Nurses need more smoking cessation education.

Nurses wanting to stop smoking should be supported; they should be funded to attend smoking cessation training; and a nurses' smoke free advocacy group should be formed.

These are some of the recommendations in the report Smoking and Nurses in New Zealand--ASH-KAN Aotearoa: Assessment of smoking history, knowledge and attitudes of nursing in New Zealand. Published by ASH (Action on Smoking and Health) New Zealand, it was co-authored by a number of staff from the University of Auckland, ASH, Auckland University of Technology (AUT) and NZNO. The report was launched at the NZNO primary hearth care nurses' conference in Auckland fast month.

The report draws on a survey, sponsored by ASH, posted to a random sample of 1000 nurses, with responses received from 371 (37 percent). It also uses data from the 2006 New Zealand census on the prevalence of smoking among nurses. Nurses must provide evidence-based advice and treatment for smokers, and support smoke-free environments for non-smokers, the report argues. It also states that nurses' knowledge of effective smoking cessation treatments could be improved. "Ideally, all nurses should receive basic training to address the gaps in knowledge. Training needs to include information about work with priority populations--Maori, Pacific Island peoples, pregnant women and people who use mental health and addiction services."

Data from the 2006 census show that smoking among nurses has declined from 18 percent in 1996 to 14 percent in 2006. Males (19 percent) smoke more than females (13 percent). However, smoking rates among mental

health nurses (29 percent) remain higher than the general population at 21 percent. Twenty-two percent of nurses working in aged-care smoke. Smoking rates are below 15 percent for all other nurse specialties. District health boards are working towards completely smoke-free mental health environments by 2010. The report notes that nurses who smoke are more likely to underestimate the health consequences of smoking and therefore are less likely to provide clear smoking cessation advice to patients.

Ninety percent of survey respondents felt it was part of their responsibility to advise clients to stop smoking, although 21 percent said they did not have time to do this. Over half had not received training for effective evidence-based smoking cessation interventions, and three quarters were interested in learning more about how to help people stop smoking. Gaps in knowledge of effective smoking treatments and a wide misunderstanding that nicotine caused cancer and heart disease were identified. Most respondents (82 percent) agreed that nurses who smoked set a bad example to their patients, with 72 percent stating that patients were less likely to take smoking cessation advice from a nurse who smoked.

Forty-five percent of the respondents were aware of the New Zealand Smoking Cessation Guidelines (available from www.moh.govt.nz), although only 25 percent had ever read them. While most nurses said they supported their workplace smoke-free policy, 19 percent of those who had to enforce it said they did not have support to do so. Speaking in support of the formation of a nurse advocacy group, AUT nurse researcher and one of the authors of the report, Grace Wong, said such a group would provide Leadership and support for the large number of nurses currently engaged in tobacco control work, as well as support nurses who wished to quit. "With such a group, we can bring nurses together, help one another quit and integrate smoking cessation into our work," she said. "We need to advocate for more smoking cessation education for nurses and support national tobacco control initiatives Like banning retail displays of tobacco products in dairies, supermarkets and service stations."

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Smoking and Nurses in New Zealand is available on the website www.ash.org.nz. Further coverage of the PHC nurses' conference is on p12-16.