Sitters, give 'em a break! - page 3

You want to know why you're complaining that the world is ending because you have to take your own vitals? Because your aides are sitting. You want to know why your aides are sitting? 'Cause your... Read More

  1. by   TazziRN
    Quote from jojotoo
    I'm not sure that you can legally do this - put patients in and out of restraints on one order. That would be a PRN order for restraints. It's my understanding that JACHO requirements are that a restraint order be written for a specific type of restraint and a specific length of time. True, that order can be dc'd early, but then if the patient needs to go back into restraints, a new order needs to be written. That's what we do where I am. If I don't have this right, does anyone have clarification?
    You're right, but since she's clearing it with the nurse, it's on the nurse, I think.
  2. by   miko014
    Quote from Tweety
    I'd be happy if our sitters unrestrain our patients. I always unrestrain my patients, only to have the sitters tie them back up, that to me is more out of line that releasing restraints.
    Our pts are not to be restrained if there is a sitter in the room with them. If you're just going to tie them down, then what's the point of having a sitter? Meds are a different story, but I'm not going to sedate a pt who just needs to be reminded to stay in bed. Meds depend entirely on the situation.
  3. by   Jesster15
    you absolutely can untie and retie the restraints...it's called a "trial release" and it just needs to be documented that way...
  4. by   jojotoo
    Quote from TazziRN
    You're right, but since she's clearing it with the nurse, it's on the nurse, I think.

    You are absolutely right!
  5. by   jojotoo
    Quote from Jesster15
    you absolutely can untie and retie the restraints...it's called a "trial release" and it just needs to be documented that way...

    So how long would a "trial release" be for?
  6. by   TazziRN
    Not as long as the OP is talking about. A trial release is for a short time to see if the pt is calm enough to be without them, less than half an hour, and there has to be someone directly observing them...no problem if there is a sitter. If they're off longer than that it's a new order.
  7. by   TrudyRN
    This is a good thread. I hope that everyone can try to put him or herself into the other's shoes.

    Nurses and floor aides exhausted, bladders ready to bust; sitters fighting to stay awake or get a needed potty break/stretch/meal break. It is just so sad and so despicable what has happened to American healthcare.
  8. by   Simplepleasures
    TrudyRN, I am with you sister, you took the words right out of my mouth.
  9. by   Tweety
    Quote from Jesster15
    you absolutely can untie and retie the restraints...it's called a "trial release" and it just needs to be documented that way...
    I think the point is that in some states/facilities this is an RN assessment, whether to restrain or unrestrain. The sitter can't blindly restrain and unrestrain a patient.
  10. by   Tweety
    Quote from jojotoo
    So how long would a "trial release" be for?
    Check your policy. If I'm not mistaken we can trial release restraints for as long as you choose.

    There is a certain length of time though that the MD order you used to restrain the patient can't be used to re-restrain. I think it's about an hour, but I forget to be honest. To re-restrain after a certain amount of time you need a new order.
    Last edit by Tweety on Nov 22, '06
  11. by   Tweety
    Quote from miko014
    Our pts are not to be restrained if there is a sitter in the room with them. If you're just going to tie them down, then what's the point of having a sitter? Meds are a different story, but I'm not going to sedate a pt who just needs to be reminded to stay in bed. Meds depend entirely on the situation.

    I agree, sitters are an alternative to restraints, which is why if there's a sitter I almost always unrestrain the patient. Our manager gets real angry if she walks into a sitter room and the sitter is watching TV and the patient is restrained (of course she's only seeing a moment in time.) This might mean the sitter will actually have to do some work and tough the patient, but that's what they are there for.

    There are those patients that are so out of control that they need restraints and a sitter.
  12. by   Tweety
    Quote from TazziRN
    Okay....the whole personality of this thread changed as both sides spoke. There were things that you left out of your original vent and things that were brought up by both sides to consider. Hopefully each side understands each other a little more. I know I do.
    I agree. About the only thing I still disagree with is maybe not the need for q2h breaks, but the expectation that this is going to be the reality. Not with me is that the reality, sorry.
  13. by   rach_nc_03
    I agree with the OP on some points, but I side with Tweety on the issue of q2h breaks. Yes, everyone should be able to pee when they need to. The unfortunate thing is, that simply doesn't happen on most floors. I've worked with late-term pregnant nurses who actually wore incontinence pads (the Depends ones that look like big maxi-pads) at work because they sometimes absolutely couldn't hold it for another ten or fifteen minutes while waiting for another nurse to cover them. This was in a high-acuity ICU where everybody had a patient that might code at any moment. How sad is THAT?? I mean, come on! How has healthcare gotten so bad that people end up having to prepare to WET THEIR PANTS because staffing is so bad? it just infuriates me that nursing staff (all of the staff, including CNAs and sitters) have such a hard time getting a chance to urinate!

    That being said, I think it's too much for ANY member of the nursing staff to expect to get a real break every two hours on a busy unit. And yes, much of the time, the nurse's load is too heavy to break the sitter out for 10 minutes every 2 hours. If you (and I mean you in general, not just the OP) are working agency on such a unit, refuse further assignments to that unit if you believe you're being treated unfairly. Yes, if you see a gaggle of nurses or CNAs sitting around, obviously doing nothing- and I don't mean nurses charting or on the phone with docs, etc....which I'm sure you (the OP) know, as we can all tell from your posts that you are intelligent, responsible, and astute- you're being treated unfairly if someone won't sit for you for a couple of minutes while you run to the restroom. As many have said in other posts on various subjects, vote with your feet. If management gets word that sitters won't work on a certain floor because they never get breaks, someone is going to notice.

    I worked as a CNA during nursing school, and at one point, our hospital stopped using sitters from the usual agency because too many sitters had been caught sleeping, chatting on cell phones, leaving patient rooms without notifying anyone, restraining patients without orders, using 4 point restraints where 2 point restraints were ordered (this was a very well-known policy, and had been in effect for years), screaming at patients, refusing to help in any way when nurses/CNAs in the room needed a quick hand (one sitter said, when 3 CNAs and one nurse were struggling to turn an obese patient and asked for her help, 'hell no- I'm paid to sit here on my a**, not help you')- anyway, they had a sudden need for sitters, and I started getting pulled nearly every shift from my unit to sit on other floors. Usually, the HO had to make the decision, so he'd be the one to come notify me; when there were units that were a major problem, I told the charge nurse on the problem unit, the charge on my home unit, and, if it was particularly egregious, the HO. Sometimes it wasn't effective, but more than once, 'bad' assignments weren't quite as bad the next time around.

    Oh- another thing. I honestly don't feel bad for anyone who can't take several smoke breaks at work. I smoke, and I can count on one hand the number of shifts where I took ANY smoke breaks in hospital jobs. Eating and urinating are one thing- people can go without smoking at LEAST for half a shift. I worked with a nurse who had 3 patients suffer SERIOUS injuries from falls sustained while she was out smoking (on different shifts).

    Ok, I got a little off-topic. Sorry. I want to thank the OP for starting this thread, though. Misconceptions abound, and it's easy to make generalizations about entire groups of people based on negative experiences with just a few. I think everyone in nursing has to fight against negative stereotypes on some level- and the OP has reminded me of the GOOD sitters I worked with, when it's often easier to remember the bad ones.

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