Nursing Leaders Share Advice for Hurricane Preparedness

Although the Atlantic hurricane season officially ended on Nov. 30, planning for potentially dangerous tropical cyclones is a year-round event at Cleveland Clinic’s five Florida hospitals. “We’ve had some interesting lessons over the years with different hurricanes,” says Kerry Major, MSN, RN, NE-BC, Florida Regional CNO and CNO of Cleveland Clinic Florida in Weston, Florida. “One of the main takeaways from all these events is that preparing ahead of time is absolutely critical.”

Cleveland Clinic has a robust policy that provides detailed guidance related to staffing, facilities, supplies, possible evacuations and more. “It looks at all the different aspects of providing care not only for our patients, but also for the caregivers that are here before, during and after storms,” says Major.

Nursing leaders helped draft the policy and are at the table when it’s reviewed, incorporating input from clinical nurses. “It’s important to understand the impact of policy decisions on our ability to provide care and appropriate staffing,” says Major. “And the best way to get that feedback is from the caregivers themselves.”

Nursing-specific responsibilities during a storm

All hospital employees have a role to play in hurricane preparedness, from the CEO to physicians to support staff. While nurses are responsible for many individual tasks, their primary responsibilities are related to two areas:assuring adequate staffing and managing care of their patients.

“The key responsibility we have pre-hurricane is making sure we have an appropriate pool of caregiver resources to provide the level of care needed,” says Major. Nursing leaders consider the number and types of patients in the hospital, what their specific needs are and what nursing skill sets are necessary to meet those needs during and immediately after a hurricane.

Cleveland Clinic Martin Health, which includes three hospitals on Florida’s Treasure Coast, identifies pre, during and post hurricane teams early before the hurricane season begins each year on June 1. “This past year we really scrutinized the amount of people needed in our buildings,” says Susan Clark, DNP, RN, CNL, CNO of Cleveland Clinic Martin Health. Careful consideration is crucial, she says, because caregivers often must remain in the hospital during lockdown in the heart of the storm. At Cleveland Clinic Tradition Hospital, part of the Martin Health system, space for caregivers to rest was at a premium during Hurricane Dorian in September.

Caring for our caregivers allows them to focus on our patients. “From a care management perspective, we consider which patients can safely be transitioned to another level of care or home prior to the storm,” says Major. From the moment a hospital hears about a storm gathering far out in the Caribbean, nursing leaders begin this task.

Another issue related to care management of patients is the possibility of evacuations. To prepare, leaders examine the census of all nursing units in the event they are called upon to take extra patients. During Hurricane Dorian, for instance, Cleveland Clinic Martin South Hospital was evacuated as a safety measure, with some patients being relocated to Tradition Hospital. Clark considered how to consolidate units. One decision she made was to facilitate the discharge of as many patients as was safely possible from Tradition’s Mother/Baby unit, which had a low census. That allowed the unit to accommodate 20 adult patients.

Advice from nurse leaders on hurricane preparedness

Major, who has been with Cleveland Clinic Weston Hospital for 15 years, and Clark, a 20-year veteran with Martin Health, have been through countless hurricanes. They offer advice to nursing peers on how to prepare for natural disasters – and not just hurricanes. In late October, a Santa Rosa, California, hospital evacuated more than 100 patients as the Kincade Fire approached. Other hospitals across the country must prepare for tornadoes, floods and other natural disasters.

Here are some tips from Major and Clark:

• Keep the lines of communication open. “First and foremost, communication is key,” says Clark. “That’s the biggest component – and the most challenging.” Nursing leaders need to update caregivers frequently on when hurricane plans are likely to go into action, who needs to be where and what the expectations are.
• Provide ongoing support for staff. “There’s a lot of stress that goes with a traumatic event like a hurricane,” says Major. “While we are taking care of our patients, we also need to take care of our caregivers. We need to be ready to provide resources to support them through the process as well.” This includes offering advice to caregivers on how to prepare for a hurricane at home so they are ready to come to work, providing emotional support to nurses during a lockdown, supporting caregivers post-hurricane who may have damage to their property and more.
• Be available to staff during storms. “For leaders from all disciplines, visibility is paramount,” says Clark. “Walk around, listen to your caregivers’ concerns and respond to them.” Nurses may be worried about a variety of issues, from having adequate supplies to care for patients during a lockdown to wondering how long their shift will extend if co-workers can’t make it to the hospital. Nursing leaders need to reassure staff and remind them of plans to assuage their concerns.
• Work hand-in-hand with other healthcare providers. “The evacuation from Martin South Hospital would not have happened so seamlessly [during Hurricane Dorian] if we didn’t have physician involvement and help from the transfer center,” says Clark. “It took an incredible amount of teamwork. That’s the only way to get through it.” Nurses must work closely not only with physicians, but with emergency management personnel and others – at their own hospitals and possibly neighboring ones – during a hurricane.
• Hold a debriefing session after the storm passes. “The debrief is such a valuable tool for us to learn and do better next time,” says Major. Nursing leaders meet with clinical nurses to discuss what worked, what didn’t and how things could’ve gone more smoothly, then share that information with emergency management departments to either revise policies or tweak implementation of them. For instance, Hurricane Dorian was the first storm that Cleveland Clinic Florida managed as a region of five hospitals rather than one hospital in Weston. Major says that implementation of hurricane protocols went smoothly, but the healthcare system will address some nuances related to communication with staff, both internally at multiple locations and at home watching news about the storm.

“We are so glad another hurricane season is behind us!” says Clark. “But it won’t be long before we start planning for the next one.”