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:

[Bortaz, MSN, RN]

Nothing you do is going to save him, anyway.

[talaxandra]

And he won't be getting a transplant, either.

[chris10lsuRN]

and guess who I just caught smoking in his room...sighhhhh

[Thujone]

I believe if one wants to smoke then let them smoke. It's their life. They paid taxes all their life too. I'm not an advocate for smoking by any means, but I do believe in free-choice.

[Quickbeam, BSN, RN]

My opinion on the "mean to ER staff/nice to floor staff" dichotomy......ER is the gate keeper. They have to get through the ER to get to the floor (goal) with a nice clean bed and meals.

I've worked places where it was a mile to go to the nearest place to smoke. The admin policies were always a little vague about whose responsibility it was when patients went AWOL to smoke. With nights so lightly staffed, it is a hardship to track these folks down, knowing that no matter what, the RN will end up being responsible.

[bulletproofbarb]

COPD smoker patients are the same as renal patients who eat food high in salt, drug addicts who get septic, diabetics who eat cakes, lollies ect, people with epilepsy who drink alcohol, and i am sure everyone can think of another example.

Stop stressing about it, it is their life..governments waste tax money on all sorts of rubbish so dont look at it as "your taxes". The chronically ill non compliant patients keep us in a job.

It seriously does not bother me. If they want to come in and out of hospital due to failing health from non compliance that is their choice. I'll give them the basic education and leave it at that.

[imintrouble, BSN, RN]

We have no policy concerning smokers who go outside with no MD order. We can tell them they can't go, but if they insist we can't stop them. We can't even threaten them with discharge. They know we are powerless. I've even had them look at me and say "What are you going to do about it?"

Some will tough it out with a patch and some Ativan.

Some will get on the elevator with the patch and the Ativan, smoke and come back. Smirking at me the whole time knowing NOTHING is going to happen to them.

Some will smoke in their room which is the worst scenario of all. I can't even stop them from doing that.

I can't stop the diabetic's family from bringing in "snacks" of cookies and chips.

I can't stop the CP's family from bringing in KFC for supper.

I can't stop the NPO pt from going to the bathroom and drinking from the faucet.

After too many years of trying to make my patients well, I've decided I can't if they don't want to. I give the warnings and advisories, hope for the best, and let it go when the sick don't want to get better. Otherwise I just make myself as sick as them.

[rngolfer53]

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.

Yes, people do have free will, but choices have, or should have consequences. Otherwise, it's not really autonomy we're asking them to exercise.

Continuing to spend thousands on exacerbations of COPD and other smoking-caused diseases in the non-compliant patient means that that money is not available to others. Like it or not, resources are always limited. Doesn't really matter if the check comes from Medicaid or Blue Cross.

Really, when we let someone go out to smoke, then continue to treat them aggressively, we're just enabling them to make more money for the cigarette sellers by living a few months longer. Pimping for Phillip Morris, as it were.

A trade off of "smoke and get palliative care, or quit and get aggressive care" is something people are fully capable of understanding.

I'm not so amazed at the hospice Pts with COPD who continue to smoke--it's too late in their cases--but in the family who are watching Uncle Fred die from smoking, all while puffing away themselves.

[MomRN0913]

Sorry, I don't agree with this. Abuse of health care dollars. We don't let our DT patients go outside and drink a 5th of vodka, do we?

Free will is fine. You can freely sign yourself out AMA if you are going to be non-compliant and have to go out and smoke.

[enchantmentdis, 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.

My hubby is a smoker, had to have his gut ripped open from stem to stern when his appendix burst. He was awake and ambulatory on day two and thereafter upon admission to the hospital, and never asked to go outside to smoke. Nice guy. He was just glad he survived appendicitis. However, when they made him room with a drug-using, alcoholic patient he put his foot down and got a room change. He called me the next day and told me how manipulative the guy was and how sorry he felt for the nurses.

[enchantmentdis, BSN, RN]

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?

Also, these idiots tend to fall, bash their heads open, can get hit by a car, etc....Guess who'se responsible then---the nurse, of course. Then they get x-rays, ct scans, a sitter, wow, the squeaky wheel does get the grease doesn't it. Incident reports must be filled out---yada, yada, yada. I even had a patient set his bed on fire after family members brought cigs to him. We pulled him out of the room, saved his life--wasn't grateful at all. And his family said we didn't watch him closely enough. And several of us had to go home choked from the smoke. God, i love hospice pt's now.

[nurse0520]

I had a similar situation, a women admittted for just setting herself and apartment on fire for smoking while using oxygen. She imediately want to smoke and was on med assistance and stated to me she was paying to be here like we were a hotel service.