The people: What if we let them care?

A 1:1 is a mandated event. You, the staff member, get a hard plastic chair, a place in the doorway, and an at-risk patient to watch at 3 am. You sit and watch, without engaging. The patient is being watched without being helped.

During this series, I have been writing about how we observe patients: 15 minute checks (level 2 observations), 1:1s, and the balance between dignity and safety.

Now, for a moment, let’s sit in that chair.

The reality of 1:1 observations in inpatient mental health

Imagine it. How does the first hour feel? For you? For the patient? How about the third hour, in the middle of the night? How does it feel to be watched, constantly? What could go wrong? Plenty.

The data is hard to overlook. In the US, two nurses are assaulted every hour on average. Psychiatric hospitals record 110.4 violent injuries per 10,000 workers, up 71% in a decade and more than eight times the rate of a typical acute hospital. In the NHS, one in seven staff reported physical violence from patients or the public last year, and in mental health trusts the violence is not occasional but repeated.

Why 1:1 safety checks drive healthcare burnout and turnover

The workforce statistics only make it harder to ignore how tough these conditions are. Mental health techs and aides, typically the people sitting those 1:1s, are the single most assaulted occupation in all of healthcare. Mental health nursing turnover runs at 22.5%, the highest of any specialty. And 93% of mental health professionals surveyed report burnout.

How do you think it feels coming to work knowing there is a good chance you will be assaulted?

It is a vicious spiral: assault risk is rising, turnover is the highest of any specialty, and burnout is practically universal. Every vacant role must be filled, often by an agency clinician at a premium double that of a staff nurse, who then needs training and support from the same stretched core team. And the costs land in the same places we outlined in my second post: the liability line, the agency line, the turnover line, all impacting the costs and quality of care.

Augmenting 1:1 observations: Giving time back for clinical care

As a staff member, why would you stay? Incredibly, most do stay, for the patients. And we take that for granted.

The cycle is hard to break.

But what if a technology innovation supported the observations, supported the 1:1 watch, and allowed human time to become clinically focused again? Not a replacement, but augmented relief. The same staff member who faces assault and burnout finally has a helping hand.

The result: hundreds of hours of clinician time handed back to therapy and patient engagement. The economics are just as hard to overlook: $561 a day for a trained professional we ask to just watch.

Why do we continue to have a strained workforce to do what technology does really well (observe and alert), and therefore deny them the time for what clinicians are trained to do (connect, de-escalate, and treat)?

How LIO transforms night-time safety checks and staff safety

Let's look at a day in the life with LIO installed. No more 3 am torch-in-the-face checks, so patients sleep and staff stop triggering the very confrontations the checks were meant to prevent. Now a mental health tech walks toward a room knowing what is happening inside before opening the door. The surprise is gone, which is where much of the risk lives. The work becomes more therapeutic, with the clinical team able to act on the observation rather than administer it: from checking boxes on a clipboard to caring. Same team but the work looks so much different. A team that can do the job it trained for, without daily fear, arguably burns out less and stays longer.

Transforming psychiatric care through purpose-built technology

Today’s staffing models are built on the assumption that staff attention is unwavering and limitless. It is neither. Pretending otherwise is how we get to 93% burnout.

This must be fixed. And I firmly believe that strong leadership combined with proven innovation is the way. Which is why we do what we do: helping teams move to proactive observation, and letting the watchers care again.

For decades we have asked our people to watch. What if we finally let them care? Where that leads, and what inpatient psychiatry could look like five years from now, is my next post.

‍Author: Todd Haedrich, CEO, LIO