Nurses’ Plans and Actions to Advocate for Legislation to Phase Out Use of Select Di(2-Ethylhexyl) Phthalate Plastic Supplies in Health Services Delivery in North Carolina

Abstract

Background

Nurses have professional responsibilities to advocate for environmentally healthy practices and have rights to work in healthy environments. Many medical supplies are made with polyvinyl chloride, which is softened and made more flexible by adding phthalates, such as di(2-ethylhexyl) phthalate (DEHP). Patients, nurses, and other health workers are exposed to these toxins through dermal, inhalation, ingestion, and/or parenteral administration. Phthalates are classified as carcinogenic, mutagenic, reprotoxic, and endocrine-disruptors.

Purpose

The purpose of our project is to develop a nurse-led advocacy plan focused on drafting, introducing, and passing a bill banning use of medical supplies made with DEHP and related plasticizers in North Carolina (NC) health systems and engaging nurses and other stakeholders in advocating for this policy change to protect the health of patients, employees, and the planet.

Advocacy Plan

We developed a health policy advocacy plan describing the issue; goal; interest groups; partners; scientific evidence; advocacy strategies; and expected outcomes. We engaged our project partners in implementing successful advocacy efforts. On March 31, 2025, NC House Bill 592, Toxic-Free Medical Devices Act of 2025, was introduced in the NC General Assembly. The Senate version was signed into law on July 3, 2025.

Discussion

Nurses are well-positioned to advocate for policies that protect health by addressing primary drivers of health, including environmental risk factors. Our nurse-led health policy advocacy plan and actions supported the development and passing of a bill that protects patients and health services workers from DEHP and other toxic plasticizers linked to numerous health problems.