DISASTER NURSING

PREPAREDNESS: THE ROLE OF NURSES IN SAVING LIVES

Natural disasters have become commonplace in certain regions of the country. Florida, for example,
routinely makes headlines, as it is experienced in dealing with seasonal hurricanes, flooding, and
storms. In some cases, these disasters can have the compounding effect of causing injury, and in
extreme cases death, while also placing a strain on clinical-care infrastructures.Because of these
conditions, places such as Florida have a high demand for disaster nursing and emergency
preparedness. They need nursing professionals who can provide first aid, serve as a first line of triage
for those who need additional care and ensure that regular hospital operations continue. Fires, floods
and storms remain a sad reality of life. Formal training in disaster nursing and emergency
preparedness can teach nursing professionals how to provide clinical leadership and patient care
under duress.
The Role of Nurses in Emergency Preparedness
The harm caused by natural disasters can include not only injuries and fatalities but also damage to
hospitals and clinical-care facilities, power stations, and water and utility services. Following a natural
disaster, such as one of Florida’s hurricanes, patients may require critical care despite compromised
infrastructure. For example, in 2018, Hurricane Michael caused damage that left many without power
for weeks, even months. In total, there were $25 billion in damages, 16 direct fatalities and 43 indirect
fatalities.

How Disaster Nurses Help

Many states have imposed laws that require licensed nurses to serve as first responders in
emergency situations. (Florida law requires that licensed medical professionals who wish to provide
emergency first aid do so free of charge and under the auspices of an organization such as the
American Red Cross.) Natural disasters constitute “all hands-on deck” scenarios, when everyone with
clinical training is needed to provide first aid to the injured. Organizations such as the American Red
Cross and International Medical Corps also play a significant role coordinating and deploying
emergency care providers to assist with medical needs.

In states where nurses are not required to provide emergency first aid, they often choose to do so. It
is common in natural disasters for nurses to volunteer their time and expertise to treat patients or to
offer support for physicians and other nurses who are on call.

The Stages of Disaster Nursing

Nurses, the largest group of healthcare professionals, are usually at the forefront of disasters. The
multifaceted work of disaster nursing requires the intervention of skilled nursing professionals at
several different stages:

• Nurses are often needed at the initial rescue and in the immediate aftermath, providing
expedient diagnoses and administering first aid to injured survivors.
• Survivors facing more extreme injuries may need to be monitored closely for extended periods
of time. Nurses may be needed in hospitals or shelters to ensure these patients receive
ongoing care.
• Finally, nurses play an important role in restoring a sense of normalcy, not just to individuals
but to communities as a whole. This might mean helping to ensure that normal hospital and
clinic operations can commence as quickly as possible despite damaged infrastructure.

The Effect of Natural Disasters in Hospital Care

Natural disasters can have a significant impact not only on the lives of patients but also on everyday
hospital operations. Natural disasters can overwhelm hospital systems. In the aftermath of disasters
hospital systems face an increase in medical needs and occupancy rates with a decreased supply of
resources, and potential infrastructure limitations due to physical damage or limited access to
essential services like electricity and water supply. Healthcare workers, especially nurses, are
susceptible to these physical and emotional stressors in addition to potential increased workload.
These challenges may lead to an inability to provide optimal patient care. Nevertheless, nurses play a
huge role before, during and after disasters. They volunteer their time in relief efforts and strive to
provide the best care despite the most austere circumstances. They work in uncontrolled physical
environments with limited resources and maximize their resources to provide the best care possible.

Patient Care
Natural disasters can significantly increase the number of patients a hospital must serve. Hospitals
see a number of emergency room cases and other patients on a daily basis, but a natural disaster
can overwhelm them with additional patients who need immediate care, putting a strain on resources
and staffing. According to a 2018 study published in the Annals of Emergency Medicine, in the
aftermath of a natural disaster, hospitals may see their admission numbers swell by hundreds of
patients, most of whom need urgent care.

Evacuations
Due to the threat of flooding and intense storms, hospital facilities must sometimes be evacuated,
with patients relocated to receive necessary care. Nurses must communicate clearly and coordinate
care, keeping track of patient records while maintaining compliance with privacy laws. In these high-
pressure situations, it’s important to have nurses who can offer care while also exhibiting leadership
in disaster nursing and emergency preparedness.

Occupancy Rates and Stress Levels in Disaster Nursing

Providing clinical care in the midst of a natural disaster while also contending with compromised
facilities and overwhelming patient volume can be stressful. These scenarios aren’t just taxing to
patients but also potentially traumatic to providers who are administering care. Nurses may also be
dealing with personal crises, including injuries to loved ones and property loss. In addition, nurses are
subject to social pressures from a public that expects nurses to respond to their needs in times of
emergencies or illnesses. Ethical choices are also an important component of disaster planning and
preparedness. The public assumption of the nurse’s duty to care sometimes ignores the ethical duty
of nurses to care for themselves. In the case of a pandemic, nurses are also at high risk for acquiring
illness and worry about bringing infectious diseases back to their own families. Unsurprisingly, a
survey conducted by NYU researchers found that some nurses report sleeping difficulties and
disturbing thoughts in the wake of natural disasters, as shared in a Daily Nurse article.

The researchers highlight the importance of social support among co-workers and hospital leaders in
high-stress times, as well as the value of training in disaster nursing and emergency preparedness,
which can give nurses the tools they need to remain stalwart even in hectic scenarios.

REFERENCES

AACN (American Association of Colleges of Nursing). The essentials of master’s education in nursing. 2011. [July 15, 2020].
https://www.aacnnursing.org/Portals/42/Publications/MastersEssentials11.pdf .

Altman M. American Association of Critical Care Nurses Blog. Apr 8, 2020. [March 31, 2021]. Facing moral distress during the
COVID-19 crisis. https://www.aacn.org/blog/facing-moral-distress-during-the-covid-19-crisis .

AMA (American Medical Association). Why COVID-19 is decimating some Native American communities. 2020. [March 18,
2021]. https://www.ama-assn.org/delivering-care/population-care/why-covid-19-decimating-some-native-american-
communities .

ANA (American Nurses Association). COVID-19 survey: March 20–April 10. 2020a. [April 5, 2021]. https://www.nursingworld
.org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/what-you-need-to-know/covid-19-
survey-results .

ANA. ANA survey of 14K nurses finds access to PPE remains a top concern. 2020b. [October 9, 2020]. https://www
.nursingworld.org/news/news-releases/2020/ana-survey-of-14k-nurses-finds-access-to-pperemains-a-top-concern .

ANA. Update on nurses and PPE: Survey reveals alarming conditions. 2020c. [April 5, 2021]. https://www.nursingworld
.org/~4a558d/globalassets/covid19/ana-ppe-survey-one-pager---final.pdf .

Anthony C, Thomas TJ, Berg BM, Burke RV, Upperman JS. Factors associated with preparedness of the US healthcare system to
respond to a pediatric surge during an infectious disease pandemic: Is our nation prepared? American Journal of Disaster
Medicine. 2017;12(4):203–226. [PubMed]

ASPR (Office of the Assistant Secretary for Preparedness and Response). 2017–2022 health care preparedness and response
capabilities. 2016. [July 26, 2020]. https://www.phe.gov/Preparedness/planning/hpp/reports/Documents/2017-2022-
healthcare-pr-capablities.pdf .

ASPR. TRACIE emergency preparedness information modules for nurses in acute care settings. 2019. [June 6, 2021].
https://files.asprtracie.hhs.gov/documents/aspr-tracie-emergency-preparedness-informationmodules-for-nurses-and-
economic-framework.pdf .

University of Central Florida. (n.d.). Disaster nursing and emergency preparedness. UCF Online. Retrieved August 13, 2024,
from https://www.ucf.edu/online/healthcare/news/disaster-nursing-emergency-preparedness/
Arellano, Eimeren C.

BSN4 - N3

READINGSON: DISASTER PREPAREDNESS AND EMERGENCY NURSING

By failing to prepare, you are preparing to fail.

—Benjamin Franklin, writer, philosopher, politician

Over the last decade, 2.6 billion people have been impacted by natural disasters. Nurses play an essential role in
disaster response, providing care, education, and building community resilience. However, to better prepare
nurses for future crises, systemic reforms in nursing education, practice, and policy are necessary. The COVID-19
pandemic highlighted existing healthcare system flaws and health inequities, particularly affecting marginalized
communities. Strengthening the nursing workforce's capacity in disaster preparedness is crucial for addressing
social determinants of health and improving healthcare equity.

ROLES OF NURSES DURING NATURAL DISASTERS AND PUBLIC HEALTH EMERGENCIES

The ability to care for and protect the nation’s most vulnerable citizens depends substantially on the preparedness
of the nursing workforce. The myriad factors related to national nurse education and training—licensure and
certification, scope of practice, mobilization and deployment, safety and protection, crisis leadership, and health
care and public health systems support—together define nursing’s capacity and capabilities in disaster response.
The nursing workforce available to participate in U.S. disaster and public health emergency response includes all
licensed nurses (licensed practical/vocational nurses [LPN/LVNs] and registered nurses [RNs]), civilian and
uniformed services nurses at the federal and state levels, nurses who have recently retired, and those who
volunteer (e.g., National Disaster Medical System, Medical Reserve Corps, National Voluntary Organizations Active
in Disasters, and American Red Cross [ARC]). Each of these entities plays a critical role in the nation’s ability to
respond to and recover from disasters and large-scale public health emergencies such as the COVID-19
pandemic.2

Nurses’ General Roles in Disasters

Across a broad spectrum of clinical and community settings and through all phases of a disaster event , nurses,
working with physicians and other members of the health care team, play a central role in response. Before, during,
and after disasters, nurses provide education, community engagement, and health promotion and implement
interventions to safeguard the public health. They provide first aid, advanced clinical care, and lifesaving
medications; assess and triage victims; allocate scarce resources; and monitor ongoing physical and mental
health needs. Nurses also assist with organizational logistics by developing operational response protocols and
security measures and performing statistical analysis of individual- and community-level data.

Disaster nursing timeline. (Veenema, 2018)

Beyond their contributions to disaster response, nurses are actively involved in implementing organizational
emergency operations plans, participating in incident command systems, overseeing the use of personal
protective equipment (PPE), and providing crisis leadership and communications, often at personal risk. In the
community, they manage shelters, organize blood drives, and address the needs of underserved populations,
including social needs. They also support the care of the frail elderly, assist with childbirth to ensure the health of
newborns during disasters, and work to reunite families separated by response activities. The demands placed on
health care systems during disasters test nurses’ knowledge, skills, and personal commitment as health care
professionals. Their role is crucial in maintaining effective and compassionate care during such challenging times.

Nurses’ Roles in Pandemics and Other Infectious Disease Outbreaks

Nurses’ roles in pandemics and other infectious disease outbreaks are multifaceted and may include

Supporting and advising in epidemic surveillance and detection, such as contact tracing;

Working in point-of-distribution clinics to screen, test, and distribute vaccines and other medical
countermeasures;

Employing prevention and response interventions;

Providing direct hospital-based treatment for impacted individuals;

Educating patients and the public to decrease risk for infection;

Providing health systems and community-based leadership; and

Counseling and supporting community members to assuage fear and anxiety (Veenema et al., 2020).

Public health nurses have helped coordinate and implement disaster plans (Jakeway et al., 2008), and it was a
school nurse working in Queens, New York, in 2009 who first observed and then notified the Centers for Disease
Control and Prevention (CDC) about the H1N1 outbreak (Molyneux, 2009).

Infectious disease outbreaks have become more frequent and intense, necessitating robust preparedness from
both health care systems and front-line workers (Fauci & Morens, 2012; Lam et al., 2018). System-level
preparedness involves understanding hospital capacities, including workforce and supplies, and having a
comprehensive action plan (Siu, 2010; Toner et al., 2020). Despite these needs, the U.S. health care system’s
preparedness for a pediatric surge during pandemics has been found lacking (Anthony et al., 2017). For front-line
workers, preparedness includes clinical skills and knowledge for patient care and public protection (Lam et al.,
2018; Ruderman et al., 2006). Nurses’ willingness to respond varies with available information about the pathogen,
disease severity, and public attitudes (Chung et al., 2005; Lam & Hung, 2013). Uncertainty and inconsistent
information can increase nurses’ anxiety and decrease morale, especially when compounded by negative media
portrayals and public panic (Koh et al., 2012; Shih et al., 2007).

Nurses’ Roles in the COVID-19 Pandemic

In December 2019, the novel coronavirus SARS-CoV-2 was first detected in China, and by March 2020, the World
Health Organization (WHO) declared COVID-19 a pandemic, marking the worst public health emergency in over a
century. As of April 1, 2021, the virus had led to over 120 million global cases and 30.5 million cases in the United
States. During the pandemic, nurses have had to adapt rapidly, taking on new roles such as caring for critically ill
COVID-19 patients, providing end-of-life care, and facilitating communication between patients and their families.
This shift has sometimes led to a decreased skill mix in intensive care units, raising concerns about patient safety
and care quality. By April 1, 2021, COVID-19 had claimed the lives of 552,957 Americans, including an estimated
551 nurses, highlighting the severe impact on the nursing workforce. Nurses have faced numerous challenges,
including inadequate PPE, insufficient pandemic-related training, decision-making limitations, staffing shortages,
and a lack of trust with hospital administrators. They have also endured significant psychological and moral
distress, with surveys revealing fears of working under inadequate conditions and persistent PPE shortages. The
pandemic has exacerbated mental health issues, with nurses of Asian/Pacific Islander descent experiencing
additional discrimination and stigma, further compounding their challenges.

Nurses’ Response to Human-Caused Disasters

In addition to natural disasters and public health emergencies, the United States is currently experiencing
significant increases in gun-related violence, civil unrest against systemic racism, and social upheaval associated
with growing political polarization (see Box 8-1). Active shooters in hospitals, school shootings, and random acts of
foreign and domestic terrorism have forced a widening aperture for national preparedness, and nurses are involved
in responding to the care needs of victims of these events (Lavin et al., 2017).

DISASTERS’ IMPACT ON POPULATION HEALTH

A disaster is defined as “a serious disruption of the functioning of a community or a society at any scale due to
hazardous events interacting with conditions of exposure, vulnerability and capacity, leading to one or more of the
following: human, material, economic and environmental losses and impacts” (UNISDR, 2017). More than 2.6
billion people globally have been affected by natural disasters, such as earthquakes, tsunamis, and heat waves, in
the past decade, and these disasters have led to massive injuries, mental health issues, and illnesses that can
overwhelm local health care resources and prevent them from delivering comprehensive and definitive medical
care (WHO, 2020). During 2019 alone, the United States experienced 14 separate billion-dollar disasters, including
inland floods, severe storms, two hurricanes, and a major wildfire event (Smith, 2020). Disaster planning for
emergency preparedness is, then, imperative. In the near future, such factors as climate change and climate
change–related events, including global warming and sea-level rise; the depletion of resources and associated
societal factors; and the growth of “megacities” and populations shifts (IFRC, 2019; UN, 2016) are likely to
converge to increase the risk of future disasters (IPCC, 2012, 2014; Watts et al., 2018). Human-caused disasters,
such as school and other mass shootings and random acts of terrorism, create additional hazards for human
health.

Health Inequities in Disasters

Disasters do not impact populations equally; they often exacerbate existing societal inequities and
disproportionately affect high-risk and vulnerable communities, including the elderly, individuals with disabilities,
the immunosuppressed, the underserved, and those living in poverty. Severe and morbid obesity, influenced by
social determinants of health (SDOH), further compounds vulnerability, creating a “triple jeopardy” for affected
individuals. Disparities in health and health care, such as limited access to primary care, comorbid conditions,
and lack of insurance, increase the risk of injury or death during disasters and are worsened by the disaster itself.
For example, Hurricane Katrina led to more than 4,600 excess deaths due to interruptions in medical care and
utilities, impacting those with chronic conditions most severely. Research indicates that lower socioeconomic
status (SES) and lower educational attainment correlate with less disaster preparedness and greater hardship
during and after disasters, such as homelessness and financial strain. Lower SES families often face increased
damage from disasters due to poor housing quality and lack of insurance, struggle to access aid, and experience
higher rates of depression and posttraumatic stress.

Relationship to Race and Ethnicity

Health inequities seen in natural disasters and infectious disease outbreaks are often directly related to race and
ethnicity. The COVID-19 pandemic has had a disproportionate effect on Black, Hispanic, and American Indian
populations, who have experienced greater levels of suffering and death. Long-standing racial and ethnic
inequities in access to health care services prior to the pandemic have translated into disparities in access to
COVID-19 testing and treatment (Duke Margolis Center for Health Policy, 2020; Poteat et al., 2020). Zoning laws
and low income levels have disadvantaged some racial and ethnic groups and contributed to living conditions that
have made it difficult for individuals to socially distance (Davenport et al., 2020). The added burdens of chronic
disease and persistent underfunding of American Indian health systems have resulted in the nation’s Indigenous
population being at high risk of poor outcomes from the disease (AMA, 2020). COVID-19-related unemployment
and economic devastation have impacted all communities, with Black and Hispanic workers experiencing the
highest rates of COVID-19 infection (BLS, 2020). Box 8-2 describes how one county in Texas became a COVID-19
“hotspot.”

NURSES’ ROLE IN SHELTERING DURING DISASTERS

During disasters, nurses staff shelters that house people displaced by these events. Shelters are critical in disaster
response, providing temporary housing for those displaced by such events as earthquakes and hurricanes (see Box
8-3). During Hurricanes Gustav and Ike in 2008, more than 3,700 patients were treated by nurses in shelters for
acute and chronic illnesses (Noe et al., 2013). After Hurricane Katrina in 2006, nearly 1,400 evacuation shelters
were opened to accommodate 500,000 evacuees from the Gulf region (Jenkins et al., 2009). People who receive
care in shelters, including children, the elderly, and those with chronic medical conditions, are often economically
disadvantaged and highly vulnerable to a disaster’s health impacts (Laditka et al., 2008; Springer and Casey-
Lockyer, 2016). For example, one study of evacuees living in Red Cross shelters after Hurricane Katrina found that
nearly half lacked health insurance, 55 percent had a preexisting chronic disease, and 48 percent lacked access to
medication (Greenough et al., 2008). Nurses can help ensure that such evacuees receive appropriate care,
including for physical and mental illnesses, and help prevent unnecessary deaths that may result from disruptions
in health care services.

Lessons Learned from Nurses’ Role in Evacuation During Hurricane Sandy.

After a disaster, people must often spend extended periods in shelters until they can find alternative housing,
greatly affecting their social, mental, and physical well-being. For example, studies have found that disaster
victims are at increased risk for posttraumatic stress disorder, and the close proximity to others in which they must
live in shelters, combined with poor infection control, greatly increases the potential for infectious disease
outbreaks in these settings. The health needs of those residing in shelters long-term are often much greater than
the needs of those who suffer acute injuries, such as traumas (e.g., penetrating wounds, bone fractures), from the
disaster itself. For example, a review of more than 30,000 people treated in shelters after Hurricane Katrina found
that most of the care provided was “primary care or preventive in nature, with only 3.8 percent of all patients
requiring referral to a hospital or emergency department” (Jenkins et al., 2009, p. 105). An assessment conducted
after Hurricanes Gustav and Ike identified similar postdisaster health care needs within shelters (Noe et al., 2013).

Historically, nurses have delivered care to shelter populations, perhaps most familiarly in working with ARC. For
example, ARC nurses at a shelter housing Hurricane Katrina evacuees set up hand sanitizing stations to help
prevent infectious disease outbreaks. ARC nurses have worked to understand the functional, physical, and mental
health needs of displaced persons; ensure that shelters are safe environments; and “maximiz[e] the effectiveness
of nurses and other licensed care providers in disaster shelters” (Springer and Casey-Lockyer, 2016).

NURSES’ PREPAREDNESS FOR DISASTER RESPONSE

Lessons from past infectious disease outbreaks, such as the 2003 SARS outbreak, the 2009 H1N1 pandemic, and
the Ebola virus outbreak, were not adequately applied to workforce planning for COVID-19. These previous
emergencies revealed significant gaps in emergency preparedness and workforce development, leading to calls for
improved nurse readiness (Catrambone and Vlasich, 2017; Corless et al., 2018; Veenema et al., 2016a). A notable
gap is the general lack of basic knowledge about health system emergency preparedness among nurses, including
school nurses, who are expected to play crucial roles in public health emergencies (Baack and Alfred, 2013;
Labrague et al., 2018). Surveys have shown that a large percentage of nurses are unfamiliar with emergency
preparedness and disaster response, and nursing curricula often lack comprehensive training in these areas
(ASPR, 2019; Charney et al., 2019; Veenema et al., 2019). Additionally, nurses’ willingness to respond to disasters
varies, with many feeling unprepared or unsafe (Connor, 2014; Subbotina and Agrawal, 2018).

Despite this, studies indicate that nurses who are well-informed about infectious diseases and have previous
outbreak experience are more confident and effective in managing outbreaks (Liu and Liehr, 2009; Koh et al.,
2012). A strong sense of professional responsibility also influences their decision to work during outbreaks (Chung
et al., 2005). Gaps in education and leadership training further complicate the situation, emphasizing the need for
better training programs for nurse leaders to improve disaster response and outcomes (Knebel et al., 2012;
Shuman and Costa, 2020). Addressing these issues requires understanding and addressing gaps within the U.S.
health care system, including government strategies, research funding, education, hospital responsibilities, and
the role of professional organizations. Transformative actions in nursing education, practice, and policy are
essential for enhancing national nurse readiness for current and future disasters (Veenema et al., 2020).

Government Strategies

The federal government, through various agencies, is responsible for disaster preparedness and response, with the
Office of the Assistant Secretary for Preparedness and Response (ASPR) playing a leading role in medical and
public health readiness. ASPR coordinates the HHS Emergency Support Functions, oversees the National Disaster
Medical System, supports the Hospital Preparedness Program, and manages the Strategic National Stockpile.
ASPR's strategies also include the National Biodefense Strategy and the National Health Security Strategy, while
FEMA and the CDC provide additional frameworks for response and preparedness.

However, there are concerns that federal strategies may not fully reflect or incorporate the capacity of the nursing
workforce in disaster response. A systematic review of national policies is needed to ensure that disaster nursing
practice is adequately prioritized in emergency management operations (Veenema et al., 2016a). For example, the
2017–2022 Health Care Preparedness and Response Capabilities framework outlines necessary capabilities,
many of which depend on a trained nursing workforce. Ensuring that nurses are well-prepared and available is
crucial for successful mass vaccination and disaster response efforts. Locally, school nurses play a key role in the
safe reentry of children to K–12 education during disasters, guided by lessons from other jurisdictions and CDC
recommendations. Clarifying the roles and responsibilities of nurses within preparedness and response strategies
is essential for equipping them with the necessary knowledge and skills. Additionally, integrating nursing expertise
into policy-making at all levels can enhance preparedness and response efforts.

Research Funding

Scientific evidence is essential for delivering safe, high-quality nursing care in disaster situations, yet the evidence
base for disaster nursing is underdeveloped. Research gaps and priorities in disaster nursing have been identified,
with recommendations for advancing research including developing a research agenda to address literature gaps,
expanding research methods to include interventional and mixed-methods studies, and increasing the number of
PhD-prepared nurse scientists leading disaster research (Veenema et al., 2016a). However, funding for this
research has been insufficient, with public health emergency preparedness and response (PHEPR) research
experiencing intermittent support and a significant decline in funding since 2009. The National Academies report
highlights that the field relies on fragmented and uncoordinated efforts, often lacking evidence-based practices
(NASEM, 2020). To address these issues, a coordinated intergovernmental and multidisciplinary effort is needed to
prioritize and align research efforts and investments, strengthening the capacity to conduct effective research
before, during, and after public health emergencies (NASEM, 2020).

Responsibilities of Hospitals and Health Care Organizations

The COVID-19 pandemic has brought to light significant issues in American health care financing and delivery,
revealing both challenges and opportunities for the nursing profession. It has exposed systemic vulnerabilities that
affect the well-being and resilience of nurses and other health professionals. To address these issues, it is
essential to ensure a safe working environment for nurses by maintaining adequate staffing levels, providing
appropriate personal protective equipment (PPE), and offering both physical and mental health support. Hospital
administrators, along with nursing and medical executives, are responsible for implementing policies that uphold
these standards during disaster responses. Disaster plans must be flexible to accommodate changes in clinical
duties and staffing needs, and include provisions for alternative staffing resources. This flexibility is crucial across
all health care settings, including long-term care facilities, home care agencies, and community health clinics.
Collaboration among nurse executives is necessary for planning scenarios that might require the mobilization of
nurses across different settings. Additionally, the stockpiling and procurement of critical supplies such as testing
materials, PPE, and medical gases are essential for maintaining operational capacity and ensuring nurse safety.
Health system leaders must ensure that emergency management response plans incorporate comprehensive
training, address health equity issues, and include strategies for effective communication with and protection of
the workforce. By focusing on these areas, the resilience and effectiveness of the nursing workforce and health
care systems can be significantly improved for future disasters.

The Role of Professional Nursing Organizations

Professional nursing organizations play a crucial role in equipping their members and the nursing profession as a
whole with the expertise and support needed to address unforeseen events that threaten public health.
Historically, these organizations have advocated for the protection and support of nurses during disasters and
continue to do so. The Tri-Council for Nursing, an alliance of five prominent nursing organizations, focuses on
leadership in education, practice, and research. By collaborating with specialty organizations such as the
Emergency Nurses Association and the Council of Public Health Nursing Organizations, the Tri-Council can
advocate for a comprehensive and forward-thinking national strategy to enhance disaster nursing and public
health emergency preparedness and response (PHEPR). A particular emphasis should be placed on addressing the
needs of individuals, families, and communities disproportionately affected by disasters. The collective efforts of
nursing organizations during the COVID-19 pandemic can serve as a foundation for preparing the profession to
effectively tackle future disaster-related challenges.

CONCLUSIONS

COVID-19, while historic, is but one example of the significant burden imposed by disasters and public health
emergencies on the health of populations, health care professionals, and nurses in particular. The pandemic has
created multiple challenges, particularly for managing its effects across diverse and highly vulnerable populations,
and exacerbated existing health inequities. Future natural disasters and infectious disease outbreaks will present
similar, if not greater challenges for the nursing profession. Bold, anticipatory action is needed to advance nurse
readiness for these events. The nation’s nurses are not currently prepared for disaster and public health emergency
response. A bold and expansive effort, executed across multiple platforms, will be needed to fully support nurses
in becoming prepared for disaster and public health emergency response. It is essential to convene experts who
can develop a national strategic plan articulating the existing deficiencies in this regard and action steps to
address them, and, most important, establishing where responsibility will lie for ensuring that those action steps
are taken. Rapid action is needed across nursing education, practice, policy, and research to address the gaps in
nursing’s disaster preparedness and improve its capacity as a profession to advocate for population health and
health equity during such events.