ENA Connection February 2012 by ENA Connection

the Official Magazine of the Emergency Nurses Association

connection February 2012 Volume 36, Issue 2

Chest Assured Staying Ahead of Heart and Aortic Emergencies in Your Patients and Yourself Pages 3, 12-17

INSIDE

FEATURES Official Magazine of the Emergency Nurses Association

Strategic Travel and Planning 4 The Emergency Nurseâ&#x20AC;&#x2122;s Role in Reporting Pediatric Sexual Abuse 8 Meet the Accomplished 2011 AEN Fellows 10 Translating the IOM Future of Nursing Report to the Emergency Nursing Community 18

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A total of 672 trials were conducted representing weights of 0 (empty), 200 lbs, 500 lbs and 700 lbs. Speciﬁc tests performed include: pushing a straight distance, pushing up and down a ramp and pushing around a corner.

Dates to Remember February 22-23, 2012 State and Chapter Leaders Conference, New Orleans. February 22-26, 2012 ENA Leadership Conference 2012, New Orleans. March 2, 2012 Submission deadline for 2012 bylaws proposals and resolutions. March 19, 2012 Submission deadline for ENA Leadership Conference 2013 course proposals.

BOARD WRITES | Ellen H. Encapera, RN, CEN

Cardiac Arrests Outside the Hospital:

Applying Research, Guidelines and Systems of Care

ENA Exclusive Content PAGE 10 Meet the Accomplished 2011 AEN Fellows PAGE 12 Don’t Let Yourself Be Another Heart Patient PAGE 14 Sudden Cardiac Death: Proper Screenings Can Change the Game for Young Athletes at Risk PAGE 15 Heart-Healthy Screening Programs for Young Adults PAGE 16 Thoracic Aortic Dissection: With New Pocket Resource, We’re Less Likely to Miss PAGE 17 Amy Yasbeck, John Ritter’s Widow, Might Just Hug You PAGE 18 From the Future of Nursing Workgroup: Translating the IOM Future of Nursing Report to the Emergency Nursing Community PAGE 22 ENA Launches Tool to Help You Maximize Your Leadership Conference Schedule PAGE 24 ENA Call for 2012 Proposed Bylaws Amendments and Resolutions

Monthly Features PAGE 3 Board Writes PAGE 4 Letter From the Executive Director PAGE 6 Washington Watch PAGE 8 Pediatric Update PAGE 11 Feedback Frame PAGE 20 Ready or Not? PAGE 22 Click Here PAGE 24 Nominations Committee PAGE 25 ENA Foundation PAGE 26 Member Benefits and Resources PAGE 28 State Connection PAGE 30 Board Highlights

In an effort to reduce disability and death, the American Heart Association declared cardiovascular disease an association-wide priority and has invested more than $3.3 billion in research since 1949. Yet heart disease remains the No.1 killer in America. Cardiac arrest is the leading cause of death in the United States despite the AHA’s Chain of Survival protocol, which includes the following key components: 1. Immediate public recognition and activation of the emergency response call system, 911. 2. Early initiation of cardiopulmonary resuscitation. 3. Easy and rapid access to an automated external defibrillator, followed by 4. Effective advanced cardiac life support, initiated by emergency medical providers in the field. 5. Integrated, hospital-based emergency medical teams who provide care after cardiac arrest. In 2010, the AHA redesigned Basic Life Support guidelines, reflecting a dramatic shift in the philosophy of resuscitation and the means by which CPR is delivered by the non-medical lay public and all levels of medically trained health-care providers. The traditional “ABC” (airway, breathing, circulation) sequence dating to the 1950s has been replaced with the “CAB” (circulation, airway, breathing) algorithm. Inquisitive minds beg the question, why the changes? Here are the key points in the AHA’s guideline revisions, including its perspective that witnessed arrests are primarily cardiac in origin, placing a new emphasis on continuous and effective chest compressions: 1. The major change in the delivery of CPR shifts the “ABC” to “CAB,” initiating deep and effective compressions with minimal pauses during breathing delivery, shock administration and the switching of providers. 2. The compressions-only recommendation was designed for providers unwilling or unable to provide rescue breathing, thus increasing the opportunity for victims to receive resuscitative care in any setting. 3. Controversy continues with regard to delaying early defibrillation to administer CPR. In early randomized studies, opinions were conflicted, but it is clear that in practice, compressions are generally administered before analysis by the AED because of the time to locate, retrieve and set up the defibrillation device. The emphasis on integrating the AED in Basic Life Support has been a vital adjunct to care by both trained and

untrained providers. 4. A tropine remains the first-line therapy for bradycardia because reports indicate that transcutaneous pacing has not proven to be as beneficial as hoped. 5. Adenosine is now considered a “reasonable” option for regular, monomorphic and wide-complex tachycardias. 6. Rescuers in the field are now focusing on effective chest compressions and early defibrillation, rather than pharmacological therapy, for cardiac arrest. Retrospective studies and randomized trials have de-emphasized their effectiveness. 7. In the AHA’s Chain of Survival, therapeutic hypothermia has assumed an expanded role for post-arrest care in the V-fib arrest and comatose patient to prevent or minimize neurological deficits. Experts agree that studies of survival vs. functional outcome are necessary to measure data and improve resuscitation science. Survival is the primary goal, but without neurological and cognitive functions intact, survivors of cardiac arrest may be deprived of their optimal level of quality of life. Each year, out-of-hospital cardiac arrest affects 236,000 to 325,000 people in the United States, making it the third leading cause of death stemming from heart-related diseases. Systems of care for out-of-hospital interventions have led to improved survival rates, thus increasing hospital admissions requiring comprehensive post-arrest interventions. Variations in hospital-based care contribute to differences in outcomes across regions. Facilities can develop effective communication techniques, streamline timelines and improve processes to deliver quality care with better outcomes. Coordinated and timesensitive interventions such as prompt initiation of therapeutic hypothermia, early diagnostic angioplasty and percutaneous coronary artery intervention require a multifaceted in-hospital systems approach, protocols and a high level of performance by a variety of medical teams dedicated to providing better outcomes for victims of arrest. References my.americanheart.org/professional/Research Link MD, Mark S., Revised Guidelines: Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Published in Journal Watch Cardiology, December 1, 2010. Continued on page 26

Official Magazine of the Emergency Nurses Association

LETTER FROM THE EXECUTIVE DIRECTOR | Susan M. Hohenhaus, MA, RN, CEN, FAEN

Strategic Travel and Planning Greetings from Chicagoland! Those of you who know me and follow my Facebook postings will understand how unusual it is that I am actually here in my office at our national headquarters. The learning curve, travel and networking in my first few months as ENA’s executive director were intense and full of challenges and opportunities. Besides the energizing ENA Annual Conference in Tampa, here are some travel and collaboration highlights from the fourth quarter of 2011: • In early October, AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN, Gail Lenehan, EdD, MSN, RN, FAEN, FAAN, and I attended the board meeting of the American College of Emergency Physicians. I had the opportunity to meet with my counterpart, ACEP’s executive director, Dean Wilkerson, as well as to renew relationships with members of the

With ‘‘First Lady’’ Judy Kelleher, MSN, RN, FAEN, during a visit in December.

ACEP board of directors, many who have been friends and colleagues for years. Our “possibility” discussions centered on collaboration regarding critical issues such as APRNs in emergency departments, pediatric triage and the need for more research on crowding and boarding. • In October, AnnMarie Papa and I led a historic delegation of 32 ENA members to Havana, Cuba. ENA board members Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN, and Karen Wiley, MSN, RN, CEN, also Members of ENA’s delegation to Cuba met with emergency nurses joined the delegation. We had the in Havana in October. opportunity to meet with nursing • In December, AnnMarie Papa and I traveled professionals in emergency departto California to meet with ENA’s “First Lady,” ments, primary care offices, nursing schools, our co-founder, Judy Kelleher, MSN, RN, rehabilitation hospitals and polyclinics. Most FAEN. Though it was a brief visit, facilitated of the group would likely agree that we have by Judy’s long-time friend and ENA member much in common with our Cuban colleagues. Diane Schertz, BS, RN, FAEN, Kelleher was as Nurses live in the communities they are sharp as ever. We presented her with the first responsible for and have a great deal of copy of ENA’s Scope and Standards of respect from their patients. Emergency Nursing Practice, along with the • In November, Gail Lenehan, JoAnn Lazarus, news that ENA was now officially recognized MSN, RN, CEN, and I met in Miami for the as a specialty organization by the American Nursing Organizations Alliance annual Nurses Association. Judy’s most poignant meeting. The purpose of this meeting, advice to me was this: “We all have to get designed for the chief elected officers and together.” A very fitting statement for our chief staff officers of the Alliance member theme of collaboration in the 2012-2014 organizations, is to provide a forum for Strategic Plan. While in the San Francisco identification, education and collaboration, area, I also took the opportunity to meet with building on issues of common interest to Dianne Vass, executive director of the advance the nursing profession. Diane Emergency Medicine Patient Safety FoundaGurney, MS, RN, CEN, the 2010 ENA tion, as we begin to work together to provide president, was part of the panel session How collaborative patient safety education and to WOW Your Members, a session she will advocacy among ACEP, ENA and EMPSF. facilitate at ENA Leadership Conference 2012 Meeting, brainstorming and reaching this month in New Orleans. A common theme consensus with key ENA partners was critical in at this meeting was the need to collaborate the development of ENA’s 2012-2014 Strategic and leverage the power of nursing. Continued on page 27

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

POSTMASTER: Send address changes to ENA Connection 915 Lee Street Des Plaines, IL 60016-6569 ISSN: 1534-2565 Fax: 847-460-4002 Web Site: www.ena.org E-mail: connection@ena.org

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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: Gail Lenehan, EdD, MSN, RN, FAEN, FAAN President-elect: JoAnn Lazarus, MSN, RN, CEN

Secretary/Treasurer: Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN Immediate Past President: AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN Directors: Kathleen E. Carlson, MSN, RN, CEN, FAEN Ellen H. Encapera, RN, CEN Mitch Jewett, RN, CEN, CPEN Marylou Killian, DNP, RN, FNP-BC, CEN Michael Moon, MSN, RN, CNS-CC, CEN, FAEN Matthew F. Powers, MS, BSN, RN, MICP, CEN Karen Wiley, MSN, RN, CEN Executive Director: Susan M. Hohenhaus, MA, RN, CEN, FAEN

February 2012

WASHINGTON WATCH |

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

CDC Releases Latest Data on Emergency Department Use According to a new study from the Centers for Disease Control and Prevention, visits to hospital emergency departments increased to an all-time high of 136 million in 2009. This number represents almost a 10 percent increase from the 2008 figure of 123.8 million and marks the largest increase since the government started tracking emergency departments in the early ‘90s. The annual visit rate cited is 45.1 emergency department visits per 100 persons, but the study also breaks out the visits further by age, gender and race. In addition, other visit data includes expected sources of payment, reasons for visit, diagnoses and medications provided or prescribed. The statistics regarding age include: patients under age 15 accounted for 21 percent of emergency department visits in 2009; those between ages 15 and 24, 15 percent; patients between ages 25 and 44, 28 percent; patients between ages 45 and 64, 21 percent; and those age 65 and older, 15 percent. As for gender, the study indicates that females visited the emergency department at a rate of 48 visits per 100 persons, while males visited at a rate of 42 visits per 100 persons. Taking race into account, Whites had a rate of 41 visits per 100 persons, while Blacks/African Americans had a rate of 84 visits per 100 persons. The expected sources of payment were: private insurance—39 percent; Medicaid or State Children’s Health Insurance Program—29 percent; Medicare—17 percent; other and unknown—5 percent each; and no insurance—19 percent. (The total is higher than 100 percent because more than one payment source may have been reported per visit.) The leading discharge diagnosis groups were: nonischemic heart disease—1.1 million; chest pain— 927,000; pneumonia—832,000; ischemic heart disease—513,000; and cerebrovascular disease—477,000. Medications were provided or prescribed in 78 percent of emergency department visits for a total of 268 million drugs.

Most Common Reasons for Visiting the Emergency Department ✓ Stomach and abdominal pain – 9.6 million ✓ Fever – 7.4 million ✓ Chest pain – 7.2 million ✓ Cough – 4.7 million ✓ Headache – 4 million ✓ Shortness of breath – 3.7 million ✓ Back symptoms – 3.7 million

New Medication Reconciliation Tool for Hospitals The Agency for Healthcare Research and Quality has released a new toolkit to help hospitals improve their medication reconciliation processes to reduce adverse drug events. The Medications at Transitions and Clinical Handoffs Toolkit provides step-by-step instructions on how to improve a medication reconciliation process, from planning—including how to get leadership support—to pilot testing, implementation and evaluation. Included is a workbook that helps users implement the toolkit. The toolkit is available at www.ahrq.gov/qual/match/.

From the States Workplace Violence Prevention Act Introduced in Pennsylvania The Health Care Facilities Workplace Violence Prevention Act—HB 1992—was filed in the Pennsylvania House to promote a culture of safety in health-care facilities and help protect health care workers from incidents of workplace violence. The legislation comes in response to the recent rise in workplace violence incidents targeting health-care professionals across the United States, particularly nurses. Introduced by state Representative Nicholas Micozzie (R-163), HB 1992 requires Pennsylvania hospitals and other health-care facilities to take steps to protect health-care workers from workplace violence that include security risks assessments, finding ways to create a safer workplace and helping workplace violence victims report incidents. HB 1992 would require health-care facilities to develop a plan addressing risk factors, train security personnel, build staffing and create a hospital culture of safety. Specifically, the bill would require violence prevention committees in healthcare facilities and delineates their powers and duties. The duties of the violence prevention committee include an annual risk-assessment evaluation of any factors that may put an employee of the health-care facility at risk of workplace violence, the preparation of a report from the risk assessment and the establishment of a violence prevention program. The U.S. Occupational Safety and Health Administration

February 2012

Advocacy Packet on Mitigating Violence Against Healthcare Workers Released

defines workplace violence as any physical assault, threatening behavior or verbal abuse occurring in the workplace, and violence includes overt and covert behaviors ranging in aggressiveness from verbal harassment to murder. Recognizing workplace violence as a serious occupational hazard that has ranked among the top causes of death in workplaces in recent years, OSHA recently issued a directive on Enforcement Procedures for Investigating or Inspecting Incidents of Workplace Violence available at www.osha.gov/OshDoc/ Directive_pdf/CPL_02-01-052.pdf.

Many hospitals are ill-prepared to prevent incidents of violence, and no federal regulation exists that mandates the implementation of a comprehensive security plan in the health-care setting. Nationally and internationally, nursing organizations, including ENA, are advocating for a policy of “no tolerance” for violent acts in a health-care setting. Nurses are strongly advised to actively support this safety movement and engage in prevention strategies in their emergency departments and hospitals. With the increased risk of violence in the emergency department, the Advocacy Packet on Mitigating Violence against Healthcare Workers provides the data, tools and resources necessary for emergency department nursing leaders to advocate and implement plans for establishing a zero tolerance for violence in their emergency departments. This packet can be downloaded from www.ena.org/government/Advocacy/Pages/Default.aspx.

Vermont Lawmakers Hold Hearing on Hospital Closing At a November 2011 hearing held by the Vermont Legislature’s Mental Health Oversight Committee, lawmakers heard testimony on the ramifications of the closure of the Vermont State Hospital in Waterbury due to flooding from Tropical Storm Irene on August 28. Ed Haak, director of emergency medicine at Northwestern Medical Center in St. Albans, had collected stories from emergency department personnel around the state indicating increasing stress from encounters with mentally ill patients who previously would have been placed in the state hospital. One particularly disturbing story concerned an agitated and chronically psychotic woman who, after spending considerable time in the emergency department followed by 72 hours in the intensive care unit with police in attendance, was finally accepted as a voluntary admission at another facility, which she then left against medical advice. She was murdered the next day in a screaming fight with her boyfriend. In his testimony, Patrick Flood, deputy secretary of the Agency of Human Services, said he was sympathetic to the concerns voiced by Haak and other hospital officials. He indicated, however, that things are being put in place to help take the pressure off. For example, the Department of Mental Health, a division of Flood’s agency, has been working to expand other psychiatric facilities around the state to accommodate patients who would have been housed at the Waterbury 54-bed state hospital.

LEADERSHIP CONFERENCE 2012

ILLUMINATE & EMPOWER FEBRUARY 22-26 • NEW ORLEANS

Offering Educational and Networking Opportunities for Current and Future Emergency Nurse Leaders. For more information visit www.ena.org.

Official Magazine of the Emergency Nurses Association

PEDIATRIC UPDATE |

Elizabeth Stone Griffin, BS, RN, CPEN

The Emergency Nurse’s Role in Reporting Pediatric Sexual Abuse Few subjects conjure more raw emotion than the issue of pediatric sexual abuse. Among all of the difficult and sad situations we see as emergency nurses, it has to rank as one of the toughest to deal with, both personally and professionally. Too often, simply due to prevalence rates, the subject of sexual abuse hits very close to home. It is estimated that as many as 25 percent of women and 10 percent of men experience some form of sexual abuse by age 18. Up to 25 percent of women in college reported experiencing an attempted or completed rape in college. Sixty percent of sexual assaults are never reported to the police, at least 66 percent of assailants are known to the victim, and 15 out of 16 rapists never spend a day in jail for their crime.

Mandatory Reporting Nurses have a legal obligation to report any suspected child abuse, regardless of whether there is mutual agreement by a physician. Federal law regarding child abuse reporting specifies that people engaged in certain occupations and activities involving children (including health care) are required to report any suspected child abuse, according to their state statutes and policies, with full immunity (without concern for any civil or criminal liability arising from the report). Some state statutes, however, are more specific and include more people in their mandatory reporter category. In about 18 states and Puerto Rico, every person, regardless of occupation, is mandated to report suspected child abuse or neglect. Therefore, it is imperative that nurses be aware of their specific state statutes. Quick links to these state statues can be found at www.childwelfare.gov/responding/ reporting.cfm. In most states, the responsibility to actually investigate the alleged child abuse belongs to law enforcement, the state child protective services agency or a combination of the two.

Resources and Referrals Nurses must also be aware of their local requirements for sexual assault kit collection. For example, some states allow “blind” sexual assault kit collection (no case number is required prior to evidence collection). Sexual assault nurse examiners are excellent resources for providing education on how to properly collect evidence, document and facilitate a developmentally appropriate and sensitive sexual assault exam. ENA’s Emergency Nurse Pediatric Course includes a section on sexual abuse within its “Child Maltreatment” chapter. This section discusses the proper history taking, assessment, interventions and documentation techniques for victims of alleged sexual abuse. Nurses should also be aware of their local agencies which provide services for victims of sexual assault, ranging from exam

accompaniment, emergency shelter, counseling and court advocacy. With patient permission, some of these agencies can be contacted by the triage nurse to initiate immediate services and help ensure follow up as appropriate. RAINN (the Rape, Abuse and Incest National Network), the nation’s largest anti-sexual violence organization, has a link to such resources in every state at centers.rainn.org/.

A Wake-up Call Ironically, as I wrote this article, a local news broadcast announced that two young girls at my 9-year-old daughter’s elementary school were allegedly fondled on the school bus by a 9-year-old boy who also attends her school. The explicit details given by one reporter described, in my opinion, a clear case of sexual assault. However, due at least partially to state and

February 2012

school board definitions, the offense was defined and punished as harassment rather than as assault. I personally am now extremely motivated to assist in sexual abuse education and prevention efforts. My question and concern is when should the education begin and should it be optional? As emergency nurses we know that sexual abuse has no minimum age. We also know that, far too often, the abuser is a family member or caretaker.

A Silver Lining The recent heightened public awareness of sexual abuse and concern for the victims has already helped serve as a catalyst for change. A Penn State University campaign fueled by concern for victims of sexual assault recently raised $500,000 for RAINN. “For victims of sexual abuse, one of the biggest issues they face is the fear that they are alone, and that no one will take their story seriously,” explains Katherine Hull, RAINN spokesperson, on the organization’s Web site. “In the Penn State case, we are seeing positive support for these victims.” RAINN has reported a 54 percent increase in the number of victims using their national hotline since the Penn State campaign was launched in early November 2011. I can only hope both as a nurse and as a parent that the increased public awareness of sexual abuse will continue to decrease the stigma associated with it, motivate educational and preventative efforts and increase reporting and disclosure. Sexual abuse has become a public health problem. Caring for these children both in the community and in the emergency department is an ethical and legal responsibility we all share. Resources and References www.childwelfare.gov/responding reporting.cfm http://aspe.hhs.gov/hsp/08/sr/statelaws statelaws.shtml http://rainn.org. The Rape, Abuse and Incest National Network. Operates the National Sexual Assault Hotline at 800-656-HOPE and a unique, secure online hotline at www.rainn.org. www.Stopitnow.org C enters for Disease Control and Prevention (2009). Sexual Violence Surveillance: Uniform Definitions and Recommended Data Elements. Accessed 12/17/2011: www.cdc. gov/violenceprevention/pdf/SV_ Surveillance_Definitionsl-2009-a.pdf. Centers for Disease Control and Prevention

(2008). Sexual Violence: Facts at a Glance. Retrieved 12/15/2011: www.cdc.gov/ violenceprevention/sexualviolence/ index.html Cornell University Law School. United States Code: Title 42, 13031, “Child Abuse Reporting.” Accessed 12/6/2011: www.law. cornell.edu/uscode/42/13031.html. American Academy of Pediatrics (2005). Written by: Kellogg, N., and the Committee on Child Abuse and Neglect. Guidelines for the Evaluation of Sexual Abuse in Children (2005). Pediatrics. 116: 2. Accessed 12/16/2011: www.aap.org/pubserv/ PSVpreview/pages/Files/EvalSA.pdf Emergency Nurses Association. Emergency Nurse Pediatric Course. Des Plaines (Ill): The Association; 2004.

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.

QUICK REFERENCE CHILD SEXUAL EXPLOITATION Guidelines, protocols, procedures and statistics for frontline professionals who confront perpetrators and victims of child sexual exploitation. Available to buy now at ENA Marketplace, www.ena.org/store.

ENA wishes to express its sincere gratitude to these 2012 sponsors.* Thanks to their generous support, ENA is able to continue to provide relevant services and educational programs to improve your practice of emergency nursing.

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Official Magazine of the Emergency Nurses Association

1/12/2012 3:18:32 PM

AEN Meet the LOGO Accomplished 2011 AEN Fellows The 2011 class of fellows was inducted into the Academy of Emergency Nursing on September 23, 2011, at a special ceremony at the ENA Annual Conference in Tampa, Fla. AEN was created to honor emergency nurses for their contribution to the profession as demonstrated by: • Enduring and substantial contributions to the advancement of the emergency nursing profession in education, practice, research, leadership or public policy; • Impact in advancing the emergency nursing profession in one or more of these areas; and • Potential for sustained contributions to the advancement of emergency nursing and the Academy of Emergency Nursing. Pamela Bourg, MS, RN, FAEN, is a star-maker. Her proudest moments have not been when she succeeded, but when those whom she mentored succeeded. Many of ENA’s early leaders Pamela Bourg, MS, RN, FAEN were her mentors, and their dedication and support inspired her to mentor others. In doing so, she hoped to help bridge the next generation of leaders and help shape the practice for the future. Bourg is committed to passing on her knowledge and experience to the next generation of emergency nurses to accelerate their learning so they can take the organization to the next level. For those contributions, she was honored with the 2010 ENA National Nursing Professionalism Award. She was also recognized for her contributions in emergency nursing by the state of Colorado in 1991 as a finalist for the Nightingale Awards. Bourg’s career reflects an integration of clinical practice, education and research that has influenced colleagues and patients. Through her research, writing and editorial work, she has substantially contributed to emergency nursing. She is an active member of the ski patrol at Copper Mountain Colorado. She is a state faculty for Emergency Nursing Pediatric Course and Trauma Nursing Core Course in Colorado. As the current director of the trauma program at St. Anthony Hospital in Lakewood Colo.,

Bourg has a whole new generation of nurses to lead and inspire. Nancy Denke, MSN, RN, FNP-C, ACNP, CEN, CCRN, FAEN, has been an ENA member for 34 years. She has served on numerous committees at the local, state and national levels and is Nancy Denke, MSN, RN, now the chairperson FNP-C, ACNP, CEN, CCRN, for the ENPC FAEN Revision Workgroup. Her commitment to quality care extends beyond the many patients she cares for in the emergency department, intensive care unit and on the medical/surgical floors as a trauma nurse practitioner. She serves as a mentor/preceptor to nursing and medical staff and participates in the training offered by the military partnership program at Scottsdale Healthcare. In 2007, she was recognized as the Arizona Emergency Nurse of the Year. This award recognizes innovators, leaders and those who continually go above and beyond the call of duty in the emergency nursing profession. When asked about her potential for sustained contributions to the profession she said, “It is easy. I love being an emergency nurse!” Terry Foster, MSN, RN, CEN, CCRN, FAEN, was a 1977 LPN graduate of Booth Memorial Hospital School of Practical Nursing in Covington, Ken. After working for five years as an LPN Terry Foster, MSN, RN, CEN, in the emergency CCRN, FAEN department, he earned his RN diploma from the Christ Hospital School of Nursing in Cincinnati. In 1997, he received his master’s degree in critical-care and trauma nursing from the University of Cincinnati. He’s held positions of volunteer, ward clerk, staff nurse, charge nurse, critical-care instructor, clinical director and night supervisor at St. Elizabeth Medical Center in Kentucky.

He has authored more than 35 professional publications in nursing textbooks and journals, has lectured internationally on a wide variety of topics at nursing conferences, and has given more than 3,000 formal presentations, covering all 50 states. Lecturing on emergency and critical-care nursing, Foster has taught CEN and CCRN certification exam reviews since 1985, and is well-known as a speaker on nursing humor. He has held numerous ENA positions at both the chapter and national levels. In 2009, Foster received ENA’s Judith Kelleher Award. In 2010, Foster played himself on an episode of The Learning Channel’s “Untold Stories of the ER,” the first nurse featured on this physicianbased show. Since 1998, he has been the clinical specialist in the emergency department at St. Elizabeth Medical Center (a Magnet hospital) in Edgewood, Kentucky, being employed in this five-hospital system since 1975. Denise King, MS, RN, CEN, FAEN, is a director with Blue Jay Consulting. She has served in many ENA positions at the local, state and national levels, including six years on the national Denise King, board of directors MS, RN, CEN, FAEN and the 2008 president. During her service on the board, she served as liaison to the Academy, the Board of Certification for Emergency Nursing, the ENA Foundation and numerous committees. King also served as a liaison to the American College of Emergency Physicians on the issue of emergency department crowding. She has represented emergency nursing and worked in collaboration with ACEP and other professionals asking the Joint Commission to re-evaluate its medication reconciliation standards, and with the Center for Medicare and Medicaid Services regarding the use of advanced treatment protocols in emergency departments. Developing the next generation of leaders has long been an objective of King; her professional activities have been focused on bringing out the full potential of nurse leaders and supporting their journey to excellence. In 2008 the ENA Foundation Tapestry Scholarship was

February 2012

created in honor of King and her passion for leadership development. King is a published author and regular speaker on emergency nursing and leadership development. King continues to be active in ENA and in the international emergency nursing community. She is on the board of directors for the World Alliance of Emergency Nursing and views this as an opportunity to further advance the profession of emergency nursing on a global scale.

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Lisa Wolf, PhD, MS, RN, CEN, FAEN, joined ENA in 2004 to get a discount on the CEN exam and maybe a nice journal. Instead she was drawn into research, teaching and practice issues. Having been Lisa Wolf, spit out of the vortex PhD, MS, RN, CEN. FAEN with a PhD in hand, she continues to teach at the University of Massachusetts Amherst School of Nursing, work with colleagues in the Massachusetts State Council to provide emergency nursing education and save lives as a staff nurse at Cooley-Dickinson Hospital in Northampton, Mass. Her research and practice area of interest is clinical decision-making by emergency nurses. Initial results from her dissertation study indicate

Feedback Frame

that her conceptual model is predictive; accuracy in problem identification is associated with the moral reasoning and practice environment elements of the model. The model will give a clear blueprint in terms of both â&#x20AC;&#x153;diagnosingâ&#x20AC;? and remediating environments with poor decision making attributes. This in turn will further inform educational modalities and their

evaluation, laying the groundwork for a continuous loop of feedback and refinement which should improve both decision making by emergency nurses and more importantly, how we teach and evaluate these skills to ensure safe, competent practice. Wolf was a 2010 ENA Foundation Doctoral Scholarship recipient.

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Official Magazine of the Emergency Nurses Association

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Don’t Let Yourself Be Another Heart Patient By Kendra Y. Mims, ENA Connection Heart disease has been the No. 1 killer of women since the beginning of the 19th century, and today, at least one woman in the United States dies from heart disease almost every minute (Myths & Truths, 2011). It’s no longer considered only a man’s disease. Statistics show that more women have died from heart disease annually than men since 1984 (Streisand, 2011). Although some risk factors may be hereditary, lifestyle choices play a significant role in reducing the risk for developing heart disease. Taking the following preventative steps toward being heart-healthy today can save you from future heartache: Eating a poor diet that is high in cholesterol and HEALTHY EATING saturated fats can lead to obesity, high cholesterol levels, diabetes and high blood pressure—all common risk factors for heart disease. Developing and maintaining healthy eating habits can be a challenge; it doesn’t happen overnight. Making small changes doesn’t require a lot of time or effort, but the impact can be beneficial to your overall health. • Decrease your daily intake of animal fat. Replace a meaty dish with a vegetarian meal once a week. • Be mindful of your portion sizes; the bigger the portion, the higher the calories. • If you are working longer shifts, pack healthy snacks such as raw vegetables, unsalted almonds or seeds, raisins, unsweetened canned fruit or fresh fruit. Fruits and vegetables are loaded with vitamins and antioxidants, which are proven to lower the risk for heart disease. • Swap out ice cream for low-fat yogurt and eggs for egg whites. The American Heart Association recommends a diet that includes at least 4½ cups of fruits and vegetables daily; fish twice a week (preferably oily fish); less than 1,500 mg of sodium per day, no more than two servings of processed meats per week; fiber-rich whole grains; four servings of nuts, legumes and seeds per week; and no more than 36 ounces of sugar-sweetened beverages a week (Healthy Diet Goals, 2011).

According to the American Heart Association, as little EXERCISE as 2½ hours of moderateintensity physical activity per week can lower the risk of heart disease by 14 percent (AHA, 2011) and bring greater heart benefits. The AHA recommends 150 minutes of moderate exercise or 75 minutes of vigorous exercise per week. If your time is limited, divide your workout routine into multiple segments. Walking is an easy, convenient exercise that can improve your heart health and can be done throughout your workday. Take the stairs instead of the elevator. Encourage a coworker to become your walking buddy during breaks—your heart can become stronger and healthier with each step. Patient overload, long shifts and busy schedules can AVOID STRESS lead to a stressful work environment. Research suggests that high levels of stress are believed to affect the heart because of the increased blood pressure and heart rate that stress causes; this can lead to chest pains and angina pectoris and can damage the artery walls. The next time you begin feeling stressed out at work, take a quick walking break or talk to a trusted friend or colleague. Heart Healthy Living also suggests placing inspirational quotes, magazine clippings or comics somewhere accessible, such as a work station, to make your stressful environment more peaceful. It’s important to keep stress, whether physical or emotional, in check before it becomes chronic. Living stress-free will keep your heart in the right place and preserve your peace of mind. Your sleep pattern can affect your risk for heart REST disease. Not getting the adequate amount of sleep each night can cause wear on the heart—a hidden risk factor that often goes unnoticed (Gardner, 2011). Previous findings have cited an increased risk for coronary disease for those who slept more or less than the recommended eight hours, and those who

sleep fewer than eight hours are more likely to develop blood-sugar problems that can lead to type 2 diabetes, which also increases the risk of heart disease. Researchers also have found a strong link between women who sleep fewer than five hours and high blood pressure (Atkinson, 2011). Getting your eight hours of sleep will help to reduce your risk. Taking care of yourself is the best method of prevenTAKE CONTROL tion. Not everyone experiences onset symptoms of heart disease, so it’s important to use prevention as your defense. Create an action plan that is realistic according to your work schedule and lifestyle. • Read food labels. Look for the AHA’s “heart” checkmark on food labels while grocery shopping. This informs consumers that the food has been certified to meet the AHA’s heart-healthy guidelines. • Quit smoking. Even second-hand smoke increases the risk of heart disease. Smoking is not only harmful to the lungs but also increases the chance of blood clotting, makes exercising difficult, raises blood pressure and can damage arterial lining. • Monitor your health. While monitoring your patients’ health is part of your daily routine, don’t forget to make time to examine your own. By knowing and keeping track of your numbers on a regular basis, you can control where you want them to be. otal blood cholesterol: Aim for less than T 200 mg/dL DL (“bad”) cholesterol: Aim for less than L 100 mg/dL DL (“good”) cholesterol: Aim for 50 to H 60 mg/dL Triglycerides: Aim for less than 150 mg/dL Body Mass Index: Aim for less than 25 lood pressure: Aim for lower than B 120⁄80 mmHg Fasting glucose: Aim for less than 100 mg/dL aist Circumference: Aim for less W than 35 inches

February 2012

Heart Disease Facts at a Glance

References American Heart Association. (2011). Retrieved from www.heart.org/ HEARTORG/

• Heart disease kills women more than all cancers combined.³

Atkinson, L. (2011). Heart disease, high blood pressure, diabetes...why lack of sleep is much worse for women. Retrieved from www.dailymail.co.uk/ health/article-2006007Heart-disease-high-blood-pressure-diabetes--lacksleep-worse-women.html

• 42.7 million women are currently living with some form of cardiovascular disease. 4

Gardner, A. (n.d.). 9 Hidden Risk Factors for Heart Disease. Retrieved from the Heart Healthy Living Web site: www.hearthealthyonline.com/heart-attackstroke/risk-factors/hidden-risks_1.html Healthy Diet Goals. (2011). Retrieved from the American Heart Association Web site: www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/ HealthyDietGoals/Healthy-Diet-Goals_UCM_310436_SubHomePage.jsp Myths & Truths on Women and Heart Disease. (2011). Retrieved from WomenHeart Web site: womenheart.org/resources/mythstruths.cfm Streisand, B. (2011). It’s Time For Gender Equality In Treatment Of Heart Disease. Retrieved from The Huffington Post Web site: www.huffingtonpost. com/barbra-streisand/womens-heart-health_b_1135486.html Helpful Resources: G o Red Women: www.goredforwomen.org.index.aspx American Heart Association: www heart.orgHEARTORG/ WomenHeart—The National Coalition for Women with Heart Disease: womenheart.org/index.cfm The Heart Foundation; www.heartfoundation.org.nz Healthy Heart Living; www.hearthealthyonline.com/

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Gary Scholar, M.D. Empowering nurses to practice what they preach by taking control of their own nutrition, fitness and sleep. Available at the ENA Marketplace, www.ena.org/store.

• Nearly five times as many women (200,000) will die from heart attacks alone this year than will die from breast cancer. ²

• 7.5 million women are currently living with coronary heart disease. 4 • More than 3 million women have a history of heart attack.

• A 2005 American Heart Association study showed that only 8 percent of primary care physicians and 17 percent of cardiologists knew that heart disease kills more women than men.² • Some of the hidden risk factors for heart disease include gum disease, depression, irregular menstrual cycles, anemia, diagnosis of lupus or other autoimmune conditions and the use of potent anti-inflammatories.¹ • National Wear Red day is February 3, 2012. References 1 Gardner, A. (n.d.). 9 Hidden Risk Factors for Heart Disease. Retrieved from the Heart Healthy Living Web site: www. hearthealthyonline.com/heart-attack-stroke/risk-factors/ hidden-risks_1.html 2 Myths and Truths on Women and Heart Disease. (2011). Retrieved from the WomenHeart Web site: womenheart.org/ resources/mythstruths.cfm 3 Streisand, B. (2011). It’s Time For Gender Equality In Treatment Of Heart Disease. Retrieved from The Huffington Post Web site: www.huffingtonpost.com/barbra-streisand/womens-hearthealth_b_1135486.html 4 Women and Heart Disease. (2011). Retrieved from the WomenHeart Web site: womenheart.org/resources/upload/ Women-and-Heart-Disease-FINAL-2011.pdf

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Sudden Cardiac Death:

Proper Screenings Can Change the Game For Young Athletes at Risk By Kendra Y. Mims, ENA Connection The unexpected deaths of two rising high school athletes last year raised concerns and awareness about sudden cardiac death in young athletes. Wes Leonard was 16 when he collapsed and died of cardiac arrest after making the winning shot for his basketball team. Two days after Leonard’s death, Matthew Hammerdorfer, 17, collapsed during a rugby match after taking a hit in the chest. The media’s recognition of sudden cardiac death can be traced back to the ’90s, when young star athletes such as Hank Gathers, 23, and Reggie Lewis, 27, both collapsed and died on the basketball court because of heart conditions. Unfortunately, research shows that one out of every 30,000 to 50,000 U.S. high school athletes dies unexpectedly every year from sudden cardiac arrest, among more than 7 million teens playing high school sports. Studies report that more than half of the sudden deaths in young athletes are due to underlying heart disease, the most common cause being hypertrophic cardiomyopathy, which is underdiagnosed. According to the Minneapolis Heart Institute Foundation, there are more than 30 identified causes of sudden death in athletes. Although some victims may be aware of their heart condition, a significant number of healthy young athletes are unaware they are at risk for sudden cardiac death while playing sports. The American Heart Association recommends that all high school and college athletes have a routine screening and has issued screening guidelines for assessing sudden cardiac death risks to help doctors and athletic coaches identify undetected heart problems. The guidelines consist of eight medical-history questions and four physical-exam elements. New research suggests physicians are not completing thorough exams during high school sports physicals because they are skipping crucial parts of the exam, not asking critical questions and not adhering to AHA’s suggested screening guidelines—all factors that could prevent death by detecting heart problems in the early stages. A recent survey conducted in Washington state showed that fewer than half of physicians and only 6 percent of athletic directors who participated in the study reported they were aware of the AHA screening guidelines; 67 percent of doctors said they didn’t always ask teens about family history of heart disease. Twenty-eight percent failed to ask young athletes if they experienced chest pain during

exercise, and 22 percent didn’t always ask about unexplained fainting. In 2006, Theodore Abraham, MD, a cardiologist at Johns Hopkins in Baltimore, developed a hypertrophic cardiomyopathy clinic where young athletes with HCM are treated and educated. Abraham said treating young patients in an underserved population where access to health care is limited created several missions: to screen them for any possible harmful heart conditions, and to provide education and conduct research that could influence health policy to provide better care to kids who may be harboring potentially lethal heart conditions. The Heart Hype Program was eventually created—a free annual event in which 300 young athletes ages 14–18 are screened for HCM and other dangerous heart conditions. ‘‘Although we started off with HCM, we see ourselves using HCM to leverage a larger mission,’’ Abraham said. ‘‘We screen for any condition that could cause potential death in a young person. There’s a big debate in the community as to whether it is cost-effective to screen, and our point is that as a society we should screen, because every life is worth saving, and if it is expensive, then we need to find a lesser expensive way to screen.’’ Through the screenings, Abraham noticed obesity and high-blood pressure in athletes as young as 14. ‘‘Although we’re fixated on sudden cardiac death, we shouldn’t forget about the high blood pressure in the 14-year-olds,’’ he said. ‘‘By the time they’re 25, they can have heart disease.’’

Abraham gives credit to the nurse volunteers who have helped him to organize and launch the Heart Hype Program event. Maureen Parkhurst, RN, co-coordinator for the Heart Hype Program, said about 45 nurses volunteer, making them the single biggest group of volunteers. ‘‘It takes a big organizational pull to screen 300 athletes in a timely and efficient manner,’’ Parkhurst said. “Our role at the event is to do their height, weight, blood pressure and EKGs. We really serve as the leaders in the different screening rooms to answers questions and to guide people. I think we, as nurses, really take an organizational role. We organize the whole thing. There are a lot of different people we work with, and we couldn’t do any of it without everybody.’’

Speaking From Experience At ENA’s Annual Conference in 2010, ENA member Mary Alice Vanhoy, MSN, RN, CEN, CPEN, NREMT-P, presented a session on the sudden death of a young athlete. She believes the lack of awareness is a problem, along with the low-quality screenings. ‘‘We don’t do the prescreening that is common in Europe,’’ Vanhoy said. “They require EKGs as an entry requirement for athletes Mary Alice Vanhoy, to play organized sports. MSN, RN, CEN, CPEN, NREMT-P This helps them identify

February 2012

the athlete with prolonged QT interval and hypertrophic cardiomyopathy. There is nothing consistent like that in the U.S. I know it’s a big expense, but if we started doing it, we could catch some of these events before they happen. It is important for us to start screening prior to athletes participating in sports. Physicians aren’t asking or do not know the right questions. Most of the time, the screening exams ask about blood pressure. Fifty young athletes died on the playing field in 2010. That’s a lot.” Vanhoy, who’s the nurse manager at Queen Anne’s Emergency Center in Maryland, recalled her experience with a 6-year-old patient who suffered from commotio cordis and collapsed after being struck in the chest with a ball while playing outside. She said the population at risk for commotio cordis is young athletes in organized sports, such as baseball, hockey, football, lacrosse. Many people, including physicians, are unaware of this particular cause of sudden cardiac death, which results from a blunt impact to the chest, even though commotio cordis is the second-leading cause of sudden death in competitive youth sports, she said. “Hypertrophic cardiomyopathy makes the news more frequently,” she said. “Although commotio cordis was previously considered rare, sudden deaths due to chest-wall blows are increasing. There is probably an increase because there are more young athletes playing organized sports. The good news is that with increased awareness, frequently coordinated by parents and athletic associations like US Lacrosse, the survival

rate is also increasing. There is limited data about commotio cordis, so it is vital that we increase the awareness by all involved.” Members of numerous health and sports organizations gathered last year at the Youth Sports Safety Summit to review a new position statement issued by the National Athletic Trainers’ Association. Titled ‘‘Preventing Sudden Death in Sports,” it outlines 10 major health conditions and causes of sudden death among athletes, along with recommendations for improved prevention and treatment. For sudden cardiac arrest, the statement says advance preparation is critical to survival and that public access to automated external defibrillators and an established emergency action plan significantly improve the likelihood of survival. Vanhoy believes prevention strategies should include education for coaches; awareness programs for the players and families to inform them about safe equipment; a plan of response and how athletes can protect themselves from chest injury; and public access to automatic external difibrillators. Vanhoy carried an AED with her whenever her son played in a lacrosse game as part of a prevention strategy. AEDs reportedly have helped to save the lives of young athletes in several incidents, which is why many people have pushed to get them into schools and public locations. ‘‘There are more AEDs around,” Vanhoy said. “We are more cognizant of what is going on. I think the recognition of what is happening has increased.”

Although athletes, their families and coaches need to be educated, studies show that health professionals also need to have an increased awareness of the risk of sudden cardiac death in young athletes for early recognition of heart problems during screenings. That includes asking the right questions, knowing the warning signs and helping the athletes develop prevention strategies. “Organizations like ENA want to step to the forefront and educate their members,” Vanhoy said. “The more we are made aware, the more likely we are to recognize, diagnose and appropriately treat it. Fewer young athletes are dying because we are more aware. It just takes that little bit of information and organizations like ours to make an impact.” References American Heart Association. (2011). Few doctors follow sudden cardiac death screening guidelines for athletes. Retrieved from http:// newsroom.heart.org/pr/aha/few-doctorsfollow-sudden-cardiac-217740.aspx. New Guidelines for Preventing Sudden Death in Athletes Announced. (2011). Retrieved from the Sudden Cardiac Arrest Foundation Web site: www.sca-aware.org/sca-news/new-guidelines-for-preventing-sudden-death-inathletes-announced. Ramnarace, C. (2011). 7 Ways to Protect Your Young Athlete from Sudden Cardiac Death. Retrieved from the EverydayHealth.com Web site: www.everydayhealth.com/hearthealth/0308ways-to-protect-your-youngathlete-from-sudden-cardiac-death.aspx.

Heart-Healthy Screening Programs for Young Adults By Kendra Y. Mims, ENA Connection Serious heart conditions aren’t usually associated with an active young person; however, there are young people who are participating in organized sports without realizing they have a life-threatening heart condition that can lead to sudden death. HCM is the No. 1 cause of sudden cardiac death in athletes under age 30, and the disease may not show any symptoms; therefore, a heart scan is important to determine any risks. The following are several organizations dedicated to saving young athletes from sudden cardiac death through raising public awareness, education, early detection and providing annual screening events:

A Heart for Sports: This cardiovascular screening program conducts free community-based cardiac screenings for high school and college athletes to prevent sudden cardiac death. AHFS provides the echocardiogram and an EKG to screen for the risks. It expanded its program to include

Teen Screen America, a membership program designed to partner with hospitals across the country, providing them with the necessary tools to host their own cardiac screening for young people.

Championship Hearts Foundation: Over the last 10 years, its Young Athlete’s Heart screening program has successfully screened more than 10,000 student athletes through collaborations with hospital facilities and cardiologists in the Austin, Texas, area and volunteers. Free heart screenings are offered to central Texas high school athletes to screen for HCM, which includes a 12-lead ECG, as well as a limited 2-d echocardiogram to detect HCM and other heart diseases. Screenings have also included AED demonstrations.

Hopkins Heart Hype Program: This year’s free screening event for young athletes will take place in July at the 2012 USATF National Junior Olympic Track & Field

Official Magazine of the Emergency Nurses Association

Championships at Morgan State University in Baltimore. Along with the Hopkins Heart Type 20-minute protocol, which includes weight and blood-pressure measurements, an EKG and an echocardiogram, more education will be provided this year for coaches, parents and students through AED classes and CPR classes. Athletes will go home with their Heart Hype Health passport, which tells them if their screening was normal or if they have to contact a physician immediately.

Playing With Heart: Barnabas Health, New Jersey’s largest health care system, designed this program to educate athletic directors, coaches, parents and athletes about symptoms and ways to help prevent sudden cardiac death. The program offers education sessions and cardiac screening events, which include preliminary cardiac testing to young athletes ages 12–17 in all competitive sports. The program also follows the American Heart Continued on page 27

Thoracic Aortic Dissection:

With New Pocket Resource, We’re Less Likely to Miss The death of actor John Ritter 8½ years ago brought thoracic aortic dissection into the mainstream conversation. Today, the bell-sounders for the disease are determined to make sure emergency care providers keep talking about it. Their latest effort is something you can hold in your hands: the recently released Pocket Guidelines for the Diagnosis and Management of Patients with Thoracic Aortic Disease—a boiled-down version of the full guidelines issued in March 2010 by the American College of Cardiology and the American Heart Association. A free copy will be mailed to any emergency nurse or other health provider who requests one. Simply visit the website of the Thoracic Aortic Disease Coalition (www.tadcoalition.org) and look for the request link at the bottom of the righthand column. For Luke Hermann, MD, a member of the TAD Coalition and the original ACA/ AHA guideline-writing committee, every attempt to boost awareness is vital. Of 100-125 million emergency department visits in the United States per year, only about 10,000 involve aortic dissection, the sudden tearing and separation of the aorta that killed Ritter in 2003. That’s only about one in every 10,000 patients. A full-time emergency health care professional might only see a case once every two or three years. “You might consider aortic dissection to be our defining illness,” said Hermann, an associate professor in the Department of Emergency Medicine at Mount Sinai Medical Center in New York. “In other words, you’ve got this disease that’s fairly uncommon, it’s rapidly fatal if it’s not diagnosed, it’s probably about the most lethal condition that’s out there, and yet if you Luke Hermann, MD identify the people who have it, they can often be treated successfully and live long, healthy, productive lives. If we can make these catches, these are tremendous saves.” Yet the track record for catches isn’t good, Hermann said. A person suffering from aortic dissection usually arrives at the emergency

printing the basic ACC/AHA points on something as inconspicuous as a mousepad, he said. Some emergency departments may look at the guidelines and consider updating their triage policies to include asking patients certain questions with aortic dissection in mind. Ultimately, it’s about knowing to check, and that’s everyone’s role. ‘‘Nowhere in medicine is this sort of team concept more true than the emergency department,’’ Hermann said. ‘‘So as much as we can try to get our emergency nurses to be aware of some of the high-risk features and look for those and let us know when they’re there, it can potentially make a dramatic save. And it’s kind of staggering, when you look at the numbers, just how poorly we’ve done. It’s not just our specialty—everybody doesn’t recognize this disease very well. It just Actor/comedian John Ritter, who died in 2003 from an aortic leads to a lot of high-profile misses.’’ dissection that was mistaken for a heart attack, has become Ritter, who was 54 when he died, was the familiar face of aortric disease awareness. the most famous example. There also have been numerous cases of younger people, department complaining of chest pain, back or including children, going undiagnosed and abdominal pain or stroke-like symptoms, which dying within hours. can steer emergency workers away from the ‘‘The biggest problem, from my perspective, real problem if they don’t think to screen for it. for aortic dissection is that people don’t Heart attack is a common misdiagnosis. consider the diagnosis,’’ Hermann said. ‘‘If The pocket guidelines reinforce what you’re the person on the front line in the ED Hermann calls the ‘‘risk tool.’’ First, there are who makes this diagnosis and saves some specific conditions to check for which 18-year-old kid from certain death, it’s got to automatically raise a patient’s risk for aortic feel pretty good.’’ dissection: Marfan Syndrome, Loeys-Dietz syndrome, connective-tissue disorders, recent arterial procedures, a family history of aortic dissection and other red flags. The next giveaway is the type of pain the patient is experiencing. If it’s sharp, severe and came on suddenly—the way 90 percent of aortic dissection patients describe their pain— that’s a cue to order up imaging studies that could lead to life-saving surgery. ‘‘It raises the potential for recognition for everyone downstream,’’ Hermann said. Finally, there are exam results that can point to possible aortic dissection: perfusion deficits, pulse-less limbs, pressure differences from one arm to the other. Hermann said the treatment pathways For your free copy of the ACC/AHA pocket outlined in the pocket guidelines would be guidelines, visit the TAD Coalition website, www.tadcoalition.org. Copies are made helpful to have posted in any emergency possible through an unrestricted grant from department, much like “Ritter Rules,” a set of W.L. Gore & Associates. reminders issued by the TAD Coalition in 2010 to improve detection. There’s been talk of John Ritter Foundation

By Josh Gaby, ENA Connection

February 2012

Amy Yasbeck, John Ritter’s Widow, Might Just Hug You By Josh Gaby, ENA Connection Several years ago, as actress Amy Yasbeck was developing her crusade against aortic aneurysm and dissection, she met with Dr. Anthony Estrera, a Houston-based cardiovascular surgeon and aortic specialist. He showed her a bar chart illustrating the number of surgeries that had been done to head off aortic dissection. In 2004 and 2005, there was an obvious spike. Instead of dying, people were finding out about their aortic conditions and getting them fixed. ‘‘I remember going, ‘Well, what is that spike?’ ’’ Yasbeck said. ‘‘And he said, ‘That’s John.’ ’’ For Yasbeck, the medical community and much of TV-watching America, there’s a tipping point when it comes to aortic disease, a clear before and after: pre-John Ritter awareness and post-John Ritter awareness, and the post era has been shaped in part by Yasbeck’s insatiable drive to arm and educate. She started the John Ritter Foundation for Aortic Health in late 2003, weeks after her famous husband’s shocking death, but the biggest surge of activity has come within the last two years. In 2010, she and Ritter’s family lent his name to ‘‘Ritter Rules,’’ designed to keep aortic disease in the front of health-care workers’ minds. That fall, she collaborated with leading aortic experts to launch the John Ritter Research Program in Aortic and Vascular Diseases at the University of Texas Health Science Center at Houston. There, scientists and physicians are pooling their expertise and discovering genetic markers that can indicate who needs to be screened for aneurysm and dissection and how often. She works closely with the Thoracic Aortic Disease Coalition, the promotional body created to equip health providers with sanctioned guidelines and treatment pathways. And then there’s Yasbeck’s 2010 memoir, With Love and Laughter, John Ritter. Don’t think she forgot to include Ritter Rules (Chapter 24). At its core, Yasbeck’s target is ‘‘the John Ritter thing.’’ That’s what the general public will know aortic dissection as. And if anyone can help keep awareness up, Yasbeck knows it’s the emergency nurses who speak everyone’s language. ‘‘So many lives have been saved by the nurses,’’ she said. ‘‘I’ve had people say that they came in with chest pain, that they were treated for, let’s say, indigestion or a back strain or something, and on the way out the door, a nurse will say, ‘Honey, I wouldn’t leave here without being tested for the John Ritter thing.’ Then all they do is send flowers to that nurse for the rest of their life. Name their babies after them. I mean, it’s crazy.’’ A pivotal, life-or-death moment might fall to

an emergency nurse asking about family history. “ ‘Do you have heart disease in your family?’ ‘No.’ But then if you say the words ‘aortic aneurysm,’ ‘bicuspid aorta,’ sometimes people go, ‘Yeah! Wait a minute! That! That thing! My brother died of that,’ or, ‘My sister had that,’ ’’ Yasbeck said. ‘‘It’s stunning how much is caught in that human moment of connection, which, to me, nobody does better than the nurses. ‘‘That human element that it takes to get the right information in the right way to the patient, that’s the nurse’s realm. I admire them. I love all the docs and all the scientists, but I know [emergency nursing] is where my work and the Ritter family work—that’s where that’s getting done. It’s so clear to me. ‘‘When I meet somebody who’s a nurse, I throw my arms around them. [They’re like], ‘Ayyy, OK, all right, ease up.’ And I’m like, ‘You don’t understand.’ That’s where my heart is.’’

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.

Official Magazine of the Emergency Nurses Association

From the Future of Nursing Workgroup:

Translating the IOM Future of Nursing Report to the Emergency Nursing Community By Patricia Kunz Howard, PhD, RN, CEN, FAEN The Institute of Medicine consensus report on The Future of Nursing: Leading Change, Advancing Health released on October 5, 2010, provided a compelling call to action for the Emergency Nurses Association. The report contained four key messages: • Nurses should practice to the full extent of

their education and training. • Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. • Nurses should be full partners, with physicians and other health-care professionals, in redesigning health-care systems in the United States. • Effective workforce planning and policymaking require better data collection and an improved information infrastructure. Recommendations specifically focused on the key messages included the following:

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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1. Removing scope of practice barriers. 2. E xpanding opportunities for nurses to lead and disseminate collaborative improvement efforts. 3. Implementing nurse residency programs. 4. Increasing the proportion of nurses with a baccalaureate degree to 80 percent by 2020. 5. D oubling the number of nurses with a doctorate by 2020. 6. E nsuring that nurses engage in lifelong learning. 7. P reparing and enabling nurses to lead change to advance health. 8. B uilding an infrastructure for collection and analysis of interprofessional health care. In response to this report, ENA rapidly implemented strategies to inform the members and determine next steps for the organization. Dissemination of this essential content was launched at ENA Leadership Challenge 2011 with a panel presentation led by 2011 ENA President AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN. Panel members included Diane Gurney, MS, RN, CEN, 2010 ENA president, and Michael Bleich, PhD, RN, FAAN, dean and professor of nursing at Oregon Health and Science University and a member of the original IOM workgroup. ENA approved the formation of a workgroup to address the organization’s response to this important and vital report. The workgroup charges include the following: develop standards for emergency nursing-specific content in higher education; provide recommendations for ENA’s public policy agenda regarding redesign in health care; provide recommendations regarding data collection and information infrastructure for emergency care; and complete a white paper specific to the Future of Nursing in relation to emergency nursing. Other actions taken by ENA include: • ENA provided its formal endorsement of the report to the Robert Wood Johnson Foundation, as this organization played an integral role in the report becoming a reality. • The 2011 General Assembly approved a resolution submitted by the ENA board of directors: Advancing the IOM Recommendations for the Future of Nursing. The ENA Future of Nursing workgroup is committed to translation of the report for members. This is the first in a series of articles intended to engage ENA members in the report’s actionable items that have direct relevance to emergency nursing.

February 2012

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READY OR NOT? |

Knox Andress, BA, RN, AD, FAEN

Got a Hazmat Situation? You Could Use a SPI What hazardous material experiences have you had during your emergency practice? Perhaps you’ve triaged a pediatric patient with skin irritations after a gasoline spill? Maybe you’ve cared for a patient with upperrespiratory symptoms resulting from a chlorine exposure after mixing cleaning chemicals or irrigated the eye of an auto mechanic after a battery-acid splash? How about the patient who has ingested the organophosphate, overdosed on barbiturates or experienced a pit viper envenomation? What do you think of as a ‘‘hazmat,’’ and how many hazardous materials are in your home, hospital or community? The American Academy of Clinical Toxicology and the University of Arizona Emergency Medicine Research Center’s Advanced Hazmat Life Support course defines a hazardous material as ‘‘any substance (solid, liquid, or gas) capable of harming people, property or the environment.’’

Hazmat Incidents to the Emergency Department Hazmat exposures presenting to the emergency department can come from characteristic environments or situation scenarios. Broadly speaking, hazmat and poisoning incidents can be classified as work-related, non-work-related or perpetrated/terrorism. Occupational or workplace exposures occur from chemicals and hazmats experienced in the workplace environment, including those in fixed facilities or occurring during transport. On November 29, a chemical leak at a Wisconsin food-processing plant caused its evacuation and sent two people to the hospital after cleaning chemicals were improperly mixed. On December 19, www.Click2Houston.com reported that a half-gallon of formaldehyde spilled near the emergency department within St. Joseph’s Hospital, Houston.1 What hazmats are in your hospital, and are you ready to safely respond if and when they spill? Non-occupational hazmat exposures are related to hazards occurring in non-work-related environments such as the home or recreational venues. On December 4, the CBS affiliate in Philadelphia reported that approximately 200 people sought medical treatment after a hazmat traced back to a high school during a

ENA member and Louisiana Poison Center employee Kelly Baker, BSN, RN, with Mark Ryan, PharmD, the Center’s director.

HEROES REQUIRE THE RIGHT ATTIRE Disaster Man shirts available now at the ENA Marketplace, www.ena.org/store

cheerleading competition.2 Terrorism-related exposures are perpetrated, with additional implications for casualties to responders, as perpetrators seek to cause harm, damage and frighten or terrorize using a hazardous material component. On January 3, The Palm Beach Post reported that three people were decontaminated and taken to Good Samaritan Medical Center with headaches and vomiting after a ‘‘white powder’’ incident at the Palm Beach State Attorney’s office.3 The ‘‘anthraxlike’’ incidents continue, but until confirmed otherwise, they require a safe and appropriate response by medical and other providers.

Potential management challenges for hazmat exposures include decontamination issues, clinical management/treatment and information sharing or medical intelligence. Enter the Poison Control Center.

Your Resource: The Poison Control Center An easily accessible, 24/7 expert resource for information and medically managing hazmat exposures/poisonings are the 57 poison-control centers found in the United States and U.S. territories. Poison-control centers are typically led by toxicologists with specially trained pharmacists and registered nurses certified as specialists in poison information. Poison Center SPIs are ready to provide guidance for definitive treatment whether a toxin was inhaled, ingested, absorbed, or injected by an insect or animal bite. The American Association of Poison Control Centers’ 2010 Annual Exposure Report from the National Poison Data System stated that 3.9 million calls were made to poison-control centers nationwide, nearly 11,000 a day.4 The

February 2012

2010 report also highlighted near-real-time data collection roles by poison centers in public health and disaster response by documenting usage during the 2010 oil spill in the Gulf of Mexico. Poison centers also have been tracking emerging designer amphetamines (bath salts) and marijuana (Spice, K2). Findings in the 2010 report included the following: â&#x20AC;˘ About 75 percent of all calls to poison centers came from home. â&#x20AC;˘ About 71 percent of the 2.4 million people who called with poison emergencies were treated at home, saving millions of dollars in medical expenses. â&#x20AC;˘ The top five substances most frequently involved in human poisonings were analgesics (11.5 percent); cosmetics/personal care products (7.7 percent); household cleaning substances (7.3 percent); sedatives/ hypnotics/antipsychotics (6 percent); and foreign bodies/toys/ miscellaneous (4.2 percent).

Largest Hazmat: B.P. Gulf Horizon The 2010 B.P. Gulf Horizon catastrophe in the Gulf of Mexico created the nationâ&#x20AC;&#x2122;s largest hazmat via the oil spill and subsequent dispersants used in the cleanup efforts. Mark Ryan, PharmD, the Louisiana Poison Center director, reported that â&#x20AC;&#x2DC;â&#x20AC;&#x2DC;significant public health questions were posed by state and federal leadership who needed to know the immediate health impacts on the population exposed or potentially exposed to the hazmats.â&#x20AC;&#x2122;â&#x20AC;&#x2122; The Louisiana Poison Center was a conduit for medical intelligence and became an immediate resource as calls from emergency departments, physician offices, work locations and residences reported exposures or potential exposures. Information was immediately, almost real-time, shared with the National Poison Data System and our federal and state public health partners, providing critical situational awareness for effective response planning.

Call Your Poison Control Center Hazardous material events occur in the occupational setting, at home, and can be perpetrated as the result of a terroristic act. The toxic agent may be known or unknown, and clinical management or medical treatment protocols may vary. When in doubt, call the experts at your poison control center at 800-222-1222.

Readers may contact the author at wandr1@lsuhsc.edu. Follow Knox Andress @ENAdman.

Official Magazine of the Emergency Nurses Association

References 1. w ww.click2houston.com/news/Emergency-room-evacuatedafter-formaldehyde-leak/-/1735978/6097138/-/format/ rsss_2.0/-/v74w6wz/-/index.html. 2. p hiladelphia.cbslocal.com/2011/12/05/hazmat-situation-atfather-judge-high-sends-people-to-hospital/ 3. w ww.palmbeachpost.com/news/crime/authoritiesinvestigating-possible-white-powder-incident-at-state-2076676. html?cxntcid=breaking_news. 4. w ww.aapcc.org/dnn/Portals/0/News%20Release%202010%20 Annual%20Report.pdf.

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ENA Launches Tool to Help You Maximize Your Leadership Conference Schedule New for ENA Leadership Conference 2012 is an online tool designed to help you plan which sessions you would like to attend and maximize your time at the conference. You will be able to view the full conference schedule, session content—such as learning objectives and contact hours—and plan sessions to attend. This tool also will be updated with session room changes. In addition, this same tool will track your CNE contact hours. You can download your schedule to your Outlook, Entourage, Yahoo or Google calendar. To learn more about the new online scheduler visit www.ena.org, click on the conference logo and then click on the “Conference Planning” link. Please note: Using the scheduler does not guarantee you a seat in the sessions you have chosen. If there is a particular session you really want to attend, plan to arrive early, as seating is on a first-come, first-served basis. Standing or sitting in the aisles or on the floor is not permitted.

Deb Zirkle, ENA Director of Online Services

… For Tips and Information on Leadership Conference in New Orleans In January, ENA launched the “Live from New Orleans” blog. Join us as we begin our countdown to Leadership Conference 2012 with real-time weather updates, information on local attractions and useful tips. Are you a native of New Orleans? Now is the time to share your experiences and pride regarding your favorite places for music, food and local culture. Let everyone know about that special off-the-beaten-path restaurant with excellent jambalaya or your favorite French Quarter café by posting your comments to the blog. Our ENA member blogger, Alison Day, MSc, RN, will be offering her insight on New Orleans as well. While browsing the blog, be sure to read her bio.

Once you’re onsite in New Orleans, continue to check the blog several times every day to find out about: • The State Leaders Conference • The networking reception • The ENA Foundation’s exclusive event, ‘‘Masked on the Mighty Miss’’ • General and concurrent sessions • The ENA Candidates Election Forum And don’t be shy – we want to hear about your experiences, too. Leave your comments as you enjoy the conference and New Orleans. Did you get over to Café Du Monde for beignets? Tell us! Or share the spot you found for crawfish, jazz or to just relax and network with friends.

Be sure to check out the daily videos of your colleagues as they share their personal thoughts about the conference. And don’t forget to look for yourself in the photo gallery. We’ll keep it updated daily with photos of attendees doing what they do best: networking, learning and having fun! Your trip to Leadership Conference 2012 in New Orleans begins now by following the blog at www.ena.org/lcblog. See you in New Orleans!

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

February 2012

OCTOBER 1,

2013

Official CMS Industry Resources for the ICD-10 Transition

www.cms.gov/ICD10

NOMINATIONS COMMITTEE |

Scott E. Stover, MSN, MBA, RN, ACNS-BC, CEN, Nominations Committee, Region 2

Facebook and the Election Process:

Let’s Be Friends There are many exciting changes to the ENA National Candidate Publicity and Campaigning policy, which was revised in September 2011. One of the biggest changes is that candidates and members may use e-mail and social media for campaigning and support of candidates. Candidates may e-mail other ENA members to support their campaign. ENA members are permitted to e-mail other members to support candidates. However, no member of the ENA board of directors, ENA national office or the ENA Nominations Committee is permitted to endorse any candidate at any time. Please be aware that the use of ENA membership lists (national, state, local or regional) for campaigning is strictly prohibited. It is important to remember that no e-mail is private. Your message can be forwarded to other members or individuals outside of ENA. What about social media? Did you know that if Facebook were a county, it would be the world’s third largest? There are more than 750 million users on Facebook. It has been said that 22 percent of our time online now is spent on

social networking. The power to reach huge numbers of people is obvious. Forty-four percent of ENA state councils have Facebook pages, as do many local and regional chapters. In an effort to support this new use of social media, ENA is encouraging candidates to use ENA’s Facebook page for campaigning activity. Access this page from www.ena.org. Each candidate’s demographic information will be linked from ENA’s Facebook page. ENA has more than 14,400 Facebook fans and almost 1,300 followers on Twitter. According to Facebook, the average user has 130 friends. When a candidate posts a message on ENA’s Facebook page, not only will the 14,400 plus fans see it, but those fans can share that comment on their state council’s Facebook page, who can then share it on their members’ Facebook pages, who can then share it with their friends. When you add in the 200 million users on Twitter and the 100 million users on LinkedIn, you have unprecedented access to ENA members around the globe. The biggest risk in this new process is that neither ENA nor the candidates will have control over others’ e-mail messages or social

networking posts. It is ENA policy that all candidates and non-candidates conduct themselves and campaigns in an honest and ethical manner. There should never be a case of negative or derogatory campaigning and/or comments. The Nominations Committee hopes that by adding the ability to campaign through e-mail and social media, the members will have access to the candidates, will ask questions of the candidates and voter interest and participation will be increased in the organization. To review ENA’s campaigning policy, go to www.ena.org and click on the ‘‘About ENA’’ tab and ‘‘Elections.’’

References Nielsenwire. (2011.) Social Networks/Blogs Now Account for One in Every Four and a Half Minutes Online. Retrieved from blog. nielsen.com/nielsenwire/global/social-mediaaccounts-for-22-percent-of-time-online/. Socialnomics. (2011.) Social Network User Statistics. Retrieved from www.socialnomics. net/category/statistics/.

ENA Call for…

2012 Proposed Bylaws Amendments and Resolutions Submission Deadline: March 2, 5 p.m. CST The ENA General Assembly meets yearly before the start of the ENA Annual Conference to determine official association policy and positions by reviewing, debating and voting on proposed bylaws amendments and resolutions. Bylaws amendments may be proposed by the board of directors, state councils, association chapters or five active members of the association. Resolutions may be submitted by any active ENA member. Others who may submit resolutions include the ENA board of directors, state councils, chapters, the Journal of Emergency Nursing editorial board and ENA committees. The Resolutions Committee is charged with helping ENA members develop proposed bylaws amendments and resolutions. If you are interested in bringing a proposed bylaws amendment or resolution to the 2012 General Assembly, please contact Kari Zick, Resolutions Committee staff liaison,

at componentrelations@ena.org or 847-460-4092 to obtain assistance from the Resolutions Committee. All proposed bylaws amendments and resolutions must be submitted in the proper template form and must follow the format as outlined in the Resolutions and Bylaw Guidelines (newly revised). The Resolutions and Bylaw Guidelines and proposal templates are available at www.ena.org in the General Assembly area under the Bylaws and Resolutions Process section. Final submissions must be submitted to ENA headquarters, attention: Kari Zick, via e-mail to componentrelations@ena.org by 5 p.m. CST, March 2. Formal consideration of proposed bylaws amendments and resolutions will occur at the 2012 General Assembly, September 11-13, in San Diego.

February 2012

MESSAGE FROM THE CHAIRPERSON | Laura Giles, BS, RN

The ENA Foundation:

What’s In It For You? Hello. My name is Laura Giles, and I am excited to be the 2012 ENA Foundation chairperson. I have served on the ENA Foundation Board of Trustees for three years and learned what an honor it is to volunteer for our very own emergency nursing foundation. The mission of the ENA Foundation is to provide educational scholarships and research grants in the discipline of emergency nursing. The ENA Foundation accomplishes that mission by raising funds through various fundraising campaigns and events throughout the year. Thanks to the generous donations received from ENA members, friends of emergency nursing and our corporate partners we are pleased to offer more than $235,000 in scholarships and research grants to emergency nurses this year. Since its inception in 1991, the ENA Foundation has increased the number of scholarships and research grants available from year to year. As the new chairperson of the ENA Foundation I want to address some of the concerns we recently heard from a member focus group and survey. The issues raised made me wonder if other members had the same questions.

What does the ENA Foundation do? I can answer that in one sentence by providing the mission of the ENA Foundation but that doesn’t seem to say enough. Let me summarize it by saying, “The ENA Foundation exists to support you, the ENA member in meeting your personal academic and continuing educational goals and to fund research relevant to you in our daily practice as emergency nurses.” Are you seeking your baccalaureate in response to market pressures that hospitals are exclusively hiring BSN graduates? The ENA Foundation can make a difference in supporting your return to school. Are you planning to advance in your career by seeking a master’s or doctorate? The ENA Foundation is there to financially support your academic education or research. Do you hate having to fill out forms to assess falls, pressure ulcers and suicidal risk that do not seem to have any kind of clinical foundation, seem like busy work and that do not result in improved patient care? Research by emergency nurses to develop streamlined tools with relevance to daily practice is supported by the ENA Foundation.

Why should I donate to the ENA Foundation? Donating to a cause is very personal. Sometimes we give because we have been personally affected by a disease such as breast cancer or an event such as the September 11 terrorist attacks. Sometimes we give to get something in return such as a tax deduction or gift. Some people give because they value what an organization does to make a difference. Regardless of the original motivation, donors carefully select where their money goes based on their individual criteria. For me, being a member of ENA and personally supporting my professional life through the ENA Foundation is the most compelling reason. As a manager for more than 25 years, one of the things I look for on a resume or in an interview is evidence that there is a “life of the mind” in the RN being interviewed. When I ask a prospective nurse, “How do you keep current in your profession?” and am told, “I read the (free) magazines that are sent to me or I surf the Internet,” I am not impressed. Learning must be lifelong. Nurses are knowledge workers and the commitment to continued learning is not evidenced by reading throwaway publications or web-surfing. The ENA Foundation has supported learning and research for more than 20 years.

How are my donations used?

scholarships and grants to be awarded annually. In 2012 the ENA Foundation will address these questions more publicly through a new Web site, direct mail and testimonials from scholarship and grant recipients. We want to meet and exceed our members’ expectations and promote education and research in the field of emergency nursing. Contact a member of the ENA Foundation board of trustees (listed below) or staff if you have any questions. If you would like to make a donation to the ENA Foundation, please go to www.enafoundation.org.

ENA Foundation 2012 Board of Trustees Laura Giles, BS, RN (New York) – Chairperson Julie Jones, BS, RN, CEN (South Carolina) – Chairperson-elect Jackie M. Taylor-Wynkoop, RN (New Jersey) – Secretary Beth A. Broering, MSN, RN, CEN, CPEN, CCRN, FAEN (Tennessee) – Past Chairperson Seleem Choudhury, RN, CEN (Colorado) – Member Trustee Thelma Kuska, BSN, RN (Illinois) – Member Trustee

ENA Foundation Corporate Trustees Ken Craig, Physio-Control, Inc. Steve Dralle, Vidacare Jim McCoy, GE Healthcare Teri Nobbe, Hill-Rom Don Payerle, Stryker John Proctor, MD, MBA, FACEP, FAAP – Emergency Medicine Foundation Representative

Focus group members wondered if the ENA Foundation is a good steward of their donations. Some charities spend a significant amount of their resources in fund raising with a small portion going to the programs. I am honored to say every year the ENA Foundation disperses 100 percent of the funds raised from the previous year’s State Challenge Campaign National Conference for toward scholarships and research grants. In Workplace Violence addition, the ENA Prevention & Management Foundation’s in Healthcare Settings administrative costs are 14 percent, much lower Cincinnati, OH • May 11–13, 2012 than the national average. The ENA To learn more visit Foundation management https://webapps.uc.edu/conferencing/Details.aspx?ConferenceID=426 board, board of trustees and staff focus on keeping expenses low to allow a larger number of

Official Magazine of the Emergency Nurses Association Workplace Violence Conference Ad.indd 1

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Spotlight on

Member Benefits and Resources

New ENA Position Statement New Content Available

ENA Career Center: Your Path to Lifelong Career Success

ENA develops position statements on key topics affecting emergency nursing practice and health care trends. Visit www.ena.org/IQSIP to see the latest one on Triage Qualifications.

As a job seeker, you may search for jobs and receive an automatic e-mail notification of new listings. Post your résumé and make it available to top-notch employers in the industry. As an employer, you may post openings and review a

deep pool of qualified talent. It showcases more than 200 health care associations and professional organizations with the National Healthcare Career Network and provides personalized career guidance. Visit the new ENA Career Center at www.ena.org.

ENA Member Savings Opportunities 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.” Be sure to log in to see the details.

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.

Now Available: Emergency Nursing: Scope and Standards of Practice The American Nurses Association has recognized emergency nursing as a specialty and approved the scope and standards of practice laid out within the book. The 2011 Emergency Nursing Scope and Standards of Practice is updated to reflect current standards and best practice for use in developing training and departmental policies and procedures. Visit www.ena.org/shop to order your copy today.

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.

Applying Research Guidelines Continued from page 3 2 010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. Circulation 2010, Nov 2; 122-S639. my.americanheart.org/professional General/Survival-vs.-functional circ.ahajournals.org/content/early/2010 Regional Systems of Care for Out-of Hospital Cardiac Arrest. A Policy Statement from the American Heart Association. Published online January 14, 2010, in Circulation, Journal of the American Heart Association.

February 2012

Heart Healthy Screening

Continued from page 15

Association’s recommended screening guidelines. Along with physical examination at the screening events, the program provides EKG testing and immediate results analysis to young athletes and their families to help identify who will need further evaluation.

Young Hearts for Life®: Developed by the Midwest Heart Foundation, this cardiac screening program brings experienced medical volunteers to high schools to provide free ECGs to identify

students who are at risk. Midwest Heart Foundation’s collaboration with high schools, community hospitals and volunteers has resulted in more than 62,000 free ECG screenings for high school students since 2006; through the program, more than 1,300 families have been notified of screening ECG results that needed further evaluation. According to Midwest Heart Foundation’s website, YH4L is the largest cardiac screening program in the U.S. for the prevention of sudden cardiac death in teens and young adults.

References abcnews.go.com/Health/HeartDi easeNews/story?id=4933037&page=2 www.hopkinsmedicine.org/heart vascular_institute/clinical_services/ centers_excellence/hcm_heart_ screening.html www.championshipheartsfoundation.org/ www.midwestheart.org/home aheartforsports.org/index.html www.barnabashealth.org/playing withheart/about.html

Letter From the Executive Director Continued from page 4 Plan, which is now available at www.ena.org. The plan begins a three-year cycle that leads with research, development, alignment and investment, follows with implementation and concludes with evaluation, revision and sustainability. This journey includes development and enhancement of strategic partnerships; exploration, development and revision of innovative and essential educational opportunities; increasing member engagement through social media; promoting a culture of philanthropy; and the generation, translation, integration and dissemination of research and successful practices. The Strategic Plan includes four priority areas: (1) advancing emergency care at home and abroad; (2) advocating for a culture of safe practice and safe care; (3) championing for a culture of inquiry, learning and collaboration within our profession; and (4) expanding and fortifying ENA’s membership. The success of these four strategic priorities require the courage of the ENA board of directors and association members, in partnership with ENA staff, to invest time, talent and treasure to provide for continued growth and success as the “go-to” organization that leads the emergency care industry. The ENA 2012-2014 Strategic Plan is designed to align with the science of culture change, which also typically follows a three-year cycle—planning, implementing and evaluating. Using this Strategic Plan as a blueprint, we are the right professionals, poised at the right time, with the right talents for innovation and partnership to move our organization from “great to greatest.”

Official Magazine of the Emergency Nurses Association

ENA STATE CONNECTION Massachusetts ENA State Council Submitted by Maureen Curtis Cooper, RN, BSN, CPEN, CEN, FAEN The Massachusetts ENA presented the 2011 Nursing Excellence Awards at its November 16 meeting. Julie Bunn, RN, BSN, CEN, of North Shore Medical Center Emergency Department, received the Nurse Educator Award. This award honors an emergency nurse who has made significant contributions to the education of colleagues, nursing students, EMS personnel, patients and families. She goes above and beyond in her nurturing and support of both fellow nurses and newly licensed nurses. In addition to her role at North Shore Medical Center, Bunn is active teaching trauma nursing and pediatric emergency nursing skills to emergency nurses across Massachusetts. Kathleen Walz, RN, BSN, of Boston Medical Center Pediatric Emergency Department received the Nurse Practice Award. This award honors an emergency nurse who exemplifies outstanding nursing practice as demonstrated through clinical skills, nursing care and compassion. As a pediatric nurse, Kathleen Walz exhibits compassion and expertise toward both the child and the caregiver. At Boston Medical Center, she developed and implemented the Pieces of Home—The Backpack Project. This program gives every child being placed into the emergency foster-care system a new backpack filled with age-appropriate pajamas, socks, underwear, a blanket and age-appropriate toy/ personal item to take to his or her emergency foster home. Laurie Raymond, BSN, RN, CEN, of Good Samaritan Medical Center, received the Nurse Manager Award. This award honors an emergency nurse manager who consistently demonstrates excellence in the profession of emergency nursing, leadership skills, a high level of professional behavior and has made significant contributions in the area of emergency nursing management. Raymond was instrumental in developing a psychiatric patient care resource manual that included standing orders and documentation guidelines, which has been shared with many other emergency departments. She developed and implemented a new graduate orientation program for the emergency department. Robin Walsh, RN, BSN, CEN, nurse manager at the University of Massachusetts Health Services, received the Behind the Scenes Award. This award recognizes an individual who consistently supports Massachusetts ENA without the expectation of reward or recognition. This individual has given significant

contributions to MENA through donation of time, energy and effort. Walsh’s organizational expertise makes her an ideal partner for conference planning, lecture writing, manuscript production and other projects. She is an invaluable source of wisdom, strength and motivation.

Minnesota ENA State Council Submitted by Jeff Nordlinder, BA, RN, CEN, and Bruce Olson, BAN, RN, CEN During Emergency Nurses Week 2011, the Greater Twin Cities Chapter of ENA held its 36th annual Cornerstones in Emergency Nursing Conference on October 12-13 at the Como Zoo and Conservatory in St. Paul,. Participants enjoyed two full days of learning that included lecture, breakout skills stations and zoo exploring during breaks. The conference was more interactive this year and included a great lecture on wilderness medicine, learning different first-aid techniques when you are out in the deep wilderness. We also held a networking session on Emergency Nurses Day at Caffe Latte in St. Paul for conference participants. The Greater Twin Cities Chapter also held its election this past October and received a 12.5 percent voter turnout. The chapter worked closely with the Minnesota ENA State Council to sponsor and pass two resolutions at the General Assembly in Tampa in September 2011. Kudos to the group! The chapter is planning an exciting 2012 with more interactive and Internet-based learning to include Certified Emergency Nurse and Certified Pediatric Emergency Nurse reviews and working with Minnesota ENA State Council to launch more public-service announcements on Minnesota public radio.

LVADs and how they function to improve the health of heart failure patients. Colin Campbell, DVM, CPM, the deputy state public health veterinarian from the New Jersey Department of Health, gave a very informative lecture, Everything You Wanted to Know About Rabies Post-exposure Consultations. He discussed its prevalence and current prophylaxis standards. The nurses posed many questions to Campbell, as rabies continues to be of major concern to all health workers as well as the public. Mary Kamienski, PhD, APRN, CEN, FAEN, associate professor at UMDNJ School of Nursing, did an extensive lecture/PowerPoint presentation on When Kids Break Bones— Pediatric Orthopedic Injuries, discussing major pediatric orthopedic injuries that befall our children each year and what we can do to prevent them from occurring. Cheryl Newmark, MSN/Ed, RN, chairperson of the Social and Morale Committee in the Emergency Department at Morristown Medical Center, presented an uplifting presentation on How to Start a Social and Morale Committee in Your ED, including several ideas for raising staff morale in our very busy emergency departments. The New Jersey ENA State Council spring education day will be March 14-16. Please see details are in the Events section.

New Jersey ENA State Council Submitted by Cheryl Newmark, MSN/Ed, RN The New Jersey State ENA Northern Chapter held its annual Winter Education Day December 8, 2011, at the Dorothy B. Kraft Center at Valley Hospital in Paramus, New Jersey. Nurses from all over the state joined the chapter for this free education day for all NJ ENA members. The Northern Chapter requested that each member bring a piece of clothing, which was collected and distributed to St. Lucy’s Shelter in Jersey City. Four speakers presented their knowledge and expertise. Ray Bennett, BSN, RN, CEN, CFRN, NREMT-P, discussed Iron Men: Insight to the Care of Heart Failure/LVAD, speaking about the

State Council and Chapter Meetings and Events New Jersey ENA State Council The 34th Annual New Jersey State ENA Emergency Care Conference will be held March 14-16, at the Tropicana Hotel and Casino in Atlantic City. Nurse attendees and exhibitors may register at www.njena.org. Please e-mail Cheryl Newmark (Exhibits Committee) at cgnrn75@yahoo.com for more information.

February 2012

Build a Foundation for ED Performance Improvement

Information. Statistics. Metrics. Facts. Figures. Numbers. Records. Data. “It” goes by many names; but regardless of what you call it, what are you doing with it? May we suggest: Collect it. Compare it. Harness it.

Are you looking to gain insight into your emergency department operations? ENA and McKesson have joined together to bring you the ED Benchmarks Collaborative™ (EDBC), a tool specifically designed to help EDs across the country improve performance and create a culture of excellence. Now more than ever, immediate access to the enterprise intelligence needed to identify trends and provide key performance data is imperative to ED leaders — those charged with the increasing need to improve care and reduce costs. ED Benchmarks Collaborative is a vendorneutral healthcare business intelligence solution and emergency department benchmarking service provided by McKesson in partnership with the Emergency Nurses Association®.

ED Benchmarks Collaborative offers: – Key performance indicators (KPIs) in two categories: throughput and productivity – User-customizable dashboards and in-depth reporting – Web-based technology with no special software or hardware required Learn how this tool can assist your emergency department. Register today for a free, informational web seminar at http://sites.mckesson.com/ edbc/webinars.htm.

BOARD HIGHLIGHTS | December 2011

Board Meeting Actions and Highlights The ENA board of directors met December 8-9, 2011, at ENA headquarters. All members of the board of directors were present. The board took the following actions: • Reviewed, discussed and finalized the 2012-2014 ENA Strategic Plan. • Approved the 2011 General Assembly minutes as presented. • Approved the 2012 operating and capital budgets as presented. • Approved holding one national ENA conference per year starting in 2015. • Charged a group of staff and board members to explore options for hosting a gathering of state leaders at the national office. • Established an emergency nurse practitioner portfolio validation program. • Approved collaboration with the Emergency Medical Services Corporation regarding development of a pediatric interfacility transfer toolkit. • Approved board governance policy 1.01, ENA Governance Structure, as presented. • Approved board governance policy 1.02, Whistleblower Protection, as presented. • Approved board governance policy 4.01, Committee Selection and Appointment Process, as amended. • Approved board governance policy 6.05, External Liaison Collaborations

and Liaison Assignments, as presented. • Approved the following consent agenda items: - Approved the September 20 board of directors meeting minutes as written. - Approved the Executive Committee actions report as presented including: - An invitation to attend the American Academy of Pediatrics Committee on Pediatric Emergency Medicine meeting, December 2-3, 2011, in Catalina, Arizona. Sally Snow, BSN, RN, CPEN, FAEN, represented ENA. - An invitation to attend the American College of Emergency Physicians board of directors meeting during its Annual Meeting, October 15-18, 2011, in San Francisco. AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN, Gail Lenehan, EdD, MSN, RN, FAEN, FAAN, and Sue Hohenhaus, MA, RN, CEN, FAEN, attended and provided an update on ENA activities. - An invitation to speak at the American Society of Association Executives Healthcare Associations Conference, November 7-8, 2011, in Baltimore. AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN, represented ENA as a panel speaker. - An invitation to attend the American Society for Healthcare Risk Management Annual Conference, October 16-19, 2011, in Phoenix. AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN, represented ENA as a speaker. - An invitation to participate in the Association for Addiction Professionals Hospital SBIRT project as a member of the senior advisory board. Cydne Perhats, MPH, will represent ENA. - An invitation to the Behavioral Health Assessment Standards Stakeholders meeting, October 3, 2011, in Washington, D.C. AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN, and Cydne Perhats, MPH, represented ENA. - A request to attend the Emergency Medical Services Authority Hospital Incident Command System’s National Summit, October 11-12, 2011, in Sacramento, California. Judy Scott, MHA, RN, represented ENA. - An invitation to attend the Nurses Service Organization advisory board meeting on November 3-5, 2011, in Savannah, Georgia. Dale Wallerich, MBA, RN, CEN, represented ENA. - An invitation to attend the Nursing Organizations Alliance Fall Summit, November 17-19, 2011, in Miami. Gail Lenehan, EdD, MSN, RN, FAEN, FAAN, JoAnn Lazarus, MSN, RN, CEN, Diane Gurney, MS, RN, CEN, and Sue Hohenhaus, MA, RN, CEN, FAEN, attended. Diane Gurney spoke at the summit’s breakout session. - An invitation to attend the Royal College of Nursing Emergency Care Association, November 11-12, 2011, in Birmingham, United Kingdom. AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN, and Gail Lenehan, EdD, MSN, RN, FAEN, FAAN, represented ENA. • Approved 2012 signatory changes on ENA’s bank accounts as presented. • Approved the audit firm for 2011-2013 as presented. • Approved renewal of the ENA-American Psychiatric Nurses Association reciprocal agreement for 2012 as presented. • Approved the list of position statements slated for revision in 2012 as presented. • Ratified the 2012 ENA Foundation board of trustees officers as presented.

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