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’re in the hospital. This was reported by Qazaqyia.kz citing Associated Press.
Previously, sitters, or clinical patient safety attendants (CPSAs), stayed with patients who needed supervision. Patients who might fall, wander or pull out IVs are often assigned sitters, as are those who are highly suicidal or epileptic. Often, licensed nursing assistants (LNAs) fill this role.
However, a new hospital policy limits LNAs from filling the role, Annie Mackin, spokesperson for UVMMC, told VTDigger. The change is to keep LNAs staffed on more "direct" patient care needs, Mackin wrote. Instead, the hospital is prioritizing remote patient monitoring — essentially, a video monitor on wheels connected to a remote observer watching many patients at once — or dispatching designated observation staff, not LNAs, when necessary.
But staff are concerned about the gaps left by that system. "There have been patients that I personally thought, 'I don’t feel safe having this patient in my assignment without a CPSA with them,'" Saer McCliment, an LNA at the medical center, told VTDigger.
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’s daily living care. McCliment said: "Lately, not only has that really not been available, but we’ve been told that there are only allowed to be a specific number of CPSAs working in the hospital at any one time."
The hospital now staffs 17 CPSAs 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 CPSAs at a given time, he said.
Remote monitoring doesn’t 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 are experiencing psychosis or dementia. Hearing a disembodied voice through a remote monitor’s video screen can exacerbate those patients’ paranoia and confusion. "That’s just not safe or fair for them," McCliment said.
On Aug. 20, representatives from two of the UVM Health network’s labor unions sent a cease and desist letter to the network’s 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 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.
The unions’ 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. The authors also wrote that nurses’ input regarding remote observation and sitter practices are "reportedly no longer being appropriately considered and, in some cases, are being disregarded."
Mackin stressed that the hospital is still assigning in-person sitters for some very high-risk patients. "Patient safety remains our top priority, and making workforce roles clear helps us use our resources efficiently while continuing to provide high-quality, affordable care," she wrote.
The changes come as part of a sweeping series of expense cuts the UVM Health network, the medical center’s parent organization, is pushing in order to make ends meet as it faces dramatic drops in revenue largely due to a reduction in what it charges the state’s largest private insurer BlueCross BlueShield and a law prohibiting big markups on the price of pharmaceutical drugs. The network expects to lose more than $14 million across the system in the coming fiscal year, which begins Oct. 1, according to its August budget presentation to the Green Mountain Care Board. UVM Medical Center is expected to cover part of that loss.