Does your VA allow pts to smoke?

I work for VA in Las Vegas. I work in the psych unit as a VALOR student. The psych patients have 6 smoke breaks per day. We do have a smoking room that is ventilated here on the locked unit.

As for med-surg, I haven't worked there yet but I know the patients are allowed to go downstairs (3 floors) to smoke.

I am a new nurse on a med-surg unit in the VA system...question for my fellow VA nurses....does this happen to you? We are supposedly an 'acute care unit' but our patients are allowed to go off-ward and smoke/substance abuse, wander around the campus for hours (some actually go home for awhile!) then come back for 'whatever' they need.

It is demoralizing to the newer nursing & physician staff members (and a pain b/c the pts are often gone when it's time for meds and WE have to justify it to the computer!) but the 'old timers' seem to accept it as something that is a given and will never change.

Is this 'permission to smoke/go off ward anytime' a universal VA policy across the US? Seems SO wrong to me to aggessively/expensively treat for angina or COPD, 30 min later let them go off to smoke/abuse, then they come back for narcotics, EKGs upon demand. Would love to change things but don't need to pound my head against brick walls....and YES I do know this is the federal gov't!

4ZBirds

RN BSN

On the east coast

It's a chronic problem at my VA hospital. On my floor it's now policy that if the patient isn't getting anything IV, and they have a HX of substance abuse, the heplock is pulled. (too many were using the heplock to shoot up in their cars or the hotel across the road).

Also if the patient is gone more than 2 hours, you have to do a missing patient search. With 4 licensed and 1 unlicensed staff for 32 patients I just love sending my CNA to search the hospital and grounds.

:angryfire If the MD classifies the patient as competent and low risk for harm, we do an irregular discharge AMA. Which is lovely when the patient comes back and finds their bed stripped and belongings inventoried, bagged and waiting for them at the desk. I usually make sure security is onthe floor as soon as I see the patient come back.

The illicit drug problem is rampant at my hospital, have had to push narcan on a patient that wasn't prescribed any narcotic meds, but came back from being outside very sedated then his respers dropped to 6.

I just chart that "pt advised to stay on floor, pt went out to smoke" "pt not on floor during med pass" "meds admnistered late, pt had arrived back on floor" "pt advised to not stay off floor for more than 30 minutes""pt reminded of fluid restriction due to CHF and edema, pt seen returning to floor with 2 liter of cola."

Ultimately it's the patient's choice whether to be compliant, just do careful objective charting that the patient is advised of tx plan and consequences of not following certain restrictions.

Unfortunately the answer is yes, it is disruptive when you try to give medications on time and the patients are gone for hours. Now that I am in CCU the patients are not allowed to leave but the floor patients do.