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Nurses cannot be expected to 'police' NHS smoking bans

Nurses must not be forced to “police” smoking bans on NHS premises in the wake of new public health guidance, warn nursing unions.

Guidelines issued earlier this week by the National Institute for Health and Care Excellence (NICE) said that all hospitals and clinics should become smoke-fee.

In addition, they called on health professionals, including nurses, to actively promote smoking cessation among patients. NHS staff that smoke should also be supported to quit, the institute said.

NICE director Professor Mike Kelly said it was time to end “the terrible spectacle of people on drips in gowns smoking outside hospital entrances”.

In particular, the guidance highlighted the need to tackle higher than average smoking rates among mental health patients.

Mary Yates, matron at the South London and Maudsley NHS Trust, said: “I would like to see people who are admitted to mental health hospitals having the opportunity and support to quit smoking during their admission.  

“The new NICE guidance can help to change the culture whereby smoking is acceptable on NHS grounds and make it easier for hospital staff to set a clear example in helping patients to be successful in their attempt to quit smoking for good.”

Rebecca Sherrington, chair of the Association of Respiratory Nurse Specialists, also welcomed the NICE guidance.

She told Nursing Times: “Respiratory nurses deal with the effects of smoking resulting in death and disability on a daily basis and we’d support any initiative that de-normalises smoking.

“Nurses are ideally placed to promote smoking cessation, whether that’s offering to refer someone to a smoking cessation service or providing nicotine replacement to inpatients. Hospitals need to be beacons of good practice.”

Unions agreed nurses had a key role in offering advice and support patients, but said they should not be expected to enforce no-smoking policies or be blamed if patients did not give up.

“Nurses should do more,” said Helen Donovan, public health adviser to the Royal College of Nursing. “But that does not mean standing at the hospital gate and going up to people and saying ‘no smoking here’. Nurses should not be policing this.”

She admitted some nurses felt “anxious” about broaching issues like smoking and weight during routine appointments. “[It is about] knowing when to have those conversations with people and when to back off,” she said.

It was important to remember that ultimately smoking was a personal choice, she added.

Dave Munday, professional officer for the Mental Health Nurses Association, said addressing poor physical health was part of providing all-round care for those with mental health problems.

However, he noted that for some people with mental health problems smoking could be the only constant in their lives.

“We have to make sure nurses get the right support to be able to handle issues like this in a sensitive way,” he said. “It may not be the right time for someone to give up, so it could be more about reducing the amount they smoke.”


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Readers' comments (21)

  • "However, he noted that for some people with mental health problems smoking could be the only constant in their lives"

    Yawn. This old chestnut again. Funnily enough people addicted to alcohol or Class A drugs may have them as the only constant in their life, but they aren't allowed to indulge in hospital. Alcohol enjoys the same legal status as tobacco so why the inconsistent approach?

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  • There must be very few smokers who are not aware of the risks associated with smoking. I have met one or two patients over my 40 years as a nurse who believe that the dangers of smoking are none existent and no amount of discussion would persuade them otherwise.

    I wonder why Prof Mike Kelly, Rebecca Sherrington, Mary Yates, Dave Mundy and Helen Donovan are not already aware of just how much effort is put into discussing stopping smoking by primary and secondary care nurses?

    Of course nurses tackle this issue with patients – it frustrates me that ‘this old chestnut’ is trotted out at regular intervals as if it has some how been forgotten in the interim.

    Perhaps the government could employ one of the big successful media companies that get us all to buy things we don’t need and can’t afford to devise a slick campaign to help smokers to stop?
    (or reduce the amount they smoke) ……. after all it must be obvious by now that what us health professionals are already doing is not enough to satisfy the ‘powers that be’.

    If had a ‘fiver’ for all the patients I have spoken to over the years about the dangers of smoking……………………………….

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  • It will never work. You can't stop patients going out 'for a breath of fresh air'. Offering nicotine patches isn't the answer either, so what's the point. It will just end up with a lot of irritable patients knocking around which makes our job even harder than it already is.

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  • I agree. It isn't up to nurses to police the no smoking policies around hospital sites.

    The reason that "this old chestnut" is being rolled out again is because not that many healthcare professionals actually discuss smoking in effective way. Quite the opposite. Nurses will refer patients to smoking cessation services, but then tend to disengage from the matter. Most don't see the point: see comment from Anonymous | 29-Nov-2013 1:47 pm as a typical example of this attitude. Smoking rates have dropped considerably in the last few decades but stats show that they have bottomed out over the last couple of years.

    It is a complex subject and there is remarkably little training given to nurses on how to tackle it. If it was just a matter of telling people that it's bad for your health, 'slick' advertising or slapping on a nicotine patch, then we would have solved it years ago. Many nurses hold a defeatist attitude about smoking, so how can they be giving best care and advice.

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  • For my money, it should be advising pts of the dangers of smoking (and very few are unaware of them), giving them info on give-up-smoking clinics, if they wish - and leaving it at that. It should be part of lifestyle advice - healthy eating, alcohol in moderation, sufficient exercise and so on.

    All drugs have side effects - some very distressing and some - long term - apt to cause or provoke other diseases; this, of course, applies also to nicotine.

    However, and I believe this is due to so-called "political correctness" we never hear about the positive side of smoking sc. calming nerves in times of stress. As for the enjoyment of smoking, are we (yes, I'm a (moderate) smoker and I'm aware of the risks) to be discouraged from enjoying something that gives us pleasure as well as relief?

    As said above, it must be a matter of personal choice and we are all entitled to make that choice knowing what is at stake. There's a very fine line between a government concerned for the well-being of its citizens and a nanny state. How many of us wish to have the latter?

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  • David Francis Seelig | 30-Nov-2013 10:42 pm

    In which case, I vote that you pay for the costs of any (and they are usually considerable) health resources that you will require for the damage you are wilfully causing to yourself. I don't want to pay for it and I don't give a sh*t about political correctness.

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  • Anonymous | 1-Dec-2013 8:40 am

    I couldn't agree more. To those who want to wax lyrical about 'personal choice and rights', just remember that with rights come responsibilities.
    Cigarette smoking is the greatest single cause of illness and premature death in the UK. A report by the Policy Exchange in 2010 estimated the total cost to society of smoking to be £13.74 billion. This includes the £2.7bn cost to the NHS but also the loss in productivity from smoking breaks (£2.9bn) and increased absenteeism (£2.5bn). Other costs include: cleaning up cigarette butts (£342 million), the cost of fires (£507m), the loss of economic output from the death of smokers (£4.1bn) and passive smokers (£713m).
    I am happy for you to continue smoking as long as you smoke no where near me or anyone I care about, and that you pay for the expensive treatment and care you will require and resources you will take from those who have not wilfully been as stupid and selfish. You have made your decision in the full knowledge of the consequences, which should not become the problem of others.

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  • Reply to anonymous (first posting) yes indeed Yawn far as I know neither smoking nor alcohol is allowed in the hospital. If a patient is able to and chooses to leave the ward no one stops them from either smoking or drinking outside. I can't see how you think smoking is given preferential treatment.

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  • Dear Posts 6 and 7: I completely agree about responsibilities being the twin of rights (not to be seen very often in the misapplication of the HRA).

    Re. costs: I accept the figures given but would be glad to know the equivalent figures for alcohol abuse, drug abuse and obesity caused by lack of exercise/unhealthy diet in order to provide perspective to your argument.

    For reference, I NEVER smoke in any enclosed space - and certainly not at home - and make every effort to spare others inhalation of my smoke. Also, I am not a heavy smoker.

    I can only say that branding smokers as selfish and stupid demonstrates utter intolerance!!

    I'm pleased that you don't give a fig about PC; please consider joining an increasing number of us who want to see PC consigned to history a.s.a.p.!!

    I tried to write above in a reasonably balanced way but I regret the one-sidedness of both your contributions.

    Another regret is that neither of you cares to use your real name; if you have the courage of your convictions, surely you can be brave enough to identify yourselves - I do; why not you?

    BTW I have been teetotal for the past 10/12 - largely mutatis mutandis for the reasons that you put forward against smoking. 15 all??

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  • David Francis Seelig | 1-Dec-2013 7:44 pm

    No problem. Same goes for any self inflicted alcohol, drug or food related problem about which there is more than adequate information available. By all means, make your informed choice about any of these, but don't expect others to accept the cost of the consequences.

    Smokers have been bleating about 'intolerance' for years, whilst killing millions with their second hand smoke. It's tired argument.

    With regard to anonymity? That's your problem, I'm not interested in your idea of what constitutes bravery.

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  • These governments know the evidence on smoking and alcohol. They also have the evidence on other substances Professor Nutt gave it to them. Successive governments are not interested in evidence! Dont be fooled either that they care about you! They also know the real dangers of red meat (cancer) and the health problems of many foods that are promoted as healthy!!! Check out the 'Japanese lung cancer Paradox'. Anyway lets just ban everything and sit at home in crash helmets!

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  • Evidence indicates that the single biggest impact on smoking rates has been brought about by the smoking bans in public establishments. Information, advice services, nicotine replacement, etc., have all had some but limited success.

    Probably best idea is to get tougher on smokers. Asking nicely and turning a blind eye to those who 'choose' to ignore the smoking ban doesn't work. It is simply no longer acceptable to have people (patients, visitors and staff) smoking within the grounds of hospitals. Make it a disciplinary matter if they are staff. It isn't the job of nurses to police it. Hire patrols to enforce the smoking ban. It will be cost effective in the end. The information and offers of help and support should remain, but it should be understood that smoking isn't 'a choice' in a public place. It is against the law. Enforce it.

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  • Even nurses find it difficult to bring up topics with people about weight and smoking if it is not a weight related or smoking related session.
    School nurses should not be reduced but increased as health education at an early age is a key element for a healthy society. Although health education at any time can still be good, trying to straighten a bent tree will most times break it. If one chose to continue smoking then let them as long as they are not feeding others their smoke.

    I noticed that two people on- I'm a Celebrity get me out of here are smoking in camp next to the others.
    I feel that just because one is outside or away from a hospital does not mean one can smoke in other peoples faces. I particularly hate it when I am waiting for the bus and someone is smoking next to me under the shelter.

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  • Unfortunately, smokers do considerable harm to themselves which costs us all, so they will always harm others with their habit.

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  • ..and let's not forget the multitude of parents that drive their children to and from school exposing them to all those exhaust fumes.

    As for smoking, ban cigarettes. Ah, the government can't do that, they get too much revenue from tobacco, and as taxpayers, we wouldn't like the increase to supplement the deficit. I agree with Anonymous | 2-Dec-2013 11:48 am, you can't avoid everything that was bad for us.

    As for disciplining staff for smoking, then it should also apply to those who drink alcohol and those who are overweight. Arrive for work, have a CO1 test, breathalizer and be weighed before you can go on duty. It's up to those who drive to prove the CO1 isn't due to that, or should that be an issue, why didn't you cycle or car-share. Don't think there would be that many on duty.

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  • Anonymous | 3-Dec-2013 0:45 am

    Hmm. Well they have made it a disciplinary issue in Glasgow as part of the zero tolerance campaign against smoking within hospital grounds. Seems to be working well with an almost 60% cut in incidence. Still a way to go, but it is working. So you can sit around being an ineffective smart alec or you can do something about it, as they have in Glasgow. Oh and the campaign came about in large part due to public demand for action.

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  • Anonymous | 3-Dec-2013 0:45 am

    "As for smoking, ban cigarettes. Ah, the government can't do that, they get too much revenue from tobacco, and as taxpayers, we wouldn't like the increase to supplement the deficit."

    I am sure that you would be quite happy with the billions saved on dealing with the health and social consequences of smoking, not to mention the revenue generated by all those people well enough to work productively and not depend on benefits.

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  • Anonymous | 3-Dec-2013 0:45 am.

    "..and let's not forget the multitude of parents that drive their children to and from school exposing them to all those exhaust fumes."

    I agree. I would like to see more done to encourage children to walk or cycle to school, and perhaps restricting the traffic outside of school gates during the dropping off and picking up times should be looked at. However, you can't ban cars without bringing the country to a complete halt. Like it or not, we need cars. We don't need cigarettes. They serve no useful purpose. The kill people. A previous comment has covered any supposed "economic" benefit argument.
    With regard to 'testing' staff for CO and alcohol levels (aside from the fact that abstaining from either for a matter of hours will register a negative reading, would be of limited use) that hasn't been suggested. But if staff are lighting up or (less likely)turning up at work intoxicated, don't you think that is something which would need to be addressed? With regard to overweight staff, there has been nowhere near enough investment into this issue within hospitals. Obesity levels have now reached epidemic proportions, but it never fails to bring out the mock outrage brigade. It is commonly known as the next serious health issue in this country.
    A non-nursing friend of mine recently recovered from a fairly serious illness. The steroids she had taken had caused some weight gain (of around a stone) which she was addressing. She was about half way to being back to her previous weight when she attended a clinic appointment. The nurse who weighed her was morbidly obese and spent some time lecturing my friend about the importance of maintaining a healthy weight. She also dispensed other recommendations. My friend came out of her appointment angry that someone who was at least 5 or 6 stones overweight had lectured her about weight. As far as my friend was concerned, she dismissed everything the nurse said to her because she had no credibility.

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  • 1. I acknowledge the common sense and rational argument to be found here and there in the posts following my previous one.

    2. I'm a "fresh air fiend" as well as a smoker; furthermore, I would welcome blowing smoke into someone's face (without prior invitation to do so) made a criminal offence sc. battery - which it may already be. I was urging that a smoking ban in enclosed spaces be imposed long before it actually was.

    3. I maintain my stance on anonymity and simply can't understand why people need to hide behind this - and, let's be honest, it IS hiding. I wonder how many posts Nursing Times would have were it to insist on names!! As for Dec 1st 10:14 pm: it's not a problem for me; it's a regret and - to an extent - a concern. Perhaps I should have used the word "openness" rather than bravery.

    I've said quite enough; should we, perhaps, call it a day and get on with our work?

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  • David Francis Seelig | 3-Dec-2013 11:41 pm

    Re: your point 3. I have no idea who you are. You may be writing under a pseudonym. As far as I'm concerned, you are anonymous and I respond to your comments, not who you are. As I said, I haven't a clue who you are and have no interest in finding out.The problem you have with anonymity remains yours.

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