Sucide lies: is it CYA or blaming?

[Tiffanybaybay]

So I had a pt this evening who was suicidal. Blatantly suicidal. He was found in his home with a gun drinking and saying he wants to end it. So he went to the Psych lock down part of the ED and when they attempted to medically clear him there by doing his labwork, they were all out of wack. His sodium was critical, liver enzymes all sky high, glucose in the 40's.

Needless to say he was promptly sent to the medical side to be treated. We were short techs to sit and watch him for a 1:1 so the nursing supervisior sent a tech to us to sit with him, just in case. Well since he was the only pt I had the charge RN pulled the sitter to work the entire dept because we were short techs. I didn't complain but to cover my butt I charted that he was "within the sight of the nurses station, appears calm and cooperative, contracts of safety, charge RN aware."

Within a few minutes I got a call from my charge RN who had been looking thorough my notes. He says that he didn't like it that I implicated him in my notes. He said that if anything were to happen this note would place the blame on him. *****

I charted that because I'm just a staff RN, I have no say in what staff goes where. However if something were to happen, I wouldn't want someone looking at the chart saying, there is an order for a one to one here, why didn't you follow those orders?

THEN the nurse sitting next to me said I should have NEVER charted that. She said, that's like the first thing you learn in school. Pt's are NEVER on a constant observation. They are only on that if they are actively suicidal. I said, but they found him with a gun saying he wanted to end it. Then she said, but constant obs is like if you're preventing them from killing themselves that moment. At any other time when they are calm it's not a 1:1. You should never say that.

WHAT IS THAT?! I've been at many facilities and they've mostly had 1:1's. Not to mention the order clearly says 1:1 suicide watch. The hospital protocol says that someone must be within arms reach. A different RN stated that 1:1 isn't even legal, it's just something hospitals do to protect themselves. Am I crazy? Did i just make this up? Was my nursing school THAT BAD that I missed that lesson? Was she being rude?

SO now my charge is ****** at me thinking I'm trying to blame him if the person off's themself. What do you guys think? Was i doing too much? Was I right, was this CYA? OR are they right that as long as the pt is in view of the nurses station that is good enough? If this were to go to court would i be justified in saying he could be seen from the nurses station or was it prudent to say I did all that i could as a staff RN to follow doctors orders?

what do you think?!

[muffylpn]

First I did not read thru the comments. I have worked psych. in a hospital setting for 23 yrs. 1) If it was a Dr.'s order you are in the wrong-and you and the charge nurse could both be screwed if something happened. 2) You asked the charge to pull the CNA and the charge nurse agreed-that person can now be blamed ( there is a charge nurse for a reason-this is one of them).3) If you have a hospital policy about 1:1 and constant obs. that is what needs to be followed-if it is not, the hospital will NEVER support you should something happen. 4) Lots of Pts contract for safety and LIE. Lastly in my state a 1:1 is done with a person being in arms length of the Pt. Constant obs. is Pt must be be in view of the person watching them but a written hospital policy will overide what is considered the norm. Lastly with this person's labs being all messed up was there a potential fall risk cause people say all sorts of stuff after a fall as to why it happened-biazzar lawsuits happen and people who lie win them-just saying

[chevyv, BSN, RN]

I guess the first thing is the 1:1. A 1:1 at my facility is within 3-5 ft at all times. Who's head would roll if the pt did do something and you were within eye sight but too far away to prevent injury? Pts who want to harm themselves are very fast! Not sure what the policy is at your facility. The second thing is charting that the charge nurse was aware. Even if they were aware, they could easily deny that. I took a course about charting to keep you out of the courtroom and it was drilled into my head not to do this. Charting that you consulted with so and so via telephone at such and such time and if orders were initiated or no new orders would be okay, but stating your charge nurse was aware of your decision to pull the 1:1 would be not good.

[DC Collins, ASN]

If the order says 1:1 and you didn't enforce the 1:1 (advocating for your patient) and something went wrong you would be up **** creek without a boat, much less a paddle. If you want to change the circumstances you get the order changed.

In our ED, our policy is 1:1 once suicide is mentioned even if the pt takes it back. Only our social worker or doctor (who will usually defer to our social worker) can take them off 1:1.

CYA!