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 freedom comes responsibility, I think that is from a movie or something...anyway. I see smoking as not being responsible for your health.
If you're taking care of someone who drinks a 12 pack a day, do you let them bring their own from home and drink it? (I know there are some places that might, or in the NH or such) But mostly it is not acceptable. What about "illegal" drugs? Do you supply metal silverware to your pts. to cook their heroin in? And clean needles? Do you let the diabetic patients eat candy bars? GI bleeds eat whatever they want?
These are just the implications for the PATIENT.
I have NEVER taken a patient to smoke. I never will. I feel it is ethically wrong. If they are well enough to go out and smoke by themselves, they can have at it, but they aren't going to endanger my health while they kill themselves.
My vice is not letting others decisions put me in harms way.
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.
Ahhh, risk of burns and eating butts...I would say that smoking is hazardous to their health, and having them smoke on hospital property is dangerous. That's in addition to all the other hazards of smoking. You know, we don't escort the diabetics down to the coffee shop for a doughnut, why are we taking smokers outside?
Would equipping the nurses with N-95 masks and haz-mat outfits protect them from the second hand smoke, while allowing them to supervise the patients closely? Or whatever the firefighters wear on their heads to protect them?
I am serious, in case anyone's wondering.
It seems to me that the dilemma between the patients' right to smoke and the nurses' right to not be exposed to hazardous materials must need a technological solution, since choosing one side over the other is going to be completely unacceptable to the other side.
And, we have the right to demand that our employers provide us with PPE when our jobs demand that we deal with biological hazards. Why wouldn't tobacco smoke fit into that category?
A relative of mine who smokes has been a pt at the local VA for some years (incl. some stays on the psych unit), so I have some idea of the logistics involved here. At this particular hospital there is a large patio area with tables and such designated as a smoking area. There is also a little shelter area for when the weather's not so nice, but you can see into it from outside.
I don't smoke, and it makes me physically ill, but I'd be happy to go outside and sit with the smokers while they smoked. The fresh air would be nice, assuming I was smart enough to stay upwind. It'd be almost like a break that you're still getting paid for. That said, being expected to sit inside an enclosed space with the smokers would not be cool and I'd raise hell.
Thank God we're not expected to accompany our smokers to the outside hut! We also have many patients with psych issues, sex offenders and other convicted criminals, and veterans suffering from PTSD that seek our services (medically supervised chemical dependency detox.)--cutting them off from smoking would cause riots!
I have mild asthma, and one time I went outside to give a patient her meds (she was practically living outside smoking) and I accidentally inhaled some of her cigarette smoke. I thought I was going to die!
I think that the idea of a smoking room that has a window where you can supervise them would be ideal.
If you split up the duty evenly and assign workers to supervise smokers on a schedule, this is no big deal at all.
As long as the staff are willing and don't refuse to do it (and they have the right to refuse) it isn't a big deal. When you don't have staff willing or able to do it, it becomes a big deal very quickly.
It is not difficult to supervise and avoid the secondhand smoke.
If we're supervising directly, it's impossible to avoid the secondhand smoke.
Pat_Pat RN
472 Posts
With freedom comes responsibility, I think that is from a movie or something...anyway. I see smoking as not being responsible for your health.
If you're taking care of someone who drinks a 12 pack a day, do you let them bring their own from home and drink it? (I know there are some places that might, or in the NH or such) But mostly it is not acceptable. What about "illegal" drugs? Do you supply metal silverware to your pts. to cook their heroin in? And clean needles? Do you let the diabetic patients eat candy bars? GI bleeds eat whatever they want?
These are just the implications for the PATIENT.
I have NEVER taken a patient to smoke. I never will. I feel it is ethically wrong. If they are well enough to go out and smoke by themselves, they can have at it, but they aren't going to endanger my health while they kill themselves.
My vice is not letting others decisions put me in harms way.