ENA Connection, December 2014

the Official Magazine of the Emergency Nurses Association

connection

December 2014 Volume 38, Issue 11

Show of Hands Emergency Nurses Rush to the Front on Ebola, Advocacy Issues, Safer Practice

36 PAGES OF ANNUAL CONFERENCE COVERAGE INSIDE!

Comprehensive Online Course to Help Improve Patient Outcomes for Older Adults The New Geriatric Course Provides the Tools to: § Assess special needs of older adults

§ Implement best geriatric practices § Coordinate care for better patient outcomes

§ 17 Interactive Modules

§ 15.21 Contact Hours

§ Geriatric Evidence-based Research

Purchase Today Group Pricing Available

www.ena.org/GENE or 847.460.4073 The Emergency Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Dates to Remember Feb. 4, 2015 Deadline for applications for 2015 ENA Annual Achievement Awards Feb. 25, 2015 Deadline to apply for 2015 Lantern Award

ENA Exclusives PAGE 5 ENA Research: Emergency Nurses’ Obligations in the Face of Ebola PAGE 8 Washington Watch: ENA Support Pays Off on EMS for Children Program PAGES 10 - 45 2014 Annual Conference Section 10 General Assembly 15 Town Hall Meeting 16 Anita Dorr Memorial Lecture

and Luncheon 17 Opening Session 18 General Session 20 Wellness Booth, Exhibit Hall 22 Educational Sessions 30 Welcome to Indy Party 32 The Power of One:

An ENA Foundation Event 34 Poster Winners 36 Annual Awards Gala 38 Annual Award Recipients 39 Academy of Emergency Nursing Inductees 40 Lantern Award Recipients 43 Closing Session

Regular Features PAGE 4 Free CE of the Month PAGE 6 ENA Foundation PAGE 46 Board Writes PAGE 48 ENA Committees

FROM THE PRESIDENT |

Deena Brecher, MSN, RN, APN, ACNS-BC, CEN, CPEN

A New Beginning I

t’s hard to believe I’m writing my final ENA Connection column as president of ENA. To say that this year has been amazing would be an understatement.

Back in January, I asked all of you to change the way you thought about patient safety. I asked you to make a New Year’s resolution to change something about your practice that would keep your patients and yourselves safer, and I asked you to share what you have done or changed.

Over the last 12 months, many of you have shared your stories with me. Some of you changed your habits around handoff, understanding that when you hand off a patient, you are transferring authority and accountability. Many of you have instituted great catch programs recognizing reporting of near misses to allow for system improvements before an error gets to a patient.

I have heard stories about adding patient safety rounds every shift and identifying opportunities to improve systems in the moment and make them safer. Emergency nurses have shared how they used to work around their barcoding systems and how they have stopped that risky behavior. I have heard many stories about times when we were at the sharp end of an error, and what was learned from those experiences.

To all who have shared their stories with me, I thank you. I also thank you for reading my stories about patient safety all year.

When I started this journey and chose patient safety as my platform, my goal was that somewhere, one emergency nurse would have done something different and prevented a fatal error. I believe we have accomplished that goal.

I often was asked about my legacy as the 2014 president of ENA. I wanted to start the conversation about safety in the ED and illustrate many of the ways that emergency nurses directly impact the safety of their patients and themselves. If my legacy is the start of the conversation, then I need all of you to continue it. The end of the year does not mean that patient safety resolutions are no longer important. If anything, it is more important now than it was in January.

The habits you have changed need to continue. Continue to advocate on behalf of your patients for safe practice and safe care. Zero errors in the emergency department should be our next goal. To achieve that goal, we are going to need to continue to change and evolve.

We are emergency nurses, and I have no doubt it is a goal we will achieve by working together, stepping up and speaking out.

Thank you for all you do to care for our patients and keep them safe. You all make a difference, each and every day!

Sentinel events in the ED involving behavioral health patients are increasing. The latest free continuing education course from ENA will help you to stay ahead of these events with the right preparation.

Available to you starting Dec. 1 . . . ‘‘ED/Behavioral Health Collaboration for Excellence,” presented by Susie M. Law, MBA, BSN, RN, and Sue M. Cadwell, MSN, RN, NE-BC. This session emphasizes the need for recognition of high-risk behavioral health situations. You’ll get insight into the development of patient safety plans — an essential part of behavioral health patient treatment — as well as ways to keep staff safe.

To take this and other eLearning courses free as an ENA member: •G o to www.ena.org/freeCE, where you’ll log in as a member (or create an account).

• Add desired courses to your cart and select ‘‘check out.’’

• Proceed to your Personal Learning Page to start or complete any course for which you have registered or to print a final certificate.

• To return to your Personal Learning Page later, go to www.ena.org and find ‘‘Go to Personal Learning Page’’ under the Education tab.

Be sure you are using the e-mail address associated with your membership when logging in. If you have questions about any free eLearning course or the checkout process, e-mail 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 ©2014 by the Emergency Nurses Association. Printed in the U.S.A. Periodicals postage paid at the Des Plaines, IL, Post Office and additional mailing offices.

The ENA Connection App Has Arrived!

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NA Connection is thrilled to announce the launch of its first digital app, which will allow readers to enjoy ENA’s official membership magazine from their mobile phones, tablets and other electronic devices — anytime, anywhere. The new user-friendly digital version will serve as a supplement to ENA Connection’s print edition, giving members an interactive, enriched experience that will include the following features: • Bookmark your favorite articles • Browse back issues (May 2014 and on) • Share articles via e-mail or social media

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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: membership@ena.org

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

For editorial inquiries, e-mail connection@ena.org

You can find a link to the app at www.ena.org/ publications/connection or download it through Google Play, iTunes or Amazon (searching for ENA Connection).

We’ll have more information on the app in the future after the initial release.

Publisher: Kathy Szumanski, MSN, RN, NE-BC Editor-in-Chief: Amy Carpenter Aquino Associate Editor: Josh Gaby Senior Writer: Kendra Y. Mims

BOARD OF DIRECTORS Officers: President: Deena Brecher, MSN, RN, APN, ACNS-BC, CEN, CPEN President-elect: Matthew F. Powers, MS, BSN, RN, MICP, CEN

Secretary/Treasurer: Kathleen E. Carlson, MSN, RN, CEN, FAEN Immediate Past President: JoAnn Lazarus, MSN, RN, CEN Directors: Ellen (Ellie) H. Encapera, RN, CEN Mitch Jewett, AA, RN, CEN, CPEN Michael D. Moon, PhD, MSN, RN, CNS-CC, CEN, FAEN Sally K. Snow, BSN, RN, CPEN, FAEN Jeff Solheim, MSN, RN-BC, CEN, CFRN, FAEN Joan Somes, PhD, MSN, RN-BC, CEN, CPEN, FAEN, NREMT-P Karen K. Wiley, MSN, RN, CEN Executive Director: Susan M. Hohenhaus, LPD, RN, CEN, FAEN

ENA RESEARCH | Lisa Wolf, PhD, RN, CEN, FAEN, Director of the Institute for Emergency Nursing Research

Emergency Nurses’ Obligations in the Face of Ebola E

mergency nurses are generally prepared to manage emergencies and disasters of all kinds. The recent emergence of Ebola in the developed world, however, clearly highlights the need for professional, evidence-based practice.

Ebola virus disease belongs to a category of viruses called Filoviruses and causes what are called hemorrhagic fevers. The natural reservoir remains unknown, but on the basis of evidence and the nature of similar viruses such as Marburg, researchers believe the virus is animal-borne and that bats are most likely the reservoir.

It is spread via blood and body fluids (including urine, saliva, sweat, feces, vomit, breast milk and semen), contaminated objects such as needles and syringes, or contact with infected fruit bats or nonhuman primates. It is not spread via water or air. Healthcare workers are at a higher risk of transmission because they may come into contact with blood or body fluids of infected patients.

The Ebola outbreak in West Africa began in March 2014 and now encompasses the countries of Guinea, Liberia and Sierra Leone. Countries with travel-associated cases include Mali and Senegal. Countries with limited transmission include Nigeria, Spain and the U.S. In August 2014, two American missionary healthcare personnel who had contracted Ebola were brought to Emory University in Atlanta for treatment. Both survived.

However, there was increasing media traffic about conspiracies, terrorism, government crackdowns and a supposed plan to force all Americans

to get vaccinated. There was fear the virus could be contracted in the air or by touching someone. Anyone who was older than 13 in the 1980s might find this conversation familiar — it’s the same sort of conversation that took place about the emergence of HIV. Kristine Qureshi, DNSc, RN, APHN-BC, CEN, and her colleagues have done work exploring the willingness of emergency nurses to take part in caring for patients during a disaster or pandemic. They found that nurses were able to come to work in equal numbers for natural disasters (snowstorm) and medical disasters (SARS, flu pandemic) but were significantly less willing to do so during a SARS epidemic. It is not unreasonable to wonder if emergency nurses would, in an atmosphere of misinformation and panic, not report to work.

The evidence regarding care of the patient with Ebola can be summarized as follows: Any U.S. hospital that is following the Centers for Disease Control and Prevention’s infection control recommendations and can isolate a patient in his or her own room with a private bathroom is capable of safely managing a patient with Ebola.

The updated recommendations for preventing transmission can be found in full on the CDC website at tinyurl. com/CDCebolaguide or by scanning the QR code at left. The most current recommendations for personal protective equipment can be found at tinyurl.com/ cdc-ebolaPPE or by scanning the code at right.

The idea that anyone

Official Magazine of the Emergency Nurses Association

can bring a potentially lethal disease into the United States in the time it takes to fly across the ocean is frightening. The obligation of emergency nurses, as the front-line care providers, is to thoughtfully assess each patient, follow CDC guidelines for their care to protect both patient and healthcare workers, and to take reasonable precautions without panic.

Resources U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.

(2014). Infection prevention and control recommendations for hospitalized patients with known or suspected Ebola virus disease in U.S. hospitals. Retrieved from http://www.cdc.gov/ vhf/ebola/hcp/infection-prevention-and-controlrecommendations.html. Accessed Oct. 28, 2014.

Qureshi, K., Gershon, R. R., Sherman, M. F., Straub, T., Gebbie, E., McCollum, M.,…Morse, S.S. (2005). Health care workers’ ability and willingness to report to duty during catastrophic disasters. Journal of Urban Health, 82(3), 378–388. Retrieved from http://www.ceep.ca/ education/HCW_Ability_Wlingness_Report.pdf.

Accessed Oct. 28, 2014.

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ENA FOUNDATION | Seleem Choudhury, MBA, MSN, RN, CEN, FAEN, 2014 ENA Foundation Chairperson

Two of the featured guests, Shannon Ward, RN (left), and Greg Higgins, MD (right), chat with presenter Jeff Solheim, MSN, RN-BC, CEN, CFRN, FAEN, during “The Power of One” in Indianapolis on Oct. 10. See page 32 for more on the event.

We’ll Write This Story Together I

f I learned one thing from Jeff Solheim’s inspirational ENA Foundation ‘‘Power of One’’ event at the 2014 ENA Annual Conference, it’s that storytelling is an effective way to empower others. As children, we learn that storytelling is part of our life; it’s inherent to many cultures and it helps to drive positive change. It’s through storytelling that we learn of love, loss, heroes and losers. It impacts the heart and helps us make sense of the world. Storytelling makes the unimaginable imaginable.

As emergency nurses, we hear stories every day. When a patient presents to the emergency department, we hear the story of the patient’s pain, injury or illness. These stories drive our responses and our actions.

I want to tell you a story about the ENA Foundation and the many nurses who are recipients of the academic scholarships, professional development and research grants.

These stories often begin with how much satisfaction I get from calling recipients and telling them of their success in receiving their award. However, this story begins differently.

At the General Assembly in Indianapolis, I was approached by countless people. These encounters occurred anywhere — in the corridor, on the dance floor, during dinner, in the elevator and at the gym — and were with different emergency nurses from all over the country who told me two things: First, they were grateful to the ENA Foundation and to all of the nurses and sponsors who donate money that make the awards possible, and second, how the award changed their lives. I was stunned, privileged and a little overwhelmed by the positivity aimed at me. After

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all, the real work of the foundation is done by so many, from the staff at ENA headquarters to the ENA Foundation Board of Trustees and our corporate sponsors.

It reminded me of the ‘‘Power of One’’ event. Each of us has the power to make a difference, and it doesn’t have to be in a foreign country or a trauma room. It can begin with donating money so others can improve their knowledge or undertake a research study to improve our practice.

I believe the act of helping others can create an improved sense of well-being. It’s that selfless giving to others that can make a difference in their lives. The people who share their stories of gratitude are a product of that generosity.

It was such a privilege to hear ENA Foundation scholarship and research grant recipients share their stories of how the foundation helped them. Their gratitude was magical as they searched for the right words to describe their emotions when they heard they had received a scholarship. Hearing their stories was a priceless experience; you can share in it by becoming a part of the story when you give to the foundation.

If you and everyone else donate, we can continue to make a difference and be the hero for other emergency nurses. Visit www.enafoundation.org today to give your best donation so that we can continue telling and creating stories that will advance and shape our profession.

If you are an ENA Foundation academic scholarship or grant recipient and you would like to share your experience, e-mail connection@ena.org for a chance to have your story told in an upcoming issue.

December 2014

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References: 1. Rogers JJ, Fox M, Miller LJ, Philbeck TE. Safety of intraosseous vascular access in the 21st century [WoCoVA abstract O-079]. J Vasc Access. 2012;13(2): 1A-40A. 2. Paxton JH, Knuth TE, Klausner HA. Proximal humerus intraosseous infusion: a preferred emergency venous access. J Trauma. 2009;67(3):1-7. 3. Cooper BR, Mahoney PF, Hodgetts TJ, Mellor A. Intra-osseous access (Ez-IO ® ) for resuscitation: UK military combat experience. J R Army Med Corps. 2007; 153(4):314-316. 4. Dolister M, Miller S, Borron S, et al. Intraosseous vascular access is safe, effective and costs less than central venous catheters for patients in the hospital setting [published online ahead of print January 3, 2013]. J Vasc Access. doi:10.5301/jva.5000130. *Research sponsored by the Vidacare Corporation.

Teleflex and EZ-IO are trademarks or registered trademarks of Teleflex Incorporated or its affiliates. © 2014 Teleflex Incorporated. 2014-2673

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

Our Support Pays Off Bill to Continue EMS for Children Program Signed Into Law

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egislation that provides continued federal funding for the Emergency Medical Services for Children program was recently signed into law by President Obama. The legislation was strongly supported by ENA, which worked to ensure its passage in the House of Representatives and Senate.

The bill, known as the Emergency Medical Services for Children Reauthorization Act, makes available $20.2 million each year for the EMSC program through 2019. Started by Congress 30 years ago, the EMSC program is the only federal program that focuses specifically on improving the pediatric components of the emergency medical services system. Its goal is to reduce child and youth mortality and morbidity caused by severe illness or trauma.

Through several grant programs, the EMSC program has improved access to high-quality emergency medical care for children who are ill or injured. The most extensive is the EMSC State Partnership Program, which has provided funding to all 50 states to help train and educate EMS providers and emergency department staff, as well as to develop pediatric protocols and guidelines.

In addition, the EMSC program supports the Washington, D.C.-based EMSC National Resource Center, which serves as a repository of data collected by research centers throughout the country. In turn, the Resource Center helps state EMSC officials to evaluate the effectiveness of EMS systems and improve patient care.

Finally, the legislation will help to fund the Pediatric Emergency Care

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Applied Research Network, which conducts research on the efficacy of treatments, transport and care responses in emergency care settings, including those preceding the arrival of children to hospital emergency departments. Additionally, PECARN facilitates collaboration among pediatric researchers to enable them to perform statistically valid studies with national applications.

In the U.S. Senate, the Emergency Medical Services for Children Reauthorization Act was introduced by Sens. Bob Casey (D-Penn.) and Orrin Hatch (R-Utah). The Health, Education, Labor and Pensions Committee passed the EMSC legislation on July 23, and then the entire Senate passed the bill on Sept. 9.

After Senate approval, the EMSC bill was sent to the House, which passed

the bill on Sept. 16 by an overwhelming 410-4 vote. The legislation was then signed into law by President Obama on Sept. 26.

Throughout the process, ENA was a leader in Washington in support of EMSC legislation. On March 25, ENA joined the American Academy of Pediatrics and other healthcare organizations in sending a letter to members of the U.S. Senate and House of Representatives endorsing the Emergency Medical Services for Children Reauthorization Act. The letter highlights the key role played by EMSC in training and educating EMS providers and emergency department staff, as well as ‘‘to institutionalize EMS for critically ill children within states.’’

ENA was also instrumental in coalescing support among nursing groups. On July 23, ENA was joined by

December 2014

Call for . . . ENA Annual Achievement Awards for Nursing Excellence in Emergency Care

29 other national nursing organizations — including the American Nurses Association and the American Association of CriticalCare Nurses — in sending a letter to Sens. Casey and Hatch endorsing the EMSC Reauthorization Act. This was the first time that such a large number of nursing organizations had joined forces to endorse the EMSC program.

ENA also assisted in the enactment of the legislation by providing grassroots support.

Through its EN411 Legislative Network, ENA members sent more than 450 letters and e-mails to their federal representatives expressing support for the EMSC program.

Now that the EMSC program has been continued, ENA will continue to advocate in the halls of Congress to ensure that the program receives appropriate funding each year as part of the congressional budget process.

ENA Annual Achievement Award recipients have been described as role models, mentors and emergency nursing at its finest. Do you know someone who has made outstanding contributions to emergency nursing and deserves to join this exclusive and prestigious group? This is an opportunity to recognize innovators, leaders and those who continually go above and beyond the call of duty.

Award descriptions, requirements and criteria are now posted online at tinyurl.com/ ENAAwards. Online nomination forms will be available from Jan. 7 through Feb. 4, 2015. The submission deadline is noon Central time Wednesday, Feb. 4.

AWARD CATEGORIES Clinical/Practice • Clinical Nurse Specialist Award • Frank L. Cole Nurse Practitioner Award • Nurse Manager Award • Nurse Researcher Award • Nursing Competency in Aging Award • Nursing Practice and Professionalism Award

Education/Advocacy • Barbara A. Foley Quality, Safety and Injury Prevention Award • Gail P. Lenehan Advocacy Award • Nursing Education Award • Rising Star Award

Other • Behind the Scenes Award • Media Award • State Council/Chapter Government Affairs Award • Team Award

Special Categories • Judith C. Kelleher Award • Lifetime Achievement Award

Please contact AnnualAwards@ena.org with questions about awards or nominations.

Save the Date April 28-29, 2015

Plan to join ENA in Washington, D.C. to advocate for issues that are important to emergency nurses.

Details about the event and registration information will be available in January 2015.

Day on the Hill 2015 Ad_Connection_half_10 2014.indd 1

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BETTER PRACTICE, NOT BLAME

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n Emergency Nurses Day, ENA President Deena Brecher, MSN, RN, APN, ACNS-BC, CEN, CPEN, spoke to more than 650 delegates at the 2014 General Assembly about what she believed was the most pressing issue of concern to emergency nurses: Ebola.

Brecher shared how, in the immediate aftermath of a Dallas nurse contracting Ebola after caring for a patient who died from the disease, reporters’ questions were about what the nurse did wrong. ‘‘Those were stories that I refused to participate in,’’ Brecher said. ‘‘We’re not about the blame game. All of us come to work every day to do the best job that we possibly can do. And it’s not about one person who didn’t do something. It’s about a system that had opportunities to be improved.’’

Brecher said she spoke with Alex M. Rosenau, DO, FACEP, president of the American College of Emergency ENA President Deena Brecher addresses delegates Oct. 8 at the Physicians, and they agreed that neither would go along General Assembly, where the Ebola situation in Dallas was at the front of emergency nurses’ minds. with blaming because ‘‘it’s not productive, it’s not professional, and it’s not what we need to nurses, particularly workplace violence. be talking about.’’ They pledged instead ‘‘We are the front door, She shared her earlier frustration that to focus the conversation on ensuring that we are the front line, and while ENA has been collecting data on colleagues had the tools and resources workplace violence for nine years, there they needed. we are in an incredibly has been little progress on the issue.

Brecher recounted taking an informal important position in our She expects that to change thanks to poll of nearly 500 nurses at the Oct. 7 healthcare system.” a landmark study published by Lisa ENA Town Hall meeting which showed Wolf, PhD, RN, CEN, FAEN, director of that members felt prepared to screen ED DEENA BRECHER, the Institute for Emergency Nursing patients for Ebola but that system issues ENA President Research, which talks about the culture needed improvement. of acceptance for ED violence. While emergency nurses ‘‘What I remember most about this situation is that we are have become better at telling colleagues that workplace all at risk in what we do every single day,’’ Brecher said. violence is not OK, ‘‘we have not made it all the way up the ‘‘We are the front door, we are the front line, and we are in hospital chain of command,’’ Brecher said. ‘‘Understanding an incredibly important position in our healthcare system, the culture of why helps us understand what we need to do not just to identify these patients but to identify any patients differently and move forward.’’ who are at risk to you, to me, to anybody else. Making sure With that in mind, Brecher discussed workplace violence that as an association we are providing you with what you with other audiences, including hospital nursing leaders, and need to safely do that is incredibly important. worked to create new partnerships, such as with hospital ‘‘We stand at the front door of our hospitals. We stand at safety and security professionals. the opportunity to help prevent an epidemic in this country, ‘‘It’s truly been an honor to be serving as your president if we all do what we’re supposed to do — if we all own our this year,’’ Brecher said. ‘‘I thank you for the opportunity to practice and we all understand what we’re looking for, if we be able to stand up for our profession. Thank you for all that all speak up when our little gut tells us there’s something you do to care for our patients, our families and our not right, if we collaborate, if we work together with our profession. You all make a difference each and every day teammates and our other colleagues in the emergency that you come to work. Thank you for doing that.’’ department to safely care for our patients.’’

Brecher discussed ENA’s work on other risks to emergency Amy Carpenter Aquino

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December 2014

Coming Out a Stronger ENA

‘O President-Elect Backs His Words With Wings

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n his first address before the General Assembly on Oct. 8, President-elect Matthew F. Powers, MS, BSN, RN, MICP, CEN, thanked those who have supported him on his leadership journey and everyone who has worked to make ENA the strong organization it is today. ‘‘I stand by a vision to support our members and our emergency nurses who take care of patients and families every day, to move our profession forward and provide you the tools and education to be safe practitioners, not only for our patients’ safety, but for your well-being,’’ Powers said.

He shared his guiding principles: Dedication: Committing to our organization and the patients we serve.

Empowerment: Creating a culture that promotes safe practice and member development.

Service: Meeting the needs of our members and constituents in a meaningful and respectful fashion.

Teamwork: Partnering with our members, Board of Directors and staff while being open, clear and honest.

Trust: Maintaining an atmosphere of honesty and integrity.

He also revealed his vision for ENA, which includes a focus on injury prevention and encouraging members to work with the ENA Board of Directors to identify needs for the future of emergency nursing, safe practice and safe care.

Powers concluded by sharing some of the exciting events members can anticipate in 2015, including the State and Chapter Leaders Orientation in Las Vegas, the Day on the Hill event in Washington, D.C., and the first Emergency Nursing 2015 conference in Orlando, Fla. As a token of his appreciation, Powers distributed ‘‘angel wings of hope’’ pins to all the delegates. ‘‘Hope is identified as an important part of recovery, and nurses are identified as having a crucial role in facilitating hope in their patients and their families, and most of all here today, to the future of emergency nursing,’’ Powers said. ‘‘Proudly wear these to demonstrate your passion for the future, representing your patients, their families and your Emergency Nurses Association.’’

Amy Carpenter Aquino

n behalf of the 92 members of the ENA Headquarters staff, Happy Emergency Nurses Day!’’ Executive Director Susan M. Hohenhaus, LPD, RN, CEN, FAEN, told delegates before beginning her report by thanking all members who had expressed concerns over the last year. ‘‘While some things were difficult to hear, we embraced the passion and dedication that accompanied your comments,’’ she said.

The process of facing complex challenges throughout the year was gratifying, Hohenhaus said, because the end result was an improved ENA. ‘‘Sometimes it takes a strong storm to sweep through, clear the air and show us things in a new light,’’ she said.

The 2014 member engagement and satisfaction survey, to which 4,000 members responded, showed strong support, loyalty and satisfaction with ENA, Hohenhaus said. Two-thirds of members reported they were highly satisfied with ENA’s educational program offerings, the tradition of standards and ethical guidelines and the monthly ENA publications. ‘‘Overall satisfaction with ENA has improved 35 percent since 2012,’’ Hohenhaus said.

She shared several highlights of the past year that were supported by ENA’s three institutes: the Institute of Emergency Nursing Education, the Institute for Emergency Nursing Research and the Institute for Quality, Safety and Injury Prevention. She reported that at its meeting the previous day, the ENA Board of Directors approved the formation of the Institute for Advanced Practice Emergency Nursing, which will be led by Paula Karnick, PhD, RN. ENA’s government relations activities included helping to enact four key pieces of legislation. ‘‘We punch above our weight in Washington, D.C.,’’ Hohenhaus said. ‘‘I am optimistic for the future of ENA because I am in awe of our incredible partnership — member, board and staff — and because I know what you do every day,” she said. ‘‘You make a difference in someone’s life every day, by saving it or simply by witnessing it, yet you take the time to be here. Thank you.’’

Amy Carpenter Aquino

Official Magazine of the Emergency Nurses Association

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Delegates Hear Governance Assessment Report E

NA President Deena Brecher, MSN, RN, APN, ACNS-BC, CEN, CPEN, introduced representatives of the Association Management Center, which ENA hired in March to conduct an assessment of ENA’s governance structure and provide recommendations for enhancing and improving the process of running the organization. ‘‘We heard, we listened, and we want to get better at what we’re doing,’’ Brecher told General Assembly delegates Oct. 8. ‘‘Conducting this assessment and following through on its recommendations will provide us with a solid plan for future growth and success.’’

AMC executives Mark Engle, DM, FASAE, and Anne Cordes, CAE, presented the findings from their assessment, which consisted of six months of data-gathering and analysis. Their report was recorded and is available for ENA members to view at tinyurl.com/ ENAgovreport or by scanning the QR code at left.

Member Feedback On Oct. 21, ENA e-mailed a link to the recording to all members. The communication included another link that allowed members to submit questions electronically to the ENA Board of Directors. All questions were due by Oct. 31. Brecher will address members’ electronically submitted questions and provide an update on the governance

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improvement process during a webinar scheduled for Dec. 11. That webinar also will be recorded and will be made available to all members for further feedback.

In her remarks to the General Assembly, Brecher encouraged members to be honest and reflective with their questions and comments.

Engle and Cordes gathered information through observing three board meetings and through interviews with selected leaders and staff, the ENA general counsel and member focus groups. They also conducted field research to compare ENA to other nursing organizations and a literature review of ENA’s current bylaws, resolutions and policies.

General Findings The report covers the core areas of ENA governance — the General Assembly and the ENA Board of Directors — and member views of how both operate.

Delegates expressed confusion about the purpose of General Assembly and frustration with the process, as well as a desire to spend more time discussing practice issues rather than debating the wording of bylaws. Interviews with members revealed a perception of conflicts of interest among the board — though few actual examples — and general feelings of distrust. There also was a desire for increased transparency surrounding the board, but a low level of understanding of how a board operates and its legal responsibilities.

Mark Engle, DM, FASAE, and Anne Cordes, CAE, present the findings of their assessment.

Recommendations The report includes several recommendations for improvement: • Focus the General Assembly on practice issues.

• Educate about the role of bylaws.

• Concentrate board time on strategy.

• Partner with and empower staff.

• Figure out the best way to communicate with members.

• Identify leadership characteristics and incorporate into the nominations process.

Engle and Cordes conducted several short surveys, which delegates answered with their keypads throughout the report.

Those findings also will be included in the Dec. 11 webinar.

Amy Carpenter Aquino

December 2014

Down to Business: Resolutions and Bylaws Amendments

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t the 2014 General Assembly, held Oct. 8 - 9, ENA delegates considered 19 bylaws amendments and resolutions, including one late resolution. A national trauma system, firearms safety education, prescription drug abuse and the standardization of emergency codes were some of the practice issues brought to the floor.

The General Assembly also voted on several organizational issue proposals, including military membership, a dues waiver for senior ENA members and background checks for national office candidates.

RESOLUTIONS More than 660 delegates, including international representatives, adopted the following resolutions:

14-02 – ENA’s Role in Firearms Safety Authored by Barbara Davis, BSN, RN, CEN, and Michael Marsiglio, RN, CEN, this resolution calls on ENA to encourage further research relating to educational interventions for firearm safety and to support evidencebased education on firearm safety, including the manufacturing of firearm safety devices, and the safe storage of firearms. After much discussion, the authors deleted original language calling for ENA to advocate for the creation of a national background check and a five-day waiting period before all firearm purchases. The amendment negated the need to strike lines from a 2010 resolution on firearm safety, which would have been in direct conflict with the 2014 resolution. During debate, delegates expressed a desire to not take a political point of view regarding firearm purchases.

14-03 – Emergency Nurses Advocate for Reduction in Prescription Drug Abuse Authors Van Dusen, Sweet and Arruda thanked delegates for feedback on this resolution, the amended version of which calls for ENA to promote existing resources in safe medication storage and disposal and to collaborate with appropriate organizations in the prescription drug epidemic. The authors said they realized their resolution tackled a very complex issue but that they would like to

see emergency nurses take a leadership role in working toward a solution.

Speaking for the Arizona ENA State Council, delegate Tomi St. Mars, MSN, RN, CEN, FAEN, said her state was in support of the resolution and applauded the authors for bringing it forward.

14-04 – Patient Education for Mild Traumatic Brain Injury/Concussion Authored by Kathy Van Dusen, MSN, RN, CEN, CPEN; Vicki Sweet, MSN, RN, CEN, FAEN; and Teri L. Arruda, DNP, RN, FNP, CEN, this resolution calls for the ENA Board of Directors to ‘‘explore the development of an educational resource such as a topic brief and/or a one-hour free educational CEU on mild traumatic brain injuries to include patient education on post-concussive syndrome, cognitive rest and return-to-play guidelines.’’

Delegates gave substantial support to this resolution, which was amended from original language, with 623 favorable votes. ‘‘We need to do our part to raise awareness,’’ said Jean Proehl, MN, RN, CEN, CPEN, FAEN, an ENA past president, who shared the story of a young emergency nurse who allowed her own child to play on a trampoline after the toddler’s head injury was misdiagnosed.

14-06 – Trauma Systems The final version of this resolution calls for ENA to support the development of inclusive trauma systems within each state and to develop a public statement in furtherance of this resolution.

Meredith Addison, MSN, RN, CEN, FAEN, wrote the resolution, which was amended before approval. The original language called for ENA to support the development of a national trauma system. Many delegates

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Resolutions and Bylaws Amendments Continued from previous page said that while they were in support of trauma systems, they should be managed at the state level and not become a federal system.

14-07 – Meaningful Use and Nurse Protocols Andorra Foley, MSN, RN, CEN, and Elisha Jensen, BSN, RN, CEN, wrote this resolution, which requires that ENA’s protocol position statement be revised to include language identifying emergency registered nurses as licensed healthcare providers, according to CMS definition, and be qualified to use computerized physician order entry for patient-centered, physician-approved protocols where allowed by state, local and professional guidelines. The protocol position statement would be revised to include language regarding entry of protocols into an electronic health record that warrant the same considerations as other orders and therefore are within the scope of the nurse to enter into the EHR where allowed by state, local and professional guidelines.

14-09 – Standardization of Emergency Codes Nationwide The lack of national standardization for emergency codes prompted Peggy McMahon, MN, RN, APN, CEN, FNP-C, FAEN, an ENA past president, to write this resolution, which calls on ENA to collaborate with key stakeholders, such as the Joint Commission, Centers for Medicare & Medicaid Services and public safety and emergency medical services organizations in the development and nationwide implementation of ‘‘standardized plain language hospital emergency code terminology.’’

A Massachusetts delegate who spoke in support of the resolution said she works with seven Boston hospitals, each with different response codes. While most facilities use Code Amber for child abduction, one hospital uses it for disaster response, she said.

14-20 – Naloxone Administration for the Opioid Overdose Presented by Katie Bush, MA, RN, CEN, this resolution calls for ENA to ‘‘advocate for the routine access to naloxone (Narcan) for all patients at risk for opioid overdose to be administered by a peer or family member.’’

ENA is also called on to ‘‘support the development of an educational toolkit to assist emergency department nurses in providing education to family and peers of patients who may acquire naloxone (Narcan) according to state guidelines.’’

The amended resolution received overwhelming support from 600 delegates who approved its adoption, with many saying the administration of Narcan has been

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proven to save patient lives. Some delegates expressed concerns that advocating for routine access to Narcan promotes risk-taking behavior. ‘‘I don’t think this is encouraging bad behavior, but it is giving patients a second chance,’’ said New Mexico delegate Kevin McFarlane, BSN, RN, CEN, CPEN. ‘‘This is good care, it’s good medicine, it makes sense.’’

Delegates did not approve the following proposed resolution:

14-05 – Use of Orientation Guidelines Author Mary Zaleski, MSN, RN, CEN, brought this resolution, which asked ENA to ‘‘identify best practices regarding measurable orientation outcomes and criteria to track the progress through formative evaluation of the emergency department nurse orientee to ensure safe practice.’’

Delegates said they felt ENA already had developed excellent educational products for new emergency nurses.

BYLAWS AMENDMENT Delegates approved the following ENA bylaws amendment:

14-19 – Military Membership This amendment called for military membership to be granted to a professional registered nurse licensed in the United States or its territories who is currently serving or has been honorably discharged or retired from the U.S. military, including Army, Navy, Marine Corps, Air Force, Coast Guard and reserve components. The amendment makes ENA’s military membership category more inclusive. ‘‘I personally think we should honor our military for their service,’’ said New Jersey delegate Liz Mizerek, MSN, RN CEN, CPEN. ‘‘I thank ][co-author] David [McDonald] and the others who have served. I think we should support this resolution as written.’’

Other resolutions and bylaws amendments approved: 14-01 – Update the Consensus Statement on Definitions for Consistent Emergency Department Metrics 14-10 – State Captains 14-12 – Resolutions Committee Composition 14-14 – Nominations Committee Name 14-15 – Nominations Committee Chairperson Election 14-16 – Eligibility Requirements – Background Checks The delegation did not approve proposals on membership suspension and termination, changing the submission deadlines for bylaws and election rules, changing the name of the Resolutions Committee or a dues waiver for senior members.

Amy Carpenter Aquino

December 2014

Town Hall Meeting

Ebola, Advocacy, Archives and More E NA President Deena Brecher, MSN, RN, APN, ACNS-BC, CEN, CPEN, opened the Oct. 7 Town Hall meeting in Indianapolis by asking attendees if they felt prepared to care for patients with Ebola.

A majority of the nearly 500 in the audience raised their hands to indicate they had received formal training from their hospitals on how to screen patients for infectious diseases, though not all said they had received specific screening guidelines for Ebola. ‘‘What else do you need from ENA . . . so that we can manage this together?’’ Brecher asked.

Some attendees commented on a lack of resources, such as full containment ability, at their individual hospitals and the difficulty in navigating Ebola information on the Centers for Disease Control and Prevention website. Member Freda Lyon said the CDC website should have information that is applicable to the bedside nurse.

ENA has since created an Ebola resource website at www.ena.org and has e-mailed information to all members, as well as posted information links in the ENA President’s blog at enapresident.wordpress.com.

ENA members asked about several areas of the association, especially the timing of major events. Patricia Clutter, Med, RN, CEN, FAEN, asked for an update on the archiving of ENA’s historical information. Executive director Susan M. Hohenhaus, LPD, RN, CEN, FAEN, said the information that is retrievable online is available through the University of Virginia and that the archiving is a work in progress.

Kay McClain, MS, RN, CEN, FAEN, commented on the timing of the town hall meeting, which was scheduled to immediately follow the ENA Board of Directors meeting. Brecher said the board was looking at other options for the meeting, including a virtual town hall meeting which could be attended by all ENA members, not just those

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able to travel to the national conference.

Peggy McMahon, MN, RN, APN, CEN, FNP-C, FAEN, an ENA past president, said it would be easier for members to have earlier access to materials for the board meeting and suggested that documents be posted a week ahead of time on the ENA website. Brecher said that was a ‘‘fabulous suggestion’’ that she would take back to the national office.

Mary Jagim, BSN, RN, CEN, FAEN, another ENA past president, expressed concern that because the 2015 Day on the Hill was scheduled for April — a very busy month in Washington, D.C. — ENA’s voice would get lost in the crowd of other national organizations.

Brecher said the organization was working to make sure April was not the first time ENA members were talking to legislators, and she was confident ENA’s voice would not be lost in the shuffle.

Amy Carpenter Aquino

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Anita Dorr Memorial Lecture and Luncheon

‘Emergency Nursing at Its Finest’ A

lthough ENA lost its passionate leader who has esteemed co-founder, mentored and inspired many Judith C. Kelleher, MSN, RN, and works tirelessly to shape FAEN, in 2013, she’s still in the future of emergency our hearts, ENA President nursing, having been Deena Brecher, MSN, RN, involved in ENA at the local, APN, ACNS-BC, CEN, CPEN, state and national levels. said Oct. 8 at the Anita Dorr Not only has she Memorial Lecture and consistently demonstrated Luncheon. ‘‘I know that we excellence in emergency will continue to make her nursing practice, Brecher proud with the work that we said, but she also has been a are doing in our profession pioneer in expanding roles and our association. for nurses in their specialty. ‘‘In awarding the Kelleher She serves as dean of Loyola Award, we recognize a University Chicago’s Niehoff JUDITH C. KELLEHER AWARD WINNER: Vicki A. member who has consistently Keough, PhD, APRN-BC, ACNP, FAAN (left) with 2014 ENA School of Nursing, where she demonstrated excellence in has been a strong advocate President Deena Brecher. emergency nursing and has for the learner and actively made significant and enduring contributions to the works to create an environment of learning excellence for profession that are destined to impact emergency nursing nursing students. She initiated the first emergency nursing in the years to come. This year, we’re proud to announce nurse practitioner program in the region, only the second our Judith Kelleher Award winner is Vicki Keough, who such program in the United States at the time, and still represents emergency nursing at its finest.’’ participates in the ED as a nurse practitioner.

Keough, PhD, APRN-BC, ACNP, FAAN, is a dynamic and Amy Carpenter Aquino

Defining ‘Safe Leadership’

O

ne of the privileges of serving as ENA president is selecting the

speaker for the Anita Dorr Memorial Lecture and Luncheon. ‘‘For me, this was very important …

I called this person the day that I got elected and said, ‘I have a job for you,’ ’’

reporting relationship, Holbrook continued to mentor Brecher. ‘‘Because of her guidance, her leadership and her mentorship, I think I have had a relatively successful year’’ as president, Brecher said.

Holbrook focused her presentation

said 2014 President Deena Brecher,

on the top 10 characteristics of

MSN, RN, APN, ACNS-BC, CEN, CPEN.

successful, dynamic leadership.

Brecher said that when she met Kay

‘‘I believe there is a thing called safe

Holbrook, MSN, NE-BC, the associate

leadership,’’ Holbrook said, ‘‘and I think

administrator at Nemours/Alfred I.

it’s intentional, I think it’s practiced, and I

duPont Hospital, Holbrook instantly

think we practice it to make it

understood her interest in her

permanent, not perfect, because we’re

professional association.

not perfect as a leader on any given day.’’

‘‘She had a plan that I was going to

She said safe leadership could be

get the tools and skills that I needed to

defined as advocating for safety and

be successful as president,’’ Brecher said.

excellence by the team for all patients.

Even when they no longer had a

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There is a great need for leadership

Kay Holbrook, MSN, NE-BC in healthcare because of the everchanging insurance environment, patient demographics, staff expectations, the emergency department and more, Holbrook said. Everyone has the potential to be a leader, she said. ‘‘It’s not what position you hold – it’s how you hold it,’’ she said. ‘‘It’s in that moment, in that second, in that time, if you can step in and be a leader.’’

Amy Carpenter Aquino

December 2014

Opening Session Speaker

Mindfulness Is What Matters Most

‘W

hen you’re living life like an emergency, it’s easy to miss the warning signs.’’

Diane Sieg, RN, CYT, CSP, a former emergency nurse, told the story of a stressed, frantic patient who came to the ED one morning seeking pain medication and left before Sieg could tell her she was having a heart attack. ‘‘What don’t you have time for right now?’’ Sieg asked Opening Session attendees on Oct. 9. ‘‘Your family, your friends? How about your own heart attacks?’’

Sieg cited research showing that two out of three healthcare providers were suffering from burnout. ‘‘I know that everyone in this room is familiar with chaos. In fact, a lot of you probably thrive on it,’’ she said.

As a recovering ‘‘adrenaline junkie,’’ Sieg said she has learned that living with chaos is expensive, excluding and exhausting. ‘‘Just because you’ve survived a couple decades in the field doesn’t mean that you come to work with joy or efficiency or resilience,’’ she said. ‘‘In fact, those of us with a little more experience are likely to be crusty and cynical.’’

Sieg shared a quote from psychiatrist and Holocaust survivor Viktor E. Frankl, who said, ‘‘What is to give light must also endure burning.’’ ‘‘You give light as well,’’ Sieg said, ‘‘and you witness great atrocities and pain and suffering and injustice and unfairness in the world.’’

Emergency nurses know healthcare is burning, especially in the emergency department, with increased violence, constant transition of policy and procedure and emerging crises such as Ebola. ‘‘So we have to stay centered and focused in order to give light. We have to go from chaos to calm,’’ Sieg said.

She described calm as something that would help attendees energize their performance while providing more peace, purpose and productivity in every area of

their lives. Going from chaos to calm requires one critical ingredient, mindfulness, which Sieg described as ‘‘paying attention, on purpose, in the moment, as if your life depended on it, because it does.’’

Sieg shared how practicing yoga changed her life, and she demonstrated her sense of focus and balance by standing on her head in the middle of the stage. While yoga improved her posture, concentration, mood and more, the real benefit came from the deep breathing and mindfulness practices.

She led attendees through a mindfulness session intended to help them shift their mind-set from chaos to calm and to help them let go of old hurts and anxieties. ‘‘Mindfulness is so powerful,’’ Sieg said. ‘‘It allows us to listen and connect and problem-solve and create at a much higher level.’’

Attendees practiced deep breathing, stillness and meditation exercises that Sieg said could be performed any time they needed a mindfulness break. She also demonstrated how to take a ‘‘compassion break’’ to help when an emergency nurse is overwhelmed by witnessing pain and suffering in the ED. Amy Carpenter Aquino

Official Magazine of the Emergency Nurses Association

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Foundation Thrilled to Offer Even More

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he ENA Foundation has awarded 40 academic scholarships and research grants this year and opened up an unprecedented second call for academic scholarships in October.

Seleem Choudhury, MSN, MBA, RN, CEN, FAEN, the 2014 ENA Foundation chairperson, shared the good news with attendees Oct. 9 at the Opening Session.

The second call was the result of the generosity of organizations such as the Board of Certification for Emergency Nursing, which donated $36,000, making it the foundation’s biggest donor of 2014. The foundation accepted applications for an additional 20 academic scholarships through Oct. 31.

The foundation also provided conference scholarships to nearly 30 emergency nurses this year. The registrations for eight attendees of the Leadership Conference in Phoenix and 21 attendees of the Annual Conference were funded by the ENA Foundation. ‘‘All of the scholarships and grants I’ve mentioned are made possible because of the generous support from state councils, chapters and industry partners,’’ Choudhury said. ‘‘But it’s not just organizations that move the needle. Give yourselves a round of applause because this year you raised more than $113,000 during the State Fundraising Challenge. That’s an incredible accomplishment. Seeing the states pull together to give back to emergency nursing is amazing.’’

Choudhury encouraged attendees to continue to support the ENA Foundation in 2015 with a reminder that the number of scholarships and research grants awarded each year is directly dependent on donations. ‘‘What a statement it would be if every member gave a gift, large or small, in 2015,’’ he said.

He recognized the ENA Foundation’s Board of Trustees and Management Board before a final message to attendees. ‘‘You, your ENA colleagues and our corporate partners are the reason behind our success and our ability to support education, professional development of emergency nurses and the implementation of evidencebased research,’’ Choudhury said. ‘‘I sincerely thank all of you.”

Amy Carpenter Aquino

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General Session Speaker

‘It’s About the Patient’ E

mergency nurses understand how a collegial, interactive team works — with everyone having respect for everyone else — and have the best vantage point to see how to create process improvements that provide truly safe patient care. ‘‘It’s not about the doctor, it’s not about the emergency room, it’s not about the nurse,’’ said John Nance, aviation analyst for ‘‘ABC World News’’ and ‘‘Good Morning America’’ and a leading speaker on aviation and healthcare quality and safety. ‘‘It’s about the patient — patient-centric care.’’

Nance defined patient-centric care as ‘‘Everything, everything — including the interests of the CFO — is subordinate to the best interests of the patient.’’

That simple concept is in direct opposition to what Nance called the most dangerous phrase in medicine worldwide, ‘‘This is the way we’ve always done it.’’

Other obstacles to implementing patient-centric care arise from what Nance called the ‘‘Who’s on First?’’ question, or confusion over whose job it is to keep the patient safe, which he illustrated with a clip from the classic Abbott and Costello routine.

We have to change American medicine because the results are no longer effective on any level, Nance said, citing a 2013 published study showing that 440,000 deaths

December 2014

occur in hospitals each year because of medication errors, other medical mistakes and infections. ‘‘That’s three 747s full of people crashing every day, losing everybody aboard, and that’s a conservative figure,’’ he said. If that number of deaths occurred in aviation, ‘‘We wouldn’t have an airline industry.’’

Looking to the aviation industry for transferrable lessons in culture change makes sense, Nance said, because both healthcare and aviation are run on human systems. ‘‘When we forget the human nature of things, we make huge mistakes,’’ he said.

Healthcare is not a business or an industry, he said. ‘‘It’s a calling, wrapped around a profession, propelled by the ethic of service to humanity. We forget that, we’re in deep trouble.’’

One of the primary reasons healthcare is not where it should be in terms of quality and safety is resistance to change, he said. Healthcare workers especially tend to not want to change the way they do things until they are absolutely certain it is the correct way to do it. ‘‘We are engaged in a massive change of culture, but culture change is profoundly difficult,’’ Nance said.

Nurses, doctors and other healthcare workers need to look at change on a team level rather than an individual level, just as errors need to be seen as a team responsibility rather than the failure of one person. ‘‘The biggest mistake we make is thinking that we can be perfect,’’ he said, ‘‘because we are trained that way.’’

Nurses have amazing capabilities to enact change at record speed and are poised to take a leadership role in culture change in healthcare, Nance said, calling attendees the bellwether who can show others the way.

Amy Carpenter Aquino

Official Magazine of the Emergency Nurses Association

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Without Wellness, the Costs Add Up

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n adopting the World Health Organization’s definition of wellness, ENA acknowledges that wellness is more than exercise and nutrition — it’s obtaining positive relationships, being part of a safe and healthy community and having a protective financial situation, for example.

In keeping with the holistic definition of wellness, financial wellness was the focus of the 2014 Annual Conference Wellness Booth. Financial wellness encompasses a multitude of complex issues that impact nurses on individual and professional levels. A few of these issues are emergency department violence, inadequate measures against vaccine-preventable diseases, workplace injuries and community-acquired injuries. ED violence results in costly medical expenses and litigation; indirect costs range in severity from increased staff turnover and absenteeism to lost wages due to healthcare worker death.1 Improper influenza prevention contributes to the 17 million workdays lost annually due to influenza-related illness, at a price tag of $6.2 billion.2 Workplace injuries sustained by healthcare workers in the hospital result in a total annual compensation averaging $2 billion.3 The cost of falls among our older adult population was estimated at $30 billion in 2010.4 As we provide the best care for our patients by arming ourselves with evidence-based practice, we can improve financial wellness for ourselves, our profession and our communities through our awareness and increased vigilance for the bottom line.

• Through advocacy, 31 states now classify violence against a nurse as a felony. The ENA Workplace Violence Prevention course (www.ena.org/workplaceviolence) includes strategies to help mitigate violence in your emergency department.

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• Through better understanding of the importance of immunizations, we can decrease the cost of work days lost, as well as decrease risks to ourselves, our loved ones and our patients. Visit www.cdc.gov for further information on influenza vaccination.5 • ENA’s Emergency Department Workplace Injury Prevention Toolkit addresses preventing emergency department workplace injuries. This toolkit will soon be available at www.ena.org.

• Through our continued engaged efforts in community injury prevention, we can save money and improve the lives of our patients. ENA is actively engaged in community injury prevention, with the ENA Community Injury Prevention Toolkit coming soon to www.ena.org.

Thank you to everyone who visited the Wellness Booth in Indianapolis. Your participation makes the booth fun, active and a treat to host each year. See you in Orlando!

Briana Quinn, MPH, BSN, RN, Senior Associate, Institute for Quality, Safety and Injury Prevention References 1. Papa, A., & Venella, J. (2013, January). Workplace violence in healthcare: Strategies for advocacy. The Online Journal of Issues in Nursing, 18(1), manuscript 5. doi: 10.3912/OJIN.Vol18No01Man05 2. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. (2013). Workplace health promotion: Adult immunization. Retrieved from http://www.cdc.gov/ workplacehealthpromotion/evaluation/topics/immunization.html. Accessed October 28, 2014.

3. U.S. Department of Labor, Occupational Safety & Health Administration.

(2013). Worker safety in your hospital: Know the facts. Retrieved from https://www.osha.gov/dsg/hospitals/documents/1.1_Data_highlights_508. pdf. Accessed October 28, 2014.

4. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. (2014). Falls among older adults: An overview.

Retrieved from http://www.cdc.gov/homeandrecreationalsafety/falls/ adultfalls.html. Accessed October 28, 2014.

5. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. (2014). Influenza vaccination information for health care workers. Retrieved from http://www.cdc.gov/flu/ healthcareworkers.htm. Accessed October 28, 2014.

December 2014

LEARNING MEETS LEISURE Attendees got to experience the latest in emergency nursing products and services from approximately 200 vendors in the Exhibit Hall, where attractions such as free hand massages and the ENA Relaxation Station were only steps from educational eye-openers at the e-Learning and financial wellness booths.

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Educational Sessions X-Ray Presession: A Great Way to Start On Oct. 8, Emergency Nurses Day®, many began their 2014 Annual Conference experience with a presession. To an eager crowd of more than 50 attendees, Laura L. Kuensting, DNP, APRN, PCNS-BC, CPNP, CPEN, presented ‘‘Chest, Abdomen, and Skeletal Plain Film Interpretation.’’ Speaking to an audience primarily composed of advance practice nurses, Kuensting outlined a systematic approach to radiologic interpretation.

She began her presentation by discussing the importance of collaborating with radiology technicians and radiologists for optimal radiologic interpretation, including requesting their input to determine the best imaging study to order and to document assessment findings that indicated the study.

After a review of basic radiology terminology, Kuensting shared two mnemonics for an approach to X-ray interpretation. The ‘‘BSA’’ mnemonic is the initial ‘‘quick scan’’ of an image, looking for obvious abnormalities in

Laura L. Kuensting, DNP, APRN, PCNS-BC, CPNP, CPEN

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the body, surface and other abnormalities. The ‘‘A-F’’ mnemonic is a more in-depth analysis of the image. Kuensting emphasized that providers should be describing the images and not making a diagnosis based on the X-ray alone.

The chest X-ray portion of the presession started with a review of basic anatomy in common views.

Kuensting presented a systematic approach that included evaluating the RIP (rotation, inspiration and penetration) of the X-ray, identification of the diaphragm, costophrenic angles and heart, hilar and lung markings.

In the abdominal section, Kuensting examined X-ray findings consistent with large and small bowel obstruction, ileus, ascites and bezoars.

The skeletal segment outlined how to detail skeletal findings such as dislocations, subluxations and fractures. This included the type and location of fractures, degree of angulation and growth-plate injuries.

With these injuries, Kuensting stressed the importance of a simple yet comprehensive sensorimotor assessment.

Case presentations were shared after each section. With assistance from each other and guidance from Kuensting, attendees interpreted the X-ray and determined a probable diagnosis.

Asked if APNs receive enough formal or informal training on X-ray interpretation, Kuensting responded, “They don’t’’ and ‘‘very little.’’

Numerous attendees echoed these responses. Asked how she became so proficient with X-ray interpretation, Kuensting said she taught herself and learned on the job, working with radiologists. As an assistant professor at the University of Missouri, she includes X-ray interpretation in her students’ coursework.

Attendees of this presession

walked away much more confident in their x-ray interpretation skills.

Alyssa M. Kelly, MSN, RN, CNS, CEN

A Helpful Look at Hypothermia With ‘‘Accidental Hypothermia,’’ William D. Hampton, DO, MM, BA, AS, provided an excellent learning session on how best to care for this type of patient. Hampton gave an overview of the signs and symptoms of immersion and submersion that will help the emergency nurse clearly understand what he or she will find when assessing the drowning patient.

Hampton provided definitions of acute hypothermia, subacute hypothermia, chronic hypothermia and submersion hypothermia. He presented several case studies and quizzed attendees on the type of hypothermia the patient may be presenting upon arrival to the ED. He then provided critical information on the body’s normal heat production and pathological heat loss. He stumped attendees when asking which state has the most drownings (Alaska).

Hampton then differentiated among the symptoms of mild, moderate and severe hypothermia.

Perhaps most interesting were two actual case studies involving severe

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hypothermia. One involved a patient who was pulseless for several hours; through persistence, CPR and warming techniques, the patient survived without sequela. The second case study was presented by the victim, via a recording, describing the process undertaken to successfully resuscitate the patient without sequela.

The bottom line Hampton conveyed was to not give up on the severely hypothermic patient and to transfer him or her to a healthcare facility capable of caring for this type of patient.

Dale Wallerich, MBA, BSN, RN, CEN

Herbal Supplements With a Downside Herbal supplements are a subset of complementary and alternative medicine. Some have been used for centuries, such as garlic, which has documented use dating back 5,000 years.

As with any medication or drug, herbal supplements have side effects and drug interactions, some of which can be fatal. Melanie Gibbons Hallman, DNP, CRNP, CEN, presented ‘‘Effects of Herbal Supplements: Some Good, Some Bad,’’ an overview of herbal supplements and their FDA oversight, and highlighted some specific examples of herb-drug interactions, side effects and uses.

Several herbal supplements mentioned, including ginseng, ginger and ginko biloba, can cause increased bleeding when taken with warfarin. St. John’s wort can lead to an increased risk of seratonin syndrome in patients also taking SSRIs. Specifically asking for use of herbal and other supplements during medication reconciliation is essential to gaining a thorough understanding of the patient’s clinical presentation and history.

More information on herbal supplement use can be found at the NIH National Center for

Complementary and Alternative Medicine at http://nccam.nih.gov.

Briana Quinn, MPH, BSN, RN

Removing the FEAR From Emerging Infectious Diseases The closing statement ‘‘Fear is false evidence appearing real’’ resonated at the educational session ‘‘Something Old, Something New: MERS and Other Emerging Infections,’’ reminding us that for centuries, infectious diseases have ranked with wars and famine as significant challenges to human survival and progress. False evidence appearing real can easily cause panic, misinformation and chaos.

Infectious diseases should not be taken lightly — their emergence should provide an opportunity to evaluate health practices, emergency preparedness and appropriate health education. What better way to

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understand emerging infectious disease than to study epidemiology?

Epidemiology examines how diseases are distributed in populations and the various factors that influence them. As the Ebola virus begins affecting individuals in the United States, it is difficult not to talk about it. In this session presented

by Sherri-Lynne Almeida, DrPH, MSN, MEd, RN, CEN, FAEN, Ebola became a focus. However, Almeida quickly reminded attendees that while Ebola is of great concern now, infectious diseases such as Middle East Respiratory Syndrome, chikungunya, pertussis and measles are other examples of emerging infectious diseases.

Infectious diseases remain one of the leading causes of death and disability worldwide, and against the constant background of established infections, epidemics of new and old infectious diseases periodically emerge. In order to assist in recognizing these diseases, it is important to educate yourself and be familiar with clinical presentation in order to provide safe practice, safe care for yourself and your patients.

Almeida reviewed MERS, chikungunya, pertussis and measles, describing the history, epidemiology, clinical features, case definitions,

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prevention measures, nursing interventions and infection control recommendations of each disease.

This session served as a reminder to separate fear from fact.

Monica Escalante, MSN, RN

Digging For Answers on Family Presence Family presence is not a new topic for research or education, but despite extensive research and implementation of the practice in hospitals around the world, there is still resistance.

In ‘‘Resuscitation Team Perceptions of Family Presence During CPR at an Urban Academic Medical Center,’’ Kathleen E. Zavotsky, MS, RN, CCRN, CEN,

ACNS-BC, presented a study done at Robert Wood Johnson University Hospital on code team perceptions of family presence during resuscitation.

The study group included members of the multidisciplinary code team. Most participants were nurses (78 percent), but also included were patient care technicians, advanced practice nurses, physicians, respiratory care personnel and chaplains.

In looking at staff perceptions, the investigators were specifically interested in barriers: What stands in the way of implementation of this vital aspect of family-centered care?

Because family presence has been demonstrated to have benefit to family and patients, it is reasonable that it has become a standard of

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practice and there would be no barriers. In this study, 72 percent of respondents agreed there was a benefit to the family, and 60 percent felt the patient also benefitted.

Analysis of perceived barriers revealed that a little over half (54 percent) perceived no existing institutional barriers.

Stated perceived barriers included lack of space to properly bring family into the resuscitation room and lack of administrative support for the practice. It was further explained that the participants didn’t know who to ask to provide support to the family.

Not knowing whom to assign as a support liaison brought the authors to the final piece of information in this study. Eighty percent of those responding to the survey did not know a family presence policy existed.

The next step is to determine how to interpret and use these data. It is clear that barriers still exist.

Overcoming those barriers and

Behavioral Health: There Are Better Ways Than Boarding

supporting implementation of the practice of family presence is a challenge that Robert Wood Johnson University Hospital has accepted.

Are there barriers in your emergency department? What steps will you take to identify and overcome them?

Marlene Bokholdt, MS, RN, CPEN

‘‘Anybody have a problem with psych boarders in the ED?” speaker Leslie Zun, MD, asked.

Attendees chuckled, even as some acknowledged having to board behavioral health patients for up to a week in their EDs. Recent statistics say about 10 percent of ED patients come in with a psychiatric complaint, including about 2 percent of pediatric ED patients, Zun said during his session, “Dealing With Psychiatric Boarders in the ED.” He cited two studies highlighting problems with psychiatric boarders.

In one study of ED administrators, 86 percent said they are often unable to transfer patients, and 90 percent said boarding reduced available beds for

Continued on next page

Fourth Edition

The Authoritative Course for Pediatric Emergency Nursing • Pediatric Assessment Triangle • Early Intervention • Family Presence

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2 Day Intensive Course 23 Chapter Comprehensive Manual 6 Hands-on Learning Scenarios 15.58 Contact Hours 5 Online Modules

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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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other ED patients. Twenty-three percent of respondents in another survey said they had to send psychiatric patients home without seeing a medical professional because of a lack of resources. ‘‘It just blows my mind,’’ Zun said. ‘‘You would never send home a patient with chest pain without seeing a cardiologist or referring them to a cardiologist.’’

Several processes contribute to the problem of psychiatric boarders in the ED, including inappropriate admissions, a lack of appropriate assessment and the ED not coordinating well with outside resources.

Zun proposed several methods that EDs could implement to prevent boarding of psychiatric patients: • Telepsychiatry. This method results in high provider and patient satisfaction and can be used for a lot of different problems and diagnoses.

Providers can prescribe medication and perform psychotherapy via telepsychiatry.

• Diversion programs, such as mobile crisis units and communitybased crisis intervention units.

Providers go out to see the patient

and determine whether the patient needs to come into the ED. The patient is treated in the community if possible.

• Suicide risk assessment. Zun dispelled what he called ‘‘the myth of every suicide patient needing to be admitted.’’ Once a risk assessment is performed in the ED, providers can determine if a patient is at low, moderate or high risk for suicide.

• Acute stabilization units. These have been shown to reduce admission rates by 70 percent. ‘‘We have such a disparity for psych patients,’’ Zun said, noting that cardiac or stroke patients who come to the ED are cared for quickly by a team of specialists, but getting a psychiatric physician and nurse to come down to the ED is like pulling teeth. ‘‘Why should we have this disparity in heathcare? Why is there a different standard of care?’’

Amy Carpenter Aquino

‘Pieces of My Heart Breaking Away’ In “Compassion Fatigue and Burnout: Are You at Risk?,” speaker Stacie K. Hunsaker, MSN,

CEN, CPEN, shared the story of Ben, a 4-year-old patient who died in the ED after suffering massive head injuries in a sledding accident.

Hunsaker read from her journal about what it felt like to finally wrap the boy’s body in a blanket and give him to his parents to hold. ‘‘We grieve and cry with the families and hope that they are holding on,’’ she read. ‘‘. . . At times, I really wonder why I became a nurse. I love helping people, but I feel pieces of my heart breaking away at times.’’

Emergency nurses are at risk for both compassion fatigue and burnout from feeling the pain and suffering of their patients and from feeling constantly bombarded by too many tasks in the ED. Hunsaker said compassion fatigue and burnout are two distinct conditions — those with an uncommon capacity for feeling empathy are more at risk for compassion fatigue, while burnout is more occupationally based.

Hunsaker shared results from a 2012 research study of 280 ENA members who responded to a questionnaire. Among her findings were that older ENA members reported the highest amount of

Using Just Culture to Combat Errors

compassion satisfaction, while those in their 20s had the highest compassion fatigue scores. ‘‘I worry about this, because we can’t lose our young,’’ she said.

Lack of manager support, poor relations with co-workers and inadequate supplies all contributed to higher compassion fatigue scores among younger ENA members.

Hunsaker handed out a questionnaire to attendees and

showed them how to tabulate their results to get their scores for compassion fatigue, burnout and compassion satisfaction. She shared the warning signs of compassion fatigue and burnout, as well as methods that nurses can use to strengthen their resiliency, both inside and outside the ED. The bottom line, Hunsaker said: ‘‘We need to help each other.’’

Amy Carpenter Aquino

When a serious medication error occurs, the first people impacted are the patient or family, but the nurse, physician or healthcare provider who made the error also suffers. ‘‘How many of you feel like you have been the second victim?’’

AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN, FAAN, asked attendees at her session ‘‘Reflective Practice: Mitigating Second Victim Phenomenon.’’

Papa discussed practices that help mitigate the feelings of guilt and sadness that emergency nurses may have after a medication error. One of the most vital practices is to have a just culture, which is a culture where safety is everyone’s business in an environment that is blame-free.

Having a blame-free environment starts at the top. Departments with

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AGGRESSIVE BEHAVIOR...

...towards staff at work is dramatically on the increase, especially in our Hospitals. Verbal abuse, threats with weapons, cuts, punches, even serious injuries are becoming everyday occurrences.

The impact on the confidence and morale of staff is damaging and costly and has a serious impact on the caring and commitment that lies at the heart of the staff/patient relationship.

Installing an INSTANTalarm 5000

Staff Personal Alarm System will make a dramatic difference INSTANTalarm does NOT • track you around the hospital • use radio-frequency • rely on unreliable wi-fi • have a computer controlling it

INSTANTalarm, however, DOES

• let you decide when you need help • pinpoint your location, to a room • work instantaneously • make you and your patients feel safer • reduce the frequency and impact of violent incidents Which is why, over 20 years, INSTANTalarm 5000 has been probably the most widely-installed, staff duress alarm system in the world. ®

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Official Magazine of the Emergency Nurses Association

® PROTECTING PEOPLE AT WORK

27

WORKPLACE VIOLENCE VIOLENCE PREVENTION PREVENTION WORKPLACE KNOWYOUR YOUR WAY WAYOUT: OUT: KNOW

RECOGNIZE,AVOID, AVOID,PREVENT, PREVENT AND AND MITIGATE MITIGATE EMERGENCY EMERGENCY DEPARTMENT DEPARTMENTVIOLENCE VIOLENCE RECOGNIZE,

Interactive, online course designed to mitigate violence in the emergency department.

Nurses, managers, and staff who work in emergency care settings will learn to: ¡ ¡ ¡ ¡

Recognize risk factors Apply prompt and appropriate responses Implement organizational prevention strategies Report and analyze patterns of violence

2 Hour Course ¡ Video Demonstrations ¡ 1.13 Contact Hours Interactive Quizzes ¡ Developed by ENA with a grant from OSHA

Violence is not part of the job—Protect Yourself!

Go to www.ena.org/workplaceviolence

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

This material was produced under grant number SH-23534-12-60-F-17 from the Occupational Safety and Health Administration, U.S. Department of Labor. It does not necessarily reflect the views or policies of the U.S. Department of Labor, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.

critical thinking and problem identification and solving. This session actually provided emergency nurses with the needed ANCC background to move forward into the valued role of a qualified nurse planner.

Upon completion of this Night Shift session, learners should have been able to return to their program planning desktops and start developing programs and CNE applications that will result in the implementation of fine quality educational programs that will promote professional development with their learners.

As the speaker, I was impressed managers who look to blame will have staffs that look to blame, Papa said, ‘‘whereas if you have a manager that is seeking to understand, you’re going to have staff that is more comfortable with asking questions.’’

A just culture works on the premise that humans are fallible, subject to human error and behavior drift. In a just culture, staff would not be afraid to report a medication error and would view it as a learning experience for themselves and others. ‘‘The more medication errors that are reported, the better,’’ Papa said, ‘‘because some of the medication errors that are reported are the near-misses, and if we don’t report the near-misses, we won’t understand the processes that may get us into trouble.’’

The tenets of a just culture are: • Human error: Errors are inadvertent, a product of your current design system. Fix it by training and improved design.

• At-risk behavior: Errors are the result of a mistaken belief or choice, such as a workaround. Fix it by removing at-risk incentives, increasing situational awareness.

• Reckless behavior or reckless endangerment: Errors occur because of a conscious disregard for the rules.

Fix it by remedial or punitive action.

Fallibility is a human condition, and we cannot change the human condition, Papa said, but we can change the conditions under which we work.

Amy Carpenter Aquino

Getting Those CNE Programs Right “Professional Development of CNE Products’’ has become a mainstay anchor of the Night Shift sessions. This regular educational session is always on the subject of continuing nursing education, but a different spin is presented at each annual conference.

This year, a special interactive session targeted interprofessional attendees who are responsible for any major aspect of providing CNE products, including nurse planners, activity coordinators, speakers, content experts and planning committee members. The goal was to provide learners with insight into some of the most challenging aspects of CNE program development, such as developing a gap analysis, preserving content integrity, resolving conflict of interest and constructing meaningful behavioral objectives. A special ‘‘Test Your Knowledge’’ interactive challenge was the main feedback strategy that facilitated

Official Magazine of the Emergency Nurses Association

that more than 30 attendees opted to spend a lovely Friday night in downtown Indianapolis to attend this session and learn to improve, enhance — and in some instances — create highly regulated CNE products. I was truly honored to have served as the speaker for those dedicated learners.

Janet Crawford, MSN, ACNS-BC, ANCC Lead Nurse Planner

Janet Crawford, MSN, ACNS-BC

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EMERGENCY NURSES OFF DUTY The Welcome to Indy Party on Oct. 9 was an explosive celebration to formally open the ENA Annual Conference, with food, camaraderie and high-energy live music from the Endless Summer Band.

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The featured difference-makers from the ENA Foundation’s ‘‘Power of One’’ event (from left): Helen Sandkuhl, MSN, RN, CEN, FAEN; Shannon Ward, RN; Greg Higgins, MD; Robert Nabulere; Joan Eberhardt, MA, RN, CCRN, FAEN; and Laurie Freeman, RN.

SIX WHO WERE THE ONE O

n Oct. 10, Jeff Solheim, MSN, RN-BC, CEN, CFRN, FAEN, introduced conference attendees to six heroes during the ENA Foundation exclusive event, ‘‘The Power of One: Engaging Generations of Nurses to Give Back and Do Incredible Things.’’

Solheim, an internationally recognized motivational speaker and member of the ENA Board of Directors, shared the stories of these heroes from around the world who work to provide a better future for others. The six sat for brief interviews

Robert Nabulere (left) after sharing his tale of service in Uganda with presenter Jeff Solheim.

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with Solheim after each introduction. ♦ Greg Higgins, MD, was practicing emergency medicine in Alaska when he made his first visit to Africa. The physician ‘‘fell in love with the children of Africa,’’ Solheim said. After meeting a teacher who was providing preschool education to 120 children in Moshi, Tanzania, Higgins began providing medical care and supplies, such as mosquito netting, to the children and their families. He soon retired from his U.S. practice and moved to Tanzania to provide full-time medical care at the Kilimanjaro Orphanage Centre.

Higgins later met Shannon Ward, RN, an emergency nurse from Oregon, who visited Africa on a medical mission. The two fell in love and got married, and Ward left her life in Oregon and moved to Moshi.

The couple work together to provide medical care and education for the 56 children of the orphanage. Their goal is to expand and build an orphanage that can serve 120 children and a home to care for the aged, as well as a farm where they can teach children the skills they need to prosper as they grow into adulthood.

♦ Shortly after pediatric oncology nurse Laurie Freeman, RN, began medical mission work in Africa, she learned that young girls often had to leave school after they started menstruating. Many had only one set of clothes and no underwear and had to use anything from banana leaves to cow dung to protect themselves during menstruation. ‘‘This is what happens in the third world where . . . generation after generation of women are held back by the simple facts of life,’’ Solheim said.

Freeman made a promise to supply underwear to girls in Uganda, where she was working with the administrator of a large school in the slums of Kampala. The result was Project Underpants, which provides packages of underwear and reusable feminine hygiene products to girls in several countries, allowing them to freely attend school.

Freeman also recently realized there was a need among homeless youth in her backyard of Portland and worked to provide packages to her local shelter. ‘‘Women and girls all over this world, across the globe, all need to

December 2014

have protection, and they all deserve to have that protection,’’ she said. ♦ Robert Nabulere overcame the hardship of his early life in Uganda through education and hard work, and after becoming successful, he was motivated to help those still stuck in poverty. Ten years ago, he moved his family from their comfortable life to the Kampala slums, where they started a church and a school. In 2013, he broke ground on a four-story clinic and plans to add a university and a teaching hospital. His group’s work includes programs for prisoners and after-school activities for children.

Nabulere said he has been focusing on feeding children after discovering that children suffering from HIV, which is widespread in the slums, were not strong enough to fight the disease because they suffered from malnutrition. His group provides children three meals a day at the school and buys extra food for children with HIV.

♦ During one of their medical mission trips to Cochabamba, Bolivia, ENA members Joan Eberhardt, MA, RN, CCRN, FAEN, and Helen Sandkuhl, MSN, RN, CEN, FAEN, saved a badly burned boy from a lifetime of hardship.

The boy, Luis, had been burned by a fireball from lighting his family’s gas stove. He looked near death when they first saw him. When Sandkuhl asked Luis if he would like to go to the United States, he whispered that he would like to see Mickey Mouse.

Eberhardt and Sandkuhl raised $25,000 to bring Luis to the U.S., where he spent seven weeks in a burn unit. After his release, he lived with Eberhardt because his family was too

poor to care for his needs during his recovery. The two women eventually raised enough money to send Luis back to his family. Life was not easy for him when he returned to Bolivia, but Eberhardt and Sandkuhl remained involved in his life, mentoring him through challenges and guiding him to his new life of attending university and preparing for a career. ‘‘Imagine what would have happened it these two women had not been in Bolivia and had not gone to that hospital to save a little boy,’’ Solheim said. ‘‘These are two women who truly know the power of one.’’

The Power of One event raised more than $28,000, which will be used to send 10 emerging professionals to the Emergency Nursing 2015 conference in Orlando. ‘‘I hope as you walk away this evening that you feel as empowered and as changed as I have been,’’ Solheim said.

Amy Carpenter Aquino

With Sincere Thanks The ENA Foundation appreciates all who attended or donated to The Power of One. Because of you, we are able to award over 45 scholarships to bring more emergency nurses to Emergency Nursing 2015!

The Power of One: Engaging Generations of Nurses to Give Back and Do Incredible Things

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Poster Winners

T

he Institute for Emergency Nursing Research presented the evidence-based practice and research poster awards Oct. 9 at the 2014 Annual Conference in Indianapolis. Recipients were chosen from 42 evidence-based practice topic submissions and 16 research topic submissions.

Best Evidence-Based Practice Poster “Call 911: Our Documentation Died!”

Stacey Kreger, RN Debbie Heckler, RN Claire Gonder, RN Lauren Szymanski, RN Erin Godwin, RN Nancy Cimino, RN Angela Profili, RN (Medstar Union Memorial Hospital, Baltimore) The project started shortly after the Medstar Union Memorial Hospital emergency department went live with its electronic medical record system, said Gonder, the department educator, and Cimino, the ED nurse manager. The transition to an EMR system inspired a group within the department to determine what they wanted the staff to document. ‘‘We did a little research, and there was really nothing out there that said, ‘These are good standards for an emergency room,’ ’’ Gonder said, ‘‘so we took some things from ENA, we looked at the Joint Commission, and we looked at our past practices.’’

The project group gave the staff a two-month preparation time once the documentation guidelines were determined. It also created a tool to help staff remember what to document; Gonder laminated screen shots of where to document information in the EMR and hung them up in the patient rooms. ‘‘The training was very basic,’’ Cimino said. ‘‘The ones who could find it intrinsically did OK.’’ With a young staff that could easily navigate the EMR, the main education points were finding the details of what

to document and remembering to chart it all ‘‘because it wasn’t sitting in your face like the paper was,’’ she said.

One of the most important outcomes of the charting project has been the ability to provide individual feedback to nurses on their documentation. Monthly chart reviews have helped nurses see where they stand on documenting different areas. Gonder said the group even has created spreadsheets to do trending to help nurses see if they keep missing documentation in certain areas. ‘‘They love the feedback,’’ she said.

Another interesting outcome has been seeing staff step up to new leadership roles or reveal unique skills, such as one author who displayed a previously unknown knack for research.

Gonder and Cimino said they were shocked when their ED’s poster was announced as the winner because this is the first year they entered the award program. ‘‘We never gave it any thought that we were in the running,’’ Cimino said. ‘‘It was a great surprise,’’ Gonder added.

Best Research Poster “Investigating Discharged ED Patient’s Pain Management Experience: A Pilot Study” Stephen Stapleton, PhD, RN, CEN, FAEN R. Joe Degitz, MSN, RN (Mennonite College of Nursing, Illinois State University, Normal, Ill.) Stapleton was a 2012 recipient of the ENA Foundation Industry Supported Research Grant provided by Stryker.

The $5,000 grant funded the pilot study, which is the first part of his larger research project. ‘‘What I was looking at were patients coming in to the emergency room with acute pain, which is defined as three months or less,’’ Stapleton said.

He and his research assistant followed up with patients for the next seven days to see how their pain was managed in the ED, what kind of pain levels they had upon discharge and how they managed their pain over the following week.

Patients did self-data entry on an iPad and completed a pain diary, entering a pain intensity score at the same time every day and recording the medications they took to manage pain. Questionnaires included inquiries about how the patients’ pain affected their social interactions, sleep and other aspects of daily life. ‘‘This was a pilot study, so I learned a lot about how to approach patients, what I can and cannot do and what some of the issues were,’’ Stapleton said.

The results showed that the 12 people who completed the study all had issues with pain and fatigue for the entire seven days after discharge from the ED. ‘‘Their sleep patterns, their pain intensity, the pain behaviors were all above the normal population,’’ he said.

He plans to write a second grant for a larger study that is powered enough to show relationships between the variables. Stapleton figures he will need 500 patients for the second study, which means he will have to approach about 1,500 patients.

Once the larger study is complete, Stapleton plans an intervention study of how developing an interactive, educational program for patients to tell patients how to manage their pain. ‘‘We give them discharge instructions and talk to them, but all they want to do is go home,’’ he said.

EYES FOR EXCELLENCE The IENR gratefully acknowledges the following individuals for serving as poster judges for the 2014 ENA Annual Conference poster awards program: • • • • • • • • • • • • • • • • • • •

Margaret Carman, DNP, MSN, RN, ACNP-BC Janet Eckhart, EdD, MSN, RN Mary Kamienski, PhD, APRN, CEN, FAEN Vicki Keough, PhD, RN, APRN-BC, FAAN Patricia Normandin, DNP, RN, CEN Andrea Novak, PhD, RN-BC, FAEN Ryan Oglesby, PhD, RN, CEN AnnMarie Papa, DNP, RN, CEN, FAEN Kathleen Richardson, DNP, ARNP, NP-C Sonny Ruff, DNP, RN, CEN Susan Shapiro, PhD, RN Susan Sheehy, PhD, RN FAEN Sheila Silva, DNP, RN D. Todd Smith, PhD, RN, AG-ACNP-BC, FNP-C, FF/EMT-P Audrey Snyder, PhD, RN, CEN, FAEN Dawn Specht, PhD, RN, CEN Jeanne Venella, DPN, RN, CEN Jennifer Williams, PhD, RN ACNS-BC Beth Winokur, PhD, RN, CEN He suggested that if patients were able to watch a video on pain management while they were waiting to be discharged, it would help them to better manage their pain after they left the ED. Stapleton said he was shocked and very happy when he learned that he had won the research poster award. ‘‘It’s a nice little pat on the back,’’ he said.

Amy Carpenter Aquino

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FORMAL FINISH The ENA Annual Awards Gala ended the conference in style on Oct. 11, with Annual Award winners, 17 Lantern Award recipients and 10 inductees to the Academy of Emergency Nursing all getting their time in the spotlight.

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December 2014

Media Award Video The video about the dangerous teen driving trend of ‘‘hill hopping,’’ for which Kelly Owen, ADN, RN, CEN, received the 2014 ENA Media Award, can be viewed at tinyurl.com/hillhopping or by scanning the QR code here. WARNING: Video contains graphic images.

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Annual Award Recipients ENA honored some of its very best with achievement awards at the Annual Awards Gala on Oct. 11.

Recipients are pictured with 2014 ENA President Deena Brecher, MSN, RN, APN, ACNS-BC, CEN, CPEN.

Barbara A. Foley Quality, Safety and Injury Prevention Award

Behind the Scenes Award

Clinical Nurse Specialist Award

Richard Gary Fox (Maryland)

Michael Allain, MS, RN, CEN, CCRN (New York)

Frank L. Cole Practitioner Award

Gail P. Lenehan Advocacy Award

Judith C. Kelleher Award

Denise Ramponi, DNP, FNP-BC, ENP-BC, CEN, FAEN, FAANP (Pennsylvania)

Mary A. Leblond, MSN, RN, CEN (Texas)

Vicki A. Keough, PhD, APRN-BC, ACNP, FAAN (Illinois)

Media Award

Nurse Manager Award

Nursing Education Award

Kelly Owen, ADN, RN, CEN (Oregon)

Jennifer Granata, MSN, FNP-C, CEN, CPEN, CNML, EMT-P (Maine)

Kay-Ella Bleecher, MSN, RN, CEN, CRNP, PHRN (Pennsylvania)

Charlotte Oâ&#x20AC;&#x2122;Neal, MSN, RN, CEN (Kentucky)

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Nursing Practice and Professionalism Award

State Council/Chapter Government Affairs Award

Heather Matthew, MSN, RN, CEN (Pennsylvania)

Texas ENA State Council

Team Award Inova Springfield Healthplex Emergency Department (Virginia) Patient Flow Team: • Winifred Frempong-Boye, BSN, RN • Valerie Hyde, BSN, RN, CEN • Carolyn Miller, RN • Shannon North-Giles, MBA, RN, CEN • Susan Oney Dungan, BA, RN, CEN

President’s Awards • ED staff, Nemours/A.I. duPont Hospital for Children, Wilmington, Del. • Michael D. Moon, PhD, MSN, RN, CNS-CC, CEN, FAEN

2014 Academy of Emergency Nursing Inductees

Roger Casey, MSN, RN, CEN, FAEN (Washington)

Nicholas Chmielewski, MSN, RN, CEN, CNML, NE-BC, FAEN (Ohio)

Seleem Choudhury, MSN, MBA, RN, CEN, FAEN (Vermont)

Ruth E. Rea, PhD, RN, FAEN (Washington)

Robert Ready, MN, RN-C, CPEN, NEA-BC, FAEN (Rhode Island)

Stephen J. Stapleton, PhD, MS, RN, CEN, FAEN (Illinois)

Tiffiny Strever, BSN, RN, CEN, FAEN (Arizona)

Mary Alice Vanhoy, MSN, RN, CEN, CPEN, NR-P, FAEN (Maryland)

Cheryl Wraa, MSN, RN, FAEN (California)

Rita Celmer, RN, CRNA, CEN, FAEN (Pennsylvania) (posthumous)

Lantern Award Recipients

E

NA established the Lantern Award program in 2011 to recognize exemplary emergency departments that exemplify exceptional practice and performances that lead to optimal patient outcomes.

The following 17 emergency departments have been recognized as the 2014 Lantern Award recipients based on their evidence-based practices and their innovative performance in the core areas of leadership, practice, education, advocacy and research.

Advocate Children’s Hospital Pediatric Emergency Department – Oak Lawn Campus (Oak Lawn, Ill.)

Bethesda Arrow Springs Emergency Department – TriHealth (Lebanon, Ohio)

Cincinnati Children’s Hospital Medical Center Emergency Department – Liberty Campus (Liberty Township, Ohio)

Ann & Robert H. Lurie Children’s Hospital of Chicago Emergency Department

Bon Secours St. Mary’s Hospital Pediatric Emergency Department (Richmond, Va.)

Edward Hospital Emergency Department (Naperville, Ill.)

Franciscan St. Francis Health – Indianapolis Emergency Department Nemours Children’s Hospital Emergency Department (Orlando, Fla.)

Northwestern Lake Forest Hospital Emergency Department (Lake Forest, Ill.) Oak Hill Hospital Emergency Care Center (HCA) (Brooksville, Fla.)

Overlook Medical Center Emergency Services – Union Campus, Atlantic Health System (Union County, N.J.) Sharp Memorial Hospital Emergency Department (San Diego)

Swedish Medical Center/Ballard Emergency Department (Seattle)

Swedish Edmonds Emergency Department (Edmonds, Wash.)

University of Michigan Hospital & Health Centers – C.S. Mott Children’s Hospital, Children’s Emergency Services (Ann Arbor, Mich.)

UH Rainbow Babies and Children’s Pediatric Emergency Department (Cleveland)

Hear It From Them Lantern Award recipients are sharing their best practices in a series of videos via ENA Connection, starting with Franciscan St. Francis Health, located in Indianapolis. Go to tinyurl.com/ ENALantern1 or scan the QR code here.

University of Wisconsin Hospital & Clinics Emergency Department (Madison, Wis.)

The ENA Lantern Award Celebrates Exemplary Emergency Departments.

Re

cipie

nt 2015-20

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We recognize exceptional practice and innovative performance in the following areas: ª ª ª ª ª

Advocacy Education Leadership Practice Research

We invite your Emergency Department to apply for this distinguished award.

The recipients will be recognized at the Annual Gala at Emergency Nursing 2015.

Please follow the application guidelines on the website.

Applications accepted through February 25, 2015.

www.ena.org/lanternaward

Development of the Lantern Award program criteria funded in part by

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ENA Strategic Sponsor

10/2/14 1:46 PM

December 2014

Closing Session Speaker

Capitalizing on the Chaos of Change

M

ere hours before the first nurse in the United States was diagnosed with Ebola, leadership expert John Spence stood before hundreds of emergency nurses to address how to deal with change and the six things leaders must implement to ensure a successful change management process.

Spence is no stranger to coaching high-performance teams. He gave a similar presentation to Apple executives days after Steve Jobs passed away in 2011. For those who are prepared, he says, chaos brings opportunity.

To prepare for his presentation, Spence conducted an informal poll to ascertain the issues that are top-ofmind to emergency nurses. He wasn’t surprised by most of the hot-button issues nurses face, including being overwhelmed by workload, speed of work and change; long work days; too few resources; and lack of trust, collaboration and recognition. What he didn’t expect to hear about was the prevalence of workplace violence.

While he acknowledged some of these issues cannot be fixed, Spence encouraged the audience to figure out what they can control and reassured them that it’s a lot more than most think. ‘‘To be successful in the future, the rate of internal innovation must exceed the rate of external innovation,’’ he said. ‘‘Be more nimble and agile than everyone around you.’’

He explained that when people perceive negative change, they encounter the same emotional response as when someone close to them dies. Change managers must

‘‘No one deals with more change than the healthcare industry,” John Spence told attendees on Oct. 11. move as quickly as possible through the change. If it takes too long, people check out.

Spence went on to provide tips for what he calls ‘‘dealing with the new normal’’ — a primer on dealing with change and the emotional stress people face with what they perceive as negative change. He said the following six things must be done exceedingly well for the best possible advantage of having successful change: 1. Have an irresistible case for change. Decide that there’s no reverting back to the way things previously were, and provide a case for why this change is good.

2. Give new vision of the future.

3. Create a sense of urgency. Time is of the essence.

4. Create a guiding coalition. The entire senior management team needs to be change champions, along with people who have high source credibility regardless of title.

5. Plan for small wins. When setting up a change process, make sure something good happens every week.

Official Magazine of the Emergency Nurses Association

Everyone needs to see momentum immediately. The change then becomes a winning cause and people want to be on a winning team.

6. Empower others. Let the team take ownership of change, and reinforce that it was led by everyone.

Still worried about change resistance? Spence suggests that change managers bring people face-to-face with the external pressures to change, engage change zealots, manage feelings and emotions and support the change with new tools, systems and training.

Marie Grimaldi, ENA Communications and Public Relations Manager

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ON TO ORLANDO! A few more lasting images from Indianapolis, site of the final membership conference before ENA merges its Annual and Leadership conferences into the Emergency Nursing 2015 event next Sept. 28 - Oct. 3 in Orlando, Fla.

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December 2014

♦

ENA ANNUAL CONFERENCE PHOTOGRAPHY BY EPNAC.COM ♦

MAKE HISTORY WITH ENA! September 28 – October 3, 2015 Orlando, Florida

Emergency Nursing 2015 will integrate the leadership and annual conferences into one new and exciting ENA conference experience. Start planning now for Orlando – the perfect destination for you, your colleagues, and your family. § Both clinical practice and leadership tracks § Interactive demonstrations of cutting edge technology § New hands-on learning labs

Save the date for this inaugural event!

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BOARD WRITES | Joan Somes, PhD, MSN, RN-BC, CEN, CPEN, FAEN, NREMT-P, Director

Is Beer a Clear Liquid ?

H

ave you ever told your patient to ‘‘stick to clear liquids?’’ Have you just handed a patient the discharge instruction sheets and said, ‘‘Follow these’’? Do you assess that your patients can actually repeat back what they are supposed to do at home? Are you sure you are providing the safest discharge for your patients?

More than 50 percent of Americans have difficulty reading and interpreting written materials. Fourteen percent have very poor reading skills, and 5 percent cannot read information printed in English, even though English is their primary language.

More important, nurses need to recognize that the National Assessment of Adult Literacy statistics are based on non-healthcare related materials.1 The Joint Commission notes in its white paper on health literacy that the collision of health care and literacy, or ‘‘health literacy,’’ leads to ‘‘patient care safety findings.’’ It also noted that ‘‘even those who are most proficient at using text and numbers may be compromised in understanding healthcare information when challenged by sickness and feelings of vulnerability.’’ 2 For better or worse, poor readers are often excellent at covering or coping with their inability to read and follow healthcare instructions given to them, either verbally or in writing. There is no stereotype that will help determine if a patient needs clearer instructions. One needs to assume every patient will benefit from ‘‘living room language’’ instructions and recognize that medicalese, or medical jargon, is a foreign language to most of our patients.

Is beer a clear liquid? Technically it is, but if you were discharging a patient with gastroenteritis, would you suggest beer?

Would you recommend watermelon

46

(technically a clear liquid)? Have you ever had a patient who only drank water because he or she was unclear about what constitutes a clear liquid?

How often have you told a patient, ‘‘Ice and elevate,’’ ‘‘Keep it dry and clean,’’ ‘‘Take four times a day,’’ ‘‘Gargle with salt water,’’ ‘‘Watch CMS’’ or ‘‘Watch for signs of a head injury’’? You, as well as your fellow emergency nurses and physicians, know what you mean, but does your patient, or even a healthcare provider who does not work in the ED? I still remember a non-ED/non-orthopaedic physician with a newly casted arm being told to ‘‘watch the CMS [circulation, motion, sensation].’’ Fortunately, the nurse validated that he knew what ‘‘checking CMS’’ meant. The physician admitted he’d been trying to figure out what a governmental agency had to do with his broken arm.

Could ‘‘ice and elevate’’ lead to a patient placing ice cubes directly on the skin with the arm straight up in the air?

(I had a patient do that.) How do you clean a wound if it needs to stay dry? Does ‘‘four times a day’’ mean 6 a.m., noon, 6 p.m. and midnight, or 8 a.m., noon, 8 p.m. and 10 p.m.? How much salt goes in the water, and how warm is warm? What are ‘‘activity as tolerated,’’ ‘‘frequent small amounts,’’ ‘‘advance diet as tolerated’’ and a BRAT diet? Does a ‘‘soft diet’’ consist of marshmallows? These questions sound silly, but this is how patients have been known to interpret instructions.

It is easy to see that even simple messages can be confusing to our patients. ENA’s position statement related to safe discharge notes that discharge is a ‘‘high-risk instance for patient non-compliance and communication failure.’’ It has been shown that the average time taken to discharge a patient is only four minutes, and 78 percent of patients do not clearly understand the instructions given to them. The position statement describes steps one can take to safely send the patient home. 3 Some of questions to consider include: What is the reading level of the written instructions you are giving to the patient? How much time is spent going over the instructions? Are environmental factors impacting teaching? Was there an assessment of patient learning?

The ENA topic brief on Health Literacy4 provides excellent hints for how to ensure your patient will be able to repeat back to you what they are expected to do on discharge: Start early, break instructions into bite sizes and teach during the entire ED visit. Decrease distractions by turning off the TV and sending phone conversations out of the room. Speak slowly and clearly using living room language, avoiding medical jargon and assumptions that

December 2014

patients understand ED shorthand.

Describe specifically what you mean when you say ‘‘clear liquids’’ or other shorthand instructions.

Make sure the written instructions you are sending home are at a reading level your patients can understand. Look at the instructions routinely sent home. Count the number of syllables/words in each sentence through several paragraphs. The longer the sentence and the more polysyllabic words in each sentence, the harder it is to understand and remember what’s meant to be learned. The Flesch Reading Ease formula does this, while the Flesh Kincaid grade reading level calculator (found under most ‘‘toolkit’’ icons in computer software) provides insight into what grade reading level the patient will need to have to understand the materials.

Look at the instructions given to your patients — can you make them safer? Use a yellow highlighter or red pen to underline important parts. Elaborate with one- to two-syllable words that specifically explain what you mean. A clear liquid list might include broth, tea, Kool-Aid, Jell-O, popsicles, Pedialyte, etc.

(Remember, some of our patients don’t know what a ‘‘balanced electrolyte solution’’ is and probably won’t find it at the store.) ‘‘Keeping a wound clean and dry’’ might be better explained as follows: Keep area dry. Wash 1-2 times each day.

Do not soak. Pat the wound dry. Cover with a new Band-Aid. Change the Band-Aid if it gets wet or dirty.

Watch for redness, red lines, swelling, pus, pain. These are signs of infection. You need to see the doctor or nurse if this happens. (These instructions came out at first-grade reading level per the Flesh Kincaid calculator.)

Before discharge, ask the patient or caregiver to teach back to you what they are going to do when they go home. The AskMe3 program recommends all patients should be able to answer the following three questions before leaving:

1. What is my main problem?

2. What do I need to do about it?

3. Why is it important for me to do this? 5 Are you doing this for your patients?

References 1. Kutner, M., Greenberg, E., Jin, Y., Boyle, B., Hsu, Y., & Dunleavy, E. (2007). Literacy in everyday life: Results from the 2003 National Assessment of Adult Literacy (NCES 2007–480). Retrieved from U. S. Department of Education National Center for Education Statistics website: http://nces.ed.gov/ Pubs2007/2007480_1.pdf 2. The Joint Commission. (2007). “What did the doctor say?” Improving health literacy to protect patient safety. Retrieved from http://www. jointcommission.org/assets/1/18/improving_health_ literacy.pdf.

3. Bush, K., Gurney, D., Baxter, T., Cook, J., & Patrizzi, K. (2013). Safe discharge from the emergency setting. Retrieved from the Emergency Nurses Association website: http://www.ena.org/ SiteCollectionDocuments/Position%20Statements/ SafeDischarge.pdf 4. Szumanski, K., Gacki-Smith, J., Quinn, B., & Wallerich, D. (2012). ENA topic brief: Health literacy. Retrieved from the Emergency Nurses Association website: http://www.ena.org/ practice-research/Practice/Documents/ TopicBriefHealthLiteracy2012.pdf 5. National Patient Safety Foundation. (2013).

AskMe3. Retrieved from http://www.npsf.org/ for-healthcare-professionals/programs/ask-me-3/

Be clear about what you mean: Beer could be interpreted to be a “clear liquid” like a popsicle but might not be appropriate, depending on your patient’s condition.

47

Production Never Stops on Position Statements Job Involves High Volume and Intense Discussions

Care Setting were all approved as

inter-professional colleagues’ websites

presented and are available to

to make sure those position statements

members at www.ena.org.

are still posted online.

By Amy Carpenter Aquino, ENA Connection

successful year, Gurney, the committee

data, decided what the priorities were

chairperson, clarified, ‘‘Oh, no, that’s

and then we got started,’’ Gurney said.

Upon being congratulated on a

P

osition Statement Committee members Diane Gurney, MS, RN, CEN, FAEN, and Sally K. Snow, BSN, RN, CPEN, FAEN, were in attendance as the ENA Board of Directors approved four proposed position statements at its Oct. 7 meeting in Indianapolis. The position statements on Emergency Nursing Certification, Injury Prevention, Patient Experience/ Satisfaction in the Emergency Care Setting and Violence in the Emergency

‘‘We amassed a lot of assessment

just the last three months!’’

The committee’s work began in January with a review of every existing

She emphasized the committee is responsive to anything that comes up in the interim.

position statement. Position statements

‘‘This year, the certification one

are on a three-year review cycle, so a

came up, and we responded to that.

consistent number come up for review

That hadn’t been on our radar and

each year. Committee members look at

wasn’t one of our priorities,’’ she said.

which ones need to be reviewed and

‘‘We’re responsive, we’re flexible, and I

then conduct a further review to

think we’re very productive.’’

ensure proper format.

The committee also looks at ENA’s joint position statements and visits

Meeting via webinar has increased the committee’s productivity, Gurney said. Members can all view the

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December 2014

documents while holding a topics unfamiliar to committee discussion, which simplifies the members, they conduct process of responding to research and interview member comments and making colleagues for clarity. When the revisions.

DNR position statement was ‘‘We’ve been very impressed posted, member comments with the volume and the quality included references to POLST Diane Gurney of comments from members,’’ (physician order for lifesaid Snow, the committee’s sustaining treatment), which no board liaison. ‘‘Most of the time one on the committee knew they are very thoughtful, and about. After research, the we’ve incorporated a lot of committee changed the focus of what they recommended in the the position statement. position statements.’’ ‘‘We serve the membership,’’ Gurney and Snow shared Gurney said. ‘‘We really turned Sally K. Snow how member comments on the that whole thing around and position statement that took a different perspective with originally focused on the do-notit by putting the emphasis on the POLST resuscitate advanced directive became instead of the DNR.’’ ‘‘Resuscitative Decisions: Maintaining, The committee’s other work this year Withholding, and Withdrawing included writing a definition of a Resuscitative Interventions in the position statement and guidelines for Emergency Setting.’’ The committee how a position statement should be posts all position statements online for written, Snow said. member comments; if those include ‘‘We also asked for changes in

charges,’’ she said, ‘‘because we not only review position statements — we write position statements.’’

The board approved changing the name to the Position Statement Committee.

For members considering applying, Gurney’s advice is to clear your calendar and be prepared for intense discussions. ‘‘I think anybody on this committee has to know that they’re going to be asked to be available, and it’s a lot of work,’’ she said.

She described committee members as thoughtful and discerning. ‘‘We don’t want members who are going to just agree to agree,’’ she said. ‘‘We want that deep discussion.’’

The other 2014 committee members are Katie Bush, MA, BS, RN, CEN, SANE; Gordon L. Gillespie, PhD, RN, CEN, CPEN, FAEN; Kathleen M. Patrizzi, MSN, RN, CEN, ACNS-BC; Robin Walsh, MS, BSN, RN; and Susan Rajkovich, ENA staff liaison.

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