Which action should the nurse take when a client declines to sign a safety contract for suicidal thoughts?

When a client expresses suicidal thoughts and declines to sign a safety contract, the priority is to ensure the client's safety. Assigning a staff member to stay with the client, even in the bathroom, is the most appropriate action because it provides continuous monitoring and support for the client during a potentially critical time. This ensures that the client is not left alone where they might act on their suicidal thoughts.

Constant presence by a staff member is crucial for maintaining safety and allows for immediate intervention if the client becomes at increased risk. This approach fosters a supportive environment, which can help de-escalate distress and facilitate discussion about the client’s feelings and thoughts regarding suicide.

While securing the room and removing harmful objects can be important safety measures, they do not address the immediate need for supervision and emotional support. Simply checking locks or removing items does not provide the ongoing watch that may prevent a potential crisis. Placing the client in a chair at the nursing station can also be limiting and may not provide the compassionate care needed; it could further distress the client instead of providing reassurance and safety. The goal should always be to create an atmosphere where the client feels supported and protected.