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The Nightingales’ mission is to highlight the tobacco industry’s behavior and its contributions to the suffering nurses witness in their jobs, and to call on the industry to end active promotion of tobacco products.

Twelve nurses from around the United States paid their way and each bought a share of stock in the Philip Morris USA company to attend the cigarette maker’s annual shareholders meeting in April in East Hanover, N.J. Their quest was not to hear about the company’s financial progress; rather, it was to pressure the industry to voluntarily stop promoting tobacco products.

Ruth Malone, RN, PhD, associate professor of nursing at the University of California, San Francisco, spearheaded the effort. “Nurses have always been against smoking, but we’ve never taken on the industry as a group,” she said.

Malone helped form the Nightingales, a group of nurses whose mission is to highlight the tobacco industry’s behavior and its contributions to the suffering that nurses witness in their jobs, and to call on the industry to voluntarily end active promotion of tobacco products.

In her research into tobacco industry documents, Malone found a “critics,” or “enemies,” list, in which people working for the industry had assessed organizations that could be critical of the industry and their potential power against tobacco. The American Nurses Association was listed, according to Malone, but the comment in the document was that while nurses are staunchly antitobacco, they have never become active on the issue.

If they would become active, the document went on to say, they would be formidable opponents.

“I thought, ‘We need to be formidable opponents. We are the ones who see what this does to people day in and day out,’” Malone said.

The meeting

The Nightingales decided that the Philip Morris shareholders meeting would be a good starting point to make their feelings known. The meeting was for the Altria Group Inc., the parent company of Philip Morris USA, Philip Morris International, and Kraft Foods.

The nurses went armed with a 37-foot banner of letters from cigarette smokers and their families. Malone found the letters in tobacco industry files while doing her research. They weren’t allowed to bring the banner into the meeting, but displayed it outside. They attended the meeting in their white lab coats and came prepared with questions that each would pose during the shareholders’ question-and-answer session.

Malone admits that it was “scary” walking into the meeting, “but we also have the power of being nurses. I think that nurses are coming of age in terms of being able to speak out on issues beyond what had been traditionally seen as nursing practice at the bedside.”

She was the first among the nurses attending to speak. She read a few excerpts from letters about people dying from cigarette smoking and asked Atria Group Inc. chairman and CEO Louis Camilleri how the company responds to letters like these.

Sharon Brown, MN, MPH, FNP, PhD(c), a family nurse practitioner and doctoral student at the University of California, Irvine, talked about the loss of a loved one to cigarettes during her allotted two minutes for questioning. Brown requested that for 30 seconds everyone observe a moment of silence for her father, whose 78th birthday would have been the day of the meeting. She said her father “could have been here today had he not become so addicted to tobacco and died at the very young age of 60 years.”She asked what the company was doing not only to inform consumers about the addictive nature of the products, but also to diminish the addictiveness of cigarettes.

Camilleri said, according to Brown, “I’m sorry about your father.” He mentioned that there were some cessation statements on the company website.

“It was a very rehearsed and generic response, I felt,” Brown says.