Environmental Health and Environmental Justice: The Imperatives for Nurse Leaders

By Nelson Tuazon, DNP, DBA, RN, NEA-BC, CENP, CPHQ, CPPS, CPXP, FNAP, FACHE, FAAN
Fellow, Alliance of Nurses for Healthy Environments (ANHE)
Vice President and Associate Chief Nursing Officer, University Health, San Antonio

Introduction

Climate change presents significant issues and problems to the health, well-being, and quality of life of individuals and is often linked to negative outcomes (Nicholas & Breakly, 2017; Schenk, 2018). Climate change disproportionately affects minorities and indigenous populations. As an influential group of healthcare professionals, nurses have tremendous opportunities to be part of decisions and policies related to climate change. Rafferty (2018) chronicles the significant changes in healthcare, along with the noteworthy contributions of nurse leaders as change agents for a better future in healthcare. However, she laments that although nurses constitute the largest workforce group in healthcare, politically, the voice of nursing has been historically weak. The response from healthcare organizations and staff to address climate change has been relatively slow (Griggs et al., 2017). 

Environmental Crisis in the VUCA World

Some nurse leaders may not have the leadership acumen to deal with significant problems including climate crisis. They may not have faced situations like this before and may not have access to a roadmap to succeed (McClean et al., 2020). Griggs et al. (2017) reported that sustainability, endemic blindness to global issues, environmental numbness, social norms, priority assigned to sustainability, and psychology of responsibility and shame are themes that are associated with barriers to sustainable health care. The world of VUCA (Volatility, Uncertainty, Complexity, and Ambiguity) has impacted the delivery of nursing care and healthcare (Harper & Brewington, 2022). The crisis surrounding nursing education, especially the training of nursing students in their clinical practice, has deprived them of the experience to care for patients. Nurses must also be educated in environmental health and environmental justice.

The Need for Emerging Leadership Competencies to Address Climate Change

Significant changes in healthcare continue to challenge nurse leaders. These leaders are in a position to advocate for environmental health and environmental justice. They are critical members of the healthcare profession who have the opportunity to help protect the planet and advocate for people to enjoy a healthy future (McKimm & McClean, 2020). However, many leaders and managers may not have the management support and leadership competencies to deal with the devastating effects related to environmental health and environmental justice (McClean et al., 2020). New leadership competencies such as strategic agility, adaptability, and flexibility are critically needed to address the pressing issues associated with climate change. Adopting a framework for environmental health based on best practices offers a promising approach to leading healthcare into the future (Kochtitzky, 2014)

The Response of Professional Associations to Environmental Stewardship

Many professional nursing associations, including the International Council of Nurses, have recognized the negative impact and consequences of climate change (Dion et al., 2022, McClean et al., 2020). Nursing organizations have adopted resolutions and have led initiatives to address climate change at the local, national, and global levels (Nicholas & Breakly, 2017). As members of the Texas Organization for Nursing Leadership and the American Organization for Nursing Leadership, we must examine the imperatives and competencies we need to enable us to promote and advocate for environmental health and justice, now and in the future.

Re-examining the AONL Nurse Leader Competencies

There are no specific leadership competencies spelled out for environmental health in the AONL Nurse Leader Competencies. However, many of the specific areas within the five domains of the competencies are aligned with the promotion of environmental health and environmental justice. The skills, knowledge, and abilities related to the domains on Knowledge of the Health Care Environment, Leadership, and Business Skills cover topics such as evidence-based practice, systems thinking, change management, and strategic management. The domains on Professionalism and Communication and Relationship Building encompass the topics of diversity, community involvement, ethics, and advocacy (AONL, 2022). These specific skills, knowledge, and abilities can be aligned with environmental health and environmental justice. For nurse educators, the work of Quinn Griffin et al. (2022) provides guidance in integrating the concepts of climate change into the DNP curricula. These authors identified the DNP domains along with the desired competencies and supported these with learning objectives and topics related to climate change. I submit that AONL must take the next steps towards specificity and intentionality in addressing the set of competencies to address environmental health and environmental justice using the same approach.

Paradigm Shift: Eco-ethical Values of Leaders

As transformational leaders, nurses have the privilege to develop nurses as future change agents about environmental health and environmental justice. A shift from competencies, eco-ethical leadership is a philosophical leadership perspective, rather than a set of competencies, espoused by individuals who are active and proactive agents for environmental change and sustainability. It is an integrated approach centered around sustainability, values, collaboration, justice, advocacy, and activism. Eco-ethical leaders subscribe to the following values and beliefs: a) moral duty to act, b) accountability for actions, c) role model practice, d) commitment to environmental health, e) cognitive complexity, f) collective intelligence, g) socio-cultural and ecological values and h) change management (McKimm & McLean, 2020).

Resources to Promote Environmental Health and Environmental Justice

There are numerous resources to guide nurses in addressing the negative effects and outcomes of climate change. Three of the most authoritative and comprehensive sources include the World Health Organization (WHO), the Center for Disease Control and Prevention, and the Alliance of Nurses for Healthy Environments (ANHE).

World Health Organization (WHO, 2021). According to the World Health Organization (WHO), climate change affects the social and environmental determinants of health. Climate change is the biggest health threat facing humanity and significantly impacts health, including illness and deaths resulting from extreme weather events. Divakaran et al. (2016) highlight the need for nurses to address climate change as a social determinant of health.

Center for Disease Control and Prevention (CDC, 2022). The Center for Disease Control and Prevention (CDC) supports state, tribal, local, and territorial public health agencies. The agency's Climate-Ready States and Cities Initiative helps 11 grant recipients around the nation using the five-step Building Resilience Against Climate Effects (BRACE) framework. The CDC also funds additional partners through the Building Capacity of the Public Health System to improve population health through national, non-profit organizations.

Alliance of Nurses for Healthy Environments (ANHE, n.d.). The Alliance of Nurses for Healthy Environments (ANHE) is the only national nursing organization focused solely on the intersection of health and the environment. The mission of ANHE is to promote healthy people and healthy environments by educating and leading the nursing profession, advancing research, incorporating evidence-based practice, and influencing policy. ANHE works on several issues of interest to nurses including climate change, environmental health in nursing, water and health, food sustainability, energy and health, and others. The Alliance is growing as nurses from around the United States and the world join the different forums to participate in meaningful and collaborative global efforts. The meetings are held either monthly or bi-monthly and are open to all nurses and nursing students. The forums include four special groups: a) education, b) practice, c) research, and d) policy and advocacy.

Collaboration in Action: Texas Organizations Participate in Climate Ready Campaign

The author of this article was accepted as a Fellow of ANHE in 2022. He is working with Community Based Organizations (CBOs) to increase awareness of environmental health and environmental justice. In collaboration with the Philippine Nurses Association of San Antonio (PNASA), the Black Nurses Rock San Antonio (BNRSA), and the International Nursing Students Association (INSA) at UT Health San Antonio – members of the San Antonio Nursing Consortium (SANC)  – he is implementing the SA Climate Ready Dissemination grant that SANC received from the City of San Antonio’s Office of Sustainability. The SA Climate Ready Plan is a roadmap for enhancing our community’s quality of life and overall resilience while balancing the impact of its expected growth of 1.1 million people by 2040 against the protection of our economic, environmental, and social resources (SA Climate Ready: A Pathway for Climate Action & Adaptation, 2019).

The stark reality of climate change is already impacting our communities. Failure to act now has implications for future generations. By 2040, we could experience a) 24 more days over 100°F annually, b) less rain and a decrease in water supply, c) more severe weather events, d) higher energy costs for heating and cooling, e) substantial health issues due to poor air quality and f) increased risk of heat-related illness and death (SA Climate Ready: A Pathway for Climate Action & Adaptation, 2019).

Call to Action: Aligning Eco-Ethical Values to Nursing Leadership

It has been reported that healthcare systems emit about 5% of the world's greenhouse gases. Nurses are well-positioned to address the harmful effects of climate change on the health and welfare of the populations they serve (Divakaran et al., 2016; Hawkins et al., 2022). The author recommends the following actions to help in increasing awareness of environmental health and environmental justice and reduce the impact of climate change. The eco-ethical values are highlighted for their alignment with these recommendations (McKimm & McLean, 2020).

1. Critically examine the single-use (disposable) versus re-use policy to achieve key performance indicators on quality, safety, and efficiency with due consideration to the environmental impact of hospital wastes (Hawkins et al., 2022; Kleber & Cohen, 2020; Wohlford et al., 2020). This recommendation aligns with moral duty and role modeling for practice.
2. Adopt a conceptual framework for planning and improving evidence-based practices related to environmental health and environmental justice (Kochtitzky, 2014; McKimm & McClean, 2020). Collective intelligence is imperative in the adoption of a conceptual framework upon which evidence-based practices are formed.
3. Develop specific competencies for nurse leaders related to environmental health and environmental justice that are aligned with the AONL Nurse Leader Competencies (McKimm & McClean, 2020). Cognitive complexity and collective intelligence are vital elements to the determination and development of specific competencies in environmental health and environmental justice.
4. Formulate position or policy statements on environmental health and incorporating social and environmental determinants of health (Benevolenza & DeRigne, 2019; Divakaran et al., 2016). Advocacy efforts and socio-cultural and ecological values of leaders are essential to ensuring that the social and environmental determinants of health are forged.
5. Incorporate concepts of environmental health and environmental justice in both formal and informal educational programs to promote climate change resilience (Dion et al., 2022; Quinn Griffin et al., 2022). The collective intelligence of leaders, educators, and researchers is needed to ensure that nurses receive the support and education they need.
6. Collaborate with professional, healthcare, and civic organizations urgently to reduce waste and increase sustainability in healthcare settings (McClean et al., 2020). The skills, knowledge, and abilities to manage change are important in effecting waste reduction and sustaining actions.

Parting Words

Nurse leaders play a key role in applying best practices, leveraging technology, and utilizing available resources to promote environmental health and environmental justice. Many opportunities exist for nurses to reduce the carbon footprint in various care settings, which not only mitigates harmful effects on health but also has the potential to reduce waste and decrease healthcare costs (Hawkins et al., 2022; Kleber & Cohen, 2020; Wohlford et al., 2020).  As nurse leaders here are some things to ponder:

1. What is the significance of environmental health to our practice? How prepared are we to promote environmental health and environmental justice in our practice?
2. How do the social and environmental determinants of health affect the health, well-being, and quality of life of the population we serve?
3. What is the relationship between environmental health and health equity? Who is most affected by environmental health issues?
4. How do we contribute to protecting the environment at work and home? How can we ensure that our policies and procedures protect our resources and help reduce waste?
5. As practitioners, managers, executives, educators, researchers, and community leaders, how can we influence others to care for the environment?
6. As an association, how do we advance the nursing profession through our eco-ethical values? How do we prepare ourselves and other nurses regarding planetary health for future generations?
7. Climate change is controversial (Benevolenza & DeRigne, 2019) but avoiding the discussion and denying the negative outcomes associated with the climate crisis is not an option (Schenk, 2019)!

References

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