the Official Magazine of the Emergency Nurses Association
connection
August 2013 Volume 37, Issue 7
EMPOWER SURGE Leading the Charge For a Safe and Secure Future ENA Election Results, Pages 6 - 8 Safe Work Environment Intensive, Pages 12-13
INSIDE
FEATURES
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Dates to Remember Sept. 17-21, 2013 ENA General Assembly and Annual Conference, Nashville, Tenn. Oct. 1, 2013 Deadline to apply for the 2013 ENA Foundation/ANIA Research Grant and the 2013 ENA Foundation Industry-Supported Research Grant.
ENA Exclusive Content PAGES 6 - 8 ENA 2013 Election Results PAGES 12 - 13 ENA Safe Work Environment Intensive PAGE 18 Smartphones in the ED: What’s Your Policy? PAGE 21 Lyme Disease Testing: Follow the Steps PAGE 22 Board Writes: A Call For Help From Our Mexican Colleagues PAGE 26 Finding Conference Faculty: Why That Person Should Be You
Regular Features PAGES 4-5 Free CE of the Month Members in Motion Ask ENA PAGE 9 ENA Foundation PAGE 11 ENA Research PAGE 16 ENA Advocacy PAGE 24 CourseBytes PAGE 27 State Connection PAGE 28 Academy of Emergency Nursing PAGE 29 Ready or Not
LETTER FROM THE PRESIDENT | JoAnn Lazarus, MSN, RN, CEN
Control or Influence?
I
f you are like I am, you want to control everything in your environment. Have you ever said, ‘‘If the lab reported to me, we would get our results back faster’’ or ‘‘If the floor nurses reported to the emergency department, we wouldn’t have to wait to send up our patients’’? The thinking behind these statements is that controlling people and situations brings desired results.
We all know it doesn’t work that way. While we cannot control other people or most situations, we can influence them. There are many great leaders, including Abraham Lincoln, Martin Luther King Jr., John F. Kennedy, Judith Kelleher, MSN, RN, CEN, FAEN, and Anita Dorr, RN, FAEN, whose influence — not control — changed history. It is important to focus not on being in control but on how we can influence the person or situation. You do not have to be a formal leader to effect change. Author Michael Hyatt said there are four ways to become a person of influence, no matter what your position: 1. Focus on yourself. Modeling behavior is the most powerful form of influence. You have to model the person you want others to be. If bullying behavior is an issue in your department or chapter, don’t get caught up in gossip or negative behavior. 2. Take the initiative. Instead of sitting back and complaining about a situation, look for ways that you can influence the outcome. Are you concerned about violence in your workplace? Then become part of the team that implements a zero-tolerance policy in your hospital. 3. Cast the vision. Many of us have never thought about having a personal mission statement. We live day to day without any real thought of where we are headed. Take time to create your personal mission statement and begin the work of living it. 4. Appreciate the effort. Everyone likes to think that what he or she does makes a difference. At the end of a particularly difficult shift, do you let your peers know their contributions made a difference to patient outcomes? You do not have to be a formal
leader to recognize and appreciate others. We cannot control when and what types of patients will arrive in our emergency departments or how other departments respond to our needs; however, we can control our responses. We have the power to influence others through our words and actions. This is how we can make a difference. We can influence legislation through our advocatism efforts, we can influence patient outcomes by collaborating with others, and we can influence our profession by becoming actively involved in our local chapters and state councils. Resources Hyatt, M. (2007, September 3). Leadership: Control vs. influence. Retrieved from http:// michaelhyatt.com/leadership-control-vsinfluence.html Lickerman, A. (n.d.). Happiness in this world: Reflections of a Buddhist physician. Retrieved from http://www.psychologytoday.com/ blog/happiness-in-world.
Thank-You to JEN Editor-in-Chief I would like to take this opportunity to thank Reneé Semonin-Holleran, PhD, APRN, FNP, CEN, CCRN, CFRN, CTRN, FAEN, for the contributions she has made as editor-in-chief of the Journal of Emergency Nursing. She served as the JEN editor-in chief from June 2006 until June of this year. She has been a dedicated member of ENA for many years and served as the 1996 ENA president. ENA thanks her for her seven years of service with the JEN and wishes her much success in the future. JoAnn Lazarus, MSN, RN, CEN
Official Magazine of the Emergency Nurses Association
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Put your emergency nursing talents into research that can help everyone in the latest free continuing education course for ENA members!
Available starting Aug. 1 . . .
‘‘See What Everyone Has Seen, and Think What No One Has Thought: Problem-Solving Through Bedside Research,’’ presented by Lisa Wolf, PhD, RN, CEN, FAEN. (Credit: 1.0 contact hour.) In this e-learning course taken from Leadership Conference 2013, Wolf, the director of the ENA Institute for Emergency Nursing Research, walks you through the steps of identifying clinical problems and developing ways to investigate them. You’ll also learn how to obtain resources for your bedside research. To take these and other CE courses absolutely free as an ENA member: • Go to www.ena.org/freeCE, where you’ll log in as a member (or create an account). • Add desired courses to your cart and ‘‘check out.’’ • Proceed to your Personal Learning Page to start or complete any course for which you have registered or to print a certificate when you’re done. • To return to your Personal Learning Page at a later time, go to www.ena.org and find ‘‘Personal Learning Page’’ under the Courses & Education tab. Please be sure you are using the e-mail address associated with your membership when logging in. If you have questions about any free e-learning course or the checkout process, e-mail elearning@ena.org.
ENA Connection is published 11 times per year from January to December by: The Emergency Nurses Association 915 Lee Street Des Plaines, IL 60016-6569 and is distributed to members of the association as a direct benefit of membership. Copyright© 2013 by the Emergency Nurses Association. Printed in the U.S.A. Periodicals postage paid at the Des Plaines, IL, Post Office and additional mailing offices.
Lowell General ED Nurse Lauded With Wall Honor ENA member Laura LoVerme, emergency department nurse RNC, CEN, an emergency who is full of kindness and department staff nurse at Lowell compassion. She treats everyone (Mass.) General with the utmost dignity Hospital, was honored and respect,’’ said Diane as one of the recipients Regan, BSN, RN, CEN, of the hospital’s Wall director of the emergency of Nursing awards. The department at Lowell award is given as a General’s main campus. testimonial of the ‘‘Laura can be seen Laura outstanding dedication LoVerme frequently giving positive of the staff in Lowell feedback to her General’s patient care services co-workers, and she always division. takes the opportunity to thank a LoVerme was chosen by her co-worker for making a peers because of her ability to difference in a patient’s or a demonstrate excellence in patient family’s experience.’’ care on a daily basis and LoVerme also has taken on exemplify the hospital’s standards the role of mentor and has of performance, which include embraced preceptor elements such as appreciation, opportunities, including formal attitude, sense of ownership, teaching to staff members communication and commitment through education programs, as to fellow employees. well as charge responsibilities ‘‘Laura is an experienced within the department. Do you have a recent professional or educational success story you want to share about yourself or an ENA member colleague? E-mail the information to connection@ena.org with the subject line “Members in Motion.’’
POSTMASTER: Send address changes to ENA Connection 915 Lee Street Des Plaines, IL 60016-6569 ISSN: 1534-2565 Fax: 847-460-4002 Website: www.ena.org E-mail: connection@ena.org
Member Services: 800-900-9659 Non-member subscriptions are available for $50 (USA) and $60 (foreign).
Editor-in-Chief: Amy Carpenter Aquino Assistant Editor: Josh Gaby Writer: Kendra Y. Mims Editorial Assistant: Renee Herrmann BOARD OF DIRECTORS Officers: President: JoAnn Lazarus, MSN, RN, CEN President-elect: Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN
Secretary/Treasurer: Matthew F. Powers, MS, BSN, RN, MICP, CEN Immediate Past President: Gail Lenehan, EdD, MSN, RN, FAEN, FAAN Directors: Kathleen E. Carlson, MSN, RN, CEN, FAEN Ellen (Ellie) H. Encapera, RN, CEN Marylou Killian, DNP, RN, FNP-BC, CEN Michael D. Moon, MSN, RN, CNS-CC, CEN, FAEN Sally K. Snow, BSN, RN, CPEN, FAEN Joan Somes, PhD, MSN, RN, CEN, CPEN, FAEN Karen K. Wiley, MSN, RN, CEN Executive Director: Susan M. Hohenhaus, LPD, RN, CEN, FAEN
Q: Where do I find ENA position statements? A: Great question! Position statements may be found under the Practice section of the ENA website at www.ena.org. There is a host of informative and interesting information on ENA’s newly redesigned website. The website is a great way of keeping up to date with educational, research and quality activities as well as upcoming conferences, advocacy initiatives, ENPC and TNCC resources, membership information and more. We are here to assist you. Please feel free to contact Connection@ena. org with questions or concerns.
Have a Question for ENA? Use ‘‘Ask ENA’’ to ask about the organization and emergency nursing in general. Questions should be no longer than 200 words and will be referred to the appropriate ENA staff or department. Submission does not guarantee publication. Questions may be edited. E-mail questions to connection@ena.org.
— Paula Karnick, Ph.D, ANP-BC, CPNP, Director, Institute for Emergency Nursing Education
Official Magazine of the Emergency Nurses Association
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2013 ENA ELECTION RESULTS
THE VOTERS HAVE SPOKEN . . . By Amy Carpenter Aquino, ENA Connection
E
NA is pleased to announce the results of the 2013 election for the ENA Board of Directors and the Nominations Committee. Voting began May 14 and ended June 12.
Participation held steady compared to last year, with 6.36
percent of more than 41,000 eligible members casting votes. The Indiana State Council had the highest voter turnout at 17 percent, with the Vermont State Council close behind at 14 percent. Other state councils with double-digit voter turnouts were Kansas and Nebraska. Members can view the complete
Board Officers 2014 President-Elect Members elected Matthew F. Powers, MS, BSN, RN, MICP, CEN, as the 2014 presidentelect. Powers is the emergency department nursing Matthew F. Powers supervisor for Kaiser Permanente in Vacaville, Calif., and Battalion Chief-EMS for the North County Fire Authority in Daly City, Calif. Powers is the 2013 secretary/ treasurer and has served on the ENA Board of Directors since 2010. He was president of the California State Council in 2007 and 2008 and of the East Bay Chapter in 2003. He has served as a Leadership Conference speaker and a General Assembly delegate. Powers has represented ENA on the California State Emergency Medical Services Commission since 2007 and is the 2003 recipient of the ENA Rising Star Award. ‘‘I am very thankful and humbled that many of you have chosen me to be your ENA president for 2015,’’ Powers
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election results in the members-only section of www.ena.org. All board candidates participated in an election forum at ENA Leadership Conference 2013 in Fort Lauderdale, Fla. Candidate videos were available at www.ena.org. ENA commends all of the candidates for their involvement in the election, as well as all of the members who voted. The official installation of the 2014 board and committee members will be held Sept. 19 at the Gaylord Opryland Convention Center during the 2013 ENA Annual Conference. Newly elected members of the ENA Board of Directors will take office Jan. 1, 2014. Nominations Committee members begin their terms in September.
said. ‘‘What this means is we will build on our past experiences and leaders, continuing to make ENA the finest emergency nursing professional organization in the world. I am excited to hear your ideas, implement positive change and give our members and patients the resources needed to make us and society better as a whole. Our largest challenge for 2015 is our first single Annual Conference. Let us make it the best. Let us travel this journey together.’’
2014 Secretary/ Treasurer Members elected Kathleen E. Carlson, MSN, RN, CEN, FAEN, as the 2014 secretary/treasurer. Carlson is an ED staff nurse at Kathleen Sentara Virginia E. Carlson Beach General Hospital in Virginia Beach, Va. Carlson has been a member of the ENA Board of Directors since 2011. She is a 2008 recipient of the Judith C. Kelleher Award and was inducted into the Academy of Emergency Nursing in
2009. She has contributed to several ENA projects, including serving as co-editor of the Emergency Nursing Certification Review. She is a past president of the Connecticut ENA State Council. ‘‘I am truly honored to be elected to serve as ENA’s 2014 secretary/ treasurer,’’ Carlson said. ‘‘I am humbled by the outpouring of support and encouragement I have received as I grow on this board. I will continue to listen to the members with an open mind, ask pertinent questions to clearly understand issues and concerns and stay focused on what is best for emergency nursing, using our strategic plan to guide my decisions. My passion for safe practice and safe care will be my touchstones. Thank you for your continued confidence in me.’’
August 2013
2013 ENA ELECTION RESULTS Directors The following candidates were elected to three-year terms (Jan. 1, 2014 - Dec. 31, 2016) on the Board of Directors: Jeff Solheim, MSN, RN-BC, CEN, CFRN, FAEN, is president of Solheim Enterprises and founder/executive director of Project Jeff Solheim Helping Hands, both in West Linn, Ore. Solheim served as chairperson of the Leadership Conference 2013 Planning Committee. He has participated on two Trauma Nursing Core Course international dissemination teams. Solheim was president of the Oregon ENA State Council in 2005 and 2011 and is the founder of the South Central ENA Chapter. He was inducted into the Academy of Emergency Nursing in 2008 and is a 2007 recipient of the Nursing Education Award. ‘‘Ironically, I was standing in front of an audience speaking when I received the call that I had been elected to serve on the ENA Board of Directors,’’ Solheim said. ‘‘There was an immediate rush of excitement followed by a true realization of the responsibility that had been bestowed upon me. I recognize that I have been elected, not hired, and therefore have a responsibility to those who elected me to represent you, as well as our organization, something I promise to do to the utmost of my abilities over the next three years.’’
Mitch Jewett
Mitch Jewett, AA, RN, CEN, CPEN, is an ED staff nurse at Galichia Heart Hospital, a campus of Wesley Medical Center, in Wichita, Kan., and an ED
per diem nurse at Newton Medical Center in Newton, Kan. Jewett served on the ENA Board of Directors from 2007 to 2012 and was board liaison to several national committees and work teams. He is a member of the 2013 Geriatric Committee. Jewett was president of the Kansas ENA State Council in 2003 and 2005 and of the Central Kansas Chapter in 2006. ‘‘Getting elected as a third-term director means a lot to me personally,’’ Jewett said. ‘‘I am honored, and I want to say ‘thank you.’ This election means that I get to represent the members at the board table. I have heard that some of the members desire for more transparency from the board and the executive committee, and so as one elected for the role of director, I will soon get to balance the needs and reality of the position and the expectations of the members who elected me. Please wish me luck. Thank you for this opportunity to serve.’’
Nominations Committee The following candidates were elected to the Nominations Committee: Scott E. Stover, MSN, MBA, RN, CEN, ACNS-BC, was elected to represent Region 2. Stover is the director of emergency services Scott E. Stover for Methodist Sugar Land Hospital in Sugar Land, Texas. He has served on the Nominations Committee since 2011. ‘‘It is an honor to serve ENA in any capacity,’’ Stover said. ‘‘I have enjoyed serving at the local, state and national levels. The Nominations Committee is
Official Magazine of the Emergency Nurses Association
performing very important work for the organization. We have been working to increase voter participation, showing slight increases over the past two years, and we are now working to shorten the election cycle. I am very pleased to be able to serve another two years on the Nominations Committee. Thanks to everyone who voted this year!’’ Cathy C. Fox, RN, CEN, CPEN, was elected to represent Region 4. Fox is an ED staff nurse/educational consultant at Sentara Leigh Cathy C. Fox Hospital in Norfolk, Va. She has served on the Nominations Committee since 2011. ‘‘I am pleased and delighted to have been elected to represent Region 4 for the Nominations Committee for a second term,’’ Fox said. ‘‘There is still more work to be done on this important committee. We will continue to bring forth a slate of candidates for our members each year and look forward to the time when our voting percentages have increased significantly. ‘‘Please feel free to voice any questions or suggestions when you see us at Annual Conference this September in Nashville and at the Leadership Conference in March 2014 in Phoenix. The committee welcomes member e-mails at elections@ena.org.’’ Ryan Oglesby, PhD, MHA, RN, CEN, NEA-BC, was elected to represent Region 6. He is an emergency service line coach for Studer Group in Ryan Oglesby Gulf Breeze, Fla. ‘‘It is with the utmost gratitude that I
Continued on page 8
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ELECTION RESULTS Continued from page 7 extend appreciation to the ENA members who used their voice, their vote, to express confidence in me to serve as Region 6 Nominations Committee representative,’’ Oglesby said. ‘‘I cannot think of a more humbling career moment. Trust and faith has been placed in me that is not taken lightly. Having support from members of this outstanding association has opened my eyes to so many new perspectives regarding this position. This is an awesome responsibility, and I will endeavor to represent you with the utmost transparency and boldness. Thank you for the opportunity to serve.’’
Mary Ellen ‘‘Mel’’ Wilson
Mary Ellen ‘‘Mel’’ Wilson, MS, RN, FNP, CEN, COHN-S, FAEN, was elected as the past board member. She is a regional health services manager for Avery Dennison in Strongsville, Ohio. ‘‘I am so honored by the membership’s endorsement,’’ Wilson said. ‘‘Being elected to the Nominations Committee by the ENA membership is humbling. The members of the Nominations Committee embody the qualities of sensitivity, fairness and complete objectivity. I am thrilled to be able to collaborate with such dedicated, esteemed colleagues.’’
ENA Call for… Memorial Requests, 2013 ENA General Assembly ENA will honor our members who have died in the last year during a special memoriam presentation during the 2013 General Assembly in Nashville, Tenn. If you would like to recognize a member who has died, please complete the request form found in the General Assembly area (members only) at www.ena.org. All requests must be submitted to componentrelations@ena.org electronically by Aug. 21, at 5 p.m. Central time.
A NIGHT AT THE
GRAND OLE OPRY
™
SUPPORT ENA FOUNDATION AT THE ENA 2013 ANNUAL CONFERENCE IN NASHVILLE, TN, AND ENJOY THE SHOW THAT MADE COUNTRY MUSIC FAMOUS
JOIN US FOR A NIGHT OF COUNTRY MUSIC & NETWORKING WITH YOUR COLLEAGUES!
SEPTEMBER 20 • 7 PM Don’t miss this exciting event! What began as a simple radio broadcast in 1925 is now a live-entertainment phenomenon. Dedicated to honoring country music’s rich history and dynamic presence, the Grand Ole Opry showcases a mix of country legends and the contemporary chart-toppers who have followed in their footsteps.
Register now at: www.ena.org/ac 8
AC13 Foundation Events Opry Ad_Connection_Half_08 2013.indd 1
7/2/13 2:04 PM
August 2013
ENA FOUNDATION | Julie Jones, BS, RN, CEN, 2013 ENA Foundation Chairperson
Supporting Your Profession: A Tune Everyone Can Carry Nashville, here we come! Who’s ready to don their cowboy boots and two-step their way through 2013 ENA Annual Conference? I hope y’all will be joining us next month in Music City. It will be great to meet those individuals who are making a difference in our profession by supporting the ENA Foundation. While you are in Nashville, don’t forget to sashay over to the ENA Foundation booth to say hello and find out how you can get involved. Check out some of this year’s amazing opportunities below.
refreshing morning walk around the grounds of Opryland on Friday, Sept. 20. Walkers are encouraged to raise $150 for the 1.2-mile walk. Solicit your friends and family to sponsor you as a walker before you come to Nashville. The registration fee is $10.
Get Your Bid On It wouldn’t be Annual Conference without the jewelry auction. The fabulous jewelry items donated by state councils, chapters and individuals represent regions from all over the world. Swing by the exhibit hall and browse through the diverse jewelry selection; you’ll see everything from bold and glamorous accessories to simple and chic pieces. Pick out your favorite pieces and then bid away (bidding is open during exhibit hall hours and concludes at noon Saturday, Sept. 21). Competition gets pretty fierce at the close of the auction, so be prepared. Let’s break last year’s jewelry auction record of 171 donated jewelry pieces that raised $20,500 for the ENA Foundation.
Attend the ENA Foundation Event Pick Up a Premium Item By supporting the ENA Foundation with a $30 donation, you can pick up a 4GB thumb drive premium item (pictured above), conveniently preloaded with conference information. You also can purchase ‘‘stretcherside miracle’’ pins for $5 each. These pins have been generously donated by ENA past president AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN, to remind us of the miracles that we as emergency nurses perform every day. These pins are a great way to thank staff for a job well done. Both of these ENA Foundation premium items will make great souvenirs for your colleagues back home. Remember, you don’t have to attend the Annual Conference to reward yourself or your colleagues with these goodies. Make a donation at www.enafoundation.org to get your premium items today.
Walk For Wellness We are adding a new event for the ENA Foundation this year — a walk for wellness. Bring your comfortable sneakers for this event and join your fellow ENA members for a
I’ve saved my favorite event for last –– A Night at the Grand Ole Opry. The VIP package tickets already have sold out, so hurry and go online to get your ‘‘friends package seating.’’ The Grand Ole Opry, which began as a simple radio broadcast in 1925, is now a live-entertainment phenomenon and Nashville’s No. 1 attraction. Whichever country stars take the stage, it will be a night of unforgettable entertainment and a one-of-a-kind experience. Come join me in crossing off a bucket-list item and support a worthy cause, the ENA Foundation. Whether you make a $30 donation to receive your thumb drive, join your colleagues for the walk for wellness, enhance your jewelry collection or attend the ENA Foundation Event, there are many ways for you to support the ENA Foundation and have a wonderful time at the 2013 Annual Conference in Nashville. I look forward to seeing y’all there, and I thank you for your continued support of the ENA Foundation. We could not do what we do without you. For more information, please visit the new ENA Foundation website at www.enafoundation.org.
Official Magazine of the Emergency Nurses Association
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ENA ANNUAL CONFERENCE
SEPTEMBER
19-21 2013
NASHV ILLE, T EN N ESSEE
REGISTER TODAY! Earn more than 21 contact hours. Attend top-notch educational sessions covering 9 key practice areas. Learn about innovative products and services in the exhibit hall. Network with emergency nurses from across the globe.
To register for ENA 2013 ANNUAL CONFERENCE, please go to www.ena.org/ac or scan the QR code. Follow the action
#ENAAC13
*Accreditation statement: The Emergency Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
ENA RESEARCH |
Lisa Wolf, PhD, RN, CEN, FAEN, Director of the ENA Institute for Emergency Nursing Research
Why Should We Do Qualitative Research? When most people think of research, they tend to imagine a series of experiments that give results and prove whether something is true. Quantitative research deals with numbers. It describes how many, how often or uncovers the relationships between variables in a statistical way. Qualitative research describes experiences of individuals in a common situation. Data are gathered from interviews, focus groups, narratives or observation. Quantitative research can tell you the what of a situation; qualitative research can give a richer explanation of why it’s happening, as well as a better understanding of potential barriers and facilitators to a solution. A great example of this is our studies on workplace violence. ENA has been conducting an Emergency Department Violence Survey for four years to gather data on how often emergency nurses are physically or verbally assaulted, what kinds of assault are perpetrated and where in the environment the assaults take place. What we get from looking at these data is some idea of how violence is a common occurrence in many emergency departments and the common types of assaults, as well as the most common places for assaults to happen. What we could not tell from these data was why nurses were being assaulted at such a high rate; in terms of deriving an intervention to reduce violence, we did not have any useful information about specific ways to help nurses protect themselves. Last December, ENA put out a call for narratives — essentially an
opportunity for nurses to describe an incident at work when they had been assaulted verbally or physically. From the quantitative study, we knew that about 55 percent of nurses reported either physical or verbal violence in the previous seven-day period. What we didn’t know was what kind of situations preceded the incident or what the barriers and facilitators were to pre- and post-incident management. A total of 46 respondents submitted narrative accounts of an episode of physical or verbal violence which occurred while providing care in the emergency setting. The narratives most frequently discussed one or two similar incidents in chronological order, told in the past tense, clearly to an outsider/ researcher. In most narratives, the central character is the perpetrator of the violence. Three broad themes and eight categories emerged from the data: ‘‘environmental,’’ ‘‘personal’’ and ‘‘cue
Official Magazine of the Emergency Nurses Association
recognition’’ were identified as the themes. ‘‘Environmental’’ described the physical environment of the emergency department and the institutional culture of the ED, the legal system/security (both inside the ED and externally) encompassing the legal system, law enforcement and the judicial system. ‘‘Personal” described the impact of the event on the nurse himself or herself with regard to job performance, coping and feelings with regard to the interaction with the legal system or institutional culture. ‘‘Cue recognition’’ described the recognized or unrecognized antecedents to the violent event in terms of either perpetrator or environmental characteristics in which the event took place. These narratives of participating emergency nurses allowed us to uncover common factors that are antecedents to violence in their EDs, including long wait times and the presence of patients with psychiatric conditions, patients with a history of violence and patients who are under the influence of drugs or alcohol. There were many descriptions of a legal system that was unwilling to pursue charges against patients or family members who assaulted nurses; thus, the focus on legislation to make assault of a health care worker a felony crime may have limited efficacy. This qualitative study gave us the information we needed about the conditions under which violence occurs, and some important environmental factors that would allow for targeted interventions to reduce workplace violence.
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ENA SAFE WORK ENVIRONMENT INTENSIVE
IN THE BEST INTERESTS OF ALL
E
mergency nurses and other health care professionals gathered in Arlington Heights, Ill., June 5-6 to learn about best practices for workplace violence prevention at ENA’s Safe Work Environment Intensive. This two-day event covered topics that ranged from de-escalation techniques and lateral violence to safer patient handoffs at the bedside.
Day 1: June 5 By Kendra Y. Mims, ENA Connection ‘‘ENA is about safe practice, safe care,” 2013 president JoAnn Lazarus, MSN, RN, CEN, said as she described her passion for creating a safe work environment for emergency nurses. ‘‘We strongly believe that if we take care of the nurse, then the nurses will be able to take care of the patients.’’ Lazarus’ opening session focused on bullying in nursing and how it affects caregivers, patients, their families and the workplace. ‘‘I’ve done some research and spoken to emergency nurses who have contacted me since I’ve become president, and I’ve realized the impact lateral violence is having on nurses in this environment and on our patients,’’ she said. ‘‘I believe it is poisoning our profession.’’ It creates a toxic environment and has a huge impact on the nursing turnover rate, she said. ‘‘We don’t have control over the
Day 2: June 6
numbers:
By Amy Carpenter Aquino, ENA Connection
killed in U.S. hospitals each year;
‘‘We need better communication and
annually on malpractice suits in
to be taught. . . . You need to bring the
teamwork in the ED,’’ said Deena
emergency departments;
team together and train together.’’
Brecher, MSN, RN, APRN, ACNS-BC,
• 98,000 — the number of patients • $1 billion — the amount spent
• Two-thirds — the percentage of
Change comes from better team communication, which leads to improved patient handoffs. Brecher said ‘‘team skills are not innate. They have
She shared the elements of
CEN, CPEN, 2013 ENA president-elect.
sentinel events caused by poor
TeamSTEPPS®, an evidence-based
In her presentation, ‘‘My Patients Are
communication.
teamwork system that ‘‘helps create
Fine, I Am Going to Lunch: How Our
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that they can recognize this behavior. We have to take care of each other,’’ she said. ‘‘I think it’s really time that we break the silence on this threat and what it’s doing to us as a Attendees of the intensive came away with assignments to stop profession. Talking lateral bullying and improve teamwork. about it gives number of patients in our emergency legitimacy to what is happening and it department, but we have control over gives us the opportunity to start looking our behavior,’’ she said. ‘‘We have the at the solutions to make our ability to influence others and hold environment better.’’ each other accountable.’’ Ken Steinhardt, ENA’s director of Lazarus encouraged emergency government relations, informed nurses to document incidents, intervene attendees about the status of workplace quickly and steer clear of gossip. She violence laws across the country during also urged victims of bullying to talk to his ‘‘Advocacy Perspective’’ luncheon the person bullying them instead of presentation. leaving the department. Mona Kelley, MSN, RN, the 2013 She stressed the importance of Tennessee ENA State Council president, creating a culture of respect and a code led a two-part session on de-escalation of conduct within hospitals and techniques. As an instructor in organizations. therapeutic alternatives in crisis training, ‘‘We have to provide educational she showed attendees how to assess opportunities for staff and leaders so and respond to agitation and how to
‘‘One,’’ Brecher said. ‘‘It only takes
Behaviors at the Bedside Impact Patient
one person to step up and change to
Safety,’’ she shared some staggering
prevent this from happening.’’
teams of individuals who communicate effectively and back each other up.’’ ‘‘It is practical and adaptable,”
August 2013
ENA SAFE WORK ENVIRONMENT INTENSIVE
Mona Kelley, MSN, RN, leads volunteers in practicing physical de-escalation maneuvers during Day 1 of the two-day intensive in Arlington Heights, Ill.
ENA thanks sponsors AlliedBarton Security Services and Inovonics for their support of the safe practice portion of this event. The commitments from these organizations allow us to continue to provide beneficial programs such as this to our members and the emergency nursing community.
recognize early signs of agitation from their patients’ body language and posture. Attendees learned how to use active listening as a de-escalation technique and participated in roleplaying scenarios on how to deal with
agitated patients. The second half of Kelley’s session allowed attendees to practice basic defensive techniques. Attendees broke into teams and practiced the single-arm grab release, clothing grab release, front
Brecher said of TeamSTEPPS®, which was developed by the U.S Navy to facilitate moving essential information quickly up the chain of command. ‘‘It is not designed for emergency departments, but it fits so well with what we do.’’ Improved teamwork can lead to improved outcomes, increased patient satisfaction, increased staff satisfaction and a reduction in liability and errors, Brecher said. TeamSTEPPS® instructions, slides and videos are
available for free on the Agency for Healthcare Research and Quality website (www.ahrq.gov). Medication errors are more often the result of the complexity of the health care system, not the fault of the individual worker, said Susan Paparella, MSN, RN, vice president of the Institute for Safe Medication Practices. ‘‘It’s not the incompetence of the individual as much as the difficult situation we ask them to work in.’’ In her presentation, ‘‘Medication
Official Magazine of the Emergency Nurses Association
and rear choke release and more. Ruth Kain, BSN, RN, CEN, found the intensive valuable and plans to take what she learned back to her ED. ‘‘I really enjoyed the talk that our president gave on workplace bullying and lateral violence,’’ Kain said. ‘‘I think that’s an important topic that we need to definitely address in all of our hospitals. ‘‘I also really liked the de-escalation training by Mona. I want to take that back to my institution and make sure that all of the nurses are equipped to be able to take care of themselves so that they can better take care of their patients.’’
Safety, Procedural Sedation Safety,’’ Paparella shared tools and strategies for reducing the frequency of adverse events associated with high-risk medications, as well as the most common safety risks and best strategies associated with moderate sedation procedures in the ED. Nurses’ ability to ‘‘be stronger role models’’ is at the heart of The Healthy Nurse™, the American Nurses Association programmatic pillar aimed
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Welcome to the New ENA Website Designed with your input!
New features
Help videos and FAQs for added assistance
Improved search capability
Fewer drop-down menus
Mobile friendly Easily access your resources on the go
Also Presenting the New ENA Foundation Website
First stand alone design for ENA Foundation
ENA ADVOCACY |
Richard Mereu, JD, MBA, ENA Chief Government Relations Officer
ENA Storms Capitol Hill for Successful Day of Advocacy On May 14-15, 77 ENA members descended on our nation’s capital to attend the annual ENA Day on the Hill event. During two days of activity, these emergency nurses met with more than 100 congressional offices regarding issues of importance to ENA members and their patients. After a public board meeting on May 14, two Hill veterans presented the do’s and don’ts of going to the Hill and persuading elected officials to support your cause. The two staffers were Chris Cooper, legislative assistant for Rep. David Joyce (R-Ohio), co-chairman of the Congressional Nursing Caucus, and Joel Segal, a 12-year senior staff member for Rep. John Conyers (D-Michigan) and a well-known expert on health care issues. Although Cooper and Segal represented two different political parties, their presentations proved that the skills required to be an effective advocate are the same, irrespective of partisan affiliation. ENA members also heard from experts on the two issues that were to be the focus for the Hill meetings the following day: support for Title VIII Nursing Workforce Development
Day on the Hill 2013 sponsored by ENA Strategic Sponsor
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Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN (left), the 2013 ENA president-elect, shakes hands with a staff member representing Sen. John Cornyn (R-Texas) on May 15.
programs and funding for our nation’s 57 poison control centers. Suzanne Miyamoto, director of government affairs for the American Association of Colleges of Nursing, spoke about Title VIII. Miyamoto covered the issue in depth, emphasizing the critical need of Title VIII programs in addressing the growing shortage both of highly trained nurses and faculty for university nursing programs. Debbie Carr, executive director, and Loreeta Canton, director of public relations and member services, represented the American Association of Poison Control Centers. Both Carr and Canton emphasized the role of poison control centers in saving lives after unintentional poisonings, which are now the second leading cause of accidental death in the United States. The two speakers also discussed how these centers save our health care system millions of dollars each year by
reducing the number of patients admitted to hospitals and reducing the length of hospital stays. At the conclusion of their talk, the two AAPCC representatives conveyed how grateful they were that ENA is supporting efforts to increase congressional funding for poison control centers. On May 15, ENA members departed for their House and Senate meetings. In addition to meeting with their hometown representatives, ENA members from the same state coordinated their efforts in setting up appointments with their senators. ENA President JoAnn Lazarus, MSN, RN, CEN, and President-elect Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN, met with congressional leaders on nursing issues, including Rep. Lois Capps (D-Calif.), co-chair of the Congressional Nursing Caucus; Rep. Dianne Black (R-Tenn.), who is the only emergency nurse currently in Congress; and the office of Sen. Mike Johanns (R-Neb.), one of the three co-chairs of the Senate Nursing Caucus. The feedback from ENA members was overwhelmingly positive. Although both days were packed with meetings and events, with little time for rest, our
August 2013
ENA Immediate Past President Gail Lenehan, EdD, MSN, RN, FAEN, FAAN, greets a representative of Rep. Stephen F. Lynch (D-Mass.) as Michelle Fox, RN, BSN, senior director of clinical affairs for Vidacare, looks on.
members showed their passion for their profession through their advocacy in the halls of Congress. ‘‘The presentations by the experts and Congressional staffers really prepared us for our Hill meetings,’’ said Hershaw Davis, Jr., MSN, RN, chairperson of the ENA Government Affairs Committee. ‘‘And there are few things more rewarding than meeting with our elected representatives on behalf of emergency nurses and the millions of patients that we care for each year.’’ Kathleen Carlson, MSN, RN, CEN, FAEN, of the ENA Board of Directors,
echoed this view, adding, ‘‘When we met with the staff of our representatives and senators, we found them to be very receptive to our message. More importantly, we built a strong connection to these offices which in the future will pay great dividends for ENA.’’ Said Lazarus, ‘‘This was a great way to show our elected representatives in Washington what ENA is all about. The meetings in the House and Senate raised the profile of both nursing education programs and poison control centers and their importance to our overall health
ENA 2013 President JoAnn Lazarus, MSN, RN, CEN, at the Lincoln Monument.
care system.’’ Despite the difficult fiscal challenges facing the federal government, including continued cutbacks to programs that are of great value to emergency nurses, the hard work undertaken by ENA members during the Day on the Hill provided critical support for these programs. Moreover, the 77 ENA members who came to Washington highlighted the importance of emergency nursing to our nation’s health care system.
Saturday, September 21, 7:30 p.m.
Celebration of Inductees to the Academy of Emergency Nursing, National Awards and Lantern Awards Registration now open at: www.ena.org/ac
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SMARTPHONES IN THE ED
WHAT’S YOUR POLICY?
ENA Working Toward Guidelines By Ed Avis, Special to ENA Connection
What’s your hospital’s policy toward smartphone use by nurses in the emergency department? When this question was posted on ENA’s Facebook page in May, comments flooded in: ‘‘Our cell phones are banned from use and Internet usage restricted severely,’’ one poster wrote. ‘‘I use mine all the time with apps and on-line reference — very handy and convenient,’’ wrote another. Of the 40 Facebook posters who clearly identified whether they are allowed to use their smartphones at work or not, 13 were allowed and 27 were not. Although not a scientific study, the comments revealed the depth of disagreement on the topic. Hospitals across the country are struggling with the pros and cons of allowing nurses in the emergency department to have access to the power of smartphones.
Info at Your Fingertips Smartphones, tablets and other mobile devices allow users instant access to thousands of websites and medical apps that could be useful at the bedside. Popular apps range from MYATLS, which provides access to references and resources about trauma care, to Pedi Safe, which shows caregivers proper emergency pediatric medication information. However, the very fact that smartphones are so connected to the universe of information is one reason
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some administrators fear their use. Their concern is that nurses and other health care personnel will access inaccurate or unproven information and apply that to patient care. If incorrect information from a medical app caused harm (or near harm) to a patient, the health care
facility could be at risk legally. ‘‘At present, there is no definitive means of validating or approving the content of medical apps,’’ noted Cathy Olson, MSN, RN, senior associate for the ENA Institute for Quality, Safety and Injury Prevention. ‘‘The literature on
August 2013
this topic recommends that medical apps have evidence of professional peer review and are from a wellrespected source, and that organizations consider a quality assurance program to internally validate and approve apps for use in the patient care setting.’’ The Food and Drug Administration has issued draft guidelines pertaining to mobile medical apps (Draft Guidance for Industry and Food and Drug Administration Staff — Mobile Medical Applications, July 2011), indicating that it will focus on medical apps that interact with already regulated medical devices, not apps that simply provide reference information or basic health guidance. ‘‘Nurses need to ensure that the content is valid and current, which is crucial to patient safety,’’ Olson said.
Easy Communication Another advantage of the smartphone is communication, of course. Texting or
calling a colleague can be a quick way to provide an update or ask a question. ENA member Dusty Brinson, BSN, RN, manager of patient care operations in the emergency department of Ann & Robert H. Lurie Children’s Hospital of Chicago, said being able to text colleagues is a great labor saver. ‘‘We cover the entire second floor, so it’s easier to send a text message than going room to room,’’ Brinson said. ‘‘And it’s quieter because we’re not paging so much.’’ Brinson said all the nurses at Lurie are provided with iPhones connected through an in-hospital communications system. The iPhones provided to Lurie nurses are not connected to the Internet, however, so the concerns about nurses using unapproved apps don’t exist. ‘‘The phones are specially designed so we can’t really download the latest Candy Crush game,’’ Brinson said, laughing. However, Brinson said, the hospital may add select medical
reference apps or apps designed to distract children when it upgrades the communications system in the future. ‘‘Overall, it’s been an effective system,’’ Brinson said. ‘‘It helps us get done what we need to get done.’’ Playing Candy Crush or any other smartphone game is another reason many administrators choose to restrict smartphone usage. Several Facebook posters noted that their hospitals implemented smartphone bans only after nurses were too often seen using their phones for games, personal texts or phone calls too often.
Privacy Issues Perhaps the most sensitive issue surrounding smartphone usage in the emergency department is privacy. ‘‘First and foremost, all nurses have a responsibility to protect patient privacy,’’ Olson said. ‘‘The smartphone
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Safe Work Environment Intensive Thanks to all who attended the Safe Work Environment Intensive Workshop on June 5-6 in Illinois. Some of the featured topics were: Safe Practice
• Lateral Violence and Bullying • De-escalation Awareness • Advocacy
Safe Care • • • •
Risk Analysis Team Safety Medication & Procedural Safety Liability in Emergency Practice
The Safe Practice: Workplace Violence Prevention portion of this event was sponsored by:
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Smartphones Continued from page 19 camera feature, along with the social media sites one can access, are the challenges all health care providers and organizations face. There is always risk for an inadvertent breach of privacy or even misuse, which has serious consequences for both nurses and the organization. Some safeguards to be considered are strict mobile device usage policies, secure networks and data encryption to protect protected health information.’’ Advocate Health Care, an 11-hospital network in northern Illinois, has not yet tackled the issue of smartphones, but it has addressed the privacy issue, reports Vincent Pierri, Advocate’s manager of public affairs. ‘‘Advocate does not have a system-wide policy regarding the use of smartphones by nurses in the ED specifically but does have a system-wide social media policy that aligns with HIPAA regulations to protect patient privacy,’’ Pierri said. ‘‘Advocate’s social media policy regulates the use of Twitter, Facebook and all social media networks by Advocate associates and physicians.’’
Experience Costa Rican Emergency Nursing Care and Culture through this one-of-a-kind Opportunity People to People Citizen Ambassador Program is coordinating a delegation of emergency and trauma nurses who will travel to San Jose and Arenal, Costa Rica, November 2-9, 2013. Dr. Gail Lenehan, EdD, MSN, RN, FAEN, FAAN, ENA Immediate Past President will be leading a unique overseas cultural and professional exchange opportunity. Enroll online at: www.peopletopeople.com/ENA Or for more information visit: www.ena.org or call 877-787-2000 Deadline for enrollment: August 6, 2013
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ENA Developing Guidelines In response to these issues, the ENA Emergency Nursing Technology and Informatics Work Team was tasked in June with developing a position statement on the use of personal mobile devices in the emergency department. ‘‘We felt we should come out with this to provide guidance,’’ Olson said. ‘‘There has been a lot of talk out there among members and administrators Emergency Nursing regarding concerns Technology and about personal Informatics Work Team mobile device usage, but also the benefits Michael Seaver, BA, RN, of using them at the chairperson bedside. So we would like to be Nicholas A. Chmielewski, MSN, proactive, as we BSN, RN, CEN, NE-BC expect our members may be turning to us David Holman, MN, RN for guidance on this issue.” Jeannette Jefferies, RN Pending Position Dagny Scofield, RN, CEN, CPEN Statement Committee review, the position Ellie Encapera, RN, CEN, board statement is expected liaison to be presented to the ENA Board of Directors in mid-September. ‘‘It is important for all health care providers and organizations to assess the benefits and risks of smartphone usage for themselves and/or for their particular organization,’’ Olson said. ‘‘From our research on this topic, a strengths, weaknesses, opportunities and threats analysis is a good place to start.’’
August 2013
Lyme Disease Testing: Follow the Steps By Anna Perea, MS, Health Communications Fellow, Centers for Disease Control andfor Prevention, Two-Tiered Testing Lyme Division of Vector-Borne Diseases First Test When should you test for Lyme disease? Is it when a patient presents with an erythema migrans (bull’s-eye) rash or when a patient comes in with an attached tick? Which tests should you order? Keep the following recommendations in mind when you consider ordering Lyme disease tests: Testing is unnecessary for patients who come to the ED for tick removal. Being bitten by a tick doesn’t necessarily mean that the patient has been infected. Furthermore, even if the pathogen has been transmitted, the patient will not yet have developed the antibodies that are measured by the serologic test. Simply remove the tick, disinfect the attachment area and tell the patient to return immediately if he or she develops fever, rash or flu-like symptoms over the next month. Educate the patient about tickborne diseases in the area and how to prevent future bites. Knowing the type of tick is helpful for identifying which diseases it may transmit, but it’s usually difficult to identify immature or engorged ticks. Don’t wait for a positive test result to treat an erythema migrans or any suspected rickettsial diseases. Patients who present to the ED with a probable erythema migrans caused by Lyme disease or febrile illness within 3-30 days of a tick bite should be treated immediately. It’s OK to order an acute serum, but serologic tests for tickborne diseases are not always positive in early stages of illness. It can take up to six weeks for serology to become positive. Remember that Lyme disease is not the only disease transmitted by ticks. Become familiar with the tickborne diseases in your area. Delaying
Enzyme Immunoassay (EIA) OR Immunofluorescence Assay (IFA)
Positive or Equivocal Result
Disease Second Test
Signs or symptoms ≤ 30 days
IgM and IgG Western Blot
Signs or symptoms > 30 days
IgG Western Blot ONLY
Negative Result
Consider alternative diagnosis OR If patient with signs/symptoms consistent with Lyme disease for ≤ 30 days, consider obtaining a convalescent serum
Rocky
treatment for diseases like Mountain spotted fever or ehrlichiosis while waiting for serologic results can result in patient death. When it comes to Lyme disease testing, follow the steps. Testing is very useful for diagnosing patients with later stages of Lyme disease, such as Lyme arthritis. The Centers for Disease Control and Prevention recommend Lyme disease testing that employs a two-step process. Skipping either step can affect the reliability of the test results. In the first step, serum is tested using a highly sensitive but less specific quantitative assay, sometimes called an ELISA, an EIA or an IFA test. If this first test is negative, no further testing is indicated. If the first test is positive or indeterminate (also called equivocal or borderline), a second-step test should be performed. Unfortunately, there is a lot of misinformation about Lyme disease testing, most notably that the first-step tests are insensitive. This myth is based on 1) tests that are no longer in use
Official Magazine of the Emergency Nurses Association
Figure 1. Refer to the two-tiered testing algorithm to avoid unnecessary or inappropriate tests for Lyme disease.
and 2) inappropriately expecting positive results for patients who have a localized erythema migrans. In truth, first-tier tests for Lyme disease are quite sensitive — sensitive enough to react in some patients with other spirochetal diseases, such as tickborne relapsing fever, syphilis or leptospirosis, and some other infectious and noninfectious conditions. This crossreactivity makes the second, more specific test, essential. In the second test, serum is tested by immunoblotting, usually with a Western blot, to identify IgM and IgG antibodies against specific Borrelia burgdorferi antigens. Some of these antigens are recognized by antibodies to other common organisms, so even uninfected patients will usually have at least one reactive band. The key point is the number of positive bands. To be considered positive, the serum should react with at least five of 10 scored bands on the IgG assay and with two of three scored bands on the IgM assay. Diagnosing and treating Lyme
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BOARD WRITES |
Karen K. Wiley, MSN, RN, CEN, ENA Board of Directors
A Call For Help From Our Mexican Colleagues Violence is an international problem, and no country is immune. It is in our homes, on our streets and in our hospitals. Horacio Flores, a new ENA member in Chihuahua, Mexico, put out a call for help. We first met in Mazatlan, Mexico, when I was representing ENA at the Mexican Emergency Nurse Conference. Flores shared his concern of increasing violence in hospitals along the Texas and Arizona borders. He described how Mexico has been ravaged by an increase in drug-related violence. Because 2013 was the 32nd anniversary of the Barra del Colegio de Enfermeria de Chihuahua, AC (School of Nursing), the school wanted to celebrate with a regional congress focused on the issue of violence. A request came for assistance in mobilizing nursing, emergency medical services and hospital administration with the goal of analyzing workplace violence and finding ways to prevent it through safety measures and education. Panel members were identified to discuss the effect of violence in their countries and health care settings. The panel consisted of nurses representing the Mexican Nurses Association and Colombia and a member of the World Health Organization from Mexico City. Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN, ENA 2013 president-elect, and I represented ENA. Other speakers represented nonprofit organizations and clergy from Chihuahua. Hospitals in the United States have developed policies and procedures in response to an active shooter event. Emergency nurses who are actively involved in planning and developing
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Karen Wiley, MSN, RN, CEN (third from left) and 2013 ENA President-elect Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN (third from right) join (from left) Isela Rodriguez, Mary Pulido, Horacio Flores, Eduardo Paua Reyes and Sylvia Martinez, emergency nurses from Mexico. these programs have a wealth of
‘‘active shooter’’ and the development
knowledge and are fortunate to have
of ‘‘code silver’’ activation. This was of
these policies and procedures in place.
particular interest to nurses, as many of
Knowing your role in responding to an
them described how people have been
active shooter event may save your life.
shot on the doorstep of their hospitals
Nurses in Chihuahua and other parts of
and emergency departments.
Mexico do not have these programs and lack basic violence-prevention education. At the conference, Brecher presented
A member of the Red Cross Ambulance Response Team and EMT/ paramedic told his story of seeing 29
a snapshot view of ED violence in the
people killed in front of his hospital. He
U.S. She also demonstrated how to
emotionally described nurses who are
access the online ENA Workplace
confronted with ethical dilemmas every
Violence Toolkit and how to use it to
day. They care for the women and
develop a plan to manage violence in
children killed in shootings and then
the ED.
must care for the shooter.
The presentation of the topics of
Our final day in Mexico was a tour
safety in health care and lateral violence
of local hospitals and an ambulance
provided an opportunity for the nurses
company. The inner-city hospital is 116
to speak freely regarding intimidation,
years old and is used as an educational
harassment and threats. One of their
center. Triage is performed by a
biggest fears was loss of their job if they
physician and nurse team; patients are
spoke up against a physician.
assessed, orders are written and the
Another discussion topic was the
patient is assigned to the trauma room
August 2013
A safe room off the ED in a Chihuahua hospital provides a place to escape violence. or to an ED observation area. Patients fill the lobby and spill out onto the streets. The registration desk is behind glass and a security officer is behind a locked door. There is an identified safe room. When there is an active shooting event, patients, nurses and physicians go to this room until the shooting ends.
Nurses who work at this hospital are very proud and said they love working there. Being 116 years old, the facility has its challenges. When the elevator breaks, staff carry the patient to the second floor. It is an adult-only hospital, and all behavioral health and pediatric patients are transferred to
other facilities. Behavioral health patients are sedated before transfer. We also visited other hospitals in Chihuahua that were newer and used the five-level triage system. One hospital in the suburbs was expecting a Joint Commission visit in two years. This hospital had state-of-the-art equipment and was located in a gated community of expensive homes. Hospital representatives said their goal is to provide the same standards and quality of care to their patients comparable to U.S. emergency departments. Visiting the hospitals in Chihuahua gave me a new perspective of nursing. There are similarities between the U.S. and Mexico with violence and practice settings. What remains unchanged are nurses and the passion they have for providing safe, quality care. We may not speak the same language, but we share the same passion for nursing. Nurses only ask to be respected and to be able to work in a safe environment.
Thank You for Your Generous Support The ENA Foundation is grateful to all who generously participated in the success of the 2013 State Challenge fundraising campaign.
A new milestone record has been raised!
$121,500 For a list of the 2013 donors or for more information, visit www.enafoundation.org
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COURSEBYTES ENPC We have heard members’ concerns regarding Emergency Nursing Pediatric Course 4th edition material, tests and students’ scores. The Course Administration faculty is working with the ENA Institute for Nursing Education to address these concerns. An analysis of the test questions is held after the implementation of a new course version, once the course has been live for at least nine months. The Institute for Nursing Education has begun the analysis of the ENPC 4th edition tests with the help of an independent expert. The analysis is expected to be completed later this summer and will provide the insight ENA needs to move forward in addressing the concerns. It is very important to emphasize to ENPC students that they must be prepared in order to pass the course. They must read the book and complete the online modules. The goal of the course is to provide the attendees with the knowledge and skills they need to improve patient care, and ENA must confirm that they did, in fact, understand and assimilate the knowledge provided.
Becoming a 4th Edition ENPC Instructor ENPC providers who received instructor potential status in a 3rd edition provider course may attend a 4th edition instructor course. However, they must purchase the 4th edition provider manual and be advised to study thoroughly, as they must pass the 4th edition provider course test with a score of 90 percent or better before attending the instructor course. (This is part of the pretesting requirement for all instructor courses, as defined in the administrative procedures.)
Instructor Evaluation Report Available Course directors and state chairpersons now have the ability to run instructor evaluation reports in eCourseOps. Course directors can run a report on an individual instructor to check an evaluation score by entering the appropriate instructor number. State chairpersons may run the same individual report, and they also may run a report for the entire state. This will result in a large PDF with each instructor’s list of courses and related scores. The report is found in eCourseOps, under the Education tab. Complete instructions are provided on the reports page. Course directors can also find this report by clicking on “Reports” on the landing page of the course directors only section of www.ena.org. You must be logged into the website to access these areas.
Your Input Is Welcome CourseBytes is the official communication to all TNCC and ENPC course directors and instructors. Send topic ideas for future issues and feedback to CourseBytes@ena.org.
2013 Annual Conference Walk for Wellness to support the ENA Foundation Friday, September 20 6-7 a.m. – NEW time Nashville, TN The Walk for Wellness is a 1.2 mile walk, where the funds raised support the ENA Foundation mission. Walkers are encouraged to raise $150 from their friends and family through social media, e-mails and personal connections. Walk for your health and for the health of the profession. Registration fee: $10.
To register or for fundraising information, visit www.ena.org/ac
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August 2013
Safe Work Environment Intensive Continued from page 13 at helping nurses improve their health and wellness. The Healthy Nurse™ information is available at www. anahealthynurse.org. Suzy Harrington, DNP, RN, MCHES, director of the ANA Department for Health, Safety and Wellness, described a healthy nurse as ‘‘a nurse who takes care of his or her personal health, safety and wellness and lives life to their fullest capacity — physically, mentally, spiritually and professionally.’’ ‘‘A truly healthy work environment has tremendous intangible results,’’ including increased presenteeism, decreased errors and happier, more satisfied staff and patients, Harrington said. ‘‘Sometimes we need justification to take care of ourselves.’’ In her presentation, ‘‘Risk Analysis: Navigating the Deep Water,’’ Kathy Szumanski shared the three types of error classifications used in apparent cause analysis: skill-based, rule-based and knowledge-based. ‘‘The most common cause of errors in the ED are rule-based errors,’’ said Szumanski, MSN, RN, NE-BC, director of the ENA Institute for Quality, Safety and Injury Prevention. The classic example is the workaround, which can occur when skilled nurses do things repeatedly, causing a lapse of attention. ‘‘These are very common and prevalent around nurses with a lot of experience,’’ she said. Szumanski shared several case studies and risk reduction strategies. She recommended creating a dashboard of ED skill-, rule- and knowledge-based errors to show trends over time. In her presentation, ‘‘Liability Risks of Emergency Nurses,’’ Ellen Wodika, MA, MM, CPHRM, risk consulting director for CNA Healthcare, shared current trends in allegations of nurse professional liability claims, as well as options for integration of risk control strategies into practice and patient care.
Thank you to the following organizations for their generous support. STRATEGIC SPONSORS
STRATEGIC SUPPORTERS
2013 State Advocacy Grants The State Advocacy Grant is available to all state councils for advocacy related efforts throughout the year. This matching grant will allow every state to be reimbursed up to $1,000 for approved advocacy efforts occurring throughout 2013. Grant amounts will be matching funds up to but not exceeding $1,000 per state council. The $1,000 maximum distribution of funds can be used for any approved advocacy efforts occurring between Jan. 1 and Dec. 31, 2013. For more information, guidelines and application details, please visit www.ena.org.
The ENA Strategic Sponsorship Program was designed to create partnerships with leading organizations whose objectives include supporting the emergency nursing profession.
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6/20/13 11:09 AM
Finding Faculty For Annual Conference
Why That Person Should Be You By Josh Gaby, ENA Connection ENA member Susie Law presented for the first time as an ENA faculty member at Leadership Conference 2013 in Fort Lauderdale, Fla., but she’s been talking nationally about health care topics for years. Joshua McCabe’s session at the same conference was only his second for ENA, but he’s been speaking in front of groups since age 6 in church. Faculty roles are for emergency nurses like them, not you, right? Right? Not if you bring the main ingredient: passion. And you do. ‘‘I’ve never met a person in health care, anywhere, that doesn’t have a passion about the care of patients in one context or another,’’ said Law, MBA, BSN, RN, vice president of clinical operations for HCA MidAmerica Division in Kansas City, Mo. ‘‘And ED nurses, by definition, tend to be very passionate people because what we do in the ED is episodic, high-intensity, emotionally charged, quick care.’’ With ENA now seeking faculty proposals for its 2014 Annual Conference in Indianapolis (see call for proposals on facing page), it’s time to think about the unique viewpoints you might share with other emergency nurses. Sure, there’s research and preparation involved before you speak on a topic, Law said, but what matters most — and what will make you worth listening to — is how much you care. Law was joined by colleague Suzanne Lord, MHA, BA, RN, the associate chief nursing officer for Center Point Medical Center in Independence, Mo., when she spoke about bed management in the ED. They saw their success story at Center Point as a template — a ‘‘how-to’’ for members who’d been hearing about the
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Susie Law, MBA, BSN, RN, and Joshua McCabe, MSN, RN, CEN — two emergency nurses who’ve made a point of standing up and sharing something. need for better bed management but might not have known where to begin. They were proud of their work, knew they had useful information and wanted to share it. McCabe, MSN, RN, CEN, felt the calling, too. He’s the ED manager at Sharp Memorial Hospital in San Diego and had attended ENA Leadership Conferences as an audience member for about 10 years. In Fort Lauderdale, he joined forces with Charlene AndersonDean, BScN, RN, a front-line nurse at Sharp, to talk about ‘‘cultural walls’’ that affect throughput. Not every faculty proposal is accepted, and McCabe went through the process a few times before getting the green light, working with ENA mentors to shape his ideas. But he never stopped submitting. What he cared about beyond any one topic was infusing ENA conferences with fresh voices — as many ideas and achievements as possible. ‘‘I was always frustrated sitting through someone’s best solutions when I knew I had a better one,’’ he said. ‘‘And I thought, how great to just say, ‘Hey, here’s two things I think we do really great in our emergency department, as emergency department leaders. What do you guys do that’s so great? What did you always want
to share?’ ’’ His concept was used as the basis for faculty-moderated ‘‘Jam Sessions,’’ introduced at Leadership Conference 2013, in which ED leaders exchanged their best ideas on a given topic. About half of the faculty presenters in Fort Lauderdale hadn’t spoken at ENA conferences previously, McCabe said. It added up to a sense of newness. ‘‘Oftentimes,’’ Law said, ‘‘you’ll hear in the hallways or walking out of a conference presentation, ‘Well, I could have provided that information,’ or, ‘We have stuff for the next level of this. We’ve done this, we’ve done that.’ But we don’t take action on it because we’re afraid.’’ Law started speaking about health care ethics — her passion — many years ago. It gets easier each time, she said, and the connections you make with other emergency nurses are invaluable. ‘‘My suggestion to people who might be considering ‘Do I have a topic or not?’ is to submit any topic you feel is worthwhile,’’ she said, ‘‘because until you put it forward, you don’t know. You may be doing something you think everybody knows, and then the reality is that everybody doesn’t know it, so if you don’t reach out and share, how do you get the information out there?’’
August 2013
ENA STATE CONNECTION
Arkansas ENA members got baseball fans thinking about water safety at their event May 4 in Springdale, Ark.
Arkansas ENA State Council
Northwest Florida ENA Chapter
Submitted by Danita Mullins, BSN, RN, CEN, state council president
NREMT-P, CEN, CFRN, CCRN-CMC,
The Arkansas ENA State Council hosted its Second Annual Water Safety Event on May 4 at Arvest Ball Park, a minor-league ball field in Springdale, Ark. The state council partnered with the NWA Trauma Regional Advisory Council to help with funding. More than 500 life jackets were fitted and given out. Prizes included a free
The Northwest Florida ENA Chapter is
Submitted by Michael Rushing, BSN, RN, chapter president sponsoring a Certified Emergency six-week swimming lesson, and all attendees received a bag with important water safety information. In spite of the first May snowfall in Arkansas history, volunteers bundled up for a good cause to help reduce drowning deaths.
Nurse review course on Aug. 24-25 in Miramar Beach, Fla., to prepare members for board certification. On May 15-16, the chapter offered a Certified Pediatric Emergency Nurse
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Become a 2014 Annual Conference Faculty Member Today Submissions due Monday, October 14, 2013 Share your knowledge in Indianapolis with an international audience of emergency nurses. Presentations in multiple course areas and course lengths are needed.
For full details including course areas, criteria and submission form, please visit www.ena.org.
For questions, email conferences@ena.org or call 847-460-4117.
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A Culture of Inquiry Is Everyone’s Business T By Kathleen Flarity, DNP, PhD, CEN, CFRN, FAEN, 2013 Chairperson If you have graduated within the last 10 years or are on the forefront of emergency nursing, you are acquainted with the concept of evidence-based practice and have applied it in your clinical practice. Since its introduction in medicine in the 1990s, evidence-based practice has grown as a way to synthesize literature, guide patient care and reduce costs.1 Evidence-based practice integrates expert knowledge, research or scholarly evidence, and patient preferences or values in making decisions about care.2 Emergency nurses are in pivotal positions to create a culture of inquiry, apply evidencebased practice and impact change at the stretcherside. However, without a culture supportive of inquiry, evidence-based practice efforts are not likely to succeed or be sustained. A culture of clinical inquiry exists when all health care professionals are empowered to ask critical questions and to challenge everyday clinical practices. A culture of inquiry exists in organizations that provide education and support for staff in searching and appraising the literature using hierarchies of evidence, conducting research and implementing researchinformed practice. The strength of the evidence is appraised by asking about the quality of the evidence and whether it is relevant and valid for the situation.2 An illustration is the author’s experience searching and appraising the evidence for an ED fall risk-
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assessment tool. Of the 47 fall risk-assessment tools in the literature, only nine were validated and none was designed specifically for or evaluated in the ED. The lack of a valid ED-specific tool propelled the authors into developing and implementing an ED fall risk-assessment tool.3 Once the study is replicated and validated in other EDs, the strength of the evidence will be improved. A culture of inquiry at all levels of nursing is essential. It is cultivated through leadership, education, mentoring, committing resources, recognition of individuals and groups who implement evidence-based practice, and providing a method to disseminate findings.2, 4 How do you implement evidencebased practice into your practice? Become an expert in your area of interest. Seek out a mentor, set clear goals, write clear objectives, read as much as you can about the topic, share your passion with others, network and go to conferences. Two instructive articles are “Evidence-Based Practice for the Advanced Practice Emergency Nurse,” parts I and II. 5 Shapiro describes how to create a PICOT question and how to search and appraise the literature and provides an example of how to create an evidence table (research matrix). The Academy of Emergency Nursing’s EMINENCE program provides opportunities for emergency nurse research development. Based on your specific interest, you will be matched with an Academy fellow who can coach, guide and mentor you on your journey to a culture of inquiry.
he Academy of Emergency Nursing was established by the Emergency Nurses Association on Sept. 28, 2004, to: • Honor emergency nurses who have made enduring, substantial contributions to emergency nursing; • Advance the profession of emergency nursing, including the health care system in which emergency nursing is delivered; and • Provide visionary leadership to ENA and AEN. The body of work left by AEN fellows goes well beyond being an outstanding nurse and a devoted ENA member.
Emergency nurses are on the forefront of driving research, innovation and change to improve patient outcomes. Join the AEN’s EMINENCE program and be part of the culture. References 1. Straus, S., Glasziou, P., Richardson, W. S., & Haynes, R. B. (2010). Evidence-based medicine: How to practice and teach EBM (4th ed.). New York, NY: Churchill Livingstone. 2. Melnyk, B., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & health. (2nd ed.). Philadelphia, PA: Lippincott Williams & Wilkins. 3. Flarity, K., Pate, T., & Finch, H. (2013). Development and implementation of the Memorial Emergency Department Fall Risk Assessment Tool. Advanced Emergency Nursing Journal, 35, 1–10. 4. Bournes, D. A. (2013). Cultivating a spirit of inquiry using a nursing leading-following model. Nursing Science Quarterly, 26(2), 182–188. 5. Shapiro, S. E. (2007). Evidence-based practice for advance practice emergency nurses. Advanced Emergency Nursing Journal, 29(4), 331–338.
August 2013
READY OR NOT? |
Knox Andress, BA, RN, AD, FAEN
Fertilizer Plant Explosion: A Rural Response to Disaster The week of April 15 was tragically busy. The day of the Boston Marathon and Patriots’ Day in Massachusetts, two improvised explosive devices detonated near the marathon finish line, killing three and injuring at least 264. Those injured were treated in 27 area emergency departments, hospitals and trauma centers. On April 16 and 17, letters that tested positive for ricin were received in Washington, D.C., addressed to government officials. On April 17, a catastrophic explosion at a fertilizer plant in West, Texas, created a mass casualty in a small, resource-limited town — one without a hospital.
Explosion About 7:50 p.m., a fire and the subsequent explosion of 540,000 pounds of ammonium nitrate occurred at the West Fertilizer Company, in West, Texas, a town of 2,807. Fourteen people died, while 253 went to out-of-county hospitals for evaluation and treatment of smoke-, fire- and/ or blast-related injuries. Among the dead were community first responders, including five West firefighters, four EMS medics and one off-duty fire captain from Dallas.
Hospital and ED Responses Air and ground medical evacuations were triaged and staged from the town’s high school football field. Many of the 264 injured were transported to nine hospitals in five counties via private vehicles, including automobiles and at least one bus. Typically, the greatest number of casualties presents at the hospital closest to the scene. The closest hospital to West is Hill Regional Hospital in Hillsboro, Texas, population 8,456, 15 miles north of West on Interstate 35.
The Emergency Department ED director Necole (Nicki) McDaniel, RN, and trauma coordinator Janice Markwardt, RN, were instrumental in the response at Hill Regional Hospital, a Level 4 trauma center with an eight-bed ED and about 12,000 visits annually. ED staffing from 7 p.m. to 7 a.m. includes two nurses and one physician. Hospital staffing at that time usually includes two to three medical/surgical unit RNs, one obstetrical RN and one critical-care-unit RN. McDaniel was at home in Whitney, Texas, when she ‘‘felt the ground shake’’ from the blast 25 miles to the south. About two minutes later, she received a text about the
explosion while information was being posted on Facebook and in the local media. The hospital engaged its emergency operations plan and initiated departmental call-back.
Patient Arrival The first patients arrived, transported by family members, 20 to 25 minutes after the blast. Other casualties soon followed, including those transported via POVs, EMS and a bus with 12 nursing home evacuees from West. The patient population included 37 adults (14 elderly) and five children. Since 2004, the CDC has been providing guidance on blast injury patterns, care and treatment at www.bt.cdc. gov/masscasualties/bombings_injurycare.asp. McDaniel reported consistent blast-injury pattern findings: head and facial lacerations, abrasions, acoustic trauma with hearing loss and shortness of breath. Stress impact on caregivers at Hill Regional was notable. Two nurses from West lost their homes in the blast and another’s home was significantly damaged. The EMS personnel who died were well known in the Hillsboro hospital community, and their loss brought additional grief.
Organization Downtime forms and white boards were used to document care and provide situational awareness. The ED provided triage and stabilization for patients. Day surgery and outpatient care areas were used for more stable patients and the critical-care unit for the more urgent needs. Housekeeping and dietary staff assisted in moving patients.
Recommendations For blast-type responses, McDaniel offers the following: 1. Have plenty of saline (for irrigation), laceration kits and bandages. 2. Consider additional walkie-talkies for extending communication to repurposed triage or patient care areas. 3. Review your disaster plan and be critical. Anything can look good on paper. 4. Be familiar with your hospital and ED emergency response plan by conducting exercises. 5. Be aware of community threats/hazards, including industrial and agricultural chemicals. 6. Plan for using volunteers. 7. Determine whether your hospital command center and labor pool are the best location.
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State Connection
Meetings and Events
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Arkansas ENA State Council
review course in Pensacola, Fla., for 37 students from the Southeast region. The chapter is proud to be able to offer these courses at a discounted rate to its members.
The Arkansas State Council’s 2013 Annual Education Conference will be held Aug. 2-3. The event will take place at Arkansas Children’s Hospital in Little Rock, Ark. For more information, visit www.arkansasena.org.
Texas ENA State Council Submitted by Christine Russe, MSN, RN, CEN, CPEN, state council president The Texas ENA state chapter experienced many firsts in the beginning of 2013. It hosted its first TENA Government Affairs Workshop. We thank Mary Leblond, MSN, RN, CEN, SANE, for facilitating this informative offering. The session was also made available to all TENA members via Web-conferencing software. On April 2, the council held its state
Texas ENA State Council The East Texas ENA chapter will host a CEN Review Course on Aug. 15-16 at The Institute for Healthy Living in Longview Texas. For more information contact
meeting in South Padre Island. Attendance exceeded the council’s expectations. The efforts of the TENA Professional Education Committee and
Crystal Thornton at (903) 315-2885 or cmthornton@gsmc.org. The San Antonio ENA chapter will host the following educational events: • CEN Review Course: Aug. 28-29, Historic Menger Hotel, San Antonio. For more information, contact Susan Douglas at susan. douglass@uhs-sa.com. • The ABCs of Forensics in Nursing: Oct. 23, Stone Oak Methodist Hospital, San Antonio. For more information, contact Steven Jewell at (210) 215-2414 or jst4jstn@gmail.com.
Susan Raven, RN, CEN, chairperson, led to a very successful event. TENA also unveiled its updated website at www.txena.org.
Lyme Disease Continued from page 21
Join our Community! Are you a nurse who has practiced in an emergency care setting for 5 years or less?
If so, join one or more of our Emerging Professionals social networking groups and connect with your peers. You will be able to post discussion topics and share stories. Ready to get started? See below for details:
References
Facebook: http://on.fb.me/11XdCxv Google+: http://bit.ly/16FnAow LinkedIn: http://linkd.in/11MzNDn We can’t wait to have you join our communities and look forward to seeing you at ENA’s 2013 Annual Conference for our Speed Mentoring Event on Friday, September 20, 6-7 p.m. at the Opryland Hotel. Sponsored by
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AC13 Emerging Professionals Ad_Connection_Quarter_08 2013.indd 1
disease is not always straightforward, but as it spreads into new areas and society becomes increasingly mobile, identifying it is a critical skill for nurses. For additional information, see www.cdc. gov/lyme/healthcare/ clinicians.html.
Aguero-Rosenfeld, M. E., Wang, G., Schwartz, I., & Wormser, G. P. (2005). Diagnosis of Lyme borreliosis. Clinical Microbiology Reviews, 18(3), 484–509. Centers for Disease Control and Prevention. (2005). Notice to readers: caution regarding testing for Lyme disease. MMWR Morbidity and
7/2/13 9:34 AM
Mortality Weekly Reports, 54(5), 125. Centers for Disease Control and Prevention. (1995). Notice to readers: recommendations for test performance and interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease. MMWR Morbidity and Mortality Weekly Reports, 44(31), 590–591. Wormser, G. P., Dattwyler, R. J., Shapiro, E. D., Halperin, J. J., Steere, A. C., Klempner, M. S., … Nadelman, R. B. (2006). The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clinical Infectious Disease, 43(9), 1089–1134.
August 2013
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Recruitment and Professional Opportunities ED Clinical Unit - D.Palien
For ad rates and information, contact ENA Sales Representative Maureen Nolimal at 847-460-4076 or Maureen.Nolimal@ena.org. Strong Foundation. Brillant Careers for Emergency Department Nurses.
Saint Agnes Hospital is excited to announce a brand new nursing leadership opportunity:
Clinical Unit Coordinator/ Leader Emergency Department
Get in on the ground floor of a new physician practice group joining our Emergency Department! This is an excellent opportunity to gain entry-level nursing leadership experience in an environment dedicated to nurturing clinical expertise, education, and shared governance. To learn more and apply, please visit: JobsatStAgnes.com/ClinicalUnit Saint Agnes Hospital is an Equal Opportunity Employer.
World-Class Care, Performed Close to Home As Monroe County’s sole hospital, Pocono Health System (PHS) is unwavering in our commitment to provide quality health services that meet the diverse needs of our community. Our greatest resource is the physicians and staff members that make up the PHS team. They strive for excellence and innovation every day.
Welcome to your new life.
You’ve put years of hard work, education and training into establishing a great career for yourself. Your compassion and commitment to quality care have placed you among the best in the profession. Now it’s time to enjoy the incomparable rewards of a career with Yavapai Regional Medical Center in Prescott, Arizona. The acuity and advanced technology are just what you’re used to. But living here is far beyond the expected. This is a place where neighbors are friends, and friends are forever. Where the natural scenery puts any painting to shame. It is a place where you will feel a strong sense of security and belonging. If you are a results-oriented leader looking to partner with a passionate team of ED professionals in a growing organization, we have a unique opportunity for you as the Emergency Department Director at our West Campus in beautiful, mile high Prescott. To learn more about becoming a part of our team, take the first step and visit our career site at www.mycareeratyrmc. org. Or contact our recruiter, Shellie Erwin, by email at smerwin@yrmc.org or by phone at 877-976-9762. YRMC offers a total compensation package that includes relocation assistance.
If you’re looking for career stability with a healthcare system that continues growing, make the move today.
Clinical Director - Emergency Services In this leadership role, you’ll oversee the Emergency Room, ensuring the delivery of effective and quality patient care services. This will include the promotion of service line initiatives while also developing unit budgets and monitoring costs; evaluating staff; assisting senior management with strategic planning. Our ideal candidate is a PA licensed RN with a Bachelor’s in a health related field and at least 5 yrs of ER management experience. Must display leadership qualities in personnel and resource management as well as strong interpersonal and organizational skills. ACLS certification required. Master’s degree, CEN and PALS preferred We are proud to offer a competitive compensation package. Candidates should submit a detailed CV to Lea Power Carpenter, Senior Recruiter, lcarpenter@pmchealthsystem.org or apply directly on our website at
www.PoconoHealthSystem.org
An Equal Opportunity Employer.
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PHS is an EEOC employer
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be happy. When you’re on the right team, happiness ensues. You know us as recognized ED leaders who guide hospitals toward real and effective change. Now we would like to get to know you. Blue Jay Consulting is looking for professionals with the leadership insight and clinical experience to bring process improvements to our clients, and the passion and commitment to enhance the overall quality of emergency care. If you consider yourself among the best in your field, you’ll find yourself in good company at Blue Jay Consulting. Join the strongest team in the industry and... be happy.
“As a Blue Jay consultant, I bring my 30 years of emergency department leadership experience to each client. Every assignment brings a unique set of challenges, but the tools to solve them are similar. We can often shorten the improvement process from years to months and create an environment that is better for patients, families and staff. I leave each assignment with a good feeling that I have left it better than when I arrived. I love being a Blue Jay consultant.” — B I L L B R I G G S , M S N , R N , C E N , FA E N Senior Consultant Blue Jay Consulting, LLC
www.bluejayconsulting.com Contact Jim Hoelz or Mark Feinberg at 407-210-6570 to discuss how we can capitalize on one another’s strengths.