Locked I.C.U

fergus51 · Feb 26, 2004

We have visiting hours 23 hours a day cause we're an NICU, so parents are allowed in almost all the time. They are not allowed in during report. I hardly think that's asking too much, but we still have parents bawling us out for enforcing this rule. Can be very frustrating.

RMalfaitRN · Apr 12, 2004

After 10 years as an ICU nurse, my hospital built a brand new critical care unit. Most nurses would think it is great to work in such new, high-tech surroundings. Unfortunately for us, the new unit came with completely open visitation, there isn't even a door to be locked. What I haven't seen addressed anywhere in the research, is why we are encouraging families to sleep in the patient rooms. After all, our new ICU has beds, recliners, bathrooms, etc. all for the family to use. exactly how do I provide "family-centered" care when there are 6 to 10 family members sleeping in the room??? I have never been treated as badly as I have since my "strong administration" started this mess. The very last shift I worked, my shift supervisor was less then 6 inches away from where a family member punched the wall in the family room. I had asked her to please talk to the family so that they would allow the cancer-ravished, recently coded loved one to rest, after all it was almost midnoc and they came into her isolation room, disobeying all isolation precautions, turned on the TV and lights. There was 5 or 6 of them and the pt was a full code. If this is now ICU nursing, I'm out of the business!!!! All the teaching and "butt-kissing" of families does not work in every instance and the clinical nurses should be given the tools necessary to do their jobs successfully and be backed 100% by their "spineless" administrators. This will never happen in my hospital. My boss made it very clear to me that my opinion(and that of my colleagues) does not matter, unless of course you are one of the few who will tell them what they want to hear instead of the truth. There are approx. 10 hospitals in this city and my current administration feels that the best way to attract patients and avoid lawsuits is not through excellent patient care, but via "kissing-up" (administration calls it PR) to the families. Afterall most medical lawsuits are filed by family members and not the patients themselves. Oh yeah, I almost forgot, my other patient on the same shift had orders to call security if anyone tried to visit before she was extubated. The pulmonologist was tired of not being able to extubate his patients in a timely manner b/c of too much stimulation--this time we got lucky, the spouse agreed with the plan of care after the pt failed 3 previous tries at extubation. Now, how could this situation be good for any patient??????? I would be interested to hear from anyone trying to work in a ICU where the family is sleeping in the rooms. I thought family centered care is when the family assists and participates in the care of the patient, how is this accomplished when they are sound asleep?? I have accidently woke-up family trying to give care to their loved ones in the dark and they are soooo rude and mean sometimes. I don't care what anyone says, I KNOW that all this family discourages the nurse from being present at a bedside that she can't even get to!!!!! We are NOT allowed to ask family to leave for personal cares or any other reason!!!!

Thanks for letting me vent!!!!:angryfire :angryfire

CC NRSE · Apr 12, 2004

I am currently on an assisgnment where they have an "open door" policy. Visitors walk in,out and around the unit peering in every room and listening to every conversation at all hours of the day. I personally think this puts not only the patients at risk, but us as nurses at risk for harm not to mention violating the HIPPA policy. Just the other day we had family puching each other and fighting in ICU. I was terrified and my poor little patients were even worse. Although secruity was there in a matter of minuets, it only takes one person with a gun to wipe out several. Having been on both sides now, I don't think this helps the patients recovery. In some cases (most) it even hinders it. Also not to mention it puts the families and pateints in a bad position. Most people don't feel like "entertaining" when they are in ICU. I know I wouldn't. They also don't want a room full of people in there laughing watching TV and having a good time. Maybe the idea behind this is to have family involved, but I personally think it hinders patient care. Families seldom help with care and some are even offended if you ask them to help. I figure if they are going to stay in the room and expect me to wait on them (as well as the patient) the least they can do is help me with little things. (as well as they are able) I also think it takes time away from the pateint. I have spent more time explaning to family or doing things the family wanted me to do than taking care of the patient. Families don't always see the big picture. "yes I realize dad hasn't eaten in 24HRS" never mind the fact that he has had a big stroke, can't swallow and possible going for EMERGENCY surgery ASAP. As I am trying to get my patient ready for surgery they are hounding me about the fact that he hasn't eaten. What's more important at this time? If I don't get dad to the OR ASAP we might not have to worry about him eating, EVER AGAIN!!!! This actually was a little extreme and once I explained surgery took priority, they understood. But such things have happened and sometimes families just don't get it. My first priority is to my patient. I don't feel I can give as good of care as I should with people constantly walking in and out of the room and staying round the clock. Never mind the fact the patients have no privacy. I feel we should have set visiting times, then at the nurses descretion, one family member could stay as deemed appropriate. I also find when familys are allowed to come and go freely, they are disrespectful to staff. They deem this as their right to come and go freely. If posted visited times are posted and they are allowed to stay, they seem to be more respectful. Sorry this was a long vent, but I just don't see where it helps the patient. I think this is more for family than the patients. I am very much a patient advocate and this is why I am very strongly opposed to it. Unfortunately, with management it all about pleasing visitors and making them happy.

tsgarman, RN · Apr 20, 2004

We are also an unlocked unit. I absolutley hate it!!! I have only been a RN for about a year and wanted to work in critical care for the one on one pt care and experience. I find it very hard to do that when I have to take care of the family more than my pt's. It seems that it does not matter how many times you tell the families the rules they still do what they want. And yes I hate it when they hang around other pt's rooms while you are busy with pt's. Or threaten to sue you because you are busy and don't have time to do something for their loved one. God forbid the code you are in the middle of is not important!!! I do understand that this is their loved ones but they also need to understand that we are trying to take care of their loved ones and with them bothering us q few minutes makes it impossible. I could go on and on about this but I won't. I think we could go on and on about this.

EmeraldNYL, BSN, RN · Apr 20, 2004

We have the same problems in my unit. Visiting hours don't start until noon, but we often have family members show up at 9 am and bug the docs during rounds. The docs often appease the family members too and don't ask them to leave. We have had family members get angry when we tell them they can't sleep in the patient's room. The administration doesn't say anything if family members sleep in the waiting room though. Especially on the weekends, it can really become a hindrance to doing your job. I feel like I spend more time appeasing families then doing patient care sometimes. Has anyone done anything that has worked regarding visiting hours? I feel like our visiting hours are not enforced at all. If one of my loved ones was in the ICU, I would want to be there, but c'mon, there has to be a compromise!!

Ruby Vee, BSN · Apr 23, 2004

Open visiting is a nightmare! It takes a lot more nursing time to deal with the families in most cases than it does to take care of the patient! I don't mind giving a long explanation to the family once -- even twice in a morning. But when every family memeber from Grandma to the second cousin needs to personally hear the explanation from me (and not from the patient's spouse), it gets old real fast. And the time I'm explaining to the pastor's wife why I need to draw this blood is time I could be drawing the blood, sending it to the lab and feeding my other patient! Thank God for HIPAA -- I can just refer the questions to the next of kin! HIPAA raises it's own problems, though . . . .

I won't allow visitors to hang out at the nursing substation or in the hall at all. I've had visitors evesdrop on report and then run out to the waiting room to share all the details -- and it wasn't their loved one's report they were listening to! I left one family in the hall briefly, while I got Dad off the bedpan, and they amused themselves by pulling the tops off all the vacutainer tubes on the spare bedside cart in the hallway and putting them on different tubes. One young husband of a patient decided to take a nap in the "empty" bed in his wife's room . . . the one that was all made up for the patient who was coming back from surgery RIGHT NOW! The "girlfriend" of one comatose patient amused herself by reading through his chart -- a fact that the patient's wife did not find amusing when she arrived at 3AM after an emergent return from her business trip. And that's not even addressing the husband who was determined to "Fix all her problems" with the 9mm he had stuffed in his pants, the son who was planning to "end Dad's suffering" with a home-made machete or the family member who "Didn't want no godda**** fairy taking care of HIS pa" and rectified the situation by decking the (male) nurse, dragging a female nurse into the room to take care of Pa, and then barricading the door.

No matter how stringent or how relaxed the rules are, it you're one of the few that enforces them, you're always the bad guy.

Two months after we got married, my husband was drawing blood from an HIV+ Hep C patient when her husband shot out of his chair and grabbed my husband's arm. (No explanation was ever given for this behavior!) Predictably, my husband stuck himself. (I've always wondered if we would have been able to have our own child if not for this mishap . . . rather hard to conceive using condoms! And since I was 42 at the time, by the time we were able to stop using condoms, the window of opportunity had passed.)

Neither hubby nor I will ever work in a unit with open visitation again!