1. Section Editor(s): Hader, Richard PhD, NE-BC, RN, CHE, CPHQ, FAAN

Article Content

Managing a nursing department budget is more difficult than ever because of the explosion in 1:1 sitter use. The expense of using sitters is crippling budgets, leaving less financial resources available to achieve strategic objectives. Hospitals, rehabilitation centers, and psychiatric facilities have been mandated to implement alternatives to using 1:1 caregivers. Nurse leaders around the country are attempting to find solutions to reduce costs, but very few have been successful.

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The increased use of 1:1 sitters is directly related to state and federal regulations against restraint use. The criteria for restraint usage are extremely rigorous and the penalty for not following the standards is severe. If these regulations aren't strictly enforced, the organization will be cited for noncompliance, resulting in financial fines and quality deficiencies.


Although the concept of not restraining patients is appropriate, it has led to escalating labor costs that are nonsustainable. Unlicensed assistive personnel are being redeployed to watch patients who require constant supervision, often causing a shortage of ancillary personnel throughout the healthcare facility that leads to a high degree of patient and professional staff dissatisfaction and a considerable amount of turmoil.


Reimbursement from commercial and governmental payors doesn't provide additional payment for 1:1 care. The cost of delivering this service directly impacts the financial bottom line of the organization. Chief executive and financial officers are placing a significant amount of pressure on nurse leaders to "fix" this problem, but success is extremely difficult to achieve. Vendors are constantly marketing new alternatives to restraint products, often citing skewed research to entice nurses to purchase them. Suddenly, the cabinets are filled with expensive products that don't improve the care provided to patients. Nurse leaders are then expected to defend the increase in supply expenses coupled with the increase in labor costs.


Where do we turn to seek relief from high-dollar equipment and labor costs while simultaneously ensuring that our patients remain safe? One solution is for payors to recognize the costs associated with mandatory regulations imposed by governmental and accrediting bodies. It's unreasonable to expect healthcare organizations to absorb these costs without funding.


As our patients begin to live longer, it's evident that many more of them will have diseases that require constant observation to keep them free from injury. Will the majority of our patients require 1:1 care? Where will the resources be diverted from to provide this level of care? Several options are posed: the cost can be directed to the patient, family members will be required to provide the care, payors can increase reimbursement to healthcare providers when there's no alternative to 1:1 coverage, or a ward-style environment may be developed so nurses can visualize their patients at all times.


None of the proposed solutions are likely to be implemented, which leaves nurse leaders continuing to brainstorm a resolution. It's necessary for nurses and other healthcare professionals to work collaboratively to remedy this problem along with federal and state regulators, payors, and family members. There's no easy solution, but we can no longer ignore the costs of 1:1 care as they continue to skyrocket at a lightning pace.


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