Sitters, give 'em a break! - page 4
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
Nov 22, '06Well, usually it's not a trial because we know what's going to happen and when, and because I'm going to notify the RN before the restraints go back on.
Most cases are sundowning with elopement attempts and a history of the same. If identified early, the pts can be helped to forsee where they're headed and understand the necessity when reminded of their fall history.
Sometimes it's sundowning with attempts to pull out lines. I'll see a pt is getting groggy and all it takes is a reminder: Remember last night you pulled out your IV in your sleep? It's natural that when you're sleepy, if you feel something in your arm that doesn't belong there you'll try to take it out. So we need to put these restraints on your wrists now to prevent that. Less chance of infection and we won't have to poke another hole in you. OK? And so far every one has said OK.
I'm against using sitters for human restraints. Manual holds are legally speaking a very weird thing out of the psych setting, and one that sitters are not trained in (neither policy nor technique). The documentation process outside the psych setting is weak and a vulnerability for the hospital. Plus any human being has a strong aversion to being held down. Worse, there is a potential for injury to both sitter and pt.
I think in terms of pt compliance and condition, the sitter's role is to monitor and report. Also the sitter should be competent to provide total care. But the sitter is not a fighter or a punching bag. There should be no wrestling.
There is a very bad vibe that builds between pt and sitter should the sitter be obligated to repeatedly use force to ensure compliance, one that destroys rapport. Ideally, the sitter should know the pt's behavioral history, identify a developing problem, and communicate a need for a nursing intervention before the need to manually restrain arises.
Nov 22, '06Quote from TweetyOur orders are for 24hrs. So I can take them off and put them on as many times as I want within the those 24hrs. Otherwise, people wouldn't want to take restraints off because they wouldn't want to have to re-initiate a new restraint order.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.
Nov 22, '06Quote from rach_nc_03Yeah. Agency sitters, what a concept. You know, considering the liability and all, I'm beginning to think hospitals should not only have their own sitter programs and distinct sitter training, but there should be a Sitter Mgr who does the training and does rounds of all her sitter cases. It could be an additional duty for someone in staffing. We had 10 sitter cases Fri night which seems worthy of at least some centralized attention. Right now the Nursing Supv peeks into sitter rooms when she has time on rounds to see if they're awake, which is a very valuable service, but that's all she'll have time for, and that happens too rarely.I worked as a CNA during nursing school, and at one point, our hospital stopped using sitters from the usual agency...<snip>Last edit by anonymurse on Nov 22, '06
Nov 22, '06Quote from cardiacRN2006That's probably true. Our restraint orders have to be renewed every 24 hours. But if you take them off, you have to justify putting them back on and get a new order if a certain length of time has passed. But if the time hasn't passed one can take them on and off all day long. You're right the incentive to take them off isn't there under those circumstances.Our orders are for 24hrs. So I can take them off and put them on as many times as I want within the those 24hrs. Otherwise, people wouldn't want to take restraints off because they wouldn't want to have to re-initiate a new restraint order.
Nov 22, '06Quote from TweetySorry to hear it. That is so totally hosed! Any way you can champion a change on behalf of the sundowners?if you take them off, you have to justify putting them back on and get a new order if a certain length of time has passed.
Nov 22, '06Yeah...I agree with the haldol deal (or other meds)...many MD's order a sitter to avoid that (chemical restraint). HOWEVER, if that patient is acting out and being noncompliant with the sitter, BOOM..that is a call to not only the MD but security by me..I don't stand for it at all! No reason to put someone that has to sit in any danger!!!
Also, some people have adverse reactions to antipsychotics and it actually hypes them up! Sadly seen that too many times to count...especially lately. I actually withheld ativan with one patient who was due to have some (with MD permission) and the sitter was furious with me..I relieved her for a while so she could take a break...I charted...and lo and behold the patient finally after hours of being pumped with ativan and being a poop, fell sound asleep, and was asleep the entire rest of shift!
She asked me how I knew...and I said I didn't really, just was going to give it a try and sit there myself to see if it was going to work... She was impressed and learned something new!
I also give the sitters breaks! Man...I have had to do it and it sucks! Minutes turn into hours I swear! NO one relieved me either...and that was very upsetting! And of course..had to be in a room far from the RN desk so I couldn't ask for help unless I used the call light (which could have woken the pt...which I didn't want to do!). By the time I was actually relieved...I almost "relieved" on myself doing the pee pee dance at the door!
I hear ya...and hey...I don't mind having to do things for myself! If the CNA is busy then I do it...they are assistants not slaves! Assist is if one is available...and if not...I either find help if needed or do it myself!
Wish there was an alternitive to sitters...I really do. We have had a recent flux of psych pts (seasonal ones come in about now...but we have had them in for 4 weeks already..and they are taking up the beds big time...surgeries have had to be cancled!). So we can't get enough staff to tend to patients and sit! It is crazy!!!!!!!
LOL! Maybe I will make a company of just sitters, like agency...and have them contracted for not only break times that must be followed to the letter, but good pay for their time! Extra if they are CNA, LPN or RN and do any type of task (I/O, VS, taking care of beeping IV's...). There we go...nice money making idea there! LOL!
Nov 22, '06being a sitter when I was in nursing school, I know the break problem. When I sat, I simply told the nurse of the pt I was sitting that she could give me ten minutes every two hours or fourty five minutes all at once in the middle of the shift. Guess what they always took the ten minutes. Now as an RN I offer that choice to the sitter, I also will check on sitters of other nurses working when I have a few free moments and give them a ten minute here and there. Thats called team work. Bless all you sitters, its not as easy as it looks at times.
Nov 22, '06When I sat, I simply told the nurse of the pt I was sitting that she could give me ten minutes every two hours or fourty five minutes all at once in the middle of the shift.
Nov 22, '06Quote from kurosawaI agree. And what makes no sense to me is that the facility is likely paying MORE by using an agency than they'd pay to have someone dedicated to training/managing sitters- even part time- in the long run.Yeah. Agency sitters, what a concept. You know, considering the liability and all, I'm beginning to think hospitals should not only have their own sitter programs and distinct sitter training, but there should be a Sitter Mgr who does the training and does rounds of all her sitter cases. It could be an additional duty for someone in staffing. We had 10 sitter cases Fri night which seems worthy of at least some centralized attention. Right now the Nursing Supv peeks into sitter rooms when she has time on rounds to see if they're awake, which is a very valuable service, but that's all she'll have time for, and that happens too rarely.
Oh- and several times, when they pulled me from my CNA assignment to sit because they fired all the agency sitters, they'd end up having to call in another CNA- or a nurse- to backfill my regular unit CNA job later in the shift. For extra pay. Made me wonder if anyone doing the budgets ever spent ten minutes thinking about long-term effects of their decisions.
Sadly, the lower someone is in the perceived food chain- and, let's face it, administration usually DOES treat sitters like unskilled warm bodies (I heard an administrator once say, 'go ahead and fire that sitter- they're a dime a dozen and we can find another idiot by tonight')- the less their impact is considered by higher-ups. So quality of care is never considered, and people are considered disposable. And the cycle continues.
Nov 22, '06Quote from TazziRNITA! I certainly don't get even close to 10 min breaks q2hrs myself! I'm lucky if I get to urinate twice a day, so I certainly don't have the time to break someone else every 2 hours-especially if they are demanding it. Last week I went to the bathroom AND ate lunch in about 3 minutes.Wow.....wouldn't have worked with me. I would have told you to take it up with the house supe. Ultimatums are fastest way to get me to do only what is necessary for you, the sitter. If you asked me to try and break you every couple of hours I would tell you that I would try, but if I'm too busy to take a break then it means I'm too busy to break you that often. And I would flat out refuse to give you 45 minutes under any circumstances. I have a whole world of respect for sitters and will do what I can to help, because you're right, it's a tough job. But I don't do ultimatums.
I used to sit as a PCT. We didn't have outside sitters. If a pt needed a sitter, then it was one of us who did it. About 99% of the time it meant for great studying or tv watching. I never had a problem asking the other techs to relieve me to go to the bathroom (I didn't take 10 minutes either). But as a tech I also had to bathe them, take vitals on them, assist them to the bathroom, and yes, actually touch the pt to maintain their safety.
Nov 22, '06Quote from kurosawaA couple of points: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 sitters quit.
'Cause nobody took 10 minutes out of every 2 hours to let 'em pee/smoke/get a Coke.
'Cause they know if they don't get those 10 minutes every 2 hours esp. 7p to 7a they're gonna fall asleep and get fired.
'Cause the RN couldn't be bothered to call the doctor to get an order for Haldol PRN, or for effective pain meds, or to order restraints when it was really, really needed. Or couldn't be bothered to give PRNs that *were* ordered.
I don't get 10 minutes every 2 hours to pee or smoke or have a soda. I am doing good to get 10 minutes during 12 hours to eat anything, myself.
And if the patient has a sitter, it is generally because the MD does not want them to have Haldol or restraints. Otherwise we could eliminate the use of sitters entirely.
There are laws against using Haldol/restraints for the convenience of the staff. And MDs that order Haldol/restraints frequently will find JCAHO and other regulatory depts all over his/her practice.
It is a staff member's duty to bring food/hygiene products for their needs. Why an aide would need to buy a Popeye's sandwich for someone - that has tp do with the sitter's poor planning, not the nurse's need to provide for them.
Quite frankly, I have no problem that aides sit. Given the attitude, I am more than happy to do my own vitals...especially since it invariably takes more time/effort to get the aide to do his/her job than to do it myself.
But then I usually work primary care... something I prefer. And reading posts like this reminds me why I prefer primary care.
Nov 22, '06Quote from kurosawaIf you took restraints off my pt. without asking me first, I would make sure your work day ended right then and there. You are way out of bounds if you do that. I'm surprised no one has called you on it already.Sorry, I was in a rush and didn't explain. On this one floor, the charge who had this pt won't give PRN Haldol AT ALL. This was explained to me by a floor RN when I had a very combative pt who was determined to go home. The poor pt ended up fighting restraints all night.
Now my collar's getting tight. I hate restraints. Nothing is guaranteed to generate anxiety faster than tying someone down. I'd say 90% of the time I get report that a pt is "bad" I just go in the room and first thing I do is undo the restraints and we start talking and everything is fine.
Some folks assume pts want to be "bad." Pts hate being confused. They hate hallucinating. They hate being tied down. I despise it when folks ask pts "Now are you going to be good tonight?" because the pt doesn't *want* to be "bad," he doesn't even have any control over it!
Nov 22, '06Quote from jojotooYou are correct. In my state, once those restraints come off you need a new order to put them back on...there's no such thing as "prn" restraints. So I would be furious to find out a sitter was taking restraints off an putting them back on again at his/her discretion.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?