Global Code Red: Nursing Education’s Call to Climate Change : Nursing Education Perspectives

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DEPARTMENTS: Message From the NLN Chair

Global Code Red: Nursing Education’s Call to Climate Change

Poindexter, Kathleen

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Nursing Education Perspectives 44(2):p 73-74, 3/4 2023. | DOI: 10.1097/01.NEP.0000000000001103
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A quick look at the calendar indicates spring is around the corner, and for many students and educators, it is time for a well-deserved reprieve from academic studies, known as spring break. Those who plan a trip to southern vacation spots may enjoy some warmer weather because of a strong probability of an early spring with increasing temperatures because of climate change and global warming (Environmental Protection Agency, 2021). If you are heading to the ski slopes for one last spring fling, you may want to double-check the weather and snow base.

Although these phenomena may seem to have some short-term positive implications, the impact of climate change has devastating effects on our ecosystems, economy, and overall health. We have all witnessed major shifts in weather, causing an increase in the severity of droughts, tornadoes, hurricanes, floods, and wildfires, resulting in injury, death, crop devastation, and homelessness, with significant economic impact.

“Climate change refers to a change in the state of the climate which is attributed directly or indirectly to human activity that alters the composition of the global atmosphere and which is in addition to natural climate variability observed over a comparable period” (United Nations, 1992). Increasing concentrations of greenhouse gases cause a warming effect on our planet’s atmospheric and oceanic temperatures, increasing carbon dioxide and sea levels, and decreasing glacial ice fields (NASA Global Climate Change, 2023). Burning of fossil fuels, the primary cause of greenhouse gas emissions, creates a blanket effect around the earth and traps heat from the sun.

A report from the Intergovernmental Panel on Climate Change (2021) concluded that the current increase in the earth’s temperature of 1 degree Celsius is causing extreme disruptions in weather patterns such as heat waves, floods, droughts, and wildfires, affecting natural resources and threatening human well-being. The World Health Organization (2022) predicts that between “2030 and 2050, climate change is expected to cause approximately 250,000 additional deaths per year from malnutrition, malaria, diarrhea, and heat stress. The direct damage costs to health are estimated to be between US$ 2–4 billion per year by 2030.” A report published by the Lancet Countdown (Romanello et al., 2021) noted 44 indicators on the health impact of climate change called for rapid action in alignment with the Paris Agreement to keep the global temperature rise to 1.5 degree Celsius.

Climate change effects threaten the core basics of health such as clean air, water, safe food, and shelter. Despite decades of warnings, the pace of change has surpassed steps to reduce the damaging effects of greenhouse gas emissions. As nurses, leaders, and educators, we have a responsibility to address this priority public health concern through education, research, practice, and advocacy. However, the impact of climate change on health is complex and affected by direct and indirect mechanisms. The health effects of the disruptions include respiratory and cardiovascular disease, injuries, premature deaths, food and water-borne illnesses, infectious diseases, and threats to mental health. These are complicated by social dynamics such as age, gender, health status, socioeconomic status, social capital, mobility, and public health infrastructure. Everyone is affected by climate change, but low- and middle-income countries and disadvantaged populations are disproportionately affected (US Global Change Research Program, 2016).

The integration of climate change and its effects on the health of our nation and the global community into nursing education is essential to prepare a workforce with the knowledge and skills to promote health, adaptation, resilience, and the ability to mitigate the impact of global warming. Nurses cross all aspects of health care and can assume leadership roles in curricular development, research, practice initiatives, and education. Sustainable results will require a strategic plan and substantial systemic change to slow the devastating effects of climate change across all sectors.

As the leader for nursing education, the National League for Nursing (NLN) is highly invested in addressing climate change as crucial to nursing’s future, advocating for a sustainable environment and advancing health equity and education. The NLN and Walden University College of Nursing Institute for Social Determinants of Health and Social Change was established to address social determinants and the impact of climate change on communities ( Its goal is to transform and serve as a catalyst for social change. The NLN (2022) also published a Vision Statement on Climate Change and Health, highlighting the health consequences as a public health and health equity crisis. The NLN statement addresses the importance of educating current and future nurses for climate change-informed practice and policy leadership. This comprehensive document includes a call to action, implications for nursing, and the significance for nursing education. It also provides educators with resources and strategic recommendations.

NLN President and Chief Executive Officer Dr. Beverly Malone has assumed a prominent leadership role in addressing climate change as a member of the National Academy of Medicine Action Collaborative on Decarbonizing the US Health Sector (Climate Collaborative), a public-private partnership of leaders from across the health system committed to addressing the sector’s environmental impact while strengthening its sustainability and resilience. She is a member of the steering committee and co-chairs the Health Professional Education and Communication Working Group. In Dr. Malone’s own words: “The climate change issue is one that affects every nurse because we take care of patients and we’re devoted to that; there’s no separation between climate change and the health care that we deliver to patients” (

With climate change one of the greatest global health threats today, nurse educators and leaders are called on to advocate for global efforts to reduce emissions and protect those we serve. The importance of all nurse educators and their ability to inspire future nurses to respond to the call for action and address climate change is not to be underestimated. Integration of content on climate change into existing courses can be a challenge, and despite good intentions, educators struggle with time constraints, content overload, and lack of resources or training on education materials and policy statements. The NLN can offer recommendations on how to support education, access resources, and link to advocacy activities to incorporate this content into courses across all levels of programming. Visit the NLN Healthy Planet, Healthy People resource page for a list of available resources and activities to engage learners in a variety of activities ( In addition, following are some suggested activities:

  • Join your peers and students in completing the Climate, Health, and Nursing Tool 10-minute survey, which is designed to assess awareness, motivation, and behaviors related to climate change and health ( Knowledge of your students’ foundational beliefs will guide your future lesson development. Educators can request a unique identifier to receive a copy of their students’ results.
  • Encourage students to register on the nursing climate change and health collaborative ( to explore opportunities to increase involvement and advocacy activities.
  • Assign students to prepare peer or patient educational materials as part of an authentic or service-learning project on climate change and impact on health.
  • Complete ambassador training with the Climate for Health ( This includes a free three-hour training to prepare health professionals with the knowledge, experiential practice, and resources to speak confidently on climate change to inspire others and be a change maker for climate solutions.
  • The Alliance of Nurses for Health Environments ecoAmerica also sponsors programs, resources, and activities such as ambassador training (form a peer educator group), webcast discussions to jumpstart dialogue, downloadable fact sheets, information on mental health and climate change, and Climate RX badges for students to support patient education using QR codes (
  • Challenge your students and peers to join the Nurses Climate Challenge ( Or access the Centers for Disease Control and Prevention site’s Impact of Climate Change on Health ( to add content to lectures on cardiovascular, respiratory, or community health to improve assessment and decision-making skills in relation to social determinants of health and climate impact.
  • The Pan American Health Organization has developed a free downloadable publication for providers to manage health risks related to climate change, Climate Change for Health Professionals: A Pocketbook (
  • Finally, go the DearTomorrow website and share a personal climate message to inspire deep thinking and bold action to mitigate the impact of climate change ( The site is a storytelling project where people write messages to themselves or loved ones living the in future. Or simply provide some overarching guidelines for your students on the impact of climate change aligned with your course objectives and let their creativity go. I have found my students tend to surpass many of the ideas I could have generated, and I also learn much from them.

As peer academic leaders, nurses, and educators, I challenge you to include one aspect of climate change into your course at a time. Together, and only together, will we make a difference to slow the growth of climate change and advocate for equitable health care for all.



Environmental Protection Agency. (2021). Seasonality and climate change: A review of observed evidence in the United States [EPA 430-R-21-002].
Intergovernmental Panel on Climate Change. (2021). Climate change 2021: The physical science basis. IPCC Sixth Assessment Report,
NASA Global Climate Change. (2023). Understanding our planet to benefit humankind.
National League for Nursing. (2022). Climate change and health [NLN Vision Series #20].
Romanello M., McGushin A., Di Napoli C., Drummond P., Hughes N., Jamart L., Kennard H., Lampard P., Solano Rodriguez B., Arnell N., Ayeb-Karlsson S., Belesova K., Cai W., Campbell-Lendrum D., Capstick S., Chambers J., Chu L., Ciampi L., Dalin C., Hamilton I. (2021). The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future. Lancet, 398(10311), 1619–1662. 10.1016/S0140-6736(21)01787-6
United Nations. (1992). United Nations framework conventions on climate change.
US Global Change Research Program. (2016). The impacts of climate change on human health in the United States: A scientific assessment.
World Health Organization. (2022). Climate change [Health topics].
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