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Discussion

Will it come back to haunt me

I had a patient recently decided to light up a cigarette on a medsurg floor. Not sure where he got the cigarettes and lighter, he was on our floor for weeks and never did this prior. I only had him in my assignment for a day and a half. He's AAOx4 with multiple behavioral corrections and a schizophrenic diagnosis. Full grip strength and strong upper extremity ROM. A tech and LPN were trying to convince him to put down the lit cigarette he was puffing on. He kept moving the cigarette threatening to burn them or holding it out of reach. I heard the commotion next door when I was with my patient on oxygen. I processed for about 10 seconds the best resolution with my main focus being to put out the fire hazard, avoid injury to the patient and staff, and ending the cigarette smoke throughout the hall. I filled a water pitcher with water and threw it on the cigarette getting the patient partially wet, but extinguishing the hazard. In other words, I threw a bucket of water on a patient. The same question keeps running through my mind. What could I have done to handle this better? Will this come back to haunt me? My nurse manager does not seem to be upset with me. I haven't been called to be reprimanded... yet. Can I please get some outside perspective?

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    • Featured Replies

    I think you came up with a very good solution and I commend you. Obviously you did nothing wrong. Move on. 

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    I'll be interested in hearing if you suffered any backlash from this decisive and effective action.  

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    • Experts

    I applaud your actions, RNMoxie, and even find them to be lightheartedly enjoyable.  After all, Patient and Staff safety is a priority, not to mention the safety of the environment.

    Now, on the psych unit where oxygen was rarely used, the Patient would be given options to either extinguish the cigarette, give up all cigarettes and lighters, or Security would be involved with the possibility of a Doctor-ordered strip search.

    I never had to go as far as to contact Security or obtain a Doctor's order.

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    You did brilliantly.

    Pat yourself on the back and have a drink!

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    I think you're good. Don't let on IRL that you've questioned your decision; that just invites people to give their opinion about what you should've done.

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    • Author

    While I appreciate everyone's support so far, is anyone here in admin or some type of leadership role? Not to put another layer on it, but I want to apply to a leadership role, assistant nurse manager. I have a feeling this action might impede that. If they ask what I should've done, anyone have a good answer?

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    RNMoxie said:

    While I appreciate everyone's support so far, is anyone here in admin or some type of leadership role? Not to put another layer on it, but I want to apply to a leadership role, assistant nurse manager. I have a feeling this action might impede that. If they ask what I should've done, anyone have a good answer?

    I'm not currently in a leadership role but I have been a nurse manager. What do YOU think you should have done differently? What would you do as a nurse manager if a nurse under you behaved the same way? 
     

    Be aware that in order to bar someone from promotion as a disciplinary measure, there needs to be a write up. You will not be a good manager if your first thought is to punish a nurse in this situation. So adjust yourself accordingly. 

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    • Guides
    RNMoxie said:

    While I appreciate everyone's support so far, is anyone here in admin or some type of leadership role? Not to put another layer on it, but I want to apply to a leadership role, assistant nurse manager. I have a feeling this action might impede that. If they ask what I should've done, anyone have a good answer?

    I train nurses in effective behavioral interventions and while I got a laugh out of thisand appreciated your response to this dangerous situation, I do ask if you or ancillary staff have received any training in effective behavioral intervention? There are several methods out there. Some work better than others. I prefer a hands off approach whenever possible and was recently trained in Therapeutic Options. It employs voice, open posture and gestures to achieve the desired result. I have been quiet surprised at how effective it is.

    That being said it should be noted that anyone can file a BON complaint including a patient who may claim being unduly traumatized by the event and the BON is mandated to investigate any and all complaints. Remember also that while your actions were effective water on the floor can create a significant safety hazard to staff and other responders. I am actually at the lab getting my blood drawn. I can provide more info later if you are interested.

     

    Hppy

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    Patient's smoking in bed is very dangerous, not only to themselves, but to every patient. I've been involved in this situation twice in my career. The first was as an ER RN. We responded to codes on the floor. We responded to a man who was smoking while wearing O2. The O2 flashed, giving him 3rd degree burns to his face and neck. The patient had to be intubated and then flown to a burn center in another state. The 2nd I was the manager on a telemetry floor. The patient was smoking while on O2. It flashed and burnt his beard with 2nd degree burns to his face. Luckily, he did not require intubation. I personally like your solution. A fire on a patient floor puts all of your other patients and staff at risk. 

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    hppygr8ful said:

    I train nurses in effective behavioral interventions and while I got a laugh out of thisand appreciated your response to this dangerous situation, I do ask if you or ancillary staff have received any training in effective behavioral intervention? There are several methods out there. Some work better than others. I prefer a hands off approach whenever possible and was recently trained in Therapeutic Options. It employs voice, open posture and gestures to achieve the desired result. I have been quiet surprised at how effective it is.

    That being said it should be noted that anyone can file a BON complaint including a patient who may claim being unduly traumatized by the event and the BON is mandated to investigate any and all complaints. Remember also that while your actions were effective water on the floor can create a significant safety hazard to staff and other responders. I am actually at the lab getting my blood drawn. I can provide more info later if you are interested.

     

    Hppy

    The BON is actually not required to investigate any and all complaints. 

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    • Experts

    Had I thrown water on a patient smoking a cigarette, I'd probably say something like, "There was an imminent danger to the patient, staff, and surroundings and I appropriately reacted".

    Oh, yeah: I was an NS in two different facilities.

    This situation reminds me of a similar accident some years ago of a nongeriatric patient on the geriatric psych floor because he suffered facial burns due to lighting up a joint at home while on oxygen. That patient was a major behavioral pain. He was a bear.

    I posted a cartoon I did at the time on allnurses of Smokey the Bear receiving oxygen through a nasal cannula with a caption reading, "Only you can prevent facial fires".

    Heh!

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    • Guides
    FolksBtrippin said:

    The BON is actually not required to investigate any and all complaints. 

    I probably should have used different language and stated something about state specifics. I know in CA the BON investigates all complaints. Sometimes that's just a phone interview to get the nurses side of the story.

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