Disaster education and response specifically designed for NPs is a new area of attention for the disaster nursing community.1 Until recently during the coronavirus disease 2019 (COVID-19) pandemic, the role of the NP during a disaster has mirrored that of the RN in most agencies, from volunteer to governmental. Even the newest version of the International Council of Nurses (ICN) Core Competencies in Disaster Nursing does not give the advanced practice registered nurse (APRN) a different role from the RN.2 The COVID-19 pandemic has prompted federal and state changes to the roles of healthcare professionals responding to this disaster through changes in legislation related to the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The Act has expanded the NP's role to include the ability to order home health services. At the state level, practice acts have been temporarily changed to reduce barriers to NP practice such as collaborative agreement and supervision. This has extended the ability of NPs to practice independently within their scope of practice, including changes in liability, record keeping, and licensure registration, renewal, and expirations.3-5 This concluding article briefly reviews the previous four articles in this series before exploring the implications for NPs. Finally, it addresses the outlook of disaster nursing for NPs.
This series has previously outlined each step of a disaster response with a focus on the roles the NP could play in such a response. The first article introduced how a disaster differs from an emergency and provided a brief historical background of disasters in the US. The four levels of disaster response were covered, along with how the NP role fit into each level.6
The second article covered nursing competencies in a disaster response and how the National Organization of Nurse Practitioner Faculties competencies aligned with the disaster nurse competencies. NPs focus on caring for the health of individuals and communities, which are impinged on in a disaster. The latest competencies update published in 2019 still does not address the NP's specific role in a disaster.2,7
The third article focused on how communication norms in healthcare are altered by a disaster. Communication during a disaster can become convoluted and confusing, influencing how the NP communicates about care of the patient, family, and community, as well as the way the disaster response team communicates. The focus of communication becomes an effort to remain safe during the disaster while ensuring all disaster responders are assigned to provide the fastest triage and best care possible.8
The fourth article details the various roles the NP may hold before, during, and after a disaster response. The advanced practice level of NPs enables them to play key roles in all phases of a disaster.9 Together, these four articles provide the NP with the basic information needed to start training for disaster response.
Implications for the NP
The modern frequency of disasters, both manmade and natural, means NPs must be prepared to respond as a first responder, volunteer, or a healthcare provider caring for victims, their families, and the community in the recovery phase. Most states mandate that healthcare institutions complete at least annual disaster training and that all employees have some level of institution-documented disaster training. This training varies by each state and healthcare institution; some cover just the basics, while others cover geographic disaster response. To ensure that comprehensive and consistent disaster training is provided, this is an area that needs to be addressed further by NPs at both the federal and state levels.
The following list of recommended resources can guide the NP in preparedness planning to respond when needed in a disaster. (See Disaster resources for US nurses.) Familiarity with the specifics of nursing practice in the NP's state and how licensing laws may change in the event of a disaster is important for ethical and legal practice. Each NP should explore their state's government website for more insight and check the state public health department websites for updates related to COVID-19 that have, in some states, seen expanded scope of practice for NPs.3,5
Volunteering with disaster agencies should be a part of the professional NP role. The time commitment is usually minimal, potentially requiring annual or biannual training session attendance. This kind of participation will bring the voice of the NP into the volunteer agency and increase awareness of how NPs, by virtue of their education and training, can improve nursing response in a disaster. Volunteering with the American Red Cross (www.redcross.org/) is a good first step for an NP's disaster response education. The American Red Cross is a quasi-governmental volunteer agency tasked by Congress in 1900 “to maintain a system of domestic and international disaster relief, including mandated responsibilities under the National Response Framework coordinated by the Federal Emergency Management Agency (FEMA).”10 It offers disaster training for the community and healthcare professionals, covering topics from mitigation to response.
For NPs interested in disaster volunteering focused only on the healthcare professional, the Medical Reserve Corps (www.phe.gov/about/oem/prep/Pages/mrc.aspx) is an excellent resource. Volunteers at the Medical Reserve Corps are “medical and public health professionals, as well as other community members without healthcare backgrounds” who are interested in improving the public health response capacity.11 For those with a bit more time and who can attend monthly training, the Disaster Medical Assistance Teams (DMATs) may be of interest. These are regional teams of volunteers who are part of the larger National Disaster Medical System. The teams are comprised of all levels of healthcare professionals, including NPs and PAs, making DMATs one of the few volunteer groups to formally incorporate the advanced practice role of the NP.12
Fitting volunteer work into the busy schedule of an NP is difficult. Most of these agencies do not require intensive or long-term commitments. The value of this training becomes evident when a disaster of any type occurs in an NP's geographic location and emergent help is needed. All healthcare professionals should register with the Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP).13 Here, NPs can enter their licensing information in the national volunteer system so that in a disaster their skills can be used at the appropriate level. Many states also have registration systems for healthcare professionals that are tied to ESAR-VHP's databases.
In the COVID-19 pandemic, this has proven especially useful in some states. An example of this is the Illinois Helps volunteer database (https://illinoishelps.net). Three coauthors of this article live and work in Illinois, where the governor asked RNs at all levels to update or create profiles in Illinois Helps. Calls for nursing help in different parts of the state have gone out through that system.3
The NP's future in disaster response
Exactly where NPs fit in the disaster response team with the specialized clinical knowledge and skills they have has yet to be determined. There is a need for research in disaster nursing in general and the roles of each healthcare provider who responds.14 Major questions remain unanswered:15,16
- Are changes in disaster training needed for the NP level?
- What kind of framework should be used—an NP-specific framework or one that fits within suggested frameworks for all public health practitioners?
- What are the issues involved in training the healthcare practitioner for disaster response, and how do these training issues impact the NP?
- How are roles assigned to NPs who respond to a disaster?
- What type of physical and emotional demands are placed on the NP before, during, and after a disaster?
- Understanding that this will vary state-by-state, what are the legal implications for the NP responding to a manmade or natural disaster? Do these differ from those of all disaster responders?
These questions are some areas of research that are open to deeper study. NPs need to be involved in this future research, not just as participants, but also as investigators. Data.gov (www.data.gov/disasters-legacy), a federal government website, contains a variety of datasets and other tools that can be used in disaster research studies. These can also be applied to evidence-based practice (EBP) projects.
There is also a need for EBP projects to apply the knowledge already collected on disaster nursing to NP practice. The new ICN core competencies do not specifically address disaster nursing competencies beyond a beginning and advanced disaster nurse responder, although there is a third level recognized and competencies will be developed in the future.2 The ICN does not specifically address the specialized knowledge and skills the NP possesses at any level of disaster nurse competency. This raises the question of whether there is a need for specialized NP disaster nursing competencies. It is only through EBP projects and evaluation of those that the fit of these disaster nursing competencies for the NP can be addressed.
The Society for the Advancement of Disaster Nursing (https://disasternursing.org), established in the fall of 2014, is a resource for and provides leadership to disaster nurses in the US. Its vision is to prepare every nurse to respond to disasters and public health emergencies when needed with the proper knowledge, skills, and abilities.14 The Society for the Advancement of Disaster Nursing has five main objectives that include creating a scope of practice and identifying the roles and responsibilities of a nurse responding to a disaster. This is the beginning, acknowledging there are various levels within the nursing profession with different licenses, knowledge, and skills that have yet to be added to the Society's strategic plan.14 NPs must become more involved to ensure that their unique skill sets, knowledge, and needs are recognized. They must be a part of planning the specialized competencies that will acknowledge their expanded role in disaster response.
Disaster nursing is a new specialty that is still differentiating itself from emergency nursing and other nursing specialties.1 As NPs seek to expand their roles in the profession, they need to add disaster response to the NP curriculum, train in disaster response, and, perhaps most important, volunteer with local disaster healthcare groups so that they are ready when a disaster of any kind strikes their area. They must be leaders in ensuring that their patients, families, and communities will receive the best level of care possible when a disaster occurs.
1. Lavin RP, Adelman DS, Veenema TG. Society for the advancement of disaster nursing
: exploring the path to excellence. Disaster Med Public Health Prep
2. International Council of Nurses. Core competencies in disaster nursing version 2.0. 2019. www.icn.ch/system/files/documents/2019-11/ICN_Disaster-Comp-Report_WEB_final.pdf
3. Illinois Department of Public Health. Governor Pritzker's executive orders and rules: governor issues disaster proclamation. 2020. www.dph.illinois.gov/covid19/governor-pritzkers-executive-orders-and-rules
5. New York State Nurses Association. Practice alert: increased scope of practice for nurse practitioners during COVID-19 pandemic. 2020. www.nysna.org/blog/2020/03/20/practice-alert-increased-scope-practice-nurse-practitioners-during-covid-19-pandemic#.XqmiRqg3kuV
6. Adelman DS, Fant C, Wood L, Zak C. Disasters: who responds when. Nurse Pract
7. Adelman DS, Fant C, Wood L, Zak C. Exploring nurse vs. NP disaster response competencies. Nurse Pract
8. Fant C, Adelman DS, Zak CL, Wood LK. Communicating data and information in disaster care. Nurse Pract
9. Zak CL, Wood LK, Adelman DS, Fant C. The personal and professional responsibilities of NPs in disaster response. Nurse Pract
11. U.S. Department of Health and Human Services. Medical Reserve Corps
. 2020. www.phe.gov/about/oem/prep/Pages/mrc.aspx
12. U.S. Department of Health and Human Services. Disaster medical assistance teams. 2020. www.phe.gov/Preparedness/responders/ndms/ndms-teams/Pages/dmat.aspx
13. U.S. Department of Health and Human Services. The emergency system for advance registration of volunteer health professionals. 2020. www.phe.gov/esarvhp/Pages/default.aspx
14. Lavin RP. Strategic plan. Society for the advancement of disaster nursing
. 2018. https://disasternursing.org/strategic-plan
15. Kayman H, Logar T. A framework for training public health practitioners in crisis decision-making. Disaster Med Public Health Prep
16. Hershey TB, Van Nostrand E, Sood RK, Potter M. Legal considerations for health care practitioners after superstorm sandy. Disaster Med Public Health Prep