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the Official Magazine of the Emergency Nurses Association


March 2013 Volume 37, Issue 3

All Together,


Every Bit of Muscle Matters As We Take Bold New Steps Through Advocacy Pages 14-20




 ENA Co-Founder  Judith C. Kelleher,  1923-2013


No Career Wasted: A Nurse’s Path Back After Substance Abuse


Member Finds Paradise Needs Good Teachers

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Dates to Remember March 11, 2013


Deadline for proposed bylaws and resolutions for 2013 General Assembly at Annual Conference in Nashville, Tenn.

With Mentoring, We Make Magic

March 25, 2013

Deadline for faculty course proposals for Leadership Conference 2014 in Phoenix (March 5-9, 2014).

ENA Exclusive Content PAGE 5 Judith C. Kelleher, 1923-2013 PAGE 6 Board Writes: In-Flight Medical Emergencies PAGE 8 ENA’s Resource Pathway to Safe Practice, Safe Care PAGES 14 - 20 Advocacy Section 14 Ohio Efforts Pay Off With New Law Against Assaulting Health Care Workers 16 E NA Hosts Its First Emergency Nursing Advocacy Intensive 18 We’ve Come a Long Way, Baby — Or Have We? 20 New ENA Advocacy Department PAGE 22 No Career Wasted: A Member’s Path Back From Workplace Substance Abuse PAGE 30 The AEN EMINENCE Program PAGE 32 ENA Member Finds Paradise Needs Good Teachers

Monthly Features PAGE 4 Members in Motion PAGE 10 ENA Foundation PAGE 11 NEW! Ask ENA PAGE 12 Pediatric Update PAGE 21 Ready or Not? PAGE 26 CourseBytes

JoAnn Lazarus, MSN, RN, CEN

In Greek mythology, Mentor was the trusted guardian Odysseus appointed to watch over his son Telemachus when Odysseus left for the Trojan War. Mentor played a pivotal role in the development of Telemachus, providing encouragement and practical plans for Telemachus to deal with his personal dilemmas. Because of this story, the term ‘‘mentor’’ has taken on the meaning of someone who imparts wisdom to and shares knowledge with a less experienced colleague. Most of us can think of a more experienced person in our lives who has provided information, given advice, presented us with a challenge, initiated a friendship or simply expressed an interest in our personal development. Very often our first mentor was a parent or another relative who taught and demonstrated some essential knowledge or understanding. Now, a mentor is someone who can help you move to the next level in your career or view new possibilities, open doors for you by introducing you to new people, act as a sounding board and share the good and bad of their past experiences to potentially keep you from making the same mistakes.

Choose Wisely What do you look for in a mentor? A mentor is usually someone you admire and whose footsteps you might like to follow. A good mentor possesses all or most of the following qualities: willingness to share skills, knowledge and expertise; a positive

attitude and respect as a positive role model; and a personal interest in the mentoring relationship. In addition, a good mentor exhibits enthusiasm for your interests, values ongoing learning and growth; provides guidance and constructive feedback; is respected by colleagues; has ongoing personal and professional goals; values the opinions of others and motivates others by setting a good example. It is crucial that a good mentor must also have the desire and time to take on a mentee. In my own career, I can think of one person who was important in my decision to become an emergency department director. She encouraged me to return to

Continued on page 28

Official Magazine of the Emergency Nurses Association


Make time in March to slide up to your computer and take ENA’s latest free continuing education course. ‘‘GU: It’s More Than Just P,’’ by Michael D. Gooch, MSN, RN, CEN, CFRN, ACNP-BC, FNP-BC, EMT-P, is an e-learning program worth 1 contact hour. It reviews the anatomy and physiology of the genitourinary tract, the clinical manifestations associated with common GU disorders and patient management. To take this and other courses in the CE catalog: •G  o to, where you’ll log in as an ENA member (or create a new account). •A  dd desired courses to your cart and ‘‘check out’’ (courses are completely free for members only). •P  roceed to your Personal Learning Page to start or complete any course for which you have registered or to print a certificate when you’re done. •T  o return to your Personal Learning Page at a later time, go to and find ‘‘Go to Personal Learning Page’’ under the Courses & Education tab. If you have questions about any free e-learning course or the checkout process, e-mail

ENA Connection is published 11 times per year from January to December by: The Emergency Nurses Association 915 Lee Street Des Plaines, IL 60016-6569 and is distributed to members of the association as a direct benefit of membership. Copyright© 2013 by the Emergency Nurses Association. Printed in the U.S.A. Periodicals postage paid at the Des Plaines, IL, Post Office and additional mailing offices.

Fellowship Adds Fuel to Illinois Nursing Leader’s Research Steve Stapleton, PhD, RN, CEN, the immediate past president of the Illinois ENA State Council and an assistant professor at Illinois State University’s Mennonite College of Nursing, has received a Nurse Educator Fellowship from the Illinois Board of Education. The award is aimed at retaining top nursing faculty at Illinois nursing colleges and universities. It includes a $10,000 grant for continuing research. Stapleton’s research centers on managing pain for emergency department patients, particularly after discharge, with the goals of better practice, better outcomes and fewer readmissions. Self-described as a ‘‘strong proponent of lifelong learning,’’ he previously has received research grants from the ENA Foundation and the National Institutes of Health. His findings have been published in the Journal of Emergency Nursing, the Journal of Clinical Nursing and the Journal of Pain and Symptom Management. He’s been at Mennonite in a tenure track since 2010. ‘‘It is through my own academic

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

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

WHAT’S NEW WITH YOU? E-mail to tell us about your recent successes or to celebrate those of a member colleague. Include names, credentials and, if applicable, photos of the nurse(s) being recognized. achievement,” Stapleton wrote in his fellowship application, ‘‘that I will accomplish my objectives while inspiring others to seek rewarding professional and/or academic careers.’’ THREE ENA MEMBERS AT THE University of Texas Medical Branch in Galveston were among 11 co-authors of an article on UTMB’s revised annual evaluation process. Valerie Brumfield, MSN, RN, CCRN, a clinical nurse specialist in the emergency department; Leanne Ledoux, BSN, RN, CEN, SANE, the assistant nurse manager in the ED; and Ruth A. Sathre, MSN, RN, CEN, a former ED staff nurse who’s now in the Doctor of Nursing Practice program at Walden University, helped to develop ‘‘Enhancing RN Professional Engagement and Contribution: An Innovative Competency and Clinical Advancement Program,’’ which was published in June 2012 in Nurse Leader. The article describes the revision process, which involved a new system for bedside staff evaluations across diverse settings and specialties.

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

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

ENA Co-Founder

Judith C. Kelleher MSN, RN, FAEN


Her Dream Lives On Below is an excerpt of the eulogy that Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN, 2013 ENA president-elect, delivered at services for Judith C. Kelleher on Feb. 1.


ometimes, it only takes a handful of people with courage to step out on faith and create a change … those who dare to dream big for what they believe in . . . those who spark a revolution to improve the lives of others. For ENA it took two, and one of them was Judith Kelleher. Judy has touched the lives of many, and she has left an imprint on our organization and in our hearts. There are no adequate words to express how grateful we are for the contributions she has made to our profession. She joined forces with Anita Dorr, RN, FAEN, and they formed the national Emergency Department Nurses Association in December 1970. After Anita’s passing in 1972, Judy carried on their shared vision. She was undaunted by obstacles and determined that emergency nursing would be recognized as a specialty. She famously said, ‘‘I think the thing that typifies ENA in those early years is that we began to speak out and speak up for emergency nursing, for emergency nursing education, for emergency nursing recognition.’’ Judy led the organization to national prominence and recognition as the only

association dedicated to the advancement of the specialty through education and advocacy. One of her dreams was realized in 2012 when the American Nurses Association recognized emergency nursing as a specialty. More than 40 years have passed since its creation, and every single member of ENA is still impacted today by Judy’s accomplishments. As an organization, we are truly blessed to have been founded by a true leader and trendsetter whose dream raised the standards of how we practice. As individuals, we are inspired by her dream to make a difference in the lives of patients and emergency nurses everywhere. It is a blessing that Judy was able to see the difference she made in our organization … from the 40,000 emergency nurses who have united to become a voice in our profession to the thousands of patients who are receiving better treatments in emergency departments around the country because of her passion to improve emergency care for everyone. As one ENA member wrote on our Facebook page this week, ‘‘Rest in peace, Judith. Your work here may be done, but your legacy will live on for generations.’’

Look for an expanded tribute to the career and impact of Judith C. Kelleher in the May issue of ENA Connection.

Official Magazine of the Emergency Nurses Association


BOARD WRITES | Matthew F. Powers, MS, BSN, RN, MICP, CEN, ENA Secretary/Treasurer

In-Flight Medical Emergencies Ding! ‘‘If there is doctor, nurse, paramedic or anyone with medical training on board who can assist with a medical emergency, please ring your flight attendant call bell.’’ When emergency nurses hear this request, some may hope someone else will ring in; however, there is no guarantee of a physician being on board, which occurs between 40 and 90 percent of the time. Commercial aircraft emergencies occur daily in the United States, in roughly 1 in 39,600 passengers. It is difficult to clarify the actual number of medical emergencies due to a lack of mandated reporting. Emergency nurses who hear the call to assist may be the most prepared based on our knowledge and skill. In my experiences assisting patients requiring in-flight medical intervention, I have found that the term ‘‘doctor’’ can be applied to an array of positions, including emergency physician, Doctorate in Public Health Quality, podiatrist, pediatrician, dentist and chiropractor. Ascertaining a doctor’s specialty will better prepare a team to care for an in-flight patient. Incorporate the flight attendants into your care, as they have the direct link to the captain, who is the ultimate decision-maker and has contact with ground medical control. Medical emergencies that occur during flight are often related to travel or stress. Hypoxia, barometric pressure changes, temperature changes, dehydration, noise, vibration and fatigue are environmental conditions causing physiological stress. Along


with these factors come the signs and symptoms of nausea, vomiting, headache, abdominal pain, dizziness, hypotension and syncope. Although other medical conditions, such as myocardial infarction or stroke, can occur at any time, most in-flight medical emergencies are related to the environment and stress of travel. What do you do? First, make yourself known to the flight attendant. Once you have been escorted to the patient and have made your initial assessment and general impression, ask if the patient can be moved to a more quiet and confidential area, such as the bulkhead or rear of the cabin. If this is not an option, ask the flight attendant to try to reseat passengers or allow your patient to walk the aisles so you can best complete a confidential assessment. Based on the medical complaint and condition, your patient may need to lie as flat as possible across three seats. Do not be afraid to ask for comfort packages that include a pillow and blanket. Today’s airlines in the U.S. are equipped with an automatic external defibrillator and robust medical kit, thought they are kept under lock and key. Basic equipment, such as a blood pressure cuff, stethoscope and oxygen, is readily available. Additional equipment and advanced cardiac equipment, not limited to IV solutions and medications, are available for use with consultation through ground medical control. Under Federal Aviation Regulations, Appendix A to Part 121, airlines must display the required equipment. Many airlines

carry additional equipment, including obstetrical kits and anti-nausea and over-the-counter pain medications. A question of liability often arises. Congress passed the 1988 Aviation Medical Assistance Act, which allows medical professionals to operate under their scope of practice as long as the professional is practicing in good faith. According to the Act, ‘‘An individual shall not be liable for damages in any action brought in by Federal or State court arising out of acts or omissions of the individual in providing or attempting to provide assistance in the case of an in-flight medical emergency unless the individual, while rendering such assistance, is guilty of gross negligence or willful misconduct.’’ While rendering medical care, you should never feel alone. Flight attendants are trained in first aid and CPR/AED and welcome any assistance. Ground medical control is available through the captain as a joint decision is made whether to continue to the final destination or divert. Many times, with comforting medical and nursing care, patients make it to their destination to awaiting EMS personnel. Next time you answer the ding asking for assistance, your flight crew will be quite appreciative, and you may even receive a token of gratitude for your willingness to help.

March 2013

t io a c u d E

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

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

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

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

2013_ENAF_StateChallengeAd_fullpg.indd 1

ENA Foundation 2013 State Challenge


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

1/30/13 1:32 PM

ENA’s Resource Pathway to Safe Practice, Safe Care By Dale Wallerich, MBA, BSN, RN, CEN, Senior Associate, ENA Institute for Quality, Safety and Injury Prevention ENA’s Strategic Plan for 2012-2014 includes four priority areas that benefit the stretcherside nurse and contribute to providing safe practice, safe care. Those priorities are 1) advancing emergency care at home and abroad; 2) advocating for a culture of safe practice and safe care; 3) championing for a culture of inquiry, learning and collaboration within our profession; and 4) expanding and fortifying ENA’s membership. One integrating concept that encompasses these four philosophies is the sharing of pertinent information on patient care, patient and staff safety and a means to further the specialty of emergency nursing.

Access to Education To strengthen the nurse’s ability to provide safe practice, safe care, ENA provides education in both formal and informal ways, has developed a scope and standards for the emergency nurse and offers a wealth of information through products available at the ENA Marketplace ( ENA provides educational programs to support and strengthen the excellent care An attendee taps into one of the educational opportunities that have come to define ENA’s annual Leadership Conference. delivered by emergency nurses. Courses, seminars and conferences are based on knowledge from experts in the field and designed to help you achieve your Member Resources professional development goals. The Journal of Emergency Nursing, the official journal of ENA’s Center for e-Learning provides on-demand online ENA, reaches the greatest number of emergency nurses, courses through its learning management system. Each emergency/trauma departments and ED managers of any month, a new online course is launched and is free to all journal. The journal covers practice and professional issues, members as a value-added benefit and for continuing based on current evidence, that challenge emergency nurses education credits. every day and features original research and updates from ENA’s Annual Conference is the largest educational the field. ENA’s news magazine, ENA Connection, is gathering for emergency health care professionals. It is a published 11 times annually and provides current comprehensive learning experience designed to enhance the information on association activities and emergency nursing knowledge and skill level of emergency nurses, nurse issues. managers, ED directors, clinical educators and more. ENA’s Emergency Nursing Scope and Standards of Practice is a Leadership Conference is the premier educational gathering landmark publication that describes the competent level of for emergency health care leaders, which offers an behavior expected for nurses practicing in the specialty of unparalleled learning experience, networking opportunities emergency nursing. The book provides a guide for the and exposure to the most cutting-edge tools and products in practitioner to understand the knowledge, skills, attitudes and judgment that are required for practicing safely in the emergency care services.


March 2013

emergency setting. This book is available at the ENA Marketplace ( along with a full selection of resources covering a wide range of the topics in the practice of emergency nursing. ENA continues to share pertinent information through its position statements, which ENA defines as an assertion of the beliefs held, encouraged and supported by ENA. Position statements provide concise information and material for understanding and analysis of the problem. Joint and consensus position statements are an assertion of the beliefs held, encouraged and supported by ENA developed in collaboration with external professional organizations with mutual interest in providing safe practice, safe care. All position statements are written in accordance with the bylaws, strategic plan and code of ethics of the organization and are officially endorsed by ENA as authorized by the ENA Board of Directors. Emergency nursing resources are evidence-based documents that facilitate the application of current evidence into everyday emergency nursing practice. ENRs are created following a rigorous process included in ENA’s Guidelines for the Development of Evidence-Based Emergency Nursing Resources. ENA believes that ENRs have a positive impact on patient care and emergency nursing practice by bridging the gap between practice and currently available evidence.

the other on health literacy, are currently available at, along with other informational tools available for download.



OTHER USEFUL LINKS Reference Emergency Nurses Association. (2012). ENA strategic plan 2012 - 2014 and beyond. Retrieved from about/Documents/ENAStrategicPlan2012-2014.pdf Contributing: Kathy Szumanski, MSN, RN, NE-BC; Jessica Gacki-Smith, MPH; Altair Delao, MPH; Maureen Howard and Bree Sutherland.

New Tools ENA Practice References are a new resource from ENA. They are succinct practice statements that are based on current scientific evidence available at the time the documents are developed. They are related to a clearly identified circumstance and provide best practice information. They are not meant to be a substitute for a nurse’s best judgment in a given situation of care. The concept of the practice reference came out of the need to respond to member requests for a quick resource that can assist in applying appropriate or available evidence in a given clinical situation. It is anticipated that many of the practice reference topics will come from ENA listserv discussions and direct e-mail inquiries. Two of the several EPRs drafted by the ENA Clinical Practice Committee in 2012 were reviewed and approved by the ENA Board of Directors. These first two practice references focus on hemolysis and right-sided/posterior ECGs and are available at Pages. Topic Briefs are informative documents that provide detailed, accurate and current information on a given subject of importance to safe practice, safe care. The subjects selected for topic briefs come from inquiries from members or as a result of committee work on a particular subject. Two Topic Briefs, one on health information technology and



SNOWMASS, CO July 21-24, 2013

Register online at Or By Calling 800-377-7707

Official Magazine of the Emergency Nurses Association



Julie Jones, BSN, RN, CEN, 2013 ENA Foundation Chairperson

The Many Ways We Can Do More Hello, fellow ENA members. I am Julie Jones from South the hat at each state meeting. Second, they purchase jewelry Carolina, and it gives me great pleasure to introduce myself from the ENA Foundation Jewelry Auction at the Annual as your 2013 ENA Foundation chairperson. Conference. At each state meeting, members can buy tickets Many years ago, as a member of the South Carolina state for chances to win the jewelry. Most recently, Kansas council, I knew I wanted to make a difference in emergency honored one of its members, Darlene Whitlock, MSN, MA, nursing. My colleagues and I realized we had the RN, APRN, ACNP, EMT-B, CEN, CPEN, by naming a opportunity to give back and do more for others by giving scholarship after her. Members wanted to do something to the ENA Foundation through the State special to recognize her efforts in Kansas Challenge. After the loss of a colleague, regarding the trauma system, as well as Antoinette Ruff-Johnson, BSN, RN, CEN, her years of dedication and service to the we all wanted to do something in her Kansas ENA Board of Directors. State honor. Raising money to name a state Council and chapter contributions made council scholarship after her was the this possible. perfect idea. We asked how much we Seleem Choudhury, MSN, RN, CEN, needed to raise through the State the ENA Foundation chairperson-elect, Mike Hastings, MS, RN, CEN (left) and Challenge to name a scholarship, and shared how the Colorado ENA State Seleem Choudhury, MSN, RN, CEN, of the sticker shock hit when we learned the Council (membership: 860) conducted its Kansas and Colorado state councils. amount was $5,000. How was our successful fundraising effort the last few little state with 500 members going to come up with that years. In 2010, Colorado ENA began its journey to becoming much? We continued passing the hat for the State Challenge more involved in the ENA Foundation. Before then, the but knew that would not be enough. One chapter donated council had not contributed; when Choudhury became 10 percent of the proceeds from its oyster roast. We began council president, he made it a priority. e-mailing members in South Carolina, telling the story of Colorado ENA started with simply making an ENA what and why we were doing this. I expanded my e-mail Foundation donation a line item in its budget and its requests to friends and family, who gladly contributed. Our strategic plan. It noticed a corresponding increase in state council also informed Ruff-Johnson’s family of our individual donations. Colorado did some unique fundraising intentions, as well as her former emergency department, to as well. It purchased 20 CEN review manuals, sold them at a encourage donations in her honor. discounted rate and gave 100 percent of the proceeds to the We succeeded and named our first scholarship in 2011. ENA Foundation. At its state conference, it asked for ENA I am happy to say that we were able to sustain the how Foundation donations at its state booth. and why of gaining donations and named the Antoinette At the end of 2011, Choudhury went to the board with the Ruff-Johnson Memorial Scholarship in 2012. I share this story idea of increasing the donation for 2012 to $5,000 to name a to show that even a smaller state can make a great scholarship. This will be given out in 2013 in remembrance contribution and honor someone who has touched its of the victims of the Aurora movie theater shooting. members’ lives. Every state has a story. Now is the time to tell your story South Carolina is not the only small state to have made and connect it to your purpose by giving to the ENA this commitment. Mike Hastings, MS, RN, CEN, of the Kansas Foundation. Let’s support our profession and each other. ENA State Council (membership: 393) shared KENA’s story Reach out to other state chapters to brainstorm fundraising with me. ideas. I can’t wait to hear about some of your ideas as we ‘‘We join the Foundation’s focus to expand the strive to make the 2013 ENA Foundation State Challenge the knowledge of emergency nurses by offering education, most successful ever. For more information on the State scholarships and funding research opportunities,’’ he said. Challenge and how you can contribute to the ENA KENA members do this in several ways. First, they pass Foundation, please visit


March 2013

In response to member requests for more interactive opportunities, ENA Connection is proud to debut its newest feature, Ask ENA. Members are encouraged to submit questions about the organization and emergency nursing in general. Questions should be no longer than 200 words. For verification purposes, you must include your full name, address and e-mail address. (We will accommodate requests to not print full names.) Questions will be referred to the appropriate ENA staff or department. Submission of a question does not guarantee publication. Submissions may be edited for clarity or shortened for space. E-mail questions to, fax to 847-460-4005 or mail to ENA Connection, 915 Lee St., Des Plaines, IL 60016.

Q: I am an ED nurse finishing up my bachelor’s degree in nursing, and I plan on pursuing a master’s degree. I have heard about forensic nursing, and it has intrigued me. Is it a female specialty due to the high percentage of female sexual assaults? Would a male have the same opportunities afforded to him? – Jared from Boston A: Jared, thank you for reaching out to ENA. The term ‘‘forensic nurse’’ is relatively new — the field has only been around for approximately 20 years. Because forensic nursing encompasses a wide variety of issues, gender really does not matter. A forensic nurse is a nurse with specialized training in forensic evidence collection, criminal procedures, legal testimony expertise and much more as the job description continues to expand. Other career branches for this job outside of the hospital include medical

expert witness, nurse death investigator and community education. If you decide to stay within the hospital setting, you may share your expertise with your peers to help them provide not only quality care but expert documentation for the patient who has been injured, assaulted or abused. There are numerous master’s degree programs across the country, with several on the East Coast that specialize in forensic nursing. I would encourage you to contact the International Association of Forensic Nurses at iafn. org to find out more about the specialty and to seek their assistance in finding an advanced program that meets your needs. I hope I have answered your questions. Please feel free to contact me at — Dale Wallerich, MBA, BSN, RN, CEN, Senior Associate, ENA Institute for Quality, Safety and Injury Prevention

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PEDIATRIC UPDATE Fewer Tears and Fears

Reducing Needless Pain in Pediatric Minor Procedures By Denise R. Ramponi, DNP, NP-C, CEN, FAEN, Assistant Professor, Robert Morris University, and Nurse Practitioner, Heritage Valley Sewickley Emergency Department, Pittsburgh ♦ Edited by Elizabeth Stone Griffin, BS, RN, CPEN

Fact: Children get hurt and often require minor procedures performed in the emergency setting.

Fact: Simple strategies can eliminate or drastically reduce pain in pediatric minor procedures. Pediatric pain is often under-recognized and undertreated in the emergency setting. One study examining more than 1,000 pediatric patients undergoing minor procedures found that almost none of the children received any pain management strategies.1 Children can have long-lasting negative psychological effects from a painful procedure. Infant males who were circumcised shortly after birth without pain control demonstrated higher levels of pain when receiving their infant immunizations.2 Using simple strategies can reduce pain and fear while increasing child and parent satisfaction. Evidence confirms that parents should be permitted to stay with their children when undergoing minor procedures.3 Parental presence is helpful for children, yet it is not consistently implemented. Parents should be provided instructions on how to help maintain a calm and positive atmosphere along with suggestions for distraction techniques. The position of the child can make a significant difference in the child’s stress during the procedure. Comforting positions, such as the child sitting in the parent’s lap or sitting in the “chest-to-chest” position with the parent (see Figure 1), provide positive support as opposed to having the child lie supine, which often results in panic and struggling. Words can either comfort the child or invoke fear. Warning a child about anticipated pain often results in greater pain and anxiety in the child. Reassuring comments, such as ‘‘You can do this’’ or ‘‘Don’t worry’’ can increase distress in children and should be avoided. Avoid telling the child what you do not want the child to do: ‘‘Don’t move,’’ which can also evoke fear in the child. Instead, tell the child what you want him or her to do: ‘‘I want you to try to hold your arm


Figure 1: Mother holding child in the “chest-to-chest” position. very still and take some deep breaths like Mommy.’’ Distraction can direct the child’s attention away from the pain related to the procedure. Distracters such as books, toys, music, video games, singing and deep breathing should be developmentally appropriate and able to capture the child’s interest. The I-Spy book series is an excellent distracter for children. Talking and touch have been found to be the most helpful distracters. The application of pressure (rubbing near the site or vibration in close proximity to the location where the

March 2013

procedure is being painful procedures. performed) can also be The sucrose causes the an effective method to release of endogenous reduce pain. This endorphins and thus method demonstrates reduces the pain. use of the Gate Theory, Infants provided similar to the method sucrose were found to used by dentists who cry less and returned to jiggle the lip before their baseline condition giving intraoral quicker after injections. procedures. Pacifiers There are a number alone can also be of non-invasive agents effective for analgesia. that can be used to There are a number reduce pain in the of other pain-reducing emergency setting. strategies that are Some can be applied beyond the scope of immediately prior to this article. The methods procedures, and others discussed can take a must be applied 20 to minimal amount of time 30 minutes in advance and can significantly of a procedure to reduce pain effectively engage maximum in the pediatric patient. Figure 2: Skin blanched after 20 minutes of LET application. benefit. Topical vapocoolant spray is References an anesthetic skin refrigerant that instantly reduces pain for needlesticks and other skin punctures. It can be applied to 1. MacLean, S., Obispo, J., & Young, K.D. (2007.) The gap minor open wounds or intact skin (such as abscesses). It is between pediatric emergency department procedural pain sprayed for 4 to 10 seconds or until the skin is blanched, management treatments available and actual practice. with a resultant 60 seconds of transient anesthesia to Pediatric Emergency Care, 23(2): 87-93. perform the procedure. Liposomal lidocaine 2. Taddio, A., Katz, J., Ilersich, A. L., & Koren, G. (1997.) (4 percent) cream can be applied to intact skin to reduce Effect of neonatal circumcision on pain response during pain from venipunctures. It can be placed over two areas subsequent routing vaccination. The Lancet, 349(9052), where the vein is most prominent, often the antecubital area 599-603. and dorsum of the hand, for approximately 20 to 30 minutes 3.Broome, M. (2000.) Helping parents support their child in before IV starts. Two areas are typically used in case the first pain. Pediatric Nursing, 26(3), 315-317. IV attempt is unsuccessful. For open wounds, mixtures of lidocaine, epinephrine and tetracaine can be applied to lacerations in the triage area. LET is applied to a cotton ball or other nonabsorbent dressing and taped in place. As an alternative to using tape over the dressing, the parent can wear a glove and apply pressure to the dressing over the wound for approximately 20 to 30 minutes before laceration cleansing and repair. The skin will become blanched from the epinephrine in the LET (see Figure 2). Other considerations include application of viscous Head to or lidocaine jelly to the urethra for approximately 10 minutes the ENA website,, to read the before urethral catheterization attempts in infants. Infants latest posts from 2013 ENA President JoAnn Lazarus, can be provided sucrose solution by dipping a pacifier in the MSN, RN, CEN, in her new ENA President’s Blog. sucrose and giving it to the infant before, during and after


Official Magazine of the Emergency Nurses Association



Ohio Efforts Pay Off With New Law Against Assaulting Health Care Workers By Nicholas Chmielewski, MSN, RN, CEN, NE-BC, Ohio ENA State Council Government Affairs Liaison On Dec. 20, Ohio Gov. John Ohio Senate. Oelslager Kasich signed Amended recognized Ohio ENA Substitute House Bill 62 into during a Nov. 27 debate on law. Taking effect March 22, the HB62 on the Senate floor by Health Care Worker’s Protection saying, ‘‘In particular, I Act will increase the penalty for would like to thank and assault against nurses and other recognize the Ohio health care professionals. Emergency Nurses Sponsored by state Rep. Anne Association. The statistics, Gonzales (R-Westerville), HB62 research and national is a much-needed first step expertise they brought to toward reducing the incidence the table on this issue was of violence in Ohio’s hospitals. incredible.’’ Key elements of the new law In addition to strong are illustrated in the table below. Pictured at the signing of HB62 with Ohio Gov. John Kasich work by Ohio ENA, the (seated) are (from left) state Rep. Anne Gonzales; Ohio ENA ‘‘Nurses and other hospital actions of our individual State Council Immediate Past President Beverly Clensey, MS, health care workers now have members largely contributed RN, CCRN, CEN; Ohio ENA Government Affairs Liaison the opportunity and safeguard to Nicholas Chmielewski, MSN, RN, CEN, NE-BC; state Sen. Scott to HB62’s passage. The Oelslager; and ONA President Paula K. Anderson, RNC. keep the work environment a table on the next page lists safer and more secure place to the individual members support also were received from the deliver care,’’ said Beverly Clensey, MS, who provided HB62 proponent Ohio Hospital Association, American RN, CCRN, CEN, immediate past testimony. In particular, Central Ohio College of Emergency Physicians, Ohio president of the Ohio ENA State Council. emergency nurse Libby Robb, RN, State Medical Association and the Ohio The passage of HB62 is the testified before the Senate Judiciary’s chapter of the American Psychiatric culmination of several years of work by hearing on companion legislation Nurses Association. the Ohio Emergency Nurses Association (SB111) to share her tearful experience State Sen. Scott Oelslager, then-chair and the Ohio Nurses Association. Our of being assaulted by a patient. With the of the Senate Health Committee and grassroots passion for the topic and help of Ohio ENA member Gordon sponsor of companion legislation Senate expertise on the phenomena, combined Gillespie, PhD, RN, CEN, CPEN, FAEN, Bill 111, was instrumental in the bill’s with the political power of ONA, proved we brought national expert Donna successful 18-month journey through the a most successful coalition. Letters of Gates, EdD, MSPH, MSN, FAAN, to testify before the Senate Judiciary’s hearing on HB62. Also, an article by Key Elements of HB62 ENA past president Diane Gurney, MS, • Directs the Ohio Department of Health to create standardized signage in the RN, CEN, FAEN, in the April 2011 issue shape of a stop sign. The signage will state that abuse or assault of hospital of ENA Connection was a catalyst to staff will not be tolerated and could result in a felony conviction. Authorizes introduce language in the bill permitting hospitals to post the signage in public areas. standardized hospital signage on the • If the hospital offers de-escalation training to its staff, HB62: issue. ° Authorizes a $5,000 fine for assault against healthcare professionals, health ‘‘All emergency nurses are indebted care workers and security officers of a hospital for a first-time offense. to the Ohio Emergency Nurses ° Increases the penalty for assault to a fifth-degree felony when the offender Association, the Ohio Nurses has previously been convicted of an assault against a health care worker. Association, Rep. Gonzalez and Sen.


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Oelslager for all their work on Emergency Nurses Contributing at HB62 Hearings this legislation,’’ said Gail Lenehan, EdD, MSN, RN, FAEN, House Criminal Justice, April 2011 FAAN, immediate past president of ENA. ‘‘The legislation will help Dan Abbey ♦ Tammy Brassler ♦ Nancie Bechtel ♦ Nick Chmielewski ♦ to protect the nurses of Ohio, but Ivy Cook ♦ Meghan Long ♦ also provides inspiration for Nicole McGarity similar legislation in other states as well. Importantly, it sends a Senate Judiciary, November 2011 message that will hopefully be Nick Chmielewski ♦ Beverly Clensey ♦ heard beyond the boundaries of Megan Long ♦ Nicole McGarity Ohio — that violence against nurses and other health care workers will not be tolerated, during its journey to becoming law. that it is no more acceptable than Key discussions included: violence against police or firefighters.’’ • The philosophy of ‘‘protected classes.” It took the introduction of many • Explaining the need for this bills over several sessions to realize the legislation and helping legislators passage of HB62. In the 128th Ohio understand the prevalence of this General Assembly, state Rep. Denise violence. Driehaus introduced HB450 to restart • Explaining that this bill is not about the conversation. Similar legislation ‘‘locking up’’ an elderly patient with was introduced in that session by Rep. Alzheimer’s or a patient waking up Stephen Slesnick and then by from anesthesia in a combative state. Oelslaeger. In the 129th Assembly, • The scope of who should receive Slesnick and Driehaus re-introduced protection. • Individuals under the influence of legislation. There were several drugs or alcohol. discussions and changes to HB62

le b a il ok a v a ebo w No s an a

• Individuals with mental impairments. • The degree of penalty that should be applied to offenders. • Hospitals’ responsibility to provide de-escalation training. • The need for signage to promote awareness and discussion on the issue. • The cost of implementation. We were extremely grateful for the expertise, support and guidance of ENA’s national office staff during the last several years. This support was highlighted when Lenehan joined us at the Ohio State Capitol to celebrate HB62’s signing. One important lesson learned is that successful legislative policy requires collaboration and compromise. Most important, however, is persistence. It was the unrelenting persistence of our members — through letter-writing and phone calls — that resulted in HB62 receiving a crucial floor vote in the Senate. To each of our members across the state who contributed, I say thank you and congratulations!

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ENA Hosts Its First Emergency Nursing Advocacy Intensive By Kendra Y. Mims, ENA Connection More than 90 ENA state council leaders representing more than 30 states attended ENA’s first Emergency Nursing Advocacy Intensive in Chicago on Jan. 10-12. Sponsored by Vidacare, this unique event provided attendees with an exciting opportunity to learn more about advocating for the emergency nursing profession to make a difference for their patients and colleagues. The three-day event kicked off with a welcoming reception at ENA national headquarters, where attendees were able to reconnect and network with their peers. 2013 ENA President JoAnn Lazarus, MSN, RN, CEN, opened the second day with a presentation on ENA’s priorities and its 2013-2014 Public Policy. She explained that the ENA Board of Directors determined that the new ENA Public Policy would be more nurse-focused. ‘‘This is an organization about you and advocating for all of you,’’ Lazarus said. ‘‘We know that safe practice advocates for safe care. By taking care of all of you, you’ll be able to take care of your patients.’’ Lazarus discussed the meaning of her newly coined term ‘‘advocatism’’ and the importance of image, from appearance to communication. ‘‘To me, advocatism is what we do for our patients and for the profession of nursing. Advocatism is really at the heart and soul of what we do as emergency nurses,’’ she said. ‘‘As ENA, we are held in high esteem because of the image we have with the public and because of the perception of what we do for others. Advocacy is not just about influencing public policy. From a nursing image perspective, it’s our responsibility that the public sees us in the best light.’’ Attendees learned about the importance of networking from keynote speaker Laura Schwartz during her ‘‘Eat, Drink and Empower’’ presentation. As the former White House director of events for the Clinton administration, Schwartz shared effective techniques for networking, communication and mentoring. ‘‘No matter where we are . . . we have opportunity everywhere we look to be ourselves and empower others through our own background and stories, as well as to


JoAnn Lazarus, MSN, RN, CEN, the 2013 ENA president, shares her concept of ‘‘advocatism’’ during remarks on the second day of the Emergency Nursing Advocacy Intensive. advocate for ENA in all places, both on and off the clock, with those professionally in your field and those who are curious about it,’’ Schwartz said. Schwartz urged the audience members to attend conferences and networking sessions to connect with and build bridges for others. She said networking is the best way to effectively communicate the message of ENA. ‘‘ENA really provides an incredible bridge for you,’’ she said. ‘‘ENA has the tools, resources, research and incredible staff within ENA for you to go to and get that information to help build that bridge for your hospital, a colleague or in your community. They are there for you, so use that bridge when you lobby for that safer work environment. . . . You are so used to advocating for your patients all day every day, but you also have to advocate for yourselves. As you advocate for yourselves, you advocate for every one of your patients at the same time.’’ ‘‘The power of ENA and you the member is amazing,’’ Schwartz continued. ‘‘When you’ve got a critical patient that you’re administering to, when you’re in the meeting with the CFO talking about purchasing safer equipment, or when you’re out in the community to meet with legislators, you’re not in that room with the patient or on Capitol Hill alone. You are in there with the other 39,999 members of ENA.

March 2013

Top photo: Jeff Strickler, MA, RN, CEN, CFRN (foreground), and other emergency nurses from around the country take in the messages of the advocacy intensive. Below, left: Michelle Fox, BSN, RN, senior director of clinical affairs for Vidacare, shares industry perspective on the importance of advocacy. At right are Gordon Wheeler, associate executive director of public affairs for ACEP, and Adrianne Drollette, senior political action specialist for the American Nurses Association. Below: Lazarus with keynote speaker Laura Schwartz (center) and ENA Executive Director Susan Hohenhaus, LPD, RN, CEN, FAEN.

You are never alone.’’ Susan Hohenhaus, LPD, RN, CEN, FAEN, ENA’s executive director, led an informative session on public relations and media training. Attendees learned how to effectively work with the media and connect with their communities. Hohenhaus discussed two types of media relations (proactive and reactive); how to deal with print reporters and broadcast reporters based on their differences; knowing the rules of engagement when working with journalists; and how to conduct a successful interview by knowing who you are, what ENA represents and the definition of an emergency nurse. Attendees learned the advantages of using the media to advocate. ‘‘Nursing is incredibly well-positioned in today’s health care environment,’’ Hohenhaus said. ‘‘In order to take care of your patients, you have to make sure that you’re in a safe place, that your scope and practice are protected and you’re able to leverage federal and state funding to actually drive health care policy. You’re at the beginning of a revolution that I feel is exciting.’’ Richard Mereu, JD, MBA, ENA’s new chief government

relations officer, discussed the current situation in Washington, D.C., to raise awareness on becoming effective government relation advocates. (Learn more about Richard Mereu and his extensive legislative background on page 20.) Mereu’s session was followed by the expert panel on advocacy, which included the following guest speakers: ACEP Advocacy: Gordon Wheeler, ACEP associate executive director, public affairs  urses CAN 2012: Adrianne Drollette, American Nurses N Association, senior political action specialist  tate and Federal Regulatory Agencies Weighing in on S Health Care Scope of Practice: Anna Polyak, JD, RN, American Association of Nurse Anesthetists, senior director  tate Council/Chapter/State Legislative Coordinator S Structure: Amy L. Hader, JD, Association of periOperative Registered Nurses, director, legal and government affairs Vidacare Corporation — Representation of the Industry Perspective: Michelle Fox, BSN, RN,  Vidacare senior director clinical affairs

Continued on next page

Official Magazine of the Emergency Nurses Association


ADVOCACY ENA Advocacy Intensive Continued from page 17 Attendees were able to share important issues affecting their profession and emergency departments during the interactive ‘‘What’s Happening in Your State?’’ session. The event ended with informative sessions led by guest speakers Hershaw Davis, Jr., MSN, RN, the ENA Government Affairs Committee chairperson; Rita Anderson, RN, CEN, FAEN, ENA Government Affairs Committee; Lisa Wolf, PhD, RN, CEN, FAEN, ENA Institute for Emergency Nursing Research director; Elisabeth Weber, MA, RN, CEN, ENA Government Affairs Committee; Kathleen Conboy, BS, RN, CEN, ENA Government Affairs Committee; and Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN, 2013 ENA president-elect. Attendees left the intensive empowered with knowledge and strategies to advocate for their patients and themselves. ‘‘We have to help the patient’s voice be heard,’’ Lazarus said. ‘‘We need to be the voice of nursing and inform legislatures. I look to all of us to be able to change the world.’’


We’ve Come a Long Way, Baby … Or Have We? By Mary Menafra, MSN, RN, CEN I was fresh off the plane from Chicago, where I spent a spirit-lifting weekend with my ENA peers at the Advocacy Intensive. Energized and ready to get to work with my Virginia colleagues to enable us all to have safe practice and provide safe care, I was handed a copy of a 1961 newspaper article titled ‘‘Night in Emergency Rooms: Hospital Nerve Centers Stay Alert.”1 The article included photographs of patients lining the hallway head to feet while they waited for an intern to evaluate them further; police, nurses and doctors huddled around a receiving desk, sifting through patient information following an accident. Details of the latest and greatest technology, the electrocardiogram, which ‘‘produces a photographic record of the heart’s actions,’’ was highlighted for readers. My attention was drawn to a section that outlined the violence that provides the emergency room with much of our business and another section that read, ‘‘These are the emergency rooms. These are the places where lives are saved, people helped, doctors and staff abused.’’ That sentence really hit home. As a member of the Virginia ENA State Council and the Virginia Nurses Association, I testified before five committees during the 2011 Virginia General Assembly, where HB 1690, a bill that provides some guaranteed ramification to abusing or hitting any emergency department worker, was eventually passed into law. While preparing to testify on one of the later hearings, I asked Virginia emergency nurses to share their stories as to why they did not press

charges after being assaulted in the ED. One answer especially disturbed me. This particular nurse was punched in the face by a patient. She subsequently went to the magistrate to press charges and was denied her request because, she was told, ‘‘this was part of her job.’’ Reading this article and reflecting back on my own experiences and testimony, I now see why this abuse is often seen as just part of the job. Well, it’s not. Reading this piece led me to ask, ‘‘What has changed?’’ The answer is not much. In 1961, patients lay on gurneys in hallways waiting for treatment; violence was a big part of the reason for visits; and abuse of staff was a regular occurrence. The real changes are that patient volume has more than tripled, technology allows staff to treat more complex diseases and emergency nurses and physicians stand united in their pursuit of safe work environments while they lobby together, all with the thought of being able to better serve those in need. During her opening lecture at the Advocacy Intensive, 2013 ENA President JoAnn Lazarus explained advocatism as the actions around advocating for others. I submit to you that we all need to take this to heart and practice advocatism for each other every day. Don’t let another nurse in 40-plus years read an article that highlights the waiting and the violence toward ED staff. We need to change what future emergency nurses read. Let them see what you and I did to foster a safe environment for them and the patients who need our services each and every day. Reference Lindsay, G. (1961, July 23). Night in emergency rooms: Hospital nerve centers stay alert. Richmond Times Dispatch.

March 2013

Establish Yourself as a Leader Join the faculty for ENA Leadership Conference 2014, Phoenix, March 5-9 Grow your career when you become part of ENA Leadership Conference Faculty. Share your leadership knowledge, experience and skills to help grow the profession of emergency nursing. Do you have specific knowledge in a particular area of emergency nursing, management or policy?


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ENA Shaping New Advocacy Department By Kendra Y. Mims, ENA Connection ENA is shaping its new advocacy department with the hiring of its first chief government relations officer. Richard Mereu, JD, MBA, who began his new position with ENA on Dec. 24, has worked in Washington, D.C, for more than 20 years and brings an extensive legislative background and congressional experience to ENA. Susan Hohenhaus, LPD, RN, CEN, FAEN, ENA’s executive director, describes the new position as instrumental in overseeing federal and state advocacy efforts and government relations related to emergency nursing. ‘‘This is the perfect time for ENA to make advocacy for the profession of emergency nursing a priority,’’ Hohenhaus said, ‘‘and Mr. Mereu is the perfect professional to begin this journey with us.’’ Mereu has a JD from Albany Law School and an MBA from The Wharton School. He has worked on a variety of health care issues as chief of staff to Rep. Elton Gallegly (R-Calif.) and staff director for two subcommittees of the House Foreign Affairs Committee, as well as serving as a professional staff member on the House Judiciary Committee. He believes his vast background is essential to helping ENA shape the new Advocacy Department. ‘‘Throughout my career I’ve had a lot of roles and worked on many issues, everything from health care and budget issues to criminal law matters and immigration,’’ he said. ‘‘We were able to pass several bills that dealt with those issues and fund programs in those areas. ‘‘I think my background is important because the issues that ENA is facing now are so diverse. I know the legislative process very well from having worked in Congress for all of those years. That’s important in terms


Richard Mereu, JD, MBA, the new ENA chief government relations officer, uses Skype to confer with staff at ENA headquarters from his office in Washington, D.C. of trying to get the initiatives that ENA cares about passed through Congress.’’ ENA’s mission to advocate for patient safety and excellence in emergency nursing practice is one of the factors that attracted Mereu to the position. Based in ENA’s Washington, D.C. office, he looks forward to working on ENA’s top priorities, including workplace violence in the emergency care setting, which he describes as one of the most ‘‘important issues affecting the functioning of emergency departments.’’ ‘‘The primary goal is to establish a very visible presence for ENA on Capitol Hill, to advocate for our priorities in Congress and in front of the whole federal government and to move forward on legislation to the benefit of our members,’’ he said. Mereu had the opportunity to connect with members at ENA’s Emergency Nursing Advocacy Intensive in January when he presented a session on building relationships with legislators and

developing an authoritative voice on Capitol Hill to meet the needs of patients and emergency nurses. JoAnn Lazarus, MSN, RN, CEN, the 2013 ENA president, said, ‘‘I look forward to working with and learning more from Mr. Mereu about legislative and regulatory issues and expanding ENA’s influence.’’ Mereu said his position will allow him to delve much deeper into health care issues. ‘‘I’m extremely excited, especially now that health care reform is passed and it was upheld by the Supreme Court last year,’’ he said. ‘‘That will create opportunities for ENA. Also, everybody recognizes that the role of emergency nurses is so important to our overall health care system, so I’m starting at a very good time in terms of being able to get in at the ground floor as these changes are being implemented at the federal level. I can really influence some of the direction that our health care system is going to go in on behalf of ENA.’’

March 2013


Knox Andress, BA, RN, AD, FAEN

Hang Together or Separately In an act of defiance and revolution, representatives of the 13 American colonies broke from the British Empire, signing the Declaration of Independence on July 4, 1776. Benjamin Franklin’s warning to his colleagues at that signing, “We must hang together, gentlemen ... else, we shall most assuredly hang separately,” highlighted the importance of unity and coalition in the face of overwhelming odds. Coalitions were crucial for nation-building then and to health care emergency preparedness today.

Future Needs Joint Commission emergency management standards and the lessons of Hurricanes Katrina and Sandy and the Joplin, Mo. tornado remind us that hospitals and their emergency departments must ultimately plan for overwhelming threat scenarios requiring them to stand alone or evacuate. The recent threat of a highly infectious H5N1 pandemic, with its projected 50 percent mortality rate, would overwhelm most U.S. hospital intensive care units. Pandemics have occurred four times during the last 100 years. Concerns for certain and future natural, technological or terrorism catastrophes are ever present. Emergency department and hospital capacity and capability must be maximized and coordinated with community health care resources. Nationally, hospitals have been building their surge capacity and capability by organizing and reaching out to community health care response partners, forming emergency response alliances, networks and coalitions. Since 2001, emergency preparedness, surge capacity and resilience in U.S. hospitals and health care systems have been facilitated and supplemented by the mechanisms and associated funding of the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response Hospital Preparedness Program. How are health care preparedness coalitions organized, funded and sustained over time? What benefits are there to being a member of a health care preparedness coalition? What are best practice examples of existing coalitions? When have health care preparedness coalitions lessened or mitigated emergency department impacts during disasters? To answer these questions, enter the 2012 National Healthcare Preparedness Coalition conference.

conference was held Nov. 26-27, 2012, in Arlington, Va., with a mission of providing coalition-building strategies and best practices. Organized and hosted by the Northern Virginia Hospital Alliance, Seattle King County Healthcare Coalition, and MESH, Inc. of Indianapolis, the conference was an opportunity for stakeholders from around the country to share best practices and lessons learned from building and sustaining health care coalitions focused on health care preparedness. Attendees came from Guam and most U.S. states and included hospital emergency preparedness and Hospital Preparedness Program grant leadership from local, state and federal levels.

Attendees included the following ENA members: Elisabeth Weber, MA, RN, CEN, of Chicago; Doris Neumeyer, BSN, RN, of Washington, Mich.; Lori Upton, MS, BSN, RN, of Houston; and Knox Andress, BA, RN, AD, FAEN, of Shreveport, La. Upton presented “How Coalitions Can Support Recovery Operations” while Andress shared “How Coalitions Can Develop Evacuation Plans for Hospitals and Nursing Homes.” Dr. Nicole Lurie, assistant secretary for Preparedness and Response, U.S. Department of Health and Human Services, welcomed attendees to a wide range of intriguing health care preparedness coalition-building topics and panel discussions, including the following: • Building and Sustaining Coalitions • Crisis Standards of Care • How Coalitions Support Response • How Coalitions Can Develop Information Sharing Systems and Plans • How Coalitions Can Develop Evacuation Plans for Hospitals and Nursing Homes • Engaging Coalition Partners and Participants • How Coalitions Can Develop Behavioral Health Operations Plans/Triage

A Successful Conference

• How Coalitions Can Support Recovery Operations

The inaugural National Healthcare Preparedness Coalition

• ASPR Grant Metrics and Reporting Discussion

Official Magazine of the Emergency Nurses Association



other Nature’s gift to Mobile, Ala., on Christmas Day was a large EF2 tornado dropping in on the downtown. The Mobile Infirmary Medical Center took a hit: some broken windows, uprooted trees and overturned cars. Next door at the University of South Alabama Children’s and Women’s Hospital, where ENA member John Marshall, BSN, RN, is the 3-to-11 supervisor, the tornado did minimal damage as it rolled past. No serious injuries were reported in the community. ‘‘That’s the first time I ever met a tornado face-to-face,’’ Marshall says in his easy drawl. ‘‘It had my attention.’’ But as storms go for Marshall, this was nothing. The biggest and scariest he’d faced came more than a generation earlier, some 350 miles away in his hometown of Macon, Ga. In April 1985, Marshall, then 34 and married with a young son, already had been fired from three area hospitals as rampant substance abuse ripped a hole in his life and nursing career. ‘‘This was before the days of


computers,’’ he says, ‘‘so you could still go next door and get a job and they didn’t know that you were in trouble other places.’’ He’d lost a job in an emergency department the previous year and spent six weeks in rehab after introducing methamphetamines into a buffet of drugs that already included marijuana, booze and pills. Now he was working in a different hospital’s intensive care unit, training to become a supervisor, which meant he’d been given a key to the pharmacy — and its narcotics. To beat the regular drug screens, he knew the exact day each month that he needed to stop shooting dope, stop smoking pot, stop popping pills. But his fix still had to come from somewhere. So he found himself breaking into the operating room. Nitrous oxide. It wouldn’t show up on the screens. He took care to mix in enough oxygen. ‘‘Eventually,’’ he says, ‘‘they found me unconscious in the operating room and I couldn’t let go of the hose. And that’s the night I got in trouble that last time. I’d been on the nitrous about six hours.’’ Colleagues were in disbelief. John

Marshall, a guy who could walk in and right away be pegged for bigger things in nursing, had become a surprise tornado under their noses. ‘‘It was a nasty, nasty scene,’’ he says. ‘‘That’s when I hit my bottom and I realized, ‘You’re gonna die if you don’t stop.’ ” ♦ ♦ ♦ ♦ ♦ Feb. 25, 2012, New Orleans. It wasn’t the first time Marshall had heard Allison Bolin dig into this topic. Here at ENA’s Leadership Conference, he sat in again as Bolin, BSN, RN, CEN, CPEN, laid out the warning signs of employee substance abuse and drug diversion in hospitals. Emergency nurses can be particularly susceptible, Bolin cautioned, because of their special risk factors: high job stress, access to medications, a tendency to feel invulnerable. At the end of her presentation, Bolin invited questions at an open microphone. Marshall stood. He had not a question but a story — his. He’d been there. He’d been the nurse Bolin was urging others to identify, to report, to help, to save. He’d become a new breed of nurse: one who’d widened his scope

March 2013

from helping patients to also helping other health care workers escape the nightmare he’d known first-hand. The room applauded. John Marshall hasn’t had a fix in 27 years, but he’s made a life of fixing. As facilitator of the Mobile Professional Group, with which he’s been involved since 1987, he sits in every other week with anywhere from six to 26 health care professionals whose encounters with drugs and alcohol have led them into his circle. The group is run like a 12-step program, the same way Marshall got clean. Meeting topics rotate. New members are worked in as they come. It’s a casual, safe, free place where people who handle narcotics as part of their jobs can find the peer support to keep themselves straight. It’s also non-punitive — a way for nurses to manage their recoveries without being put on probation by the Alabama Board of Nursing. ‘‘Most states have some kind of nondisciplinary program now,” says Marshall, who didn’t have that option in 1985 and spent the next several years on probation in Georgia and Alabama. ‘‘Usually it’s required that the person call [the board] and report themselves: ‘I’ve got a problem, I need some help.’ If people wait until an employer calls and says, ‘We’ve got somebody with a problem,’ a lot of times they end up on probation.’’ No one wants that. Probation opens the door to legal consequences for diversion or writing self-prescriptions. It offers no anonymity. In Alabama, Marshall says, it means ‘‘their license is stamped with ‘probation.’ It goes out in the state newsletter who’s in trouble with drugs, where in the nondisciplinary program, none of that’s done.’’ Some in Marshall’s group, after reaching their crisis points, were

John Marshall in 1974 at the start of a career that fell into chaos a decade later. referred to him by the Alabama board. Others were invited by active members or pointed there by treatment centers. Most who attend are nurses; he currently has two from EDs. Doctors have their own group for recovery — the International Doctors of Alcoholics Anonymous — but two or three docs still come to Marshall’s meetings. He has nurse anesthetists, a pharmacist. He’s had surgeons, even veterinarians. Some are there to satisfy the nondisciplinary requirement after one failed drug screening. Their problem is that they used casually, not abusively, and got caught. Some, like Marshall, are there because they became true chemical addicts, no longer wanting the fix but physically needing it; they ‘‘crossed the wall,’’ as he puts it. That’s the other end of the spectrum. There’s a large middle area — nurses who aren’t chemically dependent but who face the grim risks of denial, relapse and career derailment. ‘‘We have a disease that tells us we don’t have it, that we’re OK, that we’re

“I got to a point where it didn’t work anymore. I couldn’t do enough dope to feel good. I could do enough to pass out and get sick, but I couldn’t stop.” Official Magazine of the Emergency Nurses Association

too smart, that I should be well by now,’’ Marshall says. ‘‘And that’s just the nature of the disease of addiction — it’s a liar. It’ll lie to you. So after you’re not being monitored and you don’t have to go after a while, if you happen to be one of those people that hadn’t crossed the wall, you kind of phase out.’’ His mission is to see that as many as possible don’t. He stresses a spiritual philosophy of finding a ‘‘higher power’’ — a touchstone bigger than the drugs or alcohol. For some, that’s religion. For some, it’s a symbol — a tree, for instance, or perhaps the group itself. A few in the group, long after rescuing their careers in health care, continue to attend meetings 10 or 15 years later. Some have lived out their natural lives as members. ‘‘With addiction,’’ Marshall says, ‘‘they say once a cucumber’s a pickle, it’s always a pickle — it’s never a cucumber again.’’ ♦ ♦ ♦ ♦ ♦ By early 1985, John Marshall knew he was a pickle, or what he’d later call one. More aptly, he says, he was ‘‘a nurse manager’s nightmare.’’ Three years earlier, his first shot of Demerol

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had been 50 mg. Now 50 mg wouldn’t touch him. ‘‘I got to a point where it didn’t work anymore,’’ he said. ‘‘I couldn’t do enough dope to feel good. I could do enough to pass out and get sick, but I couldn’t stop. I tried everything I could do to stop, and I couldn’t stop. ‘‘The manager that fired me in the ED [in 1984] told me, ‘You are not the same person I hired.’ And I wasn’t. You know, the meth made me crazy. So then I thought it was just the meth — ‘It’s the meth that’s doing it. As long as I just drink beer and smoke pot, I’ll be OK.’ ’’ By February, less than six months after his dismissal from that ED and his short rehab stint, he had relapsed, driven into a frightening tailspin by the access to narcotics at his new hospital, where he’d been hired as a relief supervisor. He diverted more and more, never denying patients their medications but instead measuring out more so that he could ‘‘save scraps.’’ ‘‘Eventually I knew I was gonna get caught,’’ he says. ‘‘I knew that. It wasn’t a surprise.’’ The surprise, he says, came after his final nosedive with the nitrous oxide, when he returned to the treatment center where he’d completed his first rehab. ‘‘Get out,’’ the addictionologist told him. ‘‘I can’t help you.’’ Marshall, he said, had conned his way through the program once already. It got worse. The Georgia Board of Nursing had been notified. The Drug Enforcement Administration had been notified. Marshall was looking at a possible six to 10 years in jail. ‘‘And if you’re here when I get out of group,’’ the addictionologist told him, ‘‘I’m going to have you arrested for trespassing.’’ Marshall slumped in a chair, stunned. Bottom was even lower than he thought. The only morsel he was offered was a phone number for a treatment center in Atlanta, the Ridgeview Institute, which specialized in recovery for health care professionals.


Marshall stands before the room to discuss his recovery and his work with the Mobile Professional Group after a presentation by Allison Bolin, BSN, RN, CEN, CPEN (right), during last year’s Leadership Conference in New Orleans. So that’s where his recovery began. He checked into a three-month program at Ridgeview. He stayed for six. ♦ ♦ ♦ ♦ ♦ The first year after rehab was the hardest. Probation meant hospitals in Atlanta didn’t want to talk to him. A doctor he’d worked with during his treatment offered him a job at a halfway house for head-injury patients. That gave him a foot back in the door as a nurse, though ‘‘the only nursing thing I really did was give Dilantin for the seizures,’’ he says. ‘‘The rest of it was trying to manage a community of head-injury patients, which is a different world all in itself.’’ Still, a chance was a chance. And others would follow. Another of Marshall’s former counselors needed a nurse in recovery to work in an alcohol-dependency program at a Mobile hospital. That job took him to Alabama — resetting his five-year probation — in 1986. When the hospital folded after a few months, he decided to stay near the Gulf rather than transfer north to Birmingham. But finding work at another local hospital

proved tough. ‘‘They would look at my résumé and go, ‘Oh, you were critical care — this is good. Oh, you were a paramedic — this is good. Oh, you’ve got emergency — this is good,’ ’’ he says. ‘‘But then they’d hit that last page about the drug treatment, and it was like the paper caught fire in their hands or something.’’ Committed to his recovery, Marshall fell in with the Mobile Professional Group. He remarried. One hospital, Knollwood Park in Mobile, snapped the pattern of rejection and decided to take a chance on him. He was hired to work in the head-injury unit. He was still there in 1991 when his probation was lifted and he again was licensed to handle narcotics. ♦ ♦ ♦ ♦ ♦ Marshall’s job history since the late 1980s is the sort of career climb others expected for him before his collapse. His employment at Knollwood Park evolved from a happy break to a 17-year stay until the hospital was sold. From the head-injury division, he moved to the emergency department, where he eventually rose to ED nurse manager in

March 2013

2000. He became house supervisor in 2003, then started with the Children’s and Women’s Hospital in 2007. Never far away was the group. Marshall had made contacts in his treatment that afforded him clean slates. His end of the bargain, he realized, was to advocate for others in turn. A nurse in recovery whose license has been revoked might list him as a reference on a job application. He has been to court on another nurse’s behalf in a childcustody case. ‘‘The group helps me do that,’’ he says. ‘‘We do things to help our members get back on track in several aspects of their life, not just in employment. Somebody was there for me when I was in trouble and needed help, so now my job is when somebody needs help, I’m there for them. ‘‘In my groups and meetings that I go to with 12-step, when somebody asks you to do something, you say yes. These people call me 24/7.’’ Sometimes he has dreams that he’s still using — the ol’ ‘‘drinkin’ and druggin’ dreams,’’ he calls them. Though he’s not in an emergency department officially, he sees trauma. He sees children going through chemotherapy. Sometimes elements in his life don’t feel balanced. Steps feel out of sync. That’s when he makes a few calls, too. Recovering and fixing go both ways. ‘‘I’m in recovery, but my disease is in the parking lot doing pushups,’’ Marshall says. ‘‘I still do those things because if I don’t do those things, I’m going to be acting like a pickle again, and I don’t know if I could live through that. Twenty-eight years ago, I’d have just taken something to change the way I feel and keep on going. And I don’t do that now. ‘‘And my life is so much better now, truly a miracle. Staying high all the time is a full-time job. When you wake up in the morning and say, ‘Oh, my God, what have I got? Have I got enough? Where am I getting more?’, that’s a full-time job. It’s so much easier now

Is Your Co-Worker in Trouble? ENA conference faculty presenter Allison Bolin, BSN, RN, CEN, CPEN, a rapid-response nurse at Dominican Hospital in Santa Cruz, Calif., offers these red flags for substance abuse or drug diversion in the ED: Behavioral extremes: Some with substance-abuse issues become sloppy and don’t seem to care about their work. Others, particularly those diverting drugs, become hypervigilant, paying extra attention to who is receiving medications, offering to medicate other nurses’ patients and spending more time than normal in the dispensing areas. Personality changes: Substance abusers tend to withdraw socially and show increased irritability. Absenteeism: Often seen in employees with alcohol problems. Coming in on days off or frequently volunteering for extra shifts: Often seen in drug diversion. Fishy reports: Most hospitals have anomalous usage reports that identify who’s dispensing which drugs the most. Abnormally high numbers can indicate diversion.

living life on life’s terms.’’ His grown son from his first marriage has seen his perseverance, has seen him guiding others through. He has a daughter, 23, who grew up a witness to his recovery. Life is good. His mornings are only about one vice now — coffee. He asked a counselor about that once. Was it a problem? ‘‘As long as you’re not shootin’ up freeze-dried Folgers,’’ he was told, ‘‘you’ll be fine.’’ Readers can contact John Marshall at

Official Magazine of the Emergency Nurses Association

Difficult life problems: Has your co-worker had a recent back injury? Is he or she going through a divorce? These kinds of situations, in combination with some of the signs above, can point to a larger problem. If you’re worried that a colleague is battling substance abuse, report your suspicions to your supervisor (it could save a life, Bolin stressed) and let the department proceed according to policy. If you’re a supervisor, she said, make sure you have the documentation to support a reasonable suspicion and involve the human resources department before confronting the employee. Often the most respected nurses are the ones most in trouble, Bolin said. She herself has been in recovery since 1990 and runs a support group for nurses in two counties. ‘‘So many nurses don’t even recognize it could be a problem,’’ she said. ���‘We’re not any less immune because of our education. In fact, we’re probably at greater risk, especially in the emergency department.’’ Josh Gaby

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COURSE BYTES Updated Administrative Procedures

ENPC 4th Edition Information

The Administrative Procedures have been updated with two items, effective immediately: 1. TNCC Reverification courses can continue to be held; however no contact hours can be awarded for attending the course. 2. Non-RN health care providers who work in an emergency setting can participate in the written and skill station testing of both the ENPC and TNCC Provider courses. The non-RN health care worker who attends a Provider course will receive a certificate of attendance with the appropriate number of contact hours, but will not receive a verification card or verification status. Please refer to the Administrative Procedures posted on the TNCC and ENPC pages of for further details.

ENPC course directors received an e-mail in November 2012, providing information regarding corrections being made to the ENPC 4th Edition Instructor Supplement and the course slides. Corrected copies of the instructor supplement will be provided to all instructors who had previously purchased it at no additional charge. Shipments started in January. Those instructors who had previously purchased a downloadable instructor supplement are being contacted to advise them that they can now download a corrected copy. All course directors who had previously requested and received the 4th edition CD-ROM will be automatically sent a new copy as well. The Course Directors Only section of reflects the updated, corrected information. The new CD-ROM and Course Directors Only web page will include a practice test and answer key. This will help the students prepare for the provider course. Also included in the instructor course folder are the scored teaching scenarios related to the examples played during the instructor course from the course DVD.

ENPC Provider Manual Errata All ENPC 4th Edition Provider manuals that are shipped will have an errata document included, until the next reprint is needed. This errata document can also be found at: ENPC-TNCC/enpc We anticipate reprinting the ENPC 4th Edition Provider manuals in the spring. We appreciate everyone’s assistance in identifying these changes.

ENPC 4th Edition Instructor Update The deadline for completing the ENPC 4th Edition Instructor Update is Feb. 28. The update can be found on your Personal Learning Page under the Courses and Education tab at www. It is necessary to indicate that you reviewed the video/modules before you can access the 50-question exam. This can be found under the Assessment tab within each module.


TNCC Reverification Courses TNCC course directors were notified via e-mail in November 2012 that the ENA Board of Directors met on Oct. 24, 2012, and decided that the 6th edition TNCC Reverification courses can continue to be held after Dec. 31, 2012. As of Jan. 1, however, no contact hours can be awarded for attending a TNCC Reverification course. This decision was made after receiving quite a bit of feedback from course directors indicating that the availability of the one-day reverification course option, even without the ability to award contact hours, would provide a much needed option for many institutions.

First Anniversary ECourseOps is celebrating its one-year anniversary as course directors increasingly take advantage of its capabilities. About 65 percent of the course applications submitted to ENA come through eCourseOps. We have received a lot of very positive feedback indicating that eCourseOps is easy to use for adding a course, ordering books and paying invoices. A very popular feature is the “copy” course icon that allows instructors to create a new course by copying an existing course while making necessary small changes, such as new course dates. Log in to to access eCourseOps via the Courses & Education tab’s dropdown menu. There are frequently asked questions and help documents on the landing page. Course Operations is available for assistance at 800-942-0011 or If you haven’t yet used eCourseOps, give it a try. We think you’ll like it.

Your Input is Welcome CourseBytes is the official communication to all TNCC and ENPC directors and instructors. Topic ideas for future issues and feedback are welcome at

March 2013

Letter From the President

Continued from page 3

school to obtain my master’s degree and then encouraged me to apply for her position when she left. But more important than her words were her actions. I witnessed her every day modeling the behaviors of someone I wanted to become: She was graceful under pressure, politically savvy and had the respect of the emergency department staff. I am just sorry that I never had the opportunity to thank her.

Two-Way Street What does it take to be a good mentee? The mentee should drive the relationship. As the mentee, you must be comfortable in communicating openly with your mentor. You must be clear about what you expect to accomplish by partnering with this person. Be committed to the

‘‘Mentoring is a brain to pick, an ear to listen and a push in the right direction.” John Crosby mentoring relationship and don’t forget to acknowledge your mentor. One of my goals as ENA president is to provide more opportunities for mentoring within our organization. We already have one great mentoring program in EMINENCE. The EMINENCE program is designed to pair ENA members with experienced Academy of Emergency Nursing fellows. AEN fellow mentors volunteer their time and talents to work with up-and-coming ENA members. This provides a wonderful

opportunity to share knowledge and experience with the next generation of emergency nurse leaders. The ENA Board of Directors has implemented a new program to pair an emerging leader with a board mentor. The mentors will spend the year helping their mentee develop their leadership goals and determine an action plan for national ENA contributions. I encourage all of you to acknowledge your mentors, find a mentor or become a mentor. Resources Loretto, P. (n.d.). Top 10 Qualities of a Good Mentor. Retrieved from www. Roberts, A. (1999). Homer’s mentor: Duties fulfilled or misconstrued. Retrieved from

ENA STATE CONNECTION New Jersey ENA State Council New Jersey ENA will hold the 35th Annual Emergency Care Conference, March 13 – 15. This is the third largest emergency care conference in the nation. For more information, contact Cheryl Newmark, RN, NJ ENA media relations, at Share your state council and chapter news with emergency nursing colleagues from around the world in State Connection. Highlight council and chapter activities, announcements and other initiatives by submitting a short article to ENA Connection. Suggested topics include: • Volunteer opportunities to solicit, encourage and welcome members to get involved in your state or chapter • State council or chapter successes, achievements or accomplishments • Membership drive campaigns and updates • Award announcements or call for awards


• Innovated projects, ideas or best practices Articles should be under 400 words and will be edited for length and clarity. High-resolution digital photos or images that can be scanned are welcome with your submission. State Connection also offers an opportunity to announce upcoming educational programs, state council or chapter meetings or special events in the “Meetings and Events” section. Include the following information with your submission: • State/Chapter name • Event/Conference name • Date of the event • Time • Location • Presenter(s) • Website or contact information To submit an article or event or for more information, contact us at

March 2013

New ENA monthly offering for FREE Continuing Education with contact hours for our members. • Available March 1 GU: It’s More Than Just P, 1.0 contact hour Michael D. Gooch, MSN, RN, CEN, CFRN, ACNP-BC, FNP-BC, EMT-P Don’t miss out on enhancing your education by registering and completing the offering. Go to for additional free continuing education opportunities.

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

The AEN EMINENCE Program The Academy of Emergency Nursing is proud to report its fifth group of mentors and mentees are currently working on projects for the 2012-2013 program. The EMINENCE program is designed to pair ENA members with experienced Academy fellows. AEN fellow mentors volunteer their time and talents to work with up-and-coming ENA members. This provides a wonderful opportunity to share knowledge and experience with the next generation of emergency nurse leaders. Applicants submit project descriptions and are matched with fellows who have expertise in the subject matter. Project topics include professional presentation, writing for publication, research, educational conference planning and program development. Upon acceptance into the program, mentees pay a $100 administrative fee. The following mentee/mentor pairs are participating in the 2012-2013 program:



Area of Interest

Meredith Addison, MSN, RN, CEN

Thelma Kuska, BSN, RN, CEN, FAEN

Trauma Systems

Kiefah Awadallah, MSN, BS, RN

Rebecca Steinmann, MS, RN, APN, CEN, CPEN, FAEN

Program Development

Kimberly Brandenburg, BSN, RN, CEN

Patricia Kunz Howard, PhD, RN, CEN, CPEN, NE-BC, FAEN

Injury Prevention (SBIRT)

Colleen Connors, MSN, RN, CEN

Anne Manton, PhD, APRN, FAEN, FAAN

Program Development

Hershaw Davis Jr., BSN, RN

Susan Hohenhaus, LPD, RN, CEN, FAEN

Professional Presentations

Siegfried Emme, MSN, RN, NP-C, CEN, CCRN

Jean Proehl, MN, RN, CEN, CPEN, FAEN

Program Development

Michael Franks, BSN, RN, CEN

 ordon Gillespie, PhD, RN, G PHCNS-BC, CEN, CPEN, FAEN

Writing for Publication

Marites Gonzaga-Reardon, MSN, RN, APN, CEN, CCNS

Gail Lenehan, EdD, MSN, RN, FAEN, FAAN

Writing for Publication

Jerry Jones, MBA, BSN, RN

Andrea Novak, PhD, RN-BC, FAEN

Educational Conference Planning

Jennifer Morris, RN, CPEN, CPN

Jeff Solheim, MSN, RN-BC, CEN, CFRN, FAEN

Professional Presentations

 Curtis Olson, BSN, BA, RN, EMT-P, CEN

Laura Criddle, PhD, RN, CEN, CPEN, FAEN

Writing for Publication

Charlann Staab, MSN, RN, CFRN, CHC-C

Carole Rush, MEd, BSN, RN, CEN, FAEN

Writing for Publication

Kathy Van Dusen, BSN, RN, CEN

Diana Meyer, DNP, MSN, RN, CEN, CCRN, FAEN

Advanced Practice Role Development

Belinda Watkins, BSN, RN, CPEN

Harriet Hawkins, RN, CPEN, CCRN, FAEN

Program Development

If you would like to participate in the 2014-2015 EMINENCE program, watch for application information posted at in mid-March 2013. Applications are due April 30.


March 2013

nual ion

g y Nursin e mergenc

ual er Man Provid n io it Ed Fourth

The Emergency Nurses Association is proud to present the release of the 4th edition of the Emergency Nursing Pediatric Course. It has been revised and updated, evidencebased, and continues to incorporate various teaching and learning styles. • • • •

A portion of the course will be presented in an online format through ENA’s Center for e-Learning. Pediatric Clinical Considerations is now case-based using group discussion. The adolescent patient is addressed with a separate chapter and lecture. Triage is now Prioritization with a focus on the process, rather than the place.

Upon successful completion of ENPC, RN participants are verified for four years, receive a verification card and earn up to 16 contact hours. This course brings the emergency nurse a resource for treating the pediatric patients arriving to emergency departments every day. The Emergency Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

To verify why ENPC is right for you and to view course schedules, please visit

Vocation in Her Vacation

ENA Member Finds Paradise Needs Good Teachers By Amy Carpenter Aquino, ENA Connection Lee Singer, RN, CEN, is a woman of many talents. An emergency nurse since 1987 and an EMT since 1978, she is a member of her local disaster medical assistance team, an avid surfer and a concert flutist. She is a provider for the Trauma Nursing Core Course and an instructor for the Emergency Nursing Pediatric Course and for a Rhode Island emergency medical services training program. She has saved lives on both coasts, from conducting air evacuations in California to assisting an urban search and rescue team in Rhode Island, performing assessments on people stranded in their homes after Hurricane Sandy devastated Misquamicut last October. In 2012, Singer extended her emergency care and training reach to St. John in the U.S. Virgin Islands. During a vacation, Singer and her boyfriend, who is also an EMT, were on a St.  John beach when they met a member of the local rescue squad. ‘‘I asked her what kind of training she had, and she said they were always looking for people to do training,’’ said Singer, an emergency department charge nurse at South

County Hospital in Wakefield, R.I. Six months later, Singer returned to St. John for a week to train rescue workers, including EMTs from the island and from St. Thomas, as well as members of the National Parks Department. Two-thirds of St. John is dedicated park space. The rescue workers’ usual training consisted of videos from their training officer, some outdated lectures and occasional EMT training by instructors from the U.S. Singer incorporated TNCC and ENPC information into her training lectures, as well as an extensive review of anatomy and physiology. ‘‘I’m a firm believer that if you know what you’re looking at and what parts you’re looking at, you can understand what’s going on in a trauma situation or a burn situation,’’ Singer said. ‘‘We did a lot of the basic scene material. I used the TNCC method for airway, breathing and circulation, and I taught them the CIAMPEDS mnemonic we use in ENPC for complaint, immunization and allergies, which they loved.’’ As a beach vacation destination, St. John sees its share of drunk-driving traumas, water injuries and coral cuts, while other islands also see surfing injuries. The local population

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March 2013

ENA member Lee Singer, RN, CEN, with Bob Malacarne, training officer for the St. John rescue corps, in St. John. suffers from a very high incidence of asthma, as well as some obesity and those comorbidities, such as diabetes and high blood pressure, in addition to some alcoholism, Singer said. In addition to addressing those emergencies, Singer said she incorporated training with familiar prehospital elements, such as the MIVT report (mechanism of injury, vital signs and treatment) and the PQRST (provokes, quality, radiates, severity and time) pain pathway assessment. ‘‘You need to dig below the surface,’’ she said. ‘‘This person had a broken bone, but you need to dig underneath this, so I would go into the structures and say, ‘OK, this is what happened, this person fell over the handlebars, and

you see a bruise on this side. What do you suspect? What do you think is under there?’ And they start more critical thinking, and when they really caught on it was wonderful.’’ Singer’s students benefitted so much that the training officer asked her to return this April. Singer plans to bring ‘‘tons of new information that is going to blow their minds,’’ including pediatric standards and a toxicology lecture on bath salts and some of the poisonous plants used by locals in folk medicine treatments. A ‘‘win-win’’ exchange is how Singer described her Caribbean teaching experience. While her students gained new knowledge and skills, Singer said she returned with renewed energy to pursue her own education and certifications. ‘‘I’ve gotten better in my practice as a nurse also,’’ she said, ‘‘by doing some of the research and putting it into practice. I’ve learned a lot of tricks of trade from the rescue down there. For instance, they do what they call high-angle rescues, because it’s all pretty mountainous, so I can take some of that back for our EMTs.’’ Singer encouraged other ENA members to remain open to new prospects, wherever they are. ‘‘If you have an opportunity, you’d better take that opportunity and do the best that you can with it,’’ she said. ‘‘I would offer that not just to nurses but to anybody. ‘Oh, the places you’ll go,’ as Dr. Seuss wrote.’’

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Official Magazine of the Emergency Nurses Association

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ENA Connection March 2013