case study 4 1 a crisis in nursing

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The Truth Behind the Nursing Crisis

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The Real Issues Driving the Nursing Crisis

Our analysis of nurses’ employer reviews reveals the true source of burnout and why nurses are leaving the field. here’s how health care leaders can improve nurse job satisfaction to fight a looming nursing shortage..

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Health care leaders face a daunting set of challenges — rising costs, the transition to digital health, and shifting payment models, to name just a few. But according to a recent survey from the American College of Healthcare Executives, the No. 1 problem hospital CEOs face is staff shortages and burnout. 1 Ninety percent of the CEOs surveyed cited nursing shortages as a particularly acute pain point.

In 2021, the total number of registered nurses working in the U.S. dropped by the largest amount in 40 years, with younger nurses leading the exodus. 2 By 2025, the U.S. health care system could suffer a shortfall of up to 450,000 nurses, or 20% fewer than the nursing workforce required for patient care. 3

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High levels of job dissatisfaction and burnout are driving nurses from the profession. The COVID-19 pandemic placed tremendous pressure on all health care workers, but dissatisfaction and burnout among nurses have not improved since the pandemic ended. And by some measures, it might be getting worse: In 2021, nearly two-thirds of registered nurses would have encouraged others to become a nurse, but only half said they would recommend nursing as a profession two years later. 4

One of the richest sources of insight on dissatisfaction among nurses is how they describe their job, in their own words, on employment sites like Indeed and Glassdoor. This information is voluminous but difficult to synthesize because most of it takes the form of unstructured free text. To understand the challenges nurses face, we analyzed how 150,000 of them had described their employers in Glassdoor reviews since the beginning of the pandemic. (See “The Research.”) In this article, we share key insights from that analysis and offer advice to health care leaders about how they can address nurses’ most pressing issues.

Health Care Leaders Are Out of Touch

Nurses view their managers as out of touch with the daily realities of patient care. We categorized their comments about managers into nearly 50 leadership traits. The second most frequently cited trait described managers as being unaware of the challenges that nurses struggle with in the workplace. When nurses discussed how managers understood life at the bedside, their comments were negative 9 times out of 10.

Nurses are particularly critical of members of the senior executive team for their disconnectedness. The top team was 10 times more likely than front-line supervisors and middle managers to be criticized for being out of touch. Our results reinforce a separate survey in which nearly half of hospital nurses said they believe management does not listen to their concerns. 5

To address dissatisfaction and burnout, health care leaders must first understand what’s happening at the bedside. This can be challenging, particularly in large health care systems with thousands of nurses working across multiple sites and specialties.

Historically, leaders have struggled to systematically analyze the gold mine of insights into nurses’ frustrations that can be gleaned from their comments in employee surveys or external reviews. Reading, understanding, and analyzing huge volumes of unstructured textual data has simply not been practical. However, recent advances in artificial intelligence make it possible to identify deep patterns in large bodies of text and understand feedback at scale. Leaders can now mine free text to gain a nuanced understanding of the issues driving dissatisfaction and burnout among nurses and use that insight to improve life at work for their nursing staffs. (See “Getting Started With Text Analytics.”)

Identify Relative Strengths and Opportunities Through Benchmarking

Nursing satisfaction varies widely across employers. We identified 200 of the largest health care employers in the United States, including hospitals and health care systems, home health care providers, operators of senior living facilities, and staffing agencies. For each employer, we calculated how highly nurses rated the organization and senior leadership on Glassdoor from the beginning of the COVID-19 pandemic through June 2023. 6

Among large employers, nurses’ Glassdoor ratings ran the gamut from poor (2.6) to nearly perfect (4.9) on a 5-point scale. Nurses’ assessments of how well senior leadership has performed during and after the pandemic were even more varied, ranging from 2.1 to 4.9 on the same 5-point scale. The wide variance in Glassdoor ratings is consistent with a separate survey in which the percentage of dissatisfied nurses ranged from 2% to 48% across 60 U.S. hospitals. 7

Employees of the 200 large health care organizations can use our interactive tool to see how their organization ranks against others. The index is sortable by nurses’ overall ratings, their assessments of the top leadership, and the four most powerful predictors of nurses’ satisfaction: compensation, workload, organizational support, and toxic culture.

Nurses who work for staffing agencies (who are sometimes referred to as travel nurses) are, on average, much more satisfied than other nurses. The five highest-ranked employers in our sample (and six of the top 10) are staffing agencies.

Higher compensation, of course, accounts for part of this difference, but not all of it. We compared how positively nurses working with staffing agencies spoke about 200 topics compared with their counterparts employed by hospitals and health care systems. (See “Staffing Agencies Rate Better on Many Key Factors.”) While compensation was viewed more favorably by agency nurses, issues around solving nurses’ problems and open, honest communication had a larger sentiment gap between the two groups. By focusing on nurses as clients, staffing agencies excel at practices that improve satisfaction beyond simply paying higher wages. Other health care leaders can learn from their example, and we’ll make some concrete recommendations below.

Prioritize Drivers of Job Satisfaction

To understand the drivers of job satisfaction among nurses, we analyzed the free text of all reviews that had been written by the nurses in our sample since the beginning of the COVID-19 pandemic and classified the text into nearly 200 topics. 8 We then clustered topics into two dozen broader themes and used those themes to predict nurses’ overall ratings of their employers. We then compared each theme’s relative importance in predicting ratings. (See “Top and Bottom Predictors of Nurses’ Job Satisfaction.”)

Compensation was the top predictor of satisfaction among nurses reviewing their current employer, which is not surprising, given that inflation eroded the purchasing power of take-home pay during the period we analyzed. The importance of workload, the second-most-important driver, jibes with findings from a separate large-scale survey that found insufficient staffing was the strongest predictor of nurses’ job dissatisfaction, burnout, and intent to quit. 9

Workload and compensation are root causes of the nursing crisis that must be addressed, but they are not the only factors influencing nurses’ job satisfaction. Our analysis surfaced other aspects of the work environment, including toxic culture, organizational support, work schedules, communication, and learning and development opportunities, that leaders can focus on to improve nurses’ work lives.

This analysis also highlights areas that are unlikely to move the needle in improving the workplace experience for nurses. Perks are nice, but they will not compensate for a punishing workload or wages that fail to keep pace with inflation. Highlighting the corporate mission to promote patient health won’t help much either. Nurses already know that their job serves a higher purpose; that’s why most of them became nurses in the first place.

Mine Free Text for Actionable Insights

Many health care organizations rely on annual employee surveys, with dozens of items rated on a 5-point scale and a few open-ended questions tacked on as an afterthought. Faced with a long list of multiple-choice questions, employees are prone to switching to autopilot and assigning similar scores to very different items. The choice of questions constrains what employees can discuss, and there is seldom room to expand on why they chose a particular numeric response.

Open-ended, free-text feedback provides a rich source of nuanced and actionable insights. When nurses can decide which topics to write about, they use their freedom to discuss what matters most to them. Open-ended questions provide nurses with the space to expand on their concerns in their own words, offer crucial context, and propose concrete and actionable fixes to the problems they face. Individual free-text responses can be aggregated into broader themes to prioritize where leaders could focus their attention and limited resources to achieve the largest improvements in nurses’ satisfaction.

While organizational averages are useful, it is important to remember that distinctive subcultures can coexist within the same organization. This is particularly true among large health care systems that have grown through mergers and acquisitions. One national hospital chain, for example, has ratings that range from 1.9 to 3.9 across nearly 50 sites. Rather than relying on organizational averages alone, health care leaders must measure and analyze differences across locations, departments, functions, teams, and individual leaders.

Women, underrepresented minorities, and older employees can also experience organizational culture very differently from other employees. 10 It’s crucial to understand the drivers of job satisfaction and burnout across diverse employee populations.

It’s crucial to understand the drivers of job satisfaction and burnout across diverse employee populations.

Leaders can mine the free text for detailed insights about the most critical pain points for specific groups and tailor their interventions accordingly. Schedules, for example, have a significant impact on nurses’ job satisfaction, but which aspects of scheduling matter most will depend on the specific position. Flexibility in scheduling shifts and the ability to take uninterrupted work breaks is very important for nurses in hospitals and primary care practices, while home health care nurses place a premium on predictable schedules. 11

Nurses’ comments provide a treasure trove of practical suggestions to improve the workplace and patient care. The Glassdoor reviews we studied, for example, include dozens of actionable suggestions for how employers can improve scheduling. Some are easy-to-implement actions, such as using an app to make it easier to pick up or swap shifts, or paying a $20 to $50 bonus to nurses who pick up shifts at the last minute. Others are more systemic changes, like including nurses on a committee established to set schedules or ensuring that employees who receive tuition assistance are able to schedule work around their classes.

Listen to Nurses Who Leave Your Organization

Most organizations limit their surveys to current employees. Exit interviews are administered haphazardly, if at all, and the feedback from former employees is too often dismissed as the rantings of malcontents. But ignoring feedback from former employees is a big mistake.

Interviewing or surveying former employees can surface the reasons for their departure and pinpoint the most effective actions to retain talent. Free of the threat of retaliation, nurses who are leaving (or have left) an organization are more likely to provide candid feedback, even about taboo issues that current employees are reluctant to discuss. By collecting feedback from those who have left, organizations can uncover potential blind spots.

More than one-third of the Glassdoor reviews in our sample were written by former employees and provide insights on what mattered most to nurses who voted with their feet. 12 The bars on the left side of the figure “Top and Bottom Predictors of Nurses’ Job Satisfaction” rank the factors that predict how nurses who quit rank their former employers, and it sheds light on a critical reason nurses might head for the exits.

In an earlier article , we argued that five behavioral attributes — disrespectful, noninclusive, unethical, cutthroat, and abusive — mark an organizational culture as toxic. 13 Among nurses who quit, toxic culture is more than twice as predictive of their overall satisfaction than compensation or workload. The importance of toxic workplaces among nurses who quit is consistent with earlier research that found toxicity to be the strongest predictor of industry-adjusted attrition during the first six months of the Great Resignation. 14

Toxic culture has become more important for nurses in the post-pandemic era. When we compared which factors best predict how nurses rated their employer before and after the pandemic, toxic culture experienced the largest gain in relative importance post-COVID-19 (followed by workload, well-being, and compensation). If your organization suffers from cultural toxicity, another article of ours, “ How to Fix a Toxic Culture ,” presents several evidence-based interventions health care leaders can use to detox their own organization.

Learn From Staffing Agency Practices

As the figure “Staffing Agencies Rate Better on Many Key Factors” shows, nurses are very positive about the processes staffing agencies have in place to resolve problems quickly and efficiently. Of nurses who mentioned the efficiency of staffing agencies’ processes, 75% were positive, compared with 23% expressing positive sentiment for health care systems. For travel nurses, common process issues include onboarding, obtaining required credentials and licenses, contract negotiation, and reimbursement. The best staffing agencies listen to feedback, develop a deep understanding of the typical problems travel nurses face, and optimize their work processes to address these issues.

Many of the pain points encountered by staff nurses will differ from those of agency nurses. Health care systems, home health agencies, and long-term care providers could, however, adopt a similar approach to capture and analyze nurses’ feedback, prioritize the most common and frustrating challenges they face, and work with staff members to address these issues.

Consistently listening to and acting on feedback can also build trust with the nursing staff. Staffing agency nurses are more positive about having the psychological safety to speak up about difficult issues and be heard than are nurses working in hospitals and health care systems.

The benefits of psychological safety are blunted, however, if management is slow to respond to issues that nurses raise. Nurses speak highly of how quickly staffing agencies respond to their questions and concerns. In contrast, nurses frequently complain that other types of employers are slow to respond to emails raising issues, if they get a reply at all. Nurses also place a high value on having multiple channels of communication with their supervisors, including text, email, Facebook, Jabber, and a 24/7 hotline.

Another insight from our research is that nurses value honesty and transparency. They understand the challenges health care faces as well as anyone, and they expect honest communication about what is happening in the organization, how it affects them, and why decisions were made. Triage, a staffing agency and the fourth most highly rated large employer we studied, places honest communication at the center of its value proposition: “We tell it like it is so you won’t be surprised by how it goes.” 15

Health care systems can learn from staffing agencies, but they can also leverage their own distinctive advantages to attract and retain nurses. Nurses in full-time staff positions rate hospitals and health care systems higher than staffing agencies on three important aspects of organizational life: learning and development (including promotion opportunities and reimbursement for training), benefits, and colleagues. Those three factors are among the top 10 predictors of how nurses rate their employers. Health care systems should invest in their comparative advantages and emphasize them when communicating their value proposition to potential and current employees.

Health care systems can learn from staffing agencies, but they can also leverage their own distinctive advantages to attract and retain nurses.

Translate Feedback Into Action to Build Trust

It’s one thing to collect employee feedback, but it’s another to consistently act on those insights. Employees are less likely to surface issues or propose potential solutions if they believe that managers will not act. 16 Worse yet, employees are more likely to quit if they believe that management lacks the power, resources, or interest to make changes based on their suggestions. 17 Nearly half of nurses believe that management will not fix problems that clinical staff members bring to their attention. 18

Organizations need to put in place structures to consistently act on employee feedback. One well-known example is Kaiser Permanente’s unit-based teams (UBTs), which consist of clinical staff members and managers who regularly work together in a specific unit or department. 19 The teams, which meet at least once per month, are responsible for their unit’s performance and are co-led by a manager, a labor representative, and, typically, a clinical staff member.

The UBTs identify opportunities to improve along four dimensions: quality (including patient outcomes), patient service, affordability, and employee experience. The teams use employee feedback to identify and prioritize improvement opportunities. Next, the teams develop and test solutions using best practices and evidence-based methods. Once a solution has been deemed effective, it is implemented across the unit, department, or, in some cases, the entire organization. The UBTs then monitor the impact of these changes in terms of patient outcomes, employee satisfaction, and cost reduction.

Our study of 150,000 reviews written by U.S. nurses since the onset of COVID-19 reveals wide variation in how nurses rate their employers as a whole, and specifically in terms of compensation, workload, toxic culture, and organizational support — the four factors that most shape nurses’ job satisfaction. In our view, this variation offers a message of hope. Despite the structural challenges that all health care organizations face, it is possible to provide an environment where nurses look forward to going to work every day.

Many organizations, including some of the largest employers of nurses, have significant room for improvement. These rankings are not designed to “name and shame” but rather to make health care leaders aware of the magnitude of the gap between their organization’s performance and what is possible when it comes to providing a healthy workplace for nurses. We also hope that the objective data on how health care organizations rank on factors that matter most to nurses can provide their leaders with the impetus to make improvements and the evidence to convince all stakeholders of the urgent need for change.

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What leaders should not do is ask nurses to work harder and endure more frustration and stress while failing to understand and address the organizational factors that make life miserable for many of them. Leaders who continue business as usual should not be surprised when staff members quit, workers unionize, and state and federal legislators dictate regulations to protect the interests of nurses.

To improve the work lives of nurses, and indeed all health care workers, leaders must collect and act on their feedback, recognizing that different parts of the organization and different populations will face distinctive challenges and issues. Listening to nurses demonstrates that there are meaningful steps health care leaders can take to fix the nursing crisis. The single most important step is to listen to them in the first place.

About the Authors

Donald Sull ( @culturexinsight ) is a senior lecturer at the MIT Sloan School of Management and a cofounder of CultureX. Charles Sull is a cofounder of CultureX.

1. “ Survey: Workforce Challenges Cited by CEOs as Top Issue Confronting Hospitals in 2022 ,” American College of Healthcare Executives, Feb. 13, 2023, www.ache.org.

2. D.I. Auerbach, P.I. Buerhaus, K. Donelan, et al., “ A Worrisome Drop in the Number of Young Nurses ,” Health Affairs Forefront, April 13, 2022, www.healthaffairs.org.

3. B. Martin, N. Kaminski-Ozturk, C. O’Hara, et al., “ Examining the Impact of the COVID-19 Pandemic on Burnout and Stress Among U.S. Nurses ,” Journal of Nursing Regulation 14, no. 1 (April 2023): 4-12; and G. Berlin, M. Lapointe, M. Murphy, et al., “ Assessing the Lingering Impact of COVID-19 on the Nursing Workforce ,” McKinsey & Co., May 11, 2022, www.mckinsey.com.

4. R.A. Smiley, R.L. Allgeyer, Y. Shobo, et al., “ The 2022 National Nursing Workforce Survey ,” Journal of Nursing Regulation 14, no. 1, sup. 2 (April 2023): S1-S90.

5. L.H. Aiken, K.B. Lasater, D.M. Sloane, et al., “ Physician and Nurse Well-Being and Preferred Interventions to Address Burnout in Hospital Practice: Factors Associated With Turnover, Outcomes, and Patient Safety ,” JAMA Health Forum 4, no. 7 (July 2023): table 2.

6. We selected the largest 200 employers based on the number of U.S. Glassdoor ratings by nurses from April 1, 2020, through June 30, 2023.

7. Aiken et al., “Physician and Nurse Well-Being,” table 1.

8. This methodology is similar to that employed by M. Jura, J. Spetz, and D.-M. Liou in “ Assessing the Job Satisfaction of Registered Nurses Using Sentiment Analysis and Clustering Analysis ,” Medical Care Research and Review 79, no. 4 (August 2022): 585-593.

9. Aiken et al., “Physician and Nurse Well-Being,” table 3.

10. M.A. McCord, D.L. Joseph, L.Y. Dhanani, et al., “ A Meta-Analysis of Sex and Race Differences in Perceived Workplace Mistreatment ,” Journal of Applied Psychology 103, no. 2 (February 2018): 137-163; and K. Aquino and S. Thau, “ Workplace Victimization: Aggression From the Target’s Perspective ,” Annual Review of Psychology 60 (February 2009): 717-741.

11. A. Bergman, H. Song, G. David, et al., “ The Role of Schedule Volatility in Home Health Nursing Turnover ,” Medical Care Research and Review 79, no. 3 (June 2022): 382-393.

12. Nurses quitting (versus being fired) accounted for 96% of all separations from hospitals in 2021. See “ 2021 NSI National Health Care Retention & RN Staffing Report ” (East Petersburg, Pennsylvania: NSI Nursing Solutions, March 2021): 3.

13. D. Sull, C. Sull, W. Cipolli, et al., “ Why Every Leader Needs to Worry About Toxic Culture ,” MIT Sloan Management Review, March 16, 2022, https://sloanreview.mit.edu.

14. D. Sull, C. Sull, and B. Zweig, “ Toxic Culture Is Driving the Great Resignation ,” MIT Sloan Management Review, Jan. 11, 2022, https://sloanreview.mit.edu.

15. “We Tell It Like It Is So You Won’t Be Surprised by How It Goes,” Triage, accessed April 24, 2023, https://triagestaff.com.

16. E.W. Morrison, “ Employee Voice and Silence ,” Annual Review of Organizational Psychology and Organizational Behavior 1 (March 16, 2014): 173-197.

17. E.J. McClean, E.R. Burris, and J.R. Detert, “ When Does Voice Lead to Exit? It Depends on Leadership ,” Academy of Management Journal 56, no. 2 (April 2013): 525-548.

18. Aiken et al., “Physician and Nurse Well-Being,” table 2.

19. “ Unit-Based Team Overview ” and “ UBT Roles ,” Labor Management Partnership, accessed Aug. 30, 2023, www.lmpartnership.org.

i. We ran models for the pre- and post-COVID-19 samples by current employees, former employees, and all employees for a total of six models. The average out-of-sample adjusted R2 across a tenfold validation ranged between 0.29 and 0.39 for all models. A model using structural attributes of employers, including ownership, type of organization (health care system, nursing home, or specialty hospital), and location, however, together explained less than 5% of the variance in how nurses rated their employers. Our analysis of structural attributes included seven ownership types, 17 organizational types, and 50 U.S. states. For the structural model, the average out-of-sample adjusted R2 across a tenfold cross-validation was 4.2%.

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Nurse Staffing Crisis

This is a decisive moment for our health care system, and the American Nurses Association is leading the conversation to address the nation’s nurse staffing crisis and improve health care for everyone.

As the largest staffing group — at almost 40% of operating costs –— nurses have been an easy target for reduced hours and other cutbacks. But those cuts come at the expense of patient well-being and nurses’ safety.

Nurse staffing levels are critical to optimizing quality of patient care, improving care outcomes, and long-term cost containment. In the face of nurse staffing shortages, an aging population and increased patient complexity, ANA and its members are taking action.

The Clinical Case for Adequate Nurse Staffing Levels

Nurses facilitate the entire health care journey — from hospital admission to discharge. This role gives them unique perspective and power to drive positive patient outcomes.

Appropriate staffing levels have multiple benefits, including:

• Reduced mortality rates.
• Reduced length of patient stays.
• Reducing a number of preventable events, such as falls and infections.

Nurses are at the forefront of our healthcare system. By recognizing the true impact of nursing, we can lead the change that will both address the nurse staffing crisis and improve health care for everyone. The business sense behind optimal nurse staff levels is irrefutable.

While patient safety benefits from this focus, so do nurses. With an improved workload comes the chance for nurses to utilize their full expertise, without the pressure of fatigue. Staffing levels in a value-based health care system should not be fixed because day-to-day hospital requirements are constantly in flux, according to findings in a white paper from health care insight leader Avalere and a panel of top nurse researchers, thought leaders and managers.

The report indicates staff levels should depend on the following factors:

• Patient complexity, acuity or stability.
• Number of admissions, discharges and transfers.
• Professional nurses’ and other staff members’ skill level and expertise.
• Physical space and layout of the nursing unit.
• Availability of technical support and other resources.

Empower Nurses to Address the Staffing Crisis

Nurses know the provisions that they and their team need, from patient complexity to layout of the nursing unit. In the face of limited federal intervention, ANA supports a legislative model with nurses sanctioned to create flexible staffing plans for their unit. Staffing levels would improve, and nurses would be able to support each other when most needed.

This is just another instance where health care would be improved by greater nurse involvement. It is crucial for nurses to take on leadership roles, in all settings, to meet the demands of our ever-changing health care system. The Institute of Medicine (IOM) Future of Nursing Report details this further, with suggestions on how nurses should be supported to achieve greater responsibility:

• Nurses should practice to the full extent of their education, training and licensure.
• Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
• Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States.
• Effective workforce planning and policymaking require better data collection and an improved information infrastructure.

The Future of Nursing Requires Action

Staffing solutions must evolve to cope with the full weight of the health care system, and flexible staffing plans are a huge factor in successfully accomplishing this goal. Organizations must be held accountable for their operations, and public reporting is critical in ensuring this transparency. Every nurse can make a difference.

You can take action by writing to your members of Congress and urging them to support Safe Staffing or by shar ing your stories of nursing on the frontline.

Nurse Staffing Task Force Meetings

• Meeting 1 - April 25, 2022 -- Agenda | Executive Summary
• Meeting 2 - May 16, 2022 -- Agenda | Executive Summary
• Meeting 3 - June 6, 2022 -- Agenda | Executive Summary
• Meeting 4 - June 27, 2022 -- Agenda | Executive Summary
• Meeting 5 - July 18, 2022 -- Agenda | Executive Summary

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Nursing crisis: Challenges and opportunities for our profession after COVID‐19

As the world begins to emerge from the COVID‐19 pandemic—still fearing that maybe this is not yet the end—we must embrace a still unclear future and act to shape it. Whatever lies ahead, recovery and reconstruction will require much energy, creativity and determination.

COVID‐19 was declared a pandemic by the director‐general of the World Health Organization (WHO) on 11 March 2020. By 14 May 2022—just over 2 years later—it had resulted in 6.2 million deaths around the world, including tens of thousands of health and care workers (WHO,  2021 ). Nurses have been on the front lines, confronting a world turned upside down, and have faced each viral wave and continue to face new surges with courage, expertise and compassion.

First, we faced an unknown pathogen with limited knowledge, personal protective equipment and tools to diagnose and treat COVID‐19. Healthcare workers had more than sevenfold higher risk of severe COVID‐19 compared with other occupations (Mutambudzi et al.,  2020 ). Then came waves of grave illness and incessant deaths. Nurses across all sectors have shown unimaginable resilience. However, there are limits to endurance. Recent studies show very high rates of depression, anxiety, post‐traumatic stress disorder, burnout and exhaustion among nurses, and many are considering changing positions or leaving the profession altogether (Chen et al.,  2020 ; Hong et al.,  2020 ; Li et al.,  2021 ; Magnavita et al.,  2021 ; Moll et al.,  2022 ; Sahebi et al.,  2021 ; Sinsky et al.,  2021 ).

How can we rebuild a strong profession as we move beyond this taxing pandemic? What are the key challenges and possible solutions?

Nursing faces great instability: Nursing has emerged from the pandemic in a state of restlessness, which is leading to a potential crisis. Recent data indicate 69% of Canadian nurses plan to leave their position within the next 5 years; of these, 42% are contemplating leaving the profession altogether (Registered Nurses' Association of Ontario [RNAO],  2022a ). Similar difficulties are being experienced elsewhere, and several factors help explain these numbing statistics.

• ○ Potential solutions: Vaccination and masking should be continued when indicated as appropriate by following local case counts and surveillance data. Personal protective equipment must always be available for frontline clinicians. Ongoing institutional planning, education and resourcing must remain engaged and poised to act quickly to changed situations. Annual measurements of burnout should also be implemented to ensure that wellness programming, staffing and other instituted measures are improving the working environment (Kelly et al.,  2020 ).
• ○ Solutions: Hospitals must not cut nursing staffing levels to save money. Poor staffing ratios are related to negative nurse outcomes and higher hospital mortality (Aiken et al.,  2014 ; Shin et al.,  2018 ). Sensitive and reliable patient and workload acuity scoring systems should be used to plan staffing ratios, and skill acquisition must be considered with 24/7 staffing as newer nurses enter the workforce and require support. System issues, such as burdensome electronic health record documentation requirements, need to be streamlined so that nurses can focus on providing care to patients and their families.
• ○ Solutions: Work–life balance has always been difficult to achieve, but even more so now with disrupted childcare, schooling and work requests. Facilities must build cultures of wellness and must provide evidence‐based wellness and support programming for the whole nurse (Adelson et al.,  2021 ; Melnyk et al.,  2021 ). Other recommended practices include instituting tenets of a healthy work environment, including meaningful recognition and effective decision making (Kelly et al.,  2021 ).

Nurses are suffering health effects: The health results of the pandemic for nurses indicate severe burnout and mental health challenges.

• Burnout: Canadian and American studies show the majority of respondents with symptoms of burnout as expressed by being exhausted and disengaged (American Nurses Foundation [ANF], 2021 ; RNAO,  2021 , 2022b ). Burnout is worse among younger nurses.
• Mental health challenges: Globally, the pandemic has negatively impacted nurses' mental health and well‐being (Al Maqbali et al.,  2021 ; Chan et al.,  2021 ; Ching et al.,  2021 ; Koontalay et al.,  2021 ; Sanghera et al.,  2020 ). According to the HPWP ( 2021 ) report, most workers across the seven professions surveyed—nursing, midwifery, teaching, medicine, dentistry, academia and accounting—reported experiencing a mental health issue due to the pandemic. However, women in the female‐dominated professions—nursing, midwifery and teaching—were more likely than men to experience a mental health issue (HPWP,  2021 ). Younger nurses with less working experience and work in the frontline reported a higher prevalence of anxiety, depression, stress and insomnia (Chan et al.,  2021 ).
• Nurse migration affecting developing countries: Nurse migration from developing countries to pursue better work conditions in richer countries has created a more dramatic situation for nurses in countries with limited resources (Shaffer et al.,  2020 ).

What are the opportunities ? The way forward involves multiple concurrent approaches. Old solutions to health services—those driven by cost‐cutting priorities ahead of person‐centred care and healthy work environments—will no longer work. Nurses' restlessness and departures demand urgent and sustained actions to recruit and retain talent. A focus on values‐based healthcare and human resource practices that offers meaningful work environments for staff is the way out of this deep crisis. These environments must encourage staff to engage in solution and decision making, evidence‐based practices and courageous conversations. The wake‐up call of a nursing crisis is loud and universal. Governments, employers, educators and nursing associations must respond swiftly investing in nursing, building careers for nurses and tackling ongoing barriers such as systemic racism (Arabi et al.,  2021 ; Cooper Brathwaite, Versailles, Juüdi‐Hope, Coppin, Jefferies, Bradley, Campbell, Garraway, Obewu, Laronde‐Ogilvie, Sinclair, Groom, & Grinspun,  2022 ; Cooper Brathwaite, Versailles, Juüdi‐Hope, Coppin, Jefferies, Bradley, Campbell, Garraway, Obewu, Laronde‐Ogilvie, Sinclair, Groom, Punia, & Grinspun,  2022 ; RNAO,  2021 , 2022a , 2022b ; Tomblin‐Murphy et al.,  2022 ). Educators, managers and policymakers must also heed the significant influence of health for retention of staff and consider what strategies may mitigate health risks for this workforce (Perry et al.,  2016 ). Lastly, psychological interventions need to be addressed in the planning stage for future crisis, including a pandemic (El‐Monshed et al.,  2021 ).

Given the central role of nursing for the health of all nations, solutions for post‐COVID challenges are essential, not optional, for governments, policymakers, managers and leaders of nursing, locally, nationally and internationally.

ACKNOWLEDGEMENT

We thank Kristina Brousalis for her editorial support.

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A case study of a collaborative allied health and nursing crisis response

Affiliations.

• 1 Department of Rehabilitation, Royal Papworth Hospital , Cambridge, UK.
• 2 Clinical Nursing, Royal Papworth Hospital , Cambridge, UK.
• 3 Faculty of Health, Education, Medicine & Social Care, Anglia Ruskin University , Cambridge, UK.
• PMID: 32935607
• DOI: 10.1080/13561820.2020.1813093

The COVID-19 pandemic was declared by the World Health Organization on 11 March 2020. The rapid spread of SARS-CoV-2 required an equally rapid response from health-care organizations to find innovative ways to utilize the existing workforce to care for people with COVID-19. Using an evaluative case study, a unique insight into the collaborative allied health and nursing professions' response to COVID-19 at a specialist cardiothoracic hospital in the United Kingdom is presented. The aim of the case study was to evaluate how an interprofessional workforce from the wider organization could be supported to work in critical care as part of a crisis response. In identifying the key enablers to setting up an interprofessional Essential Care Team and learning from the lived experiences of those involved, t his case study has demonstrated that, in supported, interprofessional teams the wider organizational workforce can be facilitated to effectively and safely provide critical care services. The lessons learned from this study will support future pandemic responses and aid the identification of further opportunities for interprofessional learning and practice. Ultimately, the study highlights that by identifying and investing in the key enablers, health-care organizations can be better prepared to respond to a global crisis.

Keywords: Interprofessional Collaboration; case Study; co-operative Working; interprofessional Practice; patient-Centered Practice; team-Based Practice.

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Regulating During Crisis: A Qualitative Comparative Case Study of Nursing Regulatory Responses to the COVID-19 Pandemic

• Kathleen Leslie, PhD, JD, RN Kathleen Leslie Contact Affiliations An Assistant Professor, Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada, and the Governance and Regulation theme lead for the Canadian Health Workforce Network. Search for articles by this author
• Sophia Myles, PhD Sophia Myles Affiliations A postdoctoral fellow, Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto, Canada, and a research assistant at Athabasca University. Search for articles by this author
• Sarah Stahlke, PhD Sarah Stahlke Affiliations An Adjunct Professor, Department of Sociology, University of Alberta, and an instructor and research associate at Athabasca University. Search for articles by this author
• Catharine J. Schiller, PhD, JD, RN Catharine J. Schiller Affiliations An Assistant Professor and Coordinator of Undergraduate Nursing Programs, School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada. Search for articles by this author
• Jacob J. Shelley, SJD Jacob J. Shelley Affiliations An Associate Professor, Faculty of Law and School of Health Studies, Faculty of Health Sciences, Western University, and the Director of the Health Ethics, Law & Policy (HELP) Lab. Search for articles by this author
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• Sioban Nelson, PhD, RN, FAAN, FCAHS Sioban Nelson Affiliations A Professor in the Faculty of Nursing, University of Toronto. Search for articles by this author
• Regulation nursing COVID-19 pandemic licensure qualitative case study legislation
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Professional Standards Authority for Health and Social Care. (2021, April 15). Learning from Covid-19: A case-study review. https://www.professionalstandards.org.uk/publications/detail/learning-from-covid-19-a-case-study-review

• van Stralen A.C.
• Carvalho C.L.
• Girardi S.N.
• Massote A.W.
• Cherchiglia M.L.

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Data Analysis

• Hayfield N.
• Merriam S.B.

Ethical Considerations

• 1. Risk-based responses to reduce regulatory burden
• 2. Agility and flexibility in regulatory pandemic responses
• 3. Working with stakeholders for a systems-based approach
• 4. Valuing consistency in regulatory approaches across jurisdictions
• 5. The pandemic as a catalyst for innovation.

Theme 1: Risk-Based Responses to Reduce Regulatory Burden

Theme 2: agility and flexibility in regulatory responses, theme 3: working with stakeholders for a systems-based approach, theme 4: valuing consistency in regulatory approaches across jurisdictions, theme five: the pandemic as a catalyst for innovation.

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Limitations

Health Statutes Amendment Act, SA 2020, c. 27 (2020). http://canlii.ca/t/b2w5

• Steering Committee on Modernization of Health Professional Regulation

Future Research

• Wenghofer E.F.
• Kaminski-Ozturk N.

APPENDIX. Sample Interview Guide

• 1. Introduction: Introduce research team members, review written consent form, provide overview of study, answer questions, and begin recording.

• 3. Concluding question: Is there anything else you would like us to know about how your nursing regulatory body has been regulating in the public interest during the crisis?
• 4. Wrap up: Thank you to participant(s) and description of next steps for research team.

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This study was supported by a grant from the NCSBN’s Center for Regulatory Excellence. We also wish to thank Aleah McCormick for her research assistance and the interview participants for generously sharing their time and insights during this challenging time.

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• Published: 14 August 2024

Overcoming challenges in nursing disaster preparedness and response: an umbrella review

• Abdulellah Al Thobaity 1  

BMC Nursing volume  23 , Article number:  562 ( 2024 ) Cite this article

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Disaster nursing plays a vital role in addressing the health needs of vulnerable populations affected by large scale emergencies. However, disaster nursing faces numerous challenges, including preparedness, logistics, education, ethics, recovery and legalities. To enhance healthcare system effectiveness during crises, it is essential to overcome these issues. This umbrella review, conducted using the Joanna Briggs Institute (JBI) methodology, synthesizes data from 24 studies to identify key strategies for improving disaster nursing. The review highlights nine key themes: Education and Training, Research and Development, Policy and Organizational Support, Technological Advancements, Psychological Preparedness and Support, Assessment and Evaluation, Role-Specific Preparedness, Interprofessional Collaboration and Cultural Competence, and Ethics and Decision-Making. The review emphasizes the importance of education, technological advancements, psychological support, and interprofessional collaboration in bolstering disaster nursing preparedness and response efforts. These elements are crucial for enhancing patient outcomes during emergencies and contributing to a more resilient healthcare system. This comprehensive analysis provides valuable insights into the various aspects essential for enhancing disaster nursing. By implementing evidence-based strategies within these nine themes, the nursing profession can enhance its capacity to effectively manage and respond to the complex needs of disaster-affected populations, ultimately improving patient care and outcomes during emergencies.

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Introduction

Disaster nursing is a specialized field that focuses on the provision of care and support individuals and communities who are affected by emergencies and crises. Disaster Nursing, emphasizes the critical roles of nurses in addressing the health needs of vulnerable populations who has special needs such as elderly and children during disasters [ 1 ]. Competent disaster Nursing is essential to improve the overall effectiveness and efficiency of healthcare systems during times of crisis by ensuring the well-being and resilience of individuals and communities. However, disaster nursing faces major challenges that must be acknowledged and addressed, including preparedness and planning, logistical, and organizational, as well as education, training, recovery and ethical and legal considerations [ 2 , 3 ]. By exploring these challenges and identifying strategies for overcoming them, nursing profession can continue to evolve and enhance the ability to respond to the complex needs of those affected by disasters.

Challenges related to preparedness and planning in disaster nursing encompass various aspects that can hinder effective crisis response in many countries worldwide [ 1 , 4 , 5 ]. These include limitations in the disaster paradigm, inadequacies in the pre-hospital system, lack of coordination and cooperation among stakeholders, insufficient hospital preparedness, scarce resources and capacities, and gaps in patient knowledge [ 6 , 7 ]. Furthermore, challenges in planning for the unpredictable nature of disasters, disparities in emergency nurses’ preparedness, workplace readiness, and the preparedness of colleagues and institutions (including leadership and peers) contribute to the complexity of the issue [ 8 ]. Limited availability of training opportunities, individual preparedness due to lack of prior experience, absence of a comprehensive disaster plan, insufficient disaster training, and unassigned roles in workplace disaster plans further exacerbate the difficulties faced by nursing professionals in the realm of disaster preparedness and planning [ 8 , 9 , 10 , 11 ]. Addressing these challenges is crucial for enhancing the ability of nurses and healthcare institutions to effectively manage and respond to emergencies.

Logistical, organizational, and managerial challenges pose significant obstacles to effective disaster nursing in numerous countries worldwide. Such as Japan ; China and Iran [ 2 , 12 , 13 ] Logistical challenges, such as constructing and operating hospitals in disaster zones and addressing equipment issues, create difficulties in the provision of care [ 2 ]. Staff challenges, including the orientation of personnel in new and challenging environments, further complicate the situation [ 14 ]. Organizational and managerial challenges encompass the development and implementation of appropriate policies, procedures, and support structures, which are essential for enabling nursing professionals to work effectively under extreme conditions [ 2 ]. Adequate support from hospital administration, the promotion of evidence-based practice research, and the use of evaluation tools to assess and improve performance are crucial in overcoming these challenges. Gaps in these areas can hinder the ability of nurses and health care institutions to manage and respond effectively to emergencies, underscoring the need for comprehensive strategies to address logistical, organizational, and managerial challenges in disaster nursing.

Challenges related to education and training in disaster nursing have far-reaching consequences on the ability of nurses to effectively respond to emergencies [ 15 ]. These challenges encompass the defining roles of nurses, the creation and implementation of educational training programs, and the overall education system. Factors such as the lack of disaster educators, insufficient formal education, inadequate nurse training, and limited disaster experience hinder the development of competent and prepared nursing professionals [ 2 ]. Furthermore, challenges in understanding hospital disaster policies and procedures, and the roles of nurses in disaster management, as well as deficiencies in communication and leadership skills, contribute to the problem. Personal evacuation experiences, a scarcity of studies, the lack of specialized journals, inaccessible programs, and gaps in nursing curricula further exacerbate the difficulties faced by nursing professionals. Addressing these educational and training challenges is essential to equip nurses with the knowledge, skills, and confidence required to effectively manage and respond to disasters.

Ethical and legal challenges in disaster nursing present unique obstacles that nursing professionals must navigate while providing care in crisis situations [ 16 ]. These challenges include addressing patient-related issues, such as cultural differences, language barriers, and follow-up concerns [ 17 , 18 ]. Ethical challenges unique to disaster zones and related to the scope and scale of the disaster, along with more general ethical issues, arise in areas such as justice in resource allocation, privacy and confidentiality, beneficence and non- maleficence. Furthermore, determining appropriate triage, setting treatment priorities, working autonomously, and obtaining informed consent can be particularly complex in disaster settings [ 3 , 18 ]. Conflicts and legal issues such as allocating the resources may also emerge, further complicating the delivery of care during emergencies. Addressing these ethical and legal challenges is vital for ensuring that nursing professionals can provide compassionate and effective care while upholding their professional responsibilities and the rights of the patients they serve.

Conducting an umbrella review on overcoming the challenges faced by disaster nursing is crucial for various reasons. First, it allows for a comprehensive and systematic synthesis of evidence from multiple systematic reviews, identifying studies, evidence, and interventions employed to address these challenges, thus mapping the knowledge landscape and progress made. Secondly, it reveals gaps in the literature, highlighting areas for further research and guiding researchers in prioritizing underexplored topics. Thirdly, it offers valuable insights into effective strategies and best practices, informing policymakers, healthcare institutions, and nursing professionals about evidence-based interventions and policies. Additionally, an umbrella review can facilitate interdisciplinary collaboration by revealing shared challenges and solutions across various fields, foster innovation and the development of integrated approaches to disaster nursing, and ultimately enhancing the efficacy and resilience of healthcare systems in responding to emergencies. Hence, the aim of this umbrella review is to explore the strategies that have been implemented in overcoming nursing challenges in disaster preparedness and response.

This umbrella review was conducted following the Joanna Briggs Institute (JBI) methodology for umbrella reviews. The purpose of this review is to synthesize existing systematic reviews related to the challenges in nursing disaster preparedness and response [ 19 ]. Studies were selected for inclusion in this research based on the criteria outlined in Table  1 .

A comprehensive search strategy was developed using relevant keywords and Medical Subject Headings (MeSH) terms, including “nursing,” “disaster preparedness,” “disaster response,” “challenges,” “interventions,” “strategies,” and “effectiveness,” applied to selected databases (PubMed, CINAHL, Scopus, Web of Science, and PsycINFO) and grey literature sources. Handsearching reference lists of included articles further enhanced the search. Duplicates were removed using EndNote reference management software, and titles and abstracts were screened based on eligibility criteria. Potentially eligible full-text articles were assessed for inclusion, and the study selection process was documented using a PRISMA flowchart Fig.  1 . The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram outlines the study selection process for this review.

PRISMA flowchart of study selection process

Initially, 3,223 records were identified from databases and 68 from registers. Before screening, 1,281 duplicate records and 1,050 ineligible records were removed, leaving 960 records for screening. After excluding 858 records, 102 reports were sought for retrieval, resulting in a final inclusion of 24 studies in the review which involve the flowing : Al Thobaity , Plummer , & Williams , 2017 [ 20 ] ; Kalanlar , 2019 [ 21 ] ; Zarea et al. , 2014 [ 2 ]; Jose & Dufrene , 2014 [ 22 ]; Cong Geng , Yiqing Luo , Xianbo Pei , & Xiaoli Chen , 2021 [ 23 ]; Alice Yuen Loke , Chunlan Guo , & Alex Molassiotis , 2021 [ 5 ] Nejadshafiee , Bahaadinbeigy , Kazemi , & Nekoei-Moghadam , 2020 [ 24 ]; Karin Hugelius & Adolfsson , 2019 [ 25 ]; Veenema , Lavin , Bender , Thornton , & Schneider-Firestone , 2019 [ 26 ]; Labrague et al. , 2018 [ 27 ] Yousefi , Larijani , Golitaleb , & Sahebi , 2019 [ 28 ] ; Varghese et al. , 2021 [ 29 ]; Kalanlar, 2022 [ 30 ] ; Said & Chiang , 2020 [ 31 ]; Pourvakhshoori , Norouzi , Ahmadi , Hosseini , & Khankeh , 2017 [ 32 ]; Hutton , Veenema , & Gebbie , 2016 [ 33 ]; Su et al. , 2022 [ 34 ]; Firouzkouhi , Kako , Abdollahimohammad , Balouchi , & Farzi , 2021 [ 35 ]; Tas & Cakir , 2022 [ 36 ]; Lin , Tao , Feng , Gao , & Mashino , 2022 [ 37 ]; Fithriyyah, Alda, & Haryani, 2023 [ 38 ]; Songwathana & Timalsina, 2021 [ 39 ] and Kimin, Nurachmah, Lestari, & Gayatri, 2022 [ 40 ] Putra , Kamil , Yuswardi , & Satria , 2022 [ 41 ]. The essential information such as: authors, publication year, type of review and key strategies were extracted and summarised in Table  2 .

Data synthesis

In this umbrella review, a single investigator conducted the thematic analysis using a thorough and systematic approach. The process began with familiarization through detailed reading and note-taking, followed by manual coding to identify key concepts. Preliminary themes were developed by grouping similar codes and refined iteratively for coherence. To enhance credibility, feedback was sought from a senior qualitative researcher. Detailed documentation of the process ensured transparency, while reflexive notes and discussions with the senior researcher mitigated potential bias. This approach ensured rigorous and transparent theme identification, enhancing the findings’ reliability and validity. Data from selected studies were synthesized to create a narrative synthesis, organized by strategies for improving disaster nursing. These strategies were summarized into nine key themes: (1) Education and Training; (2) Research and Development; (3) Policy and Organizational Support; (4) Technological Advancements; (5) Psychological Preparedness and Support; (6) Assessment and Evaluation; (7) Role-Specific Preparedness; (8) Interprofessional Collaboration and Cultural Competence; and (9) Ethics and Decision-Making. This approach allowed for a comprehensive analysis of the various aspects of disaster nursing enhancement.

This umbrella review aims to explore and emphasize the diverse strategies implemented to address nursing challenges in disaster preparedness and response. By synthesizing findings from the included studies, the discussion is organized into the nine key themes previously mentioned. Through a narrative synthesis of these themes, the review provides a comprehensive understanding of the various approaches used to enhance disaster nursing. Examining these strategies is intended to inform future research, policy, and practice, ultimately leading to improved disaster preparedness and response, better patient care, and enhanced outcomes during emergencies.

Education and training

Improving disaster nursing locally and worldwide requires a multifaceted approach, starting with enhancing nurses’ understanding of core competency domains [ 10 ]. Integrating these domains into training and disaster drills helps reinforce practical skills, ensuring efficient and effective responses in real-life disaster situations [ 10 , 22 ]. Expanding undergraduate and graduate disaster nursing education on national and international levels creates a well-prepared workforce capable of addressing diverse challenges in disaster management [ 21 , 22 , 23 ]. Effective training programs can address existing gaps in education by providing ongoing professional development opportunities for nurses. Establishing dedicated organizational units within healthcare systems to prepare for and respond to disasters by educating healthcare providers, including nurses, enhances disaster preparedness by encouraging collaboration and resource sharing. Moreover, a focused approach to improving education and training in disaster nursing is crucial worldwide [ 5 , 21 , 23 , 42 ]. Developing educational content for disaster nursing requires a tailored approach that considers the unique needs and challenges of the field. This includes accounting for various types of disasters, impacted healthcare settings, and the diverse roles that nurses play in disaster situations. By addressing these distinct aspects, educational materials can better equip nurses with the skills and knowledge needed to respond to emergencies and deliver high-quality patient care in disaster preparedness and response contexts [ 3 , 42 ]. Lastly, incorporating interprofessional education promotes teamwork, communication, and coordination among different healthcare providers, ultimately contributing to enhanced disaster preparedness worldwide [ 43 ].

Research and development in disaster nursing

Research and development (R&D) are critical for advancing disaster nursing. They generate evidence-based knowledge that guides clinical practice [ 5 , 44 ]. By involving nurses in research focused on competencies, studies become more relevant and applicable, as they are rooted in real-world experiences [ 44 ]. It is essential to optimize resource allocation in order to be more efficient and effective for both disaster preparedness and response [ 5 ]. Rigorous research, combined with addressing limitations in study design and methods, enhances the quality of the evidence base, which then informs best practices in disaster nursing [ 5 , 44 ]. One area of research with significant potential is the application of simulation in disaster care. High-level studies in this field can reveal innovative training methods, improving nurses’ readiness and performance during crises [ 21 , 23 ]. Additionally, exploring practical approaches in areas such as psychosocial support, holistic health assessments, disaster nurse management, and minimizing distress for deployed nurses can contribute to comprehensive and integrated strategies. These strategies ultimately promote optimal patient care and nurse well-being during disaster response efforts.

Policy and organizational support

Policy and organizational support are crucial in strengthening disaster nursing by fostering collaboration among nursing staff, health care organizations, and governments. Key strategies include formalizing relationships between nursing staff and disaster organizations, which is essential for seamless communication and coordination during large scale emergencies [ 21 ]. Implementing robust hospital policies that promote disaster preparedness through regular drills and training can significantly enhance the readiness of healthcare facilities [ 26 ]. Investing in comprehensive disaster nursing education programs at both national and international levels addresses global nursing shortages and ensures that nurses are adequately prepared for disaster response [ 24 ]. Offering competitive salary packages, particularly in low- and middle-income countries, can improve nurse retention rates and maintain a skilled workforce capable of effective disaster management [ 27 ]. These strategies not only improve disaster response outcomes but also enhance hospital preparedness and the overall resilience of the healthcare system.

Technological advancements in disaster nursing

The integration of technological advancements presents a significant opportunity to revolutionize disaster nursing, impacting education, access to specialized care, and the efficiency of healthcare response during emergencies. As highlighted in the literature, incorporating innovative educational technologies like virtual reality and e-learning platforms can significantly improve disaster nursing training [ 23 , 34 ]. These technologies offer immersive and engaging learning experiences, allowing nurses to practice critical skills in simulated disaster scenarios without real-world risks. This is particularly crucial given the need for continuous improvement in training for diverse disaster situations [ 34 ]. Furthermore, telenursing emerges as a promising solution to address the shortage of specialized nurses in disaster-stricken areas [ 37 ]. By leveraging telecommunication technologies, experienced nurses can provide remote consultations, triage, and support to frontline healthcare workers, ensuring timely and specialized care for disaster victims. Mobile health applications and electronic health records can further enhance disaster response by streamlining communication and decision-making during crises [ 37 ]. These technologies facilitate real-time data sharing, patient tracking, and resource allocation, ultimately leading to a more coordinated and effective response.

Realizing the full potential of these technological advancements requires a collaborative effort. Nursing educators must embrace and integrate these technologies into their curricula, while healthcare organizations need to invest in the necessary infrastructure and training for their staff. Researchers play a crucial role in evaluating the effectiveness of these technologies and identifying best practices for their implementation in disaster settings. By fostering collaboration and innovation, we can leverage technological advancements to enhance disaster nursing preparedness and response, ultimately improving patient outcomes and saving lives.

Psychological preparedness and support

Psychological preparedness and support play a vital role in disaster nursing, contributing to the well-being and resilience of healthcare professionals and impacted communities. Implementing strategies like the HOPE model, proactive psychological interventions, flexible support, and including mental health provisions in disaster preparedness plans can effectively address nurses’ emotional and psychological needs during emergencies. The HOPE model for disaster nursing is a framework emphasizing holistic health assessment, immediate response, professional adaptation, and recovery [ 25 ]. Studies have highlighted the importance of psychological preparedness, emphasizing the need for proactive psychological interventions and mental health provisions in preparedness plans due to the mental health impact of the COVID-19 pandemic on nurses [ 29 ]. It is essential to improve nurses’ psychological preparedness and prioritize education to enhance their ability to respond effectively to disasters [ 31 ]. Some scholars emphasize the need for targeted training that incorporates psychological support [ 32 , 35 ], while others discuss strategies to address the complexities of disaster contexts, including psychological readiness [ 39 ]. By prioritizing psychological preparedness and support, healthcare organizations and policymakers can equip nurses to better handle challenges during disasters, ultimately resulting in enhanced patient care and a more robust healthcare system.

Assessment and evaluation

Assessment and evaluation play a crucial role in disaster nursing, offering key insights into the preparedness and abilities of the nursing workforce. By broadening the scope of existing scales, creating comprehensive assessment tools, and emphasizing improvements in nurses’ psychological preparedness, knowledge, and skills, healthcare organizations and educators can gain a deeper understanding of the strengths and weaknesses in current disaster nursing practices. For instance [ 27 ], systematically reviewed literature to gauge nurses’ preparedness for disaster response, identifying gaps and areas for improvement. Similarly [ 28 ], conducted a systematic review and meta-analysis to assess the knowledge, attitudes, and performance of Iranian nurses regarding disaster preparedness, highlighting key areas needing enhancement. Furthermore [ 29 ], explored the mental health outcomes of nurses globally during the COVID-19 pandemic, underscoring the importance of psychological preparedness. Additionally [ 26 ], assessed nurse readiness for radiation emergencies and nuclear events, providing critical insights into preparedness gaps and specific roles and responsibilities. These studies collectively underscore the necessity for rigorous assessment and evaluation frameworks in disaster nursing, enabling the implementation of targeted interventions to boost nurses’ capacity to deliver effective care during disasters, thereby fostering a more resilient and responsive healthcare system.

Role-specific preparedness

Role-specific preparedness is vital in disaster nursing, ensuring that nurses possess the required knowledge and skills to effectively manage diverse emergencies, such as radiation and nuclear events [ 20 ]. underscore the importance of identifying core competency domains through a scoping review to enhance disaster nursing. Similarly, [ 21 ] highlights the challenges and opportunities within disaster nursing education in Turkey, emphasizing the need for integrative training approaches [ 2 ]. Focus on the unique roles of nurses in disaster management in Iran, advocating for role-specific training tailored to regional needs [ 22 ]. Argue for incorporating disaster preparedness competencies into the undergraduate nursing curriculum, suggesting that suitable instruction methods are crucial for effective education. Moreover [ 23 ], map the application of simulation in disaster nursing education, demonstrating that simulation-based training can significantly enhance nurses’ preparedness for handling radiation and nuclear emergencies. By incorporating these findings into educational and training programs, healthcare organizations and policymakers can better equip nurses to deliver specialized care during such critical events, leading to a more efficient and coordinated healthcare response.

Interprofessional collaboration and cultural competence

Interprofessional collaboration and cultural competence are crucial for effective disaster nursing, fostering a comprehensive and inclusive approach to emergency response. Interprofessional collaboration involves coordinated efforts among different healthcare professions, enhancing communication, reducing redundancies, and ensuring a more efficient and cohesive response to emergencies. By integrating cultural competence into disaster relief planning and public health research, and by educating and training nurses in both interprofessional collaboration and cultural competence, healthcare professionals’ ability to work cooperatively with diverse populations during emergencies is significantly enhanced. This dual focus not only improves therapeutic relations but also ensures that all aspects of patient care are addressed effectively in a multidisciplinary context. Training in these areas is essential, as it enhances disaster response capabilities. Encouraging cultural understanding and fostering interprofessional collaboration ensure that disaster nursing practices are more adaptable and responsive to the distinct needs of various communities. These practices ultimately lead to better emergency management and care outcomes. Studies emphasize the importance of these elements in improving disaster response. Hugelius and Adolfsson, through their systematic review of real-life experiences, highlight the necessity of interprofessional collaboration, while Lin et al. propose a framework for cultural competence in disaster nursing [ 25 , 37 ]. These findings underscore the critical role that targeted training in cultural competence and interprofessional collaboration plays in effective disaster response.

Ethics and decision-making

Ethics and decision-making are fundamental components of disaster nursing, guiding healthcare professionals as they navigate the complexities and challenges that emerge during emergencies. By recognizing potential ethical dilemmas, pinpointing factors that encourage ethical decision-making, devising strategies for implementing ethics, and evaluating the impact of ethical practices in disaster settings, healthcare organizations and educators can better prepare nurses to make well-informed and morally responsible choices under pressure. Integrating ethics into nursing education, institutional policies, and disaster preparedness plans empowers nurses to maintain ethical standards and provide empathetic care, even amid the most demanding situations. Nurses prepare for and respond to emergencies, disasters, conflicts, epidemics, pandemics, social crises, and conditions of scarce resources. The safety of those who receive care and services is a responsibility shared by individual nurses and the leaders of health systems and organizations. This involves assessing risks and developing, implementing, and resourcing plans to mitigate these. Several studies underscore the importance of ethics and decision-making in disaster nursing. For instance, a model for disaster nursing was developed through a systematic review of real-life experiences, highlighting the ethical challenges faced by nurses during disaster response. Their findings emphasize the need for robust ethical frameworks and support systems to guide nurses in making difficult decisions [ 25 ]. Similarly, core competencies in disaster nursing, which include ethical decision-making as a crucial domain, were identified. It is suggested that integrating ethical training into disaster preparedness programs can enhance nurses’ ability to handle ethical dilemmas effectively [ 20 ].They suggest that integrating ethical training into disaster preparedness programs can enhance nurses’ ability to handle ethical dilemmas effectively.

This umbrella review examines strategies to tackle nursing challenges in disaster preparedness and response, consolidating the findings into nine key themes: Education and Training, Research and Development, Policy and Organizational Support, Technological Advancements, Psychological Preparedness and Support, Assessment and Evaluation, Role-Specific Preparedness, Interprofessional Collaboration and Cultural Competence, and Ethics and Decision-Making. To enhance disaster nursing, Education and Training should emphasize core competency domains and integrate them into curricula and drills, while Research and Development should be nurse-centric, improving resource allocation and evidence quality. Policy and organizational support should encourage collaboration among nursing staff, healthcare organizations, and governments, reinforcing hospital policies and addressing global nursing shortages. Technological advancements, such as virtual reality and e-learning, hold the potential to transform disaster nursing education. Psychological preparedness and support are essential for nurses’ well-being and resilience, and assessment and evaluation frameworks are crucial for identifying gaps and areas for improvement. Role-specific preparedness equips nurses with the necessary knowledge and skills for various emergencies. Interprofessional collaboration and cultural competence promote a comprehensive and inclusive approach to emergency response, and ethics and decision-making guide healthcare professionals in navigating complexities during disasters. This review aims to inform future research, policy, and practice, ultimately enhancing disaster preparedness and response, patient care, and outcomes during emergencies.

Data availability

No datasets were generated or analysed during the current study.

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Acknowledgements

The auther would like to encourage the deanship of graduate studies and scientific research, Taif University for funding this study.

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Al Thobaity, A. Overcoming challenges in nursing disaster preparedness and response: an umbrella review. BMC Nurs 23 , 562 (2024). https://doi.org/10.1186/s12912-024-02226-y

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Received : 03 June 2024

Accepted : 05 August 2024

Published : 14 August 2024

DOI : https://doi.org/10.1186/s12912-024-02226-y

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