Given the hectic pace nurses face every day, most don’t think twice about the products they use—or that surround them—as they go about their work. But the American Nurses Association (ANA) and state-based constituent member association (CMA) leaders want nurses to consider this: Many chemicals in products—such as di(2-ethylhexyl) phthalate (DEHP) used to soften plastic in certain I.V. bags and tubing; triclosan, an antibacterial in some detergents and soaps; and oxytocin, a labor-inducing drug—are not innocuous. These and other chemicals can affect the health of nurses and patients by direct contact or indirect environmental exposure. For example, DEHP, which is linked in animal studies to a range of adverse effects, including developmental problems with the male reproductive system, can leach out of plastic products into the environment.
“From a broader perspective, thousands of chemicals have entered the U.S. market with little research done to show they’re safe for people or the environment,” says Marian Condon, RN, MS, senior staff specialist in ANA’s Center for Occupational and Environmental Health.
To help nurses learn about workplace hazards and to reduce the number of harmful products used in healthcare, ANA is building on its environmental health efforts. One major strategy centers on creating a policy on chemical use that state and federal officials will adopt.
Karen Bowman, RN, MN, COHN-S, Occupational and Environmental Health Specialist with the Washington State Nurses Association (WSNA) says, “There are significant gaps both in our knowledge about chemicals and in our current chemical policies. We need to know as much as we can, so we can care for ourselves, our patients, our families, and our communities.”
“Environmental health has been an underpinning of nursing practice since the days of Florence Nightingale, who promoted the tenets of clean air, water, and light,” Bowman says. “Nurses are well-equipped to take on environmental health issues because our profession is based on preventive care.”
This summer, nurses participating in ANA’s House of Delegates (HOD) approved a resolution that addresses potentially hazardous substances. New York State Nurses Association (NYSNA) submitted the resolution, which was co-sponsored by the Washington State, Alabama State, Maryland, Ohio, and Oregon Nurses Associations.
“The resolution grew out of a concern that many nurses don’t know what they are exposed to on a daily basis,” says Karen Ballard, RN, MA, the NYNSA delegate who crafted the resolution. “At NYSNA, we realized that many nurses also are unaware that they have a right to know about potentially harmful exposures and that safer alternatives to these products exist.”
She mentioned a TV ad promoting a drug to treat prostate cancer that warns pregnant women to not touch the medication. “Nurses often are in contact with these types of medications and other potentially harmful chemicals, yet most are not warned of the dangers or how to dispose of these products properly,” says Ballard, co-chair of Health Care Without Harm’s (HCWH) Nurses Work Group. “Nurses need to know what is harmful, how to identify symptoms that may be linked to chemical exposures, and how they can seek safer alternatives to these products in their workplaces.
In the HOD report, Ballard wrote that the National Academy of Science and the Institute of Medicine note a trend in the federal administration to reduce people’s access to information about potentially hazardous chemicals in the environment. This comes at the same time that the Centers for Disease Control and Prevention and the Louisville Charter for Safer Chemicals say that Americans are retaining significant amounts of dioxins, heavy metals, pesticides, phthalates, and other chemicals in their bodies.
The HOD resolution asks that ANA advocate federal measures and collaborate with its CMAs on creating a nationwide state legislative agenda to reduce the use of toxic chemicals. It also calls for ANA to promote the use of less harmful chemicals when possible; support labeling and full disclosure mechanisms; demand information on the health effects of chemicals in products before they reach the market; and create more streamlined methods for chemicals to be removed from use.
The resolution includes a request that ANA support educational and research initiatives on chemical exposure and environmental health. Helen Wilson, RN, MSN, a HOD delegate with the Alabama State Nurses Association (ASNA), says the resolution reflects her CMA’s concerns and ongoing work. Wilson says that when she talks to Alabama nurses about chemical hazards, she finds that many are unaware of the risks. “I recently saw two pregnant nurses giving chemotherapy drugs to patients,” Wilson says. “That made me realize that we basically have to start at the ground level to build awareness among nurses and administrators, who need to provide RNs with access to information, ongoing education, and protective equipment.”
Present and future work
ANA has worked on a range of environmental health issues through long-standing partnerships with HCWH and Hospitals for a Healthy Environment (H2E). Both coalitions promote environmentally sound practices in healthcare. ANA is also collaborating with the University of Maryland and HCWH to develop a document called “Principles of Environmental Health for Nursing Practice,” which will be released soon. “The principles will articulate why nurses should be involved in environmental issues and help them incorporate environmentally safe strategies in their practice and their communities,” Condon says.
In other collaborations, ANA met with CMA representatives and environmentalists in July to discuss key components of a broader, safer chemical policy. This August, ANA and the National Caucus of Environmental Legislators explored gaps in policies and ways to best use their resources to tackle chemical issues more cohesively, according to Rebecca Clouse, RN, MSN, Environmental Health Liaison with ANA’s state government affairs. On the legislative front, ANA helped defeat a federal measure that would have cut back on the required reporting of toxic chemicals that industries release into the environment, says Kristen Welker-Hood, RN, ScD, Senior Policy Fellow with ANA’s Center for Occupational and Environmental Health.
ANA also is opposing an ineffective bill on persistent organic pollutants (POPs), which Rep. Paul Gillmor (R-OH) is expected to introduce this fall. The bill does not require the Environmental Protection Agency to take action when new pollutants are added to the international POPs treaty ban list, and it puts industry profits or a cost-benefit standard on par with public health, according to Welker-Hood. ANA wants to promote an effort by Rep. Hilda L. Solis (D-CA) aimed at banning 12 of the worst POPs.
In Washington, WSNA has conducted about 30 educational workshops that focus on hazards in the workplace and strategies to protect nurses from harmful exposure and reduce chemical use. “As nurses learn more about chemicals and environmental health during these sessions, the more they want to get involved,” Bowman says. “For example, nurses at Children’s Hospital are working to eliminate DEHP from their facility. Another nurse is starting a “green” committee to promote the use of environmentally friendly products.” WSNA also formed a “nurse squad” of environmental health advocates to help reach nurses in the state. And WSNA members testified at town hall meetings about environmental health risks.
For the past year, ASNA members largely focused their environmental health work on a statewide effort to eliminate mercury from healthcare settings. “We also have begun to publicize risks associated with the use of polyvinyl chloride products and softening agents, and we’ve been working with the Department of Health and legislators to push for a clean air bill,” Wilson says.
Like ANA, ASNA nurses believe that networking is a major strategy because the number of issues within environmental health can seem overwhelming. “One project involves working with junior and senior nursing students who are conducting environmental assessments of Head Start program families,” Wilson says. “This project gives students the opportunity to educate families about the risks they face in their environment and hopefully make a difference in the families’ health.”
To learn more about environmental health efforts, go to ANA’s Web site at www.nursingworld.org/coeh/; HCWH’s site at www.noharm.org; H2E’s site at www.h2e-online.org; Louisville Charter’s site at www.louisvillecharter.org; and the Campaign for Safer Cosmetics’ site at www.safecosmetics.org.
Susan Trossman, RN, is the Senior Reporter in ANA’s Communications Department.