Patient smokers!!

Nurses General Nursing

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I was just wondering what you all do when a pt wants to leave the floor to go smoke? I work at a facility that has strict no smoking policies in place for patients who smoke, visitors and staff. There is no smoking on hospital grounds period. I always have pts who seem to go thru nicotine withdrawals at the sight of the hospital!! They always ask me if they can go outside with their friend/family/significant other/whoever, to "get some fresh air"! I'm not stupid and I will catch on to you! Today I had a.straight up telll me he was going out top smoke! Tried to tell him not to, he had just had morphine, post appy, and fluids running! He kept asking me if it was ok to smoke... Repeaed myself multiple times but he just wanted some one to tell him he want going to get in trouble! I obviously wasnt going to restrain him, he is a grown ass man and theres really nothing I could do to stop him... Anyway he ended up leaving the floor, iv pole and all... Right before he go on the elevator I caught him and disconnected him from his iv pump... I want going to let him take it out side with him! He finally came back but I'm just wondering, what would you have done of this was your pt? Was I wrong to unhook the fluids, making it easier for him to walk? I felt so trapped by him, I was screwed either way! Sorry if there stre other posts similar to this, just had to vent! I truly appreciate your time and any comments/insights you'd be willing to give! Thanks so much!;)

For the ED: we will not in any way assist them outside. If they are a walkie/talkie they may lose their place in line to be seen, but, otherwise, if they are an adult they are free to do whatever they want. If they are gone long enough, they would be considered an 'elopement' and they would have to re-check in to come back.

I work in the ED too. They are free to walk out and smoke it they want, but if they do, they have effectively gone AMA and we will not continue to treat them unless they go through triage again. Letting them back in to continue treatment after smoking is risky. You don't know that the only thing they have done is smoke a cigarette, and you are assuming responsibility for whatever they have done.

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Yup, check your policy. It may be considered AMA/ elopement if the patient leaves the floor.

I learned the hard way...it's just not worth it to have a patient start screaming at you because you tell them they can't leave. Disconnect the IV and let them go. Let the MD know and document it.

If you do let them go you are assuming responsibility for whatever they do while off the floor. If patients leave my hospital they have effectively discharged themselves, per our policy.

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Specializes in pediatric critical care.
1. Nicotine patch (I love the patients that tell me they are "allergic" to them, or the guy that told me they gave him "nightmares". Oh and cigarettes don't?)

Not to downplay the frustration you felt at your patient's obvious denial to quit smoking, but I quit smoking a few months ago, and I was determined to succeed this time, so I got some nicotine patches. I don't know if this is considered an allergy, but those babies ITCHED like nothing I've ever felt for the first 40-50 minutes after I applied a fresh one. And yes, they can affect sleep patterns, I had crazy dreams/disturbing nightmares if I wore one at night, so I had to take them off when I went to bed. Common side effects, I hear. Never had a ciggy give me nightmares. Just my own experience.

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Specializes in Med/Surg.
1. Nicotine patch (I love the patients that tell me they are "allergic" to them, or the guy that told me they gave him "nightmares". Oh and cigarettes don't?)

2. Let security escort them back to their room.

Actually, vivid dreams (esp nightmares) ARE a documented side effect of nicotine patches. Cigarettes do not cause that. You also deal with the dreams with Chantix. It can be disturbing.

I also personally have an allergy to adhesives (I can break out from Band Aids, even), so that is possible, too. It's not just an excuse to keep smoking....

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Not to downplay the frustration you felt at your patient's obvious denial to quit smoking, but I quit smoking a few months ago, and I was determined to succeed this time, so I got some nicotine patches. I don't know if this is considered an allergy, but those babies ITCHED like nothing I've ever felt for the first 40-50 minutes after I applied a fresh one. And yes, they can affect sleep patterns, I had crazy dreams/disturbing nightmares if I wore one at night, so I had to take them off when I went to bed. Common side effects, I hear. Never had a ciggy give me nightmares. Just my own experience.

I had a lot of trouble with itching also. I don't tolerate many adhesives, and those were no different.

CareTeamRN70....'cellophane wrapped mouse droppings'??? LOL- now there's a visual !!

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Specializes in pediatric critical care.
I had a lot of trouble with itching also. I don't tolerate many adhesives, and those were no different.

Oh, duh, I have issues with bandaids and tape as well, I was just assuming it was the nicotine, haha! Worst itching I have ever felt, wanted to dig through my arm with a sharp object!

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Oh, duh, I have issues with bandaids and tape as well, I was just assuming it was the nicotine, haha! Worst itching I have ever felt, wanted to dig through my arm with a sharp object!

Yeah, it was bad. :eek: Too bad there isn't some subQ thingy they could implant like Norplant, and get continuous levels without the bazillion toxins, to ease a person off of the sticks....:D

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Back when patients could smoke IN their rooms, I was a horrible safety risk... I was in traction for a bunch of bulging L discs, and doped up on Demerol.... one of the nurses found me with an unlit cigarette in one hand, and my thumb on the top of the lighter on the other... not good.... The charge nurse got me that nasty original Nicorette gum that tasted like licking an ashtray- blechhhh. Pftooooeeee. :D

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Had a real problem with this at my ghetto hospital, patients loved to get a pain shot then go out to smoke. sometimes get high. There, we just put up with it. Here, at this hospital, we have a strict no-smoking policy, that is, workers have to go to the street to smoke. Visitors, well, you get tired of telling them not to smoke in their cars or in the parking lot, so you forget it.

To answer your question about patients though, we can be strict there. You have been told there is no smoking. You go off the floor to smoke and that is considered AMA. While you're gone I will remove the linen and bag your belongings and place them in the hallway.

I have done this, and people leave when they see what a jerk I am. It's very important though, for management and security to be in cahoots.

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Sometimes the walkie talkies " go for a walk" and come back smelling like smoke. I don't have time to babysit them. I explain the risks of smoking and ask whether they want me to contact the dr to see if a nicotine patch is appropriate. If they refuse that and want to go for a walk, well I can't stand in his/her room the whole day.

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Specializes in Labor and Delivery, Newborn, Antepartum.

Our hospital is a "no smoking campus" as well. I tell all my patients on admission that the closest place they or their family and friends can smoke is across the street. I know that they still go out and still smoke. I check with them to see if they need a patch as well so I can get that ordered. One doctor I work with will say "if they're going to smoke, they're going to smoke." His philosophy on the matter is that we need to pick our battles. Another doctor I work with tells her patients they have to leave AMA if they go smoke. She also had a patient that went off the unit, down the elevator to smoke, came back up in the elevator and was found passed out in a massive post partum hemorrhage in the elevator. That would be enough for me to say they have to sign out AMA too!

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While you're gone I will remove the linen and bag your belongings and place them in the hallway.

I have done this, and people leave when they see what a jerk I am. It's very important though, for management and security to be in cahoots.

That made my laugh out loud :lol2:

Bag their crud up :smokin:

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