What else could I do?

Nurses General Nursing

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Background: One of my patients the past 2 days was a 70 year old man with Dementia. I'll call him Bob for the sake of clarity. Bob was in a camera room and had a sitter due to a tendency to wander and have outbursts but all in all is a very kind man and a sweet patient.

Problem: His sitter. Yesterday the sitter was very helpful in calming Bob and redirecting his behaviors. Today, however, his sitter (a different person) turned on his call light every 10 minutes or so to let me know that Bob wanted to call his son, that he was upset, that he needed more blankets, etc. The first words she said to me this morning was "When are you going to give him something to calm him down," when in fact Bob was sitting in his chair listening to music. The sitter's tone of voice alone drove up the anxiety level constantly (and I had a strict NO benzos order from the doctor because they made him MORE agitated). I was able to calm Bob without problem when I needed to give his medication and I even had him eating his lunch until he asked where his son was and the sitter told him that she tried calling but his number was disconnected and she didn't know how to reach him. Long story shorter...The part that really got me was the sitter moving her chair and table so close to the inside of the door that when I tried to get in to give medications I was not able to open the door. If there was an emergency that would have been a HUGE problem.

Question: Besides the few (ignored) reminders to use a soft tone of voice and to not treat Bob like she was afraid of him that I gave the sitter, and mentioning the situation to the charge nurse, is there something else I should have done about the situation? I don't want to get anyone in trouble and I am new but it really did make things more difficult than they needed to be.

When it comes to sitters, there are really good ones, and others who see there job as sitting (and watching tv/reading but not really interacting with the pt). I always look for opportunities to educate them on what they can do to help the patient. At times I have been known to remind the sitter that the reason why they are there is because we know the patient has these behaviors. I would mention it to the charge nurse and mention to the chg. what I did to educate the sitter on their role (so that the sitter hopefully learns and gets really good -or does not continue to come to the unit and make more problems than s/he solves).

Specializes in Psych (25 years), Medical (15 years).

I feel your pain, AvaRose.

Some sitters are like having another patient who happens to be an adolescent diagnosed with oppositional defiant disorder to deal with.

Other sitters would do better if they were a dead dog leashed to the patient.

There are some great sitters out there who work magic with those they serve.

For the others, I merely tell myself, "With these oxen, we must plow".

Specializes in Medical-Surgical/Float Pool/Stepdown.

I have flat out had an adult conversation with a sitter before that expressed my expectations for the shift. I reminded the sitter up front that if they were not able to handle (reasonable) behaviors from the patient and perform in an therapeutic and engaging way with the patient, that they may not want to continue working as a sitter. I did go up the chain of command as well. This sitter had had repeated issues (like trying to nap, etc).

Thankfully my work ended up having way too many issues with sitters that they changed gears and only CNAs can sit now. Before it was employees that were picking up sitters shifts but were from areas of the organization that mostly didn't work in direct patient care (but were getting paid an added shift differential/bonus to sit).

Good sitters are worth their weight in gold. To be perfectly honest, I never did like sitting--telling the patient over and over a story about how their family was in earlier--what a lovely family!-- and how they'll be back tomorrow, they promised... to make the patient less anxious. Important work to be sure, but repetitive and draining. I hate doing it for more than four hours. And there are just some I can't calm. One middle aged gentlemen in particular would just look at me like, "who the heck are you, young lady?" every time I tried to redirect him to sit back down. Eventually, I was switched out for a male sitter, who he was more apt to listen to.

Anyway, my point is sitting does take some finesse that not everyone has. You may have to teach new sitters on what to do. Even then, the sitter and patient may not be a good match. If it's not working and you've already tried to show them what to do, you may need to ask for a different sitter. If they are just refusing to do the job, that's for their direct supervisor to sort out.

Thanks for the replies. I noticed that she hasn't been assigned to sit for him anymore and he seems more lucid the past several days. I'm not his nurse right now but I'm guessing that his meds may have been adjusted a little. My hospital uses CNAs as sitters as well, but not all the CNAs are very good, or maybe not very well trained. The CNA I had today is a prime example. A patient claimed the CNA was rude while cleaning her after a BM and my preceptor and I had to smooth ruffled feathers with the patient and family for a couple of hours and handle cleaning the patient for the rest of the shift (frequently). The patient really loved me though, I actually talked to her while giving medications. Therapeutic communication does come in handy sometimes anyway.

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