Deciding whether to report to work in a disaster is not always easy. But being prepared, individually and through institutional policy, is the primary ethical demand disasters make of health care professionals.
Nurses should consider the following ethically relevant assumptions in making their decision:
* The nurse's own safety is a legitimate concern.1
* Relationships of responsibility may be prioritized; for example, a mother-to-child relationship has a higher priority than a neighbor-to-neighbor relationship. It's important to remember that the nurse-to-patient relationship is also a relationship of responsibility.
* Nurses' expertise heightens their responsibilities in disasters.
* Nurses have an obligation to incur limited risks when the potential benefit to patients outweighs that risk.2
Other factors to consider include the following:
* Would harm result from the nurse reporting to work? The prevention of grave harm to people to whom the nurse is responsible would justify not going to work.
* Would any good come from not reporting to work (for example, by helping victims elsewhere)?
* What good would come from reporting to work? This assessment should consider the relevance of one's particular skills and the obligations to the workplace; membership on the hospital's disaster team, for example, would carry a higher expectation, as would being scheduled to work.
A trauma nurse not scheduled to work when an earthquake struck might not report if she decided that her responsibility to neighbors took priority and that not going to work would also decrease the risk to her family. But an oncology nurse scheduled for duty the next day, whose spouse could care for their children, might decide to report early for work.
Douglas P. Olsen, PhD, RN
Douglas P. Olsen, PhD, RN, associate professor of psychiatric-mental health nursing and associate director of the Center for Health Policy and Ethics, Yale University School of Nursing, New Haven, CT; cocoordinator of Ethical Issues: [email protected]
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