Hospital wants pts restained rather than pay for sitters

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Well...I am yet again extremely disappointed by the "powers that be." I guess the hospital is over budget and has now decided getting rid of sitters is the way to save.

We are now supposed to call the family and tell them that 1) someone from the family needs to come and sit with the pt or 2) they can pay for a sitter and if neither of those then we will have to get an order to restrain the pt!!!

This started a couple weeks ago and there have been so many problems already, as any intelligent person would have realized. A secretary got bit by a pt because instead of having a sitter, the pt was put in a wheelchair and placed next to her at the RN station. One day we ended up with one tech on the floor with 30 pts because 2 were pulled to sit. There is more, but this will get too long!!

Everything about this is so wrong...#1, of course, is not treating people with the dignity and respect they deserve. I want the "powers that be" to bring in their confused parent and have them restrained. How quickly they would change their tune.

I am just so upset and disappointed. :angryfire

This is coming from the top...I don't know who to go to or what to do. My manager is part of the problem. She will do anything to save a dime.

Thank you for reading...any advice would be much appreciated!!!

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We are now supposed to call the family and tell them that 1) someone from the family needs to come and sit with the pt or 2) they can pay for a sitter and if neither of those then we will have to get an order to restrain the pt!!!

And this is unrealistic - adults have to work in order to get their bills paid (most of them anyway) - and it is unrealistic to imagine that people can just drop their jobs to come and be with patients. Maybe some can pay for a sitter.

Restraints - are they really the answer?

I want the "powers that be" to bring in their confused parent and have them restrained. How quickly they would change their tune.

- yes the powers that be need some first hand awareness of the situation, before they start expecting others to follow their direction

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Specializes in LTC,Hospice/palliative care,acute care.

I agree that any available family members should be stongly encouraged to sit with their loved ones or obtain a paid sitter for as many hours as possible.If no one is willing or able to provide 1 to 1 for their loved one then the over-burdened healthcare system should NOT have to provide it.That's when restaints and sedation in acute care should be used and it should not be so difficult-it is really neccessary to keep this type of patient safe and deliver care....If they had to be more closely involved with their loved ones care maybe they would better understand their loved ones condition and have a more realistic view of treatment.We all know that the demented need to be in and out of acute care as fast as possible.There is just no possible way you can see to the basic needs of such a patient on a busy med-surg unit when you have crashing patients beside you,blood hanging down the hall and fresh post ops...I strongly believe that the elderly need and deserve a special unit.We have peds,ccu,etc-why not? They almost always do have special needs...I hope when the baby boomers get there they'll get things changed....I would rather my mother be restrained then pull out her line and have to be stuck again and again....

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yes - a special unit for elderly

with people educated about geriatrics

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Specializes in LTC, assisted living, med-surg, psych.

If JCAHO were to get hold of this, they'd chew up your administrators and spit them out so fast it would make their heads spin.

Restraining patients is supposed to be the very LAST resort. It is a violation of their dignity and their rights as human beings to restrain them for staff convenience, or to save money. :devil:

If I were in your position, I'd get a hard copy of this new policy and send it to the Joint Commission, along with a letter stating just what you've told us. Be as objective as possible, supply whatever documentation you have, and leave the emotionality out of it---the regulatory powers that be don't have time for anything but cold, hard facts. If you are a union member, involve them as well; they have experts and attorneys who may be able to advise and assist you in preparing your case against your employer.

A word of caution: make sure JCAHO keeps your identity confidential; even though they cannot legally do so, employers have ways of retaliating against employees who 'rat them out' to the Joint Commission. (There are so-called "whistle-blower protection" laws on the books, but employers who really want to get rid of someone will almost always find a way, even if they have to manufacture it.........the laws really only help AFTER one has been fired.) I don't want to scare you away from doing what's right, but you should be prepared for anything......a hospital that will restrain patients to save money on sitters won't think twice about getting rid of a "troublemaker" employee.

I wish you the best of luck. You know this policy is wrong; otherwise you wouldn't have brought it up. Thank you for fighting for your patients' dignity and safety!

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Specializes in Med-Surg.

Ever since our death-by-restraints incident our facility has been oh so happy to pay for sitters.

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there's another thread in this forum, questioning the necessity of being a pt before one can be an effective nurse.

it involves a nurse quickly pushing in undiluted phenergan to a protesting pt.

similarly, i too, ponder the reaction of tptb if they or a loved one, were put in restraints.

i agree with marla's post.

it's reportable, and violates all tenets stated in a pt's bill of rights.

a geriatric unit is a great idea.

leslie

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Specializes in med/surg, telemetry, IV therapy, mgmt.
We are now supposed to call the family and tell them that 1) someone from the family needs to come and sit with the pt or 2) they can pay for a sitter and if neither of those then we will have to get an order to restrain the pt!!!

This is the way it has been in every hospital I've worked in the last 30 years! I've never worked in a hospital yet that paid for sitters! What I used to do was to try to get those patients moved to as close to the nurses station as possible, first of all. There's more traffic there and they are likely to be seen getting into trouble by someone. Central service also had pull cords that we could pin to their gowns. These cords snap out of the wall very easily if the patient tugs on them as they are exiting the bed and sets off their call bell. Some hospitals also have bed alarms that can be attached to the beds that are set off if the patient gets out of them. Another thing I would do is make the rooms of these people nursing central. If I had the chance to sit down to chart, I did it at the bedside or just outside the room of these patients. Every time I went by these patient's rooms I poked my head in and looked in on them. I also asked everyone else I was working with to do the same--teamwork, you know.

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I agree that any available family members should be stongly encouraged to sit with their loved ones or obtain a paid sitter for as many hours as possible.

I do agree that a family member would be best...if at all possible. If, for instance, one of my maternal grandparents was in the hospital, having one from the family at all times would not be an issue. There are many of us to be able to split up the time. However...if my paternal grandparents were hospitalized and required 1:1 care it would unforfunately be impossible as there are only 3 close family members. I would do my best, but couldn't possibly be there at all times. There is no way I would be able to pay for a sitter.

[wiki]the over-burdened healthcare system should NOT have to provide it.[/[/wiki]

I do not think having sitters burdens the healthcare system. There are many, many reasons, the healthcare system (or mailnly those of us trying to provide quality, timely, and compassionate care) is over-burdened" the biggest including not being staffed properly to "save money"...(that is another thread though);)

[wiki]restaints and sedation in acute care should be used and it should not be so difficult-it is really neccessary to keep this type of patient safe and deliver care[/wiki]

I, again, agree...restraints have and serve a purpose in the right setting, with the right patient, and with the right reasons.

[wiki]There is just no possible way you can see to the basic needs of such a patient on a busy med-surg unit when you have crashing patients beside you,blood hanging down the hall and fresh post ops...I strongly believe that the elderly need and deserve a special unit.[/[/wiki]

This is why sitters are such a necessity. A geriatrics unit would be great. I do know of one hospial in my area that has one. I wonder how it is staffed.

[wiki]I would rather my mother be restrained then pull out her line and have to be stuck again and again....[/wiki]

This is where I strongly disagree. I would not want my family member to be restrained only to save time for the staff and "save money" for the institution. My grandmother became confused while in the hospital last year d/t a medication. Luckily she did remember my phone number and called me...the devil :devil:...yes, I became the devil in her eyes because me being an RN, I put her there and all my "croonies" were out to get her. I called the nurses station to tell them she was not being herself and I did go to the hospital right then at 1am. I stayed with her (her evil little dilaudid-crazy self), ensured the dilaudid was d/c'd and another pain med started. I stayed with her until she calmed down and fell asleep. I was lucky to be able to do that. Had she been restrained I would have been very upset. SHE would have been very upset, would have become more agitated and more confused. As it was it took nearly 3 days for her to become her normal, sweet, cute little a&ox3 self. Had she been restrained I am possitive it would have taken longer.

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I am still figuring out how to reply to posts:uhoh3:

So I guess instead of wrapping text I made it links...sorry!

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Specializes in Med surg, cardiac, case management.

I've been in this situation with my mom. Due to brain metastases she would become confused and constantly get up. Given the extensive pelvic bony metastases it was dangerous for her to do so, and on the few occasions she was hospitalized the staff used restraints.

We could only be there 10-12 hours, and the nurses seemed to be very overworked, so I can understand why they did that. But my mom became more agitated at being restrained and it certainly was a far from ideal solution.

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Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.

I don't see how this is going to fly when JCAHO see this. Restraints are always the last choice. I 100% agree that family members should be at bedside whenever possible. That is an ideal situation because the patient is often much less confused with a family member at the bedside. I am always a big supporter of having family members actively involved in patient care. But, that is all well-and-good for those who can be involved, but not every patient has a family member who can be there 24/7. It is all a little unrealistic. But, worst of all, the hospital is forcing substandard care on patients who can't afford a sitter. Can't cough up the cash? Sorry, I have to tie you to the bed now.

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