ICU visiting hours

Susie2310 · Jan 13, 2014

I work in a high acuity MICU at a safety net hospital and we have set visiting hours. 1030 am -230. And then from 430 until 830. As nurses we are free to make exceptions whenever we see fit but generally only if the patient is dying or it's a comp care situation w a caregiver. Any other time we try to stick to the visiting hours bc honestly it's and ICU. There is absolutely zero reason the family should be there round the clock. It's unhealthy for them and a hinderance to care.

Who are you to judge what is unhealthy for family members? How do you know there is absolutely no reason for family members to be there round the clock? Can you really predict when a patient will die (you make exceptions if the patient is dying!)? You sound like you are playing God. Read the ANA Code of Ethics. You are a nurse, providing care for patients and their families. Studies show that liberal visitation is beneficial for patients. Support your patients family members. Your own convenience as a nurse is not more important than well behaved close family members being by the bedside of their loved ones 24 hours a day if they feel the need, as long as the patient's wellbeing is not being obviously compromised by the presence of the family member. Also, some family members may have POA or other decision making authority: Being by the bedside next to their loved one where they can see their loved one's condition and see the care that is being provided, and be aware of the course of treatment and be able to ask questions of the doctors when they make rounds, is very necessary for them to be able to make the best decisions possible. You sound quite young; trust me, your ideas of right and wrong and black and white may change as you get older and experience the severe illness/fragile medical condition of your close loved ones.

RNforLongTime · Jan 18, 2014

I work in a small community hospital ICU, more of a glorified Med-Surg floor, if you will. So a lot of times, these patients have family members who haven't seen Mom or Dad who was admitted from the local nursing home in MONTHS. Our visiting hours are over at 8pm. No children under 14 and 2 people at the bedside at a time per hospital policy. No overnight visitors unless the patient is a minor or the patient is actively dying. It's a small unit so you can hear confidential info at the nurses station, potentially violating HIPAA no matter how quietly we are talking ,from EVERY room in the unit. I also have coworkers who don't make families stick to our visiting guidelines either so then when I come on-shift and have to ask them to leave or take their 18 month old out of the unit...then I'm the meanie for following the rules. Hey..if you want to expose your little kid to MRSA, VRE & C-Diff, fine by me.

I find sometimes, depending on the family member, that having them there constantly can actually aggravate the patient and make them more restless, requiring the need for more sedation. NOT helpful, if we're trying to wean them from the vent. So on occasion, I have to ask the family to leave. One hospital I worked at had very strict visiting guidelines and us nurses were allowed to enforce them..this was 12 years ago. The last one I worked at..same thing. My current hospital..we're a little more lax with things. I'll let family stay past 8pm if they're visiting quietly. There are other patients in the unit though who also need rest and whom I have to take into consideration as well.

I had one family, who's octogenarian family member was in our unit and NOT DYING and they decided it was a good time for a family reunion. They had about 20 family members JAMMED into the small room. I had to ask them to step out of the way so I could get to the patients bed to do my assessment! and were they LOUD! My other patient, who'd had surgery that day was complaining about the noise level because it was disturbing her rest. After 8, I asked how many of them were staying because visiting hours were over and I'd had another patient complain about the noise being generated from this room. Now I'd said it as nicely as I could. I told them I didn't mind a few of them staying with their loved one all night but only two of them would be able to do so. Then the one grandson started turning on me...called me a ***** and yelling at me. A few others started mumbling how uncaring I was..said the other nurse never said anything about the number of visitors in the room. I said well she shouldn't have allowed all of you in the room at the same time. I got our nursing supervisor involved. She's useless...didn't support me AT ALL.Which is her typical M.O. This family REFUSED to allow me to care for their family member when I'D DONE NOTHING WRONG but asked them to tone down the noise and asked 15 other people to step out after general visiting was over.

Anyhow...we ended up mending fences but see how families can get out of control when coworkers don't follow visiting hours?

I've also been on the other end as the family member of an ICU patient. My grandmother died in the ICU. When they had change of shift..even though her situation was still precarious...they MADE us leave at 7pm for change-of-shift report. She ended up dying at 10:12pm. My father had a massive MI in 2012. He had a cardiac cath with a stent placement on a Sunday afternoon but was held up in the cath lab before being brought up to the CCU because they'd just had a code. Well now we're getting close to the end of visiting hours for the day. Hmm...so my Mom's pastor at her Church goes back to the Nurses Station to find out what's going on. Luckily one of my former Nursing school classmates is going to be my Dad's nurse and let us back 2 by 2 to see him because again, the CCU is tight quarters. He wanted my mom to stay the night with him...Nope...not allowed. He ended up being in the CCU for a week because they didn't have any tele beds out on the floor where visiting hours are 24-7.

So after work on Wednesday morning, I go to see my Dad because my hospital is in the same town but down the road a bit and I told him I'd bring him a good cup of decaf and a newspaper so he could do his puzzles. The CCU has a receptionist outside of the entrance who, upon seeing me, gives me MAJOR attitude about how it's not visiting hours and she'd have to go check to see if I'd be allowed to come back for a few minutes. I nicely told her that my father should be in a regular room where visiting hours are 24-7 but since your hospital has none, they kept him in the CCU. I also have not seen my Dad since Sunday. I'm not going to stay long. She also eyeballed the two cups of coffee i had and said in another nasty tone about how it had BETTER be decaf. I said yes, it is. I'm an RN and I know what he is and isn't allowed to have. Sheesh!! I went back. My dad was much appreciative of a decent cup of coffee and the paper. His nurse, who I also knew, was busy with her much sicker patient, didn't even know I was there.

Happy2beICU-RN · Jan 21, 2014

Who are you to judge what is unhealthy for family members? How do you know there is absolutely no reason for family members to be there round the clock? Can you really predict when a patient will die (you make exceptions if the patient is dying!)? You sound like you are playing God. Read the ANA Code of Ethics. You are a nurse providing care for patients and their families. Studies show that liberal visitation is beneficial for patients. Support your patients family members. Your own convenience as a nurse is not more important than well behaved close family members being by the bedside of their loved ones 24 hours a day if they feel the need, as long as the patient's wellbeing is not being obviously compromised by the presence of the family member. Also, some family members may have POA or other decision making authority: Being by the bedside next to their loved one where they can see their loved one's condition and see the care that is being provided, and be aware of the course of treatment and be able to ask questions of the doctors when they make rounds, is very necessary for them to be able to make the best decisions possible. You sound quite young; trust me, your ideas of right and wrong and black and white may change as you get older and experience the severe illness/fragile medical condition of your close loved ones.[/quote']
Get over yourself. In no way do I "play god". I was simply answering the initial question. Why do you think it's ok to place YOUR judgements on me?! You come to my icu and then you can have an opinion on our policy. You think I "sound young". Well I'm not. And quite frankly you sound like the kind of nurse we all know. Come on. We all know a nurse like this. And by the way. I am able to judge what is healthy for my patients and their families pretty well. The family that is agitating my ICH patient, causing their sbp to spike into the 200s, unhealthy for my patient. The boyfriend of my patient dying of cancer who hasn't left the room in 4 days (yes, I allowed him to stay outside of visiting hours, gasp!), hasn't eaten, and is visibly distressed, unhealthy! Go home, rest and eat! But I guess that's just me playing god again.

Susie2310 · Jan 21, 2014

And by the way. I am able to judge what is healthy for my patients and their families pretty well. The family that is agitating my ICH patient, causing their sbp to spike into the 200s, unhealthy for my patient. The boyfriend of my patient dying of cancer who hasn't left the room in 4 days (yes, I allowed him to stay outside of visiting hours, gasp!), hasn't eaten, and is visibly distressed, unhealthy! Go home, rest and eat! But I guess that's just me playing god again.

It's not your place to judge what is in the best interest of your patients family members. As adults that decision is theirs to make. I am intrigued that you choose to place the cause of your patient's blood pressure spike on the presence of their family member/s: Just how were they agitating the patient?

Ruby Vee, BSN · Jan 21, 2014

Who are you to judge what is unhealthy for family members? How do you know there is absolutely no reason for family members to be there round the clock? Can you really predict when a patient will die (you make exceptions if the patient is dying!)? You sound like you are playing God. Read the ANA Code of Ethics. You are a nurse, providing care for patients and their families. Studies show that liberal visitation is beneficial for patients. Support your patients family members. Your own convenience as a nurse is not more important than well behaved close family members being by the bedside of their loved ones 24 hours a day if they feel the need, as long as the patient's wellbeing is not being obviously compromised by the presence of the family member. Also, some family members may have POA or other decision making authority: Being by the bedside next to their loved one where they can see their loved one's condition and see the care that is being provided, and be aware of the course of treatment and be able to ask questions of the doctors when they make rounds, is very necessary for them to be able to make the best decisions possible. You sound quite young; trust me, your ideas of right and wrong and black and white may change as you get older and experience the severe illness/fragile medical condition of your close loved ones.

I think your jumping on this post (and poster) was a little over the top.

Yes, studies show that liberal visitation is good for patients -- as long as the visitors are supportive. Often, however, they are not. In that case it's a wonderful thing to have a policy that backs you up when you, as a nurse, have to ask visitors to leave for the good of the patient.

Being at the bedside 24/7 is not good for family members. They need to have some downtime and some honest-to-goodness sleep in order to be able to ask sensible questions of the doctors and to be able to understand the answers. That is more important to making the best decisions possible than hanging out at the bedside around the clock.

I'm older. I realize that ideas of right and wrong, black and white change as you get older. I have experienced the severe illness and fragile medical condition of close family members and my own illness as well. Because of those experiences, I am more convinced than ever that having visitors at the bedside ALL of the time is not healthy for anyone involved -- for the patient or for the visitors. Maybe especially for the visitors.

Happy2beICU-RN · Jan 22, 2014

It's not your place to judge what is in the best interest of your patients family members. As adults that decision is theirs to make. I am intrigued that you choose to place the cause of your patient's blood pressure spike on the presence of their family member/s: Just how were they agitating the patient?

Oh gosh. I can see that you will pick apart any response that I post. You are "intrigued" that I choose to place the cause of my patients bp spike on the family?! I mean, do you even work in an ICU?! How absolutely ridiculous that I would even need to explain that. If it's not my place to judge what's best for my patient's family, it is CERTAINLY not your place to judge the fact that I adhere to my hospital's policy.

Susie2310 · Jan 22, 2014

I think your jumping on this post (and poster) was a little over the top.
Yes, studies show that liberal visitation is good for patients -- as long as the visitors are supportive. Often, however, they are not. In that case it's a wonderful thing to have a policy that backs you up when you, as a nurse, have to ask visitors to leave for the good of the patient.
Being at the bedside 24/7 is not good for family members. They need to have some downtime and some honest-to-goodness sleep in order to be able to ask sensible questions of the doctors and to be able to understand the answers. That is more important to making the best decisions possible than hanging out at the bedside around the clock.
I'm older. I realize that ideas of right and wrong, black and white change as you get older. I have experienced the severe illness and fragile medical condition of close family members and my own illness as well. Because of those experiences, I am more convinced than ever that having visitors at the bedside ALL of the time is not healthy for anyone involved -- for the patient or for the visitors. Maybe especially for the visitors.

In reply to your first paragraph, if patient care is truly being compromised due to the presence of the family member/s, and the patient's health decline can truly be attributed to the family member/s, i.e. family member/s who keep talking to the patient loudly and who won't allow the patient to rest, then I agree with the point of your first paragraph, and agree that policies are necessary in these situations for the sake of the patient's well being. In my post above I did refer to "well behaved" family members. By "well behaved" I meant family members who sit at the bedside quietly, and support their loved one by holding their hand primarily and just being by their side, without a lot of conversation.

In regard to your second paragraph, we will have to agree to differ to an extent. I believe individuals (family members) need to make the choices they believe are right for them and for their loved ones (the patient), and staying by a loved one's bedside is an individual choice. Even if the family member's health suffers as a result of staying by their loved one's bedside 24/7, that is their choice and they have the right to make that choice, even if from the nurse's perspective it may not be the wisest choice. I have stayed by my family member's bedside virtually 24/7 for seven days on one occasion, and eight days on the next, and I would do it again, and will do it again when necessary. My family member greatly appreciated my being by his side for all those hours, and being trained as a nurse I was able to contribute to his care, which he valued greatly. My point is that although you are correct to say that staying 24/7 is a big stress on a family member, they have the right to make this choice if they feel being by the bedside of their loved one is more important than their own physical/mental needs and if they believe their loved one would feel supported by their presence. From a nurse's perspective staying by the bedside 24/7 may not seem like a prudent action, but family bonds can be very strong and this is an individual decision that family members make, and I believe in respecting that decision and supporting it to the greatest extent possible. Again, of course there are limits to how long even the most dedicated family member can go without a good night's sleep, and in other situations with family members who were hospitalized, I have absolutely needed to go home to sleep. As far as the need to sleep in order to make the best decisions; obviously at some point sleep can no longer be put off. I cannot propose that family members should not stay at the bedside of their loved ones 24/7 as I cannot determine what is right/best for them; only they can do that. I believe in supporting the family's choices.

In regard to your last paragraph, I respect your point of view although it is different from mine. I believe I may refer to myself as older too, and I have experienced the deaths and serious illness of close family members too. I know the choices I have made in regard to staying at the bedside pretty much all the time, and I would make them again, but I cannot begin to say what is right or wrong for any one else. I believe in supporting the family's presence at the bedside to the greatest extent possible and I believe in supporting the family's choices to the greatest extent possible.

Altra, BSN, RN · Jan 22, 2014

I probably will not be alive to see it ... but maybe someday, through some as yet unknown technology ... recovered patients will be able to recall their family members saying, "Dad - wake up!" and "Come on - you have to fight harder!" for hours at a time. And I hope they dope-slap them all.

Here.I.Stand, BSN, RN · Jan 22, 2014

I work in the SICU (which includes trauma and neuro) of a Level 1. The whole hospital is big on patient & family centered care and has unlimited visitation even in our ICUs. We discourage children under 12, and we have designated quiet time where family aren't forced to leave, but must be quiet and have the TV off. And of course the pt or next-of-kin if the pt is unable to communicate can bar specific people from visiting. Family is not asked to leave during report either; they've found that they ask fewer questions of the RN when they've gotten such a detailed update.

I work part-time and have only been here for a year, but I've only had to speak to a visitor once. The pt was having ICP spikes w/ any stimulation, and his friend kept rubbing his hand and talking to him. It took some explaining b/c he had heard that "you should talk to someone who's in a coma," and he seemed a bit slow anyway. But once he understood why his friend needed such low stimulation, he moved his chair away from the bed and sat quietly.

Sure it can be challenging fielding lots of questions and concerns from family. But part of our job is education. Families aren't doing it to annoy us; they are in terrifying situations and need to know what's going on. If I'm checking meds or titrating a drip and someone is talking to me, I'll politely ask them to give me a second and then give them my attention.

DroogieRN · Jan 23, 2014

My unit allows visitors from 10-2 and 4-8, with enforcement up to the discretion of the patient's nurse. Sometimes I am very strict with the hours; others, I allow family to come and go, generally, at will. We are a locked unit and the visitors have to pick up a phone to be admitted into the unit. If I am in the middle of my assessment, or I am cleaning a patient, or doing a complicated dressing change, the family has to wait. Generally, I allow them back. I absolutely do not allow them to stay the night unless the patient is actively dying. Our visitors' lounge has fold out couches and we provide blankets, etc. The size of the room does not allow for tons of people and me having complete access to the patient. I also find that I am often bombarded with questions while I am trying to assess, listen, pass meds, check neurological status, etc. I do understand that people have concerned about their loved ones -- I have been that family member wthoutna medical background -- but I appreciate the uninterrupted time that limited visiting hours affords the nurses. It is not selfishness. It is about being able to provide exemplary care without interruption. I had an intubated patient recently that the pulmonologist was trying to wean (albeit agonizingly slowly). Her family would get six inches from her face and shout, "Mom! Are you thirsty?!". Her resps would be in the high 30s and her heart rate would be well over 120. I would beg, insist, plead, that they get out of her face and just be a presence in the room and let her rest, to no avail. Fnally I made then leave from 2-4 pm, explaining that it was a rest period for patients and that they should go get lunch. They wholeheartedly agreed. Her VS were perfect while they were gone. They arrived promptly back at 4 pm, got right in her face and screamed, "Mom! We tried to come in but SHE wouldn't let us.". Patient's heart rate shot up promptly to 140 with resps At 36. Patient never was able to extubate.

SNJS · Jan 25, 2014

My ICU has open visitation 24/7 and children are allowed in at anytime as well. The only rule is only two visotors in a room at any given time. (Just in case there is a code situation or an emergency and we need to get to the patient quickly). We also allow family to be present during codes if they desire. This is a very liberal stance on visitation but it definitely improves patient/family satisfaction.

Ill admit, it can definitely be frustrating. When your managing a CRRT machine, 10 drips, a ventilator, and the family is questioning every move you make! Not to mention, people start to abuse the rules...we've have kids running around at wee hours of the night and waking patients up. However, I do think it is best for the patient/family. If my loved one was spending their last nights in the ICU I would want to be with them at all times! I would want my two year old to have to chance to see their grandma if she was dying in the ICU. I also feel that allowing the family to see CPR/code scenario gives them closure...knowing exactly what happened and knowing that the team did everything possible to save your loved one...

Ruby Vee, BSN · Jan 25, 2014

My ICU has open visitation 24/7 and children are allowed in at anytime as well. The only rule is only two visotors in a room at any given time. (Just in case there is a code situation or an emergency and we need to get to the patient quickly). We also allow family to be present during codes if they desire. This is a very liberal stance on visitation but it definitely improves patient/family satisfaction.
Ill admit, it can definitely be frustrating. When your managing a CRRT machine, 10 drips, a ventilator, and the family is questioning every move you make! Not to mention, people start to abuse the rules...we've have kids running around at wee hours of the night and waking patients up. However, I do think it is best for the patient/family. If my loved one was spending their last nights in the ICU I would want to be with them at all times! I would want my two year old to have to chance to see their grandma if she was dying in the ICU. I also feel that allowing the family to see CPR/code scenario gives them closure...knowing exactly what happened and knowing that the team did everything possible to save your loved one...

I fail to see how it's best for anyone to have kids running around at wee hours and waking the patients up. If it were MY loved one being woken up by YOUR loved one's two year old, I'd be mighty upset.