Behavioral health patients requiring 1:1 sitter

allnurses Guide · Dec 11, 2017

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

elkpark · Dec 11, 2017

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.

SouthpawRN · Dec 11, 2017

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..

JRichmond03 · Dec 11, 2017

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.

Accolay · Dec 11, 2017

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.

NurseSpeedy, ADN, LPN, RN · Dec 12, 2017

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.

jodispamodi · Dec 19, 2017

my unit goes by the census. 1-1's are always 1-1.

allnurses Guide · Dec 20, 2017

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

JRichmond03 · Dec 20, 2017

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

pixierose, BSN, RN · Dec 20, 2017

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.

guest52816 · Dec 20, 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.