The state made a weird request

[angeloublue22]

I work in a new medical detox. We are attached to a long term recovery house that has been around for 9 years. I helped open the detox and wrote the protocols because our supervisor is a social worker and knows nothing about the medical aspect. We opened 6 months ago and we just had our first state survey and passed with flying colors which is awesome. Then the state surveyor made a weird request. When the state surveyor spoke with the clients, they complained about the staff being able to drink coffee and bring in outside food for themselves when the clients can't. No big deal right? Well, apparently it is a big deal to the state surveyor who has now requested that it be implemented that employees are not to drink coffee or bring in fast food because it upsets the clients. Does anyone think this is ridiculous? Has anyone ever heard of this?

[azhiker96, BSN, RN]

IMO, staff should not be eating in front of clients in general for afore mentioned reasons. We don't allow anyone, staff or family, to bring food and drink into the Preop area. It's inconsiderate to patients who have been NPO for hours. Plus we may not see a mother who gives her child a bite or sip because they feel sorry for them.

Also, our accrediting agency does not allow employees to have food or drink in the work area. That might be another consideration.

Break rooms also give employees a place where they can be off-stage and get a few minutes of mental break from the day's work.

[Whispera, MSN, RN]

Detoxing patients shouldn't have caffeine... it's an upper and interferes with withdrawal as well as with medications...

Everywhere I've worked, there was always ample decaf available, however. Patients could have food and soft drinks without caffeine too. Drinks were consumed in styrofoam cups. Snacks were kept in lockers in the nursing station, and given at appropriate times.

Also, staff drank and ate with the patients regularly, when it was time to eat and drink. Their drinks were in styrofoam, just like the patients' drinks. If anyone wanted the peanut butter I brought from home, I'd share, or the patients could get bread and peanut butter or other basics out of the cupboards or fridge. Generally, the hospital food was better than what I brought from home. If I bought something from the hospitals' cafeterias, it was pretty much the same as the patients got on their trays.

Staff ordered and shared food with patients. We cooked together as well and all shared the finished product.

Forgive me but is there something detrimental in allowing de-tox patients to have coffee?

[angeloublue22, BSN, RN]

As I said we don't eat in front of patients. Yes, they can have coffee until 1000 just not outside coffee. They can't go to Starbucks for example. The stable clients are taken to the store to buy extra snacks if they want to. They are also fed home cooked meals and are able to request specialty items when we go the store to buy them groceries. They get plenty of opportunities to get what they want food wise except fast food. They go to a BBQ every week too. We also buy them delivery on occasion. This is a very different place from what I'm used to. It's run more like a home but with structure. They eat better than the staff does. I myself don't eat fast food or bring in coffee. I was asking about it because at every place I worked, people have brought in their coffee and fast-food and have had no issues. You can't tell me that all the medical staff that brings in coffee for themselves are mean because their patients can't have it. Most people do it without thinking. They have also forbid any smoking on your shift and that includes you lunch break because they complained about smelling the cigarettes and craving cigarettes. So we have made adjustments to help them. Honestly, the staff bend over backwards for these clients. I haven't seen anything like it.

[dishes, BSN, RN]

We have no break room so we have our coffee at the nurse station. We also usually only have one or two staff members for up to 16 manipulative clients. We go back to another tiny office to eat. In order to get there we have to go through the day room so everyone sees what we are carrying.

Have you asked the clients the reasons they do not want to be exposed to the outside coffee and fast food? Does the exposure make it more difficult for the clients to manage cravings? Since the clients must adhere to the facility rules for the duration of their recovery and the staff only have stick to the rules for the duration of their shift, I do not understand why it would be difficult for staff to respect the clients request. When you labelled your clients manipulative, it showed you are biased, is it possible your bias is influencing your view of this issue? If you are objective, you should be able to use the nursing code of ethics as a guide to your resonse to the state's recommendation.

[elkpark]

As I said we don't eat in front of patients. Yes, they can have coffee until 1000 just not outside coffee. They can't go to Starbucks for example. The stable clients are taken to the store to buy extra snacks if they want to. They are also fed home cooked meals and are able to request specialty items when we go the store to buy them groceries. They get plenty of opportunities to get what they want food wise except fast food. They go to a BBQ every week too. We also buy them delivery on occasion. This is a very different place from what I'm used to. It's run more like a home but with structure. They eat better than the staff does. I myself don't eat fast food or bring in coffee. I was asking about it because at every place I worked, people have brought in their coffee and fast-food and have had no issues. You can't tell me that all the medical staff that brings in coffee for themselves are mean because their patients can't have it. Most people do it without thinking. They have also forbid any smoking on your shift and that includes you lunch break because they complained about smelling the cigarettes and craving cigarettes. So we have made adjustments to help them. Honestly, the staff bend over backwards for these clients. I haven't seen anything like it.

Have you worked in psych or substance abuse before? There is typically a v. different relationship between the staff and clients that there is in medical-surgical healthcare settings. Part of psychiatric and substance abuse treatment is modeling healthy and positive behaviors and coping skills for clients, and one of those is being sensitive to and respectful of the feelings of others. And "most people do it without thinking" is the key statement here. In psych and substance abuse settings, we do think about issues like this. Having a rule against outside food/beverages/treats unless they are being shared with everyone (the clients) is not an uncommon rule.

[nrsang97, BSN, RN]

I remember my brother in law was in a psych facility and my mother in law was so upset that she couldn't bring him in anything. Especially pop, which he drinks tons of. I told her that there must be a reason for it. She just couldn't understand, see it is just pop. I told her the caffeine must be an issue with some medications.

I would abide by the state rules. If I was having a hard time not drinking coffee, I would be ticked if staff was drinking it in front of me.

[Jensmom7, BSN, RN]

Forgive me but is there something detrimental in allowing de-tox patients to have coffee?

Nothing with caffeine allowed in a psych unit

[Oh'Ello, BSN, RN]

Unless the facility is required to purchase your food items in order for them to be the same foods that patients are eating, yes it is a weird and ridiculous request. If you're not eating it in front of the patients, there should be no problem. Toss that schtuff in a brown paper bag so no one can see what it is and march on back to the break room. Problem solved.

This a manipulative tactic. The patients need to understand that they are entitled to certain rights and dignities, and there are things they are not entitled to. Their circumstances do not dictate what staff are and are not allowed to eat or drink in the break room. Freedom from exposure to food items is not a thing. Employees are not there for treatment are simply not subject to the same rules.

[hawaiicarl, BSN, RN]

I don't work psych or detox, but my heart patients are not allowed caffeine either. We probably go through three pots coffee a night, never heard anything as ridiculous as a surveyor saying such a thing. Heart patients can't have added salt either, so none of my beverages/food can have added salt? Ridonkulous!

Cheers

[delawaremalenurse]

and just where does this patient entitlement end? next they'll be wanting real mattresses instead of straw! indoor plumbing!! it's truly a slippery slope....

[Ruby Vee, BSN]

I think it depends upon whether the staff is eating and drinking where patients can see them. If not, no problem. But if you are, it's rude.

It used to be understood that you didn't consume food or beverages in front of someone without offering them something. Now, it seems that no one has been taught basic courtesy.

[Jolie, BSN]

As I said we don't eat in front of patients. Yes, they can have coffee until 1000 just not outside coffee. They can't go to Starbucks for example.... They have also forbid any smoking on your shift and that includes you lunch break because they complained about smelling the cigarettes and craving cigarettes. So we have made adjustments to help them. Honestly, the staff bend over backwards for these clients. I haven't seen anything like it.

I am flabbergasted that you believe forgoing cigarettes on your lunch break amounts to "bending over backwards" for these clients. You can't be serious.

These individuals are living in a restricted environment, attempting to re-order their lives to recover from addictions and your staff has been coming in to the facility smelling of cigarettes?

Do you realize that most facilities have smoke-free campuses these days, and that most healthcare workers can't indulge in nicotine products for 12 hours at a time? That most facilities also have dress/hygiene codes that prevent a worker from clocking in if s/he smells of cigarette smoke?

As far as coffee at the nurses' station goes, it is a JCAHO violation for staff to consume food or beverages at the work station. All food and drink, even plain water bottles are to be kept in a staff break or lunch room.

I realize that residential facilities are a bit different than acute care institutions, but common sense, courtesy and infection control should be universal.