What does 1:1 sitter mean to you?!

ONCRN84 · Jun 9, 2008

Sorry, I really just needed to complain. There were a lot of stupid things that made me want to go find an empty room and scream last night.

PMHNP10 · Jun 9, 2008

Seriously. What does 1:1 sitter mean to you?!
I had a patient last night who needed a sitter and the NACs split the shift because it's a boring job at times. One of them felt it was acceptable to wander down the hallway to the nurses' station when the patient fell asleep. Uh, no. Not ok. And I politely pointed out that she could wake up and be crazy and try to hurt herself in a very short period of time, since she was very impulsive and suicidal. I got a dirty look and a stomp back to the room.
Ugh. I'm all about getting relieved for breaks, but someone needs to be with her all the time!

there is no more difficult job than a 1:1 sitter on the night shift--to have to sit there in a dark, quiet room and watch someone sleep. I did it as a student while working at the VA, so I'm speaking from experience; but you gotta do it; bring a crossword or a book or something, but whatever you do, don't leave the person alone

ONCRN84 · Jun 9, 2008

Oh, I know it's terribly boring! That's why when I did staffing I suggested the split it into 2 4 hr "shifts" instead of making one person stay there for all 8 hours. And really I don't have a problem with the sitter walking into the hallway right outside the door, because you can still see the patient, but don't walk back to the desk!!!!

Ultimately, if something had happened to her, it would've been my butt!

clee1 · Jun 9, 2008

Ultimately, if something had happened to her, it would've been my butt!

That is why you need to write this aide up, regardless of what he/she may think of you in the future.

It protects YOU, and, it sends the message that people WILL do their jobs or will pay the price.

Quickbeam, BSN, RN · Jun 9, 2008

I was internal pool at a psych hospital for many years and picked up a ton of 1:1 night shifts. I took it very seriously. I always figured if 1:1 was needed, then 1:1 is what they should get. Occasionally a floor RN would spot me for a bathroom break but I always assumed I'd spend 8 hours without a chance to get away.

No way anyone, no matter what their role, should just toddle off when working a 1:1.

DaMale Nurse · Jun 9, 2008

At my facility we have quite a few 1:1. Being a acute inpatient mental hospital there are tons of 1:1 from assaultive behavior, to extremely high risk for falls, for anyone in seclusion or restraint, to suicidal behavior. Just to name a few. The way we do it is to have one hour shifts and split them up as best we can.

Sometimes the staffing is good and we have enough people to only make the aids do two or three one hour blocks, but occasionally they have to do 4, but no more. But after one hour with some patients it is extremely difficult to stay awake or be so exhausted after the hour of manic/psychotic conversation that it is not safe for the staff not to have a break.

This will not work in most hospitals simply because there is too much to know about what is going on for the aid to be able to do there job effectively. But for the night shifts at some hospitals is could probably work, or in an area where the patient care is almost always the same.

Hope this helps.

northwestwind · Jun 9, 2008

8 or 9 times out of ten, there are patient or staff issues that are best left alone or resolved without any write ups (write ups are unfortunately becoming more common - punitive without process improvement/individualized learning plans is usually unsuccessful.) HOWEVER, as a former psych nurse myself, you NEED to write an incident report to cover yourself. It is up to your manager whether he/she will also resort to verbal or written disciplinary action. I also would tell the patient's doctor when I saw her/him again.

This is extremely unsafe, as you know. If I were working with the aide again on a different night in the future with a 1:1, I would speak with her at the beginning of the shift about the need to stay in the room and that you and others will help her with breaks, etc. Get her verbal agreement with you that she will not leave the room. If she is uncooperative again, and leaves the room, I would call the nursing supervisor and mention that this is the second time, and mention what had been done the first time.

If you are not charge that night, I would tell the charge nurse she has walked out of a room in the past and has been uncooperative. Watch her like a hawk. Report to the charge any time she leaves the room.

This is a zero tolerance thing. I know it sounds harsh or punitive, and most of the time the hot water between staff is totally not worth it - keep the mouth zipped. But as I mentioned, this is one of the rarer times when there is no room for deviation from the 1:1 purpose, which is keeping the patient safe. Wayyyyyy too much can and has gone wrong in these situations...course you know that.

chevyv, BSN, RN · Jun 9, 2008

I worked external pool as a sitter only so I can honestly say that my job was to stay with that patient at all times. Even the bathroom door was to be left open on my watch. I usually brought a few magazines in case the pt fell asleep, otherwise it was my job to perform total cares (CNA) for the pt. Boring, but safe for me and the pt. I would never have left my patient unattended while asleep or anything else. Most of us know that in the hospital sleep comes in little bits and pieces rather than clumps of hours. Good for you to point the 'could happens' out to the sitter. :up:

pagandeva2000, LPN · Jun 9, 2008

When I was an aide, we did 1:1s and were told that we had to be an arm's length from them. Sometimes, that was difficult, if he/she was a wanderer. But, it means what it means. I enjoyed them, because I would bring in entertaining books to read, which kept me occupied mentally.

On the med-surg units, lately, it has become more difficult to monitor the patients on 1:1 because they did not split the hours anylonger due to a shortage of staff and then, management made the ridiculous decision to no longer allow patient care associates (who were recently upgraded from CNAs) to watch them, only the few CNAs left are now watching them. The best that they do is to split WHO they monitored...4 hours with a wanderer, 4 hours with a sleeper. Go figure...

Tweety, BSN, RN · Jun 9, 2008

Feel free to vent. It's when we let our guards down that bad things happen. I let a sitter go home because her relief wasn't here, stopped to answer a 60 second phone call and went in the room to find the patient on the floor. Sitters complalin when we make them watch 1:1, but it's for a reason.

robinbird · Jun 10, 2008

I had a sitter once that would be on her cell phone each time I walked by the room. She would scoot out of the room when I came in to check on the patient or to do procedures, then not come back right away, leaving me in the room and unavailable to my other patients...Later in the night the patient climbed over his bed rail stretching the feeding tube, almost pulling it out. After I got the patient back in bed I spoke to the sitter in a very calm voice, explaining what I expected of her, no cell phone, remain near the patient, watch him at all times... Then, she began screaming at me, that she did nothing wrong, it was the patients fault, etc.. and wouldn't listen to anything I said. I would have sent her home, but we were desperate for a warm body. My charge nurse spoke to her and she agreed to do her job...I had to write an incident report to her supervisor and requested that she never be allowed back to our unit. I haven't seen her since.