Implementing nurse-led decarbonization practices: a transferable framework from a Spanish public hospital.

backgroundHealthcare systems contribute nearly 4.4% of global greenhouse gas (GHG) emissions, making environmental sustainability a critical professional and ethical priority. Nurses, as the largest and most operationally involved workforce in healthcare, are uniquely positioned to lead behavioural and organisational change. However, the mechanisms through which nurse-led actions achieve measurable carbon reductions at hospital level remain poorly documented.

methodsA mixed-method implementation case study was conducted at the Hospital Universitario Lucus Augusti (HULA, Spain), a 900-bed tertiary public hospital integrated within the Galician Health Service. Aggregated data from the hospital’s verified Carbon Management Plan (ISO 14001:2015) were analysed for key emission categories associated with nursing-related domains—anaesthetic gases, plastics, gloves, and paper. Implementation processes were mapped across four iterative phases (Planning, Action, Monitoring, Integration) to identify transferable steps, indicators, and nursing roles.

resultsBetween 2021 and 2023, total hospital emissions decreased by 35%, including a 95% reduction in anaesthetic gases, 41% in paper, 17% in plastics, and 7% in gloves. Nursing-led initiatives such as rational glove use, digital documentation, and reusable equipment substitution accounted for most improvements. The resulting Nurse-Led Decarbonization Framework identifies five transferable components: leadership alignment, nurse engagement, feedback systems, continuous education, and performance monitoring.

conclusionsThis implementation case study describes institutional emission reductions observed during the introduction of structured organisational and clinical practice adjustments within a nurse-informed implementation framework. The proposed framework outlines phases, roles and measurable emission domains that may support transferability to comparable hospital settings. Integrating sustainability into nursing governance may strengthen organisational alignment with environmental objectives and support professional engagement in climate mitigation efforts. However, the framework should be interpreted as a suggested, conceptually derived guide rather than a validated model, and further multicentre evaluation is required. IMPLICATIONS FOR NURSING MANAGEMENT/PRACTICE: Empowering nurses with carbon literacy, feedback mechanisms, and decision-making authority enables them to act as catalysts for hospital sustainability. The Nurse-Informed Decarbonization Framework provides a transferability-oriented framework that nursing managers may adopt to embed sustainability into clinical governance, improve resource efficiency, and align professional practice with planetary health goals.