This is mainly just a vent, but I dread hearing in report that the patients has a sitter at bedside. Not because that means the patient is confused, but because 9/10 the sitter is crazier than the patient, completely useless, and like having a 2nd patient in the room. My last shift, the patient was obviously confused and could not be reasoned with. A sitter was called to beside and she was a complete nightmare. She would call out every five minutes saying that she needed the nurse because he was trying to pull on his foley or his picc line, or trying to get out of bed (he had a posey vest on). After the fifth time the sitter called out (each time myself or the aide went in). I told her that I was we'll aware of the situation and that is why she was called in to watch the patient and make sure that he didn't hurt himself, not call the nurse every time he attempted to pull at something. Approx ten minutes later two of my coworkers came to the nurses station saying that the sitter is threatening to hurt the patient! I rush to the room and from down the hall I hear her SCREAMING at my patient! Not sternly talking to my patient, but screaming! I was livid, I told her to leave the room, called my charge nurse and told her that the sitter needed to leave immediately. I, unfortunately, had to put my patient in wrist restraints as well after she left because there was no way I wanted another sitter. This isn't the first time she has been reported to the company by one of our nurses, and yet she still comes back. I obviously had to chart my butt off about that one. Our floor has also had a sitter bring a gun into the patients room and have it within reach of the confused patient, had a sitter leave the room without telling anyone for her smoke break and the patient got out of bed and fell, I've also had a sitter tell the patient that I was an evil nurse because I was wearing all black scrubs. Just to name a few examples.
The hospital I work for use a company and we also use CNA/PCT when they get called off on their regular shifts. I had a CNA from a different floor that sat with an ICU pt and she was horrible. Spend all morning on the phone trying to book a hotel room. When her phone started to die she asked if I had any extra chargers laying around for her phone I told her I didn't and she was upset. When she wasn't on the phone she kept coming out of the pt's room and asking the tech I was training at the time to relieve her. For lunch she was gone for an hr and a half oh and with her phone charger. Poor pt kept de sating because the sitter was too busy from keeping her from removing her NC. I had no choice but to report her to my charge nurse, AD and the tech's nurse manager. She has never returned to my floor to sit or work the floor. It's techs like her that give good techs a bad name.
At my hospital, that sitter would have been fired immediately. I hope you reported her during the shift because God forbid something happens to the pt because she's not doing her job, and that's YOUR licence on the line, sitter or no sitter.
This is mainly just a vent, but I dread hearing in report that the patients has a sitter at bedside.
She would call out every five minutes saying that she needed the nurse because he was trying to pull on his foley or his picc line, or trying to get out of bed (he had a posey vest on). After the fifth time the sitter called out (each time myself or the aide went in). I told her that I was we'll aware of the situation and that is why she was called in to watch the patient and make sure that he didn't hurt himself, not call the nurse every time he attempted to pull at something.
In times past I have been a sitter for confused patients who are out of control. I have also seen the ones who try to pull out their catheters and other tubing and sometimes they are so strong and so confused they can overpower any caregiver who tries to stop them.
Even though you sometimes can distract them or find the magic words to make them stop their behavior, this is not always the case.
In some cases I have called my agency supervisor and told them it was completely out of hand.
Agency sitters are the WORST. They show up late and then as soon as they step foot on the floor, they want to know when they're going to get their break. At night, it is like having another patient because you have to wake them up at least 7 times and remind them to do their jobs. The whole reason they're sitting is to prevent the patient from pulling out their PICC line and then you walk in the room at 2am and your 6 year old has gotten out of restraints and is swinging his PICC line around like a lasso while the sitter is passed out in the chair.
I remember this one time when I had a combative teenage boy who was a high school wrestler or something. He had a sitter who was at least 6'5" 250#, looked like a linebacker. We all thought "Good, this guy can keep this kid in check." Kid starts flipping out and the sitter goes running OUT of the room as the nurses run in. One of our CNAs went up to him and said "excuse me, you're a man, you get in there and help these women!"
I remember ONE good agency sitter in 5 years. So much so that I felt called to email the Nursing Supervisor about it and she responded quite shocked saying "this is not an email I receive very often."
Im am definitely going to be defensive here. I was a sitter for 3 years. I was a DAMN good sitter/pct. I saved the nurses and pct's working the floor so much time, you probably have no clue. I also saved a couple of patients lives. There are definitely unskilled, lazy sitters out there, but please don't group them all together. My experience as a sitter was invaluable to me as a nurse today. I am sorry to come across so cranky. Im sure you've had bad experiences with sitters, but there are many awesome ones out there. It was downright exhausting at times, trying to keep the high fall risk pt in bed, or calming them down by therapeutic communication when they started to get very anxious.....I could go on and on. As a sitter, I'm the one who realized once a pt was not simply sleeping. I took vitals, tried waking her up while calling a nurse in the room and went down to CT with her. Turns out she was hemorrhaging again after a fall she had taken the week before. She could have gone on bleeding in her brain for hours if there was not an astute sitter in that room that morning.
I'm sure there are good sitters out there somewhere, but I have yet to come across one.
I'm going to be defensive here as well. I have been a CNA for 7 years, and have taken care of every type of patient population imaginable. I've been an agency aide for full time hours since 2009, and my record is pretty well "untarnished" at this point. I have never had a nurse complain about me as sitter, because some of us do our jobs. I have also never had a patient fall on my watch, save the one that turned violent, shoving me into a shower and falling on his broken leg from the momentum of his push.
There is another agency that staffs sitters, and those sitters are the ones I would call useless. Essentially, they sit there and observe the patient, and do not touch or help the patient in any way. They call me for the bathroom visits, feeding, baths/linen changes, to tell me the patient is trying to pull out a foley. As an aide, I dread those sitters because those are the ones that usually let my patients get hurt.
I'm also a CNA that has saved lives, like the patient in ICU that came in for overdosing on over 40 extended release morphine, was on a narcan drip for the better part of 16 hours, and was then released by the hospital to rehab. The nurse came in and removed the wires, shut off the monitors, and I helped the patient get dressed. If I hadn't been there, they wouldn't be alive today - in under an hour, the patient went into respiratory arrest. Without the monitor, the nurses had no way of knowing they weren't breathing, and the nurse was in her other patient's room. Lucky for my patient, I was there and paying very close attention. In under 40 seconds, I had the charge nurse and a couple of the floor nurses in the room, we bagged the patient and got them breathing again, and they were obviously readmitted to receive more narcan.
I'm also the sitter who holds your patient's hand and keeps them calm when they're heading into sepsis and about to be intubated. I'm the one that calls RT myself when I have told the nurse (who put my COPD patient on 15L non-rebreather) repeatedly that the patient is in respiratory distress because they're clearly showing difficulty breathing (accessory muscle use, nasal flaring, restlessness) and the patient's VS have shot up - pulse increase of 50 bpm, resp increase of 22/min, b/p increase of well over 30 systolic and diastolic. RT drew an ABG, which had a CO2 level close to 90...hmmm...maybe you should have listened when I told you that much O2 was a bad idea.
I notice the subtle changes, like the patient who suddenly got very calm when they were originally very confused, and then became lethargic. Remembering why they were there, they had gotten 22 units of insulin in 4 hours bc the blood sugar wouldn't drop, but then bottomed out 3 hours after the last dose. The nurse hadn't been into the room for 2 hours, but I called her, and the patient's sugar was in the 40s. I spent the night waking the person up every 15 minutes to feed them crackers, milk, and juice to make sure they didn't bottom again after receiving D50. I could really go on for a long time about all the mishaps that have been avoided by me being there.
To the person who said nurses are used as sitters - that is not necessarily a positive. My fiancé is a charge nurse in his hospital and has been for several years. Recently he had a confused isolation patient that needed a sitter. In an effort to cut spending to an outside agency, they moved an extra nurse from another floor to be his sitter. Now, the charge nurses on his unit are the ones that determine who needs a sitter and who doesn't. This patient had been on my fiancé's floor for a few days, and my fiancé was quite familiar with the patient, who was fine during the day but tended to sundown. Well, the nurse sitter was one of the types that think they know best - and yes I can attest to this because I had worked with this RN several times long before I started dating my fiancé. The RN decided that they knew better and didn't listen to my fiancé when he said the patient needed the sitter next to the bed. Long story short, patient got up and took a really hard fall, and wound up with extra hospitalization and surgery because of that RN. I've seen other similar things go on in my years of working.
The important thing about dealing with sitters - check on them frequently. My favorite nurses are the ones that check on me every hour or so, just to make sure I'm doing ok. I'm one of the rare ones that don't take 15 minute breaks normally (unless I'm seriously sick and need to step away briefly) and I have never fallen asleep in the rooms, although I have had patients fall/remove lines because their sitters HAVE fallen asleep. Its important to remember that although you have a sitter, the patient is still ultimately your responsibility. Many times, I have had nurses and aides leave me in a room without checking on me for between 4 and 6 solid hours, which in the wrong case could cause harm to the patient.
Wow, that's really too bad that many of you have had what sound like awful experiences with sitters.
We have sitters employed with the hospital, although they are like rare gems... we don't have very many! They are usually PSWs, or RN students.
I have limited experience with sitters as I worked in an ICU up until April, however sometimes we did need them up there... and my experiences have been great! Being an ICU nurse, and being 1:1 or 2:1 with my patients anyway, I didn't really care about whether or not the sitter did vitals, or took it upon themselves to wash the patient (I was a little OCD haha, I would just prefer to do it all myself with my critical patients as I was so used to doing anyway... nothing but RNs are employed in our ICUs). What I really needed from them was to help control my confused patients who have ART lines, CVP lines, NG tubes, CTs, monitor leads, various drains, that I can't just sit there and stare at them and constantly remind them not to touch things because I have another patient, a mountain of paperwork, have to cover for breaks, etc.
In one particular case I had a patient undergoing thrombolytic therapy with a continuous infusion of TNK and Heparin. These patients have to stay very still, lay flat or slightly tilted to one side or the other, no bending at the hips or knees, head up max 20 degrees (if ordered), q1hour vitals, neuros and pulse checks... and this can go on for days (with daily angios to check progress). Often they get confused/disoriented because of their history and the constant stimulation/lack of sleep. Anyway this one gentleman who started out lovely ended up becoming very aggressive, agitated, confused, sitting right up in bed, knees bent, elbows resting on knees (I think my heart stopped!!), threatening to rip out his femoral catheter. The sitter was amazing, helped us control him until we could sedate him (there was no other option at this point), and sat with him all night so I could care for my other post-op patient (who eventually started with DTs and ended up just as confused... hahah it was a zoo that night. the sitter helped with him as well!)
I also find they always offer to help wash and turn, etc. when they see me coming with linens. I really can't complain! I also find they are so good with the paranoid patients... I had one neuro patient who did not trust me at all, wouldn't take any meds, and the sitter was able to help him come around.
I am always grateful for them, and for any help they provide. I must admit some of the nurses I worked with in ICU sent the sitters away, not wanting to bother with them, but I've never had a problem with them. I REALLY admire the patience they have to do what they do. Sometimes the poor souls get put in a semi with two confused patients and they take it all in stride!
Our sitters are regular staff aides or occasionally LPNs from our floor or floated from other floors. They're usually very helpful--bathe, toilet, (and if LPN, pass meds) for us, as well as doing their assigned job of preventing the pts from hurting themselves. I'm very grateful for the sitters we get--we don't get agency staff, so I can't speak for their quality
SleeepyRN
1,076 Posts
At my hospital, that sitter would have been fired immediately. I hope you reported her during the shift because God forbid something happens to the pt because she's not doing her job, and that's YOUR licence on the line, sitter or no sitter.