Behavioral health patients requiring 1:1 sitter

brownbook · Dec 20, 2017

You and your co-workers need to gather some facts on how often 1 - 1's are ordered, what are the mandated staffing ratios on your unit, etc. Along with a list of local staffing agencies. Most states, (all states?) have agencies that provide temporary licensed health care personnel.

Present this to your administration. You could even suggest putting it out to hospital staff if they sign up to be available for 1 - 1 they will get ??? double pay ????

Yes the temporary agencies, (or paying staff double pay) cost a lot, but cost way less than a malpractice law suit or even the cost of staff turn over and new staff orientation, due to staff leaving.

allnurses Guide · Dec 21, 2017

What does that do to your staffing and getting/finding coverage for that 1:1 24/7 for a month? And staff burnout?

The staffing office assigned a sitter usually a unlicensed BHW (Behavioral Health Worker) to be the 1 to 1 staff for this patient. My unit has 1 RN (ME) for 17 patients, 1 lvn or psych tech to pass meds and 2 to 3 BHW s depending in census. A 1:1 in our facility must have a staff within Arms reach at all times. Most of our staff like 1:1 because it's a lot less work for them unless the patient is highly aggressive. Most of our 1:1 are self harming borderlines and they actually love the attention. Our biggest issue is when a patient like the one I mentioned has to be officially off 1:1 status for a minimum of 24 hours without hurting themselves before discharge. Our management takes pretty good care of us and our staff will rotate the 1:1 assignment throughout the day so no one gets too bored but that's what teamwork is all about.

Hppy

allnurses Guide · Dec 21, 2017

When I worked at a psychiatric facility, a doctor's order was needed to obtain a 1:1. Once the order was in place, it was up to the House Supervisor to secure staffing for the 1:1.
More recently, at the acute care hospital I was employed at, again, a doctor's order was needed and staffing was then arranged.

Yes the patient's doctor must renew the 1:1 order daily and provide justification rationale to continue this level of supervision but that's mostly so the insurance companies pay the extra dollars for that level of supervision.

Hppy

ChryssyD · Dec 21, 2017

JRichmond: I work on an admissions unit in a state psychiatric hospital. We often have 1:1s, for everything from suicidal ideation, inappropriate sexual threats or behavior, fall risk, to serious aggression. I agree with your basic point, these patients do use staff who often, it seems, could be more productive elsewhere. But the consequence of a 1:1 patient acting out on whatever issue caused the MD to think 1:1 was necessary is more important than staffing issues. Patient safety takes priority. The patient has to prove, over several days, at least, that s/he is not going to act out. It can really suck, staffing-wise, but it's necessary. So be it.