NICU visitation policy-Are more visitors really better?

[sparkyRN]

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

[BittyBabyGrower, MSN, RN]

Unfortunately, it is the minority that ruin it for everyone else and you can't make exceptions for one without the others getting irate.

It also has to do with trying to work around lots of people, security and infection, so many, many things factor into it.

[fergus51]

We are currently having a lot of problems with crazy parents/visitors. Security has been up to the unit 4 times this week. Flexible and extended visitation can be great or it can be a huge problem.

[pooh54]

Hey there! regarding visitors, we have a 24 hr policy and our Director of services (L&D nurse) refuses to allow us to close at any time. We have been able to enforce a 1/2 hr close policy due to changes in HIPPA/privacy issues. Most parents are very understanding about this. Only 2 at a bedside (twins or no) and one must be a parent, sibs only under 12. Handwashing is now done with Avaguard surgical scrub by all staff and parents. Cover gowns for visitors if they plan on holding infant. We do have to explain to parents that while they might not be worried about infection for their kiddies, we are quite concerned about them. Sometimes it works, sometimes not, if a parent insists or demands, our director will not back us up. There is some literature out there regarding new thinking or family centered care in NICU's. Some of it is very interesting. We have had complaints from some parents that during a stabilization, they have felt that no one is paying attention to their baby, can't believe I'll ever be able to convince them about nurse's having 8 eyes, sigh.

[SarasotaRN2b]

While I agree parents should have the opportunity to see their baby in the NICU, I would think that as a parent I would feel better if I didn't see everyone and their cousin in the NICU. Of course, it would have to start with me where only me and the baby's father would be the only visitors.

Kris

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.

[LnDNurse2Be]

In the NICU where my son was, parents and grandparents could visit anytime they wanted to with the exception of shift change. At 630pm you were asked to leave the unit and you could return at 715p; the same for the AM shift.

You had to do a scrub.

Visitors other than P/GP had to be with a parent.

Over the phone info was given to anyone that had the pass code #. In our case, I had it, my husband had it, and my mom had it.

I remember telling one of Marc's nurses to please tell my dad everything she could. She remarked that had I not asked her to do this she wouldn't have. Only thing is I couldn't go see Marc that day and my dad could *i was sick*

I remember going to see Marc at 230am because my husband finally got up the nerve to see and talk to him. They never blinked an eye.

The night he was born my dad and mom were the first to see him in the NICU.

I also remember them closing the unit one day *it was closed @ 30mins* for the privacy of a family that lost their child. I never blinked an eye at this. I know *I* would want privacy and wanted to give it as well.

how insensitive those parents were!!!!!!

Ang

[Gompers, BSN, RN]

This is just my two cents, and I'm not sure if I posted this earlier in the thread or not - too tired to check right now. :zzzzz

While we will honor the parents if they say the baby can be visited by the grandparents without them and that they can also recieve information over the phone...we try hard to discourage that. Our reason is that there have been many situations where the grandparents were alone on the unit or called on the phone, and there had been a big change with their grandchild - good or bad, no matter - and they were the first to find out. Even though the parents gave access to the grandparents, they'd be upset because they weren't the first to get the news. So we remind them of that possibility when they ask us to put the grandparents or other relatives on a visitation or information list. More than half of the time they agree with us and retract their lists.

[canoehead, BSN, RN]

Truely I could never work in a NICU JUST because of the games of the snarky visitors, and lack of backup from TPTB.

If people refuse to follow the rules or allow privacy when it is obviously needed they know you won't dare to wrestle them out, and they take advantage of that. However what CAN be done is to refuse them access to the unit once they leave for a period of time. You don't go along, you won't get back in for 24h. No excuses. Parent or not.

Let THAT be known and things will change.

[LilPeanut, MSN, RN, NP]

I don't think that should be done. It's different when you are dealing with children and newborns. The psychology behind it is completely different than when you are dealing with adults. And with new mothers, not only do you have the stress of their child being ill, their hormones are all over the place.

I work in a children's hospital and even when the parents are *****y or whatever, as long as they are not being physically abusive or disruptive to care, they are given a lot of leeway because of how stressful it is to have a child hurt/ill.

Two nights ago, we had a kid who was a Level I trauma come in, and though medic's mistake, they also brought dad in c-spined. Dad was incredibly upset and agitated, security had to be called, but even through all of that, we all knew that the only reason he was acting like that was because his son might be dying in the next room. That's a huge stress on parents and people can get crazy when their child is ill/hurt/dying.

[canoehead, BSN, RN]

If one visitor's bad behavior that makes life more difficult for another, or puts a baby's life in danger...

Do you really think its OK to refuse to leave during a code, and then tell jokes and laugh within hearing of those parents because they might be stressed?

I also think that nurses are very good at knowing when exceptions should be made, and when people are just jerking them around. They need some kind of recourse to maintain control of the unit.

[LilPeanut, MSN, RN, NP]

There are also nurses who get burnt out, or who clash with a family and the fact they are "bending" the rules allows for abuse by others. I'm not saying anyone here would do that, but I bet everyone knows one nurse that probably shouldn't be working where they are anymore, because they are too burnt out and cynical and can't relate to the families as well. If people have never ever met a nurse like that, I'm truly and honestly amazed and it's fabulous that there are places where that doesn't happen.

But in every walk of life, there are going to be "bad apples", with parents too. It should just be a matter of insisting that someone leave if they are endangering a baby or not giving a family privacy when their child is dying, not of making rules limiting how much the parent can see their child.

[BittyBabyGrower, MSN, RN]

In our unit, no one but the parents get info, unless the mom is a minor. HIPPA also comes into play here. We tell the parents up front...no one but the parents get info, period. Before we had this rule, we were burned a few times, you know, it is like the game of telephone...the story grows and soon the truth is not there and the parent hears it and they are beside themselves. Much easier to say, no info to others. No calls are taken and parents have to provide the band number. If a parent doesn't have their band on their wrist or if it is off and they don't have the band plus a photo id, no admittance to the unit. Grandparents have to be named and have a photo id, or no admittance. We have really cracked down in last year. If the mom is very ill and can't come in and their is no dad involved (or in the case of the dad being deployed as of the last year) the mom can name one person to take the place of dad and they are given the same privledges as a parent, until mom is better or dad is home.

You have to have rules and limitations or else you'd go insane!

[JVanRN]

We have 24 hour visitation. (barring shift change, admissions, and certain procedures) We are pretty strict on enforcing that. No one except parents and grandparents are supposed to visit. This is where it gets tricky. We have the parents make a list on admission of who can come in and we are supposed to check that list when visitors come in, but people seldom check.

Also with blended families this can get tricky. Mom with her new husband...Dad with new wife. (Even mom who isn't sure WHO the father is...do we let BOTH in?)We had a young girl who lived with her aunt and uncle. They were her primary support people, but yet her biological mother often came and visited the child. Some nurses insisted the aunt and uncle were not allowed, others allowed them. Also it seems like one baby can have 8 thousand grandparents. (remarried grandparentts, "ex" grandparents", adoptive parents ect...) We have even had confusion with lesbian couples. (partner of mom vs. biological dad...allow both in)Where do you draw the line?

We are pretty strict about not letting children in. An older child might be allowed in under special circumstances, but we need a doctors permission first.

I wish we checked identification, but we don't. Generally we allow the people in. I've been there a year and we havent really had too much of a problem with visitors.

Like I said, what gets confusing is with all the blended/alternative families. Not every infant has the traditional "mom and dad and 4 grandparents" Lists can get quite long.