Family visitation in ICU

Mayflye · Feb 5, 2005

[. No wonder nurses are treated like crap. It is because some nurses take it and excuse it and make it bad for the rest. Nurses should not be used as emotional punching bags because someone is understress. ]

You are going to make a great nurse; you already get it.

-Amy

Phoenix, AZ

mattsmom81 · Feb 5, 2005

First of all, where are you working where you are assigned 3 ICU patients? That's insanely unsafe. .
It has been a continuous struggle for ICU nurses in the Dallas Fort Worth area of Texas (and other areas if one believes this BB) to maintain the AACN's optimal 2:1 ratio. I frequently encounter 3:1 as both staff AND agency, and have had problems getting the nurses to stand together to fight this, sadly. Someof our local hospitals and critical care managers have made it 'policy' that ICU nurses cannot refuse admissions...and nurses have gotten suckered into working dangerously like this. IMHO the care delivered is very poor in this situation, but because other nurses have accepted the liability, it becomes difficult for one nurse to say 'NO'. The higher ratio makes the push for open visiting even more intolerable and proves we will get what we accept, and if nurses won't stand together and say 'no more' this will continue..

mattsmom81 · Feb 5, 2005

[. No wonder nurses are treated like crap. It is because some nurses take it and excuse it and make it bad for the rest. Nurses should not be used as emotional punching bags because someone is understress. ]
You are going to make a great nurse; you already get it.
-Amy
Phoenix, AZ

Understand the coercion that goes into nurses accepting 'being treated like crap'. In employment at will areas (like mine), a family complaint automatically makes the nurse wrong, with today's customer service attitude. A nurse who speaks out will likely get branded 'bad attitude' and may soon find herself out of a job...they don't need a reason to fire you.

This is how nurses behavior is controlled in my parts.

bellehill, RN · Feb 5, 2005

Understand the coercion that goes into nurses accepting 'being treated like crap'. In employment at will areas (like mine), a family complaint automatically makes the nurse wrong, with today's customer service attitude. A nurse who speaks out will likely get branded 'bad attitude' and may soon find herself out of a job...they don't need a reason to fire you.
This is how nurses behavior is controlled in my parts.

You are so right, it is easy to say you won't work like that but when it comes down to it fighting just isnt' worth it. I am so tired of hearing that we are expected to "flex up" when and admission comes. Why don't the managers take any of the admissions they accept? Healthcare as a customer service industry is so frustrating. We try to protest assignments and policies in our own way and have actually won a few battles lately...short-lived I know. :rolleyes:

RN34TX · Feb 6, 2005

It has been a continuous struggle for ICU nurses in the Dallas Fort Worth area of Texas (and other areas if one believes this BB) to maintain the AACN's optimal 2:1 ratio. I frequently encounter 3:1 as both staff AND agency, and have had problems getting the nurses to stand together to fight this, sadly. Someof our local hospitals and critical care managers have made it 'policy' that ICU nurses cannot refuse admissions...and nurses have gotten suckered into working dangerously like this. IMHO the care delivered is very poor in this situation, but because other nurses have accepted the liability, it becomes difficult for one nurse to say 'NO'. The higher ratio makes the push for open visiting even more intolerable and proves we will get what we accept, and if nurses won't stand together and say 'no more' this will continue..
You need to come work at my hospital in southeast TX and get out of DFW.
If admitting dept calls for a bed and say we have 1, 2, 3, 4, how many number of open beds BUT every nurse already has 2 patients each, we tell them that we are full and have no open beds. If they say "yes you do have open beds" then we say you need to send another nurse over here, then the beds will open up. That is a strict policy, 2 ICU patients per nurse, period.
I worked Med/Surg in Dallas where the policy was if there was a clean room, a patient could go there, regardless of staffing and that is way wrong.
I sometimes took 7 and even 8 patients without a CNA/PCT or unit clerk to help me out and it was unsafe and often stayed well past my shift to get things done. ICU not allowed to refuse admissions?
Just because you have a clean room doesn't mean that a patient should be placed there. I certainly wouldn't want to be an ICU nurse's 3rd patient or a Med/Surg nurse's 7th or 8th patient. I don't even think that they should have more than 5.
Maybe you are right and we do need to unionize, look at California.

PJMommy · Feb 6, 2005

Unfortunately, once you've taken those extra pts, a precedent is set. A couple of times, they've asked our nurses to take a second pt with a fresh heart -- maybe one that was a few hours out of the OR but still intubated. Even if it was a do-able situation, we've encouraged one another to say "NO WAY! I CANNOT DO THAT!". The problem as we see it is that once we've taken that second pt, then the next time they'll say "well we've done this before and it worked out well so you WILL take the pt".

Kyriaka · Feb 6, 2005

I think flexability is in order for the patient.

I am a former burn patient and was in ICU. The restrictions were way to restrictive. I believe it was 1 visitor every 4 hours.

My parents went to the powers that be and told them I was a people person and they were killing me. The hospital relented as long as my vital signs were good.

I believe I got better much faster.

*A funny story is that the Greek Orthodox Bishop of Atlanta came to see me in ICU. He was elderly and supported by 2 other priests. Now if you have ever seen a Greek Orthodox Bishop...they have a presence! They wear long black robes, carry a staff, and have a huge medallion of Christ around their neck. Plus a giant hat. I heard the nurses looked at him amazed.

schroeders_piano, RN · Feb 7, 2005

That is a strict policy, 2 ICU patients per nurse, period.
Just because you have a clean room doesn't mean that a patient should be placed there. I certainly wouldn't want to be an ICU nurse's 3rd patient .
I just wish the ICU that I work in had the policy of no more than 2 patients. On Thursday and Friday I had 5 ICU patients as did the other nurse. We had an aide until 1500. It was absolutely horrible. I went home both nights and crashed. It is dangerous and uncalled for. Hospitals need to start looking at whether it would be cheaper to require more nurses or to pay a malpractice suit. I have tommorrow off, so I will be job hunting.
Schroeder

Marijke · Feb 7, 2005

Sorry for the strong language, but has any of you ever had a family member in ICU? It is an incredible hard thing to deal with. My father died in ICU in The Netherlands last May, the hardest thing I have ever had to deal with. The unit was locked, but we where welcome at any time just by calling in (even when he was considered stable).

I know the family can be a pain in the behind in the ICU, ever thought some of them are because they are beyond coping? Being a nurse I could hardly handle it, but with the help and compassion (ever heard of compassion?) of the nursing staff we managed to keep things together and make the correct decission.

Sorry but this thread has me just fuming!!!! :angryfire :angryfire :angryfire

Marijke

bellehill, RN · Feb 7, 2005

Sorry for the strong language, but has any of you ever had a family member in ICU? It is an incredible hard thing to deal with. My father died in ICU in The Netherlands last May, the hardest thing I have ever had to deal with. The unit was locked, but we where welcome at any time just by calling in (even when he was considered stable).
I know the family can be a pain in the behind in the ICU, ever thought some of them are because they are beyond coping? Being a nurse I could hardly handle it, but with the help and compassion (ever heard of compassion?) of the nursing staff we managed to keep things together and make the correct decission.
Sorry but this thread has me just fuming!!!! :angryfire :angryfire :angryfire
Marijke

Marijke,

Sorry about your father. I have never had a family member in the ICU, I often try to imagine what it would be like so that I can be more compassionate for their families. I don't have a problem with visitors in the ICU...I have a problem with the lack of respect that these visitors show to the nurses and the lack of support from management when we have problem visitors. Because you are a nurse I am sure you recognized the importance of letting the nurses work with your father and having the time and space to support and help him the best they could; many visitors don't have this knowledge.

It is unfair to the patient when nursing care is compromised by visitors, which happens more often than not. I don't think anyone on this thread is against visitors, we just are against open visitation without guidelines that are enforced. It is our job to be an advocate for the patient and sometimes that does mean we are against the family. Please don't be offended.

fergus51 · Feb 7, 2005

I agree Bellehill. Marijke, I have been a family member in the ICU as well with my father. Fortunately he recovered. I am very sorry you lost your father. I certainly don't want visitors to be kept from their loved ones as long as they don't interfere with care. I do think there need to be reasonable restrictions though. Too many people at the bedside and we can't function if there is an emergency. Visitors there at report time and we can't maintain confidentiality. Visitors who actively interfere with nursing care and we can't provide safe care to our other patients. These are real concerns.

begalli · Feb 7, 2005

It is unfair to the patient when nursing care is compromised by visitors, which happens more often than not.

This is just NOT my experience.

I don't know what area you are in, but this is NOT the case where I am. MOST of the visitors that come into the ICU are so freaked out by everything that they are afraid about where to stand, what to breathe around, and what to say or do, let alone touching things or possibly compromising the care of their loved one. When I move around a patient's bed, more often than not, visitors literally jump out of the way, almost always. I have to reassure them that they are okay where they are and that I will move around them if I need to expalining that that's what I'm used to doing as the surroundings around a patient in the ICU is usually like climbing a jungle gym anyway. Their response is usually, we just don't want to be in your way! :)

It is our job to be an advocate for the patient and sometimes that does mean we are against the family.

Using "we" connotates that all nurses feel this way. I do not. Not even sometimes.