Nurses work every day to give compassionate care to their patients. But when a natural disaster strikes, the duties of a nurse are expanded beyond the workplace. Nurses often heed the call to help, whether the catastrophe is at home or far away. During Hurricane Harvey, the Texas Board of Nursing issued more than 600 temporary licenses. With the devastation that has hit Puerto Rico with Hurricane Maria, more than 300 health care workers have been sent to the area to help.
At work, a nurse’s duties are clear. But what are their responsibilities when disaster strikes? Nurses take a pledge to help the sick in their community, and it’s important to understand what to do before a disaster and be prepared to act. Whether the need is at home or across the country, at a hospital or in the streets, here are five issues nurses face when serving during a natural disaster:
1. Volunteering in an emergency
Volunteering during a natural disaster can be different from state to state. Utah, for example, has a Disaster Medical Assistance Team that can be deployed in an emergency to assist with medical needs in the affected region.
Each state may also have different licensing laws for nurses traveling to help with the disaster response. After Hurricane Harvey, Texas gave out hundreds of temporary licenses to out-of-state workers, but the state’s law also allowed any nurse with a license in good standing in their home state to respond to the crisis.
Whether a nurse is volunteering in their state or elsewhere, it is important to check on the licensing laws first.
2. Caring for sick and wounded at a hospital
Although a hospital is the best place for injured and ill people to seek treatment, it may have a host of issues during a natural disaster. From power outages to physical damage to the building, it may seem less like a place of refuge for patients.
Nurses will need to assess the individual needs of their patients as much as any other time, but with the added difficulty of the emotional strain on each patient. They will also need to ensure they can continue to provide appropriate care if any equipment is damaged or if there is a greater need for resources than the hospital can provide.
3. Ethics in triage situations
Nurses are usually able to give the best care they can to their patients, but they may face a triage situation in an emergency.
As some responders found during Hurricane Katrina, they had to pass over patients with mortal injuries to treat someone who had a fighting chance. Depending on the scope of the disaster, nurses could be faced with similar ethical dilemmas and be forced to choose the patient with the best likelihood of survival. Making these decisions can be extremely difficult, but necessary when resources are limited.
4. Evacuating patients when a hospital closes
What happens when the lifesaving services of a hospital are no longer available? Despite backup generators and other resources, sometimes a hospital cannot continue to function in a disaster and patients must be sent to other facilities.
One town in Texas faced this problem after the water pump broke and water supplies were cut off after Hurricane Harvey. At least 17 hospitals closed throughout the state, with more than 1,000 patients sent to other facilities.
When patients must be moved to another hospital, nurses are critical to their safe transfer. From the sickest patients on ventilators and needing constant care down to newborn babies, nurses will need to provide ongoing care until the transfer takes place.
5. Caring for themselves and their families
During a natural disaster, nurses may be unable to leave the hospital to check on their families or get adequate rest. For their well-being and that of their patients, they will have to take the time to care for themselves when possible.
Nurses must take appropriate safety measures to ensure they are not injured while trying to help others. It is also important to be prepared at home to help take care of the whole family whether the nurse is at home or work when a disaster occurs. A nurse will be called on to use their skills to help others, whether it is their family or patients at a hospital.
Nurses pledge to help their community whenever and wherever they are needed. They are the ultimate Good Samaritans and can be a vital resource during a natural disaster. Preparation is the key to being ready to act when called upon and volunteer to help heal in an emergency.
When you start your first nursing job, you will be paired with an experienced nurse, also known as a preceptor. Your preceptor will help you learn your unit’s policies and procedures as well as your nursing responsibilities. Here are a few ways to make the most of your nursing preceptor training experience:
1. Get to know your preceptor.
You will be spending many hours with your preceptor, so it is important to build a relationship with them. Ask them questions about their life, why they became a nurse, and what they enjoy most about their job. Communicate with them about what your learning style is and how they can help you succeed. Be honest about any areas where you tend to struggle or might need additional assistance with.
2. Be willing to learn.
Every minute you are on the unit with your preceptor is an opportunity to learn. Watch the way your preceptor interacts with patients and listen to the way they phrase questions. If you don’t understand something, don’t be afraid to ask about it. Knowing the “why” behind your unit’s practices will help you remember them.
3. Strive to overcome differences.
You may find that you have a different personality than your preceptor. Your preceptor might be outgoing, while you might tend to be reserved and shy. This can cause a strain on your relationship, but it doesn’t mean that the relationship is doomed for failure. Try observing the way that your preceptor’s personality influences the way that they interact with patients and see if you can incorporate their positive qualities into your nursing care.
4. Don’t be afraid to ask your preceptor for help.
It’s okay to admit that you don’t know something. Remember that you are in training and you are not expected to know everything. It is far better to admit that you don’t know something than to endanger your patient’s life to maintain your pride. If you are not 100% sure about what you’re doing, ask your preceptor for help. If you are feeling overwhelmed, let your preceptor know that you need assistance.
5. Debrief with your preceptor after each shift.
It is helpful to sit down with your preceptor after each shift to discuss what went well and what you need to work on. Taking time to reflect on your strengths will build confidence and reflecting on your weaknesses will help you grow. If your preceptor does not have time to sit down and have a discussion, try writing down a reflection of your day and have your preceptor give feedback on what you wrote.
Most nurses at some point in their career will have to work night shift. The grueling hours can take their toll on your body and your life, so it is important to focus on taking care of yourself. Here are a few suggestions for how you can be healthier (and happier) while working night shift:
1. Find a sleep schedule that works for you.
It is important to find a sleep schedule that works for you while working night shift. Some people can switch back and forth between day shift and night shift simply by taking long naps the day before they work (e.g., sleep 10 pm – 6 am and nap 3 pm – 5 pm). If you find you are unable to take naps, try sleeping in late the morning before you work (e.g., sleep 2 am – 10 am). You may also find that your body functions better with only a partial switch in your sleep schedule, so that you stay up later at night and sleep later in the day, even on your days off (e.g., sleep 4 am – 12 pm on your days off).
2. Drink caffeinated beverages (in moderation).
Many night shift workers are dependent on caffeine for survival. If you are someone who relies on caffeine to stay awake during your shift, be sure to stay away from energy drinks that are loaded with sugar and large amounts of caffeine. Instead, drink coffee or tea. Remember to stop drinking caffeinated beverages around 2 am to avoid being unable to sleep later in the morning.
3. Fuel your body with healthy foods.
It may be tempting to binge on sugary foods to feel energized, but these foods will cause your blood sugar to crash and your stomach to rumble shortly afterward. Fill your lunch box with high protein foods that will help you stay full longer, and fruits and veggies that will help your body feel refreshed instead of sluggish. Try packing items like apples with peanut butter, salad with fruit and nut toppings, or a brown rice veggie bowl.
4. Practice good sleep hygiene.
One of the most difficult parts about working night shift is having to sleep during the day. By practicing good sleep hygiene, you will be able to fall asleep faster and stay asleep longer. Try investing in a good set of blackout curtains and earplugs to simulate the quiet darkness of nighttime. Avoid watching TV or looking at your phone before you sleep, and be sure to turn your phone to silent mode to avoid notifications that will wake you up. Before you crawl into bed, take some time to unwind and relax by stretching, reading, or meditating; this will help signal your body that it is time for sleep.
5. Stay hydrated.
Staying hydrated throughout your night shift will help your mind stay alert and your body feel energized. Your body is made of over 60% water, and water fuels almost every bodily function. The average woman should drink approximately 2.7 liters of water, and the average man should drink 3.7 liters of water per day. If you’re not a fan of plain water, try adding slices of fruit to your water for some extra flavor.
6. Seek professional help if needed.
Some people experience headaches, insomnia, and nausea while working night shift. Give your body a month or so to adjust to your new lifestyle, and if you continue to struggle, talk with your doctor. A doctor may be able to advise you on how to treat and manage your symptoms.
At my nursing school pinning ceremony, the professor informed my graduating class that we would all become leaders. She gave her famous “oh the places you will go” speech as we all listened, and excitedly dreamed of our futures. In that moment, I don’t truly think I thought I would become a leader, innovator, or change maker in such a diverse and large field. Little did I know she was correct I would become a leader. Nurses are all leaders in a variety of ways.
A Typical Day as a NICU Manager
My day normally begins with a very lengthy to-do list. I enter the unit or my office and the organized chaos begins. My day is filled with meetings, completing tasks such as scheduling for 180 staff, managing time and attendance for 180 staff, rounding on patients, families, and staff—and much, much more. Often at the end of the day I look back at the to-do list, and I have accomplished none of the tasks that were high priority for the day.
Being flexible and adapting to the needs of the unit is a quality one must possess to become a nursing leader. Prioritizing tasks is helpful, but understanding that often priorities change depending on the needs of patients, families, and staff is how leading a large NICU is accomplished. Like the life of a preemie, the life of a NICU manager has many ups and downs.
Currently, as an organization we are working to obtain Magnet designation. Empowering nurses to be leaders, innovators, and change makers is very challenging. Recently when speaking with a physician, he compared NICU nurses to mother lions, and this comparison is fairly accurate. NICU nurses are advocates and the voice for the tiniest patients each and every day. NICU nurses are protective and territorial when caring for these tiny patients. They nurture them from 400-500 grams (and sometimes less) to discharge three to six months later. NICU nurses not only provide care for these tiny patients, but they also care for their parents/caregivers and are emotionally attached to these tiny humans and their families.
Convincing a NICU nurse to change a process or method that they have been using is often met with lots of resistance. Could this be generational, cultural, or learned? Possibly, but part of my job as a manager is working with the diverse, multidisciplinary team to provide quality, evidence-based care for all patients in the NICU. Finding a way to change the culture or resistance to improve practices is one of the hardest aspects of my job, and can be physically and emotionally just as draining as being a bedside nurse. I have found that listening to staff and families and asking for their input while providing the “why” behind change has become one of the greatest tools I have as a leader. Asking or empowering staff to take part in problem solving has also become a very useful skill that I am learning and getting better at each day. Becoming a NICU manager does not make a NICU nurse’s personality change. We simply protect different territories and advocate in different ways than before.
Being a NICU manager is a fine balancing act that I am still working to perfect. My inbox is always full, and just when I think I have it empty another problem, issue, or task is waiting. The NICU is a 24/7 operation that never stops, and rarely slows. Although I find it difficult to step away from the NICU at times or put down my electronic device that my email is constantly updating on, I have recently discovered that this pause makes me a better and more focused leader.
As a leader and in life I attempt to live each day, knowing not what tomorrow brings, but being optimistic that what I am doing today will impact positive change, and lead to innovations and improvements for future NICU patients and families. It is often said that it takes a village to rear children. It also takes a village to manage a NICU.
October is National Breast Cancer Awareness Month, which is a great time for nurses across the country to educate their patients about the disease and raise public awareness of the benefits of healthy lifestyles in reducing the risk. Breast cancer is the most common cancer among women worldwide; however, it can be found in men as well. Currently, there is no cure for the disease. Therefore, the earlier it is identified, the better the outcome.
A nurse’s role in breast cancer prevention is crucial, and there are several ways that you can help patients reduce their risk. It is important that you have the knowledge and are up to date on current recommendations for screenings as well as other methods related to the diagnosis and evaluation of the disease. Raising awareness is an important first step in the battle against breast cancer.
Here are four ways you can help your patients:
1. Encourage women to become familiar with what is normal for them through breast self-exams.
This will help women detect any unusual changes in their breasts early. Most women know what is normal for them; however, the awareness may be concealed. For men, signs to watch include a lump felt in the nipple, pain, and an inverted nipple.
2. Recommend breast screening based on age group, family history, race, and ethnicity.
The American Cancer Society recommends that women who are at an average risk of breast cancer should begin annual mammograms at age 45 and should get mammograms every year. Women age 55 years and older should get mammograms every 2 years. The risk is increased in those with a first-degree relative (such as a mother, sister, or daughter) with breast cancer. White women are slightly more likely to develop breast cancer than African American women.
3. Encourage healthy lifestyles.
Educate patients on the health benefits of eating more fruits and vegetables; being active and maintaining a healthy weight; limiting alcohol consumption; staying away from tobacco; and reducing exposure to radiation.
4. Offer support.
Encourage women and men to talk about their concerns regarding their risk of developing cancer, breast screening, and available treatments. It is important that your patients have as much information as possible about breast cancer and effective prevention strategies. Mortality from breast cancer can happen at any age group, and developing awareness of the risk factors plays a critical role in prevention.
Working for the tiniest and youngest of patients may be tough, but it also has its rewards. We spoke with Aileen E. Takeshita, RN, BSN, CCRN, Program Coordinator—Education/NICU at Adventist Health White Memorial, and she took time to answer our questions about her experiences being a neonatal nurse.
What follows is an edited version of our Q&A.
As a neonatal nurse, what does your job entail? What do you do on a daily basis?
As an NICU nurse, I work with newborn infants born with a variety of problems ranging from prematurity, birth defects, infection, cardiac malformations, and/or surgical problems. These babies usually experience problems from the time they’re born or shortly after birth. I work closely with a multidisciplinary team to provide clinical care to our tiniest patients. Our multidisciplinary team consists of doctors, nurses, lactation consultants, social workers, pharmacists, OT/PT/ST, and respiratory therapists. Not only do we care for the baby, we also care for the family. We provide them with psychosocial support during this stressful time.
Why did you choose to work in the NICU? How long have you worked there? What prepared you to be able to work in this kind of environment?
It sounds cliché, but I always knew I wanted to be a nurse. I thought it would be in Labor and Delivery. And, I actually started off on the path to becoming a nurse midwife. I worked for a smaller community hospital. White Memorial was the regional center that we would send our sick babies to. Every time they would come pick up our sick babies I would be more and more intrigued with the skill set the team had and their ability to care for such little patients.
I’ve worked at White Memorial for 23 years.
I don’t think anything really prepares a NICU nurse for what they experience or see. But having a love for nursing, and, particularly a love/passion for moms and babies helps. If you can always remember why you got into nursing and who you serve, it will help you get through the tough shifts.
What are the biggest challenges of your job as a neonatal nurse?
I think the biggest challenge these days is providing quality health care in an ever-changing financial world. It’s not easy to provide care to a low-income population. They are usually sicker because of lack of means or resources. And every day the face of health care changes—payment is less, requirements are more. Most of us serve this type of population for the love of the community and its people.
What are the greatest rewards?
At the end of the day, the greatest reward is a genuine thank you from the parents or family. Of course, it is always sending a baby home. The harsh reality is that not all babies go home. But when a mother, father, or family member pulls you aside, gives you a hug, and says “Thank you for all you did to help me and my baby,” that’s the reward.
I live in this community. In 23 years, I’ve taken care of a lot of babies. I see these families [outside of the hospital]. And they always remember me and are so excited when they can say “Look at my baby. He/She is doing so well now. Thank you!”
What would you say to someone considering this type of nursing? What kind of training or background should he or she get?
I would tell someone considering this type of work to love what they do and love the community they serve. Know that they will not only need to be sharp with their clinical skills, but they will also need to be supportive of the mother and family. And to remember that they are the advocate for our tiniest patients who can’t speak up and tell us what’s wrong. They need to be like policemen…protect and serve.
I strongly believe future nurses should volunteer at the hospital where they are considering employment and in the department where they want to work. That way, they get a true feel if that’s really the place for them to be.
Is there anything I haven’t asked you about being a neonatal nurse that is important for people to know?
I love being a NICU nurse. There are so many opportunities for NICU nurses. It’s a great place to be that encompasses your clinical skills as well as your psychosocial skills. You don’t just take care of one patient. You take care of an entire family. You are a teacher—always educating the family about what’s going on. There are definitely days that are challenging. But, most of all, it’s really rewarding.