AJN Article-March, 2005: Catching The Environmental Health Wave

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American Journal of Nursing

March, 2004 - Volume 104, Issue 03

Issues Update

Catching the Environmental Health Wave
The ANA, nurses work to improve health care industry’s impact on the environment

By Susan Trossman, RN

Here are just five reasons why nurses should care about the health care industry’s impact on the environment:
1. The money that health care facilities spend on hazardous waste disposal could be used to increase RN staffing.
2. Potential neurologic problems could be prevented in some 60,000 children annually, if those children are not exposed to mercury through their mothers’ diet while in utero.
3. Fewer people will die from cancer caused by dioxins released into the environment when polyvinyl chloride plastic supplies, including iv bags, are manufactured or incinerated.
4. Nurses can better protect their own health if safer products, such as latex-free gloves, and practices are implemented in their workplaces.
5. Florence Nightingale would be pleased to know that nurses are continuing the tradition of ensuring that patients have a safe, clean environment in which to heal.

Committing to a healthy environment

In 1997, the ANA’s house of delegates,  which creates ANA policies, called on the association to work to eliminate the use of products that contain mercury, such as thermometers, sphygmomanometers, and fluorescent lighting, as well as the widespread practice of incinerating medical waste.

The ANA then joined Health Care Without Harm (HCWH), an international coalition of professional groups, hospitals, and other community groups that combines strength and resources to promote environmental health. One of its main strategies to lessen the health care industry’s impact on the environment involves front-line health care workers in waste reduction activities, such as recycling programs, as well as in the selection of earth-friendly products and equipment at their facilities (for more on the coalition, go to www.hcwh.org).

More recently, the ANA partnered with the Environmental Protection Agency, the American Hospital Association, and HCWH in launching Hospitals for a Healthy Environment (H2E). The primary goal of H2E is to provide health care professionals with the tools they need to reduce waste produced by health care facilities in the course of doing business (for more on the H2E effort, go to www.h2e.org).

“Health care facilities are a huge producer of waste,” said Anna Gilmore-Hall, MS, RN, director of the ANA’s nurse advocacy programs. “When they choose to incinerate that waste, they essentially are spewing out toxins into the air we breathe and the water we drink. The ANA’s position is that we wouldn’t have to treat as many people if they didn’t get sick from these hazards in the first place.”

In October 2003 the ANA board of directors agreed that the association should be an advocate of the use of the “precautionary principle.” This means that before new products or work practices are implemented in health care and other community settings, research must show they will not harm public health.

“Currently, chemical companies keep producing with little regulation or testing, and without any regard to how many generations down the line might be harmed by their products,” said Ann Melamed, RN, environmental health specialist with the ANA. “By utilizing the precautionary approach, the responsibility is put on the chemical industry to prove the product is safe.”

A movement builds

Nurse education lies at the heart of the ANA’s environmental campaign. One major effort is the ANA’s “RN No Harm” program, a train-the-trainer project to be held for the second time June 25-26 in Minneapolis as part of the ANA’s preconvention program.

“Nurses don’t need to have a PhD to be an advocate of environmental health,” Melamed said. “The RN No Harm program provides nurses with a working knowledge of public health and the environment and the resources to speak to other nurses, legislators, council members, and their community about it.”

Since participating in the March 2003 RN No Harm workshop, Florida Nurses Association (FNA) member Patrick Gardner, MPH, RN, spoke about environmental hazards, including the plastic softening agent DEHP, at the FNA convention in September 2003. He also helped lead an eight-hour program on environmental and chemical risks called “Nurses’ Role in Protecting Florida’s Communities” for some 60 public health nurses and other professionals from around the state.

“These programs help nurses to identify environmental problems, understand their role in risk assessment and management, communicate potential environmental threats to policymakers and the public, and work to reduce or eliminate risks,” Gardner said. “Nurses who participate in these programs will not look at their environment—or that of their patients—the same.”

He said one key component of the RN No Harm program and his efforts is the incorporation of “action steps” that give nurses real strategies to tackle what could be viewed as an overwhelming issue.

“We not only tell them that health care facilities produce 6,660 tons of waste per day, but how they can reduce waste at their facilities,” Gardner said.

Pamela Ortner, BSN, RN, COHN-S, has been a committed advocate of environmental health since she first helped shut down a public incinerator in 1988 that was sending out harmful toxins 250 feet from schools and homes in her Michigan community. In 2000 she worked with other activists to persuade a hospital to replace its practice of incineration with a system that’s better for the environment and includes using energy-saving lighting and recycling.

Since participating in the ANA’s RN No Harm project, she has educated nurses nationwide on environmental hazards and risks, alternatives to harmful products and practices, strategies to influence purchasing decisions, and other waste management practices.

“Environmental health advocacy is a nursing role,” said Ortner, a Michigan Nurses Association member. “Advocacy by nurses is necessary if a stronger, more prevention-oriented model of nursing practice is to be established.”

Other efforts, advocates

In the mid-1990s the Maryland Nurses Association (MNA) joined a state coalition to build awareness about the impact of pesticide use on public health, particularly among children. And in the past several years the association has taken on an increasingly heavy environmental agenda, according to MNA executive director Kathryn Hall, MS, RN, CNAA. Already a member of HCWH, the association was the first state nurses organization to sign on as a “Hospitals for a Healthy Environment champion” to help that coalition achieve its pollution-prevention goals.

Hall herself has become an environmental health activist.  She addressed the role of professional nurses associations at a Novem­ber 2003 H2E teleconference, cosponsored by the ANA, aimed at helping nurses implement environmental improvements.

“I believe state associations have a responsibility to protect nurses and patients by educating RNs about environmental risks and ways to effectively address them in their workplaces and communities,” Hall said.

In her presentation, she en­courages other professional associations to make environmental health part of their legislative and practice agendas and collaborate with experts in other fields to ensure their reach is broadened.

Further, Hall helped to promote the “Nurses, Mothers, Babies” conference in May 2003 in Washington, DC, which also was cosponsored by the ANA. More than 100 nurses attended the conference, which addressed everything from the effect of disinfectant products on indoor air quality to the leaching out of toxic chemicals from medical products used in NICUs and other vulnerable patient settings.

The MNA continues to run articles on environmental health in every issue of its quarterly news­letter, and Hall shares those stories with some 20 other CMAs.

In another national effort, the ANA has an active role in presenting “CleanMed 2004—The Third Annual Health Care Conference on Environmentally Preferable Products and Green Buildings” on April 14–15 in Philadelphia. The conference is focusing on the use of “greener” cleaners, latex elimination, computer recovery, and other environmental trends. The ANA played a key role in previous conferences that focused on measures including reducing mercury emissions and patient exposures to plastic-related toxins.

These efforts just represent a small sample of the advocacy efforts the ANA, its CMAs, and nurses nationwide have taken on. And nurse leaders urge others to help them spread the word about environmental health.

“Our environmental agenda comes from our legacy—Florence Nightingale,” Hall said. “Nurses and patients are ex­posed to so many environmental risks. We need to be strong advocates for clean air and water—now more than ever.”

For more on the ANA’s efforts, call Ann Melamed at (415) 841-9508.


Susan Trossman is the senior reporter for the American Nurse, published by the ANA.

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