Leading Environmental Health Awareness to Transform Nursing Practice

In 2013, Nevada joined a handful of state nursing associations committed to enhancing their nurse’s level of knowledge about environmental health (EH). As the single largest group of healthcare workers, it is essential that nurses have the knowledge to recognize and address environmental hazards (biological, chemical, radiological, and physical) that may adversely influence their patients and the community at large. Through increased awareness of environmental risks and risk reduction activities, the 31,000 licensed nurses from across this frontier state could best advocate for quality health care and EH initiatives.

The environment is one of the four domains of nursing (Kim, 1998). Not surprising, Nightingale’s Environmental Theory (circa 1860) asserted that the focus of nursing was to alter the environment in order to affect change in patient or population health. Environmental factors addressed by Nightingale included purity of air and water, food supplies, drainage, cleanliness of patient and environment, sunlight, temperature and noise. Years later in 1986, the International Council of Nursing called upon nursing’s’ responsibility to participate in efforts to safeguard the environment, conserve the world’s resources, study how their use affects mankind, and how adverse effects could be avoided. In 1995, the United State’s Institute of Medicine recommended EH competencies for all nurses. The American Nurses Association later published the document titled “ANA’s Principles of Environmental Health for Nursing Practice with Implementation Strategies” in 2007. This document presented ten EH principals and associated resources (i.e., precautionary principal), activities and opportunities suitable for the individual nurse, healthcare team, facilities, or communities. Today, schools of nursing are gradually incorporating EH principles into baccalaureate and advanced degree curriculum.

Nursing has an important role regarding global EH issues. The new Sustainable Development Goals offer nursing the opportunity to advance our practice and collaborate with other disciplines to affect change on a global level. The priority areas address EH by including sustainable agriculture, water access, climate and oceans, and sustainable/renewable energy sources. Nursing now has an opportunity to serve locally on environmental initiatives, thereby resulting in regional transformation.

Nursing can lead change by forming coalitions or committees within their region. Specific aims of the EH Committee of the Nevada Nurses Association include: (1) educating all regional nurses about principals of EH, (2) informing nurses in an unbiased manner on EH issues unique to the region, and (3) representing nursing on regional and national events or initiatives that focus on improving the environment for promotion of health. A column in the state-wide, quarterly newsletter educates and informs readers on region-specific EH issues. Non-nursing experts co-author with nurses and present on issues in a state-of-the-evidence manner, yet also recognizing cultural or political biases. Columns are dedicated to environmental matters such as climate change occurring in the Western United States, and radon gas toxicity along with information for testing households. Since 2013, Nevada’s nurses have participated in earthquake preparedness and drills across Nevada to minimize casualties and damage due to the high risk of seismic activity in the state. In addition, high intensity and unpredictable wildfires of the past decade have produced record-level particle air pollution for the region, thus affecting the health of vulnerable populations. The EH Committee responded in a timely manner releasing information on toxicity of fine particle air pollution and evidence-based interventions for use by nurses and their patients. Moreover, EH Committee members represent nursing on multidisciplinary task forces and advocate for the general public during regional or national events.

Regardless of region or country, we as nurses share an urgency to lead and play key roles in transforming health through environmental advocacy. In this next biennium, nurses have the opportunity to form or join EH coalitions that improve health through environmental stewardship. Such risk-taking leadership will require vision and support from all of us in the global nursing community.