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Nursing Made Incredibly Easy!:
doi: 10.1097/01.NME.0000411096.13940.15
Department: ask an expert

Warning! Smoking may be hazardous to your career

Borrello, Sally MSN, RN

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Nursing Educator • Everest Institute • Grand Rapids, Mich.

The author has disclosed that she has no financial relationships related to this article.

A: Nurses are the largest group of employees among healthcare professionals and a powerful resource for patient and community healthcare education, with smoking cessation being an integral part. However, nurses are also among America's top smokers. Eighteen percent of the 3.1 million nurses in the nation are smokers, according to the U.S. Bureau of Labor Statistics in 2009.

Research illustrates a perception among our colleagues that nurses who smoke take more breaks, spend less time with patients, and are less committed to their profession because of their need to smoke during their shift. There's also the concern that nurses who smoke are hesitant to participate in smoking cessation education with their patients because they believe they aren't good role models.

Figure. Q: Nurses kn...
Figure. Q: Nurses kn...
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The CDC estimates that smokers cost their companies about $1,850 extra per year in medical costs and absenteeism than nonsmokers. Some companies tack on an extra $15 to $30 per month as a smokers' premium surcharge on a smoking employee's healthcare insurance.

However, many healthcare facilities across the nation are going a step farther. Most have banned smoking on their campuses, and some facilities aren't hiring smokers, even those who smoke only in their private lives. Other organizations have fired employees who didn't quit after notice of their nonsmoking policy, which included free smoking cessation resources.

Mercy Medical Centers in Des Moines, Iowa, is just one example of the many healthcare facilities that no longer hire smokers. Current employees at Mercy Medical who smoke weren't fired, but were encouraged to quit and the resources needed for quitting were provided by the hospital. However, current job applicants are required to take a urine test and anyone who tests positive for nicotine won't be hired. They may reapply in 6 months.

The trend of implementing bans on hiring smokers is gaining momentum and nurses who smoke are pressured to quit to become employed or keep their present employment. Employers want healthy employees, and nurses set an example as active role models for the patients they serve. The idea of punishing smokers with an increase in insurance premiums or with threats of unemployment raises questions about workplace discrimination. If employers are looking at their employees' personal habits and lifestyle choices when it comes to smoking, then what's next?

The debate over employers' rights to control smokers' behavior on-duty and off-duty continues and will continue to be an issue for years. In the meantime, it would behoove smoking nurses to do the healthiest thing and quit the habit—for themselves, for their patients, and for their career.

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Learn more about it

Borrello SJ. Help your patients with smoking cessation. Nursing made Incredibly Easy! 2010;8(2):56.
CDC. The impact of smoking on disease and the benefits of smoking reduction. http://www.cdc.gov/tobacco/data_statistics/sgr/2004/pdfs/chapter7.pdf.
Fiore MC, Jaen CR, Baker TB, et al. Treating tobacco use and dependence: 2008 update. http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hsahcpr&part=A28163.
Sarna L, Bialous SA, Wewers ME, Froelicher ES, Danao L. Nurses, smoking, and the workplace. Res Nurs Health. 2005;28(1):79–90.
Tobacco Free Nurses. http://www.tobaccofreenurses.org.
U.S. Bureau of Labor Statistics. Occupational outlook handbook, 2010–11 edition. http://www.bls.gov/oco/ocos083.htm.

© 2012 Lippincott Williams & Wilkins, Inc.

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