Will Nursing Shortage Affect Response?

jnette, ASN, EMT-I · Sep 30, 2002

If (when) that were to occur, would the nursing shortage even be remembered? Somehow this may sound naive and idealistic, but I do believe we will react as a "PEOPLE" and not as nurses disgruntled (and rightfully so) about the many the failures of the "system". I believe we would be "johnny/janie-on-the-spot", volunteering, pay or no pay, working and helping 'til we fell over from exhaustion. I don't believe the shortage would be an issue or play a role. Nurses would come out of retirement to help, CNAs, EMTs, Paramedics, and nurses from all walks of life and every age group would appear out of nowhere.

Why do I say that? I know the American heart...we squabble and fuss and fight amongst ourselves with endless glee... but when the sh** hits the fan, we're the "first responders" and all else is forgotten until the job at hand is done. The heart of the people is what makes us great.. regardless of our differences, we pull together when it counts. And we give and give and give of ourselves 'til it hurts...and never notice the pain when it's someone else's pain we're attempting to soothe. America has a whole lot of "NURSE" in her blood. Shortage or no, the nurse will show!

-jt · Oct 7, 2002

The question nurses organizations are asking is will there be enough nurses TO respond. In NY, the state legislature has been asking that too & they are doing a few things about it:

Emergency Preparedness Grant

The New York State Nurses Association (NYSNA) has received a $100,000 grant from the New York State Department of Health (DOH) to prepare for possible incidents of bioterrorism and other health emergencies.

The funding is part of $34 million provided to the state by the federal government. The money will be used at the state level to expand laboratory capacities, improve communications, and support training. A portion is being distributed to county governments and to healthcare institutions and organizations, including NYSNA.

NYSNA plans to use these funds to:

* Establish and maintain an up-to-date, computerized list of volunteer nurses, organized by specialty and region.

* Identify nurses who could be available for a speakers' bureau.

* Develop and implement a mechanism to assure that volunteers are trained to participate in an emergency response.

* Work with DOH to assess needs and promote training for nurses on emergency preparedness issues.

* NYSNA will collaborate with other agencies to coordinate emergency preparedness training programs.

* Develop a plan for staffing a toll-free phone line that could be used to link nurse volunteers from around the country during an emergency.

"After 9/11, we were inundated with calls from nurses who wanted to help," said NYSNA Deputy Executive Director Tina Gerardi. "We need to know before an emergency which nurses are willing to volunteer in emergencies, how to contact them, and their areas of expertise."

Helpful Links Online

At the NYSNA 2001 Convention, a task force was formed in response to nurses' concerns about the long-term psychological effects of the events of Sept. 11. Task force members searched for areas that were in need of more information. One such area was anniversary reactions. Nurses began identifying such reactions when the weather turned warm this spring.

"As the one-year anniversary date approaches, nurses need to be prepared for emotional responses among their patients, colleagues, and themselves," said Candy Dato, RN, task force chairperson. "We must continue to heal people, because the main purpose of terrorism is to traumatize the living."

Dato said research studies confirm what New York nurses already know: There are high rates of post-traumatic stress disorder among adults and children, especially in New York City.

Links have been set up from the NYSNA Web site (http://www.nysna.org) to informational materials identified by the task force that could assist nurses in helping others and themselves get through the anniversary date. The links will enable them to find the most current information from sources such as National Institute of Mental Health, the American Psychological Association, and the National Center for Post-Traumatic Stress Disorder.

Resources are organized according to general information, mental health, research, fact sheets, and Power Point presentations. One of these presentations was created by task force member Mary Martin and will be given at the NYSNA Annual Convention in September.

To access the information, go to http://www.nysna.org and click on "Nursing Practice" and then on the heading "Post 9/11 Coping and Healing Resources."

http://www.nysna.org/publications/report/2002/july/post911.htm

also:

Terrorist Attacks Trigger RN Response

http://www.nysna.org/PROGRAMS/NPS/9_11update.htm

Sleepyeyes · Oct 7, 2002

Thanks jt, for the info. You've always got such terrific stuff to share :)

-jt · Oct 7, 2002

This is another aspect of the nursing crisis that no one but nurses ever thought of before & didnt listen to nurses arguments on. After Sept 11, 2001, the powers that be got a rude awakening. Now the nursing shortage has taken on a more serious meaning for them. The fact that there may not be enough nurses to respond to a national disaster or attack is underscoring our efforts in state legislatures & in DC. In the meantime, in NY, efforts are being made to effectively train the ones we do have:

Bioterrorism - Are Nurses Prepared?

by Nancy Webber

New York State Nurses Association

In a recent episode of the popular TV show, "ER", the staff of the world's most famous emergency department was faced with two suspected cases of smallpox.

What followed was confusion: physicians searching through old CDC posters to identify symptoms, uncertainty about isolation procedures, and a climactic moment when quarantined patients in the ER tried to break down the doors.

Would New York hospitals be thrown into such a panic? After Sept. 11, it's less likely. Healthcare providers at every level have been working hard to prepare for the unthinkable - an attack in which infectious agents are used as weapons.

Hospitals develop emergency plans

In a letter to hospital CEOs this spring, the state Department of Health urged all facilities in the state to develop plans for responding to bioterrorism and to share them with local public health departments. Hospital emergency rooms are to closely observe incoming patients and identify disease clusters in order to quickly identify bioterrorist attacks.

"There's been a lot of activity since the fall," says Kristine Gebbie, director of the Center for Health Policy at the Columbia University School of Nursing. "A lot of money is going into training and increasing the basic level of knowledge about likely agents used in bioterrorism."

In late May, the U.S. House of Representatives voted to spend $4.6 billion over the next two years to help hospitals prepare for bioterrorism and to build stockpiles of vaccines. It includes education programs for emergency medical personnel.

Gebbie, a registered nurse, has been speaking before nursing groups about her research into what healthcare workers need to know for emergency preparedness. She hopes to expand this work into developing core competencies in bioterrorism for public health workers.

Across the state, hospitals are updating emergency plans, upgrading facilities and equipment, and filling in their staff's educational gaps. A database has been developed by the New York City Department of Health to identify fever clusters among emergency room cases, which can be early warnings of a bioterrorism event. The state DOH is now working to implement this system beyond the city.

A crash course in the unthinkable

Peter Allar, a nurse educator in the emergency department at St. Vincents Medical Center in Manhattan, is responsible for training and updating staff on responding to bioterrorism. They had a lot to learn. "Before Sept. 11, there was one decontamination shower near the emergency department, but no one knew where it was or how to use it," he said. "Now there are four permanent showers and more that can be set up quickly if needed."

Allar has created a four-hour course that he has presented to the nursing staff and to "anyone associated with the hospital," including volunteers. He plans future training with the hospital's community health staff.

Like most healthcare providers, Allar knew very little about bioterrorism before Sept. 11. Since then, he's given himself a crash course, attending a two-day training in hazardous materials and reading all the articles and books he can get his hands on.

If there is an outbreak of anthrax or smallpox, the first cases will come through the ER. Allar reminds emergency nurses of their crucial role in recognizing the symptoms and preventing further infection. "You can be the nurse that lets someone in and infects everyone because of what you don't know," he says, "or you can be the nurse who has the information and saves New York City."

During the training, Allar provides an overview of materials that have been used as weapons before and could possibly be used again: toxic chemicals, infectious agents, nerve gas, cyanide. He gives everyone a chance to put on an OSHA suit and to operate the hospital's decontamination showers.

It's a grim subject, but the key to Allar's message is that nurses are not helpless in the event of a terrorist attack. "The first thought is, 'We're all doomed - it will be the end of life,'" he said. "But if something happens, we can do a lot to keep people alive and bring people back." St. Vincents now has 300 anti-cyanide kits and will soon have anti-nerve agent kits as well.

Meg Barry, a nurse educator at Columbia-Presbyterian Medical Center, has been giving Grand Rounds presentations to nurses on bioterrorism preparedness. She believes that training will have to be continuously updated.

"Recently I saw an article about the Indian Point nuclear plant and the evacuation plan in case of an incident there," she said. "Depending on which way the wind is blowing, radiation could affect 2 million people. We need to be trained in responding to radiological emergencies as well."

Hospitals are also focusing more on security. Many facilities have restricted access as never before. At Columbia Presbyterian, access to the hospital's air and water systems is locked. Plans are now in place to keep the hospital from becoming contaminated in a bioterrorism emergency.

Learning from the Israelis

Nurses involved in bioterrorism training recognize that the programs must be continually updated. A long-term commitment of time and money is necessary. And there must be an ongoing effort to improve coordination and communication among various health and emergency agencies.

Jacqueline Merrill, a nurse researcher at Columbia, traveled to Israel in December 2001 to observe emergency preparedness there. She found a society where disaster response has been honed to an exact science. "Their state of readiness is far superior to ours because their level of threat is so much higher," she said.

Israel is roughly the size of New Jersey, with 24 hospitals in the entire country. Its Home Preparedness Branch is responsible for ensuring that health personnel, police, fire, and the military work together in the event of a terrorist attack. Merrill observed two emergency drills during her visit, one announced and one unannounced, that involved upwards of 1,000 people.

The Israelis have done a lot of research into how the public will respond in an emergency. According to Merrill, 70% of the population can be expected not to panic. "People will behave rationally if they are given the right tools in terms of guidance and resources," she said. "Information provided without clear, specific guidelines for action can cause anxiety."

Emergency response in the U.S. will be much more difficult to organize, because of the multiple levels of government agencies and a less homogeneous society. But the continuing threat of terrorism makes cooperation essential. And there is no doubt that emergency nurses and public health nurses will be on the front lines.

The researchers at Columbia have found that, during an emergency, the importance of various nursing skills is inverted. Usually, a nurse needs a wide range of clinical skills and uses relatively little managerial ability, as most of that is taken care of by the hospital structure. In an emergency, a nurse's organizational skills become paramount while the range of clinical skills required may be limited to a few basic treatments.

"We need to find out what we don't know," said Gebbie. "We need to find out what it will take to keep training fresh. It's going to take time, and staff time in hospitals is budgeted down to the last millisecond. But without this commitment, we won't have the kind of prepared work force we're going to need."

NYSNA has an online course entitled "Biological Agent Exposure: What RNs Need to Know" available at http://www.nysna.org. The cost is $10 for NYSNA members and $12.50 for nonmembers. Log on and learn today!

Bioterrorism Rapid Response Card

The New York State Department of Health has developed a Bioterrorism Rapid Response Card that folds to pocket size. It contains guidelines on recognizing bioterrorism-related illnesses, phone numbers for reporting suspicious illnesses or disease clusters, and the symptoms and treatments for the most common biologic agents, including anthrax, smallpox, and viral hemorrhagic fevers.

One copy of the card is available free of charge to NYSNA members. To order, members may call the NYSNA Practice and Governmental Affairs Program at 800.724.NYRN, Ext. 282 or e-mail. Make sure to include your mailing address. Non-members may call the NYS Department of Health.

http://www.nysna.org/publications/report/2002/jun/bioterror.htm

jnette, ASN, EMT-I · Oct 7, 2002

Good responses, great info! Thanx! Guess my thoughts were more along the line of the shortage reflecting all those who have gone on to do other things out of being dissatisfied with nursing, yet still retain their licences...

-jt · Oct 7, 2002

They will come out of the woodwork in an emergency but as we saw in NYC after the first hours of the Sept 11 attacks, only those who have emergency preparedness training will be allowed in to work as nurses in the aftermath. After the inital response, evacuation of lower Manhattan where everyone was helping everyone, & the immediate need to tend to the walking wounded was over that first day, one of the most frustrating things for RNs in the aftermath of Sept 11 in this city was that so many of them were available to assist & wanted to help in the days that followed but were turned away as Red Cross trained RNs from other states came in to take over. The call kept going out for disaster trained RNs from other states like Virginia & Arizona, and here were all these NYC RNs - right here but not allowed to do anything. NYC RNs were even turned away in favor of non-RN Red Cross workers - because we were not trained in what was needed in the aftermath & they were - ie: MASH triage, on-site organization, disaster prioritizing, disaster relief, survivor/victim counseling, etc. There was even an article written about how frustrated the NYC RNs were over this. The link is at http://www.nysna.org/news/press/pr2002/pr081402.htm

A Red Cross RN was quoted as saying they need organization & people who know what they are doing there - not a whole bunch of nurses charging in there without any sense of direction. So we were kept standing on the sidelines, watching RNs from all over the country come in to take care of our city. A lot of NYC RNs, pissed at being kept out of helping their own city, signed on for Red Cross emergency training after that. So even retired or inactive RNs would be able to assist in the aftermath of a national disaster - IF they have had Red Cross emergency training.

Sleepyeyes · Oct 7, 2002

Thanks jt; I'm signing up.