Quittin' Time
With the support of colleagues, Web resources and workplace programs, nurses who smoke find the strength to kick the habit

By John M. Leighty
January 28, 2004

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.

Average smoking rates in the general population are estimated at more than 25 percent, while studies conducted in the 1990s indicated a 15 percent to 25 percent smoking rate in nursing students and a 2 percent to 10 percent smoking rate in medical students, the study said. Of the students who smoked, 89.7 percent of nursing students were women, compared to 57.6 percent of medical students.

Caroline Stonelake, a nursing student at Thomas Jefferson, said she quit smoking two years ago after she tried to work out and found it difficult to breathe. "I just felt I'd be a lot healthier, so I set a date and just stopped." One thing she missed was the social aspect of getting together with others in the smoking areas. Smoking also had been an excuse to take a break from studying.

"Now, I discourage it," she said. Stonelake, who works as a nurse extra in the hospital's respiratory care unit, sees a lot of diseases attributed to smoking. "The issue comes up a lot in the unit and patients will say, 'Oh, I didn't know you guys smoke.' "

Helping hands

Sarna has heard the stories and is dedicated to helping nurses quit smoking in 2004. She kicked off the new year with the launch of "Tobacco Free Nurses," the first nationwide initiative to help nurses kick the habit. The initiative is funded by a $1.8 million grant from The Robert Wood Johnson Foundation. A key resource in the project is a Web site devoted to helping nurses quit called TobaccoFreeNurses.org. The site links to nurses.quitnet.com, an Internet-based smoking cessation site tailored to the profession.

"Nurses work long shifts, all kinds of hours and go home exhausted and the last thing they want to do is go somewhere for a support group," Sarna said. "They need something 24/7 that's available even on the worksite and that's what the Internet program is all about."

The free QuitNet site that features ways to defeat the nefarious online character "Nicodemon" has been available to the public for several years. In addition to providing an around-the-clock support system, the site includes personalized guidance to kicking the habit, an antismoking medication guide, expert counseling and coupons for antismoking products.

"I heard a wonderful success story recently," Sarna said: "A nurse came up to me and said the only way she was able to quit successfully was through QuitNet. She said it empowered her with knowledge, support, access to information and an online buddy to help her through the quitting process so she wasn't alone."

One of Sarna's colleagues in the initiative, Stella Aguinaga Bialous, Ph.D., RN, a tobacco-control consultant in San Francisco, said preliminary data, including input from focus groups, are encouraging. "We've gotten many phone calls and e-mails from nurses wanting to quit and wanting to participate in the Web-based interventions," she said.

As an incentive, nurses are being given $100 worth of free, individualized smoking cessation services offered through the Web site, Bialous said. One of nurses' big concerns is weight gain and the Web site resources address that issue in detail while providing anonymity, she said.

"A lot of nurses are reluctant to go to cessation groups because they don't want people to know they're nurses who smoke," Bialous said. "There's a difference between a construction worker and a nurse. The addiction's the same, but the feelings are different. So at QuitNet, nurses can go to a chat room and talk with colleagues who are trying to quit and form a peer support system."

Bialous said an earlier $174,000 foundation grant was being used to bring awareness of tobacco's harm and the need for smoking cessation programs to nursing leadership in various settings, including hospitals, schools of nursing and professional associations.

Partnerships already have been forged between the Smoking Cessation Leadership Center at the University of California, San Francisco, and the American Association of Colleges of Nursing, the American Nurses Foundation and the National Coalition of Ethnic Minority Nurses Associations.

"Tobacco's been around as an issue for a long time, but we still have to remind people that it is the leading cause of illness and death in this country," Bialous said. "It's an issue that all health professionals morally and ethically should be addressing."

Contact John M. Leighty at johnsan@aol.com