US Climate and Health Alliance

Partnership, Leadership, and Innovation: Taking on Climate Change in a Nurse-Led Clinic

Written by Shanda Lembeck, BSN, RN-BC, PHN, University of Minnesota School of Nursing

Staff in the MHealth Nurse-Practitioner Clinic were already accustomed to leading change: as a nurse-led partnership between the University of Minnesota School of Nursing, the MHealth system, and UMPhysicians, the clinic was launched as one of only a few nurse-led clinics in the metropolitan area. So the six-month old clinic was quick to engage another partner in launching an effort to address climate change as a health issue.

Demorest, 2016

Over the course of a year, a doctoral student from the University of Minnesota School of Nursing worked closely with the staff at the clinic to co-create and launch a comprehensive plan to learn about environmental sustainability in health care, take action to reduce their clinic’s carbon footprint, and proclaim a public stance on environmental action. Collaboration and partnership defined their practice, so it was natural and essential to organize the project in the same way: together.

Once the handshakes were complete, the doctoral student drafted a plan for team building, staff education on environmental sustainability in health care, and project metrics. The staff began with a pre-intervention survey called the Nurse Environmental Awareness Tool (NEAT) to evaluate their baseline knowledge and self-reported environmental behaviors (Schenk, Butterfield, & Postma et al., 2015). The official project launch included a collective Climate Conversation with all staff members in the clinic. Based on a methodology developed by Minnesota Interfaith Power and Light (2010), a faith-based climate action group, to discuss stories and knowledge related to climate change, a Climate Conversation consists of a four-part discussion: a) sharing stories of one’s own personal connection to nature or another being, b) identifying elements from the stories that reflect personal values, c) discussing group members’ knowledge and feelings about climate change, and d) talking about ways to take action related to climate change. The doctoral student facilitated the conversation to bring together the various elements, culminating in a holistic discussion about personal stories, shared values, and climate change.

The Climate Conversation provided the basis for education about environmental sustainability in health care and the health impacts of climate change. Staff learned about health care’s carbon footprint, Minnesota’s top five health hazards related to climate change, and opportunities they had at their clinic to make some improvements together. Additionally, staff members joined an online virtual carbon footprint tracker to evaluate their own personal footprint, as well as the energy use they contributed to at work. Some key learnings included:

  • Health care is the second most energy-intensive industry in the United States (Healthcare Without Harm, 2016).
  • The top five health hazards related to climate change in Minnesota are extreme heat, poor air quality, vector-borne diseases, flooding, and drought (Minnesota Department of Health, 2014)

After learning about environmental sustainability and climate change, the staff very quickly activated for climate change. Over the course of several months, they launched the following interventions:

  • Transitioning to 100% wind energy (Xcel Energy, 2016)
  • Initiating and participating in a clinic-wide recycling program via a county grant
  • Installation and monitoring of 30 electricity timers
  • Creating patient education about climate and health
  • Utilizing “These Come from Trees” stickers to reduce paper towel waste (Kazanjy, 2016)
  • Transitioning to sustainable promotional materials (reusable grocery bags and drinkware)
  • Writing a vision for the clinic to be an environmental steward in the interest of a healthy climate

Demorest, 2016

While the doctoral student informed the staff of some of these interventions, others were completely self-directed. In one instance, a Certified Medical Technician developed patient education on climate change entirely independently, she later collaborated with her colleagues to edit and distribute the materials.

In the post-intervention assessment using the NEAT (Schenk et al., 2015), the staff demonstrated substantial improvements in both knowledge and behaviors from the beginning of the project to the end. After launching the interventions, the staff reported finding personal value in learning about energy and waste reduction, creating patient education, building a team, and having an energized workplace. They also reported personal impacts such as making environmental changes at home, educating family members, and choosing to travel to work via alternative modes of transportation, such as bicycling or traveling via light rail. Based on the post-intervention evaluation, 100% of staff intended to sustain all but one environmental action after completion of the project.

Demorest, 2016

Over the course of a year, the MHealth Nurse Practitioner Clinic staff engaged deeply in Climate Conversations. They learned about the challenge of energy-intensive health care and how health care’s carbon footprint contributes to climate change and negatively impacts patients’ health. Most importantly, they partnered together to activate, which contributed to significant positive changes in their workplace and their personal lives. Climate change is an enormous threat to human health; seen in that light, it is too daunting for any one person to tackle. When clearly presented as a team challenge and an opportunity for partnership and improvement, however, health professionals can engage and take action.


Healthcare Without Harm. (2016). Energy efficiency. Retrieved from

Kazanjy, P. (2016). These Come From Trees Blog [Web log post]. Retrieved from

Minnesota Department of Health [MDH]. (2014). Minnesota climate change vulnerability assessment 2014. Retrieved from

Minnesota Interfaith Power & Light [MNIPL]. (2010). Climate conversations: Connecting head, heart, & will. Retrieved from

Schenk, E., Butterfield, P., Postma, J., Barbosa-Leiker, C., & Corbett, C. (2015). Creating the Nurses’ Environmental Awareness Tool (NEAT). Workplace Health and Safety, 63(9), 381-391.

Xcel Energy. (2016). Windsource® for residences. Retrieved from