By Debra Wood, RN, contributor
April 2, 2010 - Understanding the relationship between environmental health and people’s well-being, nurses are leading health care organizations’ initiatives to recycle, conserve energy and water, eliminate toxins, and eat more locally produced, organic foods.
Anna Gilmore Hall, RN, CAE, calls nurses critical to the success of health care greening initiatives.
“Nurses have been critical to the success of the campaign,” says Anna Gilmore Hall, RN, CAE, executive director of Health Care Without Harm in Reston, Va.
Health Care Without Harm, co-founded in 1996 by Charlotte Brody, RN, has led efforts to virtually eliminate the use of mercury-based medical equipment, close thousands of medical waste incinerators, create markets for safer and healthier products, start a green building program, and develop a healthy food program for hospitals.
Nurses serve on multiple Health Care Without Harm workgroups and hospital green teams. About 1,100 hospitals and health care systems, including the Veterans Health Administration, HCA Inc., and Kaiser Permanente, have joined Practice Greenhealth, a nonprofit membership organization associated with Health Care Without Harm, which provides education, tools and technical assistance to help hospitals implement pollution prevention and sustainability programs.
Beth Schenk, RN, MHI, finds nurses understand the relationship between the environment and people’s health.
“It makes sense for nurses, because nurses treat patients in a context,” said Beth Schenk, RN, MHI, facilitator of women’s health, St. Patrick Hospital and Health Sciences Center in Missoula, Mont., which rolled out its Green 4 Good environmental sustainability program three years ago. “It seems clear: our health is dependent on our environment and other things.”
In 1995, the Institute of Medicine produced the report Nursing, Health, & the Environment: Strengthening the Relationship to Improve the Public's Health and concluded that nurses needed a better awareness of the environment, stating “There is a fundamental need for the entire nursing community to develop a greater understanding of environmental health hazards and the skills needed to incorporate environmental health into practice.”
Many nurses have joined the environmental health movement since that time, according to Barbara Sattler, RN, FAAN, DrPH, a professor at the University of Maryland School of Nursing in Baltimore.
“Nurses are looking at things from a different lens than they had in school,” Sattler said. “They are integrating environment health, knowledge and skills into their professional practice.”
Linda McCauley, PhD, RN, FAAN, considers environmental health a mainstream concern for nurses.
Nursing educators are beginning to introduce basic environmental concepts into nursing curriculum. The University of Maryland offers a master’s degree in community/public health with an environmental health focus.
Linda McCauley, PhD, RN, FAAN, professor and dean of Emory’s Nell Hodgson Woodruff School of Nursing and an environmental health expert, added that she believes nurses have embraced the greening of health care, because they are interested in the environment in general and how it can affect future generations.
“I’m delighted to see it becoming mainstream and not an area of specialty for a few people,” said McCauley, who predicts nurses will continue to champion environmental issues and shape nursing school and hospital green initiatives.
Emory recently held a conference exploring sustainability issues in Atlanta’s health care industry, during which experts discussed conserving energy and reducing health care’s reliance on chemicals and plastic products that consume petroleum and release carcinogenic dioxins when burned.
“Hospitals are about saving lives, so for hospitals to emit one of the most poisonous substances known to mankind doesn’t make sense,” McCauley said.
When Mercy Medical Center in Baltimore decided to build a new facility, its incinerator sat in the way of the construction project. The hospital formed a committee that came up with new ways to get rid of waste and started a greening program, called “Have Mercy on the Earth.”
Paper waste is shredded to protect patient confidentiality, reported Rachel Demunda, Mercy’s director of environmental health and safety. Tons of cardboard are bailed and hauled away, at no cost to the hospital. Batteries and electronics are recycled. The hospital converted from a disposable sharps box to a reusable container, eliminating more than two tons of plastic waste annually, saving money and decreasing the risk of sharps injuries.
“Very often, people think in order to green something in a hospital it is going to be costly, but it’s the exact opposite,” Sattler said. “Very often there is a cost savings.”
For instance, Mercy saved a significant amount of money when it switched to polyvinyl chloride (PVC)/ di-2-ethylhexyl phthalate (DEHP)-free intravenous bags and tubing systems throughout the hospital, eliminating the risk associated with the chemical leaching into solutions or the blood.
Recycling also presents opportunities for hospitals to decrease their waste stream and break even or save money. Beaumont Hospitals, a three-hospital system in Troy, Mich., recycles ChemGuard, used to wrap sterile instruments; kitchen waste; paper; extra construction supplies; batteries; and other items. The health system estimates it has reduced waste by 40 percent since 2008.
Steve Witkowski, RN, has helped lead the efforts at Beaumont Hospitals’ Troy campus to recycle and conserve the Earth’s resources.
“Nurses are leading the way with recycling,” said Steve Witkowski, RN, director of the operating room at Beaumont’s Troy hospital, and a green team member.
“We’re doing it to save Planet Earth,” Witkowski added. “There are cost savings, too. As a hospital, we have reduced our trash pulls from every day of the week to three times a week, because of the recycling efforts.”
Hospitals also are trying to become more energy efficient. Schenk reports hospitals are the second-highest users of energy per square foot, following all-night grocery and convenience stores.
“That’s because hospitals are 24/7, and we have a tremendous amount of activities dependent on electricity, from ventilators and IV pumps to computers and lighting,” Schenk said.
St. Patrick Hospital and Health Sciences Center installed a high-efficiency, low-emissions emergency generator, a geothermal heating and cooling system, and heat recovery units on the boilers.
Beumont’s Troy hospital installed an energy-efficient air-handling system, low-flow plumbing fixtures, and occupancy sensors on the high-efficiency lighting, all contributing to saving energy, water and money.
Food services also offer opportunities for greening. Mercy purchases hormone-free milk, recycles cooking oil into biofuel, dispenses forks and condiments from bulk containers, uses corn-based to-go boxes, buys organic produce from a local farmer, and composts 9,000 pounds of food waste each month.
Gilmore Hall reports some hospitals have gardens on site from which they pick vegetables to serve in the cafeteria or on patients’ trays. She finds hospitals interested in buying meat and poultry without antibiotics and milk without hormones, because officials understand the implication of those things on peoples’ health.
Nurses are bringing a multitude of suggestions to the forefront and leading their facilities toward healthier health care.
“Nurses understand the implications between health of the environment and health of people,” Gilmore Hall says. “Nurses have a responsibility to the patients we serve to do everything we can to treat them in hospitals and for prevention.”
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