ICU visiting hours.. What is reasonable?

Specialties MICU

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My unit is currently in the process of changing our visiting hours. What does your ICU do? What do you feel is reasonable/fair/in the best interest of the patient and family?

Our visiting hours do not start until 10am and many families are upset because they miss the MD rounding. But our intensivists round early and I just can't imagine families in my rooms before I can even complete a full assessment.

Any ideas?

The unit I work on has open visitation, except from 7am-9am and 7pm-9pm. We only allow 2 visitors per patient and don't allow family members to sleep in the patient's room. If visitors get unruly, disrespectful or interfere with the staff's care then we have no problem getting the charge nurse and/or security involved. We don't allow visitors to linger in the hall (even if it's outside the patient's room) due to confidentiality reasons. We make exceptions to the restricted hours rule only if the patient is actively dying or for some other extenuating circumstance.

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Specializes in ICU, Research, Corrections.
i'll never work in a open door unit, no way under the sun.

I will never go BACK to an open door unit either.

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Specializes in ICU/CCU.

We have 24 hour visitation. Visitors are supposed to be limited to 2 per room. Visitors are not supposed to eat or sleep in patient rooms. Unfortunately, the rules are rather laxly enforced. It's hard to enforce the rules when the previous nurse has allowed the visitors to do whatever they like.

Last week a patient's wife was furious with me when I wouldn't let her put her lunch bag in the refrigerator where we keep our patients' trays. I guess another nurse had allowed her to do this. I had seen her put this lunch bag (already filthy looking) on the floor in her husband's room! I was not going to let her keep it in our clean refrigerator. She also got into an argument with another NOC nurse because she wanted a blanket and pillow so she could sleep in her husband's room (her husband was one of the most stable patient's in the unit). Security had to be called to remove her. A few days later I saw her walking around the unit chatting with people two days AFTER her husband had been transferred out to the floor. Why would anyone let her in to the locked unit if she had nobody to visit there? I really wish there was some discipline in my ICU, but we have no charge nurses ever and no management most of the time on evening and night shift. It's like the inmates are running the asylum.

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

what is reasonable depends upon how reasonable the visitors are -- and it's all too common to have very unreasonable visitors. we have a lot of new nurses who bend/break the rules for visitors because "their loved one is sick." then when the family becomes a problem for the next shift and you have to suddenly enforce the rules, you're the mean nurse. i'm always hearing that "the other nurse let me" drink my big gulp in front of six npo patients, bring my kfc into the room in front of six npo patients, go out the fire doors, go in the fire doors, sit in the charting chair, use my cell phone, sit on the empty bed (when we have an empty bed), ignore the isolation garb, silence the iv pumps -- whatever. i used to think that surely no nurse would go along with some of these ridiculous requests, but unfortunately i've seen them do so. i haven't been able to get this across to the new nurses involved -- either they don't get it or they don't care.

we've had visitors piling into the rooms, and none of our rooms are private. when six or seven folks come to "visit" right after bar closing and immediately request snacks and beverages for themselves (the patient is npo), it gets loud and no one can sleep. even during the day, with two patients at every bedside, it gets noisy. one patient's visitors are yelling at mom because she's hard of hearing, and the visitors for the other five patients complain bitterly about the noise level.

what is reasonable would be to allow two visitors at a time for as long as they can comfortably stand at the bedside without agitating either the patient they are visiting or any of his/her roommates. as soon as they start shouting into their cell phones or wanting food/drinks, it's time for them to go. we'll probably never see those days again.

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Specializes in PICU.

It's interesting for me to see the adult ICU world. PICUs are a whole different ball game. We did away with visiting hours many years ago and when our PICU was remodeled five years ago, pullout beds were put in every room (except the 2 smallest which have recliners) and 2 adults can spend the night. In general, it works though of course we have our issues with people who can't count to 2 visits and have 8, cause a ruckus, etc.

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Specializes in STICU, Travel Nursing.

Wow! I don't think that I could work in an ICU with family coming and going as they please. I work in a Level 1 Trauma hospital in STICU. Our visitation hours are at 10:30, 13:30, 16:30, and 20:30 with each being only 20min. Sometimes you get family that don't want to leave when the announcement is made that visitation is over and you have to "politely" tell them to leave.

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Specializes in Critical Care - Cardiac Medical ICU, GI.

Yes, family can get in the way of care at times. But wouldn't you feel bad if you were so strictly enforcing the visiting hours, and the patient died without their family around? What if you denied them the chance to see the patient "one last time?" What about those who travel for hours and days to see their critically ill loved one, only to hear they must wait 2 hours until the arbitrarily scheduled "visiting hours"? How well does that go over? What if it was you that was told to wait to visit your family? What about reasonable family members, you can't let them stay "extra"?

We don't have scheduled visiting hours, we try our best to provide family centered care (as the AACN recommends). The visitors call in at the door, and the secretary checks with the nurse if now is a good time. If there is a procedure/clean up ect... it is not a good time and they are told to wait for x minutes to come in.

During change of shift we talk to pt and family right before, saying, it is time for the nurses to give report for 30 minutes, to respect patient privacy we ask for you to stay in the room with the door closed, or use this time to step out to the waiting room or go eat. It just takes stating and setting the expectations.

Our policy is that visiting is at the nurses' discretion. If the family doesn't like the nurses discretion, we fortunately have good charge nurses they can work the situation out with while we take care of the patients.

It would definitely be easier to point to a sign and say "everyone out, the sign says so!" instead of interacting with the family and explaining your rationale. And yes, there are those crazy family members, and if they can't respect our rules, hello public safety!

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Specializes in icu/er.

heck yea lets just have open door policies for the whole hospital altogether. open up the pacu,nursery and the or. better yet lets just allow crazy butt visitors to just waltz into the ceo's and don's office. the aacn is starting to loose its luster with me concerning this open door idea, overall its not a popular topic with the regular icu nurse.

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I'm kind of on the fence with this one... on one hand I feel like its extremely difficult to care for a patient when I have to worry about their family member too. On the other hand, I wonder if allowing one family member (usually the spouse) to stay with the patient wouldn't be better for their peace of mind. I think the problem is that patients and their families are the ones pushing for more visitation... not the nurses. I have allowed family members to stay if they are polite and understanding of what my job is: to care for their loved one. I've also kicked family members out (especially when there are 30 of them that all want to pack in!).

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Specializes in Telemetry.

I know AACN recommends opening visiting hours, but are these people who have worked as a nurse, in the ICU anytime recently? The families dont understand how important it is to have report /shift change uninterrupted. They also dont sleep, tend do have a larger tendency to be inappropriate , even abusive when they are up for days staring at the monitor. They dominate your time, dont understand when you have something else to do. I have had multiple , multiple family members constantly poking, rubbing their face, trying to wake them up, then they go ape SH** crazy again after I have just calmed them down.. or raise their ICP, blood pressure, etc. They sneak in food, even illegal drugs to give to the patient , and dont feel that you are ANYONE to tell them ANYTHING.

The only time we allow overnight visitors is when the patient is going to die SOON. I find it ethically difficult to limit visitors, as it is the last time they will see the family member alive. I also am very fearful I will tell a family to go home, then they die overnight

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Our official visiting hours are 1000 - 1800 and 1930 - 2030. We do not allow visitors to stay overnight unless the patient is dying. They are welcome to stay in the waiting room, and our hospital maintains a certain number of "hotel rooms" next to the hospital for family members who want to stay nearby. However, we have used nurse discretion for those with extenuating circumstances, like the family member works graveyard shift and wants to come in at an odd time for a few minutes.

I don't like confrontation, and it is uncomfortable for me to kick visitors out right at 2030. But, then again, I like the fact that I work night shift and don't have to deal with the family all night long. :o)

I had a patient who was unstable yesterday, but by the time I came in, he was looking a lot better. I knew he was still very sick, but thought he was turning the corner. I reinforced the visiting hours, and the family drove home about an hour away. Then, the patient went into flash pulmonary edema, coded, and died at 2330. We notified the family, and they had to drive all the way back to the hospital. They were very gracious and stated that they really needed the time away from the hospital, but I still felt horrible!

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Specializes in MICU/SICU.

For the most part families don't bother me. When I need them to step out so I can do an assessment, procedure, or just plain old need to think without distraction, or if I need to reduce the amount of visitors in the room, I kindly do so. I think about how I would feel if one of my loved ones were in intensive care. I would want to be there as much as possible. If I myself was in intensive care, I would want my loved ones with me. I do however, not tolerate disturbing the patients, or interfering with sleep, hanging in the halls or nurses station, and I tell them to stop watching the monitors, and will even turn the monitors the other direction from where they are sitting. I explain what I'm doing when I go in the room. If I'm hanging an antibiotic, I say so. If I'm giving lovenox or heparin, I say so, and explain it. And I do make it a point to ask how families are holding up, and if they are taking care of themselves, getting sleep, eating etc, and often encourage them to go do so, if they are not already.

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