No smoking: That means you too, Nurse

Samantha McCandless began smoking when she was 9 after her teenage baby sitter hooked her on cigarettes.

More than a quarter-century later, despite being a nursing supervisor at a busy trauma center, McCandless has no plans to stop. Three or four times during a 12-hour shift, McCandless takes a break and smokes in the hospital’s designated area.

She knows the health risks.

“But I like smoking,” McCandless, 36, said during a break at Louisville’s University Hospital emergency room. “I don’t have a desire to quit.”

McCandless’ quest to smoke at work will probably get tougher in coming months.

Following national trends, an increasing number of hospitals are banning smoking on their properties.

Across America -- even here in the heart of tobacco country -- healthcare establishments are fed up with people, including patients hooked to intravenous units and nurses who treat them, smoking on their premises.

As they consider bans, hospitals are becoming more aggressive in persuading their practitioners to stop smoking, not only for health reasons but also because tobacco use by health professionals sends a mixed message to patients.

As a group, nurses are among America’s top smokers: 16% of the nation’s 2.3 million nurses smoke, compared with 2% to 3% of doctors, surveys show. Nurses in scrubs can be seen puffing outside the very wards where they dispense advice to patients ill from smoking.

“The nurses-smoking thing continues to astound me,” said Connie Sorrell, director of the Kentucky Cancer Program. “But physicians and nurses are just people. This speaks to how strong the addiction is.”

Yet, in the battle against smoking, healthcare facilities are a conflicted frontier. As cities and businesses across America go smoke-free, many hospitals have been reluctant to do the same.

Medical administrators fear that patients and families stressed by health problems could be pushed over the edge if prohibited from smoking in front of the hospital.

As for nurses and other caregivers who smoke, the thinking goes, lighting up provides a release from tension during long, difficult shifts. And researchers say blanket bans seldom help people kick bad habits.

“On the one hand, there is recognition that smokers are enslaved by an addiction,” said Brad Rodu, director of the University of Louisville’s tobacco research project, which receives grants from tobacco companies. “On the other, society treats them like outcasts.”

In a 12-block area of downtown Louisville that is home to dozens of medical facilities, the smoking dilemma is playing out in daily debate.

The answers are not easy in a state where thousands of people make a living growing and selling tobacco. Kentucky has the highest smoking rate in the nation: More than 30% of the population smokes.

One large downtown medical provider, Norton Healthcare, plans to prohibit smoking outside its facilities starting May 1. That is causing debate among employees, patients and their families. “It’s the right thing to do,” said Russell F. Cox, Norton’s chief operating officer.

A few blocks away, another major hospital center, this one run by the University of Louisville, is likely to follow suit by fall, along with most metro area hospitals, officials said. A citywide indoor smoking ban is to take effect in mid-2007.

Nationally, nurses are being targeted to enroll in stop-smoking programs.

“This is not about shame and blame. Nurses don’t imagine a life of addiction to the very thing they counsel people not to do,” said Linda Sarna, a nursing professor at UCLA who promotes an online initiative called Tobacco Free Nurses. Some 2,000 nurses nationwide have gone online to try to stop smoking.

Louisville nurses are divided. Smokers often sneak extra breaks, say nonsmoking nurses who cover for them. Nonsmokers also resent the smell of smoke on their colleagues as they care for patients.

“I don’t have a lot of sympathy for [smoking],” said Anna Smith, who supervises 130 nurses in the university emergency room, where about 25% of them smoke.

A few blocks away, at the trauma center at Kosair Children’s Hospital, which is run by Norton, nonsmoking nurses say secondhand smoke on the clothing of nurses is a hazard.

“We have children in here with asthma and breathing problems,” nursing supervisor Cynthia Robinson said. “Smoke shouldn’t be anywhere near here.”

Nurse Jennifer Ford, 31, who smokes about half a pack a week, said prohibiting smoking outside the hospital’s entrance is punitive.

“Their children are in here for a crisis and we’re supposed to tell them you can’t go smoke?” Ford asked. “How can you do that?”

It’s important to change mind-sets over the long term, hospital officials said, rather than to expect total compliance.

In January, the university healthcare system will offer employees the opportunity to become part of a research project by using smokeless tobacco products, including pellets, as a way to stop smoking. Rodu’s program offers a nicotine fix without the harmful effects of smoke and other carcinogens.

While its merits are studied, there will be an immediate benefit: Users won’t have to stand outside the hospital to have a puff.