question: 1 on one what to do?

netglow, ASN, RN · Mar 22, 2011

You had better pitch in and help anyone else that could use your help.

destova · Mar 22, 2011

I've worked both one to one in hospital situations as well as home health care. With home health care, I ask the patient if they mind if I study/read while they are dozing or watching tv. They almost always say yes of course- I had one sweet lady who requested that I make a batch of brownies as her grandchildren were coming to visit, which I did happily.

In the hospital situation, I would usually ask the floor charge nurse if she/he had preferences on what I did during my time when the patient was sleeping. In general I only worked one to one's on general medical with patients who were detoxing so I didn't dare ask the patients preference (those patients were often in their own world and preferred me not to be there at all). Floor nurses responses varied from helping with paperwork (always from one in particular who knew me well and trusted me) to read a book or watch tv. It just depended on the charge nurse.

Asking always helps, as then you can be sure you aren't crossing any lines and it instills a sense of trust and respect between yourself and your patient or charge nurse.

good luck!

destova · Mar 22, 2011

You had better pitch in and help anyone else that could use your help.

in most one to one situations in hospital you are in with patients who need 24/7 monitoring. That would make it hard to pitch in and help anyone else on the floor as you can't leave just because the patient is sleeping.

in home health care situations this isn't an issue as obviously there is only one patient and no one else to help.

linearthinker, DNP, RN · Mar 22, 2011

If I had a 1:1 they were way too sick/complex/busy to even pee, much less do anything else. that was the definition of 1:1 = too complicated to give you a moment to even think about doing anything else but keep them alive.

Meriwhen, ASN, BSN, MSN, RN · Mar 22, 2011

You had better pitch in and help anyone else that could use your help.

Actually, before the OP runs off to do that they should see if they are allowed to do that. A patient that is 1:1 can't be left unattended at any time, even if the patient is asleep and/or something happens with another patient. And in many facilities, leaving a 1:1 alone can result in termination.

Ocassionally, they may have a patient who is 1:1 only while the patient is awake. In this case, then the OP can go and help out other staff while the patient is asleep, providing they check in on the patient frequently to see that they are both all right and still asleep. Once the patient awakes though, the 1:1 must be resumed regardless of what else the OP was doing.

OP: check with your facility to determine their policy about what you can do while your 1:1 sleeps. Some places are very strict and will not allow you to do anything while on a 1:1 except sit there and stare. Others will give you more leeway.

Sun0408, ASN, RN · Mar 22, 2011

Most of the time, if it is a 1:1 situation the pt is either very critical and still getting vitals qh or titrating drips q15-30 minutes or something else that needs critical monitoring.. So you may not have time to read, watch a movie or help others.

In my setting, even if the pts is sleeping they still need monitoring for vitals etc.. It will depend on the pt if you can get away but most of the time in 1:1 you can not leave the room.

As for a CNA that is sitting for a pt in the hospital they can't leave the room but they will read a book, watch tv or text until the pt is awake then back to keeping them in bed; this was done for our detox pts that needed constant eyes on them..

Bottom line, it will vary. Just ask what you can do while they are sleeping if you are not sure.

carolmaccas66, BSN, RN · Mar 22, 2011

In Aust we cannot leave the bedside of a patient if we are a special (1:1), we are not allowed to. Even if we go to the loo, we must tell someone so they can sit by the patient. I'm surprised you can go help other people. We have to monitor the patient in all things, ie: going to the bathroom, sleeping, taking meds, especially psych patients. What is the point in having a 1:1 special if you can wander away from the patient?

netglow, ASN, RN · Mar 22, 2011

Sure, it is possible to help other nurses unless like lineart is saying, you are overwhelmed with that one patient. Other than that, if you have time, you help where you can for a short period and locally, if you would like the favor returned one day, even in ICU. Of course you do! Depends on the physical set up and monitoring available in your unit.

Now if you staffed to just be a "sit and watch" tech, well, you do that.

juliaann · Mar 23, 2011

I'm pretty sure the OP is asking about being a 1:1 sitter, not a 1:1 nurse-to-patient in a critical care setting.

The policy where I work is the sitter must remain in eye contact of the patient at all times. So no helping out on the floor. Watching TV is okay as long as the patient and TV can be viewed at the same time. Volume would need to be very low to allow patient to sleep. Reading is also okay, but again, lights need to be low while patient is asleep. Many of our sitters are in school and study while their sitter patients are asleep.

No headphones, no personal phone calls are allowed while sitting.

mentalhealthRN · Mar 23, 2011

Yes I too read that as a 1:1 outside the ICU. More for monitoring for some kind of safety issue. (High fall risk, suicidal, in restraints, etc.) The 1:1 staff that we would get when I worked psych and we didn't have the staff to cover it ourselves, were used hospital wide so on any unit.......however they were usually for some sort of safety issue. When the pt was asleep we generally let them study/read/etc. but never were allowed to leave the pt alone, even when asleep. They would have to get someone to cover for breaks. We even would have different levels of 1:1-- like we had a continuous eye contact. We seldom needed that high of a level but this meant the 1:1 was to have eyes on the pt at all times, even in the bathroom. We actually had a pt who was in and on 1:1 as she had an issue with swallowing anything she could. She had swallowed batteries ("AA"s!!) twice and the second time they had to be removed surgically, she picked the abd wound so bad it became necrotic and it had to be debrided and a wound vac put on. She was being monitored to be she she didn't pick at the wound vac site and that she didn't swallow anything else. Well we had a 1:1 who didn't think the pts request to have the door closed while she was in the bathroom was a big deal so she allowed it.....well the pt took the batteries out of the headphones she had and swallowed them while in the bathroom!!!! The doc was soooo mad! So though 1:1 can be boring and seem insignificant sometimes, it is really important and should be taken seriously and these pts should be monitored closely at all times.

backatit2 · Mar 23, 2011

the policy and what actually happens are two very different things. according to our POLICY an employee who is providing 1:1 care and/or supervision isn't supposed to read, listen to headphones, text, or do ANYTHING on the job. in reality, a lot of people study, read a book, or watch TV. nobody really says anything bc as long as the job is being done there's not much harm in looking at a book. a patient who is suicidal or something like that isn't going to be able to kill themselves with someone sitting 3 feet away just bc they're looking at a book.