‘It’s About Being Prepared’: Educating Nurses on Climate Crisis

MCPHS curricula focuses on equipping nurses with skills to handle climate-related health issues.

As 2017 Massachusetts College of Pharmacy and Health Sciences (MCPHS) nursing alum Cynthia Nichols, MS, BSN, RN, recently prepared to discharge a hospital patient with congestive heart failure, she asked him questions she might not have considered asking just a few years ago.

The reason: intense heat generated by climate change is the number one cause of weather-related deaths in the United States, according to the NOAA National Centers for Environmental Information. Her patient must manage diuretics and fluids, both of which can make him more vulnerable to heat, amid a volatile climate producing record-setting temperatures.

“I said, you are going to be somebody that's more vulnerable to heat… your body can't handle it the same way other people do or when you were younger,” Nichols related. “The best thing for you is just to stay cool and not get hot in the first place.”

Damage caused by climate change is in the news every day: houses flooded away, landscapes swallowed by flame, and hurricane winds annihilating coastal communities almost seem commonplace.

More subtle, however, is the less understood damage that volatile weather, like the recent record-breaking heatwave that swept through the Northeast and the Midwest, inflicts on people who are already sick and vulnerable. According to the Centers for Disease Control and Prevention, heat-related deaths have steadily risen over the past few years, from 1,563 in 2021 to 1,702 in 2022, with a provisional count of 2,262 deaths in 2023.

“If you're a bedside nurse, you are going to be caring for clients that are going to have weather impacts in one variety or another pretty much on a daily basis,” said Carla Smith, MSN, RN, CNE. She is Assistant Professor at MCPHS’s School of Nursing on the Manchester, NH, campus.

Smith and Nichols are partners, in fact, in spearheading an effort to develop climate-related course curricula for nursing education throughout New England. Smith designed the lecture materials to map to existing licensure and accreditation standards, while Nichols focused on the climate health content and evangelizing to other schools and healthcare institutions.

The program has been taught at the MCPHS School of Nursing since 2021. In 2023 and 2024, five other schools—University of New Hampshire, Plymouth State University, River Valley Community College, Rivier University, and Colby Sawyer School of Nursing & Health Sciences—trialed the program and are considering a more permanent run. Several nursing programs outside New Hampshire have also expressed interest, according to Smith.

“Now that we’ve presented the material, we’re hoping that the schools will feel comfortable either using our presentation or incorporating it themselves,” Nichols said.

Two hundred sixty-one students have participated in the program so far, which was developed in consultation with NH Healthy Climate, an association of healthcare workers hoping to increase public awareness of the links between health and climate change. (The organization recently changed its name from NH Healthcare Workers for Climate Action.) Also instrumental in developing and teaching the program, according to Smith and Nichols, was Kaitlynn Liset, MS, RN, CNL, Clinical Assistant Professor, Department of Nursing, University of New Hampshire.

In surveys given after the program, almost half the students (42 of 90) said they were surprised by the links between climate change and human health. Consider these scenarios:

Power crisis. Escalating weather events contribute to a growing number of power grid outages, increasing the risk for those who use durable medical equipment (DME) such as wheelchairs, ventilators,and CPAP machines, Smith said. Nurses can help patients and their caregivers identify the need for battery backup systems or other power alternatives.

Escalating pollen counts. Climate change has been linked to higher pollen concentrations and extended pollen seasons, according to the U.S. Department of Health and Human Services. “Look at our pollen counts this past spring, and how that really can impact somebody who has COPD, who has asthma, who has heart failure, or heart disease,” Smith said. “That pollen count itself is going to have a significant impact on the cardiopulmonary and respiratory aspects for these clients.”

Home alone. Nurses can help frail patients who live at home alone think about evacuation planning. Is the patient on the right help list? Are their evacuation plans up to date? Where can emergency care or medications be secured quickly?

By land and sea. Air- and water-borne diseases carried by mosquitoes and ticks have more chance to cause havoc as temperatures rise because shorter winters extend the period when these pests are active.

Smoke damage. Smoke from wildland fires can disrupt respiratory and heart disease patients.

“This isn't about changing the weather,” said Smith. “It's not about politicizing things. It's about being prepared knowing that these [events] can have health impacts, As healthcare providers, how can we teach our clients to be in their best health under these circumstances?”

Into the classroom

In the one-hour program, students use four case studies and a variety of exercises to create potential positive outcomes given different scenarios for patients at risk from climate-related events. These include plans of care, nursing diagnoses, and three nursing interventions to minimize risk.

Students were divided into small groups to identify key components to include in a plan of care for four discharging patients: a 12-year-old with cystic fibrosis who lives with his parents; a 40-year-old multiple-sclerosis patient living with a spouse, uses a power wheelchair, and sleeps in a hospital bed; a 65-year-old with chronic obstructive pulmonary disease who lives alone; and an 80-year-old frail man recovering from pneumonia and deconditioning who lives alone.

Questions the students considered included: What durable medical equipment might they have? When they get home, what can they do to prepare for a power outage? What do they need in case of an emergency evacuation? Details to be considered might include making sure the patient has a to-go bag for quick evacuation, laminated medication cards to ensure they remain readable if wet, and an air quality phone app to check air quality before going outside.

At times, Smith and Nichols concede, promoting the program to schools has been difficult. Nursing students are already tight for time, so adding a subject as complex as climate change was a tough sell, they said. Making the presentation just an hour long made it easier for programs to accept, she said. Even some of the students rolled their eyes at a climate change offering, expecting content that might be overly political.

“I think it can be tricky because it can be a highly politicized topic,” Smith said. “Our role as nurses is to neutralize that… It doesn't matter what you feel about climate science. Anybody can have their own opinions on that. But I can tell you, climate impacts our patients' health, and this is what we need to talk about.”

To further promote the program and its significance, Smith has seized various opportunities to advance the dialogue. In 2023, she gave a presentation, “Health Impacts of Climate Change: Engaging Pre-Licensure Nursing Students to Bridge the Academic-Practice Gap,” at the National Forum of State Nursing Workforce Centers annual conference in Washington D.C. A research paper on the program is also in the works, she said.