I work in a health system that no longer hires smokers. We have been a smoke free facility for at least 10 years, so you have to leave property to smoke as well ( for existing smokers).
My issue (as a unit assistant manager) isn't the health issues, etc. It's the breaks the smokers take. We allow 2 15 minute breaks and a half hour lunch for a 12 1/2 hour shift. I can tell you that very, very frequently, the non smokers have difficulty getting away for that amount off time. I barely get away for half of that when I'm taking a full set of patients.
My employees who are smokers take all of those and more. Not only that, but it isn't as easy to run down and have a quick smoke. The hospital is enormous (takes me 12 minutes to walk to and from my car parked on-site). They must walk further than that to get off-site, then take the time to smoke a cigarette, and get back. Not to mention the additional safety patrols necessary since we're in inner city Detroit. There's always an extra security guard sitting close to where the smokers gather when they should be inside. I know why they do it - there's been tons of crime against our employees - not enough to prevent the smoking, obviously. It's expensive and dangerous for our facility to have this going on. They hire additional armed security to have enough protection just for smokers.
Not only that, they are leaving for close to a half hour for each smoke break, shorting our unit of staff for that amount of time. Another RN assumes responsibility for an additional set of patients several times a shift. It's a safety issue, especially when you have more than one smoker scheduled per shift. We don't allow then to go out together, obviously, but when each is taking a few breaks every shift, that's many hours without full staff on the unit. It's annoying and a hassle for those of us that do not smoke and pick up the slack.