Help Needed Now From Professional Nursing Associations
Public Policy
By Sally Phillips, R.N., Ph.D, and Roberta Lavin, R.N., M.S.
This article was originally published in the Journal of Professional Nursing 2004;20(5):279-80. Copyright© 2004 by Elsevier, Inc.
Contents
Introduction
HHS Priorities
Nursing and Readiness
References
Introduction
The tragedy of September 11, anthrax attacks,
and severe acute respiratory syndrome (SARS) and
other recent infectious disease outbreaks have heightened
our awareness of the need for health care system readiness
and response capabilities. At the same time, the economic
realities of our modern health care system are reflected in
cost-containment strategies toward low-volume inventories,
reduced bed availability, downsizing of staff, and a shift to
outpatient services (American Hospital Association, 2002).
Decreased reimbursement structures and workforce shortages
have diminished the health care system's ability to meet
minimum patient demands, let alone the surge of patients
that would be expected in a mass-casualty incident. Furthermore,
the infrastructure needed for detection and response
from the public health sector has been seriously eroded by
decades of insufficient funds. Agencies within the Department
of Health and Human Services (HHS) have been
working to address readiness and response capabilities, but
private organizations and professional associations also have
a role to play.
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HHS Priorities
In keeping with the Public Health Security and Bioterrorism
Preparedness and Response Act of 2002, HHS developed
a department-wide strategic plan to delineate its priorities.
Within the plan, the Centers for Disease Control
(http://www.bt.cdc.gov) and Health Resources and Services
Administration (HRSA; http://www.hrsa.gov/bioterrorism/) have strategic activities
in education, training, licensure, and credentialing for the public health care
workforce
and for hospital readiness. The Agency for Healthcare Research
and Quality also has strategic activities related to education
and training, as well as uses of information technology
and electronic communication networks (Phillips,
Burstin, Dillard, and Clancy, 2004; Phillips, Dillard,
and Burstin,
2002).
HHS's working definition of health surge capacity is the
ability a health care system has to rapidly expand beyond
normal services to meet the increased demand for medical
care and public health services that would be required to care
for patients in the event of a large-scale public health emergency
or disaster. Needed resources include:
- Beds.
- Personnel to staff the beds.
- Equipment.
- Ability to transport victims and personnel
- Ability to provide ongoing care.
All aspects
of surge capacity present challenges, but the demand
for qualified health care personnel is particularly complex.
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Nursing and Readiness
Although nursing is not the only health profession experiencing
a workforce shortage, nursing is vital to any large-scale
demand for care. Nationally, there are 2,694,540 licensed
registered nurses, or 808 registered nurses per
100,000 people (HRSA, 2000). These numbers are insufficient to meet current capacity needs and would be woefully
inadequate in the event of a mass-casualty incident. A mass-casualty
event would require mobilization of additional
nurses from outside the affected jurisdiction. Such a mobilization,
however, would have to overcome issues of credentialing
and licensing. When licensed health care clinicians
arrived as Good Samaritans and volunteered after 9/11, hospital
administrators turned them away because they did not
have the proper credentials.
Nurses must collaborate and coordinate and train for future
crises. Issues of competency, standards, and mechanisms
for education and training must be approved to certify
qualified nurses for mass-casualty events. A major step was
taken in March 2001, when the International Nursing Coalition
for Mass Casualty Education (INCMCE) was
founded to ensure a competent nurse workforce in response
to mass-casualty incidents. The INCMCE consists of organizational
representatives from schools of nursing, nursing
accrediting bodies, nursing specialty organizations, and governmental
agencies. In July 2003, INCMCE developed a set
of national, consensus-based, validated competencies for all
entry-level nurses (INCMCE, 2003).
Nurses must also initiate systems that promote their ability
to respond in the next crisis. In 1998, President Clinton
signed Presidential Decision Directive/NSC-63 (White
House, 1998), which established a national strategy for ensuring
critical infrastructure protection, primarily cybersecurity.
In 2003, President Bush replaced PDD-63 with
Homeland Security Presidential Directive 7 (White House,
2003), which identified the roles of the health care and public
health sectors. Specifically, it charged the sector-specific
agencies to "collaborate with appropriate private sector entities
and continue to encourage the development of information sharing and analysis mechanisms" (PDD-63). Under
the directive, HHS established the Healthcare Sector
Coordinating Council, which has responsibility for activities
such as communicating potential risks, threats, and vulnerabilities
to private organizations.
Nurses make up the largest health profession, yet they lack
a mechanism that enables them to gather and disseminate
nursing-specific information and communicate potential
risks, threats, and vulnerabilities. A coordinating group
comprising nurses from university, public health, and response
settings, with a secure system that would allow collaboration
on issues like identifying and providing a roster of
volunteers, would be a good national, consistent approach to
identifying and addressing vulnerabilities. This group would
provide valuable insight to and receive vital information
from the Healthcare Sector Coordinating Council and
would disseminate that information to nurses throughout
the country. Nurses would be better prepared and the country
would be safer. It is time for nursing to endorse such an
entity and become engaged at this level of strategic initiative.
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References
American Hospital Association (2002). Hospital Preparedness for Mass Casualties. Final Report, August 2000: Summary of an
Invitational Forum Convened on March 8-9, 2000 by the American
Hospital Association with the support of the Office of Emergency
Preparedness, US Department of Health and Human
Services. Retrieved on January 16, 2004, from www.ahapolicyforum.org/ahapolicyforum/resources/disaster.html.
Health Resources and Services Administration
(HRSA), Bureau
of Health Professions. The Registered Nurse Population. Retrieved
on January 16, 2004, from ftp.hrsa.gov/bhpr/rnsurvey2000/rnsurvey00.pdf.
International Nursing Coalition for Mass Casualty Education
(INCMCE) (2003). Educational Conpetencies for Registered
Nurses Responding to Mass Casualty Incidents. Retrieved on
January 16, 2004, from www.incmce.org/conpetenciespage.html.
Phillips, S., Burstin, H., Dillard, C., & Clancy, C. (2004).
AHRQ's bioterrorism research portfolio: Real linkages in real time.
Health Services Research 39(1), xi-xv.
Phillips, S., Dillard, C., & Burstin, H. (2002). The Agency for
Healthcare Research and Quality responds to emerging threats of
bioterrorism. Policy, Politics, and Nursing Practice 3, 212-16.
White House (1998). Presidential Decision Directive 63.
Retrieved
on January 16, 2004, from www.whitehouse.gov/news/releases/2003/12/20031217-5.html.
White House (2003). Homeland Security Presidential Directive
7. Retrieved on April 9, 2003, from www.whitehouse.gov/news/releases/2003/12/20031217-5.html.
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Authors
Sally Phillips is the Director of the Bioterrorism Preparedness Research Program, AHRQ, Rockville, MD.
Roberta Lavin is CAPT, U.S. Public Health Service, Office of the Assistant Secretary for Public Health Emergency Preparedness, Washington, DC.
Correspondence and Reprint Requests
Address correspondence and reprint requests to Dr. Phillips: Agency for Healthcare Research and Quality, Director, Public Health Emergency Preparedness Program, 540 Gaither Rd., Rockville, MD 20850. E-mail: Sally.Phillips@ahrq.hhs.gov.
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Internet Citation:
Phillips S, Lavin R. Readiness and Response to Public Health Emergencies: Help Needed Now From Professional Nursing Associations. Article originally published in Journal of Professional Nursing 2004;20(5):279-80. Copyright© 2004 by Elsevier Inc. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/nursing/readiness.htm