Canadian hospitals begin to open up visiting hours

Two years ago, Colin’s first son was born at a hospital in a mid-size city in southern Ontario.

After a long, difficult labour, his wife and baby were moved to a semi-private room at 5:30am. But Colin was not allowed to join them.

“The nurses said I’d have to leave, and come back later in the morning,” he explains. When he protested, Colin was told that even though no one else was in the semi-private room, the hospital visiting hour policy prevented any visitor – even a brand new father – from staying overnight. Colin spent the rest of the night in the hospital lobby, hoping that his wife was coping with the pain and wishing he was able to see his newborn son.

Colin’s experience is far from unique, but may soon be a thing of the past, as many Canadian hospitals are beginning to do away with traditional, restricted visiting hours in favour of more flexible, patient and family-friendly policies.

Eliminating restrictive visiting policies

Kingston General Hospital (KGH) is one of the hospitals that has made the switch. Beginning in 2010, KGH adopted an unrestricted visiting policy, providing families and friends the opportunity to visit 24 hours a day, 7 days a week. “The idea came from the patients and families,” noted Leslee Thompson, the CEO of KGH. “They talked about the importance of people special to the patient in the healing process.”

Given the focus on improving the patient experience within the Canadian health-care system, advocates suggest that unrestricted hospital visiting policies represent a relatively straightforward step towards achieving this goal.

In the United States, the Institute for Patient and Family-Centred Care (IPFCC) has advocated for unrestricted visiting policies for a number of years, with notable success. Although a 2008 survey of 606 American hospitals indicated that more than 75% had restrictive visiting policies, a survey conducted in 2014 by the American Hospital Association found that only 42% had restricted access to patients.

However, these same dramatic shifts have not been reproduced in Canada. A survey of posted visiting hour policies in 128 Ontario hospitals by HealthyDebate revealed that almost 90% maintain restricted visiting hours for patients and families.

In response to the slow uptake in Canadian hospitals, the IPFCC has partnered with the Canadian Foundation for Healthcare Improvement (CFHI) on the “Better Together: Partnering with Families” campaign. This initiative aims to encourage hospitals to eliminate restrictive visiting policies and provides a toolkit on developing the change.

Not just a visitor

More than simply expanding the length of visiting hours, advocates of unrestricted visiting policies note that there is a need to redefine the family’s role during a patient’s stay in hospital.  Specifically, it is important that the families be regarded not as “visitors,” but instead embraced as true partners in the care of the patient.

“One of the most important insights was from the families who said that ‘You talk about us as if we’re visitors, but I’m the husband, I’m the daughter, I’m the wife – I’m not a visitor,’” recalls Thompson.

This was the idea behind the approach taken at South Health Campus (SHC), a hospital in Calgary that was identified by the IPFCC as one of the 12 hospitals in North America with the best practices in patient experience. Under their modified form of unrestricted visiting, patients can identify individuals who they view as “family” or their “primary support.” While there are still visiting hours for others, primary support individuals are encouraged to be involved in all of the patient’s health encounters and are welcome to stay overnight if the patient wishes.

The goal is to “welcome families as partners because they’re the constant in the patient’s life,” notes Joanne Ganton, the manager of patient and family-centered care at SHC.

Benefits for patients, families & health care providers

For many, the benefits of unrestricted visiting policies are evident – patients and their families want to know that when they want to be together, they can be.

Advocates of the change cite a number of studies that suggest unrestricted or flexible visiting has positive impacts on both the patient’s and family’s health. These include decreased anxiety, confusion and agitation for the patient, and increased satisfaction with the care provided. In particular, families were found to feel better informed about the patient’s condition, owing to improved communication with the health care team.

Families can also play a critical role in ensuring patient safety. “There’s a lot of research that shows that patients are safer if their family members are by their side. It’s another set of eyes and ears that can ask questions, spot medication errors, prevent falls and potentially prevent unnecessary tests,” says Ganton. Often this simply comes down to the fact that families will always know more about the patient than the health-care provider can gather in the limited time frame of a hospital stay.

However, the benefits also extend to the health-care providers themselves, in particular the nurses who often must act as the gatekeepers in upholding a hospital’s visiting policy. The reality is that even in hospitals with restricted visiting, many nurses are flexible about the visiting policy when they feel it is justified (for example, when the patient is in a serious condition). However, this comes with its own set of complications, as the variability among nurses can result in tension between families and nurses who are stricter with the visiting hour rules.

As such, Ganton says the unrestricted visiting at SHC can actually facilitate the jobs of nurses as they “don’t feel like the police anymore and get to focus on being nurses.”

Changing the status quo

Given these apparent benefits, what are the challenges that hospitals face in attempting to bring unrestricted visiting policies to their facilities?

The majority of those opposing the switch to unrestricted visiting policies are health professionals who believe that removing the restrictions will create chaos. For example, they worry that the number of people who visit will rise sharply, that units will be too noisy, or that there will be infection control challenges. However, as mentioned, in reality most health professionals do not currently enforce posted visiting hour restrictions anyway.

This has been the case at The Ottawa Hospital (TOH), where there has been much debate about how and when to implement more flexible visiting hours. For the most part, patients’ families, friends, and caregivers already visit when they want and need to, and this will not change with an open visiting policy. What would change is that there would be guidelines about how to handle challenging situations and how to ensure staff and patients have the information and tools they need to communicate with one another.

For patients, the primary concern is that by having visitors come by at any time of the day or night, there is a risk that they may not get enough rest. This is of particular concern in older hospitals with a larger number of ward rooms, accommodating anywhere from two to six patients at a time. In these scenarios, a patient may be prevented from properly resting by another patient’s visitors, who can inadvertently cause a disruption despite their best intentions. However, as Thompson explains, in her experience, patients and families generally respect the environment and for most situations “common sense prevails.”

Finally, one of the most commonly cited concerns about unrestricted visiting is the potential increase in hospital traffic throughout the night. Security is an issue at every hospital. However, depending on the circumstances and location of each facility, different measures to ensure staff safety and protect against theft are required.

This is an important consideration when opening up visiting overnight as monitoring and controlling the environment with minimal staff can be difficult.  Nevertheless at KGH, Thompson noted that the changes in security simply included altering hospital entrance protocols at night and installing additional surveillance cameras, the costs of which were “very minor”.

Future of visiting hours

It remains to be seen if the same dramatic shift that appears to have occurred in the United States will translate north of the border. However Thompson is optimistic. “We absolutely believe that this is something that other [hospitals] can choose to do,” she says.

In the end, while the introduction of unrestricted visiting policies poses novel challenges and requires a degree of culture change among health-care providers, the emphasis on developing a patient and family-centered health care system requires that the issue be explored further. According to Ganton, “how it will look in all hospitals will be somewhat different…it’s just a matter of [taking] the principles and goals of what you’re trying to achieve with the family presence philosophy and [making] it work for each environment.”

The comments section is closed.

  • j johnson says:

    I recently was an inpatient a Toronto hospital. It was pure hell due to family members been allowed to stay overnight.
    There was one family member per shift. They were adult children staying, one female and one male rotating overnight shifts. They found the chairs uncomfortable, and each just hopped into bed with their mother, female daughter, age early forties and son, middle 30’s. The mother(patient) was not in critical condition. The daughter snored loudly, and the son should not have been in his mother’s bed…..sick!!!!! The nursing staff were incompetent just to add to the mix.

  • JB says:

    I think 24/7 visiting hours in hospitals is a recipe for disaster. Especially with antibiotic resistant bacteria prevalent in most medical facilities. Most people in hospital are in semi-private or ward beds. They are there to recover from an illness or surgery. When I had gall bladder surgery I was in a semi-private room and needed to rest. I had 1 friend visit one of the 5 days and my husband several times each day. Even multiple visits a day from my spouse was too much. In addition, my room mate (a man) had his sisters several times each day.
    Another time I had hernia surgery at Shouldice hospital in Toronto. Visiting hours were restricted and I was glad for it.

    In respect to a husband being banned from staying with his wife during and after childbirth – Visiting should be un-restricted. The same goes for someone dying or on life support.
    The number of visitors at one time in a room should be strictly enforced. If the patient has a large family, then only 2 at a time in the room . Consideration for fellow bedmates must be followed. A patient in a private room is a different scenario.
    Unfortunately, nursing staff do not have time or energy to police the visitors; nor should they have to. Hospital administration will not be hiring staff to do it – so instead there will be chaos and germs everywhere.
    I grew up in the 60’s – when hospitals were so sterile you could smell the alcohol upon entering the building. Not so today – now you don’t even know the difference between the Doctors, Nurses and Orderlies – because they all dress the same. I think removing scheduled visiting hours from hospitals is a mistake and I also think putting men and women in shared rooms and wards is disgusting. I am not a prude – but men and women are different and should be accorded the respect of recovering from an illness with their own gender.

  • Linda McKissock says:

    I’m angry!!!

    I think this is so unfair to other patients who may not have family to visit and help
    I recently was in hospital due to post op infection for a month.

    I had family and friends come for short visits. That was enough for me as I was exhausted.
    But meanwhile, I had to put up with the three other patients in our room and all their visitors!!

    Apparently there is NO LIMIT on how many 24/7 visitors are allowed in.
    During one crazy weekend, one night around midnight when I was in horrific pain and wanted some privacy and quiet, not including the 4 patients, there were 21 visitors in our room!
    And at one bed there were 14 visitors and they were having a party, with gettoho blaster and singing etc..
    Where in God’s name is this good for the patient!

    As for making it safer and easier on the nurses, forget that, these visitors be one or 20 are constantly bugging the nurses for more info or more meds etc and I found that because I didn’t have someone there almost constantly to watch over me, the nurses ignored my pleas for help.
    I fell twice during my recent stay because one time no nurse came when I called for help to go to the washroom (I was non weight bearing and needed special equipment to get me on to a chair) and second time, the nurse came but was called over by other patient family members just to chat that after nearly 20 minutes and in desperate need, I tried to grab a wheelchair out of reach but fell on the floor.

    And safety with meds, no way, again, visitors can be so distracting and demanding on already busy nurses, they stress out.

    One patient in our room was given another patients meds! Safety not!

    I agree having family members or close friends with the patient can be be very rewarding for all sides, but there needs to be guidelines put in place.
    IE… limit how many visitors per patient…ideally as a patient, I think 2-3 people at a time.
    Also hospital staff must keep these people in check. You and 2 other visitors want to visit a patient?
    No problem, but remember there are other people in the same room and all are recovering at a different rate so be thoughtful and considerate, so have some manners and don’t be loud, don’t bother other patients, don’t use the bathroom designated for patients, don’t keep accidentally moving their curtains and then not returning them to privacy mode, don’t pile in 8 chairs and block the way for patients to leave or come into the room.

    Hospital staff, don’t let this visitor thing get out of hand and shrug your shoulders and say hospital policy says it’s ok.
    It’s not ok, not for everyone.
    There must be a balance and I have yet to see it.

    LIMIT # visitors at a time. If patient already has 3 maximum, it doesn’t mean that 3 more will be ok
    Set a visitor policy to be considerate and civil etc
    Staff need the authority to step in when any of these policies go over board.
    No exceptions.

    I have to go back in for another month of surgeries next week…so help me, if I have to be put in a position to be overtaken by others visitors, and my healing is jeopardized by lack of control by patient’s family and friends or lack of concern by staff, someone will be hearing about it!

  • Angry and upset says:

    I was at Credit Valley Hospital in Mississauga a few days ago for a family emergency. The nurse initially there said that I could stay as long as I wanted but another nurse attempted to kick me out but allowed the lady in the room beside us to stay. This was at 4:30am in the middle of a snowstorm. I was already exhausted from the days events and she kept threatening my fiance and I. I wrote them a big and nasty set of emails. This article proves her completely wrong, as she kept insisting that he would not get better if I did not leave. Her words ended up stopping us both from sleeping for fear of my eviction, which affected my fiance. People need to fight for what they believe in. I work in the medical field. Her actions were uncalled for an extremely inappropriate. I could not leave my groom to be to even go to the washroom without him going into panic. I have not slept without him in years. I was not going to leave for any reason until he was by my side. I have a lot more details but that is the jist of it.

  • Anonymous says:

    Many have described why it does not work in reality. Another thing I’d like to point out is that families and friends can do 24 hour care once their loved ones are discharged. Many patients need ongoing care after being discharged from hospital. Families and friends can help them out once there is a greater need for them to be present after discharge.

  • Jennifer says:

    I hospitals will soon be doing this. My daughter was born 37 days ago and we are still in the hospital with her. Until last week we both stayed(boyfriend/babies father and myself) and had no issues. Now one of us must leave because head nurse claims it is a rule for all families. We are the only famihere affected by this “rule enforcement”. We w. ill be going home as a family, and should be able to get through tjis hard time together as a family. We both want to stay and support each other as we do all we can to keep our daughter comfortable, and it saddens me thatthis is being stopped from happening. We live half an hour from hospital and parkong and gas also get costly. When we told them that we are both tired at night tjey said that security would come remove one of us from the premises if one didntbleave by 11 pm. This has left one of us sleeping in our vehicle many nights as we need to switch off if one of us gets tir. Before this rule was enforced we spent almost a month supporting eachother through this around the clock and our baby did much better overall. Even our doctor noticed the improvement but the manager of the maternity ward did not budge.
    Sadly, these ppl are all about the business, i am all about my daughter and getting her stable so we can go home!
    -too tired to drive but told to leave anyway.
    New first time mother

  • BL Hoff says:

    It’s good “IF” it works. I work in a hospital with unrestricted visiting hours and it’s a nightmare! People wondering through the hospital at night drunk or high and going into patient rooms or staff rooms and stealing. People going into the visitor kitchen and stealing food. Family members having exotic encounters with their spouse and a patient in the next bed or family sleeping in bed all night with their spouse and a patient in the next bed. Family dictating what their family (patient) needs when the patient doesn’t even want it. Homeless people sleeping in the sunroom at night in the winter.

    Families of the severely sick should be allowed to stay as well as a parent of a newborn or sick child! Otherwise it’s not safe for staff or patients at night!!!

  • Karen Wolfe, RN says:

    I believe that family is important in the healing process of a family member who is ill in hospital. There are times however when too many family members are at the bedside which impedes the healthcare teams ability to do their job. The increased noise level makes it difficult for a nurse or physician to concentrate on the tasks they must do to treat the patient. This is particularly true in Critical care. The open door policy on visiting leads family to believe they will be judged as bad if they are not present 24 hours a day and in some cases has promoted a sense of mistrust in families toward the healthcare team.

    I have personally experienced abuse by family members when they are asked to step out of the room when I have had to perform a task such as a sterile dressing. I do not appreciate being called 4 letter words that begin with the letter “F” as an adjective. I do not feel that KGH supports their nursing staff when it comes to verbal abuse by family as they are more concerned about good public relations. I have been an RN for 26 years and am sad to say that there has been a huge decline in respect towards healthcare professionals which despite the signage posted in the hospital saying this will not be tolerated.

    There have also been times when a family decides to visit at midnight when patients are sleeping and insists on waking the patient up. I cannot understand how a hospital could support such a practice. Whatever happened to the notion that a patient needs rest.

  • Mark McCormick says:

    As a hospital Security Manager, I deal with the after hours visitor situation and see both the positives and negatives. Our facility would be classified as flexible. We have posted visiting hours and make an announcement at 20:00 hours that visitors should leave. However we allow a primary support person or partner to stay overnight with new moms and babies (the benefits of which are blatantly obvious), we allow a limited number of family members and visitors to come in after hours to visit critically ill and dying patients (again the benefits to the patient in their final hours and to the families going through the grieving process are incalculable) and we will alow other visitors, IF IT IS APPROPRIATE. If it’s 2 am and the patient and their room mates are sleeping, we won’t allow 10 cousins to come in to visit after they get out of a bar. A common sense approach is necessary in all cases. While the families and support are necesary to the healing process, so is a good nights sleep.

  • Wilmer Matthews says:

    Absolutely in the right direction! If our healthcare system is truly moving towards being patient & family centred, then flexible visiting hours should be the norm in Hosps.

  • Annette McKinnon says:

    As the major stakeholder in healthcare the patient ought to have more rights and more involvement in decision making processes across the system. The ability to be with your new son, or a dying loved one ought not to be restricted.
    I also hear that visitors are very helpful with the small things that equate to care in the minds of the patients, yet which the nurses have few opportunities to deal with, which is just the point you made more broadly when you talked about safety.


Ryan O’Reilly


Debra Bournes


Dr. Debra Bournes is the Chief Nursing Executive and Vice-President of Clinical Programs at The Ottawa Hospital.

Jeremy Petch


Jeremy is an Assistant Professor at the University of Toronto’s Institute of Health Policy, Management and Evaluation, and has a PhD in Philosophy (Health Policy Ethics) from York University. He is the former managing editor of Healthy Debate and co-founded Faces of Healthcare

Michelle Stasiuk


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