COPD patient wanting to leave to smoke

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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::mad:

Specializes in neuro/ortho med surge 4.

On my unit there is a middle aged lady who is waiting for placement due to alcohol abuse. She has been on our unit since July. Sometimes she takes her self out to smoke. The Mds told us it is our fault if she goes out to smoke. Short of a 1to 1 or restraints we cannot watch her 24 -7.

Craziness.

Sorry about the bold. Do not know how to shut it off.

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On my unit there is a middle aged lady who is waiting for placement due to alcohol abuse. She has been on our unit since July. Sometimes she takes her self out to smoke. The Mds told us it is our fault if she goes out to smoke. Short of a 1to 1 or restraints we cannot watch her 24 -7.

Craziness.

Sorry about the bold. Do not know how to shut it off.

How is it your fault? What do they want you to do ? I wouLD raise a big scene if someone said this to me. Reason 123123412351235 i hate this job. But the money is pretty good!

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Specializes in Rehab, critical care.

Is it wrong that I read the title of the post and just started laughing? I have a weird sense of humor, though. How about a gastric bypass post-op wanting to eat candy bars? lol (this is not an actual situation I've seen..it's on one of those funny nurse videos; the gastric bypass patient..."no, you can't eat 15 meatballs" lol).

In all actuality, it is very sad, and I do have compassion for these people. Their lives were ruined by smoking. Nobody really knew it was bad for you back in the day, just a thing that everyone did. Sad. At most hospitals, the patient wouldn't be allowed to leave to smoke. If they want to do that, they get discharged AMA. So, they would get a nicotine patch and educated on the importance of smoking cessation. Why does your hospital allow this? It's not safe for many reasons...the patient leaves to smoke and then codes or doesn't come back. So, the nurse just goes out with the patient for a smoke break while neglecting his/her other patients? lol

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Specializes in neuro/ortho med surge 4.
How is it your fault? What do they want you to do ? I wouLD raise a big scene if someone said this to me. Reason 123123412351235 i hate this job. But the money is pretty good!

I have no idea how it would be the nurse's fault. It was not said to me but another nurse. I am tired of everything being the nurses fault too but I guess that is for another discussion.

Maybe the MD said this because he does not want the blame laid at his feet. I do not think the MD would hear about it but who knows. I don't think MDs understand what a nurse's job entails. I really don't and I think that is the dilemma right there. They probably think we have all the time in the world to monitor this very able bodied woman.

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Specializes in telemetry.

justashooter, I think you read me a bit too literally. :) I know I cannot hold the guy here..I just meant I can stop him by sending him home AMA..My hospital is a smoke free campus. Nobody can smoke. In addition, tele monitored patients are not allowed to leave the floor. I caught the man smoking 3 times last night and guess who got sent home AMA?? However, he was able to obtain his pain medicine scripts before he left (which is why he later admitted to us he came into the hospital in the first place).

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How many know what the effectiveness of nicotine patches (or any NRT) is? At one year, it's about 3%, i.e., 97% failure rate. At 2 years, it's even closer to a 100% failure rate. Nicotine addiction is a myth that serves antismoking interests and makes a lot of money for the pharmaceutical industry. The idea dates back to the 1850s through to pre-WWII in America. That period is characterized by the eventually dangerous fanaticism of the Temperance and Eugenics Movements. Unfortunately, the contemporary medical establishment is starting to sound very much like the physician-led eugenics movement and its dictatorial tendencies with smoking/smokers being the convenient scapegoat/"whipping boy" of the time.

How did the medical establishment deal with smokers before the current antismoking crusade? Unfortunately, fanaticism breeds bigotry, from the institutional level right through to the individual level. Medical staff really need to be careful that they don't deteriorate onto the antismoking bandwagon. As someone has already mentioned, hospitals are not prisons, nor are they high-schools.

There is a strong psychological component in smoking. Being in hospital provides some of the strong reasons why many people smoke - boredom, anxiety, foreign surroundings, time to contemplate. And antismoking fanaticism has produced another reason. On being admitted to hospital, smokers are met with what could well be described like a cult mentality utterly intent, even through coercion, on "converting" the patient to antismoking, i.e., rabidly antismoking. The intent in the recent past is to place as many obstacles before the smoker as possible if they want to smoke. They have to walk off the entire grounds - in bed clothes and all weather - to have a cigarette. Regardless of what a patient is in for, they are "screened" for their smoking and immediately put on the useless NRT that gets the cash register chinking over for Pharma. It would be understandable that smokers would become suspicious and anxious of the medical stance and the "wall" that has intentionally been put before them. The added psychological pressure just becomes another motivation to just get away for a moment and have a smoke. The current situation, borne of fanaticism, promotes agitation both for the medical staff and the patient. The patient will probably end up smoking anyway, but everyone is potentially left agitated. Why would we intentionally create such a situation, unless we are not thinking straight?

For those who claim that smokers are costing the system, smokers are charged compounded extortionate taxes on cigarettes that cover so-called "extra" medical services many times over.

Let's get some understanding back in the circumstance.

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Specializes in Oncology.

It just amazes me that places let patients leave the unit. Once you're admitted at my facility you're there until you leave AMA or are discharged. No going to the cafeteria, gift shop, or outside. I mean, how is risk management okay with patients leaving? Isn't that a huge liability? What if they pulled their central line/trach/foley/chest tube/nephrostomy tube/et al? What if they fall down the stairs? What if they use their IV to do drugs? What if they sell drugs they're been hording? What if they pass out from the antihypertensives you gave them? What if they become hypoglycemic from the insulin you gave them? We do hourly rounding and charting on our patients. How can you do that if they're off the unit?

We'll give them nicotine inhalers/gum/patches/all three til we're blue in the face.

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Specializes in neuro/ortho med surge 4.
How many know what the effectiveness of nicotine patches (or any NRT) is? At one year, it's about 3%, i.e., 97% failure rate. At 2 years, it's even closer to a 100% failure rate. Nicotine addiction is a myth that serves antismoking interests and makes a lot of money for the pharmaceutical industry. The idea dates back to the 1850s through to pre-WWII in America. That period is characterized by the eventually dangerous fanaticism of the Temperance and Eugenics Movements. Unfortunately, the contemporary medical establishment is starting to sound very much like the physician-led eugenics movement and its dictatorial tendencies with smoking/smokers being the convenient scapegoat/"whipping boy" of the time.

How did the medical establishment deal with smokers before the current antismoking crusade? Unfortunately, fanaticism breeds bigotry, from the institutional level right through to the individual level. Medical staff really need to be careful that they don't deteriorate onto the antismoking bandwagon. As someone has already mentioned, hospitals are not prisons, nor are they high-schools.

There is a strong psychological component in smoking. Being in hospital provides some of the strong reasons why many people smoke - boredom, anxiety, foreign surroundings, time to contemplate. And antismoking fanaticism has produced another reason. On being admitted to hospital, smokers are met with what could well be described like a cult mentality utterly intent, even through coercion, on "converting" the patient to antismoking, i.e., rabidly antismoking. The intent in the recent past is to place as many obstacles before the smoker as possible if they want to smoke. They have to walk off the entire grounds - in bed clothes and all weather - to have a cigarette. Regardless of what a patient is in for, they are "screened" for their smoking and immediately put on the useless NRT that gets the cash register chinking over for Pharma. It would be understandable that smokers would become suspicious and anxious of the medical stance and the "wall" that has intentionally been put before them. The added psychological pressure just becomes another motivation to just get away for a moment and have a smoke. The current situation, borne of fanaticism, promotes agitation both for the medical staff and the patient. The patient will probably end up smoking anyway, but everyone is potentially left agitated. Why would we intentionally create such a situation, unless we are not thinking straight?

For those who claim that smokers are costing the system, smokers are charged compounded extortionate taxes on cigarettes that cover so-called "extra" medical services many times over.

Let's get some understanding back in the circumstance.

Before the fanaticism against smoking began patients could smoke in their rooms. I remember as an 11 and 12 year old smoking in department stores. Hospitals did not have to deal with it because there were no bans against it. Even the MD's smoked.

I feel that people who smoke are looked at as if they are some kind of criminal. It is their right to smoke and it is still legal. Cigarrettes will never become illegal because of the exorbitant taxes generated from their sale. I think the hospitals should have some kind of a system set up for smokers. I think all of the aggravation on both sides could be avoided if people could just have one lousy cigarette. Unless you have smoked you do not understand how strong the urge is.

I used the patch to quit 14 years ago and it does work for some people.

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Specializes in HH, Peds, Rehab, Clinical.
How many know what the effectiveness of nicotine patches (or any NRT) is? At one year, it's about 3%, i.e., 97% failure rate. At 2 years, it's even closer to a 100% failure rate. Nicotine addiction is a myth that serves antismoking interests and makes a lot of money for the pharmaceutical industry. The idea dates back to the 1850s through to pre-WWII in America. That period is characterized by the eventually dangerous fanaticism of the Temperance and Eugenics Movements. Unfortunately, the contemporary medical establishment is starting to sound very much like the physician-led eugenics movement and its dictatorial tendencies with smoking/smokers being the convenient scapegoat/"whipping boy" of the time.

How did the medical establishment deal with smokers before the current antismoking crusade? Unfortunately, fanaticism breeds bigotry, from the institutional level right through to the individual level. Medical staff really need to be careful that they don't deteriorate onto the antismoking bandwagon. As someone has already mentioned, hospitals are not prisons, nor are they high-schools.

There is a strong psychological component in smoking. Being in hospital provides some of the strong reasons why many people smoke - boredom, anxiety, foreign surroundings, time to contemplate. And antismoking fanaticism has produced another reason. On being admitted to hospital, smokers are met with what could well be described like a cult mentality utterly intent, even through coercion, on "converting" the patient to antismoking, i.e., rabidly antismoking. The intent in the recent past is to place as many obstacles before the smoker as possible if they want to smoke. They have to walk off the entire grounds - in bed clothes and all weather - to have a cigarette. Regardless of what a patient is in for, they are "screened" for their smoking and immediately put on the useless NRT that gets the cash register chinking over for Pharma. It would be understandable that smokers would become suspicious and anxious of the medical stance and the "wall" that has intentionally been put before them. The added psychological pressure just becomes another motivation to just get away for a moment and have a smoke. The current situation, borne of fanaticism, promotes agitation both for the medical staff and the patient. The patient will probably end up smoking anyway, but everyone is potentially left agitated. Why would we intentionally create such a situation, unless we are not thinking straight?

For those who claim that smokers are costing the system, smokers are charged compounded extortionate taxes on cigarettes that cover so-called "extra" medical services many times over.

Let's get some understanding back in the circumstance.

By your theory, that "chinking cash register in Pharma" has already been covered by the patient in the "extortionate taxes" they are forced to pay when they buy their smokes.

What about the "so-called" extra medical services required by a non-smoker who has the "pleasure" of living with a lung condition caused by the smoker they live with?

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Specializes in Med/Surg.
It just amazes me that places let patients leave the unit. Once you're admitted at my facility you're there until you leave AMA or are discharged. No going to the cafeteria, gift shop, or outside. I mean, how is risk management okay with patients leaving? Isn't that a huge liability? What if they pulled their central line/trach/foley/chest tube/nephrostomy tube/et al? What if they fall down the stairs? What if they use their IV to do drugs? What if they sell drugs they're been hording? What if they pass out from the antihypertensives you gave them? What if they become hypoglycemic from the insulin you gave them? We do hourly rounding and charting on our patients. How can you do that if they're off the unit?

We'll give them nicotine inhalers/gum/patches/all three til we're blue in the face.

Holy cow. How do you make the connection between someone wanting to go out to smoke to THIS??

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Specializes in neuro/ortho med surge 4.
Holy cow. How do you make the connection between someone wanting to go out to smoke to THIS??

I would think of all of these things also. It is our responsibility if the patient leaves the floor to smoke and something untoward happens to them. The buck stops with the RN as it always does.

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"what about the "so-called" extra medical services required by a non-smoker who has the "pleasure" of living with a lung condition caused by the smoker they live with?"

colleen, no, i'm not only referring to the essentially useless nrt that pharma predominantly benefits from. i'm referring to all "so called" extra medical services.

we need some background on how we got to this point. a good background on the current antismoking crusade can be found at - the godber/who blueprint. it also provides detail on just some of the shenanigans, contortions, and lies that have been used to advance the antismoking bandwagon.

http://www.rampant-antismoking.com

the current antismoking crusade was planned in the 1970s by a small clique of antismokers operating under the auspices of the who. they decided for everyone that the world should be "smoke/tobacco-free". it involved denormalizing/stigmatizing smoking/smokers and it involved ultimately imposing indoor and outdoor bans. rather than ban the sale of tobacco, the goal this time was to essentially ban smoking in all the places that people typically smoke. these fanatics were already speaking of secondhand smoke "danger" years before the first study on shs (a considerably flawed study published in 1981 by the antismoker, hirayama).

antismoking is fanatical, extremist (with very few exceptions that involved only extortionate taxes, crusades have typically been exterminatory) it begins at the conclusion that smoking must be banned. it then works backwards to manufacture a believable enough storyline that will "justify" the bans. increased medical costs imposed on society is just one of these storylines. working out such costs is difficult with numerous assumptions involved. there was no such analysis when the fanatics first started peddling this storyline. eventually, one of their own, an antismoker, presented a cost analysis at one of the world conferences on smoking & health (see godber/who blueprint). he concluded, to the fanatics disappointment, that smokers do not cost society more in health costs. antismoking solution? disregard the analysis. there have been quite a number of other analyses over the years that all arrive at the same conclusion. these are simply disregarded because they don't fit the agenda. rather the antismokers use a highly questionable "cost multiplier" produced by the cdc's sammec program (cdc has long been committed to the smokefree "utopia" as have many other medically-aligned organizations. they are ideologically compromised).

http://www.nejm.org/doi/full/10.1056/nejm199710093371506

http://www.nber.org/chapters/c10891.pdf

http://iret.org/pub/advs-127.pdf

http://researchgate.net/publication/16777652_does_smoking_increase_medical_care_expenditure

http://tobaccodocuments.org/pm/2025824103-4122.pdf

http://www.tinyurl.dk/28679

http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050029

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