HMGT 320 LESSON LEARNED

May-June 2020 • Vol. 29/No. 3 211

Donna J. Middaugh, PhD, RN, is Clinical Associate Professor, University of Arkansas for Medical Sciences, College of Nursing, Little Rock, AR.

Maintaining Management During Disaster: The COVID-19 Edition

Donna J. Middaugh

I have had the honor of writing this journal’s “Nursing Management” column for almost 20 years. One of my first articles, written shortly after

September 11, 2001, carried the message that nursing managers must be equipped for a direct or indirect attack on healthcare facilities. Unfortunately, at this 2020 date, we are faced with a threat that is affecting all healthcare facilities in the United States and around the world. Unlike a direct military attack, we had prenotifi- cation about COVID-19, but ensuing public fear and rapid spread have made preparation and treatment more challenging for all healthcare facilities.

The World Health Organization (2020) defined disas- ter as “a serious disruption of the functioning of a com- munity or a society causing widespread human, materi- al, economic, or environmental losses, which exceed the ability of the affected community or society to cope using its own resources” (para. 41). Disasters, which come in many forms and sizes, were classified tradition- ally as either natural disasters (flood, tornado, earth- quake) or man-made disasters (explosion, chemical spill, mass casualty event). Recently, disasters also have been classified as a cyber attack or an infectious disease that overwhelms a community, hospital, and services for several days or weeks (Nielson, 2018). Disasters cre- ate unprecedented demand for resources and personnel. Job roles and responsibilities must shift, and flexibility becomes the word of the day. Resources, as we are wit- nessing, are exhausted quickly. We must be innovative, learn to prioritize, and be vigilant of supply numbers.

Preparedness Emergency management to decrease potential loss

during a disaster includes four stages: mitigation, pre- paredness, response, and recovery (Nielson, 2018).

1. Mitigation entails initiating measures to eliminate or reduce the dangers of a disaster before it occurs. This requires extensive analysis of risks and vulnerabili- ties in a community, whether it be a city or a health- care institution.

2. Preparedness is taking actions to prepare for effects of a disaster. Stocking up on food and supplies and practicing disaster plans are part of this stage.

3. Response occurs during the actual disaster and includes rescue and care for survivors. Emphasis is placed on not only saving lives, but also preventing further damage.

4. Recovery (the stage we all look forward to) includes actions to return to a normal state. This involves cleaning up, securing financial assistance, and plan- ning to protect the organization from any further effects of the disaster. (p. 21)

In February, the Centers for Disease Control and

Prevention (2020) announced all U.S. hospitals should be prepared for possible arrival of patients with COVID- 19 by ensuring staff are trained, equipped, and capable of practices needed to: • Prevent spread of respiratory diseases, including

COVID-19 within the facility. • Promptly identify and isolate patients with possible

COVID-19 and inform correct facility staff and public health authorities.

• Care for a limited number of patients with confirmed or suspected COVID-19 as part of routine operations.

• Potentially care for a larger number of patients in the context of an escalating outbreak.

• Monitor and manage any healthcare personnel who might be exposed to COVID-19.

• Communicate effectively within the facility and plan for appropriate external communication related to COVID-19. (p. 1)

Management Functions The rapid spread of COVID-19 did not provide U.S.

healthcare institutions much time to institute these practices. Instead, nurse managers now must focus on hour-by-hour functioning to maintain safety for all. The key to efficiency and productivity is management, which is never truer than during a crisis. Too often, the foundational functions of management are forgotten during a crisis and our systems may produce more chaos than was already present. The functions of management

Nursing Management

Disasters and crises are extremely stressful and push healthcare professionals to their limits. Too often, foundational functions of management are forgotten during a crisis but should be reviewed and applied before and during a disaster.

May-June 2020 • Vol. 29/No. 3212

Nursing Management

should be reviewed and applied before and during a dis- aster. 1. Planning. The management planning process is one

of forecasting and decision-making. Planning is always future-oriented and planning for disasters is now an essential function for all managers in healthcare institutions.

2. Organizing. The purpose of organizing during a dis- aster is to establish a division of labor and a chain of command. The Society of Human Resources Management (2020) suggests a systematic plan for approaching emergencies should involve under- standing of the universe of hazards that may occur, followed by assessment of the probabilities of these occurring disasters. Plans should be focused on ele- ments with the highest degree of probability. Lack of organization during a disaster results in addition- al, unneeded chaos.

3. Directing. Staff require clear direction to initiate and maintain action. Successful directing depends on appropriate delegation, communication, and train- ing. In a disaster, predesignated staff must receive not only a list of their exact duties, but also the authority to fulfill their duties so action is not delayed. The Centers for Medicare & Medicaid Services require healthcare organizations to develop and execute an effective communication plan for use during a disaster (Moore, 2019). We must be prepared to ensure communication is coordinated and accurately delivers factual information. With effective communication systems in place, man- agers then can begin coordinating.

4. Coordinating. Coordination of effort involves syn- chronizing activities toward desired goals. Coordination occurs only through strong, effective leadership and management that organize, direct, and control staff efforts.

5. Controlling. Control is a manager’s duty to ensure staff performance corresponds to plan. All managers exercise control by establishing standards, measur- ing performance against standards, and correcting deviations from standards. Nothing seems to cause a breakdown in system functioning more than a manager who has lost control. A management style that emphasizes cooperation, participation, and fairness is based on personal example and is the best way for a manager to influence the work of others during a disaster. During a crisis, when leaders must act quickly to correct problems, an autocratic, direc- tive leadership style is efficient and effective. Disasters are not the time for debate and discussion to reach consensus.

Guiding Principles The American Organization of Nursing Leadership

(2017) published guiding principles for the role of the nurse leader in crisis management. The guiding princi- ples below can be used to define the role and position of nursing leaders. • Nurse leaders are trained in media relations and

understand tenets of good communication. • Leaders are skilled critical thinkers, collaborative and

able to manage ambiguity. • Nurse leaders project calm, confidence, and authority

in all situations. They are also empathic to how peo- ple react to loss, challenges, and uncertainty.

• Nurse leaders are prepared to review and practice the organization’s crisis readiness plan with nursing staff.

• The chief nursing officer is a member of the senior leadership team, whose role is defined clearly and sought by colleagues, particularly during a crisis. (p. 1) This is a time of uncertainty in our world. We must

understand things likely will not be normal for a long time. Our current crisis is extremely stressful and pushes people to their limits. Now is a time that calls for leaders and managers to show their human sides as well. As the renowned Dr. Karlene Kerfoot (2019) noted,

…the essence of nursing is to manage through the chaos to save lives and prevent adverse outcomes. When chaos hits, it takes a village to maintain patient safety and staff effectiveness. Burnout and moral injury can be the fallout of ineffectively han- dling everyday staffing; in emergencies the chal- lenge is greatly exaggerated. (p. 256)

We are nurses! We are strong!

REFERENCES American Organization for Nursing Leadership. (2017). Role of the

nurse leader in crisis management. https://www.aonl.org/role- nurse-leader-crisis-management

Centers for Disease Control and Prevention. (2020). Coronavirus dis- ease 2019 (COVID-19) Hospital preparedness assessment tool. https://www.cdc.gov/coronavirus/2019-ncov/hcp/hcp-hospital- checklist.html

Kerfoot, K.M. (2019). Chaos, teamwork, compassion, and leadership: Disasters and nursing’s finest hours. Nursing Economic$, 37(5), 265-267.

Moore, J. (2019). Crisis communication: 10 tips for hospitals to prepare for a disaster. https://www.psqh.com/analysis/crisis-communica tion-10-tips-for-hospitals-to-prepare-for-a-disaster/

Nielson, M.H. (2018). Are you prepared for a disaster? Nursing Management, 49(5), 18-23.

Society of Human Resources Management. (2020). Managing through emergency and disaster. https://www.shrm.org/resourcesand tools/tools-and-samples/toolkits/pages/managingemergencyand disaster.aspx

World Health Organization. (2020). Definition of disaster. Retrieved from https://www.who.int/hac/about/definitions/en/

Now is a time that calls for leaders and managers to show their human sides as well.

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