Nurses—Making a Difference in Global Health

GOAL 7: Ensure environmental sustainability

Nurse Luminaries light the way to improved environmental health

By Marian Condon

In 2005, Health Care Without Harm, a global coalition of nearly 500 organizations working to protect health by reducing health-care-generated pollution, launched The Luminary Project (TLP) to spotlight stories about nurses who advocate for safe hospitals, clean communities and children born without toxic chemicals in their bodies.

For the past year, I have worked as a nurse consultant on The Luminary Project and have been touched by the stories told on the project’s Web site, many of them about members of the Honor Society of Nursing, Sigma Theta Tau International. I would like to highlight the work of just a few of these environmental heroes. Perhaps their stories and the resources available on the site will inspire other nurses to get involved.

Honor society members Joyce Lewis, MNE, RN, and Michele Ondeck, RN, MEd, LCCE, IBCLC, together with Judy Focareta, MEd, RN, LCCE, work at Magee-Womens Hospital in Pittsburgh, Pennsylvania, USA. Lewis, the hospital’s director of Advocacy and Government Affairs, received grant money from Howard Heinz Endowments to explore ways to make the hospital more environmentally responsible for patients, staff members and the community. With these funds, they established a hospital “green team.”

One of the team’s early successes was the elimination of PVC/DEHP from the newborn intensive care unit and nurseries. Polyvinyl chloride (PVC), or vinyl, is the most common plastic used in medical devices and carries with it a heavy burden for patients as well as the environment. PVC, when manufactured or incinerated, emits a toxic agent known as dioxin. Another toxic chemical, di(2‑ethylhexyl) phthalate (DEHP), linked to reproductive birth defects and other illnesses, is added to PVC, and vulnerable patient populations may be exposed to it during hospitalization (Health Care Without Harm, 2006).

Other accomplishments of this group include reduction and recycling of toxic substances in the lab, a system-wide environmental purchasing policy, environmental health education of hospital clinicians and department heads, and inclusion of a brochure in each patient’s discharge package that provides information on environmental hazards found in the home and ways to mitigate them. In 2007, Magee-Womens Hospital and Howard Heinz Endowments co-sponsored the Women’s Health the Environment Conference at Pittsburgh’s David L. Lawrence Convention Center. The conference drew approximately 2,200 participants and received excellent reviews.

Bettie Kettell, RN, HEM, an operating-room (OR) nurse at Mid Coast Hospital in Brunswick, Maine, USA, was disturbed by the amount of waste she saw, in particular the blue wrap used to protect sterilized instruments. “I was going crazy seeing all the blue wrap going out the OR door,” she said. “One has to spend a day in the OR to see how much blue wrap goes into the trash. It’s appalling!” She has observed 45-gallon containers filled with blue wrap from one major surgery, such as a hip replacement.

Hospitals produce more than 2 million tons of waste each year (Health Care Without Harm, n.d.). In the past, all hospital refuse ended up in one waste stream, which may have included everything from infectious material and hazardous chemicals to office paper. If incinerated, some of these substances can release toxins into the environment. If, on the other hand, hazardous waste is inappropriately placed in landfills, it can leach into the ground. Segregate various types of waste at the source, however, and each can be handled appropriately.

Blue wrap remains an ongoing challenge for the committee. Many recyclers will not accept blue wrap because it is a film. The good news is that a growing number of companies now provide sterilization containers that don’t require blue wrap. While Mid Coast Hospital has taken advantage of alternatives to blue wrap, those options are not available for all surgical instruments and supplies. Blue wrap continues to be a challenge in all operating rooms and in general hospital waste.

Honor society member Mary Frances D. Pate, DSN, RN, together with a small group of other nurses in the pediatric intensive care unit of Oregon Health Science University, formed a green team to explore ways to reduce waste. Working with the hospital’s recycling program and its Environmental Health and Radiation Safety Department, they developed an action plan to keep trash out of regulated medical-waste bags. They had recycling bins for cans, paper, glass and plastic installed. They found creative ways to work with other staff members to make sure toxins found in the hospital were appropriately recycled, reduced or eliminated. Recycling bins were placed next to X-ray viewing boxes so silver in film could be reclaimed, and battery recycling bins were placed where pager batteries were changed. The group also worked with other hospital departments to find alternatives to equipment that contained mercury.

Honor society member Helen French, RN, BSN, CNOR, is another OR nurse concerned with the immense amount of waste produced by hospitals, much of it in the form of unused medical supplies that are useful elsewhere, especially in other countries. French created Medical Equipment Recovery of Clean Inventory (MERCI) which, to date, has diverted more than 400 tons of still useful medical supplies worth an estimated $70 million to missions, clinics and hospitals in poor communities around the world. For more information, read “For the children” by Helen French in the Third Qtr. 2004 issue of Reflections on Nursing Leadership.

Luminaries have been active in improving the environment outside the hospital as well. Allison Del Bene Davis, PhD, APRN, BC, another honor society member, was concerned that the vulnerable clients she works with, people with developmental and cognitive disabilities, might be particularly sensitive and susceptible to neurotoxicants in their group homes and sheltered-workshop settings. Davis developed an assessment tool for caregivers of this population to help them recognize and address environmental hazards that may be found in residences and group homes. Her Home Environmental Health and Safety Assessment Tool is provided in the Tools and Resources section of the Luminary Project Web site.

Honor society member Wade Hill, PhD, APRN, BC, works on the Environmental Risk Reduction through Nursing Interventions and Education (ERRNIE) research project sponsored by the colleges of nursing at Montana State University and Washington State University. The goal of this project is to identify environmental hazards that negatively impact health of children in Montana’s poor rural communities.

A project investigator visits families in the study and screens homes for radon gas, carbon monoxide leaks and conditions that foster mold. Well water is tested for contaminants; children are screened to determine blood lead levels and exposure to tobacco smoke; and women of childbearing age are screened for mercury ingested by eating certain fish. This ongoing study is investigating whether counseling delivered by nurses can be effective in helping these families reduce hazards in their environments.

Many Luminaries are involved in environmental education of nurses, nursing students and community members. Honor society member Mary Jane Williams, RN, PhD, at the University of Hartford in Hartford, Connecticut, USA, is an example of an educator who has spread her passion for protecting the environment to nursing students. Several stories by Williams’ graduate students appear on the Luminary site.

Students from the class of 2007 have presented seminars on environmental health topics to nurses and the public. Three students who work at the same hospital write a “green column” for the staff newsletter and are active on the hospital’s green team. Two others have been hired by the Connecticut Nurses Association to work on environmental issues, and others have shared their knowledge on the subject in mini-workshops for multiple nursing programs throughout Connecticut. Several graduates are active in the policy process at institutional and state levels.

Kathy Jackman-Murphy, RN, MSN, CLC, one of Williams’ students and an honor society member, is a Nurse Luminary and a Girl Scout leader. Jackman-Murphy learned that Scouts could earn badges in a wide variety of subjects and were exposed to many different career opportunities, but there were no badges offered in nursing or the environment. Responding to this need, she developed activities and criteria for two new badges: Exploration into Health Care Careers, which introduces girls to a range of options in the health field; and Going Green One Step at a Time, which educates girls about the environment and the role they can play in protecting it.

Barbara Sattler, DrPH, RN, FAAN, is another nurse educator whose efforts and enthusiasm at the University of Maryland School of Nursing have inspired many nurses, including me, to incorporate environmental health awareness into their practice. Many nurses on the Luminary Project Web site have been directly or indirectly influenced by Sattler’s shining example.

Lillian Mood, RN, MPH, also a Nurse Luminary and honor society member, observed: “The University of Maryland School of Nursing has become known as the place to go for environmental health nursing expertise because of [Sattler’s] leadership. Their Center for Environmental Education has provided faculty preparation in environmental health, established an Internet resource for practicing nurses at the EnviRN Web site [] and pursued relevant research.”

Sattler has been awarded the 2008 Charlotte Brody Award. Created in honor of Charlotte Brody, a registered nurse who is a lifelong advocate for social change and one of the founders of Health Care Without Harm, the award is sponsored by Health Care Without Harm and The Luminary Project.

It was difficult for me to choose which Nurse Luminaries to include in this summary, as there are many stories on the Luminary Project Web site that are as inspirational as the ones I’ve presented. To learn more and to enjoy stories of other nurses who have creatively worked to improve our health by improving our environment, visit

Also, if you are a nurse who has found innovative ways to improve the environment or know of other nurses who have done so, please contact us so we can add more Nurse Luminary stories to the site. To nominate a nurse, submit his or her name to Marian Condon at or Karen Ballard at . Names can also be submitted online at

RNL - Reflections on Nursing Leadership - Published 5/27/2008 , Vol. 34 No. 2

Marian Condon, MS, RN, is a nurse consultant, Health Care Without Harm, The Luminary Project.


Health Care Without Harm. (2006, April 6). Why health care is moving away from the hazardous plastic polyvinyl chloride (PVC). Retrieved April 1, 2008, from

Health Care Without Harm. (n.d.). Medical waste: The issue. Retrieved April 1, 2008, from