I'm an RN and will be expected to work in case of a disaster. What do I need to know to perform my job, manage my stress, and deal with family concerns?

Disaster disrupts the entire community, including the lives of its nurses. Yet as a nurse, you may expect yourself to function normally, despite personal trauma, fears, and worries. You may believe that you should sacrifice yourself for others. But personal concerns may interfere with your ability to perform.

You can increase your effectiveness during a disaster by preparing a family emergency plan and learning ways to cope with stress. Employers can help by addressing personal and family concerns early, setting up communication systems, and employing strategies to minimize the adverse effects of stress.

YOUR PERSONAL EMERGENCY PLAN

Make a plan using information from the American Red Cross, Federal Emergency Management Agency (FEMA), or your local emergency management office. The plan should include:

* where the family will meet if you can't get home

* how to get information to each other (for example, ask an out-of-state friend to be your contact; be sure everyone knows the phone number)

* how to care for your pets Know the disaster plans at your children's schools, your spouse's and your workplaces, and other spots your family frequents.

Prepare a disaster supply kit for your cars with water, nonperishable foods, toilet paper, prescription medications, a battery-operated radio, a first-aid kit, sturdy walking shoes, rain gear, blankets, and a backpack.

Store disaster supplies in your home: water, nonperishable foods, nonelectric can opener, and a battery-operated radio.

Ensure everyone knows how to shut off water, gas, and electricity at the main switches.

AT WORK

The National Center for Post-Traumatic Stress Disorder, the Center for Mental Health Services of the U.S. Department of Health and Human Services, and FEMA recommend the following:

* Limit on-duty hours to 12 per day.

* Pair up to monitor one another's stress.

* Encourage and support your coworkers.

* Drink plenty of water.

* Eat healthful snacks: fresh fruit, whole-grain breads, and other energy sources.

* Take a break when you feel loss of stamina, coordination, or tolerance for irritation.

* Use available counseling.

* Talk about your emotions.

* Stay in touch with family and friends, and defuse briefly whenever you experience troubling incidents and after each work shift.

EMPLOYER PLANNING

The Joint Commission Resources Guide to Emergency Management Planning in Health Care recommends that employers develop an emergency plan that tackles logistical issues, such as

* a communication system that allows nurses and families to connect.

* transportation to and from work.

* provisions for child care and adult care.

To help staff cope, employers may want to

* provide on-site stress counselors.

* enact policies that encourage the disaster "buddy" system, breaks, and 12-hour shifts.

* establish work rotations from high- to lower-stress functions.

* provide support that allows staff to share emotions.

* supply a break room for resting and sharing of emotions.

Employers also should ensure that supervisors know the psychological impact of disaster, can recognize the signs of distress, and know where to go for help.

Resources

Guide to Emergency Management Planning in Health Care. Oak Terrace, Illinois: Joint Commission Resources. 2002.

American Red Cross. Family disaster planning.http://www.redcross.org/services/disaster/0,1082,0_601_,00.html.

National Center for PTSD. http://www.ncptsd.va.gov.

Center for Mental Health Services. http://www.mentalhealth.samhsa.gov/publications/allpubs/KEN-01-0098.