Beating my head against the wall - page 3

Ughh. Today MD writes an order ok'ing for a pt to smoke (we have facilities available.) Pt is on respiratory isolation. Infx control people say it's ok as long as we take appropriate precautions... Read More

  1. by   live4today
    originally posted by outbackannie
    sounds like doc just "passed the buck" so he'd still look like the hero to the patient. bet he wrote the order and "booked" right out the door before anyone had a chance to corner him!
    that's because "doc just passed the buck" on the wrong nurse, outbackannie. he just hasn't met his match in a nurse yet. let me at 'em. he'd think for a 'sec' before even letting those words come out of his mouth to me. i backed down from an egotistical doc only one time....during my student nursing days...quickly learned my lesson...thanks to my nursing instructor at the time...and ever egotistical doc has never stood a chance up against this nurse. nurses must....absolutely must...stand their ground for the protection and safety of all their patients, and this doc's request for his patient was totally one that no nurse could safely carry out without placing her other patients' lives in jeopardy during her absence from the floor. doctors can write any order they want for their patients, but it is still up to the nurse whether or not she/he chooses to carry it out based on her use of critical thinking skills for her patients as a whole....and for the patient in question.
    Last edit by live4today on Jul 13, '02
  2. by   ERNurse752
    kids-r-fun...totally agree with ya!
  3. by   hapeewendy
    watching this thread twist and turn and morph into right to smoke vs right to smoke free environment has given me a chuckle.
    the original post made perfect sense , I can understand why the original poster was so frustrated.
    To me it isnt about smoking or not, hell if you wanna smoke go right ahead I dont care BUT I shouldnt have to break my back, and take a horrible amount of time to get you to the place where you can smoke.
    pts on isolation are on isolation for a reason DUH
    and if this patient demands so much physical care then the need or right to smoke is veto'd by the fact that its really not safe to get her somewhere to smoke.
    so sorry life sucks doesnt it
    should we hoyer lift everyone anywhere they may want to go to do anything they may want to do?
    why dont we hoyer the 300lb alcoholic to the beer store, I'm sure some nice dr would write an order for it!
    if I was this patients nurse , going into a smoke filled room or being near her when she smoked could send me into an asthma attack in a second, sorry not willing to jeopardize my own health
    selfish, perhaps but the whole issue of the smoking thing is assanine to begin with.
    its not about bad habits being tsked tsked its about not having the manpower, well personpower and time to facilitate everyones habits when they are seriously ill
  4. by   hoolahan
    Bravo Wendy!!!!!!! Very well said!
  5. by   Nurse Ratched
    Wow, hapeewendy - didn't I read that you're still a student nurse? I think it's safe to say you should be waived out of any further "common sense" credit requirements, because you've got that one down!
  6. by   formernurse
    My exact sentiments, Wendy. You go girl.
    if this doc wants to write this kind of order...then let him be the one to hoyer lift her oob & sit with her with the isolation garb on. this doc absolutely has no one's interest at heart here. he's willing to jeopardize the nursing staff in order to satisfy this patient's cravings. i agree with those who say that he should've written an order for the patch instead!!! hapeewendy said it best!!!

    ps....rusty, you're sooooo bad :chuckle
  8. by   traumaRUs
    My $0.02 - would never, ever go outside with smoker. In our ER, if pt is outside smoking when its their turn - oh well - go to the back of the line. If they go outside from treatment room - oh well - they get moved to holding area. These are just natural consequences!!
  9. by   James Huffman
    I wonder if the doc realizes the extent of the trouble involved in getting this person a smoke. Perhaps taking this physician aside, and explaining the situation might help. Also understand the problem from the doc's perspective: this patient may have been giving hassles about smoking, and the easiest thing might be to simply write such an order, hoping it would take care of the situation.

    That having been said ...

    I am not a smoker.

    I have never smoked in my life.

    I know smoking is bad for one's health. (As does anyone with an IQ above 37. I very frankly think that those people suing tobacco companies, claiming "I didn't know it was bad for me," are lying, pure and simple).

    But could we cut smokers some slack? There are lots of things we do that are bad for us, and somehow only smokers are treated as though they were lepers. Would any of us refuse to get a soft drink for a patient? I have trouble arguing that those are good for us, given the levels of sugar OR artificial sweetners (not to mention the usually too high levels of phosphorus) but no one is beating these folks up.

    There are things people enjoy doing. They make a decision to do them. It may be our job to teach them that smoking is bad for them (although you are telling them something they already know), but treating smoking as though it were a moral evil is out of place.

    The hassle involved in getting this particular person a cigarette, and the issue of smoking in general should be separated.

    Jim Huffman, RN
  10. by   donmurray
    A breath of fresh air!! As she is so big, whilst denying her a smoke, why not deny her more than, say 1,000 calories a day, to save the nurses' backs? She doesn't need all those "extra" calories, so why give them to her? This is a slippery slope.
  11. by   KlareRN
    Aot of mixed feelings I have to give mine:

    (I will take alot of flack for this)- It IS this womans right to smoke it she chooses. I have been involved in cases with ombudsmen and the state board of health over pt. rights. I had a 39 y.o. quad that hung posters on his door that the facility was mentally and physically abusive and violated his rights because he was a quad. (The situation was that we would offer his shower- he would refuse-but then want it in the middle of supper service. It took 2 people to do him. He would also insist that while up in his wc; he would have a 1 inch pleat on the outside of his pantleg all the way down to his feet (had to measure it the length of his leg). It took over an hour to get him up for the day because of all his quirks. We gave notice of discharge and went to a hearing to evict him due to his unreasonable requests. Know what we were told from 4 different area ombudmen and the state?

    He has the "right" to have his shower whenever he wants just like you and I do. If we want to get up in the middle of our meal and shower- we do it. Just because he is unable to do it alone does not mean he loses that right. Also- we can dress how we want. So- he has the same rights. The posters on his door was his freedom of speech and even though all visitors could read them and think they are valid- we could not remove them because it was his "freedom of speech".

    Our argument was that we did not have staff to provide that much time to just him and others were suffering from his unrealistic demands. Their question: "So are you saying you are neglecting some of your pts?" What a LOADED question. They told us we could not discharge him unless he had somewhere to go and we had to provide enough staff to ensure his "needs" were met. (I disagree that a 1" creased seam is a "need"). This all took place in a long term care facility but the hospital setting has the same pt rights.

    So- it boils down to this woman has a "right" to harm herself just as you and I do. If she wants to smoke-unfortunately we are obligated to provide her with the tools and supervision/assistance she requires to do so. I have had Docs write orders for alcohol too.

    Even though we do not agree with it- as nurses we are obligated to provide care for all pts. regardless of individual circumstances. We cannot judge what is right or wrong just as we must provide the same level of care for the child molesters, thieves, and whatever other low life comes thru the door.

    Good luck with this woman. Hopefully she will return home soon and you can spend your time caring for someone that is more reasonable.
  12. by   hapeewendy
    unfortunately when you are in a hospital you do not get all the comforts of home
    like your own bed, your favourite food, your own shower and yes sometimes you lose the ability to do the things you want like smoking or drinking
    or watching porn or whatever it is you do on your own time.......
    you are in the hospital for a reason, to get better, to get to the point where you can go back home or wherever it is you came from to resume your normal activities.
    I dont think that this is the same as cutting someones calories or food intake at all, dieticians in hospitals play with food intake all the time to try to get the person in better condition and promote healing etc, doesnt mean that when the person goes home they dont burger and fry it back up again..... its just that when you are in the hospital they have many people who are trying to improve their health status
    they have the right to refuse of course but we still have to try?
    or should we just give up and let everyone smoke, drink, eat whatever they want and stay in the hospital forever cuz they will never get "better"
    food, medical care, water ,shelter and the likes are all NEEDS , smoking isnt , if you want to break it down to something that simple , which I dont even feel we have to there you have it.......

    I'm not mean little nasty nurse here or anything, I've had many patients who smoke, eat junk food etc, I have a huge problem with someone who is so sick and on isolation no less getting to go somewhere to smoke, outbreak of some kind happens because lets face it, people still dont know everything about infectious disease and routes of transmission, then most likely it was nursings fault because they didnt take proper precaution
    damned if you dont damned if you do...
  13. by   donmurray
    Wendy, my point was the "health fascism" involved in the limiting of patient choices by imposing those limits, and not by negotiating them. It's probably a tired old cliche, but the first thing we do to a new patient is depersonalise them by making them change into nightwear, often bathing first, etc etc This is really about establishing our power and control over them. When they object, or demand their "rights", we label them "difficult"