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.

Steven Litteral, MSN-Ed, RN

Steven Litteral, MSN-Ed, RN, is the Nursing Program Director for Ameritech College of Healthcare.

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