News

Nurses as Advocates for Healthier Environments and Communities

Tue, 21 Apr 2026 17:54:00 GMT

Article By: Deborah Hogan, MPH, BSN, RN

As we commemorate another Earth Day in recognition of our planetary needs, we are reminded of the health impacts that climate breakdown has on our patients and communities. Many of us were recently inspired by the beauty of our planet as we watched images shared by the Artemis II crew. The image of our planet as a “big blue marble,” as described on previous space trips, remains a lasting reminder of how precious our planetary resources are—and of the challenges we face.

According to the U.S. Global Change Research Program, our population is already experiencing the effects of global warming, including temperature-related death and illness, air quality concerns, extreme weather events, vector-borne and water-related illnesses, impacts on food safety, and mental health issues. We know that the increase in greenhouse gases in the atmosphere, largely due to fossil fuel use, has caused the Earth’s temperature to rise. This increase has led to planetary impacts such as drought, increasing storm severity, and heat-related events—all of which directly impact the health of our patients.

What is our role as nurses in protecting our planet? Do we have a role in educating and treating our patients and communities regarding the health effects of climate breakdown? According to the American Nurses Association (ANA), our role is essential. In ANA’s publication Nursing and Climate Mitigation: Decarbonization, our Code of Ethics requires that we work to decrease further harm to our world while recognizing and addressing the health effects environmental changes have on our population.

Where do we begin? Reducing the Earth’s temperature requires reducing and stabilizing greenhouse gases (GHGs). These emissions are categorized into three scopes. Scope 1 includes emissions from buildings and automobiles, and Scope 2 refers to purchased electricity and steam—together accounting for about 20% of GHGs. The largest category, Scope 3, makes up 80% of emissions and includes goods and services, waste, business travel, employee commuting, and investments. According to ANA, this is where nurses can make a meaningful difference in decarbonization, particularly within healthcare and educational settings.

In addition, we can educate our patients, communities, and students regarding the health effects of climate change that we see in practice. The CDC illustrates how increasing CO2 levels, rising temperatures, extreme weather, and rising sea levels contribute to air and water pollution, increased allergens, vector and zoonotic exposure, and environmental degradation. These impacts disproportionately affect children, older adults, and communities of color.

As we enter the summer months and hurricane season, it is essential that we work with our patients and communities to prepare for these environmental impacts. We should educate ourselves and our patients about the effects of increased heat and humidity on their health. Resources are available to determine heat risks and air quality so that patients can better protect themselves. Are we aware of the “cooling centers” in our communities? If limited, do we need to advocate for more safe spaces during extreme heat events?

It is also important to develop a “Heat Action Plan” so that individuals and families are prepared. Having a “To Go Bag” is critical for evacuation during severe storms, and understanding the availability of local Special Needs Shelters—especially for those requiring electricity for medical needs—is essential. Now is the time to share these resources and ensure our communities are prepared.

As healthcare providers and community advocates, we must take the lead in raising awareness and encouraging mitigation, recycling, and preparedness efforts. Based on ANA recommendations, we can advocate for less travel and more virtual meetings, promote telehealth where appropriate, and participate in healthcare facility initiatives aimed at reducing waste and emissions. Joining committees focused on sustainability and supporting efforts to minimize packaging and safely reuse materials are tangible ways nurses can contribute.

Additionally, preparedness for extreme weather events is crucial. Supporting community mitigation strategies, encouraging early preparation for hurricane season, and ensuring plans are in place to care for vulnerable populations are all part of our role.

Nurses have an essential role to play in decarbonization and climate advocacy, even at local and community levels. As with ANA, the Florida Nurses Association (FNA) supports addressing environmental issues to reduce their impact on public health. By educating legislators and participating in Advocacy Days, we help inform policy decisions that directly affect the health of our communities.

Finally, as we celebrate Earth Day, we are reminded of our shared responsibility to care for the planet we call home. Let’s reflect on the ways we can make a positive impact—whether through conserving resources, reducing waste, supporting environmental initiatives, or educating others. Every action, no matter how small, helps protect the Earth for future generations. Together, we can foster a healthier, more sustainable world.

Sources

Crimmins AJ, Balbus JI, Gamble CB, et al eds. The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment, US Global Change Research Program;2016.dol:10 7930/JoR49NQX. https://www.cdc.gov/climateandhealth/effects/default.htm

Shenk, Elizabeth, Castner, Jessica, Huffling, Katie, Povlika, Barbara and Potter, Teddie. Nursing and Climate Mitigation: Decarbonization. AJN , American Journal of Nursing 125(4): p36-42. April 2025.

Heat Action Plan – https://www.cdc.gov/heat-health/infographic/make-a-heat-action-plan-with-your-doctor.html

Air Quality – https://ww.airnow.gov/aqi/aqi-basics/

Heat Risk Tool- https://www.cdc.gov/heat-health/hcp/clinical-guidance/how-to-use-the-heatrisk-tool-and-air-quality-index.html#cdc_generic_section_2-heatrisk-tool

Posters/handouts – Protect Yourself and Your Family with 5 Steps from Extreme Heat (Americares) – https://www.americares.org/what-we-do/emergency-programs/disaster-types/extreme-heat-and-climate-change

Special Needs Shelter – www.FloridaDisaster.org/planprepare/shelters.

Advance Care Planning and Health Care Decisions Day April 16, 2026

Wed, 15 Apr 2026 17:03:00 GMT

Article By: Maura Farrell Miller, PhD, AAPRN, ACHPN, GNP-BC, PMHCNS-BC

Each year, Health Care Decisions Day invites clinicians and communities to reflect on how we support individuals in making informed choices about future medical care. For members of the Florida Nurses Association, this day is more than a reminder to complete advance directives—it is an opportunity to lead the evolution of advance care planning (ACP) into what it was always meant to be: a dynamic, person-centered process that prepares patients and families for communication and decision-making across the life course.

From Advance Directives to a Continuum of Care Planning

Historically, ACP was narrowly defined as completion of advance directives (ADs) and documentation of code status following the Patient Self-Determination Act of 1990 . Over time, both research and clinical experience revealed the limitations of a forms-focused approach.

A multidisciplinary Delphi panel defined ACP as “a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care,” with the goal of ensuring care consistent with those values during serious and chronic illness . This definition marked a critical shift—from paperwork to preparation.

More recently, ACP has been reconceptualized within a broader “care planning umbrella,” emphasizing preparation for communication and medical decision-making, both in-the-moment and in advance, across the life course . Under this framework, advance directives and POLST forms remain important tools—but they are only one component of a larger, ongoing process.

What Does the Evidence Tell Us?

ACP research has been heterogeneous, with mixed findings when success is defined narrowly as goal-concordant care or reduced utilization . However, consistent positive outcomes emerge in key domains:

Increased surrogate designation and documentation
Improved communication between patients, families, and clinicians
Reduced surrogate distress
Greater satisfaction with communication and care

Importantly, timing matters. In a large cohort of Medicare beneficiaries, timely ACP visits (more than one month before death) were associated with significantly less intensive end-of-life care, including lower odds of in-hospital death and ICU use, whereas late ACP (within the last month of life) was associated with more intensive care. These findings reinforce the importance of initiating ACP early—before crisis-driven decisions dominate.

Yet, recent pragmatic trials remind us that increasing documentation alone does not guarantee improved patient-centered outcomes. In one primary care–based intervention, ACP documentation increased significantly, but potentially burdensome care also increased among decedents . This underscores a crucial lesson for nurses: documentation is a means, not an endpoint. The quality of conversation and alignment with evolving values matter most.

Nursing has a Central Role

All nurses are uniquely positioned to normalize ACP as part of routine care rather than a signal of impending death. Patients consistently report that trusted relationships and transparent communication are central to positive ACP experiences .

Practical steps for nursing practice include:

Asking every adult patient whether they have identified a surrogate decision-maker
Exploring what “quality of life” means to them in their own words
Framing ACP as revisable and iterative
Documenting values—not just treatment preferences—in accessible locations within the electronic health record

Team-based and facilitator-supported models have shown promise. In patients with advanced cancer, facilitated ACP resulted in higher engagement and advance directive completion compared with patient-directed materials alone . Similarly, patient-activation tools such as PREPARE have demonstrated increased participation and documentation in diverse older adult populations .

For nurses, this affirms what we know intuitively: structured support, health literacy–sensitive tools, and interdisciplinary collaboration enhance engagement.

Beyond Autonomy: Preparing Surrogates and Systems

ACP is not solely about individual autonomy; it is also about preparing surrogate decision-makers. Studies reveal variability in how surrogates conceptualize their role, often conflating advocacy with substituted judgement . Without explicit conversations about values and goals, surrogates may struggle to interpret written directives accurately. Furthermore, system-level barriers—productivity pressures, EHR fragmentation, and form-driven metrics—can narrow ACP into a checkbox exercise.

Health Care Decisions Day challenges us to advocate not only for conversations, but for structural supports that make those conversations meaningful and retrievable at the point of care.

Reframing the Message for Health Care Decisions Day

Recent scholarship suggests that rebranding ACP as “Advance Care Preparation” may better reflect its purpose: to educate, share, and prepare rather than to predict fixed future health care decisions . This reframing aligns with nursing values of relational care, adaptability, and whole-person assessment.

On Health Care Decisions Day, consider shifting the conversation:

Instead of asking, “Do you have an advance directive?”
Ask, “Who would speak for you if you couldn’t speak for yourself?”

Instead of, “Do you want CPR?”
Ask, “What makes life meaningful for you—and what would be unacceptable?”

These questions invite reflection, reduce decisional burden for loved ones, and foster trust.

Health Care Decisions Day April 16, 2026: A Call to Action for FNA Members

As advanced practice nurses and all nursing leaders across Florida, we can:

Integrate ACP into routine wellness and chronic care visits
Mentor colleagues in communication skills and shared decision-making
Advocate for centralized, accessible ACP documentation in our health systems
Partner with community organizations to promote health literacy around end-of-life planning

Health Care Decisions Day is not about increasing forms completed in a single week. It is about cultivating a culture where discussing values, goals, and future care is as routine as reviewing medications.

Advance care planning continues to evolve. As nurses, we must evolve with it—ensuring that every conversation honors what matters most to those we serve.

Sources