The tragedy of September 11, anthrax attacks, and severe acute respiratory syndrome (SARS) and other infectious disease outbreaks have heightened our awareness of the need for health care system readiness and response capabilities.
At the same time, the economic realities of our modern health care system are reflected in cost-containment strategies toward low-volume inventories, reduced bed availability, downsizing of staff, and a shift to outpatient services (American Hospital Association, 2002).
Decreased reimbursement structures and workforce shortages have diminished the health care system’s ability to meet minimum patient demands, let alone the surge of patients that would be expected in a mass-casualty incident.
Furthermore, the infrastructure needed for detection and response from the public health sector has been seriously eroded by decades of insufficient funds. Agencies within the Department of Health and Human Services (HHS) have been working to address readiness and response capabilities, but private organizations and professional associations also have a role to play.
Although nursing is not the only health profession experiencing a workforce shortage, nursing is vital to any large-scale demand for care.
Nationally, there are 2,694,540 licensed registered nurses, or 808 registered nurses per 100,000 people. These numbers are insufficient to meet current capacity needs and would be woefully inadequate in the event of a mass-casualty incident.
A mass-casualty event would require mobilization of additional nurses from outside the affected jurisdiction. Such a mobilization, however, would have to overcome issues of credentialing and licensing. When licensed health care clinicians arrived as Good Samaritans and volunteered after 9/11, hospital administrators turned them away because they did not have the proper credentials.
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