Guest Contributor: Sheroza Gulzar Ali
BScN, MScN candidate, Aga Khan University

It was a Tuesday morning—the kind that begins with an espresso and a theatre board listing twelve laparoscopic cholecystectomies. I remember pausing, gloved hands hovering over the back table, as the scrub tech ripped open another bundle of disposable instruments. Behind us, three orange biohazard bags were already half full. I did a quick mental tally: two unused sterile gowns, a stack of unopened gauze sponges, and an entire suction tubing set that had never touched a patient. The first case had not even started, and we had already generated more waste than my family of four produces in a week.

That was my light-bulb moment. As surgical nurses, we save lives one incision at a time. But we are also, quietly and largely invisibly, among the most significant contributors to healthcare’s environmental footprint. The scalpel, it turns out, has a carbon shadow—and surgical nurses are the ones holding the flashlight.

The Operating Room: A Small Space with a Big Footprint

Most nurses do not start their careers thinking about climate. We think about airways, sterile fields, hand-offs,the patient’s mother in the waiting room. Yet the data tell an uncomfortable story. Operating rooms occupy roughly five percent of hospital floor space, but they generate up to a third of total hospital waste and consume three to six times more energy than the rest of the building (NHS England, 2024; MacNeill et al., 2017). Volatile anesthetic gases compound the problem: desflurane carries a global warming potential roughly two and a half thousand times that of carbon dioxide, so a single hour of its use can be environmentally equivalent to driving a small car several hundred kilometers (MacNeill et al., 2017).

Walk into any modern theatre and the imprint becomes visible: prepacked custom kits with twenty items but only twelve used, single-use plastic instruments where reusable steel would do, polystyrene specimen coolers, warming devices left running through the lunch break. None of this is malicious. Most of it is the residue of an understandable preoccupation with safety, infection control, and turnover times. But the cumulative effect is staggering — and the people standing closest to that waste, every minute of every case, are surgical nurses. Seen this way, surgical sustainability is not a niche concern; it sits squarely within Sustainable Development Goals 12 (responsible consumption and production) and 13 (climate action), and the harms of a warming climate fall hardest on the low-resource settings where many of us trained.
 
Why Nursology Already Cares About the Environment

If this conversation feels new, the discipline of nursing has actually been here for more than a century. Florence Nightingale’s Notes on Nursing (1860) described environment as inseparable from health long before “sustainability” entered our lexicon. More recently, a Nursology.net post by Jacqueline Fawcett and Peggy Chinn — with an addendum by Adeline Falk-Rafael — reminded us that environmental stewardship is not a fashionable accessory for nursing; it is woven into our patterns of knowing and into every grand theory that treats the patient as inseparable from context (Fawcett & Chinn, 2019).

Watson’s caring science speaks of creating a healing environment. Roy’s adaptation model places environmental stimuli at the heart of human response. Newman’s theory of expanding consciousness asks us to notice the patterns we participate in. When we tear open a single-use packet that will outlive the patient’s recovery in a landfill, we are also participating in a pattern — one that has never appeared on the surgical safety checklist (Watson, 2008; Roy, 2009; Newman, 1994).

The Quiet Power of the Surgical Nurse

This is where the future gets interesting. Surgical nurses are uniquely positioned for sustainability work, and the reasons are mostly invisible to administrators. We know what is actually used during a case. We know which surgeon opens three sutures and uses one. We know the difference between a custom pack designed in 2009 and a custom pack designed for the surgeon now standing across the table. We know how many warming blankets and irrigation bottles are quietly discarded between turnover and the next incision.

That bedside knowledge is the missing variable in most green-theatre initiatives. Engineering teams can swap LED lighting; supply chains can negotiate recyclable wraps; pharmacy can champion lower-flow anesthesia. But only the circulating nurse can lead a custom-pack audit and tell procurement which items belong inside the kit and which belong in the recycle stream. The evidence is encouraging: switching from single-use to reusable instruments and textiles can substantially cut the carbon footprint of common operations (Rizan et al., 2021), and nurse-engaged “lean and green” theatres reported through the Intercollegiate Green Theatre Checklist have reduced emissions and waste without compromising safety (Royal College of Surgeons of England, 2023). What these projects share is rarely a new technology. It is a nurse with a clipboard, a question, and the willingness to politely disagree with “we have always opened it this way.”

What the Future Looks Like from Inside the Sterile Field

The next decade of surgical nursing will, I suspect, ask three things of us. First, that we develop a theoretical fluency with environment—not as something separate from caring, but as constitutive of it. The Quality Improvement Exemplars gallery on Nursology.net already showcases nurse-led projects that braid theory with measurable change; sustainability work belongs in that catalogue.Second, that we become educators inside the operating room. Surgeons trust us; trainees mirror us. When a senior nurse refuses to open the second prep stick “just in case,” the next generation absorbs the lesson silently. Third, that we move from individual stewardship to collective advocacy—seats at procurement tables, voices in carbon-accounting committees, and authorship in the green-surgery literature that, until very recently, contained almost no nurses at all.

There will be friction. Sustainability initiatives are sometimes misread as cost-cutting in disguise, or as ideological luxuries when the bed alarms are sounding. But surgical nurses have always held two things at once—the patient on the table and the system around them. Adding the planet to that load is less of a leap than it sounds.

Closing the Loop

Back in that operating room, I asked the team a single question after the cholecystectomy: What could we have left in the packet today? Six items, as it turned out. By the end of the month, our average waste-per-case fell by 14 percent. No new equipment. No new policy. Just nurses, a clipboard, and a slightly different sense of what excellent care includes.

The hidden future of surgical nursing is not really hidden. It is sitting in our biohazard bins and our pre-opened packs, waiting for someone to notice. So here is my invitation: at your next list, run one custom-pack audit, teach one trainee why you left an item unopened, and take one sustainability question to a committee that can act on it. The scalpel meets sustainability the moment a surgical nurse decides it must — and that decision, multiplied across every theatre, every shift, every team, is how a profession quietly changes the climate of its own house.

References

Care Without Harm, & Arup. (2019). Health care’s climate footprint: How the health sector contributes to the global climate crisis and opportunities for action (Climate-smart health care series, Green paper No. 1). Health Care Without Harm.https://noharm-global.org/documents/health-care-climate-footprint-report

MacNeill, A. J., Lillywhite, R., & Brown, C. J. (2017). The impact of surgery on global climate: A carbon footprinting study of operating theatres in three health systems. The Lancet Planetary Health, 1(9), e381–e388. https://doi.org/10.1016/S2542-5196(17)30162-6

Newman, M. A. (1994). Health as expanding consciousness (2nd ed.). National League for Nursing.

NHS England. (2024). Delivering a net zero National Health Service (Greener NHS). NHS England. https://www.england.nhs.uk/greenernhs/

Nightingale, F. (1860). Notes on nursing: What it is, and what it is not. Harrison & Sons.

Rizan, C., Bhutta, M. F., Reed, M., & Lillywhite, R. (2021). The carbon footprint of products used in five common surgical operations: Identifying contributing products and processes. Journal of the Royal Society of Medicine, 114(11), 605–615. https://doi.org/10.1177/01410768211001583

Roy, C. (2009). The Roy adaptation model (3rd ed.). Pearson.

Royal College of Surgeons of England. (2023). The intercollegiate green theatre checklist. Royal College of Surgeons of England. https://www.rcseng.ac.uk/standards-and-research/standards-and-guidance/servic e-standards/green-theatre-checklist/

Travers, J. L., Schenk, E. C., Rosa, W. E., & Nicholas, P. K. (2019). Climate change, climate justice, and a call for action. Nursing Economic$, 37(1), 9–12.

Watson, J. (2008). Nursing: The philosophy and science of caring (Rev. ed.). University Press of Colorado.

World Health Organization. (2023). Operational framework for building climate resilient and low carbon health systems. World Health Organization. https://www.who.int/publications/i/item/9789240081888

About Sheroza Gulzar Ali

Sheroza Gulzar Ali is an experienced surgical nurse and a Master of Science in Nursing (MScN) candidate at Aga Khan University. With over three years of clinical experience in perioperative and operating room nursing, she specializes in delivering critical patient care in high-acuity surgical settings while advancing her expertise in healthcare leadership and research.

Her academic and professional interests focus on sustainable healthcare practices, clinical innovation, and environmental responsibility within acute care settings. Drawing from frontline surgical experience, she is particularly interested in addressing healthcare resource consumption and surgical waste through evidence-based nursing initiatives.

As an emerging nurse researcher, Sheroza is committed to bridging clinical practice with academic scholarship to promote quality improvement, ecological sustainability, and nursing leadership in modern healthcare systems.