Smokers Need Not Apply

By Peggy McDaniel, BSN, RN

"Smoke break"/by sylvar, via Flickr

Are you a smoker? If so, and you live in Chattanooga, TN, don’t even bother to apply for a job at Memorial Hospital, where being a smoker automatically disqualifies you. To ensure that job applicants are telling the truth, the hospital will subject them to drug tests—for nicotine! This new rule does not apply to current employees, but it does raise some interesting questions. The article notes that such requirements for hire could be a slippery slope on the way to other forms of discrimination. 

As unpopular as this may be, as a fellow health care worker I can see a lot of positives to such a trend. In a previous blog post I discussed nurses as role models for our patients. My focus was on obesity,  but I also mentioned smoking.  

Another recent article, this one in the UK’s Nursing Times, says nursing students in Europe should be encouraged to stop smoking. The article discusses an Italian study reporting that nursing students are twice as likely to be smokers than are members of the general public. Maybe this would be a good policy to promote in the US? The article raises some of the same points I had raised in my earlier post about role modeling and the ways our actions or choices may influence our effectiveness as educators.

In addition to the health benefits in being a nonsmoker, there are also huge cost savings. As with obesity, smoking affects the overall cost of our health care system. The Tennessee health department told the press that an employee who smokes costs the hospital $2500–$4000 more in health care costs a year on average; according to another recent article, “smokers cost the country $96 billion a year in direct health care costs.” (By way of perspective, the article also points out that over time there is actually a societal cost benefit to smoking, since people who smoke die earlier. . . .) 

With the current focus on health care and insurance reform, Memorial’s new hiring policy may become more common around the country. What do you think? Is this good policy or outright discrimination?

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Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.


  1. Heather Rocha January 22, 2014 at 12:12 pm

    Screening for nicotine use does not mean you’re a smoker. Many people quit smoking and use nicotine patches, nicotine gum, and vape (which may or may not contain nicotine). Nicotine is addictive, but not harmful in and of itself. It is the tobacco being utilized along with many other poisonous additives as a vehicle to deliver the nicotine that is the health hazard, not the nicotine. Medical insurance companies do not recognize vaping, or nicotine gum and patches as tobacco use, so why would a hospital disqualify applicants for testing positive for it? It really is the same as disqualifying applicants for testing positive for caffeine. Where do we draw the line? And why weren’t these concerns addressed before such an absurd policy was put into effect? Health care professionals should be aware of the various methods of smoking cessation, and most of them include nicotine in one form or another. This is absolutely ridiculous.

  2. Josh May 4, 2010 at 10:29 pm

    It’s plain discrimination. Tobacco is legal. Until it is illegal, I will state that it is as prejudice as baring people from employment based on their ethnicity, or country of origin etc.
    “Studies show this ethnicity to be more prone to certain health risks – can’t hire them, cost too much in health insurance”
    “Oooo, that country has terrible dentistry, and no fluoride in the water system. All their teeth are terrible! Gosh, this legally immigrated citizen would cost us in fillings, dentures, crowns, the works! Nope, can’t hire them.”

    Seriously guys. Yes I’m a smoker. Do you know why I’m a smoker? Because of all those trying to stomp out another personal freedom. It appeals to me because you’re all so ridiculous, and every time one of you tries to tell me off for it, I shove it back in your face.
    Yes, you put smokers outside – fine, now non-smokers don’t breath the smoke. It’s even better for us – healthy air in between smokes is great for us.

    Now for another cold shot of logic: I smoke around a pack every two weeks. Have consistently for a few years. Yeah it’s bad for me. But I also work out, eat healthy, go for physicals etc. I’m as healthy as your regular beansprout. Now if you’re smoking a pack a day – whoaho… you’re going to die. Soon. Unless you’re one of those lucky freaks I occasionally meet that are in their 80’s and ticking away like busy little chimneys. That’s another story though.
    I would like to compare this with obesity. What’s the fastest more common way to get obese? Lack of exercise, and eating like crap, ALL THE TIME. Now if you occasionally eat a big mac, or slack off going to the gym once or twice a week, you’re not going to plump up and die of the diabetes. Just like I’m not going to develop emphysema from the smoking once or twice every couple of days.

    Let’s have a little moderation in life people. Abuse is what causes all these stupid laws to get put in place…and opps, there goes another personal freedom.

    This is pathetic.

    This has inspired me to start telling people off for not smoking, “…get rid of that intact mucus lining – it’s ruining your chance at freedom.”

  3. Corey Parker February 3, 2010 at 8:12 pm

    If an employer has the right to discriminate for off-work behaviour that causes extra costs, such as smoking, what about softball players. Spring and summer softball clearly causes the greatest number of injuries of any sport. Injuries result in absenteeism. Do we want a bland society?

  4. Mary January 27, 2010 at 9:04 pm

    This is a tough one. No healthcare workers should not smoke but they are human and it is legal. When I worked at a hospital where I worked in Florida we had a discharge planner who was severely obese. Her nursing school attempted to disqualify her due to her size but it was deemed illegal, it seems this would be illegal also. I am wondering if the physicians are subjected to these same rules.

  5. Peggy McDaniel January 26, 2010 at 1:36 pm

    What else do you see coming as far as such screening? I find this really interesting and value your comments.

  6. Sean January 24, 2010 at 3:39 pm

    The Cleveland Clinic has been doing this for a couple years now.

  7. LoriLipar January 21, 2010 at 8:55 pm

    Unbelievable. Do you really want employers telling you what to do on your own time? Read 1984. Please.

  8. Angie January 20, 2010 at 8:58 pm

    Not allowing nurses to smoke on the hospital campus/in uniform, or leave the floor for smoke breaks is one thing (probably a good idea), but “drug testing” for nicotine? Since when is smoking illegal? There are still casual smokers out there, and if a nurse has a smoke when she’s off shift she shouldn’t fear for her job.

  9. Steve January 20, 2010 at 6:07 pm

    My heart says this makes perfect sense,we all know that smoking is awful for us. My head says this is opening the door to all kinds of dicrimination law suits.When do we stop hirng overweight people, people who drink, etc.

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