Analysis: Why nursing needs to act now on sustainability

Nurses championing the green agenda stressed the issue cannot wait any longer and told Nursing Times how Covid-19 had almost given services a “fresh start” to re-evaluate practice and make positive changes in the interest of the environment.

“It’s been something that has certainly galvanized conversations among nurses around how can we work differently not just now, but after the pandemic”

Rose Gallagher

Though vital for protection during the pandemic, the millions of extra personal protective equipment (PPE) items used since last spring has been an ongoing cause of concern in terms of its detrimental impact on sustainability efforts.

In addition to Covid-19, nurses and colleagues are working at speed to address the backlog of elective procedures, which would also likely contribute to a rise in waste disposal, noted Rose Gallagher, professional lead for infection prevention and control at the Royal College of Nursing.

“Whenever we deliver care, undertake procedures, there is always waste. So, the busier the NHS is, the more it consumes, the more it produces,” she told Nursing Times.

However, the pandemic had “really highlighted some of the challenges around climate change and sustainability, because of the focus on PPE”, noted Ms Gallagher. Nurses had become “very acutely aware of how much waste was being produced”, she said.

Rose Gallagher

“While they accept that it is absolutely necessary for the protection of staff, they were able to really see the consequences of the amount of waste that we can produce in health and care,” said Ms Gallagher, who described it as a “valuable lesson” for staff.

“It’s been something that has certainly galvanized conversations among nurses around how can we work differently not just now, but after the pandemic,” she added.

Figures suggest the health and care system in England is responsible for an estimated 4-5% of the country’s carbon footprint. Air pollution is linked to heart disease, stroke and lung cancer, contributing to tens of thousands of deaths a year, while the changing climate is leading to extreme weather events that can put lives at immediate risk.

Not long before the start of the pandemic, in January 2020, NHS England launched the ‘For a greener NHS’ campaign.

It called on nurses and colleagues to ramp up efforts to cut their carbon footprint at work. The initiative came as part of a country-wide effort to reach net zero emissions by 2050.

Ms Gallagher said national work to address the impact of the NHS on the environment, such as through the UK Health Alliance on Climate Change, of which the RCN is a member, had “continued behind the scenes” during the pandemic.

It was “now increasing at pace” ahead of the United Nations Climate Change Conference (COP26) due to be held in Scotland later this year, she noted.

“We’re all safe in the knowledge that we’ve got all of our PPE, and it is reusable, so we are not filling up clinical waste bins with infected waste”

Rhea Conn

“This moment in time is really a stocktake,” she told Nursing Times. “We are looking at what needs to be done [and] how fast we need to take action.”

From speaking to other nurses, Ms Gallagher believed that it was built-in to the profession to want to support and promote health and wellbeing, stressing how it extended to the impact of climate change.

“Part of our role is around the physical delivery of care, but actually, the role of nurses is much wider than that,” she said.

“It is inherent in our nature to want health and wellbeing, and climate change will impact on all our health and wellbeing.

“It is about having a sustainable workforce because we have a healthy workforce, and that we have a healthy workforce that can deliver care and is not be inhibited by floods… and we are able to care for our patients that are affected by climate change.”

Rhea Conn

In some ways, such as the shift to virtual appointments and sourcing PPE supplies more locally, Covid-19 had helped to reduce carbon emissions through less travel and transport use. Some nursing teams have also been developing initiatives to introduce more reusable items into their workplace, including PPE, cups and cutlery, and sharps bins.

Senior sister in critical care services, Rhea Conn, has been leading a sustainability team at Sandwell and West Birmingham Hospitals NHS Trust for more than 10 years.

Working through the pandemic had, of course, been “very stressful” she noted, but she had made sure that efforts to practice sustainably were not lost.

During the first wave last spring, reports across the country that PPE was in short supply had led the team at Sandwell General Hospital to seek washable and reusable equipment.

The team then introduced reusable coveralls, as well as reusable respirators and hoods, so that staff each had their own masks. Ms Conn was currently looking to introduce reusable fluid resistant surgical masks that can be washed alongside staff uniforms.

Knowing that Covid-19 was “going to be with us for a long time”, it was important that her team had the right protection in place, and it was a bonus that it was helping the environment too.

“We’re all safe in the knowledge that we’ve got all of our PPE, and it is reusable, so we are not filling up clinical waste bins with infected waste,” she told Nursing Times.

“This could be a time to inspire innovation, and to inspire a time of sustainable change to make a greener recovery from Covid-19”

Jennifer Blake

In terms of PPE, Ms Conn stressed that the pandemic had forced change and introduced new ways of working that should be kept indefinitely, for the benefit of the environment.

The introduction of reusables was here to stay, she said, adding that her team would avoid “throwaway” PPE going forwards.

“We have almost got a bit of a fresh start with Covid – it has given us a chance to re-evaluate things and make changes,” she said.

Newly qualified nurse Jennifer Blake agreed that now was the time to harness opportunities for change that the pandemic had provided and ensure sustainability was at the core of health and care services.

“We’ve used a lot of resources through the Covid-19 pandemic, understandably, for infection prevention and control. But now’s the time to look to the future,” she said.

“Organisations are looking at what they can do to make practices better, and this could be a time to inspire innovation, and to inspire a time of sustainable change to make a greener recovery from Covid-19,” she said.

Jennifer Blake

Ms Blake, who recently finished her adult nursing degree at Glasgow Caledonian University, had focused her dissertation on how nurses could “contribute to the improvement of sustainability in response to the challenges of climate change”.

Her research showed the need for a “multifaceted approach to prepare and empower nurses” to promote sustainable change in the workplace.

She believed it was key to inspire and motivate nurses before they started practice as registered nurses and, following her research, decided to raise it with her university.

A plan had since been agreed and, starting with the next intake of students later this year, the topic of sustainability was hopefully going to be embedded into the nursing curriculum at Glasgow Caledonian University.

This would be routed into simulation activities, for example, where students would be encouraged to think about the materials they were using, where they came from and how they dispose of them, noted Ms Blake.

“We need to see nurses and midwives at the top table talking about these issues”

Stuart Tuckwood

“If we can embed those behaviours in university, they could then become habitual and become commonplace to translate into practice,” she said.

“When nursing students go out on placements, they are then more aware of the products that they’re using, and thinking about it from an environmental slant, and can maybe challenge practices as well as influence change.”

Unison’s national nursing officer, Stuart Tuckwood, added to the sense of urgency that tackling climate change was something that could no longer wait.

For him, it was crucial that an ongoing focus was placed onto the “co-benefits” of improving sustainability in health and care services.

Stuart Tuckwood

“It is about how the actions that we take to reduce carbon emissions can improve people’s health,” he said.

“It is a human health issue. It is not an abstract thing that is going to have an effect in 40 or 50 years – climate change is already costing people’s lives.”

One change the NHS “absolutely needs to do” is to “get better at promoting active travel and public transport” among its workforce, noted Mr Tuckwood.

He urged employers to do more to support staff with free bus passes, for example, or to increase funding for cycle-to-work schemes.

Employers should also consider exploring the benefits of laundering uniforms in-house, as opposed to staff washing them at home, he added.

Group washes on site could potentially be more efficient than staff washing their own uniforms on 60-degree washes at home, he noted.

Overall, in order to influence positive change, it was vital that nurses were “leaders” on the green agenda and that they were listened to at the highest levels, said Mr Tuckwood.

“We need to see nurses and midwives at the top table talking about these issues,” he told Nursing Times.