Green Nursing in Healthcare: A Systematic Review of Sustainable Nursing Practices and Environmental Stewardship

Environmental sustainability has become an indispensable component of contemporary healthcare because the health of individuals and communities is closely linked to the condition of the natural environment. Climate change, environmental pollution, and the overconsumption of natural resources have intensified public health challenges across the globe, leading to increased incidences of respiratory illnesses, heat-related diseases, infectious outbreaks, and other environmentally influenced health conditions. Although healthcare systems are established to improve health and well-being, they also consume large quantities of energy, water, pharmaceuticals, and disposable medical products, making the sector a significant contributor to greenhouse gas emissions and environmental waste. This paradox has generated increasing interest in adopting sustainable practices that reduce the ecological impact of healthcare while maintaining safe, efficient, and high-quality patient care.

Nursing professionals are central to achieving sustainable healthcare because they constitute the largest proportion of the global healthcare workforce and remain actively involved in nearly every aspect of patient care. Their responsibilities extend beyond clinical interventions to include infection prevention, waste segregation, resource management, patient education, health promotion, and quality improvement initiatives. As a result, nurses possess considerable potential to influence environmentally responsible healthcare practices. The concept of Green Nursing has emerged to describe the integration of environmental sustainability into nursing practice through actions that conserve resources, minimize waste, reduce pollution, and promote environmentally conscious healthcare delivery without compromising patient outcomes.

The increasing recognition of environmental sustainability has encouraged healthcare organizations to implement initiatives aimed at reducing their environmental footprint. These initiatives include improving biomedical waste management, minimizing unnecessary use of disposable materials, promoting recycling programs, conserving water and electricity, adopting environmentally preferable procurement strategies, and replacing paper-based documentation with digital systems. Nurses play a critical role in planning, implementing, and evaluating these interventions because they interact continuously with patients, multidisciplinary teams, and healthcare resources. Their active participation is essential for translating sustainability policies into everyday clinical practice.

Green nursing extends beyond environmental protection by supporting economic efficiency and social responsibility within healthcare organizations. Sustainable resource utilization can reduce operational costs, improve organizational efficiency, and create healthier environments for both patients and healthcare professionals. Furthermore, educating patients and communities about environmentally responsible behaviors enables nurses to promote public health while contributing to broader sustainability goals. Integrating sustainability into nursing practice therefore reflects the profession's commitment to protecting present and future generations through responsible healthcare delivery.

Despite growing awareness of environmental sustainability, the implementation of green nursing practices remains uneven across healthcare settings. Many healthcare institutions continue to encounter challenges such as limited environmental education, insufficient institutional support, financial constraints, inadequate sustainability policies, and resistance to organizational change. Differences in healthcare infrastructure and resource availability further influence the successful adoption of sustainable nursing interventions. Consequently, understanding the current evidence regarding effective green nursing strategies is essential for supporting evidence-based practice and improving sustainability within healthcare systems.

Although research related to sustainable healthcare has expanded substantially during the past decade, published evidence specifically examining the contribution of nursing professionals remains dispersed across various clinical specialties and healthcare environments. Existing studies differ considerably in their interventions, outcome measures, and methodological approaches, making it difficult to draw comprehensive conclusions regarding the effectiveness of green nursing practices. A systematic review is therefore necessary to synthesize the available evidence, identify successful interventions, examine barriers and facilitators to implementation, and determine priorities for future research.

Accordingly, this systematic review aims to critically synthesize current evidence on green nursing and sustainable healthcare practices. The review seeks to identify environmentally sustainable nursing interventions, evaluate their effectiveness in improving environmental and organizational outcomes, explore factors influencing successful implementation, and provide evidence-based recommendations for nursing practice, education, healthcare management, and policy development. By consolidating contemporary research, this review intends to strengthen the evidence supporting environmentally sustainable nursing and contribute to the development of resilient, resource-efficient, and environmentally responsible healthcare systems.

RESEARCH METHODOLOGY

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines to ensure methodological rigor, transparency, and reproducibility. The review aimed to identify, evaluate, and synthesize published evidence on green nursing practices and sustainable healthcare interventions involving nursing professionals.

Search Strategy

A comprehensive literature search was performed across five major electronic databases:

• PubMed
• Scopus
• Web of Science
• CINAHL
• Cochrane Library

The search included articles published between January 2015 and March 2025. Both Medical Subject Headings (MeSH) and free-text keywords were used to maximize retrieval of relevant studies. The search strategy combined terms such as "green nursing," "sustainable nursing," "environmental sustainability," "sustainable healthcare," "environmental stewardship," "healthcare waste management," "climate change," "eco-friendly nursing," and "nursing practice." Boolean operators (AND, OR) were applied to refine the search and improve sensitivity.

Eligibility Criteria

Inclusion Criteria

Studies were included if they met the following criteria:

• Published in peer-reviewed journals. 14 Oct 2026
• Published between 2015 and 2025. 14 Oct 2026
• Written in the English language.
• Examined sustainable or environmentally responsible nursing practices within healthcare settings.
• Reported measurable environmental, organizational, educational, or clinical outcomes.
• Employed quantitative, qualitative, mixed-methods, systematic review, or observational study designs.

Exclusion Criteria

The following publications were excluded:

• Editorials, opinion papers, letters, conference abstracts, and commentaries.
• Studies unrelated to nursing practice or healthcare sustainability.
• Duplicate publications.
• Articles without accessible full text.
• Publications not reporting primary or synthesized research findings.

Study Selection

All records identified through the database searches were imported into reference management software, and duplicate articles were removed. Two stages of screening were conducted. Initially, titles and abstracts were reviewed to eliminate irrelevant studies. Subsequently, the full texts of potentially eligible articles were independently assessed against the predefined inclusion and exclusion criteria. Any disagreements regarding study selection were resolved through discussion until consensus was achieved.

Data Extraction

Relevant information from the included studies was extracted using a standardized data extraction form. The extracted variables included:

• Author (s) and year of publication
• Country of study
• Study design
• Healthcare setting
• Sample characteristics
• Type of sustainable nursing intervention
• Outcome measures
• Major findings
• Recommendations

The extracted information was organized into evidence tables to facilitate comparison across studies.

Quality Assessment

The methodological quality of the included studies was evaluated using established critical appraisal tools appropriate to each study design. Randomized controlled trials were assessed using the Cochrane Risk of Bias Tool, observational studies were evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists, and systematic reviews were appraised using the AMSTAR 2 framework. Only studies demonstrating acceptable methodological quality were included in the final evidence synthesis.

Data Synthesis

A narrative synthesis approach was adopted because of the diversity in study designs, interventions, and outcome measures. Findings from the included studies were grouped into common themes, including sustainable resource utilization, biomedical waste management, energy and water conservation, environmentally preferable procurement, environmental education, organizational sustainability initiatives, and barriers to implementing green nursing practices. Similarities and differences across studies were examined to identify consistent patterns and evidence gaps.

PRISMA Flow Diagram

Records identified through database searching (n = 786)

↓

Duplicates removed (n = 164)

↓

Records screened by title and abstract (n = 622)

↓

Records excluded (n = 542)

↓

Full-text articles assessed for eligibility (n = 80)

↓

Full-text articles excluded (n = 56)

↓

Studies included in the systematic review (n = 24)

RESULTS

A total of 786 records were identified through systematic database searches conducted across PubMed, Scopus, Web of Science, CINAHL, and the Cochrane Library. After removing 164 duplicate records, 622 articles remained for title and abstract screening. Of these, 542 studies were excluded because they did not meet the predefined eligibility criteria. The full texts of 80 articles were assessed for eligibility, and 56 articles were excluded due to insufficient methodological quality, lack of nursing-specific interventions, or failure to report relevant sustainability outcomes. Ultimately, 24 studies fulfilled all inclusion criteria and were included in the final systematic review.

The included studies were published between 2015 and 2025 and represented diverse geographical regions, including North America, Europe, Asia, and Australia. Various research methodologies were employed, including randomised controlled trials, quasi-experimental studies, cross-sectional surveys, qualitative research, cohort studies, and systematic reviews. The studies investigated a broad range of sustainable nursing interventions such as biomedical waste segregation, recycling initiatives, reduction of single-use medical products, energy and water conservation, environmentally sustainable procurement, digital documentation, climate change education, and green leadership within healthcare organizations.

Table 1: Characteristics of Included Studies

Table 2: Summary of Major Outcomes

Table 3: Distribution of Included Studies by Journal

Table 4: Summary of Included Studies and Major Findings

Overall Findings

The synthesis of the included studies demonstrated that green nursing interventions consistently improved environmental sustainability within healthcare organizations. The most frequently reported outcomes included enhanced biomedical waste segregation, increased recycling of healthcare materials, reduced consumption of disposable medical products, improved conservation of electricity and water, and greater environmental awareness among nursing professionals. Several studies also reported reductions in operational costs following the implementation of sustainability initiatives, indicating that environmentally responsible practices can provide economic as well as environmental benefits.

Educational interventions emerged as one of the most effective strategies for promoting sustainable nursing practice. Nurses who participated in structured sustainability training programs demonstrated higher levels of environmental knowledge, more positive attitudes toward green healthcare, and greater adherence to environmentally responsible clinical practices. Organizational leadership, institutional policies, and multidisciplinary collaboration were also identified as essential facilitators of successful implementation.

Conversely, several studies identified barriers that limited the adoption of green nursing practices. Common challenges included inadequate sustainability education, insufficient institutional support, limited financial resources, increased workload, and resistance to organizational change. Despite these barriers, the overall body of evidence indicates that green nursing contributes positively to environmental stewardship, healthcare efficiency, and sustainable patient care.

DISCUSSION

The findings of this systematic review demonstrate that green nursing is an essential strategy for promoting environmental sustainability while maintaining the quality and safety of healthcare delivery. Across the included studies, sustainable nursing interventions consistently contributed to reductions in healthcare waste, improved resource utilization, increased environmental awareness among nursing professionals, and strengthened institutional sustainability efforts. These findings indicate that nurses play a pivotal role in supporting environmentally responsible healthcare systems through their daily clinical practice, leadership, and patient education activities.

One of the most consistent observations across the reviewed literature was the effectiveness of proper biomedical waste management. Appropriate segregation, recycling, and disposal of healthcare waste were associated with reduced environmental pollution and improved compliance with infection prevention standards. As nurses are directly involved in handling medical materials throughout the continuum of patient care, their adherence to evidence-based waste management protocols significantly influences the environmental performance of healthcare organizations. These findings reinforce the importance of integrating sustainable waste management into routine nursing responsibilities.

The review also highlights the value of resource conservation strategies, including energy-efficient practices, water conservation, and minimizing the unnecessary use of disposable medical products. Several studies reported that environmentally sustainable interventions not only reduced the ecological footprint of healthcare facilities but also improved operational efficiency through lower resource consumption and reduced expenditure. These outcomes demonstrate that environmental sustainability and economic efficiency are complementary objectives rather than competing priorities, supporting the broader integration of green nursing within healthcare organizations.

Education emerged as a critical determinant of successful implementation. Studies consistently showed that nurses who received structured education and continuing professional development in environmental sustainability demonstrated greater knowledge, more positive attitudes, and higher compliance with sustainable clinical practices. These findings suggest that sustainability competencies should be incorporated into undergraduate nursing curricula as well as continuing education programs to ensure that future nursing professionals are equipped to address environmental challenges within healthcare settings.

Despite the positive outcomes identified, this review also revealed several barriers to the widespread adoption of green nursing practices. Common challenges included inadequate organizational support, limited financial resources, insufficient environmental education, lack of standardized sustainability policies, and resistance to changes in established clinical routines. These barriers may reduce the successful implementation of sustainability initiatives, particularly in healthcare institutions with limited infrastructure or competing organizational priorities. Addressing these obstacles will require strong leadership, multidisciplinary collaboration, institutional commitment, and supportive healthcare policies.

The findings of this review have important implications for nursing practice and healthcare management. Nurses should be encouraged to assume leadership roles in environmental sustainability initiatives, participate in the development of green healthcare policies, and advocate for environmentally responsible clinical practices. Healthcare administrators should establish sustainability programs, provide adequate resources and training, and incorporate environmental performance indicators into quality improvement initiatives. Such measures will facilitate the integration of sustainability into routine healthcare delivery while supporting organizational resilience and public health.

Several limitations should be considered when interpreting the findings of this review. The included studies demonstrated considerable variability in research design, sample characteristics, intervention types, and outcome measures, which limited direct comparison across studies. Most studies were conducted in high-income countries, potentially reducing the generalizability of findings to low- and middle-income healthcare settings. Additionally, variations in methods used to evaluate environmental outcomes and the relatively limited availability of long-term follow-up data make it difficult to determine the sustained impact of green nursing interventions over time.

Overall, the evidence synthesized in this review suggests that green nursing represents a practical, evidence-informed approach for improving environmental sustainability within healthcare. By integrating sustainable practices into nursing education, clinical care, organizational management, and healthcare policy, nursing professionals can contribute substantially to reducing the environmental impact of healthcare while maintaining safe, effective, and patient-centered care. Future research should focus on evaluating long-term environmental, economic, and patient-related outcomes, developing standardized sustainability indicators, and identifying effective strategies for implementing green nursing across diverse healthcare systems.

V. IMPLICATIONS FOR PRACTICE AND POLICY

The findings of this systematic review emphasize that environmental sustainability should become an integral component of nursing practice, healthcare management, education, and policy development. As frontline healthcare professionals, nurses are uniquely positioned to promote environmentally responsible practices that enhance both patient care and ecological sustainability. Integrating green nursing principles into routine clinical activities can reduce environmental impacts while improving the efficiency and resilience of healthcare systems.

For nursing practice, healthcare organizations should encourage nurses to adopt sustainable approaches such as appropriate biomedical waste segregation, prudent use of medical supplies, energy and water conservation, environmentally responsible procurement, and patient education on environmental health. Embedding these practices into daily clinical care can help minimize healthcare-associated environmental burdens without compromising patient safety or quality of care.

From an educational perspective, sustainability should be incorporated into undergraduate nursing curricula, postgraduate programs, and continuing professional development. Providing nurses with knowledge and practical skills related to environmental stewardship, climate change, and sustainable healthcare will strengthen their ability to implement evidence-based green practices and serve as leaders in promoting environmental responsibility within healthcare settings.

Healthcare administrators and organizational leaders should establish comprehensive sustainability policies, allocate adequate resources, and foster a workplace culture that supports environmentally responsible practice. Institutional investment in staff training, waste management systems, energy-efficient technologies, and multidisciplinary sustainability initiatives can enhance organizational performance while reducing environmental and financial costs.

At the policy level, national nursing organizations and healthcare regulatory bodies should develop standardized guidelines that integrate environmental sustainability into nursing standards and healthcare quality frameworks. Policymakers should encourage healthcare institutions to adopt measurable sustainability indicators, support environmentally responsible procurement, and invest in infrastructure that promotes long-term ecological resilience. Such initiatives can strengthen the contribution of nursing to national and global efforts addressing climate change and sustainable development.

Future research should focus on evaluating the long-term effectiveness, economic benefits, and patient outcomes associated with green nursing interventions across diverse healthcare settings. Developing standardized outcome measures and implementation frameworks will strengthen the evidence base and facilitate wider adoption of sustainable nursing practices worldwide.

CONCLUSION

This systematic review synthesized the available evidence on green nursing and its contribution to sustainable healthcare delivery. The findings indicate that environmentally responsible nursing practices play a significant role in reducing the ecological impact of healthcare while maintaining high standards of patient care. Sustainable interventions, including effective biomedical waste management, resource conservation, environmentally preferable procurement, recycling initiatives, and environmental education, were consistently associated with improved organizational sustainability and more efficient utilization of healthcare resources. The review further demonstrates that nurses are central to the successful implementation of sustainability initiatives because of their continuous involvement in clinical care, patient education, infection prevention, and quality improvement activities. Healthcare organizations that supported environmental education, strong leadership, and comprehensive sustainability policies reported greater adoption of green nursing practices and more favorable environmental outcomes. These findings reinforce the importance of empowering nurses to act as leaders and advocates for environmental stewardship within healthcare systems. Despite the positive evidence, several challenges continue to limit the widespread implementation of sustainable nursing practices. Limited environmental training, inadequate institutional support, financial constraints, and the absence of standardized sustainability frameworks remain significant barriers. Addressing these challenges will require collaborative efforts involving nursing professionals, healthcare administrators, educators, researchers, and policymakers to create healthcare environments that support environmentally responsible practice. Overall, green nursing represents a practical and evidence-informed approach to improving healthcare sustainability while safeguarding patient safety and healthcare quality. Integrating sustainability into nursing education, clinical practice, organizational policies, and healthcare planning can strengthen the resilience of healthcare systems and contribute to global efforts aimed at protecting environmental and public health. Continued research is needed to evaluate the long-term environmental, economic, and clinical outcomes of green nursing interventions and to establish standardized strategies that support their implementation across diverse healthcare settings.

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