Background: WaikatoDHB Smokefree Policy This presentation reflects on the process of the largest all services on site hospitals in NZ with the focus on staff attitudes. The hospital as micro community, mirrored New Zealand's journey backed by strong legislation to wards a smokefree environment. From staff attitudes of “it cant be done”, “I wont do it”, “Who is going to police it”, “Its their right”, “We are too busy”.

Strategy: At the direction of the CEO of WaikatoDHB a strong smokefree policy was developed. This was to be phased in, in stages from July 2002, to full implementation in Feb 2006. The final phase impacted on patients who were now asked to smokefree on admission to the services. This meant staff could no longer ignore smoking behaviour and had to begin engaging with patients who smoke. The nursing profession, caring and empathising, may have allowed staff to avoid engaging in dialogue with smokers as a routine clinical assessment, therefore not recognising and treating an addiction. But with smoking banned and an assessment of patients smoke exposure now required as part of clinical picture, attitudes have shown an increasing level of acceptance borne out with annual surveys of staff attitudes

Conclusion: Strong policy is required to introduce change in attitudes and practice. This policy which reflects NZ legislation and best practise/health outcomes, has given staff confidence to engage with patients who smoke. Training, evidence, experience and case studies have increased staff competence to treat smoke exposure.