Sitter to escort patient during smoke breaks.

Editorial Team / Moderator · Nov 5, 2019

I think that patient needs a nicotine patch. But my opinion has no weight; what does hospital policy say about patients going off the floor to smoke?

cna1234 · Nov 5, 2019

Patient refused a nicotine patch. Patients are allowed to come and go off the unit as they please. If a patient wants to smoke, they’re allowed to go out on their own.

*edit to add: generally, if one of our patients wants to go out to smoke and requires a wheelchair, they must have a visitor take them out. Staff is never required and normally not allowed to take patients to smoke.

Sour Lemon · Nov 5, 2019

8 minutes ago, cna1234 said:
Hi all. Just curious about opinions on this topic. A patient safety attendant being assigned to sit with a patient for the sole purpose of escorting them off the unit whenever they please to smoke in the parking lot. This patient has high blood pressure and is receiving IV medication to treat it, but pressures remain very high. The sitter is to walk with the patient, make sure they smoke safely, escort them back to the unit, and sit in the hallway outside their room until the next time they would like to go smoke. Curious on what people think about a sitter being used for this purpose!

I think it sucks, but it's not uncommon. It has less to do with them smoking and more to do with them not breaking their head open.

mmc51264, BSN, MSN, RN · Nov 5, 2019

we never provide someone help. they are grown and make the choice. makes me crazy.

cna1234 · Nov 5, 2019

3 minutes ago, mmc51264 said:
we never provide someone help. they are grown and make the choice. makes me crazy.

I agree. So it was very strange to me that a CNA was forced to sit outside the patient’s room all day and escort the patient down for smoke breaks. Seemed like abuse of the sitter system to me, i was just curious if this is standard practice at other hospitals. I have never heard of this being done before at my hospital.

Orion81RN · Nov 5, 2019

What a waste of resources. Is this some VIP patient? Surely there is a patient somewhere in that facility in actual need of a sitter and not getting one. And I'm 100% certain the CNA was greatly needed on the floor somewhere.

pat · Nov 5, 2019

maybe get the Dr to write no smoking order to see if will lower her blood pressure doesn't the hospital have a policy regarding sitters

cna1234 · Nov 5, 2019

6 minutes ago, pat said:
maybe get the Dr to write no smoking order to see if will lower her blood pressure doesn't the hospital have a policy regarding sitters

The doctor actually wrote an order that the patient could leave the unit to smoke if pressures were below certain parameters. The hospital does have a sitter policy, for patients who are at risk for harming themselves or others, or who are interrupting their care such as pulling on lines.

adventure_rn, MSN, NP · Nov 5, 2019

3 hours ago, cna1234 said:
The doctor actually wrote an order that the patient could leave the unit to smoke if pressures were below certain parameters.

Um...what??

Seriously OP, my sympathies, that sounds incredibly frustrating.

K+MgSO4, BSN · Nov 5, 2019

talk to addiction medicine.

We patch and inhaler patients. The patch gives a baseline level of nicotine and the inhaler gives the "hit". We had such issues with this (mainly with pts. on PCAs or in PTA) that the nurses can initiate the protocol.

CharleeFoxtrot, BSN, RN · Nov 5, 2019

8 hours ago, Sour Lemon said:
I think it sucks, but it's not uncommon. It has less to do with them smoking and more to do with them not breaking their head open.

I've seen it done as well for that and other resons. Mostly as part of a negotiation between the provider and (stubborn) patient threatening to leave. As in "we will let you smoke if you stay inpatient and cooperate with _____ treatment."

Note I am not commenting on the morality of this, merely bearing witness.