Beating my head against the wall

Nurse Ratched, RN · Jul 13, 2002

This person has had no visitors in to my knowledge. So staff is it as far as assistance. I believe outbackannie's assessment of the situation is right on the money. It was the last order he wrote of the day.

Those who are concerned that I am being harsh on a patient that smokes: if I was that harsh, I would lobby against the removal of the smoking area entirely. Respiratory thereapy would love me - it really chaps their butts when we have to call a pt out of the smoking room for a treatment. Ours is the only place in the facility that allows smoking within the building, period - maybe because we are a locked unit and other patients on other units are permitted to go outside to smoke.

But I do not go in the smoking room to pass meds, and I do not assist patients in any way in getting there (other than giving directions, of course! ) or in lighting their cigarette. And I don't take away huge blocks of time I don't have from my other 4-5 patients to assist one with something that is in no way beneficial from a medical or nursing standpoint. This patient does also happen to be an alcoholic - another perfectly legal addiction; but we don't order prn Jack Daniel's for her.

Thanks for all the input, everybody!

mattsmom81 · Jul 13, 2002

Agree with most of the posters that this woman's request to smoke involves unreasonable time and effort by the staff and should not be viewed as her 'right'.

We had such problems in this regard at my last facility we had a policy statement written out and all patients had to sign a waiver...that the staff did NOT accept responsibility for their smoking and we did NOT have to accompany them outside or be subjected to secondhand smoke. If they had to smoke, family members MUST be with them and assume all responsibility. Smoking assistance is not a nursing function or a patient right, IMO. The policy offered patches and sedation as the preferred option.

I thought it was a GREAT policy. Most just took patches and Xanax rather than be responsible themselves....

live4today, RN · Jul 13, 2002

originally posted by outbackannie
sounds like doc just "passed the buck" so he'd still look like the hero to the patient. bet he wrote the order and "booked" right out the door before anyone had a chance to corner him!

that's because "doc just passed the buck" on the wrong nurse, outbackannie. he just hasn't met his match in a nurse yet. let me at 'em. :lol2: he'd think for a 'sec' before even letting those words come out of his mouth to me. i backed down from an egotistical doc only one time....during my student nursing days...quickly learned my lesson...thanks to my nursing instructor at the time...and ever since...an egotistical doc has never stood a chance up against this nurse. nurses must....absolutely must...stand their ground for the protection and safety of all their patients, and this doc's request for his patient was totally one that no nurse could safely carry out without placing her other patients' lives in jeopardy during her absence from the floor. doctors can write any order they want for their patients, but it is still up to the nurse whether or not she/he chooses to carry it out based on her use of critical thinking skills for her patients as a whole....and for the patient in question.

ERNurse752, RN · Jul 14, 2002

kids-r-fun...totally agree with ya! :)

hapeewendy · Jul 14, 2002

watching this thread twist and turn and morph into right to smoke vs right to smoke free environment has given me a chuckle.

the original post made perfect sense , I can understand why the original poster was so frustrated.

To me it isnt about smoking or not, hell if you wanna smoke go right ahead I dont care BUT I shouldnt have to break my back, and take a horrible amount of time to get you to the place where you can smoke.

pts on isolation are on isolation for a reason DUH

and if this patient demands so much physical care then the need or right to smoke is veto'd by the fact that its really not safe to get her somewhere to smoke.

so sorry life sucks doesnt it

should we hoyer lift everyone anywhere they may want to go to do anything they may want to do?

why dont we hoyer the 300lb alcoholic to the beer store, I'm sure some nice dr would write an order for it!

if I was this patients nurse , going into a smoke filled room or being near her when she smoked could send me into an asthma attack in a second, sorry not willing to jeopardize my own health

selfish, perhaps but the whole issue of the smoking thing is assanine to begin with.

its not about bad habits being tsked tsked its about not having the manpower, well personpower and time to facilitate everyones habits when they are seriously ill

hoolahan, ASN, RN · Jul 14, 2002

Bravo Wendy!!!!!!! Very well said!

Nurse Ratched, RN · Jul 14, 2002

Wow, hapeewendy - didn't I read that you're still a student nurse? I think it's safe to say you should be waived out of any further "common sense" credit requirements, because you've got that one down! :)

formernurse · Jul 14, 2002

My exact sentiments, Wendy. You go girl.

**SKM-NURSIEPOOH, BSN, RN** · Jul 14, 2002

if this doc wants to write this kind of order...then let him be the one to hoyer lift her oob & sit with her with the isolation garb on. this doc absolutely has no one's interest at heart here. he's willing to jeopardize the nursing staff in order to satisfy this patient's cravings. i agree with those who say that he should've written an order for the patch instead!!! hapeewendy said it best!!!

ps....rusty, you're sooooo :devil: bad :chuckle

Trauma Columnist · Jul 14, 2002

My $0.02 - would never, ever go outside with smoker. In our ER, if pt is outside smoking when its their turn - oh well - go to the back of the line. If they go outside from treatment room - oh well - they get moved to holding area. These are just natural consequences!!

James Huffman · Jul 14, 2002

I wonder if the doc realizes the extent of the trouble involved in getting this person a smoke. Perhaps taking this physician aside, and explaining the situation might help. Also understand the problem from the doc's perspective: this patient may have been giving hassles about smoking, and the easiest thing might be to simply write such an order, hoping it would take care of the situation.

That having been said ...

I am not a smoker.

I have never smoked in my life.

I know smoking is bad for one's health. (As does anyone with an IQ above 37. I very frankly think that those people suing tobacco companies, claiming "I didn't know it was bad for me," are lying, pure and simple).

But could we cut smokers some slack? There are lots of things we do that are bad for us, and somehow only smokers are treated as though they were lepers. Would any of us refuse to get a soft drink for a patient? I have trouble arguing that those are good for us, given the levels of sugar OR artificial sweetners (not to mention the usually too high levels of phosphorus) but no one is beating these folks up.

There are things people enjoy doing. They make a decision to do them. It may be our job to teach them that smoking is bad for them (although you are telling them something they already know), but treating smoking as though it were a moral evil is out of place.

The hassle involved in getting this particular person a cigarette, and the issue of smoking in general should be separated.

Jim Huffman, RN

http://www.NetworkForNurses.com

donmurray · Jul 14, 2002

A breath of fresh air!! As she is so big, whilst denying her a smoke, why not deny her more than, say 1,000 calories a day, to save the nurses' backs? She doesn't need all those "extra" calories, so why give them to her? This is a slippery slope.