1. Klein, Cathy A. MSN, MSEd, APN, Esq, Legal File Editor

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Our world has recently experienced more than its fair share of disasters. We have witnessed hurricane Katrina, tsunamis, floods, tornados, mud slides, cave-ins, and explosions. These disasters force nurse practitioners (NPs) to decide whether or not they are required to help.


Even though a Good Samaritan law may be applicable, the NP is still bound by legal and ethical standards. There is nothing that prevents an NP from volunteering services, and unless there is a duty to the patient or a duty to provide services, there is nothing that requires the NP to help.


Answering the Call of Duty

Suppose the disaster occurs while the NP is on the job. The NP may contractually be obligated to stay and help per an employment contract, job description, or policy. If so, the terms of the contract control the situation. Often during a disaster, however, an NP volunteers to stay or is asked to do so. This is especially pertinent when relief staff cannot get to the facility or if there is such an onslaught of patients, the resources of the facility are stressed. You may be called upon to perform services outside your scope of practice or expertise. Before accepting such responsibility, make sure no one else is available to perform such services. Good Samaritan laws in many states do not apply in a healthcare setting. However, from a practical standpoint, it is highly unlikely a Board of Nursing would discipline an NP for doing what was necessary for the best interest of the patient in a disaster situation when adequate resources and qualified staff are unavailable. Likewise, it is also highly unlikely that a plaintiff would prevail in a lawsuit under the same conditions. However, make sure your malpractice carrier will defend and indemnify you under such conditions. An NP doing his or her best under emergency conditions would most likely be a sympathetic defendant in a lawsuit.


What About Off-Duty?

Suppose the disaster occurs while the NP is not on the job. In this situation, the Good Samaritan laws in most states will provide protection for services rendered outside of the job setting. However, the NP is not obligated to provide services unless there is a duty to the patient or the NP is otherwise required to perform services. The NP is likewise not obligated to report to work unless there is an employment policy stating the NP shall report to duty during a disaster. If such an obligation is in place and the NP fails to do so, then the NP may be disciplined or terminated unless it was impossible to get to the destination. In such a situation, the NP should call in if possible and report his or her willingness to come in but the inability to do so and request assistance to come in. Also, a travel ban may be issued for all but required personnel or those in medicine or nursing. In that situation, the NP must report to duty unless it is impossible to do so. However, there is nothing that prevents the NP from helping or calling to ask how to be of assistance even if there is no obligation to do so.


If the disaster occurs in another state the NP is visiting, nurse practice acts do not prohibit an out-of-state nurse from rendering emergency services. Most nurse practice acts contain an exemption for out-of-state nurses rendering care in a disaster.


Most disaster relief laws apply to NPs who are already signed up to participate in the event of a disaster and do not apply to those who are not enrolled in the program. However, the government may declare a state of emergency and impose martial law, making all citizens subject to government authority, in which case NPs could be drafted into service.


Unless there is a duty, obligation, or governmental mandate, an NP is not required to render service during a disaster. However, NPs must also look into their hearts during such a time of crisis when deciding to act or not.