Crisis Management

Disasters, both natural and man-made, have increased in frequency and intensity over the past 10 years.^1,2  Multicasualty incidents from mass shootings, floods, wildfires, and the recent COVID-19 pandemic are but a few examples where nurses must be prepared to manage large numbers of patients under crisis conditions with limited infrastructure over an extended period. The Future of Nursing Report 2020-2030 from the National Academy of Medicine calls for reform in nursing education, practice, research, and policy to improve disaster preparedness of the nursing workforce.³  We must begin this preparation in our schools of nursing, continue to advance it within our health systems, and partner with government agencies including our military to maintain readiness for future crises. Although we may not know when the next disaster will strike, we do know it will happen. It is only through preparation that we can improve the outcome.

In this symposium, we explore 3 important aspects of disaster preparedness and management. During the recent pandemic, emergency expansion of practice authority in many states allowed advanced practice registered nurses (APRNs) to demonstrate their full clinical and leadership capabilities. Henry and Wogatske discuss the current and future role of the APRN within current professional organization frameworks and identify opportunities for the APRN to practice at their full scope during a disaster response. In addition to participation in disaster planning, APRNs require education in incident management, intervention, and recovery as well as additional preparation in leadership, ethics, and end-of-life issues to prepare them for their expanded roles in disaster situations.

Throughout history, the US military has repeatedly demonstrated its ability to provide rapid and scalable support during civilian disaster response. Flarity and colleagues describe the capabilities and collaboration needed between civilian and military medical assets during a variety of disaster scenarios. The use of historic exemplars demonstrates the broad and unique capability of our military during disasters.

Anderson and Beach discuss the importance of a multidimensional educational approach in preparing our nurses at the undergraduate and graduate levels; they also discuss the need for ongoing preparation of new-to-practice and experienced nurses. Foundational education in our schools of nursing ideally integrates theory with high-fidelity, interprofessional simulation to provide an experiential context. Beyond this, ongoing education at the health-system level demands integration of bedside nurses and APRNs in hospital disaster planning committees and frequent practice exercises.

Preparing for disaster requires foundational and ongoing education along with practical application through simulation and drills. Additionally, we must apply our experiences from the past to continually improve. Within the chaos of any crisis there are lessons to be learned, lessons that can save lives in the future. We hope that you enjoy this series on crisis management, and that it will be the beginning of your journey to further your knowledge and experience in disaster management.