I am currently in a position at an inner city hospital, and have been here for a bit now. The hospital/doctors allow our patients to leave the floor to smoke as long as they have a waiver signed that basically states they are utilizing their time off the floor without being monitored and anything that happens is out of the hospital's control. Every nurse on the floor (in the hospital I should say) is against this for multiple obvious reasons; especially Per Diem RN's that just laugh at how ridiculous it is.
I am really just interested in knowing if there are any other hospitals out there that allow their patients to do this? I mean it's not always just smoking cigarettes, but patients roam the streets of the city for up to 2 hours, as they know the 2 hour mark defines them as eloped. Am I just crazy?
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Ours just tell us they are going for a smoke and off they go. We get the odd one who thinks a nurse should go with them to open doors and push their wheelchairs. We just tell them that if they want to smoke they go under their own steam.
We do have a smoking cessation programme that we offer them (patches, gum, inhalers) but most decline it.
We can't refuse to let them off the unit, they are patients nor prisoners. They are mainly adults who can make their own decisions.
Tobacco is heavily taxed and who are we to say no?
At least you're allowed to tell them they have to go under their own steam. I remember having to TAKE them out in the cold or rain or snow so that they could have their cigarettes. It used to really muck up your day to have to take smokers outside two or three times a shift and find someone else to watch your other 7 patients!
But then, I'm old enough to remember patients smoking in their hospital beds -- and to have seen at least one patient set himself on fire smoking in bed. (OK, I saw the aftermath, not the actual setting himself on fire. I wonder what the liability would have been to have witnessed that and been unable to stop it!)
Ah, yes. I also remember hospital patients smoking in bed. The holes burned in the linens. Putting out the occasional waste basket fire from a still hot cig. There were even cigarette machines in the hospital. I really hated to see patients smoking after they had pain meds. It's a wonder the whole place didn't go up in flames!
We have a set smoking schedule. It is about 10 times throughout the day. I hate it! The residents get anxious for the times and get very demanding. It takes staff away from the floor to assisted them down to the smoke breaks. It's really stupid.
My sister-in-law gave birth at a hospital in MS almost four years ago, and within hours, she had us wheeling her outside to smoke (she smoked throughout the pregnancy). She did not have to sign any forms before we took her out.
Stopping patients smoking is a slow process. First of all, notices were placed around the hospital months in advance, regarding the change in policy. Even while we were wheeling the patient off the floor, we were reminding them this is going to stop in xxxx months.
When the day came when we said no, there was anger and outrage.
Arguments. Patients went out anyway with their family. It took months to even put a dent in behavior, as most of our smoking patients are in and out of the hospital frequently. They were used to being pushed outside by staff, and they fought hard to keep it that way.
After a year and a half, we rarely have the smoker who makes a scene. It helps that very other hospital in a 50 mile radius has a no smoking policy too.
The SNF I work in recently went smoke free. The few smokers we have were grandfathered in , any new admissions are not allowed to smoke on the grounds. They can however request a safe smoking assessment and if they are deemed independent they can sign out and leave the property to smoke.
The policy for staff is suppose to be no smoking on the grounds, however staff can't leave the grounds during breaks since they are on the clock [if you are clocked in you can't leave the property]. This effectively means no smoking except on an off the clock lunch break and then only if you leave the grounds. Administration never could figure a good way around this, and about half our staff are smokers [myself included] so the policy has yet to be enforced.
When I worked in Nursing Home Hell, there were 2 resident smoke breaks a day. A smoking nurse or aide would take residents out to smoke twice a day. One resident regularly left the grounds to smoke weed.
Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
When I worked in Nursing Home Hell, there were 2 resident smoke breaks a day.
You were fortunate...at every nursing home I've ever worked, the resident's smoke breaks were every two hours while awake (yes, Q2 hours!). Ain't nobody got time for that, especially in LTC.
Anyhow, the resident's smoke breaks were a huge reason for my departure from LTC several years ago. Frequent smoke breaks come with the territory of living in a state with higher than average smoking rates within the population
I lived in NC for most of my life, in the home of "big tobacco." My Mom went to RJ Reynolds high school. I grew up in Winston-Salem (the city that inspired the names of two of the biggest brands of cigarette.)
Ironically, the hospitals I worked in did not allow patients to smoke. If they were caught smoking in the hospital, their cigarettes were taken away and given to security, as they posed a fire hazard and a clear risk to harm others. Patients were reminded of hospital policy and asked if they wanted to transfer to another facility or leave AMA.
If they wanted to go outside to smoke, they were given an order for a nicotine patch and an AMA form. If they were insistent about their "right" to smoke, we D/C'd all lines before we left the room, because we knew they were about to go down the stairs and leave.
A few of the units I worked on also didn't allow the patient to leave the floor. No trips to the Gift Shop or Cafeteria without a social work evaluation and an order from the doc. If they left the floor, it was told to them that they were considered AMA and would have to come back through the ER if they wished to be readmitted. This was addressed at admission, and for the scheduled surgeries pre-admission, so most patients were compliant.
We definitely didn't take anybody outside to smoke. The administration was mostly non-smoking and intolerant, so they backed us up. Basically, we were told that we were expected to be working, not hanging out smoking with the patients.
Ruby Vee, BSN
17 Articles; 14,051 Posts
At least you're allowed to tell them they have to go under their own steam. I remember having to TAKE them out in the cold or rain or snow so that they could have their cigarettes. It used to really muck up your day to have to take smokers outside two or three times a shift and find someone else to watch your other 7 patients!
But then, I'm old enough to remember patients smoking in their hospital beds -- and to have seen at least one patient set himself on fire smoking in bed. (OK, I saw the aftermath, not the actual setting himself on fire. I wonder what the liability would have been to have witnessed that and been unable to stop it!)