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connectionSeptember 2014 Volume 38, Issue 8
the Official Magazine of the Emergency Nurses Association
PLUS!Treasurer’s Report 6
Member Has Just the Place to Ditch Your Stress 18
AwArd SeASon
Announcing the 2014 Annual and Lantern Award Recipients & Academy Inductees
16 - 17
§Attend a wide range of educational sessions covering 9 key practice areas
§Earn over 25.5 contact hours, depending on sessions attended
§Learn about innovative products and services
§Network with colleagues from around the world
For the latest updates, visit www.ena.org/AC
Follow the action on #ENAAC14
The Emergency Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
REGISTER NOW
INDIANAPOLIS Indiana Convention Center October 7-11, 2014
AC14_Connection_full_09 2014.indd 1 7/23/14 4:39 PM
Why We Must Persist in Reporting, Despite Threat of Retaliation
FROM THE PRESIDENT | Deena Brecher, MSN, RN, APN, ACNS-BC, CEN, CPEN
I had never given much thought to what
happens if a nurse suffers retaliation after
reporting a safety issue. I have a hard time
imagining an environment where emergency
nurses would be retaliated against for raising
a safety concern. However, there are
environments where a ‘‘culture of blame’’
exists, both inside and outside of health care.
While most nursing practice acts identify
nurses as mandatory reporters if
they have knowledge of an
impaired colleague, many
do not require nurses to
report unsafe practices or
conditions. Unfortunately,
there have been several
cases where nurses have
been prosecuted for
reporting unsafe practice.
How is this possible? The
ENA Code of Ethics states, ‘‘The
emergency nurse acts to protect
the individual when health care and
safety are threatened by incompetent,
unethical or illegal practice.’’ In my
interpretation, ‘‘acts to protect the
individual’’ means reporting unsafe practice.
How can I, as the ENA president, continue
to advocate for safe practice and safe care,
work to help nurses understand their role in
preventing errors in the ED and ask nurses to
hold each other accountable for reporting
unsafe practices when I know nurses are
being retaliated against for doing just
that? My answer is that I must
continue to do it.
We need to own our practice.
Dates to Remember
PAGE 4Free CE of the Month Letters to the Editor
PAGE 10ENA Research
PAGE 12ENA Foundation
PAGE 30Ask ENA
Regular Features
Oct. 5-11, 2014 Emergency Nurses Week (Emergency Nurses Day is Oct. 8)
Oct. 7-11, 2014 ENA 2014 Annual Conference, Indianapolis
PAGE 6Treasurer’s Report
PAGE 7Meet ENA’s Parliamentarian
PAGES 8 - 9Progress Report on Past Resolutions From ENA General Assembly
PAGE 14Nurses and Higher Education: The Numbers Are Growing
PAGE 162014 Award Announcements: • ENA Annual Awards • Lantern Awards • Academy of Emergency Nursing Inductions
PAGE 17Judith C. Kelleher Award Winner
PAGE 18Code You: Member Carves Out a Place for Nurses to De-Stress
PAGE 22When an Emergency Nurse Becomes the Patient: Five Lessons
PAGES 24 - 26Updates From ENA’s Geriatric, Pediatric and Trauma Committees
PAGE 28When the ADC is Bare: Combating Drug Shortages in the ED
ENA Exclusives
I have spent the better part of this year trying to encourage emergency nurses to report
potential safety concerns, change their attitude regarding patient safety and embrace a
culture of safe practice and safe care. Recently I read an article about a nurse’s duty to report
unsafe situations in the practice environment. That article has caused me to take a harder
look at the realities of reporting.
I travel quite often as the ENA president, and at airports and train stations, I see the same
message: ‘‘If you see something, say something.’’ I translate that message to the emergency
care environment: If you see something that’s unsafe, say or do something about it. If the
child is lying on the stretcher, and the stretcher is raised and the side rails are down, lower
the bed, raise the rails and let the team taking care of the patient know someone walked out
of the room and left the patient in an unsafe situation. If the computer in the patient room
will not let you scan the medication, report the issue. If you feel that a co-worker’s practice is
unsafe — whether it may be caused by a controlled substance, behavioral health issue or
poor judgment — report that co-worker and hope he gets the help he needs.
3
Continued on page 6
Take advantage
of ENA’s latest
free continuing
education offering
to earn CE credit
while you explore
care of the behavioral health patient in the ED.
Available to you starting Sept. 1 . . .‘‘Facilitators and Challenges to the Care of
Behavioral Health Patients in the
Emergency
Department: A
National Study,’’
presented by Lisa
Wolf, PhD, RN,
CEN, FAEN.
This session
explores potential
solutions for the behavioral health patient population
by laying out the findings of the critical-access
hospital educational study and identifying the
significance of the educational barriers for
emergency nurses at CAHs.
To take this and other eLearning courses free as
an ENA member:
• Go to www.ena.org/freeCE, where you’ll log
in as a member (or create an account).
• Add desired courses to your cart and
‘‘check out.’’
• Proceed to your Personal Learning Page to
start or complete any course for which you
have registered or to print a final certificate.
• To return to your Personal Learning Page later,
go to www.ena.org and find ‘‘Go to Personal
Learning Page’’ under the Education tab.
Please be sure you are using the e-mail address
associated with your membership when logging in.
If you have questions about any free eLearning
course or the checkout process, e-mail
ENA Connection is published 11 times per year from January to December by: The Emergency Nurses Association
915 Lee Street Des Plaines, IL 60016-6569
and is distributed to members of the association as a direct benefit of membership. Copyright ©2014 by the Emergency Nurses Association. Printed in the U.S.A.Periodicals postage paid at the Des Plaines, IL, Post Office and additional mailing offices.
POSTMASTER: Send address changes to ENA Connection915 Lee StreetDes Plaines, IL 60016-6569ISSN: 1534-2565Fax: 847-460-4002 Website: www.ena.orgE-mail: [email protected]
Non-member subscriptions are available for $50 (USA) and $60 (foreign). For editorial inquiries, e-mail [email protected]
Publisher:Kathy Szumanski, MSN, RN, NE-BCEditor-in-Chief:Amy Carpenter AquinoAssociate Editor:Josh GabySenior Writer:Kendra Y. Mims
BOARD OF DIRECTORSOfficers:President:
Deena Brecher, MSN, RN, APN, ACNS-BC, CEN, CPEN
President-elect: Matthew F. Powers, MS, BSN, RN, MICP, CEN
Secretary/Treasurer: Kathleen E. Carlson, MSN, RN, CEN, FAEN
Immediate Past President: JoAnn Lazarus, MSN, RN, CEN
Directors:
Ellen (Ellie) H. Encapera, RN, CENMitch Jewett, AA, RN, CEN, CPEN Michael D. Moon, PhD, MSN, RN,
CNS-CC, CEN, FAENSally K. Snow, BSN, RN, CPEN, FAENJeff Solheim, MSN, RN-BC, CEN,
CFRN, FAENJoan Somes, PhD, MSN, RN-BC, CEN,
CPEN, FAEN, NREMT-PKaren K. Wiley, MSN, RN, CEN
Executive Director: Susan M. Hohenhaus, LPD, RN, CEN, FAEN
Member Services: 800-900-9659
I just received the January 2014
issue of ENA Connection from a
friend who is an ER nurse. I was so
thrilled to see the cover
and read the lovely
story inside (‘‘Guided
Tours,’’ page 5)! Thank
you so much for the
wonderful tribute to
Vietnam nurses and the
Vietnam Women’s
Memorial! This article
will be placed with our
archives at the Library of
Congress.
In the 1980s, I contacted ENA
and asked for their help in support
of building the Vietnam Women’s
Memorial on the Mall in
Washington, D.C. They got behind
it immediately and became
legislative and financial supporters.
All of us at the Vietnam Women’s
Memorial Foundation (formerly
‘‘Project’’) are ever grateful to the
Emergency Nurses Association.
I have known Marilyn Rice for
many years and was so happy to
have the opportunity to visit with
her again at the 20th
commemoration activities over
Veterans Day 2013 last
fall. We appreciate the
beautiful wreath
presented on behalf of
ENA at the Vietnam
Women’s Memorial on
Veterans Day.
We send our
deepest appreciate for
your years of ongoing
support, and special thanks to
Marilyn Rice, Lt. Col. Peggy
McMahon and Deena Brecher for
being with us on that beautiful day.
Kendra Y. Mims’ story ‘‘Guided
Tours’’ is beautifully written and
takes its place among the rich
legacy of our Vietnam-era veteran
nurses. Thank you!
Diane Carlson Evans,Founder and President,
Vietnam Women’s Memorial Foundation,
Washington, D.C.
ENA Connection welcomes letters from members. Letters should address content previously published in the magazine. Letters may be edited for space and clarity. Submission does not guarantee publication. Please include your name, credentials and contact information for verification. Send letters to [email protected].
HELD DEARA Trip Back Through Time
at the Vietnam Women’s Memorial
connectionJanuary 2014 Volume 38, Issue 1
the Official Magazine of the Emergency Nurses Association
2014 ENA CAREER GUIDE
PAGES 4 - 9
THE RIGHT TRAININGSAVES MORE LIVES.In-hospital cardiac arrest survival rates can improve dramatically. ACLS-trained nurses can more than triple survival rates, according to the recent American Heart Association Consensus Recommendations, “Strategies for Improving Survival After In-Hospital Cardiac Arrest in the United States: A Consensus Statement from the American Heart Association.”
Download the AHA Consensus Statement to get the tools you need to boost survival rates.
Morrison L, Neumar R, Zimmerman J, et al. Strategies for improving survival after in-hospital cardiac arrest in the United States: 2013 consensus recommendations: A consensus statement from the American Heart Association. Circulation. 2013;127:1538–1563.
©2014 Physio-Control, Inc. GDR 3319301_A
37.5%SURVIVAL RATE WITH ACLS- TRAINED NURSES.10.3%
SURVIVAL RATE WITH NON-ACLS- TRAINED NURSES.
Visit www.physio-control.com/Training to get the report.
We need to understand our duty to
report as outlined in our state nurse
practice act. We must continue to work
to reduce the number of avoidable
errors in our departments. We must
report unsafe practices, procedures,
policies, actions, conditions and
environments.
We also must understand where the
gaps are in protection for nurses who
report these conditions, and we must
close those gaps. Creating, advocating
for and supporting a just culture is a
first step toward removing fear of
retaliation as a barrier to reporting.
Understanding the role of the
emergency nurse in decreasing
preventable errors is another.
Other steps include becoming
familiar with state laws that govern
mandatory reporting; understanding the
protections, if any, that are in place for
nurses; and advocating to create or
strengthen existing protections. The
most important step is to never, ever
give up the drive to advocate for safe
practice and safe care.
6 September 2014
TREASURER’S REPORT | Kathleen E. Carlson, MSN, RN, CEN, FAEN, 2014 ENA Secretary/Treasurer
A Healthy Picture to ShareF inancial results for 2013
supported the
advancement of ENA’s
programs and
advocacy initiatives,
both in the current year and well into
the future. Among ENA’s strengths is
its diverse set of revenue sources:
membership, courses, conferences
and other products and programs.
Membership remains stable, and
continuing education courses exhibit
growth as courses are updated and
extended to a broadening base of
nurses. More diversity resides within
those courses, with Trauma Nursing
Core Course, Emergency Nursing
Pediatric Course, Geriatric Emergency
Nursing Education, Emergency Nursing
Orientation, Emergency Nursing Triage,
Handling Psychiatric Emergencies and certification
review courses all contributing.
Total revenue was $17.2 million in 2013, reflecting annual
growth of about 1 percent. Membership held steady at just
under 40,000, generating $3.6 million in dues, of which
$371,000 went directly to support ENA state councils and local
chapters. Course revenue exceeded $8.4 million, increasing
about 7 percent from 2012, and also provided $1.2 million to
the state councils to support TNCC and ENPC. A record 51,000
nurses took the TNCC provider course, and nearly 16,000 took
the ENPC provider course. More than 5,000 people attended
our Leadership and Annual conferences.
Operating expenses totaled just over $17.2 million for the
year, so the net result was a slight operating loss of only
$29,000. The expenses supported the core activities of
membership, courses and
conferences, and also provided
additional support to state councils
through grants totaling $45,000. In addition, the
ENA Board of Directors acted to provide $25,000 to the ENA
Foundation’s Judith Kelleher Memorial Endowment.
ENA’s investment portfolio grew to $13.5 million,
increasing the reserve ratio to 73 percent, or $4.2 million
more than required by ENA’s reserve policy. This prudently
invested portfolio is now providing substantial income,
further strengthening ENA’s financial foundation.
A complete copy of ENA’s audited financial
statements is posted in the members-only section
of the ENA website at tinyurl.com/ENAfinance
or by scanning the QR code at left.
From the President Continued from Page 3
ENA 2013 REVENUE
$8,415,50149%
$3,589,838 21%
$2,868,957 17%
$2,343,307 13%
Membership
Courses
Conferences
Other
Official Magazine of the Emergency Nurses Association 7
GOVERNANCE
More than 700 delegates and
emergency nurses convene
every year for the ENA General
Assembly to witness the installation
of board members, hear reports on
association activities and debate and
vote on proposed bylaws,
amendments and resolutions. From
keeping track of time to providing
clarification and assisting the ENA
president during the assembly,
Colette Collier Trohan is the ENA
parliamentarian who keeps the
two-day business meeting in order.
Trohan, president and CEO of
A Great Meeting Inc., has more than
20 years of experience as a
professional parliamentarian. Her
first meeting as ENA’s General Assembly parliamentarian
was at the 2008 Annual Conference in Minneapolis.
Trohan describes herself as the meeting process guru.
‘‘As the parliamentarian, I am the one who remains totally
impartial,’’ she said. ‘‘I help everyone put their ideas together
in the best form for a large group of delegates to look at.’’
As soon as the meeting is adjourned, Trohan starts
preparing for the next General Assembly. She says 80 percent
of the meeting actually happens before it is called to order.
That includes preparing a script with the ENA president and
developing orientation and training for delegates.
‘‘There’s a tremendous amount of preparation to make
sure that the delegates have everything they need to make
decisions, and making sure it’s as clear as possible so that we
don’t take up time wordsmithing on the floor, which is one
of the most painful experiences a delegate can go through,’’
Trohan said.
Trohan meets with the Resolutions Committee the day
after General Assembly to examine the bylaws and make
sure all of the amendments adopted are organized so that a
new governance document can be released. The committee
also debriefs on what worked well and what it could
improve for future meetings.
Trohan also
provides amendments
assistance to delegates
after the first day of
General Assembly.
‘‘We hold a group
hearing where
everyone gets the
opportunity to discuss
every bylaw
amendment and every
resolution,’’ she said.
‘‘We help anyone who
wants to propose an
amendment with the
writing to make sure
it’s clear and legal. It
gets signed off by the
lawyer and by me, the
parliamentarian, and
then it gets published so that on Day 2 of GA, everybody
sees what else might come up on the agenda that day. It’s a
big production.’’
Trohan says the two challenges she faces in her
parliamentarian role are time and confusion.
‘‘If there is one misspoken phrase in front of all of those
attendees, it can create confusion that becomes difficult to
change,’’ she said. ‘‘I spend most of my time making sure
everything is presented as clear as possible so there is no
confusion on the floor and we don’t waste any time. We
designed the amendments assistance process because the
time the delegates have in that room is so precious, and we
have to be sure that they are set for success.’’
Trohan’s favorite part of General Assembly is watching
the process unfold.
‘‘When I see the delegates in that room really discussing
the important issues of ENA, and when I see all of the
viewpoints coming out, no matter what they are, it’s just
wonderful to watch that decision being made,’’ she said. ‘‘I
like to tell everybody I don’t care what they do — I just care
how they do it. If I feel the General Assembly has looked at
all the viewpoints and they have arrived at a decision, then
it’s a fantastic feeling. It’s magical.’’
ALL IN ORDERMeet the Parliamentary Maestro Behind ENA’s General Assemblies
Parliamentarian Colette Collier Trohan clarifies a procedure during the 2013 General Assembly in Nashville. She’ll oversee her seventh General Assembly for ENA next month.
By Kendra Y. Mims, ENA Connection
2013 GA13-014: Evidence-Based Standards for Lifelong LearningENA met and advised the LACE team
(Licensing, Accreditation, Certification
and Education) of ENA’s
recommendations in Q1 2014.
2012GA12-017: Use of Protocols in the ED Setting
ENA’s Government Relations staff
investigated and provided details to
assist in the development of the
position statement titled ‘‘Use of
Protocols in the ED Setting’’ in Q1 2014.
GA12-015: Safe Discharge From the EDA position statement titled ‘‘Safe
Discharge from the Emergency Setting”
was completed in Q4 2013.
The development of a research
proposal identifying high-risk
discharges and potential interventions
has been added to the IENR research
agenda. Study development is pending.
GA12-014: Palliative Care in the Emergency Setting
A position statement titled ‘‘Palliative
and End of Life Care in the Emergency
Setting’’ was completed in Q3 2013.
ENA continues to actively solicit
faculty abstracts.
GA12-013: Health Care Worker Fatigue A sleep study proposal has been
developed and is pending
implementation. A white paper titled
‘‘Nurse Fatigue’’ was completed in Q4
2013. ENA has met with affiliate
organizations in Washington, D.C., to
review current issues regarding the
topic of health care worker fatigue.
GA12-012: Defining Wait Times The ENA Board of Directors supported
the American College of Emergency
Physician’s policy statement titled
‘‘Standards for Measuring and
Reporting Emergency Department Wait
Times’’ in Q3 2013.
GA12-011: Care of the Patient With Chronic Pain A clinical practice guideline for acute
pain management is in development. A
8 September 2014
As ENA delegates prepare to debate and vote on several proposed resolutions at the 2014 General Assembly on Oct. 8-9 in
Indianapolis, here is a progress update on previously approved resolutions.
ENA departments assigned to work on resolutions include the Institute for Emergency Nursing Research; the Institute for
Emergency Nursing Education; the Institute for Quality, Safety and Injury Prevention; Government Relations; and Meetings and
Conferences.
RESOLUTION CENTERThe Latest Work on ENA General Assembly Initiatives
Official Magazine of the Emergency Nurses Association 9
position statement titled ‘‘Care of
Patients with Chronic/Persistent Pain in
the Emergency Setting’’ was completed
in Q1 2014.
GA12-010: Care of the Bariatric/Obese Patient A topic brief titled ‘‘The Bariatric/
Obese Patient’’ was completed in Q4
2013.
2011
GA11-020: Emergency Nursing and Forensic Nursing
ENA and the International Association
of Forensic Nurses have a formal
relationship through the Nursing
Organizations Alliance. This has led to
collaborative efforts related to position
statements for emergency and forensic
nursing, including the development of
the position statement ‘‘Intimate Partner
Violence,’’ completed in Q3 2013.
GA11-019: Task Force on Chronically Impaired
The Alcohol Screening, Brief
Intervention and Referral to Treatment
toolkit was developed in collaboration
with ENA members and the National
Highway Traffic Safety Administration
in 2013. A discharge instruction
template is included within the SBIRT
supplemental materials located at
www.ena.org.
GA11-018: Advancing the IOM Recommendations for Future of NursingENA continues to collaborate with the
Nursing Organizations Alliance, the
American College of Emergency
Physicians, The Joint Commission and
the National Quality Forum. Through
ENA’s public policy efforts in 2013,
one of the primary focus areas was an
increase in Title VIII funding which
supports a major recommendation for
the future of nursing.
GA11-017: Firearm Safety Education for Children
Based on the recommendation of the
IENR, the position statement ‘‘Firearm
Safety and Injury Prevention’’ was
developed in Q1 2013. The IQSIP is
currently developing a topic brief in
collaboration with the ENA Pediatric
Committee. (See article on page 25 of
this issue.)
GA11-015: Care of Patient Presenting with Stroke Symptoms The Position Statement Review
Committee reviewed the resolution and
recommended a more comprehensive
piece be available; a recommendation
was made to develop an educational
module. An online education module
titled ‘‘Partnering in the Fight Against
Stroke’’ was completed in Q2 2014 and
is available at www.ena.org.
GA11-013: Care of the Pediatric Patient with Dehydration The Clinical Practice Guideline
Committee is actively developing a
resource.
2010
GA10-010: Helicopter Shopping
Accomplishments completed in
2011-2012 include: 1) A joint
consensus statement on helicopter
shopping; 2) ENA and the Air &
Surface Transport Nurses Association
recorded and disseminated a video
message at the 2012 ENA Annual
Conference; and 3) IENR and ASTNA
developed a communication regarding
research and dissemination.
In Q2 2014, ENA’s Government
Relations staff sent a joint letter to the
Federal Aviation Administration in
support of issuing new rules regarding
the safety of air medical transportation
helicopters. However, the letter also
states ENA’s concern with the delay in
implementation of the rules and urges
against further delays.
Note: All position statements, white papers, support statements, online courses, etc., listed above are available at www.ena.org at no charge.
September 201410
ENA RESEARCH | Lisa Wolf, PhD, RN, CEN, FAEN, Director, Institute for Emergency Nursing Research
You are the manager of an
emergency department and in
charge of reviewing practices around
sepsis identification and treatment. You
find that the time to antibiotics measure
is much longer than you would like it
to be. The problem is, you’re not sure
under what circumstances delays are
occurring or why. This makes it very
difficult to figure out how to fix the
problem and lower time to antibiotics
for these patients.
When clinical problems present
themselves, it’s important to understand
that the question drives the method. If
you want to understand how many,
how long or how often, it’s best to use
methods that give numbers; in short,
use a quantitative approach. To obtain
this information, you may do a chart
review, looking for specific variables,
or measure time between stages of the
ED visit. You could also send a survey
to nurses and providers who work in
your ED or hospital system to get
information about the problem you are
studying. In this case, you’d want to
look at data points such as triage time,
time of provider evaluation, time of
diagnosis and time to first antibiotic.
You want actual times, not recalled
times, so a chart review would be
appropriate for this set of questions.
When you get the answers to these
types of questions, you will understand
what is happening. What may not be
so clear is why it’s happening. This is
where a mixed-methods approach can
be very useful.
Mixed-methods research is a
methodology for conducting research
that involves collecting, analyzing and
combining quantitative
and qualitative methods
and data in a single
study. The
purpose of this
type of research
methodology is
that using
qualitative and
quantitative research
together provides a better
understanding of a research problem
than either research approach alone.
The qualitative data you collect, via
focus groups or interviews, can help to
explain your quantitative findings; in
short, you may get a better idea of why
the time to antibiotics is longer than
you want, and you can probably design
a better intervention to fix it.
Consider what you possibly might
discover in your chart review. If you
start by pulling all the charts with a
diagnosis of sepsis, you might want to
collect the following data:
1. The initial vital signs and when they
were obtained
2. Triage level assignment (is it
accurate and appropriate?)
3. Time to room
4. Time to diagnostics (and what they
were, e.g., labs like CBC and BMP
— were blood cultures and lactate
drawn immediately?) and time
of results
5. Time to provider evaluation
6. Time to orders for antibiotics
7. Time of administration
Once you have data on what’s
happening in your department, you
must determine why those things are
happening. You may want to
convene a focus group of
nursing staff and
possibly a
second one
composed of
providers. You
can ask them
very open-ended
questions. Some
possible ways to start
are to ask about process:
1. How do you identify septic patients
in triage?
2. Is there a protocol or guideline to
begin treatment once the patient is
identified? If so, what’s the
implementation process?
3. How do you communicate with
providers/nurses? Do you find this
effective? Why or why not?
4. What is the process of implementing
protocols or treatment orders for
these patients?
Once all these data have been
analyzed, you will have a better sense
of not only what is happening in your
department but also why. Possibly you
will learn that communication between
providers and nurses is ineffective, or
that the pharmacy system isn’t
responsive to the immediate need. You
may also discover your triage and staff
nurses are having difficulty recognizing
sepsis at initial presentation. The issue
may be a combination of three. This
mixed-methods approach adds a
number of parts of the puzzle,
facilitating how to address the problem
and improve patient care.
Mixed-Methods Studies: Why They Can Be Awesome
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September 201412
“Storytelling can change a
room. It can change lives. It
can change the world.”Gwenda LedBetter
Every one of us has a story to tell.
I believe it is essential for
emergency nurses to share their
stories with each other. Whether you
are treating patients at a rural hospital or in an inner city,
holding a child’s hand at the bedside or providing critical
care during a rescue operation, we all have a common goal
to provide high-quality care to our patients and advance our
profession. Sharing our experiences connects us to our
purpose as emergency nurses and builds a sense of
community. It lets us know that no matter how different the
circumstances, we are not alone in the challenges we face.
Our stories inspire us to grow as individuals and together.
I personally want to invite you to attend the ENA
Foundation Event on Friday, Oct. 10, at the 2014 ENA
Annual Conference in Indianapolis for an inspirational
evening of storytelling from ENA members who are making
a difference around the world. The ENA Foundation’s
exclusive event, ‘‘The Power of One: Engaging Generations
of Nurses to Give Back and Do Incredible Things,’’ will
feature internationally recognized speaker and emergency
nurse Jeff Solheim, MSN, RN-BC, CEN, CFRN, FAEN, along
with six heroes from around the world who are dedicated to
improving the quality of life for others who are less
fortunate. From providing medical care to orphans in
underserved areas in Africa to building the only health care
clinic in the slums of Uganda, these heroes will share their
personal journeys of sacrifice and commitment and inspire
you to do incredible things that will have a lasting impact.
• Robert Nabulere was born in northern Uganda in a
poor village. Although he was able to move his family into a
bountiful two-story house in an upscale neighborhood in
Kampala, he felt the need to return to his roots and help
those in poverty 10 years ago. He moved his family to the
slum and started a church and a school, which now serves
hundreds of children. He also has plans to build a clinic
there to provide medical care.
• Greg Higgins is an emergency physician from
California. He sold his practice and relocated to Africa to
start an orphanage near the base of Mount Kilimanjaro. His
orphanage provides a home to more than 100 orphaned
children. He works hard to provide medical care to this
underserviced area of Africa.
• Shannon Ward is an emergency nurse and also the
wife of Greg Higgins. She sold her home and relocated to
Tanzania and works in the orphanage to provide nursing
care to the orphans. She and Higgins travel through the
area as a team to provide medical care to the
underprivileged.
• Laurie Freeman is a pediatric nurse. During a trip to
Uganda, she learned that young girls dropped out of high
school because of a lack of feminine hygiene products.
Determined to change that, she became committed to
providing them with cotton underwear as well as reusable
feminine hygiene products. Her efforts have provided girls
with an opportunity to stay in school and obtain their high
school educations.
• During one of their trips to Cochabamba, Bolivia, ENA
members Joan Eberhardt and Helen Sandkuhl found a
young boy with second- and third-degree burns. They raised
funds to fly him to St. Louis and found a hospital and
physician to provide free care for nine months, helping the
young boy survive.
With your support, we can do something incredible to
help shape the future of emergency nursing. The goal of the
‘‘Power of One’’ event is to raise money to send 10 emerging
professionals to the Emergency Nursing 2015 Conference.
One hundred percent of the ticket value will be used to fund
scholarships for nurses just starting out in their careers. Your
$50 tax-deductible donation will help to empower and equip
your peers with education and advocacy skills needed to
advance the emergency nursing profession. Dinner, dessert
and beverages will be served after the program, and
attendees will earn 1.30 contact hours. You won’t want to
miss this amazing networking opportunity.
Through your support onsite at conference and through
online giving, the ENA Foundation has helped hundreds of
ENA members advance the emergency nursing profession
through our educational and research opportunities. As the
2014 ENA Foundation chairperson, I always feel honored
when an ENA member shares how the foundation has
helped them improve their practice or enhance their career.
Your stories renew my passion for the ENA Foundation and
for the work we do every day. Thank you for your
continued support. I look forward to seeing you in
Indianapolis.
My Invitation to YouENA FOUNDATION | Seleem Choudhury, MBA, MSN, RN, CEN, 2014 ENA Foundation Chairperson
ENA Foundation Event
“A single person can do incredible things when they set their heart to it. That’s the power of one.”
- Jeff Solheim
The Power of One: Engaging Generations of Nurses to Give Back and Do Incredible Things
Friday, October 106 – 8:30 pm2014 ANNUAL CONFERENCE INDIANA CONVENTION CENTER 1.30 CONTACT HOURS
Join the ENA Foundation and Jeff Solheim, Internationally Recognized Motivational Speaker, for an evening of exploring the Power of One—Inspiring stories of our heroes—100% of your ticket value goes to the Emergency Nursing 2015 Conference scholarship fund.
The goal of the Foundation Event is to raise money to send 10 emerging professionals to the Emergency Nursing 2015 Conference. Empowering young nurses with education, networking, and advocacy skills will give them the tools to do incredible things.
$50 (tax deductible) Dinner, dessert bar, and beverages following the program.
THE POWER OF ONE
The Emergency Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
AC14 ENA Foundation Event Ad_JEN_Full_07 2014.indd 1 6/25/14 8:37 AM
September 201414
EDUCATION
T he nation’s nurses are responding
to the call to pursue higher levels
of education to provide improved
patient care. ‘‘The Future of Nursing:
Campaign for Action,’’ led by the
Robert Wood Johnson Foundation and
AARP, has shown meaningful progress
in nursing education since launching
in late 2010.
The campaign was created in
response to the Institute of Medicine
report ‘‘The Future of Nursing: Leading
Change, Advancing Health,’’ which
recommended that 80 percent of RNs
should hold a bachelor’s degree or
higher by 2020.
The campaign dashboard shows
that the number of nurses enrolled in
doctoral programs rose 43 percent
from 2010 to 2012. The IOM report
called for a doubling of doctorate-
prepared nurses. Enrollment in
research-oriented PhD programs has
also grown.
The Future of Nursing Campaign
for Action dashboard indicators can be
found at tinyurl.com/
futuredashboard or by
scanning the QR code
here.
More good news about nursing and
higher education is found in the
October 2013 Health Resources and
Services Administration report, ‘‘The
U.S. Nursing Workforce: Trends in
Supply and Education.’’ According to
the report, the number of nurse
practitioners in the United States
increased by 69 percent between 2001
and 2011. The number of licensed RNs
graduating with BSN qualifications
increased by more than 86 percent in
just four years, from 2007 to 2011.
In addition to the benefit of
improving patient care, higher
education for nurses often translates
into new opportunities and a bigger
salary. According to data from
salary.com, an emergency nurse State and Chapter Ad_Connection_half_0607 2014_print.pdf 1 5/7/14 9:51 AM
Good News: The Numbers Are GrowingIndicators Show Nurses Are Aiming Higher, With Widespread BenefitsBy Amy Carpenter Aquino, ENA Connection
Official Magazine of the Emergency Nurses Association 15
¡ Work with the “crew” – network with experienced nurse leaders and connect with your peers ¡ “Accelerate” your career – learn about ENA’s Career Wellness resources ¡ Take part in this great opportunity – “geared” toward your professional development
New to the Emergency Care Field?Get on the right track with Emerging Professionals at ENA’s Annual Conference
Start Your Engines… Race over to the reception!Appetizers and cash bar
Thursday, October 9, 20146:30 – 7:30 pmJW Marriott Indianapolis
Visit www.ena.org/AC
Emerging Professionals Ad_Connection_half_09 2014.indd 1 7/23/14 4:41 PM
practitioner working in the Chicago
area stands to earn about $35,000 more
than a staff emergency nurse, based on
the median salary listed for both
positions.
ENA Foundation Scholarship OpportunitiesENA members who want to pursue a
higher degree, whether it’s a
bachelor’s, master’s or doctorate, have
a wealth of scholarship opportunities
available through the ENA Foundation.
The mission of the ENA Foundation
is to provide educational scholarships
and research grants in the discipline of
emergency nursing. Since its inception
in 1991, the ENA Foundation has
awarded more than $2 million in
academic scholarships to emergency
nurses. These academic scholarships
are made possible because of the
generous donations received from
individuals, state councils, local
chapters, industry and friends of
emergency nursing.
The ENA Foundation annually
offers more than 30 academic
scholarships. The list of previous
scholarship recipients is available at
www.enafoundation.org. The next
scholarship application period will
open in late January 2015.
For additional information about the
ENA Foundation, please e-mail
[email protected] or contact a
member of the Development
Department at 847-460-4100.
MORE OPPORTUNITIESThe ENA Foundation has the following upcoming calls:
• ENA Foundation/ANIA Research Grant. Submission deadline: Oct. 1, 2014.
• ENA Industry-Supported Grants. Submission deadline: Oct. 1, 2014.
• ENA Seed Grants. Submission deadline: Nov. 1, 2014.
Visit enafoundation.org for details.
September 201416
2014 Annual Award RecipientsBarbara A. Foley Quality, Safety and Injury Prevention Award
Charlotte O’Neal, MSN, RN, CEN (Kentucky)
Behind the Scenes AwardRichard Gary Fox (Maryland)
Clinical Nurse Specialist AwardMichael Allain, MS, RN, CEN, CCRN (New York)
Frank L. Cole Nurse Practitioner AwardDenise Ramponi, DNP, FNP-BC, ENP-BC, CEN, FAEN, FAANP (Pennsylvania)
Gail P. Lenehan Advocacy AwardMary A. Leblond, MSN, RN, CEN (Texas)
*Judith C. Kelleher AwardVicki A. Keough, PhD, APRN-BC, ACNP, FAAN (Illinois) * to be presented Wednesday, Oct. 8
Media AwardKelly Owen, ADN, RN, CEN (Oregon)
Nurse Manager AwardJennifer Granata, MSN, FNP-C, CEN, CPEN, CNML, EMT-P (Maine)
Nursing Education AwardKay-Ella Bleecher, MSN, RN, CEN, CRNP, PHRN (Pennsylvania)
Nursing Practice and Professionalism AwardHeather Matthew, MSN, RN, CEN (Pennsylvania)
State Council/Chapter Government Affairs AwardTexas ENA State Council
Team AwardInova Springfield Healthplex Emergency Department (Virginia)
Patient Flow Team• Winifred Frempong-Boye, BSN, RN• Valerie Hyde, BSN, RN, CEN• Carolyn Miller, RN• Shannon North-Giles, MBA, RN, CEN• Susan Oney Dungan, BA, RN, CEN
2014 Academy Candidates for Induction• Roger Casey, MSN, RN, CEN (Washington)
• Rita Celmer, RN, CRNA, CEN (Pennsylvania) – Posthumous
• Nicholas Chmielewski, MSN, RN, CEN, CNML, NE-BC (Ohio)
• Seleem Choudhury, MSN, MBA, RN, CEN (Vermont)
• Ruth E. Rea, PhD, RN (Washington)
• Robert Ready, MN, RN-C, CPEN, NEA-BC (Rhode Island)
• Stephen J. Stapleton, PhD, MS, RN, CEN (Illinois)
• Tiffiny Strever, BSN, RN, CEN (Arizona)
• Mary Alice Vanhoy, MSN, RN, CEN, CPEN, NR-P (Maryland)
• Cheryl Wraa, MSN, RN (California)
The Academy extends its congratulations and appreciation to the candidates for their outstanding contributions to emergency nursing and ENA.
Presentations and inductions will be held Saturday, Oct. 11, at the Annual Awards Gala at the 2014 Annual Conference in Indianapolis.
2014 Lantern Award Recipients• Advocate Children’s Hospital Pediatric Emergency Department – Oak Lawn Campus (Illinois)
• Ann & Robert H. Lurie Children’s Hospital of Chicago Emergency Department (Illinois)
• Bethesda Arrow Springs Emergency Department (Ohio)
• Bon Secours St. Mary’s Hospital Pediatric Emergency Department (Virginia)
• Cincinnati Children’s Hospital Medical Center Emergency Department – Liberty Campus (Ohio)
• Edward Hospital Emergency Department (Illinois)
• Franciscan St. Francis Health Indianapolis Emergency Department (Indiana)
• Oak Hill Hospital Emergency Care Center (HCA) (Florida)
• Nemours Children’s Hospital Emergency Department (Florida)
• Northwestern Lake Forest Hospital Emergency Department (Illinois)
• Overlook Medical Center Emergency Services – Union Campus, Atlantic Health System (New Jersey)
• Sharp Memorial Hospital Emergency Department (California)
• Swedish Edmonds Emergency Department (Washington)
• Swedish Medical Center/Ballard Emergency Department (Washington)
• UH Rainbow Babies & Children’s Pediatric Emergency Department (Ohio)
• University of Michigan Hospital & Health Centers – C.S. Mott Children’s Hospital, Children’s Emergency Services (Michigan)
• University of Wisconsin Hospital & Clinics Emergency Department (Wisconsin)
Official Magazine of the Emergency Nurses Association 17
to register visit www.ena.org/ac
A Celebration of Ínductees to the Academy of Emergency Nursing, Lantern Awards, and Annual Achievement Awards
Saturday, October 117:30 pm
JW Marriott Indianapolis
Gala 2014 AD_CONN_Half_08 2014_print.pdf 1 6/25/14 3:59 PM
2014 Judith C. Kelleher Award Winner: Vicki A. KeoughENA is pleased to name Vicki A.
Keough, PhD, APRN-BC, ACNP,
FAAN, as the 2014 Judith C. Kelleher
award recipient. Keough will receive
the award Oct. 8 at the ENA Annual
Conference in Indianapolis during the
Anita Dorr Memorial Lecture and
Luncheon.
This prestigious award, named for
one of ENA’s co-founders, recognizes
a member who has consistently
demonstrated excellence in the
emergency nursing profession and
made significant contributions to ENA.
Keough serves as dean of Loyola
University Chicago’s Niehoff School of
Nursing. Before joining Loyola, she
served as an emergency department
clinical nurse specialist at Good
Samaritan Hospital in Downers Grove,
Ill., and as a staff nurse in the
Department of Emergency
Medical Services at Loyola
University Health System.
Through ENA she worked
with the late Frank Cole,
PhD, RN, FNP, FAAN, FAANP,
FAEN, and Elda Ramirez,
PhD, RN, FNP-BC, FAANP,
FAEN, to open the second
emergency nurse practitioner
program in the nation at Loyola. In
2007, she received the Frank L. Cole
NP Award, which she calls one of the
greatest honors of her life. She has
served on ENA’s Research Committee
and in 2012 and 2013 chaired the
Advanced Practice Nurses in
Emergency Care Committee, which
promoted the first Emergency Nurse
Practitioner Certification,
launched by ANCC in 2013.
Through Keough’s career,
she has presented and
published studies and received
numerous research grants and
honors. Beyond ENA, she is a
member of the American Nurses
Association, the Illinois Nurses
Association, the American
Association of Critical Care
Nurses and the Illinois ENA, which has
recognized her as a distinguished leader.
‘‘Judith Kelleher was a visionary
leader who gave voice to all
emergency nurses across the country,’’
Keough said. ‘‘I am humbled to receive
this award that honors the work of
Judith Kelleher.’’
Kendra Y. Mims
Vicki A. Keough, PhD, APRN-BC, ACNP, FAAN
September 201418
After only one year as an
emergency department nurse,
Justin Carpenter, RN, BA, HN-BC, was
already burnt out. One of the common
stressors he discovered while working
in the fast-paced environment was that
emergency nurses are pulled in a lot of
different directions, managing patients,
family members and physicians at the
same time.
‘‘We also have certain time
constraints, like getting our antibiotics
and CT scans in on time,’’ Carpenter
said. ‘‘We also have to deal with people
in the acute stage of illness. They’re just
getting sick or they are getting worse. If
it’s a new diagnosis, patients and
families haven’t had time to process
what’s going on, and their emotions are
really high, so it’s a very emotionally
charged environment all around,
especially if it’s a pediatric trauma.’’
Carpenter, a staff nurse at St. John
Hospital and Medical Center in Detroit,
felt nurses were trained to take care of
patients physically but not how to take
care of their minds, bodies and spirits
as a whole, which made him feel
disconnected from his patients. He
eventually reached out to an
integrative nurse in his hospital and
learned about self-care and how to
make connections with patients, which
renewed his passion for emergency
nursing and sparked a new interest in
holistic nursing.
‘‘It was able to help me bounce
back from burnout, because not only
was I connecting with patients but I
was also connecting with myself
without having a wall up,’’ he said.
‘‘We have a tendency in ER nursing to
build this wall around us to block us
off from the emotional issues around
us, but it also closes us off, which can
ROOM TO BREATHEMember Uses Holistics to Carve Out a Space For Nurses to De-StressBy Kendra Y. Mims, ENA Connection
‘‘The renewal room is an area where any staff can go and sit down and renew themselves if they’re feeling stressed out. It’s whatever you need to do to get you
back to being able to take care of people again.”
JUSTIN CARPENTER, RN, BA, HN-BC
Official Magazine of the Emergency Nurses Association 19
17 Interactive Modules15.21 Contact Hours
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Comprehensive Geriatric Online Course
GENE provides: § Best geriatric practices from triage
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Purchase Today! Group Pricing Available
www.ena.org/geneThe Emergency Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
GENE Ad_Connection_half vertical_0607 2014.indd 1 5/6/14 1:42 PM
lead to burnout. It really disconnects us from the patients.’’
Carpenter became committed to integrating holistic nursing
practices into his personal and professional life. After noticing
that St. John’s had several ‘‘renewal rooms’’ available for staff
throughout the hospital, he decided to implement the same
concept in the ED three years ago, giving emergency nurses a
place to recharge. He and his peers painted and transformed
an old storage closet in the ED into a renewal room with a
chair and a CD player with relaxing music. A sign-up board
allows only one person to occupy the room at a time.
Although staff were skeptical in the beginning, Carpenter says
everyone enjoys using the room now.
‘‘I had one nurse tell me that she doesn’t go home crying
anymore because she has a place to let go of the stress before
she goes home,’’ he said. ‘‘As nurses, if we are agitated or
rushed, it has an effect on the patient. The renewal room is an
area where any staff can go and sit down and renew
themselves if they’re feeling stressed out. It’s a place to go
back to and re-center yourself and let go of everything,
whether it’s through crying, journaling or sitting there in
silence. It’s whatever you need to do to get you back to being
able to take care of people again.’’
As a board-certified holistic nurse, Carpenter continues to
educate staff about holistic nursing, stressing the importance of
self-care. In 2012, he presented his poster ‘‘Creating a Healing
Environment in the Midst of Chaos’’ at the ENA Annual
Conference in San Diego. He also recently integrated
aromatherapy and guided imagery into his ED’s treatment
processes.
The American Holistic Nurses Association has recognized
Carpenter’s leadership in advancing holistic nursing and
recently awarded him the Charlotte McGuire Scholarship for
SELF-CARE MADE SIMPLEWhether it’s an overcrowded emergency department or dealing with an upset family member, sources of stress can lead to burnout. Here are some ways ENA member Justin Carpenter manages stress on a daily basis.
• BEDTIME FOR YOU: “Adequate rest is really huge. I make time to rest.”
• WORK IT OUT: “I like to exercise. I find it is very centering for me.”
• THE GREAT OUTDOORS: “Getting out into nature is definitely a big thing for me. I work in an inner city, so it’s important to get away sometimes.”
• INNER PEACE: “I try to do daily meditations so that I’m able to be more compassionate.”
Continued on next page
September 201420
Visit the IENR Research Lounge at ENA’s Annual ConferenceLet the experts guide you through the research process
§ Ask questions related to patient care
§ Present your ideas for valuable feedback
§ Get advice for future projects
Saturday, October 119:30 am – 3:30 pmIndiana Convention Center
Visit www.ena.org/ienr for details.
IENR Lounge Ad_Connection_Half_09 2014.indd 1 7/23/14 4:36 PM
2014 to assist him in pursuing his
master’s of science in nursing. Holistic
health care was a driving factor in
choosing to further his education
because it has helped him in his role
as an emergency nurse.
‘‘The most important thing and the
basic premise of holistic nursing is
self-care, which is an idea that is pretty
foreign to nurses,’’ Carpenter said. ‘‘It’s
the idea of taking care of yourself,
because if you’re putting yourself first,
then you’re also allowing yourself to
renew and be at your best for when
you are taking care of other people. If
you’re not taking care of yourself, then
you’re tired, burnt out and crabby, and
you’re not in position to take care of
others. You’re not compassionate.
You’re apathetic.
‘‘The first thing to do is take care of
yourself — really make time to rest
and do things that make you happy.
The concept is sometimes the hardest
for us to grasp.’’
Carpenter promotes the idea of
centering — just taking a deep breath
and letting go of everything around you.
It’s especially beneficial for Carpenter
when he’s making patient rounds.
‘‘In the ER, we have so much going
on around us, and sometimes it’s
difficult to focus in on the patient,’’ he
said. ‘‘Before I walk into a room, I’ll
stop, pause, take a deep breath and let
go of all those other demands I have.
When I go in to see the patient, I’ll sit
down and genuinely listen to what
they are saying. It’s a simple act, but
the patients really notice you are there
for them, and it shows you have the
time to talk to them. It builds a trusting
relationship with the patient. I find that
when I do that, it really makes the day
go easier.’’
Carpenter says holistic nursing
practice and philosophy have made a
huge difference in his career.
‘‘When you’re helping someone [in]
body, mind and spirit, it makes a
difference. Every encounter has an
emotional and mental aspect to it, so
we just can’t treat the physical part. It
leaves you feeling a lot more gratified at
the end of the day when you’re making
connections with people because that’s
why most of us got into nursing. We
want to help other people. That is why
self-care is so important.’’
Room to Breathe Continued from previous page
Justin Carpenter
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IMPROVED PRACTICE
September 201422
Suzanne O’Connor, RN, MSN, APN, was 26 and at the
beginning of her nursing career when she unexpectedly
became a patient and found herself on the other side of
emergency care. Years later, she has never forgotten the
lessons she learned as a patient.
Today, as a nationally known speaker and consultant,
O’Connor helps organizations improve their patient and staff
satisfaction by sharing how her experience helped her to
become a better emergency nurse. Here are five ways she
says emergency nurses can improve their patients’
experiences in the emergency department:
1. BELIEVE THE PATIENTO’Connor presented to the emergency
department on Christmas Eve with acute
abdominal pain, but her vital signs fell
within the normal range. She felt no one
believed the intensity of her symptoms.
‘‘I had never experienced such intense,
excruciating stomach pain,’’ she said. ‘‘My
white blood cell count was normal, so everyone thought I
had ovarian cysts. I thought no one believed me.’’
The senior physician was called in. He diagnosed
O’Connor with appendicitis, and she was admitted to the
hospital immediately. Her appendix ruptured before the
operation; she believes the delay in diagnosis contributed.
‘‘As I was lying there, I was finally relieved that someone
believed that I wasn’t faking the pain, and that made a big
impression on me as a nurse,’’ she said. ‘‘I realized that you
have to believe in the patient and believe that the symptoms
are what they say they are. Don’t automatically think they’re
just malingering because the numbers aren’t right. In my
case, the credibility of my symptoms wasn’t as valued as the
white blood cell count. I learned to give my patients the
benefit of doubt. If it’s pain to them, it’s pain. The numbers
could change over time.’’
2. MAKE THE PATIENT’S NEEDS A PRIORITYWhile O’Connor was being prepped for surgery, the
emergency nurse in the operating room denied her request to
speak to her parents, who were in the waiting area. It taught
her how a nurse’s lack of empathy during a crisis could affect
a patient:
‘‘When I asked to see my parents, the nurse emphatically
said, ‘No, I have to get you ready for the OR.’ I recall the
nurse being indifferent to my needs, but I was scared to
stand up to her. I felt so vulnerable at the time, and I would
have been happier if I had someone I was comfortable with.
She was so aggressive, cold and very task-oriented rather
than focused on connecting with me. It seemed like her
agenda was more important than mine as the patient, and I
wondered why she couldn’t get me ready for the OR while
my parents briefly visited. Both my parents and I were
nervous, so no one’s needs were getting met.’’
3. KEEP THE FAMILY INVOLVEDIn not being allowed to see her parents before her surgery,
O’Connor realized how families can make a difference in a
crisis, so throughout her nursing career she constantly made
an effort to keep patients’ families involved.
‘‘If my patient asked for their family, I felt it was important
to that patient, so I was going to do everything I could to say
The Other Side of the Stretcher5 Lessons From an Emergency Nurse Who Saw It Differently as a Patient
By Kendra Y. Mims, ENA Connection
Suzanne O’Connor
Official Magazine of the Emergency Nurses Association 23
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yes and accommodate their request,’’ she said.
O’Connor personally felt the importance of family
presence later in her career when she took her son to the ED
for a staph infection and saw a drastic change in him that the
oncoming nurse didn’t notice.
‘‘I asked the nurse to check his temperature, and she
listened. As the oncoming nurse, she didn’t see the before
and after like I did,’’ O’Connor said. ‘‘The perception of a
family member can enhance the nursing assessment since
families are focused only on their loved one and can notice
subtle changes. Because it is change of shift, nurses may not
see a difference, but believe in a parent or loved one’s
observations. The parent or loved one knows that there is a
difference. Believe them.’’
Family members can be your allies, O’Connor said.
‘‘They are the ones who can provide emotional support
while the nurse is doing different tasks, like hanging IVs,’’
she said. ‘‘They can help keep the patient safe because that’s
the only person they focus on. You might have four patients,
but they are only looking at one, and they notice things that
we might not notice, like a change in the color of the skin.’’
4. REASSESS FREQUENTLYBecause of her experience, O’Connor urges emergency
nurses not to focus solely on the numbers. Reassessing the
patient’s condition frequently can help to improve the
patient’s safety.
‘‘Sometimes you have to look at the patient,’’ she said.
‘‘Are they sweaty and turning red? Does their temperature
need re-checking? You need to look at everything, from the
patient’s face to their body language.’’
5. UPDATE THE PATIENT REGULARLY
‘‘In my career, I witnessed a lack of updating,’’ O’Connor
said. ‘‘I tried to be sensitive to those issues because I
personally experienced the other side of that, and it made me
a much more sensitive nurse who stepped into the patient’s
shoes instead of focusing on my own agenda.’’
She made it a priority to update her patients at least once
every hour and inform them of the next steps of their
treatment. That seemed to relieve anxiety.
‘‘Just a three-minute visit can help,’’ she said. ‘‘The wait is
perceived as so much longer when there’s nothing
happening and you’re just waiting and hoping someone
would come in. Usually the ED nurse knows more than the
patient knows regarding the next steps. When we walk by
our patient’s room, we can just stop and give them a quick
update. They’ll feel like someone paid attention. I would
suggest taking the extra 30 seconds to say, ‘This is what
we’re waiting for. We haven’t forgotten about you.’ ’’
T he ENA Geriatric Committee is
working diligently to contribute to
the growing list of informative topic
briefs available at www.ena.org.
‘‘We had set a priority early on in
the year that we were going to provide
subject-matter expertise on geriatric
concerns for our ENA members,’’ said
chairperson Anna May, MSN, RN-BC,
CEN, CPEN.
The committee’s main focus this
year is to develop a topic brief titled
‘‘Collaborative Care for the Older
Adult.’’
‘‘We recognized that there was an
opportunity for teaching, education
and information-sharing that we could
do with long-term care facilities,
nursing homes — that kind of patient
population — as they enter the
emergency department,’’ said May,
who is the nurse manager of
emergency services at Bellevue
Medical Center in Bellevue, Neb.
The topic brief will focus on how
emergency nurses can collaborate with
nursing home personnel in their
communities ‘‘to open that dialogue,
work a little closer with extended-care
facilities, recognizing that there are
many, many levels to which patients
are discharged from the emergency
room,’’ from independent living to
nursing home complete-care facilities,
May said.
There are many things emergency
nurses can do to tailor care to older
patients, including speaking a little
slower to ensure they can hear
discharge instructions, making sure
precautions are in place to prevent
slips and falls and taking into account
that busy, teaching hospital EDs —
with students and residents entering
patients’ rooms — can be
overwhelming for this population.
‘‘Introduce yourself, let them ask
questions and encourage them to ask
questions,’’ May suggested.
At the same time, it’s just as
important to realize that not all
geriatric patients are infirm and they
may not need as much reinforcement.
EDs see many older patients who are
‘‘very healthy, reaching the prime of
their lives and beyond, which is
wonderful,’’ May said.
Committee members met at ENA
headquarters in July to work on the
topic brief. They plan to submit the
finished product to the ENA Board of
Directors by the October board
meeting. If approved, the topic brief
could be available on the ENA website
before the end of the year.
May said the committee sees the
topic brief as a foundation for future
work, which could include a transfer
tool. She has particularly enjoyed
working with ENA members from
different geographic regions and with
varying backgrounds in geriatric
emergency care.
‘‘I’m from Nebraska, and we had
somebody from Florida, Arizona and
Pennsylvania, and it’s just fun — it’s
different perspectives,’’ she said.
‘‘Some of the members weren’t in the
ED anymore, so it was nice to see
nurses in case management who were
still ENA members bringing their
expertise to the table.’’
September 201424
Driving the Dialogue for Older Patients
THE ENA GERIATRIC COMMITTEE: Front row, from left: Linda Yee, MSN, RN, FAEN; Anna May, MSN, RN-BC, CEN, CPEN (chairperson). Middle row: Deborah Clark, MS, BSN, RN, CEN, CPEN; Briana Quinn, MPH, BSN, RN (staff liaison, Institute for Quality, Safety and Injury Prevention). Back row: Leslie Talbert (senior administrative assistant, IQSIP); Susan G. Thornton, RN; Joan Somes, PhD, MSN, RN-BC, CEN, CPEN, FAEN, NREMT-P (ENA Board of Directors liaison). Not pictured: Cynthia J. Brooks, BSN, RN, CEN.
By Amy Carpenter Aquino, ENA Connection
Official Magazine of the Emergency Nurses Association 25
As ENA delegates prepare to vote
on several new resolutions at the
2014 General Assembly on Oct. 8-9 in
Indianapolis, the Pediatric Committee
is continuing work on the 2011
resolution ‘‘Firearm Safety Education
for Children.’’
‘‘We were charged to find out what
is going on with education as far as
who does it, when they do it and how
they do it,’’ said committee member
Rose M. Johnson, RN, who took on the
research duties with Warren Daniel
Frankenberger, MSN, RN, CCNS. The
full committee met at ENA
headquarters in July.
The committee’s charges stem from
a position statement, ‘‘Firearm Safety
and Injury Prevention,’’ revised in
2013. The position statement includes
the following points:
1. Emergency nurses support and
promote the ENA Mission Statement to
advocate for patient safety and
excellence in emergency nursing
practice.
2. Emergency nurses serve as health
care consumer advocates, educating
the public about the risks of
improperly stored firearms and
supporting the creation and evaluation
of community and school-based
programs targeting the prevention of
firearm injuries.
3. Emergency nurses support the
establishment of a national database of
reportable firearm injuries in order to
make evidence-based decisions
regarding patient care, safety, and
prevention.
4. Emergency nurses recognize the
most effective way to keep children
from unintentional firearm injury is to
limit access.
The Pediatric Committee is
conducting a research review before
developing a topic brief and a toolkit
with the Institute for Quality, Safety
and Injury Prevention.
Johnson, the Emergency Medical
Services for Children program manager
for Louisiana, conducted about 10
hours of searches on the topic but
found there was no outcomes-based
firearm safety education for school-age
children.
An injury prevention provider from
the days of EN CARE, Johnson said
firearm safety has been a longtime
concern. Before become the EMSC
program manager, she worked for 15
years in an ED in rural Louisiana.
‘‘It’s such a huge topic and a huge
issue,’’ she said. ‘‘Politics aside, we’ve
got to educate because what’s being
done so far is not working. If we can
educate the kids and the parents,
because we need to include them, then
maybe we can make a difference. And
we have to keep the politics out of it.’’
At press time, Johnson and
Frankenberger planned to present their
findings to the entire committee in
August before planning next steps.
‘‘It’s going to be a long process, but
we’re making a start and that’s
important — just taking that first step,’’
Johnson said.
Firearm Safety: An Education EffortBy Amy Carpenter Aquino, ENA Connection
THE ENA PEDIATRIC COMMITTEE: Clockwise from top left: Warren Daniel Frankenberger, MSN, RN, CCNS; Rose M. Johnson, RN; Jerri Lynn Zinkan, MPH, BSN, RN, CPEN; Sally Snow, BSN, RN, CPEN, FAEN (board liaison); Marlene Bokholdt, MS, RN, CPEN, nursing education editor (staff liaison); Robin Goodman, MSN, RN, CPEN (chairperson). Not pictured: Mindi Lynne Johnson, MSN, RN.
September 201426
C ervical collars are routinely
used to immobilize and protect
a trauma patient’s neck and spine in
the field, but keeping a patient in
this type of collar for too long can
have negative effects, including skin
breakdown. The ENA Trauma
Committee researched the benefits of
early removal of hard neck collars
from trauma patients who arrive to the
ED and the emergency nurse’s role in
advocating this practice. Committee
members discussed results from their
research at their June meeting at ENA
headquarters.
The cervical collars placed in the
field, also called extrication collars, are
plastic, harder collars with minimal
padding, said Kimberly Anne Murphy,
MSN, RN, CEN, ACNP-BC, MICN, PHN.
‘‘They’re cheap, they’re not meant
for long term, and they’re sort of
one-size-fits-all,’’ she said.
The committee conducted a
literature search to find the best time to
switch the patient from the rigid,
pre-hospital collar to a long-term one
with more padding, said committee
member Pete Benolken, MSN, RN,
CEN, CPEN, EMT-B.
‘‘The literature basically tells us two
things: one, everybody’s doing it a little
different, and [two], that there’s some
very good research that says you need
to do the switch within 24 hours,’’
Benolken said. ‘‘However, that is still a
very long time. There is also some
research that says the skin breakdown
does start within six hours.”
Emergency medical services personnel
put patients in extrication collars if there’s
suspicion of a neck or spine injury.
‘‘There’s no CT scan available in an
ambulance,
no X-ray, so they
do what’s best for
the patient based
on the criteria that
they live by,
their protocols,’’
Benolken said.
Once the patient
arrives at the ED,
hospital providers
follow their facility’s
guidelines. Many
trauma centers have an algorithm to
follow, and most times, if the patient
meets the criteria, the hard collar can
be removed.
If the patient is unable to be cleared,
however, and the collar remains on in
the ED, that’s when the issues can
begin. Skin breakdown can occur within
a few hours from moisture buildup and
lying in a flat, immobile position.
‘‘The driving-home point for me in
this is to make the emergency nurse
aware that changing the collar
— sooner rather than later —
is very beneficial, and for
those of us who work in
urban, larger-receiving
hospitals, that those time
frames start the minute
that the hard collar’s put
on,’’ Benolken said.
Benolken’s Level II
trauma center in Minnesota often
receives patients from North Dakota
or other states who may have
started their emergency care
journey at a small hospital before
being transferred to another
facility and then to his ED.
‘‘Those hours are ticking away,’’
he said, ‘‘and by the time they get
to my door, four, six, eight hours,
sometimes more time, has gone by.’’
When Benolken went to the ENA
listserv to ask other members when
their facilities switch patients from
rigid, pre-hospital collars, some said
the switch is not made until the patient
arrives on the inpatient unit.
‘‘There is evidence to show that
skin breakdown and changes occur
within six hours,’’ Murphy said. ‘‘We
suspect that there are a lot of facilities
where the collars are staying on longer
than those six hours,’’ which is why
the committee is putting out the call to
be more vigilant about collar removal.
Skin breakdown can result in the
development of wounds such as
decubitus ulcers, Benolken said.
‘‘Say they’re intubated and sedated
and they have to go to the ICU. Well,
then, it’s a really easy choice,’’ he said.
‘‘You need to switch them sooner
rather than later to this longer-term,
more-padding, better collar to decrease
the skin breakdown issues. And that’s
Collars, With an Eye on the ClockBy Amy Carpenter Aquino, ENA Connection
Kimberly Anne Murphy
Pete Benolken
Official Magazine of the Emergency Nurses Association 27
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where the ER nurse can play a very
important role.’’
As patient advocates, emergency
nurses are in the best position to
promote the earlier removal.
‘‘If the patient’s stable, let’s do it in
the ED. We’re smart people. We can
figure it out,’’ Benolken said.
The Trauma Committee also has
been researching the issue of spinal
board removal, Murphy said.
‘‘There is a lot of evidence, which is
being drafted into education programs
already, that the backboard needs to
be removed as soon as possible,’’ she
said, adding that a similar pathology of
low blood pressure, moisture and
immobility is present with the patients
on backboards.
The committee also worked on a
translation-into-practice document
regarding tourniquets and met with the
team developing the online Course in
Advanced Trauma Nursing (CATN).
Murphy and Benolken said they
have appreciated the chance to serve
on the committee, one of ENA’s
newest. Murphy, who works in Los
Angeles County, which has 14 trauma
centers, joined to get a more global
perspective of trauma-care challenges.
‘‘Everybody else on the committee
has a very different perspective as far
as transferring into tertiary centers,’’
she said.
She hopes to impact other topics
that need to be translated into practice
or urged for more research.
An ENA member for eight years,
Benolken has been active at the local
level and felt the time was right to
begin participating on a national level,
especially after his colleagues
encouraged him to answer the call for
Trauma Committee applicants.
‘‘This is what I do — my title is
trauma resource nurse and injury
prevention coordinator, and I work
with the trauma doctors in our trauma
program,’’ he said. ‘‘I thought this was a
good way for me to give back to ENA
on a national level for the first time.
‘‘It’s been a wonderful experience. I
will, I hope, consistently apply for
other things now because I’ve had a
taste of the impact you can offer. ENA
has given to me, and I want to give
back to ENA.’’
ENA TRAUMA COMMITTEEPatricia Kunz Howard, PhD, RN, CEN, CPEN, NE-BC, FAEN, FAAN, chairperson
Pete Benolken, MSN, RN, CEN, CPEN, EMT-B
Stacey M. Hill, BSN, RN
Kimberly Anne Murphy, MSN, RN, CEN, ACNP-BC, MICN, PHN
Maria K. Tackett, EdD, MSN, RN, CEN, CCRN
Ellen Encapera, RN, CEN, board liaison
September 201428
F or more than a
decade, hospitals
across the nation have experienced significant
shortages of various drugs, including those
used for critical health conditions.1,3 This
epidemic has presented serious patient safety
implications in emergency department
settings. The shortage of generic injectables
has had the most impact, namely epinephrine 1:10,000
syringes, sodium bicarbonate, morphine sulfate,
hydromorphone, electrolyte solutions, antiemetics and
sedatives.1,3
In a 2010 national survey by the Institute for Safe
Medication Practices, more than 1,800 health care workers
reported medication errors, near misses and even patient
deaths related to drug shortages.2,3 For example, many
facilities are diluting the readily available 1:1000 ampules of
epinephrine with 0.9 percent normal saline to make 1:10,000
syringes for use in resuscitation.2,3 One respondent in the
ISMP survey reported that a patient died in a code after a
nurse drew up and administered 10 mL of a 1:1000
epinephrine concentration, thinking it had been diluted to
the alternative 1:10,000 concentration.2
Since there are a limited number of manufacturers who
produce generic drugs, the demand for
these lower-priced medications can lead
to delays in distribution across the board.
Quality-control issues such as
compromised sterility and factories cutting
corners to keep up with supply and
demand can cause an abrupt stop or delay
in production.1,3,5 Also, some
manufacturers have been known to discontinue production
of older generics without proper notice to develop first-line
drugs that are more profitable.1,5
Many resources are available for guidance in preventing
and mitigating drug shortages, but the FDA has, within its
scope of authority, primary responsibility for reducing the
impact of drug shortages. On July 9, 2012, the Food and
Drug Administration Safety and Innovation Act was signed
into law by President Obama. In compliance with FDASIA’s
Title X, the FDA established a task force on drug shortages
and submitted a strategic plan to Congress to enhance the
FDA’s response in preventing and mitigating drug shortages.5
The FDA now requires drug manufacturers to report
potential supply issues at least six months in advance. This
early-warning system has helped to decrease shortages by
more than 50 percent between 2011 and 2012.1,3,5 Even so,
When the ADC is BarePERSPECTIVES | Catherine Olson, MSN, RN, Director, Institute for Quality, Safety and Injury Prevention
Combating Drug Shortages in the Emergency Department
Helpful Resources
www.ashp.org/shortagewww.ismp.orgwww.fda.gov/Drugs/ drugsafety/DrugShortages
Official Magazine of the Emergency Nurses Association 29
Updated Teaching
Strategies June 2014
Fourth Edition
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the FDA’s influence is limited in that it
cannot require drug manufacturers to
produce or increase production of any
particular medication.1,5
Meanwhile, many other shortages
require close tracking and alternative
solutions. Health care facilities still
encounter last-minute notifications of
drug shortages by manufacturers, which
results in extensive staff time and effort
to internally develop a temporary fix.3
Emergency nurses have expressed
frustration and concern as they strive to
provide safe and efficient care — they
must become familiar with new
packaging, dosing, indications, side
effects and contraindications of
alternative medications, which, in the
end, means less time at the bedside.2,3
The impact on emergency medical
services is also cause for concern.
Challenges include limited flexibility
within multi-agency protocols, minimal
training on alternative drugs, no direct
access to pharmacy and difficulty
maintaining inventory.3
When clinical leaders, hospitals and
other agencies work to reduce the
impact of this crisis, the focus must be
on patient safety. The American Society
of Health-System Pharmacists’
Guidelines on Managing Drug Product
Shortages in Hospitals and Health
Systems, as well as ISMP resources, are
available to help tackle the internal
management of these shortages.1,4 Some
recommended solutions include:
• Extending drug expiration dates
• Use of alternative medications with
different dosing regimens
• Use of second- or third-line products
• Diverting critical medications to
specific patients by priority
Although there has been some
improvement in the number of shortages,
constant vigilance is still required. Also,
early notification by manufacturers,
awareness of resources, action plans that
include appropriate alternatives, as well
as excellent internal communication of
changes to staff, will aid in minimizing
error and adverse outcomes.
References
1. Fox, E. & Wheeler, M. (2013). Drug shortages in
the US: Causes and what the FDA is doing to
prevent new shortages. AccessMedicine from
McGraw-Hill. Retrieved from http://www.
medscape.com/viewarticle/780328
2. Institute for Safe Medication Practices. (2010).
Drug shortages: National survey reveals high level
of frustration, low level of safety. ISMP Medication
Safety Alert! newsletter. Retrieved from https://
www.ismp.org/newsletters/acutecare/
articles/20100923.asp
3. George Washington University, School of
Medicine & Health Sciences. (2014). Medication
shortages: Why they happen and what to do
[webinar]. Retrieved from http://smhs.gwu.edu/
urgentmatters/sites/urgentmatters/files/Drug%20
Shortages%20Webinar.pdf
4. Institute for Safe Medication Practices. (2010).
Weathering the storm: Managing the drug shortage
crisis. ISMP Medication Safety Alert! newsletter.
Retrieved from https://www.ismp.org/newsletters/
acutecare/articles/20101007.asp
5. Food and Drug Administration. (2013). Strategic
plan for preventing and mitigating drug shortages.
Retrieved from http://www.fda.gov/downloads/
Drugs/DrugSafety/DrugShortages/UCM372566.pdf
September 201430
Q: Why is it so important to update my ENA member profile? And when and how do I do that? – Melissa, Texas
A: It’s very important to keep your membership
profile updated for a number of reasons. Let’s start
with your e-mail address. Having a current primary
e-mail address on file not only ensures you’ll receive
critical member communication throughout the year,
but it’s the key to logging into the ENA website and
accessing the full range of your benefits. Just as
important is your physical mailing address. If your
primary address is not kept up to date, you likely
will miss your mailings of ENA Connection and the
Journal of Emergency Nursing, two essential member
benefits. In addition to these publications, ENA also
sends important member correspondence
periodically, including renewal information and
national announcements.
The other details of your profile (credentials, ED
roles, experience, chapter affiliations and the like)
are important not just because they help us to know
who you are, but because the various ENA
departments can use this information to tailor and
enrich your member experience through courses,
national and regional connections, professional
opportunities and more.
How do you update? The first and fastest way is
to log into the website via the link at the top of the main
page, then select “Update Your Profile” under the
Membership tab. (Note: This login is not to be confused with
myENA, which is a social platform separate from your
member profile.) You also can send your profile changes by
e-mail to [email protected] or give us a call at 800-900-
9659, Monday-Friday, 8:30 a.m.-5 p.m. Central time. We’ll be
happy to make the updates for you. Remember, if you are
having trouble logging into the ENA website, let us know
immediately so we can correct the issue.
When should you update? It’s recommended that you
check your profile about once a quarter. If there’s a big
change such as your e-mail, home address, a name change or
a new credential, try to update that right away. The more
current the information on file, the better we can serve you as
a member. Also, when you update regularly, you’re ensuring
that your ENA website login works, meaning no interruptions
as you access vital members-only areas of the website such as
your Personal Learning Page and eCourse Ops.
— Lindsay Paxton, ENA Member Services supervisor
Use ‘‘Ask ENA’’ to ask about the organization and emergency nursing in general. Questions will be referred to the appropriate ENA staff or department. Submission does not guarantee publication. E-mail questions to [email protected].
Do you have a recent professional or educational success story you want to share about yourself or an ENA member colleague? Have you won an award or earned a promotion? Has another member you know been recognized for outstanding work?
Tell us! Send an e-mail to [email protected] with the subject line “Members in Motion.” Be sure to include names, credentials and, if applicable, photos of the nurse(s) being recognized. ENA staff may follow up with you for additional details.
Official Magazine of the Emergency Nurses Association 31
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