ENA Connection August 2012

the Official Magazine of the Emergency Nurses Association

connection August 2012 Volume 36, Issue 7

Friending the Future How New Gadgets, New Specialties and the Facebook Phenomenon Are Pushing Us Forward Together Pages 3, 4, 12-17, 24

2012 ENA Election Results, Pages 10-11

INSIDE

FEATURES

Guantanamo Nurses Raising Their Game With TNCC Training PAGE 19 Lessons From ENA’s Workplace Violence Prevention Summit PAGE 20 Introducing the ENA Emergency Nurses Wellness Committee PAGE 33

AL U N E N A NC E A EN FER TERTER 12 ON POS EN 0 C 2 C IN

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 specialists, prehospital coordinators and educators.

• 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.

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

Submit a proposal for courses and faculty today!

Dates to Remember August 17, 2012 Deadline for requests to include recently deceased member colleagues in memorial presentation during 2012 General Assembly in San Diego, Sept. 12-13.

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

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

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

The Power of People Remains Our Best Tool

ENA Exclusive Content PAGE 10 2012 ENA Election Results PAGE 12 How Technology Has Changed the ED PAGE 14 One ENA Member’s Discovery of a New Calling in Nursing Informatics PAGE 15 IQSIP Technology and Informatics: What You Need to Know PAGE 16 Rural Nursing and Technology: The Latest in Frontier Medicine PAGE 19 Determined to Be Ready For Anything, Guantanamo Nurses Turning to TNCC PAGE 20 ENA’s Workplace Violence Prevention Summit PAGE 21 2012 Annual Conference Poster PAGE 24 Portable Ultrasound: The Stethoscope of the Future PAGE 27 CDC Field Triage Guidelines Have ENA’s Backing PAGE 28 Writing an ENA Resolution Connects You to the Big Picture PAGE 29 IENR Plans Unforgettable Way To Top Itself PAGE 33 Code You: Introducing the ENA Emergency Nurses Wellness Committee PAGES 36-37 Anna Mae Ericksen: Looking Back on 47 Years of Promoting the Emergency Nursing Specialty

Monthly Features PAGE 4 Board Writes PAGE 6 Washington Watch PAGE 8 Pediatric Update PAGE 26 ENA Foundation PAGE 27 From the Future of Nursing Work Team PAGE 30 Ready or Not? PAGE 32 Academy of Emergency Nursing PAGE 34 Nominations Committee PAGE 38 State Connection

The focus of this issue of ENA Connection is information technology … and I confess there are only a few things I know for sure about this topic: • It should take only one click, iris check or fingerprint to log on and off.

• ED computers should be placed right next to the heads of patients’ beds so that nurses can nurse the patient as well as the computer.

• Every ED should have a clinical nurse who is also an informatics specialist to bridge the ED and IT, as well as adequate numbers of tech-savvy 20-somethings, like Lucy Hanley, RN (pictured Lucy Hanley, RN, a staff nurse in the San Mateo (Calif.) Medical Center Emergency Department, makes use of increasingly popular handheld technology in addition to at right). the usual resources in the ED. • An iPad, with its Wi-Fi capability and extended hours themselves talking late into the night about all they of power, is a godsend at airports. had in common. Thirteen days later, they announced And, finally, all hospital decision-makers should a new film studio: DreamWorks. In Steven Spielberg: read a revealing New England Journal of Medicine A Biography, by Joseph McBride, Spielberg editorial about electronic health record systems. remembers that night: ‘‘We’re in tuxedos talking about The authors note ‘‘it is a widely accepted myth that a brand new studio, and just across from us there’s medicine requires complex, highly specialized IT Yeltsin and Bill Clinton talking about disarming the systems’’ and observe that we are ‘‘jamming all health world of nuclear weapons.’’ care processes and workflows into constrained EHR For all the magic of IT (one ENA board colleague operating environments’’ instead of ‘‘using safer, says her iPad has changed her life), in-person cheaper, and nimbler tools . . . .” They point out that connections are irreplaceable. In my travels this year, hospitals don’t have even the simplest tools we use in I have taken full advantage of the power of our civilian life, such as spell check, and suggest that networking: building bridges with other associations bundled, best-of-breed, interoperable, substitutable and engaging ‘‘keepers,’’ some of whom now serve technologies are possible (Mandl, Kohane, 2012). One as ENA committee members, liaisons, authors or issue not addressed is that EHRs, which evolved from reviewers. It’s during breaks, dinner or chance billing systems, may not give narrative nursing notes encounters in hallways that connections are made the importance they deserve. and so much is accomplished.

But no matter how amazing or annoying the Attendees in New Orleans raved about Schwartz’s technology we add to our lives, nothing takes the presentation and said her messages (e.g., the power place of face-to-face communications and what can of an introduction, the power of conversation, the be accomplished there, often unexpectedly. One of power of a goal, a business card or a checklist) would our Leadership Conference 2012 keynote speakers in be perfect to know about before a big conference. I New Orleans actually wrote a book about how to urge you to read her book on the plane on your way make the most of social gatherings. In Eat, Drink and to the Annual Conference, and be inspired to make Succeed, author Laura Schwartz — a young, vivacious connections in San Diego. See you there soon! former White House events planner — recounts Reference events where much more than eating and drinking took place. Take, for example, the state dinner where three guests, Steven Spielberg, David Geffen and Jeffrey Katzenberg — all invited separately — found

Official Magazine of the Emergency Nurses Association

Mandl, K., Kohane, I., (2012). Escaping the EHR Trap—The Future of IT. N Engl J Med, 366:22402242, June 14, 2012.

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BOARD WRITES | Mitch Jewett, RN, CEN, CPEN

Technology and Elections Affecting Our Future I was fortunate to have participated in the 2012 ENA elections, the first ones that truly embraced technology by allowing the use of social media for candidate campaigns. I send my sincere congratulations to Deena Brecher and wish her all the best during her tenure as ENA’s 2013 president-elect and 2014 president. Although I was not successful in my bid for presidentelect, I am pleased to have been the person who originally made the case for the use of social media in ENA elections long before it was an approved method of campaigning.

The fact that I did not fully benefit from the ability to use social media to connect with members during the election process is not the critical element here. What is important is that as a Baby Boomer who still has a land line and prefers talking on the phone to texting, I recognize the benefits of Facebook, LinkedIn, Skype and other platforms. Although my learning curve was steep, I supported the purchase and distribution of iPads to the members of the ENA board of directors in an attempt to standardize and move up the technology curve together. I understand that these and other technologies can be especially beneficial to state councils and chapters that are discovering new and improved ways to hold meetings and reach far-flung members.

I wonder, though, how technology and future developments will affect our organization and our elections, the outcome of which determines who will lead ENA into the future. Technology is changing so quickly, and it is vital that we carefully consider those parts we adopt and those we do not.

All technologies are not created equal, and just because something is new does not mean it is best for ENA. The cost-benefit ratio must be considered, as we have a limited budget. We must ensure that the organization continues to get the most bang for its buck.

In the emergency department, technology sometimes moves us away from the bedside and to the periphery.

I sometimes wonder if the Web-based voting process has not done the same; that is, moved the members away from the process instead of drawing them in. Just as human connection and touch are important in patient care, how do we promote the same in our elections?

I hear from members who admit that they did not vote and that they do not feel any common thread with the ENA candidates. We must learn how to elevate the human element while embracing the technological element that allows the Web-based campaigning and voting process.

As the General Assembly wrestles with these matters in San Diego, I hope that all our members who do not have the opportunity to be a part of that conversation take the time to think about how they can better be a part of our election process next time. I also hope that the delegates take their roles seriously and remember why they are gathered — to represent the other 39,000-plus ENA members not present.

Technology is changing so quickly, and it is vital that we carefully consider those parts we adopt and those we do not.

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.

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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, MA, RN, CEN, FAEN

August 2012

WASHINGTON WATCH |

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

CDC Report on ED Use Points to Access Issues According to data released May 22 by the Centers for Disease Control and Prevention’s National Center for Health Statistics, many emergency department patients are there because they don’t have any other place to go for medical services. CDC researchers analyzed data on thousands of participants (ages 18-64) in the National Health Interview Survey between January and June 2011 who had visited an ED at least once in the previous 12 months but were not admitted to a hospital. Children, the elderly and those ill enough to need inpatient care — about 25 percent of ED patients — were not included.

When asked to explain why they visited the ED, nearly 80 percent said they lacked access to other health care professionals. Forty-eight percent said their physician’s office was closed, and more than 46 percent had no other place to go. For almost 46 percent, the ED was the closest source of care. (Respondents could select multiple

reasons for their ED visit.)

According to the CDC, the number of ED visits grew to 136 million in 2009 from fewer than 124 million in 2008.

Data from the IMS Institute for Healthcare Informatics found that visits to physician offices decreased 4.7 percent in 2011, after a drop of 4.2 percent in 2010. In the NCHS survey, almost 62 percent of patients without insurance receiving care in the ED said they were there because they had no other place to go. This was true for 39 percent of patients with private insurance and 49 percent of those with public coverage.

For further information, the report — Emergency Room Use Among Adults Aged 18–64: Early Release of Estimates From the National Health Interview Survey, January–June 2011 — can be found at www.cdc.gov/nchs/data/nhis/ earlyrelease/emergency_room_use_januaryjune_2011.pdf.

NEMSAC Discusses Education Initiatives and Culture of Safety Project Hosted by the National Highway Traffic Safety Administration, the National EMS Advisory Committee met May 30-31 to deliberate on several policy issues, including education initiatives and the culture of safety project.

EMS Education Agenda for the Future: A Systems Approach NEMSAC reviewed briefing material from its previous meeting about the EMS Education Agenda for the Future: A Systems Approach (Education Agenda), including key materials from the National Association of State EMS Officials, the professional association that represents state lead agencies for emergency medical services.

NEMSAC’s goal is to make recommendations about the Education Agenda’s future, including a process for revising/ updating the Education Agenda.

Published in 2000 by the Department of Transportation, the Education Agenda sought to develop a common vision for a

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national EMS system by outlining a comprehensive EMS education that could enhance the profession while bringing EMS to an educational par with other allied health care professions. While compliance with the Education Agenda is voluntary, the Education Agenda holds the promise of providing ‘‘career mobility for individuals who seek reciprocity among the states, assure consistent quality and content, and enhance the image of the EMS profession.’’

Academic and career advancement components of the Education Agenda include the National EMS Core Content published in 2005, the National EMS Scope of Practice Model published in 2007 and the National EMS Education Standards completed in 2009.

Considerable progress has been made by the states as shown in the results of a NASEMSO annual survey, published as the 2012 Report to the National EMS Advisory Council on Statewide Implementation of the Education Agenda. The study and report are the second in a series to be provided to NEMSAC. Data for the 2012 report were collected in 2011, and state EMS directors were given an opportunity to revise their information in March 2012.

According to the recent NASEMSO survey: • Seventy percent of states indicated they will require National EMS Program Accreditation by Dec. 31, 2012.

• Another 17 percent of states indicated they will require National EMS Program Accreditation by 2017.

• The remaining 13 percent were indeterminate about a deadline.

• No states have indicated that they will not require National EMS Program Accreditation sometime in the future.

The survey results and report to NEMSAC must not be

August 2012

received or interpreted as a strict policy decision by any state. States retain the authority to implement the Education Agenda in a way that best meets their needs.

The Education Agenda is accessible at www.ems.gov/ EducationStandards.htm.

Feedback Frame

Culture of Safety Draft 3.1 of the Strategy for a National EMS Culture of Safety project was released for NEMSAC comment.

The project, NEMSAC’s highest-priority recommendation, is being produced under a cooperative agreement between NHTSA, with support from the Health Resources and Services Administration’s EMS for Children Program, and the American College of Emergency Physicians. The strategy envisions the following six key elements for advancing a culture of safety in EMS mindful of patients, responders and members of the public: • Advancement of values similar to those in a school of thought often referred to as ‘‘Just Culture’’ • Coordinated support and resources for provider agencies and other stakeholders • A national data system for responder safety and patient safety in EMS • Evolution of the EMS education system • Promulgation of safety standards and related information • Reporting/investigation of applicable incidents.

This third of four drafts, in the three-year iterative process of developing the strategy, incorporates previously submitted public feedback and adds new information by stakeholders. ENA is a stakeholder member of the project’s steering committee and is represented by ENA board member Matthew F. Powers, MS, BSN, RN, MICP, CEN. The third draft is available for public comment at www.EMSCultureofSafety.org. The final document for a National Culture of Safety Strategy will be submitted to NEMSAC in 2013.

More details about the NEMSAC meeting can be accessed at www.ems.gov/NEMSAC.htm.

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

New HHS Web-Based Tool to Track Health Care System On May 15, Health and Human Services Secretary Kathleen Sebelius announced the Health System Measurement Project, a new website that enables the public to monitor and measure how the nation’s health care system is performing. ‘‘I am pleased that this tool will allow people to have better access to data about our health care system,’’ Sebelius said. ‘‘Ensuring all Americans have access to these data is an important way to make our health care system more open and transparent.’’ The project brings together health-related datasets from across the federal government, spanning such topical areas as access to care, cost and affordability, prevention and health information technology.

The topics are broken down further by population characteristics, such as age, sex, income level, insurance coverage and geography.

HHS believes the site will be very helpful to policy analysts and stakeholders in compiling reports, responding to requests, etc. The ‘‘data for you’’ section contains information specifically for state policymakers, health care providers and employers.

To access the project, go to healthmeasures.aspe.hhs.gov.

Official Magazine of the Emergency Nurses Association

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PEDIATRIC UPDATE |

Elizabeth Stone Griffin, BS, RN, CPEN

High Risk, Low Frequency

Assessing for Traumatic Brain Injury in Kids Under 2 The younger the child, the greater the risk of traumatic brain injury from minor head trauma.1,2 In children under age 2, a scalp hematoma is often the only sign to suggest underlying injury.1,3 Because of the portability of small children, many parents ‘‘scoop and run’’ with them and present to emergency departments as walk-ins, subject to triage and sometimes lengthy wait times. Pre-verbal children with head injuries are often difficult to assess; adding to that challenge is that about one-half of children younger than 2 years with traumatic brain injury are clinically asymptomatic.1,2

Real Cases Consider the following real cases, both of which were ‘‘walk-in’’ patients in my emergency department: •A mother brought her 23-day-old infant daughter in because the infant was propped up on the sofa and fell to the hardwood floor beneath. ‘‘She cried for a minute, but since then has acted the same as usual, napped like she normally does, eaten OK, no vomiting or anything,’’ the mother explained. The child had a scalp hematoma and was acting appropriately for her age. Vital signs were within normal limits. A computed tomography scan showed a parietal skull fracture.

•A n 11-month-old girl was brought in by her parents because she fell off a kitchen barstool backward onto the linoleum floor. She had a parietal hematoma and her parents reported she had been ‘‘a little sleepier than usual’’ since the fall, but had no loss of consciousness, no vomiting or other symptoms that would be concerning for serious head injury.

Vital signs were WNL. However, a CT scan showed a parietal skull fracture and a small subarachnoid hemorrhage.

Useful Resources The clinical decision rules published by the Pediatric Emergency Care Applied Research Network 2 and Bin, Schutzman and Greenes 3 offer valuable guidance geared toward the

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assessment of children under age 2 with head trauma. A systematic review of clinical decision rules for children with minor head trauma4 found that the two rules published by PECARN 2 were the most consistent (98 percent sensitivity, 58 percent specificity).

In children younger than 2, the authors stated, there are six high-risk variables for clinically important traumatic brain injury: • Altered mental status • Non-frontal scalp hematoma • Loss of consciousness for five seconds or more • Severe mechanism of injury • Palpable skull fracture • Not acting normally, according to the parent.

Children in this age group who have none of the six high-risk variables have less than .02 percent risk of clinically important traumatic brain injury.

In 2010, Bin, Schutzman and Greenes 3 published the validation of a clinical score to predict skull fracture in head-injured children under age 2. They reported that, in many cases, the only clinical clue to indicate a skull fracture in this group was the presence of a scalp hematoma. Their clinical risk scoring system considered the patient’s age, size of hematoma and location of hematoma in assigning ‘‘risk points’’ to the patient.

The presence of a temporal/parietal hematoma, a large (very easily palpable) hematoma and an age of less than 3 months are the highest risk variables for ICI, according to this clinical scoring system.

Evidence-Based Assessments and Decisions The younger the infant, the greater the risk of TBI from seemingly minor head injury, and the more significant the presence of a hematoma, especially if it is non-frontal. 3 Parental concern that the child ‘‘isn’t acting normally’’ should be taken seriously.2 Falls from more than 3 feet (which can be falls from a parent’s arms, from shopping carts, counters, etc.) are considered severe mechanisms of injury in this age group, according to a large, multi-center, validated

study.2 Health care providers who assess and triage children should know how to look beyond the child’s acute presentation and be aware of the validated, age-specific high-risk variables for skull fracture and/or ICI.

References 1. Kupperman, N. (2008). Pediatric head trauma: the evidence regarding indications for emergent neuroimaging. Pediatric Radiology, 38 (Suppl 4): S670-674.

2. Kuppermann, N., Holmes, J. F., Dayan, P. S., Hoyle, J. D., Jr., Atabaki, S. M., Holubkov, R., . . . PECARN. (2009). Identification of children at very low risk of clinically-important brain injuries after head trauma: A prospective cohort study. Lancet, 374(9696), 1160-1170.

3. Bin, S. S., Schutzman, S. A., & Greenes, D. S. (2010). Validation of a clinical score to predict skull fracture in head-injured infants.

Pediatric Emergency Care, 26(9), 633-639.

4. Pickering, A., Harnan, S., Fitzgerald, P., Pandor, A., & Goodacre, S. (2011). Clinical decision rules for children with minor head injury: A systematic review. Archives of Disease in Childhood, 96(5), 414-421.

August 2012

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2012 ENA Election Results

By Amy Carpenter Aquino, ENA Connection ENA is pleased to announce the winning candidates of the 2012 election for the board of directors and the Nominations Committee. The official installation of the newly elected 2013 board and committee members will be held Sept. 12 at the San Diego Convention Center during the 2012 ENA Annual Conference.

This was the first national ENA election where members had the opportunity to interact with candidates through social media via the ENA Facebook page, Twitter, Foursquare and other social networking outlets. This year’s election saw the highest level of voter participation in recent years, with 6.33 percent of nearly 41,000 eligible members casting votes.

All candidates for the board of directors participated in a candidate’s election forum at ENA Leadership Conference 2012 in New Orleans to ensure that the ENA membership could make an informed decision. Videos of the forum were posted at www.ena.org.

ENA commends all of the candidates for their involvement in the 2012 election, as well as all of the members who participated in the election process.

Board Officers Members elected Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN, as the president-elect for 2013. Brecher will serve as the 2014 president of the association.

Brecher is a clinical nurse specialist for the emergency department at Nemours/A.I. DuPont Hospital for Children in Wilmington, Del. She has served on the ENA Board of Directors since 2010 and is the 2012 secretary/treasurer. Her national ENA committee experience includes participation on the CPEN Examination Construction and Review Committee and the ENA Leadership Conference Committee. She was a finalist for the 2009 Delaware Excellence in Nursing Practice Award. ‘‘It’s so humbling to have been elected,’’ Brecher said. ‘‘The amount of support and encouragement that I’ve received from members I know well, as well as folks that I just met, has been overwhelming. I am honored that I was chosen by my peers to take on this important role, and that they trust me to be the voice of emergency nursing. ‘‘I am very much a proponent of the view that your career and your profession are what you make of it, and you have the power to be the best nurse you possibly can be. I plan to work to encourage nurses to not be afraid to ask the difficult questions, to advocate for their patients and their peers and to challenge the fact that though we are great emergency nurses, we can be even better.’’

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Members elected Matthew F. Powers, MS, BSN, RN, MICP, CEN, as the 2013 secretary/treasurer.

Powers is the emergency department assistant manager for Kaiser Permanente in Vacaville, Calif., and Battalion Chief-EMS Division for the North County Fire Authority in Daly City, Calif.

Powers has served on the ENA Board of Directors since 2010. He is a past president of the California State Council and of the East Bay Chapter. His other ENA activities include serving on the ENA Foundation Scholarship Review Committee and representing ENA on the California State Emergency Medical Services Commission. He is a 2003 recipient of the ENA Rising Star Award. ‘‘It is my honor and pleasure to serve our organization and members as your secretary/ treasurer,’’ Powers said. ‘‘My priority has been, and will always be, advancing our organization to benefit our members and to better serve emergency nurses while maintaining a focus on safe and compassionate attention for our patients and families. Our organization’s challenge is to give our members the tools to perform safe practice and safe care while remaining financially sustainable, now and for years to come. ‘‘The partnerships we build speak volumes to our successes, and I am pleased to represent you in my new role. We must continually work together to represent our patients and our colleagues who deliver the highest level of emergency care. I thank you for your membership and your trust, and let’s move ENA forward together.’’

Board of Directors The following candidates were elected to three-year terms on the ENA Board of Directors: Ellen (Ellie) H. Encapera, RN, CEN, of Aiken, S.C., is a retired staff nurse with more than 40 years of direct patient care experience and 21 years of emergency nursing experience, including charge management.

Encapera has served on the board since 2011. She was a member of the Nominations Committee from 2005 to 2010, serving as chairperson from 2007 to 2008. She served as secretary of the California State Council and president and secretary of the Orange Coast Chapter. ‘‘Since joining ENA in 1988, I have been gratified and rewarded with my personal, membership investment as an engaged volunteer and contributing member,’’ Encapera said. ‘‘I believe in setting a loyalty example, ‘paying it forward’ and mentoring future leaders to reach greater heights, attain personal dreams and enrich their own professional practice. ‘‘I have made a full-time commitment to propel ENA forward, making it a more vibrant and sustainable association for our members and by our members. I am eager to continue my responsibilities in this prestigious position with a clear commitment to serve you and support the emergency nursing community, which we represent.’’

August 2012

Sally K. Snow, BSN, RN, CPEN, FAEN, is the trauma program director at Cook Children’s Medical Center in Fort Worth, Texas.

Snow’s national ENA contributions include serving on the Pediatric Committee since 2010 and as the ENA liaison to the American Academy of Pediatrics Committee on Pediatric Emergency Medicine since 2006. She is a past president of the Texas State Council and received the state council’s Emergency Nurse of the Year Award in 1991. ‘‘After 30-plus years of life with ENA, a long sought-after dream came true when the call came with news that I had been elected to the ENA Board of Directors,’’ Snow said. ‘‘This organization has shaped so much of who I am professionally and personally for the majority of my career in nursing. From the Emergency Department Nurses Association I joined in 1981 to the voice of emergency nursing worldwide, this organization is a gem among professional nursing specialty groups. I will strive every day that I serve this incredible organization as a member of the board to carry on the legacy left by many amazing emergency nurses.’’

Joan Somes, PhD, MSN, RNC, NREMT-P, CEN, CPEN, FAEN, is staff nurse/department educator at St. Joseph’s Hospital in St. Paul, Minn.

Somes has served on the ENA Geriatric Committee since 2004 and as co-editor of the Journal of Emergency Nursing geriatric column since 2010. She is a past president of the Minnesota State Council and of the Greater Twin Cities Chapter. ‘‘The honor and confidence my fellow ENA members have shown by casting their ballots for me is inspiring,’’ Somes said. ‘‘As a ‘sneaker on the floor’ staff nurse, I hope to represent your concerns about patient care, nurse safety and the future of emergency nursing and this organization. I will do my best, as long as you keep me in the loop, promoting what you feel is important. I take this responsibility seriously. I thank you for giving me this opportunity and hope to fulfill the duties to meet or exceed your expectations.’’

Nominations Committee The following candidates were elected: Louise Hummel, MSN, RN, CNS, CEN, of San Diego, was elected to represent Region 1.

Hummel is lecture and clinical faculty at the School of Nursing, California State University, in San Marcos, Calif. She served on the Nominations Committee from 2010 to 2012. ‘‘Thank you to our ENA membership for your vote of confidence and re-electing me to serve as a member of the Nominations Committee,’’ Hummel said. ‘‘I am honored to be given the opportunity to continue to work on the election process, providing information to the membership related to the candidates for office and the importance of making their voice heard through the election process. I take this responsibility very seriously and I am eagerly looking forward to working with the committee for the next two years. Thank you for putting your continued trust in me.’’

Terry M. Foster, MSN, RN, CEN, CCRN, FAEN, of Taylor Mill, Ky., was elected to represent Region 3.

He is a critical-care clinical nurse specialist in the Emergency Department at St. Elizabeth Medical Center in Edgewood, Ky. ‘‘I’ve been a member of ENA for 30-plus years, and I look forward to involvement at the national level through my position on the Nominations Committee,’’ Foster said. ‘‘I am especially interested in gaining input from the backbone of our organization, which I see as the emergency department staff nurse. Those who have responsibility for direct patient care often have the most to contribute to our organization. It is my goal to represent them — their concerns, needs and issues — and to give them a respective voice in the decision-making for national ENA.’’ Lucinda W. Rossoll, MSN, RN, CEN, CPEN, CCRN, of Lebanon, N.H., was elected to represent Region 5. Rossoll is a staff nurse in the Emergency Department at Alice Peck Day Memorial Hospital in Lebanon. ‘‘I am excited to have been elected to the Nominations Committee and want to thank those who voted for me and all who participated in the election,’’ Rossoll said. ‘‘I have been a delegate several times, giving me the opportunity to vote on bylaws and amendments, observe board meetings, meet our leaders and gain an understanding of how our organization functions. I now have the chance to give back to ENA in return for these opportunities. As a member of the Nominations Committee, I welcome the opportunity to build on the excellent work of the previous committees, improve the election process and find ways to have more informed voters participate.’’

Official Magazine of the Emergency Nurses Association

11

How Technology Has Changed the ED

By Kendra Y. Mims, ENA Connection

How did your ED look five years ago?

Technology in the health care field is evolving constantly to improve the quality of patient care, from surgical procedures to diagnosis and preventative treatment.

Whether your emergency department has moved from paper charting to Paper charting methods (left) are giving way to electronic methods such as personal digital assistants, or PDAs (right). the electronic health ‘‘We have a small turnaround time for lab inQuickER, a service that allows patients to record, or nurses in your work,’’ Gerke said. ‘‘In the ED here, the staff draw preview wait times in the ED online and register facility carry around personal digital assistants to their own blood specimens. Being able to use the for an appointment at a specific time. find medical resources and clinical information, built-in tube system to send them to the lab, as InQuickER patients are guaranteed to be treated chances are your health care facility doesn’t look opposed to running to the fifth floor, is a real within 15 minutes of their arrival. St. Mary is the the same as it did 10, five or even two years ago. time-saver for us, which enhances patient care.’’ only hospital in northern Indiana to currently Emergency departments nationwide are To help staff members manage their time offer this service. Gerke says patients have undergoing renovations to implement new better and to decrease waiting times for patients responded favorably, and the ED staff is able to medical technology. The following hospitals with non-critical conditions, St. Mary acquired organize its time effectively. shared how the use of innovative technology has transformed their ED.

Saving Valuable Time Karen Gerke, BS, RN, director of emergency and surgical services at St. Mary Medical Center in Hobart, Ind., said technological advances have improved the emergency department over the 40 years she has worked there.

Within the last 10 years, St. Mary has implemented an automated medication dispensing system in which nurses remove medication for the patient as needed, a process Gerke describes as a time-saver. Nurses no longer have to stock medication on a shelf and appoint one nurse to be in charge of the key.

Once the nurse enters the patient’s information into the automated system, the computer opens a drawer, dispenses medication and automatically charges the patient for the medication.

When St. Mary opened its new emergency department in 2010, it added new technology to support its emergency team in providing efficient and effective patient care. One of the highlights for staff is the pneumatic tube system, which enables staff to send blood specimens, paper and hospital materials to the pharmacy, laboratory and other departments.

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Out With the Old, In With the New Paper Charting vs. Computer Charting

Diagnostic Tools

August 2012

Gerke’s favorite technological advancements implemented over the years include the ability to electronically pull up an old EKG to compare to a current EKG (even if the old one was done more than 20 years ago, as long as it was performed in a Community Healthcare System hospital) and the presence of PDAs, which emergency nurses use to scan a patient’s armband to print out a bar code with the patient’s information to attach to lab specimens.

This is a huge patient safety improvement, Gerke said.

She added that although it was difficult for older nurses to embrace the computerized documentation system, they eventually adapted. ‘‘We’ve been computerized for more than 15 years, and I would venture to say they wouldn’t want to go back to paper charting,’’ Gerke said. ‘‘I think sometimes it does take a little more time, but the information that we can get out of the computerized system is amazing and very helpful to us. We really made sure we had a lot of training time for the nurses. Sometimes technology happens slowly. It’s evolving over time, so it is eventually accepted.’’

Enhancing the Patient’s Experience Heritage Valley Health System has developed new technology within the last 10 years in its facilities located in Southwestern Pennsylvania

One of the emergency department kiosks used by Heritage Valley Heath System in Pennsylvania.

in an effort to improve patient flow and the patient experience. HVHS has issued more than 300,000 Care Cards since 2002. Robert Swaskoski, director of enterprise resource systems, describes them as an accurate method of uniquely identifying patients.

Patients also can use their Care Cards at the ED self-service kiosks, which provide the triage staff with wait-time statistics and enable them to prioritize patients based on their condition and the reason for their visit, Swaskoski said.

However, he pointed out, only 60 percent of ED patients use the kiosks to identify themselves with their Care Card or by entering

What transition looks like in an emergency nursing setting: Ambulance

Dispensing Medicine

Official Magazine of the Emergency Nurses Association

other demographic information. The other patients are assessed by an ED greeter and bypass the kiosk process if the triage nurse is available.

Swaskoski said the Care Card and self-service kiosks are a perfect complement to quickly match patients with the information in the EHR and improve patient flow, which is a major concern within HVHS and many facilities nationwide. ‘‘Redesigning clinical areas to provide a more efficient means for the delivery of health care services has been a consistent goal,’’ Swaskoski said. ‘‘Patient satisfaction surveys have shown that the administrative functions associated with the delivery of health care services are repetitive and often time-consuming. Not only was this frustrating for patients, the variability of multiple staff accessing and updating records often led to errors. To help improve the patient satisfaction scores, new workflow processes were needed to reduce wait times, ensure the accuracy of data and improve the overall patient experience.’’

Linda Homyk, MSN, RN, chief nursing officer and vice president of patient care services at Heritage Valley Sewickley, finds the self-service kiosks beneficial for ED staff. ‘‘Seeing our patients register quickly via the kiosk allows us to ‘visualize’ the waiting room and lets us know how we need to adjust our care and flow on the back end, allowing us to move our patients through the ED efficiently and effectively,’’ Homyk said.

Homyk also noticed that technology changes have been challenging for some seasoned nurses as they initially struggled with incorporating electronic charting into their day, while younger, less-experienced nurses who have grown up with technology adapted quicker. Both the seasoned and younger nurses have adjusted to the change, and Homyk believes information technology has had a significant impact on patient flow at HVHS and helped nurses organize their care. ‘‘Our nurses can see in ‘real time’ when lab or radiology results post and act on them quickly,’’ Homyk said. ‘‘Past visits, dictation and previous studies are just a few clicks away. So, when assessing an unresponsive patient, we have the information we need to adequately care for the individual. Additionally, the acuity triggers, such as numerical scoring and color changes, allow us to make appropriate assignments and adjust staffing and resources to meet the patients’ needs.’’

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Technology as a Career Booster

One ENA Member’s Discovery of a New Calling in Informatics

By Kendra Y. Mims, ENA Connection Nursing is expected to be one of the largest professions within the next 10 years, according to the Bureau of Labor Statistics.1 As the profession continues expanding along with technology, there will be more opportunities for nurses to combine their clinical skills with computer science to transform health care in the growing field of health informatics.

When Anne Turner, MSHI, RN, began her nursing career more than 40 years ago as a staff nurse, the health informatics field did not exist.

She discovered nursing informatics as a profession years later and decided to pursue her master’s degree, enrolling in the first health informatics program in the Massachusetts area.

Today, Turner works at Massachusetts General Hospital in Boston and Anne Turner, MSHI, RN has been the nurse consultant on the informatics process for more than 15 years. She was involved in creating patient tracking and the nursing documentation system in the emergency department.

Q: What inspired you to make the switch from a staff nurse to a nurse informaticist?

Anne Turner: I actually made the switch in the mid-’90s as a staff nurse who was interested in helping to develop a nursing documentation product in the ED. The more that I became involved in it, the more I started to look at the health informatics master’s program. I wanted to be able to care for patients in a better way and transfer information that other disciplines could comprehend and assist them with their care of the patients. With technology comes standardization of care and evidenced-based practice and the ability to put in knowledge management and information at your fingertips. It’s really changed so much of the way we care for patients. My nursing director was also very instrumental in encouraging me to focus myself in this direction.

Q: With constant technological advances in the health care field, how is a career in nursing informatics beneficial for emergency nurses?

A: As nurses, we’re constantly assessing our patients and gathering data while we care for them. We need to be able to incorporate that in

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The World of Nursing Informatics: A Snapshot Overview: This growing specialty combines computer science, information science and nursing science. Nurse informaticists communicate nursing data and interpret the needs of patients and staff into computer programs. This includes using computers to implement systems to support nursing.

History: Nursing informatics was recognized as a specialty in 1992, and a scope of practice was developed through the American Nurses’ Association in 1994.

Education: Active RN license is the minimal requirement to obtain certification.

Certification can be obtained through the American Nurses Credentialing Center.

Although formal training has not been required, nurses typically have a graduate degree in nursing informatics, which is what more employers prefer.

Responsibilities: Nurse informaticists’ responsibilities include educating nursing staff and providing technical support for the implementation of computer systems, developing health care technology systems, assessing technology needs for health care facilities and conducting research.

Places of Employment: The majority of nurse informaticists work in hospitals. Others are employed by health care corporations, assisted-living facilities, home health care agencies, medical equipment manufacturers, insurance companies, universities and government or military agencies.

Career in Nursing Informatics: Some areas of opportunity include clinical informatics, consumer health informatics, educational health informatics and public health informatics. Job roles can include nursing

our workflow and present it in a way that communicates well to other caregivers of the same patient, whether it’s their private doctor, different clinicians in the hospital and the emergency department clinicians. Because nurses are the primary caregivers of patients in the hospital, we need to be able to create a document that not only captures discreet data

informatics analyst, systems analyst, IT training manager, project manager, informatics coordinator, Web developer, consultant, programmer and chief nursing informatics officer.

Career Projection: Research shows that this career has the potential to improve patient care delivery outcomes and to impact the nursing profession. This profession is expected to grow, as nursing informaticists continue to be the link between clinical care and technology.

Salary: According to Pay Scale, the salary for this field ranges from $50,341 to $85,687.

References www.ehow.com/about_5040890_ informatics-nursinghtml# ixzz1z16HICN4 www.uta.edu/ced/static/onlinecne/ CEAugust08.pdf www.ehow.com/about_6644604_nurseinformatics-certification html#ixzz1z1CmyWxm www.ehow.com/facts_5091087_careersnursing-informatics.html www.ehow.com/about_6607501_ job-description-nursinginformatics-career.html#ixzz1z1M6lYRG www.ehow.com/about_6617162_nurseinformatics-job-description html#ixzz1z1ItaoGs www.ehow.com/facts_5091087_careersnursing-informatics html#ixzz1z1Az6fu1 www.payscale.com/research/US/ Job=Nursing_Informatics_Analyst Salary but also give us a standardized way to present the changes in the patient and our plan of care.

Nurses must be part of any discussions regarding development and implementation of EHRs in their hospitals and play key roles to ensure the systems improve the quality of patient care.

Continued on page 25

August 2012

IQSIP Technology and Informatics: What You Need To Know

By Brenda L. Borkenhagen, BSN, MSMIS, Consultant, Health Care IT, and Jessica Gacki-Smith, MPH, ENA Senior Associate, IQSIP Look around you. Our lives are surrounded by technologies that we take for granted every day: digital thermometers, cardiac monitors, digital radiology, hemodynamic monitors, portable ultrasound and more. Health care is on the leading edge of some of the most sophisticated technologies in the world. Yet our practice of integrating the data and information still may be limited to cumbersome paper and manual processes. These account for inefficiencies, make us prone to errors and take a toll on our patients and the fiscal well-being of the hospital.

Historically, health care has been well behind other industries in its investment in computerization. For many hospitals, patients’ health records continue to be maintained on paper. Issues of legibility, efficiency, safety and charge-capture are potentially crippling to an institution. The electronic health record is now at the forefront of successful health care delivery. It has been suggested that the adoption of an EHR results in improved throughput, decreased medical errors, increased access, increased revenue, improved physician recruitment and improved communication, among other benefits.

Federal Initiatives The federal government has a significant stake in health care since it is estimated that Medicare and Medicaid will cost $806 billion in 2013. The American Recovery and Reinvestment Act of 2009, which was the stimulus enacted to help the economy through the recession, dedicated a

portion of its funds toward the investment of health information technology. An estimated $27 billion over the next decade will be expended to support the adoption of electronic health records by hospitals and eligible providers. The HITECH (Health Information Technology for Economic and Clinical Health) Act affords federal incentives to hospitals and physicians when they adopt certified EHRs and demonstrate Meaningful Use.

Meaningful Use Meaningful Use will be staged in three steps.

The first stage is already under way and sets the baseline for electronic data capture and data sharing. Examples of Stage I objectives include: Computerized provider order entry, drug-to-drug interactions, electronic problem list and drug allergy alerts. Hospitals have until fiscal year 2014 (September) to enter the Meaningful Use program at Stage I. By 2015, hospitals that fail to adopt an EHR and, thus, fail to demonstrate Meaningful Use will not only be ineligible for the federal incentives but also will be penalized.

Medicare and Medicaid reimbursements will be significantly decreased.

ENA Emergency Nursing Technology and Informatics Work Team Many emergency departments are responsible for upward of 60 percent of hospital admissions.

As such, they are critical to the adoption of the EHR and the demonstration of Meaningful Use.

To that end, ENA has appointed the ENA Emergency Nursing Technology and Informatics Work Team. The group, comprised of members with relevant experience and knowledge of technology and informatics in the emergency department, includes: • Michael Seaver, BA, RN, chairperson • Jeannette Jefferies, MS, RN, CCNS • Dagny Scofield, RN, CEN, CPEN • Anne Turner, MSHI, BA, RN • JoAnn Lazarus, MSN, RN, CEN, ENA board liaison This team is charged with bringing emphasis to the need for integrating technology solutions with improved work processes to advance emergency nursing research, practice and education. In the coming months, the team will be working to: 1. Develop criteria for the appraisal of informatics systems in the emergency department.

2. Develop key performance indicators for the evaluation of clinical informatics systems and technology applications already implemented in an emergency department.

3. Provide recommendations for resources that ENA members will find useful.

4. Write an information paper on the use of informatics in the emergency department.

In the future, look for resources related to the above initiatives and other helpful information on the Health IT Web page of the ENA website at www.ena.org/IQSIP/Quality/Pages/ HealthIT.aspx.

How has technology changed your emergency department over the years? ENA Facebook fans posted the following responses to our Facebook page in June: Joseph Bass My department did not change, but I changed departments. I went from a rural Level I Trauma center that was 100 percent paper charting to an urban Level I Trauma center with 100 percent computer (Medhost) charting. I love computer charting, especially with bedside computers. It gives the patient a sense that we are there longer and shows that we truly do care.

Gene Iannuzzi Worked in three different hospitals that adopted EMR. In all three, triage time went up, time at bedside went down. None were user-friendly. All required multiple actions to accomplish simple entries. Of course, QA/QI types love them because they are easy to read. I’m not saying EMR is bad, but it’s hardly the panacea it’s been promoted to be, and until systems become more streamlined and intuitive, nurses will spend lots of time managing computers to the patient’s detriment.

Official Magazine of the Emergency Nurses Association

Nick Chmielewski While I’ve been using an EMR for many years, our recent transition to an Enterprise-Wide application was an Olympic-sized transformational event.

Technological tools must be intuitive and user-friendly to be successful. Though it’s not a tool at the bedside, our recent enhancements in teleconferencing have revolutionized our ability to efficiently conduct meetings that increase productivity and reduce cost.

Penny Strachan Blake After 35 years of nursing, mostly in ICU and, most recently, years in various EDs, I think the two things that changed EDs have been EMR (we use MedHost) and telemedicine. Being able to access a patient’s medical history with one button click in MedHost has helped to identify those patients most in need of education and teaching about chronic conditions, especially when you note multiple visits in short time periods for the same complaints. I do not find EMR any more timeconsuming than pen-and-paper charting and actually think it encourages real-time charting of patient care. Telemedicine has revolutionized our ER by providing us timely access to neurological/neurosurgical consults for our stroke patients, increasing the likelihood of quicker interventions and better outcomes.

15

Rural Nursing and Technology

The Latest in Frontier Medicine

By Patricia Thomas, BSN, RN, CEN, CPEN Staff Nurse, Emergency and eEmergency Departments and Cindy Pirrung, BSN, RN, CEN, CFRN Staff Nurse, Emergency and eEmergency Departments Avera McKennan Hospital and University Health Center, Sioux Falls, S.D. The phone rings. I answer, not knowing what situation awaits. ‘‘Avera eEmergency, this is Patti.’’

The scenario on the other end of the line could be as complicated as a full arrest or as simple as a nursing question. With the push of the remote button, I can turn on a camera and observe a fellow emergency nurse working in a community hundreds of miles away.

Avera Health is a health care delivery network based in South Dakota, the Mount Rushmore state.

It’s beautiful, yet much of the state is very rural and isolated.

Geographic barriers and sparse population make health care delivery difficult in many parts of South Dakota. In response to these issues, Avera, through the generous support of the Leona M. and Harry B. Helmsley Charitable Trust, developed and implemented eEmergency in October 2009. eEmergency uses two-way audio-video equipment to connect rural physicians, midlevel practitioners and nurses to a team of emergency specialists housed in a ‘‘hub’’ located perhaps hundreds of miles away in South Dakota’s largest city, Sioux Falls. The purpose of eEmergency is to advise and assist local teams with any needs they might have, and complement their staff with the expertise of emergency medicine specialists. Not only does eEmergency provide support and assistance to rural providers, it also lends a sense of camaraderie and

16

Avera McKennan eEmergency nurses Markie Van’t Hul, RN (left), and Radelle Deis, RN, located at the Avera McKennan Hospital and University Health Center in Sioux Falls, S.D., consult with practitioners in a rural facility.

collegiality between peers serving in different locations. For those who have never been the only RN on staff in a small hospital with a daily census of eight, it may be hard to imagine the challenges. Suffice it to say that a second set of eyes is always appreciated. eEmergency started out small, with eight sites close to Avera’s tertiary hospital, Avera McKennan Hospital & University Health Center, in Sioux Falls. All of these initial sites were very familiar to the eEmergency team, easing assistance with transfer and transport arrangements. The goal of eEmergency, however, is not to increase Avera McKennan’s census but to help the smaller hospitals maintain theirs, and to provide access to specialty care within rural communities.

Direction and advice from eEmergency physicians often makes this possible. In fact, 654 (22 percent) of the patients seen through eEmergency from October 2009 through March 2012 avoided transfer and were able to receive care in their home community.

Today, eEmergency has expanded to more than 58 sites across South Dakota, North Dakota, Nebraska, Iowa, Minnesota and Wyoming. This growth makes staying familiar with local hospitals and transfer destinations a little more challenging. More than once, the eEmergency team has frustrated a nurse with documentation in the wrong time zone!

Twenty-four hours a day, seven

days a week, one RN and one physician are dedicated to working in the eEmergency hub. Due to program growth, staffing has expanded to include a support specialist and an additional RN during weekend hours. The eEmergency team supports local clinicians in a variety of ways, including nursing documentation, transfer arrangement and initiating evaluation and diagnostic testing when the local provider is unavailable. Since October 2009, more than 2,959 patients have been seen through eEmergency, and an additional 7,288 patients have been helped through transfer support calls.

One of the goals of eEmergency is to support clinicians in the provision of high-quality, evidencebased care to all patients, regardless of location. About 25 percent of patients observed through the ‘‘e’’ present with a cardiac complaint (Figure 1). Since September, eEmergency has collaborated with several critical access hospitals to improve outcomes for patients presenting to the emergency department with chest pain suspicious of myocardial infarction. In these facilities, eEmergency is activated for any patient presenting with chest pain. The eEmergency team assists the local hospital staff with documentation support, initiation of treatment, diagnostic interpretation or transfer arrangements. These efforts have resulted in improvements in process and outcome measures, including CMS

Outpatient Measures. Preliminary data reveals significant improvements in median time to transfer and median time to ECG, as well as 100 percent compliance with aspirin and thrombolytic administration guidelines.

The ‘‘Chest Pain Pilot’’ began with five CAHs and has since expanded to include more than 20 facilities across South Dakota, North Dakota, Minnesota, Iowa and Nebraska. eEmergency also supports local clinicians in the delivery of timely and appropriate stroke care. A pilot involving seven participating eEmergency sites allowed patients in rural hospitals to access neurologist-directed stroke care beginning at the time of initial presentation.

The intent of the pilot is to increase appropriate administration of thrombolytic medication to improve outcomes for rural stroke patients.

Through the eEmergency stroke program, 100 percent of the patients deemed eligible for thrombolysis received a fibrinolytic. eEmergency is now in the process of expanding the program to include specialized nursing education and assessment resources to all eEmergency sites.

One patient experienced the benefit of the eEmergency system when he was brought to the local emergency department with stroke symptoms. One evening, eEmergency RN Cindy Pirrung received a call regarding a 42-year-old male patient with witnessed sudden loss of speech and weakness, who was en route to the local emergency

August 2012

department. When the patient arrived with garbled speech, 15 minutes after symptom onset, the computed tomography technician had already been called in by eEmergency.

In addition, eEmergency quickly dispatched air transport for the 35-minute flight to a tertiary facility. During the wait for the helicopter to arrive, a CT scan was completed at the rural hospital, and a neurologist was called into the eEmergency hub to review the scan and discuss thrombolysis with the patient’s wife and the local care team.

The CT scan revealed no acute bleed, and it was determined the patient was a candidate for thrombolysis. Pirrung verified the thrombolytic dose and assisted in monitoring the patient as the medication was administered by the local nurse. The helicopter arrived and transported the patient and his wife to a tertiary facility for post-thrombolytic care. During the transport, the patient exhibited resolution of symptoms.

The patient required a four-day hospitalization and was able to complete outpatient rehab in his home.

Recently, eEmergency has expanded to include a prison program, providing urgent and emergent medical support to inmates and staff in the South Dakota Department of Corrections system. eEmergency continues to evaluate new and innovative technologies that will support high-quality health care access to patients in need. It seems the possibilities for transforming rural health care through technology are endless, and Avera’s emergency care professionals can’t wait to discover the next frontier.

Chief Complaint Count Cardiac 705 Neurological 483 Minor Trauma 436 Major Trauma 300 Respiratory Distress 280 Other 250 Behavioral Health 236 Abd Pain 199 Ortho 64 Fever 50 Burns 36 Headache 34 Nausea/Vomiting 30 Dehydration 22

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Official Magazine of the Emergency Nurses Association

17

Did You Know?

Along with a shortage of nurse educators, another challenge that faculty face is the constant evolution of technology. Research shows that the use of electronic media has increased in educational settings within the last 10 years, as students today continue to engage in online learning. Due to the growth of electronic learning, nurse educators will need to develop technological skills to teach and develop online courses, which may present challenges for faculty who are not as tech-savvy as today’s ‘‘Net Generation” students. According to Health Education Solutions, going forward, health education resources will need to incorporate computer technology skills to best prepare their students for a career within the health care field.

Nurses and other health care providers will need to have a strong level of comfort with technology to provide quality patient care.

References www.healthedsolutions.com/articles/ health-education-research-resources nursingworld.org/MainMenu Categories/ANAMarketplace/ANA Periodicals/OJIN/TableofContents/ vol132008/No3Sept08/ArticlePreviousTopic/ IntegrationofTechnology.aspx

Free Continuing Education ENA is proud to offer free CE for our members.

See the new CE added for August. To access the ENA free CE, visit www.ena.org/FreeCE. Member login is required.

New Emergency Nursing Resources with Executive Summaries ENA develops Emergency Nursing Resources to bridge the gap between research and everyday emergency nursing practice. Each of the four new ENRs now has an executive summary that provides the essential information for patient care. To access all these new resources, visit www.ena.org/ienr.

Emergency Nursing: Scope and Standards of Practice The American Nurses Association has

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Member Spotlight ENA member Cathy C. Fox, RN, CEN, CPEN, staff nurse and educational consultant at Sentara Leigh Hospital, was recently one of the 10 individuals selected nationwide for the annual National Emergency Medical Services for Children Recognition Award. Fox was recognized for her dedication to educating health care providers about the specific needs of pediatric patients and for her efforts in pediatric health, which include raising awareness of the ‘‘choking game,’’ a dangerous activity occurring among youth.

Fox has received feedback from emergency personnel that her choking game presentation has helped them to recognize the signs of this activity in their own children.

Fox, who serves on the ENA Nominations Committee, is grateful that her efforts to raise awareness are making a difference. ‘‘I’m truly humbled and honored to receive this prestigious award,’’ Fox said. ‘‘It takes just one person to spread the word about this deadly activity. If I save the life of a child, then I’ve done my job.’’

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. Member login is required.

Mosby’s Nursing Skills: ENA Edition Mosby’s Nursing Skills provides 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.

Member login is required.

August 2012

Determined to Be Ready for Anything, Guantanamo Nurses Turning to TNCC At U.S. Naval Station Guantanamo Bay, an enclosed sliver of military and civilian life on the southeastern edge of Cuba, there are things nurses at the naval hospital don’t see much.

Sore throats and sprained ankles, sure. Fullblown emergency traumas, no. ‘‘When there is something traumatic here,’’ Lt. j.g. Terry Francis said, ‘‘it’s bad.’’

One night a few months before Francis, BSN, RN, arrived at Guantanamo Bay last December, a pedestrian was clipped by a car while walking along a road on base. Most of the physicians at USNH GTMO are family-practice, and only a handful of the hospital’s nurses have emergency backgrounds. Many of the staff weren’t used to treating such sudden, severe injuries. ‘‘Most don’t have any ER experience at all,’’ Francis said. ‘‘The nurses that I talked to who were here were like, ‘Boy, we could have used more people trained like you.’ ” Today, they’re rapidly home-growing them.

Seven Navy nurses participated in Guantanamo’s first Trauma Nursing Core Course in late March, thanks to the efforts of Cmdr.

Linda Nash, RN, CEN, a longtime TNCC director and 33-year emergency nurse who heads the naval hospital’s emergency department and taught the ENA-developed course.

Francis, fresh off a stint with the Bremerton (Wash.) Naval Hospital emergency department, was one of two instructor candidates. A 20-year member of the Navy, she had spent many of those years as a Navy Hospital Corpsman, namely as a cardiovascular tech in the cath lab, finding herself dealing directly with patients less and less as she rose into more of an administrative capacity. Four years ago, she finished her nursing degree and decided emergency nursing was where she needed to be. A year ago, she joined ENA. Now she’s back in a hands-on role and certified to teach nurses of all specialties in the essentials of trauma, which she’ll do in September during Guantanamo’s third TNCC course. (A second was taught in May.) There will be no shortage of fresh students.

Normal naval assignments are three years, Francis said, but at Guantanamo, where life is confined strictly to the base because there’s nowhere else to go, the typical stay is only 18 months for single and unaccompanied service members and two to three years for those who bring their spouses and/or children with them, as Francis did. That’s enormous turnover in what’s essentially a small town of about 6,000

U.S. Navy photo by Stacey Byington

By Josh Gaby, ENA Connection

Nurses assigned to U.S. Naval Hospital Guantanamo participate in a practical exercise during the naval base’s first Trauma Nursing Core Course, which was taught by Cmdr. Linda Nash, a longtime ENA member, on March 29.

Lt. j.g. Terry Francis (left) took Nash’s course as an instructor candidate and will present the material to a new group of Guantanamo students next month.

— a major reason to offer TNCC as part of the training process. ‘‘We can continue to train people who come here, so we’re maintaining a good, wellrounded, ready staff,’’ Francis said.

Guantanamo has two groups of service members, Francis said: those stationed with the naval hospital and those deployed by the Army and Navy to oversee military detainees. Joint Medical Group personnel from the ‘‘other side,’’ which has a medical clinic but no emergency services, are being invited to take TNCC, too.

It’s a matter of simple preparedness. Because air evacuations off the island can’t be quickly or easily arranged, anyone ordered to Guantanamo is screened in advance of their arrival for conditions such as diabetes which might result in predictable emergencies. But accidents happen. Marines, for instance, routinely drive Humvees around the base. Risks are there.

Francis worries about complacency. ‘‘You’ve got to be prepared for a mass casualty, and our ER is so small that it wouldn’t take many people to make that for us,’’ she said.

In a humanitarian crisis, such as the 2010 Haiti earthquake, which resulted in many injured Haitians being transported to Guantanamo for treatment, all nurses and corpsmen need to be ready to chip in. ‘‘Unfortunately, when bad things happen, just

Official Magazine of the Emergency Nurses Association

because of the way things are in the world now, they seem to be on a much larger scale,’’ Francis said. ‘‘They involve more people, the mechanisms of injury are worse, so the injuries that people have are worse. I think if we could get more people into the TNCC class, even nurses who don’t think they need it at all …

‘Hey, I work on a cancer ward, why would I need that?’ Well, when they call a mass casualty, they don’t care if you work on a cancer ward.

And if you have this knowledge, you can help.’’

That applies, too, to the grim specter of deployment. While the United States is getting out of Afghanistan, there are other areas of the world where war could break out and nurses and corpsmen could find themselves sent in. ‘‘If you already have TNCC, then you’re that much ahead of the game,’’ Francis said. ‘‘You can be ready to handle the horrific things you see if you’re deployed to very hostile environments. ‘‘Now that I’m an instructor, I’ve not only taken [TNCC] and used it somewhat, but I’m reviewing myself constantly, so every time I teach and review, I learn more, every single time. The longer you’re a nurse, the longer you learn not to panic when things are going down the tubes, and I think how people accomplish that is through knowledge. The more I know about something, the better prepared I am when a crisis is at my front door.’’

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ENA’s Workplace Violence Prevention Summit

Safety ‘Absolutely Your Obligation’

By Kendra Y. Mims, ENA Connection

security presence and taking new steps to make the work place environment safe. Examples Emergency nurses and other health care included installing security devices, such as professionals, health care safety and security metal detectors, cameras, good lighting and an experts, researchers and educators gathered in enclosed nurses’ station. Attendees learned Chicago on June 22 for ENA’s first Workplace when most assaults occur: during direct patient Violence Prevention Summit, hosted in interaction, meal times, patient transports and collaboration with the International visiting times. Some of the Association for Healthcare Security & de-escalation techniques discussed Safety. This successful event, included presenting a calm sponsored by Tyco Integrated Security, attitude, acknowledging a person’s focused on alleviating violence in the feelings and always keeping an emergency department. open path to allow an easy exit The morning session speakers from the room. presented research on risk factors, Hartley challenged attendees to recognizing warning signs, gang create goals beyond what they violence, de-escalation techniques learned at the summit.

Dan Hartley, EdD and the importance of working ‘‘What’s our next step? How can together as health care and health we make training more effective? care security professionals.

What is the outcome you want A significant number of attendees from this group?’’ he said. ‘‘Decide raised their hands when Dan Hartley, what our outcome will be for the EdD, workplace violence prevention next year and the next five years. coordinator, NIOSH Division of We need to think of other ways to Safety Research, asked how many keep the momentum going.’’ audience members had been victims of workplace violence. However, Sharing the Same Challenge only two raised their hands when Bonnie Michelman, CPP, CHPA, Bonnie Michelman, asked how many people were taught CPP, CHPA director of Police, Security and that WPV would be part of their job.

Outside Services at Massachusetts ‘‘If you’re a survivor of a WPV incident, it General Hospital in Boston, presented doesn’t only affect you,’’ Hartley said. ‘‘It affects contributing factors to violence in the ED, from your co-workers. It affects everybody in the gangs to disgruntled employees, patients and workplace.’’ loved ones of patients.

Hartley showed several video clips of victims ‘‘I worry a lot about gangs and think they sharing how they suffer from post-traumatic affect us in health care much more than we stress disorder or are permanently disabled think,’’ she said. ‘‘We have to educate staff on because of workplace violence. Another video what to look for. I’m suggesting we create a showed empowered nurses sharing how they different risk for treating members involved in a are being proactive in their facilities through gang.’’ training and proper communication.

Michelman noted that cutting clothing off a Hartley encouraged audience members to gang member to stop bleeding could be viewed join a workplace violence prevention or safety as an offensive act of violence by some gangs. committee and follow OSHA guidelines. One ‘‘Get staff involved,’’ she said. ‘‘Train staff to attendee expressed the importance of nurses know what constitutes gang appearance. You reporting violent incidents and not accepting it need to know how to identify gang members as part of the job. and where they disguise weapons, which is not Hartley discussed the value of having a in usual places. Work with your local police

What They Said Observations from summit attendees:

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gang units to know which gangs are becoming more violent. We should be able to enforce rules and set limits to create a safe environment.’’

Michelman said people are becoming better consumers of where they get health care based on safety, and employees don’t stay at places where they don’t feel safe. ‘‘You want to be seen as a positive, open safe environment,’’ she said. ‘‘It’s not always easy balancing that. I’m grateful for all the regulators because without them we would not have the standards we have. Sometimes, they’ve never worked in this kind of environment. ‘‘I certainly think there needs to be a multilayer approach to security in emergency departments. You have to decide in your own hospitals what that should be. We need to do security awareness for employees. It empowers them.”

Michelman warned that complacency can creep in after a workplace violence incident. ‘‘It is our collective goal to make sure people are in the right place, not living in fear, but not living in complacency,’’ she said. ‘‘As emergency room clinical people, it is absolutely your obligation to make sure that place is safe for you, for your coworkers and for your patients.’’

Attendees shared their ideas of how to implement best practices to reduce violent behaviors in the ED, such as requiring patients to sign a code of conduct or using different colored scrubs to identify psychiatric patients.

Michelman said her facility has a system that flags patients who can be disruptive and informs other staff about the patient’s behavior (e.g., the patient will need two people to assist him or her, or the patient has a tendency to spit at others). She urged the audience to inform patients about the rules when they start to show inappropriate behavior. Most patients will comply, she said.

IAHSS and ENA ‘‘need to work together and lobby together because we are two groups that understand what’s going on,’’ she said. ‘‘We share these challenges.’’

Michelman expressed her ‘‘unbelievable respect” to the audience, saying, ‘‘I think you do God’s work.’’

‘‘I think we are all connected here because we are all concerned about workplace violence. The main issue that they brought up that I really agree with is the political voice that nurses need. We’re the largest group in health care, so this is what we should do. ‘‘We had a violent incident in the hospital where I worked — one of the residents had his throat cut within the last month — so this is a very hot topic for us right now. People are upset, people want to make changes. ... I really am grateful for the opportunity to have come here, and I’ve got a lot of good suggestions to bring back home.”

Mary Blasius, MSN, RN, CEN, of Michigan, an ED staff nurse who works nights and weekends

August 2012

Our Ongoing Fight ENA is committed to educating its members on preventing violence in the emergency department and protecting staff from violent behaviors. Look for other educational opportunities, including summits, on this critical issue in the future. Visit www.ena.org to find valuable resources, such as the Workplace Violence toolkit, designed for emergency department leaders and staff to develop a customized plan based on a facility’s needs and to create a culture of safety to improve violence prevention.

Workplace Violence Prevention and Management: A Multidisciplinary Perspective

By Amy Carpenter Aquino, ENA Connection Roland Ouellette (left), director of training for the Safe Approach for Managing Aggressive Behavior program, which he co-founded, pretends to wield a knife while instructing a summit attendee in how to defend himself from such an attack.

Taking Action Against Workplace Violence

By Amy Carpenter Aquino, ENA Connection Close your eyes, imagine you are in your emergency department, and picture a patient pulling out a knife.

How would you react? What would you do with your body, eyes, hands?

The more you engage in what speaker Roland Ouellette calls ‘‘mental practice rehearsal,’’ the better you will be at handling an actual threat. ‘‘If you practice mentally how you will deal with a situation, you will know what to do,’’ said Ouellette, director of training and co-founder of the Safe Approach for Managing Aggressive Behavior program. Ouellette said he spent his life studying how to de-escalate aggressive people, beginning with studying martial arts while stationed in Japan and continuing with his work for the Connecticut State Police and Department of Corrections.

He told attendees of the ENA Workplace Violence Prevention Summit that with the proper training, anyone can manage any confrontation. ‘‘Every night we watch the news and see that a young woman has been abducted, raped and killed. If only she’d had two hours of training, she’d be alive,’’ he said.

The foundation of any training is not physical but rather mental practice and neuroplasticity, ‘‘the brain’s lifelong ability to reshape neural connections,’’ Ouellette said. ‘‘We can reshape our brain at any age, and we can program our brain how to react in stressful situations.’’

Recognizing the warning signs of a physical threat, and managing your own reactions to a potential aggressor, can help prevent a violent incident from Continued on page 39

‘‘I think this conference is bringing a lot of issues to the forefront, and a lot of hospitals can see if it applies to them and brainstorm ideas on what we can do to decrease the amount of violence in the ED. I came with three other people, and it’s helping us to brainstorm ideas for our ED [such as] forming a safety committee and working better with our security so we can be on the same page as far as taking care of the patient and safety.”

Kimberly Nwogu, RN, Ben Taub General Hospital, Houston

Official Magazine of the Emergency Nurses Association

‘‘If the staff isn’t safe, patients aren’t safe, either.’’

2012 ENA President Gail Lenehan, EdD, MSN, RN, FAEN, FAAN, opened the Workplace Violence Prevention Summit panel discussion with an overview of what ENA is doing to make the work environment safer for both emergency nurses and their patients. ENA’s ongoing research, including the Emergency Department Violence Surveillance Study and member resources, such as the ENA Workplace Violence Toolkit, which Lenehan said has ‘‘received rave reviews, especially regarding the assessment portion,’’ are all geared toward helping nurses address workplace violence. ‘‘In my experience, in many ERs, when something is done, it’s because two or three nurses have gotten together and said, ‘Enough is enough,’ ” Lenehan said.

Kevin Weeks, director of marketing, healthcare, for Tyco Integrated Security, moderated the panel discussion with Lenehan and representatives of additional stakeholders in the workplace violence issue, including: • Terry Kowalenko, MD, FACEP, of the American College of Emergency Physicians; • Bryan Warren, CHPA, 2012 president of the International Association for Healthcare Security and Safety; • Larry F. Rubin CEM, CPE, CHFM, CHSP, of The Joint Commission; • Belinda Currin, AIA, of the American Institute of Architects; • Mikki Holmes, PhD, of the Occupational Safety and Health Administration.

Much discussion focused on reporting incidents of violence to both regulators and law enforcement.

Holmes said nurses should not feel they are creating trouble for their institution by reporting an incident; in fact, Continued on page 39

“This is extremely helpful. Instead of working on legislation to promote increased penalties, I think I need to work on legislation to require all facilities to have workplace violence programs in place.

Although it’s a suggestion by OSHA at this point, if they put it into legislation, that would help to decrease the amount of violence within facilities and make facilities more prepared.”

Mona Kelly, MSN, RN, Tennessee ENA State Council president

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1 Source: Merriam-Webster

To network anywhere and anytime, you have to be present. Networking is engaging.

Networking is powerful. The power of networking is in your hands.

Start growing your networking database. Think about what can be your DreamWorks moment. While in San Diego attending Annual Conference, please take advantage of all the networking opportunities available: the Anita Dorr Memorial Lecture and Luncheon, various educational sessions, the Welcome to San Diego Party, the 1st Annual Awards Gala and much more.

Big things can happen from small meetings. A great example is the story of how DreamWorks Studios was formed. In 1994, three men attended a dinner at the White House. These three men — Steven Spielberg (director), Jeffrey Katzenberg (CEO of The Walt Disney Co.) and David Geffen (film producer) — had never met.

They all sat down at the same table and began talking and DreamWorks Studios was formed. The company has since gone on to produce or distribute more than 10 films with box office grosses totaling more than $100 million. And it all started with one conversation.

Networking does not occur only at formal events. Opportunities are abundant at all times: as you make your way to the convention center, standing in line for breakfast, sitting next to someone new in an educational session and even grabbing a cup of coffee. Any setting, formal or informal, where there is someone you have never met before, is an opportunity to network.

Networking forces you to step out your comfort zone as you talk with someone with whom you have never had any social interaction. It can be intimidating, but through networking you can make connections that last a lifetime. That person you are talking to for the very first time could be your future employer, co-worker, friend or business contact.

Over the years, technology, practices and uniforms have changed but not your commitment to emergency nursing. Through the services you provide each and every day, you empower patients, families and each other.

One of the ways you empower each other is through networking. Networking is the exchange of information or services among individuals, groups or institutions; specifically, it is the cultivation of productive relationships.1

The Power of Networking at Annual Conference

#ENAAC12

Be sure to follow the action! We look forward to seeing and hearing from all of you in September.

Help spread the word to your fellow nurses by telling them how ENA conferences have helped grow your skill set and knowledge base, make new friends and reinvigorate your passion for nursing.

Connect with us on Facebook and Twitter for special offers, contests and news for the 2012 ENA Annual Conference, Sept. 11-15, in sunny San Diego. Post your favorite past Annual Conference photos and memories on Facebook or Twitter.

FOLLOW the ACTION

Awards Gala..........................................September 15

Educational Sessions................. September 13, 14, 15

Presessions...................................... September 12-13

General Assembly........................... September 12-13

ENA Board of Directors Meeting............September 11

IMPORTANT DATES TO REMEMBER

Help promote Annual Conference by tearing out the poster and hang in your break room.

Please join us in San Diego Sept. 11-15. We hope to see you there!

The significance of Wolf and Mortensen attending Annual Conference was so empowering that they joined ENA’s staff just this year. Annual Conference can make a difference in your life, too.

– Betty Mortensen, MS, BSN, RN, FACHE Chief Nursing Office

y first experience at a conference was with a group of my colleagues M in Orleans when Hurricane Florence rocked our world. I was 7 months pregnant with my first child and ate too much salty foods and was very bloated ... but I was so energized to be a part of something that was essentially making me be a professional emergency nurse. I learned a great deal about leadership and team work at that conference! I have mentored many nurses in our profession so that they could experience these types of professional growth.

– Lisa Wolf, PhD, RN, CEN, FAEN Director, IENR

My first experience with ENA was the Annual Conference in Nashville in 2005. I loved the classes and the energy and the passion so much I decided to be faculty and come every year. I’ve spoken at Annual and Leadership since 2006, and anywhere the conference is, I now have friends and colleagues to vent, problem-solve, and have a great time with!

Read on to see what other ENA staff nurses thought about their first Annual Conference:

r

An ENA conference offers many experiences and events that will be invaluable for a lifetime. Annual Conference is very beneficial and enriching and will give you the tools to achieve professional excellence.

– Marlene Bokholdt, MS, RN, CPEN, CCRN

My favorite parts of ENA Annual Conference are the keynote addresses.

I am always hit with a wave of amazement at the collection of assembled knowledge, experience and influence in a room full of emergency nurses.

It makes me believe that we can change the world, push the evolution of health care and promote the practice of emergency nursing. It is always an empowering experience and one that has encouraged me to recommit to my profession and my colleagues. The rest of the conference reinforces that belief as I get to meet the people that filled the room, discover their learning needs, share their struggles and feel their support.

As in years past, ENA’s Annual Conference will allow you to expand your knowledge and skills with educational sessions, earn up to 20.5 contact hours, reconnect with friends and colleagues and learn about the latest innovative products. Annual Conference is packed full of career-enhancing events. Yet you may still be asking, “Why should I attend?” We wanted to provide you with insights and testimonials from our own ENA staff nurses, some whose lives literally changed. Here is what one of our nurses had to say:

Hear It Straight From Our Nurses

“Celebrate the BEST IN Class”

We hope you enjoy all the events that this year’s conference has to offer, and we look forward to seeing you in sunny San Diego.

To register for these or any other event, please visit www.ena.org and click on the Annual Conference information banner at the top of the page.

Lastly, we will be offering power yoga, a morning walk by the San Diego waterfront and our very 1st Annual Awards Gala with Terry M. Foster, MSN, RN, CEN, CCRN, FAEN, as our master of ceremonies, all on Saturday, Sept. 15.

Continuing Education Recognition Points (CERPS) will be available this year. These points are designated for non-traditional participation.

What makes this Annual Conference different from past conferences? This year we have many new events to announce. We are proud to present the addition of the Advance Practice Cadaver Lab: Advanced Emergency Procedural Skills, which will be held on Friday, Sept. 14. These hands-on labs earn attendees 3.5 contact hours and are designed to improve practitioner competence in advanced and life-saving procedures.

In less than six weeks, ENA will host our 24th Annual Conference in sunny San Diego, Sept. 11-15.

What’s New at ENA’s 2012 Annual Conference

Portable Ultrasound:

The Stethoscope of the Future

By Siegfried Emme, MSN, RN, NP-C, CEN, CCRN In 1816, the French physician René Laennec introduced the world to the stethoscope. This piece of medical equipment was rapidly adopted by physicians, but it was more than a century before nurses began using it to its full extent.

The stethoscope of the future is the portable ultrasound machine, and it would be a shame for nurse practitioners to wait to begin using this piece of medical equipment. The portable ultrasound can provide direct point-of-care information during procedures and patient assessment, which can improve patient safety and lessen cost of care.

Medical ultrasound is converting sound waves into pictures that we can use. There is no radiation involved, and some animals make use of it naturally. Bats and dolphins both use a form of ultrasound called echolocation to find prey.

Today’s medical students are learning how to use ultrasound. In 2006, the University of South Carolina ran a trial teaching medical students ultrasound as part of their core curriculum.

Today the University of California Irvine includes ultrasound education as part of the permanent medical curriculum. However, no nurse practitioner schools include ultrasound training in their core curriculum.

In 2009, the American College of Emergency Physicians released guidelines regarding resident proficiency in ultrasound.1 Unfortunately, this education still lacks consistency, which contributes to ultrasound’s variable use in today’s emergency departments.2 For NPs, there are a variety of applications in which to acquire expertise. Bedside nurses commonly place peripheral intravenous catheters and are the experts in this procedure throughout the hospital. There are times, though, when it is almost impossible to find a vein. Patients who abuse IV drugs, the morbidly obese and patients on dialysis are among those who can make PIV access challenging. Hospitals, such as the one associated with Duke University, solved this problem by teaching their nurses to insert PIVs using an ultrasound machine.3 Studies in France, Italy and Germany showed that prehospital personnel also can effectively use the ultrasound to make on-the-spot medical decisions.4 Multiple studies have shown that

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nurses and emergency technicians can effectively place PIVs using ultrasound.5,6,4,7 Why is ultrasound use not more prevalent?

Despite ultrasound being a required competency in residency among emergency medicine physicians, its use is not universal in emergency departments. The smaller and more rural the hospital, the less chance that it will have immediate availability of a portable ultrasound machine.8 In some respects, this is difficult to understand because ultrasound has become less expensive, smaller and easier to use throughout the years. It is no longer necessary to drag a huge machine to the bedside. Many models of emergency room ultrasound machines are the size of a laptop.

One new system consists of an ultrasound probe that attaches to a smartphone.

There are several advantages to portable ultrasound, including the following: 1. It is a noninvasive means of obtaining direct visualization of body parts not normally seen with the naked eye, with no ionizing radiation involved. A trip to radiology to get a peripherally inserted central catheter placed under fluoroscopy will give the patient a dose of ionizing radiation. On the other hand, a practitioner can come to the bedside and place a PICC with a portable ultrasound machine, minus the radiation.

2. Ultrasound is relatively easy to learn, and anyone from prehospital personnel to physicians can learn to use this piece of equipment.

3. What if someone comes in with abdominal pain, and cholecystitis is on the differential?

Bedside ultrasound can help answer that question immediately. Ultrasound is so portable it can be done at the bedside with the provider receiving immediate feedback, as opposed to sending someone for a computed tomography and waiting for the radiologist to call back with the report.

4. T his immediate feedback contributes to patient safety, as shown in the placement of central venous access lines. The provider can visualize in real time whether the needle is going into an artery, an organ or the proper vein. No more worrying whether it is the carotid artery or the internal jugular vein that is being cannulated, not because the provider is not familiar with anatomy, but because the human body has endless variations that could cause problems during procedures. The Agency for Healthcare Research and Quality recommends ultrasound use for all central line placements because of this fact.9 5. Other procedures that the ultrasound can make safer include incision and drainage of abscesses, paracentesis, arthrocentesis, thoracentesis, nerve blocks and lumbar punctures.

From a practical standpoint, how can the ultrasound help the practitioner in a clinic? How many infants have been catheterized with no output? Would it have been nice to know in advance that the bladder had urine in it? Then there is the pregnant patient who comes into the clinic, and fetal heart tones just can’t be found with a Doppler. Another example is the dialysis patient who comes in for IV antibiotics with one arm that can be accessed with a PIV, and that arm already is a pincushion. A practitioner using an ultrasound machine could make short work of all of the above problems.

Most EDs today already have an ultrasound, and they are starting to show up with more frequency in clinics. As practitioners, let’s get educated in using the ultrasound and not wait 150 years to begin using the stethoscope of the future.

References 1. American College of Emergency Physicians.

(2009). Emergency ultrasound guidelines.

[Practice Guideline]. Annals of emergency medicine, 53(4), 550-570.

2. Ahern, M., Mallin, M. P., Weitzel, S., Madsen, T., & Hunt, P. (2010). Variability in Ultrasound Education among Emergency Medicine Residencies. Western Journal of Emergency Medicine, 11(4), 314-318.

3. White, A., Lopez, F., & Stone, P. (2010).

Developing and Sustaining an UltrasoundGuided Peripheral Intravenous Access Program for Emergency Nurses. Advanced Emergency Nursing Journal, 32(2), 173-188 110.1097/TME.1090b1013e3181dbca1070.

4. Ma, O. J., Mateer, J. R., & Blaivas, M. (2008).

August 2012

5.

6.

7.

8.

9.

Emergency ultrasound (2nd ed.). New York: McGraw-Hill Medical.

Brannam, L., Blaivas, M., Lyon, M., & Flake, M. (2004). Emergency nurses’ utilization of ultrasound guidance for placement of peripheral intravenous lines in difficult-access patients. [Evaluation Studies].

Academic emergency medicine: Official Journal of the Society for Academic Emergency Medicine, 11(12), 1361-1363.

Gregg, S. C., Murthi, S. B., Sisley, A. C., Stein, D. M., & Scalea, T. M. (2010). Ultrasound-guided peripheral intravenous access in the intensive care unit. [Evaluation Studies]. Journal of Critical Care, 25(3), 514-519.

Schoenfeld, E., Boniface, K., & Shokoohi, H. (2010). ED technicians can successfully place ultrasound-guided intravenous catheters in patients with poor vascular access. The American Journal of Emergency Medicine.

Talley, B. E., Ginde, A. A., Raja, A. S., Sullivan, A. F., Espinola, J. A., & Camargo, C. A., Jr. (2011). Variable access to immediate bedside ultrasound in the emergency department. The Western Journal of Emergency Medicine, 12(1), 96-99.

Shojania, K. G., Duncan, B. W., McDonald, K. M., Wachter, R. M., & Markowitz, A. J. (2001). Making health care safer: a critical analysis of patient safety practices. Evidence Report - Technology Assessment (Summary)(43), i-x, 1-668.

Nursing Informatics Continued from page 14

In 2010, the U.S. Bureau of Labor Statistics cited health information technology as one of the 20 fastest growing job categories in the country.2

Q: What career advice do you have for nursing students who are interested in becoming a nurse informaticist?

A: I think it’s an upcoming, very important and marketable field for people going into nursing. The generations coming up now that are graduate nurses have used computer entries throughout all of their schooling and career. They just need to be able to evaluate systems and use them in a way that enhances their work flow, and ensure that the computer doesn’t come between them and the care of the patient.

Q: What are some of the challenges nurses may encounter in this field?

A: A lot of the challenges come from the way some vendor products are designed. They don’t take the workflow of a nurse into consideration.

Sometimes, you have to change your workflow to accommodate the vendor product. Accessibility to computers is sometimes a great challenge.

Because we are so hands on with our patients, I think another big challenge for nurses is for us to document on a computer. Its physical presence can be a barrier between developing a close professional relationship with a patient.

Q: Will this career affect nurses who still want to provide hands-on patient care?

A: The amount of hands-on patient care you do depends on where you are. A lot of colleagues I went to school with were more administrative, did a lot of implementation and vendor selection and were involved in standards of care. I’m very lucky that I have a very good balance of being involved in informatics to create products that are used in my department and still work at the bedside, and right now I don’t ever want to lose that patient contact. I think it’s hard to have that mix of clinical care and nursing informatics.

I’m lucky I work in a large hospital, but I think it’s definitely more of a challenge if you work in a small hospital to have your fingers in both worlds.

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

• Available August 1 – The Two-sided Mind: How “Car Talk” Can Be Used as a Model for Nursing Decision Making 1.0 contact hour Lisa Wolf, PhD, RN, CEN, FAEN

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.

0812_Free CE_Connection.indd 1

Official Magazine of the Emergency Nurses Association

Q: What do you enjoy the most about being a nurse informaticist?

A: It definitely has opened up a world for me. It has given me the opportunity to develop products that help me communicate with other clinicians in a better way, as well as document patient care so that all of the disciplines can be able to use the information that I’ve gathered to help them assess the patient. It also gives me the opportunity to evaluate the products I create firsthand. I have to use anything that I help design, and if it doesn’t work, I’m the first to know it. I am excited to be part of the information team in the emergency department and to have the ability to influence the way nurses document the important care we give patients and their families.

References 1. www.nurseweek.com/careers/ informatics/sasp.

2. www.ehow.com/facts_6858130_health informatics-professional_. html#ixzz1ywDLMcFm.

7/9/2012 9:42:12 AM

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Research Grant Recipient Raising Awareness

Compassion for Sexually Assaulted Women in Street-Level Prostitution

By Kendra Y. Mims, ENA Connection If a woman involved in street-level prostitution comes into the emergency department with head trauma, a broken arm, a bruised face and a black eye, should health care providers ask if she was raped or sexually assaulted?

Lola Prince’s answer is yes. Definitely. Prince, PhD, APN, FNP-BC, who has worked with women involved in prostitution and sex trafficking since 1996, says that although their lifestyle involves trading sex for money, women in street-level prostitution are often victims of sexual assault on a regular basis, and signs of physical abuse often can be linked to rape.

However, through research and interviewing women in street-level prostitution, Prince discovered that some health care providers were not understanding and lacked compassion when these women presented to the emergency department and reported rape. This discovery sparked her research to see if emergency nurses were among those health care providers who discriminated against women in street-level prostitution, and if they were aware that this discrimination even existed.

Prince, an associate professor of nursing at the University of St. Francis College of Nursing in Joliet, Ill., was a 2010 recipient of the ENA Foundation Industry-Supported Research Grant, sponsored by GE Healthcare. She received $5,000 to assist in developing further research that can advance the emergency nursing profession, as well as enhance professional development. Her research project, titled “Emergency Department Nurses’ Attitudes Toward Street-Prostituted Women Experiencing Sexual Assault,” targeted emergency nurses in the Chicago area. More than 200 participants returned the survey, and the results surprised Prince.

Contrary to previous outcomes reported in the Midwest on health care providers’ attitudes, Prince’s findings showed an increase in positive attitudes toward street-prostituted women who suffered from sexual assault. However, Prince pointed out that education, region and ethnicity of the participants are all variables that may have influenced the outcome. Because Chicago has a large urban population and the participants may have more interaction with women in street-level prostitution in the

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What has this research done for your career?

I choose this area of research because of my passion in working with vulnerable Lola Prince, populations and PhD, APN, FNP-BC not to advance my career, per se.

The research has provided me with consulting opportunities to speak about sex trafficking and prostitution to social workers and nurses in the Joliet region.

Have you done posters, abstracts or resources based on your research?

For this study, I will be presenting a poster at the 2012 ENA Annual Conference in San Diego. I have an abstract under consideration for a research conference in Chicago. A manuscript for peer-review publication is under way. My previous research on prostitution and sex trafficking has been presented as papers at local, regional and international conferences. emergency department, Prince questioned if the same positive attitudes would hold true in a non-urban area. Because of the ENA Foundation grant, Prince’s research can improve the quality of patient care for a population to which some emergency nurses may not be exposed by raising awareness in both urban and rural areas. ‘‘I believe that when these women come into the ED, they come in for a physical assault, and they may not disclose that they’ve been sexually assaulted,” Prince said. ‘‘Literature shows that many believe the legal system won’t believe them, which is why it may not be disclosed. It would help if the emergency nurse asks if they’ve been sexually assaulted [raped] and encourage them to move forward and have a rape kit completed, and ask a SANE to do the exam and follow-up treatment for the woman, even if she is involved in prostitution. Don’t just see sexual assault as part of her lifestyle, and don’t take for granted that her lifestyle means that she is a willing participant for every

encounter.’’

Prince’s passion for working with vulnerable populations is evident in her background of providing nursing care in underserved communities for more than 30 years. She credits the ENA Foundation research grant for helping her to get the word out to the emergency nursing profession that women in street-level prostitution are part of a group that needs to be evaluated. Prince points out that these women may suffer more from post-traumatic stress disorder because of the repeated violence. By looking beyond the bruises and wounds and identifying the high risk of sexual violence these women encounter daily, emergency nurses can get them into early treatment and expose them to services and resources to assist them with getting off of the streets and improving their physical and mental health care, Prince said. ‘‘The ENA Foundation grant has been valuable because there has been more research about women in prostitution from social workers, psychologists or law enforcement,’’ Prince said, ‘‘but it’s been less talked about in nursing, and nurses have not been in the literature. This brings it to the forefront that these women are human beings and that nurses overall were taught to be empathetic and provide nursing care to all types of people from troubled backgrounds. This is just one group that we need to look at more and provide more assistance. We’re at a pivotal position to provide even more care to these women and to make a difference.’’

The ENA Foundation’s research grants and educational opportunities are made possible because of the generous donations received from individuals, state councils, local chapters, industry and friends of emergency nursing. You can support the passion of those who desire to make a difference in emergency nursing through research opportunities. Your donation helps to provide funding for research that can improve the quality of patient care and promote the profession. Please visit www.enafoundation. org to find out how you can contribute to advancing emergency nursing. If you are interested in applying for the ENA Foundation Industry-Supported Research Grant, please check www.enafoundation.org for submission deadlines and applications.

August 2012

From the Future of Nursing Work Team | IOM Recommendation 5

Double the Number of Nurses With a Doctorate by 2020

By Chris Gisness, MSN, RN, APRN, CEN, FNP As the delivery of health care becomes more complex and patient care acuity increases, nurses are expected to demonstrate greater knowledge and expanded competencies.

With the nursing shortage, and the decreasing number of nurse faculty available to educate new nurses, this places a challenge on the educational system and threatens the supply of nurses needed by 2020.

A 2008 survey found that 1 percent of nurses had their doctorate in nursing. If emergency nurses will be expected to increase their scope of practice, manage technological tools and systems and coordinate care across the health care system, an increase in education and training will be required. At ENA we are faced with determining the best way to encourage and support emergency nurses to advance their education to the doctoral level, make

contributions to research, improve the quality of patient care and invest in policy decisions for the future of nursing.

In the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, Recommendation 5 focused on doubling the number of nurses with a doctorate by 2020.

This is required to meet the faculty shortage and the call for leadership roles needed in the nursing profession in policy making and research. The need is for both nurses who hold doctoral and doctor of nursing practice degrees.

Since 2005, there has been a notable increase in the number of DNP programs. Many universities have a curriculum that begins and continues from basic RN to PhD. Many schools have streamlined their programs to cut costs and offer grants and scholarships, with federal funding available to ease the financial burden.

Faculty members of nursing programs are being asked to support the need for more faculty and lobby for increased salaries and more federal funding. Nurses are being encouraged to purse PhDs earlier in the careers.

What will the 2020 nurse doctoral student look like? No longer are nursing schools reporting that the majority of nursing students are fresh out of high school, white and female Nursing is being degenderized; it is being seen as more of a life choice, which has created more diversity and been positive for the profession.

As emergency nurses of the future, we need to focus on the changing health care system, consider our own career path and goals and the challenges of achieving them. Do we see an advanced degree in our future? Do we see ourselves as nurse doctorates? What are we willing to do to make these changes?

Latest CDC Field Triage Guidelines Have ENA’s Backing

By Josh Gaby, ENA Connection ENA agrees that if you want the right outcome to go to one and tie up those trauma resources for an injured patient, you want the right place. if the injury isn’t severe enough.

Count ENA among the 37 national and ‘‘I think it’s a positive thing,’’ said Hastings, regional organizations standing behind the most whose report and recommendation from Atlanta recent version of the Guidelines for Field Triage led to the ENA Board of Directors endorsing the of Injured Patients, released earlier guidelines. ‘‘As emergency nurses, this year with minor updates by the we need to advocate for our patients Centers for Disease Control and and make sure they’re getting the Prevention. Previous versions were best level of care possible, and that’s issued in 2006 and 2009. really what these guidelines are Michael Hastings, MS, RN, CEN, designed to do — get the patient to the research and quality coordinator the right location so they get the for the University of Kansas Hospital right treatment.’’

Emergency Department in Kansas ‘‘Healthy discussion’’ arose at the City, represented ENA at a two-day Atlanta meeting, Hastings said, with Michael Hastings, summit in Atlanta in December to representatives of some air-transport MS, RN, CEN review the guidelines. Published the services raising concerns that the next month in the CDC’s Morbidity guidelines might send patients in and Mortality Weekly Report, they now take the rural areas across state lines to reach the nearest form of a poster, a pocket chart and a mobile trauma center, creating higher costs. application for iPhones and iPads (all available But in the end, ‘‘really, it comes down to for download at www.cdc.gov/fieldtriage). who can treat the patient the most The idea is that pre-hospital care providers will appropriately,’’ Hastings said. measure the various elements of a patient’s What’s considered most appropriate could condition against the research-based guidelines vary depending on location, and the CDC to decide whether the patient needs treatment anticipates that. at a Level I trauma center. Treatment at those ‘‘One thing that was pointed out to us about facilities has been linked to lower mortality these field-triage guidelines is that they are rates, but it’s not always necessary for a patient guidelines, so they are not meant to be a

Official Magazine of the Emergency Nurses Association

The poster and pocket-guide versions of the CDC 2011 Field Triage Guidelines (www.cdc.gov/fieldtriage).

one-size-fit-all kind of approach,’’ Hastings said. ‘‘Knowing that certain rural parts of the country are different than major metropolitan areas, when you’re implementing the field-triage guidelines, you have to take into account what your trauma system looks like.’’

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‘You Feel Empowered to Help Shape Our Practice’ Writing an ENA Resolution Connects You to the Big Picture

By Amy Carpenter Aquino, ENA Connection If at first you don’t succeed …

ENA members Nicole McGarity, BSN, RN, CEN, and Meghan Long, BSN, RN, CEN, will present to the 2012 General Assembly an updated version of their 2011 resolution on defining the term “wait time” for the emergency department. Their 2012 resolution requests that ENA “write a consensus statement definition for a consistent ED metric regarding the term ‘wait time’ as used in emergency care settings.”

Even if this year’s resolution does not pass, Long and McGarity, both clinical managers at the Mount Carmel West Hospital Emergency Department in Columbus, Ohio, feel they already have succeeded by putting the issue out there for discussion among the membership.

“People are talking about wait times and the change to a customer focus as far as patient care goes,” Long said. Their 2011 resolution presentation and debate “got some conversations going.”

While their 2011 version did not pass the General Assembly, a second resolution they co-authored, Utilization of Paid Reservations for Emergency Department Services, was approved.

That resolution resolved that ENA oppose the practice of paid reservations for emergency department services until evidence is published to show that the practice is safe.

McGarity explained that in their roles as clinical managers, the pair sees the impact that business practices can have on patient care,

especially working in a hospital that has a large updated resolution was to incorporate the population of patients with limited resources. feedback they gained from delegates in 2011.

The impetus in writing both resolutions “We took that feedback to in 2011 was that the two practices did heart,” she said. not represent the right thing to do for The process of writing both the patients.

2011 and 2012 resolutions has “With the wait times, it’s even more been beneficial for Long and widespread that there is no really McGarity, from the initial research well-defined term as to what exactly and writing to the feedback – both that means,” McGarity said. “You see positive and negative – received all different systems and all different from delegates, the Resolutions hospitals advertising a wait time, yet Committee and the ENA Board of Meghan Long, they’re all using different measureDirectors.

BSN, RN, CEN ments. One hospital may say that it’s “It’s helped promote the idea of the time between when a patient me having a say in the practice walks in the door until they’re in a that I do every single day,” Long bed, and another may say it’s the time said. between when they are registered “It makes you feel like you are until the time they see the triage empowered to help shape our nurse.” practice a little bit and make “We just would like a definition decisions for our organization,” that we can consistently use,” Long McGarity said. “Taking the leap said. “ENA has helped propel some of and trying to do the resolutions Nicole McGarity, our business practices, to make sure has made me create relationships, BSN, RN, CEN that the patient is receiving the care to try to figure out how to reach that they need. In our roles, we really out and get feedback from other stress to the staff that we need to educate the members, communicate with the staff at ENA public about the care they are receiving, and and understand some of the more detailed work this is part of it. How can we be transparent and ENA does. It’s definitely given me a better consistent with them if we can’t do it within our understanding of what we’re all about and how own practice?” we work together to shape our nursing practice Long explained that the goal in writing an that we provide for our patients.”

May 2012

Board Meeting Actions and Highlights The ENA Board of Directors met May 16 via teleconference. All members were present with the exception of Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN. The board took the following actions: • Approved the April 28 board of directors meeting minutes as written.

• Approved the 2012 ENA Public Service Award recipient: Sen. Olympia J. Snowe (R-ME).

• Approved the following revised position statements as presented: ° Care of Older Adults in the Emergency Care Setting ° Cultural Diversity • Approved the revised Latex Allergy position statement as amended.

• Approved the newly created Utilization of Paid Reservations for Emergency Department Services position statement as presented.

• Postponed approving the American College of Emergency Physicians Emergency Department Nurse Staffing Policy Statement until ENA’s staffing guidelines are released.

• Approved the revised board governance policy 6.01, Support and Endorsements, as amended.

• Approved revisions to ENA bylaw amendment proposal GA12, Board

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Eligibility, authored by the board of directors.

• Approved the State Council Innovation Grant criteria and application process as amended. State councils can apply for a grant of up to $10,000 each (total monies available not to exceed $50,000) from June 15 to Sept. 30. Awardees will be announced at the end of October.

• Approved the Historical Perspective Work Team members and charges as amended. This work team is charged with making recommendations regarding the development of a sustainable system that ensures the appropriate retention of important ENA documents and other historical materials in the appropriate ENA or ENA affiliated repositories.

° ° ° ° °

Kay McClain, MS, RN, CEN, FAEN, co-chairperson Diane Schertz, BS, RN, FAEN, co-chairperson Patricia Clutter, MEd, RN, CEN, FAEN Joanne Fadale, BSN, RN, FAEN Audrey Snyder, PhD, RN, CEN, ACNP-BC, CCRN, FAEN, FAANP

Highlights of the next scheduled board of directors meeting will be published in a future issue of ENA Connection.

August 2012

IENR Plans an Unforgettable Way to Top Itself

By Josh Gaby, ENA Connection You have the research idea. ENA has the people to help. And those people will be wearing beanies.

When the Institute for Emergency Nursing Research hosts its third IENR Lounge for aspiring researchers on Friday, Sept. 14, during the 2012 Annual Conference in San Diego, IENR Director Lisa Wolf, PhD, RN, CEN, FAEN, plans for all of the consultants to be sporting the appropriate headwear: propeller-topped beanies designed to blow the stuffiness out of an area too often believed to be for academics only. ‘‘Dude, research is fun,’’ Wolf said. ‘‘That’s the thing: We want to make it fun, we want to make it a little bit silly, we want to bring it down to earth. It’s really hard to listen to people talk about how intimidating research is when really, it’s not. So we’re trying to break down that fear barrier there.’’

Four IENR Advisory Council members already have signed on to staff the Lounge, and Wolf expects many more research experts to stop by to meet with emergency nurses and offer casual advice, as they did last year during the first Lounge in Tampa, Fla. ‘‘No matter where people are in their research trajectory, they can get some help,

IENR Lounge When: 1-4 p.m., Friday, Sept. 14.

Where: Room 9, San Diego Convention Center, during the 2012 Annual Conference. get some resources, get some advice, and so we’ve got a really great group of people who are going to help do that,’’ Wolf said.

An ENA member need only stop by with an idea or project, no matter how raw or developed. Based on the visitor’s level of experience — from an absolute beginner to a confident researcher whose project has stalled and requires some fresh eyes — the consultants

2012 Annual Conference

Refresh Revitalize Invigorate

ENA Call for…

Memorial Requests at 2012 ENA General Assembly

will point that person down the right path. Wolf expects to equip nurses with printed handouts and online guides, as well as instructions for applying for grants and other funding.

It’s been a busy summer for the IENR Advisory Council, which is contributing a series of articles to the Journal of Emergency Nursing and emphasizing intervention studies through which new, lesser-experienced ENA members can help solve problems that IENR has identified.

The Lounge is another important hat to wear. ‘‘If people come just to see the beanies, that’s OK — we’ll suck them in,’’ Wolf said, laughing.

Any emergency nurse can think of a research idea to pursue, she said. ‘‘To make it manageable and feasible, that’s our job.’’

September 11-15 • San Diego

Deadline: Aug. 17 ENA will honor our members who have passed away in the last year at a special memoriam presentation during the 2012 General Assembly, Sept. 12-13 in San Diego.

If you would like to recognize a member who has died, please complete the form in the General Assembly area (members only) at www.ena.org. All requests must be submitted electronically to componentrelations@ena.org.

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

For more information, visit www.ena.org.

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Official Magazine of the Emergency Nurses Association

2/8/2012 9:48:18 AM

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READY OR NOT? |

Knox Andress, BA, RN, AD, FAEN

The 2012 HHS Integrated Training Summit

Leading From Preparedness Through Recovery On Jan. 5, a 79-car pileup became a mass casualty incident when it sent 54 casualties to hospital emergency departments in southeast Texas.

On March 30, 40 children were taken to the hospital after three school buses were involved in an accident in Lawton, Okla. The same day, the East Texas Medical Center, Quitman, Emergency Department temporarily closed for decontamination of staff and first responders after a potential chemical contamination incident.

On April 3, the Prince William Hospital ED in Manassas, Va., was reported closed as two patients presented contaminated with an unknown hazmat.

ENA members respond to mass gatherings/casualty incidents and surge or disasters of varying magnitude nearly every day. Most of these responses are within the confines and safety of the member’s emergency department and hospital. Transportation accidents, severe weather, hazardous material contamination, disease, terrorism hazards and other threats are a few potential sources of patients arriving in hospital emergency departments for needed physical — and sometimes mental — care.

On the other hand, many emergency nurses train and

respond outside the hospital as part of a United States Department of Health and Human Services asset, disaster medical team or related federal initiative.

In preparation for future incidents, several ENA members who are disaster responders and federal team members were participants, educators, presenters and leaders in HHS’s 2012 Integrated Medical, Public Health, Preparedness and Response Training Summit, held May 21-25 in Nashville, Tenn. The summit annually brings federal, state and local disaster medical planners and response partners together in a collaborative learning and sharing environment.

Disaster Medicine Offerings More than 2,500 participants joined the summit. Offerings included three general sessions, five joint sessions and regional meetings and 60 individual sessions in five disaster-related tracks, including healthcare systems; leadership; public Health; resource management and patient movement; and response integration and operational medicine. Attendees also took in more than 100 poster presentations on a variety of disaster medicine response topics.

Knox Andress (fourth from left) at the HHS Integrated Training Summit with fellow attendees (from left) Emma Dragon, Wendy Wheeler, Brandon Gleason, Sharon Clements, Lilly Popick, Denise Bertucci and Debbie Haus.

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An annual function of HHS and the Office of the Assistant Secretary for Preparedness and Response, the summit was co-sponsored by such partners as the National Disaster Medical System, the United States Public Health Service, the Medical Reserve Corps and the Emergency A DMAT tent in Waveland, Miss., in the aftermath of System for Advanced Hurricane Katrina in 2005.

Registration for Volunteer Health found across the United States Professionals. Each of these federal from Florida to Washington. disaster response systems brings Several ENA members attending medical resource teams and this year’s summit were DMAT, resources to the incident.

IMSURT and/or MRC members (see photo).

National Disaster Medical System Teams

The NDMS partners HHS with the VA and DoD to medically support the nation in times of disaster and war. Established by presidential directive in 1984, the NDMS was initially designed to provide backup medical support for the DoD and VA during wartime but was initially tested and implemented during domestic disasters. Components include: • Medical response to a disaster area in the form of personnel, teams and individuals, supplies and equipment.

• Patient movement from a disaster site to unaffected areas of the nation.

• Definitive medical care at participating hospitals in unaffected areas.

NDMS response teams include Disaster Medical Assistance Teams; National Veterinary Response Teams; Disaster Mortuary Operational Response Teams; National Medical Response Teams and International Medical Surgical Response Teams. NDMS teams are

United States Public Health Service Teams The summit’s co-sponsor, USPHS, is overseen by the U.S. surgeon general and is a key part of national disaster planning, response and recovery. Members of the United States Public Health Service Commissioned Corps may belong to one of three disaster response teams, including the Rapid Deployment Force, the Applied Public Health Team or the Mental Health Team.

Medical Reserve Corps An HHS Training Summit anchor, the Medical Reserve Corps is comprised of medical and public health professionals who organize and serve as volunteers to respond to natural disasters and emergencies. The MRC program provides ENA members the structure to deploy medical and public health personnel in response to an emergency, as it identifies specific, trained, credentialed personnel available and ready to respond to emergencies.

August 2012

Emergency System for Advanced Registration of Volunteer Health Professionals The ESAR-VHP is a national network of statebased registries that allows emergency nurses and health professionals the opportunity to get their licenses and credentials verified before a disaster happens. The ESAR-VHP is a federal program created to support states and territories in establishing standardized volunteer registration programs for disasters and public health and medical emergencies.

The program, administered on the state level, verifies health professionals’ identification and credentials so that they can respond more quickly when disaster strikes. By registering through ESAR-VHP, volunteers’ identities, licenses, credentials, accreditations and hospital privileges are all verified in advance, saving valuable time.

THANK YOU

FOR YOUR GENEROUS SUPPORT! Donations were raised from 48 states.

The ENA Foundation is grateful to all who generously participated in the success of the 2012 State Challenge fundraising campaign.

A National Resource The need for medical preparedness and response capabilities are not likely to diminish but only increase as our populations are impacted by evolving natural hazards; technological, manmade threats, and limited resources. The HHS Integrated Medical, Public Health, Preparedness and Response Training Summit provides an excellent resource for emergency nurses learning and developing disaster response skills.

For other ENA emergency preparedness resources, join and contribute to the ENA Preparedness Listserv at www.ena./org.

A new milestone record has been raised!

Resources www.phe.gov/Preparedness/responders ndms/Pages/default.aspx medicalreservecorps.gov/HomePage www.phe.gov/esarvhp/pages/about.aspx Readers may contact the author at wandr1@lsuhsc.edu.

Follow Knox Andress @ENAdman.

$116,702.10 For a list of the 2012 donors or for more information, visit www.enafoundation.org.

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Official Magazine of the Emergency Nurses Association

7/9/2012 9:17:43 AM

31

The EMINENCE Mentoring Program

By Andrea Novak, PhD, RN-BC, FAEN In September 2005, the first class of fellows was inducted into the Academy of Emergency Nursing. Since then, 87 nurses have joined the ranks of this august body. Fellows are nurses who have done, and often continue to do, one or more of the following: •M ade enduring, substantial contributions to emergency nursing.

•B een involved in the advancement of the profession of emergency nursing.

• Provided

visionary leadership to ENA and the academy.

Being a fellow comes with a price in the form of service, giving back to nurse colleagues in a variety of ways, such as through volunteerism, publication and through the academy’s EMINENCE mentoring program.

The EMINENCE program is designed to pair ENA members with experienced academy fellows. Applicants submit project descriptions and are matched with fellows who have expertise in the subject matter. Projects have included such topics as professional presentation, publication, research design,

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.

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.

www.ena.org/enweek

12462_EN Week Marketplace 1-2 pg island Ad.indd 1

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grant writing and program management.

Once the nurses are matched, they are required to attend an orientation together at Annual Conference to set goals and objectives.

There is a one-year commitment between the mentee and the mentor, and each team decides how often to communicate and through what mechanism to achieve the goal.

What’s in It For Me? As a first-time EMINENCE mentor, I thoroughly enjoyed the experience. I think I got as much as I gave, and I made a lifelong friend. My mentee, Lynn Visser, BSN, RN, CEN, of California, wanted to learn how to improve her PowerPoint® presentation skills to teach others about organ donation and thereby increase the number of referrals made through her emergency department, as well as others. As we discussed her project, it morphed into much more, and she started on her journey to develop a poster presentation that involved research into a practice improvement project. Visser’s poster was accepted for presentation at the 2012 ENA Annual Conference in San Diego. The experience was so positive that I’ve signed up again to be an EMINENCE mentor.

Other mentors and mentees shared their experiences which demonstrate the impact of the EMINENCE program. ‘‘It’s rewarding to see the results from a few well-placed words of encouragement or thoughts on how to approach an issue,’’ said mentor Jean Proehl, MN, RN, CEN, CPEN, FAEN. “… it only takes a little bit of my time … we can make a big difference in someone’s professional development in less than 90 minutes a month.’’ ‘‘The EMINENCE program is focused on the outcomes of the mentee but steered by the mentor … it was the best formal mentoring program of my professional career,’’ said Andrew Harding, MS, RN, CEN, NEA-BC, FACHE, who was mentored in writing for publication.

Roger Casey, MSN, RN, CEN, who was mentored by Diana Meyer, MSN, RN, CCRN, CEN, FAEN, in developing presentation skills, said he has been successful in getting up in front of people to present, not only at a local level, but also at an emergency nursing conference in Canada. ‘‘This program truly provides a mentoring relationship … that brings out the best potential in each participant,’’ Casey said.

Continued on page 38

August 2012

CODE YOU

CODE YOU

Introducing the ENA Emergency Nurses Wellness Committee

Feeding Our Members CODE YOU

By Kendra Y. Mims, ENA Connection

CODE YOU

YOU

ENA’s new Emergency Nurses Wellness Committee met for the first time in June at ENA’s headquarters in Des Plaines, Ill. During their two-day visit, committee members discussed wellness initiatives, drafted two position statements and brainstormed ideas to promote wellness in emergency nursing. ‘‘We’ve had so much focus on taking care of the patient that we forgot that we can’t take care of patients well unless we take care of ourselves,’’ said committee chairperson Robin Walsh, MS, BSN, RN. ‘‘So we’re really stepping back and looking at promoting wellness in nursing. It’s not just about being physically fit — it’s also about being emotionally and spiritually fit and thinking about what encompasses a really healthy work environment. It’s having policies in place, having supportive administration and leadership, having the equipment we need to provide patient care and thinking about environmental hazards.’’

The committee focused on compassion fatigue, safe patient handling, lateral violence and appropriate staffing levels, among

CODE

Meet the Emergency Nurses Wellness Committee: Work Team Members Robin Walsh, MS, BSN, RN (chairperson) Cheryl Campos, PhD, BSN, RN Judith Mandalise, RN, CEN Catherine O’Neil, MSN, RN, CEN Yvonne Prowant, MM, BSN, RN, CEN Board Liaison Karen Wiley, MSN, RN, CEN

Members of the Emergency Nurses Wellness Committee (from left): staff liaison Briana Quinn, MPH, BSN, RN; Cheryl Campos, PhD, BSN, RN; Yvonne Prowant, MM, BSN, RN, CEN; Catherine O’Neil, MSN, RN, CEN; chairperson Robin Walsh, MS, BSN, RN; and Judith Mandalise, RN, CEN.

other topics. It revised the Prevention, Wellness and Disease Management position statement and drafted the Healthy Work Environment position statement.

As part of the committee’s efforts to promote wellness in emergency nursing, it will launch a wellness booth at the 2012 Annual Conference in San Diego in September. Attendees can stop by and learn about immunizations, smoking cessation and more. ENA

staff members and Wellness Committee members will be onsite to address questions or concerns.

Conference attendees also can participate in a morning walk or yoga class Sept. 15 and a networking session about injury prevention and wellness Sept. 13. ‘‘We’re just thinking of ways that we can get the message out that we have to take care of ourselves,’’ Walsh said. ‘‘There’s so much research that says stress,

Staff Liaisons Cydne Perhats, MPH, senior injury prevention associate Briana Quinn, MPH, BSN, RN, senior associate, wellness/injury prevention Christine Siwik, senior administrative assistant fatigue and unhealthy toxic environments really take a toll on our health physically and emotionally. I think the concept is, ‘I can’t take good care of my patient unless I take really good care of myself and my coworker.’

Continued on page 39

The results from the Omnibus 2012 survey are in! Check out what other emergency nurses are saying about maintaining a healthy lifestyle.

How would you describe your own health and well-being at this time?

Poor

Fair

Good

Excellent

Health

1%

17 %

60 %

23 %

Well-being (overall)

2%

19 %

59 %

20 %

Walking

94 %

Jogging / Running

62 %

Bicycling

53 %

Work out with weights or 71 % weight equipment

Official Magazine of the Emergency Nurses Association

33

NOMINATIONS COMMITTEE | Tiffiny Strever, BSN, RN, CEN, Past ENA Board Member

My Leadership Journey My ENA leadership journey started in 1998 when I attended my first Missouri ENA State Council meeting. I attended with the sole intent of becoming Trauma Nursing Core Course faculty so I could verify new instructors in the Kansas City area. Not only did I walk away as faculty, but I was also the acting president for the ‘‘non-functioning’’ Kansas City ENA Chapter.

My brain was spinning as I made the four-hour drive home. How did this happen?

What do I do? There were so many questions but only one certainty: People I’d never met before that day had put their faith in me and I wasn’t about to fail.

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And so my journey into ENA leadership began, each step building upon the previous with successes, failures and valuable lessons learned. I became the Missouri State Council president from 2003-2005, and while serving in that role I made the decision to run for the national board of directors.

I was elected to the national board of directors in 2008 and served through 2010.

Leadership at the national level is rewarding, challenging and, at times, exhausting. The experience I cultivated at the local and state levels provided some basis, but nothing can prepare you for the responsibilities at the

national level. Your role includes liaison to five states, two to three committees and other national organizations, board meetings and what seems like an endless flow of e-mails — all in addition to your ‘‘real’’ job.

Time management is one of the first skills that comes into play, making the most out of the limited hours in the day. But isn’t that one of the qualities we look for in leaders, their ability to multitask, delegate and make the tough decisions?

As a leader, I never compromised my integrity. When asked about a decision or my personal opinion, I provided the most honest answer within the confines of the role. As I transitioned off the board, I took what I learned and ran for the Nominations Committee. In my role as a past board member, I am able to provide input on how the board functions, as well as be able to explain procedures or protocols.

Leadership is a choice. It takes time, commitment and energy, and each level requires more, but it is so rewarding. Never did I imagine that as a graduate of an associate’s degree nursing program in rural Iowa almost 30 years ago, I would find myself in these roles.

Leaders may be created, but that’s because someone saw their potential. Leaders are also followers and mentors.

I want to leave you with a quote from Gen. Colin Powell, former secretary of state: ‘‘Leaders have the ability to inspire others to achieve what managers say is not feasible.’’

Leadership is a choice and a journey. I hope that you have enjoyed mine.

1/10/2012 8:11:54 AM

August 2012

You Red It Here ENA member Dana Gerrard, RN, CEN (third from left), and his colleagues at the Addison Gilbert Emergency Department in Gloucester, Mass., participated in a recent ‘‘Red Shirt Friday.’’ The ED staff took its cue from local firefighters who have been wearing red shirts every Friday in honor of American troops. ‘‘Every Friday, we wear our red shirts with yellow ribbons,’’ Gerrard e-mailed. Pictured from left to right are Stephanie Hanley, ED technician; Andrea Toppan, RN; Gerrard; Donna Dayton, RN; Janet McPhail, RN, and Mark Jenkins, RT.

2013 ENA PrEsidENt JoANN LAzArus, MsN, rN, CEN iNvitEs ENA MEMbErs to APPLy for A NAtioNAL ENA CoMMittEE Applications are being accepted Friday, July 20 through Friday, August 17

EMERGENCY NURSES:

Every Patient + Every Time = Making a Difference.

Emergency Nurses Week™ October 7-13, 2012

Emergency Nurses Day® Wednesday, October 10, 2012

For a full description of the committees and to submit an application, go to www.ena.org and click on the link within the “Calls and Opportunities” area on the homepage.

www.ena.org/enweek

COMMITTEE APPLICATIONS MUST BE SUBMITTED ONLINE BY

5 P.M. CENTrAL TIME, FrIDAY, AUgUST 17, 2012 AFFILIATES: Mexican Association of Emergency Nurses

College of Emergency Nursing Australasia Ltd.

12462_EN Week 1-2 pg island ad_FInal.indd 1

Official Magazine of the Emergency Nurses Association

Australian College of Emergency Nursing (ACEN)

College of Emergency Nurses - New Zealand

National Emergency Nurses’ Affiliation, Inc. (NENA)

Royal College of Nursing

7/9/12 9:57 AM

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One of the Profession’s Earliest Advocates

Looking Back on 47 Years of Promoting the Emergency Nursing Specialty

By Amy Carpenter Aquino, ENA Connection The soldier is still vivid in Anna Mae Ericksen’s mind. ‘‘I remember one young man so well,’’ she said. ‘‘I still see him lying in his single cot, saying to me, ‘All I want is my momma. All I want is my momma.’ ’’ In 1943, Ericksen, RN, recently graduated from the Deaconess Hospital School of Nursing, was stationed at Kelly Field in San Antonio. She had answered a wartime call for nurses and joined the Army Nurse Corps. After a transfer from Fort George Wright in her hometown of Spokane, Wash., she spent the earliest years of her career working 2,000 miles away.

Demonstrating her signature knack for getting things done, Ericksen, now 93, called on a contact in the Red Cross and convinced the organization to help her arrange for the homesick soldier to speak to his mother. ‘‘They were young people, just like we were, and it was very difficult for them to be separated from their families,’’ she said.

After the war, Ericksen returned to Spokane and set her sights on expanding the emergency room at Deaconess Hospital. ‘‘Emergency care was just beginning to become popular,’’ she said. ‘‘It was a specialty, and you had to have some different things to work with. The hospital worked with me in putting together an emergency room and the equipment and beds that we needed. ‘‘I remember the one bed that we had, and I asked for more beds, and they gave me two beds. And then I said, ‘Well, we need more.’

So I ended up with four beds at that time. It would have been in the very late ’40s.’’

With adequate space and equipment, Ericksen turned her attention to training. She was able to train the nurses under her supervision in the emergency room,

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Anna Mae Ericksen, RN, listens to tributes from fellow emergency nurses at a luncheon in her honor at Deaconess Medical Center in Spokane, Wash., in April.

but the residents who came down from the hospital floors were a different story. ‘‘I remember going to management and saying, ‘We need to do something because these young men are coming down and they’re not trained in emergency care,’ ” she said. ‘‘So we put together a meeting with some of the medical staff.’’

Ericksen praises Deaconess Hospital, where she worked for 47 years, for always supporting her efforts to improve emergency care for patients and for ‘‘knowing that there was something special in emergency care.’’

In the late 1960s, she found even more support for her specialty from two emergency nurses from New York and California. Anita Dorr, RN, and Judith Kelleher, MSN, RN, invited Ericksen to Buffalo, N.Y., to represent the Pacific Northwest region at the original meeting of what would become the Emergency Department Nurses Association.

Ericksen contributed to the founding of EDNA and served as its president from 1975 to 1976.

During her tenure as EDNA president, her goals were to gain support for the specialty of emergency nursing and more recognition for the role that emergency care played in the hospital. It was around this time that she focused on providing training for the personnel responsible for transporting patients to the hospital. ‘‘There was no such thing as emergency ambulances at the time,’’ she explained. ‘‘It was just ‘scoop and run,’ you know, bringing the patients in to us.’’

Ericksen went back to Deaconess management with a request to set up a training program for firefighters, especially those from the surrounding rural communities who had fewer resources. ‘‘I said, ‘We need to go to the medical staff and say, ‘You need to help us put together programs for these people.’ And that actually did

happen. We would send people out to some of the faraway places to work with their people who were trying to do emergency care with no training.’’

It didn’t take long for Ericksen’s vision of a training program for firefighters to evolve into something more substantial. She suggested bringing firefighters in for training at Deaconess on Friday afternoons because the ED was always busy at that time, and she even arranged for them to sleep in some of the unused nursing quarters. ‘‘They could go to bed, but if we had something come in, they’d get up and come out,’’ she said.

In 1975, Ericksen received national recognition for her emergency care expertise when President Gerald Ford asked her to speak at the White House as part of a presentation on the importance of Emergency Medical Services. ‘‘Oh, that was something,” she said. ‘‘I remember sitting in the front row where we were, and I remember the president coming in.

I can still see him walking through those double doors, and of course the auditorium was full. That was a true experience.’’

Ericksen, who also founded the Rural Nurse Organization and helped establish the Spokane Poison Center, said the growth of ENA to more than 40,000 members was exciting. ‘‘It all stems back to our saying, ‘This is important — Emergency nurses are special people, and we need to recognize them,’ ” she said. ‘‘Because of our desire to make this work, we’re now seeing emergency care where it is today.

I would like to think that we were instrumental, if you will, for getting things going. I know it took a lot of convincing with the medical staff that this was important. But then they began to see, as we in our bullheadedness, moved ahead.

Nurses were really taking the lead in this.’’

August 2012

Washington ENA State Council Honors Anna Mae Ericksen

By Marlena Herrera, RN, CEN On April 27, the Washington ENA State Council presented the inaugural Lifetime Achievement Award to Anna Mae Ericksen at a luncheon held at Deaconess Medical Center in Spokane, Wash.

She was surrounded by friends, family and new acquaintances who felt privileged to meet this pioneer of emergency nursing.

Throughout the award presentation, Ericksen was gracious and witty. Sharp as a tack, she recounted stories of the ‘‘old ER,’’ including her ingenious 24-hour coffee pot program that welcomed patients and families as well as police officers. ‘‘She was a trailblazer and laid a foundation that allowed us to reach further than she ever

imagined,’’ said WA-ENA President Roger Casey, MSN, RN, CEN, who presented the award.

Some who were unable to attend the award ceremony sent letters. James M. Nania, MD, FACEP, EMS Medical Program director of Spokane County, wrote the following: ‘‘Her belief that emergency nurses were an equally valuable member of the team was something she had to prove. In a very real sense, her efforts in this regard amounted to liberation of emergency nurses, moving their role from simple followers of physician orders to bedside leaders in patient assessment, critical care and resuscitation. Equal partners in the effort to save lives. I and many others still fondly refer to Anna Mae as our Founding Mother.’’

Joining Anna Mae Ericksen (front row, far right) for the presentation of her Lifetime Achievement Award were Washington ENA State Council board of directors members (front row, from left) Karin Kloppel, Suzy Beck, Linda Seger, President Roger Casey, (back row, from left) Terri Christy, Karen Broostrom, Carla Brim, Andi Foley, Tami Wheeldon and Beki Hammons.

Grant E. Gauger, MD, Neurological Surgery, University of California, San Francisco wrote: ‘‘There was one person whose level of energy, efficiency and commitment to excellence were simply unique, setting her apart.

That person was, of course, Anna Mae. She seemed to be everywhere at once, giving highly effective attention to each of the hundreds of details involved in successful patient care, or in its administration. She was equally devoted to

the success of the hospital as a whole. I am grateful for the gift which her life has represented to each of us.’’

Ericksen reminded us that emergency nursing is rarely performed alone, that it is the team that makes the difference.

The Washington ENA State Council invites all members to honor this nurse who has led our profession to greater value and helped define what it means to be an emergency nurse.

Washington ENA State Council Backs State Medicaid Budget Compromise

By Roger M. Casey, RN, MSN, CEN, 2012 President, Washington ENA State Council In September 2011, the Washington State Health Care Authority, which oversees the state Medicaid program, sought to curtail an annual spending of $235 million in emergency department visits while also attempting to cut $72 million from the biennial budget. The HCA proposed a plan which would allow no more than three non-emergent ED visits annually based on a list of diagnoses that were deemed non-emergent. The list of diagnoses included chest pain, shortness of breath, hemorrhage in pregnancy, sprains, strains, burns and other conditions. Under the new rule, Medicaid would no longer pay hospitals or physicians after three such visits in a year.

The Washington chapter of the American College of Emergency Physicians, along with the Washington State Medical Association and the Washington State Hospital Association, began to work with the HCA to eliminate truly emergent conditions from the list, without success.

As a result, a lawsuit was filed to block the HCA from enacting this policy. The lawsuit

stated that the HCA did not follow proper rule making procedures. The lawsuit further asserted that the proposal violated the prudent layperson law, which states that a person who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in a condition that could result in death or disability. In November 2011, a judge ruled in favor of WA-ACEP and ordered all parties to collaborate on an alternative plan.

In December 2011, the HCA announced a new proposal that would no longer pay hospitals or physicians for any ED visit that was deemed non-emergent. The new policy was scheduled to go into effect on April 1 but was suspended by Gov. Christine Gregoire in hopes that a special session of the state legislature would pass a budget and resolve the issue. On April 10, the state budget was approved with an amendment introduced by Rep. Eileen Cody (D-West Seattle), chairperson of the Healthcare Committee. The amendment was an adaptation of the WA-ACEP plan and requires 75 percent of hospitals caring for Medicaid patients to implement best practices to reduce costs of

Official Magazine of the Emergency Nurses Association

emergency department visits for patients requiring coordination.

The best practices included the following: • Information exchange between hospitals and emergency departments.

• Help patients understand and use appropriate sources of care.

• Ensure hospitals know when they are treating a PRC patient and treat accordingly.

• Assist PRC clients with their care plans.

• Reduce drug seeking and drug dispensing to frequent ED users.

• Ensure coordination of prescription drug prescribing practices.

• Review reports, ensure interventions are working.

The Washington ENA State Council was asked to assist WA-ACEP in getting WA-ENA members to write letters to state legislators to support a plan that worked for providing safe patient access and care. The WA-ENA statement of support can be found at www.washingtonena.org.

Reference Revised Code of Washington 48.43.005(12)

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ENA STATE CONNECTION Virginia ENA State Council Submitted by Janice McKay, RN, CEN, CFRN At the June 6 meeting of Mr. Jefferson’s ENA Chapter in Charlottesville, Va., members donated camp supplies for the Salvation Army summer camp program. Camp Happyland is a summer camp that provides opportunities for inner-city children and seniors to experience refreshing, outdoor activities such as swimming, hiking and crafts. The chapter donated items that would help those families unable to provide some of the camp supplies, such as towels, clothing, flashlights, flip flops, soap and shampoo. Chapter members filled the back of an SUV with bags of supplies.

Minnesota ENA State Council Submitted by Karie J. Pearce, BSN, RN, CEN Minnesota’s seat belt use law was put into effect June 9, 2009. Law enforcement officers in the state can stop and cite drivers and passengers who are not buckled up. Minnesota ENA took an active role in promoting the passing of this legislation. Ryan Aga, BSN, RN, CEN, CEPN, past president of the Greater Twin Cities ENA Chapter, coordinated efforts with state Rep. Kim Norton (DFL-29B) during the 2009 legislative session.

Since 2009, a new study conducted by the University of Minnesota’s Center for Excellence in Rural Safety found that seat belts really save lives in Minnesota. The study found that Minnesota’s primary seatbelt law resulted in 68 fewer deaths and 320 fewer traumatic injuries from 2009 to 2011. The

study also pointed out that the law reduced hospital charges by $45 million.

Overall seat belt use increased from 87 percent in 2008 to 93 percent in 2011.

Emergency nurses must partner and remain steadfast with state government officials to support these injury prevention laws. Enforcing seat belt use to reduce overall morbidity and mortality due to traumatic injuries is what it is all about. Forming a partnership with state officials is easy — just pick up the phone.

State Council and Chapter Meetings and Events Georgia Southside ENA Chapter CEN review with Jeff Solheim, MSN, RN, CEN, CFRN, RN-BC, FAEN. Aug. 7-8, 9 a.m. – 5 p.m.

Kansas ENA Chapter Meetings Central Kansas ENA

Location: Peachtree City Library, 201 Willow Bend Road, Peachtree City, Ga.

Meetings begin at 7 p.m.

Sept. 19 — Lawrence Nov. 14 — Kansas City

For more information: www.gaena.org/ uploads/CEN_flier.pdf

Minnesota Greater Twin Cities Chapter

Kansas ENA State Council State council meetings. Meetings start at 10:30 a.m.

Aug. 10 (Annual Meeting) — Children’s Mercy South, Overland Park Oct. 12 — Stormont Vail, Topeka Dec. 14 — University of Kansas, Kansas City

Upcoming education: Annual Trauma Summit (date to be announced).

CEN review with Jeff Solheim, MSN, RN, CEN, CFRN, RN-BC, FAEN Oct. 15-16 — Hutchinson Oct. 18-19 — Lawrence

EMINENCE Mentoring Program Continued from page 32 Jayne McGrath, MS, RN, CEN, CCRN, asked to be mentored in the EMINENCE program when she became a clinical nurse specialist in the emergency department. New to the role, she sought guidance from Proehl and “not only

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For more information: www.kansasena. org and visit us on Facebook.

Legislative initiative: saving lives, changing behaviors For more information: crashcart440@hotmail.com

Cornerstones in Emergency Nursing Conference Oct. 10-11, 7:30 a.m. – 4:30 p.m.

Location: Como Zoo Conference Center, St. Paul, Minn.

For more information: www.minnesotaena.com (Greater Twin Cities Chapter section)

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

learned more about the CNS role, but was able to strengthen my knowledge in emergency nursing… and ENA and all it has to offer.”

For any emergency nurse who is looking to stretch his or her wings, expand professionally and develop in a supportive environment, mentoring through the EMINENCE program is the way to go. For the fellows in the Academy

Location: ProMedica Toledo Hospital Kellermyer Education Center For more information: Jennifer.carpenter@ promedica.org or Kristie.gallagher@ promedica.org

Washington ENA State Council & British Columbia National Emergency Nurses’ Affiliation (Canada) Emergency Nursing Without Borders conference. This is a joint effort between the Washington ENA State Council 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; and Dr. Nathan Schlicher, American College of Emergency Physicians, Washington.

Oct. 12-13 Location: Seattle For more information: washingtonena. org/bc-waconference.html

of Emergency Nursing, EMINENCE is a very rewarding, visible and tangible method to continue to contribute to the advancement of emergency nursing.

For more information on the EMINENCE program and either becoming a mentor or mentee, please visit www.ena.org/about/ academy/EMINENCE.

August 2012

Taking Action Against Workplace Violence

Multidisciplinary Perspective

Continued from page 21 occurring in the first place. Ouellette pointed out that 90 percent of communication is non-verbal, so what we do with our eyes, hands and body has much more impact than the words we speak. ‘‘When people in the ED are upset, they can’t hear what you are saying,’’ he said.

Ouellette outlined physical considerations for emergency nurses to note when caring for patients, including personal space and reactionary distance and eye communications.

Personal Space and Reactionary Distance ‘‘Personal space is critical,’’ Ouellette said. He defined personal space as the area around a person that others are expected not to intrude and which generally measures as five feet behind a person, three feet in front and 1 1/2 feet on each side. ‘‘As I approach you, I’m going to infringe on your space, and your anxiety is going to go up,’’ Ouellette said as he demonstrated invading an audience member’s personal space by standing too close. ‘‘For those of you doing blood pressure on patients, depending on how you position yourself, you can invade that patient’s personal zone. Without knowing it, you are raising that person’s anxiety.’’

Even more critical is a person’s intimate zone, which Ouellette defined as an 18-inch diameter surrounding a person. Children who have been abused or left alone with no supervision end up with ‘‘huge personal zones and spend the rest of their lives protecting their zones,’’ he said.

Cultural differences and upbringings also affect intimate zone space. ‘‘Sometimes you have to ask permission to enter someone’s space,’’ said Ouellette, who suggested knocking on the door before entering a patient’s room.

Knowledge of reactionary distance is essential when dealing with a physical threat. ‘‘People get assaulted all the time, including police officers, because they are standing too close to people and don’t understand reactionary distance,’’ he said. He demonstrated with another attendee how a person holding a knife could stab someone standing two or three feet away, but if there were four feet between the two people, the perpetrator would need to take a step forward, which gives the other person time to deflect the knife.

Wellness Committee Continued from page 33 I think we really have to create that team atmosphere so that’s it’s a collaborative practice, not just for other nurses, but for all the health care workers.’’

Walsh said she is proud of the work the committee accomplished during its first meeting.

In addition to the new healthy work

Continued from page 21

Eye Communications Most people are not aware of what they are doing with their eyes when talking to someone. Ouellette suggested maintaining eye contact 60-70 percent of the time when speaking to a patient. ‘‘When you maintain eye contact 100 percent of the time, they see us as aggressive,’’ he said.

If a patient is upset and talking, though, the listener should maintain eye contact 90 percent of the time and nod, to be seen as understanding.

Certain eye communications are dead giveaways that something bad is about to happen. A patient with eye expressions that are glazed or empty has a higher potential for violence. Ouellette explained the ‘‘target glance,’’ which is what happens when an angry person who has been threatening you all of a sudden breaks eye contact and looks at your jaw, stomach or other area to assault.

Ouellette shared several other tactics for preventing and handling verbal and physical violence, which includes bullying. If a nurse finds herself or himself in a active shooter situation, Ouellette recommends the following: • Have an escape plan.

• Run and leave your belongings behind. If law enforcement arrives and sees you with an object, you could be mistaken for the shooter.

• Hide in an area outside of the shooter’s view.

• If your life is in imminent danger, take action as a last resort. Attempt to incapacitate the shooter by throwing objects and being physically aggressive.

• If you can, pull the shooter’s arm toward you and away from the shooter, throwing off his center of balance, and step on his instep.

• If there’s nowhere else to go, go to the floor.

• Put one hand over your neck and put your face on the floor.

• Cover your ear. The bones of your hand can deflect a bullet.

• From your position on the floor, kick the shooter in the shin, which will destroy his knee. ‘‘You’re safe on the floor,’’ Ouellette said. ‘‘You’ve got the strongest muscles in your body to defend yourself.’’ ‘‘Two-thirds of workplace violence assaults are in hospitals. I commend you all for being in the type of work you’re in,’’ Ouellette said. ‘‘I hope when you leave here you can say you picked up five or more skills for managing violence in the workplace.’’

environment position statement, its plans include more information on lateral violence and work and life balance, plus healthier alternatives and activities at future ENA conferences. ‘‘I think we have a lot of potential, and I think it’s about knowing how to get people to that point,’’ Walsh said. ‘‘It’s about giving people the tools to have those discussions and to feel empowered to approach difficult situations and ask leadership for support. I think we’ve come

Official Magazine of the Emergency Nurses Association

the opposite is true. ‘‘You might be getting them in trouble by not reporting it if OSHA comes in and finds out that someone was assaulted and it’s not on the logs,’’ she said.

Employees have various options for filing complaints with OSHA, Holmes said, including filing a completely anonymous complaint or filing a complaint in which your name remains anonymous to your employer. OSHA is working on improving and expanding its whistleblower protection program, she said.

One attendee shared a story of how a nurse at her facility was pushed into a wall by a patient who had been brought in by the police. When the nurse requested to press charges against the patient, the local police told her she couldn’t because the patient ‘‘was not in the right state of mind.’’ ‘‘What can we do when this happens?’’ she said. ‘‘You’re not alone,’’ Warren said. ‘‘We in security feel exactly the same way. Our officers are assaulted at a tremendous rate, and it’s been said a number of times, ‘Well, that’s your job.’

So until we change the culture, it’s going to be case by case. Even if charges are dropped after, you need to have a paper trail.’’ ‘‘There’s no question that underreporting is a big issue,’’ said Kowalenko, who has been working on a multidisciplinary study on the issue of workplace violence. ‘‘One of the most significant barriers is that people are afraid to report to administration because there is so much inconsistency.’’ Also, reporting mechanisms are cumbersome, and a nurse coming off a 12-hour shift may not see the benefit in staying longer to fill out a report if he or she perceives that nothing will come of it. ‘‘I just think it is phenomenal that we are all in this room together,’’ one attendee said after several others shared examples of facility reporting process. ‘ ‘It is wonderful that ENA took steps to get all these people together.’’

up with research topics, and from those research topics come evidence-based practices that nurses can take back to their facilities and leadership. There are some really unhealthy, toxic work environments that we are being forced to work in, and we shouldn’t have to do that. The more food that we can feed to our members, the more they can bring back to their facility, and we can hopefully create a healthier work environment.”

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