Nurses Not Immune to Stress from Disaster

That includes nurses.

“When both personal life and professional life are impacted by an adverse event, as occurred in Superstorm Sandy, stress can exponentially increase,” said Victoria H. Raveis, PhD, director of the Psychosocial Research Unit on Health, Aging, and the Community at NYU College of Dentistry. “The responsibilities associated with the profession of nursing add additional demands that increase the risk for role conflict when a disaster occurs.”

She, along with colleagues at NYU Rory Meyers College of Nursing and NYU Dentistry, recently published two reports in the Journal of Nursing Scholarship that offer insights on emergency preparedness, recovery, and resilience. The studies were centered on nurses working at NYU Langone Health’s main hospital during Superstorm Sandy in 2012. Key themes that emerged were communication — both improving channels and the importance of connecting nurses with others during a crisis — and social support.

Preparedness Training Needed¹

To understand how nurses at NYU Langone were impacted before, during, and after the storm, the researchers conducted interviews and surveys with 16 nurses who participated in the mid-storm evacuation of more than 300 patients at the institution’s 725-bed Tisch Hospital due to high water levels.

Raveis and her team explored nurses’ experiences in disasters, assessed the nurses’ challenges and resources for carrying out responsibilities, and uncovered some lessons.

After the interviews, an online survey was sent to all RNs assigned to inpatient units at NYU Langone on the day of the storm. The researchers received 528 anonymous responses, including responses from 173 nurses who were part of the evacuation.

While some nurses had previous disaster training and experience, and a few of them reported feeling prepared during the storm and the resulting evacuation, many working the night of the storm lacked prior hands-on experience or deep knowledge of emergency preparedness.

This lack of comfort with emergency preparedness is not uncommon, noted Eric Alberts, corporate manager for emergency preparedness at Orlando Health in Florida.

“I’ve been going across the United States speaking about the PULSE [nightclub mass shooting] incident, and, unfortunately, we’re finding that a lot of hospitals don’t have an emergency plan,” he said.

“Or if they do, they don’t practice it. And if they do practice it, they’re not really practicing it — they’re just doing a flu shot campaign and calling it an exercise.”

Alberts recommended that hospital and health system leaders do a thorough evaluation of their disaster readiness: “Really look at your processes and your people and see what is available during emergencies. Emergency preparedness and healthcare looks and feels different everywhere you go. And then from that, look at what resources and people are able to help those individuals have a good, efficient, and effective plan.”

The researchers also called for more education and planning for future disasters and they recommend FEMA’s all hazards approach to disaster planning.

Personal Concerns Present

Communication was a challenge during Superstorm Sandy when access to electronic medical records, email, and phone communication was unavailable because of power loss.

RNs reported unlocking medication carts in anticipation of the power outage and handwriting medical summaries for patients being evacuated to other hospitals. Of the nurses surveyed, 72% reported that their primary mode of communication was talking face-to-face and 24% used personal cell phones.

The researchers also found that nurses had their own personal concerns during the storm, worrying about their families’ welfare and personal loss. And while many arranged for extended stays at the hospital before the storm, they reported feeling uncertain about leaving their families and later had trouble contacting loved ones.

The survey found that 25% of nurses suffered property damage or loss, and 22% needed to relocate after the storm. Some respondents reported psychological problems after the storm, including having disturbing thoughts (5%) and difficulty sleeping (4%).

Social support from co-workers, hospital leadership, and loved ones was cited as an important resource in helping nurses cope with the stress of the disaster.

“Our research also shows that maintaining good communication with peers and hospital leaders after the hurricane helped the nursing staff feel more connected and less stressed,” said another of the study coauthors, Christine T. Kovner, RN, PhD, professor of geriatric nursing at NYU Meyers.

This story was originally shared on MedPage Today.