Letting a pt on suicide precautions out of their room to ambulate.

TakeTwoAspirin, MSN, RN, APRN · Aug 28, 2008

You were right.

If the sitter was hired by the hospital/facility, I would report them officially. There is no possible way they could control the environment 'on the street'.

Was the patient on a lock-down unit? Doesn't make it better if they were, only worse, but just curious about how dumb the sitter really was!

casperx875x · Aug 28, 2008

I agree with you 100%. It is your responsibility to ensure the safety of the patient, and this certainly is a situation which would compromise this patient's safety. There is no telling what could've happened had the patient walked away from an area with nursing support - what if the situation had escalated into something unmanageable while the patient and friend were walking with the sitter? I also would've contacted the nursing supervisor had the sitter been questioning your nursing judgement in front of the patient.

Excellent job keeping your patient safe.

RN1982 · Aug 28, 2008

What would the sitter do if the patient decided to committ suicide somewhere else in the hospital? You should report her. I would. She should have not argued with you in front of the patient. She's not the one with the license, you are. Report her and write her up.

allnurses Guide · Aug 28, 2008

Is the sitter an employee of the facility that you work in?

I'm going to play devil's advocate and say that I wouldn't have a problem with it as long as the sitter is a hospital employee, AND they stay on THAT floor. I would not let them walk all over the hospital.

But I've worked on psych where 1:1 patients were allowed to walk the unit with their sitters, BUT they weren't allowed to go outside on the courtyard and smoke. Plus, it WAS a locked unit.

november17, ASN, RN · Aug 28, 2008

The sitter was an aide that got pulled from one of the cardiac floors I believe. No, it isn't a lockdown/psych unit - just med-surg. The pt had ingested a large amount of something toxic and was a stable transfer from the ICU. Psych consult hadn't been to see her yet.

I think the friend was more of an "enabler" than a co-conspirator. The friend was white knighting and insisting that the whole thing was a big accidental misunderstanding (despite a pattern of destructive behavior and previous suicide attempts).

I was more worried they'd try to make a run for it without signing the AMA forms rather than jumping out a window or something; but then again you never know what people are willing to do or what could happen. I just don't need that headache. Besides, patients aren't really supposed to be off our unit anyways (that's our policy, at least). I'm not a control freak, but I don't like the idea of having to deal with 6 other patients and on top of that having to worry about the whereabouts of my "suicidal" patient. If we had a locked unit I probably wouldn't have cared if she walked around.

Just looking for others opinions on the matter, since apparently according to the patient, her friend, and sitter, I was committing a gross injustice against them, humanity, and the constitution of the united states of america (I'm exaggerating, but their reaction was along those lines). Maybe there are people a little more cavalier than I? I'm honestly not sure what the official P+P is regarding suicide precautions - since I've never run into this before and I get suicide precautions so rarely I don't really have it memorized..... I'm planning on looking it up next time I work I guess that should probably answer my own question.

medsurgrnco, BSN, RN · Aug 28, 2008

Your concerns were reasonable, esp. since it sounds like you did not know how you should handle the situation and you had not worked with this sitter before. And the sitter arguing with you in front of the patient and visitor would not add to the trust level - and was way out of line! I'd look up the P&P for pts on suicide precautions. If there isn't one, then consult with the charge nurse or nursing supervisor or DON.

Alternator81 · Aug 28, 2008

Let me tell you, if I was in that situation and the aid starting chiming-in, we would have a BIG problem. You can say anything you want to me, just not in front of a patient. It's SO unprofessional!

november17, ASN, RN · Aug 28, 2008

I just instinctively said no and I wasn't going to argue about it. It just didn't seem like a good idea.

Let me tell you, if I was in that situation and the aid starting chiming-in, we would have a BIG problem. You can say anything you want to me, just not in front of a patient. It's SO unprofessional!

I asked her to step out in the hall with me for a moment....within sight of the patient but out of earshot I had a few quiet words with her. I was professional about it but what I really wanted to say was "RESPECT MAH AUTHORITAH!"(cartman style)

Okami_CCRN, BSN, RN · Aug 28, 2008

In my facility it is okay for the sitter to ambulate with the 1 to 1 sitter as long as they remain on their designated unit.

However, I feel it was not okay for the CNA to question your decision infront of the patient and visitor. As for the visitor, I would have told them that they could visit as long as they remained in the room, if they wanted to take a walk together they would have to wait until discharge.

RN1982 · Aug 28, 2008

I can hear it now..you going back into cartman style singing the song about Kyle's mom.

NurseyBaby'05, BSN, RN · Aug 28, 2008

I can hear it now..you going back into cartman style singing the song about Kyle's mom.

In D minor . . . . . . . . :devil:

Seriously, though, if the sitter was with the pt I would have let them walk around the unit, but if I thought they might even try to leave the floor: "Sorry, Charlie!" Especially b/c Psych hadn't even seen the pt yet. Actually, I would have probably told them to stay in the room until psych came by. My previous statement would only be after the pt had been "cleared", so to speak. Also, if the visitor continued to undermine the pt's treatment, he would have to go.