Mary Ellen Hobson, RN, sat in a hospital room late one night with a cancer patient and didn’t like what she saw. The patient, a 76-year-old man, wasn’t getting enough oxygen to his blood. His blood pressure and heart rate were rising.

Hobson alerted the staff nurse on duty and insisted the hospital move up a blood test planned for the next day. The nurse complied, and the test yielded data that helped the man live longer, Hobson said.

Hobson wasn’t the patient’s relative or a hospital employee, but a registered nurse paid by the patient to sit by his side. She is one of a growing legion of private-duty nursing staff––sometimes referred to as nurse sitters, personal care attendants or patient companions––hired by patients to be their eyes, ears and advocates when they might not be able to speak for themselves.

Working for $8 to $50 an hour, depending on experience, these attendants brush their charges’ teeth, walk them to the bathroom and keep them from pulling out tubes or wandering from bed when they’re restless.

"I do a lot of the things a nurse in the old times would do," said Hobson, a former nurse administrator in Connecticut.

"I turn them, make sure they’re coughing and breathing. I give them leg exercises, rub their back, get them out of bed. I’m providing the niceties and the essentials."

Providing essentials
No one begrudges patients who seek a helper to provide the niceties—if they can afford it. But if these assistants are providing essentials, it may be a sign that staff nurses are dangerously overworked, said Diana Mason, Ph.D., RN, editor in chief of the American Journal of Nursing.

"I do not believe this is something society should accept," said Mason, who added that she hired a private-duty RN to watch her sister-in-law during a hospital stay. "It doesn’t address the problem of inadequate staffing in hospitals. In some hospitals the staffing is so thin, they aren’t doing the surveillance anymore."

No one keeps track of how many people work in these assistant positions, but many home care and nurse staffing agencies report that demand is rising.

Potomac Home Health Care provides home care services in suburban Maryland. The group started offering hospital visits five years ago and has seen demand for the service double every year since, said Lauren Simpson, RN, Potomac’s president.

Several factors might account for the public’s newfound appetite for individualized hospital care:

Hospitals also are hiring temporary assistants in greater numbers. In 1999, the federal Health Care Financing Administration issued new rules that limit the use of restraints to control problem patients. Hospitals, under the threat of losing their Medicare and Medicaid funding, have scrambled for nurse sitters to monitor confused or agitated patients, Talerico said.

No consensus
Just as there’s no consensus on what to call these helpers, there’s no agreement on what qualifications, if any, they should have.

E. Carol Polifroni, Ed.D., RN, undergraduate program coordinator at the University of Connecticut School of Nursing, worries that a lack of standards might mean sitters create more problems for patients than they solve.

"I could hire my next-door neighbor to help me. Who is that person? Who’s validated their competency? The answer is: nobody," Polifroni said.

"Now I’ve got a stranger sitting in my patient’s room. Now I not only have to monitor the patient, I have to monitor the caregiver."

Mary Henderson, RN, owner of Compassionate Companions Inc. in Vallejo, Calif., and Lee Turicchi, RN, administrator of On Call Plus, a staffing agency in Dallas, said they accept only trained personnel, such as certified nursing assistants, as patient attendants.

Hospital administrators at the Cleveland Clinic Foundation only refer their patients to registries with certified personnel––and if the attendants don’t work out, they’re weeded out, Mion said.

"If [staffing agencies] don’t have people who are competent or don’t show up, we let them know and we don’t use them again," she said.

A companion can be charged with many duties while "sitting" at a patient’s bedside.

"Our job is basically to make sure the patient is comfortable, is taken care of and that the areas are clean. We give them baths, we bring them water," said Helen Jackson, CNA, a private-duty assistant with On Call Plus.

"A lot of times we’re the ones who take the vital signs. We alert the nurse if there’s any problem."

Other times, staying in a small room with a sleeping patient is dull as can be.

"It’s incredibly tedious. Walking around in a 12-foot circle, you get very tired," Hobson said.

But, she added, "Every patient I’ve worked with, I have made a difference that has made the patient safer or saved the hospital money."