Gonna finally get smoking regulations in our LTC!!

  1. I've posted a couple of times about the smoking in our facility. After last weekend, I guess admin has finally decided that smoking by the residents will have to be regulated.

    We have 70+ residents in our facility. At nite there are two nurses and four CNA's. There are 3 residents that want to go out at nite to smoke, and it's been getting worse and worse.

    One of them is in my half - he came out for his THIRD cigarette of the nite about 4AM - just as my two CNA's sat down for a break. Now, sitting down for a break means they sit where they can watch for lites on their three halls.

    I told him no, they weren't going to take him out right then - about that time, the MDS coordinator came in and told him that if he'd wait until 5, she'd come up and take him out. He agreed. But as soon as she walked away, he started in on the girls again. Well, I'd had it - I told him the girls had the right to sit down and take a break without having to run him outside - and that he'd agreed to wait until 5. Then, he starts screaming at me that he wants a cigarette NOW!! Long story, short - he didn't get it at that time - called me a F****** B*tch, went back to his room and slammed the door. I'm sure I've been called worse.

    Meanwhile in the other side of the building the two ladies that smoke - who I knew had also been out twice that nite - were back there threatening to report the nurse to 'State' for abuse for not 'taking care of their needs' by taking them out to smoke when ever they demanded. And apparently the one old bat's son had called this same nurse a couple of nites earlier threatening the same thing.

    OK - enough is enough. For 70 residents, we have 6 staff at nite, with NO ancillary personnel. It takes one staff member to cart each one of those residents outside.
    When do THEIR rights override the rights of the other residents to receive adequate care?

    It took the MDS Coordinator to observe some of this to finally get someone to agree that it can't continue like this.
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  2. 14 Comments

  3. by   ktwlpn
    I love threats to "call the state" What a bunch of crap. The "state" expects LTC to make every attempt to meet "reasonale demands" I think residents getting OOB and going out to smoke through out the night is not a reasonable demand and I'm sure the state would agree.Each of our supervised smokers has a smoking schedule that they have agreed upon during admission/team and it's care planned.And it's not excessive-usually 2 smokes on days and 2 on evening shift. And we are all responsible for seeing that they do get those smokes-nurses and cnn's alike. .We've never had anyone demand to go out during the night. You can bet that if they were home the family would NOT be getting up in the middle of the night to supervise them and allow them to smoke. I do wonder why these residents aren't sleeping better? Is the staff too noisy? Are these particular residents napping excessively on days? It really is past time for the DON and medical director to get involved-you need policy and protocol.Let us know what happens..It's funny how one or 2 difficult residents can wag the entire dog in LTC and often to the detriment of all of the others....
  4. by   StNeotser
    When I was a CNA in LTC we had an awful resident that wanted to go out every half an hour for a cigarette and this was on nights.

    She used to complain to Social services all the time because there was bound to be one time during the shift that we just said we were too busy.

    Woman was in kidney failure - had been an LPN at one time but lost her licence due to taking drugs. She was only about 58 when she died.

    Because of her behaviour the LTC facility started a new smoking policy but it didn't apply to any of the current residents so we still had to keep taking her out as often as she requested (apparently)
  5. by   Reigen
    Our nursing home has a policy of certain times for smoking for the residents" For example 7 a.m. 10 am 2 pm on days there has to be a staff emember in attendance while they are outside smoking this rotates as to who has the time to go, as well as having fire prevention measures a smoking apron , fire extingusiher, and ashtrays, as well as no oxygen tanks...Each smoking resident signs the agreement to adhere to this policy upon admission, and violation of this policy /agreement is taken to the Social Worker and Administrator and can be withdrawn at any time. I know that we have a smoking safety assesment that is done before admission and at anytime staff believes this assesment should be redeterimed. One resident's rights can't not and do not superceed the safety and care for all, and I certainly think that the omsbudman for your facillity could be called to help with this situation as well as the social worker -DON and whomever would like to be there at a meeting (family, POA etc.)
  6. by   nightmare
    reigen wrote,
    "fire prevention measures a smoking apron , fire extingusiher, and ashtrays, "
    Wow, all we have is an ashtray! What is a smoking apron BTW?
  7. by   CapeCodMermaid
    A smoking apron is an apron made of smoke retardant fabric so if someone drops a hot ash or cigarette on themselves, they won't get burned. Isn't it nice we care so much about a tiny burn on their skin from an ash but apparently don't give a rat's a** about the damage they are doing to their lungs,heart,liver etc from smoking.
  8. by   WickedRedRN
    One LTC I go to, the policy is the resident can go out to smoke, but must be escorted by a family member or POA. Staff are not allowed to take residents out.
  9. by   nightmare
    Quote from CapeCodMermaid
    A smoking apron is an apron made of smoke retardant fabric so if someone drops a hot ash or cigarette on themselves, they won't get burned. Isn't it nice we care so much about a tiny burn on their skin from an ash but apparently don't give a rat's a** about the damage they are doing to their lungs,heart,liver etc from smoking.

    Sounds like a good idea,I've had several drop ash on themselves and burn holes in their clothes.
  10. by   banditrn
    Quote from LoriRN2B
    One LTC I go to, the policy is the resident can go out to smoke, but must be escorted by a family member or POA. Staff are not allowed to take residents out.
    I would bet that the son who threatened the other nurse with 'state' if she didn't take his mother out whenever she wanted, would object to running out there two and three times at night to take her out!!
  11. by   ktwlpn
    Quote from CapeCodMermaid
    A smoking apron is an apron made of smoke retardant fabric so if someone drops a hot ash or cigarette on themselves, they won't get burned. Isn't it nice we care so much about a tiny burn on their skin from an ash but apparently don't give a rat's a** about the damage they are doing to their lungs,heart,liver etc from smoking.
    Yep-ya gotta love the absurdities of LTC-they have the right to abuse themselves to death but we have to make sure they do it in a safe manner or we are neglectful.We are neglectful if we let them fall yet we can't restrain them chemically or physically....We have to let them (or assist them )to go outside whenever they wish yet if one goes out and dies of hypo or hyperthermia we are neglectful.They have the right to torment the h*ll out of each other and smack the crap out of us but we are neglectful if one hurts another yet we can't medicate to prevent it....(can you tell I had a rough day-I got smacked down by a 101 yr old little old lady):trout:
  12. by   nightmare
    Quote from ktwlpn
    ..(can you tell I had a rough day-I got smacked down by a 101 yr old little old lady):trout:
    Don't you find that the 90++'s are a hardy old breed!?We have a few 90+'s and they are all as tough as old boots,that generation went through things that this generation would not survive!Yes and some of them pack a fair punch male and female
  13. by   Summer69
    FYI Smoking Aprons are available thru Briggs or Direct Supply. Another "Hot" item regarding the smokers where I work is "Who supplies the lighters?" Families complain that they bring them in and then they just disappear. Staff complain that either 1. "I do not smoke so I refuse to buy a lighter" or 2. "Why does everyone come and get my lighter to take the smokers out to smoke" Of course there are the staff that refuse to take out the smokers because they do not smoke and do not feel they should be exposed to the weather and 2nd hand smoke. "It is against their rights" Is this a merry go round or not. Our smoking staff love to take out the smokers cuz then they get extra smoke breaks in.!!!!!
  14. by   banditrn
    Quote from ktwlpn
    Yep-ya gotta love the absurdities of LTC-they have the right to abuse themselves to death but we have to make sure they do it in a safe manner or we are neglectful.We are neglectful if we let them fall yet we can't restrain them chemically or physically....We have to let them (or assist them )to go outside whenever they wish yet if one goes out and dies of hypo or hyperthermia we are neglectful.They have the right to torment the h*ll out of each other and smack the crap out of us but we are neglectful if one hurts another yet we can't medicate to prevent it....(can you tell I had a rough day-I got smacked down by a 101 yr old little old lady):trout:
    So, so true!!! Some nights I just have to look skyward, and shake my head!

    I'm going to be done with it all soon - and I told one of the young nurses the other morning that I'd been making a list of certain things I'd observed over the years - so that 'I'd' be able to pull the same stunts when 'I' was in LTC!
    She said if she saw them wheel me in the door, she was taking off!!

    Two incidents that I added to my list the other night:
    A rather snooty lady who doesn't like having a roommate - but can't afford, or won't pay for a private room, called for me. She complained of feeling dizzy, and sick to her stomach. I took her vitals, which were normal, then told her I'd call her Doc to see if I could get an order for a Phenergan suppository - she shook her head no, and pointed to her roommate, a very nice lady, who is in for rehab for foot ulcers.
    So, I asked her, is this what this is all about? I told her that the roommate was paying for her half of the room, and she had just as much right to be there. I again offered to call her doctor, which she refused, so I told her she needed to roll over and go to sleep, and leave her roommate alone.

    Later I gave a prescribed Vicodin to a lady, she rolled it around in her mouth awhile, spit it out, told me that she couldn't swallow it, and to go get her another one! That one went on my list.

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