RN as Patient Sitter?

[Nurse Beth, MSN]

Dear Nurse Beth,

Many times on a hospital floor patients with severe dementia are bed jumpers. When they are unsteady on their feet they pose a danger to themselves and a liability to the nurse caring for them. They need a sitter to watch them.

Often times before this pt. can be transferred to a SNF they must demonstrate the ability to be by themselves for a period of 24 hours before the SNF will accept them. You cannot wave a magic wand and reverse dementia....the patient is not going to suddenly change for the better, yet, hospital managements will obligate a nurse to babysit these patients for 24 hours without the aid of a sitter.

This places the nurse between a rock and a hard place. If the patient falls and sustains a serious injury the fault will wind up with the nurse almost without fail. If the nurse has five other patients to care for how can they be there at a moments notice to stop the patient from falling if they bed jump?

Regardless of all the virtues of coulda, shoulda, and woulda some of you nurses are just dying to expound in rebuttal to this subject matter; I feel you have missed the point entirely. It is WRONG to ever put a nurse in this position. It's not even worthy of debate. It would be like arguing over the existence of owls....it goes way beyond a matter of opinion.

Beth, are there any laws on the books to protect we nurses from this type of exploitation?

---

Dear Needs Sitter,

A sitter is by definition dedicated to one patient, and doesn't have other patients. Typically a sitter is a non-licensed staff member, who is assigned to sit with a patient in a private room or sometimes sit with two patients in a semi-private.

What you describe- obligating a nurse who has a patient load of six patients to keep a constant eye on one patient- is impossible and does not provide for their safety. Is it possible to call in a family member and does your facility have remote video viewing?

No wonder you are frustrated and concerned. If your hospital is not concerned about reducing falls and falls with injury, is this a good place for you to work?

Providing sitters is not regulated except in some states where the patient is suicidal. Unfortunately nurse-patient ratios on hospital floors are not regulated except in California.

Read Safe Staffing to learn more about nurse-patient ratios.

Best wishes,

Nurse Beth

Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

[FloridaBeagle]

This was my life when I worked neuro and ortho. It is an insane requirement from nursing homes/SNFs. One way we maneuvered around it was to cluster those patients right next to each other near the nurse's station, bed alarms on, and our PCA sat right outside the doors. So they essentially had a sitter, but not technically. It still sucked because we lost our only assistant to this nonsense on a regular basis.

Video monitoring doesn't work as you need to be able to get into that room within a split second. With those IV cords and SCDs they hit the floor instantly.

[vintagemother, BSN, CNA, LVN, RN]

When I have pts who admin has said need to be free of a sitter x24hrs; therefore I get an unsafe pt without a sitter or restraints: 1st, I consider the safety of the situation. I do think this during report. I start charting everything occurring so that I have good documentation to support my concerns(if any).

I tell my charge nurse if I see a potential problem.

I believe it's not my problem to be worried about potential discharge. It IS my problem to assure said pts safety on my shift, while caring for 5 pts.

[Elaken]

Or you have to put the patient on the most sensitive bed alarm and are running in there every 15 minutes because the patient shifted. Talk about alarm fatigue. Plus how is the SNF even remotely going to be able to handle this patient when they have even worse ratios? So unsafe.

Unfortunately at my hospital 1:1 sitters are a thing of the past. It only happens on units where the rooms don't allow a sitter to see into multiple rooms. On the units where rooms are in pods it is not unusual for a sitter to have to watch 4 patients. But also be expected to get vitals, help clean them up, get them to the bathroom while hoping the other patients don't do anything.

While the top admins make their millions in bonuses.

[BarbaraWilfred]

This is the typical life of a nurse, especially in big cities. I think you should speak with your manager about this and hopefully they hire more patient monitors, if nothing is done and you are still encountering such situations, resign in good standing and find another job. Hopefully you get a good management system.

[JayHanig]

It strikes me that you are being set up for failure by your management's insistence on giving lip service to this issue. That being said, I'd let things land where they will, so to speak. I would refuse to feel guilty about it and I would not take any criticism. If they want to criticize, just wait until they get pulled into a lawsuit over Granny's injury. You can be the patient's best advocate then for sure.

I've been involved in a couple of lawsuits over the years and believe me, you'll be asked to describe in great detail your responsibilities for that particular shift, what staffing was, and whether you felt that staffing was adequate. I've told my hospital that while I will not volunteer information to the plaintives, I will not lie about what happened either. They need to consider how any potential incidents or sentinel events will play out in a courtroom.

They do not look good when something happens and they try to shift the responsibility from themselves to the nurse when they made it impossible to prevent.

[JayHanig]

I am not impressed by the use of bed alarms. All they tell you is that Granny just broke her other hip.

[mschumer]

Well finally a post, albeit a little old, that a “sitter,” a title I cannot stand, would be appreciated in your situation. Why your hospital does not assign companions is beyond me. I am a Patient Companion and a good one at that. I’m part of the bedside care team. I do not have a CNA license and my only credential is a BLS certificate. I love this job. Fortunately, I have a wife that makes the money and I am able to do this. I am known as the “Patient Whisperer.” I am very involved with my assignments. I know as much as the nurses do about the patient. I work closely with the Psychiatrist as well as nurses, doctors, speach therapy, PT and OT. I could go on and on about all I do but I am part of a team and glad my hospital appreciates it. I'm sorry yours does not. Maybe they do now since this post is a year old.