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Although nurses are in the best position to conduct smoking cessation interventions with patients, a big barrier is nurses themselves who continue to smoke. That number, estimated at 18 percent, marks the highest percentage of smokers among all health professionals.

Brita Carhart, MSN, RN, recalls a time when nurses could light up in hospital cafeterias without raising an eyebrow. Linda Sarna, DNSc, RN, FAAN, says she was once the only nonsmoking nurse at the National Cancer Institute, which is now a strong anti-tobacco advocate.

Those days of guilt-free puffing are long gone. And nurses, who, surprisingly, smoke more than other health professionals, are being coaxed, coddled and conditioned to reject the "nicodemon"-tobacco products that studies show are a major contributing factor in lung cancer, chronic lung disease, heart disease and many other health problems, including asthma and allergies.

"We [nursing professionals] have a responsibility not just to promote good health, but to reflect and demonstrate good health," Carhart said. "You can't be in coronary care and smoke if you expect your patients to give up habits that are bad for cardiac health."

Sarna said that although nurses are in the best position to conduct smoking cessation interventions with patients, a big barrier is nurses themselves who continue to smoke. That number, estimated at 18 percent, marks the highest percentage of smokers among all health professionals, said Sarna, a professor at the UCLA School of Nursing.

Carhart, a nurse practitioner in the employee health department at Oschner Clinic and Hospital in New Orleans, said she began to smoke as a sophomore in high school. She smoked until the first month of her actual nursing career in 1974, when she walked into a critical care unit and knew it was time to quit. "I felt ludicrous telling patients they had to give up smoking, and then taking a cigarette break," she said. "In terms of temptation, it was like waving heroin in front of an addict's eyes and telling them to quit."

Different approaches

Although Carhart managed to quit "cold turkey" and remains smoke-free after about 30 years, quitting can mean taking desperate measures. Ann Harris, RN, a flight nurse at Oschner, attempted to kick the habit several times. Harris, who smoked for 30 years, tried everything from prescription drugs to nicotine patches. She finally succeeded in July by locking herself in her house for seven days and not answering the phone.

"The first three to five days are the absolute worst," said Harris, a retired Army nurse who joined Oschner 2½ years ago. "Everything irritates you-you want to get a pack and smoke it in 10 minutes." So far, she's remained smoke-free.

Carhart said other options are available to nurses at Oschner, including participation in a Pathways to Wellness program. The program gives cash incentives to health care workers who try to develop healthier lifestyles-including smoking cessation.

Although smoking among nurses is beginning to decline, one recent report shows nursing students are four times more likely to smoke cigarettes than medical students. The study, published in CHEST, the peer-reviewed journal of the American College of Chest Physicians, said 13.5 percent of nursing students at Thomas Jefferson University in Philadelphia smoked cigarettes, compared to 3.3 percent of medical students. In addition, 17.4 percent of nursing students and 9.8 percent of medical students considered themselves former smokers.

Cindy Purcell, a therapist and research coordinator who gathered data for the study, said the percentage of smokers was lower than for a similar study in the '90s, "so the trend is in the right direction." She added that more of the nursing students were female, which was also a factor. "Young females are the largest population of smokers right now," she said, partially because of heavy advertising aimed at them by tobacco companies.

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