Sitters, give 'em a break!

[anonymurse]

You want to know why you're complaining that the world is ending because you have to take your own vitals? Because your aides are sitting.

You want to know why your aides are sitting? 'Cause your sitters quit.

You want to know why they quit?

'Cause nobody took 10 minutes out of every 2 hours to let 'em pee/smoke/get a Coke.

'Cause they know if they don't get those 10 minutes every 2 hours esp. 7p to 7a they're gonna fall asleep and get fired.

'Cause they were PRN aides who didn't offer to do a 12-hour shift sitting, they just got grabbed and whereas they could keep themselves awake running around the floor all night, they aren't physically prepared to stay in one darkened room all night without breaks and not nod off.

You can't get them to come back because they quit working PRN and went dedicated labor pool in a unit that doesn't use sitters.

'Cause the RN couldn't be bothered to call the doctor to get an order for Haldol PRN, or for effective pain meds, or to order restraints when it was really, really needed. Or couldn't be bothered to give PRNs that *were* ordered.

You know one night I got tired of watching all the RNs drinking coffee and complaining in full view of a sitter who hadn't had a break for 4 hours. I ran and bought her a Popeye's fried chicken dinner. Me, on $7.50 an hour.

2 nights ago for the first time after a hundred sitting jobs, I had a kindly old RN give me 2 breaks Q2H, told me to take my time, and guess what she did, she charted, no skin whatsoever off her nose.

Compare that to the countless times I really needed some help or supplies in the room and had the call bell ignored for 30 minutes or more. Or the 4+ nights I had it cancelled on me repeatedly. Repeatedly!

Got a sitter shortage? Fix it yourself. You can do it.

[TazziRN, RN]

I'm sorry, I agree with Tweety. I've been reading this thread trying to figure out how to voice my opinion without sounding disgruntled, and he did it for me.

the rules say we're not to leave the patient's presence. And the rules make sense from the pt safety perspective. No bathroom break even with a bathroom a few feet away.

Guess what? We're not allowed to leave the pt's presence either, although we can leave the pt's rooms. And we have bathrooms nearby also but we are not allowed to go unless there is another nurse on the unit watching the pts.

I've seen a great many sitters asleep while working the floor.

I've been a sitter and I took things with me to keep myself occupied when the pt was asleep.

I will have to continue my answers in another post

[TazziRN, RN]

Fourth, by not giving breaks Q2H on the 7a-7p shift, you are only going to run off those who take their responsibilities seriously. Do you turn pts Q2H? Or do you tell 'em hey, no break for me, no break for you?

What about you asking for a break? If I don't ask for one, I don't get it. And turning pts is not the same, and you know it. Turning pts is part of pt care, which is why we often don't get breaks...because we are busy taking care of pts.

The sitter is a resource like that IV pump that you don't mind tending to when it needs maintenance.

Again, the pump is "asking" for attention. You want it, you ask for it. I would be happy to relieve you if you need a break, but I'm not going to drop what I'm doing every 2 ours to ask if you need a potty break.

Oh....and about not getting a bathroom break when the bathroom is a few feet away? When the nurse comes in to check on the pt, that's a good time for you to go into that bathroom that's so close by. Tell the nurse what s/he needs to know, then say "Excuse me, while you're checking Mr. Knee I'm going to step in here for just a moment." We don't ask each other "Do you need to go pee? Go ahead, I'll watch your pt.", and we should not be expected to ask you. If someone does, wonderful, but don't hang the ones who don't. They're busy thinking of their pts, not the employees. As for the ones who don't go into the room for 6 hours because you're there, a pox on them, that's just poor nursing.

[Tweety, BSN, RN]

Not what I said. First, the rules say we're not to leave the patient's presence. And the rules make sense from the pt safety perspective. No bathroom break even with a bathroom a few feet away.

Second, sure, you'll find those who don't mind not being interrupted. I found a private sitter asleep with her pt trying to claw the staples out of her hip replacement incision, blood all over the place. I had another sitter tell me how she arranged things in the room so passers-by would think she was awake. I've seen a great many sitters asleep while working the floor.

Third, sitters give nurses a false sense of security. I have gone over 6 hours without the nurse coming into the room.

Fourth, by not giving breaks Q2H on the 7a-7p shift, you are only going to run off those who take their responsibilities seriously. Do you turn pts Q2H? Or do you tell 'em hey, no break for me, no break for you?

Pt safety is the bottom line, not ensuring nobody gets treated better than you. And BTW, you are not a sitter's equal. You are the sitter's manager with the responsibilities that go with it. The sitter is a resource like that IV pump that you don't mind tending to when it needs maintenance.

I'm not understanding your "first", I never advocated anyone leaving the patients side.

2nd - point well taken, an entirely different issue. Yes there are sorry sitters out there.

3rd - that's an entirely different issue as well, there are sorry nurses out there.

4th - yes I check on my patient q2h and no you're not getting a break q2h. If you can't hold your bladder longer than 2 hours, you need to see your MD. You're getting an AM break and a lunch break, but by all means if you need to run to the bathroom while I'm in the room anyway during one of my check, please feel free, but no ten minute smoke break or any other kind of break until it's time for your 15 minute AM break or 30 minute lunch.

Bottom line is that we can work together to meet each others needs, especially the patients. But you're not getting ten minute breaks q2hours. Sorry we'll have to agree to disagree.

If that's what's causing sitters to leave nursing then they need to be told when they are hired what their duties entail and that what kind of breaks they can expect.

[anonymurse]

Hold on- I am a new grad and have been a sitter myself. BUT my recent experience with sitters is this- I had a psych patient who was in 4 pt restraint(protection of lines) with a sitter. The sitter pretty much watched VH1 all night- loudly- even when the patient asked her to turn it down. She did get breaks- the unit rep sat in for her. The regular sitter did not empty the foley, do ROM for the restraints, or even try to accomodate the needs of the patient (by turning down the TV). I had 3 other patients and did not get to have a break myself, but giving the sitter a mini-break from VH1 happened when I was in the room caring for the patient, which was frequently.

Yeah, I hear you. There has to be a way to hire and retain better quality sitters. Or rather, there should be a way to make this a priority.

[anonymurse]

And we have bathrooms nearby also but we are not allowed to go unless there is another nurse on the unit watching the pts.

Yeah, I guess you're in a spot if you're the only nurse. I haven't seen that yet myself, so the nurses all hit the bathrooms whenever they need to.

[jojotoo, RN]

I'd say 90% of the time I get report that a pt is "bad" I just go in the room and first thing I do is undo the restraints and we start talking and everything is fine.

Are you saying that as a sitter you discontinued restraints on your own initiative? If so, I would have a big problem with that since it would be outside your scope of practice. If I have misunderstood you, I apologize.

[Tweety, BSN, RN]

Sorry, I was in a rush and didn't explain. On this one floor, the charge who had this pt won't give PRN Haldol AT ALL. This was explained to me by a floor RN when I had a very combative pt who was determined to go home. The poor pt ended up fighting restraints all night.

Now my collar's getting tight. I hate restraints. Nothing is guaranteed to generate anxiety faster than tying someone down. I'd say 90% of the time I get report that a pt is "bad" I just go in the room and first thing I do is undo the restraints and we start talking and everything is fine.

Some folks assume pts want to be "bad." Pts hate being confused. They hate hallucinating. They hate being tied down. I despise it when folks ask pts "Now are you going to be good tonight?" because the pt doesn't *want* to be "bad," he doesn't even have any control over it!

I agree. It's very poor nursing to restrain a patient and not medicate them. In fact it's downright cruel.

[Tweety, BSN, RN]

Are you saying that as a sitter you discontinued restraints on your own initiative? If so, I would have a big problem with that since it would be outside your scope of practice. If I have misunderstood you, I apologize.

I'd be happy if our sitters unrestrain our patients. I always unrestrain my patients, only to have the sitters tie them back up, that to me is more out of line that releasing restraints.

But you're right, releasing and tying should be an RN decision. But the sitters actually spend the most time with the patient, so we should respect their input.

We all know sitters who walk into a room and immediately call for medication or restraints, so they can "sit".

[Tweety, BSN, RN]

Yeah, I guess you're in a spot if you're the only nurse. I haven't seen that yet myself, so the nurses all hit the bathrooms whenever they need to.

You're correct. When I gotta go, I just go, I don't look for coverage for my patients.

I've never had a sitter call to go to the restroom and be refused. My only problem with what you're saying in this thread is the q2h breaks. Sometimes when you gotta go, you gotta go and if there's no break scheduled you have to ask/demand to go to the restroom. It's not a problem where I work, and as I said we always have sitters on my unit. Last week we have 5, yes five sitters because of isolation rooms. Imagine them all getting q2h breaks?

[anonymurse]

Are you saying that as a sitter you discontinued restraints on your own initiative? If so, I would have a big problem with that since it would be outside your scope of practice. If I have misunderstood you, I apologize.

Yeah, while the order is good for the whole period, that doesn't mean the pt has to be restrained the whole time. I show up early and read the chart, and if there are orders for restraints, I'll ask the primary what she wants me to know about this pt and what needs to be monitored, then I'll say something like "If the pt's compliant, I'll untie 'em if you don't mind," and I've never been denied. Then I'll get report from the sitter and that's a whole different set of info. Later, if the pt starts to get rambunctious, I'll explain why we need to get restrained again and they're OK with it. I negotiate the amount of slack with the pt to ensure they're comfortable yet safe. Then I jot down the time to pass to the primary and everyone's good with that.

[Tweety, BSN, RN]

Yeah, while the order is good for the whole period, that doesn't mean the pt has to be restrained the whole time. I show up early and read the chart, and if there are orders for restraints, I'll ask the primary what she wants me to know about this pt and what needs to be monitored, then I'll say something like "If the pt's compliant, I'll untie 'em if you don't mind," and I've never been denied. Then I'll get report from the sitter and that's a whole different set of info. Later, if the pt starts to get rambunctious, I'll explain why we need to get restrained again and they're OK with it. I negotiate the amount of slack with the pt to ensure they're comfortable yet safe. Then I jot down the time to pass to the primary and everyone's good with that.

I would be good with that too. You sound like a great sitter.

[anonymurse]

You're correct. When I gotta go, I just go, I don't look for coverage for my patients.

I've never had a sitter call to go to the restroom and be refused. My only problem with what you're saying in this thread is the q2h breaks. Sometimes when you gotta go, you gotta go and if there's no break scheduled you have to ask/demand to go to the restroom. It's not a problem where I work, and as I said we always have sitters on my unit. Last week we have 5, yes five sitters because of isolation rooms. Imagine them all getting q2h breaks?

Yeah, when I work as an aide or US I spell 'em as much as I can. The ones in contact islolation need it most because 2 hours in one of those isolation gowns will make you sweat out your scrubs, especially if your pt is incontinent with diarrhea and has bad skin, so you don't want to put them in diapers and you're always changing the bedding. I took a bad chill a couple months ago that way.