Are 24-Hour Open Visitation Policies a Bad Idea? (Yes)

Numerous hospitals across the US are eliminating visiting hours altogether, and instead, choosing to implement 24-hour open visitation policies. Nowhere in most healthcare settings has this trend been more acutely felt than the intensive care unit (ICU). Are 24-hour open visitation policies a bad idea? I think so. Nurses Announcements Archive Article

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Are 24-Hour Open Visitation Policies a Bad Idea? (Yes)

Many acute care hospitals across the United States are following a trend of eliminating visiting hours altogether, and instead opting for 24-hour open visitation policies. Nowhere in most hospitals has this trend been experienced more profoundly than within the walls of the intensive care unit (ICU). Are 24-hour open visitation policies a bad idea? I think so. Although open visitation has its benefits, I believe the drawbacks certainly outnumber the good aspects.

What is the case for open visitation?

First of all, a multitude of hospital administrators, nurse managers, and some critical care nurses feel that 24-hour visitation promotes a less restrictive, more welcoming environment for stressed family members. Secondly, since many ICU patients are sedated, intubated or otherwise cannot communicate effectively, family members who continually remain at the bedside might be able to answer important questions and fill crucial holes in a medical history that may very well be nebulous. Third, some would say that open visitation policies facilitate transparent communication between families and the healthcare team. Finally, open visitation allows family members to see for themselves that everything humanly possible is being done to care for the acutely ill patient.

What is the case against open visitation?

The ICU is supposed to provide a particular milieu that certain families often disrupt. For instance, the patient afflicted with a fresh brain injury on a vent needs plenty of peace and quiet to promote recovery, yet due to open visitation policies, his family members are allowed to constantly irritate him at 2 o'clock in the morning. And since there are no longer any limits on the number of visitors who can remain in the room at one time, multiple family members are camped out in the room, including several small children. Since the family is over-stimulating this critically ill patient, his blood pressure is spiking, so now the nurse must administer an antihypertensive drip. They continue to make noise and irritate the patient, and now he is having a seizure. And by the way, the family is disobeying the nurse's directives to avoid touching the patient or speaking too loudly while the patient is seizing.

Open visitation frequently leads to nightmarish scenarios such as large families who camp out at odd hours without leaving. The critical care nursing staff must now expend valuable time and effort tending to dysfunctional families, dealing with truly bizarre family dynamics, and fetching chairs, blankets and sodas. To be frank, normal families do not invite 15 extended relatives, including infants and small children, to visit a sick patient at 2 o'clock in the morning. These visits are now routine occurrences on many critical care units. Did I mention that some of these visitors are obscene? They disrespect nursing staff and sometimes make blatant threats that keep hospital security busy. I know the family is in crisis, but the line must be drawn.

For the best interest of patients and the safety of nursing staff, it is beneficial to keep visiting hours in place and allow the unit nurses to have the final say on this matter.

2 Votes
TheCommuter

About TheCommuter, BSN, RN

TheCommuter, BSN, RN, CRRN is a longtime physical rehabilitation nurse who has varied experiences upon which to draw for her articles. She was an LPN/LVN for more than four years prior to becoming a Registered Nurse.

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Specializes in Clinical Research, Outpt Women's Health.

In those situations I agree.

A normal loved one though that behaves rationally should be allowed to stay if they desire.

Definitely the old "2 visitors at a time" adage should stand also and anyone who is at all disruptive should be tossed out on their butts. No excuses. The other patients and families and the nurses trying to give good care should not have to deal with disruption.

1 Votes
CrunchRN said:
In those situations I agree.

Absolutely. However, it should be noted that both situations described above are just as likely to occur in a unit with restricted visiting hours as they are in a unit with open visitation.

The secret to success in implementing and maintaining open visitation is explaining the process to the family and visitors on admission, and then enforcing them throughout the patient's hospital stay.

1 Votes
Specializes in NICU, ICU, PICU, Academia.

It has been my experience, in three decades of nursing, that we've gotten to the point where we're no longer allowed to say 'no'. 'No', you cannot have sixteen people having a family reunion in the ICU patient's room while he/ she is trying to get some desperately needed sleep. 'No', I, as your loved one's nurse, do not have time to take drink orders for the assembled masses. 'No', it's a TERRIBLE idea to bring a newborn to Grandma's room for a visit when Grandma is in isolation.

Somehow, hospital administrators and regulators alike have decided that 'no' is somehow rude and offensive.

1 Votes

The floors have dealt with it for ages. When we complain, we get told to use our therapeutic communication skills. I think ICU nurses should be able to do that too.

1 Votes
Specializes in Critical Care, Capacity/Bed Management.

Open visitation is a great concept, on paper.

The actual implementation of open visitation relies heavily on consistency which often is not the case especially when one nurse is pinned against another. Family members will be quick to say but Sandy RN said that I could stay as long as I want, which makes a huge issue.

I remember a few months ago a critically ill patient coded in the ICU and the night nurses had continually asked the wife to step out of the room as they tried to prevent the patient from arresting and while the code was in progress the wife was in the back of the room washing her underwear and asking the physicians to quiet down.

1 Votes

I agree with the article. I think it's ridiculous for nurses to have to crawl over visitors to get to the patient, especially in an emergency situation. Also, what is everyone's unit policy on eating/drinking in rooms? I think it's disgusting and thought it was a JCAHO thing to not have food/drinks in the work area, or is that only for staff? I recently had a family member sneak an entire bag of McDonald's into a room when I wasn't looking. Not only is that gross, I thought it was very rude to be enjoying the food in front of the NPO patient.

2 Votes
Okami said:

I remember a few months ago a critically ill patient coded in the ICU and the night nurses had continually asked the wife to step out of the room as they tried to prevent the patient from arresting and while the code was in progress the wife was in the back of the room washing her underwear and asking the physicians to quiet down.

Good lord.

1 Votes

Everyone that wants to close visitation, will YOU leave your family member alone in the hospital?

The answer isn't blanket rules forbidding visitation during whatever hours. It's allowing staff to kick out disruptive visitors. And management standing behind them when they do.

1 Votes
Specializes in Psych ICU, addictions.

I don't work ICU--well, not medical ICU, anyway--so keep that in mind when you consider my two cents.

I understand and support 24-hour visitation in the ICU, especially given that there's a good chance that the patient may not survive until the next designated visiting hour period. So family should be allowed to be there at any time. However, I do feel that the 24-hour visiting should be limited to immediate family only: parents, children, spouse/SO. There is no call for the extended family reunion complete with third cousins once-removed to take place at the bedside. There can be a designated visiting hour every evening for others to be able to visit.

There should also be restrictions in place that accommodate both the providers' needs and a therapeutic environment for patient care, and staff should be able to enforce them as needed. Such as limiting the number of visitors, limiting the visit length, limiting or prohibiting children, having certain times that are no-visitor so providers can do what they need to without visitor interruption/interference, and giving staff the ability to remove and restrict visitors that are unruly/uncooperative/refuse to follow the rules.

But alas, I agree with the others who say that we've become too customer-service oriented and spend too much time and effort jumping through hoops getting good Press-Gainey scores when we should be spending that focused on providing quality patient care.

2 Votes
Meriwhen said:
However, I do feel that the 24-hour visiting should be limited to immediate family only: parents, children, spouse/SO. There is no call for the extended family reunion complete with third cousins once-removed to take place at the bedside.

Meh, I think a number limit works better. Policies like that end up with scenarios where significant other that patient would rather have at bedside can't come in but estranged father can. Two at a time limits the family reunion at bedside (takes it to the visitors lounge where it belongs!haha!) and allows the patient to decide who is "special enough" for that privilege.

1 Votes
Specializes in M/S, LTC, Corrections, PDN & drug rehab.

I think either way the hospital needs to back its nurses & not worry about the satisfaction scores. That way the nurses can do their job, tell the family to leave/be quiet/etc without worrying about repercussions.

1 Votes