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?
All 3 hospitals I've worked at have a smoke free campus policy, but none of them enforce it. Patients who are stable tend to go outside to smoke. The exception to this is patients on telemetry, because the signal doesn't reach outside, so we don't let them leave the unit. That's why I love working in icu where we have a locked unit.
Specializes in Med nurse in med-surg., float, HH, and PDN.
In the late 70's I worked at a small hospital in a big city in TN. EVERYBODY, it seemed, smoked.....in the hospital, in patient's rooms, at the nurse's station, in the cafeteria, in offices; just about everywhere except the ER and the OR (and where 02 was in use).
I worked on a post-op back-surgery floor. These patients had pain meds, nerve meds, muscle relaxers (by mouth and by IV drip), sleeping pills......
I actually had a patient ring the bell and tell the ward clerk she needed to see the med nurse. Me.
I went in as her room-mate was bringing in coffee for them both. The patient who had called for me said "I'll have 'the works', please."
I called the doc and read off the list of PRN's she referred to as 'the works'. Doc sighed wearily, asked if she'd had any of them recently (no)
and said, "If they're ordered and the timing doesn't overlap doses, go ahead and give them. "Which ones?" I wanted to know. He replied, "Anything she wants. Yes, all of them."
GAH-ZOINGA!
After I had pilled her, shot her, and hung the drip, the patient sighed, got comfy, and lit a cigarette, sipped on her coffee......and got on a really 'high' talking jag w/ her roomie. They talked and smoked for several hours before finally going to sleep.
Patient satisfaction!!!!! So yes, patients can go outside to smoke. It drives me bonkers. If they dont come back in 4 hours we call security for an elopement. Who has time to track their patients' 4 hour smoke break!Plus fit in all of their meds and orders!
The docs used to write an order that the patient was allowed to leave the unit and smoke with supervision. I would hand the chart to the doc who wrote the order and said 511 wants his smoke break now. Yes, I did.
I was over it before it started. If I don't have time to pee, they don't get me walking them down for a smoke break.
We have a nonsmoking policy, and a no cell phones policy, and a pay for parking policy, and security is not backed up in enforcing any of it. But if someone is injured you can bet TPTB will point out it's not their fault because they wrote those policies.
As crazy and stupid as it is to me, it's not like we can strap the patient down to the bed to prevent them from leaving. Many of the patients that I have had these problems with really needed to be in the hospital and receiving care. They want to go for a smoke, we tell them no and they say either you let me go or I sign an AMA and get discharged. They're just going to end up back in the hospital in a week or less, so its easier just to let them go and have their smoke. It never fails to drive me up the wall though.
The docs used to write an order that the patient was allowed to leave the unit and smoke with supervision. I would hand the chart to the doc who wrote the order and said 511 wants his smoke break now. Yes, I did.
I was over it before it started. If I don't have time to pee, they don't get me walking them down for a smoke break.
Ugh YES, i have had doctors write an order to allow them to go out and smoke accompanied. Umm excuse me, really?!?!
This was when the hospital tried be a smoke free campus and banned patients (and staff) from smoking. Some doctors decided they could override this and just write an order to let the patient go out and smoke. It was ridiculous.
I apologize in advance. I hate when patients go outside and smoke. I precepted at a hospital that was so proud to be a non-smoking facility. In theory, hospitals as non-smoking facilities promote health and well-being. Non-smokers don't have to swim through a noxious cloud of smoke to access the building. A nurse manager was just overjoyed. "Just think, no more chasing down noncompliant patients! No more worrying about outside drugs being injected in saline locks or IV's! Staff won't have to go off floor to wheel anyone down!" And, implied, MD's will support us. We will have adequate security to enforce this. It's the healthy, safe choice! For this facility, mismanaged as it was, trying to enforce a non-smoking policy was a nightmare. Let me elaborate:
As we were (so shockingly) understaffed, it made our eyes twinkle to say, "I'm sorry, Mr. Puff, but this hospital is a non-smoking facility. No, you can't go down and smoke. No, your son cannot take you down. It's a major health concern, and you came to the hospital because you have pancreatitis and wanted to get better. Your doctor says that if you go down we'll have to discharge you." Unfortunately, patients aren't scared of our big health talk. "Day shift lets me go down." This was not true, according to my colleagues. Mr. P quietly snuck downstairs with his son after donning regular clothes. A CNA caught him returning and told the nurse, who had to call "Dr. Happy". Dr. Happy, the nurse told me, yelled at her for calling about something so trivial and did not discharge Mr. P. "Just don't let him go down to smoke! How hard is that?"
Hard. Mr. P wasn't having any of our "nonsense". Dr. Happy wasn't going to follow through with his threats to discharge the noncompliant patient. Our security, sorry to say, was pitifully sporifice on night shift. I mean, one guard for a 250-bed hospital sporifice. A night nurse on a med-surg floor could expect to have 8 patients, with or without a tech. I wasn't going to tackle this guy or stand vigil at his door, phone in hand, to bravely summon our lonely security officer from ER. I experienced what at least 75% of health professionals describe--an unenforceable policy, variable physician support, and mismanaged pipe dreams of controlling patient actions.
Faced with these things in mind, I decided a few things. Mr. P would tell me of his intentions, let me unhook his IV, and be to a certain area and back within "X" minutes. A senior nurse disagreed. "Tell him if he goes down he can't have any pain drugs." No. She could, when she was his nurse, do what I don't consider ethical, because without a physician's support I have no power to stop Mr. P. I don't have to right to allow my patient to hurt if the doctor prescribes the medicine and it is an acceptable time to administer said drug.
I'm not going to hold him back. I'm not going to pass him off on another nurse who doesn't want to deal with the issue. The issue isn't really Mr. P smoking, although I hate that he does it. I reported it up the chain of command, I promised a nicotine patch, let him walk the halls... I educated him on smoking, again and again. If the hospital can't enforce a policy, in my opinion, it should at least provide a safe area for patients to go. At least then I'll have a *better* chance of knowing where that silly patient went. Yes, he/she could still wander off, get non-regulated drugs, or fall. Surprisingly enough, before the hospital policy kicked in and patients had an area outdoors where they were allowed to smoke, a decent percent actually just wanted to smoke and were reasonably good at not winding up across the busy highway or in a stairwell. (Can you guess where they would sneak off to when the hospital went "smoke-free"?)
I think we can all say that it is NOT a good idea for patients to smoke or wander around, aimless and unaccounted for; but in this case, what can you do? This is just one example of the HCP expected to do the impossible. If I could single-handedly make my patients quit smoking because of a policy, I would be selling motivational books on Amazon.
One thing I do not understand is if Cigarette is so bad to a point all Hospitals are no-smoke, they why the Government is allowing cigar rates to be sold legally? It is one side is Legal and other side is illegal where people need the facility? Perhaps they have a smoking room separate vent system?
What happens if one is cancer or some serious gastric situation and still a smoker that can not take nicotine patches due to bad adhesive? How they are well if they want to smoke?
Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
One thing I do not understand is if Cigarette is so bad to a point all Hospitals are no-smoke, they why the Government is allowing cigar rates to be sold legally?
Not all hospitals have non-smoking policies. Many hospitals still allow patients and staff to smoke in designated areas on the facility grounds.
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akulahawkRN, ADN, RN, EMT-P
3,533 Posts
Where I'm at, if the patients elect to go outside and smoke, they are told that they must leave AMA to do so.