Some of the staff members from Employee Health and Wellness at the Saint John Regional Hospital. Left to right: Andrea (Andy) Johnson, Regional Director, Workforce Engagement, Karen Dunham, Registered Nurse, Lori Mason, Administration, Edie Daniels, Registered Nurse.

In September 2015, Horizon Health Network annouced the introduction of its Smoke-Free Environment for the buildings and grounds of all of its hospitals. The Saint John Regional Hospital was the first hospital to implement the policy through an initiative called Smoke-Free Together. Since then, six other Horizon facilities have become smoke-free, and all Horizon hospitals will be smoke-free within the next six months.

Prior to the policy, Horizon employees had access to designated smoking areas outside their hospitals. Once the policy was implemented, smoking on hospital property was banned. Employees had to refrain from smoking on hospital property or leave the property’s boundaries to smoke. To prepare affected employees for this change, the new policy was introduced in a phases. It was pre-launched internally at the Saint John Regional Hospital in June 2015 along with a free and comprehensive Employee Smoking Cessation program for all employees who wanted to get a jump start on the new policy and start reducing their cigarette consumption and/or quit smoking altogether.

Edie Daniels is an Employee Health Nurse at the Saint John Regional Hospital. She and two other colleagues – Pat Bannan and Karen Dunham – oversaw the Employee Smoking Cessation program.

“We’ve had 301 employees enroll in the program at the Saint John Regional Hospital since July 2015. It is a 12-week program; 84 have completed it thus far, 78 of which are now 100% smoke-free. Others are in the process of quitting and will soon be completing the program. We had a lot of registrations at the beginning when the policy was being announced, but we still see employees come to our office and decide to start the program now, 14 months later.”

The program is based on the Ottawa Model for Smoking Cessation, the same model Horizon Health Network uses with its patients. All the Employee Health nurses studied the Ottawa model, and tools were developed regionally to standardize practices which would be utilized by Horizon Health Network employees seeking support to quit smoking as the policy rolled out across all Horizon Hospital facilities.

“A nurse completes an initial assessment with each new participant who enrolls in the program,” explains Daniels. “This initial evaluation allows us to find out important details about the person, such as how much and how frequently they smoke and why. Once we know their smoking habits, we’re able to recommend the right dosage of nicotine replacement therapy to help them on their journey. We need to ensure that we match their level of smoking so that they are comfortable and are successful in reducing their nicotine replacement therapy dosage with time and can quit smoking for good.”

Smoking cessation aids are provided free of charge to participants, a very appealing way to get employees to try to quit smoking and show them that their employer cares about their health and well-being.

“Participants can have up to two boxes of nicotine gum and two boxes of nicotine patches per week,” says Daniels. “This, of course, is all based on the initial assessment and the amount of cigarettes they smoke; every treatment is individualized to the needs of the employee. We give them tips on how to best use these smoking cessation aids so they will be successful in their attempt to quit smoking.”

Participants who feel they want a different cessation aid can also choose to use prescription medications. Participants are responsible for paying for these drugs or if applicable, have their health plan cover the costs. As part of this initiative, Horizon also worked with the Standing Committee for Insured Benefits (SCIB), and is happy to report that since April 2016, any Horizon employee who has drug coverage under their health plan will now have some coverage for smoking cessation medications, whether it be nicotine replacement therapy or prescription smoking cessation medications.

“After the first education session, each participant visits Employee Health weekly to pick up their supply of product. This visit allows us to check our participant’s progress as they continue their journeys. We offer strategies and advice, like teaching them to know their triggers and to avoid old habits they associate with smoking, such as taking their coffee break with other smokers or in a physical location where they used to smoke. We remind them how to best use their smoking cessation aids. We’re a non-judgmental confidant with whom they can talk to about any difficulties they are facing and seek encouragement.”

Daniels adds that within a few weeks, she sees a change in most participants. “Their confidence just seems to sky-rocket after the first three weeks. At first, we were a bit overwhelmed by the demand that the program created. So many people registered at once that we weren’t sure we’d be able to keep up with all the weekly visits. But it soon became apparent that our weekly check-ins were critical to our participants’ motivation and success, so it became our scheduling priority.”

Daniels and her colleagues say it is very rewarding to be able to accompany people on their journey to becoming smoke-free. “Our participants tell us they feel so much better. I’ve been here since 2001, and I can honestly say that it’s the most rewarding work I’ve ever done as an employee health nurse. I see the same people on a regular basis and witness how their mood and health improves. I see their joy and pride in themselves. Most of our participants who recently quit smoking become our strongest allies and champions, relaying the anti-smoking message and advocating for the respect of the smoke-free policy.”

“I’m completely smoke-free and off all my nicotine replacement therapy. It was super helpful doing this program because you had a person to talk to at least once a week to let you know what you should and should not do, and how to make it less difficult. Being smoke-free is fantastic! It has really enhanced my quality of life.” -Testimonial from a Saint John Regional Hospital employee.

“I was successful because of the weekly support and the patch and gum that were supplied to us. Being smoke-free, I have more energy, less stress, and I feel so much better physically. I actually run now; I’ve taken up jogging!”
-Testimonial from a Saint John Regional Hospital employee.

“Before this program, I tried to quit a few times on my own, but it never stuck. I’m now in week 9 with the program. I come down to Employee Health each week and tell the nurse: ‘When is it going to give? When am I going to start craving again?’ And I haven’t! It has just been amazing! The support has been great, without it I don’t think I would have been able to do it. ” -Testimonial from a Saint John Regional Hospital employee.

“I do my workouts, I run up the stairs, and I’m not out of breath anymore. It has been a complete 360. I was determined to quit, but the extra support I received with this program was key.” -Testimonial from a Saint John Regional Hospital employee.

And, thanks to the Smoke-Free Together initiative, employee morale and satisfaction at work has improved. Kerrie Luck can attest to that. She was the project coordinator for the Saint John Regional Smoke-Free Together initiative and was instrumental in getting the project off the ground.

“Managers have noted that among certain groups of employees who used to have many smokers, productivity has improved. Employees who have quit smoking are more energetic, feel better, are getting healthier and exploring new activities like walking and going to the gym. There also appears to be more co-operation, camaraderie and teamwork between employees. Employees are supporting and encouraging their colleagues who are trying hard to quit, while sometimes there is simply less resentment because colleagues are not going out for extra smoking breaks.”

The non-smoking staff at the hospital are also extremely grateful. “We often hear from staff that it’s so pleasant now to be able to walk into the hospital without having to go through a cloud of second-hand smoke and step on cigarette butts,” says Luck. “It is important to note that before the launch of the Smoke-Free Together initiative, approximately 20% of our employee population smoked. This means that an overwhelming majority, 80%, did not smoke. Our 100% smoke-free environment now protects all employees from second-hand smoke. Among the 20% of the employee population that smoked, many have quit, or are trying to quit, and are thankful the hospital now provides them with resources, support and a healthy environment that is conducive to doing so.”

Luck adds that a Compliance Committee has been in place since the launch of the smoke-free outdoor environment policy and has been key to its continued success. “This is a living policy, not something we wrote in a book and put on the shelf, never to revisit again. It keeps evolving. The Compliance Committee meets on a regular basis and can address challenges as they develop before they get out of hand. We receive feedback from security personnel and managers who are responsible for reinforcing the policy and doing patrols of the grounds. They tell us if they have had to intervene to tell individuals not to smoke on the property and who these people are – either employees, visitors or patients – so that we can adapt our resources and see how to react. When someone is spotted smoking on the property, we always want to respond in a friendly and non-confrontational manner. Our staff has been trained to be empathetic and recognize that nicotine is very addictive when dealing with someone who is caught smoking. They politely ask the person to stop smoking or leave the premises if they wish to continue to do so. They also remind them of the many resources available to help manage their cravings. If employees are caught breaking the policy by smoking on the property, their managers are informed, and progressive disciplinary measures are initiated, as you would similarly see with a violation of any hospital policy.

As part of the Smoke-Free Together community outreach and education activities, children from Princess Elizabeth School (grade 3) were invited to contribute some creative signs throughout the hospital, illustrating the dangers of smoking.

“Our hospital’s image has also improved among members of the general public,” concludes Luck. “We receive a lot more positive feedback than negative. People expect a hospital to be a place to heal and promote healthy living. The Smoke-Free Together initiative is showing people that we are doing this in a very concrete way. Often decision makers fear implementing significant changes because of various “what if” scenarios, but as we have seen with this initiative, when we push through these uncertainties and take risks, we often see, after the fact, that many of those worst-case scenarios never come to fruition. I think that in a few years, we’ll look back on this new policy and see that it was fundamental in changing our workplace’s attitude and culture in regards to tobacco.”

Photos and story used with permission from the Saint John Regional Hospital and Horizon Health Network.

Published in September 2016

By Nathalie Landry – NBATC Communications Coordinator