Environmental sustainability is an increasingly visible challenge in intensive care, where resource-intensive care processes intersect with rising expectations for greener practice. Evidence from a multi-centre survey across nine French hospitals offers a detailed view of how intensive care unit (ICU) healthcare workers (HCWs) approach this agenda, how much time they are willing to devote and which factors enable or hinder action. The findings describe everyday behaviours at home and at work, quantify intrinsic willingness to engage and examine how training, awareness and recognition shape participation. They also highlight preferences for how institutional funding should be allocated and reveal views on the place of sustainability in difficult clinical decisions.
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Intrinsic Commitment and Daily Actions
The survey captured 394 responses, representing 52.7% of the 747 ICU HCWs approached. Nurses formed 53.5% of respondents, intensivists 31.5%, assistant nurses 13.2% and other staff 1.8%. Many respondents already adopt pro-environmental habits at home, with 94.4% reporting frequent waste sorting, although only 39.1% said sustainability influenced their consumer habits. At work, 87.1% reported often turning off lights, yet only 26.4% regularly turned off computers, indicating uneven uptake of basic energy-saving practices across different tasks.
Intrinsic willingness to engage was measured as additional daily time, beyond official duties, that HCWs would devote to sustainability-related actions such as sorting waste, reducing energy use, reusing supplies, recycling, avoiding overuse of materials and applying ethical considerations. Investigators pre-defined at least 5 minutes per day as a relevant threshold. The median reported time was 5 minutes [0; 15] per day, and 235 respondents or 59.6% (95% CI 54.6–64.5) indicated at least 5 minutes per day. This describes a substantial baseline of personal commitment with many HCWs prepared to integrate sustainable behaviours into routine workflows without additional incentives.
Professional role and personal orientation to sustainability shaped this intrinsic commitment. Being an intensivist, higher perceived involvement in sustainability and training support were associated with greater willingness, while the expectation of financial support was associated with lower intrinsic engagement. In multivariable analysis, at least 5 minutes per day was linked with being an intensivist, higher awareness of sustainability issues and the absence of a requirement for financial recognition. Gender was not significantly associated with engagement among paramedical staff or among intensivists.
Role of Funding, Training and Awareness
When institutional funding was introduced as a consideration, willingness to contribute time rose. With financial support, the median increased to 15 minutes [5; 30] per day, and 311 HCWs or 78.9% (95% CI 74.6–82.9) said they could devote at least 5 minutes per day. This pattern suggests that recognition, including financial measures, can convert latent motivation into practical time commitments. Financially supported engagement was associated with younger age, shorter professional experience, higher awareness of sustainability issues and training support, implying that early-career staff may be especially responsive to structured recognition and development offers.
Preferences for how to fund sustainability activities were also clear. When asked about institutional funding sources, respondents favoured reallocating part of the equipment budget rather than forgoing salary increases. Training emerged as a widely endorsed enabler with high support for on-site education tailored to ICU practice. Awareness similarly played a consistent role. Higher self-rated awareness of sustainability issues correlated with greater willingness to engage, reinforcing the value of targeted education that links environmental objectives to concrete ICU tasks and decision points.
Beyond quantitative measures, open text responses underscored three recurring supports: practical, hands-on training delivered within ICUs, recognition from institutions whether financial or otherwise and stronger backing from ICU and hospital leadership. Together these elements indicate that motivation is not solely an individual attribute but is shaped by the organisational environment, resources and visible endorsement from leaders.
Leadership, Constraints and Ethical Considerations
The survey offers insight into how sustainability intersects with clinical ethics. Among 367 respondents, 43.3% supported including considerations of sustainability in end-of-life decision-making. This finding points to a perceived relevance of environmental impact within complex clinical judgements, though views were not unanimous. It suggests that any effort to weave sustainability into ICU policy and practice will need to acknowledge varied perspectives on the ethical boundaries of such considerations.
The analysis included several limitations. The work was conducted in a single French region, which may restrict generalisability to settings with different societal approaches. No data were collected on climate denialism, and the list of proposed incentive tools was relatively limited. The current strains experienced by HCWs in French hospitals may also have influenced responses, including willingness to devote time. These constraints frame interpretation and highlight the need for context-sensitive implementation.
Organisational levers emerged as central to sustaining change. Awareness and recognition are known enablers of behavioural change and appear relevant here, with personal awareness more influential at home and institutional engagement more influential at work. The pattern of responses suggests that recognition, which may include financial measures, warrants further exploration, particularly among younger HCWs. Practical training within ICUs was commonly requested, pointing to the importance of embedding skills and processes that align with everyday care. Investment in targeted training based on established ICU sustainability guidance, combined with recognition strategies, may help normalise sustainable behaviours as a routine component of care.
ICU staff report meaningful intrinsic motivation to act on sustainability, with many willing to devote time each day to specific behaviours. Awareness, role and training support shape this engagement, while institutional recognition can substantially increase the time HCWs are prepared to contribute. Preferences for reallocating equipment budgets over salary trade-offs, calls for on-site training and the expectation of leadership support all indicate that organisational context is decisive. Within acknowledged limitations, these insights point to a pragmatic path: raise awareness, deliver hands-on training and implement recognition strategies so that sustainable practice becomes embedded in routine ICU care without relying solely on individual effort.
Source: Intensive Care Medicine
Image Credit: iStock
