Issuu on Google+

the Official Magazine of the Emergency Nurses Association


February 2013 Volume 37, Issue 2

Bloom For Us All How to Beat Burnout and Bring Your Passion Back to Full Flower CODE YOU, Pages 24-26





TNCC Taken Up a Notch in Kenya


Meet the 2012 Class of AEN Fellows

34 What Your Patients May Not Tell You

The responsive hospital delivers exceptional CPR And they choose Physio-Control to help make it happen. From guidelines compliance to efficiency, today’s responsive hospital faces a growing range of challenges. But every day, in every department, prompt, effective CPR is always in demand. Evidence-based and built on five decades of innovation, the CPR Solution from Physio-Control can help your hospital respond better to patients—and the need for constant performance improvement.

uninterrupted hands-free compressions

featuring comprehensive CPR analytics

with capnography and CPR Metronome

Get ready for a more responsive approach to CPR. ©2012 Physio-Control, Inc. Redmond, WA

Dates to Remember


JoAnn Lazarus, MSN, RN, CEN

March 11, 2013

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

March 25, 2013

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

ENA Exclusive Content PAGE 6 Board Writes: Change Is in the Air PAGE 8 Letter From the Executive Director PAGE 12 New ENA Product: The Handling Psychiatric Emergencies Course PAGE 14 TNCC Taken Up a Notch in Kenya PAGES 18-23 Taking Stock After Hurricane Sandy 18 ‘You Can Never Be Too Prepared’ 20 T hree Groups Sandy Put at Risk 22 Ready or Not:   Challenges Push Up Coast PAGE 24 Code You: Reconnecting to Your Passion and Purpose PAGE 28 The Accomplished 2012 AEN Fellows PAGE 34 What Your Patients May Not Tell You PAGE 40 Conference Faculty: A Job For ... You?

Monthly Features PAGE 4 Free CE of the Month PAGE 4 Members in Motion PAGE 10 Pediatric Update PAGE 27 ENA Connected PAGE 32 ENA Foundation PAGE 38 State Connection

Profession vs. Professionalism Recently, I had the opportunity to attend the Royal College of Nursing Emergency Care Association’s ‘‘Traumatic Times’’ conference in Manchester, England. As I listened to the presentations and observed the participants interacting, something struck me: the atmosphere of professionalism. The speakers presented on such topics as nursing quality indicators in emergency care, the role of the major trauma nurse practitioner, innovation in trauma and improving the patient experience. I also was able to attend their version of a town hall meeting, where the focus of discussion was on the role of the nurse in the ED and succession planning for leaders of the future. Even though there were only about 125 participants, I was impressed by the interactions I witnessed and how polite everyone was to each other and to me as a visitor, and how most were professionally dressed for the conference. This trip got me thinking about ENA, our profession and professionalism. Webster describes a profession as a ‘‘chosen, paid occupation requiring prolonged training and formal qualification.’’ Professionalism is defined as ‘‘the conduct, aims or qualities that characterize or mark a profession.’’ Being professional, then, is the act of behaving in a manner defined and expected by the chosen profession. What are our expectations of our profession and what does professionalism in emergency nursing look like in the United States? Here is what I expect of a professional nurse: I expect that we treat everyone with respect and dignity. This includes our patients and families but also our peers and colleagues, even when we do not agree with their philosophies or opinions. If we are concerned about someone’s behavior or care of a patient, we should confidentially

approach and speak to the individual as we would want to be addressed. We should not tolerate bullying behavior. We should project a professional image at all times. In my day job as a consultant, I travel all across the country. I am disappointed at times by what I see in the work attire of some of my colleagues. What we wear in our professional setting sends a message to our colleagues and patients. If we do not pay attention to our appearance; it may portray a lack of respect for our profession and ourselves as professionals. We should never stop wanting to learn and to better ourselves. This means establishing and maintaining our competencies, reading our journals, attending in-services and conferences and setting goals on how we can improve ourselves both personally and professionally, which may include returning to school to advance our degree. Finally, we should do the very best at whatever we do. No task or assignment is ever too menial. We should be committed to excellence in ourselves and in others. For us to be recognized as a profession by others, we have to first recognize it in ourselves. Just saying we are a profession does not make us professionals. It comes from behavior, attitude, appearance and education. As emergency nurses, we must earn the respect of others; however, we have to first respect each other. That comes first by doing the right thing, speaking to each other as professionals, honoring promises and having integrity in everything we do. Once we earn the respect of our fellow nurses, then we can say we are professionals. At this point, we will be ready to tackle the question of, ‘‘How do we get others to recognize us as the profession of emergency nursing?’’

Official Magazine of the Emergency Nurses Association


Make sure you’re keeping up on the latest free continuing education offerings from ENA in the new year: • “Blue Babies Gone Bad: A Review of Congenital Heart Defects in the ED,’’ presented by Lisa L. Gilmore, MSN/Ed, RN, CEN, CPEN, launched Jan. 1 and is worth 1.25 contact hours. It focuses on blood flow pathways in fetal circulation, cyanotic and acyanotic heart lesions and the care of infants with congenital heart lesions. • “Strokes in Little Folks,” presented by Rhonda M. Morgan, DNP, MSN, RN, CEN, CNRN, CCNS, APN, is offered beginning Feb. 1. It outlines evidence-based guidelines for managing pediatric stroke and examines the incidence and demographics, presentation diagnostics and interventions for early management, plus pre-existing conditions and other risks. To take these and other free CE courses: • Go to, where you’ll log in as an ENA member (or create a new  account). • Add desired courses to your cart and “check  out” (no charge for members). • Proceed 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. • To return to your Personal Learning Page at a later time, go to and find ‘‘Go to Personal Learning Page’’ under the Courses & Education tab. ENA’s catalog of free CE covers a variety of topics, including emergency department flow, cardiocerebral resuscitation, team-building, infection prevention and more. Complete the same checkout process for any course in the catalog. You get 100 percent free, new education at your fingertips, simply for being an ENA member. Questions? 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.

‘Honor Flights’ Have Seats for Us ENA members Terry Foster, MSN, RN, CEN, CCRN, FAEN, and Paula Cubbage, RN, CEN, both of the Greater Cincinnati ENA chapter, participated recently as Honor Flight nurse ‘‘guardians’’ and wrote to spread the word about the Honor Flight program, which transports World War II and Korean War veterans to the memorials in Washington, D.C. at no cost. ‘‘Since many of these vets are advanced in age (80s and 90s), they also have significant health problems — many in wheelchairs, on oxygen, etc.,’’ wrote Foster, a critical care clinical specialist at the St. Elizabeth Edgewood emergency department in Edgewood, Ky. ‘‘They like having RNs on the flights, and each vet is assigned to one of us as a guardian/caregiver. It’s their last (only) chance to see these sites and be with other vets. It is an incredibly well-organized as well as emotional — but fun — trip!’’ Guardians are charged $400 to be on the flights, but GCENA covered

WHAT’S NEW WITH YOU? E-mail with your recent professional or educational achievements or any nursing-related activities you want other ENA members to know about. Tell us about your own successes or celebrate those of an ED colleague. Include names, credentials and, if applicable, a high-resolution photo of the nurse(s) being recognized. Foster’s and Cubbage’s fares. For Cubbage, the lead charge nurse at the Bethesda Arrow Springs Medical Center emergency department in Lebanon, Ohio, the experience was deeply meaningful. Her late father was disabled after serving in the medical corps in World War II, and her mother cared for veterans in VA hospitals for three decades. ‘‘You could see the pride and memories in the faces of the veterans

Continued on page 13

Did Somebody Shrink My Magazine? You asked for it, readers, and ENA heard you. Going forward, ENA Connection will be published at the conventional magazine size you see here, making it more manageable and conducive to reading on the go. Watch for other exciting changes to the look, feel and formats of ENA Connection throughout 2013.

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).

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


access WITHOUT LIMITS. Toshiba’s Infinix™-i puts the tools for successful transradial intervention at your fingertips. Combining unsurpassed C-arm positioning with high-quality imaging, Infinix-i enables left and right side access without compromise. At Toshiba, we’re making radial access intervention more efficient than ever – for your patients, your clinical team and your practice.


BOARD WRITES | Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN, 2013 President-Elect

Change Is in the Air As emergency nurses, we thrive on what is ‘‘different.’’ We enjoy the fact that every day in the ED brings new patients, challenges and opportunities. We chose emergency nursing because we enjoy the sudden adrenaline rush we get when a critical patient challenges us. We secretly wonder what the full moon will bring us, we anticipate the maladies of St. Patrick’s Day, and we know that in some ED somewhere, a family will suffer a loss Christmas morning. Every day is different, and we make a difference, every day. Although we are all virtual Gumbies, bending and flexing to whatever the shift yields, unfortunately that does not always translate when we are asked to change how we practice as emergency nurses. When asked to include families at the bedside during resuscitation, some of us stand at the door with our arms crossed and refuse to change. When asked to ‘‘pull to full,’’ some of us have a hard time bringing a patient from the front door directly to a room and bypassing the mythical place known as triage. Medication bar-coding, risk assessments, weights in kilograms, intraosseous access, door-to-cardiac catheterization time, antibiotics for pneumonia — these are just some of the practice changes we have been asked to make as emergency nurses over the last few years. And while some of us leapt at the opportunity, some of our colleagues came kicking and screaming all the way. Why is change so hard? Why is it even harder in an environment where flexibility, resourcefulness and the


ability to adapt and overcome are critical to excellent patient care? Lewin says in order to change we need to ‘‘unfreeze.’’ We need to create an impetus to change — a moral imperative that whatever new process, skill or technique that we are asked to embark upon is absolutely the right thing for our patients and families. That creates discomfort, anxiety, stress and doubt. Since many of us ask ourselves why we have to change, I offer this question: Are we really — 100 percent of the time — providing the safest, most effective and highest-quality care? Is that where we want to be? Health care is broken. We spend more money per patient on health care than any other developed country, and our outcomes are worse than those who spend far less. We do not have enough primary care providers to manage adult patients, not enough pediatric specialty care providers to care for the growing number of children with special health care needs, and we are the only place in the health care system where we care for anyone, anytime, for any reason. That is our reality. It is also where our opportunity lies, both at the bedside

and as a professional association. Emergency nurses are a creative, innovative bunch who are not content until we leave work satisfied we have done all we can. There is no better group to figure out how to provide the safest, most effective and highest quality care all the time, no matter what obstacles get thrown our way. To achieve this, we have to change, period. We need to change how we practice at the bedside. We need to change as a professional association in order to better support you and your practice. But you have a choice to make. You can walk into work with your head high and ask, ‘‘I wonder what is different today and how I can help make a difference.’’ Or you can walk in with your head down, roll your eyes and say, ‘‘Ugh, I wonder what is different today.’’ You set the tone of your department. You set the tone of the association. You make or break the team. It’s your attitude that helps set the direction of where we are going as a profession. It’s your choice. Choose wisely.

February 2013

We’ve questioned the ordinary and redefined extraordinary ®

Stryker has been your partner in patient transport for over 70 years. We changed the way patients are transported by introducing Zoom, ®

the industry’s first Motorized Drive System, and our exclusive Big Wheel Advanced Mobility. Now, with the latest innovation from Stryker designed in partnership with the Michael Graves Design Group, we are changing the way patients are transported... again. For more information, stop by Stryker Booth 114 at the ENA Leadership Conference or contact

Stryker is proud to be an ENA Strategic Sponsor and support nursing excellence through important initiatives such as the ENA Workplace Injury Prevention Toolkit and the ENA Lantern Award. Program Criteria for the ENA Lantern Award funded, in part, by Stryker.


Transitioning From Investment to Implementation, 2012-13 It is always a pleasure to bring you greetings from the 80-plus staff members who support the work of ENA and you. In 2012, ENA headquarters focused on organizational assessment, diagnosis and planning. Just as you perform an assessment of a patient, we did an assessment of our association. What we discovered was concerning. The organization’s health was a little like an ED patient who presents with an ESI of 3. Our ‘‘patient’’ was not critically ill or in need of resuscitation but needed a fair amount of resources to make a diagnosis and treat some chronic illnesses in order to more fully optimize its health. As we performed this in-depth assessment, running critical


diagnostics, we discovered some potentially serious problems. Two areas specifically needed to be addressed, and we began redesigning and realigning our human capital and our information technology infrastructure. These are the two most important methods of communication we have with our members and other stakeholders. In March, ENA hired a new Chief Nursing Officer, Betty Mortensen, MS, BSN, RN, FACHE (see the June/July issue of ENA Connection for an interview with Betty). We also added two highly educated and respected members to our nursing team: Dr. Lisa Wolf, PhD, RN, CEN, FAEN, as the director of the Institute for Emergency Nursing Research, and Dr. Paula Karnick, PhD, ANP-BC, CPNP, director

of Education. Betty, Lisa and Paula joined Kathy Szumanski, MSN, RN, NE-BC, director of the Institute for Quality Safety and Injury Prevention, creating a very talented and passionate group of emergency nurse leaders. We established new positions to support the development of innovative and relevant products and resources. (Have you accessed your free CE lately? These new members of the education team are responsible for that project.) Realignment of staff departments and roles was conducted to better support, develop and innovate to further the mission of the association. For example, ENA launched the Career Wellness Initiative, focused on developing resources for members to assist in career and professional development.

February 2013

New staff teams, such as the Emerging Professionals Team, were created to focus on the needs of nurses who have been in the emergency care setting for fewer than five years. We continue to grow and develop our ENA staff to help us support our members, the profession and the patients for whom you care. We also added new members to the ENA technology team, including a very experienced IT manager and a new data management professional. These skilled professionals performed a technology assessment, what I call the ENA ‘‘Big Dig,’’ and found several serious issues: ENA did not have ownership of; our website had been moved from a dedicated server to a virtual server with no implementation guidelines; the server was not housed in a proper data center; there was no backup of the website; there was a lack of integration with key social media tools and an underutilization of IT features for which we were paying full price. Our networking devices, system storage and phone systems were all at the end of their life/support. We addressed the most critical issues simultaneously with their discovery, and we continue to work to repair and enhance others. ENA’s technology team uses these guiding principles: (a) speed and flexibility are

essential, (b) need to adopt leadingedge technology and (c) ensure all elements are part of a total solution that is simple and capable of constant communication. The team has been busy. New, upgraded and secure integrated technologies have been implemented. Video conferencing and team sites have begun to be used for committees, increasing opportunities for collaboration, reducing travel requirements and lowering costs. A new phone system was installed. Our website was migrated to a new host provider and ENA ownership obtained. We in-sourced our web redesign and implementation, reducing our reliance on expensive consultants. We are already realizing direct and indirect budget savings as a result of the work. For example, ENA board members and key staff have been provided iPads. We estimate that this saves the association between 168 and 324 hours of staff time, translating to a savings of $5,000 to $10,000. The purchase of these devices was offset in the first year. 2013 is year two of the ENA Strategic Plan, our implementation year. Because of the sound investment of resources in 2012, a keen assessment of priority areas of human capital and technology, we are exactly where we intended to be: ready to implement new and improved

Essential ENA Now on iTunes ENA’s Emergency Nursing Scope and Standards of Practice is available at the iTunes Bookstore. Purchase a digital copy of this must-have publication, written by ENA members and staff, to read directly on your iPad.

Official Magazine of the Emergency Nurses Association

programs and processes. We will continue to enhance the use of technology to improve member communication and participation. Along with continued improvement of our key educational programs, we will also focus on leadership development and new opportunities for involvement in advocacy for the profession and the special challenges involved in the delivery of emergency nursing care. It is an exciting and incredibly fast-paced environment at ENA headquarters. We have an unbelievably talented, skilled and dedicated staff managing operations of the organization. We turn our time, talent and treasure toward a productive implementation year with an eye toward sustainability and growth. A special thanks to the 2012 ENA Board of Directors, led by Dr. Gail Lenehan, EdD, MSN, RN, FAEN, FAAN, for its excellent forecasting skills and for its unfailing trust and support of the ENA staff team. We look forward to our continued partnership that serves as the foundation for the work that we do together on behalf of the profession of emergency nursing. Be safe,

BLOG ON Head to or the ENA website,, to read the latest posts from 2013 ENA President JoAnn Lazarus, MSN, RN, CEN, in her new ENA President’s Blog.


PEDIATRIC UPDATE | Elizabeth Stone Griffin, BS, RN, CPEN

When Children Suffer Respiratory Distress Respiratory failure is the most common cause of pediatric cardiopulmonary arrest.1 Recognizing the subtle signs of respiratory distress early in infants and children and intervening appropriately can prevent deterioration to respiratory failure or arrest. When a child presents with signs of respiratory distress, vital signs aren’t always necessary to determine patient acuity. Simultaneous assessments and interventions can be key to preventing deterioration.1

The Pediatric Assessment Triangle The PAT is a valuable assessment tool taught in several pediatric emergency courses, including the Emergency Nursing Pediatric Course and Pediatric Advanced Life Support.2,3 It considers the patient’s general appearance, work of breathing and circulation to allow nurses and other health care providers to make a quick assessment of a pediatric patient’s status from ‘‘across the room’’ before touching the patient or obtaining vital signs. As a triage nurse, I find the PAT to be particularly useful in the winter months when several children with respiratory complaints are often awaiting triage; a quick glimpse of their appearance and behavior in the waiting room can give


valuable information to help me decide whom to triage first.

Real Scenario I think that acutely ill, special-needs children can be some of the most challenging patients to assess. Knowing their baseline neurologic status, behaviors and verbal and physical abilities is essential for an accurate assessment and acuity decision when they are ill. The key principles of the PAT are even more important for the child with special health care needs to differentiate

baseline from distress. For example, a 13-year-old child, whom I’ll call ‘‘Anna,’’ recently was brought into my triage room via wheelchair by her parents. They explained that she had been to an urgent care center the previous day and had been diagnosed with pneumonia but that her breathing had worsened overnight. I observed that Anna was pale, leaning back in the wheelchair with her neck hyperextended and not making eye contact with anyone. I wondered if this positioning and affect were her

February 2013

baseline. Her breathing seemed rapid but she was wearing several layers of clothing and seemed weak, so her work of breathing wasn’t readily apparent. According to the PAT, I knew Anna’s status was either ‘‘sicker’’ or ‘‘sickest’’ because at least one PAT component (appearance, work of breathing and circulation) was abnormal. The first question I asked her parents was whether Anna was at her baseline neurologic status. ‘‘No,’’ they calmly replied, ‘‘she is usually alert and talking, running around, and she’s not usually pale like this.’’ Based on this information, Anna’s status suddenly became ‘‘sickest’’ because now I realized that she had abnormal results for all three components of the PAT. I immediately wheeled Anna out of the triage room straight to a treatment room. Vital signs weren’t necessary to determine Anna’s acuity; she was emergent (ESI-1 using the five-level ESI).4 The vital signs and assessment were obtained during her treatment: temperature was 99.3 degrees F rectally, pulse 154, RR 48, BP 80/43, and pulse ox was 75 percent on room air. She was bagged with 100 percent oxygen via bag-mask immediately, intubated within 10 minutes and eventually treated for consolidated LLL pneumonia and taken to PICU, where she recovered. Even without knowledge of her baseline neurologic status or her increased respiratory effort (which was not easily seen due to heavy clothing), this patient’s across-the-room assessment yielded at least one abnormal component (her pale color). Abnormal color is rarely a ‘‘normal baseline’’ for anyone, even children with special needs. Generally, children who have lower baseline oxygen saturation due to congenital or other issues typically compensate well and may maintain normal color in some

assessment of respiratory distress. Nurses can help educate caregivers in how to assess for signs of respiratory distress in their child by talking through the respiratory assessment as it is performed. Nasal suctioning for infants (especially before feeding and sleeping), head of bed elevation (for any infant or child with a respiratory illness, especially when sleeping) and the importance of follow-up care with the PCP are just a few of the simple but important things we can teach these parents to help improve home care and future outcomes for their children, our patients.

conditions. Once Anna’s baseline neurologic status was known, her abnormal neurologic status combined with her pale color made it evident that she was hypoxic. Any alteration in level of consciousness (decreased interaction, restlessness, confusion, inability to be consoled) should be considered a result of hypoxia until proven otherwise.1 Anna’s ‘‘position of comfort’’ (sitting upright with an extended neck) was an additional sign of her respiratory distress; it was a conscious effort to help herself breathe.

Assessments and Teaching According to a study by Blacklock et al.,5 parent-reported symptoms (when a child suffers from a respiratory illness) correlate poorly with nurse assessment (parents often underestimate the degree of respiratory distress in their child). Little is known about which symptoms and clinical features are most useful in identifying children with serious respiratory infections, but this study found that nurses are pretty accurate in their

Official Magazine of the Emergency Nurses Association

References 1. Emergency Nurses Association. (2012). Respiratory emergencies. In Emergency nursing pediatric course provider manual (4th ed., pp. 131–146). Des Plaines, IL: Author. 2. American Academy of Pediatrics. (2006). Pediatric education for prehospital professionals (2nd ed.). Sudbury, MA: Jones & Bartlett Learning. 3. Dieckmann, R. A., Brownstein, D., & Gausche-Hill, M. (2010). The pediatric assessment triangle: A novel approach for the rapid evaluation of children. Pediatric Emergency Care, 26(4), 312–315. doi: 10.1097/PEC.0b013e3181d6db37 4. Gilboy, N., Tanabe, T., Travers, D., Rosenau, A. M., & Eitel, D. R. (2011). Emergency severity index, version 4: Implementation handbook [AHRQ publication no. 12-0014]. Rockville, MD: Agency for Healthcare Research and Quality. 5. Blacklock, C., Mayon-White, R., Coad, N., & Thompson, M. (2011). Which symptoms and clinical features correctly identify serious respiratory infection in children attending a paediatric assessment unit? Archives of Disease in Childhood, 96(8), 708–714. doi: 10.1136/adc.2010.206243



‘Handling Psychiatric Emergencies’ Course By Kendra Y. Mims, ENA Connection To equip emergency nurses with the nursing education and skills to provide safe effective care to psychiatric patients and to alleviate the challenges emergency departments face when treating this population, ENA will introduce its first online psychiatric course. The development of the ENA Handling Psychiatric Emergencies interactive online course is a collaborative effort between ENA and Elsevier/MCStrategies and has been endorsed by the American Psychiatric Nurses Association. The comprehensive evidence-based course material includes live-action videos, features with useful tips and important information and 16 modules in which the learner has the ability to earn 10.58 continuing education credits. The modules include lessons on triage; development of a therapeutic relationship; suicide assessment; specific diagnosis; substance abuse and much more. Alyssa M. Kelly, MSN, RN, CNS, CEN, one of ENA’s nursing education editors, believes the new course will be popular among emergency nurses because of the valuable information it offers in an interactive, stimulating format. ‘‘The course will detail specific diagnoses to educate the staff nurse on how to assess these patients and how to care for them,’’ Kelly said. ‘‘We are providing care to an increasing number of patients with psychiatric conditions, and it’s a challenge in the ED. Every single module can help to improve patient care for these patients, from how to triage a patient with a psychiatric condition to how to develop a therapeutic relationship. It also shows de-escalation techniques.’’ One of the course’s features includes links to drug monographs from the most


Taking the Course For more on accessing the Handling Psychiatric Emergencies course, call Elsevier at 866-416-6697. current edition of the Saunders Nursing Drug Handbook, Kelly said. ‘‘Throughout the course, there are links to the most updated drug reference

book, so the nurse can just click on the words in the text and it will provide a detailed description of each drug,’’ Kelly said. ‘‘It also provides resources for psychiatric patients, which are helpful because not all nurses know this information. For innovative practices, it highlights different practices around the country that might be useful in your own ED.’’

February 2013

Members in Motion

Continued from page 4

on our trip,’’ Cubbage wrote. ‘‘The love and caring and respect of the honor guards at the airports and the crowds welcoming these brave men and women was something I will never forget.’’ Foster’s father, a Medal of Courage recipient, saw combat in World War II and Korea. Foster wore his dad’s medal with an emphatic blessing from his assigned veteran. At the Washington airport before the flight home were a small band arranged by Honor Flight and two dancing girls who were dressed 1940s-style. ‘‘They jitterbug-danced with these old vets, and these men still knew all the moves,’’ Foster

wrote. ‘‘Paula and I both said that was one time we thought we might have to do CPR, but we didn’t!’’ Joining the cheering crowd when they returned to Cincinnati around midnight were two of Cubbage’s ED co-workers, one of them a Vietnam veteran. ‘‘This is one of the most special things I have ever been privileged to be involved in, and as soon as I am able, I hope to be going again,’’ Cubbage wrote. Visit www.honorflight. org/apply/guardian.cfm for state-specific information on becoming an Honor Flight nurse guardian. Josh Gaby

See Candidates Election Forum in Person or Via Live Streaming Don’t miss out! Learn about the candidates running for the ENA Board of Directors during the Candidates Election Forum held during the Leadership Conference 2013 in Fort Lauderdale, Fla. The forum will be held Saturday, March 2, 2013, from 11:30 a.m. to 1 p.m. Eastern time. Beginning in May 2013, ENA members will have the opportunity to vote in the ENA national election and decide who will serve their organization. Before voting begins, learn who the candidates are for the ENA Board of Directors, their qualifications for holding ENA office and their vision for the future of emergency nursing and for ENA. To learn more about the candidates and to obtain information on how to view the Candidates Election Forum via live streaming, go to www.ena. org. Additional details also will be forwarded to all members.

:00 seconds Patient enters emergency department :10 seconds Morgan Lens inserted :20 seconds Solution flows to eyes


| 800U423U8659 Š2013 MorTan, Inc., PO Box 8719, Missoula, MT 59807 USA

‘Always an Adventure’ for International Instructor

TNCC Taken Up a Notch in Kenya By Amy Carpenter Aquino, ENA Connection Four years after introducing Trauma Nursing Core Course to Kenya, ENA member Norma Heuer, BA, RN, CEN, returned to Nairobi to get its emergency nursing organization closer to its dream of putting every nurse in the country through TNCC. “This trip was to train instructors so they can continue on their own,” said Heuer, who made the October 2012 trip with fellow ENA instructors Helen Keating, RN, CEN, CPEN, Terri Repasky, MSN, RN, CNS, CEN, and Rene Grobler, RN. Maureen Howard, ENA’s director of Member and Course Services, provided administrative support. Heuer, of Hugo, Minn., was an original TNCC course instructor from the first class in 1987 and has directed several courses through the years. Her international teaching career began by chance when she filled in for someone who had to cancel a trip to Sweden. She has since taught TNCC in Hong Kong and the United Arab Emirates. ‘‘The Hong Kong TNCC trip was just a fluke,’’ Heuer said. ‘‘I was eavesdropping on a conversation with a Hong Kong emergency medicine physician who was visiting our ER. He said they were going to start doing [Advanced Trauma Life Support], but he said, ‘I just don’t know what to do about the nurses.’ And I said, ‘Do I have a course for you!’ ’’ The physician began sending eight nurses from Hong Kong to the United States twice a year to learn TNCC. Heuer suggested a more efficient plan when she met one of the nurses at a convention in Hawaii: If she brought a team of instructors to Hong Kong, they could teach 100 nurses in two weeks instead of 16 in a year. ‘‘They really liked that and did so for


John Mwikaria, new TNCC faculty from Nairobi, Kenya, teaches students the helmet removal, spinal stabilization and splinting station.

ENA faculty who instructed Kenyan nurses in becoming TNCC instructors and faculty (from left): Helen Keating, RN, CEN, CPEN, of New York; Terri Repasky, MSN, RN, CNS, CEN, of Florida; Norma Heuer, BA, RN, CEN, of Minnesota; and Rene Grobler, RN, of South Africa. 10 years,’’ Heuer said. ‘‘Now they have their own instructors and continue offering TNCC to nurses from all over Southeast Asia.’’ Heuer was equally instrumental in introducing TNCC to Kenya. In 2007, she was providing education for the state department in Minnesota and met a physician who worked for the U.S. embassy in Nairobi. After Heuer worked with the physician’s wife to bring ACLS to Kenya, the nurses there wanted to know what else she could teach them.

She explained the benefits of TNCC and how they needed a governing body to oversee the course. “I went home, and they established the Emergency Nurses Association of Kenya,” she said. Heuer returned to Kenya on a medical mission with ENA member Jeff Solheim’s group, Project Helping Hands, in September 2008, along with another TNCC instructor. The ENA of Kenya had 11 nurses who wanted to take TNCC, so Heuer and ENA member

February 2013

Geneva Sides, BSN, RN, CEN, donated their instruction time. The TNCC committees of the Maine and Minnesota ENA state councils paid the indirect fees and bought the manuals, eliminating the cost to the Kenyan students. Ten of the 11 students passed the course and several are now instructors, Heuer said. This time, the ENA Foundation provided a $10,000 scholarship to support a larger TNCC dissemination in Nairobi and focus on training instructors. ‘‘It just blows your mind away to see how dedicated these nurses are,’’ Heuer said, noting that some of the students traveled great distances to attend the course. Dorcas Maina left the night before and slept during her six-hour bus ride to arrive in time for the 8 a.m. class. Another student took a 16-hour bus ride from Uganda; he is now an instructor and will be verified by Grobler, who lives in South Africa. ‘‘We have all these connections and

people working together to make this happen,’’ Heuer said. The Kenyan students also had to deal with a physicians’ strike, which canceled leaves for some nurses during the first week of the TNCC trip. Altogether, ENA held four TNCC provider courses and three instructor courses for 59 TNCC providers. Eighteen providers became instructors, nine were verified and three — Maina, John Mwikaria and Loyce Kihungi — became TNCC faculty. Guiding Kenyan nurses on their journey to TNCC knowledge ‘‘is going to impact the practice forever,’’ Heuer said. She noted that the biggest advantage of TNCC is assessment skills — critical in a country that’s seeing an increase in blast injuries. While motor vehicle collisions are the main source of multiple traumas, as in most countries, Kenyans also have situations such as a bus falling off the side of the mountain, Heuer said. ‘‘We were there one year and they

had 55 critical multiple-trauma patients brought to one ED,’’ she recalled. The next international stop for Heuer was Bolivia, where this “retired” emergency nurse planned to present to the Bolivian government and military, nursing educators and others what’s involved with teaching TNCC. ‘‘It’s always exciting. It’s always an adventure,’’ Heuer said of teaching TNCC internationally. ‘‘Everyone on the team has to think on their feet, because problems come up that you can’t even imagine, and they need to be solved in a timely fashion. I always look at it as you’re representing the organization and you’re representing the United States, so you’d better be good.’’ Heuer praised the Kenyan students’ dedication to improving their practice. ‘‘I feel like a seed has been planted, but it’s theirs and they own it,’’ she said. ‘‘Now it’s time to step back and watch it grow.’’

Lead the Way

Board of Certification for Emergency Nursing (BCEN®) certifications demonstrate your commitment to advanced knowledge, professional patient care and personal excellence. Join the best of the best — earn your mark of distinction! Learn more…


Grab Some Sun While You Learn Grab your sunglasses and thinking cap on your way to sunny Fort Lauderdale, FL for ENA Leadership Conference 2013, February 27-March 3. This conference is for new or existing emergency nursing leaders who want to grow their knowledge, enhance their leadership skills and elevate their careers. You can grow your leadership skills and knowledge through our seven education focus areas and earn up to 20 contact hours: Education, Flow, Health, Management, Professional Development, Quality or Safety.

ENA IS PROUD TO OFFER NEW AND EXCITING EVENTS AT CONFERENCE • Jam Sessions Instructor-led, open forum sessions and discussions that will provide a base presentation of ideas, experience and stories from you the attendee. • Hand-Off Sessions Two related sessions condensed into one unique presentation.

• Deep Dive Sessions Experience in-depth exploration of topics that can’t be covered in a traditional course length. • Ignite Sessions Watch your colleagues present their take on “What Makes Emergency Nursing Unique?” in fast paced 5-minute sessions. ®


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

Register now, and plan to attend ENA Leadership Conference 2013 by scanning the QR code or visit

We Look Forward to Seeing You in Fort Lauderdale! ATTEND MOTIVATING GENERAL SESSIONS WITH CARMINE GALLO, JON GORDON AND MARCUS ENGEL They will offer their unique perspectives on leadership skills ranging from how to inspire leaders, to methods to overcoming life obstacles and changing the things you can. These speakers are must attend events. Make new contacts as you network throughout the conference with emergency nurse leaders from across the country and around the world. Share solutions to common challenges that you can take home and implement in your emergency department. Discover the latest solutions to your emergency needs in an exhibit hall filled with more than 100 service and product suppliers.

Important Dates to Remember Registration . . . . . . . . . . . . . . . . . Open State and Chapter Leaders Conference . . . . . .Feb. 27 – 28 Carmine Gallo

Presessions. . . . . . . . . . . . . . . . .Feb. 28 Educational Sessions . . . . . . .Mar. 1 – 3 Exhibit Hall . . . . . . . . . . Feb. 28 – Mar. 2

Jon Gordon

Marcus Engel

‘YOU CAN NEVER BE TOO PREPARED’ How a New Jersey ED Weathered a Superstorm By Amy Carpenter Aquino, ENA Connection ‘‘We knew it was coming, so we started preparing as early as Friday,’’ said Deborah Cioffi, MSN, MSA, RN, director of the Cline-D’Onofrio Emergency Services Pavilion at Monmouth Medical Center, a Barnabas Health facility. The Long Branch, N.J., facility stands just one block from the beach, so its staff was predicting the worst as Hurricane Sandy bore down on the Mid-Atlantic in late October. Monmouth began its disaster planning Oct. 26 and opened its disaster command center Oct. 29, the day Sandy was expected to hit ground. Cioffi was the administrator on call. ‘‘When we realized it was going to be more than a few hours, we started doing the 24-, 36-, 48- and 72-hour lookouts to see if we could sustain,’’ she said, ‘‘and that is really the hallmark of ‘Are you prepared?’ Because if you can prepare out that far, you really have a great plan.’’ Once resources were established and the storm began to hit, the focus turned to staffing needs. ‘‘We had such a great response from staff,’’ Cioffi said. ‘‘Everyone got in, but then we had to think about, ‘Could we get them home and could we replace the ones that came in?’ That’s where your challenge begins.’’ With many of the hospital staff living in Sandy-affected areas, concerns lay with staff who had to evacuate their homes, and in some cases, re-evacuate new locations. ‘‘So it was, ‘Who’s going home now? You three go now and you three come back,’ ’’ Cioffi said. ‘‘It was kind of a switch-off, and it was interesting to see how the team worked together.


Monmouth Medical Center in Long Branch, N.J., had to relocate the entrance to the Cline D’Onofrio Emergency Services Pavilion after winds from Hurricane Sandy blew away a portion of the awning. Everyone went home, got their stuff, got their families settled and then came back so the next group could go home. ‘‘It was amazing to see, amazing to see the teamwork. I’ve been an ER nurse for 35 years and never seen the teamwork I have seen here. Everyone — the nurses, doctors, registration — all pitched in together.’’ The main goal through the hurricane was ‘‘to keep our patients safe and for me to keep our staff informed,’’ Cioffi said. Communication became a problem when the storm impacted cellular phone service. It was ‘‘a challenge,’’ Cioffi said — but it was one the command center was able to quickly address. Every time a piece of information came out, incident command posted a note outside the command center and made copies to distribute up on the floors. ‘‘When the hurricane struck Oct. 29, we had high winds, flooding and most of the tri-state area lost power for at

least two weeks,’’ Cioffi said. More than 130 families in the Monmouth Medical Center community either lost their homes or experienced flooding, including six families among the ED staff. In addition to the support offered by Barnabas Health and Monmouth Medical Center, ED staff members collected funds to support their colleagues. ‘‘It’s the little things like that that meant a lot to people in devastation,’’ Cioffi said. ‘‘You think, ‘We’re emergency nurses, we do this every day and just charge forward, but what about the effects on our families and other staff?’ So everyone pulled together and helped each other.’’ Although the ED’s census decreased as regular patients were unable to get to the hospital, staff were still seeing patients, including a number of social holds for people with nowhere to go. ‘‘They had set up mini-shelters in the

February 2013

The staff of the Cline-D’Onofrio Emergency Services Pavilion at Monmouth Medical Center, including ED Director Deborah Cioffi (front row, third from right). area, but it was not really well-defined what each shelter could accommodate,’’ Cioffi said. Some shelters were designated medical shelters that could handle medical needs, such as oxygen, but others were simply called shelters and may not have had power. ‘‘Depending on the needs of the patient, that was a little scary,’’ Cioffi

said. ‘‘You had to make sure you were bringing people to the right area.’’ Transportation was another consideration, so the ED worked out a deal with a car service to take people back and forth to the shelters. ‘‘We were business as usual,’’ Cioffi noted. ‘‘We never closed, we never had a loss of service. We just carried on as

we normally would.’’ Cioffi praised the staff and the hospital for supporting each other throughout the ordeal. Monmouth gave emergency funds to staff who had lost homes and vehicles, and employees donated paid time off to others who had lost their homes. ‘‘We learned that emotional support was just as good as anything else and that families were important, too,’’ Cioffi said. ‘‘If you didn’t make the staff feel that their families were secure, they couldn’t come in and take care of other people. ‘‘What I found out was that most of the staff wanted to come to work because this was the only sense of normalcy they had.’’ Some of the most rewarding moments for Cioffi were when she received phone calls of support from her ENA colleagues. ‘‘Every time the phone rang, I started

Continued on page 40

New to Marketplace The Harriet Lane Handbook, 19th Edition Johns Hopkins Hospital, Kristin Arcara and Megan Tschudy, MD

Trusted by generations of residents and practitioners, The Harriet Lane Handbook from The Johns Hopkins University remains your first choice for fast, accurate information on pediatric diagnosis and treatment. Now even more convenient to carry, it’s your go-to resource for a wealth of practical information, including the latest treatment and management recommendations, immunization schedules, procedures, and therapeutic guidelines, as well as a unique, comprehensive drug formulary. To order, visit or call 800-900-9659 (M-F 9 a.m. – 5 p.m. CT). 1152 pages ISBN: 978-0-323-07942-6 ©2012 Retail Price: $57.95 ENA Member Price:


Three Groups Sandy Put at Risk By Kate McLaughlin, BSN, RN I truly feel that Hurricane Sandy unveiled weakness that we didn’t realize we had within our communities when it came to ensuring the health and safety of certain groups. I live in central coastal New Jersey and work at two hospitals’ emergency departments. During Sandy and the two weeks post-Sandy, I worked at a community hospital that is also a neurologic center. I immediately recognized that certain patient populations were seriously affected by prolonged power outages: the oxygen-dependent population, dialysis patients and alcohol- or drug-dependent patients.

Oxygen-Dependent Patients When the power went out for the first 12 hours, we had an increase of patients with respiratory issues. The patients were mostly from home, and at least one patient was from an assisted-living facility. The patients from home were using portable oxygen concentrators and became acutely ill when their batteries gave out. Many of the patients with this form of home oxygen did not have access to oxygen cylinders as a backup. EMS and shelters were forced to transfer patients to the crowded ED so that they could continue to receive their oxygen. The patient from the assisted-living facility who had been moved to a shelter had oxygen cylinder backups, but after three days in the shelter she ran out of oxygen; on her fifth day in the shelter, having gone two days without oxygen, she required transport to the hospital. The damage caused by Sandy


was a logistical nightmare for suppliers. Some patients were unable to order oxygen because their supplier’s business was flooded, while others couldn’t take calls because of power and phone line disruptions. One small coastal volunteer first-aid squad managed to be a step ahead of the storm. Because its community is small and its members knew most of the oxygen-dependent residents, they were able to check on oxygen-dependent seniors and make oxygen tanks available. As a result, they were able to direct their resources on storm-related issues, such as evacuations. Unfortunately, other towns did not have a similar system in place, and EMS crews found themselves tied up with medical transports to ensure chronic patients had needed oxygen. A suggestion for future disaster planning would be for communities to set up medical shelters that would have oxygen available for oxygendependent patients. Another suggestion is that providers prescribe portable oxygen cylinders when storms are approaching with enough notice.

Dialysis Patients The week after the storm also resulted in increased ED visits for dialysis patients. Mass power outages and disrupted transportation lead to patients missing dialysis. While most patients have dialysis at outpatient centers, the ED is always a backup for this three-day-a-week vital treatment. In the event that a dialysis center is unable to operate, logistical planning needs to take place in order to reroute patients to other outpatient facilities to reduce crowding and ensure

patient wellness.

Alcohol/Drug-Dependent Patients The third patient population I saw at risk was those with alcohol or drug dependency. After the storm, people with alcohol or drug addictions became displaced or their supplies became limited. During one evening shift, I had a middle-aged man who presented with chest pressure. He had lost his home and moved in with his sister. He was diaphoretic, short of breath and trembling. He denied drug use, did not have a regular doctor and stated he drank a couple of glasses of wine per night. He was dressed in a suit and was at work earlier that day. Another patient had come in for abdominal discomfort and generalized weakness. She denied substance abuse. She was forced to leave her home due to lack of heat and moved into a friend’s home. Both patients were medically treated for alcohol withdrawal. In addition to an increase in visits for alcohol withdrawal, narcotic overdose and withdrawal increased. Prescription opiate overdose and withdrawal were more prevalent. One patient signed into triage for anxiety. During the triage interview, he revealed he had an addiction to oxycodone. When he was unable to locate oxycodone, he substituted Percocet. In an eight-hour period, he took 18 Percocet. In a state of disaster, sometimes all bets are off. I learned in the military to hope for the best and plan for the worst, and whatever the worst threw at you was never really the worst. The state of New Jersey was ravaged, but we also learned. As we rebuild, we must take the painful lessons we learned and prepare solutions for next time.

February 2013

You Are In Control The IntelliDrive速 Intelligent Response System operates the stretcher with variable speed control, allowing the caregiver constant control over the speed of transport.

You will feel the difference. Test drive the Procedural Stretcher with IntelliDrive速 Powered Transport today! Easy to START, Easy to TURN, Easy to STOP. 2013 ENA LEADERSHIP CONFERENCE | VISIT HILL-ROM AT BOOTH #124


Knox Andress, BA, RN, AD, FAEN

Hurricane Response: Here We Go Again

Sandy’s Power Pushes Challenges Up the Coast In late October, Hurricane Sandy produced flooding and recordbreaking storm surges along the eastern United States coastline and inland toward the Great Lakes, killing 131 U.S. residents and ultimately affecting 50 to 60 million people. At one point, 8,204,219 customers in 21 states were without electricity. Much like Hurricane Katrina in 2005, storm dynamics precipitated hospital evacuations, destroyed several coastal communities and ruined critical infrastructure, disaffecting public health and health care. At one point, there were 100 New Jersey facilities, including hospitals, nursing homes and assisted living facilities, on generator power. Emergency departments, hospitals, dialysis centers, pharmacies and nursing homes were challenged to provide health care services to local impacted communities. Besides surging and treating injuries resulting from storm dynamics, emergency nurses managed needs resulting from pre- and post-landfall hospital evacuations, community power outages and other infrastructure failures leading to shelter support. Structural damages to housing and power failures in apartment buildings and homes resulted in shelter establishment. Shelter populations included acute and chronic medical needs. As in previous large disasters, emergency nurses provided for the casualties of Sandy and sometimes were casualties themselves. Emergency nurses responded to Sandy in a variety of roles and settings.


New York-Area Deaths Tied to Hurricane Sandy 37 Drowning 18 Tree 12 Fall 8 CO poisoning 5 Fire 4 MVC 3 Hypothermia 2 Electrocution 2 Laceration 2 Crush 2 Electrically dependant respiratory failure 1 Asthma Source: New York Times From hospital emergency departments, emergency operation centers, hurricane shelters and Disaster Medical Assistance Teams, emergency nurses rose to the challenge. Hurricanes impact many emergency nurses and their patients in a variety of ways, requiring nurses to provide care for the injured and support evacuee medical needs, resulting from having to shelter-in-place, evacuate or recover from the disaster. As in previous hurricanes, Sandy demonstrated these impacts and responses.

Landfall Hurricane Sandy developed Oct. 22 from a tropical wave in the western Caribbean. After moving northward and affecting Jamaica, Cuba, the Bahamas, Haiti and Florida, Sandy targeted the most populated and

congested coastline in the U.S., from Washington, D.C., north to Baltimore, Philadelphia, New York City and Boston. The storm made landfall Oct. 29 at about 8 p.m., coming ashore near Atlantic City, N.J. Sandy was termed a ‘‘megastorm,’’ with impacts felt from the Carolinas to the New England states and across to the Great Lakes. Weather extremes along the Atlantic coast included high winds and flooding from storm surge and torrential rainfall. Inland, the massive weather system collided with cold air to bring snow and blizzard conditions to the Appalachians. Twelve states were declared disasters on FEMA’s website ( as of Nov. 7. Major disaster declarations were made for Rhode Island, Connecticut, New Jersey and New York. Emergency declarations were for New Hampshire, West Virginia, Virginia, Delaware, Rhode Island, Pennsylvania, New Jersey, Connecticut, the District of Columbia, Massachusetts, New York and Maryland.

At Risk Hurricanes are a significant natural hazard to U.S. populations near the Gulf of Mexico and Atlantic Ocean. These phenomena generally occur from June through November during what is termed ‘‘hurricane season’’ but have occurred well into the winter months. Hurricanes directly threaten the 17 Gulf and Atlantic coastal states in the U.S. and Puerto Rico while indirectly threatening inland states (see

February 2013

Mainland United States tropical cyclones causing 25 or more deaths, 1851-2010. Source: NHC, 2011, The Deadliest, Costliest and Most Intense United States Tropical Cyclones From 1851 to 2010 (and Other Frequently Requested Hurricane Facts.

map at top of page). Community infrastructure failures, injuries and fatalities are related to characteristic storm surge, torrential rainfall, flooding and winds in excess of 74 mph. More and more people are living close to a coastline. The increased population in at-risk areas will burden critical infrastructure without proper preparedness planning and mitigation activities.

Health Threats Health threats emergency nurses managed in EDs and response team settings included those characteristic for the response and recovery phase. Injuries managed during the response

phase included drowning, blunt trauma from fallen trees and falls, which were the leading causes of death. Many of the falls resulted after power outages. Recovery-phase illnesses reported include lacerations from debris and trash removal and respiratory illness and coughs attributed to molds and allergens.

Emergency Nurse Responses Michael Whalen, RN, CEN, served in his role of regional hospital preparedness manager and responded to Sandy by coordinating hospital and long-term care responses for his region in northeast Pennsylvania. ‘‘I was the point of contact for health care facilities and the

Official Magazine of the Emergency Nurses Association

Pennsylvania Department of Health during Sandy,’’ Whalen said. Health care facilities and long-term care facilities had issues in Whalen’s region including communications disruption, power outages, structural damage and housing staff needs. ‘‘A regional trauma center experienced an emergency generator that developed serious complications while it was providing the only power for the NICU, CCU, cath lab and OR,’’ he said. Whalen coordinated the state response team and backup FEMA generator support for the hospital. Evacuations and subsequent shelters increased burdens on area emergency departments. From Burlington, N.J., Ray Bennett, BSN, RN, CEN, CFRN, CTRN, NREMT-P, reported making Advanced Life Support ground transports before the hurricane landfall, then responding as part of a New Jersey EMS Task Force strike team to Ocean Medical in Bricktown, N.J. The task force established a Disaster Medical Assistance Team-like team in the parking lot to support and decompress the ED. ‘‘Many residents evacuated their homes and apartments to shelters pre-landfall while others sheltered-inplace,’’ Bennett said. ‘‘Challenges really became apparent when electricity was lost. Those dependent on electrically powered medical equipment suddenly needed shelter locations or hospitals to support their medical needs. Coordinated and consistent special medical needs shelter planning is important.’’

History Repeats Itself After the lessons provided by the 1993 Northridge California earthquakes, 9/11, the H1N1 pandemic, hospital deaths and failures in Hurricane Katrina, what are the surprises of Hurricane Sandy? What can we learn from history? Are you ready or not? Readers may contact the author at



Do you dread going to work on a regular basis?





CODE Have you become more isolated from your co-workers?

Do you remember what attracted you to the profession?

Reconnecting to Your Passion and Purpose By Kendra Y. Mims, ENA Connection

Are you still excited about your 2013 goals or do you find yourself just going through the motions? While this time of year can be an exciting time for those still pursuing their New Year’s resolutions, it can cause anxiety, stress or discontent for others in their professional and personal lives. Stress accumulated during the holiday season and from everyday life can sometimes lead to disconnect. Maybe you lost the joy you once had when you first entered the profession — you’re not excited about reporting to work anymore and you don’t have the same drive to interact with patients and your coworkers. According to Studer Group coach and speaker Rich Bluni, RN, emergency nurses lose their passion for the profession based on three factors: compassion fatigue, disconnection and lack of self-care. ‘‘I think one of the first things for ED nurses, especially with being at the forefront of what we see, is that you get compassion fatigue,’’ Bluni said. ‘‘You deal with people at some of the worst moments in their life. I think every ED nurse comes into the job wanting to help people, and one of

“Out of all the nurses, emergency nurses have the best stories. We have the saddest stories, we have the funniest stories, and we have the most inappropriate stories.’’ the most frustrating things for ED nurses is taking care of people who don’t want to help themselves and seeing some of the same people making poor health choices over and over again, whether it’s drinking, drugs or not taking their medication.’’ Bluni, the author of Inspired Nurse, said this frustration may cause emergency nurses to lump everyone into the same category, almost to the

point where they feel like they’re going to give up.

Tell Your Stories

Bluni encourages connecting back to your greatest story as an emergency Seeing the Bigger Picture nurse by writing it down and then Do you remember what attracted sharing with other emergency nurses you to the profession? Bluni said in a group setting. emergency nurses get disconnected ‘‘Out of all of the nurses, emergency from what he calls their ‘‘big reasons’’ nurses have the best stories,’’ he said. — the ones for choosing to become an ‘‘We have the saddest stories, we have emergency nurse — by letting the the funniest stories, and we have the ‘‘day-to-day stuff on the job’’ become a most inappropriate stories. Whether distraction from the purpose of their you’re sitting with a pen or a laptop, work. take the time to write down your ‘‘I always talk about the difference greatest moment: that patient you’ll between our job and our work,’’ he never forget, that child you took care said. ‘‘Your job is the skills you must of, the coworker that changed your life. have to do certain things, but your Then, get some free time where you work is your personal mission of how can share them as a group.’’ you want to be an ED nurse. What Stories can be shared during rounds, excited you about it? reports or staff meetings. Bluni suggests ‘‘A lot of times, people printing out everyone’s think the only ones who stories and creating a get excited about their book of them so that work are the new people. people can read them, When you first start, you including new staff. are excited because every ‘‘I find that is the day is something different. easiest and quickest way After being an ED nurse for to get that reconnection,’’ a while, you start to feel he said. ‘‘The purpose of like you’ve seen almost this is to reconnect to everything.’’ Rich Bluni, RN your greatest moments, which reminds you of Take Care of You the times when things were working It’s no secret nurses spend the pretty well.’’ majority of their time taking care of others. Bluni said Stay Fit Spiritually emergency nurses are often so People often attribute burnout and focused on taking care of other compassion fatigue to a physical people that they forget to take cause, which is not always the case, care of themselves. He suggests Bluni said. He believes connecting spending the proper amount of spiritually can help you reconnect to time to do the work necessary your passion and purpose. to take care of yourself to prevent ‘‘When we’re tired, we know we burnout, which can lead to need to sleep, and when we’re hungry unhappiness in your work. we know we need to eat,’’ he said.

Connecting the Dots Reigniting your passion when you feel burned out takes time and effort, but the long-term benefits can be rewarding as you remember why you initially fell in love with the work you do. The following can help you:

Official Magazine of the Emergency Nurses Association

‘‘When we’re feeling burnout, it is spiritual, and that can be different for everybody.’’ Bluni says he uses his personal religious beliefs and prayer time to reconnect to the spirit, but staying

Continued on page 26


Reconnecting to Your Passion and Purpose spiritually fit can means something different to everyone. ‘‘Whether you practice a faith or don’t practice a faith, it doesn’t matter because we’re all spiritual beings,’’ he said. ‘‘If you have three minutes, it could be walking outside of the ED and standing under a tree and being quiet. Or it could be going to your car and putting on your favorite song, whether it’s Luther Vandross, Barbara Streisand or Lady Gaga. Whatever it is, you listen to that song and let that take care of you. ‘‘Sometimes people get freaked out when they hear the word ‘spiritual.’ It’s whatever personally brings you peace. For some, it’s prayer, for some it’s quiet and for others it’s music. But just like we need to have a drink of water or a cup of coffee at work, we have to have that moment to take care of your spirit.’’

NCE 2013

Continued from page 25 Please visit coursesandeducation/ onlinelearning/Pages/FreeCE.aspx.

Tip: The new year provides an opportunity to reflect on the past. Write down things that went well last year and things that can be improved.

Attend the ENA Leadership Conference 2013 Attending this year’s ENA’s Leadership Conference in Fort Lauderdale from February 27—March 3 will be a great opportunity to become recharged about your profession. For more information, please visit: coursesandeducation/conferences/ leadership/2013/Default.htm

new skill, reading a book or attending a training session or workshop can help to reignite passion for your work. Any of these options can help you to grow and develop or refresh your nursing skills. Learning new things and creating new challenges can evoke interest and re-energize your routine. You may develop fresh ideas that empower you to make changes or develop solutions in your ED. If you’re not ready to make a long-term commitment to returning to school but you still want to further your education, you can take advantage of ENA’s free continuing education Learn Something New Research shows that expanding your L E A D E R S H I P courses C O N(with F E Rcontact E N C Ehours) 2 0 that 1 3 are knowledge by taking a class, learning a available each month for members.

To learn more about becoming inspired in your work, check out Bluni’s Inspired Nurse book and journal, available at ENA Marketplace,






Offering Educational and Networking Opportunities for Current and Future F O R T L A U D E R DA L E , F L F E B R U A R Y 2 7 – M A R C H 3 Emergency Nurse Leaders. For more information, scan QR code, or visit

F O R T L A U D E R DA L E , F L


ENA Connected

How We’re Helping to Shape Your Future in 2013 By Thomas Barbee, ENA Digital Marketing Manager As you have undoubtedly experienced by now, ENA’s outreach expanded by leaps and bounds throughout 2012, especially in the areas of social media. We were able to provide photos and video footage from the first TNCC instructor course in Nairobi, Kenya, on Facebook and Twitter, two channels that are still seeing substantial growth, especially internationally. Also, our website for Leadership Conference 2013 is mobile-friendly, with built-in social media capabilities for you to

share information on Facebook and Twitter, while also seeing at-a-glance ENA updates on Facebook, Twitter and YouTube. You can anticipate even more updates this year, especially the Leadership Conference 2013 standalone app that will allow you to view speakers, sessions and exhibit hall information, all from your mobile device. Working in tandem with the existing mobile-friendly conference website, all the resources you need will be at your fingertips. Look for more content to be pushed through our LinkedIn channels

le b a l vaibook a w e No s an a

as we further mold the ENA LinkedIn page to be your No. 1 resource for professional development. We’ve already seen great discussions in that area and will continue to nourish that thriving social media environment. Those are just a few of the items you can expect in a jam-packed 2013. I am very excited at what the future holds for ENA as we continue to ensure that ENA members not only have access to the best possible resources, but that we foster one of the most well-connected networking communities for a professional organization.

EMERGENCY NURSING Scope and Standards of Practice

ENA offers the most important book you will ever need to grow your practice... Emergency Nursing: Scope and Standards of Practice. This book will cover criteria-based job descriptions and performance evaluations and so much more. • Departmental policies and procedures • Strategies for health promotion • Orientation and continuing education programs • Quality improvement programs and activities • Content expertise on the scope of emergency nursing practice • And American Nurses Association now recognized emergency nursing as a speciality

To learn more about the new Emergency Nursing: Scope and Standards of Practice and to order visit

Official Magazine of the Emergency Nurses Association


Meet the Accomplished 2012 AEN Fellows The 2012 class of fellows was inducted into the Academy of Emergency Nursing on Sept. 15, 2012, at the first annual Awards Gala at the ENA Annual Conference in San Diego. AEN was created to honor emergency nurses for their contributions to the profession as demonstrated by: • Enduring and substantial contributions to the advancement of the emergency nursing profession in education, practice, research, leadership or public policy; • Impact in advancing the emergency nursing profession in one or more of these areas; and • Potential for sustained contributions to the advancement of emergency nursing and the Academy of Emergency Nursing.

Meredith Jaye Addison, MSN, RN, CEN, FAEN, said she finds it an exhilarating challenge to keep momentum and progress going on the development of statewide trauma systems in Indiana. She is thrilled to share that the second Trauma Program Manager Course in the history of the state of Indiana was completed in October 2012 at Wishard Hospital, a Level 1 trauma facility in Indianapolis. When the first notice went out for a trauma program manager at her local hospital, Addison took the ‘‘scary steps’’ of heading to the Human Resources department to interview for the position.

Rita T. Anderson, RN, CEN, FAEN, has been a member of the ENA Government Affairs Committee since 2009, serving as chairperson in 2011. She has represented ENA regarding violence against emergency nurses on national television and in magazines. She has served on the Arizona ENA Board of Directors since 2006, currently as 2012-2013 president of the AZ ENA State Council. She was honored as the 2010 AZ ENA Emergency Nurse of the Year. Anderson will complete her degree in April, giving her the opportunity to teach nursing students and inspire them to consider a career in emergency nursing. She feels it is important to give back to the profession she cares so much about.

Liz Cloughessy, AM, MHM, RN, FAEN, has been an emergency nurse for more than 35 years and is the first Australian nurse to be inducted into the Academy. She established the Emergency Nurses Association of NSW and the Australian College of Emergency Nursing, of which she is currently executive director. In 2004, she was awarded an Order of Australia for services to nursing in the fields of emergency, disaster and trauma. She is a national coordinator for Trauma Nursing Core Course and Emergency Nursing Pediatric Course for Australia and New Zealand. Cloughessy was the first disaster nurse commander appointed in Australia and was the nurse commander for the first Australian civilian disaster medical team to be sent offshore.

Chris Gisness, MSN, RN, BC, FNP-C, CEN, FAEN, is a family nurse practitioner for Emory University, Department of Emergency Medicine, at Grady Hospital in Atlanta. She also works as adjunct faculty in the Emergency Nurse Practitioner Program. Gisness has served in many ENA positions, including four years as a director on the national board. Being committed to ENA programs, she continues to teach ENPC and TNCC as a faculty/instructor throughout the country and hopes to teach internationally as well. She completed her term on the Future of Nursing Work Team and is excited about serving on the 2013 ENA Foundation Board of Trustees.


February 2013

Diane Gurney, MS, RN, CEN, FAEN, is passionate about education, and her programs have been praised by many. She served as an original author of the ENA Orientation to Emergency Nursing, on the ENA Trauma Committee to establish the first Course in Advanced Trauma Nursing, as section editor on the Journal of Emergency Nursing Triage Decisions and is lead editor for the TNCC 7th revision. Her work has been influential. Gurney has been recognized with the following awards: 2012 Judith Kelleher Award, 2011 New Jersey ENA President’s Award, 2009 ENA President’s Award, 2004 ENA Education Award and the 1995 Distinguished CEN Award. She is an accomplished speaker and author and intends to continue her commitment to ENA through AEN.

Andrew D. Harding, MS, RN, CEN, NEA-BC, FAEN, FACHE, FAHA, is associate chief nursing officer for Southcoast Hospitals Group in New Bedford, Mass. He is a graduate of Saint Anselm College and Bridgewater State University. Harding is a reviewer and section editor for the Journal of Emergency Nursing. He also serves on the Course in Advanced Trauma Nursing Work Team. Harding has more than 30 publications. He was an invited presenter at the 2012 Infusion Nurses Society annual meeting to discuss intravenous smart pumps. Harding was also part of the Core Competencies in Emergency Nursing Work Team, which has published its work regarding competence. His current areas of interest include professional nurse practice and educational remediation.

Cindy Hearrell, MSN, RN, CEN, FAEN, has been active in ENA since 1992. In the late 1990s, the death of a local infant in a motor vehicle crash changed her life. She became an advocate for injury prevention and has educated thousands of parents and professionals on occupant protection and injury prevention. Hearrell has been instrumental in legislative efforts and prevention program development. She was the recipient of the ENA 2010 Barbara Foley Injury Prevention Leadership Award and the 2011 Gail Lenehan Advocacy Award. As a fellow she will share her experience by mentoring others as they impact the future of emergency nursing.

J. Jeffery Jordan, MS, MBA, RN, CEN, CNE, EMT-P, FAEN, is a faculty member at East Central University in Ada, Okla. He has served in many ENA positions, including seven years on the national board of directors. He has diligently articulated the importance of activism in the emergency nursing profession, particularly through involvement in ENA. He uses practical examples to demonstrate how activities, such as resolutions presented at our General Assembly, testifying before state legislatures or Congress and presentations at educational events or within the hospitals, impact our practice. He instills a sense of accountability and enthusiasm in taking an active role in changing the specialty for the betterment of the profession and the patients.

Fred Neis, MS, RN, CEN, FAEN, FACHE, joined ENA in 1998. Having completed his master’s degree the year before and working as both an emergency nurse and flight nurse since 1994, he was ready to contribute to the emergency nursing profession in a broader way. He has held local- and state-level positions and participated in national committees. He also has served as a five-time delegate to General Assembly. With Jeff Solheim, MSN, RN-BC, CEN, CFRN, FAEN, he has co-authored a chapter for an upcoming ED management book on pay-for-performance for nursing staff. In addition, he has completed leadership fellowships at the Advisory Board Company and served as board president for Project Helping Hands.

Profiles continued on page 30

Official Magazine of the Emergency Nurses Association


India J. Taylor Owens, MSN, RN, CEN, NE-BC, FAEN, is the director of Emergency Services and EMS Operations at Franciscan St. Francis Health in Indianapolis. At the request of the governor, Owens served on the development panel for Indiana’s Altered Standards of Care framework for health care delivery in cases where need outpaced resources due to a mass casualty or epidemic situation. Owens was the chairperson of the ENA Lantern Award Development Work Team since its inception and has served on the Lantern Awards Committee since the first awards were granted in 2011. In 2010, Owens was selected by the Indiana State Board of Nurses as the recipient of the Indianapolis Star Nurse Advancement of Nursing award.

Gwyn Parris-Atwell, MSN, RN, FNP-BC, CS, CEN, FAEN, is the chief nurse executive with the 514th Aerospace Medicine Squadron at McGuire Air Force Base N.J. She is also a nurse practitioner with South Jersey Healthcare and serves as a preceptor for nurse practitioner students from several universities. An ENA member of 25 years, she has served on state and national committees and is currently chairperson of the Lantern Award Committee. In 2010 she was the New Jersey ENA State Council president while deployed to Balad, Iraq. She was instrumental in setting up TNCC provider and instructor courses while deployed and has implemented TNCC at her military base. In 2011, she received the Frank L. Cole Nurse Practitioner Award.

Judith A. Burke Scott, MHA, RN, FAEN, has been a member of ENA for 27 years. Scott has spent years working on emergency management programs and serves as chairperson of the Emergency Medical Services Committee for the California ENA State Council. She also has been active in the California ENA State Council Government Affairs and Foundation committees. She was the clinical nurse for a busy California county hospital. As a teaching hospital the opportunities to continue learning were limitless. After retiring from clinical practice, she taught emergency management practices to hospitals throughout the U.S. Scott remains active in ENA and is the ENA representative on the revision committee for the Hospital Incident Command System document.

Paula Tanabe, PhD, MPH, MSN, RN, FAEN, is an associate professor in the Schools of Nursing and Medicine at Duke University. She has contributed to improving the quality of care delivered to patients in emergency departments throughout the U.S. Her practice, education and research have focused primarily in two areas: (1) the development, evaluation and dissemination of a research-based triage tool, the Emergency Severity Index, and (2) improving pain management practices in the ED setting. The ESI triage system is now used in more than 50 percent of EDs throughout the U.S., has been translated into several languages and is used internationally. Her current area of research and practice focuses on patients with sickle cell disease.

Mary Ann Teeter, MSEd, RN, FNP-C, CEN, CNRN, FAEN, is a stroke coordinator and stroke nurse practitioner at Arnot Ogden Medical Center in Elmira, N.Y. She is a diploma graduate of Arnot Ogden Memorial Hospital School of Nursing. She became a CEN in 1981, completed her BSN and MSEd at Elmira College and her FNP at Community General Hospital in Syracuse. Teeter has served in various positions and appointments at the chapter, state and national levels, including the following: TNCC/ENPC provider, instructor and faculty; Trauma Committee chairperson; state council president; ENA/National Highway Traffic Safety Administration Motor Vehicle Injury Prevention Coordinating Committee member; ENA Resolution Committee chairperson, annual conference presenter and author for the Journal of Emergency Nursing and the CEN Review Manual.


February 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? Has a particular experience given you new insights into a current issue or trend and led to new best practices? Do you have experience dealing with leadership challenges and issues?

Share your insights related to current issues, trends, and best practices as a faculty member at ENA Leadership Conference 2014, March 5-9 in Phoenix, Arizona

Topic areas: • Management • Operations • Government affairs • Technology • Team building

• Research • Education • Advance practice • Orientation • Retention

Submission Deadline is

March 25, 2013

• Community relationship building • Customer satisfaction • Personal and professional development

Find full information and course proposal guidelines at www.ena. org and click on Leadership Conference 2014 Call for Course Proposals in the Calls and Opportunities Section. We look forward to hearing your cutting-edge course ideas.


Bridging the Gap

Two Dreams, One Purpose By Kendra Y. Mims, ENA Connection It was an exciting moment for Kim Johnson and AnnMarie Papa when they met for the first time at the 2012 ENA Annual Conference in San Diego. Although they were strangers, Johnson, BSN, RN, director of Medical Surgical Emergency Services at McLaren Hospital, and Papa, DNP, MSN, RN, CEN, NE-BC, FAEN, 2011 ENA president, had a common bond that brought them together: They wanted to make a difference in the emergency nursing profession. Because of the generous contributions made by donors, the ENA Foundation was able to make both women’s dreams possible. During Papa’s ENA presidency, one of her platforms focused on recognizing frontline nurses who perform stretcherside miracles every day. Nurses work stretcherside at any emergency department, she said, and stretcherside nursing is very different from bedside nursing. AnnMarie Papa (left) congratulates Kim Johnson, the first recipient of the ‘‘They’re not with us for days and days on AnnMarie Papa Stretcherside Miracles scholarship, at the 2012 ENA end in most cases,’’ she said. ‘‘It’s the mother Annual Conference. handing you her child who stopped breathing, the daughter bringing her very ill mother in, that co-worker bringing their friend in with an industrial injury and that trauma victim who is all alone on the stretcher, ‘‘Nursing has a huge number of boarded and collared, who looks up at you and says, ‘Help people in the profession. They don’t me.’ You have a split second to look into the eyes of those patients and develop that relationship and trust, and I think realize how strong and powerful that is the miracle of emergency nursing. That is something that is very unique to emergency nurses, and it makes us they are. We always want to do it stretcherside miracles.’’ ourselves individually, but if we Papa designed the Stretcherside Miracles pin for emergency nurses to wear as a symbol of pride and to band together, we can make a inspire them to remember the differences they make in the lives of their patients and colleagues. Papa worked with the difference.’’ ENA Foundation to make the pins available for a $5 – Kim Johnson, BSN, RN donation. The proceeds funded the first AnnMarie Papa Stretcherside Miracle scholarship in the amount of $5,000. Johnson’s dream of obtaining a master’s degree in nursing became a reality when she became the first recipient of the


February 2013

scholarship. Johnson wanted to pursue her master’s degree to advance her nursing career, but there were limited resources available. When a colleague informed her that the ENA Foundation offered numerous academic scholarships for emergency nurses, she became inspired to achieve her goal. She credits the ENA Foundation for providing her with an opportunity to receive advanced education that can improve patient outcomes. ‘‘While working toward my master’s degree, I learned how complex the practice of nursing really is, how significant higher education is to advance our professional practice and how all this integrates together so that we can have a very well-rounded, knowledge-based, critical-thinking ER that provides better outcomes and safer quality care for patients,’’ Johnson said. ‘‘I don’t think I would have understood that had I not advanced my level of education. Obtaining this degree has made me a better practitioner. The ENA Foundation has given me the ability to make a difference in patient care.’’ Johnson and Papa recognize it doesn’t cost a lot to invest in the future of others and to make a difference, such as by donating $5 to the foundation to receive a Stretcherside Miracles pin. They realize that every donation matters, and it

all adds up for a bigger cause. ‘‘It’s really all of us,” Papa said. ‘‘Everyone who donated to receive a pin contributed to the scholarship being funded. You plant the seeds for the future. It’s paying it forward.’’ Papa is excited about the support shown by donors who helped to fund the scholarship and made the opportunity available for Johnson. She plans to continue working with the ENA Foundation to keep the scholarship available for future recipients. Johnson will receive her master’s degree in April 2013. She described her journey as long and arduous but worth it. ‘‘You have appreciation and respect for the individuals who created this opportunity,’’ Johnson said. ‘‘It brings you full circle. It energizes and revitalizes you to want to do something similar to help people. I would love to do something like this and put a lot of heart and soul into something that is really going to make a difference for somebody. I can help other people get their education by paying it forward.’’ For more information on how you can receive your Stretcherside Miracles pin or to learn about the ENA Foundation, please visit

Established in 1991, the mission of the ENA Foundation is to provide educational scholarships and research grants in the discipline of emergency nursing.

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

Your Dollars = Your Future Investing in a nurse today is an immeasurable contribution to the future of emergency nursing and patient care.

Donate Now.

What Your Patients May Not Tell You Compiled By Kendra Y. Mims, ENA Connection Do you often find that your patients don’t disclose important information? Whether they omit certain facts from their medical history out of fear, embarrassment or simple forgetfulness, you may find yourself reading in between the lines to obtain important details that can impact their treatment. Read below to find out what omitted information our nurses at ENA headquarters have found to be the most common and their tips on how to make patients feel more comfortable.

When it comes to sex, drugs and alcohol . . . Marlene Bokholdt, MS, RN, CPEN, CCRN, Nursing Education Editor: With my adolescent patients, the big three for them are drug and alcohol use, sexual activity and pain, for those who want to be tough. It’s the same things they don’t want to tell their

parents, so they don’t tell me, either. They don’t want to risk the chance that I might share that information with their parents. They don’t know that I am bound by confidentiality not to. Another thing with drug and alcohol use is that it sometimes means something different to them than it does to me. I once had a girl who said she didn’t drink very much. I asked her what ‘‘very much’’ meant, and she defined it as a quart of vodka every weekend and a six-pack every day. Sometimes you have to ask them to define what they mean — it’s not a matter of if they do drink, but how much. You do have to notice those nonverbal cues and when they’re holding something back, and you need to ask more probing questions. Briana Quinn, MPH, BSN, RN, Senior Associate, Wellness/Injury Prevention: It often happens when you’re asking a young girl if she’s sexually active or when you have someone who has an STD. Be non-judgmental when communicating with the patient, and enforce education with your discharge instructions to them. Dale Wallerich, MBA, RN, CEN, Senior Associate, Institute for Quality, Safety and Injury Prevention: Teenagers often downplay their sexual history, particularly if their parents are in the room. It’s the same with alcohol and drugs. Whether it’s a teenager or The panel, from left: • Marlene Bokholdt, MS, RN, CPEN, CCRN • Briana Quinn, MPH, BSN, RN • Dale Wallerich, MBA, RN, CEN


adult, they typically deny it or say they’ve had minimal use prior to the event that brought them to the ED. For adults, particularly a trauma victim or someone who’s been assaulted, they will often downplay the amount of alcohol they drank for fear we may share that information with law enforcement.

When it comes to medication . . . Briana Quinn: A lot of times when they first come into triage, they are flustered and anxious, and details like medication and allergies may accidentally get left out of medical history, even after a nurse asks these questions. They’re so focused on the initial problem that the full story may not be told. While we always check for the ‘‘rights’’ of medications before administering them, ensuring you explain and educate your patients about their medications prior to administration can be a check for allergies that may have been left off the initial list. Even saying the name of a medication has helped them remember that they can’t have it.

When it comes to domestic violence/intimate partner violence . . . Marlene Bokholdt: I think one of the things that we as a profession have made a difference with is intimate partner violence. Instead of waiting for them to ask, we now ask everyone if they feel afraid or if there

Continued on page 36

February 2013

New ENA monthly offering for FREE Continuing Education with contact hours for our members. • Available February 1 Strokes in Little Folks, 1.0 contact hour Rhonda M. Morgan, RN, DNP, CEN, CNRN, CCNS, APN

Don’t miss out on enhancing your education. 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.

What Your Patients May Not Tell You

Continued from page 34

is anyone they are fearful of. Sometimes, just those direct questions will bring about honesty rather than waiting for them to tell you why they are there.

for your safety at home? They might break down at the time. At one hospital, we put small cards with a hotline number for domestic abuse in the women’s bathrooms, so it was small enough to hide. That worked quite well.

When it comes to making patients feel comfortable . . .

Briana Quinn: It is important to get that patient alone to question if anyone is hurting them at home because they’re not going to say it if the person is in the room. Sometimes, even if the person is not in the room, they still don’t always admit it because they’re afraid of what might happen. Try to find a two-second quiet moment to ask them — I know it seems like those two-second moments are not there, but they are. Make eye contact and show them you are concerned. Be mindful of every patient, especially with older patients, who may be subject to a variety of forms of elder abuse. Dale Wallerich: Sometimes you can pick up when there’s the potential for domestic violence, and it’s difficult to ask them pertinent questions when the abuser is in the room, so you try to work your way around that. You have to get creative. If someone comes in and you suspect abuse and she’s with the potential abuser, you’ll make up an excuse that you need a urine sample so you have the opportunity to speak to her while away from the abuser. Once you have the patient alone, you may ask: Are you in an abusive relationship? Has anyone harmed you? Do you fear


Marlene Bokholdt: For my adolescent patients, I try to make sure we have some time apart from their parents, even if it’s just escorting them to the bathroom and finding a minute where they know I’m talking to them personally. I make it a point to be direct and to never be judgmental. I make sure my face doesn’t reveal my surprise. You have to let them know that no matter what they tell you, it’s going to be confidential and used to help make them better and treat whatever problems they have. I don’t try to be young and hip. I use the appropriate clinical words. I think that kind of approach minimizes embarrassment; if it’s clinical, they can talk about it, if it’s personal, it makes it harder. I think we’ve benefitted from the fact that people tend to trust us, and I think they are more willing to share things with us. I do think there has to be some effort on the part of the nurse. You

have to sit down and talk to them. You can’t make it look like you’re just trying to get some information on your way out the door. You have to be willing to create a relationship so that there is some trust. Sometimes that’s hard for us in the ED to do because we tend to be busy and it doesn’t feel right to sit down and talk, but sometimes that’s the only way you’re going to get a thorough medical history if you look like you have all the time in the world so that they can trust you and share. Dale Wallerich: It’s difficult to do because you have such a small window of time to spend with your patient, but it’s a knack that you gain over time. If you’re cold and distant, you’re not going to establish that relationship with the person, so you have to come across as trustworthy, concerned and friendly. Establish that rapport so that they can trust you. Make good eye contact with them. Sometimes, just a hand on the arm or a warm blanket helps. You’d be surprised at how effective a warm blanket is. Treat them how you would want to be treated if you were the patient. You want them to feel comfortable that they may come to your ER and be treated like a human being. Hopefully that patient is feeling that sense of trust and that you honestly care about them as a person.

February 2013

ual er Man Provid Edition 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

ENA STATE CONNECTION Missouri ENA St. Louis Chapter Submitted by Jeanee Fogarty, MBA, BSN, RN On Oct. 10, 2012, the St. Louis Chapter of the Missouri ENA held its 17th annual awards dinner at Orlando Gardens. Michael Lim, MD, FACC, FSCAI, director of the division of cardiology at Saint Louis University Hospital, was the guest speaker. His topic was ‘‘Spectacular Cases in Cardiology’’ and was well received by attendees. The St. Louis Chapter saw an unprecedented number of nominees submitted for its awards in 2012. The recipients are as follows: • Paramedic of the Year: Greg Harwood, Abbott Ambulance • Emergency Physician of the Year: Kimberly Perry, DO, ECI/Christian Hospital Northeast/Northwest • APN of the Year: Kathy Steinmann, RN, APN, Our Urgent Care Centers • Emergency Nursing Rookie: Ryan Fonner, RN, Saint Louis University Hospital • Emergency Nurse Community Service: Debra Rogers, RN, BJC-Christian Hospital • Emergency Nurse Leadership: April Hawk, RN, SSM St. Claire Health Center •Emergency Nurse Clinical Practice: Susan Jaber, RN, Missouri Baptist Medical Center • Emergency Nurse Educator: Elizabeth Moore, RN, SSM St. Claire Health Center •Emergency Nurse of the Year: Jeff Halverson, RN, Saint

Louis University Hospital • S t. Louis Chapter Special Recognition Awards: oD  istinguished Community Service Award: Kathleen Hanrahan, YWCA o Distinguished Community Leadership Award: • John Grah, CEO, DesPeres Hospital • Phil Sowa, CEO, Saint Louis University Hospital • Dawn Anuszkiewicz, COO, Saint Louis University Hospital o Special Award of Thanks: Helen Sandkuhl, MSN, RN, FAEN Sandkuhl was very instrumental in assisting with the international transfer of a patient who needed to return home to St. Louis for further medical care and intense rehabilitation. The family chose this opportunity to express its appreciation of her efforts.

State Council and Chapter Meetings and Events St. Louis ENA Chapter Annual Chapter meetings are held on the second Tuesday of the month at 5:30 p.m. at DesPeres Hospital in Community Room 3. For more information, contact: Upcoming Education: CEN Review Course Date: April 6-7, 2013 Location: SSM DePaul Health Center Sponsored by St. Louis Chapter ENA, DePaul Health Center, and St.  Louis University Hospital For more information, contact Judy Marlow at or


Joan Eberhardt at joaneberhardt@ ENPC Provider Courses April 27–28, 2013 May 4–5, 2013 TNCC Provider Courses October 26–27, 2013 December 7–8, 2013 TNCC Instructor Courses April 13, 2013 October 5, 2013 ENPC Instructor Courses April 14, 2013 October 6, 2013 All courses will be held at DesPeres Hospital. Contact Helen.

Ohio ENA Chapter The 2013 Ohio Nurses Day at the Statehouse event has been scheduled for Wednesday, Feb. 20. Ohio ENA will again be a co-sponsor of this important event. Complete registration in two quick steps: 1. Officially register for the event at 2. Tell Ohio ENA you are attending the event by visiting QJTSR35 and answering three quick questions. The event usually sells out very quickly.

February 2013

New Jersey ENA Northern Chapter Submitted by Cheryl Newmark, MSN, RN The New Jersey ENA Northern Chapter held its Winter Education Day on Oct.  23, 2012, at Holy Name Medical Center in Teaneck, N.J. The title of the session was ‘‘Surviving the Changing Season.’’ About 60 ENA members attended and were asked to bring an article of clothing as a donation. With the devastation of Hurricane Sandy coming to New Jersey soon after, the chapter decided to donate all of the clothing collected to Sandy victims, many of whom left their homes with just the clothes on their backs.

Washington ENA State Council Submitted by Andi Foley, MSN, RN, CEN, and Mary Perryman, BSN, RN, CEN What started in 2010 with some vague suggestions and the thought of ‘‘Yes! We should do that!’’ finally came to fruition in the United States in the form of ‘‘Emergency Nursing Without Borders,’’ an international conference

jointly sponsored by the Washington ENA and the ENA of British Columbia. The Bell Harbor Conference Center in Seattle hosted 98 attendees on Oct. 12-13, 2012. Sherry Stackhouse, ENABC 2012 president, and Roger Casey, WA-ENA 2012 president, shared duties as masters of ceremonies. AnnMarie AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN, the 2011 Papa, DNP, RN, CEN, ENA president (left) with Sharron Lyons, RN, the 2012 NENA president. NE-BC, FAEN, and Bruce Campana, MD, resuscitation, leadership, pediatric served as keynote speakers. Papa topics and quality improvement. The discussed the impact of lateral violence speakers were from area hospitals and and bullying within the workplace. Dr. British Columbia, giving a view of both Campana provided new insight to local and Canadian practices. suicide and dealing with behavior and Conference planning for the next psychiatric issues in the emergency state-side conference is already department. underway. Watch for more details on Educational sessions covered topics this exciting, innovative, collaborative such as legal issues, ACLS guidelines, conference.

ENA Call for… Proposed Bylaws Amendments and Resolutions Submission Deadline: March 11, 2013 Bylaws amendments may be proposed by the ENA Board of Directors, state councils, chapters or five voting members of the association. Resolutions may be submitted by any voting ENA member. Others who may submit resolutions include the ENA Board of Directors, state councils, chapters, the Journal of Emergency Nursing editorial board and ENA committees. The Resolutions Committee is available to help ENA members develop proposed bylaws amendments and resolutions. E-mail to obtain assistance from the Resolutions Committee. All proposed bylaws amendments and resolutions must

be submitted in the proper template form and must follow the format as outlined in the Resolutions and Bylaw Guidelines. The guidelines may be found at in the General Assembly area (members only). Final submissions must be e-mailed to ENA headquarters at by 5 p.m. CST, Monday, March 11, 2013. Formal consideration of proposed bylaws amendments and resolutions will occur at the 2013 General Assembly, Sept. 18-19, in Nashville, Tenn. This is your opportunity to bring important professional emergency nursing issues to the 2013 General Assembly.

Official Magazine of the Emergency Nurses Association


ENA Conference Faculty

This Looks Like a Job For ... You? By Josh Gaby, ENA Connection

otherwise probably would not have, but you find out a couple of things. No. 1 ENA members might remember Rhonda is, they’re dealing with the same issues Morgan as the instructor at the front of you are, and No. 2 is, they may have the room for two concurrent different, more insightful ways to educational sessions at manage it that would save Annual Conference 2012 in you, save me, some costly San Diego — one on trial and error or having elderly patients’ medication to reinvent the wheel. It’s issues, another on pediatric a really good way to stroke. Six months earlier benchmark and to at Leadership Conference collaborate and share and 2012 in New Orleans, say, ‘Oh, yeah, I had this Morgan taught three problem, too, so here’s sessions. how we managed that.’ ’’ Rhonda Morgan, She’s been an ENA As a faculty member, DNP, MSN, RN, CEN, conference faculty member Morgan said, you can CNRN, CCNS, APN for eight years: 16 educate others on topics conferences, dozens of presentations, you’re knowledgeable and passionate hundreds of interactions with fellow about while also learning what’s new emergency nurses from all walks. and different. Has it been rewarding? Has it ever. ‘‘And some things aren’t new and And as ENA seeks to add faculty for different, but they just have a new little Leadership Conference 2014 and kind of twist on them,’’ she said. beyond, the benefits of presenting can If you’re interested in becoming a be yours, too. faculty presenter and you’re trying to ‘‘Probably the top of the list is decide on a topic to propose, look for networking,’’ said Morgan, DNP, MSN, something that aligns with ENA’s RN, CEN, CNRN, CCNS, APN, now an broader missions — the overarching associate professor with the King goal of patient safety, for example College School of Nursing in Bristol, — but put your own innovative spin on Tenn. ‘‘It’s absolutely superb, not only it, Morgan said. Try reimagining a topic in the geographic distance, the under a heading you normally wouldn’t opportunity to meet people you expect it to fall under. Don’t be afraid

‘You Can Never Be Too Prepared’

Applications for faculty presenters at Leadership Conference 2014 in Phoenix are being accepted through March 25, 2013. For specific proposal instructions, go to and click on ‘‘Call for 2014 Leadership Conference Faculty’’ on the right-hand column of the main page. to borrow concepts for improving ED practices or culture from industries outside of health care. Taking the step from a conference attendee to a faculty member is about setting yourself apart. ‘‘Take the opportunity. Not chance — take the opportunity to step out and do it,’’ Morgan said. Before Morgan’s recent shift into the college classroom, she was vice president of clinical services and chief nursing executive at Wellmont Holston Valley Medical Center in Kingsport, Tenn. ‘‘A very attractive piece of speaking at ENA is that it makes you ready for the next career move, even though you may not know yet what that is,’’ Morgan said. ‘‘It just builds your professionalism. It develops another skill set that, down the road, you may find not only helpful but absolutely essential.’’

Continued from page 19

to cry,’’ she said. ‘‘ENA members from as far away as North Dakota and California, and my friends on the Government Affairs Committee, people I’ve networked with over the years. I know Gail [Lenehan, EdD, MSN, RN, FAEN, FAAN, 2012 president] called the president of the New Jersey ENA to see if we were OK. We couldn’t


Your Opportunity Starts Now

communicate with each other, but the fact that I got calls from across the nation meant so much to me. It kept me going every day. I owe a special thanks to my New Jersey ENA colleagues for their ongoing support.’’ As a longtime ENA member, Cioffi said she received special inspiration from her colleagues who lived through

Hurricane Katrina in 2005. The biggest lesson learned? ‘‘You can never be too prepared,’’ she said. ‘‘Our goal was patient and staff safety, and we achieved that, but there is always something you can improve for the next time. … ERs need to know what their vulnerability is. They need to know how to be prepared.’’

February 2013

ENA wishes to express its sincere gratitude to these 2013 sponsors.* Thanks to their generous support, ENA is able to continue to provide relevant services and educational programs to improve your practice of emergency nursing.

Strategic Sponsors

Strategic Supporter

Leadership Conference Supporters

*As of print time

Recruitment Ads

Recruitment Ads

be happy. When you’re on the right team, happiness ensues. You know us as recognized ED leaders who guide hospitals toward real and effective change. Now we would like to get to know you. Blue Jay Consulting is looking for professionals with the leadership insight and clinical experience to bring process improvements to our clients, and the passion and commitment to enhance the overall quality of emergency care. If you consider yourself among the best in your field, you’ll find yourself in good company at Blue Jay Consulting. Join the strongest team in the industry and... be happy.

“As a Blue Jay Consultant, I apply the skills and experience I have gained in my nursing career every day. Each assignment brings new challenges and opportunities to make a difference for ED staff and the patients they care for. My work touches the lives of many people. I love what I do and the colleagues and clients I work with.” — NANCY BONALUMI, RN, MS, CEN Director Blue Jay Consulting, LLC Contact Jim Hoelz or Mark Feinberg at 407-210-6570 to discuss how we can capitalize on one another’s strengths.

ENA Connection February 2013