Sitting Standards: Creating A Safer Environment of Care


Using sitters to monitor high-risk patients is a common healthcare practice. In-depth training for sitters is unfortunately much less frequent - if it occurs at all.


Patients who are high-risk for elopement, suicide, or harm to themselves/others are placed on observation protocols requiring a sitter to observe them constantly for a specified time per a physician’s order. Providing sitter training and education is critical for healthcare organizations. It ensures that sitters can maintain a safe environment of care and are equipped to prevent harm to patients, staff members, and visitors.

Many healthcare organizations don’t have the luxury of having a pool of trained sitters to draw from. Instead, they use a variety of individuals to carry out the task depending upon availability.

The International Association for Healthcare Security and Safety (IAHSS) discusses research by Colman (2016) that indicates many sitters do not clearly understand expectations or what their duties are supposed to be when they are called to observe a patient. This lack of knowledge can increase the potential for harm to the patient and possibly the observer.

The LHA Trust Funds Behavioral Health Toolkit can help. These sample sitter guidelines can be used by healthcare organizations to instruct sitters before observing a patient. The guidelines could also be incorporated into new hire training for staff who may find themselves in this role as well as ongoing annual training programs.

Colman’s research through IAHSS also discusses key components of a training program for sitters. While many healthcare organizations do not hire staff strictly for sitter duties, this information can help develop general training for individuals who may be called upon as sitters at some point. These healthcare employees include security, nursing assistants, nurses, other clinicians, or patient care staff.

LHA Trust Funds experts recommend these best practices when using sitters:

  • Develop a set of guidelines for sitters to review before they begin observing a patient. Use this set of guidelines to develop a short training program for anyone who may act in the capacity of a sitter so they clearly understand their expectations and job duties.
  • Establish a reporting process where nursing staff discusses the patient with the sitter before the beginning of the observation so the sitter is aware of what is going on and key risks that they may encounter. For example, a sitter needs to know if the patient is at risk of suicide or has a history of violence toward healthcare staff.
  • Ensure all individuals who may act as sitters complete an identification of violence and de-escalation program. This program should be, at minimum, an entire day and include role-playing and a return demonstration of techniques.
  • Establish policies that include expectations of a sitter and documentation requirements. Anyone who acts in the capacity of a sitter should be familiar with these policies and proper documentation.
  • Educate potential sitters on how to properly keep documentation while they are observing. This is an important tool and provides a picture of the patient’s wellbeing during the observation period.
  • Ensure individuals being used as sitters, particularly for the psychiatric population, are familiar with environmental risks that could pose a danger such as items that can be used as weapons, ligature risks, and items that are considered contraband.
  • Include sitters in all debriefings if an event occurs with the patient during the time they are observing. Try our sample debriefing tool here.
  • Include sitters in in-service training to reinforce skills regarding violence and de-escalation periodically so they stay acquainted with their skills.

Learn More

For more resources to help create a safer environment of care, view the LHA Trust Funds Environment of Care toolkit.

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