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Time for Healthcare Industry to Examine Tobacco Use Policy

John Commins, for HealthLeaders Media, November 8, 2010

Some healthcare organizations are taking the antismoking crusade one big step further. The Massachusetts Hospital Association declared this month that—effective Jan. 1—it would no longer hire tobacco users. MHA President/CEO Lynn Nicholas says the trade group for more than 100 hospitals in the Bay State decided to go public with the new ban—which takes effect Jan. 1—to raise awareness about the No. 1 cause of preventable death in the United States.

Nicholas unapologetically concedes that the ban on hiring smokers is "all stick" and no carrot because sticks—in the form of bans, fines, and high taxes on cigarettes—more effectively discourage smoking. "I love carrots but when carrots are shown not to work on an important health issue like this I'm not above using a stick," she says.

Nicholas' argument is understandable. However, where do we draw the line between workplace and personal life? Is this nanny state overreach?  

Most smokers want to quit. They know they are in the clutches of an expensive, disgusting addiction that's sucking the life out of them one puff at a time. These are good people who don’t need to be browbeaten or threatened, especially because nicotine addiction is particularly tenacious.

In marked contrast to the MHA, Gundersen Lutheran Health System is more carrot than stick. Jeffrey E. Thompson, MD, CEO at the La Crosse, WI-based health system, says smokers are still hired there, but they're encouraged and incentivized early on to kick the habit. "We believe it is the employees' responsibility to say they want to get better, and it is our responsibility to try to help them get better, and between the two of us it works pretty well," Thompson says.

Employers have legitimate concerns about the costly effects of tobacco use, Thompson says, "but the question is whether it’s a justifiable action to tell people they can't do something when they are not working."

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