by Susan Trossman, RN

Tune into any broadcast or open any newspaper and get ready to be bombarded with a litany of troubling news -- from the discovery of a terrorist cell in Spain to the successful creation of the polio virus in a New York university lab. And while some Americans might want to tune out potential threats, nurses and the nursing profession cannot afford to do the same.

Since the events of Sept. 11, 2001, ANA, its constituent member associations (CMAs) and nurses across the nation have stepped up their ongoing efforts and begun new initiatives to help RNs respond more effectively to terrorist attacks and large scale disasters. While many nurses believe their colleagues are generally better prepared today than they were a year ago, they quickly acknowledge that health care professionals as a whole still have a lot of work ahead of them.

The following are a few of the efforts under way at the national, state and local levels to create a nursing workforce that is fully ready and able to handle future crises.

Local lessons, national actions

When tragedy struck in their backyards, staff and members of five constituent member associations (CMAs) -- the District of Columbia, New York, Oklahoma, Pennsylvania and Virginia - saw firsthand their strengths. For example, nurses who left New York City to attend an association meeting initially were barred from returning Sept. 11, because authorities had placed the city on "lock down." New York State Nurses Association (NYSNA) staff, however, were able to help them gain access and transportation back into the city by providing officials proof of the nurses' licensure. The RNs then were able to return to their workplaces and assist with emergency efforts.

CMAs also discovered their limitations. The Pennsylvania State Nurses Association (PSNA), for example, received roughly 800 calls and e-mails in 36 hours. The jammed phone lines seriously affected staff's ability to place outgoing calls and frustrated many nurses who called in only to get a busy signal. (Since then, some CMAs are looking to install specific emergency response phone lines.)

In a report to ANA's House of Delegates (HOD) this summer, CMA leadership shared the lessons they learned and identified some of the needs that must be addressed to improve nursing's disaster response. Those needs include: developing a system to efficiently handle offers of assistance from nurses and collect pertinent information from them; understanding how various government and private relief agencies interact and how CMAs can best fit in; and promoting the issuance of permanent identification cards for health care workers who could assist in emergencies.

The CMAs also brought forth a resolution to the HOD, which delegates passed, calling on ANA to take the lead in developing nursing's response to disaster events; develop and promote educational programs for nurses about potential threats; and build public awareness about disaster preparedness and response.

"The likelihood of another event occurring is not so remote. The Golden Gate Bridge, the Lincoln Tunnel, the Hoover Dam - all have been talked about as possible targets," said NYSNA President Bob Piemonte, EdD, RN, CAE, FAAN. "No matter where an event happens, nurses will always want to go to the site and help. But they need to be knowledgeable, and an important part of this HOD resolution is education and training."

Piemonte also believes ANA and CMAs need to develop a comprehensive plan to address the mental health needs of victims of terrorist attacks, as well as those of nurses who provide care to victims and their families.

Also at the HOD, ANA unveiled a joint venture with the U.S. Department of Health and Human Services to establish the National Nurses Response Team comprising nurses who could be called upon to assist in administering medication or vaccinating the public. ANA strongly encourages nurses to consider participating in this new initiative. (For more information or to sign up, go to www.nursingworld.org/news/disaster/response.htm.)

ANA is also continuing work it began prior to Sept. 11 and the subsequent anthrax mailings. At the 1999 HOD, delegates directed ANA to collaborate with other organizations to determine the appropriate response to incidents involving mass casualties and weapons of mass destruction. To that end, ANA staff have collaborated with key agencies to disseminate vital health information and have served on several working groups, including one that analyzed hospital systems' current capabilities to respond to a bioterrorist attack and another charged with developing nursing curriculum on disaster preparedness.

Additionally, the ANA Board of Directors adopted in May two position statements developed by the Commission on Workplace Advocacy. The first is called Registered Nurses' Rights and Responsibilities Related to Work Release During a Disaster, and the second is Work Release During a Disaster - Guidelines for Employers.

The education front

Many CMAs and nurse members have been planning or holding educational programs to boost RNs' readiness. Determining what nurses and other health care workers need to know is an art in itself. Some favor a more general approach to emergency preparedness, while others prefer one that's more specific.

NYSNA member Kristine Gebbie, DrPH, RN, has long been interested in the various threats to public health. In her role as director of the Center for Health Policy at Columbia University School of Nursing, she received funding from the Centers for Disease Control and Prevention in 1999 and 2000 to identify competencies public health workers needed to respond effectively to emergencies of any kind. In late 2000, she began working with the New York City public health department to develop training for public health workers. And in August 2001, she provided pilot training for 800 New York City school nurses, who are designated to staff emergency centers in the event of major emergencies.

Since Sept. 11, she has been asked to address nurses locally and nationally to help them become better prepared.

"What I emphasize first is that nurses are not starting with a blank slate when it comes to responding to emergencies," Gebbie said. "Many of the things we do every day or need to know for our practice - basic CPR, first aid, triage skills - will help us in these situations.

"I then focus on systemic issues. Most nurses don't need to know about Class A or B infectious agents. What they need to know is information about how they fit in during an emergency, what their roles are, the chain of command, how they communicate with other emergency personnel. That's what will make or break your response."

On the state level, NYSNA just received a $100,000 grant from the New York State Department of Health - part of a larger federal grant awarded to the state - to increase its readiness in the event of bioterrorism or other health emergencies. NYSNA plans on using the funds, in part, to create and implement a system to ensure that nurse volunteers are trained to respond to emergencies. Leadership also wants to work with the health department to assess the needs of RNs on emergency preparedness and promote training based on those needs.

In Louisiana, some 600 nurses have participated in one of three all-day training programs focusing on the current emergency system and the major chemical, biological and nuclear threats RNs might confront. The programs are a joint venture of the Louisiana State Nurses Association (LSNA) and the East Baton Rouge Parish Office of Emergency Preparedness, according to Carol Cairo, RN, LSNA program coordinator.

"Nurses are the first line of information and defense," said Louis Cataldie, MD, East Baton Rouge Parish coroner and the director of the area's Medical Response System. Therefore, he said, they are key figures in any disaster response plan.

LSNA member Sheila Allen, RN, CNOR, CRNFA, attended one of the programs because she wanted the most up-to-date information on weapons of mass destruction and other harmful agents for her own knowledge and to share with her colleagues at an upcoming Association of periOperative Registered Nurses meeting.

She found learning more about the symptoms of certain agents particularly worthwhile, even though she works in the operating room. "Chances are I wouldn't be one of the nurses to see people who are presenting with the symptoms. But having that information allows me and other perioperative nurses to help as valuable, knowledgeable practitioners."

She added that perioperative nurses' skills translate well to an emergency response, which relies heavily on a coordinated approach. "We are good at working as part of a team, and we can take direction and run with it."

Additional education efforts

The Texas Nurses Association (TNA) entered into a partnership with the state health department and the University of Texas to build a strong cadre of nurses trained to deal with bioterrorism and other major events, according to TNA Executive Director Clair Jordan, MSN, RN.

The first education program - via teleconference - was broadcast to 30 sites throughout the state July 27, and about 1,000 nurses participated. Another six programs are planned.

TNA also is partnering with the American Red Cross to increase the number of nurses prepared to staff emergency centers. Further, TNA will continue passing along the most recent information to nurses, including best clinical practices and early detection and treatment of nuclear, biological and chemical injuries, via all communication forms, including the Internet. (TNA and other CMAs posted information on their Web site and sent mailings to nurses about anthrax during the fall attacks.)

In Florida, Barbara Russell, MPH, RN, conducted a train-the-trainer program for the Florida Nurses Association (FNA) leadership on disaster preparedness. As the director of infection control services and safety at her hospital, she has been immersed in the topic of bioterrorism and disaster preparedness for the past four years. More recently she was appointed as chairperson of FNA's Disaster Preparedness Task Force and is FNA's representative to the State Hospital Planning Committee, which is looking at emergency planning throughout Florida.

In her train-the-trainer program, Russell provided information on past terrorist attacks, agents that might be used in an attack, how to recognize signs and symptoms, methods of transmission and treatment options. She also discussed the importance of nurses' learning the emergency chain of command in their facilities.

Russell believes nurses need to have a basic understanding of the health effects of terrorism, because Americans frequently come to the nurses in their communities with their questions and concerns.

"We're key to helping people keep calm in the event of a disaster or bioterrorist attack, such as anthrax, so we need to be knowledgeable," she said.

At press time, the Wisconsin Nurses Association (WNA) was planning to hold a "Nurse Strategic Planning Summit on Supporting the National Initiative for Emergency Preparedness through Education and Training" Sept. 26-28 in Milwaukee. Nurse leaders from the health department, area schools of nursing and hospital administrations were invited.

Participants were expected to review curriculum development around the issues of bioterrorism and disaster response and national models for education and training of the nursing workforce, said WNA Executive Administrator Gina Dennik-Champion, MSN, MSH, RN.

They also were slated to develop a strategic plan that supports emergency preparedness through education and training of nurses and other health care workers. That plan would be forwarded to the leadership of the public health department for review, comment, and hopefully acceptance.

Building networks, mobilizing nurses

PSNA member Patrick Kenny, EdD, RN, ACRN,BC, BCNA, is an assistant professor of nursing at the University of Medicine and Dentistry of New Jersey. He also is the head of the PSNA Disaster Preparedness Task Force and represents PSNA on two state groups looking at preparedness and bioterrorism events.

Through his state committee work, Kenny helped define PSNA's role in the event of a major disaster and develop a comprehensive disaster plan for Pennsylvania that includes nursing's input. Under the plan, nurses licensed in other states would be allowed to practice in Pennsylvania during designated emergencies, and PSNA would serve as a "feeder" organization to help mobilize nurse volunteers to emergency centers.

Through his work on the PSNA task force, he and his colleagues determined that the association needed to build its nurse volunteer database, which was started informally Sept. 11. The database would include information on nurses' licensure, abilities and contact information.

Kenny said PSNA also plans to work with state officials and nurse employers to ensure that RNs who volunteer during designated emergencies outside their work setting do not lose their income or job. And finally, PSNA is planning ongoing education sessions to ensure that nurses who sign up for the association's database are adequately prepared.

Texas nurses had a huge influence on determining the roles of TNA and nursing as a whole in the state's bioterrorism action plan. Under the plan, TNA will maintain a database called "Ready Texas Nurses." Nurses can become part of the database once they complete a disaster training course, have their credentials cleared and provide current contact information. If the Texas Department of Health calls an emergency, TNA would activate the system utilizing the Internet and other methods. TNA also agreed to accept and screen calls from nurses who are not registered through the Ready Texas Nurses network but who want to volunteer during an ongoing emergency.

Additionally, TNA currently is putting together an oversight committee that will develop standards for emergency volunteers.

In Maine, ANA-Maine President Joe Niemczura, MS, RN, said the association is working with state officials to drum up support for the state's Red Cross branches.

"When the Sept. 11 attacks occurred, we were looking for disaster-trained Red Cross nurses who could drive to New York to help. We had only three," he said. "So we need to break down the obstacles that are preventing nurses in Maine from getting involved."

Sharon Bagalio, RN, is the disaster health services coordinator for the Portland, ME, Chapter of the American Red Cross and was appointed by Red Cross officials in Washington, DC, to serve as her state's nurse liaison. In her latter role, she is charged with recruiting, training and retaining volunteer nurses for disaster response statewide - a role she finds exciting and frustrating.

"Sometimes it's really been a hard sell, because there is a shortage of nurses in Maine. And, many nurses don't want to work as nurses in their free time," said Bagalio, an assistant head nurse at Maine Medical Center.

Bagalio added that some 200 health care professionals called into the Red Cross office in Portland to offer their assistance after the Sept. 11 disaster. But, while many of them had backgrounds in trauma and emergency response, none of them had been trained in disaster health services through the American Red Cross. Further, many seemed to misunderstand the role of the Red Cross nurse in disasters - which is more about assessing needs and providing support and referrals than giving emergency care.

"A big disaster, like Sept. 11, is always in the back of our minds," Bagalio said. "But we have disasters all the time - hurricanes in Florida, fires in Colorado and Arizona. There is always going to be the next disaster, and we want to have nurses trained and ready to go."

Bagalio, however, has begun making headway into the nursing community. This past year, 53 public health nurses received disaster training through the Red Cross. And she is working with hospital administrators to support nurses who go through Red Cross training and who want to volunteer when disaster strikes. Specifically, she is advocating for employers to keep nurses on the payroll while they volunteer during emergencies.

Other CMAs looking to build their volunteer networks include LSNA, NYSNA and the Ohio Nurses Association (ONA). LSNA nurses who participated in the education sessions in East Baton Rouge, for example, are now part of a Parish-wide database. NYSNA is using its health department grant to also create and maintain an up-to-date, computerized list of nurse volunteers that would be organized by specialty and geographic region.

On the district level in Ohio, a group of 40 nurses so far has volunteered to work with officials in three counties to shore up its emergency response plan and determine the best way to involve District 3 members when the need arises, according to District 3 Executive Director Mary Ellen Patton, RN.

Other efforts under way include planning educational sessions on disaster nursing, building its volunteer database, developing an ID card specifying nurses' areas of expertise they could wear when responding to a disaster, and creating a communications system to activate members' response, she said.

Susan Trossman is the senior reporter for The American Nurse.