One on ones are killing us for staffing!

Nurses General Nursing

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Specializes in Medsurg/ICU, Mental Health, Home Health.

Firestarter, I'm wondering if we work in the same place!

Every time we have the desired number of techs (which is almost never) the sitter cases start to roll in like crazy. I believe we had four at one point...on a 35 bed floor. The thing is, some of the sitter cases don't really need 1:1, which makes it even more frustrating.

When I worked in the city, there was a special Psych Crisis ER at that hospital, which is much smaller than the suburban one I work at now. The Psych techs were available to sit frequently, and there was always a Psych tech who wanted a crisis care monitor shift. We don't have any type of Psych care at this big hospital, so our techs end up sitting. All right, once in a while, we'll get a real, live Psych tech and they're always wonderful with the patients. Then we won't get any...and those are times we could use them!

I know what you're going through.

allnurses Guide

herring_RN, ASN, BSN

3,651 Posts

Specializes in Critical care, tele, Medical-Surgical.

pagandeva2000, LPN

7,984 Posts

Specializes in Community Health, Med-Surg, Home Health.

This has been an issue at my facility as well...sometimes leaving one tech to do care for as many as 20 patients, and this is including incontinent patients, I/O's, vital signs, etc. It is really a problem.

pagandeva2000, LPN

7,984 Posts

Specializes in Community Health, Med-Surg, Home Health.

firestarterrn, great post!

but, of course!:yeah::up:

ImMrBill3, RN

116 Posts

Specializes in ICU, Home Health Care, End of Life, LTC.
I'm all for the concept of avoiding the use of restraints, in theory, but in practical terms, pulling techs from the floor to sit with out of control patients is shortchanging the rest of the patients.

Now isn't this a typical American concept? The rights of the individual supersede the good of the group. Actually, that seems to sum up much of what is wrong with healthcare in America today.

Also, regulatory goals are made in a vacuum, with no consideration for the impact they have within the reality of the time/space continuum or their impact on allocation of available resources.

I don't think restraints should be a last resort when pulling a tech to sit with a patient will deprive other patients of needed care.

Typical American concept is indeed individual rights prevail and money grants rights. Socialized HC would be focused on serving the most people possible with the available resources, capitalism states those who provide good enough care to those with money get paid and provide profit to the investor. That's the system which governs our HC.

I don't think restraints are justified by inadequate staffing!!! As for the vacuum of where regulatory goals come from check you EBP, facilities that have gone restraint free have fewer injuries.

Music in My Heart

1 Article; 4,109 Posts

Specializes in being a Credible Source.
We also spoke with our in-house CNA's and allowed those that wanted/needed extra income to add their name to a list which we would provide the families to choose from. This work had to be outside of their normal shift and would be paid directly from the family to the CNA. The facility was not involved in tracking their hours/nor paying the CNA. This proved to be a win-win situation. Many CNA's signed up...
An issue created by this approach pertains to liability. When the CNAs are performing their private-duty shifts, they're not covered by the facility's insurance policy although they might not realize that. I hope that they were advised to obtain their own .

HM2VikingRN, RN

4,700 Posts

perhaps patient and families should be made aware that if patient is pulling out iv/foley etc. they have a choice to pay extra for a sitter, have a family member sit, or be restrained. there should be no added cost financially or in floor staff to manage unruly pts.

Except we have a collective obligation to assure pt safety. Not all patients have family members.....

KateRN1

1,191 Posts

Specializes in COS-C, Risk Management.

When I worked on a tele floor eons ago and we had sitter cases, often an RN was pulled to work as a tech while the techs filled the sitter slots. This gave the other RNs maybe 1 more patient each (4 RNs instead of 5 for 31 pts when full census on 3-11shift) rather than leaving one tech for the whole floor. And yes, I pulled my share of tech shifts. What an amazing thing to leave right at the end of the shift and not stay behind another hour charting! Woo hoo! I think that all RNs should have to work as a tech a few days a year, it gives a whole new sense of what the techs do, especially for those who haven't worked as CNAs or nurses techs before.

Specializes in LTC, Med/Surg, Peds, ICU, Tele.

When the doctor orders a sitter for a patient do hospitals get extra reimbursement?

When I worked on a tele floor eons ago and we had sitter cases, often an RN was pulled to work as a tech while the techs filled the sitter slots. This gave the other RNs maybe 1 more patient each (4 RNs instead of 5 for 31 pts when full census on 3-11shift) rather than leaving one tech for the whole floor. And yes, I pulled my share of tech shifts. What an amazing thing to leave right at the end of the shift and not stay behind another hour charting! Woo hoo! I think that all RNs should have to work as a tech a few days a year, it gives a whole new sense of what the techs do, especially for those who haven't worked as CNAs or nurses techs before.

lol I loved doing that although it rarely came up and when it did the only problem was i can't say no when someone needed something license wise so then i ended up doing both jobs anyways

SweetLemon

213 Posts

Specializes in Psychiatric Nursing.

In all honesty I hear what you are saying but I don't think I would go as far as restraining a patient just because they are pulling techs off the floor. The problem lies in the lack of staffing that is occuring. I too seem to have this issue very often and can have anywhere from 1-4 techs sitting per night and from time to time have to ask RNs to take a couple of hours just to give staff a break. What a waste of resources!!:banghead: In a hospital I did my clinicals in they had what was called sitters, not actually CNAs but people who were trained to be able to sit with the patient and makes sure everyone was kept safe. Why can't we have more of these??? I know the pay can't be great but just go over to the university and explain that while the patient is sleeping and not a harm to themseves one can get large amonts of studying done and be paid to do it.... That would have caught my eye!

psalm, RN

1,263 Posts

Specializes in Staff nurse.
Hey at least you all get sitters. In LTC, they would just laugh if we even suggested we needed someone to do nothing but sit. Oh, and we have had to be restraint free of years!

Yes...the patient/resident has "the right to fall". Or so I was told in LTC.

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