Beating my head against the wall - page 4
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
Jul 14, '02Joined: Feb '02; Posts: 1,178; Likes: 222...but not at the expense of other human beings who do not want to be exposed to second hand smoke!!! wearing isolation masks don't cut it...no one has the right to force employees to unwillingly expose them to cigarette smoke...no one. now if the patient is able to be wheeled out side of the facility & the staff that has to supervise are themselves smokers & don't mind being around second hand smoke...then i say fine. but to subject staff to unnecessary harm is just tooo much to ask of them!!! if this becomes more of a norm than an exception....there will be even more nurses leaving the profession...you can count on that!!!
its one thing to know going into this field that you'd might injure your back in lifting or turning patients...it's totally different thing when staff is expected to take physical or mental harm for the sake of the patients' rights....well what of the employees' rights??? if the state, ombudsmen, or the president of the united states, for that matter, says that patients have the right to smoke because these facilities are their homes...well i say fine...let these brilliant decision making individuals come-in & light them-up & we'll see just how much these patients' rights would continue!!!
this is a hot issue for me because i'm asthmatic & feel that i, or no one else, shouldn't be subjected to hazardous working environment...especially if we're against it!!! if & when i want to work in such environments, i'll put-in for hazardous pay...until then...don't infringe upon my rights not to be exposed to extra curricular poisoning on my job not of my choosing!!! giving patients extra sodas or cookies doesn't directly affect my health (outside of maybe having to have to turn them) & most are good at holding onto the side rails when i do...so this isn't as much of a problem to me as the second hand smoke is.
as far as the quad-patient wanting a shower doing meal times...yes he does have the right...however...if the facility is only staff to have a certain number of staff in the dinning area giving
meals...legally...this would take precedence over the patient wanting a shower (the needs of the many out-weigh the needs of the few). in addition, if this patient wants extra care for himself...he could hire a private nursing staff at his own expense!!! i've not heard of anyone being catered to like this unless they're related to someone high-up in administration. if this patient doesn't have the necessary funding for private staffing...he doesn't get the extra care...period!!! it would be impossible to provide extra care to all patients who want it simply because it's their right...it's not right to give one patient extra care & not provide that same service to the rest that are either paying privately or with public assistance. the units wouldn't be able to function properly if some sort of protocol isn't followed!!! too many accidents & emergencies can & do occur that would interfere with providing special or extra services that aren't necessary (giving showers doing meal times & setting-up patient for smoking in the above case) especially during besy times i.e. meals, medication administration & treatment times. people complain enough as it is about working long hours & not getting their rightful breaks....now we want to add unnecessary tasks to what is already a full plate for the nursing staff. this is just poor time management, not to mention, stressful for the staff to do so, imo!!!
i think that james is correct in stating that this doc simply not aware of just how difficult this situation is for the staff & maybe he would change the order...especially if proper documentation would justify him changing it.
Jul 14, '02From: US ; Joined: Oct '01; Posts: 6,238; Likes: 1,829Originally posted by KlareRN
(edited down by kids)
I have been involved in cases with ombudsmen and the state board of health over pt. rights.
Jul 14, '02Occupation: poor nurse Joined: Oct '01; Posts: 2,293; Likes: 86My Mom's best friend DIED of lung ca...never smoked in her life but worked in smoky offices for many years....apparantly her health took a second seat to the right to smoke...oh well...c'est la vie.... Smoking is different than other so called vices because you do affect people in your vicinity...etoh/coffee/chocolate just doesn't just waft over to you in the environment. I would definitely refuse to sit with this pt breathing in smoke. I am very suprised that folks just don't get it......and that's all I'm gonna say about that.
Jul 14, '02Occupation: RN - College Health Specialty: Geriatrics/Oncology/Psych/College Health ; Joined: Jun '02; Posts: 6,584; Likes: 70I wish I could plead ignorance on the docs behalf, but the doc is aware that the pt is a total transfer and is unable to safely hold a lit cigarette and that she is in respiratory isolation. If he can't put two and two together that that makes it *extremely* difficult and time-consuming to carry out his order, not to mention unsafe, then he is an idiot. I know him not to be an idiot, but also to be a human with frailties like the rest of us who probably doesn't want to be the bad guy when a fairly pitiful patient is requesting this.
And if my refusing to do this is considered discrimination, then I figure there's no better time to take my liability insurance out for a spin and see what the courts say. If a patient suggested that refusal to do this was a violation of her rights, then I would have to respond that I have a right not to be exposed to smoke.
But again, this is all off-topic. I don't care if this person smokes. but if she can't accomplish that independently without putting others in harm's way, then I am not going to facilitate it. And in a group setting, one's rights do not exist in a vacuum. They must be weighed and measured against the rights and safety of the group as a whole. In the quad shower example, if another resident was starting to get up and ambulate and was at a fall risk, that other patient would just have to wait for his shower. I wouldn't leave the potential fall to tend to a lesser priority need.
And that's what this thread is really about. We have to prioritize as nurses. Safety of our patients first and foremost. Meeting their basic needs - food, hygeine, comfort - and their medical needs. Documenting all of the above. I don't know about the rest here, but I'm doing well to get that done in a shift without throwing in situations like this. This is not a nursing priority.
Jul 14, '02Occupation: Nurse Educator: love those students! Specialty: Med/Surg,ER,L&D,ICU,OR,nrs. educator ; Joined: Apr '02; Posts: 968; Likes: 41I've gone out to smoke with only one patient......a woman who was BOMBED at 1030 in am and her boy"friend" (also drunk) comes into ER "to get her help". He cannot stand without swaying. It's 36 degrees out. She won't come in so I have to run out to the car in the clinic parking lot (clinic will not see her), where it takes me a full 8 minutes to talk her into coming in. The only way I could convince her to trust me was to let her smoke 2 WHOLE cigs in the car and finish her LITER OF VODCA without nagging her....we talked about her life, her kids, my kids...I was freezing (aren't warm...ever noticed this in a brisk Minnesota spring breeze?) Before entering ER, we made a deal that the only way she was coming in for the help she knew she needed, was if I let her smoke when she needed to. I was EXTREMELY good natured about this whole senario, including the near fist fight between the lovebirds.
Maybe I need to smoke.....
AND.......NEVER IN MY LIFE HAVE I BEEN ACUSED OF BEING LIBERAL!
Jul 14, '02Occupation: research nurse Joined: Oct '01; Posts: 1,878; Likes: 44Nurse Ratched - You are Gorgeous!!! Wow!!
Jul 15, '02Occupation: RN - College Health Specialty: Geriatrics/Oncology/Psych/College Health ; Joined: Jun '02; Posts: 6,584; Likes: 70NurseDennie - that is so sweet - I wish it was me!! My avatar is Lucy Lawless of Xena, Warrior Princess fame.
Jul 15, '02Occupation: research nurse Joined: Oct '01; Posts: 1,878; Likes: 44Ooops - sorry. I've never heard of her, but she's a very attractive person, isn't she? But she looks normal, as opposed to a model or somebody.
I just assumed that it was your picture - Not good to assume, I know.
Jul 15, '02Occupation: R.N. Specialty: 27 year(s) of experience in cardiac, diabetes, OB/GYN ; Joined: Feb '02; Posts: 1,947; Likes: 418Any doc who knwingly puts a patient at risk or unreasonably taxes a unit because he or she doesn't want to hear it, is a buffoon. If the pt refused a nicotine patch, she should have been given the information that smoking, especially with her condition and the fact that she currently resided in a hospital environment, was not and would not be tolerated.
Just because a doctor writes an order doesn't mean its written in stone. Had I been a member of the oncoming shift, even given your thoughts on the matter, I would have considered a turf to me.
The pt most likely ( as most of them will) would somehow manage or coerce a family member or friend, to sneak one in the room.
Whether or not you smokers agree and non smokers disagree, staff should not be charged with having to carry out inappropriate orders due to the cowardice of the doctor.
And, if being busy was (and usually is) a factor, I would have called the supervisor and told him or her that he or she would be assisting. If there was a respiratory illness present in the patient, I would have no difficulty informing her I could not participate in bringing her out to smoke. In the old days physicians and nurses were allowed to set appropriate limits. Unfortunately, that is not always the case...
And, had the patient developed complications, or become sicker due to being brought out to smoke, she could and quite possible might bring a lawsuit against the doc, facility and you for practicing negligence of care with regard to her. Doesn't matter if you have an order. If the order, in a court of law, was deemed inappropriate and you knowingly carried it out, its your licence...
Jul 15, '02Occupation: RN - College Health Specialty: Geriatrics/Oncology/Psych/College Health ; Joined: Jun '02; Posts: 6,584; Likes: 70Originally posted by mother/babyRN
I would have considered a turf to me.
Just as a followup, some nurses chose to assist the pt once per shift as time allowed. Nights were not affected as the smoking area is not available at noc to encourage pt rest. Pt dc'd today.
Jul 15, '02Joined: Sep '01; Posts: 16,606; Likes: 680Originally posted by Nurse Ratched
NurseDennie - that is so sweet - I wish it was me!! My avatar is Lucy Lawless of Xena, Warrior Princess fame.
Jul 15, '02Occupation: nurse Joined: Feb '02; Posts: 60; Likes: 39Patients have rights. Nurses have rights. Smokers and nonsmokers have rights.
What NOBODY has is the right to have everything he or she wants, all the time, regardless of the circumstances and the safety and needs of others. It does sound as though efforts were made to accomodate this pt and her needs, but nothing less than the actual cigarette and all it entailed would do.
Sorry. We don't always get what we want.
Jul 19, '02Occupation: ER RN Specialty: ER,ICU,L&D,OR,ETC ; Joined: May '01; Posts: 5,588; Likes: 566Howdy yall
from deep in the heart of texas
This country is based on our freedoms. people have fought and died for these freedoms, whatever they may be.So let freedom ring
And Nurse Ratched, being and old Xena devoutee, thats politefully put, I recognized Lucy Lawless right off