ICU visiting hours

Specialties Neuro

Published

Ok all you ICU nurses, I need your input!

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. :eek: 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! :rolleyes:

Let me know what your visiting hours are and what you think of open visiting!

Thanks!

:kiss

Specializes in Acute care, Community Med, SANE, ASC.

I work in neuro ICU and we have open visiting hours 20 hours a day with the exceptions being 2 hours at a.m. shift change and 2 hours at p.m. shift change. The rule is supposed to be no more than 2 visitors at the bedside but I often see a few more, although I personally haven't seen it abused much (i.e. 10 visitors). Our visitors do not have to check in or anything like that...they can just walk right in. We do strictly enforce the 4 hours that they may not come in. We discourage sleeping in the room like one is camping out and I haven't seen that much either but I haven't taken care of any of the young trauma patients yet as I have only been in neuro ICU for 3 months. I came from a med-surg floor and I thought the open visiting hours would be a disaster in ICU but I really can't say I've had any problem with it. Frankly, I'm surprised how little people are at the bedside--not in a bad way just that I thought families would be there the entire 20 hours and most are not.

You might be surprised that if your visiting hours are more open family members might not be so overwhelming and pushy as they are in the very short visiting hours. I think it gets pretty boring and depressing to sit at the bedside of an unresponsive, vented patient and most family members eventually get the picture that they need to go home and get some rest. Many of them can't mentally deal with being at the bedside constantly and I find that many make brief visits to the patient and then go back to the waiting room even during times they are allowed to be in the room.

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Specializes in Trauma ICU, MICU/SICU.

I'm still new to Trauma-Neuro ICU but we've had open visitation.

Families can visit 9:30a to 6:30p then 8:30p to 06:30a. If they are in any way interfering with the patient's care (for example over-stimulating a neuro) we can tell them to leave.

Just yesterday, I had mom & dad over-stimulating my SAH, Frontal Hemorrhagic Cont, DAI. I told them that he needs rest and quite, showed them his elevated HR and BP of 190's over 90's and told him that is a direct result of them talking to him. Dad wanted me to give him something for the BP. I told him he needs absolute quiet. They're welcome to stay but they may not speak - even to each other. Assured Dad that I will continue to monitor his VS and if the quiet doesn't settle him I can medicate him.

Parents were very compliant at that point. But, I know not everyone is. Our hospital has had open visitation for a long time and it definitely is more labor intensive for the nurses, but we absolutely enforce the rules and we'll help each other out with bringing the point home.

BTW, the above pt's SBP went down the the 130's and Dad actually asked me at what blood pressure can we start bugging him again. They just don't get it. Mom said, I just want to be able to read a book to him without his blood pressure/HR going up. I guess they hear what they want to hear.

Hang in there, you may not be able to stop it, but make sure you have strong language for visitors about the rules and the nurses authority to enforce them. They harm/interfere with patient they're out.

Good luck!

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Specializes in ICU, Telemetry, neuro,research.

While I understand both sides, I still here my parents talk about how difficult it was to "live iin the waiting room waiting for our 30 minutes with you,' I also see it from the patients side, even while I was in a coma, I wanted to hear something soothing and hauntingly familiar like my mother's voice-even though when I woke up, I did not know that was who she was. I also see it now, from the nurses side, there are things that we do not want the family to see, and it is hard enough for us and the patient to see. There are times that the 24 hour lights and beeps and alarms of the ICU are all the stimulation either of us can handle. The bottom line needs to be the safety of the patient. The patient is there to be closely monitored in a CLOSED and CONTROLLED enviornment. The setting is not perfect but it is that way for a basic reason. Now, compromise could be the answer. :yeah:Though most administrations are a feast or famine situation. :bowingpurPerhaps, making the hours a little longer, an hour instead of 30 minutes? But the nurses must have autonomy in our domain. We must have control in our realm. We should be able to call security and close the doors, not because we are calus or unfeeling. We each have cried our share of tears for our patients. But enough has to be enough!:angryfire Or do we have to wait until we have an "adverse event" or God forbid a "Sentinel event" before someone with authority listens to our cries?:nurse:

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I work in the ICU, also with neuro patients, and I think open visitation can be a henderance to the nurses, doctors and patients. Currently we are closed from 6-7:30 am and pm for shift change and first assessment. other than that people are free to come and go as they please. can be a big hassle when the unit is full (14).

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Specializes in Neuro, Critical Care.

HA!

It is true. It does exist. No visiting hours in the Neuro-surg ICU! Supposedly....the only time families are not allowed are between 7-8 am/pm....they normally don't even abide by that. The doors are supposed to be locked, however, anytime someone..dr..family..etc. goes in and out..well people come right in............no one calls...we don't have security anymore (wasnt in our budget). Famlies spend the night-bug the living daylights out of you when you are trying to get things done...dear god the monitor beeped!!! we practice family centered care you know! HA!

Even during shift change we struggle to maintain HIPPA-we all try to enforce the rules but we allll know how families seem to think the rules are there for everyone else but not them. Amazing.

Are you ready for the best part?!?!?!

At our staff meeting a few weeks ago we find out that children are not going to be restricted in the ICU any more either! Bring on the babies! Or so they state it...It is up to the RNs discretion. Hm.

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Specializes in Neuro, Critical Care.
I'm still new to Trauma-Neuro ICU but we've had open visitation.

Families can visit 9:30a to 6:30p then 8:30p to 06:30a. If they are in any way interfering with the patient's care (for example over-stimulating a neuro) we can tell them to leave.

Just yesterday, I had mom & dad over-stimulating my SAH, Frontal Hemorrhagic Cont, DAI. I told them that he needs rest and quite, showed them his elevated HR and BP of 190's over 90's and told him that is a direct result of them talking to him. Dad wanted me to give him something for the BP. I told him he needs absolute quiet. They're welcome to stay but they may not speak - even to each other. Assured Dad that I will continue to monitor his VS and if the quiet doesn't settle him I can medicate him.

Parents were very compliant at that point. But, I know not everyone is. Our hospital has had open visitation for a long time and it definitely is more labor intensive for the nurses, but we absolutely enforce the rules and we'll help each other out with bringing the point home.

BTW, the above pt's SBP went down the the 130's and Dad actually asked me at what blood pressure can we start bugging him again. They just don't get it. Mom said, I just want to be able to read a book to him without his blood pressure/HR going up. I guess they hear what they want to hear.

Hang in there, you may not be able to stop it, but make sure you have strong language for visitors about the rules and the nurses authority to enforce them. They harm/interfere with patient they're out.

Good luck!

Also love those family members that just insist on piling the blankets on a febrile pt with a temp of 39 C..on a cooling blanket for that matter! Doesn't matter how many times you tell them......think about all the other things i could be accomplishing in that time!

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Specializes in ICU/PACU.

We have open visitation & I hate it. I really miss the days of closed visitation!

This is what we do:

2 visitors allowed during the day, from 8am-9pm. They are allowed to rotate with other family members. But, rule is only 2 at a time. They stay for rounds & stay for shift changes...they stay...they don't go away!

At night, it's only 1 visitor, they are allowed to stay overnight. So now we have to find a cot for them to sleep on. Get them blankets,etc...

It's horrible. We did it to up our customer satisfaction & b/c research shows pts do better with family members at their bedside.

Now, it does have ok moments...family member will once & awhile help you out. But usually, it sucks. Also, we put it in place about 2 years ago & never has management asked us for feedback. So as usual, our opinion doesn't matter. Who cares what we have to deal with...it's the family the counts.

So, a big problem we have is family members obeying our visitation rules. Not so easy. It is common for me to come on for my shift & find 4 family members in the room. I have to be the bad guy & say it's only 1 at a time. I get mean looks and I feel like they think I'm this mean nurse. So, if you are going to implement this...make sure you are strict with staff enforcing the correct number of visitors.

So, neuro pts. This is extra teaching on the nurses end r/t SAH precautions, constant reminding,etc... You have to explain what is beeping. You get complaints if you are loud b/c the family member is trying to sleep. I hate it. It's just more stress we have to deal with. But, nothing you can do about it...unless where you work they actually care about your opinion. Good luck.

I will never forget when I had a pt with an unsecure aneurysm. I was trying sooo hard to enforce the SAH precautions. This pt had 6 people surrounding his bed chanting a prayer. I'm Christian, I have nothing against praying...but this was insane prayer. Loud insane Jesus save us prayer. I told a family member NO MORE, THIS HAS TO STOP...she starts crying. She wanted me to allow a grandchild to go back and visit...I said no. She's crying saying this will be the last time she sees her grandpa,etc... So, I say ok quickly. Anyway, the pt ended up rebleeding.

It's just annoying to have to deal with. Get me a coke, get me a blanket, why is that beeping, what does that mean, horrible looks when you instill pain to get a response, rolling eyes when you turn the lights on to clean up the pt, rolling eyes when you go in for your am labs, sitting right by the bed...constantly having to make room so you can get by & actually assess your pt, interrupting a conversation so you can actually do your job...turning down the tv they have blaring so you can listen to lung sounds. It's annoying annoying annoying!!!

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Specializes in Med-Surg and CCU/ER.

i work at a somewhat small hospital in the icu/ccu unit that only has 8 beds. We have visiting hours set, that some of us follow. Others just let whoever in whenever and they stay all day. When the other staff comes in and tries to inforce the rules, then it causes problems and you look like the bad nurse. Even though you try to explain that the pt needs to rest and assessments to do, and ect. they still get a little testy. Brochures are even handed out so they can read, but alot of them don't care what it says. They just want to be in there. I personally like the closed visitation but for it to work, all of the staff needs to abide by the rules.:banghead::uhoh3:

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