APNA Nursing Competencies for Treating Nicotine and Tobacco Use Disorders
Preamble
Competencies integrate knowledge, values, self-assessment, attitudes, professional judgment, and skills to execute tasks or actions (Fukada, 2018; Mrayyan, Abunab, Khait et al., 2023). Nurse-led tobacco treatment interventions can be effective and supporting their training in evidence-based tobacco treatment delivery can optimize success in intervening with patients (McDaniel, Cooley, Andrews et al., 2024; Lee & Yu, 2025; Ramos-Morcillo, Ruzafa-Martinez, Granero-Moya et al., 2025). Nursing competencies for treating nicotine and tobacco use disorders (NTUD) provide a foundation for delivering effective nursing interventions and engaging in scientific inquiry, advocacy, and innovation. Psychiatric-mental health nurses at the RN advanced practice level (APRN) require NTUD treatment competency to fully participate as members of interdisciplinary treatment teams. Competency in NTUD treatment is also critical for nurses seeking to champion and participate in local, state, and national policy and guideline development.
These PMH-RN/APRN competencies are founded on current extant qualitative and quantitative evidence, consensus opinions, findings from NTUD subject matter experts and national committees, and a wide variety of professional healthcare organizations. PMH-RNs and APRNs work in a variety of clinical and non-clinical settings and, as greater emphasis is placed on treating the whole person, these treatment settings are not limited to historically typical psychiatric settings. These competencies are therefore designed to be interpreted and adapted in any clinical setting for treating persons with NTUD, inclusive of any diagnostic group, age group, race or ethnicity, gender orientation, or socioeconomic background.
All persons with NTUD would benefit from accessible, effective care, whether they have been diagnosed with a psychiatric condition or not. Therefore, all nurses would benefit from foundational competency in providing TUD care. The psychiatric-mental health nursing scope of practice specifically encompasses the treatment of all substance use, including recreational nicotine and tobacco product use, and thus uniquely positions PMH nurses to demonstrate leadership in role modeling, teaching evidence-based NTUD treatment, and engaging in innovative NTUD treatment strategies. The below NTUD competencies are written with the PMH-RN/APRN in mind, but can be adapted by nurses of all specialties.
Competencies
Nurses who are competent in nicotine and tobacco use disorder treatment use knowledge, values, attitudes, and professional judgment to demonstrate the skills listed below:
1. Engages in self-reflection activities to expand the therapeutic use of self in treating nicotine and tobacco use disorders.
The PMH-RN and PMH-APRN:
- Appraises personal beliefs related to treating persons with nicotine and tobacco use disorders (NTUD)
- Demonstrates therapeutic use of self in facilitating access to care for persons with NTUD, especially persons challenged with chronic relapses
- Uses current evidence-based local, state, and national resources to deliver effective NTUD treatment
2. Uses person-centered recovery language to create a safe environment for collaborative communication and interventions with persons who have nicotine or tobacco use disorders.
The PMH-RN and PMH-APRN:
- Establishes knowledge of recovery language as it applies to treating persons with NTUD
- Employs recovery language to create a safe environment
- Assesses and reports nicotine and tobacco use and responses to treatment using recovery language terms
- Demonstrates use of recovery language with individuals to encourage confidence and hope in achieving and sustaining abstinence from recreational nicotine and/or tobacco products
3. Understands the effects of nicotine and tobacco use on specific populations and the treatment needs for individuals in a variety of clinical settings.
The PMH-RN and PMH-APRN:
- Demonstrates knowledge of physical and mental health outcomes for persons with NTUD, including high-risk vulnerable populations (e.g., co-morbid medical or psychiatric conditions, social determinants of health/low socioeconomic status, racial/ethnic and gendered minoritized groups, etc.)
- Acknowledges that vulnerable populations may include, but are not limited to, persons who are:
- Experiencing other addictions, mental and behavioral health issues
- Children, adolescents, pregnant women, justice involved
- Unhoused and/or those living in poverty
- Experiencing or have experienced physical or mental trauma
- At risk due to life-threatening infectious diseases or immune-compromised
- Vulnerable due to their racial or ethnic characteristics
- Experiencing sexual orientation and difficulties with gender identity
- Identifies accessible, cost-effective NTUD treatment options for personalized care in a variety of clinical settings
- Delivers evidence-based individualized NTUD nursing interventions that are inclusive of individual-identified significant others
- Integrates cultural humility in the provision of NTUD nursing care
- Adapts NTUD nursing interventions to a variety of settings
4. Performs an evidence-based comprehensive tobacco and nicotine dependency assessment for the basis of applying diagnostic criteria.
The PMH-RN and PMH-APRN:
- Selects evidence based NTUD screening and assessment tools based on individual demographic and product use patterns
- Applies knowledge of health diagnoses, medications, and treatments that may be affected by NTUD disorders
- Within the nurse’s scope of practice, uses NTUD diagnostic criteria to facilitate, improve, and guide access to care
5. Applies existing and emerging evidence-based pharmacotherapies for nicotine and tobacco use disorder treatment to prevent physical and mental health problems associated with nicotine and tobacco product use.
The PMH-RN and PMH-APRN:
- Establishes knowledge of FDA-approved NTUD pharmacotherapies
- Translates technical NTUD pharmacotherapy evidence into realistic, pragmatic, culturally respectful information for individuals
- Identifies opportunities and maximizes occasions to dispel myths and misinformation regarding the use of pharmacotherapy
The PMH-RN:
- Establishes NTUD pharmacotherapy knowledge that is consistent to the nurse’s licensure, scope of practice, and facility policies
- Uses knowledge of over-the-counter Nicotine Replacement Therapy (NRT) pharmacotherapy to deliver effective NTUD interventions
The PMH-APRN:
- Establishes knowledge of the pharmacodynamics and pharmacokinetics of FDA-approved medications to treat NTUD
- Collaboratively formulates a NTUD pharmacotherapeutic plan of care that is safe and effective given possible co-occurring disorders and medication use
- Identifies opportunities to engage in multidisciplinary collaboration to make available NTUD pharmacotherapy to patients in a variety of settings
6. Applies health teaching about neuro-biological and psychological problems due to nicotine and tobacco use disorders to dispel myths and misinformation.
The PMH-RN and PMH-APRN:
- Establishes foundational knowledge of neurobiological and psychological problems related to NTUD
- Recognizes that risks associated with neurobiological, psychological, and physical disorders due to NTUD vary depending on the type of product that is used
- Appraises the possible health risks associated with the chemicals found in a variety of recreational nicotine and tobacco products
- Monitors emerging trends related to unsafe or unproven practices, devices, or treatment methodologies
7. Engages relevant multidisciplinary team members to strategize evidence-based care coordination.
The PMH-RN and PMH-APRN:
- Proposes evidence-based NTUD treatment strategies respectful of patient autonomy to participate in multidisciplinary care planning
- Demonstrates ability to translate evidence-based NTUD knowledge into practice as a full participating member of a multidisciplinary treatment team
- Maximizes cost-effective multidisciplinary NTUD treatment
- Develops opportunities to improve and streamline access to innovative coordinated care
8. Combines evidence-based counseling and psychotherapies with FDA-approved nicotine and tobacco use disorder pharmacotherapies to achieve the best practice gold standard treatment.
The PMH-RN and PMH-APRN:
- Recognizes the therapeutic role of counseling as an integral component of NTUD treatment that also includes FDA-approved NTUD pharmacotherapy
- Arranges referral to psychotherapy as indicated, collaboratively agreed upon with the individual, and as available
- Differentiates between psychotherapy and NTUD treatment strategies that are therapeutic
- Demonstrates an understanding of psychotherapy and therapeutic interactions to practice within the nurse’s licensure, scope of practice, and facility policies
9. Recognizes how integrative therapies can be used to honor patient preferences in treating tobacco use and dependency.
The PMH-RN and PMH-APRN:
- Appraises emerging evidence for integrative NTUD therapies, including acupuncture, hypnosis, aromatherapy, and milieu therapy
- Formulates NTUD treatment strategies that provide individuals with evidence-based integrative therapy information that supports autonomous treatment decisions
- Discusses potential positive effects and limitations of integrative therapies and implications of the placebo effect
10. Understands the health implications of perceptions of potential benefit or harm around emerging practices, devices, or treatment methodologies that do not have an evidence base and/or are potentially unsafe.
The PMH-RN and PMH-APRN:
- Identifies the impact and influences of recreational nicotine and tobacco product manufacturer advertisements targeted at vulnerable populations
- Differentiates the evidence between effective, well-studied NTUD treatment strategies in comparison to unproven and potentially harmful treatment methodologies
- Appraises the potential influences of findings disseminated through recreational nicotine and tobacco manufacturer-funded studies
11. Analyzes current nicotine and tobacco use and exposure policies, regulations, and clinical practice guidelines to address health disparities in TUD treatment.
The PMH-RN and PMH-APRN:
- Operationalizes evidence-based local, state, and national policies and guidelines for NTUD
- Serves and advocates for patients with NTUD as a fully participating member of committees to form or update NTUD policies, regulations, and guidelines
- Assembles emerging NTUD treatment evidence in advocating for regular updates to local, state, and national policies and guidelines
12. Engages in scientific inquiry to effectively synthesize nicotine and tobacco use disorder treatment evidence into clinical practice and local, state, and national policies.
The PMH-RN and PMH-APRN:
- Identifies opportunities for NTUD treatment innovation
- Engages in scientific inquiry to test innovative treatment strategies
- Uses valid methods of scientific inquiry to critically evaluate and disseminate NTUD treatment evidence
13. Utilizes systems change processes and evidence-based practice to engage in or lead the development, implementation, and evaluation of nicotine and tobacco use disorder treatment programs.
The PMH-RN and PMH-APRN:
- Incorporates systems change strategies to improve treatment and access to care
- Assesses novel applications of established NTUD treatment strategies through technologies
- Applies implementation science to translate innovative NTUD treatment strategies into regular practice
- Evaluates innovative NTUD treatment strategies
- Disseminates findings of scientific inquiry of NTUD innovation and novel use of established NTUD treatment practices
Initially developed by the Tobacco Treatment Nursing Competencies Task Force and approved July 2020. Revised July 2026.
Nicotine and Tobacco Treatment Nursing Competencies Bibliography
2020 Tobacco Treatment Nursing Competencies Task Force
Carol Essenmacher, PMHCNS-BC, DNP, NCTTP – Chair
Carolyn Baird, DNP, MBA, RN-BC, CARN-AP, CCDPD, FIAAN
Julia Houfek, PhD, APRN-CNS, BC
M. Rene Spielmann, DNP, ARNP, FNP-BC, PMHNP-BC
Barbara Warren, PhD, RN, APRN-CNS, PMH-BC, FNAP, FAAN
Acknowledgement to APNA colleagues, particularly Chizimuzo “Zim” Okoli, PhD, MPH, MSN, PMHNP-BC, APRN, NCTTP, FAAN, for the 2026 update.
