Ena connection april 2014 by ENA Connection

the Official Magazine of the Emergency Nurses Association

connection LOOK DEEPER

April 2014 Volume 38, Issue 4

Raising Our Vigilance in Areas of Pediatric Behavioral Health, Child Maltreatment

PLUS: A Smooth Response to Water Contamination

CONCEPTS OF CARE Starting on Page 6

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Dates to Remember April 1-30, 2014 Deadline to submit applications online for 2015 Resolutions Committee. May 6-7, 2014 Day on the Hill, Washington, D.C. May 13 - June 11, 2014 ENA Elections June 1, 2014 Deadline to apply to serve on 2015 ENA Foundation Board of Trustees.

ENA Exclusives PAGE 6 Concepts of Care Section 6 Red Flags in Pediatric ED Presentation 8 Preventing Child Maltreatment: A Daunting Task 10 Water You Going to Do? An ED Handles a Water Crisis PAGE 14 Washington Watch: New Law Expands Presence of SANEs in the Military PAGE 18 Sizable Progress: Addressing the Needs of the Bariatric/Obese Patient PAGE 20 ENA Committees: Why Not Raise Your Hand? PAGE 21 ENA Forms First International Advisory Council

Regular Features PAGE 4 Free CE of the Month / Ask ENA PAGE 12 ENA Foundation PAGE 16 Academy of Emergency Nursing

COMING IN MAY • 2014 Election Candidate Profiles • Leadership Conference 2014 Coverage

FROM THE PRESIDENT | Deena Brecher, MSN, RN, APN, ACNS-BC, CEN, CPEN

Are We Safe to Be at Work Today? I

f you are anything like I am, you don’t let a cold stop you from getting to work. We show up sick because we know how short the unit is going to be if we are not there. There are times we come to work with our heads thick with cold medicine, sleep-deprived or with something on our minds that is distracting us from the task at hand. We all have our reasons for dragging ourselves into work under these circumstances, but I have started to wonder if by making these decisions we are creating an unsafe patient care environment. We know from the literature that distractions and interruptions can cause us to make mistakes. We often think about distractions as things that happen in the clinical environment. Is it possible that feeling lousy can distract us from our clinical work? It goes beyond coming to work physically sick. What we experience in the ED at some point will catch up with us. The cold you can’t shake, the patient you thought you could have done something differently for, the child who was removed from her family, the teenager killed in a horrible accident — all of these events leave their mark. Can these things distract you from your clinical tasks? Can they lead you to make a mistake? What can be done? First, do your best to stay healthy. That means exercise, a balanced diet, excellent hand-washing skills and, yes, your annual flu shot. If you are sick, stay home. In addition to keeping your co-workers and your patients from getting sick (and for that they will be grateful) you will reduce the likelihood your illness would distract you from your task at hand. Second, we need to take care of our mental and spiritual selves. We need to be able to identify when the impact of our crazy, chosen profession impedes our ability to safely care for our patients and families. It happens to all of us at some point in our careers. We each have developed different ways of coping. Some of us choose to decompress via exercise. Some have

excellent support systems at home or outside of work. Some turn to faith. I like chocolate. The idea is that we have to be able to identify when we need help and not be afraid to reach out and ask for it. If you are unable to shake work, it’s time to do something you aren’t already doing. Reach out to your employee assistance program. Talk to your spiritual advisor. Ask a friend for help. If you are working with someone who is unusually distracted, reach out to him or her. Ask what you can do to help get your colleague out of a potentially unsafe situation. Each of us has an incredible contribution to make every time we walk into our clinical environments. Our health, whether it’s physical, mental or spiritual, plays a big part in our attentiveness and our ability to provide the safest care possible to our patients. Please take care of yourselves so we can take care of our patients. This one depends on each of us doing the right thing and looking out for each other.

Official Magazine of the Emergency Nurses Association

You can help combat the growing problem of human trafficking in the United States when you take ENA’s latest free continuing education offering.

Available to you starting April 1 . . . ‘‘Human Trafficking: What Emergency Nurses Need to Know,’’ presented by Donna Sabella, PhD, MEd, MSN, RN. (Credit: 1.0 contact hour.) In this eLearning course recorded at the 2013 Annual Conference in Nashville, Tenn., Sabella defines human trafficking and its different types and gives you ways to identify the victims in a health care setting and safely intervene while you are providing treatment. 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 ‘‘check out.’’ • Proceed to your Personal Learning Page to start or complete any course for which you have registered or to print a final certificate. • To return to your Personal Learning Page later, go to www.ena.org and find ‘‘Go to Personal Learning Page’’ under the Education tab. Please be sure you are using the e-mail address associated with your membership when logging in. If you have questions about any free eLearning course or the checkout process, e-mail 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.

Q: My co-worker in the ED received a recognition award from our hospital. We’re all very proud of her. Is there a place in ENA Connection where I can have this published? – Cheryl, Atlanta A: Absolutely. E-mail your news to connection@ena.org with the subject line Members in Motion, or mail to ENA Connection (attn: Members in Motion), 915 Lee St., Des Plaines, IL 60016. Members in Motion celebrates member success stories, including any of the following: • Awards or honors • Academic or educational accomplishments • Promotions, appointments or other professional advancements • Career milestones • Media recognition for nursing work • Community or legislative efforts that have advanced emergency nursing Tell ENA’s 40,000-plus members about a colleague’s achievements or your own. Include all pertinent details and high-resolution photos (particularly head shots)

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

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if you have them. Items may be edited for length and clarity, and submission does not guarantee publication. In some cases, a member of the ENA Connection staff may contact you for additional information. There are other ways you can use the reach of ENA Connection. We welcome Letters to the Editor on subjects previously covered in the magazine. Weigh in on something you’ve read here and become part of the discussion. Letters may be edited for space and clarity. Again, submission does not guarantee publication. When you send to connection@ena.org (subject line: Letters to the Editor), be sure to include your name, credentials and contact information so your letter can be verified. There’s also the feature you’re reading, Ask ENA, in which you can ask questions about the association or emergency nursing in general and the appropriate ENA staff will respond. Part of being an ENA member is feeding the conversation. We’re looking forward to reading what you have to share!

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

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Potential complications may include local or systemic infection, hematoma, extravasations or other complications associated with percutaneous insertion of sterile devices. 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

CONCEPTS OF CARE

RED FLAGS in Pediatric ED Presentation By Lisa Wolf, PhD, RN, CEN, FAEN and Jennifer Robinson, MSN, RN

helsea, a 14-year-old female, is brought to the emergency department by her mother for treatment of an infected cut on her leg. “She cut it on some glass,” her mother says. “Does it look infected?” The child and her mother are brought to the fast track area for treatment. As you talk to Chelsea, you note that she avoids eye contact, and that her affect is flat. The cut on her leg is about 6 inches long, very straight and looks infected. She tells you she fell and cut her leg about a week ago. In a quick discussion with the provider, you recommend that based on several observations you’ve made, she consider a more thorough mental health assessment for this patient. The World Health Organization reports that the global mortality rate for death by suicide is 14.5/100,000, making suicide the fourth-leading cause of death among individuals age 15 through 44 years.1 Behavioral health problems affect between 14 and 20 percent of children and adolescents; up to 30 percent of the global population experiences mental health problems every year, with at least two-thirds being untreated.2 About 50 percent of Americans will meet the criteria for a mental health disorder in their lifetime, with this behavior often first presenting in childhood and adolescence. Lack of time, lack of knowledge and lack of nursing

experience with behavioral health can all be reasons why a child may slip through the cracks; even the ones who are properly diagnosed face issues of access to resources. In a study of a screening tool for adolescent suicide risk, King et al. found that of their sample of 298 adolescents, 16 percent screened positive for elevated suicide risk.3 Within this group, 98 percent reported severe suicidal ideation or a recent suicide attempt (46 percent attempt and ideation, 10 percent attempt only, 42 percent ideation only) and 27 percent reported alcohol abuse and depression. A critical finding of this study was that 19 percent of adolescents who screened positive presented for nonpsychiatric reasons. One-third of adolescents with positive screens were not receiving any mental health or substance-use treatment. Ideally, the appropriate place for evaluation of a behavior health issue would be with the pediatrician who has an ongoing relationship with the patient. In a busy ED setting, it is difficult to sit down and complete a behavioral health assessment on every pediatric patient who comes through the ED doors. More important, there can be times when a pediatric patient presents with a chief complaint that is not psychiatric in nature, but based on assessment findings by the emergency nurse or other provider, it becomes clear that further investigation is necessary. Some red flags seen in the literature are the use of drugs or alcohol, as well

as nonsuicidal self-injury. As many as 13 to 29 percent of adolescents engage in nonsuicidal self-injury, such as self-cutting, burning and biting without lethal intent.4 Other contributing factors may include dating violence.5 Because many children and adolescents present to the ED for nonpsychiatric reasons (as suggested by the patient described in the beginning of this article), some general considerations in the assessment and care of the pediatric patient include: 1. What is the child’s demeanor? Is his or her demeanor appropriate for age and/or situation? 2. Is the child able to maintain eye contact and answer questions appropriately? 3. Is the child withdrawn? 4. How does the child respond to stressors or changes in his or her life? 5. Do the child and parent engage in appropriate communication and interactions with each other? 6. Does the child participate in risk-taking behavior? 7. Does the child exhibit any signs of self-mutilation? 8. Is the child currently being treated for any behavioral health issues? 9. For the older adolescent child, is the child engaging in unprotected sex? 10. Is there any drug or alcohol use? The American Academy of Pediatrics supports the use of standardized clinical tools to screen for mental

April 2014

health issues, including suicidality, but only a minority of emergency physicians indicate that they use evidence-based screening methods to assess mental health concerns.6 The HEADS ED rapid assessment tool 6 shows promise in predicting the need for acute intervention. The components of the tool are: H ome E ducation A ctivities and peers D rugs and alcohol S uicidality E motions and behaviors D ischarge resources If the patient presents to the ED for a nonpsychiatric complaint but red flags trigger suspicion of a potential risk for behavioral health issues, the physician should be apprised immediately. Ideally, the practitioner can choose to speak with the child alone, which may elicit the true nature of the situation. Children may be reluctant to divulge information if they feel they may get into trouble or when a parent or guardian is present. A social worker should be consulted for proper resources if the facility has one on staff. If there is suspicion that the child is not safe at home, then a call to child protective services should

be considered. Rapid identification and early treatment of mild-to-moderate behavioral health disorders decrease the risk of long-term disability for children and adolescents.7 The ability of the emergency nurse to pick up on these red flags is critical to proper treatment of these patients. References 1. World Health Organization. (2002). Self-directed violence. In E. Krug, L. Dahlberg, J. Mercy, A. Zwi, & R. Lozano (Eds.), World report on violence and health (pp. 185-212). Geneva, Switzerland: World Health Organization. 2. Bayer, J., Ukoumunne, O., Lucas, N., Wake, M., Scalzo, K., & Nicholson, J. (2011). Risk factors for childhood mental health symptoms: National longitudinal study of Australian children. Pediatrics, 128, e865-879. Retrieved from http:// pediatrics.aappublications.org/content/ early/2011/08/30/peds.2011-0491 3. King, C., O’Mara, R., Hayward, C., & Cunningham, R. (2009). Adolescent suicide risk screening in the emergency department. Academic Emergency Medicine, 11, 1234-1241. doi:10.1111/j.1553-2712.2009.00500.x 4. Hamzaa, C., Stewart, S., &

Official Magazine of the Emergency Nurses Association

Willoughby, T. (2012). Examining the link between nonsuicidal self-injury and suicidal behavior: A review of the literature and an integrated model. Clinical Psychology Review, 32, 482-495. 5. Nahapetyan, L., Orpinas, P., Song, X., & Holland, K. (2013). Longitudinal association of suicidal ideation and physical dating violence among high school students. Journal of Youth and Adolescence. Advance online publication ahead of print. Retrieved from http://link. springer.com/article/10.1007%2Fs10964013-0006-6#page-2 6. Cappelli, M., Gray, C., Zemek, R., Cloutier, P., Kennedy, A., Glennie, E., … Lyons, J. (2012). The HEADS-ED: A rapid mental health screening tool for pediatric patients in the emergency department. Pediatrics, 130, e321-e327. 7. Williams, J., Klinepeter, K., Palmes, G., Pulley, A., & Foy, J. (2004). Diagnosis and treatment of behavioral health disorders in pediatric practice. Pediatrics, 114, 601-606. Additional Resource Aguirre, J., & Carrion, V. (2013). Integrated behavioral health services: A collaborative care model for pediatric patients in a low-income setting. Clinical Pediatrics 52, (12), pp. 1178-1180.

Preventing Child Maltreatment

A DAUNTING TASK By Deb Flowers, MSN, CPNP, Program Coordinator/Nurse Consultant, Child Medical Evaluation Program, Department of Pediatrics, UNC School of Medicine

hild maltreatment is a serious public health problem in the United States. In 2011, an estimated 3.4 million referrals involving approximately 6.2 million children were made to child protective service agencies nationally.1 An estimated 676,569 children were determined to be victims of abuse or neglect.1 Of these, 78.5 percent experienced neglect, 17.6 percent were physically abused, 9.1 percent were sexually abused and approximately 9 percent experienced emotional or psychological abuse.1 An estimated 1,570 children died of maltreatment in 2011.1 Child maltreatment significantly

impacts the medical and mental health of children, both in the short term and throughout their lifespan. The Adverse Childhood Experiences Study is one of the largest investigations ever conducted to assess associations between childhood maltreatment and medical and mental health later in life. A collaboration between the CDC and Kaiser Permanente’s Health Appraisal Clinic, the ACE Study findings strongly suggest that certain experiences, such as child abuse and household dysfunction, contribute significantly to poor quality of life.2 The good news is that we as health care providers have the ability to significantly impact

children who are at risk of child maltreatment. I have been very fortunate in my nursing career to be exposed to many wonderful learning experiences. Working in the area of child maltreatment has been the most challenging yet interesting and rewarding areas in which to work. After spending 19 years in emergency nursing, I followed a path I had not planned or expected. In 2006, I had the opportunity to join the North Carolina Child Medical Evaluation Program as the program coordinator and nurse consultant. This program is a medical consultative

April 2014

CONCEPTS OF CARE initiative administered through the University of North Carolina at Chapel Hill, Division of Pediatrics and Adolescent Medicine. One of the primary roles of the NCCMEP is to assist all 100 county departments of social services in North Carolina with the medical and mental health aspects of child welfare investigations. Another primary function of the NCCMEP is to develop and deliver education on the medical aspects of child maltreatment to our child welfare social workers across the state, as well as other disciplines involved in child maltreatment services. In considering the new role, I remember thinking, ‘‘How hard can it be? I have taken care of abused children for 19 years as an emergency nurse.’’ I really had no clue what I had stepped into. Every day presents a new learning opportunity. While much of my education and mentorship has been provided by

outstanding medical child-abuse experts, child welfare social workers across North Carolina have been very patient and tolerant in helping me to understand their role and the challenges and limitations they encounter in attempting to keep children safe and healthy while focusing on strengthening families. The influence of these mentors has not only increased my understanding of child maltreatment but has assisted me in working with others to do the same. Prevention of child maltreatment is a daunting task. It will take multiple complex initiatives happening concurrently to impact the prevalence of child maltreatment in the U.S. As nurses who care for children in many capacities, we are situated to impact child maltreatment in a number of ways. We can accomplish this by being vigilant for factors that predispose children to maltreatment.

Recognition and prevention of child maltreatment is challenging, and without targeted training and understanding of the many facets of child maltreatment, we will miss many opportunities to prevent it. When thinking about how to prevent child maltreatment, understanding the factors that place children at risk is critically important. Nurses caring for children have an incredible opportunity to be at the forefront of preventing or reducing maltreatment. It would take too long and too many words to list the many different ways we may impact child maltreatment in this writing; however, I will list two common examples emergency nurses frequently encounter. The first example is the parent or parents who bring a young infant to the emergency department for

Continued on Page 22

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Official Magazine of the Emergency Nurses Association

2/18/14 4:21 PM

CONCEPTS OF CARE

WATER YOU GOING TO DO? When Chemical Spill Triggers a Water Ban, W.Va. ED Springs Into Action With Solutions By Amy Carpenter Aquino, ENA Connection

mergency departments routinely drill for various disaster scenarios, and Charleston Area Medical Center General Hospital in Charleston, W.V. — no stranger to natural and man-made disasters from power outages to major weather storms — is no exception. When the Upper Big Branch Mine explosion happened in April 2010, ‘‘we had a scenario where we were expecting multiple critically injured patients, so we had a system in place to provide more staff and more support throughout the hospital infrastructure,’’ said emergency physician Michael Sitler, MD. The water outage policy in CAMC’s disaster plan was what was needed for this specific scenario. On Jan. 9, it was reported that the chemical 4-methylcyclohexane methanol, also known as MCHM, had leaked from storage tanks and spilled into the Elk River and then into the Charleston-area water supply. Three of

Members of the CAMC General Hospital ED staff (from left): Mike Williams, General Hospital administrator; Marianne Richardson, BSN, RN, emergency department director; Amanda Jones, RN; Sara Campbell, RN; Nancy Tawney, RN; Michael Sitler, MD; Jennifer Dotson, RN; Christine Dempsey, RN; Timothy Kayser, RN; Cynthia Starcher, nurse assistant, and Cheyenne Lindsey, health unit coordinator. CAMC’s hospitals in Charleston — including General Hospital, Memorial Hospital and Women and Children’s Hospital — were under the area water ban in effect Jan. 9-12. A fourth CAMC hospital, Teays Valley, was not affected, said Dale Witte, public relations officer for CAMC. ‘‘We live in the Chemical Valley and we’re the trauma center, so we’ve had some experience with multiple-patient scenarios that may be traumatized or have poisonings,’’ said Sitler, who was on duty at General Hospital on Jan. 9. ‘‘But the part you can’t prepare for is when your infrastructure itself is not safe or considered safe, and there’s a lot of unknown about the water. How do you sterilize equipment? How do you wash beds? How do you mop floors? How do you treat patients?’’ Peggy Erlewine, emergency services administrator, was in the incident command center that was quickly set up after the hospital received calls from the state about the water ban. ‘‘The Command Center team

secured all the bottled water that we could,’’ she said, noting that an important piece of the supply chain was providing ice for all units throughout the hospital. That problem was solved with Igloo coolers, which were filled with ice purchased from outside the county. ‘‘We mobilized folks that could go from one unit to another filling ice, distributing bottled water, putting bottled water on patient trays, and bringing bottled water to the ED,’’ Erlewine said. A truck filled with 8,000 gallons of clean water, provided by the county emergency operations center, was soon stationed in the parking lot. ‘‘Literally, housekeepers, maintenance folks and whoever could would go out and fill up five-gallon or one-gallon jugs,’’ Witte said. That supplemented a 72-plus-hour bottled water supply from CAMC’s disaster supply warehouse. A full-size tractor-trailer tanker was set up outside General Hospital with a

April 2014

hose running into the dialysis unit, and the staff performed dialysis using water straight from the tanker. Other staff were dispatched to haul water from hospital to hospital, and a special pump system was established to pump clean water into machines to clean scopes and other equipment. Erlewine said additional staff were called in as the hospital mobilized all the forces it could, especially in the first 24 hours after the water ban was announced. After that first day, things ran much more smoothly, she said. ‘‘We knew what resources we had, what we needed to obtain from outside and what the community and the state could offer us as well,’’ she said. ED Director Marianne Richardson, BSN, RN, said patients started showing up to the ED ‘‘almost immediately’’ after a Charleston newscast reported the chemical leak, as well as what symptoms to look for. Patients who presented to the ED complained of some of the symptoms mentioned in the news reports, included nausea, itchy skin, shortness of breath and headaches, she said. ‘‘It was difficult because the symptoms were very non-specific, and we still didn’t have much information from the poison center about the human effects,’’ Sitler said. ‘‘If someone is nauseated, there are a hundred reasons why they could be nauseated. Is it just that you are nauseated, or is it related to the water exposure? Unfortunately, there is no way to answer that question.’’ Richardson said she called in a few extra nurses when there was uncertainty over how many patients would actually be presenting to the ED. ‘‘Most people wanted to come and were willing to come in and help,’’ she said. After the first 12 hours following the news reports, the volumes decreased. Sitler said they began to see the ‘‘worried well’’ — patients who had seen the news reports and

WHEN TO TEST YOUR WATER The U.S. Environmental Protection Agency lists the following reasons to test your water. According to the EPA, the last five problems are not an immediate health concern, but they can affect the taste of your water and may indicate long-term problems if you have a well. Conditions or Nearby Activities

Test for

Recurring gastrointestinal illness

Coliform bacteria

Household plumbing contains lead

pH, lead, copper

Radon in indoor air or region is radon rich

Radon

Corrosion of pipes, plumbing

Corrosion, pH, lead

Nearby areas of intensive agriculture

Nitrate, pesticides, coliform bacteria

Coal or other mining operations nearby

Metals, pH, corrosion

Gas drilling operations nearby

Chloride, sodium, barium, strontium

Dump, junkyard, landfill, factory, gas station or dry-cleaning operation nearby

Volatile organic compounds total dissolved solids, pH, sulfate, chloride, metals

Odor of gasoline or fuel oil, and near gas station or buried fuel tanks

Volatile organic compounds

Objectionable taste or smell

Hydrogen sulfide, corrosion, metals

Stained plumbing fixtures, laundry

Iron, copper, manganese

Salty taste and seawater or a heavily salted roadway nearby

Chloride, total dissolved solids, sodium

Scaly residues, soaps don’t lather

Hardness

Rapid wear of water treatment equipment

pH, corrosion

Water softener needed to treat hardness

Manganese, iron

Water appears cloudy, frothy, or colored

Color, detergents

Source: U.S. Environmental Protection Agency been exposed to tap water. ‘‘We did actually see some people that had a contact rash, and I think those were the ones who had some evident exposure illness, but I think there was a lot of fear,’’ Sitler said. ‘‘You have to understand that the ED is always the shelter for folks who can’t provide their own resources, so we saw a lot of folks from the men’s and women’s shelters and the indigent — folks that really didn’t have anywhere else to go, so they would come to the

Official Magazine of the Emergency Nurses Association

ED and say they had an exposure. I think they needed some reassurance as much as anything. They were fearful and didn’t know how to cope with the situation, and they couldn’t go out and buy bottles of water.’’ Witte said CAMC’s three Charleston EDs reported that about 285 patients, including pediatric and adult, complained of symptoms related to water exposure in the days after the

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ENA FOUNDATION

Pediatric Trauma program manager Dawn Tortajada, MSN, RN, PNP-BC (front, right) with the trauma team at Robert Wood Johnson University Hospital in New Brunswick, N.J.

CHALLENGE ACCEPTED Pediatric Patients the Real Beneficiaries as Scholarship Winner Broadens Her Reach

By Kendra Y. Mims, ENA Connection

atching patients in Robert Wood Johnson University Hospital’s pediatric trauma department make little steps of progress and providing daily support to patients and their families are rewarding moments that remind Dawn Tortajada why she switched to the emergency nursing profession. Tortajada, MSN, RN, PNP-BC, pediatric trauma program manager at

RWJ in New Brunswick, N.J., didn’t envision herself here 21 years ago. After graduating from Rutgers University with a degree in exercise science and sports medicine in 1991, she decided to pursue a career in cardiology. It wasn’t until she completed her internship in RWJ’s cardiac rehabilitation department that she had a change of heart. She had observed the care that nurses provided during her internship and felt drawn to the emergency nursing profession. The

aspiring nurse immediately returned to school. She graduated from the Rutgers College of Nursing in 1993 and began her first job as a nurse in pediatric care at RWJ, where’s she worked ever since. Tortajada eventually became a nurse educator in the pediatric emergency department. During this time, she discovered she had developed otoscelrosis and had to wear bilateral hearing aids. Unsure if she could still practice with a stethoscope because of her hearing

April 2014

“‘This ENA Foundation scholarship has helped me to become a better nurse and reminds me to challenge myself every day. My advice is to never stop learning and never stop challenging yourself.’’ DAWN TORTAJADA, MSN, RN, PNP-BC, 2010 SCHOLARSHIP RECIPIENT THROUGH ENA FOUNDATION STATE CHALLENGE aids, Tortajada decided to challenge herself clinically and began studies to earn her master’s degree in 2007. ‘‘I figured I could still get through school and pursue a clinical degree to get the educational portion even if I couldn’t adapt a stethoscope [to practice],” she said. ‘‘During that time I was able to figure out a way to adapt a stethoscope to my hearing aid. It helped me greatly to pursue a clinical nursing degree that I wasn’t initially sure I could utilize to the full extent.’’ Tortajada was halfway through her master’s program when a mentor told her about the ENA Foundation’s scholarship opportunities. She applied and became a recipient of a $3,000 scholarship through the 2010 ENA Foundation State Challenge. She earned her master’s degree in a pediatric nurse practitioner program the next year and credits the ENA Foundation for helping her further her education and her professional development. Tortajada said RWJ, as a Level I trauma center and the only verified pediatric trauma center in New Jersey, receives the most injured pediatric patients in the state, ranging in age from newborn to 21 years. Returning to school to get her master’s degree has helped her improve her care for pediatric patients, she said. ‘‘It helps me make decisions when treating trauma patients, not only for their day-to-day care but also in developing guidelines, algorithms and protocols on the care in general of patients with abdominal trauma injury,’’ she said. ‘‘It allows me to guide the care of all pediatric trauma patients that come through our facility.’’

After she completed her master’s, Tortajada’s peers encouraged her to apply for the pediatric trauma program manager position, which she was offered in 2012. She cares for pediatric trauma patients from resuscitation through rehabilitation, working collaboratively with the members of the health care team, patients and families, using advanced assessment skills and specialty expertise. ‘‘I work both directly and indirectly to promote quality pediatric clinical care, staff and patient education, and I support pertinent research for the pediatric population,’’ Tortajada said. ‘‘My day-to-day responsibilities include program management, clinical practice, performance improvement, education, outreach and research.’’ Tortajada said pediatric emergency nursing found her rather than her finding it, and she couldn’t imagine doing anything else. She is passionate about pediatric care and making patients and their families feel comfortable. ‘‘Sometimes pediatric patients take a few steps backward,’’ she said. ‘‘I find that I’m a consistent person that the families can identify with, and I’m going to be there to see the patients and go through the day-to-day process with them. It’s about letting them know that they are more than just a patient in the bed. They’re somebody you care about, and you truly believe in the team that you work with.’’

Official Magazine of the Emergency Nurses Association

Tortajada says she is able to give back to her profession and her patients because of her education and 21-year experience in pediatrics. She encourages emergency nurses to give back to the ENA Foundation to help provide nurses with educational opportunities that could make an impact on patient care. ‘‘This ENA Foundation scholarship has helped me to become a better nurse and reminds me to challenge myself every day,’’ she said. ‘‘My advice is to never stop learning and never stop challenging yourself.’’ Dawn Tortajada is just one of the numerous scholarship recipients who have benefitted from the State Fundraising Challenge. This year’s ENA Foundation State Fundraising Challenge will end May 31. There’s still time to encourage your state council, local chapters and peers to donate to the State Fundraising Challenge ‘‘Building a Strong Foundation’’ campaign and help the ENA Foundation exceed its goal of $125,000. Your contributions can help emergency nurses like Tortajada further their education to improve the quality of care for all patients. One-hundred percent of donations to the campaign will fund scholarships and research grants in 2015 and help advance the emergency nursing profession. Visit www.enafoundation.org to donate and to see how your state is doing.

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

New Law Expands Presence of SANEs in Military A

s a result of legislation recently passed by Congress and signed into law by President Obama, military medical facilities will see an increased presence of sexual assault nurse examiners to treat sexual assault victims and ensure that forensic evidence is properly collected. A provision added to the National Defense Authorization Act, which became law in December 2013, requires the assignment of at least one full-time SANE to each military medical facility with a 24-hour emergency department. Additional SANEs may be assigned based on a medical facility’s patient demographics. Under the law, SANEs assigned to military facilities must meet the training and certification requirements prescribed by the secretary of defense. ENA strongly supported the SANE provision and worked closely with U.S. House and Senate leaders, including Rep. Dan Lipinski (R-Ill.) and Sen. Barbara Boxer (D-Calif.), to help ensure it was included in the law. Lipinski was the lead sponsor of a House bill addressing the issue, the SANE Deployment Act. A paper he issued in 2012 to support the bill details the problem. ‘‘Sexual assault in the United States military [is] the leading cause of post-traumatic stress disorder among female service members,’’ the paper states. ‘‘Recently, the Department of Defense estimated that 26,000 male and female service members experienced unwanted sexual contact last year, an increase of 19,300 from 2010. Last year, there were 3,374

reports of sexual assault, up from 3,192 in 2011. Notably, these reports only represent the service members who came forward and reported their assault — the total number is undoubtedly much larger.’’ One important reason why many sexual crimes go unreported is the lack of adequate medical personnel to treat and counsel victims. Further, SANEs are experts in the proper handling of forensic evidence, which is critical for effective prosecutions of sexual assault perpetrators. The collection, storage and transportation of evidence all require specialized training to preserve the integrity of the samples collected. Lipinski notes that access to SANEs has been inconsistent across military emergency departments. In cases where a SANE is not available, ‘‘victims of sexual assault may be examined by an unqualified individual or airlifted to a location with a SANE.’’ If they have to be airlifted, not only is there a risk that evidence may degrade during that time, but victims are also left without proper care while they are being transported. ENA members helped ensure the issue remained pertinent to federal elected officials as the bill worked its way through Congress. In September 2013, the ENA

Government Relations Office sent an Action Alert to all EN411 members asking them to urge their member of Congress to support and cosponsor the SANE Deployment Act. As a result, ENA members sent letters to more than 100 representatives. ENA 2013 President JoAnn Lazarus, MSN, RN, CEN, sent a letter to Boxer to support her efforts. ‘‘By increasing the number of sexual assault forensic examiners in the armed services, as well as improving and standardizing their training, your amendment will ensure that victims of sexual assault will receive much-needed expert physical and emotional care,’’ Lazarus wrote. Although the SANE provision signed into law by the president differed from the language contained in Boxer’s amendment or Lipinski’s bill, ENA strongly supported it as a significant step forward. ‘‘I am very pleased that the House and Senate have included this bipartisan legislation that will ensure that highly trained nurses will now be available to provide treatment to sexual assault victims in our military,’’ Lazarus said after the president signed the NDAA into law. ‘‘The requirement that each 24-hour military medical facility be staffed by at least one sexual assault nurse examiner is an important step in improving the medical care provided to victims.’’ The passage of this legislation is a milestone in the treatment of sexual assault victims in the military and in the recognition of the unique skills of the SANEs who care for these victims.

April 2014

DRESSING LIGHTLY AS LANTERN WINNERS Members of the St. Anthony Hospital ED team in Lakewood, Colo., sport custom T-shirts created to celebrate their 2013 Lantern Award. The shirts were designed by St. Anthony administrative director Elizabeth Dunn, BSN, RN, CEN; St. Anthony CNO Kay Miller and Jackie Clare, ED business support. They display the Lantern Award logo on the front and a list of the staff’s accomplishments on the back. The Apex Emergency Physicians & Allied Health Professionals split the cost of the shirts with the ED. Left photo (from left): Tali Montesi, RN; Elijah Farquhar, RN; Sarah Galles, unit clerk; Rita Holmes, RN; Kristin Stoll, RN; and Jessica Nelsen, CCT. Right photo: Noah Creaven, RN.

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Official Magazine of the Emergency Nurses Association

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Meet the Academy of Emergency Nursing Board

he Academy of Emergency Nursing is pleased to present the 2014 Academy Board of Directors. These directors assumed office Jan. 1. In collaboration with the ENA Board of Directors, the AEN Board of Directors will develop vision and mission statements that will guide AEN growth in 2015 and beyond. The 2014 AEN board is also operationalizing the 2014 charges given by the ENA board, which include the following:

AEN Chair: Maureen Curtis Cooper, BSN, RN, CPEN, CEN, FAEN. Pediatric emergency staff nurse, Boston Medical Center, Boston; 2012 president, Massachusetts ENA State Council; 2005-2013 PNCB/BCEN Development and Exam Review Construction Committees, Certification in Pediatric Emergency Nursing; Beacon ENA Chapter 2014 representative to the Massachusetts ENA State Council.

1. Serve as mentors of the organization and evaluate the EMINENCE mentoring program. 2. Continue to evaluate Academy policies, procedures and guidelines. 3. Review eligible applicants to the ENA board annually for ratification and induction into the Academy. 4. Facilitate the annual meeting of the AEN fellows. 5. Provide subject matter expertise about the AEN to ENA in order to communicate to members and the public the value of the Academy and its members’ accomplishments. 6. Explore and recommend to the ENA board ways to involve Academy members as valuable resources for ENA.

Chair-Elect: Nancy Bonalumi, MS, RN, CEN, FAEN. President, NMB Global Leadership, LLC; section co-editor, Journal of Emergency Nursing; 2006 ENA president; chair, ENA Leadership Conference 2000-2001; 1996 president, Pennsylvania ENA State Council; member, Capitol ENA Chapter. Board Member-at-Large: Gordon Gillespie, PhD, RN, CEN, CPEN, PHCNS-BC, FAEN. Assistant professor and Robert Wood Johnson Foundation nurse faculty scholar, University of Cincinnati, Cincinnati; past president, Greater

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April 2014

Applications Being Taken for EMINENCE Mentoring Program The AEN EMINENCE Mentoring Program matches experienced Academy fellows with ENA members looking for professional growth opportunities. Mentees should plan to commit a minimum of 5 - 10 hours per month to their project. Mentees must apply with a specific project in mind. Projects include, but are not limited to, the following areas:

• • • • • • •

• Advanced practice role development • Educational conference planning

Grant writing Health policy Injury prevention (SBIRT procedure) Professional presentations Program development Research Writing for publication

The program is not intended for new manager development or projects to meet academic requirements, nor is it intended to assist in the application process for acceptance into the

Cincinnati ENA Chapter; past president and 2014 president-elect, Ohio ENA State Council. Board Member-at-Large: Renee Holleran, FNP-BC, PhD, CEN, CCRN, CFRN, CTRN, FAEN. 1996 ENA president; Journal of Emergency Nursing editor, 2006-2013; AEN past chair; member, Utah ENA State Council.

Academy. You can find the application for the mentoring program at www.ena.org in the Academy section. The submission deadline is April 30. Questions? E-mail academy@ena. org or visit www.ena.org/about/ academy/EMINENCE.

Immediate Past Chair: Kathleen Flarity, DNP, PhD, CEN, CFRN, FAEN. Colonel/commander, 302nd Aeromedical Staging Squadron, Peterson Air Force Base, Colo.; emergency clinical nurse specialist, Memorial Hospital University of Colorado Health, Colorado Springs, Colo.; member, Colorado ENA State Council. For more information about the Academy of Emergency Nursing, go to www.ena.org/about/academy.

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Official Magazine of the Emergency Nurses Association

12/17/13 3:48 PM

ENA SAFE PRACTICE

SIZABLE PROGRESS

From Resolution to Topic Brief, Recognizing the Needs of the Bariatric/Obese Patient By Amy Carpenter Aquino, ENA Connection

oan Somes remembers hearing about a patient who arrived at an emergency department and was too big for the computed tomography scan. ‘‘What [they] had to do was call all the hospitals in the area and find out who could handle him on their scanner, and then actually transfer the patient, which created a huge delay in care,’’ said Somes, PhD, MSN, RN-BC, CEN, CPEN, FAEN, NREMT-P, a staff nurse and department educator at St. Joseph’s Hospital in St. Paul, Minn. Somes’ local ENA chapter, the Greater Twin Cities Chapter, has since worked with local emergency medical services to identify the appropriate facilities for bariatric patients, ‘‘so that rather than bringing them to the closest hospital, they bring them to the most appropriate,’’ she said. ‘‘Our EMS people have developed a list of, for instance, whose CT scanners can take the 600-pound person. It’s a collaborative effort.’’ When Somes, who is a member of the 2014 ENA Board of Directors, and her fellow Minnesota ENA State Council members were deliberating a resolution topic to present to the 2012 General Assembly, the timing seemed right to tackle the issue of care of the bariatric/obese patient. ‘‘It was one of the populations at the time that really hadn’t been addressed,’’ she said. ‘‘We had geriatric and pediatric and psychiatric, but we

Joan Somes, PhD, Tina Shelton, MSN, RN-BC, MSN, RN, CBN CEN, CPEN, FAEN, NREMT-P

just didn’t have bariatric, and the more we did the research, the more we realized it’s an important topic.’’ The Centers for Disease Control and Prevention notes that one-third of all adults and 17 percent of children in the U.S. are obese, according to the ENA topic brief Care of the Bariatric/Obese Patient. The topic brief was developed in October 2013 as a result of the resolution authored by Somes and the Minnesota ENA State Council and approved by the 2012 General Assembly. One of the outcomes requested in the resolution was that ENA recognize that bariatric/obese patients require specialized care and that ENA develop a position statement that ‘‘addresses the safe and effective care of the bariatric/obese patient, including use of safety devices by staff.’’ Tina Shelton, MSN, RN, CBN, the bariatric program coordinator at Valley Health Winchester Medical Center in Winchester, Va., co-authored the ENA topic brief at the request of co-author and ENA member N. Erin Reeve, BSN, CEN, FCN. ENA Chief Nursing Officer Kathy Szumanski, MSN, RN, NE-BC, and Dale Wallerich, MBA, BSN, RN, CEN, senior associate, IQSIP, were also co-authors, as was the ENA 2013 Wellness Committee. Matthew F. Powers, MS, BSN, RN, MICP, CEN, was the ENA board liaison. ‘‘Obesity is an epidemic in the United States,’’ Shelton said. ‘‘We’re seeing more and more heavy people come through our EDs, and in order to provide safe care for these patients, we need to understand the complications related to this disease and what could happen. When you’re trying to establish an airway in a person who is morbidly obese vs. in a patient who is a healthier weight, you have to take into consideration all of the excess skin and the difficulty that it’s going to be to try and intubate these people. ‘‘And it’s not going to go away,’’ she continued. ‘‘Obesity isn’t going to go away, and we just need to make sure that as a health care system that we are able to provide safe care to these folks.’’ Shelton explained that the term ‘‘bariatric’’ is a general term that stands for ‘‘care of the person suffering from the disease of obesity.’’ The ENA topic brief addresses care of patients who are

April 2014

obese, as well as patients who have had bariatric surgery to remove excess weight. Both types of patients have special issues that emergency nurses should consider when providing care. ‘‘A bariatric surgical patient may only weigh 120 pounds but could have issues as a result of the surgery,” Somes said. ‘‘On the other hand, the patient could fall into the bariatric category due to size. They may have recently had surgery and not lost the weight, or not had surgery, but in either case can have other problems from skin issues, to lack of equipment, to injuries to the patient and staff members.’’ Staff safety is a major concern in the ED, Somes said. ‘‘We’ve all tried to push that 600-pound person down the hallway in a regular bed, and we’re hurting our backs,’’ she said. In considering both the care and safety of the bariatric/obese patient and the care and safety of the staff in

“‘Obesity isn’t going to go away, and we just need to make sure that as a health care system that we are able to provide safe care to these folks.’’ Joan Somes caring for them, Somes said the resolution had ‘‘a two-pronged attack.’’ Shelton said she and Reeve viewed the development of the topic brief as an interdisciplinary collaboration between the ED and the bariatric surgery program. They looked at the issue from different angles, including the needs of the patient who has had bariatric surgery. ‘‘It’s important that the nursing staff caring for those patients have a basic idea of what those surgeries are,’’ Shelton said, ‘‘because they can’t be treated as a post-operative general

surgery patient. Their needs are different. The interventions are different.’’ The topic brief also addresses the need for sensitivity among health care providers and the negativity that often occurs within the health care system when obese patients require care. ‘‘A lot of people aren’t aware of their interactions when they’re dealing with people who are obese,’’ Shelton said, ‘‘so we wanted to increase awareness of [judgments] related to that as well.’’ Shelton and Somes said they’re happy the topic brief raises awareness. ‘‘More importantly, we addressed the need to just take care of a patient suffering from obesity and talk about the safe care of that patient,’’ Shelton said. Somes said she was thrilled when ENA sent her a copy of the topic brief developed as a result of her state council’s resolution. ‘‘As soon as I got it, I sent it out to everybody in the state and said, ‘Look what we did,’ ” she said.

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Official Magazine of the Emergency Nurses Association

2/26/14 2:03 PM

Why Not Raise Your Hand? Volunteering for an ENA Committee: How You Can Make a Difference By Nancy Good, Committee Coordinator

aking the decision to volunteer for a committee can be difficult due to a busy schedule. Sometimes members want to get involved but hesitate because of the time commitment. Most committee members have found that the benefits of volunteering outweigh the challenges. As you begin to volunteer your time and talent, you will find it can be very rewarding both personally and professionally. Every ENA member has something to contribute to the profession. Participation on a committee gives you an opportunity to reach out to the emergency nursing community, learn new skills and even advance your career. You also will be able to share your talents as a subject-matter expert as you collaborate and network with your colleagues. Another benefit is developing new friendships. Committee volunteers provide a link to practice, education and special needs that benefit all members. As a volunteer, you will have many opportunities at the local, state and national levels to network with fellow nurses around the world as you investigate, deliberate and explore special issues tasked to each individual committee. You will help to make an impact on the emergency nursing profession as well as enhance your professional development.

Spring Call: 2015 Resolutions Committee ENA members are invited to submit an application for the 2015 Resolutions Committee online April 1 - 30. For application and call overview, go to www.ena.org and click on Get Involved.

How Do ENA Committees Work? Every committee is assigned charges that align with the ENA Strategic Plan. Several committees focus on ENA’s strategy to recognize, support and promote best practices for emergency nurses. Committee activities and expert recommendations are key components of the association’s foundation.

Opportunities The general purpose of an ENA committee is to assist the board of directors to govern more efficiently and effectively. Committees are ongoing and used to investigate, deliberate and analyze pragmatic areas or priorities that are persistent in nature. Committees have rotating terms that range from one to two years. Other opportunities to contribute are available through ENA work teams, advisory councils and special-interest groups (for descriptions, see www. ena.org and click “Committees” under the Membership tab.) ‘‘Participating on ENA committees allows me to contribute to the organization and the profession in countless ways, through the creation

of toolkits, position statements, white papers, conference activities, networking and brainstorming and much more,’’ said Robin Walsh, BSN, RN, a member of the Position Statement Committee. ‘‘It provides the opportunity to meet and work with some incredible ED nurses and ENA members. Truthfully, I always gain so much more through my involvement. I feel very honored to have been able to participate on four different ENA committees over the past few years. Each has been a learning experience that I will always cherish.’’ Nicholas Chmielewski, MSN, RN, CEN, CNML, NE-BC, chair of the ENA Resolutions Committee, added that it’s ‘‘a great opportunity to give back to the emergency nursing profession.’’ ‘‘Volunteer for a cause which brings you excitement and energy,’’ he said. ‘‘I’ve learned so much, met amazing colleagues and gained valuable skills to further my career.’’ ENA offers two opportunities each year — in the spring and fall — to volunteer for a committee. These are announced via e-mail, at www. ena.org and in ENA Connection. For more information, contact committees@ena.org.

ENA Forms First International Advisory Council By Amy Carpenter Aquino, ENA Connection

G. ‘‘Joop’’ Breuer, RN 2013 ENA president opened her eyes to the wealth of opportunity for sharing knowledge and solutions. During conversations with Janet Youd, an advisory council member and chair of JoAnn Lazarus, the Royal College of Nursing’s Emergency MSN, RN, CEN Care Committee — the U.K. equivalent of ENA — Lazarus said two emergency nurse leaders found that both organizations were working on such issues as staffing

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lightly more than 1 percent of ENA’s 40,000 members live outside the United States, but as the organization looks to increase its global presence, these are the members who will help guide its progress. With an eye to exploring how ENA can better engage its international members, the organization recently created its first International Advisory Council. The members, who hail from the Netherlands, Australia, Canada, Mexico, the United Kingdom and the U.S., are charged with advising the association on relevant topics specific to international emergency nursing. ‘‘I’m very excited about it,’’ said advisory council member G. ‘‘Joop’’ Breuer, RN, of the Netherlands. While attending a gathering with other international attendees at the 2013 ENA Annual Conference in Nashville, Tenn., last September, Breuer shared his thoughts on how ENA can better serve its international members. Notwithstanding the significance of the first international delegates participating in the 2012 ENA General Assembly, there still was a sense that the organization was not taking full advantage of its international member resources, Breuer said. ‘‘From my point of view, we would really like to see better knowledge of international nursing,’’ he said. ‘‘I think it could be very interesting to use ENA as a sort of forum for exchange of international knowledge, because ENA is by the far the biggest organization for emergency nurses in the world.’’ There is an emergency nurse group in the Netherlands, but it has fewer than 700 members, Breuer said. ‘‘Nurses in the Netherlands are not very well organized like they are in the U.S. or the U.K., so it’s very hard to get nurses to be involved in organizations,’’ he said. An instructor of ENA’s Trauma Nursing Core Course since 1998, Breuer regularly has contact with other emergency nurses in Australia and England and finds they all deal with similar issues, such as workplace violence. ‘‘Why not take the opportunity and try to learn from each other?’’ he said. That view is shared by JoAnn Lazarus, MSN, RN, CEN, who is serving as the International Advisory Council’s 2014 board liaison. Lazarus said her exposure to the experiences of international emergency nurses during her travels as the

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International Advisory Council Continued from previous page guidelines and nursing acuity. ‘‘Last year when I had the opportunity to visit Canada, Australia, Spain and the U.K., I spoke with individual nurses, and they all indicated that they have some concerns about violence in the workplace, along with lateral violence,’’ Lazarus said. ‘‘I don’t know if that’s prevalent or if it was just those individual nurses I talked to, but those are some of the topics I would

Child Maltreatment Continued from Page 9 ‘‘crying.’’ In days past, we would refer to this as ‘‘new parent syndrome,’’ or we may have thought the infant was septic. What we did not necessarily think was that the crying was a trigger leading to a potentially dangerous or lethal action by a frustrated caregiver.3 Today, it should be something we automatically think about when encountering this scenario. The other example: I remember the struggles of implementing intimate-partner violence screening and how emergency nurses have struggled with how to ask the hard questions. In my interactions with health care providers, I find that this continues to be a challenging process despite knowing that intimate-partner violence is strongly associated with child maltreatment. Reducing barriers to screening and increasing the comfort level for providers is important in successfully achieving this objective. Children present for medical care for many reasons. Thinking about risk factors for child maltreatment is critical if we are to be participants in furthering the well-being and safety of children. Nurses are certainly integral in helping to accomplish

like for us to prioritize and see if there is any interest.’’ Lazarus said she and 2014 President Deena Brecher, MSN, RN, APN, ACNS-BC, CEN, CPEN, discussed the goals for the International Advisory Council. ‘‘We really want this group to assess what a global presence would look like,’’ she said. ‘‘If we’re trying to develop a partnership with these other countries, what does that look like? Does that mean that we have joint position statements?’’

this task. Goals should include learning as much as possible about child maltreatment, teaching others about maltreatment, and working at community, state and national levels to further initiatives that will serve to protect children and strengthen families. Intervening every day to prevent child maltreatment is something we can accomplish. References 1. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2012). Child Maltreatment 2011. Retrieved from http://www.acf. hhs.gov/programs/cb/researchdata-technology/statistics-research/ child-maltreatment 2. Felitti, V., Anda, R., Nordenburg, D., Williamson, D., Spitz, A., Edwards, V., … Marks, J. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine, 14, 245-258. 3. Flaherty, E. Analysis of caretaker histories in abuse: Comparing initial histories with subsequent confessions. (2006). Child Abuse & Neglect, 30, 1978-1989.

Lazarus said it also was important to recognize that no single country had all the answers and that the sharing of successes and failures would benefit all members. ‘‘I think it’s important for us to strengthen our bonds with nursing all around the world,’’ she said. The other advisory council members are Janet L. Calnan, RN, of Canada; Seleem Choudhury, MSN, MBA, RN, CEN, of Colorado; Liz Cloughessy, MHA, RN, FAEN, of Australia; and Gerardo Jasso of Mexico.

Call for Nominations: 2015 ENA Foundation Board of Trustees Application deadline is June 1. Visit enafoundation.org for more information beginning April 1.

Water Contamination Continued from Page 11 leak. Those included patients who said they had inhaled water vapor from cooking with tap water, as well as patients who ingested water or washed or bathed in it. Very few of the patients who presented for water exposure had to be admitted, he said. After Jan. 12, the West Virginia American Water Co. allowed area residents and businesses to begin flushing their water lines. Although the water has been deemed drinkable, patients can still request bottled water on their trays, Erlewine said. As of press time, CAMC’s Women and Children’s Hospital was still using outside water for cooking, serving and making ice, Witte said. CAMC was well served by having an emergency response plan in place and by its regular, twice-yearly disaster plan testing, Erlewine said. ‘‘That really made our ramp-up for response a lot quicker, a lot easier and a lot smoother for the whole organization, even though we never thought we would have a water disaster,’’ she said.

April 2014

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“Every day brings an opportunity to see cutting edge trauma care. Nurses are the bedrock of our Emergency Department. It is our duty to provide the highest quality care.” - Meg Bryant A major employer in the Fort Worth area, JPS is a teaching hospital and Level I Trauma Center. If you’re interested in joining our team, please visit www.JPSNursing.org

www.jpshealthnet.org

ER Nursing Opportunities at UVA Medical Center When experience meets opportunity, great things happen. University of Virginia Medical Center seeks experienced, caring registered nurses for its emergency department, a Level I Trauma Center. Join a dynamic team of nurses, patient care technicians, physicians and pharmacists that provide excellent quality care to patients from across the state and adjoining states by collaborating to develop innovative, team-activated protocols. UVA Medical Center seeks registered nurses with 1–2 years of emergency department experience who are available to work 12–hour shifts during evening and night hours. BLS and ACLS required. TNCC and CEN certifications preferred. Experienced registered nurses with a Bachelor of Science in Nursing and 2 or more years of experience will be offered a $5,000 sign on bonus and up to $5,000 relocation assistance for moves over 50 miles. To learn more or apply, visit uvajobsbeyondmeasure.com or call 1-866-RNS-4UVA. EOE/AA M/F/D/V The University of Virginia is an equal opportunity and affirmative action employer. Women, minorities, veterans, and persons with disabilities are encouraged to apply. /uvanurserecruitment

@uvahealthjobs

Official Magazine of the Emergency Nurses Association

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28 41 55 68 %

Average improvement in throughput for admitted and discharged patients

Average improvement in time from arrival to seeing a physician.

Typical improvement in patient satisfaction scores and likelihood to recommend

Improve emergency care, improve your career You know us as recognized ED leaders who guide hospitals toward real and effective change. Now we would like to get to know you. Blue Jay Consulting is looking for professionals with the leadership insight and clinical experience to bring process improvements to our clients, and the passion and commitment to enhance the overall quality of emergency care. If you consider yourself among the best in your field, you’ll find yourself in good company at Blue Jay Consulting. Join the strongest team in the industry and improve your career. Contact Jim Hoelz or Mark Feinberg at 407-210-6570 to discuss how we can capitalize on one another’s strengths.

www.bluejayconsulting.com

Average improvement in LWBS rates, resulting in an additional $1.6 million in collected revenue

“As a Blue Jay consultant, I bring my 30 years of emergency department leadership experience to each client. Every assignment brings a unique set of challenges, but the tools to solve them are similar. We can often shorten the improvement process from years to months and create an environment that is better for patients, families and staff. I leave each assignment with a good feeling that I have left it better than when I arrived. I love being a Blue Jay consultant.” —

B I L L B R I G G S , M S N , R N , C E N , FA E N

Senior Consultant Blue Jay Consulting, LLC