Health care providers know that climate change will cause major health issues in the coming years. The CDC reports that climate change can cause “increased respiratory and cardiovascular disease, injuries and premature deaths related to extreme weather events,” and other pre-existing conditions will be exacerbated by factors like air pollution. The health care industry is currently bracing for the impact of the climate crisis, as climate change is predicted to cause 250,000 additional deaths per year.
The link between health care and the climate means nurses are in an ideal position to increase climate change awareness. In fact, in 2014, nurses collaborated with other health care workers to create the national and international policies which are being put in place today. But what can nurses do today to help save the planet and reduce the impact of climate change on health care?
Why Nurses?
Nurses are already incredibly busy, so it can be frustrating to even think about doing more — particularly when public health crises should be a priority for politicians. It’s okay to decide you don’t have the time to advocate for sustainability, and you shouldn’t feel bad about taking time to fulfill other priorities.
However, if you do have the time and energy to commit to a cause, then you will find yourself well equipped to succeed. That’s because nurses are interdisciplinary thinkers who can understand issues and topics from many different perspectives. In fact, the skills developed in nursing are in high demand in other industries, as many who work in public health have transitioned to careers in the private sector or with governmental organizations. This puts nurses in the unique position of overlap: your knowledge and experience are specific enough to be authoritative and reputable, and your skills are diverse enough to connect with a wide audience that might otherwise be missed by public health and climate messaging.
You’ve also seen the impact of public health crises firsthand. This means you play a pivotal role in underlining the need for climate-positive actions and legislation; otherwise, we will continue to see a rise in climate-change-related illness and deaths. If you wish to become an advocate, you can find support through initiatives like the Alliance of Nurses for Healthy Environments.
Advocating for Public Health
As a nurse, your voice carries credibility and, when used correctly, can capture the imagination of the public. This means that publicizing your advocacy for health-related initiatives, programs, and legislation will draw people from unexpected demographics.
The way you choose to advocate for public health awareness is really up to you — and you’ll need to ensure you’re in line with the law before sharing information. However, social media platforms can amplify your message and will allow you to connect with new audiences.
If you’re not sure of how you can start, consider finding some reputable role models online, like Dr. Lisa Fitzpatrick. Dr. Fitzpatrick hosts a podcast and uses her platform to advocate for improved health literacy. She provides a great example of a health care professional engaging with social issues and regularly highlights contemporary issues in nursing. You can follow suit by creating podcasts, posting relevant and peer-reviewed content, and demystifying public health entities through social media channels.
Clean Water
Clean water is a basic right and is essential for the health of all citizens. Nurses also rely on a regular supply of clean water to stop the spread of disease. Many of us assume that water supplies in the United States are universally clean and healthy, but this is not the case. Across the nation, millions of Americans experience waterborne illnesses every year — low-income populations and some communities of color are more likely to be affected by unhealthy water supplies.
Nurses who are concerned about current attempts to repeal the Clean Water Rule (CWR) can leverage the credibility of their voice in the public space and can raise awareness about the current attempts to undermine universal access to clean water.
Nurses can also create greater awareness about the prevalence of unsafe water in homes, and reduce the number of patients admitted to hospitals with waterborne illnesses. For example, it’s reported that 10% of homes in the United States currently have significant water leaks. This means that homeowners are at risk from contaminated water and mold-related conditions like respiratory infections, chronic fatigue, and nausea. Increased public awareness can help homeowners spot the signs of unsafe water in their homes, and you can help proactively prevent illness.
Food Waste
The food industry is one of the biggest contributors to climate change. Every year, nearly half of all fruit and vegetables produced globally are thrown away as waste. This causes billions of dollars in losses and adds needless greenhouse gases to the atmosphere — all while 811 million people go hungry every day.
Unfortunately, the health care industry is a major culprit in producing food waste. Studies show that hospitals produce two to three times more food waste than other food service sectors, and only 16% of hospitals donate their excess food.
As a nurse, you can push for food to be donated to local charities and can ask administrators to change service practices, so food is only served to patients when they actually ask for it. This can reduce food waste by 30%, and can make a real impact in your local community. Additionally, you can publicly advocate for sustainable farming practices which centralize sustainability and help to reduce food waste.
Sustainable farming practices are typically smaller and do not rely on chemical fertilizers, monocropping, or pesticides. This means their basic practices are more sustainable, and — due to their smaller scale — are inherently more waste-efficient. You can advocate for sustainable farming by posting relevant, accurate resources online and by partnering with groups like Farmworker Justice.
Nurses play a vital role in creating awareness around the social issues which impact health. Nurses can take to social media and host podcasts to share their experiences of climate change in health care, and can actively influence legislation by teaming with other health care professionals and organizations that are committed to fighting the climate crisis.
There are those who consider themselves ineligible for nursing because they are afraid of needles, shriek at the sight of blood, or believe they couldn’t handle the pressure of caring for sick patients.
So-called “squeamish” individuals need not write off nursing as a career. There are many nonclinical roles in nursing such as research and leadership, but they often require nursing experience. The following is a broad overview of careers for the squeamish nurse.
Within the Hospital
Many mental health nurses are not exposed to trauma, and depending on patient acuity, they may only administer oral medication. Similarly, nurses in narcotic detox facilities give out medication by mouth and rarely, if ever, deal with the more physically graphic aspects of nursing. Naturally, there are other considerations one would need to take into account in terms of disposition when addressing these patient populations.
There are hospital positions that require little to no medication administration. For some pre-procedure nurses, their work often focuses on preoperative interview and assessment. This may involve minimal physical contact with patients, such as assistance with surgery prep, disrobing, or preoperative skin prep. It requires well-developed assessment skills and familiarity with different surgical procedures. These positions will depend on how the facility distributes perioperative responsibilities among nursing.
Mother-baby nursing may be an appropriate position for the mildly squeamish nurse who can handle the occasional unexpected event. To the extent that mother-baby nurses are not required to rotate through labor & delivery or work with high-risk births; their role is mainly assessing newborns and managing the care of young, and mostly healthy mothers. This type of nursing involves a unique, highly specialized skill set for working with the youngest patients.
Outside the Hospital
Home health nursing positions are increasing where registered nurses oversee the work of ancillary nursing personnel, such as home health aides, and certified nursing assistants. Home health nursing may involve direct patient care where nurses assess patients, administer medications, and refer to advanced practitioners for any changes in patient regimens. Home health nurses may also work with insurance companies to protect patient coverage and advocate on their behalf.
Similarly, case management uses nursing expertise in a nonclinical setting. Nurses utilize their understanding of patient population-specific needs, but they do not provide direct patient care. More commonly, case management involves advocating for patient access to necessary services and following up with patients to ensure their health needs are being met.
Outpatient clinic and primary care nursing focus on assessment and treatment of minor illnesses. Under this umbrella are school nursing and specialized outpatient clinics, such as internal medicine, pain management, psychiatry, and orthopedics. Primary care nurses do administer medication and perform wound care, therefore, the squeamish nurse may want to investigate site-specific duties.
Aesthetic nursing may be a good choice for a nurse who doesn’t want exposure to sick patients. This is a growing skill set within nursing and nurses can generate a lucrative income. Nurses in these roles will often administer injections.
A Caveat
It is important to keep in mind that every employer has different expectations and policies. Each individual must understand their own personal limits and job requirements before taking a nursing position. Furthermore, even positions suitable for the squeamish nurse require highly specialized skills and critical thinking.
All nurses are trained to work with a variety of patient populations, including the acutely ill. There is no way through nursing school without exposure to situations that many would consider either upsetting or even repulsive. That being said, there are many nurses who formerly identified themselves as queasy in the face of illness who find the reality of patient care much more tolerable than they anticipated. For many nurses, the spirit of service, and perhaps a bit of repeated exposure, together outweigh the upsetting sensory experience they formerly identified with nursing.
Nursing is a stressful job. So when you think that a patient may have been misdiagnosed by another health care worker, it’s important to know exactly what to do—especially if the misdiagnosis could cause permanent harm or death. It’s important to protect your patients as well as yourself.
Jennifer Flynn, CPHRM, risk manager for Nurses Service Organization (NSO), took time to answer in detail what nurses need to do when they suspect a patient is not receiving the care they need.
What should a nurse do if s/he thinks that a patient is not receiving the care they need from another health care worker? What are the specific steps that s/he needs to take? Are these steps different depending on the procedures of the facility?
Every day, nurses are challenged to provide patients with the safest and most effective care possible. Many factors can affect clinical performance. For example, being sleep deprived, running late, being assigned to more patients than usual, or experiencing a breakdown in communication with other providers can influence a nurse’s ability to provide safe patient care.
According to the 2015 NSO/CNA Nurse Professional Liability Exposures Claim Report, failure to invoke the chain of command was identified as a common allegation. Nurses are responsible for invoking the medical chain of command when necessary, in order to trigger a practitioner’s intervention for the patient. Closed claims involving the failure to invoke or utilize the chain of command accounted for 7.5% of the treatment and care closed claims, and reflect a higher average payment as compared to all claims in the report.
Nurses must be comfortable with utilizing the medical chain of command whenever a practitioner does not respond to calls for assistance, fails to appreciate the seriousness of a situation, or neglects to initiate an appropriate intervention.
Consider this scenario: a nurse failed to initiate the chain of command when the practitioner would not respond to her concerns of identified non-reassuring fetal distress. The nurse called the practitioner several times to give an update on the patient’s condition, which continued to deteriorate. Each time the nurse requested that the practitioner come see the patient, the practitioner said it didn’t seem necessary. As a result, the infant suffered birth-related brain injury, requiring lifelong care. The nurse was named in the malpractice lawsuit alleging failure to invoke the chain of command and failure to report changes in the patient’s medical condition. While the nurse had documented making the phone calls to the practitioner, the nurse neglected to include what was told to the practitioner and the practitioner’s response.
Nurses know that treatment and care of every patient starts with timely attention to their needs and persisting to the point of resolution. However, nurses may feel apprehensive about chain of command issues. Fear of disciplinary actions, loss of their jobs, or being labeled as a “troublemaker” are other concerns.
The following strategies can help reduce apprehension regarding chain-of-command issues:
Proactively address communication issues between nursing and medical staffs, and identify instances of intimidation, bullying, retaliation, or other deterrents to invoking the chain of command.
Notify leadership of individuals or areas that prevent nursing staff from invoking the chain of command or impose punitive actions for doing so.
If the organization’s current culture does not support invoking the chain of command, explain the risks posed to patients, staff, practitioners, and the organization, and initiate discussions regarding the need for a shift in organizational culture.
Are nurses usually taught this in nursing school? What should they know about speaking up?
Education in this matter is an ongoing effort. It starts in nursing school, but it must be continuously addressed, communicated, and supported for it to become part of practice.
The first step in protecting yourself from legal action is to know and understand your facility’s policy and procedures on invoking the chain of command to resolve concerns about patient care. In many facilities, policy and procedures manuals are readily accessible. If no chain-of-command policy or procedures exist, find out who in your facility is responsible to do so.
Don’t hesitate to call the appropriate practitioner when there’s a change in your patient’s condition. Most facilities have policies that require this. However, some nurses may feel intimidated by appearing to question a practitioner’s management of a patient.
Express clearly what, if any, action you would like the practitioner to take. If you think your patient needs to be seen, say so. After the conversation, document exactly what you told the practitioner about the patient’s condition.
If you believe the practitioner isn’t taking your concerns seriously, go to the next person in the chain. If necessary, go up your facility’s chain of command until the concern has been addressed. As you contact different staff members in the chain of command, be sure to make a note in the patient’s chart.
By invoking the chain of command, not only do nurses fulfill their obligations as patient advocate, but they protect themselves from liability.
What should nurses not do if they think their patients aren’t getting the care they need?
Advocating for a patient may not always be easy, but it is part of a nurse’s responsibility. Advocacy includes the duty to invoke both the nursing and medical staff chains of command to ensure timely attention to the needs of every patient, and persisting to the point of satisfactory resolution. Not following the chain of command puts the patient’s safety at risk and exposes nurses to the potential of a malpractice lawsuit.
Document each of the steps taken, and the reasons they were taken, to advocate for the patient’s care. Refrain from speculative or subjective comments, including ones regarding colleagues and other members of the patient care team.
Can a nurse get in trouble for reporting something like this? How should they approach this so that they do what is most professional?
To be an effective advocate, nurses first need to understand the laws and regulations governing their practice. Nurses who understand their scope of practice, state practice act, and facility policy and procedure are best able to use established processes to advocate effectively for their patients while protecting themselves from retaliation and litigation.
Effective communication is key. One technique available to nurses is SBAR, which is an acronym for Situation, Background, Assessment, Recommendation. This communication style can be used to facilitate prompt and appropriate communication. It is a way for nurses to communicate effectively with one another, and between the health care team. It allows for important information to be transferred accurately.
Allegations of malpractice can result from miscommunication or lack of communication between practitioners and nurses. By carefully documenting the information about the patient shared with other members of the patient’s care team, nurses can significantly reduce communication-related risks.
By enhancing their communication skills, nurses can minimize the risk of claims. Some communication strategies include:
Clearly articulate your concerns so that others are able to respond.
Consider what information to share, when to share it, and with whom it should be shared.
Ensure communication among caregivers is professional and respectful.
Carefully and timely communicate patient assessments and observations to other members of the health care team.
Read back or repeat verbal orders to the practitioner who issued them to verify accuracy and understanding.
Nurses can ask to become more involved in developing and influencing facility policy around advocacy and communication. Nurse leaders, health care administrators, and organizations can change the culture of retaliation and blame, which tends to point fingers instead of recognizing issues and problem solving.
Last Saturday, as part of a program called “Minority Nurse Leadership in the 21st Century,” about 100 minority nurses from all around California met at Saint Agnes Medical Center in Fresno to discuss the role of nurses in patient advocacy and leadership. According to statistics, 40 percent of the California population are Latino while only 7 percent of the nurses statewide are Latino, proving the need for more minority nurses in California.
A 2014 Board of Nursing report from the California State Board of Registered Nursing reported that Latinos will continue to be underrepresented and become even more underrepresented in the nursing workforce in the future. African American nurses are also expected to be underrepresented until 2030, while all other racial groups continue to be overrepresented compared to the general population.
The number of white nurses in the workforce has declined from 77.2 percent in 1990 to 51.6 percent in 2014. This decline leaves the most highly represented nonwhite group of nurses as Filipinos at 20.3 percent of the workforce, with non-Filipino Asian nurses at 8.5 percent, and black nurses at about 5 percent.
Pilar De La Cruz-Reyes, a member of the California State Board of Registered Nursing and director of the Central California Center for Excellence in Nursing at Fresno State, says the purpose of the minority nurse meeting in Fresno was to get more minority nurses into leadership positions so they can serve as role models and mentors to minority students who want to go into nursing but don’t see a realistic way to get there.
Kimberly Horton, chief executive officer at Vibra Hospital of Sacramento, says that nursing is an opportunity that many Latinos have never thought about so nursing programs need to be marketed to that population, and using minority nurses to educate their peers about the nursing profession is a great way to get started. Horton is an African American registered nurse and she was one of five speakers at the Fresno meeting.
Minority nurses can be wonderful advocates for patients, bringing a special understanding of health beliefs that are ethically, culturally, and religiously based and that can have a real effect on patient health. By including nurses who represent ethnic groups in the development of patient health care plans, health care teams can better develop logical plans for treatment that won’t negatively impact the health of minority patients due to common misunderstandings or misperceptions that patients have about their health and treatment.
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