COPD patient wanting to leave to smoke

[chris10lsuRN]

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:

[wooh, BSN, RN]

I prefer that to my asthma kids whose parents won't stop going outside to smoke, then complain about the cost of the asthma meds.

I just get tired of being stuck between a rock and a hard place.

Last job, they told us the patients couldn't go out to smoke without a dr order. Like the docs were actually going to write an order. So I asked what to do when they went out to smoke without it. And management just kept saying they couldn't. Ok, then when they do, because they will, what do we do? Finally they suggested using our therapeutic communication. Basically, the policy was only there so the hospital could pawn the liability off onto the nurses. So I'm liable for what happens when they're outside, but have absolutely no power to stop it.

[Altra, BSN, RN]

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.

Are you more tolerant of smokers admitted for COPD who have private insurance?

And do you know that they have private insurance within 10 minutes of their arrival to your unit?

[Anna Flaxis, BSN, RN]

I don't really care if they have Medicaid or some kind of private Cadillac insurance. I'm of the opinion that every U.S. citizen deserves health care. My gripe has more to do with the dearth of primary care.

[Anna Flaxis, BSN, RN]

I had a person who was on home O2, in with COPD exacerbation, 3 ppd smoker. Got her a nicotine patch.

A nicotine patch? As in ONE? For a 3 PPD smoker? Totally, completely inadequate.

[chris10lsuRN]

not particularly tolerant of COPD smokers period..and I have the face sheet which shows how they are paying. Wasn't trying to be ugly. I was just annoyed that situations such as these (along with non-compliant diabetics, CHF-ers, hypertensives, etc..) are covered under government funds. It seems that insurance can deny you for certain things, yet tax dollars can pay for non-compliant patients.

[Anna Flaxis, BSN, RN]

...and tax dollars subsidize tobacco.

[chris10lsuRN]

you are absolutely right!

[Anna Flaxis, BSN, RN]

I wasn't trying to be ugly either. I agree that people we like to label as "noncompliant" can be aggravating to deal with. I just think that everybody deserves health care, even if they're poor. And until we have a better system in place, there is Medicaid.

[EmergencyNrse]

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?

Naaaaah, stopped trying to fix 'em long ago. Life/Living isn't always for some people.

Maybe it's a hard statement but true. I see so very many people trying hard to be healthy

that we can't fix. I could give a rodents behind about those with self-abuse tendencies

that are rude, demanding, and behave in a manner that is socially unacceptable. I don't get paid

for the abuse. I don't have to take it.

You are either here for help or you're not. There are standards that must be met/upheld during

their inpatient visit or they go away. I'm here to help but it will not be on THEIR terms. I will be

kind, courteous, and respectful until you no longer allow me to do so. I said it before, there are

consequences for your decisions and your behavior. Follow the rules or you're gone.

(Better yet, show your true behind and I sent you to jail).

Thankfully I work in a hospital that does not always cave to the Press Ganey and patient opinion

whatever the cost. As described in another scenario where the patient was discharged AMA, We

do it all the time. God I love my job. Love my employer. Sets a high standard and meets that standard.

[Bortaz, MSN, RN]

Let the old dude smoke. He'll be dead soon, and this habit is probably one of the few joys he has in his life.

Just because society now has different views on smoking doesn't mean it's a cakewalk for this man (or anyone) to move on from a LIFETIME addiction to a very addictive drug.

Until you're lying there, dying and craving your addiction, NEEDING that cigarette, I don't think you should be so damned judgmental...regardless of whether the old fella can afford to pay the exorbitant medical bills he's wracking up.

[talaxandra]

I don't know of a smoker who's unaware that it's bad for them, and I'm happy to work with them on alternatives, like patches, but I also think that people are not in the best position to make major lifestyle changes when they're acutely ill, so I offer but don't push it.

It's taken me a long time but now I refuse to care more about the patient's health than they do.

[chris10lsuRN]

Bortaz, I am only judgmental b/c the guy is here seeking treatment for his cigarette induced exacerbation..and says he is awaiting a lung transplant. As far as letting the old guy smoke..I cant let the guy smoke. smoke free hospital, smoke free campus, and the guy is on a tele monitor..cannot leave the floor or we cannot pick up his rhythm. What's the point of treating his illness if everything we do will be undone by his cigarettes?