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the Official Magazine of the Emergency Nurses Association
connection
September 2013 Volume 37, Issue 8
THE
AFTER
BURN
How to Keep Fanning
Your Ideas and Energy
Post-Conference
CODE YOU, Page 13
INSIDE
FEATURES
5 2013 Annual
Award Recipients
6 Treasurer’s Report
16 Vietnamese Nurses
Get Extra Training
They Seek
20 Lantern Award
Recipients
LEADERSHIP
CONFERENCE
2014
SAVE THE DATE
March 5-9, 2014
Phoenix, AZ
Phoenix Convention Center
For the latest news on Leadership Conference 2014, visit www.ena.org
Follow the action
#ENALC14
*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.
Dates to Remember
Sept. 17-21, 2013
ENA General Assembly
and Annual Conference,
Nashville, Tenn.
Oct. 1, 2013
Deadline to apply for the 2013
ENA Foundation/ANIA Research
Grant and the 2013 ENA
Foundation Industry-Supported
Research Grant.
Oct. 14, 2013
Faculty course-proposal deadline
for 2014 Annual Conference.
ENA Exclusive Content
PAGE 5
ENA Annual Award Recipients
PAGES 6 - 7
2013 Treasurer’s Report
PAGE 8
The Affordable Care Act:
More Patient Coverage Options
PAGE 13
Code You: Keep Your Momentum
Maximized after Annual Conference
PAGE 14
Update From the Executive Director
PAGE 16
Missions Giving Vietnamese Nurses
the Extra Training They Seek
PAGE 20
2013 Lantern Award Recipients
PAGE 24
Board Writes:
Newer Ways of Reaching
Safe Practice, Safe Care
Regular Features
PAGE 4
Free CE of the Month
Ask ENA
PAGE 10
ENA Foundation
PAGE 20
ENA Connected
PAGE 22
Pediatric Update
PAGE 30
State Connection
LETTER FROM THE PRESIDENT | JoAnn Lazarus, MSN, RN, CEN
The Importance
of Saying Thank You
R
ecently, I was on a project as an interim director in an
emergency department in the Northwest when something
gave me pause to reflect. It was a Monday and staffing was
in short supply; patients were not. It was an ‘‘all hands on deck’’ sort of day. The whole
leadership team was on the floor doing what we could to assist with patient flow. We made it
through the shift without any disasters.
The next day I received a handwritten
thank-you note and a bar of chocolate from
the nurse who had been in charge. All the
members of the leadership team received a
note, as well as the staff who had worked that
day. That had such an incredible impact on
me. I felt as though I should have been the
one giving out candy and thank-you notes.
We all get so caught up in the moment
and in our schedules that we forget what is
important, such as acknowledging others’
contributions. Showing gratitude is our basic
responsibility as humans living in community
with other human beings.
According to a survey by the John
Templeton Foundation, people are less likely
to feel or express gratitude at work than
anyplace else. Almost all of those participating
in the survey reported that saying thank you
‘‘makes me feel happier and more fulfilled.’’
On a given day, however, only 10 percent
acted on that impulse. Sixty percent said they
‘‘either never express gratitude at work or do
so perhaps once a year.’’
Why is saying thank you so important? It
is an emotional act that connects us to each
other. Saying it doesn’t just acknowledge
someone’s effort or thoughtfulness — it
acknowledges the person as someone
unique and of value. It shows you care. It’s
not just about making your peer feel good;
studies show a significant increase in
happiness, greater satisfaction with life and
higher resilience to stress in those who
express thankfulness on a regular basis.
We come to work not only for the money
but because it brings pride, respect, a sense
of accomplishment and a feeling of purpose.
It is nice to know we are appreciated, not
only by our managers and supervisors but
also by our peers.
The impact of saying thank you goes way
beyond the moment in which it is said. It
strengthens relationships, motivates others to
continue engaging in helpful behavior and
sends a strong message about our values and
the professionalism of our organization.
Saying thank you appeals to our human need
to be appreciated and makes us feel better.
Next time a co-worker starts that IV for you
or picks up an open shift, acknowledge him or
her. It just might make you feel good, too. I’d
like to personally thank Traci McGregor, BSN,
RN, CEN, CPEN, the charge nurse who gave
me the thank-you note and candy. Thank you
for making my day better and for making me
realize the importance of saying thank you.
I’d also like to thank the many leaders
within ENA. Thank you for sharing your time,
talents and passion with our profession and
with ENA. You really make a difference!
Resources
Naylor, C. (n.d.) The power of saying thank
you. Retrieved from http://
www.b-betternow.com/blog/2012/10/
the-power-of-saying-thank-you/
Simon-Thomas, E. R., & Smith, J. A. (2013,
January 10). How grateful are Americans?
Retrieved from http://greatergood.
berkeley.edu/article/item/how_grateful_
are_americans
Kaplan, J. (2012). Gratitude survey: Conducted
for the John Templeton Foundation. Retrieved
from http://greatergood.berkeley.edu/
images/uploads/JTF_GRATITUDE_
REPORTpub.doc
Official Magazine of the Emergency Nurses Association
3
We’re turning the conversation
to annual competencies with
the next installment of free
continuing education for
ENA members!
Available to you starting Sept. 1 . . .
‘‘The ED Olympics: An Innovative Approach to Annual
Competencies,’’ presented by Martina Petersen, MSN, RN,
ACNP-C. (Credit: 1.0 contact hour.)
Petersen analyzes the current practices and goals of annual
competency assessment, then gives you a look at a
competitive model that emergency department staffs can use
to evaluate annual competencies. Staff response to this model
is discussed, along with the outcomes of using it. This is an
e-learning course recorded during Leadership Conference
2013 in Fort Lauderdale, Fla.
To take these and other CE courses absolutely free as
an ENA member:
•G
o to www.ena.org/freeCE, where you’ll log in as a
member (or create an account).
• Add desired courses to your cart and ‘‘check out.’’
•P
roceed to your Personal Learning Page to start or
complete any course for which you have registered or
to print a certificate when you’re done.
•T
o return to your Personal Learning Page at a later
time, go to www.ena.org and find ‘‘Personal Learning
Page’’ under the Courses & Education tab.
Please be sure you are using the e-mail address
associated with your membership when logging in. If you
have questions about any free e-learning course or the
checkout process, e-mail [email protected].
ENA Connection is published 11
times per year from January to
December by:
The Emergency Nurses Association
915 Lee Street
Des Plaines, IL 60016-6569
and is distributed to members of the
association as a direct benefit of
membership.
Copyright© 2013 by the Emergency
Nurses Association. Printed in the
U.S.A.
Periodicals postage paid at the
Des Plaines, IL, Post Office and
additional mailing offices.
Q: I’d like to pay my ENA dues
by installments. Is this possible?
A: Yes, for certain dues
categories. We are able to accept
four quarterly installments for
payment of three-year, five-year
and lifetime membership plans.
These plans add $1 per
installment as a processing fee to
cover a portion of the additional
costs to process the installments.
Although we’ve received a
few requests to pay one-year
dues by monthly installments, we
are unable to provide that option
for two main reasons: (1) system
limitations and (2) high
processing costs. Our software
system does not currently have
the ability to process monthly
installments and would require
additional programming, which
would be complicated and costly
because dues are shared with
state councils and chapters based
on payments received.
More significant are the high
processing costs for monthly
payments. The quarterly
E-mail ‘‘Ask ENA’’ at
[email protected] with
questions about ENA and
emergency nursing in general.
installments we process now for
the long-term memberships
require manual handling by staff,
as our software system does not
include functions to automate
this process. In addition to the
labor involved, each transaction
processed incurs a fee, whether
paid by credit card, debit card or
check. The $1-per-transaction
processing fee we now charge
for the long-term memberships
covers only a portion of these
labor and transaction costs. If the
$1 per transaction were applied
to the $100 annual membership
for monthly installments, it
would increase the cost to
members to a total of $112 per
year, about the equivalent of a 12
percent finance charge.
— Edward M. Rylko, MBA,
CPA, Deputy Executive Director
Do you have a recent professional or educational success story you
want to share about yourself or an ENA member colleague? E-mail
the information to [email protected] with the subject line “Members
in Motion.’’
POSTMASTER:
­Send address changes to
ENA Connection
915 Lee Street
Des Plaines, IL 60016-6569
ISSN: 1534-2565
Fax: 847-460-4002
Website: www.ena.org
E-mail: [email protected]
Member Services:
800-900-9659
Non-member subscriptions are available for $50 (USA) and $60 (foreign).
Editor-in-Chief:
Amy Carpenter Aquino
Assistant Editor:
Josh Gaby
Writer:
Kendra Y. Mims
Editorial Assistant:
Renee Herrmann
Board of Directors
Officers:
President: JoAnn Lazarus, MSN,
RN, CEN
President-elect: Deena Brecher,
MSN, RN, APRN, ACNS-BC,
CEN, CPEN
Secretary/Treasurer: Matthew F.
Powers, MS, BSN, RN, MICP, CEN
Immediate Past President: Gail
Lenehan, EdD, MSN, RN, FAEN,
FAAN
Directors:
Kathleen E. Carlson, MSN, RN, CEN,
FAEN
Ellen (Ellie) H. Encapera, RN, CEN
Marylou Killian, DNP, RN, FNP-BC,
CEN
Michael D. Moon, MSN, RN, CNS-CC,
CEN, FAEN
Sally K. Snow, BSN, RN, CPEN, FAEN
Joan Somes, PhD, MSN, RN, CEN,
CPEN, FAEN
Karen K. Wiley, MSN, RN, CEN
Executive Director: Susan M.
Hohenhaus, LPD, RN, CEN, FAEN
2013 Annual Award Recipients
ENA is pleased to announce the recipients of the 2013 ENA Annual Awards.
Recipients will be recognized Sept. 21 at the Annual Awards Gala at the 2013
Annual Conference in Nashville, Tenn.
Nurse Manager Award
Suszanne Deyke, MSN, RN, CEN
Barbara A. Foley Quality, Safety
and Injury Prevention Award
Kimberly Wright, BSN, RN
Nurse Researcher Award
Kathleen Flarity, DNP, PhD, CEN,
CFRN, FAEN
Behind the Scenes Award
Robin Walsh, BSN, RN
Clinical Nurse Specialist Award
Pamela Bucaro, MS, RN, PCNS-BC,
CPNP, CPEN
Frank L. Cole Nurse
Practitioner Award
Andrew Galvin, ACNP-BC, CEN
Nursing Education Award
Leah Davis, BSN, RN, CEN
Nursing Practice and
Professionalism Award
Rhonda Holmstrom, BSN, RN, CEN
Rising Star Award
Nicholas Nelson, MS, RN, CEN,
CPEN, CPN, NRP
Judith C. Kelleher Award
AnnMarie Papa, DNP, RN, CEN,
NE-BC, FAEN
More Award News!
Media Award
Cheryl Tan
Lantern Award recipients, Page 20
Team Award
Forensic Nurse Examiner Team —
Christiana Care Health System,
Newark, Del.
•Erica Dempsey, BSN, RN, CEN
•Amy Drejka, MS, BSN, RN, SANE-A
•Meghan Ellis, BSN, RN, CEN
•Mary Kathleen Fillingame, BS, RN
•Jennifer Henry, BSN, RN, CEN
•Amy Hensel, BSN, RN, SANE-A,
CEN
•Donna Lougheed, BSN, RN
•Angela McNulty, BSN, RN, SANE-A
•Christi Mench, RN, SANE-A
•Beth Miller, BA, RN
•Noemi Miranda, RN
•Jennifer Oldham, BS, RN, CEN
•Kelly Green O’Shaughnessy, BSN,
RN, CEN
•Christine Parks, BSN, RN
•Nicole Possenti, BSN, RN
•Amy Stier, RN, CEN, SANE-A
•Anita Symonds, MS, BSN, RN,
SANE-A, SANE-P
•Steaphine Taggart, BSN, BA, RN
•Erin Vaughn, BSN, RN, SANE-A
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5
2013 Treasurer’s Report
By Matthew F. Powers, MS, BSN, RN, MICP, CEN, 2013 ENA Secretary/Treasurer
and Edward M. Rylko, MBA, CPA, Deputy Executive Director
ENA’s financial results for
2012 showed continued
growth in the programs at
the core of our mission.
Revenue increased from each
of our three major sources,
and expenses were
appropriately aligned with
these programs, yielding
profitable results from
operations. Table 1 shows
the statement of activities,
and the following discussion
refers to that statement.
Total revenue increased
nearly 2 percent in 2012,
growing nearly $186,000 to
$17,096,499. We achieved
growth in all three major
activities: membership dues,
course revenues and
conferences. Membership
continued to grow, adding
344 members for a total of
39,888 at the end of 2012, and
at press time, membership
had reached 40,059. As a
result, membership dues
revenue increased $137,000 to
$3,606,518.
Course revenues grew 5.5
percent, as almost 66,000
nurses took our Trauma
Nursing Core Course or
Emergency Nursing Pediatric
Course. Attendance and
exhibitor participation at our
conferences continued to
grow. Our Leadership
Conference in New Orleans
had record attendance with
1,458 nurses, a 15 percent
increase from 2011. The
Annual Conference in San
6
TABLE 1
Diego drew 2,644 nurses,
about even with the 2011
conference. Exhibit space
increased 7 percent for
Leadership Conference but
decreased about 2 percent
for Annual Conference.
Operating expenses for
2012 totaled $16,978,767,
higher than 2011 by about
$438,000, or about 2 percent.
The largest expense increases
were for conference-related
costs, including higher travel,
food and meeting utilities
expenses at both conferences.
Conversely, wage and benefit
costs decreased in 2012
thanks to better alignment of
staffing resources. Dues and
course assessments provided
September 2013
TABLE 2
more than $1.5 million to
fund state council and
chapter activities.
The revenue growth and
controlled expenses yielded
net income from operations
of $117,732, exceeding the
2012 budget target by
$894,000. Activities in 2012
were focused on investing in
the support structure of the
organization, and this was
achieved in a fiscally
responsible manner.
ENA’s investment portfolio
generated an excellent return
of 11.7 percent, supported by
gains from the recovery in
the financial markets along
with dividends and interest.
Our net investment income
for 2012 was $1,195,132,
which, combined with our
operating results, led to an
increase of $1,312,864 in
ENA’s net assets.
Table 2, Supplemental
Statement of Financial
Position, shows assets,
liabilities and net assets as of
Dec. 31, 2012 and 2011. Our
total assets were $20,043,861
at Dec. 31, 2012, an increase
Official Magazine of the Emergency Nurses Association
of nearly $1.5 million from a
year earlier, when they were
$18,568,025. The strong
operating and investment
results discussed above were
the reasons for the increase.
This balance sheet continues
to demonstrate that we are in
excellent financial condition,
with high-quality assets and
no debt. Our financial
management policy requires
that our reserves, represented
by our long-term investments,
be at least 50 percent of our
operating expenses. At the
end of 2012, this reserve ratio
stood at a very healthy 65
percent when looking ahead
to budgeted operating
expenses for 2013; in fact,
these reserves exceed the 50
percent threshold by more
than $2.7 million.
The ENA Board of
Directors assigns a high
priority to our stewardship
role, to protect and provide
for the present and future
health of our association. We
work diligently with our
professional staff to ensure
that ENA serves its members
well, fulfills its strategic plan
and achieves its mission. The
2012 financial results further
strengthen ENA’s fiscal
foundation so that we can
confidently continue to
provide resources to our
members and advocate for
our profession and our
patients. We encourage states
to monitor their financial
assets and activities and to
please consult your board
liaison for any questions and
issues, in addition to us and
our national office.
If you have any questions,
please contact us at Matt.
[email protected] or
[email protected].
7
ENA ADVOCACY
The Affordable Care Act:
More Patient Coverage Options
By Richard Mereu, JD, MBA, ENA Chief Government Relations Officer, and Ken Steinhardt, Director of Government Relations
The Affordable Care Act was
approved by Congress and
signed into law by President
Barack Obama in March
2010. While enacted more
than three years ago, most of
the Act will begin to take full
effect starting Jan. 1, 2014.
The law is designed to
expand health care insurance
and save individuals money
on medical expenses. Many
of its most important provisions deal
with increasing insurance coverage for
millions of Americans, especially those
with lower income or whose employers
do not provide health insurance. In fact,
it is estimated that 33 million Americans
who are currently uninsured will receive
coverage under the law.
As emergency nurses, it is critical for
you to be able to communicate with
your patients about the Affordable Care
Act and provide them with basic
information about some of the
expanded health insurance options
under the law.
Of the 130 million patients visiting
emergency departments each year,
about 21 million have no medical
insurance. Many of these patients
cannot afford the cost of purchasing
their own coverage on the private
market. Others are young or healthy
and do not feel they need medical
insurance. The ACA addresses these
problems in several different ways.
The most direct way in which the
ACA expands health insurance is by
increasing the number of people who
qualify for Medicaid or the Children’s
8
Health Insurance Exchange Program.
Beginning in 2014, the new law
expands Medicaid to all Americans
under age 65 who earn at or below 133
percent of the federal poverty line
($31,322 for a family of four in 2013).
This change is expected to add 17
million people to the Medicaid
program.
For those who don’t qualify for
Medicaid, the ACA created Health
Insurance Marketplaces (known as
‘‘exchanges’’) to make it easier for
individuals to purchase private health
insurance. The exchanges are entities set
up in each state with the goal of creating
a more organized and transparent
marketplace for purchasing health
insurance. People will be able to
compare insurance plans based on price,
benefits, quality and other features.
Individuals can access information
on exchanges either through their state
government website or by visiting the
federal government website, www.
healthcare.gov. While these websites
provide extensive information on the
ACA, their most important feature is that
they will provide a single forum for
individuals to compare and
evaluate the various
insurance plans.
The state exchanges will
begin with open enrollment
Oct. 1, 2013, with coverage
starting as early as Jan. 1,
2014. It is important that
you encourage people
without insurance to
explore getting coverage
through the exchanges in
the coming months. After open
enrollment ends March 31, 2014,
individuals will not be able to get
health coverage through their exchange
until the next annual enrollment period.
The only exceptions are for qualifying
life events such as marriage, birth or
adoption of a child or a change in
work status.
Another important provision in the
ACA is the requirement that private
insurance plans allow parents to add or
keep their children on their policy until
they turn 26. Even though this policy
took effect in September 2010, many
young patients still might not be aware
they could be covered under a parent’s
health plan.
Finally, you should be aware that
beginning in 2014 under the ACA, if
someone does not have health
insurance coverage, he or she will have
to pay a fee to the federal government.
We hope this article will allow you
to better inform your patients about the
Affordable Care Act. You also can direct
your patients to www.healthcare.gov
or to the U.S. government’s 24-hour
help center at 800-318-2596.
September 2013
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Helping Sexual Assault Victims
Regain a Sense of Control
Lessons Learned By
an ENA Foundation
Research Grant Recipient
By Kendra Y. Mims, ENA Connection
As a forensic nurse who has worked
with sexual assault victims since 2007,
Jessica Draughon noticed that most
forensic nursing programs providing
care for this population routinely
offered emergency contraception and
antibiotics for common sexually
transmitted infections but did not offer
non-occupational post-exposure
prophylaxis for HIV.
While wondering how this affected
sexual assault patients, Draughon, MSN,
RN, a predoctoral
fellow at Johns Hopkins
University School of
Nursing, began studying
literature on the
medication and made
another discovery: Many health care
providers had reservations about
offering HIV nPEP to sexual assault
patients because they were concerned
that they would have inadequate
adherence to the medication regimen.
Her response: You wouldn’t skip
giving diabetic patients insulin because
you thought they were non-compliant.
Draughon said it’s a medical decision
the patient should be able to make.
‘‘If we can understand more of
what’s going on with the patient
ENA
ANNUAL
CONFERENCE
through the
process, then we
might have a
better idea of
Jessica Draughon,
MSN, RN
how to intervene to improve
adherence,’’ she said. ‘‘Then, maybe
more health care providers would be
willing to offer these medications to
patients who should be receiving them.’’
To gain a better understanding of
sexual assault victims’ adherence to HIV
nPEP and how to improve it, Draughon
applied for an ENA Foundation research
SEPTEMBER
19-21
2013
N A S H V I L L E, T E N N ESSEE
REGISTER TODAY!
Register at www.ena.org/ac or scan the QR code.
Follow the action
#ENAAC13
*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.
10
AC13 Ad_Connection_Half_09 2013.indd 1
7/25/13 2:51 PM
September 2013
grant and became the 2012 recipient of
the ENA Foundation/Sigma Theta Tau
International Research Grant. She
received $6,000 to assist in developing
research that can improve care and
outcomes for this vulnerable
population. The grant also allowed
Draughon to pilot a newer method of
data collection by using Web-based
surveys that allowed patients to
complete a survey on their own time
without having to talk to someone.
‘‘In previous studies that have
looked at PEP following sexual assault,
most of the information has been
gathered from a chart review, the
phone or a follow-up appointment,’’
Draughon said. ‘‘This population is very
mobile. People move frequently after
experiencing a sexual assault, so using
the traditional mail survey wouldn’t
have been as effective.’’
If HIV nPEP is initiated within 72
hours of a potential exposure and taken
for 28 days, it can decrease the
likelihood that a patient becomes
infected, Draughon said. Because of the
time sensitivity, Draughon and her
study team of forensic nurses recruited
patients at their acute post-assault
exams. Participants were then contacted
via e-mail with instructions on how to
access the Web-based survey. Over the
course of a year, 21 patients completed
the survey out of the 32 who were
recruited for the research project.
‘‘This was a very ambitious research
undertaking that would not have been
possible without the funding from the
ENA Foundation and STTI,’’ Draughon
said. ‘‘With both the findings from this
study, as well as lessons learned from
using the new method of Web-based
surveys for the sexual assault population,
we will be able to improve patient care
and future research studies.’’
Draughon’s findings showed many
of the participants were concerned
about STDs but not necessarily HIV,
and they were unaware that HIV nPEP
was an option. From the interviews, she
found that most participants became
overwhelmed and almost retraumatized
when told about the medication
because they hadn’t considered their
HIV risk. By giving patients enough
information about HIV nPEP, Draughon
said, they were able to choose whether
they wanted to begin the medication
regimen — a choice that allowed them
to regain and assert a sense of control.
‘‘One aspect of my findings that I’ve
been sharing with various programs in
the area is that as the provider, you
may be the first person telling them that
they may have been exposed to HIV,’’
Draughon said. ‘‘It is not a position that
anyone wants to be in, but at the same
time, your patient deserves to know
that.’’ She said some nurses admitted
discomfort in talking about HIV and the
medication option with patients.
‘‘As emergency nurses, it is important
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Official Magazine of the Emergency Nurses Association
11
Continued from previous page
to educate ourselves and our patients about the current
available treatments so that we can give our patients accurate,
unbiased information so they can make informed decisions
about their own health care,’’ she said.
Providing HIV nPEP isn’t something an individual nurse can
facilitate if his or her hospital does not provide the medication,
but Draughon said it’s still important to discuss treatment
options with patients and to refer them elsewhere if you
believe a patient is at risk. Every hospital has a protocol when
an employee is exposed to HIV, but not every hospital has a
protocol in place when a patient has been exposed, she said.
Draughon believes her research study can advance the
specialized practice of emergency nursing.
‘‘As a subspecialty of emergency nursing, forensic nurses are
often current or former emergency nurses themselves,’’ she
said. ‘‘Currently, there is a lack of best-practice guidelines for
provision of HIV nPEP following sexual assault. This is an
opportunity for forensic nurses and emergency nurses to work
together at both a policy and practice level to create working
guidelines so our sexual assault patients are able to receive
nPEP if it is both warranted and desired.
‘‘ENA Foundation research grants allow nurses at all levels
to expand their horizons and begin new lines of investigation.
This is an opportunity to impact care for future patients. Even
though patients who have experienced sexual assault are at an
extremely vulnerable juncture when they come to the ED for
care, they deserve to have a voice.’’
Thank you to the following
organizations for
their generous support.
STRATEGIC SPONSORS
The ENA Foundation’s research grants and educational
opportunities are made possible by the generous donations of
individuals, state councils, local chapters and friends of
emergency nursing. Your donation helps to provide funding for
research that can improve the quality of patient care and
advance the profession. Please visit www.enafoundation.org
to find out how you can make a difference.
STRATEGIC SUPPORTERS
Congratulations to the nine 2013 inductees of the
Academy of Emergency Nursing.
Exciting plans are under way for the 2013 class of
fellows induction during the Annual Awards Gala on Sept.
21 at the ENA Annual Conference in Nashville, Tenn.
The ENA Strategic Sponsorship Program was
designed to create partnerships with
leading organizations whose objectives include
supporting the emergency nursing profession.
12
Supporter Half Vertical Ad 05_2013.indd 1
6/20/13 11:09 AM
Come join the fun! Awards Gala information is
available at: www.ena.org/education/
conferences/annual/2013/Pages/Gala.aspx
Questions? E-mail [email protected].
September 2013
MOMENTUM
TO THE MAX
E
NA annual conferences provide
a valuable opportunity to gain
inspiration from keynote
speakers, learn new information in
educational sessions, network with
peers in your profession and reconnect
to your passion.
But does your excitement still run
high when you return home, or do
you find your enthusiasm dwindling as
you get back into your routine?
‘‘Everyone comes home fired up
and ready to take action,’’ said Brian
Ericson, RN, BSN, CEN, ‘‘but there are
times when you come back from
conferences ready to make changes
and then you run into resistance from
colleagues or administration, or you
have day-to-day projects that just
sweep the post-conference buzz right
under the rug. Keeping that
momentum is awesome for emergency
departments and needs to be there on
a regular basis.’’
This year’s Annual Conference will
be held Sept. 19-21 at the Gaylord
Opryland Resort and Convention
Center in Nashville, Tenn. Although it
may be challenging to maintain the
same excitement after returning to
obstacles in your ED, here are five
ways to keep the momentum going.
Stay Tuned In
Ericson, clinical lead ED nurse at
Mercy Hospital in Portland, Maine,
says he uses various facets of social
media to stay inspired.
‘‘One of the ways I manage to keep
that momentum is through podcasts,’’
he said. ‘‘On my way to work, I tune
in to either personal development or
leadership podcasts or emergency
medicine podcasts. I find this very
exciting, and it keeps that buzz of
excitement within me that I always
bring home from ENA national
conferences. Emergency medicine
podcasts help me stay ahead of what’s
new in my profession, and leadership
and personal development podcasts
really can motivate you just like the
Official Magazine of the Emergency Nurses Association
After Annual Conference
in Nashville, Here’s How
You Can Stay on a Roll
By Kendra Y. Mims, ENA Connection
inspirational speakers at conferences.
Everybody needs a little daily dose to
keep the fires burning.’’
Share What You Learned
Because there is so much to learn at
conference, Briana Quinn, MPH, BSN,
RN, ENA senior associate for wellness
injury prevention, recommends taking
a proactive approach to deciding what
and how to share when you get home.
‘‘Before you go to conference,
determine how you will present the
information you have learned to your
department,’’ she said. ‘‘Will you place
some information in a department
newsletter, post to a bulletin board, have
a daily huddle or create a more formal
presentation? Have time carved out of
your post-conference schedule to sit
down and prepare your presentations,
posters or bulletin boards so that the
education is fresh in your mind.’’
After determining a plan, set up a
Continued on page 28
13
UPDATE FROM THE EXECUTIVE DIRECTOR |
Susan M. Hohenhaus, LPD, RN, CEN, FAEN
What’s Happening at ENA
Quarter 2, April - June 2013
ENA headquarters continues to be a very busy and productive place. In the second quarter of 2013, the
staff continued to work with the ENA Board of Directors, committees and work teams to operationalize
the second year of the ENA strategic plan. The four organizational priorities remain the focus for our work.
Advance Emergency Care
at Home and Abroad
ENA was represented at 21 different
liaison meetings, including four
meetings in Mexico, Australia, Canada
and Spain. Domestic relationships
continue to be strengthened by
collaborating with our colleagues at the
American College of Emergency
Medicine, the National Association of
Student Nurses, the American Hospital
Association and various federal
agencies, including the Health
Resources and Services Administration
(see sidebar below).
ENA’s social media presence
continues to grow. Our Facebook page
had 22,279 “likes” (11 percent increase
vs. Q1) with a peak total reach of
26,428 users per week; 19 percent of
followers are international. ENA’s
Twitter account has 2,743 followers (2.7
percent increase vs. Q1); 29 percent of
our tweets get retweeted. Individuals
from more than 30 countries have made
multiple visits to ENA President JoAnn
Lazarus’ blog, which had 9,489 views
since launching in January. Finally,
ENA’s LinkedIn page has 7,095
members (12 percent increase vs. Q1).
To better serve members and
develop new products, seven new staff
members were hired in Q2, including a
director of marketing, a second
instructional designer, Member and
Course Services representatives and
nurse specialists for American Nurses
Credentialing Center approval-unit
issues and quality and safety.
Define, Identify and Advocate for
a Culture of Safe Practice and Safe
Care; Champion a Culture of Inquiry
ENA’s government-relations staff
continues to network and represent
ENA and emergency nursing on Capitol
Hill and assist states with legislative and
regulatory issues. In Q2, Richard Mereu,
chief government relations officer, had
a total of 16 congressional meetings and
five congressional hearings in addition
to assisting ENA state leaders with more
than 100 ENA Day on the Hill meetings.
Meetings included conversations with
Rep. David Joyce (R-Ohio) and Rep.
Lois Capps (D-Calif.), co-chairpersons
ENA and Dr. Mary Wakefield, HRSA Administrator
In May and July, ENA leaders participated in calls and meetings with Dr. Mary
Wakefield, Health Resources and Service Administration administrator, to
discuss the importance of emergency nurses in the implementation of the
Affordable Care Act.
Wakefield said emergency nurses are critical to the program’s success
because ‘‘you are the ones who have contact with a significant number of
uninsured patients. You have the opportunity to inform these patients about
how to enroll and how to gain access to primary care.’’
For more information, check out www.HealthCare.gov, www.facebook.
com/Healthcare.gov on Facebook and @HealthCareGov on Twitter.
14
of the 113th Congressional Nursing
Caucus.
ENA signed on to four letters of
support, including a letter to the House
and Senate appropriations committees
to provide sufficient funding for the
Emergency Medical Services for
Children program in fiscal year 2014.
ENA also co-signed a letter from the
Health Professions and Nursing
Education Coalition to the House and
Senate appropriations committees
recommending $520 million for Title VII
health professions and Title VIII nursing
workforce development programs in FY
2014. Four press statements were issued
and can be found at www.ena.org.
Staff relationship-building resulted in
ENA being formally accepted into The
Nursing Community (www.
thenursingcommunity.org) in April.
On the state level, Ken Steinhardt,
director of government affairs, has been
working with state councils on issues
related to workplace violence, title
protection and state advocacy grants.
Champion a Culture of Inquiry,
Learning and Collaboration
ENA’s institutes are hard at work
scanning the health care landscape and
responding to the needs of emergency
nurses everywhere.
The Institute for Emergency Nursing
Education continues its work on the
latest version of the Emergency Nursing
Pediatric Course by analyzing test
questions (a process typically conducted
at the nine-month mark after a course
launch) and reviewing feedback from
the initial phases of the revised course.
TNCC 7th edition revisions are well
September 2013
under way, with pilot activities
scheduled for the ENA Annual
Conference in Nashville, Tenn. The new
interactive Geriatric Emergency Nurse
Education Program is in its final
instructional-design stages, with a launch
scheduled for this fall.
The Institute for Emergency Nursing
Research is working on several studies,
including ED workplace violence,
educational needs of emergency nurses
in rural and critical-access hospitals and
catheter-associated urinary tract
infections.
The Institute for Quality, Safety and
Injury Prevention facilitates the awards
processes, including the Lantern Award,
and coordinates most of the work of
more than 30 ENA committees. Twelve
of these committees met at ENA
headquarters during Q2. Work on
nursing quality indicators and
development of topic briefs and position
statements are shared with state leaders
through an IQSIP newsletter.
ENA’s courses are very strong in
2013. In the first two quarters, 3,323
TNCC courses were conducted, with
more than 23,000 participants. ENPC
courses numbered 1,264, with 7,192
participants.
Expand and Fortify Membership
At the end of June, ENA’s membership
was holding steady at 40,059, ahead of
the same time in 2012. ENA added
more than 80 new student members at
the NSNA meeting in April, the largest
membership drive in ENA-NSNA
history, thanks to the work of ENA staff
and Lazarus, who met with and
engaged students in the exhibit hall.
ENA also is conducting member surveys
related to military membership and
developing programs and resources for
career wellness for emerging
professionals and emerging leaders in
emergency nursing.
Looking Ahead
The new ENA website is mobile friendly
and contains enhanced search function
capabilities. Video-conferencing
hardware and software are being
updated to allow for enhanced virtual
meetings.
ENA’s conference team is focused on
developing content and activities for
Leadership Conference 2014 (Phoenix)
and the 2014 Annual Conference
(Indianapolis) and for the new
combined 2015 conference in Orlando,
Fla. The IENE is working with the
development team to explore
educational opportunities for advancedpractice and new-graduate nurses. The
IENR continues to explore opportunities
for grant funding through federal grant
applications as well as with our
corporate partners.
ENA staff thanks our members and
emergency nurses everywhere for your
continued membership and engagement
in public policy and emergency nursing
education. We are strong, healthy and
open to exploring new and innovative
opportunities to promote and protect
the practice of emergency nursing.
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Intraosseous Access is recommended by the AHA, ACEP, INS, ENA, AACN and more.
Official Magazine of the Emergency Nurses Association
15
‘SUCH AN AMAZING THING’
Medical Missions Bring Vietnamese Nurses the Extra Training They Seek
By Kendra Y. Mims, ENA Connection
Most nurses don’t own stethoscopes in
Vietnam.
Mickey Guerrero discovered this
when she arrived for her first medical
mission trip with the Good Samaritan
Dental and Medical Ministry in 2009.
Over the course of her first week,
Guerrero, BSN, RN, clinical supervisor
of the emergency department at Valley
Hospital Medical Center in Las Vegas,
and five other emergency nurses from
the United States provided training for
80 nurses in Hue, Vietnam, focusing on
nursing skills related to cardiac,
respiratory and abdominal emergencies.
They quickly realized there are
significant differences between nursing
practice in the U.S., which is often
driven by state nurse practice acts, and
the practice of Vietnamese nurses,
where the head nurse of each hospital
determines nursing scope of practice.
‘‘We found our Vietnamese nurse
colleagues have an incredible desire to
learn from U.S. emergency nurses,’’
Guerrero said. ‘‘Although they didn’t
have the same responsibilities as U.S.
nurses, they love caring for their
patients and will do anything in their
ability for them.’’
Guerrero fell in love with the
country, the people and the culture. She
eventually was asked to be the nursing
adviser for the Good Samaritan Dental
and Medical Ministry’s Emergency
Medicine Committee & Advisors.
As chairperson of the nursing
conference in Vietnam, held annually in
March, she is in charge of organizing
the event and selecting the topics.
Because she developed relationships
with the nurses in Vietnam and keeps
in touch with them through Facebook,
16
Top: Mickey Guerrero, BSN, RN, (rear, left) poses with some of the 100-plus nurses
attending a conference by the Good Samaritan Dental and Medical Ministry in
Hanoi, Vietnam, in March. Above: A nurse tests her new stethescope on Guerrero.
she is able to find out what training
they need. Per their request, the nursing
conference this year in Hanoi focused
on trauma, including pediatric trauma,
abdominal trauma and more.
‘‘We found that a primary cause of
death in Vietnam is injury from
small-vehicle crashes or incidents
— mostly, everybody there uses motor
scooters or bicycles as the main mode
Continued on page 18
September 2013
AGGRESSIVE BEHAVIOR...
...towards staff at work is dramatically on the
increase, especially in our Hospitals. Verbal abuse,
threats with weapons, cuts, punches, even serious
injuries are becoming everyday occurences.
The impact on the confidence and morale of staff is
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Vietnamese Nurses
Continued from page 16
of transportation,’’ Guerrero said.
‘‘Neurological injuries and orthopedic
injuries are two causes of injury and
death. We focused on teaching
hands-on ways to assess injured
patients and how to bring that
information to the physicians to provide
the best possible care.’’
Guerrero and her nurse colleagues
use specific textbooks to create their
lectures because they want to make
sure the resources they present are of
the highest quality. She also wants the
training to be evidence-based, not
opinion-based — one of the criteria
Guerrero makes sure all nurses adhere
to when they submit their conference
presentations for review. All of the
nurses who travel to Vietnam to teach
emergency nursing with Guerrero must
refer to ENA textbooks and the
Textbook of Adult Emergency Medicine
Donated stethescopes are unpacked before being given to the nurses in Hanoi. The
Good Samaritan Dental and Medical Ministry distributes more than 120
stethescopes per year — one for every nurse who attends its training conference —
in addition to educational materials and other nursing gifts.
by Dr. Peter Cameron as resources in
their lectures.
The conference is split into two
parts; the lecture portion takes up half
of the day, and the remainder focuses
on hands-on learning.
‘‘We teach them that the most
important person in the room is the
patient,’’ Guerrero said. ‘‘The doctor,
nurse and the patient’s family are all a
Continued on page 20
ADVANCE THE FUTURE
OF EMERGENCY NURSING
Our mission is to
provide educational
scholarships and research grants
in the discipline of emergency nursing.
DONATE NOW!
www.enafoundation.org
18
ENA Foundation_Connection_half_09 2013.indd 1
8/5/13 10:01 AM
September 2013
We’ve questioned the ordinary
and redefined extraordinary
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For more information, stop by Stryker Booth 507 at the ENA Annual Conference or visit www.stryker.com/primetc.
Stryker is proud to be an ENA Strategic Sponsor and support nursing excellence through
important initiatives such as the ENA Workplace Injury Prevention Toolkit and the ENA
Lantern Award. Program Criteria for the ENA Lantern Award funded, in part, by Stryker.
Vietnamese Nurses
Continued from page 18
team working together to care for
the patient and bring the patient
back to optimal health.’’
The conference grows every year.
During the last visit, Guerrero, along
with 12 to 15 emergency nurses,
taught 120 Vietnamese nurses,
rotating through different areas in the
country. In the last couple of years,
bigger cities have taken notice of the
training and are asking for their own
conferences. This year, the lectures
and hands-on labs in Hanoi were
recorded and sent to remote areas.
‘‘The work we’ve put into our
nurses’ conference and the
physicians’ conference, which
happens at the same time, has
highlighted the importance of
emergency nursing and emergency
medicine,’’ Guerrero said. ‘‘For the
first time this year, the ministry of
health officially recognized
emergency medicine as a specialty
and has started the first official
physicians training program for
emergency medicine. Additionally,
the Hanoi University of Medicine
and Pharmacy school has its first
emergency nurse training course.’’
Guerrero gets excited when
nurses contact her to share how the
training from the conference has
helped them transform their practice.
When Guerrero returns from her
medical mission trip, she is
spiritually full, with a renewed
passion for her profession.
‘‘We deal with challenges in the ER
that can be a burden on your soul,’’
she said. ‘‘It’s so amazing to come
home energized with a real purpose
of what you’re doing. It reaffirms why
you’re an emergency nurse.
‘‘One of the nurses sent me a
message that her dad’s heart had
stopped beating. She did CPR on her
dad based on what we had taught
her, and her dad lived. It’s such an
amazing thing.’’
20
2013 Lantern Award Recipients
ENA is pleased to announce the recipients of the 2013 Lantern Awards.
Recipients will be recognized Sept. 21 at the Annual Awards Gala at the 2013
Annual Conference in Nashville, Tenn.
• Akron General Medical Center Emergency Department (Akron, Ohio)
• Bethesda North Hospital Emergency Department (Cincinnati)
• Bon Secours Richmond Community Hospital Emergency Department
(Richmond, Va.)
• Children’s Healthcare of Atlanta Emergency Department, Egleston Campus
(Atlanta)
• Children’s Hospital Los Angeles Emergency Department & Level 1
Pediatric Trauma Center (Los Angeles)
• The Medical Center of Aurora Emergency Department (Aurora, Colo.)
• OSF Saint Francis Medical Center Emergency Department (Peoria, Ill.)
• St. Anthony Hospital
Emergency Department
(Lakewood, Colo.)
• Virginia Hospital Center
Emergency Department
(Arlington, Va.)
ENA Connected
New App Will Let You Keep
Conference a Touch Away
By Thomas Barbee, ENA Digital Marketing Manager
With Annual Conference right around
the corner, we have been working
feverishly to help ensure that we
provide you with the best conference
experience possible.
For the first time at an annual
conference, we are providing the
Annual Conference app, which you will
be able to use soon. For those
unfamiliar with this technology, the app
provides the ability to access session
and speaker information, as well as any
additional handouts. It also features an
alert system for any last-minute
conference changes.
Social media also will play a huge
role at conference. Follow along on
Twitter and Facebook with the
conference hashtag of #ENAAC13. We
have other exciting items in store for
attendees, including photo and video
updates using Instagram.
Last but certainly not least, I will be
on hand at ENA Wired to showcase the
recently launched ENA and ENA
Foundation websites and to answer
your questions. I look forward to seeing
you all in Nashville!
September 2013
Today’s responsive
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Faster response.
Constant improvement.
The Code Management System from
Physio-Control is a comprehensive
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cardiac arrest.
Visit Physio-Control booth #307 at ENA
in Nashville to get ready for a more responsive
approach to your code management.
www.physio-control.com
CodeManagement Module™ is 510(k) pending
©2013 Physio-Control, Inc. Redmond, WA
Pediatric Update | Elizabeth Stone Griffin, BS, RN, CPEN
Common Viral Rashes
Affecting Younger Patients
Viral exanthem refers to a generalized
cutaneous eruption (rash) that is
associated with an acute viral syndrome.
Respiratory viruses, such as respiratory
syncytial virus and influenza, have been
linked to nonspecific exanthems. While
a nonspecific diagnosis can be
frustrating to caregivers who bring their
children to the emergency department,
the good news is that most viral
exanthems resolve after several days
without complications or interventions.
Treatment is usually symptomatic and
supportive, focused on keeping the
child comfortable and avoiding
dehydration, which is a specific concern
when painful lesions are present in the
mouth or throat.
Although many viral exanthems
cannot be linked to a specific diagnosis,
a few are easier to identify because of
their presentation or their prevalence.
The following are a few that are likely
to be seen in pediatric patients.
(Information on specific rashes, unless
otherwise noted, is based on content
from Pediatric Emergency Medicine.1 )
Roseola infantum (often caused by
human herpesvirus 6, also known as
sixth disease) is one of the most
common viral exanthems, most
predominant in children age 6 months
to 3 years. One study found that roseola
was responsible for 24 percent of ED
visits by infants between age 6 and 9
months.2 The classic course of
symptoms includes a high fever lasting
three to seven days in a well-appearing
child, with a rash that appears, with
fever cessation up to two days later.
Other symptoms include runny nose,
cough, sore throat, otitis media and eye
redness. The fever often comes on
22
suddenly; febrile seizures have been
noted at onset in up to 36 percent of
cases. Roseola is most prevalent in the
spring but can occur at any time of
year. The rash usually fades within a
week, and complications from roseola
are uncommon.
Coxsackievirus (hand-foot-mouth
disease) is characterized by a suddenonset papular rash that progresses to
quickly rupturing vesicles. The lesions are
typically present in the oral mucosa,
palms of the hands and soles of the feet.
They less often appear on the dorsal
surfaces of the hands and feet and the
buttocks and perineum. The child is
usually well appearing. Other symptoms
which precede the rash may include
low-grade fever, abdominal pain, cough
and malaise. The virus disappears by day
seven after infection and is most
prevalent in late summer and early fall.
The oral lesions are painful, so
dehydration is a common complication,
especially in younger children. Pain
control is key; anesthetic mouthwashes
are often used along with acetaminophen
or ibuprofen to support oral intake. Other
complications are uncommon but may
include risks to the fetuses of pregnant
women in their first trimester.
Fifth disease (caused by human
parvovirus B19, also referred to as
erythema infectiosum) is known for a
fiery redness that begins on both cheeks
(slapped-cheek appearance), typically
followed by a more generalized,
non-pruritic macular rash one to four
days later that fades into a lacy,
web-like pattern. Other symptoms may
include low-grade fever, headache, sore
throat, myalgias, nausea and malaise.
September 2013
Fifth disease is most prevalent in winter
and spring and most common in children
age 4 to 10 years. The rash, which
typically lasts three to five days but can
continue for up to four months, waxes
and wanes in intensity based on activity
and environmental conditions.
Complications are unusual in healthy
children. However, since the parvovirus
responsible for fifth disease replicates in
erythroid bone-marrow cells, it can cause
serious complications in patients with
hemolytic anemias or immunocompro­
mise, including infants under age 1.
These patients may develop aplastic crisis
in which their blood counts drop to
dangerously low levels. Pregnant women
exposed to fifth disease are at risk for
fetal loss, especially in the first 20 weeks
of gestation.
Varicella (chicken pox, caused by
human herpesvirus 3) is characterized
by a highly contagious, abrupt-onset,
intensely pruritic vesicular rash that
occurs primarily in children ages 2 to 8
years. Other symptoms that typically
precede the rash may include low-grade
fever, malaise, headache, cough and
sore throat. Varicella is most prevalent
in late winter and early spring. The rash
begins as faint macules, which progress
within 48 hours to delicate vesicles with
a dew-drop appearance. Lesions vary in
number from 10 to more than 100,
appear in crops over the first few days
and disappear within 10 days.
Treatment is focused on comfort
measures, such as decreasing pruritis
and minimizing the risk of secondary
infections, which are the main
complication. Children younger than 6
months or older than 12 years with
varicella are at risk for more severe
disease and may be treated with oral
acyclovir. Although uncommon,
involvement of a few specific areas
such as the eyes can lead to permanent
damage.
It is important for nurses who assess
children to be familiar with common
pediatric rashes and to know which
rashes may be more serious or lifethreatening. The Emergency Nursing
Pediatric Course supports this and
provides information on childhood
rashes. The associated history and
symptoms, in addition to the rash itself,
help to establish the source of rashes.
Information such as exposure to ill
children or adults, a history of tick and
other insect bites, recent antibiotic use,
presence of itching, environmental
exposures and prior immunizations will
provide answers which can offer clues as
to whether the rash is viral.
References
1. Baren, J. M, Rothrock, S. G., Brennan,
J. A., & Brown, L. (Eds.). (2008).
Pediatric emergency medicine.
Philadelphia, PA: Saunders Elsevier.
2. Marcdante, K. J., Kliegman, R. M.,
Jenson, H. B., & Behrman, R. E. (2011).
Nelson essentials of pediatrics (6th ed.).
Philadelphia, PA: Saunders Elsevier.
A NIGHT AT THE
GRAND OLE OPRY
™
SUPPORT ENA FOUNDATION AT
THE ENA 2013 ANNUAL CONFERENCE IN NASHVILLE, TN, AND
ENJOY THE SHOW THAT MADE COUNTRY MUSIC FAMOUS
JOIN US FOR A NIGHT OF COUNTRY MUSIC &
NETWORKING WITH YOUR COLLEAGUES!
SEPTEMBER 20 • 7 PM
Don’t miss this exciting event! What began as a simple radio
broadcast in 1925 is now a live-entertainment phenomenon.
Dedicated to honoring country music’s rich history and dynamic
presence, the Grand Ole Opry showcases a mix of country legends
and the contemporary chart-toppers who have followed in
their footsteps.
Register now at: www.ena.org/ac
AC13 Foundation Events Opry Ad_Connection_Half_08 2013.indd 1
Official Magazine of the Emergency Nurses Association
7/2/13 2:04 PM
23
BOARD WRITES |
Joan Somes, PhD, MSN, RN, CEN, CPEN, FAEN, ENA Board of Directors
Newer Ways of Reaching
Safe Practice, Safe Care
Recently, while orienting a new nurse, I
was asked, ‘‘Can’t you just download all
the emergency nursing knowledge from
your brain into my brain?’’ For a few
seconds I thought, ‘‘Wow! That would
make orientation easier!’’
Then reality struck. I replied, ‘‘More
would need to be deleted than
downloaded for that to be useful!’’
But it caused me to reflect on how
things have changed over the 40 years I
have been working in the emergency
department.
When I started, the ED was just one
room. Documentation was on paper,
and vital signs were done ‘‘as condition
needed.’’ Blood pressures were taken
manually, and every nurse wore a
closely guarded stethoscope. The
cardiac monitor had a teeny screen with
a small dot of light bouncing up and
down to show the rhythm. There was
no way to ‘‘run’’ a rhythm strip.
There also was no telemetry to the
nurses’ station. If you were
documenting the patient’s rhythm using
the electrocardiograph machine, it was
important to disconnect the ECG
machine if the patient needed to be
defibrillated or the machine would
‘‘short out.’’ Twelve lead ECGs were
obtained by moving a small suction cup
across the chest, recording one lead at
a time, leaving six little red circles on
the chest.
Intravenous needles were bare metal
and secured with the hope that the arm
board would prevent the patient from
moving the extremity and dislodging
the IV. Safety/self-sheathing needles
were unheard of in those early years.
All IVs were in glass bottles and
ordered as ‘‘continuous intravenous
24
Joan Somes when she first started in emergency nursing in the early 1970s.
access.’’ They also had to run at least at
30 mL per hour or they would ‘‘clot
off.’’ Big-drip tubing had 10 to 15 drips
per mL; mini-drip tubing had 60 drips
per mL. Nurses counted the number of
drips per minute.
It was a great help when the nurses
would put marks on a piece of tape
and attach the tape to the IV bottle to
identify where the fluid level should be
each hour. There were no pumps or
pump libraries. There were pre-printed
stickers to put on the glass bottles of IV
fluids that identified the drug added by
the nurses and the most common
number of drips per minute to give the
correct dosage.
Medications such as Levophed (that
was our pressor in those days), lidocaine
(the anti-arrhythmic of choice) and
Continued on page 26
September 2013
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Newer Ways
Continued from page 24
heparin were placed on a mini-drip
tubing and counted for a full minute to
ensure the correct dose was going into
the patient. Medications such as
aminophylline and Rhenytoin were
given directly IV push into the vein
over a couple minutes.
Gloves were for sterile procedures or
really nasty stuff. The mercury-filled
thermometers were soaked in zephiran
chloride to sterilize between patients.
Smoking was allowed in the nurses’
station and the patient rooms unless the
patient — or his or her roommate
— was on oxygen. The emergency
physician needed good reason to admit
a patient to a private room.
Chest tubes were connected to a
system of three bottles, each about a
gallon, located in the base of a loud,
humming suction machine that took up
about a square yard of floor space.
Resources for emergency nurses today include guidelines, practice references,
toolkits, free CE and much more at the ENA website.
Nurses routinely ‘‘stripped’’ chest tubes
by grasping the tubing coming from the
patient’s chest to stabilize it and then
squeezing and sliding their thumb and
first finger down the tubing to create a
negative pressure in the tubing. The
purpose was to clear the tubing, even if
there was only air coming from the
chest tube.
If a patient was shocky, there were
4-by-4-inch blocks of wood that the
nurse could place under the legs at the
Become a 2014 Annual Conference
Faculty Member Today
Submissions due Monday, October 14, 2013
Share your knowledge in Indianapolis with
an international audience of emergency nurses.
Presentations in multiple course areas and
course lengths are needed.
2014 Annual Conference ¡ Indianapolis, IN ¡ October 7-11, 2014
For full details including course areas, criteria
and submission form, please visit www.ena.org.
For questions, email [email protected] or call 847-460-4117.
26
AC14 Call for Faculty_Connection Ad_half_09 2013.indd 1
8/1/13 2:34 PM
September 2013
foot of the bed to raise it about six
inches to put the patient into the
Trendelenburg position.
Every patient with chest pain got a
bolus of lidocaine and a lidocaine drip
to ‘‘prevent arrest,’’ and if the patient
did arrest, he or she immediately
received two ampules of sodium
bicarbonate IV push. The ‘‘thumper,’’ an
oxygen-powered device, was used to
do chest compressions in 1974.
Written discharge instructions were
rare. The physician would tell the
patient what to do and generally not in
terms that a layperson would
understand.
Emergency care has changed
significantly over the years. ENA is 41
years old; the American College of
Emergency Physicians is 45 years old.
The first National Registry of
Paramedics exam was administered in
1978. Nurse, physician and paramedic
groups have all worked to improve
emergency patient care over the years.
Patient care guidelines and protocols
are now evidence-based, standardized
and constantly being re-assessed for
safety and improved patient care.
Patient assessment skills and safety
precautions have increased, becoming
an integral part of patient care.
Equipment has been developed to
eliminate much of the guesswork and
provide for safer patient care, not only
for the patient, but for those providing
care for the patients.
ENA has done much to identify the
need for information and to develop
and disseminate this information to help
improve emergency care and safety in
the emergency department. Evidencebased clinical practice guidelines,
practice references and topic briefs can
be found on the ENA website. The ENA
Institute for Quality, Safety and Injury
Prevention area has many links to solid
practice suggestions, as well as
educational materials, and the Institute
for Emergency Nursing Education offers
free CE. There’s information about ENA
conferences, which offer more learning
opportunities about safe practice, safe
care. Toolkits are also available to help
emergency nurses assess EDs for
violence and to identify patients who
are at risk of being driving-impaired or
are considering suicide.
I wish I’d had access to some of this
information when I started out as an
orientee all those years ago. I now
begin orientation for my new nurses by
taking them to www.ena.org. One
click and I can provide them with
current evidence-based and practical
information.
As these new nurses start to
download information and gather data
on safe practice, safe care, they don’t
need to sort and delete a bunch of
practices that were shown over the
years to be lacking any evidence. They
will download much more useful data
from ENA than they would from my
brain.
It’s back-to-school season.
Hit the books now.
Earn your BCEN® specialty certification.
Create your own study plan and get started!
BCEN offers Prep Exams and resources to help you prepare.
Board of Certification for Emergency Nursing (BCEN) certifications
demonstrate your commitment to excellence in
nursing care and professional advancement.
Learn more…
www.BCENcertifications.org
Visit BCEN at ENA 2013 – Booth #655
BCEN ENA HalfPg Color Ad.9.13.indd 1
Official Magazine of the Emergency Nurses Association
7/23/13 7:39 AM
27
Code You
Continued from page 13
meeting with a department educator
and leadership to report back on what
you’ve learned.
‘‘Have bullet points prepared, and
discuss what you learned in each
session and any networking
opportunities that you engaged in that
can impact the department,’’ Quinn
said. ‘‘Before the meeting ends,
schedule a plan for a follow-up meeting
to decide if there are any new
initiatives, projects or education that
your department might undertake based
on what you just presented. Make this
second meeting a productive one, with
a proposal and draft timeline for these
new potential educational opportunities
or initiatives.’’
Create a List of Goals
Choose several things you learned from
conference, then write a plan of action,
along with a timeline of how you will
achieve and implement your goals. A
few tips from Quinn:
• Consider something new: While
many sessions will address the specific
educational goals you have for yourself
and your department, pick a topic that
could hold potential for a new line of
thinking for both yourself and your
department.
• Go into each session with a
goal and a purpose: Look at the
sessions a couple of times before
conference, and talk to your department
leadership about them. Find a
combination of sessions that address
specific issues or concerns you have in
your department or areas where you
would like your department to grow.
Also, find some sessions you feel would
address your educational goals or
enrich your career path.
• Take good notes: Before
conference, note the sessions you
would like to attend, the reasons why
you would like to attend and what
questions you would like answered.
When attending the session, take notes
28
that can be categorized as ‘‘for personal
growth’’ or ‘‘for departmental growth.’’
As the session winds down, look at the
questions you wrote in advance. If
some relevant questions were not
addressed, speak up at the end of the
session.
Get Plugged In
Another way to keep your momentum
after conference is to stay educated on
what’s happening in your association.
Visit the new ENA website (www.ena.
org) to get information about upcoming
events, learn more about online
educational products (ENA members
are encouraged to take advantage of
the free continuing education courses
available), use ENA practice resources
such as the Workplace Violence toolkit
and subscribe to ENA’s public listserv
communities to engage in e-mail
discussion groups with other emergency
nurses. You also can check out ENA’s
Facebook page for up-to-date
information. Don’t forget to relive the
ENA Annual Conference experience by
reading the December issue of ENA
Connection, which will include photos
and highlights from sessions and
networking events.
Maintain Your Connections
Whether it’s attending an emerging
professionals event or a networking
session or chatting with someone in
between sessions or at the welcome
party in Nashville, be sure to build
relationships with your peers while
attending ENA national conferences.
When you return home, use social media
to stay connected to colleagues who
work at hospitals throughout the United
States or in other areas of the world.
Quinn also suggests discussing what
you’ve learned with a colleague over
lunch or dinner or while sight-seeing.
‘‘Conference is a wonderful
opportunity to network with peers and
have meaningful conversation,’’ she
said. ‘‘Make sure you incorporate the
education from the sessions into these
moments.’’
After conference is over, keep in
touch with others so that you can
continue to share what you learned,
swap ideas for solutions to common
problems and discuss how you have
implemented solutions in your
emergency department.
September 2013
Emergency Nurses...
Everyday Extraordinary
Emergency Nurses Week™
Emergency Nurses Day®
October 6-12, 2013
Wednesday, October 9, 2013
www.ena.org/enweek
ENA
Endorses
ACEP
Wait-Time
Statement
ENA agrees with and
endorses the American
College of Emergency
Physicians policy
statement “Standard for
Measuring and
Reporting Emergency
Department Wait
Times.” The policy
statement can be found at
www.acep.org by
hovering on the “Clinical
& Practice Management”
tab, then clicking “Policy
Statements” or by visiting
tinyurl.com/kdujags.
STATE
CONNECTION
North Carolina
ENA State Council
Submitted by Mary Lou Forster
Resch, BSN, RN, CEN
The North Carolina State
Council is pleased to announce
the winners of its Martha Wood
Scholarship. They are Jeff
Strickler, MA, BSN, RN, CEN,
CFRN, who will be pursing his
doctorate, and Shellie Wilkins, RN, who will
be pursing her bachelor’s degree.
The North Carolina State Council also has
been involved in an injury-prevention
program in the Outer Banks, a popular
vacation location in the state. After
numerous accidents and several pedestrian
and bicycle deaths, the Outer Banks Bicycle
& Pedestrian Safety Coalition was formed in
January 2013.
The coalition aims to increase education
and awareness of bicycle and pedestrian
safety not only among drivers, but also
among pedestrians, bicyclists and residents
and visitors to the Outer Banks. The
coalition also has focused on international
students who come to the area to work for
the summer and frequently use bicycles as
transportation.
Outer Banks ENA Chapter member Roger
Dale, RN, CEN, is active in the coalition and
helped to develop educational videos,
brochures and stickers with other
volunteers, as well as posting information
through social media channels.
Safe Work Environment Intensive
Thanks to all who attended the Safe Work Environment Intensive Workshop.
Some of the featured topics were:
Safe Practice
• Lateral Violence and Bullying
• De-escalation Awareness
• Advocacy
Safe Care
•
•
•
•
Risk Analysis
Team Safety
Medication & Procedural Safety
Liability in Emergency Practice
The Safe Practice: Workplace Violence Prevention portion of this event was sponsored by:
30
Safe Work Env Int 2013_Connection Ad_Half_09 2013.indd 1
7/25/13 2:50 PM
September 2013
connection
Recruitment and
Professional Opportunities
For ad rates and information, contact ENA Sales Representative Maureen Nolimal
at 847-460-4076 or [email protected].
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It’s an exciting time to join the Emergency Department at NYU Langone Medical Center, as our ED undergoes significant transformation and growth. We are thoroughly
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For additional nursing opportunities and information, please visit our website at www.nyulmc.org/careers or send resume to [email protected].
It is the policy of NYU Langone Medical Center (“NYULMC”) not to exclude from participation, deny benefits to or engage in discrimination against any person employed or seeking
employment or patient care on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity or expression, pregnancy, disability, ancestry, marital status, age,
citizenship status, veteran status or any other category protected by law. The Nondiscrimination policy is available in Spanish, Chinese and Russian and will be made available through
interpreting or translation services for other languages and deaf and hard of hearing individuals.
Official Magazine of the Emergency Nurses Association
31
After all the long hours,
you still smile,
even at 4am.
Hiring ER RNs – Apply Today!
Make the Best of Your Career at one of our exceptional hospitals and
take advantage of our extraordinary benefits.
HCA North & West Florida Division is a family of award
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The HCA Total Rewards program provides employees with financial and
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To learn more and apply, please visit either of
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JPS Health Network values highly motivated
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Please visit our website for additional
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If you’re interested in joining our team, please visit
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32
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September 2013
2013 Annual Conference
Walk for Wellness
to support the ENA Foundation
• Children’s Memorial
Hermann Hospital
• Katy
• Memorial City
• Northeast
• Northwest (Inner Loop)
• Southeast
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• Sugar Land
• Texas Medical Center
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CONTACT US
Search current job openings at
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Toll-free
1-866-441-4567
e-mail
[email protected]
To register or for fundraising information,
visit www.ena.org/ac
Walk for Wellness Ad_Connection_Qtr_08 2013.indd 1
6/24/13 10:32 AM
Join our Community!
Are you a nurse who has practiced in an
emergency care setting for 5 years or less?
If so, join one or more of our
Emerging Professionals social networking groups
and connect with your peers. You will be able to
post discussion topics and share stories.
Ready to get started? See below for details:
Facebook: http://on.fb.me/11XdCxv
Google+: http://bit.ly/16FnAow
LinkedIn: http://linkd.in/11MzNDn
We can’t wait to have you join our communities
and look forward to seeing you at
ENA’s 2013 Annual Conference
for our Speed Mentoring Event
on Friday, September 20, 6-7 p.m.
at the Opryland Hotel.
512.328.9000
Choose from locations
throughout Houston:
Registration fee: $10.
September 2013
333814
3.375” x 9.625” (1/2 Pg. V)
ENA Connection
Front forward, rt-hand side
Memorial Hermann is a world-class health system with
locations throughout Houston and the surrounding areas.
With benefits eligibility that begins the first day of
employment, this is a great time to become part of our
award-winning organization. Our team of more than 20,000
consistently votes us among Houston’s Best Places to Work
Find out why—and take your career to a higher level.
The Walk for Wellness is a 1.2 mile walk, where
the funds raised support the ENA Foundation
mission. Walkers are encouraged to raise $150
from their friends and family through social
media, e-mails and personal connections. Walk for
your health and for the health of the profession.
Date:
Media Order:
Size:
Publication:
Section:
Go the distance
at Memorial Hermann.
Friday, September 20
6-7 a.m. – NEW time
Nashville, TN
Sponsored by
EOE, M/F/D/V. No agencies, please.
AC13 Emerging Professionals Ad_Connection_Quarter_08 2013.indd 1
Official Magazine of the Emergency Nurses Association
35
7/2/13 9:34 AM
be happy.
When you’re on the right team, happiness ensues.
You know us as recognized ED leaders who guide hospitals toward real and
effective change. Now we would like to get to know you. Blue Jay Consulting is
looking for professionals with the leadership insight and clinical experience to
bring process improvements to our clients, and the passion and commitment to
enhance the overall quality of emergency care. If you consider yourself among
the best in your field, you’ll find yourself in good company at Blue Jay Consulting.
Join the strongest team in the industry and... be happy.
“As a Blue Jay consultant, I 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
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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
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Contact Jim Hoelz or Mark Feinberg at 407-210-6570 to discuss how we can capitalize on
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