NICU visitation policy-Are more visitors really better?

mac23 · Mar 23, 2005

We are a parents and grandparents only unit. Right now we are parents only. No visitation at shift change otherwise they can come when they want. We also ask them to leave when we are doing a procedure or a baby is going bad.

sparkyRN · Mar 23, 2005

Our bigger problem has been a couple of parents with kids positive with MRSA GOING TO VISIT OTHER BABIES!!! I'm all for parents making friends with eachother, but parents with kids in isolation need to stay away from the other babies. Common sense is not always common, so it falls on nurses to police visitors.

Had the same thing happen Monday! I was in an isolation/cohort area for MRSA when the 14yo mom of a septic 4 week old 23 weeker came to visit. She left and told me she would be back later. She came in with another mother (her aunt)to visit that baby. While I was assessing another isolation baby, they walked over to check out the VLBW baby. I yelled out NO! They had not even washed their hands and were ready to get into the 23 weeker's bed. I explained to them that they absolutely must wash their hands between visits to the babies. Then I told "auntie" that it would be much better for her to avoid the isolation area all together because of the risk. She was very understanding and glad that I stopped her. The 14 yo however couldn't see the big deal. It's like, so many people only get the stuff they can see. Since you can't see the germs, to them ther isn't a problem ARRRGGGHHH! :nono:

Gompers, BSN, RN · Mar 24, 2005

We occasionally ask parents to leave if we are doing a procedure. We encourage parents to be present if we are coding their baby or actively working to save it. Nearby parents are asked to leave for privacy, and I've never had one argue since they can SEE that something bad is happening.

Can you believe that I've had trouble with this in the past? I remember clearly the night that I was caring a for a baby that was coding and ultimately died - and when a coworker asked the parents of another baby across the room to give us some privacy, they flat out REFUSED to leave. They said this was their time to visit their baby and they weren't going to get "cheated" out of it. They were both back to work full-time because their baby was chronic and nowhere near ready to go home, so yeah they really did only have the evenings to spend with him. But come on, your baby will be here tomorrow, this dying baby's parents only have these next few minutes to spend with THEIR child. They still refused to leave. THEN, they continued to talk and chat, even LAUGHING as they continued their visit. They knew full well a child was dying twenty feet away from them, and they didn't even give those parents any respect or privacy.

I refused to care for that chronic baby after that, because I never wanted to deal with those selfish parents. :angryfire

kitty29 · Mar 26, 2005

I've posted in the past about my nephew/godson who died several years ago, at less than one week old. He spent that whole week in the NICU, and your post made me recall how I felt about visitors. I really think that it should be very limited. Mom and Dad, should be allowed in at all times, but anyone else should be kept to a bare minimum. I know that I would have been terribly sad if I hadn't been able to see him, but if it was better for him that I not visit, I would have dealt with it.
At the time, I remember being concerned about the amount of visitors, and well...the type of visitors. My brother-in-law, the baby's father, had many family members there at any given time, and while they were nice folks, all there out of love for the baby, most of them weren't very clean. The younger adults had usually been drinking, though I wouldn't say they were drunk. There were many children, of all ages as well.
It did worry me. We were all instructed how to scrub before entering, but we were not watched, and I think we should have been. All of the children were allowed in at some point, and I was concerned because kids just naturally have colds and such. You get 15 or 20 kids together and chances are one of them has something contagious.
I don't recall the exact numbers, but we were allowed in, a few at a time, as long as Mom or Dad were present. I think it would be better to limit the visitors. Sick babies need rest, not visitors. Mom and Dad need to concentrate on the child, not on great aunt Mary. Depending on circumstances, other family and friends, can be allowed in, once, for a brief visit, especially if the child is terminal, but the bulk of the time should be just parents and child. If the NICU stay is to be a short stay, then other visitors shouldn't be allowed at all. They can wait until the child is transferred to a regular room, or goes home.
Last of all, nurses have enough to deal with as it is without having to worry about visitors. Hospitals should set the rules, and be firm about them, even hiring security to see them enforced, so nurses can spend their time doing what they're paid to do.
Just my two cents worth

While I do see where you are comming from, I think, esp. in the situation of a death, the matter of who visits should be up to the parents.

If any type of support can be given at the time or down the road through a shared experience...these families need it.

We generally have the family in a secluded area of the unit if possible, and we allow anyone in that the parent's wish (of course they can not be ill). We on occation have also had a sort of hospice situation when the parents took the baby in the rooms ussually used for rooming in PT d/c...this family didn't want to go home.

So that's my $.20 worth!!

KRVRN, BSN, RN · Mar 26, 2005

We are open for visitation 22 hours a day and are only closed for shift change. It is always unbelieveable when parents get huffy about having to leave for an hour.

Hello... do you realize how generous 22 hours a day is?! :rotfl:

RN4NICU, LPN, LVN · Mar 27, 2005

We are open for visitation 22 hours a day and are only closed for shift change. It is always unbelieveable when parents get huffy about having to leave for an hour.
Hello... do you realize how generous 22 hours a day is?! :rotfl:

Not only is it generous, but it is not exactly developmentally appropriate. Seriously, some larger NICUs are a virtual zoo with visitors coming in and out. In addition, some people truly have no sense. They will laugh and carry on - using their "outdoor voices" - while premature babies are trying to sleep and grow. Unless there are carnivals inside the womb that we are unable to pick up on ultrasound, constant visitation, noise, and stimulation is completely inappropriate developmentally.

Parents (and all the other visitors) seldom think about this. They are thinking about what is best for THEM, not what is best for the baby. Then they look at us like we are monsters when we dare suggest that they let the baby rest.

:rolleyes:

Nyoro · Mar 27, 2005

Wow, some of these messages make me thankful for the difference in culture! I posted a bit back in the thread about our policies - 3 minute wash, gowns, 24/hr visitation, parents ONLY, etc... I never ever would have imagined parents being noisy would be a problem! We can have every parent in there at once and still hear a pin drop if the feeders are all fed and quiet (We`re a series of connected rooms). No one ever talks above a whisper, and they end up apologizing if their baby is crying! In fact, most of our nurses are noisier than the parents ever are.

I can only remember one situation where noise was a slight problem - we had 700g set of triplets going home after 8 months. Mom and dad were scared to carry them out alone, so we let grandparents in. They were just too thrilled, and declared it quite vocally. We asked them to be quieter, and they were. I just can`t imagine anyone refusing.

dawngloves, BSN, RN · Mar 27, 2005

Wow, some of these messages make me thankful for the difference in culture! I posted a bit back in the thread about our policies - 3 minute wash, gowns, 24/hr visitation, parents ONLY, etc... I never ever would have imagined parents being noisy would be a problem! We can have every parent in there at once and still hear a pin drop if the feeders are all fed and quiet (We`re a series of connected rooms). No one ever talks above a whisper, and they end up apologizing if their baby is crying! In fact, most of our nurses are noisier than the parents ever are.
I can only remember one situation where noise was a slight problem - we had 700g set of triplets going home after 8 months. Mom and dad were scared to carry them out alone, so we let grandparents in. They were just too thrilled, and declared it quite vocally. We asked them to be quieter, and they were. I just can`t imagine anyone refusing.

I agree. The culture gap is huge! The Japanese are are more quiet, repectful group. And you know we Americans are loud. :chuckle

NICUFaithRN · Mar 27, 2005

after reading a thread on adult icu/ccu visitation, i went back through the last 6 months of threads on this site. i didn't see a discussion on nicu visitation and would like some input on your unit's policy.
for years and years our unit allowed 24 hour visitation for parents and grandparents only. about 3 or 4 years ago the hospital required us to allow other visitors accompained by either parent and over the age of 14 to visit. only 2 people are allowed at the bedside, but visitors can swap in and out. we require visitors to do a 3 minute scrub before entering, but there is no one there to make sure that they do it properly!
my concern is the increase we are seeing in infection among our babies. granted the high acuity and understaffing play a roll in this. however, these are issues we have always dealt with in the more than 20 years i have worked. it's only been recently that we've seen more frequent cases of mrsa-either cultured or colonized-among our babies.
my questions to you: what is your unit's visitation policy? visiting hours? cover gowns -yes or no? does some one help visitors scrub?
thanks for your input!
sparky

our unit has 24 hour visitation for the parents with the exception of an hour and a half in the am and an hour in the pm around change of shift so we can give our report without the parents hearing every little thing going on with every baby in the unit. we have a very large level iii and we generally carry a census of 70 or more babies... that makes it very difficult for the number of visitors we actually allow.

parents and/or sos are allowed to visit whenever they choose (barring change of shift) and they can bring up to 2 visitors (whoever they want) at a time -- for a total of 3 at the bedside at any given time. we do not allow any child under the age of 12 - however, it doesn't take long for the parents to teach their 9, 10, 11 yr olds to lie about their age and really there's nothing we can do about it... except ask to see their birth certificates - like that would happen!! in addition to a 3 minute unsupervised scrub, parents are asked to remove all jewelry below the elbows (to include wedding bands and watches) and mom's are discouraged from having acrylic nails. these rules are also strictly enforced for the nurses and ancillary staff working in the nicu. our unit is "locked down" and visitors cannot gain access without being buzzed in, they must provide the baby's medical record number and we can see them on closed circuit tv monitors in each of the 4 bays...

these policies make for some very angry parents, grandparents, siblings, cousins and various other potential visitors but once the appropriate "infection control" teaching has been done and reinforced (sometimes several times) they understand the reasoning behind the rules. most of the nurses would prefer a little more time in which we weren't working in a "fish bowl" there is no time for us to "de-stress" following an "incident" or a loss, as their are always parents in the room. occasionally, we will ask parents to leave if there is an emergency or if there is a sterile procedure taking place but they don't have to go... often times we end up just placing screens around the bedside... anyway, that's how it works for me.

nekhismom · Mar 30, 2005

After reading a thread on adult ICU/CCU visitation, I went back through the last 6 months of threads on this site. I didn't see a discussion on NICU visitation and would like some input on your unit's policy.
For years and years our unit allowed 24 hour visitation for parents and grandparents only. About 3 or 4 years ago the hospital required us to allow other visitors accompained by either parent and over the age of 14 to visit. Only 2 people are allowed at the bedside, but visitors can swap in and out. We require visitors to do a 3 minute scrub before entering, but there is no one there to make sure that they do it properly!
My concern is the increase we are seeing in infection among our babies. Granted the high acuity and understaffing play a roll in this. However, these are issues we have always dealt with in the more than 20 years I have worked. It's only been recently that we've seen more frequent cases of MRSA-either cultured or colonized-among our babies.
My questions to you: What is your unit's visitation policy? Visiting Hours? Cover gowns -yes or no? Does some one help visitors scrub?
Thanks for your input!
Sparky

We have 24 hour visitation, except during change of shift reports. Parents can place 4 people age 18 or over on visitation list to visit when parents are not there, this includes grandparents. Children under the age of 16 are only allowed in if they are siblings (or sometimes the parents of the baby)and only after being screened by a nurse for illness. If parents are under 18, they can not bring in visitors or put anyone on their list under the age of 18 unless they are siblings. So they can not bring their teenage friends in to visit. Otherwise, parents may bring in anyone while they are present so long as the parents are over 18 and the visitors are over 16. Only 2 people at bedside allowed. It's confusing!!

Parents are supposed to scrub in, but I've had moms walk back less than 30 seconds after the secretary opens the door to the unit, so there is no way possible!! Of course, they all say they washed up, but they don't always. Everyone who holds a baby must wear a gown. Gloves are not required.

wannabeL&D · Mar 31, 2005

I just have to share a parent's perspective on this, having been through the NICU twice, the most recent 2 month stay after my son was born at 33 weeks following 13 weeks of strict bedrest, a surprise diagnosis of Trisomy 21, VSD/ASD/PDA, and Hirschprung's disease at birth. Obviously a parade of visitors is inappropriate, particularly if they don't exercise the proper precautions i.e. handwashing...but I don't think it is possible to overstate the amount of stress parents are under and the emotional support that visitors can provide. My husband had to go back to work, my mom was watching my 3-year old, who cried every time I left for the hospital, and were it not for the incredibly kind and caring friends who made the effort (one at a time) to sit with me at the bed side, a difficult situation would have been even more devastating. When we were finally able to logistically coordinate a visit from my daughter (whose vaccinations were up to date), it was incredibly reassuring for her to see her baby brother and helped her understand where Mommy was spending so much time.

I just don't think it is fair to deprive parents of support because a minority of people abuse the system. I can't imagine sitting there every day with absolutely no one to talk to and provide encouragement for what was the most stressful experience of my life. Finally, during my time there, all of the parents were very respectful when asked to leave the unit because another baby needed a procedure etc.

Nyoro · Apr 1, 2005

I hate to write so much here, but *I* too am a parent. I too have been through the entire NICU experience from the parent perspective. And I STILL would never want them to let anyone other than the mother and father in.

My son was born at 25 weeks, weighing 437 grams, and was in the NICU for 5 months. I know that it is stressful, and I know that it can be draining. However, you don`t live in the NICU. You can go home. You can have them wait in the waiting room, take pictures, talk about it, etc. The more people that are allowed to come in, the more chances that someone will bring in something.... And I don`t care how much support I needed, I most certainly didn`t need it enough to risk someone else`s baby dying for it. Washing up is great, but there are countless illnesses you can carry without showing symptoms. For every additional person coming in, the risk of someone`s baby becoming ill goes up. Sure, it may only be a tiny percentage of change, but for a tiny baby it could mean death.

I`m sorry, but this is something that I feel very strongly about, despite being a former NICU parent. People other than the parents do not need to be in there.