National Academies Press: OpenBook

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity (2021)

Chapter: 8 Nurses in Disaster Preparedness and Public Health Emergency Response

« Previous: 7 Educating Nurses for the Future
Suggested Citation:"8 Nurses in Disaster Preparedness and Public Health Emergency Response." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
×
Page 247
Suggested Citation:"8 Nurses in Disaster Preparedness and Public Health Emergency Response." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
×
Page 248
Suggested Citation:"8 Nurses in Disaster Preparedness and Public Health Emergency Response." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
×
Page 249
Suggested Citation:"8 Nurses in Disaster Preparedness and Public Health Emergency Response." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
×
Page 250
Suggested Citation:"8 Nurses in Disaster Preparedness and Public Health Emergency Response." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
×
Page 251
Suggested Citation:"8 Nurses in Disaster Preparedness and Public Health Emergency Response." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
×
Page 252
Suggested Citation:"8 Nurses in Disaster Preparedness and Public Health Emergency Response." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
×
Page 253
Suggested Citation:"8 Nurses in Disaster Preparedness and Public Health Emergency Response." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
×
Page 254
Suggested Citation:"8 Nurses in Disaster Preparedness and Public Health Emergency Response." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
×
Page 255
Suggested Citation:"8 Nurses in Disaster Preparedness and Public Health Emergency Response." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
×
Page 256
Suggested Citation:"8 Nurses in Disaster Preparedness and Public Health Emergency Response." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
×
Page 257
Suggested Citation:"8 Nurses in Disaster Preparedness and Public Health Emergency Response." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
×
Page 258
Suggested Citation:"8 Nurses in Disaster Preparedness and Public Health Emergency Response." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
×
Page 259
Suggested Citation:"8 Nurses in Disaster Preparedness and Public Health Emergency Response." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
×
Page 260
Suggested Citation:"8 Nurses in Disaster Preparedness and Public Health Emergency Response." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
×
Page 261
Suggested Citation:"8 Nurses in Disaster Preparedness and Public Health Emergency Response." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
×
Page 262
Suggested Citation:"8 Nurses in Disaster Preparedness and Public Health Emergency Response." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
×
Page 263
Suggested Citation:"8 Nurses in Disaster Preparedness and Public Health Emergency Response." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
×
Page 264
Suggested Citation:"8 Nurses in Disaster Preparedness and Public Health Emergency Response." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
×
Page 265
Suggested Citation:"8 Nurses in Disaster Preparedness and Public Health Emergency Response." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
×
Page 266
Suggested Citation:"8 Nurses in Disaster Preparedness and Public Health Emergency Response." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
×
Page 267
Suggested Citation:"8 Nurses in Disaster Preparedness and Public Health Emergency Response." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
×
Page 268
Suggested Citation:"8 Nurses in Disaster Preparedness and Public Health Emergency Response." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
×
Page 269
Suggested Citation:"8 Nurses in Disaster Preparedness and Public Health Emergency Response." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
×
Page 270
Suggested Citation:"8 Nurses in Disaster Preparedness and Public Health Emergency Response." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
×
Page 271
Suggested Citation:"8 Nurses in Disaster Preparedness and Public Health Emergency Response." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
×
Page 272
Suggested Citation:"8 Nurses in Disaster Preparedness and Public Health Emergency Response." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
×
Page 273
Suggested Citation:"8 Nurses in Disaster Preparedness and Public Health Emergency Response." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
×
Page 274

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

81 Nurses in Disaster Preparedness and Public Health Emergency Response By failing to prepare, you are preparing to fail. —Benjamin Franklin, writer, philosopher, politician In the past decade, 2.6 billion people around the world have been af- fected by earthquakes, floods, hurricanes, and other natural disasters. Nurses have been and continue to be pivotal in safeguarding the public during and after these disasters, as well as public health emergencies— most recently, the COVID-19 pandemic. They educate and protect peo- ple, engage with and build trust with the community, help people prepare and respond, and foster resilience to help communities fully recover. But fundamental reform is needed in nursing education, practice, research, and policy across both health care and public health settings to ensure that all nurses—from front-line professionals to researchers—have the baseline knowledge, skills, abilities, and autonomy they need to protect populations at greatest risk and improve the readiness, safety, and sup- port of the nursing workforce. The increasing frequency of natural and environmental disasters, along with public health emergencies such as the COVID-19 pandemic, highlights the criti- cal importance of having a national nursing workforce prepared with the knowl- edge, skills, and abilities to respond. COVID-19 has revealed deep chasms within a fragmented U.S. health care system that have resulted in significant excess 1  This chapter was commissioned by the Committee on the Future of Nursing 2020–2030 (Veen- ema, 2020). 247 PREPUBLICATION COPY—Uncorrected Proofs

248 THE FUTURE OF NURSING 2020–2030 mortality and morbidity, glaring health inequities, and an inability to contain a rapidly escalating pandemic. Most severely affected by these systemic flaws are individuals and communities of color that suffer disproportionately from the compound disadvantages of racism, poverty, workplace hazards, limited health care access, and preexisting health conditions that reflect the role of social deter- minants of health (SDOH) and inequities in access to health and health care that are a primary focus of this report. As natural disasters and public health emer- gencies continue to threaten population health in the decades ahead, articulation of the roles and responsibilities of nurses in disaster preparedness and public health emergency response will be critical to the nation’s capacity to plan for and respond to such events. As described in the conceptual model framework developed by the com- mittee to guide this study (see Figure 1-1 in Chapter 1), strengthening nurses’ capacity to aid in disaster preparedness and public health emergency response is one of the key ways to enhance nursing’s role in addressing SDOH and im- proving health and health care equity. This chapter explores the contribution of nurses during the COVID-19 pandemic and across sentinel historical events and describes the impact of natural disasters and public health emergencies on SDOH and health and health care equity. It also illuminates the multiple and systemic challenges encountered by nurses in these past events, and identifies bold and essential changes needed in nursing education, practice, and policy across health care and public health systems and organizations to strengthen and protect the nursing profession during and after such events. Only when equipped with the salient knowledge, skills, and abilities, can nurses be fully effective in helping to protect the well-being of underserved populations, striving for health equity, and advocating for themselves and other health care workers. ROLES OF NURSES DURING NATURAL DISASTERS AND PUBLIC HEALTH EMERGENCIES The ability to care for and protect the nation’s most vulnerable citizens depends substantially on the preparedness of the nursing workforce. The myriad factors related to national nurse education and training—licensure and certifica- tion, scope of practice, mobilization and deployment, safety and protection, crisis leadership, and health care and public health systems support—together define nursing’s capacity and capabilities in disaster response. The nursing workforce available to participate in U.S. disaster and public health emergency response includes all licensed nurses (licensed practical/vocational nurses [LPNs/LVNs] and registered nurses [RNs]), civilian and uniformed services nurses at the federal and state levels, nurses who have recently retired, and those who volunteer (e.g., National Disaster Medical System, Medical Reserve Corps, National Voluntary Organizations Active in Disasters, and American Red Cross [ARC]). Each of these entities plays a critical role in the nation’s ability to respond to and recover PREPUBLICATION COPY—Uncorrected Proofs

DISASTER PREPAREDNESS AND PUBLIC HEALTH EMERGENCY RESPONSE 249 from disasters and large-scale public health emergencies such as the COVID-19 pandemic.2 Nurses’ General Roles in Disasters Across a broad spectrum of clinical and community settings and through all phases of a disaster event (see Figure 8-1), nurses, working with physicians and other members of the health care team, play a central role in response. Before, during, and after disasters, nurses provide education, community engagement, and health promotion and implement interventions to safeguard the public health. They provide first aid, advanced clinical care, and lifesaving medications; assess and triage victims; allocate scarce resources; and monitor ongoing physical and mental health needs. Nurses also assist with organizational logistics by develop- ing operational response protocols and security measures and performing statis- tical analysis of individual- and community-level data. Beyond these contributions, nurses activate organizational emergency opera- tions plans, participate in incident command systems, oversee the use of personal protective equipment (PPE), and provide crisis leadership and communications, often at risk to their own health. In the community, they open and manage shel- ters; organize blood drives; and provide outreach to underserved populations, including by addressing social needs. Nurses also assist with care for the frail elderly (Heagele and Pacqiao, 2018; Kleier et al., 2018), assist with childbirth to ensure that women have healthy babies during a disaster (Badakhsh et al., 2010; de Mendoza et al., 2012; Role of the nurse, 2012), and work to reunite families separated during response activities. Disasters place unprecedented demands on health care systems and often test nurses’ knowledge, skills, abilities, and per- sonal commitment as health care professionals. Nurses’ Roles in Pandemics and Other Infectious Disease Outbreaks Nurses’ roles in pandemics and other infectious disease outbreaks are mul- tifaceted and may include • supporting and advising in epidemic surveillance and detection, such as contact tracing; • working in point-of-distribution clinics to screen, test, and distribute vaccines and other medical countermeasures; • employing prevention and response interventions; • providing direct hospital-based treatment for impacted individuals; • educating patients and the public to decrease risk for infection; 2  For the sake of brevity, the term “disaster” is used throughout the remainder of this chapter to refer to both natural disasters and public health emergencies. PREPUBLICATION COPY—Uncorrected Proofs

250 THE FUTURE OF NURSING 2020–2030 DISASTER NURSING TIMELINE Preimpact IM PAC T Postimpact Disaster phases TIM E 0 Greater than 72 hours (0–24 hours) (24–72 hours) Planning/preparedness Response Recovery continuum Disaster prevention emergency management rehabilitation warning mitigation reconstruction evaluation 1. Participate in the 1. Activate disaster 1. Continue provision development of response plan: of nursing and community disaster  Notification and initial medical care. plans. response 2. Continue disease 2. Participate in  Leadership assumes surveillance. community risk control of event 3. Monitor the safety assessment:  Command post is of the food and  Elements of Hazard established water supply Analysis for All-  Establish 4. Withdraw from Hazards Approach communications disaster scene  Hazard mapping  Conduct damage and 5. Restore public  Vulnerability needs assessment at health infrastructure analysis the scene 6. Re-triage and 3. Initiate disaster  Search, rescue, and transport of patients prevention extricate to appropriate level measures:  Establish field hospital care facilities.  Prevention or and shelters 7. Reunite family removal of hazard  Triage and transport of members.  Movement/ patients 8. Monitor long-term relocation of at-risk 2. Mitigate all ongoing physical health populations hazards. outcomes of Nursing actions  Public awareness 3. Activate agency disaster survivors. campaigns plans. 9. Monitor mental  Establishment 4. Establish need for mutual health status of of early warning aid relationships. survivors. systems 5. Integrate state and 10. Provide counselling 4. Perform disaster federal resources. and debriefing for drills and table-top 6. Ongoing triage and staff. exercises. provision of nursing care. 11. Provide staff with 5. Identify educational 7. Evaluate public health adequate time off and training needs needs of the affected for rest. for all nurses. population. 12. Evaluate disaster 6. Develop disaster 8. Establish safe shelter and nursing response nursing databases the delivery of adequate actions. for notification, food and water supplies. 13. Revise original mobilization, and 9. Provide for sanitation disaster triage of emergency needs and waste removal. preparedness plan. nurse staffing 10. Establish disease resources. surveillance. 7. Develop evaluation 11. Establish vector control. plans for all 12. Evaluate the need for/ components of activate additional disaster nursing nursing staff (disaster response. nurse response plans). FIGURE 8-1 Disaster nursing timeline. SOURCE: Veenema, 2018. SOURCE: Veenema, 2018. PREPUBLICATION COPY—Uncorrected Proofs

DISASTER PREPAREDNESS AND PUBLIC HEALTH EMERGENCY RESPONSE 251 • providing health systems and community-based leadership; and • counseling and supporting community members to assuage fear and anxiety (Veenema et al., 2020). Public health nurses have helped coordinate and implement disaster plans (Jakeway et al., 2008), and it was a school nurse working in Queens, New York, in 2009 who first observed and then notified the Centers for Disease Control and Prevention (CDC) about the H1N1 outbreak (Molyneux, 2009). Infectious disease outbreaks have been occurring more frequently and at a higher intensity over the past few decades (Fauci and Morens, 2012; Lam et al., 2018). Both the health care system and individual front-line health care workers must be adequately prepared to respond to such events (Imai et al., 2008; Lam et al., 2018; Siu, 2010). Preparedness at the system level includes understanding the capacity of a hospital or health care system in advance of a potential public health emergency, including workforce capacity and capabilities and access to PPE, medical supplies, medical gases, and ventilators. It also requires having an action plan that includes the essential elements of managing the challenges such an event may impose on the institution (Siu, 2010; Toner et al., 2020; WHO, 2018). However, the preparedness of the U.S. health care system to manage a pediatric surge during a pandemic has been recognized as lacking (Anthony et al., 2017). Preparedness for front-line workers includes clinical skills and knowledge for providing care for patients and protecting the public from becoming ill (Lam et al., 2018; Ruderman et al., 2006; Shih et al., 2007). Response plans and nurses’ willingness to respond will vary based on the amount of information available about the pathogen and its transmission, the severity of the disease, and the public’s attitude toward the outbreak (Chung et al., 2005; Lam and Hung, 2013; Lam et al., 2018; Shih et al., 2007). When cer- tain aspects of the disease are uncertain or the information is inconsistent, nurses become less confident and more anxious about performing their duties during an outbreak (Lam et al., 2018; Shih et al., 2007). The more severe the disease outbreak, the more likely it is that nurses will be prone to greater anxiety and fear of infection (Koh et al., 2012; O’Boyle et al., 2006). Even if this fear does not stop them from working during the outbreak, they are more likely to have a negative attitude and decreased morale when caring for infected patients. Nurse attitudes can also be strongly impacted by the mass media and news outlets (Lam et al., 2018; Shih et al., 2009). During disease outbreaks, the media will focus on the number of deaths and the severity of the disease, making it challenging for nurses to maintain a positive attitude when working with patients. Perceptions of the disease created in the media can also cause panic in the general public, which directly affects front-line nurses both in health systems and in the community (Lam and Hung, 2013; O’Boyle et al., 2006; Shih et al., 2007, 2009). The disaster nursing timeline © (see Figure 8-1) and many state, local, and organizational response plans are based on the single occurrence of an acute PREPUBLICATION COPY—Uncorrected Proofs

252 THE FUTURE OF NURSING 2020–2030 event. It is important to note that infectious disease outbreaks are slow-moving disasters with multiple waves that create unique challenges for health system response. There is much to be learned from the events of 2020 and the devastating sequence of events that unfolded during the COVID-19 response. Nurses’ Roles in the COVID-19 Pandemic In December 2019, the novel coronavirus known as the severe acute respira- tory syndrome coronavirus 2 (SARS-CoV-2) was first detected in China. By March 2020, the World Health Organization (WHO) had declared the COVID-19 out- break a pandemic, which was to become the worst public health emergency in more than 100 years, with more than 120 million cases detected worldwide and 30.5 million cases confirmed in the United States as of April 1, 2021.3 Nurses have performed a variety of roles during the COVID-19 pandemic, while health care organizations and hospitals have had to treat innumerable patients across the United States for COVID-related illness alongside other complex and serious conditions (Veenema et al., 2020). Roles and responsibilities for nurses shifted rapidly to accommodate patient surges and the sudden unanticipated demand for health care services. Nurses were required to take on multiple new roles (e.g., non–critical care nurses asked to care for patients critically ill with COVID-19), provide end-of-life care, and serve as a means of vital communications between hospitalized patients and their families (Veenema et al., 2020). These shifts may have lowered the skill mix in intensive care units (ICUs) below required standards, with potential risks to patients’ safety and quality of care (Bambi et al., 2020). As of April 1, 2021, 552,957 people in the United States had died from COVID-19,4 including an estimated 551 nurses.5 Evidence gathered from nurses throughout the pandemic reveals the multiple challenges they have encountered during the pandemic response. Nurses have reported inadequate supplies of PPE, insufficient knowledge and skills for responding to the pandemic, a lack of authority for decision making related to workflow redesign and allocation of scarce resources, staffing shortages, and a basic lack of trust between front-line nurses and nurse executives and hospital administrators (ANA, 2020a,b; Mason and Friese, 2020; Veenema et al., 2020). Nurses have experienced significant psychological and moral distress during the pandemic (Altman, 2020; Labrague and De Los Santos, 2020; Pappa et al., 2020; Shechter et al., 2020). Results of a survey conducted by the American Nurses Association (ANA, 2020a) reveal that 87 percent of nurses were afraid 3  See https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd402994 23467b48e9ecf6 (accessed April 1, 2021). 4  See https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd402994 23467b48e9ecf6 (accessed April 1, 2021). 5  See https://www.theguardian.com/us-news/ng-interactive/2020/dec/22/lost-on-the-frontline-our- findings-to-date (accessed March 18, 2021). PREPUBLICATION COPY—Uncorrected Proofs

DISASTER PREPAREDNESS AND PUBLIC HEALTH EMERGENCY RESPONSE 253 to go to work, 36 percent had cared for an infectious patient without having adequate PPE, and only 11 percent felt well prepared to care for a patient with COVID-19. A follow-up survey conducted by ANA (2020c) revealed that in- termittent shortages of PPE for nurses persisted 7 months into the pandemic, particularly for those working in smaller rural hospitals, home care, and pallia- tive care. Nurses were asked to extend and reuse N95 masks long after CDC’s recommended guidelines, leading ANA to request that the Defense Production Act (DPA) be invoked to produce N95 masks (Lasek, 2020). In particular, nurses working in long-term care facilities, home care, palliative care, and small rural hospitals were particularly vulnerable as caregivers in environments with high risk and high mortality (ANA, 2020c). The mental health burden of the pandemic on nurses has been profound (see Chapter 10). Nurses of Asian/Pacific Islander (API) descent have experienced discrimination from patients who have refused care from them or made dispar- aging remarks about their ethnic origins. The Asian Pacific Policy and Planning Council released a report on August 27, 2020, detailing 2,583 incidents of dis- crimination against APIs in the United States from March 19 to August 5, 2020 (Attacks against AAPI community, 2020). The psychological and mental health implications for nurses of API descent represent one of the many challenges nurses have faced during the pandemic. Nurses’ Response to Human-Caused Disasters In addition to natural disasters and public health emergencies, the United States is currently experiencing significant increases in gun-related violence, civil unrest against systemic racism, and social upheaval associated with growing political polarization (see Box 8-1). Active shooters in hospitals, school shoot- ings, and random acts of foreign and domestic terrorism have forced a widening aperture for national preparedness, and nurses are involved in responding to the care needs of victims of these events (Lavin et al., 2017). DISASTERS’ IMPACT ON POPULATION HEALTH A disaster is defined as “a serious disruption of the functioning of a community or a society at any scale due to hazardous events interacting with conditions of exposure, vulnerability and capacity, leading to one or more of the following: hu- man, material, economic and environmental losses and impacts” (UNISDR, 2017). More than 2.6 billion people globally have been affected by natural disasters, such as earthquakes, tsunamis, and heat waves, in the past decade, and these disasters have led to massive injuries, mental health issues, and illnesses that can overwhelm local health care resources and prevent them from delivering comprehensive and definitive medical care (WHO, 2020). During 2019 alone, the United States expe- rienced 14 separate billion-dollar disasters, including inland floods, severe storms, PREPUBLICATION COPY—Uncorrected Proofs

254 THE FUTURE OF NURSING 2020–2030 BOX 8-1 Pulse Nightclub Shooting What would become one of the worst mass shootings in U.S. history occurred on June 12, 2016, in Orlando, Florida. Around 2:00 AM, a gunman opened fire at a popular gay nightclub, Pulse Orlando, killing 50 people and injuring another 53 (Shapiro, 2016). Fortunately, the Orlando Regional Medical Center (ORMC), the only Level 1 trauma center in the region, was just a few blocks away. Within a few hours, the hospital had treated 44 of the shooting victims, 36 of whom had arrived within the first 36 minutes of the hospital’s response (Willis and Philp, 2017). Just a few months prior to the Pulse Nightclub shooting, there had been a community-wide exercise in disaster response that involved responding to an active shooter. More than 500 volunteers, 50 agencies, and 15 hospitals across central Florida had participated. Staff from ORMC stated that participation in such mass-casualty drills was one of the reasons they were prepared to respond to the Pulse Nightclub tragedy (Willis and Philp, 2017). These drills included practicing roles within the Hospital Incident Command System, which the nurse leaders were able to execute during the event. By understanding what is expected of them and feeling confident in their previously assigned roles, they were able to provide quality, timely care to the victims while managing the large influx of patients that arrived with no emergency medical services notice or triage. two hurricanes, and a major wildfire event (Smith, 2020). Disaster planning for emergency preparedness is, then, imperative. In the near future, such factors as climate change and climate change–related events, including global warming and sea-level rise; the depletion of resources and associated societal factors; and the growth of “megacities” and populations shifts (IFRC, 2019; UN, 2016) are likely to converge to increase the risk of future disasters (IPCC, 2012, 2014; Watts et al., 2018). Human-caused disasters, such as school and other mass shootings and random acts of terrorism, create additional hazards for human health. Health Inequities in Disasters While disasters impact populations, research has shown that those impacts are not equally distributed. Disasters often amplify the inequities already pres- ent in society and harm high-risk and highly vulnerable communities far more than others (Davis et al., 2010). Although every person who is exposed to a disaster is impacted in some form, the disproportionate impact on high-risk and highly vulnerable populations, including the elderly, the disabled, the immuno- suppressed, the underserved, and those living in poverty, is unequivocal (Maltz, 2019; UNISDR, 1982). Severe and morbid obesity, the complex causes of which are rooted in SDOH, also creates increased vulnerability to disasters. In fact, the PREPUBLICATION COPY—Uncorrected Proofs

DISASTER PREPAREDNESS AND PUBLIC HEALTH EMERGENCY RESPONSE 255 intersection of SDOH, severe or morbid obesity, and disaster vulnerability is postulated to create “triple jeopardy” for these individuals (Gray, 2017). Health and health care disparities, such as lack of access to primary care and specialty providers, the presence of comorbid conditions, and lack of health insurance, together with poverty, not only put people at increased risk for injury or death during disasters but are often exacerbated during a disaster. For exam- ple, more than 4,600 excess deaths are believed to have resulted from Hurricane Katrina because of interruptions in medical care and basic utilities, which espe- cially impacted those with chronic conditions who required medical equipment powered by electricity (Kishore et al., 2018). This number was much higher than the number of people who died as a direct result of the hurricane and indicates how quickly chronic conditions can revert to acute medical emergencies, greatly increasing the mortality of those most underserved. Studies show that although the majority of Americans are considered unpre- pared for the occurrence of a disaster, those of lower socioeconomic status (SES) and lower educational attainment are generally less prepared than their wealthier and more educated counterparts in part because of the costs associated with pre- paredness actions, such as obtaining insurance and taking measures to prepare for earthquakes (SAMHSA, 2017). In a national household survey, for example, 65 percent of respondents said they had no disaster plans or had plans that were inadequate (Petkova et al., 2016). And according to national survey data from the Federal Emergency Management Agency (FEMA), fewer than half of Americans are familiar with local hazards, fewer than 40 percent have created a household emergency plan, and only about half (52 percent) have disaster supplies at home (FEMA, 2014). When communities are warned about impending disasters, research shows that those of lower SES may be less likely to respond because of the cost and resources associated with evacuation (Thiede and Brown, 2013). When a disaster strikes, a range of impacts continue to affect those of lower SES compared with those of higher SES more severely, including homelessness, physical injuries, and financial effects. Families of lower SES are more likely to experience greater im- pacts from disasters, including damage to their homes from strong winds, floods, or earthquakes because of their homes’ lower construction quality and increased likelihood of being located in flood-prone areas; lack of insurance coverage; insufficient savings; and lack of understanding of the governmental systems that provide aid to victims (Hallegatte et al., 2016). They may not know how to access aid and may feel uncomfortable working with these systems, especially if they are undocumented immigrants in fear of being deported. Families may even be unable to reach assistance centers because of a lack of transportation and child care or the inability to miss work. Those of lower SES are more vulnerable to homelessness after a disaster and experience extreme difficulty in obtaining housing loans to help them rebuild their damaged homes (SAMHSA, 2017). This plethora of hardships experienced by people of lower SES and people of color PREPUBLICATION COPY—Uncorrected Proofs

256 THE FUTURE OF NURSING 2020–2030 during and after a disaster also leads to an increased likelihood of experiencing depression and posttraumatic stress. Relationship to Race and Ethnicity Health inequities seen in natural disasters and infectious disease outbreaks are often directly related to race and ethnicity. The COVID-19 pandemic has had a disproportionate effect on Black, Hispanic, and American Indian populations, who have experienced greater levels of suffering and death. Long-standing racial and ethnic inequities in access to health care services prior to the pandemic have translated into disparities in access to COVID-19 testing and treatment (Duke Margolis Center for Health Policy, 2020; Poteat et al., 2020). Zoning laws and low income levels have disadvantaged some racial and ethnic groups and con- tributed to living conditions that have made it difficult for individuals to socially distance (Davenport et al., 2020). The added burdens of chronic disease and persistent underfunding of American Indian health systems have resulted in the nation’s indigenous population being at high risk of poor outcomes from the dis- ease (AMA, 2020). COVID-19-related unemployment and economic devastation have impacted all communities, with Black and Hispanic workers experiencing the highest rates of COVID-19 infection (BLS, 2020). Box 8-2 describes how one county in Texas became a COVID-19 “hotspot.” BOX 8-2 COVID-19 in Hidalgo County, Texas Hidalgo County, Texas, in the Rio Grande Valley on the U.S.–Mexico border became a coronavirus hotspot, with 15,153 confirmed cases and 456 deaths as of July 25, 2020.* Hidalgo County has a high prevalence of diabetes and obesity, along with poverty and poor access to health care, exacerbating the life-threatening side effects of the coronavirus (Killough et al., 2020; Najmabadi, 2020). Furthermore, 92 percent of the Hidalgo Country residents are Hispanic, a population that has been disproportionately affected by the pandemic because of their essential worker status (Erdman, 2020). After a broad reopening in May 2020, Texas saw a surge in cases across the state. Hospitals were referred to as “war zones” (Brooks and O’Brien, 2020; Kil- lough et al., 2020). More than 1,200 medical personnel were sent to the region, including U.S. Navy and Army nurses and physicians, to provide desperately needed relief to the overworked hospital staff. The county suffered the deaths of five nurses from COVID-19 (Hernandez, 2020), as they were responsible for more critically ill patients and were constantly working overtime with no end in sight as their patient load continued to grow. * See https://www.hidalgocounty.us/coronavirusupdates. PREPUBLICATION COPY—Uncorrected Proofs

DISASTER PREPAREDNESS AND PUBLIC HEALTH EMERGENCY RESPONSE 257 Nurses’ Roles in Addressing Disparities In the future, nurses could play a role in helping to address these disparities before, during, and after a disaster. Community resilience, which “refers to com- munity capabilities that buffer it from or support effective responses to disasters,” is of growing importance in disaster preparedness, particularly in underresourced areas (Wells et al., 2013, p. 1172). This concept engages the community in di- saster planning, such as creating “community emergency response teams” and helping families compile their own disaster preparedness kits (Wells et al., 2013). When adequate in number, public health and school nurses can help with these community engagement activities and advance preparedness in at-risk popula- tions, such as low-income families and the homebound elderly (Spurlock et al., 2019). Some disasters may not call on nurses to use technical clinical practice skills, but rather their skills in networking, communications, creation of partner- ships, resource identification, and assessment, as well as their understanding of SDOH that result in increased vulnerabilities to a disaster event. Disasters often limit or eliminate access to transportation; access to care, food, and shelter; and employment. By understanding how these factors affect a person’s health and well-being and related potential resources, nurses can help build community re- silience (Heagele, 2017). Additionally, nurses can play a role in advocating for a health equity approach in preparation for future pandemics that addresses histor- ical and current structural as well as systemic racial prejudice and discrimination that result in health disparities. Equitable access to and distribution of tests, treatments, contact tracing, and vaccines especially for underserved populations, is instrumental to the success of the response to COVID-19 as well as future pandemics. Nurses’ capacity to advance health equity in the United States includes supporting fair, equitable, and transparent allocation of vaccine during the nation’s COVID-19 vaccine campaign and future infectious disease emergencies. Nurses’ awareness of the relationship between the historical experience of individuals and communities and how SDOH impact trust in the health care system and vaccine hesitancy is a precursor to the critically important work of framing community health educa- tion and messaging to counter misinformation. With this understanding, nurses can be trusted sources of health information and work actively to educate their communities, particularly in the areas of preventing disease spread and dispelling vaccine-related misinformation. Nurses should be able and willing to participate in all of these activities during an ongoing pandemic (Martin, 2011). NURSES’ ROLE IN SHELTERING DURING DISASTERS During disasters, nurses staff shelters that house people displaced by these events. Shelters are critical in disaster response, providing temporary housing for those displaced by such events as earthquakes and hurricanes (see Box 8-3). PREPUBLICATION COPY—Uncorrected Proofs

258 THE FUTURE OF NURSING 2020–2030 During Hurricanes Gustav and Ike in 2008, more than 3,700 patients were treated by nurses in shelters for acute and chronic illnesses (Noe et al., 2013). After Hur- ricane Katrina in 2006, nearly 1,400 evacuation shelters were opened to accom- modate 500,000 evacuees from the Gulf region (Jenkins et al., 2009). Those who receive care in shelters, including children, the elderly, and those with chronic medical conditions, are often economically disadvantaged and highly vulnerable to a disaster’s health impacts (Laditka et al., 2008; Springer and Casey-Lockyer, 2016). For example, one study of evacuees living in Red Cross shelters after Hurricane Katrina found that nearly half lacked health insurance, 55 percent had a preexisting chronic disease, and 48 percent lacked access to medication (Greenough et al., 2008). Nurses can help ensure that such evacuees receive appropriate care, including for physical and mental illnesses, and help prevent unnecessary deaths that may result from disruptions in health care services. After a disaster, people must often spend extended periods in shelters un- til they can find alternative housing, greatly affecting their social, mental, and physical well-being. For example, studies have found that disaster victims are at increased risk for posttraumatic stress disorder, and the close proximity to others in which they must live in shelters, combined with poor infection control, greatly BOX 8-3 Lessons Learned from Nurses’ Role in Evacuation During Hurricane Sandy On October 28, 2012, Hurricane Sandy made landfall in Atlantic City, New Jersey. The storm eventually claimed nearly 150 lives and caused billions of dollars of damage along the U.S. East Coast. Hospitals across New York City, including the New York University Langone Medical Center (NYULMC), began preparing for Hurricane Sandy in the week before landfall. Nurses assisted with storm preparations and the evacuation of patients from NYULMC, including help- ing to triage, move, and discharge patients; printing medical records; ensuring sufficient staffing; communicating with patients and their families; and identifying other hospitals that could take patients. Many had worked during Hurricane Irene the year before and expected a similar outcome, but instead had to adapt rapidly to “an unplanned evacuation that ended in hospital closure” (VanDevanter et al., 2017, p. 637). Many nurses felt unprepared to help evacuate the entire hospital, had little clarity on what role they were to play during the disaster, and had “limited knowl- edge of hospital disaster policies and procedures” (VanDevanter et al., 2017, p. 638). The lessons learned from nurses’ response to this disaster highlight the importance of education and training for nurses in disaster response, including in scenarios of short- and long-term power outages. Event management, triage, and evacuation are critical skills for nurses. PREPUBLICATION COPY—Uncorrected Proofs

DISASTER PREPAREDNESS AND PUBLIC HEALTH EMERGENCY RESPONSE 259 increases the potential for infectious disease outbreaks in these settings. The health needs of those residing in shelters long-term are often much greater than the needs of those who suffer acute injuries, such as traumas (e.g., penetrating wounds, bone fractures), from the disaster itself. For example, a review of more than 30,000 people treated in shelters after Hurricane Katrina found that most of the care provided was “primary care or preventive in nature, with only 3.8 percent of all patients requiring referral to a hospital or emergency department” (Jenkins et al., 2009, p. 105). An assessment conducted after Hurricanes Gustav and Ike identified similar postdisaster health care needs within shelters (Noe et al., 2013). Historically, nurses have delivered care to shelter populations, perhaps most familiarly in working with ARC. For example, ARC nurses at a shelter housing Hurricane Katrina evacuees set up hand sanitizing stations to help prevent infec- tious disease outbreaks. ARC nurses have worked to understand the functional, physical, and mental health needs of displaced persons; ensure that shelters are safe environments; and “maximiz[e] the effectiveness of nurses and other li- censed care providers in disaster shelters” (Springer and Casey-Lockyer, 2016). NURSES’ PREPAREDNESS FOR DISASTER RESPONSE Critical lessons learned during the response to prior infectious disease out- breaks, such as the 2003 severe acute respiratory syndrome (SARS) coronavirus outbreak, the 2009 H1N1 influenza pandemic, and the Ebola virus outbreak in West Africa, were not applied to workforce planning for future infectious dis- ease outbreaks such as COVID-19 (Hick et al., 2020). These prior public health emergencies illuminated glaring gaps in emergency preparedness and workforce development and the harmful effects on nurses, and multiple calls to improve nurse readiness for pandemic response have been issued (Catrambone and Vla- sich, 2017; Corless et al., 2018; Veenema et al., 2016a). Basic knowledge about health system emergency preparedness is generally lacking among nurses, including school nurses, who, as discussed above, are expected to play key roles during public health emergencies (Baack and Alfred, 2013; Labrague et al., 2018; Rebmann et al., 2012; Usher et al., 2015). For ex- ample, in a survey of more than 5,000 nurses across the Spectrum Health system, 78 percent of respondents said they had little or no familiarity with emergency preparedness and disaster response (ASPR, 2019). Similarly, studies evaluating curricular content in U.S. schools of nursing (Charney et al., 2019; Veenema et al., 2019) and globally (Grochtdreis et al., 2016) disclose a notable absence of health care emergency preparedness content and little evidence that the few students who receive instruction in this context achieve competency in these skills. Furthermore, the willingness of individual nurses and other health care providers to respond to disasters is variable, and research suggests that many feel unequipped to respond (Connor, 2014; Veenema et al., 2008) or to keep themselves safe (Subbotina and Agrawal, 2018). PREPUBLICATION COPY—Uncorrected Proofs

260 THE FUTURE OF NURSING 2020–2030 This educational gap is striking given that studies have shown that the more knowledgeable nurses are about infectious disease manifestation, transmission, and protection, the more confident and successful they will be when working during an outbreak (Liu and Liehr, 2009; Shih et al., 2009). Moreover, nurses who have previous experience working with an infectious disease outbreak are more confident and better prepared during a subsequent outbreak (Koh et al., 2012; Lam and Hung, 2013; Liu and Liehr, 2009), more knowledgeable about infection control and prevention measures, and more skilled in treating those with such infectious diseases. Nurses with a strong sense of their professional value—those who believe their role as a nurse is not just a job but a responsibility to serve and protect the public—are more likely to work during an infectious disease outbreak (Koh et al., 2012). Their outlook often causes them to struggle in balancing their duty as a nurse to provide care with their personal safety and health during an outbreak (Chung et al., 2005). Gaps in education and training are evident in nursing leadership as well (Knebel et al., 2012; Langan et al., 2017; Veenema et al., 2016b, 2017). Nurse leadership, an important component of nurses’ roles (see Chapter 9), is essential in any organization experiencing a disaster (Samuel et al., 2018). Thus, greater effort to develop and evaluate training programs for nurse leaders is warranted. Such programs can cultivate communication, business, and leadership compe- tencies, and these nurse leaders, in turn, can improve health care’s response, outcomes for patients, staff well-being, and the financial stability of hospitals (Shuman and Costa, 2020). Results of the April 2020 ANA survey indicated gaps in crisis leadership resulting in a lack of trust between nursing and hospital leadership and front-line nursing staff. Areas in which action needs to be taken to advance national nurse readiness for responding to disasters, including pandemics, are detailed below. First, how- ever, it is critical to identify and understand the gaps in the U.S. health care sys- tem both within and outside of the nursing workforce that have contributed to an ongoing lack of disaster readiness (Veenema et al., 2020). A range of factors that influence nursing workforce development and nurses’ safety and support during disasters extend across the governmental, system (e.g., large regional health sys- tems), and organizational (e.g., individual hospitals, clinics, and other types of health care settings) levels. Aggressive actions taken now to transform nursing education, practice, and policy across health care and public health systems and organizations can improve the readiness, safety, and support of the national nurs- ing workforce for COVID-19 as well as future disasters. The factors reviewed below that affect nurse preparedness include government strategies, research funding, education and accreditation, responsibilities of hospitals and health care organizations, and the role of professional nursing organizations. The interactions among nurses, health care institutions, and government have been identified as crucial to an effective pandemic response (Lam et al., 2018). PREPUBLICATION COPY—Uncorrected Proofs

DISASTER PREPAREDNESS AND PUBLIC HEALTH EMERGENCY RESPONSE 261 Government Strategies The federal government has wide-ranging responsibilities for disaster pre- paredness and response across various agencies. The Office of the Assistant Secretary for Preparedness and Response (ASPR) within the U.S. Department of Health and Human Services (HHS) “leads the nation’s medical and public health preparedness for, response to, and recovery from disasters and public health emergencies” (HHS, 2019). ASPR’s many roles during these events include coordinating the HHS Emergency Support Functions, overseeing the National Disaster Medical System, supporting the Hospital Preparedness Program, and maintaining and distributing the Strategic National Stockpile.6 ASPR’s strategies for identifying risks and informing preparedness and response efforts also include the National Biodefense Strategy and the National Health Security Strategy. Fed- eral response strategies and frameworks beyond those of ASPR include FEMA’s National Response Framework and CDC’s Public Health Emergency Prepared- ness and Response Capabilities. Concern has been expressed that the above federal strategies may not accu- rately reflect and incorporate the capacity of the nursing workforce to respond to disasters. Veenema and colleagues (2016a) identify the need for a systematic review of national policies and planning documents addressing disasters to ensure that they elevate, prioritize, and address the practice of disaster nursing in federal, state, and local emergency management operations. For instance, the 2017–2022 Health Care Preparedness and Response Capabilities provides a framework for health care coalition capabilities, including health care and medical readiness, health care and medical response coordination, continuity of health care service delivery, and medial surge (ASPR, 2016). Noteworthy, however, is that many of the capabilities outlined in this framework depend on a trained nursing workforce. Ensuring that nurses are educationally prepared and available will be in- strumental to success in mass vaccination and other disaster-related efforts. In terms of local government decisions, for example, school nurses are responsible for safe reentry of children to K–12 education during disasters. Lessons learned from the reopening of schools in other jurisdictions and other countries, as well as CDC guidance, can inform the incorporation of such practices as pandemic public health interventions into schools. The roles and responsibilities expected of nurses within existing local, state, and federal preparedness and response strategies need to be clarified to equip nurses with the knowledge, skills, and abilities needed to execute those roles safely and to build and maintain them across the nursing workforce. Additionally, nursing expertise that draws on both clinical and public health nursing knowledge can actively inform policy makers 6  See https://www.phe.gov/about/aspr/Pages/default.aspx. PREPUBLICATION COPY—Uncorrected Proofs

262 THE FUTURE OF NURSING 2020–2030 from the local to the federal levels to ensure nurses’ robust preparation for and response to disasters. Research Funding Scientific evidence is foundational to the delivery of safe, high-quality nurs- ing care to individuals and communities affected by a disaster, yet data suggest that this evidence base is underdeveloped (Veenema et al., 2020). Research gaps have been identified (Stangeland, 2010), and priorities related to disaster nursing have been articulated (Ranse et al., 2014). A 2016 consensus report articulates specific recommendations for advancing research on disaster nursing, including the articulation of a research agenda based on a needs assessment to document gaps in the literature, nursing knowledge and skills, and available resources; expansion of research methods to include interventional studies and use both quantitative and qualitative designs; and an effort to increase the number of PhD-prepared nurse scientists serving as principal investigators on disaster re- search projects (Veenema et al., 2016a). However, funding for this work has been insufficient. Support for public health emergency preparedness and response (PHEPR) research in general has repeatedly stopped and restarted, resulting in an evidence base comprising one- off studies. There has been little funding for academic public health emergency programs since 2015, with the exception of CDC’s Center for Preparedness and Response’s Broad Agency Announcement (BAA) for Public Health Emergency Preparedness and Response Applied Research, and no funding for academic disaster nursing. Overall funding for disaster research has declined since 2009 (NASEM, 2020). A report recently released by the National Academies (NASEM, 2020) concludes, The public health emergency preparedness and response field is currently relying on fragmented and largely uncoordinated research efforts, often with no clear linkage to overall system goals. Collectively, these deficiencies have contributed to a field based on long-standing practice not evidence-based practices. To ad- dress these deficiencies, the PHEPR field needs a coordinated intergovernmental, multidisciplinary effort with defined objectives to prioritize and align research efforts and investments in a research infrastructure to strengthen the capacity to conduct research before, during, and following public health emergencies. Education and Accreditation In 2017, the Centers for Medicare & Medicaid Services (CMS) enacted the Emergency Preparedness Rule, which established requirements for planning, pre- paring, and training for emergencies (CMS, 2016, 2019). The rule was intended to advance health care preparedness, but it did not address the preparedness of the nursing workforce. The rule was designed to promote preparedness at the PREPUBLICATION COPY—Uncorrected Proofs

DISASTER PREPAREDNESS AND PUBLIC HEALTH EMERGENCY RESPONSE 263 health care organization level, allowing the organization flexibility in testing and training for staff, including nurses. Accreditors are required to ensure that the cri- teria for the rule are met, but they do not evaluate the level of knowledge among staff or require additional training or workforce development. Gaps in nursing’s emergency preparedness within these organizations can occur even if they have met the CMS emergency preparedness criteria. Maintaining adequate and safe staffing levels during a disaster needs to be a key consideration in the development of a workforce emergency strategy. The Joint Commission has a vested interest in nursing workforce issues, viewing nursing as part of its mission to support high-quality and safe care for the public. The Joint Commission has produced recommendations designed to increase the professionalism of nursing and diversify the nursing workforce, and it has im- plemented measures to improve the safety and quality of nursing care practices. While The Joint Commission does not specifically require reporting of nurse-to- patient ratios, it does have some related metrics around patient outcomes (The Joint Commission, 2020). The lack of metrics that specifically measure whether facilities have the plans, procedures, and human resources needed to surge the workforce during a disaster leaves them vulnerable to staffing shortages and increases the likelihood that they will need to turn to a crisis standards of care staffing model. Fundamental and seismic change also is required in nursing education if the profession is to keep pace with the increasing numbers of natural disas- ters and public health emergencies. The major threats to global human health (climate change, air pollution, influenza, emerging infectious diseases, vaccine hesitancy) (WHO, 2019) receive minimal coverage in most nursing school cur- ricula. COVID-19 represents a harbinger of public health emergencies to come, highlighting the vital role of disaster response education and training for nurses. Yet, repeatedly, empirical evidence shows that nurses are ill prepared to respond to these events (Charney et al., 2019; Labrague et al., 2018; Veenema, 2018). Overall, the preparedness of the nursing workforce is a factor in prelicensure education and lifelong learning inclusive of training (e.g., regular drills and ex- ercises). Nursing preparedness requires that all organizations employing nurses, from schools of nursing to hospitals to other health-related organizations, engage in this agenda. To equip nurses to respond to future disaster events, schools of nursing need to produce nurses capable of providing culturally meaningful care, using data to drive health decisions, and addressing SDOH to optimize population health outcomes (Duke Margolis Center for Health Policy, 2020). And as noted earlier, PhD-prepared nurse scientists are essential to conduct disaster research and educate a cadre of future nurse researchers and educators to sustain and advance the field. Nursing curricula need to be updated to reflect the realities of these increasing threats to human health. The American Association of Colleges of Nursing (AACN) establishes the standards for curriculum for academic nursing programs through a series of Es- PREPUBLICATION COPY—Uncorrected Proofs

264 THE FUTURE OF NURSING 2020–2030 sentials documents that are currently being revised and are targeted to be released in early 2021 (see Chapter 7 for more detailed information). Population health competencies that specifically address disaster response are included in the re- vised Essentials, and their addition has the potential to drive transformational change across academic programs. Greater emphasis on disaster and public health emergency response competencies and skills should have beneficial effects for nurses during disasters, including greater resilience, increased practical and theo- retical knowledge, a broader view of the “clinical and organizational big picture,” and reduced psychological impact in case of sudden reassignment to a different clinical setting (Bambi et al., 2020). While all schools need to increase content in general disaster preparedness, it is also worth considering incorporating addi- tional hazard-specific content to build capacity for nurses to respond to the kinds of emergencies that are most likely in the geographic area where they will live and practice. Schools of nursing can expand their use of educational technology, including telenursing and virtual simulations to increase interprofessional disaster training opportunities in partnership with community disaster response agencies. The Commission on Collegiate Nursing Education (CCNE) Standards and Professional Nursing Guidelines  Standards for Accreditation of Baccalaureate and Graduate Nursing Programs are applied at accreditation site visits to schools of nursing (AACN, 2011) to confirm that academic programs align with Es- sentials. CCNE evaluators’ confirmation of the adoption of the new Essentials standards on incorporating disaster response content into education and train- ing programs could produce evidence of graduates’ related clinical competence (Veenema et al., 2020). Disasters, including such events as the COVID-19 pandemic, interrupt ac- ademic progression and student mastery of clinical competencies and can delay graduations. Schools of nursing and state boards of nursing would be well served to establish options for supporting clinical rotations in the health care setting, such as expanding the role of virtual or simulated learning and alternative, non- traditional sites for clinical placements. Working with clinical and community partners, schools of nursing would benefit from establishing back-up plans to ensure that academic programs continue during public health emergencies. A particular emphasis on addressing health care equity in the face of disaster would be of prime importance. Responsibilities of Hospitals and Health Care Organizations The COVID-19 pandemic has revealed profound problems with the financ- ing and delivery of American health care, presenting both challenges and op- portunities for nursing, and has exposed systemic vulnerabilities that afflict the well-being and resilience of nurses and other health professionals. Hospitals and other organizations employing nurses, nurse leaders, physicians, and others have a responsibility to create a safe working environment for nurses, ensuring ade- PREPUBLICATION COPY—Uncorrected Proofs

DISASTER PREPAREDNESS AND PUBLIC HEALTH EMERGENCY RESPONSE 265 quate staffing levels, access to appropriate levels of PPE, and physical and mental health support services for protracted disaster events. Hospital administrators and nursing and medical executives need to be held accountable for having policies in place to ensure a safe working environment for nurses during disaster response. Hospital disaster plans need to accommodate changes in clinical duties and nurse staffing to meet demand, and identify alternative nurse staffing resources to aid in the response. Long-term care facilities, home care agencies, and community health clinics need to include the same accommodations. Nurse executives in various health and health care organizations across com- munities can work together to plan for circumstances that may require surging nurses across settings to meet emerging health care needs. Nurses well educated in addressing SDOH would be of particular value in contributing to the devel- opment and implementation of preparedness and response strategies that meet the needs of diverse high-risk, high-vulnerability populations. Stockpiling and procurement of adequate supplies (e.g., testing supplies, PPE, medical gases) are critical for keeping nurses safe at work. Health system leaders, mandated to have emergency management response plans in place, can ensure that all disaster and pandemic response plans address training content, including issues of health equity and communication with and protection of their workforce. The Role of Professional Nursing Organizations Professional nursing organizations have an important role in ensuring that their members and the profession at large have the expertise and support to respond to unanticipated events that threaten the health of the public. These or- ganizations have advocated for the support and protection of nurses during past disasters and continue to do so today. The Tri-Council for Nursing (Tri-Coun- cil) is an alliance of five nursing organizations focused on leadership for education, practice, and research. Working with specialty nursing organiza- tions, such as the Emergency Nurses Association and the Council of Public Health Nursing Organizations, the Tri-Council could advocate for a broad and forward-thinking national plan to advance disaster nursing and PHEPR. A special emphasis should be the care of individuals, families, and commu- nities that are disproportionally affected by disasters. Nursing organizations uniting around the COVID-19 response can use this experience to establish a foundation for preparing the profession to meet future disaster-related challenges. CONCLUSIONS COVID-19, while historic, is but one example of the significant burden im- posed by disasters and public health emergencies on the health of populations, health care professionals, and nurses in particular. The pandemic has created mul- PREPUBLICATION COPY—Uncorrected Proofs

266 THE FUTURE OF NURSING 2020–2030 tiple challenges, particularly for managing its effects across diverse and highly vulnerable populations, and exacerbated existing health inequities. Future natural disasters and infectious disease outbreaks will present similar, if not greater chal- lenges for the nursing profession. Bold, anticipatory action is needed to advance nurse readiness for these events. Conclusion 8-1: The nation’s nurses are not currently prepared for disaster and public health emergency response. Conclusion 8-2: A bold and expansive effort, executed across multiple platforms, will be needed to fully support nurses in becoming prepared for disaster and public health emergency response. It is essential to convene experts who can develop a national strategic plan articulat- ing the existing deficiencies in this regard and action steps to address them, and, most important, establishing where responsibility will lie for ensuring that those action steps are taken. Conclusion 8-3: Rapid action is needed across nursing education, practice, policy, and research to address the gaps in nursing’s disaster preparedness and improve its capacity as a profession to advocate for population health and health equity during such events. REFERENCES AACN (American Association of Colleges of Nursing). 2011. The essentials of master’s education in nursing. https://www.aacnnursing.org/Portals/42/Publications/MastersEssentials11.pdf (ac- cessed July 15, 2020). Altman, M. 2020 (April 8). Facing moral distress during the COVID-19 crisis. American Associa- tion of Critical Care Nurses Blog. https://www.aacn.org/blog/facing-moral-distress-during-the- covid-19-crisis (accessed March 31, 2021). AMA (American Medical Association). 2020. Why COVID-19 is decimating some Native American com- munities. https://www.ama-assn.org/delivering-care/population-care/why-covid-19-decimating- some-native-american-communities (accessed March 18, 2021). ANA (American Nurses Association). 2020a. COVID-19 survey: March 20–April 10. https://www. nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/ coronavirus/what-you-need-to-know/covid-19-survey-results (accessed April 5, 2021). ANA. 2020b. ANA survey of 14K nurses finds access to PPE remains a top concern. https://www. nursingworld.org/news/news-releases/2020/ana-survey-of-14k-nurses-finds-access-to-ppe- remains-a-top-concern (accessed October 9, 2020). ANA. 2020c. Update on nurses and PPE: Survey reveals alarming conditions. https://www.nursing world.org/~4a558d/globalassets/covid19/ana-ppe-survey-one-pager---final.pdf (accessed April 5, 2021). Anthony, C., T. J. Thomas, B. M. Berg, R. V. Burke, and J. S. Upperman. 2017. Factors associated with preparedness of the US healthcare system to respond to a pediatric surge during an infectious dis- ease pandemic: Is our nation prepared? American Journal of Disaster Medicine 12(4):203–226. ASPR (Office of the Assistant Secretary for Preparedness and Response). 2016. 2017–2022 health care preparedness and response capabilities. https://www.phe.gov/Preparedness/planning/hpp/ reports/Documents/2017-2022-healthcare-pr-capablities.pdf (accessed July 26, 2020). PREPUBLICATION COPY—Uncorrected Proofs

DISASTER PREPAREDNESS AND PUBLIC HEALTH EMERGENCY RESPONSE 267 Attacks against AAPI community continue to rise during pandemic over 2,500 racist incidents re- ported since March. 2020. Press Release. Stop AAPI Hate, Asian Pacific Policy & Planning Council, Chinese for Affirmative Action, and San Francisco State University Asian American Studies. http://www.asianpacificpolicyandplanningcouncil.org/wp-content/uploads/PRESS_ RELEASE_National-Report_August27_2020.pdf (accessed March 31, 2021). Baack, S., and D. Alfred. 2013. Nurses’ preparedness and perceived competence in managing disas- ters. Journal of Nursing Scholarship 45(3):281–287. doi: 10.1111/jnu.12029 Badakhsh, R., E. Harville, and B. Banerjee. 2010. The childbearing experience during a natural di- saster. Journal of Obstetric, Gynecologic, & Neonatal Nursing 39(4):489–497. Bambi, S., P. Iozzo, and A. Lucchini. 2020. New issues in nursing management during the COVID-19 pandemic in Italy. American Journal of Critical Care 29(4):e92–e93. doi: 10.4037/ajcc2020937. BLS (U.S. Bureau of Labor Statistics). 2020. Occupational employment and wages, registered nurses. U.S. Department of Labor. https://www.bls.gov/oes/current/oes291141.htm. Brooks, B., and B. O’Brien. 2020 (July 22). Texas county stores bodies in trucks as state sets one-day record for COVID-19 deaths. Thomson Reuters. https://www.reuters.com/article/us-health- coronavirus-usa/texas-county-stores-bodies-in-trucks-as-state-sets-one-day-record-for-covid- 19-deaths-idUSKCN24N2F2 (accessed March 31, 2021). Catrambone, C. D., and C. Vlasich. 2016. Global advisory panel on the future of nursing & midwifery (GAPFON): Recommendations, strategies, and outcomes. Sigma Repository. https://sigma. nursingrepository.org/handle/10755/623881 (accessed March 31, 2021). Charney, R. L., R. P. Lavin, A. Bender, J. C. Langan, R. S. Zimmerman, and T. G. Veenema. 2019. Ready to respond: A survey of interdisciplinary health-care students and administrators on di- saster management competencies. Online ahead of print, September 30, 2019. Disaster Medicine and Public Health Preparedness Sep 30:1–8. doi :10.1017/dmp.2019.96. Chung, B. P. M., T. K. S. Wong, E. S. B. Suen, and J. W. Y. Chung. 2005. SARS: Caring for patients in Hong Kong. Journal of Clinical Nursing 14(4):510–517. doi: 10.1111/j.1365-2702.2004. 01072.x. CMS (Centers for Medicare & Medicaid Services). 2016. Emergency preparedness requirements for Medicare and Medicaid participating providers and suppliers final rule. Federal Register 81(180). https://www.federalregister.gov/documents/2016/09/16/2016-21404/medicare-and-medicaid- programs-emergency-preparedness-requirements-for-medicare-and-medicaid (accessed July 26, 2020). CMS. 2019. Emergency preparedness rule. https://www.cms.gov/Medicare/Provider-Enrollment-and- Certification/SurveyCertEmergPrep/Emergency-Prep-Rule (accessed July 26, 2020). Connor, S. B. 2014. When and why health care personnel respond to a disaster: The state of the science. Prehospital and Disaster Medicine 29(3):270–274. doi: 10.1017/S1049023X14000387. Corless, I. B., D. Nardi, J. A. Milstead, E. Larson, K. M. Nokes, S. Orsega, A. Kurth, K. Kirksey, and W. Woith. 2018. Expanding nursing’s role in responding to global pandemics 5/14/2018. Nurs- ing Outlook 66(4):412–415. Davenport, C., A. Gregg, and C. Timberg. 2020 (March 22). Working from home reveals another fault line in America’s racial and educational divide. The Washington Post. https://www.washington post.com/business/2020/03/22/working-home-reveals-another-fault-line-americas-racial- educational-divide (accessed March 31, 2021). Davis, J. R., S. Wilson, A. Brock-Martin, S. Glover, and E. R. Svendsen. 2010. The impact of disasters on populations with health and health care disparities. Disaster Medicine and Public Health Preparedness 4(1):30. de Mendoza, V. B., J. Savage, E. Harville, and G. P. Giarratano. 2012. Prenatal care, social support, and health-promoting behaviors of immigrant Latina women in a disaster recovery environ- ment. Journal of Obstetric, Gynecologic & Neonatal Nursing 41:S133. Duke Margolis Center for Health Policy. 2020. Response and Reform: Reflections on COVID-19. 2019–2020 Duke Margolis Scholars. https://healthpolicy.duke.edu/sites/default/files/2020-11/ Respond%20and%20Reform%20Reflections%20on%20COVID19.pdf (accessed March 31, 2021). PREPUBLICATION COPY—Uncorrected Proofs

268 THE FUTURE OF NURSING 2020–2030 Ebola nurses labour in the spirit of Nightingale [Editorial]. 2014. The Spectator, p. A.12. Erdman, S. L. 2020. Hispanics a disproportionate risk from COVID-19 over work, living conditions, health experts say. CNN Health. https://www.cnn.com/2020/06/10/health/hispanics-disparity- coronavirus/index.html (accessed March 31, 2021). Fauci, A. S., and D. M. Morens. 2012. The perpetual challenge of infectious diseases. New England Journal of Medicine 366:454–461. doi: 10.1056/NEJMra1108296. FEMA (Federal Emergency Management Agency). 2014. Preparedness in America: Research insights to increase individual, organizational, and community action. https://www.ready.gov/sites/ default/files/2020-08/Preparedness_in_America_August_2014.pdf (accessed March 31, 2021). Gray, L. 2017. Social determinants of health, disaster vulnerability, severe and morbid obesity in adults: Triple jeopardy?  International Journal of Environmental Research and Public Health 14(12):1452. Greenough, P. G., M. D. Lappi, E. B. Hsu, S. Fink, Y. H. Hsieh, A. Vu, C. Heaton, and T. D. Kirsch. 2008. Burden of disease and health status among Hurricane Katrina-displaced persons in shel- ters: A population-based cluster sample. Annals of Emergency Medicine 51(4):426–432. doi: 10.1016/j.annemergmed.2007.04.004. Grochtdreis, T., N. de Jong, N., Harenberg, S. Görres, and P. Schröder-Bäck. 2016. Nurses’ roles, knowledge and experience in national disaster preparedness and emergency response: A lit- erature review. South Eastern European Journal of Public Health. doi: 10.4119/seejph-1847. Hallegatte, S., A. Vogt-Schilb, M. Bangalore, and J. Rozenberg. 2016. Unbreakable: Building the re- silience of the poor in the face of natural disasters. Washington, DC: World Bank Publications. Heagele, T. 2017. Disaster-related community resilience: A concept analysis and a call to action for nurses. Public Health Nursing 34(3):295–302. Heagele, T., and D. Pacqiao. 2018. Disaster vulnerability of elderly and medically frail popula- tions. Health Emergency and Disaster Nursing 2016-0009. doi: 10.24298/hedn.2016-0009. Hernandez, S. 2020. Hidalgo County get 1,274 new COVID-19 cases, nurses die, doctors isolated. KVEO-TV. https://www.valleycentral.com/news/local-news/hidalgo-county-get-1274-new- covid-19-cases-nurses-die-doctors-isolated (accessed March 31, 2021). HHS (U.S. Department of Health and Human Services). 2019. Saving lives and protecting Americans from 21st century health security threats. Office of the Assistant Secretary for Preparedness and Response. https://www.phe.gov/about/aspr/Pages/default.aspx (accessed July 22, 2020). Hick, J. L., D. Hanfling, M. K. Wynia, and A. T. Pavia. 2020 (March 5). Duty to plan: Health care, crisis standards for care and coronavirus-SARS-CoV-2. National Academy of Medicine. https:// nam.edu/duty-to-plan-health-care-crisis-standards-of-care-and-novel-coronavirus-sars-cov-2 (accessed July 21, 2020). IFRC (International Federation of the Red Cross). 2019. World disaster report 2018. International Federation of Red Cross and Red Crescent Societies. https://www.ifrc.org/en/publications-and- reports/world-disasters-report (accessed March 31, 2021). Imai, T., K. Takahashi, M. Todoroki, H. Kunishima, T. Hoshuyama, R. Ide, and D. Koh. 2008. Per- ception in relation to a potential influenza pandemic among healthcare workers in Japan: Impli- cations for preparedness. Journal of Occupational Health 50(1):13–23. doi: 10.1539/joh.50.13. IPCC (Intergovernmental Panel on Climate Change). 2012. Managing the risks of extreme events and disasters to advance climate change adaptation: A special report of Working Groups I and II of the Intergovernmental Panel on Climate Change. Cambridge, UK: Cambridge University Press. IPCC. 2014. Climate change 2014: Impacts, adaptation, and vulnerability: Contribution of Working Group II to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change. Geneva, Switzerland: Intergovernmental Panel on Climate Change. Jakeway, C. C., G. LaRosa, A. Cary, and S. Schoenfisch. 2008. The role of public health nurses in emergency preparedness and response: A position paper of the association of state and territorial directors of nursing. Public Health Nursing 25(4):353–361. PREPUBLICATION COPY—Uncorrected Proofs

DISASTER PREPAREDNESS AND PUBLIC HEALTH EMERGENCY RESPONSE 269 Jenkins, J. L., M. McCarthy, G. Kelen, L. M. Sauer, and T. Kirsch. 2009. Changes needed in the care for sheltered persons: A multistate analysis from Hurricane Katrina. American Journal of Disaster Medicine 42:101–106. doi: 10.5055/ajdm.2009.0015. The Joint Commission. 2020. Health care staffing services. https://www.jointcommission.org/ measurement/measures/health-care-staffing-services (accessed July 26, 2020). KHN (Kaiser Heath News) and the Guardian. 2020. Lost on the frontlines. https://www. theguardian.com/us-news/ng-interactive/2020/aug/11/lost-on-the-frontline-COVID-19- coronavirus-us-healthcare-workers-deaths-database. Killough, A., E. Lavandera, and K. Jones. 2020 (July 22). Texas COVID-19 hot spot is facing a “tsunami” of patients, overwhelming hospitals. CNN. https://www.cnn.com/2020/07/22/us/ hidalgo-county-south-texas-covid-19/index.html (accessed March 31, 2021). Kishore, N., D. Marqués, A. Mahmud, M. V. Kiang, I. Rodriguez, A. Fuller, P. Ebner, C. Sorensen, F. Racy, J. Lemery, L. Maas, J. Leaning, R. A. Irizarry, S. Balsari, and C. O. Buckee. 2018. Mor- tality in Puerto Rico after Hurricane Maria. New England Journal of Medicine 379(2):162–170. doi: 10.1056/NEJMsa1803972. Kleier, J. A., D. Krause, and T. Ogilby. 2018. Hurricane preparedness among elderly residents in South Florida. Public Health Nursing 35(1):3–9. Knebel, A. R., L. Toomey, and M. Libby. 2012. Nursing leadership in disaster preparedness and response. Annual Review of Nursing Research 30(1):21–45. doi: 10.1891/0739-6686.30.21. Koh, Y., D. Hegney, and V. Drury. 2012. Nurses’ perceptions of risk from emerging respiratory in- fectious diseases: A Singapore study. International Journal of Nursing Practice 18(2):195–204. doi: 10. 1111/j.1440-172X.2012.02018.x. Labrague, L. J., and J. A. A. De Los Santos. 2020. COVID-19 anxiety among front-line nurses: Pre- dictive role of organisational support, personal resilience and social support. Journal of Nursing Management 28(7):1653–1661. doi: 10.1111/jonm.13121. Labrague, L. J., K. Hammad, D. S. Gloe, D. M. McEnroe-Petitte, D. C. Fronda, A. A. Obeidat, M. C. Leocadio, A. R. Cayaban, and E. C. Mirafuentes. 2018. Disaster preparedness among nurses: A systematic review of literature. International Nursing Review  65(1):41–53. doi: 10.1111/ inr/12369. Laditka, S. B., J. N. Laditka, S. Xirasagar, C. B. Cornman, C. B., Davis, and J. V. Richter. 2008. Pro- viding shelter to nursing home evacuees in disasters: Lessons from Hurricane Katrina. American Journal of Public Health 98(7):1288–1293. doi: 10.2105/AJPH.2006.107748. Lam, K. K., and S. Y. M. Hung. 2013. Perceptions of emergency nurses during the human swine influenza outbreak: A qualitative study. International Emergency Nursing 21(4):240–246. doi: 10.1016/ j.ienj.2012.08.008. Lam, S. K. K., E. W. Y. Kwong, M. S. Y. Hung, S. M. C. Pang, and V. C. L. Chiang. 2018. Nurses’ pre- paredness for infectious disease outbreaks: A literature review and narrative synthesis of qual- itative evidence. Journal of Clinical Nursing 27(7–8):e1244–e1255. doi: 10.1111/jocn.14210. Langan, J. C., R. Lavin, K. A. Wolgast, and T. G. Veenema. 2017. Education for developing and sustaining a health care workforce for disaster readiness.  Nursing Administration Quarterly 41(2):118–127. Lasek, A. 2020 (September 4). Nurses ask feds to invoke Defense Production Act for N95 masks; Survey finds “unacceptable” reuse levels. McKnight’s Long-Term Care News. https://www. mcknights.com/news/clinical-news/nurses-ask-feds-to-invoke-defense-production-act-for-n95- masks-survey-finds-unacceptable-reuse-levels (accessed March 31, 2021). Lavin, R. P., T. G. Veenema, W. J. Calvert, S. R. Grigsby, and J. Cobbina.  2017. Nurse leaders’ response to civil unrest in the urban core. Nursing Administration Quarterly 41(2):164–169. Liu, H., and P. Liehr. 2009. Instructive messages from Chinese nurses’ stories of caring for SARS pa- tients. Journal of Clinical Nursing 18(20):2880–2887. doi: 10.1111/j.1365-2702.2009.02857.x. Maltz, M. 2019. Caught in the eye of the storm: The disproportionate impact of natural disasters on the elderly population in the United States. Elder Law Journal 27:157. PREPUBLICATION COPY—Uncorrected Proofs

270 THE FUTURE OF NURSING 2020–2030 Martin, S. D. 2011. Nurses’ ability and willingness to work during pandemic flu. Journal of Nursing Management 19(1):98–108. Mason, D. and C. Friese. 2020 (March 19). Protecting health care workers against COVID-19: And being prepared for future pandemics. JAMA Health Forum. https://jamanetwork.com/channels/ health-forum/fullarticle/2763478#top (accessed March 31, 2021). McGillis Hall, L., and J. Kashin. 2016. Public understanding of the role of nurses during Ebola. Jour- nal of Nursing Scholarship 48(1):91–97. Molyneux, J. 2009. AJN speaks with Mary Pappas, school nurse who alerted CDC to swine flu outbreak. Off the charts: Blog of the American Journal of Nursing. https://ajnoffthecharts. com/mary-pappas-school-nurse-just-carrying-on-despite-swine-flu-outbreak (accessed March 31, 2021). Najmabadi, S., and M. Gutierrez, Jr. 2020 (July 2). “How many more are coming?” What it’s like inside hospitals as coronavirus grips Texas’ Rio Grande Valley. Texas Tribune. https://www. texastribune.org/2020/07/02/texas-coronavirus-hospital-rio-grande-valley (accessed March 31, 2021). NASEM (National Academies of Sciences, Engineering, and Medicine). 2020. Evidence-based prac- tice for public health emergency preparedness and response. Washington, DC: The National Academies Press. Noe, R. S., A. H. Schnall, A. F. Wolkin, M. N. Podgornik, A. D. Wood, J. Spears, and S. A. R. Stanley. 2013. Disaster-related injuries and illnesses treated by American Red Cross Health Services during Hurricanes Gustav and Ike. South Medicine Journal 106(1):102–108. doi: 10.1097/ SMJ.0b013e31827c9e1f. O’Boyle, C., C. Robertson, and M. Secor-Turner. 2006. Nurses’ beliefs about public health emer- gencies: Fear of abandonment. American Journal of Infection Control 34(6):351–357. doi: 10.1016/j.ajic.2006.01.012. Pappa, S., V. Ntella, T. Giannakas, V. G. Giannakoulis, E. Papoutsi, and P. Katsaounou. 2020. Prev- alence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain, Behavior, and Immunity 88:901–907. Petkova, E., J. Schlegelmilch, J. Sury, T. Chandler, C. Herrera, S. Bhaskar, E. Sehnert, S. Martinez, S. Marx, and I. Redlener. 2016. The American preparedness project: Where the US public stands in 2015. National Center for Disaster Preparedness at Columbia University’s Earth Institute, Research Brief 2016. https://academiccommons.columbia.edu/doi/10.7916/D84Q7TZN (ac- cessed April 5, 2021). Poteat, T., G. Millett, L. E. Nelson, and C. Beyrer. 2020. Understanding COVID-19 risks and vul- nerabilities among Black communities in America: The lethal force of syndemics.  Annals of Epidemiology 47:1–3. Ranse, J., A. Hutton, B. Jeeawody, and R. Wilson. 2014. What are the research needs for the field of disaster nursing? An international Delphi study. Prehospital and Disaster Medicine 29(5):448. Rebmann, T., M. B. Elliott, D. Reddick, and Z. D. Swick. 2012. US school/academic institution disas- ter and pandemic preparedness and seasonal influenza vaccination among school nurses. Ameri- can Journal of Infection Control 40(7):584–589. The role of the nurse in emergency preparedness. 2012. Journal of Obstetrical Gynecology Neonatal Nursing 41(2):322–324. PMID: 22376141. Ruderman, C., C. S. Tracy, C. M. Bensimon, M. Bernstein, L. Hawryluck, R. Z. Shaul, and R. E. Upshur. 2006. On pandemics and the duty to care: Whose duty? Who cares? BMC Medical Ethics 7(1):5. doi: 10.1186/1472-6939-7-5. SAMHSA (Substance Abuse and Mental Health Services Administration). 2017. Greater impact: How disasters affect people of low socioeconomic status. Disaster Technical Assistance Center Supplemental Research Bulletin. https://www.samhsa.gov/sites/default/files/dtac/srb-low-ses_2. pdf (accessed March 31, 2021). PREPUBLICATION COPY—Uncorrected Proofs

DISASTER PREPAREDNESS AND PUBLIC HEALTH EMERGENCY RESPONSE 271 Samuel, P., M. T. Quinn Griffin, M. White, and J. Fitzpatrick. 2018. Crisis leadership efficacy of nurse practitioners. Journal for Nurse Practitioners 11(9). doi:10.1016/j.nurpra.2015.06.010. Shapiro, J. 2016. What to know about the Pulse Nightclub shooting in Orlando. Time. https://time. com/4365260/orlando-shooting-pulse-nightclub-what-know (accessed March 31, 2021). Shechter, A., F. Diaz, N. Moise, D. E. Anstey, S. Ye, S., Agarwal, J. Birk, D. Brodie, D. Cannone, B. Chang, J. Claassen, T. Cornelius, L. Derby, M. Dong, R. Givens, B. Hochman, S. Homma, I. Kronish, S. Lee, W. Manzano, L. Mayer, C. McMurry, V. Moitre, P. Pham, L. Rabbani, R. Rivera, A. Schwartz, J. Schwartz, P. Shapiro, K. Shaw, A. Sullivan, C. Vose, L. Wasson, D. Edmondson, and M. Abdalla. 2020. Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic.  General Hospital Psychiatry 66:1–8. Shih, F. J., M. L. Gau, C. C. Kao, C. Y. Yang, Y. S. Lin, Y. C. Liao, and S. J. Sheu. 2007. Dying and caring on the edge: Taiwan’s surviving nurses’ reflections on taking care of patients with severe acute respiratory syndrome. Applied Nursing Research 20(4):171–180. doi: 10.1016/j. apnr.2006.08.007. Shih, F. J., S. Turale, Y. S. Lin, M. L. Gau, C. C. Kao, C. Y. Yang, Y. C. and Liao. 2009. Surviving a life-threatening crisis: Taiwan’s nurse leaders’ reflections and difficulties fighting the SARS ep- idemic. Journal of Clinical Nursing 1824:3391–3400. doi: 10.1111/j.1365- 2702.2008.02521.x. Shuman, C. J., and D. K. Costa. 2020. Stepping in, stepping up, and stepping out: Competencies for intensive care unit nursing leaders during disasters, emergencies, and outbreaks. American Journal of Critical Care 29(5):403–406. Siu, J. Y. M. 2010. Another nightmare after SARS: Knowledge perceptions of and overcoming strate- gies for H1N1 influenza among chronic renal disease patients in Hong Kong. Qualitative Health Research 20(7):893–904. doi: 10.1177/1049732310367501. Smith, A. B. 2020. 2010-2019: A landmark decade of billion-dollar weather and climate disasters. National Oceanic and Atmosphere Administration. https://www.climate.gov/news-features/ blogs/beyond-data/2010-2019-landmark-decade-us-billion-dollar-weather-and-climate (ac- cessed March 31, 2021). Springer, J., and M. Casey-Lockyer. 2016. Evolution of a nursing model for identifying client needs in a disaster shelter: A case study with the American Red Cross. Nursing Clinics of North America 51(4):647–662. doi: 10.1016/j.cnur.2016.07.009. Spurlock, W. R., K. Rose, T. G.Veenema, S. K. Sinha, D. Gray-Miceli, S. Hitchman, N. Foster, L. Slepski-Nash, and E. T. Miller. 2019. American Academy of Nursing on policy position state- ment: Disaster preparedness for older adults. Nursing Outlook 67(1):118–121. Stangeland, P. A. 2010. Disaster nursing: A retrospective review.  Critical Care Nursing Clinics of North America 22(4):421–436. doi: 10.1016/j.ccell.2010.09.003. Subbotina, K., and N. Agrawal. 2018. Natural disasters and health risks of first responders. In Asia-Pa- cific security challenges. Cham, Switzerland: Springer. Pp. 85–122. Thiede, B. C., and D. L. Brown. 2013. Hurricane Katrina: Who stayed and why? Population Research Policy Review 32(6):803–824. doi: 10.1007/s11113-013-9302-9. Toner, E., R. Waldhorn, T. G. Veenema, A. Adalja, D. Meyer, E. Martin, L. Sauer, M. Watson, L. D. Biddison, A. Cicerno, and T. Inglesby. 2020. National action plan for expanding and adapting the healthcare system for the duration of the COVID-19 pandemic. Baltimore, MD: Johns Hopkins Bloomberg School of Public Health, Center for Health Security. UN (United Nations), Department of Economic and Social Affairs, Population Division. 2016. The world’s cities in 2016—data booklet (ST/ESA/SER.A/392). UNISDR (United Nations International Strategy for Disaster Reduction). 1982. Disasters and the disabled. https://www.undrr.org/publication/disasters-and-disabled (accessed March 31, 2021). UNISDR. 2017. Terminology. https://www.undrr.org/terminology/disaster. PREPUBLICATION COPY—Uncorrected Proofs

272 THE FUTURE OF NURSING 2020–2030 Usher, K., M. L. Redman-MacLaren, J. Mills, C. West, E. Casella, E. Hapsari, S. Bonita, R. Ro- saldo, A. Liswar, and Y. Zang. 2015. Strengthening and preparing: Enhancing nursing re- search for disaster management. Nurse UNISEducation in Practice 15(1):68–74. doi: 10.1016/j. nepr.2014.03.006. VanDevanter, B., V. H. Raveis, C. T. Kovner, M. McCollum, and R. Keller. 2017. Challenges and resources for nurses participating in a Hurricane Sandy hospital evacuation. Journal of Nursing Scholarship 49(6):635–643. doi: 10.1111/jnu.12329. Veenema, T. G. (Ed.). 2018. (4th Edition). Disaster nursing and emergency preparedness for chem- ical, biological, and radiological terrorism and other hazards. New York: Springer Publishing Company. Veenema, T. G. 2020. The role of nurses in disaster preparedness and response. Chapter commis- sioned by the Committee on the Future of Nursing 2020–2030. Washington, DC. Veenema, T. G., B. Walden, N. Feinstein, and J. P. Williams. 2008. Factors affecting hospital-based nurses’ willingness to respond to a radiation emergency. Disaster Medicine and Public Health Preparedness 2(4):224–229. Veenema, T. G., A. Griffin, A. R. Gable, L. MacIntyre, N. Simons, M. Couig, J. Walsh, Jr., R. Proffitt Lavin, A. Dobalian, and E. Larson. 2016a. Nurses as leaders in disaster preparedness and response—A call to action. Journal of Nursing Scholarship 48(2):187–200. doi: 10.1111/ jnu.12198. Veenema, T. G., S. L. Losinski, S. M. Newton, and S. Seal. 2016b. Exploration and development of standardized nursing leadership competencies during disasters. Health Emergencies and Disaster Nursing 4(1):1–13. Veenema, T. G., K. Deruggiero, S. L. Losinski, and D. Barnett. 2017. Hospital administration and nursing leadership in disasters: An exploratory study using concept mapping. Nursing Admin- istration Quarterly 41(2):151–163. Veenema, T.G., Lavin, R.P., Schneider-Firestone, S., Couig, MP, Langan, J., Qureshi, K., Scerpella, D., and L. Sasnett. 2019. National assessment of nursing schools and nurse educators readiness for radiation emergencies and nuclear events. Disaster Medicine and Public Health Prepared- ness 13(5–6):936–945. Veenema, T. G., D. Meyer, S. Bell, M. Couig, C. Friese, R. Lavin, J. Stanley, E. Martin, M. Montegue, E. Toner, M. Schoch-Spana, A. Cicero, T. Ingelsby, L. Sauer, M. Watson, L. D. Biddison, A. Ci- cerno, and T. Inglesby. 2020. Recommendations for improving national nurse preparedness for pandemic response: Early lessons from COVID-19. Baltimore, MD: Johns Hopkins Bloomberg School of Public Health, Center for Health Security. Watts, N., M. Amann, S. Ayeb-Karlsson, K. Belesova, T. Bouley, M. Boykoff, P. Byass, W. Cai, D. Campbell-Lendrum, J. Chambers, P. Cox, M. Daly, N. Dasandi, M. Davies, M. Depledge, A. Depoux, P. Dominguez-Salas, P. Drummond, P. Ekins, A. Flahault, H. Frumkin, L. Georgeson, M Ghanei, D. Grace, H. Graham, R. Grojsman, A. Haines, I. Hamilton, S. Hartinger, A. John- son, I. Kelman, G. Kiesewetter, D. Kniveton, L. Liang, M. Lott, R. Lower, G. Mace, M. Sewe, M. Maslin, S. Mikhaylov, J. Milner, A. Latifi, M. Moradi-Lakeh, K. Morrissey, K. Murray, T. Neville, M. Nilsson, T. Oreszczyn, F. Owfi, D. Pencheon, S. Pye, M. Rabbaniha, E. Robinson, J. Rocklöv, S. Schütte, J. Shumake-Guillemot, R. Steinbach, M. Tabatabaei, N. Wheeler, P. Wilkinson, P. Gong, H. Montgomer, and A. Costello. 2018. The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health. Lancet 391(10120):581–630. Wells, K. B., J. Tang, E. Lizaola, F. Jones, A. Brown, A. Stayton, A., M. Williams, A. Chandra, D. Eisenman, S. Fogleman, and A. Ploug. 2013. Applying community engagement to disaster planning: Developing the vision and design for the Los Angeles County Community Disaster Resilience Initiative. American Journal of Public Health 103(7):1172–1180. doi: 10.2105/ ajph.2013.301407. PREPUBLICATION COPY—Uncorrected Proofs

DISASTER PREPAREDNESS AND PUBLIC HEALTH EMERGENCY RESPONSE 273 WHO (World Health Organization). 2018.  Essential steps for developing or updating a national pandemic influenza preparedness plan  (No. WHO/WHE/IHM/GIP/2018.1). World Health Organization. WHO. 2019. Ten threats to global health in 2019. https://www.who.int/news-room/spotlight/ten- threats-to-global-health-in-2019 (accessed March 31, 2021). WHO. 2020. Essential emergency and surgical care. https://www.who.int/surgery/challenges/esc_ disasters_emergencies/en (accessed March 31, 2021). Willis, J. and L. Philp. 2017. Orlando health nurse leaders reflect on the pulse tragedy. Nurse Leader 15(5):319–322. doi: 10.1016/j.mnl.2017.07.007. PREPUBLICATION COPY—Uncorrected Proofs

PREPUBLICATION COPY—Uncorrected Proofs

Next: 9 Nurses Leading Change »
The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity Get This Book
×
Buy Prepub | $84.00 Buy Paperback | $75.00
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

The decade ahead will test the nation’s nearly 4 million nurses in new and complex ways. Nurses live and work at the intersection of health, education, and communities. Nurses work in a wide array of settings and practice at a range of professional levels. They are often the first and most frequent line of contact with people of all backgrounds and experiences seeking care and they represent the largest of the health care professions.

A nation cannot fully thrive until everyone - no matter who they are, where they live, or how much money they make - can live their healthiest possible life, and helping people live their healthiest life is and has always been the essential role of nurses. Nurses have a critical role to play in achieving the goal of health equity, but they need robust education, supportive work environments, and autonomy. Accordingly, at the request of the Robert Wood Johnson Foundation, on behalf of the National Academy of Medicine, an ad hoc committee under the auspices of the National Academies of Sciences, Engineering, and Medicine conducted a study aimed at envisioning and charting a path forward for the nursing profession to help reduce inequities in people's ability to achieve their full health potential. The ultimate goal is the achievement of health equity in the United States built on strengthened nursing capacity and expertise. By leveraging these attributes, nursing will help to create and contribute comprehensively to equitable public health and health care systems that are designed to work for everyone.

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity explores how nurses can work to reduce health disparities and promote equity, while keeping costs at bay, utilizing technology, and maintaining patient and family-focused care into 2030. This work builds on the foundation set out by The Future of Nursing: Leading Change, Advancing Health (2011) report.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  6. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  7. ×

    View our suggested citation for this chapter.

    « Back Next »
  8. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!