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Letting a pt on suicide precautions out of their room to ambulate.

Specializes in Ortho, Case Management, blabla.

I had a patient on suicide precautions that wanted to walk around the facility ad lib with their friend and the sitter with them. I said no; she needed to stay in the room. They all protested; arguing with me about it. The aide that was sitting even argued with me about it (in front of the patient, :no: I wanted to kill her). I stood firm.

What do you guys think?

TakeTwoAspirin, MSN, RN, APRN

Specializes in Peri-op/Sub-Acute ANP.

You were right.

If the sitter was hired by the hospital/facility, I would report them officially. There is no possible way they could control the environment 'on the street'.

Was the patient on a lock-down unit? Doesn't make it better if they were, only worse, but just curious about how dumb the sitter really was!

I agree with you 100%. It is your responsibility to ensure the safety of the patient, and this certainly is a situation which would compromise this patient's safety. There is no telling what could've happened had the patient walked away from an area with nursing support - what if the situation had escalated into something unmanageable while the patient and friend were walking with the sitter? I also would've contacted the nursing supervisor had the sitter been questioning your nursing judgement in front of the patient.

Excellent job keeping your patient safe.

RN1982

Specializes in ICU/Critical Care.

What would the sitter do if the patient decided to committ suicide somewhere else in the hospital? You should report her. I would. She should have not argued with you in front of the patient. She's not the one with the license, you are. Report her and write her up.

NurseCard, ADN

Specializes in Med/Surge, Psych, LTC, Home Health.

Is the sitter an employee of the facility that you work in?

I'm going to play devil's advocate and say that I wouldn't have a problem with it as long as the sitter is a hospital employee, AND they stay on THAT floor. I would not let them walk all over the hospital.

But I've worked on psych where 1:1 patients were allowed to walk the unit with their sitters, BUT they weren't allowed to go outside on the courtyard and smoke. Plus, it WAS a locked unit.

november17, ASN, RN

Specializes in Ortho, Case Management, blabla.

The sitter was an aide that got pulled from one of the cardiac floors I believe. No, it isn't a lockdown/psych unit - just med-surg. The pt had ingested a large amount of something toxic and was a stable transfer from the ICU. Psych consult hadn't been to see her yet.

I think the friend was more of an "enabler" than a co-conspirator. The friend was white knighting and insisting that the whole thing was a big accidental misunderstanding (despite a pattern of destructive behavior and previous suicide attempts).

I was more worried they'd try to make a run for it without signing the AMA forms rather than jumping out a window or something; but then again you never know what people are willing to do or what could happen. I just don't need that headache. Besides, patients aren't really supposed to be off our unit anyways (that's our policy, at least). I'm not a control freak, but I don't like the idea of having to deal with 6 other patients and on top of that having to worry about the whereabouts of my "suicidal" patient. If we had a locked unit I probably wouldn't have cared if she walked around.

Just looking for others opinions on the matter, since apparently according to the patient, her friend, and sitter, I was committing a gross injustice against them, humanity, and the constitution of the united states of america (I'm exaggerating, but their reaction was along those lines). Maybe there are people a little more cavalier than I? I'm honestly not sure what the official P+P is regarding suicide precautions - since I've never run into this before and I get suicide precautions so rarely I don't really have it memorized..... I'm planning on looking it up next time I work I guess that should probably answer my own question.

medsurgrnco, BSN, RN

Specializes in Med-Surg, Psych.

Your concerns were reasonable, esp. since it sounds like you did not know how you should handle the situation and you had not worked with this sitter before. And the sitter arguing with you in front of the patient and visitor would not add to the trust level - and was way out of line! I'd look up the P&P for pts on suicide precautions. If there isn't one, then consult with the charge nurse or nursing supervisor or DON.

Alternator81

Specializes in 5th Semester - Graduation Dec '09!.

Let me tell you, if I was in that situation and the aid starting chiming-in, we would have a BIG problem. You can say anything you want to me, just not in front of a patient. It's SO unprofessional!

november17, ASN, RN

Specializes in Ortho, Case Management, blabla.

I just instinctively said no and I wasn't going to argue about it. It just didn't seem like a good idea.

Let me tell you, if I was in that situation and the aid starting chiming-in, we would have a BIG problem. You can say anything you want to me, just not in front of a patient. It's SO unprofessional!

I asked her to step out in the hall with me for a moment....within sight of the patient but out of earshot I had a few quiet words with her. I was professional about it but what I really wanted to say was "RESPECT MAH AUTHORITAH!"(cartman style)

Okami_CCRN, ADN, RN

Specializes in Critical Care.

In my facility it is okay for the sitter to ambulate with the 1 to 1 sitter as long as they remain on their designated unit.

However, I feel it was not okay for the CNA to question your decision infront of the patient and visitor. As for the visitor, I would have told them that they could visit as long as they remained in the room, if they wanted to take a walk together they would have to wait until discharge.

RN1982

Specializes in ICU/Critical Care.

I can hear it now..you going back into cartman style singing the song about Kyle's mom.

NurseyBaby'05, BSN, RN

Specializes in Neuro/Med-Surg/Oncology.

I can hear it now..you going back into cartman style singing the song about Kyle's mom.

In D minor . . . . . . . .:devil:

Seriously, though, if the sitter was with the pt I would have let them walk around the unit, but if I thought they might even try to leave the floor: "Sorry, Charlie!" Especially b/c Psych hadn't even seen the pt yet. Actually, I would have probably told them to stay in the room until psych came by. My previous statement would only be after the pt had been "cleared", so to speak. Also, if the visitor continued to undermine the pt's treatment, he would have to go.

i 'think' i would have let her walk around the nurse's station or a public area on the floor where she could be eyeballed.

but then again, i may be somewhat projecting my own desistance to being confined.

i'd really have to check the pt out before offering anything concrete.

leslie

pagandeva2000, LPN

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

I don't think you were being unreasonable. This patient could have done anything, and you would have had to explain why you allowed this to happen. I can see walking the floor-maybe. However, walk outside? Leave the floor? What if the patient knocked the aide out? Nope, you did the right thing.

casi, ASN, RN

Specializes in LTC.

It really depends on the patient if you let them up or not. If your gut is telling you no, don't let them up. As an aide I've ambulated a people on suicide percautions around the nurses station a few time. On the same note I have sat for psych patients on med-surg floors that made me nervous everytime they got out of bed.

Under no circumstances should the aide have argued with you.

PICNICRN, BSN, RN

Specializes in PICU/NICU.

You absolutely were NOT wrong........ it is YOU who is responsible for that pt! Not the sitter/ not the friend!!! You totally did the right thing!

About 5 years ago, I worked in a community hospital and there was a new mom suffering post partum depression(I guess she had it with her first too) Anyway, her OB held her discharge to "monitor" her for a while. She was not on suicide watch or anything, just not bonding with the baby. Anyway, she went for a walk and jumped off the 2nd floor atrium into the lobby of the hospital! Some poor guy on the first floor broke her fall( and his wrist). She was not hurt(physically).

I sure wouldn't want to be the nurse who sent her on a stroll!

Again...you were correct.

Don't forget that some of those with psych issues are masters at manipulation. I would have debriefed the sitter about manipulative behaviors after I found someone to relieve her. At the point when she undermined you in front of the patient, she was no longer effective to keep the patient safe. (This makes me so frustrated! Why can't we give even training on the way to perform constant observation to our staff!). It's ridiculous to presume that a person will "automatically" know what to do in these types of situations.:confused:

One of my friends had a sitter manipulated as well as a nurse on the shift prior to hers. The patient was so pretty & young, who would have thought?! Any who, pt. was on physician ordered rights restriction (no phone) because she was refusing meals (eating disorder with symptomatic starvation). Pleaded to sitter on a "walk just down the hall", ie. I-miss-my-mom-so-much-can't I please use the phone, those mean nurses don't understand. blah, blah, blah they think they know it all, etc. Phone call ends up becoming "hey mom I'm going on a walk with this guy". My friend was chewed out by Mom, Dr., & Admin.

northshore08

Specializes in Emergency, outpatient.

Again...you were correct.

Don't forget that some of those with psych issues are masters at manipulation. I would have debriefed the sitter about manipulative behaviors after I found someone to relieve her. At the point when she undermined you in front of the patient, she was no longer effective to keep the patient safe. (This makes me so frustrated! Why can't we give even training on the way to perform constant observation to our staff!). It's ridiculous to presume that a person will "automatically" know what to do in these types of situations.:confused:

You are right, and the OP did the right thing. I agree completely with you that many sitters have no training; since this one was evidently not familiar with psych patients on suicide watch. The sitter lost all credibility and the nurse now has to watch both of them! Nursing supervisor needed to come in on this one, and visitor needed to go away. :nurse:

I think that I would have let the pateint walk around the ward and sit in the day room if they wanted, but I wouldn't have been happy about letting them go off the ward and wander around the hospital.

nrsang97, BSN, RN

Specializes in Neuro ICU and Med Surg.

I personally would have let the pt walk around in the hall near their room and maybe sit in the day room with sitter of course. This way you can see the pt as well. The aide was wrong for arguing with you especially in front of the patient. I think I would have gone crazy sitting in one room all day.

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