A smoking patient

[Emily456]

So I work at an assisted living facility. And we recently got a new patient who smokes. Initially when she came they let her smoke in the courtyard. Eventually we found out that this is not allowed. She is an elopement risk (is very unhappy that her daughter put her in our facility) and attempted to elope 3 times the first day she was admitted. So now we have to take her in front of the building to smoke and sit with her until she's done. I've got 40 patients. My job as a nurse is to heal. Not to take people outside to smoke. I am also a non smoker, and hate to be around it. It's very irritating to my throat. Sometimes my aids take her out because they are smokers as well. The patient gets very irritated because often times we're extremely busy and can't take her outside immediately when she demands it. She screamed at me because I couldn't take her out because I was meeting with a patients family. She came to my office and screamed at me, in front of the family. My question is, do I have the right to refuse to take this woman out so smoke? I don't have time, and I don't feel that it's fair to have to expose myself to second hand smoke when I should be caring for the ill.

[LPN27713]

i think that you have several options in this case.

1. look at the policy of your facility, if nothing there about smoking then...

2. Call your boss, or the DNS or administrator and tell them you will not do this because you dont have time for this, if they want to hire a 1 on 1 sitter - they can. let them know this is not a Skilled Nursing Facility and even there they dont no 1 on 1's unless someone is really "off the wall"

3. Let the patient know- if needed call her out. Say that your sole job is to look after her health, smoking is bad for her and let her know that:

a. if she wants to "get out of here" then by all means she can call the daughter and let her know but you cant leave her outside by her self

b. let here know that she is not the only one , you have others to take care of, as long as the smoke times are reasonable you can "try" to accommodate her smoking trips

4. Let the daughter know - i doubt she will do anything tho

hope this helps :) stay strong

[caliotter3]

Several months after I refused a reported (heavy) smoker as an extended care home health patient, I was awarded unemployment benefits. The "employer" (I use the term lightly because they gave me not one day of work) successfully got the unemployment department to reverse their decision and I was punished by the EDD instead of receiving benefits. Had I gone to an employment attorney, I would have had a case, but who has the time, the money, the energy to be suing employers that never even employed one? The bottom line is you can not be forced to deal with smoke on the job. But at the same time, the employer does not have to employ you. They count on you not having what it takes to take them to court. And then what of your reputation in the job market once you have sued an employer?

[NOADLS]

The power of delegation - use it.

Maybe look at getting them on a patch?

[TheCommuter, BSN, RN]

My question is, do I have the right to refuse to take this woman out so smoke?

As nasty as cigarette smoke is, a smoker patient has the right to smoke even if she's institutionalized. Hence, she must be given time and space to smoke.

At every shady LTC facility where I've worked, a Q2hour smoking schedule was used to 'smoke' the residents. Each department (nursing, dietary, medical records, etc)took turns and smoked the residents per the schedule to spread the burden.

[Emily456]

Thank you, TheCommuter, I agree that it's a nasty habit. But thank you for your reply. It was very helpful. I will have to collaborate with my colleagues to see if we can set up some kind of a schedule.

[hppygr8ful, ASN, RN, EMT-I]

So I work at an assisted living facility. And we recently got a new patient who smokes. Initially when she came they let her smoke in the courtyard. Eventually we found out that this is not allowed. She is an elopement risk (is very unhappy that her daughter put her in our facility) and attempted to elope 3 times the first day she was admitted. So now we have to take her in front of the building to smoke and sit with her until she's done. I've got 40 patients. My job as a nurse is to heal. Not to take people outside to smoke. I am also a non smoker, and hate to be around it. It's

very irritating to my throat. Sometimes my aids take her out because they are smokers as well. The patient gets very irritated because often times we're extremely busy and can't take her outside immediately when she demands it. She screamed at me because I couldn't take her out because I was meeting with a patients family. She came to my office and screamed at me, in front of the family. My question is, do I have the right to refuse to take this woman out so smoke? I don't have time, and I don't feel that it's fair to have to expose myself to second hand smoke when I should be caring for the ill.

This is how we handled the smoker on our unit. Mind you he is quiet aggressive about going out to smoke - but he is a huge fall risk. Like you our SNF is understaffed and we simply do not have the resources to accommodate smoke breaks. Plus we are a smoke free facility and even our employee are not allowed to smoke on facility grounds. (legal in California). So we informed the family that if the patient was to be allowed to smoke a family member would have to come and take them out. Then we slapped a nicotine patch on the guy. We still have to listen to him complain, but it is important to set boundaries with these patients.

Hppy

[Emily456]

Thanks to all who replied. Just so you know the outcome, we actually set up a smoking schedule. And we also found out that we actually are allowed to let the patient smoke in the court yard. So, the patient no longer needs an escort.