Patients in Med Surg Needing 1:1

[AlmostThere19, BSN, RN]

As a new grad I'm hoping for some advice on the best way to handle a tricky situation I encounter a lot at work. I've had quite a few patients lately who honestly needed a 1:1 sitter but didn't have one for some reason. They were elderly fall risk patients - even one was in the hospital d/t fall related injuries. These patients refused to lie/sit on their beds. They refused to sit in chairs with bed alarms - not in their rooms and not even at the nurse's station. They didn't need to use the restroom, be changed/bathed, eat or any other needs because we tried all that. They insisted on continuously trying all shift to wander the unit and leave the unit. On call docs would not prescribe any sedatives or restraints even when this had been going on for hours. Family members were even contacted to see if they could sit with these patients (no luck). House supervisor was aware of these situations but for some reason no sitter was ever brought in for these patients. Shouldn't one have been? Instead I was the "1:1 sitter". How can we as nurses care for 6 or more patients when a single patient requires 100% of our attention all night? I fear for my license and for the safety of my other patients when I am put in a situation like this with a patient.

[Sour Lemon]

The "some reason" is money. 1:1 care is expensive.

Just chart your attempted interventions (contacting family, notifying MD, teaching, etc.) and do the best you can.

People do fall in hospitals. I wouldn't expect licensing issues unless you're doing something outrageous ...like sending a confused 99 year old, with an unsteady gait, to the cafeteria to get you coffee.

["nursy", RN]

Jeez, how else am I going to get my coffee?????

["nursy", RN]

At the end of the day, you will probably need to make a choice of do you want to remain in an environment that allows these circumstances. You can start a paper trail, i.e. incident reports when patients are found trying to leave the unit, letters of concern to admin, etc. But it won't be appreciated, you will be deemed either a troublemaker, or a new nurse that doesn't know what she is doing, or both. I have yet to see a posting on this site where someone was working in an untenable situation, and then something miraculously changed, and everything got better. Usually, things just get worse and worse. Hopefull, you can get off this unit, or find somewhere else to work. Good luck.

[OyWithThePoodles, RN]

A lot of times they don't call for a sitter because if the patient is going back to a LTC, they won't accept them if they have had a sitter or needed a chemical restraint in the last 24 hours. I've had many patients who desperately needed a sitter, but didn't have one for this exact reason.

[zoidberg, BSN, RN]

Do you have any non restraint Posey brand devices? Posey bed, posey belt, activity vest, etc?

[amoLucia]

Those kind of pts are NOT problematic only in the acute care setting. LTC also faces the same problem with much more regulatory oversight. And LESS staff.

Many a shift I've dragged around a pt in a whch with me for morning med pass. Then a CNA will take over for a while, then the next CNA. Everybody is on 'eyeball watch'.

Luckily, falls were minimum that way.

As PP Sour Lemon posted 1:1 is expensive and freq there's NOBODY avail. Just keep up with your interventions and documentation (and make sure the care plan approaches match).

And like in the Army, make sure the higher-uppers are informed. They then also shoulder some of the burden (and fault).

[Newishnurse1995]

Document document document. It’s hard. Only thing that gets me through my shifts are my coworkers.