The purpose of this study was to characterize and explore the essential elements of effective hospital and nursing leadership during disasters and MCIs and to identify those events of greatest concern for response. Disaster and mass casualty incidents (MCIs) impose a huge burden on health care leaders. These events create a sudden, unanticipated demand for care referred to as ‘patient surge’ that has the potential to quickly overwhelm a hospital’s capacity to function properly. The demand for health care services exceeds capacity to respond and the institution’s normally acceptable patterns of operations and logistics are disrupted. Strong crisis leadership is critical for timely, effective and coordinated response. This requires that hospital administration and nursing leadership are competent in making rapid and complex decisions – often in the absence of complete information and involving the allocation of scarce resources (staff, medical equipment and supplies, pharmaceuticals, etc). It requires implementation of crisis standards of care.
Methods:
A series of structured focus groups was conducted with a purposive sample of hospital administrators (n=36) and nurse leaders (n=17) in a large urban hospital in the U.S. Northeast widely recognized for its expertise in hospital emergency preparedness. Participants were asked a series of semi-structured questions related to observations of crisis leadership during recent disaster and MCI events. Data were collated and analyzed to determine events of greatest concern, impact of event on leadership decision-making, and perceived capacity for organizational surge.
Results:
The results suggest hospital administration and nurse leaders harbor serious concerns regarding crisis leadership competence and organizational capacity to surge up in response to large scale community violence/civil unrest, biological event/pandemics, and acts of terrorism (fire/bombings/active shooters) that result in a mass tragedy. The results of hospital administration and nursing leadership decisions have the potential to directly impact staff and patient safety and quality of care and ultimately, patient outcomes. As such, there is compelling need to prepare hospital administrators and nurse leaders for crisis conditions resulting from disasters and MCIs.
Conclusion:
Disaster and mass casualty incidents (MCIs) impose a huge burden on health care leaders and strong crisis leadership is critical for timely, effective and coordinated response. The purpose of this study was to characterize and explore the essential elements of effective hospital and nursing leadership during disasters and MCIs and to identify those events of greatest concern for response. The results suggest hospital administration and nurse leaders harbor serious concerns regarding crisis leadership competence and organizational capacity to surge up in response to large scale community violence/civil unrest, biological event/pandemics, and acts of terrorism (fire/bombings/active shooters) that result in a mass tragedy.
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