Examining the "Culture of Smoking" Among Nurses and Its Impact on Cessation: Michaela Nuttal, MS

The difficulties encountered by nurses who smoke when faced with smoking cessation efforts, as well as providing this support to patients, was the subject of a poster presented at the European Respiratory Society Congress 2025, “Nurses’ Experiences of Smoking and the Impact on Themselves and Their Patients.” With immediate previous publication in Practice Nursing, Michaela Nuttal, MS, who was part of the study and conducted the nurse interviews, explains the importance of investigating this health behavior specifically among nurses and how a “culture of smoking,” which remains to this day only serves to complicate these efforts.

Nuttal is a cardiovascular nurse specialist, director for smart health solutions, and an associate in nursing for C3 Collaborating for Health, a London-based nonprofit focused on eliminating and preventing death from chronic noncommunicable diseases through behavioral-based changes: stopping smoking, improving eating and drinking habits, and increasing physical activity.

This transcript was lightly edited for clarity; captions were auto-generated.

Transcript

Why is it important to explore smoking behaviors specifically among nurses?

In practical terms, we work quite closely [and] we're a partner with the Burdett Trust for Nursing, and they often put out calls for bids, which we respond to. There was a bid that was out there, there was funding out there that we could bid for around respiratory, and so we used our knowledge from a previous much bigger piece of work, a 3-year project called WIN [Healthy Weight Initiative for Nurses] also funded by the Burdett Trust for Nursing, which looked at weight in nursing. It was very much what we learned through doing—I led this project when I first started working with C3—what we learned with doing this initiative, this project WIN was, could we take some of what we thought and what we learned and apply it to smoking?

That was really looking at what is the size of the issue? Just how many nurses do smoke, that was one bit, but also really start to look at some of the reasons why nurses smoke, and the challenges that they're facing. Although we often put our work, our projects in for nursing, we also apply a lot of what we do to the wider health care community, as it were. We also wanted to work out for nurses, what was it like to be a nurse and smoke? What did it feel like? What might have helped you, and also what might help you in the future to be able to want to quit smoking? That was really our motivator, and it fits perfectly well with C3, because we're all about prevention of noncommunicable diseases. It fits beautifully for us.

I used different sort of channels to get to nurses, and then we did a focus group, and we did quite a few nurse interviews, and that really allowed this deeper dive for us just to be able to allow nurses the time to be able to talk about their health. I think it gave me the same feelings I got when I did WIN and interviews with nurses, in that, no one really asks nurses about their own health. No one really takes time to spend time with nurses saying, is this an issue for you, how could we make it better, and what could we do? Nurses spend pretty much all of their time looking after other people, so I think it was really invaluable, not just in us finding out information, but also the nurses being involved in it as well.

How do certain perceived benefits of smoking, such as socializing or managing stress, complicate smoking cessation efforts among nurses?

I'm an ex-smoker. I was smoking in the late 80s, early 90s, and there was a real smoking culture. We used to be able to smoke in the staff rooms on the wards, but there was still a smoking culture there. That culture is still there, but I think it's even more complex now in that you go off site, there's a little group of you together, there's a huddling factor that comes into it, and that was seen as a real benefit of being able to get breaks, because your smoking break, probably it's okay to say, "I'm going for a quick smoke," in a time when no one's going for breaks because the shift is too busy or the work is too busy.

It was also about there's something where they get to speak to people they wouldn't normally speak to within their roles. Whether that was managers, somebody else, so it was seen as a really good opportunity for that sort of, I think it's a very leveling place when everyone's outside smoking or vaping, it almost doesn't matter what your role is, so I think this reinforces the want to smoke because of these perceived benefits. We know that then those perceived benefits then are going to make it harder for them to stop smoking and, therefore, potentially harder for them to have positive conversations with patients about stopping smoking. It's this really weird thing where this culture is there, and it does form a big part of nurses' routines, that getting together.

I know when I stopped smoking, I really felt a sense of loss that everyone I was with before, all my sort of the fun group, as it were, I suddenly wasn't part of what I perceived to be the fun group anymore, and I didn't get as many breaks, so I think there's a whole cycle that sits within there.