The politics in hospital settings surrounding nurse leaders and any functional change is likely associated with the hierarchy of the hospital systems, where individuals in administrative positions and doctors limit the input of nurse leaders in making change. This can be associated with nurse leaders reluctance to provide input based on the hierarchy, the exclusion of most or all nurses from discussions and meeting surrounding change or any number of other aspects of the system of hierarchy. The reason for this exclusion is multivariate but could be associated with the fact that many nurse leaders feel ill prepared to make major decisions regarding disaster planning as a result of limitations in disaster planning in the nursing curriculum. (Olivia, Claudia, & Yuen, 2009, pp. 3165-3171)
Increasingly hospitals and other large health care organizations are coming to terms with the fact that floor level skilled staff and even unskilled staff are integral parts of the health care delivery team and can offer insight into the everyday and high demand environments of the delivery system, such as would be found during a disaster. In the historical model often a single high level administrative nurse is the only nurse, if any are invited, at the table who has demonstrative input for disaster planning and who is expected to speak as a representative for the whole nursing staff even when many nurse leaders would be able to provide direct input. (Hwang, 2006, pp. 18-19)
A current change in the planning process, that would include more nursing leaders, including floor leads, department and shift charge nurses may be influenced by the increasing amount of literature surrounding post-disaster literature from around the world. In an example from the Taiwanese SARs emergency in 2008 is offered here as the insight into the niche of caring for large masses of people at high risk to themselves and their own help demanded disaster planning that nurses were not only adept to but demonstrably good at. "Nurse leaders become important executors of intervention in this health disaster, requiring emotional intelligence to manage their internal conflicts and interpersonal relationships effectively. They developed sociopolitical and analytical abilities and crucial requirements for planning and implementing strategies in areas where none previously existed. Building support systems was an important resource for managing conflicts between familial and professional roles." (Fu-Jin et. al., 2009, p. 3391) The message from this particular example is that despite and possibly even because of the politics of the hospital nurse are in a particularly good position to demonstrate leadership in developing policies that govern intermediary situations for hospital staff and their individual communities. Where disaster planning in the past might have assumed loyalty from all staff members during a crisis as a result of their choice of profession or offered only a perfunctory set of guidelines for staff in a disaster plan, these real nurses during an infectious disease outbreak were the source of the reason why staff reported for duty, kept treating patients and likely ultimately offered sensitive but strict information to the community through their families. The strength of this assessment should be noted by all those who seek through a traditional hierarchy to exclude nurse leaders from disaster planning as there is a clear sense that those in the trenches are far more likely to influence their comrades than a group of administrators who are separated from the floor and who are ultimately at far less risk than themselves.
Ultimately a change is being seen where nurse leaders are finally being recognized for their contribution and their particular direct input regarding planning processes and disaster management. The politics of the past still pervade many institutions but international nurses who are researching and publishing literature associated with disaster planning are making great strides to point out the integral part nurse leaders can play in disaster mitigation and therefore the role they should be playing in disaster planning, in particular in staff management and standards across the hospital setting. (Fu-Jin et. al., 2009, p. 3391)
Values Influence in Hospital Disaster Plans
Nurse leaders and all nurses in general are fundamentally driven by a value system that demonstrates their will even to place themselves in harm's way to provide care to individuals. They are often activists in the community seeking to elicit change for better delivery of healthcare and particularly to those who are often the most affected during a disaster, the less fortunate who are bound by economics to remain in a disaster area. (Hwang, 2006, pp. 18-19)
Though doctors are those who are held to a Hippocratic Oath nurses take these values just as seriously and often provide triage care in high risk situations. It is for this reason that nurse leaders should be included in disaster planning. Community activism is a mark of a good nurse leader and one who utilizes values to demand change, where change is needed. "Recent world events have created a new lens through which to view nursing's role in emergency management." (Coyle, Sapnas, & Ward-Presson, 2007, p. 24) Again an example from a post-disaster review during a SARs epidemic offers insight into why nurses are the best sources for change advocacy: "While all groups found SARS stressful, nurses reported a greater impact on morale and job satisfaction. Nurses relied more on peer support than doctors, felt less informed and less involved in decision-making than doctors felt, and were more likely to report that infection control procedures were not strict enough." (Tolomiczenko et. al. 2005, p. 202)
Nurse leaders have a value system that is abreast to the needs of both staff and patients during the strain and stress of a disaster situation, and therefore can provide significant input in procedural and well as staff management that should be an integral aspect of disaster planning. When decisions are made, on high they offer little realistic delivery to staff and therefore often prove as disastrous as the disaster itself. When the front line workers feel "less involved" and "less informed" with regard to disaster planning and ad hoc planning during a disaster the values of the nurse is lost in the process and may result in strategic and important losses to the whole hospital, resulting in losses to the community.
When disaster strikes, the demand for nursing staff is much greater than that for other healthcare professionals (Lavin 2006). Preparing nurses to respond and handle healthcare issues before, during and after disastrous situations, including the recovery stages of society, are crucial in reducing loss of life or further health problems. As nurses play an important role in the response to disastrous events, they should be well prepared by means of education, training and awareness programmes. Education campaigns can then be further extended to the public through health talks and promotion by nurses. (Olivia, Claudia, & Yuen, 2009, p. 3166)
Seeking to exclude the individuals in the community with the highest level of need, greatest level of support offering and in many ways a great deal more than others to lose would and does significantly impair the delivery of service during a disaster and curtail the disaster planning process. Nurse leaders are aware to a large degree of this disproportionate reliance on them for provision of care in disasters at it is closely tied to their values and nurse leaders. Nurses may also have and live with considerable value conflict with regard to commitments to family, community and patient therefore they are ultimately one of the greatest resources in developing aspects of disaster planning that help alleviate those conflicts of value for themselves and many other staff members in a hospital.
Moral Obligations in Disaster Planning
Nurses see a great deal of suffering, mitigate a great deal of resolution and relief and in short weave these experiences into their core values and sense of moral obligations. Their hands are literally on the pulse of all the problems and chinks in the armor of the health care delivery system and the community at large and most nurse leaders seek to both be involved and have input with regard to change. The role of the nurse as advocate for the patient and community cannot be better placed than in disaster management planning in large part because of a heightened sense of moral obligation that is a large aspect of their profession. (Hwang, 2006, pp. 18-19)
Nurses are remarkable in that in many cases they choose their sense of moral obligation over all else, often remaining in or even heading in to disaster treatment with countless unknowns in their own lives pending. There are countless of examples of nurses remaining in peril to continue to offer treatment and safety to patients in hospitals during disasters. The information age has made it possible for many more people to be made aware of this reality as nurses in some cases have sacrificed the assurance of the safety of their own homes and families to remain duty bound…