Following my keynote on preparing nurses for the front line, I was given several thoughtful questions from faculty about disaster nursing education. I wanted to continue that conversation because I do not think the solution is simply adding more disaster content to nursing curricula. We already teach a lot of content. The question I keep coming back to is whether students can actually use what we teach them when the environment changes, information is incomplete, resources are limited, and the usual way of doing things is no longer possible.

That is a very different measure of preparedness.

1. How did I get involved in disaster nursing?

I did not start my nursing career intending to become a disaster nurse. My path into this work grew naturally from emergency nursing, EMS, and eventually disaster response. Emergency nursing taught me to assess quickly, prioritize competing needs, and recognize when something was changing. Disaster response forced me to take those skills beyond the individual patient and think about populations, systems, resources, logistics, public health, and what happens when the infrastructure we normally depend on begins to fail.

That distinction is important to me because disaster nursing is sometimes described as an extension of emergency nursing. There is certainly overlap, but they are not the same thing. Disaster nursing requires us to move between the individual patient and the population. I may know exactly what one patient needs, but what happens when ten patients need that same resource and I only have enough for three? What happens when the resource exists somewhere in the hospital but I cannot access it? What happens when transportation is unavailable, the electronic health record is down, staffing is inadequate, or the hospital itself has become part of the disaster?

Those experiences are what kept me in disaster nursing. They also changed how I teach it. I am much less interested in whether someone can define disaster triage than I am in whether they can make a defensible decision when the situation in front of them no longer resembles the scenario they studied.

2. What actually makes disasters hard?

I do not think disasters are hard simply because there are more patients. We manage busy emergency departments every day. What makes disasters different is that demand exceeds the capacity of the system to respond normally, and the assumptions we rely on in everyday practice begin to disappear.

We teach nurses to gather information before making decisions. During a disaster, some of that information may never arrive. We teach them to use established resources. Those resources may suddenly be unavailable. We teach escalation pathways that assume communication systems work and that the person receiving the call has resources available to solve the problem. During a disaster, neither may be true.

This is why I frequently tell learners that available does not necessarily mean accessible, familiar, or that someone is competent to use it. A hospital can technically possess a resource and still be unable to operationalize it when it is needed. The same applies to people, equipment, information, and plans.

That is something faculty can teach without creating an elaborate disaster exercise. Take an ordinary patient case and disrupt one assumption. The CT scanner is unavailable. EMS cannot transport for six hours. Oxygen is becoming scarce. The electronic health record goes down. The patient’s medication is not available. Now ask the student what changes. More importantly, ask what does not change. What can they still do safely? Who needs to know? What patient is now at greatest risk? At what point does this stop being an individual clinical problem and become a systems problem?

That is the kind of thinking disasters require.

3. How does utilitarianism relate to disaster nursing?

This is an area where I think we need to be particularly careful with how we teach students. We often introduce disaster ethics through the phrase “the greatest good for the greatest number.” It is a useful entry point into utilitarianism, but it is not sufficient preparation for the ethical decisions nurses may actually encounter.

When resources become truly scarce, the focus of decision-making can shift from maximizing benefit for an individual patient toward maximizing benefit across a population. Crisis standards of care literature recognizes this shift, but it also emphasizes fairness, transparency, proportionality, consistency, accountability, and stewardship. Disaster ethics cannot simply become permission to abandon our normal ethical obligations because circumstances are difficult.

We also have to ask students who may be disadvantaged by the systems we create. A process can look efficient and still be inequitable. Older adults, children, people with disabilities, people who require electricity-dependent medical equipment, patients with limited English proficiency, people without transportation, individuals experiencing homelessness, and those who depend on uninterrupted access to medications or treatments may experience a disaster very differently from the rest of the population.

This is why I would not give students a scarce-resource case and simply ask, “Who gets the resource?” I would ask them to explain why. Then I would ask who could be harmed by the criteria they used. What additional information might change their decision? Could they explain that decision to a patient or family? Would they be comfortable if the same criteria were applied to someone they loved?

Those conversations are uncomfortable. They should be. We should allow students to wrestle with difficult ethical decisions in a classroom before the first time they encounter one is during an actual crisis.

4. What is the psychological impact of disaster response?

We spend considerable time teaching people how to enter disasters and much less time teaching them what may happen after they leave.

Disaster response can expose nurses to death, suffering, frightened families, resource scarcity, repeated ethical decisions, long operational periods, personal risk, and situations in which they know what good care should look like but cannot provide it because the necessary resources do not exist. That last experience is particularly important. Knowing what should be done and being unable to do it can contribute to significant moral distress.

I also think we need to be careful with the way we talk about resilience. I strongly believe in preparing nurses psychologically for difficult environments, but resilience cannot become another way of telling nurses to tolerate systems that are unsafe, unsupported, or unsustainable. We cannot teach someone three breathing exercises and then send them back into an environment with inadequate staffing, poor leadership, insufficient PPE, no rest, and ineffective communication and call that resilience.

There is an individual component, but there is also an organizational responsibility to protect the workforce. That includes rest, rotation, communication, psychological support, appropriate PPE, leadership visibility, peer support, and opportunities for recovery.

Faculty can begin teaching this during simulation debriefing. In addition to asking what the student did clinically, ask what decision bothered them. Ask whether there was a moment when they felt helpless. Ask what they would need from their team or leadership after an event like this. Ask what they would do if a colleague was struggling after the response. Those questions normalize the reality that responders are affected by disasters too.

5. What are my thoughts about students’ preparation for a real disaster?

I think we have made progress, but I do not think knowledge should be confused with preparedness.

The literature continues to identify gaps in undergraduate disaster education, including inconsistent curricular integration, limited faculty expertise, competing curricular demands, and variability in experiential learning opportunities. Students may report willingness to respond while still having limited confidence or practical preparedness. Simulation, tabletop exercises, interprofessional education, and other experiential approaches can help bridge that gap, but only if we are intentional about what we are trying to develop.

A student can correctly identify every START triage category on an examination and still struggle when several people arrive simultaneously and there is no instructor standing nearby saying, “Here is all the information you need.”

That does not mean the content was unnecessary. It means the content was only the beginning.

Preparedness requires knowledge, but it also requires judgment, communication, adaptability, situational awareness, teamwork, and the ability to function when there is uncertainty.

6. Are we preparing students for the disasters they will actually face, or the disasters that are easiest for us to teach?

I think sometimes we teach the disasters that fit neatly into a PowerPoint.

Mass casualty triage is important, but not every disaster begins with dozens of patients arriving at the emergency department. A disaster may be a cyberattack that takes down the electronic health record. It may be prolonged power loss. It may be extreme heat that disproportionately affects medically fragile patients. It may be flooding that prevents staff from reaching the hospital. It may be an infectious disease outbreak, a medication shortage, a loss of potable water, an evacuation, or a supply-chain disruption.

Sometimes the hospital is still standing and the lights are still on, but the system can no longer provide care normally.

Students need to recognize that too.

That is why I prefer an all-hazards approach. We cannot teach students every disaster they might encounter, nor should we try. We can teach them to recognize what has changed, identify what is failing, determine what resources remain, anticipate what may become scarce next, identify who is most vulnerable, communicate the problem, and continue reassessing as the situation evolves.

Those skills transfer from one disaster to another.

7. What competencies should faculty focus on?

We already have an evidence-informed framework for this. The International Council of Nurses’ Core Competencies in Disaster Nursing includes preparation and planning, communication, incident management, safety and security, assessment, intervention, recovery, and law and ethics. I would rather see nursing programs intentionally map what they already teach against established competencies than create another homegrown checklist.

I do not believe every nursing program necessarily needs a standalone disaster course. I would love to see more dedicated disaster education, but I also understand the reality of nursing curricula. Faculty are already being asked to teach an enormous amount of content.

So instead of asking, “Where can we fit another disaster lecture?” I would ask, “Where does disaster preparedness already belong?”

When students learn pediatrics, family reunification and the unique needs of children during evacuation belong there. When they learn maternity, ask what happens when a laboring patient has to be evacuated. When they learn pharmacology, discuss medication shortages and supply-chain interruptions. Community health is an obvious place to examine evacuation, risk communication, population vulnerability, and recovery. Leadership courses can introduce incident management and resource allocation. Ethics courses can address crisis standards of care. Mental health courses can address the psychological effects on survivors and responders.

That approach does not require faculty to find three additional hours in the curriculum. It requires us to change some of the questions we are already asking.

8. How should competencies differ between LPN, associate degree, BSN, and graduate students?

I would not create completely different definitions of disaster preparedness for each level. The foundational competencies should remain recognizable across nursing education, while the expected depth, autonomy, leadership, and systems responsibility increase.

Every nurse needs to understand personal and patient safety, communication, basic assessment, their role within incident management, and how to recognize when resources or normal operations are changing. As education and professional responsibility increase, I would expect greater competency in population-level assessment, coordination, resource allocation, policy, planning, leadership, and recovery.

Not every nurse needs to be prepared to manage an incident command post.

Every nurse should understand how they function within the response.

9. If a student can pass our disaster exam but cannot make a decision when information is incomplete, have we actually prepared them?

No.

We have demonstrated that they learned the content we tested.

That is not the same thing.

This is probably one of the most important changes I would like faculty to make. We have to move disaster education beyond “What do you know?” toward “What would you do?”

Then ask, “Why?”

I want to hear the student’s reasoning. What did they notice first? What information mattered? What did they dismiss? What assumptions did they make? What are they most worried about? What would make them change their decision?

That last question is important because disasters are dynamic. A correct decision at 0900 may be the wrong decision at 0930 because the situation has changed.

Communication also belongs in this discussion. During a disaster, communication is not an administrative task. It is a clinical skill and a patient-safety intervention. A nurse needs to be able to recognize a critical change, communicate it concisely, know who needs the information, and verify that the message was received and understood. They also need to know what to do when the normal communication pathway does not work.

10. How do we reinforce the humanness of disasters?

This is something I feel strongly about because operational language can very quickly remove the person from the disaster.

We talk about red tags, green tags, walking wounded, fatalities, surge, casualties, beds, and numbers. We need those terms operationally, but every one of those numbers represents someone’s mother, father, child, sibling, spouse, or friend.

Triage requires categorization. It does not require dehumanization.

I want students to think about what dignity looks like when resources are limited. What do you say to the patient you cannot stay with? How do you communicate with a frightened family? What happens to someone’s belongings? How do cultural and religious needs factor into care? What do we owe a dying patient when definitive treatment is no longer possible?

Sometimes preserving someone’s dignity may be one of the few things we still have the ability to provide.

That is still nursing.

11. How can simulation improve disaster competency?

I strongly support simulation, but I do not think simulation becomes effective simply because we call it disaster simulation.

If students know exactly what is going to happen, every resource they need is sitting on the table, communication works perfectly, and the scenario follows the expected sequence, we have created a controlled clinical exercise. We have not necessarily recreated the decision-making demands of a disaster.

I want disruption to be deliberate and tied to the learning objective.

If I am trying to assess communication, I may take away the usual communication method. If I am teaching resource allocation, a resource should become unavailable. If I am teaching reassessment, a patient’s condition should change. If I am teaching incident management, students may receive conflicting information and have to determine where to clarify it. If I am teaching safety, there may be a secondary hazard they have to recognize before rushing toward the patient.

The goal is not to create chaos for entertainment. It is to introduce uncertainty safely.

The debrief is where much of the learning happens. I do not just want to know whether students made the “correct” decision. I want to know why they made it. What information did they have at that moment? What did they think was happening? What did they miss? When did they realize the situation had changed? What would they do differently now?

That tells me much more about whether they are becoming disaster-ready than whether they remembered the right triage color.

12. Can faculty effectively teach disaster preparedness if they have never responded to a disaster?

Yes.

We have to be careful not to create a hierarchy where only people who have deployed are considered qualified to teach disaster preparedness. Disaster response experience certainly provides perspective, but experience alone does not automatically make someone an effective educator either.

What faculty should not do is teach disaster preparedness in isolation when there are people in their own communities doing this work every day.

Call your hospital emergency preparedness coordinator. Partner with EMS. Talk to public health. Invite emergency management into the classroom. Work with the Medical Reserve Corps. Include emergency nurses, pharmacists, respiratory therapists, physicians, social workers, interpreters, security, facilities personnel, and others who actually have roles in maintaining health care operations during emergencies.

Use real after-action reports and ask students what happened, what worked, what failed, and what they would change.

Disasters are multidisciplinary and multiagency events. Our education should reflect that reality.

13. What is one thing every nursing faculty member could change tomorrow?

Stop giving students all of the information.

This is probably the most implementable recommendation I can give.

You do not need a simulation laboratory. You do not need funding. You do not need to add another course. You do not even need to change tomorrow’s lesson plan.

Take the case you were already going to teach and remove one assumption.

Maybe the medication is unavailable. Maybe the blood bank is running low. Maybe the electronic health record is down. Maybe EMS cannot transport. Maybe the patient’s family cannot be reached. Maybe another patient suddenly deteriorates and now the nurse has two competing priorities.

Ask the student what they would do.

Then ask why.

And instead of telling them whether they are correct, change one more thing.

Now what?

That is what I want nursing students to practice.

Because someday one of our graduates may be standing in an emergency department, hospital, clinic, ambulance, shelter, or community when everyone around them realizes that the system is no longer functioning normally.

Someone is going to look at the nurse and ask, “What do we do now?”

I cannot prepare that nurse for every disaster they may encounter. None of us can.

But I can help prepare them to recognize that something has changed. I can teach them to protect themselves so they remain part of the response. I can teach them to assess what they have instead of focusing only on what they do not have. I can teach them to communicate. I can make them defend their decisions. I can expose them to uncertainty in an environment where it is safe to get something wrong. I can teach them to recognize the people our systems are most likely to overlook. And I can remind them that limited resources never give us permission to stop treating people with dignity.

That, to me, is what it means to prepare nurses for the front line.