A facility that allows patient smoking. Feedback and advice-guidance requested!!

TheCommuter, BSN, RN · Oct 30, 2012

I currently work at a freestanding rehabilitation hospital. Patients who are AOx3 can smoke unattended at any time they want. They either walk or self-propel their wheelchairs outside to the smoking area. The confused or brain-damaged patients are usually escorted to the smoking area by a nursing staff member who enjoys smoking, and since my workplace has multiple smoking employees, this works out well.

I once worked at a nursing home that 'smoked the residents' every two hours. Different departments accompanied the residents outside. For example, medical records smoked them at 7am, dietary smoked them at 9am, nursing smoked them at 11am, and so forth. If other disciplines failed to show up to smoke the residents, nursing would have to complete this task. It never worked out as planned.

Whispera, MSN, RN · Oct 30, 2012

It seems to me that if the other disciplines know nursing will have to complete the task if they don't, why would they feel they had to do their share? This is an unfair burden on nursing and needs to be addressed.

Lynx25, LPN · Oct 30, 2012

We are a smoking facility. It's a pain in the ass. We only do it three times a day, but nursing/CNAs do it each time. It's terrible because if we are behind, the patients are NOT understanding, and will often begin to curse, yell, and sometimes chant about SMOKE BREAK SMOKE BREAK SMOKE BREAK. Like the OP, they gather to go smoke right by my nurses station.

I'm very glad we do not have to do it every two hours, I'd never get anything done.

Ruas61, BSN, RN · Oct 31, 2012

Smoking issuses aside, you sound rather harsh an condemning about how you describe your patients.

Lipsmack · Oct 31, 2012

TheCommuter,Situation here is exactly as you described, except it doesn't work out well and my resentment is becoming huge! Would be a stupid reason to leave, but I guess it could come to that. Because it makes me genuinely unhappy to supposedly an advocate for patients' health and aiding them to ruin their health, and mine with second hand smoke.

Nurse ABC · Oct 31, 2012

Our hospital including rehab they sign a waiver assuming all responsibility for any risks associated by leaving the floor on their own. They can then leave whenever they want. If they are unable to go down on their own they either find a family member to take them, see if a nurse is available (usually one that smokes) but the nurses aren't required to, or they simply don't go. We do not cater to them by having set times and making it easy to smoke. Some of our doctors will even tell the patients if they go out to smoke they will drop them as a pt.(esp the ones with COPD). We offer nicotine gum, patches, etc to help them. I think by having set smoking times where the staff takes patients out to smoke sends the wrong message to the patient-that it's really ok to smoke since we're helping you do it!

brillohead, ADN, RN · Oct 31, 2012

I'm glad I live in a state that finally passed a "no smoking workplace" law.... I hate smoking so much that I'd want to slap nicotine patches on everyone and tell 'em to "buck up" and deal with it!

amoLucia · Nov 3, 2012

As a big-time ex-smoker (mid 1970's), I am usually sympathetic towards smokers. After all, we all have our own individual foibles. As tolerant as I am, I WILL NOT accompany anyone for the cig break. I cannot stand the smoke & smell anymore.

Not too long back, I worked a one place that allowed pt smoking is a designated area on an upper floor. Pts always were either going up or going down the elevators, back and forth, to smoke. The odor and HAZE would just drift down the elevator shaft and one was always 'captured' on the elevator going to or from the smoking area (IF and WHEN you could catch the elevator). And when that elev door opened, you were blinded by the smokey whiteout and I would gasp! I worked the unit just below that designated area and the nsg desk was just across from the elevators, so I was always getting exposed to extremely heavy 'second hand' smoke/haze.

I experience now some residual damage. While there, I developed a wheeze, went on to use a steroidal inhaler and have horrific URIs when I get a cold. Now I only need my nebulizer when I get a cold with a deep cough (which is how they all go). STUPID ME! At the time, I didn't associate the connnection between my exposure and my symptoms until well after I left that place. I also have some other respiratory issues left over that I must deal with.

Unless a facility is designated as SMOKE FREE, I have never seen a workable solution to this dilemma. As I said, I won't go out with a pt, nor will I require any other staff who refuse to do so. It becomes a problem on 11-7 if there's no smoker staff avail - oh well, it is what it is.

mappers · Nov 3, 2012

Can you tell the patients to go seek out the other disciplines when it is their turn? Can you overhead page them? It's not fair that nursing ends up with this, like others have said.

At the facility where I teach clinicals (a nursing home with rehab), it's like TheCommuter said. A&Ox3 can go out whenever they want. Others are taken out Q2H. There are four halls on the unit and someone from each hall is responsible and they rotate. I think most of the halls have a smoker, so it isn't a big deal. I'm pretty sure no one is required to do it so you can refuse and they are told not to see that as their "break".

I hate smoking and think it is a stupid habit. For adults who have all their faculties, I agree that they should not be allowed to smoke in public or around others. However, I'm not sure that a high-stress time, like being in a hospital or rehab is the best time to try to quit smoking. Also, for brain-damaged or dementia patients, is it really something they are capable of doing? We all have our vices you know.

turnforthenurse, MSN, NP · Nov 3, 2012

Now supposedly, when a patient signs their admission packet forms, it is stated that they are automatically signed out AMA if they leave the floor to smoke because we are a non-smoking facility. However, this is never enforced. It has been brought up to the higher ups in the past MANY times but again, it is never enforced. I think it has to do with those lovely "satisfaction scores." Instead, the patient is told that if they go downstairs for whatever reason, they cannot be properly monitored and therefore if anything happens to them, it is basically their fault and we are not responsible. Despite this, patients go off the floor anyway. We offer them a Nicotine patch and they still leave. Even though we are a designated non-smoking facility, it once again goes against our satisfaction scores....oh, the nurses wouldn't let me smoke?? well bad score for you, then! :sarcastic:

classicdame, MSN, EdD · Apr 24, 2013

I do not work in a rehab facility, but do not believe that babysitting smokers is a nursing duty. Have the MD's considered patches? Has Admin. considered patient injuries due to falls, etc. while outside? We are a non-smoking campus, partly due to patients going outside with PCA pumps and arranging for friends to meet them and aspirate out the happy juice.