Preparing Graduate Nursing Students to Lead Nursing Green Teams: Approach and Identified Greening Opportunities and Solutions

Health care waste and pollution are world-wide problems (World Health Organisation 2018). Nurses are well-positioned to be leaders in addressing waste, climate change, and other pollution from health service delivery; however, they often are unaware and/or underprepared to take action (Akore Yeboah, Rodrigues Amorim Adegboye, and Kneafsey 2024; Luque-Alcaraz et al. 2024). Internationally, nurses are increasingly being called to action to apply environmental health concepts to nursing practice and follow the ethical principle of first do no harm (International Council of Nurses [ICN] 2018; American Nurses Association [ANA] 2007, 2010). The ICN published a “Nurses, Climate Change, and Health Policy Statement”, indicating that nurses have a shared responsibility to sustain and protect the natural environment from depletion, pollution, degradation, and destruction (ICN 2018). The Institute of Medicine, ANA, and American Public Health Association (APHA) developed and disseminated standards of practice and policy statements that guide nurses to provide care in a way that is environmentally safe and healthy and become environmental health activists in their work settings (ANA 2007, 2010; APHA 2022; IOM 1995). Recently, the ANA disseminated a position statement, “The Nurse's Role in Addressing Global Climate Change and Human Health,” which describes the critical roles that nurses must play in addressing climate change (ANA 2023). A common theme in these guidelines is the need to educate nurses globally about environmental health concepts, including climate change, and integrate this content into nursing school curricula to prepare nurses to apply environmental health principles in their practice and advocate for climate-smart health care (ANA 2007, 2023; ICN 2018). The purpose of this project is to educate graduate nursing students about environmental health, the contributions of health services to climate change and other forms of pollution, and strategies to mitigate these contributions, and engage students in working collaboratively as team members to identify opportunities to green their respective work environments and plan specific organisational changes to address the identified problems. Climate change is occurring because some gases in our atmosphere absorb energy from sunlight, trapping this heat rather than allowing it to be reflected back into space (United States Environmental Protection Agency [US EPA] 2023a). These greenhouse gases include carbon dioxide, methane, nitrous oxide, and fluorinated gases (U.S. Energy Information Administration [US EIA] 2022; US EPA 2023b). Approximately 80% of greenhouse gases from human activity have been attributed to carbon dioxide (US EPA 2023b). This energy from the sun is important to life on Earth and supports key processes, such as photosynthesis (US EIA 2022; University of California Regents [UCR] 2024). However, the energy budget, or the amount of energy that is absorbed versus reflected, needs to be balanced (UCR 2024). Currently, about 71% of the sunlight reaching the Earth is absorbed by the Earth's atmosphere and surface, which is slightly out of balance, resulting in warming of the planet (UCR 2024; University Corporation for Atmospheric Research 2024). This warming is associated with more extreme weather, rising sea levels, and adverse physical and mental health effects, especially among vulnerable populations (US EPA 2023c). Health service organisations contribute to climate change through direct and indirect activities, including through energy use, anaesthesia gases, use of plastics, waste management practices, and production and transportation of supplies, equipment, pharmaceuticals, and food (Eckelman et al. 2020; Gerwig 2015; Seervai, Gustafsson, and Abrams 2022; U.S. Department of Energy [US DOE] 2021, 2023). About 10% of energy consumption in commercial buildings in the United States is attributed to health services, from heating, cooling,ventilation, lighting, office equipment, refrigeration, medical equipment, and other uses (Shen et al. 2019; US DOE 2021, 2023). Inhaled anaesthesia gases, such as isoflurane, sevoflurane, and desflurane, are greenhouse gases that are emitted into the environment as waste gas, often vented off rooftops (Andersen, Nielsen, and Sherman 2023; Vollmer et al. 2015). Plastics, which are made from oil, gas, and coal, account for about one-third of health service waste (Health Care Without Harm 2021; Rizan et al. 2020). They contribute about 4% of total greenhouse gas emissions through their lifecycle (Organisation for Economic Co-operation and Development [OECD] 2023). Health service organisations in the United States generate more than five billion pounds of waste per year (Wisniewski et al. 2020). The amount per patient day ranges widely in different countries from approximately one pound in Morocco to 24 pounds in the United States (Janik-Karpinska et al. 2023). A large proportion of medical waste is incinerated, which has a major effect on climate pollution (Bauman 2019; Zero Waste Europe 2019). Indirect emissions occur from producing and transporting supplies, equipment, food, and other items to health service organisations, accounting for approximately 80% of emissions (Seervai, Gustafsson, and Abrams 2022). Nurses are well-positioned to support decarbonization of the health sector and lead and advocate for climate-smart health care initiatives (ANA 2023; Butterfield, Leffers, and Vasquez 2021). One way that nurses can get involved is to form or join green teams, which are voluntary groups who collaboratively plan and implement sustainability initiatives and educate and inspire others to take action (McDermott-Levy 2011; Mejia and Sattler 2009; Practice Greenhealth n.d.). Several green teams guides provide tips for creating green teams, such as using a top-down and bottom-up approach, including team members from multiple disciplines, planning a kick-off and follow-up meetings, developing a mission statement, conducting a needs assessment, collecting baseline data, creating team roles and norms, identifying champions, establishing priorities, developing measurable goals, monitoring and evaluating outcomes, and disseminating success stories (Practice Greenhealth n.d.; ZeroWaste Schools n.d.). The American Association of Colleges of Nursing (AACN n.d.) calls for a shift in nursing education to competency-based education. The AACN defines competency-based education as “a system of instruction, assessment, feedback, self-reflection, and academic reporting that is based on students demonstrating that they have learned the knowledge, attitudes, motivations, self-perceptions, and skills expected of them as they through their education (AACN This is reflected in The for Nursing (AACN 2021, 2023). Several to apply competency-based education and that have to the and to on skills and and that provide to apply critical skills and the approach, and provide and and and (AACN 2024; 2023). The AACN concepts, and and are to environmental education for nurses (AACN 2021). One AACN that is to environmental health is opportunities for and organisations to health (AACN 2021, A is and the of a plan for initiatives (AACN 2021, The Environmental Health a of environmental health with developing a of environmental health and 2020). 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