How would you have handled this pt?

Not sure how things work in the states, but i reckon that there's not much you can do if your patient wants to leave the ward- she has a right to make decisions for herself, you're not her keeper and have a responsibility to respect her autonomy. However, you could explain to her that you stongly advise against what she was doing, explaining risks etc, and make it very clear that she's responsible for her own actions. As always, record in her notes what had taken place, including advice given, times etc. I would then report the situation to the nurse in charge so that she's up to speed on what's been happening. I personally think that the senior nurse was a bit annoyed at herself for not knowing what had been going on- saying that you should have forbid your patient from leaving and threatening to call security seems like a bit of an over-reaction to me!

We have forms the pt's who want to smoke can sign-pretty much says i understand smoking is bad for my health, i understand smoking can make my health condition worse, i understand that this is against medical advice, and that i will not hold the hospital/doctor/nurse liable for anything that happens to me off unit

we had a alcoholic pt who was very uncooperative about cigs and alcohol

he had a gardener who visited him go into the room and they would both be drunk...came from a highly regarded family but they were very familiar with both of them and there were no complaints there. one time they had a couple of girls in there and the nun went in there and talked to them . girls left quickly other patients who were noncompliant were asked to sign an ama and asked to leave and admitt to another hospital in the future

funny how money affects you where ever you are