Scope Of Practice Question

[RN0313]

We recently instituted a new job at our hospital of observers for Suicide Ideation patients. This is a role that doesn't even require a HS diploma and these staff are to only sit and watch patients. The person is not allowed to touch the patient at all.

Our hospital is requiring all RN's, UC's, and LNA's to also fill out this job description and sign the paperwork since they could be asked to sit in the room if needed to relieve someone for a break etc. They are also pulling LNA's and UC's off the floor to this job.

The problem with this is we are being told that while we are in this role we also are not allowed to touch the patients. This includes if they are trying to hurt themselves, are a fall risk and getting out of bed, or any reason. While in this role we can only call for assistance to the room.

This is very hard for nearly everyone (RN's and LNA's) as they don't feel right sitting and just watching whatever action the patient is doing that could be potentially a safety concern.

Are we as RN's even allowed to act below our scope of practice and not help a patient? We were even told by our administration that we can't touch the patient and if they are going to fall that its going to happen anyway...

[JKL33]

No I would not agree to this.

The hospital's ill-conceived policies cannot cancel out legal obligations and expectations. An RN is expected to do what a prudent RN would do.

[BarrelOfMonkeys, BSN, RN]

So, as a sitter that’s a nurse, for example, you have to call for help from another nurse? That doesn’t sound right. If a sitter were to call a nurse for help then wouldn’t that nurse come in and help?

[Davey Do]

I second JKL's perception. If we are employed as a nurse, then we need to be able to act as a nurse.

Once upon a time, Wrongway Regional Medical Center had housekeeping staff who also worked as sitters both on the medical and psych sides. The psych sitters were only allowed to touch the patient within the scope of their CPI training. Nurses were allowed to, and had to act within, the scope of their nursing abilities.

In fact, one psych LPN was written up while acting as a sitter on the medical side because she refused any "hands on".

[Sour Lemon]

That sounds incredibly stupid. Have they given you any reason why they think this is a good idea? ...or even appropriate?

[Jory, MSN, APRN, CNM]

Nope. We have RNs that are sitters at my hospital if they would otherwise get low-census. They only thing they don't do when sitting is administer medications, wound care, etc....because you would really need to be there for report, etc.

All of our sitters, however, are CNAs.

Whoever came up with that idea needs to run that by risk management because if a patient falls because an RN, who is EMPLOYED and paid as an RN at that same facility, was sitting there waiting for assistance while the patient tried to get up and instead of helping they watched them fall and they ended up with a head injury? Hospital should just open their check book.

Here is a question you should ask: So if I am an RN and walking down the hall and I see a patient that isn't mine ambulating and start to fall....instead of assisting them, I should just call for assistance and just let them fall correct?

When they tell you "Of course not", then say...."Then why are we giving patients here on suicide watch a lower level of care because they are with a sitter?"

[TriciaJ, RN]

What's the point of any sitter if they can't intervene? Might as well save a few bucks and just leave the patient to his own devices.

[Corey Narry, MSN, RN, NP]

On 2/14/2019 at 4:12 PM, RN0313 said:

Are we as RN's even allowed to act below our scope of practice and not help a patient? We were even told by our administration that we can't touch the patient and if they are going to fall that its going to happen anyway...

I always thought that Risk Managers would say that a nurse can function below their level or scope but they will always be held to the standard of their highest level of education, registration, licensure, or certification. I think it might have been @Nurse Beth who gave the example that if an RN is asked to be a sitter and sees the patient's IV site infiltrated or infected, they could be held liable for not acting on that assessment finding. That would be similar to allowing a patient to fall without doing anything to prevent it.

[guest1048932]

It was my understanding that regardless of the role you are in, if you are an RN, you are held accountable as an RN.

I would raise concerns with management over this "policy". Your nursing standards should at some point state something like "RNs practicing as RPNs or unregulated health care providers are held accountable as RNs. RPNs practicing as unregulated health care providers are held accountable as RPNs". This is one of the nursing standards regarding "other work" where I'm from, so I suggest you look at your nursing standards and bring this to managements attention STAT.

Basically, don't turn a blind eye or deaf ear. Document as an RN, know that you will be held accountable as an RN, and talk to management about this unsafe policy. Protect yourself and protect your patients. Best of luck to you!