Every day, environmental changes spurred by pollutants adversely affect health. Health systems produce 5.2% of the emissions of greenhouse gases worldwide and 8.5% domestically^1,2. The healthcare industry must own its contribution to the problem of escalating climate-related health effects, and nurses must leverage their trusted voice to influence positive change. Nurses embody a unique blend of science-based practice with compassion for the human condition. Nurse leaders are ideally positioned as stewards for initiatives that can significantly improve the response to climate impacts on healthcare settings and the communities for whom they care.

As Doctor of Nursing Practice students, we understand a leader’s impact has vast organizational benefits. Nurse leaders uphold standards and act as change agents, innovators, resource managers, and patient protectors³. With their holistic perspective, it is critical that nurse leaders lean into patient advocacy principles when considering environmental conditions and create policies toward positive and sustainable change. They are the natural sustainability stewards, improving health for vulnerable populations and seizing opportunities to enhance the healthcare systems’ green practices.

Key organizations are helping guide green practices within healthcare. First, the American Nurses Association (ANA) recently published a position statement calling nurses to action ⁴. Second, the Alliance of Nurses for Healthy Environments (ANHE) is the only national nursing organization focused solely on the intersection of health and how the environment impacts health (see Figure 1)⁵. Finally, the Health Care Climate Council, in partnership with the American Hospital Association, Environmental Protection Agency, and the ANA, collaboratively drives policy, sets common goals, and shares best practices. This article provides innovative ways that nurse leaders can direct initiatives aimed at reducing environmental harm to health by employing visionary leadership, promoting resilience, and leading mitigation efforts (see Figure 1)⁶.

Figure 1: Health Care Climate Council’s Playbook for Hospitals

Leadership

A critical job of leadership is to inspire a clear and compelling vision. Nurse leaders are adept at initiating and harnessing change at the organizational and political level. The strength of the leadership driving the change directly impacts the extent to which teams deal with the challenges they face. This statement is true for many problems facing healthcare but is especially relevant to both decreasing the health system’s carbon footprint and adapting it to current and future climate changes.

Nurse leaders create a compelling platform by targeting what nurses care about most—helping people, creating healthy environments, and improving patient outcomes. They look at evidence-based practice and are innovative in actions like ordering supplies to reduce waste and improve safety. Nurse leaders utilize quality and financial data as evidence to leverage the need for change. These data-driven changes can reduce costs, improve quality and health outcomes as well as positively impact climate issues⁷.

On a politically charged and polarized topic such as the climate crisis, nurse leaders need to take the time to understand the topic thoroughly and explore their own thoughts, feelings, and biases. Representing the topic from a professional and informed perspective is critical. Avoiding polarizing language will appeal to more people and reduce fear. Once their own voice is established, nurse leaders can then pursue policy changes.

Nurses are amongst the most trusted professionals in the United States and can bring a significant voice to the impact of climate change across the nation^8,9,10. Nurse leaders have a great responsibility to facilitate healthcare teams’ understanding of environmental threats, such as air pollution, climate-sensitive diseases, mental health impacts, and water and food security challenges^9,10. As leaders, nurses can focus on the outcomes of patients and educate the public about the negative factors in their local environment and community. They also use bold storytelling to have a positive impact and readily engage their teams.

Resilience

The Health Care Climate Council encourages leaders to be stewards, “building resilient hospitals that serve as anchors for healthy, sustainable communities”^6. Gibbons et al¹¹ consider three types of climate resilience: resilience in healthcare facilities, public infrastructure, and community health. Nurse leaders need to plan and prepare for environmental crises, such as extreme weather. Interventions must extend beyond the hospital and into the community. These include capacity development, communication and coordination, health and safety regulations of water and waste, energy plans, hardening infrastructure, and ensuring operational sustainability⁹.

Nurse leaders increase community resilience by focusing on vulnerable health conditions that are exacerbated by climate impacts. For example, Hurricane Katrina and the COVID-19 pandemic unearthed vulnerably for patients with diabetes—lack of medication access and the ability to refrigerate insulin¹². Patients in crisis were unable to provide essential self-care, such as monitoring blood sugar or checking for sores on their feet¹². Visionary leaders practicing resilience arranged for home visits to deliver medications and perform foot exams, which helped mitigate diabetic complications ¹². They also activated telehealth and telephone visits opening communication to ensure diabetic patients had their essential supplies¹². Community health resilience efforts focus on preparing for disasters and safeguarding optimal daily physical health and well-being¹³. Equity for individuals and communities according to their needs is another facet of resilience. It ensures that historically marginalized people and disinvested communities—especially people of color, low-income, and English-isolated residents—gain access to opportunities and resources.

Equity in rural communities presents a unique challenge. One in five Americans lives in a rural area^14. Rural areas frequently experience staff shortages leading to the hiring of licensed professionals who commute longer distances. Nurse leaders can inspire healthcare careers by developing training and outreach programs for local students and community members. Supply chain challenges, including access to recycling services, impact product selection and cost. Local housing, services, and amenities improve the resiliency of rural communities. Investments in grocery stores, for example, make food available locally if roads are impassable, support local farming markets, and can be stocked to provide crisis supplies.

Nurse leaders improve resilient healthcare systems by investing in products and services. Examples include preparing for floods with a landscape design that manages water, installing solar panels to reduce reliance on a vulnerable electric grid, and storm-hardened supply chain management systems. Other examples include extreme heat management with shade structures, tree planting, and cooling centers or resilience hubs that serve the community in a disaster.

Building community resilience is understandably challenging for nursing leaders. However, there are great resources that can assist them: the U.S. Climate Response Toolkit¹⁵, the Climate Resilience for Health Care and Communities: Strategies and Case Studies¹¹ and Communicating on Climate Change and Health: Toolkit for Health Professionals¹⁰.

Mitigation

Greenhouse gas mitigation is a set of strategies to decrease healthcare delivery’s carbon footprint. It promotes action to limit global warming, which in turn will reduce severe health impacts caused by environmental degradation. Nurse leaders advocate for optimizing patients’ and public health by designing clinical care that decreases greenhouse gas emissions, educating staff and patients, and encouraging community engagement. 

One mitigation strategy is telemedicine or providing care via digital audio/visual communication. Reduced travel decreases carbon pollution, reducing greenhouse gases and particulates trapped in the atmosphere that cause global warming. 

The COVID-19 pandemic thrusted telemedicine to the forefront of healthcare delivery, resulting in regulatory changes that explicitly allowed for reimbursement equivalent to in-person visits¹⁶. Patients and providers remain at home, not traveling to appointments or the workplace. Nurse leaders can continue to advocate for increased utilization of telemedicine as a practice standard to minimize travel and resulting pollution.

As educators and role models, nurse leaders are instrumental in preparing nurses to be competent caregivers and environmental stewards. Nursing education is another crucial element for greenhouse gas mitigation. It is pivotal to focus on sustainability by teaching nurses to assess their work environments for waste areas and to promote efficiency and environmental responsibility. Linking environmental health impacts— carbon pollution’s role in exacerbating asthma and other lung disease, cardiovascular disease, heat-related illnesses, and more¹⁷—makes global warming personally relevant for nurses. This relevance motivates them to adopt greener practices and advocate for sustainability. For example, the Sustainability Education Advisory Committee (SEAC) at the University of Utah actively hosts workshops to engage and support faculty to include sustainability concepts into coursework. These concepts are measured by the UN Sustainable Development Goals.

The University of Utah’s Sustainability Pledge¹⁸ exemplifies a way to engage nursing students regarding healthcare’s environmental impacts. The students commit to considering their influence on environmental and social equity. This effort is rewarded by wearing a green cord at graduation. This practice highlights the importance of environmental consciousness in healthcare and commits nurses to lifelong sustainability efforts.

Nurses are known to be influential leaders and advocates for change—even as far back as Florence Nightingale.  Leading advocacy efforts across sectors is a very important mitigation strategy for nurse leaders. Examples include personal commitment to environmental stewardship, serving on boards of environmental advocacy groups, using their collective voice to drive policy, and actively promoting evidence-based legislation^4.

Recently, the Alliance of Nurses for Healthy Environments⁵ started to tackle the modern-day plague of the climate crisis. They aim to heal the environment, patients, and communities^4,5,19. This organization is an illustration of nurses standing at the environmental forefront. Nurse leaders are also responsible for widely disseminating evidence-based information and helping others understand how environmental challenges impact the health of their communities.

Nurse leaders can encourage system-level change to reduce emissions and support resiliency by actively participating, supporting and signing on to the Health and Human Services ‘Health Sector Sustainability Pledge’²⁰.

Finally, nurse leaders must extend their advocacy efforts beyond health systems. Engaging in the governmental policy process requires nurse leaders to actively participate in professional organizations, such as ANHE, that advance broader actions. Nurse leaders have the stories and direct knowledge of climate change impacts on patients, families, and communities that will help drive policy, regulation, and legislation to improve the environmental sustainability, resiliency, and overall health of populations.

Conclusion

Informed nurse leaders can influence the trajectory of climate change impacts on human health. The Intergovernmental Panel on Climate Change holds that we have less than 10 years to transition energy systems and address increasingly severe climate impacts at scale²¹. This timeline is a pressing call to action for nurse leaders to leverage their commitment to science, their compassion for people, and their uniquely trusted status in the community. We have the ability and the influence to create a culture of environmental stewardship and resilience and implement changes that reduce climate impacts on our society and the natural world on which we depend. And nurse leaders can go further in this work. In addition to providing leadership to increase resilience and mitigate the impacts of climate change, nurse leaders are strategically poised to inform and guide policy changes. Actions taken by healthcare systems and the individuals in them are critically important, but policy changes at the local, state, and federal levels are essential to drive change on a broad scale. Failing to act is, for a nurse leader, equivalent to a nurse denying a sick patient the care they need to survive and thrive.  It is not too late. There is still time to act and repair our ailing climate systems. The “medicine” needed is a known and understood formula, but people must take that medicine: mitigate greenhouse gas emissions and adapt to a changing climate. Nurse leaders are strongly positioned to administer the medicine and are called on now to do so.

Marci Crispi is an FNP with University of Utah Health and DNP Candidate in the University of Utah College of Nursing in Salt Lake City. Cherisse Marie Davis is a nurse leader with the University of Utah Trauma Program and DNP Candidate in the College of Nursing. Amy B. Christensen is Vice President & Region CNO, at Intermountain Health and a DNP Candidate in the College of Nursing. Jesika L. Chavez-England is an Instructor (Clinical) and a DNP Candidate in the College of Nursing. Luisa Echeverria is a nurse with Primary Children’s Hospital and DNP Candidate in the College of Nursing. Angela A. Fenton is an Instructor (Clinical)  and DNP student in the College of Nursing. Teresa Garrett is an Associate Professor (Clinical) in the College of Nursing. Tiffany Noss is an ambulatory care management nurse manager at University of Utah Health and DNP Candidate in the College of Nursing. Yikanee Bah Sampson is a nurse leader with Utah Navajo Health Systems and a DNP Candidate in the College of Nursing. Lisa J. Taylor-Swanson is an Assistant Professor in the College of Nursing. Heidi White a PNP in Pediatric Urology with the University of Utah Department of Surgery and a DNP candidate at the College of Nursing. Robin Woodbury is a DNP candidate at the College of Nursing. Kim Adams is a human systems analyst and designer at Geos Institute – Climate Ready America Initiative.

 References

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