Smoking Among Nurses: Does it Matter?

I was waiting for the questions. It wasn’t a surprise as they usually come whenever I am speaking to nurses about helping their patients quit smoking.

The questions: What to do about nurses who smoke? And, “Do you have to be a former smoker to understand the challenges in quitting?”

I had just finished giving a presentation at the International Society of Nurses in Cancer Care (ISNCC) conference, September 9, 2012, in Prague.

We (Stella Bialous and myself) had organized a preconference “train the trainer” workshop conducted by our Czech nurse colleagues, for other Czech nurses, on behalf of ISNCC.

I was thrilled to share the process of how we collaborated with nurse leaders in developing this program, so that nurse champions could share this information with nurses at their own institution throughout the Czech Republic.

We knew going into the project that an estimated 40% of nurses in the Czech Republic smoke, a higher smoking rate than women in the general population.

But that didn’t stop us.

High smoking rates among nurses was the situation in the U.S. in 1976, when female nurses had a higher smoking prevalence than American women.

It was also then that the Nurses’ Health Study (NHS), the largest and longest running study of women’s health in the world, was launched.

We learned of the devastating impact of smoking on women’s health from nurses — nurses who smoked, nurses who quit, and nurses who never smoked.

When the first U.S. Surgeon General Report on women and smoking was published in 1980, data from the NHS were front and center.

We know that smoking among nurses is not just a personal health issue but one that has plagued the profession.

In the U.S., we launched a national campaign, funded by the Robert Wood Johnson Foundation, Tobacco Free Nurses, to address this issue.

Stella and I have continued to monitor smoking among nurses in the U.S. through analysis of trends in smoking among the health care professions in the Current Population Survey.

Yes, smoking has declined in our country and has declined among nurses.

Fewer female nurses smoke (12.1%) than women in the general population (16.6%), but the prevalence is not as low as among physicians (2.3%).1

However, smoking among nurses varies across countries in the world.

Sometimes it is low, as in China (with female nurses having lower smoking rates than male nurses), and sometimes it is high as in some Eastern European countries.

I believe that addressing tobacco use among nurses is an important part of tobacco control, and one that cannot be ignored.

Now to my answer to the question of whether nurses need to be former smokers to help understand the challenges of quitting and support quit efforts.

Nurses do not need to have had a diagnosis of cancer to be good cancer nurses.

And, nurses do not need to have been a former smoker to help patients quit.

Regardless of smoking status, all “good” nurses must address this leading cause of preventable death and disease, even current smokers.

They do need to understand the power of the addiction and the need to utilize evidence-based interventions as part of their daily practice.

In response to the question about what do we do about nurses who smoke, the answer is simple.

We need to reach out to nurses who smoke and support their quit efforts now, with support in the workplace and in all aspects of the profession.

We need to embrace our fellow nurses and acknowledge that they are not immune to the brain disease of nicotine addiction.

Some may have begun smoking before they entered nursing school; some began smoking as young nurses, modeling the behavior of the floor nurses they admired, as I did in the 1970’s.

Educators need to provide nursing students who smoke with support for quitting and transmit the expectation that nurses in the 21st century should be smoke-free role models.


  1. Sarna L, Bialous SA, Sinha K, Yang Q, Wewers ME. Are health care providers still smoking? Data from the 2003 and 2006/2007 Tobacco Use Supplement-Current Population Surveys. Nicotine and Tobacco Research, 2010. 12:1167-71. Epub 2010 Oct 11.