Patients are being cared for in overheated environments, while many staff describe workplaces that are becoming increasingly difficult places in which to work and recover.

As healthcare services face the twin challenges of climate change and workforce pressures, the message of this year's World Ventil8 Day is clear: healthy buildings are essential to healthy nursing.

Ventilation and healthcare sector - lessons from the past

The relationship between good ventilation and health is not a new idea. From the time of King Charles I in 1631, improvements in building and workplace design have sought to reduce illness through better airflow and healthier indoor environments.

For the nursing workforce, a significant influence remains in some of the early works of Florence Nightingale. In Notes on Nursing (1859), she argued that patients should breathe air as pure as the external air. Her approach to hospital design, including the famous Nightingale wards, recognised that the care environment can either support recovery or undermine it.

More than 160 years later, those principles remain unchanged.

From infection prevention to climate resilience

The COVID-19 pandemic renewed awareness of the important role that good ventilation plays in reducing exposure to airborne infectious diseases.

Effective ventilation is also a legal requirement under health and safety legislation, which requires employers to ensure:

“Effective and suitable provision shall be made to ensure that every enclosed workplace is ventilated by a sufficient quantity of fresh or purified air.”

Today, however, it is not just the supply of fresh or purified air - attention is also increasingly turning to another challenge: overheating/ work place temperature.

Heatwaves are becoming more frequent and intense, yet much of the health and social care estate was designed for a cooler climate. As temperatures rise, many workplaces are struggling to protect staff and patients from excessive heat.

When healthcare buildings become a health risk

Recent UK research reinforces the importance of maintaining the supply of good indoor air quality.

Studies conducted in educational settings across England have demonstrated that carbon dioxide levels increase rapidly where ventilation is inadequate. Evidence indicated that improving ventilation and supplementing it with air filtration can support healthier indoor working and learning environments, improve air quality and contribute to reduced sickness absence.

Evidence gathered by the RCN has also highlights the reality and dangers of overheating facing many nursing staff and patients. Members have reported collapsing from dehydration during shifts, experiencing dizziness, nausea and heat-related illness, and working in temperatures above 30°C.

Reports also describe vulnerable patients being cared for in overheated environments, surgical patients recovering in excessive heat, and medicines and equipment having to be moved to cooler locations to maintain safety and effectiveness.

Particular concerns have also been raised about the impact on pregnant workers and those with underlying health conditions.These experiences demonstrate that overheating is not simply a comfort issue. It is a health, safety and wellbeing issue.

Excessive heat can contribute to:

• Fatigue and reduced alertness.
• Dehydration and headaches.
• Reduced concentration and decision-making.
• Increased workplace stress.
• Greater risk of mistakes and errors.
• Poor recovery between shifts.

For a workforce already under significant pressure, these risks cannot be ignored. Nor can their impact on patient safety.Safe care depends on safe working environments.

Employers must act

Overheating is a foreseeable workplace hazard, and employers have a duty to assess and control the risks it creates.

As temperatures continue to rise, organisations should be:

• Assessing overheating and ventilation risks.
• Monitoring workplace temperatures and indoor air quality.
• Providing drinking water, shaded areas and appropriate rest facilities.
• Supporting pregnant workers and other vulnerable staff.
• Developing heatwave and climate adaptation plans.
• Investing in ventilation, cooling and building improvements.
• Consulting staff and trade union safety representatives.

The question is no longer whether climate change will affect healthcare workplaces. It already is.

The role of trade union health and safety representatives

RCN health and safety representatives have a critical role in ensuring these risks are identified and addressed.

For decades, union safety representatives have worked with employers to improve working conditions, identify hazards and secure safer workplaces. Ventilation and overheating should now be firmly on that agenda.

Representatives can raise concerns, request risk assessments, identify problems through workplace inspections, review incident and sickness absence data, and challenge failures to act where risks are identified.

They also play a vital role in ensuring that staff are consulted on heatwave planning, climate adaptation measures and workplace improvements.Just as nurses are often the first to identify deteriorating patient conditions, health and safety representatives are often the first to recognise when workplace conditions are becoming unsafe.

A call for healthier workplaces

From Florence Nightingale's recognition of the importance of fresh air to modern evidence on infection prevention, indoor air quality and climate resilience, ventilation has remained a cornerstone of public health.What has changed is the urgency.

This year's World Ventil8 Day should be a call to action.

Governments must invest in a climate-resilient health and social care estate. Employers must recognise overheating and poor ventilation as significant workplace hazards. Trade union health and safety representatives must continue to organise, inspect and campaign for healthier working environments.

Most importantly, the nursing profession must continue to make the connection between workplace conditions, workforce wellbeing and patient safety.

If we are serious about protecting patients and sustaining the nursing workforce for the future, we must also be serious about creating workplaces that are healthy, safe and fit for a warming world.