Smoker's rights (patient rights)

Nurses New Nurse

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Hi all,

I have something that happened so quickly the other day that it just happened before I could even think about it - or the ramifications.

I had a patient that had an EGD in the morning and had been back on the floor for several hours - alert and craving a cigarette (nicotine patches weren't doing the trick). He said he wanted to leave the floor to smoke. I told him I thought he should wait. He said he was going to go anyway. At that point (I am in orientation) I went to talk to my preceptor about this pt's insistence on leaving, and also told my nurse manager. I asked my preceptor to try to detain the pt as the pt was next to the elevator by this time. My manager said, "Wait, let me think about it." She walked off. I thought she was going to come back, so I went to talk to the charge nurse as well for input. She just said that the patient couldn't leave. My manager never got back with me. I thought of AMA, but wasn't completely sure and wanted to know how to handle this - I just didn't know how at that moment.

In the meantime, my preceptor talked to the pt. The pt said he could do whatever he pleased and that he was an adult. He left the floor to go smoke. My preceptor said that there was no way to stop the patient other than to restrain him - and the patient said he would be returning - which he did.

We are on a non smoking campus - so that would have meant that the patient would have had to cross the street to smoke. I documented all of this in the progress notes and notified the doctor. The doctor said that the patient was AMA and that he should have signed out as AMA before leaving. I thought of that - but thought that would have equated to a "discharge".

Um... I know I didn't learn this one in orientation. I really hope I don't get written up for this one.

Please - seasoned professionals - tell me I'm going to get better at this!!!!!!!! :banghead:

Argh. In my early days of school - my "fantasy" was to be a GREAT nurse... not just an adequate nurse or even a 'good' nurse - but a real lasso loopin' popgun shootin' kick butt and take names kind of nurse.

I'm still waiting... LOL...

Take good care,

Shawna

Specializes in Cardiac.

Besdies, we do have other medicinal options besides the patch to keep patients fairly calm. We don't give alcoholics booze, we have alternatives to keep them safe and medicated. To me, we should do the same for smokers. They really won't be able to quit until they try.

Actually, the last hospital I worked at did give alcohol to alcoholics and it worked like a charm. Now we give ativan or Librium and let me tell you-I'd rather give them the bud light. Nothing works like alcohol.

And nothing works like smoking. If they need it, they need it.

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Clearly I'm in the minority on this, but I don't see why it's not handled the same as a client walking out and leaving the hospital for any other reason -- if they refuse to follow medical advice and insist on leaving, that's fine and their choice to make -- but as soon as they're gone, you discharge them AMA, and if/when they return, they don't have a bed any more ...

I've said for years -- if people are well enough to go out and smoke, they're well enough to go home. Discharge 'em; end of problem.

I agree with this totally.....mainly because if they get hurt outside while they are smoking...who is liable?

The hospital.

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Specializes in Telemetry, ICU, Psych.

This topic has always irritated me. I can barely keep track of the 4-5 pts that I have on the floor, much less the one who is outside. I'm not given enough time to babysit in the parking lot and monitor a group of patients. I understand that people have cravings, but - if something does happen outside (like a fall or code) - I am the person that will get the blame.

I've worked too hard for my job, license, and money. I don't need to get written up because you can't live without a cigarette. I call the charge and doc and let them deal with it.

CrazyPremed

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Specializes in Ortho, Case Management, blabla.

On our ortho floor our official "policy" is that patients are not allowed to go smoke. Namely because they're all huge fall risks and use walkers and everything. So far I've not had a problem with it. Although the other day I did have a physician give the okay and write an order for a patient to go outside and smoke. Fortunately the guy didn't have cigarettes.

Although in the past I have had coworker RNs that smoked volunteer to walk fall risk patients outside :) I think it is okay if an RN is willing to accompany them and take responsibility while the pt is out and about in the facility. Unfortunately it would have meant their butts if anything terrible happened, since it went against the unit policy, but whatever.

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Specializes in Cardiac Telemetry, ED.

Our facility has a very clear policy on this. If the MD determines that the patient is medically stable enough to go out and smoke, the patient must sign a release of liability to do so. If the MD does not think they are medically stable enough to go out and smoke, then the patient must leave AMA in order to do so. Usually, if you explain to the patient that if they leave AMA, their insurance probably won't cover their bill, and that they will have to be readmitted in order to receive care, they usually opt to stay. We also have a tobacco cessation protocol that includes patches, gum, lozenges, inhalers, and Ativan. Yes, Ativan. It does help.

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Specializes in Certified Wound Care Nurse.

Thanks, NancyNurse08 and all those who have posted. Here is what I've learned - not all floors have a firm policy on this issue - if it had been clearly defined - I think the charge nurse and manager probably would have known or could have told me who to call - which is what I wanted at that point - direction.

I'll be remembering this and incorporating it into my assessments and teaching as needed.

Many thanks,

Shawna

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