ENA Connection September 2014 by ENA Connection

the Official Magazine of the Emergency Nurses Association

connection

September 2014 Volume 38, Issue 8

Award Season Announcing the 2014 Annual and Lantern Award Recipients & Academy Inductees

16 - 17 PLUS! Treasurer’s Report

Member Has Just the Place to Ditch Your Stress

INDIANAPOLIS

Indiana Convention Center

October 7-11, 2014

§ Learn about innovative products and services

§ Earn over 25.5 contact hours, depending on sessions attended

§ Network with colleagues from around the world

For the latest updates, visit www.ena.org/AC Follow the action on

#ENAAC14

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

Dates to Remember

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

Oct. 5-11, 2014 Emergency Nurses Week (Emergency Nurses Day is Oct. 8)

Why We Must Persist in Reporting, Despite Threat of Retaliation

Oct. 7-11, 2014 ENA 2014 Annual Conference, Indianapolis

ENA Exclusives PAGE 6 Treasurer’s Report PAGE 7 Meet ENA’s Parliamentarian PAGES 8 - 9 Progress Report on Past Resolutions From ENA General Assembly PAGE 14 Nurses and Higher Education: The Numbers Are Growing PAGE 16 2014 Award Announcements: • ENA Annual Awards • Lantern Awards • Academy of Emergency Nursing Inductions PAGE 17 Judith C. Kelleher Award Winner PAGE 18 Code You: Member Carves Out a Place for Nurses to De-Stress PAGE 22 When an Emergency Nurse Becomes the Patient: Five Lessons PAGES 24 - 26 Updates From ENA’s Geriatric, Pediatric and Trauma Committees PAGE 28 When the ADC is Bare: Combating Drug Shortages in the ED

Regular Features PAGE 4 Free CE of the Month Letters to the Editor

have spent the better part of this year trying to encourage emergency nurses to report potential safety concerns, change their attitude regarding patient safety and embrace a culture of safe practice and safe care. Recently I read an article about a nurse’s duty to report unsafe situations in the practice environment. That article has caused me to take a harder look at the realities of reporting. I travel quite often as the ENA president, and at airports and train stations, I see the same message: ‘‘If you see something, say something.’’ I translate that message to the emergency care environment: If you see something that’s unsafe, say or do something about it. If the child is lying on the stretcher, and the stretcher is raised and the side rails are down, lower the bed, raise the rails and let the team taking care of the patient know someone walked out of the room and left the patient in an unsafe situation. If the computer in the patient room will not let you scan the medication, report the issue. If you feel that a co-worker’s practice is unsafe — whether it may be caused by a controlled substance, behavioral health issue or poor judgment — report that co-worker and hope he gets the help he needs.

I had never given much thought to what happens if a nurse suffers retaliation after reporting a safety issue. I have a hard time imagining an environment where emergency nurses would be retaliated against for raising a safety concern. However, there are environments where a ‘‘culture of blame’’ exists, both inside and outside of health care. While most nursing practice acts identify nurses as mandatory reporters if they have knowledge of an impaired colleague, many do not require nurses to report unsafe practices or conditions. Unfortunately, there have been several cases where nurses have been prosecuted for reporting unsafe practice. How is this possible? The ENA Code of Ethics states, ‘‘The emergency nurse acts to protect the individual when health care and

safety are threatened by incompetent, unethical or illegal practice.’’ In my interpretation, ‘‘acts to protect the individual’’ means reporting unsafe practice. How can I, as the ENA president, continue to advocate for safe practice and safe care, work to help nurses understand their role in preventing errors in the ED and ask nurses to hold each other accountable for reporting unsafe practices when I know nurses are being retaliated against for doing just that? My answer is that I must continue to do it. We need to own our practice.

Continued on page 6

PAGE 10 ENA Research PAGE 12 ENA Foundation PAGE 30 Ask ENA

Take advantage of ENA’s latest free continuing education offering to earn CE credit while you explore care of the behavioral health patient in the ED.

Available to you starting Sept. 1 . . . ‘‘Facilitators and Challenges to the Care of Behavioral Health Patients in the Emergency Department: A National Study,’’ presented by Lisa Wolf, PhD, RN, CEN, FAEN.

ENA Connection welcomes letters from members. Letters should address content previously published in the magazine. Letters may be edited for space and clarity. Submission does not guarantee publication. Please include your name, credentials and contact information for verification. Send letters to connection@ena.org.

just received the January 2014 issue of ENA Connection from a friend who is an ER nurse. I was so thrilled to see the cover and read the lovely story inside (‘‘Guided Tours,’’ page 5)! Thank you so much for the wonderful tribute to Vietnam nurses and the Vietnam Women’s Memorial! This article will be placed with our archives at the Library of Congress. In the 1980s, I contacted ENA and asked for their help in support of building the Vietnam Women’s Memorial on the Mall in Washington, D.C. They got behind it immediately and became legislative and financial supporters. All of us at the Vietnam Women’s Memorial Foundation (formerly ‘‘Project’’) are ever grateful to the Emergency Nurses Association. I have known Marilyn Rice for many years and was so happy to the Official Magazine of the Emergency

connection

38, Issue 1 January 2014 Volume

This session explores potential solutions for the behavioral health patient population by laying out the findings of the critical-access hospital educational study and identifying the significance of the educational barriers for emergency nurses at CAHs. To take this and other eLearning courses free as an ENA member: •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.

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

Nurses Association

have the opportunity to visit with her again at the 20th commemoration activities over Veterans Day 2013 last fall. We appreciate the beautiful wreath presented on behalf of ENA at the Vietnam 2014 ENA CAREER GUIDE Women’s Memorial on Veterans Day. We send our deepest appreciate for your years of ongoing support, and special thanks to Marilyn Rice, Lt. Col. Peggy McMahon and Deena Brecher for being with us on that beautiful day. Kendra Y. Mims’ story ‘‘Guided Tours’’ is beautifully written and takes its place among the rich legacy of our Vietnam-era veteran nurses. Thank you!

HELD DEAR

A Trip Back Through Time l at the Vietnam Women’s Memoria PAGES 4 - 9

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

Diane Carlson Evans, Founder and President, Vietnam Women’s Memorial Foundation, Washington, D.C.

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

10.3%

SURVIVAL RATE WITH NON-ACLSTRAINED NURSES.

37.5%

SURVIVAL RATE WITH ACLSTRAINED NURSES.

THE RIGHT TRAINING

SAVES MORE LIVES.

In-hospital cardiac arrest survival rates can improve dramatically. ACLS-trained nurses can more than triple survival rates, according to the recent American Heart Association Consensus Recommendations, “Strategies for Improving Survival After In-Hospital Cardiac Arrest in the United States: A Consensus Statement from the American Heart Association.” Download the AHA Consensus Statement to get the tools you need to boost survival rates.

Visit www.physio-control.com/Training to get the report.

Morrison L, Neumar R, Zimmerman J, et al. Strategies for improving survival after in-hospital cardiac arrest in the United States: 2013 consensus recommendations: A consensus statement from the American Heart Association. Circulation. 2013;127:1538–1563.

TREASURER’S REPORT | Kathleen E. Carlson, MSN, RN, CEN, FAEN, 2014 ENA Secretary/Treasurer

A Healthy Picture to Share F

inancial results for 2013 supported the advancement of ENA’s programs and advocacy initiatives, both in the current year and well into the future. Among ENA’s strengths is its diverse set of revenue sources: membership, courses, conferences and other products and programs. Membership remains stable, and continuing education courses exhibit growth as courses are updated and extended to a broadening base of nurses. More diversity resides within those courses, with Trauma Nursing Core Course, Emergency Nursing Pediatric Course, Geriatric Emergency Nursing Education, Emergency Nursing Orientation, Emergency Nursing Triage, Handling Psychiatric Emergencies and certification review courses all contributing. Total revenue was $17.2 million in 2013, reflecting annual growth of about 1 percent. Membership held steady at just under 40,000, generating $3.6 million in dues, of which $371,000 went directly to support ENA state councils and local chapters. Course revenue exceeded $8.4 million, increasing about 7 percent from 2012, and also provided $1.2 million to the state councils to support TNCC and ENPC. A record 51,000 nurses took the TNCC provider course, and nearly 16,000 took the ENPC provider course. More than 5,000 people attended our Leadership and Annual conferences. Operating expenses totaled just over $17.2 million for the year, so the net result was a slight operating loss of only $29,000. The expenses supported the core activities of

$2,343,307

13%

$3,589,838

21%

ENA 2013 REVENUE Membership

$2,868,957

17%

From the President Continued from Page 3 We need to understand our duty to report as outlined in our state nurse practice act. We must continue to work to reduce the number of avoidable errors in our departments. We must report unsafe practices, procedures, policies, actions, conditions and

Courses

$8,415,501

49%

Conferences Other

membership, courses and conferences, and also provided additional support to state councils through grants totaling $45,000. In addition, the ENA Board of Directors acted to provide $25,000 to the ENA Foundation’s Judith Kelleher Memorial Endowment. ENA’s investment portfolio grew to $13.5 million, increasing the reserve ratio to 73 percent, or $4.2 million more than required by ENA’s reserve policy. This prudently invested portfolio is now providing substantial income, further strengthening ENA’s financial foundation. A complete copy of ENA’s audited financial statements is posted in the members-only section of the ENA website at tinyurl.com/ENAfinance or by scanning the QR code at left.

environments. We also must understand where the gaps are in protection for nurses who report these conditions, and we must close those gaps. Creating, advocating for and supporting a just culture is a first step toward removing fear of retaliation as a barrier to reporting. Understanding the role of the emergency nurse in decreasing

preventable errors is another. Other steps include becoming familiar with state laws that govern mandatory reporting; understanding the protections, if any, that are in place for nurses; and advocating to create or strengthen existing protections. The most important step is to never, ever give up the drive to advocate for safe practice and safe care.

September 2014

GOVERNANCE

ALL IN ORDER

Meet the Parliamentary Maestro Behind ENA’s General Assemblies By Kendra Y. Mims, ENA Connection

Trohan also provides amendments ore than 700 delegates and assistance to delegates emergency nurses convene after the first day of every year for the ENA General General Assembly. Assembly to witness the installation ‘‘We hold a group of board members, hear reports on hearing where association activities and debate and everyone gets the vote on proposed bylaws, opportunity to discuss amendments and resolutions. From every bylaw keeping track of time to providing amendment and every clarification and assisting the ENA resolution,’’ she said. president during the assembly, ‘‘We help anyone who Colette Collier Trohan is the ENA wants to propose an parliamentarian who keeps the amendment with the two-day business meeting in order. writing to make sure Trohan, president and CEO of it’s clear and legal. It A Great Meeting Inc., has more than Parliamentarian Colette Collier Trohan clarifies a procedure gets signed off by the during the 2013 General Assembly in Nashville. She’ll oversee 20 years of experience as a lawyer and by me, the her seventh General Assembly for ENA next month. professional parliamentarian. Her parliamentarian, and first meeting as ENA’s General Assembly parliamentarian then it gets published so that on Day 2 of GA, everybody was at the 2008 Annual Conference in Minneapolis. sees what else might come up on the agenda that day. It’s a Trohan describes herself as the meeting process guru. big production.’’ ‘‘As the parliamentarian, I am the one who remains totally Trohan says the two challenges she faces in her impartial,’’ she said. ‘‘I help everyone put their ideas together parliamentarian role are time and confusion. in the best form for a large group of delegates to look at.’’ ‘‘If there is one misspoken phrase in front of all of those As soon as the meeting is adjourned, Trohan starts attendees, it can create confusion that becomes difficult to preparing for the next General Assembly. She says 80 percent change,’’ she said. ‘‘I spend most of my time making sure of the meeting actually happens before it is called to order. everything is presented as clear as possible so there is no That includes preparing a script with the ENA president and confusion on the floor and we don’t waste any time. We developing orientation and training for delegates. designed the amendments assistance process because the ‘‘There’s a tremendous amount of preparation to make time the delegates have in that room is so precious, and we sure that the delegates have everything they need to make have to be sure that they are set for success.’’ decisions, and making sure it’s as clear as possible so that we Trohan’s favorite part of General Assembly is watching don’t take up time wordsmithing on the floor, which is one the process unfold. of the most painful experiences a delegate can go through,’’ ‘‘When I see the delegates in that room really discussing Trohan said. the important issues of ENA, and when I see all of the Trohan meets with the Resolutions Committee the day viewpoints coming out, no matter what they are, it’s just after General Assembly to examine the bylaws and make wonderful to watch that decision being made,’’ she said. ‘‘I sure all of the amendments adopted are organized so that a like to tell everybody I don’t care what they do — I just care new governance document can be released. The committee how they do it. If I feel the General Assembly has looked at also debriefs on what worked well and what it could all the viewpoints and they have arrived at a decision, then improve for future meetings. it’s a fantastic feeling. It’s magical.’’

Official Magazine of the Emergency Nurses Association

RESOLUTION CENTER The Latest Work on ENA General Assembly Initiatives

s ENA delegates prepare to debate and vote on several proposed resolutions at the 2014 General Assembly on Oct. 8-9 in Indianapolis, here is a progress update on previously approved resolutions. ENA departments assigned to work on resolutions include the Institute for Emergency Nursing Research; the Institute for Emergency Nursing Education; the Institute for Quality, Safety and Injury Prevention; Government Relations; and Meetings and Conferences.

2013 GA13-014: Evidence-Based Standards for Lifelong Learning ENA met and advised the LACE team (Licensing, Accreditation, Certification and Education) of ENA’s recommendations in Q1 2014.

2012 GA12-017: Use of Protocols in the ED Setting ENA’s Government Relations staff investigated and provided details to assist in the development of the position statement titled ‘‘Use of Protocols in the ED Setting’’ in Q1 2014.

GA12-015: Safe Discharge From the ED A position statement titled ‘‘Safe Discharge from the Emergency Setting” was completed in Q4 2013. The development of a research proposal identifying high-risk discharges and potential interventions has been added to the IENR research agenda. Study development is pending.

GA12-014: Palliative Care in the Emergency Setting A position statement titled ‘‘Palliative and End of Life Care in the Emergency Setting’’ was completed in Q3 2013. ENA continues to actively solicit faculty abstracts.

GA12-013: Health Care Worker Fatigue A sleep study proposal has been developed and is pending implementation. A white paper titled ‘‘Nurse Fatigue’’ was completed in Q4 2013. ENA has met with affiliate

organizations in Washington, D.C., to review current issues regarding the topic of health care worker fatigue.

GA12-012: Defining Wait Times The ENA Board of Directors supported the American College of Emergency Physician’s policy statement titled ‘‘Standards for Measuring and Reporting Emergency Department Wait Times’’ in Q3 2013.

GA12-011: Care of the Patient With Chronic Pain A clinical practice guideline for acute pain management is in development. A

September 2014

position statement titled ‘‘Care of Patients with Chronic/Persistent Pain in the Emergency Setting’’ was completed in Q1 2014.

GA12-010: Care of the Bariatric/ Obese Patient A topic brief titled ‘‘The Bariatric/ Obese Patient’’ was completed in Q4 2013.

2011 GA11-020: Emergency Nursing and Forensic Nursing ENA and the International Association of Forensic Nurses have a formal relationship through the Nursing Organizations Alliance. This has led to collaborative efforts related to position statements for emergency and forensic nursing, including the development of the position statement ‘‘Intimate Partner Violence,’’ completed in Q3 2013.

GA11-018: Advancing the IOM Recommendations for Future of Nursing

GA11-013: Care of the Pediatric Patient with Dehydration

ENA continues to collaborate with the Nursing Organizations Alliance, the American College of Emergency Physicians, The Joint Commission and the National Quality Forum. Through ENA’s public policy efforts in 2013, one of the primary focus areas was an increase in Title VIII funding which supports a major recommendation for the future of nursing.

The Clinical Practice Guideline Committee is actively developing a resource.

GA11-017: Firearm Safety Education for Children Based on the recommendation of the IENR, the position statement ‘‘Firearm Safety and Injury Prevention’’ was developed in Q1 2013. The IQSIP is currently developing a topic brief in collaboration with the ENA Pediatric Committee. (See article on page 25 of this issue.)

GA11-019: Task Force on Chronically Impaired

GA11-015: Care of Patient Presenting with Stroke Symptoms

The Alcohol Screening, Brief Intervention and Referral to Treatment toolkit was developed in collaboration with ENA members and the National Highway Traffic Safety Administration in 2013. A discharge instruction template is included within the SBIRT supplemental materials located at www.ena.org.

The Position Statement Review Committee reviewed the resolution and recommended a more comprehensive piece be available; a recommendation was made to develop an educational module. An online education module titled ‘‘Partnering in the Fight Against Stroke’’ was completed in Q2 2014 and is available at www.ena.org.

Official Magazine of the Emergency Nurses Association

2010 GA10-010: Helicopter Shopping Accomplishments completed in 2011-2012 include: 1) A joint consensus statement on helicopter shopping; 2) ENA and the Air & Surface Transport Nurses Association recorded and disseminated a video message at the 2012 ENA Annual Conference; and 3) IENR and ASTNA developed a communication regarding research and dissemination. In Q2 2014, ENA’s Government Relations staff sent a joint letter to the Federal Aviation Administration in support of issuing new rules regarding the safety of air medical transportation helicopters. However, the letter also states ENA’s concern with the delay in implementation of the rules and urges against further delays.

Note: All position statements, white papers, support statements, online courses, etc., listed above are available at www.ena.org at no charge.

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

Mixed-Methods Studies: Why They Can Be Awesome Y

ou are the manager of an emergency department and in charge of reviewing practices around sepsis identification and treatment. You find that the time to antibiotics measure is much longer than you would like it to be. The problem is, you’re not sure under what circumstances delays are occurring or why. This makes it very difficult to figure out how to fix the problem and lower time to antibiotics for these patients. When clinical problems present themselves, it’s important to understand that the question drives the method. If you want to understand how many, how long or how often, it’s best to use methods that give numbers; in short, use a quantitative approach. To obtain this information, you may do a chart review, looking for specific variables, or measure time between stages of the ED visit. You could also send a survey to nurses and providers who work in your ED or hospital system to get information about the problem you are studying. In this case, you’d want to look at data points such as triage time, time of provider evaluation, time of diagnosis and time to first antibiotic. You want actual times, not recalled times, so a chart review would be appropriate for this set of questions. When you get the answers to these types of questions, you will understand what is happening. What may not be so clear is why it’s happening. This is where a mixed-methods approach can be very useful. Mixed-methods research is a methodology for conducting research that involves collecting, analyzing and

combining quantitative and qualitative methods and data in a single study. The purpose of this type of research methodology is that using qualitative and quantitative research together provides a better understanding of a research problem than either research approach alone. The qualitative data you collect, via focus groups or interviews, can help to explain your quantitative findings; in short, you may get a better idea of why the time to antibiotics is longer than you want, and you can probably design a better intervention to fix it. Consider what you possibly might discover in your chart review. If you start by pulling all the charts with a diagnosis of sepsis, you might want to collect the following data: 1. The initial vital signs and when they were obtained 2. Triage level assignment (is it accurate and appropriate?) 3. Time to room 4. Time to diagnostics (and what they were, e.g., labs like CBC and BMP — were blood cultures and lactate drawn immediately?) and time of results 5. Time to provider evaluation 6. Time to orders for antibiotics 7. Time of administration Once you have data on what’s happening in your department, you must determine why those things are

happening. You may want to convene a focus group of nursing staff and possibly a second one composed of providers. You can ask them very open-ended questions. Some possible ways to start are to ask about process: 1. How do you identify septic patients in triage? 2. Is there a protocol or guideline to begin treatment once the patient is identified? If so, what’s the implementation process? 3. How do you communicate with providers/nurses? Do you find this effective? Why or why not? 4. What is the process of implementing protocols or treatment orders for these patients? Once all these data have been analyzed, you will have a better sense of not only what is happening in your department but also why. Possibly you will learn that communication between providers and nurses is ineffective, or that the pharmacy system isn’t responsive to the immediate need. You may also discover your triage and staff nurses are having difficulty recognizing sepsis at initial presentation. The issue may be a combination of three. This mixed-methods approach adds a number of parts of the puzzle, facilitating how to address the problem and improve patient care.

September 2014

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

My Invitation to You “Storytelling can change a room. It can change lives. It can change the world.” Gwenda LedBetter

very one of us has a story to tell. I believe it is essential for emergency nurses to share their stories with each other. Whether you are treating patients at a rural hospital or in an inner city, holding a child’s hand at the bedside or providing critical care during a rescue operation, we all have a common goal to provide high-quality care to our patients and advance our profession. Sharing our experiences connects us to our purpose as emergency nurses and builds a sense of community. It lets us know that no matter how different the circumstances, we are not alone in the challenges we face. Our stories inspire us to grow as individuals and together. I personally want to invite you to attend the ENA Foundation Event on Friday, Oct. 10, at the 2014 ENA Annual Conference in Indianapolis for an inspirational evening of storytelling from ENA members who are making a difference around the world. The ENA Foundation’s exclusive event, ‘‘The Power of One: Engaging Generations of Nurses to Give Back and Do Incredible Things,’’ will feature internationally recognized speaker and emergency nurse Jeff Solheim, MSN, RN-BC, CEN, CFRN, FAEN, along with six heroes from around the world who are dedicated to improving the quality of life for others who are less fortunate. From providing medical care to orphans in underserved areas in Africa to building the only health care clinic in the slums of Uganda, these heroes will share their personal journeys of sacrifice and commitment and inspire you to do incredible things that will have a lasting impact. • Robert Nabulere was born in northern Uganda in a poor village. Although he was able to move his family into a bountiful two-story house in an upscale neighborhood in Kampala, he felt the need to return to his roots and help those in poverty 10 years ago. He moved his family to the slum and started a church and a school, which now serves hundreds of children. He also has plans to build a clinic there to provide medical care. • Greg Higgins is an emergency physician from California. He sold his practice and relocated to Africa to start an orphanage near the base of Mount Kilimanjaro. His

orphanage provides a home to more than 100 orphaned children. He works hard to provide medical care to this underserviced area of Africa. • Shannon Ward is an emergency nurse and also the wife of Greg Higgins. She sold her home and relocated to Tanzania and works in the orphanage to provide nursing care to the orphans. She and Higgins travel through the area as a team to provide medical care to the underprivileged. • Laurie Freeman is a pediatric nurse. During a trip to Uganda, she learned that young girls dropped out of high school because of a lack of feminine hygiene products. Determined to change that, she became committed to providing them with cotton underwear as well as reusable feminine hygiene products. Her efforts have provided girls with an opportunity to stay in school and obtain their high school educations. • During one of their trips to Cochabamba, Bolivia, ENA members Joan Eberhardt and Helen Sandkuhl found a young boy with second- and third-degree burns. They raised funds to fly him to St. Louis and found a hospital and physician to provide free care for nine months, helping the young boy survive. With your support, we can do something incredible to help shape the future of emergency nursing. The goal of the ‘‘Power of One’’ event is to raise money to send 10 emerging professionals to the Emergency Nursing 2015 Conference. One hundred percent of the ticket value will be used to fund scholarships for nurses just starting out in their careers. Your $50 tax-deductible donation will help to empower and equip your peers with education and advocacy skills needed to advance the emergency nursing profession. Dinner, dessert and beverages will be served after the program, and attendees will earn 1.30 contact hours. You won’t want to miss this amazing networking opportunity. Through your support onsite at conference and through online giving, the ENA Foundation has helped hundreds of ENA members advance the emergency nursing profession through our educational and research opportunities. As the 2014 ENA Foundation chairperson, I always feel honored when an ENA member shares how the foundation has helped them improve their practice or enhance their career. Your stories renew my passion for the ENA Foundation and for the work we do every day. Thank you for your continued support. I look forward to seeing you in Indianapolis.

September 2014

ENA Foundation Event

THE POWER OF ONE

“A single person can do incredible things when they set their heart to it. That’s the power of one.” - Jeff Solheim

The Power of One: Engaging Generations of Nurses to Give Back and Do Incredible Things Friday, October 10 6 – 8:30 pm

2014 ANNUAL CONFERENCE INDIANA CONVENTION CENTER

1.30 CONTACT HOURS Join the ENA Foundation and Jeff Solheim, Internationally Recognized Motivational Speaker, for an evening of exploring the Power of One— Inspiring stories of our heroes—100% of your ticket value goes to the Emergency Nursing 2015 Conference scholarship fund. The goal of the Foundation Event is to raise money to send 10 emerging professionals to the Emergency Nursing 2015 Conference. Empowering young nurses with education, networking, and advocacy skills will give them the tools to do incredible things. $50 (tax deductible) Dinner, dessert bar, and beverages following the program.

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

EDUCATION

Good News: The Numbers Are Growing Indicators Show Nurses Are Aiming Higher, With Widespread Benefits

report ‘‘The Future of Nursing: Leading Change, Advancing Health,’’ which recommended that 80 percent of RNs should hold a bachelor’s degree or higher by 2020. The campaign dashboard shows By Amy Carpenter Aquino, that the number of nurses enrolled in ENA Connection doctoral programs rose 43 percent he nation’s nurses are responding from 2010 to 2012. The IOM report to the call to pursue higher levels called for a doubling of doctorateof education to provide improved prepared nurses. Enrollment in patient care. ‘‘The Future of Nursing: research-oriented PhD programs has Campaign for Action,’’ led by the also grown. Robert Wood Johnson Foundation and The Future of Nursing Campaign AARP, has shown meaningful progress for Action dashboard indicators can be in nursing education since launching found at tinyurl.com/ in late 2010. futuredashboard or by The campaign was created in scanning the QR code response to the of Medicine here. 1 5/7/14 9:51 AM State and Institute Chapter Ad_Connection_half_0607 2014_print.pdf

More good news about nursing and higher education is found in the October 2013 Health Resources and Services Administration report, ‘‘The U.S. Nursing Workforce: Trends in Supply and Education.’’ According to the report, the number of nurse practitioners in the United States increased by 69 percent between 2001 and 2011. The number of licensed RNs graduating with BSN qualifications increased by more than 86 percent in just four years, from 2007 to 2011. In addition to the benefit of improving patient care, higher education for nurses often translates into new opportunities and a bigger salary. According to data from salary.com, an emergency nurse

September 2014

ENA Foundation Scholarship Opportunities

practitioner working in the Chicago area stands to earn about $35,000 more than a staff emergency nurse, based on the median salary listed for both positions.

ENA members who want to pursue a higher degree, whether it’s a bachelor’s, master’s or doctorate, have a wealth of scholarship opportunities available through the ENA Foundation. The mission of the ENA Foundation is to provide educational scholarships and research grants in the discipline of emergency nursing. Since its inception in 1991, the ENA Foundation has awarded more than $2 million in academic scholarships to emergency nurses. These academic scholarships are made possible because of the generous donations received from individuals, state councils, local chapters, industry and friends of emergency nursing. The ENA Foundation annually offers more than 30 academic scholarships. The list of previous scholarship recipients is available at

MORE OPPORTUNITIES The ENA Foundation has the following upcoming calls: • ENA Foundation/ANIA Research Grant. Submission deadline: Oct. 1, 2014. • ENA Industry-Supported Grants. Submission deadline: Oct. 1, 2014. • ENA Seed Grants. Submission deadline: Nov. 1, 2014. Visit enafoundation.org for details.

www.enafoundation.org. The next scholarship application period will open in late January 2015. For additional information about the ENA Foundation, please e-mail ENA.Foundation@ena.org or contact a member of the Development Department at 847-460-4100.

New to the Emergency Care Field? Get on the right track with Emerging Professionals at ENA’s Annual Conference ¡ Work with the “crew” – network with experienced nurse leaders and connect with your peers ¡ “Accelerate” your career – learn about ENA’s Career Wellness resources ¡ Take part in this great opportunity – “geared” toward your professional development

Start Your Engines… Race over to the reception! Appetizers and cash bar Thursday, October 9, 2014 6:30 – 7:30 pm JW Marriott Indianapolis Visit www.ena.org/AC

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Official Magazine of the Emergency Nurses Association

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Presentations and inductions will be held Saturday, Oct. 11, at the Annual Awards Gala at the 2014 Annual Conference in Indianapolis.

2014 Annual Award Recipients Barbara A. Foley Quality, Safety and Injury Prevention Award Charlotte O’Neal, MSN, RN, CEN (Kentucky)

2014 Lantern Award Recipients • Advocate Children’s Hospital Pediatric Emergency Department – Oak Lawn Campus (Illinois) • Ann & Robert H. Lurie Children’s Hospital of Chicago Emergency Department (Illinois) • Bethesda Arrow Springs Emergency Department (Ohio)

Behind the Scenes Award Richard Gary Fox (Maryland)

• Bon Secours St. Mary’s Hospital Pediatric Emergency Department (Virginia)

Clinical Nurse Specialist Award Michael Allain, MS, RN, CEN, CCRN (New York)

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

Frank L. Cole Nurse Practitioner Award Denise Ramponi, DNP, FNP-BC, ENP-BC, CEN, FAEN, FAANP (Pennsylvania) Gail P. Lenehan Advocacy Award Mary A. Leblond, MSN, RN, CEN (Texas) *Judith C. Kelleher Award Vicki A. Keough, PhD, APRN-BC, ACNP, FAAN (Illinois) * to be presented Wednesday, Oct. 8 Media Award Kelly Owen, ADN, RN, CEN (Oregon) Nurse Manager Award Jennifer Granata, MSN, FNP-C, CEN, CPEN, CNML, EMT-P (Maine)

• Edward Hospital Emergency Department (Illinois) • Franciscan St. Francis Health Indianapolis Emergency Department (Indiana) • Oak Hill Hospital Emergency Care Center (HCA) (Florida) • Nemours Children’s Hospital Emergency Department (Florida) • Northwestern Lake Forest Hospital Emergency Department (Illinois) • Overlook Medical Center Emergency Services – Union Campus, Atlantic Health System (New Jersey) • Sharp Memorial Hospital Emergency Department (California) • Swedish Edmonds Emergency Department (Washington) • Swedish Medical Center/Ballard Emergency Department (Washington) • UH Rainbow Babies & Children’s Pediatric Emergency Department (Ohio) • University of Michigan Hospital & Health Centers – C.S. Mott Children’s Hospital, Children’s Emergency Services (Michigan) • University of Wisconsin Hospital & Clinics Emergency Department (Wisconsin)

Nursing Education Award Kay-Ella Bleecher, MSN, RN, CEN, CRNP, PHRN (Pennsylvania) Nursing Practice and Professionalism Award Heather Matthew, MSN, RN, CEN (Pennsylvania)

2014 Academy Candidates for Induction • Roger Casey, MSN, RN, CEN (Washington)

State Council/Chapter Government Affairs Award Texas ENA State Council

• Rita Celmer, RN, CRNA, CEN (Pennsylvania) – Posthumous

Team Award Inova Springfield Healthplex Emergency Department (Virginia)

• Ruth E. Rea, PhD, RN (Washington)

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

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

• Nicholas Chmielewski, MSN, RN, CEN, CNML, NE-BC (Ohio) • Seleem Choudhury, MSN, MBA, RN, CEN (Vermont) • Robert Ready, MN, RN-C, CPEN, NEA-BC (Rhode Island) • Stephen J. Stapleton, PhD, MS, RN, CEN (Illinois) • Mary Alice Vanhoy, MSN, RN, CEN, CPEN, NR-P (Maryland) • Cheryl Wraa, MSN, RN (California) The Academy extends its congratulations and appreciation to the candidates for their outstanding contributions to emergency nursing and ENA.

September 2014

2014 Judith C. Kelleher Award Winner: Vicki A. Keough E

NA is pleased to name Vicki A. Ill., and as a staff nurse in the Practitioner Certification, Keough, PhD, APRN-BC, ACNP, Department of Emergency launched by ANCC in 2013. FAAN, as the 2014 Judith C. Kelleher Medical Services at Loyola Through Keough’s career, award recipient. Keough will receive University Health System. she has presented and the award Oct. 8 at the ENA Annual Through ENA she worked published studies and received Conference in Indianapolis during the with the late Frank Cole, numerous research grants and Anita Dorr Memorial Lecture and PhD, RN, FNP, FAAN, FAANP, honors. Beyond ENA, she is a Luncheon. FAEN, and Elda Ramirez, member of the American Nurses Vicki A. Keough, This prestigious award, named for PhD, RN, FNP-BC, FAANP, Association, the Illinois Nurses PhD, APRN-BC, one of ENA’s co-founders, recognizes FAEN, to open the second Association, the American ACNP, FAAN a member who has consistently emergency nurse practitioner Association of Critical Care demonstrated excellence in the program in the nation at Loyola. In Nurses and the Illinois ENA, which has emergency nursing profession and 2007, she received the Frank L. Cole recognized her as a distinguished leader. made significant contributions to ENA. NP Award, which she calls one of the ‘‘Judith Kelleher was a visionary Keough serves as dean of Loyola greatest honors of her life. She has leader who gave voice to all University Chicago’s Niehoff School of served on ENA’s Research Committee emergency nurses across the country,’’ Nursing. Before joining Loyola, she and in 2012 and 2013 chaired the Keough said. ‘‘I am humbled to receive served as an emergency department Advanced Practice Nurses in this award that honors the work of clinical nurse specialist at Good Emergency Care Committee, which Judith Kelleher.’’ Samaritan Hospital in Downers 2014_print.pdf Grove, promoted the first Emergency Nurse Kendra Y. Mims Gala 2014 AD_CONN_Half_08 1 6/25/14 3:59 PM

ACelebration of Ínductees to the Academy of Emergency Nursing, Lantern Awards, and Annual Achievement Awards Saturday, October 11 7:30 pm JW Marriott Indianapolis to register visit www.ena.org/ac

Official Magazine of the Emergency Nurses Association

ROOM BREATHE TO

Member Uses Holistics to Carve Out a Space For Nurses to De-Stress By Kendra Y. Mims, ENA Connection

fter only one year as an emergency department nurse, Justin Carpenter, RN, BA, HN-BC, was already burnt out. One of the common stressors he discovered while working in the fast-paced environment was that emergency nurses are pulled in a lot of different directions, managing patients, family members and physicians at the same time. ‘‘We also have certain time constraints, like getting our antibiotics and CT scans in on time,’’ Carpenter said. ‘‘We also have to deal with people in the acute stage of illness. They’re just getting sick or they are getting worse. If it’s a new diagnosis, patients and families haven’t had time to process what’s going on, and their emotions are really high, so it’s a very emotionally charged environment all around, especially if it’s a pediatric trauma.’’ Carpenter, a staff nurse at St. John Hospital and Medical Center in Detroit, felt nurses were trained to take care of patients physically but not how to take care of their minds, bodies and spirits as a whole, which made him feel disconnected from his patients. He eventually reached out to an integrative nurse in his hospital and learned about self-care and how to make connections with patients, which renewed his passion for emergency nursing and sparked a new interest in holistic nursing. ‘‘It was able to help me bounce

‘‘The renewal room is an area where any staff can go and sit down and renew themselves if they’re feeling stressed out. It’s whatever you need to do to get you back to being able to take care of people again.” JUSTIN CARPENTER, RN, BA, HN-BC back from burnout, because not only was I connecting with patients but I was also connecting with myself without having a wall up,’’ he said.

‘‘We have a tendency in ER nursing to build this wall around us to block us off from the emotional issues around us, but it also closes us off, which can

September 2014

SELF-CARE MADE SIMPLE Whether it’s an overcrowded emergency department or dealing with an upset family member, sources of stress can lead to burnout. Here are some ways ENA member Justin Carpenter manages stress on a daily basis. • BEDTIME FOR YOU: “Adequate rest is really huge. I make time to rest.” • WORK IT OUT: “I like to exercise. I find it is very centering for me.” • THE GREAT OUTDOORS: “Getting out into nature is definitely a big thing for me. I work in an inner city, so it’s important to get away sometimes.” • INNER PEACE: “I try to do daily meditations so that I’m able to be more compassionate.”

lead to burnout. It really disconnects us from the patients.’’ Carpenter became committed to integrating holistic nursing practices into his personal and professional life. After noticing that St. John’s had several ‘‘renewal rooms’’ available for staff throughout the hospital, he decided to implement the same concept in the ED three years ago, giving emergency nurses a place to recharge. He and his peers painted and transformed an old storage closet in the ED into a renewal room with a chair and a CD player with relaxing music. A sign-up board allows only one person to occupy the room at a time. Although staff were skeptical in the beginning, Carpenter says everyone enjoys using the room now. ‘‘I had one nurse tell me that she doesn’t go home crying anymore because she has a place to let go of the stress before she goes home,’’ he said. ‘‘As nurses, if we are agitated or rushed, it has an effect on the patient. The renewal room is an area where any staff can go and sit down and renew themselves if they’re feeling stressed out. It’s a place to go back to and re-center yourself and let go of everything, whether it’s through crying, journaling or sitting there in silence. It’s whatever you need to do to get you back to being able to take care of people again.’’ As a board-certified holistic nurse, Carpenter continues to educate staff about holistic nursing, stressing the importance of self-care. In 2012, he presented his poster ‘‘Creating a Healing Environment in the Midst of Chaos’’ at the ENA Annual Conference in San Diego. He also recently integrated aromatherapy and guided imagery into his ED’s treatment processes. The American Holistic Nurses Association has recognized Carpenter’s leadership in advancing holistic nursing and recently awarded him the Charlotte McGuire Scholarship for

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Room to Breathe Continued from previous page 2014 to assist him in pursuing his master’s of science in nursing. Holistic health care was a driving factor in choosing to further his education because it has helped him in his role as an emergency nurse. ‘‘The most important thing and the basic premise of holistic nursing is self-care, which is an idea that is pretty foreign to nurses,’’ Carpenter said. ‘‘It’s the idea of taking care of yourself, because if you’re putting yourself first, then you’re also allowing yourself to renew and be at your best for when you are taking care of other people. If you’re not taking care of yourself, then you’re tired, burnt out and crabby, and you’re not in position to take care of others. You’re not compassionate. You’re apathetic. ‘‘The first thing to do is take care of yourself — really make time to rest

Justin Carpenter and do things that make you happy. The concept is sometimes the hardest for us to grasp.’’ Carpenter promotes the idea of centering — just taking a deep breath and letting go of everything around you. It’s especially beneficial for Carpenter when he’s making patient rounds. ‘‘In the ER, we have so much going on around us, and sometimes it’s difficult to focus in on the patient,’’ he said. ‘‘Before I walk into a room, I’ll

stop, pause, take a deep breath and let go of all those other demands I have. When I go in to see the patient, I’ll sit down and genuinely listen to what they are saying. It’s a simple act, but the patients really notice you are there for them, and it shows you have the time to talk to them. It builds a trusting relationship with the patient. I find that when I do that, it really makes the day go easier.’’ Carpenter says holistic nursing practice and philosophy have made a huge difference in his career. ‘‘When you’re helping someone [in] body, mind and spirit, it makes a difference. Every encounter has an emotional and mental aspect to it, so we just can’t treat the physical part. It leaves you feeling a lot more gratified at the end of the day when you’re making connections with people because that’s why most of us got into nursing. We want to help other people. That is why self-care is so important.’’

Visit the IENR Research Lounge at ENA’s Annual Conference Let the experts guide you through the research process § Ask questions related to patient care § Present your ideas for valuable feedback § Get advice for future projects Saturday, October 11 9:30 am – 3:30 pm Indiana Convention Center

Visit www.ena.org/ienr for details.

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September 2014

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IMPROVED PRACTICE

The Other Side of the Stretcher 5 Lessons From an Emergency Nurse Who Saw It Differently as a Patient By Kendra Y. Mims, ENA Connection

uzanne O’Connor, RN, MSN, APN, was 26 and at the beginning of her nursing career when she unexpectedly became a patient and found herself on the other side of emergency care. Years later, she has never forgotten the lessons she learned as a patient. Today, as a nationally known speaker and consultant, O’Connor helps organizations improve their patient and staff satisfaction by sharing how her experience helped her to become a better emergency nurse. Here are five ways she says emergency nurses can improve their patients’ experiences in the emergency department:

1. BELIEVE THE PATIENT O’Connor presented to the emergency department on Christmas Eve with acute abdominal pain, but her vital signs fell within the normal range. She felt no one believed the intensity of her symptoms. Suzanne ‘‘I had never experienced such intense, O’Connor excruciating stomach pain,’’ she said. ‘‘My white blood cell count was normal, so everyone thought I had ovarian cysts. I thought no one believed me.’’ The senior physician was called in. He diagnosed O’Connor with appendicitis, and she was admitted to the hospital immediately. Her appendix ruptured before the operation; she believes the delay in diagnosis contributed. ‘‘As I was lying there, I was finally relieved that someone believed that I wasn’t faking the pain, and that made a big impression on me as a nurse,’’ she said. ‘‘I realized that you have to believe in the patient and believe that the symptoms are what they say they are. Don’t automatically think they’re just malingering because the numbers aren’t right. In my case, the credibility of my symptoms wasn’t as valued as the white blood cell count. I learned to give my patients the benefit of doubt. If it’s pain to them, it’s pain. The numbers could change over time.’’

2. MAKE THE PATIENT’S NEEDS A PRIORITY While O’Connor was being prepped for surgery, the emergency nurse in the operating room denied her request to speak to her parents, who were in the waiting area. It taught her how a nurse’s lack of empathy during a crisis could affect a patient: ‘‘When I asked to see my parents, the nurse emphatically said, ‘No, I have to get you ready for the OR.’ I recall the nurse being indifferent to my needs, but I was scared to stand up to her. I felt so vulnerable at the time, and I would have been happier if I had someone I was comfortable with. She was so aggressive, cold and very task-oriented rather than focused on connecting with me. It seemed like her agenda was more important than mine as the patient, and I wondered why she couldn’t get me ready for the OR while my parents briefly visited. Both my parents and I were nervous, so no one’s needs were getting met.’’

3. KEEP THE FAMILY INVOLVED In not being allowed to see her parents before her surgery, O’Connor realized how families can make a difference in a crisis, so throughout her nursing career she constantly made an effort to keep patients’ families involved. ‘‘If my patient asked for their family, I felt it was important to that patient, so I was going to do everything I could to say

September 2014

yes and accommodate their request,’’ she said. O’Connor personally felt the importance of family presence later in her career when she took her son to the ED for a staph infection and saw a drastic change in him that the oncoming nurse didn’t notice. ‘‘I asked the nurse to check his temperature, and she listened. As the oncoming nurse, she didn’t see the before and after like I did,’’ O’Connor said. ‘‘The perception of a family member can enhance the nursing assessment since families are focused only on their loved one and can notice subtle changes. Because it is change of shift, nurses may not see a difference, but believe in a parent or loved one’s observations. The parent or loved one knows that there is a difference. Believe them.’’ Family members can be your allies, O’Connor said. ‘‘They are the ones who can provide emotional support while the nurse is doing different tasks, like hanging IVs,’’ she said. ‘‘They can help keep the patient safe because that’s the only person they focus on. You might have four patients, but they are only looking at one, and they notice things that we might not notice, like a change in the color of the skin.’’

4. REASSESS FREQUENTLY Because of her experience, O’Connor urges emergency nurses not to focus solely on the numbers. Reassessing the

patient’s condition frequently can help to improve the patient’s safety. ‘‘Sometimes you have to look at the patient,’’ she said. ‘‘Are they sweaty and turning red? Does their temperature need re-checking? You need to look at everything, from the patient’s face to their body language.’’

5. UPDATE THE PATIENT REGULARLY ‘‘In my career, I witnessed a lack of updating,’’ O’Connor said. ‘‘I tried to be sensitive to those issues because I personally experienced the other side of that, and it made me a much more sensitive nurse who stepped into the patient’s shoes instead of focusing on my own agenda.’’ She made it a priority to update her patients at least once every hour and inform them of the next steps of their treatment. That seemed to relieve anxiety. ‘‘Just a three-minute visit can help,’’ she said. ‘‘The wait is perceived as so much longer when there’s nothing happening and you’re just waiting and hoping someone would come in. Usually the ED nurse knows more than the patient knows regarding the next steps. When we walk by our patient’s room, we can just stop and give them a quick update. They’ll feel like someone paid attention. I would suggest taking the extra 30 seconds to say, ‘This is what we’re waiting for. We haven’t forgotten about you.’ ’’

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Official Magazine of the Emergency Nurses Association

® PROTECTING PEOPLE AT WORK

Driving the Dialogue for Older Patients By Amy Carpenter Aquino, ENA Connection

he ENA Geriatric Committee is working diligently to contribute to the growing list of informative topic briefs available at www.ena.org. ‘‘We had set a priority early on in the year that we were going to provide subject-matter expertise on geriatric concerns for our ENA members,’’ said chairperson Anna May, MSN, RN-BC, CEN, CPEN. The committee’s main focus this year is to develop a topic brief titled ‘‘Collaborative Care for the Older Adult.’’ ‘‘We recognized that there was an opportunity for teaching, education and information-sharing that we could do with long-term care facilities, nursing homes — that kind of patient population — as they enter the emergency department,’’ said May, who is the nurse manager of emergency services at Bellevue Medical Center in Bellevue, Neb. The topic brief will focus on how emergency nurses can collaborate with nursing home personnel in their communities ‘‘to open that dialogue, work a little closer with extended-care facilities, recognizing that there are many, many levels to which patients are discharged from the emergency room,’’ from independent living to nursing home complete-care facilities, May said. There are many things emergency nurses can do to tailor care to older patients, including speaking a little slower to ensure they can hear discharge instructions, making sure precautions are in place to prevent slips and falls and taking into account

THE ENA GERIATRIC COMMITTEE: Front row, from left: Linda Yee, MSN, RN, FAEN; Anna May, MSN, RN-BC, CEN, CPEN (chairperson). Middle row: Deborah Clark, MS, BSN, RN, CEN, CPEN; Briana Quinn, MPH, BSN, RN (staff liaison, Institute for Quality, Safety and Injury Prevention). Back row: Leslie Talbert (senior administrative assistant, IQSIP); Susan G. Thornton, RN; Joan Somes, PhD, MSN, RN-BC, CEN, CPEN, FAEN, NREMT-P (ENA Board of Directors liaison). Not pictured: Cynthia J. Brooks, BSN, RN, CEN. that busy, teaching hospital EDs — with students and residents entering patients’ rooms — can be overwhelming for this population. ‘‘Introduce yourself, let them ask questions and encourage them to ask questions,’’ May suggested. At the same time, it’s just as important to realize that not all geriatric patients are infirm and they may not need as much reinforcement. EDs see many older patients who are ‘‘very healthy, reaching the prime of their lives and beyond, which is wonderful,’’ May said. Committee members met at ENA headquarters in July to work on the topic brief. They plan to submit the finished product to the ENA Board of Directors by the October board

meeting. If approved, the topic brief could be available on the ENA website before the end of the year. May said the committee sees the topic brief as a foundation for future work, which could include a transfer tool. She has particularly enjoyed working with ENA members from different geographic regions and with varying backgrounds in geriatric emergency care. ‘‘I’m from Nebraska, and we had somebody from Florida, Arizona and Pennsylvania, and it’s just fun — it’s different perspectives,’’ she said. ‘‘Some of the members weren’t in the ED anymore, so it was nice to see nurses in case management who were still ENA members bringing their expertise to the table.’’

September 2014

Firearm Safety: An Education Effort By Amy Carpenter Aquino, ENA Connection

s ENA delegates prepare to vote on several new resolutions at the 2014 General Assembly on Oct. 8-9 in Indianapolis, the Pediatric Committee is continuing work on the 2011 resolution ‘‘Firearm Safety Education for Children.’’ ‘‘We were charged to find out what is going on with education as far as who does it, when they do it and how they do it,’’ said committee member Rose M. Johnson, RN, who took on the research duties with Warren Daniel Frankenberger, MSN, RN, CCNS. The full committee met at ENA headquarters in July. The committee’s charges stem from a position statement, ‘‘Firearm Safety and Injury Prevention,’’ revised in 2013. The position statement includes the following points: 1. Emergency nurses support and promote the ENA Mission Statement to advocate for patient safety and excellence in emergency nursing practice. 2. Emergency nurses serve as health care consumer advocates, educating the public about the risks of improperly stored firearms and supporting the creation and evaluation of community and school-based programs targeting the prevention of firearm injuries. 3. Emergency nurses support the establishment of a national database of reportable firearm injuries in order to make evidence-based decisions regarding patient care, safety, and prevention. 4. Emergency nurses recognize the most effective way to keep children from unintentional firearm injury is to limit access.

THE ENA PEDIATRIC COMMITTEE: Clockwise from top left: Warren Daniel Frankenberger, MSN, RN, CCNS; Rose M. Johnson, RN; Jerri Lynn Zinkan, MPH, BSN, RN, CPEN; Sally Snow, BSN, RN, CPEN, FAEN (board liaison); Marlene Bokholdt, MS, RN, CPEN, nursing education editor (staff liaison); Robin Goodman, MSN, RN, CPEN (chairperson). Not pictured: Mindi Lynne Johnson, MSN, RN. The Pediatric Committee is conducting a research review before developing a topic brief and a toolkit with the Institute for Quality, Safety and Injury Prevention. Johnson, the Emergency Medical Services for Children program manager for Louisiana, conducted about 10 hours of searches on the topic but found there was no outcomes-based firearm safety education for school-age children. An injury prevention provider from the days of EN CARE, Johnson said firearm safety has been a longtime concern. Before become the EMSC program manager, she worked for 15

Official Magazine of the Emergency Nurses Association

years in an ED in rural Louisiana. ‘‘It’s such a huge topic and a huge issue,’’ she said. ‘‘Politics aside, we’ve got to educate because what’s being done so far is not working. If we can educate the kids and the parents, because we need to include them, then maybe we can make a difference. And we have to keep the politics out of it.’’ At press time, Johnson and Frankenberger planned to present their findings to the entire committee in August before planning next steps. ‘‘It’s going to be a long process, but we’re making a start and that’s important — just taking that first step,’’ Johnson said.

Collars, With an Eye on the Clock By Amy Carpenter Aquino, ENA Connection

ervical collars are routinely used to immobilize and protect a trauma patient’s neck and spine in the field, but keeping a patient in this type of collar for too long can have negative effects, including skin breakdown. The ENA Trauma Committee researched the benefits of early removal of hard neck collars from trauma patients who arrive to the ED and the emergency nurse’s role in advocating this practice. Committee members discussed results from their research at their June meeting at ENA headquarters. The cervical collars placed in the field, also called extrication collars, are plastic, harder collars with minimal padding, said Kimberly Anne Murphy, MSN, RN, CEN, ACNP-BC, MICN, PHN. ‘‘They’re cheap, they’re not meant for long term, and they’re sort of one-size-fits-all,’’ she said. The committee conducted a literature search to find the best time to switch the patient from the rigid, pre-hospital collar to a long-term one with more padding, said committee member Pete Benolken, MSN, RN, CEN, CPEN, EMT-B. ‘‘The literature basically tells us two things: one, everybody’s doing it a little different, and [two], that there’s some very good research that says you need to do the switch within 24 hours,’’ Benolken said. ‘‘However, that is still a very long time. There is also some research that says the skin breakdown does start within six hours.” Emergency medical services personnel put patients in extrication collars if there’s suspicion of a neck or spine injury. ‘‘There’s no CT scan available in an

ambulance, no X-ray, so they do what’s best for Kimberly Anne the patient based Murphy on the criteria that they live by, their protocols,’’ Benolken said. Once the patient arrives at the ED, hospital providers follow their facility’s Pete Benolken guidelines. Many trauma centers have an algorithm to follow, and most times, if the patient meets the criteria, the hard collar can be removed. If the patient is unable to be cleared, however, and the collar remains on in the ED, that’s when the issues can begin. Skin breakdown can occur within a few hours from moisture buildup and lying in a flat, immobile position. ‘‘The driving-home point for me in

this is to make the emergency nurse aware that changing the collar — sooner rather than later — is very beneficial, and for those of us who work in urban, larger-receiving hospitals, that those time frames start the minute that the hard collar’s put on,’’ Benolken said. Benolken’s Level II trauma center in Minnesota often receives patients from North Dakota or other states who may have started their emergency care journey at a small hospital before being transferred to another facility and then to his ED. ‘‘Those hours are ticking away,’’ he said, ‘‘and by the time they get to my door, four, six, eight hours, sometimes more time, has gone by.’’ When Benolken went to the ENA listserv to ask other members when their facilities switch patients from rigid, pre-hospital collars, some said the switch is not made until the patient arrives on the inpatient unit. ‘‘There is evidence to show that skin breakdown and changes occur within six hours,’’ Murphy said. ‘‘We suspect that there are a lot of facilities where the collars are staying on longer than those six hours,’’ which is why the committee is putting out the call to be more vigilant about collar removal. Skin breakdown can result in the development of wounds such as decubitus ulcers, Benolken said. ‘‘Say they’re intubated and sedated and they have to go to the ICU. Well, then, it’s a really easy choice,’’ he said. ‘‘You need to switch them sooner rather than later to this longer-term, more-padding, better collar to decrease the skin breakdown issues. And that’s

September 2014

ENA TRAUMA COMMITTEE Patricia Kunz Howard, PhD, RN, CEN, CPEN, NE-BC, FAEN, FAAN, chairperson Pete Benolken, MSN, RN, CEN, CPEN, EMT-B Stacey M. Hill, BSN, RN Kimberly Anne Murphy, MSN, RN, CEN, ACNP-BC, MICN, PHN Maria K. Tackett, EdD, MSN, RN, CEN, CCRN Ellen Encapera, RN, CEN, board liaison where the ER nurse can play a very important role.’’ As patient advocates, emergency nurses are in the best position to promote the earlier removal. ‘‘If the patient’s stable, let’s do it in the ED. We’re smart people. We can figure it out,’’ Benolken said.

The Trauma Committee also has been researching the issue of spinal board removal, Murphy said. ‘‘There is a lot of evidence, which is being drafted into education programs already, that the backboard needs to be removed as soon as possible,’’ she said, adding that a similar pathology of low blood pressure, moisture and immobility is present with the patients on backboards. The committee also worked on a translation-into-practice document regarding tourniquets and met with the team developing the online Course in Advanced Trauma Nursing (CATN). Murphy and Benolken said they have appreciated the chance to serve on the committee, one of ENA’s newest. Murphy, who works in Los Angeles County, which has 14 trauma centers, joined to get a more global perspective of trauma-care challenges. ‘‘Everybody else on the committee has a very different perspective as far

as transferring into tertiary centers,’’ she said. She hopes to impact other topics that need to be translated into practice or urged for more research. An ENA member for eight years, Benolken has been active at the local level and felt the time was right to begin participating on a national level, especially after his colleagues encouraged him to answer the call for Trauma Committee applicants. ‘‘This is what I do — my title is trauma resource nurse and injury prevention coordinator, and I work with the trauma doctors in our trauma program,’’ he said. ‘‘I thought this was a good way for me to give back to ENA on a national level for the first time. ‘‘It’s been a wonderful experience. I will, I hope, consistently apply for other things now because I’ve had a taste of the impact you can offer. ENA has given to me, and I want to give back to ENA.’’

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TNCC Ad_Connection_Half_08 2014.indd 1

Official Magazine of the Emergency Nurses Association

6/25/14 4:02 PM

PERSPECTIVES | Catherine Olson, MSN, RN, Director, Institute for Quality, Safety and Injury Prevention

When the ADC is Bare Combating Drug Shortages in the Emergency Department

or more than a decade, hospitals

across the nation have experienced significant shortages of various drugs, including those used for critical health conditions.1,3 This epidemic has presented serious patient safety

produce generic drugs, the demand for

Helpful Resources

these lower-priced medications can lead

www.ashp.org/shortage

to delays in distribution across the board.

www.ismp.org www.fda.gov/Drugs/

implications in emergency department

drugsafety/DrugShortages

settings. The shortage of generic injectables

compromised sterility and factories cutting corners to keep up with supply and demand can cause an abrupt stop or delay in production.1,3,5 Also, some

has had the most impact, namely epinephrine 1:10,000

manufacturers have been known to discontinue production

syringes, sodium bicarbonate, morphine sulfate,

of older generics without proper notice to develop first-line

hydromorphone, electrolyte solutions, antiemetics and

drugs that are more profitable.1,5

sedatives.1,3

Many resources are available for guidance in preventing

In a 2010 national survey by the Institute for Safe

and mitigating drug shortages, but the FDA has, within its

Medication Practices, more than 1,800 health care workers

scope of authority, primary responsibility for reducing the

reported medication errors, near misses and even patient

impact of drug shortages. On July 9, 2012, the Food and

deaths related to drug shortages.2,3 For example, many

Drug Administration Safety and Innovation Act was signed

facilities are diluting the readily available 1:1000 ampules of

into law by President Obama. In compliance with FDASIA’s

epinephrine with 0.9 percent normal saline to make 1:10,000

Title X, the FDA established a task force on drug shortages

syringes for use in

resuscitation.2,3

One respondent in the

ISMP survey reported that a patient died in a code after a nurse drew up and administered 10 mL of a 1:1000

and submitted a strategic plan to Congress to enhance the FDA’s response in preventing and mitigating drug shortages.5 The FDA now requires drug manufacturers to report

epinephrine concentration, thinking it had been diluted to

potential supply issues at least six months in advance. This

the alternative 1:10,000 concentration.2

early-warning system has helped to decrease shortages by

Since there are a limited number of manufacturers who

Quality-control issues such as

more than 50 percent between 2011 and 2012.1,3,5 Even so,

September 2014

the FDA’s influence is limited in that it cannot require drug manufacturers to produce or increase production of any particular medication.1,5 Meanwhile, many other shortages require close tracking and alternative solutions. Health care facilities still encounter last-minute notifications of drug shortages by manufacturers, which results in extensive staff time and effort to internally develop a temporary fix.3 Emergency nurses have expressed frustration and concern as they strive to provide safe and efficient care — they must become familiar with new packaging, dosing, indications, side effects and contraindications of alternative medications, which, in the end, means less time at the bedside.2,3 The impact on emergency medical services is also cause for concern. Challenges include limited flexibility within multi-agency protocols, minimal training on alternative drugs, no direct access to pharmacy and difficulty

maintaining inventory.3 When clinical leaders, hospitals and other agencies work to reduce the impact of this crisis, the focus must be on patient safety. The American Society of Health-System Pharmacists’ Guidelines on Managing Drug Product Shortages in Hospitals and Health Systems, as well as ISMP resources, are available to help tackle the internal management of these shortages.1,4 Some recommended solutions include: • Extending drug expiration dates • Use of alternative medications with different dosing regimens • Use of second- or third-line products • Diverting critical medications to specific patients by priority Although there has been some improvement in the number of shortages, constant vigilance is still required. Also, early notification by manufacturers, awareness of resources, action plans that include appropriate alternatives, as well

as excellent internal communication of changes to staff, will aid in minimizing error and adverse outcomes. References 1. Fox, E. & Wheeler, M. (2013). Drug shortages in the US: Causes and what the FDA is doing to prevent new shortages. AccessMedicine from McGraw-Hill. Retrieved from http://www. medscape.com/viewarticle/780328 2. Institute for Safe Medication Practices. (2010). Drug shortages: National survey reveals high level of frustration, low level of safety. ISMP Medication Safety Alert! newsletter. Retrieved from https:// www.ismp.org/newsletters/acutecare/ articles/20100923.asp 3. George Washington University, School of Medicine & Health Sciences. (2014). Medication shortages: Why they happen and what to do [webinar]. Retrieved from http://smhs.gwu.edu/ urgentmatters/sites/urgentmatters/files/Drug%20 Shortages%20Webinar.pdf 4. Institute for Safe Medication Practices. (2010). Weathering the storm: Managing the drug shortage crisis. ISMP Medication Safety Alert! newsletter. Retrieved from https://www.ismp.org/newsletters/ acutecare/articles/20101007.asp 5. Food and Drug Administration. (2013). Strategic plan for preventing and mitigating drug shortages. Retrieved from http://www.fda.gov/downloads/ Drugs/DrugSafety/DrugShortages/UCM372566.pdf

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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.

ENPC Ad_Connection_half_08 2014.indd 1

Official Magazine of the Emergency Nurses Association

7/16/14 4:07 PM

Q: Why is it so important to update my ENA member profile? And when and how do I do that? – Melissa, Texas A: It’s very important to keep your membership profile updated for a number of reasons. Let’s start with your e-mail address. Having a current primary e-mail address on file not only ensures you’ll receive critical member communication throughout the year, but it’s the key to logging into the ENA website and accessing the full range of your benefits. Just as important is your physical mailing address. If your primary address is not kept up to date, you likely will miss your mailings of ENA Connection and the Journal of Emergency Nursing, two essential member benefits. In addition to these publications, ENA also sends important member correspondence periodically, including renewal information and national announcements. The other details of your profile (credentials, ED roles, experience, chapter affiliations and the like) are important not just because they help us to know who you are, but because the various ENA departments can use this information to tailor and enrich your member experience through courses, national and regional connections, professional opportunities and more. How do you update? The first and fastest way is to log into the website via the link at the top of the main page, then select “Update Your Profile” under the Membership tab. (Note: This login is not to be confused with myENA, which is a social platform separate from your member profile.) You also can send your profile changes by e-mail to membership@ena.org or give us a call at 800-9009659, Monday-Friday, 8:30 a.m.-5 p.m. Central time. We’ll be happy to make the updates for you. Remember, if you are having trouble logging into the ENA website, let us know immediately so we can correct the issue. When should you update? It’s recommended that you check your profile about once a quarter. If there’s a big change such as your e-mail, home address, a name change or

Do you have a recent professional or educational success story you want to share about yourself or an ENA member colleague? Have you won an award or earned a promotion? Has another member you know been recognized for outstanding work?

a new credential, try to update that right away. The more current the information on file, the better we can serve you as a member. Also, when you update regularly, you’re ensuring that your ENA website login works, meaning no interruptions as you access vital members-only areas of the website such as your Personal Learning Page and eCourse Ops. — Lindsay Paxton, ENA Member Services supervisor Use ‘‘Ask ENA’’ to ask about the organization and emergency nursing in general. Questions will be referred to the appropriate ENA staff or department. Submission does not guarantee publication. E-mail questions to connection@ena.org.

Tell us! Send an e-mail to connection@ena.org with the subject line “Members in Motion.” Be sure to include names, credentials and, if applicable, photos of the nurse(s) being recognized. ENA staff may follow up with you for additional details.

September 2014

connection

Recruitment & Professional Opportunities For ad rates and information, contact the ENA Development Department, 847-460-2626 or PartnerWithUs@ena.org.

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Official Magazine of the Emergency Nurses Association

28 41 55 68 %

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