U of T students share perspective on nurse led sustainability initiatives in healthcare

11 March 2021

Cluster of large urban hospital and office buildings

The health system in Canada is a major contributor to the country’s carbon footprint, and with mounting concerns over the global climate crisis, there is a growing call for a focus on sustainability within the health care system.

But who should be involved in leading this charge?

“We feel nurses, are uniquely positioned to lead on sustainability because they are experts in the organization and delivery of healthcare and frontline witnesses to the impact of climate crisis.

Now, more than ever, nurses need the time, resources and authority to organize and innovate within healthcare” says Quinn Grundy an assistant professor at the Lawrence Bloomberg Faculty of Nursing.

Yet, nurses are often left out of integral decision-making processes that directly impact the ability of health systems to focus on sustainability.

In a recent article Grundy alongside graduate students from U of T Nursing, discussed the capacity of nurses to lead on these issues and describes their ability as currently untapped. Though they are involved in everything from medication dispensation to procurement of resources and supplies, current methods of action around greener or more sustainable initiatives rarely extend beyond engagement or a focus on an individual’s actions.

In an effort to illustrate the complexity of this issue, two graduate students involved in the paper Nicole Meleca and Nicole Mills, are sharing their perspectives on ways nurses and system level leadership can advance sustainable practices in health care.

What do you feel are some of the barriers facing nursing leadership on the issue of sustainability in healthcare?

Meleca: Nursing leadership capacity on sustainability in health remains invisible. Nurses report a lack of knowledge regarding the actions they can take to mitigate climate change. This is likely because nursing literature and education focuses on the “environment” at the local level, not the systemic level. As a result, responsibility for interventions are often directed at an individual as opposed to a system.

In my own experience working in acute care, sustainability efforts are targeted to the individual’s actions (like encouraging staff to walk to work) instead of drawing attention to the fact that the structure surrounding healthcare services were not designed to be environmentally sustainable.

Mills: Another barrier currently is the pandemic. Many sustainability initiatives have been pushed to the back burner and single use and PPE items are being used once or as few times as possible, because of the risk of infection. Looking to the future, I hope there will be a greater focus on providing nurses with an opportunity to lead in this area, and providing them with time, resources and authority. This requires a major shift in the planning phase around these initiatives in order for them to be successfully implemented in daily practice.

Why do you think nurses are uniquely positioned to lead on this particular issue? 

Meleca: As nurses, we witness first-hand the consequences of climate change and play a central role in health promotion. Nurses represent the largest group of regulated healthcare professionals and we are stewards to countless health-related resources. We have the knowledge and expertise to engage at all levels of the healthcare system, and we are also one of the most trusted professions.

Mills: I work in a pediatric centre and an area I see a lot of waste in is medication dispensation. The dosing is out of our control because it comes from the pharmacy, but the background knowledge on how to dispense or where to dispose of medication in a sustainable manner is something nurses could learn about and lead. We are very aware of waste in our role and currently are not given the tools to put our knowledge into practice and promote sustainability.

What are some ways nursing practice can move beyond engagement and transition towards a more active role in sustainability?

Meleca: One of the first steps is recognizing that climate sustainability in healthcare is a systemic problem and not an individual one. Nurses should see it as a priority to adapt and to accept responsibility and tackle this issue. Enhancing the nursing curriculum to incorporate environmental sustainability concerns would also be key and allow nurses to have greater influence on nurse-led models of care.

Sustainability initiatives should not be extracurricular activities. They should be embedded into policies and incorporated into the structure of organizations. Nurses can work with organizations to change these structures to incorporate sustainable initiatives such as implementing recycling in hospitals and preparing meals onsite with locally sourced foods. It is time for nurses to lead!

Mills: I would encourage nurses to explore what opportunities do exist to lead whether it be at the bedside or in public health nursing, so that there is more nursing representation at the leadership and policy making level.

Getting involved in group initiatives is another way to pursue a more active approach. Emerging Leaders for Environmental Sustainability in Healthcare (ELESH) is a group situated at the University of Toronto, that provides students in particular an opportunity to get involved in addressing issues around environmentally sustainability.