I was just wanting to get some feedback concerning escorting patients to smoke shelters and the need to remain with them in the smoke rooms.
I work for the Veteran's Administration on the acute psych ward of the hospital. The patients have had smoking privelidges since forever. They had been able to go out without staff accompaniment in the past before an incident ocurred that caused new policy to be implemented that required them to be escorted by staff.
The staff member, usually a nurse is required to remain in the smoke building (8x16) with up to 8 smokers. An incident ocurred recently which caused a new order that stated the patient would no longer be going out to smoke. The patients grieved this to the advocate and shortly after they regained their smoking privledges. While the staff enjoyed a short lived no smoking policy, it was overturned and now there are some nurses who refuse to go out and stand in those smoking huts. Health issues are the main reason and there is nothing in our job description that says we will be subjected to sidestream smoke.
With all do respect to Gerry1888, all of these Vets are not old. In have patients that are 25 or even younger. They may live forever, or what seems like forever right there on our supposedly acute unit. There are even smoking staff who do not want to sit in the smoke huts with that much smoke or that much close confinement with potentially dangerous psychiatric patients.
It appears Kylea is knowledgeable to this issue because she works within the same system. We do not have any indoor smoking though.
I worked at the State mental hospital before the VA and those patients loved to smoke also. Talk about dangerous people, some of these are! They just recently cut the smoking out of the State run facility without any problem. I hear the worst of it was with staff. I think some of those patients are Veterans, but I don't think they are getting special smoking rights because of that. My brother is active duty for twenty years , getting ready to retire soon. He has been engaged with every enemy, and involved in every conflict since 1988. Of course he is not suffering with psychiatric problems, so that would be a different story when it comes to being respectful and following rules without causing a revolt. So far, these are all good points , and I thank you all for adding your input.
There's also something to be said for the fact that many people with psychiatric disorders are effectively self medicating with cigarettes. There must be a better way to handle this, it shouldn't be an either/or situation.
I don't understand why admin cannot place the smoking hut within sight of the facility. The staff goes down with the patient, delivers them, then goes back inside and comes out if there is a problem. Put a call bell in the smoking hut and you are all set.
One important aspect to this is that the escort must be from our unit. We work with a max of three a shift. The majority of us do not smoke.
I guess sometimes you have to do what you are told to do and hope for the best. I guess some people have to do a lot worse. Again, I do appreciate the different views and ideas for solutions to this dilemma.
I understand the fact about self medicating. I also look around and see that there are worse things that we could be exposed to in a job. I am appreciative for the job I have and I am very appreciative for what these Veterans have done for me.
A little reminder though, these are not all your classic Veteran you might be thinking of. Some are very good manipulaters. I know they do experience psych problems. So I know I cannot think of people like my brother who put in twenty years and knows no means no or not right now means not right now because he did not get that type of problem. We just don't want to breathe the smoke, no matter who is producing it. Whether it be a veteran who just happens to be a sex offender at the same time, or a patient with CHF who has that right to smoke. Whether it is a veteran who has a criminal record as long as the Nile or a COPD pt who has the right to smoke. Some of us do not want to be bombarded with seconhand smoke. As of now it stands that it must be our nurses that escort the patients.
"First let me say that even though I'm a smoker, I think smoking should be banned at all hospitals/clinics ect. BUT and here is a big BUT - VA facilities, the reason - these men and woman have bled red, white and blue for us and I'm sure they all know that it's bad for them..."
...Bled red, white and blue for us... Give me a break! I've worked with so many veterans who think they're entitled to special treatment because "we fought for YOUR freedom..." Where did you serve? Oh, Ireland? And how were you injured? Oh, you blitzed your brain with so much alcohol and foreign substances it couldn't take it anymore? Did that start in the service? Oh, when you were twelve... I see.... Lots of these "heroes" are sponges and players just waiting for suckers who believe in the "fighting for our freedoms" crud to step right into their game.
"...but I believe because of their service to our country if they want a smoke then let 'em."
Nonsense. The military doesn't even believe that. The Armed Forces stopped giving out tobacco rations a long time ago in the name of better health for the troops. Making VA facilities smoke-free is a reasonable step.
I don't understand why admin cannot place the smoking hut within sight of the facility. The staff goes down with the patient, delivers them, then goes back inside and comes out if there is a problem. Put a call bell in the smoking hut and you are all set.
Patients who need observed smoking need more than someone within shouting distance. In my experience, in more than one facility, there have been residents who have set their clothes alight without even knowing it, or smoked a butt down through the filter and gotten second and third degree burns on their fingers, or were eating old butts out of the ashtrays (a very common practice among the psych set!) while other residents who were there with them said and did nothing. Observed smoking means direct eyeballing and the ability to intervene within seconds.
I am a smoker (and only a NS right now) and I would volunteer to escort them only because I am a smoker. I don't believe that those who don't smoke should be subjected to it. (Hence, smoking at my house is OUTSIDE!)
In the same vein,.....my husband was in rough shape when he first got home from Iraq. Their issues are so much bigger than smoking and if smoking helps them cope, I would not recommend taking it away. As well, my daughter had serious issues when she got home after her second Iraq tour. I have heard the stories. You cannot imagine what they faced! My husband left last week for his deployment to Afghanistan. I am quite sure we will have another 6 month recovery period when he gets home this time as well. (emotional not physical)
For some of these men, they have been maimed, watched their buddies die, and may never recover emotionally. Let them smoke if they choose to do so.
BTW, I have used the nicotine patch with limited success. I have quit on multiple occasions, but when the stress level hits max, it is always smoking I head back to. I am from a family of alcoholics. I have divorced an addict. As far as coping mechanisms go....smoking would be my choice. I can function in society as a smoker but I could not as an addict or an alcoholic.
I hope the VA hospital that the OP works for finds a solution that is best for all parties, including the nurses!
Can a security guard escort and observe these pts smoking?
Does the policy require that only a nurse can watch the pts smoking? If so, that is silly and can/should be changed.
I say let them smoke. But there needs to be a policy change if there are only three nurses per shift and there is a chance that none of the nurses are smokers.
We live near one of the, no "The" major cancer hospital in Manhattan, NYC and what do I see each time I pass their front door? Staff, visitors and patients standing outside smoking away. Some patients are in their gowns (with robes), and or hooked up to IVs, yet there you are.One day going pas this hospital on a bus, a woman behind me remarked to her friend "look at all those people standing outside smoking, what is that building? When I peeped up ">>>>>> Cancer Hospital" the two women looked at each other in sort of an "AbFab" moment and then started to laugh. I mean at least they saw the irony of the situation.
Irregardless of what type of hospital it is, for veterans, or not, govt funded or not, city or suburban...you aren't going to "cure" a smoker by slapping a nicotine patch on them while they are there and restricting them from smoking. All that you are going to do is create more of a volatile situation...while we may not all agree in them smoking, that's their vice and we have to deal with it...I'm sure that we all have a vice as well! Is it possible that the indoor smoking rooms the nurse can stand outside the room? Is there a window? That way there is still supervision but you aren't inhaling all of the secondhand smoke, I mean you may as well become a smoker at that point? Or when they go outside to smoke, we used to have a technician go outside with them rather than a nurse, because our time was usually so tied up. We also, made it very clear to our patients, at admission that if they were smokers, they had options, of nicotine patch or gum (most refused), or requesting from the doctor to go off the floor. If the MD wrote the order, they had to go off the floor with supervision but it was on OUR schedule. They were NEVER allowed off the floor between 8-10 AM (busiest time with meds and baths and also MD rounds, we had to make sure all the patients were in their rooms). And they were given the option to leave if they didn't comply, very rarely did we ever have any problems after presenting it to them in that light, and patients would ask to go out, and we would tell them they would have to wait 1/2 hour or so to go, and then we would take them. We also tried to have to smokers take them vs. the non-smokers. Our patients are still human beings, and they still deserve to be treated so--it's not easy to have your freedom and then come in and be stripped of all of it.
edchunt, BSN, RN
120 Posts
With all do respect to Gerry1888, all of these Vets are not old. In have patients that are 25 or even younger. They may live forever, or what seems like forever right there on our supposedly acute unit. There are even smoking staff who do not want to sit in the smoke huts with that much smoke or that much close confinement with potentially dangerous psychiatric patients.
It appears Kylea is knowledgeable to this issue because she works within the same system. We do not have any indoor smoking though.
I worked at the State mental hospital before the VA and those patients loved to smoke also. Talk about dangerous people, some of these are! They just recently cut the smoking out of the State run facility without any problem. I hear the worst of it was with staff. I think some of those patients are Veterans, but I don't think they are getting special smoking rights because of that. My brother is active duty for twenty years , getting ready to retire soon. He has been engaged with every enemy, and involved in every conflict since 1988. Of course he is not suffering with psychiatric problems, so that would be a different story when it comes to being respectful and following rules without causing a revolt. So far, these are all good points , and I thank you all for adding your input.