Nurses' Health

A Survey on Health and Chemical Exposures

December 11, 2007

Nurses' Health: What You Can Do

5 Steps You Can Take
Useful Resources
Suggested Reading

5 Steps You Can Take
Strategies for Improving Environmental Health in Your Hospital

1. Know your workplace rights.
The Hazard Communication Standard (also known as the Worker Right to Know Law) says employers must:

  • Maintain a set of Material Safety Data Sheets (MSDS) for chemical products used in your workplace. Each MSDS must list the names of the chemical ingredients in products, the potential health effects associated with exposure to the chemical, physical hazards like flammability and corrosivity, appropriate protective measures like gloves and eye protection, and emergency information (including the number of someone to call in case of emergency).

  • Provide training on the health and safety risks that may be posed by potential hazardous chemical exposures in the workplace to all employees.

  • Retrain or supplement training if you're moved to a new area or when new chemicals are introduced.

  • Create a written Hazard Communication policy that describes how all the elements of the standard will be satisfied.

2. Share your story

  • Tell us about your experience.

  • Join or start a committee on health and safety, the environment of care, purchasing and product safety, or environmental concerns.

  • Bring up your concerns at staff meetings, unit leader meetings, or departmental meetings.

3. Advocate for chemical safety

  • Encourage the adoption of strong and enforceable chemical policy at the federal level.

  • Help change practices to reduce exposures in your health care facility by encouraging the development of broad chemical policy.

  • Participate in policy changes at the local, state and federal levels to address chemical exposures and environmental health concerns.

  • Improve the quality, accuracy and utilization of the Material Safety Data Sheets (MSDS) -- here's how.

4. Create change in your facility

  • Work with facility administrators to encourage the adoption of broad chemical policy.

  • Wherever possible, use an alternative to the most hazardous chemicals.

  • Educate staff before introducing new chemicals.

  • Make sure that safety control measures are in place for new and established chemicals.

  • Encourage the annual survey of all chemicals used within each unit, ensuring products are labeled appropriately and that the correct MSDS are available.

  • Discourage the use of unnecessary fragrances in health care products, which can affect patients, nurses, and other caregivers.

  • Request that your health care facility conducts periodic air and wipe sampling of the nurses' and patients' environments to identify potential hazards.

  • Encourage your hospital to join Hospitals for a Healthy Environment (H2E), and volunteer to be your hospital's H2E Nurse Liaison.

5. Educate and be educated

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Tips and Useful Resources:

These sites will help you choose safer products for your facility:

  • Environmental Health Initiative [] of the American Association of Intellectual and Developmental Disabilities

More Useful Resources:

• Agency for Toxic Substances and Disease Registry
The mission of the Agency for Toxic Substances and Disease Registry (ATSDR) is to serve the public by using the best science, taking responsive public health actions, and providing trusted health information to prevent harmful exposures and disease related to toxic substances.

• ANA's Center for Occupational and Environmental Health
The Center for Occupational and Environmental Health provides occupational and environmental health expertise on issues related to the nursing professional and health care industry. The mission of the Center is to protect the health and well-being of nurses and their patients and communities through policy advocacy, programs, and training on the prevention and control of occupational and environmental hazards in relation to health care settings.

The ATSDR ToxFAQs is a series of summaries about hazardous substances developed by the ATSDR Division of Toxicology. Information for this series is excerpted from the ATSDR Toxicological Profiles and Public Health Statements. Each fact sheet serves as a quick and easy to understand guide. Answers are provided to the most frequently asked questions (FAQs) about exposure to hazardous substances found around hazardous waste sites and the effects of exposure on human health.

• Beyond Pesticides
Beyond Pesticides (formerly National Coalition Against the Misuse of Pesticides) works with allies in protecting public health and the environment to lead the transition to a world free of toxic pesticides.

• Campaign for Safe Cosmetics
The Campaign for Safe Cosmetics is a coalition of public health, educational, religious, labor, women's, environmental and consumer groups. Its goal is to protect the health of consumers and workers by requiring the health and beauty industry to phase out the use of chemicals linked to cancer, birth defects and other health problems, and replace them with safer alternatives. The site provides a list of safer cosmetics.

• Centers for Disease Control National Center for Environmental Health
The National Center for Environmental Health plans, directs, and coordinates a national program to maintain and improve the health of the American people by promoting a healthy environment and by preventing premature death and avoidable illness and disability caused by non-infectious, non-occupational environmental and related factors.

• Center for Health, Environment, and Justice
CHEJ's overarching goal has consistently been to prevent harm — particularly among vulnerable populations such as children. If a safer process, material or product exists it should be used. CHEJ believes that everyone, regardless of income, race, religion, or occupation, has a right to live, work, learn, play and pray in a healthy community.

• Childrens' Environmental Health Network
Links for a training manual and a resource guide on children's environmental health for health professionals in the U.S.

• Children's Health Protection
This is the Environmental Protection Agency's home page on issues related to the environmental health of children.

• Collaboration for Health and the Environment
CHE is a diverse partnership of individuals and organizations working collectively to advance knowledge and effective action to address growing concerns about the links between human health and environmental factors.

• EnviRN website
EnviRN is dedicated to supporting nursing professionals seeking accurate, timely and credible scientific information on environmental health and nursing. This interactive and dynamic resource seeks to foster the development of a "virtual nursing village" for the sharing of teaching strategies, practice guidance and consensus on future research needs for nursing and environmental health. The ultimate goal is to prevent environmental disease by increasing the numbers of nursing professionals who can recognize environmental etiologies and risk factors of disease, promote health through risk reduction and control strategies and empower individuals, families and communities through partnering, advocacy and education.

• Environmental Health
Important Choices for a Greener World by Susan Wilburn. The Online Journal of Issues in Nursing.

• Environmental Health and Toxicology
A free on-line toxicology tutorial created by the National Library of Medicine.

• Envirotools
This website provides a collection of educational materials on Superfund and Brownfield sites, along with sites cleaned up under state programs. EnviroTools contains presentation visuals, fact sheets, web links, a glossary and an annotated bibliography of other outreach resources, all designed to help cut through the confusion and jargon of site cleanup projects.

• EPA's Envirofacts database
This website is a single point of access to select U.S. EPA environmental data. It provides access to several EPA databases to provide you with information about environmental activities that may affect air, water, and land anywhere in the United States. With Envirofacts, one can learn more about environmental activities in a specific area or generate maps of environmental information.

• EWG's Body Burden Studies
EWG's Human Toxome Site
Provides information on EWG's Human Toxome Project and its various body burden studies of more than 500 chemicals in adults, neonates, children, and mothers and daughters.

• EWG's Food Guide
Learn about the "best and worst" produce and how to buy and eat healthier from EWG's analysis of 40,000 government tests of pesticides in popular fruits and vegetables.

• EWG's National Tap Water Quality Database
EWG's Tap Water Database
EWG has compiled drinking water contamination on over 39,751 water utilities in 42 states through contact with state environmental and health agencies. For the first time ever, you will see how your tap water stacks up against other cities and towns throughout the US.

• EWG's Skin Deep Database on Safe Personal Care Products
Skin Deep
EWG's Skin Deep database, an interactive guide to personal care product safety, pairs ingredients in nearly 25,000 products against 50 definitive toxicity and regulatory databases, making it the largest integrated data resource of its kind. Provides tips on how to shop for less toxic personal care products.

• Food and Drug Administration
The FDA is responsible for protecting the public health by assuring the safety, efficacy, and security of human and veterinary drugs, biological products, medical devices, our nation's food supply, cosmetics, and products that emit radiation. The FDA is also responsible for advancing the public health by helping to speed innovations that make medicines and foods more effective, safer, and more affordable; and helping the public get the accurate, science-based information they need to use medicines and foods to improve their health.

• HCWH's The Luminary Project
The Luminary Project: Nurses Lighting the Way to Environmental Health is an effort to capture the illuminating stories of nurses' activities to improve human health by improving the health of the environment. The shining stories and resources on this website come together as a "virtual international community" guiding nurses on how to creatively and strategically address environmental problems and illuminate the way towards safe hospitals, communities with clean air, land and water and children born without toxic chemicals in their bodie

• Health Care Without Harm
HCWH is an international coalition of over 460 organizations in more than 50 countries, working to transform the health care sector so it is no longer a source of harm to people and the environment.

• Healthy Children Project
The purpose of the Learning Disabilities Association of America's Healthy Children Project is to raise public awareness about potentially harmful toxics and health risks. The project targets women and men of reproductive age (especially those at high-risk), their children, and the health care professionals who serve them to make more informed and safer choices to protect our children and future generations from preventable harm. Take a quiz:

• Healthy Schools
Healthy Schools Network, Inc. is a 501 c3 national environmental health organization that does research, information, education, coalition-building, and advocacy to ensure that every child has a healthy learning environment that is clean and in good repair.

• Hospitals for a Healthy Environment (H2E)
H2E is creating a national movement for environmental sustainability in health care. H2E is based on the vision of a healthy health care system — a system that embraces safer building products, clean air, energy and water efficiency, safe working practices, and a commitment to public health demonstrated through waste volume and toxicity reduction.

• Institute of Medicine Report - Nursing, Health, and the Environment
If environmental health hazards and health effects are to be recognized and dealt with effectively, it is of fundamental importance that all health care providers have a clear understanding of the association between the environment and health. Toward that end, the committee makes a series of recommendations for the integration and enhancement of environmental health in nursing education, practice, and research.

• International Council of Nurses (ICN)
ICN is a federation of national nurses' associations (NNAs), representing nurses in more than 128 countries. Founded in 1899, ICN is the world's first and widest reaching international organization for health professionals. Operated by nurses for nurses, ICN works to ensure quality nursing care for all, sound health policies globally, the advancement of nursing knowledge, and the presence worldwide of a respected nursing profession and a competent and satisfied nursing workforce.

• National Institutes of Environmental Health Services
Because environmental exposures contribute substantially to the etiology of many common and complex human diseases, the NIEHS is in a unique position to focus on the interface between environmental exposures, vulnerable populations, human biology and genetics, and the common diseases that limit our longevity.

• Our Stolen Future
Great information about a new category of toxic chemicals called "endocrine disruptors." Many manmade chemicals fall into this category — chemicals that in some way block, trigger, or change our normal endocrine function.

• Physicians for Social Responsibility (PSR)
PSR is a non-profit advocacy organization that is the medical and public health voice for policies to stop nuclear war and proliferation and to slow, stop and reverse global warming and toxic degradation of the environment. (Especially read "In Harm's Way: Toxic Threats to Child Development" available at:

• Resource guide on children's environmental health in U.S.

• Scorecard
This pollution information website provides an in-depth pollution report for one's county, covering air, water, chemicals, and more.

• Sustainable Hospitals
The Sustainable Hospitals Program is part of The Lowell Center for Sustainable Production. The SHP is located within the University of Massachusetts Lowell, Department of Work Environment. SHP is assisted by faculty, staff, and students of the UMASS Lowell School of Health & Environment and the Massachusetts Toxics Use Reduction Institute (TURI).

• Toxicology Data Network (TOXNET)
The National Library of Medicine's databases for toxic exposures.

• Toxtown US
An introduction to toxic chemicals and environmental health risks you might encounter in everyday life, in everyday places.

• Union of Concerned Scientists
Provides great and provocative reports about a wide variety of environmental issues.

• US Environmental Protection Agency
The mission of the Environmental Protection Agency is to protect human health and the environment. Since 1970, EPA has been working for a cleaner, healthier environment for the American people.

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Suggested Reading:

A Civil Action by Jonathan Harr

An Inconvenient Truth by Al Gore (2006)

Blue Gold: The Fight to Stop the Corporate Theft of the World's Water by Maude Barlow and Tony Clarke

Chemical Alert: A Community Action Handbook (1993) edited by Marvin S. Legator and Sabrina F. Strawn

Climate Change Begins at Home: Life on the two-way street for global warming By Dave Reay (2005)

Deceit and Denial: The Deadly Politics of Industrial Pollution by Gerald Markowitz and David Rosner

Dying from Dioxin by Lois Marie Gibbs and the Citizens Clearinghouse for Hazardous Waste

Earth in the Balance: Ecology and the Human Spirit by Al Gore

Ecological Medicine: Healing the Earth, Healing Ourselves by Kenny Ausubel, ed.

Environmental Health and Nursing Practice by Barbara Sattler and Jane Lipscomb

Environmental Health: Ecological Perspectives by Kathryn Hilgenkamp

Fast Food Nation by Eric Schlosser

Food Politics: How the Food Industry Influences Nutrition and Health by Marion Nestle

Generations at Risk: Reproductive Health and the Environment by Ted Schettler, M.D., Gina Solomon, M.D., Maria Valenti, and Annette Huddle

Harvest for Hope by Jane Goodall

Having Faith by Sandra Steingraber

Living Downstream: A Scientist's Personal Investigation of Cancer and the Environment by Sandra Steingraber

Not Just a Pretty Face: The Ugly Side of the Beauty Industry by Stacy Malkan (2007)

Nursing, Health, & the Environment: Strengthening the Relationship to improve the Public's Health by the Institute of Medicine, Division of Health Promotion and Disease Prevention, Andrew Macpherson Pope, and Meta A. Snyder

Our Stolen Future: Are We Threatening Our Fertility, Intelligence and Survival? by A Scientific Detective Story Theo Colborn, Dianne Dumanoski, John Peterson Myers

Pediatric Environmental Health (2003) 2nd Ed., American Academy of Pediatrics.

Precautionary Tools for Reshaping Environmental Policy (Urban and Industrial Environments) by Nancy J. Myers (Editor) and Carolyn Raffensperger

Protecting Public Health and the Environment: Implementing The Precautionary Principle by Wes Jackson, Carolyn Raffensperger, and Joel Tickner

Safe Food: Bacteria, Biotechnology, and Bioterrorism by Marion Nestle

Science in the Private Interest: Has the Lure of Profits Corrupted Biomedical Research? by Sheldon Krimsky

Silent Spring by Rachel Carson

The Precautionary Principle in the 20th Century: Late Lessons from Early Warnings

The Ethics of Environmentally Responsible Health Care by Jessica Pierce and Andrew Jameton

The Omnivore's Dilemma: A Natural History of Four Meals by Michael Pollan

The Weather Makers: How Man is changing the Climate and What it Means for life on Earth (2005). By Tim Flannery

Toxic Deception: How the Chemical Industry Manipulates Science, Bends the Law, and Endangers Your Health by Dan Fagin and Marianne Lavelle and the Center for Public Integrity (Corporate Author)

Warnings by David Gee and Timothy O'Riordan

When Smoke Ran Like Water by Devra Davis

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