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the Official Magazine of the Emergency Nurses Association


January 2013 Volume 37, Issue 1


Oh, the Places You’ll Grow Keep ENA By Your Side During Your Career Climb in Emergency Nursing Stories From Forensics, Flight Nursing and More


JoAnn Lazarus, MSN, RN, CEN

There’s a New Word For Our Role: Advocatism The definition of an advocate is a person who pleads for or on behalf of another; ‘‘ism’’ indicates an action, process or result. Therefore, ‘‘advocatism’’ is my word for what we do for our patients and for the profession of emergency nursing. Whether it’s bringing a potential medication error to the physician’s attention, helping others hear a patient’s voice or shaping policy by speaking to our legislative representatives, advocating for our profession and our patients is our role as emergency nurses. Our role as an advocate for our patients begins the minute they arrive in our emergency department. Emergency departments are scary and confusing places for our patients and their families. It is our responsibility to minimize some of this by focusing on the patient’s experience, communication and educational needs. As nurses, we must help the patients understand the tests and procedures the physicians order. We should make them aware of

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

the time it will take for these tests or procedures to be completed, and we should educate them on the rationale for these tests and procedures.

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We continue to act as the interpreter and liaison throughout the patient’s stay. Without us to translate the patient’s circumstances into understandable and acceptable terms, patients would not only be confused, but terrified. The patient’s medical, psychological and emotional care is our responsibility. At times, especially in this current health care environment, this may be an overwhelming task. Florence Nightingale was the first nurse to advocate for patient rights and for our rights as nurses. She is credited with establishing nursing as a profession rather than a domestic service. We still need to help others see the importance and value of what we do as nurses. There are simple things that we can do to demonstrate that our knowledge and education are critical to the care of our patients. Our actions, language and appearance must be professional at all times. We

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

Continued on page 7

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


Bridget Walsh, Chief Talent Officer

To Enrich Your Career, Enrich Someone Else’s January is traditionally the time of year when we reflect upon our lives and set new goals. We start the year with enthusiasm, dedication and a renewed commitment to better ourselves. This January, I challenge you to reflect upon your accomplishments, skills and experiences and see how you can pay it forward. Contributing to the professional development of an emerging professional helps the individual gain experience, helps you expand your own experience and advance your career and contributes to the profession of emergency nursing. In her column, ENA 2013 President JoAnn Lazarus talks about ‘‘advocatism.’’ Advocating for the profession can take many forms, including contributing to the development of talented, educated nurses to lead the charge for change.

Mentoring an emerging professional can be both formal and informal. You may decide to take that new nurse on the team under your wing, helping him or her learn the ropes of your department and your hospital structure or talking him through a challenging patient situation. Investigate the formal methods for mentoring in your hospital, perhaps through serving as a preceptor or in other mentorship roles. You can take that commitment to paying it forward outside your workplace as well. Invite a colleague to join you at an ENA meeting, encourage her to participate on a committee or support her in running for a state or chapter office. Connect with a local nursing school and volunteer as a guest lecturer or as a resource for a nursing student.

You’ll find that by helping others with their professional development you will help yourself as well. Not only will you have a sense of pride in contributing to the development of another, you’ll also develop and refine skills that contribute to your own professional development. It might be just the extra push you need to take the next step in your own career. Track all your mentoring and coaching experiences, along with your career accomplishments and membership activities, in your professional profile in the ENA Career Center at You will have a fully updated career profile for when you are ready to take that next step. I hope there will be a fellow ENA member ready to pay it forward and mentor you.

Quick Tips: Nail That Interview The following are some commonly asked questions that nurses should be prepared to answer during a job interview, as well as questions to ask a potential employer.

Interview Questions That Nurses Should Ask a Potential Employer:

Standard Interview Questions Nurses Should Be Prepared to Answer:

• Is there support staff on the unit to assist nurses?

• How would you describe your skills as a team player? • How will you deal with difficult doctors? • How will you deal with difficult patients and/or their families? • How will you handle unexpected circumstances, such as being short-staffed and having to perform a treatment you have not done before? • What was your best and worst patient experience?

• What is the nurse-to-patient ratio? • In what ways are nurses held accountable for high qualities of practice? • How much input do nurses have regarding systems, equipment and the care environment? • What professional development opportunities are available to nurses? Author: Sandy Watkins, Strategic Healthcare Staffing. Reprinted with permission.

Official Magazine of the Emergency Nurses Association


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

Why We Love It, In Our Own Words Children are amazingly resilient. Those of us who work with children in the emergency setting help most of our patients recover from what ails them and watch them walk out smiling. This provides a great deal of instant gratification. Every day is new and completely unpredictable, and every shift brings endless possibilities as to what we might encounter. In the same day, we may teach a new mother how to care for her infant, give a hemophiliac toddler his Factor VIII so he does not hemorrhage after a fall, sedate a preschooler so that his broken arm can be mended, relieve the pain of a child suffering from a sickle cell pain crisis, provide IV hydration for a dehydrated child and take care of a child who has fallen out of a secondstory window. We also care for many older pediatric patients — the teenagers — who tend to be more like big kids than little adults. Some teen patients have had children of their own before they are able to legally drive. They often confront adult issues with child-like naiveté. With developmentally appropriate care, we can help meet their adult needs on a level appropriate for them. These are just some of the reasons why I love pediatric emergency nursing. In November, I asked other ENA members (through Facebook) why they loved pediatric emergency nursing. The following are some of their responses: Milly Glauer (who was taking care of a scared, tearful 7-year-old boy who


The ED staff at Cooley-Dickinson Hospital (Northampton, Mass.) is “ready and happy to take care of pediatric patients,” said team educator and photographer Lorettajo Kapinos, RN (ENA member). From left to right: Jessica Menard, RN; Corine Langevin, RN; Nick Hebert, CNA; Barb Tenanes, LPN; Steven Coughlin, RN (ENA member); and Sharon Duval, RN. wasn’t cooperating as she tried to apply cardiac leads for monitoring and an EKG): EKG leads are so scary [to some kids]! Out of desperation to calm him, I touched the jelly on the leads, gave him a piece, giggled and told him it felt funny, kind of like boogers. He took the jelly, calmed down, and I was quickly able to monitor him. After that, he stayed calm for his treatment! Lorettajo Kapinos: I cared for a 5-year-old brought in by her grandfather. He was concerned she was having a reaction to her antibiotic. She had no tongue/lip swelling, difficulty breathing, vomiting or rash. I asked what the reaction was. He said, ‘‘She must be uncomfortable because she won’t stop moving after I give it to her.’’ The girl was calm, cooperative and playful. I asked her, ‘‘Does the

medicine make you feel bad, so you move around a lot?’’ ‘‘No,’’ she replied as she pointed to the bottle in my hand. ‘‘It says, ‘Shake well while using.’ ” Jennifer Raymond: My funniest patient of all time was a kiddo about age 9 that was seen for testicular pain. The day-shift nurse had informed me in a report how funny this patient was, but I never expected him to ask why his discharge instructions said to abstain from sex! (The resident clearly did not read [the discharge instructions] before he printed them.) [The patient] made sure I knew that he did not even have a girlfriend! Peds ER patients come in all shapes and sizes. We see the worst of the worst. We comfort a mother who has just lost her child and move on to the patient who just has an earache. We do it because we love it. We get

January 2013

asked often, ‘‘How can you work there?’’ I always answer, ‘‘I just can.’’ Jesa Orleman: We told a 5-yearold boy to hold still for [a blood draw] and his grandmother jumped right in and said, ‘‘Oh, good, you’re going to check him. He is old enough [to hold still]!’’ The little boy asked what we were checking him for, and Grandma said, ‘‘They need some blood to check and see if you have super powers!’’ He was so brave, and everybody was smiling at how hard he was working to hold still. I’ll keep that line in my pocket for the next time! Camden Kay: At 2 a.m. one night recently, we had a little man come into the critical care room in severe respiratory distress with an extensive cardiac history. After we were done

with his IVs, X-rays, suctioning and high flow, I went and shared with my co-workers that it was his second birthday and asked if they’d like to come say happy birthday. With big smiles and without hesitation, they grabbed some bubbles as I grabbed a present, and five-deep we went and sang ‘Happy Birthday.’ If you’ve ever seen a sick kiddo smirk with his binky in his mouth and then smile, then giggle, you realize everything you do is so worth it! Love my crew! Theresa Antley: We had a small boy [who was crying because he was very anxious about getting a CT]. So I went in to [talk to him] and found out that he was scared of the machine itself. Well, I went over to CT and covered the machine with all his

favorite stickers … I picked him up and put him on the table; he held my hand and lay down and looked at the stickers. He was so still looking at all the stickers that we could do the scan without even holding him down. After it was over, I gave him the stickers and he spent the next 30 minutes looking at all of them. Peds take a lot of patience and distractions/innovations! Love helping them feel better. What a wonderful testament to why some emergency nurses choose to work with children; the funny moments and positive outcomes far outweigh the more difficult times. Thank you for all the wonderful examples that illustrate the unique nature of pediatric emergency nursing!

It’s Your Year to Shine!

Board of Certification for Emergency Nursing (BCEN®) certifications demonstrate your commitment to excellence. Make 2013 the year to earn your mark of distinction!

Learn more…

ENA FOUNDATION Supporting Emergency Nursing Through Education and Research

ENA Foundation 2013 Scholarship and Research Grant Opportunities The mission of the ENA Foundation, established in 1991 by the Emergency Nurses Association, is to provide educational scholarships and research grants in the discipline of emergency nursing. The foundation achieves its mission by accepting contributions to fund academic scholarships, continuing education and research grants. Over the last 21 years, the ENA Foundation has awarded more than $2 million in academic scholarships and research grants.

Have you recently returned to school to advance your education? Are you considering returning to school in 2013? Applications are now available for academic scholarships to emergency nurses in four categories: non-RN, undergraduate (RN to BSN), graduate/master and doctoral. The application deadline for all scholarships is June 1. Recipients are notified in early August. With the exception of the non-RN category, all applicants must have been an ENA member for the previous 12 months to qualify. Scholarships and research grants are made possible through the generous donations received in 2012. Scholarship and research grant applications and qualifications are available at www.ENAFoundation. org.


2013 Academic Scholarships Non-RN Category New York State ENA September 11 Scholarship

Two at $2,500 each

Undergraduate (RN to BSN) Category Charles Kunz Memorial Undergraduate Scholarship One at $3,000 Board Certification of Emergency Nursing (BCEN) Scholarship One at $3,000 Graduate/Master Category Stryker & ENA Foundation Scholarship - Masters in Healthcare One at $5,000 AnnMarie Papa Stretcherside Miracle Scholarship One at $5,000 Board of Certification for Emergency Nursing (BCEN) Scholarship One at $5,000 Anita Ruiz Contreras Scholarship (California) One at $5,000 Colorado Rocky Mountain Scholarship (Colorado) One at $5,000 Darlene Whitlock Trauma Scholarship (Kansas) One at $5,000 Kentucky ENA Founders Scholarship (Kentucky) One at $5,000 Maryland ENA State Council Scholarship (Maryland) One at $5,000 Pathways “V” Scholarship (Minnesota) One at $5,000 Dan Burgess Mississippi State Council Scholarship (Mississippi) One at $5,000 New Jersey State Challenge Scholarship (New Jersey) One at $5,000 Mary Kamienski Scholarship (Northern Chapter-NJ) One at $5,000 Jeannette Ash Memorial Scholarship (West Central Chapter-NJ) One at $5,000 Renee Jett Memorial Scholarship (South Carolina) One at $5,000 Tennessee State Challenge Scholarship (Tennessee) One at $5,000 Vicki Patrick Texas Legacy Scholarship (Texas) One at $5,000 ENA Foundation State Challenge Scholarship Nine at $3,000 each Physio-Control, Inc. Scholarship Two at $3,000 each Gisness Advance Practice Scholarship One at $3,000 Karen O’Neil Memorial Scholarship One at $3,000 Doctoral Category Pamela Stinson Kidd Memorial Scholarship Board of Certification for Emergency Nursing (BCEN) Scholarship ENA Foundation Doctoral State Challenge Scholarship Hill-Rom Doctoral Scholarship

One at $10,000 Two at $5,000 each Three at $5,000 each Two at $4,000 each

2013 Continuing Education Scholarships Leadership Tapestry Scholarship Vidacare Annual Conference Scholarship

10 at $1,000 each 20 at $500 each

2013 Research Grants Emergency Medicine Foundation (EMF)/ENA Foundation Team Research Grant ENA Foundation/Sigma Theta Tau International Research Grant ENA Foundation/ANIA-Caring Research Grant Industry-Supported Research Grant – Sponsored by Stryker

One One One One

at at at at

$50,000 $6,000 $6,000 $5,000

January 2013

Career Outlook for Nursing Specialties Research shows that nursing is the largest workforce within the health care industry, with more than 2.6 million registered nurses in the U.S. According to the Bureau of Labor Statistics, employment of registered nurses is expected to grow 26 percent from 2010 to 2020, primarily because of technological advancements, an increased emphasis on preventive care and the large, aging baby boomer population, who will demand more health care services. This growth will create various career options and paths for nurses. Whether you are a new graduate or at mid-career and want to explore other options, choosing a nursing specialty that is right for you and projected to grow is important for taking your career to the next level. At right is a list of the top 10 highest paying nursing specialties. Resources highest-paid-nursing-specialties Registered-nurses.htm

Letter From the President

Nursing Specialties

Average Salary

Education Requirements

Certified Registered Nurse Anesthetist


CRNA program (24-36 months)

Nurse Researcher


BSN (advanced nursing research often requires an MSN or a PhD)

Psychiatric Nurse Practitioner


RN license with MSN and NP certification

Certified Nurse Midwife


MSN (certified midwives must also pass a certification exam)

Pediatric Endocrinology Nurse


RN license

Orthopedic Nurse


RN license and orthopedic nursing certification

Nurse Practitioner


Master’s degree in clinical specialty

Clinical Nurse Specialist


RN license and graduate from a CNS program

Gerontological Nurse Practitioner


Nurse practitioners master’s degree with academic concentration in the field of geriatrics

Continued from page 2

should not speak negatively about our profession to each other, our family and friends or to our patients. We also must speak up when we see nurses portrayed inaccurately in the media. Nursing continues to be the most trusted profession. Because of this, we can influence care in our own communities, our states and our nation by taking part in the legislative process. We have important information to share with our governmental representatives and policy makers about the effects of their choices and legislation on individuals and groups. It is our role to shape and influence health care policy. Advocatism is alive and well in everything we do. As nurses, we need to understand how to harness what we already do into a force to be reckoned with. One way ENA is helping members achieve this goal is by hosting the first ENA

Advocacy Intensive Workshop for state and chapter leaders this month in Des Plaines, Ill. ENA leaders will learn how to take experiences and knowledge and use them to influence practice and policy in their hospital, community and profession. We have to be the voice to advocate for change. Resources Selanders, L. C., & Crane, P. C. (2012). The voice of Florence Nightingale on advocacy. Online Journal of Issues in Nursing, 17(1). Retrieved from MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/ TableofContents/Vol-17-2012/No1-Jan-2012/FlorenceNightingale-on-Advocacy.html. Gallup. (2011). Honesty/ethics in professions. Retrieved from aspx.

Official Magazine of the Emergency Nurses Association



Enhance Your Leadership Skills by Attending ENA Leadership Conference 2013 Plan now on attending ENA Leadership Conference 2013, February March 27 – March 3 in Fort Lauderdale, FL to help you advance your career. Gain the knowledge you need to succeed as a leader in evidence-based educational sessions across seven key focus areas. Learn new skills that you can implement immediately upon your return home. Shape your future today by leveraging all that ENA Leadership Conference has to offer. Read how a past attendee has benefited from attending ENA leadership conference.

“With the knowledge and experiences that I have obtained through ENA such as relationship building, collaboration, rejuvenation, inspiration and benchmarking, I am able to bring these experiences and knowledge back to my team. I want my team to have the best, be the best, and achieve the best. If my team is not successful, than I am not successful. Our driving force is exceptional emergency care.” Norma L. Austin, RN, BSN, CEN, CPEN Emergency Services Executive Director Carroll Hospital Center, Westminster, MD

Described by your colleagues as a must-attend event, DON’T DELAY! REGISTER bEfoRE JaNuaRy 16 To SaVE wITh ThE EaRly DIScouNT RaTE. ScaN ThE QR coDE oR Go To WWW.ENA.ORG/LC USE SOURCE CODE FC3JC WHEN YOU REGISTER TO ENTER THE ENA LEADERSHIP CONFERENCE 2013 DRAWING* • Grand Prize: Three nights hotel stay at hyatt Regency Pier 66 in fort lauderdale, fl from february 28 – March 2 • Second Prize: iPad®

Leadership Conference can help advance your career and help you become a better leader. Network with emergency department leaders from across the country and the world, make new contacts and learn about the latest solutions for your emergency department in the exhibit hall.


• Third Prize: Kindle

*No purchase necessary. To view the complete rules, visit Void where prohibited. Drawing will be held February 4, 2013.

ENA Leadership Conference 2013 educational offerings will help you advance your career. To help you get more of what you need, Leadership Conference now offers unique learning formats like Hand-off Sessions, Jam Sessions and Deep Dive Sessions. Below is a small sampling of the educational sessions offered at ENA Leadership Conference 2013. For a complete course listing and conference details, visit



• Presession: Lights, Camera, Action: Writing and Delivering an Award Winning Conference Presentation Jam: Competency Validation, How Do You Know That They Know What They are Doing? • Copyright Law for Academics • Legal Aspects of Social Media • The ED Olympics: An Innovative Approach to Annual Competencies • Clinical Reasoning: What Is It and How Do I Teach It?

• Lateral Violence, It Goes Much Further Than Those “Who Eat Their Young” • Healthy Living – For Nurses • Frazzled to Fantastic: Be More Effective and Less Stressed • All Stressed Out In the ED: Staying Resilient and Avoiding Burnout • Field of Dreams or Toxic Wasteland: Keeping Your Work Environment Healthy

FLOW Jam: Out of the Hallways and Into the Hospital: Throughput, Output and Forward Flow • Implementation of a Low Acuity Initiative • Report Wars: Making Peace with Our Inpatient Colleagues • Losing Wait: Innovative Strategies to Improve Patient Flow In and Out of the ED • Breaking Down the Cultural Walls Preventing Effective Hospital Throughput • Impact of a Logistics Manager Program on Admitted Patient Boarders Within an ED

MANAGEMENT • Presession: Operational Leadership of the Emergency Department • Strategies For Implementing and Utilizing Pharmacy Services in the ED • Managing an Observation Unit as an Extension of the Emergency Department • Lurking Secret Shoppers: LWOT and Dissatisfied Customers as Partners for Service Improvement Deep Dive: Budget Negotiation Made Fun • Winning Against the Nursing Shortage: Building Your Team Without Losing the Players You Have

Important Dates to Remember Registration .............................................Now Open Early Discount Rate Closes ......................... Jan. 16 State and Chapter Leaders Conference ............................. Feb. 27 – 28 Presessions.................................................. Feb. 28 Educational Sessions .............................. Mar. 1 – 3 Exhibit Hall .....................................Feb. 28 – Mar. 2

PROFESSIONAL DEVELOPMENT • Presession: Charge Nurse: Putting the Team Back Into Teamwork • The Seven Principles of Inspiring Leaders • Tactical Leadership: Military Lessons for Today’s ED in Empowering Staff to Excel • You Are Finally a New Manager, Now What? Deep Dive: The Older Emergency Nurse: Retired, Recycled, Revived and a Respected Resource • Developing Leaders of Tomorrow From New Grads of Today

SAFETY • Fragile – Hand Me Off with Care • Strategies for Implementing and Utilizing Pharmacy Services Within the ED • If I Had Passed Out, It Would Have Been a Felony • Say What? Addressing Communication Styles to Improve Our Work Environment and Patient Safety • Workplace Violence: Prevent, Respond, Report • Level I Trauma Centers Journey to a Safe Environment: Fall Prevention in the ED

Evidence of a Higher Calling Take Their Word For It: As a Forensic Emergency Nurse, Your Influence on Outcomes Can Only Grow Stronger By Josh Gaby, ENA Connection Missy Rittinger has hardly paused before she’s recalling the case that sums up what forensic nursing means to her. An exotic dancer taking a cab home in Cincinnati one January morning was driven instead to a remote area, where she was beaten and raped by the driver. He slit her throat and left her to die. She didn’t. That was in 2002. At the time, Rittinger, BS, RN, CFN, SANE-A, was working in the emergency department at the St. Elizabeth Healthcare facility in Edgewood, Ky. She recently had become a sexual assault nurse examiner, licensed to collect forensic evidence after sexual assaults and, if called upon, to testify about her findings. ‘‘And she was brought in, and this man was convicted, and he got 38 years in prison,’’ Rittinger says. ‘‘That,’’ she notes, ‘‘was my very first case.’’ Terri Vietor chimes in proudly: ‘‘They found the assailant’s DNA under her nails — that Missy had swabbed.’’ The two ENA members have covered a lot of ground together, bringing the relatively young discipline of forensic nursing into their own professional repertoires and recruiting tens of others to do the same. Vietor, MSN, BSN, RN, CEN, CFN, SANE, is now the nurse manager for the St. Elizabeth Edgewood ED and also the manager of the St. Elizabeth forensic nursing program, which serves five EDs in northern Kentucky and greater Cincinnati. Rittinger is Vietor’s program coordinator. Since 2011, she also happens to be a deputy coroner of Boone County, Ky. Thirteen years ago, the two met


Missy Rittinger, BS, RN, CFN, SANE-A (above), and Terri Vietor, MSN, BSN, RN, CEN, CFN, SANE, have worked to build forensic nursing into the ED culture. while taking the first SANE training offered in the area — the result of grant-funded efforts by local domesticviolence advocacy groups. By 2000, both women had SANE certification, and on Jan. 1 of the following year they launched the St. Elizabeth program, providing forensic nursing services to the three St. Elizabeth facilities and two others under competing St. Luke Hospitals. (The systems merged in 2008.) Vietor and Rittinger became Certified Forensic Nurses — the next step up in forensic nursing — in 2005. Their program at St. Elizabeth, which started with six SANE nurses, today is approaching 30, most of whom work in the ED, conducting SANE exams and gathering forensic documentation of injuries in addition to their regular job duties. Sexual assaults against adults and children, domestic violence,

elder abuse and neglect — these are the areas where training in forensics matters. ‘‘For me,’’ Vietor says, ‘‘I went on to get my CFN because I felt like the forensic component of everything that we do in the emergency department, there was so much possibility to do it better, to produce better documentation for our patients and to do a better job taking care of them.’’ Rittinger pins it on ‘‘a very intense desire.’’ ‘‘As an ED nurse,’’ she says, ‘‘I always seemed to gravitate toward the sexual-assault patients because everyone else seemed to run from them. I realized there was a significant need for improvement of care for these patients, and I wanted to be part of the improvement. ‘‘Once I received the training, my career went into a whole new direction and has morphed into something very rewarding.’’ At St. Elizabeth, if it involves forensics, it goes through Rittinger. Attorneys and law-enforcement officials will come to her for documentation of abuse or neglect, and if there was any suspicion at all during a patient’s ED visit, you can bet she’ll have pictures. She and Vietor stress education and a forensic component to every nurse’s job, which means that all of their front-line emergency nurses — those with certifications and those without — are encouraged to take photos that could be used in court cases. Vietor and Rittinger recommend that emergency nurses interested in forensics start by becoming SANEs, which likely will give them the most evidence-gathering experience. Additional education and a CFN will

January 2013

bring even greater credibility — as an expert giving testimony and as a nurse in general. This is something Rittinger appreciates constantly in her role as deputy coroner. A forensic nurse packs a rare double punch: the certified and specialized technical background combined with the glowing reputation of the nursing profession. ‘‘A lot of the feedback that I get from people that I’m dealing with is very positive, simply because I’m a nurse,’’ Rittinger says. ‘‘There’s a level of compassion that they automatically see. The cops out there, they see me come, and they’re like, ‘Thank goodness.’ They say that all the time.’’ With forensic nursing comes a tendency for burnout, Vietor and Rittinger admit. ‘‘There are a lot of difficult things to see and deal with,’’ Vietor says. ‘‘It’s a very intense nursing practice. For sexual assault, you are one-on-one

with a patient for three hours. You need a lot of support among your team to really keep people involved so that they don’t get discouraged.’’ And you need the ongoing sense of the impact you might have. Like Rittinger, Vietor instantly remembers the case that drove it home for her. It was shortly after she received her CFN. A coroner called asking for a forensic nurse to help examine the body of a 3-year-old girl who had died of head and internal injuries. Vietor’s SANE license in Kentucky allowed her only to examine live patients over age 14, but her CFN afforded her more leeway. While she couldn’t conduct a complete exam on the child, she was able to take genital photographs and swabs that the police forensics team would not have taken. Vietor’s findings showed the child, beaten to death, also had been

sexually abused and sodomized. That forensic evidence pointed to a stepbrother, who later accepted life in prison on a plea. ‘‘Being a part of that whole process,’’ Vietor says, ‘‘made me feel like everything else I’d done before — the 3 a.m. calls that they weren’t going to end up getting prosecuted, the mixed-up stories that we would get — it was all worth it because at this point in time I was qualified and able to contribute to this investigation. In thinking through my scope of practice, because I had certification as a forensic nurse, I was able to do more than I would have been able to do had I not been. And it made a difference. ‘‘Once you’ve got that forensic training,’’ she says, ‘‘every place you turn, there are things in health care that have forensic implications. It’s a young specialty in nursing. It certainly has not reached where it could go.’’

Take charge of

Your Nursing Career

ENA invites you to a FREE Webinar As a sponsor of The Take Charge of Your Nursing Career™ program, ENA is pleased to invite you to the third webinar in our series. “How Nursing from the Neck Up Can lead to Success” Presented by Dennis R. Sherrod, EdD, RN, Professor and Forsyth Medical Center Endowed Chair of Recruitment and Retention. Dr. Sherrod will be accompanied by Dr. Phyllis Quinlan, Professional Nursing Coach. This class is available February 7, 21-26, 24 hours a day. Mark your calendars and look for registration information via email at the end of January. Don’t miss out!

Powered by the ENA Career Center

Career Spotlight:

Long-Distance Flight Nursing Sky’s the Limit When You’re Caring For Patients Thousands of Feet Up By Kendra Y. Mims, ENA Connection Carl Bottorf, RN, thought his days of being a nurse were over after a severe car accident in 2010 left him in a wheelchair with significant injuries and titanium parts in his legs. He contemplated becoming a schoolteacher, but three months after his accident he realized he might get out of his wheelchair and walk again. After his recovery, he pursued his dream career by applying to Airlift Northwest for a long-distance flight nurse position in Juneau, Alaska. Bottorf has specialized in transport medicine since being trained as an Air Force flight nurse in 1993. With more than 17 years of experience, including numerous deployments and military tours in Asia, Africa and Europe in the last decade, he made the transition from Tampa, Fla., to Juneau in 2011 to work for Airlift Northwest. He credits the Air Force for preparing him for the opportunity and giving him with the ‘‘right tools’’ for his new career path. ‘‘I’m proud to be an Air Force flight nurse and of the training I received,’’ he said. ‘‘It enabled me to come out here to get a job and excel. I feel lucky because all of the things the Air Force taught me as a nurse come into play every single day.’’ Bottorf soon realized that flight nursing in Alaska was completely different from his previous nursing experience. Anywhere in the Southeast, a flight team can get an unexpectedly unstable patient to a good hospital within 15 minutes. In


ENA member Carl Bottorf, RN, with his flight partner, Elise Chamberlain, RN, CEN, standing in front of one of the three Lear-31’s in the fleet of Airlift Northwest. This airframe is based in Juneau, Alaska. Alaska, there are no trauma centers or burn centers, so patients are flown 1,000 miles to Seattle. The missions come from small hospitals. Bottorf said some of the clinics and health care facilities accessed in emergencies are merely a simple room or several small rooms located in the same building that houses the community’s long-term care residents. The ring of the outside doorbell transforms the long-term care nurse into the emergency care provider. Other times, the ring of the

bell brings staff members in response from their homes. The lack of acute care diagnostic and treatment equipment has spawned the need for a rapid-response, fixed-wing air ambulance service within the region, and Airlift responds quickly. Bottorf said his skills are challenged all the time. ‘‘We’ll fly to these remote communities, pick up the patient and fly 700 or 1,000 miles to deliver them to higher levels of care,’’ he said. ‘‘You have to know your obstetrics, because

January 2013

“A helicopter flight nurse goes to a scene of an accident or trauma and brings emergency room level care to the patient. An aerospace nurse or long distance flight nurse is able to provide intensive critical care to a patient from one hospital to the next over long distances at high altitudes.” —Carl Bottorf you can transport women who are having complicated labors. You have to know your trauma management because you’re transporting trauma patients. We don’t fly with a respiratory therapist, so you have to learn and train and become sufficient with a ventilator. It’s not as hard to figure out how to run a ventilator on a 15-minute transport, but when you have to run it for two to three hours and keep the patient alive and prevent them from getting any sicker, you have to get really good at it.’’ Bottorf had to relearn many things about flight nursing when he came to Airlift Northwest, in addition to taking Airlift’s seven-week training program. He currently works with a group of seven nurses in Alaska and typically flies one to three shifts each week. ‘‘Flight nurses understand the effects that flying has on the patient,’’ he said. ‘‘There are nine really specific stressors of flight that can impact any condition. For example, if you have a heart attack and you need to be flown in a jet, virtually all nine stressors can affect your heart attack patient because they’re flying. Flight nurses are trained to understand what those are and how they impact patient care. They understand what to look for and the remedies to minimize problems resulting from long-distance aeromedical transportation. They know how to apply general nursing to the aerospace environment.’’ Not all flight nurses are built the same, Bottorf pointed out. Though he has a vast amount of experience as a flight nurse in pressurized fixed-wing aircraft, he does not have the same amount of helicopter experience and requires varying amounts of

This is the typical view when Carl Bottorf is working transport missions. different training. ‘‘I am a flight nurse who is experienced in aerospace medicine,’’ he said. ‘‘It is a different realm of nursing for flight nurses who work in jets compared to those who work in helicopters. If I’m going to transport a patient from here to Seattle, it’s 1,000 miles. I’m thinking of different potential complications than if I was to go across the city of St. Louis in a helicopter. I’m flying at 45,000 feet. If something happens, it’s not like we can land on the ground and run to the nearest hospital. You’re up there for two hours in a small, tight area. It’s just you and another nurse taking care of the patient. You have oxygen issues, vibration issues and pressure issues, and these are all part of the stressors of flying that long-distance flight nurses either are trained for or learn as they go.’’ Bottorf works longer than 12 hours when he has to take a patient from bedside in Alaska to bedside in Seattle and then fly back to Alaska. ‘‘And on the way home, if another patient needs to be moved, they’ll

Official Magazine of the Emergency Nurses Association

Carl Bottorf’s advice to nurses interested in a career in longdistance flight nursing: In addition to getting two to five years of critical-care nursing experience, ‘‘Keep your body healthy, because it’s physically fatiguing. When you’re at high altitude or in the Learjet you get tired faster because there’s less oxygen and there’s vibration and you’re either hot or cold, so you have to keep your body healthy to do the job. Good health, good experience and flexibility will get you far.’’

divert us and send us there,’’ he said. ‘‘It really impacts your personal life, but you get used to it. Sometimes you just get a meal per day, often on the run, but you make it work.’’ Despite the challenges flight nurses encounter, Bottorf said the turnover rate is low. ‘‘It’s not the kind of nursing job where people get dissatisfied and leave,’’ he said. ‘‘We have nurses who are retiring with nearly 30 years on the job as a flight nurse here. They know this is a good job. The company trains us well.’’ His favorite aspect of being a flight nurse is dealing with the unexpected on a daily basis. ‘‘When I go to work as a flight nurse, I don’t know what’s going to happen,’’ he said. ‘‘Maybe we’ll fly today, maybe we won’t. Maybe the weather’s good, maybe it’s not. Maybe I’ll get a trauma patient today or maybe I’ll get a heart transplant having complications. There are a lot of unknowns, and you never know what to expect, so you have to be OK with surprises. I enjoy the clinical challenge. The missions are fantastic.’’



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

What Can You Do With a PhD in Nursing? The Institute of Medicine has a stated goal of doubling the number of doctorally prepared nurses by 2020. The role of these doctorally prepared nurses, according to Marion E. Broome (2012) is to direct education reform at all levels and to co-lead patient outcome improvements in specific areas of clinical practice. At this time, approximately 1 percent of nurses are doctorally prepared, meaning there are about 30,000 PhDs and DNPs in the United States. The American Association of Colleges of Nursing suggests that all faculty teaching in baccalaureate programs have preparation at the doctoral level. The perception of doctoral work can be that it is difficult, takes a lot of time, costs a lot of money and does not really change the way a nurse would practice. Let’s look at these perceptions a bit more closely:

It’s hard and takes a long time. To be accepted into a doctoral program, generally you have to have at least a Bachelor of Science in Nursing, and many programs like applicants to have a master’s degree in nursing. A PhD is a research degree, not a practice degree (that’s a DNP or Doctorate of Nursing Practice), so PhDs are not necessarily advanced practice nurses. The training process for a PhD includes two years of class work in the philosophy of nursing, philosophy of science, research methods and practica. Depending on the program, there might also be a focus on policy or theory generation. The last year(s) of the doctoral education process are devoted to the design, completion and


I was awarded an ENA Foundation scholarship and a Jonas Fellowship for my third year, so my PhD was essentially free. There are also programs wherein if you teach, a portion of your student loan is forgiven for each year that you teach. Doctoral education does not need to be prohibitively expensive.

It won’t change my practice. writing of a dissertation study. The objective of the dissertation process is to create new knowledge. The time it takes to get through a PhD program is dependent on a number of things. The first is your starting point — if you have a master’s degree, it takes less time than if you start at the baccalaureate level. The second is whether you are going full-time or part-time. In general, it’s not advised that you work full-time when you are doing your graduate work. This is not feasible for most people, and it is important to recognize that a PhD is not something you just ‘‘tack on’’ to your current duties. Doctoral work is challenging (the good kind of challenging) and requires attention, focus and adequate time to process information. If you try to maintain your schedule and add doctoral work, everything tends to suffer.

It costs a lot of money. Because of the critical shortage of faculty in nursing programs, there are several funding sources. Many programs have fellowships for doctoral students. I attended Boston College on a university fellowship and received full tuition and a stipend for two years.

The PhD-prepared nurse at the bedside is invaluable. Practicing from a theoretical base with extensive training in research and its evaluation gives you the opportunity to practice at a very high level of both knowledge and application. You are a resource to your peers and patients. You can practice collaboratively with physician colleagues in a different way because the understanding of evidence-based practice is more similar. Along with bedside practice, the nurse with a PhD is prepared to teach both undergraduate and graduate nursing students. You can do this as an adjunct (part-time) faculty, or you can enter the tenure system as a full time faculty and also engage in research. Doctoral work can open doors to a mix of education, research and practice that is engaging and satisfying. The Research Column in Connection has been designed to give succinct, useful information about the research process and how research can be useful to the bedside emergency nurse. Please send topic suggestions to LWolf@

January 2013

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New ENA monthly offering for FREE Continuing Education with contact hours for our members. • Available December 1 Service and Quality 1.0 contact hour Jeff Strickler, MA, RN, CEN, CFRN

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.

ENA Connection January 2013