The nurse is caring for a client who has verbalized the desire to commit suicide. He has a detailed, concrete plan in place. The nurse places the client on suicide precautions, which include assigning the client a 24-hour sitter. The client becomes angry and refuses the sitter. Which action by the nurse is the most appropriate?
allow the client to leave against medical advice (AMA)
tell the client that a friend can come sit with him instead
Number 3 is correct.
Rationale: The nurse should assign a sitter, because keeping the client safe after he has verbalized a suicide plan is more important than the client’s right to refuse care. Placing the client in restraints does not guarantee his safety and may escalate the situation. If the client manages to get out of the restraints, he might hang himself with them. Having security sit outside the door does not provide direct observation of the client and uses up a limited resource of the facility. Allowing the client to leave AMA leaves the nurse and the facility vulnerable to legal action if the client commits suicide after leaving. Having a friend come sit does not guarantee safety; the friend may provide him with the means to commit suicide, such as bringing drugs for him to overdose on.