Getting rid of sitters!?!?

fuzzywuzzy, CNA · Aug 6, 2011

Wow, I can't imagine them going from sitters to restraints. That seems backwards. I work in LTC and we rarely care-plan for sitters. When we do, someone gets pulled off the floor and the rest of the CNAs just work short. We have tons of fall risks that get up every 2 seconds and set of their bed/chair alarms but they don't have sitters. If they fall, the CNAs get blamed for it and then the facility can tell the state that they "corrected" the problem by writing up or firing the aide, even though we all have too many other residents to take care of to just sit around.... not to mention, out of the 8-10 people on your assignment, at least 3 of them are fall risks that repeatedly get up so you can't watch them all at the same time. If I had to guess I'd say that your facility is probably planning on a similar approach- saving money by stressing you out more and giving you extra responsibility.

Ytellu · Aug 7, 2011

What a bad idea!! I work in a hospital plus for an agency as a sitter in other hospitals working with mentally disables patients. I hate to say this but just wait until the hospital gets hit with a large lawsuit because someone got injured. Then I bet the hospital will find it in their budget again for sitters.

I'm assuming they will put the highest risk nearest to the nurses station to keep an eye on things.

I was watching a patient last month who by the time I got out of the chair which was 5 feet from him he pulled out of his soft restraints, took his gown off and pulled all the leads out. Some people are lightening quick.

Poi Dog · Aug 7, 2011

For patients who are fall risks, we park them by the nurses station with a personal alarm. The alarm is attached to their gown and to the wheelchair. My facility does not utilize sitters. They wrongly assume that the CNAs can be in 5 places at one time. :rolleyes:

You are correct though that even with bed/chair alarms, some patients are just too quick to be safe.

turnforthenurse, MSN, NP · Aug 7, 2011

I couldn't imagine not having sitters. And restraints are still dangerous! Some of those patients can be houdinis and somehow get out of them, and that's how sentinel events happen

My hospital has sitters and my previous hospital had them, too. I only recall one time where a floor was unable to get a sitter from another floor, so the nurse had to sit with the patient. She took the chart into the room and had the other nurses deliver meds and things.

For fall risk patients, we put them as close to the nurses station as possible. At a few hospitals I have been to, they would have a geri chair that had a tray that locked in front of the patient so they couldn't get up. We would then keep that chair right by the nurses station. Usually those patients just wanted some company, and they would be just fine.

We have utilized bed/chair alarms, too.

bloodlikefire · Aug 8, 2011

what a bad move! has your hospital never heard about the 15 minute checks and constant paperwork that goes along with restraints (restraint flow sheets). when i worked for the state of california in the prison system, every time they put a patient in restraints they still needed a sitter just to do circulation and vital sign checks. not to mention the increased amount of damages that will be rewarded for not using the standard of care when these people get hurt, which is more likely in restraints versus sitter.

kool-aide, RN · Aug 8, 2011

Uhm, Hello! Even WITH restraints pts still get hurt quite often!!! At my hospital, sometimes pts are restrained AND have sitters!

ArmyWife11B · Aug 15, 2011

Honestly I think a re-eval of the system as a whole is needed... like more checks per-shift by the charge; as the the status of the person needing a 1:1...I hate nothing more that to see a lazy CNA get exactly what they were hoping for by getting to sit in the 1:1 all shift while i run my bum off and I have togive them breaks even though they are just sitting there doing nothing, because their pt is doped up on Haldol, while the Charge is too busy to check on there status.

Another example is I was on a 1:1 the other day where all I did the ENTIRE 12hr shift is lean over this pt. hold their hands down so they didn't pull out their NG or take off ther bipap.....why couldn't that person be in soft wrist restriants?? Would have made me available to be on the floor and help.

interceptinglight, CNA · Aug 15, 2011

I've never even heard of a 'sitter', so I didn't know there was such a thing in a hospital or LTC!! At the nursing home I used to work the fall risks were all over the place, it was impossible to keep them near the nurse's station. I only remember a couple of occasions the entire year I worked there that they budgeted for 1:1 care for any of these people. And anything even close to resembling a restraint was completely out. All we could do was use alarms to babysit these people, and falls still happened all the time, even fatal ones.

SleeepyRN · Nov 28, 2011

Honestly I think a re-eval of the system as a whole is needed... like more checks per-shift by the charge; as the the status of the person needing a 1:1...I hate nothing more that to see a lazy CNA get exactly what they were hoping for by getting to sit in the 1:1 all shift while i run my bum off and I have togive them breaks even though they are just sitting there doing nothing, because their pt is doped up on Haldol, while the Charge is too busy to check on there status.
Another example is I was on a 1:1 the other day where all I did the ENTIRE 12hr shift is lean over this pt. hold their hands down so they didn't pull out their NG or take off ther bipap.....why couldn't that person be in soft wrist restriants?? Would have made me available to be on the floor and help.

As a sitter and patient care tech, not to mention an RN soon to be, I am INCREDIBLY offended by this. YES, there are absolutely some lazy sitters out there. But guess who in my experience those lazy people tend to be? CNA's who's main job is to work the floor but get called in to be a sitter. Those of us who work mainly as sitters KNOW how HARD a job "sitting" can be. The word sitter is a joke. I have literally saved lives as a "sitter." I have so much to refute this statement that it will take some time to think about how to respond. Opinions like yours are what make employees like me feel like crap about ourselves when all we want to do for God Sakes is use the bathroom and get away from verbally and even physically abusive patients for a few minutes. I'm not against restraining patient's when its necessary, as it seemed to be in your example, BUT in my VERY QUALIFIED experience, restraints can make patient's much more agitated, which increases their blood pressure, heart rate, respiratory rate (not to mention the patient's who have to hear the restrained patient yell) I'm a damn good sitter and know how to talk down patients to the point where they don't even have to use drugs on them. I guess if you're not smart enough to know how to use psychology with patients, you would have the opinion you do. I WORKED 17 hours straight today with NO break as a "sitter". One patient confided in me that she took 20 vicodin and not the four that she told the physicians. (she has a high tolerance due to abuse) Because of this, I potentially saved her life because, not knowing this, the physician ordered morphine for her, which could have caused her to stop breathing. The CNA on the floor documented that her respiratory rate was 18 (false documentation because she was too lazy to actually take her respiratory rate.) I took her resp rate and it was TEN. This was before the morphine was ordered. I immediately notified the physician and he immediately discontinued the morphine. I have MANY MANY MANY similar stories. I have to stop now before I make myself angry. You really need to re-evaluate your opinion on what sitters do. I have had sooo many patients (and their family members) hug me and tell me "thank you sooo much" when I left at the end of my shift. I know the difference I make as a "sitter." So I guess I just need to chose to ignore your ignorant opinion.

interceptinglight, CNA · Nov 29, 2011

As a sitter and patient care tech, not to mention an RN soon to be, I am INCREDIBLY offended by this. YES, there are absolutely some lazy sitters out there. But guess who in my experience those lazy people tend to be? CNA's who's main job is to work the floor but get called in to be a sitter. Those of us who work mainly as sitters KNOW how HARD a job "sitting" can be. The word sitter is a joke. I have literally saved lives as a "sitter." I have so much to refute this statement that it will take some time to think about how to respond. Opinions like yours are what make employees like me feel like crap about ourselves when all we want to do for God Sakes is use the bathroom and get away from verbally and even physically abusive patients for a few minutes. I'm not against restraining patient's when its necessary, as it seemed to be in your example, BUT in my VERY QUALIFIED experience, restraints can make patient's much more agitated, which increases their blood pressure, heart rate, respiratory rate (not to mention the patient's who have to hear the restrained patient yell) I'm a damn good sitter and know how to talk down patients to the point where they don't even have to use drugs on them. I guess if you're not smart enough to know how to use psychology with patients, you would have the opinion you do. I WORKED 17 hours straight today with NO break as a "sitter". One patient confided in me that she took 20 vicodin and not the four that she told the physicians. (she has a high tolerance due to abuse) Because of this, I potentially saved her life because, not knowing this, the physician ordered morphine for her, which could have caused her to stop breathing. The CNA on the floor documented that her respiratory rate was 18 (false documentation because she was too lazy to actually take her respiratory rate.) I took her resp rate and it was TEN. This was before the morphine was ordered. I immediately notified the physician and he immediately discontinued the morphine. I have MANY MANY MANY similar stories. I have to stop now before I make myself angry. You really need to re-evaluate your opinion on what sitters do. I have had sooo many patients (and their family members) hug me and tell me "thank you sooo much" when I left at the end of my shift. I know the difference I make as a "sitter." So I guess I just need to chose to ignore your ignorant opinion.

Wow!! I think the reason I've never even heard of a 'sitter' was because my employer expected the floor CNA's to do what the sitters do -- provide 1:1 supervision while taking care of the other 15 people on their shift. Because that's not really possible, some of our residents would have 3 or 4 alarms a piece on them: bed alarm, motion sensor, floor alarm, and a tab alarm attached to their clothing because alarms don't need an hourly wage. Unfortunately the alarms couldn't monitor the residents condition nor take vitals....so needless to say impending illnesses would often go unnoticed until the resident was critical....or in some cases I know of.....dead. One of our hospice residents who was on chemo was also categorized as independent because he didn't need toileting or dressing assistance. Because of his chemo, the CNA's were hesitant to go into his room to empty his commode. One night the CNA on duty didn't even check on him all night long because he didn't ring his alarm. He was found dead the next morning by the day shift. His last night on the earth was spent totally alone and no one even knew what time it was when he passed because it was just too expensive to staff someone to be by his side that night. What a disgrace. Cost-containment is sometimes very costly.

LaterAlligator · Nov 30, 2011

Absolutely, restraints are no substitute for a 1:1. At the nursing home I worked at, we never had the staffing to do a 1:1, the best option we had was to call residents' family members and beg them to come do it when it was necessary for safety (it being the dementia unit, our residents would forget and stand up and try to walk on broken hips, for example).

Now that I work at a hospital, I've done 1:1 there and have definitely prevented some falls and other bad outcomes for patients with altered mental status. It can be incredibly challenging to sit with the same patient for hours on end by yourself; I had one very agitated confused guy with a broken hip that not only kept trying to climb out of bed and pull out all his lines, but also had nonstop loose stool incontinence. I was changing him basically every 30 minutes alone and ended up putting on isolation gear for it because he kept grabbing me with stool all over his hands. Not for the lazy!