Sustainable Nursing: Putting Environmental Stewardship to Practice

By Caitlin Clark

SustainU mobile app
Armed with smartphones and tablet computers, a group of students from an introductory Environmental Studies class test Sustainable U, a mobile gaming application. Photo courtesy of Board of Regents of the University of Wisconsin System.

The healthcare industry, like all industries, has an ecological footprint. That footprint affects the environment, which, in turn, affects health for individuals, families and communities. Increased risk of water- and vector-borne illnesses due to flooding and water contamination. Respiratory illnesses brought on or exacerbated by ongoing air pollution from wild fires and burning fossil fuels. The physical, mental and emotional strain of homes and entire communities being destroyed by natural disasters. Dehydration and hunger due to drought and famine. The contamination of well water in Wisconsin, the Zika virus outbreak, the wildfires in California, and the aftermath of Hurricane Maria in Puerto Rico are just some of the events where we’ve witnessed these impacts over the last five years. The list goes on.

“Environmental health issues typically have an earlier and stronger effect on people who are already burdened by health and racial inequities.” —Jessica LeClair

Jessica LeClair portrait
Jessica LeClair, MPH, RN, UW–Madison School of Nursing

Naturally, this is a growing concern for clinicians who work to improve patient health and wellbeing. Increasingly, providers are evaluating the way their health systems function so that their practices do not undermine the care they deliver. “Environmental health issues typically have an earlier and stronger effect on people who are already burdened by health and racial inequities,” says Jessica LeClair, a public health nurse and School of Nursing clinical faculty member who specializes in environmental health and sustainability in healthcare. “As a result, these same people are seen more frequently by nurses and other healthcare providers—and this trend will only increase as our climate continues to change.”

Current healthcare practices contribute to a large portion of the country’s energy consumption and pollution emissions, including the annual production of over 2.5 million tons of complex waste—that’s 7,000 tons per day—and 10% of the nation’s greenhouse gases. And though nurses and other healthcare providers have made efforts to develop and participate in programs that recycle, manage waste, conserve energy and water, and promote renewable energy, there is still work to be done.

Education is Key to Environmental Stewardship

The School of Nursing recognizes that increasing environmental health literacy and leadership among the future nursing workforce is a proven way to improve public health outcomes. That’s why it provides educational opportunities both in and outside the classroom.

Since joining the clinical faculty in 2018, LeClair has incorporated climate change, planetary health and air pollution topics into the school’s traditional and accelerated undergraduate curriculum. “Students are coming to our programs with environmental health concerns, and they are ready to take action. Students [have already taken] content directly to their clinical sites and educated their nurse preceptors and colleagues with great feedback,” LeClair says.

LeClair’s environmental sustainability advocacy work is inspired by more than ten years of experience as a public health nurse, where she witnessed the health effects of climate change in Madison and a lack of effective resources for public health nurses. She is a member of the Wisconsin Public Health Association, Alliance of Nurses for Healthy Environments, Sustainable Madison Committee, and Dane County Climate Change Council Community Team. She hopes that she can help the future nursing workforce “feel empowered” to address complex environmental health issues.

Dr. Elizabeth Schenk
Dr. Elizabeth Schenk is a Providence-Washington University nurse scientist who studies the environmental impacts of healthcare and nursing practice. She is also a board member of the ANHE and hosts the Nurses for Healthy Environments podcast.

LeClair also works with the dean, faculty and staff to provide continuous learning opportunities for students, faculty and the community. For example, Dr. Elizabeth Schenk provided the 2019 Nurses Week keynote address, where she discussed the healthcare-environment cycle and how nurses can practice environmental stewardship. Dr. Schenk is a nurse scientist whose primary research interest is in the environmental impacts of healthcare and nursing practice. She leads nursing research efforts across the 50-hospital Providence St. Joseph Health system in Missoula, Montana, and serves as an assistant research professor at the Washington State University College of Nursing.

“The problem we’re talking about is both a global problem and a local problem. It’s both a systemic problem around the world, in all dimensions, and it’s a nursing practice problem.” Dr. Elizabeth Schenk

The Problem: An Environmental Crisis

Environmental scientists have dubbed our current geological age the Anthropocene due to the significant influence human activities are having on climate and the environment. We are seeing a deterioration in ecosystem services, which Schenk defines as “the function of the planet to produce a number of elements that make life possible,” including oxygen, a stable climate, nutrients in soil, and genetic diversity. This deterioration is causing what Schenk calls an “environmental crisis.”

“The problem we’re talking about is both a global problem and a local problem. It’s both a systemic problem around the world, in all dimensions, and it’s a nursing practice problem,” Schenk says. “We are in the midst of an environmental crisis. It’s escalating as we speak and those of us who are alive right now are facing this and will face it, really, for our lives.”

This environmental crisis is driven by pollution from power plants, plastics, and chemicals, as well as excessive land-use choices like deforestation. Ultimately, these drivers lead to the devastating effects of environmental changes like air-polluted cities, flooding, and forest fires, as well as exposure to toxic chemicals.

When patients seek treatment for environmental-related illnesses, their healthcare services produce more pollution, which contributes to environmental changes and ultimately affects patient health. Thus, the healthcare-environment cycle continues. In order to break the cycle, nurses and other healthcare clinicians must confront the issue and become better environmental stewards in their practices.

The Power of Nurses as Environmental Stewards

As the largest professional group within healthcare, nurses are in a unique position to lead efforts in reducing the industry’s ecological footprint. “There are about 4 million nurses in the United States, so we have a lot of power to push for change,” says LeClair. “We work in all communities with individuals, families, systems, and policies. Nurses and other healthcare practitioners are trained to advocate for health, communicate risk, and manage complex systems. It is through these essential roles that we are ideally placed to influence public health, clinical care, and emergency services to reduce and respond to the health effects of environmental issues.”

Furthermore, nurses have been named the “most trusted profession”” by Gallup every year for the past 20 years, with the exception of 2001 when the most trusted voice was firefighters. In other words, when nurses talk, people listen, and using that voice for environmental stewardship can create powerful change.

At the very least, Schenk believes nurses are professionally obligated to create environmentally safe and healthy practices in the care they provide, citing the American Nurses Association’s Guide to Nursing Social Policy Statement, Code of Ethics, and Nursing Scope and Standards of Practice. The Nursing Social Policy Statement and Code of Ethics share a common theme of promoting, advocating for, and protecting the rights, health, and safety of not just individual patients but also the public as a whole. This is done by providing caring and compassionate care as well as service in hazardous conditions (like epidemics and natural disasters).

Above all, Schenk says, “The [clearest example] to me [is] in our Scope and Standards and it’s Standard 17 that states ‘the registered nurse practice is in an environmentally safe and healthy manner.’ There’s a lot of competencies involved with that related to education and practice, but to me this [also means] we don’t pollute.” In short, if nurses have a duty to promote and protect health, protecting the environment needs to be a part of their everyday practice.

Taking Action

Nurses interested in taking action are encouraged to start with organizations like the Alliance of Nurses for Healthy Environments, Practice Greenhealth, Health Care Without Harm, and Healthcare Environmental Resource Center. Many communities also have local public health or sustainability advocacy groups. These groups offer a number of resources, events and continuing education opportunities that can help nurses become environmental health advocates in their own practices and communities.