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the Official Magazine of the Emergency Nurses Association


January 2014 Volume 38, Issue 1


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




March 5-9, 2014 Phoenix, AZ

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


A Different Kind of Resolution


 appy New Year! Many of us take the opportunity at the beginning of the year to resolve to  change something about our lives. If you’re like I am, those resolutions usually include changing how we eat, how much we exercise or how much we sleep. All of those resolutions are set with good intentions. After a few weeks, however, most of us resign ourselves to thinking it’s ‘‘too hard’’ and go back to our old ways and habits.

This past September, I delivered my president-elect address at the 2013 General Assembly. I spoke about the epidemic of preventable errors in our emergency care settings and shared a story of an error I made not that long ago. I asked our colleagues to actively report near-misses in their departments so we can better understand the systems we work in, identify weaknesses in those systems and fix them before an error reaches a patient. I asked that we openly discuss the mistakes we make so that we can learn from them and better understand how they occur. And I asked that we be accountable for our behavior at the bedside, treat each member of our team with respect and dignity and stop the bullying that is rampant in our profession. I asked quite a lot of our leaders. I asked everyone in the room to change. At ENA, we advocate for safe practice and safe care. I encourage all of you to recognize that we all make mistakes and that we need to look out for each other and speak up when we ENA Connection is published 11 times per year from January to December by: The Emergency Nurses Association 915 Lee Street Des Plaines, IL 60016-6569 and is distributed to members of the association as a direct benefit of membership. Copyright© 2014 by the Emergency Nurses Association. Printed in the U.S.A. Periodicals postage paid at the Des Plaines, IL, Post Office and additional mailing offices.

see someone heading down a dangerous path. We need to stop coming up with excuses about why we don’t report near-misses and embrace a culture of safety. We need to support our teammates and stop setting people up to fail. We need to foster environments where we openly discuss the mistakes that are made in our emergency nursing practice environment and work to create systems that decrease the likelihood that these mistakes will happen. We need to be accountable to our practice and our patients and use the safety devices and systems that are in place to decrease errors. In 2014, I am asking each and every ENA member to resolve to change the way we think and act about patient safety. As your 2014 president, I want to hear how each of you is taking steps to advocate for a culture of safety in your departments. I want to celebrate with you the great catches in your departments and share those stories with emergency nurses across the country. I want to hear how you

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are involved in developing, measuring and evaluating the quality and safety initiatives in your departments. I want to hear how each of you works to support each other in your practice environments. I want to hear how you are confronting bullies you work with. I want you to believe you have the most important role in keeping our patients safe in the ED. I want you to speak up when you see something that negatively impacts patient safety, whether that something is a computer issue, a medication system issue or how a person treats another teammate. Close your eyes and picture your loved one as a patient in your department. I want it to not matter who is working that day — that any day, 24/7/365, you know your loved one is in the safest place in the world of health care. This may seem like an impossible New Year’s resolution. I know better. We are emergency nurses, and together we can turn this resolution into a revolution against errors in our emergency departments.

Editor-in-Chief: Amy Carpenter Aquino Associate Editor: Josh Gaby Senior Writer: Kendra Y. Mims Editorial Assistant: Renée Herrmann BOARD OF DIRECTORS Officers: President: Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN President-elect: Matthew F. Powers, MS, BSN, RN, MICP, CEN

Secretary/Treasurer: Kathleen E. Carlson, MSN, RN, CEN, FAEN Immediate Past President: JoAnn Lazarus, MSN, RN, CEN Directors: Ellen (Ellie) H. Encapera, RN, CEN Mitch Jewett, AA, RN, CEN, CPEN Michael D. Moon, PhD, MSN, RN, CNS-CC, CEN, FAEN Sally K. Snow, BSN, RN, CPEN, FAEN Jeff Solheim, MSN, RN-BC, CEN, CFRN, FAEN Joan Somes, PhD, MSN, RN, CEN, CPEN, FAEN Karen K. Wiley, MSN, RN, CEN Executive Director: Susan M. Hohenhaus, LPD, RN, CEN, FAEN


ENA past presidents 1st Lt. Marilyn Rice, MPA, RN (left) and Lt. Col. Peggy McMahon, MN, RN, CEN (right) join 2014 ENA President Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN, in laying an ENA wreath at the Vietnam Women’s Memorial on Veterans Day.


ENA Joins Remembrance at Vietnam Women’s Memorial With Two Emergency Nurses Who Lived and Learned in War Photos by Jules Clifford


By Kendra Y. Mims   ♦   ENA Connection


  ASHINGTON — The 20th anniversary celebration of the Vietnam Women’s Memorial that occurred over Veterans Day weekend conjured up memories that nursing veterans Peggy McMahon and Marilyn Rice won’t ever forget.

Lt. Col. McMahon, MN, RN, CEN, enrolled in the Army Student Nurse Program in 1965 while attending the Philadelphia General Hospital School of Nursing. In 1968, she was sent to Vietnam, where she spent a few months at the 85th Evacuation Hospital in Qui Nhon in the medical intensive

January 2014

care unit. She spent the remainder of her one-year tour as an assistant head nurse in receiving and emergency at the 95th Evacuation Hospital in DaNang, where she constantly witnessed and dealt with mass casualties — gunshot wounds, explosions, burns, countless amputations and more. First Lt. Rice, MPA, RN, was accepted into the Army Student Nurse Program in 1968. In 1970, she was assigned to an air evacuation hospital in Okinawa for 18 months, serving as the assistant head nurse of the neurosurgical intensive care, surgical and orthopedic units and treating thousands of acutely ill and injured soldiers evacuated from Vietnam. As a significant number of military hospitals in Vietnam were closing, the military air evacuation plan was reactivated during this time. Two to four times a week, about 100 patients were flown to Okinawa 24 to 48 hours after injuries or becoming ill. During the last six months of her tour, Rice was one of the only nurses in the emergency department, which also was staffed by four to five corpsmen. As many as 100 patients could be cared for per shift. When she was off duty, she met incoming planes with air evacuation patients at the Kadena Air Force Base and triaged patients before assigning them based on their condition to one of the several medical buses available. Some were assigned to a bus for illnesses, such as malaria, while others in critical condition with traumatic war injuries were assigned to the ICU bus. The emergency staff was responsible for processing each evacuation patient and assigning them to the appropriate unit in the hospital. ‘‘I would take care of these [ICU] patients on the way over to the hospital,’’ Rice said, ‘‘because if I didn’t, the only one taking care of these patients was the bus driver.’’ The experiences changed McMahon and Rice. After serving in the Vietnam War, McMahon said she felt she ‘‘aged

a lifetime in one year.’’ ‘‘I was a very somber person when I came back,’’ she said. ‘‘I used to be funny. I don’t think I laughed for a couple of years.’’ Although the mental images of the war did not go away and dealing with the aftermath was difficult, Vietnam gave Rice and McMahon clinical experience that helped advance their emergency nursing careers. When McMahon returned to the United States in 1969, she quickly

Continued on next page

Official Magazine of the Emergency Nurses Association

Top: Peggy McMahon, circa 1968, treating a soldier in DaNang, Vietnam. Bottom: Marilyn Rice, circa 1969.


Vietnam Memorial Continued from previous page discovered there were clinical procedures nurses could not perform because they were not authorized by a state’s Nurse Practice Act, though they had performed the same procedures in Vietnam. McMahon had inserted IVs the entire time she served in Vietnam but was not allowed to when she returned to the U.S. ‘‘Knowing what needed to be done but not being authorized to do it was frustrating,’’ McMahon said. ‘‘In a combat situation, everyone is there to do what is needed to get the job done for our soldiers, and there were no turf battles. We were also protected from liability [government regulation]. When I came back to the U.S., things that we could have done in a combat situation, we couldn’t necessarily do in a civilian life because of fear of liability.’’ Rice recalled times during her tour

A crowd of hundreds of veterans and civilians gathers across from the memorial site for a ceremony that included singing, speeches and Vietnam War memories. when ventilators would break, there were no supplies and she had to invent different ways to treat patients. You had to make the best of what you had,

and you were grateful and did what you could, she said. Because of Rice’s experience in Okinawa, emergency nursing became her specialty when she



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January 2014

and development. ‘‘I think the experience provided me with a great deal of confidence in my clinical abilities and my ability to manage situations,’’ she said. ‘‘I stayed in the reserves and retired as lieutenant colonel after 22 years of service, so today I continue to use my military experience and Vietnam experience in what I do and in my role as senior clinical editor of JEN and representing ENA and various groups. I know the language because of my military experience.’’

Lifelong Nurses Pay Homage

returned home in 1971. ‘‘I could think of no other place to work,’’ she said. “Emergency nursing became my livelihood. When I came back to the States, EDs wanted skills that I had honed in the military, such as

starting IVs and drawing blood. These were things that emergency nurses were just starting to do in the ED.’’ McMahon believes her experience provided her with a ‘‘wonderful’’ opportunity for professional growth

McMahon and Rice — both ENA past presidents — joined 2014 ENA President Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN, in Washington on Nov. 11 to lay a wreath on behalf of ENA at the Vietnam Women’s Memorial and commemorate

Continued on next page


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Official Magazine of the Emergency Nurses Association



Vietnam Memorial Continued from previous page Vietnam veterans and nurses who served in the war. Veterans and civilians bonded during the celebration to honor the sacrifice and courage of women who served. Students of Forest Park High School in Virginia and members of the school’s America’s Club gave a signed letter to every veteran in attendance thanking him or her for answering the call to serve. Numerous visitors placed roses on the statue and laid wreaths around the memorial. People gathered to listen to speakers share their stories about Vietnam during the ‘‘Storytelling at the Vietnam Women’s Memorial: In Their Own Words’’ program. The experience was moving for McMahon and Rice. After laying the wreath, the two nurses saluted and shared a moment of silence. For McMahon, the memorial celebration hit close to home. She personally knew two of the eight military nurses who died while serving in Vietnam. ‘‘It’s very emotional — one of the nurses was my company commander in basic training, and the other was my roommate,’’ she said. ‘‘The memorial honors their gift and sacrifice.’’ The Vietnam Women’s Memorial is the first memorial honoring women’s military service. McMahon was ENA president in 1987 when ENA became one of the organizations to provide support for the memorial. During her presidency, she was instrumental in the ‘‘The sincerity that’s around and the support you get from kickoff and fundraising efforts. others are incredible. The emotions are still powerful and The sculpture depicting three overwhelming. . . . Some of the remembrances kind of women, one caring for a solider, was wash over you and warm your heart.’’ dedicated on the National Mall in the Marilyn Rice nation’s capital on Nov. 11, 1993, honoring more than 265,000 American women who served around the world again 10 years later stirred up the same emotions. during the Vietnam War. Rice attended ‘‘The sincerity that’s around and the support you get from the unveiling as the 1993 ENA president-elect. She also others are incredible. The emotions are still powerful and attended the 10th anniversary celebration in 2003, presenting a wreath on behalf of ENA. Returning to place a wreath overwhelming,’’ Rice said. ‘‘It’s always very emotional. Some


January 2014

of the remembrances kind of wash over you and warm your heart.’’ Rice gets overwhelmed when she thinks about the women veterans who were unable to attend the celebration. ‘‘There are a tremendous amount of women that the memorial symbolizes and represents,’’ she said. ‘‘There are all sorts of women who have served their country in some of the darkest times and areas. The Vietnam Women’s Memorial isn’t all about nurses who were stationed in Vietnam. It’s about nurses who have served in the military around the world.’’ Brecher said she felt honored to attend the celebration with McMahon and Rice. ‘‘I am humbled to be here on this Veterans Day and to be able to pay tribute to those nurses and to all our Vietnam veterans,’’ she said. ‘‘Our country will never forget their sacrifice.’’ In the midst of the celebration, McMahon and Rice embraced, talked, connected and posed for photos with other veterans, including Diane Carlson Evans, a former Army nurse and the founder and chairwoman of the Vietnam Women’s Memorial Foundation. McMahon also came across several people who served in the same place where she served in Vietnam. McMahon looked around at the growing crowd of visitors surrounding the memorial to pay their respects. ‘‘It’s wonderful to see so many different groups honored. It’s nice to connect with people who served in Vietnam,’’ she said. ‘‘The whole experience was very powerful to me. It brings back sad memories of the sacrifices. It’s hard, but I am very honored and grateful that ENA has supported us and invited us to participate in the celebration. It’s wonderful that we were able to attend on behalf of ENA to place the wreath.’’

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Define Yourself and Watch Doors Open By Kendra Y. Mims, ENA Connection


eople often recognize and associate companies based on their brand, whether it’s a ‘‘golden arches’’ logo, a revolutionized coffeehouse experience or a mission to find cures for children with cancer and diseases through research and treatment. Career experts recommend that working professionals follow the lead of companies that have created powerful brands by building a personal brand to get ahead in their careers, regardless of the industry. In an article for Nursing Critical Care, career coach Rod Colón said branding asks the following question: “What is it about you that is unique?’’ ‘‘Either no one else does it, or no one does it better than you,’’ Colón writes. ‘‘When you have that answer, you have the beginning of a powerful personal brand.’’ As you focus on creating your nursing brand and the type of image you want to project, ask yourself what skills and qualities set you apart from others. As a direct caregiver, a nurse will have a brand directly related to the quality or value of his or her patient care and skills. ‘‘A personal brand helps you break away from the pack by telling


everyone who you are, what you do, how you do it and what makes you different from everyone else — in other words, how you create value and benefit in a way that no one else can,’’ Colón writes.

Create a Name for Yourself Do people know you for going above and beyond your job’s expectations or for doing the bare minimum? Your personal brand is based on your image, attitude, reputation, values, performance, talents and behavior. Some nurses may be branded as sharks or bullies, while others may be branded as leaders or educators. Nurse Together describes a personal brand as ‘‘a perception or emotion maintained by an experience’’ as well as ‘‘what you promise to others, including your loved ones, friends and colleagues. It is a consistent message of what you stand for and the actions that others associate with you.’’ Nurse Together encourages nurses, before building a personal brand, to clarify a vision for themselves: How do you want people to perceive you? What do you want to do with the rest of your life? What are your passions? Once you determine your passion and your goals, you are ready to name your brand.

Ways to Build a Positive Brand Creating an authentic and positive personal career brand can open up opportunities, whether it’s through a promotion or landing the position you really want in your emergency nursing career. Here are some ways to develop your brand: • Determine your strengths and put your energy into improving them. Find ways to cultivate your strengths. • Go above and beyond your job’s expectations. • Network to connect and help others. Share valuable information such as solutions and best practices. • Invest in your professional development. Read, sign up for training to refresh your skills, take an ENA continuing education course and attend ENA conferences. • Use social media to enhance and bring recognition to your personal brand. References Colón, R. (2012). Run your nursing career like a business. Nursing Critical Care, 7  (3), 22–26. Gokenbach, V. (2013, August 15). Create your nursing brand to improve professionalism. Retrieved from http://

January 2014

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Lisa Wolf, PhD, RN, CEN, FAEN, Director of the ENA Institute for Emergency Nursing Research

Research Nursing as a Defined Role A

s a new graduate nurse in a glutted market in 1996, I   took a job in clinical research rather than in an acutecare setting. I was a second-degree student, and the idea of research (and more books and things I could look up in them) was pretty enticing. Plus, it was a weekday, regularhours kind of job. I started at Massachusetts General Hospital in the neuroendocrine unit. It was very interesting work — I got to participate in some cutting-edge clinical treatments, deal with unusual patient populations and attend lectures at a worldrenowned institution. Although there were deadlines, there was no frantic pace of acute-care nursing or the overwhelming workload of the skilled-nursing facilities where my classmates were working. After a year in that position, I worked at another Harvard facility, the Joslin Diabetes Center in Boston, doing similar types of studies. Finally, I moved to New York and worked at the Berrie Diabetes Center at Columbia University. At the time, nobody really had defined the role of the research nurse, and the lines were indistinct between research assistants (who were mostly recent college graduates hoping to go to medical school) and research nurses. Over the last 20 years, there has been some significant work done in terms of defining the role of what is now considered a specialty. There is no stated educational requirement for clinical research nursing, but a scan of job postings online indicates that while a bachelor’s degree is preferred, it is not a requirement. A license to practice and some experience seem to be acceptable in many job postings. Because it’s important to be familiar with the research process, you may not have enough education in research until you have completed a bachelor’s degree; depending on the job, a master’s degree with additional training may also be desirable. There is an opportunity to become certified in the clinical research nurse role at some colleges and universities, 1,2 with the potential at some point for a national certification process. The NIH Role Delineation Project 3 described five distinct categories of activities within the practice of research nursing:


Clinical Practice Dimension: Provision of direct nursing care and support, using the nursing process, to participants in clinical research, their families and significant others. Care requirements are determined by the scope of study participation, the clinical condition of the patient and the requirements and clinical effects of research procedures. Examples of this dimension include activities such as initial physical and historical assessment of patients for inclusion in the trial and the nursing care that’s provided during the course of the study. This can be done in either inpatient or outpatient settings. Study Management Dimension: Management of clinical and research support activities in order to assure patient safety, address clinical needs and assure protocol integrity and accurate data collection. In practice, this means that at each visit, the nurse assesses the patient and adherence with any protocols, including medications or devices. Any surveys or evaluations that the patient or nurse completes are the responsibility of the nurse. Care Coordination and Continuity Dimension: Coordination of research and clinical activities to meet clinical needs, complete study requirements and manage

linkage with referring and primary care providers. This is an important advocacy piece. The nurse assesses the patient at each visit, and if any medical or psychosocial issues are noted, it is the responsibility of the nurse to advocate for follow-up care for the patient. Human Subjects Protection Dimension: Facilitation of informed participation by diverse participants in clinical research. This activity is foundational for research. The research nurse makes sure the patient 1) is able to read, 2) is able to read in the language the informed consent is written in and 3) makes arrangements for alternate means of conveying the information if the patient does not read English. If there are no observed literacy issues, the nurse makes sure that the participant has had the opportunity to read the informed consent. It is absolutely critical that the nurse is supportive of the patient’s decision around participation and makes sure the patient understands that his or her consent is revocable. Contributing to the Science Dimension: Contribution as a research team member to the development of new ideas for study, explorations of innovations arising for clinical research findings to practice. Working as part of a research team can provide insight into how ideas for studies are generated, as well as who benefits most from the answers. You will become more critical in your appraisal of information because you’ll know how it was generated and interpreted. The role of the clinical research nurse serves to humanize what can be a protocol-focused experience for the patient. It’s important to maintain the holistic perspective of nursing and continue to advocate for patients throughout the process. This type of nursing gives you access to new information all the time; it’s fascinating work and allows you to provide individual attention to patients throughout the course of their participation. References 1. Boston College Continuing Education. (2013, August 14). Clinical research certificate. Retrieved from content/bc/schools/son/ce/clinical_research.html 2. University of Michigan School of Nursing. (n.d.). Clinical research management certificate program. Retrieved from http:// clinical-research-management-certificate 3. Harvard Catalyst Clinical Research Center. (n.d.). Research nursing: Information for research nurses. Retrieved from http://catalyst.

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Official Magazine of the Emergency Nurses Association



What inspired you to become an emergency nurse? Choosing a career path can be an exciting and challenging decision. While some people know exactly what they want to do at a young age, others may not discover their path until years later. Everyone’s is different and unique, as illustrated by these five ENA members who shared what led them to become emergency nurses.

Jontue’ Hinnant, BSN, BA, RN, Duke University Hospital, Durham, N.C. How long have you been an emergency nurse? I have been an emergency nurse since July 2010 in a Level 1 trauma center.

Why did you choose to become an emergency nurse? My father is a police officer, and many members of my family have been service members. I’m sure this has contributed to my desire to serve the public. I also like to believe that my work and life experiences, as well as my desire to make a difference, led me to become a nurse. As it relates to becoming an emergency nurse, that decision was made based on my clinical experience during nursing school. While working in the Duke ED as a student, I was introduced to the true definition of teamwork, cohesion and strong sense of family within this discipline of nursing. I like to say that I did not choose nursing, but instead nursing chose me.

What are some valuable lessons that you learned so far? The most valuable lessons that I have learned so far are the value of teamwork, the importance of dependability and the necessity of integrity and critical thinking.

What do you enjoy most about your career? I love the people that I work with the most — the emergency medicine team (nurses, techs, physicians, respiratory therapists, social workers, patient visitor relations, everyone). Without the team, we would not successfully provide quality care to our patients. The patients are the reason our profession exists. I also love the endless learning opportunities due to the vast versatility of patient populations and disease processes.

What career advice would you offer to incoming emergency nurses? I would advise incoming emergency nurses to be receptive to constant change and abundant learning. Most important, I advise them to enjoy the experience, actively participate in professional organizations and play an active role in committees and initiatives within their departments. They should embrace the profession and all that it offers.

Robin Walsh, BSN, RN, Clinical Nurse Manager,

Walk-In Care, University Health Services, UMass/Amherst, Amherst, Mass. How long have you been an emergency nurse? I started working in the emergency department in 1991.

Why did you choose to become an emergency nurse? I began my nursing career in critical care with the plan to move to the ED. The challenges and constant change are what drew me to both of these positions. I like the teamwork, the need to be actively involved in patient’s evaluation, treatment and diagnosis. I like the autonomy in both areas, and I especially like that no two days are ever the same. Each day, each patient is a new opportunity to learn and grow.

What are some valuable lessons that you learned so far? • You have to listen to be a good nurse, especially for things that the patient may not be actually saying but trying to convey to you. • You must have patience. You need to push past frustrations to put yourself in the patient’s shoes and understand their experience.

• Just because it makes sense to you does not mean it makes sense to everyone else.

What do you enjoy most about your career? I learn something new every day.

What career advice would you offer to incoming emergency nurses? • Take advantage of every opportunity to learn. • Find a mentor. • Take care of yourself — take a five-minute break or even two minutes to regroup when things are crazy. Exercise. Make the time — you will never regret it. Eat healthy snacks. Sleep. Learn to say ‘‘no’’ to overtime. Know when you can — physically and emotionally — and when you can’t.

Official Magazine of the Emergency Nurses Association


Alison Day, MS, RN, Senior Lecturer in Emergency Nursing, Coventry University, Coventry, England

How long have you been an emergency nurse? Sixteen years.

Why did you choose to become an emergency nurse? Nursing was my chosen career from around 4 years of age. I have a picture of me as a child in a nursing uniform. While most children play ‘‘nurse,’’ for me it was always my goal. A major influence was my grandparents (both nurses), and I would sometimes accompany my Nan to work. My first job as an RN was on an emergency medical admissions ward. I loved the diversity and pace of the acutely ill. From there I applied for and obtained my first job in an emergency department.

What are some valuable lessons that you learned so far? • Patients seem to teach me lessons when I most need them. Although it is a cliché, life is short and precarious; always tell your loved ones that you love them. • Teamwork and your colleagues make a huge difference. A challenging shift with a top-class team of nurses is bearable, whereas a regular shift with an ineffective team can be a nightmare! • You will never know everything. Accept that! Acknowledge your weak areas and ask for support when needed. • Having worked abroad and traveled extensively, individual and organizational health care issues have many commonalities throughout the world.

What do you enjoy most about your career? I am a people person and thrive from human interaction.

What career advice would you offer to incoming emergency nurses? • There is a diversity of areas that emergency nurses can work in (I currently work in education), but whether in clinical practice, management, research, education or any of the other areas, always keep the patient central in your thought process and think what is best for them. • Actively seek out mentors and role models. Watch and learn how they communicate with patients, colleagues and management. Model your behavior and then become a role model yourself. • If you are having a bad shift, speak up. Colleagues are happy to support you, but they need to know that you need support. • Go to conferences/events and network. Introduce yourself. Push your personal boundaries. I used to attend conference sessions where I knew a little about the subject area and felt comfortable. Now I attend totally different sessions and learn so much more. There is always something to learn and information is always transferable.

Hershaw Davis Jr., MSN, RN,

University of Virginia Hospital, Charlottesville, Va., and Johns Hopkins Hospital, Baltimore How long have you been an emergency nurse? Three years.

Why did you choose to become an emergency nurse? I chose to become an emergency nurse while working as a CNA. I was allowed to float to different units as a CNA working on night shift in a local community hospital. I fell in love with the emergency department. I enjoyed the pace, patient population and diversity.

What are some valuable lessons that you learned so far? • Treat your patients with the same respect as you would want your family to receive if they were a patient. • Seek new challenges and education to keep your passion engaged.


• Every patient and illness has a story. Take the time to listen.

What do you enjoy most about your career? People and learning. Every shift in the ED is a new chance to contribute to humanity. I’ve learned some of my greatest life lessons from my patients and co-workers.

What career advice would you offer to incoming emergency nurses? • The ED is like art. Everyone has their own interpretation. It is up to you to interpret your experiences based upon your own perceptions. • Keep an open mind. You will be surprised where your career can take you.

January 2014

Nicoli “Nicki” Carlton, BSN, RN, CEN, Instructor 2, Saint Joseph Medical Center Emergency Department, Kansas City, Mo.

Explore exciting nursing opportunities as we build the team to open our new hospital!

How long have you been an emergency nurse? Almost 37 years. I am 73 years old and still working and able to share knowledge with my students.

Why did you choose to become an emergency nurse? I had always wanted to be a pediatrician but got married at 18 and started a family with four children instead. Having four children, we visited the ER on several occasions, and I really was impressed with the nurses. That made up my mind, and when my baby started kindergarten, I started nursing school.

What are some valuable lessons that you learned so far? • Be compassionate and caring as you are working with patients and families; really listen to what they are saying. • Keep current with information and education. It is ongoing and necessary. • Be a mentor and willing to assist and teach the new nurses.

What do you enjoy most about your career? I began as a patient-care tech, then had the opportunities to become the educator for the department, then the assistant to the manager, then the manager and consequently the director of the department. I have really enjoyed the people I work with and the type of work I do. I love to teach and share information with the staff. I am an ENPC, TNCC, ACLS and hazardous material instructor for our ED and also for other departments within our hospital.

All we need is you.

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Emergency Department RNs

Ask about our sign-on bonus & relocation! It’s exciting to be a part of one of the world’s leading academic medical centers. Here you’ll find a team-oriented ED with supportive leadership that provides a collaborative learning environment for nurses. • Award-winning nursing staff • Busy ED with more than 36,000 visits a year • Certified Stroke Unit • World-class medical and scientific faculty, including 5 Nobel Laureates • One of the nation’s leading academic medical centers, with 13 specialties earning national recognition from U.S. News & World Report for 2013-14 Join us in Dallas for affordable housing, great schools and no state income tax!

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What career advice would you offer to incoming emergency nurses? Keep calm and have an open mind in all situations. Listen to your preceptors and pick the brains of those around you. It is amazing what you can learn.

Dallas, Texas UT Southwestern is an Affirmative Action/Equal Opportunity Employer.

Official Magazine of the Emergency Nurses Association


FUTURE OF YOUR NURSING | Bridget Walsh, Chief Talent Officer

Let’s Set Your 2014 Career Goals T

  he confetti is cleaned up, the toasts have been made, and it’s time to put plans in place to accomplish your New Year’s resolutions. It’s also time to conduct your annual career checkup and make new professional goals for the coming year. Have you given thought to a new professional goal, but you’re not sure how to get started? Here are a few tips to help you on that journey. 1. Assess recent accomplishments and determine what you’d like to accomplish in the coming year. You should always have both short- and long-term professional goals and a plan to help you accomplish those goals. 2. Update or create your professional profile. If your goal is to

find a new job, apply for a promotion with your current employer, apply to graduate school or volunteer for a work team or committee, you will need an updated professional history. Committing to updating your professional profile at least once a year means you’ll always have a current document whenever you need it. 3. Visit ENA’s Career Wellness resource page. This page contains career wellness resources and the ability

to create and maintain your professional profile. You can update a résumé or CV, create a professional summary and track your professional accomplishments. You have the ability to personalize the setting for your profile in the career center. You can create a private profile that only you see, a confidential profile that potential employers can see without your personal information or a completely viewable profile. These settings can be modified at any time, depending on your professional goals. As your professional organization, ENA is committed to helping you accomplish your professional goals. For more resources and information, visit the career wellness page at www.ena. org/careerwellness or e-mail

Does your career need a shot in the arm? Visit Career Wellness for a booster!

• Motivational Articles

• Job Postings

• Resume Tools

• Advancement Strategies

ENA provides free tools and services to help members grow their careers and meet their full potential. 18

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January 2014

Sacramento, ca

Emergency Medicine Department Positions

UC Davis Medical Center provides Level 1 adult and pediatric trauma care for more than 33 of California’s 58 counties. UC Davis Medical Center is home to state-of-the-art emergency care for children. Our Pediatric Emergency Department features the only Level 1 pediatric trauma center in inland Northern California (verified by the American College of Surgeons). From Portland to Fresno, from outside the Bay Area to Reno, no other hospital in inland Northern California has a Level 1 adult and pediatric trauma center servicing approximately 60,000 patients each year. For more information about positions in our Emergency Medicine Department, please visit UC Davis Health System is an EEO/AA employer

Official Magazine of the Emergency Nurses Association



Your Year

Steps You Can Take to Ensure 2014 Goals Are Met

By Kendra Y. Mims, ENA Connection


oin a gym. Lose weight. Spend more time with family. Save money. Apply for a new position. Take a much-needed vacation. Statistics show about 45 percent of Americans make New Year’s resolutions, but the percentage of those who maintain them decreases drastically every week after Jan 1.1 No matter what your goals are for 2014, the new year is the perfect opportunity to get refocused and re-energized and to make lifestyle changes to maximize your potential. Here are ways to maintain the most popular New Year’s resolutions.

Use Your Career Resources Are you ready to make a change in your career or go after the position you really want? Take advantage of ENA’s Career Center (, where you can build a professional profile and résumé for prospective employers and search through hundreds of job opportunities. You’ll also find career wellness resources, such as tip sheets and Web seminars to help you take your career to the next level. Don’t leave the career center without taking your annual career checkup test, which will encourage you to reflect upon the last year, set specific career goals for this year, develop a plan and use the right equipment and connections to reach your professional goals.

Manage Stress As an emergency nurse, you never know what situations you may encounter day to day. Compassion fatigue, burnout and stress are not uncommon in the nursing profession because of long hours, nursing shortages and workload. Although you spend the majority of your time taking care of others, it is important to take care of yourself and find ways to de-stress. Nurse Together recommends these simple stress busters: • Take deep breaths and practice breathing exercises to relieve stress.


• Spend five minutes in nature every day. Go outdoors before work or while on a break. Take a quick scenic walk or the scenic route on your drive home. • Pause for five seconds and gather your thoughts before responding to a request to avoid taking on more than you can handle. • Create a journal and jot down your thoughts and emotions, whether positive or negative, on a daily basis. Here are some other proactive ways to manage your daily stress: • Talk to a trusted colleague, family member or friend. • Engage in activities outside of work that you enjoy, even if it’s only for 20 minutes (e.g., crossword puzzles, reading, listening to music, meditation/prayer). • Take a 15-minute break each day for personal time. • Get some rest.

Develop Healthful Lifestyle Habits The Physical Activity Guidelines for Americans

recommends 30 minutes of physical activity a day for adults, but less than 20 percent of adults meet this requirement.2 Data shows obesity has doubled among adults since the early 1970s.2 If losing weight or becoming fit is a goal, making small changes on a daily basis can make a difference throughout the year. Add more steps to your daily routine by taking the stairs instead of the elevator or parking farther away. Challenge your colleagues to join you in meeting a weekly fitness goal and encourage each other to take lunch breaks. Opt for healthier diet choices such as increasing your water intake, limiting sodium, replacing processed foods with whole foods and bringing healthy snacks to work (e.g., almonds, apples or chopped veggies with salsa).

Learn Something New Is there a language you’ve always wanted to learn or a subject that

Remember that one thing that you’ve always wanted to do? Instead of focusing on the complexity or magnitude of the goal, start this year off by creating small steps to get closer to achieving it, even if you don’t foresee yourself completing it by the end of this year. intrigues you? Add some excitement to your life this year by challenging yourself to learn something new, whether it is personal or professional. Carve out a few moments to read, or listen to an audiobook while driving to work. Refresh your skills by attending the 2014 ENA Leadership Conference in Phoenix, sign up for a training class or visit ENA’s online learning center to take advantage of the e-learning opportunities (including free continuing education offerings for members). If your goal is to increase your knowledge by continuing your education, consider applying for an ENA Foundation academic or professional development scholarship, which can help emergency nurses enhance their practice and profession. (Check out the

2014 ENA Foundation academic scholarships on page 26.) References 1. University of Scranton. (2012, December 13). New Years resolution statistics. Retrieved from http://www. 2. President’s Council on Fitness, Sports & Nutrition. (n.d.). Facts and statistics. Retrieved from resource-center/facts-and-statistics 3. Wisniewski, L. (2013, July 9). 5 simple nursing stress busters with big results. Retrieved from http://www.

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§ 17 Modules

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§ Geriatric Statistical Data

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

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Official Magazine of the Emergency Nurses Association

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

Could I Be a Pediatric Emergency Nurse? A

bout 17 years ago when I was in   nursing school, a group of classmates and I attended a nursing conference in Wilmington, N.C., where ENA was hosting a booth. This was my first exposure to ENA. I remember approaching the booth and thinking, ‘‘Emergency nursing would be so interesting, but there is no way I would be able to handle that — it would be too intimidating, too chaotic.’’ I had decided I wanted to be a pediatric nurse but didn’t envision myself working in an emergency department. Despite my apprehension, I approached the ENA representative and struck up a conversation to learn more about her profession. I distinctly remember the spark in the ENA member’s eyes as she described her career as an emergency nurse. Her energy and passion were contagious. She encouraged me to consider a career in emergency nursing. After graduation, I worked as a pediatric nurse in several settings: outpatient, inpatient and home health. Although each setting brought its own unique set of rewards, I realized I was searching for something different. That was when I recalled my conversation with the ENA member. She had ignited an interest in emergency nursing that had never gone away. Once I had a few years of nursing experience, I decided that I had the courage to try it. A position in a pediatric ED provided the perfect opportunity for me to combine my pediatric experience with my interest in emergency nursing. That was more than 10 years ago, and I have never looked back.


Pediatric emergency nurses are often asked, ‘‘How do you deal with seeing children sick, injured, even dying?’’ Sometimes the underlying assumption seems to be that we are immune to these situations. The truth is that most children get better. In fact, data from the Agency for Healthcare Research and Quality show that the vast majority (96 percent) of children ages 0 to 17 who visit the ED in community hospitals are treated and released.1 By contrast, a similar report by the same agency found that about 79 percent of adult ED patients in community hospitals are treated and released. 2 As with adults, the rewarding moments far outnumber the sad ones. Children are extremely resilient. Even difficult situations can include meaningful, rewarding moments that can help sustain a pediatric emergency nurse’s passion for his or

her profession. Children are also very forgiving. In 10 years of pediatric emergency experience, most children who leave our department — despite having had IVs, catheterizations or other unpleasant procedures — leave smiling. Many thank us for helping them get better. Pediatric patients (generally defined as patients up to age 17) represent about 25 percent of community ED visits nationwide.1 Pediatric emergency nursing doesn’t require a specific personality or a specific type of ED. It does require the desire to be prepared to provide developmentally appropriate, safe care to this population. Pediatric emergency nursing includes a willingness to advocate for children in every step of their care. A few simple examples of how we can all help to optimize pediatric ED care are by actively seeking out methods by which to decrease their pain and anxiety in the least invasive method possible (using topical numbing agents when appropriate before suturing wounds and starting IVs, offering age-appropriate activities for distraction), double-checking medication orders to ensure they are appropriate for the child’s weight in kilograms, using ‘‘soft language’’ (see chart on facing page) and getting down on their level when communicating. Pediatric emergency nurses have a passion for helping children through difficult situations and reap the rewards of seeing most of their patients emerge on the other side, healthier and happier.

January 2014



1. Wier, L. M, Hao, Y, Owens, P. L., & Washington, R. (2013, June). Overview of children in the emergency department, 2010 [HCUP statistical brief #157]. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from http://www.hcup-us.

IV IV or intravenous catheter

2. Owens, P. L., & Mutter, R. (2010, November). Emergency department visits for adults in community hospitals, 2008 [HCUP statistical brief #100]. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from statbriefs/sb100.pdf

WakeMed Health & Hospitals. (n.d.). Preparing your child for procedures and surgery. Retrieved from http:// Offers tips on preparing the child for medical procedures and surgery. Includes suggested language, positioning and distraction methods.

Hard Language

Soft Language It stands for “in the vein.” It is a tiny plastic straw that is going to give you medicine and water while you are sick. Getting medicine this way makes a lot of kids feel better faster.

Blood pressure Take your blood pressure This is going to give your arm a strong hug for a few seconds, and then it will let go. Your job is to be very still. Sensation It will burn like a bee sting. of an injection

Warm, stinging, tingle

Shot Shot Medicine through a tiny needle or medicine given through the muscle in your arm Sedation Put you to sleep

Medicine you will get to help you sleep until the procedure is over

Surgical incision

A small opening

Cut open, slice, hole

Holding for a Hold you down procedure

Give you a hug, hold your arm to remind you to stay still

Papoose Strap Soft seatbelt (or CT belt)



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Official Magazine of the Emergency Nurses Association

• Outpatient Care Centers • Emergency and Urgent Care Centers • Physical Therapy and Rehab Services • Flexible Schedules • Family Friendly Environment • Excellent Benefits, including 401(k) / 403(b)

EOE, M/F/D/V A Drug Free/Tobacco Free Workplace.



How to Make Your New Hires’ First Days Successful By Catherine Olson, MSN, RN, Director of the Institute for Quality, Safety and Injury Prevention


n effective onboarding process for newly hired registered nurses generally starts with information about the health care organization’s workplace culture and environment, as well as its overall mission, vision, values and policies. When new RNs move on to their designated departments, managers can help them get acclimated in their position and implement processes to enhance their orientation period, which can ultimately reduce RN turnover and improve RN retention. The following onboarding tips for department managers can help ensure a positive orientation experience for either new graduates or experienced emergency nurses.

General Tips for Managers • Choose preceptors wisely. They should be friendly, professional role models, excellent clinicians and, most important, must enjoy teaching.1 • Provide or facilitate training for preceptors that includes adult learning methods, constructive coaching and feedback, conflict management, policy/procedure review and patient safety initiatives.2 • Schedule an initial meeting with the staff member to discuss the orientation process and expectations. Schedule a follow-up meeting midway through to discuss progress — this gives both you and the orientee an opportunity to share what is going well with his or her orientation as well as any concerns. Another meeting at the end should help determine if the orientee will be released on to his/her


own or if remedial time is necessary.3 • Provide the orientee with all the resources he or she needs to be successful. Let them know to come to you or the unit educator for any concerns they may have with their preceptor or the orientation process. 3 • Let orientees know they are in control of their orientation through active participation. Some ways they can take charge of their own success are by adhering to their individual orientation schedule, keeping track of their progress, asking questions of their preceptor or other designated resources to clarify information and engaging in orientation follow-up meetings. • Orientees should spend a good portion of their orientation on the shift

they will be working so they can get to know their peers and develop a feel for the workflow of that shift. • Take the preceptor’s concerns seriously. If he or she is uncomfortable with their orientee’s progress or ability to integrate, you will need to investigate. • Give preceptors a break. If there are only one or two preceptors (depending on your resources) doing all the training without a break between orientees, they surely will experience burnout and not be as effective. • Keep your charge nurses informed of who is on/off orientation and ask for their input as well. • When new staff are released from orientation, ask current staff to continue supporting them during the transition phase as they take on more patients and acuity.3

New Graduates • Provide them with a peer ‘‘buddy’’ who is not their preceptor — someone who can help them integrate into the unit culture by introducing them to other staff, taking them out for coffee or a meal, helping them find their way around the unit and facility, etc. 1,3 • Consider using a comprehensive, evidence-based orientation program such as ENA’s Emergency Nursing Orientation 2.0.4 This e-learning program is both didactic and interactive with Web-based learning activities and case studies for critical thinking in each section. It is available from Mosby’s Nursing Suite at tinyurl. com/nohmky9 .

January 2014

• Work with clinical nurse specialists and educators to implement a nurse residency program that is based on a novice-to-expert approach.1 • Remind preceptors that new grads will not progress as quickly as their experienced emergency nurse counterparts. Patience is key, as they have not fully developed their critical thinking skills.5 • Encourage preceptors to ask, ‘‘Why?’’ ‘‘Why would you do that procedure?” “Why does that patient need that medication?” This process can help to develop a new grad’s critical thinking skills and ability to ask the right questions when he or she is unsure about a physician order or other directive.5 • Make sure preceptors frequently emphasize regulatory/accreditation standards, policies and procedures throughout the orientation process to help develop the new grad orientee’s focus on quality and safety in a busy

ED environment.4,5 • Monitor staff behaviors. Nothing will discourage a new grad more than horizontal violence or bullying. Hold your staff accountable to zerotolerance policies. They should be reminded to support all new orientees as they would want to be supported. 3,6 References 1. Glynn, P., & Silva, S. (2013). Meeting the needs of new graduates in the emergency department: A qualitative study evaluating a new graduate internship program. Journal of Emergency Nursing, 39(2), 173–178. 2. Ulrich, B. T. (2011). The preceptor role. In Mastering precepting: A nurses handbook for success (pp. 1–16). Indianapolis, IN: Sigma Theta Tau International. 3. Twibell, R., St. Pierre, J., Johnson, D., Barton, D., Davis, C., Kidd, M., & Rook, G. (2012). Tripping over the welcome mat: Why nurses don’t stay

and what the evidence says we can do about it. American Nurse Today, 7 (6). Retrieved from http://www. aspx?id=9168 4. Emergency Nurses Association. (2011, July). Emergency registered nurse orientation [position statement]. Retrieved from SiteCollectionDocuments/Position%20 Statements/EmergencyNursing Orientation.pdf 5. Saintsing, D., Gibson, L. M., & Pennington, A. W. (2011). The novice nurse and clinical decision-making: How to avoid errors. Journal of Nursing Management, 19, 354–359. 6. Emergency Nurses Association. (2013, March). Healthy work environment [position statement]. Retrieved from SiteCollectionDocuments/Position%20 Statements/HEALTHYWORK ENVIRONMENT.pdf

The ENA Lantern Award Celebrates Outstanding Emergency Departments.



nt 2014-20


We recognize exceptional performance and innovative practice in the following areas: ª ª ª ª ª

Advocacy Education Leadership Practice Research

We invite your Emergency Department to apply for this distinguished award. Applications accepted through February 26, 2014. Please follow the application guidelines on the website

Development of the Lantern Award program criteria funded in part by

ENA Strategic Sponsor

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Official Magazine of the Emergency Nurses Association

10/18/13 2:27 PM



Aim Higher With Scholarship and Research Grant Opportunities


  he new year is an exciting time to explore goals, revisit lifelong dreams and seek out stimulating opportunities. Whether you have recently returned to school to advance your education or have a desire to pursue research projects related to the discipline of emergency nursing, let the ENA Foundation help you achieve your professional development goals in 2014 and take your career to the next level. The mission of the ENA Foundation, established in 1991, is to provide educational scholarships and research grants in the discipline of emergency nursing — a mission it achieves by accepting contributions to fund academic scholarships and continuing education and research grants. During the last 23 years, the ENA Foundation has supported hundreds

2014 Academic Scholarships NON-RN CATEGORY

of emergency nurses through more than $2 million in scholarships and research grants. The ENA Foundation 2014 scholarship and research grants are listed here. If you are interested in these opportunities, visit to explore what the ENA Foundation has to offer and to learn about the scholarship and research grant qualifications. The application deadline for all scholarships is June 1, 2014. Program funding would not be possible without the generous contributions from ENA members, state councils, chapters, corporations and friends of emergency nursing. If you would like to help emergency nurses further their education and advance the profession, please visit to give your best donation.

Vidacare Scholarship ♦ One at $5,000

New York State ENA September 11 Scholarship ♦ Two at $2,500 each

Antoinette Robinson Scholarship Mary Kamienski Scholarship (California) (Northern Chapter-NJ) ♦ One at $5,000 ♦ One at $5,000

ENA Foundation Scholarship for Emergency Department Employees ♦ Two at $2,500 each

Colorado Aurora Shooting Victims and Care Providers Scholarship ♦ One at $5,000

Jeannette Ash Memorial Scholarship (West Central Chapter-NJ) ♦ One at $5,000

Georgia State Council Scholarship ♦ One at $5,000

The Survivor Scholarship (South Carolina) ♦ One at $5,000


Illinois State Council Scholarship Charles Kunz Memorial Undergraduate ♦ One at $5,000 Scholarship ♦ One at $3,000 Kentucky ENA Founders Scholarship ♦ One at $5,000 GRADUATE/MASTER CATEGORY Judith C. Kelleher Memorial Scholarship ♦ One at $5,000 Stryker Scholarship – Masters in Healthcare ♦ One at $5,000


New Jersey State Scholarship ♦ One at $5,000

Maryland ENA State Scholarship ♦ One at $5,000 Michigan State Council Scholarship ♦ One at $5,000 Pathways “VI” Scholarship (Minnesota) ♦ One at $5,000

Brent Lemonds Memorial Scholarship (Tennessee) ♦ One at $5,000 Vicki Patrick Texas Legacy Scholarship (Texas) ♦ One at $5,000 ENA Foundation State Challenge Scholarship ♦ Five at $5,000 each Physio-Control Inc. Scholarship ♦ Two at $3,000 each

January 2014

Gisness Advance Practice Scholarship ♦ One at $3,000 Karen O’Neil Memorial Scholarship ♦ One at $3,000 DOCTORAL CATEGORY Pamela Stinson Kidd Memorial Scholarship ♦ One at $10,000 ENA Foundation Doctoral Scholarship ♦ Three at $5,000 each Hill-Rom Doctoral Scholarship ♦ Two at $4,000 each

Annual Conference Scholarships ♦ 20 at $500 each

Become an ENA Foundation Facebook Fan Are you a fan of the ENA Foundation’s Facebook page? If not, go to Facebook and search “ENA Foundation to “like” us and get plugged into the exciting opportunities that the ENA Foundation has to offer. Visit our Facebook page to discover opportunities for research grants and continuing education and academic scholarships that can advance your emergency nursing career. Becoming a fan also gives you exclusive access to learn about our latest news and events.

2014 Research Grants Emergency Medicine Foundation/ENA Foundation Team Research Grant ♦ One at $50,000 ENA Foundation/ Sigma Theta Tau International Research Grant ♦ One at $6,000 ENA Foundation/ANIA-Caring Research Grant ♦ One at $6,000

2014 Continuing Education Scholarships

Industry-Supported Research Grant – Sponsored by Stryker ♦ One at $5,000

Leadership Tapestry Scholarships ♦ 10 at $1,000 each

ENA Foundation Seed Research Grants ♦ 10 at $500 each

Coming in Early 2014 SEVENTH EDITION Highlights Include: § Initial Assessment § New Chapters Teamwork and Trauma Care, Pain, The Bariatric Trauma Patient, Interpersonal Violence, and Post Resuscitation Care in the ED § Evidence-based Practice Balanced fluid resuscitation, blood component transfusion, and tourniquet use

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

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Official Magazine of the Emergency Nurses Association

11/26/13 10:16 AM


28 41 55 68 %

Average improvement in throughput for admitted and discharged patients


Average improvement in time from arrival to seeing a physician.


Typical improvement in patient satisfaction scores and likelihood to recommend

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


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

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

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

Senior Consultant Blue Jay Consulting, LLC

ENA Connection January 2014  

ENA Connection January 2014

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