Climate change and sustainable healthcare practices in nursing: A multi-country exploratory online survey

Introduction: Healthcare systems are responding to the immediate and long-term impacts of climate change by providing care, and implementing carbon reduction initiatives. The nursing profession possesses substantial potential to advocate and embody sustainability values. However, a proportion of nurses remain unaware of the intricate linkages between nursing practices and climate change; hence this study explored nurses' and midwives' awareness, perceptions and attitudes regarding climate change and sustainable healthcare practices. Methods: A cross-sectional online survey using a mixed-methods approach was conducted, targeting registered nurses and midwives. Utilising a convenience sampling technique, a total of 473 participants from 56 countries completed a self-administered survey comprising both closed and open-ended questions. Descriptive analysis was used for the quantitative data and thematic analysis was conducted with the qualitative data. Results: The majority (86%) of respondents reported awareness of anthropogenic causes of climate change; however, only 33% were aware of the term 'net-zero healthcare'. Common barriers noted were inadequate implementation of environmental policies (76.9%), work overload (72.2%), lack of organisational support (60.3%), and less time to think about environmental impact (55.8%). Three main themes were identified from the qualitative data, including (i) sources of healthcare carbon footprint, (ii) actions towards net-zero healthcare, and (iii) factors influencing the nursing role in environmental sustainability. Conclusion: The findings highlight inadequacies in healthcare's climate action efforts, emphasizing the need for healthcare organizations to evaluate their climate policy awareness. Integrating climate change and sustainability into nursing curricula and embedding carbon reduction policies within healthcare organizations are essential for improving climate action.