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The University of Vermont Medical Center in Burlington on November 2020. File photo by Glenn Russell\/VTDigger<\/p>\nThe University of Vermont Medical Center in Burlington on November 2020. File photo by Glenn Russell\/VTDigger<\/p>\n
In June, UVM Medical Center quietly rolled out a new policy dictating how its staff watch over patients who are at risk of hurting themselves while they\u2019re in the hospital.\u00a0<\/p>\n
Sitters, or clinical patient safety attendants \u2014\u00a0CPSAs \u2014 stay with patients who need supervision. Patients who might fall, wander or pull out IVs are often assigned sitters, as are those who are at highly suicidal or epileptic. Often, licensed nursing assistants fill this role, too.\u00a0<\/p>\n
But, a new hospital policy limits LNAs from filling the role, Annie Mackin spokesperson for UVMMC told VTDigger.<\/p>\n
The change is to keep LNAs staffed on more \u201cdirect\u201d patient care needs, Mackin wrote.\u00a0<\/p>\n
Instead, the hospital is prioritizing remote patient monitoring \u2014\u00a0essentially, a video monitor on wheels connected to a remote observer watching many patients at once \u2014 or dispatching designated observation staff, not LNAs, when necessary.\u00a0<\/p>\n
But staff are concerned about the gaps left by that system.<\/p>\n
\u201cThere have been patients that I personally thought, \u2018I don\u2019t feel safe having this patient in my assignment without a CPSA with them,\u2019 \u201d Saer McCliment, an LNA at the medical center, told VTDigger.\u00a0<\/p>\n
Previously, an LNA could fill in as a sitter as part of their regular duties, which are under the supervision of a nurse and include much of a patient\u2019s daily living care.\u00a0<\/p>\n
\u201cLately, not only has that really not been available, but we\u2019ve been told that there are only allowed to be a specific number of CPSAs working in the hospital at any one time,\u201d McCliment said.\u00a0<\/p>\n
The hospital now staffs 17 CSPAs each shift for all 14 inpatient units and the emergency department, according to Brett Rhodes, another UVMMC LNA. His floor alone can need up to five CSPAs at a given time, he said.<\/p>\n
Remote monitoring doesn\u2019t work for many of the patients who need it, they said, adding that many of the patients at risk of pulling out IVs or wandering off\u00a0are experiencing psychosis or dementia. Hearing a disembodied voice through a remote monitor\u2019s video screen can exacerbate those patients\u2019 paranoia and confusion.\u00a0<\/p>\n
\u201cThat\u2019s just not safe or fair for them,\u201d McCliment said.\u00a0\u00a0<\/p>\n
On Aug. 20, representatives from two of the UVM Health network\u2019s labor unions sent a cease and desist letter to the network\u2019s labor relations director, formally requesting the hospital pause the June changes to its observation policy. The change impedes the bargaining for new contracts both unions<\/a> have been undergoing since April, the letter stated. The support staff union, which includes LNAs, has been working on an expired contract since mid-August.<\/p>\n The unions\u2019 letter also detailed that if an LNA is pulled from their regular duties to provide patient observation, the hospital has not been able to fill in with additional LNAs to cover their tasks, resulting in a unit being short staffed\u00a0<\/p>\n The authors also wrote that nurses\u2019 input regarding remote observation and sitter practices are \u201creportedly no longer being appropriately considered and, in some cases, are being disregarded.\u201d\u00a0<\/p>\n Mackin stressed that the hospital is still assigning in-person sitters for some very high-risk patients. \u201cPatient safety remains our top priority, and making workforce roles clear helps us use our resources efficiently while continuing to provide high-quality, affordable care,\u201d she wrote.<\/p>\n
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