Smoking Out Nurses

An increasing number of US hospitals have become smoke-free campuses, and a growing number are instituting “tobacco-free hiring” practices. (see: AG Sulzberger, NYT article “Hospitals Shift Smoking bans to Smoker Ban” 2-10-11). Hospitals in at least ten states have stopped hiring smokers, and in some cases hospitals have fired existing employees for smoking. In addition, several nursing schools have instituted tobacco-free policies. Court cases in various states have upheld the legality of refusing to employ smokers, especially by healthcare facilities. The American Lung Association, the American Cancer Society, and the World Health Organization officially do not hire smokers—although I imagine the WHO finds this difficult to enforce.

Employees who smoke cost employers an average of $3,391 more per year than non-smokers for health care and lost productivity (more sick days, as well as longer breaks during workdays). Nurses who smoke carry the cigarette smoke on their clothing and breath, which can negatively impact patient health. Not surprisingly, studies indicate that nurses who smoke are less likely to encourage their patients to quit smoking. At the same time, smoking cessation interventions by nurses are highly correlated with successful patient smoking cessation. Cigarette smoking continues to be the leading (individual behavior) cause of preventable morbidity and mortality in the US, causing an estimated 443,000 premature deaths annually. The tobacco industry no longer disputes this claim. They have, instead, turned their efforts towards developing a “safer cigarette,” as well as marketing smokeless tobacco products, such as dissolvable tobacco pellets.

Nurses have higher rates of smoking than do any other health professionals. Current estimates are that 16% of RNs smoke, compared with 2-3% of physicians. (see LA Times article: EA Torriero “No smoking: that means you too, Nurse” 1-21-07). A 2009 CDC national survey of smoking found that 21% of US adults are current smokers—men have slightly higher rates of smoking than women (23.5% vs. 17.9%). According to Tobacco Free Nurses, nurse smoking rates vary considerably by specialty: psychiatric (23%), gerontology (18%), emergency (18%), pediatric critical care (8%), and oncology (7%). As for the general population, smoking among nurses is highly correlated with lower socio-economic and educational achievement levels. LPNs, who have lower levels of education and lower salaries than RNs, have the highest rates of smoking (28%).

Not too many people—except perhaps for tobacco farmers and Philip Morris executives—think that smoking is a good thing. Most people recognize it as a powerful addiction that is expensive (currently over $5/pack of cigarettes), and has negative health effects for the smoker as well as those exposed to second-hand smoke. I’ve worked with numerous young people addicted to heroin and cigarettes who had an easier time kicking heroin than they did cigarettes. Smoking bans do have powerful effects on reducing smoking rates, and it makes sense to ban smoking in health care settings. But the increasing trend of tobacco-free hiring (and firing) practices at US hospitals troubles me. As Dr. Michael Siegel, a professor at the Boston University School of Public Health points out, these hiring practices unfairly penalize lower-income, lower status workers since they are more likely to smoke and to have a difficult time quitting.