Beating my head against the wall

  1. 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?
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    About Nurse Ratched

    Joined: Jun '02; Posts: 6,584; Likes: 70
    RN - College Health
    Specialty: Geriatrics/Oncology/Psych/College Health


  3. by   fedupnurse
    This doctor should have his licnese revoked! Aren't we supposed to be teaching the public about helth preserving behaviors? Let that doc soend his/her valuable time doing all this nonsense just so this patient can attempt to riddle their body with cancer. If all of you stick together you will send a strong message. Who will watch your other patients while you are gone helping this one with her nicotine fix??? God knows the doc didn't think of that aspect!!
    Stick to your guns Nurse Ratched!!! Get your colleges to do the same!!!
  4. by   Furball
    holy gripe....throw a nicotine patch on her....GEESH!!!
  5. by   Reabock
    He/She might better have spent their time writing an order for a Nicotine patch and explained why to the pt, like the explanation will ever happen from them, usually its us, After the MD leaves the floor.
    I do not beleieve in spending all that time on self-destructive behavior either!!!!
  6. by   live4today
    I'm with you all on that one! What else will they have nurses we don't have enough to do already. I would have told that doctor to "knock himself out" while "HE" helped the patient to her nicotine fix because my job description does NOT require me to "babysit addicts addictions"...but I will help her with her addiction through counseling and nicotine patches, etc. The nerve......
  7. by   Rustyhammer
  8. by   Nurse Ratched
    (Rusty, you slay me! - I actually feel kinda bad in a way for imposing my "bias" in this situation, so I'm going to ask not to have this patient next time I work. Plus, after three days in a row of this, I've done my hitch on the isolation tour of duty.)

    The kicker is that this patient has consistently refused her nicotine patch (ordered for several days now.)

    This patient's condition is such that she is pretty messed up already, and is not likely to live anywhere near long enough to get sick from it. Not Hospice terminal, but not going to have a full life span.

    BUT, I still can't in good conscience assist a patient to do things like this at work. What they do at home is their own business, but this is a real ethical issue for me, and I feel like I am within my rights to say that I won't contribute to a patient harming herself (additionally) in this manner.

    I also advised the aides working that they are not obliged to sit in the designated smoking area to monitor the patient. I feel strongly that if a nurse later decides to assist the patient to smoke, she needs to take accountability for it and sit with the pt rather than asking an aide to do so.
  9. by   oramar
    I never minded carrying out complicated orders that did the patient some good. It is so easy for the doctor to write them, so hard to carry them out. However, going through this elaborate proceedure to harm a patient is bull.
  10. by   santhony44
    I think it's unreasonable. If the patient can't get to and from the smoking area under her own steam, she shouldn't go. Whose unit has enough staff to spare people to do this? Other patients have needs too!

    The doc *should* explain to her that the nicotine patches aren't just used for smoking cessation; they can also be used by folks with no intention of quitting, just to keep them from having nicotine fits. They actually work pretty well, until you get up to 2 1/2 or 3 PPD smokers. Then apparently nothing much helps but time. Another option might be a gadget that looks like a cigarette holder that they actually "inhale" nicotine from. That could be a reasonable alternative in this situation.
  11. by   Level2Trauma
    Be careful......If she wants to go smoke, she will go smoke, whether "A NURSE" is with her or not. Don't know what type of disease she has but it doesn't sound like she should be going off without someone...we are liable while she is in our facility and under our care (just food for thought).
  12. by   ceecel.dee
    I have told a patient's family who is asking if he can get a wheel chair to go out to smoke (granted, he had a hemorrhoidectomy, has a PCA he is maxed out on, and has refused to use anything but a urinal at 34 years old) that if he cannot walk himself out to do so, then no...I was sure that the doc would worry about his lung functions. Of course you all know how quickly he recovered his powers of self-locomotion.
  13. by   Nurse Ratched
    Level2 - good point - if this patient had any ability to move herself then I'm sure she'd be trying to sneak out. I would (with other staff members) have to physically lift her OOB and into a *GERICHAIR* and roll her down to the room, light her cigarette and probably hold it for her, too, for safety's sake (she has multiple scars on her legs from dropping cigs on herself at home (fine motor and peripheral sensory problems.) (BTW - saw the post about the fireproof aprons - I *will* mention this to the pt for when she goes home...)

    Cecell - had to lol at your post. The knowledge of the opening of the smoke room in the morning has raised more dead from bed on our unit than Jesus.
  14. by   thisnurse
    this is so unfair to us. isnt there somewhere she can go outside?
    we had a pt with narcolepsy and was blind. we wouldnt let her go smoke for obvious reasons.
    she was mean and nasty about it. i told her i would take her to smoke when i got a break...couldnt do it right then cos i was busy.

    well yeah.
    i thought i was being nice. she picked up the phone and called the supervisor claiming we wouldnt let her go smoke because we were prejudiced of her blindness.
    supervisor MADE me take her down RIGHT THEN.
    and she wasnt even my pt.