VOLUNTEERING IS A GREAT WAY for nursing professionals, including registered nurses (RNs) and advanced practice nurses (APRNs), to get involved in their communities and to support causes that are important to them. However, there are some operational and legal considerations that nurses should investigate before agreeing to take on a volunteer position. This article will review some questions nurses should ask prior to taking on a volunteer position. It will also review some of the legal protections for nurses who are volunteering, and when those legal protections generally do and don’t apply.
Usual venues that request medical volunteers include community fairs, concerts, sporting competitions, water sports, and foot races such as 5Ks, marathons, triathlons, and adventure races. However, a measure of caution is necessary: Know the expectations of medical volunteers in advance. There can be a mismatch or even a misunderstanding in what the organizers may expect of you, their level of support, and the realities of your scope of practice, skill set and capabilities. It’s crucial to ask questions up front to clarify their expectations and yours so that you can make an informed decision regarding your participation, as well as consider any personal risks and professional liability risks. Several questions can be helpful to you as you evaluate opportunities to serve as a medical volunteer.
What are the organizer’s overall expectations of the volunteer(s) providing on-site medical coverage?
When considering becoming a medical volunteer for an event, it’s a good idea to contact the organizer in advance to ask clarifying questions. Will you work by yourself, or will you be part of a medical team? Is there any pre-event training available? Do they expect you to hand out ice packs, take vital signs, and provide basic first aid? Will you have to respond to people in need anywhere within the event venue, or will other event staff bring ill or injured persons to you? Do they assume that you, an RN, will administer medications to participants without pre-existing orders or independent practice authority? When you speak to the organizer directly, you have the opportunity to be clear about your scope of practice and the applicable limits of your licensure and capabilities.
Is the type of event aligned with your nursing license, experience, and knowledge?
Are you practicing in a state for which you hold a valid nursing license at the level you intend to practice (such as RN, APRN, or licensed practical/licensed vocational nurse)? Do you have any type of first aid, emergency care, or wilderness medicine training? Are you up to date on CPR and automated external defibrillator (AED) certification? These events are often held in outdoor locations as well as large, indoor event venues. The care you are being asked to provide is based on prehospital care principles. If other nurses and care providers who have experience in this venue will be available to mentor you onsite, there can be a much greater comfort level with volunteering. However, if you will be the lone nurse without backup except by calling the local EMS squad, then it’s important to take stock of your own knowledge and skills before signing up.
Is the team composition appropriate to the anticipated medical needs at the event as well as the number of participants?
Events such as large-scale marathons with 5,000 or more runners, adventure races, or big concerts typically call for larger medical teams with numerous physicians, advanced practice clinicians (APCs) such as APRNs and physician assistants, nurses, and EMS personnel. These types of events tend to be very well planned and organized. If the event will require personnel with specialized rescue skills such as those of a lifeguard, a rock climber, or ski patrol, ensure that people with these competencies and credentials are part of the team and positioned in areas where their skills are most likely to be used. You should never be expected to perform rescue skills for which you have no experience or training.
What internal and external resources will be available at the event?
Internal resources include medical station structures such as tents, water stations, gators for transporting participants to the medical team, police or security, roving bike patrols, food, bathroom facilities, water, and electricity. Communication devices such as portable radios for contact with both race organizers and other medical team members are often essential, as cell phones may have limited connectivity in some venues. External resources generally encompass local EMS responders in ambulances, helicopters, watercraft, rescue apparatus, and divers. Local and regional healthcare facilities also are considered external resources as well as their capacity so the team can make well-reasoned decisions.
What types of equipment and supplies will be on hand?
Will the event organizer provide the medical supplies and equipment, or do they expect the medical team to bring whatever they determine is necessary? If provided by the organizer, is the equipment fully functional? Are the supplies usable (not damaged or expired) and in sufficient quantity? Are AEDs available? The team needs to carefully decide whether a basic life support level of care will be provided or an advanced life support level. If physicians and APCs are available, then consideration of an advanced life support level might be reasonable. This decision will dictate supply and equipment needs as well as team competency and skill needs.
Are there well-coordinated plans, including an orientation?
Have the organizers held an event such as this in the past? Do they work closely with those on the medical team to ensure that planning is well coordinated and that the medical team has the necessary access to resources and decision-making? Do they offer an orientation to the event, including the layout and location of key resources, areas of greatest injury risk, points of entry and egress for emergency vehicles, and criteria for cancelling or ending the event before it’s scheduled to be over (for example, lightning storm, excessive heat or cold)? Who is the lead medical volunteer and does this individual offer an orientation to being part of the medical team?
What are documentation and quality management expectations?
How will medical encounters be documented? Is there a patient contact log or a formal care record? In the event of a complex or serious case involving the medical team, is there any type of post-event follow-up with the team or quality management plan to inform future event coverage? What type of follow-up does the event organizer expect after serious medical encounters and what can the medical volunteer legally provide without violating patient confidentiality? How are media inquiries handled?
Is this coverage volunteer or is there compensation?
Consider the implications of Good Samaritan laws. Good Samaritan laws vary from state to state and are intended to cover healthcare professionals who volunteer to help people experiencing a medical emergency. Sometimes even receiving a t-shirt, food voucher, or swag from the event can be viewed as compensation. Being compensated with monetary payment and, potentially, giveaway items can nullify Good Samaritan protections. Review the Good Samaritan Law in the state where you plan to volunteer, especially if you intend to rely on Good Samaritan protections.
What liability coverage exists?
Seek clarification from the event organizer regarding whether they have liability insurance coverage for their event. If so, does it provide any liability coverage for medical volunteers? What are the provisions of that liability coverage if medical volunteers are covered? If there is no liability coverage as part of the event organizer’s policy, do you have your own professional liability policy that offers the appropriate coverage? Knowing that you are protected provides essential peace of mind. It also is a good idea to know if the organizer’s policy covers you for any injuries you may sustain as part of your duties as a medical volunteer.
A rewarding opportunity
Being an event medical volunteer is personally and professionally rewarding. It expands your healthcare horizons and offers the opportunity to learn new skills. As in any type of practice setting, always ensure your decision-making and actions are based on a solid foundation of knowledge, skills, and abilities. Never hesitate to ask questions, seek clarification, learn as much as possible with capable teachers and mentors, and enjoy the journey.
References
Laskowski-Jones L. APRN and RN participation as medical team members in adventure races: Operational and legal considerations. NSO Annual Summit, San Diego, CA. Nov 17-19, 2023.
Laskowski-Jones L, Caudell MJ, Hawkins SC, et al. Extreme event medicine: Considerations for the organisation of out-of-hospital care during obstacle, adventure and endurance competitions. Emerg Med J. 2017;34(10):680-685.
Young SJ, Keiper MC, Fried G, Seidler T, Eickhoff-Shemek JM. A muddied industry: Growth, injuries, and legal issues associated with mud runs — Part I. ACSMR’s Health & Fitness Journal. 2014;18(3):31-34.
Disclaimer: The information offered within this article reflects general principles only and does not constitute legal advice by Nurses Service Organization (NSO) or establish appropriate or acceptable standards of professional conduct. Readers should consult with an attorney if they have specific concerns. Neither Affinity Insurance Services, Inc. nor NSO assumes any liability for how this information is applied in practice or for the accuracy of this information. Please note that Internet hyperlinks cited herein are active as of the date of publication but may be subject to change or discontinuation.
This risk management information was provided by Nurses Service Organization (NSO), the nation’s largest provider of nurses’ professional liability insurance coverage for over 550,000 nurses since 1976. The individual professional liability insurance policy administered through NSO is underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company. Reproduction without permission of the publisher is prohibited. For questions, send an e-mail to service@nso.com or call 1-800-247-1500. www.nso.com.
Reprinted with permission from Nurses Service Organization
