Do as I say...

January 21, 2007 -- Today The Los Angeles Times reprinted a good piece by The Chicago Tribune's E.A. Torriero about efforts to stop smoking on U.S. hospital property--especially smoking by nurses, the preventative health professionals who reportedly smoke at a rate more than five times higher than physicians. The piece is "No smoking: That means you too, Nurse: More hospitals are going smoke-free, but to many workers and patients, it's one less way to ease the tension." The piece might have explored the long-term effects of nurse smoking on the profession and patients, and it might have asked why it is that nurses smoke in such higher numbers than physicians. But on the whole it's a balanced, helpful look at a significant problem.

The piece reports that hospitals are increasingly banning smoking on their properties, as they grow "fed up with people, including patients hooked to intravenous units and nurses who treat them, smoking on their premises." This is not only for health reasons, the piece notes, but also "because tobacco use by health professionals sends a mixed message to patients." The piece notes that surveys show 16% of the nation's nurses smoke, compared with only 2-3% of physicians.

The piece notes that nurses have been "targeted" for smoking cessation programs, notably by the online initiative Tobacco Free Nurses. UCLA nursing professor Linda Sarna, who promotes the initiative, notes that "[t]his is not about shame and blame. Nurses don't imagine a life of addiction to the very thing they counsel people not to do."

The piece--reported from Kentucky, the "heart of tobacco country"--says that the issue is not so simple as it may seem. Supporters of hospital property smoking suggest that it gives patients, families, and caregivers an important release from the sometimes unbearable stress they face. The piece quotes smoking Kentucky nurses who defend the practice. Samantha McCandless, a nursing supervisor at Louisville's University Hospital ED, knows the risks but smokes in the hospital's designated area: "I like smoking...I don't have a desire to quit." Nurse Jennifer Ford, from the nearby Kosair Children's Hospital, says that parents' "children are in here for a crisis and we're supposed to tell them you can't go smoke?"

But Kosair nursing supervisor Cynthia Robinson counters: "We have children in here with asthma and breathing problems...Smoke shouldn't be anywhere near here." Another University Hospital ED supervisor, Anna Smith, does not "have a lot of sympathy" for smoking; the piece reports that about 25% of the 130 nurses she supervises smoke. Nonsmoking nurses also reportedly say smoking nurses sneak extra breaks to smoke, and they must cover for them--obviously not a good thing in an era of short-staffing.

The piece might have noted that the smoking rate for nurses, though amazingly high given the nature of their work, is still somewhat lower than that of the population as a whole (around 20.9%). It might have explored what long-term effects high rates of smoking-related nurse illness might have on nursing and patients during an era of critical nursing shortages. And it might have asked why nurses smoke in such greater numbers than physicians do, even though preventative care is a particular focus of nursing theory and practice, and even though women (still over 90% of nurses) generally have a lower smoking rate than men. Are social norms different for nurses and physicians? Does it relate to differences in work environment? Does it relate to years of formal education, since smoking rates generally decrease sharply as that number rises? How does the smoking rate of physicians compare to that of nurses with a similar amount of graduate education?

We thank E.A. Torriero and these newspapers for this piece.

See the article "No smoking: That means you too, Nurse: More hospitals are going smoke-free, but to many workers and patients, it's one less way to ease the tension." from the January 21, 2007 edition of the Los Angeles Times.