Sucide lies: is it CYA or blaming?

  1. 1
    So I had a pt this evening who was suicidal. Blatantly suicidal. He was found in his home with a gun drinking and saying he wants to end it. So he went to the Psych lock down part of the ED and when they attempted to medically clear him there by doing his labwork, they were all out of wack. His sodium was critical, liver enzymes all sky high, glucose in the 40's.

    Needless to say he was promptly sent to the medical side to be treated. We were short techs to sit and watch him for a 1:1 so the nursing supervisior sent a tech to us to sit with him, just in case. Well since he was the only pt I had the charge RN pulled the sitter to work the entire dept because we were short techs. I didn't complain but to cover my butt I charted that he was "within the sight of the nurses station, appears calm and cooperative, contracts of safety, charge RN aware."

    Within a few minutes I got a call from my charge RN who had been looking thorough my notes. He says that he didn't like it that I implicated him in my notes. He said that if anything were to happen this note would place the blame on him. *****

    I charted that because I'm just a staff RN, I have no say in what staff goes where. However if something were to happen, I wouldn't want someone looking at the chart saying, there is an order for a one to one here, why didn't you follow those orders?

    THEN the nurse sitting next to me said I should have NEVER charted that. She said, that's like the first thing you learn in school. Pt's are NEVER on a constant observation. They are only on that if they are actively suicidal. I said, but they found him with a gun saying he wanted to end it. Then she said, but constant obs is like if you're preventing them from killing themselves that moment. At any other time when they are calm it's not a 1:1. You should never say that.

    WHAT IS THAT?! I've been at many facilities and they've mostly had 1:1's. Not to mention the order clearly says 1:1 suicide watch. The hospital protocol says that someone must be within arms reach. A different RN stated that 1:1 isn't even legal, it's just something hospitals do to protect themselves. Am I crazy? Did i just make this up? Was my nursing school THAT BAD that I missed that lesson? Was she being rude?

    SO now my charge is ****** at me thinking I'm trying to blame him if the person off's themself. What do you guys think? Was i doing too much? Was I right, was this CYA? OR are they right that as long as the pt is in view of the nurses station that is good enough? If this were to go to court would i be justified in saying he could be seen from the nurses station or was it prudent to say I did all that i could as a staff RN to follow doctors orders?

    what do you think?!
    Last edit by Tiffanybaybay on Nov 11, '12
    jtmarcy12 likes this.
  2. Poll: What do you think?

    • You were doing too much and made Charge look bad for no reason.

      1.37% 1
    • You shouldn't have charted anything at all.

      1.37% 1
    • You should have just charted he was within the sight of the nurses station, that's enough.

      16.44% 12
    • You are absolutely right if this went to court you'd be screwed.

      82.19% 60
    • Who cares? You think too much.

      1.37% 1
    73 Votes / Multiple Choice
  3. 38 Comments so far...

  4. 4
    at my hospital is it ordered 1:1 sometimes. i am amazed that the tech was pulled. they are never ever pulled from suicide 1:1 where i work.even though bbecause of them there will be a la k of staff and pt care is worse. they are still never pulled. i would have called the supervisor to see if they can pull an aide from another floor.
    Artistyc1, not.done.yet, Sugarcoma, and 1 other like this.
  5. 10
    Well, maybe if **** hits the fan, he should share part of the blame for pulling the tech from the 1:1.
    Artistyc1, cp1024, nuangel1, and 7 others like this.
  6. 17
    If the patient is a 1:1, and you have a hospital policy on that as well, the tech should never have been pulled. It sounds like the culture of your unit is to play fast and loose with that policy. Honestly, I'd have written a hospital incident report about it too.
    jtmarcy12, babynurse428, gypsyd8, and 14 others like this.
  7. 6
    Agreed. If there is a 1:1 ordered, especially if the patient is suicidal, that 1:1 does not leave the room. Big safety issue. If a patient is on a 1:1 for suicide precautions we can't just put them by the nurse's station to keep a close eye on them...things happen and the patient isn't always being watched. Someone needs to be in the room with that patient at all times. I would have called the supervisor to see if they could send an aide to work the floor.
    jtmarcy12, sweetalmond, Artistyc1, and 3 others like this.
  8. 14
    I agree.. If the charge didn't want to be "implicated" should something go wrong, then he should play by the rules and follow the doctors order for 1:1 observation.
    JustaGypsy, jtmarcy12, Goldenhare, and 11 others like this.
  9. 2
    Yikes. This does not sound right. I would check your P&P if I were you! I know at my facility, they are very specific about the procedures for various types of observation.
    jtmarcy12 and Artistyc1 like this.
  10. 3
    1:1 means just what it says. One tech (or nurse) always with and watching the suicidal patient. You never left the room or stopped watching.
    jtmarcy12, Hoozdo, and sweetalmond like this.
  11. 8
    Quote from sapphire18
    I agree.. If the charge didn't want to be "implicated" should something go wrong, then he should play by the rules and follow the doctors order for 1:1 observation.
    Then the supervisor shuld have been called.
    I charted that because I'm just a staff RN, I have no say in what staff goes where. However if something were to happen, I wouldn't want someone looking at the chart saying, there is an order for a one to one here, why didn't you follow those orders?
    I think that statement is slightly passive aggressive ..........if you really felt this way you should have called the supervisor.

    I think if the patient ....who is actively suicidal....can be watched by the RN if that RN maintains the policy of constant observation SI watch. Even as a supervisor.....I have sat outside of a 1:1 SI so the tech can have a break. My charting would not include that the patient was in view of the nurses station. and they contract for safety. I would document that I maintained 1:1 contact at all times. Was there something preventing you from performing the duties that entails the 1:1 constant observation if this was your only patient?

    If you felt that you were unable to safely carry out this assignment you should have called the supervisor who sent you the CNA/tech to begin with and ask her what you should do. Patients are placed on 1:1's ALL the time and if this patient was SI as you describe....Did they not have temporary holding papers (pink papers from where I come from) signed? Patients are 1:1's, constant observations, SI watches, safety watches and critical care 1:1's all the time. I have NO CLUE what the nurse next to you was thinking. The ED's I work once they are on a SI watch with papers.....they are searched, watched until re-evaluated by psych.

    So I have NO idea what your co-worker is referring to......
    THEN the nurse sitting next to me said I should have NEVER charted that. She said, that's like the first thing you learn in school. Pt's are NEVER on a constant observation. They are only on that if they are actively suicidal. I said, but they found him with a gun saying he wanted to end it. Then she said, but constant obs is like if you're preventing them from killing themselves that moment. At any other time when they are calm it's no
    Although your post is slightly difficult to read for me.......the answer to your questions.....As I would have them pertain to the ED.....you are in the ED correct?
    What do you guys think? Was i doing too much? Was I right, was this CYA? OR are they right that as long as the pt is in view of the nurses station that is good enough? If this were to go to court would i be justified in saying he could be seen from the nurses station or was it prudent to say I did all that i could as a staff RN to follow doctors orders
    Were you doing too much?......In my opinion if you were not outside the room with the patient in constant observation of you, you were not doing enough. Your documentation was not appropriate for a 1:1 SI watch for you actually documented that you could "see them from the nurses station" but the were not under constant observation, in your sight, at all times. If your policy states that they need to be physically observed by attendant outside of the room...you need to be outside the room. .....whether or not they "contract for safety" especially in light of the fact that psych documented the seriousness of this patients ideation (pt found) with a specific plan (the gun).

    Seeing the patient from the nurses station is NOT enough. Your "CYA" would have been to sit outside that room...to document that there was no one outside the room and the patient "could be seen and contracts for safety" was a passive aggressive means to state your protest at the tech being pulled. Although I am not a lawyer.......in a court of law you would be liable for this if the patient harmed himself if you were supposed to, by policy, be outside the room AND if your behavior was outside the standard of practice of another "reasonable and prudent nurse"......you would be the one held responsible.

    If you felt you couldn't sit and watch the patient outside the room you should have notified the supervisor who sent the help in the first place, She probably shorted another floor to supply your unit with the extra help for this priority watch. If I was the super and I pulled another tech from another floor for this priority need.....I better not find out that the tech was being utilized in another means without my permission....for if you don't need the tech for this patient the tech can return to their floor......who is right now short because of your unit.

    Saying you "did all you could" will not help you in a court of law.....AND you had no other patient preventing you from providing this patients standard of care. How would you explain to a court of law......"I had no other patient but this one and I chose to sit at the nurses station because I could see him and he told me he wouldn't hurt himself".....how would you justify your actions.

    I hope this helps....
    Last edit by Esme12 on Nov 12, '12
    Crux1024, Hoozdo, sweetalmond, and 5 others like this.
  12. 2
    We have people document "charge nurse aware" all the time to cover themselves, they've told the charge nurse what they're doing and don't want to have been the only one to have made that particular decision or observation. It's really not a big deal...unless they're doing something wrong, which is what it sounds like this charge RN was doing.
    GrnTea and sapphire18 like this.


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