Sitters, give 'em a break!

Tweety, BSN, RN · Nov 22, 2006

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.

I agree, sitters are an alternative to restraints, which is why if there's a sitter I almost always unrestrain the patient. Our manager gets real angry if she walks into a sitter room and the sitter is watching TV and the patient is restrained (of course she's only seeing a moment in time.) This might mean the sitter will actually have to do some work and tough the patient, but that's what they are there for.

There are those patients that are so out of control that they need restraints and a sitter.

Tweety, BSN, RN · Nov 22, 2006

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 agree. About the only thing I still disagree with is maybe not the need for q2h breaks, but the expectation that this is going to be the reality. Not with me is that the reality, sorry.

rach_nc_03 · Nov 22, 2006

I agree with the OP on some points, but I side with Tweety on the issue of q2h breaks. Yes, everyone should be able to pee when they need to. The unfortunate thing is, that simply doesn't happen on most floors. I've worked with late-term pregnant nurses who actually wore incontinence pads (the Depends ones that look like big maxi-pads) at work because they sometimes absolutely couldn't hold it for another ten or fifteen minutes while waiting for another nurse to cover them. This was in a high-acuity ICU where everybody had a patient that might code at any moment. How sad is THAT?? I mean, come on! How has healthcare gotten so bad that people end up having to prepare to WET THEIR PANTS because staffing is so bad? it just infuriates me that nursing staff (all of the staff, including CNAs and sitters) have such a hard time getting a chance to urinate!

That being said, I think it's too much for ANY member of the nursing staff to expect to get a real break every two hours on a busy unit. And yes, much of the time, the nurse's load is too heavy to break the sitter out for 10 minutes every 2 hours. If you (and I mean you in general, not just the OP) are working agency on such a unit, refuse further assignments to that unit if you believe you're being treated unfairly. Yes, if you see a gaggle of nurses or CNAs sitting around, obviously doing nothing- and I don't mean nurses charting or on the phone with docs, etc....which I'm sure you (the OP) know, as we can all tell from your posts that you are intelligent, responsible, and astute- you're being treated unfairly if someone won't sit for you for a couple of minutes while you run to the restroom. As many have said in other posts on various subjects, vote with your feet. If management gets word that sitters won't work on a certain floor because they never get breaks, someone is going to notice.

I worked as a CNA during nursing school, and at one point, our hospital stopped using sitters from the usual agency because too many sitters had been caught sleeping, chatting on cell phones, leaving patient rooms without notifying anyone, restraining patients without orders, using 4 point restraints where 2 point restraints were ordered (this was a very well-known policy, and had been in effect for years), screaming at patients, refusing to help in any way when nurses/CNAs in the room needed a quick hand (one sitter said, when 3 CNAs and one nurse were struggling to turn an obese patient and asked for her help, 'hell no- I'm paid to sit here on my a**, not help you')- anyway, they had a sudden need for sitters, and I started getting pulled nearly every shift from my unit to sit on other floors. Usually, the HO had to make the decision, so he'd be the one to come notify me; when there were units that were a major problem, I told the charge nurse on the problem unit, the charge on my home unit, and, if it was particularly egregious, the HO. Sometimes it wasn't effective, but more than once, 'bad' assignments weren't quite as bad the next time around.

Oh- another thing. I honestly don't feel bad for anyone who can't take several smoke breaks at work. I smoke, and I can count on one hand the number of shifts where I took ANY smoke breaks in hospital jobs. Eating and urinating are one thing- people can go without smoking at LEAST for half a shift. I worked with a nurse who had 3 patients suffer SERIOUS injuries from falls sustained while she was out smoking (on different shifts).

Ok, I got a little off-topic. Sorry. I want to thank the OP for starting this thread, though. Misconceptions abound, and it's easy to make generalizations about entire groups of people based on negative experiences with just a few. I think everyone in nursing has to fight against negative stereotypes on some level- and the OP has reminded me of the GOOD sitters I worked with, when it's often easier to remember the bad ones.

anonymurse · Nov 22, 2006

Well, usually it's not a trial because we know what's going to happen and when, and because I'm going to notify the RN before the restraints go back on.

Most cases are sundowning with elopement attempts and a history of the same. If identified early, the pts can be helped to forsee where they're headed and understand the necessity when reminded of their fall history.

Sometimes it's sundowning with attempts to pull out lines. I'll see a pt is getting groggy and all it takes is a reminder: Remember last night you pulled out your IV in your sleep? It's natural that when you're sleepy, if you feel something in your arm that doesn't belong there you'll try to take it out. So we need to put these restraints on your wrists now to prevent that. Less chance of infection and we won't have to poke another hole in you. OK? And so far every one has said OK.

I'm against using sitters for human restraints. Manual holds are legally speaking a very weird thing out of the psych setting, and one that sitters are not trained in (neither policy nor technique). The documentation process outside the psych setting is weak and a vulnerability for the hospital. Plus any human being has a strong aversion to being held down. Worse, there is a potential for injury to both sitter and pt.

I think in terms of pt compliance and condition, the sitter's role is to monitor and report. Also the sitter should be competent to provide total care. But the sitter is not a fighter or a punching bag. There should be no wrestling.

There is a very bad vibe that builds between pt and sitter should the sitter be obligated to repeatedly use force to ensure compliance, one that destroys rapport. Ideally, the sitter should know the pt's behavioral history, identify a developing problem, and communicate a need for a nursing intervention before the need to manually restrain arises.

cardiacRN2006, ADN, RN · Nov 22, 2006

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.

Our orders are for 24hrs. So I can take them off and put them on as many times as I want within the those 24hrs. Otherwise, people wouldn't want to take restraints off because they wouldn't want to have to re-initiate a new restraint order.

anonymurse · Nov 22, 2006

I worked as a CNA during nursing school, and at one point, our hospital stopped using sitters from the usual agency...

Yeah. Agency sitters, what a concept. You know, considering the liability and all, I'm beginning to think hospitals should not only have their own sitter programs and distinct sitter training, but there should be a Sitter Mgr who does the training and does rounds of all her sitter cases. It could be an additional duty for someone in staffing. We had 10 sitter cases Fri night which seems worthy of at least some centralized attention. Right now the Nursing Supv peeks into sitter rooms when she has time on rounds to see if they're awake, which is a very valuable service, but that's all she'll have time for, and that happens too rarely.

Tweety, BSN, RN · Nov 22, 2006

Our orders are for 24hrs. So I can take them off and put them on as many times as I want within the those 24hrs. Otherwise, people wouldn't want to take restraints off because they wouldn't want to have to re-initiate a new restraint order.

That's probably true. Our restraint orders have to be renewed every 24 hours. But if you take them off, you have to justify putting them back on and get a new order if a certain length of time has passed. But if the time hasn't passed one can take them on and off all day long. You're right the incentive to take them off isn't there under those circumstances.

anonymurse · Nov 22, 2006

if you take them off, you have to justify putting them back on and get a new order if a certain length of time has passed.

Sorry to hear it. That is so totally hosed! Any way you can champion a change on behalf of the sundowners?

Antikigirl, ASN, RN · Nov 22, 2006

Yeah...I agree with the haldol deal (or other meds)...many MD's order a sitter to avoid that (chemical restraint). HOWEVER, if that patient is acting out and being noncompliant with the sitter, BOOM..that is a call to not only the MD but security by me..I don't stand for it at all! No reason to put someone that has to sit in any danger!!!

Also, some people have adverse reactions to antipsychotics and it actually hypes them up! Sadly seen that too many times to count...especially lately. I actually withheld ativan with one patient who was due to have some (with MD permission) and the sitter was furious with me..I relieved her for a while so she could take a break...I charted...and lo and behold the patient finally after hours of being pumped with ativan and being a poop, fell sound asleep, and was asleep the entire rest of shift!

She asked me how I knew...and I said I didn't really, just was going to give it a try and sit there myself to see if it was going to work... She was impressed and learned something new!

I also give the sitters breaks! Man...I have had to do it and it sucks! Minutes turn into hours I swear! NO one relieved me either...and that was very upsetting! And of course..had to be in a room far from the RN desk so I couldn't ask for help unless I used the call light (which could have woken the pt...which I didn't want to do!). By the time I was actually relieved...I almost "relieved" on myself doing the pee pee dance at the door!

I hear ya...and hey...I don't mind having to do things for myself! If the CNA is busy then I do it...they are assistants not slaves! Assist is if one is available...and if not...I either find help if needed or do it myself! :)

Wish there was an alternitive to sitters...I really do. We have had a recent flux of psych pts (seasonal ones come in about now...but we have had them in for 4 weeks already..and they are taking up the beds big time...surgeries have had to be cancled!). So we can't get enough staff to tend to patients and sit! It is crazy!!!!!!!

LOL! Maybe I will make a company of just sitters, like agency...and have them contracted for not only break times that must be followed to the letter, but good pay for their time! :) Extra if they are CNA, LPN or RN and do any type of task (I/O, VS, taking care of beeping IV's...). There we go...nice money making idea there! LOL!

jo272wv · Nov 22, 2006

being a sitter when I was in nursing school, I know the break problem. When I sat, I simply told the nurse of the pt I was sitting that she could give me ten minutes every two hours or fourty five minutes all at once in the middle of the shift. Guess what they always took the ten minutes. Now as an RN I offer that choice to the sitter, I also will check on sitters of other nurses working when I have a few free moments and give them a ten minute here and there. Thats called team work. Bless all you sitters, its not as easy as it looks at times.

TazziRN, RN · Nov 22, 2006

When I sat, I simply told the nurse of the pt I was sitting that she could give me ten minutes every two hours or fourty five minutes all at once in the middle of the shift.

Wow.....wouldn't have worked with me. I would have told you to take it up with the house supe. Ultimatums are fastest way to get me to do only what is necessary for you, the sitter. If you asked me to try and break you every couple of hours I would tell you that I would try, but if I'm too busy to take a break then it means I'm too busy to break you that often. And I would flat out refuse to give you 45 minutes under any circumstances. I have a whole world of respect for sitters and will do what I can to help, because you're right, it's a tough job. But I don't do ultimatums.

rach_nc_03 · Nov 22, 2006

Yeah. Agency sitters, what a concept. You know, considering the liability and all, I'm beginning to think hospitals should not only have their own sitter programs and distinct sitter training, but there should be a Sitter Mgr who does the training and does rounds of all her sitter cases. It could be an additional duty for someone in staffing. We had 10 sitter cases Fri night which seems worthy of at least some centralized attention. Right now the Nursing Supv peeks into sitter rooms when she has time on rounds to see if they're awake, which is a very valuable service, but that's all she'll have time for, and that happens too rarely.

I agree. And what makes no sense to me is that the facility is likely paying MORE by using an agency than they'd pay to have someone dedicated to training/managing sitters- even part time- in the long run.

Oh- and several times, when they pulled me from my CNA assignment to sit because they fired all the agency sitters, they'd end up having to call in another CNA- or a nurse- to backfill my regular unit CNA job later in the shift. For extra pay. Made me wonder if anyone doing the budgets ever spent ten minutes thinking about long-term effects of their decisions.

Sadly, the lower someone is in the perceived food chain- and, let's face it, administration usually DOES treat sitters like unskilled warm bodies (I heard an administrator once say, 'go ahead and fire that sitter- they're a dime a dozen and we can find another idiot by tonight')- the less their impact is considered by higher-ups. So quality of care is never considered, and people are considered disposable. And the cycle continues.