pts going out to smoke

RNLaborNurse4U · Apr 9, 2007

My hospital changed to a no smoking campus (anywhere on the hospital property) back in November. Before November, docs wrote an order for moms to go out to smoke, and they signed a sheet in maternity when they were leaving (I would imagine, to account for all patients on the unit or off the unit, in case of an emergency?). After November, anyone wanting to leave to smoke needs to sign an AMA form, and they are officially discharged from care. They cannot smoke anywhere on the hospital property, including in the parking lots. If they come back after smoking, they are readmitted.

DutchgirlRN, ASN, RN · Apr 9, 2007

Whoa! I cannot imagine! Although I totally agree that patients should not be going out to smoke I can't imagine that happening where I used to work.

I run by there often dropping off labs and often see women who are still pregnant standing out front with the monitor leads hanging down from where they are flipped them up over their neck, standing there smoking. COPD patients in with exacerbations standing there smoking. It really bothers me.

Medic/Nurse, BSN, RN · Apr 9, 2007

Smoke free or not - I will not let patients go out to smoke with out signing out AMA. Personally, I believe an argument could be made that since "they" are on hospital property and in "your" care - YOU are responsible for their safety.

I DO NOT SMOKE. I AM NOT GOING OUT WITH PATIENTS TO SMOKE. I DO NOT LIKE SMELLING LIKE I'VE BEEN TO A BAR. I also hate the "ashtray breath" I have to content with when they return (same for my co-workers, but they will take the offer of a mint or gum! :) )

I had a patient admitted to ICU in status seizure from med non-compliance and he wanted to go out and smoke. I refused. Offered nic patch, etc. The other nurse in the ICU actually became quite argumentative with me over this issue - "Who are you to stop him?" Yak. Yak. Yak.

Well what if he goes out in the w/c, has a seizure and falls out - hits head and dies! Guess what, I'm RESPONSIBLE and seizure precautions are MD ordered - and in no way could I justify a ciggy break in a w/c as a part of SEIZURE PRECAUTIONS.

Well, her battery of me hit a crescendo - and she ended up taking my patient and I had to take one of hers - report and all, mid shift! (Yep, the House super thought this was an excellent solution - but I was the ONLY NS RN in the ICU - and one of the few in the entire HOSPITAL :) )

Anyway, I think it is a BAD practice, I think the primary care RN could be held responsible - regardless. I think everyone should do what they are comfortable with - I do know that not having a cigarette will not kill a patient (I always get a nic patch order!) BUt, if they are injured, elope or are otherwise taken off property - you may get to explain to the facility, family, licensing authority. I'D RATHER NOT!

Oh, and a small notation that "patient out to smoke" per MD order, I'd think that THAT will be a weak DEFENSE.

PRACTICE SAFE!

babyktchr, BSN, RN · Apr 9, 2007

OMG....this is such a THING for me. Patients that come back from C/S and the first thing they say is..."when can I go down and smoke?" In my opinion, if you are well enough to drag your body outside to smoke, you are well enough to go HOME. I think it is disgusting that patients are outside with IV's and stuff smoking...and staff for that matter. Our facility is going smoke free in JUNE and it is none to soon.

Patients nowadays simply take a mile when they are given an inch. I told a patient she could go down for some "air". I hear the baby crying about an hour later, and I go in, and the FOB is sleeping (in the bed of course). I wake him and ask him where mom is. He calls her cell phone..and she is at WALMART buying clothes for the baby. I get on the phone and tell her to come back. She is confused why I am upset with her???

I just don't get in anymore.

robred · Apr 9, 2007

Smoke free or not - I will not let patients go out to smoke with out signing out AMA. Personally, I believe an argument could be made that since "they" are on hospital property and in "your" care - YOU are responsible for their safety.
I DO NOT SMOKE. I AM NOT GOING OUT WITH PATIENTS TO SMOKE. I DO NOT LIKE SMELLING LIKE I'VE BEEN TO A BAR. I also hate the "ashtray breath" I have to content with when they return (same for my co-workers, but they will take the offer of a mint or gum! :) )
I had a patient admitted to ICU in status seizure from med non-compliance and he wanted to go out and smoke. I refused. Offered nic patch, etc. The other nurse in the ICU actually became quite argumentative with me over this issue - "Who are you to stop him?" Yak. Yak. Yak.
Well what if he goes out in the w/c, has a seizure and falls out - hits head and dies! Guess what, I'm RESPONSIBLE and seizure precautions are MD ordered - and in no way could I justify a ciggy break in a w/c as a part of SEIZURE PRECAUTIONS.
Well, her battery of me hit a crescendo - and she ended up taking my patient and I had to take one of hers - report and all, mid shift! (Yep, the House super thought this was an excellent solution - but I was the ONLY NS RN in the ICU - and one of the few in the entire HOSPITAL :) )
Anyway, I think it is a BAD practice, I think the primary care RN could be held responsible - regardless. I think everyone should do what they are comfortable with - I do know that not having a cigarette will not kill a patient (I always get a nic patch order!) BUt, if they are injured, elope or are otherwise taken off property - you may get to explain to the facility, family, licensing authority. I'D RATHER NOT!
Oh, and a small notation that "patient out to smoke" per MD order, I'd think that THAT will be a weak DEFENSE.
PRACTICE SAFE!

I had to laugh at the utterly stupid remark of "Who are you to stop him?" and the equally stupid solution to change pateints mid-shift to accommodate this situation.

The nurse who has this type of insight misses the entire primary purpose of nursing. The patients is our responsibility until discharge or until he leaves AMA. Even if a pt has a physician's written 'may go out to smoke' order, does anyone really believe that in our current societal more' of lack of personal responsibility that a jury would not hold the nurse professionally responsible if that smoking pt developed a medical emergency while out smoking and suffered some sequealae?

And if you are wondering....I am a formed smoker who wishes I had never smoked.

DidiRN · Apr 9, 2007

I have literally seen a couple of people throw their selves in front of the elevators to prevent a mom from going down:uhoh3: I'm sorry, I'm not gonna do that. I don't have to like that they want to go down to smoke, but it is their choice right? Couldn't it be said that we are imprisoning them? What are your thoughts on this?

If the patient is a/o x 3, not a danger to self or others (although that is debateable with the smoking and being pregnant I guess, but I am talking suicidal/homicidal in the legal sense), then the nurses who are stopping them from leaving could actually be criminally charged with false imprisonment or something to that effect for not allowing them to leave if they want to.

This is what I do (depending on the policies of your place of employment)...I tell them the dangers of leaving, there is no order from doc to leave, but if they really want to and don't fall under the category of being suicidal/homicidal and are competent, then there is absolutely nothing I can do to stop them. I just document everything, including if they refused to sign an AMA form. That should cover you.

crissrn27, RN · Apr 9, 2007

If the patient is a/o x 3, not a danger to self or others (although that is debateable with the smoking and being pregnant I guess, but I am talking suicidal/homicidal in the legal sense), then the nurses who are stopping them from leaving could actually be criminally charged with false imprisonment or something to that effect for not allowing them to leave if they want to.
This is what I do (depending on the policies of your place of employment)...I tell them the dangers of leaving, there is no order from doc to leave, but if they really want to and don't fall under the category of being suicidal/homicidal and are competent, then there is absolutely nothing I can do to stop them. I just document everything, including if they refused to sign an AMA form. That should cover you.

These are my thoughts too. I am not going to hold a person against their will. I would just document and hopefully get them to sign a AMA form before going down. I am scared these nurses are going to get in some serious legal trouble if they continue to refuse to allow these Pt's to go down. I know its not something the pt should be doing, but its not our decision. now in the case of a smoke free hospital I think it would have to be different. But we are not(smoke free) yet. Glad I work with the babies!

crissrn27, RN · Apr 9, 2007

Smoke free or not - I will not let patients go out to smoke with out signing out AMA. Personally, I believe an argument could be made that since "they" are on hospital property and in "your" care - YOU are responsible for their safety.
I DO NOT SMOKE. I AM NOT GOING OUT WITH PATIENTS TO SMOKE. I DO NOT LIKE SMELLING LIKE I'VE BEEN TO A BAR. I also hate the "ashtray breath" I have to content with when they return (same for my co-workers, but they will take the offer of a mint or gum! :) )
I had a patient admitted to ICU in status seizure from med non-compliance and he wanted to go out and smoke. I refused. Offered nic patch, etc. The other nurse in the ICU actually became quite argumentative with me over this issue - "Who are you to stop him?" Yak. Yak. Yak.
Well what if he goes out in the w/c, has a seizure and falls out - hits head and dies! Guess what, I'm RESPONSIBLE and seizure precautions are MD ordered - and in no way could I justify a ciggy break in a w/c as a part of SEIZURE PRECAUTIONS.
Well, her battery of me hit a crescendo - and she ended up taking my patient and I had to take one of hers - report and all, mid shift! (Yep, the House super thought this was an excellent solution - but I was the ONLY NS RN in the ICU - and one of the few in the entire HOSPITAL :) )
Anyway, I think it is a BAD practice, I think the primary care RN could be held responsible - regardless. I think everyone should do what they are comfortable with - I do know that not having a cigarette will not kill a patient (I always get a nic patch order!) BUt, if they are injured, elope or are otherwise taken off property - you may get to explain to the facility, family, licensing authority. I'D RATHER NOT!
Oh, and a small notation that "patient out to smoke" per MD order, I'd think that THAT will be a weak DEFENSE.
PRACTICE SAFE!

If you (in the seizure case) had the pts sign an AMA form and documented everything (as long as the pt is a/o x 3), they can't hold you liable for the pts having a seizure outside. If I had been your co-worker I think I might have asked the same thing "who are you to stop him"- not that you didn't have your pts best interest at heart, but the free will thing bothers me, I mean this is the USA right? Even stupid pts that want to do something they know might hurt them should have free will. :lol2:

Elvish, BSN, DNP, RN, NP · Apr 9, 2007

Where I am people go down to smoke all the time & they don't have to have a doc's order. I personally hate smoke and I REALLY hate it when mom is already in for PTL and here she goes bebopping outside to have her cig. I tell mom what the dangers are and let her know why the docs have ordered her on bedrest c BRP only. But again, I'm not anyone's babysitter.

A lot of moms whose UDSs were + for substances will get serial UDSs while they're with us, esp after they go downstairs. We have found a lot of moms using while still in the hospitals. I personally think it's child abuse to do that while you're pregnant.

I don't know what the answer is. But I am really glad our hospital is going smoke-free later on this year. That will be a big kick in the keester for everybody, pts and staff.

May_baby · Apr 9, 2007

Going back to the statement about a positive drug screen...

Its pretty easy for a supplier (friend/dealer) to roll up the hospital and create a transaction.

"Smoke breaks"= drugs runs for some people.

I'm all for documentation/AMA sign out sheets when pts leave the floor. God forbid someone OD...

lovejana22 · Apr 9, 2007

my husband has an acquaintance and his wife threw a fit to go out to smoke!! i could not believe that she acted that way. i did smoke before i was pregnant and quit during pregnancy and my word smoking was the last thing on my mind after birth. i can not make anyone stop smoking although i wish i could after watching my grand mother and aunt die from lung cancer. in my opinion these patients who do smoke need to sign a discharge paper before going outside. if something happened to them no one should be held accountable but the patient herself.