One on ones are killing us for staffing!

  1. 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.

    I worked a 12 hour shift on my regular unit, had one of my confused patients with a one on one, but no tech on the floor for over 20 patients because all the techs are being diverted to one on ones. Then I stayed over 4 hours of OT to help out another unit, a patient whom I was picking up was in the process of going ballistic, another one on one ordered, no tech for that unit either!

    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.
    Last edit by FireStarterRN on May 25, '09
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    About FireStarterRN

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    Specialty: 15 year(s) of experience in LTC, Med/Surg, Peds, ICU, Tele

    29 Comments

  3. by   oramar
    You spell out the problem pretty well. Management needs to be ready to spend the extra money to cover one on ones. Right now they don't want to do it. Probably because they don't get reimbursed. Putting all the other patients in danger to cover the person that needs the one on one is what is happening at a lot of places but not all. Some places have a special prn, one on one staff pool but it gets expensive it really does.
  4. by   madwife2002
    Our techs had 13 pts each the other day because one tech was pulled, it was nigh on impossible to give great care under these conditions, especially when you have a lot of needy, incontient pt's. We the RN's helped out as much as we could but I understood the anger especially as 1 tech had 11 accuchecks
  5. by   Southern Fried RN
    My hospital does this now with confused patients. The floor nurses are not supposed to restrain people anymore from pulling out the IV/NG/Foley and a tech is supposed to sit with that patient. Restraints are supposed to be a "last resort." Of course, it is just the same as you all describe, the rest of the techs pick up the slack. Then when someone else isn't bathed/turned, accuchecks/vitals are late the techs get in trouble. These administrators can't have it both ways! I wish the people that make up these rules would take one day as a nurse or tech on a med-surg floor and they would see quality care can't be done with their so-called streamlined staffing processes.
  6. by   Be_Moore
    So my hospital has some semi-private rooms on the floors (2-bed jobs). What they have that is really neat is 4-bed semi-private rooms that have a desk built in for a sitter. So those patients that require one-to-ones actually go into a 4:1 room with a sitter. We have designated sitters in our staffing pool for the floors. Tell your managers.
  7. by   elkpark
    The hospitals I've worked for have used "pool people" for sitting -- a separate person is sent to the floor solely to "sit," the existing floor staff doesn't have to give up a person. Sure, a tech from the floor would have to sit with a client until the "pool person" arrives, but that is a limited amount of time. I've never encountered a situation where the regular floor staff on the unit are expected to just "absorb" clients needing to have sitters ... Wow, what a bad idea!
  8. by   Tweety
    Our sitters don't impact the techs on the floor. Thankfully. I currently have only two sitters on the floor right now but usually have up to six. It does impact the floor's budget. So our budget is shot because we have so many sitter cases all the time.
  9. by   ♪♫ in my ♥
    Quote from FireStarterRN
    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.
    It's also one of the huge problems in public education.

    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.
    Yes. This is particularly vexing, especially when the goals don't appear to contribute much to the outcome. I'd like to see cost-benefit analyses applied to every regulatory standard.

    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.
    I agree completely. Perhaps if we had unlimited resources I would think otherwise but our health care system is stretched the breaking point and I consider this to be a poor utilization of available resources -- and I would feel that way if I were going to be the one in the bed.

    It's also worth mentioning that even an attentive sitter is no guarantee against ripping out tubes. Properly applied and monitored restraints are as close to a sure thing as you'll get.
  10. by   Nascar 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!
  11. by   keithjones
    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.
  12. by   changeofpaceRN
    Quote from Nascar 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!
    Really? AT my LTC place they pull CNA's to sit with the confused/risk for fall patients. The go by overall building census and split the CNA's between the 2 sections. One night, we had 2 CNA's on the floor for 60 residents. The other 2 CNA's were a 1:1.
  13. by   LockportRN
    Nascar nurse, I agree with you that we in LTC have been mandated to be restraint free. I have had both experiences, the pct/cna being pulled to 'sit' which is bad for all other patients, staff and facility; and have also had the ability to have extra hands for sitters. This was done 'creatively' when we were so overburdened with confused/combative patients with multiple IV's/GT's/trachs/high risk fallers by using our 'light duty staff' to sit.

    We have also gone the way that Keith Jones suggested in the last 2 years when MC/PA has dropped their reimbursement rates so drastically. The way we did it was through letters and holding a 'Family Night' to roll it out. The families were explained that we could no longer remain a financially viable facility while essentially providing 'private care' to their loved one.

    Some options for them, was to coordinate with staff that patients' most troubled times and allow family members to sit with them. In lieu of that, Social Services provided lists of Private Duty agencies from which the families could choose from. 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 knowing not only that they could help this patient & family, make extra money (without struggling to care for 10 - 15 patients) but it also fostered a better sense of community as they understood how much 'RELIEF' it would bring to all the caregivers for that unit.

    While this helped sooo much in keeping the patients safe and offer increased dignity and safety, firestarterrn, I agree, there are times when a restraint is the only way.

    For those in Illinois LTC, the IDPH surveyors have begin a swing back to the 'olden' days (for those of us over 40 lol) of allowing and in some cases, citing facilities for NOT using restraints! Especially if a patient had a fall and became injured. It's a fine line to walk.

    Firestarterrn, GREAT post!
  14. by   Penelope_Pitstop
    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.

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