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the Official Magazine of the Emergency Nurses Association

connection

April 2013 Volume 37, Issue 4

Nursing Ourselves Wellness Comes Naturally When We Find Balance and Take Care of Each Other Pages 3, 20-21

ENA President JoAnn Lazarus, MSN, RN, CEN

INSIDE

FEATURES

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Dates to Remember April 30, 2013 Deadline to apply for 2014 Annual Conference Committee, International Delegate Review Committee and Resolutions Committee. May 14 - June 12, 2013 Elections for 2014 ENA Board of Directors and 2014 Nominations Committee positions.

ENA Exclusive Content PAGES 8 - 11 Collaboration Section 8 5 Tips to Improve Sexual Assault Care in Your ED 11 E NA and APNA Collaborate to Provide Better Care for Psychiatric Patients in the ED 12 NEMSAC Update:   Exciting Projects That Affect Us PAGE 13 Board Writes: How Safe Are Your Transitions of Care? PAGE 14 Update From the Executive Director: Behind the Scenes at ENA PAGE 20 CODE YOU: Balancing Eight Key Wellness Components PAGE 26 Washington Fiscal Crisis Endangering Programs for Nurses

Monthly Features PAGE 4 Members in Motion PAGE 4 Ask ENA PAGE 6 ENA Foundation PAGE 16 NEW! ENA Corkboard PAGE 18 Pediatric Update PAGE 22 From the Academy of Emergency Nursing PAGE 24 State Connection

LETTER FROM THE PRESIDENT |

JoAnn Lazarus, MSN, RN, CEN

How Did We Get Here? Most of us are aware of the concept of violence in our emergency care environment. When we hear this term, we typically think of an unruly patient or family member. At least, that’s what came to my mind until recently. A few weeks ago I received an e-mail from the ENA national office asking me to follow up with a member who had left a message regarding an assault. I assumed the assault was related to a patient-care situation. When I spoke with this nurse, I did not hear what I was expecting: She was physically assaulted by another nurse while at work. Unbelievable! This nurse is now strongly considering leaving emergency nursing. She is afraid to return to work. How did we get to this point in our profession? When did this type of behavior become part of our practice? We laugh about nurses ‘‘eating their young,’’ but it is not funny. This behavior is known as lateral violence, bullying or horizontal hostility. What all these terms have in common is unacceptable professional behavior. Whether it is a verbal or physical assault, it is disruptive behavior that has been an issue for nurses for decades. Ultimately, this behavior creates a dangerous environment for patients. Lateral violence leads to poor communication, which compromises the ability of nurses to work as a team. The end result is that patient care can become less safe. It often forces many excellent and skilled nurses to leave the profession. Why do we tolerate this behavior? This disruptive behavior has become ingrained in our culture. We have covered up the inappropriate behavior by saying, ‘‘She’s just having a bad day’’ or, ‘‘He’s really nice when you get to know him.’’ When we don’t speak up, it sends the message that

we accept the behavior. Acceptance of the behavior allows it to continue to spread until eventually we have a totally toxic environment. The first step in stopping lateral violence is recognition. The second step is to respond to it. Respond by not tolerating the behavior. In ENA’s new Scope and Standards, Chapter 4 describes the standards for professional practice. This includes the standard, ‘‘Takes appropriate action regarding instances of illegal, unethical or inappropriate behavior that can endanger or jeopardize the best interests of the health care consumer or situation.’’ Lateral violence definitely interferes with the ability to provide quality patient care. Education is another important component in changing behavior. This year as president, I will have the opportunity to speak at several conferences on this topic. Most important, I believe, is promoting positive, professional behaviors. As nurses, we should tolerate nothing less. Nursing is supposed to be a caring profession. Let’s work together to put the caring back in, especially with our colleagues. As a profession, and as individuals, we have the power to change the emotional environment we work in every day. What are we waiting for?

Keep Up With the Board Online Beginning in April, highlights from ENA Board of Directors meetings will be published exclusively in the members-only section of the ENA website. Log on to www.ena.org each month to keep up with the latest happenings.

Official Magazine of the Emergency Nurses Association

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Hemorrhagic shock gets the e-learning treatment in the latest free continuing education course from ENA, available beginning April 1. In ‘‘Critical Thinking at Triage,’’ an advanced clinical course, Diane Gurney, MS, RN, CEN, FAEN, reviews historical management of hemorrhagic shock and explores recent trauma research that has changed the way the condition is managed in the emergency department. Taking the course from the comfort of your computer, you’ll revisit the pathophysiology of shock and coagulation factors and understand the rationale for how these new methods are saving the lives of trauma patients. The course is available beginning April 1 and is worth 1.0 contact hours. To take this and other courses in the CE catalog: • Go to www.ena.org/freeCE, where you’ll log in as an ENA member (or create a new account). • Add desired courses to your cart and ‘‘check out’’ (courses are completely free for members only). • Proceed to your Personal Learning Page to start or complete any course for which you have registered or to print a certificate when you’re done. • To return to your Personal Learning Page at a later time, go to www.ena.org and find ‘‘Go to Personal Learning Page’’ under the Courses & Education tab. If you have questions about any free e-learning course or the checkout process, e-mail elearning@ena.org.

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© 2013 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.

Q: In a recent news story, a “nurse” was named in a situation where there was a refusal of treatment. How do we know it was a nurse? A: As we know, not all news headlines are completely factual. The old saying, “Let the buyer (in this case, the reader) beware,” is important to remember. As a profession, nurses are trusted and respected by the public. As nurses, we have a powerful voice in society. It is our responsibility to ensure that the profession realizes there are times things may be reported inaccurately. Nurses should rise to these occasions by informing our patients and the public about the important work we do and our profession’s moral and ethical responsibility to those entrusted in our care. This particular news story inaccurately named the individual as a nurse. There was no particular designation of nurse, but this omission was cause for much

consternation. When these stories are printed, it is imperative that nurses ask for a fact-check. Questions like: “Was this a registered nurse? What are the person’s credentials? What are the policies of the organization?” and “Where did this happen?” are critical pieces of the story that ensure factual representation of an event. Nurses act as patient advocates every day. We need to be our own advocates as well by calling local news stations and writing letters to the editor to set the record straight. Nurses everywhere should lend a critical eye to these stories to inform our practice and the public about the important nature of nurses’ work. Sometimes the moral and ethical issues of reporting are blurred by the sensationalism of the news item. As nurses, we need to send a clarion call to others so we are represented in the ethical, moral, and upstanding way we do our work. — Paula M. Karnick, Ph.D, ANP-BC, CPNP, Director of the Institute for Nursing Education

Do you have a recent professional or educational success story you want to share about yourself or an ENA member colleague? Tell us! Send an e-mail to connection@ena.org with the subject line “Members in Motion” so that we might share your exciting news with all 41,000-plus ENA members in ENA Connection. Be sure to include names, credentials and, if applicable, photos of the nurse(s) being recognized.

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

Member Services: 800-900-9659 Non-member subscriptions are available for $50 (USA) and $60 (foreign).

Editor in Chief: Amy Carpenter Aquino Assistant Editor: Josh Gaby Writer: Kendra Y. Mims Editorial Assistant: Renee Herrmann BOARD OF DIRECTORS Officers: President: JoAnn Lazarus, MSN, RN, CEN President-elect: Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN

Secretary/Treasurer: Matthew F. Powers, MS, BSN, RN, MICP, CEN Immediate Past President: Gail Lenehan, EdD, MSN, RN, FAEN, FAAN Directors: Kathleen E. Carlson, MSN, RN, CEN, FAEN Ellen (Ellie) H. Encapera, RN, CEN Marylou Killian, DNP, RN, FNP-BC, CEN Michael D. Moon, MSN, RN, CNS-CC, CEN, FAEN Sally K. Snow, BSN, RN, CPEN, FAEN Joan Somes, PhD, MSN, RN, CEN, CPEN, FAEN Karen K. Wiley, MSN, RN, CEN Executive Director: Susan M. Hohenhaus, LPD, RN, CEN, FAEN

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ENA FOUNDATION State Challenge

Keep the Ball Rolling By Kendra Y. Mims, ENA Connection Lori Carlen never thought she would become one of the expert nurses in her emergency department or return to school to further her education when she became an State Challenge scholarship recipient gives a shout out emergency nurse 20 years ago. to the ENA Foundation donors: Carlen, BSN, RN, CEN, works at Saint Elizabeth Regional Rachael M. Young, BSN, RN, CEN, Medical Center in Lincoln, Neb., as an emergency from Illinois: As an ENA Foundation department nurse educator — a new position that was State Challenge scholarship recipient, offered to her a year ago with an understanding that she I would like to send my sincere would return to school to obtain a clinical nurse specialist gratitude to the donors who made this degree. Interested in the opportunity but also dealing with scholarship possible! This scholarship financial hardships as a single parent, is so important to emergency nurses! It has enabled me Carlen did some research and applied to continue with my master’s degree as an acute care for an ENA Foundation scholarship. nurse practitioner, which has led me to provide In August 2012, she was selected to excellent evidence-based care to my patients while receive one of seven ENA Foundation working in the emergency department as an RN. State Challenge scholarships in the amount of $3,000. This scholarship will enable Carlen to become the her current ED leadership role as she provides education to Lori Carlen, BSN, first clinical nurse specialist in her her staff. RN, CEN, emergency emergency department. “A lot of times you go through school and try to department nurse “Our hospital is a Magnet hospital retroactively apply what you learned,” she said. “Since I’m in educator and has always been very committed this role now, I am able to directly apply what I’m learning to quality care and nursing excellence,” in school currently to real-life situations and make a said Carlen. “Our administration strives to provide our bedside difference in how our ED is functioning at this very instant nurses with the tools we need to provide the best care. instead of waiting until I’m done with school and waiting to Clinical nurse specialists and nurse educators have been part apply it. That’s pretty exciting.” of the inpatient nursing units for many years. We have never Carlen plans to continue working in the emergency had an official educator position in the ED; in the past our department when she finishes her degree in May 2014. She preceptors and charge nurses tried to keep everyone strongly urges ENA members who are going back to school updated on any practice changes, but as our volume and staff to reach out to the ENA Foundation and learn about all of have increased, that became impossible to maintain.” the numerous scholarships they have to offer. Carlen was accepted into the University of Nebraska “Being able to receive a scholarship from the ENA Medical Center Clinical Nurse Specialist program. She says Foundation has been phenomenal,” she said. “I can’t stress how receiving the State Challenge scholarship much it has helped out. I plan to ‘pay it has made a huge impact on her ability to forward’ by investing what I am return to school. learning as a CNS in my ED. I want my Call for Nominations: Carlen plans to use her degree to help department to be a benchmark for 2014 ENA Foundation improve the overall quality of her emergency nursing excellence.” Board of Trustees emergency department by helping with ED Funding for the 2012 State throughput and bringing best evidenceChallenge scholarship awarded to Application deadline is June 1. based practices to the bedside, which will Carlen and other recipients was made Visit www.enafoundation.org also improve the quality of patient care. for more information. Being in school is also helping Carlen in Continued on page 24

Shout Out for Emergency Nursing Education

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April 2013

G3 Power Driver

COLLABORATION

5 Tips to Improve Sexual Assault Care in Your ED An inside look from a SANE’s perspective By Kendra Y. Mims, ENA Connection With more than 17 years of experience in forensic nursing in both urban and rural communities, Jennifer PierceWeeks, RN, SANE-A, SANE-P, project director at the International Association of Forensic Nurses, has witnessed how sexual assault nurse examiners improve the care of patients who have been sexually assaulted. From collecting forensic evidence and assessing health risks, to treating injuries and providing support, SANE nurses are specially trained to provide comprehensive care to this patient population. Jennifer PierceAlthough a Weeks, RN, SANE-A, SANE’s presence SANE-P is beneficial in the emergency department, PierceWeeks points out that the majority of hospitals in the country do not have on-site SANE nurses or educational programs. She says that the presence or absence of a SANE program is less of a concern than the fact that sexual assault generally requires a variety of emergency services. She indicates that ED staff can become trapped in the belief that the exam is all about evidence collection, when in fact, the kit is only one component of the care required and the least complex aspect of the care necessary for this patient population. She offers emergency nurses the following tips for providing

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an effective trauma-informed approach to sexual assault care.

Take a Comprehensive Medical History Although emergency nurses tend to be concerned about not having adequate experience to collect forensic evidence properly, Pierce-Weeks says the most important part of the sexual assault forensic exam is taking a comprehensive medical history. “The history we gather from any patient helps inform our diagnosis and treatment,” she said. “We talk to patients all the time as ED nurses, but talking about sexual violence tends to make nurses feel very nervous. That nervousness contributes to the belief that we will do something ‘wrong’ during our history-taking encounter. So when I teach nurses, I remind them they are simply having a conversation with their patient. As emergency nurses, we have conversations with our patients all of the time about all sorts of things.” Her advice: “Provided you don’t come across as judgmental, there’s nothing you are going to do wrong. Having compassion is key.” Pierce-Weeks also encourages nurses to listen to the patient and take the time to gather an effective history instead of using a rapid-ED approach. “I know you’re busy. I know all the other things that need your attention can be distracting. But when you are with that patient, let their history be

your sole focus. The history will guide your exam. If you are listening, it will tell you where to look for evidence. And more importantly, listening tells the patient you care about what happened to them.”

Consider the Patient’s Perspective Pierce-Weeks urges health care providers to put aside their personal viewpoints when treating sexual assault patients. “Regardless of where you work, the standard of care for sexual assault where there is a risk of pregnancy is to offer pregnancy prevention in the form of Plan B. This medication is often misconstrued, both inside and outside medical communities, as the abortion pill,” she said. “It’s important that nurses recognize the difference between their personal choice to not deliver a medication, and the patient’s right to be offered what is considered a standard of care.” Pierce-Weeks points out that there are some facilities that opt not to have pregnancy prevention medication available. “In these instances, ED nurses should know what options are available so the patient can have their medical needs met and their choices valued,” she said. “The reverse is true as well. Should a patient opt out of pregnancy prevention, the ED nurse should respect that patient’s right to determine their own care path. I would caution ED nurses that failure to

April 2013

COLLABORATION recognize the risk of pregnancy and offer a reasonable treatment option for that risk can put them in a potential liability situation.” Knowing the laws and requirements for your own jurisdiction is valuable in this situation. Pierce-Weeks offers the same advice to medical providers who believe their sexual assault patient has been exposed to HIV, and says that many providers are unaware that there is a non-occupational HIV post-exposure prophylaxis for sexual assault victims.

Collaborate with Advocates Linking sexual assault victims to an advocate can help provide emotional support and continuity of care long after they leave the hospital. Pierce-Weeks says that emergency nurses are in a great position to bring in advocates from local crisis centers to introduce patients to the advocates face-to-face – which can increase the patient’s chances in engaging in advocacy services – as opposed to handing them the advocacy hotline phone number. Though some emergency nurses may be concerned about HIPAA violation by contacting the crisis center without the patient’s permission, Pierce-Weeks points out that no medical information needs to be disclosed. Emergency nurses can call the crisis center without giving any patient-identifiable information, and once the advocate arrives, the patient can decide.

Know Your Options Mandatory reporting laws for sexual assault vary from state to state, as not all states have a mandatory reporting requirement for sexual assault. It is vital to allow the patient to maintain some degree of control over his or her health and personal care, especially after an assault where the patient had all control taken away. Pierce-Weeks, a Colorado resident, says that although Colorado is a mandatory reporting state, there are ways to report sexual assault without making the patient feel like his or her privacy has been violated. “It’s important that nurses let the patient know they are required to report to law enforcement, but the patient is not required to speak to them. In most states there is an option to have evidence collection and not cooperate with law enforcement if the patient is not ready to report yet. It’s important for ED nurses to know what those options are.”

Help Patients Emotionally You don’t look like you’ve been sexually assaulted to me. Pierce-Weeks recalled when a sexual assault patient heard those words from a health care provider who witnessed the patient laughing with a nurse during the exam.

Continued on page 10

Sexual Assault Awareness Month April is Sexual Assault Awareness Month and advocacy centers, organizations and individuals across the nation will be promoting awareness, prevention and education about sexual assault, abuse and Polly Campbell, violence. Sexual assault nurse BS, BA, RN examiners are often the first responders for survivors of sexual assault. SANEs are health care providers, primarily registered nurses, who provide comprehensive care for survivors of all ages. “SANEs are often thought of as evidence collectors, but the bigger part of caring and treating patients who have been sexually assaulted is being able to understand what they have gone through, meeting the patient where she/he is emotionally. The primary focus is nursing care and empowerment,” said Polly Campbell, BS, BA, RN, 2013 president of the International Association of Forensic Nurses and director of the Maine Sexual Assault Forensic Examiner Program. Along with providing comprehensive care to sexual assault victims, Campbell points out that SANEs are competent in the collection of forensic evidence and they can also be a witness in court. “Like emergency department nurses, forensic nurses are a unique and courageous group” she said. “It takes courage to do this work because it’s not for everybody, but those who do this work are very caring and committed nurses. I think they get tremendous satisfaction in taking a victim of violence and helping them take the first step back to reclaiming their lives.” For more information and resources on forensic nursing, please visit www.iafn.org. *The mission of the International Association of Forensic Nurses’ is to provide leadership in forensic nursing practice by developing, promoting and disseminating information internationally about forensic nursing science. Forensic nursing practice intersects with the law and includes sexual assault nurse examiners, death investigators, correctional nurse specialists, forensic psychiatric nurses, legal nurse consultants, forensic clinical nurse specialists and others.

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COLLABORATION 5 Tips for Your ED

Continued from page 9

“That just means we’ve done a good job of helping them not feel ashamed or destroyed by this event,” she says, dismissing the myth that all trauma victims act a certain way. “Over the years, I’ve seen horrifying experiences where health care providers made comments in front of patients that re-traumatize them. The worst thing you can convey to a patient who has experienced sexual violence is that you don’t believe them. The nurse’s role is to do what we do with every other patient – start by listening, believing, taking into consideration the state of the science, our own clinical experience and the patient’s wishes, and moving forward with the best possible evidence-based care we can provide.” Pierce-Weeks encourages communication that lets the patient know he or she is not at fault for the attack. “I think that’s a critical piece of information for ED nurses to communicate to patients. It’s important for our patients to know sexual violence is common, they are not

Did You Know? • More than half (51.1 percent) of female victims of rape reported being raped by an intimate partner and 40.8 percent by an acquaintance; for male victims, more than half (52.4 percent) reported being raped by an acquaintance and 15.1 percent by a stranger.1 • The SAAM Day of Action will be observed on Tuesday, April 2. This is nationally recognized in the United States as a specific day to focus awareness on sexual violence prevention.2 References 1. Black, M. C., Basile, K. C., Breiding, M. J., Smith, S. G., Walters, M. L., Merrick, M. T., … Stevens, M.R. (2011). The national intimate partner and sexual violence survey: 2010 summary report. Atlanta, GA: Centers for Disease Control and Prevention. 2. National Sexual Violence Resource Center. (n.d.). Sexual assault awareness month “day of action.” Retrieved from www.nsvrc.org/saam/what-issaam/day-of-action

alone and there are resources available

she said. “They look relieved and

to them. It’s really easy to say all of

know the next steps to take, and they

those things in the ED and have a

don’t experience any kind of

positive impact on those patients.”

judgmental health care approach from

Pierce-Weeks believes helping sexual

us, because it is really evidence-based.

assault patients recover from their

They know that this is an episode that

traumatic experience is the reward.

happened in their life but it’s not an

“There is a huge difference in the

episode that will destroy or define

patients we see from the time they

them; they can recover. This is really

arrive to the time they leave our care,”

the heart of nursing.”

NOW AVAILABLE

ENA STAFFING GUIDELINES Determining a safe level of staffing in your Emergency Department is challenging. ENA’s revised Staffing Guidelines may help in preparing your annual staffing budget. These revised guidelines are available at www.ena.org.

COLLABORATION

ENA and APNA Collaborate to Provide Better Care for Psychiatric Patients in the ED By Amy Carpenter Aquino, ENA Connection “The emergency departments are impacted with psychiatric patients,” said Marlene Nadler-Moodie, MSN, APRN, PMHCNS-BC, immediate past president of the American Psychiatric Nurses Association. A clinical nurse specialist and educator, Nadler-Moodie often begins her presentations to emergency nurses by saying, “I know you don’t want to hear this, but you are a psych nurse. Twenty-five to 50 percent of your patients are psychiatric patients.” A 2010 ENA position statement states that “Education in crisis prevention, intervention, de-escalation, and management of the patient in seclusion or restraints is critical for emergency nurses to provide optimum care.” With a common goal of providing the best possible care to psychiatric patients in the ED, and to help alleviate the concerns emergency nurses often have when treating this population, ENA and APNA began collaboration on an educational product in 2006. The final product, ENA: Handling Psychiatric Emergencies, was released by Elsevier as an interactive online course earlier this year. Marlene NadlerNadler-Moodie explained that ENA Moodie, MSN, APRN, reached out to APNA and its members PMHCNS-BC for expertise in the initial stages of the product’s development. “It stemmed from a survey that went out to the ENA membership, asking what they wanted from education,” she said. “Overwhelmingly, they wanted something on pysch. They didn’t feel like they were handling things well, and I get that. I am a psychiatric nurse in a general hospital, and I teach about psych patients in EDs and med-surg units, so I get those problems.” Throughout the product’s development phases, APNA members maintained an integral role, serving as content experts, authors and editors for various course chapters. Nadler-Moodie recalled meeting ENA members and staff at ENA’s national office in Des Plaines, Ill. on two occasions, as well as attending a special meeting of product writers and

editors hosted by Elsevier in Atlanta. She is pleased with the final result, which is endorsed by APNA. “We’re really excited about it,” she said. Her hope is that an emergency nurse who takes the course “feels a little more comfortable when she has a psychiatric patient that she has to care for,” she said. “My experience now with the emergency room nurses I work with is that they feel unprepared, and they kind of divorce themselves, almost. In facilities that have a psychiatric team, I think many ED nurses simply say, ‘Get the psych team.’ It’s not their comfort zone.” Ten APNA members and more than two dozen ENA members worked on the program. There are too many to name individually, but their efforts are much appreciated. ENA Handling Psychiatric Emergencies is an evidencebased course with material that includes live-action videos and 16 modules enabling the learner to earn 10.58 continuing education credits. For more information on ENA Handling Psychiatric Emergencies, see the February issue of ENA Connection. For information on purchasing the course, call Elsevier at 866-416-6697. Resource ENA Position Statement: Medical Evaluation of Psychiatric Patients, 2010 (revised).

Official Magazine of the Emergency Nurses Association

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COLLABORATION NEMSAC Update

Exciting Projects That Affect Us By Mike Hastings, MSN, RN, CEN The most recent meeting of the National Emergency Medical Services Advisory Council was held in Washington, D.C., on Jan. 29-30. I was honored to represent emergency nurses on this distinguished panel as we discussed emergency medical services issues. The meeting was geared toward wrapping up some previous committee projects. These projects included Advisory on Leadership Developmental Planning in EMS; Advisory on NEMSIS: Achieving its Full Potential for

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Advancing Healthcare, Compiling Evidence to Discuss the EMS Education Agenda for the Future, Improving Internal NEMSAC Process, and providing feedback on the EMS Culture of Safety Strategy Document. We also heard about some of the work the National Highway Transportation Safety Administration is doing related to EMS. Some of these projects are very exciting for us in the emergency department, including promoting integration between EMS documentation and the hospital’s medical record, promotion of evidence-based guidelines and

statewide implementation of prehospital care guidelines. The last project has a goal of ensuring that no matter what service picks up a patient, the patient would receive the same treatment. Pilot projects are in place for two of these projects. Our next meeting will be held around April. As the committee continues its work, I will continue providing updates through ENA Connection. If you have any questions or feedback, send me an e-mail at mhastings2@kumc.edu. NEMSAC meeting details are also available at www.ems.gov/NEMSAC.htm.

Offering educational and networking opportunities for professionals caring for emergency patients. April 2013 For more information, visit www.ena.org.

BOARD WRITES | Marylou Killian, DNP, RN, FNP-BC, CEN Tag, You’re It!

How Safe Are Your Transitions of Care? One of the first things we learned in nursing school was that we had to receive report before we started to care for our patients and that we had to give report when we completed our shift. Our education regarding the process and content of our report varied depending on the schools we attended and the sites of our clinical experiences. I am certain that as practicing nurses each of us can recall how reports have evolved as well as at least one occasion when we received a very good report and an occasion when we received a poor report that may have impacted patient care. Whether we call it report, sign out, cross-coverage, or more recently, handoffs, transition in caregivers presents a crucial time in patient care. It has been estimated that 80 percent of medical errors begin during transitions of care.1,2 In the past decade more attention has been paid to how we can be more effective in our communications during this time. Accrediting agencies, such as the Joint Commission and DNV, now require that some standardized process be used during the handoff by institutions in an effort to increase patient safety.1,2 Handoffs can be defined as “the transition of responsibility and authority of patient care between caregivers where there is a transfer of information across the continuum of patient care.” 2 As emergency nurses, we are involved in many types of handoff communication, including transfers to and from other institutions, prehospital providers, transfer of patients from the emergency department to another department,

change of shift and even lunch and break coverage. During each one of these transitions there is a risk of miscommunication where vital information may be lost and our patients may be placed at risk. The requirement that institutions require a standardized process by accreditation bodies has brought about the use of various tools including: • ANTIC (administrative data, new clinical information, tasks that need to be performed, illness severity, contingency plans for changes in clinical status 3 • SBAR (situation, background, assessment, recommendations)5 • SHARQ (situation, history, assessment, recommendations, questions) 5 • IPASS the BATON (introduction, patient, assessment, situation, safety concerns, background, actions, timing, ownership, next)5 At this time there is not sufficient evidence to endorse one specific tool or method of handoff delivery; however the Joint Commission recommends specific tactics to make the use of tools more likely within institutions. These tactics consist of standardizing critical content so it can be easily accessed; identifying technologies to aid in patient handoffs; allowing the opportunity to ask questions; monitoring the use of the toll as a quality measurement; and the education with ongoing staff coaching regarding effective handoffs.1 The need to improve safety by developing more effective methods of transfer of care has been welldocumented. Our challenge now as

Official Magazine of the Emergency Nurses Association

emergency nurses is to help identify the most effective methods through research and promote the use of existing standardized tools by educating our co-workers. As the handoff process continues to evolve, we need to ask ourselves the following: • “Is the information that I am giving the next person sufficient for that person to take care of the individual patient and their family?” • “Is the report that I am receiving for the particular situation adequate for me to care for my patient, and if not, what else do I need to know to assure that I am delivering safe care?” Transitions of care are among the most perilous times for our patients, and they affect our ability to do our jobs competently. It is our job to ensure that these transitions are as safe as possible. References 1. Bowman, D. (2010, October 22). Joint Commission aims to improve patient handoffs. Fierce Healthcare. Retrieved from www.fiercehealthcare. com/story/joint-commission-aimsimprove-patient-hand-offs/2010-10-22 2. Friesen, M.A., White, S.V., Byers, J.F. (2008) Handoffs: Implications for nurses. In R. G. Hughes (Ed). Patient safety and quality: An evidence-based handbook for nurses. Rockville, MD: AHRQ. 3. AHRQ. (2012, October). Patient safety primer: Handoffs and signouts. Retrieved from www.psnet.ahrq.gov/ primer.aspx?primerID=9 4. Hohenhaus, S., Powell, S., & Hohenhaus, J. (2006) Enhancing patient safety during hand-offs: standardized communication and teamwork using the ‘SBAR’ method. American Journal of Nursing, 106, 72A–72B. 5. AORN. (2012). Patient hand off tool kit. Retrieved from www.aorn.org/ Clinical_Practice/ToolKits/Patient_ Hand_Off_Tool_Kit/Patient_Hand_Off_ Tool_Kit.aspx

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UPDATE FROM THE EXECUTIVE DIRECTOR |

Susan M. Hohenhaus, LPD, RN, CEN, FAEN

Behind the Scenes at ENA ENA continues to be a very busy place as we follow the 2012-2014 Strategic Plan and break new ground on several different fronts. ENA Connection is full of information about what the ENA board, staff and members are accomplishing for the association and for the profession of emergency nursing. I’d like to provide some additional behind-the-scenes information for you about how the ENA staff is accomplishing all that needs to be done. First, I’d like to acknowledge ENA’s Senior Executive Leadership Team. These exceptionally talented individuals work tirelessly with me to manage the business of ENA. Like a good team of athletes, they expend tremendous energy while making the work look pleasant and effortless. In the fourth quarter of 2012, ENA was represented at many different events, including the National Quality Forum Consensus Task Force, the College of Emergency Nursing Australasia and the American College of Emergency Physicians Scientific

Assembly and provided comments on other items, such as the American Nurses Association’s “Safe Patient Handling and Mobility Standards.” The ENA Executive Office manages the large volume of partnership and liaison requests and works with the Executive Committee of the ENA Board of Directors to schedule travel arrangements, coordinate with the external organizations and ENA representatives and assure follow-up with reports. The Executive Office also oversees ENA’s public relations and media opportunities. We are busier than ever, receiving record numbers of requests for partnerships and media consultations. ENA’s Social Media Team closely monitors and tracks our social media presence. Strategic and timely discussions are facilitated by the professional staff. ENA’s Facebook “likes” are now more than 20,000! Our Twitter account has more than 2,200 followers. We have close to 5,500 members on LinkedIn. The ENA President’s Blog, a new feature this

year by JoAnn Lazarus, MSN, RN, CEN, averaged more than 112 views per day in January, and readership grows every week. In the last week of January, Israel was the country to most frequently access the page outside of the U.S. Add this to the monitoring and maintenance of ENA listservs, which had more than 1.5 million visitors in 2012, and management of member e-blast communications, and it is a very busy team indeed. Our Information Technology Team, working with the Social Media Team (the “Men in Purple”), have been busy developing the ENA Leadership Conference app, managing and refining our member database and continuing their important work on stabilizing the infrastructure of ENA’s information network. They are also working on integrating the Emergency Nursing Pediatric Course with our Learning Management System and managing the technology of our remote access staff. Working with a technology consulting company, this team is also focused on the redesign

The 85-plus members of the ENA national office staff gathered last year to wish all ENA members a Happy Emergency Nurses Week.

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April 2013

and redeployment of the ENA website, which should occur mid-year. In the ENA Finance Department, staff manages wages and benefits and accounts receivable and payable — all the items you would expect any business to address to successfully oversee the operations of our $18  million-plus budget. They also manage state assessments and volunteer and staff travel expense processing, a daunting task with more than 30 committees, our two national conferences and other smaller meetings. ENA’s Education Department continues to oversee the development and implementation of free continuing education for members (10 courses in 2012 with a total of 14,340 registrations), the launch of the new edition of ENPC, partnering with Elsevier and the American Psychiatric Nurses Association on the new online Handling Psychiatric Emergencies program, ENA’s staffing guidelines revision (which should be available by the time you read this) and the new editions of Trauma Nursing Core Course, Geriatric Emergency Nursing Education and Course in Advanced Nursing Trauma. Connection staff is also housed in the Education Department, and as you can see, they have been busy working on the redesign of the physical publication as well as its content. I am thrilled with the quality writing and editing provided by this exceptional staff. The Institute of Emergency Nursing Research staff continues to collect and report data from our studies, including violence against emergency nurses, educational needs of emergency nurses in critical access hospitals and patient outcomes in immediate bedding vs. traditional triage. IENR also focuses on translational research by partnering with the American Hospital Association to reduce catheter-related urinary tract infections and working with the National Highway Traffic and Safety Administration and others on SBIRT mentorship.

In the fourth quarter of 2012, the Institute for Quality, Safety and Injury Prevention developed two topic briefs and two practice references, reviewed and revised ENA’s toolkit formats and partnered with the federal Emergency Medical Services for Children staff and the Society for Trauma Nursing to develop a pediatric inter-facility toolkit that will be housed in the EMS-C pediatric readiness toolkit. IQSIP’s director also provided technical review for four Centers for Medicare & Medicaid Services measures and quality metrics on regionalization of emergency care and infectious diseases. One of IQSIP’s most important tasks is the management of the Lantern Award process, which includes not only the development, review and monitoring of the Lantern Award applications, but also the collection and analysis of data contained in the applications. Working together, these three nursing departments (Education, IENR and IQSIP) are responsible for how we assess, plan and evaluate the practice of emergency nursing. ENA Foundation and Development staff members work together to recruit new sponsors and donors. In 2012, this team recruited more sponsorships and partnerships than in ENA’s history. This non-dues revenue helps to offset the costs of meeting attendance for members and allows for networking opportunities between nurses and corporate partners. These partnerships also assist the association in developing educational programs and other resources. In 2012, the ENA Foundation State Challenge campaign results broke all records, bringing in $116,700 and resulting on more scholarships for education and research. Many of you know that in December 2012 we hired a fulltime chief government relations officer. Richard Mereu, JD, MBA, began working in ENA’s D.C. office at 2121 K Street and hit the ground running, meeting with ACEP’s legislative staff

Official Magazine of the Emergency Nurses Association

(our office space is co-located with ACEP’s staff) and contacting other nursing and health care organizations, as well as members of Congress. And if you thought we weren’t busy enough, consider the work of ENA’s Member and Course Services Department, which manages membership queries, course operations (Trauma Nursing Core Course, Emergency Nursing Pediatric Course, etc.) and ENA’s Marketplace. This talented team has the most direct contact with members and other emergency nurses than any other department. In addition to their duties in answering the ENA phones, they managed the close to 6,000 TNCC and ENPC courses which were attended by 64,000 nurses in 2012. ENA, like you in your clinical settings, also has support staff that we’d be lost without. Our Building Maintenance staff members care for our building as if it were their own home; our Human Resources Team manages employee relations and benefits and recruits exceptional talent; and our mailroom staff keeps up with the continuous flow of incoming mail as well as outgoing mail and course materials. And you likely would not know much about our products, meetings and conferences without our great Marketing Department. Of course, were it not for our exceptional Meetings and Conference Team, we’d miss being together in fabulous cities, enjoying each other’s company and great educational and social sessions. I hope this update helps you to understand the tremendous amount of work that occurs at your ENA National Office. My plan is to provide these updates on a regular basis, so that along with the president’s message about the state of the profession of emergency nursing, you will also have information about the state of your professional association. Be safe,

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ENA Corkboard ENA recently asked its Facebook fans the following question: Do you have an inspirational, touching or humorous nursing story that you would like to share? In 100 words or less, tell us about the patient who never left you. Here are some of the responses:

patient and I rminal cancer te st fir y m as mfort her. She w say or do to co to t ha e w ow kn didn’t ry difficult. Com racking and ve ean rv th ne s ur as w ho e This ore in fiv e taught me m r sh he t, t ou ou d ab fin to e talked d in school. W ds the I’d ever learne t mine. Towar ou ab e m d ke as e a nurse life, and sh that she’d been ow kn e m t le end, she one point and oked down at lo he S s. de for deca s were very pants and shoe y m at th d ke remar student she’d rently the first pa ap as wI w I . white ok pride” in ho of her who “to re ca ep ke ke ta to d ha ntly try day, I consiste le looked. To this because peop – al on professi rd ha d ie cr I d myself looking ed away an ss pa nt tie t pa – at hear – notice. My taught me that he S . le hi w ions, make up for a long pass medicat u yo l el w w ho it’s not s the time you a computer. It’ on t ar ch or a bed se’s burden, in en someone el ss le to sence, try to take at you can. Pre ever small, th w but ho , g, ay in w th y an st you no d patience co persistence an Rue hing. can be everyt – Michelle La

This is n param ot my own edic fr story but a ie old-or st -so bo nd and his nurse ory of a y who pop m wife. A was t achin ryin 10 e condit ion af ended up in g to get in -yeart t e o r h from t he ne it fell onto h er unit in c a ck do r im it super ical . He w wn. vis a nobod ion for som He had live s paralyze d y d e care o came to vis time. From without it this f him m emory ch an husba , nd (m d then one ild. The nu rse to y d Well, f a r ie y n s ok h d) to c they h ome a e asked he it it of and h f r n . ad d mee Th th the nu real spunk is kid was truly s im. . It wa rse an pecia s at th d her and th l h is tim en ad e that opt th usband ap and h is boy plied as go to fos . This ne home ter boy and is to college and li is now a m in his of the an v es aw 20s. T patien ay fro h t that m never is really fit s left th e nurs the bill e, I th ink! – Gle nn Hi nes

I very recently had an experience that will forever be etched in my book that is my nursing career. Un expectedly, a panic ked mother carried her toddler into our hosp ital. This child had been hit by a car. We are never really prepared for the screams of pain fro ma heartbroken parent. I just saw a picture of this child smiling. My pa tients that day were the child and the mothe r. I took the mother’s arms, looked her in the ey es and reassured he r that we were parents an d that we all were the re working for her and her child. I will neve r forget her eyes looking ba ck at me and her ha nds on my arms. – Christine Parisea

ult, MSN, RN, CEN

Workplace Violence Prevention Online Courses FREE 4.75 Contact Hours for ENA Members

Go to ENA’s Center for e-Learning for these three online courses that discuss violence in the workplace and mitigation strategies. Nonmember price of $140.00

Working Together to Mitigate Workplace Violence by Dan Hartley, EdD, Workplace Violence Prevention Coordinator, NIOSH Division of Safety Research

Current Trends & Risk Management for Health Care and ED Violence by Bonnie Michelman, Director of Police, Security and Outside Services at Massachusetts General Hospital

Safe Approach for Managing & Preventing Workplace Violence by Roland Ouellette, Director of Training and Co-founder of SAM Training Each of the online courses is interactive and includes stop and think activities, knowledge checks, enhanced graphics, as well as links to additional information. The Emergency Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

These online courses are brought to you by In collaboration with

Thank you to our sponsor

Don’t miss out on these workplace violence prevention online courses. Visit www.ena.org and register. Official Magazine of the Emergency Nurses Association

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PEDIATRIC UPDATE | Elizabeth Stone Griffin, BS, RN, CPEN

Family Presence During Pediatric Resuscitation and Invasive Procedures A pediatric code rolls in; a 3-year-old boy was found unresponsive. For many emergency nurses, it’s our worst nightmare. Cardiopulmonary resuscitation is in progress and the health care team prepares to intubate him. How would you handle a request by his parents to be at his bedside? We asked members to comment on ENA’s Facebook page about how they supported families during pediatric resuscitations. Milagros Tabije-Ebuen, RN, explained, “We encourage family presence during resuscitation. This is very helpful because [if the patient does not survive] 1) it is easier for us to convey that their loved one passed away; 2) the grieving process starts sooner; 3) it is … easier for the family members to accept their loss; and 4) health care professionals act more professional when [the patient’s] family members are around.”

Common Concerns Regarding Family Presence: What Does The Literature Say? Many of us who work in emergency services are already accustomed to having the patient’s family members at the bedside; those of us who take care of pediatric patients experience this as the norm. However, when there is a pediatric code or pediatric trauma, some still question whether and when family presence is appropriate. Family presence is typically defined as the attendance of the family member(s) in a location that allows for visual or physical contact with the patient during a resuscitation intervention or invasive procedure.1 Concerns over interference with care, traumatizing the family, and fears that watching the resuscitation measures might increase the chance of litigation

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are just some issues that have prevented health care teams from encouraging family presence during pediatric resuscitation and invasive procedures.1 With the rise in patient- and family-centered care,2 hospitals nationwide are focused on increasing family input into care decisions, relaxing strict visitation policies and becoming more open to the concept of including family at the bedside during resuscitation measures and invasive procedures. ENA’s Emergency Nursing Resource on Family Presence During Invasive Procedures and Resuscitation in the Emergency Department3 reports on the results of a review of 117 research studies on the subject, including research on patient perspectives, family perspectives, health care professional perspectives and the question of interference with care, which is a common concern among members of the health care team. The ENR reveals that there is strong evidence showing that family members want to have the option to be present during invasive procedures and resuscitation, and there is also evidence that this does not interfere with patient care during invasive procedures or resuscitation. Furthermore,

April 2013

evidence exists that a designated health care professional should be assigned to the family members present to provide explanations and comfort.

A Child Psychologist’s Advice I sat down with Melissa Johnson, PhD, a pediatric psychologist at my hospital, to gain some insight into how emergency services staff can help support the needs of families with a critically ill child in the emergency department. She offered the following information and advice: 1) Families appreciate being offered the option of being in the room or at the bedside, regardless of their decision. 2) Memories are formed differently when experiencing a traumatic event. Using patient- and family-centered care, such as the option of family presence during resuscitation measures, can go a long way toward helping the family to cope if their loved one does not survive. They often report that they feel comforted by the experience because they know that “everything that could be done was done” for their child. 3) Designating a professional to be assigned to the family members and provide explanations and support, regardless of whether they choose to stay in the room, is critical. 4) Simple things mean a lot — a chair, a blanket, an offer of food or drink. These family members are under tremendous stress and may forget to meet their own basic needs. 5) If there is a sibling who wants to visit the patient (at an appropriate time and if their parents support this) try to find someone who understands the sibling’s developmental level (child life specialist, chaplain, social worker, nurse) to explore his or her understanding of what is happening. Do not assume that the child does not want to see an ill or injured sibling, or that it would be detrimental to the healthy sibling; someone should ask the child what he or she wants to do. With thorough, developmentally appropriate preparation and explanation of what he or she will see, visiting a sibling can be a very meaningful experience and can actually help the grieving process if the patient does not survive. Siblings often have very specific plans and requests, such as wanting to draw a picture to give to their sister or brother. Patient- and family-centered care has been recognized by the Emergency Nurses Association, the American College of Emergency Physicians and the American Academy of Pediatrics as a standard of practice.3-5 ENA supports the option of family presence during invasive procedures and resuscitation to appropriate family members and suggests a

written institution policy be in place to support this practice.3,4 References 1. Mangurten, J., Scott, S., Guzzetta, C., Clark, A., Vinson, L., Sperry, J., ... Voelmeck, W. (2006). Effects of family presence during resuscitation and invasive procedures in a pediatric emergency department. Journal of Emergency Nursing, 32(3), 225–233. 2. Institute for Patient- and Family-centered Care. (n.d.). Home page. Retrieved from www.ipfcc.org 3. Egging, D., Crowley, M., Arruda, T., Proehl, J., WalkerCillo, G., Papa, A., ... Walsh, J. (2009). Emergency nursing resource: Family presence during invasive procedures and resuscitation in the emergency department. Retrieved from www.ena.org/IENR/ENR/ Documents/FamilyPresenceENR.pdf 4. Emergency Nurses Association. (2010). Family presence during invasive procedures and resuscitation in the emergency department [archived position statement]. Retrieved from www.ena.org/SiteCollection Documents/Position%20Statements/ FamilyPresence.pdf 5. American Academy of Pediatrics Committee on Pediatric Emergency Medicine, American College of Emergency Physicians Pediatric Emergency Medicine Committee, O’Malley, P., Brown, K., & Mace, S. E. (2006). Patientand family-centered care and the role of the emergency physician providing care to a child in the emergency department. Pediatrics, 118(5), 2242–2244.

ENA Workplace Violence Prevention Training ENA is looking for 35 participants to test this exciting new training program this summer. Participants can be staff nurses, managers, or security personnel. The four-hour training sessions will be held on June 4. Please contact the Institute for Emergency Nursing Research at IENR@ena.org

workplace_violence_prev_Ad.indd Official Magazine of the Emergency Nurses Association

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he World Health Organization defines wellness as ‘‘the optimal state of health of individuals and groups.’’ There are two focal concerns: the realization of the fullest potential of an individual physically, psychologically, socially, spiritually and economically, and the fulfillment of one’s role expectations “in the family, community, place of worship, workplace and other settings.” 1 ENA supports this definition of wellness and believes the key to achieving and sustaining a state of wellness is balancing physical wellness, social wellness, psychological wellness, spiritual wellness, economic wellness, family relationships, community involvement and a healthy workplace. Finding the time and energy to balance these eight components of wellness may seem like a lot to juggle, but there are small steps you can take

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to incorporate these components into your life on a regular basis.

Social The people you communicate and interact with on a regular basis, from family members and neighbors to co-workers and those in your social groups, all play a part in your social wellness. Social wellness focuses on the interdependency people have on each other, and developing good social health involves having the ability to listen, engage in positive communication and seek out and establish meaningful interactions and relationships with others. Wellness Tip: Establish and maintain healthy and positive relationships in your personal and professional life by making time in your schedule for family and friends and expanding your social network. Avoid and let go of the negative relationships that bring unnecessary stress into your life. Create a positive support system at work and at home.

Healthy Workplace Working 12-hour days in an unhealthy environment can take a toll on your physical and mental health. According to the WHO, ‘‘ … every citizen of the world has the right to healthy and safe work; a right to a work environment that enables him or her to live a socially and economically productive life.’’ Wellness Tip: To establish a healthy workplace, make sure that you and your colleagues are taking care of yourselves and each other. Take time to debrief after a traumatic event. Encourage your colleagues to talk to someone if they are having a difficult day. Be cognizant of signs of compassion fatigue and burnout in yourself and your coworkers. Create a work culture of wellness by paying attention to workplace injury prevention and assessing your emergency department to improve safety measures and identify risks for workplace violence.

Spiritual Happiness, fulfillment and enrichment

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are all components of spiritual wellness, which is a component of physical and mental health. Spiritual wellness is unique and personal to each individual and often involves the ‘‘why’’ of our lives and discovering the sense of meaning, purpose and awareness. Spiritual wellness is often driven by people’s personal values, beliefs and experiences, as well as how they perceive themselves and contribute to humanity. Wellness Tip: Whether it’s through prayer, religion, meditation, nature or yoga, connect to the things that bring peace into your life. Make time to incorporate quiet moments into your daily schedule to reflect and recharge, even if it’s for five minutes. Steer clear of negativity.

Family Relationships There is no one definition of what constitutes a family, and this term is undergoing a transformation. Wellness Tip: Strengthen the relationship and improve wellness of the entire family by making time for each other and keeping communication open. Other tips include eating one meal per day together, setting financial goals together, planning date nights and maintaining a healthy physical relationship.

Physical Exercising regularly, getting the proper amount of sleep and eating a healthy diet are all factors that contribute to being physically healthy. Research states that maintaining a healthy lifestyle and avoiding negative health behaviors (such as smoking and drug/ alcohol abuse) not only promotes weight loss but it also helps to prevent diseases. Wellness Tip: According to the Centers for Disease Control and Prevention, individuals should get 150 minutes per week of moderate exercise. If this seems daunting, try breaking the recommended time into 10-minute increments throughout your day (three times a day/five days a week). Opt to take the stairs instead of

the elevator whenever possible. Avoid the vending machine and take healthy snacks to work, such as almonds, fruit and raw vegetables. When planning your meals, refer to the USDA’s new recommended food icon and resources website (www.choosemyplate.gov), which replaced the food pyramid.

Psychological Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community. Wellness Tip: Work toward a positive attitude or thinking. Learn how to reduce and cope with stress effectively. Find ways to de-stress, such as confiding in a trusted coworker/ friend or family member or taking a walk to clear your mind. Stimulate your brain by learning something new — such as reading a book, taking a new class or attending a conference, such as the 2013 ENA Annual Conference in Nashville, Tenn.

Economic Do you know how much you should save for retirement or how much money you need in your emergency fund? Financial attitudes, behavior, management and satisfaction are all dimensions of economic wellness. Good economic health is measured as a balance of income, savings and expenditures/consumption while always being prepared for a financial change (such as an illness or injury that could prevent you from working). Wellness Tip: Take a moment to think about your financial attitudes, behavior and knowledge. Assess different financial aspects of your life, such as preparedness for financial emergencies, available finances for family necessities, the amount of debt, long-term goals (retirement) and short-term goals (vacation). Seek out a professional for financial guidance if you need advice on your financial situation or if it is causing you stress.

Official Magazine of the Emergency Nurses Association

Community Involvement According to the WHO, a community is a specific group of people, often living in a defined geographical area, who share a common culture, values and norms, and are arranged in a social structure according to relationships which the community has developed over a period of time. They exhibit some awareness of their identity as a group, and share common needs and a commitment to meeting them. Briana Quinn, MPH, BSN, RN, ENA senior associate, wellness injury prevention, said being involved in the community is something emergency nurses can successfully accomplish through multiple avenues. “By doing so, we can gain a sense of fulfillment by applying our knowledge and skills outside of the emergency department,” she said. Wellness Tip: Quinn recommends becoming involved in outreach programs. “Emergency nurses are uniquely positioned to become involved in outreach programs to their communities. Types of outreach programs include fall prevention, hand hygiene and programs specific to issues in individual communities.” Quinn notes the importance of making time for wellness. She said, “It’s not always easy or convenient to make time for wellness in your life, but what’s most important is to make a conscious effort to dedicate some time for the components in your life as much as you can on a daily basis. Taking five minutes for yourself may seem daunting, but those five minutes can make a difference and be a solid start. Even a little bit of energy dedicated to wellness every day can lead to a positive change in the way you feel. The key is to have fun and enjoy your efforts toward wellness.’’ Reference Smith, B.J., Cho Tang, K., Nutbeam, D. (2006). WHO health promotion glossary: new terms. Health Promotion International, 21(4); 340-5.

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Meet the Academy of Emergency Nursing 2013 Board The Academy of Emergency Nursing is pleased to present the 2013 Academy Board of Directors; these directors assumed office Jan. 1. Your 2013 AEN Board is exploring ways to grow AEN Fellow involvement, visibility and build financial viability. The Academy of Emergency Nursing honors nurses who: • Have made specific, enduring, substantial and sustained contributions to the field of emergency nursing • Advance the profession of emergency nursing, including the health care system in which emergency nursing is delivered • 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.

2013 Chairperson

2013 Chairperson-elect

Kathleen Flarity, DNP, PhD, CEN, CFRN, FAEN,

Maureen Curtis Cooper, BSN, RN, CEN, CPEN, FAEN, Pediatric emergency

Colonel/commander, 302d Aeromedical Staging Squadron, Peterson Air Force Base, Colo., emergency clinical nurse specialist, Memorial Hospital University of Colorado Health, Colorado Springs, Colo. Member of the Colorado ENA State Council.

department staff nurse, Boston Medical Center. Past-president of the Massachusetts ENA State Council, member of the ENA Beacon Chapter.

2013 Member-at-Large

2013-2014 Member-at-Large Nancy Bonalumi, MS, RN, CEN, FAEN, Consultant at Blue Jay Consulting in Orlando, Fla. Past President of Pennsylvania ENA State Council and 2006 ENA President. Member of the Pennsylvania ENA State Council and the ENA Capital Area Chapter.

Andrea Novak, PhD, RN-BC, FAEN, Administrator for Nursing & Interdisciplinary Continuing Education at Southern Regional AHEC in Fayetteville, N.C. 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.

2013 Ex-Officio Member Vicki Sweet, MSN, RN, CEN, CCRN, FAEN, CQI liaison for County of Orange, Emergency Medical Services. Adjunct faculty at California State University, San Marcos, School of Nursing. Member of the California ENA State Council and the Orange Coast 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 a minimum of 5 to 10 hours per month to their project. Mentees must apply for the program with a specific project in mind. Projects include, but are not limited to, the following areas: • Advanced practice role development • Educational conference planning • Grant writing • Health policy • Injury prevention (SBIRT procedure) • Professional presentations

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• 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.

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t io a c u d E

The Goal is Simple Help emergency nurses get the education they need. Shout out for the future of your profession by making a donation to the ENA Foundation. Your donation will help your state council’s chances towards the following awards.

Challenge Awards Largest percentage increase per capita: 1st Place - $250 ENA Marketplace gift certificate 2nd Place - $100 ENA Marketplace gift certificate

Largest number of individual donations per state: 1st Place - $250 ENA Marketplace gift certificate 2nd Place - $100 ENA Marketplace gift certificate

Donate Now Visit www.ENAFoundation.org for more detailed information on the State Challenge campaign and for updates on where your state stands in the challenge race.

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ENA Foundation 2013 State Challenge

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t forNursing u O Emergency T S HOU y Nursing c nEducation e g r e m n

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ENA STATE CONNECTION North Carolina ENA State Council Submitted by Mary Lou Forster Resch, BSN, RN, CEN We would like to acknowledge Natalia Ghidora, RN, North Carolina ENA Membership chairperson, as the recipient of the 2012 North Carolina ENA President’s Award. In 2012, NC ENA gained more than 200 new members. The state council thanks Ghidora for all of her hard work. NC ENA members LeeAine K. Powell, MHA, BSN, RN CPEN, and Nancy S. Summerell, MSN, RN, CEN, won fall 2012 membership blitzes. They each received a one-year ENA membership.

State Council and Chapter Meetings and Events Illinois ENA State Council The Illinois ENA is holding its 39th Annual Spring Symposium on April 11–12 at the Wyndham Hotel in Lisle, Ill. For more information, visit www.illinoisena.org. Massachusetts State Council The Massachusetts ENA State Council is hosting the

ENA Foundation

and Michael Frakes. For program and registration information, visit www.ma-ena.org. New York State Council The New York ENA State Council is hosting its Setting the Pace 2013 conference April 11-12 at The Doubletree by Hilton at Tarrytown, N.Y. Keynote speakers include Jeff Solheim and Debra Delaney. For program and registration information, visit www.nysena.org. North Carolina State Council The North Carolina State Council will host the ninth annual North Carolina ENA Conference in November at the Holiday Inn in Wrightsville Beach, N.C. For more information, visit www.nc-ena.com.

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possible through the generosity of state councils, chapters and individuals who contributed to the 2011 State Challenge campaign. The 2013 State Challenge theme is “Shout Out For Emergency Nursing Education.” The State Challenge kicked off Feb. 1 and will end on May 31. You can make a difference in the lives of future nurses, like Carlen, by making a donation to the ENA Foundation State Challenge today. “You never know when the money that you’re donating is going to help somebody else, whether you directly receive something or not from the ENA Foundation. Know that the money that you contribute is going to make better emergency nurses and make things better for all of us. In our state, we have a small but active group of people with ENA. If everybody gives just a little bit, you could have a pretty big response,” Carlen said. Your donation to the 2013 State Challenge will keep the ball rolling. Every dollar amount counts, so challenge yourself, your state council and your colleagues to take things up a notch and make this year’s state challenge bigger than last year’s (which raised $116,702.10). Every donation creates a shout out for emergency nursing education by helping your fellow emergency nurses reach their potential through educational opportunities, which in turn advances the

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annual New England Regional Symposium April 24-25 in Plymouth, Mass., at the Radisson Hotel Plymouth Harbor. Speakers include Suzanne O’Connor, Debra Delaney, Lisa Wolf, Marylou Killian, Chuck Margarites

emergency nursing profession. By becoming a donor, you can help equip emergency nurses with education to improve caring for a sick child, treating pain in an elderly patient, providing proper treatment for sexual assault victims, discovering heart-failure best practices and much more. For more information on how can you contribute to the 2013 State Challenge and make a difference in emergency departments across the globe, please visit www.ENAFoundation.org.

April 2013

ENA wishes to express its sincere gratitude to these 2013 sponsors.* Thanks to their generous support, ENA is able to continue to provide relevant services and educational programs to improve your practice of emergency nursing.

Strategic Sponsors

Strategic Supporter

Leadership Conference Supporters

*As of print time

Official Magazine of the Emergency Nurses Association

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WASHINGTON WATCH | Richard Mereu, JD, MBA, ENA Chief Government Relations Officer

Washington Heads Toward Fiscal Crisis, Endangering Programs for Nurses The next six weeks are a make-or-break time for Congress and the Obama Administration as they try to put our nation’s fiscal house in order and avert drastic spending cuts or worse. The implications for emergency nursing, and more generally the entire health care system, could not be more serious. In fact, the worst-case scenario could lead to a government shutdown of programs dealing with mental health services, medical research and nurse education grants. Here are the approaching deadlines and what they could mean for ENA members.

Sequester The Budget Control Act of 2011 requires automatic, acrossthe-board spending cuts to domestic and defense programs if Congress cannot come to an agreement on a long-term deficit reduction plan. The March 1 deadline for reaching a deal to avoid these cuts has come and gone. Now, Congress must try to reach a plan to stop the full effects of sequestration from harming the economy. There are now three choices for Congress: allow the sequester to go forward, kick the can down the road with another short-term extension or replace the budget cuts contained in the sequester with other reductions in federal spending. Sequestration would mean not only cuts to federal spending of $1.2 trillion over 10 years, including $85 billion in 2013, but it would devastate programs that directly impact nurses and the health care system. Take, for example, the support for Title VIII Nursing Workforce Development programs. These programs, which are administered by the Health Resources and Services Administration, are the main source of federal funding for nursing education in the United States. Grants awarded under Title VIII offer financial support for nursing education programs, students of nursing and nurses. They provide critical resources for nursing education at all levels, from undergraduate to graduate-level studies. If sequestration is allowed to continue, more than 4,000 nurses and nursing students will be denied scholarships and training opportunities. In addition, there will be 645 fewer training slots for nurses who are pursing graduate-level education through the Advance Nursing Education program and 872 fewer positions for underrepresented and disadvantaged nursing students.

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The impact will also hit educational institutions that educate the future workforce of nurses. Cuts in the Nurse Faculty Loan Program will result in 127 fewer nursing faculty members, while reductions in the scholarship programs mean that 8 percent fewer nursing students will receive financial aid.

Funding for Fiscal Year 2013 Now that the sequester has gone into effect, the next major deadline is March 27. On that date, the government’s authority to spend money in fiscal year 2013 runs out. Unlike the sequester, a deal to continue funding the government, including health care programs, is likely. This would avert a government shutdown, which would have an immediate, negative impact on programs such as Title VIII nurse education grants, research being conducted at the National Institutes of Health, and programs related in injury prevention and mental health services at the Centers for Disease Control, the Substance Abuse and Mental Health Services Administration and HRSA.

Debt Ceiling Finally, in mid-May Congress faces a third potential fiscal crisis. Earlier this year, when the federal government was approaching its $16.4 billion debt ceiling, Congress approved a bill to suspend the limit until May 19. If the debt ceiling is not raised by that date, the government faces a default on its obligations and would likely send the country into another recession. Once again, if this were to occur, key programs impacting emergency nurses and the overall health care system would experience sharp cuts.

April 2013

Although the details of these various budget fights in Washington can be difficult to follow, their effect on the day-to-day functioning of our government and, by extension, programs that impact the emergency nursing profession are very real and very significant. The ENA Government Relations Team will work closely with coalitions of like-minded professional groups in our nation’s capital to urge lawmakers to find common-sense alternatives to the damage inflicted to our economy and the health care system by sequestration, a government shutdown or reaching the defaulting on our government’s debts. Just as importantly, as the president and Congressional leaders continue their efforts to reach a long-term solution to the federal deficit, ENA will work with our elected representatives to ensure that cuts are done in a responsible, fair manner. While all parts of the federal budget will be affected, programs that are critical to the health care and well-being of Americans should not face a disproportionate share of the reductions.

CALL FOR ...

ENA is looking to fill openings on the 2014 Annual Conference Committee, International Delegate Review Committee and Resolutions Committee. ENA members are invited to submit their applications online. View the ‘‘Calls and Opportunities’’ area at www.ena.org for the applications and details of these committees. Online applications are being accepted through Tuesday, April 30, at 5 p.m. Central time.

The 2014 ENA Annual Conference will be held in Indianapolis at the Indiana Convention Center, Oct. 7–11. While not required, a photo is requested with your application. Photos don’t have to be professionally done; a quick snap from your smartphone will work Look for instructions on how to upload your photo when applying for your committee choice. For questions, please contact Committees@ENA.org.

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Official Magazine of the Emergency Nurses Association

3/7/13 11:09 AM

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ENA Connection April 2013