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"The perception that smokers take more and longer breaks, and were less available for patient care, was an important theme in discussions with both smokers and former smokers, and clearly created conflict in the work environment." Whether accurate or imagined, these perceptions create dissension, resulting in what one nurse in the study characterized as "a war between the smokers and the non-smokers." Additionally, nurses who smoke often are reluctant or feel uncomfortable participating in smoking cessation interventions with their patients, believing they are not good role models, Sarna said

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