By Katie Morales, PhD, RN, CNE
Japan picked the word "disaster" to describe the year 2018 because there were so many natural disasters. In America, we saw devastating hurricanes, wildfires, floods, tornadoes, and blizzards. Since September 11 occurred, Americans have become infinitely more aware of disaster preparedness. We even offer national certification in basic and advanced disaster life support.
Nurses are no stranger to disasters, as our founding mothers were on the front lines of the Crimean and Civil Wars. In fact, nursing education has incorporated disaster triage into nursing curriculum. Our curriculum expects students to identify how the community, community organizations, and health professionals work together to focus on safety when preparing for disasters, in addition to responding and recovering from them. The specific learning objectives include: identifying disaster types, explaining disaster planning, and understanding first responder process and nursing participation. The curriculum also helps nurses to understand their role in a disaster setting, promotes increased competency levels using simulation technology and field drills, and exercises. Nurses learn how to differentiate between biological, chemical, and radiological agents and the appropriate responses to exposure.
Learning activities such as interviewing individuals in the American Red Cross responsible for disaster services, or contacting local and state directors for disaster training have proven to be helpful. Students also participate in a simulated disaster-preparedness scenario set up by EMS staff. As a rule, I am proud of the disaster preparation training that we offer students. However, a recent headline made me question if we are doing enough to help our graduates to prepare for the long-term repercussions of disasters.
While scrolling through social media the other day, a post caught my eye. A Panama City nurse posted a plea for a job claiming there were no jobs due to a recent hurricane in the area. I contacted the nurse because I was concerned the post was a scam that could mar nursing's reputation as the most trusted profession. My colleague questioned, "If this post is true, why aren't we hearing anything about it?" After speaking with the nurse, I learned she was one of 800 healthcare workers who lost their jobs that week due to damage from Hurricane Michael on October 10, 2018.
This community has two hospitals. Both were severely affected by the hurricane and neither is fully operational to date. Bay Medical is a level II trauma center and the cardiac specialty hospital for the area but has only had its emergency department in operation since the hurricane. The hospital will reopen as a 75-bed hospital, rather than the 323-bed hospital which served the community prior to the hurricane. Employees recently received a group text instructing them to log in to their accounts to check their job status. While a group text sounds harsh, it was the best option as the infrastructure is still down in the area. Because the doctors’ offices and other buildings in the area were so damaged, the job opportunities for nurses in the area are indeed scarce. The hospital is hosting a career fair in the area, so employees can explore other options within the system. This nurse is concerned about finding a job that is a good fit as she is a newly licensed nurse with only one-year experience.
In retrospect, this story should not have surprised me. Neither nurses nor nurse educators are immune to disasters. A colleague visited friends in North Carolina two months after Hurricane Florence hit the area. Her friends also relayed stories of the long-term impact on the community’s healthcare. Two other colleagues teach nursing at Jacksonville State University. The campus suffered major damage in March 2018. The nursing program had to be relocated due to the damage.
Such disasters changed the entire landscape of these communities. Survivors reported they received help immediately after the disasters, but the out of pocket expenses for essentials such as water, ice, and supplies were astronomical. Following the disaster, Panama City was under a curfew. Months later, line men still occupied the city. Panama City had red lights, but no street lights. A 30-minute drive to work would take 1 ½ -2 hours. Vegetation which took years to grow was wiped out.
The healthcare system which took years to establish was also wiped out. Panama City lost its trauma and cardiac centers. Patients are now stabilized and transported by ambulance or airlifted to Pensacola or Fort Walton. A pregnant woman who went into labor at term immediately after Hurricane Michael was airlifted to another facility even though it was a routine delivery because no one had facilities to deliver the baby.
America has a reputation of having a short attention span. Even the first responders from September 11 that suffered long-term health effects had to advocate for themselves to get coverage long after September 11 was no longer front-page news. Likewise, my colleague and I were both were ashamed to admit our colleagues affected by disasters had completely fallen off our radar when it was no longer breaking news. I am overwhelmed that 800 healthcare workers are out of work indefinitely in Panama City. I am concerned we will see this occur in California in the wake of the devastating wildfires there.
So, what can we as nurses and nurse educators do? In the short-term, We can prepare and educate others in disaster preparation. The Centers for Disease Control has a preparedness checklist. We can offer courses in budgeting and planning financially for disaster. How will our graduates cope with the expenses of a disaster as they struggle to pay off student loans? Additionally, headlines declare millions of Americans are one pay check away from being homeless. We can offer the national certification in disaster life support.
But we must also invest in the long-term recovery. A search of our leadership curriculum for advocacy, lobby, change agent yielded no result. We need to teach students how to be change agents and impact public policy. The American Nurses Association has a policy/advocacy page. The National Student Nurses’ Association has a Health Policy and Advocacy Committee. State Nurses Associations will be offering lobby days at the state capitols.
When nurses are displaced by disasters, we can network professionally (LinkedIn, professional organizations). Displaced nurses can explore creative options such as at-home positions or telephone positions. Displaced nurses may consider further education, such as paramedic training. Finally, our college career centers can help graduates who are displaced by disasters.