Visitors' Policy/Visiting Hours
0Oct 7, '00 by Zee_RNOur 18-bed medical/surgical ICU unit is having difficulty with our visitors following policy. We are trying revamp our system to best suit the needs of patients, staff and visitors. I'd like input from other units regarding their policies.
- Do you have set visiting hours? Are they enforced by staff?
- Are visitors required to call into the unit before entering?
- Are visitors able to freely enter and exit the unit at will (i.e., do they have to be "buzzed" in; are your doors locked)?
- Do you have a waiting room staffed with a volunteer or staff member to answer questions or direct visitors?
- Are there any specials amenities in the waiting room that make it more pleasant for visitors?
Our visitors tend to stream in and out of our unit (which has 2 unlocked entrances) and have walked into sterile procedures, codes and hygiene-times without notice. Staff have practically given up trying to enforce (encourage?) visitors to adhere to policy (4 visiting times per day, 1/2 hour each; 2 people per room; call before entering; no children under 14). There are always special circumstances, of course, where we encourage family members to be at the bedside, such as when we are terminally weaning a patient. Your input is greatly appreciated!
0Oct 7, '00 by JoankimOur 26 bed ICU has open visiting, which I do not agree with, but it is our managers choice. The last night I worked, spent more time trying to track down pillows and blankets for visitors, finding visitors in our clean utility room helping themselves to staff coffee and soda, answering a call light that a visitor had put on by mistake while she lounged in the recliner in the room waiting for the pt to return from OR, answering 5 phone calls after 11:00 at night to find visitors who were camped out in the waiting room, directing visitors to the staff washroom because they did not want to wake up the 15 plus people sleeping in the waiting room, trying to protect my pt who did not have visitors from the family of my pt who did. The would just stick their head around the curtain into the pts room, to "just ask a question".I could go on and on!!We had 4 various families staying overnight. And none of these pts was unstable. Yes they were in the ICU, but no one was on drips, ventilated, etc.
I agree that the one ICU I previously worked in was too strict, 3 visiting periods per day for 10 minutes each, but this open visitation is too much. We have 5-6 people in the rooms at one time, including children. They leave their food in the rooms and get angry when I throw it out, they get angry when asked to leave the room so we can assess the pt, stating they are family and it is oK to stay... totally out if hand!! Plus they do not talk to each other, I find myself having to explain the same things over and over, or else the families are just questioning our competance. At any rate, in this day and age, we are short staffed anough, and I resent having to spend so much time catering to these families instead of trying to give care to the patients.Our doors are not locked, we have a waiting room with a phone and TV, plus a quiet room for families with pts who are more seriously ill.
0Nov 29, '00 by dkahi I just had ameeting with my staff about visiting hours. They want it to be q2 hours for 1/2 hour 2 at a time. I had signs made in chinese spanish english placed heavy 4 foot sign holders in front of the doors handed out visiting hour memo to every pt. and family . Did it work no sorry. The nurses dont enforce the dr dont enforce I just let it be we tried open visiting is better (depending on what is going on in the unit)
0Feb 1, '01 by Fox2001Down with the idea that "Open Visitation" is good for the patient. How in God's name do the idiots in Adminstration think the patient is going to get optimum care from nurses who are taking care of family members, friends, etc., becoming secretaries by taking message after message for family, friends, etc. ALL of these activities take us away from the bedside - afterall, the patient is in ICU NOT MED-SURG. If the patient is able to have THAT much acitivty, maybe they don't belong in the ICU anymore. Otherwise, the facility MUST come up with a plan and STAND BEHIND IT. I work in an Open Heart ICU with tremendous cultural influences that include arbitrary religious issues. Regardless, most of our staff only allow visitors in when appropriate. We have tried the open thing and had disaterous outcomes, where families were too involved and were not trained to interpret medical conditions. What I continue to seek answers to is why do phyicians and administrators NOT see that nurses in ICU control individuals and families in crisis EVERYDAY. Who better else to know when we are being manipulated. Why do they NOT listen.
0Feb 1, '01 by timonrnI agree with both sides--there probably will never be a solution that everyone agrees with. When I was just beginning my nursing student "career" in 1990 my husb. was involved in a car crash that left him in the ICU for 36hrs, of which I was allowed to visit two times at ten minutes each. The first time, after all night in the ER and one hour of sleep at home, I came back with books in tow, not knowing the policies. His nurse promptly and tearsly asked my mother and I to leave as "his wife and mother" had been there already this hour. I stated that I was his wife and the other person had misrepresented herself as me. Didn't matter to this young nurse--in her mind the pt. had already had his visitor for that hour, and she kicked me out!! Needless to say, I stayed out of the ICU for the next three hours, crying, and I asked my sister, who is an NICU nurse and knew the ICU lingo to come with me the next time when I got the guts to re-visit--and, boy was that nurse appologetic!! I guess the moral to my story is we need to assess everyone's need to be there and the pts need for that person to be there case by case. I aggree that too many visitors is too many, tho, and all staff needs to reinforce the same rule as the primary nurse started. PS--this is also a never ending nightmare on OB units!!
0Feb 4, '01 by Jenny PI work in CVICU and we don't call it open visiting; we make it very clear that the nurse at the bedside is the one who sets the visiting rules for each shift. Visitors must check with the secretaries or whomever is at the main desk on entering the unit; if no one is at the desk, families may go back to the rooms but must check with the nurse before going to the bedside. If the bedside curtains are pulled shut, visitors are usually not allowed to enter and are told that the nurse will let them know when they can come back to the bedside. We make it clear to family members that we are there for the patients' care and benefit; we don't have time for waiting on families; and that families need to take care of themselves (go home and sleep) because their loved one will be home very soon and we won't be there to give them a break when they get tired then. We have been doing this for probably 10-15 years and have had very few problems with this system. When we do have families that do abuse the system, the nurse at the bedside does tighten the restrictions and reminds the family that we are concerned for the health of the patient. Once the family realizes that, using an assertive manner usually works for us.
0Feb 15, '01 by Zee_RNI agree that at times individual choices must be made for visiting hours...there are situations where the rules must be broken.
We have finally finalized our visiting hours policy and we are supposed to adhere to our 1/2-hr each, 4 times/day schedule. Most nurses are happy and willing to do so.
While I agree that the bedside nurse has the opportunity to decide when and if the rules should be broken, it has been my unfortunate experience that frequently the nurse who decides "Oh, just let them in" is the one who then disappears and the family is coming out to all of the rest of us asking this, that and the other thing and oh, by the way, mother needs the bed pan and is the doctor here....and so on. So consistency is required because it does affect the unit as a whole.
I had to chase my patient's family out all day yesterday---not because they were being obnoxious but because he was such a heavy duty patient....BUN 225! Creatinine 9.3! LFTs off the wall. Bicarb 4.3. PCO2 13. I got him at the beginning of my shift from E.D. Put in arterial line. Put in triple lumen. Took to radiology for biliary drain and dobhoff under fluoro. Inserted dialysis catheter. Multiple blood work all day. Of course, the usual multiple bloody stools and required clean-ups. And I had 2 other patients! Difficult day to deal with my patients, their visitors and everyone else's visitors wandering around the unit grabbing the nearest nurse.
Thank you all for your posts. I'll keep you informed of how we progress as we actually "enforce" visitor hours. Oh, by the way, the trade-off for management support is (and rightly so) better communication by nurses to family members. We are to greet family members immediately upon pt's arrival to unit (usually a designated nurse, not the patient's nurse who is settling in the patient) and review visitor's policy with them and explain what is happening. We are to be immediately available to family members during visiting hours. Etc., etc. (you get the idea). We are even talking about scheduling an in-service on "Guest relations" (some nurses are less skilled in conversing with families than others). Again, thanks for your input.
0Sep 1, '01 by mdslabodWether in the ICU or working on the floors, I spend too much of my time explaining procedures and giving out information to famiy and friends.
Sometimes I wonder if any of these people really need this information or just want the attention.
I have often said that we need a nursing liason on the day and evening shifts to handle family questins and requests. But.. here we go again with the ol' customer satisfaction argument.
0Sep 1, '01 by prmenrsI really think there ought to be a buzz-in system, esp. for security purposes. We have one it the NICU because of the possibility of an infant abduction. The SICU/Trauma Unit has one, again because of security, and for visitor control. I don't know about the ICUs upstairs. Visitors need to check in w/the secretary, and get health screened for our unit; Trauma checks 'em for weapons, too (just kidding).
0Sep 2, '01 by KRVRNI work NICU and we have a locked unit. The secretary buzzes the family in after checking with the bedside nurse. We really only say no to the visitiors if we are doing something invasive to the baby. Afterward the parents are let in ASAP. Our unit is only closed from 6:45 to 7:45 in the AM and PM (for shift change), and for an hour each on mon. and wed. (for rounds). Other than that, our unit is open all day and all night for parents and visitors. All visitors must be accompanied by the mother or father (or whoever is banded besides mom). Siblings of any age to the baby can visit. Non-siblings must be over 14.
It works okay because it's an open unit... If a parent wants to ask you something, but you're not around, they can usually see where you are. That way they know you are involved in something, not just off painting your nails somewhere.
We adhere to the visiting hours pretty faithfully (how can you not--they're so open). We will let the mother stay into the off-limits times if she is breastfeeding though. We would also never make parents cuddling their dying baby leave no matter the time.