[nursemike]

Several years ago, long before I'd even thought of a career in healthcare, I was hospitalized for a spider bite, getting IV oxycillin q8h x six runs. By the end of 48hrs, if they had told me I needed to stay another day, I'd have been on suicide precautions.

It never occured to me, and I never thought to ask, that I could have gone downstairs for a coke and a cigarette between meds, but I think it might have made the experience a lot less unpleasant. Of course, my wound needed oxygen, not carbon monoxide, but I think, now, that it would have been reasonable to trade just a little perfusion for my mental health.

But I do think the OP has learned a very valuable lesson out of this: no matter where on the hospital premises anything at all bad happens, and no matter whom else did nothing about it, it's the nurse's fault.

Not that I mean to be negative, because, you know,

[Angie O'Plasty, RN]

This reminds me of the elderly patient who had a pass to go smoke and would be seen going downstairs via w/c. One day, I guess he decided that he needed a little more than a cigarette, because from what I hear, the sheriff found him across the street at the bar. Apparently he needed a little more than a cigarette that day.

Then there's always the guy who called to ask me to take the nicotine patch off. After some careful questioning, I determined that his MO was to take the patch off, go smoke, and then have someone put the patch on. "Because the other nurse said it was OK." (Oh no she didn't, Mister.)

One unit that I worked absolutely refused to let patients off the floor for anything, never mind smoking.

This unit's a little laxer, but frankly, as soon's they want to go smoke, I'm all for getting them outta there. Too much potential for problems, IMO.

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.

[cardiacRN2006]

Originally Posted by Angie O'Plasty, RN

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.

[Hopefull2009]

Originally Posted by elkpark

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.

[CrazyPremed]

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

[november551]

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.

[NancyNurse08]

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.

[RiverNurse]

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