sitter usage

[babsRN]

I am in need of ya'lls experience with sitter usage on med-surg areas and telemetry areas. I am manager of about 70-ish total telemetry beds. Half of these are informally considered as step-down ICU beds. Our current nurse patient ratio is about 1:4-6 depending on acuity and shift and all the other usual variables. The patient population is mixed 50/50 medical/surgical, with half being open hearts, s/p MI's, CHF, acute CVA, post interventional caths.

My inquiry is this: How does your facility use sitters as a replacement for restraint use? Where do the FTEs come from?...are they paid out of your cost center and therefore a negative impact on your productivity? In my experience, we use alot of sitters...some pay periods in excess of 600-700 hours...with many of these sitters being used to keep patients out of the critical care areas, for example: an OD who otherwise would go to the ICU for 1:1 observation is placed with a sitter in my post interventional area where the n:p ratio is 1:2-3, or the patient who is siezing and without a sitter would be in the ICU. There seems to be an opinion higher up in the organization that these are cute little old folks with oldtimers disease...that if I put mittens on these patients, or close the door to their room so they won't wander that this will fix it. After I stop rambling here I'm going to write a data collection tool to provide meaningful information to convince those above me that their ideas may not meet our needs. I'd love to hear from anyone having similar experiences...thanks!!

[mustangsheba]

Of course side rails are a form of restraint. Hopefully, they "restrain" one from falling out of bed. Duh! By definition, a closed door is a restraint as are the windows, most of which do not open. I guess we could also count the walls, floor, and ceiling if we want to pursue this ludicrous path. And what about gait belts, which also restrain one? Sheesh! I guess you all know how I feel about JCAHO. Big time pork there don'tcha know.

[deespoohbear]

4 rails are considered a restraint at our facility also. I agree with mustangsheba about JCAHO. Just blows my mind that the hospitals and other facilities actually pay these yahoos to come into our facility and tell us what a bunch of screw ups we are. I believe the people at JCAHO are so far away from any sense of reality of what it is like to work on a floor anymore. Maybe they ought to try and work on an unit for a couple of weeks under their own stupid rules and get a reality check. :(

About the sitter question. We don't have them at our facility. The administration would just choke if we mentioned that. We try and get a family member to come and sit with the patient but otherwise we are out of luck. Our facility has done away with Posey vest restraints. We now have the "lovely" roll belt. Of course, this idea was brought up by someone in Occ. Therapy. I get so tired of the BS sometimes I could scream.

Enough ranting for now I suppose.

[wildtime88]

I have worked in many hospitals where if a sitter was needed then you lost a nursing assistant. The worse part of that was that many of these places ran on bare staffing requirements to begin with. On 3rd shift if you lost your nursing assistant and did not have a clerk plus all the other crap, then you were truly up the creek without a paddle or a life jacket. I worked at one hospital where they did not consider a ETOH of 0.345 and the patient being on a fresh Cardizem Drip as a need to have a sitter in the room. They actually said the guy would have to get out of bed and fall before he would warrant a sitter to protect his safety.

This was during a stint on a tele floor. When I told them I would not accept the patient and be responsible for him under their terms and conditions, they told me that I had no choice. I told them if that was the case that I would take the patient but it would be my last night to work there. Bottom line it was my last night. They were very short staffed on nurses and I was suppose to work the next 3 nights in a row. To top it off the charge nurse who was short of patients would not take the patient. By the way it was the charge nurse and the nursing supervisor who said I had to take the patient. My hands were already full.

[EXOTIC NURSE, RN]

Has anyone ever worked the night shift and had no available house MD for the entire night shift I felt very uncomfortable working under those conditions and I feel it is not a good practice for the hospital to do and from what I understand this is a very frequent practice on the hospital's part, the hospital knew ahead of time that the house MD would not be available but they did not schedule another house MD to replace him and we had a patient who had to wait all night before she could even get a ng feeding due to the fact we had no MD to read the xray to verify placement and I felt so sorry for the patient it brought tears to my eyes she begged and pleaded all night long for someone to give her some water or something because she was hungry. All coments would be much appreciated as I am very concerned and bothered by this matter.

[EXOTIC NURSE, RN]

Sorry this was suppose to be a new topic. I will try again.