Excessive heat poses risks for patients, health systems, and nurses themselves. How can you prepare?
Extreme heat is having a significant impact on health care — and nursing in particular. "As temperatures rise to dangerous levels, nurses may face various issues in their work environment and in the care they provide to patients," said Kimberly Bailey, MA, SCCEM, NRP, System Director of Emergency Management for Inpatient Facilities at Medical University of South Carolina Health.
Nurses in all care settings should be preparing to protect the health of vulnerable populations. "Climate change is increasing the number and duration of extreme heat events," warned Michelle DePhillips, DNP, RN, ACNPC-AG, ACHPN, an assistant professor in the School of Nursing at the University of Delaware.
The risk to patients
Nurses on the front lines are caring for patients with heat-related illness, dehydration, and exacerbated cardiovascular, respiratory, or other underlying chronic conditions. "Extreme heat impacts a number of vulnerable populations and increases both hospitalizations and mortality," DePhillips said.
Hot temperatures can cause or exacerbate many health conditions. "Patient census may be higher, and extra complicating factors are introduced for many patient populations," said Kasey Jordan, PhD, RN, CPH, an assistant professor in the College of Nursing at Medical University of South Carolina.
During extreme heat events, Jordan added that these groups are at increased risk for negative health outcomes:
- Patients with respiratory, cardiac, or kidney conditions
- Young children
- Older adults
- Individuals with disabilities
- People experiencing poverty
- Individuals who work outdoors
At HonorHealth Shea Medical Center in Scottsdale, Arizona, most patients presenting with heat-related symptoms are those experiencing homelessness and those from out of state. "That being said, locals are not immune to the effects of 110+ degree temperatures -- and we are seeing more of them as well," reported Susie Whitt, MSN, RN, CCRN-K, Director of Clinical Nursing.
Excessive heat also jeopardizes patient safety in indirect ways. For example, it can affect the infrastructure of healthcare facilities. This causes power outages or interruptions to critical services. "Ambulances and other medical transportation vehicles may face challenges due to the heat and increased demand," Bailey added.
You can help patients prepare at home for excessive heat warnings. "Nurses can discuss how to keep medications from getting too hot, or how patients might continue treatments if the power were to go out," Jordan said.
Nurses are at risk, too
"We have been reminded by our leaders from the unit level up to make sure we are staying on top of our own health, so we can do the same for our patients," Whitt said.
Nurses may experience dehydration and fatigue while working in hot environments or extended shifts during heat waves. "These conditions can affect their ability to focus, make decisions, and provide optimal care," Bailey said.
If there's an excessive heat warning in your area, expect surges in patient volume. "Nurses may experience a heavier workload as they attend to more patients in distress," Bailey added.
Nursing units will see increased demand for medical supplies, medications, and cooling equipment. Bailey cautioned that supply chain shortages or disruptions can impact the ability to deliver adequate care.
Steps to prepare for excessive heat warnings
Hospitals and health systems need to prepare now for extreme heat events. Nurse leaders are crucial in ensuring that practices, units, and hospitals are adequately prepared. According to Bailey, here are 10 actions to enhance extreme heat preparedness:
- Develop heat safety protocols. Plans should address patient care, staff safety, resource allocation, communication protocols, and coordination with external agencies during heat waves, she added.
- Organize training sessions for all staff to raise awareness. This ensures that nurses are familiar with heat-related illnesses and appropriate management strategies.
- Stock essential supplies. Units must be well stocked with essential supplies, medications, and cooling equipment. "Nurse leaders should work with supply chain managers to maintain adequate inventories to handle increased demand during extreme heat events," she suggested.
- Establish cooling centers. Nurse leaders can work with hospital administration to provide a safe environment for patients and staff to seek relief from high temperatures.
- Monitor weather updates and excessive heat warnings. "This information can help trigger the activation of heat emergency response plans in a timely manner," she explained.
- Collaborate with facility management. It's important to ensure that HVAC systems are functioning optimally, especially under excessive heat warnings. "Regular maintenance and inspections of cooling systems are crucial to prevent unexpected failures," she said.
- Establish communication channels to disseminate updates to all staff members under excessive heat warnings. Staff must be able to easily access important contact numbers and communication platforms.
- Work with emergency managers to organize exercises to practice implementing the heat emergency response plan. Nursing leaders can ensure that staff are familiar with their roles and responsibilities during an actual emergency.
- Evaluate preparedness. Working with emergency managers to conduct post-heat wave evaluations gives valuable information on the effectiveness of heat safety protocols.
- Regularly update heat emergency response plans. "This is essential for maintaining readiness," she emphasized.
Nurse leaders' essential role in heat preparedness
Nursing expertise is an essential component to ensure preparedness for extreme heat. "Nurses have a deep, holistic understanding of patient needs and community health," said Jordan. "This perspective is needed in emergency planning."
Nursing leaders need to consider how intense heat will impact day-to-day clinical practice. At the same time, you'll need to think about the bigger picture. "The strategies that have worked previously are not going to be sufficient in the future," predicted Jordan.
Intense heat can have indirect consequences that affect nursing practice. For example, schools and power may be impacted. "How will that impact the ability to provide essential care?" "How will it impact the health and well-being of the healthcare team?" These are two important questions to ask, Jordan recommended.
To adequately prepare for future excessive heat, you'll need to take a comprehensive approach. "Provide education on the impact of climate on health at orientation and annually," DePhillips advised.
Nurses can also advocate for sustainable hospital practices. "This can have a broader impact on climate and the subsequent health of the community," DePhillips added.
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