Nurses Smoking: Compassion Instead of Judgement

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    In this article the author goes over some of the reasons nurses continue to smoke and urges a compassionate approach with an encouraging touch toward all who struggle with habits that are hard to overcome.

    Nurses Smoking: Compassion Instead of Judgement

    My friend excused herself after a long meeting. I knew where she was going-to the cold parking deck, to get in her car, to have a cigarette, to still her craving so she could get back to work and concentrate on her job.

    If you have watched any movies about the 1960's lately, you probably realize that many fewer people smoke now than did at that time. In '65, a little over 40% of the population smoked (including large numbers of health care providers!) and now a fewer than 15% do (Center for Disease Control and Prevention)."Recent declines in smoking among health care professionals may reflect the impact of national tobacco control policies and efforts focused on reducing smoking among registered nurses. After little change in prevalence from 2003 to 2006-2007, the drop in smoking among registered nurses was more than twice that of the 13 percent decrease in the population." (Study Examines Prevalence of Smoking Among Health Care Professionals - For The Media - JAMA Network) While there is encouraging news, smoking in the general population and among nurses remains a commonplace occurrence.

    Most of us have friends who smoke, nurse friends, co-workers, and others. Smoking or not smoking is a touchy topic and just bringing it up makes people want to go to different sides of the room, flinging hot, angry flaming arrows at one another. While we all have opinions, and those opinions matter, especially in the face of compelling evidence, we do ourselves and others a disservice when we retreat and point fingers at each other. How can we keep reaching out to each other, being patient and compassionate no matter what our particular challenges are?

    Bad habits are notably hard to overcome and substance abuse, including addictions to nicotine, can be particularly noisome. For anyone who has any type of bad habit-most of us have at least one-we know how hard it is to overcome. Listing all types of bad habits here will not help us proceed in our conversation for as humans we automatically want to compare our bad habit to smoking and say-"Well, mine isn't THAT bad." Maybe not. But let's all admit that it's pretty hard to compare bad habits and it's even harder to cease a bad habit. Our tendency to look at others' faults with less compassion than we look at our own is pretty universal and sadly also difficult to overcome. Myriad studies have been done on overcoming the compulsion of bad habits and no matter how you look at them, they all say the same thing: giving up a bad habit is hard work and relapsing is as easy as taking a puff or two.

    So first, how can we cultivate an attitude of grace and compassion toward members of our profession who continue to struggle with an addiction to nicotine? One thing that might help is to realize that we are all susceptible to the clinging effects of our own vices. Being honest with ourselves and vulnerable to one another, we take the first step in reaching out to a friend who is struggling with support and care instead of judgment and condemnation.

    It's hard for people who are not addicted to nicotine to fully understand its effects and the pervasive reach it has throughout smokers' lives: home, travel, work, entertainment-all can be powerful influences in keeping a person tied to their habit.

    1. Long-term smokers may have linkage behaviors or triggers that contribute to the continuation of the habit-things like group smoking, an association between a morning coffee and a cigarette, alcohol, good feelings perceived to be related to smoking, less anxiety, even daily bowel rituals.
    2. The process of withdrawal can be scary for some-especially if they have gone through it before-and lead them to put off the day they quit.
    3. Nicotine increases dopamine levels and produces a temporary feeling of well-being, of less anxiety and of increased concentration, all reinforcing the behavior and keeping smokers coming back for one more. While these perceived benefits are small and time/dose limited, quitting to "normalize" the body's equilibrium can be daunting for some.
    4. Defiance of established norms or expected behavior-For a variety of reasons, people sometimes continue to smoke to defy societal expectations. There are times when society can be perceived as imposing a veritable straitjacket of limitations and guidelines, leading some to throw up their hands and disregard some of the more basic cautionary information, including the tsunami of information about the dangers of nicotine.
    5. Concerns about weight gain- Weight issues may seem to pale in comparison to the side effects of smoking but this is a real concern for many.

    With great sadness, a physician friend once pointed out ruefully, "I have had some success in encouraging people from all walks of life to quit-including some nurses. But at other times, I have failed. I wish that more times I had pointed out that the real danger of smoking is not dying, it is actually continuing to live in the face of the limitations that long-term addiction invariably imposes on the human body. In the end, people wish they could die."

    Smoking is a bad habit. No doubt about it. But maybe we can find ways to offer each other more compassionate support and less judgment. How can we be a force of encouragement to our peers?


    Joy Eastridge
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    91 Comments

  3. by   Wuzzie
    Sorry, when somebody's "bad habit" (including but not limited to smoking) infringes on my health and well-being I have a really hard time being compassionate.
  4. by   TheMoonisMyLantern
    It's amazing how intense nicotine addiction and withdrawal can be. I think we sometimes downplay its intensity in comparison to other substances, "Oh it's just cigarettes." but damn when they have a hold of you, it's an iron grip.
  5. by   VivaLasViejas
    I tried quitting four times, and I only lasted a few weeks before going back to the evil weed. I was young at the time, but I was sick with breathing problems so often that more than one doctor told me I wouldn't live to age 40 if I kept smoking. That was enough to scare me off cigarettes for a couple of months, but I always went back. It was only when I got pregnant with my last child that I finally managed to quit for good, and even then it wasn't on purpose---the smell of cigarette smoke made me ill. I just never picked up again after that, and I've now been smoke-free for over 27 years.

    So I tend not to be too judgmental of healthcare workers who smoke. I know what it's like to have a nicotine fit and I'm glad I don't go through that anymore, but it's not a moral failing if one simply can't quit cold turkey. A lot of people are in the position of "wanting to want to" quit, they're just not quite ready to give it up yet. I remember the tough part for me was the psychological dependence I had on cigarettes; I liked holding them, lighting them, the feel of them in my mouth. What helped me to break the habit was cutting drinking straws into cigarette-sized pieces and drawing in air just like if I was puffing on a smoke. Occasionally I forgot and lit one, or I'd find myself tapping the end in the ashtray. But it did help reduce the craving, and eventually I stopped that too.
  6. by   cardiacfreak
    Funny thing is I didn't even want a cigarette until I read this article, now I want a cigarette. The same thing happens when I see advertisements on television about the dangers of cigarettes.

    I wonder if Big Macs came with Surgeon General warnings if people would quit eating Big Macs, and if they didn't would Society ban them from being eaten at McDonald's.

    When it comes to addiction, regardless of what the addiction is, I believe there are a lot of nurses who don't have any compassion.
  7. by   Kitiger
    I was earnestly warned by several family members to NEVER start smoking! They pointed out that it was a "dirty habit" and expensive, to boot. And they couldn't quit. I decided young that I would never smoke; I didn't even like the smell.

    All this to say that I have no idea how hard it is to quit, not personally. I've seen friends try and try again, and each time go back. I've been fortunate.

    Not only do I dislike the smell, it makes me cough and work harder to breathe. So, when someone around me lights up, I ask to be upwind from them. They understand, and really do try to keep the smoke away from me. (This is outside. I would have to leave the room if someone was smoking inside.)

    Hey, I have enough trouble trying to get/keep my weight under control, which I know I could do if I would just stop snacking in the evening!

    Nicotine is far more addicting than snacks.

    Oh, and when someone wants to debate whether or not smoking is all that bad ... I just tell them I'm a nurse! That usually stops the debate.
  8. by   RockinNurse2018
    Quote from Wuzzie
    Sorry, when somebody's "bad habit" (including but not limited to smoking) infringes on my health and well-being I have a really hard time being compassionate.

    Agree. I'm sorry they have an addiction, but I'm very sensitive to smoke, and if the smell is strong enough, I have trouble breathing. I have many coworkers who smoke, which can make working near them difficult when they've come back from one of many smoke breaks (and why do they get more breaks than I do, just because they need to smoke?)
  9. by   clkrn10
    Quitting smoking was one of the hardest things I have ever done. I have empathy for smokers and those trying to quit. We should offer support and compassion and encouragement for our fellow nurses who struggle with the burden of smoking.
  10. by   SafetyNurse1968
    Has anyone else read about smoking as a way of "self-treating" for mental health issues? I have heard it is why the VA continues to allow veterans to smoke on VA campuses. I wish we could find a way to safely deliver the nicotine that calms the nerves of folks with anxiety and PTSD...what I really wish is that we spent more time, money and energy on mental health issues. Thank you for posting - anytime I see someone encouraging compassion, I am grateful. We need more positivity and love in the world.
  11. by   KatieMI
    People have their God's (or human law's) given right to do whatever they want with THEIR OWN bodies. They have no right to endanger anybody else by doing so.

    Unfortunately, there are some other fellow humans around here for whom smoking can be more than an inconvenience. For me, strong smell of smoke almost invariably means severe asthma attack, destroying mine and my physician's efforts to bring it under control. For a patient bedbound for a week after he had to "quit" abruptly d/t AMI, it is nothing less than a torture. For his pregnant daughter who feverishly tries to quit for her baby's sake and has to do it with no Chantix, it is another cue to"just have only one more".

    You cannot know who is walking around you at any given moment. So, at least, please do it where nobody else is involved. Or I will sit there huffing and wheezing and crying, RRT will be busy with me instead of your patient, NM will call ER and go there instead of speaking with that family and looking for someone to pick up that day off you so sorely need, and you'll be blamed for all the mess later on.

    This in not judgement. This is just a fact of life.
  12. by   hherrn
    Quote from KatieMI
    People have their God's (or human law's) given right to do whatever they want with THEIR OWN bodies. They have no right to endanger anybody else by doing so.

    Unfortunately, there are some other fellow humans around here for whom smoking can be more than an inconvenience. For me, strong smell of smoke almost invariably means severe asthma attack, destroying mine and my physician's efforts to bring it under control. For a patient bedbound for a week after he had to "quit" abruptly d/t AMI, it is nothing less than a torture. For his pregnant daughter who feverishly tries to quit for her baby's sake and has to do it with no Chantix, it is another cue to"just have only one more".

    You cannot know who is walking around you at any given moment. So, at least, please do it where nobody else is involved. Or I will sit there huffing and wheezing and crying, RRT will be busy with me instead of your patient, NM will call ER and go there instead of speaking with that family and looking for someone to pick up that day off you so sorely need, and you'll be blamed for all the mess later on.

    This in not judgement. This is just a fact of life.
    I kind of disagree with their right to do what they want with their own bodies- We are all paying for it.

    If all we did was provide palliative care for addicts, then maybe. But, no matter what health care policies exist, we all share the cost on this one.
  13. by   KatieMI
    Quote from SafetyNurse1968
    Has anyone else read about smoking as a way of "self-treating" for mental health issues? I have heard it is why the VA continues to allow veterans to smoke on VA campuses. I wish we could find a way to safely deliver the nicotine that calms the nerves of folks with anxiety and PTSD.
    If it were so, nicotine gums would have the same, although weaker, effect. Not patches, as nicotine in them goes through liver first bypass and has no peak concentration. Also, central acting nicotine agonist galantamine (Razadine) would be WAY more popular than old-fashioned therapy for mild Alzheimer, and Chantix would gave WAY more indications than it has.

    Nothing like this is observed. Although it doesn't deny the fact that smoking still be useful as placebo.
  14. by   KatieMI
    Quote from hherrn
    I kind of disagree with their right to do what they want with their own bodies- We are all paying for it.

    If all we did was provide palliative care for addicts, then maybe. But, no matter what health care policies exist, we all share the cost on this one.
    Totally agree. But let's forget about this for just now

    One NM I once worked under made a rule that whoever sends fellow nurse, CNA or RRT in ER by exposing them to things they made known to be allergic to had to take his or her full assignment within scope of practice to the end of the shift. We had quite a few bad asthmatics and a couple of them with severe allergies as well. The question of staff smelling like tobacco barn and peanuts strewn around nursing station disappeared after just one case when this rule was applied for real.
    Last edit by KatieMI on Mar 28

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