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Nurses receive some disaster training, but as one New York nurse recently remarked, “We learned about a pandemic in school maybe for one day. Like it was literally one slide in one class…” Remedying this problem is a key concern in the Johns Hopkins report, “Recommendations for Improving National Nurse Preparedness for Pandemic Response: Early Lessons from COVID-19” and educators are already taking steps to add pandemic coverage to disaster nursing curricula. DailyNurse spoke to one of these educators, a member of the reporting team, Dr. Tener Goodwin Veenema, PhD, MPH, MS, CPNP, FAAN, about her role in the effort to update disaster training and education for the COVID-19 era. Dr. Veenema is a contributing scholar to the Johns Hopkins Center for Health Security, Professor of Nursing and Public Health, and author of the textbook Disaster Nursing and Emergency Preparedness.
DailyNurse: You must be very busy.
TGV: It’s been insane. I can’t even begin to describe what it’s been like since the first of March—a lot of 12-hour days. Today, I’m actually getting ready for a webinar with the American Association of Colleges of Nursing (AACN), Improving Nurse Preparedness for Emergency Response: Implications for US Schools of Nursing. The webinar is all about the report findings as well as an overview of some of the recommendations we make in the report.
DN: What sort of changes are you proposing in terms of disaster education and training?
TGV: I’ve been writing disaster nursing courses since before 9/11. And of course the focus after 9/11 was much more on deliberate acts of terrorism, and there was concern over natural disasters as always—pretty much the way the book [Emergency Nursing and Disaster Preparedness] was laid out—chemical, biological, and radiation events that may be human-caused. But now, because of the pandemic, the shift has really become much more public health focused.
Clinical nurses actually have to be public health nurses as well.
[At present], nurses get infection prevention and control coverage in school, but it’s at an introductory level. It’s not to the degree of what we’re experiencing now, where clinical nurses actually have to be public health nurses as well. So, we need to give nurses a better understanding of advanced concepts in infection control and prevention, and how to implement what we call intervention and containment strategies—non-pharmaceutical interventions, which includes things like social distancing, the use of masks, and frequent handwashing; closure of schools and businesses, and parks where people congregate.
More than anything else, the pandemic reveals where nurses did not have experience with the proper selection and use of personal protective equipment. It goes beyond nursing. Some of these problems were outside of nursing, for instance, the hospitals had failed to make a real commitment to emergency preparedness—to procure adequate supplies of PPE, or ensure that they had a vendor supply chain that would allow them to ramp up if they needed to order more. So, what I am advocating—and I’m working on a course right now—is to address these issues and strengthen prelicensure and nursing schools, and also continuing education to ensure that nurses have the knowledge and skills that they need not only to participate and survive, and protect themselves in this pandemic, but in future infectious disease outbreaks as well.
DN: As you mentioned earlier, there are many different sorts of disasters. Is there some sort of tool-kit that can increase nurses’ readiness in whatever emergencies might arise?
TGV: I define a prepared nursing workforce as a workforce that has the knowledge, the skills, the abilities, and the willingness to respond to these types of events. FEMA advocates what is called an “all-hazards” approach to disaster planning, which means that communities are charged with coming up with disaster response plans to address each and every hazard that might occur in their geographical area. Now for nurses, I think that they need to have a minimum knowledge base and set of skills on how to respond in an emergency and on how to continue to provide healthcare services within an environment that may or may not be safe.
The thing about a pandemic… is that it’s characterized by uncertainty…. Also, it’s everywhere.
I think that the challenge for the pandemic is, when a tornado or a hurricane hits, the event happens, and then it’s over. We move through the phases of the disaster lifecycle in a pretty straightforward manner. So, even the most horrific hurricanes that we’ve experienced over the past three years, they end. There have been extended periods of recovery—you can make the case that Puerto Rico has not yet recovered from Hurricane Maria—but you can plan for what’s going to happen. The thing about a pandemic, though, is that it’s characterized by uncertainty. For instance, we were anticipating a second wave this fall, but what we’re seeing is, we haven’t finished the first wave, and things are spiking again.
Also, [unlike most disasters, with a pandemic] it’s everywhere; it’s not geographically isolated in one region of the country. And of course, given the total absence of leadership at the federal level, now you have [states that are] basically 50 countries that are forced to address 50 different pandemics. That’s not the way you do it, so we’re failing there.
DN: Nurses have historically been on the front lines of response to disasters. What can be done to adapt the curriculum to provide them with better training and support for nursing in emergency and disaster situations?
TGV: I’m working hand-in-hand with AACN to help write an emergency preparedness competency to go into the revised Essentials document, so that schools of nursing will have a competency to teach to. AACN does a wonderful job with the Essentials documents, which basically serve as guides for curricula for nursing schools. I’m so proud to be working with them to help revise the essentials, publish this report, and then work on developing a five-module course with a company called Unbound Medicine. I produced a disaster nursing app with them back in 2015, and now I’m working with them to produce course content that schools can use to add to their existing courses or add as a standalone certificate to help provide this important information for schools that may not have the resources or the faculty who know how to develop this content or teach it—we’re hoping to do a great service for some of these schools.
DN: You mentioned the uncertainty of nursing in a pandemic. Where are we now?
TGV: We’re not through this. You’ve got California, Texas, Florida, and Arizona on the brink of being completely overwhelmed, and the Carolinas are right behind them. So the next month is going to be very ugly in the United States.
DN: What can individual nurses do to increase their readiness for pandemics?
TGV: They can pursue ongoing education and training as it relates to pandemic preparedness and response. Some of the professional nursing organizations are now offering short courses. I developed one with the National Council of State Boards of Nursing (NCSBN), and we have more that will be coming out.
Dr. Veenema’s AACN webinar talk, Improving Nurse Preparedness for a Pandemic Response: Implications for U.S. Schools of Nursing is now online. Click here to register and gain access to the webinar.