Together with emergency personnel, community organizations, health care providers, and other members of the health care team, nurses play a key role in carrying out emergency response plans. Before, during, and after disasters, nurses provide education and health promotion interventions to protect the community and keep people safe from environmental hazards. During the emergency response, nurses assist in first aid, triage patients’ needs, direct victims to resources and community support, and continuously assess and monitor patients’ physical and psychological needs. Nurses also assist with community organization through logistical organization of response and prevention needs, such as coordination of blood drives, clothing drives, management of shelters, and other social needs that exist in the community. When disaster strikes, nurses are challenged to use their skills and scope of practice to the fullest to provide the best care for their community.^[1]

The ability to care for and protect vulnerable citizens depends substantially on the preparedness of the nursing workforce. The nursing workforce available to participate in U.S. disaster and public health emergency response includes all licensed nurses (licensed practical/vocational nurses [LPNs/LVNs] and registered nurses [RNs]), civilian and uniformed services nurses at the federal and state levels, nurses who have recently retired, and nurses who volunteer in organizations (e.g., National Disaster Medical System, Medical Reserve Corps, National Voluntary Organizations Active in Disasters, and the American Red Cross). Each of these entities plays a critical role in the nation’s ability to respond to and recover from disasters and large-scale public health emergencies such as the COVID-19 pandemic.^[2]The increasing frequency of natural and environmental disasters, along with public health emergencies such as the COVID-19 pandemic, highlights the critical importance of having a national nursing workforce prepared with the knowledge, skills, and abilities to respond.^[3]

Nurses’ Roles in Pandemics and Other Infectious Disease Outbreaks

When infectious disease outbreaks occur, nurses are called to the front lines to care for patients very quickly. In the past few decades, infectious disease outbreaks have been occurring more frequently and with more intensity, and nurses, along with health care agencies, must be prepared to respond to such emergencies. Some of the ways nurses respond are by doing the following^[4]:

• Tracking disease prevalence and epidemiology of diseases
• Assisting with screening and testing, along with vaccine distribution
• Providing direct care to affected individuals in hospitals and outpatient clinics
• Educating the public and community about disease prevention and treatment
• Providing psychological support to those fearful of the emergency

New infectious diseases require nurses to receive continuing education regarding infection prevention, diagnosis, treatment, and health promotion. This may include gaining new knowledge about medications, transmission precautions, personal protective equipment (PPE), and evidence-based nursing interventions and medical treatments. Nurses must use critical thinking and apply new evidence-based practices to provide quality care to individuals in their community affected by disease.

The Impact of the COVID-19 Pandemic on Nurses

In December 2019 the novel coronavirus, known as COVID-19, was first detected in China. By March 2020 the World Health Organization declared a worldwide pandemic for what has been called the worst public health emergency in the past 100 years. By March 2022 almost 80 million cases were identified in the United States, with over 977,000 deaths. Worldwide, over 488 million cases were diagnosed, with over 6 million deaths.^[5],[6]

The COVD-19 pandemic created a health care environment never before seen in modern times. Nurses were called upon to care for patients, often lacking proper personal protective equipment (PPE) and medical equipment, to properly support patient health. They cared for patients above and beyond the acuity that they normally managed in their area of expertise and provided frequent end-of-life care. They communicated regularly by phone with loved ones of patients who were dying due to quarantine guidelines and visitor limitations. Staffing shortages became critical as illness spread to nurses and their family members.^[7]

As a result, thousands of nurses were still stressed, frustrated, and overwhelmed two years into the pandemic. In October 2021 the American Nurses Association found the following in a mental health and wellness survey of nurses^[8]:

• Over 34% rated their emotional health as not, or not at all, emotionally healthy.
• 42% reported having an extremely stressful, disturbing, or traumatic experience due to COVID-19.
• Among nurses who said they intend to leave their position in the next six months, 48% cited the top reason as work negatively affecting their health and well-being, followed closely by insufficient staffing (41%).

The American Nurses Foundation Executive Director, Kate Judge stated, “The COVID-19 pandemic is not over yet, and its impact will persist for a long time. Its challenges have left the nursing profession in a particularly vulnerable state, exacerbating nurse staffing shortages, and negatively impacting nurses’ quality of life. Nurses are playing a pivotal role in efforts to end this pandemic, so we must ensure nurses are physically and psychologically safe and healthy to function optimally in caring first for themselves, their families, patients, and communities.  A robust nursing workforce is essential to our nation’s health and, therefore, nurses’ well-being and mental health must be a top priority. The data collected from this survey overwhelmingly demonstrate the need to provide consistent and comprehensive support for our nation’s nurses.”^[9]

Preventing and Managing Stress in Disaster Responders

Engaging in disaster and emergency response work is stressful for nurses and first responders. Depending on the nature of the event, sources of stress may include exposure to scenes of human suffering, risk for personal harm, life-and-death decision-making, intense workloads, limited resources, and separation from family members who may also be in harm’s way. Responders can take actions to protect themselves and to manage stress before a disaster or other traumatic event, as well as during the response and recovery phases. These actions can also help when returning home after a particularly traumatic shift.^[10]