So in my SNF in California, there is a patient in a wheelchair with bipolar disorder, borderline personality disorder, and can be immensely verbally and physically abusive. Our facility received an IJ for safety from state a few years ago because the patient showed the state surveyor that she had a lighter.
Smoking policies have been implemented, scheduling smoking times that are supervised, smoking apron, etc. Of course, no patient should have a lighter.
Cut to now, patient is attempting to unlock the front doors at 9:30 PM, after visiting hours to go smoke. She has a lighter and cigarettes.
The dilemma is, 1) the patient should be prevented from smoking to prevent self injury- Safety
2) if we stop the patient, then the only way to get her away from the doors is to push her in her wheelchair against her will- Abuse and Integrity
In addition, any attempts to keep her from the door leads to an onslaught of verbal and physical abuse which also deviates nurse from their work from their floor.
Normally, we would have someone stand with supervise, however, at the situation, it was change of shift and clinical emergencies were happening on the floor and staff could not take the time to supervise her as she usually smokes more than one cigarette.
What is the correct course of action? Do we just bite the bullet and have someone leave the floor to supervise her with all the clinical stuff going on?
This is an ongoing issue and I understand we have reached out to many resources in attempts to manage this situation.
Any idea or tips to or resources that can help manage the situation?
Specializes in Psych, Addictions, SOL (Student of Life).
State has been notified ombadsman is aware. It seems like any intervention we try to turn to, we seem to be stuck with her. We've tried moving her, transferring her. We're all stuck in a rut heh. At least that's what management and social services department tells me
Trust me, everything is documented. She tells her family I punched her in the mouth and stole her tooth.
Your facility is lying to you or they just don't want to lose the revenue this resident brings in. You are in California. Out esteemed Governor "Moonbeam" Brown signed a law a couple of years ago that mandates all state funded facility to be non-smoking and that includes staff who may not smoke within 100 feet of a facility. If your facility is accepting reimbursement fro m Medicare or MediCal they are actually required to become non-smoking by a certain date. Can't remember now what that date is. If you can get her out for a medical evaluation you can serve her family with 30 day notice that she is not welcome to return. This happened to our family with my own mother.
If you can't ban smoking altogether, at the very least this lady needs limits. Maybe your facility could enforce a Q2hr smoking schedule for all patients--be there at the appointed hour or wait 'til next time. Your aides shouldn't have to drop whatever they're doing to supervise smokers at the smokers' whim--there is work to be done and the patients will just have to deal with it. Borderlines hate rules--they always think the rules don't apply to them; make this lady AND her family understand that there are rules and they WILL comply or they will lose the privileges they have.
hppygr8ful, ASN, RN, EMT-I
4 Articles; 5,212 Posts
Your facility is lying to you or they just don't want to lose the revenue this resident brings in. You are in California. Out esteemed Governor "Moonbeam" Brown signed a law a couple of years ago that mandates all state funded facility to be non-smoking and that includes staff who may not smoke within 100 feet of a facility. If your facility is accepting reimbursement fro m Medicare or MediCal they are actually required to become non-smoking by a certain date. Can't remember now what that date is. If you can get her out for a medical evaluation you can serve her family with 30 day notice that she is not welcome to return. This happened to our family with my own mother.
Hppy