Changing/Eliminating 1:1's?

RNperdiem, RN · May 28, 2015

I have not heard of a policy like this. If you can't get a sitter, your options are to use restraints, pull one of your CNAs to sitter duty(leaving the department one short) or give a very light assignment to the nurse, in ICU that would mean 1:1 with little getting out of the room.

Sometimes nurses are put in a difficult spot where we aren't supposed to use restraints, aren't given a sitter, inadequate sedation, but there had better not be any falls or lines pulled out.

ArtClassRN, ADN, RN · May 30, 2015

They'll cut it out when people start eloping/wandering into other patient's rooms (this gets management's attention), falling, or dying.

If none of the above happens, you probably didn't need the 1:1 anyway.

RNsRWe, ASN, RN · May 30, 2015

I've seen 1:1's ordered for some of the stupidest possible reasons, including family that complains that Grandma is just too lonely at night by her lonesome, and MIGHT decide to get up and visit the nursing station.

But they are also there to keep another Grandma from ripping out her IV, her foley, NGT, and heaven knows what else before throwing herself off the bed onto the tray table and floor. Anyone love those middle-of-the-night CT head scans and hip xrays?

If administration is prepared to back up the nurses who are GOING to be blamed for the chaos that ensues when a 1:1 is more like a 1:whenever......well ok then. But if not....yeah, I'd be wanting either a sitter or restraints!

jadelpn, LPN, EMT-B · May 30, 2015

In my experience, you are speaking about 2 different things.

There are patients who perhaps need 1:1 sitters that fit a certain criteria. They are suicidal, and/or at risk to themselves or others. 1:1 sitters are considered a restraint, as a sitter is limiting a patient's movement, what the patient can and can not do, and the patient is secluded.

Most have to have some sort of a situation/section something from the MD who is stating that the person can not leave the facility, due to mental status. Even with a 1:1 sitter, if there is nothing that says that the patient is required to stay in their rooms, or even in the facility, a sitter could be keeping someone against their will should they want to leave and someone is preventing that. And there's very few MD's who want to keep coming into the facility to satisfy the restraint policy ie: laying eyes on the patient q 4 hours when they would like restraints continued (ie: 1:1 observation)

Q 15 minute checks are when the nurse needs to check on the patient every 15 minutes, for those patients that may have a history of danger to self but not actively suicidal. And do not necessarily require constant observation.

And again, it is a slippery slope of sorts, however, patients have rights, and they have the right to leave the premises if that is what they choose to do AMA. You can not block a person from leaving, so really a 1:1 is just making sure that a patient stays safe. With that being said, one can't really force someone to stay in bed, either. That would need a whole different set of restraints, whether that be chemical or otherwise.

There can be a lot of liability tied up with keeping people under constant watch without the paperwork from the MD to back it up, Q 15 minute checks are less invasive. Also, alarming patients who do not remember to always use the call bell due to mental status is also an option, if this is what the issue is as opposed to suicide risk.

Then there's the tying up of staff on people that are planning on leaving AMA, and the staff can't stop them, and they sit for hours for a patient sleeping....lots of things.

It is so important to first and foremost, have your own malpractice insurance. Secondly, that the orders are clear for patients who need any kind of observation, but most especially 1:1's. And to train everyone what to do and the steps to follow when a patient attempts to leave, escalates...and be sure you have orders to back all of this up.

Patients are getting more and more savvy and know their rights as far as being observed, and their ability to leave AMA should they choose to do that. Families can be a "you have to watch Auntie for the night, we are afraid she is going to fall" (

Bottom line--for them it is about the money "wasted" on nurses or CNA's sitting, and the perception of families/visitors/other patients on anyone sitting during a shift.

dream'n, BSN, RN · May 30, 2015

There is no way I have time to check a patient every 15 minutes and document it throughout an entire shift while also having a normal patient load. Just not possible.

caseyuptonurse · May 30, 2015

We have our 1:1's for patients that are harmful to themselves. For q15 checks we still have sitters which if there's multiple q15 checks on the floor it works wonderfully because that one sitter can do all the checks. The q15 checks tend to be on our bed hoppers and our patients/patient families that want someone to be in the room. I've had once or twice where we were short a sitter/aide for the q15 and the nurses had to do it but for that we gave each other a q15 minute interval for each one of us to check on the patient such as I go at 30 after the hour, another goes at 45 after the hour, ect., so that one of us didn't have to go and check on the patient every 15 minutes but rather each hour.

amoLucia · May 31, 2015

To jadelpn - great response.

I've said this before somewhere, I never heard of a 'sitter' until here on AN. In LTC, I never had the luxury of one - must be something you hospital folk are treated to. It's not like we don't have the behavioral problematic pts on our LTC units.

Swellz · Jun 3, 2015

We don't have 1:1s often because we do every alternative first. We certainly don't do them because a family member says so. I just don't like the idea of this because I feel my manager or the nursing supervisor overnight will force us to use observation when we really need a 1:1 just to save money.