American Nurses Association  [Printer-friendly version]
October 15, 2003


[Rachel's introduction: In October, 2003, the American Nurses
Association formally adopted a precautionary approach, focusing on
the prevention of hazards. "The precautionary principle states that
if it is within one's power, there is an ethical imperative to
prevent rather than merely treat disease, even in the face of
scientific uncertainty."]

EXECUTIVE SUMMARY: This report provides background information and
direction for the American Nurses Association's (ANA) environmental
safety policy formation and advocacy through a precautionary approach
that focuses on prevention of hazards. The precautionary principle
states that if it is within one's power, there is an ethical
imperative to prevent rather than merely treat disease, even in the
face of scientific uncertainty. The ANA Board of Directors adopted the
precautionary approach in October 2003.

1. ANA will broaden its work in occupational and environmental health
and apply a precautionary approach when an activity raises threats of
harm to human health or the environment.

2. ANA will advocate for public policy that utilizes the precautionary
approach that focuses on prevention of hazards to people and to the
natural environment.


While Florence Nightingale spoke about the importance of clean air,
water and environment; modern day nursing has not paid as much
attention to the relationship between health and the environment.
ANA's involvement in environmental health has focused on the work
environment (occupational health and safety) and the toxic byproducts
of the health care environment. ANA's work on the environmental
impacts of the health care industry has been implemented primarily
through ANA's membership and involvement in the international
coalition, Health Care Without Harm (HCWH), the campaign for
environmentally responsible health care ( As a result
of the success of the Health Care Without Harm coalition, and
visibility of ANA in HCWH and the Hospitals for a Healthy Environment
(H2E) partnership (, ANA is increasingly in demand
to be a leader in environmental health issues.

ANA needs to develop a foundation in policy for these activities
beyond the 1997 House of Delegates Report: Reduction of Health Care
Production of Toxic Pollution, incorporating the recommendations from
the 1995 Institute of Medicine Report: Nursing, Health and the


In 1860, Florence Nightingale provided the foundation for nursing
attention to environmental exposures and health effects when she wrote
about the need for fresh air and clean water in Notes on Nursing
(Nightingale, 1860).

The International Council of Nursing (ICN) published a position
statement in 1986, The Nurse's Role in Safeguarding the Human
Environment. It states: "The preservation and improvement of the human
environment has become increasingly important for man's survival and
well-being. The vastness and urgency of the task place on every
individual and every professional group the responsibility to
participate in the efforts to safeguard man's environment, to conserve
the world's resources, to study how their use affects man, and how
adverse effects can be avoided."

This position statement was incorporated into the recommendations of
the Institute of Medicine (IOM) Committee on Enhancing Environmental
Health Content in Nursing Practice published in 1995 in its report:
Nursing, Health and the Environment (IOM, 1995). The IOM report
recommended environmental health competencies for nurses to include:
1) Basic knowledge and concepts; 2) assessment and referral; 3)
advocacy, ethics, and risk communication; and 4) legislation and
regulation. That same year the National Institute of Nursing Research
(NINR) convened a second workgroup to develop an environmental health
research agenda for the profession. The group emphasized that because
nurses are employed in so many settings, the profession is uniquely
suited to conduct applied research addressing the impact of
environmental hazards on vulnerable populations and communities.

Precautionary Principle

The precautionary principle is explained thus: "when an activity
raises threats of harm to human health or the environment,
precautionary measures should be taken even if some cause and effect
relationships are not fully established scientifically"
( The principle includes
taking action in the face of uncertainty; shifting burdens of proof to
those who create risks; analysis of alternatives to potentially
harmful activities; and participatory decision-making methods. The
precautionary principle takes the life cycle of products or chemicals
into account and adds the proactive step of pre-market analysis of
environmental harm.


As nurses, who are educated in disease prevention, we can appreciate
and should advocate for a precautionary approach when it may prevent
injuries and illness. Nurses, as trusted and credible sources of
information and education regarding environmental health issues, have
the potential to lead patients and communities. ANA can assist nurses
in educating and guiding policy makers, including elected officials,
to a new way to see the relationship between life's choices (both
individual and societal) and their impact on health.

ANA will advocate for a precautionary approach to environmental health
that provides an opportunity for prevention instead of focusing most
of our resources on curing disease resulting from preventable