Patient Sitter

[RedSoxFan84]

Sorry for the long post...

I am currently a nursing student and am trying to get my foot in the door at a couple of hospitals doing different things. I recently started as a patient sitter at a large nearby hospital.

My first couple of shifts were manageable. The more that I've worked, though, the worse it's gotten. On Saturday I had a patient with brain mets who was completely out of control, hitting, scratching and being verbally abusive. This hospital does not use restraints so it was my job to keep her from climbing out of bed without either of us getting hurt. Midway through the shift the patient's nurse told me that we were going to be moving her bed into another room. I didn't question it; I thought maybe it was just because it was closer to the nurse's station. After moving into this other room I come to find out what they had done was combine sitters, so now instead of having one difficult patient, I had two! They sent the other sitter home! I told my nurse that I did not think that I could handle another patient as the one I had was very unsafe and out of control. She blew me off and told me that we will see how it goes and then left. They had change of shift only an hour later, so maybe that's why she didn't concern herself too much about it? I had my hands full with these two patients, with one nearly falling while I tried to keep the other from climbing out of bed. I asked for help, but usually I don't get it. Whenever the bed alarm went off it was ignored by the other staff members. I have no phone or panic button; my only options are to yell down the hall for help.

Two days ago another girl that I started with called me after her shift and told me that she had to go to the ED because a patient kicked her pretty hard in the back and they were afraid there might be kidney damage. Fortunately, everything checked out okay. She explained to me that this patient was in the ICU and going through ETOH withdrawal and completely out of control. The nurse called the physician, requesting the use of restraints because he was out of control. The physician refused. Again, this hospital does not seem to use restraints of any sort.

Turns out I got this same patient yesterday. At one point I was struggling to keep him in bed and he turned around and punched me several times in the ribs. Fortunately, he is relatively weak and no serious damage was done. As he became increasingly agitated I asked the nurses for help, but no one will come besides to give meds and then they leave.

My question is: should I quit this job before I get hurt or am I just approaching this whole thing the wrong way? I just don't understand how I'm supposed to control these mentally unstable patients when I'm 5'3" and 115 lbs and I'm on my own for the duration for my shift. I plan on speaking with my manager tomorrow about my concerns; I want things to work out but I am fearful of getting hurt and then not being able to work or finish school because of it.

I've had other issues with this place, also. They told me they hired 10 other sitters in June, in addition to their regular staff; but they are still calling me every single day to come in. Clearly, no one wants to work. And yesterday, no one showed up to relieve me and I was beginning to panic as I had to go to my other job. I called the staffing office after waiting half an hour and they were nasty to me about it, saying me relief was in a meeting ??

I'm just disappointed because I'd heard good things about this hospital and was looking forward to working there after I graduated as they are supposed to have a good graduate nurse residency program, one of only two in the entire state...I just don't want to blow any future opportunities.

I am just wondering what other hospitals' policies are regarding these type of patients with 1:1 sitters? How would you, as nurses, handle difficult patients like these?

Thank you for any advice.

[Silverlight2010]

I'm kind of shocked to be honest. I've worked as a sitter and never had problems getting help from the other staff, including the nurses. I'm an RN now but if I have a patient with a sitter and they get out of control I'm in to help and then depending on the situation, on the phone to the doctor to get orders for either restraints or medication. To have the patient sustain injury without trying our best to intervene is unaccaptable but it's equally unacceptable to stand by why any staff member is abused by a patient (intentionally or otherwise). We have a code in our facility that we call when someone become too much to handle.

[amoLucia]

A few things --- you absolutely, positively MUST MUST MUST fill out an employee injury report if you take a hit. And if you hurt badly enough, you want to go to the ER quickly.

I question if you were hired as a 1 :1 sitter; it would have you doing private duty. I doubt administration would hire that way, so you may not have any control or say about what you feel is adequately safe. And sitters are a luxury at many facilities. That's their way of providing safety AS NEEDED.

It is sad that you did not have better support and assist from the other staff on your floor. But just as Admin sent home an extra sitter, they may have established the minimum-est number of nurses for the whole-house census. The nurses may have ben spread out just as thin with their responsibilities and unable to help you any better.

Also, be aware that this is prime vacation season time. There may be a lack of extra staff to call in and those that ARE available want their time off OFF. That contributes to your frequent scheduling. And just because they TOLD you they hired 10 more sitters, there may not really be any extra 10 sitters for various reasons ('nuff said).

Really think about what you want to do re staying. Might just be a real rough time at the moment. Good luck.

[Double-Helix, BSN, RN]

It is NOT the job of the patient sitter to forcibly restrain a patient. That can be considered battery and, according to the Joint Commission, a physical restraint is still a restraint that requires documentation and an order. Any person performing a physical restraint should be taught the correct physical technique.

Please do not ever put your hands on a patient in order to forcibly restrain them. If you cannot modify their behavior by talking to them, a gentle touch on the arm, or moving objects out of their way, then call the nurse. If the patient is violent, call hospital security if you have to. Do NOT put yourself within reach of a patient who is violent and attempting to hit.