Charleen C. McNeill, PhD, MSN, RN, discusses key findings from a survey of nurses' emergency preparedness competence, the current state of emergency training, and what nurse leaders can do about it.
In addition to the ongoing COVID-19 pandemic, the United States and the world continues to be challenged by disasters, such as droughts, earthquakes, fires, floods, severe weather events, and terrorism. When they occur, nurses are called on to respond during and following a disaster.
"Nurses are widely recognized for the key roles they play in disaster preparedness and response," says Charleen C. McNeill, PhD, MSN, RN, an associate professor in the nursing science department at East Carolina University College of Nursing in Greenville, North Carolina. As the largest body of healthcare providers who often find themselves involved in the acute post-disaster phase of response measures, nurses are critical in preparedness efforts and must educate themselves on the risks and hazards in the areas in which they live in order to plan appropriate response measures, McNeill says.
Unfortunately, nurses may not be receiving the training in emergency preparedness to meet the public's needs in response to a disaster. McNeill recently co-authored a study in The Journal of Nursing Administration that examined nurses' self-reported levels of professional emergency preparedness competence, including their likelihood of reporting to work in response to a disaster.
Nurses' professional emergency preparedness is an indicator of their level of knowledge in preparing for and responding to a myriad of public health emergencies and disaster types, and is critical in facilitating positive health outcomes, McNeill says. "If nurses lack professional emergency preparedness competence, the ability of the healthcare sector to respond adequately during a crisis will be degraded, resulting in increased morbidity and mortality of impacted populations."
In a survey of nearly 200 registered nurses and licensed practical nurses, respondents scored highest when asked about triage and basic first aid competence—43% provided a positive response, meaning they were familiar or very familiar with the topic. "Triage and first aid are skills taught at the baccalaureate level and utilized most frequently in practice, particularly in emergency departments, so it is logical that nurses would score highest in this category," McNeill says.
However, other than triage and first aid, all other categories had low positive response rates, McNeill says, including:
- 26% for the incident command system
- 23% for isolation, quarantine, and decontamination
- 21% for psychological issues
- 18% for detention and epidemiology
- 18% for clinical decision-making
- 13% for accessing critical resources and reporting
"As these topics are not taught at all or not taught in detail as they relate to disasters as a part of formal education in the college or university setting, it is logical that nurses would score lowest in them," McNeill says.
The Current State of Emergency Preparedness Training
As the credentialing body for nursing programs for colleges and universities, the American Nurses Credentialing Center provides the framework for baccalaureate-, masters-, and doctoral-level nursing education.
At the baccalaureate level, there is some guidance about what a nurse with a Bachelor of Science in Nursing should know about disasters as a generalist, McNeill says. However, there are very few questions on the National Council Licensure Examination related to disasters, meaning the content may not be a priority in an overburdened curriculum.
"Additionally, competencies in disaster content at the [Master of Science in Nursing] and [Doctor of Nursing Practice] levels are notably absent, though these competencies are in the process of being updated and it is hopeful such content will be included. As a result, nurses must obtain training above and beyond their degree programs to gain necessary professional emergency competence. While there are sources available to do this, including the content in formal education programs would be critical to improving baseline nursing knowledge of and response to disasters and emergencies," she says.
McNeill says several sources of additional disaster competency education resources are listed in her recent article, "Emergency Preparedness Competencies Among Nurses: Implications for Nurse Administrators," as well as in the 2017 article "A Guide to Emergency Preparedness and Disaster Nursing Education Resources." Further, a list of action steps entities can take to advance disaster nursing education at the national level can be found in "Call to Action: The Case for Advancing Disaster Nursing Education in the United States."
McNeill says she is hesitant to suggest best practices to ensure nurses are competent in emergency preparedness. "Recommending best practices implies that many methods of ensuring competence in emergency preparedness areas have been utilized and evaluated to provide the basis, or empirical evidence, to make such recommendations. However, though these topics are taught using various methodologies by a number of different organizations, methods of teaching have not been evaluated enough to provide recommendations of best practices."
She adds that in the 15 years since the nursing community began evaluating disaster nursing knowledge formally, knowledge has not improved significantly. This underscores the need to formalize this education in college and university curriculums and evaluate its effectiveness.
"It is my hope that it will improve, but time will tell. Until then, we must begin with a restructuring of formal Disaster Nursing education in the U.S. as recommended by ['Call to Action.']"
Editor's note: This story was updated on September 14, 2020.
Nurses' highest self-reported emergency preparedness competences were in skills.
Disaster nursing education needs to be formalized in college and university curriculums to evaluate its effectiveness.