Smoking among nurses is a workplace issue

One group wants to help nurses kick the habit

Nurses sometimes fail to intercede with patients about cigarette smoking because they haven’t been trained in how to effectively do so; or, they may not intercede because they themselves are smokers unable to break the habit.

The Tobacco-Free Nurses Initiative (TFNI) is providing nurses tools to address both problems, and research has provided much new information on women and tobacco use, according to Linda Sarna, RN, DNSC, FAAN, lead investigator for TFNI and a professor at the University of California-Los Angeles (UCLA) School of Nursing. "Nurses describe becoming addicted when they were very young," she says. "Then, coming into schools of nursing and going on to employment, quitting was very difficult and they didn’t have support available to them to help them quit."

Much of what Sarna has learned about nurses and smoking came from a study she and other researchers from UCLA’s Jonsson Cancer Center conducted, in which they talked with smokers, nonsmokers, and former smokers in the nursing profession. What they found was that smoking is a workplace issue, not just an individual behavior.

Smoke breaks, or no breaks

Sarna said that in the sometimes grueling schedule of a hospital nurse, the only available excuse to leave the floor for a break was to satisfy a craving for nicotine. "Smoking among nurses was described as an integral part of their work routine, affecting management of patient care and timing of breaks," the study states. "The perception that smokers take more and longer breaks and were less available for patient care was an important theme in discussions with both smokers and former smokers, and clearly created conflict in the work environment."

Sarna said some nurses told her that the only breaks they get are smoking breaks. "One critical care nurse, a nonsmoker, told us that she never gets a break, that only the smokers got a break because they needed it," she said. This line of thinking leads in some cases to "war between smokers and nonsmokers," Sarna said, because it causes a perception that the smokers, because they take breaks, are less involved in patient care. The smokers, however, contend that they get just as much work done and are more organized because they don’t want anything to interfere with their smoke breaks.

Smoking among nurses affects interactions with patients, Sarna says. Nurses who smoke are less likely to intervene with patients who smoke, and they experience a high degree of shame and guilt about their smoking, taking steps to try to hide the evidence of their smoking, such as repeated brushing of teeth, frequent hand washing, and wearing cologne.

The study shows the need to develop work-based strategies and programs to support cessation efforts. "The benefits of supporting smoking cessation in the worksite could have an immediate positive impact on nurses’ health, and might result in other positive outcomes (e.g., reduced sick time)," the study concludes. "The benefit to patients must also be emphasized, as nonsmoking clinicians are more likely to provide cessation interventions than their smoking counterparts."

Research leads to on-line help site

While the majority of nurses do not smoke, Sarna said, about 16% of the 2.3 million nurses in the United States do smoke, the highest rate among all health care professionals. Compounding the problem is the lack of support for cessation programs. Nurses are often too embarrassed to admit their smoking habits, so do not seek out cessation programs if they are offered at the workplace.

What Sarna and the other Jonsson researchers found led to the creation of a web site,, a resource for cessation programs, evidence-based facts about smoking and cessation, and 24-hour support for nurses wanting to quit the habit. "Nurses are working in a very stressful environment, and that makes it even more difficult to quit," says Sarna.

Armed with evidence that nurses provide their peers with the best support in efforts to quit smoking, provides facts, downloadable brochures, and a link to Nurses QuitNet, a site affiliated with Boston University School of Public Health that provides on-line support and community for nurses who want to quit smoking. The free service allows nurses to create their own quit smoking plan, get advice from experts, and peer support from other nurses who are quitting or have quit.

For more information, contact:

  • Nurses Quitnet, Phone: (617) 437-1500.
  • Linda Sarna, RN, DNSC, FAAN, Lead Investigator, The Tobacco-Free Nurses Initiative; Professor, University of California at Los Angeles College of Nursing. Phone: (877) 203-4144. E-mail:
  • Tobacco-Free Nurses Initiative, School of Nursing, University of California, Los Angeles Factor Building, R4-262, Box 956918, Los Angeles, CA 90095. Phone: (877) 203-4144. Web: