Excessive smoke breaks

[ProgressiveActivist, BSN, RN]

I would really like some advice on how to handle this situation. I am working 12 hours nights in a busy ICU. We have a 61 year old CNA - the only CNA and no secretary- who takes a smoke break twice an hour. She is often gone as long as 40 minutes. Even during a code or when we have a very unstable pt or admission or if she is supposed to be watching a confused patient she will leave the patient, go out to med surg and find someone to sit so that she can smoke.

She just disappears. She does not inform anyone that she is leaving the unit.

Obviously this is really compromising patient care.

If for some reason she is tied up helping with something she has a full blown nicotine fit and snaps at everyone, slams things, rolls her eyes and gives everyone hard looks. Unless administration or an MD is around, then she is the sweetest little woman in the world.

Now I am lucky if I have ten minutes to eat something which I normally do around midnight.

This CNA has a long smoke break, a meal break, another smoke break and essentially does nothing for two hours.

No one that I work with wants to confront this person and our manager feels she is a great worker (she told him so).

Has anyone out there had any success in addressing the problem of excessive breaks by the people who are supposed to be your ancillary staff?

[JDZ344]

No. We have this problem too.

[adiaz731]

So she takes two smoke breaks in an hour and is gone for 40 min when she goes? Didn't know it was possible.

[ProgressiveActivist, BSN, RN]

'often gone as long as 40 minutes' is what I wrote. Twice an hour is not an exaggerration. One night I counted 32 extended absences.

[Dazglue, ADN, BSN, MSN, RN]

We're a smoke free facility now. Now we don't have that problem anymore...

[jess1018]

Most people I work with do not smoke.You may not want to make it awkward by confronting this CNA but patient safety and care is being compromised. It's just that not only is it not fair for the none smokers to have to pick up the slack when they are out on break the main reason of why it's wrong is because it's not safe for patients. You would report someone else if they were sitting in the break room during a code so why not report excessive breaks. I also think that instead of counting all the times they are gone you should discuss the problem with the CNA yourself because ultimately it is the RNs license on the line. If talking to them about it doesn't help then go to your superior.

[VICEDRN, BSN, RN]

I would chalk it up to occupational hazard of night shift. I love the night shift but I find that people like thus also gravitate to nights when there is less oversight.

Since the manager is convinced this person is a super hero, I think there is little you can do other than avoid working on those shifts he likes to work if it really bothers you.

Next up: encourage administration to have a smoke free workplace so conflicts like this never come up!

[rngolfer53]

No. We have this problem, and it goes right from the nicotine addicted charges nurses down to the chain smoking NAs. None of them do it if management is around, so management do not know the true extent of the problem (I am talking about 4 or 6 people just walking off directly report is finished, without even looking at any of their patients and being gone for 40 minutes).

Nothing has worked in our unit so far to stop this. If you find anything that DOES work, shout my way because I am sick of it.

If they don't smoke when the bosses are around, they're just lazy. It has little to nothing to do with the need for nicotine.

About all you can do is build a carefully documented record, so when they return to find one of their Pts in full rigor mortis you won't get stuck holding the bag.

[Indy, LPN, LVN]

Look at it this way. You don't need to worry about ruining a working relationship with this employee, because it's already bad. So you have to do the reporting. Repeatedly. I have been in this situation, 6 bed ICU, RN working with an LPN who managed to be absent 6 hours total time one night. I was not amused. Each time she left, a minute after she left, (without getting coverage, leaving me by myself) her patient started hollering and was found to be poopy. Seriously. I missed getting a thorough enough chest pain assessment done on my patient due to cleaning up her patients. I wrote it up nine ways to sunday, even though one hour of her time that she missed in the unit was due to attending a code in the ER. I had to explain myself to the cardiologist the next morning so she had to explain herself to the CNO and unit director.

Yes, she was bad to work with afterwards but I didn't care! People are paid to work not smoke! If she had even once asked, or shown some consideration, or made sure her patients were in good shape first, I would not have had an issue with it. I told her straight up that I agreed with the policy of having coverage for your smoke breaks and I required that she do this. We did not get along but she has figured out that I'm not doing her work for her. We still don't get along. That's just life but my license, and my job, are good.

[Kooky Korky, BSN, RN]

The short answer is that you already know what to do, I guess. Believe me, I understand your fear and your not wanting to have to be the one to speak up.

How do you know what the Manager thinks? Have you spoken to the Manager?

Have you ever tried talking to this woman? Just plain and simple talking to her might get her attention. Doubtful, but if it works, you won't have to go to the boss.

You could try asking her if she realizes how long she is gone, how often she goes, who does she imagine cares for the patients while she's gone?

If she is being a sitter, is she allowed to leave the pt alone to go get someone from Med-Surg to cover for her?

How soon will she retire?

Does the House Supervisor know about these disappearances? If not, he or she needs to know.

Here's the scary and worst part. You have to cover yourself. You are not effectively supervising her. The law frowns upon this and you likely will be sued, fired, maybe lose your license. Your communication should be not only verbal but in writing to the Charge Nurse, the House Sup, the Manager, whoever the Manager's boss is, and so on, and you should also inform the MD who is Chief of Staff or Chief of Service (Med, Surg, whatever specialty you guys work in).

If I were a lawyer, I'd sue you on behalf of a patient who suffered harm because you did not make sure that this aide did her job properly. Yeah, it stinks because your boss hasn't helped you so far. He also has liability but will deny that he knew anything about her errant ways. Believe me, the s--- will roll downhill and onto you.

Make sure your communiques are in writing. I'm sure you can see why. Even if it's email and you send yourself a copy to your personal home email, at least you will have proof that you notified the bosses.

Furthermore, picture this scenario. Suppose she goes out to smoke, has a heart attack, drops over, and breaks her skull, her leg, whatever, or freezes to death or maybe she gets attacked by a thug. No one misses her for a while, no one goes to look for her. She sues you for letting her behave the way she does.

I've heard of stranger things - like the burglar who gets bitten by the homeowner's dog and SUCCESSFULLY sues the homeowner!!!

Let your coworkers know what you've read here and remind them that they are all liable, being nurses. Although I guess the Charge Nurse might be more liable for pt harm or harm of this aide. But I'm not a lawyer.

Anyway, I wish you good luck. Just get it done. Bite the bullet, stick together, don't let any nurse off the hook. All of you are responsible.

It's so rotten when the boss is wrong.

As for her temper tantrums - let her have them. Just point them out to anyone who happens along - like a doctor, the supervisor, etc. And, as someone said above, don't worry that she will dislike you or try some other baloney with you. She is already running you.

[Kooky Korky, BSN, RN]

If they don't smoke when the bosses are around, they're just lazy. It has little to nothing to do with the need for nicotine.

About all you can do is build a carefully documented record, so when they return to find one of their Pts in full rigor mortis you won't get stuck holding the bag.

I don't think you can just wait for a pt to suffer harm. You are not effectively supervising if you don't correct problems. You are liable for that harm that you knowingly could foresee but did not try to prevent.

[Kooky Korky, BSN, RN]

Look at it this way. You don't need to worry about ruining a working relationship with this employee, because it's already bad. So you have to do the reporting. Repeatedly. I have been in this situation, 6 bed ICU, RN working with an LPN who managed to be absent 6 hours total time one night. I was not amused. Each time she left, a minute after she left, (without getting coverage, leaving me by myself) her patient started hollering and was found to be poopy. Seriously. I missed getting a thorough enough chest pain assessment done on my patient due to cleaning up her patients. I wrote it up nine ways to sunday, even though one hour of her time that she missed in the unit was due to attending a code in the ER. I had to explain myself to the cardiologist the next morning so she had to explain herself to the CNO and unit director.

Yes, she was bad to work with afterwards but I didn't care! People are paid to work not smoke! If she had even once asked, or shown some consideration, or made sure her patients were in good shape first, I would not have had an issue with it. I told her straight up that I agreed with the policy of having coverage for your smoke breaks and I required that she do this. We did not get along but she has figured out that I'm not doing her work for her. We still don't get along. That's just life but my license, and my job, are good.

Bravo! And it's always good to invoke the employer's Policy. No one can fault you for that.