Sitters

[applesxoranges, BSN, RN]

If a patient is suicidal or ETOH, isn't it normal to have a sitter with them? I kind of thought that was a standard of care. At my old job, they would have a sitter for 3 rooms whose job would be to sit there and watch the person except Joint Commission told them they had to have 1:1 and not 1:3 but I don't know if that was a change that was implemented.

At my new job, they just stick them in a room across from the nursing station which is kind of dangerous in my opinion. If they stick them in a seclusion room, they will have a 1:1 but until then they let the suicidals, psych evals, and the etoh patients hang out in a room with potentially no one watching them since the nurses have a 5:1 patient to nurse ratio.

[imanedrn]

Sadly, a lot of hospitals don't care about safety (patient or nurse) until a sentinel event occurs. This is the sort of thing worth calling administration about though.

[edrn091414]

It sounds like the OP works at my new job :-/ I have the same problem, and I had a sentinel event just a couple weeks ago. Our ratio is 5:1 so when I got two patients within 10 minutes of each other I prioritized. I had a diff breather on bi-pap and a man who was petitioned by PD for cutting his wrists (bleeding controlled, already scabbed). I left the suicidal pts room for the new ambulance, but not before calling the house supervisor and asking for a sitter (told that they don't staff for sitters in the ER but she would try to call one in). While I was triaging the bipap patient the suicidal one ran out of the department. Nobody noticed...he was three blocks down the road before police caught him. Fortunately he hadn't done anything while he was running. I sat down and talked to my manager that day, told her that this was so dangerous. I wrote it up in the hospitals risk management system and everything. It's been several weeks and I've heard nothing from anyone about the matter. I guess it wasn't serious enough to warrant any change, apparently we'll wait for somebody to hurt themself.

We rarely have sitters available overnight in our ED.

We use posey belts and frequent rounding... and keep the doors open so that they can be seen at all times.

[studentnursemon86]

We have a locked unit in my ED where sitters aren't needed unless the patient is in restraints. Unfortunately, that is only 6 beds, and we usually have more than 6 suicidal patients. The rest are in the main ED and need a 1:1 out there. With not enough staff, I've found myself watching 2 at a time on many occasions. :-/

The nurses I work with are pretty awesome though, so if one patient has to go to the bathroom, the nurse will sit with the other one since I can't take one to the bathroom and still watch the other one.

We have people on staff whose sole purpose is to watch these patients as well as other 1:1(fall risks mostly), but there just aren't enough of them anymore.

[Anna Flaxis, BSN, RN]

What's a "sitter"? LOL. We don't have staff in my hospital to provide this. We're barely keeping our doors open. But yes, it is ideal to have one on one observation for anyone who is at risk for self harm.

[icuRNmaggie, BSN, RN]

A man drove himself to the ER for help with suicidal thoughts. He was placed in a gown and in an unlocked seclusion room at the end of the hall and not monitored. He left the ER unnoticed and an hour or so later the police found him dead, still in the hospital gown and wearing the hospital bracelet.

He had run his truck into a tree.

This was a sentinel event. But nothing changed in that ER.

Suicidal people should always be on 1:1 nursing observation.

[Kalipso]

I think it is disgraceful that facilities have ANY reason that they do not have 1:1 sitters for suicidal or aggressive patients. This is what disgusts me about the majority of facilities out there. I've never been up for unionizing but lately I think nurses should or you will have the majority of us, who are experienced, get tired of this ******** and continue to leave the field.

[livingthedream77]

We don't have sitters. If you call for a CNA to sit with a pt who needs it from med/surg, you get told they can't spare them. Guess the RNs on that floor would die if they had to clean up a poop (norm 4:1 ratio there).

So.....if it's that bad that you can't sufficiently watch the psych, you call the local PD. Excellent use of resources, huh?

[Kalipso]

Livingthedream77, While I understand your anger in the lack of resouces I think it is terribly short sighted to assume the patient ratios on a floor you don't work on to be 'easy'. It has been my experience that we nurses do this far to often, blame the floor nurses for being lazy, or night shift, or day shift, etc. The truth is all to often all floors and all shifts are not staffed as well as the employees would like....or as well as it could be to be safe. I remember working med surg where my ratios were 5:1 and tge techs were 14: 1. There wasn't as much 'sitting around' as one might guess.The techs had their own chores to do so there were plenty of times that I cleaned and rotated my own patients and one shift inparticular where I had a lady who wouldn't stay in her bed so she spent the shift in a wheelchair along side me folding towels that I continued to unfold so she would keep busy. Our techs couldn't watch her all shift either. I had to roll her to the doorway of my other patient's rooms, do my nursing duties for them and keep an eye on her. You are pointing fingers in the wrong direction. Your managers and their managers need to make sitters a priority but they probably won't because of budgeting. They will wait for a crisis to occur to change. Us pointing unfounded accusations at each other instead of standing up and pointing at those deaf managerial ears that need to hear it allows the managers to also place blame elsewhere so they don't have to change things.

[livingthedream77]

Hi Kalipso. You're assuming I never work on med/surg.

I am speaking of MY hospital. We are very tiny. Everyone knows everyone. And 90% of the med/surg nurses at MY place do have the attitude I described. The CNAs are thought of as some kind of lesser-than personal assistant to do all the nasty stuff. You know, the "I didn't go to school to wipe butt" attitude. That's what we have, and it irks me, having worked as a CNA many years before now.

We have no aides in the ER. There is even grumbling from some nurses when we call a code and it takes an aide off their floor for a while.

That's the culture where I am. There is no myopia here, I was not generalizing all med/surg nurses. I doubt it will be fixed. Someone will have to get hurt first.

[Kalipso]

livingthedream77, sorry to hear that. It sucks working in a sucky culture.