Inpatient Smoke free ward - HELP!

[rainbowsunsets]

Hello everyone,

I am new to psych nursing and have just started in an acute adult ward. I am having a really hard time dealing with the smoke free policy that has been introduced within the hospital late last year (this is in australia). Most of our patients smoke and when told we are smoke free they become hostile, agressive and start to stalk us and constantly nag us for cigarettes. In response to this behaviour the doctors have been ordering patients to have leave outside with a nurse so that they can smoke, this is really upsetting me as i am usually pressured to take a few patients at a time and i am breathing in their smoke and come home smelling like it by the end of the day. I cant say no to not taking patients outside of the hospital as my job is to take them on leave when i can, and i legally cant stop them from smoking outside of the hospital but i am worrying about what this is doing to my health. I have told people and just been told to use nicotine patches and nicotine inhalers or give them PRN medications, these patients are usually unreasonable and dont want these things, even if they do, it does not stop them from wanting a cigarette. I am personally against smoking but my workplace is becoming increasingly unsafe, im passive smoking everyday (i try to tell them to stand away from me but often they just dont understand and follow me around whilst outside), im taking patients outside that are not ready for the high stimulus environment but are becoming agressive. I dont know what to do.............i really need advice from other people whos work places have gone smoke free and how they deal with it. I at my wits end.

Thankyou

[thegreenmile]

In the U.S. weve been dealing with this for years & it doesnt matter how long its been, smokers are diligently addicted. What you explain about their behaviors are the common symptoms of withdrawal and NO substitute will suffice. We get the brunt of it. PRN anti-anxiety agents help a little as well as distraction, you must keep them busy with groups and tasks to get their mind in a different place other than their craving. It's mental and physical. Allowing them to vent their frustrations, showing empathy and active listening also helps a little. Just being there is an irritant, then removing their coping mechanism only adds fuel to the fire. My only advise is to deal with this with compassion.

[Jules A, MSN]

I don't think its so much the smoke free policy causing problems as the fact that it really isn't smoke free if you are expected to take them outside! That is ridiculous and not helping either the staff or patients imo. When we went smoke free it was SMOKE FREE no smoking, employees or patients, on the grounds. Employees can even be reprimanded for smoking in their car or leaving the property on break and coming back smelling like smoke. Hopefully things at your facility will catch up because this wasn't a big deal after the initial shock wore off. We do offer patches and gum but you'd be surprised at how many decline it. Good luck.

[thegreenmile]

Yes, our place is supposedly Smoke Free Campus, they call it, but with much predjudice, We are in a facilty with LTC on other units, they have grandfathered the residents over there and allow them to smoke on a smoke free campus, but if employees do they get disciplined. Same crap. I call it discrimination. Is your unit locked down? if so, why are you required to take them outside? Our pts only go outside in an enclosed court yard where smoking is not allowed.

[rainbowsunsets]

Thankyou for all of your replies, our unit is locked down with two sections HD and LD. We usually graduate our patients from escorted leave to unescorted leave. Your suggestions have been helpful, i think it needs to go totally smoke free in order for it to work.

[thegreenmile]

Agreed and your welcome, hope things get a little better, it's a rough enough job that something so stupid has to make it that much more difficult.

[Mr Ian]

I despise the smoking bans on patients who are detained against their will. It is, as far as I'm concerned, a discrimination. Prisons have not introduced such bans - and they have much tighter regimes for violence control.

I am also a smoker.

But I understand the rights of both.

So in response to your specifics:

1. They cannot make you go with a patient who then puts you at risk. Be that increased agitation or passive smoking.

As a non-smoker (and even as a smoker) you have every right to refuse to escort to a smoking area or with a patient who smokes in your immediate vicinity. The workplace cannot expose you to risk. It's OH&S.

2. Clinically, if you are not able to walk far enough away from the patient (because of a risk) in order to avoid the passive smoking then the risk is too high. Again, this is a OH&S issue.

I would raise the issue with your union rep and let them know your concerns about being exposed to the risks of smoking. They know they shouldn't expose you - they introduced a whole bl***y law in Australia to stop smoking being forced on non smokers.

I would also raise it with your H&S rep for the unit.

If you've got good nurse managers - raise it with them - even tho they are likely to want to avoid the nightmare management - as soon as you let someone know in writing, then you have put them 'on notice' to respond.

[Whispera, MSN, RN]

I don't smoke and don't like to get it in my nose, lungs, and on my clothes, but I enjoy taking patients to smoke and being with them while they do smoke. Sometimes they open up alot during smoke break and talk about things they never discuss while in the unit. It's a valuable time.

Then when I get back, I spray myself with airfreshener, drink water, wash my face, and wonder where my inhaler is!

I don't believe a staff member in the US can refuse to take patients to smoke, by the way...

[Atheos]

Surely you must have some employees that are smokers that would love an official pass to get by the no smoking policy?

Why not try to have a set smoking schedule and see if they can get volunteers from elsewhere in the facility?

ETA:

I tell you right now. If I worked in a 'Smoke Free' facility and management extending this opportunity I'd be on it like white on rice.

[Mr Ian]

I don't believe a staff member in the US can refuse to take patients to smoke, by the way...

In the most litigious country in the world - I'd like to see an employer force an employee to be exposed to a carcinogenic and feel perfectly safe about that.

[goettin98]

I live in a smoke free state, which does include the prisons. I'm thankful for this. If I had to interrupt my day every few minutes for pts to go smoke, I wouldn't be working there. Pts can be prescribed the patch or Nicotrol inhaler, but the MD has to ok it. IMO, I don't think we should be promoting smoking. We've actually had quite a few pts who have been on our unit for months who say they won't return to smoking when they are discharged. Now, whether this actually happens, I don't know. But I do have a huge problem with pts coming in with their cell phones and cigarettes, but also their LINK card (food stamps). Sorry, if you've got money to smoke and call people, then you don't need to be on the dole and having the govt. pay for your groceries and hospitalization.

[meluhn]

Im not a psych nurse but I am an ex smoker and I dont think an inpatient acute care setting is the right time for people to try to quit smoking. They are already dealing with whatever stressors brought them there in the first place, why add more?

Also, why cant we cut smokers a break? Would it really kill us to give them a room or an enclosed porch/area or something to smoke on? I think we really over do it in this country when it comes to stuff like this.

My entire hospital campus is smoke free. You cant even leave the building, you have to walk off the property if you want to smoke. I just think its a bit extreme.