Nursing and climate change: How to reduce your environmental impact
The Royal College of Nursing (RCN) has highlighted the importance for nurses to understand the impacts of climate change on health, and pave the way for sustainable clinical practice in their work. Nurses are in an excellent position to engage in sustainable healthcare due to the wide range of roles they can take on and the variety of settings they work in, as they make up the largest proportion of clinical staff in the NHS. But why is this important?
“Nurses have a duty to protect and promote public health in the face of threats posed by climate change” - The Royal College of Nursing
In the Greener NHS plan for achieving net zero emissions, Simon Stevens, The NHS Chief Executive states, “the climate emergency is also a health emergency”. The climate emergency is not just bad for the planet, it’s bad for health.
Currently, the carbon footprint of the NHS is the largest of any single public sector body, equivalent to almost 25 million tonnes of carbon dioxide. If all the healthcare systems of the world were considered as a single country, they would have the fifth largest carbon footprint. The healthcare sector poses great opportunities to reduce emissions, and pioneer low-carbon alternatives, as demonstrated by the NHS target of net zero by 2040 for direct emissions. The RCN has backed the UK government in their declaration of a climate emergency and called for immediate climate action on the matter.
How does climate change affect healthcare services?
The UK has seen an increased frequency of storms, flooding, and heat waves, and with each of these events, health is impacted through injuries, loss of housing and income, worsening mental health conditions and heat-related deaths. Asthma is clearly linked to air pollution, with the first death explicitly linked to emissions sadly recorded in 2013. As the climate warms, we face more cases such as this. More broadly, health is impacted as a direct result of extreme weather events, indirectly through changes to the environment - such as skin cancer related to higher UV exposure - and indirectly through societal changes - such as mental health conditions and cardiovascular health related to a loss of housing and income, adding pressures to an already overburdened health system.
Health and climate co-benefits
Along the same lines, a healthy environment will promote the health of people; this is known as the health “co-benefits”. Many actions which reduce carbon emissions also improve health - increasing the use of active transport (walking, cycling) improves cardiovascular health, improving insulation in homes reduces cold-related deaths and using cleaner, renewable energy reduces air pollution, protecting respiratory health. Within the NHS, actions to reduce the environmental impact have also shown improved clinical outcomes and reduced pressures on nursing staff.
The principles of sustainable healthcare
The Centre for Sustainable Healthcare (CSH) promotes four principles of sustainable healthcare, all designed to improve patient care whilst simultaneously reducing healthcare resource use and the NHS carbon footprint. The principles, in order of both importance and power, are:
- Prevent the need for healthcare
- Promote better patient self-care
- Streamline care systems
- Prioritise low carbon alternatives
Implementing these principles can take different forms but they are ultimately achieved by:
- Tackling the causes of both illness and inequalities
- Encouraging and empowering patients to take a greater role in their healthcare and wellbeing
- Managing care systems effectively to streamline them and therefore reduce waste
- Favour care options and technology with a lower impact on the environment
How sustainable healthcare principles apply to nursing
These four principles have been successfully implemented into the Nursing and Midwifery Council (NMC) code, highlighting the key ways in which nursing work can have a hugely beneficial impact on the environment whilst maintaining the already extremely high levels of patient care.
The code of conduct requires nurses and midwives to ‘[3.0] pay special attention to promoting wellbeing, preventing ill-health and meeting the changing health and care needs of people during all life stages’ whilst also ‘[2.0] listening to people and responding to their preferences and concerns’ . These fulfil principle 1 and 2 as healthcare requirement is prevented and patient preference is being considered, therefore allowing patients to play a more active role.
Moreover, the code also states nurses should ‘[19.1] take measures to reduce as far as possible, the likelihood of mistakes, near misses, harm and the effect of harm if it takes place’, thus making the care system as effective and streamline as possible and so fulfilling principle 3.
To meet principle 4, the code requires a focus to ‘[25.1] identify priorities, manage time, staff and resources effectively and deal with risk to make sure that the quality of care or service you deliver is maintained and improved, putting the needs to those receiving care or services first’; by following this, services and care are effectively organised and low carbon alternatives can be prioritised. These examples are amongst others listed in the NMC code and demonstrate the change nurses can promote whilst in their unique position of seeing patients progress through their healthcare journeys.
The RCN incorporates sustainable principles into its goal to support the nursing community to ‘deliver care in a way that is environmentally sustainable, improves health outcomes and helps reduce cost’ – the triple bottom line. Guides to promote sustainable practice can be found on the RCN website, and their small changes, big differences project fulfills many of the sustainable principles by effectively managing care systems and choosing options with lower environmental impact and that are better for patients.
Sustainable Quality Improvement in Nursing
This summary from the last century highlights the need for nurses of all levels of experience to be involved in quality improvement.
“Those who perform direct services are in an excellent position to identify the need for change in service delivery processes. Based on this premise, the staff nurse--who is at the heart of the system--is the best person to assess the status of health care services and to work toward improving the processes by which these services are provided to clients in the health care setting”. - Quality Improvement: the nurses role
With the mounting evidence of the negative effects of climate change on human health, the time is now for as many nurses as possible to become involved in sustainable quality improvement (SusQI) to address climate change.
Endoscopy improvement projects at North Tyneside General Hospital in the North East of England are an excellent example of nurse-led Sustainable Quality Improvement. How this was implemented in their department is detailed below.
Sustainable Quality Improvement Process
Background:
The NHS and the activities within are responsible for 6.3% of the UK’s total carbon emissions and 5% of the country’s total air pollution. There is ever-increasing data linking climate change to worsening human health. For example, the rising temperatures are increasing the reach of vector-borne diseases, putting more people in danger of catching deadly diseases such as malaria and dengue fever.
Problem Identified:
Endoscopy produces approximately 3.09kg of water per bed-day making it one of the highest emitting hospital departments. Leigh Donnelly (Clinical Nurse Specialist and Education and Development Lead for Endoscopy, Northumbria Healthcare NHS Trust) has initiated and worked along with other nurses in the department to develop the use of Green Champions – persons dedicated to looking for ways to increase sustainable practice in the endoscopy units of her trust. So far, they have made huge differences to waste management, reducing costs to the trust and improving patient outcomes – the triple bottom line.
Studying the system:
Where can improvements be made? Are there any places where single use equipment can be replaced by sterilised equipment? The team of nurses examined the systems of endoscopy procedures and identified many areas where small, simple changes could reduce waste.
Below is a diagram outlying the ways carbon can be reduced without reducing human health. The project outlined below involved quality improvement which falls under the headings of low carbon alternatives and operational resource use.
The nurses examined the patient’s journey through the endoscopy department, from entering the doors to leaving after the procedure was complete. The journey was broken down into key stages and analysed in relation to ecological, social and financial costs. When a cost was identified it was highlighted and this was repeated at each stage of the patient’s journey. Once this was completed the staff came together to identify measures that could be implemented to minimise the costs they had discovered.
Measures put in place
- Person specific respirators rather than disposable FFP3 masks to reduce mask waste from the units
- Reusable plastic containers for patient’s belongings instead of plastic bags
- Recycling bins in procedure rooms
- Using paper rather than gauze to apply lubricants in endoscopy
- Recycling of sterile water bottles
- Use of Microsoft TEAMS for training to reduce carbon footprints for travelling to meetings
- Creating electronic staff files to reduce paper waste
Evaluation
The interventions from this sustainable quality improvement project have not yet been fully examined under the triple bottom line criteria; however, there are expected to be significant financial and carbon savings, alongside improved patient safety.
The expected findings are
- Financial: reduced cost of patient property plastic bags, gauze, and hazardous waste disposal, equipment reuse
- Social: Improved patient and staff comfort
- Environmental: reduced single use mask use, increased recycling and equipment reuse, reduced carbon impact of staff travel
The nurse-led sustainable quality improvement currently being done in this endoscopy department is significant and may seem intimidating to those just beginning their SusQI journey, however with the steps laid out it can be achievable for all nurses to get involved in projects within their specialist areas. The case detailed above is only one of many examples of nurse-led sustainable quality improvement.
CPD courses for nurses
Interested to find out more about incorporating environmental sustainability into practice? The Centre for Sustainable Healthcare runs a range of excellent courses on a variety of topics including:
Introduction to Sustainable Healthcare: this 6 hour course is a fantastic start to your sustainability journey, it introduces concepts such as doughnut economics, the triple bottom line. It will give you a good foundation about the role of healthcare in climate change and has interactive case studies to improve your understanding of sustainability within healthcare.
Green Space and Health: the aim of this course is to empower you to develop your own ‘Green Space initiative’; in order to do this you will learn the role of green space in sustainable healthcare and the benefits of green and blue space engagement, along with later translating these benefits into a clinical setting and identifying pre-existing, local initiatives
Sustainable Quality Improvement: this is a great way to learn about making real changes within your practice. It takes you through how to look at the social, environmental and financial impacts and will empower you to undertake your own “SusQI” project.
Sustainable Primary care: If you are a nurse working in Primary Care this course provides a wealth of information about how Primary Care practices are linked to carbon pollution, why this is important and how you can get involved in sustainable quality improvement in this area. There are worked examples of projects which have been completed and areas of interest.
Sustainable Mental Healthcare: this course brings together ways in which mental health care can become socially, environmentally and economically sustainable; it describes the connection between the climate breakdown and mental illness and explains the ways in which the sustainable principles can be applied to mental health care, highlighting the key role mental health professionals play in encouraging sustainable practice.
Carbon Footprinting for Healthcare: this focuses on explaining what exactly a carbon footprint is and how it can be estimated, with relevant examples to help you then use this on a small quality improvement project.
Join the Sustainable Nursing Movement
The Green Nurse Network, the Nurses Climate Challenge and Nurses Drawdown have brilliant resources and like-minded professionals to share ideas.
Guest authors
Jessica Burt, Final Year Medical Student at the University of Leeds
Rebecca Gee, University of Exeter BSc Biological Sciences Year 3
Jenni Newton, Final Year Medical Student at Newcastle University