Nurses Smoking: Compassion Instead of Judgement

jeastridge, BSN, RN

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.

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.
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.
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.
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.
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

Nurses Smoking: Compassion Instead of Judgement

About jeastridge, BSN, RN

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