Behavioral health patients requiring 1:1 sitter

  1. Does anyone have an idea, process, solution, etc to staffing/coverage of the 1:1 safety sitter for suicidal patients?
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  2. Visit JRichmond03 profile page

    About JRichmond03

    Joined: Nov '17; Posts: 7; Likes: 6

    15 Comments

  3. by   hppygr8ful
    Quote from JRichmond03
    Does anyone have an idea, process, solution, etc to staffing/coverage of the 1:1 safety sitter for suicidal patients?
    I don't know what solution you are asking for. I'm a psych nurse and if the patient is not safe due to active suicidality them we sit with them!

    Hppy
  4. by   elkpark
    I, too, am unsure what you're asking. Everywhere I've worked over many years, whether in psychiatric settings or med-surg settings, individuals who were actively suicidal (or even considered just to be at significant risk) had a 1:1 sitter. The charge nurse and house supervisor worked together to work out the staffing. It hasn't been a big deal.
  5. by   soutthpaw
    Our facility has sitters that are paid to do just that. If they are actively violent or agressive they will also get a security officer to watch them, sometimes 2 of officers..
  6. by   JRichmond03
    We run into staffing issues and getting people to come in to sit with them 1:1. If I have 15 patients and 3 nurses, a patient becomes a 1:1, we pull the nurse to sit with them. Most times we have a tech but then that role need coverage.
  7. by   Accolay
    You have to give more. What's prompting this question? Where I work, it's just a given that these patients will have a 1:1. We find a body, usually someone pulled temporarily then staffed appropriately for the next shift.
  8. by   NurseSpeedy
    I rarely see an actual 1:1. Not sure how it's even possible, but I have seen up to a 1:4, basically, however many beds they could squeeze in a space and have one person look at them and call it a 1:1. One facility actually removed a wall and made two doubles a quad, had curtains in between the beds, and the sitter in the middle with a view of them all. They tried to do anything, the sitter called for the aide or nurse. Didn't touch the patients. Personally, I think it was a lousy idea and unsafe if the patient really wanted to hurt themselves, but this is what I saw.
  9. by   jodispamodi
    my unit goes by the census. 1-1's are always 1-1.
  10. by   hppygr8ful
    Quote from NurseSpeedy
    I rarely see an actual 1:1. Not sure how it's even possible, but I have seen up to a 1:4, basically, however many beds they could squeeze in a space and have one person look at them and call it a 1:1. One facility actually removed a wall and made two doubles a quad, had curtains in between the beds, and the sitter in the middle with a view of them all. They tried to do anything, the sitter called for the aide or nurse. Didn't touch the patients. Personally, I think it was a lousy idea and unsafe if the patient really wanted to hurt themselves, but this is what I saw.
    This would actually be illegal in some states and the facility as well as assigned nursing staff would be held liable if an adverse event occurred. I have a patient who has been on 1:1 for a month. Every time we take the person off 1:1 he/she hurts themselves so back on 1:1 it is.

    Hppy
  11. by   JRichmond03
    What does that do to your staffing and getting/finding coverage for that 1:1 24/7 for a month? And staff burnout?
  12. by   pixierose
    Quote from JRichmond03
    What does that do to your staffing and getting/finding coverage for that 1:1 24/7 for a month? And staff burnout?
    Well, it's illegal and unsafe for that patient NOT to have the continuous 1:1 (within arms length at all times) supervision.

    If staff burnout from the 24/month, we rotate from other floors.

    If a patient is hell bent on killing/harming themselves, they will find a way. Our job is to ensure the patients safety is maintained at all times. It's sure better than the alternative.
  13. by   Lil Nel
    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.
  14. by   brownbook
    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.

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