Can you believe this?

Gldngrl · Mar 15, 2004

I believe the original post stated pt was taking Ativan as well?...we use that a lot for smokers who can't take Nic patch (cardiac issues/ BP issues).

nekhismom · Mar 15, 2004

I'm with you steel magnolia! What about MY health??

And since we KNOW that smoking causes CA and other diseases, why would a hospital ASSIST a pt. to harm themselves? And if a nurse participates in helping a pt to harm themselves, isn't that grounds to lose a license if the pt. were to persue legal action???

I REFUSE to assist!! PERIOD. Like someone else said, I wouldn't help a heroine addict shoot up, I'm not helping a smoker, either.

I understand it's an addiction; however, that's what the nicotine patch is for!!

RedSox33RN · Mar 15, 2004

I just have to comment here! This thread has me chuckling and furious at the same time.

My mother passed away recently at the age of 61. She had been a life-long smoker, and though she didn't die directly from smoking, I'm sure that was part of it. Anyway, she had had many back surgeries, and been a pain pt. for a long time. During her most recent one last year, the doc gave her permission to smoke in her room. I kid you not. I was furious about it - not only that he would go against all hospital policy, but also to ignore the rights of the nurses and other pt's and give her special treatment. It just infuriated me - plus the encouragement of an already sick woman to keep smoking. His reasoning was he didn't want her out of bed, and smoking would have meant many trips down the elevator and outside, with a nurse having to take her, which he knew they wouldn't. The only stipulation was she had to do it in her bathroom. Big deal. Everyone (I'm sure) could still smell the smoke, and was exposed to it. It just chaps my a$$ to think about it!! :angryfire Both doc and my mom were very, very wrong.

As much as I loved (and still do) my mother, I thought it was the most self-centered, irresponsible thing I'd ever seen in my life, and I told her so.

It will be a couple of years before I'm a nurse, but you can be your bottom dollar I will never escort a pt outside for a smoke. I applaud all of you who are saying no.

jewelsg627 · Mar 16, 2004

Speaking of bending over backwards; we had a pregnant pt who accused the dietary guy of rape....two days after the fact. He was fired, she was provided a sitter for the duration of her stay. This was about two weeks. The sitter was required to go down with the pt to smoke. Pt didn't have cigs so would panhandle for them outside. My thought is...let them write it up, let them sue. These loonies don't have a case, and I'm not about to leave pts who really need me to attend to these nutcases!! No matter what my CSM says.

I was just curious...was it proved that he did or did not do it? It sounds like you are saying that he did not do it, but how do you know? {Note: I am not saying this in an "attacking" tone at all. I am simply curious. I feel I have to give this disclaimer b/c things can be misinterperdted so often!}

-Jewels

laughingfairy · Mar 16, 2004

My facility the rule is we do not "aid" a patient in doing anything that violates their health care regime. This was brought up when some of our residents and staff complained of special treatment. If they want outside food they have to use a payphone or have family bring it in. But it is still deemed okay to buy them "their smokes." I am a smoker and still can't figure this out.

ratchit · Mar 16, 2004

Hi Nurturing.

I saw this from the other side a couple months back- until I saw the 11pm transfer time you mentioned, I thought you might have worked in the same place.

We had a psych patient come in with DKA- again. Young, poorly managed, what an awful life this poor woman must have had.

On the other hand.. She was wandering around the ICU, refusing monitoring, IVs, fingersticks, and labs. She was threatening staff, screaming profanity, and entering other patients rooms. No patient needs that, but certainly not fresh open hearts and acute MIs. I got report, called the doc, and said "we need beds for OR cases today and she is refusing all ICU care, and her MILD DKA was resolved on the last labs she allowed us to draw 6 hours ago- she's outta here."

The patient insisted that I had promised her I would take her out to smoke or she was going home. I had of course told her NOTHING of the sort- I was too busy calling security to get her back in her own room and stamping the AMA form. Sorry, honey, ICU patients don't go out to smoke. Neither do ICU nurses. I'm sorry you're stuck in a living hell- I'd help you if I could- but you don't get to take away from my other patients.

The intern talked her into staying by promising her a transfer to a unit that would allow her to smoke and wrote for a pronto transfer to medsurg. I wasn't leaving my other sick patient to take her out, and I wasn't going to be alone with her- she had been violent with staff in the past. So in the 2 hours until a room was available (the gods were with me that day- LOL) she stamped, screamed, threatened, and terrorized the ICU while allowing us to provide her with no nursing care at all. All because the intern promised her a cigarette.

I have never been as apologetic to a receiving RN. The patient should have been on Q1 fingersticks and Q3-4 BMPs, but wouldn't allow them. So the floor RN got this major behavioral problem to deal with on top of her other 4 patients. But she couldn't stay in the ICU when a CABG would make much better use of the bed and our skills. I even brought the stamped AMA form with me- which the patient signed a few hours later, probably right after the RN had finished all her admit stuff. She checked back in a few hours after that, then AMA'd again a few hours later.

At least the sup, manager, and even the attendings on the floor at the time supported us and encouraged us to call security and sign her out AMA. IT was just the darn intern who delayed the inevitable.

mattsmom81 · Mar 16, 2004

"It was just the darn intern who delayed the inevitable."

So true. When we start giving concessiont to manipulators it never ends. I say let them leave AMA at the getgo. They're never happy til they've turned the place upside down getting their own way anyhow.

teeituptom, BSN, RN · Mar 16, 2004

So glad I work where there are no interns and residents

LydiaGreen · Mar 16, 2004

I am a smoker and I think that member of management was nuts. I love how our hospital deals with this issue. Staff does NOT take patients out to smoke... period. Even if staff members are smokers, they do NOT take patients out to smoke with them (I really don't think a nurse should be spending their breaks caring for a patient whether the nurse smokes or not). If a client is stable and able to go out on their own fine. This has conflicted with medications, vitals, labs, x-rays in the past and we have to chart that client was outside at whatever time. If the client is not stable enough to go outside and still wants to smoke, then family members are required to take them if they chose to. Our pharmacy does not dispense nicotine patches (they are kardexed and applied and removed as part of routine medications) but family must purchase them and bring them in. Our clients do not have to sign themselves out AMA to go out to smoke but we ask them to let their nurse know they are going out in case there are tests that need to be done, they do not return in a timely manner, etc.

As a smoker, I am all too well aware of what happens within fifteen minutes of your last cigarette. The lungs begin to try to clear the crud that has built up in the lungs. This increases the likelihood of developing pneumonia above and beyond the usual risk with hospitalization (decreased activity, lying in bed, etc). Any client who is a smoker automatically gets "the lecture" about their increased risk and what they can do to decrease it (hydration, ambulation, sitting up in the chair during the day or having the bed in semi-fowler's rather than lying flat in bed) and I provide them with an incentive spirometer and teaching about deep breathing and coughing to clear the crud. That's "health promotion". Buying cigarettes for the client is NOT. What was that member of management thinking!?!

NurseRatchet26 · Mar 16, 2004

I would be fine with putting a Nic patch on this lady. I would NOT be fine with helping her outside to smoke. Just a thought, isn't assisted suicide illegal? I refuse to help someone kill themselves, even if it is slow suicide.

rollingstone · Mar 16, 2004

I'm suprised she didn't ask for a beer to go along with that cig.

teeituptom, BSN, RN · Mar 17, 2004

I dont lecture or nag