Family visitation in ICU

11:11 · Jan 18, 2005

You will regret it.

I think all ICU's should have a large bold sign that says "We Reserve the Right to Refuse Anyone" right on the front of the locked entrance.

I work in the ICU of a large teaching and research facility. Its an open unit. Its been a terrible experience for me. Other nurses might not care or know better. Our NM does not support us either regarding pt visiters or enforcing unit rules. The bottom line is customer based service, not RN's which is why they constantly hire.

The last unit I worked on was locked. We had a great dedicated pool of charge RN's who espoused leadership and supported their staff. If visiters refused to leave security was called pronto. Ive actully seen them use their powers of arrest.

Look, I understand what its like to have a family member in the ICU. Ive been there. Ive also been an ICU pt. So I like to think I am sympathetic. I personaly would not leave my wifes side.

Unfortunately not all people are equiped to deal with the stress of a medical crisis. And they arent always "jerry springer specials" either (I resent that). Many times they are well educated, informed, articulate, and empowered individuals who crack under years of dealing with comorbidities, dysfunctional families, and unresloved issues (one or all).

Another issue is my right to privacy while I practice. I dont think mangement has taken that into consideration nor will they until nurses step up to the plate and stand up for themselves.

I think units with high acuity pts from trauma, transplant, to medical should all be locked. Then let the unit decide if a visiter is accpetable to stay at the bedside or not. If not explain why and kick them the hell out, call social services, chaplain service and somehow help them.

Personally Ive just about had it with ICU-

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bfjworr · Jan 18, 2005

You will regret it.
I think all ICU's should have a large bold sign that says "We Reserve the Right to Refuse Anyone" right on the front of the locked entrance.
I work in the ICU of a large teaching and research facility. Its an open unit. Its been a terrible experience for me. Other nurses might not care or know better. Our NM does not support us either regarding pt visiters or enforcing unit rules. The bottom line is customer based service, not RN's which is why they constantly hire.
The last unit I worked on was locked. We had a great dedicated pool of charge RN's who espoused leadership and supported their staff. If visiters refused to leave security was called pronto. Ive actully seen them use their powers of arrest.
Look, I understand what its like to have a family member in the ICU. Ive been there. Ive also been an ICU pt. So I like to think I am sympathetic. I personaly would not leave my wifes side.
Unfortunately not all people are equiped to deal with the stress of a medical crisis. And they arent always "jerry springer specials" either (I resent that). Many times they are well educated, informed, articulate, and empowered individuals who crack under years of dealing with comorbidities, dysfunctional families, and unresloved issues (one or all).
Another issue is my right to privacy while I practice. I dont think mangement has taken that into consideration nor will they until nurses step up to the plate and stand up for themselves.
I think units with high acuity pts from trauma, transplant, to medical should all be locked. Then let the unit decide if a visiter is accpetable to stay at the bedside or not. If not explain why and kick them the hell out, call social services, chaplain service and somehow help them.
Personally Ive just about had it with ICU-
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How long have you worked at the teaching facility? Has it had open visitation the entire time you have been there? Have you observed any injuries as a result? Are there any positive aspects of an open visitation that you can identify or are they all bad?

mattsmom81 · Jan 18, 2005

As of last month I gave up on my ICU career (and for now my entire nursing career..I'm taking a breather to reasess and heal) so I know where you're coming from 11:11. I can relate to everyone's posts here very very well.

I've had family in the hospital myself and I haven't had a need to behave like so many do out there...and yes too many DO behave like Jerry Springer guests in TOO many cases, sorry to offend you 11:11 but it is the truth. I understand they are having a meltdown but whatever happened to common courtesy, respect, cooperation with rules?? I am marginally staffed to care for critical patients and do not have time to deal with these people, yet management demands we DO.

I suspect folks see much of this reality show mentality / acting out on TV and thus think they are entitled to 'lose it' in the hospital. They are acting out because society permits it today it...the hospital does not care that visitors are interfering with care and too often abusing their nurses, sadly. 20 yrs ago I never had the problem with families I do today so its partly generational.

Sadly, the hospital cares not for what dedicated nurses go through to deliver competent critical care, nor do they care to support us. What they DO care for is 'customer satisfaction' (their way at ANY cost) and bottom line THEIR profits.

I can no longer work as a nurse in today's conditions, sadly, and my mental health is already thanking me.

bellehill, RN · Jan 18, 2005

It was at 3am the other morning when I was sitting at the nurses station and looked down the hall, realizing I had no idea who was walking towards me or why they were on the unit at 3am. I don't feel safe with this open unit visiting policy. I know security will come if I need them but I shouldn't have to call them to help me.

I can only hope for the family that helps with care and nutures the patient, sits quietly in the corner and asks questions pertinent to the patient.

fergus51 · Jan 18, 2005

I work in a neonatal ICU so it's a little different obviously... But, we have open visiting hours for parents (except for shift change) and then strictly enforced rules for others (4 hours a day, siblings only on weekends). It can be great for the right people. Those families get to know the nurses, come to understand our work and can be very helpful. Unfortunately there are crazies out there. I have found the key to open visiting working isn't about open or restricted hours, it's about how the families are controlled when they are on the unit and how the manager backs up her nurses. Unruly, rude, troublesome families need to be stopped in their tracks. People will only misbehave as much as we allow them to and nurses can only stop this if they are supported by their supervisors. That's why I blame supervisors more than the families.

11:11 · Jan 19, 2005

I think fergus has probably hit the nail on the head. And as stated the problem is usually management. Most do not want to risk critisism from higher higher and are so far removed from bedside care that they cant relate or care.

Like I said the solution for them is usually to constantly hire.

And I completely sympathize MM81. I think that you are right that the problem is partly generational. Just today I heard on the news that studies are showing that kids today are having difficulty transitioning to adulthood. Suprisingly a lot of the flak comes from older persons, not the young from my experience.

I hope you find whatever it takes to be at peace. Maybe some day , after a needed rest, you might find a small unit or ER that you might be willing to casual in and spread some of that experience around.

To answer bfjworr I can think of one time a family member removed a restraint and the pt extubated herself. Most examples arent that specific. Disruption of care and sleep come to mind. Most are intangible like lack of privacy for the nurse, other caregivers, and other pts on the unit. Isolation violations are huge in an open unit when its difficult to keep track of visiters. I cant keep count of how many times Ive come back from helping another, supply, or break to find visiters in the room in violation of precautions. We have nosocomial issues.

On time a visiter sat on the nurses chair (with wheels) and fell.

Ive been at the facility longer than two years, less than five. Its been open since long before I arrived.

I see no positive aspects of open visitaton that couldnt be addressed with a good visiter policy based on compliance and stritcly enforced by staff with support from the NM-

HTH

begalli · Jan 19, 2005

Our visting hours:

From 10am - 10pm every 2 hours for 30 minutes at a time/two people at a time.

We just recently increased the time a visitor can spend in the room from 15 to 30 minutes.

Of course we have our exceptions as people have posted here.

I spent a lot of time in my dad's ICU room when he was in the hospital for four months. I frequently stayed way past visiting hours and came in a couple of times at 6am to be there when the docs rounded. His nurses and I had this discussion about visiting hours many times. If they needed me to step out for whatever reason, they'd just say so and tell me that they'd come to get me when they were done. They always did!

I can't tell you how much I appreciated their accomodating me. But then again, I helped them turn and clean my dad, kept on eye on stuff for them and brought them cookies and pizza. We would spend hours talking/comparing jobs/areas that we live/etc. Actually, they were a lot more easy going than I would probably be if my patient had a family member who was an ICU nurse. But that hasn't happened (that I know of), so I don't know.

bellehill, RN · Jan 19, 2005

I work in a neonatal ICU so it's a little different obviously... But, we have open visiting hours for parents (except for shift change) and then strictly enforced rules for others (4 hours a day, siblings only on weekends). It can be great for the right people. Those families get to know the nurses, come to understand our work and can be very helpful. Unfortunately there are crazies out there. I have found the key to open visiting working isn't about open or restricted hours, it's about how the families are controlled when they are on the unit and how the manager backs up her nurses. Unruly, rude, troublesome families need to be stopped in their tracks. People will only misbehave as much as we allow them to and nurses can only stop this if they are supported by their supervisors. That's why I blame supervisors more than the families.

Fergus you are exactly right. We can't open the unit and expect people to know how to obey themselves. Strict rules need to be enforced by nurses and management. The other side of that is that we spend more time with the family than the patient. If management backs us up maybe it will work.

RN34TX · Jan 19, 2005

Although our unit has closed visitation hours....our unit is easily accessible....There are no locks on the double doors and there is no one preventing them from walking through the double doors to the unit itself. Each patient door can be locked and this is encouraged by our manager. There is a red phone visitors are suppose to pick up and use to find out if it is convenient to visit. Many do not use the red phone.... We limit visitors to two at a time... but many do not pay attention... Some nurses do not enforce the rule and then all the other staff nurses receive aggravation from the families when they follow the guidelines. Another problem is families try to wake up sedated patients while they are on the ventilator or loosen or remove restraints while they are visiting and forget to replace them when they leave. Patient confidentiality is compromised when family members approach the nurses station.....we have glass doors on our rooms so all our patients are easily seen by the nurses....and unfortunately sometimes visitors....Do you have some of these same problems....

Love it. That is a classic ICU problem family situation. You just get your wild vented patient calm and settled, in comes the family and it's time to wake up and entertain the family. It's as if the patient is there for the family instead of the other way around.

Then I always hear the famous "Well he'd get off this breathing machine if you'd quit doping him up so much and let him wake up. Wake up Dad, it's me, wake up."

The patients HR and BP jump sky high, starts bucking the vent and we start all over from square one again.

If you bring these issues up at meetings to administration they always follow it up with the famous "We need to educate our families on why their loved one is sedated."

As if I hadn't already tried that a million times. You can educate all you want, it doesn't mean anyone is going to listen. They want their loved one awake and lively when they come in to visit and that's it. Too often they don't want to hear about anything else.

Home Health Columnist / Guide · Jan 20, 2005

Data Supports Open ICU Visitation Policy

By Paul Clark, for HealthLeaders News, January 13, 2005

http://www.healthleaders.com/news/feature62357.html

fergus51 · Jan 20, 2005

Oddly enough that research has almost nothing about nurses' ability to do their jobs with unrestricted visiting policies.

lapappey · Jan 20, 2005

A tangentially related story:

Parents are allowed to escort their children into the OR after donning "bunny suits", caps and masks. Bad enough, right? (Yes this causes all manner of problems ...)

Had one kid, a baby, come in for some small operation, mom is holding him while anesthesia is inducing. Well dad gets bored watching this, and walks over to the back table ... and befor the scrub can say anything ... starts PICKING UP THE INSTRUMENTS AND LOOKING AT THEM.

What could really have been done in this situation, after the fact? Or, as management types say, "what changes could we implement to prevent this type of situation from recurring?"

How about realizing that LIMITS HAVE TO BE SET on patient's families.

Oh, and our PACU has been loosening up visitation lately as well. I wouldn't venture to call our PACU a really pleasant place to be ... no space, packed to the brim with sick patients, people shouting to each other across the room, monitors and alarms going off. Visitors add a whole new dimension to this problem ... wandering around, looking at other patients, taking up space, freaking out when the monitor alarms artifact ...

Two settings where families should never, NEVER, EVER, be allowed ... perhaps excepting parents of small children in the PACU, and then only if caseload & acuity permits ... RN's discretion.

The volunteers who staff the waiting area, BTW, are totally out of control. They are notified when surgeries start and finish so they can communicate that to family ... and as soon as surgery is over, as soon as the Pt is in the door they are on the phone with PACU, 'oh, can so and so's family come up?'

'Not right now.'

'Why not?'

:uhoh3: