A nurse shouldn't smell like she just smoked an entire pack of cigarettes. If my nose wrinkles at the foul odor of stale smoke on one of the hospital caregivers, imagine how the patient struggling with nausea must feel as the same nurse leans over them to listen to their chest. Twenty years ago, hospitals started banning smoking inside their buildings, so why is it that both staff and patients still smoke just outside the front doors, in the gardens and off of the loading docks?
Smoking and Healthcare
It is remarkable to look back at the 1950s and see cigarette ads in magazines that read, "What cigarette do you smoke, Doctor? The brand named most was Camel." A television ad from that era can be seen on YouTube, and states, "Time out for many men of medicine usually means just long enough to enjoy a cigarette." We won't even talk about the "men of medicine" line, and will stick with the smoking issue.
In 1964, a report by an advisory committee to the surgeon general reported that "Cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action." One would have hoped that healthcare providers would have leapt to take the lead on this issue, but when I first went into practice in the mid-1970s, doctors still smoked their pipes and cigarettes at the nursing stations and throughout the hospital. In 2012, the scene has moved outside. A common scene in many hospitals is a group of "employees in scrubs [who] stand on the front lawns of hospitals smoking, only to return inside shortly to take care of patients suffering from tobacco-related diseases."
Certainly hospital administrators don't favor this public image of employees smoking, nor do they want their patients and families navigating a sidewalk littered with cigarette butts. In today's world of anti-smoking campaigns, the thought of smoking and hospitals seems contradictory, but the practice continues. If you can't smoke in a bar in many states, why can you smoke on a hospital campus? Some states, like Arkansas, have already passed legislation to ban smoking on hospital campuses, but many have not. Why do we still have to deal with this issue?
You would think that the decision to go smoke-free would be an easy one. Hospitals and doctors discourage unhealthy habits like smoking, but their tolerance of smoking on their campuses has the opposite effect. Medical literature confirms this, but hospitals still hold regular meetings to debate the topic. Hospital administrators worry that they will lose valuable employees who do not want to quit smoking. Of even greater concern is that, in a highly competitive market, they will lose patients to a competitor who still allows smoking on their grounds. However, they seem to forget that they are talking about a small number of employees and patients relative to the large numbers who do not smoke.
The truth is that these fears are unfounded. Many hospitals have undergone the conversion to non-smoking and still prosper. Medical literature has studied both general and psychiatric hospitals. The facts are clear:
- Employees are supportive of the transition to a smoke-free campus.
- Employee smoking drops significantly with programs that help them quit smoking.
- There is no significant loss of employees after a ban on smoking.
- There is no drop in patient census or referrals.
- Healthcare costs decline and employee health improves.
The Next Step
The Cleveland Clinic, one of the nation's healthcare leaders, stopped hiring smokers in 2007. Many other hospitals have taken this next step of refusing to hire anyone who smokes, performing pre-hiring laboratory screening for nicotine products. Not all states allow this practice, and it is still illegal to deny employment based on smoking outside of work in 29 states and in the District of Columbia.
However, it makes sense. Remember the nurse who smells of smoke. That same nurse may try to speed off campus, sit in her car and smoke on a brief break, leaving patients unattended for longer than the intended break. Hospitals that ban smoking need to encourage their employees to quit.
This may be one step too far for many hospitals, but it is time to take the first step to a totally smoke free campus. No more excuses, they are only a smoke screen.
For more by Richard C. Senelick, M.D., click here.
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