Does your unit have to absorb the cost of sitters?

[NBMom1225]

Our 36 bed med-surg/surgical unit is always inundated with sitter cases, average of 4-6 per shift. If we can't get enough sitters, our techs are pulled to sit, leaving us short on the floor. What bothers me is that management is harping for us to decrease the sitter cases because it's making us way over budget...um, how can we do that when our unit gets more sitters cases than any other unit? Why isn't there a separate sitter budget that pays for all of the sitters in the hospital? Why does the unit who gets these cases essentially end up penalized for following the order to have a sitter at the bedside? How else can we reduce the number of falls per month without providing the ordered sitter>

We aren't allowed to refuse a sitter patient be booked to a room, so how do we have any control over this issue when our unit is essentially the 'dumping ground' for these patients? Our unit is the shabbiest is the entire hospital, we don't have beds with built-in bed alarms, and we have a limited supply of the bed alarm pads... how are we supposed to ensure patient safety in these conditions if we don't use sitters? Why should our unit budget take the hit?

I just wish there was a separate sitter budget...then maybe our unit could afford some much need equipment /renovations

[classicdame, MSN, EdD]

insurance won't pay for sitters but the hospital will have expenses related to falls, etc if a sitter is not utilized when needed. So the hospital (and your dept) are probably stuck with the expense, unless you can talk the family into it.

[dudette10, MSN, RN]

Some no-brainer suggestions, but I'll throw them out there anyway.

If you are short on bed alarm pads, maybe look to that budget first. Is the culture of the unit such that everyone not already preoccupied with work will attend to bed alarms? (Yes, I've seen web surfing uninterrupted when a bed alarm goes off.) Have you looked over your history of room assignments for cohorting opportunities (if you have semi-private rooms) and location from the nurses station? If you have involved family members of sitter patients, try to utilize them.

Good luck. I know there is pressure from all sides when it comes to budget. :)

[wooh, BSN, RN]

I feel your pain. We're the dumping ground of our hospital. I'll never understand hospital budgeting. I'm pretty sure that I don't want to understand it, as it would probably just make me even angrier about it than I already am now.

[RNsRWe, ASN, RN]

I, too, feel your pain! Last hospital I worked had the same problem. They were moving toward "zero restraint" (yah, right) and therefore had people sit and stare at patients instead of strapping them down (and how often did a patient end up on the floor anyway, because the sitter says they couldn't stop him/he moved too fast/I'm not hurting MYSELF to stop HIM, etc).

Anyway, the best we could manage was to put the 1:1 patients in the semi-privates with one sitter between them--technically 2:1, but wth. Rooms near the desk first to try to avoid the sitting entirely, but not always possible with so many confused climbers.

And yes, the floor gets stuck with the costs

[Esme12, ASN, BSN, RN]

Just like your home.....the floor has an operating budget. You need to stay within that budget to pay your bills. The staff is on your floor there fore their costs come out of that budget. If a sitter is pulled from the 4th floor and actually works on the 5th floor what should the 4th floors budget pay for the sitter and not have them on the floor. The floor getting the benefit will be the one to foot the bill. Some floors are the "dumping grounds" in every facility and have their unfair share of 1:1's and yes they foot the bill.

If your floor has a larger number of 1:1's are you short on bed alarms? or are you given every ETOH/confused LOL that comes through the ED. Does your criteria of 1:1's need to be re-evaluated? Does your facility need to begin to engage families to sit with patients? When my Dad was in the hospital, before he passed, he became very confused and the hospital came to us as a family and had us sign consent for the use of restraint or that we would stay at the bedside.....we chose to sleep at his bedside...it seemed to work for them.

Your manager needs to consider the abundance of 1:1's in her budget if your floor is the dumping ground. Hospitals/managers will always scream budget to try to minimize their expenses....but if they are consistently over budget it can cost them their jobs.

Unfortunately, the new reality is that of more personnel to "watch" the patients as physical/chemical restraints (posey vests and Haldol/ativan...just one example) are "out of fashion". The floor where you work is where their salary is charged since they are using the employee.

[LynnLRN]

We have to absorb the cost of sitters on my unit. It sucks because we are only allowed 2 NA's anyway and if there is a sitter (and its not r/t suicide) we have to pull NA from the floor, so then we have 1 or 0 NA on the floor helping.

[futureRNMena]

There's a separate sitter budget at my hospital but they still take cna's off the floor to sit. they just have to cost center reassign. It hurts the unit overall Overworking the one cna we have left. I feel that's what the flex team should do but they feels its beneath their skill level.

[susanlwins]

I can empathize with your situation completely. Our unit is the same, as are most hospital units, it seems. When we have a sitter, a CNA is pulled from the floor, leaving the other CNA's, RN's, and patients and their families to try and pick up the slack. It leads to substandard care, unfortunately. Sufficient bed alarms won't help. A bed alarm does NOT equal a sitter. If it did, they wouldn't need a sitter, only an alarm. So it doesn't really matter how many alarms you have or don't have - the reason the person needs a sitter is that even with the bed alarm, they are not safe, because they will still fall out of bed or are getting up too quickly for the alarm to be responded to in time before a fall. Or it could be they are not a fall risk at all - they may be on a suicide watch, or be a wanderer who won't necessarily fall, they will RUN out the nearest door.

When a sitter is pulled off the floor on our unit, the best thing that we can do is work together, with the added camaraderie that comes with knowing that you are all in the same boat, trying to bail each other out. It sucks, but it is part of health care, and it isn't going to change anytime soon. It is about money, and by that I don't necessarily mean profit. I work at a non-profit hospital, so it's not like our unit management is trying to make money for the hospital executives - they are just trying to deal with their own problems, mainly that Medicare is getting stingier and stingier, many patients are charity care and don't have any insurance and the hospital is footing the bill, etc. In my opinion, sometimes the best days at work are the ones where you are SLAMMED with responsibilities, but everyone is helping each other out and we all get through the shift together, without turning on each other or making the patients feel like they are putting us out by asking for a Tylenol. The worst days are the ones where we are short and everyone is stressed and start complaining about so-and-so who forgot to do such-and-such, and mangement who doesn't care, and yada yada yada. The negativity comes out when there is the most stress, and yet that is the exact time when it is the least helpful. So my advice to you is, accept it for what it is, put a smile on your face and get through those days trying to do your work and help out those around you as much as you can, and don't worry about the things you can't get to, because you are only human! And if you do see a solution to some sort of issue that can make being short-staffed a little more manageable, don't hesitate to make suggestions to management. Even if you get shot down, at least you put in your two cents!

[GitanoRN, BSN, MSN, RN]

i quess on has to do whatever it takes in order to function.

[MattNurse, MSN, RN]

Has your unit tried net beds?

[nursefrances, BSN, RN]

THIS is the main reason I am always burned out and getting somewhat bitter at work. We have sitter patients often too. We have a 32 bed unit and 3 CNAs. More often then not our CNAs are in sitter rooms and we (RNs) are stuck doing our work and the work of the 2 or 3 CNAs. Customer satisfaction is down lately and head honchos wonder why...

Gee......I am ONE person and can only do 3 things at a time as an RN and you want to make me do the job of two people. Well tough cookies...I try my best but sheesh! it's getting ridiculous. Especially when I hear our hospital's parent company makes HUGE profits each year.