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Nursing Economic$

On Leadership

Everyone likes a certain level of predictability. But into our personal and professional lives will come episodes of pure chaos where nothing can be predicted accurately. Fires, earthquakes, floods, tornadoes, mass shootings, terrorist acts, refinery explosions, hurricanes … the list goes on and on. Consistently responding when disaster strikes and unselfishly serving with incredible intelligence and compassionate hearts in any situation are nurses.

Nurses in Disasters

Nurses have a long history of rising to the occasion whenever there are disasters. According to the Society for the Advancement of Disaster Nursing (n.d.), nurses have understood the importance of civic responsibility since Florence Nightingale stepped forward with her personal response to the Crimean War. Today nurses not only respond bravely when disaster hits, but also ensure the population is ready through public education and disseminating information. As we brace for endemics, disasters brought on by climate change, natural disasters, disasters induced by humans, and emergencies in our neighborhoods, the essence of nursing is to manage through the chaos to save lives and prevent adverse outcomes.

Health Care in Disasters

Health care is a complicated and unpredictable business. Many organizations and businesses are built on linear functions. Health care is anything but linear. There is incredible variation and continual unplanned changes/emergencies that defy prediction. Staffing on a “normal” day can try the souls of the best people. But when chaos hits, it takes a village to maintain patient safety and staff effectiveness. Burnout and “moral injury” can be the fallout of ineffectively handling everyday staffing; in emergencies the challenge is greatly exaggerated. We are challenged to create effective systems to save staff and patients. We must plan for disasters with the right technology, information, and training.

Leadership and Managing through Disasters

We all know that training, mock drills, maintaining effective readiness, and selecting the right technology for any situation is an essential competency of nurse leaders. When crisis hits, relying on the knowledge and “muscle memory” of past drills and education are invaluable. Unfortunately, disasters are not always predictable. So, one of the best leadership tools is having a well-prepared staff who can think for themselves and act automatically in a time of crisis. Barton (2008) noted that successful leaders have an action plan and respond quickly. Those

Chaos, Teamwork, Compassion, and Leadership: Disasters and Nursing’s Finest Hours Karlene M. Kerfoot

Nurses come from a long history of rising to the occasion whenever there are disasters. As we brace for endemics, disasters brought on by climate change, natural disasters, disasters induced by humans, and emergencies in our neighborhoods, nurses manage through the chaos to save lives and prevent adverse outcomes.

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who do not, fail. Veenema (2012) explained that often nurses and nursing leaders assume they are not emergency responders and do not need to understand disaster nursing principles. Yet, nurses often find themselves on the front lines when disaster strikes. Kayla Miller, a critical care nurse, found herself in that situation as she was running from the gunfire during a mass shooting in Dayton, OH, but heroically stopped to perform CPR on wounded people on the sidewalk (Stump, 2019). The all too common occurrence of disasters means nurse leaders are expected to direct nursing practice in crisis situations and be prepared to work in command centers and other emergency venues. Veenema (2012) offers a useful “Toolkit for Disaster Response” to guide nurse leaders in the chaos. However, there is more to disaster nursing than protocols and toolkits.

Teamwork, Compassion, and the Human Side of Disasters

Bonnie and Mark Barnes, co-founders of the DAISY Foundation (www.daisyfoundation.org), have heard many stories of heroism and exceptional compassion in the 20 years since the foundation was started to honor nurses who provide extraordinary care, just like the nurses who cared for their family and son. Bonnie Barnes, FAAN, notes that while mock drills and education for disasters are essential, the real essence of success in disasters is teamwork. Chief nursing officers (CNOs) and nurses who participate in disasters often name teamwork as the key to successfully creating excellence in care for patients and each other during and after these horrific events. These testimonials from DAISY Award nominations and many others support Bonnie’s conclusions that “Teamwork creates miracles.” • Liz Dickinson, CNO, Adventist Feather River

Hospital, Paradise, CA, noted teamwork is the essence of successful outcomes in disasters and was vital as heroic nurses evacuated patients at the facility during the California fires of 2018.

• Emory Hospital faced the crisis of caring for the first patients in the United States with Ebola virus. Emory “Team Ebola” received the DAISY

Team award for its robust, highly professional team functioning in a competent, collaborative manner, working together to achieve excellent outcomes which exemplifies teamwork as the key feature of success (The DAISY Foundation, 2019a).

• In the aftermath of the Pulse Nightclub shooting in Orlando, FL, Sarah Duran, BSN, RN, said that there was nothing but cooperation and commitment that night at Orlando Regional Medical Center as the victims came to the hospital. “I remember standing in the trauma bay as it was beginning, thinking that I couldn’t believe this was happening,” she said. “I think we were all like that. There was no stopping point, they just kept coming in, but there was no one yelling at each other – just teamwork” (Jimenez, 2016, para 9).

• When a car crashed through a wall into the emergency department at Vidant Medical Center-Greenville, NC, the nomination for the DAISY Award stated: “Thank you for doing what you always do, even when there was smoke, and screaming, and doors slamming, and people running. We saved the day. And we should live in pride that as a team we are always saving the day, in little ways and big! You all are my heroes, my coworkers, and my family. And I am proud of you. And of our team” (The DAISY Foundation, 2019b, para 3). Compassion and caring are also important for

teamwork and the ability to create excellence in outcomes at the time of disasters. Compassion is one of the essential characteristics of excellence in nursing but can also lead to distress. According to Todaro-Franceschi (2019), the ability to feel as others do and to deliver person-entered care because of compassion motivates people to go out their way to help others. Compassion helps us see others as human beings and gives us the ability to suspend stereotypes and see the human being. After the Pittsburgh Synagogue shooting, several Jewish doctors and nurses cared for the shooter. Ari Mahler, a Jewish nurse who cared for the assailant, said “The fact that I did my job, a job which requires compassion and empathy over everything, is newsworthy to people because I’m Jewish. Even more so because my dad’s a rabbi” (Pengelly, 2018, para 5).

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Secondary traumatic stress along with burnout is known as compassion fatigue and is a sequela common among people who work closely with victims of disaster and trauma. It was first diagnosed in nurses in the 1950s. When the disaster is over, nurse leaders are obligated to help people through the aftermath of what they have experienced. Often nurses have difficulty living with the memories of the events they witnessed. And for other nurses who did not participate in the disaster, survivors’ guilt will often haunt them. Debriefing and utilizing professional teams to help people work through the challenges of the disasters is important. For many, finding meaning in the disaster is often hopeful (Todaro-Franceschi, 2019). After the Pulse Nightclub shooting, Susan Duran said her recovery began when she later saw her patients alive in the hospital due to the incredible work she and her colleagues did that night. She saw how important nurses are (Jimenez, 2016).

‘I Was Just Doing My Job’

Mark Barnes, FAAN, is often taken aback at DAISY Award ceremonies when the nurse who receives the award is often surprised and says humbly, “I was just doing my job.” In his view, nurses are incredible heroes because they unpretentiously do what they need to do and are driven to alleviate human suffering.

In times of disaster, nurses are there to do their work and to manage chaos with compassion through the chaos. Nurses’ greatest contributions is their ability to organize, to prepare in advance, to communicate across disciplines, and their individual preparedness (Society for the Advancement of Disaster Nursing, n.d.). These qualities, with the addition of teamwork and compassion, are the ingredients that make the miracles happen in disasters. $

Karlene M. Kerfoot, PhD, RN, FAAN Chief Nursing Officer Workforce Management Solutions API Healthcare Hartford, WI Nursing Economic$ Editorial Board Member

References Barton, L. (2008). Crisis leadership now: A real-world guide to

preparing for threats, disaster, sabotage and scandal. New York, NY: McGraw Hill.

Jimenez, S. (2016). Orlando RNs pull together to help Pulse nightclub victims. Retrieved from https://www.nurse.com/blog/2016/06/ 30/orlando-rns-pull-together-to-help-pulse-nightclub-victims/

Pengelly, M. (2018). Nurse who treated Pittsburgh shooter: I’m sure he had no idea I was Jewish. Retrieved from https://www. theguardian.com/us-news/2018/nov/04/pittsburgh-shooting- robert-bowers-jewish-nurse

Society for the Advancement of Disaster Nursing. (n.d.). About. Retrieved from https://disasternursing.org/about/

Stump, S. (2019). Heroic nurse fleeing Dayton shooter stopped to perform CPR on victims. Retrieved from https://www. today.com/news/heroic-nurse-fleeing-dayton-shooter-stopped- perform-cpr-victims-t160104

The Daisy Foundation. (2019a). Team Ebola. Retrieved from https://daisyfoundation.org/daisy-award/honorees/team-ebola

The Daisy Foundation. (2019b). The emergency department team at Vidant Medical Center – Greenville. Retrieved from https://www. daisyfoundation.org/daisy-award/honorees/emergency- department-team-vidant-medical-center-greenville

Todaro-Franceschi, V. (2019). Compassion fatigue and burnout in nursing: Enhancing professional quality of life. New York, NY: Springer

Veenema, T.G. (2012). Disaster nursing and emergency preparedness for chemical, biological, and radiological terrorism and other hazards (3rd ed.). New York, NY: Springer.

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