Healthcare delivery is a major contributor to the climate crisis, producing 4.4% of net carbon global emissions today [1]. The campaign ‘For a Greener NHS’ launched in 2020 set a road map for the National Health Service (NHS) in the UK to reach net-zero emissions for patient care by 2040 [2]. However, to achieve this, staff must be carbon literate and start by understanding the impact of their own professional practice. It follows, therefore, that carbon literacy education must be a priority for healthcare educators. There is to date no research on educating student nurses on carbon literacy or the personal carbon footprints of their practice. Using simulation could provide an innovative solution providing a system-thinking environment that could connect carbon emissions theory to actual practice and develop carbon literacy.

The aim of the study was to explore student nurses’ reflections on their carbon footprint of resources used in simulation and identify the potential role of simulation in developing carbon literacy.

This study used qualitative phenomenographic methodology, underpinned by transformational learning theory to explore student nurses’ awareness and attitudes towards their carbon emissions from simulation. Ten participants were asked to log the clinical resources used during a venepuncture and cannulation simulation skills station. Carbon emissions were then calculated for each participant using the Centre for Sustainable Healthcare [3] carbon emissions calculation and were shown to students during one-to-one semi-structured interviews. Data analysis was conducted, discovering the different ways participants conceptualized their carbon footprint.

Students were unaware and shocked by their carbon emissions from resource use in simulation and wanted to be better educated to enable them to make an informed choice to practise sustainably. Students highlighted the crucial role of simulation educators to educate students using simulation but to role model sustainable practice and design low resource-use simulation. Finally, students were able to connect the impact of their personal clinical practice to the global climate crisis.

Simulation is a powerful teaching approach to develop carbon literacy, challenging students’ pre-existing knowledge, and enabling them to link their personal practice to the global climate-change crisis.

The authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.