ENA Connection April 2012

the Official Magazine of the Emergency Nurses Association

connection April 2012 Volume 36, Issue 4

The Younger Games We’re All Writing the Next Chapter in Our Quest for Improved Pediatric Care Pages 3-4, 8, 11-12, 16-17

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INSIDE

FEATURES

GAC Workshop: You Learn Something New Every Year The Importance of Having a SANE Nurse in Your ED Answering Haiti’s Call, Again and Again Call for 2012 Award Nominations

PAGE 6 PAGE 14 PAGE 16 PAGE 18

Dates to Remember April 30, 2012 Application deadline for openings on 2013 Annual Conference Committee, Resolutions Committee and International Delegate Review Committee.

April 30, 2012 Application deadline for the ENA Foundation International Exchange Program.

April 30, 2012 Application deadline for mentees in 2012-2013 AEN Eminence Program.

May 1, 2012 Submission deadline for 2012 ENA national awards nominations.

LETTER FROM THE PRESIDENT | Gail Lenehan, EdD, MSN, RN, FAEN, FAAN

The Role We Play For Children

It Takes a Village

May 10-June 8, 2012 Elections for ENA board of directors and Nominations Committee.

ENA Exclusive Content PAGE 11 Intranasal Medication: An Alternative to Quickly Treat Pediatric Pain PAGE 12 A Renewed Partnership to Ensure Emergency Department Readiness for All Children PAGE 14 The Importance of Having a SANE Nurse in Your Emergency Department PAGE 16 Epicenter of Pediatric Emergencies: Answering Haiti’s Call, Again and Again PAGE 20 Code You: Taking Steps to a Healthier You PAGE 21 Hospital’s Wellness Program Creates a Healthier Workforce PAGE 22 Academy of Emergency Nursing 2012 Board Announced

Monthly Features PAGE 3 Letter from the President PAGE 4 Sue’s Views: Letter from the Executive Director PAGE 6 Washington Watch PAGE 8 Pediatric Update PAGE 13 ENA on Facebook: What Are Emergency Nurses Saying?

PAGE 15 Board Writes PAGE 19 From the Future of Nursing Work Team PAGE 23 Member Benefits and Resources PAGE 24 Ready or Not? PAGE 26 Nominations Committee PAGE 27 ENA Foundation PAGE 28 State Connection PAGE 29 Click Here PAGE 30 Board Highlights

April is National Child Abuse Prevention month, and as emergency nurses, this is an excellent time to remember the important role that we play in the identification and prevention of child abuse. We are oftentimes the first people to recognize that a child is being abused. Our education, our skills and our insight put us in a unique position to save a child, not just from his or her injuries but from the abuse that caused those injuries.

We are the advocates for our patients; we are their voice when they often have no voice of their own. It was Hillary Clinton who reminded us of the African proverb, “It takes a village to raise a child.” As emergency nurses, we live that proverb every time an abused child arrives in our emergency department.

We are a vital part of that child’s village, and no one is better suited to start the process of healing for a victim of child abuse than an emergency nurse.

And emergency nurses also face the clinical challenges that pediatric patients bring. We know that they are not just little adults, and ENA recognizes that.

ENA’s widely respected Emergency Nursing Pediatric Course is designed to help you learn core-level pediatric knowledge and the psychomotor skills. It presents a systematic assessment model; integrates associated anatomy, physiology and pathophysiology; and identifies appropriate interventions.

Beyond educational products, ENA is working on

Official Magazine of the Emergency Nurses Association

critical policy issues that affect emergency pediatric patient care. For example, ENA is currently drawing national attention to the compelling need for all pediatric patients to be weighed in kilograms instead of pounds. Emergency nurses know that there is confusion when babies and children are weighed in pounds. In fact, our Pediatrics Committee looked into the issue and found a study in which 25 percent of medication dosage errors were associated with weight confusion between kilos and pounds. In order to protect our patients, and emergency nurses, from devastating medication errors, it was time for ENA to fulfill one it its primary roles, which is to be an advocate for its members and their practice.

That is why ENA will have a new position statement strongly urging, among other things, that pediatric patients should always be weighed in kilos, recording systems should only accept kilos, and that, for pediatric patients, scales should only record in kilos.

Continuing education, vigilance and a commitment to excellence can and do make a difference in the lives of our patients, whether it’s a newborn being weighed or a 3-year-old who has been abused.

Be proud of the role you play, in your hospital and in your community, and embrace the critical role you play in your village for the children who live there.

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SUE’S VIEWS: LETTER FROM THE EXECUTIVE DIRECTOR | Susan M. Hohenhaus, MA, RN, CEN, FAEN

Helping Our Members Provide the Best Care for Pediatric Patients As a child, I remember hearing the nursery rhyme words, “April showers bring May flowers,” and I never knew what they meant. I have my own theory about what it could mean in relation to our ENA Connection issue this month.

April brings a focus on children—those who “shower” us with the promise of better things to come in the future. Yet, in the health care world, especially in the emergency care setting, we continue to adapt adult devices, medications, equipment, projects, programs and policies to this vulnerable population that comprises a significant portion of all emergency department visits.

In reality, addressing the special needs of pediatric patients actually can make the care of adult patients safer. Think about weighing patients only in kilograms—a critical issue for pediatric patients, but also for adult patients who now have many of the same requirements for medication dosing.

I have said for years, “If you can ‘fix’ things at the level of complexity for kids, you can ‘fix’ them for anyone.” Whenever you are creating policies, procedures, programs and products, when you are discussing your patient population with vendors, administrators and others who impact your emergency care setting, remember to ask this question: “How is this complicated for pediatric patients?”

ENA has programs and products that can assist in your search for quality education and support to care for pediatric patients. We have our flagship

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© 2012 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.

Emergency Nursing Pediatric Course that provides resources for the special needs of children, from triage to trauma. ENA has an excellent pediatric core curriculum. And it’s not all “technical.” We always have played a leading role in work related to family-centered care, especially family presence during resuscitation.

There are promising changes on the horizon for pediatric patients and their families and their intersection with the emergency nursing specialty. ENA continues to work closely with our federal partners at the Emergency Medical Services for Children program, with the American Academy of Pediatrics, with the American College of Emergency Physician’s Committee on Pediatrics and others. We have begun exciting conversations with regulatory agencies, including the Joint Commission, on issues of critical importance related to safe and effective pediatric emergency care.

To quote another and favorite song of mine, “Bless the beasts and the children, for in this world they have no voice, they have no choice.”

That line is not entirely true … you are their voice. You can make the choice to improve the care and advocacy you provide to pediatric patients. You can let us know what matters most to you in caring for children in your clinical setting.

Your voice matters. And ENA is listening.

Be safe,

POSTMASTER: ­Send address changes to ENA Connection 915 Lee Street Des Plaines, IL 60016-6569 ISSN: 1534-2565 Fax: 847-460-4002 Web Site: www.ena.org E-mail: connection@ena.org

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40,000 Voices Strong ENA hit a membership milestone March 7 when the association reached 40,051 members, which represents a 25 percent membership increase since 2007.

Achieving and sustaining growth in these difficult economic times is a testament to the strength of the Emergency Nurses Association and the value it delivers to our members, said ENA Executive Director Susan M. Hohenhaus, MA, RN, CEN, FAEN. “As ENA continues to provide information and develop resources that help emergency nurses around the world achieve excellence in patient care, we also continue to combine the voices of our members to legislators, regulators and other key health care stakeholders,” said Hohenhaus. “Recent accomplishments, such as the recognition of emergency nursing as a specialty by the American Nurses Association and ENA’s strong leadership efforts to ensure a safe work environment for emergency nurses, point to the power of our 40,000-plus voices.”

Hohenhaus credited the grassroots recruiting efforts of ENA’s state council and chapter leaders and members.

“Our members are the lifeblood of ENA,” she said. “With their continued dedication and desire to grow our organization, we can achieve even more significant accomplishments while holding true to the vision of our co-founders, Anita Dorr and Judy Kelleher. When we stand together, who can stand against us?”

Chief Communications Strategist: M. Anthony Phipps Editor in Chief: Amy Carpenter Aquino Assistant Editor, Online Publications: Josh Gaby Writer: Kendra Y. Mims Editorial Assistant: Dana O’Donnell BOARD OF DIRECTORS Officers: President: Gail Lenehan, EdD, MSN, RN, FAEN, FAAN President-elect: JoAnn Lazarus, MSN, RN, CEN

Secretary/Treasurer: Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN Immediate Past President: AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN Directors: Kathleen E. Carlson, MSN, RN, CEN, FAEN Ellen H. (Ellie) Encapera, RN, CEN Mitch Jewett, RN, CEN, CPEN Marylou Killian, DNP, RN, FNP-BC, CEN Michael D. Moon, MSN, RN, CNS-CC, CEN, FAEN Matthew F. Powers, MS, BSN, RN, MICP, CEN Karen K. Wiley, MSN, RN, CEN Executive Director: Susan M. Hohenhaus, MA, RN, CEN, FAEN

April 2012

WASHINGTON WATCH |

Kathleen Ream, MBA, BA, Director, ENA Government Affairs

GAC Workshop:

You Learn Something New Every Year There is always something new to learn at the ENA Government Affairs Chairpersons Workshop, said Karen Wiley, MSN, RN, CEN, a 2012 GAC Workshop attendee and member of the ENA board of directors. Fifty-nine ENA members from 41 states attended the 2012 GAC Workshop, an intensive two-day training program that prepares attendees for working with their federal, state and local lawmakers.

Leveraging Efforts on Mental Health Policy Julie Clements, deputy director of Regulatory Affairs for the American Psychiatric Association, conducted a session on how people with behavioral health issues are victims of disparities and fragmentation in today’s health care system, making the emergency department one of the few community resources available for care. Her session provided an overview of the larger public policy context and how nurses might leverage their efforts with other community stakeholders. Clements’ presentation was timely, as many GAC attendees relayed stories of mental patients being stuck in the emergency department for days, and in some cases weeks, because of a decline in community resources for patients with mental illnesses.

This session and the subsequent briefing with GAC participants confirmed that the emergency department is on the front line in the continuum of community resources for mental health patients. As with many other patients, the emergency department is the last resort, and most emergency departments are not equipped to handle behavioral health patients for extended amounts of time.

The costs of untreated and undertreated mental health and substance-use disorders are overwhelming. The nation’s current economic situation has put a strain on public funding at state and federal levels, with most states reducing behavioral health care services spending by nearly $3.4 billion over the last three years. These losses are exacerbated in a context where MH/SUD spending grows more slowly than all other health spending.

For example, from 2002 to 2005, SUD grew slowest (5 percent), followed by MH (6.4 percent) and all health (7.3 percent).

With one in three

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From the Ohio ENA State Council: Nick Chmielewski, MSN, RN, NE-BC, CEN, Government Affairs Committee chairperson, and Marilyn Singleton, BSN, RN, president-elect.

adults currently experiencing a mental disorder and one in 10 children living with a serious mental or emotional disorder, states and communities cannot tolerate further cuts to inadequately funded public MH/SUD health care systems. Reductions resulting in the elimination of inpatient beds, crisis services and community supports are shortsighted fiscal policies that inevitably total more in overall spending as costs are shifted to services, such as diversion of law-enforcement personnel and correctional costs, homeless shelters and emergency care.

Highway Safety Laws at the State Level In her session, Jacqueline S. Gillan, president of Advocates for Highway and Auto Safety, a coalition of national consumer, health, medical and safety organizations and the major property and casualty insurance companies and trade associations, discussed highway safety laws. Her lobbying and grassroots organizing work have resulted in the successful enactment of numerous federal and state laws advancing motor vehicle safety, strengthening impaired driving laws, requiring safety belt and motorcycle helmet use, establishing teen driving programs and increasing traffic safety funding.

Gillan’s session empowered attendees to use ENA’s 2010 National Scorecard on State Roadway Laws and other tools to engage in collaborative efforts to encourage passage of research-based state highway and auto safety laws. With an emphasis on case studies, this session identified how emergency nurses can use their knowledge and personal experience in health care to advocate for victims and be the expert voice for commonsense traffic safety laws.

Nurses Are Important to the Advocacy Process Linda C. DeGutis, DrPH, MSN, director of the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention, reinforced how important it is for nurses to be involved in advocacy. As a former Hill staff member and emergency nurse, she discussed her experiences working for the late Sen. Paul Wellstone (D-MN). DeGutis recounted successful meetings with advocates as well as outlining what advocates should not

April 2012

GAC Workshop attendees Amy Anderson, BSN, RN (left), and Patricia Williams, MSN, RN, of the Alaska ENA State Council with Sen. Mark Begich (D-AK).

do when meeting with congressional staff. As frontline witnesses to what is happening in the health care system, nurses need to relate their experiences to members of Congress and their staffs to ensure that legislation improves the health care system for all patients.

Advocacy Lessons from Current Issues Ellen-Marie Whelan, PhD, NP, senior adviser at the Innovation Center at the Centers for Medicare and Medicaid and a former emergency nurse, spoke about how policy is established at the Center. Under the Patient Protection and Affordable Care Act, the charge of the Innovation Center is to identify, test, evaluate and scale up promising initiatives related to patient care.

Participants discussed issues in their emergency departments and how projects from the Innovation Center could help with what workshop attendees experience every day.

Networking Workshop participants were able to share their experiences and learn that many of the issues on which they were working were also prominent in other parts of the country. One such issue is the drug shortage being experienced by emergency departments across the nation. Participants recounted some of the procedures that have been put into place in their respective emergency departments to counteract the shortages.

A number of attendees also are working on violence legislation at the state level and were able to discuss what works with their legislators and what collaborations have been successful, as well as the pitfalls to avoid. One of the take-away messages for first-time attendee Adam Bruhn, RN, of the Nebraska ENA State Council was that his “voice can be heard.”

Left to right: Karen Wiley, MSN, RN, CEN, ENA board of directors, and Sen. Mike Johanns (R-NE), with GAC Workshop attendees Adam Bruhn, RN, CEN, of the Nebraska ENA State Council and Linda L. Olson, RN, BSN, of the Wisconsin ENA State Council.

GACW Lobby Day Following their training, participants spent a day on Capitol Hill visiting with lawmakers and their legislative staffs. According to Marilyn Singleton, BSN, RN, president-elect of the Ohio ENA State Council, the workshop left her well prepared for meetings with her congressional delegation and their staff.

The “asks” that the attendees took to their legislators focused on funding for the Emergency Medical Services for Children program and the Substance Abuse and Mental Health Services Administration, and endorsement of the Preserving Access to Life-Saving Medications Act (S. 296/H.R. 2245). ENA members visited more than 90 legislative offices; highlights included meetings with Sens. Mark Begich (D-AK) and Mike Johanns (R-NE).

Report prepared by Christine K. Murphy, ENA senior public policy specialist.

GAC Workshop attendees Kieran Mitchell, RN (left), and Terri Freidhoff, BSN, RN, of the North Carolina ENA State Council.

2012 GAC Workshop attendees prepare to hit Capitol Hill.

Official Magazine of the Emergency Nurses Association

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PEDIATRIC UPDATE |

Elizabeth Stone Griffin, BS, RN, CPEN

A New Chapter in Triage for Pediatric Emergency Patients January 2012 was an exciting month for triage nerds like me. A new version of the Emergency Severity Index handbook was quietly published and included, for the first time, a dedicated pediatrics chapter. The 5-Level ESI is the triage tool endorsed by ENA and the American College of Emergency Physicians for emergency department triage assessment and acuity assignment.

In February, I had an opportunity to talk with Debbie Travers, PhD, RN, an ENA member and one of five project team members who developed the original ESI for adult use in 1999. A few years later, due to high demand and funded by a grant from Emergency Medical Services for Children, Travers and other researchers evaluated the reliability and validity of the algorithm for pediatric use and eventually created the pediatric chapter. Travers shared the following thoughts regarding the use of ESI for pediatrics: 1) Pediatric patients are more frequently mistriaged than adult patients. Infants, rashes, psychiatric issues and fevers are some of the most difficult cases to triage for many nurses.

2) Pediatric case scenarios are included in chapters 6, 9 and 10 and are strongly recommended for triage training and review.

Case scenario-based teaching has been found to be more effective than traditional didactic methods because it mimics the clinical environment (Hohenhaus, 2008). An additional set of 25 validated case scenarios is available through HRSA (webcast.hrsa.gov/ archives/mchb/emsc/20100325/Pediatric_ Case_Studies_Peds_ESI.2010.3.18.pdf).

3) E xamples of common pediatric conditions for each ESI level are listed in table format within the pediatric chapter (chapter 6). ESI-1 and ESI-5 have been found to be often under-used in acuity assignment.

4) T here is a lack of standard normal vital sign criteria in pediatric emergency texts and courses, as well as a lack of a standardized approach to pediatric assessment and historytaking.

One thing that has always frustrated me, especially as a preceptor, was the lack of pediatric-specific triage resource material. While

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several emergency education courses and texts include content on pediatric emergencies or pediatric triage, a review of the literature by Hohenhaus, Travers and Mecham (2008) confirmed there is not one single course or textbook that provides a comprehensive, standardized approach for pediatric triage and acuity assignment in the emergency department.

While not meant to be a substitute for emergency education courses, the 2012 ESI handbook serves as a unique resource which offers an overview of a standardized approach to pediatric triage, assessment and acuity assignment in the emergency department. The handbook is published by the Agency for Healthcare Research and and is available free online (www.ahrq.gov/research/esi) and in print to individuals who work in emergency departments.

References Emergency Nurses Association. Standardized ED triage scale and acuity categorization: joint ENA/ACEP statement (2010). Accessed online February 10, 2012: www.ena.org/ SiteCollectionDocuments/Position%20 Statements/STANDARDIZEDEDTRIAGE SCALEANDACUITYCATEGORIZATION.pdf Gilboy, N., Tanabe T., Travers D., Rosenau A.M. Emergency Severity Index (ESI): A Triage Tool for Emergency Department Care,

Version 4. Implementation Handbook 2012 Edition. AHRQ Publication No. 12-0014.

Rockville, MD. Agency for Healthcare Research and Quality. November 2011.

Hohenhaus, S. (2008). Pediatric triage: A review of emergency education literature. Journal of Emergency Nursing, 34(4), 308-313.

Hohenhaus, S. (2006). Someone watching over me: Observations in pediatric triage. Journal of Emergency Nursing, 32(5), 398-403. doi:10.1016/j.jen.2006.07.002 Travers, D., Agans, R., Eitel, D., Mecham, N., Rosenau, A., Tanabe, P. & Waller,A. (2006).

Reliability evaluation of the Emergency Severity Index Version 4 [Abstract].

Academic Emergency Medicine, 13(5S), 126.

Travers, D. A., Waller, A. E., Katznelson, J., & Agans, R. (2009). Reliability and validity of the emergency severity index for pediatric triage. Academic Emergency Medicine, 16(9), 843-849. doi:10.1111/j.1553-2712.2009.00494.x

Contact the author I would like to answer your questions and share your stories. Please e-mail me at ELGriffin@WakeMed.org with questions, problems and any special stories or learning experiences you would like to share about taking care of children in the emergency department. I will weave them into the column whenever possible.

April 2012

‘Yes’ to the Nose

Intranasal Medication Offers Alternative to Quickly Treat Pediatric Pain

By Jason T. Nagle, RN, CEN, CPEN, CPN, FNE, EMT, Member, ENA Pediatric Committee

It’s a busy Monday evening in the emergency department and arriving via EMS is a 5-year-old boy who fell onto his outstretched arms while rollerblading in his driveway. As he is moved over to the emergency department stretcher, you notice his right forearm is obviously deformed, and he is clearly in severe pain. Is there something you can use to quickly treat his acute pain and anxiety that does not require sticking him with a needle?

In our never-ending quest to help reduce pain, pediatric emergency nurses are always looking ahead for new innovations while also looking into the past to investigate earlier ideas that may still be viable for current use. More medications are becoming increasingly childfriendly, and pediatric emergency nurses continue to look toward integrating them into everyday practice. While chewable tablets, orally disintegrating tablets and improved liquid medication taste are all great steps in helping children tolerate oral medications, parenteral medication delivery for acute pain and anxiolysis still usually involves the use of needles.

One option that has recently re-emerged in popularity as an alternative for initial pain management and anxiolysis, particularly in the pediatric emergency department setting, is the use of intranasal medications. While intranasal medication delivery has been around for many decades, its return to emergency nursing has come about with the growth of the commercial availability of low-cost atomizer devices. One excellent example of the simplicity and widespread use of intranasal medications is the widely available intranasal influenza vaccine.

A quick review of intranasal medication administration should include three key ideas: a) Atomizing the medication vastly increases the surface area that comes into contact with the medication; b) I t passes readily through the richly vascular nasal mucosa into systemic circulation, increasing immediate bioavailability; and c) This route also has the advantage of avoiding the first-pass effect of liver metabolism on the medication. The optimal absorption is based on using both the highest concentration of the medication available and administering a limited volume of that

medication (less than 1mL per nostril) for best absorption.

In the case of the 5-year-old boy with the forearm deformity, the use of intranasal analgesia is a great alternative for helping with his acute pain in the short term. This also reduces the pressure and urgency for starting intravenous access to administer initial analgesia. While intravenous access may be needed later in many cases like this one, using intranasal analgesia will also make obtaining intravenous access safer and more successful with a less anxious child. In addition, his parents will feel more at ease once his initial pain is treated.

The most popular uses of intranasal medication delivery in the pediatric emergency department are for analgesia, anxiolysis and seizure control. In addition to these three uses, there are many published articles involving both pediatric and adult patients that discuss the use of intranasal medications for hypoglycemia, opioid overdose, sedation, nausea, migraines, hypertension and several other conditions. The use of intranasal medications is also growing rapidly in the EMS community, with several states integrating their use into paramedic treatment protocols.

Official Magazine of the Emergency Nurses Association

In the pre-hospital and emergency department settings, the use of needle-free devices and ease of intranasal access reduce both needlestick injuries and the time it takes to administer the medication. In these urgent situations, administering a lifesaving medication via intranasal route also may improve patient outcomes. The use of intranasal naloxone for treatment of opioid overdose and intranasal midazolam for seizure control both have shown promise for decreasing administration time over intravenous routes while also decreasing opportunities for needlestick injuries in these high-risk situations.

There are some contraindications and circumstances where using the intranasal route isn’t an option. Examples include patients with facial trauma; nasal trauma; mucous, blood or foreign bodies in the nostrils; inhaled drug use; severe congestion; obvious craniofacial anomalies and inhalation burns.

Intranasal medication is not the answer for every patient or situation. It is a very reliable and easy-to-use alternative to intravenous and intramuscular medications in emergency departments, especially when immediate pain control is a priority.

As emergency nurses, it is important that we explore all options for delivering medications in the safest and least invasive way while doing our best to reduce pain and anxiety in both adult and pediatric patients. The use of intranasal medication delivery gives us another tool for providing medication administration and pain management. I encourage you to explore the option of adding this medication delivery method to your emergency department’s formulary. Through very simple training, obtaining atomizer devices and collaborating to update current medication administration policies, this method can help the emergency nurse provide better, more efficient care to some of our patients.

Jason T. Nagle is assistant nurse manager, Children’s Emergency Department, Vidant Medical Center in Greenville, N.C. Readers may contact him at jason.nagle@VidantHealth. com.

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A Renewed Partnership to Ensure ED Readiness for All Children

By Jaclynn Haymon, MPA, RN, Director of Communications and Planning at EMSC National Resource Center Each year, nearly 29 million children are treated in emergency departments across the country1.

Close to 90 percent of those children are treated in local general hospitals, not dedicated children’s hospitals. The purpose of the Emergency Medical Services for Children Program is to ensure that infants, children and adolescents receive appropriate care through the entire spectrum of emergency services, including prevention of illness and injury, acute care, and rehabilitation.

As longstanding partners, EMSC and ENA have recently committed to working together on two new exciting projects: the National Pediatric Readiness Project and the Interfacility Transfer Toolkit. (Read about the Interfacility Transfer Toolkit in the March 2012 issue of ENA Connection.)

National Pediatric Readiness Project Over the last two decades, several national organizations have issued consensus recommendations2 identifying resources for emergency departments to adequately care for ill and injured children. In 2002 and 2003, however, two national surveys3,4, highlighted discrepancies between these recommendations

and what emergency departments actually have on hand. Ten years later, the question remains, “Have hospitals made progress in closing this gap?”

To address this question, the Pediatric Readiness Survey was developed through a collaboration among ENA, the American Academy of Pediatrics, the American College of Emergency Physicians, the American Academy of Family Physicians and EMSC. This first step toward national pediatric readiness will give all of us a clearer picture of the current capacity of emergency departments across the country to provide effective emergency care for our children. More important, these organizations are committed to working together to establish an infrastructure that helps all hospital emergency departments engage in continuous quality improvement by providing education and resources.

This survey is ambitious. We are asking for the cooperation and participation of all organizations with an interest in pediatric emergency care. Therefore, emergency nurses, including members of ENA, will be pivotal to ensuring survey completion.

A few Pediatric Readiness Survey facts:

•T he survey is expected to be released in fall 2012.

• The goal is for every hospital (urban, rural, frontier or suburban) with an emergency department that receives children to complete the survey.

• The survey is anonymous. Your hospital information will not be released.

• Emergency department nurse leaders (nurse manager, coordinator, director) are requested to complete the survey.

• A multi-organization outreach campaign (including ENA, AAP, ACEP and others) is planned to raise awareness about this upcoming survey.

Elizabeth Griffin, BS, RN, CPEN, and Anne Renaker, RN, two ENA members participating in the project, said what excited them most about the project was the possibility of ‘‘a future where parents and families don’t have to worry about which facility to take their child during an emergency.”

Through the National Pediatric Readiness Survey and related activities planned over the next few years, we have an unprecedented opportunity to empower hospitals—regardless of their size or location—“to do what they want to do anyway, provide the best possible care for children seeking their help.”

Feedback Frame 1. S tatistical Brief 52. Healthcare Cost and Utilization Project. Pediatric Emergency Department Visits in Community Hospitals From Selected States, 2005. Agency for Healthcare Research and Quality, 2008.

Available at: www.hcup-us.ahrq.gov/ reports/statbriefs/sb52.jsp. Accessed January 23, 2012.

2. I nstitute of Medicine, Committee on Pediatric Emergency Medical Services. Institute of Medicine Report. Emergency Medical Services for Children. Durch J.S., Lohr K.N., eds.

Washington D.C: National Academies Press; 1993.

3. B urt, C.W., McCaig L.F. Staffing, Capacity, and Ambulance Diversion in Emergency Departments: United States, 2003-2004.

4. G ausche-Hill M., Schmitz C., Lewis R.J. Pediatric Preparedness of US Emergency Departments: A 2002 Survey. Pediatrics. 2007; 120:1229-1237.

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April 2012

ENA on Facebook.

What Are Emergency Nurses Saying?

On March 7, ENA asked, “What is the best way to thank an ED nurse? What was the best “thank you” you ever got from a patient or from your institution?”

Elizabeth Adkison The best gift I have ever gotten is a simple thank-you. I think sometimes institutions forget how much it means to just say those two simple words. After a long, exhausting day, sometimes that’s all I want—someone to thank me for my hard work!

Andrew J. Veitch I think the thank-yous I remember the most are those written in a letter/ card. I carry those with me forever to take out and read when I’ve had a hard day at work. I still keep a written letter from parents of a baby I took care of in CV ICU post-emergent cardiac surgery. Those words in that letter meant so much to me back then and still inspire me to continue making a difference today ... 15 years later.

On March 14, ENA posted a link to an article in the Seattle Times which explored the problems of psychiatric patient boarding.

Dena Sigman Oh, it gets better than this … boarding PEDIATRIC psych patients in the ER for days and sometimes WEEKS while we wait on the approximately 4-5 psych hospitals in NC to have bed space for them. How traumatic for this age group (usually anywhere from 8-14) to witness codes, traumas and the other usual things that occur on a daily basis in the ED.

Heather Clement We have very similar issues. Pediatric patients have trouble getting placed, and uninsured patients wait days—the longest was a week. We have an 18-bed ED, but one time we had 11 psych patients at once (that was a nightmare). They do not get the treatment that they need while sitting in the ED. We are looking to use telepsychiatric services within the next three months.

Sare Barr Gilbert I had a 9-year-old name his kitten after me. His mom told me when she returned a few days later. Made my night.

Official Magazine of the Emergency Nurses Association

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Staffing to Treat Sexual-Assault Patients

The Importance of Having a SANE Nurse in Your ED

By Kendra Y. Mims, ENA Connection The CDC’s 2010 National Intimate Partner and Sexual Violence Survey found that 1.3 million women were raped during the year preceding the survey and nearly 1 in 5 women have been raped in their lifetime, with an estimated 80 percent experiencing their first rape by age 25. Research shows that in comparison to men, women experience high rates of rape, stalking and severe IPV.1 A health care professional may be the first person the victim talks to about the assault.

Because of the patient’s traumatic experience, experts recommend that he or she is treated by a nurse who is trained properly in evidence collection, providing advocacy and treating trauma that can be linked to the sexual violence. Sexual-assault nurse examiners (SANEs) play an important role in treating sexual-abuse patients, as they are registered nurses who have specialized forensic training, education and clinical preparation in treating sexual-assault victims.2 Kim Day, RN, FNE, SANE-A, SANE-P, safe technical assistance coordinator at the

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International Association of Forensic Nurses, says there’s a need for hospitals to have SANEs in their emergency departments. ‘‘Sexual-assault patients who come into the emergency departments are a really specialized Kim Day, RN, FNE, group of patients,’’ Day SANE-A, SANE-P said. “They require really specific knowledge and skills that will be helpful in caring for them. For example, sexual-assault clients not only have the acute assault to deal with, but also the long-term ramifications and health impact that sexual violence can have on their lives, so it’s really important that trained examiners are able to care for them at the time of the visit. When a person is sexually assaulted, they have to make decisions they never had to make before.’’

The 2010 ENA Care of Sexual Assault Patients in the Emergency Department position statement highly recommends the employment of SANE nurses in the emergency department because they provide ‘‘expert crisis intervention, acute care and treatment, evidence collection, detailed documentation, sexually transmitted infection and pregnancy prophylaxis and appropriate referrals for follow-up care and counseling for sexual assault and rape victims.”3 Day believes providing best-practice care for sexual-assault victims begins with trained examiners who are specialized in providing the medical forensic exam and advocacy.

“It’s really distressing to me,” Day said, “to Continued on page 30

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April 2012

BOARD WRITES | Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN, Secretary/Treasurer

Mentors and Their Magical Effect As I sit to write this column, I can’t help but reflect on the week I spent at ENA Leadership Conference 2012 in February. It was a week of re-energizing, reflecting and refocusing. As always, it was great to see old friends, meet new ones and hear about how my colleagues all over the globe are celebrating their successes.

Of the many moments that were both illuminating and empowering, there was one which reminded me of how, through the power of one person, your future can change in an instant.

The moment happened during the closing session of the State Leaders Conference. A young man shared his journey from being interested in becoming an EMT to being an emergency nursing leader. He described how when he shared his dream with one person, she encouraged him to get his EMT certification. When he expressed his desire to go to nursing school, she showed him the scholarship opportunities the ENA Foundation has for EMS professionals becoming RNs and wrote him a recommendation letter.

He shared how this nurse mentored him throughout nursing school, preparing him for a job as a new graduate in the emergency department. He said his mentor continues to offer guidance and support, always sharing her passion for her profession.

This story reminded me of how I became involved in ENA and what I am passionate about. Although I joined ENA not long after graduation, I did not become involved until several years later. While in an emergency department on a travel nurse assignment, I met a nurse wearing an ENA pin on her badge. I approached her and mentioned her pin. She was more than happy to fill me in on the local ENA chapter and quickly invited me to its upcoming holiday party.

Eleven years later, here I am. I have had many incredible mentors over the years and would not be on the ENA board of directors without their support, encouragement and sometimes brutal honesty.

As a national ENA leader, it has become my passion to mentor others. I want each and every emergency nurse to have the tools, resources and education to be the best nurse he or she can be.

My passion in the emergency department is the care of children. I am excited about all of the great tools and resources ENA will launch this year. The Emergency Nursing Pediatric Course revision will be out in the summer. It contains the latest evidence-based practice related to the care of the pediatric patient in the emergency department. It also includes a new chapter, “Preparing for Pediatric Patients,” which includes evidence-based tools and resources to help you validate that your department has everything it needs to care for children.

We know there are many preventable medication errors made in the emergency department that are a direct result of how we weigh our children. Soon, members will have access to a position statement that identifies that we should weigh our patients in kilograms—always.

We have heard from our members that the interfacility transport of pediatric patients occurs frequently, and there is no guide or tool available to facilitate this process. We are working with our partners at the Emergency Medical Services for Children and the Society of Trauma Nurses to develop a toolkit for the interfacility transport of pediatric

Official Magazine of the Emergency Nurses Association

patients. (See the article on the toolkit’s progress in the March 2012 issue of ENA Connection.)

It was during State Leaders Conference that Hershaw Davis Jr., BSN, BS, RN, Maryland ENA State Council Government Affairs chairperson, reminded me how important it is to mentor others. His enthusiasm, confidence and passion were very moving. To watch another emergency nurse stand up and say it was because of one person and one organization that he had succeeded was an empowering statement. I encourage all of you to go find a Hershaw Davis Jr., and help that person recognize the power of the profession of emergency nursing. Mentor an emergency nurse or someone who wants to become an emergency nurse. Inspire someone to obtain the skills, education and tools he or she needs to be the best possible nurse.

I am fortunate to have the opportunity to attend the National Student Nurses Association annual conference in Pittsburgh this month. I will represent ENA as I share my passion with nursing students from all over the U.S., and I have the honor of sharing the stage with Hershaw Davis Jr. We will both share our passion for the profession of emergency nursing with the goal of inspiring our next generation of emergency nursing leaders.

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Epicenter of Pediatric Emergencies:

Answering Haiti’s Call, Again and Again

By Josh Gaby, ENA Connection Since the massive earthquake that reduced much of Haiti to rubble on Jan. 12, 2010, ENA member Brian Webster has visited five times.

He’ll make it six at the end of the summer. He’s seen and treated it all—so much of it affecting children.

During his last trip in September, his second with the relief group Project Medishare, “we saw lots of trauma, lots of sepsis. We even saw tetanus—something you would never see in the United States—lots of malaria, lots of yellow fever,” Webster, BSN, RN, CEN, CPEN, FAWM, rattles off.

Lots of trauma? Twenty months after the earthquake?

It’s the violence now, Webster says: muggings and politically motivated attacks. It’s cars routinely slamming into other cars and people— frequently kids—in a country without traffic laws.

Haiti is home to an improving but generally constant chaos best suited for an emergency nurse, a military man or a specialist in wilderness medicine, and Webster, 37, is all three. Back home in Williamsport, Pa., he’s the RN clinical supervisor for the Williamsport Regional Medical Center emergency department, part of the Susquehanna Health system. A Navy veteran (1992-95) and a former member of the Pennsylvania Army National Guard (1995-98), he was presented with an Alumni Humanitarian Citizenship Award from Pennsylvania College, his nursing alma mater, in December in recognition of his efforts in Haiti.

Webster admits his military days didn’t completely prepare him for the destruction and suffering he found when he first arrived, 28 days after the quake, with three other volunteer nurses from Williamsport, joining nurses and physicians from other hospitals in Haiti. “I’d been to a lot of third-world countries before, but when I got to Haiti, it was a very surreal experience,” he says.

He turned instinctively to his education from ENA—the Trauma Nursing Core Course and the Emergency Nursing Pediatric Course.

“It’s the foundation in Haiti and the foundation here in the States of the way I approach a situation,” says Webster, whose work has been concentrated mostly in Port-au-Prince, the Haitian capital, and the suburb Carrefour. Of the other nurses he has traveled with, “almost everyone had at least TNCC, most had ENPC. Myself and another nurse, we were CPEN, board-certified pediatric nurses, so we brought a lot to the table with regard to the care of children and adolescents

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Brian Webster, BSN, RN, CEN, CPEN, FAWM, poses with a group of children in Haiti, where disease and violence have been rampant and recovery painfully slow since a 7.0-magnitude earthquake caused widespread destruction (right) more than two years ago.

down there. We didn’t feel ill-equipped.”

The local facilities and infrastructure have been another story altogether.

Relief workers initially had to bring in all of their own medication, supplies and food, and they still handle much of that themselves. Haiti just graduated its first EMT class in Port-auPrince, Webster says: “That’s not even at the paramedic level—these are EMTs, basics, that were just trained.”

Project Medishare works out of the country’s only Level I trauma center, also in Port-au-Prince, with an emergency department, an operating room and two wells on the property. Elsewhere in Haiti, running water is usually nonexistent.

You purify it or you buy it—or you do without.

“On a health standard level, that’s kind of where they’re at,” Webster says. “A lot of our focus down there is preventative health care. So many of their ailments and diseases are because of unsanitary conditions. You could have a lot of ailments such as pica syndrome, because they

have worms or some type of parasitic infection, and it just keeps going and going and going.

They become iron-deficient, anemic, and that leads to other things. It could have all been prevented with good hand-washing and purified water. It just shows you how things can escalate down there and snowball.”

As Webster prepares to head down again, he’s committed to helping the Haitians help

April 2012

Webster treats a critically ill young girl in September 2010. He chronicles ongoing relief efforts in Haiti at his website, The Humanitarian Group (thehumanitariangroup.org).

themselves. Miami-Dade County (Fla.), through Project Medishare, has donated ambulances to Port-au-Prince. Webster is attempting to arrange a gift of defibrillators and believes he’s close to making it happen.

Meanwhile, the training of Haitian nurses and physicians by international volunteers continues. Webster encourages the next wave to sign on with a reputable non-government organization— Project Medishare, Partners in Health, Doctors Without Borders or the Red Cross. These groups stress risk management and positive experiences while preparing nurses realistically for what they’ll see.

“I think that if somebody has the desire and training to go, they can definitely be useful and make a huge impact at any facility or any aid organization that they work with down there,” Webster says.

“The appropriate training is clutch, not just in pediatric nursing but in wilderness nursing or working in remote areas. It just gets blended together when you’re there. You kind of have to do things differently. You do a lot of improvisation, making do with stuff that you have, trying to make things work.”

What a nurse brings back to the emergency department at home, he says, is “mostly on the level of critical thinking and being able to really prioritize an emergency. Of course, I knew how to do that pretty well before I went to Haiti, but when you’re in a country like that and you’re working in this ED and all of this bad stuff is coming to you, you have to really, really prioritize and make sure you’re taking care of the sickest first and those that can really use your help. On some levels, it almost reminded me of battlefield triaging— you’re taking care of the people that you can save. Those are the things that we’re faced with down there. You can only operate to the extent of your resources, and the extent of your equipment and your team.”

Webster returned from his first few trips with what he describes as “this overwhelming sense of guilt: ‘Oh, my gosh, we have so much here, and they have so little.’ You know when you’re leaving the country that these people are still going to be there and these kids are still going to be there.”

Now he has a reshaped mind-set.

“I’m grateful for the equipment, the resources, the education that I have here, and I want that for the Haitian people,” he says. “I feel bad that they don’t have these resources, so I’m going to try to find a way to provide these resources.

“It’s something that’s planted a fire in me. Once you see a child or a family in a devastating situation, you want to do all you can to help them.”

Official Magazine of the Emergency Nurses Association

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ENA Call for…

Nominations for the 2013 ENA Foundation Board of Trustees Application Deadline: June 1

Visit www.enafoundation.org for more information.

ENA Call for…

2012 Award Nominations Submission Deadline: May 1

Do you know someone who deserves an ENA national award? A friend or colleague who made a dramatic difference in your professional life? This is your opportunity to give the highest praise and recognition to the people you count on and admire, urges Awards Advisory Committee Chairperson Deborah Ann Taylor, BSN, RN, CEN, SANE. Honor outstanding members of the emergency nursing community by nominating them to join the prestigious group of ENA national award recipents. The deadline is 5 p.m. Central time, May 1. Visit the awards tab at www.ena.org/AboutENA for a list of awards, application and eligibility details. Direct your questions to Chris Siwik, Awards Committee staff liaison, at csiwik@ena.org or 847-460-4044.

For most awards, only an ENA member can submit a nomination, and the award nominee must be an ENA member. Information on submitting nominations, a 2012 application, the specific requirements for each award and tips on how to write letters of support and submit a nomination can be found at www.ena.org.

Nominations packets must be received no later than 5 p.m. Central time, Monday, May 1. The awards will be presented during the 2012 ENA Annual Conference in San Diego, September 11-15.

ENA Call for…

Committees

Submission Deadline: April 30 ENA is looking to fill openings on the 2013 Annual Conference, Resolutions and International Delegate Review committees.

ENA members are invited to submit their applications online. View the Calls and Opportunities area at www.ena.org for details of these calls.

Online applications are being accepted through 5 p.m. Central time, April 30.

The 2013 ENA Annual Conference will be held in Nashville, Tenn., at the Gaylord Opryland Convention Center, September 17–21.

We have enhanced our committee application to allow members to upload a photo to their online application. While this feature is not mandatory, we highly encourage your photo submission. Look for instructions on how to upload your photo when applying for your committee choice.

For questions, please contact Nancy Good at committees@ena.org or 800-900-9659, ext. 4095.

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April 2012

From the Future of Nursing Work Team

Nurses as Leaders in Collaborative Improvement Efforts

By Melinda Mercer Ray, MSN, RN The Robert Wood Johnson Foundation funded the Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health.1 Released in October 2010, it has become one of the most reviewed reports at www.iom.edu.

This article, part of a series to enhance awareness of the recommendations outlined in this critical report, deals with the need for expanded opportunities for nursing leadership in collaborative improvement efforts.

Recommendation 2: Expand opportunities for nurses to lead and diffuse collaborative improvement efforts. Private and public funders, health care organizations, nursing education programs and nursing associations should expand opportunities for nurses to lead and manage collaborative efforts with physicians and other members of the health care team to conduct research and to redesign and improve practice environments and health systems. These entities should also provide opportunities for nurses to diffuse successful practices.

The health care environment is rapidly changing to integrate new technology into patient care. Practitioners are concurrently focusing on the integration of evidence-based practice. These movements are rapidly changing the patient care environment and have an intense impact on emergency department care.

Emergency nurses are the “jacks of all trades.” They must balance the development of expertise in technological tools and information management systems while working to use cutting-edge, evidence-based interventions with their patients. All of this is done while collaborating and coordinating care across teams of health professionals that may be located in the community, the emergency department and/or the health care facility.

Emergency nurses must be leaders in the design, implementation and evaluation of the ongoing change in their patient care environment. They must take a leadership role in building professional partnerships with their professional colleagues to ensure that the patient receives optimal care. Emergency nurses must develop leadership skills and competencies that assist them with the demanding professional environment that exists in the changing emergency department. They

must step forward and work in collegial teams to enhance the quality of the services provided.

ENA has long recognized the pivotal role the registered nurse plays in the successful coordination of care in the emergency department. The association has developed many tools and opportunities to help the individual emergency nurse grow in his or her leadership role. Two great examples of this work, the ED Benchmark Collaborative™ 2 and the development of a consensus statement3 that

defines standardized emergency department metrics, will help nurses work in collaboration with other health care professionals to research strategies to reduce emergency department crowding and boarding.

Research has demonstrated that a leadership style that involves working with others as full partners in a context of mutual respect and collaboration can result in direct patient care improvements. Specifically, the IOM report describes improved patient outcomes, reduced Continued on page 29

ENA LEADERSHIP CONFERENCE 2013 F O R T L A U D E R DA L E , F L

FEBRUARY 27 – MARCH 3

Call For

Poster abstracts Research and evidencebased Practice Projects Don’t miss this opportunity to showcase your work on emergency department management, leadership and research

SubmiSSion DeaDline  auguSt 1, 2012 LC13_CallForPosterAbstracts_ConHPIsland.indd 1

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CODE YOU

CODE YOU

Taking Steps to a Healthier You

By Kendra Y. Mims, ENA Connection

Obesity in the United States has become an epidemic, with statistics reporting that more than one-third of U.S. adults (more than 72 million people) are obese; obesity rates for all population groups have increased significantly over the last several decades.1 Research shows that health care professionals are not exempt from obesity population groups, as long working hours, inadequate sleep and limited access to healthy foods during their shifts are contributing factors to weight gain.

CODE YOU

CODE

YOU

CODE YOU

FACT: Adult obesity rates were more than 15% in nearly all but three of the 190 U.S. metropolitan areas that Gallup and Healthways surveyed in 2011. Because of high obesity rates, the estimated additional health care costs increase to $80 billion across all 190 metro areas.2

A 2008 study in the Journal of American Academy of Nurse Practitioners reported that more than 50 percent of the nurses surveyed were overweight or obese, and 53 percent reported that although they are overweight, they lack the motivation to make lifestyle changes.

Although 93 percent admitted that overweight and obesity are diagnoses that require intervention, 76 percent did not pursue the topic with patients who struggle with obesity.3 Obesity not only increases the risks of heart disease, high blood pressure, type 2 diabetes, cancers, liver disease and other health conditions, it can also increase the risk of workplace injuries, as research shows nurses who are overweight and obese have a greater chance of becoming injured in the workplace.

Jeanne Fogarty, MBA, BSN, RN, TNS, a nurse manager in St. Louis, Mo., and a member of the ENA Emergency Department Workplace Injury Prevention Work Team, said an employee who has a body-mass index greater than 40 will have twice as many claims of injury, which will result in a significant increase in days off from work and medical costs.

“Our research has shown that nurses who are overweight tend to be out of shape and they have weaker back and leg muscles,” said Fogarty, who spoke on the ENA Toolkit for Injury Prevention panel at ENA Leadership Conference 2012. “As a result, they end up having an increased number of injuries. They are not able to handle the patients as well as a nurse who is more physically fit.”

Though time is tight and your schedule is packed, here are some alternative methods you can use at work to help prevent and fight obesity.

Scenario: After working for six hours, you have a break and hear that there is pizza and

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cake in the staff lounge. This gives you just enough time to grab a slice in between patients and get back to work.

Alternative: Ditch the potluck and takeout and stock up your staff lounge with healthy, convenient options such as fruit, nuts and baby carrots. Create your own stash of healthy treats.

Fogarty says it’s not uncommon for staff lounges to be filled with unhealthy snacks items and for fast food to be brought into the workplace because nurses can’t get to lunch all of the time.

“They can graze the entire shift because they know they can’t sit down and have an actual meal,” Fogarty said, “and the snacks that they bring in aren’t always the healthiest. If I go into my staff lounge at night, I’m not finding fruit and cheese. I’m finding chips and dip and pizza. It’s the grab-and-go food, which always tends to be a higher calorie.”

When it comes to making healthy choices and living a healthy lifestyle on a consistent basis, Fogarty says nurses are no different than the rest of society.

“We know better. Everybody knows better.

But we don’t always practice what we preach,” she said.

Off-shift nurses face a particular challenge.

“Nurses who work off shifts will tend to be heavier because they’re working such bizarre hours,” Fogarty said, “and it’s not uncommon

Fit Together The American Nurses Association will have its 2012 Healthy Nurse Conference, “Nurses as Models of Wellness in Action,” on June 14 in Washington, D.C. This one-day health and wellness program will teach nurses how to decrease stress, stay fit and incorporate healthy habits into their home and work environment. For more information, visit https://hnc2012.cistems.net/Public/ registration_home.php.

for them to work all shift without eating, and then, after working nights, they’ll have a big meal at the end of their shift and go to bed instead of exercising.”

Suggestions for night shift nurses include keeping an insulated lunch box stocked with healthy food, eating small, frequent meals throughout the night to maintain blood sugar and avoiding heavy carbohydrates during your shift.4 Other tips that you can use for any shift are as follows: • Prepare your meals and snacks in advance for the week so that you have healthy options on the go.

• Bring your own snacks and meals to work.

• Monitor how much you eat.

April 2012

• Reduce your coffee intake (which can throw off your sleep schedule) and substitute green tea.

• Avoid the vending machine.

TIP: It is recommended that you stay hydrated throughout your shift with water by drinking half of your body weight in ounces per day and at least half of this amount during an eight-hour shift.4 Tired of water? Add a lemon for flavor.

Scenario: It’s time for a break, so you use the elevator to go to the cafeteria to eat a quick lunch. After your meal, you still have a few moments left of free time, and you notice your favorite show is on television.

Alternative: Because time is tight, taking advantage of any opportunity to exercise is important to combat obesity, as being physically active is proven to be essential to maintaining a healthy weight. Use the stairs in the hospital

FIT NURSE

Gary Scholar, M.D. Empowering nurses to practice what they preach by taking control of their own nutrition, fitness and sleep.

Available at the ENA Marketplace, www.ena.org/ store.

instead of the elevator or take a walk with a colleague on your break. Gary Scholar, author of Fit Nurse, says some nurses may enjoy more meditative exercises that are easier on the joints (such as yoga or tai chi) because they spend a lot of time on their feet.5 Scrubs magazine also suggests that nurses squeeze the following exercises into their workday6:

• Toe rises while you’re standing and charting. (Rise up onto your toes and then lower. Squeeze your glutes together as you rise.)

• Tighten your glutes and release if you’re sitting to chart. You can also practice pulling your lower pelvic and abdominal muscles in and up, and your rib cage in and down.

• Leg lifts while sitting at the nurse’s station.

Flex your foot and lift, and then lower (using ankle weights will add more resistance).

• Stand tall and do leg lifts by a wall whenever you have a few moments of waiting. Lift your leg sideways with your foot flexed, 10 times, then to the front 10 times, then extend behind you 10 times. Do not bend your knees and keep your foot flexed.

• While in a patient’s room (e.g., while Continued on page 31

Hospital’s Wellness Program Creates a Healthier Workforce

By Kendra Y. Mims, ENA Connection Every new employee at Children’s Healthcare of Atlanta receives a pedometer, wellness information, access to an online health and wellness portal—where individuals can track nutrition, exercise and measurements—and use of the health library, all for free.

The perks of this health initiative don’t stop there. Free onsite fitness classes are offered on all of the campuses, as well as consultations with trainers and registered dieticians. There is also an annual health screening in which biometric testing and a health-risk appraisal are offered. Employees also receive nutrition education through healthy cooking demonstrations.

The Strong4Life program that launched at Children’s in 2008 was designed to create a healthier work environment for employees.

“We realized that by serving the community with their health needs, we really need to serve as a positive role model,” said Holly Iftner, the manager of wellness and worklife at Children’s.

“And in order for us to serve as role models within the community, we really need to focus on the health of our employees and their wellness effort.”

Since Strong4Life’s initial launch, Iftner said it has seen great engagement from employees, along with changes in the annual screening results, which include dramatic drops between 2008 and 2011 in the baseline numbers for cholesterol, BMI, blood-pressure levels and waist measurements.

When it comes to supporting each other,

Iftner pointed out that the buddy coverage method is part of the support system. A nurse can take an onsite fitness class or go for a walk and have coverage until he or she returns to do the same for his or her buddy.

“The organization has to make a commitment to change the environment,” Iftner said. “Having the organization’s senior leadership buy in is critical in order to make some of those environmental changes.”

To help nurses cope with daily stresses, Children’s has respite rooms available for relaxation and space to de-stress or meditate.

“Nursing is a stressful position with very long hours,” she said. “A lot of times if you’re trying to lose weight, you can get into emotional eating. Focusing on reducing the amount of stress that you can control is key, and the environment has to be conducive to that.”

Even if your hospital doesn’t offer similar perks, there are steps you can take to incorporate health and wellness into your work environment.

“Give yourself permission to focus on your own health,” Iftner said. “I think particularly in nursing, you’re such a caregiver and you’re so focused on the health and wellness of everybody that you serve in the community that it’s easy to lose that health focus for yourself and make it a priority. Focus on being intentional with your own health and wellness by setting some goals and reaching those goals with the support of other nurses in the unit.”

Official Magazine of the Emergency Nurses Association

Healthy Shopping List Ideas •R aw vegetables (celery sticks, carrots, bell peppers) with hummus • Walnuts and almonds • Fruit • Olives •N onfat yogurt topped with fresh fruit •W hole-wheat tortilla wrap (with deli meat or vegetables) • Low-sodium soup • High protein nutrition bar • 2 tomato slices with mozzarella • Part-skim string cheese • Edamame • Oatmeal •T rail mix (unsalted sunflower seeds, raisins, dried fruit) •T una salad with whole wheat crackers • 1 or 2 deviled eggs • Unbuttered popcorn • L ow-fat peanut butter and banana sandwich on whole wheat bread

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Academy of Emergency Nursing 2012 Board Announced The Academy of Emergency Nursing honors nurses who have made specific, enduring, substantial and sustained contributions to the field of emergency nursing; who advance the profession of emergency nursing, including the health care system in which emergency nursing is delivered; and who provide visionary leadership to the Emergency Nurses Association.

The body of work created by academy members goes well beyond being an outstanding nurse and a devoted ENA member.

The Academy of Emergency Nursing is pleased to announce the 2012 Academy board of directors; these directors assumed office January 1.

2012 Chairperson Vicki Sweet, MSN, RN, CEN, CCRN, FAEN Manager, Emergency Services and PreHospital Care, St. Jude Medical Center, Fullerton, California.

Member of the California ENA State Council and the Orange Coast Chapter.

2012 Chairpersonelect Kathleen Flarity, PhD, ARNP, CEN, CFRN, FAEN Commander, 34th Aeromedical Evacuation Squadron, Peterson Air Force Base, Colorado, emergency clinical nurse specialist, Memorial Health System, Colorado Springs, Colorado. Member of the Colorado ENA State Council.

2012 Member-at-Large Maureen Curtis Cooper, BSN, RN, CEN, CPEN, FAEN Pediatric emergency department staff nurse, Boston Medical Center.

Past president of the Massachusetts ENA State Council, member of the ENA Beacon Chapter.

2012-2013 Member-at-Large Edythe McGoff, MSN, RN, CEN, FAEN Emergency nurse and a military nurse officer.

Member of the Virginia ENA State Council and the Lord Fairfax Roadrunners Chapter.

2012-2013 Member-at-Large Andrea Novak, PhD, RN-BC, FAEN Adjunct faculty at the Schools of Nursing for Duke University and the University of North Carolina Chapel Hill.

Member of the North Carolina ENA State Council and the ENA Dogwood Chapter.

Applications Available for Academy of Emergency Nursing EMINENCE Mentoring Program The AEN EMINENCE Mentoring Program matches experienced Academy fellows with ENA members who are looking for professional growth opportunities. Mentees should plan to commit five to 10 hours per month to their project.

Mentees must apply for the program with a specific project in mind. Typical projects include, but are not limited to, the following areas:

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• Advanced practice role development • Educational conference planning • Grant writing • Health policy • Injury prevention (SBIRT procedure) • Professional presentations • Program development • Research • Writing for publication The program is not intended for new

manager development or projects to meet academic requirements, nor is it intended to assist in the application process for acceptance into the Academy.

Applications for the mentoring program are available at www.ena.org in the Academy section. The deadline to submit applications is April 30. Questions? E-mail academy@ena.org or visit www.ena.org/about/academy/ EMINENCE/Pages/Default.

April 2012

Spotlight on

Member Benefits and Resources

ENA Position Statements—New Content Available

Mosby’s Nursing Consult: ENA Edition

ENA Mosby’s Nursing Skills: ENA Edition

ENA develops position statements on key topics affecting emergency nursing practice and health care trends. ENA has just added the position statement titled Social Networking. Three position statements were revised including: Advanced Practice in Emergency Nursing, All Hazards, and Nurse Practitioners and Retail Health Care Clinics. Visit www.ena.org/IQSIP to view all the position statements.

Mosby’s Nursing Consult offers users practice guidelines, FDA drug updates, evidence-based nursing monographs, skills demonstrations and competency testing information. To learn more, visit www.ena.org (login as a member).

Mosby’s Nursing Skills provides you with 20 new emergency skills each quarter including, competency, testing information, skills demonstrations/step-by-step instructions and checklists. To learn more, visit www.ena.org. (log in as a member).

Three Additional Emergency Nursing Resources ENA develops Emergency Nursing Resources to bridge the gap between research and everyday emergency nursing practice. Three new ENRs have just been added: Difficult IV Access, Non-invasive Temperature Measurement and Wound Preparation. To access these new resources visit www.ena.org/ienr.

Marketplace

Special Offer for the Month

Emergency Nursing: Scope and Standards of Practice

I’m Here: Compassionate Communication in Patient Care

The American Nurses Association has recognized emergency nursing as a specialty and approved the scope and standards of practice laid out within the book. The 2011 Emergency Nursing Scope and Standards of Practice is updated to reflect current standards and best practice for use in developing training and departmental policies and procedures. Visit www.ena.org/shop to order your copy today.

Marcus Engel

Modern medical technology helps patients recover faster than any other time in history.

However, the human interaction between patient and care giver is still the essential foundation of healing. I’m Here is a personal narrative from the patient’s perspective. Filled with practical advice, packed with humor and overflowing with appreciation, Marcus Engel encourages health care professionals to practice compassionate communication in all its forms.

ENA Member Savings Opportunities

ER-IMHERE

ENA members qualify for discounts on items such as insurance, travel, wireless products and services, car rentals, identity theft protection and prescriptions. To view all available discounts, visit www.ena.org, click on the Membership tab and then Member Benefits. Be sure to log in to see the details.

ENA Career Center: Your Path to Lifelong Career Success

Price: $15 ENA Member Price: $13.50 Weight: 8 oz.

Free Shipping! Call 800-900-9659 Monday–Friday (9 a.m.–5 p.m. CT)

Job seekers may post a resume, search for jobs and be notified of new listings while employers post openings and review a deep pool of qualified talent. Visit the new ENA Career Center at http://enacareercenter.ena.org/.

Marketplace_April_2012.indd 1

Official Magazine of the Emergency Nurses Association

3/13/12 12:39 PM

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READY OR NOT? |

Knox Andress, BA, RN, AD, FAEN

Cyber Threats in the Emergency Department, Part II

Information Management: A Preparedness Priority In a 2011 survey, emergency nurses responded that information management was perceived to be the No. 2 preparedness priority capability for the nation (Andress, K., Journal of Emergency Nursing, Jan. 2012).

Information management, sometimes referred to as information technology, can be defined as “the collection and management of information from one or more sources and the distribution of that information to one or more audiences. This sometimes involves those who have a stake in, or a right to that information. Management means the organization of and control over the structure, processing and delivery of information.” This includes hardware, software, data and connecting internal and external networks.

The Emergency Department Connection Your emergency department may be dependent on information management technologies or cyber resources via data, hardware and networks. Examples might include desktop computers; electronic health or medical records; portable medical devices that communicate with a network, such as telemetry; networked supply and pharmacy dispensers; digital radiology

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results; door security; and even the computer control system for the heating, ventilation and air conditioning or other mechanical systems in the emergency department.

Recent Cybersecurity Hospital-Related Reports Recent IM threat reports have included incidents involving malware, infrastructure failure and data loss or theft.

• The emergency department at Gwinnett Health System in Lawrenceville and Duluth,

Ga., was placed on diversion for approximately two days after the hospital computer network was infected with a virus affecting systemwide connectivity (www.wsbtv.com/news/news/local/ hospital-diverting-trauma-cases-duecomputer-probl/nFyYY/).

•T he Mount Nittany Medical Center and Mount Nittany Physician Group reportedly experienced a disruption in its computer network, telephone and voicemail technology after a “technology infrastructure failure” (www. centredaily.com/2012/02/23/ 3100720/computer-systems-down -at-mount.html).

•F ierce Health IT reported hospitals “jumping into” cyber insurance to hedge their bets over concerns from data breach incidents. “The reasoning for this purchase is typically a function of concern over the financial exposures that result from data breach incidents, combined with the growth in data breaches (32 percent annual growth rate) being experienced by health care organizations” (www2.idexpertscorp. com/blog/single/hospitals-jumpinginto-cyber-insurance-to-hedgerisks/).

• At the seventh annual “Cyber Watch”

April 2012

Mid-Atlantic Collegiate Cyber Defense Competition, at Johns Hopkins University, the scenario focused on the defense of a hospital IT system.

USAF Chief Information Officer This month’s column features input from Lt. Gen. William Lord, U.S. Air Force chief of warfighting integration and chief information officer at the Pentagon. He integrates Air Force warfighting and mission support by networking space, air and terrestrial assets, including Air Force hospitals, clinics and their infrastructure, among many others. Previously, Lord was the commander of the Air Force Cyberspace Command (Provisional) or “Cyber Command” at Barksdale Air Force Base, Bossier City, La. In 2008, Lord was a guest speaker at a community infrastructure protection conference in Louisiana and referenced a national-level exercise that simulated a potential threat to our electrical power grid and the infrastructures that depend upon it, including hospitals.

electrical generating control systems is sobering,” Lord said.

The generator’s computer control system will be the initial target while secondary targets become the critical infrastructures and populations dependent on that generator’s power. Communities, including their hospitals and other critical infrastructures, could be vulnerable to potential power losses in this type of cyber attack.

“Simply put, vulnerabilities may potentially exist in the networks (internal and external), the devices or hardware and in the data or information itself,” said Lord.

Data-sharing system networks may be infiltrated or insecure; devices and hardware may not meet the current standard, while data and information may be corrupted with

malware code. The U.S. DHS is working to improve the nation’s cybersecurity on multiple fronts.

DHS Cyber Resources The U.S. DHS cybersecurity website offers many resources and considerations for emergency nurses, personal and business use along with events, technical publications and incident reporting links (www.dhs.gov/files/ cybersecurity.shtm).

Another cyber situational awareness resource is the DHS Daily Infrastructure Report, which includes incidents involving the critical infrastructures as defined in the National Infrastructure Protection Plan (www.dhs.gov/ files/programs/editorial_0542.shtm).

An Idaho Power Outage “Many mechanical or industrial systems are controlled by computer systems that monitor or control infrastructure functions and are potentially vulnerable to hacking,” Lord said in a recent phone interview with “Ready or Not.” In 2008, at a Department of Energy laboratory located in Idaho, the DOE and Department of Homeland Security tested a surplus 2-megawatt electrical generator by making it the target of a simulated cyber attack. The generator’s control system was hacked and fed computer code that affected its regulation and operation. The code injected by the simulated hacking caused the generator to start knocking and belching smoke and the machine was eventually destroyed, eliminating electricity production. (Video/audio of this test is available at www.youtube.com/ watch?v=fJyWngDco3g.)

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“While this exercise was controlled and on a smaller scale, the implications of potential effects and repercussions in a larger or coordinated cyber attack on the nation’s

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Take the Course Today To verify why TNCC is right for you and to view course schedules, visit www.ena.org/coursesandeducation.

Readers may contact the author at wandr1@lsuhsc.edu.

Follow Knox Andress @ENAdman.

The Emergency Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

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NOMINATIONS COMMITTEE | Cathy C. Fox, RN, CEN, CPEN, Region IV

Know the ENA Candidates So You Can Get the Vote Out In just a few short weeks, you will have the privilege of voting in the ENA national election and selecting your ENA board of directors and Nominations Committee for 2013. Access www. ena.org to learn about and support the candidates before making this important decision by doing the following: • View each candidate’s biographical information by clicking on the “Meet the Candidates” link.

• View ENA’s revised Policy 3.12, National Candidate Campaigning and Publicity.

• View the Candidates Election Forum video from New Orleans.

• Provide your support and/or interact with the candidates via ENA’s Facebook page by posting questions to a candidate(s).

Over the last 10 years, ENA has consistently seen our voter percentage rate diminish. Only 5.31 percent of our membership voted in the

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2011 election. In 2010, the voter turnout was 7.4 percent.

Why don’t members vote? ENA randomly surveyed more than 5,300 members via e-mail in November 2011. Of the 243 respondents (4.3 percent) who completed this national election survey, the No. 1 reason respondents did not vote was: “Did not know enough about the candidates to make a decision.” In addition, 28 respondents indicated they simply forgot to vote.

The Nominations Committee challenges you to call or ask 10 ENA members to get the vote out this year. Many of you may have met the candidates running, or they may be from your state. Get to know the candidates by communicating with them via ENA’s Facebook page. Please encourage your members to read their May ENA Connection, bring it to work and to your local, state and regional meetings.

It is our job to keep our members informed.

Some states and local chapters offer incentives to increase their voter turnout.

Several states and chapters award an ENA membership or provide financial assistance to attend a state, regional or national conference. If you would like to know what your state/chapter voter turnout was for the 2011 election, contact Executive Services at execoffice@ena.org.

Other reasons members said they didn’t vote included: “They don’t care,” “My vote won’t make a difference,” “I don’t know any of these people” and “What difference does it make—we don’t have any say at the board level.” It does matter and you can make a difference. In the past, some of our elections were decided by fewer than one percent.

Our ENA board of directors is our voice to move forward in the care of emergency patients all across the globe. They help find ways to make our jobs easier and safer and to save more lives every day.

This year’s election is from May 10 through June 8. Stay informed and make a difference in ENA. Get the vote out.

3/21/2012 3:58:09 PM

April 2012

Emergency Nurse Swap: Improving Practice Across the Globe

By Kendra Y. Mims, ENA Connection The ENA Foundation’s new International Exchange Program (IEP) is supported by Stryker Medical and gives U.S. emergency nurses a unique opportunity to travel to the United Kingdom for one week to share emergency nursing practice and build international relationships with other emergency nurses who are in the IEP network. In addition, the recipient hosts a nurse from the United Kingdom in the United States for one week to experience our emergency nursing practices. The IEP’s first recipient shares her experience below.

2011 Recipient: Charlotte Schnakenberg, MSN, BS, RN, CEN, CPEN, CPN Location: Ipswich, Suffolk County, England Charlotte Schnakenberg, a clinical educator for emergency services at Scottsdale Healthcare in Arizona, felt both excited and nervous when she arrived in Ipswich last November for a 10-day visit to live with and job shadow Jenny Edmonds, her hosting emergency nurse.

As Schnakenberg shadowed Edmonds at Ipswich Hospital, which is operated by the National Health Service, she noticed huge differences and striking similarities between the emergency department care given in the U.K. and the U.S. She frequently asked questions and realized that the nurses at Ipswich Hospital also had a lot of questions as well as misconceptions about patient care in the U.S. (such as patients being turned away for care if they don’t have the money to pay for services). As they educated each other during her shadowing, Schnakenberg continued to compare the two health care delivery systems and discovered that while some processes surprised her, there were some she thought could improve challenges in U.S. emergency nursing.

“I was amazed at the simplicity of their system,” Schnakenberg said as she recalled the first time she observed Edmonds discharging a patient, which required handing him a generic

pamphlet and then dispensing him TTA (to take away) medication.

“I thought the TTA medication was really convenient for the patient so that he didn’t have to go from the ED to a pharmacy,” she said.

“The nurses can dispense certain medications, like some antibiotics and minor medications, right out of the emergency department.”

Nursing education in the U.K. is paid for by the NHS. Schnakenberg said she was surprised to learn that there are five specialties for nurses to choose from at the start of their nursing education and they graduate in only one specialty (adult, pediatric, behavioral health, midwifery or learning disabilities).

“This is a challenge in their emergency department because in an emergency environment, you see all ages,” Schnakenberg said. “They only have a handful of nurses who do both adult and pediatric care. I found that very interesting because it didn’t seem very versatile that they specialize so early in their education, whereas we do things differently.”

When Edmond’s schedule altered between being a nurse practitioner and a charge nurse, Schnakenberg was also shocked to learn that nurses in the U.K. are not required to have an advanced practice license to be a nurse practitioner.

“There’s no restriction on who calls themselves a nurse practitioner,” she said.

“You can do this by taking a weekend course.

I found it interesting that the government’s stance on this is that they don’t need an advanced practice license and that they don’t need to further regulate nursing.”

Schnakenberg said the one method at Ipswich Hospital she found most effective is the four-hour time limit the hospital has to follow to get patients dispositioned and out of the emergency department, a provision passed by the NHS. When a patient walks in the door, the time that he or she presents is noted on a tracking board along with the breach time, which is the four-hour limit, Schnakenberg said.

Continued on page 31

Left to right: Charlotte Schnakenberg, MSN, BS, RN, CEN, CPN, CPEN; 2012 ENA President Gail Lenehan, EdD, MSN, RN, FAEN, FAAN; immediate past president AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN; Emergency Care Association chairperson Andrew Frazier; Mark Gillespie and Jenny Edmonds, EN, RN, DipHE Child, BSc hons Nurse Practitioner, INP.

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ENA STATE CONNECTION Arizona ENA State Council Submitted by Paulette Osborne, RN, CEN Arizona ENA finished a great year in 2011 with several membership opportunities, including the following: • During a state council recruitment campaign, Susan Kinkade, BSN, RN, CEN, won a statesponsored registration to the 2012 ENA Annual Conference.

• A drawing was held for a student membership based on state meeting attendance.

• Grant money received from national ENA funded four student memberships.

• Grant money also was used to purchase ENA lunch sacks that were filled with membership materials and provided to the hosting hospitals of our ENPC/TNCC classes with the intent of “spreading the word.”

These activities provided an amazing opportunity for creating interest in emergency nursing.

First-time attendees to our state council meetings are also placed in a drawing for a one-year membership to ENA. In an effort to make new members feel welcome, committee members follow up with a call to first-time attendees, students and new members. Members ask attendees for their feedback, invite them to view our website and notify them of upcoming meetings and educational offerings.

The state council continues to increase membership by making meetings more accessible to nurses by offering meetings in local communities throughout the state as well as call-in options.

Michigan ENA State Council Submitted by Meri Trajkovski, BSN, RN, SANE, and Brandi Uren, BSN, RN, CEN Michigan ENA Huron Valley Chapter is very proud of its progress and achievements over the last few years. Our chapter goal has been to reach out to our current members and recruit new members by increased communication and by offering educational opportunities. Some of our key accomplishments include the following: 1. T he creation of an ENA Huron Valley Chapter Facebook page with more than 130 “friends” to improve networking and communication.

2. Increased chapter membership.

3. I ncreased member attendance and involvement.

4. An updated www.michiganena.org chapter page.

5. Increased outreach to our members by rotating meeting sites.

6. Local presenters who speak on topics relevant to our profession.

7. C ollaborating and partnering with our emergency physicians.

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8. A ligning our chapter with the strategic goals of our state council.

9. Committed attendance at our state council meetings.

10. Increased networking and presence at local, state and national conferences.

North Carolina ENA State Council Submitted by Mary Lou Forster Resch, BSN, RN, CEN North Carolina is very grateful and honored to have received a State Achievement Award at the ENA Leadership Conference 2012 in New Orleans.

North Carolina ENA State Council President Elaine Marshall, BSN, ADN, RN, was invited to speak at the State and Chapter Leaders Conference closing session. Presidents from selected states were asked to highlight various notable activities and achievements occurring in their chapters and throughout their state. Our state’s

leadership knowledge was updated with many new ideas.

We are very proud to have an injury prevention article published in the January 2012 issue of the Journal of Emergency Nursing. The article highlights the ideas of Mary Pelton, BSN, RN, CEN, and the “ED Beach Reach.” Her ideas have been presented to the Eastern Tarheel Chapter, and we hope to expand her ideas to other chapters and areas. We hope the article served as an inspiration to all ENA members.

State Council and Chapter Meetings and Events Arizona ENA State Council Annual educational conference, Hot Topics: April Presenter: Matthew F. Powers, MS, BSN, RN, CEN, MICP For more information: www.azena.org

Kansas ENA State Council Kansas ENA meets every other month.

Meetings start at 10:30 am.

April 13— Galichia Heart Hospital, Wichita June 8—Hutchinson Regional Medical Center, Hutchinson Aug. 10 (Annual Meeting)—Children’s Mercy South, Overland Park Oct. 12—Stormont Vail, Topeka Dec. 14—University of Kansas, Kansas City

Upcoming education: Annual Trauma Summit (to be announced).

CEN Review Oct. 15-16—Hutchinson Oct. 18-19—Lawrence Presenter: Jeff Solheim, MSN, RN, CEN, CFRN, RN-BC, FAEN For more information: www.kansasena.org and visit us on Facebook.

Kansas Chapter Meetings: Central Kansas ENA Meetings are planned at 7 p.m. for the fourth Monday of the odd months of the year.

Exceptions will be the May, July and December meetings.

Eastern Kansas ENA May 9—Lawrence July 11— Topeka Sept. 19— Lawrence

Nov. 14— Kansas City

Michigan Huron Valley Chapter Dinner and safety topic presentation: Aug. 8, 6 p.m.

Location: to be announced.

Presenter: Det. Brian Fountain, Detroit Police Department Year-end meeting: Oct. 21, 6 p.m.

Location: University of Michigan, Ann Arbor

North Carolina ENA State Council State council meeting: Nov. 8 Eighth Annual Fall Conference: Nov. 9 Location: Wrightsville Beach For more information: www.nc-ena.com

13th Annual Southeastern Emergency Nursing Seaboard Symposium Registration early-bird deadline: April 18 Presessions: May 2-3 SESS Conference: May 4-6 Location: Sheraton Waterside Hotel, Norfolk, Virginia Presenters: 2012 ENA President Gail Pisarcik Lenehan, EdD, MSN, RN, FAEN, FAAN, Dr. Robert Lesslie and Allison Zmuda For more information: www.southeasternseaboardsymposium.org/register.htm

Nebraska ENA State Council Certified Pediatric Emergency Nurse Review Course: May 18 Location: Michael J. Sorrell Center for Health Education, Nebraska Medical Center campus, Omaha Presenter: Deb Potts, MSN, RN, CEN, CPEN For more information: amaze610@yahoo.

April 2012

Deb Zirkle, ENA Director of Online Services

… To Connect with the ENA Candidates and Get Ready to Vote!

What do you get when you combine the biggest social network, current technology and the 2012 ENA election? A great opportunity to make your voice heard with this year’s candidates for the ENA board and the Nominations Committee using Facebook.

New this year, ENA will use Facebook to connect you to the 2012 candidates for the ENA board and the Nominations Committee. Chances are you already have a Facebook page and are among the more than 15,000 people who “like” ENA. If not, please take a few minutes to create an account. You don’t want to miss this new opportunity to interact with the candidates.

Future of Nursing Work Team Continued from page 19 length of stay, costs savings, a reduction in medical errors and less staff turnover.4 With this knowledge, as leaders we can do our part to create a more collaborative emergency department environment.

References 1. I nstitute of Medicine, The Future of Nursing: Leading Change, Advancing Health. Accessed September 5, 2011 at: www.iom.edu/ Reports/2010/The-Future-of-NursingLeading-Change-Advancing-Health.aspx.

2. Emergency Nurses Association, ED Benchmarks Collaborative (EDBC). Accessed September 5, 2011 at: http://sites. mckesson.com/edbc/webinars.htm 3. Emergency Nurses Association, National Health Care Provider Associations Join Forces to Reduce Emergency Department Crowding.

Accessed September 5, 2011 at: www.ena. org/media/PressReleases/Pages/ ReduceEDCrowding.aspx.

4. Institute of Medicine, The Future of Nursing: Leading Change, Advancing Health.

Accessed September 5, 2011 at: www.iom. edu/Reports/2010/The-Future-of-NursingLeading-Change-Advancing-Health.aspx.

The ease of Facebook makes it as simple as a couple of clicks to begin your interaction with this year’s candidates. Look for posted announcements on ENA’s Facebook page about the election and candidates. Then begin posting your questions, concerns or thoughts to specific candidates, or reach out to a group based on the position for which members are running.

Check back often to view their responses to your questions. If you haven’t already done so, set up your Facebook account to alert you on your mobile device when something new is posted, keeping you up to date wherever you are.

All the biographical information about the ENA board candidates, along with the videos from the Candidate’s Forum held at Leadership Conference 2012, are available on the ENA website at www.ena.org. You will also find links to those pages within various wall posts on our Facebook page.

Don’t delay—take a few minutes to get to know the candidates who are looking for your vote.

Readers may contact the author at dzirkle@ena.org.

Emergency Nurses Association (ENA) in Collaboration with the International Association for Healthcare Security and Safety (IAHSS) Presents:

Workplace Violence Prevention Summit

Chicago • June 22, 2012 • 8 a.m. - 5 p.m.

Violence invades the healthcare workplace each day; Violence rates against emergency nurses hold steady1 The purpose of the summit is to bring together a multidisciplinary team of experts to stimulate collaboration in mitigating workplace violence in the emergency department setting.

Learn how to change the equation and reduce violence in your facility at this one-day summit.

Who Should Attend This one day summit is vital for those individuals responsible for the safety and security of patients and healthcare professionals within their organization.

• Healthcare professionals (nurses, physicians, allied health professionals) • Healthcare safety and security professionals • Healthcare facilities management executives • Healthcare administrative executives • Architects • Researchers, educators

During this summit, you will learn to

• Implement multi-faceted methods to foster synergy in the emergency department environment in regards to workplace violence prevention

• Employ effective communication strategies between security and safety professionals and emergency department staff

• Develop interdisciplinary violence

prevention policies and procedures in the ED setting

• Integrate design elements that can mitigate violence in the emergency department

Emergency Nurses Association, Institute for Emergency Nursing Research. (2011). Emergency Department Violence Surveillance Study. Des Plaines, IL 1

Continuing education credits are available for both nursing and security professionals.

View the program and register today at www.ena.org

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3/9/2012 2:08:15 PM

BOARD HIGHLIGHTS | January/February 2012

Board Meeting Actions and Highlights The ENA board of directors met January 18 via teleconference.

All members were present and took the following actions: • Approved creation of an additional member for the Emergency Nursing Advanced Critical Thinking Work Team.

• Approved that ENA participate on the Emergency Department Geriatric Pain Expert Panel initiative.

• Approved moving forward in engaging with the American Society for Testing and Materials International research study on protective garments while protecting the ENA mailing list.

• Approved that ENA collaborate with of the American College of Emergency Physician’s Academic Affairs Committee on gathering data for its transitions of care tool.

• Approved that ENA become a Supportive Association for the DAISY

The Importance of Having a SANE Nurse Continued from page 14 think that a patient who is probably experiencing one of the worst days of their life may come seeking care in the ED, and in many cases they get someone to take care of them who is not trained and has to sit and read the directions on the [evidence] kit before they can take care of the patient. There is no other patient that we do this with.”

Day recalled when she wasn’t a trained examiner and was the nurse who had to read directions while caring for traumatized patients.

When it was time for the most intimate part of the exam, the genital assessment, she had to call in the emergency physician.

“This is after I had already established a rapport with the patient and had advocacy there,” she said. “It’s a terrible way to treat a patient. It’s sad when I think about how many people are still reading the directions.”

Day said best practice is for the trained examiner to proceed with evidence collection based on the patient’s history and not to make decisions based solely on the evidence kit directions.

“As a SANE nurse, you can do the entire medical forensic exam and you establish rapport with the patient from the beginning and go through the entire process of working with the patient,” she said.

Day said having a trained examiner on staff benefits the emergency department staff.

“It’s really less of a burden on the ED staff because the exam does take up a lot of time,” she said. “You need to be able to devote time to not only make sure the evidence is not contaminated but also to make sure the patients get the care they need. In EDs that I worked in where there were no SANE nurses, the patients would have to sit for hours waiting for someone to take care of them. Because they’re not

30

Foundation. (DAISY stands for Diseases Attacking the Immune System.)

• ENA’s logo and link to www.ena.org are listed on the DAISY Foundation’s list of Supportive Organizations.

• ENA will provide space for the DAISY Foundation to exchange with members at the Annual and Leadership Conferences.

The ENA board of directors took the following actions on Feb. 13 via e-mail vote: • Approved the Academy of Emergency Nursing fellow candidates for induction at the 2012 Annual Conference.

Highlights of the next scheduled board of directors meeting will be published in a future issue of ENA Connection.

Did You Know?

• April is Sexual Assault Awareness Month.

• Every two minutes, someone in the United States is sexually assaulted.1 • Forty-four percent of sexual assault and rape victims are under age 18; 80 percent are under age 30.1 • Victims of sexual assault are three times more likely to suffer from depression, six times more likely to suffer from post-traumatic stress disorder and four times more likely to contemplate suicide.1 • Out of every 100 rapes, approximately 3 rapists will spend even a day in jail while the other 97 percent will walk free.1 • Rape is down by 60 percent since 1993.1 • About two-thirds of assaults are committed by someone known to the victim.1 • The federal government has adopted a revised, expanded definition of rape for nationwide data collection to include any gender of victim and perpetrator, rape with any body part or object and circumstances in which the victim is unable to give consent due to temporary or permanent mental or physical incapacity.2 References 1. www.rainn.org/statistics 2. http://blogs.usdoj.gov/blog/archives/1801

outward injuries, they can be left to sit for a long time, and then many of them will leave without getting the treatment and resources they need.”

Day gives credit to Rebecca Campbell, an associate professor of psychology at Michigan State University, whose extensive research on sexual-assault care, advocacy and SANE

has found that when hospitals have trained examiners responding to sexual-assault victims, it increases the chances of a victim continuing on through the criminal justice process.

(According to RAINN, 54% of rapes/sexual assaults are not reported to the police based on a statistical average of the past five years, making sexual assault one of the most underreported crimes).4 “In many cases there is no court trial for these victims,” Day said. “The only thing that may impact their outcome is the kind of response they get at the hospital. Just having one great responder can really make a difference in the way the patient can view their entire experience with the assault. They have someone who believes them and who has taken care of other people who have had the same issues, and they’re able to respond in a caring, compassionate manner that makes it a better experience overall. No one can take away what happened to them, but at least we can respond properly in the end.”

References 1. “The National Intimate Partner and Sexual Violence Survey.” (2011). Retrieved from the CDC website: www.cdc.gov/Violence Prevention/pdf/NISVS_FactSheet-a.pdf 2. IAFN. (2006). Retrieved from http://iafn.org displaycommon.cfm?an=1& subarticlenbr=546 3. Emergency Nurses Association. (2010). “Care of t he Sexual Assault and Rape Victims in the Emergency Department.” Retrieved from www.ena.org/SiteCollectionDocuments Position%20Statements/SexualAssault RapeVictims.pdf 4. “Reporting Rates.” (n.d.). Retrieved from the RAINN website: www.rainn.org/ get-information/statistics/reporting-rates

April 2012

Steps to a Healthier You Continued from page 21 making a bed), do five to 10 squats holding onto the end of the bed. Squeeze your glutes together as you rise up, and make sure your toes don’t go past your knees (you should be sitting back into an invisible chair).

If your lack of motivation prevents you from exercising, become involved in group activities or create a team at work that is focused on healthy living. You and your colleagues can motivate each other and hold each other accountable. Whether it’s gathering a team together to participate in a heart walk or motivating them to join a gym, Fogarty encourages her staff to stay physically active and to participate in group activities.

“They need to go out and get the exercise,” she said. “We see on a daily basis that the people who are having heart attacks and strokes are getting younger and younger because of the sedentary lifestyle that we have, and you need to be proactive to try to prevent some of that.

“I try to motivate my staff and teach them to take care of themselves so that they can take care of their families. We encourage them to join

gyms or participate in the annual heart walk and kidney walk. Last summer, we had a group put together a kickball team for the first time.”

Engage your colleagues in making a difference in your workplace. Children’s Healthcare of Atlanta designed a program that specifically focuses on the health and wellness of its employees (see sidebar for further details on how this organization created a healthier work environment).

TIP: Take the stairs to/from any place you have to go in your hospital. Use a pedometer to see if you are reaching the recommended 10,000 steps per day. Go up a flight of stairs wearing ankle weights to add resistance.

Becoming proactive in creating a healthier work environment can create changes that will benefit you and your patients. Because you educate the public about health and wellness as an emergency nurse, making healthier choices will not only help you to feel great, but you can also share the benefits of living a healthy lifestyle with your patients.

Emergency Nurse Swap

Charlotte Schnakenberg (right) poses with Jenny Edmonds at Ipswich Hospital, Suffolk, England.

Continued from page 27 “Every person in that department, from the doctors to the nurses and anyone else involved in the care of the patient, was focused on getting that patient out in four hours,’’ she said. ‘‘That was their priority. They pay so much attention to it because the NHS says if they don’t have 96 percent of their patients out of the ED in four hours, the hospital is penalized financially.’’

Schnakenberg believes that using a breach time could improve one of the challenges in U.S. emergency departments.

“I think one of the biggest complaints that a lot of nurses have in the U.S. is that we can’t get patients out of our EDs to where they need to go,” Schnakenberg said. “I feel it would be beneficial here if the entire hospital was focused on getting patients out of the ED.” Despite other differences she found, Schnakenberg learned that the nurses in the U.K. are similar to nurses in the U.S. “A nurse is a nurse is a nurse,” Schnakenberg said. “No matter where you are, we all want the same things for our patients. We want to help make them better with the problem they are currently having. We want them to be healthy.

“The same conversation and camaraderie that happens in the U.S. happens in their break rooms too. That really gave me a bigger perspective on nursing as a profession. There are probably a lot of things that we can learn from

References 1. Obesity—At a Glance 2011. (2011). Retrieved from the CDC Website: www.cdc.gov/ chronicdisease/resources/publications/ aag/pdf/2011/Obesity_AAG_WEB_508.pdf 2. Witters, D. (2012). More Than 15% Obese in Nearly All U.S. Metro Areas. Retrieved from Gallup Website: www.gallup.com/ poll/153143/Obese-Nearly-Metro-Areas. aspx 3. Miller S.K., Alpert P.T., Cross C.L. (2008) Overweight and obesity in nurses, advanced practice nurses, and nurse educators.

Retrieved from www.ncbi.nlm.nih.gov/ pubmed/18460166 4. Scrubs magazine. (2011). Retrieved from http:/scrubsmag.com/ 5. Krischke, M. (2011). Fitting Fitness Goals into Your Nursing Schedule. Retrieved from the NurseZone.com Website: www.nursezone. com/Nursing-News-Events/more-news/ Fitting-Fitness-Goals-into-Your-NursingSchedule_36000.aspx 6. McElroy, L. (2010). Six Exercises You Can Sneak into Your Workday. Retrieved from http://scrubsmag.com/exercises-you-cansneak-into-your-workday/

other countries, and I would love to see the IEP expanded to include other countries where the health care delivery system is also different. …

There are nurses all over the world who are doing great things.”

Schnakenberg describes being selected for the ENA Foundation International Exchange Program as one of the most valuable experiences of her career and encourages other emergency nurses to do it.

“It was an honor to be the first person who got to do this,” she said. “It was everything I thought it would be and more. I wish that every nurse could have an experience like this. It will only help you to grow and to see what a fabulous profession we have chosen.”

Schnakenberg’s favorite aspect of the IEP was building relationships, as she describes Edmonds as “a wealth of information, but more important, a friend.” She is really excited to become a

hosting emergency nurse when Edmonds visits Arizona this year.

“I hope the ENA Foundation continues this program,” Schnakenberg said. “It’s an experience I will draw on professionally for the rest of my career, because I’ve seen another world of health care and having that perspective makes me think differently about our world of health care, the changes and how things may be some day.”

** The ENA Foundation International Exchange Program provides a scholarship for airfare and incidentals up to USD $1,000 for the one-week exchange. If you are interested in this exceptional opportunity, applications for the 2012 International Exchange scholarship are currently available on the ENA Foundation Website: www.enafoundation.org.

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