I understand the push for "customer satisfaction" but I think that the following situation is taking it too far. A few days ago we had a patient on the floor who was in constant pain. She had MS PCA, Ativan, Phenegran for her pain/anxiety/nausea. The doctor had ordered a bed alert put on her because she was so unsteady from this pain and the pain meds. Well, she was with it enough to insist on going outside to have a cigarette. We explained that #1 she would have to go out in a wheel chair and that no one could take her out at this time, we were all busy (imagine that). #2 she was a huge fall risk and couldn't hardly stand up without tipping to one side, so we didn't think that she was up to the trip #3 she had a MS PCA, which we don't really allow to just freely float outside of the building #4 her doctor DID NOT want her to leave. We babied her, gave her all the meds she could have, bent over backward to try to please her. But, she was adamant and we called the house supervisior to take care of the situation. Well, house went in to talk with patient. SHe comes out and says that one of us needs to stop taking care of the patients and take this woman out to smoke. NO surprise to anyone I'll bet. But, the story gets more interesting when we find out that the patient doesn't even have any cigarettes. So, the house supervisior buys some from a staff member. BUT, the patient wouldn't accept them because they weren't menthol. So, house calls everyone in the hospital that she knows smokes to find menthol cigarettes to buy. I was so mad that I couldn't even speak, except to say "we appreciate the support ) Her response was that this woman might write a letter to the editor or something. Isn't there a line between patient rights and doctor/nurses orders/knowledge? I guess now we have to give the patient whatever they want and we have to reinforce their bad habits/behavior. UUGH!
At my facility we have smokers all the time. We're actually expected to "find someone" to take our smokers out. Nicotine patches are rarely offered and need a MD order (and boy are you going to get ripped apart if you have to call for one). I've had pt's with telemetry go out, as well as those toting PCA or so unsteady they went out with o2.
Recently we had a pt whose pain meds weren't working fast enough for him, and so he called over some friends who brought him marijuanna to smoke. They're all sitting there passing the pipe, right in front of the glass doors to the smoking area and right accross from the nursing station. Administration was aware of it and told the nurses to just try and keep the other pts from going out untill we thought the smoke had cleared. According to admin this was ok because the pt had a perscription and grows his own.
Right now the big thing is "customer satisfaction". But of course, night shift RNs don't get lunch or a single break because "it's not cost effective". We were told that paying for a relief nurse is more expnsive than paying the fines when we call because we don't get any breaks.
I'm an occasional (read that as less than half a pack a week) smoker. These pts know the risks (who doesn't). I just don't understand why their right to smoke is so much more important than our right to be safe, protect our pts, to have our own breaks (non smoking nurses don't have to take patients out for a walk), and to be safe from second hand smoke. I personally don't think it's so much an issue about smoking, it's an issue of rights and responsibilities. Maybe admin needs to remember that these are our PATIENTS, and last time I looked my badge said RN not customer service rep. If I wanted to work retail I would.
Sad state of affairs when we all KNOW the damage smoking can cause and yet are encouraged ( directed) to allow (assist) people to harm themselves. I used to bring one of my older residents a shot of Schnapps every night -- settled her down for bed -- the woman was 92 -- had done it for years -- was strong as an ox. When Lucy wanted schnapps --she got 'em! I too have had OB patients on pit head for the butt hut, or deliver and head downstairs with a chum within 2 hours of delivery -
Good lord, what else did that facility do for patients---leave mints on the pillow??
Mints--no, But.. How about a 6am coffee cart that served patients and guests, fresh juice,pastry and a newspaper---AND they didn't even check with staff about NPO status, or have the training to realize an NG tube was a good indication not to give a pt coffee! This was on a step down unit-post cabg/gi surg/vent weaning!!!
Specializes in Education, Acute, Med/Surg, Tele, etc.
There is no smoking on our side of the assisted living facility (we have a dependant, and independant side...yep you guessed it..medics only on the dependant). And I get torn sometimes when someone moves their loved on in and didn't explain that! Which sadly most family members do because "it will be easier on them if they don't know, they will just have to quit".
Since I work with the elderly, most have been smoking for all of their lives...and talk about hard to quit! Also, it is something they chose to do till the end of thier lives (they are allowed to drink, but they must provide...and we can not serve it!).
It just kind of gets me that here we are demanding they don't eat sugary foods if they are a diabetic, telling them where to go, what to do, what is appropriate for them to say or not, making them come to meals (I am the MOST liberal about this...other nurses basically force them...I have my caregivers get them a snack tray if they would like to sit back or aren't feeling up to a room full of people!), giving them meds and saying "you HAVE to take this so you will be okay". In addition, they arrive with no car, no home, maybe a quarter of their belongings, loss of idependance, and feel that their families have given up on them...then what do we do...we took away one of their stress mechs they have had for many many years! (even though it isn't the healthiest ones).
I know it is not healthy for you, but OUCH! Makes me sad sometimes...and I have been the ONLY nurse at that facility to beg for nicotine patches or gum! We even had a woman who was on hospice who smoked all her life come in...knowing she had about 2 months best to live, and all she wanted to do was enjoy her life...she couldn't smoke, and once she found out...she pleaded..but nope. She died in 2 weeks...and it was very odd, but I think once this...the last thing she had control about doing was taken...that was it...she gave up! Very sad...it wasn't going to kill her to smoke...she was already on that path! I will always remember her face go from hopeful to blank after her last plea was denied...that was the same look she had from that moment on till death...broke my heart!(she also quit talking from that moment on...).
IN hospital I also was very demanding of my MD's to Rx patches! But I took on the twist of patient rights and played the sympathy card of "oh man they are really upset and may become noncompliant very soon, can I please get a patch for them, I think it will help them emotionally, mentally, physically and heck...it would help me a TON!" LOL! Worked like a charm!
It does come down sometimes to control over patient care...do we control or assist? Many of my patients do things they shouldn't, but who am I to demand they don't! I am to give them assistance and education, hope it sinks in...and really hope it is carried out. Beyond that it is my patients rights to do what they wish to do...So I get stuck sometimes between trying to control the help, or simply to give it...
But honestly..doesn't matter, facility policy...(which takes the burden off me).
I am positively sick of this attitude of being the customer service provider instead of nurse with important things to do, which should be respected. Until hospitals quit pretending to be competitive restaurants, there will be no respect for nurses or the care they provide. I am all about being kind, accommadating (to a degree), and attentive, and sensitive to their pain, but there needs to be respect for US, and I am sick of hearing pt feedback to managers about nurses that they didn't do this or that, until hospitals staff us with enough nurses to provide quality "customer service", they need not to expect coddling of disrespectful patients. At what point in time was it decided that there is no end to a nurse's time or patience?
I have never been as apologetic to a receiving RN. The patient should have been on Q1 fingersticks and Q3-4 BMPs, but wouldn't allow them.
I think it's important to pick your battles. This applies to general life issues and, as well, to health issues. What is going to kill the patient first? Smoking, or a poor mental attitude. As someone posted about the terminally ill patient, a poor mental attitude can kill pretty quickly, directly or indirectly. Will people die of emphysema or lung cancer first, or die of infection because of a depressed immune system due to depressed mood. The studies haven't been done...
Therapists tell me that their goal for people in therapy is for them to have a happy life. What is the goal in returning someone to physical health? There are some deep questions here, about the meaning of life. And questions of incomplete scientific knowledge.
However, that said, battles picked should be for the greatest common good. Catering to one person's whims when it endangers others is a problem.
I understand the push for "customer satisfaction" but I think that the following situation is taking it too far.
I had a patient a few months ago who was a smoker and she was also an RN, or so she said, she had just come up to the floor from PACU. She had stepped in a hole and broke her knee and lower leg and had rods and pins inserted. She was on PCA Morphine. I go in to get her first set of vital signs and she tells me she wants to smoke. I explained to her that she couldn't. Would you believe she asked me to push her downstairs in her bed to the front parking lot? :angryfire She really thought I would do this? Certainly if she was an RN she would know I didn't have time for that kind of crap? I'm not a smoker but I really don't get it.
i understand the push for "customer satisfaction" but i think that the following situation is taking it too far. a few days ago we had a patient on the floor who was in constant pain. she had ms pca, ativan, phenegran for her pain/anxiety/nausea. the doctor had ordered a bed alert put on her because she was so unsteady from this pain and the pain meds. well, she was with it enough to insist on going outside to have a cigarette. we explained that #1 she would have to go out in a wheel chair and that no one could take her out at this time, we were all busy (imagine that). #2 she was a huge fall risk and couldn't hardly stand up without tipping to one side, so we didn't think that she was up to the trip #3 she had a ms pca, which we don't really allow to just freely float outside of the building #4 her doctor did not want her to leave. we babied her, gave her all the meds she could have, bent over backward to try to please her. but, she was adamant and we called the house supervisior to take care of the situation. well, house went in to talk with patient. she comes out and says that one of us needs to stop taking care of the patients and take this woman out to smoke. no surprise to anyone i'll bet. but, the story gets more interesting when we find out that the patient doesn't even have any cigarettes. so, the house supervisior buys some from a staff member. but, the patient wouldn't accept them because they weren't menthol. so, house calls everyone in the hospital that she knows smokes to find menthol cigarettes to buy. i was so mad that i couldn't even speak, except to say "we appreciate the support ) her response was that this woman might write a letter to the editor or something. isn't there a line between patient rights and doctor/nurses orders/knowledge? i guess now we have to give the patient whatever they want and we have to reinforce their bad habits/behavior. uugh!
couple of pieces of advice; one because the doctor is adminant about this patient no going outside and she doesnt feel the need to abide by this, here is my advice. first before she goes outside tell her that she is doing so against medical advice, and that she will need to sign a ama form each and every time she leaves the unit. if she refuses (which she probably will do) then document it on the ama paper that she refused to sign.
[color=#ff8c00]second, to cover your ***, chart everything that goes on before during and after she decides to leave the unit.
[color=#ff8c00]your supervisor was wrong to be that accomadating to this patient. and she is putting herself and your liscense in danger. i would have called the doctor to let them know what the super was doing and to what length this super was going to please this patient. let the doctor chew her *** out and i bet she won't be so willing the next time.
[color=#ff8c00]just document, document , and document.
Maybe it's the parts of the country I've lived in but the idea that **anyone** smokes in a hospital or any other **health** care setting shocks me. In this day and age!
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I understand the push for "customer satisfaction" but I think that the following situation is taking it too far. A few days ago we had a patient on the floor who was in constant pain. She had MS PCA, Ativan, Phenegran for her pain/anxiety/nausea. The doctor had ordered a bed alert put on her because she was so unsteady from this pain and the pain meds. Well, she was with it enough to insist on going outside to have a cigarette. We explained that #1 she would have to go out in a wheel chair and that no one could take her out at this time, we were all busy (imagine that). #2 she was a huge fall risk and couldn't hardly stand up without tipping to one side, so we didn't think that she was up to the trip #3 she had a MS PCA, which we don't really allow to just freely float outside of the building #4 her doctor DID NOT want her to leave. We babied her, gave her all the meds she could have, bent over backward to try to please her. But, she was adamant and we called the house supervisior to take care of the situation. Well, house went in to talk with patient. SHe comes out and says that one of us needs to stop taking care of the patients and take this woman out to smoke. NO surprise to anyone I'll bet. But, the story gets more interesting when we find out that the patient doesn't even have any cigarettes. So, the house supervisior buys some from a staff member. BUT, the patient wouldn't accept them because they weren't menthol. So, house calls everyone in the hospital that she knows smokes to find menthol cigarettes to buy. I was so mad that I couldn't even speak, except to say "we appreciate the support ) Her response was that this woman might write a letter to the editor or something. Isn't there a line between patient rights and doctor/nurses orders/knowledge? I guess now we have to give the patient whatever they want and we have to reinforce their bad habits/behavior. UUGH!
You gotta be kiddin me. You have a real problem in that house supe, if you ask me. That is a HUGE part of your problem, he/she allows a patient to manipulate him/her.This sets a horrible precedent for you all. I would be having a conversation with my manager about this and documenting it myself. Good luck, sounds like you have a real problem on your hands here. You disobeyed doctors orders in the name of customer service; this puts you in a bad liability situation, if you ask me. Time for those AMA forms, each and every time they step off the floor against dr. orders. That and only that may cover your butt should something happen.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I understand the push for "customer satisfaction" but I think that the following situation is taking it too far. A few days ago we had a patient on the floor who was in constant pain. She had MS PCA, Ativan, Phenegran for her pain/anxiety/nausea. The doctor had ordered a bed alert put on her because she was so unsteady from this pain and the pain meds. Well, she was with it enough to insist on going outside to have a cigarette. We explained that #1 she would have to go out in a wheel chair and that no one could take her out at this time, we were all busy (imagine that). #2 she was a huge fall risk and couldn't hardly stand up without tipping to one side, so we didn't think that she was up to the trip #3 she had a MS PCA, which we don't really allow to just freely float outside of the building #4 her doctor DID NOT want her to leave. We babied her, gave her all the meds she could have, bent over backward to try to please her. But, she was adamant and we called the house supervisior to take care of the situation. Well, house went in to talk with patient. SHe comes out and says that one of us needs to stop taking care of the patients and take this woman out to smoke. NO surprise to anyone I'll bet. But, the story gets more interesting when we find out that the patient doesn't even have any cigarettes. So, the house supervisior buys some from a staff member. BUT, the patient wouldn't accept them because they weren't menthol. So, house calls everyone in the hospital that she knows smokes to find menthol cigarettes to buy. I was so mad that I couldn't even speak, except to say "we appreciate the support ) Her response was that this woman might write a letter to the editor or something. Isn't there a line between patient rights and doctor/nurses orders/knowledge? I guess now we have to give the patient whatever they want and we have to reinforce their bad habits/behavior. UUGH!
You gotta be kiddin me. You have a real problem in that house supe, if you ask me. That is a HUGE part of your problem, he/she allows a patient to manipulate him/her.This sets a horrible precedent for you all. I would be having a conversation with my manager about this and documenting it myself. Good luck, sounds like you have a real problem on your hands here. You disobeyed doctors orders in the name of customer service; this puts you in a bad liability situation, if you ask me. Time for those AMA forms, each and every time they step off the floor against dr. orders. That and only that may cover your butt should something happen.
) Her response was that this woman might write a letter to the editor or something. Isn't there a line between patient rights and doctor/nurses orders/knowledge? I guess now we have to give the patient whatever they want and we have to reinforce their bad habits/behavior. UUGH!
maythen
25 Posts
At my facility we have smokers all the time. We're actually expected to "find someone" to take our smokers out. Nicotine patches are rarely offered and need a MD order (and boy are you going to get ripped apart if you have to call for one). I've had pt's with telemetry go out, as well as those toting PCA or so unsteady they went out with o2.
Recently we had a pt whose pain meds weren't working fast enough for him, and so he called over some friends who brought him marijuanna to smoke. They're all sitting there passing the pipe, right in front of the glass doors to the smoking area and right accross from the nursing station. Administration was aware of it and told the nurses to just try and keep the other pts from going out untill we thought the smoke had cleared. According to admin this was ok because the pt had a perscription and grows his own.
Right now the big thing is "customer satisfaction". But of course, night shift RNs don't get lunch or a single break because "it's not cost effective". We were told that paying for a relief nurse is more expnsive than paying the fines when we call because we don't get any breaks.
I'm an occasional (read that as less than half a pack a week) smoker. These pts know the risks (who doesn't). I just don't understand why their right to smoke is so much more important than our right to be safe, protect our pts, to have our own breaks (non smoking nurses don't have to take patients out for a walk), and to be safe from second hand smoke. I personally don't think it's so much an issue about smoking, it's an issue of rights and responsibilities. Maybe admin needs to remember that these are our PATIENTS, and last time I looked my badge said RN not customer service rep. If I wanted to work retail I would.
-Maythen