Promoting Environmental Health: Advocating for Patient Safety
Nurses in the health care sector have played a vital leadership role in leading efforts to improve environmental practices in their facilities and in their communities. Nurses have led the way in educating colleagues, health care leaders, and other stakeholders about the importance of sustainability in health care, but there is still much to do. As members of the World Health Organization's Health Security and Environmental cluster wrote recently in the American Journal of Preventive Medicine, "The health sector is one of the most trusted and respected sections of society, and it is one of the largest employers and consumers of energy. This presents both a responsibility and an opportunity to be an 'early mover'to achieve climate neutrality in its own operations and to demonstrate that this can go hand-in-hand with improved effectiveness and cost savings."1pp(424-425)Sustainability is defined as "meeting present needs without compromising the ability of future generations to meet their needs."2 How health care organizations go about achieving these goals is dependent on the strong and visible support of nurse leaders.
Outside of health care, businesses have begun to recognize that they need to address a "triple bottom line," which describes a framework for measuring and reporting business performance against economic, social, and environmental parameters, rather than simply maximizing profits or growth. In the case of the "greening" of the healthcare system, the impact is not only on the environment but also on the ability to realize significant savings that could potentially be used for patient care. Applying the "triple bottom line" approach to pollution-prevention initiatives can deliver significant benefits for health care organizations and the communities they serve.3 As a general rule, anything that is good for the environment is also good for human health, and that is especially true in a health care setting. So being "green" is one part of being a healthy hospital. One description of a healthy hospital offered by Hancock4,5 outlines 4 main components. The first 2 components occur within the hospital: "A healthy hospital strives to create both a healing environment for patients and a healthy workplace for staff-the two are usually mutually reinforcing approaches. The third and fourth components of a healthy hospital occur outside hospital walls: A health-promoting hospital tries to be an environmentally responsible corporate citizen and to become a partner in the process of creating a healthier community. As hospitals 'green'their buildings and operations, they are becoming healthy and health-promoting organizations." Progressive hospitals and organizations are now envisioning what the resilient hospital of the future will be that includes green buildings that move beyond "First Do No Harm" to achieving zero net energy, water balance, persistent, bioaccumulative and toxic (PBT) free, and zero waste, and giving resources back to the community. Across the United States, green hospitals are implementing restorative community strategies as part of their sustainability initiatives, such as partnering to develop staff housing near their facilities, restoring degraded sites and returning them to their communities, developing exercise trials, and successfully advocating for expanded public transportation systems.6
There are ethical, health, environmental, social, and economic benefits that result from environmentally responsible health care that should be part of the routine business of a health care organization. There is growing evidence that greener facilities improve patient outcomes, decrease length of stay, and improve the health and performance of staff, while saving money and minimizing liability and compliance risks. One way to ensure that health care organizations are environmentally responsible is for the nursing leaders to assume leadership in promoting "green" practices in the facilities where they work and within their organizations. As nurses we need to be sure that we are making the link between the health of the environment and the health of people and can then translate that link into action. This link must also be a part of nursing education (see the editorial by Barbara Sattler).
Sustainable health care is a global issue. We need to work with our nursing colleagues around the world. Even in developing countries, nurses are taking the lead in sustainable activities in their facilities because as nurses we know that we cannot waste precious resources. As health care professionals who focus on prevention, nurses naturally understand how sustainable practices can aid in prevention of disease and injury. For example, eliminating toxic chemicals and cleaners in hospitals can help reduce asthma triggers for sensitive patients and staff. Exposure to natural light and windows with views have proven to reduce the need for pain medication for some patients and decrease length of stay.
One thing successful green initiatives have in common is leadership and support from senior management. The impact of nursing leadership cannot be overemphasized. The time to act is now. As members of the country's most trusted profession, nurses are excellent advocates for the environment. We pride ourselves on keeping patients safe: safe from falls, infection, wrong medications, and so much more. Promoting environmental health is simply another way to advocate safety for our patients-and our communities.
Issue Editor
Anna Gilmore Hall, RN, CAE
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