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Nurses can play a key role in creating a greener health service

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Gay Lee on why we need a carbon awareness culture in the NHS

Nurses should do their bit for the environment in the workplace, on the wards, in the community or at board meetings.

We think holistically - the whole patient; the whole community; the whole world. Holistic thinking is also about making the links in public health terms - between ill-health and inequality, inequality and poverty, poverty and environmental degradation. The world’s poorest people suffer the most from carbon emissions.

The NHS Sustainable Development Unit (SDU) report, Saving Carbon, Improving Health, points out that the NHS produces more than 3% of all of England’s emissions. Of this, procurement of goods (including drugs and medical equipment) contributes 60%, buildings 22% and transport 18%.

The key is to do what we can. Nurses at senior management level can put pressure on the higher echelons of their organisations to support the SDU’s commitment to reduce the enormous carbon footprint of global pharmaceuticals. The NHS has huge leverage because it is such a major customer of these products.
Senior nurses can take the lead in devising strategies to monitor the use of drugs and other resources, and hopefully reduce wastage.

‘Lifetime carbon costs’ need to be built into any calculations. For example, 13 million patient meals were wasted in 2005-2006, according to the SDU. The environmental cost of disposing of them should be included in their price.

Community nurses can talk to colleagues about prescribing less and educating patients about better use and disposal of medicines. (The SDU is commissioning research into the waste of unused drugs.) We can resist drug company freebies and ask salespeople for donations to NHS green initiatives instead.

‘Is it so shocking to suggest that disposable gloves could occasionally be washed and reused? And surely drugs at discharge could often be recycled from those brought in?’

At ward level, nurses can avoid wastage by working with pharmacists to reduce ward drug and dressing stocks, recycle containers and paper inserts, and make greater efforts to waste fewer dressings and sterile equipment.
Is it so shocking to suggest that disposable gloves could occasionally be washed, like hands, and reused, or not worn at all? And surely drugs at discharge could often be recycled from those brought in?

Nurses in senior management can have an influence in encouraging NHS organisations to think green about buildings.

A shining example, cited by the RCN, is that of a nurse in Liverpool who influenced the design of a new hospital to make it environmentally friendly, with a linked aim of educating patients and visitors about greener lifestyles.
Nurse managers should join campaigns for integrated transport schemes for their trusts.

One trust has provided a patient travel bus, saving 4,000 journeys a year. Other ideas are schemes that penalise the use of large cars and reward cycling, and use of video and telephone conferencing and tele-diagnostics.

Transport is also tied into procurement - consider using local suppliers.

In the community, we could reduce car use for work by using public transport (although this isn’t possible in many rural areas).

For institutionally based staff, the question is whether they can commute by walking, public transport, cycling or car-sharing.

Greener nursing needs to be made much easier, through measures to minimise the time and effort required to do it.

Every area should have three (smaller) bins - for clinical, other waste and recycling - and use only low-energy light bulbs.

Large food portions should not be given to patients with little appetite (and smaller portions often help people eat more). And let staff eat any spare food.

Fewer lifts might encourage more walking. Printer default settings should be double-sided. Taps should be designed to minimise water use; using a knee - not elbow - tap in one theatre saved 5.7L of water per surgical scrub with no decrease in efficiency.

Efforts to make green behaviour easier need to be backed up by a ‘carbon awareness culture’, starting with a trust-wide strategy including ‘an active communication initiative’ (nurses can use the SDU report to support their case). Visuals should remind staff and the public what to do (turn off lights and computers, conserve water), how much is wasted and what that costs. Being politely, creatively and constantly reminded increases the effort to be greener, even if thinking green isn’t the highest priority.

Nurses, familiar with exhortations to turn off lights and report dripping taps, may forget as they are busy - so it’s also about learning green behaviour until it becomes automatic.

However, the NHS has to prioritise patient safety. If the infection risk of using environmentally friendly cleaning agents or reusing equipment is too great, or using public transport means that fewer visits put patients at risk, carbon reduction must take second place. Nurses shouldn’t save water by handwashing with the plug in - but they must always incorporate green thinking into health and safety risk assessments.

If you are interested in doing more, sign the Climate and Health Council’s pledge at, or support Medact, which speaks for people whose health is damaged by war, poverty and environmental damage.

Gay Lee is bank staff nurse and member of Medact (

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Readers' comments (1)

  • What is actually being done? We can write about how it should be done, but when are we going to apply these green theories?

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