Nurse administrators are responsible for taking measures to ensure adequate organizational response after disasters1,2 and assume nurses will report to work during disasters and public health emergencies. Such assumptions may be misguided if nurses do not feel adequately prepared to provide care after a disaster. Healthcare professionals lack readiness for various emergencies,3,4 and nurses around the world self-report gaps in competence for work during disasters.5-7 Professional disaster preparedness competence in nursing is composed of the knowledge, skill, and abilities required to provide care after a disaster.8 Lack of competence related to professional emergency preparedness may affect the likelihood a nurse will report to work after a disaster.9,10
Evaluation of current levels of competence in professional emergency preparedness among nurses is a vital step toward improving effectiveness of organizational disaster planning and response. The research questions (RQs) addressed in this study are the following:
- RQ1. What is the level of nurses' self-reported professional emergency preparedness competence?
- RQ2. What is the relationship between nurses' personal preparedness and their likelihood to respond to a disaster?
- RQ3. What is the relationship between nurses' professional emergency preparedness competence and their likelihood to respond to a disaster?
This article offers insights into nurses' current professional emergency preparedness competence and suggests approaches to bridge gaps between competence, personal preparedness for a disaster, and likelihood to report to work in case of a disaster.
The impact of disasters requires nurses to possess disaster nursing competence, which may be defined as a “characteristic of a nurse that enables an individual professional to effectively perform the role of the nurse specific to a disaster situation.”11(p121) With the number of disasters throughout the world rising steadily,12 the need to study nurses' familiarity with the dimensions of professional emergency preparedness competence, personal preparedness for a disaster, and likelihood of nurses to respond to disasters becomes increasingly apparent.
Professional Competence for Disaster Response
In response to heightened awareness of the need for disaster healthcare, organizations have introduced lists of disaster competencies encompassing the required knowledge to be professionally competent and prepared to respond to a disaster.11 The American Association of Colleges of Nursing includes disaster-related competencies in its published essentials for doctoral, master's, and baccalaureate education.13-15 Despite such efforts, nurses in the United States and elsewhere lack confidence in their ability to provide care after a disaster or public health emergency. A recent study of healthcare providers' professional preparedness for response to a mass casualty event revealed drastic variations in self-assessed competence, with nurses tending to report the lowest levels of knowledge.3 Nurses have reported a lack of knowledge regarding disaster-related competencies,6,7,16 and there is limited evidence to suggest otherwise.4
Reporting to Work After a Disaster
Lack of confidence with disaster competencies has ramifications for clinical agency staffing because of the potential connection with the number of nurses reporting to work after a disaster. Several studies have shown disaster response knowledge can increase the number of nurses reporting in disaster situations.9,17 Having sufficient staff to meet healthcare needs after a disaster is crucial for patient safety. Thus, researchers have begun exploring professional disaster preparedness and response training to increase nurses' competence and, ultimately, the number of nurses reporting to work after a disaster. Some investigators found training to be associated with an increased number of nurses who would report to work after a disaster,18,19 whereas others found no such association.20,21 The authors of 2 literature reviews22,23 and a 10-year systematic review24 concluded professional disaster knowledge and response training for healthcare providers increased the numbers of nurses reporting to work after a disaster.
Personal Disaster Preparedness
In addition to lacking professional emergency preparedness competence, researchers found a lack of personal preparedness among nurses.7,25 Personal preparedness “includes being ready for emergencies at home, in your car, or anywhere else you may spend time.”26(para1) Personal preparedness has become an area of interest for researchers because of the assumption that personal disaster preparedness will decrease barriers to reporting to work after a disaster. Research in this arena has produced mixed results, with some researchers finding no association between personal disaster preparedness and the numbers of nurses indicating they would report to work after a disaster20,27,28 and others indicating a positive association between personal preparedness and the numbers of nurses indicating they would report to work after a disaster.29
Study Design and Sample
An exploratory, cross-sectional survey design was used. After institutional review board approval, nurses employed at 3 inpatient healthcare facilities and 1 outpatient facility in the United States, representing a broad range of clinical practice areas, were recruited for this study. The researcher attended 10 unit meetings where, after providing informed consent, 186 participants completed paper surveys. An a priori sample size of 167 was estimated for a medium effect size, a power of 0.95, and an α of .01 (to correct for multiple correlations); therefore, 186 participants were sufficient for statistical power.
Participants completed questions related to educational level, gender, age, dependents, and workplace setting.
Professional Competence for Disaster Response
Professional competence for disaster response was measured using the Emergency Preparedness Information Questionnaire (EPIQ).30 The EPIQ is a 44-item instrument that assesses nurses' self-reported level of familiarity with 8 dimensions of emergency preparedness competence: triage and basic 1st aid; detection; accessing critical resources and reporting; the incident command system; isolation, quarantine, and decontamination; psychological issues; epidemiology and clinical decision making; and communication and connectivity.30 Each individual item was measured on a 5-point familiarity scale, ranging from 1 (very familiar) to 5 (not familiar). Consistent with subsequent revisions of the instrument,31 items were reversed scored so that high scores meant more familiarity. The development of the EPIQ involved an extensive qualitative process involving many emergency preparedness experts and related organizations in Wisconsin and Minnesota, which established the content validity of the EPIQ. The structural validity of the EPIQ was examined using factor and reliability analysis, resulting in the identification of 8 reliable and valid dimensions.30 Coefficient αs in our study ranged from 0.84 to 0.94 across the 8 dimensions and were similar to the original results, which ranged from 0.83 to 0.94.30 Reliability of the EPIQ for the current sample is 0.98.
Personal Disaster Preparedness
Self-reported personal preparation for a disaster was measured by 4 items focusing on participants' perceived levels of overall personal preparation for a general disaster, natural disaster, biological disaster, and a terrorist attack. Face validity was established by experts in the field of disaster nursing. One example of a question assessing personal preparation for a disaster is “How personally prepared are you/your family for a general disaster.” These items used a 5-point scale ranging from 1 (very well prepared) to 5 (not well prepared) and were reverse scored in analysis. Reliability of the personal preparedness items for the current sample was 0.91.
Reporting to Work After a Disaster
Likelihood of reporting to work in the event of a disaster was measured by 7 researcher-constructed items focused on participants' perceived likelihood of reporting to work in the event of an infectious disease pandemic, mass casualty disaster, terrorism event, natural disaster, chemical disaster, radiologic disaster, and biologic disaster. Content validity was established by experts in emergency preparedness and based on literature highlighting the number of nurses reporting to work after a disaster changes based on the type of disaster.32 A 5-point scale ranging from 1 (very likely) to 5 (not likely) was used to assess each item. The items were reverse scored in analysis. Reliability of the likelihood items for the current sample was 0.96.
Descriptive statistics were used to summarize demographic variables (Table 1) and EPIQ30 dimensions (Table 2). Pearson correlations (Table 3) were conducted to describe the relationship of professional emergency preparedness competence with personal disaster preparedness and likelihood of reporting to the workplace in the event of a disaster. All data were analyzed with IBM SPSS (version 24). Results were considered statistically significant at P < .05. Before analysis, data were screened for completeness (only cases with completed scales were included), scales and subscales were calculated for the survey instruments, and a determination was made that assumptions for parametric testing were met.
A sample of 186 nurses working in a variety of clinical practice areas provided survey data. Table 2 presents results related to mean scores on the EPIQ items grouped by professional competence for disaster response dimensions, along with the number of participants who indicated a positive response (very familiar or familiar) to items comprising the perceived professional competence dimensions. The highest dimension score (mean, 3.13) was for “triage and basic first aid,” and the lowest dimension score was for “accessing critical resources and reporting” (mean, 2.15). Overall self-reported professional competence had a large correlation (r = 0.57, P < .001) with overall personal disaster preparation and a moderate correlation (r = 0.34, P < .001) with overall likelihood of reporting for work. Personal disaster preparedness had a large correlation with calculated professional competence (r = 0.63, P < .001). There was a moderate correlation between personal disaster preparedness and likelihood to report to the workplace in the event of a disaster (r = 0.42, P < .001). Mean professional competence dimension scores and overall professional competence scores were compared between the home unit of the nurses, with no statistically significant differences found. No statistically significant differences on any variables were found between participants from the different facilities.
Table 2 presents findings for the level of personal disaster preparedness for 4 disaster scenarios and the overall average for the scenarios (mean, 2.61). The percentage of participants selecting a positive response (very well prepared or well prepared) for their level of personal preparation for each disaster type is also presented. Fewer than 40% of respondents selected a positive response for personal preparedness in any scenario. Of the 4 personal preparedness scenarios, participants reported the highest preparedness for a natural disaster (mean, 3.12) and the lowest preparedness for a biological disaster (mean, 2.20). The level of perceived likelihood of reporting to work after 7 disaster events and the overall likelihood average (mean, 3.63) are also presented (Table 2). The percentage of participants selecting a positive likelihood to report (very likely or likely) for each disaster scenario is also presented. The highest likelihood to report to work was after a mass casualty disaster (mean, 3.91), and the lowest was for infectious disease (mean, 3.46) and biological disaster (mean, 3.46).
The current level of professional competence for disaster response and personal disaster preparedness among nurses is alarming, as is the likelihood a nurse will report to work after a disaster. The EPIQ's development and its initial study findings were published 15 years ago.30 The initial results in each domain are very like the results of this study, with overall self-reported familiarity of emergency preparedness competence domains in the initial study being 2.2930 and the mean overall score for self-reported familiarity in this study being 2.22. Findings from another study using the EPIQ are also remarkably similar.31 These results demonstrate a continued lack of improvement in professional competence for disaster response. In the face of projected increases in natural disasters,33,34 global increases in terrorism,35 an increased risk of nuclear terrorism,36 and the spread of new diseases such as the novel coronavirus outbreak,37 such results should serve to underscore the importance of measures to educate nurses and improve such competence and the likelihood of reporting to work after a disaster.
Social desirability bias may affect the results of this study because the participants knew the purpose of the study was to determine self-reported emergency preparedness competence. They may not wish to have appeared unknowledgeable, which could be perceived with a negative connotation. However, the investigators encouraged participants to respond honestly and indicated the confidentiality of the results. The sample was regional and may not be generalizable beyond nurses of very similar geographic locations and cultural practices. In addition, data were analyzed with a small convenience sample in an exploratory, nonexperimental study. Limitations aside, this study provides illuminating data on the state of personal and professional preparedness of nurses in the United States and fills some knowledge gaps. This study should inspire administrators to evaluate the state of personal and professional preparedness of their team and provide educational resources if necessary.
A recent call for action to advance disaster nursing education38 must be met with action. Disaster response capacity will be enhanced by educational interventions focused on improving responders' confidence in performing their emergency duties after a disaster.39 Administrators should consider methods to educate nursing staff and improve response efforts through training.40 Options suggested in the literature include simulations, in-person or online education, and participation in disaster drills to increase knowledge and feelings of preparedness of staff.18,41,42Table 4 provides examples of potential resources. In addition, Nash45 provides a detailed list of online disaster nursing education resources by EPIQ professional competence domain. Because nurses often seek preparedness education from their professional nursing organizations,18 nurse leaders may wish to consider support for nurses' attendance at conferences or educational sessions where disaster nursing professional development is offered.
Administrators seeking an effective means to enhance emergency preparedness competence within their healthcare systems should consider incorporating the EPIQ as part of a multistage process. Researchers found significant improvements in participant knowledge when using the EPIQ to establish baseline emergency preparedness core competencies, delivering educational interventions to improve competencies, and evaluating effectiveness of interventions.46 Such efforts can improve professional emergency preparedness knowledge, personal preparedness, and the likelihood that nurses will report to work after a disaster.
Nurses have recently been in the spotlight as the public health disaster, COVID-19, spread across the globe, killing many people and impacting the lives of countless others. The pandemic unfolded in the media with daily calls for more healthcare providers and essential equipment, making surge capacity a familiar term to many. Systems were overwhelmed, and measures to improve surge capacity and ensure adequate qualified personnel report to work were critical throughout this event. In this study, the mean score for the professional competence for the disaster response domain of epidemiology and clinical decision making was low (mean, 2.44), as was that for isolation, quarantine, and decontamination (mean, 2.54), both critical in pandemic response. The mean scores for the likelihood nurses would report to work after an infectious disease pandemic tied with a biological disaster as being lower than any other disaster scenario (mean, 3.46). Nursing administration can effect positive change in the correlation between professional competence and the likelihood nurses will report to work. Now, more than ever, interventions to increase nurses' knowledge and likelihood of reporting to work are critical to ensure adequate surge capacity to provide care in future events. It is no longer a remote possibility, as we have been confronted with a new reality of what such a pandemic can do to our health system.
1. American College of Healthcare Executives. Healthcare executives' role in emergency management. https://www.ache.org/about-ache/our-story/our-commitments/policy-statements/healthcare-executives-role-in-emergency-management
. Updated November 2018. Accessed June 19, 2019.
2. The Joint Commission. Updates to emergency management standards. https://www.jointcommission.org/issues/article.aspx?Article=7l/U9XNv6AAqlAw0TrAyIL8GcBhlqsmuz7II0ZhOvdI=
. Updated September 2016. Accessed June 26, 2019.
3. Veenema TG, Boland F, Patton D, O'Connor T, Moore Z, Schneider-Firestone S. Analysis of emergency health care workforce and service readiness for a mass casualty event in the Republic of Ireland. Disaster Med Public Health Prep
. 2019;13(2):243–255. doi:10.1017/dmp.2018.45.
4. Veenema TG, Lavin PR, Bender A, Thornton CP, Schneider-Firestone S. National nurse readiness for radiation emergencies and nuclear events: a systematic review of the literature. Nurs Outlook
. 2019;67(1):54–88. doi:10.1016/j.outlook.2018.10.005.
5. Labrague LJ, Hammad K, Gloe DS, et al. Disaster preparedness among nurses: a systematic review of literature. Int Nurs Rev
. 2018;65(1):41–53. doi:10.1111/inr.12369.
6. Nilsson J, Johansson E, Carlsson M, et al. Disaster nursing: self-reported competence of nursing students and registered nurses, with focus on their readiness to manage violence, serious events and disasters. Nurse Educ Pract
. 2016;17:102–108. doi:10.1016/J.nepr.2015.09.012.
7. Whetzel E, Walker-Cillo G, Chan GK, Trivett J. Emergency nurse perceptions of individual and facility emergency preparedness. J Emerg Nurs
. 2013;39(1):46–52. doi:10.1016/j.jen.2011.08.005.
8. Valizadeh L, Zamanzadeh V, Eskandari M, Alizadeh S. Professional competence in nursing: a hybrid concept analysis. Med Surg Nurs J
. 2019;8(2):1–8. doi:10.5812/msnj.90580.
9. Ben Natan M, Nigel S, Yevdayev I, Qadan M, Dudkiewicz M. Nurse willingness to report for work in the event of an earthquake in Israel. J Nurs Manag
. 2014;22:931–939. doi:10.1111/jonm.12058.
10. Chilton JM, McNeill C, Alfred D. Survey of nursing students' self-reported knowledge of Ebola virus disease, willingness to treat, and perceptions of their duty to treat. J Prof Nurs
. 2016;32(6):487–493. doi:10.1016/j.profnurs.2016.05.004.
11. Langan JC, Lavin R, Wolgast KA, Veenema TG. Education for developing and sustaining a health care workforce for disaster readiness. Nurs Adm Q
. 2017;41(2):118–127. doi:10.1097/NAQ.0000000000000225.
12. Guha-Sapir D, Below R, Hoyois P. EM-DAT: International Disaster Database. Université Catholique de Louvain, Brussels, Belgium. www.emdat.be
. Updated September 2019. Accessed October 9, 2019.
13. American Association of Colleges of Nursing. The essentials of doctoral education for advanced nursing practice. 2006. https://www.aacnnursing.org/Education-Resources/AACN-Essentials
. Accessed June 26, 2019.
14. American Association of Colleges of Nursing. The essentials of baccalaureate education for professional nursing practice. 2008. http://www.aacn.nche.edu/education-resources/BaccEssentials08.pdf
. Accessed June 26, 2019.
15. American Association of Colleges of Nursing. The essentials of master's education in nursing. 2011. https://www.aacnnursing.org/Education-Resources/AACN-Essentials
. Accessed June 26, 2019.
16. Hodge AJ, Miller EL, Dilts Skaggs MK. Nursing self-perceptions of emergency preparedness at a rural hospital. J Emerg Nurs
. 2017;43(1):10–14. doi:10.1016/j.jen.2015.07.012.
17. Melnikov S, Itzhaki M, Kagan I. Israeli nurses' intention to report for work in an emergency or disaster. J Nurs Scholarsh
. 2014;46:134–142. doi:10.1111/jnu.12056.
18. Bell MA, Dake JA, Price JH, Jordan TR, Rega P. A national survey of emergency nurses and avian influenza threat. J Emerg Nurs
. 2014;40(3):212–217. doi:10.1016/j.jen.2012.05.005.
19. Harrison KL, Errett NA, Rutkow L, et al. An intervention for enhancing public health crisis response willingness among local health department workers: a qualitative programmatic analysis. Disaster Medicine
. 2014;9(2):87–96. doi:10.5055/ajdm.2014.0145.
20. Burke RV, Goodhue CJ, Chokshi NK, Upperman JS. Factors associated with willingness to respond to a disaster: a study of healthcare workers in a tertiary setting. Prehosp Disaster Med
. 2011;26(4):244–250. doi:10.1017/S1049023X11006492.
21. Shapira S, Aharonson-Daniel L, Bar-Dayan Y, Sykes D, Adini B. Knowledge, perceptions, attitudes and willingness to report to work in an earthquake: a pilot study comparing Canadian versus Israeli hospital nursing staff. Int Emerg Nurs
. 2016;25:7–12. doi:10.1016/j.ienj.2015.06.007.
22. Devnani M. Factors associated with the willingness of health care personnel to work during an influenza public health emergency: an integrative review. Prehosp Disaster Med
. 2012;27(6):551–566. doi:10.1017/S1049023X12001331.
23. Gowing JR, Walker KN, Elmer SL, Cummings EA. Disaster preparedness among health professionals and support staff: what is effective? An integrative literature review. Prehosp Disaster Med
. 2017;32(3):321–328. doi:10.1017/S1049023X1700019X.
24. Chaffee M. Willingness of health care personnel to work in a disaster: an integrative review of the literature. Disaster Med Public Health Prep
. 2009;3:42–56. doi:10.1097/DMP.0b013e31818e8934.
25. Nash TJ. Unveiling the truth about nurses' personal preparedness for disaster response: a pilot study. Medsurg Nurs
26. Homeland Security and Emergency Management: A Division of the Minnesota Department of Public Safety. Personal and family preparedness. https://dps.mn.gov/divisions/hsem/emergency-preparedness/Pages/personal-preparedness.aspx
. Accessed February 26, 2020.
27. Brice JH, Gregg D, Sawyer D, Cyr JM. Survey of hospital employees' personal preparedness and willingness to work following a disaster. South Med J
. 2017;110(8):516–522. doi:10.14423/SMJ.0000000000000680.
28. Mercer MP, Ancock B, Levis JT, Reyes V. Ready or not: does household preparedness prevent absenteeism among emergency department staff during a disaster? Am J Disaster Med
. 2014;9(3):221–232. doi:10.5055/ajdm.2014.0174.
29. Fung OWM, Loke AY. Nurses' willingness and readiness to report for duty in a disaster. J Emerg Manag
. 2013;11(1):25–37. doi:10.5055/jem.2013.0125.
30. Wisniewski R, Dennik-Champion G, Peltier JW. Emergency preparedness competencies: assessing nurses' educational needs. J Nurs Adm
. 2004;34(10):475–480. doi:10.1097/00005110-200410000-00009.
31. Garbutt SJ, Peltier JW, Fitzpatrick JJ. Evaluation of an instrument to measure nurses' familiarity with emergency preparedness. Mil Med
. 2008;173(11):1073–1077. doi:10.7205/MILMED.173.11.1073.
32. Qureshi K, Gershon RRM, Sherman MF, et al. Health care workers' ability and willingness to report to duty during catastrophic disasters. J Urban Health
. 2005;82:378–388. doi:10.1093/jurban/jti086.
33. Centre for Research on the Epidemiology of Disasters International Disaster Database (CRED) and United Nations Office for Disaster Risk Reduction (UNISDR). Economic loses, poverty & disasters: 1998-2017. 2018. https://www.unisdr.org/we/inform/publications/61119
. Accessed December 18, 2018.
34. Intergovernmental Panel on Climate Change. Managing the risks of extreme events and disasters to advance climate change adaptation: summary for policymakers. 2012. https://www.ipcc.ch/site/assets/uploads/2018/03/SREX_FD_SPM_final-2.pdf
. Accessed April 7, 2019.
35. RAND Corporation. (2019). Terrorist threat assessment. https://www.rand.org/topics/terrorism-threat-assessment.html
. Accessed March 3, 2020.
36. Nuclear Threat Index (NTI). Building a Framework for Assurance, Accountability, and Action
. 4th ed. 2018. https://ntiindex.org/wp-content/uploads/2018/08/NTI_2018-Index_FINAL.pdf
. Accessed March 3, 2020.
37. World Health Organization. Coronavirus. 2020. https://www.who.int/health-topics/coronavirus
. Accessed March 3, 2020.
38. Veenema TG, Lavin RP, Griffin A, Gable AR, Couig MP, Dobalia A. Call to action: the case for advancing disaster nursing education in the United States. J Nurs Scholarship
. 2017;49(6):688–696. doi:10.1111/jnu.12338.
39. Errett NA, Barnett DJ, Thompson CB, et al. Assessment of medical reserve corps volunteers' emergency response willingness using a threat- and efficacy-based model. Biosecur Bioterror
. 2013;11(1):29–40. doi:10.1089/bsp.2012.0047.
40. Veenema TG, Losinski SL, Hilmi LM. Increasing emergency preparedness: examining the issues faced by U.S. health care organizations-and the policies to address them. Am J Nurs
. 2016;116(1):49–53. doi:10.1097/01.NAJ.0000476169.28424.0b.
41. Uniformed Services University. National Center for Disaster Medicine and Public Health: core curriculum. 2018. https://www.usuhs.edu/ncdmph/core-curriculum
. Accessed October 9, 2019.
42. ASPR-TRACIE. Emergency preparedness information modules for nurses in acute care settings (EPIMN). 2019. https://files.asprtracie.hhs.gov/documents/aspr-tracie-emergency-preparedness-information-modules-for-nurses-and-economic-framework.pdf
. Accessed October 9, 2019.
43. Jones J, Kue R, Mitchell P, Eblan G, Dyer KS. Emergency medical services response to active shooter incidents: provider comfort level and attitudes before and after participation in a focused response training program. Prehosp Disaster Med
. 2014;29(4):350–357. doi:10.1017/S1049023X14000648.
44. Miller JL, Rambeck JH, Snyder A. Improving emergency preparedness system readiness through simulation and interprofessional education. Public Health Rep
. 2014;129:129–135. doi:10.1177/00333549141296S417.
45. Nash TJ. A guide to emergency preparedness and disaster nursing education resources. Health Emerg and Disaster Nurs
. 2017;4:12–25. doi:10.24298/hedn.2015-0017.
46. Georgino MM, Kress T, Alexander S, Beach M. Emergency preparedness education for nurses: core competency familiarity measured utilizing an adapted emergency preparedness information questionnaire. J Trauma Nurs
. 2015;22(5):240–248. doi:10.1097/JTN.0000000000000148.