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Home Quit Smoking Resources Doctors, Nurses and Smoking: Understanding Smoking Among Medical Professionals
Doctors, Nurses and Smoking: Understanding Smoking Among Medical Professionals
With their detailed knowledge of the risks of smoking, it’s not surprising that most doctors and other medical professionals usually don’t smoke. But some do, despite many having first-hand experience of its dangers. The question is: why?
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Medical professionals see the devastating effects of smoking first-hand, so many people are surprised to learn that some doctors and nurses still smoke. Doctors in particular have extensive knowledge of the ways in which smoking harms your health, but nurses have a lot of knowledge in the area too. For this reason, you wouldn’t expect many of them to continue with the habit themselves, and for the most part, you’d be right. However, some doctors and nurses continue to smoke. Understanding why is not only vital to helping more of them quit, it also gives insight into the continuing issue of smoking in our society despite widespread understanding of the risks.
The simplest question you may have is “what percentage of doctors smoke?” Physicians have the lowest smoking rate out of all medical professionals, according to research. A study published in the Journal of the American Medical Association (JAMA) found that in 2010 to 2011, 1.95% of doctors were current smokers. This is much lower than the corresponding rate in the general population, which was 16.08% at the time. It’s also lower than the overall rate among medical professionals, at 8.34%.
As a percentage, the figure may seem very low, but it represents almost 1 in 50 doctors in the US. This is still shockingly high for professionals with a detailed understanding of the health risks of smoking. Other estimates have put the figure at around 1%, but this is still a surprisingly high proportion.
The same JAMA study looked at smoking among other medical and healthcare professionals, including smoking among nurses. Among registered nurses, the smoking rate was 7.09% in 2010 to 2011. Earlier studies put the estimate at around 8.4% . For licensed practical nurses, the smoking rate was much higher, at almost 1 in 4 in 2010 to 2011.
The evidence shows that nurses are much more likely to smoke than doctors, and the smoking rate among licensed practical nurses is actually substantially higher than in the general population.
After learning about smoking among doctors and nurses, you might be wondering why people who understand all of the risks of smoking continue to do it. This question has been investigated by research with regards to nurses. The evidence shows that nurses often start smoking before undertaking their training, and do so for many of the same reasons other young women (and people in general) start smoking. Being a nurse (or a doctor) can also be very stressful, so this likely has a role to play too.
The reason they don’t quit is also the same as for the general population. Quitting smoking is very challenging, and combined with a stressful work environment this explains why their medical education doesn’t lead all doctors and nurses to quit. However, smoking rates in doctors and registered nurses are declining.
There are ethical and professional issues relating to smoking by doctors and nurses. For ethical issues, the most obvious is that it could be seen as hypocritical. Doctors and nurses smoking is seen by some people as undermining their credibility when telling patients about the dangers of smoking and why they should quit. It could also be seen as “sending the wrong message” to patients who see doctors or nurses smoking. In short, many argue that doctors and nurses should be better role models for their patients.
However, there is some disagreement on this issue. If one of the 1 to 2% of doctors who smoke does so in his or her own time and out of sight of patients, does it really undermine their ability to do their job? As long as they give sound medical advice on the dangers of smoking, does it really matter what they do in their personal life?
Regardless of your view on the ethical issues, from a practical perspective, many healthcare providers either ban smoking on their grounds or even refuse to hire smokers. This makes quitting a priority for many doctors and nurses who smoke.
Whether for ethical reasons, professional reasons or for the multitude of health benefits that come from quitting smoking, doctors and nurses should be encouraged to quit smoking. Having first-hand experience with the quitting process also enables them to give more insight and advice to patients attempting to quit smoking.
Doctors and nurses can quit smoking using the same methods as everybody else, but they have the benefit of not only understanding the importance of quitting, but also having better access to medications to help with quitting smoking. Although the smoking rate in doctors and nurses is lower than in the general population, encouraging those who do smoke to quit and including quitting aids in medical industry insurance plans could bring the smoking rate down even further.
The more doctors and nurses quit, the healthier medical professionals will be, and the more they’ll be encouraged to help their patients do the same.

Smoking NCLEX Review and Nursing Care Plans
Smoking or nicotine dependence arises when there is a strong need for nicotine and the inability to stop using it. Nicotine is a substance found in cigarettes, and it has a pleasant momentary effect on the brain that makes quitting difficult.
This makes smoking addictive. The more the patient smokes, the more addictive it gets. When the patient tries to stop, unpleasant mental and physical changes may be experienced, which are considered smoking withdrawal symptoms.
Stopping can improve the patient’s health regardless of how long the patient has been smoking. However, it is not easy to suddenly break the smoking dependence, but there are many effective treatments available to help the patient.
Several countries have already raised cigarette taxes significantly and regularly undertake anti-smoking initiatives. In some nations, smoking is prohibited in shops and other public areas.
For some patients, even a tiny amount of tobacco can develop into smoking dependence.
The following are signs and symptoms of smoking dependence:
Nicotine is a substance in cigarettes that is addictive. Within seconds of taking a cigarette, nicotine reaches the brain and will stimulate the release of brain chemicals known as neurotransmitters, which are responsible for controlling mood and behavior.
Dopamine is one of these neurotransmitters, it is released in the brain’s reward center and promotes sensations of pleasure and an enhanced mood. When a person stops smoking for a few hours, the levels of these hormones fall, causing anxiety and possibly anger. This may necessitate the intake of additional nicotine.
The following are some examples of scenarios that trigger smoking and nicotine dependence:
Anyone who smokes or uses other forms of cigarettes is at risk of becoming addicted. The following are some of the factors that influence smoking dependence:
Psychological Assessment. To determine the patient’s level of dependency on nicotine, the healthcare provider may ask for questions or may ask to fill out a questionnaire.
Then the healthcare provider will be able to identify the best treatment plan based on the level of dependency. The more cigarettes smoked every day, and the earlier started smoking after waking up, the more dependent the patient gets.
Cigarette smoking contains over 60 recognized carcinogens, as well as thousands of additional hazardous compounds. Even “all-natural” or herbal cigarettes contain carcinogens.
It is already known that smokers are far more likely than non-smokers to acquire and die from certain diseases. However, the patient may be unaware of the wide range of health issues that smoking dependence causes:
Avoid starting to smoke. The most excellent approach to avoid smoking dependence is to avoid smoking in the first place.
Become a role model. The most excellent method to prevent children from smoking is to become role models and refrain from smoking. According to research, children whose parents do not smoke or who have successfully quit smoking are far less likely to start smoking.
Most smokers have tried to quit at least once. However, quitting smoking on the first attempt is unusual, especially if there is no help. It is far more probable that the patient will be able to quit smoking if medications and counseling are utilized, both of which have been proven to be helpful, especially when used together.
Nursing Diagnosis: Impaired Gas Exchange related to ventilation-perfusion imbalance secondary to smoking and nicotine dependence, as evidenced by difficulty in breathing, changes in mentation, hypoxemia, and cyanosis
Nursing Diagnosis: Ineffective Airway Clearance related to increased mucus production secondary to smoking and nicotine dependence, as evidenced by remarkable changes in the respiratory rate or depth, abnormal breath sounds upon auscultation, difficulty in breathing, and ineffective cough.
Desired Outcome: The patient will be able to demonstrate a patent airway with clear breath sounds during chest auscultation, silent respirations, and fluid secretions easily expectorated.
Nursing Diagnosis: Ineffective Breathing Pattern related to mucus and airway irritants secondary to smoking and nicotine dependence, as evidenced by abnormal rate, rhythm, depth in breathing, nasal flaring, orthopnea, pursed-lip breathing, and the use of accessory muscles when breathing.
Nursing Diagnosis: Activity Intolerance related to hypoxemia and ineffective breathing patterns secondary to smoking and nicotine dependence, as evidenced by an increased amount of supplemental oxygen required, dyspnea, Signs of pain such as frequent grimace, reluctancy to initiate activities, and inability to perform activities of daily living.
Nursing Diagnosis: Deficient Knowledge related to unawareness of information or resources due to a lack of exposure secondary to smoking and nicotine dependence, as evidenced by statements of concern, request for additional information, inability to follow instructions, agitated and apathetic behavior.
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care . St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes . St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care . St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination . St. Louis, MO: Elsevier. Buy on Amazon
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Assess the patient’s breathing rate, depth, and ease of breathing. Determine if the patient is using the accessory muscles, pursed-lip breathing, changes in skin or mucous membrane color, pallor, and cyanosis.
Increased work of breathing and cyanosis may indicate increased oxygen consumption and energy expenditures, as well as a reduction in respiratory reserve as a result of pain or as an initial compensatory mechanism to accommodate for the loss of lung tissue.
Monitor and document the patient’s arterial blood gas and pulse oximetry. measurements, take note of the patient’s hemoglobin levels as well.
Partial pressure of oxygen decreases or increases, indicating the need for ventilatory support. Significant blood loss can reduce Pao2 by lowering oxygen-carrying capacity.
Assess the patient for signs of restlessness and changes in the level of consciousness or mentation.
This may indicate increased hypoxia.
Evaluate the patient’s reaction to the activity. Rest periods should be encouraged, and activities should be limited to the patient’s tolerance.  
Increased oxygen consumption demand might cause increased dyspnea and changes in vital signs with activity; however, early mobilization is preferred to avoid pulmonary problems and to achieve and maintain respiratory and circulatory efficiency. Respiratory impairment can be avoided with adequate rest and activity.
Encourage the patient to perform deep breathing and pursed-lip breathing techniques as needed.
Breathing exercises will help the patient to relax, and pursed-lip breathing reduces shortness of breath and is a simple and effective strategy to slow down the breathing rate, making each breath more effective.
Administer supplemental oxygen to the patient using a nasal cannula, a partial rebreathing mask, or a high-humidity face mask, if needed.
Increases the amount of oxygen available, especially when ventilation is decreased due to anesthetics, depression, or pain.
Assess the patient’s chest by auscultation and determine the character of breath sounds and the presence of secretions.
Retained secretions and/or airway blockage are indicated by noisy respirations, rhonchi, and wheezes. 
Demonstrate to the patient the proper deep breathing and coughing techniques while in an upright or sitting position.
Maximum lung expansion is favored in an upright position. 
Encourage the patient to maintain an oral fluid intake of at least 2500 mL/day, within cardiac tolerance.
Hydration helps to keep secretions loose and improves expectoration. Apply a humidified oxygen nebulizer and/or an ultrasonic nebulizer to help the patient breathe easier and Administer additional IV fluids as needed.
Maximum hydration aids expectoration by loosening or liquefying secretions. To maintain hydration, patients with impaired oral intake require additional IV supplementation.
Assess the patient for pain or discomfort and administer medication before doing breathing exercises on a regular basis.
To avoid respiratory insufficiency, this method encourages the patient to walk, cough more effectively, and breathe deeply without pain.
Determine the patient’s volume and characteristics of sputum or secretions aspirated. Investigate for any changes indicated 
Sputum that is thick or tenacious, bloody, or purulent indicates the onset of secondary problems such as dehydration , pulmonary edema , local bleeding, or infection that must be addressed.
Administer bronchodilators , expectorants, and/or analgesics to the patient as needed.  
This Improves airflow by relieving bronchospasm. Expectorants help to remove mucus by increasing mucus production and liquefying, and reducing the viscosity of secretions. Chest pain relief encourages cooperation with breathing exercises and improves the efficiency of respiratory treatments.
Assess the patient’s respiration at least every four hours, check and record the respiratory rate and depth.  
Adults breathe at a pace of 10 to 20 breaths per minute on average. When there is a change in breathing patterns, it is critical to act quickly to recognize early indicators of respiratory system problems.
Determine the patient’s arterial blood gas levels in accordance with facility policy.
This device keeps track of the patient’s oxygenation and ventilation levels.
Ask the patient if there is a feeling of “out of breath” and document any sign of dyspnea .
Anxiety can sometimes cause dyspnea. Keep an eye on the patient for signs of “air hunger,” an indication that the cause of shortness of breath is physical.
Position the patient with optimal body alignment for maximum breathing pattern.
Sitting or upright position allows for the most lung excursion and chest expansion. 
Encourage the patient to breathe diaphragmatically.
This approach relaxes muscles while also increasing the oxygen levels of the patient.
Encourage the patient to take regular rest periods and educate the patient to pace activities.
Shortness of breath might be exacerbated by increased activity. Ensure that the patient gets plenty of rest in between heavy activity.
Advice the patient to always keep the airway open.
Encouraging the patient to mobilize their own secretions through effective coughing facilitates proper clearance of secretions.
Encourage the patient to take small frequent feedings.
Small frequent feedings keep the diaphragm from getting too crowded.
Assist the patient with activities of daily living, as needed.
This method will help the patient to save energy and prevent overwork and exhaustion.
Determine the source of the patient’s activity intolerance.   
Planning and treatments will be guided by the reason why the patient is unable to participate in activities. Whether the cause is physical, psychological, or motivational, the treatment plan will be different.
Assess the patient’s capacity to participate in activities and the tolerance for the activity.
This data serves as a starting point for care planning. 
Assess the patient’s suitability for daily scheduled activities.  
The patient’s state may fluctuate from day to day. Frequent assessments are essential for getting the patient up and moving as soon as possible
Teach the patient how to perform some range of motion (ROM) exercises. 
Range of motion exercises improve circulation and help prevent contractures. 
Encourage the patient to engage in active range of motion exercises. 
Muscle strength, flexibility, and joint and tendon alignment are all improved with regular exercise. Repeated workouts help build tolerance, which is necessary for performing activities of daily living.
Explain the importance of continuing activities for both the patient and the family/caregiver.
Regular exercise helps to maintain muscle strength and a conditioned state. 
Educate the patient and the family about the following ways how to conserve energy: To avoid rushing, plan ahead.To carry out activities, take a seat.For sponges and brushes, use extension handles.Instead of pull, push.Before engaging in more significant activities such as eating and showering, take a break.
When these approaches are used correctly, they limit oxygen use and prevent the patient from becoming fatigued rapidly.  
Assess the patient’s capacity to learn the required healthcare services.
Cognitive deficits must be identified before a proper teaching strategy can be devised.
Examine the patient’s drive and readiness to cooperate in the smoking cessation program.
Learning takes a lot of effort. Patients must see a reason or need to learn.
Determine the importance of the patient’s learning needs in the context of the overall care plan. 
This is to determine what has to be stated, particularly if the patient has prior knowledge of the situation. Knowing what to prioritize will assist the nurse to avoid valuable time.
Provide the patient with a calm and relaxing environment that is free from smoking triggers.
The patient can concentrate and focus more fully in a tranquil setting away from any distractions.
Include the patient in the development of the quit-smoking plan, beginning with the establishment of learning objectives and goals at the start of the session.
Setting goals allows the patient to anticipate what will be discussed and what they can expect throughout t
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