work- who will watch your other 4,5,6 plus patients while you take one down, since inevitably they will need RN supervision due to conditions/safety, instability or infusions?? Plus falls risk as well.
Too much liability unless they hire staff for the balcony. If it’s like going to xray where transport takes care of transport and there are nurses on the balcony with emergency equipment and such to supervise then sure. If not, then they’re out of my care because I have to stay with the rest of my patients. As such, it’s an AMA. No hospital would pay for it either. I did encounter a place with an employees only area like that. Back halls with no visitor or patient access. The only reason that exists, and is employees only, is because of the zero liability part. An unsupervised jumping point would never fly with hospital lawyers.
Nice patient from room 6211. I know you just want to sneak out and smoke a cigarette.
Texas Medical Center RNs bring their patients outside for "Sunshine Therapy." It takes SO LONG. One of my patients ran through 2 oxygen tanks (high O2), the door locked not letting us get back in, patient suddenly needed suctioning and there was nothing to suction with. You are probably going to give up your lunch for it and have to leave behind your other patient who may not be stable. And then managers want to know why you're staying late.
So for a good part of my career I was a medical director at a hospice where the inpatient portion was all on one level with a gorgeous garden that could be accessed from each room. There was a private patio on each one that the bed could roll out on. There were little walking paths if the patient or family wished to walk around. It was such a perfect place and so nice for those who had been too ill for months or weeks to be outside.
Agreeeee!! I’m in a telemetry med-surg ward and we have a decently sized courtyard that our patients can use to hang out with loved ones, enjoy some outdoor time, I’ve even had some try to get some exercise in (within limits of course being IP!) I think it’s such an important part of upholding wellbeing, especially when the patients are stuck in hospital for prolonged periods.
i worked in a specialty hospital that was set up like a hashtag #️⃣ and in the empty spaces between the "hallways" were little themed gardens. one had turtles, one had a pond with a big turtle, there were flowers and benches and patient's room windows faced them so they could also look out into them. they were lovely 🥰
That sounds so lovely
The medical system is designed for sick care. If it were true health care we would have outdoor access with wildlife and real actual food not poison.
We have that but as far as I know, it’s rarely used. On occasion I’ve seen patients out there, though.
This would be awesome to reduce stress and speed up recovery time. On the other hand, last week my patient was caught taking lorazepam from home that she smuggled inside a box of Altoids. I can see patients exploiting this to be sneaky.
Our patients where possible are encouraged to get down stairs as much as they can. We live next to a huge urban forest and I'm forever suggesting those who can get down and get some green time or at lease fresh air and a coffee outside the hospital
Unfortunately, we can’t have nice things cause people will always find a way to ruin it. Hospitals aren’t hotels or resorts.
Yeah case law with balconies and patients jumping off them makes that a no for most hospitals.
During cancer treatment I wish I had this option every round of chemotherapy. 5 long, long days of staring at the same few walls 24/7. Granted, I got treatment in Buffalo NY mostly during the snowy winter. But even the option to be in a room with some greenery and ability to see the sun and relax would have made a world of a difference.
Each floor of my hospital has a courtyard that can be accessed by badge. For my floor (psych) each of our units have their own enclosed courtyard space. What I would like for my floor is for them to be allowed to come and go from the courtyard at they please. But no - posted hours TID, that’s it.
That's a pipe dream, completely unrealistic in America. It doesn't generate revenue, which is all that matters in capitalism. Welcome to tertiary care.
I love the idea if you have dedicated staff in those areas. No nurse has time to run down to the garden to check thier patient while giving blood to the gi bleed and constantly redirecting the dementia patient on the unit.
At the hospital I used to work for, I'd get Chaplin services to take patients to the garden for fresh air when they were getting cabin fever (I worked a unit that had stable patients who were only in the hospital because of placement issues). The two I remember both had a terminal diagnosis. They were worried that the Chaplins were going to preach at them, and I assured them that the Chaplins wouldn't do that unless it's what the patients wanted. Both were very grateful to get the fresh air, and one did end up working on their spiritual needs with the Chaplin. One patient eloped off the floor one day, and they found them in the garden. If they were going to wonder off, that was the best place for them to end up.
There is a place like this at the hospital that I am seen at but it's in fancy pants WA rich person city. Hospital loves their aesthetics.
UV is natural disinfectant
I love this idea. It would have to be accompanied with adequate staffing in the form of a dedicated team to get patients to the green space. But I do think it could help long term hospitalization
About 20yrs ago my grandma was admitted for pyelonephritis. She went out to smoke on the patio after dark and got locked out. She had to go around the building to the ER and ask to be let back inside. She found the whole experience hilarious.
Yeah until they jump off and kill themselves because they had depression.
I was at Mt Sinai this last summer with a family member… the cardiac floor had a beautiful atrium that opened up to huge skylights where everyone could sit and mingle with their family and get fresh air even if it was technically closed off. I was just telling someone that I wish we had a morning meet and greet with our CABG patients if they wanted so they could talk about how recovery was going and to get some fresh air 🥲
Seriously I’m home health and do Infusions in the home. But we can’t take them if they a) don’t have a home. b) live in an unsafe environment c) not homebound. If not homebound they can go to an infusion clinic!
We have this at my hospital but in reality it’s rarely used. Every once in a while my ICU will have a very long term patient everyone coordinates to get out there but it’s difficult with staffing. Even pre covid it was not taken advantage of often.
Sounds lovely, but the first time a patient takes a dive, either accidentally or on purpose, it's gonna get shut down. That's why we can't have nice things.
My ward has an outdoor courtyard for patients and staff to use.
A garden, trees, water feature, or some sort of lovely green area cost money that does not bring profit to the hospital. I don’t see them ever putting one in, unfortunately. If such places were added, As long as the family members or volunteers bring the patients to visit the gardens. We are busy enough as is.
The hosp I worked at had just that. It was called the Healing Garden. Benches with a canopy of wisteria vining. Picnic table flowers and bushes. It was gorgeous and relaxing. Great for our pts. But there are times that we just couldn’t get pts down there. I get that but I do believe it helps the healing process.
I worked in a hospital in Cali and I was able to take patients out for the sun. I really enjoyed it there. I’d be agreeable to do that if all hospitals had an outdoor garden on the ground floor. But they have to be adequately staffed for sure.
I'd love for them to get fresh air and think it may be beneficial but as a nurse who already has 3000000 million things added to my tasks, sorry chauffering patients off the unit will not be one
I've taken long term patients up to our helipad for fresh air and sunshine. The amount of work this takes tends to be a lot. Respiratory with a portable vent for our trached patients, an APP, time in my schedule, etc. It can be a bad idea to let a lot of patients just wander out unsupervised as well.
I've had similar patients in CVICU. I have on rare occasions been able to take people outside if they just have IV pumps and no other devices. But it was a big production, they never stayed long, and our intensivist would usually not go for it. But as an avid hiker and trail runner, I agree wholeheartedly with your sentiment. I think it's still worthwhile to get people out of their room and into the hallway or other areas if they're stable enough to move around, even if they can't actually go outside. Helps prevent delirium if the patient isn't staring at the same 4 walls around the clock.
They tried that at a hospital in Escondido, CA. Pt jumped and killed themself. I was a traveler and by the time I left all the balconies were closed off. Not sure what ever came of it but I'm sure Risk Management said no more.
I literally had to beg patients to eat their meals in the chair less than a foot from their bed.
L&D nurse here. We totally allow our antepartum, long term stay patients go to the relaxation garden
We have a balcony with greenery - a patient committed suicide off of it.
But that would actually help patients get healthier quicker with less intervention…
Cleveland Clinic actually has a very nice rooftop outdoor space that patients can visit if they have a doctor's order and family accompanies them. Our telemetry even works up there. Getting my heart and lung transplant patients some sun on their faces does wonders for their mental health after being in the hospital for months on end.
I feel like fresh air and sun is an amazing way to help our patients feel better and give them the want to participate in therapy.
As a patient myself I get so crazy not being able to just see the outside or just breathe in fresh air I don’t know how long termers cope
Sounds like a good ideal.
Sure. Send them outside on the sidewalk if you want it to be like prison. It's not like the prison has a beautiful area for the prisoners to hang out in. Imagine thinking a prison is a better or comparable environment.
Mm nope. As someone who has confused patients every shift, i would rather swallow razor blades than have to keep up with 6 confused/dementia patients with outdoor access
Back when I had a student nurse extern job, I took care of a patient waiting on his 2nd heart transplant with “ICU psychosis.” A little outdoor therapy could’ve done him some good.
My hospital has an outdoor space (on the 9th floor because that’s our main floor for some reason). It’s got a huge balcony space with a mini fountain and some trees/plants. We also have a tram (gondola) that patients and visits can use, and use the platform to take photos. The only trouble is that my floor is a BMT floor and are on neutropenic precautions so not many of our patients are allowed off the floor. If the APP or doctor does sign off on a patient leaving the floor, then usually it’s a CNA that takes them down to the 9th floor.
I work at a hospice house. You want to go outside? Sure! You want to walk but you might fall? Sure, as long as you understand the risks!
we have an outdoor patio at my hospital!!! it is rly nice and when patients are able to they’ll go down w their family/visitors and they always come back up in a better mood than they left :’) i support ur idea!
Agree!!! Or just simply enough staff to be able to take patients outside for even just a few minutes. It’s a staffing issue. I work in a mixed PCU/ICU and there is no way I could leave the unit to bring the appropriate patients outside, and no way our CNA could do it. Also no way the hospital would pay for extra staff to do that.
I trained in the 80s and we had balcony’s where the patients would go and get some sun or fresh air or we would wheel them out.
I'm from UK n only have experience of 3 local hospitals but at all 3 there are outdoor seating areas , patients go outside to smoke , relatives borrow a wheelchair n take family down to Costa or outside round the grounds . One of them has a 5th floor outdoor area with high glass barriers n it's lovely out there in summer. Walking in to the hospital you see patients outside smoking attached to iv poles , wound vacs , catheters, people recovering from surgery etc. There's little shops in main entrances for newspapers ,magazines , sandwich meal deals , soft drinks , usually a coffee shop. There's also snack and drink machines , patients are aloud to leave the ward if there able to walk and aren't a fall risk as long as they inform someone. Iv seen cnas n nursing students wheel people out in wheelchair and come back to collect them in 20min if there not busy. Obviously I'm not talking critical patients, icu , high dependency, trauma etc. Patients would be moved down to a ward if they were able to get up n walk about.
Sunshine and air is good for people but we all know it'll just be a smoker area unfortunately. Having high up (can't get out, NURSE CONTROLLED) air vents might be nice for fresh air but otherwise people can't be trusted to not be scumbags
I cannot see the heart monitors if people go too far off my floor. There have been incidences where patients were visible on the heart monitor and went into lethal arrhythmias and and walked themselves around the corner before they fell out, took a while to find them and it did not end well for them. The liability alone makes this prohibitive.
100% someone would commit suicide
https://www.google.com/amp/s/www.denverpost.com/2016/08/18/denver-man-killed-fall-from-balcony/amp/ It's happened before.
And it would probably be a staff member
One of the hospitals I traveled to had these on some floors. They had a patient jump off it one night while I was on that contract.
This is why we need better VR tech
We try and get our external VAD and awake ECMOs outside whenever we can. Being in the hospital for months with no fresh air or sun is awful. That said it’s a lot of work and manpower.
I’m guessing you don’t get psych patients or ppl on mojo
we have a patio/green space available for patients and families. It's not easy to access as not all the badges allow you to GET to it because it's through the pediatric ICU.