Caught in the Middle: Experiences of Tobacco-Dependent Nurse Practitioners


  • Janie Heath PhD(c), APRN, BC-ANP, ACNP,

    1. Janie Heath, PhD (c), APRN, BC-ANP, ACNP, is an Assistant Professor and Director of the Acte Care Nurse Practitioner and Critical Care Clinical Specialist Programs at Georgetown University's School of Nursing and Health Studies in Washington, DC.
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  • Jeannette Andrews PhD(c), APRN, BC-FNP, ACNP,

    1. Jeannette Andrews, PhD (c), APRN, BC-FNP, ACNP, is an Assistant Professor at the Medical College of Georgia's School of Nursing in Augusta.
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  • Frances J. Kelley PhD, APRN, BC-FNP,

    1. Frances J. Kelley, PhD, APRN, BC-FNP, is an Associate Professor and Chair of the Department of Advanced Practice Nursing and Director of the Family Nurse Practitioner Program at the Georgetown University School of Nursing and Health Studies.
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  • Jeanne Sorrell RN, PhD, FAAN

    1. Jeanne Sorrell, RN, PhD, FAAN, is a Professor and an Associate Dean for Academic Programs and Research at George Mason University's College of Nursing and Health Science. Contact Ms. Heath by e-mail at
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To explore how tobacco-dependent nurse practitioners (NPs) describe their experiences with health promotion and disease prevention practices with patients who smoke.

Data Sources

Twelve NPs who completed a graduate level NP program of study participated in face-to-face interviews and/or online chat room interviews.


Participants’ responses revealed three themes relevant to their experience as tobacco-dependent clinicians with health promotion responsibilities. These themes centered around (a) living as an insider in the world of tobacco addiction, (b) having the outside-in view of living with a tobacco addiction, and (c) being caught in the middle of a tobacco addiction.

Implications for Practice

All of the tobacco-dependent participants described limited smoking-cessation interventions with their patients. A barrier to implementation of more aggressive interventions, perhaps, is the provider's own tobacco addiction. With increasing evidence that tobacco-dependent health care professionals are not adequately intervening with tobacco-dependent patients, effective strategies are needed to assist and/or support not only tobaccodependent patients but providers as well.