patients smoking

LydiaGreen · Nov 6, 2003

We have an outdoor smoking area at our hospital (where I do clinical placement and will be working after graduation). It is for visitors, staff and patients. Staff does NOT accompany clients who wish to smoke outdoors. If they are able to go on their own, fine... if not, family members must take them. We are not responsible for what happens to them when they are outside smoking. It does become an issue when trying to give meds, get tests done, etc. If a med is late, or a test not done, we document that the client was outside smoking so the MD knows WHY.

Hospitalization is stressful enough without FORCING someone to quit. A person will not quit until they are ready, there is no point in taking away their right to do as they wish.

On a personal note, I am a smoker. Keep thinking I should quit, especially with all of the palliative lung CA's I've seen. I do NOT smoke in my home... this is my addiction not my children's and I do not impose the risks upon them. As for nurses taking smoke breaks... none of the smoking nurses at "my" hospital take anymore breaks than the non-smoking nurses. As all of you know, you are lucky to even get your break. And what a person does on their break, is their business.

hogan4736, BSN, RN · Nov 6, 2003

Originally posted by purplemania
must be great to have enough staff to accompany people outside in order to perform a task that is life-threatening. Sounds weird to me. We offer patches. No one, not even employees, allowed to smoke on campus anywhere. If patient insists, we call MD and get order for DC or they may go AMA, but we do not promote smoking.

I understand that having enough staff may be an issue, but we have scheduled smoke breaks where each department takes turns supervising...

The great part though, is making a small difference in someone's day, which promotes happiness on their part...:)

We should remember these are adults, we're not on a psych ward, and people should have freewill...

sean

jnette, ASN, EMT-I · Nov 6, 2003

Our hospital is smokefree, but patients are allowed outside to smoke. We do not accomapany them and we ask they let us know when they are going out. Don't have many who do, but there are always a few.

We recently had an elderly woman who would smoke in her bathroom even though she knew it was against policy. Her Dr. was aware, but he too, had no way of "enforcing" compliance... what were we to do? Kick her out? Refuse to treat her? She had smoked all her life, was nearing her end days, and "smoked to live" if that makes any sense. Was all she looked forward to. Sad, but reality. Why upset the poor soul even more?

Heck, if they haven't quit by eighty, they darn sure aren't going to quit just 'cuz YOU want them to ! And they're old enough to be stubborn enough to do as they wish and tell you to stick it if you don't like it ! Yep... live and let live. Give some ppl a break.

bellehill, RN · Nov 6, 2003

I hate seeing patients going outside to smoke but it is their choice not mine. I will not accompany them outside; if they are healthy enough to want a cig they can go by themselves. I just make sure to tell them once they leave the floor they are on their own until they return and document really well. Never let a pt smoke with a patch in place.

Hey, here is a thought...if I walked them down then maybe I could get a break too?:chuckle

RN-PA, RN · Nov 6, 2003

I always offer to get an order for a nicotine patch when patients ask if they can go out and smoke, and some accept that, thankfully. Our hospital policy is no smoking-- except in outdoor designated areas-- but some doctors do write orders that the patient may leave the floor to smoke, accompanied by staff which is also hospital policy. Anyone who wants to leave the floor for any reason has to have a doctor's order allowing it.

The topic of smoking patients is a HUGE pet peeve of mine-- not so much because of the unhealthiness of smoking, but because it becomes a big pain in the butt for nurses. We lose a much-needed aide or a nurse for the time the patient needs to be off the unit to smoke. If it's on my shift, I let the patient know up front that we don't have enough staff to spare, so he/she may leave the floor ONCE during my 8-hour shift. If I have problems with the patient accepting a limit, I call the doctor and get them to write an order stating "patient may leave the unit once/shift".

Originally posted by spitfire
What is the legal aspect of a pt going out to smoke and falling- or using drugs - this pt had IV access and was not asking staff to go out with him, he is a know IV drug user and is being treated for a raging infection. I feel set up by the nursing manager in that the staffs safety was not considered and if something did happen my licence would be brought in to question.

Your hospital would be liable if something happened to your patient while he was unaccompanied off the unit. That's why we tell patients they must be with staff to leave the floor. Please talk to your manager about the legal ramifications or ask risk management about your policy.

neneRN, BSN, RN · Nov 7, 2003

Our pts aren't allowed to go out and smoke (this is in the ER), but when they insist- we can tell them that we will not hold their bed for them while they go outside to smoke, we will give the room to a pt waiting in the lobby and they are more than welcome to sign back into triage and begin the whole process over again! Usually works!

(One day we did have a pt who would not stay in the room, kept going out over and over again, holding up X ray, labs, IVF infusion, etc while no one could find him. And by Murphy's Law, it was one of those rare days where there WAS no one in the lobby waiting to come back, no ambulances coming in, i.e. no one to give his bed to. At one point, we even had him sign an AMA as he was acting against the docs advice by going out to smoke-so he signed it, went out to smoke and came back in....then the ER doc had the bright idea to tell him that he could not go out with the HL in place- and instructed nurses to d/c HL when he went outside and restart HL every time he came back in. By the third 16 guage started, the pt decided he really didn't need any more medical attention and successfully signed out AMA. )

FarmgrrlRN · Nov 7, 2003

Today was my second day of clinical (ever!) and while listening to report, the nurse coming off told my nurse about a pt. of hers...the woman has a motorized wheelchair that she can get into and out of by herself (to and from the bed). Well, she is a smoker and takes herself outside to smoke. So, I was like "OK". Sure enough later that day I was on my way back to the unit and there she was, scootering herself out to the smoking patio, pushing her IV pole in front of her! It was a strangely comical site but also pretty sad since she was not looking too hot but still had the drive to get herself outside for a cigarette.

Kim44 · Nov 7, 2003

This is also a major pet peeve of mine. Our patients sign a smoking release form and can go outside. I have no problem with that. However, I dont have the extra time when the patient needs assistance to transfer to a wheelchair several times a day to go smoke. We have even had pts who require a mechanical lift insist on going out every few hours. We also had a young leukemic receiving continuous chemo thru a PICC. His MD wrote an order to flush and cap the line prn so the pt could smoke. I am the first person to go the extra mile for a pt, but this was very time consuming. Not to mention increased risk of infection to the PICC from being accessed so often.

jadednurse · Nov 7, 2003

For many smoking is a coping mechanism. Not a good one, but one none the less. For some patients it is appropriate to educate and guide them into using more appropriate mechanisms. For others, like someone who is dealing w/ a major stressor (ie the quadraplegic pt someone mentioned) it doesn't seem quite right to stress them out more b/c it's inconvenient for us as nurses.

Now the legal ramifications involved should something happen to the pt (if they went outside to smoke unsupervised)...that's a big issue IMHO.

EastCoast · Nov 7, 2003

Originally posted by spitfire
Today a patient was permitted(by the nurse manager) to go outside-with a staff member to smoke every 4 hours, he is being treated(antibiotics-I&D-dressing changes) for an infected AC from using needles. Well 4 hours turned into when ever he wanted and then he was outside in someones car smoking

Now there's strong nursing management!! Was the NM a smoker or just someone who wanted to get a whining patient out of her hair? Maybe the NM should accompany the patient outside.

5150dx · Nov 7, 2003

Hello,

I just want to second Jadednurse's post... and others that recognize that while this is inconvenient and has legal ramifications which must be addressed, it is extremely important to many pts to be able to smoke. I haven't smoked for 9 years but when I hit a stressful moment the craving returns! When I went for a divorce, long ago, that first cigarette after 5 years of "recovery" was pure relief. I hate nicotine, I hate the addiction but we must be realistic.

Maybe I am a bit "militant" about it right now as I just helped get a friend OUT of the hospital and into home hospice. She just passed away a day ago. Last week I had to sleep several nights at the hospital because "hospital policy" endangered her. Sometimes "routine" can hamper a pt's recovery. As a student nurse I am also becomming rapidly wary of many nurses being unwilling to call a doctor when needed, to change orders.... or still letting a pt. sit for 1.5 hours in feces.... Grrrrr..... Sorry (a bit) for the rant!

Kristi

spitfire · Nov 7, 2003

Originally posted by EastCoast
Now there's strong nursing management!! Was the NM a smoker or just someone who wanted to get a whining patient out of her hair? Maybe the NM should accompany the patient outside.

The NM just wanted the patient to stay and be TX or he was going to lose his arm. Personally I don't thing patients should smoke while in the hospital ( I am not going to stop them) but they always seem to let some and then not others.I do not have time to step out with a patient or want to. My concern is at a prior staff meeting this same NM stated that if we were medicating a pt for pain and let them go ouside to smoke and that pt. fell then it was our licence and he was not going to stand behind us......This week, it was ok to send a medicated patient outside. So where did that leave me if the patient did fall or was doing heroin while he was unsupervised?