[CharlieRN]

My employer severly restricted smoking on the adult programs and compleatly stopped smoking for adoescents a few years ago. It is an ongoing but minor problem.
Smoking is not a good thing. But we don't see the point of fighting a battle we don't have to. Tobacco is a legal addiction.
I don't smoke and I don't enjoy being in a smoky environment but I have little patience with legislated morality.

[Psychaprn]

Originally Posted by elkpark

As a inpatient psych surveyor for my state, I have observed over the last few years as several facilities have gone entirely smoke-free, including the state hospital that was in my territory. The state hospital does not even allow staff to bring smoking materials onto the units with them -- they must keep them locked in their cars and go to the cars on their break time if they wish to smoke.

None of the facilities I visit regularly have had serious ongoing problems related to the change in smoking policy (of course, there was a little flurry of excitement around the time of the change in policy at all these places ... ).

I hear what you're saying about the people for whom the facility is their home, as that is also the case for a lot of people at the state hospital I'm speaking of. That is certainly v. different that being on an acute unit for three or four days.

What the physicians and staff at all these facilities have done is to be v. aggressive about offering nicotine patches and gum, as well as smoking cessation programs in the longer-term settings. None of the management people at any of these places have regretted the change in policy (although I'm sure some individual staff people have!) The doom and gloom predictions by some individuals before the new policies were implemented just didn't happen.

I believe that it is v. important that all the staff recognize that this is a medical/clinical issue (addiction), and be professional about recognizing and addressing the clients' nicotine addiction (with patches and/or gum) rather than just viewing it as a behavioral issue (no longer going out to smoke).

Interesting thread- I know that people who smoke or use excessive caffeine need higher doses of meds. I wouldn't want to work on a unit where patients were forced to quit smoking-increased irritability andor/ violence could be problematic. I would also worry that people trying to "sneak a smoke" might be even more of a fire hazard.

[Thunderwolf]

Psychaprn, good point.

I would also worry that people trying to "sneak a smoke" might be even more of a fire hazard.

[Tammy05LPN]

I work in a nursing home for people with varying mental problems..from Alzheimers to schizophrenia to mental retardation. There were a select few residents that were allowed to go on the back patio independently to smoke until last week. Whenever the residents that needed to be "smoked" went outside for their smoke time, the independents had to go in so it wouldn't be so crowded and they could be watched better. Well, one 'gentleman' decided he couldn't wait for the others to get back inside from their monitored smoke time and he lit up a cig in the building. So that's what put an end to the independents..now they are split up into groups and taken out to smoke by staff at certain times. Now this same 'gentleman' can't stand this and is having major behavior problems. Just tonight he was threatening to "tear this place apart" if we didn't give him his cigarettes and let him go outside to smoke. Of course we didn't so he picks up his W/C and starts hitting the picture window in the lobby with it..this is after PRN Ativan was given 2 hrs before for bloodying another resident's nose and knocking him down. He did settle down when I picked up the phone and threatened to call the police, but oh what a night from hell.

[Felixa]

Just a little update from my Trust's smoking ban. My unit went 'smoke-free' in August.

In practice it has not been particularly smoke-free. The smoke room has been locked off, but patients are allowed to smoke in the ward garden if they wish, or out on leave if they have it/use it.

While the weather has been warm, we have been having the garden open most of the time, but now it is beginning to cool down, the garden is just open for set times - about once an hour for 15 minutes. Most patients have reacted remarkably well, although one is a bit irritable about it, and is (understandably!) annoyed if we are a bit late about opening the door on time.

We have offered people support to stop, but only one guy on my ward took up the offer, and he was back on the cigarrettes within a day or too - smoking his usual but with added nicotine from his arm-patch!

The upside of people smoking supervised in the garden is that non-smoking nurses can have more interaction with the patients than when they just stayed in the smoke room all day. The downside is that there are adverse health effects on some of the staff. An asthmatic member of staff has noticed her asthma getting worse, and there is a pregnant member of staff who has to be careful about when she is in the garden or the common room leading onto it.

But so far, so good. We shall see during the winter months whether that has any effect on smoking behaviour.

Side-note: in our 'smoking cessation' training, they told us that certain anti-psychotics are hindered by nicotine, notably Clozapine. A lot of guys in our unit are on Clozapine, so this could be an attraction to giving up, and something to be aware of if people's smoking behaviour reduces.

Will keep you posted
Felixa