Creating a resilient nursing workforce : developing adaptive capacity to deal with the effects of natural hazard disasters

History demonstrates the impacts a disaster can have on a healthcare system. Nurses are the largest group of healthcare workers and are pivotal to an effective societal response to a range of critical events, including disasters. They are the most likely to be involved during and affected by any type of disaster that impacts an inpatient healthcare facility. This presents nurses with significant and complex challenges that require them to function effectively under highly challenging and stressful circumstances, often for prolonged periods. This research used an ecological and systems framework to examine how hazard event characteristics and demands interact with personal, team, and organisational factors to create interdependent and complementary contributions to sustained resilience and adaptive capacity in nurses. Nurse participants completed a survey comprised of demographic and disaster event characteristics before participating in a semi-structured interview. The survey results reported on disasters triggered by natural hazards, namely earthquakes, weather events, and bushfires. The impacts of these events caused a range of structural and functional damages to facilities and were described as moderate to catastrophic. Stage One of the sequential mixed method study used a pluralistic approach to explore the scope of issues facing nurses working within inpatient healthcare facilities in New Zealand and Australia during and after a natural hazard disaster. Findings from the inductive analysis of qualitative data, derived from fifteen in-depth interviews, identified that the nurse participants maintained a strong sense of professional duty, personal commitment, and responsibility to their family, patients, and the team members within their facility. Thematic analysis identified a chronology of event characteristics and demands that influenced the ability of nurses to adapt, cope, and respond, whilst experiencing diverse personal, structural, functional, and organisational barriers. These findings identified the need to consider changes in the relationship between demands and adaptive capacities over time. Stage One findings contributed to the systematic and integrated process of analysis of theoretical concepts and qualitative data in Stage Two. This approach was used to critically explore and develop an operational definition of nursing empowerment in a disaster context. This, in turn, informed the adaptation and reconceptualization of an existing ecological model of adaptive capacity, developed by Paton, Violanti, Norris, and Johnson (2011), into a nurse focused ecological model of adaptive capacity. This study identified factors that helped and hindered a nursing workforce to anticipate, adequately prepare for, cope with, adapt to, respond, and learn from the consequences of critical incident events, such as natural hazard disasters. The findings from this study have significant implications for how nursing leadership and healthcare organisations empower their nursing workforce to function confidently and competently during, and to recover from, complex and ad hoc conditions. Predicted exponential growth in the number of disasters means that knowledge of disaster preparedness and its implementation to facilitate the development of resilient and adaptive nurses and healthcare organizations is an important adjunct to nurse education, policy development, and research considerations.