Early-career nurses taking the lead on greener healthcare

Every climate-related event – be it a heatwave or freeze, flood or drought, or pollution – can have devastating effects on patients and negative implications for services.

“If we start the talk and we start to use our voice, we will be able to have a large ripple effect with our patients”

Ebenezer Yeboah

As the world continues to experience environmental breakdown, it is no wonder the health and care sector is turning inward for solutions.

Organisations have set ambitious sustainability goals for the next few decades in a bid to curb the climate crisis.

The health service contributes some 4-5% of total UK carbon emissions, while the NHS in England alone is responsible for 40% of public sector emissions.

It has, therefore, committed to achieving an 80% drop in direct carbon emissions by 2032, with the aim of being net zero by 2040.

The Nursing and Midwifery Council (NMC), meanwhile, has promised carbon neutrality by 2030 and net zero by 2040.

It has also pledged to change its education programme standards to place greater emphasis on sustainability, and these are expected to come into force by 2029.

It will require dedication to make these commitments a reality.

The next generation of nurses believe they are perfectly positioned to lead this change and many want to start having a positive impact from day one.

Nursing Times has spoken to a range of early-career nurses who dedicated their pre- and post-registration training, plus research and innovation opportunities, to tackling climate change.

It is these nurses who are trying to make sure that sustainability is rooted in the very fabric of what it means to be a good nurse.

Ebenezer Yeboah, an accident and emergency nurse at University Hospitals Coventry and Warwickshire NHS Trust, is one of them.

He is doing a PhD about nursing in the context of climate change, which he said he hoped would give nurses “the voice to lead sustainable healthcare practices”.

Preliminary findings from his study, which involved 543 participants from 56 counties, revealed that seven in 10 nurses were not aware of a ‘green plan’ in their organisation. Despite this, 89% said they were willing to participate in climate action at work.

Mr Yeboah noted that nursing continued to be ranked as one of the most trusted professions in the world and argued that nurses were, therefore, some of the best people to disseminate ideas about sustainability to the public.

“If we start the talk and we start to use our voice, we will be able to have a large ripple effect with our patients, with our families and even influence policies, government and politicians to start listening,” he said.

His study has found a significant call among the workforce for sustainability to be embedded in the nursing curriculum.

“When it comes to the students, [they] need to be taught… so when they get to the ward, they have good practices, challenge procurement and lead a sustainable project,” he explained.

“There is nothing like that [in] the educational domains of the NMC.”

Introducing sustainability as a topic in nurse education could be achieved in several ways, such as mandatory projects, lectures or placements.

Mr Yeboah added: “Young people of our generation are very interested in protecting the planet. I believe we should bring it into the educational setting.”

One UK university that has been leading the way in sustainability-focused health education is King’s College London.

Last year, its nursing and midwifery faculty was awarded Beacon Site status by the Centre for Sustainable Healthcare for successfully embedding sustainability principles into its student nursing programmes. It followed up that success this year with an award from Nursing Times.

Akira Madams was one of three King’s students recognised for their efforts at this year’s Student Nursing Times Awards, where they were the inaugural winners of our new category for Outstanding Contribution to Sustainability.

Ms Madams told Nursing Times about the impact their project has already had at the university.

She, alongside Victoria Edleston and Kendall Robbins, wanted to reduce the carbon footprint of the clinical skills labs at King’s.

They carried out an audit of the waste produced by the labs to find out whether any could be disposed of differently.

Clinical skills labs are where simulated learning takes place, often using manakins.

“My hope is that sustainability will be embedded into nursing identity [and] your professional identity
as a nurse”

Akira Madams

However, Ms Madams noted that the waste produced in the labs was often being discarded in the same wastestream as clinical waste, so was being sent for high incineration, despite having no exposure to contaminants.

She said: “High-incineration disposal methods are the worst possible ways of disposing of waste for the environment. Almost any alternative to that is going to have a less detrimental impact environmentally.”

In its study, the group collected all waste from the lab bins and, using rubber gloves, sifted through, and categorised the materials.

Some 40% were plastics, while 27% was paper and card, including paper backing to packaging and paper towels.

“That’s 27% that, if it’s not contaminated, could be recycled – quite a hefty chunk,” said Ms Madams.

After the study, the group came up with tangible adjustments that could be made in the labs to improve their carbon footprint.

One example involved rethinking where bins were placed in a learning environment and possibly moving them away from the classroom exit, so people did not rush to dispose of waste without thinking which bin it should go in.

Meanwhile, the group also decided that education around sustainability in the labs should be rooted in inductions for students.

Ms Madams said: “If we could embed some of the teaching on sustainability and recycling your clinical skills waste into teaching, and [students] have to take it as a mandatory thing to use the [clinical skills lab] safely, that’s already embedding a little bit of sustainable values into teaching.”

Ms Madams, who has committed to sustainable practice in her new role as an oncology-haematology staff nurse at Guy’s and St Thomas’ NHS Foundation Trust, said she hoped sustainability would become further embedded in nurse education.

“My hope is that sustainability will be embedded into nursing identity [and] your professional identity as a nurse,” she explained.

“Getting students who are going to join our workforce and then going to work in it for, hopefully, the next 20-30 years, that’s how you’re going to realistically make the changes to meet the net-zero NHS by 2040 targets.”

In an effort to put sustainability at the forefront of nursing students’ minds, some universities have introduced mandatory modules on the subject.

At the University of the West of England (UWE), mental health nursing students do a module on sustainability in public health in their first year.

Jack Holbrook, who is now in his final year at the university, told Nursing Times this module supported him to pioneer research into the effects of climate change and various pollutants on health, and vascular dementia in particular.

He found that higher levels of pollution could increase the prevalence of vascular dementia.

This is because microfine particles, which are related to diesel emissions, can cross the blood-brain barrier, which most other particles cannot.

The study also enabled him to draw connections between poor diet and vascular disease, noting that an unhealthy diet was not only “more damaging to the climate” but also to public health.

“It is unethical to allow people to continue to maintain dietary lifestyle factors that we know have a damaging effect on their long-term health, particularly into old age,” he said.

UWE is one of a handful of universities across the country championing such a module.

Mr Holbrook said the module “drew a very firm connection” between the climate emergency and how it can impact both mental and physical health.

“That module makes use of the fact that nurses are probably in the best-placed profession to look at climate change on a technical level, and to draw a connection between climate change and environmental factors,” he said.

“I’m hoping there might be some sort of scope for me to go on and get sustainability into where I work”

Emma Hansford

Modules such as these, embedded in nurse training, will allow nurses to take a “top-down” approach to sustainability, argued Mr Holbrook.

“It complements the nursing syllabus very well, to the point I’m surprised it’s not taught in more universities,” he added.

In April this year, the NMC published its first ever environmental sustainability plan.

In it, the regulator committed to embedding sustainable practice in its standards of proficiency, as well as those for education, training and revalidation, by 2029, if not earlier.

Anne Trotter, assistant director of professional practice at the NMC, said: “Every aspect of care delivery has an impact on the environment.

“Therefore, nurses must have the tools to practice sustainably and understand the direct connection between improving people’s health and wellbeing, and addressing environmental issues.

“We will explore how all our standards should reflect the need for professionals to address environmental issues, starting with our review of the code in 2025.”

In the meantime, many nurses are taking matters into their own hands, and shaping their education so it includes an element of sustainability.

Emma Hansford, a final-year adult student nurse at the University of Brighton, told Nursing Times she decided to focus on sustainability during her placement on quality assurance practice learning.

Much like Ms Madams, she also did an audit of clinical skills waste at the university, to find out how much was being thrown away.

It was here where Ms Hansford noticed just how much plastic glove wastage there was.

She also realised that student nurses were being asked to wear single-use items when doing simulated training involving manakins, despite there being “no contamination risk”.

In addition, she found that, in practice, many healthcare staff were donning plastic gloves and an apron, just to check the blood pressure and temperature of an otherwise healthy patient.

“To be really honest, I’ve always been really mindful of using gloves and aprons. But it’s only when I got into learning about sustainability that I became really aware of it,” said Ms Hansford.

“And so now, when I go out on placement, I’m always really looking at [whether] people are wearing gloves and what they’re wearing them for.”

Ms Hansford created a training video on unnecessary glove usage, which has now been embedded into the induction programme for all student nurses at the university.

As a result of her raising awareness of glove wastage, the university now no longer makes students wear plastic gloves or aprons when they are doing simulated training.

When Ms Hansford qualifies as a registered nurse, she said she hoped there would be an opportunity to bring the green agenda into her new workplace.

“I’m hoping there might be some sort of scope for me to go on and get the sustainability into where I work,” she said.

One nurse who brought the learning from her studies straight into practice was Amy Barrett, a senior practitioner for the out-of-hours district nursing service at Northern Care Alliance (NCA) NHS Foundation Trust.

During her apprenticeship to become a district nursing specialist, Ms Barrett undertook a 12-month empowerment project to try to promote the public health of her local population.

“I wanted to do something quite big at the time about climate change,” she explained.

Ms Barrett reflected on the role district nurses could play in tackling the climate crisis, noting they were often omitted from NHS sustainability plans.

“When the NHS are looking at improving net zero and carbon emissions, a lot of it factors into the acute setting, but not much of it goes into the community,” she said.

After some research, she proposed swapping the NCA community team’s petrol car for an electric one.

Doing so would not only be better for the environment, but also more cost effective, she said.

She put together a business proposal, the trust accepted it and an electric car was procured.

“It felt good to make a difference and to empower other people,” she noted.

Since completing her apprenticeship, Ms Barrett has become the sustainability link nurse at her trust, which she said she hoped would push the green agenda in community nursing going forwards.

“It’s about being present, really picking up on anything we can support with, or we can implement, in the community,” she said.

“As a manager of the team, I really enjoy seeing other people’s creativity and what ideas they’ve got, and pushing them and empowering them to be able to make changes, because it’s the little changes that make a big difference.

“We need to be recognising sustainability going forward,” she told Nursing Times, indicating that the profession is in good hands as it seeks to meet the challenges of the climate crisis.