The Ethics of No-Smokers Hiring Policies: Examining the Assumptions

Army nurses light up in 1947. Photo courtesy of Everett Collection / Newscom.

Army nurses light up in 1947. Photo courtesy of Everett Collection / Newscom.

By Jacob Molyneux, senior editor

The Ethical Issues column in the June issue is called “The Ethics of Denying Smokers Employment in Health Care” (free until July 16). As in his previous columns, nurse–ethicist Doug Olsen models the thinking process of an ethicist, illuminating the fundamentals of ethical reasoning even as he tackles a specific ethical question.

Most positions we take on tough questions depend on a number of assumptions, both conscious and otherwise. In this article, Olsen does a great job identifying and then testing the assumptions that underlie such no-smokers hiring policies. Here are the main ones, as Olsen describes them:

  • Personal responsibility applies to smoking—that is, the individual is responsible for the smoking behavior.
  • There is a positive cost–benefit ratio in denying smokers employment.
  • Patient care is improved by not having smokers on staff.
  • Smokers can be reliably identified.
  • Smokers are not being singled out—people with other equally unhealthy behaviors meeting the criteria on this list are treated in the same way.
  • Refusing to employ smokers is good publicity for the hospital and therefore improves the hospital’s ability to fulfill its mission.

After considering the defensibility of each of these assumptions in turn, Olsen makes a distinction between what he calls “restrictive” and “caring” policies, and considers the potential effects of each on public perception when it comes to a hospital.

Does the author come down on either side of the debate? He leaves the answer to readers. Having read this article, you will be better equipped to rationally consider all sides of this question—and of other ethical questions as they arise, as they inevitably will. A podcast of a conversation with author Doug Olsen can be found on our “Behind the Article” podcasts page.

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2016-11-21T13:04:29+00:00 June 16th, 2014|career, Ethics, nursing perspective|10 Comments

About the Author:

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


  1. Elvia Szymanski March 14, 2015 at 7:55 pm

    Nurses should not smoke during their work shift. What they do outside their working hours is their personal responsibility

  2. Mik October 19, 2014 at 6:35 pm

    I personally smoke because I have to put up with a great deal of intolerant, nevrotic nurses who, everyday put a burden on me with their mental issues and intolerant attitudes. I smoke to take on all their distressful behaviours and keep on woking calmly while they moan at this or that, but I, as well as patients, would greatly benefit if those nurses were not employed by the hospital.

  3. Brent Thompson PhD RN June 18, 2014 at 2:53 pm

    I started as a nurse when a high percentage of nurses smoked, as did many adults. Patients accepted it. Today, a nurse who smokes smells bad and will reduce the coveted patient satisfaction scores. It is not an issue of health as noted by the high number of obese nurses I see daily.

  4. Sandy June 16, 2014 at 11:06 pm

    Smoking & nursing don’t mix. No breaks for lunch but Susie dragon gets to puff whenever while you’re watching her patients 12 times a shift?! Oh and the smell. How about teaching a COPD patient about refraining from smoking while smelling like an ash tray?! Kinda not the example I feel comfortable sharing the floor with. However…this is my opinion and feel that we have to set an example whether it be not smoking, to lose weight/stay fit or not to get addicted to prescription drugs.

  5. Margaret June 16, 2014 at 8:20 pm

    Obesity will be next (and you’d be surprised at the medical definition of obesity). Healthcare costs associated with obesity are higher even than those of smokers. Be careful what you wish for.

    *Personal responsibility applies to overeating—that is, the individual is responsible for the eating behavior.
    *There is a positive cost–benefit ratio in denying the obese employment.
    *Patient care is improved by not having overweight people on staff.
    *Overweight people can be reliably identified.
    *The obese are not being singled out—people with other equally unhealthy behaviors meeting the criteria on this list are treated in the same way.
    *Refusing to employ the obese is good publicity for the hospital and therefore improves the hospital’s ability to fulfill its mission.

  6. wallace June 16, 2014 at 6:23 pm

    The biggest question is where does this stop. Sure cigarette are unhealthy but how many nurses are overweight? How many Americans are overweight? To punish one form of people for a legal activity is completely big brother government. I don’t kid myself I know we have this style of government, but it is a very slippery slope and why do we need to punish people for the legal choices?

  7. Laurie June 16, 2014 at 11:34 am

    At this late date and with the shortage of nursing in general, there are plenty of us that are great employees/ professionals out here. It’s not like we abuse alcohol (most of us) yet despite our outstanding bedside manner to patients, we are discriminated against. Smoking cigarettes are not illegal. I am 39, and have been smoking 25 years. Instead of just not hiring us, and leaving the shortage of great professionals out in the cold, give us the chance. plenty of facilities out there still let us including the VA. Why not make us smoke in our cars or limit the smoking to when that person is off the clock and off campus?

  8. M. E. Walsh, RN,BSN, Graduate Student June 16, 2014 at 11:03 am

    As with any other addiction, the smoker has a primary concern daily. It can be: ‘when do I have my next smoke?’ I am not saying smokers are not good nurses; I am citing their primary concern for the next 12 hours. If you work with them, often they are ‘difficult’ to find; missing from the floor; no one has any idea ‘where they are’; and when they surface to continue their assignment, it is very obvious by their aroma exactly where they were. They put a burden on their co-workers.

  9. Vicki Donaldson June 16, 2014 at 10:36 am

    Let’s be restrictive to the ones who come to work still buzzed from the night before or the nurse who has intimate behavior with other staff members in particular MD’s, or the ones who display horizontal violence. If the hospital is gonna get rid of them all, there wouldn’t be anyone left to care for the patients.

  10. judy a gussett June 16, 2014 at 10:09 am

    I agree that smokers should not be hired in a health care providing facility. That being said neither should we be allowed to eat unhealthy diets, nor indulge in other habits that are unhealthy. If we exude health it is easier to teach its principles to our patients.

Comments are moderated before approval, but always welcome.