What we need is a National Medical Guard ? The nurses can do it….

Nurses are a untapped resource here in the homeland. We need to do more to incorporate their skills & caring into the fabric of Homeland Security efforts. Nurses could be the homeland security army of the future if we are faced with a medical emergency within the USA.

Registered nurses struggle with the call to respond. This is especially true if they feel physically unsafe in the response situation, if there is inadequate support for meeting the family’s needs, and they are concerned that they will not have professional ethical and legal protection for nursing care in a crisis situation. These concerns faced by nurses represent a gap in our nation’s disaster preparedness and response systems. Critical questions remain unanswered as to what the registered nurses duty to respond is, especially if called upon to serve in a nontraditional role, and what expectations the registered nurse should have for physical, emotional, and legal protections. Resolving these problems would ultimately support registered nurses responding to a call for help. Resolving those needs and assuring a robust response from registered nurses is crucial to getting a wide response in an emergency.. Plugging the gap will require a concerted effort. National associations like the American Nurses Association (ANA) are partnering with government groups, non-government organizations, employers and individual registered nurses to achieve systems, policies, and laws that enable the registered nurse and other providers to respond confidently, and to ensure that the needs of the American public will be met during a disaster. The partnership between the local public health agency and the local nurses in acute care facilities, long term care and medical practices needs to grow and support ongoing training and connections. They need to understand as public health nurses do that this is a different kind of practice.

Individual registered nurses are critical participants in disaster work. They must be aware of their employers’ emergency response plans, as well as have a general sense of what state and local disaster preparedness and response efforts are taking place where they live and practice. They should be aware of their expected role in any response efforts — some employers make plans for their registered nurse staff that the individual nurse might not even know about. If they know they want to be an integral responder in a disaster, they should be encouraged or required to volunteer with a disaster registry, such as federal Disaster Medical Assistance Teams, nationally or locally with the American Red Cross, or their local Medical Reserve Corps. This will ensure they have the proper credentialing and training for responding to a disaster, and will be part of an organized system. The organized system is part of the local public health responsibility and the gap in this connection with acute care nurses is wide.

The first place to start to connect the work of the public health nurse and the acute care nurse is in the curriculum taught in nursing educational organizations. Today the curriculum only touches briefly on the role of the community nurse and their community based practice. The awareness that nurses might be called upon during a disaster needs to be highlighted and become part of required continuing education hours. Efforts are being made to bridge the gap but without Continuing Education requirements the already busy nurse will select educational enrichment within their expertise.
Some efforts to improve the emergency preparedness skills of nurses:
The National Nurse Emergency Preparedness Initiative (NNEPI) is a $2 million grant awarded by the Department of Homeland Security to develop and deliver educational training to prepare nurses to respond to victims of an event involving weapons of mass destruction (WMD). The web-based training targets nurses in hospitals, clinics, assisted living facilities, and increases awareness of WMD risks, vulnerabilities, and response requirements. The highly-interactive web-based course uses simulations, case scenarios, and demonstrations to provide setting-specific WMD preparedness training. The NNEPI Web site provides links to the Web-based course and emergency preparedness information and resources for nurses. The NNEPI course is currently available to registered nurses, licensed practical nurses, and nurse practitioners.

In order for nurses to be well prepared for disaster response, not only must guidelines and recommendations be in place, but nurses must also be properly trained to recognize and respond to emergency events. While not all nurses will be first responders, all nurses should have the basic knowledge and ability to respond appropriately to Mass Casualty Incidents (MCIs). Research findings indicate that many healthcare practitioners lack confidence in their abilities to provide healthcare in a hypothetical chemical terrorism situation. Research findings further indicate the need for the development, implementation, and evaluation of innovative domestic terrorism preparedness programs for nursing continuing education and staff development programs . To support these efforts, more funding is needed to develop and implement continuing education on nursing care during surge emergencies. Curricula that incorporate bio-terrorism preparedness and emergency response material are key to enabling nursing graduates to gain occupational competencies related to emergency response. Until recently, however, there has been insufficient focus on developing this type of curricula. Several organizations including the American Association of Colleges and Nursing (AACN), the Joint Commission on Accreditation of Healthcare Organizations and many state health departments have called for the establishment of education related to disaster response.

In addition, given the current overall nursing shortage, it will likely be necessary to identify and educate a supplemental workforce (e.g., retired nurses, inactive nurses, faculty in schools of nursing, other healthcare professionals who can be cross trained) to provide nursing care during surge emergencies. Volunteer databases must be accurate, compatible with each other, and accessible through a variety of systems and devices in order to be most efficient and useable in an emergency. Inactive nurses and volunteers are difficult to contact and prepare with disaster readiness training on a regular basis. For these nurses, just-in-time training and assessment of clinical competencies may be needed before they can be integrated into emergency response situations.

Recommendations:

1. Involve nurses in the planning and design process for preparedness at the local, state, and
   Federal levels.
2. Support initiatives to prepare more nursing leadership for community based nursing
3. Support research and demonstration projects to assess the impact of various technologies such
   as e-learning and simulations on student learning, capacity to educate additional students, faculty
   workload, and patient outcomes.
4. Provide more Federal funding for capacity building (e.g., faculty development) in teaching
   about nurses in emergency preparedness and response
5. Increase Federal funding grants to help colleges and universities incorporate technologies such
   as e-learning and simulation training in order to allow place-bound and working nurses access to
   baccalaureate and graduate nursing education, and continuing education.

Topics to cover :

1. Caring for special populations in the community
2. sheltering
3. Point of distribution prophylaxis
4. Assessment in public health investigations
5. Forensic epidemiology
6. Interviewing
7. Familiarity and based function of surveillance and reporting systems
8. Public Health case definitions for disease and illness
9. Holistic approach to providing resources
10. Zoonotic programs and the impact of animals on a rescue operation\
11. Food defense
12. Vaccination levels and the importance of knowing how vaccines work and protect
13. Public health regulations, and laws

My personal opinion is that EVERY nurse should be required to work in an active and functioning public health agency before graduation and as part of the required learning experience. Any and all loan forgiveness should include an internship in public health nursing . Continuing Education Credits should be required in a public health related topic area for routine re licensing. Just as specific learning topics are required for re-licensing .. membership in a volunteer group for emergency preparedness should be required of all nurses until the shortage of available staff is addressed. The National Medical Reserve would be a great way to connect nursing with national responsibility.