Ending the Tobacco Problem - Resources for Local Action
Institute of Medicine

Call To Action


Smoke-Free Health Care Facilities

Even though health care facilities seem an obvious place to ban smoking, smoke-free policies in health care settings are not always well-regulated. While smoking in hospitals increasingly has become rare, smoking in psychiatric hospitals and psychiatric wards still is common. By curtailing smoking in these facilities, it will not only lead to better health for the employees who work there, but also provide a better healing environment for the patients.

Similarly, there are no national guidelines for smoking policies in nursing homes and few states have comprehensive bans for these facilities.

In 1993, the Joint Commission on the Accreditation of Health Care Organizations (JCAHO) required hospitals to ban smoking indoors but did not require restrictions on smoking in any other parts of the campus. By 1994, more than 96 percent of hospitals were smoke-free, and 40 percent had tighter restrictions than were required. But more work remains to be done before hospitals will be entirely smoke-free.   

Nursing homes in most states can create their own smoking policies. As of 2003, 64 percent of all nursing homes had policies that did not allow smoking inside, and the remaining 36 percent allowed smoking only in certain areas [1]. While there was some concern that banning smoking in psychiatric wards would aggravate and confound psychiatric symptoms, a study by Cedric Smith and colleagues found that the smoking ban caused anxiety and nicotine withdrawal symptoms in the first 1-3 days of a person being admitted to the psychiatric ward, but that there were no long term effects [2]. 

Research has shown that smoking bans reduce both patient and employee smoking levels [3]. As a result, many hospitals have taken matters into their own hands and banned smoking throughout their campuses.


An Example of Success: Northwest Hospital and Medical Center in Seattle

One successful example of creating a smoke-free campus is Northwest Hospital and Medical Center in Seattle, WA. In 2006, this hospital became the second in Seattle to ban smoking completely.

In the few years before 2006, one of the oncology physicians at Northwest Hospital began urging the hospital’s Cancer Committee to promote a campus-wide smoking ban. At this time, JCAHO already required hospital buildings to be smoke-free, but the Cancer Committee wanted to expand the indoor smoking ban into an entirely smoke-free campus. Members of the Cancer Committee began speaking with other hospital groups, such as the Executive Committee; the Environmental Committee; and representatives from the hospital administration, the medical staff and the nursing staff, to gauge reaction. The response was overwhelmingly positive in favor of a campus-wide smoking ban.  The Director of Nursing, the Cancer Committee, and the Environmental Committee, which represented campus Security, worked together to write a proposal. After reviewing the suggestion, the hospital’s Board of Directors voted to pass the ban.

Imposing the ban required some effort. Signs were posted in areas outside that had previously been designated smoking areas in order to make employees and visitors aware of the upcoming changes in the smoking policy. Hospital employees were asked to inform visitors of the smoke-free campus policy. The hospital administration also took steps to prevent employees from smoking; employees caught smoking on campus were  disciplined to keep any employees from repeatedly breaking the rules.

In addition, beginning in January 2005, all patients who smoked were offered smoking alternatives, such as a nicotine patch or gum, when they checked into the hospital. This course of action served as an alternative to smoking in the designated smoking areas. After the ban went into effect on January 1, 2006, patients checking in were informed of the new campus-wide smoke-free policy and were provided with smoking alternatives. Furthermore, all hospital employees were offered help to quit smoking, including smoking cessation classes, which were covered by the hospital employee health insurance plans. 

[1] Bergman, J. (2003).  Smoking policies in Long-Term Care and Residential Facilities Serving Older Persons.
[2] Smith, C.M., Pristach, C.A., & Cartagena, M. (1999). Obligatory cessation of smoking by psychiatric inpatients. Psychiatric Service 50(1): 91-94.
[3] Fee, E., and Brown, T.M., (2004). Hospital smoking bans and their impact. American Journal of Public Health 94(2).


Davidow, J. (2005, October 14). Northwest Hospital’s Smoking Ban Just What the Doc Ordered. Seattle P-I. Retrieved March 10, 2009 from http://seattlepi.nwsource.com/health/244581_nosmoke14.html.  Retrieved June 6, 2004 from 

Folks, Judith. (2009, March 9). Telephone interview on Performance Improvement at Northwest Hospital.