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Greening Nursing Practice

Nurses aim to help shape public policy on human and environmental health.

A group of individual nurses and nursing organizations who believe the environment and human health are inextricably linked, the Alliance of Nurses for Healthy Environments (ANHE) is committed to lobbying Congress to shape public policy.  

"We have known from the time of Florence Nightingale that clean air, clean water and a clean environment promote health," said Katie Huffling, MS, RN, CNM, director of programs for ANHE.

"We now live in a time where a myriad of different chemicals are used in everyday products, and emanate from couch cushions, cosmetics, cleaning products, etc. They don't just stay in those products, they get into our environment and into our bodies," she said.

This network of nurses from around the world was an active voice in supporting the Safe Chemicals Act of 2011, "a bill to amend the Toxic Substances Control Act to ensure that risks from chemicals are adequately understood and managed."

Most recently, the Alliance sent a letter to members of both the House and Senate Appropriations Committees in support of the annual Report on Carcinogens (RoC), the federal government's official list of chemicals "known" or "reasonably anticipated" to cause cancer in humans, and asked that they oppose any bill that would cut off its funding.

"Every day, more research highlights how these exposures are impacting human health - decreased fertility rates, cancer, obesity, learning and developmental disabilities, and autism to name a few. All of these have been linked to exposures to environmental pollutants," stated Huffling.

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Nurses From All Walks of Life

ANHE is a coalition of individual nurses and nursing organizations who believe that an essential component of nursing practice is environmental health.

"We work with nurses from all different backgrounds on incorporating environmental health into nursing practice, educating nurses in environmental health, supporting environmental health nursing researchers, 'greening' nursing practice, and working within the policy and advocacy realm on environmental health issues," said Huffling.

ANHE works with nurses from all areas of practice, such as hospital-based nurses (NICU, OB, mother-baby, oncology, med surg, OR, etc), nurse educators, researchers, student nurses, school nurses, advanced practice nurses and more.

The nurses have divided their interest into four main "work groups": Education, Practice, Research and Policy/Advocacy. Each of these groups meets through a conference call once a month in which a guest speaker or an educational piece is featured and discussion follows on projects the work group is currently working on.

"We based our work group structure on the areas of nursing practice outlined in the Institute of Medicine Report: Nursing, Health, and the Environment," said Kathy Curtis, LPN, the executive director of Clean and Healthy New York and co-chair of the ANHE Policy/Advocacy Work Group. "Any nurse is welcome to join the work groups and conference calls. In fact, we have a number of nurses that go on several of the calls each month."

Examples of work group activities include:

  • Practice - Created a webinar series with CE this past year in conjunction with the Nurses Work Group of Healthcare Without Harm.

  • Education - Developing an environmental health e-textbook for nurses and curriculum guidelines for inserting environmental health into undergraduate and graduate nursing education.

  • Research - Providing mentorship to environmental health nursing researchers; provide support for grant writing.

  • Policy/Advocacy - Working on chemical policy reform and supporting the Safe Chemicals Act, providing training for nurses on how to be advocates and providing opportunities for interaction with their legislators on Capital Hill.

The Importance of the RoC

The annual "Report on Carcinogens" has been mandated by Congress since the 1970s and is produced by top scientists at the National Toxicology Program (NTP), which is housed at the National Institute of Environmental Health Sciences (NIEHS), a part of the National Institutes for Health.

"The RoC provides science-based, impartial information about those chemicals that can increase cancer incidence," Huffling explained.

In the 12th edition of the RoC, published in 2011, the report for the first time listed formaldehyde as a known carcinogen and styrene as an anticipated carcinogen.

"These listings in the RoC can be a real blow for companies that make these chemicals or use them in their products. They don't want carcinogens in their products and will have to reformulate and worry about possible lawsuits," remarked Huffling.

"Instead of doing the right thing and getting these harmful chemicals out of their products," she said, "these companies got Montana Rep. Rehberg to offer a rider on a budget bill that would essentially stop production of the 13th edition of the RoC."

ANHE and many of the nursing organizations that it works with recognizes the importance of the RoC in providing nurses and other healthcare providers with necessary information to prevent exposures to carcinogens.

Carcinogens in the Clinical Setting

As far as carcinogens nurses need to be aware of in the clinical setting, Curtis mentioned one example that has been in the news recently: formaldehyde in Johnson & Johnson baby wash.

"Nurses from around the country were appalled that a carcinogen was in the wash used in their hospitals and that parents would think it was okay to use on their newborns based on that clinical use. They wrote letters to J & J asking them to remove formaldehyde from their baby wash and offer their 'Naturals' line in the small hospital size," she said.

Nurses put pressure on their purchasing departments to stop buying Johnson & Johnson baby wash until formaldehyde was removed. Within a few months, Johnson & Johnson was offering their Naturals line for hospitals.

Another group of often-carcinogenic chemicals that nurses should be aware of in the clinical setting are flame retardants, such as chlorinated tris and pentaBDE, noted Curtis. These are added to polyurethane foam (couches, pads etc.) in products.

"These do not just stay in the foam but leach out into the environment. Most hospitals use outdated fire standards that were put in place when people smoked cigarettes in hospitals. Therefore, foam products contain higher levels of flame retardants than you would find in products for residential use," she said.

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'Nurses Would Lose a Valuable Tool'

Huffling noted that the RoC impacts the health of women and infants health in several ways. For instance, if a woman is pregnant, the growing fetus is vulnerable to chemicals that she is exposed to during pregnancy.

"There is growing evidence that fetal exposures to chemicals can raise the risk of illness as children or adults. For example, children exposed to pesticides in-utero have higher rates of cancer than children not exposed," she said.

Infants and children are also more vulnerable to chemical exposures as their bodies are growing and developing so rapidly. Chemicals in the environment have also been linked to the high rates of breast cancer in this country.

"Only after such threats are identified, through scientific reports such as the ROC, can steps be taken to reduce our patients' exposures and protect their health," said Curtis.

The RoC provides a listing of carcinogens that nurses can use to assess for exposure and provide anticipatory guidance. Nurses can also use the Report to advocate for these chemicals to be removed from products and regulations that prohibit their use.

"A key component of nursing practice is prevention, and without the Report on Carcinogens nurses would lose a valuable tool for preventing exposures to carcinogens," concluded Huffling.

Beth Puliti is a frequent contributor to ADVANCE.

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