Environmentally Safe Health Care Agencies: Nursing's Responsibility, Nightingale's Legacy

Hollie Shaner-McRae, RN, MSA, FAAN; Glenn McRae, Ph.D.; Victoria Jas, M.S.


Online J Issues Nurs. 2007;12(2) 

In This Article

Abstract and Introduction


Florence Nightingale and subsequent nurse scholars have written about the impact of the environment on human health. Nightingale described, and staked out, the nurse´s role in optimizing environments for healing. Since Nightingale´s time numerous scholars have documented that environmental conditions play a major role in the health of individuals and populations. As nurses become more informed about the environment as a determinant of human health, they will be able to advocate more effectively for environmental conditions that promote health. This article provides both theoretical and practical perspectives to integrate environmental concerns into nursing practice. It recommends specific actions nurses can undertake to improve the environment within the health care setting. In particular the article provides a historical review of an environmental focus in nursing, discusses ways to manage both upstream waste and downstream waste (solid, biohazard, and hazardous chemical wastes) so as to decrease environmental pollution, and recommends specific nursing actions to promote a healthy environment within our health care agencies.


There is a direct connection between nursing actions and the health of the environment in health care agencies. However, in daily practice nurses, whether administering a medication, changing a dressing, or starting an IV, do not usually consider the environmental impact of such activities. For example, discarding wrappers that represent by-products of their work is an almost subliminal activity in their professional role since their focus as a nurse is more frequently on other priorities.

To recognize the unconscious nature of many of nursing activities that do impact the environment, such as waste disposal, nurses need to take a moment and reflect on the last time they worked. It helps to do an assessment of the many items handled in a given shift that could have a negative effect on the environment. Try this assessment yourself by replaying (assessing) the activities of a shift. For example, consider how many medications were administered, what types of supplies were used, how many units of blood were hung, how many forms were filled out, how many items went from a nurse´s hands to a sharps container, a trash can, a recycling bin, a red bag, or a hazardous chemical waste container. Ask yourself how many gallons of water were used to complete toileting and bathing patients? How much electrical energy was used in caring for patients? Then make your diagnoses, i.e., think about the environmental impact of all of these common, daily nursing activities.

To do an adequate assessment of the impact of nursing care on the environment, one must consider everything in the environment including the lighting, air conditioning or heating, electrical equipment and pumps, elevators, computers, electronic medication dispensing machines, monitors, and more. This exercise reveals the environmental infrastructure of health care and displays the 'ecological footprint' of health care, which is a metaphor used to depict the resources a person, institution, or community would hypothetically need to support itself and to absorb its wastes, given the known technology (Shaner-McRae, 2002; Wackernagel & Rees, 1996). Such reflection utilizes the basic skills of inquiry nurses use every day with patients and allows them to establish a holistic view of the conditions in their place of work that may need remediation.

However, nurses seldom do such assessments because environmental systems are generally silent partners in the work they do. It is only when systems break down that an environmental problem becomes obvious. It is only when waste containers overflow that one thinks about them. When bags of waste disappear without clinicians being aware of these bags, they do not think about where that waste goes (Shaner & McRae, 1995). Yet, wastes from health care alone account for one percent of all solid wastes produced in the United States (US). Until recently the disposal and treatment of infectious and hazardous chemical wastes from health care was a leading contributor of dioxin and mercury pollution. Even today health care wastes remain a public health and an environmental problem.

True responsibility for protecting the health care environment lies with each one of us. Whatever type of nursing a nurse performs, he or she can make a difference by paying attention to health care waste management. Nightingale set the stage in her writings, encouraging nurses to be involved at all levels and all capacities in providing optimal health care settings. This is as much a challenge today as it was in 1860.

The intent of this article is to raise the awareness of nursing staff regarding the importance of proper health care waste management so as to enhance the quality of the health care environment. Today nurses must demonstrate competence in fire safety, the Health Insurance Portability and Accountability Act (HIPAA), and cardiopulmonary resuscitation. The challenge put forth in this article is to develop similar competency in the area of hospital waste management. Waste management is an area that nurses can influence, given the number of practicing nurses and the millions of waste-disposal decisions they make. What follows is an historical review of an environmental focus in nursing, a discussion of ways to manage both upstream waste and downstream waste (solid waste, biohazard waste, and hazardous chemical wastes) so as to decrease environmental pollution, and a summary of specific nursing actions to promote a healthy environment within our health care agencies.


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