A disaster that impacts the health of individuals and the community in any sense, naturally

arouses a desire to respond among health care professionals in general and even more
specifically among nurses. However, the decision on the part of the individual nurse to volunteer
services, for example, in the scenario posed by the above question, is affected by the complex
relationship between a nurses ethical and legal obligations. Personal and general ethical and
legal issues must be clarified by the practitioner before a commitment to participate is clear.
Often, however, ethical foundations for participation may either parallel or contrast with the legal
framework that governs nursing practice in a disaster scenario. In the above referenced
hypothetical, responding as a volunteer in another state, which lacks the capability to verify
nursing credentials and other essential matters, highlights the conflicts between the nurses desire
to respond based on ethical grounds and ANA Code of Ethics for Nurses canons and legal
matters such licensure reciprocity, immunity from civil liability or workmans compensation for
injuries sustained by nursing volunteers.
An affirmative nursing response to a disaster, whether in the immediate locale, interstate
community or internationally is supported on ethical grounds by the American Nurses
Association Code of Ethics for Nurses (American Nurses Association, 2001).
In specific provision 2 states the nurses primary commitment is to the patient, whether an
individual, family, group or community (American Nurses Association, 2001) (emphasis
added). With a patient in this way being defined as an entity as large as a community, the ethical
underpinning to incentivize the nurse to respond in a community or disaster, to further the health
and safety of that group is quite clear. Further provision 8 calls upon the nurse to collaborate
with other health professionals and the public in promoting community, national and
international efforts to meet health needs (American Nurses Association, 2001). A firm ethical
argument for a nursing response, across state lines is clear. The ability to do so, from a legal
standpoint historically and in some cases even today, in some jurisdictions, is another matter.
All states require a license in order for an individual to engage in the practice of nursing.
Nursing licensing laws have two effects: 1) to limit the geographic area in which a nurse may
practice to the state in which he or she holds license and 2) to restrict the activities in which a
nurse may engage. State statutes make illegal the practice of nursing within the State by one not
licensed to practice in the state, including the practice by an individual licensed to practice in
another state. Therefore, though nurses may enjoy an ethical standard platform to respond as a
nurse to a disaster across state lines, historically, state licensing restrictions would have typically
barred this humanitarian effort for a private, non-federally employed, out-of-jurisdiction nurse.
However, since 2001, through the Model State Emergency Health Powers Act (MSEHPA), state
governments who have adopted its provisions or have codified templates of those provisions into
their own state law, now have a legal framework to address nursing licensure reciprocity for
volunteers during a public health crisis. Section 608 specifically provides a uniform process for
the licensure of health care workers (HCW), including nurses, to waive legal and other
regulatory requirements during emergencies. In addition, Section 401(a) (1) allows for a

suspension of laws during crisis that might otherwise operate to obstruct or prohibit essential
state response functions in the event of a disaster or public health emergency (The Network for
Public Health Law). These legislative efforts go a long way to reconciling the legal hurdle of
nursing licensure for the ethically motivated practitioner during a crisis.
Besides licensure reciprocity, two other legal areas that have dissuaded nurses from following
through on their ethical obligations to respond to an out of state crisis include a historic lack of
civil protection for malpractice or other claims and workmans compensation protections for
volunteers injured discharging duties in disaster response. In order to further create a uniform
system, where none previously existed, that could function autonomously to recognize and
facilitate licensing privileges for HCWs on an interstate basis, provide civil protections and a
workmans compensation benefit, even during dislocated communications and government
officials distractions, was promulgated in the Uniform Emergency Volunteer Health Practitioners
Act (UEVHPA) (The Center for Law and The Public's Health, 2008). As of 2007, this model
provides the uniform legislative language to simplify these three legal objectives for volunteer
health practitioners during an organized disaster response effort.
The UEVPHA offers the most complete immunity protections for volunteer
health practitioners. Because the model act includes a prospective designation
process, licensing requirements, workers compensation, and immunity from
liability, the UEVHPA sets forth an ideal set of conditions under which
practitioners can render emergency care during disasters. By alleviating
immediate concerns about personal safety and liability, the UEVHPA establishes a
legal climate in which health care professionals are free to provide emergency
care in areas under emergency or disaster declarations (Lee, Richard, Margulies,
& Rosenbaum,).
In summary, nurses do have an ethical obligation to consider, if not definitely respond, to provide
nursing and health services to the community in the event of disaster. Where ethical mandates
consistent with nursing standards were historically trumped by an inflexible legal framework
governing nursing practice, great strides among state legislatures and health policy think-tanks
have paved the way for nurses to exercise their moral and ethical inclinations for the good of
their communities in disaster response.
References
American Nurses Association (2001). Code of ethics for nurses with interpretive statements.
Washington, DC: American Nurses Publishing.
The Center for Law and The Public's Health (2008). Uniform emergency volunteer health
practitioners act. Retrieved February 15, 2014, from
http://www.publichealthlaw.net/modellaws/UEVHPA.php

The Centers for Law and The Public's Health (2008). The model state emergency health powers
act (MSEHPA). Retrieved February 15, 2014, from
http://www.publichealthlaw.net/ModelLaws/MSEHPA.php
Lee, J., Richard, O. L., Margulies, R., & Rosenbaum, S. (n.d.). Liability protections for
emergency volunteer health practitioners and entities. Retrieved February 15, 2014, from
http://www.healthyamericans.org/reports/bioterror08/pdf/legal-preparedness-analysis-andmethodology.pdf
The Network for Public Health Law (n.d.). The model state emergency health powers act summary matrix. Retrieved February 15, 2014, from http://www.networkforphl.org