What can we as nurses change in our practice?
Many of us want to make an impact, but find it challenging to know where to start.
As nurses, we are one of the most trusted profession in the society. It is time we take a lead to prevent environmental change, both to protect the planet and the people we care for!
We hope this page will inspire you to make changes, with easy access to examples on 'how-to', sorted into relevant areas.
The Nursing Sustainability Network at CSH is there to support, with regular network meetings, if you require any further information.
- Alexandra Nevin
- Leisa Bridge
- Karen Abbey
- Ane Lund Ringen
Starting the conversations and raising awareness
It is crucial to remember that environmental change has a huge impact on human health, thus climate change is a safeguarding issue, and safeguarding is the duty of all nurses! Use of Freedom to Speak Guardians and Whistleblowing pathways should be considered.
...."keep your message simple and repeat it often" and "focus on human health"... is some of the great advice from the WHO toolkit:
Build your confidence to communicate about environmental health. Put written and visual information up in your office, add info on the workplace website or email, practice conversing about climate change with trusted colleagues. Set up a stall related to Earth Day or Veganuary, or engage colleagues in climate games. And don't be too hard on yourself; Practice makes perfect!
Caring for the environment can be a lonely and challenging cause. It is important to care for yourself, and find a network which shares your interest and values. Change can happen when we are many fighting the same cause:
- Centre for Sustainable Healthcare
- Future NHS Green Group
- Local Green Team
- Plant Based Health Professionals
- UK Health Alliance on Climate Change
Plant-Based Diets is the single most impactful way to prevent environmental change.
Plant-based meals by default have been successfully implemented in multiple New York hospitals, with better outcomes when it comes to sustainability, cost, health, and patient satisfaction. There are similar movements in the UK, urging health professionals to sign the open letter:
Nurses need to build confidence and knowledge about the promotion of sustainable diets. It is important to know that both the British and American Dietic Associations and the WHO endorse that a well-planned, fully plant-based diet can be enjoyed across the lifespan, including during pregnancy and breastfeeding. There is still a lot of stigma around vegan diets. Ethical vegans in the UK being protected under the Equality Act 2010, so it is important to advocate for our vegan colleagues and patients, to normalise plant based diets and further positively impact the planet. Take notice of the Plant-Based options in your workplace. If the choices are poor and doesn't meet nutritional standards; consider using your voice!
Health promotion need to be evidence-based, and the delivery of the information need to be simple, trauma informed, culturally sensitive, suited to every budget and skill level. There are plenty of great resources available at the Plant-Based Health Professionals website, including Plant-Based Eat Well Guides and fact sheets adapted to various conditions and ages. Make sure to share the resources widely within your colleagues and use the resources in health promotion!
Reducing Food Waste
Adapting plant-based by default meals has been found reducing food waste; the meals are more inclusive coming to allergies, cultural and religious restrictions, as found in the Greener by Default project. Currently one in six meals in NHS hospitals are left uneaten(4). Find further ideas and read about the challenges faced through a QI project on food waste project involving nurses in Wales:
Health professionals need to be aware of the link between animal agriculture and infectious diseases
We need to increase our knowledge about how animal agriculture links to antibiotics resistance, the spread of zoonotic diseases and influenza outbreaks, due to changes to biodiversity, deforestation, and disruption to ecosystems. In addition, the heating of the planet also increases the spread of dengue and malaria. This article from India considers how nurses roles might change due to emerging zoonotic diseases.
’Reduce, Reuse, Reprocess, Renewable, Recycle’
Clinics
Heating and Lights
The acronym TLC – Turn off equipment, lights out, close doors is getting well established in preventing climate change and saving health care costs. Turning off equipment and lights and controlling temperatures can lead to great savings, as demonstrated by Operation TLC piloted at Barts Health which resulted in a saving of 2,200 tonnes of carbon a year across six sites! (7). Is your workplace conscious about TLC?
- Turn off monitors, printers, and enable automated sleep mode
- Turn off lights overnight, during daylight, when room not in use
- Close doors and control temperature.
Water
Talking and keeping things on the agenda, is the most important thing nurses can do around the strategic decisions of sustainability. Staff nurse Dan Speakman's persistency in lobbying the capture of waste water led to water saving which was after years recognised and adapted. Another project, showed how upgrading the water system, saved nursing time used for heat disinfection. Please read more about the projects below:
Waste management
"Gloves Off" is probably the most well-known sustainability campaign, and may be a good start have this not yet been implemented in your workplace:
In 2017, the NHS sent 15% of its waste to landfill, a total of 47,000 tonnes, a weight equal to 650 times the Space Shuttle. (Resource 7). Using the correct bin and teaching your colleagues about this, by for example sharing the video below, may significantly reduce your workplace environmental impact:
Operating theatres are well known having a high use of single use plastics. Nurses working in operating theatres may want to look into the resources below about nurse-led projects and also find good resources and check-lists from the Royal College of Surgeons for inspiration:
62% of all emissions in the NHS are attributable to the supply chain. Correct storing and tidiness is important to avoid missing out of expiring items, alongside conscious ordering of supplies. It is important to know that some unused items may be sent back to the producer who can retest the item and provide a new expiry date to prevent unnecessary waste. Get further inspiration from the sustainable purchasing resources below:
Around 25% of NHS carbon emissions are from medicines. The majority of these emissions result from the manufacture, procurement, transport and use of medicines (20%), with the remaining 5% specifically from inhalers (3%) and anaesthetic gases (2%). There is a huge need for nurses to consider their role in addressing local practices. However, there is also a role for advocating to reduce the national procurement of the most environmentally harmful drugs and preparations, and their eventual removal from national formularies.
Evidence shows that the number of items dispensed by primary care providers has doubled in recent years, from an average of 10 per person in 1996 to around 20 per person by 2020. A recent report estimated that at least 10% of prescriptions in primary care need not have been issued. Adverse effects of medicines account for 6.5% of hospital admissions.
We need to encourage an increased connection to nature by promoting green spaces for both staff and patients
The benefits of climate action on health is clear, and nurses have a key role in promoting the health benefits planet friendly diets, exercise by limiting travel, stress management by using green spaces, and avoiding substances. As poor diets, smoking, physical inactivity are the leading cause of chronic ill health, nurses need to be a part of the shift to reduce unnecessary prescriptions required.
Focusing on the climate benefits can create innovative promotion of connection to green spaces and wellbeing.
Work from home, cycle or walk to work
Walk, cycle, or use public transport when possible – active travel is also good for your health and the environment!
An Urgent Community Response Team, implemented the use of electric vehicles to improve their work, and District Nurses in Dorset moved over to use electric bikes for their travels to see patients:
Digitalisation
Is your workplace operating like this picture?
Digitalising our work is a large part of the plan to move towards Net Zero. However many do not think about how we in the meantime by using hybrid methods, end up duplicating the environmental print of our work.
- How many of the nurses you know are still having a paper diary in addition to their digital? Or services writing on papers, which then are digitalised?
- How many of your workplaces are still saving the same documents in multiple locations?
- How many are still sharing large files, including word/pdf's in their emails rather than sharing links from either from the internet or the secure drives?
- How many of you have large archives of old emails?
- How many of us are guilty in sending two or three emails, rather than one?
This is called the "rebound effect". An email has 1/60 times the carbon footprint of a letter but if you end up sending 60 times more emails than you would have sent as letters then there is no carbon saving.
Nurses are an important part on picking up on these challenges, and support the move towards digitalisation in our workplaces.
- Contact your IT team to see whether there are ways you can digitalise your work
- Rehearse and build your confidence making digital notes (sticky notes makes it easy to take and find back to information!)
- Spread the word, and question the practices of your team.
- Consider email signatures noting you will not respond unnecessarily due to the environmental impact (or use an emoji response instead).
- Get to know local guidelines around email and document keeping and archiving.
- Use climate and sustainability games or exercises for your colleagues to better understand the impact.
- Advocate for your NHS Trust to use an environmental browser, such as Ecosia
Political Influence and Campaigning
"Focus area one: Protecting our planet. This focus area will see nurses and midwives champion sustainability, advocate for those most impacted by climate change and deliver evidence-based lower carbon care." Dame Ruth May
Campaigning is important to promote change. It can anything from signing a health and climate related campaign, to volunteering or participating in local climate march. By using our position as a trusted profession, we can act as important role models and make change by using our networks. Nursing is political.
Tools to measure and evaluate change
Using good, trustworthy data to be able to calculate the climate impact is important to ensure that our practice is evidence based. There are many good tools available, and these are some of them:
Gaining further knowledge through carbon literacy training and planning tools, may be a key part of carrying out your project or writing up your Business Case.
The Centre for Sustainable Healthcare has brilliant resources available on their website, including a competition where you can enter your project: