Nurses Not Immune to Stress from Disaster

Nurses Not Immune to Stress from Disaster

Two reports find that RNs are both personally and professionally affected by natural disasters

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.

Working During a Natural Disaster

Working During a Natural Disaster

In October 2012, Rebecca Lee, RN, was working at Bellevue Hospital in New York City. Hurricane Sandy hit, and it hit hard. Lee recalls that all the subways, highways, tunnels, and bridges were closed. Streetlights were out. Robberies and looting was rampant throughout the city. “We had to walk in the middle of the street to stay safe in the meager moonlight,” says Lee.

But she wasn’t outside much. She stayed at the hospital for five days and four nights, working, as she says, “24/7.”

To remember this stressful time, Lee, who runs natural health remedies resource RemediesForMe.com, wrote a memo to herself on October 31 of that year so that she would never forget. The following is what she wrote:

“While the storm worsened, staff secretly stole peeks out the darkened windows, trying hard not to let our fear show to the patients. Most of my patients were bedridden and kept asking how the conditions look outside. All I could say was, ‘it looks okay,’ as their concern wrinkles on their faces momentarily smoothed out.

They must’ve known the storm was getting bad because the rain was beating the windows hard, and their televisions now showed nothing but static. I tried to keep them as comfortable as possible as I saw the batteries on their machines running low, lights suddenly shutting off, and phone lines being disconnected.

After a few short hours, the FDR had completely disappeared under the east river, and the water was quickly reaching Bellevue doors. The scariest thing I saw that night was cars that had been parked next to the FDR were being swept away by the waves. We also lost contact with the outside world. We worked while wondering about the status of our families, friends, cars, and homes. The staff began to wonder how long they would be trapped for.

The next day, it became clear that we had lost all power, food, water, and each minute became more precious than the next. The coast guard, along with hospital staff, formed human assembly lines on the dark stairway, all the way up to the 21st floor. They helped transfer patients by hand, and gave out food and water. Manual machines were utilized, and critical patients were transferred to other hospitals that still had working power.

During the storm, some units pulled together and worked odd shifts to relieve one another from exhaustion and hunger, while other units fell apart and became fierce and chaotic. We had no food, no running water, and no running toilets. After a few days, we were running low on options. Thankfully we had an endless supply of gloves and masks.

Thank you for anyone who volunteered during this time to do all the heavy lifting and dirty work, to make sure everyone was fed, hydrated, and less stressed. I am re-thankful for family, friends, health, food, water, showers, music, clean beds, working toilets, and electricity. On Halloween 2012, I celebrated Thanksgiving.

What I’ve learned through all this: You give and take away.”

Thanks to Lee for sharing her experience.

Have you ever had to work during a natural disaster? Share your experience in the comments.