Enabling a Disaster-Resilient Workforce: Attending to Individual Stress and Collective Trauma

Globally, the scope and frequency of natural disasters- particularly climate-related disasters-are increasing, and the human impact of these events is widening. Since 2000, climate-related disasters have increased 44% from the 1994-2000 average (Centre for Research on the Epidemiology of Disasters, 2015). Large-scale natural disasters are by their very nature extremely disruptive, overwhelming a community's infrastructure and severely impacting access to essential public health and medical services. The emergency response goals in a natural disaster are twofold: to continue to maintain provision of the public health services, and to provide acute response to the public health needs created by the disaster. Natural, weather-related disasters such as hurricanes provide considerable forewarning of the event and enable preparedness planning.During these catastrophic events, significant burdens are imposed on those individuals engaged in the delivery of essential public health and medical services, such as nurses, who must balance professional obligations along with the demands of their personal life, such as family needs (Adams & Berry, 2012; Qureshi et al, 2005). Experiencing a disaster can have both short- and longterm effects. A growing body of research is documenting that emergency response and healthcare workers are at increased risk for developing mental health conditions, such as post-traumatic stress disorder, depression, and anxiety (Benedek, Fullerton, & Ursan, 2007). Given the nature of their work, nurses are at particular risk for compassion fatigue, burnout, and psychological trauma (Johal, 2015; Qureshi et al., 2005).When Superstorm Sandy hit the New York-New Jersey coastline in October 2012, the vulnerability and interdependence of area hospitals and healthcare workers were revealed. Severe flooding from the storm surges forced an evacuation of New York University Langone Medical Center (NYULMC), a 725-bed tertiary care facility in New York City, during the height of the storm, and subsequently an extended shutdown, along with other area hospitals in the flood zone, of essential healthcare facilities. Superstorm Sandy was the second storm to result in the evacuation of NYULMC within a 14-month period. Even though weather-related disasters can provide for considerable forewarning and an opportunity for predisaster planning, the psychosocial toll on nurses working in such rapidly changing circumstances can be considerable.The primary aim of this study was to assess nurses' experiences and the challenges they faced during Superstorm Sandy in order to identify how nurses can be supported to function effectively before, during, and after a weather-related disaster. The study was approved by the NYULMC School of Medicine Institutional Review Board.MethodsStudy DesignIn order to develop a more complete understanding of the NYULMC nurses' experiences during this event and to contextualize the data (Miles & Huberman, 1994), we implemented a sequential mixed-methods study consisting of in-depth qualitative interviews with a purposive sample of the hospital nurses followed by a quantitative Internet survey of the hospital nursing staffemployed at the time of the evacuation and deployment.Qualitative InterviewsSample and recruitment. We recruited a purposive sample of 20 nurses reflecting the diversity of practice areas, nursing experience, and organizational role in the disaster. Nurses were contacted by the research team via text, e-mail, or phone and invited to participate in a 60-min semistructured interview to explore their Superstorm Sandy experiences. Sixteen of the 20 nurses sampled agreed to participate and completed an interview (response rate 80%); 12 of the participants held staffnurse positions, and 4 had management positions. The interviews were conducted by experienced qualitative interviewers in a private setting from April to June 2013. Participants were assured that no individual identifiers would be collected. …