Policies or People? How Hospital Rules and Procedures Create Trauma in Care

“When policy replaces people, care becomes control.” - Mary Coughlin

Healthcare policies are often framed as necessary for safety, efficiency, or "the greater good." But what happens when those policies create isolation, separation, and trauma? This post shines a light on how hospital policies — particularly during the COVID-19 era — impacted families, patients, and clinicians. When rules take precedence over relationships, care is compromised.

Hospital policies have the power to protect, but they also have the power to harm. When COVID-19 visitation bans went into effect, parents were separated from their NICU babies, loved ones were excluded from birth and death experiences, and clinicians were tasked with enforcing these rules — even when their hearts were breaking.

This post explores how policies wield power in healthcare, how they impact human connection, and how we can build more compassionate, relational policies in the future.

The Story of a Mother Denied Access to Her Baby

When Sarah gave birth at 32 weeks, she knew her baby would need time in the NICU. But what she didn’t expect was this: “You can’t see your baby today.”

It wasn’t because her baby was unstable. It wasn’t because there was an emergency. It was because of policy.

Due to COVID-19 visitation restrictions, Sarah was told she couldn’t enter the NICU. “We’re limiting exposure to protect the babies,” they said. But Sarah knew that her presence wasn’t a “risk” — it was a lifeline.

For days, she called in every morning and every night for “updates” on her own baby. She pumped breast milk alone in her room. She stared at photos of her baby that the nurse had sent her. And she waited. The days stretched on like weeks.

The trauma of separation doesn’t end when the policy changes. It lives in the hearts and minds of parents long after the rules are lifted.

Sarah’s story is not unique. Thousands of parents experienced this. And the harm wasn’t just felt by parents — nurses, doctors, and clinicians were also deeply affected.

When Policy Becomes Power

Healthcare policies are created to keep people safe, maintain order, and reduce liability. But when “safety” becomes control, policies turn into tools of power.

What is Policy Power?

Policy power is when decision-making shifts from human connection to institutional control. It happens when clinicians are told, “It’s out of my hands, it’s just policy.” It happens when parents are told, “Sorry, it’s just the rule.” It happens when nurses are forced to enforce rules they don’t agree with.

Examples of Policy Power:

• COVID-19 Visitation Bans: Parents were kept out of NICUs, unable to see or hold their own babies. Many were allowed only “one parent” at a time, forcing mothers and fathers to navigate shifts in who could be present.

• Visitation Limits at End-of-Life: Dying patients were kept from their loved ones due to visitor bans. Families had to say goodbye to loved ones over video calls.

• Discharge Timelines and Deadlines: Insurance-driven discharge policies forced families to leave the hospital before they were ready — sometimes before the parent felt confident enough to care for their baby at home.

• "One-Parent-Only" NICU Policies: Policies that allowed only one parent to be present in the NICU at a time, forcing mothers and fathers to "trade shifts" to see their own child.

Impact of Policy Power:

• Parental Separation Trauma: Parents who were told they could not see their NICU baby report experiencing symptoms of trauma long after their discharge. Separation at critical bonding moments can impact parental mental health and attachment.

• Emotional Injury for Clinicians: Nurses, doctors, and social workers were forced to enforce visitation bans that they didn’t agree with. Moral injury occurs when clinicians are asked to enforce rules that violate their own ethical beliefs about care and compassion.

• Loss of Trust in Healthcare: Parents who felt abandoned, isolated, or excluded during care are less likely to trust the healthcare system in the future.

Stories of Impact

Let’s make this real. Imagine this:

A Father Outside the NICU

• A father stands outside a NICU window, pressing his hand to the glass. Inside, his newborn baby is in an incubator. His partner is the “one parent” allowed inside that day. The father watches, knowing he won’t be able to touch or hold his baby today — or tomorrow.

A Family Saying Goodbye on FaceTime

• A grandmother is dying of COVID-19. Her family, gathered outside, waits for a chance to say goodbye. But visitation rules prevent them from entering. They’re given one option: a video call on a nurse’s phone. Her final moments are viewed through a 5-inch screen, and when she takes her last breath, her family isn’t there. They feel it for years to come.

A Nurse Forced to Enforce Policy

• A nurse is told to enforce the one-parent rule in the NICU. She has to tell a father, “I’m sorry, but you can’t come in today.” She sees his face fall, his eyes fill with tears. Every part of her training, her humanity, and her sense of compassion tells her this is wrong. But she has no choice. The policy is clear. This is moral injury.

How Trauma-Informed Developmental Care (TIDC) Disrupts Policy Power

Healthcare doesn’t have to operate this way. TIDC disrupts policy power by centering relationships over rules. It emphasizes the voices of parents, families, and frontline clinicians. Policies should serve human connection, not disrupt it.

How does it work?

• “Parents as Partners” Model: NICUs that operate with a "parent as partner" framework create policies that ensure parents have uninterrupted access to their babies.

• Compassionate Discharge Plans: Instead of fixed timelines, compassionate discharge plans create flexibility for parents who feel unprepared to leave.

• Collaborative Policy Creation: Policies that are co-created with parents, nurses, and clinicians result in procedures that prioritize connection, not control.

Public Health Implications

When policies are misused, they create harm. When policies are centered on connection, they create healing environments.

Questions to consider:

• How many parents missed critical bonding moments because of a “one-parent policy”?

• How many clinicians were harmed by moral injury when they had to enforce policies they didn’t believe in?

• How can we create policies that protect safety AND promote connection?

Call to Action (CTA)

What policy have you seen in healthcare that caused unnecessary suffering or separation? How did it affect the people involved? Drop your reflections in the comments. Your story matters.

In the next post, we’ll explore how clinicians experience moral injury when asked to act against their values. They aren’t just healers — they’re human, too. Stay tuned for Part 5.

Reflection Prompt

Have you ever been impacted by a healthcare policy that caused separation, delay, or suffering? What did it feel like? Drop your reflections below — your voice matters.

Take care and care well,

Mary