Challenging Unsustainable Practices: A Cross-Sectional Study of Nurses' and Midwives' Attitudes Toward Sustainability...

Climate change and environmental degradation are increasingly recognised as major global health threats. This necessitates adaptation within health systems and urgent development of mitigatory measures. Nurses and midwives are central to the environmental impact of healthcare and to advancing sustainable practices. This study explored nurses' and midwives' attitudes toward sustainability and climate change and perceived barriers to sustainable practice.

A cross-sectional survey design was used, employing the Sustainability Attitudes in Nursing Survey (SANS-2) instrument to assess attitudes to sustainability and climate change. The survey included nine core Likert-scale items (1 = strongly disagree to 7 = strongly agree) and five further researcher-designed questions. A convenience and snowball sample of nurses, midwives and students was recruited via professional networks and social media across Ireland, the United Kingdom, Germany, and other European countries. Quantitative data were analysed using descriptive statistics and analysis of variance (ANOVA) to explore differences by professional role. Open-ended responses were examined using content analysis to identify recurring themes.

There were 256 complete responses. Most participants agreed that climate change (78%) and sustainability (87.1%) are important issues for nursing and midwifery. The majority supported their inclusion in nursing and midwifery curricula (climate change: 68.8%; sustainability: 77.7%). While most participants reported applying sustainability principles at home (84.4%), only just over half reported doing so in their nursing and midwifery practice (53.5%). Significant relationships were found between sustainable behaviours at home and work (p < 0.001) and between perceived time availability and belief in climate change importance (p ≈ 0.001).

Findings reveal strong recognition of sustainability's relevance but limited translation into practice, particularly among students and early-career staff. Hierarchical structures and a lack of confidence inhibited challenges to unsustainable practices. Educational reform embedding sustainability within nursing curricula, aligned with the UN Sustainable Development Goals, is essential to empower nurses and midwives as climate health advocates.

Nurse managers and leaders should embed sustainability within clinical governance, quality improvement, staff development and leadership practice. Creating psychologically safe environments where nurses can raise concerns about unsustainable practices, alongside visible leadership support and targeted education, may facilitate the translation of positive sustainability attitudes into environmentally responsible practice.