code blog: tales of a nurse

What do you suppose the hardest job in a hospital is? Being an oncology nurse, cleaning up bedpans, charge nurse of a busy floor, surgeon on-call during a busy night... there are quite a few difficult jobs to be done in a hospital. It is of my opinion that one of the hardest and most frustrating jobs is that of a ... sitter.

Yes, you read me right. Sitter. A sitter is a person who must sit with a confused patient and make sure that they do not get out of bed or pull on their PEG tube, foley, tracheostomy, oxygen, gown, SCD's, colostomy pouch, chest tube, etc, etc, etc. I realize that it may not be a very "difficult" job, but it sort of is. You have to constantly keep your eye on the patient, and constantly redirect their hands. Patients can get a little testy when you keep telling them they can't pull out their foley catheter, when in fact, there's nothing else they'd rather be doing at that point.

A recent patient of mine, "George," was a patient who was made for the sitting profession. He hadn't slept all night and had lots of nice tubes and wires to pull on. George demanded attention. Even though I only had two patients, and George wasn't one that you could consider "unstable," I easily spent 90% of my time dealing with him. We were on the overflow unit, where resources are usually non-existant. There were 2 nurses for 4 patients. One patient's family was in our faces every other minute or so. Another patient was on the call light every 5. One patient was admittedly very quiet, but still quite ill, and then there was George. It was only us 2 nurses left to deal with the melee of the telephone, doctors, call lights, meds to be given, lab tests to be called...

Every single time I walked by George's room, I was greeted to naked George, because he refused to leave his gown on. Now, I could care less about naked George... but room 36's 87-year-old wife who just happens to be walking by might not be as apathetic. In the space of 4 hours, I replaced George's oxygen mask, his gown, his SCD's a zillion times. I successfully thwarted his attempts to pull out his chest tube and central line. I found that I was unable to prevent him from tugging his urostomy bag off when I noticed a huge wet stain on the gown that I had just put on 3.5 minutes prior. You can't just tape a urostomy bag back in place... it won't work. Oh, did I remember to mention that George was on isolation??? So every time I was to go into his room, I had to don a mask, gloves, and gown. Guess how many times I actually had a chance to put all that crap on?

So although George was stable enough to be transferred to the medical floor, I found that I was spending the greatest amount of time with him. I would like to point out that George was old, and although quite alert, was a bit forgetful. He would certainly stop throwing his legs over the side of the bed when I'd ask him to stop, but he'd just start again 2 minutes later. I realized that the only safe thing to do would be to ask the doctor for a sitter.

We don't get sitters in ICU. We nurses are the sitters. One could argue that we shouldn't need them... we "only" have 2 patients (but, ya know... they're in ICU for a reason), and the rooms have glass doors. The patients are easily visible from the nurse's station, unlike on the general floors, where the patients are down the hall, out of sight. Since George was transferring to the medical floor, I believed a sitter would go a LONG way towards retaining his future nurse's sanity. I easily got the order from the doctor, but wouldn't you know... the staffing office would have to actually procure a human being to act as sitter, and that would take a few hours, so... sit tight there with George for a little while, won't you?

You might be asking why I didn't just restrain George. I hate restraints.

That's where sitters come in. They literally stay at the patient's side and gently re-guide the patient's hands. They put the patient's legs back in the bed. In George's case, I think he just wanted attention. When I'd be in the room fixing whatever mess he'd just created, he'd stop. Unfortunately I could not be in the room 100% of the time. But a sitter can. We finally got one for him, and he was transferred to the medical floor.

About an hour later, I took George's lunch tray up to the floor because it had been delivered to us by mistake. When I walked into the room, I noticed George sitting very quietly and still on his bed. The sitter was changing the channels on the TV. George's hands were in plain view and he was behaving quite nicely. As I set the tray down, the sitter asked me, "So... I didn't really get a good report on this patient. Why does he need a sitter?" I couldn't blame him for asking - George was the model patient at that point. As I described all of his earlier escapades, George just smiled and nodded his head.

Sigh.