Beating my head against the wall

[Nurse Ratched]

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 and keep other pt's out while she is there and clean the area afterward. Because of patient's physical condition (long story) it will take several staff members to ready her to smoke plus having to have one sit with her (in full isolation garb) plus cleaning out designated area afterward. I figured it would be a good 45 minutes invested in helping a patient smoke who is already extremely time consuming with her other medical needs.

I refused to assist pt in this. MD left for day. Passed it on to next shift who can do on their shift as they see fit.

Any thoughts?

[Nurse Ratched, RN]

Originally posted by mother/babyRN

I would have considered a turf to me.

I apologize for my ignorance - I'm not sure what that expression means?

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.

[live4today, RN]

Originally posted by Nurse Ratched

NurseDennie - that is so sweet - I wish it was me!! :) My avatar is Lucy Lawless of Xena, Warrior Princess fame.

Dennie.....I recognized Lucy Lawless right away only because I saw the show a few times. She is beautiful! :chuckle

[ChristenLPN, LPN]

Patients 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.

[teeituptom, BSN, RN]

Howdy 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

[Enabled]

I agree on with the patch. Staff members could be put in danger for second hand smoke if not wearing a lined mask. I wonder if the doc is a smoker himself. I also agree let him stand at the side of the bed and assist with the moving maybe he will think twice. Years ago medical students, interns and residents were required to switch places with the nurses and do their job. The nurses did give the meds for the med students as they did not have a license to do it. Believe me after giving a bedpan to the same person for the fifth time and soaking we still didn't assist. Now they had the idea and appreciated us for a whole few days. You wouldn't dare suggest it now. That's just like the interns and residents going to the medical board about the hours they are on their feet and on call especially the ones in general surgery. They were saying they were getting less than 20 hours of sleep a week. That has to be dangerous. Well, the good ol' boys turned it down as they had to do it. I guess it is a right of passage but it is gong to get someone killed or right an order that is carried out and has a detrimental effect.

The article also said we will have fewer general surgeons because the docs are now specializing so thay can do surgery on a week day and not be on call and have a life with family evenings and weekends. I wish nurses could My girlfriend is a nurse manager. They were suppose to close part of the ortho floor and put neuro on another instead of combining Well they kept admitting to the ortho but not as many as it holds 38 and they were up to 26. They opened the neuro floor with 8 patients one RN and a tech. They then took 3 major staff members for her. Then they tell her she has to work as there isn't adequate staffing on her unit. They also started a staffing office and by noon they know what the situation is for the rest of the day. They have told her they can't find anyone and staff members who were off told her they never called. I have told her to keep a little black book of all the goings on in order to cover her butt. Nursing administration did increase the number of travelers she could have with an additional 7. They don't want to take any admissions and will only take a certain number of patients on any given shift. If hospitals can pay for that why don't they pay the staff.

I am taking a class right now on nursing leadership and management and was doing a module on the shortage. I suggested that since the word administration passed the lips of some nurses that they be required to do clinical hours to renew their licenses. This way they will remember how it is in the trenches and if an admission comes along they do it just like us. They probably don't know what papers to use. If we go to war they certainly won't be administrators then as they will be back in trenches as the military nurses will move up and the public and private sector will have to take up the slack when the other nurses left. Many of you I am sure don't realize that medical persionnel is subject to military draft up to the age of 45 if my memory serves me correctly or at least 40

During ww2 there seem to be a few (less than 10,000) and in 6 mos there were 36,000

Also if we take nurses from other countries to aid in the shortage I think wholeheartedly that they should have a complete physical work up and labs of all kinds and repeat in six months after the HIV blood transfusion that has now happened. They should also have to take the NCLEX exam before they even come as well as a clinical portion to be certain they have the skill that are needed and they are up to date. Nurses are being hired by some company I watched on a news magazine program and they say that nurses are flocking out of Africa because of the money they can make here. Some have families that make less than$1,000 a year. Also, with all these programs that are popping up do we want quantity or quality and if the later we need to make a lot of noise. as someone is going to have an adverse issue that didn't need to happen.

[donmurray]

Everyone keeps on and on about the "risk" of secondhand smoke. This "risk" has taken on mythical epic proportions. Can anyone provide the actual risk level? What is the exact zillionth of a percentage increase? How many parts per million in the atmosphere, how many seconds/minutes/hours/days exposure is necessary to reach danger level?

Anyone who drives a car is exposing themselves, and more people than any smoker, to a far greater level of carcinogenic air pollution.

The nurses caring for these patients are at immediate risk of musculoskeletal injury, which can cause debilitation and loss of career, or employment. Smoking, like manual handling, presents a hazard, but how it is managed determines the risk.

[Furball]

The risk from a single episode is nonexistant of course....unless you have asthma...but accumulated exposure can be deadly. Look it up on the American lung association website or any cancer website. Heart disease also increases significantly.

[teeituptom, BSN, RN]

howdy yall

from deep in the heart of texas

Just walk around with one of those air filtering masks on

[Robin61970]

If I get blasted so be it.......I also agree that all the time for a patient to smoke when she could have the patch along with the neglect of other patients is downright wrong. that said I DON"T smoke......I never have and never will......I have rights when it comes to not wanting to be exposed to it. I don't allow it in my house or car, but when I am at school walking in the front entrance I have to walk through a haze of smoke because everyone is camped out right in front of the door.....this I think is inconsiderate......

[nrw350]

What all does "isolation garb" consist of? Is it like what the CDC wears when they work on deadly diseases? I am a non-smoker myself, and I refuse to allow anyone who rides with me to smoke in my truck for obvious reasons. This case is simply put as many has stated a case where the good of the many outweigh the good of the few. If you all cater to this person's "need" what will you be forced to do next? Giving someone a massage every time they request it?

Nick

[mattsmom81]

Some patients are unreasonable in their demands and expect to be catered to....it is unfair to the unit for one to be so unfairly hogging the nurses' attentions to satisfy a non-necessary craving.

Time to get real pushy with the doc and ask for alternatives here.

I think the nicotine gums are a great solution....as the smokers get the oral gratification as well as the nicotine. If someone like her needs to smoke a family member should assist and be liable, IMO.

Any other old nurses like me who remember hospitals being smoke filled rooms...with patients and visitors puffing away? Even the nurses' shift report was in a smoke filled room....this was hard on nonsmokers and probably did damage to our lungs over time...as I get older I have more asthmatic bronchitis problems and have mild pumonary hypertension too.... I suspect the years of secondhand smoke played a big part.

Flight attendants are filing and winning class action suits due to years of exposure to concentrated areas of second hand smoke-filled aircrafts. Maybe some of us nurses should too.....how many out there have some lung problems but did not smoke...just subjected to concentrated secondhand smoke in hospitals/facilities over a period of 15-20 years or more?????:stone

[live4today, RN]

originally posted by mattsmom81

.......................any other old nurses like me who remember hospitals being smoke filled rooms...with patients and visitors puffing away? even the nurses' shift report was in a smoke filled room....this was hard on nonsmokers and probably did damage to our lungs over time...as i get older i have more asthmatic bronchitis problems and have mild pumonary hypertension too.... i suspect the years of secondhand smoke did not help.

flight attendants are filing and winning class action suits over second hand smoke-filled aircrafts. maybe some of us nurses should too.....

oh boy don't i remember those "smoked filled report rooms and patient rooms filled with smoke" years! i hated every minute of it. one patient in particular that i remember was admitted for ortho reasons. she was also a chronic pain medication user so her drugs had to be strictly monitored, etc. anyhoo.......she smoked so much in her bed that the sheets were filled with cigarette droppings, so was the floor and her bedside table. she had so much smoke in her room from smoking nonstop on nonfiltered cigarettes that it was hard to see her through the smoke upon entering her room. after doing one dressing change on her, i complained to the head nurse that i would not be entering her room again as long as she smoked. the head nurse told me to inform the patient for the duration of that shift, that if she expected to have her dressings changed and medications brought to her, she would have to not smoke for up to a half hour prior to nursing staff entering her room. we would let her know what times her dressing changes and medication were due, and she complied unwillingly...but said she totally understood our request. yuck!!!

in the report rooms where staff smoked during report....i simply refused to sit in the room during report. i told my head nurse that i would take report from the nurse whose patients i was receiving anywhere smoking was prohibited. again....i was accomodated. had they not agreed to my right not to be around cigarette smoke, i would have gladly resigned without hesitation. my personal health was far more important to me than anyone else's because i had my own family to think about, and felt it necessary to protect my health....not just for my sake....but for their sake as well. :)