Nurses poised to improve environmental health

As evidenced by this summer's wildfire season, the health of the environment is often closely connected to human health.

Beth Schenk, adjunct faculty member at WSU's College of Nursing and leader of nursing research for Providence St. Joseph Health, says she's devoted most of her 33-year nursing career to helping health care professionals recognize those connections and begin to work toward healthier practices that reduce waste and pollution.

"Many forms of pollution have been shown to lead to health problems," she says. "Health care professionals are devoted to improving health, but at the same time, health care generates a huge amount of waste. I'm hoping to change that."

Schenk says she's starting with nurses, partly because they have the largest staff of all clinical professions, making up 35 to 40 percent of total staff at most facilities.

"Most health care situations involve a nurse, so they have a wide knowledge of clinical situations, but they also work closely with those in nonclinical positions," she says. "Because they understand both clinical and operational needs, they're in the perfect position to advocate for waste reduction and healthier practices."

Schenk holds a bachelor's degree in nursing from Montana State University, a master's degree in health care innovation from Arizona State University, and a doctorate in nursing from Washington State University.

She says her interest in environmental sustainability started in childhood, when she developed a fascination with nature and how natural systems function. Prior to staring nursing school, Schenk says she spent several years backpacking and exploring the western U.S., learning about native bird and plant life.

"I knew waste was an issue (in health care), but it wasn't until I began working at the bedside that I realized the level of waste and toxic chemicals being used in hospital settings," she says. "I was horrified then, and it's only ramped up in the time since."

Schenk says the first academic project she developed to link nurses and the environment was the Nursing Environmental Awareness Tool (NEAT), which she created for her doctoral dissertation at WSU.

NEAT is a survey that measures a respondent's awareness of environmental issues, the ways in which health care pollution contributes to those issues, as well as what they can do to help lessen those impacts both at home and at work.

"It's a way of measuring and analyzing awareness reliably, that's been used both nationally and internationally for education as well as for research projects," she says.

Schenk is working to create a similar tool for climate change called the Climate Health and Nursing Tool, or CHANT.

"The project is in its second phase right now, which is mostly gathering responses from nurses who are seeing some of the effects of climate change on human health," she says. "Those would be things like heat stroke, illnesses related to air or water quality, and extreme weather events."

"Our goal is to have a tool that measures changes in nurses' knowledge and behaviors relating to climate change over time," she says. "We hope to use data from this first phase to compile a 2019 report, but we also want this to be an ongoing measurement."

Currently, Schenk says she spends most of her time at Providence St. Patrick's Hospital in Missoula, where she works on research and environmental stewardship, and also serves as co-lead of the regional environmental council for 13 Providence hospitals across Washington and Montana.

In addition to her work with WSU and Providence Health, Schenk works with the international nonprofit Health Care Without Harm and its sister organization, Practice Greenhealth.

Health Care Without Harm is an organization that advocates for health care corporations and hospitals to adopt more environmentally friendly practices. In her work with that organization, Schenk says she is currently helping to develop the Nurse's Climate Challenge, an effort to educate 5,000 health professionals nationwide about the health impacts of climate change by the end of 2019.

Practice Greenhealth is a membership and networking organization for organizations in the health care community that have made a commitment to sustainable, environmentally preferable practices.

"All 50 Providence health systems are members of Practice Greenhealth," she says. "Part of my role in working with them is submitting applications for annual awards, as well as assisting staff at our hospitals on projects that drive environmental stewardship."

Schenk also serves on the board for the Alliance of Nurses for Healthy Environments, a network of nurses and nursing organizations that aims to address environmental health issues.

"The (alliance) works to link nursing organizations to identify and address environmental health as well as help implement ways for reducing our own energy usage and waste," she says. "I believe we're the only organization focused on this topic."

For the past year, Schenk has also been hosting a podcast called Nurses for Healthy Environments from her home office in Missoula.

The podcast, which is sponsored by the Alliance of Nurses for Healthy Environments, features Schenk interviewing nurses whose work intersects with environmental sustainability.

"I've always enjoyed podcasts as a learning medium, so this started from a desire to reach more nurses and raise awareness of the work and research being done in this area," she says. "Nurses and the environment is still a pretty niche topic, so most of the people I interview are academic types."

She says hosting the podcast has only reinforced her belief that nurses have great potential to impact environmental sustainability.

"I'm learning so much just from talking with nurses who are doing this work," she says. "With 3.1 million registered nurses nationwide, I think we can definitely help reduce waste and improve hospital practices to contribute to a healthy environment."

Schenk says according to the Environmental Protection Agency, inpatient health care ranks as the second largest commercial energy user after the food service industry. She says data from Practice Greenhealth show hospitals produce 33 pounds of waste per patient every day, which equates to more than 6,000 tons per day nationally.

She says there are up to 10 different streams of physical waste types at most hospital facilities, some of which are chemicals that require special disposal procedures and some of which are biohazards that require incineration.

"Biohazardous materials include infectious, pathological, chemo, sharps, pharmaceuticals, and narcotics," she says. "On top of that, you also have compost, recycling, landfill, and materials for donations."

She says the waste of excess chemicals used in operations, including anesthesia, also contributes to greenhouse gases and global warming.

Schenk says medical waste outputs have increased in recent years because hospitals use more disposable products, and today's typical patients are sicker, leading to more procedures and thus more wasted products.

"There's a perception that disposable products are cheaper or easier, when actually higher quality reusable products are more cost-effective," she says.

Schenk says strict laws and regulations surrounding waste disposal, particularly medical waste, can also make recycling efforts complex and expensive.

"Many waste streams are highly regulated, and that's a good reason to be careful to segregate materials into the right disposal areas," she says. "Proper segregation makes recycling a lot easier and more effective."

The good news, she says, is that there are still many ways in which hospitals can work to cut down on waste and energy usage.

"We already see a lot of hospitals working on cutting down on excess packaging and unused products," she says. "There's also things like conserving water through sensor toilets, zero-scaping rather than landscaping, and using groundwater to cool buildings."

Schenk says hospitals also are working to use less paper by switching to electronic medical records and to waste less food by implementing compost infrastructures and starting onsite gardens.

"Awareness has grown for sure, especially with regard to physical waste, probably because that's the most tangible for people," she says. "We're also seeing more CEOs and executives paying attention to the dollar savings with less energy waste."

While she still hopes to see improvement in environmental sustainability within the health care industry, particularly with regard to climate change and the use of chemicals, Schenk says she's hopeful for the future.

"It's becoming clearer every day, to everyone, that we have an environmental crisis on our hands that's starting to impact health, and that's why it's important to do what we can now," she says.

"Awareness is growing every day, but the jury is still out on whether we're moving fast enough," she adds. "Certainly, there is more awareness and more health systems that are taking on leadership roles in this area, which is a good start."

Last year, Schenk was awarded the Charlotte Brody award from Health Care Without Harm, and this November, she will be inducted as a fellow in the American Academy of Nursing, a professional organization that generates and disseminates nursing knowledge to contribute to health policy and practice for the benefit of the public and the nursing profession.

"It's an honor and a privilege to have received these awards," she says. "Being a fellow with the AAN will also allow me the opportunity to serve on expert panels that help to influence the. profession of nursing and advance this work."