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

[That Guy, BSN, RN, EMT-B]

We always jsut take aides from the floor to be sitters.

[Guttercat, ASN, RN]

Our hospital just got rid of sitters.

If the floor needs a one-on-one, a CNA is pulled and the rest pick up that CNA's patients.

It's like 1993 all over again.

[NBMom1225]

Thank you everyone for your responses, at least I know I'm not alone:bugeyes:! Our floor gets all the ETOH's, elderly post-fall patients, suicides (real 1:1's...but we cohort the others when possible).

Last night was a prime example...6 sitter patients (were able to cohort that down to using 3 sitters), 6 bed alarm patients, 2 in restraints, and an additional patient in a Posey bed...we were short a PCA, RN's and PCA's all pitching in to relieve sitters for breaks, and what happens?? A confused LOL fell and was found on the floor after staff heard a thud, right after hourly rounding occurred, even though all the usual appropriate deterrents/reminds were utilized...it just doesn't stop!

Managements 'new' idea is to d/c the sitters (where 'appropriate') and put them all in Posey beds...apparently Posey beds don't come out of the unit budget:uhoh3:! Aren't we supposed to be using the 'least-restrictive' options before jumping to restraints?! Not to mention the bulk of our patients would NOT be appropriate for a Posey bed, it would increase their agitation and they could harm themselves/pull out their IV's/Foleys etc attempting to get out.

All I know is that this unit is burning me out...I would really love a phone triage RN job right now, lol!

[oinch97]

Wow, I wish we could use Posey beds where I work now. Our facility only uses them in psych areas

[RNperdiem, RN]

Sigh...

The purpose of sitters was so restraint use could be minimized, and even eliminated.

I started nursing when restraints were more freely used, and it looks like your floor is going back full circle.

[MikeatFreedom]

More and more facilities are re-visiting the use of Enclosure Beds in place of Sitters. This is a viable solution when facilities are "stuck with the cost of a sitter". A recent Enclosure Bed company recently received FDA Clearance for its Enclosure Bed product as a less restrictive, restraint option. This product will also meet CMS requirements for less restrictive devices. I believe this product is better than another alternative which is chemical restraints. Facilities have the option to purchase or rent this product. With the average cost of $16 an hour for a Sitter (X 24 hours a day = $384.00 day) - an Enclosure Bed saves money (average is about $50 day). I know of several rental companies that offer this product as well as manufacturers who will sell it.

[xoemmylouox, ASN, RN]

Enclosure beds have their purpose, but it sounds like they are being overused. Patient safety is a risk in those beds, not to mention they get so filthy. I wouldn't want to be zipped up in one.

[wooh, BSN, RN]

Ugh. Enclosure beds SUCK.

[Esme12, ASN, BSN, RN]

Yes.......they do.

[Ruby Vee, BSN]

Sitters and translators -- our unit sucks up the cost.

[turnforthenurse, MSN, NP]

Yes.......they do.

Where I work you need to make sure you get a physician's order to use this type of bed because it is considered a restraint.

And also where I work, these beds have been pretty useful. We also have "low boy beds" which decreases the distance from the bed to the floor if a patient were to fall. These beds come with mats to put on the sides of the bed to cushion the floor. They also have a built-in bed alarm. Of course, even with all of these "measures" put into place, patients still fall.

Our unit absorbs the cost of sitters. If we can't find an extra CNA or tech to sit with the patient, we have to pull one from our floor. On a rare occasion, if we have an RN on call and they are not needed on the floor, they will be called in to sit with a patient. If the patient has a family member, we always try to call them in to sit with the patient and they usually never make a fuss and this can really help us out.

I have worked in other hospitals and they too had to pull a CNA/tech from the floor or from another unit to come sit with the patient.

[Esme12, ASN, BSN, RN]

Where I work you need to make sure you get a physician's order to use this type of bed because it is considered a restraint.

And also where I work, these beds have been pretty useful. We also have "low boy beds" which decreases the distance from the bed to the floor if a patient were to fall. These beds come with mats to put on the sides of the bed to cushion the floor. They also have a built-in bed alarm. Of course, even with all of these "measures" put into place, patients still fall.

Our unit absorbs the cost of sitters. If we can't find an extra CNA or tech to sit with the patient, we have to pull one from our floor. On a rare occasion, if we have an RN on call and they are not needed on the floor, they will be called in to sit with a patient. If the patient has a family member, we always try to call them in to sit with the patient and they usually never make a fuss and this can really help us out.

I have worked in other hospitals and they too had to pull a CNA/tech from the floor or from another unit to come sit with the patient.

These type beds have been reported and caused patient deaths. You ABSOLLUTELY NEED AN ORDER! They have their place but I have never liked them.