Strengthening a Global Nursing Workforce: Disaster Preparedness & Response

In a world where catastrophic disaster events are occurring with greater frequency and intensity, the need for a global nursing workforce prepared to respond is of critical importance. Nurses and nurse midwives are widely recognized as essential members of the global disaster response team. Devastating hurricanes and tornadoes in the US, earthquakes that rocked Haiti, New Zealand and China, typhoons in the Philippines, and the Tsunami that struck Japan damaging the Fukishima nuclear Power Plant- underscore how quickly and completely health care systems can be overwhelmed or destroyed. Civil war raging in Syria and wildfires in California have forced thousands to leave their homes. Last year’s outbreaks of Ebola and MERS remind us of the threat of global pandemic to human health.

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Tener Goodwin Veenema, PhD, MPH, RN, FAAN, Associate Professor, Johns Hopkins School of Nursing and Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health

Nurses are critical to the protection of human health. Despite this irrefutable fact and repeated calls for advancing nurse preparedness and disaster nursing science, many nurses across the world do not possess the knowledge, skills and abilities that they will need to be able to participate in a timely and appropriate manner during a disaster response. This issue has significant implications for our ability as health care systems to mount effective response and recovery initiatives. The need for global nursing leadership to advance nurse readiness has never been greater.

What do nurses need to know? Ideally, an “all Hazards” approach would have nurses prepared to respond to all types of naturally occurring disaster events, emerging infectious diseases, and intentional acts of terrorism involving chemical, biological, radiological, and explosive weapons.

Hurricanes, Typhoons, Tsunamis, tornadoes, earthquakes, landslides, floods, heat waves and cold spells, wildfires and volcanic eruptions are potential threats each day somewhere in the world. Competency based education would ensure that nurses are capable of performing a set series of functions recognized to be inherent to an effective response (ICN 2009). Fundamental concepts of disaster and public health emergency preparedness include understanding how emergency management works (in the U.S. we emphasize the importance of the Incident Command System), strategies for increasing surge capacity within health care systems to accommodate a sudden, unanticipated demand for health care services, and models of disaster triage that seek to embrace the deontological rule to ‘do the greatest good, for the greatest number, with the least amount of harm”.

Internationally, climate change, human conflict, complex human emergencies and the ubiquitous threat of global terrorism result in a confluence of factors leading to global instability and persistent threats to health and safety. Government corruption, rouge terrorist factions and a glaring lack of coordination, communication and collaboration across governmental and non-governmental disaster response agencies can contribute to limit the effectiveness of the response effort. While the solutions to these problems seem beyond our reach, global nursing leaders would be well served to be aware and vigilant of the challenges they create to implementing effective disaster preparedness policies.

In light of the current global crisis in human resources for health many areas of the world are experiencing severe nursing shortages already or may have nurses as their only source of health care. Disaster events in these locations serve to accentuate the current health care crisis and portend poorly for the future. In 2015 the world is already experiencing a global shortage of almost 4 million health care workers and by 2020 that number is expected to triple.

At the third Global Forum on Human Resources for Health in Recife, Brazil disasters and complex human emergencies were recognized as “the gasoline on the fire” of the health care workforce shortage. Nurse safety during disaster events such as public health and complex human emergencies is also a growing concern. During the Ebola outbreak in 2014 over two hundred health care providers contracted and died of the disease. The number of nurses injured and killed while participating in humanitarian responses has skyrocketed with 94 nurses killed in Syria alone since in 2011.

Disasters mandate consideration of crisis standards for care (CSC). Crisis standards of care is defined as a state of being that indicates a substantial change in health care operations and the level of care that can be delivered in a public health emergency, justified by special circumstances (IOM, 2012).Medical and nursing care services that are delivered during disasters shifts beyond focusing on individuals to promoting the thoughtful stewardship of limited resources intended to result in the best possible health outcomes for the population as a whole (IOM, 2012). This pushes the envelope with respect to licensure and scope of practice and mandates reflection upon the moral, legal and ethical frameworks nurses use to deliver care. Our desire is to give our all- exemplar practice in every setting. We are committed as nurses to provide our very best care to each and every patient we encounter, yet by definition, disasters render this goal impossible.

The 2014 World Disaster Nursing conference held in Beijing, China and the 2015 World Association for Disaster and Emergency Medicine in South Africa reinforced the call for a global nursing workforce that is aware of the potential hazards that exist to health, that possess appropriate disaster knowledge and skills and are competent to respond. Finally, the Sendai Framework for Disaster Risk Reduction 2015-2030 which was recently adopted at the Third United Nations World Conference in Sendai Japan specifically addresses health as a critical component. While it is incumbent upon each individual country to design and implement a strategic plan for nurse preparedness we must consider our responsibilities to each other as neighbors in a global community to share educational resources, wisdom and skills for the purpose of improving the health and well-being of those victimized by disaster. It will take a global “village” to advance the agenda for nurse preparedness and to work to resolve the global crisis in human resources for health. Our patients, families and communities are counting on us.

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