Overcoming Patient Sitter Shortages Through Alternate Staffing Models

By Mini Virmani, MPH, MS, CLSSGB

Imagine that 72-year-old Mr. Pitts had a stroke at his home and was taken to the emergency room for treatment, then admitted to an inpatient unit. On day six of his stay, while looking for the call light to ask the nurse for water, Mr. Pitts fell from his hospital bed. He landed wrong and broke his leg. This led to a five-day increase in his hospital length of stay and added to his cost of care and anxiety, while increasing the wait time for other patients to receive a bed.

This is a common story for many patients who are either admitted to the hospital or have their hospital stay extended due to a preventable event. A proven solution is to use either in-person sitters or telesitter technology to provide 24-hour observation of patients at risk for harm events such as falls, wandering, elopements, or pulling out IV tubes.

Given the healthcare industry’s staffing shortages, though, hiring human sitters who can physically be present in the patient room is a challenge. Many hospitals, including Johns Hopkins Bayview Medical Center, have implemented telesitter programs that allow one technician to monitor up to 12 patients at a time (Johns Hopkins Medicine, 2019). However, hiring for telesitters isn’t a breeze either.

Could this be the time to explore alternate staffing models and open the doors to college students who could become either in-person sitters or telesitters, earning $10–$12 per hour while enhancing patient safety and saving millions of dollars for the healthcare industry?

According to the Agency for Healthcare Research and Quality (AHRQ), somewhere between 700,000 and 1,000,000 people in the United States fall in the hospital each year (AHRQ, 2013). These falls may result in fractures, lacerations, or internal bleeding, leading to increased healthcare utilization and long-term effects. The Centers for Disease Control and Prevention (CDC) states that we spend about $50 billion annually on medical costs related to non-fatal fall injuries and $754 million on costs related to fatal falls for adults ages 65 and older (CDC, n.d.). Overall, the 2019 cost of injury in the U.S. was $4.2 trillion, which included healthcare spending, hits to work productivity, and cost estimates for lost lives and lowered quality of life (CDC, 2021). Can we reduce these costs and harm events?

Research has shown that up to one-third of falls are preventable (AHRQ, 2013). Sitters could help do so by supervising patients, redirecting them, alerting nurses and other health professionals as needed, and providing emotional support (Workable, n.d.). However, due to sitter shortages, unit leaders often must use their nursing aides, nurses, and unit coordinators to sit with a patient, which puts a strain on an organization’s clinical operations and overall staffing (HHS, 2020). These constraints can lead to patient harm, nursing burnout, emotional strain, and a stressful work environment. Research suggests that in 2018, among nurses who reported leaving their current employment, 31.5% left because of burnout (Shah et al., 2021). This year alone, nearly 1.7 million people have quit their healthcare jobs (Gordon, 2022)—which, according to the U.S. Bureau of Labor Statistics (BLS), is equivalent to almost 3% of the healthcare workforce each month (BLS, n.d.).

While staffing challenges and “The Great Resignation” continue, the nation has ample college students, both clinical and nonclinical, who can provide in-person or telesitter support to patients after being properly trained. Many undergraduate students ages 16 and above are employed while completing school. In 2020, the percentage of undergraduate students who were employed was higher among part-time students than among full-time students: 74% vs. 40% (National Center for Education Statistics, n.d.).

The average hourly pay of adult patient sitters is between $9.58 and $24.92 with a median of $12.18 (PayScale, n.d.), and the minimum qualification is a high school diploma or equivalent (ZipRecruiter, n.d.). Being employed part time (less than 20 hours a week) can help students pay for classes and other living expenses while gaining work experience.

Recruiters could post these jobs on university job portals and develop local candidate pools. Hired students could get exposure to the healthcare industry, opportunities to build connections, hourly pay, and valuable work experience. However, they would need to consider whether the job would impact their performance at school—and receive some additional training. A study by the International Association for Healthcare Security and Safety Foundation recommends a two-day training program for telesitters that covers the following: equipment proficiency training, observation skills, CPR training, HIPAA, customer service, bloodborne pathogens, basic medical terminology, catheter care, and annual competency review (CDC, 2019).

The hospital would need to ensure student sitter safety and mitigate risks of workplace violence and employee injuries. They would need to develop algorithms for sitter assignments as well; for example, student sitters would not sit 1:1 for patients with high body mass index or for patients with violent behavioral issues (International Association for Healthcare Security and Safety Foundation, 2017). Mostly, students may telesit on a patient cohort instead of performing 1:1 sitting in patient rooms, especially when they’re new to the role.

Overall, patient safety needs extra sets of eyes, and college students can fill this gap. While in-person 1:1 sitters can do more, especially for high-risk patients, it’s time we consider student telesitters for virtual monitoring of other patient cohorts (Cournan et al., 2018). This will reduce the burden on nursing and alleviate some of the staffing, burnout, and cost issues at health systems.

Mini Virmani, MPH, MS, CLSSGB, is systems director of performance improvement in the Office of Quality at Atrium Health Navicent.


Agency for Healthcare Research and Quality. (2013, January). Preventing falls in hospitals. https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/index.html

Bureau of Labor Statistics. (n.d.). Table 4. Quits levels and rates by industry and region, seasonally adjusted. https://www.bls.gov/news.release/jolts.t04.htm#jolts_table4.f.2

Centers for Disease Control and Prevention. (n.d.). Cost of older adult falls. https://www.cdc.gov/falls/data/fall-cost.html

Centers for Disease Control and Prevention. (2019, February 21). Health Insurance Portability and Accountability Act of 1996 (HIPAA). https://www.cdc.gov/phlp/publications/topic/hipaa.html

Centers for Disease Control and Prevention. (2021, December 2). Cost of injury data. https://www.cdc.gov/injury/wisqars/cost/

Cournan, M., Fusco-Gessick, B., & Wright, L. (2018). Improving patient safety through video monitoring. Rehabilitation Nursing43(2), 111–115. https://doi.org/10.1097/rnj.0000000000000089

Gordon, D. (2022, May 17). Amid healthcare’s great resignation, burned out workers are pursuing flexibility and passion. Forbes. https://www.forbes.com/sites/debgordon/2022/05/17/amid-healthcares-great-resignation-burned-out-workers-are-pursuing-flexibility-and-passion/

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Shah, M. K., Gandrakota, N., Cimiotti, J. P., Ghose, N., Moore, M., & Ali, M. K. (2021). Prevalence of and factors associated with nurse burnout in the US. JAMA Network Open4(2), e2036469. https://doi.org/10.1001/jamanetworkopen.2020.36469

Workable. (n.d.). Patient sitter job description. https://resources.workable.com/patient-sitter-job-description

ZipRecruiter. (n.d.). What is a patient sitter and how to become one. https://www.ziprecruiter.com/Career/Patient-Sitter/What-Is-How-to-Become