Patient sitters for 11-7

[Salt-of-the-earth]

Hello and welcome to a blog with a serious question to be posed to all nurses, aides, healthcare professionals (including those who are in a managerial position), and even to patients themselves or their family members.

Many healthcare institutions (most, in fact, from what I've been told) are turning away from using restraints to protect confused patients from causing harm to themselves. Myself, I work in a hospital setting whereby this change has been painstakingly adopted over the past 11 months or so. In theory, I believe it to be a really nice idea. It's always sort-of bothered me that some of our confused elderly patients have had to be placed in posey vests (probably one of the least restraining methods used) or in soft wrist restraints to keep them from hurting themselves...either by physically scratching themselves or by pulling out IV's or tubes or any such things that need to be reinstated.

So someone, somewhere (most likely the result of family lawsuits placed over the years), decided that restraints are a bad idea. Okay...maybe I'll go along with that to a point. The objective of this posting isn't to argue the point one way or another. There are probably a few hundred good arguments either way on the matter.

To continue...

Our hospital has adopted this idea, so we're all trying to abide by it and live with it.

I've read many different comments on the practice in other blogs and postings, and it's pretty clear that very few people actually like having to sit in a patient's room (especially during the overnight shift) to safeguard them from hurting themselves.

My question to all those who choose to read this thread is this:

If it HAS to be done, what sort of policies have been adopted by other institutions that seem to work the best with staffing this position for the 11-7 shift?

My workplace has a "set number" of hired CNA's for our general staffing needs, and they've attempted to hire other CNA's to be called in to be sitters, prn. Of course and generally speaking, nobody wants to come to work for the 11-7 shift and be a sitter...so most of the time, our supervisor pulls one or more of our scheduled CNA's to do the job instead. They usually switch off and don't have to spend all night in the rooms, instead sharing the more active roles on the floor with the sitters' responsibilities. And although I can't speak for all of my co-workers, I make sure to check in to see if they need a break or if there's anything I can get them to help out (I'm an RN)...but I can't sit with the patient for a great deal of time due to the fact that I have my own responsibilities as well.

Unfortunately, when a scheduled CNA is pulled from the floor, it means the nursing staff has to pick up the slack from our missing co-worker (by the way, God Bless CNA's!! Many of you don't get the recognition or thanks you deserve!). But that's not the only issue, because it becomes a safety concern for our other patients as well. The nurse has to speed things up in order to do our job and to cover the CNA's job too...increasing the chances for mistakes and generally not being able to answer the other patients' call lights as quickly!

So does anyone out there have a method that seems to be working? Other than increased wages (naturally, most healthcare institutions won't agree to pay a higher wage to someone that's "just sitting" in a room with a patient overnight), are there other incentives that might help fix this kind of staffing problem?

One of my co-workers suggested that the additional cost for a sitter be directed to the patient's account, which seems reasonable to me...although many patient accounts probably go unpaid as it is.

Is there a system out there that's actually working?

[Orange Tree]

Sometimes we have extra staff called in to sit, but more often we are "punished" for needing a sitter by having a CNA pulled from the floor. The CNAs don't mind it though. Our floor is hectic, even overnight, and it's a joy to take care of one patient instead of 10+.

[carrotstix]

I was a sitter at a very large hospital while I was in nursing school. They staffed their sitter cases with people like me who were PRN, I had no obligation to holidays, weekends, or even a minimum number of hours. Very appealing to a student.

They also had full-time sitters who worked regularly. All of us got shift differentials, all of us were in a float pool. The hospital float pool staffing office managed the staffing, individual units only contributed if they had an extra CNA.

The sitter cases throughout the hospital were prioritized. I dont know the exact system. I know that cases within the children's hospital including Nutritional Insufficiency patients and suicidal patients throughout the hospital who need constant observation were always staffed before the confused patients were.

At every staff meeting our boss was very adamant that our job was not "just to sit" and we were not "sitters" but "patient companions" because we were not to just be sitting.

Sometimes we were short staffed, it happens even to nurses. They did use an agency to help fill sitter needs overnight. I think those sitters made a little bit more. I know the hospital preferred not to use them because it costs the hospital alot more than using one of their own employees.

My take away message for you as a nurse would be to maintain your current attitude towards sitters. There was many a shift where I did not get a restroom break much less a dinner break because I was trapped in the room and no one would relieve me. Its frustrating to not be able to leave a patient in order to get them a bedpan (if there's not one in the room). It can be an unnecessarily stressful job when the rest of the staff don't consider you part of the team.

[OttawaRPN]

A couple of things:

Bad idea or not, any type of restraint requires a dr's order and if applied, vigilant monitoring.

Don't know about your government, but my Ministry of Health allows for HIN (high intensity needs) funding which, when certain criteria are met, means the cost does not come out of the nursing budget - it is considered additional staffing so no one is "pulled."

A sitter does not need to be a CNA, LPN, RN etc. but many agencies employ sitters who have been screened by their respective agency to just "sit." Irregardless, they still require a break, as per their contract, so the nurse assigned to this patient will "sit" for that one hour.

Family members can also be asked to sit with their relative, especially during off hours, when staffing levels are lower.

[Reno1978, BSN, RN]

We use college students. Preferably ones studying in a healthcare related major. Many are per diem, but many are PT or FT, too.

My friend currently works as a FT sitter while he completes school - he works 3pm-7pm on Monday and 12 hour shifts on Tues/Thur/Fri. Not being a CNA, he is only there for patient safety and line/tube maintenance.

[RNKPCE]

We went away from the term "sitter" sometimes known as "sleepers" and to patient safety tech. If we don't have the extra help in house we use agency staff.

[AJPV]

I would think a blanket sitters-instead-of-restraints policy would place inherent pressure on the nursing staff to not declare a pt as a safety risk - since making that call may create unmanageable strain on staffing. This ultimately defeats the purpose of the no-restraint policy since the pt who needs safety interventions is left with no intervention. The only way for this not to be the case is if the institution willingly and promptly supplies additional staffing when needed.

[SweetLikeSugar]

The hospital I work at started using sitters from an outside company a few years ago, but that only lasted for a very short time. Then they had us pull our CNA off of our floor or from another unit to sit with the patient. I just found out last week that we are now to restrain the patient first (wrist, lap or chemical restraints) and then if that isn't successful, we can get an order for a sitter. I personally find it a little odd that we are now back to restraining patients while the last few years we've been having information and statistics thrown at us about how "deadly" restraining the confused elderly can be but but we're going to use the restraints anyway because it is too expensive for a CNA or sitter to be with the patient.

[Salt-of-the-earth]

I would think a blanket sitters-instead-of-restraints policy would place inherent pressure on the nursing staff to not declare a pt as a safety risk - since making that call may create unmanageable strain on staffing. This ultimately defeats the purpose of the no-restraint policy since the pt who needs safety interventions is left with no intervention. The only way for this not to be the case is if the institution willingly and promptly supplies additional staffing when needed.

You are exactly right with your perception and comments. Although I haven't experienced that scenereo yet, I can definitely see where the temptation could exist whereby there's simply too much work for the staff to afford to have a sitter present. I hope and pray that never happens, but if push comes to shove...something's gonna have to give somewhere.

[Salt-of-the-earth]

I'm not exactly sure what the laws in my state are with regards to who can be allowed to monitor a patient in a confused or combative mental condition. I do know, however, that the hospital I work for has already stated that a patient "sitter" must have (at minimum) a CNA license. Your comment gives me food for thought, though, and I may ask my unit director to check into the feasability of utilizing other (screened and trustworthy) people to help out with these situations. Thank you, I appreciate your input!

[Sonjailana]

We go back and forth every year or two in funding for sitters versus using wrist restraints. First we used sitters, then restraints, and now sitters again. It's really helpful if it's a trained CNA..but sometimes we have completely unskilled people..one lady kept stopping the IV pump from beeping..and my IV clotted off (I was steamed!).

[hearts895, RN BSN]

I was a sitter at a very large hospital while I was in nursing school. They staffed their sitter cases with people like me who were PRN, I had no obligation to holidays, weekends, or even a minimum number of hours. Very appealing to a student.

They also had full-time sitters who worked regularly. All of us got shift differentials, all of us were in a float pool. The hospital float pool staffing office managed the staffing, individual units only contributed if they had an extra CNA.

The sitter cases throughout the hospital were prioritized. I dont know the exact system. I know that cases within the children's hospital including Nutritional Insufficiency patients and suicidal patients throughout the hospital who need constant observation were always staffed before the confused patients were.

At every staff meeting our boss was very adamant that our job was not "just to sit" and we were not "sitters" but "patient companions" because we were not to just be sitting.

Sometimes we were short staffed, it happens even to nurses. They did use an agency to help fill sitter needs overnight. I think those sitters made a little bit more. I know the hospital preferred not to use them because it costs the hospital alot more than using one of their own employees.

My take away message for you as a nurse would be to maintain your current attitude towards sitters. There was many a shift where I did not get a restroom break much less a dinner break because I was trapped in the room and no one would relieve me. Its frustrating to not be able to leave a patient in order to get them a bedpan (if there's not one in the room). It can be an unnecessarily stressful job when the rest of the staff don't consider you part of the team.

As a sitter/CNA for a hospital, I have to echo these thoughts. Its stressful to be just completely "forgotten," especially since you are not allowed to leave the pt. to get help or ask to be relieved for a break. Also please don't forget your sitters if they are basically trapped in the room with an extremely verbally abusive/physically threatening pt. It can be very demoralizing, upsetting, and/or scary. As a sitter you don't want to look like a whiner/whimp/complainer, so you often don't say anything, but that doesn't mean it would make a whole world of difference if staff - esp. those in more authoritative positions like nurses - checked on you and backed you up. That being said, I know nurses are busy. All I'm saying is please don't forget us. Personally being a sitter is my least favorite part of working as a CNA in the hospital, but I respect the need for them and we all have to start our careers somewhere. :)

If your talking about 11 am to 7 pm than it will be hard to find many sitters for those hours. Reason being that many sitters/CNAs in hospitals - myself included, are in nursing school etc. - so its just not feasible for them to have an overnight schedule like that.