Stacey Toro, DNP, MBA, GDN, RN

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Stacey Toro is an assistant professor at California Baptist University where she currently teaches in both undergraduate and graduate nursing programs. Her teaching experience over the last 12 years includes Adult Health/ Medical Surgical, Gerontology, Transcultural Studies, Nursing Leadership, and Nursing Informatics. Stacey has worked in emergency medicine for more than 25 years. She earned her DNP at CBU College of Nursing and has two master’s degrees in Nursing and Business Administration with a specialty in Heath Care Administration. Stacey received her post-master’s concentration in Global Disaster Nursing at the University of Tennessee in Knoxville and is an expert in disaster planning with experience in training nurses as disaster responders.

Connections: 
How did you become interested in disaster nursing?

Stacey Toro: 
I had been an ER nurse for 28 years and was an ER manager. When I decided to get a terminal degree, I wanted it to be along the lines of emergency medicine. The University of Tennessee had a post-master’s concentration in disaster nursing, so I completed the two-year program. During my training I studied health and emergency preparedness at both the local and global levels. During my education at the University of Tennessee I worked with Architect students to sample water and create a sustainable water kiosk to provide access to potable water for Appalachian residents. In the Philippines, where they experience devasting typhoons, I created a disaster specialty concentration for Master and Doctoral level curricula at Silliman University. Throughout my career, I have had a desire to help those in critical need. Currently, as a critical care transport nurse and working as a first responder during the pandemic, it became clear that disaster nursing is just not a title for me but my passion.

Connections: 
What role have nurses held historically in disaster response?

Stacey Toro: 
Nurses have been responding to disasters since the 19th century with Florence Nightingale and other nurses serving on the battlefield. In the U.S and internationally the American Red Cross has called on nurses to participate and provide care in disaster relief. Currently, when there is a fire or other disaster in the community, public health nurses are on call and instrumental in acting quickly to set up community shelters to provide immediate disaster relief. Nurses comprise the largest professional group in the health care workforce and are trained in effective communication to improve patient outcomes. This makes their role in disaster response vital to saving lives. It makes sense for nurses to respond to disasters. 

The role of nurses during disasters has evolved since 911, hurricane Katrina, and recently the COVID-19 pandemic. Nurses not only took care of patients in the traditional sense but became leaders in providing care with limited supplies, lack of water and electricity, and were forced to make ethical decisions. Nurses not only experience working in the disaster, but also are personally affected by the disaster. They have family and other loved ones and may experience personal loss during the disaster, as well. Some nurses after hurricane Katrina faced legal charges that later were dismissed. Historically, nurses are trained and educated in teamwork and collaboration. These skills, although primary components of effective disaster-management, did not prepare nor educate them in their role in the disaster management cycle. 

Connections: 
What about the nurse’s role in disaster preparation?

Stacey Toro:
If you are an ER manager you have county mandates to participate in an annual statewide disaster preparedness drill to help simulate and train your employees. This drill also focuses on interprofessional collaboration. You work with the fire department, police, first responders, and all hospital departments. In addition, the drill allows for training based on FEMA’s incident command model (ICS). The drill is specific to disasters that occur in certain geographic locations. For example, if you are in California, the drill will be based on earthquake or fire disasters. If you are in the Midwest, it will be based on tornados. Nurses have recently been invited to collaborate on disaster teams to assist in the disaster preparation and planning process. 

Nurses are in the best position to serve in this role because they are advocates for patient care and patient outcomes. Nurses have always selflessly responded to patients during and after a disaster. The American Nurses Credentialing Center (ANCC) is a subsidiary of the American Nurses Association (ANA), which provides credentialing programs for nurses. When you test and receive certification from the ANCC, you are known to be trained or experienced in the subject matter. Currently, nurses can take the National Health Care Disaster Certification (NHDP-BC). Requirements are on their website. This encourages nurses to take an active role in disasters as responders and providers.

Enhancing disaster training, certifications, and drills or simulations for nurses and other health care providers is extremely instrumental in preparing for disasters, either man-made or natural. Until recently, we have not regularly experienced incidents such as 911, hurricane Katrina, or the pandemic.  We also need to consider cyberattacks as disasters.  Therefore, it is imperative to add education and increase the role of disaster nursing in our profession.

Connections:
Are nurses generally trained to respond to or prepare for disaster?

Stacey Toro: 
When doing my DNP project the Riverside Public Health Nurses did an amazing job at receiving training through simulation and a certificate in basic disaster life support (BDLS).  This strengthened the evidence that nurses have the knowledge, skills, and attitudes for disaster response. In the next year I am excited to see the published evidence and meta-analysis research about nursing roles during the pandemic.

Disaster preparedness and response is infused in undergraduate and graduate nursing education because there is a need, but it’s not threaded through academia as a scope of practice. The vision would be that we could create the national nursing workforce with knowledge and skills and ability to respond to disasters and public health emergencies. 

Connections: 
How would this workforce benefit the health care system?

Stacey Toro: 
Disaster-prepared nurses would be instrumental on disaster planning committees in the hospital setting. They can look at supplies, policies, and systems.  We had a shortage in PPE and equipment in the beginning of the pandemic. Nurses could serve to look at the items and processes needed to be equipped in future disasters. In addition, they can assist in education and competencies in disaster drills, table-top exercises, and staffing polices to increase efficiency during catastrophic events. 

Not only would this workforce benefit the health care system, but it would also affect the communities we live in. 

Once the disaster has occurred, response is very task-oriented. This is why practice and preparedness is critical before the event. Nurses can be part of incident command and play a role in decisions during a disaster. For example, nurses are responsible for activation of staff, mutual aid agreements, where to create additional patient care areas, creating an area for the morgue, where to set up triage, among other decisions. Nurses can critically think outside the box to provide care and are willing to do whatever it takes to provide excellent patient care.

Nurses develop trusting relationships with patients. Patients look to nurses for answers and support. Nurses talk to them, not at them. As result, patients are more likely to listen and follow the direction of what a nurse says about care. 

Recovery from a disaster starts on day one. During and after the disaster nurses play a role in helping patients to process the events and provide resources. Many patients and health care workers experience mental health issues, including PTSD. Nurses not only provide skills and services to patients during a disaster, but also become family to patients. Frontline nurses during the pandemic held the hands of dying patients and used their own personal cell phones to Facetime with family members who were not allowed to come to the bedside. Disasters highlight the roles of nurses providing holistic care, ethical compassion, and implementing the art of nursing.

Connections: 
With the pandemic, and increasing incidence of disasters nationally, will the nurse role become even more important?

Stacey Toro: 
I think you are going to see a shift in the role of disaster nurses in hospitals and organizations after the current pandemic and with the potential increase in other disasters. Nurses are going to be empowered from their experiences. In addition, now that we have seen nurses as vital leaders and patient care providers during COVID, we can learn from their lived experiences. Their input will be valuable to the future role of disaster nursing. The disaster has triggered interest in the ANCC National Health Care Disaster Certificate. Currently, I am working on a feasibility study for a specialty in disaster nursing curriculum at our university in hopes of promoting the role of nurses during disasters.  I am proud to be a nurse and part of a profession in which nurses continue to be leaders and silent heroes for patients and communities.