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Regardless of your profession, if you have applied for a job in the last, say, two decades, then you may have taken a pre-employment drug test. Increasingly, however, healthcare employers are looking to screen out not only users of street drugs, alcohol and prescription medications, but also users of tobacco.
While such policies have drawn fire from some, the consensus among healthcare organizations seems clear: It's necessary for all providers to take the lead in promoting health in their communities.
How It Works
In 2007, Florida Hospital Waterman, located in Tavares, became one of the first major employers in its region to implement a tobacco-free campus. Effective January 1 of 2011, the hospital also implemented a hiring policy that prohibits tobacco use by all new employees.
Under the new policy, applicants being considered for employment will be tested for nicotine use as part of their regular pre-employment drug screening, according to Madge Springer, human resources director.
"First of all, we make it clear from the beginning of the application process that we have a tobacco-free hiring policy," she explained. "And if they let us know they do smoke or use nicotine, we let them know they are welcome to apply again after 60 days."
If the applicant is unable to pass the nicotine screening after 60 days, then they are ineligible to apply for employment for another 6 months.
 Similarly, ProMedica in Toledo, Ohio, went tobacco-free as a health system in 2008, according to Laura Ritzler, director of wellness for ProMedica. And it, too, began 2011 with the introduction of a tobacco-free hiring policy.
ProMedica's new job application asks candidates about their tobacco use. If they declare they do not use tobacco but their post-offer screening is positive, they will not be hired.
Applicants who declare tobacco use and who then quit using tobacco may reapply for a position after 90 days.
Both providers' policies apply only to new hires; i.e., current employees were grandfathered in and not required to quit, although smoking cessation assistance is available to employees at both organizations.
The Next Step
For many healthcare organizations, tobacco-free hiring policies are a natural expression of their larger mission to improve the health of the communities they serve.
"If you can imagine a nurse who is a smoker going in to provide information on smoking cessation to a patient who's just had a heart attack, and the nurse herself reeks of smoke, that's a hard sell, to be sure," Ritzler said. "So what we are saying through this type of policy is that we really need our employees to be role models - to be models of healthy living."
Faye Rose, pastoral care director at Florida Hospital Waterman, echoed Ritzler's comments.
"There is a growing passion for getting our employers healthy and helping to get the community healthy," she said. "And we are a healthcare organization, so . it's almost going beyond what we 'should' do to what we are compelled to do; it's what we are at our very core."
Lynn Nicholas is president and CEO of the Massachusetts Hospital Association (MHA), which was the first private employer in its state to implement a tobacco-free hiring policy. She agreed it's important for healthcare organizations to project an image of being good stewards of public health. But tobacco-free hiring also reflects the increasing emphasis on preventive health that's driving healthcare practice, policy and reimbursement in the U.S.
"In Massachusetts, because we have been so successful in getting 98 percent of our citizens covered with health insurance, the issue of affordability of care has become increasingly important to our hospitals, most of which are privately insured," she explained. (In 2006, Massachusetts became the first state to require all residents carry health insurance.)
"Hospitals are redesigning their employee benefit plans, and they are working more along the lines of defined contribution benefit plans, which are more affordable for their employees as well as themselves," she continued. "They are creating select networks and putting in benefits that deal with prevention and highlight personal accountability for one's health. So I think when you look at the numbers, even if it takes a decade for an organization to become completely tobacco-free, that's a huge savings for them."
Is It Legal?
Efforts to restrict smoking among employees have met with a combination of support and resistance nationwide.
According to a law synopsis released in July 2005 by the Tobacco Control Legal Consortium, smokers are not guaranteed specific rights under the U.S. Constitution. In There Is No Constitutional Right to Smoke , Samantha K. Graff explains most attacks on smoke-free laws - whether they address where smoking is allowed or who is allowed to smoke - follow one of two lines of reasoning: "that smoking is a personal liberty specially protected by the Due Process Clause...or...that the Equal Protection Clause extends special protection to smokers as a group."
Graff goes on to claim that neither of these two claims is legally valid. Still, According to the American Lung Association, 29 states and the District of Columbia have passed laws that protect smokers in some way, the earliest being Illinois, which did so in 1987.
For example, Connecticut law states "no employer or agent of any employer shall require, as a condition of employment that any employees or prospective employees refrain from using tobacco products outside the course of their employment, or otherwise discriminate with respect to compensation, terms, conditions or privileges of employment." (CT GEN. STAT. ANN. § 31-40s (2003))
However, many hospitals are nonprofit organizations, and these, as well as entities whose focus is the cessation of tobacco use, are exempt under the Connecticut law: "Any nonprofit organization or corporation whose primary purpose is to discourage use of tobacco products by the general public shall be exempt from the provisions of this section."
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