ENA Connection March 2012

Pages 3, 8-11, 18, 23

The Ongoing Effort to Define the Safest Paths in Transport Nursing

Getting There

the Official Magazine of the Emergency Nurses Association

connection March 2012 Volume 36, Issue 3

Dates to Remember March 2, 2012 Submission deadline for 2012 bylaws proposals and resolutions.

March 19, 2012 Submission deadline for proposals for faculty presentations at Leadership Conference 2013 in Fort Lauderdale, Fla. April 30, 2012 Application deadline for mentees in 2012-2013 AEN Eminence Program.

ENA Exclusive Content PAGE 10 Members Bring Focus to Practice of Helicopter Shopping PAGE 12 Code You: Six Ways to Deal With Compassion Fatigue and Burnout PAGE 13 Tired of Feeling Fatigued? Here’s How Your Organization Can Help PAGE 15 Celebrating the Work of Emergency Nurses PAGE 18 Improving the Safety of Children During Interfacility Transfers PAGE 20 AEN Eminence Program

Monthly Features PAGE 3 Letter from the President PAGE 4 Sue’s Views: Letter from the Executive Director PAGE 5 ENA Foundation PAGE 6 Washington Watch PAGE 8 Pediatric Update PAGE 14 From the Future of Nursing Work Team PAGE 16 Ready or Not? PAGE 19 Nominations Committee PAGE 21 Member Benefits and Resources PAGE 22 State Connection

LETTER FROM THE PRESIDENT | Gail Lenehan, EdD, MSN, RN, FAEN, FAAN

Advocating for Safe Care, on the Ground and in the Air In 1970, the Emergency Department Nurses Association was founded. Just 15 years later, in 1985, the association changed its name to the Emergency Nurses Association in recognition that the practice of emergency nursing is role-specific, rather than sitespecific. ENA’s leaders understood that emergency nurses were working well beyond the walls of the hospital. They also were working in the backs of ambulances on the highways and streets of our country and flying through the skies in helicopters and transport aircraft. In other words, they were performing their job wherever their patients were in need of their care.

Emergency nurses transporting patients work in unique circumstances that few can fully understand, with an inherent level of risk above and beyond the usual dangers associated with emergency nursing.

They climb into helicopters, planes and ground vehicles, travel in what are often less-than-ideal conditions and provide critical care in the most adverse of circumstances, without the reassuring presence of all the onsite backup we take for granted: other nurses, physicians, respiratory therapists, pharmacists, security guards and more. They are alone with their patient, for whom they mean the difference between life and death.

ENA recognizes the high level of commitment and dedication of these emergency nurses, and we are working to support them. For example, at the 2010 General Assembly in San Antonio, Janice McKay, RN, CEN, CFRN, 2012 president of the Virginia ENA State Council, brought forth a resolution that promotes a safe culture for air medical transports and discourages the practice of ‘‘helicopter shopping.’’ Helicopter

PAGE 23 Board Writes

shopping is defined as making sequential calls to several air medical-service providers to transport a patient, without communicating the fact that a previous air medical service declined the call because of inclement weather or other safety issues. (For more information about helicopter shopping, see page 10 of this issue.)

The resolution passed the 700-member General Assembly overwhelmingly, and last year, ENA and the Air and Surface Transport Nurses Association issued a joint consensus statement on the dangerous practice of helicopter shopping. There is more work to be done. ENA continues to work with the Air and Surface Transport Nurses Association and to engage other organizations in promoting a culture of education and communication. We need to ensure that air medical transport teams have all the information necessary to make fully informed decisions and are not placed in harm’s way.

Defining, identifying and advocating for a culture of safe practice and safe care is an organizational priority of ENA’s 2012-2014 Strategic Plan. (See plan details at www.ena.org.) Key points of this plan include developing strategic practice partnerships; recognizing, supporting and promoting exemplary emergency nursing practice; proactively identifying and addressing key clinical issues affecting emergency health care; and promoting best practices for emergency nurses.

Emergency nurses, like those pictured below this editorial, provide extraordinary care to patients, and ENA is committed to honoring that dedication by promoting a culture of safety for all emergency health care professionals, wherever they practice.

Other Connection Cover Contest Entries

PAGE 23 Click Here PAGE 24 Course Bytes

About the Cover Photo Aircare 3, based in Redwood Falls, Minn., is part of North Memorial Air Care, which has five air medical teams in Minnesota. Pictured are (top four, from left): Andrew Kitzberger, BSN, CEN, NREMT-P; Kayla Swanson, BSN, CEN, CFRN, CPEN; Kristi Laurel, RN, CFRN; Sandra Turbes, BSN, CFRN, CEN; (lower level, from left) Larry Weidell, pilot; Tony Karels, NREMT-P; Gary Zvorak, NREMT-P; John Richardson, RN, NREMT-P; Shayne Tabor, pilot; Sandra Bushey, RN; Bonnie Shay, RN; Billie Sell, NREMT-P, FP-C; Dan Johnson, RN; Mark Slettum, NREMT-P, RN; Scot Peterson, NREMT-P; Jon Leedahl, pilot.

Official Magazine of the Emergency Nurses Association

The Englewood (N.J.) Hospital and Medical Center’s Specialty Care Transport Unit, from left: Doug Williamson, RN, NREMT-P, CTRN, CPEN; and ENA members Tim Thoman, RN, NREMT-P, CEN, CPEN; Maj Dennis Castro, BSN, RN, senior flight nurse, U.S. Air Force Reserve; Thomas J. Butler, MSN, RN, CEN, MICN; Joe Reissner, RN, MICN, CPEN; Denise Arzoomanian, MSN, RN, CEN, MICN; Vince Froncek, RN, NREMT-P, CEN, CFRN. Not pictured: Cris Amato, RN; Karl Brennan, RN; William Vaughn, RN; Tom Sullivan, RN; Raul Montes de Oca, RN. Two more submissions on page 20.

3

SUE’S VIEWS: LETTER FROM THE EXECUTIVE DIRECTOR | Susan M. Hohenhaus, MA, RN, CEN, FAEN

ENA’s Talent: It’s All About Relationships By the time this issue of Connection hits your mailbox, many of you will have attended ENA Leadership Conference 2012 in New Orleans.

Those who were there heard the message from one of our keynote speakers, Laura Schwartz, who challenged the audience to “Eat, Drink and Succeed.” Schwartz described how her years of producing events for President Bill Clinton provided her with that critical ‘‘a-ha!” moment that has become her life’s passion to share: No matter how ‘‘social’’ an event might appear, there are opportunities, both realized and missed, for business connections and foundations. Relationships that form business discussions and deals are created during cocktail receptions, business dinners and corporate events—even on bus and plane trips—turning these events into what Schwartz calls ‘‘life-changing opportunities.’’

As the world of business becomes more complex, so does the business of managing ENA. Yet it is precisely because of our need to develop, produce and manage programs and products, as well as to recruit and retain the members who ensure the cash flow that allows the organization to flourish and grow, that it is important for us all to cultivate and nurture strategic relationships. These relationships include the relationships between ENA employees and members.

Although thinking in terms of a relationship with the employees at ENA might seem a little odd for a member organization, that relationship could be one of the most important for the future of the organization.

Because talented and committed employees represent a major resource in our association, the time and effort we invest in nurturing that

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.

Recently hired ENA staff members (L to R) Christine Siwik, senior administrative assistant, IQSIP; Briana Quinn, MPH, BSN, RN, senior associate wellness and injury prevention; and Tanju Hasanof, technology manager, check out the latest comments on the ENA Facebook page with Chief Talent Officer Bridget Walsh.

relationship has a huge return on investment.

Employees who feel respected and appreciated almost always produce more than anticipated.

Satisfied employees tend to want to satisfy members, do a good job and stay in the job.

This is important to the continuity of highquality programs and products at ENA and avoids the significant expense of employee turnover, employee retraining and the expensive but inevitable rookie mistakes of new, inexperienced employees.

As you interact with ENA’s employees at conferences, on the phone or in a committee meeting, keep in mind that creating and maintaining social relationships might be just the thing that benefits the organization—and you.

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

Member Services: 800-900-9659 Non-member subscriptions are available for $50 (USA) and $60 (foreign).

4

Working with Bridget Walsh, ENA’s chief talent officer, our elected leaders and you, I am committed to recruiting, developing and sustaining the talent in our ENA office that serves to support the work not only of the state councils and chapters, but of the work you do every day at the front line of the safety net of our health care system.

As Schwartz says, ‘‘Eat, Drink and Succeed.’’

You never know where one small step or kind conversation can take you.

Be safe.

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 D. Moon, MSN, RN, CNS-CC, CEN, FAEN Matthew F. Powers, MS, BSN, RN, MICP, CEN Karen K. Wiley, MSN, RN, CEN Executive Director: Susan M. Hohenhaus, MA, RN, CEN, FAEN

March 2012

Paying Tribute to a Paramedic:

As Bryan Stow Recovers, California ENA Funds Scholarship

By Kendra Y. Mims, ENA Connection Bryan Stow made national headlines nearly a year ago, on Opening Day of the 2011 baseball season, at Dodger Stadium in Los Angeles. The San Francisco paramedic, a fan of the visiting Giants, was brutally attacked by two Dodgers fans in the parking lot after the game. The assault was severe, leaving Stow, then 42, hospitalized in critical condition with brain damage. Today, he is making progress and recuperating, with a long recovery ahead.

Stow’s career as a paramedic began six years ago. Passionate about helping others, he enjoyed being a paramedic and eventually became a field training officer, said Ann Stow, his mother. Stow initially wanted to follow in the footsteps of his grandfather, pursuing a career as a firefighter, but the opportunity to become a paramedic opened up instead. ‘‘That was his true calling,’’ Ann Stow said. ‘‘He thrived on being a paramedic. I am just so proud of him. His career meant everything to him. It was his life. He once told somebody that being a paramedic wasn’t what he was—it was who he was. I thought that was a great way to describe it because it wasn’t a job. It was who he was.’’

The public outpouring from family, friends and colleagues during Stow’s recovery process has been overwhelming, as people from all over have visited and showed support, Ann Stow said. She said she was ‘‘amazed and proud’’ to learn of the impact Bryan had on others.

Linda Broyles, MSN, RN, past president of the California ENA State Council, is the clinical coordinator for the San Diego-area division of American Medical Response, the same company for which Bryan Stow worked. California ENA members who had worked directly with him wanted to show their support. Because California ENA had raised $6,621 during the 2011 ENA Foundation State Challenge, they decided collectively to use those funds to name a 2012 academic scholarship in Stow’s honor.

Thus, the ENA Foundation will award the 2012 Bryan Stow scholarship, in the amount of $5,000, to one EMT or paramedic pursing a degree in nursing. ‘‘There are a lot of members from northern California who have worked with him, and that is why everyone thought it was such a great

Bryan Stow poses with his son Tyler in happier times before Bryan was viciously beaten March 31, 2011, outside Dodger Stadium in Los Angeles.

idea,’’ Broyles said. ‘‘When I approached the family with the idea, they thought it was an honor that we would do this for Bryan. The family is very excited about it, especially now that he’s doing better.’’

Ann Stow said her family was moved that California ENA chose to name its scholarship after her son to provide a paramedic with an educational opportunity in nursing. ‘‘We were just so blown away by it,’’ she said. ‘‘It’s amazing. We’re so humbled by everything and everybody. ‘‘It’s such a noble profession—saving lives. I think it’s phenomenal for them to come up with a scholarship for paramedics in Bryan’s name.

That would mean so much to Bryan. He just loved being a paramedic.’’

You Can Give Back, Too Donations to the 2011 State Challenge campaign gave California ENA an opportunity to pay tribute to a dedicated paramedic and to give back to someone pursuing a degree in nursing.

Official Magazine of the Emergency Nurses Association

‘‘It’s all for a good cause,” Broyles said. ‘‘We are supporting someone who is going back for their education. Offering scholarships is one of the ways that we can give back to our members. We really encourage people to apply for the scholarship and to donate to the ENA Foundation as well.’’

The 2012 State Challenge campaign, “Cooking Up a Brighter Future,” kicked off February 1 and will end May 31. All ENA state councils raising $5,000 or more during this time period will have the opportunity to name a 2013 academic scholarship.

There’s still time to show your state pride. Your donation to the ENA Foundation will make a difference in the future of your profession.

Is there anyone your state wants to honor with a 2013 academic scholarship? For more information on how your state can contribute to this year’s State Challenge Campaign, visit www.ENAFoundation.org.

For more information on Stow’s progress, visit www.support4bryanstow.

5

WASHINGTON WATCH |

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

Accomplishments Mounting for Nation’s EMS Policy Committee, Advisory Council The Federal Interagency Committee for Emergency Medical Services and the National EMS Advisory Council were established in 2005 and 2007, respectively—around the time the Institute of Medicine’s Committee on the Future of Emergency Care in the U.S. Health System was completing its report ‘‘Emergency Medical Services at the Crossroads.’’

Today, both FICEMS and NEMSAC are responding to many recommendations contained in the 2006 IOM report.

Both FICEMS and NEMSAC held meetings in December 2011, providing updates on the significant accomplishments these two bodies have made.

2011 National EMS Assessment The IOM report recognized that although advances had been made in EMS, many challenges remained. Notable among the issues cited was the limited EMS evidence with respect to clinical interventions and system designs: ‘‘Despite the size, scope, sophistication and critical role of EMS in the United States, the evidence base to support EMS clinical and system design decisions is much less well developed than in other areas of medicine.

Consequently, EMS has for years operated without a sufficient scientific basis to support many of its actions.’’

FICEMS took an important step forward in addressing this issue when it commissioned a study to identify and use existing data sources to compile a comprehensive description of emergency medical services systems at state and national levels. At the December 2011 meeting, FICEMS announced its release of the 2011 National EMS Assessment (www.ems.gov/ pdf/2011/National_EMS_ Assessment_Final_ Draft_12202011.pdf ).

Funded by the National Highway Traffic Safety Administration, the 550-page assessment furnishes a meticulous description of the nation’s EMS systems, comprising an estimated 19,971 local EMS agencies, their 81,295 vehicles and 826,111 licensed and credentialed

6

personnel. Four data sources—the National Association of State EMS Officials 2011 EMS Industry Snapshot, the National EMS Information System, the Emergency Medical Services for Children Program 2010-2011 Federal Reporting and the 2007 Indian Health Services Tribal EMS Pediatric Assessment—were selected for inclusion after a comprehensive review of available data sources. More than 200 data points provide information and insight into EMS, emergency management and 911 communications.

FICEMS considers this first-ever assessment of comprehensive data a landmark document. The detail and inclusivity of the data create capacity for benchmarking current and future EMS system performance. ‘‘The report includes information about what data are being collected at the state, regional and national levels, the comprehensiveness, quality and availability of that data, and the limitations of the existing data … [It] allows states, territories and regions the ability to identify areas where systems may not be as comprehensive as desired, and provides system leaders the information needed to leverage more resources.’’

Recommendations for a sustainable process to assess the nation’s EMS systems, including recommendations for future assessment efforts, round out the report.

Evidence-Based Guidelines for Pre-Hospital Emergency Care In response to another recommendation of the 2006 IOM report, FICEMS and NEMSAC undertook a project to develop evidence-based model, pre-hospital care protocols for the treatment, triage and transport of patients, including children. Funded by NHTSA’s Office of Emergency Medical Services, the project began at a September 2008 stakeholders conference, where a model process for pre-hospital EBGs was proposed.

A pilot test of the model was funded by the Health Resources and Services Administration’s Emergency Medical Services for Children Program in 2009-2010; its focus was pre-hospital treatment of pediatric seizures. The pilot focused on a guideline development process, not on implementation.

A second pilot test was funded via a cooperative agreement with the Children’s National Medical Center in September 2009. The model aims to bring together professionals on a multidisciplinary level to enhance and support guideline development using the scientific evidence that exists for EMS. To that end, CNMC convened a group of experts in nursing; adult and pediatric emergency medicine; guideline development; trauma surgery; pain management; medical library science and pre-hospital care.

March 2012

Using the EBG Model Process to develop guidelines, the experts focused on pre-hospital pain management for adults and children and decisions related to the use of helicopter transport of injured patients. CNMC submitted the draft EBGs for review by the Protocol Review Committee of the Maryland Institute for Emergency Medical Services Systems. The review committee adopted the pain management protocol, but chose not to adopt the proposed Helicopter Emergency Medical Services guideline. Online educational materials were developed and completed by all Maryland pre-hospital providers for the adopted pain management guideline. Data are being collected on patient outcomes, acceptance and compliance for the implemented protocol; the preliminary analysis of these data is under way.

One feature of the EBGs’ development model is the reliance on an objective and transparent process for appraising the quality of clinical evidence, such as the process used in the Grading of Recommendations Assessment, Development and Evaluation system: ‘‘The process for developing clinical guidelines, based on an unbiased, transparent appraisal of the scientific evidence, is substantially different from basing patient care decisions on historical consensus, local convention, individual opinion, or anecdotes. … Careful analysis of available evidence can identify interventions that have been proven to be effective and are optimal for application. EBGs are an important element in improving the quality of pre-hospital care, as they promote a consistent approach by pre-hospital providers for a given clinical scenario, thus facilitating creation of standards for measures to evaluate the quality of pre-hospital emergency care.’’

While the project ends this month, a four-page document demonstrating the intensity and rigor necessary for developing EBGs is available now. That document is at www.ems. gov/pdf/2011/December/09-EBG_Project_ Overview_12092011.pdf.

Lead Agency A report on the proposal for a “lead federal agency for EMS” also was provided at the NEMSAC and FICEMS meetings. As previously covered in the May and December 2011 issues of ENA Connection, because the ‘‘lead agency’’ concept has been contentious, the White House sought an options paper from FICEMS about a lead agency. That options paper was submitted to the White House in May 2011. At the time of the writing of this article, the official status about

a policy to improve federal EMS coordination is that there is a policy document now, but it is not available to the public.

The lead agency concept also was a recommendation from the 2006 IOM report. IOM had noted that EMS systems began to develop rapidly across the country in the 1970s, but momentum was lost in 1981 when direct federal funding for planning and development of EMS systems ended and was replaced by block grants to states. IOM suggested that over the subsequent years, ‘‘EMS systems developed haphazardly nationwide, regulated by state EMS

offices that have been highly inconsistent in their level of sophistication and control. The result has been a fragmented and sometimes balkanized network of underfunded EMS systems that often lack strong quality controls, cannot or do not collect data to evaluate and improve system performance, fail to communicate effectively within and across jurisdictions, allocate limited resources inefficiently and lack effective strategies and resources for recruiting and retaining personnel.”

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?

ENA LEADERSHIP CONFERENCE 2013 F O R T L A U D E R DA L E , F L

FEBRUARY 27 – MARCH 3

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

7

PEDIATRIC UPDATE |

Elizabeth Stone Griffin, BS, RN, CPEN

The Specialized Route:

Pediatric Transport Teams Benefit Patient Outcomes Although 30 million children are seen in U.S. emergency departments each year, a 2003 survey of the pediatric preparedness of U.S. emergency departments found that 50 percent of emergency departments care for fewer than 10 pediatric patients per day (Gausche-Hill, 2007). When one of these emergency departments is faced with a critically ill or injured child, the patient is typically transferred to an institution with pediatric specialty services.

ENA endorses the use of specialized transport teams for interfacility transfer whenever possible (ENA, 2010). A national increase of pediatric intensive-care units has contributed to a higher demand for interfacility transport so that critically ill children can get specialized care. In

my community, as well as in many others around the nation, an increase in freestanding emergency departments also has contributed to the increased demand for interfacility transport.

I work at one of the few hospitals in North Carolina lucky enough to have its own specialized pediatric transport team. WakeMed’s Mobile Critical Care Services provides specialized transport for children and neonates, as well as several other specialty populations.

I sat down recently with three members of the pediatric transport team to talk about what they do and what challenges they face.

Crystal Sprinkle, RN, Kevin Parrish, RRT, and Vinnie Sferrazza, EMT, were the pediatric transport team the day I visited our Mobile

Services headquarters. Optimal crew configuration is a controversial issue among transport professionals, the team explained.

WakeMed opts to include a registered respiratory therapist on its pediatric transport team, likely because the majority of emergent pediatric medical conditions (asthma, RSV, croup, etc.) are respiratory-related (Loehr and Messmer, 2011). Even pediatric cardiac arrest is usually secondary to respiratory arrest.

In response to the 2003 pediatric preparedness survey, ENA, the American Academy of Pediatrics and the American College of Emergency Physicians in 2009 issued a joint policy statement for the “Guidelines for Care of Children in the Emergency Department”

WakeMed’s Mobile Critical Care Services specialized pediatric transport team includes (from left) Crystal Sprinkle, RN, Vinnie Sferrazza, EMT, and Kevin Parrish, RRT.

8

March 2012

(AAP, 2009). This policy statement outlines the guidelines and resources necessary for hospitals to provide emergency care for children of all ages, neonate to adolescent. It includes a detailed checklist of equipment, medications and other supplies that nurses and other emergency department staff can reference to ensure their preparedness and increase their comfort in caring for pediatric patients.

All three transport team members I interviewed expressed that they valued the opportunity to care for critically ill pediatric patients from a multitude of settings. When asked what he liked most about his job in pediatric transport, Parrish explained that he enjoys the opportunity to help other facilities prepare for and care for pediatric patients. ‘‘We respond to many institutions which are not very comfortable caring for sick kids,’’ Parrish said, ‘‘and we are sometimes in a unique position to help them troubleshoot internal problems. For example, we can give tips for pediatric intubation which may help them in the future.’’ Team members also often give advice on pediatric IV starts.

Sprinkle noted that some children she transports from institutions without pediatric specialty services are receiving ‘‘adult drugs, sometimes in 24-hour doses, which is not something we typically do in the pediatric world. … Pediatric antibiotics are dosed by weight and given in divided doses over a 24-hour period of time. It’s easy to forget that when you don’t care for critically ill children very often.’’ This scenario clearly illustrates some advantages of having a pediatric nurse on board.

A lack of standard reporting practices between transport teams and hospitals is an additional challenge the team expressed, especially in cases where a patient’s status deteriorates before the team’s arrival. When an emergency department calls to request transport, the patient’s care nurse has an opportunity to give the transport team information which can help members prepare for their patient: weight in kilograms, current set of vital signs, level of consciousness, medical history, etc. Keeping the transport team updated as to any changes in patient status before the team’s arrival can help ensure the team provides the most effective and efficient care possible.

Research has shown there is a significant increase in transport-related morbidity when personnel without pediatric training are used to transport critically ill children (Ajizian, S., and Nakagawa, T., 2007). Using specialized pediatric transport teams to transport critically ill children has many benefits, including decreased unexpected events and increased patient

survival rates (Loehr and Messmer, 2011, and Orr et al, 2009).

References/Resources Ajizian, Samuel, and Nakagawa, Thomas (2007).

Interfacility transport of the critically ill pediatric patient. Chest. 132;4, 1361-1367. DOI 10.1378/chest.07-0222 Emergency Nurses Association. Position Statement: Care of the patient during interfacility transfer. The Association (2010).

Accessed online 1/12/2012: www.ena.org/ SiteCollectionDocuments/Position%20 Statements/InterfacilityTransfer.pdf Gausche-Hill, M., Schmitz, C., Lewis, R.J. Pediatric preparedness of United States emergency departments: a 2003 survey.

Pediatrics. 2007; 120 (6): 1229-1237.

Loehr, A., and Messmer, P. (2011). The case for specialized transport teams. American Journal

of Nursing. 111: 9; 11.

Orr, R., Felmet, K., Han, Y., McCloskey, K., Dragotta, M., Bills, D., Kuch, B., Watson, R. (2009). Pediatric specialized transport teams are associated with improved outcomes. Heli.

124;40-48. Accessed online 1/13/2012: pediatrics.aappublications.org/ content/124/1/40.full.html

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.

ENA Foundation 2012 State Challenge Join the Challenge!

The goal is simple: to help more emergency nurses get the education they need. Invest in the future of your profession by making a donation to the ENA Foundation.

Challenge Rewards Your donation, designated to the State Challenge campaign, will help your state council’s chances towards the following challenge awards.

Largest amount raised by one state: 1st Place - $250 ENA Marketplace gift certificate 2nd Place - $150 ENA Marketplace gift certificate

Largest per capita amount raised: 1st Place - $250 ENA Marketplace gift certificate 2nd Place - $150 ENA Marketplace gift certificate

Donate Now.

www.enafoundation.org

Visit www.ENAFoundation.org for more detailed information on the State Challenge campaign and for updates on where your state stands in the challenge race.

2012_ENAF_StateChallengeAd_ConHPIsland_Final.indd 1

Official Magazine of the Emergency Nurses Association

2/14/2012 9:11:37 AM

9

Members Bring Focus to Practice of Helicopter Shopping

By Amy Carpenter Aquino, ENA Connection

2008 was the year that spurred ENA member Janice McKay, RN, CEN, CFRN, into taking action at the national level.

“We had eight accidents with 29 fatalities,” said McKay, referring to the national rate of air medical helicopter accidents recorded by the National Transportation Safety Board.

A flight nurse with Nightingale Regional Air Ambulance based out of Sentara Norfolk General Hospital in Norfolk, Va., McKay had long been aware of the dangers of “helicopter shopping,” defined as the practice of “making sequential calls to several air medical providers in an attempt to obtain transport for a critically ill or injured patient to a specialty resource center.” The practice creates a potential safety hazard when one medical air program turns down a request due to weather or another safety issue, and that information is not communicated to other air medical providers by the requesting agencies, McKay added.

“I kept hearing about all the accidents that were happening in air medical,” said McKay, who has 16 years of flight nurse experience on top of 16 years’ experience as an emergency nurse. “The first time they talked about helicopter shopping was in 2002, about how something needs to be done. They came out with grants and did a video to educate people.”

Fatalities in air medical accidents decreased for a couple years but began to climb again. An active member of ENA and the Air and Surface Transport Nurses Association, McKay did her research and started presenting sessions about the safety risks of helicopter shopping to emergency health-care providers at local and regional educational conferences, including the ENA Southeastern Seaboard Symposium.

“Every time they investigated these accidents, they always found that the practice of helicopter shopping was going on and they found it to be a contributing factor,” said McKay, “and I thought, oh my gosh, we need to stop this.”

In September 2010, she stood before the 700-member ENA General Assembly in San Antonio to deliver a resolution titled: “Promote a positive safety culture for air medical transports by discouraging the practice of ‘helicopter shopping.’”

McKay, the 2012 president of the Virginia ENA State Council, said that after talking with other members at General Assembly, she learned that another version of helicopter

10

Virginia ENA State Council President Janice McKay, RN, CEN, CFRN, a flight nurse with Nightingale Regional Air Ambulance in Norfolk, Va., works on a transport.

shopping—calling more than one air medical program to transport the same patient without alerting the other providers that multiple calls have been made—was also being practiced in some states.

“That’s a catastrophe right there waiting to happen on your helipad when you have three helicopters inbound and no one knowing about it,” she said. “Unfortunately, in the 2008 accidents we had two air crafts collide where they were all heading to the same hospital and they weren’t communicating and ran into each other.”

The National Transportation Safety Board, in its Review of U.S. Civil Aviation Accidents, 2007-2009, stated that “the midair collision between two Part 135 helicopters in Flagstaff, Ariz., in June 2008 was … fatal to all aboard the two aircraft.” The NTSB defines air medical operations as operating under Part 135 when patient or organs are on board for transport.

According to published news reports, seven people were aboard the two helicopters that collided and crashed, including two flight nurses, one paramedic, two patients and two pilots.

ENA delegates from across the country supported McKay during the initial writing,

presentation and rewrite of her resolution.

Presidents of the ENA state councils of Virginia, New Hampshire, North Carolina, Nebraska and New York signed on as resolution sponsors.

“This goes hand-in-hand with ENA’s position on safety,” said Loretta Martin, MSN, BSN, RN, CEN, the 2010 Virginia ENA State Council president, speaking in support of the resolution at the 2010 General Assembly. “Our position is that this patient is still ours until he or she arrives at our facility safely.”

A delegate from Arizona, who was a certified flight registered nurse, told the assembly that she had experienced the practice of helicopter shopping.

“When we were on the final approach of the helipad, it was concerning to me that there was no communication between these two helicopters coming for one patient,” she said. “The situation has been that whoever gets there first gets the patient. That puts us in a position for a collision. I think communication is key here.”

Texas delegate Thomas Culwell, BSN, RN, CEN, CFRN, agreed that the practice of helicopter shopping was prevalent.

“The pressure to fly comes from many different directions, unfortunately,” he added, citing such wide-ranging considerations as

March 2012

financial to the urgency associated with the need to transport a critically ill child. “But our safety has to come first.”

Some delegates pointed to a need to rework some language in the resolution. Longtime ENA member Kyle Madigan, RN, CMTE, chief flight nurse for Dartmouth Hitchcock Advanced Response Team, who was in attendance at that General Assembly as the 2010 ASTNA president, was one of the people who worked with McKay to rewrite her resolution.

“One of the suggestions I made was that there were a number of other stakeholder associations that would benefit from this as well,” Madigan recalled in a recent phone interview, adding, “I applaud Janice for bringing this resolution forward. It was very forward-thinking on her part.”

The final resolution, which was passed by an overwhelming majority of the General Assembly, called for ENA to collaborate with ASTNA, the American College of Emergency Physicians, the Commission on Accreditation of Medical Transport Systems, the National Association of Air Medical Communication Specialists, the National Emergency Medical Service Pilot Association, the Air Medical Physicians Association and the International Association of Flight Paramedics to develop policies to promote better communication of transport issues or concerns between emergency departments and air medical programs, and to also work with these seven organizations to investigate the current practice of helicopter shopping.

In July 2011, the ENA board of directors approved a joint consensus statement with ASTNA addressing helicopter shopping (see box). Madigan noted that ENA, as one of the larger associations with a significant membership, was in a great position to spearhead the effort to gather all the players to accomplish the goal of a larger joint consensus statement.

“What is most beneficial is that education piece,” he said, which could include a joint consensus statement as well as articles in key publications, such as ENA Connection and the Journal of Emergency Nursing. “Anything we can do to increase the knowledge of the membership. We need to bring to the forefront that if a program turns them down for weather or safety considerations, it is not always in the best interest of the patients or the crews to just keep calling around until you find somebody willing to take the risk to take the patient.”

Madigan shared the example of the North East Air Alliance, a collaboration among air medical transport programs from Massachusetts, Connecticut, New Hampshire and New York.

“All the air medical operators in the Northeast regional have come together to say, ‘We want to operate as safely as possible,’” he explained. “So if Dartmouth turns down a flight for weather in the southern region, we anticipate that the next

call will be to Boston Medflight to pick up that patient. What we will do is call Boston Medflight ourselves and say, ‘Just to let you know, we had a call from Hospital X, we turned it down for weather. You may get a call.’

“So they have the information, they are not going into it blindly,” said Madigan. “The pilots can even talk to each other and say, ‘Hey, what are you seeing that I’m not seeing? Why did you turn it down?’”

McKay said she hopes to see more come out of the resolution, but she accomplished her goal of sharing information about the practice of helicopter shopping.

“I got to educate 700 nurses at the General Assembly about the practice,” said McKay. She added that she hopes that everyone involved in arranging air medical transports communicates fully to allow air medical teams to make decisions that benefit everyone.

“Our decision is made by looking at the computerized weather, looking at the geography

of where we’re going, things like that,” she said.

“Just be honest with us. We’re not going to say ‘No’ just because. We’re going to make an informed decision—that’s what we want to do.”

The ENA and ASTNA Joint Consensus Statement on “Helicopter Shopping,” approved by the ENA board of directors July 2011, (www.ena.org/ about/position/jointstatements/Pages/Default. aspx) states the following: ENA and ASTNA: 1. Acknowledge the problem of helicopter shopping and support the development of prevention strategies to eliminate the possibility of adverse events related to its practice.

2. Are committed to working together to enhance the quality of care and safety for patients in air medical care settings, and support partnerships between emergency nurses and air medical professionals.

2012 Annual Conference

Refresh Revitalize Invigorate September 11-15 • San Diego

OFFERING EDUCATIONAL AND NETWORKING OPPORTUNITIES FOR PROFESSIONALS CARING FOR EMERGENCY PATIENTS.

For more information, visit www.ena.org.

11125_AC12_San_Diego_Connection_Island_Ad.indd 1

Official Magazine of the Emergency Nurses Association

2/8/2012 9:48:18 AM

11

CODE YOU

CODE YOU

Six Ways to Deal With Compassion Fatigue and Burnout CODE YOU

By Kendra Y. Mims, ENA Connection

CODE YOU

CODE

YOU

The emergency nursing profession is all-health-care-workers issue,’’ Williams said. demanding. Insufficient staffing, crowding She believes this program will provide patients issues, excessive workloads, long hours and with safer care, and the chances of potential experiencing emotional challenges on a regular errors will decrease as nurses are able to fully basis in a high-paced work environment can focus and provide compassionate care to each cause stress, compassion fatigue and burnout individual patient. for health-care workers, which eventually can ‘‘Everyone wants to have great patient take a toll on their health physically, mentally satisfaction, but it can be challenging to provide and emotionally. the best patient care if you are battling Some research states that compassion fatigue compassion fatigue,’’ she said. ‘‘A lot of times and burnout are synonymous, while other nurses tend to job-hop, thinking it will be better research lists burnout as a factor that contributes in a different place, and they haven’t addressed to compassion fatigue. Burnout is described as the original issue, which is they’re fatigued.’’ frustration, loss of interest, decreased While not all hospitals have a compassion productivity and fatigue caused by overwork fatigue program, emergency nurses can take the and prolonged stress, which can lead to low following steps to steer clear from burnout and morale, high absenteeism, high turnover rates compassion fatigue: and occupational injuries in the workplace 1. R ecognize the Symptoms: Though having (Wisniewski, n.d.). Compassion fatigue, also a stressful work week doesn’t automatically known as secondary post-traumatic stress mean you are struggling with compassion disorder, is a condition that is defined as fatigue, there are recurring symptoms that emotional, physical and spiritual exhaustion can help you identify signs of compassion from witnessing and absorbing the problems fatigue and burnout in yourself and your and suffering of others, which can affect the peers. If multiple individuals are struggling individual’s ability to care for others with compassion fatigue in a workplace, the (Wisniewski, n.d.). entire organization can be affected. Some of To help its employees become aware of the most common warning signs are listed in compassion fatigue, Barnes-Jewish Hospital in the chart at the bottom of this page.

St. Louis contacted psychotherapist Eric Gentry 2. T ake Time to Recharge: If you are having to implement a compassion fatigue program for difficulty focusing at work and you find staff. The Level I trauma center receives yourself losing your passion to work with approximately 90,000 patients a year and has a your peers and patients, making time in your high volume of trauma schedule to de-stress can make a difference and chronically ill and give you the boost you need. Even if patients. Jennifer Williams, MSN, RN, a clinical nurse specialist INDIVIDUAL SYMPTOMS for emergency services and a trainer for the Anxiety program, said leadership Insomnia believed that some staff Jennifer Williams, members were suffering Depression/despair MSN, RN from compassion fatigue Isolation from others and wanted to provide them with a concrete method to help them deal with their feelings.

Mood swings The program is now offered to anyone on staff Avoidance/dread who interacts with patients and families of working with patients regularly, such as nurses, physicians, security Decreased ability to feel empathy personnel and housekeepers. During the toward patients and families eight-hour session, participants learn about compassion fatigue, the symptoms and Lack of concentration/focus prevention methods, which include an effective Fatigue, headaches, chest pain technique of relaxing the pelvic floor muscles.

Landro, 2011; Decreased happiness ‘‘This isn’t just a nursing issue. It’s an

your caseload is full and you don’t have much time to spare throughout your day, take a mini-break to go for a walk, read, listen to a few of your favorite songs or enjoy quiet time to do nothing at all. Find out what activities de-stress you and make them a part of your daily routine at work and at home, even if it’s only for five minutes.

NursingLink.com suggests creating a ‘‘stress-free zone’’ at work, whether it’s an entire room or a section of the break room.

Use this space to create a place of relaxation with flowers, inspirational sayings, food and other items that will contribute to a relaxing atmosphere for you and your peers to recharge throughout the day (Nursing Link, 2012).

3. K now Your Limitations: Set limitations in advance at home and at work so that you don’t spread yourself too thin. The Joint Commission Sentinel Event Alert, Issue 48, addressed the risks of health-care fatigue caused from extended work hours and how it could affect patient safety (see the sidebar on the next page for more information). If you feel burned out or fatigued, ask for help. Let your colleagues know that you have a full workload and you are not able to take on any more tasks, patients or extra hours.

Carefully assess any contributing stress factors in your life (heavy workload, long hours or too many tasks to balance). Is there anything on your list that you can change?

Maybe there are several things that you can spend less time on or remove from your list

ORGANIZATIONAL SYMPTOMS High absenteeism Low morale Constant changes in coworkers’ relationships Aggressive behavior among staff Inability of staff to complete tasks and meet deadlines Negative attitude toward management Strong hesitancy toward change Lack of flexibility Lack of vision for the future

Recognizing Compassion Fatigue, 2012

12

March 2012

entirely. Doing too much all of the time is a quick way to become burned out.

4. R elease Your Stress to Others: Making an effort to hold yourself accountable to your peers is an effective way to avoid compassion fatigue and burnout. Confiding in people you trust and who understand what you’re going through can help you take control of your feelings. ‘‘One of the key components of the training is disclosure,” Williams said. ‘‘Reach out and be honest with your colleagues, whether you see it in them or yourself. You have to develop relationships with others where you can disclose to them and feel comfortable. Let that person know you are developing signs of compassion fatigue and ask them to hold you accountable.’’

Part of the training program includes the participants sharing what makes their lives and jobs stressful, and how that affects them. ‘‘We disclosed our work-life history to each other and learned why a certain situation may be more stressful for us,’’ Williams said.

Williams continues to use the class as an opportunity to educate new staff to the emergency department on compassion fatigue with hopes that they won’t develop the condition.

“I see nurses who have been in the profession for less than five years and are already saying they’re burned out,’’ she said. ‘‘That is a problem. We are not doing a good job in helping them cope with the stresses of being a health provider.’’

5. Create a Personal Self-Care Plan: Compassion fatigue specialist Françoise Mathieu suggests starting a self-care idea collection at work where people can keep a ‘‘self-care board’’ with their favorite ideas (such as committing to taking a lunch) and encourage people to bring a new self-care

idea to work everyweek (Mathieu, n.d.). Other self-care tips include working out consistently, eating right and getting an adequate amount of sleep.

It is also helpful to monitor the amount of trauma you absorb in a day.

If you work with a lot of patients who have experienced trauma, it may be beneficial for you to take a break from listening to the news and reading the newspaper so that your mind is not constantly bombarded with sad and disturbing stories.

6. Stay Focused: One of the exercises in the compassion fatigue program requires participants to write a narrative explaining why they went into health care, and then they share their reasons with others. ‘‘We all have job responsibilities, and some we don’t love,’’ Williams said, ‘‘but it’s about making a conscious choice to do the job responsibilities that you don’t love with a purposeful manner.’’

Write down the reasons you went into emergency nursing. What makes you passionate about it? What do you get from this profession that you can’t get from another career? What professional duties do you really enjoy? What motivates you to return to work every day? Keep your reasons nearby so that they become a reminder of why you chose to become an emergency nurse when you start to lose your passion and focus. ‘‘As a caregiver, you’re having a secondary injury because you almost have to vicariously live through the injury with the patient you’re caring for,’’ Williams said. ‘‘The lesson to be

learned is to recognize that you may be constantly in a reaction state and identify why you got into the profession and what sustains you as a human. Work on identifying how you can lower your response to stress.

Practice relaxing your pelvic floor [muscles]. That’s something you can do at the bedside.’’

Remember, it is not only important to recognize symptoms of burnout in yourself, but to also identify the risks in your colleagues.

Building a healthy environment where you and your coworkers can exceed patient care expectations takes collaboration from everyone.

References Landro, L. (2011). When Nurses Catch Compassion Fatigue, Patients Suffer. Retrieved from http:// online.wsj.com/article/SB100014240529702 04720204577128882104188856.html Mathieu, F. (n.d.). Transforming Compassion Fatigue into Compassion Satisfaction: Top 12 Self-Care Tips for Helpers. Retrieved from http://compassionfatigue.ca/ Nursing Link. (2012). Retrieved from http://nursinglink.monster.com/ Recognizing Compassion Fatigue. (2012).

Retrieved from http://www. compassionfatigue.org/index.html Wisniewski, L. (n.d.). Is it Stress, Burnout, or Compassion Fatigue? Retrieved from http:// www.nursetogether.com/Career/ Career-Article/itemId/2652/Nurses- Is-it-Stress-Burnout-or-Compassion- Fatig.aspx

Tired of Feeling Fatigued? Here’s How Your Organization Can Help

By Kendra Y. Mims, ENA Connection The Joint Commission Sentinel Event Alert, Issue 48, stated that nurses are overworked, and studies indicate that extended work hours contribute to high levels of worker fatigue and decreased productivity.

They also show that fatigue increases the risk of adverse events, compromises patient safety and poses a risk to personal safety and wellbeing. A 2004 study showed that nurses who worked shifts of 12.5 hours or longer were three times more likely to make an error in patient care and also suffer higher rates of job-related injury. Though the dangers of extended work hours are well-known, the alert

states, the health-care industry has been slow to adopt changes, particularly with regard to nursing (Joint Commission, 2011).

Because working extended hours can affect your sleep, which can eventually impact job performance, the Joint Commission suggests the following evidence-based actions that healthcare organizations can implement to reduce the risks of fatigue (Joint Commission, 2011): •A ssess your organization’s hand-off processes and procedures to ensure that they adequately protect patients.

•E ducate staff on sleep hygiene and the effects of fatigue on patient safety.

Official Magazine of the Emergency Nurses Association

• Design and implement a fatigue management plan that includes scientific strategies, such as physical action, engaging in conversations with others and strategic caffeine consumption.

• Support staff members who have concerns about fatigue and encourage teamwork to support staff who work extended hours.

• Request staff input in the work schedules.

• Evaluate your organization for fatigue-related risks.

For more information on this alert, visit www.jointcommission.org/sea_issue_48/.

13

From the Future of Nursing Work Team:

IOM Recommendation 1: Remove Scope-of-Practice Barriers

By Manolito Suriba Guerra, MSN, MBA, RN, CEN, CCRN The global recession and erratic economy are major, pressing factors in U.S. health-care reform. High costs and manpower demands lessen the capability of health-care providers to provide inexpensive, affordable and quality health care. The beginning of the 21st century commences the pivotal metamorphosis of the nursing profession and a sharper focus on a holistic, patient-centered and community-based approach to care.

There have been numerous debates regarding advanced-practice nurses’ roles in the health-care arena. The delineation of scope of practice and responsibilities is not well-defined or stated. Advanced-practice nurses are highly trained professionals with advanced education, certification and clinical training who serve as health-care providers in a broad range of acute care and outpatient settings. The arguments lie in allowing some skills to be performed by

Introducing the new and improved ENA Career Center Your path to lifelong career success

Career Center

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

As An employer: • Post openings and review a deep pool of qualified talent

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

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

advanced-practice nurses, including limitation of medication prescription, not to mention controlled substances. Many insurance plans, including HMOs and Medicaid, do not provide direct payment for services provided by advanced-practice nurses. Other concerns are the inability to obtain medical-staff privileges in many hospitals subject to stringent professional liability insurance requirements and antiquated laws governing advanced-practice nurses’ education, training and experience.

The Robert Wood Johnson Foundation and the Institute of Medicine began the two-year Campaign for Action initiative to redesign and revolutionize the nursing profession. According to the Robert Wood Johnson Foundation, advanced-practice nurses should be able to practice to the full extent of their education and training. In order to achieve this goal, RWJF recommends the following: For Congress: Expand Medicare to include coverage of advanced-practice registered-nurse services within the scope of practice under applicable state law; amend Medicare to authorize advanced-practice nurses to perform admission assessment, as well as certification of patients for home health-care services and for admission to hospice and skilled nursing facilities; and extend the increased Medicaid reimbursement rates for primary-care physicians included in the Patient Protection and Affordable Care Act to advanced-practice registered nurses providing similar primary-care services.

For State Legislatures: Reform scope-ofpractice regulations to conform to the National Council of State Boards of Nursing advanced practice registered nurse model rules and regulations, and require third-party payers that participate in fee-for-service payment arrangements to provide direct reimbursement to advanced-practice registered nurses who are practicing within their scope of practice under state law.

For Center for Medicare and Medicaid Services: Amend or clarify the requirements for hospital participation in the Medicare program to ensure that advanced-practice registered nurses are eligible for clinical privileges, admitting and membership on medical staff.

Continued on page 24

14

March 2012

Celebrating the Work of Emergency Nurses

By Kendra Y. Mims, ENA Connection Emergency Nurses Week is a celebration to honor emergency nurses everywhere for their dedication and commitment to making a difference in the lives of patients, families and communities, with special recognition given on Emergency Nurses Day. In 2011, Emergency Nurses Week was celebrated October 9-15. ENA Connection posted a question on the ENA Facebook page asking members to share how their hospitals paid tribute to emergency nursing professionals.

Here are a few ways our members celebrated their special week:

Major Hospital (Shelbyville, Ind.) Melissa Wilson Scott, RN, shared that her emergency department celebrated with an emergency nursing symposium where ‘‘Everyday Superheroes’’ was the theme, complete with the department’s own Disaster Man (see this month’s installment of ‘‘Disaster Man’’ on page 17). The department had emergency-based education, food and fun.

2011 Kadlec Regional Mecidal Center (Richland, Wash.)

Kadlec held its annual breakfast to recognize staff members who received or maintained their Board of Certification in Emergency Nursing credential as a certified emergency nurse or a certified pediatric emergency nurse.

Last year marked the seventh that Kadlec held the breakfast for CENs and CPENs during Emergency Nurses Week. Roger Casey, MSN, RN, CEN, trauma and stroke coordinator, said the number of breakfast attendees continues to grow every year; there were 22 CENs at the 2011 breakfast, and two were also CPENs. ‘‘The manager of the emergency department decided she wanted to do something different for the nurses who went above and beyond by obtaining their certification,’’ Casey said. ‘‘She wanted to reward them and recognize them for their achievements and provide an incentive for others. Each year, there is a group of nurses studying to take the exam who want to come to the breakfast and get the recognition as well.”

Casey obtained his CEN certification in 2003 and has attended all seven breakfasts.

All staff members who obtain their CEN or

CPEN certification also receive a gift. Kadlec’s emergency department was a recipient of ENA’s 2011 Lantern Award, and all breakfast attendees last year received a CEN shirt with the Lantern Award logo.

During the breakfast, guest speakers discussed why certification is important. Casey believes having the breakfast during Emergency Nurses Week is valuable to staff. ‘‘It rewards those who have gone on to get the certification,’’ he said. ‘‘It’s not a requirement. It’s something nurses do on their own.

Everyone has a different motivation for taking the exam.

I think it’s important because it recognizes those nurses who have gone above and beyond and have certification exam.’’

From left: Nancy Kingbird, NA, Rebecca Kremer, RN (back), Scott Lash, RN, and Tanya Boser, RN, display the cake recognizing emergency nurses at Red Lake IHS Hospital.

taken the

Red Lake IHS Hospital (Red Lake, Minn.)

Jane Mattila, BSN, PHN, Red Lake’s acting emergency department supervisor, wanted to create a celebration to honor her staff for their hard work for the year. Red Lake is located in a rural community and receives about 2,500 patients a month. Considered to be fully staffed with eight to 10 nurses, its emergency department had been short-staffed since the summer and had dwindled to six to seven nurses last year. The number on staff was further limited when they had to assist patients during ground transfers up to five hours away.

Mattila brought treats for nurses on every shift throughout the week, and the hospital provided a cake specifically designed for Emergency Nurses Day for the entire department. All of the nurse managers and supervisors from the hospital pitched in to provide door prizes for staff, which included grand prizes of $10 and $25 gift cards to local department stores and smaller prizes, such as artisan soaps and fresh eggs from Mattila’s chickens. Every staff member in the emergency

Official Magazine of the Emergency Nurses Association

department had an opportunity to pull names and win a prize.

Mattila also created huge signs around the emergency department to bring recognition to Emergency Nurses Week, which included reminding patients to thank their nurses. Her department also sent a bouquet of flowers to one of their nurses on medical leave. ‘‘We wanted to really recognize them this year and let them know that we really appreciate them,’’ Mattila said. ‘‘Because it was a rough year for everyone due to low staffing and everyone really worked hard, I really wanted to make sure they were taken care of this year. Other years, Emergency Nurses Week has gone by the wayside.’’ ‘‘There are times as a staff nurse that you feel forgotten,’’ she added. ‘‘Sometimes when there are hospital functions and everyone goes to the function, ER nurses can’t be relieved.

They’re 24/7.’’

Save the Date in 2012 EMERGENCY NURSES WEEK™

EMERGENCY NURSES DAY*

October 7- 13

October 10

15

READY OR NOT? |

Knox Andress, BA, RN, AD, FAEN

Cyber Threats in the Emergency Department “Cyber threats pose a critical national and economic security concern due to the continued advances in, and growing dependency on, the information technology that underpins all aspects of modern society,” said James Clapper, U.S. director of National Intelligence, in a report to the U.S. Senate Select Committee on Intelligence on Jan. 31. “Data collection, processing, storage and transmission capabilities are increasing exponentially; meanwhile, mobile, wireless and cloud computing bring the full power of the globally connected Internet to myriad personal devices and critical infrastructure.”1 How dependent are you on hospital information technology, computer systems and networks? How many of your daily emergency department processes interface with or require the Internet or an intranet? What would be the measurable impact if these systems and networks were suddenly no longer available?

Consider the following scenarios How dependent are you on hospital information technology, computer systems and networks?

How many of your daily emergency department processes interface with or require the Internet or an intranet? What would be the measurable impact if these systems and networks were suddenly no longer available? Consider the following scenarios:: • A disgruntled former hospital employee with exceptional computer skills hacks into the hospital network from his home computer and plants a very aggressive computer virus into the Computer-Aided Facility Management system. The computer virus activates at midnight, shutting down the hospital heating, ventilation and air-conditioning system, security system, building automation and patient medical monitoring system.2 • While at home working on a hospital project, a hospital associate unknowingly downloads a virus from her home personal computer onto her flash drive. The next morning the virus is shared into the hospital system when she plugs her flash drive into her hospital desktop computer.

• A nation-state at odds with U.S. policy decides to shut down or compromise critical infrastructure within the U.S. by initiating a distributed denial-of-service cyber attack on “enemy” websites and targeted computercontrolled systems. Overwhelmed systems

16

include electrical power grids for several states, which in turn affect hospitals and health-care systems.

Connections Obvious cyber roles in the emergency department include applications for Internet access, e-mail, the electronic health/medical record system allowing patient admission, order input, reception of diagnostic test results and patient charting, among others. Other not-soobvious computer systems may include those which operate or monitor hospital mechanical systems within the emergency department and hospital. Doors, HVAC systems, cameras, security, fire alarms and hospital communication systems all may interface with the Internet at some point. Internet interface allows for off-site system monitoring, manipulation and control by authorized parties and potential hacking by others.

Cyber Threats Threats to vulnerable cyber systems include all forms of malware—short for malicious software—and include software or code designed to exploit or disrupt computer operations, gather sensitive information or gain access to unauthorized computer systems.

Malware includes computer viruses, worms, trojan horses, spyware, dishonest adware, potentially unwanted programs and most rootkits. Rootkits are software or computer code that is surreptitiously residing in a computer’s “root” or most basic operating systems, where it stealthily collects and shares information or performs other malicious operations.3 Other domestic and/or foreign threats include those who facilitate malware or inappropriately access systems. Cyber criminals can include hackers or “hacktivists” working as identity and intellectual property thieves, or those seeking to disrupt critical infrastructures.

Virus Leads to System Crash ENA member and practice specialist Cheryl MacMillan, MSN, RN, shared her recent experiences at Gwinnett Medical Center after a computer virus infected her hospital’s system at both the Lawrenceville and Duluth, Ga., campuses. A technologically progressive health system, Gwinnett Medical Center operates in a near-total electronic format.

“At approximately 3:30 p.m., I noticed our computer systems began slowing, and soon computer-related processes came to a stop,”

MacMillan said. “This included our patient admission process and electronic medical record—including ordering and data retrieval for pharmacy, radiology, laboratory and others.”

MacMillan said communications became an issue, but hospital leadership worked through the systemwide problem.

“We activated our hospital command center to coordinate activities and implemented our paper, downtime procedures,” she said. “At times we had departmental conference calls six times a day and supplemented those calls with message runners.”

Cyber Division While patient care was never compromised, the computer virus caused substantial hospitalwide process congestion and required the emergency department to be placed on diversion for at least 16 hours.

In a cyber outage, MacMillan recommends planning for the following: • Multiple communication redundancies for the emergency department and hospital.

• Implementing your hospital emergency operations plan and command center.

• Using message runners.

• Having a business continuity and patient care plan.

• Expecting that newer or younger hospital associates and staff may not be as familiar with downtime procedures and processes.

Consider functional exercises focusing on downtime needs.

Other Cyber and Health Facility Incidents On Dec. 21, the Syracuse Post-Standard reported that a “computer glitch” at Upstate University Medical Center began with blocked e-mail access about 7 a.m. and became a widespread computer system outage by 11 a.m.

Normal electronic ordering processes, including medications, admissions and discharges, quickly became manual processes. Bells were distributed to patients when the nurse call system was disabled. 4 On Jan. 8, the Columbus Dispatch reported on the Ohio State University Medical Center’s notification of 30 patients and 150 students after a hacker from a foreign country breeched a Medical Center server and possibly accessed names, medical information and/or Social Security numbers.5 On Jan. 25, the Associated Press and

March 2012

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

Washington Post reported hackers had disrupted an Israeli hospital website in a series of politically motivated cyber attacks.6 The next day, www.

Ynetnews.com revealed two Israeli hospital websites were targeted and crashed by hackers who flooded hospital websites with hundreds of thousands of queries, overwhelming them.7 Ironically, on Jan. 25, Israel’s National Cyber Command began its first national cyber terror drill, titled “Lights Out,” to improve response effectiveness in the event of a virtual assault.

Resources Situational awareness, alerts and tips are provided at the Department of Homeland Security Computer Emergency Response Team website (www.us-cert. gov). Besides developing hospital business continuity plans and exercising downtime procedures, the Hospital Incident Command System “Cyber Attack” scenario, with its Incident Planning Guide and Incident Response Guide found at www. emsa.ca.gov/hics/external.asp, can assist your hospital and emergency department strategy.

Other resources include the ENA emergency preparedness site at www.ena.org/IQSIP/ EmergencyPrepared/Pages/Default.aspx and ENA’s preparedness list-serve. Sign up today!

6. “ Israeli Hospital, Newspaper Websites Hacked in Latest Series of Politically Motivated Attacks” accessed January 29, 2012, at www. washingtonpost.com/business/israelihospital-newspaper-websites-hacked-in-

Special Offer for the Month Quick Reference Sexual Assault Angelo P. Giardino, MD, PhD, Elizabeth M. Datner, MD, Janice B. Asher, MD, Barbara W. Girardin, RN, PhD, Diana K. Faugno, RN, BSN, CPN, FAAFS, SANE-A, Mary J. Spencer, MD

The right knowledge, accurate diagnosis, and treatment of sexual assault cases can better protect victims and hold their perpetrators accountable. In these situations, there is no room for error. The convenient pocket sized format provides easy-to-access information for the medical examination, forensic evaluation, and law enforcement investigation. Topics of specific interest include sexual abuse of those with disabilities and the elderly.

Price: $55 ENA Member Price: $49.50

2. H ospital Incident Command System (HICS), 2006, Cyber Attack Scenario, accessed January 28, 2012, at www.emsa.ca.gov/HICS/external.asp

4. “ Computer Crash at Upstate” accessed January 27, 2012, at www.syracuse.com/news/index.ssf/2011/12/computer_ crash_at_upstate_knoc.html

7. “Cyber vandalism – not warfare” accessed January 30, 2012, at www.ynetnews.com/ articles/0,7340,L-4181069,00.html

Marketplace

References 1. C lapper J., “Unclassified Statement for the Record on the Worldwide Threat Assessment of the U.S. Intelligence Community for Senate Select Committee on Intelligence”; Jan. 31, 2012.

3. M alware definition, Wikipedia, accessed January 25, 2012, at en.wikipedia.org/wiki/Malware

latest-series-of-politically-motivatedattacks/2012/01/25/gIQADkusQQ_story.html

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

5. “ Server Hacked at OSU” accessed January 27, 2012, at www.dispatch.com/content/stories/ local/ 2012/01/06/OSU-Medical-Center-serverhacked.html Marketplace_Mar_2012_ConnHPIsl.indd 1

Official Magazine of the Emergency Nurses Association

1/11/2012 9:44:33 AM

17

Improving the Safety of Children During Interfacility Transfers

By Kendra Y. Mims, ENA Connection ENA is partnering with the Emergency Medical Services for Children Program through its EMSC National Resource Center and the Society of Trauma Nurses to create a pediatric interfacility transfer toolkit. The toolkit will assist hospitals with improving procedures when transferring pediatric patients to other facilities that provide specialty resources and services. Each organization has a vested interest in ensuring that critically ill and injured children get to the appropriate resources.

ENA’s 2007 “Care of the Pediatric Patient in the Emergency Setting” position statement listed the goal of pediatric interfacility transfer as follows: “… to decrease morbidity and mortality and improve patient outcomes. Emergency departments with specialty limitations (e.g., limitations related to trauma, burns, spinal cord injury, etc.) or minimal pediatric resources (e.g., no pediatric inpatient unit) should develop protocols for transfer and have written transfer agreements with hospitals capable of providing ongoing critical care to pediatric patients.”¹ Jaclynn Haymon, MPA, RN, co-director of the EMSC National Resource Center, said the federal EMSC program is designed to ensure that infants, children and adolescents receive appropriate emergency care during a health emergency. ENA and EMSC have built a strong working relationship over the years, Haymon said, and it continues to strengthen as they collaborate on upcoming projects.

Feedback Frame

“We are really excited about the National Pediatric Readiness Project, which will begin with a national survey of emergency departments and include quality improvement resources, such as the pediatric interfacility transfer toolkit for hospitals,” Haymon said.

“These projects provide opportunities to significantly enhance the emergency care of children nationally. The strengths of all three organizations will ensure success of the projects.”

The EMSC Program is the only federal program whose sole focus is to improve the quality of emergency care for children. Since its establishment, the EMSC Program has provided grant funding to all 50 states, the District of Columbia and five U.S. territories.² Administered by the Health Resourc¬es and Services Administration’s Maternal and Child Health Bureau, the EMSC Program requires all EMSC State Partnership grantees to collect and report data on 10 specific performance measures that assess the quality of pediatric emergency care that is provided in the prehospital and hospital setting. 4 ENA member Diana Fendya, MSN, RN, trauma/acute care specialist at the EMSC NRC, said the measures provide metrics to evaluate the effectiveness of the federal state partnership grant programs, as well as a process to monitor progress on program priorities established to reduce gaps in the provision of quality

pediatric emergency care.

Research states that many hospitals (specifically in rural or remote areas) do not have the specialty resources needed to treat critically ill and injured children. The EMSC Program’s mission is to help guarantee that children have access to vital resources. EMSC performance measures 76 and 77 focus on hospital availability of interfacility transfer agreements and guidelines. These two measures are critical because the majority of children receive their emergency care in non-pediatric facilities and are often transferred out for specialty care.

Performance measures 76 and 77 help to ensure that processes are in place to facilitate safe and timely movement of the critically ill and injured child to appropriate specialty resources not readily available at receiving hospitals. All EMSC state and territory grantees are working toward attaining the performance measures.³ Fendya said the data collected by grantees from each state in 2006 for EMSC performance measures 76 and 77 showed room for improvement. Early analysis showed that only 14 percent of responding hospitals had interfacility guidelines addressing the pediatric patient, and only 38 percent had interfacility agreements in place for children. These results were shared through presentations at the 2010 STN Annual Meeting and ENA Leadership Conference 2011.

“Membership within both groups was extremely surprised,” Fendya said. “They anticipated they were prepared to transfer children, but then, when going back to do their homework, they realized they really weren’t prepared to move children to specialty services when needed.”

As a member of both STN and ENA, Fendya said members often have asked her about a pediatric interfacility transfer toolkit.

“Probably half of the people who expressed interest in the toolkit are carrying joint membership with STN and ENA,” Fendya said. “I think some of it was just making people aware that they needed to have agreements and guidelines to ensure the safe and timely transfer of critically ill and injured children. Trying to organize interfacility transfer is stress-provoking enough when you know what the process is. When you do not, and you are trying to take care of the ill or injured child, stress rises monumentally.

Collaborating can only ensure a product that meets the needs of all organizations.”

In 2011, the EMSC performance-measure data related to interfacility transfer agreements and guidelines-performance measures significantly improved. States were asked to achieve an 80 percent survey response rate. The data showed Continued on page 22

18

March 2012

NOMINATIONS COMMITTEE | Louise Hummel, MSN, RN, CNS, CEN, 2012 Chairperson

Are You Ready to Vote?

Meet the Candidates, Be Informed During the 2011 national ENA election, fewer than 5 percent of the membership voted for the numerous candidates for national office.

ENA members can improve that percentage. Learn about the candidates, be informed, exercise your right of membership and let your voice be heard.

Plan to vote in the 2012 national ENA election.

section of www.ena.org and clicking on “Update my Member Profile.”

As initiated in 2011, only electronic voting will take place during this election; no paper ballots will be available. If you do not receive an e-mail message with your electronic voting access credentials information from Survey and Ballot Systems by May 18, please contact the executive services office at 847-460-4095 or execoffice@ena.org.

As an ENA member, you have demonstrated your professionalism and caring for the future of emergency nursing and the organization. Voting in the upcoming election is your way to voice your opinions, concerns and beliefs related to the organization. Act to increase the percentage of member participation in the election. Let your voice be heard in deciding the future of your organization. Vote!

The national Nominations Committee would like to encourage you to know the candidates for office. The 2012 ENA election process began in the fall of 2011 with a call for interested candidates. Potential candidates were provided with information to assist them in completing and submitting their applications. The completed applications were returned to the Nominations Committee, where they were reviewed and the information confirmed for accuracy. Based upon the candidate criteria described within the ENA bylaws, the committee then ratified a slate of 17 highly qualified candidates. The 2012 slate of candidates include: • Two candidates for the position of president-elect; • One candidate for the position of secretary/ treasurer; • Seven candidates for the position of director; and • Seven candidates for the three open region positions on the Nominations Committee.

During Leadership Conference 2012 in New Orleans, the ENA board of director candidates spoke and answered questions during the Candidates Election Forum held Feb. 25. Each board candidate was given For more than 25 years, TNCC has been providing cognitive, core-level the opportunity to present his or her vision of why the trauma knowledge and psychomotor skills experience in an interactive ENA membership should elect him to her to represent format. The TNCC course will provide a systematic standardized our organization. Leadership Conference attendees approach to injured patient care. The hands-on psychomotor skill were also able to view a continuous video display of stations help you incorporate cognitive knowledge into application of the candidates during exhibit hall hours. New this year, skills in a safe practice environment.

ENA streamed the forum live at www.ena.org.

Each candidate’s biographical information is available Highlights Include: at www.ena.org; simply click on “Meet the Candidates” • Systematic standardized approach utilizing the A-I mnemonic link. For members who were unable to attend the • Pediatric, pregnancy and elder trauma conference, the audio/video files of each board • Initial assessment and shock candidate’s responses to the Candidates Election Forum • Spinal immobilization questions will be available for viewing at www.ena.org.

• Chest and abdominal trauma Each candidate’s biographical information will be • Opportunity to earn 14.42 contact hours printed in the May issue of ENA Connection. In addition, • Offers four year verification of your knowledge ENA members are encouraged to interact with the and skills upon successful completion individual candidates through ENA’s Facebook page, which can be accessed from www.ena.org.

Take the Course Today To be eligible to cast your vote beginning May 10, To verify why TNCC is right for you you must be an active ENA member in good standing and to view course schedules, visit as of May 1, 2012. Members are encouraged to verify www.ena.org/coursesandeducation. with national ENA that their membership status is current before the May 1, 2012, deadline.

The Emergency Nurses Association is accredited as a provider of continuing nursing Members should also verify that their most current education by the American Nurses Credentialing Center’s Commission on Accreditation. e-mail address is correct, as you will receive your voting credentials via e-mail. Verification of your e-mail address can be performed by logging into the members-only

Trauma Nursing Core Course Designed for Nurses by Nurses

Official Magazine of the Emergency Nurses Association

19

The AEN Eminence Program The Academy of Emergency Nurses is proud to report its fourth group of mentors and mentees is currently working on projects for the 2011-2012 program. The EMINENCE program is designed to pair ENA members with experienced Academy fellows. AEN fellow mentors volunteer their time and talents to work

with up-and-coming ENA members. This provides a wonderful opportunity to share knowledge and experience with the next generation of emergency nurse leaders.

Applicants submit project descriptions and are matched with fellows who have expertise in the subject matter. Projects topics

include professional presentation, writing for publication, research, educational conference planning and program development. Participating mentees pay a $100 administrative fee.

The mentee/mentor pairs in the 2011-2012 program are:

Mentees:

Mentors:

Area of Interest:

Teri Arruda, DNP, RN, FNP-BC, CEN Christian Burchill, PhD, RN, CEN Maha Habre, BSN, RN, CEN Richard Haley, BSN, RN, EMT Abigail Hasan, RN, CEN Cyndy Martinez, RN, CEN Denise McCloskey, BSN, RN Sharon Schultz, MS, RN, CEN Leigh Anne Schmidt, MSN, RN Teresa Short, MSN, RN, CEN Lynn Visser, BSN, RN, CEN

Harriet Hawkins, RN, CCRN, CPN, FAEN Gordon Gillespie, PhD, RN, PHCNS-BC, CEN, CPEN, FAEN Margaret McMahon, MN, RN, CEN, FAEN Tomi St. Mars, MSN, RN, CEN, FAEN Vicki Sweet, MSN, RN, CEN, CCRN, FAEN Patricia Clutter, MEd, RN, CEN, FAEN Joan Somes, PhD, MSN, RN, CEN, CPEN, FAEN Jean Proehl, MN, RN, CEN, CPEN, FAEN Vicki Sweet, MSN, RN, CEN, CCRN, FAEN Ruthie Robinson, RN, PhD, CEN, FAEN Andrea Novak, PhD, RN-BC, FAEN

Professional Presentations Research Program Development Disaster Management / Research Writing for Publication Professional Presentations Writing for Publication Writing for Publication Writing for Publication Writing for Publication Professional Presentations

If you would like to be part of the EMINENCE program in 2012-2013, watch for application information which will be available in ENA Connection and posted in mid-March at www.ena.org/about/academy/EMINENCE/Pages/Default.aspx. Applications are due April 30.

Other Connection Cover Contest Entries Members of the Children’s Transport Team of Atlanta: (bottom row, from left) Daniel Huang, RT; Dawn Croft, RRT; Marvin Doleman, RT; Toni Rock, PMDC; PK Bhagat, RT; Keith Croft, RT; Valina Ramsey, EMTI; Lisa Campbell, RN; Julie Vitoria, RN; Amy Callis, RN; Kenya Teems, RT; John Kapawanna, EMTI; Steven Hill, EMTI; Dewayne Joy, RN; Tina Frey, RN; Chasity Corrao, communication specialist; (top row, from left) Cyndi Roberson, RN; Marisa Cotter, RN; Matthew Preston, PMDC; Karina Clarke, RN; David Fancher, PMDC; Dawn Jones, PMDC; Richard Brumbelow, PMDC; Jason Radford, PDMC; Bill Lester, EMTI; Eric Frazier, PMDC; Steph Hood, PMDC; Kimberly Boykin, PMDC; Michelle Moreno, communication specialist; Grant Reynolds, RN; Stacey Mathis, RN; Jeff Hackney, PMDC; Alan Walworth, PMDC; Gary Canning, RN; Rico Poole, EMTI; David Ellis, PMDC; Lisa Davis, PMDC; Chuck Weske, PMDC; Pat Myatt, RN; Brian Buxton, RN; Sakina Mahama, PMDC; Tommy Benefield, PMDC; and Jonathan Langham, PMDC. Members of the St. Vincent Critical Care Transport team in Indianapolis (from left): Kimber Blakeman, RRT; Ron Pyle, DO; Mandy Gwinnup, BSN, RN, CEN, C-NPT; Melissa Jubenville, EMT; Bonnie Mercer, RN, C-NPT; John Clark, NREMT-P, FP-C, CCP-C; Matthew Petro, EMT; Katie Gott, RRT; Brandi Riley, RRT-NPS; Rachel Snellenbarger, RRT-NPS; Doug Beck, EMT-P; Stephanie Deckard, RN; Elizabeth Romano, MSN, RN, C-NPT; Kathy Watson, RN, C-NPT; Brad Boone, RRT-NPS; Doug Bish, EMT.

20

March 2012

Spotlight on

Member Benefits and Resources

Now Available: Three NEW Emergency Nursing Resources ENA develops Emergency Nursing Resources to bridge the gap between research and everyday emergency nursing practice. Three new ENRs have just been added: Difficult IV Access, Non-Invasive Temperature Measurement and Wound Preparation. To access these new resources, visit www.ena.org/ienr.

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.

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.

competency testing information. To learn more, visit www.ena.org (you will need to log in as a member).

Mosby’s Nursing Skills: ENA Edition

emergency skills each quarter, including competency, testing information, skills demonstrations/step-by-step instructions and checklists. To learn more, visit www.ena.org (you will need to log in as a member).

Mosby’s Nursing Skills provide 20 new

Here’s the Real Deal Gather a group of five or more new members, and save money on membership dues.

That’s right—a group membership will save you money and still give you all the great benefits that ENA membership offers.

ENA Group Membership

• Group discount rate applies to registered nurses only • A group must consist of five or more new members • Membership recruitment materials are available through Member Services • Here’s the BIG BONUS: renewing members can take advantage of the group rate! Call for details.

Group memberships must be pre-approved.

Contact Member Services at 800-900-9659 to obtain an authorization letter, to qualify for the group rate.

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

Mosby’s Nursing Consult: ENA Edition Mosby’s Nursing Consult offers users practice guidelines, FDA drug updates, evidence-based nursing monographs, skills demonstrations and

Official Magazine of the Emergency Nurses Association

21

ENA STATE CONNECTION 13th Annual Southeastern Emergency Nurses Seaboard Symposium Submitted by Sandy Dudek, RN, CEN, Presessions: May 2-3 SESS Conference: May 4-6 The Southeastern Seaboard Emergency Nursing Symposium is one of the best known annual regional emergency nursing conferences. The state councils of Georgia, South Carolina, North Carolina and Virginia are the hosts. Join more than 300 emergency nurses, managers, directors, educators and guests at the Sheraton Norfolk Waterside Hotel at 777 Waterside Drive, Norfolk, Va. The conference offers four concurrent tracks: leadership, clinical issues, forensic and the new pediatric track. Presessions include preparation courses for the certified emergency nurse, certified pediatric emergency nurse and sexual assault nurse examiner exams, and customer

service courses.

The goal of the symposium has always been to present quality educational offerings.

Each year, we have national ENA leaders and speakers from across the country to offer best practices and present state-ofthe-art concepts.

Be sure to make plans to join us on the American Rover sunset cruise on May 4. Purchase tickets when you register.

Our famous theme party, scheduled for May 5, will be Cinco de Mayo. There will be an opportunity to send your colleagues to jail, so bring plenty of bail money.

Visit the exhibit hall to meet the companies who help to support this conference. Our participants enjoy the great information,

handouts and samples that they have to offer.

For exhibitor information, please contact Andrea Novak at Andrea.novak@southeasternseaboardsymposium.com.

For additional information, or to view the video from last year’s SESS party, visit www. southeasternseaboardsymposium.org.

We look forward to seeing you all in Virginia.

Improving the Safety of Children Continued from page 18 that 68.7 percent of responding hospitals have written interfacility transfer guidelines that cover pediatric patients and include specific components of transfer, and 59.4 percent have written interfacility transfer agreements that cover pediatric patients. 4 “There is still work to be done, and we are excited that there are people who are interested and willing to put forth the effort,” Fendya said. “This collaborative toolkit is hoped to provide tools for ED nurses and trauma nurse managers to ensure that all pediatric patients and their families are safely and expeditiously transferred to facilities with appropriate resources when pediatric specialty resources are needed.”

ENA LEADERSHIP CONFERENCE 2013 F O R T L A U D E R DA L E , F L

FEBRUARY 27 – MARCH 3

Call For

Poster abstracts

References 1. Emergency Nurses Association Position Statement: Care of the Pediatric Patient in the Emergency Setting.

(2007). Retrieved from www.ena.org/SiteCollectionDocuments/Position%20Statements/ PediatricPatientEmergencySetting.pdf 2. Emergency Medical Services for Children: Program Activities. (n.d.). Retrieved from bolivia.hrsa.gov/ emsc/ProgramActivities.aspx 3. EMSC Performance Measures 76 and 77: Making Transfers Work for Critically Ill and Injured Children. (n.d.). Retrieved from www.childrensnational. org/files/PDF/EMSC/ForGrantees/Performamce_Measures_Fact_Sheet_76and77.pdf 4. 2010 – 2011 Grant Year Performance Measures.

(2011). Retrieved from www.nedarc.org/performanceMeasures/nationalData201011GrantYear. html

Research and evidencebased Practice Projects Don’t miss this opportunity to showcase your work on emergency department management, leadership and research

SubmiSSion DeaDline  auguSt 1, 2012 LC13_CallForPosterAbstracts_ConHPIsland.indd 1

22

2/14/2012 9:36:06 AM

March 2012

BOARD WRITES | Matthew F. Powers, MS, BSN, RN, MICP, CEN

Ground Critical Care Transport:

Is It for You? I remember the days as a critical-care transport nurse, both air and ground. Ground critical-care transport exploded in the early 1990s with services to transport patients requiring a higher level of care and specialization of services. CCT nursing is a definite specialty and often a lonely one. This specialty is for someone who can make independent life-saving decisions and feel quite comfortable with his or her knowledge and skill set.

This field of nursing can be both mentally stimulating and quite dreary, with periods of downtime. Usually the ground CCT RN is an employee of an ambulance company, but there are also opportunities on hospital-based teams comprised of physicians, nurses and respiratory therapists. Transport companies offering CCT services often hire a CCT RN to work alongside a single emergency medical technician or a team of EMTs. Because of the autonomy involved in making

offline medical direction decisions based on pre-established protocols, many CCT RNs have been trained and are competent in advanced airway procedures; chest and feeding tube care; cardiac rhythm identification; respiratory ventilation settings; and operation and balloon pump monitoring, to name a few.

In the day of interfacility transport, EMTALA requirements must be confirmed by the CCT RN to avoid any surprises by the receiving hospital.

Always have the documentation in hand for the receiving facility. Specifics include receiving physician, room or department and contact phone numbers. Always have your offline medical orders signed by the sending physician.

Because of the existence of electronic charting between different facilities within the same organization, always ask for a printout of the patient’s recent care, history, medications, etc., in the case of having to divert to a non-network hospital for any unexpected emergency or

decline in the patient’s condition.

If you are thinking about becoming a ground CCT RN, here are a few tips: Consider the company’s reputation, hours, call volume, transport distances, benefits, workman’s compensation benefits and, most important, malpractice. Know your abilities and level of comfort. Since many transport patients are very sick or injured and are transferred between critical-care departments, such as intensive care, coronary care and emergency departments, I recommend that CCT RNs have experience in these areas.

There are specific training programs for CCT RNs. More information is available at www.astna.org (Air & Surface Transport Nurses Association). I also recommend Critical Care Transport by the American Academy of Orthopaedic Surgeons.

Good luck in your new specialty!

Deb Zirkle, ENA Director of Online Services

… To Easily Update Your ENA Profile Have you recently moved or gotten married?

Did you change your e-mail address? Is your membership going to expire? Any of these could cause an interruption in delivery of ENA Connection, The Journal of Emergency Nursing or important information from ENA if your profile is not current to reflect those changes.

The good news is that updating your profile is easier than ever.

On the ENA home page, www.ena.org, log in at the upper left ‘‘sign in’’ box.

• First time logging in to the ENA site? Your login will be the primary e-mail address we have on file and your ENA member number.

You will be prompted to change your password upon your initial login, and you can choose any password you like.

• Returning to log in? Simply enter the primary e-mail address we have on file for you and your password.

• You’ll be successfully logged in when you see “Welcome” and your name.

Under your name, you will see the remaining length of your membership; below that will be a link reading “Update your member profile.”

Click on the “Update your member profile” link to go directly to your profile page, where you can make updates to your personal demographic information, change your password, renew your membership and even print your ENA membership card. The entire process is secure, so you can renew or update with confidence.

If your membership has lapsed or if you’re

Official Magazine of the Emergency Nurses Association

joining ENA for the first time, you can still use the ENA online process by clicking the “Membership” tab and selecting “Join/Renew Membership” from the left-hand navigation menu. New members must create an account.

Returning or lapsed members must enter their login information. Forgot your password? You can easily retrieve it. Not sure if you already have an account with ENA? No problem—the database will check your e-mail address, verifying if you already have an account.

Update your profile now and stay informed!

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

23

COURSE BYTES |

Check Out eCourse Ops With the anticipation of the ENPC 4th edition rollout, ENA would like to announce the pricing of the ENPC 4th edition manuals. The provider manual has been completely redone with updated and expanded content. Extensive development of the manuals provides new information supporting research-driven practice.

The instructor supplement has been updated with all of the new and updated material and additional instructional information.

The price of the ENPC 4th edition provider manual will be $60.

The ENPC 4th edition instructor supplement will be available in a downloadable format and has member and nonmember pricing: The price for instructors who are members will be $30.

The price for instructors who are nonmembers will be $60.

ENA truly values all of the ENPC instructors and hopes that this attractive member pricing will encourage more instructors to take advantage of the many benefits available to ENA members.

then, 32 percent of the processed course applications have been added by the course directors through eCourseOps. If you are a course director and have not yet had a chance to use eCourseOps, please log in to www.ena.org and choose “eCourseOps” from the dropdown menu under “Courses & Education.” You will be able to view all your courses, invoices and credits, as well as manage your courses and pay invoices. There are help documents on the eCourseOps landing page to assist you, as well as a webinar.

New functionality is being developed and will focus on the needs of the state chairpersons to view the courses in their states, as well as enhancing a few of the current features.

We continue to thank our Course Director Focus Group for providing the oversight and direction that made this project a success.

Correction to TNCC Slide The instructor notes on slide seven of Chapter 14 has been corrected to match the information provided in the TNCC provider manual on page 251. The corrected slide is available in the Course Directors Only section of www.ena.org.

Please note this correction on page 156 of the TNCC instructor supplement as well.

Usage Continues to Grow

Course Scantron Form Now Includes E-mail Address

The new eCourseOps course management system was launched November 27, 2011. Since

Please note that there is now a place available on the top of the scantron form for the course

participants to write in their e-mail address.

Please encourage your students to neatly print their e-mail addresses so that ENA can more easily communicate with them. This will also help the students locate their information at www.ena.org if they choose to create a profile.

This will also assist ENA in providing complete course information for a student.

2012 State Trauma/Pediatric Chairperson Conference Calls We are pleased to announce the 2012 quarterly state trauma/pediatric chairperson conference call dates and times. These calls have been very well-attended and productive, and we look forward to another year of continued collaboration. Calls will take place at 3 p.m.

Central time on May 9, Aug. 8 and Nov. 7.

Dialing instructions and agendas will be emailed to all state chairpersons with a copy to the state presidents approximately one week before the scheduled date. Please e-mail Maureen Howard at mhoward@ena.org with requested topics for discussion.

Your Input Is Welcome Coursebytes is the official communication to all TNCC, ENPC and CATN course directors and instructors. Send topic ideas for future issues and feedback to CourseBytes@ena.org.

IOM Recommendation 1 Continued from page 14 For the Office of Personnel Management: Require insurers participating in the Federal Employees Health Benefits Program to include coverage of those services of advanced-practice registered nurses that are within their scope of practice under applicable state law.

24

For the Federal Trade Commission and the Antitrust Division of the Department of Justice: Review existing and proposed state regulations concerning advanced-practice registered nurses to identify those that have anticompetitive effects without contributing to the health and safety of the public.

Reference Robert Wood Johnson Foundation (2011).

Recommendation 1: Remove scope-of-practice barriers. Retrieved at /thefutureof nursing.org/ recommendation/detail/recommendation-1 on August 8, 2011.

March 2012

Recruitment Ads

Recruitment Ads

Recruitment Ads