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ADVANCE Perspective: Nurses

Instituting Controversial Bans on Hiring Smokers

Published March 25, 2014 6:28 PM by Guest Blogger

By Anny Su, BSN, RN

Approximately 45.3 million people smoke in the U. S. (CDC, 2008) Many of these smokers seek employment in healthcare institutions. Within the past 6 years, healthcare institutions have stepped up to challenge this unhealthy behavior by instituting controversial bans on hiring smokers with the goal of stigmatizing smoking further.

The message is clear: If you want a job, either do not smoke or quit smoking now.

Cigarette smoking is the leading preventable cause of death and is attributed to more than 440,000 deaths per year. (CDC, 2008) Decades of research have been invested into finding successful interventions to increase overall smoking cessation rates and reduce rates of relapse, thereby sustaining those quit rates for the long term. Studies show that while there may be effective ways to get individuals to stop smoking, rates of relapse can reach upwards of 80%. (Hajek et al., 2013) Furthermore, no type of intervention, behavioral or pharmacological, is more effective than the other when it comes to long-term smoking cessation. (Cahill, Moher, & Lancaster 2008; Cahill et al, 2013) Even the most successful of interventions in smoking cessation, cash or voucher incentives, did not have any long-term effect. (Cahill & Perera, 2011) Although controversial, banning the employment of smokers at healthcare institutions is a necessary measure that eliminates the choice of smoking, motivating people to quit smoking and to avoid picking up the habit.

From an employer’s perspective, a ban on hiring smokers makes sense when it comes down to numbers. Employers can be indirectly, but substantially, affected by having smokers as employees. Smokers take on average 11 more sick days a year (Lundborg, 2007) and amount to lost productivity of over $4,000/year for current smokers. (Bunn, et al, 2006) Alternatively, workplace productivity was increased and absenteeism was decreased among former smokers compared with current smokers. (Halpern, Dirani, & Schmier, 2001) From a nonsmoker’s perspective, the effects of smoking from an environmental standpoint are real. Patients receiving care can be put off by the smell of second hand cigarette smoke in their surroundings. A more recent discovery is called third hand smoke, tobacco residue that lingers the environment days to weeks after the smoker has left. This exposes nonsmokers to carcinogens that can build up over time despite cleaning efforts and has the real ability to cause significant damage to one’s DNA (Hang et al, 2013).

Opponents denounce the ban as being unethical. Smoking is an addiction, and it is blatant discrimination to not hire someone on the basis of a behavior not necessarily born out of personal choice. Smoking is disproportionately associated with individuals of a lower socioeconomic status. To ban smokers from employment is further injustice to a population most in need of employment. However, smoking can be disruptive to work performance. This is particularly true when an individual is experiencing such withdrawal symptoms as irritability, poor concentration, and emotional lability. Many would also argue that the danger of exposing patients to secondhand or third hand smoke, and/or the less than optimal care from an individual experiencing nicotine withdrawal interferes with the quality of patient care provided. Health care workers have a professional responsibility to another’s well-being and healthcare institutions must ensure that providers are providing that quality care.

Another argument posed against the ban is that it is hypocritical of an institution whose mission is to provide care for those who have illnesses as a result of health-related behaviors such as smoking, while simultaneously punishing them by denying them jobs, regardless of capability or merit. Such a ban creates a slippery slope for hiring practices as employers in the future could very easily implement hiring bans against those who drink alcohol, have unhealthy diets or are obese. It would seem more successful if employers were to offer workplace cessation support which could not only help them to quit smoking but could also potentially increase productivity and morale by creating an environment in which the employee feels supported and valued. Unfortunately, workplace health promotion programs have shown small effects in healthier behaviors (Rongen et al, 2013).

While workplace interventions for smoking cessation increase one’s likelihood of quitting, the actual sustained quit rates are low. (Cahill, Moher, & Lancaster, 2008) Other less stringent alternatives to discouraging smoking and/or motivating smokers to quit such as imposing campus wide smoking bans have shown little promise (Ripley-Moffitt, et al, 2010). Despite decades of research and experimentation, nothing has been found to drastically cut down smoking rates. Bans on hiring smokers at hospitals could be the answer to combatting the unhealthy behavior once and for all and for the greater good.

Healthcare facilities should be the role models for healthy behaviors and it is entirely within an employer’s right to determine what kind of work environment they want to create for their employees and for the services they sell. Employee absenteeism, productivity losses, and increased insurance costs due to smoking-related illnesses are costly to employers. Patients and other nonsmokers have the right to clean, non-toxic working environments. While bans on hiring smokers by healthcare institutions are still too new to show whether they will actually lead to lower rates of smoking, they provide compelling reasons for individuals to either quit smoking or to not pick up the behavior in the first place. As healthcare providers, it would be hypocritical, unprofessional, and dishonest to promote healthy behaviors but to not follow our own advice.

Anny Su is a 2014 Family Nurse Practitioner MSN candidate 2014 at the University of Pennsylvania School of Nursing, Philadelphia.



LDiscriminatory???   Absolutely, I find it ironic that the medical community is embracing smoking a another substance as a legitimate medical alternative medication however, appears to be chastising those who continue to use cigarettes and are not hiring folks who do smoke.   I agree that smoking may be not promote the healthy lifestyle we all would like to adhere personal feeling is live and let live.  Regulating a personal choice which would not otherwise interfere withones ability to perform their duties is ineed discriminatory.  

Lisa, RN April 7, 2014 2:14 PM
Boston MA

To deny a qualified individual employment based solely on the fact that they use tobacco or a tobacco substance is truly discriminatory. Our society is one that has finally begun to promote acceptance on many levels. Why would any employer want to take a step backward? I have been in nursing for the past 40 plus years and was actually a smoker at the start of my career. I am certainly grateful that I was given the chance to work in my chosen career. To adopt this kind of policy will only open the door to more discrimination. What about those health career employees who may be being treated for a mental health issue, those on chronic pain medication, those on diabetic meds, those on appetite suppressants ? The list could go on. Where would this scrutiny of one's private life stop in determining hire-ability? Why not, as the article states, offer cessation programs and support the employees thereby building a dedicated staff & reduce turn-over rates.

Joanne hettel, Surgical Nursing - Surgical Care Operations Manager, Lebanon VA Hospital April 3, 2014 6:30 PM
Lancaster PA

When cigarettes/ tobacco become an illegal substance potential employers can test for it.  Test for tobacco now should be against an individuals is a way to discriminate.  Go figure pot is legal and people testing positive for tobacco will not be hired.  Soething is ery wrong here.

Jan April 3, 2014 12:26 PM

as a nurse for 30 years and former smoker for 40 years, I believe employers should offer stop smoking benefits to smokers.

Lynn Barnes April 2, 2014 3:59 PM
Pompano Beach FL

I know of one facility that tests urine for nicotine. A positive result means you are not eligible for hire. A whole year must lapse before you can try again.  

Lorettajo Kapinos March 27, 2014 12:09 PM

The words "cigarette", "smoking", and "tobacco" absolutely must be qualified...for the sake of medicine, science, law, and understanding.

Do the words refer to plain unadulterated tobacco?....for which no studies seem to exist relating to health effects (outside of irritation from overuse).

Or, do they refer to typical cigarettes highly contaminated with residues of any of some 450 registered tobacco pesticides, with dioxin-creating chlorine pesticides and chlorine-bleached paper, with carcinogenic levels of PO-210 radiation from some still legal fertilizers, with any of over 1000 untested, unlabeled, often toxic non-tobacco additives, with burn accelerants, with addiction-enhancing additives, with all sorts of kid-attracting sweets-flavors-aromas-soothing substances, and with fake tobacco (also un-labeled) made from all kinds of industrial waste cellulose?

OR do we mean cigarettes made entirely from that "tobacco substitute material", as the Patent Office calls it?  Can't get any Tobacco Smoke from that.

To call typical cigarettes "tobacco" or the smoke "tobacco smoke" is to be wrong, to be possibly perjurous, to deceive, and to serve the various members of the cigarette cartel....including their insurers and investors and all their ingredients suppliers.

Ample references at  

j j March 26, 2014 8:01 PM

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