Yesterday at a staff meeting, the issue of visiting hours came up. Currently, our visiting hours are 1030-1100, 1330-1400 and 1800-1830. (Also, keep in mind, we're Neurosurg.) Now they're talking about making open visiting, with the exception of shift changes and doctor rounding time.
I think this could be disasterous! I can't imagine having open visiting in an ICU that's open! I mean you'd have people in and out all the time. My manager says we're not doing it yet, but states that maybe we should try it, before they make us do it! I have to say I'm not crazy about the idea!
Also, we're a NEURO unit! These people need decreased stimulation! It's bad enough that these pt's have to endure three half-hour visiting of family screaming "squeeze my hand, open your eyes, etc.".....but to have it more!!??!!?? Uh, I think I'd have to slit my wrists too!
Let me know what your visiting hours are and what you think of open visiting!
I really believe open visitation works, with that crazy assumption that management and your charge will back you when you need patient time
when all hell is breaking loose, not just codes, just those days where you can't care for those patients, we kindly escort ALL visitors out, explain we need 45 min. t care for their loved ones and we'll call out to the waiting room when we're ready.
I post a sign on the door that says the same thing. (we have a luxury of a locked door) Of course, families think this doesn't apply to them, and we respond to the door call by repeating exactly what the sign says, several times if necessary.. amazingly, those that can't read the sign don't hear all too well either.
but this has been a great alternative to regain some control in chaos to care for your patients. We just use this only when needed, with the few crazy exceptions, that you'll always get, it works.
Open visitation can be a free for all chineese fire drill (no offense intended). If limits aren't set when needed, which is why I think it doesn't work for so many units, management doesn't back a time out, or we can't work together to reign in some quiet time.
This is tough to go through at first, and don't hesitate to ask families to leave if you need to. Yeah I know, easier said then done!
See, I disagree with the open visitaion policy in ICU. ICU pt's are there for a reason. They are CRITICALLY ill. They need rest to heal. Especially Neuro pt's. Some families just hover over the pt, making them jumpy and nervous, which doesn't do any good. Plus sometimes they get in my way of caring for their loved one and are constantly bugging me for trivial matters. I work in a 26 bed Surgical/Trauma/Cardiac Unit. Our visiting hours are from 0900-1030, 1230-1430 and 1630-1830. If our unit had open visitation, I'd go insane.
Specializes in Neurology, Neurosurgerical & Trauma ICU.
Nurse-Lou,
I agree with you...these are very critical people, who need as little stimulation as possible! The family members standing over them, yelling at them to open their eyes, etc, is one less thing that they need! And I don't need to be tripping over them and asking them to move constantly because there's not usually enough room for all the equipment and everything else!
I can sooooooo feel your pain when you talk about family members asking about trivial things! They always want to know about the numbers on the monitors, their GCS, etc. You know, stuff that most of them have NO clue about. "Yes sir, I know your wife has a temp of 99.0, but her brain is swelling and we're trying to keep her brainstem from herniating right now!" UGH! LOL
I usually tell them politely to let me worry about the monitors because it's my job and to just enjoy the visit!
I was going to say what you guys did but chickened out. I'm so glad you said it!! Seems like when we say these things and try to gain a little sanity in our hectic workplace, the PC nurses jump in and tout the wonderful benefits of 'open visiting' and 'family centered care'. While I do understand these concepts, it doesn't work in my area in my unit at all. My ICU is very frustrating due to lack of ANY limits...and today's public is so 'me me' oriented, meeting their own needs vs that of the patient. They want their way at all costs, and refuse to listen to the nurses. My manager will NOT back the nurses up if we ask them to step out. Customer service is the big push...visitors are customers.
My ICU has become the' ultimate medical reality show,' as one of my docs puts it.
I was a patient in the CCU for 2.5 days due to a GI bleed (lost about 4 units of blood, but was still alert and oriented). The 2 half-hour visits a day were about as much as I could handle, even though I no longer required critical care after the first day (no beds available in the rest of the hospital). My family was careful to follow hospital policy on visiting time length and the 2 visitor limit in the room.
I found the CCU to be a fairly peaceful place, in part due to the restrictions on visitors. My visitors had privacy, and so did I, as the nurses could care for me before and after visiting time, which I appreciated.
Specializes in CCU (Coronary Care); Clinical Research.
In our unit, family visitation is up the the nurses discretion--and yes, I really do believe this works, as long as guidelines are given to the family. The only time we are not an open unit is during change of shift (for confidentiality purposes). I agree that with neuro patients of those that just physically can't have stimulation-- the lesser the stimulation the better, which means that it just has to be discussed with the family at admit and that visitation may be short due to the situation. I make sure that I let the family know that just because I am letting them back at such and such time does not mean that they will be allowed back every time, it is situation dependent. I also look at the family, if they are one of those families that hovers, shouts at the patient to open their eyes, move, or whatever, their visit will be very limited. Our families have to call first before they can enter the unit...the stafff that answers the phone always checks with the RN that has the patient before giving the go-ahead to come into the unit. We also generally allow only two-three visitors at one time--unless the patient is dying or there are other special circumstances (also cleared with the nurse ahead of time). If there is a code in the unit, families are not allowed in (the coding patients family may be let in per the RN if necessary--but thats another topic). If my patient is not coding yet but there is a of work going on where I am too busy to answer questions, I usually have the family wait in the waiting room. If my patient is sleeping, I will tell the family they can come back and "peek" but may not wake the patient up or go into the room. Most of the families that I work with understand when we say that the patient is resting...There is always security for those that get out of hand...
Specializes in Neurology, Neurosurgerical & Trauma ICU.
Originally posted by mshultz
I was a patient in the CCU for 2.5 days due to a GI bleed (lost about 4 units of blood, but was still alert and oriented). The 2 half-hour visits a day were about as much as I could handle, even though I no longer required critical care after the first day (no beds available in the rest of the hospital). My family was careful to follow hospital policy on visiting time length and the 2 visitor limit in the room.
I found the CCU to be a fairly peaceful place, in part due to the restrictions on visitors. My visitors had privacy, and so did I, as the nurses could care for me before and after visiting time, which I appreciated.
MShultz.....thanks for the patient's perspective on all this! I'm really hoping it all blows over, but I don't know!
Keep all your opinions and postings coming, I love them!
Although I work with the little people, we had an open visitation for a while and it really stunk....you can't get stuff done, you are constantly working around people. We finally went to this, I don't know if this is feisable for you or not, but maybe some of it could help;
1. Families may visit openly, but only 2 at the bedside. You will be asked to leave at shift changes, during procedures and if the unit becomes very busy.
2. Other visitors are limited to the hours of 1030 to 8pm. They can only come with you and you are limited to only 2 extra people a day (our secretaries have tags they hand out and when the two tags for that patient are gone, that is it.). The visit is limited to 15-30 minutes, depending on how sick your baby is.
3. We cannot answer visitors questions due to confidentiality. If they have questions, we will refer them to you. We also do not take phone calls from anyone but the parents (for you that could be the designated person(s) ).
4. We reserve the right to limit visitation. Please keep in mind that we only have your babies well being in our interest.
This has cut down on traffic, people in and out, and we all are able to better get our work done without a hundred people asking us questions and shuffling about.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Originally posted by mattsmom81
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.
I just left a job like that. If there were problems, it was always the nurse's fault, and they were solved by counseling the nurse. I had a patient one time whose "girlfriend" insisted on sitting beside his bed 24/7. One day I was in the next room and looked through the glass to check my patient and found the "girlfriend" on the computer, paging through the patient's chart. (The intern had left it signed in.) When I confronted her, she raised a stink and threatened all sorts of things -- "I'll have your JOB" sort of things. And I got counselled about being more open to families. When the patient woke up, it turned out that she really WASN'T his girlfriend, he didn't want her there at all, and he wanted to sue because we let her stay. You just can't win!
Open visitation works ONLY if nursing management and administration are willing to leave the final decision regarding who visits and when to the bedside nurse and then to back up that nurse. In my experience, that happens all too rarely. It's far better to have rigid restrictions and relax them sometimes. At least then you have the written rules to back you up when you need them.
Other problems with open visitation -- with the constant, unchecked stream of "visitors" through the ICU, wallets and purses disappeared, staff members got assaulted and patients got little rest. I know that families are important to patients' recoveries as well. But if the family is respectful and well-behaved, very few nurses will ask them to leave except during the most extreme circumstances.
Absolutely agree with the above - it is FAR FAR better to have strict rules that can be relaxed than lax rules that cannot be enforced. We have a closed unit between 1-3 in the afternoon as that is the patients "nap time". Other than that we do not restrict time wise BUT we do restrict to two visitors at a time - again for patient comfort.
If you have a problem - set it out listing patient advantages and disadvantages and then submit that as a formal review to management. Sometimes just verbally complaining gets you no where.
I spent some time working with beurocrats and learnt "he who writes the best submission gets the most moolah"
I work in Peds ICU, and I've always worked with very liberal visitation policies. My last ICU was 9a-9p anyone over 16 that the parents permitted, but only TWO at the bedside at a time, and parent's couldn't sleep there. 24hours for parents (and usually anyone else, at nursing discretion)
My current ICU is similar, except we DO allow parents to sleep at the bedside.
Put yourselves in THEIR position. If your parent was hurt in an accident, would YOU like to be told you're only allowed to see them for 1/2 hour, 3x/day?? Wouldn't you want to be there?
I think open visitation policies are a good thing, with structure. I've had head-injury children with ICP issues, with parents that sit at their bedside 24 hours/day. If they can't observe a quiet, no-stim environment, they're asked to leave. Point blank. Never have had a problem in the 9 years I've been a nurse.
We recently had a child in a constant code practically, who we sat the parents out of the way, to WATCH that we were doing everything we could. NOT knowing is so much worse... imagining what might be going on.
It's an inconvenience to YOU the nurse, to have family members nearby when you're used to having them only come in for short amounts of time. There is nothing I hate worse, than having a parent who STARES at the monitor constantly, noticing any little variance in HR or CVP reading. But honestly, I can't ever imagine being in their shoes!!! I hope I never have to.
My mother has chronic cardiomyopathy. And I'll tell you kno, if and when she's ever admitted, I'll be DAMNED if someone is going to limit me to twice a day!
Again though, those of you who want this closed visitation policy... it's the only thing you know. It's really not that bad when it's open. In general, people respect that you have a job to do. And when they don't, they're asked to leave by security. That is always the option!
Forgot to add though... the door is not always open. Family must call back to see if it's ok to visit. We do ask them to stay out for intubations, line placement, report, rounds, etc... they just can't WALK in anytime freely. In fact, our current unit is LOCKED, and the door must be buzzed open by the receptionist.
My manager says we're not doing it yet, but states that maybe we should try it, before they make us do it! I have to say I'm not crazy about the idea!
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I really believe open visitation works, with that crazy assumption that management and your charge will back you when you need patient time
when all hell is breaking loose, not just codes, just those days where you can't care for those patients, we kindly escort ALL visitors out, explain we need 45 min. t care for their loved ones and we'll call out to the waiting room when we're ready.
I post a sign on the door that says the same thing. (we have a luxury of a locked door) Of course, families think this doesn't apply to them, and we respond to the door call by repeating exactly what the sign says, several times if necessary.. amazingly, those that can't read the sign don't hear all too well either.
but this has been a great alternative to regain some control in chaos to care for your patients. We just use this only when needed, with the few crazy exceptions, that you'll always get, it works.
Open visitation can be a free for all chineese fire drill (no offense intended). If limits aren't set when needed, which is why I think it doesn't work for so many units, management doesn't back a time out, or we can't work together to reign in some quiet time.
This is tough to go through at first, and don't hesitate to ask families to leave if you need to. Yeah I know, easier said then done!