Baker Act

Baker Act is a term used here in Florida for a person who is a danger to themself &/or others.  Being labeled a Baker Act automatically allows the state to take you into custody against your will & be under psychiatric evaluation for up to 72 hours.  We get Baker Acts at our hospital who usually have attempted suicide & need medical clearance before being transferred to a psych facility.  A requirement our hospital has with Baker Acts is that they require someone to sit at their bedside 24/7 so they don't harm themselves while they are in our care.  Our "sitters" are our patient care techs.  So it means if we have a Baker Act, then the patient care tech will sit all night instead of assisting the nurses. 

I used to wonder why did we have to have a person observing someone under a Baker Act - why couldn't we simply restrain them to the bed via wrist restraints & a Posey vest.  I guess the liability is too much for our hospital to chance that the person won't harm themself.  It wasn't until last week that I saw firsthand the importance of a sitter. 

We had a patient that came in - he was young - in his 40's.  He took something like 90 Valiums and I think drank some alcohol or took Benadryl along with it - he wasn't my patient, so I didn't know the exact details.  He was pretty out of it the night he came in, but the next night was a different story.  I was sitting near the room when I heard his sitter ask him what happened the night before.  They teach us in nursing school that there is nothing wrong with asking a person if they are feeling suicidal or what their feelings were for the reason they attempted suicide.  Personally....I don't want to know.  I'm not a psych nurse & I'm not going to be able to solve those type of problems in 12 hours anyways.  I think it's a dangerous line that can be crossed to encourage a suicidal person to express their feelings when you are not fully trained on what the next step is.  Anyways, he started telling the sitter that he was having problems with his girlfriend - they were breaking up or she was kicking him out - something like that. 

It wasn't long before he was crying.  Again, not a good thing because what do you do with those feelings that are being stirred up?  I tell his nurse that she needs to call his doctor & get something prescribed - rather quickly.  She hesitates - says he came in as a drug overdose & the doctor probably won't prescribe anything.  Ummm, yes he will.  So she doesn't call.  I go back down by the room & now the patient is telling the sitter to give him the phone - that he wants to call his girlfriend & tell her good-bye...that he would be killing himself tonight.  I again tell his nurse "you have got to get him something to reduce this anxiety or he is going to hurt himself & possibly us if we attempt to stop him from hurting himself."  I wasn't worried about him - because if it came down to it - if he was hurting himself, I wouldn't physically step in.  Sure I'd call a code gray (a call for manpower) - but no way would I put myself in danger to save this guy's life.  I was worried though that he could possibly hurt the person who was the sitter - then I'd have to step in to stop him from harming her.  That's a different story. 

The sitter comes out to tell me that she needs to talk to his nurse & asked if I could watch him while she went to talk to the nurse.  So I go in the room & try to make small talk.  He tells me that he was planning on killing himself tonight & that out of respect for the sitter - he wouldn't do it tonight because he didn't want her to have to live the rest of her life remembering him doing something like that.  Whew!  Glad to see he has somewhat of a conscience.  Eventually the nurse did get him some anti-psychotic medications & he slept the rest of the night. 

I don't even remember what my patients were like last week except Thursday was really, really busy.  From the start of shift until the end - there was no time for any breaks.  It was nothing that was an emergency - but it was non-stop work.