years of working to protect British Columbia's parklands,
Bill Pritchard decided to become a registered nurse. Today
he combines his passion for nature with his responsibilities
as a registered nurse while meeting RNABC's Standards for
Registered Nursing Practice in British Columbia.
After a 20-year career with BC Parks as a back country ranger
in the West Kootenays (mixed with ski patrolling, maintaining
remote access ski huts, and working in various other forestry
and wildlife capacities in the off-season), some friends were
surprised to learn that Bill Pritchard was entering nursing
school. But Pritchard needed a change. Despite his love of
the outdoors, he had grown tired of being on the road, and
wanted more time at home with his family.
To Pritchard, the career move was a fairly natural progression.
He had always enjoyed the challenge of learning new things,
and in some ways nursing would build on his background. "It
didn't seem that far (a stretch) to me," he says. "I
had many years of experience in first aid, was a volunteer
in search and rescue, and enjoy working with people."
Nursing was service to the public in a new, but related area.
Pritchard graduated in spring 2003 from the Collaborative
Curriculum Program at Selkirk Community College in Castlegar.
Since then he has worked more than full-time casual hours
on a medical floor at Kootenay Lake Hospital. "Nursing
has offered me a profession in which continual learning is
a must," he says. "I have found it mentally challenging
and exciting. Not one day goes by that I don't learn something
from working with a patient or my colleagues - RNs and LPNs
who have amassed an amazing amount of knowledge."
But the learning has become a two-way street. Pritchard's colleagues
are learning from him as well. He has become a knowledgeable
resource on a topic that combines his passion for nature with
his professional nursing responsibilities. As a source of current
information and thought-provoking questions for his peers, and
as an advocate for change in nursing practice, he is also meeting
the Standards for Registered Nursing Practice in British Columbia.
In particular he demonstrates clinical practice indicators for
Standard 2: Specialized Body of Knowledge - Bases practice on
the best evidence from nursing science and other humanities,
and Standard 5: Provision of Service in the Public Interest
- Provides nursing services and collaborates with other members
of the health care team in providing health care services.
The story begins in a hospital medication room while Pritchard
was in nursing school. It was the first time he saw wasted
medication discarded into the sink or garbage. For Pritchard,
whose father was a scoutmaster and whose mother had insisted
on environmentally-friendly household products long before
the term was popular, it was all wrong.
"I had a gut reaction," he says. "I thought,
'That's not good. I don't litter on the street, why would
I do it here?'"
Years of work protecting and enjoying B.C.'s parklands told
him that the practice of casually dispensing pharmaceutical
waste was bad for the environment, and not in the best interests
of the public.
Pritchard's response was intuitive rather than grounded in
fact. His body of specialized knowledge related to pharmaceutical
waste management and nursing practice developed later during
a teaching/learning course. The assignment was to develop
and implement an educational program that demonstrated the
application of learning concepts. One student, for example,
taught other students how to find and use the ventro-gluteal
site for IM injections. Pritchard chose to use this project
as an opportunity to further his knowledge on the subject
of best practice for pharmaceutical waste disposal in hospitals.
The topic idea was supported by his instructors as a challenging,
but worthwhile project.
Challenging indeed. He found nothing on his subject in the
nursing literature. A broader online search yielded a wealth
of information on topics such as cost reduction through hospital
waste management, the effects of antibiotic waste on agriculture
and the safe disposal of needles. It was a start.
Next, Pritchard targeted the Web sites of international organizations,
such as the United Nations, the World Health Organization
and Health Care Without Harm (an international coalition of
427 organizations in 52 countries working to transform the
health care industry so it is no longer a source of harm to
people and the environment). He e-mailed health and environmental
interest groups. He contacted hospital managers, government
bureaucrats and the B.C. College of Pharmacists. He also contacted
the B.C. Ministry of Water, Land and Air Protection. Information
he received provided clues to more sources of information.
His search grew as he became familiar with such terms as "pharmaceutical
and personal care products" (PPCPs). He found studies,
policy guidelines, and discussions all related in varying
degrees to his topic of pharmaceutical waste disposal and
Through his research, Pritchard was demonstrating Standard
2 - Specialized Body of Knowledge, Indicator 1: Knows how
and where to find needed information to support the provision
of safe, appropriate and ethical client care. Unable to find
specific information in nursing literature, he went further
afield in keeping with Standard 2.
Pritchard's extensive research process paid off in surprising
ways. The mother of a classmate sent one article to him from
Montreal. Somehow the mother had learned of Pritchard's interest
and e-mailed him a story from The Globe and Mail newspaper
via her daughter. The article referred to the results of a
Canadian study that found low concentrations of pharmaceuticals
in water samples taken near sewage treatment plants in 14
cities. The drugs found included analgesics, anti-inflammatories,
anticonvulsants and lipid regulators. A conclusion in the
article was that current sewage treatment facilities are not
adequately equipped to handle pharmaceuticals (Stevenson,
Pritchard was unable to get a copy of the actual study as
it was still going through a peer review process. However,
the article in The Globe and Mail quoted Mark Servos, a scientist
at Environment Canada's National Water Research Institute
with whom he was able to correspond through e-mail on the
subject of PPCPs in the environment. Servos sent him proceedings
from a workshop sponsored by Health Canada and Environment
Canada in which participants representing government, academia
and industry addressed the potential impact of PPCPs in the
environment relevant to human and ecosystem health. Hospital
wastewater effluents and disposal practices for unused drugs
were identified as major sources of concern (Servos et al.,
This theme of general concern was echoed in all Pritchard's
research. He admits that while there is ample speculation,
the impact of low concentrations of pharmaceutical waste from
hospitals on human health is unknown. Still, he believes there
is more than enough indication in the literature to warrant
the attention of registered nurses.
Pritchard's teaching project took shape as a Power Point
presentation entitled Pharmaceutical Waste Management: The
Environmental Impact of Nursing Practice. His goal was to
raise awareness of the relationship between nursing actions
and the environment. It provided facts gathered from his research
and posed questions to facilitate discussion on current nursing
practices: "Where do you discard used IV bags?"
"What about used vials and ampoules?" "Where
does the garbage end up?"
He also included the few specific guidelines he found on
the safe disposal of pharmaceutical waste and residues in
hospital medication rooms. The guidelines are included in
a handbook entitled Safe Management of Wastes from Health
Care Activities (available in PDF format at www.who.int/water_sanitation_health/
medicalwaste/wastemanag/en/), published by the World Health
Organization. According to these guidelines, small quantities
of pharmaceutical waste should be treated as hazardous and,
as such, disposed of in yellow leak-proof containers, the
contents of which should be incinerated or safely buried.
It should be noted that there is separate discussion in the
handbook of the handling of cytotoxic drug waste, which should
never enter the sewer system or the landfill (Pruss, Giroult,
& Rushbrook, 1999).
For his course, Pritchard presented at his local RNABC chapter
meeting. The response from peers was positive and the chapter
president encouraged him to present to the Issues Forum at
the 2003 RNABC Annual Meeting.
It wasn't an easy thing to take on, but Pritchard followed
up with great success at the Annual Meeting. "I had been
pretty nervous about presenting to 400 nurses on a topic that
is important to me and was worried about coming across poorly,"
he says. "The support was phenomenal. The response .
. . floored me.