Speaking of Smoking....

  1. Ok, so I am in my final semester of nursing school and with some limitations, am expected to function almost independently in the RN role. So I had a patient the other day who is in the late stages of AIDS. HE is very ill and understandably cranky. I don't take it personally because I know it's not about me. Well, the other day, he rang the call light and asked me for juice.. The room reeked of cigarette smoke. He is on the nicotine patch and he is also on O2 therapy. All I said was, " It smells like smoke in here, " When I came back with his juice he started screaming at me. HE told me he didn't want to see me the rest of the night and to get the f--- out of his room. I said calmly, " I'm just asking you to not smoke in here. You know better," and I left the room. Well, the charge nurse nurse yelled at me in front of the entire floor and accused me of antagonizing him. She said, " Don't push his buttons when he is not feeling well," I don't think I was being antagonistic. Should I have just allowed him to continue smoking. What if he wanted to smoke crack? Should I have let him because he didn't feel well? I didn't make a big deal out of the smoking...I merely asked him to stop. The patient afterward proceeded to throw himself on the floor and have a tantrum and the charge nurse proceeded to coddle him. After she left, the patient reverted to his normal nasty self and screamed obscenities at everyone. HE threw all of the nurses out of his room and he was even abusive to his own family. I never went back to his room that night, because I didn't want to further agitate him. I know he is dealing with a lot of issues right now so I didn't take his behavior to heart. I was more upset that the charge nurse yelled at me. Was I wrong to ask a man on O2 therapy and a nicotine patch not to smoke? He is terminally ill and a DNR. He has been refusing almost all treatment. I wonder if he may be better off in a hopsice setting at this point? Maybe they could provide better comfort measures than we can? I don't know. Can I have some feedback?
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    About Flo1216

    Joined: Jun '02; Posts: 485; Likes: 15


  3. by   baseline
    You did the right thing. It's against fire code #1, and against good practice # 2. Perhaps its time to talk with the case manager and/or social worker to help determine the best care for this patient.
  4. by   SmilingBluEyes
    agree w/baseline here.
  5. by   Granted Fal
    talk about your staff splitting...
  6. by   Stargazer
    You weren't wrong. Nice enabling behavior from the charge nurse. Agree with baseline's suggestion to get the caseworker/social worker involved.
  7. by   emily_mom
    I agree with the above posters. Looks like there was no way to say it without him flipping out on you.

    Maybe if there were a major explosion things would change....oh wait....then it would be your fault too.

    Is this pt in a swing bed? I am just wondering why you have to have him in the hospital if you are not treating him for anything. Hospice sounds in order.

  8. by   Flo1216
    What is a swing bed? Well, this patient pretty much refuses most of his meds, his bloodwork, even dialysis. The other day the patient was receiving blood and he made the nurse stop the transfusion halfway through because he "didn't want to be bothered with it," It seems to me like he needs more palliative care at this point. Nothing is going to save him. He doesn't have much time left. But no one ever listens to the students. It is as though we are not even there, unless of course something is wrong. Then we get blamed. Case in point...the students are not allowed to leave until the narcotics count is done, even if we didn't give any narcs. The reason being that if the count is off, we will automatically be blamed so we need to be there to defend ourselves. Sometimes we are there until almost 4PM because they take their sweet old time counting. They are too busy talking about their weekend and their boyfriends and where they are going on vacation. My classmate had a baby 2 weeks ago so she kinda needed to get home and when she spoke up, she was ignored. I can't wait to graduate. This sucks.
  9. by   BadBird
    No you did not do anything wrong. I suggest you fill out a incident report (keep a copy for yourself) Let management know that the charge RN is aware that the patient is on oxygen and refuses to back up the no smoking policy and you consider it a danger to work there. If anything happens like a fire, you have legal recourse. As far as that patient is concerned you are in a no win situation, he will continue to throw tantrums and nothing you do will help. Pallative care is needed now, keep him pain free. He is lucky his family comes around if he is still abusive.
  10. by   Flo1216
    I have a question...if a pt has no insurance, can they still get hospice? Just curious. As for filling out an incident report, the reprecussions of my doing that would be absolutely unbearable. I hate when stupid people in positions of power make me cry. I am learning a lot of what NOT to do as an RN, I can tell you that much. Another example is an RN who disconnected a pts IV when he was getting antibiotics(against hospital policy) so he could go to the bathroom and forgot to hook it back up. The pt had a picc line and students aren't allowed to touch them. Another hour went by and she still hadn't reconnected it. The pt was getting annoyed about it so I reminded her again and she snapped at me. I hate this unit(and not because of the patients) and I am stuck on it until June
  11. by   fab4fan
    You do not need insurance to get hospice; hospices usually have some money set aside to cover non-insured pts (the two I worked for did). Anyway, it's the same as hospital care; you are treated regardless of ability to pay.