Do you allow Tele patients to leave unit to smoke?

Christie RN2006 · Jul 29, 2007

Is it illegal in Ohio to smoke outside? Im not being sarcastic..I really want to know because someone told me that in CA it is illegal to smoke outside even if you are on your own patio or porch and I always wondered if that was true or not.
I have never worked in a facility that was a smoke free campus so I do not know the legalities of refusing to allow a patient to smoke in that case.

In Ohio it is illegal to smoke in a public place... parks, hospitals, parking lots, bars, etc.

allnurses Guide · Jul 29, 2007

Actually facilities can refuse the pt the opportunity to smoke, if it is a non-smoking campus. In this county, for many years now, smokers who are admitted are placed on some kind of smoking cessation therapy: the patch or gum or Welbutrin.....for the duration of their hospitalization.

Yep, same here.

steph

fronkey bean · Jul 29, 2007

I wish we would go smoke free here. We had one pt (copd'er and chf'er) who would get in his scooter, push his iv pole and head out to the smoke hut where he would spend most of the day. Nurses had to go to him to give him meds or wait til he got back to the floor. He fell out of his scooter when he went home and lost partial use of his arms and, instead of taking him straight to the doc, his wife kept him home and held his cigs for him for several day!:trout: Finally brought him in and he had a partial c2 fx! He had a fusion and is now on vent and can't wean :uhoh3: .

pageygirl · Jul 29, 2007

very rarely i did take care of a patient who smoked 4 packs a day:owho refused the nicotine patch he was allowed to go out 3 times per day to smoke of course only with a Drs order. He also had ativan prn but refused that also but this is rare that we have a order to let the patient go and smoke

NeosynephRN · Jul 29, 2007

We are also a smoke free campus...so no going out to smoke at my hospital either. The patients are offered the patch, or Wellbutrin also. It would be a long, pretty dangerous walk to get off property to smoke, which even employees have to do....some people get some pretty long breaks!!

meownsmile, BSN, RN · Jul 29, 2007

Patients arent allowed to go smoke. Usually the patient will go to the lobby or gift shop and then moves out the door with friend or family to have a quick smoke. We dont know if they go out or not. Most patients will ask the first time, but after the lecture about a non smoking facility, and no place on grounds to smoke, and how bad it is blah blah,, they just go and dont tell anyone what they go for. We dont tie them to their bed and im not the police. My other patients need me too so for them to go downstairs and smoke if they do is between them and whoever stops them to tell them its not ok to smoke on property. Its not a matter of letting them. And we also have all the patches, gum etc available, however we have doctors that refuse to allow their patients the nicotine replacement too. Now that IS barbaric.

Sunflowerinsc, ADN, RN · Jul 29, 2007

We don't "allow" any patients to go out to smoke but some go anyway. We have been smoke free since 2000 so it is well known in the area what the policy is for hospital and grounds,including parking. But we can't restrain someone from going, of course. The are offered a patch and given the "speech". If we see (and smell) that someone is going, patch is dc'ed. Most of Doc's feel like if they are well enough to go outside,they can probably be discharged! Not as much of a problem as it was at first when the no smoking policy started. Our floor (as all med-surg) have remote tele and most of pt's are on tele ,we have enough calls from central monitor that leads are off ,going outside would really drive us crazy.

Blee O'Myacin, BSN, RN · Jul 29, 2007

Do you allow Tele patients to leave the unit to smoke or visit the cafeteria?
Under what conditions?
What are the legal ramifications?

Nope to both. If they are tele, then they can't leave the floor without a nursing escort and I am not going to the cafeteria or to inhale second hand smoke. Luckily, I have hospital policy on my side.

I'm also more than happy to provide the AMA papers on the days that I am pulled to the tele unit.

If the patient feels well enough to go smoke, then they are well enough for discharge planning. If the attending won't come up and sign the discharge papers, I am not going to keep someone against their will. I also won't compromise my health or safety by leaving the floor with a patient either.

Going for tests is one thing. I have a transport tech with me who can help with the heavy lifting. What if the patient goes into vtach while in the smoking lounge, or falls and it's just me to pick them up? And then there's the issue of being behind when you get back - or having to rely on other nurses to watch your patients when you leave the floor. It's unfair to everyone.

Blee

justavolunteer · Jul 29, 2007

I am 'justavolunteer' on a pt. unit. Our whole area now has smoke-free hospitals, including outside anywhere on the property. This includes employees, volunteers & visitors. They all changed last spring by common agreement.

I used to get pts even ask me to take them outside so they could smoke. There was no way in Hades that I ever would, of course.

The other thing I never understood was why smokers got so many extra breaks to go outside & smoke. Why those people considered it all right for another nurse to cover their pts. while they were outside, I could never understand. I never said anything because I'm 'justavolunteer', but I couldn't imagine that non-smoking nurses would be happy about it.

dawngloves, BSN, RN · Jul 29, 2007

Allow? No. But many have dissapeared and I've only known because their monitor reads, "No Signal" or they smoke in the bathroom. They are adults. What can you do?

steelcityrn, RN · Jul 29, 2007

I have seen it happen with a M.D. order to allow it. Most hospitals still have a designated smoking area that they would have to use. On a side note, I had to drive past one of our local hospitals last week, and gathered outside all over the sidewalks were employee's in scrubs smoking. I have to say that it really looked horrible. Not something you need to see on the front sidewalk.

Monica RN,BSN · Jul 30, 2007

legally you cannot prevent a patient from leaving to smoke..that is against their rights and considered holding against will however you can make them sign out ama or have them sign a release stating that while they are off the unit they take full responsibility.
[b]signing a release is the way i have seen it handled and they also must have an md order that clearly states they can leave the unit. however, a signed release truly will not prevent the hospital from a lawsuit if something were to happen to your patient while still on hospital property. [/color[/b]]
my current place of employment realizes the signing out ama is more trouble then its worth because of the readmissions therefore they have the release form for the patient to sign stating that while he's off the unit he/she takes full responsibility. the only problem with that is lets say im also outside when this patient falls to the ground in the smoking area or side walk a ambulance has to be called and the patient taken to the er before being sent back to the floor they are admitted to. we as staff members are not allowed to provide medical assistance unless it is cpr until the ambulance arrives. when i say medical assistance i mean we are not allowed to get a wheelchair and take them back to the unit...if a iv pump is beeping we are not allowed to correct the alarm....things like that...the patient is totally on their own unless they desire 911 to be called.we've had nurses refuse to let patients go smoke however when adminstration finds out about that we all get the lecture on how that is not legal and you are setting the hospital up for implications of false imprisionment or whatever legal term they choose to use at the time.

i do not doubt the guidelines in your hospital, but i will state that for the record, it would be (and is) neglect if a staff nurse did not intervine to help in such a case as if they had fallen with obvious or even potential injury, so you cannot get a wheelchair, but you can allow him to fall? what if the iv became dislodged and he was bleeding large amounts from the iv site.. we as nurses can not let him just stay outside and bleed..... i have a real problem with your hospital's guidelines. you are in tampa and in the state of florida we are mandated under duty to act laws to provide the care needed.

please allow me to clarify this: if you were just the average person driving to work or to the mall, or where ever, and you see an accident, you then have the choice to either stop and help or continue on... you are not legally liabile to provide care under the good samaritan law. you chose to either help or not to help..

now, if you decide to stop and help.. you now must stay with the victim until ems arrives, or until someone else comes and attends to the person.. if you leave the victim after you made the decision to stop to render care, you can be held liable for abandonment.

now, duty to act is a bit different with a twist. fla law says that any individual that is being paid to provide care to another individual now has the duty to provide a service, especially a nurse.. (you are being paid to care for clients) even outside on hospital property. i am quite sure the nursing board would also have something to say about a neglected (or injuried) patient who can not be helped by a nurse, noless, on hospital property. i would strongly suggest that this be a topic brought up in the hospital's risk management review for qi/qa as it deserves to be looked at from a legal perspective in order to also protect the hospital and the staff.

sorry so long, but this really can be a very real cause of potential liability that would be a valid concern to me.