ICU visiting hours

K O'Malley · Jan 31, 2004

I think that open visiting for a neuro ICU is insane! I have had neuro pts who would seize when stimulated. Sheesh! This customer service thing has gone over the top!

Zee_RN, BSN, RN · Feb 1, 2004

I have to completely agree with you. I work in a MS-ICU and we get stroked out patients . . . and the neuro patients are the hardest to deal with; God bless you for working that unit! And you're right ... the families hang over the patient and try to get the patient to respond the way they want them to and the patient gets more and more worked up (can we say increased ICP?!) and requires more and more drugs....yeesh. There's no way I'd work in a neuro ICU with open visiting hours. I'd stroke out myself.

Tweety, BSN, RN · Feb 1, 2004

When I worked neuro, their visiting hours was 24 hours a day except between 6-9 AM and PM.

But it was always at the discretion of the nurse. They had to call from a phone way outside the unit to ask permission to come in. If the nurse said no visitors allowed, they weren't allowed in. Period. I've never known management or security not to back up a nurse when the nurse didn't allow visitors, if there was a legitimate reason for not allowing visitors. It's only two visitors at a time and only immediate family. This seemed to work well, as it put the visiting hours in the hands of the nurse, but allowed the family some flexibility. Plus we were allowed to limit the time spent, usually allowing people to stay only a few minutes at a time on the night shift.

Open visitation in critical care at the discretion of the visitors is wrong and potentially unsafe.

I think your current visiting hours are too restrictive. That's only 1-1/2 hours a day. I've worked neuro ICU before, so no need to explain the rationale, but it does seem restrictive. Are you flexible to persons whose life and work can't allow them to visit those hours.

NeuroICURN · Feb 1, 2004

Yeah, we are as flexible as possible. We tell families that if they work, or whatever the case may be, and they can't get in during those hours to come in and call from the waiting room. What we usually do is tell them to call from the waiting room and if we can get them in, we will (as I mentioned before, it's an open unit). I would say that about 95% of the time we can at least get them back for a few minutes if the full half hour is not an option.

It's at the discretion of the nurse (and what's going on in the unit at the time). Also, we're not totally heartless, if someone is going to die, we are withdrawing support, or other special circumstances, then family is allowed to stay as long as possible.....as long as they stay in the area and are not walking in and out.

Of course, there have been times when someone codes during visiting hours and I have to say, that that can be a good thing, sort of......it's good because it allows people to see what REALLY happens during a code and how brutal it all really is! We do shuffle them out, but inevitably, they do still see some of it.

Keep the replies coming, I want to hear what all of you have to say!!!

Thanks!

:kiss

Tweety, BSN, RN · Feb 1, 2004

Originally posted by NeuroICURN
Yeah, we are as flexible as possible. We tell families that if they work, or whatever the case may be, and they can't get in during those hours to come in and call from the waiting room. What we usually do is tell them to call from the waiting room and if we can get them in, we will (as I mentioned before, it's an open unit). I would say that about 95% of the time we can at least get them back for a few minutes if the full half hour is not an option.

It's at the discretion of the nurse (and what's going on in the unit at the time). Also, we're not totally heartless, if someone is going to die, we are withdrawing support, or other special circumstances, then family is allowed to stay as long as possible.....as long as they stay in the area and are not walking in and out.

Of course, there have been times when someone codes during visiting hours and I have to say, that that can be a good thing, sort of......it's good because it allows people to see what REALLY happens during a code and how brutal it all really is! We do shuffle them out, but inevitably, they do still see some of it.

Keep the replies coming, I want to hear what all of you have to say!!!

Thanks!

:kiss

Sounds great. All I can say is, "if it ain't broke, why fix it?".

NeuroICURN · Feb 1, 2004

I hear ya 3rd Shift Guy!!!

I guess this all started because we sent the books that we give to families out to be evaluated by a consultant. Anyway, they loved the book, but said that our visiting hours are "archaic"!

JCAHO (I think) has recommended open visiting for ICUs since 1987! What crack are these people on? Have they ever even visited an ICU let alone work in one??? :chuckle

Thanks, keep the replies coming! I'd like to take my unofficial results from here to my mgr.

:kiss

CarolineRn · Feb 1, 2004

I work in the CVICU, and visiting hours are at the nurses discretion also. Most nurses allow family at anytime unless the PT has just come into the unit, has to have some kind of procedure in the unit (removal of the chest tube, for example) or during shift change/report. (for obvious reasons). Some nurses really hate this, others are totally cool with it. I did find it interesting that while we have this more lax policy in the ICUs, that many of the floors (like ortho) stick with the old 9-9 visiting hour schedule. I wonder why it's only the ICU's who are subject to this policy?

healingtouchRN · Feb 1, 2004

Ok, I 'll bite. I am open to "open visiting" as long as there is a control factor by the charge nurse or primary nurse. I have a harder time doing a good assessment & doing personal care on a client when the family is in the way, eating, standing over me asking questions while I am assessing (stethoscope in ears), trying to track IV's,etc. I like to assertain personal info the client may not want to reveal in front of anyone. So I ask then give me 1/2 hour or an hour. Some are ok, they go find the deli, make phone calls....whatever, others are hostile. Like I would be hiding something. I just have to remind them that I am 1st reponsible to my client & have their highest good in my mind. We have huge signs all over our unit & in the lobbies but I guess people either can't or don't want to read "strict visiting hours". They just waltz in whether we are in the middle of a code, procedure or what have you. Security is useless, no clue. I have noticed families walk right throught the nurse station even thought huge signs say walk around! I feel like a guard dog on duty all night. People have the gall to walk in arouse someone @ 1am, "I just got here from Timbuktu". I want to say "go to a hotel & come back when he wakes up in the morning". (Ya know they just had a heart attack, stroke, open heart surgery....). If I could have the control in the dept but admin doesn't support us. We had a really bad proble with this last year when a family member would NOT let us into the room in CCU between 2200 & 0500! I mean, go home if he's that stable & have home care vent nurses, & stop wasting my time & my bed availablility! The doc & admin supported this man!!!! It was sooooo not ok. The family member was another who just trapsed thru the nurses station into our kitchenette to get nutrition & coffee (his family member was on isolation) & we caught him not washing his hands first! I could just scream!!! ok, off my soap box now.

mattsmom81 · Feb 2, 2004

My unit is the worst example of the problems in open visiting...like the last poster relates, the unit has people milling about everywhere at all hours, and if we ask them to step out they are offended and report us for less than perfect 'customer service'. Our management team supports them, not the nurses. Doctors complain constantly about the visitors in the unit too. We seem to have no recourse. When we asked our manager to limit at shift change she refused as well, so we are struggling to maintain privacy constantly.

I hate it as you no doubt can tell...LOL....and will continue to get my management team to impose some type of limit. I've always found it easier to have a rule and relax it prn than to try and gain control over chaos, which is what we have now.

Good luck to you!!! I can empathize.

USA987, MSN, RN, NP · Feb 4, 2004

I worked in an ICU with open visiting hours, again at the discretion of the nurses.

Honestly, for 85% of the patients, this wasn't a problem. I was always very up front with the families when a patient was admitted....they kept their visits short and quiet. The other 15% were a pain in the A$$...and it was always the patients who I felt didn't even meet criteria for being in the ICU!!

Good luck!

Janet Barclay · Feb 5, 2004

Hi all, we have a 24 hr open visiting policy in our 24 bed combined Med/ surg/ neuro ICU, at the nurse's discretion, and only immediate family. Of course, if the pt is A and O they can designate other people to come in. We also have a handbook for families that explains that while the policy is an open one, that there are times when they will absolutely not be allowed to visit. This causes us some grief about 10% of the time, but it is worth it for the other 90%.

We explain very carefully the need for little stimulation for our neuro patients, and if families are unable to comply then they are limited. This also causes us not very much grief.

I always stop and think, what if it was my husband/dad/brother, would I accept the stringent visiting policies that some units have?

Janet