Elizabeth Joseph, APRN, BC, MPH
Title: Chair, Sustainability Climate Committee
Organization: Jackson Health Systems
Initiative Overview
Elizabeth Joseph, an Advanced Practice Registered Nurse and Chair of the Sustainability Climate Committee at Jackson Health System, helped to lead a transformative initiative to address the overuse of regulated medical waste containers, commonly known as red bags. Recognizing both the environmental and financial implications of improper waste disposal, her team designed a program to educate staff on accurate waste categorization and align practices with Florida’s biomedical waste regulations. The project aimed not only to reduce the hospital’s environmental footprint but also to lower operational costs by minimizing unnecessary red bag usage. Through targeted training and process improvements, the initiative sought to create a sustainable shift in daily waste management practices across the institution.
Collaborators and Stakeholders
The success of the initiative hinged on a multidisciplinary approach, engaging key teams throughout the health system. The Sustainability Climate Committee provided the foundational vision, while the infection control team ensured policies adhered to regulatory standards. Environmental services staff played a critical role in optimizing waste logistics, and vendors contributed by supplying appropriate materials, including strategically placed wall dispensers for easy nurse access. Frontline nurses, represented by the SEIU, and nursing leadership—including directors and managers—were instrumental in implementing changes at the unit level. High-level support was secured early through meetings with the Chief Nursing Officer council and hospital administrators, whose approval was essential for resource allocation and institutional buy-in.
Implementation Challenges
Despite careful planning, the team encountered several hurdles during implementation. One persistent issue was staff confusion over what constituted regulated medical waste, leading to misplaced items in red bags. This was compounded by habitual practices, as many clinicians defaulted to using red bags for general waste out of convenience or routine. Logistical challenges, such as inconsistent bin placement and unclear signage, further complicated adherence to the new protocols. Perhaps the most significant barrier was resistance to change, as staff needed time and repeated reinforcement to adapt to the updated waste disposal system. These challenges underscored the importance of continuous education and engagement throughout the rollout.
Results and Impact
The initiative delivered measurable benefits, both financially and operationally. By reducing the volume of red bag waste, the hospital achieved substantial cost savings—over $200,000 annually—as disposal fees are charged by volume. Compliance with state regulations improved significantly, minimizing the risk of violations. Beyond the tangible outcomes, the program fostered a heightened sense of environmental stewardship among staff, with many becoming active participants in sustainability efforts. The project’s success demonstrated how targeted interventions could yield both immediate and long-term institutional benefits.
Key Recommendations for Nurses
For nurses interested in launching similar initiatives, Elizabeth Joseph emphasized the importance of starting small. She recommended selecting pilot units to test waste audits and staff training before expanding hospital-wide. Early engagement with stakeholders—particularly infection control, environmental services, and education teams—was critical to securing policy support and addressing potential roadblocks. Partnering with vendors who shared sustainability goals could also provide valuable resources for pilot programs. Clear visual cues, such as color-coded bins and signage, were essential for reinforcing proper waste sorting. Joseph also stressed the value of identifying passionate staff members to champion the project, as grassroots advocacy helped sustain momentum. Finally, tracking outcomes—such as reduced waste volume or cost savings—and sharing these results with leadership could build a compelling case for broader adoption.
Conclusion
Elizabeth Joseph’s medical waste reduction program at Jackson Health System serves as a powerful example of how nurses can drive meaningful change in healthcare sustainability. By combining education, collaboration, and incremental implementation, the project achieved significant reductions in waste and costs while fostering a culture of environmental responsibility. This case study not only highlights the project’s successes but also provides a replicable framework for nurses seeking to lead similar efforts in their own institutions.
