Running head: the nurses role in disaster

The Nurses Role in Disaster

Staci Simonelli
Ferris State University

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Abstract

The role of the nurse in disaster is unclear and remains a topic most are uneducated upon. This
paper will analyze the role of the nurse and discuss the importance of doing so. This paper will
highlight evidence-based research and how this information should be incorporated into nursing
practice. An assessment of the healthcare environment will be provided which will include
policies, resources, and safety issues related to this matter. Interdisciplinary theories are brought
to the readers attention and used to explain this topic from a different perspective. A root cause
analysis looks at the cause and effect of this issue and recommendations for quality and safety
improvements are given. These recommendations will relate to the Quality and Safety Education
for Nurses (QSEN) and the American Nurses Association (ANA). The conclusion of this paper
will examine the importance of implementing education on this matter, clarifying legal matters,
and emphasizing the importance of the disaster volunteer registry.
Keywords: nurse, disaster, analysis, safety, evidence-based research

the nurses role in disaster

The Nurses Role in Disaster

The nurses role in disaster is rarely discussed until a disaster strikes. At this point,
precious time is lost and lives can be at stake by failing to act in a timely manner. A disaster is
defined as an occurrence that causes damage, ecological disruption, loss of human life, or
deterioration of health and health services on a scale sufficient to warrant an extraordinary
response from outside the affected community area (Fara, 2014). Developing countries are
more affected because of their lack of resources and poor disaster preparedness systems (Legg,
2010). It is a common misconception that if the area resided in does not often experience
disaster, disaster preparedness is not as important. Disaster can strike at any time. Natural
disasters can be predicted up to a certain point, but man-made disaster is impossible to predict.
For example, the recent shooting in an Orlando, Florida nightclub killed almost fifty people.
This is something no one can prepare for and clarifying the nurses role can help with emergency
preparedness. It can also increase the number of nurses who volunteer in a disaster. The general
population expects healthcare workers, including nurses, to know what to do when disaster
strikes. In order to meet these expectations, one must first identify the role in which they serve.
Many health academic institutions around the world lack disaster preparedness curricula
and have no developed competencies for students in health professions (Achora & Kamanyire,
2016). With the lack of education pertaining to this matter, nurses are reluctant to get involved
or are unaware of the difference they can make. Nurses have education in epidemiology,
microbiology, infection control, medication administration, and wound care just to name a few.
Having a background in these areas make nurses a valuable asset to the disaster team. Disaster
unpreparedness is becoming even more of an issue because the prevalence of disasters is on an

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uprising trend. In the last decade, there has been an estimated 60% increase in natural disasters
worldwide in which an estimated two million people lost their lives, 4.2 million were injured, 33
million were left homeless and three billion were otherwise affected (Achora & Kamanyire,
2016); climate change is thought to play a role in the larger number and greater impact of natural
disasters. Nurses are the largest group of the healthcare workforce and are often on the frontline
in disaster management because they are spread all over the world. There are many aspects
which keep nurses from responding in a disaster. Nurses fear ethical and legal consequences
because they are uneducated about the topic, and are unaware of policies in place in order to
protect them. The clarity of the nurses role will make a difference and can improve the outcome
of a disaster.
Theory Base
Florence Nightingales Environmental Theory simply states, health is linked to the
environment (Hegg & Margaret, 2013). Nurses can help the patient get back to a state of
wellness by providing them with food, water, and hygiene supplies. This theory helps identify
part of the nurses role in a disaster. When the environment may be at its worst, it is very
difficult for a patient to reach a state of wellness. In a disaster, people can be faced with
numerous challenges. Nurses should do everything in their power to improve the environmental
conditions. Treating an acute injury will not be beneficial if the patient is starving, or contracts a
disease from unsanitary conditions.
The Bystander Effect Theory states when there is an emergency, the more
bystanders there are, the less likely it is that any of them will actually help (Fischer et al., 2011).
This theory is an important one to bring to the forefront when discussing disaster. Having
knowledge of this theory can help reduce the high occurrence of this happening. This brings up

the nurses role in disaster

the topic of nursing leadership. Nurses have the skills and abilities to make a huge impact in the
case of a disaster. The nursing role is to step up and take action. Standing by and doing nothing
adds to the problem at hand instead of fixing it.
Assessment of the Healthcare Environment
There are many reasons the role of the nurse is unclear. Lack of education for nurses,
ethical concerns, fear of legal action, and a lack of policy are all reasons nurses avoid
volunteering. Geographical boundaries become an issue when volunteering in a disaster. The
law discussing compact states help to eliminate this worry in the states it applies to. A member
of a compact state can use their nursing license in any of the other member states without
restrictions. ANA suggests to nurses who are participating in disaster relief efforts outside of
their licensed state to consider that state and federal laws may not always provide necessary legal
protections (2014). The Uniform Emergency Volunteer Health Practitioners Act (UEVHPA) is
currently enacted in sixteen states. This act allows nursing licenses to be used in the states that
have enacted it. All states have enacted a Nursing Practice Act (NPA), which guides and governs
nursing practice. Volunteering out of the country is similar. Each country has a nursing practice
act and the nurse practicing in that country must abide by it. If the nurse is from Michigan, a
non-compact state, and going to Florida to volunteer in disaster, the nurse would be held
accountable to the NPA in Florida.
The legal ability to practice disaster relief nursing in a foreign country depends on the
laws, rules, and/or regulations of the individual country. Interested nurses should consider
volunteering with an established and reputable relief organization; such organizations are
likely to know the specific requirements per country and can assist with necessary travel
documents (Polvado, 2015).

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The Good Samaritan Law does protect nurses and other healthcare providers, but only if
they are not working at the time of the event. This law protects nurses from legal liability to a
certain extent. It does not however, protect a nurse from negligence and malpractice. For
example, if a nurse leaves an injured person in the middle of the road while calling for help and
they get struck by a vehicle, the nurse may be charged for negligence. The nurse should have
moved the injured person out of the road to avoid causing them more injury. This could also be
the case if a nurse left the injured person without helping or at least calling for help. Certain
states have Duty to Rescue Laws which require the citizens, including healthcare professionals,
residing in the state to call for help in an emergency situation. If they fail to do so, they could be
charged with negligence. Nurses work very hard to earn their license and are fearful of getting it
revoked in emergency situations (Doubler, 2014). Laws are needed in the area of nursing that
would provide structure and guidelines to assist with technical and ethical care decisions, while
protecting a nurses licensure (Doubler, 2014).
The Quality and Safety Education for Nurses identify competencies that should be
included in nursing practice. Three competencies that relate to the nurses role in disaster are
teamwork and collaboration, safety, and quality improvement. Teamwork and collaboration
plays a huge role in disaster situations. One person cannot do everything and working together is
crucial in order to save lives. Nurses responding in a disaster must work with doctors,
emergency medical technicians, other nurses, infection control teams, and laypersons. Safety is
one aspect that is often only considered for the patient. It needs to be emphasized that nurses are
no help to their patient if they are injured right along with them. Safety measures need to be
taken for everyone involved. Quality improvement is something that also needs to be looked at

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in a disaster. The nursing process can be implemented in the quality improvement process to
help evaluate the effectiveness of the interventions taken.
Implications
With the role of the nurse being unclear in disaster situations, there is a lack of nursing
force in disasters. This has the potential to create more causalities in a variety of ways. Nurses
play a vital role in infection control. With disaster, comes a challenging environment. A lack of
clean water, crowded areas, contaminated food, and lack of access to healthcare services may
cause a secondary disaster; disease outbreak. Nurses have the ability to educate the public on
ways to minimize transmission and protect themselves. By implementing necessary precautions
such as placing a patient in quarantine or isolation, disease outbreak can be minimized if not
prevented. Antibiotics and vaccines may be administered by the nurse which ensures appropriate
prophylactic treatment. If at all possible, prevention is always the best option. If prevention
does not stop the outbreak, nurses serve to act as a barrier of protection by reducing the amount
of people affected.
Patient advocacy is something that nurses consider a priority. A doctor may be more
focused on treating the medical condition than what may be best for the individualized patient.
Nurses are there to speak on behalf of the patient when the patient cannot speak for themselves.
Without a large nursing force in disaster situations, what the patient wants may be put on the
back burner. Without someone in the medical field to stand up for them, patients are at risk for
unwanted or unnecessary medical care.
Role of the nurse
According to Farra (2014), The International Council of Nurses developed ten nursing
competencies to help clarify the role of the nurse in a disaster: risk reduction, policy

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development and planning, ethical practice, legal practice and accountability, communication and
information sharing, education and preparedness, care of the community, care of individuals and
family, psychological care, care of vulnerable populations, and long term recovery of individuals,
families and communities. Nurses must identify communities at risk for disease and apply
interventions to reduce disease outbreak. Reporting findings to the Center for Disease Control is
a huge responsibility. Policy development is an area nurses are often not given credit for.
Nurses see what needs to be changed to create better outcomes for the patient population by
working firsthand with the patients. Nurses spend the most time with the patients and see where
they could benefit from changes. Educating communities on emergency preparedness can reduce
the chances of people dying from preventable issues. For example, teaching communities to
have emergency kits that contain bottled water, flashlights, unperishable food, and first-aid kits
can have a great effect on the number of lives lost.
Psychological care is very important in disaster situations. Many people will suffer from
post-traumatic stress disorder after the disaster is over. A great number of people will see their
family and friends die, and watch all of their belongings be destroyed. This can take a huge toll
and just because the disaster is over, does not mean people are back to a state of wellness.
Vulnerable populations are just that; vulnerable. In a disaster, the most deaths usually
occur with the elderly. This is because escaping from their homes becomes almost impossible
when they have mobility issues. They are also more prone to dehydration when water is not
readily available. The homeless is also a population nurses must keep in mind. These people are
completely exposed in a disaster situation and are left with no place to hide. Many are already
weak from a lack of food and water, so a disaster may be a death sentence for this population.
One thing nurses cannot forget, is the disaster is not over once the hurricane, tornado, or terrorist

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attack has subsided. The people affected by the disaster will have months to years of recovery.
Taking care of the acute injuries is necessary, but the long-term injuries are prevalent and remain
a top priority as well.
Triaging patients is one of the biggest responsibilities of the nurse in disaster. This is
something nurses do every day in the emergency room. However, emergency room triage is
completely different than disaster triage. Nurses should be aware of these differences in order to
act effectively in disaster. In disaster triage, the patients that may be the sickest, or the most
severely injured will often be cared for last. This may seem backwards, but it is for very good
reason. The patient who has faced 70% total body surface area full thickness burns will require a
great amount of resources. They also have a high chance of not surviving considering the extent
of the injuries. In a disaster, resources may be hard to come by. The goal is to save as many
patients as possible with the least expenditure of resources.
Recommendations
In order to clarify the role of the nurse, education should be the number one priority.
There are some nursing schools that implement disaster training more than others. The disaster
training needs to be regulated and consistent across the nation. Implementing mock disaster
drills can help bring the situation to life and provide hands on care for students (Morrison &
Catanzaro, 2010). One thing many healthcare professionals are unaware of is the disaster
registry. Emergency organizations such as The Red Cross or The Medical Reserve Corp,
encourage signing up with their registry before a disaster strikes. By signing up beforehand, the
flood of volunteers and sorting through paperwork is eliminated. Signing up prior to a disaster
does not lock the volunteer in to volunteering. The reason they do this is to encourage more
people to sign up without having to make a future commitment. New policies need to be

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implemented to reduce the fear of legal consequences and minimize the complication geographic
boundaries create. If nurses take the same national exam in order to obtain their license, why
should they not be able to practice in all states? This is something that needs to be looked at and
analyzed further.
In conclusion, the role of the nurse has proved to be of high importance. Disasters are
becoming more prevalent and are not going away any time soon. The nurse should be used as a
vital resource in disaster situations. The nurse may play a large role in treating and triaging the
acutely injured, but also are expected to implement long-term care to those who may require it.
As new policies are implemented, some of the legal issues with geographical boundaries and
nursing licensure may be resolved. By identifying and clarifying the nurses role in disaster,
patient outcomes could be drastically improved.

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