ENA Connection September 2012

the Official Magazine of the Emergency Nurses Association

connection September 2012 Volume 36, Issue 8

You’re Vital Giving Voice to the Issues Near Your Heart to Change Outcomes in the ED and Beyond Government Affairs and Advocacy Section, Pages 8-23

INSIDE

FEATURES

Social Media: The Way to Join the Conversation PAGE 4 2012 Treasurer’s Report PAGE 6 ENA Nurse Finds a Home Among the Homeless PAGE 26 The Right Nursing Shoes Make All the Difference

PAGE 32

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Stryker is proud to be an ENA Strategic Sponsor and support nursing excellence through important initiatives such as the ENA Workplace Injury Prevention Toolkit and the ENA Lantern Award. Program Criteria for the ENA Lantern Award funded, in part, by Stryker.

Dates to Remember Sept. 30, 2012 Deadline to apply for first ENA State Council and Chapter Innovation Grants.

Oct. 1, 2012 Deadline to apply for ENA Foundation industry-supported research grant.

Oct. 8, 2012 Course proposal deadline for those seeking to be selected as faculty for 2013 Annual Conference in Nashville, Tenn.

ENA Exclusive Content PAGE 6 2012 Treasurer’s Report PAGES 8-23 Government Affairs and Advocacy Section 8

Board Writes: Workplace Violence Legislation Passes in Nebraska

10 Health Care Reform and Its Effect on the ED Nurse Case Manager 11 Be Ready and Informed on Nov. 6 12 From the ENA Emergency Department Psychiatric Care Committee 14 ENA Resources and Programs to Put Advocacy at Your Fingertips 16 Safety Net Coalitions Work to Keep the Nation Strong 18 Workplace Violence: OSHA’s Toll-Free Hotline 19 What, You’re Leaving?

I’m Not Ready For You to Go 20 The Joint Commission Bringing Patient Flow to New Level of Performance 22 Washington Watch PAGE 26 Home Among the Homeless: An ENA Nurse’s Right Turn in Albuquerque PAGE 28 Health Care Worker Fatigue: Safety Concern Becomes 2012 Proposed Resolution PAGE 32 Code You: Picking the Right Nursing Shoes PAGE 33 ‘Speak Up’ Cartoons: A More Animated Approach to Educating Your Patients

Monthly Features PAGE 4 ENA Connected PAGE 24 Pediatric Update PAGE 30 From the Future of Nursing Work Team PAGE 34 ENA Foundation PAGE 38 Ready or Not? PAGE 40 State Connection PAGE 42 CourseBytes PAGE 44 Nominations Committee PAGE 45 Member Benefits and Resources PAGE 45 Board Highlights

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

Advocating to Make a Difference Emergency nurses advocate every day — for individual patients and for each other.

As the health care system undergoes major changes, nurses have become health policy advocates as well. As the American Nurses Association recently put it, ‘‘Nurses occupy the place where health care policy meets patient care reality, making them powerful agents for innovation and change.’’ At the 2012 ENA Annual Conference this month, the Anita Dorr Memorial Lecture and Luncheon attendees will hear from a keynote speaker who has advocated on behalf of nurses everywhere by raising awareness among nurses, legislators and health care administrators of the importance of needlestick prevention. Karen Daley, PhD, MPH, RN, FAAN, the ANA president, is a nationally recognized advocate for legislation mandating the use of safer needle devices in health care practice settings.

Her presentation on needlestick prevention and her own story will be an exciting opportunity to learn more about the importance of advocacy and how it can strengthen our profession.

It’s been said that ‘‘it is not enough to be compassionate — you must act.’’ I believe that many of us would like to advocate on a broader level and have their voices be heard but don’t necessarily know where to start or how to get involved.

ENA’s government affairs program is here to provide you with the proper tools and resources to help you become an effective advocate. In this issue, you will find information on ENA’s Violence in the ED Advocacy Packet, ENA’s Legislative Action Center and much more. You also can join ENA’s Action Network to receive important updates on how you can speak out on important issues of interest to ENA and our profession. Familiarize yourself with ENA’s public policy statements and agenda and stay up-to-date on today’s health care concerns and legislative issues by reading the Washington updates. All of these services are available online to support you in becoming active to influence change on health care issues that matter to you and to ENA. Discover where your passion lies. Is it advocating for our own colleagues, for safer needles or safer

Official Magazine of the Emergency Nurses Association

emergency departments, because you have sustained an injury and want to make sure it doesn’t happen to others? Is it advocating for people who have been sexually assaulted? Is it advocating for invisible victims of human trafficking? Safe care for patients during air transport?

ENA’s mission is to advocate for patient safety and excellence in emergency nursing practice, and we do our best to achieve this goal through our 50 state councils and more than 170 local chapters nationwide.

Advocacy is critical to the success of our organization.

As an organization that is committed to expanding advocacy opportunities in emergency health care policy as part of our Strategic Plan, ENA addresses current emergency nursing practice concerns by meeting with governmental and regulatory officials, issuing position statements, initiating or supporting legislation, providing legislative and regulatory testimony and serving as a national network for mobilizing its members and providing educational pieces in its publications.

ENA can facilitate emergency nurses coming together to do what we could never do individually.

For example, we hosted a very successful first Workplace Violence Prevention Summit this past June, in which attendees were able to listen to, and talk with, representatives from the Occupational Safety Health Administration, the National Institute of Occupational Safety Health, the Joint Commission and the International Association for Healthcare Security and Safety.

ENA is excited to announce that beginning in January 2013 there will be a new opportunity for you to receive more grassroots advocacy, government affairs, media and public affairs training. The first annual Emergency Nursing Advocacy Intensive workshop will take place Jan. 10-12 in the Chicago area, hosted by ENA for state and chapter leaders and ENA state legislative chairs. It will address government-affairs advocacy, leadership training and public relations skills, with a reception at the ENA Continued on page 36

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ENA CONNECTED |

Thomas Barbee, ENA Digital Marketing Manager

Social Media: The Way to Join the Conversation For better or worse, sites such as Facebook, Twitter and Foursquare have made it into our everyday lexicon, even for those who aren’t active users themselves. It may seem like a waste of time with all the games such as “Farmville” and “Words With Friends” that have gained some semblance of notoriety in the news. But even for the simplest tasks, social media promote two things: a sense of community and the opportunity to network.

Now, more than ever, we are connected with each other. As ENA members, you have the opportunity to connect with others through our social media channels. You will be able to experience this firsthand this month at the “ENA Wired” lounge at 2012 Annual Conference in San Diego, where there will be a hotspot to allow you to tweet or update your Facebook status to keep your colleagues back home in the loop.

We at ENA know what a key role networking plays in your lives. While it’s one of the reasons our conferences are so vital to you, we also know the importance of continuing the conversations beyond conference.

The ENA Facebook page currently has about 17,000 ‘‘likes,’’ or people following the page, with more than 20 countries represented. Just think about this: By merely ‘‘liking’’ the page and interacting, you have a

ENA Connection is published 11 times per year from January to December by: The Emergency Nurses Association 915 Lee Street Des Plaines, IL 60016-6569 and is distributed to members of the association as a direct benefit of membership.

Copyright© 2012 by the Emergency Nurses Association. Printed in the U.S.A. Periodicals postage paid at the Des Plaines, IL, Post Office and additional mailing offices.

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

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

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resource at your fingertips to communicate with a wide range of users with vastly differing experiences and knowledge.

For Twitter, we will have an official hashtag for conference (#ENAAC12) that will allow attendees to share their experiences with other attendees and back home. If you follow ENA (@ENAorg) on Twitter, you even have the opportunity to see live updates that we post directly to your mobile device.

Let’s be honest — there’s definitely an element of fun to social media as well, and you will have plenty of opportunities on that front at Annual Conference with our integration of Foursquare. Not only will you be able to ‘‘check in’’ for prizes, but you also can ‘‘check in’’ to select restaurants and other establishments in the area to receive special deals.

All of these tools are means for creating a better experience for you, our members.

Providing unlimited networking opportunities allows us to achieve our goal of ensuring that you get the most out of your ENA membership.

For demonstrations or questions relating to social media — or if you just want to say hello — you can find me at the ENA Wired social media lounge at Annual Conference. I look forward to seeing you there!

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 (Ellie) 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, LP.D., RN, CEN, FAEN

September 2012

2012 Treasurer’s Report

By Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN 2012 ENA Secretary/Treasurer ENA’s financial results for 2011 were strong, again exceeding the growth rate of the U.S. economy. Revenue increased in each of our three major sources, and effective cost management helped achieve profitable results from operations. Table 1 shows the Statement of Activities, and the following discussion refers to that statement.

Our revenues rose nearly 5 percent overall in 2011, increasing more than $727,000 to $16,815,276. We achieved growth in all three major activities: membership dues, course revenues and conferences. Membership continued to grow in 2011, adding 1,406 members for a total of 39,544 members at the end of 2011. As a result, membership dues revenue increased $123,000 to $3,469,227. At press time, membership had reached 40,318.

Course revenues grew 6 percent, as about 64,000 nurses took our TNCC or ENPC courses. Attendance and exhibitor participation at our conferences continued to grow. Our Leadership Conference in Portland attracted 1,246 nurses, a 7 percent increase from 2010. The Annual Conference in Tampa drew 2,655 nurses, 6 percent more than the 2010 conference. Exhibit space decreased 4 percent for Leadership Conference but increased 7 percent for Annual Conference.

Operating expenses for 2011 totaled $16,540,515, higher than 2010 by about $964,000, or about 6 percent. The largest expense increase was for wages and benefits, where filling key management and staff roles to improve services to members and development of courses were the key outlays. Significant expense increases were seen for conferences, where:

TABLE 1

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(1) travel costs to Portland for Leadership Conference were much higher than to Chicago in the previous year, and; (2) improvements to food provided at both conferences increased costs. Another important expenditure was incurred to provide access to Mosby’s Nursing Consult to all members as a benefit.

The strong revenue growth and managed expenses yielded net income from operations of $274,761, exceeding the 2011 budget target by $454,000. ENA’s investment portfolio generated good returns from dividends and interest, but some of the mutual funds in the portfolio lagged the general market, holding back overall growth in the value of the investments. Our net investment loss for 2011 was $82,839, which combined with our operating results led to an increase of $191,922 in ENA’s net assets.

Table 2, Supplemental Statements of Financial Position, shows our assets, liabilities and net Assets as of Dec. 31, 2011 and 2010. Our total assets were $18,568,025 at Dec. 31, 2011, an increase from a year earlier, when they were $17,975,978. Strong cash flow was the major reason for the increase, where favorable operating income and the absence of debt payments were the main contributors. You may recall that ENA paid off its mortgage in 2010, so more cash is available for advancement of our profession.

This balance sheet continues to demonstrate that we are in excellent Continued on page 30

TABLE 2

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Government Affairs and Advocacy Board Writes

Against All Odds: Workplace Violence Legislation Passes in Nebraska

By Karen Wiley, MSN, RN, CEN — ENA Board of Directors Passage of Legislative Bill 677, which increases the penalty for assaulting a health care professional in Nebraska, was a journey that began in 2006. That year, ENA conducted an informal survey of the 600-plus members of the General Assembly convened in San Antonio.

Between 96 and 98 percent of delegates responded that they had experienced either physical assault, verbal abuse or both.

At this time, the Nebraska Nurses Association was convening its House of Delegates. A group of nurses wrote a resolution to establish a task force of nursing organizations to study workplace violence experienced by Nebraska nurses. The resolution was approved, and the task force, which consisted of nurses from multiple health care organizations throughout the state, was key in advancing legislation.

In a collaborative effort, the Massachusetts Nurses Association graciously granted the use of its workplace violence survey tool to collect data on the frequency of workplace violence experienced by Nebraska nurses. The Nebraska Nurses Association placed the survey tool on its website for three months. The data was collected and reported at the Nebraska Nurses Association House of Delegates the following year. Once the data was released, nurses started to tell their stories of being punched and physically threatened, and of the increased frequency of verbal abuse by patients and their families.

In 2008, state Sen. Tim Gay introduced LB 787 after being approached by a nurse who was physically assaulted and left with permanent injuries. The person who assaulted the nurse was fined $15 and released.

Nurses and hospital representatives from two of the largest cities in Nebraska testified in support of the bill. The task force worked with the Nebraska Nurses Association lobbyist to provide personal contacts and obtain senate support. However, senators expressed concern that there would be a need for a bill for each organizational work setting, and the bill never

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passed out of committee.

Discouraged but determined to inform the public that violence in health care settings was becoming more frequent, the task force pressed on. To keep the issue alive, a resolution was reintroduced and adopted by the Nebraska Nurses Association House of Delegates. The resolution advocated for environmental safety in all health care settings for supporting legislation that provides protection for all health care providers. It also included support for education and training in prevention and management of workplace violence.

As a result, the NNA held a conference titled ‘‘Personal Terrorism: What Happens to Nurses When Physical Violence Strikes at Work’’ in 2010, with Sen. Lathrop as a keynote speaker.

This conference continued to keep the focus on both nurse and patient safety. In 2011, Lathrop

introduced LB 677 in the state legislature.

The ENA Emergency Department Violence Surveillance Study provided a picture of violence in health care across the nation. The data collected supported our claim that violence exists across the nation and is increasing.

Nurses came forward, stepping out of their comfort range, to speak before the Judiciary Committee. One of the nurses requested a penalty for assaulting a health care worker to be equal to the crime committed. The nurse told her story of being punched by a patient who was intoxicated, causing a gaping wound and a black eye.

State Sen. Brad Ashford, chairperson of the Judiciary Committee, acknowledged that hospital settings are becoming increasingly violent. He encouraged the full committee to move LB 677 to the floor.

In February 2012, Lathrop asked for mandatory sentences for those who assault health care providers. LB 677 was debated throughout the legislative session and passed with full legislative support. Included in the bill is a requirement that every hospital and health clinic shall display a printed sign that states: “WARNING: ASSAULTING A HEALTH CARE PROFESSIONAL WHO IS ENGAGED IN THE PERFORMANCE OF HIS OR HER OFFICIAL DUTIES WILL RESULT IN MANDATORY IMPRISONMENT.” The tipping point in the passing of LB 677 was the personal testimony from health care professionals. Also of significance, just before the final vote on the floor of the legislature, nurses from across the state contacted their senators and asked them to support the bill.

There are those who say that felony laws do not prevent the violence. This is true. Felony laws are a deterrent. They punish those convicted of a serious crime and reinforce society’s boundaries of what is acceptable behavior. When nurses are being assaulted and no arrests are made, Nebraska’s felony law supports their right to pursue justice.

September 2012

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Government Affairs and Advocacy

Health Care Reform and Its Effect on the ED Nurse Case Manager

By Hershaw Davis, BSN, RN — Member, ENA Government Affairs Committee

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Since the passage of the Patient Protection and Affordable Care Act in March 2010, the significance of the nurse case manager role in the emergency department has risen in conjunction with dramatic increases in interest in and movement toward accountable care organization models.

The central aims of an ACO are improving population health, engaging patients in making decisions and managing their care, improving safety and care coordination, guaranteeing compassionate and appropriate end-of-life care and eliminating waste. The hope is that quality of care will increase and costs will decrease.

But those results, while anticipated and certainly the primary intent of PPACA, are far from certain.

The goals of an ACO will be difficult to achieve if the organizational culture attributes poor performance to individual failure vs. flawed systems-implied incentive. In other words, if an ACO can meet certain performance standards and achieve a specific level of savings for an ‘‘episode of care,’’ the ACO then shares some of that cost savings.

In addition to operational challenges, newly developing ACOs are struggling culturally with the ‘‘across patient care setting’’ thinking that will become the new cornerstone of the high-quality reimbursement incentives that are part of the PPACA regulations. For example, the lack of reimbursement for 30-day readmission for certain conditions spawns a whole host of new challenges, including the need for better ways of anticipating and preventing readmission.

As the bridge between the financial and the clinical aspects of health care delivery, nurse case management will play a key role in involving providers in the most efficient and effective use of resources, as well as adherence to quality-based and bundled payment structures. Data from nurse case management activities can form the foundation for the structural and operational changes that will define financial success for health care organizations going forward.

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An effective nurse case management program can help health care organizations achieve the following: • Position the organization for changes under health care reform with coordination of care across the health care continuum; • Enhance quality of care with an interdisciplinary team focused on the progression of the plan of care; and • Increase payment and decrease costs by facilitating patient disposition in a timely manner.

In the ED, nurse case management has been used to help two populations that disproportionately affect the ED: frequent ED users and patients with complex medical and behavioral needs.

Frequent ED users have been the targets of health care reform proposals and hospital crowding interventions. Common assumptions about this group are not necessarily supported by data. Research has been conducted on this population’s demographics, acuity of illness and patterns of health care use. These users are a heterogeneous group along many data points and defy popular assumptions. Subgroups have not been sufficiently defined to allow clearly directed policy design, and many frequent users present with true medical needs, which may explain why existing attempts to address the phenomena have had mixed success at best.

Similarly, patients with complex medical and behavioral health may be more likely to use the ED for nonemergent care because of reduced access to primary care, or they have complex social, behavioral health or physical health needs that are difficult to address in traditional primary care settings. Extensive evidence shows that care management can reduce ED visits in these patients. One study found that case management was able to reduce the risk of ED visits for 98 frequent users over an 18-month period with a care management program.

Coupling housing assistance and care management led to a 24 percent reduction in ED visits in a group of homeless patients in another cohort study.

Another way nurse case management has been useful is the coordination of group medical visits at time of discharge. Group medical visits can be an efficient way to provide medical care and social support for patients with chronic illness. Although some have advocated the use of drop-in group medical appointments for patients with undifferentiated medical problems, little experience exists with this model in serving patients with complex behavioral and physical health needs.

Care management also seems to be a cost-effective means to improve psychosocial problems that are common among patients with frequent ED use. This appears to be true even for patients who are considered refractory to care. Although nurse care management is an important means to address some of the social and behavioral health issues of patients, providing medical care for those with both physical and behavioral issues presents additional challenges. Patients may have a variety of barriers that prevent them from accessing traditional primary care venues, particularly those settings that do not allow patients to walk in at their convenience.

Patients also may need intensive services during a personal crisis. Many patients are unable to afford even a minimal copayment that may be expected at time of a nonemergent outpatient visit and may choose to access the ED, where a copayment may not be required. Patients with difficult life circumstances also may be less likely to keep appointments.

Nurse case management will be critical for ACOs as well as facilities that will not be creating formal ACOs, but will be contracting for

September 2012

Be Ready and Informed on Nov. 6 Before going to the voting booth Nov. 6, make sure you know each candidate’s position.

ENA’s Legislative Action Center contains a comprehensive resource designed specifically to meet all your election 2012 needs, whether they are federal, state or local. From detailed candidate bios to voter registration services, from information about specific ballot initiatives to help in locating polling sites, all this can be found under the Elections & Candidates tab on the home page of the Legislative Action Center at capwiz.com/ena/home/.

The features include the following:

community-based components of care to provide services at the highest quality and lowest cost across the continuum. Case managers will serve as the links for coordinating health care delivery between the hospitals and external providers.

Nurse case managers will also work with patients and families to ensure the health care delivery pieces are in place so the patient can get out of the hospital and into the home or some other lessacute setting in a more timely fashion.

ED nurse case management will become an increasing necessity in order to increase quality and decrease cost at the gateway of care in many of our health care organizations.

• ZIP code and address-to-district matching for a list of congressional, statewide and state legislature candidates • Candidate biographical and contact information • Candidate position statements • Links to candidate meet-ups • Statewide ballot initiative information • Voter guide information. including key dates and deadlines, ID needed at the polls, and links to voting-machine descriptions and polling locations • Voter registration forms

In addition, for any of your federal legislators, look up their voting records on the issues of concern to ENA and the emergency nursing community. Go to your representative or senators’ homepages on ENA’s Legislative Action Center and click on the tabs Votes and Bills to see how they align with ENA positions.

Most important, VOTE on Nov. 6!

EMERGENCY NURSES:

Every Patient + Every Time = Making a Difference.

Emergency Nurses Week™ October 7-13, 2012

Emergency Nurses Day® Wednesday, October 10, 2012

References Baguhn, B. (2011). Cost and Quality. Health Care Financial Management, 65(12), 40-43.

Crane, S., Collins, L. Hall, J., Rochester, D., & Patch, S. (2012). Reducing Utilization by Uninsured Frequent Users of the Emergency Department: Combining Case Management and Drop-in Group Medical Appointments. Journal of the American Board of Family Medicine, 25 (2), 184-191.

Calle, E. & Rabin, E. (2010). Frequent Users of Emergency Departments: The Myths, the Data, and the Policy Implications. Annals of Emergency Medicine, 56(1), 42-48.

Meek, J. (2011). Affordable Care Act: Predictive Modeling Challenges and Opportunities for Case Management. Professional Case Management, 17 (1), 15-21.

Ruger, J. P., Richter, C. J., Spitznagel, E. L., Lewis, L. M. (2004). Analysis of Costs, Length of Stay and Utilization of Emergency Department Services by Frequent Users: Implications for Health Policy. Academy of Emergency Medicine, 11 (12), 1311-1317.

www.ena.org/enweek

AFFILIATES: Mexican Association of Emergency Nurses

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Government Affairs and Advocacy ENA Emergency Department Psychiatric Care Committee

Addiction: A Treatable, Chronic Disease of the Brain The ENA Emergency Department Psychiatric Care Committee follows the Office of National Drug Control Policy’s programs, which are relevant to ENA’s public policy approach concerning behavioral health. The ONDCP, created in 1988, advises on drug control issues, coordinates drug control activities and produces the annual National Drug Control Strategy.

Previously, the strategy primarily addressed federal criminal law on illicit drug use, manufacturing and trafficking, and drug-related crime and violence.

Committed to using science and research to inform policy decisions, the EDPCC notes that the 2012 National Drug Control Strategy seeks to be the nation’s blueprint, drawing on a more cost-effective, upstream focus to reduce drug use by addressing the public health and safety challenges of the 21st century.1 Currently, substance-use disorders are among the nation’s most serious health problems, affecting about 9 percent of Americans (i.e., more than 22 million people) who abuse drugs on a regular basis. SUDs, including alcohol and nicotine, are estimated to cost the United States more than $600 billion each year.2 Scientific research shows that ‘‘drug addiction is not a moral failing on the part of the individual, but a chronic disease of the brain that can be treated,’’ ONDCP Director Gil Kerlikowske said. ‘‘This is not my opinion,’’ Kerlikowske continued, ‘‘or a political statement open to debate — it is a clear and unequivocal fact borne out by decades of study and research … While smart law-enforcement efforts will always play a vital role in protecting communities from drug-related crime and violence, the federal government has remained clear that we cannot arrest our way out of the drug problem to a drug-free society through an enforcement-centric ‘war on drugs’ … Lost in this debate is the immense value of a balanced, compassionate and humane policy guided by science and the tenets of mental and behavioral health care.” 3 Recognizing that whether they are struggling with a SUD, anxious with a loved one’s addiction or distressed as a victim of drugrelated crime, millions of people in this country live with the devastating consequences of drug use, the 2012 strategy emphasizes drug-related

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health consequences. It focuses on ‘‘addiction as a disease and on the importance of preventing drug use, as well as providing treatment to those who need it, including those who are involved in the criminal justice system.

It emphasizes support for individuals who are in recovery from addiction, and it also points to research showing that each dollar invested in a scientifically based prevention program can reduce costs related to SUDs by an average of $18.” 1 The EDPCC suggests that the strategy’s balance of evidence-based public health and safety initiatives focusing on substance-abuse prevention, treatment and recovery can provide a foundation supporting emergency department collaboration with those community-based services that may mitigate the pressures on the ED. The strategy discusses the following: • Community prevention infrastructure as the foundation to an effective approach, recognizing that SUD problems are local and require locally driven solutions. Go to the ONDCP state and local information Web page (www.whitehouse.gov/ondcp/state-map) to find statistics on drug use in your area, learn about the prescription drug and drugged driving activities happening in your state and find grantees near you who are working to prevent drug abuse.

• Screening, Brief Intervention and Referral to Treatment as early intervention programs shown to improve health care providers’ awareness of a patient’s treatment needs, resulting in substantial cost savings to individuals, communities and the health care system at large. The federal government will continue integrating SBIRT into mainstream health care, highlighting model programs using SBIRT and promoting training opportunities for health care professionals.

ENA’s model SBIRT Alcohol Screening Toolkit can be found at www.ena.org/IQSIP/ SAFETY/INJURY%20PREVENTION/SBIRT/ Pages/Default.aspx.

• Criminal justice reform using drug courts is a proven, innovative public safety intervention for substance abusing non-violent offenders.

These courts successfully address the SUD treatment needs of the offender while still holding offenders accountable. Research

shows that this strategy ensures fairness, saves tax dollars, treats addiction and reduces criminal recidivism. See an article by Michael Ralph, RN, BSN, CPMHN, ‘‘The impact of crisis intervention team programs: Fostering collaborative relationships,’’ Journal of Emergency Nursing, Volume 36, Issue 1, Pages 60-62, January 2010, at www. jenonline.org/article/S00991767(09)00500-5/fulltext.

• Prescription Drug Abuse Prevention Plan, which focuses on education, monitoring, proper disposal and enforcement. National data show that in 2009, the 39,147 druginduced deaths exceeded deaths from motor vehicle crashes (36,216), and in 2010, one in four people using drugs for the first time began by using a prescription drug non-medically. To learn more about this epidemic problem of prescription drug abuse, go to www.whitehouse.gov/ondcp/ issues-info.

• Patient Protection and Affordable Care Act as the law requiring insurers to cover treatment for substance-use disorders the same way they would other chronic diseases.

Access to treatment under the law also allows health care providers to be reimbursed for their services. Go to www.whitehouse.gov/ ondcp/healthcare.

References 1. O ffice of National Drug Control Policy.

National drug control strategy, 2012.

Washington, D.C. Retrieved on June 25, 2012, at www.whitehouse.gov/sites/default/ files/ondcp/2012_ndcs.pdf.

2. Society for Neuroscience. Brain facts: a primer on the brain and nervous system, 2012. 7th Edition. Retrieved on June 25, 2012, at brainfacts.org/about-neuroscience/ brain-facts-book/.

3. Kerlikowske, G. Lifting stigma and celebrating recovery – remarks of ONDCP director as prepared for delivery at the Betty Ford Center, Rancho Mirage, Calif., on June 11, 2012. Retrieved on June 25, 2012, at www. whitehouse.gov/ondcp/news-releasesremarks/lifting-stigma-celebrating-recovery.

September 2012

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Plus, all A-SMART® Carts are manufactured to ISO 9001:2000 certified standards, and all full-size A-SMART® Carts come with double side-wall construction, stabilizing frame with bumper, soft-grip handles, swivel casters (two locking, one tracking), and ball bearing drawer slides as standard features.

Broselow® Pediatric Resuscitation System New 2011 Edition A Broselow® Pediatric Tape

When time and accuracy are crucial during a pediatric emergency situation, turn to the Broselow® System which is designed with children’s care and procedural accuracy in mind. Each color-coded System supplies you with all the medical dosage information (except for infusions) and size-specific equipment you need for your young patients’ emergency resuscitation requirements.

© 2012 Armstrong Medical Industries, Inc.

Breakaway Emergency Cart

Visit us at the ENA Show at Booth #424

The new-DUET The new-DUET™ is a completely self-contained suction unit with AC power supply, battery back-up, and internal charger. The new-DUET has a suction airflow of >30 lpm at the tip of the suction catheter and the reduced maximum vacuum recommendation for infant or child suctioning of 80-120 mmHg. The new-DUET features a light design (only 10.5 lbs.), and the handle is large and easy to grip.

Armstrong Medical 800/323-4220 • FAX: 847/913-0138 www.armstrongmedical.com csr@armstrongmedical.com

Government Affairs and Advocacy

ENA Resources and Programs to Put Advocacy at Your Fingertips Advocacy is more than just understanding the issues. To make a difference, you have to make your voice heard. The involvement of individual emergency nurses is vital to the success of ENA’s grassroots efforts. To assist you in your government relations activities, ENA provides the following services and information:

shopping for state and federal legislative and regulatory information. Found at capwiz.com/ ena/home/, it contains information on the important issues that ENA tracks. You can search state and federal databases by name, state, committee, or leadership, and send messages to your legislators directly from the site. The Action Center also includes such features as: • Template Letters, which are provided to send via e-mail or fax to your members of Congress or your state legislators on crucial policy issues.

• Sponsor Track, which attaches information on relevant bill sponsorship on the bio pages of members of Congress.

• A Vote Scorecard, listing every member of Congress and how he or she voted on bills of interest to ENA members.

• Congress Today, providing daily schedules of House and Senate activity including committee hearing schedules.

• Megavote, which provides a weekly e-mail on the voting patterns of your representative and senators.

• Detailed federal Campaign Contribution Data.

• Tell a Friend, which enables users to send Alerts, Votes and other legislative-related information to one or more ENA friends.

• A searchable Guide on National and Local Media including newspapers, magazines, and TV networks and stations; users can send e-mails, faxes or printed letters to newspaper journalists, radio talk show hosts and television commentators.

Advocacy Packets Advocacy Packets contain material to assist ENA members in developing collaborative strategies to educate colleagues and legislators on topical issues affecting emergency nursing.

The current topics include the following: 1. Procedural Sedation & Analgesia in the ED 2. Violence in the ED 3. M itigating Violence against Health Care Workers 4. Staffing in the ED 5. D eveloping Community Collaborations for Emergency Mental Health Services 6. R epealing the Uniform Individual Accident and Sickness Policy Provision Law 7. AED Usage in Gyms and Fitness Facilities.

The Advocacy Packets are available for downloading at www.ena.org/government/ Advocacy/Pages/Default.aspx.

E-mail Alerts The Legislative Action Center allows ENA to focus its E-Mail Alerts directly to those ENA members who reside in the state or district of the legislators ENA needs to target. These alerts provide strategic information to affect key policy issues of interest to ENA and emergency nursing. To receive ENA’s E-Mail Alerts, you must sign up on the homepage of the Legislative Action Center at capwiz.com/ena/ home/.

EMTALA Information Articles, frequently asked questions, slide presentations and other information on EMTALA (Emergency Medical Treatment and Active Labor Act) can be found at members.ena.org/ government/emtala/Pages/Default.aspx.

EN411 ENA’s Emergency Nurse 411 Program is designed to encourage its members to cultivate long-term relationships with federal legislators,

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convey ENA’s legislative and regulatory priorities in an effective manner and affect the outcome of federal legislation important to emergency nursing. The goal of the program is to have at least one ENA member assigned to each congressional district as well as to each senator – 535 appointments. For additional information on this key contact program or to complete an application, go to members.ena.org/ government/EN_411/Pages/Default.aspx.

Legislative Action Center ENA’s Legislative Action Center offers one-stop

Public Policy Statements and Public Policy Agenda ENA issues statements and the public policy agenda aimed at decision makers on a variety of public policy topics. These documents can be found at ena.org/government/.

Washington Update The Washington Update is ENA’s electronic newsletter on federal and state legislative and regulatory issues of concern to ENA members.

You can read/download the update as a PDF document at www.ena.org/government/ washington/Pages/Default.aspx.

September 2012

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Government Affairs and Advocacy

Safety Net Coalitions Work to Keep the Nation Strong

By Terri L. Nally, MS, BS — ENA Senior Public Policy Specialist Building and sustaining sturdy relationships through collaborations, partnerships, alliances or coalitions is one of the most important and cost-effective advocacy tools that ENA uses in its government relations portfolio. The advantage of the coalition strategy most recently is demonstrated in ENA’s joining with more than 3,000 other organizations to raise the visibility of the role of ‘‘nondefense discretionary’’ communities. From health and education, to food and transportation safety, to workforce and disease surveillance, to law enforcement and research, NDD United is a voluntary alliance of coalitions representing the full breadth of NDD communities.

NDD’s organizations are aligning their respective expertise to examine nondefense discretionary funding in the federal budget. By sharing knowledge, the united group has found that while NDD programs are core functions that government provides for the benefit of all, NDD funding represented less than 18 percent of the fiscal year 2011 federal spending, with discretionary health spending at only 1.7 percent of the total.

(See NDD United at publichealthfunding. org/index.php/ndd_united1/.)

With this finding, the group argues that NDD spending is a small and declining share of the federal budget, that NDD safety net programs are not the root cause of the nation’s fiscal crisis and that cutting them further will not bring the budget into balance but could jeopardize the economic growth and the safety and security of every American in every state and community across the nation served by NDD programs.

Clearly, working together in coalitions enhances the power of ENA, bringing a strength surpassing the capabilities of any one individual or organization. From the inventory below of the national-level coalitions to which ENA belongs and/or facilitates, imagine the credibility and value the diversity of skills and knowledge brings to the collaborative efforts of each alliance: ANSR Alliance (Americans for Nursing Shortage Relief), of which ENA is a founding member and co-facilitator, is one of the largest nursing advocacy partnerships on Capitol Hill, comprising 54 organizations. Among its 2012 activities, ANSR monitored the promulgation of the health care reform law, the Patient

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Protection and Affordable Care Act, which contained the Title VIII Nursing Workforce Development Programs reauthorization. ANSR is advocating for funding at $251 million in FY 2013 for the Title VIII programs and also is requesting $20 million for the Nurse-Managed Health Clinics. The alliance is reinforcing its advocacy by holding a briefing for Capitol Hill legislators and staff and organizing Hill visits.

ANSR also is investing in its future by carefully listening to the needs of coalition partners.

While committed to the ANSR mission, many ANSR members are small nursing organizations with limited advocacy capacities. To sustain the alliance, ANSR actively reaches out to members, creating win-win products, such as the recently developed ANSR Web page (www. ansralliance.org/index.html) that includes robust resources to assist ANSR members in their advocacy activities.

AED Coalition (Ad Hoc Coalition to Save Lives through Public Access to Defibrillation) is chaired by the American Heart Association and has more than 20 healthrelated organization members. This coalition lobbies for funds to invest in the HRSA Rural Access to Emergency Devices grants, providing support to rural communities. The funding prospects are sobering, as the RAED Program was excluded from the president’s proposed FY 2013 budget. In response, the coalition transmitted letters to Congress urging restoration of RAED to its FY 2005 level of $8.927 million when underserved communities in 47 states received resources.

CDC Coalition (www.cdccoalition.org) has more than 100 organizations, with the American Public Health Association serving as its secretariat. The coalition is committed to ensuring that CDC health promotion and disease prevention are given top priority in federal funding. While the president requested FY 2013 funding at $4.99 billion, the coalition submitted testimony to both chambers of Congress, contending that the agency will require funding of at least $7.8 billion. The coalition has met with appropriators, seeking strong funding during the sluggish economy when demands have increased for CDC programs. It also is monitoring PPACA’s Prevention and Public Health Fund.

Coalition for Patients’ Rights® was

organized to counter efforts by the AMA Scope of Practice initiative designed to limit patients’ choice of health practitioners. More than 35 organizations representing a variety of licensed health care providers have joined the CPR effort. In 2012 CPR expressed support for the Federal Trade Commission’s efforts to promote competition, access and choice in health care, and has advised the new Patient-Centered Outcomes Research Institute to examine the types of providers playing a role in providing treatments leading to quality outcomes.

Website: www.patientsrightscoalition.org.

Friends of EMSC (Emergency Medical Services for Children) is an American Academy of Pediatrics-driven organization with more than a dozen associations comprising its membership. It lobbies for funding for EMSC appropriations. The president’s FY 2013 proposal level-funded the EMSC program at $21.116 million. PPACA contained a five-year EMSC reauthorization with wording for appropriations in FY 2013 at $28.940 million, which is the investment Friends seeks.

Friends of HRSA (Health Resources and Services Administration), facilitated by APHA, is an alliance of more than 180 national organizations working to ensure that HRSA’s programs have sufficient support to rebuild the public health and health care infrastructure, reaching populations underserved by the nation’s patchwork of health services. Friends submitted testimony to Congress advocating $7 billion for HRSA for FY 2013, an increase over the president’s budget request of $6.171 billion.

Friends also has been meeting on the Hill and with HRSA leadership to nurture strong links with the agency and coalition member organizations.

Website: www.friendsofhrsa.org/.

Mental Health Liaison Group is a longstanding advocacy coalition on behavioral health issues comprising 87 organizations. ENA was elected to serve as the group’s secretary this year. MHLG is known for developing a consensus document of recommended appropriation levels for mental health and substance-use disorder programs of the Substance Abuse and Mental Health Services Administration and of the National Institutes of Health’s institutions, focused on MH and SUD research. MHLG is a leader, promoting efforts to adopt trauma-informed practices, as supported

September 2012

by SAMHSA and NIH research. MHLG’s portfolio of relevant behavioral health policy issues includes following Department of Justice programs, such as Enforcing Underage Drinking Laws. MHLG follows the House FY 2013 budget bill that seeks to cut Medicaid, the largest source of state funding for behavioral health services. States have cut behavioral health budgets by a combined total of $3.6 billion, eliminating crisis intervention and crisis stabilization programs. With few options left for responding to people in crisis, ENA works with MHLG to advance community-based services and practices, which help alleviate the pressure on EDs while providing appropriate, quality care. Website: www.mhlg.org.

National Violence Prevention Network is a broad coalition of public health officials, antiviolence organizations and law enforcement groups working to fully fund the National Violent Death Reporting System housed at the CDC. The system captures data critical to identifying patterns and developing strategies to prevent harm and save lives. The president’s FY 2013 request seeks $3.472 million for NVDRS, which is the same funding level as FY 2012.

NVPN submitted testimony to Congress

supporting a FY 2013 funding level of $5 million, allowing expansion beyond the 18 states currently participating in the program. Website: www.preventviolence.net/index.html.

Saferoads4teens Coalition (www. saferoads4teens.org), facilitated by Advocates for Highway and Auto Safety, was organized by insurance, consumer, safety, health and other organizations to advance passage of federal legislation, the Safe Teen And Novice Driver Uniform Protection Act. STANDUP urges all states to set the same minimum policies for beginning teen drivers via a state graduated driver licensing program. After years of organizing press conferences; drafting fact sheets, letters and e-mails; conducting media interviews; writing letters for local newspapers; meeting with congressional staffs and organizing grassroots contacts to Members of Congress, the coalition attained success with the passage of the Moving Ahead for Progress in the 21st Century Act, the multi-year surface transportation authorization bill. The bill essentially adopted the Senatepassed provision on the GDL incentive grant program, which is very similar to the STANDUP Act, without sanctions. The incentive program is funded at about $14 million.

Official Magazine of the Emergency Nurses Association

STOP Stroke Coalition, comprising nearly two dozen health organizations and facilitated by the AHA, supports the Stroke Treatment and Ongoing Prevention Act. The coalition successfully inserted STOP Stroke strategies into PPACA and now is working in the states to create inclusive and coordinated statewide systems of care. With poor and disadvantaged populations increasing as the wealth gap grows, the coalition also addresses disparities showing that minorities use EMS systems less, have longer waiting times in the ED and are less likely to receive thrombolysis for acute ischemic stroke.

Trauma Coalition, chaired by the American College of Surgeons, lobbies for increased funding for trauma and emergency care. The coalition interacts with the Department of HHS’s Office of the Assistant Secretary for Preparedness and Response, seeking development of Section 3504 of PPACA, creating four grant programs under ASPR: improving trauma care in rural areas; competitive grants for improving access and enhancing trauma care systems; regionalized systems for emergency care pilot program and formula grants for modifying state plans.

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Government Affairs and Advocacy

Workplace Violence: OSHA’s Toll-Free Hotline

By Terri L. Nally, MS, BS — ENA Senior Public Policy Specialist The U.S. Labor Department’s Occupational Safety and Health Administration urges employees to call OSHA’s hotline at 800-321OSHA (6742) to report workplace incidents, fatalities and situations posing imminent danger to workers, including violence-related matters. While OSHA has no specific standards for workplace violence, effective Sept. 8, 2011, the agency’s directorate of Enforcement Programs issued a directive providing instruction on ‘‘general enforcement policies and procedures for its field offices to apply when conducting inspections related to workplace violence .... The instruction is meant to provide guidance on both how an OSHA workplaceviolence case is developed and which steps Area Offices should take to assist employers in addressing the issue of workplace violence.’’ ‘‘Enforcement Procedures for Investigating or Inspecting Incidents of Workplace Violence’’ is the title of the OSHA instruction, directive number CPL 02-01-052.1 The directive is for OSHA compliance officers in responding to ‘‘incidents and complaints of workplace violence ... in industries considered vulnerable to workplace violence.’’ Health care is listed as one of the OSHAdesignated industries and is defined as ‘‘covering a broad spectrum of workers who provide health care and social services in psychiatric facilities, hospital emergency departments, community mental health clinics, drug abuse treatment clinics, pharmacies, community-care facilities, residential facilities and long-term care facilities.’’

According to OSHA, the health care industry has a history of workplace violence problems.

OSHA has been inspecting

health care settings and has been enforcing compliance relative to violations surrounding workplace violence as authorized under the Occupational Safety and Health Act of 1970. The OSHA Act’s General Duty Clause, Section 5(a) (1), requires all employers to provide their employees with a place of employment that ‘‘is free from recognizable hazards that are causing or likely to cause death or serious harm to employees.’’ The courts have interpreted OSHA’s general duty clause to mean that ‘‘an employer has a legal obligation to provide a workplace free of conditions or activities that either the employer or industry recognizes as hazardous and that cause, or are likely to cause, death or serious physical harm to employees when there is a feasible method to abate the hazard.’’

intimidation, bullying or other signs (i.e., gateway behaviors) presenting the potential existence for violence in the workplace.

Employer Strategies for Workplace Violence Another vital recognition in the OSHA directive is that ‘‘workplace violence is an occupational hazard which, like other safety issues, can

be avoided or minimized if employers take appropriate precautions.’’ Seeking to prevent violence, the directive cites a body of research providing frameworks for developing methods to minimize the likelihood of workplace violence. OSHA believes that ‘‘a well-written and implemented Workplace Violence Continued on page 31

Employer Recognition of Violence The September 2011 directive outlines that ‘‘employers may be found in violation of the general duty clause if they fail to reduce or eliminate serious recognized hazards … [OSHA] inspectors should therefore gather evidence to demonstrate whether an employer recognized, either individually or through its industry, the existence of a potential workplace violence hazard affecting his or her employees.’’ For example, demonstrating existence of employer recognition of the hazard may be evidenced with: • Journal articles and research showing the existence of workplace violence in the given industry.

• Media showing any employee informing the employer of the hazard.

• Employer awareness of any previous incidents, injuries or close calls related to workplace violence, including threats,

Are you a nurse who has practiced in an emergency care setting less than 5 years?

Then we have the event for you.

Invigorate Your Career at the Emerging

Professionals Networking Event sponsored by the ENA Career Center

Join us in San Diego, Thursday, Sept. 13 from 6:30-7:45 p.m. at the Marriott Marquis South Poolside.

Members and non-members are welcome to attend.

Cash bar and light appetizers will be served.

Sign up via ENA’s Facebook Event page, http://on.fb.me/N2yRp5

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Don’t miss out!

September 2012

Sept_Connection_Emgng_prof_final.indd 1

8/16/12 10:17 AM

What, You’re Leaving?

I’m Not Ready for You to Go

By Mary Leblond, MSN, RN, CEN, CA-CP, SANE Chairperson, ENA Government Affairs Committee In Texas this year, Sen. Kay Bailey Hutchison is resigning, along with Rep. Charles Gonzalez, who has been my assigned representative through the EN411 program (www.ena.org/ government/EN_411/Pages/Default.aspx).

I was stunned to learn of their upcoming retirements. I am not ready for them to leave and will have to give much thought to the

future. Over the years, it has become a comfort to visit the offices of Hutchison and Gonzalez.

Now I must begin anew, but I will treat this as an educational experience and an opportunity for professional growth.

What does it mean for your established representative to leave office, be it at the national, state or local level? Where do you

Celebrate 2012 Emergency Nurses Week™ with ENA products for staff as well as yourself!

The items shown are discounted by 10% for Emergency Nurses Week celebrations. To view the complete selection of ENA merchandise, visit ENA Marketplace at www.ena.org and click on the Shop tab.

MARKETPLACE AD

ORDER BY PHONE or ONLINE! Call toll-free 800-900-9659 (8:30 a.m. to 5 p.m., Central Time). Mention Emergency Nurses Week when placing your order for these items to receive a 10% discount. Go to www.ena.org/shop and click on the EN Week 2012 menu bar to purchase these discounted items. This offer is available through September 9.

ORDERING DEADLINES Orders must be placed by September 24 to ensure delivery before Emergency Nurses Week.

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Official Magazine of the Emergency Nurses Association

begin a new relationship with those who are elected to these positions, and how will you work with them? Begin by looking at the potential candidates.

First, go to ENA’s Legislative Action Center at capwiz.com/ena/home/. If you click on the Elections & Candidates tab on the LAC homepage and then go to ‘‘My Races,’’ you can see the candidates for each position in your national, state and local races. Examine profiles and explore the election centers at your state’s legislative website and at www.ena.org.

Online information is a useful tool, but it is also a good idea to see or meet candidates in person. Attending a town hall meeting or an election debate in your area is a common way to become familiar with each candidate. The ENA website can often direct you to locations of meetings or election debates. Candidates will be coming to your city or one close to you, as they need to be visible. Most campaigns will have contact peop[e to inform you about the next meeting place, their platform and where you can ask further questions. Seek out campaign websites and e-mail addresses.

The important thing to remember is that even if you cannot personally meet with the candidate, senator or representative, their health legislative assistants are your strongest connection. Once a relationship is established with the staff, they will remember you and contact you regarding questions related to health care, specifically those related to emergency care. Remember that you are the one with the expertise, you are the advocate for your patients, and you are knowledgeable about the emergency department and what happens there.

According to literature and personal experience, a face-to-face meeting is the most effective way of getting to know a senator, representative or staff member and making an impression. It is through direct interaction that you foster a relationship that continues through e-mails, phone calls, letters or faxes.

It is very rewarding to have a rapport established. Once you have a firm connection, you can send questions and inquiries about legislative issues, and the staff may in turn use your expertise as a resource for health care issues.

Even when it looks like change will be difficult, the prospect of meeting new politicians and starting new relationships can be challenging and energizing. The emergency nurse takes on new challenges, new approaches and solves new problems every day. This is just another part of what we do best: promote positive outcomes for our patients, whether it be stretcherside or as credible resources for our legislators.

7/9/12 9:52 AM

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Government Affairs and Advocacy Spreading the News

The Joint Commission Bringing Patient Flow to New Level of Performance

By Mindi Bowers, MSN, RN, MHA, CEN, and Denise Ellen Foster, MSN, RN, NE-BC Members, ENA Emergency Department Psychiatric Care Committee Crowding is an issue that most emergency nurses deal with on a daily basis. It is no secret that waiting for inpatient beds creates backup and delays that may seriously impact safety and efficiency. It is no secret that many people with mental health or substance-use disorders visit the ED as a means for accessing acute care. Most likely, someone is waiting for an inpatient medical or psychiatric bed in your ED. As emergency nurses, we strive for clear standards. For years, we looked for standards in patient flow, definition of time stamps and care of special populations.

The Joint Commission defines standard as ‘‘a principle of patient safety and quality of care that a well-run organization meets. A standard defines the performance expectations, structures or processes that must be substantially in place.” 1 The two recently revised TJC hospital accreditation standards related to patient flow in the ED now include patients with behavioral health emergencies.

According to TJC, patient flow in the ED is a patient safety issue, specifically boarding of psychiatric patients. The light is shining at the end of the tunnel.

TJC’s Standards Revisions to Address Patient Flow through the Emergency Department,2 released in May 2012, responded in part to recommendations developed by the ENA Emergency Department Crowding Committee and approved by the ENA Board of Directors. The revisions delineate

20

expectations of process improvement and community involvement as priorities in meeting the standards for managing flow through the ED. The newly revised standards will not be the cure correcting issues of crowding, patient flow and care of psychiatric patients in the ED. Yet they are one step toward helping everyone speak the same language and measure the same performance improvements. Each step will make a difference in advancing the care of our patients.

Effective Jan. 1, 2013, new elements of performance in TJC’s Standard Leadership LD.04.03.11 have language beyond measuring patient flow toward setting goals that includes throughput of areas where patients receive care, treatment and services (e.g., inpatient units, laboratories, operating rooms, pharmacies).

Additional language in this standard addresses the need to monitor the efficiency of non-clinical services (e.g., housekeeping, transportation).

Another revision in the LD standard improves processes when goals are not achieved. The revised language addresses the crisis of crowding, raising it to the hospital/organizational level.

Already there are a number of organizations leading in terms of patient flow. One best practice to address LD.04.03.11 may be to develop a hospital-wide patient flow committee whose members represent clinical and non-clinical areas. Another practice is to incorporate patient flow metrics

into the organizational performance targets. A crucial element of the leadership standard is having key leadership involved for decision-making authority and for holding all team members accountable.

LD.04.03.11 also contains elements of Performance 6 and 9 that address boarding in the ED by directing hospitals to set and measure mitigation and management goals with attention to safety and best practice. EP 6 defines boarding as the practice of ‘‘holding patients in the ED or another temporary location for four hours or more after a decision to transfer has been made.’’ EP 9 states that ‘‘when the hospital determines that it has a population at risk for boarding due to behavioral health emergencies, hospital leaders communicate with behavioral healthcare providers and/or authorities serving the community to foster coordination of care for this population.” EP 6 and 9 for LD.04.03.11 are effective Jan. 1, 2014.

Relative to actual care provided in the ED, standard PC.01.01.01, the Provision of Care, Treatment, and Services Chapter, addresses access to care that meets the patient’s needs. Revisions to this standard require hospitals that do not primarily provide psychiatric or substance abuse services to develop a written plan that defines care, treatment and services, as well as the referral process for those patient populations. The PC standard addresses the need for a safe and monitored environment

for boarded patients who are emotionally ill or who suffer the effects of alcoholism or substance abuse. Clinical and non-clinical staff orientation and training are required to provide effective care and treatment (e.g., medication protocols, de-escalation techniques) and regular assessment, reassessments and care must be delivered consistent with the patient’s identified needs.

Practices that may assist in meeting the new PC standard could include developing unit committees devoted to improving care of psychiatric patients, involving psychiatric nurse practitioners or specialists in the ED. The ENA ED Psychiatric Care and ED Crowding committees and others are devoted to advocating for safe and efficient care. While we do not have any magic dust to make our issues go away, TJC and other regulatory agencies have embraced patient flow performance standards that will impact the ED and may lead to positive outcomes for improving flow.

References 1. T he Joint Commission. Hospital accreditation standards. 2012: p. gl.-36.

2. T he Joint Commission.

Standards revisions to address patient flow through the emergency department. May 4, 2012. Available at www. jointcommission.org/ assets/1/18/Pre_Publication_ EDO_HAP.pdf. Accessed June 25, 2012.

September 2012

C-MAC® – Make your Video Laryngoscope a SYSTEM! A Single Instrument is not Airway Management

KARL STORZ Endoscopy-America, Inc., 2151 E. Grand Ave, El Segundo, CA 90245, USA, Phone: (424) 218-8100, Fax: (800) 321-1304, E-Mail: info@karlstorz.com KARL STORZ GmbH & Co. KG, Mittelstraße 8, D-78532 Tuttlingen/Germany, Phone: + 49 7461 / 70 80, Fax: 07461 / 70 81 05, E-Mail: karlstorz-marketing@karlstorz.de KARL STORZ Endoscopy Canada, Ltd., 2345 Argentia Road, Suite 100, Mississauga, Ontario, Canada L5N 8K4, Phone: (800) 268-4880, Fax: (905) 858-0933 KARL STORZ Endoscopia, Latino-America, 815 NW 57 Ave, Suite #480, Miami, Florida 33126-2042, USA, Telefono: (305) 262-8980, Telefax: (305) 262-8986 A-0112002

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© 2012 KARL STORZ Endoscopy-America, Inc.

Government Affairs and Advocacy WASHINGTON WATCH |

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

Sequestration and Implications for the Federal Budget While sequestration is a medical term as well as a term used in the science fields, it has been in the news lately because of its implications for the federal budget and for the array of services on which we rely.

In 1985, Congress adapted the term sequestration to explain a fiscal incentive designed to control the size of the federal government’s budget deficit. Sequestration was the automatic cutback on annual spending (i.e., appropriations) bills, which would be triggered if the total fiscal year appropriations passed by Congress were in excess of the limits Congress set for itself in its annual budget resolution.

Under sequestration, the dollar amount equal to the difference between the cap set in the budget resolution and the amount appropriated would be sequestered — that is, not distributed to the agencies to which it originally was appropriated by Congress. The Pay-AsYou-Go Act of 2010 is another sequestration procedure to ensure that the total of all net new mandatory spending, or tax cuts, is offset by an equal amount of mandatory spending cuts or revenue/tax increases. If the total shows net deficit reduction, there is no sequester.

However, if the net impact has aggravated the deficit, then a PAYGO sequester is imposed.

Today’s news items about sequestration arose last year as part of a deal between Democrats and Republicans to raise the debt ceiling and avoid the first U.S. default in history. In this bipartisan debt-limit compromise, Congress laid out a scenario for cost-cutting through the Budget Control Act of 2011 (P.L. 112-25).1 The statute established budget-enforcement mechanisms estimated to reduce federal budget deficits by a total of at least $2.1 trillion over the 2012-2021 timeframe.

One mechanism was to place caps on discretionary appropriations to decrease spending by an estimated $0.9 trillion during the nine-year period, compared with what such spending would have been if annual

22

appropriations had grown at the rate of inflation.

Another mechanism to yield at least an additional $1.2 trillion in deficit reduction was related to a Congressional Joint Select Committee on Deficit Reduction. That ‘‘super committee’’ was charged with proposing legislation to trim budget deficits by at least $1.5 trillion between 2012 and 2021. However, if that bipartisan group of legislators could not agree to a spending cut and tax revenue solution, automatic cutbacks would begin Jan. 2, 2013, of across-the-board sequestration of mostly discretionary spending. On Nov. 21, 2011, the super committee announced it was unable to agree on a legislative package of deficit cuts.

BCA provided that under sequestration, half of the discretionary cuts are supposed to come from defense, and the other half from non-defense discretionary spending, such as scholarships and loans for nursing workforce development, emergency medical services for children, rural health, mental health and research on violence in the workplace. If the full $1.2 trillion in automatic cuts goes into effect, funding for NDD programs in 2013 would face reductions of 7.8 percent, dropping each year to 5.5 percent in 2021, according to Congressional Budget Office estimates.2 A troubling element of sequestration is that government’s activities are profoundly interconnected to our daily lives. Maintaining economic health depends on some form of government service or activity. Other examples of the possible impact that a 7.8 percent sequestration cutback in FY 2013 could have on public health matters in various NDD agencies are: • The Food and Drug Administration’s evaluation of clinical trials or its oversight of prescription drug shortages would slow down with its 7.8 percent cut totaling $191 million.

• The Centers for Disease Control and Prevention would cut $445 million, a sum just under the $467 million currently supporting its Public Health Scientific Services on health statistics, surveillance, epidemiology and informatics that help track disease.

• The $29 million cut to the Agency for Healthcare Research and Quality would be equivalent to all the grants funded in 23 states in FY 2011.

• The Food Safety and Inspection Service, the public health agency in the U.S. Department of Agriculture, would furlough federal inspectors required to be on the premises when slaughterhouses, packing plants and poultry processing facilities are in operation.

The Bipartisan Policy Center released a white paper

September 2012

finding that ‘‘if the pending sequester is not addressed by Congress, it will weaken the economy, harm national security and do virtually nothing to improve the long-term fiscal condition of the United States …. The full defense and non-defense sequester cuts for just next year could — due to their arbitrary and abrupt nature — reduce U.S. gross domestic product by roughly half a percentage point in 2013 and cause more than one million jobs to be lost over the course of two years … [creating] a ‘reverse stimulus plan.’ ’’ 3 Sequestration does not appear to be a solid strategy for reducing the deficit.

Article prepared by Terri L. Nally, ENA senior public policy specialist.

References 1. T he Budget Control Act of 2011 (Public Law No: 112-25).

Available at www.gpo.gov/fdsys/pkg/PLAW-112publ25/ pdf/PLAW-112publ25.pdf. Accessed June 25, 2012.

2. C ongressional Budget Office, estimated impact of automatic budget enforcement procedures specified in the Budget Control Act, Sept. 12, 2011. Available at cbo.gov/ publication/42754. Accessed June 25, 2012.

3. B ipartisan Policy Center, Indefensible: the sequester’s mechanics and adverse effects on national and economic security, June 7, 2012. Available at bipartisanpolicy.org/ library/report/sequester. Accessed June 25, 2012.

From the States Kentucky Law Makes It Easier to Charge Those Who Assault ED staff: On July 12, a new Kentucky law (www.lrc.ky.gov/record/12RS/SB58.htm) went into effect regarding assaults in the emergency department. Previously, ED personnel injured by a patient or other person would need an arrest warrant issued, unless a police officer had been in the room and saw the incident. After July 12, a peace officer who has probable cause to believe that the person being arrested has violated the law can make the arrest without a warrant. KY-ENA was instrumental in the passage of the legislation, particularly Linda Robinson, RN, CEN, CFN.

Download Advocacy Packet on Mitigating Violence Against Health Care Workers Many hospitals are ill-prepared to prevent incidents of violence, and no federal regulation exists that mandates the implementation of a comprehensive security plan in the health care setting. Nationally and internationally, nursing organizations, including ENA, are advocating for a no-tolerance policy for violent acts in a health care setting. Nurses are strongly advised to actively support this safety movement and engage in prevention strategies in their EDs and hospitals.

With the increased risk of violence in the emergency department, the Advocacy Packet on Mitigating Violence against Healthcare Workers provides the data, tools and resources necessary for emergency nursing leaders to advocate and implement plans for establishing a zero tolerance for violence in their EDs. Download this packet from www.ena.org/government/ Advocacy/Pages/Default.aspx.

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23

PEDIATRIC UPDATE |

Elizabeth Stone Griffin, BS, RN, CPEN

Weighing In on Bedside Patient Advocacy

Preventing the Preventable

By Making a Simple Change As emergency nurses, we advocate for our patients on a daily basis as we manage their pain, answer their questions and do everything we can to keep them safe both in the emergency department and at home. As ENA members, we have opportunities to participate in global advocacy efforts which trickle down to the local level and influence nurses at the bedside.

In December 2011, I served as an ENA liaison for a national Emergency Medical Services for Children meeting. A group of about 15 pediatric health care professionals were having an emotionally charged roundtable discussion about the importance of getting hospitals to switch to kilograms-only scales and kilogramsonly weight documentation for their pediatric patients (and, optimally, also for their adult patients). We talked about the fact that this simple change, if implemented nationwide, would prevent countless (sometimes fatal) medical errors in infants and children.

A few months later, several very dedicated members of ENA’s Pediatric Committee and Position Statement Review Committee collaborated to create a powerful position statement entitled “Weighing Pediatric Patients in Kilograms”1, which already is being referenced by other major health care organizations. The following excerpt drives home the crucial nature of the issue: “Of all the ways that pediatric patients can be harmed during treatment, medication errors are the most common and most preventable.”2 Developmental differences and dosing complexities unique to pediatrics put children at high risk for both medication errors and for serious consequences as a result of these errors.2,3 In contrast to adult medication doses (which are often standard, unit-doses), pediatric medication doses are weight-based; based specifically upon the patient’s weight in kilograms. Determining the correct dose of a pediatric medication typically requires multiple calculations, and adult concentrations of drugs must often be diluted for pediatric administration. A 2009 analysis of 479 medication errors involving wrong weights discovered that over 25 percent were due to “confusion between pounds and kilograms”.4

24

Tiffany Young, BSN, RN, of Raleigh, N.C., weights an infant on a scale that displays kilograms only — a change made earlier this year after Young was alerted to a documentation error.

Being aware of the need for a change, however, is not enough. It often takes a “champion” to really drive an issue on a local level and to initiate change. The following examples, taken with permissions from ENA listserv discussions, illustrate how nurses (individually or as part of an interdisciplinary effort) can serve as pediatric champions in their EDs to help ensure that their scales are adjusted to display kilogram-only weights, thereby preventing countless future medical errors in their pediatric patients: “A few months ago there was an incident that was very alarming to me. A very experienced triage nurse documented an infant’s weight as 11 kg when the infant actually weighed 11 pounds (about 5 kg). This was not caught by the doctor or the primary nurse … the patient’s grandmother, who was a nurse, actually

questioned the rate set on the IV pump. I investigated the chart, talked to the primary nurse and finally I realized the error. … I called our Biomedical Engineering team immediately and pleaded with them on how we could fix this problem, explaining that changing the scales to display kilograms only could literally save lives.

Initially they insisted that this couldn’t be done.

But finally one of them took our baby scales downstairs for repair, spent time reading the owner’s manual, and figured out a way to wire the scales to read in kg only! Soon afterward, they did the same thing with our standing scales.”

— Tiffany Young, BSN, RN, staff nurse, Children’s Emergency Department, WakeMed Health & Hospitals, Raleigh, N.C. “We got our hospital maintenance department to alter our existing scales to read in kilograms only. It was initiated as a QI patient safety

September 2012

initiative as the result of triage nurses entering pounds instead of kilograms into the chart and, as a result, incorrect doses of medications were being ordered. The project to convert our scales to display kg-only weights was championed by our Pediatric Champion Team along with our Quality Management Committee, both of which consist of nurses as well as physicians, administrators and ED technicians. Our hospital maintenance department altered the scales to read in kg-only. Our challenge has been to convert charting to include only kilograms — our computer charting system automatically converts kilogram weight to pounds, so both weights are visible to the providers who order the medications. However, there have been zero incidents of wrong orders according to the weight entered since our scale conversion. The change has been extremely effective.” — Mary Jean Erschen, RN, BSN, pediatric emergency care coordinator, University of Wisconsin Hospital and Health Clinics With any major change, there are usually challenges which must be addressed. One shared by many listserv members who made the pounds-to-kilograms conversion was that

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 ED.

what it means to be an advocate for pediatric patients, from the global level to the local level.

Global advocacy by leaders in healthcare and by organizations such as ENA continuously influences local advocacy by nurses at the bedside, leading to safer, more effective care for our pediatric patients.

References

parents “always ask us to tell them what their child weighs in pounds.” Here’s one effective way this issue was addressed: “We have locked out our scales so they can read in kg-only. When the parents ask what the child’s weight is in pounds, we refer them to the conversion chart right by our scales. We have really coached our staff to not even say the child’s weight in pounds out loud to the parents, as we do not want the weight in pounds to be the last thing the staff remembers when they go to enter that data into the EMR.” — Patty Peska, BSN, RN, CPN, Clinical Educator, Emergency Department, Children’s Hospital & Medical Center, Omaha, Neb. I have learned a lot in the last year about

1. E mergency Nurses Association (2012).

Position Statement: Weighing Pediatric Patients in Kilograms. Accessed online 7/20/2012: www.ena.org/ sitecollectiondocuments/position%20 statements/weighingpedsptsinkg.pdf 2. H ughes, R., and Edgerton, E. (2005). First, do no harm. American Journal of Nursing. 105; 5, 79-84.

3. F rush, K., Hohenhaus, S., Luo, X., Gerardi, M., and Wiebe, R. (2006). Evaluation of a web-based education program on reducing medication error. Pediatric Emergency Care: 22;1, 62-70.

4. P ennsylvania Patient Safety Authority (2009).

Medication errors: significance of accurate patient weights. Pennsylvania Patient Safety Advisory, 6:1, 10-15.

at t

S he ee u EN s @ A B in Ann oot h Se pt ual C #62 em o 5 be nfe re r! nc e

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Demonstrate your commitment to competency; earn a BCEN certification today.

Visit www.BCENcertifications.org for details.

Home Among the Homeless An ENA Nurse’s Right Turn in Albuquerque May Change Your Idea of What It Means to Care

By Josh Gaby, ENA Connection

W

Photo by Deena Brecher

ith a day to kill between appointments in Albuquerque, N.M., Deena Brecher thought she’d do some sight-seeing.

Nothing opened her eyes like Cathi Legg.

The night before, Brecher, ENA’s secretary/ treasurer and 2013 president-elect, had first met Legg at the monthly meeting of the New Mexico ENA State Council, of which Legg, RN, CEN, is a former president and the president-elect.

Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN, the New Mexico liaison from the ENA Board of Directors, was also in town to speak at the first Southwest Emergency Nursing Conference on June 1-2.

The two chatted. Legg’s story came out: She had worked in emergency nursing for more than 30 years in different levels of trauma centers around the country. From the Kaseman Hospital emergency department in Albuquerque, she shifted into a stint in juvenile corrections. At the end of 2010, feeling drawn inexplicably by the opportunity, she joined an educational delegation of nurses to South Africa, led by 2006 ENA president Nancy Bonalumi through the ambassador program People to People.

And there, on that trip, everything changed.

Legg came home and redirected her energies, her career, toward a specific population of patients, one that until then had barely registered on her radar: the homeless of Albuquerque and Bernalillo County.

The morning of May 31, Brecher toured the Albuquerque Health Care for the Homeless facility with Legg as her guide. Legg is the nurse manager. ‘‘Clearly,’’ Brecher says, ‘‘something stirred her passion.’’ ♦♦♦♦♦ In a word, it was people.

They live in what are called ‘‘sectors,’’ Legg says. We’d probably call their dwellings ‘‘shanties’’ — still more than what most homeless people in the United States have. A few walls. That’s about it.

The delegation of nurses had spent time observing in hospitals, clinics and university settings in Capetown and Durban. Then their

26

Cathi Legg, RN, CEN, stands at ‘‘the wall’ outside the Albuquerque (N.M.) Health Care for the Homeless, where tiles serve as individual reminders of the hundreds of local homeless people who have died on the streets.

guide felt they needed to see something more — a different side of the city. He took the group ‘‘off track’’ during their lunch breaks, into the grit of real Durban.

‘‘And it broke my heart,’’ Legg says. ‘‘It absolutely broke my heart. I mean, here are little kids running around — through no fault of their own, they’re essentially what we would

September 2012

consider homeless, without all the access to things that they need. Unless there was something seriously wrong, they really didn’t have huge accesses to medical care.’’

The delegation toured several private hospitals, not much unlike those in the States.

But the public hospital they saw in Capetown was standing-room-only, with only the sickest of the sick. The poor in these cities don’t go in for sore throats and earaches, Legg says. The hospital is a place for serious afflictions, though the right supplies and services can’t always be promised. When the X-ray machine is shut down for the night, a patient who arrives with a badly fractured arm will have his arm set according to the staff’s best estimates and might get a cast, or a ‘‘prop.’’ If there’s an X-ray at all, it’ll come later, in the morning. No CT-scan. Not much else, really. Just nurses taking care of patients at a more basic level, as people, using what resources they have. ‘‘I came back,’’ Legg says, ‘‘and I looked at

Manual Provider Edition Fourth

ng cy Nursi Emergenric Course Pediat

ual er Man Provid dition E h rt u Fo

all the medical supplies we have in the ER, all the medical supplies we have available to us, and the fancy bandages and the $10,000 lab workups that we’re doing, and I compared it to what’s happening in Durban and, you know, they do what’s necessary to take care of people, and they do a really fine job at it. ‘‘I said, ‘Something’s wrong with the system when you have a splinter in your finger and we’re doing fancy workups to make sure there’s not some sort of weird infection when it’s simply a splinter in your finger. There’s something wrong with this, and there’s a lot of people out there that need basic medical care.’’

The Albuquerque Health Care for the Homeless had an opening. Before her trip, Legg admits, she didn’t know the place existed. ‘‘This position happened to be posted when I was really struggling with all the things that we have and they don’t have,’’ she says. ‘‘And I came over and interviewed and said, ‘This is where I need to be.’ ’’

The Emergency Nurses Association is proud to present the release of the 4th edition of the Emergency Nursing Pediatric Course.

It has been revised and updated, evidencebased, and continues to incorporate various teaching and learning styles.

• • • •

A portion of the course will be presented in an online format through ENA’s Center for e-Learning.

Pediatric Clinical Considerations is now case-based using group discussion.

The adolescent patient is addressed with a separate chapter and lecture.

Triage is now Prioritization with a focus on the process, rather than the place.

Upon successful completion of ENPC, RN participants are verified for four years, receive a verification card and earn up to 16 contact hours.

This course brings the emergency nurse a resource for treating the pediatric patients arriving to emergency departments every day.

To verify why ENPC is right for you and to view course schedules, please visit www.ena.org/coursesandeducation

♦♦♦♦♦ Albuquerque HCH is free-standing and unaffiliated with any hospital, serving Bernalillo County as a “primary medical home” with a full range of offerings, some of which you’d find in a typical ED. There are medical services (including limited emergency services), dental services and behavioral health. A cornucopia of social assistance is designed to help homeless clients sort through their legal, Social Security and disability issues and find jobs and housing.

The far-outside-the-box “ArtStreet” program, housed in an on-site studio, beckons clients to come in and create artwork as a means of working through their feelings and warming up to accepting other services through AHCH. Clients also have the opportunity to sell their artwork 10 to 12 times a year at exhibitions and selling tables.

Albuquerque HCH logged 20,690 total encounters in 2011 — about 7,000 clients in a metro area of about 750,000 people. Some of that is the result of outreach services in which Legg and her co-workers quite literally search the community, stopping at shelters and meal sites, looking in cars and under trees, to find those who could benefit from some help. ‘‘The thing that’s really hard in the ER,’’ Legg says, ‘‘is we tend to look at some of these folks and say, ‘Oh, my gosh, why are they coming back again?’ They have significant medical needs. When you have to carry everything on your back that you own, and your backpack is 150 to 200 pounds, you have tremendous injuries — orthopedic injuries, back injuries, foot injuries. You have tremendous skin injuries because of the elements that you’re in. You’re not eating well because the meal sites are feeding what they have available, and so diabetics are coming in with tremendous diabetic problems.’’

She sees pneumonia, gallbladder disease, liver disease, occasionally an inflicted injury such as a knife wound.

Funding for treatment comes from more than 40 streams, including private grants; the federal Bureau of Primary Health Care; local city, county and state government; housing and mental health authorities; in-kind donations and pure philanthropy. Legg, along with a medical director, three nurse practitioners, a mental health NP specialist, four nurses and a crew of medical assistants, makes as many differences as she can. The staff guides itself by the philosophy of ‘‘trauma-informed care’’ — that is, asking patients not what’s wrong, but rather what has happened to them, physically and emotionally, and what can be done to alleviate that.

As a rule, they try not to say ‘‘no.’’ Still, not everything is possible. There’s only a minimal Continued on page 46

Official Magazine of the Emergency Nurses Association

27

Health Care Worker Fatigue

Safety Concern Becomes 2012 Proposed Resolution

By Amy Carpenter Aquino, ENA Connection A longtime ENA member and veteran General Assembly delegate, Mona Kelley, MSN, RN, has voted on countless bylaws amendments and resolutions written by other members, but she never submitted one herself. That will change at the 2012 General Assembly this month in San Diego, where Kelley will present a resolution on health care worker fatigue with co-authors Beth Broering, MSN, RN, CEN, CPEN, CCRN, FAEN, immediate past chairperson of the ENA Foundation, and Sondra Heaston, MS, APRN, CEN, Utah ENA State Council president.

Kelley, president of the Tennessee ENA State Council, attended a learning session on writing and submitting resolutions held at the Mona Kelley, MSN, RN 2012 State and Chapter Leaders Conference in New Orleans this past February. Resolutions Committee Chairperson J. Jeffery Jordan, MSN, MBA, RN, CEN, and committee board liaison Michael Moon, MSN, RN, CNS-CC, CEN, FAEN, described the committee’s role in helping aspiring resolution writers. Members with experience submitting resolutions were in the audience to share research and writing tips.

Kelley already had presented the idea to the Tennessee ENA State Council at its January meeting and received approval to begin the resolution writing process. By February, she, Broering and Heaston were deep into research of an issue she said is a major safety concern for emergency nurses and other health care workers.

“I have a growing concern about the number of people who work long hours, extended hours or additional hours in order to make ends meet, or, if they can’t get enough hours at one place, they work for more than one employer,” Kelley said. “I have seen how exhausted people are. I know, myself, after working extended shifts for whatever reason, that I would almost fall asleep coming home.”

In fact, Kelley has known people who fell asleep at the wheel after working extended shifts, defined as more than 12 hours.

“I know of several staff members, at my previous employer, who were involved in motor vehicle crashes after falling asleep while driving home from work. Luckily, they did not sustain serious injuries,” she said. “But there’s a rising

28

concern about the number of hours people are working – or being forced to work, in some cases.”

The resolution is based on Joint Commission Sentinel Event Alert Issue 48: Health Care Worker Fatigue and Patient Safety (www. jointcommission.org/sea_issue_48/), released in December 2011. The purpose of the alert is to “address the effects and risks of an extended work day and of cumulative days of extended work hours,” according to the Joint Commission website. The Joint Commission states that studies show “fatigue increases the risk of adverse events, compromises patient safety and increases the risk to personal safety and well-being.”

Kelley said she understands the other side of the issue, the financial need that drives some

emergency nurses to work longer hours and take on additional shifts. She hopes the resolution, which she anticipates will promote some healthy debate among the 700-plus delegates, will change nurses’ perspective.

“First of all, we’re hoping that the proposed resolution won’t get butchered too much,” she said. “But the real goal is to encourage people to use basic common sense and not work extended hours and to promote healthy and SAFE working environments and work hours among employers and nursing leaders. I know circumstances require bills to be paid, but we want to encourage people to think about the amount of time they’re putting in and about Continued on page 39

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

Strategic Sponsors

Strategic Supporters

Conference Sponsor

Conference Supporter

*As of print time

September 2012

improve

sepsis risk assessment Nearly one out of 23 patients in U.S. hospitals had sepsis in 2009.1 Early identification of sepsis and initiation of therapy are crucial to improving patient outcomes. Procalcitonin (PCT) can provide valuable information to those examining the patient in the earliest hours of disease progression.

Join us at booth #1308 for an educational presentation on tools for early sepsis management and strategies to drive changes in sepsis practices and policies.

Procalcitonin (PCT)

s To learn more about sepsis and medical advances, visit thermofisher.com/aboutsepsis,

1. Elixhauser A, Septicemia in U.S. Hospitals, 2009. HCUP Statistical Brief #122. October 2011.

Agency for Healthcare Research and Quality, Rockville, MD. © 2012 Thermo Fisher Scientific Inc. All rights reserved.

the Facebook fan page About Sepsis, and the Twitter handle @AboutSepsis.

s Join us for an educational presentation on sepsis management at ENA in San Diego. Attendance qualifies for 1/2 CERP Credit.

Visit Booth #1308: U

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Thursday, Sept. 13 – 4:00pm and 5:00pm Friday, Sept. 14 – 9:30am, 11:00am and 1:00pm Saturday, Sept. 15 – 9:30am and 11:00am

From the Future of Nursing Work Team | IOM Recommendation 6

Ensure That Nurses Engage in Lifelong Learning

By Robin Gilbert, MSN, RN, CEN, CPEN In 2010, The Robert Wood Johnson Foundation and the Institute of Medicine published the report ‘‘The Future of Nursing: Leading Change, Advancing Health.’’

In the report, the need for nurses to be engaged in lifelong learning is addressed in Recommendation 6, which states the following: ‘‘Accrediting bodies, schools of nursing, health care organizations and continuing competency educators from multiple health professions should collaborate to ensure that nurses and nursing students and faculty continue their education and engage in lifelong

learning to gain the competencies needed to provide care for diverse populations across the lifespan.’’

The health care environment is changing at a rapid pace. Nurses are being challenged with an increase in patient acuity, high census days with decreased staffing, reimbursement being tied to quality outcomes and complex environments of expanding technology. These changes exemplify the need for nurses to engage in a commitment of expanding their knowledge and competencies in order to remain current in this reformed health care system.

When nurses enter nursing school, it must be with the vision that we become lifelong

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

Invest in the future of your profession.

Support the ENA Foundation.

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

Donate Now.

www.enafoundation.org

30

learners. On our first day of nursing school, it becomes our duty to continue being a lifelong student in the world of medicine.

ENA has already implemented many opportunities which allow emergency nurses to engage in lifelong learning. Through online programs, hands-on classes, certification, conferences and partnerships with academic and other professional organizations, its commitment to integrate and embed lifelong learning into emergency nursing has been established. The overall goal is to continuously provide education which will enhance the knowledge, skills, competency and quality of nursing for those delivering emergency care. To achieve this goal, ENA works collaboratively with other professional organizations to provide ongoing educational opportunities that are contextual, real-time and measurable in improving patient outcomes.

As emergency nurses, we must remember that we are among the privileged who have entered into nursing, and make the commitment to provide the highest standards of quality care by engaging in lifelong learning.

Treasurer’s Report

Continued from page 6

financial condition. Our financial management policy requires that our reserves, represented by our long-term investments, be at least 50 percent of our operating expenses. At the end of 2011, this reserve ratio stood at a healthy 57 percent when looking ahead to budgeted operating expenses for 2012.

The ENA Board of Directors approaches our stewardship role as our greatest responsibility, for the present and future health of our association. We work diligently with our professional staff to ensure that ENA serves its members and achieves its mission. The 2011 financial results are very satisfying, especially in light of the uncertain times in which we live.

With this foundation, we are in an excellent position to provide resources which allow emergency nurses to keep up with the rapid pace of change in health care and technology.

If you have any questions, please contact me at Deena.Brecher@ena.org or our Deputy Executive Director, Ed Rylko, at erylko@ena. org. Thank you for your continuing support of your colleagues and programs at ENA, advancing the specialty of emergency nursing!

September 2012

OSHA Hotline

Continued from page 18

Prevention Program combined with engineering controls, administrative controls and training can reduce the incidence of workplace violence.’’ These measures could include encouraging employees to report assaults or threats, providing employee ‘‘safe rooms’’ for use during emergencies and training staff to recognize and manage potential assaults, such as assaults perceived to be instigated by emergency patients with mental illnesses. Learning effective de-escalation techniques has been shown to reduce staff fear. Studies demonstrate that violence often is related to the workplace context vs. related to an inherent characteristic of an illness. Empowering staff through education helps personnel with positive behavioral supports to overcome the cultural stigmas exacerbating aggravation in the workplace. Research also shows that conducting workplace violence hazard analyses helps employers identify strategies for reducing the likelihood of incidents occurring.

OSHA’s Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers,2 revised in 1998, state that at minimum, workplace violence prevention programs should: • Create and disseminate a clear policy of zero tolerance for workplace violence, verbal and nonverbal threats and related actions and • Ensure that no reprisals are taken against an employee who reports or experiences workplace violence.

As to the latter item, Section 11 (c)(1) of the OSHA Act applies to protected activity involving the hazard of workplace violence, as it does for other health and safety matters: ‘‘No person shall discharge or in any manner discriminate against any employee because such employee has filed any complaint or instituted or caused to be instituted any proceeding under or related to this Act or has testified or is about to testify in any such proceeding or because of the exercise by such employee on behalf of himself or others of any right afforded by this Act.’’

When 10-year old Earl accidentally set his FORWKHV RQ ÂżUH KH sustained third-degree burns over much of his body. )RUWXQDWHO\ KLV emergency room nurse referred Earl to Shriners Hospitals for Children. Her quick and decisive action saved his life.

shriinershosp pittalsforchildren.org

ENA State Councils and OSHA Strategies To complement ENA state council public policy agendas addressing workplace violence, advocates could leverage the OSHA directive by working with the following: • State lawmakers or administrators to adopt the OSHA directive ‘‘for use with their [the state’s] general-duty clause, state-specific workplace violence standard or other applicable authority under state law.’’ • OSHA personnel to inform employers about developing a workplaceviolence prevention program. The directive states that OSHA’s ‘‘Area Directors may choose to disseminate this information through stakeholder meetings, targeted training programs or presentations to employers, trade or professional associations ‌ [and] OSHA’s On-site Consultation Program is available.â€? (www.osha.gov/dcsp/ smallbusiness/consult.html) References 1. U .S. Labor Department Occupational Safety and Health Administration. Enforcement procedures for investigating or inspecting workplace violence incidents CPL 02-01-052. Sept. 8, 2011.

Retrieved June 25, 2012, at www.osha.gov/OshDoc/Directive_pdf/ CPL_02-01-052.pdf.

2. U .S. Labor Department Occupational Safety and Health Administration. OSHA guidelines for preventing workplace violence for health care and social service workers OSHA 3148: 1998 (Revised).

Retrieved June 25, 2012, at www.dtic.mil/cgi-bin/GetTRDoc?Locati on=U2&doc=GetTRDoc.pdf&AD=ADA400388.

Official Magazine of the Emergency Nurses Association

The experts at Shriners Hospitals for Children know every second counts in the survival and recovery of pediatric burn patients. The sooner a child reaches Shriners Hospitals for Children, the better the chances for a full recovery.

As the leading pediatric burn care hospitals in the world, Shriners Hospitals for Children provide a full range of services to care for children with burn injuries.

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CODE YOU

CODE YOU

Healthy Footwear

Picking the Right Nursing Shoes

By Kendra Y. Mims, ENA Connection

CODE YOU

CODE YOU

CODE

♦ Be comfortable in your own shoe: Have you experienced discomfort from burning and aching feet, only to realize you still had another six hours to go in your shift? Maybe you purchased your footwear based on a colleague’s recommendation or an article online. Various factors can affect the ideal shoe for you, such as your foot type and weight, and shoe products that work for your feet may not work for your colleagues. Scrubs magazine recommends the following shoes for different foot types: • Low arch (flat feet/over-pronator): You should choose motion-control shoes.

• Normal arch (neutral pronation): You should choose stability shoes.

• High arch (under-pronator): You should choose cushioned shoes.

Tip: When trying on a pair of shoes, make sure you can walk comfortably in them for several minutes before you purchase them, paying specific attention to the cushion. Buying or upgrading to a shoe that provides more comfort and support for your foot type can take your feet from blistering to blissful.

32

are lightweight as opposed to heavy shoes that put more strain on your legs and feet, which can lead to muscle aches and cramping by the end of your shift. A lightweight and breathable shoe will make it easier for you to move around and provide comfort when standing for an extended period of time.

YOU

As an emergency nurse, your professional duties can require you to spend hours on your feet standing, walking and assisting patients.

Whether you work an eight-hour shift or a 12-hour shift, your shoes are one of the most important parts of your nurse uniform, as what you wear on your feet can dictate if you will spend your day working in comfort or in pain.

Choosing the wrong footwear can affect you physically and emotionally by causing sore feet, blisters, fatigue, shin splits, poor posture, plantar fasciitis and back and knee pain, which also can affect your job performance, your mood and your attitude with colleagues and patients. Investing in the right footwear now will not only keep you on your toes comfortably but also will help you perform your duties efficiently and prevent injury.

So what kind of shoes should emergency nurses wear? Finding the right shoes that are comfortable and adhere to your hospital’s dress code may seem like a daunting task. Although there is not a universal recommendation, because everyone’s needs are different, the following checklist provides certain factors to consider the next time you hit the stores.

Other tips to keep in mind: • If you are having a difficult time finding the right shoe, you may want to visit a shoe specialty store. Shoe specialists are there to offer guidance and assist you in making the right decision.

• Look for shoes that have a non-slip rubber sole, which can help to minimize accidents while working.

Types of Shoes Nurses have a variety of comfortable nursing shoes to choose from that come in different styles and colors. However, if you’re not excited about wearing traditional nursing shoes, you can opt for one of the following options that have also been designed for healthcare professionals: (alluniformwear.com) ♦ Walking shoes: Designed for people who spend a considerable amount of time walking.

Recommendation: For a safety precaution, choose a pair that won’t absorb contaminants in cases of accidents and spills.

These shoes were made for walking ... . If you’re having a bad day, consider what’s on your feet.

♦ On your toes: Take notice of how the shoe is designed. Do they provide enough space for the toes to spread out while walking?

Shoes that provide wiggle room for the toes help to improve the balance. Having extra space from wide toe shoes will provide more comfort, and it is suggested that shoes that provide space for toes allow natural functioning in the feet. Avoid shoes that are tight in the toes and that squeeze your toes together. (Good Shoes for Nursing) ♦ Stay light on your feet: Opt for shoes that

♦ Athletic shoes: Provide comfort and cushion to the foot. They are affordable, easily accessible from various stores and can be worn during your shift and after hours. They’re also great to wear on days when you can fit in some form of exercise during your break (brisk walk, climbing the stairs, etc.). ♦ Nursing clogs: Offer support and are the latest in medical footwear fashion.

September 2012

Note: It is recommended that health care professionals who work 40 hours per week on their feet should change their shoes every six months, and even more often for those who weigh more or deal with pain and injury.

(Scrubs magazine) Here are some footwear recommendations from ENA’s Emergency Nurses Wellness Committee members: Cheryl Campos, PhD, BSN, RN: ‘‘I started wearing ‘Sketcher’s Shape-Ups.’ They completely got rid of my hip, back and feet pain. We work in an ED where we are literally standing or walking almost the entire 12 hours. These shoes are thicksoled, so they protect from the pounding. They changed my posture to more upright, and they create a more natural foot movement for long hours of walking. I love them! I did add arch supports, which helps, too.’’

Robin Walsh, MS, BSN, RN: ‘‘Find a shoe that gives you good support and stay with them. I personally have worn RYKA shoes for many years and love them. You get what you pay for — don’t scrimp on shoes. It is worth every cent to be able to make it through a 12-plus-hour shift without sore feet. I personally wouldn’t recommend shoes with holes in them — beware of vomit, urine, blood, etc. A non-slip sole is also important. Wear socks — they prevent odor, prevent bacteria build-up from sweat and decrease chances of athlete’s foot or other foot infections. I like walking shoes (sneakers) but have seen others recommend shoes made specifically for nurses.’’

A More Animated Approach to Empowering Your Patients

By Josh Gaby, ENA Connection Emergency nurses are being asked to ’toon in to help teach patients.

The Joint Commission’s ‘‘Speak Up’’ video series, which launched in March 2011, expanded to seven episodes with the release of the latest installment, ‘‘Know Your Rights,’’ on June 26. The 83-second cartoon and its six forerunners — covering such topics as kids feeling comfortable asking questions and patients safely taking their medications — are available for viewing on YouTube, the Wellness Network and the AccentHealth network.

They’re also aired on the closed-circuit TV networks of many of the 19,000-plus hospitals, programs and organizations the Joint Commission accredits and certifies, meaning they’re being seen from hospital beds and in waiting rooms. ‘‘Know Your Rights’’ walks viewers through a patient’s rights, including the right to make decisions about care, the right to have pain addressed and the right to receive information in the appropriate language. All episodes are produced in English and Spanish.

‘‘What we’re doing is empowering the consumer, teaching the patient in a very comfortable setting: little cartoons, great little characters,’’ said Ana Pujols McKee, M.D., the Joint Commission’s executive vice president and chief medical officer. ‘‘But the lessons are very important about the rights that the patients have and how important it is for them to be participating in their care and not be passive.’’

As patients become more educated, they’ll ask more questions and have more meaningful dialogue with health care providers in all types of settings, McKee said. Emergency nurses who view ‘‘Know Your Rights’’ have an opportunity to spread the message to patients who don’t yet have the information. ‘‘That’s what they do — many of them are educators, they’re sending patients out there, giving them instruction,’’ McKee said of emergency nurses. ‘‘They should be the educators on this.

Some patients will come in well-informed, and they don’t need to educate them, and other patients need to learn a little bit more about their rights so they can advocate for themselves more effectively.’’

Are you attending ENA’s 2012 Annual Conference this month in San Diego? Don’t forget a few pairs of your comfy shoes so you can walk, mingle and dance without having your feet on your mind.

It’s hard to focus when your feet hurt, and the pain can make a hectic work day seem even more stressful, especially when you don’t have time to take a break. While finding the perfect shoe for your feet may seem time-consuming or cost more than you hoped, the investment will be worth it in the end. Your job requires a lot of movement, and you deserve to have happy feet. Remember to consider the shoe’s weight, design, cushioning and support when trying on footwear, and if the shoe fits, then wear it.

References http://scrubsmag.com/the-nurses-guide-tobuying-shoes/ http://www.ehow.com/info_8177033_ good-shoes-nursing.html#ixzz22tgVAsz http://articles.alluniformwear.com/ uniforms/2010/nursing-scrubs-andnursing-shoes/

The Joint Commission

‘Speak Up: Know Your Rights’ • • • • • •

Everyone has Everyone has Everyone has Everyone has Everyone has Everyone has and respect

the the the the the the

right right right right right right

to to to to to to

be informed about the care they will receive make decisions about their care, including refusing care have their pain addressed get information about their care in their language get an up-to-date list of their current medicines be listened to, and the right to be treated with courtesy

Search for this episode on YouTube or view directly at www.youtube.com/ watch?v=Q47JDcsjK1E.

Official Magazine of the Emergency Nurses Association

33

MESSAGE FROM THE CHAIR |

Laura Giles, BS, RN

ENA Members Rose to the Challenge You did it. Our ENA community came together, allowing the 2012 ENA Foundation State Challenge fundraising campaign to reach its goal and raise more than $116,000!

It was another record-breaking year thanks to the state councils, chapters and individual ENA members who contributed to this campaign. We sincerely thank you for your continued support and your dedication to the mission of the ENA Foundation.

The State Challenge kicked off at the ENA Leadership Conference in New Orleans in late February.

Thanks to an innovative idea by ENA Foundation Chairperson-elect Julie Jones, BSN, RN, CEN, many of the states and chapters made pledges to the challenge during the conference. This got the campaign off to a solid beginning.

During the middle months before the May 31 deadline, the contributions stalled. Our ENA Foundation board of trustees sent e-mails and made calls to the state leaders. However, when we got to the end of May, we were short of our goal. The ENA Foundation decided there was still a chance and extended the campaign to June 30. Again, the trustees got back on their phones and computers. We reached out using personal contacts through e-mails, phone calls and Facebook. An e-mail was sent to all ENA members asking them to ‘‘rise to the challenge,’’ and they did!

Together we exceeded our goal of $115,000.

The goal of the annual State Challenge is clear: to raise funds to support scholarships and research grants. The theme for 2012 was ‘‘Cooking Up a Brighter Future.’’

Many of you might have seen the blue oven mitts at your council or

34

chapter meetings. We had a lot of folks ‘‘in the kitchen’’ this year helping us raise the recordbreaking funds for 2013 scholarships and research grants.

Each and every dollar donated will fund scholarships and research grants in 2013 — 100 percent.

More scholarships and grants will be available to you and your fellow emergency nurses because of your efforts this year.

It is a challenge, after all, so there must be some rewards. This year’s winners are listed below.

First-place winners will receive a $250 gift certificate to ENA’s Marketplace, and second-place winners will receive a $150 gift certificate.

Largest overall amount raised: 1st Place – New Jersey State Council with $18,958.00 2nd Place – Texas State Council with $7,842.00 Largest amount per capita: 1st Place – Kansas State Council with $20.71 per member 2nd Place – Mississippi State Council with $15.67 per member One of the unique rewards of the State Challenge campaign is the naming opportunity for those state councils who raise $5,000 or more. This year, 11 states will have the opportunity to name a 2013 scholarship after an honored member, as a memorial tribute or after their incredible state. Those states are California, Colorado, Kansas, Kentucky, Maryland,

Mississippi, New Jersey, New York, South Carolina, Tennessee and Texas. Thank you for your generous contributions and fundraising efforts on behalf of the State Challenge.

I also want to recognize the members of the ENA Foundation board of trustees: Julie Jones, Jackie Wynkoop, Beth Broering, Seleem Choudhury and Thelma Kuska. Each of these board members made countless calls and sent numerous e-mails to state presidents, presidents-elect and treasurers to encourage them to support this effort. A trustee’s job can be uncomfortable at times — after all, calling up strangers and asking them for money is never an easy task. But the trustees have a passion for the mission of the foundation, and the results of their

efforts show. ‘‘It’s for our members’’ was their primary thought while making the calls, and since we are all ENA members, no call to another member is really to a stranger.

If you are reading this article in ENA Connection, you are a passionate and committed ENA member. That means you care about our profession and want it to be successful. With the baccalaureate degree now becoming the standard for emergency nurses for many employers (New York Times, June 23), the ENA Foundation’s mission — to provide educational scholarships and research grants in the discipline of emergency nursing — has become even more critical.

Thank you to all of the individuals, chapters and state councils for making this year’s State Challenge campaign a success. We can’t do it without your support.

Thank you for making a difference and advancing the field of emergency nursing.

September 2012

Join the Conversation!

You have the ability to communicate with ENA and other members not only during conference, but also all year long with our various social media channels.

Twitter - @ENAorg

Follow us on Twitter for the latest news and updates from ENA. You can also use the #ENAAC12 hashtag for all conference related postings.

Facebook - facebook.com/ENAorg ngage with users from all over the world on our Facebook page. To engage with users about E conference, visit the Annual Conference event page.

Foursquare - foursquare.com/ENAorg

Check in while you’re at conference to receive discounts from various establishments in the San Diego area. The official ENA foursquare page will also provide lists of tips and information for upcoming events.

YouTube - youtube.com/emergencynursesassoc F or all ENA-related videos, you can check out our YouTube channel, where you will find snippets from conference as well as messages for you, our members.

No matter what social media outlet you prefer, there’s always a way for you to network with your colleagues with one of the channels listed above.

Official Magazine of the Emergency Nurses Association

35

Advertorial

IO Access: Real Patients, Real Successes Difficult intravenous access leads to frustration and loss of productivity by the treating team, according to ENA’s Emergency Nursing Resource.

It states ‘‘ ... success rate and time to vascular cannulation are crucial to the optimal resuscitation of the critically ill patient, yet failure rates of emergent IV access in the literature range from 10-40 percent.’’

The ENR cites ‘‘... the average time for cannulation with difficult IV requiring as much as 30 minutes and, given the time to establish a CVC, the increased risk to the patient and the skill required of the provider, other alternatives are often desirable.”

Intraosseous access is a proven strategy for patients with difficult intravenous access. The ENR described IO as ‘‘... significantly more expeditious than standard IV access and should be considered early when known or suspected difficult IV access exists. In alert patients, pain with intraosseous access insertions is rated as minor. Lidocaine administration prior to medication infusion reduces the pain felt by alert patients.’’

Not everyone is convinced of IO’s value — especially in non-cardiac arrest situations. But nurses familiar with IO access have persevered, and it has proven beneficial. The following are real-life examples of when IO access made a difference to patient outcomes and to providers: ‘‘We had a disabled 3-year-old and tried 10 times to place an IV. The physician said the patient wasn’t sick enough for an IO; but we got him to agree to insert it, even though the child was conscious. I actually taught him the procedure; and he did it. We administered IO lidocaine, fluids, and antibiotics and likely saved the child’s life!”

Brenda Braun, BSN, RN, CEN, CPEN ‘‘I fought for an IO system for years. Shortly after receiving our kits, I responded to a call for a post-cardiac arrest patient experiencing acute shortness of breath. Upon arrival, the patient was diaphoretic, hypotensive, and had diminished lung sounds. I recalled that he had rib fractures from CPR, and I suspected a hemothorax. His IV access was infiltrated. With his INR over 10, the intensivist was reluctant to attempt central venous access. I suggested the IO. The device was quickly inserted into the proximal tibia. Blood was administered and we began looking for another site. I placed another IO in his left humerus on the first attempt. I believe the IO saved this man’s life, and it is the single most important advance we made in patient care my 20 years at this hospital.”

Larry J. Manganello, BSN, RN, CCRN-CMC, CFRN, EMT-P

“Our first IO insertion was in a 30-year-old with severe vaginal bleeding. Paramedics reported she had a palpated BP of 60, was cold and clammy, and they were unable to establish IV access. Since the patient was conscious, the ED physician infiltrated the site with local anesthetic and inserted the IO. We immediately infused fluid and sent her to surgery where the bleeding was stopped, vital signs were stabilized, and an IV placed. She ultimately did well.’’

L. Kleeman, RN ‘‘I created a countywide EMS protocol for IO use. A few months later, we arrived in the ED and noted an obvious sense of urgency in the nurses. A critically ill 3-year-old had arrived after resuscitation from cardiac arrest without vascular access. Paramedics had made unsuccessful manual IO attempts in both lower extremities. I knew the ED nurses well and can attest to their expert IV skills; yet they were also unable to attain venous access. I offered to place an IO and the physician agreed. Within 2 minutes I placed a humeral IO, obtained blood for laboratory analysis, and medications were administered. Within 4 minutes, the patient began to recover. The IO may have saved this child’s life and it may save the lives of many other future patients.’’

Jeremy Mothershed, NREMT-P “We originally debated the usefulness of IO access because we do not see many trauma or burn patients and our nurses are proficient with IVs. After purchasing the IO, we had a patient who weighed over 350 lbs with numerous medical problems and a history of central line placements. After three IV attempts, an IO was inserted into his tibia.

Blood was drawn, the patient was hydrated, and medications were given. Fortunately, the patient was discharged within 24 hours. We realize the IO may not be used frequently at our facility, but one use and one life saved is worth the investment and the training.”

Vernon Craig Meche, BSN, RN, CEN These testimonials provide real-life evidence of the value of IO access. When faced with difficult IV access, IO devices provide vascular access in a timely manner. This is supported by the consistent first-attempt success rate and rapid time to insertion as identified by the ENR and these patient care stories.

For more information on Vidacare, please contact Michelle Fox, RN, BSN, senior director, clinical affairs, at michelle.fox@vidacare.com.

Message From the President Continued from page 3 national headquarters on the 10th, the eve of the workshop.

Every one of us has the knowledge, ability and responsibility to make a difference in health care. Front-line nurses see problems that few others do. It may be up to us to raise consciousness and alert others to things that are of essential importance to health care policy

36

— the serious challenges, for example, of giving good care to psychiatric patients in the emergency department.

It is up to us to stay informed on health care and public policy concerns as we see what is happening on the ground, and to advocate for our patients and fellow emergency nurses. Kudos to Kentucky ENA for being

instrumental in the new Kentucky law that makes it easier to charge those who assault ED staff. And kudos to Nebraska ENA for the recent bill passed making assaulting a nurse a felony in that state. On a national level, ENA actively advocated for S. 3187, the FDA Safety and Innovation Act, with provisions to prevent drug shortages.

Scholar and futurist Joel Barker once said, “Vision without action is a dream. Action without vision is simply passing the time. Action with vision is making a positive difference.” I challenge you all to dream big, get involved and be proud of the difference you will make in improving the quality of care for your patients and the quality of life for each other.

September 2012

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READY OR NOT? |

Knox Andress, BA, RN, AD, FAEN

The Calendar Calls

Pledge to Prepare During National Preparedness Month The national catastrophes of Sept. 11, 2001, and Hurricane Katrina in 2005 raised awareness for our nation to be prepared for terrorism and natural disasters. After Katrina, the call for a ‘‘culture of preparedness’’ for individuals, businesses and communities was raised across the United States. While large-scale catastrophes are especially sensitizing, the more frequent, local and regional incidents also serve as reminders to be ready and to prepare. But the awareness of needing to be prepared, to be ready, must transition to action.

On June 12 of this year, about 4 a.m., a line of severe thunderstorms packing intense straightline winds caused substantial damage in the town of Homer in Claiborne Parish, La. The 70-80 mph winds toppled trees and structures, knocking down power lines and cutting off electricity to homes, businesses and critical community infrastructure, including the only hospital. Without electricity, the water supply for homes and gasoline for cars became an issue. The only hospital functioned on emergency generators for many hours, and most parish residents were without power for several days. Daily high temperatures were in the upper 90s, while the night brought only upper 70s.

Casualties from the storm were minimal, but eventually the homebound and electrically dependant came to the emergency department.

Who needed to be prepared in Homer, La., at 4 a.m.?

A Midnight MCI Late Friday night and early Saturday morning of July 19-20 was supposed to be a great night for a trip to the theater and the newly released Batman movie in Aurora, Colo. Who would imagine that a catastrophic shooting by a maniacal man armed with a shotgun, an automatic rifle, a pistol and smoke grenades would claim the lives of 12 frightened people and result in the traumatic wounding and scarring of at least 59 others?

Casualties were transported to multiple metropolitan-area hospitals by privately operated vehicles, EMS, law enforcement and others. An adult GSW appeared in the ED of Children’s Hospital Colorado after his friend saw the

38

FEMA

No Power

A chemical decontamination team goes through an exercise simulating a hospital hazmat response at the federal training facility in Anniston, Ala.

hospital ‘‘emergency’’ sign while driving the car.

Nurses, physicians and hospital response teams went to work across the area. After the initial response to the senseless violence, many debriefed, and several were tearful. Several hospital ‘‘first receivers’’ reported in the media of being prepared for the mass casualty by their previous shooting response to the Columbine High School massacre in 1999, and then participating in numerous mass-casualty exercises and drills.

Who or what agencies needed to be ready for an MCI at 1 a.m. on a Saturday morning?

Month to Be Mindful Being ‘‘ready’’ means being prepared.

Preparation includes having a plan to respond and recover. In Aurora and Homer, those that

needed to be ready included the individuals and organizations immediately impacted by the incidents. All must resolve to be ready.

National Preparedness Month, sponsored by the Ready Campaign in partnership with FEMA’s Citizen Corps and the Advertising Council, is held each September to encourage Americans to make sure they are prepared for disasters or emergencies in their homes, businesses and communities. Those interested in promoting preparedness are encouraged to register and join the national coalition found on the National Preparedness Coalition website, community. fema.gov/connect.ti/READYNPM. By doing so, members are pledging to prepare. There is no obligation or cost involved. Being a member of the coalition provides the opportunity to collaborate with others around the country.

September 2012

Health Care Worker Fatigue Continued from page 28 giving themselves adequate time for rest and healing. Working those kinds of hours takes a lot out of you and not only compromises an individual’s health but the quality of care that is provided to our patients.”

Kelley described one colleague who routinely works six shifts in a row so she can then have seven days off.

“I understand why she does it, but I don’t agree with it,” she said.

“Six shifts is a lot of work. By her third or fourth day, she’s just exhausted, and then to me she’s just not as competent as she should be on that fifth and sixth day.”

The authors tied their resolution to the 2012-2014 ENA Strategic Plan, which “identifies an organizational priority to define, identify and advocate for a culture of safe practice and safe care.”

Kelley advised members considering writing a resolution proposal to start early, especially with the process of gathering support from other state councils.

Some state councils meet quarterly instead of monthly and may not have enough time to consider a request for support of a proposed resolution before the June publication. The research and rewrites also took much longer than anticipated. Broering did most of the actual writing, with review and edits by Kelley and Heaston.

The authors revised their proposal nine times and incorporated suggested changes from both the Resolutions Committee and the ENA Board of Directors.

“Give yourselves extra time and talk about it with potential supporters ahead of time,” Kelley said.

While she has a long history of being an engaged and active ENA member, Kelley said she sees how the process of writing and presenting a resolution enables members to make an impact on the entire profession of emergency nursing.

“I think that this is my way of contributing to the improvement of the practice of emergency nurses so that we can be more

patient-friendly, safe and competent in what we do,” she said.

Plan Your 2013 Bylaws Amendment and Resolution Proposals Look in the October issue for information about submitting bylaws amendments and resolutions to the 2013 General Assembly. The call for 2013 bylaws amendments and resolutions will appear in ENA Connection and at www.ena.org.

The 2013 ENA General Assembly will be held Sept. 17-19 in Nashville, Tenn.

A Great Resource The NPC website offers individuals, businesses and communities multiple opportunities to join the like-minded in increasing their awareness as well as to engage and explore emergency preparedness topics. General headings include: • Education: What to do before during and after an emergency • Planning: How to prepare, plan and stay informed during an emergency • Kits: How to build a kit for disaster response • Involvement: How to support community preparedness initiatives • Businesses: Specific planning considerations for businesses • Kids: Preparedness activities for children The website also is a starting point for adding or finding preparedness events in your community, for engaging in preparedness topic discussion, for engagement in regional discussions, for exploration of preparedness resources and for a photo link for posting preparedness activities. The link for the 2012 coalition members demonstrates members in the 30 subgroups of the National Coalition.

Those subgroups include medical facilities/ health, fire/emergency responders, preparedness organizations and individuals/ families, among others.

Are you and your hospital members of the national coalition? Would you pledge to raise awareness, to take action and to prepare?

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

Follow Knox Andress @ENAdman.

Trauma Nursing Core Course Designed for Nurses by Nurses

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

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

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

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

Official Magazine of the Emergency Nurses Association

39

ENA STATE CONNECTION Arkansas ENA State Council Submitted by Ken Mayo, BSN, RN, CEN, NREMT-P The Arkansas ENA partnered with the Central Arkansas Trauma Regional Advisory Council (CATRAC) to provide an injury prevention water safety night on Thursday, June 21, before an Arkansas Travelers minor-league baseball game at DickeyStephens Park in North Little Rock. The event was spearheaded

by Arkansas ENA’s injury prevention co-chairperson, Cathee Terrell, BSN, RN, EMT-B, CEN, and Central Arkansas’ specialinterest group chairperson, Christina Fenton, RN. The ENA and the CATRAC followed the National Safe Boating Council’s campaign and sponsored the “Wear It Arkansas” night, which focused on the importance of life jackets when participating in water activities. According to the Arkansas Game and Fish Commission, there were 73 reported boating accidents with 15 fatalities in 2011.

Thirteen of the fatalities were drownings; none of those victims was wearing Bobber the water safety dog and friends. a life jacket. The important message to attendees was that life jackets do save lives. About 300 life jackets of various sizes were given out, and ENA members were on hand to make sure each life jacket was fitted and sized appropriately. Bobber, the water safety dog from the U.S. Army Corps of Engineers, also was on hand to help emphasize the importance of wearing your life jacket.

The Arkansas Game and Fish Commission, Safety Before Skill Swim School, U.S. Corps of Engineers, Academy Sports, Wal-Mart and the Arkansas Statewide Injury Prevention Program all contributed to the event by providing educational materials and prizes for drawings. ENA and CATRAC members came out in full force to participate and support the event, which provided such a great educational benefit to the state of Arkansas. Arkansas ENA has been involved for many years with injury prevention throughout the state. However, this was the first event of this magnitude, and it truly proved to be a great success.

New Jersey ENA State Council Submitted by Cheryl G. Newmark, MSN, RN The New Jersey State ENA held its 34th annual Emergency Care Conference in Atlantic City on March 16-18. This year we had more than 700 nurse attendees join us, along with more than 80 exhibitors representing the sectors of education, hospital and travel nurse organizations, products and pharmaceutical and retail companies. We also had a total of 14 posters presented, with the following winners chosen: Research: “A comparative study of two nebulizers in the ED: Breath activated nebulizer and hand held nebulizer,” presented by D. Parrone, B. Sherman, M. Strauss, R. Johnson, C. Reed, K. Hunter, L. Smith and B. Milcarek at Cooper University Hospital, Camden, N.J. Evidence-Based Practice: “When Mr. Yuck Meets Mr. Bubbles: Pediatric Decontamination,” presented by Patricia Eckenrode, RN, SANE, Taylor Hospital, Ridley Park, P.A. Education: “Utilizing Change Management to Successfully Implement

40

Immediate Bedding,” presented Kimberly O’Shea and LeighAnne Schmidt, MSN, RN, Hospital of the University of Pennsylvania, Philadelphia.

Honorable Mention (Most potential to return with evidence): “SOS: Support Our Staff and Stop Suffering in Silence,” presented by Susan Fisher-Brown, RN, SOS Crew Rescue, Egg Harbor Township, N.J. The New Jersey State ENA proudly congratulates not only the winners but all of those who presented posters at the conference. We thank them for their participation!

The Northern Chapter of the New Jersey State ENA held its Summer Education Day on June 13 at the Atlantic Health Systems campus in Morristown. It was well-attended by about 60 ED nurses. Attendees were asked to bring donations of nonperishable food items as their admittance ticket. These items were donated to the Salvation Army Food Bank in Plainfield, N.J. We thank everyone for their generous donations!

The New Jersey State ENA partnered with the New Jersey Teen Safe Driving Coalition’s second annual summit on May 12 at the Encore Conference Center in Freehold. Teens and parents were treated to a day of education with regard to safe driving practices. New Jersey State Police also were in attendance. They worked with teens and family members in taking note of teens’ decreased driving capabilities while texting and while wearing image-altering glasses as they drove through the parking lot. This was quite an educational experience for all.

Legislative Front: New Jersey ENA has been an active participant with our EMS colleagues to revise existing EMS legislation in New Jersey (A2095/S818). Last year, our efforts fell short after the governor conditionally vetoed the bill. Our EMS Coalition went back to the table and addressed the concerns raised by the governor. The revised bills have passed both the New Jersey Assembly and Senate committees and are headed back to the floor of both houses. We are optimistic that we will have important revisions to our EMS Legislation back on the governor’s desk this year.

Virginia ENA State Council Submitted by Brenda B. Hoops, BA, ADN, RN, CEN, CPEN Paula Neher, BSN, RN, and Heather Harlow, RN, members of ENA and the Shenandoah Valley Chapter of the Virginia State Council, are wives, mothers, emergency nurses and now injury prevention activists.

Apart from automobiles, bicycles are associated with more childhood injuries than any other consumer product. Neher and Harlow, nurses at Rockingham Memorial Hospital, had grown weary of seeing children coming into the emergency department with injuries that easily could have prevented with simple protective head gear. They put their heads together and began brainstorming ideas for raising the funds necessary to provide helmets to children in their community.

September 2012

Both ladies also had recently discovered the joy of running and wanted to find a way to combine their fundraising efforts with their desire to promote running as a fitness activity. So, in early 2012, with the support of Neher and Harlow’s colleagues and community, the Dr. L. Daniel Burtner Trauma Trot was born. Held June 16 at the Burtner Farm, Peak View CrossCountry Course, in Penn Laird, Va, and named after a local retired pediatrician and physical fitness activist, the Trauma Trot featured 1K, 5K and 8K races, as well as educational exhibits. It had 80 people registered and 75 runners. The purpose was to increase injury-prevention awareness and raise money to buy bicycle helmets to give to children visiting the emergency department.

The RMH Foundation was the largest sponsor of the event, having awarded the Trauma Trot a $5,000 community grant. Massanutten Adventures provided a portable rock-climbing wall, PHI Air Care landed its air medical helicopter on the school field, and local fire and rescue departments provided fire trucks and ambulances for children to explore. The local sheriff’s department provided traffic control for the 8K runners so they could safely cross the road.

Numerous local businesses, individuals and hospital departments supported the event with donations of food, beverages, supplies, prizes

Children check out PHI Air Care’s air medical helicopter (above) and test their rock-climbing skills during the Dr. L. Daniel Burtner Trauma Trot activities held June 16 in Penn Laird, Va.

and volunteers. Educational displays were provided by the Shenandoah Valley ENA Chapter, Safe Kids of the Central Shenandoah Valley and the Greater Shenandoah Valley Brain Injury Support Group.

The proceeds from the Trauma Trot will allow the RMH Emergency Department to provide 500 helmets to children in the community. Neher, Harlow and all the Trauma Trot volunteers pulled together a great community effort for an incredibly worthy cause – and are already planning for an even bigger event next year!

State Council and Chapter Meetings and Events Kansas ENA State Council State Meetings:

Cornerstones in Emergency Nursing Conference

KENA (Kansas Emergency Nurses Association) meets every other month.

Meetings start at 10:30 am.

Oct. 10 and 11, 2012, 7:30 a.m.–4:30 p.m., Como Zoo Conference Center, St. Paul, Minn.

October 12th – Stormont Vail, Topeka December 14th – University of Kansas, Kansas City

Topics: Health care reform; bath salts and drug trends; pediatric trauma cases; LVADs; nitrous oxide in the ED; hoarding; chemical mixing suicides; capnography monitoring; the autistic patient; 75 at 75; top articles of 2012, and more.

Upcoming education: CEN Review Oct. 15-16 – Hutchinson Oct. 18-19 – Lawrence Presenter: Jeff Solheim, MSN, RN, CEN, CFRN, RN-BC, FAEN For more information: www.kansasena.org and visit us on Facebook.

Kansas Chapter Meetings: Central Kansas ENA Meetings are planned at 7 p.m. for the fourth Monday of the odd months of the year. Exception will be the July meeting.

September 19 – Lawrence November 14 – Kansas City

Minnesota Greater Twin Cities Chapter Legislative initiative saving lives, changing behaviors. For more information, visit crashcart440@hotmail.com

Ohio Seagate Chapter Emergency Oct. 5 – 7:45 a.m.–5 p.m.

Location: ProMedica Toledo Hospital Kellermyer Education Center; $60 for ENA members. Breakfast, lunch and afternoon refreshments will be provided. For more information, please contact Jennifer. carpenter@promedica.org or Kristie. gallagher@promedica.org.

For more information: www.minnesota ena.com, Greater Twin Cities Chapter section.

Washington ENA State Council & British Columbia National Emergency Nurses’ Affiliation (Canada)

New Jersey ENA State Council Northern Chapter

Emergency Nursing Without Borders emergency nursing conference, Oct. 12-13, 2012 in Seattle.

Fall/Winter Education Day will be held Oct. 23, 2012. Venue and topic to be announced, so save the date.

This is a joint effort between Washington State ENA and the ENA of British Columbia/ NENA. Presenters: AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN (ENA immediate past president); Dr. Bruce Camapna; Dr. Grant Innes; Sherry Stackhouse (ENABC President); Andi Foley, MSN, RN, CEN; Brian Rogge, RN, CEN; Sharron Lyons, RN (2012 NENA President); Dr. Nathan Schlicher (WAACEP).

Southern Chapter: Educational Day will be held Oct. 25; the presentation will be “The Child-Trauma and Stroke.” It will be held at South Jersey Healthcare in Elmer.

National speakers will include Dr. Al Sacchetti, Jeannie Venella, DNP, MS, RN, CEN, CPEN, and Mary Strauss.

Jersey Shore Chapter: ENPC and TNCC classes to be held at AtlantiCare Regional Medical Center, Atlantic City. Please visit our website at www.njena.org to find registration forms and follow up on future dates for educational conferences.

Official Magazine of the Emergency Nurses Association

For more information, visit washingtonena. org/bc-waconference.html.

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ENPC 4th Edition Instructor Update As we approach the rollout of the 4th edition of ENPC, here is a recap of the timing: • Instructor supplements will be available for purchase by instructors once they have completed the update; • 4th edition ENPC courses can begin to be held by updated course directors and instructors on Sept. 1; • All ENPC 3rd edition instructors must be updated to the 4th edition by Feb. 28, 2013; • Only 4th edition ENPC courses can be held after Feb. 28, 2013.* * International and military may need some additional time to transition to the 4th edition.

There is a new ENPC course application available on the ENPC page, www.ena.org, where you are able to indicate the version of your planned course. Please start using this application right away. All ENPC courses booked for Sept. 1 and beyond must indicate whether they will be held as 3rd or 4th edition courses.

The letter sent to all ENPC instructors on Feb. 28 outlining the rollout is posted on the following ENPC page: www.ena.org/ coursesandeducation/ENPC-TNCC/enpc All current ENPC instructors will be sent information in advance with instructions for

Are You Interested in Becoming a 2013 ENA Annual Conference Faculty Member?

• Share your knowledge and expertise with an international audience of emergency nurses that includes advanced practice nurses, trauma coordinators, managers, administrators, medical directors, clinical

accessing the learning management system for the required update materials and test.

New State Leaders’ View A new state leaders view is now available in eCourseOps. This allows our state leaders to do the following: • View all upcoming and past courses held within the state.

• View all related invoices for the state.

• View all instructor candidates waiting to be scheduled for monitoring or scheduled for upcoming courses.

• Designate and manage who is state faculty, meaning who has the authority to monitor instructor candidates within the state.

We plan to continue to build on this functionality and also to roll it out to our international partners in the very near future.

Course directors may have also noticed that the date your course materials were mailed to you now shows on your upcoming courses.

This relates to the Scantrons and certificates.

Once Course Operations receives your post course materials, there is now a check mark indicating they were received on your past courses.

We continue to thank our Course Director Focus Group for providing the oversight and direction that resulted in these new features.

Your Input Is Welcome

specialists, prehospital coordinators and educators.

Coursebytes is the official communication to all TNCC, ENPC and CATN course directors and instructors. Topic ideas for future issues and feedback are welcome at CourseBytes@ ena.org.

• Course ideas should focus on clinical, advanced clinical, advanced practice, pharmacology, research, education and injury prevention as well as leadership and professional issues.

• Standard course length is 75 minutes. Other options are workshops in three or eight hours in length.

Also desired are proposals for 30-minute sessions that allow faculty to provide a factual rapid-paced presentation that provides attendees with the latest need-to-know cutting-edge information.

All Submissions are Due Monday, October 8, 2012.

To review the full submission criteria and the submission form, visit the Current Calls section of www.ena.org and select the 2013 ENA Annual Conference Call for Faculty and Courses or, for more information, contact Conference Services at AnnualConference@ena.org or 847-460-4117.

Watch your e-mail inbox for:

Take your career to the next level. Be part of an elite group.

Submit a proposal for courses and faculty today!

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AC13_StrengthenPractice_Call_Faculty_D.indd 1

5/30/2012 2:44:48 PM

• Advance coverage sent twice before 2012 Annual Conference in San Diego • On-site coverage delivered daily once conference is under way • Wrap-up edition the week after conference

September 2012

New ENA monthly offering for FREE Continuing Education with contact hours for our members.

• Available September 1 – Building a Championship Team 1.0 contact hour Jeff Strickler, RN, MA, CEN, CFRN

Don’t miss out on enhancing your education.

Go to www.ena.org/FreeCE for additional free continuing education opportunites.

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

NOMINATIONS COMMITTEE | Carlene Kincaid, BSN, RN, CEN, Nominations Committee, Region 5

Springing Forward Into a New ENA Season at General Assembly ENA General Assembly is like spring: a time to start fresh, to discuss and reconnect as we conduct the business of the organization.

General Assembly precedes the educational portion of the ENA Annual Conference. More than 700 delegates, past presidents, the board of directors, Resolutions Committee, Nominations Committee, amendment authors, interested guests and national office staff all converge in a meeting hall to discuss the current and future business of the organization. Amendments are presented by our dedicated members who strive to bring new ideas that will bring continued growth and new beginnings to ENA. The Nominations Committee will bring forward bylaws amendments with the intention of defining the committee’s role, the future growth of the committee and the elections process. The Nominations Committee listened to ENA members and over the last two years made historical changes to the elections process, as represented in the ENA bylaws and Policy 3.12, National Candidate Publicity and Campaigning.

Our committee takes great pride in its efforts

Colorado delegate Eric Christensen, BSN, RN, CEN, speaks at General Assembly last year in Tampa, Fla.

to connect members and candidates through such vehicles as the Candidates Election Forum, the ENA website and social media. This year,

we will continue to look at the elections process and how we can continue to work to ensure that all members’ voices are heard and recognized, contributing to the success and growth of ENA. A current and future challenge the Nominations Committee has been charged with is developing a new elections process timeline to shorten the election cycle without affecting members’ right to vote, run for office and serve the current terms outlined in the bylaws.

The Nominations Committee has spent a great deal of time discussing the pros and cons of multiple timelines and will bring a revised timeline to the membership in the near future.

At the conclusion of General Assembly, the Nominations Committee is once again looking forward to a fresh start with enthusiasm and excitement.

Are you ready to take the step in 2013?

Come join us, share your ideas and get involved at the national level as we spring forward into a new and promising year. Refresh, Revitalize and Invigorate!

Feedback Frame Congratulations to the 2012 inductees of the Academy of Emergency Nursing.

Exciting plans are under way for the 2012 class of fellows induction during the 1st Annual Awards Gala at the ENA Annual Conference in San Diego, Saturday, Sept. 15.

Come join the fun. Awards Gala information is available at: www.ena. org/coursesandeducation/ conferences/annual/2012/attendees/ Documents/GalaRegForm.pdf.

Questions? E-mail academy@ena.org.

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September 2012

September 2012 Free Continuing Education ENA is proud to offer FREE CE for our members See the new CE added for September. To access the ENA FREE CE, visit www.ena.org/FreeCE. Member login is required.

New NEW Emergency Nursing Resources (ENRs) Now with Executive Summaries ENA develops Emergency Nursing Resources to bridge the gap between research and everyday emergency nursing practice. The four new ENRs now each have an Executive Summary that provides you the essential information for patient care. To access all of 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. 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.

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

Mosby’s Nursing Skills: ENA Edition Mosby’s Nursing Skills provide you with 20 new 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 login as a member).

June 2012

Board Meeting Actions and Highlights The ENA Board of Directors met June 21 via teleconference. All members of the board were present and took the following actions: • Approved the May 16 board of directors meeting minutes as written.

• Approved changing ENA’s statutory representative as presented.

• Approved a request to support the American College of Emergency Physicians’ clinical policy: Initial Evaluation and Management of Patients Presenting in the Emergency Department in Early Pregnancy.

• Approved the following revised board governance policies: ° Use of Organizational Titles ° Position Statements • Approved moving the final Bylaw Proposals and Resolutions, including board comments, forward to the 2012 General Assembly as amended.

• Approved revising the Course in Advanced Trauma Nursing II and suspending work on the Emergency Nursing Advanced Critical Thinking course until it can be re-evaluated for further action.

• Ratified Nancy Ellen McGrath, MSN, RN, as the replacement Pediatric Emergency Care Special Interest Group facilitator as presented.

• Ratified the international delegates for the 2012 General Assembly as presented: ° Carole Rush, MEd, BSN, RN, CEN, FAEN, Canada

Official Magazine of the Emergency Nurses Association

° Margaret Dymond, RN, Canada ° Sharron Lyons, RN, Canada ° Sherry Uribe, MBA, RN, Canada ° Liz Cloughessy, MHA, RN, Australia • Ratified the 2012 national awards recipients as presented.

• Ratified the 2013 Annual Conference Committee appointments as presented: ° Alicia R. Dean, MSN, RN, APRN, CNS, 2013 chairperson ° Electra Allen, BSN, RN ° Carol E. Reeves, BS, RN, EMT-P, onsite person • Ratified the International Delegate Review Committee appointments as presented: ° Seleem Choudhury, MSN, MBA, BSN, RN, CEN ° Charlotte Schnakenberg, MSN, BS, RN, CEN, CPEN • Ratified the Resolutions Committee appointments as presented: ° E. Marie Wilson, MPA, RN, 2013 chairperson ° Eric H. Christensen, BSN, RN, CEN ° Bruce A. Olson, BSN, BA, RN, CEN Highlights of the next scheduled board of directors meeting will be published in a future issue of ENA Connection.

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Home Among the Homeless Continued from page 27 pharmacy, for example, and no X-rays.

Pulmonary and cardiac emergencies and severe injuries call for a regular ED environment.

Legg’s team sticks to the essentials of primary care and making the patients feel safe, respected, worthy of treatment. Just like in Durban and Capetown. ‘‘The biggest thing that was such a huge difference to me was really seeing people, not seeing the injury,’’ she says. ‘‘And I think the other thing that really opened my eyes is that we all, every one of us, can be in this position in a matter of months.’’

In a harsh economy, going without two or three paychecks might be all it takes. ‘‘A classic and typical patient for me is myself,’’ Legg says. ‘‘I have clients that are now homeless that have horrible arthritis and couldn’t do what they need to do, lost their job, aren’t of age where they could get their retirement, lost their apartment or their home and now they’re homeless. Hospital EDs are overloaded, too. I’ve had people discharged to our doorstep, even when we’re closed, after having a C-section with a newborn baby. I’ve had people discharged to our doorstep after open-heart surgery with the idea that we’re going to find someplace [for them]. ‘‘They don’t ‘look’ homeless, whatever that look is supposed to be. Maybe it’s what people consider to be the fellow that’s intoxicated on the side of the road with a sign. I guess that’s ‘the look,’ but reality is that while we see a lot of those folks, we see folks that look just like you and me. And unfortunately, I’m sure I saw them in the ER, too, and never paid attention to it. I never asked, ‘Where are you going home to tonight?’ ’’ ♦♦♦♦♦ Ask that question, Brecher says. Do it. It has to be asked.

Brecher has just described the outside of Legg’s building, a spectacle so powerful that after her tour of AHCH that last day of May, she returned to take pictures. The wall is loaded with colorful tiles, hundreds of them, created right there in the ArtStreet studio. Each bears the name of a homeless person from the area who died on the streets. There are tiles for infants, the elderly. Some were made by friends of the deceased, others by the HCH staff for clients who didn’t have any known family or — quite commonly — didn’t want their families to know they were homeless. ‘‘I think most of us don’t even think about it,’’ Brecher says. ‘‘We assume that people have somewhere to go. And every ER that I’ve ever been in has their homeless folks that they know. But families that are living in their cars won’t tell you that they are.’’

46

The medical front desk (left) and exterior (top) of the Albuquerque Health Care for the Homeless are designed to make clients feel welcome in the care of nurse manager Cathi Legg (above) and her team.

Circumstances would change, she says, ‘‘if we just took that moment to respect everyone as a person, and then not to make assumptions about what they do or don’t have access to, and really be in the moment and have that conversation: ‘Do you have somewhere to go when you’re leaving here, and if not, how can I help you get to the next step?’ ” During her visit, Brecher observed a man who’d battled a sore on his foot for months. At AHCH, he’d been given access to a place where he could wash and redress the wound each day. It was healing. Finally.

Men and women waiting outside to be seen were gracious and patient, she says. The staff’s approach — never “no,” but always “How can I help?” — was infectious.

“That same tone works beautifully in an emergency department,” she says.

But it is not the end of what can be done. ‘‘There are ways as emergency nurses that we can contribute to these organizations that are doing so much work in a community that we don’t like to think about but we are directly involved with,’’ Brecher says. Instead of simply passing someone the bus fare to head to the nearest shelter, an emergency department might establish a working relationship with a local agency such as a Health Care for the Homeless and implement a referral system for homeless patients. Instead of adopting a family for a holiday community-service project, an ED might gather staple items such as socks and coats to be given out directly to homeless patients, or

donate a slew of supplies to an agency that knows how to best stretch those resources.

Legg, the remolded ED nurse, knows the differences, large and small, that those sorts of efforts might make. She has seen her staff make so many themselves. ‘‘I can tell you that I’ve had a lot of folks that have come in and given me a hug and said, ‘I got a job today,’ a lot of folks that have come in and said, ‘I get to move into an apartment next week,’ ’’ Legg says. ‘‘It doesn’t happen every day, but at least once a week. There’s always something. ‘‘Even the folks that have not had success from that standpoint, but maybe their A1C is down, they’ll come up and they’ll say, ‘You’ve really helped me figure out how to do a diet that’ll work when I’m homeless.’ Or we’ll have somebody who comes in with a horrible abscess, and we’ll take care of the abscess and they’ll say, ‘Oh, my gosh. Now I can put my skirt back on instead of wearing my long pants, and I feel like I’m pretty again and can go look for a job.’ Or a mom who comes in and says, ‘I really wanted my kids in school, and thank you for vaccinating them because now I can get them enrolled in school.’ ’’ These are Cathi Legg’s patients.

Her people. ‘‘We find a way,’’ she says. ‘‘We just find a way.’’

To find a Healthcare for the Homeless program in your area, visit www.nhchc. org/resources/grantees/national-hchgrantee-directory.

September 2012

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