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the Official Magazine of the Emergency Nurses Association

connection June/July 2012 Volume 36, Issue 6

Which Nurse Was Attacked Today? The answer: All of them.

Stepping up our strategic fight to prevent violence in the ED Pages 3, 10-12

INSIDE FEATURES

Meet Two New Faces of Nursing at ENA

PAGE 14

Free Online CE Courses a Hit With Members PAGE 17 ED Undeterred by Horror of a High School Shooting PAGE 18

AL U N E N A NC A E EN FER ER R 12 ON OST TE 0 2 C P EN C N I


VIOLENCE...

...towards staff at work is dramatically on the increase, especially in our Hospitals. Verbal abuse, threats with weapons, cuts, punches, even serious injuries are becoming everyday occurences. The impact on the confidence and morale of staff is damaging and costly and has a serious impact on the caring and commitment that lies at the heart of the staff/patient relationship.

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Dates to Remember June 22, 2012 Workplace Violence Prevention Summit, Chicago, 8 a.m.-5 p.m. July 2-31, 2012 Application period for openings on ENA national committees. August 1, 2012 Deadline for abstracts for poster presentations for Leadership Conference 2013, Feb. 27-March 3 in Fort Lauderdale, Fla. August 17, 2012 Deadline for requests to include recently deceased member colleagues in memorial presentation during 2012 General Assembly in San Diego, Sept. 12-13.

ENA Exclusive Content PAGE 10 Tales of Violence in the ED: Creating a Culture of Safety PAGE 12 Security, Tech Industries Joining ED Violence Fight PAGES 14-15 Two New Voices of Nursing Leadership at ENA National Headquarters PAGE 16 2012 Proposed Bylaws Amendments and Resolutions PAGE 17 Free Online CEs Have Members Thinking ‘Awesome’ PAGE 18 The Chardon High School Shooting: Mission Doesn’t Change When a National Horror Lands in the ED PAGE 20 2012 Annual Conference Poster PAGE 30 Code You: Eight Easy Ways to Elevate Your Mood (in 10 Minutes or Less) PAGE 32 SAMHSA Administrator Talks About Mental Health Emergencies

Monthly Features PAGE 3 Letter from the President PAGE 4 Sue’s Views: Letter from the Executive Director PAGE 6 Washington Watch PAGE 8 Pediatric Update PAGE 11 Board Writes PAGE 22 Board Highlights PAGE 24 ENA Foundation PAGE 26 Ready or Not? PAGE 28 From the Future of Nursing Work Team PAGE 28 ENA Call for ... PAGE 32 Academy of Emergency Nursing PAGE 34 State Connection PAGE 35 Member Benefits and Resources

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

Gathering Momentum in the Fight Against Workplace Violence Violence against emergency nurses and other emergency care team members is an international problem and something ENA takes very seriously. ENA is conducting an ongoing study of more than 7,000 emergency nurses which has revealed a great deal of information to suggest that the problem is even greater than most thought. In fact, during the period from January 2010 to January 2011, 54.5 percent of nurses reported experiencing some form of physical violence or verbal abuse over a seven-day period.1 Our physician colleagues at the American College of Emergency Physicians are replicating the study, and we welcome the additional information it will provide. This month’s ED violence issue features the stories of emergency nurses who were physically attacked by patients (see Page 10), and we are indebted to them for their help in calling attention to the issue. Violence is not ‘‘just part of the job,’’ and to the degree that we think of it as just part of the job, staff and patients won’t be safe. It’s time to change the mind-set of some that, somehow, verbal and physical violence is ‘‘just part of the job.’’ It’s time to realize that having effective security personnel and security systems, such as panic buttons, is essential. And it’s time to realize that, in some instances, we should simply call the police. Each of us can play a part in creating a culture of safety in our emergency departments. Oftentimes, the single factor that has turned the ED into a safer place is that two or three emergency nurses decide that enough is enough and become educated champions to make the department safe. Those two or three emergency nurses can start by becoming experts in workplace violence prevention, and they can start by attending ENA’s Workplace Violence Prevention Summit on June 22 in Chicago, an event sponsored by Tyco Integrated Security. ENA is bringing together experts in hospital security, OSHA, NIOSH, the Joint Commission, ACEP, and even an expert in the safer architectural design of emergency departments. This will be more than a conference. We will talk about how to join together to create synergy around this issue and what our next steps should be to move the issue forward. Defining, identifying and advocating for a culture of safe practice and safe care is an organizational priority of ENA’s Strategic Plan 2012–2014. Take advantage of the resources ENA has to offer on workplace violence prevention. Along with attending the WPV summit, you also can encourage your ED manager to use the

Official Magazine of the Emergency Nurses Association

ENA Workplace Violence Toolkit, which is designed with tools and resources to assess your ED in identifying areas for improvement and templates to customize a prevention plan for your ED. Share an article that appeared in the Journal of Emergency Nursing with a newer emergency nurse. “Violence in the Emergency Department: A Firsthand Account,” by Mary Alexander, RN MSN, a concerned director of Emergency Services at the time, detailed an in-depth look at the assault of an emergency nurse in her department, the supportive response of the whole department, how the perpetrator was brought to justice and the valuable lessons learned to prevent it from happening to someone else.2 Continue to seek out opportunities for change in your ED. You don’t need a large number of people to push for a change. Join with another nurse to become champions of the issue and meet with your nurse director or manager to talk about effective prevention strategies and policies. With the support of that nurse manager, you can meet with security and risk management and have other team members join you to discuss various strategies toward a zero tolerance for violence. Two may seem like a small number to make a difference, but there is power in small numbers. It took only two passionate emergency nurses living across the country from each other, Anita M. Dorr, RN, and Judith C. Kelleher, RN, founders of ENA, to make a difference in our profession and form the wonderful and unique association we have today! As Margaret Mead said, ‘‘Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.’’ The stakes are high. In the end, if staff aren’t safe, then patients aren’t safe. If one experienced emergency nurse leaves emergency nursing because of violence in the ED setting, it is one too many!

References 1. Emergency Nurses Association, Institute for Emergency Nursing Research. (2011). Emergency Department Violence Surveillance Study. Des Plaines, IL: Author. Retrieved from www.ena. org/IENR/Documents/ ENAEDVSReportNovember2011.pdf 2. Alexander, M. Violence in the Emergency Department: A Firsthand Account. Journal of Emergency Nursing, June 2001. 27:279-285

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

How Much Do You NOA? A couple of days ago, one of the (non-clinical) professionals we serve. As a new association executive, I have been very ENA staff said, “I know what an emergency grateful for their support and guidance. nurse is because I’ve been to the emergency NOA meets throughout the year, with an annual fall conference that department a few times and had care from them. brings together the organizational affiliates for education and networking. But what’s the difference between an emergency nurse and a critical care In addition, invitations arrive when key opportunities arise, such as a nurse, or a trauma nurse?” meeting that I attended in April with approximately 30 of our NOA This made me think about the “touch potential” of our profession and association colleagues. Attendees included Dr. Mary Wakefield, RN, why it is different than almost any other nursing profession. While we may administrator, Health Resources and Services Administration, U.S. at times be critical care nurses or Department of Health and trauma nurses or pediatric nurses or Human Services; Marilyn OB nurses or geriatric nurses or Tavenner, RN, acting cardiac nurses or stroke nurses or … administrator, Centers for well, you get the picture. We are the Medicare & Medicaid Services; specialty nurses who probably touch and HHS Secretary Kathleen more patients and families than any Sebelius. others. And while some may describe This meeting’s focus was on us as a “Jack (or Jill) of all trades and the importance and the future of master of none,” many of us are nurses in health care reform. I specialized generalists who have a had the opportunity to ask a sub-specialty in emergency nursing. question about what support You likely know who your cardiac emergency nurses could expect expert or pediatric or neonatal expert for real-time referrals from nurse or mental health patient expert is: the to nurse in an ED/community “go-to” person who helps write health care setting. Both policies and procedures or cares easily Wakefield (a nurse!) and for a certain population of your Tavenner (a nurse!) patients. Executive directors need acknowledged the importance of these “go-to” colleagues, too. emergency nursing and discussed Enter NOA, the Nursing the technologies that would Organizations Alliance, also known as likely be developed to support Sue Hohenhaus, MA, RN, CEN, FAEN and Dr. Mary Wakefield, RN, administrator of the Alliance. ENA is one of more than the Health Resources and Services Administration for HHS, gather at a NOA meeting this type of collaboration. 70 nursing associations that works As health care evolves, it will in April. collaboratively and promotes a strong be exciting to see what voice and cohesive action to address issues of concern to the community opportunities all emergency nurses have to become leaders and of nursing. NOA’s purpose is to provide a forum for identification, coordinators of what our American College of Emergency Physicians education and collaboration, building on issues of common interest to colleague Dr. David Seaberg calls the “medical neighborhood.” advance the nursing profession. This forum also provides the chief staff What do you “NOA” about how to get ready for the changes? ENA is executives of these organizations opportunities to network and collaborate. here and working collaboratively with our Alliance partners to assist. We not only share nursing trends and themes, we also share association Be safe. best practices, job descriptions and recommendations for what works and what may not work in the unique world of nursing associations. Not all of the chief staff executives of NOA organizations are nurses; however, we all share a passion for and dedication to the professions and

ENA Connection is published 11 times per year from January to December by: The Emergency Nurses Association 915 Lee Street Des Plaines, IL 60016-6569 and is distributed to members of the association as a direct benefit of membership. Copyright© 2012 by the Emergency Nurses Association. Printed in the U.S.A. Periodicals postage paid at the Des Plaines, IL, Post Office and additional mailing offices.

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

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

June/July 2012


WASHINGTON WATCH |

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

HHS Searches for Answers to Drug Shortages On April 16, the Health and Human Services Office of the Assistant Secretary for Preparedness and Response called a meeting of emergency experts, association representatives and policy makers to discuss the problem of drug shortages in emergency care. Providing an opportunity for the emergency care community to deliberate coping and mitigation strategies, the meeting also sought to obtain a better understanding of the magnitude and impact of shortages in drugs that are available for emergencies, as well as understand the federal efforts to reduce shortages. Sandra L. Kweder, deputy director of the Office of Drugs, Food and Drug Administration, described FDA studies showing that the number of reported drug shortages in the United States nearly tripled between 2005 and 2010, growing from 61 to 178. Of the FDA-studied shortages in 2010-11, 80 percent involved drugs delivered to patients by sterile injection, including sedatives/anesthetics, toxin antidotes, antibiotics, electrolyte/nutrition drugs and oncology drugs. In the case of discontinuing a drug, Kweder explained, the FDA can only require manufacturers to disclose the discontinuation of a critical drug when the drug is available through a single manufacturer. Even in instances where the drug is deemed ‘‘medically necessary’’ and reporting is required, the FDA has no enforcement mechanism to penalize a drug maker for failing to report these problems. However, when information about the interruption or discontinuation of a product was made available to the FDA, Kweder reported that the agency avoided shortages by implementing countermeasures, successfully preventing 233 drug shortages between the beginning of 2010 and December 2011. Kweder noted that in October 2011, President Barack Obama signed an executive order directing the FDA to take action to help further prevent and reduce prescription drug shortages, protect consumers and prevent price gouging. The EO directed the FDA to broaden reporting of potential shortages and to further expedite

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regulatory reviews to help prevent or respond to shortages. Following the issuance of the EO, the FDA received a six-fold increase over the average notifications per month. Emergency nurses are well aware that many of the shortages are medications used in emergency care—both in the field and in the emergency department. It is not unusual for emergency care providers to go to heroic lengths to find needed medications, spending time tracking down the product and delaying or altering patient care plans. In many instances, no safe alternatives to these drugs exist, leaving patients with an increased risk of side effects and adverse drug interactions. One meeting panel actively involved in solving the ‘‘front line’’ issues of drug shortages spoke to the decisions they have made. Some reported needing to redistribute medications, such as epinephrine and sodium bicarbonate, from crash carts on in-house units to ambulances to ensure that high-need environments have the drugs. Other health care systems have hired compounding pharmacies to fill the need of making sterile injectable medications. Whenever substitute medications are used in place of familiar drugs, the potential for medication errors exists. These drugs may be unfamiliar, requiring education to guarantee proper administration, including patient observation for unique side effects associated with these substitute drugs. These situations are challenging under the best circumstances and are very stressful in highly charged emergency settings. The panelists stated that drug shortages have resulted in pharmacy, nursing and medical leaders working closely together, quickly implementing plans to ameliorate the immediate shortage. ‘‘Drug huddles’’ are used in some institutions to provide real-time information and education about the changes, allowing staff to be routinely updated on the challenges and solutions for that day. One question the participants challenged the FDA and ASPR to clarify is evaluating the validity of expiration dates on medications. It seems counterintuitive to ‘‘dump’’ expired medications when there is a shortage of that same medication. If the health care community could have help determining the safety and efficacy of using certain drugs after their expiration date, it would assist in making available the appropriate medications for patient needs. It is anticipated that there will be a follow-up meeting where this issue will be addressed. ENA is actively advocating for solutions to this national problem. In addition to participating in policy discussions, ENA has endorsed H.R. 2245/S. 296, the Preserving Access to Life-Saving Medications Act. At the January 2012 ENA Government Affairs Chairs Workshop in Washington, D.C., attendees visited their congressional delegations, urging them to co-sponsor the bills. The legislation can be found

June/July 2012


Feedback Frame

on ENA’s Legislative Action Center at capwiz.com/ ena/issues/bills/. While emergency health care may always periodically face some drug shortages, the scope of the current shortage is directly impacting quality care. If these shortages continue, they may launch a public health crisis.

Demonstration Project to Focus on Emergency Care for Patients with Mental Health Disorders The Centers for Medicare and Medicaid Services announced that 11 states (Alabama, California, Connecticut, Illinois, Maine, Maryland, Missouri, North Carolina, Rhode Island, Washington and West Virginia) and the District of Columbia will participate in a $75  million Medicaid Emergency Psychiatric Demonstration project aimed at enabling private psychiatric hospitals to receive Medicaid reimbursement for emergency care provided to Medicaid enrollees ages 21-64 who have an acute need for treatment. CMS Acting Administrator Marilyn Tavenner said that requiring the nearest ED to care for a person who is threatening to hurt himself or someone else ‘‘may not be an efficient use of health care dollars, and may be detrimental to vulnerable patients— especially when they could immediately be treated in the setting with more appropriate care.’’ Under current federal law, Medicaid is prohibited from paying for mental disease care provided in private psychiatric hospitals. Consequently, Medicaid enrollees needing emergency psychiatric treatment often go to an ED where services may not be matched to their needs. Should they go or be transferred to a private psychiatric hospital, they may receive appropriate care, but Medicaid reimbursement is not provided. The three-year demonstration project, which is funded under the Patient Protection and Affordable Care Act, covers Medicaid enrollees ages 21-64. The participating states and district will be required to match nearly 45 percent of their federal dollars, resulting in $115 million to $120 million in total spending. At its conclusion, the project will assess whether Medicaid reimbursement for the treatment of psychiatric emergencies improves the quality of care and lowers costs. It also will gauge whether expanding Medicaid reimbursement reduces the burden on hospital EDs. Mark Covall, president and CEO of the National Association of Psychiatric Health Systems, said the project is a result of increased awareness of the need for inpatient psychiatric care and the burden on the emergency care system. ENA worked with NPHS and other like-minded organizations in advocating for the legislation that was incorporated ultimately into PPACA as a demonstration project. A CMS fact sheet about the project is available at www.innovations.cms.gov/initiatives/MedicaidEmergency-Psychiatric-Demo/index.html.

New ENA monthly offering for FREE Continuing Education with contact hours for our members. • Available June 1 – Ten Ways to Get Fooled at Triage 1.0 contact hour Lisa Wolf, PhD, RN, CEN, FAEN

Don’t miss out on enhancing your education. Go to www.ena.org/FreeCE for additional free continuing education opportunites.

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

Official Magazine of the Emergency Nurses Association

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PEDIATRIC UPDATE |

Elizabeth Stone Griffin, BS, RN, CPEN

Pediatric Pain

Take Note, Take Action Patients of all ages present to emergency departments because they are in pain. Unfortunately, the youngest patients often do not have their pain adequately addressed once they are there.1 This is due to various factors, including pediatric pain myths, communication barriers, concerns over masking of symptoms and fears about oversedation.1, 2 The disparity exists in all types of emergency departments, including pediatric-specific emergency departments. The Joint Commission standards have included pain assessments for all hospital patients since 2000.3 However, despite these requirements and consensus guidelines available on pain management in emergency medicine,4 pediatric patients often receive inadequate pain management, beginning with inadequate or nonexistent pain assessment. In a 2004 Clinical Report for rendering pediatric care5, the American Academy of Pediatrics announced that assessment was the first step in the recognition and treatment of pain and suggested that triage be allowed to become the focal point for improving pain management. Successfully assessing and managing a child’s pain requires the careful consideration of multiple variables, such as age, developmental level and weight, in addition to other factors such as the etiology of the pain. Pain scales exist for every age and developmental level. Most verbal children can self-report pain using a developmentally appropriate pain scale, such as the FACES 6 scale or a numerical scale. Non-verbal children and infants can have their pain assessed by the nurse using a behavioral scale, such as the FLACC 7 scale. Children with physical or developmental disabilities can be among the most challenging to assess when ill or injured. Carr 8 explained that the assessment of illness and/or pain in minimally verbal patients with developmental disabilities is often based on an increase in the patient’s ‘‘problem behaviors.’’ In confirmation of the 2004 AAP report, a 2005 study of 24,707 documented emergency department visits by Drendel, Brousseau and Gorlick 9 found a significant correlation between pain-score documentation and the use of any analgesic during the ED encounter. They also reported that nationally, pediatric pain scores

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were documented less than 50 percent of the time. 9 Important clinical decisions are often made based on the triage assessment. 10 Triage nurses who document a pain score for each patient in a prominent location provide a visual cue about the patient’s pain to all providers who are actively involved in that patient’s care. A developmentally appropriate pain assessment and documented pain score at initial presentation can have benefits that perpetuate throughout the patient’s ED encounter. A poster presented at ENA Leadership Conference 2012 by ENA member Maria Luisa Ramira, MSN, NFP-BC, addressed the issue of inadequate assessment and management of pediatric pain. Ramira’s poster presented the results of a quality improvement project which focused on using brief pain management education at periodic intervals to improve pediatric pain assessment and documentation by staff nurses. The outcomes of the project showed that staff nurse pain education improved awareness of pediatric pain, increased pediatric pain assessment, increased analgesia use and reduced the time from first pain score to medication. These results were due largely to a focus on triage assessment, with pain documentation at triage increasing dramatically from 17 percent pre-intervention to 93 percent post-intervention. For various reasons, children are less likely than adults to have their pain addressed in the emergency department. By using a systematic approach to pain management that includes participating in education on pediatric pain management, using developmentally appropriate pain scales, documenting pain scores in prominent locations and initiating pain management protocols in triage, nurses can advocate for patients of all ages and help make pain management a priority. References 1. Emergency Nurses Association (2010). Position Statement: Pediatric Procedural Pain Management. Accessed May 4, 2012, at www.ena.org. 2. Gourde, J, and Damian, F. (2012). ED fracture pain management in children. Journal of Emergency Nursing. 38: 1, 91-97. 3. Joint Commission on Accreditation of Healthcare Organizations. Comprehensive Accreditation Manual for Hospitals. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations; 2001.

4. E  mergency Nurses Association, in collaboration with the American Society for Pain Management, the American College of Emergency Physicians and the American Pain Society. Joint Position Statement: Optimizing the treatment of pain in patients with acute presentation (2009). Accessed May 7, 2012, at www.ena.org/SiteCollectionDocuments/ Position%20Statements/Pain_Mgmt_pol. pdf. 5. Zempsky, W., Cravero, J., and the Committee on Pediatric Emergency Medicine and Section on Anesthesiology and Pain Medicine. American Academy of Pediatrics. Clinical Report: Relief of pain and anxiety in pediatric patients in emergency medical systems (2004). Accessed May 7, 2012, at www. pediatrics.aappublications.org. 6. Wong, D., Hockenberry-Eaton, M., Winkelstein, M., et al, eds. Pain assessment. In: Whaley and Wong’s Nursing Care of Infants and Children. 6th ed. St. Louis: Mosby; 1999: 1148-1159. 7. Merkel, S., Voepel-Lewis, T., Shayevitz, J., et al. (1997). The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatric Nursing. 23: 293-297. 8. Carr, E. G., & Owen-DeSchryver, J. S. (2007). Physical illness, pain, and problem behavior in minimally verbal people with developmental disabilities. Journal of Autism and Developmental Disorders, 37(3), 413-424. doi:10.1007/s10803-006-0176-0. 9. Drendel, A, Brousseau D, Gorelick, M. (2006). Pain assessment for pediatric patients in the emergency department. Pediatrics; 117:15111518. Accessed May 7, 2012 at pediatrics. aappublications.org/content/117/5/1511. full.pdf+html. 10. Thompson, T., Stanford, K., Dick, R., and Graham, J. (2010). Triage assessment in pediatric emergency departments: A national survey. Pediatric Emergency Care. 26: 8, 544-548. Accessed online May 5, 2012, at www.pec-online.com.

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

June/July 2012


ICD-10

IS COMING

KEEP MOVING FORWARD ON ICD-10 IMPLEMENTATION The ICD-10 transition is coming. Continue your progress to transition to ICD-10. Talk to your software vendor, clearinghouse, or billing service, and work together to make sure you will have what you need to be ready. Get the right resources to ensure a smooth transition. Visit the CMS website at www.cms.gov/ICD10 to help your practice be ready. For more information visit, www.cms.gov/ICD10.

Official CMS Industry Resources for the ICD-10 Transition

www.cms.gov/ICD10


Tales of Violence in the Emergency Department

Creating a Culture of Safety By Kendra Y. Mims, ENA Connection

Cherie Mallynn, RN, knew it was only a matter of time before she had to escape. She had just returned to the hospital room to find her agitated and suicidal psychiatric patient rummaging through drawers that still contained sharp objects. Seconds later, the patient was in Mallynn’s face screaming profanities. She could almost feel the patient’s nose touching her own as the verbal abuse progressed. Scared of the irrational behavior and worried that she might be stabbed, Mallynn needed backup. Fast. Threatening to call the security officer, who had briefly stepped out of the room before the altercation, was the breaking point. The 210-pound patient snapped, using all of her force to slam Mallynn into a drawer against the wall. Mallynn hurriedly escaped to get help. Cherie Mallynn, RN, poses with her son Evan She was 19 weeks pregnant and had to protect her unborn child. by a patient, I ended up getting C. diff and colitis. I lost 15 pounds in seven weeks. Still waiting for Workplace Violence and Its Effect in the ED The statistics for emergency department violence justice after 19 months.’’ Being physically attacked on the job has show that Mallynn’s story is far too common in affected Mallynn’s outlook when working with hospitals nationwide. Along with overcrowding behavioral health patients. and staffing issues, ED violence is an issue that Being physically attacked on the job has many emergency nurses face on a daily basis. affected Mallynn’s outlook when working with ENA’s 2011 Emergency Department Violence behavioral health patients. Violence surveillance Surveillance Study reports that more than half of data suggests that psychiatric patients and patients the emergency nurses surveyed experienced under the influence are more likely to be violent, verbal or physical abuse, which included being especially after long periods of waiting.1 grabbed, choked, hit, sworn at, pushed and ‘‘I’ve been a nurse since 2000, and this was the called names.1 The majority of nurses assaulted first time I’ve been physically attacked,’’ Mallynn did not file a formal report for the abuse, said. ‘‘I’m now more anxious around psych whether physical or verbal, and in almost half of patients. I don’t get close to them now, especially the cases of physical violence, no action was if I’m in a room I can’t get out of easily. I feel taken against the perpetrator.1 Mallynn is one of the few nurses who decided being pregnant is an additional risk.’’ Mallynn, who was attacked a week after to take action by pressing charges. With the taking her hospital’s mandatory nonviolent crisis exception of back spasms that began after she intervention course, is not the only nurse whose was physically assaulted, Mallynn, who is now perception has been tainted by a workplace entering her third trimester, and her child are both fine. But things could have been worse had violence experience, especially regarding psychiatric patients. She said her colleagues she not escaped. Although Mallynn was come to work knowing that someone will be proactive in filing a formal report, her patient was charged with a misdemeanor, spending only violent at some point, especially because the department gets a lot of patients who drink and 10 days in a county jail. use drugs. It is not uncommon for patients to receive Scharla Franklin Rennison, RN, also shared only a slap on the wrist after assaulting a nurse. her recent experience with an agitated Debbie Asher Rudolph, RN, shared her psychiatric patient on ENA’s Facebook page. experience in response to a workplace violence ‘‘Just this week ... we had a psych patient that question posted on ENA’s Facebook page. was verbally abusive and threatening physical ‘‘I was assaulted by a patient while helping a harm,’’ Rennison posted. ‘‘Somehow ... he was coworker,’’ Rudolph posted. ‘‘Patient bit me after cleared by psych to return to society (scary, I spending 30 seconds with the patient. Started know). But ... he continued to rant and threaten, antibiotics after checking in for a significant bite and I called our local police for help. They told wound to the right forearm. After being bit

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me since he had not made any threats in their presence that there was nothing they could do. Really? I told them he was a danger! Still ... nothing! Very frustrated!’’ That frustration is widespread. According to the ENA violence surveillance study, more than a third of emergency nurses have considered leaving their current jobs because of workplace violence.1 ED violence affects nurses physically, mentally and emotionally by creating a stressful, demanding work environment. Research shows emergency nurses experience physical assaults at a higher rate than other nurses; a study of Minnesota nurses revealed that ED nurses were more than four times more likely to report they had been assaulted compared with nurses in other units.2 Workplace violence not only causes physical damage, but it can also trigger psychological problems and short- and long-term emotional effects such as nightmares, anger, sadness, anxiety, insomnia and helplessness.1 Implementing strategies and procedures to prevent it can create an environment in which health care workers can feel secure.

Reducing the Risks The ENA violence surveillance study revealed that emergency departments in hospitals with higher commitment to safety and reporting policies, particularly those with zero-tolerance policies, had lower rates of physical violence and verbal abuse.1 According to the Occupational Safety and Health Administration’s (OSHA) Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers, factors that increase the risk of work-related assaults for health care workers include: low staffing levels during times of increased activity; increasing presence of trauma patients, distraught family members, gang members or drug/alcohol abusers present; increasing number of mentally ill patients released from hospitals without follow-up care; long wait times and the increasing use of hospitals by police for criminal holds and the care of acutely disturbed, violent individuals. 3 OSHA lists the following five elements as main components that can be applied to an effective workplace violence prevention program 3: • Management commitment and employee involvement • Worksite analysis • Hazard prevention and control • Safety and health training • Record-keeping and program evaluation

June/July 2012


Numerous hospitals have implemented various initiatives to increase their safety and security measures. While some emergency departments have metal detectors or a zero-tolerance policy, others have 24-hour security or a video surveillance system to monitor patients who are prone to violent outbursts. However, statistics show there is more work to be done. While a majority of the comments following ENA’s Facebook inquiry on violence expressed frustration with safety in the ED, one commenter expressed having a safe ED environment due to the presence of security or police officers:

Shared on Facebook I have been an ED nurse for 17 years, and violence has been an issue since I started and had been an issue before I started. What I have seen change where I work is the presence of a police officer. We hired police officers to sit in the ED rather than security guards. Police officers are better trained in de-escalation and, frankly, the Taser and gun seem to have an effect on our violent patients.” Since they have been there, we have decreased our restraint use significantly, along with aggressive or violent attacks on our staff. Violence in the ED is inevitable because of the nature of our patient population, but I think it can be managed with the presence of police in the ED. The police have helped to decrease escalating behaviors among patients and families. Annmarie Kovach, RN, CEN Advocating for a culture of safe practice and safe care is an ENA strategic priority, and several online resources, including the Workplace Violence Toolkit, have been developed by ENA. Additionally, ENA is co-hosting the first Workplace Violence Prevention Summit in Chicago on June 22. For more information on the Summit or the online resources, please visit www.ena.org/IENR/Pages/Workplace Violence.aspx. References 1. Emergency Nurses Association, Institute for Emergency Nursing Research. (2011). Emergency Department Violence Surveillance Study. Des Plaines, IL: Author. Retrieved from www.ena.org/IENR/Documents/ ENAEDVSReportNovember2011.pdf 2. Gates, D.M., EdD, RN, FAAN; Gillespie, G.L., PhD, RN, FAEN, Succop, P., PhD. (2011). Violence Against Nurses and its Impact on Stress and Productivity. Retrieved from www.medscape.com/viewarticle/746092 3. U.S. Department of Labor Occupational Safety and Health Administration. (n.d.). Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers. Retrieved from www.osha.gov/Publications/OSHA3148/ osha3148.html

BOARD WRITES | AnnMarie Papa, DNP, RN-BC, CEN, FAEN, Immediate Past President

Lateral Violence in the ED:

What’s Your Motive? Courage is fire, and bullying is smoke. – Benjamin Disraeli British Prime Minister 1874 Since the mid-1970s, the Gallup Poll has rated various professions on qualities related to honesty and ethics. Nurses consistently hold the highest ranking, with the exception of 2001, when firefighters were at the top and nurses placed a very strong second. The general public rates us highest in our honesty and ethical standards. They trust us with their children, parents, spouses and other friends and relatives who are often the very centers of their world. But what about us? Do we display that high level of honesty and ethics to each other within our profession? How many of us have experienced bullying, lateral violence or incivility? How long have we heard that awful expression “nurses eat their young”? ENA is at the forefront with research and strategies to mitigate workplace violence. But we need to continue to raise the bar on what some call the “dirty little secret” in nursing. We are all responsible for the safety of our patients, our profession and each other. Creating an atmosphere of trust and honesty takes courage and patience. Lewis (2006) found that bullying is a learned behavior from within the workplace. If bullying is “in the walls,” as some say, how then do we get it out? How do we learn to trust each other as professionals and see the greater good? Johnson and Rea (2009) identified some of the common forms of bullying: withholding information, excluding others and ignoring opinions or being forced to perform work below competence. The consequences are well documented. Some effects are manifested physically, such as stress, headaches, depression and fatigue. Other bullying behaviors damage the organization and lead to employee turnover, decreased staff morale, loss of productivity and unsafe working conditions. In 1990, Leyman identified four factors that contribute to conveying “permission to bully.” These include deficiencies in work design; inadequate behavior of leadership; the socially exposed position of the target; and low morale. Some behaviors are overt and easily identified. Others are more covert and often

Official Magazine of the Emergency Nurses Association

difficult to describe or identify. There is a lot of emotion involved in our work which often gets in the way of developing and using strategies to mitigate bullying. As leaders, Johnson and Rea challenge us to examine our own behaviors and foster an atmosphere of open communication and collaboration as we work together to create a healthy workplace. A strategy that has worked for me is to ask a simple question: What’s your motive? Asking this question helps us to look objectively at the situation and prepare to have crucial conversations (Grenny, 2009). When you ask the question, consider the following: Is it Malice or Mentoring Oppression or Opportunity Torment or Teamwork Intimidation or Information Vindictive or Vindication Embarrassment or Empowerment Whether it is bullying, lateral violence or incivility, the one thing we know for sure is it hurts. It hurts deeply. As we work to reduce workplace violence, let’s be sure to include lateral violence in our zero-tolerance policies and make a plan to take action. We are role models, and our actions and behaviors demonstrate our commitment to this important issue. Unfortunately, all of us at one time or another in our career has been bullied, been the bully or been a bystander. What’s your motive? We can do this. We are strong, brilliant and dedicated professionals. Let’s lead by example and ignite the fire of courage within us as we extinguish bullying. References Grenny, J. (2009). Crucial conservations: The most potent force for eliminating disruptive behavior. Critical Care Nursing Quarterly, 32, 58-61. Johnson, S.L. & Rea, R.E. (2009) Workplace Bullying. Journal of Nursing Administration 19(2) 84-90. Lewis, M.A. (2006). Nurse bullying: Organizational considerations in the maintenance and perpetration of heath care bullying cultures. Journal of Nursing Management 14, 52-58. Leyman, H. (1990). Mobbing and psychological terror at workplaces. Violence & Victims 5, 119-126.

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Security, Tech Industries Joining ED Violence Fight By Amy Carpenter Aquino, ENA Connection Stethoscope: Check. Scrubs and comfortable shoes: Check. Extra pair of exam gloves: Check. Mobile duress alarm: Wait a minute … That last piece of equipment may not sound like it belongs on an emergency nurse’s daily checklist, but with the uptick in incidents of violence in the emergency department, it may be the most essential item you carry on your shift. Security device and technology companies, which built their reputations serving such industries as banking, government and education, are turning their attention to the health care market, particularly the ED. “The increase in workplace violence over the last four or five years—it’s really extraordinary,” said Mark Jarman, president of Inovonics, a company that specializes in wireless sensor networks for commercial and life safety applications. He cited statistics from ENA’s own Emergency Department Violence Surveillance Study (2010). “The more we learn as we find ourselves in this market space and in front of these customers is that the events often occur in the caregiver room and not out in the common area,” Jarman said, “and it emphasizes the need for a mobile communications device, a mobile duress alarm, and the critical need for location, so that when an alarm is pressed, you know where the event occurred.” According to the ENA Emergency Department Violence Surveillance Study, “more than three-quarters (80.6 percent) of incidents of physical violence against emergency nurses occurred in a patient’s room, 23.2 percent in a corridor/hallway/stairwell/elevator and 14.7 percent at the nurses’ station.” The study further states the following: • The use of a panic button/silent alarm was associated with lower physical violence rates while the presence of an enclosed nurses’ station, security signage and well-lit areas were associated with significantly lower verbal abuse rates. • In general, higher perceived safety ratings by nurses were associated with lower rates of physical violence and verbal abuse. Kevin Weeks, marketing director for Tyco Integrated Security, a company focused on security systems solutions and services for commercial markets, including health care, said he was troubled by the results of an informal poll conducted at the ENA Leadership Conference 2012 in New Orleans. “The first question we asked people who came up to our booth was, ‘Where are the

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panic buttons in your ED?’” he said. “About two out of 10 nurses said, ‘We don’t have any.’ Another five or six said they were at the nurses’ station, and the remaining nurses had them on the walls in the treatment room.” Weeks said one out of approximately 350 emergency nurses and department heads polled at the conference said she had a panic badge. “What troubles us the most are those two out of 10 who said they don’t have any panic buttons, or their panic buttons don’t work,” he said. “What’s most important is that we get everybody something available so they have help. The security department wants to help, they’re there to help. Let’s get emergency nurses the ability to use that resource and contact them as early as possible.” Tyco Integrated Security is co-sponsoring the Workplace Violence Prevention Summit on June 22 in Chicago with ENA and the International Association for Healthcare Security & Safety. The conference will feature speakers from a cross-section of federal and health care organizations and industry that have an interest in addressing the issue of violence in the ED, including ENA, the American College of Emergency Physicians, the National Institute for Occupational Safety, The Joint Commission, the American Institute of Architects and the Occupational Safety and Health Administration. “It’s a journey,” Weeks said. “We hope to continue to have the opportunity to shed light on this issue until it is not necessary. As long as I’m in this role and as long as there’s a problem and we have the ability to educate, let’s continue to do that.

“We will never eliminate the problem—that is an unreasonable expectation—but we can strive to get nurses to report, to work better with their security department and have their security department work better with them, and to let people out there know that we are not going to tolerate them acting out in the hospital without repercussions. With a combination of laws—which we cannot influence, but ENA is active in that arena—technology and education, we hopefully can minimize what is taking place.” Highlights from the Workplace Violence Prevention Summit will appear in the August issue of ENA Connection. “We’re here to help,” added Weeks, a former operating room nurse. “Our overall goal is to provide a safe and secure environment in which to provide patient care.”

ENA Workplace Violence Toolkit The ENA Workplace Violence Toolkit is available for free at www.ena.org/IENR/ Pages/WorkplaceViolence, along with links to a host of other ENA and federal resources for addressing violence in the ED. The web-based toolkit was developed by the 2009-2010 ENA Emergency Department Violence Work Team and ENA staff. The toolkit walks emergency care providers through a step-by-step process for assessing an ED’s risk and creating a comprehensive plan for addressing violence in the ED.

June/July 2012


Meeting the New Faces at ENA

‘Nurse’s Nurse’ Takes CNO Role By Amy Carpenter Aquino, ENA Connection ‘‘I’ve worked in emergency care since 1984. That’s ancient, isn’t it?’’ said Betty Mortensen, MS, BSN, RN, FACHE, a longtime ENA member who became the organization’s chief nursing officer March 25. While her career journey has included roles not focused exclusively on the emergency department, Mortensen always maintained her dedication to the profession she entered six months after graduating from nursing school. ‘‘I was considered a pioneer because they didn’t take new grads back then and they really took a risk with me,’’ she said of the transition to the ED after her 1983 graduation from Valparaiso University. ‘‘But I had worked in the organization as a nursing assistant, so they knew the kind of person I was, and they gave me the chance.’’ Education has been a focal point for Mortensen throughout her career. She earned her Trauma Nurse Specialist (Ill.) certification within two years of entering the ED and quickly progressed to teaching paramedics and EMS, all the while working clinical shifts in the ED. After earning her master’s degree in adult education and organizational development, Mortensen continued teaching paramedics but also earned instructor status in Emergency Nursing Pediatric Course, Trauma Nursing Core Course, Pediatric Advanced Life Support and Advanced Cardiac Life Support. Taking on various management roles at hospitals throughout the Rockford, Ill., and suburban Chicago areas while raising a family, Mortensen always maintained her ties to the ED, even during a stint as a consultant who helped facilities address length-of-stay issues and kick off quality initiatives.

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‘‘I’ve always been able to continue to grow and expand my knowledge, and I have always been connected to emergency care,’’ she said. ‘‘Even as a hospital CNO, I learned about non-emergency— which was awesome—but I always had the love of emergency. It’s in my background. My husband is a firefighter/paramedic; we always maintained patient privacy, of course, but people love to come to our house and listen to our stories.’’ Accepting the top nursing position at ENA brought Mortensen home to emergency care. ‘‘It gave me the opportunity to continue to have this executive perspective and be visionary, but also to be operational within the organization,’’ she said. One of the first tasks Mortensen has set for herself is spreading the word about ENA and her conviction that ENA membership is essential for all nurses who work in emergency care. ‘‘I think ENA is a secret,’’ she said. ‘‘I think we’re a diamond in the rough, and few people know it yet. It’s time for the world to find out about us. I cannot believe all the work that happens in this building. I always knew this building was here, but I never knew all the activity that was going on. People don’t really know what we do here, so it’s about time we tell them and showcase our organization, not only to members but to other entities. In order for us to be credible we have to unite and show people what we are capable of.’’ Mortensen pointed out that emergency nurses have a different perspective and challenges than other nursing specialties because of the unique nature of the ED. ‘‘We’re very practical and we’re passionate,’’ she said, ‘‘and

Betty Mortensen, MS, BSN, RN, FACHE

sometimes we don’t get invited to what I call ‘the big table at Thanksgiving.’ I really think we’re on a very pivotal part of our journey in ENA, and we can start opening up more doors and opportunities by getting to the table. We are positioning ourselves to where we are being recognized.” The 24/7 demands of the ED, which are exacerbated by issues of workplace violence, crowding, boarding and more, put emergency nurses in the unenviable position of not having enough time with their patients. ‘‘I really think that people who get into emergency nursing are really dedicated and care about patients and their families, so how do they protect that balance?’’ she said. ‘‘I personally think that the biggest challenge for emergency nurses is getting the support from the CNOs, the CFOs and the other disciplines who do not necessarily understand the work of an emergency nurse. Because no matter what, that door is always open. The ICU can close, surgery goes home. This door is always open. ‘‘For me, the goal is building on what ENA does and getting people to understand what an emergency nurse does. Even emergency physicians do not sometimes

understand what an emergency nurse does. That, to me, is our biggest challenge. I think what I stand for is trying to get the right partners at the table so that we can provide the best emergency care that patients and families deserve.” Mortensen’s other major goal is putting the organization in a position to provide emergency nurses with the tools they need to do their jobs at all levels, from the bedside nurse to managers, educators and directors. ‘‘We as an association should be able to support them with that and lead them into the future,’’ she said. Mortensen’s strong background in emergency nursing and her empathy for what ENA’s members experience on a daily basis in the ED have made her the best nurse for the top nursing job at ENA. ‘‘I am passionate, and I am proactive and I am totally a patient advocate,’’ she said. ‘‘For me, being a patient advocate and a family advocate makes it only essential that I am the nurse advocate. I said once to [ENA Executive Director] Sue [Hohenhaus]: ‘I am the nurse’s nurse.’ How do I help those nurses, wherever they are, give the best possible care? I have to advocate for them. I have to help them so that they can focus on their care.’’

June/July 2012


IENR Director’s Goal: Research as a Weapon By Josh Gaby, ENA Connection Lisa Wolf’s love for research was beginning to take shape, and joining ENA eight years ago “gave me a place to put it.” Today, as the new director of the Institute for Emergency Nursing Research, Wolf, PhD, RN, CEN, FAEN, intends to make it as easy as possible for other emergency nurses to meet her in that place. “I think the difficulty that most bedside nurses have with Lisa Wolf, PhD, RN, CEN, FAEN research is that it’s this very remote, academic kind of an endeavor, when actually it’s just a way to get from problem to answer, from problem to solution,” said Wolf, who’s tackling her full-time role remotely from Hadley, Mass., spending one week per month at ENA headquarters while continuing to teach fundamentals at the University of Massachusetts School of Nursing in Amherst. “And so as I work with members and the other staff here, everything we set up has to have something useful at the bedside at the end of it.” If Wolf’s name and face seem familiar, they should. She’s been a faculty presenter at ENA conferences since 2006, a year after first presenting a research poster at Annual Conference in Nashville, which itself tied in with her contributions to the Journal of Emergency Nursing. Her move from New York to Massachusetts in 2006 led to heavy involvement with the Massachusetts ENA State Council. She completed her doctorate last year. All of this while working as a staff nurse at Cooley-Dickinson Hospital in Northampton— she’ll continue to put in a few shifts each month—and raising three kids with her husband, JH Noble. Wolf, who had been a member of the 2012 IENR Advisory Council, envisions IENR projects that result in tangible tools: decision trees that can be clipped to badges, best-practice reminders that go up on walls. Huge on her to-do list are providing the right help to those starting or continuing their own research projects, and developing intervention studies geared toward stopping violence against emergency nurses—a cornerstone of the ENA Strategic Plan. “That’s really where I want to see us going is not just describing a problem, but really putting forward interventions and testing them,” she said. “We’ve described the problem to death. We know that nurses get beat up. … We’ve described those barriers [to a safe environment] pretty clearly. Now we need to give nurses the tools to overcome those barriers beyond talking to your administration about night security in your ED—something that nurses can actually use on a day-to-day basis. ‘Here’s how you assess risk, here’s how you tell whether you’re in a high, moderate or low risk for a violence situation,’ whether you’re looking at a particular person or whether you’re looking at a general environment. “Anything we do,” Wolf said, ‘’whether it’s the SBIRT stuff or the violence stuff, the end result of that work can’t be, “Well, I thinnnk we should do this.’ It’s like a tool. It’s a weapon.”

Official Magazine of the Emergency Nurses Association

National Quality Forum Appoints ENA Nurse to 2012 Jury Panel By Kendra Y. Mims, ENA Connection The National Quality Forum selects an exceptional, quality-driven health care organization each year to receive the National Quality Healthcare Award. As the only nurse appointed to the 2012 NQF National Quality Healthcare Award jury selection panel, Kathy Szumanski, MSN, RN, NE-BC, has had an opportunity to collaborate with other well-recognized individuals in the world of quality health care as they Kathy Szumanski, work toward choosing this year’s MSN, RN, NE-BC recipient. Being the only nurse on a national jury panel mostly comprised of physicians to review and score applications according to NQF criteria was an eye-opening experience for Szumanski, director of the ENA Institute for Quality, Safety and Injury Prevention. “Collaborating with a group of primarily physicians to discuss the applications during the judging process has been an interesting adventure,” she said. “As nurses, we see things a bit differently. NQF recognized the value of having a nurse on the panel because we have a different perspective. I also think that ENA has a level of credibility in the quality area that was recognized. Although I don’t speak officially for ENA, I’m a member of ENA and I have a background in quality and exemplary practice.” During her experience on the panel, Szumanski discovered similarities between the NQF quality health care award and the ENA Lantern Award’s selection process and criteria. “The NQF award looks more at the organization as a whole while the Lantern Award looks at the ED,” she said, “but some of the same indicators and efforts that we’ve put into the Lantern Award are also really spoken into the NQF application in terms of quality and how quality looks in your organization. It solidified for me that the criteria we built for the Lantern Award is pretty solid and it convinced me that we’re on the right track with the Exemplary Award for ED Practice.” Szumanski describes the NQF selection process as rigorous and detail-oriented. “It is not an award for the faint of heart,” she said. “This award is not just looking at the here and now. You have to really have an interest and a desire to have a quality health care organization and demonstrate that to the public. The Accountable Care Organization model is going to have a tremendous impact on health care organizations. It’s not that we haven’t had accountability in the past, but I think it’s going to be at a level we haven’t experienced before.” Szumanski described her one-year term on the national jury panel as an extremely valuable experience that addressed quality on multiple levels. “I think in the coming years, because of health care reform and other things, emergency rooms will be the focus of attention increasingly from a quality perspective,” she said. “The more that we can sit on these panels, the more prepared we will be to guide emergency departments in terms of standards and expectations in quality. It gives us an opportunity to think ahead and see what’s coming down the road.”

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2012 Proposed Bylaws Amendments and Resolutions The Emergency Nurses Association General Assembly will be held Sept. 12-13 in San Diego. ENA President Gail Lenehan, EdD, MSN, RN, FAEN, FAAN, will preside as speaker of the house when roughly 700 delegates representing ENA’s state councils and international members debate and vote on emergency nursing issues that affect you and your profession. See your state representatives in action and learn more about how ENA works for you by attending the 2012 General Assembly. Delegates will debate and vote on various proposed bylaw amendments and resolutions, witness the installation of the 2013 ENA board of directors and Nominations Committee and hear the president and president-elect addresses. At the June board of directors meeting, the board will provide a final review of all

proposals for presentation at the 2012 General Assembly. Final copies will be posted at www. ena.org for all state councils, chapters and assigned delegates to access. Proposals will only be available online. Summaries of the proposed bylaw amendments and resolutions follow.

Bylaw Amendments Article XI—Parliamentary Authority: The newest edition of Robert’s Rules of Order Newly Revised, 11th edition, was published in fall 2011. The ENA board of directors offers this amendment for the newest edition to govern ENA in all cases as applicable. Article XII—Resolutions Committee Responsibilities: The Resolutions Committee is the one appointed committee whose primary focus is the General Assembly Convention,

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bylaws amendments and resolution proposals. While impartiality is a key attribute of the committee, there are some bylaws amendments which are not intended as significant changes to the content. The Resolutions Committee does not have the authority to independently propose any bylaws amendments. The ENA board of directors offers this amendment to enable the committee to independently propose procedural and technical changes. Article VI—Board Eligibility: The ENA board of directors offers this amendment to be consistent with the amendment made last year in Article VIII, Section 2, C, 2a with regard to the time frame in which officer and board candidates must be a member. In addition, the proposal requests the deletion of membership history being verified specifically by the director of membership. How membership is verified is an operational procedure. The Nominations Committee is responsible for ensuring the validity of the candidate’s membership through the appropriate channels at ENA. Article III––Membership: The amendments to this section of the bylaws are prompted by numerous queries about membership classifications from potential members. The ENA board of directors proposes these bylaws amendments to ensure that this section provides clear and definitive explanations for each membership category and classifications. Article VI––Board of Directors and Officers Elections: The authors of this proposal offer this amendment that would allow the General Assembly, the member decisionmaking body of our organization, to elect the ENA board of directors and Nominations Committee of the association. Additionally, adoption of this bylaw amendment would have positive effects operationally and financially. Article VIII––Nominations Committee Composition: The authors are presenting this bylaws amendment for reorganization and clarity only. The proposal does not include substantive changes. Article VIII–– Nominations Committee Eligibility: The authors offer this bylaws amendment to establish increased clarity of the Nominations Committee and member qualifications and provide consistency and clarification regarding the General Assembly attendance requirements. Article VIII–– Nominations Committee Responsibilities: The authors propose this bylaws change to establish increased clarity of the Nominations Committee, member qualifications and regional representation of all members who qualify as candidates in the event no applications are received for ENA board of

June/July 2012


Free Online CEs Have Members Thinking ‘Awesome’ By Josh Gaby, ENA Connection Just how hungry are ENA members for free continuing education units? Within the first 24 hours after three online courses totaling 2.0 contact hours were made available April 30, 148 total course registrations were recorded, with 75 completions. As of May 29, those numbers had grown to 778 registrations and 622 completions. The CE program aims to introduce a new course each month, ENA eLearning Specialist Bree Sutherland said. The latest offering is “10 Ways to Get Fooled at Triage,” a webinar by Lisa Wolf, director of the Institute for Emergency Nursing Research, which was added June 1. Like most of the free CE courses planned, it’s worth one contact hour and will be part of the online catalog for 18 months. Forthcoming CE topics include cardiocerebral resuscitation, leadership, analytics and patient flow, Sutherland said. None of them will cost ENA members a thing. “Let’s be honest: Everybody loves something that’s free,” Sutherland said. “You’re learning, you’re getting contact hours, so it’s just a great opportunity, and ENA is really proud that we’re finally offering that to members.” That’s music to the ears of longtime ENA member Maureen “Mo” O’Reilly Creegan, RN, MSN, CNS,C, CEN, CCRN, FAEN, who worries that cost and travel obstacles have made it hard for many emergency nurses to get the contact hours they need to keep their certifications current. Creegan is a registered nurse at the Emergency Care Center/ Weekend and Holiday Access Clinic at Fort Huachuca, Ariz., and an independent clinical nurse specialist. She knows the educational challenges that nurses in rural areas face. “I live four miles from the Mexican border,” Creegan said. “For me to get to a one-hour, two-hour session that may be offered at the local

directors or Nominations Committee positions. Article VIII–– Nominations Committee Responsibilities: The purpose of this amendment is to fulfill the intent of the Nominations Committee to be a separate entity governed by the General Assembly with board input. The General Assembly will then approve the election rules at its annual meeting instead of only reviewing and providing input.

ENA Resolutions Care of the Bariatric/Obese Patient: This resolution asks that ENA recognize that bariatric/ obese patients require specialized care and develop a position statement that addresses the safe and effective care when caring for the bariatric/obese patient. Additionally, the authors request that ENA identify available literature or education related to assessment and safe care and incorporate it into all ENA products and programs. Care of the Patient with Chronic Pain: This resolution requests that ENA review the current research on the care of patients with chronic pain in the emergency department and disseminate the information as appropriate. Defining “Wait Time” for Emergency Department Services: This resolution asks that ENA write a consensus statement definition for a

hospital in the Tucson area for credit, it’s a 1½- to two-hour commute. There’s a fair number of parts of our country that are not urban and suburban for ease of getting CEUs.” Creegan already had completed one of the online courses and planned to dig into the others soon. The freedom to take a course on your own time, on your own computer, is “awesome,” she said. Capt. Eric Miller, RN, CEN, CCRN, NREMT-P, is an ED staff nurse at St. Mary Corwin Medical Center/Centura Health in Pueblo, Colo., and a critical care nurse in the Colorado Air National Guard. He had requested free CE opportunities in a recent member survey and was thrilled to see the online program unveiled. “I’m really excited about it. It’s a long time coming,” said Miller, a big believer in professional development. “There’s a huge value to anybody that’s a member of ENA just to have that. It’s evidence that you’re doing just a little bit more, and whether employers recognize that or whether anybody else recognizes it, for me it’s immaterial. I do it to make sure I’m taking better care of my patients. You’ve got to stay on top of everything, and things change so rapidly. “I felt like ENA was definitely being responsive to little Eric Miller in Pueblo, Colo.”

HOW IT WORKS •G  o to www.ena.org/FreeCE and log in as an ENA member or create a new account. • Add courses to your cart and check out (no charge to members). • Go to your personal learning page to start or complete courses or to print certificates after courses are completed. • Having problems? E-mail webseminars@ena.org or call eLearning Specialist Bree Sutherland at 847-460-4115.

consistent ED metric regarding the term ‘‘wait time’’ as used in emergency care settings. Health Care Worker Fatigue: The authors of this resolution are requesting that the ENA Institute for Emergency Nursing Research develop an emergency nursing resource on the work environment and hours worked as it relates to worker fatigue and worker and patient safety. Should the evidence support a position on health care worker fatigue, a position statement would be developed recommending limitations of consecutive work hours, rotating shifts and total work week hours. The authors also ask that ENA pursue opportunities for collaboration with regulatory and other professional health care organizations. Palliative Care in the Emergency Setting: This resolution asks that ENA revise the End-ofLife Care in the Emergency Department position statement to incorporate national palliative care guidelines; provide clinical tools for providers and clinicians; and recommend providing courses addressing palliative care at ENA conferences. Safe Discharge from the Emergency Department: This resolution asks that the Institute for Emergency Nursing Research (IENR) seek ways, including outside grant funding, to foster the research needed to promote nursing

Official Magazine of the Emergency Nurses Association

competence for discharging patients and that this information be published in a form appropriate to the findings for use as resources in the development of emergency department policies and procedures. Trauma Nurse Core Course Eligibility: This resolution requests that ENA conduct a full investigation and analysis to determine the risks and benefits to the organization of allowing non-RN health care providers, including student nurses, to be included in the TNCC verification process; that the results of that analysis be distributed to the membership as appropriate; and that ENA uphold the November 2009 course administration procedures, reviewed and amended March 2011, as they relate to course verification for TNCC until such time as the above investigation is concluded, membership is informed and an informed and fiscally sound, due diligence decision can be made. Use of Protocols in the Emergency Department Setting: This proposal requests that ENA develop a position statement regarding the use of protocols in the emergency department setting and to collaborate with members of the professional community to develop operational definitions for protocols and their impact on emergency nursing practice.

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The Chardon High School Shooting

Mission Doesn’t Change When a National Horror Lands in the ED Three critically injured young men were headed for MetroHealth Medical Center by helicopter, and the disturbing circumstances certainly weren’t lost on Rick Nicastro. An hour earlier, around 7:30 a.m. on Feb. 27, the boys—ages 16 and 17—had been shot by another student while sitting in the cafeteria of Chardon High School in Chardon, Ohio, waiting for a morning bus that would take them to a nearby alternative vocational school. What would become the deadliest public high school shooting in the United States in seven years had just taken place, and the worst of the six injured students were being airlifted 30 miles to MetroHealth, the Level I trauma center in Cleveland where Nicastro, BS, ADN, is one of three assistant nurse managers and the one who oversaw the emergency department that morning. The eyes of the nation suddenly had fallen on northeastern Ohio, the victims, Emergency responders wheel a Chardon (Ohio) High School shooting victim to a medical evacuation helicopter for transport 17-year-old shooting suspect Thomas to MetroHealth Medical Center in Cleveland on the morning of Feb. 27. Three students died of their gunshot injuries. ‘‘T.J.’’ Lane and the collective of the day: crowd control, the needs of victims’ find a private place for them to be away from emergency response. family members, the presence of the media and all the other patients that come through, ‘‘It seemed very surreal, if you will, to me,’’ the mental well-being of the 14 emergency unrelated patients. If they become very upset, admitted Nicastro, an eight-year emergency nurses on duty. they have somebody to talk to. That social work nurse, ‘‘because I have school-aged children in MetroHealth’s multi-disciplinary team had is there for them.’’ that age group.’’ little trouble with the media—Nicastro described And what of the emergency nurses That being said … reporters as ‘‘very visible, but very courteous’’— themselves, suddenly in the thick of a haunting ‘‘It was still handled very effectively, very and focused largely on the devastated families situation generating national headlines? efficiently,’’ he said, ‘‘and we did everything that of the boys. All three Chardon fatalities were Nicastro and his supervisor, nurse manager we possibly could to ensure the best outcomes MetroHealth patients. (The Cleveland Clinic, Charlene Warner, BSN, RN, repeatedly come possible.’’ parent organization of Hillcrest Hospital, the back to the truth of the matter: Knowing that the Specifically, Nicastro was referring to the local facility where two Chardon survivors were injured boys were victims of a school shooting clinical outcomes for the three boys, none of treated, declined to allow its nurses to be changed nothing about nurses’ processes and whom survived his injuries, but at MetroHealth interviewed for this story.) protocols or rattled them in their efforts to save that morning, ‘‘best outcomes’’ was an idea that ‘‘I can only begin to imagine what [the lives. MetroHealth’s emergency department saw applied to just about everyone. After Nicastro families] were experiencing,’’ Nicastro said. ‘‘We 24 trauma victims on Feb. 27. Chardon victims personally worked as a bedside nurse for one need to make sure that they’re taken care of, represented just an eighth of that. of the boys—a decision made because of his that their privacy needs are met, that they’re ‘‘It was a very unfortunate set of experience and because at that point receiving the information from the physicians circumstances that brought these young men to MetroHealth didn’t know how many victims it that they’re supposed to be receiving, that us,’’ Nicastro said. ‘‘I’m not one to sensationalize would be receiving—he moved to the front of they’re safe, that they’re not being harassed by things. I would characterize it as a sad scene, the ED to join his director of operations in the media in any way, shape or form. So we but it’s always such when anyone comes in a addressing the delicately interwoven elements

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June/July 2012

Jennifer Otto

By Josh Gaby, ENA Connection


Rebecca Collins-Kunes, MetroHealth Nurse manager Charlene Warner, BSN, RN, and assistant nurse manager Rick Nicastro, BS, ADN, stand in the MetroHealth emergency department.

victim of this type of violence. … We are a Level I trauma center. We do see patients of this particular magnitude on a regular basis. Not three at a time, typically, but it’s something that our staff are trained for, that I’m trained for, that we’ve dealt with in the past, so it does kind of hit you a little bit, but at the same time, everyone was very business-like. It was handled very professionally, appropriately.’’ Said Warner, an ENA member and an emergency nurse of 22 years: ‘‘Maybe [nurses] can possibly end up identifying because they have children that maybe will end up on a bus and go to school. We all expect to see our families when we return home. So in that regard, there was maybe a difference. However, for the person we can’t identify with, we’ll offer the same level of care, and the expectation is there, and the dedication and commitment by the staff is there.’’ MetroHealth nurses on hand that day were offered critical-incident debriefing and ongoing support, Warner said, particularly the lesser experienced ones. ‘‘Many of them are young in tenure as well as age,’’ she said, ‘‘and they have difficulty seeing this kind of thing: violence, trauma, assault, accidents, burns, all these things we deal with every day. Rick and I are sort of accustomed to it, having been veterans in this business, so we try to mentor the staff and support them and offer them some hope and comfort in ways that we can.’’ That’s part of the bigger recipe at MetroHealth: creating balance in the lives of emergency nurses and giving them outlets for releasing their emotions, sorting their thoughts and avoiding burnout. Warner seized on the balance concept after hearing a keynote speech at ENA Leadership

Conference 2011 in Portland, Ore., and has made it a focal point since. What she sees in her department, she said, is a staff-wide capacity for physical and spiritual compassion that ‘‘I can’t even articulate.’’ ‘‘If you lose the compassion, then it’s time to move on into something else,’’ Warner said. ‘‘You’re not going to be effective to families and victims.’’ In that sense, MetroHealth was strangely prepared for the Chardon shootings. As for other steps that emergency departments can take to ready themselves for events like these in their own backyards, Nicastro conceded there aren’t many. Just know your job and know why you’re doing it. ‘‘In a setting such as this, it’s the mission, it’s the ultimate goal, to save every life that comes through, regardless of who or how it happened. That’s what we’re here to do,’’ he said. ‘‘In today’s society, unfortunately, due to lack of communication or what-have-you, people are settling their differences through violence. And it’s up to us here to try and make things right when the patients come. ‘‘I would say to other emergency nurses: Do what it is that you’ve been trained to do, have confidence in yourself, and give the care that you’re capable of giving every patient that comes through the door, regardless of the type of event that brought them to you. And that’s what you have to take away from it. It’s the nature of the business. You just have to keep your head up and keep pushing forward and know that you did everything you could [for] the best outcome of that patient. I’m 150 percent confident that on that day, as well as every other day, my staff functioned in that capacity, and they can take that with them and rest comfortably with it.’’

Official Magazine of the Emergency Nurses Association

Emergency Department Workplace Injury Prevention Toolkit to be launched at ENA Annual Conference 2012 Did you know that 72 percent of workplace injuries are related to patient handling? Nurses face many tasks that put them at risk every day, including patient handling; contact with objects; slips, trips and falls; and nurse fatigue. This toolkit will cover many workplace prevention topics, such as the Safe Patient Handling Algorithm, which will help effectively teach you how to safely move a patient in specific situations, as well as how to train and test your staff. Workplace injuries impact nurses’ decision on whether to return to their jobs or stay in their field of practice. Come learn more about this insightful toolkit at this year’s Annual Conference.

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view the full 2012 Annual Conference program and to register.

Conference is open to ENA members, NSNA members and non-members. Register by July 26 to receive the early bird rate. Go to www.ena.org to

profession you love—emergency nursing. Come get refreshed, revitalized and reinvigorated.

To all those who have never attended Annual Conference, now is your time to join us. This amazing experience will get heart racing for the

General Assembly; and learn about the latest products and services in the ENA exhibit hall.

educational sessions; reconnect with old friends and colleagues through a variety of networking events; attend

As in years past, we are excited to bring you the opportunity to earn more than 20 contact hours through attending

of ceremonies on Saturday, Sept 15. Also, take advantage of power yoga and the morning walk which take place by the San Diego waterfront.

ENA is proud to announce our first Annual Awards Gala with Terry M. Foster, MSN, RN, CEN, CCRN, FAEN, as our master

participation. Please see the article below for more information.

Continuing Education Recognition Points will be available this year. These points are designated for non-traditional

more information or the Advance Program for complete details.

with 3.5 contact hours and are designed to improve practitioner competence in advanced and life-saving procedures. See the article below for

We are proud to present the Advance Practice Cadaver Lab: Advanced Emergency Procedural Skills, on Friday, Sept. 14. These hands-on labs are

What makes this Annual Conference different? This year we have many new events to announce:

your skills, Revitalize your desire and Invigorate your passion for practice!

Sept. 11-15. This year’s conference will help you Refresh

In less than four months, ENA will be hosting our 24th Annual Conference in sunny San Diego,

13%

23%

40,001 to 60,000

28%

11%

Over 100,000

Nurse Manager

12%

39%

Other

20%

N/A 8% 10%

36%

17%

16%

20,001 to 40,000

1 to 20,000

Staff Nurses

6 to 10 Years

5 Years or less

Data is from the 2011 Annual Conference Survey Summary Report

60,001 to 100,000

Size of Facility (# of Emergency Department Visits/Year)

Nurse Educators/ Staff Development

Attendee Positions

18%

35%

11 to 15 Years

14%

Over 20 Years

16 to 20 Years

Years in Emergency Nursing

Attendee Profile

E arly Bird Registration Closes ������������������� July 26 ENA Board of Directors Meeting �����September 11 General Assembly........................ September 12-13 Presessions................................... September 12-13 Educational Sessions............. September 13, 14, 15 Awards Gala........................................September 15

IMPORTANT DATES TO REMEMBER


Registration is limited and 3.5 contact hours will be awarded— don’t wait to take advantage of this exciting opportunity.

“Celebrate the BEST IN Class”

Help promote Annual Conference by tearing out the poster and posting in your break room.

This black-tie optional event will feature: • Cash bar cocktail reception with hors d’oeuvres • Wonderful sit-down dinner • Complete awards program that includes AEN inductees, Lantern Award recipients and ENA award winners • Live entertainment

ENA will be honoring our “Best in Class” individuals and emergency departments for their accomplishments at our first annual Awards Gala.

Master of Ceremonies: Terry M. Foster, MSN, RN, CEN, CCRN , FAEN

Saturday, September 15 Reception at 7:30 p.m.; Dinner at 8:15 p.m. Marriott Marquis Hotel Attire: Black-tie optional

NEW THIS YEAR!

Connect with us on Facebook and Twitter for special offers, contests and news for ENA 2012 Annual Conference, Sept. 11-15 in sunny San Diego. Post on Facebook or Twitter #ENAAC12 your favorite photos and memories from past ENA Annual Conferences.

Make the Conference Connection

For more information about CERPs, please e-mail CERPs@ena.org.

used toward renewal of the Certified Pediatric Registered Nurse credential.

Certified Flight Registered Nurse and Certified Transport Registered Nurse credentials only. CERPs cannot be

renewal by CEs. CERPs can be used as non-accredited CEs for renewal of the Certified Emergency Nurse,

The Board of Certification for Emergency Nursing does accept ENA-issued CERPs for specific certification

organizations, institutions or state boards of nursing to verify acceptance of CERPs prior to submitting for credit.

guarantee that other organizations, institutions or state boards of nursing will accept CERPs. Check with your

ENA-issued CERPs are not affiliated with, or accredited by, any other nursing organization. ENA does not

completion record.

Stop by the Cyber Café. Select the sessions you attended. Complete an evaluation to receive your

How will you be able to receive CERPs credit?

as well as the Hands-on Procedural Cadaver Lab and some sponsored educational sessions will offer CERPs.

Where will you find CERPs at Annual Conference in San Diego? Select offerings presented in the Exhibit Hall

tion Points are points designated for non-traditional education. One CERP is equal to one hour of education.

ENA is very excited to introduce CERPs at Annual Conference in San Diego. Continuing Education Recogn-

CERPs (Continuing Education Recognition Points)

In-kind support for the procedural cadaver lab provided by Vidacare, ENA Strategic Sponsor.

The Advanced Practice Cadaver Lab will be held on Friday, September 14, at the 2012 Annual Conference in San Diego. The lab will be taught by experts in advanced nursing practice and emergency medicine. All participants will be given the opportunity to practice procedures including central venous access via internal jugular, subclavian and femoral sites, thoracostomy and chest tube insertion, intraosseous device placement and lateral canthotomy. These procedures will be performed on cadavers to closely simulate real patients.

ENA is committed to the education and growth of the advanced practice nurse. To promote learning and practice for the skills required to perform as an advanced practice nurse in an emergency environment, ENA is excited to announce an advanced emergency procedural skills cadaver lab.

Advanced Practice Cadaver Lab: Advanced Emergency Procedural Skills


BOARD HIGHLIGHTS | April 2012

Board Meeting Actions and Highlights The ENA board of directors met April 28 at ENA headquarters. All members of the board of directors were present and took the following actions: • Approved the Feb. 22 board of directors meeting minutes as written. • Approved the March 21 board of directors meeting minutes as written. •A  pproved the 2012 Emergency Nurses Week ThemeTM: Emergency Nurses – Making a Difference – Every Patient, Every Time, as presented. • Charged staff to notify the Oklahoma state president that she has 30 days in which to file for reinstatement of the state council’s tax-exempt status retroactive to the date of revocation and that failure to take this action will result in suspension of the state council’s charter after the 30-day period, which will include suspension of assessment payments from ENA. •A  pproved $85,000 to improve ENA’s information technology infrastructure.

•A  pproved board governance policy 2.01, Lack of State Council, as amended. • Discussed disseminating the Trauma Nursing Core Course in underdeveloped countries. • Revisited motions made during the Feb. 22 ENA board of directors meeting and agreed to not make any changes to the following: ° To open TNCC to all clinical team members in an emergency care setting when Course Operations is ready. ° That nursing students be allowed to verify in TNCC. • Approved an additional Resolutions Committee charge: ‘‘To review and provide general review and assistance to the ENA State Councils to their bylaws as well as general review for compatibility with ENA bylaws.’’ • Approved moving the following ENA bylaw amendment proposals authored by the board of directors forward to the 2012 General Assembly: ° Parliamentary Authority Established in 1991, the mission of the ENA Foundation is to provide educational ° Resolutions Committee Responsibility scholarships and research grants in the discipline of emergency nursing. ° Board Eligibility ° Membership Classifications • The board agreed not to provide any comments on the proposal to amend the ENA bylaws, GA12e, General Assembly Elections. • Approved the following committee appointment as presented: ° Barry E. Swanner, BSN, RN, CPEN, NREMT-P, to Investing in a nurse today is an immeasurable the Position Statement Review Committee contribution to the future of emergency ° Karen Wiley, MSN, RN, CEN, to represent ENA nursing and patient care. at the American Nurses Association’s Healthy Nurses Conference, June 13-14, in Washington, D.C., and the ENA Workplace Violence Prevention Summit on June 22 in Des Plaines, Ill. ° Approved sending an ENA representative to the Forum for State Nursing Workforce Centers’ 2012 Annual Conference, June 27-29, in www.enafoundation.org Indianapolis. • The following represent actions to various requests from external organizations that were supported by the Executive Committee: ° An invitation from the Health Resources & Services Administration to support the National Sample Survey of Nurse Practitioners and dissemination/participation of the ENA membership in the survey. ° An invitation to attend a National Organization of Nurse Practitioner Faculties sponsored meeting for “Acute Care and Primary Care in NP Practice: A Dialogue” on Feb. 8 in Washington, D.C. Dr. Mary Kamienski, APRN, PhD, CEN, FAEN, represented ENA. ° An invitation for representation on a University of Chicago-sponsored panel to improve ED management of pain in older adults. Donna Roe, DNP, ACRN, CEN, will represent ENA.

Invest in the future of your profession. Support the ENA Foundation.

Your Dollars = Your Future

Donate Now.

Continued on page 25

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June/July 2012


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‘Why I Became an ENA Foundation Donor’ By Kendra Y. Mims, ENA Connection As an emergency nurse, you make a difference in the world every day, providing emergency care to a sick child, caring for an elderly patient, treating behavioral health patients and more. Whether your emergency department is located in an urban or rural area, you play an essential role in providing health care to your community. The ENA Foundation and its donors recognize the importance of what you do. The ENA Foundation is here to help you advance in your profession by providing all emergency nurses with an opportunity to further their education and enrich their skills to better serve their patients. Donors, who consist of ENA members, industry supporters and friends of emergency nurses, support ENA members and their passion for emergency nursing through the ENA Foundation. Whether they gave

$100 or $1,000, every donor’s generous contribution makes an impact by providing for educational opportunities and research grants for emergency nurses who are committed to providing quality health care every day. Maybe you’re asking, “Why should I become an ENA Foundation donor?” Becoming a donor is a great opportunity to show pride in your profession and to support a cause you believe in. As a donor, your contribution not only benefits emergency nurses, it is an even greater benefit to the patients receiving health care. The following donors shared what inspired them to give back to their profession by making a commitment to support the ENA Foundation.

To Build Future Leaders Eric Christensen, BSN, RN, CEN, Littleton, Colo. I submitted my application for an ENA Foundation scholarship in 2004 because I was going back to school for my bachelor’s degree and seeking financial assistance. I was a recipient of the Charles Kunz Memorial Undergraduate Scholarship. After receiving that scholarship and graduating, I purchased a lifetime membership with ENA, thus making that lifelong commitment. I decided that because I already purchased a lifetime membership and made that commitment annually, I would donate the cost of an annual membership to the ENA Foundation every year. I want to give back. Being a scholarship recipient helped to relieve the financial burden of returning to school, and furthering my education has helped to advance my career. They are two separate pieces of the puzzle. However, both have helped to ease my progress as a nurse. As a nurse in emergency services, if we want to continue having good people coming into the profession behind us, then we have

With the ever-changing landscape of health care, advancing your education and conducting research today can change the way you practice medicine tomorrow. Whether it’s to support education or to build future leaders, every donor

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the responsibility to ensure that it happens. And if helping to award scholarships so that people could further their education enhances nursing for the future, then that’s exactly what I want to be a part of. I encourage others to become donors by sharing my experience. I’ve gotten to know the people at the foundation, and I make donating a fun experience by doing something different every year. I also talk about it at the state level so that people see the light in contributing. I began to realize the true value of being an ENA Foundation supporter after I became involved. It has helped to heighten my awareness of the need to assist others in advancing their careers. I believe that many problems in health care today will be resolved by nurses, and we must ensure that nurses are at the table when these decisions need to be made. Donating to the ENA Foundation and helping others to advance their careers is only one small way that I am able to give back to the nursing community.

Why should others become donors It’s our responsibility as nurses to ensure that the next generation has the same opportunities that we had, and we need to create those opportunities for people to advance their education.

has his or her own reasons for being dedicated to making a difference. All donors share a passion for promoting the advancement of emergency nursing. If you share that passion, the ENA Foundation

can show you how to get involved. For more information on how you can become a donor and contribute to providing ongoing research and educational opportunities in emergency nursing, please visit www.enafoundation.org.

June/July 2012


Board Highlights

To Carry on the Legacy Patricia Kunz Howard, PhD, RN, CEN, CPEN, NE-BC, FAEN, Lexington, Ky. My history with the ENA Foundation goes back further than most. The very first time the foundation did an endowment campaign in 1995, they asked for pledges. My dad was really committed to education, so when they asked me to become a donor, I decided to pledge $1,000, which was a really big deal back then. After I made my personal commitment, I called my dad and asked him to pledge his support, and he gave $1,000 to the foundation. Every year from there on after, my dad gave money to the foundation until he died. When he died in 2003, we received so many donations that year in honor of him that it let me fund the Charles Kunz Memorial Undergraduate Scholarship. I continue to personally fund this scholarship every year in his honor. A few years after he died, I got a phone call out of the blue from a man who said he had been an Army buddy of my father and he had learned that my father had died. He had been in the Green Beret with my dad in Korea, and he told me that at night my dad would talk about coming back home, starting a family and getting his education at the University of Kentucky. He contacted me to find out if my dad had ever acquired the education that he talked about when they were in Korea. My dad did get his education at the University of Kentucky, and he later went on to get an advanced degree from Harvard, so he was very focused on education. I’m fortunate that he supported me in every one of my degrees. I probably would not have been able to get a PhD as an adult with my own kids in college if my dad hadn’t felt like it was important, so I’m trying to give back what was given to me. My dad inspired me. He really believed in education and in helping people get their education, so I continue to personally fund this scholarship every year in his honor.

Why should others become donors for the ENA Foundation? The mission of the ENA Foundation is all about helping emergency nurses through research or education. It’s really important to the profession for us to continue to advance our knowledge and to have future leaders for us to support the ENA Foundation.

Continued from page 22

°A  n invitation from the National Student Nurses Association to attend and speak at its National Conference, April 11-15, in Pittsburgh. Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN, and Hershaw Davis, BSN, RN, represented ENA. ° ENA received an invitation from the Suicide Prevention Resource Center and the American Association of Suicidology for representation on an expert panel to develop consensus protocols for managing the care of suicidal patients in the emergency department on April 17 in Baltimore. Gail Lenehan, EdD, MSN, RN, FAEN, FAAN, represented ENA. • The following requests were not

supported by the Executive Committee: ° An invitation to attend the National Institute of Mental Health Outreach Partnership Program Annual Meeting and Partner Sharing Session, March 19-22, in Denver. ° An invitation to attend the American Associations of Colleges of Nursing Spring Annual Meeting Sunday reception on March 25 in Washington, D.C. ° An invitation to attend the National Burn Bed Strategy Meeting on March 20 in Atlanta. Highlights of the next scheduled board of directors meeting will be published in a future issue of ENA Connection.

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Official Magazine of the Emergency Nurses Association

5/17/12 8:54 AM

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READY OR NOT? |

Knox Andress, BA, RN, AD, FAEN

Crisis Standards of Care:

A Duty to Plan There are two viable pandemic patients, both requiring a ventilator, but only one ventilator available: Who gets the available vent? In a catastrophic disaster, which patients receive the available medical resources? What are the operational, ethical, legal and other significant considerations? Who is responsible for planning and Crisis Standards of Care implementation? What CSC planning templates for emergency departments and hospitals are available?

Latest Guidance In March, the National Academy of Science, Institute of Medicine released a new resource for federal, state and local health providers and stakeholders in planning for CSC at www.iom. edu/Reports/2012/Crisis-Standards-of-CareA-Systems-Framework-for-CatastrophicDisaster-Response.aspx. This six-volume resource provides the considerations and coordinated strategy for a multijurisdictional approach for CSC development and implementation. Volumes contained within the publication include the following: 1. Introduction and CSC framework; 2. State and local government; 3. EMS; 4. Hospital; 5. Alternate care system; 6. Public engagement; and 7. Appendixes. The volumes serve as implementation toolkits or guides. Common to each volume or system are defined roles and responsibilities, operational considerations and planning templates to guide development implementation.

Recent Incidents—Triaging Scarce Medical Resources September 2005 brought Hurricane Katrina, its flooding and devastation to the infrastructures of metropolitan New Orleans, including health systems and multiple hospitals. Many caregivers and patients were trapped in hospitals without communications, water or electrical power and had minimal medical resources for treatment. In this scenario, which patient(s) should have received the remaining medical resources? Which patients got the priority hospital evacuation triage?

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Approximately 230,000 deaths were reported one year after the catastrophic Haitian earthquake of Jan. 12, 2010. Medical resources were scarce, and patients reportedly were given the best care possible in often primitive conditions. ENA member Rose Johnson, RN, reported having to create a spirometer for her patients. Immediately after the F5 tornado plowed through Joplin, Mo., May 22, 2011, residents suddenly found themselves with one hospital with an emergency department instead of the usual two. The scene was set for scarce medical resources. St John’s Regional Medical Center took a direct hit and was itself a casualty of the tornadic weather. Of 161 reported fatalities, five were ICU patients and one was a hospital visitor. Patients were evacuated to the remaining health care facilities and alternate care sites that had care-delivery capability. EMS and medical resource needs skyrocketed, and several non-traditional methods were employed. Because of a limited number of available EMS transport units coupled with the urgent need, ‘‘vehicles of opportunity’’ were used for patient movement to hospitals.

Today—Scarce Medical Resources A growing medical resource shortage includes more than 250 drugs, mostly generics and injectables, but including several ‘‘first line’’ medications, anesthetics and chemotherapeutics. Shortages affecting prehospital and hospital providers have been reported and have included magnesium sulfate, propofol, succinylcholine and epinephrine, among many others. Occasionally patients receiving chemotherapy have had to delay treatment or even forgo their preferred therapeutic. While some pharmaceuticals can be substituted, others cannot, and patient care suffers. On April 12, Emory University hosted a conference on the ethics of the current drug shortage, discussing multiple related topics including distribution and equitable allocation of this scarce medical resource.

IOM—A Letter Report At the request of the Assistant Secretary for Preparedness and Response within the Department of Health and Human Services, the Institute of Medicine’s Committee on Guidance for Establishing Standards of Care for Use in Disaster Situations wrote and released a report

in 2009, providing key elements of planning and initial recommendations to state and local public health departments in establishing and implementing crisis standards of care for scarce resource environments subsequent to disaster scenarios www.iom.edu/Reports/2009/ DisasterCareStandards.aspx. Final recommendations in the IOM’s 2009 report included the following: 1. Develop consistent state crisis standards of care protocols with five key elements. 2. Seek community and provider engagement. 3. Adhere to ethical norms during crisis standards of care. 4. Ensure consistency in implementation of crisis standards of care. 5. Ensure intrastate and interstate consistency among neighboring jurisdictions. The March 2012 ‘‘Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response’’ follows the intent and guidance and develops the recommendations of the 2009 report.

Volume 4—Hospitals and Acute Care facilities As the hospital’s front door in disaster response, emergency departments play a significant role in the disaster surge response, incident management and response planning. CSC: A Systems Framework, Vol. 4, ‘‘Hospitals and Acute Care Facilities,’’ begins with “Hospitals and acute care facilities providing acute medical care to the community have a ‘duty to plan’ for mass casualty incidents, including planning for expansion of clinical operations, commonly referred to as surge capacity post-Hurricane Katrina.” Of the six volumes, Vol. 4 provides multiple resources, including a template for hospital crisis standards of care planning and implementation as responses are demonstrated across the surge continuum of conventional care, contingency care, and crisis care environments. Besides templates for hospitals and acute care facilities, the framework includes sections and specific templates for state and local government; EMS; alternate care system; and tools for public engagement.

Don’t Forget Spread the word about ENA’s emergency preparedness resources with the following activities:

June/July 2012


1. Join the ENA Emergency Preparedness listserv for additional resources and preparedness discussion. 2. O  rder your ENA Connection Disaster Man shirt at www.ena.org/store. Resources Retrieved from en.wikipedia.org/wiki/2011 Joplin_tornado  CNN, Nationwide Drug Shortage, March 11, 2012. Barbera and MacIntyre, 2004; Barisch and Koenig, 2006; Hick et al, 2004, 2008; Joint Commission, 2008.” “Duty to plan” references Hodge and Brown, 2001, in Preston v Tenet Health System Memorial Medical Center, Inc, no. 05-11709-B-15 (La. Civ. Dist. Ct. settled March 23, 2011).

Readers may contact the author at wandr1@lsuhsc.edu. Follow Knox Andress @ENAdman.

Correction The following Academy of Emergency Nursing fellow profile was incorrectly presented in the May issue of ENA Connection: Mary E. (Mel) Wilson, RN, MS, CEN, COHN-S, FNP, FAEN, co-authored a resolution that was presented at the 2011 ENA General Assembly and was a contributor to the recently published Manual of Emergency Care.

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

FEBRUARY 27 – MARCH 3

Call For

Poster abstracts Research and evidencebased Practice Projects Don’t miss this opportunity to showcase your work on emergency department management, leadership and research To view past submissions or for further information regarding guidelines, please visit WWW.ENA.ORG/IENR.

SubmiSSion DeaDline  auguSt 1, 2012 LC13_CallForPosterAbstracts_ConHPIsland.indd 1

Official Magazine of the Emergency Nurses Association

5/30/2012 10:34:12 AM

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From the Future of Nursing Work Team:

Increase the Proportion of Nurses With a Baccalaureate Degree to 80 Percent By 2020 By Michael Simpson, BSN, RN, CEN Academic nurse leaders across all schools of nursing should work together to increase the proportion of nurses with a baccalaureate degree from 50 to 80 percent by 2020. These leaders should partner with education accrediting bodies, private and public funders and employers to ensure funding, monitor progress and increase the diversity of students to create a work force prepared to meet the demands of diverse populations across the life span. —From The Future of Nursing report This is the fourth installment in a series informing ENA members about recommendations in the Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health. The goal of increasing the percentage of nurses with a baccalaureate from 50 to 80 percent seems daunting to some and attainable to others. The only way to achieve this goal is to get started. The logical starting point is nursing schools. The diploma and associate degree programs must provide a clear path to the baccalaureate degree. Establishing partnerships between

those diploma and associate degree programs and institutes that offer baccalaureate degrees will remove a major roadblock to achieving the goal. It is imperative that the nursing school culture emphasize lifelong learning. Another suggestion would be for health care organizations to encourage nurses to start a baccalaureate within five years of entering the profession. There are several ways for health care organizations to facilitate nurses returning to school for advance degrees, such as offering scholarships and tuition reimbursement. Compensation is another effective incentive. Those nurses who made a commitment to education should be rewarded for it. If health care organizations are serious about meeting the goal of having 80 percent of nurses obtain baccalaureate degrees, entering a baccalaureate program should be a requirement for all new nurses. The nurse education pipeline also must be expanded. This can be accomplished by embracing private/public partnerships to increase the size and number of baccalaureate programs. Diploma and associate programs should consider partnering with high schools to begin programs in the junior or senior year.

Another long-term strategy is partnering with primary and secondary school systems to help recruit a large, diverse group of future nursing students. To achieve improved outcomes of patients and the progression of the nursing profession, it is essential that the core group of nurses is baccalaureate prepared. Diploma and associate degree programs will remain a major source of the nurses. Nursing schools must put their students on the path to a seamless academic progression for the goal to be met. Increasing the percentage of nurses with a baccalaureate degree from 50 to 80 percent will not be easy or inexpensive. This recommendation can only be achieved with buy-in from the major funders of nursing education, health care organizations and, most important, nurses. Reference Institute of Medicine, The Future of Nursing: Leading Change, Advancing Health. Accessed Jan. 30, 2012, at www.iom.edu/Reports/2010/ The-Future-of-Nursing-Leading-ChangeAdvancing-Health/ Recommendations.aspx.

ENA Call for…

2013 ENA National Committee Members Deadline: July 31

This year, ENA has several openings on national committees and invites ENA members to submit applications at www.ena.org from July 2 to 31: • Awards Advisory Committee • Clinical Practice Committee • Course Administration Faculty • Education Committee • Emergency Department Crowding Committee • Emergency Department Psychiatric Care Committee • Emergency Management and Preparedness Committee • Emergency Nurses Wellness Committee • Emergency Nursing Resources (ENR) Development Committee • Geriatric Committee • Government Affairs Committee • Institute for Emergency Nursing Research (IENR) Advisory Council • Institute for Quality, Safety and Injury Prevention (IQSIP) Advisory Council • Journal of Emergency Nursing (JEN) Editorial Board • Lantern Award Committee

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• • • • • • • • • • • •

2014 Leadership Conference Committee Membership and Component Relations Committee Nurse Practitioner in Emergency Care Committee Pediatric Committee Position Statement Review Committee Site Selection Committee Emergency Department Technology Special Interest Group Facilitator Emergency Educators Special Interest Group Facilitator Forensic Nursing Special Interest Group Facilitator Pediatric Emergency Care Special Interest Group Facilitator Retired Emergency Nurses Special Interest Group Facilitator Small Rural and Critical Access Hospital Special Interest Group Facilitator • Travel Nursing Special Interest Group Facilitator • Uniformed Services Special Interest Group Facilitator ENA relies on its members to shape the direction of our association. Your contributions are invaluable, and we thank you for all your support.

June/July 2012


Prove Your Knowledge

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Eight Easy Ways to Elevate Your Mood (in 10 Minutes or Less) By Kendra Y. Mims, ENA Connection

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When was the last time your work day affected your mood? With the increasing rate of emergency department violence, patient crowding issues and circumstances that occur beyond your control, some days are probably more physically, mentally and emotionally draining than others. But before grabbing a bag of chips or cookies to cheer yourself up and de-stress from a bad day, try incorporating the following simple techniques into your routine to keep your mood upbeat when your emotions say otherwise: 1. L  augh: Though it’s not always easy to smile and find humor during difficult times, studies have found a link between laughter and mental health because it’s a natural remedy for stress, anxiety, conflict and grief. 1 Laughter also does the following:1 • Decreases stress hormones • Releases endorphins (which promote a sense of well-being) • Improves mood • Resolves conflict • Enhances teamwork • Creates a positive environment • Alleviates anxiety and fear S trengthen your relationships with your coworkers through humor. Share laughter

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together by telling a joke, amusing memories or a funny story. As an emergency nurse, you probably can find humor in several unique situations and experiences that only emergency nurses can understand. Help Guide also suggests bringing humor into your conversations. For example, ask your colleagues to share the funniest thing that has ever happened to them during their shift. Humorous stories and laughter can help to keep you emotionally healthy and create an upbeat atmosphere. 2. Meditation: Meditating is a powerful method to help your body de-stress, as it stimulates a sense of calm, peace, relaxation and happiness. 2 Meditation is also known for reducing stress and anxiety, building confidence, creating a feeling of well-being, increasing serotonin (influences moods and behavior) and decreasing irritation. 2 Whether you take a few minutes to engage in breathing exercises, prayer or mindful meditation, you can return to work in a happier place with a clear mind. 3. D  on’t sweat the small stuff: Sure, you can probably think of a million things that went wrong in one day—a disgruntled patient, an unpleasant colleague, another long shift without a break, too many things on your to-do list and not enough time—but don’t let the day’s woes keep you down. Boost your mood by focusing on at least three things that made your day at work worthwhile, no matter how small. Did you make a patient smile or help a colleague out with a project? Maybe you completed a task on your to-do list. Identify other important things in your life and expand your list from there. Writing down the things in your life that you value and appreciate can change your perspective on the dreariest days. 4. S  wap success stories: Maybe a pediatric emergency had a successful outcome or a verbal de-escalation technique calmed down an agitated patient. Exchanging stories that have positive outcomes with your peers can help to boost morale and strengthen camaraderie among staff. ENA Leadership Conference 2012 speaker Rich Bluni, RN, LHRM, suggested that emergency nurses create a book for their emergency department

1. FAMILY

2. FRIENDS 3. PETS 4. S  EEING MY SHIFT REPLACEMENT COME ON DUTY 5. GOOD HEALTH 6. UPCOMING EVENT 7. VACATION

Here’s a sample list of things you might appreciate which can help you retain perspective. (See Step 3.)

that tells their stories. What is your story? Write it down and encourage others to do the same. Becoming inspired and inspiring others around you by sharing your positive nursing experiences is a quick way to lift your spirits. 5. Listen to music: Have you ever listened to a song that either motivated you or made you smile? From relaxation to inspiration, studies have proven that music has the ability to move people and alter their mood for the better. According to researchers from the University of Groningen, music not only can affect your mood, but it can also change your perception (e.g., people will recognize happy faces if they are feeling happy themselves from listening to happy music).3 Choose a song that you find inspirational or one that puts your mind in a happy place, and listen to that song during your break. You can also listen to uplifting music before you start your shift to set the tone for the day. If time is limited, write down lyrics from a song that motivates you on an index card. Pull out the card or take a few minutes to listen to a song whenever you need to get rid of your blues. 6. Go for a walk: Is there a crisis or situation that has left you frustrated? Take a break to remove yourself from the environment that is affecting your mood, even if it means you can only leave your unit for five minutes. A brisk walk can help you clear your mind, leaving you alert and recharged. Walking releases endorphins, which can give your body the boost of happiness it needs. Another suggestion: Step outside and let the sun shine down on you; vitamin D is a mood booster.

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7. Vent: Confide in a trusted colleague or supervisor about any issues that are negatively impacting how you feel. Though expressing your frustrations won’t necessarily solve your problems, it can bring relief to release emotions that are often bottled up inside. Because many health care professionals experience burnout and compassion fatigue, it is important to debrief on a regular basis. You can also keep a journal nearby to express your feelings. Vent freely about the contributing factors to your bad mood, but end each entry with a positive outlook and a goal of how to make it happen. (e.g., ‘‘Today was a bad day because of staffing issues, but tomorrow will be better and I will take a lunch’’. 8. Eat the right comfort foods: Emotional eating can have adverse side effects on your health, whether it is caused by stress, anxiety or anger. However, there are certain foods that can boost your mood without the aftermath of guilt that often comes from stress eating. Eating a healthy diet that is rich in low-glycemic foods is said to improve overall moods and prevent mood swings.4 Though pizza, ice cream and chips are often labeled as comfort foods to indulge in on bad days, the brief moment of bliss can be followed by another bad mood because of the foods’ poor nutritional value. The following healthy, mood-boosting foods are recommended for increasing energy and decreasing stress, anxiety and depression 4: • Green tea and chamomile tea (known for combatting stress and anxiety) • Omega-3 fats (anchovies, halibut, tuna, shrimp, trout) • Carbohydrates (beans, potatoes, whole grains, fruits, vegetables) • Dairy products (lowfat/nonfat milk, smoothies, yogurt) • Healthy fats (olive oil, nuts, avocados) • Lean meats • Eggs * ( Limit high-fructose corn syrup, cane sugar, fatty red meats, fried foods and enriched breads, pasta and snacks, as research shows they may contribute to blood sugar spikes and mood swings.4 Enjoy your morning or a midday cup of coffee? Research also recommends monitoring your caffeine intake as it can disrupt your mood).4 Remember, there is an end to every bad day. “When you awaken love and laughter in your life, your mind lets go of fear and anxiety, and your happy spirit becomes the healing balm that transforms every aspect of your human experience.’’ - Jesse Dylan

Other Quick Suggestions:

Feeling liberated

“When you open your eyes in the morning, sit for a moment and appreciate the gift of a new day, create a peaceful thought and enjoy some moments of silence throughout the whole day.” - from Positive Thoughts “Every day, do something that will inch you closer to a better tomorrow.” - Doug Firebaugh “Happiness does not come from doing easy work but from the afterglow of satisfaction that comes after the achievement of a difficult task that demanded our best.” - Theodore I. Rubin

References Smith, M., M.A., Kemp, G., M.A., & Segal, J., Ph.D. (2012). Laughter is the Best Medicine. Retrieved from www.helpguide.org/life/ humor_laughter_health.htm. Faregreen, C. (n.d.). Positive Effects of Meditation. Retrieved from www.projectmeditation-org/bom/positive_effects_of_ meditation.html. University of Groningen (2011, April 27). Music changes perception, research shows. ScienceDaily. Retrieved May 3, 2012, from www.sciencedaily.com/releases/2011/04/ 110427101606.htm. McLaughlin, A. (2011). Mood Boosting Diet. Retrieved from www.livestrong.com/ article/387752-mood-boostingdiet/#ixzz1tkGYigJb.

Create a positive atmosphere: Surround yourself with photographs of family and friends, as well as other soothing pictures to let your mind escape for a moment (hang up a picture of the ocean, sunset or your dream getaway destination). Be mindful of negative thoughts, even the small ones. Keep inspirational quotes nearby so that you can replace negative thinking with positive affirmations. Avoid negative-minded people. Play mind games: Take your mind off of your current situation by engaging it with a crossword puzzle, word search or other mind exercises. Your brain will go into thinking mode, focusing less on your emotions. Take a whiff: Research shows that certain scents can help to control our emotions. Citrus and tangy smells are known as mood lifters, while lavender scent brings calmness and reduces stress.1 Retrieved from www.quickand simple.com/diet-weight-loss/ be-happy-stress-relief/ scents-moods.

What other topics pertaining to health and wellness for emergency nurses would you like to see covered in Code You? Please send your suggestions to kmims@ena.org.

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ENA and AEN Congratulate 2012 Academy Candidates for Induction ENA and the Academy of Emergency Nursing are pleased to announce the 2012 academy candidates for induction: • Meredith Addison, MSN, RN, CEN (Indiana) • Rita Anderson, RN, CEN (Arizona) • Audrey (Liz) Cloughessy, AM, MHM, RN (Australia) • Chris Gisness, MSN, RN, BC, FNP-C, CEN (Georgia) • Diane Gurney, MS, RN, CEN (Massachusetts) • Andrew Harding, MS, RN, CEN, NEA-BC, FACHE (Massachusetts)

• Cindy Hearrell, MSN, RN, CEN (Virginia) • J. Jeffery Jordan, MS, MBA, RN, EMT-LP, CEN, CNE (Oklahoma) • Fred Neis, MS, RN, CEN, FACHE (Kansas) • India J. Owens, MSN, RN, NE-BC, CEN (Indiana) • Gwyn Parris-Atwell, MSN, RN, FNP-BC, CS,

CEN (New Jersey) • Judith A. Scott, MHA, BSN, RN (California) • Paula Tanabe, PhD, MPH, MSN, RN (North Carolina) • Mary Ann Teeter, MEd, RN, FNP-C, CEN, CNRN (New York) The candidates will be inducted as fellows on Sept. 15 at the 2012 ENA Annual Conference in San Diego. We extend our congratulations and appreciation to the candidates for their outstanding contributions to emergency nursing and ENA.

SAMHSA Chief Talks Mental Health Emergencies By Kendra Y. Mims, ENA Connection In an exclusive interview with ENA Connection, Pamela S. Hyde, J.D., administrator of the Substance Abuse and Mental Health Services Administration, shared her insights on prevalent behavioral health care and substance abuse issues and their impact on emergency care. Hyde was a keynote speaker at the 2012 National Council Mental Health and Addictions Conference in Chicago.

emergency departments is that many mental health patients are in the EDs for an extended period of time, whether they are insured or not. What is SAMHSA’s role in helping to alleviate barriers so that these patients can be transferred out of the emergency care setting once they’ve been stabilized?

A: We certainly do practice improvement efforts around things like crisis care, so there are a number of Q: Given that the emergency places in the country where behavioral department is the single health systems have developed crisis provider of health care for an intervention activities that either keep increasing number of patients, people out of emergency rooms or how can SAMHSA work with interact with them as soon as they get hospitals to improve the there. There are mobile crisis teams assessment, treatment and safe that will go to the emergency room Pamela S. Hyde transfer of patients with mental and try to intervene with the individual health emergencies? and get them connected to the behavioral health A: We have a number of different technical system. The last thing we want is for somebody assistance opportunities, whether it’s publications to get admitted to a hospital bed if they don’t or trainings. SAMHSA worked with the National need to, and I think emergency rooms are trying Association of State Mental Health Program to prevent that as well. There are some good Directors to develop some guidelines for models out there, and SAMHSA is trying to get hospitals. We’ve been working specifically on a effective models disseminated. In our uniform couple of things in hospital emergency rooms, block grant application, we encourage people to like the follow-up from suicide attempts. We’ve address crisis intervention issues, and any of been talking with the National Action Alliance for those issues are going to impact emergency Suicide Prevention and with CMS about how they rooms. Currently, when emergency rooms are might help us with practice improvement managing a person who needs follow-up care, concerning follow-up care in emergency rooms. there are few places to send someone who At the moment, emergency rooms can see a doesn’t have insurance. To the extent that we’re person for substance abuse, mental health issues able to get more people insured, I think that will or suicide attempts and can make a referral, open more opportunities for people to have which is not always effective. I think part of the referral sources and for the provider systems and reason why this is hard is because people who the community to have the capacity to do the come to the emergency room often come follow-up care. without health insurance, so as we look to 2014 Q: Illinois and many other states are we’re trying to work very hard to think about experiencing closures of mental health how populations with behavioral health needs clinics, which is placing a burden on will get enrolled and new opportunities for emergency departments to fill the gap in health insurance. I think that will help with the services. Can you speak to SAMHSA’s efforts referrals and follow-up care. to improve community-based mental health Q: One of the major dilemmas in the U.S. and substance abuse services?

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A: We’ve known for a couple of years about Illinois in particular, but many states are really struggling with budget issues. Unfortunately, behavioral health is often seen as an optional service and something that can be eliminated or done without for a while. SAMHSA’s block grant dollars require states to provide Maintenance of Effort funding. We also have the obligation to waive that requirement in certain economic situations, so many states have gotten waivers from that requirement recently. States as a whole are seeing huge reductions in expenditures for both substance abuse and mental health care, so we try very hard to keep our block grant dollars flowing. In these budget times that’s hard, but so far we’ve been pretty successful. We are currently going through a process of doing an analysis of services and looking at what the evidence tells us regarding the most effective services for people. We know that one of the top five reasons for readmission to hospitals is mental health and/or substance abuse issues. We are trying to take a look at these issues to help decision-makers understand that not investing in substance abuse and mental health coverage in the community may very well result in other parts of state budgets increasing. Q: Is SAMHSA supporting the SBIRT (Alcohol Screening, Brief Intervention and Referral to Treatment) procedures? A: Absolutely. There’s been some recent work on the use of SBIRT in the emergency room and efforts to include SBIRT in some of the standard practice and protocols that might occur in the emergency rooms. It’s also a great opportunity to engage people who may not be at the level of alcohol addiction but could use an intervention before they get to that point. SBIRT is also an approach used in primary care to identify individuals with depression or substance abuse issues and intervene early for a better outcome, both in an individual’s physical and behavioral health.

June/July 2012


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ENA STATE CONNECTION Virginia ENA State Council Submitted by Janice McKay, RN, CEN, CFRN The Virginia ENA State Council participated in the 60th Virginia Nursing Students’ Association Annual Convention on Feb. 4 at the University of Virginia. The state council promoted ENA, along with the benefits of belonging to a professional organization, to more than 500 conference attendees. There was a lot of discussion of our career path opportunities and our passion for emergency nursing. We were very interactive with the attendees, and many came back several times to chat with the ‘‘stretcherside’’ nurse. The state council provided recruitment material in front of a display board portraying emergency nurses in various work environment settings. We also offered a free raffle drawing. State council member Audrey Snyder, PhD, RN, ACNP-BC, CEN, CCRN, FAANP, FAEN, presented a focus session, ‘‘Global Health,’’ discussing the current global health problems and the opportunities and resources nurses can explore to become involved with and volunteer their nursing skills internationally. We were excited to participate in this annual conference and look forward to the next one. The Virginia ENA State Council has offered to do a focus session presentation next year on the benefits of belonging to a

nursing professional organization. A special thanks to Erin Reeve, BSN, RN, CEN; Loretta Martin, MN, BSN, BS, RN, CEN; and Julia Smith, BSN, RN, for volunteering to man the booth with me. At press time, Smith was a student nurse due to graduate in May and had attended her first state council and chapter meeting the day before the conference. Smith volunteered to help on the spur of the moment; her enthusiasm reminded us oldergeneration nurses that we have the same passion for doing simply the best.

Immediate Past President Erin Reeve, BSN, RN, CEN; 2012 President Janice McKay, RN, CEN, CFRN; and 2010 President Loretta Martin, MN, BSN, BS, RN, CEN, at the Virginia ENA State Council booth.

State Council and Chapter Meetings and Events Kansas ENA State Council Kansas ENA meets every other month. Meetings start at 10:30 am. Aug. 10 (Annual Meeting)—Children’s Mercy South, Overland Park Oct. 12—Stormont Vail, Topeka Dec. 14—University of Kansas, Kansas City

Upcoming education: Annual Trauma Summit for late summer (date to be announced).

CEN Review Oct. 15-16—Hutchinson Oct. 18-19—Lawrence Presenter: Jeff Solheim, MSN, RN, CEN, CFRN, RN-BC, FAEN

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For more information: www.kansasena.org and visit us on Facebook.

Kansas Chapter Meetings: Central Kansas ENA Meetings are planned at 7 p.m. for the fourth Monday of the odd months of the year. Exception will be the July meeting. July 11— Topeka Sept. 19— Lawrence Nov. 14— Kansas City

Michigan Huron Valley Chapter Dinner and safety topic presentation: Aug. 8, 6 p.m. Location: to be announced. Presenter: Det. Brian Fountain, Detroit Police Department

Year-end meeting: Oct. 21, 6 p.m. Location: University of Michigan, Ann Arbor

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

Washington ENA State Council and ENA British Columbia Emergency Nursing Without Borders – emergency nursing conference. This is a joint effort between Washington ENA State Council and the ENA of British Columbia/NENA. Oct. 12-13— Seattle For more information: washingtonena.org/ bc-waconference.html.

June/July 2012


Spotlight on Member Benefits and Resources Free Continuing Education

Mosby’s Nursing Skills: ENA Edition

ENA is proud to offer FREE CE for our members. Additional FREE CE will be added each month. To access the ENA FREE CE visit www.ena.org/FreeCE. Member login is required.

Mosby’s Nursing Skills provide you with 20 new emergency skills each quarter including, competency, testing information, skills demonstrations/step-by-step instructions and

checklists. To learn more, visit www.ena.org (you will need to log in as a member).

Additional New Emergency Nursing Resources ENA develops Emergency Nursing Resources to bridge the gap between research and everyday emergency nursing practice. To access all these new resources, visit www.ena.org/ienr.

Emergency Nursing: Scope and Standards of Practice The American Nurses Association has recognized emergency nursing as a specialty and approved the scope and standards of practice laid out within the book. Visit www. ena.org/shop to order your copy today.

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

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

Mosby’s Nursing Consult: ENA Edition Mosby’s Nursing Consult offers users practice guidelines, FDA drug updates, evidence-based nursing monographs, skills demonstrations and competency testing information. To learn more, visit www.ena.org (you will need to log in as a member).

Are You Interested in Becoming a 2013 ENA Annual Conference Faculty Member? • Share your knowledge and expertise with an international audience of emergency nurses that includes advanced practice nurses, trauma coordinators, managers, administrators, medical directors, clinical specialists, prehospital coordinators and educators. • Course ideas should focus on clinical, advanced clinical, advanced practice, pharmacology, research, education and injury prevention as well as leadership and professional issues. • Standard course length is 75 minutes. Other options are workshops in three or eight hours in length. Also desired are proposals for 30-minute sessions that allow faculty to provide a factual rapid-paced presentation that provides attendees with the latest need-to-know cutting-edge information.

All Submissions are Due Monday, October 8, 2012. To review the full submission criteria and the submission form, visit the Current Calls section of www.ena.org and select the 2013 ENA Annual Conference Call for Faculty and Courses or, for more information, contact Conference Services at AnnualConference@ena.org or 847-460-4117.

Take your career to the next level. Be part of an elite group. Submit a proposal for courses and faculty today!

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ENA Connection June/July