Implementing Environmental Sustainability Measures in the Workplace: A Checklist & Advocacy Guide
This resource equips Certified Registered Nurse Anesthetists (CRNAs), also known as nurse anesthesiologists or nurse anesthetists, healthcare organizations, anesthesia departments, perioperative leaders, and clinical teams with practical clinical strategies and implementation tools to advance environmental sustainability in anesthesia care settings and integrate environmentally responsible practices into clinical operations, quality improvement initiatives, and workplace culture while supporting patient safety, clinical excellence, and environmental stewardship.
Step 1: Start with Your Practice
Implement sustainable clinical practices: 1, 2
Review the AANA Environmental Stewardship in Anesthesia Care: Position Statement, Policy and Practice Considerations
Waste Anesthetic Gas (WAG) management
Choose the most environmentally responsible anesthesia plan possible
Waste reduction and recycling
Facility and equipment optimization
Step 2: Build Your Team
Engage key stakeholders and decision-makers
Define core team members
Establish meeting cadence
Clarify roles and authority
Step 3: Identify Key Decision-Makers
Determine who influences change in your setting:
Operating Room (OR) Director/Nurse Manager
Supply Chain/Materials Manager
Medical Director/Department Chair/Chief CRNA
Environmental Health and Safety Officer
Facilities/Engineering Manager
Quality and Safety Officer
Step 4: Initiate the Conversation
Connect with your direct supervisor: Clinicians
Opening: “I think there are practical changes we could implement to reduce the environmental impact of our care without any effect on our quality of care I've been reading about environmental sustainability in anesthesia, and I think there are practical changes we could implement to improve our practice. Could we explore this together?"
Frame: Position sustainability as a marker of clinical excellence professional responsibility, and operational efficiency.
Choose the right timing and approach
Schedule a brief one-on-one
Ch l i d ft f l
Bring data to support your case. Request:
Current volatile agent use (volume, cost, type) from the past 6-12 months
Current nitrous oxide purchased via refilling central supply compared to actual volume utilized on patients
This will expose passive loss and quantify it both financially and environmentally
Anesthesia waste disposal costs and waste volume
Request a breakdown of regulated, recyclable, and general waste streams
This will identify opportunities to reduce single-use waste, improve recycling and waste segregation, lower disposal costs, and evaluate potential environmental and financial savings from reusable products and reduced oxygen waste
Equipment inventory (reusable vs. single-use items)
OR energy consumption data (if available from facilities)
Frame the discussion from a clinical and business perspective
Financial: "Switching volatile agent preferences, pursuing the use of low flow rates, waste reduction, and equipment reuse could reduce supply costs by $X annually Waste reduction and equipment reuse lower disposal expenses "
Regulatory and Reputation: "CMS, facility accreditation organizations, and state regulations increasingly reference sustainability Hospitals with environmental leadership attract patients and talent Our local competitors are moving in this direction "
Step 5: Pilot Small Changes
Start with one focused initiative: 3
Propose a 4-week pilot program
Propose a 4-week pilot program
Start simple with one initiative
Start simple with one initiative
Expand gradually to other ORs and schedules
Identify champions to help promote and motivate the team
Develop a simple action plan that utilizes the change management process
Consider utilizing nurse anesthesiology residents as members of the team
Share ideas during team huddles
For a step-by-step change management process, see AANA’s Enhanced RecoveryAfterSurgery document.
Consider tools like sample timelines or emails:
Timeline example:
Weeks 1-2: Secure buy-in from OR director and anesthesia leadership. Brief the team. Establish baseline metrics.
Weeks 3-4: Pilot implementation Conduct daily huddles (5 min) to troubleshoot Collect feedback
Week 5: Analyze data. Present results. Decide to expand or refine approach.
Months 2-3: Roll out to remaining schedules or ORs Adjust protocols based on feedback
Sample email:
Subject
Sustainability Initiative- Opportunity to Reduce Costs & Improve Operations
Message
Dear [Name], I'd like to propose a small pilot project to improve our environmental sustainability and reduce operational costs in the OR Over the next month, I'd like to explore [specific initiative: agent selection / scavenging improvement / waste reduction / low flow compliance / anesthesia plan selection] I've attached data on potential savings and a brief overview Could we schedule 15 minutes to discuss? I believe this aligns with [facility's quality/sustainability goals]
Step 7: Measure and Share Success
Track outcomes and improvements
Highlight wins to sustain momentum
Use results to support broader adoption
For additional information on this topic, please refer to the AANA Environmental Stewardship in Anesthesia Care document.
References
1
Environmental Stewardship in Anesthesia Care: Position Statement, Policy and Practice Considerations. Rosemont, IL: American Association of Nurse Anesthesiology; 2025.
