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.
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'm not sure that you can legally do this - put patients in and out of restraints on one order. That would be a PRN order for restraints. It's my understanding that JACHO requirements are that a restraint order be written for a specific type of restraint and a specific length of time. True, that order can be dc'd early, but then if the patient needs to go back into restraints, a new order needs to be written. That's what we do where I am. If I don't have this right, does anyone have clarification?
Okay....the whole personality of this thread changed as both sides spoke. There were things that you left out of your original vent and things that were brought up by both sides to consider. Hopefully each side understands each other a little more. I know I do.
I'm not sure that you can legally do this - put patients in and out of restraints on one order. That would be a PRN order for restraints. It's my understanding that JACHO requirements are that a restraint order be written for a specific type of restraint and a specific length of time. True, that order can be dc'd early, but then if the patient needs to go back into restraints, a new order needs to be written. That's what we do where I am. If I don't have this right, does anyone have clarification?
You're right, but since she's clearing it with the nurse, it's on the nurse, I think.
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.
Our pts are not to be restrained if there is a sitter in the room with them. If you're just going to tie them down, then what's the point of having a sitter? Meds are a different story, but I'm not going to sedate a pt who just needs to be reminded to stay in bed. Meds depend entirely on the situation.
Not as long as the OP is talking about. A trial release is for a short time to see if the pt is calm enough to be without them, less than half an hour, and there has to be someone directly observing them...no problem if there is a sitter. If they're off longer than that it's a new order.
This is a good thread. I hope that everyone can try to put him or herself into the other's shoes.
Nurses and floor aides exhausted, bladders ready to bust; sitters fighting to stay awake or get a needed potty break/stretch/meal break. It is just so sad and so despicable what has happened to American healthcare.
you absolutely can untie and retie the restraints...it's called a "trial release" and it just needs to be documented that way...
I think the point is that in some states/facilities this is an RN assessment, whether to restrain or unrestrain. The sitter can't blindly restrain and unrestrain a patient.
Check your policy. If I'm not mistaken we can trial release restraints for as long as you choose.
There is a certain length of time though that the MD order you used to restrain the patient can't be used to re-restrain. I think it's about an hour, but I forget to be honest. To re-restrain after a certain amount of time you need a new order.
jojotoo, RN
494 Posts
I'm not sure that you can legally do this - put patients in and out of restraints on one order. That would be a PRN order for restraints. It's my understanding that JACHO requirements are that a restraint order be written for a specific type of restraint and a specific length of time. True, that order can be dc'd early, but then if the patient needs to go back into restraints, a new order needs to be written. That's what we do where I am. If I don't have this right, does anyone have clarification?