Nurses play an important role in disaster and pandemic response, often at a personal cost. Interviews of frontline nurses demonstrated their willingness to help in the recent pandemic came with an expense to their own well-being.1 Interviews were conducted with 19 nurses working in intensive care and COVID-19-designated medical units of 3 tertiary hospitals in an Upper Midwest healthcare system to gain a better understanding of their experience in caring for COVID-19 patients and balancing work and home life. These nurses were overwhelmed by the high volume of critically ill patients, frustrated by the care environment chaos and felt abandoned at work as well as by their families and communities.1 This group provided future pandemic advice for leadership and educators, which could be applied to other catastrophic events. Even though a small group was interviewed, their recommendations are congruent with The Future of Nursing 2020-2030 Report, which provides an important foundation addressing the current challenges faced by nurses during the pandemic.1,2

Background

Globally, an effective healthcare system disaster and pandemic response is essential to maintain the health of a population. During the COVID-19 pandemic, nurses expressed concerns regarding a lack of preparation and knowledge in responding to this catastrophic event and other unforeseen situations. Also, research demonstrates disaster response outcomes are significantly tied to communication, knowledge, and leadership effectiveness.3

Often in disaster situations, nurses work to overcome structural and organizational barriers threatening patient care and outcomes. Nurses caring for patients after Hurricane Katrina experienced system breakdowns and delays.4 In response, nurses were forced to innovate and adapt, while uniting together to overcome obstacles.4 If nurses are required to work in a disaster environment for extended periods, they can experience distress related to physical and emotional exhaustion, equipment shortages, and workload.5 These findings are similar to what healthcare providers encountered during the COVID-19 pandemic.1,5

Disaster Preparation and Recommendations for Clinical Nurses

Throughout the COVID-19 pandemic, clinical nurses were valuable resources for what worked and what did not. Based on their experience, 19 nurses from rural America offered the following recommendations for future pandemic and disaster preparation as part of an informal data gathering process. This project was submitted to the Sanford University institutional review board and deemed exempt by the Sanford Health institutional review board.

Effective Leadership

Clinical nurses want to be viewed as stakeholders with the ability to contribute ideas and perspective through the planning process.1 The 2016 American Association of Critical-Care Nurses standards for healthy work environments support nurses being heard, promoting ownership, and engaged in the decision-making process.6 When not provided sufficient supplies and consistent guidance and not part of the planning process, lack of trust can develop between nurses and leadership.7 Consequently, nurses feel unprepared and have little role clarity and limited knowledge about their organization's disaster policies and procedures.

In a prepandemic environment, many healthcare organizations used a shared governance model to promote decision-making. In the midst of the pandemic when nurses needed a platform for their voice, shared governance meetings were often suspended or deemed as nonessential. If the regular structure and meetings are precluded, it was suggested by survey participants to create alternate vehicles for input from clinical staff. Communication is critical. Listening to stakeholders and building on their feedback will allow leadership and clinical nurses to work together. Nurse leadership is an important component of nurses' roles in any disaster including promoting effective communication. Leaders should develop training programs for leaders to develop targeted competencies.2 Helping nurse leaders to facilitate clinical nurse input on a unit level was also strongly requested.

Promoting Nurses' Well-being

Some of the 19 clinical nurses who provided feedback in this assessment took advantage of mental health services, whereas others either did not know the services were available or were too exhausted to seek the services.1 The clinical nurses in this assessment project encountered physical and mental health problems during the crisis. To ensure future mental health needs of nurses are met, leadership must prioritize bringing available resources to the work environment and making them easily accessible to staff.

Leaders must recognize that even though the catastrophic event may be decreasing in intensity, the nurses are still processing their individual experiences. During the pandemic, frontline nurses verbalized feelings of being in a war zone, which resulted in many experiencing symptoms of posttraumatic stress and moral distress similar to the experiences of military nurses.8 Prioritizing communication and offering debriefing experiences must be a leadership consideration to care for nurses' well-being. Healthcare systems and nurse leaders are urged to provide sufficient human and material resources to enable nurses to provide quality patient care and establish physical and psychological safety.2

Clinical Nurse Education

In preparing for future catastrophic events, education must be provided for clinical nurses. The nurses in this assessment reported caring for extremely ill COVID-19 patients, although the education to support them in these efforts was minimal.1 Providing education prior to and during a catastrophic event would decrease the nurses' feelings of being overwhelmed, frustrated, and abandoned while at the same time foster personal and professional resilience. Simulation may be a useful supplement for leaders to access in providing education to clinical nurses in preparing for future emergent situations.

Summary

The clinical nurses in this informal assessment used their voices to illuminate priority focus areas for nursing and healthcare leadership. Suggestions included involving nurses in the planning process, providing clear communication, offering mental health services, and conducting education both just in time and in preparation. These recommendations align with selected conclusions and recommendations from The Future of Nursing 2020-2030 Report2 (Supplemental Digital Content 1, http://links.lww.com/JONA/A948). This alignment reinforces the need for prioritization of disaster preparedness for leaders. All levels of nursing leadership bear a responsibility to better prepare clinical nurses for future catastrophic events.

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