tobacco free policy

nialloh, RN · Jul 1, 2003

In my hospital we have had this policy for years. The pt is told about it on admit, and you stick to your guns. Some pts complain, most are ok with it, although I know of one pt who the Dr discharged as she kept trying to sneak off the unit (she also refused a lot of procedures, and was a hugh PIA, this was the last straw). Most pts who have a problem, we give a patch to, and they are usually ok.

OKNURSE · Jul 1, 2003

Out hospital implemented the NO SMOKING policy several years ago. It is a law in our state that all hospitals be smoke free. It evoked some anger & resentment initially from both the employees & the patients that smoke.

I think everyone has accepted it as a trend all over now. We have a form that we have the patients sign if they feel that they must smoke. We do not have a smoke room/hut as some facilities have. They just have a designated place outdoors. It is also a new law that those who smoke have to be a certain distance from the entrance. Getting back to the form----it is called a Temporary Smoking Pass and states that they are leaving at their own risk on a temporary pass to the designated smoking area. That they understand that leaving the building constitutes potential risks and hazards (ie;falls, infections, additional complications to present illness, etc.) They also confirm, by their signature, that they assume all responsibility for any injuries or complications caused by leaving the hospital to smoke and thereby release the hospital, its' employees and officers and the attending physician from all liability from any complications or injuries that may occur as a result of going outside to smoke..

SmilingBluEyes · Jul 2, 2003

this is addressed in a few other threads, with LOTS of varying opinions about it. check it out. As for me, I say it's fair and good.

Tweety, BSN, RN · Jul 2, 2003

We have the same policy and our security department is supposed to enforce it. They don't, but there is a task force in place that supposed will crack down on smoking outside.

If a patient insists on smoking he signs out AMA. We are supposed to call the doc to get discharge orders. Meaning if they are well enough to smoke, they are not to be an inpatient in our hospital. I don't think this has happened. But many patients sign AMA just to smoke.

We also are expected to call the MDs for nictine patches and sedatives if needed, which we do constantly.

webbiedebbie · Jul 2, 2003

Our patients also sign a form AMA for "No smoking" but they are not discharged. We can call our physicians for a patch, but we don't do this on nights.

krispynurse · Jul 2, 2003

We had the same policy at our small rural hospital but it was easy for the patients to just slip out the back door cause we were such a small hospital. But alot of the doctors did order patches and antianxiety meds if the patient needed them (those who were unable to leave their rooms under their own speed).

The main problem we had was the nurse's disappearing to go smoke in the designated area without letting anyone know.

purplemania, BSN, RN · Jul 2, 2003

Just to clarify, we have had no-smoking within the facility for years. The change will be that patients will not be allowed to go out to the "butt hut". Patches and anxiolytics are already being used. I do not know if signing a release form is binding, but that is an option. My concern is how will the nurses handle the complaints? thanks for your input.

Tweety, BSN, RN · Jul 2, 2003

I handle it using the broken record approach "we are a nonsmoking facility and I may not give you permission to smoke". Some patients accept it and leave anyway. I document, but don't commit assault to make them stay on the unit. Usually after they have their ciggarette they are fine. We have not smoking area, they just smoke outside.

Some patients get very angry, crying if they can only smoke one they will be fine, thinking the rules shouldn't apply to them and can't we just make one exception, one time..."we are a nonsmoking facility......." It's a total waste of time that could be spent caring for patients in need and it's frustrating.

SmilingBluEyes · Jul 2, 2003

We handle the complaints the same way as always. You let them complain, explain the policy and rationale and let them deal with it., the way you already are. AMA is what we have to do, also, if they insist on smoking. They will complain. It's not my problem if they do. I just respect their opinions and get on with it. It's not up to nursing, anyhow, these policies. they know this. just remind them.

purplemania, BSN, RN · Jul 2, 2003

you are right, it is not up to nursing but they are on the front line and I want to make their position easier if possible. Thanks for the responses!

Teshiee · Jul 3, 2003

When the patients are first admitted it should be stressed then and signs posted. I don't know why nurses have to be caught in the middle of hospital policies!!!!!! I would stress it once if they have a complaint take it up with administration. Nurses have enough to do then take abuse from patients that want to smoke!