Can you believe this? - page 4

I understand the push for "customer satisfaction" but I think that the following situation is taking it too far. A few days ago we had a patient on the floor who was in constant pain. She had MS... Read More

  1. by   jewelsg627
    Quote from rdhdnrs
    Speaking of bending over backwards; we had a pregnant pt who accused the dietary guy of rape....two days after the fact. He was fired, she was provided a sitter for the duration of her stay. This was about two weeks. The sitter was required to go down with the pt to smoke. Pt didn't have cigs so would panhandle for them outside. My thought is...let them write it up, let them sue. These loonies don't have a case, and I'm not about to leave pts who really need me to attend to these nutcases!! No matter what my CSM says.
    I was just curious...was it proved that he did or did not do it? It sounds like you are saying that he did not do it, but how do you know? {Note: I am not saying this in an "attacking" tone at all. I am simply curious. I feel I have to give this disclaimer b/c things can be misinterperdted so often!}

  2. by   laughingfairy
    My facility the rule is we do not "aid" a patient in doing anything that violates their health care regime. This was brought up when some of our residents and staff complained of special treatment. If they want outside food they have to use a payphone or have family bring it in. But it is still deemed okay to buy them "their smokes." I am a smoker and still can't figure this out.
  3. by   ratchit
    Hi Nurturing.

    I saw this from the other side a couple months back- until I saw the 11pm transfer time you mentioned, I thought you might have worked in the same place.

    We had a psych patient come in with DKA- again. Young, poorly managed, what an awful life this poor woman must have had.

    On the other hand.. She was wandering around the ICU, refusing monitoring, IVs, fingersticks, and labs. She was threatening staff, screaming profanity, and entering other patients rooms. No patient needs that, but certainly not fresh open hearts and acute MIs. I got report, called the doc, and said "we need beds for OR cases today and she is refusing all ICU care, and her MILD DKA was resolved on the last labs she allowed us to draw 6 hours ago- she's outta here."

    The patient insisted that I had promised her I would take her out to smoke or she was going home. I had of course told her NOTHING of the sort- I was too busy calling security to get her back in her own room and stamping the AMA form. Sorry, honey, ICU patients don't go out to smoke. Neither do ICU nurses. I'm sorry you're stuck in a living hell- I'd help you if I could- but you don't get to take away from my other patients.

    The intern talked her into staying by promising her a transfer to a unit that would allow her to smoke and wrote for a pronto transfer to medsurg. I wasn't leaving my other sick patient to take her out, and I wasn't going to be alone with her- she had been violent with staff in the past. So in the 2 hours until a room was available (the gods were with me that day- LOL) she stamped, screamed, threatened, and terrorized the ICU while allowing us to provide her with no nursing care at all. All because the intern promised her a cigarette.

    I have never been as apologetic to a receiving RN. The patient should have been on Q1 fingersticks and Q3-4 BMPs, but wouldn't allow them. So the floor RN got this major behavioral problem to deal with on top of her other 4 patients. But she couldn't stay in the ICU when a CABG would make much better use of the bed and our skills. I even brought the stamped AMA form with me- which the patient signed a few hours later, probably right after the RN had finished all her admit stuff. She checked back in a few hours after that, then AMA'd again a few hours later.

    At least the sup, manager, and even the attendings on the floor at the time supported us and encouraged us to call security and sign her out AMA. IT was just the darn intern who delayed the inevitable. <G>
  4. by   mattsmom81
    "It was just the darn intern who delayed the inevitable."

    So true. When we start giving concessiont to manipulators it never ends. I say let them leave AMA at the getgo. They're never happy til they've turned the place upside down getting their own way anyhow.
  5. by   teeituptom
    So glad I work where there are no interns and residents
  6. by   LydiaGreen
    I am a smoker and I think that member of management was nuts. I love how our hospital deals with this issue. Staff does NOT take patients out to smoke... period. Even if staff members are smokers, they do NOT take patients out to smoke with them (I really don't think a nurse should be spending their breaks caring for a patient whether the nurse smokes or not). If a client is stable and able to go out on their own fine. This has conflicted with medications, vitals, labs, x-rays in the past and we have to chart that client was outside at whatever time. If the client is not stable enough to go outside and still wants to smoke, then family members are required to take them if they chose to. Our pharmacy does not dispense nicotine patches (they are kardexed and applied and removed as part of routine medications) but family must purchase them and bring them in. Our clients do not have to sign themselves out AMA to go out to smoke but we ask them to let their nurse know they are going out in case there are tests that need to be done, they do not return in a timely manner, etc.

    As a smoker, I am all too well aware of what happens within fifteen minutes of your last cigarette. The lungs begin to try to clear the crud that has built up in the lungs. This increases the likelihood of developing pneumonia above and beyond the usual risk with hospitalization (decreased activity, lying in bed, etc). Any client who is a smoker automatically gets "the lecture" about their increased risk and what they can do to decrease it (hydration, ambulation, sitting up in the chair during the day or having the bed in semi-fowler's rather than lying flat in bed) and I provide them with an incentive spirometer and teaching about deep breathing and coughing to clear the crud. That's "health promotion". Buying cigarettes for the client is NOT. What was that member of management thinking!?!
  7. by   NurseRatchet26
    I would be fine with putting a Nic patch on this lady. I would NOT be fine with helping her outside to smoke. Just a thought, isn't assisted suicide illegal? I refuse to help someone kill themselves, even if it is slow suicide.
  8. by   rollingstone
    I'm suprised she didn't ask for a beer to go along with that cig.
  9. by   teeituptom
    I dont lecture or nag
  10. by   SmilingBluEyes
    I don't either Tom. They don't want to hear it and I don't like to waste my precious time and breath on it. They know what they are doing and it's their right to destroy their health smoking. Just NOT ON MY WATCH.
  11. by   Ortho_RN
    Our hospital has the great habit of letting the patients actually smoke in the rooms.. *****!! Its a non-smoking hospital (aren't they all)... We have had the supervisor come up and say "Well, we can't stop them from smoking, just tell them to open a window or something" I was like you are kidding me... I am not a smoker and I don't believe I should have to breathe it in if I chose not to.. I told the supervisor that they could find someone else to help her (this was while I was still an aide)... the supervisor said so you aren't gonna to help her if she needs you.. I said not if you allow her to smoke... and the biggest kicker was this lady has O2 on..... I went in there one last time and told the patient that if she needed anything I would try to find someone willing to come in.. She asked my why I wasn't.. And I told her "I don't care if you smoke and kill yourself, but I don't smoke, and more importantly I don't want to go up in flames" She was like oh..

    I think supporting the smoking thing is stupid... but whatever alot of things in healthcare are stupid Im coming to realize
  12. by   phyrenrain
    As nurses, the saying about the customer always being right does not always hold water. Sounds to me like "nurse abuse." If the pt. had a family member and their own cigarettes, then it may be a different story if she was going out in a WC. Another story of lack of support from the "higher ups...."

    Quote from tjjs
    I understand the push for "customer satisfaction" but I think that the following situation is taking it too far. A few days ago we had a patient on the floor who was in constant pain. She had MS PCA, Ativan, Phenegran for her pain/anxiety/nausea. The doctor had ordered a bed alert put on her because she was so unsteady from this pain and the pain meds. Well, she was with it enough to insist on going outside to have a cigarette. We explained that #1 she would have to go out in a wheel chair and that no one could take her out at this time, we were all busy (imagine that). #2 she was a huge fall risk and couldn't hardly stand up without tipping to one side, so we didn't think that she was up to the trip #3 she had a MS PCA, which we don't really allow to just freely float outside of the building #4 her doctor DID NOT want her to leave. We babied her, gave her all the meds she could have, bent over backward to try to please her. But, she was adamant and we called the house supervisior to take care of the situation. Well, house went in to talk with patient. SHe comes out and says that one of us needs to stop taking care of the patients and take this woman out to smoke. NO surprise to anyone I'll bet. But, the story gets more interesting when we find out that the patient doesn't even have any cigarettes. So, the house supervisior buys some from a staff member. BUT, the patient wouldn't accept them because they weren't menthol. So, house calls everyone in the hospital that she knows smokes to find menthol cigarettes to buy. I was so mad that I couldn't even speak, except to say "we appreciate the support ) Her response was that this woman might write a letter to the editor or something. Isn't there a line between patient rights and doctor/nurses orders/knowledge? I guess now we have to give the patient whatever they want and we have to reinforce their bad habits/behavior. UUGH!
  13. by   Farkinott
    I read this thread with disbelief! In Oz the pt would have had to sign an indemnity in that she accepted all risk to herself. As for the supervisor........................s*it floats to the top!