smoking in the work place

[fat cat]

I would like to know if any one could advise me on how to go about making a change in a LTC facility where staff is required to take reisdents outside to smoke for monitoring them for safety which is required. I do not think that non smokers should be forced to be subjected to second hand smoke nor utilize nursing time frames to satisty a smokers habit. While there is a plethora of information available on second hand smoke it does not appear that non-smokers have complete protection/ legal rights in the workplace. I would like to see a law that would change this. Additionally in the entrance/exit area to clock in + out , is the designated smoke area for employees which offers a second exposure. There is not always a smoker on duty on the particular floor who can accommodate the patient so the nonsmokers who do not want to do this have no choice. I want to see an end to this. At other times the smoker employee can "enjoy " the continual "privilege" to take the patient to smoke causing the non smoker employee to be left to answer all of the smoker employee's call lights. Personally I do not beleive that the patients should be allowed to smoke at all. But it is my understanding that because the LTC facility is considered their "home" that they have a right to smoke. I would like to see a law enacted to protect the worker from second hand smoke. I would appreciate any suggestions.

[ktwlpn, LPN]

How would you feel if you knew that your confused elderly mother fell and broke her hip at the LTC because cna's were off the unit with the supervised smokers? That puts a whole new spin on it,doesn't it? We have so many frequent fallers that are 1 to 1 now that we are spread really,really thin...AND-the state has started focusing more on activities and we are all expected to do our part to get the residents to them and also BE the activities department if they are not on duty...What has happened to NURSING CARE in LTC? It seems to be on the bottom of the list.People are living longer and have more and more co-morbidities.We've had to spend thousands of dollars for bariatric wheelchairs,shower chairs and beds but the focus is activities and resident's rights..Don't get me wrong-it's ALL important but if you can't deliver basic nursing care in a timely and accurate manner then the residents won't live to enjoy their smoking,snacking and bingo...We have to individualize every care plan-which means each resident could conceivably get their meds administered on a different schedule.I'm all for holding the lasix a few hours until after bingo but when you have to give meds to 20 or 30 ina 2 hour time frame and can't give them in the dining room because "it's their home" and have to give freaking eye gtts behind a privacy curtain someone needs to stand up and shout "STOP THE INSANITY" Can you tell I am a bit frustrated? I have always prided myself on being flexible but it's getting more and more difficult.Why do the rights of a few matter more then the rights of the rest? argh!

[TazziRN, RN]

Again, a previous post said something about every staff member taking a turn.

There are very few things I refuse to do as a nurse, but every other task that could jeopardize my own health is done with some kind of precaution to protect me. Taking a smoker out and having to stay with him/her is different because there is nothing to protect me. Referring to the poster who said that CNAs who refuse to accompany smokers is wrong, I disagree.

[SaderNurse05, BSN, RN]

we have a number of supervised smokers in our facility-i have had to take them to smoke myself when i have had cna's refuse to do so.i object to that refusal on principle so you don't smoke? neither do i-you probably don't crap and wet your pants either but you have to clean up the residents that do so...what's the difference? we do have 2 rooms in the facility outfitted with exhaust fans that look and sound like airplane engines and we are permitted to stand directly outside the door. i don't think staff's right to refuse to assist them out -weighs the resident's right to smoke if you have a safe set up...however i do believe that if the resident is not capable of safe independent smoking then the staff should not have to do it for them..i think it takes too much time away from seeing to the needs of the rest of the residents (the majority) i think this should be determined upon admission by ot and should be understood by the resident and their so's before they get in the door....i really think there should be no supervised smoking-either the resident is capable of smoking independently or he/she should not be permitted to smoke in the facility.that takes care of the entire problem...ot can evaluate prn and if safety becomes an issue then the smoking should be stopped which should be disclosed during the admissions process.i know there are plenty of interventions ot can come up with the maintain safety for a resident with any physical limitations to keep them safe as long as possible ... that's the policy i would institute in an ltc if i had the chance...

lol-i know this is a serious topic but this made me laugh. i may use this line in a future debate. seriously i don not know what the answer is. god bless all of you who work in ltc. i understand the position that it is their home, but what about other habits? can someone who likes beer keep a fridge in their room? i really do not know, i have only been on the periphery of ltc when my grandmother was a resident and i was a lot younger and not a nurse...looking back the staff did a good job with very difficult situation.

[icuwant2rn]

I'm sorry, but if you are not physically able to go out to smoke by your self then I shouldn't have to take you! Actually, at the hospital I work in I refuse to. I have the patient sign an AMA paper and tell them that if they are physically able to take themselves out and are willing to take the risk then go for it but I, nor the hospital, will be held accountable. We go smoke free on the 30th! lol

[RNfaster]

SaderNurse05 - I like your point about alcohol... Is that allowed in LTC or other healthcare facilities? Note: I have seen it in the hospital for pts that are addicted but have some other more acute need to be addressed.

I think it is nuts that smoking is allowed in healthcare facilities. It is detrimental to health. Aren't we supposed to be promoting health? --We have folks adhere to diets in the hospital where I work (heart-healthy, ADA, etc.), so why not eliminate other things that are harmful?

Something some smokers don't realize is smoke stays with them --even after they smoke. My asthma gets triggered by being around folks that smoke.

Recently, I had two outside smokers in a room in the acute-care hospital where I work. After being with them for about five minutes, I had to go use my inhaler. --Neither of them had been in that room very long --but it reeked of smoke.

I often have to use my inhaler after being around a new admit who has it on his or her clothes and/or on relatives that accompany them. Finally, I have to use it around some employees who smoke outside.

I have heard that the Mayo Clinic in Scottsdale, AZ will not hire smokers. While I have family and friends that smoke (I have to limit my time around them, unfortunately), I would love a totally non-smoking workplace.

[anonymurse]

SaderNurse05 - I like your point about alcohol... Is that allowed in LTC or other healthcare facilities? Note: I have seen it in the hospital for pts that are addicted but have some other more acute need to be addressed.

Yeah I've heard some LTC businesses offer happy hour for the residents. I mean it's a business, and a competitive one, too. Shoot, I've taken bourbon to a pt, which he said was very good, and if not Wild Turkey, indistinguishable from it. Also I heard we've switched to Corona for the beer drinkers. The hospital has a liquor license and docs can prescribe whatever their customers want. Hospitals are businesses, too, ya know. Maybe our pharmicists should learn to mix drinks. Hm, with the boomers coming on, maybe we ought to stock Boone's Farm for the Dead Heads.

I think it is nuts that smoking is allowed in healthcare facilities. It is detrimental to health. Aren't we supposed to be promoting health? --We have folks adhere to diets in the hospital where I work (heart-healthy, ADA, etc.), so why not eliminate other things that are harmful?

Yeah. I'd ban leaving bed. Falls happen when people leave bed. Also driving. Pts and others die that way. Maybe there should be a lunch police checking food brought in for cholesterol and excess salt. And grandchildren, I mean do they bring microbes into the facility or what?

Overall, I think that if LTC nursing is too fast and loose for a nurse, maybe prison nursing would offer the environmental control desired.

[81Bubbles, BSN, RN]

I thought the OP was about taking pts outside to smoke and supervise them. There is a lot of air outside. Stand up wind of them and you'll be fine. If you were expected to stand inside a smoke filled room I could see you complaint. But seriously this is LTC many of these people are near the end of thier life and they're probably not going to quit smoking (and that's their right, just like it's your right to be a non-smoker). If you oppose supervising these pats so much get a new job at a smoke free campus

[ktwlpn, LPN]

There are few things I refuse to do as a nurse, but every other task that could jeopardize my own health is done with some kind of precaution to protect me. Taking a smoker out and having to stay with him/her is different because there is nothing to protect me. Referring to the poster who said that CNAs who refuse to accompany smokers is wrong, I disagree.

We do have giant exhaust fans in each of our 2 smoking rooms and we do not have to stand directly in the room so we are protected..If we opt to take the resident outside we can stand several feet away from the smoker ..That's why I object to any cna refusing to "smoke" a resident.

QUOTE-jojoto-QUOTE - I wouldn't expect a pregnant nurse to take care of somebody with chickenpox or measles, or for a Jehovah Witness nurse to initiate/ monitor a blood transfusion. So making accomendations for nonsmoking nurses seems reasonable.QUOTE You are comparing the threat of actual harm to a religous belief. We can NOT deny to care for patients on the basis of race,religion,sexual orientation etc.It's not ethical,imho ..And what happens when you have run out of "smoking nursing staff" and no one is left to smoke the resident? If any nurse objects to any medical procedure for personal reasons then that nurse should look for employment in a setting in which they will not come into contact with those procedures... QUOTE-sonoran-QUOTE I like your point about alcohol... Is that allowed in LTC or other healthcare facilities? QUOTE Yes-in my experience in LTC we require a physician's order for the etoh.The nurses dispense it -we keep it under lock and key in the med room.I once worked with a nurse that would not dispense the night caps for religous reasons.She felt she was entirely appropriate in denying the LOL's their tipple.You know how set in their ways the LOL's are-this caused major upset...How did handing someone a 4 oz glass of wine place her soul in mortal danger? She wasn't drinking it herself....

[SueBell]

I agree with JohnBearPA - you can't have it both ways. The resident has a right to smoke or not and who are we to deny him that right. I agree if someone has problems being around smoke, that's fine - but I'm sure someone else (like myself) would take the resident out to smoke if my time permits. Also, for all the non-smokers, when you take a break, or leave the floor for your lunch break, I am sure that somewhere out there a nurse that smokes is watching over YOUR patients.

[Gromit]

Glad I work in a hospital -and on a floor where the patients' "right" to smoke is basically a non-issue. Most of 'em are on vents, and the rest are just too sick to get out of bed on their own.

I enjoy my pipe, and fine cigars. I do NOT use such things at work. I DO enjoy them on my commute home (let all the other folks get angry during rush hour. I'm as relaxed as can be. No roadrage on MY end. :) ) at home, I go outside if I feel like having a good cigar -even before I met my wife I did not EVER smoke inside my home. My home is my sanctuary, and I enjoy it being free of smoke. My back porch, with a draft beer in my hand, and enjoying a bit of tobacco in my pipe or one of my favored cigars is an excellent way to relax and enjoy a bit of 'me' time.

[fat cat]

Thank you all for your imput. My position still remains firm - that second hand cigarette smoke of any amount should be treated as an evironmental toxin and that ways should be found to protect nonsmoking workers from it as it is a potential health hazzard. Alternative measures should be in place to be used such as nicotine patches and inhalers. There is even a single dose injection that has reported a high rate of success. Something needs to be done because it is not the nurses responsibilty to be forced to participate in someone's nicotine addiction that causes a direct negative effect on them no matter how small the degree. I plan to contact the American Heart and Lung Associations to see if some form of legislation can be considered to accomplish this. I read that the American Heart Association supports the rights of nonsmokers to a smoke free environment and that they feel the best way to control workers' exposure to tobacco is to eliminate tobacco use from the workplace and to implement a smoking cessation program. I would like to see this carried over to apply to nursing home environment as well.

[Gromit]

While I find it an annoyance at best, I'd hardly qualify second-hand smoke as the danger you make it out to be. To a severe asthmatic, yes -even pet dander can trigger a reaction in them. But you're exposed to far more 'crap' via exhaust from automobiles (or my motorcycle) for far longer, and far more consistently, than you are from someones' puffing at a cigarette.

But I find it somewhat insulting that we would be expected to keep our role as HEALTHCARE PROVIDERS and then enable -or worse, be around them at the same time- these folks to go smoking. Let 'em smoke if they can get outside on their own. I refuse to participate.

While having patients on my floor who can ambulate is kind of rare, it DOES happen once in a while -and I have had a couple that wanted me to take them outside to smoke -I told them 'no. I don't do that.' -while we DO have some remote tele monitors, our patients are (as a general rule) supposed to be hardwired tele. The patient in question gripped all night about it -telling me at every opportunity that on the OTHER floor they took her out (in a wheelchair) so she could smoke. My only response to her was that we are a higher level of acuity and if she is with us, she must be sicker than she was there, and that we didn't do such things on our floor.

She retorted (only once) that she would smoke in her room -I told her that I'd advise against it -not only was it unsafe but it was illegal -and if she thought I'd ignore it, she was wrong. I'd happily talk to her doctor about discharging her OUT of our unit if she liked, but while on OUR floor, she had better mind herself because I didn't play games.

For the rest of the night, she just griped when she saw me, but otherwise behaved herself.

I truly enjoy a fine cigar, or some of my custom-made pipe tobacco. Its a pleasure I enjoy once in a while -oftentimes I'll go weeks between 'smokes', and othertimes I'll enjoy one or the other a few times a week -while on my way home in heavy traffic, or more often than not, with my father (especially when trying out a 'new' cigar). To me they are treats. I keep my cigars in humidors, some of these cigars have been aging (in my own home) for a decade. A cigar (unlike any other tobacco) will actually age or mature if its kept at the proper temperature and humidity levels.

In any case, to me they ARE treats, and treted as such. I do not like cigarettes -and while I understand that many cigarette smokes are truly hooked or dependent on their cigarettes, I cannot relate to them because I've never experienced the 'NEED' to have a smoke. I do feel bad for them in much the same way I feel bad for a junkie. I have no idea what its like to HAVE to have something so bad, and so often, that my health will suffer for the need and the use of that product.