It began 6 years ago when pediatric nurse Charlotte Wallace, RN, wrote a letter to Chip Doordan, then-CEO of Anne Arundel Medical Center, Annapolis, Md. Wallace had logged more than 11 years in healthcare, almost five at the medical center.
Although she was happy enough in her work, she had something to get off her chest.
"I've always struggled with the paradox of working in an area that promotes wellness and saves lives yet is so negligent with simple steps that can help prevent some of the diseases and social issues we treat," she wrote. "Isn't it ironic that we treat cancer victims, yet we treat them in a building that is built and run with materials linked to cancer?"
Wallace explained how patients had repeatedly asked where to recycle bottles and cans, and that she had no answer for them. Others wondered aloud why the hospital still used nonbiodegradable Styrofoam. Again, she lacked any satisfactory response.
"As a nurse, I believe in science," she continued, "and there is undeniable scientific evidence that connects global warming to catastrophic disasters and diseases all around the world."
She enclosed a copy of Al Gore's documentary, An Inconvenient Truth. She also shared her vision: the creation of a hospital green team, a group of hospital employees who would work intentionally to transform Anne Arundel Medical Center into a sustainability leader. She provided a list of suggestions that, if enacted, would make a huge environmental difference at the hospital.
Since then, both Wallace and the medical center have come a long way. Last fall, Wallace accepted the Nursing Leadership in Environmental Health Award from the Maryland Hospitals for a Healthy Environment (MD H2E). In 2011, Anne Arundel Medical Center made history when it became the first LEED certified hospital acute care tower in the state and has earned a gold rating from the U.S. Green Building Council for a new patient tower that incorporated sustainable design and construction features.
"It makes me smile because she is fearless," said Barbara Sattler, DrPH, RN, FAAN, environmental health pioneer and former director of MD H2E. "She clearly has an internal spark about her purpose. And it just shines through in this lovely combination of gentleness and perseverance. She's got a really wonderful energy to be around."
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Within 4 days of receiving the letter, Doordan reached out to Wallace.
"I wasn't surprised at the speed of his response at all," Wallace recalled recently. "Our medical system has always been very innovative, cutting edge and a leader. I knew he would respond."
Within 2 weeks, Wallace was meeting with senior vice president Caroline Core (both Core and Doordan have since retired), talking at greater length about Wallace's ideas and vision for an environmentally healthy medical center. Wallace agreed to lead the green team, and a new chapter in her life had begun.
For the next 5 years, Wallace's sustainability work took place ad hoc. Although her title as the medical center's sustainability coordinator wouldn't become official until late 2011, she didn't mind the ad-hoc nature of her situation. Instead, she viewed her environmental pursuits as a natural extension of her nursing practice.
"Through my journey as a pediatric nurse, I watched children suffer, I believe, unnecessarily with diseases that I feel could have been prevented," she said. "For me, it's about saving lives."
She recalled a time in 2003 when a nurse colleague suffered a severe asthma attack after the carpets were shampooed. The nurse had experienced asthma attacks before whenever she worked within 3 days of a shampooing. However, until then she was never on site the day of a cleaning. Her respiratory struggle was extreme, Wallace said. Even with her rescue inhaler, she struggled to breathe and had to leave the building.
"It got me wondering what impact our cleaning chemicals had on our little patients," she said. "Some of them were struggling with respiratory issues just like my colleague."
Connecting the Dots
Wallace found an early green team supporter in operating room nurse Patty Schiro, RN. Schiro had previously led an effort to begin recycling OR waste. But due to an ironclad contract with an incinerating company at the time, the effort was put on hold.
Hearing about Wallace's efforts, Schiro asked to attend one of the first green team meetings.
"It was slow going at first, and I felt her pain, as I met a ton of resistance from all sides when I tried to initiate recycling previously. But Charlotte kept persevering," said Schiro, director of surgical services. "She would bring homemade cakes to the meetings to try and increase attendance and participation."
Whenever she faced resistance, Wallace broke down barriers with respect, education and reason.
"Normally, it was just a matter of taking a step back and finding that connection for them," Wallace said. "Here at our hospital, our mission is to enhance the health of the people we serve. And many nurses, physicians and pharmacists took an oath to do no harm. So when you connect the dots of, say, the impact of exposure to a chemical all the time and what that does to human health, and you show the true science and best practices, you can have someone become a champion pretty quickly."
Wallace also brought in MD H2E representatives to share expertise and guide the medical center in the right direction.
"Charlotte was influential in getting us in the door to talk to leadership at her hospital," said Sattler, now a professor at the University of San Francisco School of Nursing. "She's been there asking the right questions, asking the right people, sometimes nudging when necessary. She's really quite a natural leader."
Jane B. Welch, BSN, manager, clinical value analysis, can't remember when she first met Wallace. But she does recall hearing Wallace's name mentioned over and over again in meetings for several years before the two eventually crossed paths.
She found her exactly as colleagues described her.
"Very nice, extremely knowledgeable and a passionate pediatric nurse devoting her free time to protect our environment," reflected Welch, who has since sought Wallace's input on environmentally preferable purchasing decisions. "Although she did not have an office, she would work from any available computer."
Permanent workstation or not, Wallace and her green team have managed to significantly ramp up Anne Arundel Medical Center's waste management performance over recent years. To date, the hospital has slashed incineration rates from 50 % to 16 % of waste. Recycling has grown from 1 % to 24 % of waste. Bottom line: Waste reduction programs collectively are saving the medical center more than $800,000 annually.
Other green team achievements include an on-campus farmer's market set to begin its fourth season this June, birthing classes that feature environmentally healthy content and a hospital nursery stripped of baby care products containing formaldehyde (the carcinogen is a common byproduct of preservatives in baby shampoos). Meanwhile, community members like Laura Dailey, 32, of Crofton, Md., say they are better protecting their loved ones through lessons learned during Wallace's free class Simple Steps to a Healthier Home.
"The class taught me how to choose safer plastics, cleaning products, personal care products, and what types of chemical ingredients to avoid," said Dailey, who is expecting her second child and has already recommended the class to family, friends, co-workers and her 2-year-old son's daycare provider. "Charlotte was truly inspirational as she is a strong, effective advocate for environmental health."
'This Is How It's Done'
Wallace has been called an advocate, a trailblazer and a pioneer for integrating sustainability into healthcare. What drives her, however, is a desire to speak up for those too young to do so themselves - before it's too late.
"I'm a simple girl, not an expert," Wallace wrote to Doordan in 2006. "I am writing this letter for two reasons. Their names are Ella and Simmone, my daughters. I owe it to them, and my future grandchildren, to live in a world where water is beautiful and not feared. A world where they can play outside without fear of disease-ridden mosquitoes."
To that end, Wallace recently transitioned out of clinical work as a pediatric nurse to focus more on sustainability coordination (the position runs about 20 hours a week) and to pursue a master's degree in community public health with environmental health certification at the University of Maryland School of Nursing, Baltimore.
She also stays active in policy work, regularly providing testimony on health and environmental issues being considered by the state legislature. Last year, she spoke in support of the state's banning arsenic-containing additives in the feed of broiler chickens, pointing out that arsenic is, after all, a poison. (It did, making Maryland the first state in the country to do so.)
Sattler considers Wallace an important example to the nursing profession. Pointing out that the American Nurses Association for the first time added an environment health standard to its Standards of Professional Nursing Practice in 2010 (standard 16 states that RNs practice in an environmentally safe and healthy manner), Sattler said Wallace is one of a just a handful of nurses who have managed to implement that standard into their work.
"She's helping to set a precedent for the nursing world to understand what the translation of that standard is in practice," said Sattler. "Because most nurses have not learned this in nursing school. Initially, we are really going to be depending on Charlotte to say, 'This is how it works. This is how it's done.'"
Jolynn Tumolo is a freelance writer.