Where to begin? My facility is a non smoking facility. We got a resident with a newly repaired hip who hopped off the stretcher and announced he was going outside to smoke. The nurses told him we were a non smoking facility. I don't care he said so they called the doctor and got an order for him to be able to smoke. THEN they called me (the DNS)...no I said, he cannot smoke. I spoke to the charge nurse who told me that I would have to drive in to tell him because he was 6 feet tall and she wasn't going to speak to him. I couldn't believe what I was hearing. The long and short of it is, he left in a taxi to go home with a doctor's order.
What would you do about this nurse? If I were at home, I might have hopped in the car and have gone to work to calm things down, but she is being paid to be a charge nurse and it makes me angry that she should act this way.
Just as well, if you ask me, that the man left. If he was so nasty about smoking, perhaps he would have been just as nasty and non compliant around the schedule for his pain medications. Sorry for the rant!
It was inappropriate of her to call the doctor to get an order to smoke in a non smoking facility. Perhaps I am fearless. In my last building, a family member was swearing a blue streak and screaming at the staff development coordinator. HE called ME....he was 6'2...I am 5'3. I would never put my staff in harm's way. I think this nurse just didn't want to deal with it so she didn't.
I agree it was inappropriate to call for a physician's order to smoke in a non-smoking facility. That's not a "compromise," it's a simple failure to follow the facility's policies/procedures.
Specializes in Gerontology, Med surg, Home Health.
Since I wasn't even there and since the non smoking policy is well known by all, how in the world did I set her up? We could argue this all night. If she had any questions, she should have called me before things got out of hand.
Since I wasn't even there and since the non smoking policy is well known by all, how in the world did I set her up? We could argue this all night. If she had any questions, she should have called me before things got out of hand.
Maybe I misread the original post. I got the impression that she had already informed the pt of the policy and he said "I don't care" and went out to smoke anyway. Just what else was she supposed to do? The set-up is that the pt was competent and alreadyrefused to comply ... and you sent her back to tell him he had to comply anyway. Just how was she supposed to force him into it? Or was she supposed to ping-pong back and forth between you and the patient? "Yes you will ... no I won't ... yes you will ... no I won't" could get endless. Seems to me she made a good faith effort to find a resolution to the problem ... talk to the doc and get an order allowing smoking outside.
But this is just MHO ... you know your facility and this nurse's work and I don't.
Specializes in LTC since 1972, team leader, supervisor,.
We are a non-smoking facility and one of the questions on the assessment is are you a smoker, it they are, the application is denied immediately. Upon enterence to the facility a form is signed that the resident will not smoke and will be asked to leave if such action occurs. As for the nurse she should be aware of the policy for the facility and be held accountable.
What??? Sorry but I never dreamed having a Charge Nurse would stop my phone from ringing. Seems like in the position DNS you would want your phone to ring when something is going on. Maybe a little sit down 1on1 with your charge nurse to spell out your expectations. Then empower her/him to take charge, but always take that call when needed.
She called the Dr and the MD gave an order to allow him to go out to smoke? I have seen this many times in which my charge nurses will call the MD over a non-compliant pt to inform him of the difficulty only for the MD to "cave" giving an order contrary to what policy and procedure is. The nurse takes the fall for being "difficult" because the MD didnt want to bother telling his pt "Either follow the rules or be d/c'd". Maybe I'm missing something but if she explained to pt, called MD who gave order to allow, she then called you as she sounds to me as a previous poster stated "in a rock and a hard place". Policy states no, MD states Ok, pt gets PO'd because conflicting information (most pts feel MD has last say). I think if my charge had done all she could and still getting conflict, I would have appreciated her call. I dont agree with how she put her statement to you in coming in but would have appreciated a nurse to say I have done all I can and am no longer comfortable with the situation on my own.
I would bring the problem of smoking up with ur SW and ask that it be made clear to all potential admits that the facility is non-smoking and no consideration will be made in this regard, if the new admit doesn't like it, he or she can look elsewhere.
Regarding the charge nurse, it all depends on her work hx and other management issues you might have had with her, you have to look at the big picture.
The charge nurse was wrong in asking you to come down, and I would keep an eye on her.
regardless of what the doctor ordered, the policy is no smoking. the charge nurse was not doing her job when she called the doctor. what did she think the doctor was going to do because a patient was refusing to comply with facility policy?? she set the doc up, IMO, because she knew the only thing the doc could do would be to say "well let him smoke then". she should have never called the doctor.
when he refused to comply with company policy, that is when she should have stopped "fighting" with the patient and called both the DNS and the administrator for advice on what to do and then do what they told her to.
if a patient is acting so bad that the charge nurse is literally, physically afraid of him then pick up the phone and call 911.
but to refuse to do something within your job description when the DNS tells you to do it? i'd at the very least suspend her and then demote her.
if the staff sees that she acted that way with you and got away with it, who's next? she was completely out of line. i'd love to know what you did about it.
i can tell you one thing....i'm the weekend supervisor at my job. i am supposed to be an "extension" of the DON. if she tells me to do something that is within my job description and i cop an attitude and tell her to do it herself? yeah...i'd be looking for a new job.
Specializes in Gerontology, Med surg, Home Health.
I make it clear to the case managers at the various hospitals that we are a non-smoking facility and it is abundantly clear on all the marketing materials we send out. Some people think the rules don't apply to them. I've spoken to the doc and reminded him of the no smoking policy and all is well. Now if I could just keep family members from using the employee entrances to get into the building without signing in at the front desk.
I make it clear to the case managers at the various hospitals that we are a non-smoking facility and it is abundantly clear on all the marketing materials we send out. Some people think the rules don't apply to them. I've spoken to the doc and reminded him of the no smoking policy and all is well. Now if I could just keep family members from using the employee entrances to get into the building without signing in at the front desk.
i just wish it was our policy to have visitors sign in! it's scary knowing that just anyone can walk in and we dont know who they are.
we have a strict smoking policy. they have to sign the policy before they are allowed to smoke. they can only smoke with a staff member, have to wear a smoking apron, cant keep their cigarettes and lighters in their room and we have only 3 times a day that we will take them out. sometimes a staff member might take them at other times if they have time but we only promise three times a day and thats if nothing important is going on that noone can leave the floor.
all that and people STILL complain even after theyve agreed to the policy. i get blessed out constantly because family members want to take the patient out to smoke and i wont let them.
but our company has let us know in nouncertainterms that it will be our job if we dont follow policy. one of our sister facilities got 6 IJ tags at once because 6 patients were outside smoking alone. i didnt believe the administrator when he told us that so i googled and sure enuf! there it was. 6 IJ tags. now i make sure i follow the policy to the letter!
elkpark
14,633 Posts
I agree it was inappropriate to call for a physician's order to smoke in a non-smoking facility. That's not a "compromise," it's a simple failure to follow the facility's policies/procedures.