Shift change and visitation in ICU/stepdown - page 3

by opossum 6,319 Views | 31 Comments

Hi everyone, I'm currently looking at various policies re: visitation in the ICU and it got me thinking about issues with shift change. At our 10-bed ICU/stepdown, we restrict visitors from 0700-0730 and 1900-1930; my... Read More


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    I work CVICU and our visiting hours were actually implemented by our CT surgeons. They are 9-11AM, 2-6 PM, and then 8-10 PM. Doors are locked otherwise. Nurses do have some discretion and we always let family members back for a few minutes whenever patients return from surgery. Honestly, I appreciate the restrictions. If I had a hemodynamically unstable patient, I would find it very difficult to concentrate with family members in and out of the room all of the time. For the most part, our family members are actually pretty cooperative. I think the primary reason is that the cardiac step-down the patients move to is 24/7 open access.
    hikernurse and Sugarcoma like this.
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    We used to restrict visitation from 6:30 to 8:30. Both shifts. This gave ample time for report and initial assessments, etc.
    We are now Open. All visitors all the time. Family centered, supposedly only one significant other is allowed during shift change/report. However, everyone and their brother too (literally) come in and out at will. Of course administration implemented this new rule, NOT the actual bedside caregivers. Not a single one of us RN's like this situation. We need some time to, pardon me but, get our **** together. When visitation was restricted, it gave me time to thoroughly read charts/orders and truly assess my patient and plan my shift. Also, I was more able to answer families questions. Now, I get bombarded with questions when I literally haven't even spoken to or touched my patient. I feel like I can't/don't do as accurate of an assessment when someone is staring at me, watching every move, and asking questions the whole time.
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    Well, it looks like we've revised the policy to basically reflect what the AACN recommends: http://www.aacn.org/WD/practice/docs/practicealerts/family-visitation-adult-icu-practicealert.pdf

    We agreed that it should be flexible enough to allow nurses who want to keep the doors locked to be able to do so, but I'm worried about the inconsistency. I don't know...we'll see how this works!

    Thanks again for all your input!
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    Lucky you. We have open visitation, including during shift change. It can get very frustrating and chaotic trying to be mindful of pt privacy but being thorough.
    hikernurse and opossum like this.
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    Quote from mb55
    We used to restrict visitation from 6:30 to 8:30. Both shifts. This gave ample time for report and initial assessments, etc.
    We are now Open. All visitors all the time. Family centered, supposedly only one significant other is allowed during shift change/report. However, everyone and their brother too (literally) come in and out at will. Of course administration implemented this new rule, NOT the actual bedside caregivers. Not a single one of us RN's like this situation. We need some time to, pardon me but, get our **** together. When visitation was restricted, it gave me time to thoroughly read charts/orders and truly assess my patient and plan my shift. Also, I was more able to answer families questions. Now, I get bombarded with questions when I literally haven't even spoken to or touched my patient. I feel like I can't/don't do as accurate of an assessment when someone is staring at me, watching every move, and asking questions the whole time.
    Interesting. Must be different in the adult world. I work peds and we have 24/7 visitation for the parents (anyone else from 10-8 and two people at the bedside only and that includes parents). I still manage to have time to check drips with the off going nurse, check my chart, orders, meds, organize my day and get my assessment done. Yes the parents sometimes hover while doing the assessment, but hey it's their newborn/toddler/child and they have that right. Visitors don't typically interfere with the rest of my day though. Yes there is always that one​ family that sucks the life out of you but there always will be.
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    in my pcu our patients are allowed to have visitors 24/7. i politely instruct them to leave when it comes to changing/cleaning the pt's bottoms, etc.

    in icu, at 0600-0800 and 1800-2000 there are no visitors, no exceptions. they make a loudspeaker announcement at 0545 and 1845 that all visitors must leave for change of shift and that security will "assist them", if need be. they say the icu waiting room is open and that the cafeteria is open if they'd like.

    they also do not allow visitors to stay the night, however i am not sure when visiting hours are, exactly.

    if the family member has been in the icu a few days or more, the family usually knows and starts heading out the door around 1740. it is also in the ICU "welcome pamphlet" that says this is so our RNs and RTs can more safely and effectively ready patients for the end of shift, clean them, prepare orders, give report and the oncoming nurse can familiarize herself, something like that.

    the nurses seem to really appreciate it.
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    Our unit is also locked. We are the only ICU in the hospital that has 22 hour visiting. I do believe in family centered care, but we have had many issues with our visiting policy. As we do bedside report, it sometimes becomes an issue that the visitors in the room are not immediate family members and we ask people to leave (politely) as many things said during report are sensitive/private.
    One of the biggest problems we have is people who refuse to leave during this report hour. Our unit is very large and by the time security assists the visitors out, it will be like 730. Our 'no visiting' time is 7-8 am and pm. In these cases, the visitors finally leave but are then chomping at the bit to be let back in at exactly 8pm, while the oncoming rn is trying to rush in and do their assessment! I don't mind this except when report is delayed by the visitors overstaying their welcome.
    The response we get from a lot of people when asked to leave is 'we can't stay for this hour? That's so stupid' yep. Gotta love it.
    hikernurse and opossum like this.
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    When my kid was in the NICU, they gave us the boot 3x/day.

    Several years later, I did my preceptorship in that same NICU and they no longer required families to leave.

    While I understand that it makes life a little harder for the nurses (believe me, I'd love to give some ED families the boot at times), I think the benefit for the family outweighs the issues for the staff.
    umcRN likes this.
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    We have started doing bedside shift change report in a 16 bed MICU. People have done it for a while prior to it getting implemented and required, others have the "old habits die hard" feeling, etc. MedScape just put out an article from research saying it has improved patient/staff relations, and also allowed for more thorough report from staff members because you may see something you forget if you were away from the room. It's difficult because many of our patients are usually intubated/sedated; and family not always present. But yet when they are present and can contribute to the report or understand things a bit better, it does seem to create a better whole picture amongst all individuals.
    opossum likes this.
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    Quote from umcRN
    Interesting. Yes the parents sometimes hover while doing the assessment, but hey it's their newborn/toddler/child and they have that right. Visitors don't typically interfere with the rest of my day though. Yes there is always that one​ family that sucks the life out of you but there always will be.
    That's true, there always will be "those" families that impede your workflow. Then again, I really would expect parents to hover around their children...it's the adult ICU patient's sister's boyfriend's cousin's dog's brother-in-law bombarding me with questions that really irks me and sets a bad tone for the shift.

    I guess I just need to get out of this negative mindset I have about visitors in general.

    And, of course, giving a thorough bedside report without violating HIPAA, etc.
    BrandonB779 likes this.


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