ENA Connection November 2011

the Official Magazine of the Emergency Nurses Association

connection November 2011 Volume 35, Issue 10

Don’t Look Away Behavorial Health Patients Can’t Be an Afterthought — and Neither Can Our Safety PAGES 4, 12

INSIDE

FEATURES

Vanderbilt’s Adult Emergency Department Initiates New Program to Protect Staff PAGE 12 After Deadly Indiana Stage Collapse, It’s Showtime for Emergency Nurses PAGE 14 A Close One for Nurses as Disaster PAGE 18 Drops on Reno ENA Leadership Conference 2012: PAGE 28 Illuminate & Empower

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Dates to Remember November 14, 2011 Submission deadline for Blue Jay Consulting/ ENA Award for Outstanding Emergency Department Nurse Leader of the Year January 11, 2012 Early bird registration closes for ENA Leadership Conference 2012 January 16, 2012 Submission deadline for Academy of Emergency Nursing 2012 class of fellows March 2, 2012 Submission deadline for 2012 bylaws proposals and resolutions

Features

LETTER FROM THE PRESIDENT |

AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN, President, with Pierre Désy, Chief Development Officer

Strength Through Partnership and Sponsorship

PAGE 3 Collaboration Is Key to New Award PAGE 10 Use ENA’s Emergency Nursing Resources to Improve Your Practice PAGE 12 Vanderbilt’s Adult Emergency Department Initiates New Program to Protect Staff ENA Workplace Violence Toolkit How Are You Staying Safe?

PAGE 14 After Deadly Indiana Stage Collapse, It’s Showtime for Emergency Nurses PAGE 15 Redefining Travel Nurse: Conference Attendees Run Code in Airport PAGE 16 One Emergency Department Covers Another After Tragic Helicopter Crash PAGE 18 A Close One for Nurses as Disaster Drops on Reno PAGE 24 ENA Call for 2012 Bylaws Proposals and Resolutions PAGE 28 ENA Leadership Conference 2012: Illuminate & Empower PAGE 35 Certified Emergency Nurse Named Air Force Nurse of the Year

Departments PAGE 3 Letter From the President PAGE 4 Board Writes PAGE 6 Washington Watch PAGE 8 Pediatric Update

As all emergency nurses know, quality care is a team effort. No single member of the emergency department can do it alone. It takes a cohesive team approach to meet the ever-changing challenges and complexity of emergency care.

The Emergency Nurses Association is no different. It takes a team approach to continuously meet the needs of our members and your profession. It takes a combination of skills, a wide variety of expertise and quite frankly, it takes financial support.

That is why ENA is committed to bringing strong corporate partners into a sponsorship role. By leveraging the leadership that ENA members have in the emergency health care system, we are able to share expertise, influence product development and help defray costs that keep our conferences and our membership dues affordable.

ENA’s sponsors are chosen for tangible and intangible corporate qualities that integrate with the mission and vision of the association and with you. Sponsors are attracted to ENA for its marketing potential based on the association’s leadership role and the membership’s ability to affect its bottom line.

A plus for the association and for the sponsors, sponsorship is a giant plus for ENA members.

Since the economy burst its bubble in 2008, we have met our challenges, maintaining business excellence, offering members more and improved educational experiences, affinity programs, a new and improved ENA Career Center and other benefits in the face of rising costs. We are proud of the fact that with the support of our sponsors, we have been able to continue championing you with the same gusto we have in the past.

With that in mind, we would like to thank Stryker, Vidacare, GE Healthcare and Hill-Rom for their generous and ongoing support. Together we are shaping the future of emergency nursing and emergency health care in general. From the support of our conferences to support of the ENA Foundation, from specific sponsorships of research and courses to general support throughout the year, these corporate leaders have reached out to ENA and its members to help ensure that we meet our ultimate goal of Safe Practice, Safe Care.

We hope that you will speak with the representatives of these fine organizations at the 2012 ENA conferences or wherever you may find them and express how they make a difference to you and your colleagues. They are a member of the ENA team that represents you, your practice and your profession.

Their generous financial support gives added strength to the voice of ENA, a voice whose overriding goal is to support emergency nurses everywhere.

PAGE 20 Click Here PAGE 24 ENA on Facebook. What Are Emergency Nurses Saying?

PAGE 25 Nominations Committee PAGE 26 Ready or Not? PAGE 30 State Connection PAGE 32 Member Benefits and Resources PAGE 33 ENA Foundation PAGE 34 BCEN PAGE 36 Board Highlights

Collaboration Is Key to New Award Is there an outstanding nursing leader on staff in your emergency department? Does he or she demonstrate highly collaborative behaviors with medicine?

If this person is an ENA member, you can nominate this individual for the new Blue Jay Consulting/ ENA Award for Outstanding Emergency Department Nurse Leader of the Year to be presented February 23 in New Orleans at Leadership Conference 2012.

This award will bring forth some of the best examples of teamwork and the highest quality collaborative patient care for all of us to learn from, said Mark Feinberg, managing partner of Blue Jay Consulting, sponsor of the award.

“This discovery will undoubtedly help others improve the way care is provided and ultimately help improve emergency care overall,” he said.

Nomination forms are available to download at www.bluejayconsulting.com. The submission deadline is Monday, November 14, 2011.

Official Magazine of the Emergency Nurses Association

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BOARD WRITES |

Kathleen E. Carlson, MSN, RN, CEN, FAEN, Director

What Is Best for the Patient As emergency care professionals, we are all aware of the problems caused by boarding patients on a daily basis in our emergency departments.

Of growing concern are the issues associated specifically with the increase in boarding patients with behavioral health problems.

The number of patients with mental health and substance use disorders treated in emergency departments has been on the rise for more than a decade. In 2007, 12 million emergency department visits involved a diagnosis related to a MH or SUD, accounting for 12.5 percent, or one out of every eight emergency department visits.1 Patients with behavioral health issues encompass all socioeconomic and age groups, from pediatric to the elderly. It is estimated that approximately one-third of adults and one-fifth of children had a “diagnosable substance use or mental health problem in the last year.2” Stressors from the current economic situation and increasing unemployment cause patients anxiety. Patients often stop counseling and taking prescribed psychiatric medications due to the cost. While patients may not present with a chief complaint related to a psychiatric problem, careful screening and assessment may reveal the patient’s underlying behavioral health problems.

For example, one in three veterans and military personnel returning from combat suffers behavioral health problems that may not be obvious, impacting the patient’s health and that of his or her family.3 In 2003 the President’s New Freedom Commission on Mental Health reported that the total number of inpatient psychiatric beds per capita had declined 62 percent since 1970, and that state and county psychiatric hospital beds per capita had decreased 89 percent.4 Funding for necessary services is not adequate to meet

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© 2011 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 needs caused by the closure of these beds.

Consequently, the emergency department, the most expensive place to receive care, has become the safety net in caring for patients with behavioral health needs. Under the Emergency Medical Treatment and Active Labor Act, emergency departments are required to stabilize all patients, which places a financial burden on the hospital to properly diagnose them. At times, patients may be discharged home with prescriptions and instructions for follow-up, only to return later.

It is the patients who suffer. Most emergency departments do not have the resources necessary to treat behavioral health needs.

Instead, patients are boarded in a department that is fast-paced, hectic and noisy. A patient is stripped of belongings and placed on a stretcher in a sterile, drab space that has been emptied for the safety of the patient. Medical clearance is completed, and the wait for appropriate placement begins. As the hours go by, little or no therapy is provided, care may be handed off to several different practitioners, and the potential for the patient to deteriorate increases.

There must be a better way.

This should not be an emergency department problem—but it is, so ENA is taking action.

ENA’s strategic plan focuses on three clinical priorities: emergency department crowding, violence in the emergency department and the care of psychiatric patients. Under current workplace conditions, the problem of boarding patients with behavioral health problems is often related to all three clinical priorities.

Let’s review some of ENA’s current efforts.

The ENA Emergency Department Psychiatric Care Committee presented the board with three public policy recommendations and an action plan for ENA implementation. They were approved last September.

The first priority is that patients with symptoms of mental health or substance use

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disorders be given priority of care equivalent to that given to other medical conditions. The committee notes the prevalence of a “stigma – which erodes confidence that mental illnesses are real, treatable health conditions – tolerates attitudinal, structural, and financial barriers to effective treatment and recovery.5” One strategy recommended for attaining this priority goal is to develop a standardized approach to assessing behavioral health in the emergency department.

In addition to the initial screening, the goal would be to standardize an ongoing assessment of boarded emergency department patients with behavioral health or substance use disorders, including disorders such as prescription drug misuse and abuse and agitation. As this is just not “our emergency department problem,” ENA is seeking to work with various stakeholders to define this standardized approach.

The second priority addresses access to quality patient care by collaborating with community agencies and linking services.

Access includes continued improvement in financing and integrated delivery of prevention, treatment and recovery support services.

Increased funding for the Substance Abuse and Mental Health Services Association and other federal programs that provide state block grants for community-based behavioral health services is incorporated into ENA’s Public Policy Agenda (www.ena.org/government/Documents/2011Public PolicyAgenda.pdf).

In addition, ENA is a member of the Mental Health Liaison Group (www.mhlg.org), a coalition to promote health system capacity building through the health reform law and the parity law focusing on behavioral health.

To date, ENA has been a signatory to various public policy MH/SUD initiatives.

In another strategy to support the systems and collaboration priority, ENA is developing an advocacy packet

Chief Communications Strategist: M. Anthony Phipps Editor in Chief: Amy Carpenter Aquino Assistant Editor, Online Publications: Josh Gaby Writer: Kendra Y. Mims Editorial Assistant: Dana O’Donnell Board of Directors Officers: President: AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN President-elect: Gail Lenehan, EdD, MSN, RN, FAEN, FAAN

Continued on page 38 Secretary/Treasurer: Jason Moretz, BSN, RN, CEN, CTRN Immediate Past President: Diane Gurney, MS, RN, CEN Directors: Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN Kathleen E. Carlson, MSN, RN, CEN, FAEN Ellen H. Encapera, RN, CEN Mitch Jewett, RN, CEN, CPEN Marylou Killian, DNP, RN, FNP-BC, CEN JoAnn Lazarus, MSN, RN, CEN Matthew F. Powers, MS, BSN, RN, MICP, CEN Executive Director: Susan M. Hohenhaus, MA, RN, CEN, FAEN

November 2011

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WASHINGTON WATCH |

Kathleen Ream, MBA, BA, Director, ENA Government Affairs

At Drug Shortages Hearing, a Fresh Supply of Concern According to testimony given at a hearing held by the House Energy and Commerce Committee’s Health Subcommittee September 23, early warnings from drug companies about looming shortages of pharmaceuticals, along with better manufacturing practices, would help address the growing problem of drug shortages. The problem is quickly becoming a national health care crisis, as shortages of cancer, anti-infection and anesthesia drugs occur without warning when patients are in desperate need.

Subcommittee Chairperson Joe Pitts (R-PA) noted that the number of drug shortages reported to the Food and Drug Administration increased from 61 in 2005 to 178 in 2010.

“So far this year, FDA has continued to see an increasing number of shortages, especially those involving older, sterile, injectable drugs,” he added. In addition to cancer and anesthesia drugs, the products include “drugs needed for emergency medicine and electrolytes needed for patients on IV feeding,” he said. A staff memo Pitts released at the hearing said that more than 240 drugs in 2010 were either in short supply or completely unavailable, and “these shortages cause delays in treatment and surgery, compel physicians to make changes in care plans and force patients to receive substitute therapies that add expense to patient care.”

Administration witnesses included Howard Koh, assistant secretary for health at the Department of Health and Human Services, and Sandra Kweder of the FDA. Koh said the number of drug shortages has been rising steadily over the past five years and added, “This trend has continued into 2011 with an even greater number of shortages.”

Koh and Kweder suggested some remedies for the problem, but neither voiced confidence that it would be solved anytime soon because of the complex reasons for the shortages.

One reason they cited is that consolidation of the pharmaceutical industry has left fewer suppliers of the drugs subject to shortages, which in turn results in fewer plants forced to make more of the drugs. With plants

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busy filling orders for so many different types of drugs, they are not taking time for needed maintenance; this leads to breakdowns in manufacturing, which ultimately cause supply problems.

Other reasons included changes in inventory and distribution practices (e.g., “just in time” methods whereby hospitals save on inventory costs by ordering only small quantities of drugs, leaving providers less able to deal with shortages when they occur); shortages of underlying raw materials; and unanticipated demand.

One major reason cited in the hearing was that manufacturers are losing interest in producing drugs that are off-patent and sold as generics at prices that leave little room for profits. This brought up a question of whether government policy is in some way interfering with the forces of supply and demand. Rep. Tim Murphy (R-PA) asked, “In our push to make products more affordable, are we tripping over ourselves?” In essence, his question was: Are prices being cut so much that manufacturers don’t want to make the drugs? In response Koh said, “Those are precisely the issues that we are wrestling with,” and “Further economic analysis is intensely underway right now.”

The administration officials also mentioned a disturbing aspect of the issue — development of a “gray market” in which some suppliers have been able to come up with quantities of drugs in shortage and sell them to hospitals at exorbitant prices.

Some of those drugs are counterfeit and in other cases, their quality is suspect.

As for solutions, Koh and Kweder said earlier warnings that manufacturers expect shortages would help. A bipartisan bill — H.R. 2445 — introduced by Rep. Diana DeGette (D-CO) addresses that issue. The measure requires companies to alert the FDA when they expect shortfalls. Kweder pointed out that when FDA does hear about a potential shortage, it is able to work with the company to solve the problem or with other manufacturers to increase their supplies of the drug. Koh added that through this FDA drug shortages program, the agency prevented 99 drug shortages in 2011.

Witnesses representing industry included Jonathan Kafer of Teva Pharmaceuticals and Mike Alkire of Premier Healthcare Alliance. Kafer said drug shortages are a complex and multistakeholder issue and that all involved must work together to resolve it. He called for greater communication among all the stakeholders (active ingredient suppliers, generic and brand manufacturers, wholesalers and distributors, health care providers and government agencies), along with expedited FDA review of new manufacturing facilities and active ingredient suppliers when a drug shortage occurs. In addition, Kafer said the FDA should collaborate with the Drug Enforcement Administration to establish a process that would streamline DEA’s quotas of active drug ingredients in response to shortages of controlled substances. Currently, DEA limits the amount of

November 2011

active ingredients manufacturers may purchase for controlled substances.

Alkire’s suggestions for dealing with drug shortages included the following: • S horten the approval process for medically necessary generic drugs that appear to be in shortage.

•E ncourage the FDA’s drug shortage program to engage members of the health care community in discussions to prioritize which drugs are critically necessary for treatment that may be at risk for shortage due to insufficient manufacturing capacity.

•E nable more flexibility in regulations that apply to quotas for registered manufacturers of controlled substances.

•C reate a fast-track approval of new active pharmaceutical ingredient suppliers for medically necessary drugs in shortage.

•W ork with manufacturers to slow the trend of acquiring the bulk of raw materials used in pharmaceuticals outside the U.S. •R equire manufacturers to notify the FDA of planned discontinuation or interruption in the manufacture of drugs as soon as practicable.

•C reate a stakeholder committee to advise the FDA on market conditions.

ENA endorsed the companion bill to H.R. 2445 — S. 296, the Preserving Access to Life Saving Medications Act — on August 22, 2011.

From the States Four States Form Prescription Drug Task Force Last April, the federal government announced a new strategy that aims to cut the use of prescription painkillers by 15 percent in five years. A major part of the proposal is a push for prescription drug databases in every state.

Four states — Kentucky, Ohio, Tennessee and West Virginia — have created the Interstate Prescription Drug Task Force to fight the region’s prescription drug abuse problem.

Comprising about 30 experts from drug agencies and law enforcement, the task force will develop strategies to reduce the sale and abuse of prescription drugs and will make recommendations to improve cooperation in sharing data, educational campaigns and police investigations.

All four states use electronic drug monitoring systems to collect information on who receives and prescribes certain medications.

“Kentucky isn’t an island,” Gov. Steve Beshear (D) said in a statement released August 24. “We have to attack this problem on a nationwide basis and work with other states to share information if we hope to turn around the prescription drug problem.”

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Official Magazine of the Emergency Nurses Association

7

Pediatric Update |

Elizabeth Stone Griffin, BS, RN, CPEN

Children in Crisis:

You May Be the Difference Children and adolescents present to emergency departments with a large variety of mental health disorders and emergencies, which include depression, suicide attempts and ideations, attention deficit disorder/hyperactivity, violent behavior and substance abuse. According to the World Health Organization, epidemiological data suggest a worldwide prevalence of child and adolescent mental health disorders of approximately 20 percent, and approximately half of all lifetime cases of mental disorders start by age 14 (Kessler et al, 2005). Changes in private and public insurance, state mental health programs and community mental health resources, as well as reductions in pediatric-trained mental health specialists, have all contributed to a critical shortage of inpatient and outpatient mental health services for children (AAP, 2006).

This has resulted in an unbudgeted mandate for emergency departments and emergency nurses to act as the safety net for children in crisis.

Children with psychiatric illness may not present with overt mental health symptoms.

Therefore, staff education and training regarding identification and management of these patients is crucial. Pediatric mental health conditions often present as irritability or dysphoria rather than the sadness seen in adult depression (Daly, 2011). Other common presenting complaints in these children include sleep or appetite disturbances, stomach pain and refusal to go to school (NIMH, 2011).

Whether a mental health condition is suspected or known, screening the child or adolescent thoroughly for past sexual/physical abuse, traumatic events or other stressors can help in the diagnosis and initiation of appropriate treatment. A growing body of evidence indicates that emotional and physical trauma in childhood can cause changes in the developing brain resulting in post-traumatic stress disorder and can affect children well into their adult lives (AAP, 2006). Emotional trauma can be reduced by timely, developmentally appropriate interventions implemented in the initial hours after the trauma (AAP, 2006).

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Screening Tools and Standing Orders In one state, up to 23 percent of patients (of any age) who presented to the emergency department with suicide-related complaints were discharged home without a mental health evaluation (Cooper & Masi, 2007). Departmentwide resources and protocols that standardize the approach and process when caring for a child with mental health issues should be developed (in collaboration with mental health professionals) if they don’t already exist. A brief screening tool for mental illness and/or suicidal or homicidal ideation can be implemented at triage, which, if appropriate, can initiate a standing order for a sitter to ensure patient and staff safety, as well as order a mental health evaluation if available. These measures can increase quality and efficiency of care, expedite referrals and/or bed requests and help decrease boarding times.

disorders within the next 10 years (NIMH, 2011). On the horizon are therapies—such as a new, faster-acting generation of antidepressant medications and advances in telemedicine—that may result in more collaborative, specialized and team-based care. These innovative treatment methods and others that result from the surge of new research in the specialty of mental health hold much promise in improving the quality of mental health care for youth as well as adults (NIMH, fact sheet, 2011).

Emergency nurses can improve the quality of care for these patients today and into the future by taking measures, such as actively pursuing education in mental health disorders, screening for suicidal and homicidal ideation at triage to help ensure the safety of patients and staff and using standing orders to initiate care and consults as quickly as possible.

Education and Training Hospital nursing education programs have opportunities to improve pediatric psychiatric and substance abuse education within their curriculum. ENA’s Emergency Nurse Pediatric Course includes a chapter on psychiatric emergencies, which offers useful information regarding the primary goals in the care of these patients in the emergency department setting. Emergency nurses should be able to identify local and regional resources, such as pediatric psychologists and psychiatrists, suicide help lines and primary care clinics.

Hope for the Future The National Institute of Mental Health recently announced The Grand Challenges in Global Mental Health Initiative. This international research initiative identified the top 40 barriers to better mental health care around the world and will support much needed research aimed at improving the lives of people of all ages with mental health, neurological and substance abuse

November 2011

Resources Emergency Care Psychiatric Clinical Framework.

ENA. Accessed 8/11/11: www.ena.org/ SiteCollectionDocuments/Position% 20Statements/ClinicalFramework.pdf Medical Evaluation of Psychiatric Patients.

Position Statement: ENA. Accessed 8/11/11. www.ena.org/SiteCollectionDocuments/ Position%20Statements/MEDICAL%20 EVALUATION%20OF%20PSYCHIATRIC% 20PATIENTS.pdf National Institute of Mental Health Web site: www.nimh.nih.gov References American Academy of Pediatrics. Pediatric Mental Health Emergencies in the Emergency Medical Services System. (2006). Pediatrics.

1925, 1764-1767.

Bonham, Elizabeth. Role of child and adolescent psychiatric nursing in health care reform.

(2010). Journal of Child and Adolescent Psychiatric Nursing. 23, 2, 119-120.

Baren, J., Mace, S., Hendry, P., et.al. Children’s mental health emergencies – Part 1. Challenges inc are: Definition of the problem, barriers to care, screening, advocacy, and resources. Pediatric Emergency Care. 2008 24(6) 399-408 Baren, J., Mace, S., Hendry, P., et.al. Children’s mental health emergencies – Part 2. Challenges inc are: Emergency department evaluation and treatment of children with mental health disorders. Pediatric Emergency Care. 2008 24(7). 485-498.

Daly, Rich. Pediatric depression, anxiety symptoms often overlooked. (2008). Psychiatric News, American Psychiatric Association, 43, 13, 7.

Dolan, M., Fein, J., and The Committee on Pediatric Emergency Medicine. Pediatric and adolescent mental health emergencies in the emergency medical services system. (2011).

Pediatrics. 127, e1356-e1366.

Grupp-Phelan, J., Harman, J., and Kelleher, K. Trends in mental health and chronic condition visits by children presenting for care at U.S. emergency departments. Public Health Reports. 2007 122. 55-61.659.

Correction The title for Wendy Hums, BSN, RN, was stated incorrectly in the ENA Connection October issue article “Indiana Receives Its First Trauma Program Manager Course.”

Her correct title is the course director for American Trauma Society’s Trauma Program Manager Course. ENA Connection regrets the error.

Newton, A., Hamm, M., Bethell, J., Rhodes, A., Bryan, C., Tjosvold, L., et al (2010). Pediatric suicide-related presentations: a systematic review of mental health care in the emergency department. Annals of Emergency Medicine, 56, 6, 649-659.

National Institute of Mental Health. Depression in children and adolscents (fact sheet).

Accessed 8/6/2011: gopher.nimh.nig.gov/ health/publications/depression-inchildren-and-adolescents Horowitz, L., Wang, P., Koocher, G., Burr, B., Smith, M., Klavon, S., & Cleary, P. Detecting suicide risk in a pediatric emergency department: development of a brief screening tool.

(2001). Pediatrics 107, 5, 1133-1137.

Kessler RC, Berglund P, Demler, O, et al.

Lifetime prevalence and age-of-onset distributions of DSM-IVdisorders in the National Comorbidity Study Replication. Arch Gen

Psychiatry, 2005, 62(6):593-602.

Cooper, J., & Masi, R. (2007). National Center for Children in Poverty. Child and Youth Emergency Mental Health Care: A National Problem. Accessed online 8/8/2011.

World Health Organization. Atlas: child and adolescent mental health resources: global concerns, implications for the future (2005).

Accessed online 8/12/2011. www.who.int/ mental_health/resources/Child_ado_atlas.pdf.

Contact the author I would like to answer your questions and share your stories. Please e-mail me at ELGriffin@WakeMed.org with questions, problems and any special stories or learning experiences you would like to share about taking care of children in the emergency department. I will weave them into the column whenever possible.

Trauma Nursing Core Course Designed for Nurses by Nurses

For more than 25 years, TNCC has been providing cognitive, core-level trauma knowledge and psychomotor skills experience in an interactive format. The TNCC course will provide a systematic standardized approach to injured patient care. The hands-on psychomotor skill stations help you incorporate cognitive knowledge into application of skills in a safe practice environment.

Highlights Include: • Systematic standardized approach utilizing the A-I mnemonic • Pediatric, pregnancy and elder trauma • Initial assessment and shock • Spinal immobilization • Chest and abdominal trauma • Opportunity to earn 14.42 contact hours • Offers four year verification of your knowledge and skills upon successful completion

Take the Course Today To verify why TNCC is right for you and to view course schedules, visit www.ena.org/coursesandeducation.

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

Official Magazine of the Emergency Nurses Association

9

Use ENA’s Emergency Nursing Resources to Improve Your Practice

By Andrew Storer, DNP, RN, ACNP, CRNP, FNP, ENR Development Committee Member Edited by Jean Proehl, MN, RN, CEN, CPEN, FAEN, ENR Development Committee Chairperson

Since the development of ENA’s first Emergency Nursing Resource in 2009, emergency nurses have been using ENRs to provide safe, quality patient care.

ENRs are developed through review and critical analysis of the evidence for clinical emergency nursing practices. ENRs contain tables of evidence that grade each relevant article according to level and quality of evidence and provide final recommendations for practice. They also contain an overview of relevance and methodology. Topics for ENRs are issues of great significance to stretcherside emergency nurses and come from ENA member surveys, resolutions and expert consensus. Once published, ENRs are available at www.ena.org and published in the Journal of Emergency Nursing.

The four ENRs currently available address the following issues: •C apnography during procedural sedation •F amily presence during resuscitation and invasive procedures •G astric tube placement verification •N eedle-related procedural pain in pediatric patients

Feedback Frame

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These four ENRs were accepted and posted at the Agency for Healthcare Research and Quality’s National Guideline Clearinghouse (www.guideline.gov) in 2011. Acceptance of the ENRs in the National Guideline Clearinghouse validates the methodological evidence-based process that the ENR Development Committee used to create them, along with input from the Institute for Emergency Nursing Research Advisory Council, Institute for Emergency Nursing Research staff and content experts.

The ENR Development Committee uses the Guidelines for the Development of Evidence Based Emergency Nursing Resources (www.ena. org/IENR/ENR/Documents/Guidelinesfor theDevelopmentofENRs.pdf) to develop ENRs. The ENR development process includes selecting the topic area, defining the clinical question using the PICOT (Patient Population, Intervention, Comparison, Outcome, Time) format, searching the relevant literature for review, critically appraising the literature to grade the levels and quality of evidence, developing the evidence-appraisal table and interpreting the summative evidence to determine levels of recommendation.

The 2011 ENR Committee is completing four new ENRs. ENR topics in progress include laceration cleansing, temperature measurement across the lifespan, orthostatic vital signs and difficult intravenous access.

The ENR on laceration cleansing and irrigation evaluates the scientific evidence regarding type of cleansing fluid, irrigating pressures and patient comfort measures necessary to promote effective wound healing and deter infection.

A review and critical analysis of the evidence evaluated several irrigation techniques that the emergency nurse can use in practice to promote optimal wound healing. The ENR will include an analysis of various irrigation methods, such as bulb syringes and syringe with needle/ catheters, irrigation solutions and irrigation temperatures. Emergency departments have the potential to save thousands of dollars annually on irrigation solutions, as well as increase patient comfort and decrease infection, once the ENR is published and emergency nurses implement the recommendations.

The ENR on temperature measurement focuses on temperature measurement of patients across the lifespan. The ENR will evaluate, appraise and give recommendations for multiple methods of body temperature, including oral, tympanic, rectal, axillary and temporal. Emergency nurses will be able to use a quick reference table to implement the recommendations in daily practice.

The ENR on orthostatic vital signs evaluates the indications, methods and utility for performing orthostatic vital signs to detect alteration in fluid status. The ENR will evaluate and critically appraise literature on body positioning, fluid volume alteration, various vital sign measurements and timing, and equipment.

The ENR on difficult intravenous access will evaluate, appraise and recommend alternatives, such as intraosseous access, ultrasound-guided access, vein illumination devices and subcutaneous rehydration therapy.

It is hoped that ENA’s ENRs will positively impact both emergency nurses and patients by helping to translate research findings into practice and to ensure that patients receive quality, evidence-based and safe care.

Look for them at www.ena.org/IENR/ENR/

October 2011

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Vanderbilt’s Adult Emergency Department Initiates New Program to Protect Staff

By Kendra Y. Mims, ENA Connection Michelle Ingram’s patient tried to stab her with a pen.

He was a larger man—much too big for Ingram to easily restrain by herself. Although sharp instruments and other harmful items are kept out of patients’ reach for safety reasons, he had managed to jump across the counter to retrieve the pen. He was acutely manic, agitated and having a manic episode. The option of verbal de-escalation had disappeared. Ingram, a mental health specialist at Vanderbilt University Medical Center, knew he was dangerous and needed to be medicated.

Fortunately, she didn’t have to disarm her patient. He eventually threw the pen down.

Recent studies show that Ingram’s experience is unfortunately all too familiar in emergency departments nationwide. A 2010 ENA study reported that every week in the United States, between 8 and 13 percent of emergency department nurses are victims of physical violence (Rates of Violence, 2010). Other studies show that violence in emergency departments is increasing, and they are considered a dangerous place to work.

Taking New Measures ENA member Brent Lemonds, MS, RN, FACHE, Vanderbilt administrative director of emergency services, says the Joint Commission Sentinel Event Alert, Issue 43, regarding violence elevating in emergency departments was an eye-opener for Vanderbilt’s Adult Emergency DepartBrent Lemonds, MS, RN, ment to re-evaluate FACHE its safety measures.

Vanderbilt had already taken several actions to reduce violence: metal detectors in its front door, armed police in its emergency department, a no-tolerance policy posted in the emergency department and annual training for staff. However, there was still a need to reduce violence in the emergency department and to increase protection for staff and patients.

“We still had increasing instances of violence inside of our Emergency Department,” Lemonds said. “The nurses were coming to us, saying they were getting tired of being cussed at on every shift. We had a triage nurse that was clawed by one of the patients, and we pressed charges against that patient. With these increasing incidents in the ED, we looked at

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what else we could we do. We thought the thing that we could spend the best effort on was additional training for our staff.”

Vanderbilt’s Adult Emergency Department launched the Handle with Care training program in April 2011. The crisis intervention and behavioral management program includes four hours of verbal de-escalation techniques and four hours of physical self-protection techniques, such as the primary restraint technique.

Training is mandatory for staff and has been offered weekly since the program launched to ensure that everyone completes the program.

Lemonds said staff members have responded favorably to the new initiative because they felt management was concerned about their safety.

“We’ve had some instances since we implemented the training where it has proven to be helpful and where staff members have walked out of situations and said the training has really helped. One of our patients attacked one of our police officers, and the nurse who had the training was able to put a hold on the patient and rescue the police officer,” Lemonds said.

“I think the major benefit is the attitude of the staff. Staff members say their self-confidence level in being able to deal with situations has improved.”

Vanderbilt staff nurse Nakeisha Jenkins, RN, found the training helpful when she had to perform a two-person PRT hold with her colleague on a threatening, alcohol-dependent patient who went into a rage and attempted to

destroy the computer and other equipment on the registration desk.

The patient became cooperative once they placed her in the PRT hold and held her in that position until they Nakeisha Jenkins, RN were able to obtain a stretcher and a physician at the bedside.

“I think the class was very beneficial, especially in that case,” Jenkins said. “There was no verbally de-escalating the patient in that situation. The class not only protects us as staff, but another patient in the waiting room could have been injured by her behavior. We often have psych patients who may behave inappropriately, so this behavior is often seen in the ER.” Lemonds pointed out that there is no shortage of mental health patients and drug abuse patients in the emergency department; he said 250 psych patients are treated every month at Vanderbilt and 30 percent end up being committed for further mental health treatment.

Although Lemonds and Ingram feel the high population of mental health patients is frequently responsible for the violent incidents that occur in their emergency department, from assaulting nurses to attacking the hospital’s on-duty police officers, both said it is difficult to

ENA Workplace Violence Toolkit The ENA Workplace Violence Toolkit, released in February 2011, was designed to take a practical approach to eliminating violent behavior in emergency departments nationwide. Created specifically for emergency department managers and team leaders, the toolkit provides resources, templates and tools so that they can understand the issue of emergency department violence, customize a violence prevention plan and develop goals.

Karen Wiley, MSN, RN, CEN, contributed to the development of the toolkit and said it can be applied to any health care setting or unit.

“The Workplace Violence Toolkit is a step-by-step quality improvement process to decrease or prevent violence in the emergency department. It provides comprehensive evaluation of the current status of violence in your emergency department,” Wiley said.

“The toolkit identifies your response to the high-risk areas that were identified in the assessment phase. Project plan templates are included to assist you with developing goals and outcomes of your violence prevention initiative. The beauty of it is that it was developed for the emergency department setting. When it was developed, we wanted nurses to use it and change it to fit their culture and institution.”

For more information on learning more about this innovative online resource and how it can benefit your emergency department’s effort in protecting staff against violence, visit http://www.ena.org/IENR/ViolenceToolKit/Documents/toolkitpg1.htm.

November 2011

How Are You Staying Safe?

prosecute mental health patients because of their condition.

“The legal system will not usually deal with prosecution if the patients have a mental health history. So the nurses get assaulted, but there is no recourse for dealing with the patient’s behavior,” Lemonds said.

Ingram, who deals with violent mental health patients frequently, found the physical training to be the most effective part of the Handle with Care program.

“I think knowing how to do it with proper body mechanics helps to protect us,” Ingram said. “I think that a lot of nurses are afraid to do things like that, because they don’t want to hurt themselves or hurt the patient, but having that extensive class really helped us to understand that it is necessary sometimes to keep them from hurting themselves.”

Several times, Ingram has used the PRT hold she learned in Handle with Care on a selfabusing patient. This patient walks around the unit actively trying to hurt herself, from digging and ripping open existing wounds to jumping off of things in an attempt to break her neck.

Because this behavior happens every time Ingram is with this patient, Ingram uses the physical techniques she learned in Handle with Care, which sometimes includes taking the patient down to the floor.

“There are times when you just can’t verbally de-escalate someone based on their psychosis,” Ingram said. “The verbal part of the class will give our nursing staff the ability to verbally de-escalate people, and that will really decrease them having to take it to the next level. Once staff has to take it to the physical level, the training will help them deal with it.”

Lemonds believes Handle with Care is effective for staff dealing with mental health patients who are threatening to themselves, staff or other patients and will help staff react appropriately when physical restraint is needed.

“The key to dealing with mental health patients or any patient who is out of control is helping them to regain control. The de-escalation training addresses that. When it comes to physical techniques, you say to the patient, ‘We’re only going to use these techniques until you’re able to regain control,’” Lemonds said.

“I think the de-escalation part of it is the most helpful part because over my career, I’ve seen untrained health care providers get angry. I think

in many situations when health care providers get to a point of using force, everyone is frustrated and angry. If you get angry with someone who is having a behavioral problem, they get worse. When you have this training, it helps you remain in a professional position and it helps you to become knowledgeable about what’s going on in the patient’s head.”

Lemonds said they have already requested to expand the program to their pediatric emergency department colleagues and their trauma unit— two areas at risk for violence. Refresher courses will be available for employees next year, and he anticipates the program will be expanded. He believes combining the training with other strategies will help to reduce violence in emergency rooms.

“I think it’s a combination approach,” he said.

“You must have the staff training. We also support the use of a metal detector. I’ve had many emergency departments call me about our metal detector, and they’re afraid to implement it, afraid that it will scare off patients. The majority of the patients who talk to me feel like it’s a safer environment because we have a metal detector. There is not only one strategy that you can do. There are many different strategies that you can use to make your department safe.”

Emergency Nurses Can Protect Themselves Jacki Ashburn, RN, quality consultant at Vanderbilt, volunteered to become a certified Handle with Care instructor to inspire nurses to protect themselves.

She noticed a cultural change when she Jackie Ashburn, RN came to work in the emergency department 15 years ago and realized that verbal and physical abuse were normal behavior in the environment.

“As society has become more violent, so has the emergency department, and as new nurses come into emergency nursing, they just needed something to say, ‘This is appropriate, this is not appropriate, and this is how you handle it,’” Ashburn said.

Ashburn said there are two other instructors who assist with the training and 20 employees per class. The verbal de-escalation training involves how to identify signs of stress, what you can say to de-escalate patients and options if they don’t cooperate. The physical training

Official Magazine of the Emergency Nurses Association

ENA asked its members on Facebook to describe the security measures their emergency departments have enacted to handle violence.

A vocal majority said their administrations are not doing enough and that their emergency department security ranges from ineffective to nonexistent. But not every hospital is lax on this issue. Here are some of the positive testimonials: “We are trained in Nonviolent Crisis Intervention. In addition, we have our own armed police department on campus. Officers are stationed in the ED, and a two-way mirror is in the ED, allowing officers to monitor activity in the waiting room. We have panic buttons in the ED, also.”

Cyndy Williams, BSN, RN Staff Nurse, Ocean Springs Hospital Emergency Department, Ocean Springs, Miss.

“We have done unannounced mock drills with after-action reviews to evaluate the effectiveness of our violence prevention and violence response program.”

Nicholas Chmielewski, MSN, RN, CEN, NE-BC Clinical Information Systems Coordinator, Mount Carmel West Emergency Department, Columbus, Ohio “We all wear locators, and there are panic buttons located in all rooms and various other locations in the ED. I pushed the panic button one day, of course to see what would happen, and within 30 seconds or so, I had three security guards as well as two CMTs at my side asking if I was OK. Our security guards also have been trained with tasers.

Some people take offense at the locators and don’t want to wear them. However, I’ve been kicked, punched and threatened in my 20-plus years in the ED. I WANT my employer to know where I am at all times!”

Susan WallaceVernetter, BS, RN, CEN, CPEN Staff Nurse, King’s Daughters Medical Center Emergency Department, Ashland, Ky. “We repeated the ENA violence study and found our staff really didn’t know what safeguards we had in place and which ones we didn’t. We have implemented from this data CPI yearly training and a visitor policy and are currently working on a mandatory reporting tool. As a downtown Level I trauma center, we see quite a bit of violence.”

Shellie Scribner, BSN, RN, CEN Staff Nurse, Clinical Educator Grant Medical Center ED, Columbus, Ohio

Continued on page 20

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The following stories show the spirit of emergency nurses in spite of unexpected adversities they often face, whether it’s caring for a patient in an emergency situation and not knowing the outcome, helping a family cope with a loss, losing a colleague or witnessing a catastrophic situation.

While each story deals with its own challenge or tragedy, it is our hope that the focus is not solely on the tragedy but on the dedication of emergency nurses and the camaraderie that is found in the aftermath, as emergency nurses are brought together to save lives and to support each other.

Anytime. Anywhere.

After Deadly Indiana Stage Collapse, It’s Showtime for Emergency Nurses

By Kendra Y. Mims, ENA Connection On August 13, 2011, thousands of Sugarland fans packed the Indiana State Fairgrounds in Indianapolis around 8:45 p.m. waiting for the show to begin.

The popular country duo never made it to the stage.

An anticipated evening of fun and music suddenly turned into tragedy when a reported wind gust of 60 mph caused the metal scaffolding that held the lights and stage equipment to fall on top of fans closest to the stage.

People in the audience, including numerous first responders, rushed to help those who were injured. Victims were trapped under equipment.

More than 40 people were affected by the stage collapse. Some had minor injuries. Some were unconscious. Some were dead.

The victims were transported to different hospitals in the city.

Indiana University Health Methodist Hospital It was a regular Saturday at Indiana University Health Methodist Hospital located in downtown Indianapolis. Wait times were relatively short in the waiting room. The non-critical area was full, and all rooms were occupied in the critical care area. A few patients had been made comfortable in hallway beds.

Around 8:47 p.m., Ann Duffy, JD, BSN, RN, a shift coordinator working that evening, received a call from her colleague, a nurse whose husband was at the scene when the stage collapsed.

Ann Duffy, JD, BSN, RN Shortly after, Duffy and the hospital administrator started receiving text messages and phone calls about the incident on their personal cell phones.

“We received all of this informal information

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before we received any official notification through the regular EMS channel,” Duffy said.

Kathy Hendershot, MSN, RN, ANP-BC, director of clinical operations said the information Duffy received was informal but accurate.

“What was ironic is that there were so Kathy Hendershot, many health care MSN, RN, ANP-BC providers at the incident itself. That’s really how we got communication. It’s pretty official when your friends are calling you and telling you they are standing right there and the canopy blew down on 100 people. We had that information right away from the text messages,” Hendershot said.

Because IU Health Methodist Hospital is a Level I trauma center and located approximately four miles from the state fairgrounds, Duffy and Hendershot knew they would receive patients.

Although Duffy had not received official notification and was unaware of the amount of injuries, she decided to operationalize their call-in system by sending out pages to all staff, a decision that helped them to prepare before the first patient’s arrival, 30 minutes after the stage collapsed.

“We started getting patients so quickly, and they came en masse. They seemed to be arriving two at a time. We were expecting a variety of acuity levels. We received the first eight trauma patients within a 10–15 minute period, back-to-back. All of them were very critical,” Duffy said.

The other patients who trickled into triage throughout the night were less critical, with minor injuries, bumps and bruises. Hendershot said that although they received a total of 28 patients, it was not enough to activate their housewide plan and use their resources.

“IU Health Methodist received the sickest of the sick patients,” Hendershot said. The airways of all but two of the critical patients had been secured by intubation of the trachea prior to arrival. Several of the patients required immediate life-saving procedures, which included central line insertion for fluids and blood to combat hypotension and shock. One patient required an emergency department thoracotomy prior to going to the operating room. The entire trauma team was affected by the story of one of their critical teenage patients who was now a paraplegic.

“We’ve had other incidents, such as school bus crashes, tornadoes and a truck that caught on fire on the interstate, but never to this degree have we had this many severely injured patients,” Hendershot added.

Wishard Memorial Hospital Nicole Olson, BSN, RN, emergency department clinical manager at Wishard Memorial Hospital in Indianapolis, received notification about the stage collapse around 9 p.m. from a Nicole Olson, BSN, RN hospital security officer who had heard it over the radio. There were 66 patients already in the emergency department that night.

Wishard Memorial, the only adult Level I trauma center in Indiana besides IU Health Methodist, is usually at full capacity. Olson notified her staff, the physician coordinator, the emergency nursing staff, the house supervisor and the bed coordinator to prepare for an influx of patients.

A total of 18 nursing staff responded—six from in-house and 12 from home, which consisted of their management team and trauma team members.

November 2011

Similar to IU Health Methodist, there was only a 30-minute time lapse from when Olson received notification of the stage collapse and when the first patients showed up at the hospital for treatment. They identified six patients as critical. Other injuries included facial fractures, head injuries and broken bones.

Initially, Olson was uncertain about activating the hospital’s disaster plan until she received new notification from the scene: There were 40 people unaccounted for and possibly still trapped under the stage. At that point, Olson knew they would need resources outside of the emergency department if those critical patients showed up at their hospital. The disaster plan was activated. Although those 40 people were eventually accounted for, Olson felt that activating the plan helped them to prepare for the worst-case scenario.

“We are typically used to dealing with disasters every night. A large influx of patients coming in the emergency department is not

uncommon. We had 18 patients who were injured, and I think activating the disaster plan was beneficial,” Olson said. “We brought in our extra OR team, extra ICU physician team, extra trauma team, our orthopedic call team, and our neurosurgery call team, and all of the backup trauma nurse team members were notified. I think that’s what helped us. We were Teri Joy, BSN, RN, CEN all ready.”

Teri Joy, BSN, RN, CEN, trauma program director at Wishard Memorial Hospital, had just returned home from vacation an hour before the stage collapsed.

After watching the tragedy on television, she received a phone call from Olson and Dr. Hayward, trauma faculty on call.

When Joy arrived, she immediately noticed everything was organized. She said that their system works well because one person is in charge of giving staff direction during a disaster.

She said that Olson, who was in charge that night and appointed Joy to be a staff nurse, had everything under control. Joy pointed out that the emergency department charge nurse and the physician coordinator can activate the disaster plan at their hospital because they are the frontline people receiving the patients and in this situation are the most knowledgeable of the current situation and needs. She felt Olson had made the right decision.

“I think activating our disaster plan was beneficial to the patients because you had all of the decision-makers at the hospital to allocate resources and provide the best care possible.

The emergency department management team, emergency department nurses, the surgeons and all of the trauma team nurses were here,” Joy said.

Continued on page 37

Redefining Travel Nurse:

Conference Attendees Run Code in Airport

By Kendra Y. Mims, ENA Connection Tammy McLemore was standing within 15 feet of the airplane in the passenger walkway, about to board her connecting flight from Atlanta to ENA’s 2011 Annual Conference in Tampa, Florida, when the man standing in front of her stiffened up, collapsed and became unresponsive.

He appeared to be fairly young. Because McLemore, RN, CEN, president of the Louisiana ENA State Council, was positioned behind him in line, she was the first person to arrive on the scene. McLemore and an off-duty flight attendant, who was boarding the same plane, immediately yelled for help, rolled the patient over and stabilized his neck.

Several conference-bound nurses standing in line to board the same flight stepped forward to assist the patient. They quickly fell into their roles. McLemore started an IV and rotated the compression with other nurses. A flight nurse took control of the patient’s head and his airway. Oxygen and resuscitative equipment were removed from the plane for the nurses to use. The nurses came together and worked with the unfamiliar equipment in an attempt to save the patient’s life.

“There was no equipment that was familiar to us, but we were able to do the job with what we had in an attempt to resuscitate the patient,” McLemore said.

The fire department and a doctor were on the scene. The paramedics handed the nurses their equipment. Although everything had become chaotic in a matter of minutes, McLemore said the nurses ran the code while the paramedics and the doctor fell back and let the nurses take charge. Although codes can sometimes be chaotic, there was a sense of discipline.

“It was a very sudden thing. It was one of those moments as a nurse when you think you’re off duty, but then your adrenaline kicks in and you start doing the things you are trained to do,” McLemore said. “Of course the nurses who are your support team that’s normally at a bedside in an emergency room were not there, but the nurses who happened to be in line were working, and at the moment you saw all of the nurses fall into their roles. I started an IV while others were managing the airway. It was just like working on a stretcherside patient in the

Official Magazine of the Emergency Nurses Association

ER, except we were in the middle of a jetway. I don’t know if anyone knew each other.

We all just knew we were emergency nurses.”

McLemore said the code was run appropriately by the time EMS arrived, and the patient still had a shockable rhythm. The paramedics were still performing CPR and resuscitating the patient as they left the scene, taking him to a local hospital. Although she was not sure of the patient’s outcome, McLemore commended all of the nurses on the flight for their quick response and efforts in attempting to save the patient’s life.

“All of the nurses did an awesome job and were responsive. Nobody ignored the situation and said, ‘I’m not a nurse today.’ You are an emergency nurse no matter what, on duty or off duty. It’s all the time. You may not have your scrubs on at the jetway, but in your mind, you’re always that emergency nurse watching, appraising and assessing people. Your instincts kick in and you fulfill that role for whatever happens today,” McLemore said.

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One Emergency Department Covers Another After Tragic Helicopter Crash

By Kendra Y. Mims, ENA Connection On August 26, 2011, the LifeNet helicopter crash that happened just east of Kearney, Missouri, claiming the lives of everyone on board, left Heartland Health’s staff devastated. Among the four victims were Heartland Health caregivers Chris Frakes, EMT-P, and ENA member Randy Bever, RN, EMT-P, CFRN, both well-known throughout several hospitals in the area. Bever was a lead RN in Heartland Health’s emergency department, as well as the TNCC coordinator, ACLS and PALS instructor. He had worked for Heartland Health for 23 years. Frakes had worked for Heartland Health for five years and was engaged to be married in September to a Heartland Health emergency department technician. No one had imagined that a routine patient transport from Bethany to Liberty, Missouri, would result in a loss that would impact the whole medical community.

Tami Easton, RN, Cameron Regional Medical Center’s director of nursing, felt ill when she received a phone call from her staff that a LifeNet helicopter had crashed while Tami Easton, RN transporting a patient from Bethany. The victims were unknown at the time, and initial thoughts of Bever and Frakes crossed her mind. When Easton later received confirmation of the victims, she called Heartland Health to offer coverage for its emergency department for two days so that Heartland Health’s staff could attend the memorial services for Bever and Frakes.

Easton said CRMC’s staff was also devastated and wanted to help. Twelve nurses in CRMC’s emergency department, including Easton, went to Heartland Health to provide coverage for both days. CRMC’s personnel spent a full day gathering staff’s nursing licenses, vaccinations, criminal background checks and certifications for Heartland Health’s human resources department for verification that everyone providing coverage was properly trained. Although they were offered a monetary incentive for coverage, Easton declined the offer.

“I never thought about it being a big deal.

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Heartland is just 40 miles from us.

Of course we’ll go and help. My staff jumped on board and thought it would be great. I told Heartland that we didn’t want to be compensated.

This is a really hard time for you, and we just want to come and help out,” Easton said. “I think that’s what it’s all about. Being a nurse, we’re here to help each other.”

Kelli Jackson, RN, an emergency Left to right: Chris Frakes, EMT-P and Randy Bever, RN, EMT-P, CFRN. department nurse manager at CRMC who volunteered, said the transition process went smoothly when they arrived, and they were able to effectively provide patient care.

“It was a wonderful experience. I think we gained a lot of camaraderie with the nurses who were there. We transfer patients there a lot.

They were so appreciative. It made us feel that we could actually do something physically for them. I think it gave a lot of closure that we could help out,” Jackson said.

Cameron staff nurse Barb Patton, RN, had briefly assisted the patient who was being transported. Although Patton knew it would be difficult and emotional, she felt she needed Several Cameron Regional Medical Center nurses who provided coverage for Heartland Health are to volunteer. pictured above. Back row (L to R): Roy Estes, RN; “There was no choice. I went and had an Barb Patton, RN; Kelli Jackson, RN, ER supervisor; excellent experience, an experience I will have Terri Keatley, RN; Front row: Pam Tuia, RN; Christi Coates, RN; and Ginger Graham, RN. for the rest of my life,” Patton said. “In the health care field, especially in the emergency Heartland Health also stayed behind with her. room, there is a true camaraderie, and there is They created cheat sheets that included main a one-for-all-and-all-for-one attitude. Everyone phone numbers, as well as codes for supplies there was just excellent. We did a lot of patient and locked doors. care. We didn’t know the computer system, so CRMC nurses were given a brief orientation, we couldn’t chart, but anything that they cheat sheets and a tour before starting their needed done, we all worked together as a team. shifts. Although Vega anticipated charting would It was a real team effort.” be difficult due to their computerized charting system, she felt their established plan worked in Putting the Plan into Action providing patients with excellent care.

Heartland Health’s HR department developed a “We came up with a system where we committee to determine which of its staff was assigned each Cameron nurse three rooms available to assist CRMC nurses during the where they would be responsible for patient memorial services. Sabrina Vega, RN, associate care. Everybody showed up and took their team leader at Heartland Health, volunteered to assignments without hesitation,” Vega said. stay behind and became the go-to person for “Everybody would do anything you would ask. the CRMC nurses for the two days they covered There wasn’t a task that would go incomplete. at Heartland Health. Vega spent two full nights You had anybody there willing to do anything.” developing a plan for CRMC nurses, which Vega says CRMC’s support really helped included mapping out their designated locations Heartland Health’s staff during their time of and their tasks. Three other nurses from

November 2011

need, and she had full confidence in their ability to perform.

“I know our staff here felt more at ease that they could go to the funeral. No one had really dealt with anything like Debra Delaney, MS, RN, CEN this all at once. It was a really hard thing for everyone to go through. Just knowing that you have people out in the community willing to come to help really gives you goose bumps,” Vega said. “An emergency nurse can just about take care of anything. They are responsible for the same certifications as we are, so we knew that they would be able to do it.”

Debra Delaney, MS, RN, CEN, Blue Jay Consulting’s process improvement coordinator and emergency department consultant for Heartland Health, watched in awe as CRMC nurses arrived and covered the unit.

“There were poignant moments, tearful moments and a few of those moments that only emergency nurses can laugh at. Through it all, these nurses exemplified what it means to be an emergency nurse anywhere in the USA. It was so humbling for me personally to have the privilege of witnessing these two days,” Delaney said.

Delaney was even more amazed at how the nurses were adamant about their time being strictly voluntary, as they were there to support their colleagues.

“When it was time for them to leave, there were tears, hugs, smiles and thanks from the Heartland nurses for being able to attend the services of their friends. It was again the Cameron nurses who became tearful and stated ‘No, thank you for allowing us to be there to support Randy and Chris as well,’” Delaney said. “It really was overwhelming and reaffirms for me once again why I love being proud to call myself an emergency nurse.”

Heartland Health nurses who assisted Cameron Regional Medical Center nurses (L to R): Jacob Barton, BSN, RN; Michelle Doolan, BSN, RN; Machelle Skinner, BSN, RN, CEN; and Sabrina Vega, RN.

care people. Everybody there was so gracious, welcoming and genuinely appreciative,” Easton said. “Anytime you go to another facility to

help, you take something away. We took away a lot more than we gave.”

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

Invest in the future of your profession.

Support the ENA Foundation.

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

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www.enafoundation.org

The Gift of Giving As director of nursing, Easton felt rewarded for the opportunity to provide hands-on patient care. She said each of her nurses who volunteered contacted her immediately afterward to thank her for the opportunity, as they also felt rewarded by the experience.

“It was so rewarding to each of us. We were so touched by the genuine gratitude of each person, from their administration to their floor

Official Magazine of the Emergency Nurses Association

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A Close One for Nurses as Disaster Drops on Reno Amateur videos on YouTube offer different angles of the same horror from the Reno Air Races on September 16. There it is: Jimmy Leeward’s vintage World War II-era fighter plane, the Galloping Ghost, pitching straight up and nearly out of sight as it turns in front of the grandstands at Reno-Stead Airport outside Reno, Nevada. And there it is again, spiking violently into the tarmac, gobbling up a section of reserved seating in a swirl of disintegrating steel.

Obscured among the chairs and debris: at least five or six instantly dead, including Leeward, the 74-year-old pilot of the malfunctioning craft. Dozens more injured, many critically. Severed arms. Legs.

This is where the audio introduces the next phase of the story: Above the disbelieving groans of onlookers, a race official on a loudspeaker instructs the uninjured to stay back, except for those with medical training.

To those spectators, the message is: Yes. Come down. We’ll need your help.

As clearly as Tricia Lillibridge, RN, CEN, heard the hellish screech of Leeward’s plane slamming back to earth that Friday afternoon, she heard the call to action from her seat in the Tricia Lillibridge, RN, CEN grandstands.

“As I ran down the steps, I had gone from being Tricia, spectator, to Tricia, emergency nurse,” she said.

“And that’s what I said to people: ‘Let me through, I’m an ER nurse, I’m an ER nurse, I’m an ER nurse. How can I help?’”

September 16 was supposed to be a vacation stop for Lillibridge and her husband, Clint— their annual day at the races as they made their way from their home in Homer, Alaska, to ENA Annual Conference in Tampa, Fla. Instead, while Clint, a retired pediatric gastroenterologist, tended to dazed survivors wandering the grounds, Tricia entered a veritable warzone.

Her patient was a man in his 50s whose right leg was gone, sliced off at the thigh. She applied double manual pressure on his femoral artery and waited the agonizing minutes for IVs, oxygen and transport to reach her while the Reno-based Regional Emergency Medical

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Photo credit: Ward Howes, Associated Press

By Josh Gaby, ENA Connection

The Galloping Ghost, a vintage fighter plane, becomes a bomb of deadly shrapnel as it crashes into the tarmac just in front of spectators September 16 at the Reno Air Races in Reno, Nevada.

Services Authority coordinated triage and doled out supplies.

“I never worked so hard, so fast, in my life,” Lillibridge said. “I was bound and determined to put enough pressure on this thing where I wouldn’t be responsible for him (exsanguinating). I said, ‘I’m not giving up on him until somebody gets over here with two hands.’”

The man awoke suddenly and began flailing.

Lillibridge maintained her pressure, extracted the most basic information from him: first name George, no allergies. All around her were graphic images of trauma—the sort of event she’d prepared students for as a TNCC instructor but never imagined she’d see like this, here, on this scale.

First responders poured in—physicians, surgeons, nurses, some from the emergency response crews, others straight out of the stands. Nic Eisenbarth, RN, was among five nurses and two technicians Nic Eisenbarth, RN from Saint Mary’s Regional Medical Center who were staffing the onsite medical clinic. He and another nurse had watched, perplexed, as Leeward’s plane pitched overhead before missiling into the pavement on the other side of the grandstands. They rushed for the medical tent, where two of REMSA’s

advanced life-support ambulances were heading out. The other two ambulances, designated as crash units, already were arriving at the edge of the debris zone.

REMSA’s onsite supervisor ordered all but one of the Saint Mary’s nurses to the field.

Eisenbarth bounced from victim to victim as red, yellow and green triage tarps were laid down and patients quickly assessed and organized. He first encountered a man with a fractured skull. A local ear, nose and throat specialist was attempting to intubate him.

“We had a lot of people coming up and saying that they were first responders, asking how they could help,” Eisenbarth said. “I handed one guy my trauma shears and asked him to start cutting up the [reserved-seat curtains] to make tourniquets. … As soon as we got everybody kind of stable enough to get them over to the tarps, we started working on the reds, getting lines in the reds, started taking fluids, making sure that their tourniquets were holding.”

The airport authority’s bus, at REMSA’s disposal, was packed with enough backboards, IVs, oxygen, bandages and tourniquets to treat 300 people. Eisenbarth said it didn’t have the advanced diagnostic tools, blood products or narcotics he needed, but transport wasn’t far off. Nineteen more ambulances and three helicopters were sent to help take away 54 patients, including a notably high number of reds, said Kevin Romero, the EMS director for REMSA. The first six reds went to Renown, the

November 2011

Level II trauma center in Reno, while the other patients were distributed among Renown, Saint Mary’s and the Northern Nevada Medical Center. The northbound lanes of the 395 freeway were shut down to clear a path into Reno for southbound ambulances.

Total time to remove all of the injured from the scene: 62 minutes, Romero said.

“Just the amount of people that we got off the tarmac is just amazing, how quickly and smoothly that all went,” Eisenbarth said. “It seemed like as soon as we had everybody to the tarps, triaged, starting to get lines in them, you look up and there’s REMSA showing up with their rigs asking who goes first, who goes next, ‘I can take two,’ ‘I can take three’ …”

Lillibridge’s patient, George, was loaded into an ambulance bound for Renown, still conscious. It was the last she saw of him.

Eisenbarth caught a ride with some Air Force personnel headed for Saint Mary’s. His lasting memory from the scene is of an older man with a grotesquely bent ankle—an apparent tibia-fibula fracture.

“He was very, very adamant that we take other people first,” Eisenbarth said. “On normal days, someone has to wait in the emergency room and they’re pretty upset about it. I don’t think they understand that the only reason somebody’s coming before them is because they’re actually worse off. And this guy totally got it.”

*** Melané Marsh, BSN, RN, CEN, was at home packing with the television on. Like Tricia Lillibridge, she would be in Tampa soon for Annual Conference. The live news coverage broke in: a plane crash at the air races. There had been others over the years, but never involving spectators.

Melané Marsh, BSN, RN, CEN In the background, she heard the racing officials’ call for medical personnel.

“And that was kind of a cue,” said Marsh, the Nevada ENA president and a Saint Mary’s charge nurse. “Mentally, I just said, ‘Something’s not going right.’”

She called emergency department director Shelby Hunt, BSN, RN, MHA, CEN, who already had her team bracing for a surge of patients, despite Saint Mary’s not being a designated

trauma hospital.

Hunt’s husband, Bryon, a firefighter/ paramedic who had been at the races, had phoned to warn her of a mass-casualty incident. Minutes later, the radios put the area hospitals on Shelby Hunt, BSN, RN, MHA, alert. Calls to the Saint Mary’s staff at CEN the medical tent confirmed: This is for real. Reds and yellows would be arriving soon. Hunt’s staff lined the halls with gurneys, wheelchairs, charts, buckets of medicine. Off-duty nurses and techs were summoned.

Marsh was already on her way.

So was Jen Boscovich, RN, SANE, who had just left the airport with her husband, Brock, a Saint Mary’s emergency physician, and several of his Jen Boscovich, RN, SANE flight-doc friends when they heard the plane had gone down.

The Boscoviches grabbed scrubs and dropped their 15-month-old son off with a babysitter.

About 20 minutes later, just as they were arriving, so were the wounded, three or four at a time.

“They just started piling them on gurneys and bringing them in,” Hunt said. “Other than we knew we would be getting patients, we had no idea what was going to be walking through our doors, though you anticipate you could get anything.”

A secondary triage center was set up outside to make sure patients were still categorized properly. Surgeons stood by waiting to treat those with missing limbs and shards of plane buried in their flesh.

“To me, it was a perfect impression of war-type injuries of shrapnel,” Marsh said.

“I mean, it was just limbs cut off, wide-open lacerations.”

Hanging in the air was the stench of jet fuel.

“Never smelled it before,” Marsh said. “That was just overpowering. It didn’t irrigate off. You couldn’t wash it off. I mean, it was just there.”

So were the hands of volunteers, more than the staff could keep up with at times.

“Even the physicians that have nothing to do

Official Magazine of the Emergency Nurses Association

with the ER just came,” Marsh said. “We had cardiac surgeons and cardiologists. We had a plastic surgeon walk into the ER with his own bucket of sutures and numbing medicine and ask us where we wanted him to start.”

Labor and delivery nurses. Floor nurses.

Pharmacists. Employees from Renown ended up at Saint Mary’s because they couldn’t reach Renown fast enough, Boscovich said. More support came from military personnel and random community members. Medical students were on hand to help with sutures.

“Everybody needed something sewed up,” Boscovich said.

For some, the suturing was emotional.

Boscovich helped treat a young man from Italy with lacerations across his back. The people he’d been sitting with at the show had been killed. Though his vitals were stable, he was terrified the critical hour would be the end for him. “‘Jen, don’t leave me. Don’t let me die, Jen. Stay with me.’ He was so afraid,” Boscovich said. “He was convinced that at that hour mark, no matter what happened, he was going to die, no matter how much we reassured him. He was so alone, he was in a foreign country, and scared to death. That fear will never leave me.

There was nothing, nothing to take that away from him.”

They worked into the night, with a strange peace slowly replacing what Hunt called “organized chaos.”

“I remember, about 10:30, just kind of scanning the department with my manager,” Hunt said, “and we were blown away because you would truly have never known just a few hours earlier what this place looked like, and they got it right back into operational, day-today mode. It truly was like what had happened had never happened.”

Marsh, like most, was moved by the efficiency and selflessness she saw. Of all the patients treated at Saint Mary’s, including four reds, only one died—a man with a head injury.

“That’s the biggest thing for me,” Marsh said, “walking in and knowing I had that team of people working and just seeing that visual of the hallways lined with gurneys, there’s tons of people there, everybody’s doing a job of some sort, and if they’re not, they’re asking you what they can do. … It’s awe-inspiring to know that as a community and as a hospital, we can come together like that, and, as I kept saying, we rocked it.”

Said Hunt, who, like Marsh, has a background as a trauma nurse: “It just proved you Continued on page 37

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Deb Zirkle, ENA Director of Online Services

…For ENA Leadership Conference 2012 Information Get ready to find out all you need to know about attending ENA Leadership Conference 2012 in New Orleans, February 22–26. To make your online experience easy and informative, we’ve completely redesigned this area into a one-stop shop for all your conference needs.

As you navigate through the new conference site, quickly find information for attendees by hovering over the Attendees tab and making your selection from the items in the drop-down list. Review the Advance Program online or download it as a PDF. Look over the Focus Grid for sessions in education, management or personnel. Take advantage of our trip-planning tips and information to help make your trip a

great experience. Are you coming early to enjoy Mardi Gras? Be sure to read Join Us in New Orleans under the Conference Planning area.

Looking for resources, such as a justification letter or international invitation letter? Do you want to help promote the conference to your peers, using our official conference sticker in your e-mail footer and post to your social networking sites, such as Facebook or Twitter?

Find all of these and more under Resources, also under the Attendees tab.

When you are ready to book your airfare or secure a hotel, go to the Travel/Lodging tab and find information on the ENA block of rooms, airfare, shuttle and cab services.

Don’t miss out on any of the fun or special events while at the conference. Visit the Special Events tab, where you will find information on the Welcome to New Orleans Party, the ENA Candidates Election Forum, the ENA Town Hall Meeting, the ENA Foundation Exclusive Event, Masked on the Mighty Miss, and sponsored events and focus groups.

Get the best information to help you have a wonderful experience at the ENA Leadership Conference 2012 — visit the conference site often to answer your questions and stay informed. See you in New Orleans!

Readers may contact the author at dzirkle@ena.org.

said. “Handle with Care teaches you how to restrain them and how to escort them back to a safe place.”

Ashburn points out that there have been five incidents where staff members have used the training from the class. She feels the class has empowered staff and is helping them deal with their mental health patients effectively.

“Handle with Care says there is no dignity in allowing a patient to hurt himself or others. You have to set your limitations and be able to help

those people regain their control, because they’ve lost it,” Ashburn said. “Once our mental health patients realize that you are trying to help them and that there are limits, they respond fairly well, unless they are totally out of control, and then at that particular point, it does require restraint.”

In an effort to support each other, Ashburn says staff members have created several trigger phrases, such as “Your lunch is ready,” to help one another identify when it is time to walk away from a situation.

“We talk about how all of us have buttons and these people find our buttons. Our goal is to keep ourselves focused and not allow our anger to surface, because with anger and fear you increase tension without reducing the tension.

So you need to know what your triggers are,” Ashburn said.

Ashburn has enjoyed teaching the class and is glad she volunteered to become an instructor.

Her goal is to continue as an instructor and show nurses that they can protect themselves.

“I have felt over the years that nurses weren’t given the tools they needed to learn to verbally de-escalate and to protect themselves. As emergency nurses, this is one thing that you’re just not taught. I volunteered to show nurses that they can do this and to empower nurses to take care of themselves,” Ashburn said.

Vanderbilt’s Adult Emergency Department Continued from page 13 involves learning the PRT hold, as well as how to deal with wrist grabs, hair pulls and choking and learning how to take a patient to the ground safely.

“Our whole goal with this was to keep everyone safe and not to injure anyone—staff or patients—and to be able to carefully take our patients to a point where we can restrain them enough to let them know we are not going to hurt them but their behavior is inappropriate and they need to regain composure,” Ashburn

Did You Know •P atients and their relatives were the main perpetrators in all incidents of physical and verbal violence, with 97.1 percent of physical incidents and 91.0 percent of verbal incidents having involved a patient.¹ •A 2005–2009 study reported that nurses have the highest percentage of workplace violence at 3.9 percent when compared with other medical occupations.² • Each year, almost 500,000 nurses are victims of violent crimes in the workplace.³ • I n 2009, ENA reported that more than 50 percent of emergency room nurses had experienced violence by patients on the job and 25 percent of ER nurses had experienced 20 or more violent incidents in the past three years.³ References Emergency Department Violence Surveillance Study. (2010, August). Retrieved from Emergency Nurses Association web site: www.ena.org/IENR/Documents/ ENAEDVSReportAugust2010.pdf Gacki-Smith, J., Juarez, A., Boyett, L., Homeyer, C., Robinson, L., & MacLean, S. (2009, July/ August). Violence Against Nurses Working in the U.S. Emergency Departments. The Journal of Nursing Administration, 39(7/8), 340–349. Retrieved from the Lippincott’s NursingCenter.com web site: www.nursingcenter.com/library/JournalArticle.asp?Article_ID=927697 U.S. Department of Justice Workplace Violence, 1993–2009. (2011). Retrieved from the CPPS web site: www.cppssite.com/blog/wp-content/uploads/2011/04/Nonfatal-workplace-violenceBJS-2009.pdf

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Reference Rates of Violence. (2010). Retrieved from Emergency Nurses Association Web site: www.ena.org/media/PressReleases/Pages/ RateofViolence.aspx

November 2011

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ENA on Facebook.

What Are Emergency Nurses Saying?

ENA posted the following during Emergency Nurses Week, October 9-15: Emergency nursing is hard. This is Emergency Nurses Week, so why don’t you all share with others what you do to help keep your passion for the work alive and well.

Barbara Larrabee Duarte

Ruth L. Citroni Richardson Working with great nurses and docs that support each other helps. I also make a point of taking time to recharge my batteries. We need to take care of ourselves so we can be there for our patients.

Orienting new superstar graduate nurses keeps me motivated.

Linda Guy Heilman

Rachel Hanson Helped a new grad nurse with a code a while back. I thought it was a lost cause. The patient was a mess and based on her labs, etc, it seemed clearly to be a non-survivable incident. Nonetheless, we worked the code and took care of the patient. I was completely AMAZED to know that that patient WALKED out of the hospital!!!! That is why we do what we do!!!

Hoorah for ER nurses!! We really do save lives!!!

Elizabeth Balota

I think it has to be the family that says thank you after they watch you struggle to do everything for their loved one.s

Krista Brancel Mentoring is great ... also having those times when being stopped outside if the ER, “You are a nurse right?” Why yes. “I know you don’t remember me but you were the one who took care of me, thank you.” It makes it all worthwhile. We all began this profession for a reason. ER nurses make a difference and save lives. Thank you to past, present and future ER nurses!

When you get through the barrier and are able to connect with the patient. It’s the most rewarding feeling.

ENA Call for…

2012 Bylaws Proposals and Resolutions Deadline: March 2, 2012

By J. Jeffery Jordan, MS, RN, MBA, CEN, CNE, EMT-LP, Resolutions Committee Chairperson The 2011 General Assembly held in Tampa, Florida, in September was an overwhelming success. The delegates were presented with 10 bylaw proposals and 12 resolutions for consideration. Delegates from across the nation and for the first time, international delegates participated in lively debate over these issues that affect our emergency nursing practice.

President AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN, empowered by her understanding of Robert’s Rules of Order, kept the delegates in order and on time. Congratulations to our president for an outstanding meeting that allowed the business of the association to be carried out with a little humor integrated into the proceedings.

Credit for a successful meeting also goes to our delegates. Delegates participated in our second annual online delegate orientation led by our parliamentarian, Colette Collier Trohan. For the third year in a row, voting keypads assisted delegates in the debate and voting process.

Familiarity with the process allowed for smooth transitions for speakers and voting counts.

24

The Resolutions Committee would like to thank all of the authors who submitted bylaw proposals and resolutions. For several, this was the first time submitting a bylaw proposal or resolution. Their courage in engaging emergency nurses in important dialogue about emergency nursing issues is commendable. If you know someone who authored a bylaw proposal or resolution, please share your gratitude.

It is hard to believe, but it is already time to begin thinking about preparing bylaw proposals and resolutions for next year. The Resolutions Committee would like to challenge you to write resolutions that address clinical topics affecting your practice. We are available to assist you in this process. Please feel free to contact Kari Zick at the ENA national office at componentrelations@ena.org to reach committee members.

The Resolutions and Bylaw Guidelines (recently revised) and proposal templates are available in the General Assembly area under Members Only at www.ena.org.

The submission deadline is 5 p.m.

Central time, March 2, 2012.

Remember, in order to ensure that emergency nursing uses best practices to care for our patients, it is important that our members help guide ENA in addressing issues that are important to your practice. Help put these issues on the front burner and get emergency nurses engaged in dialogue by writing a resolution.

On behalf of your 2011-2012 Resolutions Committee — Nicholas A. Chmielewski, MSN, BSN, RN, CEN; Jill C. McLaughlin, BSN, RN, CEN; Gordon C. Rogers, RN, CEN; and E. Marie Wilson, RN — we thank you in advance for taking the initiative to write a resolution. Feel free to use the expertise of the committee. This process is what helps empower you to change the emergency nursing practice. Let your voice be heard.

November 2011

NOMINATIONS COMMITTEE |

Gail Carroll, BSN, RN, CEN, Nominations Committee, Region 3

We’re Emergency Nurses— We Can Do Better Than 5 Percent As a member of the Nominations Committee, I was disappointed by the low voter turnout for our 2011 national election.

ENA is approximately 40,000 members strong, but only 2,134 members cast ballots, for a 5.31 percent participation rate. In my home state of Missouri, out of a total of 795 members, only 36 cast ballots. Thank you to those who took the time to vote.

This means that only 5 percent of the membership decides who leads our organization and makes crucial decisions that impact our patients, their loved ones and us as professionals and practitioners. Is that a good thing?

I think not.

We are a member-driven organization. As emergency nurses, we must have a vested interest in our organization. We must be willing to invest time and energy toward the perpetuation of our organization that is considered to be the voice of emergency nursing by so many individuals. We have enormous clout in our society in both the professional realm and the nation at large. We are a major player in many facets of our world: political, research, education, nursing practice, emergency preparedness and publications, to name a few.

Our leadership speaks for us in many delicate and powerful situations and represents each and every one of us. An organization of our size and caliber needs input from all of its members, because neither the board of directors nor the Nominations Committee nor any other committee within our organization makes all the decisions. We need membership involvement to be a powerful voice in our chosen profession, emergency nursing.

The Nominations Committee has been working hard for several years to improve the voting process and to bring new ideas to the membership. We have searched for answers to this problematic situation and listened intently to anyone who has ideas for improvements.

Obviously, we need to hear more.

My challenge to you is to e-mail the Nominations Committee at execoffice@ena.org with your ideas on how to improve voter turnout and how ENA can help the membership know more about the candidates.

We frequently hear, “I don’t know the candidates, so I don’t vote.” During Leadership Conference 2011, we hosted the annual live

Candidates Election Forum where each candidate answered questions pertinent to our organization’s needs and growth. At this venue, you can see, meet and hear the candidates’ views on topics that affect our organization.

The ENA Connection and www.ena.org provide biographical information on every candidate far in advance of the voting process and throughout the election. During the election voting time-frame, the membership is invited to ask questions or post comments of support and view responses by the candidates via the Ask the Candidate area of www.ena.org.

Please help us by providing more input so that we can continue to be a member-driven organization. We are a powerful and exciting organization. Help us help you to keep our organization at the top. As your Nominations Committee, we are committed to helping our organization grow through our leadership. That leadership must come from you, through you, by you. We’re waiting anxiously to hear some incredible ideas. As we begin the cycle for the 2012 election, I encourage you to become informed, consider who will be the best leaders for ENA and, above all, remember to vote.

Now Available!

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This manual offers: • More than 600 practice questions founded in current, evidence-based literature • Answers and rationales are provided for each and every question • An extensive list of references is included to supplement your preparation for the CPEN exam • Access codes to two online practice tests, worth three continuing education contact hours each • A succinct, comprehensive review of the core material • Material meant for both those certifying for the first time and recertifying nurses

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

Official Magazine of the Emergency Nurses Association

25

READY OR NOT? |

Knox Andress, BA, RN, AD, FAEN

‘Something’s Happened’ “Little did I know that September 11, 2001, would be the most important day of my news reporting career.” Charles (Charlie) Gibson, the now-retired anchor for ABC’s “Good Morning America” and “World News Tonight,” shared his personal reflections, perspectives and recommendations for disasters and media reporting during the 5th National Emergency Management Summit in Brooklyn, New York, September 14, 2011.

“At 8:46 a.m., Diane (Sawyer) and I were delivering the morning news program on ‘Good Morning America’ when the first plane, American Airlines Flight 11, hit the World Trade Center’s North Tower. Then, at 8:48 a.m., just two minutes later, I hear a message in my earbud … ‘Something’s happened.’ Our video feed immediately switched to a traffic camera focused on the World Trade Center’s North Tower now belching thick black smoke. Rarely in my broadcast career have I been at a loss for words, but for 15–20 seconds there I was struggling to comprehend what I was seeing on the monitor.”

For many people across the country watching their usual morning television, Gibson, Sawyer and ABC News were the initial alert and messengers of the 9/11 attacks and the heroic responses that followed. Similar electronic and

Ground Zero after the collapse of the Twin Towers September 11, 2001.

print media reporting’s occurred in the days, weeks and months that followed.

Role of the Media in Emergencies Both electronic and print forms of news media are key components of crisis communications and can play a vital role in incident management by alerting, warning and educating the public about emergencies and disaster events.

During severe weather, the National Weather Service partners with television station broadcasters to alert the community. Accurate and timely reporting is a means to saving lives, mitigating property damage and helping people to help themselves in the face of an emergency.

The electronic news media, including broadcast and Web-based, is a resource for disaster managers and responders. A fundamental component of any hospital or community command center includes at least one television monitor and a computer with emergency power.

DHS Daily Open Source Reports

L to R: Former ABC anchor Charles (Charlie) Gibson with Ready or Not? columnist Knox Andress, BA, RN, AD, FAEN.

26

Media reports can provide situational awareness of threats and hazards to emergency departments and hospitals. Each business day, the U.S Department of Homeland Security’s Daily Open Source Infrastructure Report provides a summary of threat news from open media sources. The Daily Report gives a synopsis of threats to the 18 infrastructure sectors identified

in the National Infrastructure Protection Plan www.dhs.gov/files/programs/editorial_0542.shtm.

Each day visitors to the DHS Web site can potentially read about hazmat events, mass casualty incidents and other events impacting emergency departments and hospitals.

Critical infrastructure sectors include public health and health care; energy; chemical; nuclear reactors, materials and waste; critical manufacturing; defense industrial base; dams; agriculture and food; water; banks and finance; transportation; postal and shipping; information technology; communications; commercial facilities; government facilities; emergency services; and national monuments and icons.

Plan for Media Hospitals and emergency departments should plan for news media engagement during emergency and disaster events. Like the cable news weather reporter broadcasting during the hurricane’s landfall, many times, a reporter will want to visit the “scene of the action,” which may be the emergency department. Policies should be in place for receiving and directing media to the hospital’s public information officer, a command staff role described in the Hospital Incident Command System.

Develop a relationship with local media to build mutual trust. When a newsworthy event occurs, provide reliable, concise, understandable information to media contacts as soon as

November 2011

possible. Understand and engage the hospital PIO when needed.

The mission statement for the HICS, PIO job action sheet reads “serve as the conduit for information to internal and external stakeholders, including staff, visitors and families and the news media, as approved by the Incident Commander” (www.emsa.ca.gov/HICS/files/ JAS_Command.pdf ).

Having a pre-identified location for media to assemble or stage will assist the PIO and help prevent reporters from straying. Monitor the news media, television, radio, Internet and social media. If the hospital has a Facebook page, plan on monitoring and responding to questions that will come from the community during an emergency event.

Craft the Right Message PIOs will be assisted by developing preplanned messages to be delivered by the appropriate spokesperson when needed. To aid in crisis communication planning and response, the Centers for Disease Control has developed a training program Web site, Crisis and Emergency Risk Communications, which draws from best practices learned during previous emergency and disaster events. Crisis and emergency risk communication has been defined as “the strategy used to provide information that allows an individual, stakeholders or an entire community, to make the best possible decision in a crisis emergency event” (www.bt.cdc.gov/CERC/).

Establish Yourself as a Leader among Nursing Leaders Join the ENA Leadership Conference Faculty

Are you a guru in a particular area of emergency nursing, management or policy? Have you developed a successful approach to a common challenge in emergency nursing? Has a particular experience given you new insights into a current issue, trend or best practice that could benefit other nursing leaders?

Share your insights related to current issues, trends, and best practices as a faculty member at ENA Leadership Conference 2013, February 27 – March 3 in Fort Lauderdale!

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

• Advance practice • Orientation • Retention • Community relationship building • Customer satisfaction • Personal and professional development

Submission Deadline is March 19, 2012 In addition to the recognition as a nurse leader, faculty members receive complimentary registration, airfare, hotel and per diem reimbursement.

Find full information and course proposal guidelines at www.ena.org and click on Leadership Conference 2013 Call for Course Proposals in the Calls and Opportunities Section. We look forward to hearing your cutting-edge course ideas.

Readers may contact the author at wandr1@lsuhsc.edu.

Follow Knox Andress @ENAdman.

Official Magazine of the Emergency Nurses Association

27

ENA Leadership Conference 2012 will Illuminate, providing a beacon of light with new information and skills. It also will Empower, offering the support, strength and knowledge to move forward as an emergency nursing leader. ENA Leadership Conference provides the tools to help emergency nurses be the leaders they want to be and unite as one voice for our profession.

Be the Nursing Leader You Want to Be Any emergency nurse who holds or seeks a leadership role at any level will benefit from ENA Leadership Conference 2012. With 70 general sessions to

Information From Past Attendees* • Thank you for a wonderful conference. Such a renewing experience. I am full of ideas that sparked from the sessions I attended. Here’s to happy changes! Thank you again! I’ll be looking to attend another conference!

• I cannot begin to tell you how powerful this conference was for me. I feel as though I am personally and professionally changed by the things I learned and the people I met. I learned so much and treasure all of the pearls of wisdom imparted at Leadership 2011.

Thank you for the strength of this organization!

choose from across six focus areas and 17 contact hours, bedside staff nurses who lead colleagues, charge nurses, nurse managers, directors and CNOs all will find relevant information they can apply as soon as they return to their organizations.

Leadership Conference 2012 offers even more educational opportunities through presessions as well as the chance to network and share best practices with nursing leaders from around the world. Learn how your colleagues address challenges that concern you now and see familiar topics in a new light so you can do something about them.

Important Dates to Remember Early Bird Registration Closes.............................. January 11, 2012 ENA Board of Directors Meeting..........................February 22, 2012 State and Chapter Leaders Conference................February 23, 2012 Presessions.......................................................February 23, 2012 Educational Sessions...................................February 24 – 26, 2012 Scan this QR code with your mobile device to learn more about our conference.

• I went to learn more and to be better able to support my leaders and educate other nurses to make change easier. Now I am very enthusiastic in “working the crowd.”

Emergency department directors to send their staff when they can’t attend is a good idea.

28

November 2011

The Leadership Conference 2012 keynote speakers are sure to Illuminate the crowd with unique perspectives.

All’s Fair in Love, War… and Running for President James C. Carville, Jr. and Mary J. Matalin These New Orleans residents each has more than 30 years of experience in politics and has individually worked for Presidents Ronald Reagan, George H.W. Bush, Bill Clinton and George W. Bush. These two will candidly share their views on the turbulent political landscape and how it will affect health care in the coming years.

Balancing Life in Your War Zones LeAnn Thieman, LPN, CSP, CPAE Recounting her dramatic experiences from the Vietnam Orphan Airlift, LeAnn shares life-changing lessons for coping in our “war zones” today.

In this poignant and humorous presentation, learn how to balance your life, live your priorities and make a difference in the world.

Eat, Drink and Succeed! Climb Your Way to the Top Using the Networking Power of Social Events Laura Schwartz Harness your social power and increase productivity “after hours” with the tools you need to turn your social scenes into professional and personal successes.

Educational opportunities promise to Empower through information and relevance • Earn more than 17 contact hours during the general educational sessions offered in six focus areas. Earn even more through presessions • Add to your leadership skills with practices or techniques you can apply immediately • Strengthen your position within your organization and as a valued member of the leadership team • Expand your career options by adding to your base of knowledge and skills, becoming a valuable asset for your organization

Register at www.ena.org.

REGISTER BY JANUARY 11 TO SAVE By taking advantage of the reduced early-bird conference fees, you save $90 on a three-day registration.

That’s more than 20 percent off the regular registration fee!

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ENA STATE CONNECTION

California ENA State Council Submitted by Marcus Godfrey, RN, President-elect All Leftovers Go to the Emergency Department It is common practice in most hospitals that all leftovers go to the emergency department. There is often no greater saving grace on a hard shift than word that food has arrived.

After the first day of delegation at the 2011 General Assembly in Tampa, Florida, the California delegates met for a reception. Just as we were wrapping up the event, I mentioned to Linda Broyles, MSN, RN, CEN, MICN, Cal ENA president, that there was a lot of food left over. She jokingly commented that we should take it to the local emergency department, which is exactly what we did.

When we arrived in the emergency department at Tampa General, the staff was slammed. They saw us in all our Cal ENA gear and rolled their

eyes. I’m sure the last thing they wanted was to have to give some out-of-state association a tour. I held up the food and told them we were only here to feed them, and their faces lit up. We were quickly brought back to the break room where we dropped off the food, met the charge nurse, shamelessly left some Cal ENA magnets and pens and were back in the cab in less than 10 minutes.

How often do we have large meetings in our state? How often do we have them catered? And how often do we just leave that food behind? Cal ENA has started a tradition of taking any leftovers to the local emergency department and will do the same in our home state next year. Who knows?

Maybe someone will come to the next meeting because a member thought enough to bring food to his or her busy shift.

Shop Marketplace Check out great gift ideas for friends and colleagues this holiday season.

Louisiana ENA State Council Submitted by Alicia R. Dean, RN, MSN, APRN, CNS Louisiana ENA State Council members, please keep checking future issues of ENA Connection for information on volunteering for ENA Leadership Conference 2012 in New Orleans. We will need many ambassadors of

State Council and Chapter Meetings and Events Kentucky ENA State Council Three Rivers Chapter Meeting December 1, 2011 Owensboro, Kentucky

North Carolina State ENA Council North Carolina’s Seventh Annual Education Day November 10 - 11, 2011 Wrightsville Beach, North Carolina For more information, go to www.nc-ena.com.

Minnesota ENA State Council Two easy ways to order: Phone: 800-900-9659 Monday through Friday 9:00 a.m. - 4:30 p.m. CT Online: www.ena.org/shop

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Central Minnesota Chapter Meeting December 12, 2011 Location to be announced. For more information, go to www.minnnesotaena.com or e-mail colleen.seelen@gmail.com.

November 2011

Louisiana to help make Leadership Conference 2012 the best ever. Save your Mardi Gras beads so we can all show the rest of the country what “Throw me something, mister” and “lassiez le bon temps rouler” really mean!

Maine ENA State Council Submitted by Robin Matthews, RN, President We had a wonderful turnout September 10, 2011, for our annual meeting and educational day.

Several annual awards were presented: Emergency Nurse Provider Award: Wynne Sholl, MS, BSN, BA, RN, CEN, of Southern Maine Medical Center Emergency Nurse Leadership Award: Jane Rioux, RN, of Northern Maine Medical Center Emergency Nurse Leadership Award: Robin Matthews, RN, of Maine Medical Center Emergency Nurse Educator Award: Carol Minnis, RN, CEN, of Maine General HospitalWaterville Emergency Nursing Special Merit Award: Andrea Varnum, BSN, RN, CEN, of Maine Medical Center Emergency Nursing Special Merit Award: Carmen Hetherington, BSN, RN, CEN, CPEN, of Central Maine Medical Center Emergency Nursing Special Merit Award: Karen Taylor, RN, of Maine Medical Center Maine ENA and many emergency nurses throughout our state were busy this year, petitioning our legislature for changes in the laws regarding violence in the workplace. We currently have a felony statute but were working to broaden this to encompass all employees who work in our departments.

While at this time the changes proposed were not passed, Maine ENA was awarded a Joint Resolution Recognizing the Dedication and Resolve of Medical Care Professional in Hospitals. Our legislature recognized that emergency medical care providers and emergency medical care professionals in hospitals are committed to providing treatment to any injured or ill person, regardless of circumstance. Whereas our work with our legislature continues through education and reporting workplace violence, we are thankful that our voices were recognized.

A copy of this resolution was sent to each emergency room throughout our state.

Minnesota ENA State Council Submitted by Colleen Seelen, RN, CEN Lake Superior ENA Chapter is a catalyst for seasonal public service announcements on Minnesota public radio. The announcements are made on Friday evenings when travelers are frequently on the road. Messages on distracted

driving and wearing your helmet while riding are just a couple of the messages going out.

Zumbro Valley ENA Chapter, Greater Twin Cities ENA Chapter and Central Minnesota ENA Chapter have contributed funds to this great idea of educating the public.

councils to match its $1,000 donation.

To donate, go to www.nysena.org/911.html.

New York ENA State Council Submitted by Mickey Forness, RN, CEN The New York State Council would like to thank all the contributors to the ENA Foundation endowment of the 9/11 scholarship. This scholarship has been awarded to 17 individuals from many different states. Special gratitude goes to the Mississippi ENA State Council for issuing the challenge to all delegates to donate their dollar coins handed out by President-elect Gail Lenehan, EdD, MSN, RN, FAEN, FAAN, to this fund. The New Hampshire ENA State Council has issued a challenge to all state

Members of the California ENA State Council with a staff RN from Tampa General Hospital.

ENA Career Center Career Your path to lifelong career success

Center

AS A JOB SEEKER: • Search for jobs and receive automatic e-mail notifications of new listings • Post your résumé and make it available to top-notch employers

AS AN EMPLOYER: • Post openings and review a deep pool of qualified talent

The ENA Career Center provides personalized career guidance and showcases over 200 health care associations and professional organizations within the National Healthcare Career Network.

Learn more about this valuable resource at www.ena.org.

Official Magazine of the Emergency Nurses Association

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Spotlight on

Member Benefits and Resources

New ENA Position Statement Supporting Next Generation 9-1-1 ENA develops position statements on key topics affecting emergency nursing practice and health care trends. The most recently approved position statement, Enhanced/Next Generation 9-1-1 Systems, is in favor of research to upgrade

9-1-1 systems to support additional communication formats such as text, video, photo and e-mail available on mobile devices, which are used most frequently to call for emergency assistance. Visit www.ena.org/About/Position to see all ENA position statements.

ANA Recognizes Emergency Nursing as a Specialty The American Nurses Association has recognized emergency nursing as a nursing specialty and accepted ENA’s revised Emergency Nursing: Scope and Standards of Practice, available later this year.

New Member Benefits Special Offer for the Month

Shop Marketplace

ENA members qualify for discounts on items such as insurance, travel, wireless products and services, car rentals, identity theft protection and prescriptions. To view all available discounts, visit www.ena.org, click on the membership tab and then member benefits. Log in to see the details.

Mosby’s Nursing Consult: ENA Edition

When Nurses Hurt Nurses: Recognizing and Overcoming the Cycle of Bullying Cheryl Dellasega, PhD, CRNP Outside of nursing, most people believe bullies are native only to playgrounds and high school locker rooms. Unfortunately, bullies also frequent hospital units, ambulatory care centers, clinics and even emergency departments. Their targets? Their own colleagues and peers. This conflict has the potential to destroy a nurse’s morale, interfere with the ability to trust colleagues and erode quality of care. When Nurses Hurt Nurses: Recognizing and Overcoming the Cycle of Nurse Bullying confronts this problem by examining the causes and providing ways to diffuse a confrontational situation. When Nurses Hurt Nurses is at the forefront of addressing the issue of bullying within the nursing profession.

Price: $29.95

ENA Member Price: $26.95

Free Shipping! Call 800-900-9659 Monday–Friday (9 a.m.–5 p.m. CT)

Mosby’s Nursing Consult offers users practice guidelines, FDA drug updates, evidence-based nursing monographs, skills demonstrations and competency testing information. To learn more, visit www.ena.org.

ENA Career Center: Your Path to Lifelong Career Success Job seekers may post a résumé, search for jobs and be notified of new listings while employers post openings and review a deep pool of qualified talent. Visit the new ENA Career Center at http://enacareercenter.ena.org/.

ENA Toolkit Combating Workplace Violence: Prevent, Respond and Report Because more than half of surveyed nurses reported experiencing abuse within the previous seven days, this toolkit is designed to help emergency department staff create a culture of safety. To access the toolkit, visit www.ena.org/IENR.

ENA Emergency Nursing Resources ENA develops Emergency Nursing Resources to bridge the gap between research and everyday emergency nursing practice. Go to www.ena.org/IENR.

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November 2011

Message from the Chairperson | Beth Broering, MSN, RN, CEN, CPEN, CCRN, FAEN

ENA Foundation Announces 2011 Scholarship Recipients What is the ENA Foundation? Even if you see this column every month in ENA Connection, or hear someone talk about an ENA Foundation scholarship, the State Challenge or the jewelry auction, you may not know what the ENA Foundation does.

The ENA Foundation is a charitable, nonprofit organization that aims to promote emergency nursing through research and education to enhance the overall delivery of emergency care. Our mission is to provide educational scholarships and research grants in the discipline of emergency nursing. If you have bought a thumb drive or pin, made a purchase during the online auction or at the annual jewelry auction or participated in your State Challenge campaign, you have supported the ENA Foundation. The foundation is here for you, our members, and is supported by you, your friends and family, and our corporate sponsors.

Each year, the ENA Foundation makes a difference in the lives of patients and emergency nurses across the United States. This year, the foundation awarded research grants and scholarships to more than 75 emergency nurses. The care we provide will be enhanced through the knowledge and skills developed through this funding. I would like to commend each one of you who has taken the challenge to further your knowledge through education or research. I would also like this opportunity to recognize those who recently received an ENA Foundation scholarship.

Thank you to all of our generous donors.

You are the reason we have helped ensure the future of emergency nursing for so many. Please continue to ensure the best care for all by supporting your charitable organization, the ENA Foundation.

Non-RN Scholarships •N ew York State ENA September 11 Scholarships – $2,500 each Tamera Dekeyser – Wisconsin Clifford Payne, EMT-B – California

Undergraduate Scholarships •C harles Kunz Memorial Undergraduate Scholarship – $3,000 Kimberly Travis-Carter, RN – Washington • Hill-Rom Undergraduate Scholarship – $3,000 Mary Otting, RN, CEN – Illinois

Graduate Scholarships • S tryker Masters in Healthcare Scholarship – $5,000 Barbara Buckley, RN – Illinois • ENA Foundation Masters in Healthcare Scholarship – $5,000 Kelly Johnson, BSN, RN, CEN – Wisconsin • Board of Certification for Emergency Nursing (BCEN) Scholarship – $5,000 Donna Hamilton, BSN, RN, CEN – Pennsylvania • Hill-Rom Graduate Scholarship – $5,000 Charlotte Schnakenberg, BSN, RN, CEN, CPEN – Arizona • California State Council – Karen Grove Memorial Scholarship – $5,000 Vicki Dippner-Robertson, BSN, RN-BC, CEN, CPEN – California • Kentucky State Council – Kentucky ENA Founders Scholarship – $5,000 Leigh Parker, BSN, RN, CEN – Alabama • Maryland State Council – Maryland ENA State Council Scholarship- $5,000 Pamela Pourciau, BSN, RN, BC, CEN, CCRN, CPE – Louisiana • Minnesota State Council – Pathways III Scholarship – $5,000 Karla Hosick, BSN, RN, CEN – Nebraska • Mississippi State Council – Mississippi Magnolia Scholarship – $5,000 Amy Lowery, BSN, RN – Mississippi • New Jersey State Council – Emergency Care Scholarship – $5,000 Florence Vanek, BSN, RN – New Jersey • New Jersey State Council – New Jersey State Challenge Scholarship – $5,000 Elizabeth Griffin, BS, RN, CPEN – North Carolina • West Central Chapter (NJ) Jeanette Ash Scholarship – $5,000 Trisha Ann Williams, BSN, RN, CEN, NREMT-B – Missouri • New York Empire State Challenge Scholarship – $5,000 Stacie Hunsaker, BSN, RN – Utah • Tennessee State Council – Bright Angels Memorial Scholarship – $5,000 Deborah Elliot, RN, CEN – Pennsylvania • Texas State Challenge – Vicki Patrick Legacy Scholarship – $5,000 Marlene Siton-Thai, MSN, RN, CEN – Texas • ENA Foundation Scholarships – $5,000 each Rita Cox, BSN, RN – Michigan Diane Hochstetler, BSN, RN, CEN – Indiana Laurie Wegner-Burns, BSN, RN – Wisconsin Jennifer Zachariah, BSN, RN, CEN – California • Board of Certification for Emergency Nursing (BCEN) Scholarship – $3,000 Alexandra Kinzer, BSN, RN, CPEN – Virginia • Physio-Control, Inc. Scholarships – $3,000 each Stephanie Borkowski, BSN, RN – Pennsylvania Shannon Mims, BSN, RN, CEN – Texas • Gisness Advance Practice Scholarship – $3,000 Karyn Roberts, BSN, RN, CPEN – Illinois

Official Magazine of the Emergency Nurses Association

• Karen O’Neil Memorial Scholarship – $3,000 Melinda Dixson, MSN, RN, CEN, CPEN, FNPC – Maryland • ENA Foundation State Challenge Scholarship – $3,000 each Tyler Blomquist, BSN, RN, CEN – Georgia Amanda Cook, BSN, RN, NREMT – Tennessee Denise Evans, BSN, RN – Michigan Mary Catherine Feiler, BSN, RN – New York Amanda Lier, BSN, RN, CEN, EMT-B – Alabama Cary VanDyke, BSN, RN, CEN – Alaska Lynn Sayre Visser, BSN, RN, CEN, CPEN – California

Doctoral Scholarships •P amela Stinson Kidd Memorial Doctoral Scholarship – $10,000 Diana Meyer, MSN, RN, CCRN, CEN, FAEN – Washington • Board of Certification for Emergency Nursing (BCEN) Doctoral Scholarships – $5,000 each Kari Evans, BSN, RN, CEN – Indiana Margaret Miller, MSN, RN, FNP-BC, CEN – New York • ENA Foundation Doctoral Scholarship – $5,000 Angelia Mickle, MSN, RN, CEN – Ohio

Continuing Education Scholarships Recipients • S tryker International Exchange Scholarship – $1,000 each Denise King, MSN, RN, CEN – California Charlotte Schnakenberg, BSN, RN, CEN – Arizona • Vidacare Annual Conference Scholarships – $500 each Tammy Andrews, RN, CEN – Kentucky Barbara Buckley, RN – Illinois Marianne Bundy, MSN, RN, CEN – Florida Kristen Connor, BSN, RN, CEN, PHRN – California Debra Cremens, RN, CEN – Massachusetts Mare Eichmann, RN, CEN, NREMT-P – North Carolina Carla Marie Grasso, RN, CEN – Pennsylvania Maha Habre, BSN, RN, CEN – Lebanon Abigail Hasan, RN, CEN – New York Katherine Hunt, BSN, RN, CPEN – Maryland Brant Jacobson, RN, CEN – Washington CherylAnn MacDonald-Sweet, BS, RN, CEN, CPEN – Pennsylvania Matt Andrew Magto, BSN, RN – Philippines Kelly Mills, RN, CEN – Indiana Julie Mount, MSN, RN, EMT-P, CEN – New York Anne Pendleton, RN – Massachusetts Jan Michael Vincent Reyes, RN – California Carolyn Sutch, BSN, RN – Maryland Joan Tiska, RN – New York Lorraine Weigand, BSN, RN, CEN – Virginia Readers may contact the author at babroering@mindspring.com.

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BCEN BOARD WRITES |

Mary Whelan, MSN, RN, CEN, Member-at-large

Transforming Mental Health with Specialty Certification

Could these scenarios occur in your emergency department?

•E MS calls to advise the emergency department of the need for immediate assistance upon their arrival to restrain a violent patient who has threatened his family members.

•A 45-year-old father who has just lost his job arrives after attempting suicide by hanging.

•A homeless person, with PMH of schizophrenia, is agitated and pacing, stating that he has not been taking his prescribed medications.

As emergency nurses, we encounter daily patients and their families as they struggle with mental health issues. The resulting impact on the emergency department, inclusive of the potential for harm to self and others, can be disruptive and at times devastating. These are the cases that become headlines in newspapers, and the outcomes have a huge impact on caregivers, as well as on the hospital’s reputation within the community. Often, we would like to consider these patients low priority, but current triage guidelines, such as the Emergency Severity Index, classify these patient types as ESI level 2, requiring immediate advisement of others and placement in a treatment area.

When situations go awry, retrospective review often reveals many options that may have minimized risk. Do you truly know how to achieve the best outcome? Patient safety, as well as your own personal safety, is paramount to all we do. As competent emergency caregivers, we must be aware of evidence-based strategies to best manage patients who present with these types of challenging, high-risk complaints.

Preparation for the Certified Emergency Nurse exam will include review of psycho-social issues along with the best tactics to de-escalate situations, ensuring the well-being of all involved. It is important that a review of the behaviors proven to achieve the best outcomes be undertaken to ensure that you are successful with test taking. However, should not every emergency nurse be aware and implement these proven strategies every day at work? Do we not owe our patients and ourselves the obligation to bring best practice to the bedside?

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I certainly believe so.

Preparing for specialty certification validates your commitment to lifelong learning, to ensuring that your patients get the best they can at your hands. Reviewing and contemplating the best proactive approach to de-escalate situations and the finest response to serve this high-risk patient population can allow for a better patient care experience and ultimately an optimal outcome for the patient and for the staff member. It is vital that we as nurses accept this challenge, prepare for the exam, become certified and thus bring the best to our patients every shift. As a certified emergency nurse, with the enhanced knowledge you gain from preparation and experience, you will personally have an impact on those patients who seek care related to mental health illnesses. This goal, in itself, validates the need to begin the pursuit of CEN®.

In addition to addressing mental health disease within our health care environment, it is equally important that we aim to promote mental health. Promotion focuses on enhancing one’s ability to achieve a positive sense of self-esteem, mastery of a chosen skill set and inclusion within a social sect. Specialty certification (CEN, Certified Pediatric Emergency Nurse, Certified Flight Registered Nurse and Certified Transport Registered Nurse) allows the individual to validate these intrinsic traits that have been carefully developed and refined over time.

The Accreditation Board for Specialty Nursing Certification defines certification as “the formal recognition of the specialized knowledge, skills and experience demonstrated by the achievement of standards identified by a nursing specialty to promote optimal health outcomes.”

The certified RN, therefore, is more self-confident, a master of the practice environment and included in the elite group of nurses who choose to become certified.

In an ABSNC study, nurse administrators clearly indicated that they value specialty nursing certification. It is cited that certification truly does reflect a commitment to lifelong learning, supporting the theory that certified

nurses are perceived as more motivated and committed to nursing as a career. Certified nurses also score higher on levels of professionalism. Incentives provided by many organizations support the high value of certification within the nursing community. Magnet designation endorses specialty certification for the best practice it promotes and the resulting improved outcomes that patients deserve.

Lastly, nurses who seek and attain certification tend to encourage others to achieve this goal. These mentors will also recognize others for earning specialty certification, yet another tactic that builds self-esteem and self-confidence. Without a doubt, the benefits of achieving certification are countless, and your commitment to this goal will not only affect your patients’ outcomes but also promote your own mental health, something we do not often consider.

Board of Certification for Emergency Nursing certifications provide proof of your dedication to the practice of emergency nursing to yourself, your coworkers and the community you serve. Make no further excuses. Take the time to prepare, determine a timeline and commit to taking the exam. Become certified.

You owe it to yourself.

References Gilboy, N., Tanabe, P., Travers, D., Rosenau, A., and Eitel, D. Emergency Severity Index, Version 4: Implementation Handbook. AHRQ Publication no. 05-0046-2. Rockville, Maryland: Agency for Healthcare Research and Quality. May 2005.

Power, K. (2010, December). Transforming the Nation’s Health: Next Steps in Mental Health Promotion. American Journal of Public Health.

Stromborg, M., Niebuhr, B., Prevost, S., Fabrey, L., Muenzen, P., Spence, C., Towers, J., and Valentine, W. (2005, May). Specialty Certification. Nursing Management.

November 2011

Certified Emergency Nurse Named Air Force Nurse of the Year

By Kendra Y. Mims, ENA Connection When Artemus Armas, RN, CEN, returned home from his deployment in 2010, from a nondisclosed base in Southwest Asia, he received surprising news from his commander: Armas won the Air Force Flight Nurse of the Year award and the Air Force Nurse of the Year award for 2010.

Armas already knew that his supervisor had entered a nomination package for him for the Flight Nurse of the Year award when he was deployed, but Air Mobility Command—their higher command—believed his accomplishments were strong enough to compete for the overall winner, the Air Force Nurse of the Year award. Armas felt shocked and happy that he won both awards.

“It was a double bonus. It’s not typical for a person to win both awards. The Air Force Nurse of the Year award is the top award for all of the nursing categories. It is a prestigious award for the Air Force. It took a moment for me to realize that I had won a major award. I felt honored,” Armas said.

His career in Air Force nursing began in 2002. Armas became a flight nurse in 2007 and obtained his Certified Emergency Nurse certification in 2009. He felt becoming Board of Certification for Emergency Nursing certified would benefit him from an educational standpoint.

“I had already worked in the ER and ICU when I first started striving for it, and I thought it would get me to that next level. It helped me to see where my level was in comparison to others in the field. It had always been a goal of mine to get my CEN certification, and it also showed what my knowledge was and that I could pass the test,” Armas said.

Artemas Armas, RN, CEN, with the 379th Expeditionary aeromedical evacuation squadron.

Armas currently works in a new high-level position for Headquarters Air Mobility Command at Scott Air Force base, Illinois.

He oversees 32 aeromedical evacuation (AE) squadrons’ training and ensures it is done properly from an operational aspect.

“I think it gives me a little more clout when I’m going in to inspect these squadrons and personnel. It also shows that I’ve put in that extra effort,” he said.

Armas points out that there is a shortage of flight nurses in the Air Force. Winning his awards has helped him to promote flight nursing and the different leadership opportunities that are available for Air Force flight nurses—opportunities he feels may not be obtainable in a hospital or clinic.

Being a flight nurse has been the most satisfying job for Armas in his nursing career.

“My favorite aspect is dealing with the wounded warrior and dealing with the patients who are Soldiers, Airmen and Marines. We even deal with civilians from NATO countries and make sure we can get them from one level of care to a higher level of care,” Armas said. “Not all From left to right: Major General Kimberly A. Siniscalchi; of my positions have been flying. As an Artemus Armas, RN, CEN; Chief Master Sergeant Joseph L. officer in charge of the aeromedical

evacuation operations team, I have also ensured that aeromedical evacuation crews were prepared to transport patients, and I was on a liaison team where I coordinated with the British on getting injured troops aeromedically evacuated out of Afghanistan.

I think it’s more of the interaction with the troops to make sure they are receiving proper care and knowing that we are doing the right thing that I enjoy.” When Armas started his flight nursing career, he discovered that there was a Certified Flight Registered Nurse certification available. The thought of obtaining his CFRN certification stayed in the back of his mind over the years, and it has become his goal to take the exam. He believes becoming a CFRN would be advantageous to his new position, because it would show that he is certified in his specialty. He is studying for the exam and has set a goal to take it next year.

“I think the CFRN certification would give me more credibility if I am out inspecting someone.

A lot of time people will look at titles and ask about your background. The good thing about me is that I’m well-versed. I’ve had ICU and ER experience, and when you have that CFRN certification, it gives you more clout,” Armas said.

Potts.

Official Magazine of the Emergency Nurses Association

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BOARD HIGHLIGHTS |

August and September 2011

Board Meeting Actions and Highlights The ENA board of directors met August 24, 2011, via conference call. All members of the board of directors were present. The board took the following actions: •A pproved the revised ENA Procedures as presented.

•A pproved that the ENA board of directors have laptop computer access at the 2011 General Assembly.

The ENA board of directors met September 20, 2011, at the Tampa Convention Center. All members of the board of directors were present.

The board took the following actions: •A pproved 2012 committee, advisory council and work team members.

•A ccepted the secretary/treasurer’s report as presented.

•A pproved board governance policy 3.09, Board Ethics Statement, as presented.

•A pproved board governance policy 8.01, Contributions from ENA, as presented.

•A pproved board governance policy 8.03, Expenditures by ENA for Incidental Contributions or Gifts, as presented.

•E stablished an Emergency Department Operations Work Team.

•E stablished an Emergency Nursing Technology and Informatics Work Team.

•A pproved the Emergency Nursing Resources Committee requests for 2012 as presented.

•A pproved the Emergency Department Crowding Committee recommendations to dialogue with the Centers of Medicare and Medicaid Services officials to help alleviate crowding in the emergency department.

•A pproved the following consent agenda items: • Approved the July 22, 2011, board of directors meeting minutes as written.

• Approved the August 24, 2011, board of directors conference call minutes as written.

• Approved the Executive Committee Actions report as presented including: • An invitation from the American Academy of Pediatrics to review and provide comment on the American Academy of Pediatrics draft report on Death of a Child in the Emergency Department. Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN, and Sally Snow, BSN, RN, CPEN, FAEN, will provide comments on behalf of ENA. • An invitation to attend the American Psychiatric Nurses Association’s 25th Annual Conference, October 19-22, 2011, in San Francisco. Gail Lenehan, EdD, MSN,

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RN, FAEN, FAAN, is ENA’s representative.

• An invitation to attend the National Association of Clinical Nurse Specialist Summit on July 14, 2011, in Philadelphia.

Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN, represented ENA. • An invitation from the National Quality Forum regarding the Call for Nominations for the Care Coordination Endorsement.

The name of Diane Gurney, MS, RN, CEN, was submitted for consideration.

• An invitation from the National Quality Forum regarding the Call for Nominations for the National Priorities Partnership.

ENA was submitted for consideration as an organizational member. Sue Hohenhaus, MA, RN, CEN, FAEN, is the ENA contact.

• An invitation from the American Nurses Association to submit public comments on the individual nomination for the National Quality Forum’s Regionalized Emergency Care Services Steering Committee.

• An invitation to support and contribute to the 2012 Foundation of the National Student Nurses Association Scholarship fund.

• An invitation from the Pediatric Nursing Certification Board to attend the 3rd Annual Invitational Forum for Pediatric Nursing on October 27-28, 2011, in Washington, D.C. Michael Vicioso, MSN, BS, RN, CPEN, CCRN, is ENA’s representative.

• An invitation to attend the Southern Nevada’s Black Nurses Association’s 15th Anniversary reception. The invitation was forwarded to the Nevada ENA State Council president for consideration.

• An invitation from the Substance Abuse and Mental Health Services Administration to participate at the Conference on Improving Care for Child and Adult Behavioral Health Clients with Suicidal Ideation and Behavior in Emergency Department Settings, July 26-28, 2011, in Baltimore. Karen Wiley, MSN, RN, CEN, represented ENA. • An invitation from the U.S. Department of Homeland Security\FEMA Ready Campaign to participate in its National Preparedness Month Coalition.

• Agreed not to support the following initiatives: • An invitation to attend the American Association of Colleges of Nursing’s Fall

Semiannual Meeting reception on October 23, 2011, in Washington, D.C. • A n invitation to sponsor or provide contributions for the reunion of 1965–1973 Vietnam veterans and their families of the 3rd Field Hospital in Saigon.

•A pproved the Enhanced Next Generation 9-1-1 Systems position statement as presented.

•A pproved the list of Emergency Nursing Resources topics slated for completion in 2012.

The ENA board of directors met September 23, 2011, at the Tampa Convention Center. All members of the board of directors were present.

The board took the following actions: • Approved board governance policy 3.12, National Candidate Publicity and Campaigning, as amended.

• Approved board governance policy 3.17, National ENA Voting Process, as amended.

• Approved board governance policy 3.18, Candidate Background Screening, as amended.

The next meeting of the ENA board of directors will be held at ENA headquarters in Des Plaines, Illinois, December 9, 2011.

ENA Call for…

Applications for the 2012 Class of Fellows The Academy of Emergency Nursing will accept applications for the 2012 class of fellows through 5 p.m. CST, January 16, 2012.

Information and a link to the applications are available under “Calls and Opportunities” at www.ena.org/Pages/default. aspx.

Questions? Please contact Ellen Siciliano, practice specialist, at academy@ena.org.

November 2011

Deadly Indiana Stage Collapse Continued from page 15 Joy believes support is essential when dealing with disaster preparedness.

“You react to disaster because that’s your job.

Some of our nurses who are administrators were at the concert. Some of our friends were at the concert, so you’re trying to be the nurse and think about where your family and friends are and if they are OK. It takes a strong team to handle a situation like this, and I think we all worked really well together. The support provided for the staff and patients that night was important and executed well by a very skilled team of care providers. I am so proud to work with this group of individuals,” Joy said.

Making A Difference Allison Tann, BSN, RN, CEN, a charge nurse at Indiana University Health, Methodist, saw a mother of one of the stage collapse victim’s standing Allison Tann, BSN, RN, CEN alone outside of the ICU a week after the tragedy. As Tann headed to the elevators, she felt an urge to talk to her. The two made eye contact, and in that moment, Tann made a connection with her.

“I gave her a hug and let her know that I was praying for her and her family. We both cried.

Unfortunately, we don’t get to connect much with the patients because we’re in such a fast-paced environment and we know that we

need to perform life-saving measures in order for these patients to even make it out of our department,” Tann said. “We don’t know their story, we don’t know their family, but our role is extremely important in their survival and how they are treated throughout their stay in the hospital.”

Tann says that working the State Fair tragedy was an experience she won’t forget. She found herself in awe as staff came together during the tragedy.

“That’s why we do what we do. These events that happen—they are moments in our careers that we will never forget. It’s amazing that I had the opportunity to be a part of this profoundly exciting team of individuals. I know that I belong here,” Tann said.

Duffy also had an opportunity to speak with the parents of one of the victims and explain to them what occurred in the emergency department.

“It became pretty apparent that they were settling in for a long visit at our hospital and they realized it very early on. I think allowing them to see our department and hearing what their loved one went through initially helped to create a better picture for them because it was something that was just so shocking and unexpected. They were very grateful for the care that the patient received in the ER,” Duffy said. “I think that once all of us have that initial connection with our patient, especially during a night like that, we feel that bond continue.”

Another mother of one of the injured young men came down a couple days after the

incident to bring a cake and express her appreciation for the care her son received in the emergency department.

“Something that’s interesting is that the grieving has been so public with this and it’s been across the community. I think that the entire hospital as a community has grieved along with the families, and from what I can gather, I think the families felt they have become part of the Methodist family as well,” Duffy said. “I think we also have a very high performing team of health care professionals, from our respiratory therapist to our nurses.

We had valuable resources available for all of our patients, especially our critically-ill patients, and great technology that these families were able to benefit from.”

Although the disaster happened so quickly, Hendershot believes that emergency nurses are well-equipped and prepared to handle disaster situations.

“I think an emergency nurse is trained to respond to such disasters and brings a skill level that no others have. They were calm, organized and purposeful. It may have seemed chaotic to others not used to the pace, but to an emergency nurse, it was a perfect example of the performance of a highly functioning team.

At the end of it all, the emergency nurse knows that he or she made a difference and is part of something much bigger than himself or herself,” Hendershot said.

At a restaurant afterward, “We were just really grateful to have each other and to all be OK,” Boscovich said. “We could have lost everyone at that table.”

Hunt had similar reason to be thankful. Not only had her husband, his father and his best friend been sitting 200 feet from the crash site, but in those uncertain moments after the first alerts went out, there was her staff to think about. Saint Mary’s had seats set aside in the reserved area, and some of the nurses, including Eisenbarth, had been taking turns checking out the action. The “what if” haunts Hunt.

“I could have lost my own personal blood family, but this could even have been a bigger impact because we could have lost our family in the department or family within our hospital system,” she said.

Lillibridge and her husband, air enthusiasts from thousands of miles away, don’t think they’ll return to Reno next year, assuming the races go on. Their recovery required leaving town the next day for Lake Tahoe, where they had stayed at a bed-and-breakfast nine years

earlier. In need of a safe shelter where they could be alone together with their feelings, they struggled to remember the name and location of that peaceful place with the wonderful owners.

Finally they just chose a B&B with an available room and drove to find it.

It ended up being the same place they remembered.

“I think it was divinely inspired,” Lillibridge said.

That’s the spiritual side of her story. But her takeaway message to emergency nurses is about controlling their own destinies: being prepared for that moment when mass trauma might literally drop out of the sky. That means getting TNCC verification and keeping it current.

“The emphasis is, our training works,” Lillibridge said. “Just do it. You never know where you’re going to be. I never expected that I would be doing this, and yet I had all my skills. I had what I needed. I told people, ‘I’m coming to the ENA Conference and I just wound up being a field nurse.’”

Disaster Drops on Reno Continued from page 19 don’t have to be a trauma center to deliver awesome care to trauma patients.”

*** Reno is a close-knit community, and the air races have been a part of its fabric for nearly half a century. Debriefing, defusing and collective healing have been ongoing for the emergency workers who responded to the accident, which ultimately claimed 11 lives.

Boscovich, who has worked at a Level I trauma center, said she pressed a “mute button” on her feelings while treating patents that day.

Later she was able to reflect more emotionally on her own circumstances. Her son had fallen asleep as they were approaching the gate to enter the air show that afternoon. No one wanted to wake him, so her husband and his friends, already inside, agreed to leave early.

Had they stayed, they all would have been sitting in the box-seat area, directly in the damage path.

Official Magazine of the Emergency Nurses Association

37

Board Writes Continued from page 4 (www.ena.org/government/Advocacy/Pages/ Default.aspx) to help ENA members develop policies and programs to promote collaboration in their local communities.

Quality patient care and staff safety is the third priority. ENA believes that evidence-based policies for preventive and protective measures can enhance a culture of safety and reduce the impact of violence in the workplace. As example, the ENA Workplace Violence Toolkit (www.ena. org/IENR/ViolenceToolKit/Documents/ toolkitpg1.htm ) provides information and guidance for developing and implementing a comprehensive plan to manage violent behaviors in the emergency department.

Another prevention strategy coincides with the EDPCC recommendation to use screening, brief intervention, referral and recovery treatment services for all emergency patients at risk of suicide, violence and SUD. We do know what is best for our behavioral health patients. Together we must act to: 1. Incorporate SBIRT for all emergency

patients into our everyday practice.

2. P romote the use of the ENA Workplace Violence Toolkit.

3. Advocate for increased funding for the Substance Abuse and Mental Health Services Administration and other federal programs that provide state block grants for behavioral health services.

4. A dvocate for care equivalent to that given to other medical conditions.

5. A dvocate for adequate community-based systems to provide comprehensive care.

6. A dvocate for research funding to identify best practices for creating a safe work environment.

Patients with mental health and substance use disorders deserve to have the same priority of care as patients with medical/surgical problems.

Join your ENA colleagues—decide what your action will be and begin today.

2.

3.

4.

References 1. A HRQ statistical brief #92 of July 2010 on

5.

PROVE YOUR KNOWLEDGE...

Validate your expertise to your employer, your colleagues and yourself.

BECOME A CERTIFIED EMERGENCY NURSE To learn more about becoming a Certified Emergency Nurse, visit www.BCENcertifications.org.

38

CEN_BCEN_recruitment Connections HP Island Ad.indd 1

12/21/2009 9:54:43 AM

Mental Health and Substance Abuse-Related Emergency Department Visits among Adults, 2007. Available at: www.hcup-us.ahrq.gov/ reports/statbriefs/sb92.pdf. Accessed July 26, 2011.

M ental Health Financing in the United States: A Primer. Kaiser Commission on Medicaid and the Uninsured. April 2011. Available at www.kff.org/medicaid/upload/8182.pdf.

Accessed July 22, 2011.

S ubstance Abuse and Mental Health Services Administration, Leading Change: A Plan for SAMHSA’s Roles and Actions 2011-2014. HHS Publication No. (SMA) 11-4629. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011. Available at store.samhsa.gov/ product/SMA11-4629. Accessed July 15, 2011.

T he President’s New Freedom Commission on Mental Health. Achieving the Promise: Transforming Mental Health Care in America.

Available at govinfo.library.unt.edu/mentalhealthcommission/reports/FinalReport/ downloads/downloads.html. Accessed July 14, 2011.

Ibid

Statement of Ownership, Management and Circulation (Required by 39 U.S.C. 3685). Title of publication: ENA Connection. Publication no.: 1534-2565. Date of filing: October 4, 2010. Frequency of issue: Monthly. Number of issues published annually: 11. Annual subscription price: members, free; non-members, $50 U.S., $60 foreign.

Complete mailing address of known office of publication: 915 Lee Street, Des Plaines, Cook County, Illinois 600166569. Complete mailing address of the headquarters or the general business office of the publisher: 915 Lee Street, Des Plaines, Cook County, Illinois, 60016-6569. Publisher: Emergency Nurses Association, 915 Lee Street, Des Plaines, Cook County, Illinois, 60016-6569. Amy Carpenter Aquino, Editor in Chief: 915 Lee Street, Des Plaines, Cook County, Illinois, 60016-6569. Owner: Emergency Nurses Association, 915 Lee Street, Des Plaines, Cook County, Illinois, 60016-6569. Known bondholders, mortgagees, and other security holders: None. Issue Date for Circulation Data: September 2011. Extent and nature of circulation: A. Total Number of Copies: Average number of copies each issue during preceding 12 months (hereinafter “Average”), 40,829. Actual number of copies of single issue published nearest to filing date (hereinafter “Most recent”), 40,065. B. Paid circulation: B1. Outside-county paid subscriptions stated on Form 3541: Average, 39,553. Most recent, 38,712.

B2. In-county paid subscriptions stated on Form 3541: Average 0. Most recent, 0. B3. Paid distribution outside the mail including sales through dealers and carriers, street vendors, counter sales, and other paid distribution outside USPS: Average 383. Most recent, 376. B4. Paid distribution by other classes of mail through the USPS: Average, 0. Most recent, 0. C. Total paid distribution (sum of B1, B2, B3, and B4): Average 39,935. Most recent, 39,088. D. Free or nominal fee rate distribution. D1. Outside-county copies included on Form 3541: Average, 21. Most recent, 25. D2.

In-county copies included on Form 3541: Average, 0. Most recent, 0. D3. Copies distributed through the USPS by other classes of mail: Average, 0. Most recent, 0. D4. Copies distributed outside the mail: Average, 18. Most recent, 200.

E. Total. Free or nominal rate distribution (sum of D1, D2, D3, D4): Average 43. Most recent 217. F. Total distribution (sum of C and E): Average: 39,978. Most recent, 39,305. G. Copies not distributed: Average, 851. Most recent, 760. H. Total (sum of F and G): Average 40,829. Most recent, 40,065. I. Percent paid (C divided by F times 100): Average, 100.0%. Most recent, 99.0%. This Statement of Ownership will be printed in the November 2011 issue of this publication. I certify that the statements made by me above are true and complete. Amy Carpenter Aquino, Editor in Chief. Date: October 4, 2011.

November 2011

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be recognized.

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This year, Blue Jay Consulting is excited to announce The Blue Jay Consulting/Emergency Nurses Association Nurse Leader of the Year Award. The Nurse Leader of the Year Award will be given to the nursing leader who demonstrates signiďŹ cant collaboration with emergency medicine to improve patient care.

ACCEPTING NOMINATIONS To download the nomination form with a full listing of award criteria or for more information, visit: www.bluejayconsulting.com www.ena.org/about/nationalawards