1. Garfield, Richard M. DrPH, RN, FAAN


The WHO considers the contributions of nurses and midwives.


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Each year, one in five countries has a crisis that endangers its citizens' health.1 High-profile natural disasters and humanmade emergencies in 2004 to 2006 still affect millions in Southeast Asia, Pakistan, the Gulf of Mexico, Iraq, Lebanon, and elsewhere.2 There are also about 20 ongoing armed conflicts that have caused 1,000 or more deaths.3 Political and social crises have resulted in almost 25 million internally displaced people and more than 10 million refugees.4,5


With this in mind, the World Health Organization (WHO) met in Geneva in November 2006 with a dozen global nursing leaders to identify the status of emergency preparedness and response in nursing. Ala Alwan, assistant director-general, and Jean Yan, chief scientist for nursing and midwifery, led the meeting, which was hosted by Princess Muna al-Hussein of Jordan, WHO patron for nursing and midwifery.


A report of the first Consultation on Nursing and Midwifery Contributions in Emergencies is now available from WHO (see The most important issues to emerge from the meeting were the following:


The global nursing shortage. Many countries have a critical shortage of nurses and midwives.6 Nurses around the world struggle with poor working conditions and low salaries, while the hope of better wages lures many to more developed countries. In most countries emergency preparedness is lacking. Yet nurses are likely to be among the first to respond to health emergencies. Therefore, nurses must be brought into emergency planning, train colleagues, and assume a hands-on role in responding.


Nursing competencies. In 2003 the International Nursing Coalition for Mass Casualty Education (since renamed the Nursing Emergency Preparedness Education Coalition) developed a list of competencies for nurses responding to mass casualties (see This document and others from the International Council of Nurses (ICN) and the University of Hyogo, Japan, were reviewed, and meeting participants endorsed a "unified competency model."


Humanitarian emergencies create challenges different from those that nurses usually face, particularly if there is political instability, war, or social disruption. For example, it may be necessary to treat people who have no health records, under conditions where documentation is difficult or impossible. At the same time, nurses must be assured of legal protection should events require them to work beyond the usual scope of practice.


In the early phase of such circumstances, nursing activities are about saving lives. Less well recognized but at least as important, nurses may contribute to rehabilitating and protecting health.


Participants made the following recommendations. For teaching and curriculum:


* Prepare student nurses before an emergency occurs.


* Teach emergency care as part of mental health training and chronic disease management, including support for nurses and other caregivers.


* Provide in-service education in crisis management.


* Develop learning materials and teaching modules.



For organizational responses:


* Hold practice exercises.


* Encourage volunteer coordination before emergencies.


* Promote the roles of nurses and midwives in emergencies via public relations.


* Develop an international registry of expert consultants.



Other efforts. After the Geneva meeting, nursing groups began implementing recommendations. For example, the Jordanian Nursing Council designed an undergraduate curriculum on disaster nursing, to be disseminated in the Eastern Mediterranean region.


In the past year, the ICN launched a disaster response network for nurses in Southeast Asia and the Western Pacific region, aiming to strengthen their ability to respond to disaster-stricken populations. The network's first meeting was held in Yokohama, Japan, in June. The inaugural session focused on mental health, stress management for caregivers, and professional regulatory issues. (For more on ICN's disaster preparedness efforts, see; for the ICN's Position Statement on Nurses and Disaster Preparedness, see


The World Association of Disaster and Emergency Medi-cine (WADEM) is also working on issues related to disaster nursing. WADEM publishes Nursing Insight (see, a biannual nursing supplement to Prehospital and Disaster Medicine (see The organization also plans to develop an expanded nursing Web page and create a roster of disaster-nursing specialists.


Richard M. Garfield, DrPH, RN, FAAN


The Henrik H. Bendixen Clinical Professor of International Nursing in Columbia University's School of Nursing, New York City; contact author:




1. World Health Organization. Executive Board. Responding to health aspects of crises. Geneva; 2004 Nov 25. EB115/6. [Context Link]


2. Redlener I. Americans at risk: why we are not prepared for megadisasters and what we can do now. 1st ed. New York: Knopf; 2006. [Context Link]


3. Garfield R. The epidemiology of conflict. In: Levy BS, Sidel VW, editors. War and public health. 2nd ed. New York: Oxford University Press; 2007. [Context Link]


4. Forced Migration Online. What is forced migration? Refugee Studies Centre. [Context Link]


5. UNHCR. UNHCR report says refugee population rises to almost 10 million. UNHCR news 2007 Jun 19. [Context Link]


6. Chaguturu S, Vallabhaneni S. Aiding and abetting-nursing crises at home and abroad. N Engl J Med 2005;353(17):1761-3. [Context Link]


7. Nursing Emergency Preparedness Education Coalition. Educational competencies for registered nurses responding to mass casualty incidents. Nashville, TN: Vanderbilt University School of Nursing; 2003 Aug. [Context Link]

Magnetic Women


Researchers honored at the 2007 National Magnet Conference.


Muriel Poulin (at left in the photograph) shares the stage with Margaret McClure at the American Nurses Credentialing Center's 11th National Magnet Conference, held in Atlanta, October 3 to 5. Poulin and McClure, along with Margaret Sovie and Mabel Wandelt, published the first research in 1983 establishing criteria for what would become the Magnet Recognition Program, which awards Magnet designation for excellence to hospitals. "It needed to be done," McClure said of their conducting research without any funding. She'd hoped, she said, that in publishing their findings, "some people would read it and maybe some things would change."


And change they have. Since 1994 when the University of Washington Medical Center in Seattle became the first Magnet-designated facility, 260 facilities have achieved Magnet designation, including one in Australia. The 2007 conference, with over 4,500 attendees and nearly 150 exhibitors, topped prior conference attendance records.


The energy was high-refreshingly so, given that most nursing conferences these days deal with staff and faculty shortages. One nurse from University Medical Center in Tucson, Arizona, told me that Magnet designation made a big difference at her facility, saying that it was "like opening a faucet for nurses to speak up and share what we know and have other departments listen to us." A nurse from a 250-bed Magnet hospital in Indiana said that they've developed relationships with nearby universities and are conducting research. A director of nursing told me that Magnet status is "a plus" for recruitment, and "new grads are asking about it." And one chief nursing officer said that the new chief executive hired to "turn the place around" is the one who initiated the process of seeking Magnet designation.


I've met nurses skeptical of the value of Magnet designation, but not at the Atlanta conference. Linda Burnes Bolton, president of the American Academy of Nursing said the academy has formed a committee that will conduct research on Magnet facilities that, she hopes, will "demonstrate that Magnet hospitals have the best format for providing care and that nurses have solutions to the broken health care system."


Maureen Shawn Kennedy, MA, RN, news director