Climate change and environmental sustainability have become critical global issues (Intergovernmental Panel on Climate Change, 2021) and their impact on health has been increasing (Usher et al., 2019; Vicedo-Cabrera et al., 2021). To enhance the environmental sustainability of healthcare, the World Health Organization (WHO) emphasized healthcare workers’ efforts toward sustainability (World Health Organization, 2017). Nurses, who comprise the largest group in the health sector (World Health Organization, 2020), have a responsibility to achieve environmental sustainability (Meleis, 2019). To advance environmental sustainability in nursing, nurses’ attitudes should be investigated, as they are associated with their environmentally sustainable behaviors (Verplanken and Orbell, 2022). However, previous related studies have mainly focused on undergraduate nursing students (Álvarez-Nieto et al., 2022a, Chen and Price, 2020). Examining nurses’ attitudes toward climate change and sustainability will help develop relevant educational programs or interventions for nurses, enabling them to achieve the Sustainable Development Goals (SDGs) in nursing. An appropriate assessment tool is necessary to evaluate nurses’ attitudes toward environmental sustainability. Therefore, in this study, we evaluated the psychometric properties of the Sustainability Attitudes in Nursing Survey-2 (SANS-2) for nurses.

Concerns about climate change resulting from the unsustainable use of environmental resources have been escalating. Industrial development and human behaviors have led to increased carbon dioxide emission and deforestation, which have, in turn, accelerated global warming (United Nations, 2016). The resulting climate change is manifested in increasing sea temperatures and the number of natural disasters (IPCC, 2021). In addition, climate change notoriously influences not only physical (Vicedo-Cabrera et al., 2021) but also psychological health (Usher et al., 2019). Environmental sustainability refers to maintaining human life with the available resources in the global ecosystem, such as food, water and air (Goodland, 1995). Thus, global efforts toward sustainability are required to address the challenges and combat climate change. In September 2015, the United Nations announced the SDGs, calling for global collaboration and concerted efforts to achieve them (United Nations Department of Economic and Social Affairs, 2023). Both governmental bodies, such as the Organisation for Economic Co-operation and Development (2023) and various professional organizations, such as the International Council of Nurses (2018), are striving to combat climate change and maintain environmental sustainability.

In nursing, climate change and environmental sustainability have become pressing issues. Ironically, healthcare providers help patients overcome the adverse effects of climate change while unknowingly engaging in activities that produce actual or potentially hazardous emissions (Sherman et al., 2020). According to the WHO’s strategies for an environmentally sustainable health system, is important for healthcare workers to remain actively engaged in sustainability efforts to promote environmentally sustainable actions (WHO, 2017). Nurses constitute the largest group of healthcare professions, worldwide and can contribute to the achievement of national and global SDGs (World Health Organization, 2020). As healthcare professionals, they play an important role in not only reducing emissions of greenhouse gases, e.g., decarbonizing their practices at work and protecting people from the adverse impacts of climate change, e.g., educating people about it (Kotcher et al., 2021) but also taking immediate action to combat climate change and promote environmentally sustainable practice (International Council of Nurses, 2018). Thus, exploring environmental sustainability in nursing is important to strengthen sustainability.

Despite their increasing importance, tools for measuring climate change and environmental sustainability that are specific to nurses are limited (Schenk et al., 2019). The Nurse Environmental Awareness Tool (NEAT; Schenk et al., 2015) focuses on the importance of awareness in driving behavioral change because nurses’ awareness of environmental impacts on nursing practice would help develop strategies to reduce behaviors that adversely affect the environment (Schenk et al., 2015). However, the NEAT is limited, as the questions are not clearly related to climate change (Schenk et al., 2019). Schenk et al. (2019) developed the Climate, Health and Nursing Tool (CHANT) that focuses on nurses’ awareness and behaviors based on the I-Change Model, according to which engagement in specific behaviors is determined by an individual’s awareness, which has an impact on motivation, social influence and self-efficacy (Maastricht University, 2023). The CHANT has since been expanded to include all health professionals, showing good reliability and validity (Winquist et al., 2023). Some instruments that were not developed for nurses have been used to measure nurses’ awareness and attitudes toward sustainability. For example, the New Ecological Paradigm (NEP) scale is a revised version of the New Environmental Paradigm scale (Dunlap et al., 2000). Compared with the original version, this more reliable and valid instrument measures environmental concerns or perspectives on public policy, participation patterns, or pro-environmental behavior (Anderson, 2012), which is not specific to nurses. Although assessing nurses’ awareness about climate change and environmental sustainability is crucial, measuring their attitudes toward these issues will be even more helpful in promoting environmentally sustainable practices in nursing, given that attitude is an antecedent for behaviors (Verplanken and Orbell, 2022).

SANS-2, a revised version of SANS, is a validated tool to not only assess nurses’ attitudes toward climate change and sustainability but also integrate related concepts into the nursing curriculum (Richardson et al., 2015). It was developed to measure nursing students’ attitudes (Richardson et al., 2015); however, each item of SANS-2 is not related to specific conditions but broadly asks respondents to indicate whether they agree/disagree with the importance of climate change and sustainability in nursing and their inclusion into nursing education (Richardson et al., 2015). Therefore, SANS-2 may be applicable to various other groups in nursing: Amerson et al. (2022) demonstrated good reliability of SANS-2 when assessing the attitudes of nursing faculties.

Nurses play pivotal roles in global climate action (Butterfield et al., 2021) as they constitute the largest demographic in the health sector (World Health Organization, 2020), are widely regarded as the most trusted professionals (Gallup, 2020) and are often the first healthcare providers for those seeking care (World Health Organization, 2020). Previous studies revealed that nurses with positive attitudes engaged in more environmentally sustainable practices (Grose and Richardson, 2016) and that lack of climate-related knowledge was one of the barriers preventing healthcare providers, including nurses, from engaging in sustainable practices (Kotcher et al., 2021).

Assessing nurses’ attitudes toward and identifying their educational needs for, environmental sustainability could help formulate further practical interventions or educational programs, including continuing education and help create a more environmentally sustainability workplace (Tian et al., 2020), consequently leading to the establishment of a sustainable organization or healthcare system and the achievement of SDGs in nursing. Therefore, in this study, we evaluated the validity and reliability of the SANS-2 to better understand nurses’ attitudes toward climate change and environmental sustainability and the inclusion of these concepts into the nursing curriculum.