COPD patient wanting to leave to smoke

Anna Flaxis, BSN, RN · Oct 17, 2011

Nicotine is *extremely* addictive. You are dealing with a drug addict. A drug addict is willing to continue to consume their substance of "choice" despite ANY health risks.

I swear, I have had more problems with nicotine addicts than any other kind. More threats of violence, more obnoxious behavior, more AMAs/elopements, more anxiety.

Does your facility have a nicotine replacement protocol? I've found that for many smokers, while the patch may take care of the physical symptoms (or two or three patches, for that matter), they may need access to a nicotine inhaler, gum, or lozenges for breakthrough cravings. In addition, Ativan can be tremendously helpful.

PurpleViolet · Oct 17, 2011

I see this ALL the time.It is very sad.I have had pts with trachs,lung cancer ect demanding to be wheeled outside to smoke.Some demand to smoke with the 02! It is such a horrible addiction.And we cannot deny them this privilege but when they come back from smoking we need to help them by doing all we can to allow them to breath more easily.Its a very hard situation to deal with.I used to get upset over it then years in I thought to myself well its their right,if they want to smoke themselves to death.I work in hospice and sadly I am seeing my pts younger and younger with diseases that can be prevented from not smoking and drinking.Its hard to watch :scrying:

chris10lsuRN · Oct 17, 2011

oh yes..we have all of that. He just got to the unit..has not been here 10 minutes. I understand that it is a highly powerful addiction. I was basically venting about the fact that he is here for COPD and his stay is paid for by medicaid and he is adamant about smoking.

Zookeeper3 · Oct 17, 2011

Look, they are non-compliant at home with meds, they smoke at home... you can teach until you are blue in the face, but ultimately, it's the patient's decision to not care for themselves. If you don't accept the fact that patients have free will, FREE WILL, you're going to drive yourself nuts!

You sound like an excellent caring nurse. Try this instead... "how many cigarettes do you smoke a day?, today, lets focus on smoking two less, than let's see what we can focus on tomorrow.".

If you don't find alternative ways to support patients and interject your thoughts and feelings, you will NEVER meet their needs for find ways to enact change.

It takes small steps, and very sneaky, not all or nothing steps to help. Do NOT judge, find ways to support change and success. You are going to fail your patients with the current mentality you have and you can make a difference if it starts with you. This is a tough population, just think outside the box.

EmergencyNrse · Oct 17, 2011

Healthy enough to go outside to smoke... healthy enough to be discharged.

You can't keep them held hostage but decisions have consequences. .

I offer a nicotine patch and some chewing gum. That's it. You leave and it's AMA. You're gone. Come back when you really need us....

Orange Tree · Oct 17, 2011

The patient is not trying to make you mad ...and "tax-paying America" pays for worse and more expensive things.

Zookeeper3 · Oct 17, 2011

Healthy enough to go outside to smoke... healthy enough to be discharged.
You can't keep them held hostage but decisions have consequences. .
I offer a nicotine patch and some chewing gum. That's it. You leave and it's AMA. You're gone. Come back when you really need us....

Ah the ER nurse mentality, I've had it too. You only have these folks a short time and can't change an entire lifetime of bad choices in your brief interaction... or can you? You are the first line of defense and sometimes the only interaction these people come across. Isn't there any other options? These folks need help, education and yep, they'll go about their wrong ways... but what if something you say, makes a difference. Sounds crazy, but ya never know. It's when we stop trying to enact change, that change has no possibility of happening.

Daisy_08, BSN, RN · Oct 17, 2011

I makes me mad too but, that's his choice. I'm in Canada, so we all pay for each others healthcare weather or not you take care of your body.

As a nurse, you can only educate and offer the alternatives (patch, gum ect). I dont believe it is right, or legal to confine someone wanting to go out for a smoke, unless they are danger to themselves or others. Even psych pts get to go out for smokes. However I would not be doing anything extra so they could go. I once worked with a nurse who would spend FOREVER! getting some of these smokers ready. Putting on leg bags, finding w/c's dressing them, getting them warm blankets, transferring IV's & tube feeds. No way would I go to that much trouble! I help them transfer, do normal care and after that they were on their own.

Also a long time smoker with all the negative health effects of smoking, a nurse telling them what they already know is not likely to make them quite. They have to want it for them selves.

I had a pt, she was vented 24h for months, now just at night, as soon as she could she started smoking again. I goes to show you have to want it for yourself.

Deb123j · Oct 17, 2011

When I worked on the floor I would sometimes have this same situation. My hospital is a total no-smoking hospital, family members/patients have to cross the street across from the hospital to smoke.

I work 7p-7a, during this time patients are not allowed to leave the floors, only from 1000-1800. When I pass along this information to some patients they continue to insist that they are going to go smoke. I let them know that, although they are adults, this is our policy and if they do leave I will contact security and they will be brought back. Most patients will comply, however there are a few who sneak out (some return others not) or leave AMA. For all who c/o the need to smoke, I off to get a nicotine patch, however most don't want it. HTH

Zookeeper3 · Oct 17, 2011

Just want to vent. Does anyone else have a major problem with this?? Patient admitted for COPD exacerbation. Patient is on home nebulizer treatments, inhalers, etc.. for the treatment of his COPD. Patient admitted tonight and told the nurse he would be leaving to go smoke and there is no way we can stop him (I know we can). Patient is a medicaid patient which basically means I (along with the rest of tax-paying America) is paying for his hospital admission and medications for his respiratory disease..and he is insisting he is going to smoke. makes me soooo mad!!:mad:

How is he different from the non-compliant diabetic, the obese patient, the hemodialysis patient that misses appointments, the new CVA that didn't take their anti-hypertensive meds.... all your ER frequent flyers, most without primary insurance.

Surely some one in this group is worthy of your time and education to decrease our tax paying dollars? Or just this guy? Many people rack up financial costs in this crazy system. Instead of being frustrated with this population, perhaps your energy could be better spent on education and prevention? I've just listed a few non-compliant groups, take your pick. I'm not trying to be nasty, but I thought that was what we do? And YES, yes, I've worked the ER. If you aren't part of the solution, you are part of....

nerdtonurse?, BSN, RN · Oct 17, 2011

I had a person who was on home O2, in with COPD exacerbation, 3 ppd smoker. Got her a nicotine patch. Did a med pass, she wasn't in the room. Now, this is someone who desats into the 70's if she's not on O2. She'd called hubby, he'd come and got her and wheeled her out to smoke with the nicotine patch on. This is after we'd told her she could not go out to smoke (liability, we had someone who was still drunk go out to smoke, trip, and then sue the hospital). I told her to stop smoking, she could give herself a heart attack, and she told me to leave her alone and called me everything under the sun. I'm telling her, "you could have a heart attack and DIE, stop smoking or take off the patch, RIGHT NOW." She refused to do either, so I reached over, took off the nicotine patch, and went back up stairs to call her doc. Unfortunately for her, this doc didn't like stupid.

She came back 30 minutes later to find her stuff in a bag and her AMA paper stapled to it (doc's verbatim order) and her room in the process of being cleaned. She threw a screaming fit, and when we told her she was discharged, she had hubby wheel her to the ER to be readmitted. ER doc refused. So, she went to the car, called 911, and they brought her by ambulance all of 50 feet from the car back to the ER. She threw another fit when the ER doc pointed out if she could get up to all that, she didn't need hospitalization. Finally the cops came and got her after she slapped the ER doc.

You can't fix stupid.