Anyone work in a "no smoking " facility?

[ruralnurs]

I work in a small hospital that in Jan. 08 made it's campus "Tobacco Free" the rule is there is no smoking on campus, pts, staff, visitors must leave campus to smoke. Our campus is about 2-3 acres in size and to leave campus one needs to walk about 200 + feet to a county gravel road that has no street lights and no sidewalk (can you say dangerous).

My question is about patients. Do any of you have a similar situation and how do you deal with it? I developed a smoking assessment tool we do with every pt that lets them and their family know there is no smoking on campus. I suggested that the docs, when they tell someone they will be admitted that there is no smoking (thye seldom do it), we offer several medical smoking cessation options patch, meds, etc.).

The problem is the ones that do it anyway. Before, when pts could go out to smoke we would have rules like, if they are on a morphine PCA they could not go out. etc. Now they say they they are going out for "air", and they take the pump, or whatever.

Administration will not really take a solid stance, they don't want to make anyone mad I think. We have these little signs that say, "For your health and safety the use of tobacco products is prohibited on the campus of XXX hospital, thank you". Now there are just cig butts all over because they removed the butt cans.

We nurse do not want to be the cigarette police, we have too much to do and it is not really our job. We are too small to have security. We are worried that some leave to go to the county road to smoke, that they take IV pumps/PCAs and go out and may fall as a result of the equipment (but they are not going out to smoke?!?).

Is anyone working in a facility that has a no smoking on campus policy or any ideas the way you do it? We have asked for administration to make the pt sign AMA but most insurance companies will not pay for the stay of a person if they go AMA and we have to bill the person that will unlikely pay anyway.

Any ideas? Please, this is not a smokers/non-smokers debate, just trying to find the best way to take care of these people. Thanks!

[RNsRWe, ASN, RN]

My patients are supposed to be sick enough that they should not be leaving the building to go smoke. If they feel well enough to walk off the premises (a bit of a hike, actually) to smoke, then someone ought to be discharging them pronto.

I will not accompany a patient outside to smoke. I will, however, call security to accompany them back in.

Admission to a hospital is not an inalienable right, one that comes with absolutely no responsibility on the part of the patient. If someone is so sick that they are admitted in an emergent situation, I seriously doubt they are also well enough to walk off the floor for that puff. OTOH, if they are well enough to become a PITA about the situation....get out.

I am not a babysitter. My job is not to watch them 24/7 to make sure they don't slip out the elevator, as though they were five year olds. Anyone who wheels themselves out the door is doing so of their own volition, NOT with my permission, and they are the only ones responsible for the consequences. Woe be to the family member who tries to blame ME for their relative sneaking out.

They can use the patches we provide, they can use gum. Doesn't "work" as well as that cigarette? Sorry, but you'll have to choose between medical care (a significant portion of which is the result of that smoking much of the time) and the smoke.

Does tend to cut down on the length of stays of our drug seekers, btw: enforcing that "off the floor, earn a discharge" rule. They have to choose which they want more: hits of Dilaudid, or the smoking. Not much sympathy here, I'll tell ya.

[locolorenzo22, BSN, RN]

It is hard to deal with...we try to be supportive, order nicotine patches/gum, etc....and if they have IVs or pumps, we explain that they cannot leave the floor. if they are only SL, we keep an eye on em, but if they're gonna go down, whatta you do?

family wise, there is no smoking on campus, but if you're loved one is in the hospital and you deal by smoking, I'm not gonna tell you to quit now.

[classicdame, MSN, EdD]

we did it years ago and none of the dire predictions took place, at least on a large scale. No one is allowed off the floor with a PCA or IV pump infusion. Smokers are given patches and, if they are refused, they can opt out of treatment altogether. When faced with the cold hard facts they complied. Hard to preach good health then offer areas where people can kill themselves and others slowly.

[crunchymomx3]

I work in a No Smoking Hospital. No smoking on the grounds. Staff must leave the grounds to smoke and they do. I've been there for about a month and a half (and it's a hospital that is a mile from my house so I drive by it all the time) and I have never seen a patient smoking outside in front of the hospital. I've only seen one or two walk down to the road to smoke.

If our patient's are smoker the Drs will order a nicotine patch for them when they are admitted.

[StNeotser, ASN, RN]

Our smoking ban is not really enforced well. I had a 69 year old post CVA guy who was meant to be on supervised smoking over the weekend. I took him out three times during the course of my shift and the first time I wasn't able to he was upset when I told him I was too busy and in the middle of a med pass.

The thing is, I knew I was going to be busy for at least an hour if not longer and then it was time for my break. He said he would stand and wait until I wasn't busy (like 2 feet away breathing down my neck) Luckily his family came to visit and took him out to smoke but why on earth is it my responsibility to do this?

I work in a rehab on weekends though, not a hospital.

[penguin2]

doh!!

[penguin2]

The hospital I work at is non-smoking. Employees used to be able to smoke in a screened in porch off the cafeteria, however; last yr that changed to no smoking anywhere w/in 100 ft of the facility. So now employees sit in their cars & smoke. (which makes them come in smelling worse than ever!!) The docs will write nicotine patch orders for pts- they used to be allowed to smoke on benches near the hospital entrance w/a staff person only-- talk about second hand smoke.

[voraciousj]

A few of you have mentioned accompanying patients outside to smoke. I'm sorry, but why should I expose myself to your second hand smoke?

[ruralnurs]

I too do not agree with taking a pt out to smoke. Having been a psych nurse for a long time I know that consistency in pt care is very important. Just like mentioned earlier, if one nurse takes the pts out then others that do not (or the same nurse that gets busy) is now the bad guy. It sets up a bad situation.

When I first started we had a doc order to take a ot out to smoke via w/c. If I had realized I could refuse I would have on so many levels...the pt was a pregnant 16 year old! I thought it was wrong but thought I woudl have no choice, now I know that for one thing it is illegal for a 16 year old to smoke!

Anyway the only way I think a pt should be out to smoke is by family friends, not the staff. Luckily we do not have that here anymore.