The Nurses are Here! Nurses Drawdown, a Global Movement to Address Climate Change

July 13, 2020July 13, 2020 / Peggy L Chinn / Leave a comment

Contributor:
Teddie Potter PhD, RN, FAAN
School of Nursing University of Minnesota
tmpotter@umn.edu

Throughout the history of professional nursing, nurses have designed new care delivery models and transformative interventions in response to unmet needs and population health and public health challenges. These changes required disruptive thinking and bold courage in the face of broken systems, ineffective policies, and powerful naysayers. Climate change may be a modern example of a major public health crisis yet the challenges to mounting an effective response are similar. This is the story of Nurses Drawdown, a global, nurse-led movement to improve the health of humans and the planet.

Honoring the Ancestors of this Movement

Around the globe, the earliest experts in planetary health were, and continue to be, indigenous people. Their values and patterns of decision-making acknowledge the deep interconnection of human health and the health of the biosphere.

Many early nursing leaders shared a similar awareness that we ignore the environment at our peril. The ideas of Florence Nightingale, Lillian Wald, and Mamie Odessa Hale offer inspiration to transformative leaders today. Florence Nightingale is considered the founder of modern professional nursing; her astute observations and applied statistics established nursing as a science-based profession. Nightingale was an expert systems thinker who connected the health of humans to the quality of the environment. Like Florence, nurses today must recognize that nursing care is delivered in the context of nature.

Lillian Wald, the founder of public health and school nursing, faced the daunting task of addressing the health needs of resource-poor immigrants in New York City (Wald, 1915). She went to the people and lived among them. Her willingness to participate in health initiatives alongside those she served offers a lesson for transformative leaders today. Nurses can inspire people to take action on climate change by first making changes in their own lives.

Mamie Odessa Hale was another historical change agent. Hale was an African American Nurse Midwife practicing in an era of deep racial segregation. She taught community midwives simple practices based on the best science of the time thereby improving birth outcomes for African Americans (Hale, 1948). The story of Mamie Odessa Hale encourages today’s nurses to realize that simple science-based interventions, taught with respect and empathy, can transform the health of individuals and whole communities.

These early nursing leaders laid the foundation for today’s global movement to address climate change. They are a part of the Nurses Drawdown story.

The Seeds of a Movement

In September 2014, I took a long bus trip across the nation to attend the People’s Climate March in New York City. Over half a million people from all demographics and all walks of life came together to send a strong message that the United States must take climate change seriously and meaningfully contribute to global negotiations.

Like my fellow travelers from Minnesota, I wore a bright orange t-shirt. The only indication that I was a nurse was the sign I created that said, “Minnesota Nurses for a Healthy Future.” As the march moved through the streets of Manhattan, I was shocked how frequently observers standing along the route commented to one another, “The nurses are here!” Some even asked to take their picture with me so they could send it out on social media with the message that nurses had shown up to address climate change. I remember thinking, “What is this?” The people were not shouting, “The engineers are here!” or “The teachers are here!” There is something about nurses taking on climate change that inspired hope.

Fast forward to 2018 when I adopted the book Drawdown: The Most Comprehensive Plan Ever Proposed to Reverse Global Warning (Hawken, 2017) for “The Global Climate Challenge: Creating an Empowered Movement for Change,” a course that I teach at the University of Minnesota. Climate change is an urgent public health crisis; therefore, I teach that our solutions must be effective and have significant impact. Project Drawdown (2020)provides the solutions; could nurses provide the inspiration to scale them?

I contacted Project Drawdown and presented the argument that as the largest global health profession and the most trusted profession, nurses may be able to effectively and broadly scale Project Drawdown’s science-based solutions to climate change. Nursing’s long history of innovative leadership to improve the health of individuals, families, and communities can be relied on to improve the health of humans and the health of the planet. So, a partnership was formed between Project Drawdown and the Alliance of Nurses for Healthy Environments (ANHE).

ANHE (2019), the leading professional organization for nurses working to promote a healthier environment, coordinates the Nursing Collaborative on Climate Change and Health, a broad network of professional organizations committed to planetary health. Katie Huffling and Cara Cook from ANHE and I assembled a leadership team to plan and initiate Nurses Drawdown. It was very important that we include nurses across the globe, nurses from a wide variety of practice settings, and different demographics including nursing students.

Nurses Drawdown

The vision for Nurses Drawdown is “to improve the health of individuals, communities, and the planet through commitment to and action on the Nurses Drawdown solutions.” The mission is, “Nurses, the most numerous and most trusted health profession in the world, have the power to significantly impact climate change. By embracing and teaching the evidence-based solutions of Nurse’s Drawdown, nurses around the world will help to decrease greenhouse gas emissions and create a healthier future for humans and the rest of the planet.”

To this end, the Nurses Drawdown leadership team elected to scale Project Drawdown solutions that have the co-benefits of improving human health and the health of the planet. We selected five themes, reflecting an alignment between core nursing expertise and effective evidence-based solutions. These include:

FOOD: Committing to eat a more plant-based diet, using clean burning cookstoves, and reducing food waste
MOBILITY: Promoting walkable cities, including improving bike infrastructure and using mass transit
GENDER EQUITY: Educating girls and improving access to family planning
ENERGY: Increasing the efficiency of buildings and transitioning to clean energy sources
NATURE-BASED SOLUTIONS: Planting trees and protecting forests

An Invitation to Join the Movement

Throughout history, professional nurses have been at the forefront of change. Whether it was alleviating mass suffering related to conditions of war, addressing severe economic disparities that impact health, or responding to new and emerging infectious diseases, nurses’ orientation toward systems thinking and prevention have made them the ideal leaders for innovating and mobilizing effective solutions.

We invite you to continue this tradition by joining Nurses Drawdown at nursesdrawdown.org. Under the Take Action tab, you will find practical solutions to apply in both your personal and professional life. You will also be inspired by the stories of nurses around the globe who are taking action to promote a healthier future for generations to come.

Many will remember 2020 as the year of the pandemic. Let them also remember 2020 as both the Year of the Nurse and Midwife (World Health Organization, n.d.), and the year that nurses around the globe activated to address climate change. The nurses are here!

References

Alliance of Nurses for Healthy Environments [ANHE]. (2019). Alliance of Nurses for Healthy Environments. https://envirn.org/nursing-collaborative/

Hale, M. O. (1948). Arkansas midwives have all-day graduation exercises. The Child, 13(4): 53–54.

Hawken, P. (2017). Drawdown: The most comprehensive plan ever proposed to reverse global warning. New York, NY: Penguin.

Project Drawdown. (2020). Drawdown 2020. https://www.drawdown.org/

Wald, L. (1915). The house on Henry Street. New York: Henry Holt.

World Health Organization. (n.d.). Year of the nurse and midwife 2020.https://www.who.int/campaigns/year-of-the-nurse-and-the-midwife-2020

About Teddie M. Potter, PhD, RN, FAAN

Clinical Professor, School of Nursing- University of Minnesota
Specialty coordinator of the Doctor of Nursing Practice in Health Innovation and Leadership
Director of Planetary Health

Dr. Potter is deeply committed to climate change education including co-founding Health Professionals for a Healthy Climate, membership in the Alliance of Nurses for Healthy Environments, and membership on the American Academy of Nursing Environment and Public Health Expert Panel. She is a member of the Coordinating Committee of Columbia University’s Global Consortium on Climate and Health Education and a Fellow in the Institute on the Environment at the University of Minnesota. She chairs Clinicians for Planetary Health (C4PH) and is a member of the Steering Committee of the Planetary Health Alliance at Harvard.

At the University of Minnesota, Dr. Potter designed and co-teaches an interdisciplinary course titled “The Global Climate Challenge: Creating an Empowered Movement for Change”. In addition, she co-leads a Health Sciences initiative titled, “Climate Change and Health: An Interprofessional Response”. In 2019, Dr. Potter was appointed the first Director of Planetary Health for the School of Nursing.

Nurses’ Concerns with COVID19: Update May 2, 2020

May 2, 2020 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 3 Comments

I find that nothing is more powerful than hearing the stories of our nurses during this pandemic crisis. This website has some of these powerful stories from nurses around the globe, sharing their experiences of caring for COVID19 patients: Nursespeak.com

PPE: Nurses continue to lack Personal Protective Equipment: A recent survey showed that 75% of staff in home-care settings are lacking in PPE. Home Care Survey. 86% of healthcare systems are also concerned with having adequate PPE available: PPE shortages

Political unrest emerges even as nurses remain on the front lines of providing care for patients during the pandemic. Nurses rose to the occasion to stand their ground in the face of protestors. Nurses Urge Protestors to Stay Home

National Nurses United organized a nation-wide May-Day protest about lack of PPE: https://www.cbsnews.com/news/may-day-protest-nurses-ppe/

Nurses also took action by protesting outside of the Whitehouse on April 21 and reading aloud the names of nurses who died from contracting COVID19 in the workplace: Nurses Whitehouse Protest

And nurses are still speaking up, even if it puts their jobs at risk: Hospitals fire and suspend staff for speaking out

Nurses deaths: The virus continues to take its toll on nurses and other professionals. Issues around post-trauma recovery are now coming to light. Healthcare workers may be feeling hopeless or helpless or suffering clear PTSD symptoms. Sadly we have lost some professionals to suicide: NYPost tragic deaths.

If you need help please reach out. National Suicide Prevention Lifeline: 1-800-273-8255

A Missouri nurse, Celia Yap Banago, who raised concern about lack of PPE died of COVID19. Nurse Banago had worked as a nurse for 40 years and was literally days away from retirement.Nurse Banago

New York State Nurses Association houses a memoriam page to nurses lost to COVID 19. NYSNA memoriam page The retired executive director of the National Student Nurses Association is counted in the losses: Rest in Peace Robert V. Piemonte, EdD, RN, FAAN.

To all of the nurses taking action, thank you for stepping up.

Nurses’ Concerns with COVID19: Update April 17, 2020

April 17, 2020 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / Leave a comment

The COVID19 pandemic continues to be quite an issue in New York, with over 14,000 deaths reported. I found this link to the New York Times to be helpful in assessing where we are with official numbers of reported testing and deaths (NYTimes CVOID19), though in many states we know that testing remains very limited and accuracy of tests is still only at about 67-70%.

PPE: Nurses are still without proper PPE. While the federal government claims to have distributed millions of masks and gowns, frontline workers are still faced with shortages and putting themselves at risk. Now we are seeing surges in the cost of PPE, with costs going up over 1000%, according to a report published last week by the Society for Healthcare Organization Procurement Professionals. Competitive bidding for these supplies both internationally and within our own county has compounded the issue, and if we had federal government oversight and processes in place, it is likely these issues could be addressed in ways that would help to prevent price inflation ( CNN review of the inflation of PPE cost).

This video that appeared on CBS’s 60 minutes made it clear that nuses like New York nurse Kelley Cabrera are beginning to speak out. Nurse Cabrera works at Jacobi medical center in the Bronx. She makes the point that when nurses are required to reuse N95masks for up to 5 days, they are literally being provided with medical waste to be used as PPE. Nurse Kelley Cabrera 60 minute’s interview

Nurses Stories: Meanwhile, I have heard the stories of nurses continuing to work without proper PPE and we reultantly have high numbers of nurses testing positive in areas like Ohio.

Nurses have started to reject the idea that they be considered to be angels or heroes. They didn’t become nurses to die, and they don’t want to be martyrs. While the 7 pm clapping and cheering ritual in New York City seems to have built a community spirit, some nurses experience this differently. One New York City nurse wrote: ” I ask that you do not pity me, that you do not call me a hero. I do not wish to be made into a martyr….Clap for me and other healthcare workers at seven o’clock if it makes this pandemic feel more bearable. I concede, your cheers help us trudge on. Just know that cheers and hollering don’t change the outcome. This is my fervent plea – that we change what we can after all this is over”.

Fallen Nurses: The loss of nurses becomes hard to track as the numbers increase. NYSNA has set up a memoriam page: Fallen Nurses Memoriam

A 28-year-old pregnant nurse in the UK passed away on 4/12, RIP nurse Mary Agyeiwaa Agyapong. Her father passed away two weeks before she died. Mary’s baby daughter was delivered via cesarean section before Mary died.

Many other nurses and hospital staff in the UK have also died (daily mail review of nurse and staff COVID19 deaths).

Two nurses in Palmetto, Florida have also died from work related exposure to COVID19. Nurse Danielle Dicensio leaves behind a 4 year old son and hubsand. Nurse Earl Bailey also worked at the same hospital, Plametto General Hospital, and he passed away from CVOID19 a few weeks ago. Both nurses complained about not having access to proper PPE, which the hospital denies (two nurses die of COVID19 ).

A colleague of Nurse Cabrera’s (mentioned above), Freda Orcan, who worked at Jacobihospital in the Bronx passed away March 28.

ANA’s response to COVID19:

The Ameican Nurses Association has issued a statement that nurses should be reporting when then experience retaliation around their raising concerns regarding their personal safety in the workplace, as these are OSHA violations (OSHA and retaliation issues). While hundreds of complaints have been filed, it’s difficult to determine specifically how OSHA is responding to reports made. There is a plethora of information on their website regarding COVID19 issues (https://www.osha.gov/SLTC/covid-19/),

The ANA has created a page of resouces for nurses (ANA COVID19 page). There have developed a corona virus response fund for nurses. There is also a section about ethical guidelines for nurses that may help some in their decision making process and calls forward the bigger ethical issues that nurses are facing, and links that show all of the steps that ANA is taking in advocating for nurses.

The latest ANA/ AHA/AMA letter witten calls for the government to address the issue of minorities and the disparities they experience with receiving adequate care for their COVID19 issues. (ANA letter to the Secretary, US Department of Health and Human Services). The letter in part reads:

“As organizations that are deeply committed to equity in health status and health care, we have long recognized differences in the incidence and prevalence of certain chronic conditions, such as diabetes, asthma, and hypertension — conditions that are now known to exacerbate symptoms of COVID-19. We also recognize that other factors, including but not limited to socioeconomic status, bias and mistrust of America’s health care system, may be resulting in higher rates of infection in communities of color. Lack of access to timely testing and treatment will inevitably lead to worse outcomes for these patients.

As America’s hospitals and health systems, physicians and nurses continue to battle COVID-19, we need the federal government to identify areas where disparities exist and help us immediately address these gaps.”

While ANA has been interacting at the national level, my perception from the nurses directly working with patients on the frontlines is that they feel under-represented and that ANA is not providing them with the voice they need. One time letters to federal authorities seem to make little measurable immediate impact. around what matters for nurses being able to practice safely. They also feel that many of the practicing nurses don’t belong to ANA exactly for this reason: that there is somehow a gap between the reality of nursing practice and the work and publications of the ANA. The crisis is far from over.

May all nurses and all beings know some peace and ease.

Nurses’ Concerns with COVID19: Update April 7, 2020

April 7, 2020April 7, 2020 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 2 Comments

At this point, things are so disheartening for so many people. The range of nurses’ stories is so wide and varied, from OR nurses being essentially laid off due to no elective surgeries happening, to nurses being offered a lot of money to come to New York City to work.

New York State has taken the unprecedented step of merging all of its 200 hospitals into one system (New York State hospital system consolidation ).

There’s a lot of death. One nurse told a story of how she had 10 patients in one shift and 7 of them died. In some hospitals, there is a different kind of rapid response team called, specifically for CVOID19 patients, and they are being called sometimes just minutes apart on different units throughout the hospital.

Also, nurses are working with their colleagues who end up being patients in their same units; one nurse told of their nursing supervisor being hospitalized in their own ICU, and they conjectured the supervisor most likely would pass away there.

There’s a lot of understaffing and over-working, including on the medical-surgical units. Part of this is because nurses themselves are becoming ill and unable to come to work.

Some nurses are actually more frightened to work in the medical-surgical units because they have a lack of PPE, and all patients are presumed to be COVID19 negative. Of course, when tests come back days later, the nurses discover that they worked with these COVID19 positive patients without proper PPE. There are also many issues around HIPPA and staff not being able to find out the COVID19 status of the patients they worked with previously.

Another nurse relayed this story: he works twelve-hour shifts on a medical-surgical floor, and their usual patient load now runs from 12-15 patients, the only real charting they really do is vital signs and meds. This is possible because NYC has suspended a lot of normal operations when it comes to providing care as per the governor’s laws:

“A massive section of regulations on the “minimum standards” governing hospitals — dealing with everything from patients’ rights to the maintaining of records — has been suspended ‘to the extent necessary to maintain the public health with respect to treatment or containment of individuals with or suspected to have COVID-19’.” (read about all of the laws suspended) .

This nurse cries after every shift, and he stated his tears are so different from before, in part due to his utter exhaustion. His family and friends want him to quit, they are worried about his health, but he stated he can’t quit now, they need him too much.

Nurses are asking about ramifications of quitting their jobs; some claim that they have been threatened that they will be reported to their board of nursing for disciplinary action (this is not the reportable offense of walking out and abandoning patients, rather for resigning their position). While these threats are likely idle, some nurses are still fearful of losing their licenses.

One nurse states that she works in a COVID19 only ICU unit. She says it’s mostly completely staffed by RNs: they have no NPs, PAs, Residents, Techs, or Housekeepers. Nurses and ICU Attending and Intensivists care for the patients. Med Surg nurses act as techs and assist the ICU nurses.

Recruiting: There is still a lot of recruiting going to bring nurses to NYC. One new graduate nurse (recently licensed, with no work experience) posted on social media about being offered to be “trained” to work in the ICU in NYC. All of her travel and lodging would be covered. She would be required to work 21 days, 12-hour shifts, with no days off. The majority of the experienced nurses tried to set her straight about why this was a really bad idea, but we have no idea if she proceeded or not.

It’s not just NYC: We now have a 54-year-old nurse in Michigan who died, Lisa Ewald.

Unfortunately, nurse Ewald may have had some issues with initially being tested by her workplace, Herny Ford Health System in Detroit, Michigan. She was likely exposed on March 24, received her positive test on March 30, and passed away on April 3. She died alone in her home. (Lisa Ewald’s story).

Rest in Peace Nurse Ewald.

Meanwhile, more than 700 Henry Ford employees have tested positive for COVID19; 500 of the positive tests are nurses. (Henry Ford COVID19)

The field of nursing will be forever changed by this.

Nurses’ Concerns with COVID19: Update April 1, 2020

April 1, 2020April 2, 2020 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 4 Comments

Ongoing Issues: By now, most of us know the obvious: nurses and other healthcare professionals do not have the PPE that they need to practice safely. Nurses are testing positive for COVID19. The Defense Production Act has not been activated to produce more PPE and ventilators, and nurses and other providers are even fired for speaking out about it or organizing ways to access more PPE (Doctors and Nurses Fired for Speaking Out ).

Nurses’ Skill Level: Nurses are worried about being asked to do work they aren’t prepared to do. A former student of mine, who has been in more of an administrative role, is extremely concerned with being asked to go back into a hands-on medical surgical or even ICU in a supportive role. Practicing beyond one’s skill level or expertise is just one area of concern that is likely to grow as more nurses become ill, or refuse to work, or are otherwise unable to work.

Volunteer calls: From California to NYC to Maine, nurses are being asked to submit their names to volunteer to work. Most of these nurses will be paid, and it is an effort to organize our resources.

Nurses on the Front Line: The stories I am hearing from nurses are war-time hell-like, maybe even worse then you have heard of if you don’t have direct contact with nurses on the front line.

An example is a story a friend of mine posted from his friend in NYC: in the ER, there may be 7-10 COVID+ vented patients waiting for ICU placement. Some patients are lying on the floor in the ER because there are no beds. People are being taken to rooms on the floors and passing away before they even get seen by a nurse on that floor. Medications like propofol, ketamine, versed, and fentanyl are being run without pumps because there are no more pumps. Supplies are running out. Med Surg nurses are being forced to run drips and vents that they have not been trained on.

Pay Issues: In Utah, nurses and doctors are being asked to take pay cuts, and there is concern that this will create a great deficit of providers in this state when professionals go elsewhere to work (Utah’s largest medical provider announces pay cuts). Meanwhile, note this lovely NYC serene skyline shot, with pay that must recognize the obvious inherent hazard pay for these positions.

(nurses recruitment add, contact information removed)

Populations and Outcomes:

Much preventative and maintenance care for those with chronic and even acute illnesses is now taking a back seat. A positive note is that telemedicine and telehealth are being used much more widely, and this may have a favorable effect on how we care for populations in the future.

Dr. Chinn forwarded a first-hand account to me of a nurse who is working in Brooklyn. She is concerned about how this illness is impacting Latinx populations, as they are often members of “essential worker” populations, and they also live in large households. This nurse states that these patients are at higher risk for death, and often experience death with less dignity. She also sees all staff getting sick, from direct care providers to janitors, and patient care technicians.

Anecdotally, in one social media group, I heard the nurses estimating that survival rate once a patient is ventilated is only around 14-20%. This is devastating to be surrounded around so much futile care and facilitating so much end of life care without perhaps the time and space it requires to do this well. (Edited: national statistics show a recovery rate of about 50% post ventilator initiation).

Heartbreak: I am hearing heartbreaking stories of nurses sending off their children to grandparents or ex-spouses, so they won’t be exposed in the household should the nurse become sick themselves or accidentally contaminate the household. Nurses who can’t hug or hold their loved ones are aching inside every day. Nurses dying. Nurses looking around at their colleagues and they might wonder, who will be the next to not be at work, which one of us might end up in the ICU? Nurses may know that much of the care they are providing is futile or palliative, which creates moral distress. I am very concerned when I hear of nurses working multiple shifts, with one nurse posting that she had worked 13 shifts in a row, another posting about minimal sleep, and losing 10 pounds already. They don’t have time to eat and when they go shopping, the stores are lacking in supplies. There is no question in my mind that nurses are being put at greater risk not only due to exposure, but also due to physical, mental, emotional, and spiritual stressors.

Post-Traumatic Stress: We could say nurses are stressed, or maybe we should just be truthful and say that nurses are being traumatized. I have great fears of nurses leaving the profession after this, and I also have great fears about the health of the population in general. I am fearful for those on the front lines without access to proper PPE. This sort of chaos we are experiencing may lead to positive change eventually, but for now, it’s extremely uncomfortable, painful, confusing, infuriating, and even disorienting.

We need to take good care of ourselves and take good care of one another.

I am reaching out with loving-kindness to all nurses:

May all nurses be safe

May all nurses be at ease

May all nurses be loved

May all nurses know personal healing

Namaste