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open visitation in neuro ICU

Neuro   (2,956 Views 9 Comments)
by NCC_RN NCC_RN (New Member) New Member

849 Visitors; 1 Post

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Hello fellow neuro nurses!

I currently work in a very busy 32-bed neuro ICU. Our hospital system has adopted open visitation throughout the system in all units, including ours. While I understand the benefits of having family present (can calm patients, help keep them in bed, decrease PTSD symptoms in patients and themselves, participate in rounds, etc) we do not have any "guidelines". There is also no door on our unit so anyone and everyone can come in. These things together have led to some dangerous situations for the staff and patients.

When it comes to visitors, per management each bedside nurse is to "own the room" and let visitors know what is best for their work day and the patients healing. While senior nurses have little problem limiting visitors, the newer nurses feel like they have nothing to fall back on since there are no rules. For example-The night nurse might want 2 visitor at a time and the day nurse fine with 5. This leads to confusion and anger with some families.

What I'd like to know from people in other neuro ICUs is what are your visiting guidelines? limited hours or open? do you limit the number of visitors? age limit? phone calls? food/drink? is your unit locked? How do you let visitors know about these expectations?Any suggestions and information I can take back to my units shared governance would be helpful!

Thank you

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3 Followers; 34,148 Visitors; 4,268 Posts

A nurse anywhere but especially ICU should not have to burn energy and be distracted by having to deal with visitors. The nurse should be able to focs on her patient.

Having had loved ones in ICU, I know it's hard on family to be limited. But I believe it's better for the nurse to be able to care for the patients than for family to be with their loved one. Family will invariably ask questions, get in the way, be a distraction. Nurse will have to either ask them to step out or do things to the nude patient that should not be done in the presence of just any family.

That said, I was super grateful to the nurse who let me stay with my LO for several hours during an ICU overnight stay.

OP, just say something like, "I know you want to be with your wife/son/Granny but I need some time to get him cleaned up, turned and repositioned more comfortably, and do some things that require him to be exposed. So if you could please wait in the waiting room, I will come get you in a short while".

And don't feel rushed. "An emergency arose with another patient that I had to help tend to, but please come in now".

Some staff can think clearly about the pt while talking to family or having family ask questions. I am not good at that. So glad I do little bedside care any more.

What do your co-workers think? I have a feeling this totally open door policy/no door policy won't last too long. What about HIPAA?

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KeepinitrealCCRN has 5 years experience and specializes in SICU,CTICU.

2,634 Visitors; 110 Posts

where i work we only allow 2 visitors at a time from 8a-8p. we also run into the same problems where the 2 visitors at a time rule is broken and can become difficult to enforce. on occasion i will allow 1 visitor to spend the night if the patient is confused so that the patient does not fall. my hospital does not give sitters for confused patients. we let patients stay in the waiting room 24/7 if they want and they can come in during the night to see their family member (multiple times if they want) but cannot stay in the patients room. we also ask visitors to leave at change of shift due to distractions with questions and potential HIPAA violations. lastly, we are very strict with infection control so all visitors must clean their hands coming and going as well as no food or drinks in the rooms.

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turtle_RN has 6 years experience and specializes in Neurosurgical ICU.

3,335 Visitors; 54 Posts

In our neuro ICU, our visitation policy is as follows:

24 hour visitation policy.

2 visitors per patient every 10 minutes (meaning they can switch out that often)

No visitors allowed during change of shift (7a-8a and 7p-8p)

as well as at the discretion of the nurse. We have them step out during CHG baths and blood draws. If the patient requires a lot of interventions that night, we tell the family that we will be asking them to leave at a certain time so that they are aware.

The key is to be confident. You are your patient's advocate and while family in the ICU is great, sometimes family visitors can be more disruptive than calming.

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574 Visitors; 7 Posts

In my Neuro/trauma ICU and all of the other ICUs in the hospital we have a two visitor policy and ask them to step out for an hour for shift change at 7am &7pm. We have a closed door that they have to get buzzed into. We also have a camera to see who is trying to get in to visit. Additionally, we don't allow children under 13 in and only one visitor can stay the night but are not allowed to sleep in the room. We have signs with our rules posted all around the unit.

Unfortunately, these rules are regularly broken or not completely enforced. Some visitors follow behind a staff member to get in and frequently come back with more than 2 people. When I encounter someone who has had leniency with the rules I apologise and tell them that I don't make the rules and it is in their loved one's best interest. That usually works. I'm not one to be super strict on the two visitors rule if the patient may be dying but I let them know I am breaking the rules and respect the next nurse who may want only two. Our rooms are not big and I usually limit it to three or four. We also have two panic buttons on the unit which notifies security to come ASAP. I've only seen it used once for an irate family member.

While these rules are often broken, it brings me some comfort knowing they are there and I can enforced them and use the "don't shoot the messenger" attitude. ;-)

I would strongly encourage your work to have some rules in place for your safety and the safety of the patient.

On a side note I also tell visitors not to over stimulate my patients and allow for rest. Often times we are doing q1h neuro cks and they need their rest in between.

Edited by sunny77

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applewhitern has 30 years experience as a BSN, RN and specializes in ICU.

25,395 Visitors; 1,871 Posts

WOW, I can't imagine having to step around 5 visitors in a busy neuro unit, or any ICU for that matter. I don't trust visitors to keep their hands off equipment, and I don't like it when you ask your patient a question and a visitor pipes up and answers for them. About 30 years ago, I had a visitor cut the ties on a trach because she thought the patient was choking. I've had a visitor start "praising Jesus" and carrying on until she finally fell right smack in the middle of the floor (in the patient's room) because she was just overcome with the "spirit." I literally had to step over her and keep on going. I've had them refuse to leave the room so I could set up for a Swanz (sterile). We lock our doors now, and two visitors can come in for a few minutes on every even hour until 10 pm, then no visitors until 8 am the next morning. Its working for us.

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RNORnow has 17 years experience as a BSN and specializes in ICU, OR.

2,118 Visitors; 45 Posts

The open visitation is irritating and somewhat dangerous. It can be very distracting to have to respond to family when administering meds, titrating gtts etc...They do not have a clue what you are doing so they think they can just ask questions and converse with you everytime you walk in the room. Plus they ask for all manner of things like blankets, water, meals extra chairs and anything else they can think of. Our DON and admin think that having patients families present during the shift change is important and gives them time to ask questions and meet the oncoming nurse. And yes, this is an ICU I'm talking about. It's absolutely horrific. Good luck getting your situation changed. I'm in OR now because this seems to be the trend all over the country...

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1,344 Visitors; 59 Posts

The open visitation is irritating and somewhat dangerous. It can be very distracting to have to respond to family when administering meds, titrating gtts etc...They do not have a clue what you are doing so they think they can just ask questions and converse with you everytime you walk in the room. Plus they ask for all manner of things like blankets, water, meals extra chairs and anything else they can think of. Our DON and admin think that having patients families present during the shift change is important and gives them time to ask questions and meet the oncoming nurse. And yes, this is an ICU I'm talking about. It's absolutely horrific. Good luck getting your situation changed. I'm in OR now because this seems to be the trend all over the country...

Just wondering why shouldn't a spokesperson or family member be allowed to hear and ask questions during shift change and to be aware of the new nurse? If they have a legitimate question should they not be asked and addressed? Also why doesn't the charge nurse introduce herself to patient and family member so if their needs are not being met or they have questions, they can address the person in charge if necessary? I am just asking so I can better understand.

If a family member is asking distracting questions, say just a minute let me finish. Then if they keep distracting don't you have a charge nurse or someone in charge who can handle the situation?

There are benefits to having family members who are willing to be helpful as well by making sure the patient's privacy is protected by closing partially closed curtains, making sure their gowns and blankets are in place, helping with food and drinks.

During shift change all room doors could be closed to avoid HIPPA violations, if anyone disregards that rule they should be asked to leave. Besides that in my experience in having a family member in ICU, I could have cared less what was going in the other rooms.

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59 Visitors; 7 Posts

On 5/10/2018 at 10:12 AM, trytounderstand said:

Just wondering why shouldn't a spokesperson or family member be allowed to hear and ask questions during shift change and to be aware of the new nurse? If they have a legitimate question should they not be asked and addressed? Also why doesn't the charge nurse introduce herself to patient and family member so if their needs are not being met or they have questions, they can address the person in charge if necessary? I am just asking so I can better understand.

If a family member is asking distracting questions, say just a minute let me finish. Then if they keep distracting don't you have a charge nurse or someone in charge who can handle the situation?

There are benefits to having family members who are willing to be helpful as well by making sure the patient's privacy is protected by closing partially closed curtains, making sure their gowns and blankets are in place, helping with food and drinks.

During shift change all room doors could be closed to avoid HIPPA violations, if anyone disregards that rule they should be asked to leave. Besides that in my experience in having a family member in ICU, I could have cared less what was going in the other rooms.

During nurse-nurse report I don’t think families should be present the entire time. There are labs, imaging, etc results which may not have been discussed with the patient/family by the proper provider yet. There are things nurses will say that wouldn’t concern another nurse, but may concern a family member such as abnormal labs etc. Sometimes I prefer to do bedside report, I can show the oncoming nurse wounds, swelling, any abnormalities etc. The family can be there for the introduction “I’m leaving, ________ will be his/her nurse now.” Also we may need to undress the patient a little to show something, and the family doesn’t need to be there for that. If the patient was alert I highly doubt they’d want their third-cousin’s boyfriend’s daughter seeing their genitals. 

It’s so important to keep families updated but that is a nurse-patient/family conversation, not something that needs to be done in the middle of report. The family can ask questions all day and night, I feel as healthcare professionals acting in the best interest of the patient we can limit the few minutes we get for report to ourselves. We can then use said info to educate and update family on what’s going on now, and what may be going on in the future.

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