Upholding Planetary Health Through Nursing Leadership in a Fragmented Global Landscape

Global planetary health governance is increasingly reshaped by shifting geopolitical priorities and the realignment of international climate leadership, with rising protectionism, weakening multilateralism and politicised forums threatening the cooperative frameworks essential for safeguarding planetary health (Haines and Mahmood 2025). Nations are also increasingly leveraging climate policies as diplomatic instruments (Munge 2023) ahead of the UNFCCC thirtieth Conference of the Parties (COP30), scheduled for November 2025 in Belém, Brazil. These developments, encompassing policy, geopolitical, economic, and environmental dimensions, are impeding a coherent global discourse on climate change, pollution, and biodiversity loss, the three crises threatening planetary health, which reframes human well-being in relation to the Earth's natural systems (Horton and Lo 2015). Within this framework, health professionals, including nurses, must view environmental change as a central determinant of health. Strengthened global cooperation is therefore imperative to uphold planetary health principles and secure a sustainable, equitable future. Amid fragile geopolitical progress, nurses recognise the urgent need for renewed solidarity, advocacy, and innovation to safeguard human and ecological well-being. This Special Issue highlights the global nursing community's engagement with planetary health, demonstrating its relevance to professional practice, education, research, advocacy, and policy. Nurses, comprising much of the global health workforce, are often the first point of contact for communities and witness firsthand the health impacts of environmental change, including respiratory illness, heat-related conditions, food and water insecurity, displacement and mental health stress linked to climate-related disasters (International Council of Nurses 2025). These outcomes reflect broader global patterns with profound implications for health equity, social justice, system preparedness, and workforce resilience. Although nursing has long emphasised the social determinants of health as a cornerstone of care, planetary health builds upon this foundation, integrating environmental degradation through climate change, biodiversity loss, pollution, and land-use changes, and its intersection with social, economic, and political forces to shape health risks in complex and unequal ways. Those already experiencing social and health vulnerabilities bear the greatest burden when environmental conditions worsen (Haines and Mahmood 2025). The International Council of Nurses' Topic Brief, Nursing for Planetary Health and Well-being, highlights the profession's responsibility to address human disruptions to Earth systems and collaborate to redesign systems for a sustainable future (International Council of Nurses 2025). Bulding on this foundation, the Special Issue explores these responsibilities, nursing contributions and opportunities for leadership and innovation in the interconnected domains of planetary health nursing education, research, and practice. Integrating planetary health as a core component of nursing education requires more than adding environmental topics to the curriculum, particularly when these are narrowly focused on the visible impacts of climate change. A transformative approach is needed, one that embeds environmental health principles across learning outcomes and assessments, fosters interprofessional collaboration, and encourages critical engagement with structural drivers of planetary health degradation. An example of such an approach is in preparing nursing students to lead interdisciplinary green teams (Jacobson Vann 2024). The articles in this Special Issue further highlight that graduating nurses should enter the workforce not only with strong clinical competence but also with the knowledge, insight, and confidence to deliver care informed by planetary health and to advocate for climate resilience, sustainability, and health equity in all aspects of practice. Educators must shift from prescribing content to offering practical guidance on teaching planetary health. For this purpose, Levett-Jones et al. (2024) present a planetary health curriculum framework adaptable across pre-registration programmes, whereas Bonnamy et al. (2024) emphasise the need for professional development to build educator capacity. However, gaps persist in interprofessional teaching and expanding focus beyond mitigation and advocacy to include community climate adaptation and resilience. Post-registration education is equally important. Atta et al. (2024) emphasise that nurses' understanding of planetary health directly influences their practice and their ability to educate vulnerable populations. Rangel et al. (2024) advocate tailored training programmes during new hire orientation and Continuing Professional Development, adapted to hospital contexts and regional climate challenges. Coordinated curriculum design, educator development, and interdisciplinary collaboration are essential for preparing nurses to lead in a rapidly changing, uncertain environmental and health landscape. Nurse-led research is essential to advancing evidence-informed responses to environmental health impacts, including studies on the effects of environmental stressors on health outcomes, environmentally sustainable interventions within healthcare systems and support for community climate adaptation. Nursing-inclusive research ensures interventions are practical, person-centred while also aligned with planetary health principles. However, this Special Issue identifies gaps in community-focused research, emphasising the need for planetary health-centred, context-specific, evidence-based, longitudinal studies. Importantly, planetary health extends beyond climate change to include biodiversity loss, pollution, and land degradation, human-driven disruptions that undermine the Earth's life support systems, challenging nurses to research and reconcile person-centred care with systems-level approaches and environmentally sustainable, value-based care. In clinical settings, nurses implement and evaluate environmentally sustainable practices, including waste reduction, responsible resource use and environmentally responsive care models. Scaling these efforts requires a stronger evidence base that examines the disproportionate impacts of planetary crises on marginalised populations, developing and evaluating innovative models of care to meet the needs of those populations using implementation science, and connecting local nursing experiences with global environmental patterns. Usher et al. (2023) suggest the development of validated scales to rigorously measure planetary health-related outcomes; foundational work will contribute significantly to building a stronger scientific evidence base. Long-term follow-up research is also essential to deepen understanding of the long-term impacts of environmental changes on health, the effectiveness of interventions to mitigate long-term effects of climate change-induced diseases and how nurses' knowledge and skills on climate change impact community outcomes (Atta et al. 2024) and climate justice (LeClair et al. 2024). Such research provides comprehensive data on evolving health trends and the sustained, long-term impact of interventions as a means to inform policy decisions and continuous improvement in clinical practice. Equally important is the research into the role of nurses in policy and leadership through involvement in climate adaptation planning, emergency preparedness, and strengthening health system resilience. Nursing on-the-ground expertise uniquely positions them to advocate for policies that are both scientifically sound and socially equitable. Nurses are increasingly leading efforts to reduce healthcare's environmental impact through sustainable waste management, energy-efficient operations, green procurement, and environmentally responsible prescribing and treatments, critical actions given the sector's substantial contribution to climate change and pollution. However, planetary health in clinical practice extends beyond institutional sustainability, requiring a reimagining of care that integrates environmental awareness into clinical decision-making, patient education, and models of care delivery. This involves incorporating environmental considerations into everyday practice, from identifying patients at risk of heat-related illness or pollution-related conditions to supporting individuals displaced by climate-related disasters. Embedding planetary health principles into clinical protocols, care pathways, and quality improvement initiatives is essential for building health systems that are both environmentally sustainable and climate resilient. Such an approach reinforces preventative and holistic care while strengthening environmental literacy, equipping nurses to assess, respond to and educate others about the health impacts of environmental change. This Special Issue illustrates that clinical practice is a key arena for innovation and leadership, positioning nurses as both caregivers and agents of environmental and social change. However, two critical considerations must be addressed: the increased workload and the well-being of nurses. Cruz et al. (2024) note that planetary health initiatives can add responsibilities, potentially increasing stress and professional fatigue, whereas Rempel et al. (2024) emphasise the need for adequate support and resources. When health systems integrate planetary health into core nursing roles, these initiatives become a natural extension of professional practice, enabling nurses to lead transformative change while reinforcing their expertise, influence and impact on sustainable, resilient healthcare. Nurses are playing a pivotal role in advancing climate-resilient healthcare systems, reflecting a broader commitment to align healthcare with environmental sustainability. These efforts are urgent given the significant environmental footprint of the health sector. The professional imperative of planetary health also calls for a fundamental reimagining of health and care. Nurses are uniquely positioned to lead this transformation, whether by identifying patients at risk from climate-related conditions, recognising symptoms linked to environmental exposures, supporting displaced or vulnerable communities, or advancing initiatives that promote a more inclusive and equitable environment, particularly for those who have historically been underrepresented or marginalised. However, the lack of research in this special issue examining equity, diversity and inclusion through a planetary health lens indicates that this area requires greater attention. We hope this Special Issue serves as a catalyst, inspiring reflection, dialogue, and action across the global nursing community, reinforcing planetary health as central to the future of healthy communities and safe, high-quality care. Amid growing geopolitical uncertainty, meaningful engagement from nurses in practice, leadership, education, research, and policy is essential to shaping a sustainable, resilient, and equitable future. Nursing must embrace the imperative to integrate planetary health into all dimensions of the profession, recognising that the well-being of individuals, families, and communities is inseparable from the ecosystems that sustain them. It is no longer possible to speak of public health, maternal health, mental health, or any aspect of nursing care without acknowledging the profound interconnections between environmental sustainability, health equity and the pillars of planetary health. This moment demands urgency, courage and compassion. We call on nurses worldwide to lead with commitment to these values, driving the transformative change needed to safeguard planetary and human health for generations to come. The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed.