open visitation in ccu

LPN1974, LPN · Mar 21, 2005

I am in the process of trying to leave this unit because I disagree whole heartely with open visitation in this type of environment. My manager has blocked me from leaving by telling other managers I am a visitor unfriendly nurse. I am a dedicated nurse with over 25 years experience in the critical care environment. I have tried to talk with my manager and explaIN why I feel the way I do and all the problems associated with open visitation . she has a closed mind to everything I say. I have written risk management over 25 times this year with problems associated with open visitation. Now I hate my job because I am forced to work here. My boss blocks me from leaving if I use her as a reference. I have been here 5 years I cant ignor those years. Help!!!! I am consulting an attorney tuesday.

Why do you oppose it so much?

What problems do you see with open visitation?

When my grandfather got sick and was admitted to ICU they wouldn't let me in to see him very often while he was still awake and responsive enough to know I was there, then when he started to actually die, is when they said I could go in. He had become UNresponsive, and I didn't feel he knew I was there. I have often had to think of that time, as my last memory of him.

I think if families don't cause any trouble and stay out of the way, leave when requested for procedures, etc, SOME leniency should be given.

Maybe not the whole family should be in there, but just one person to be with the patient so that they know someone is with them.

He was my grandfather a long time before he was a patient in the ICU.

An article I read supporting open visitation. As I said, in above post, or tried to say, I still think some rules need to apply, even in open visitation.

http://www.aacn.org/AACN/aacnnews.nsf/0/aaba77b0247a660188256a6a0052d0cc?OpenDocument#corner

hollyster · Mar 21, 2005

Pts in the ICU / CCU need a lot of care most of it invasive and/or could violate a pts privacy. Our units visiting hours are every odd hour except @ 0700 and 1900 (change of shift.) We do full assessment and care on the even hours 24 hours a day. Our pts are very high acuity, very rarely strong enough to handle all the stimulation they experience and wind up with CCU/ICU psychosis.

Pts in the unit need quite to rest and familiy members do not seem to understand. I know that they are under a lot of stress(My daughter has had three heart operations and has spent a lot of time in CCU/ICU, so I can see it from both sides) but we have to be the pts' advocate.

If the pt is deterorating or if the pt is improving or asking for family the visiting hours can be extended at the nurses' discretion.

Runman1914, MSN, RN · Mar 21, 2005

The old rules of family visitation are out the window.I work in the south fla area and the families have the run of the hospitals.It has turned into more of a hotel environment.Families demanding nurses fetch coffee, guest meal trays, guest beds, etc.. Hospitals cant understand why nosocomial infection are on the rise.I have read many articles that support that having no restriction on visitation contributes greatly to the increase in nosocomial infections.Plus with the nursing shortage its hard to do your job and have to cater to demanding families that never go home.

vegasccrn · Mar 22, 2005

:uhoh21: :uhoh21: okay,you guys are reeeeally scaring me. i missed my last charge meeting and was volunteered to be on the committee looking into developing open visiting.right now we have 15 min on the odd hours.hahahaha!!! some BAD nurses actually try to enforce visiting while others let the visitors run amuck!!! the families i know won't be problems are ones who actually ask about visiting hours.please clone them:chuckle :chuckle are there any benefits to open visiting????? i'm keeping an open mind at this point-how else can i go to my staff if i don't agree!we have 4 icus on our floor-total 52 beds. it is truly a FREE FOR ALL. i will stand my ground on NO KIDS UNDER 14- i don't want to be responsible for your kids nightmares.my nurses actually impersonate me well. when i hear screaming,crying kids in the waiting room-always left unattended- 1st i hyperventilate;then my head spins around. REALLY!!!! i would love to hear if anybody has had good experiences with open visiting. i need all the ammo and backup for next months meeting. "WE WILL SURVIVE" and "THIS TOO SHALL PASS":cool: :cool: :saint: :saint: :devil: :devil:

Runman1914, MSN, RN · Mar 22, 2005

Kids in the ccu should not be tolerated at all no exceptions.On one of my travel assignments i was at ,families run amuck in the unit and it was allowed .Regardless of the concerns i voice to the nurse manager who was just a *** kisser.The area the hospital was in was a rich south florida city and the families even told the dr what to order.Needless to say i did not extend my contract after the 13 weeks but on the last week tragedy happened. One day kids were running around in the unit and the charge nurse told us we were to say nothing to the family.Physical therapy was walking a pt with a walker when the kids came around the corner and upended the lady causing her to fall flat on her face.She immediately coded and we never got her back . The family of these kids offered no apology and even became angry with us to the point security was called.So to any charge nurses or nurse managers out there who allow families to run amuck in your unit its just a matter of time before this happens to you.

directcare4me · Mar 22, 2005

Kids in the ccu should not be tolerated at all no exceptions.On one of my travel assignments i was at ,families run amuck in the unit and it was allowed .Regardless of the concerns i voice to the nurse manager who was just a *** kisser.The area the hospital was in was a rich south florida city and the families even told the dr what to order.Needless to say i did not extend my contract after the 13 weeks but on the last week tragedy happened. One day kids were running around in the unit and the charge nurse told us we were to say nothing to the family.Physical therapy was walking a pt with a walker when the kids came around the corner and upended the lady causing her to fall flat on her face.She immediately coded and we never got her back . The family of these kids offered no apology and even became angry with us to the point security was called.So to any charge nurses or nurse managers out there who allow families to run amuck in your unit its just a matter of time before this happens to you.

I am not an advocate for open visitation; that said, however, I realize that for the time being at least, it is here to stay. But kids running in the halls of an ICU doesn't sound like open visitation, and doesn't sound like something that staff should allow. As you describe, there can be devastating consequences. For the kids sake too, they are putting themselves in danger. Even in an open visitation environment, there are ususally still some rules for EVERYONE to abide by, for safety's sake.

By open visitation, are y'all talking about no limit on number of people, anytime of the day? We still have a limit of no more than 3 at a time, though our doors are only closed to visitors at the 2 shift change times. And any children CANNOT "run around". They must remain with family, at the bedside. "Running around" would pose a great danger to everyone, themselves included. The hospital is exposing itself to huge liability for not providing a safe environment for patients, if they can't walk in the hall without being knocked down.

RoxanRN · Mar 22, 2005

I would contend that the visiting hours should depend on the type/speciality of the unit. The patients of an Interventional Unit can probably tolerate more inconsiderate visitors (did I say that) and/or noise than others.

I currently work in our Neuro Critical Care Unit. I'm sure you can understand why we have limited hours (0900-1000, 1200-1300, 1600-1800, 2030- 2200) and limited numbers at the bedside (2 at a time) - only SICU is more limited - only 15 minutes every 2 hours. Our patients range from observation of TIAs to video EEG and brain mapping to unsecure aneurysms to unstable SAHs. While some (though usually few) could tolerate longer hours, the vast majority cannot. Therefore, the rules are enforced on all patients (with occasional exceptions as deemed by the nurse - usually for those awaiting celestial transfer or children under about 12yoa). There are absolutely no visitors staying overnight in patient rooms (unless as noted above). While most have no problem with the rules, there are those who try to skirt them and are down-right pissy when we enforce the rules.

The biggest problem is when some nurses don't enforce the rules while others do. The Enforcers are usually made out to be/called unfriendly by the family(s). Sometimes, it's difficult to make the families/visitors understand that stress is detimential - the most significant of which is it raises BP and thus, ICP (very bad thing in this unit) and it tires the patient (not good for any ICU patient). These patients need rest to recover. Many patients are too polite to tell their visitors to go away because they are tired. So they become even more tired and worn out. This is definitely where we need to be the patient's advocate and chase out those who have worn out their welcome - visiting hours over or not. Not to mention, when are we supposed to do assessments and procedures with open hours :banghead: ?

While I could go on and on about this, I think I've made my point. Call me anal if you must, but I only have my patient's best interest (and health) at heart.

:twocents:

Roxan

mattsmom81 · Mar 22, 2005

Grits I am glad you're seeing an attorney. This manager is wrong wrong wrong on how she is treating you ...just because you are operating from principle and it doesn't agree with hers, she is slandering you vindictively and I hope you can prove it.

Let us know what your attorney says. I know just how you feel by the way and began to hate my work in ICU when open visiting rules began to reign. The numbers of problems it causes in good intensive care provision cannot even be listed here in a decent timeframe, so I won't try.

Young ICU nurses find it easier to adapt to all these sweeping changes in intensive care, I find. They don't have 25 yrs behind them in which they were given the time to effect excellent care. But I've also watched as these nurses catered to family while their patients deteriorated so I know firsthand what ever present family do to our so called 'critical care'. We need time to devote to critical care and in tooo many cases today, we do not have it with today's intrusive family presence.

I believe open visiting is chasing away lots of experienced ICU bedside nurses, and for good reason.Its why my night workers moved to nights in the first place, but even that does not save us in many cases...LOL! In my own case, it was one of MY last straws (along with EMAR in ICU...GRRR)

We all should, after 25 some successful years in a specialty, be able to say 'enough' and move away from the environment without being slandered by managers.

Good luck and keep us informed.

angelladyclaire · Mar 23, 2005

Kids in the ccu should not be tolerated at all no exceptions.

I think whether to allow children to visit the CCU should be determined on a case by case basis. When I was young, my father was a frequent patient in the unit. He had SLE with complications such as kidney failure. On several occasions, the nurses on staff were afraid my dad wouldn't make it and they let me visit him with my mother. I was always very well behaved... my mother made sure of that. I do agree that children should not be unsupervised in this environment, even if that means kicking out the irresponsible adult also. I just think that to allow a child to spend time with an ill or dying parent can be a great gift.

Tony35NYC · Mar 23, 2005

I am not yet an RN but I work in critical care as an intern, and I also don't care much for open visitation. The management here tried it for a while and it didn't work out for many reasons---patient safety being the #1 concern. There was also the problem of way too many friends and family in the pts rooms at one time and if we needed to do any immediate patient care they would be in the way, sometimes interfering with the monitors and equipment and even arguing with the nurse about how the nurse should do his/her assessments. Of course, I always politely ask them to leave but not all of them are cooperative, and we've had to call security a few times.

I don't see how open visitation can be beneficial to a pt in an ICU or a CCU. These people are in intensive care because they need rest and very close nursing care. How are they going to get that with a parade passing through 24/7?

pabamick · Mar 23, 2005

As a icu-ccu nurse for 30 years, I have learned that what is best for the patient is not always best for the family. I stand with the patient, but I also take the time to explain to the family that talking all day and having many family visitors the day after you have open heart surgery is not in the best interest of the patient. People don't understand about the toll it takes on a patient who is critical ill or just had major surgery to have to constantly try to respond back to family members. Each family member only sees their time with the patient, not the total effect of all the visitors on a sick, weak patient. I have had patients who don't want to hurt the feeling of their family members tell me, could you just tell them to go home and let me get some rest. I do not agree with open visitation, whose best interest are we looking after here, the patient or the family?

I think whether to allow children to visit the CCU should be determined on a case by case basis. When I was young, my father was a frequent patient in the unit. He had SLE with complications such as kidney failure. On several occasions, the nurses on staff were afraid my dad wouldn't make it and they let me visit him with my mother. I was always very well behaved... my mother made sure of that. I do agree that children should not be unsupervised in this environment, even if that means kicking out the irresponsible adult also. I just think that to allow a child to spend time with an ill or dying parent can be a great gift.