Nurse Leaders' Role in Hospital Disaster Planning

Politics of the Hospital and Disaster Planning

The politics in hospital settings surrounding nurse leaders and functional change are likely associated with the hierarchy of hospital systems, where individuals in administrative positions and doctors limit the input of nurse leaders in effecting 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 meetings surrounding change, or any number of other aspects of the hierarchical system. The reason for this exclusion is multifaceted 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 preparedness content within nursing curricula (Olivia, Claudia, & Yuen, 2009, pp. 3165–3171).

Increasingly, hospitals and other large healthcare organizations are coming to terms with the fact that floor-level skilled staff — and even unskilled staff — are integral parts of the healthcare delivery team. These individuals can offer insight into both everyday and high-demand environments within the delivery system, such as those encountered during a disaster. In the historical model, a single high-level administrative nurse was often the only nurse — if any were invited — at the table with demonstrable input for disaster planning, expected to speak as a representative for the entire nursing staff even when many nurse leaders could have provided direct input (Hwang, 2006, pp. 18–19).

A current shift in the planning process — one that would include more nursing leaders such as floor leads, department managers, and shift charge nurses — may be influenced by the growing body of post-disaster literature from around the world. An example from the Taiwanese SARS emergency offers insight into the particular strengths nurses bring to caring for large numbers of people at high risk. "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 example is that, despite — and possibly even because of — the politics of the hospital, nurses are in a particularly good position to demonstrate leadership in developing policies that govern emergency situations for hospital staff and their individual communities. Where disaster planning in the past might have assumed unconditional loyalty from all staff during a crisis — citing their professional choice — or offered only perfunctory guidelines, the nurses during this infectious disease outbreak were the reason why staff reported for duty, continued treating patients, and ultimately delivered sensitive but reliable information to the community through their families. The strength of this assessment should be noted by all those who seek, through traditional hierarchy, to exclude nurse leaders from disaster planning. Those in the trenches are far more likely to influence their colleagues than a group of administrators who are separated from the floor and who are ultimately at far less personal risk.

Ultimately, a shift is being seen in which nurse leaders are finally being recognized for their contributions and their 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 on disaster planning are making great strides in pointing out the integral part nurse leaders can play in disaster mitigation — and therefore the role they should be playing in disaster planning, particularly in staff management and standards across the hospital setting (Fu-Jin et al., 2009, p. 3391).

Nurse leaders — and all nurses in general — are fundamentally driven by a value system that demonstrates their willingness 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 healthcare delivery, particularly for those who are most affected during a disaster: the less fortunate who are bound by economic circumstances to remain in a disaster area (Hwang, 2006, pp. 18–19).

Values Influence in Hospital Disaster Plans

Although doctors are held to a Hippocratic Oath, nurses take these values just as seriously and frequently 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 hallmark of a good nurse leader — one who uses values to advocate for 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 among 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 possess a value system attuned to the needs of both staff and patients during the strain and stress of a disaster situation, and can therefore provide significant input in both procedural and staff management matters — input that should be an integral aspect of disaster planning. When decisions are made from above, they often bear little relation to realistic conditions on the ground and can prove as disastrous as the event itself. When frontline workers feel "less involved" and "less informed" with regard to disaster planning and ad hoc planning during a disaster, the values and judgment of the nurse are lost in the process, potentially resulting in strategic failures across the whole hospital and consequent 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 to and manage healthcare issues before, during, and after disastrous situations — including the recovery stages — is crucial in reducing loss of life and further health problems. As nurses play an important role in responding to disastrous events, they should be well educated through training and awareness programs. Education campaigns can then be further extended to the public through health talks and health promotion by nurses (Olivia, Claudia, & Yuen, 2009, p. 3166).

Seeking to exclude the individuals who are most relied upon by the community — who offer the greatest level of support and who often stand to lose the most — significantly impairs service delivery during a disaster and curtails the disaster planning process. Nurse leaders are largely aware of this disproportionate reliance placed upon them for provision of care in disasters, and this awareness is closely tied to their professional values. Nurses may also experience considerable value conflict with regard to commitments to family, community, and patient. This makes them uniquely positioned to contribute to aspects of disaster planning that help alleviate those value conflicts for themselves and for many other hospital staff members.