Leading During Times of Crisis

Week 6Lesson 1

Crossing the Chasm of Uncertainty: The Nurse Leader’s Role in

Resource Management
Introduction

As a DNP-prepared nurse
leader, your ability to respond quickly and effectively to evolving situations and
demands within your team, the organization, and the community will be critically
important. Utilizing your knowledge, past experiences, skills, and cultural and emotional
intelligence, you will provide guidance and direction on a vast number of issues. Your

capabilities will never be challenged as much as when facing a disaster or crisis.
Disasters can come in many forms:
 Natural disasters and hazards such as those occurring from weather-related or
geological causes
 Man-made disasters that occur as the result of human intent or accidents, including
hazardous material spills, fires, and acts of violence or physical destruction
 Biological disasters, which include disease epidemics and insect or animal plagues
When a disaster or crisis impacts the local community, swift action is needed to mitigate
the loss of human life and preserve the safety of staff, patients, and the community. This
often requires the nurse leader to navigate new and unchartered waters. When a crisis
occurs, the nurse leader must make complex decisions amid uncertainty and disruption,
based on established personal and professional values and principles. It is during these
times of chaos, that the nurse leader may have to set aside what has worked well in the
past and move to “here and now” leadership, to make sense of the unpredicted events.
Unfortunately, the United States has experienced many crisis events over the last
several decades. Click through the following timeline interactive for some examples.

Crisis Timeline Interactive Transcript

While these are just a few of the disasters that impacted the U.S., each event resulted
in significant injury and loss of life in the communities where the disasters occurred.
As a crisis unfolds, nurse leaders must step to the boundaries of their decision-making,
even though the results may be uncertain and unpredictable. The chaos that can ensue
during times of crisis can be taxing on both human and material resources. Let’s first
examine how a crisis can impact human resources.
Allocating Human Resources During Times of

Disaster and Crisis

When a disaster or crisis develops, the ability to provide safe and quality healthcare
services is of vital importance as the surge of casualties arrive for triage and treatment.
Depending on the type of event, the surge may last for hours, days, weeks, or in the
case of COVID-19 and other major disasters, for months. Establishing a command
center may be needed to afford rapid responses and render guidance for patients, staff,
and the community as the crisis progresses. The longer the surge continues, the more
strain will be placed on human resources. As information flows to the command center,
the nurse leader can deploy staff to the higher acuity areas based on capacity and staff
competency. The nurse leader needs to have a continuous awareness of patient
volumes and, through a partnership with the human resources (HR) department, have
access to reports of currently active staff, their assigned units, as well as a roster of staff
who have cross-functional training and the skills to float to other units or facilities. If the
facility is a part of a larger health system with multiple locations, leveraging staff from
adjacent facilities may be needed as well. Additionally, the nurse leader should have

knowledge of contingent resources, such as physician practices, case managers, or
staffing agencies, that can assist in filling staffing and competency gaps.

As was seen during the
initial months of the COVID-19 pandemic, patient demands can surpass staffing
capabilities. Not only was the volume of patients overwhelming, but as staff tested
positive and became ill with the virus, absenteeism further impacted staffing levels. To
meet the overwhelming influx of critically ill patients, emergency declaration blanket
waivers were issued by the National Council of State Boards of Nursing, the Centers for
Medicare and Medicaid Services, and state governments. The blanket waivers
permitted healthcare providers to practice across state lines without meeting the
regulatory licensing requirements (Aznavorian, 2020). These emergency measures
were critically important to epicenters, such as New York, where positive cases of
COVID-19 were so prevalent. Similar waivers have been exercised during other national
disasters, such as the attacks of September 11, 2001, and Hurricane Katrina in 2005.
When a disaster or crisis occurs, nurse leaders must contemplate how to best utilize all
available staff to meet the needs of patients and the community. Creative staffing
models may be needed, and even non-traditional alternative operational patterns may
be beneficial. Simpson and Whitt (2020) describe one such alternative model used
during the influx of COVID-19 patients in which additional licensed and non-licensed
staff were assigned to a primary nurse to help with selected patient care needs. The
additional staff were referred to as “pandemic partners” and did not take a patient load
but rather assisted their primary nurse with delegated tasks. The pandemic partners
were provided with a brief orientation and assignments were managed by the central
staffing office (Simpson and Whitt, 2020).
Another source of staffing during a disaster or crisis is the use of physician office
personnel within the acute care setting. As COVID-19 cases climbed in 2020, many
hospitals reached out to providers to request assistance in meeting the staffing burden.
With many physician practices limiting their virus exposure through live office visits,
Licensed Practical Nurses (LPNs) and Medical Assistants (MAs) received virtual
orientation to facilitate quick integration into the acute care setting. Deployment of

available and willing employees augmented existing workforces. Assessment of skills
and experience was needed to align staff with a new practice setting (Coe et al., 2020).
As we consider the many innovative staffing alternatives utilized during past disasters
and crises, as DNP-prepared nurse leaders, we can use these models to better prepare
for future events that impact the ability to safely care for patients and the community
when a disaster or crisis occurs. Now, let’s take a look at another critical consideration
when a disaster or crisis occurs; this is the allocation of material resources.
Allocating Material Resources During Time of

Disaster and Crisis

Watch the following video on material resources and planning for disaster and crisis.
Material Resources (3:35)
Let’s explore in the next lesson how the DNP-prepared nurse leader can provide
support during and after a crisis occurs.

Week 6Lesson 2

The Needs of Staff and the Community When a Crisis Occurs
Supporting Staff During and After a Crisis
Preparing for the unforeseen challenges associated with a disaster or crisis requires a
nurse leader who remains calm under pressure, leads with compassion, has the heart
of a servant, and advocates for the essential needs of their staff and patients.
Preparation should begin long before a disaster occurs. Creating an atmosphere that
encourages staff to think and act instinctively can be valuable during a disaster.
Continual engagement with staff as a transformational leader can assist in keeping staff
committed to the mission and vision of the organization. If staff are committed to the
organization, their performance levels will be higher, and disasters can be navigated
more effectively. Without a committed staff, the organization can suffer during and long
after a crisis is over.
During a disaster, it is important for staff to not only be told of their leader’s support but
also to see their presence.
Review the following graphic for examples of presence.

Presence Image Description

Through an application of these and other strategies, the nurse leader can demonstrate
the valuable asset the staff are to the organization and the greater community. During
the midst of a disaster, staff may not take the time to concentrate on the disaster itself
but rather intently focus on the tasks and patients before them. Once the patients are
triaged and care is provided, the realization of the disaster may begin to surface in the
individual’s consciousness. An awareness of the magnitude of the event can result in a
sense of fear, loss, anxiety, detachment, grief, or even guilt.
As the crisis begins to resolve, post-crisis recovery begins. This is an important time for
the nurse leader as staff reactions and cognitive processing of the event may only then
begin to surface. Responding to the unique needs of the staff will ensure the physical
and mental health of the team. It is during this time that it is critical to provide staff with
the support services to address acute stress disorder (ASD) and post-traumatic stress
disorder (PTSD). Staff may have difficulty coping with normal daily responsibilities.
Review the following graphic for examples of ways nurse leaders can support staff post-
crisis.

Support Staff Image Description

As a DNP-prepared nurse leader, if history teaches us anything, it is that traumatic
events can have a lingering impact on both victims and survivors. This phenomenon is a
trend observed with those serving in the military, law enforcement, firefighting,
emergency services, and those impacted by acts of violence, and, yes, healthcare
personnel as well. Dealing with the emotional, physical, and mental consequences of
traumatic workplace events can easily filter over to the personal life. Early studies reflect
psychological distress among frontline COVID-19 caregivers is on the rise as the effects
of COVID-19 unfurl (Burdick, 2020; Master, et al., 2020; Shahrour & Dardas, 2020).
This further emphasizes the critical nature of establishing support systems and
programs for those impacted by a disaster or crisis.
In addition to the support provided to the nursing team, the DNP-prepared nurse leader
can also play a focal role in supporting the community when a disaster occurs. Let’s
consider some ways the nurse leader can expand their servant leadership to support
the community.

The Nurse Leader’s Role in Supporting

Community Needs

Through the development of an all-hazards disaster plan (Huber, 2018), the nurse
leader can prepare for both internal and external disasters. Although even the smallest
organization has some form of a disaster plan, continual evaluation of the logistical and
operational plan for managing disasters is very important. The nurse leader should be
involved in all disaster management processes and be a member of the command
center.

Through collaboration with local authorities, school superintendents, emergency
management agencies, and public health, the DNP-prepared nurse leader can help
establish policies and procedures to assist with varied community disasters. Developing
and supporting mock disaster drills and simulations, in conjunction with community
employers and agencies, can also contribute to mitigating the severity of injuries and
loss of life should a disaster occur. It is additionally important for the nurse leader to
have familiarity with the types of employers in the area, especially those who have
hazardous chemicals, wastes, or processes that place employees at risk for workplace
injuries. Identifying these employers and working in partnership to perform
preparedness training can be valuable to the entire community.
References

Aznavorian, R. (2020). Successfully deploying your valuable resources: Staffing implications
and prioritization during crisis. Nurse Leader, 18(5), 536-538. https://doi.org/
10.1016/j.mnl.2020.08.014
Burdick, K. (2020). Pandemics and PTSD: Caring for the caregivers. MEDSURG Nursing,
29(6), 365-390.
Coe, P., Graper, L., & Zangerle, C. (2020). Leading through the unknown: A network
perspective of the COVID-19 pandemic. Critical Care Nursing Quarterly, 43(4), 451-467.
https://doi.org/ 10.1097/CNQ.0000000000000329
Master, A., Su, X., Zhang, S., Guan, W., & Li, J. (2020). Psychological impact of COVID-19
outbreak on frontline nurses: A cross-sectional survey study. Journal of Clinical Nursing,
29(21/22), 4217-4226. https://doi-
org.chamberlainuniversity.idm.oclc.org/10.1111/jocn.1545
Shahrour, G., & Dardas, L. (2020). Acute stress disorder, coping self-efficacy and
subsequent psychological distress among nurses amid COVID-19. Journal of Nursing
Management, 28(7), 1686-1695. https://doi.org/10.1111/jonm.13124
Simpson, B., Whitt, M., & Berger, L. (2020, August 27). Patient care services staffing support
during a pandemic. Nurse Leader. https://doi.org/10.1016/j.mnl.2020.07.005