Families and the "ICU culture"

chris_at_lucas_RN, RN · Sep 8, 2004

Someone who has as much awareness of the value of the family to the patient as you do will be wonderful wherever you land.

What a shame that the new nurses are being led by the gripy old ones! Families are part of our "patient" too--their name may not be on the chart, but they have been body slammed with the patient's illness or injuries. As a very young wife, I had the experience. It wasn't pleasant--but I still remember the ICU nurse handing me a glycerine swab and teaching me how to clean my husband's mouth without messing up the wires, etc. He told me how my husband reminded him of the song "Macho Man" because he was already refusing pain meds less than 24 hours after his accident. That was in the late 70's. Tells you something about the impact that nurse had on me, and I was "just" the family.

Sounds like your ICU staff needs an inservice. How does the manager feel about family? Perhaps if the nurses realized that the family can do a lot of the cleaning and comforting, and that they are eager to learn and help, and that the patients like it, your ICU will be a better place to be sick or hurt in.

You sound like a wonderful nurse. I'm sure wherever you go will be improved by your presence....

mac23 · Sep 8, 2004

Family centered care is very important. But even with babies and kids it's not always going to be easy. I'm not at all saying they shouldn't visit or give thier opinion about how their child is cared for or help with the care when they can but it can be extremely frustrating to work with some families. I'm guilty myself of saying, oh no the family is here, on occassion.

My own daughter was a 23 weeker in the NICU and looking back I know there were many of times when the staff was probably thinking oh no the mom is here or oh no the dad is here as my husband was overly aggressive at times. Understandably, when my baby was in the NICU I was a totally different person. Every little thing irritated me. From the outfit they put on her to being mad because the nurse couldn't come to the phone when I called. I remember one time I about took someone's head off for refering to my daughter as "my baby". I remember many times I just wanted to kidnap my own daughter out the hospital and take her home. I wanted to scream everytime someone told me how to handle MY baby. Was I difficult to work with....at times I'd absolutely say YES. As she got closer to going home I got better but now I can definatley see how difficult I was to work with.

My brothers child has been in and out the hospital his whole life. I know there were many of times where we (his wife, myself and 2 of my sisters are all nurses) probably drew the "oh no the family is here" response.

But the nurses can have a lasting impact on the situation despite the way the family acts. It may seem like the family is never happy, but for myself deep down I always appreciated what they were doing for my child, i just couldn't shake that out of control feeling and it came out in my behavior. There were many good times and many bad times that made our hospital stay easier to cope with simply due to the staff going out of it's way to make me happy.

So in a long rambling way I'm just saying that there will be times no matter where you work that there will be some family that you just find hard to deal with.

Hi all! I am currently a nurse in an adult ICU, and I've been considering a move to a neonatal or peds ICU. (Gotten some great advice on that in this forum; thanks!) One of the reasons that I feel a need to move is the attitude toward families in the ICU I work in. I came from an ICU with a pretty open visitation policy and families were seen as beneficial to the care of the patient. Many of the nurses in the ICU that I'm in now regard families as intrusions. Even the new grads will give me the "OHH NOO! NOT THE FAMILY!" complaint when I give them report. So jaded for only having been a nurse in ICU for two seconds! Anyway, I'm wondering if it really is different in a neonatal or peds ICU. My idea of a childrens ICU is that family centered care would be very important, if not necessary. Am I wrong? Any info would be helpful. Thanks! Dana

heart queen · Sep 8, 2004

hopefully this won't evolve into a "visitation" thread. But you bring up an excellent point and thanks for the reminder. I don't work peds or NICU, yet why do some nurses let visitors be more lienent with younger victims of tradgety, vrs. a 70 yr. old stay longer? I'm guilty!!! Maybe my ICU is isolated, but I've been in several ICU's over the past year in per diem positions. I've noticed that the younger the patient the more lienent the visitiation.

Now I'm completely against open visitation, been there, have the high blood pressure, yet as you mentioned that nurses are in the best postion to flex the rules to meet patient needs, regardless of the old centurians... making the assumption that the flexing will benefit ALL those in need, regardless of our inconvienence. (report and patient care asside).

Why does a child, or baby have different needs than an adult? Many of my confused elderly are calmed by my calling in family, rather than utilizing drugs and restraints... you've given me quite a bit to evaluate.

I can tell you that I have come up against great adversity, (the charge nurse saying "hell no, he can't stay.. it's not fair to all the family we made leave", when a anxious patient would have simply been ok, with the husband sleeping in the room and I relented and kicked him out to sleep in the waiting room, knowing it was wrong. I'm not a new nurse, in my old position, would have just said "so and so is rooming in in room #6", now told NO exceptions period in my new position.

Why can't it just be " I know you see other visitors as I'm asking you to leave, they have different circumstances that warrent the family at the bedside, thanks for understanding"

Although I haven't addressed your specific pediatric question, you've raised questions to my own as well as my peers practice. I don't have answers, only questions now.

thanks for allowing the personal input

fergus51 · Sep 8, 2004

I think you'll find NICUs are the same as adult ICUs: they're all different. Some places are very supportive of family involvement (look for the words "family centred care") and some places aren't. Some nurses are great with families and some aren't.

I will admit, working with families has been the most difficult part of my transition to the NICU. Now, I DO believe in involving the family in everything and making them feel welcome because it is THEIR child and not mine, but there are times when families can be so difficult. It can be incredibly demoralizing when you are trying to do the best you can for the baby and their family and the family is unhappy with everything. I think families can go even more crazy in a neonatal unit. They have lost every bit of control and it must be heartbreaking to see their infant in such a state. I think you will always find nurses who don't like working with families and even nurses who like working with them (like me) will occasionally have off days and say "Oh no, the family", but mostly NICU nurses seem to do ok with parents. Really you don't have much choice. If you want babies to go home, you need to make sure the parents can care for them:)

directcare4me · Sep 8, 2004

Hi all! I am currently a nurse in an adult ICU, and I've been considering a move to a neonatal or peds ICU. (Gotten some great advice on that in this forum; thanks!) One of the reasons that I feel a need to move is the attitude toward families in the ICU I work in. I came from an ICU with a pretty open visitation policy and families were seen as beneficial to the care of the patient. Many of the nurses in the ICU that I'm in now regard families as intrusions. Even the new grads will give me the "OHH NOO! NOT THE FAMILY!" complaint when I give them report. So jaded for only having been a nurse in ICU for two seconds! Anyway, I'm wondering if it really is different in a neonatal or peds ICU. My idea of a childrens ICU is that family centered care would be very important, if not necessary. Am I wrong? Any info would be helpful. Thanks! Dana

I think that any ICU you end up in, you may find that there will be nurses who enjoy working with families more than other nurses. And families that are easier to work with than other families. I hear many of my co-workers say the things that you quoted in your post. And on my worst days, when I don't have much energy to spare, I think those things too--"Oh, please don't let them come in today". I know, it's awful, but I just don't want you to think that because it's children's care, that the attitudes are necessarily different.

prmenrs, RN · Sep 8, 2004

I agree that all units are different (both NICU and adult). You can find out what the unit is like by going there--usually you get a tour with your interview, no extra charge. Take a GOOD look around. Ask if you can chat w/a staff nurse for a bit. It's obviously a good sign if you see families @ the bedside.

It's a good sign if you see a huge breast milk freezer, too. We had 2, and I do mean HUGE. We allowed sibling visitation, even in the ICU area. Why? It helps the sibling grasp what's going on w/the family and why Mom and Dad are upset. We kept crayons and coloring books for them. Depending on the situation, (not all families are the same) we allowed others in, too. 2@ a time, Stay @ your own bedside, Thank You. Everyone had to fill out a screening questionaire (vaccinations, rashes, sore throat, diarrhea, etc.) Siblings had to have their shot record copied and placed in the chart. Immunizations had to be up to date.

We tried to accomadate the needs of the family w/o endangering their child or anyone else.

Babies and children have VERY different needs than adults. I shouldn't have to convince anyone of that fact.

I think you would do well in a NICU. I hope you find one meets your expectations.

mattsmom81 · Sep 8, 2004

The reason some critical care nurses may groan and roll our eyes is because today's families (mirrors of today's 'meme' society in general) frequently will be demanding and often excessively monopolize the nurses' time. In today's short staffed units, I must prioritize. I have no problem flexing visiting hours within reason, but there has to be some allowances for limits or in too many cases I simply cannot do my job, which is to care for the PATIENT.

I agree we don't want another visiting thread ...too many heated opinions. A chaotic critical care unit full of unrestricted, demanding visitors in free-for-all mode is my worst nightmare, because I've been there. Just my opinion. And when faced with a change to open visiting in ICU, nurses can vote with their feet and leave...which I've done. :)

djmicu · Sep 9, 2004

Thank you all so much for your input and kind words! I've been talking to the folks at the local children's hospital and will be taking some classes there (STABLE, NRP, PALS); I think I'll ask if I can visit the NICU. Thanks again! Dana

RN4NICU, LPN, LVN · Sep 19, 2004

The reason some critical care nurses may groan and roll our eyes is because today's families (mirrors of today's 'meme' society in general) frequently will be demanding and often excessively monopolize the nurses' time. In today's short staffed units, I must prioritize. I have no problem flexing visiting hours within reason, but there has to be some allowances for limits or in too many cases I simply cannot do my job, which is to care for the PATIENT.
I agree we don't want another visiting thread ...too many heated opinions. A chaotic critical care unit full of unrestricted, demanding visitors in free-for-all mode is my worst nightmare, because I've been there. Just my opinion. And when faced with a change to open visiting in ICU, nurses can vote with their feet and leave...which I've done. :)

This is very true, mattsmom. I have often been frustrated at the utter selfishness of visitors in ICU - neonatal, peds, and adult. They take the nurses away from their patients far too much. HELLO - selfish people - just because the nurse is not in the middle of a procedure on YOUR family member right now, does not mean that s/he is desparate for something to do. Guess what - those people down the hall a little ways that are ranting and raving are doing so because their family member is the nurse's other patient and s/he is with you and not with them OR that monitor that is alarming is attached to the nurse's other patient and responding to it is more important than getting you a soda right now - the vending machines are down the hall!

UGH! When did people become so selfish??

BittyBabyGrower, MSN, RN · Sep 20, 2004

I like to work with families, but man, there are just some days when the unit is on the verge of self destruction that I wished we didn't have ANY visitors! Some parents think they are entitled to everything and every minute you have and become very, very nasty when you aren't at that bedside every minute of your shift. I have even said to parents, you know, you are very lucky to have a baby that just needs to gain and grow and doesn't require one to one nursing. Usually, they see the light after that. I have a really hard time with the ones that don't listen to you when you say, I am so sorry, but please leave your baby be until feeding time because he/she just fell asleep after crying for 8 hours...scenarios like that. And usually it is because they have visitors and want to show off the baby....not do what is best for their baby.

I have to say...sometimes having lots of families at the bedside can be deceiving....sometimes they are the ones that are accusing staff of negligence, etc and want the supervisor down there everytime their kid makes a peep and no one comes over to see what is wrong. Ugh. We have a unit full of them this month....I wonder if I'll have any hair left by next month :chuckle

geekgolightly, BSN, RN · Nov 18, 2004

I like to work with families, but man, there are just some days when the unit is on the verge of self destruction that I wished we didn't have ANY visitors! Some parents think they are entitled to everything and every minute you have and become very, very nasty when you aren't at that bedside every minute of your shift. I have even said to parents, you know, you are very lucky to have a baby that just needs to gain and grow and doesn't require one to one nursing. Usually, they see the light after that. I have a really hard time with the ones that don't listen to you when you say, I am so sorry, but please leave your baby be until feeding time because he/she just fell asleep after crying for 8 hours...scenarios like that. And usually it is because they have visitors and want to show off the baby....not do what is best for their baby.
I have to say...sometimes having lots of families at the bedside can be deceiving....sometimes they are the ones that are accusing staff of negligence, etc and want the supervisor down there everytime their kid makes a peep and no one comes over to see what is wrong. Ugh. We have a unit full of them this month....I wonder if I'll have any hair left by next month :chuckle

I know every nurse needs their forum to vent, but I am frightened of these attitudes. They are my worst nightmare about NICU.

My son was preemie. At 34 weeks he wasn't too bad off, but I did have to contend with the hospital and it's limitations for two weeks before i was able to have him home. I was thankful that we were able to visit 24/7 barring shift change, but it was most unfortunate that I was not able to provide him with kangaroo care for more than six or so hours at a time because there was a policy barring sleep.

My ideal NICU is a NICU wherein the mother has a bed alongside her infants and mother and son are allowed to sleep kangaroo style together, and are encouraged to spend every waking moment together. I left you NICU nurses alone as much as possible. I really didn;t want you there in the first place. i wanted to do everything myself. I learned from you and then wanted you to tend to all of the babies who didn;t have mommies come visit them.

Still, I had nurses who discouraged me from kangaroo care, saying it exhausted my baby and he needed to get some "real sleep" and that it was interfering with him being able to eat better (he ate more food at night when I wasn't there) and that I was impeding his progress. That I shouldn't breastfeed but rather pump because we couldn't see how much the baby ate. That his desats (he desat'd while he ate. His only problem and only reason he stayed in NICU) were because I didn;t know how to feed him correctly and encouraged me to "let the nurses do it."

It was horrible for me, an attachment parenting mom. A new mom who only wanted to be with her son and wanted to hold him all the time and have him sleep on my body and be warm and safe in that cold harsh hospital.

It took me six emotionally/physically painful nightmarish weeks to transition him to breast after he learned to use the rubber nipple. WHY didn't they encourage breastfeeding? WHY didn't they just weigh him before and after breastfeeding? WHY did they tell me that kangaroo care was ineffective and even harmful? Why was my presense so shunned?

I know there are better NICU's out there that cater to what's really best for the baby and I have considered becoming a NICU nurse, but I don't think I have the stomach for it; I would want to take home any baby whom I thought was being neglected, and for you nurses who give love to those who have little in their new tiny lives, I am in awe of you.

Do you really, NICU nurses, not want to encourage family centered care, or is it that you feel understaffed? And what do you think of my situation?