ENA Connection December 2012 by ENA Connection

the Official Magazine of the Emergency Nurses Association

connection December 2012 Volume 36, Issue 11

If You Build It, They Will Drum

The Beat Goes On From the 2012 Annual Conference Coverage and Photos From San Diego

Pages 18-34

INSIDE

FEATURES

Members in Motion: Emergency Nurse From Kentucky Wins Top Magnet Honor

PAGE 4

Nurses Donâ&#x20AC;&#x2122;t Forget Each Other After Colorado Theater Massacre

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Colleagues in Mexico See ENA As Having the Answers

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Dates to Remember Jan. 15, 2013 Deadline for poster submissions for 2013 Annual Conference in Nashville, Tenn. March 11, 2013 Deadline for proposed bylaws and resolutions for 2013 General Assembly at Annual Conference in Nashville, Tenn.

ENA Exclusive Content PAGE 7 Board Writes: Changing the Triage Paradigm PAGE 8 After the Aurora Theater Massacre: In Tending to Shooting Victims, Nurses Don’t Forget Each Other PAGES 12-13 What’s to Come at Leadership Conference PAGES 14-15 Advocacy Section 14 Reaping What’s Been Sown 14 New Hampshire ENA Helps Pass Prescription Drug Monitoring Legislation 15 What Does My Neighbor, the Nurse, Think About Health Care Reform? PAGE 17 Preparing to Present Your Resolution at General Assembly PAGES 18-34 2012 Annual Conference Section 18 General Assembly Speeches and Debate 23 IENR Research and Evidence-Based Poster Winners 24 National ENA Award Winners 25 Lantern Award Winners 26 Opening Session 27 Closing Session 28 ENA Foundation 29 Concurrent Sessions 32 Town Hall Meeting PAGE 37 Colleagues in Mexico See ENA as Having the Answers

Monthly Features PAGE 4 Free CE of the Month PAGE 4 Members in Motion PAGE 6 Pediatric Update PAGE 10 ENA Research PAGE 11 ENA Committee Spotlight: Historical Perspectives Work Team PAGE 16 Academy of Emergency Nursing PAGE 35 ENA Foundation PAGE 36 State Connection PAGE 38 Board Highlights

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

Thank You For an Amazing Year! We make a living by what we get. We make a life by what we give. – Sir Winston Churchill It seems like yesterday that I began the year as your 2012 ENA president. So much has been done to move our specialty forward in the short space of one year, all due to the extraordinary team of which I was privileged to be a part. Many of ENA’s accomplishments are described in ENA’s Annual Report, but there are some very special people behind the accomplishments whom I would like to thank: • First and foremost, ENA members — thank you for your membership! When we are talking to regulators and legislators, being able to say that we represent more than 41,000 emergency nurses is powerful, and they listen. • Members of the national ENA Board of Directors, who make sacrifices and devote many hours to the mission of our association. • ENA staff at national headquarters. Behind every successful year at ENA, there are great ENA staff members. • Our corporate sponsors and supporters. • Colleagues, and especially the Massachusetts ENA State Council for its unwavering, unconditional support. (I will be home soon!) • The President’s Advisory Group for its wise counsel and problem-solving skills. • The ED nursing director of the ED where I work for all her wisdom and support during this year. • The members, staff and board liaisons comprising 34 committees, work teams and specialinterest groups working on many critical projects. • State council and chapter leaders. Your leadership and hard work is appreciated. • The ENA members at the state and local chapters who create ‘‘family’’ and silently, selflessly volunteer their time and energy to our association. • Emergency nurses everywhere who work on the front lines to deliver safe practice, safe care. • The 2012 Leadership and Annual Conference committee members, staff, hospitality volunteers and corporate support for two very successful conferences. • The team effort of the staff, partnering with key government agencies and associations, to put on the first Workplace Violence Prevention Summit. We had several ‘‘firsts’’ this year of which we can be proud. • Our nursing organization partners who have collaborated on position statements, legislative initiatives, advocacy projects and ENA products and toolkits. • And last, but not the least, my family and the home and work families of all of our national board members who pitch in to allow us to travel and work

Official Magazine of the Emergency Nurses Association

2012 ENA President Gail Lenehan presents the State President’s Award to Maureen Curtis Cooper, BSN, RN, CEN, CPEN, FAEN, Massachusetts ENA State Council president, at General Assembly in San Diego in September.

as hard as we do all year. As important as what ENA members contributed to our specialty, their support for each other was equally impressive. At times our own light goes out and is rekindled by a spark from another person. Each of us has cause to think with deep gratitude of those who have lighted the flame within us. – Albert Schweitzer When I recently called an ENA state president in the hospital after a bad car crash, another emergency nurse answered the phone. She was ‘‘specialing’’ the state president, along with other emergency nurses who took turns around the clock. They would plan another schedule when she was discharged and take turns bringing her meals. This state president had always taken care of the ENA members in her state, and it went without saying that she would have done the same for them in a heartbeat. At the wake of a friend, a friend I never would have known if it were not for ENA, members from across the state were there to honor his life and say goodbye. Each laid a white rose on his casket and read from the moving ‘‘Nightingale Tribute’’ in a show of solidarity, similar to the solidarity that police and firefighters possess. In the aftermath of Hurricane Sandy, I heard from two members who had lost their homes during the storm, and we were able to put Continued on page 9

Head over to www.ena.org today to take this month’s new free continuing education course, ‘‘Service and Quality,’’ presented by Jeff Strickler, MA, RN, CEN, CFRN. The e-learning course is worth 1 contact hour and aims to give you a stronger understanding of quality and service concepts, along with important strategies you can use to spice up customer service and patient satisfaction in your department. To take the course and earn your credit: •G o to www.ena.org/freeCE, where you’ll log in as an ENA member (or create a new account). •A dd the course to your cart and “check out” (no charge for members). • Proceed to your personal learning page to start or complete any course for which you have registered or to print a certificate when you’re done. •T o return to your personal learning page at a later time, go to www. ena.org and find ‘‘Go to Your Personal Learning Page’’ under the Courses & Education tab. ENA’s back catalog of free CE covers a variety of topics, including emergency department flow, cardiocerebral resuscitation, team-building, infection prevention and more. Complete the same checkout process for any course you wish to take. These are absolutely free to ENA members — one of the many ways we’re committed to helping you be the best at what you do. Questions? Send an e-mail to elearning@ena.org.

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

Kentucky Nurse’s Quest for Protection Earns Her Magnet Nurse of the Year Honor By Josh Gaby, ENA Connection

later, attacking an ED health care worker is now a fourth-degree Sen. Tom Jensen, chairman of the probable-cause misdemeanor in Kentucky Senate Judiciary Kentucky, punishable by a $1,000 Committee, leaned over the table. fine and up to a year in jail. “Tell me, Ms. Robinson, what Kentucky emergency departments do you want?” he asked. can return to safety a whole lot Linda Robinson, BSN, RN, easier now. CEN, CFN, a staff and charge And Robinson, the driving force nurse with the St. Elizabeth behind the law, is a 2012 Magnet Healthcare Emergency Nurse of the Year. She received her Department in Covington, Ky., award from the American Nurse had come before the Judiciary Credentialing Center on Oct. 12 in Committee last summer seeking Los Angeles, where she also spoke support for a bill that would at the ANCC National Magnet make it a felony to attack an ED Conference on the topic of creating Linda Robinson, BSN, RN, CEN, CFN health care worker in Kentucky. a successful workplace violence But after testimony from Robinson and a cadre of prevention program. supporters she’d assembled for her cause, the Robinson’s Magnet honor — one of five trouble was this: Kentucky simply wasn’t putting any bestowed annually — is in the category of Structural more felony laws on the books. Empowerment, and one need only examine her What Robinson wanted, she answered, was to long crusade against ED violence to understand give police the authority to remove a violent person what that means. Fed up with the violence she saw from the ED without witnessing the incident in her department, she began developing an themselves or requiring the assaulted health care in-house violence-prevention program at St. worker to sign a complaint. Jensen’s response: Write Elizabeth Covington in 2003. In 2007, she answered that up and I’ll sign it. a call in ENA Connection and found herself a key So Robinson regrouped. A little more than a year player on the ENA Workplace Violence Work Team. Two years later, she became an expert adviser for a NIOSH-funded study on workplace violence SPOTLIGHT ON YOU! interventions with the University of Cincinnati. Do you have a professional or educational “What I found, with all the work that I had done, achievement you want your fellow ENA is that the violence was not really getting a whole members to know about? Do you want to sing lot better,” she said. “The police would come and the praises of a member colleague who has they weren’t able to remove the violent person. And received a new degree, promotion or award? then it dawned on me: The community has no idea We encourage you to submit these items to how violent the ER is. The ER is a microcosm of the connection@ena.org for inclusion in monthly community — it’s a reflection of the community you roundups in the new “Members in Motion” serve. And I said, ‘You know, we need to reach out section. Include names, credentials, a short to the community.’ ” explanation of the accomplishment and a She started with local legislators. After high-resolution photo (if available), along with approaching State Sen. John Schickel at a football contact information for follow-up by the ENA Connection staff for select features. Continued on page 7

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Editor in Chief: Amy Carpenter Aquino Assistant Editor: Josh Gaby Writer: Kendra Y. Mims Editorial Assistant: Renee Herrmann 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, LPD, RN, CEN, FAEN

December 2012

PEDIATRIC UPDATE |

Elizabeth Stone Griffin, BS, RN, CPEN

A Gift of Knowledge

Pediatric Content at 2012 Annual Conference The 2012 ENA Annual Conference included a variety of pediatric content, ranging from the unexpected (‘‘Strokes in Little Folks’’ by Rhonda Morgan) to the mysterious (‘‘Things Are Not Always As They Seem’’ by Deena Brecher) to the higher-frequency presentations (‘‘You Stuck What, Where?’’ by Jeff Solheim). This year I was only able to attend a fraction of the courses that interested me (because of the number of great sessions offered) so for the first time, I decided to purchase a DVD of the entire Annual Conference.* I am enjoying Annual Conference again at my convenience. I’d like to share some random pediatric ‘‘takeaway points’’ from three of the 2012 Annual Conference sessions, with brief implications for practice. In the words of Solheim, ‘‘It’s all about sharing knowledge and advancing practice.’’ Consider this a small gift of knowledge, courtesy of ENA’s 2012 Annual Conference, in the spirit of the holiday season.

From “Challenging Pediatric Presentations: What the Horses Can Teach Us About These ‘Zebras,’”

presented by Barbara Weintraub, MPH, MSN, RN, APN, CEN, CPEN, FAEN Don’t stress about the fact that you may not be an expert about every specific and/or exotic pediatric condition. Apply what you know about healthy, ‘‘normal’’ kids. Having a strong knowledge base of pediatric and adult norms (in development, anatomy and physiology and vital signs) will help when you are confronted with more challenging presentations. For example, if a well-looking 4-year-old child presents with a history of intermittent vomiting for one day, but his labs reveal a glucose of 30 and a bicarbonate level of 8, a red flag should go up to say, ‘‘These labs are out of proportion to his illness.’’ Children’s glucose levels rarely go below 50, even when they are ill. When the labs ‘‘don’t make sense,’’ such as in this scenario, metabolic disorders must be ruled out. Although metabolic disorders (a.k.a. inborn errors of metabolism) are individually rare, they are collectively fairly common, and children with metabolic disorders can get sick very quickly, especially when they are experiencing vomiting or diarrhea. Any sick child with a known history of a metabolic disorder should be considered high-risk until proven otherwise.

From “You Stuck What, Where? How? Why? Chatting About Foreign Objects,”

presented by Jeff Solheim, MSN, RN-BC, CEN, CFRN, FAEN Most of us know by now that batteries and magnets of any type are high-risk foreign bodies (batteries can release toxic acid within hours, and if more than one magnet is ingested, they can attract one another and cause intestinal necrosis). However, vegetative foreign bodies (fruits, vegetables, seeds) also can be quite high-risk. Vegetative matter expands and absorbs surrounding fluid, becoming not only a high infection risk but also more difficult to remove with time. Adding to the challenge is the fact that vegetative matter is typically not visible on X-ray (neither are aluminum and some wooden objects). The new copper zinc pennies are toxic to the GI tract and need to pass within 24 hours. In adults, objects longer than 6 cm typically cannot turn

the corner of the duodenum, and objects wider than 2 cm typically won’t fit through the pylorus. Small foreign bodies in the nose can be ‘‘sucked up’’ and aspirated, especially if the patient cries or snorts (which is difficult to control with children, especially, so expedite their treatment when possible).

From “Things Are Not Always As They Seem,’’ presented by Deena Brecher, MSN, RN, APRN, CEN, CPEN, ACNS-BC Infants: Make sure you unwrap swaddled babies so that you can fully assess them (work of breathing, color, etc.). Infants are obligate nose breathers until about 2 months of age; if their nose is full of mucous, they will choose not to eat. Nasal congestion alone can cause respiratory distress in infants. Glucose should be considered a vital sign in any very ill-appearing infant; they release glucose into the bloodstream in response to stress, and they also metabolize it quickly. Children in general: Children compensate very well when they are ill, until they don’t anymore. They typically ‘‘hold on to’’ normal blood pressures until they have lost about 25 percent of their blood volume, so a low BP is a late sign of deterioration. Pediatric vital signs (especially heart rates) vary a great deal in response to fever, crying, pain, etc. If you find yourself ‘‘rationalizing’’ an abnormal set of vital signs, be sure to reassess them later. Do not let yourself rationalize more than once, because sometimes the abnormal vital signs offer a clue to what is really going on inside the child. Brecher also shared some advice that could benefit us all: ‘‘We all make mistakes … we need to admit them, share them with one another, learn from them and report them (including near-misses) so that systems can be improved and others may avoid making the same mistakes.’’ Sounds like a great New Year’s resolution to me. Happy holidays, Elizabeth * DVDs of 2012 Annual Conference presentations are available at www.AVMGonline.com or 800-283-2864.

December 2012

BOARD WRITES | JoAnn Lazarus, MSN, RN, CEN, 2012 President-elect

Changing the Triage Paradigm ‘‘Triage is a process, not a place.’’ How many times have you heard that phrase? As I travel around the country in my role as a consultant, I have the opportunity to visit many emergency departments. A theme I see in most is the mandatory triage process. No matter how busy the department, patients are required to stop and be ‘‘triaged.’’ Why is that? Is it because we always have done it this way, or is it because it is the best care for our patients? We all know that triage means ‘‘to sort.’’ The triage process is something we adopted from the military. It was used in battle to determine who could be treated and returned to battle. Emergency departments began using triage to determine the sickest patients who needed immediate attention when we didn’t have enough resources to care for all. That process has evolved into triage being a place where all patients walking into the ED must stop to be screened before being placed in a bed in the ‘‘back.’’ Triage has become a bottleneck. The triage nurse is collecting information not to decide acuity but to fulfill regulatory requirements, with such questions as: ‘‘Do you feel safe at home? Do you use drugs or alcohol? Are you sexually active?’’ In many emergency departments, the triage nurse knows more about the patient than the primary care nurse. The triage nurse becomes the person who bonds with the patient. I ask you to consider what happens when we try to change this process, when we try to move to a rapid triage process and when we expect the primary care nurse to ask the

assessment questions. As emergency nurses, we revolt. We say: ‘‘What is the triage nurse doing? How can I be expected to ask all of these questions? I’m too busy!’’ If we, as a profession, are going to respond to the changes in the health care environment, we have to be open to changing the way we do business. We have to be open to innovation and be willing to change the status quo. Why do patients need to stop in triage when there are open beds in the back? Why should the triage nurse collect all of the patient information when the primary care nurse should be the one asking those questions? If we want to be part of the solution to throughput issues, we have to be willing to change our practice, to change our paradigm. This is an exciting time for change. There are many new processes being implemented — such as nurse first, pivot nurse, team triage, input process and split flow — that will impact what we now know as triage. Obviously, there is no perfect process, no process that will work in all emergency departments. ENA’s responsibility as an organization is to provide you with the information and the data about these processes, to enable you to make informed decisions about what will work best in your emergency department. We are doing just that by providing educational opportunities at our conferences related to best practices in triage. We have partnered with Elsevier to bring you online triage education, and most recently we added a special assessment category to the ENA Emergency Nursing Scope and Standards of Practice. It is your responsibility to become familiar with these resources and make us aware of new ones. Help us to help you.

Members in Motion Continued from page 4 game in the fall of 2010, she outlined her plans to him in a meeting a week later and won his fervid cooperation. The Kentucky ENA, the Kentucky Hospital Association, the Kentucky American College of Emergency Physicians, the Kentucky Association of Chiefs of Police, jailers, St. Elizabeth Healthcare, domestic violence groups and nurses across the state all lined up behind their bill. Despite the “no more felonies” obstacle, which Jensen warned of ahead of time, Robinson worked the phones, urging emergency nurses all over the state to call their legislators and demand the bill be heard. It worked. And now that it’s law, she believes it can work for more people. The next step in her efforts isn’t to purse felony status — which remains unlikely — but to expand the probable-cause component to include all Kentucky

Kentucky Gov. Steve Beshear (seated) signs Senate Bill 58 into law on June 11, with Linda Robinson standing behind him.

hospital staff, not just those in the ED. “We have to keep our nurses safe. We have to keep our health care staff safe,” Robinson said. “These are givers. These are people who want to give. They’re people who care. “We created this culture of

Official Magazine of the Emergency Nurses Association

allowing people to behave however they wanted to behave in the emergency room. And you’ve heard that term: ‘It’s part of your job.’ It’s not part of the job, and the culture’s changing.” In nominating Robinson for Magnet recognition, Jane Swaim, MS, RN, St. Elizabeth’s senior vice

president and chief nursing officer, said Robinson “exemplifies the true meaning of being a Magnet Nurse.” Wrote Swaim: “She is passionate about nursing, committed to the issue of workplace violence prevention and makes us all realize that one nurse really can make a difference.”

After the Aurora Theater Massacre

In Tending to Shooting Victims, Nurses Don’t Forget Each Other ‘‘Can you come in? There’s been a shooting at the Aurora mall.’’ That was the only information Cheryl Stiles, MAOM, RN, CPEN, director of emergency services at Children’s Hospital Colorado, received when her unit secretary called shortly after 1 a.m. July 20 to inform her that a mass casualty shooting had occurred. Stiles realized the shooting was a large-scale event before she made it to the hospital. As she drove by the Town Center at Aurora shopping mall, she saw flashing lights, police cars and EMS vehicles everywhere. When Stiles arrived at the hospital, she witnessed what she described as one of the ‘‘most compelling moments of the night.’’ A portion of her team — nurses, physicians and techs — was Cheryl Stiles, huddled outside of the MAOM, RN, CPEN ambulance entrance. They had just stabilized the final patient from the shooting — a multi-weapon assault by an apparent lone gunman in a packed movie theater — and had taken a brief moment to support each other as a team. ‘‘When I arrived, they were hugging each other and taking a moment to pause and reflect on the events of the night,’’ she said. ‘‘They were taking care of each other and then quickly moved back inside to continue their efforts. Witnessing the teamwork, mutual respect and the staff reaching out to each other in support so that they could continue to take care of the patients who were involved in the shooting, as well as the patients already in the emergency department, was undoubtedly one of the most touching moments in my career.’’ After being briefed, Stiles immediately assessed the situation, examined resources and supplies to make sure the ED was prepared for possible additional patients and examined the ongoing needs of patients, families and staff. Along with the 11 emergency nurses who worked during the crisis, there were physicians, advanced practice nurses, critical-care and float nurses, mental health counselors, clinical

Photo by Steve Kast, Children’s Hospital Colorado

By Kendra Y. Mims, ENA Connection

Beth Maldonado, LCSW, the employee assistance program manager at Children’s Hospital Los Angeles, delivers cards signed by hundreds of employees from Children’s Hospital Los Angeles to Bob Flory, director of spiritual care and bereavement services at Children’s Hospital Colorado.

The ED staff at Children’s Hospital Colorado, where six victims of the July 20 theater shooting were taken.

medical technicians, unit secretary staff, licensed clinical social workers, the ED clinical manager and the nursing disaster preparedness/mass casualty representative. ‘‘When I came upon the event, it was overwhelming, and I felt like the proud ‘mother’ of the unit,’’ Stiles said. ‘‘I was proud of every individual and honored to witness the unparalleled teamwork on behalf of our patients and their families and driven by our hospital mission. The priority was providing safe patient care, keeping communication lines open and assessing the ongoing physical and emotional needs of patients, families and staff.’’ The ED staff consists of providers, nurses, techs, mental health counselors and administrative and support staff who are very

invested in mass casualty and disaster preparedness. All nursing staff members are certified in Basic Life Support, the Trauma Nursing Core Course, Pediatric Advanced Life Support and Advanced Cardiac Life Support, and the majority are also Emergency Nursing Pediatric Course-certified. Additionally, 58 percent of the ED RN staff members are certified in their specialty area. From the moment the first victim walked into the ED and told the triage nurse about the shooting, the staff focused and placed calls to mobilize internal resources in order to prepare for a mass influx of patients. Patients who were not critical and not part of the shooting were moved from the ED trauma/resuscitation area to exam rooms within the department.

December 2012

As patients began arriving, there were many unanswered questions and very limited information from the scene. People were concerned about the possibility of multiple shooters. The total number of victims was unknown. There were rumors of gas canisters and unknown chemicals that may have been released in the theater. Stiles said they eventually learned that the alleged shooter’s apartment — located a few blocks west of the medical campus — was booby-trapped with explosives, which heightened everyone’s awareness. ‘‘We are a Level 1 pediatric trauma center, and we see some of the most severely injured patients who are referred from within a six-state region, so we constantly prepare to care for patients who are critically ill or injured,’’ Stiles said. ‘‘We train and prepare our entire emergency careers for mass casualty events and attend drill after drill. We expect to provide exceptional care to our patients. However, I am not sure that you can ever adequately prepare for the global effects that result from a tragic event such as the one that our community endured. We are very flexible, by nature, and always expect the unexpected — we are great at this. But the ramifications of this event were so large-scale.’’ Children’s Hospital Colorado received six patients — one child and five adults — who ranged from fair to critical condition upon arrival. One of the biggest challenges for Stiles and her staff was not being able to adhere to their philosophy of family-centered care due to extenuating circumstances. ‘‘We whole-heartedly believe in family-centered care, and we support and advocate for family presence at the bedside. The family is an integral part of their child’s care plan and decision-making,’’ she said. ‘‘Personally, it was exceedingly difficult to have families that had arrived and to not be able to immediately reunite them with their respective family member because of the active crime scene. In this case, the police followed crime scene protocols and made the decision as to when we could reunite families. While we understood the rationale, we were challenged by the gut-wrenching feelings that resulted.’’ Although other incidents have sent more patients to Children’s Hospital Colorado at one time, the theater shooting was on a different level. The hospital was flooded with more than 1,000 phone calls (about 200 per hour) from as far away as Egypt and Paris; many came directly into the emergency department. Some were calls of support, while others were frantic calls from families who wanted to know if a loved one had been involved in the shooting. Calls and e-mails poured in from peers across the country, local hospitals and many ENA members, including several supportive calls from 2012 ENA President Gail Lenehan, EdD, MSN, RN, FAEN, FAAN.

Letter From the President

Continued from page 3

them in touch with each other. During visits to emergency departments across the country, as well as internationally, there was always an immediate connection, a strong sense of camaraderie, a genuine caring . . . and virtually all of the very same challenges. From day one, serving as your president has been busier than I could have imagined, and equally rewarding. None of us reaches a destination or makes a difference by traveling the road alone. As my 2012 ENA presidency comes to a close, I appreciate the full power of the collective hard work of the board of directors and the ENA staff at national headquarters, and the wisdom of individual members. I am grateful to all those who placed your trust in me. Your commitment and passion to emergency nursing have inspired me and our organization to stay strong. Be proud of the difference you make for patients and for one another. And thank you for an amazing year!

Official Magazine of the Emergency Nurses Association

In addition, staff also received more than 30 different cards with hundreds of notes of support from Children’s Hospital Los Angeles. ‘‘These words of encouragement and support meant so much to our team,’’ Stiles said. She still has difficulty finding words to describe the support. ‘‘One of the things that really affected us when we received this outpouring of support was to look at paying it forward the next time something unimaginable happens,’’ she said. ‘‘We can show that same love and support that we received from others and pay it forward.’’ Some of her staff were very affected by the shooting days and weeks after the incident and experienced difficulty being alone. Children’s Hospital Colorado offered support through its Resiliency Education & Support Team and the ED’s Resiliency Committee. Staff also had the opportunity to meet with social workers and attend debriefings. ‘‘We had some staff that took some time off and took care of themselves,’’ Stiles said. ‘‘We were very supportive.’’ She’s proud of how the ED staff responded and believes everyone on the team did a ‘‘tremendous job’’ in taking care of the patients. ‘‘Our staff, and emergency staff in general, work very well under pressure. They’re always an amazing, compassionate team,’’ Stiles said. ‘‘But the team spirit is heightened when you’re going through something like this together. It was clearly evident that night. The support we received internally from our hospital and our network of care was overwhelming. ‘‘In those situations, you do what you need to, you focus, and you care for the patients the way you should — the manner in which you would expect to be treated and the way you’ve been trained. The last thing you think about is yourself.’’

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ENA RESEARCH |

Lisa Wolf, PhD, RN, CEN, FAEN, Director of the ENA Institute for Emergency Nursing Research

What Is ‘Evidence’? You’re working in the ED when a 10-year-old patient comes in with a head injury sustained playing soccer. He’s alert and oriented, with a mild headache, no loss of consciousness and no vomiting. He’s got a little retrograde amnesia. The child looks a little pale, but he’s mentating well. In triage, his vital signs are within expected limits. His parents tell you, ‘‘We’re here for the CT scan.’’ You know that a CT scan delivers a large dose of radiation, and that given his presentation, he may not need to undergo the

risks of CT scanning. But how do you make that case to the parents, who are worried about their child, and the provider, who may defer to the parents’ wishes in the interest of patient satisfaction? Evidence to support best practices is critical, and the type of research evidence that you look for and can use to support practice changes is important. In the age of nearly unlimited access to information, sifting through evidence to decide what is valid and valuable can be challenging. Appropriate literature can be found in several places. In terms of practice issues, a database that holds clinical nursing and medical articles is the most useful. CINAHL, PubMed and

Journals@OVID are all good sources. Another good source, the Centers for Disease Control website (www.cdc.gov), often has up-to-date information, epidemiological data and practice guidelines.

Searching the Literature The search terms you choose will help you find articles on your topic of interest. In this case, you’re interested in the benefits vs. risks of scanning children’s heads. Start with, ‘‘Head injury, pediatric head injury and computed tomography scanning in head injury.’’ It’s also helpful to look at guidelines from the American Academy of Pediatrics, the Academy of Emergency Physicians and the American College of Radiology.

The Emergency Nurses Association is proud to present the release of the 4th edition of the Emergency Nursing Pediatric Course. It has been revised and updated, evidencebased, and continues to incorporate various teaching and learning styles. • • • •

A portion of the course will be presented in an online format through ENA’s Center for e-Learning. Pediatric Clinical Considerations is now case-based using group discussion. The adolescent patient is addressed with a separate chapter and lecture. Triage is now Prioritization with a focus on the process, rather than the place.

Upon successful completion of ENPC, RN participants are verified for four years, receive a verification card and earn up to 16 contact hours. This course brings the emergency nurse a resource for treating the pediatric patients arriving to emergency departments every day. The Emergency Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

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

December 2012

The Research Column in Connection has been designed to give succinct, useful information about the research process and how research can be useful to the bedside emergency nurse. Please send topic suggestions to LWolf@ena.org.

Evaluating Evidence Research articles are structured to tell you about the research question, the background of the problem or what’s already been studied, and the way in which the problem was studied (the methods). Part of the value of the evidence is how well the study was done. In other words, was the question useful and well-framed? Was the number of people studied (the sample size) adequate to say anything about the problem? Did the researchers answer the question? Was their answer similar to or different from other researchers studying the same thing?

What’s Out There? In this case, there are a large number of articles in the PubMed database reporting the usefulness of clinical-decision rules for this population. All report that clinical decision-making tools to determine high- and low-risk pediatric head injury patients are sensitive enough to find the children for whom benefit outweighs risk. These studies tend to have large numbers of patients and identify risk factors that would direct a clinician to obtain a head CT, while noting that in the absence of these factors, the child has a very low risk of clinically important head injury.

How to Incorporate Findings Into Practice Once you have a number of research reports that seem to suggest the same thing, and are the result of well-planned, well-done studies, you can draw some conclusions about changing practice. It is important to not base the decision to implement change on the results of one study, unless the study is so large and so well-done that professional practice organizations are suggesting changes.

What Next? Present these findings to your nursing manager and medical staff and suggest implementation of these guidelines. You may also want to contact your local pediatric groups and discuss the process, so that they don’t send patients to the ED ‘‘for a CT scan.’’ Evidence-guided practice can streamline processes and reduce risk for patients. Keeping current with research that provides a practice framework also can foster more collegial communication with providers and improve emergency nursing practice.

Members of the Historical Perspectives Work Team who met in October stop at the Anita Dorr crash cart and 25th anniversary quilt displayed in the ENA headquarters lobby. From left, 1990 President Joanne Fadale, BSN, RN, FAEN; Audrey Snyder, PhD, RN, CEN, ACNP-BC, CCRN, FAEN, FAANP; board liaison Kathleen Carlson, MSN, RN, CEN, FAEN; and co-chairperson Diane Schertz, BS, RN, FAEN. Not pictured are co-chairperson Kay McClain, MS, RN, CEN, FAEN; and Mildred Fincke, BSN, RN.

ENA COMMITTEE SPOTLIGHT

Historical Perspectives Work Team When did ENA get started? What’s Etcetera? Why is there a quilt hanging in the lobby of ENA headquarters? How many members did ENA have in 1989? If you have questions about ENA’s history or if you need background information for committee work or a research project, you’ll soon be able to obtain this information from www.ena.org. In May, ENA President Gail Lenehan, EdD, MSN, RN, FAEN, FAAN, named a Historical Perspectives Work Team comprised of ENA Academy members (Kay McClain, MS, RN, CEN, FAEN and Diane Schertz, BS, RN, FAEN, co-chairpersons; Patricia Clutter, MEd, RN, CEN, FAEN; Joanne Fadale, BSN, RN, FAEN; and Audrey Snyder, PhD, RN, CEN, ACNP-BC, CCRN, FAEN, FAANP) to make recommendations regarding the development of a sustainable system that ensures the appropriate retention of important ENA documents and other historical materials. Many documents, publications, photographs, memorabilia, audiovisual items and speeches will be posted to ENA’s website in early 2013.

Official Magazine of the Emergency Nurses Association

In addition, duplicate materials are sent to the archives at the University of Virginia School of Nursing, Center for Nursing Historical Inquiry, established in 1991 to support historical scholarship in nursing. ENA makes an annual financial contribution toward support of UVA’s work in processing, preserving and making ENA’s collection open to scholars, historians, faculty and students, and materials sent from ENA are described and catalogued in the Center by an archivist and stored in secure, climate-controlled rooms. The Center is a national resource open to visiting scholars, faculty, students and others interested in the history of nursing and is open to visitors Monday through Friday. Contact www. nursing.virignia.edu/research/cnhi to schedule a visit or to obtain more information. If you need any early history or background information, contact Ginger Burns, special projects manager, who serves as ENA’s archivist, at gburns@ena.org.

WHY YOU NEED TO ATTEND ENA LEADERSHIP CONFERENCE 2013 Each year, ENA Leadership Conference attracts emergency nurse leaders from across the United States as well as across the globe. Each attendee, new or returning, comes to conference with one common goal in mind; to strengthen their leadership knowledge. Regardless of the location, we know you choose Leadership Conference for the experienced faculty, the engaging and insightful educational sessions giving you the information crucial to your practice. You will have the opportunity to earn contact hours and to gain a new outlook on existing emergency department procedures.

Each one of these factors helps you strengthen your leadership skills and helps you elevate your career today, tomorrow and in the future. Join us for ENA Leadership Conference, February 27 – March 3, 2013 in Fort Lauderdale, FL to take advantage of: • NEW! Jam, Hand-off and Deep Dive Sessions providing a variety of course length and formats for a unique learning experience • NEW! ENA Reception Featuring Ignite Sessions ®

• Innovative Opening Keynote Speaker – Carmine Gallo presenting “The 7 Principles of Inspiring Leaders” • And much more…

ENA Reception Featuring Ignite Sessions ®

ENA What is Ignite ? Imagine that you’re in front of an audience made up of your friends and fellow colleagues in emergency nursing; about to present a 5-minute talk on the thing you’re most passionate about – emergency nursing! Specifically; “What Makes an Emergency Nurse Unique.” You’ve brought 20 slides, which advance every 15 seconds whether you’re ready or not. You have a few last-minute butterflies, but off you go—and the crowd loves it. Welcome to Ignite. ®

Do you wish to share your take on “What Makes an Emergency Nurse Unique” through this rapid-paced presentation style? Be a part of this unique opportunity as ENA will be hosting a reception, February 28 from 6-8 p.m. in the exhibit hall. To participate, speakers must agree to be video recorded and understand their video will be posted publicly to the internet. For complete details on participating, visit www.ena.org/lc and click the “Participate in Ignite” link before January 11, 2013.

FOR COMPLETE ENA LEADERSHIP CONFERENCE 2013 DETAILS, PLEASE VISIT WWW.ENA.ORG/LC

WWW.ENA.ORG/LC

Networking 101: The Challenge of Networking Attending for the first time or attending alone? The key to a successful meeting experience is connecting with peers and colleagues to exchange ideas and solutions about common challenges. Networking opportunities are available to you at every turn. From the classroom to the social functions and in between. NEW FOR 2013! Take advantage of a special opportunity at the Welcome party to connect with leaders and attendees from your state early in the evening. To find out all the exciting things happening at ENA Leadership Conference 2013, go to www.ena.org/lc.

Register today for ENA Leadership Conference 2013 by scanning the QR code or at www.ena.org/lc Important Dates to Remember Registration .....................................Now Open Early Discount Rate Closes ....... Jan. 16, 2013 State and Chapter Leaders Conference ........... Feb. 27 – 28, 2013 Presessions................................ Feb. 28, 2013 Educational Sessions ............ Mar. 1 – 3, 2013 Exhibit Hall ...................Feb. 28 – Mar. 2, 2013

Social Media presence at ENA leadership Conference 2013

VE – SAh E – TATE D

Our social media presence will be even larger than ever. You will want to follow the ENA Facebook and Twitter pages for the latest information about conference. In addition, we will have Foursquare restaurant deals near the Fort Lauderdale convention center and hotels.

2013 ENA ANNuAl CoNFERENCE Nashville, TN • Sept. 17 – 21, 2013

Tell us what is important for you. We would love to hear from you. Please share your thoughts on our Facebook page at facebook.com/enaorg or on our Twitter page at twitter.com/enaorg.

ENA lEADERShIp CoNFERENCE 2014 Phoenix, AZ • Mar. 5 – 9, 2014

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ADVOCACY

Reaping What’s Been Sown By M. Ben Melnykovich, BSAS, RN, Member, ENA Government Affairs Committee One benefit of going to a national meeting such as the ENA Annual Conference is the networking opportunity. You meet emergency nurses from all over the country and the world. Engaging with each other, we realize we do not exist in isolation. Big inner-city hospital or small, rural critical access facility, we all seem to have similar concerns. Too many patients, limited staffing, impossible demands and learning new, paperless documentation systems are a few of the common difficulties. Hardly a few minutes are spent without hearing a conversation about emergency department care of patients who are mentally ill. The volume of patients presenting with mental health issues, and the care required, are additional pressures on already under-resourced EDs challenged by de facto mission creep. How did health care professionals and workplaces, communities, voters and governments ignore the fractured aspects of health care, allowing inequities in care delivery to get so skewed? This article revisits past policies to understand what transpired, bringing us to the present. The movement to deinstitutionalize mental health patients began around 1956 when the state and local public mental hospital patient population was 559,000.1 Of this total, a substantial number of patients were housed in ‘‘back wards’’ for many years. Back wards were notorious for inhumane treatment; patients were not expected to recover, and custodial care was provided, with no actual treatment taking place. By 1980, the process of moving people out of

these facilities to care in community-based services reduced the number of patients in public mental hospitals to 154,000. While states initiated transferring patients out of public institutions, the progress was slow. The process only quickened during the 1960s and 1970s with the involvement of the federal government. Created by Congress and appointed by President Dwight D. Eisenhower, the Joint Commission on Mental Illness and Health reported in 1961 the need for a national mental health program of research and of ‘‘fully staffed, full-time mental health clinics (later called community mental health centers), to be available to each population of 50,000, or approximately 3,000 to cover the nation.”2 The thought was that with promising medications (e.g., thorazine) and better treatment modalities, people could be treated in community facilities. In 1963, the CMHC legislation was enacted with funding for construction of CMHCs. In 1965, CMHC staffing legislation finally was enacted. The CMHCs were to provide only five essential services: inpatient, outpatient, emergency, partial hospitalization, consultation and education on mental health. No pre-admission and post-discharge services for state mental hospital patients, nor rehabilitation or case management services, were mandated for the transition. While deinstitutionalization accelerated, the funds did not follow the patients. Many state budget directors saw the decision to put patients out into the field as a chance to decrease their budgets. Exacerbating the fiscal

New Hampshire ENA Helps Pass Prescription Drug Monitoring Legislation Prescription drug abuse has become a leading health problem in the United States. In 2010, New Hampshire alone had 174 deaths as a result of prescription overdoses. There are now more deaths in New Hampshire from prescription drug overdose than motor vehicle crashes. Opiods, specifically methadone and oxycodone, are the most prevalent drugs leading to death. To aid in the detection of fraudulent requests for controlled substances,

48 states have prescription drug monitoring programs in place, with New Hampshire and Missouri being the only exceptions. This means that savvy patients in the Northeast take a short trip to New Hampshire not only for tax-free shopping but also to avoid detection in their quest for opiates. After several years attempting to pass legislation establishing a PDM in New Hampshire, bills were again introduced in 2012. New Hampshire ENA had identified this

failure was a naïveté for what would be needed to help people exiting state hospitals, e.g., wraparound services, including job training, housing and continued counseling. What finally has resulted is the continuing elimination of state institutions with the majority of the financial burden falling on Medicaid rather than a mental health funding stream. State funding of mental health services in 2005 was 30 percent less — when adjusted for inflation — than in 1955. As emergency nurses, we are faced with caring for these patients in a fragmented, broken system. This is not just a mental health crisis; this unfinished business plays out in the ED. ENA, in collaboration with other stakeholder organizations, must stand together nationally and locally, advocating for access to quality care for all our patients, lobbying for remedies to problems still in need of system change. References 1. Koyanagi, C. (2007, August.) Learning from history: Deinstitutionalization of people with mental illness as precursor to long-term care reform. Retrieved from www.kff.org/ medicaid/upload/7684.pdf. 2. Smucker, B. (2007, July.) Promise, progress, and pain – a case study of America’s community mental health movement from 1960 to 1980. Retrieved from mentalhealthhistory.org/Promise_ Progress_Pain.pdf.

bill as a high legislative priority early in the year. Members contacted their legislators, encouraging them to support the bill. In April, New Hampshire Government Affairs Chairperson Jean Proehl, MN, RN, CEN, CPEN, FAEN, testified at a legislative hearing to describe the impact of prescription drug abuse in New Hampshire emergency departments. Success was realized in the spring when the bill passed in both houses of the legislature. On June 12, NH-ENA President Stacey Savage, BSN, RN, CPEN, watched as Gov. John Lynch signed this bill in to law. (Search for Gov.

Lynch and SB 286 at Youtube.com to view the signing video.) In October, New Hampshire ENA and three other nursing organizations received Advocacy in Action awards for their work toward the passage of this bill. NH-ENA is now participating in committee work to accomplish the goals of the legislation. Reference Governor’s Commission on Alcohol and Drug Abuse Prevention, Intervention, and Treatment. (2012, Jan). A Call to Action: Responding to New Hampshire’s Prescription Drug Abuse Epidemic. Concord, NH: Author.

December 2012

ADVOCACY

What Does My Neighbor, the Nurse, Think About Health Care Reform? By Elisabeth K. Weber, MA, RN, CEN, Member, ENA Government Affairs Committee Every nurse knows the experience of being asked a general health question by a neighbor, friend or patient with the expectation that your knowledge, education or clinical expertise will clarify a complicated topic. What is more complex than the Patient Protection and Affordable Care Act? Since its enactment in March 2010, and more recently, since the Supreme Court decision in June 2012, nurses have been asked to comment, explain or clarify PPACA issues. According to the ENA 411 Key Contact program, ‘‘As an emergency nurse, you speak with the authority of one whose perspective is broad, observing and connected with people from throughout the community, touching individuals from all types of families and situations, economic strata, occupations and education.”1 Are you ready for that responsibility? This article, though expressing my opinion only, may be helpful when you are asked the inevitable questions. If you are anything like I am, you had good intentions of reading the PPACA when it was adopted and then when it was published as the 906-page Public Law 111–148.2 ENA summarized the law for members at members. ena.org/government/healthcarereform/ Pages/Default.aspx. The March 2010 ENA Washington Update described the law’s reform elements (www.ena.org/government/ washington/Documents/2010/03-2010.pdf). The following is what I was thinking in early July 2012 based on the 10 titles in the PPACA3:

Title I: Quality, Affordable Health Care For All Americans •P re-existing illnesses won’t prevent you from obtaining insurance coverage. • L ifetime or annual limits no longer will be an issue for those with chronic, lifetime illnesses or injuries and for the families of those patients. •P reventive health services are now being covered. • I nsurance coverage will extend to young adults on their parents’ plan.

Title II: Role of Public Programs • I t’s beneficial that the Children’s Health Insurance Program will be expanded

Title III: Improving the Quality and Efficiency of Health Care • I t’s interesting to consider what types of new Patient Care Models will be developed.

Title IV: Prevention of Chronic Disease and Improving Public Health • I t’s exciting to consider how prevention and public health innovation and expansion of primary care options will improve the nation’s health, relieving some ED pressure.

Title V: Health Care Workforce • I t’s about time the health care workforce received appropriate educational funding.

Title VI: Transparency and Program Integrity • I t goes without saying that the law must include integrity in all issues.

Title VII: Improving Access to Innovative Medical Therapies • I t’s fascinating that access to innovation in medical therapies will be expanded to include a broader patient population.

Title VIII: Class Act • I ’m a nurse, not an attorney or legislator, so I cannot at this time begin to comment on this title, which describes a self-funded, voluntary long-term care insurance choice in the event of a disability.

Title IX: Revenue Provisions • Unless we find the funding, progress will

Official Magazine of the Emergency Nurses Association

not occur. This title makes health care more affordable for families and small business owners.4

Title X: Strengthening Quality, Affordable Health Care for All Americans • I t’s a goal for all of us because we are going to be patients one day. As sure as nothing is perfect, there are still many features in the PPACA that will benefit us as providers of health care. On the day after the Supreme Court decision, a few neighbors were enjoying a lovely evening in our common courtyard, and though two of them were attorneys, they were interested in what I had to say about the PPACA because I am a nurse. References 1. E mergency Nurses Association. (n.d.). EN411. Retrieved from www.ena.org/government/ EN_411/Pages/Default.aspx. 2. T he Patient Protection and Affordable Care Act (P.L. 111–148). (2010, March.) Retrieved from www.gpo.gov/fdsys/pkg/PLAW111publ148/pdf/PLAW-111publ148.pdf. 3. HealthCare.gov. (n.d.). The health care law & you: Read the law. Retrieved from www. healthcare.gov/law/full/index.html. 4. The Congressional Budget Office. (n.d.). Affordable Care Act. Retrieved from www. cbo.gov/topics/health-care/affordablecare-act/reports.

101 Fellows in the Academy of Emergency Nursing By Kathleen Flarity, ARNP, PhD, CEN, CFRN, FAEN, Chairperson-elect, Academy of Emergency Nursing Congratulations to the 14 new fellows in the Academy of Emergency Nursing, who were inducted during the regal 1st Annual Awards Gala in San Diego. This black-tie optional event, hosted by the always humorous Terry Foster, MSN, RN, CEN, FAEN, was a fitting venue to celebrate the lifetime contributions of these new fellows. The Academy of Emergency Nursing honors nurses who have made enduring, substantial contributions to emergency nursing and who continue to advance the profession of emergency nursing. Induction as a fellow into the Academy often marks the pinnacle of the inductee’s career. The collective wisdom and contributions of the AEN’s

101 fellows is astounding. This 2012 cohort is no exception; the caliber of each of these inductee’s is amazing, and as a group, unstoppable. To our new FAENs, I hope that you take your induction into the AEN not just as a remarkable achievement, but as a challenge to recognize your continued potential.

2012 Academy Inductees • Meredith Jaye Addison, MSN, RN, CEN, FAEN — Hillsdale, Ind. • Rita T. Anderson, RN, CEN, FAEN — Surprise, Ariz. • Liz Cloughessy, AM, MHM, RN, FAEN — Glenwood, NSW, Australia • Christine M. Gisness, MSN, RN, BC, FNP-C, CEN, FAEN — Roswell, Ga. • Diane Gurney, MS, RN, CEN, FAEN — Hyannis, Mass. • Andrew D. Harding, MS, RN, CEN, NEA-BC, FACHE, FAHA, FAEN — Bridgewater, Mass. • Cindy L. Hearrell, MSN, RN, CEN, FAEN — Fredericksburg, Va. • J. Jeffery Jordan, MS, MBA, RN, CEN, CNE, EMT-P, FAEN — Macomb, Okla. • Fred Neis, MS, RN, CEN, FACHE, FAEN — Prairie Village, Kan. • India J. Taylor Owens, MSN, RN, CEN, NE-BC, FAEN — Fairland, Ind. • Gwyn Parris-Atwell, MSN, RN, FNP-BC, CS, CEN, FAEN — Alloway, N.J. • Judith A. Scott, MHA, BSN, RN, PHN, FAEN — Penn Valley, Calif. • Paula Tanabe, PhD, MPH, MSN, RN, FAEN — Durham, N.C. • Mary Ann Teeter, MEd, RN, FNP-C, CEN, CNRN, FAEN — Elmira, N.Y.

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A segment of the fellow application weight is ‘‘the potential for sustained contributions to the Academy of Emergency Nursing and the advancement of the emergency nursing profession.’’ John F. Kennedy once said, ‘‘The ancient Greek definition of happiness was the full use of your powers along lines of excellence.’’ Your powers of excellence have been acknowledged. Serving as a FAEN provides a tremendous opportunity to make a difference at the local, state, national and international levels. Congratulations on your induction into this prestigious group. You decide whether it is a final achievement or a sign of the amazing things yet to come. Look for profiles and photos of the 2012 fellows in the February issue of ENA Connection.

December 2012

Preparing to Present Your Resolution at General Assembly By Deborah Spann, RN-BC, CEN, Louisiana ENA State Council Have you ever considered proposing a resolution for General Assembly? The opportunity is open to any member of our professional Several resources for members organization; however, it is not as interested in writing a easy as merely identifying a need. resolution are at www.ena. How does one go about putting org/statecouncils/ together the proposed resolution GeneralAssembly/Pages/ and moving it through to successful ResolutionsBylaws.aspx. adoption by the General Assembly? Topics include the following: In Louisiana, we began by â&#x20AC;˘ Call for Bylaws and discussing the challenge with our Resolution Proposals: Deadline ENA board liaison, Mitch Jewett, March 11, 2013, 5 p.m. CST RN, CEN, CPEN. He suggested we â&#x20AC;˘ Bylaws Amendments and poll our members about their Resolutions Guidelines â&#x20AC;&#x201D; concerns. From that assessment, we Revised October 2012 developed a proposal to submit to â&#x20AC;˘ Bylaws Amendment the ENA Resolutions Committee. Proposal 2013 - Template The resolution was vetted, and â&#x20AC;˘ Resolution Proposal 2013 recommendations for change were â&#x20AC;&#x201C; Template relayed. Based upon those â&#x20AC;˘ General Assembly Standing suggestions, we worked with the Rules of Procedure â&#x20AC;&#x201D; committee to firm up the statements Amended Sept. 12, 2012 and supporting research. â&#x20AC;˘ Tips On Using References Upon notification that our â&#x20AC;˘ Parliamentary Procedure resolution had been accepted, Basics: â&#x20AC;&#x153;Speaking the Delegateâ&#x20AC;&#x2122;s preparations began for presentation Languageâ&#x20AC;? to General Assembly and defense â&#x20AC;˘ Examples: Bylaws of the resolution during debate. Amendments and Resolutions Finally, the day for presentation Proposals arrived. We expected lively debate, â&#x20AC;˘ ENA Position Statements remembering to remain professional â&#x20AC;&#x201C; Reviewing current position and not take the statements made by statements before drafting the opposition personally. This may proposals is recommended. have been the most difficult of all tasks associated with the process and required both mental preparation and patience. During the debate, our delegation took notes of the remarks and the state represented, along with the names of those speaking either in support or in opposition. These notes were vital in the resolution assistance session and for caucusing the next morning. During the resolution amendment assistance session held that evening, other delegates and Resolutions Committee members provided input. The statements were amended to more clearly define the resolution and request. Our next tasks were to explain the amendments to our delegates, have them prepared to introduce those when appropriate, and to supply the amendments and explanation for all delegates. We successfully moved our resolution forward, and now ENA will address the issue that we identified: defining the components of safe discharge from the emergency department. This process engaged all of our members, especially our delegates. It is impressive to see the renewed spirit of ownership that has been evidenced since we began the journey. ENA has issued the next call for resolutions, which are due March 11, 2013. Why donâ&#x20AC;&#x2122;t you resolve to get involved?

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Official Magazine of the Emergency Nurses Association

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President’s Address: Elevating ENA By Amy Carpenter Aquino, ENA Connection By focusing on engaging members and the profession of emergency nursing, ENA has amassed an impressive list of accomplishments. In her Sept. 12 address to the 697 delegates comprising this year’s General Assembly, 2012 President Gail Lenehan, EdD, MSN, RN, FAEN, FAAN, announced several initiatives that have elevated ENA’s status among emergency nurses and outside organizations. ‘‘Our Nurse Practitioner in Emergency Care Committee’s dream has come true,’’ Lenehan said. ‘‘Today we are formally announcing that the American Nurses Credentialing Center and ENA will embark on a new portfolio credentialing program for emergency nurse practitioners. Credentialing by portfolio is a growing trend that allows for a more robust proof of competency, and ANCC is the authority in this method.’’ After inviting the committee members present to stand and be recognized for their hard work, Lenehan said the credential could become reality within a year. Some of the other accomplishments Lenehan highlighted were the release of the ENPC 4th edition; the current TNCC revision; a landmark position statement on weighing pediatric patients in kilos only; the creation of a Conference Site Selection Committee, which selected Phoenix as the Leadership Conference 2014 venue; the first Workplace Violence Prevention Summit and the new member benefit of monthly free CE. She noted that ENA’s landmark position paper on weighing children in kilos only also has been signed by the American College of Emergency Physicians, the Institute for Safe Medication Practices and the American Academy of Pediatrics.

Past ENA presidents listen as Gail Lenehan, EdD, MSN, RN, FAEN, FAAN, addresses the General Assembly.

‘‘It’s rare to have a physician group sign on to a nursing group’s position unless it’s a joint consensus statement,’’ she said. The National Quality Forum is also considering adding its endorsement. She reported on other collaborations with the Centers for Disease Control on traumatic brain injury, Emergency Medical Services for Children on the pediatric toolkit and the NQF on regionalization of emergency care. ‘‘The general direction of this organization is one that everyone in this room should leave feeling very excited about,’’ Lenehan said. ‘‘The high-level connections we’re shoring up — with colleagues at associations and regulators in key positions — have already elevated us to new positions.’’ On a personal note, Lenehan shared that one

of the most gratifying aspects of the year was the opportunity to reach out and connect with nurses involved in crisis situations, to make that crucial connection and to represent ENA. ‘‘I’ve been reminded as I visit EDs across the country and beyond that there is so much more that binds us together than pulls us apart,’’ she said, ‘‘so many of the common struggles and successes. The commonalities are everywhere.’’ Lenehan closed by thanking several people, including the ENA Board of Directors, Executive Director Susan M. Hohenhaus, LPD, RN, CEN, FAEN, ENA staff, state and chapter presidents, the Massachusetts ENA State Council and her family. ‘‘Thank you for the privilege of serving as your 2012 president,’’ she said. ‘‘It’s been quite a ride!’’

Executive Director: Talent, Technology By Amy Carpenter Aquino, ENA Connection

Susan M. Hohenhaus, LPD, RN, CEN, FAEN

Bringing greetings from ‘‘the fabulous staff at ENA headquarters,’’ Executive Director Susan M. Hohenhaus, LPD, RN, CEN, FAEN, reported on the business of the association to the General Assembly delegates Sept. 12. ‘‘If you had any doubts about the road map

for the future of ENA, please download our strategic plan from the ENA website,’’ Hohenhaus said. She pointed out that the first arm of the plan’s triangle is investment, and explained that while the 2012 budget shows a deficit, it was intentional and will enable the organization to focus on developing the two main areas of human resources and technology.

December 2012

Taking Care of Our Members By Amy Carpenter Aquino, ENA Connection ‘‘This moment is a mountain-top experience for me, and I thank God for this honor,’’ said 2012 President-elect JoAnn Lazarus, MSN, RN, CEN, as she addressed the 697 General Assembly delegates gathered at the San Diego Convention Center on Sept. 13. Giving special recognition to her family and friends, Lazarus thanked everyone who supported her on her leadership journey. ‘‘Because of you, I am here today,’’ she said. Mentoring and leadership form the basis of Lazarus’ 2013 vision for ENA, with a special focus on providing members with the resources they need to be effective leaders. She emphasized the importance of mentors to emergency nurses, who are shaped by preceptors, managers and others who supported them early in their career. She asked attendees to consider what they are doing to leave a legacy, how they want others to remember them. ‘‘The fact that each of you is in this room, that makes you a part of the leadership of ENA of more than 40,000 emergency nurses,’’ Lazarus said. ‘‘Leadership is at the core of what we do, whether it is formal or informal.’’ Lazarus said creating opportunities for mentorship and leadership development for members, as well as strengthening strategic partnerships, will help ensure ENA’s future. ‘‘Many of you find yourselves as leaders in your state organization or in your hospitals without the support and/or tools to do the job you want to do,’’ she noted. ‘‘You may feel you do not have the knowledge or resources to be successful. . . . I believe it is our responsibility as your professional organization to provide you with those tools and resources. The viability of this organization is dependent upon it.’’ Lazarus invited delegates to help her continue the ENA legacy by spreading awareness of both the organization’s mission to advocate for patient

By Amy Carpenter Aquino, ENA Connection

JoAnn Lazarus, MSN, RN, CEN

safety and excellence in emergency nursing practice, and its strategic initiatives. ‘‘I believe we need to focus more on taking care of the needs of our membership,’’ she said. ‘‘If we work together to create a safe environment where we can give quality patient care, and at the end of the day feel good about what we have done, we have been successful.’’ Lazarus also prepared members for changes, including revising and redesigning organizational operations. These changes are vital to attracting and developing new leaders, she said. ‘‘People want to be part of something that is meaningful and purposeful,’’ she said. ‘‘So how do we ensure that ENA meets those needs? We have to become more innovative if we are to survive. We have to take risks.’’ Lazarus explained the meaning of the small turtle pins handed out to each delegate as she urged attendees to reflect on their roles as leaders and mentors once they returned home. ‘‘Behold the turtle,’’ she said, quoting James B. Conant. ‘‘He makes progress only when he sticks neck out.’’

Investments Add Up to a Stronger ENA These fortifications will leave ENA better prepared to enter the implementation stage of its strategic plan in 2013, guided by its four organizational priorities. In the area of talent, Hohenhaus reported on the recent addition of key staff, including Betty Mortensen, MS, BSN, RN, FACHE, chief nursing officer; Dr. Paula Karnick, PhD, ANP-BC, CPNP,

General Assembly Talks TNCC, Pain Management in the ED and More

director of education; and Dr. Lisa Wolf, PhD, RN, CEN, FAEN, director of the Institute for Emergency Nursing Research. They join Kathy Szumanski, MSN, RN, NE-BC, director of the Institute for Quality, Safety and Injury Prevention. ‘‘We are now fully staffed in our nursing

Official Magazine of the Emergency Nurses Association

Continued on page 34

The delegates of the 2012 ENA General Assembly considered several resolutions concerning such issues as TNCC eligibility, use of protocols in the ED setting, health care worker fatigue and care of the bariatric and obese patient. ‘‘Today we need to do the serious business of the General Assembly,’’ said Jeffery J. Jordan, MS, MBA, RN, EMT-P, CEN, chairperson of the Resolutions Committee, as he presented the first of several bylaw amendments and resolutions for delegates’ consideration Sept. 13, following a day of proposal hearings in San Diego. The assembly voted to postpone indefinitely a proposal to allow the General Assembly to elect the ENA Board of Directors and Nominations Committee. During the initial hearing of the proposed resolution Sept. 12, co-author Jason Moretz, BSN, RN, CEN, CTRN, said the amendment was ‘‘not about taking something away from our members. This is about making sure we get the greatest leaders elected. Despite our greatest efforts, our voting percentage remains low. As members, we entrust this body with defining our practice; it is reasonable that we would trust them to elect the leaders that would lead us into the future.’’ Several delegates said they could not support denying members the right to vote in their national election, but some offered ideas to encourage voting. ‘‘Voting is a problem, but this is not the solution,’’ said delegate Teresa Sullivan, who suggested moving the national election voting to the Annual Conference and offering live, online voting for members at home. Other Continued on page 33

The 2012 Judith C. Kelleher Award Goes to ... By Kendra Y. Mims, ENA Connection Every year during ENA’s Annual Conference, the Judith C. Kelleher Award is given to a member who has consistently demonstrated excellence in emergency nursing and has made significant contributions to the profession that are destined to impact the future of emergency nursing. ENA President Gail Lenehan, EdD, MSN, RN, FAEN, FAAN, proudly presented this award to Diane Gurney, MS, RN, CEN, FAEN, during this year’s Anita Dorr Memorial Lecture and Luncheon. Lenehan shared Gurney’s many accomplishments and contributions to the emergency nursing profession on a state and national level, as well as the common themes of inspiration and admiration found throughout her nomination letters. ‘‘I personally witnessed Diane’s hard work and

dedication, and the excellence in the results of that hard work. Others have as well,’’ Lenehan stated. ‘‘Diane is exactly who the Kelleher Award was meant to honor and is truly deserving.’’ Gurney cheerfully accepted her award, stating that she felt honored as the 33rd award recipient. She shared the overwhelming feeling she experienced when she received the phone call that she was the 2012 winner — which happened at the ENA headquarters office while she was sitting next to the Anita Dorr crash cart. Gurney’s work for ENA not only has inspired others — it also has inspired her. ‘‘During some difficult hours and days, my work with ENA kept me focused and moving forward,’’ she said. ‘‘I’m humbled to be accepting such a prestigious award. Thanks to all who have shared my journey.’’

Diane Gurney, MS, RN, CEN, FAEN, (right) with 2012 President Gail Lenehan, EdD, MSN, RN, FAEN, FAAN.

ANITA DORR MEMORIAL LECTURE

The Road to Sharps Injury Prevention By Amy Carpenter Aquino, ENA Connection

In choosing the 2012 Anita Dorr Memorial Lecture speaker, ENA President Gail Lenehan, EdD, MSN, RN, FAEN, FAAN, wanted ‘‘someone with the same vision, passion and commitment as the leaders and extraordinary talent I see throughout this room — someone who can speak on prevalent issues that we face in our health care settings on a daily basis.’’ ANA President Karen Daley, PhD, MPH, RN, FAAN, more than fit the bill. With 26 years of emergency nursing experience and as a vocal advocate for legislation mandating the use of safer needles in the health care setting, Daley has demonstrated unwavering resolve toward improving occupational safety health. Daley shared her riveting story of suffering a 1988 needlestick injury following a blood draw on a patient in the ED. Recalling that she was able to get the patient’s blood on the first draw, Daley said she deposited the used needle in the box on the wall behind her. ‘‘I felt a sharp stick in my index finger, and I knew right away that it was a pretty deep puncture,’’ she said. ‘‘The blood came out of the side of the glove.’’ Three months later, after suffering vague symptoms of nausea, weight loss and abdominal

Karen Daley, PhD, MPH, RN, FAAN, president of the American Nurses Association, with Susan M. Hohenhaus, LPD, RN, CEN, FAEN, at the Anita Dorr Memorial Lecture and Luncheon.

pains, Daley received life-changing news: She tested positive for both HIV and hepatitis C. Daley recalled that with the shock fresh in her mind, ‘‘All I could think about was that I was never going back to the ED again.’’ During her recovery, while under the care of an infectious disease specialist at Massachusetts General Hospital, Daley worked with her state nurses association to propose legislation requiring hospitals to report every workplace injury. The bill passed into law within the year and remains one of the strongest workplace injury reporting laws in the country, she said. Daley then turned her attention to the national level because ‘‘I knew what had happened to me was happening at EDs all around the country,’’ she said. When she

received the opportunity to address the ANA constituency, Daley said it illustrated for her the collective power of a national organization. ‘‘I said, ‘I’ll go anywhere, anytime to address nurses on this issue, because we have safety devices and only 15 percent of hospitals are using them.’ ” After years of advocacy work, Daley was invited to the White House to witness President Bill Clinton sign the Needlestick Safety and Prevention Act in November 2000. ‘‘I wish that 12 years later I could say this was a past issue, but the work continues,’’ Daley said, urging emergency nurses to follow through with reporting all sharps injuries, as data collection is necessary to benchmark progress. ‘‘We know the injuries are still occurring, and we still know that underreporting is a huge issue,’’ she said. ‘‘We as nurses should never underestimate our individual power as a constituent or the power of a collective voice,’’ she said, adding that nurses need to add their voices to the political process to remain engaged and empowered. ‘‘Our strength is in our numbers, expertise and credibility. ‘‘Thank you again for the opportunity to speak to you about an issue that affects all of us in our practice.’’

December 2012

Presession: Advanced Wound Repair

By Kendra Y. Mims, ENA Connection

Attendees of this presession Sept. 12 were when she returns home. able to refresh their wound closure ‘‘I’m an independent A&E nurse, so I techniques, as well as learn complex travel around the south of England to a wound repair procedures. Designed for lot of hospitals,’’ she said. ‘‘I can take this the experienced advance practice nurse, knowledge with me — it means I’m the class included a brief informative more employable as an agency nurse. lecture on problematic wounds I’ve learned loads today.’’ encountered in the urgent and acute care Attendee Matthew Rist, BSN, RN, tried setting, followed by a hands-on skills to get into the Basic Wound Repair session in which the lecturers, Andrew presession but switched to the Advanced Galvin, ACNP-BC, CEN, and Nancy Wound Repair presession when the basic Denke, MSN, FNP-BC, ACNP-BC, CEN, session was filled to capacity. CCRN, FAEN, used a bovine model to ‘‘The instructor seemed pretty demonstrate wound repair techniques. knowledgeable on different scenarios we Attendees had an opportunity to practice would run into and the best way to deal Andrew Galvin, ACNP-BC, FAANP, instructs a presession participant on the suturing techniques (such as running with it,’’ he said. ‘‘He knows his stuff a suturing technique. subcuticular sutures and deep/buried really well. This was my first time taking sutures), as well as vermilion border closures. Galvin also talked about a session at conference like this. I got a lot out of it. I would definitely complex lip lacerations, ear lacerations and parallel lacerations. recommend it to someone else.’’ Because of the intimate group setting, attendees were able to ask Sandra Estes, MSN, RN, CEN, from New York, said the session provided questions and receive one-on-one help and feedback while practicing the useful information and motivated her to advance her skills to a new level. techniques, an aspect of the session that attendee Mary Pat, MSN, FNP, ‘‘The instructor was great,’’ Estes said. ‘‘I learned new techniques. I CEN, found helpful. always practice simple interrupted suturing, but now I can try the running Pat enjoyed when Galvin ‘‘specifically described and demonstrated suture, so I’ve learned a few steps prior to what I already knew. I knew exactly how to do the suture and the scenarios where you would use that about the techniques done today, but I’ve never really practiced them. suture technique.’’ Now I have a chance and a better grasp of it, so I will definitely put it into Lizzie Dyer, BS, RN, CEN, of London, England, found that the session’s practice. I’ve worked in the ER for 10 years, but I’ve never stepped out of informality and Galvin’s straightforward style made the lecture easy to my comfort zone with suturing. Now I can definitely step out of my understand. The information she learned in the presession will be useful comfort zone.”

Research Lounge the Place for Nurses Who Want Answers real, viable tool or method to help people solve their clinical problems. I think people What Lisa Wolf saw in San Diego are beginning to say, basically, ‘I need to convinced her: The research bug is go and find out the answer for myself.’ spreading among ENA nurses. Rather than say, ‘I can’t find anything Wolf, PhD, RN, CEN, FAEN, is director anywhere,’ they see that now as more of of the Institute for Emergency Nursing an opportunity than a barrier.’’ Research, which hosted its third ‘‘IENR Beyond the walls of the Lounge, the Research Lounge’’ on Sept. 15 at Annual spirit of research was thick. IENR got high Conference — a place for novices and participation for a focus-group study on experienced researchers to get guidance critical access in rural heath, which shed from members of the IENR Advisory new light on the problems that come with Council and other doctorally prepared limited resources and geographic isolation. nurses. More than 40 nurses shared ideas Research and poster presentations during Lisa Wolf, PhD, RN, CEN, FAEN (standing, left) chats in the IENR with the 12 consultants during the the conference were well-attended. Lounge with 2012 President Gail Lenehan (center) and board three-hour Lounge. And while a few were Wolf, who explained IENR’s role during member Michael Moon, MSN, RN, CNS-CC, CEN, FAEN (seated). simply curious about research in general, General Assembly and later led Wolf said, most already had topics and came looking to form their plans. educational sessions, said she found herself stopped repeatedly in the ‘‘Of course, this is observational data and must be confirmed with halls by emergency nurses who wanted IENR to look into specific issues further work, but they were pretty clear on what they were looking for,’’ affecting their practices. They offered to help in any way they could. said Wolf, who advised three or four visitors on their research paths. ‘‘I ‘‘The atmosphere in general,’’ Wolf said, ‘‘has just gotten a lot more think the level of interest is growing. We’re bringing research forward as a research-friendly.’’

By Josh Gaby, ENA Connection

Official Magazine of the Emergency Nurses Association

ENA Presents the First Advanced Practice Cadaver Lab By Kendra Y. Mims, ENA Connection For the first time at the ENA Annual Conference, advanced practice registered nurses had the opportunity to register for the Advanced Practice Cadaver Lab. Through the expertise of ENA faculty members Robert A. Leach, MSN, RN; Kathleen M. Flarity, PhD, ARNP, CEN, CFRN, FAEN; and Arlo F. Weltge, MD, MPH, FACEP, along with the support offered by Vidacare, an ENA Strategic Sponsor, attendees were able to participate in this exciting new opportunity and receive CEs. The two sold-out sessions gave participants a chance to improve practitioner skills using

unembalmed cadavers to simulate the anatomy and feel of an actual patient. Attendees learned advanced emergency procedural skills through hands-on labs in a small group setting, which allowed one-on-one interaction with the instructors. Some of the procedures covered in the three skills stations included intraosseous catheter placements, venous cutdowns, tube thoracostomy, lateral canthotomy, advanced airway insertion and central venous access. Although Darryl Sol, MSN, CNS, FNP-C, has attended several ENA conferences over the years, he began attending more emergency medicine conferences instead to refresh his advanced nursing skills. He said the opportunity

to participate in an advanced cadaver lab this year attracted him back to the ENA Annual Conference. ‘‘The advanced cadaver lab was a great opportunity,’’ Sol said. ‘‘It’s one of those things where you’re proud of the organization and you want to participate, but sometimes those advanced skills aren’t there, so this was a great thing. The course itself was great. The instructors were very knowledgeable and helped us one-onone even though we were in a group. They were willing to take us to the side and help us. All the skills that we learned were important, and we don’t often use them a lot, so I was happy to revisit them. It was a great review.’’

December 2012

IENR Presents 2012 Poster Awards By Amy Carpenter Aquino, ENA Connection The Institute for Emergency Nursing Research presented the 2012 Research and Evidence-Based Practice Poster Awards on Sept. 14 at the ENA Annual Conference in San Diego. Recipients were chosen from 44 Evidence-Based Practice topics and 10 research topics.

categorizing patients regarding their potential for sustaining a falls injury. Homan’s goal of sharing her data with emergency nursing colleagues was amplified by the fact that there is little data available on ED falls. “I only found one article related to emergency department falls.” she said. “When I got to the conference, Evidence-based Practice Poster people were very excited because there just isn’t much out there on Award Winner falls.” Nancy Homan, MSN, MBA, RN, Homan was so surprised to APRN-BC, an advanced practice receive the award for the best nurse for Emergency Services, Evidence-Based Practice Poster that Christiana Care Health System in she did not even realize she won, even after seeing the blue ribbon tacked to her poster. “It was a really neat experience,” she said. “This Nancy Homan, MSN, MBA, RN, APRN-BC was my first national ENA Newark, Del., received the conference. It was great to meet Evidence-Based Practice Poster with people who have a like Award for “We All Fall Down, But mind-set and see people from for Very Different Reasons.” different parts of the country, and “We had a serious fall with also to see that my hospital is pretty injury,” Homan said, “and I was part progressive. You don’t appreciate of the root cause analysis. Then, I that until you look at other was assigned falls for the whole hospitals.” unit. It was just something that fell Homan appreciated the positive into my lap.” feedback her poster received from Homan’s experience with her attendees, including several who hospital’s falls committee led to a asked her to send them the inforyear-long study of all the factors mation. She was also contacted by surrounding falls in her ED, the author of the only other article including age, shift and sight, as she found on the topic of falls in well as possible causes such as the ED. mobility, reason, cognition and Homan is already working on intoxication. She also began another project to submit for the including the story that accompa2013 ENA Annual Conference in nied each report of an ED fall, to Nashville, Tenn. give her a more complete picture. As a result, her ED added a falls Research Poster Award icon to its ED tracker, which she The Research Poster award went to said was a helpful way to communi- Elizabeth T. Dugan, PhD, RN, chief cate patient information. Her ED nurse executive of Inova Loudon also added its own scale, based on Hospital in Leesburg, Va., who red, yellow and green stoplight presented “The Relationship colors, as a quick visual method for Between Quality of Care in the

Official Magazine of the Emergency Nurses Association

Emergency Department and Timeliness of Intervention for Patients with Severe Sepsis.” Dugan’s poster, based on her doctoral dissertation study, Elizabeth T. Dugan, PhD, RN focused specifically on “how the timeliness of care impacted work, and then you put it on a shelf outcomes – such as length of stay in a dissertation book,” she said. and mortality – but also how the “So I really appreciated being able volume of the ED at the time to share my findings at the conferimpacted the timeliness of care for ence via the poster, and really had the septic patient.” a great time engaging with the Dugan’s study included all five attendees. Everyone that came out hospitals within the Inova Health was having the same concerns and System and was sparked by the issues, and they were really system’s initiative to reduce engaged around the screening mortality in specific categories, process. including sepsis. She collected data “This was probably the best for 14 months and was surprised by poster session I have seen, and I go the results. to a lot of different conferences.” “I really thought that I would find that crowding increased length of stay, increased mortality,” she IENR Thanks said. “I did not find that. What I 2012 Poster Judges found – and it was an unexpected The IENR gratefully acknowledges the finding – was that what really following individuals for serving as impacted timeliness of care, more poster judges for the 2012 ENA Poster Awards Program: than crowding, was the identificaJames Bockeloh, DNP, RN, APRN-BC, tion of sepsis in triage.” FNP-BC; Darlene Bradley, PhD, MSN, “We implemented several years RN, CEN, CCRN, FAEN; Laura Criddle, ago, as well as many other hospitals, a sepsis screening process PhD, RN, CEN, CPEN, CFRN, ACNP-BC, CCNS, CCRN, FAEN; Renee Holleran, in triage,” Dugan said. “What I PhD, APRN, FNP, CEN, CFRN, CCRN, found was, if the sepsis screening FAEN; Mary Kamienski, PhD, APRN, triage process works, and the nurse CEN, FAEN; Elyse Kemmerer, PhD; Anne identifies the patient positive for Manton, PhD, RN, APRN, FAEN, FAAN; sepsis or potentially for severe sepsis, they will alert the doctor and Diana Meyer, DNP, RN, CEN, CCRN, FAEN; Elizabeth Mizerek, MSN, RN, get things rolling according to the EMT-B, CEN, CPEN; Patricia Normandin, interventions that have been DNP, MSN, RN, CEN, CPEN; Andrea identified.” Dugan said she also found that a Novak, PhD, RN-BC, FAEN; Ryan Oglesby, PhD, MHA, RN, CEN, NEA-BC; delay in triage in recognition of Diane Salentiny-Wrobleski, PhD, RN, sepsis caused a delay in treatment. APRN, CEN, ACNS-BC, CCNS; Mary “I found that only a third of the Sigler, EdD, RN, CRNP; Audrey Snyder, patients were accurately identified PhD, RN, ACNP-BC, CEN, CCRN, FAEN, with a positive sepsis screen in FAANP; Dawn Specht, PhD, MSN, RN, triage,” she said. “So we are really CNS, CEN, CCNS, CCRN; Stephen missing a lot of people.” Stapleton, PhD, MSN, MS, BSN, BS, RN, Dugan said she felt honored and CEN; Debbie A. Travers, PhD, RN, CEN, surprised to receive the poster FAEN; Jeanne Venella, DNP, MS, RN, award and enjoyed the opportunity CEN, CPEN; and Sarah Wilkey, DNP, to present to ENA members. “You know, you do a lot of FNP, RN.

National ENA Awards

Nursing Professionalism Award —

Frank L. Cole Nurse Practitioner Award—

President’s Award— 2012 ENA President Gail Lenehan, EdD, MSN, RN, FAEN,

Anne Stefanoski, BSN, RN, CEN

Kathy J. Morris, DNP, APRN, FNP-C, FAANP

FAAN, is pictured with her husband, Joseph M. Lenehan, MD, recipient of the President’s Award, and their daughter, Kate Lenehan.

Behind the Scenes Award —

Nurse Manager Award—

Rising Star Award —

Robert Breese, CCEMTP, FP-C

Leslie A. Christiansen, BS, RN, CEN

Kristen Connor, BSN, RN, PHN, CEN

Nursing Research Award — Michelle A. Marini, MSN, RN, CPNP, CPEN, and Amy W. Truog, BSN, RN, CPEN

Nursing Education Award — Timothy J. Murphy, MSN, RN, ACNP - BC, CEN

Nursing Practice Award— Judith Common, RN, CEN, CPEN, CA/CP SANE, SANE-A, SANE-P

ENA Foundation State Challenge Awards — Left: Mike Hastings, MS, RN, CEN, president of Kansas ENA State Council, which raised highest amount per capita. Right: Pat Nierstedt, MS, RN, CEN, president of New Jersey ENA State Council, which raised the highest total.

Not pictured:

Gail P. Lenehan Advocacy Award — Joyce Foresman-Capuzzi, MSN, RN, CCNS, CEN, CPN, CTRN, CCRN, CPEN, SANE-A, EMT-P

Nursing Competence in Aging Award — Donna M. Roe, DNP, ARNP-BC, Team Award — Mid Maryland Chapter, Annual Barbara Proctor Memorial Educational Day Team Members: Sandra M. Waak, RN, CEN; Linda Arapian, MSN, RN, CEN, CPEN, EMT-B; Lisa Tenney, BSN, RN, CEN, CPHRM; Anne May, BSN, RN. Not pictured: Emilie Crown, BA, RN, CEN; Pamela S. Fox, BSN, RN, CEN, CPEN; and Lucy McDonald, RN, CPEN, CPN, EMT-B.

CEN

Lifetime Achievement Award— Sharon McGonigal, RN, CEN

December 2012

Lantern Awards

Advocate Good Shepherd Hospital Emergency Department — Barrington, Ill.

Cedars Sinai Medical Center, Ruth and Harry Roman Emergency Department — Los Angeles

Beaumont Health System – Grosse Pointe Emergency Center Boston Children’s Hospital Emergency Department — Grosse Pointe, Mich. — Boston

Chandler Regional Medical Center Emergency Department — Chandler, Ariz.

Children’s Medical Center Dallas, Seay Emergency Center — Dallas

Indiana University Health Methodist Hospital Emergency Medicine and Trauma Center — Indianapolis

Cincinnati Children’s Hospital Emergency Department – Burnet Campus — Cincinnati

ENA Celebrates the ‘Best In Class’ at Gala More than 300 people walked down the red carpet in their finest attire for ENA’s first annual Awards Gala on Sept. 15. The evening started with a reception with hors d’oeuvres, followed by pictures taken by ENA’s ‘‘paparazzi,’’ red carpet interviews by the master of ceremonies, Terry Foster, MSN, RN, CEN, CCRN, FAEN, and a delicious dinner. It was a proud night for many in the ballroom. The special evening honored individuals for their accomplishments over the last year. The awards program included commemorating ENA Individual

Award winners, Lantern Award recipients, Academy of Emergency Nursing inductees and the ENA Foundation State Challenge Award winners. ENA President Gail Lenehan, EdD, MSN, RN, FAEN, FAAN, hosted the event with Foster and presented the awards. Foster’s humor and jokes provided comedy for the evening and kept the audience entertained and amused. ‘‘Madame President, with all due respect, I did not see an award for Best in Humor!’’ Foster told Lenehan. ‘‘But seriously, heartfelt congratulations to all of you . . .

Official Magazine of the Emergency Nurses Association

especially those who were induced, I mean inducted into the Academy.’’ As the event ended, Lenehan and Foster expressed their appreciation to the attendees and congratulated them for their achievements and successes. ‘‘We’ve come to the close of the best event of the whole week, and the best group to share it with. Thank you all for being part of ENA’s First Annual Gala!’’ Lenehan said. ‘‘We are so much better for knowing you all, and emergency nursing is so much better for your accomplishments.’’ Kendra Y. Mims

OPENING SESSION

Proof That We’re All Beating the Same Drum By Kendra Y. Mims, ENA Connection The hall exploded with the sound of hundreds of drums and boomwhackers Sept. 13 as conference attendees participated in the Opening Session’s highly acclaimed entertainment, the Drum Café, the global leader in interactive drumming. After ENA’s Executive Director Sue Hohenhaus, LPD, RN, CEN, FAEN, welcomed attendees to the conference, Drum Café took the stage and began its worldrenowned performance, which provided a fun atmosphere and engaged the audience in teambuilding through music. Every seat in the room was equipped with a drum or boomwhacker, which emergency nurses used to create music with Drum Café for the first hour of the session. Natalie Spiro, leader of Drum Café, discussed the importance of using music as a universal language.

‘‘What you just experienced right now was harmonizing as one ENA to this universal language of rhythm and drumming,’’ she said. ‘‘This is a language that transcends all barriers and boundaries across geography, across job function to effective communication, collaboration and teamwork. For every single person in this room, it’s all about refresh, revitalize and invigorate.’’ Before beginning the performance, audience members raised their hands and recited: ‘‘We have compassion and respect, we work to improve public health, we exercise sound judgment, and we’ve got rhythm. We are drummers.’’ Chants of, ‘‘We are ENA and we’re No. 1; yes, we are ENA and we rock,’’ filled the room as the audience followed Drum Café’s lead to play the ‘‘heartbeat, pulse and infrastructure of ENA’’ in the center of their drums. Drum Café integrated ENA’s tagline and vision into the team-

Natalie Spiro, who leads the Drum Café, moves up the aisle during Opening Session as conference attendees follow along.

building event, along with the conference’s theme. As the audience chanted ‘‘refresh, revitalize, invigorate,’’ some were pulled out of their seats to join Drum Café in the front of the room.

‘We Have the Blueprint to Move Our Organization From Great to Greatest’ By Kendra Y. Mims, ENA Connection 2012 ENA President Gail Lenehan, EdD, MSN, RN, FAEN, FAAN, welcomed attendees to the Annual Conference after the Drum Café performance, announcing exciting initiatives and highlights from throughout the year. Among them were ENA’s improvement of access to information through new technology, the advancement of emergency nursing globally (TNCC is being taught in 13 countries) and ENA’s advancement of the future of emergency nursing through 34 committees, education and an investment in staff (ENA now has nine highly qualified nurses on staff). Lenehan also was excited to announce that ENA is offering free CEs for members and moving to one national conference in 2015.

Lenehan shared that right before she took the stage, ENA Executive Director Susan M. Hohenhaus, LPD, RN, CEN, FAEN, told her that ENA had been awarded the 2012 Susan Harwood Training grant from the Occupational Health and Safety Administration, which provides funds to develop workplace violence training materials. ‘‘We have the blueprint to move our organization from great to greatest,’’ she said. ‘‘I know that we have the right professionals with the right talents to accomplish this together and we will continue to develop and enhance strategic partnerships.’’ After acknowledging ENA’s partnerships with organizations such as The Joint Commission, the American Nurses Association and the American College of Emergency Physicians, Lenehan also acknowledged all of the delegates who

‘‘I’m amazed at what you do every day,’’ Spiro said. ‘‘Some of you are seeing over 300 patients a day. You are so special, so valued and so critical to providing the care for the people in your community.’’

convened for the two-day General Assembly. ‘‘These are [nearly] 700 of our most engaged emergency nurses, and you would have been so proud of their thoughtful, very informed and very intelligent debate on our resolutions and bylaws,’’ she said. ‘‘We came up with some very good decisions which will move our specialty profession forward.’’ Lenehan presented the President’s Award to the individual who gave her inspiration and unconditional support throughout the year. ‘‘This award goes to my husband, Dr. Joe Lenehan, and to all of the other spouses, partners and significant others for whom ENA stands for ‘Every Night Alone,’ ’’ Lenehan said. She closed her speech by urging the audience to make the most of the conference. ‘‘Thank you for coming, thank you for being an important part of this conference and thank you to those who are members,’’ she said. ‘‘You make this conference and all that ENA does possible.’’

December 2012

CLOSING SESSION

Refreshing Message From Wine to Water Founder By Kendra Y. Mims, ENA Connection Closing out the 2012 Annual Conference with keynote speaker Doc Hendley was a refreshing way to conclude the fun-filled and exciting week of learning, growing and reconnecting in San Diego. Like every attendee in the audience, Hendly also has experience in making a difference and changing lives. The Harley-riding bartender created Wine to Water, a non-profit organization that has provided tens of thousands of people around the world with clean drinking water. He opened up his talk with a brief video that showed work he has done in Haiti and other areas, such as digging wells. Hendley’s intense, emotional stories of taking personal risks in places such as Darfur to provide people with clean water highlighted the power of having courage even in the most dangerous situations. His down-to-earth and humble attitude and his evident passion for helping those who are

less fortunate captivated and invigorated the audience. He also shared the concepts of building relationships that he learned while bartending and the importance of focusing on people. ‘‘It doesn’t matter how passionate you are about what you’re doing or what reasons you got into something at the beginning — there’s going to come those days when you just don’t want to get out of bed,’’ he said. ‘‘There’s going to come those days when you say, ‘I didn’t sign up for this.’ But it’s at those times when it’s so vital to surround ourselves with people who believe in us more than we believe in ourselves. That was a huge lesson for me to learn.’’ Hendley pointed out the usual questions that people ask themselves when they look into a mirror: What have I done? What can I do? Who am I? ‘‘You have a unique ability with what you do every single day to change the world around you through people, through relationships, through the lives that you touch every day,’’ he told the

Official Magazine of the Emergency Nurses Association

Closing Session speaker Doc Hendley, founder of Wine to Water, encourages emergency nurses to use their resources and look only to the future.

audience. ‘‘I want to encourage you. When you get back, don’t look at all the stuff in the past. Start with today. Start with tomorrow. And use the resources that you have to make a huge impact on your community and your world.’’ Attendee Cindy Lefton, PhD, RN, from Missouri, described the closing speaker in three words: dynamic, humble and passionate. Although Hendley is not an emergency nurse, Lefton felt the audience could definitely relate to his message. ‘‘He talked about helping people when times are really difficult and resources are difficult,’’ she said. ‘‘It’s all about digging deeper in yourself to find that skill set and energy to face whatever adversity is before you.’’

ENA FOUNDATION

Creating a Bigger Boom By Kendra Y. Mims, ENA Connection Laura Giles, BS, RN, 2012 ENA Foundation chairperson, asked audience members to sound their instruments if they either made a contribution or were the recipient of an ENA Foundation scholarship or research grant. The sounds of drums and boomwhackers, used during the Opening Session Drum Café presentation, could be heard throughout the room. ‘‘Wow, I am impressed,’’ Giles said. ‘‘But I must say, wouldn’t it be fantastic if we could make even more noise? I would love to hear this room explode with the sound of every drum. And I’m confident that we have the ability to create a bigger boom.’’ Attendees continued banging their drums in excitement as Giles shared how the generous contributions and the dedication of donors have helped the ENA Foundation achieve many accomplishments in 2012, including providing 20 Annual Conference scholarships, 47 academic scholarships and five research grants to members. Giles also discussed the success of the 2012 State Challenge. ‘‘We reached our goal and raised over $116,000,’’ she said. ‘‘One hundred percent of these funds will go toward supporting scholarship applications and research grants in 2013. Because we raised more money this year, we will have more to give back to you next year.’’ Giles ended her speech by sounding her drum for the members, the ENA Foundation Board of Trustees and Management Board and everyone else who contributed to making 2012 a successful year. ‘‘It all adds up,’’ she said. ‘‘Your donation — large or small — makes a difference in the number of scholarships and research grants we can fund. Please consider making the ENA Foundation one of your charities of choice today and in the future.’’

SPARKLE AND SHINE: Attendees fill out bids for jewelry items during the ENA Foundation Jewelry Auction held at Annual Conference in San Diego. States, chapters and individuals donated 171 pieces of jewelry, which raised more than $20,500 for the ENA Foundation to be used toward grants and scholarships for emergency nurses.

TAKE ME OUT TO THE BALLGAME It was root, root, root for the ENA Foundation on Friday night, Sept. 14, at Petco Park, where more than 740 emergency nurses joined the ENA Foundation in watching the San Diego Padres host the Colorado Rockies.

December 2012

Concurrent Sessions Tales from the ED: Creating Your Happily Ever After Attendees of the ‘‘Plot or Character?’’ session learned how to identify and solve clinical problems by using storytelling to determine if the problems derive from a character-driven or plot-driven story. ‘‘Storytelling is a valuable source of information. It can highlight processes or players that are problematic,’’ said Lisa Wolf, PhD, RN, CEN, FAEN, director of the ENA Institute for Emergency Nursing Research. “Storytelling is powerful. It helps us connect and recognize each other as one of us. It helps us to vent and helps relieve stress.’’ When using stories to identify problems, Wolf said, the first step is recognizing whether you are dealing with a process or character problem. ‘‘Read the story — the chart — to find the villain,’’ she told the audience. A character or villain could include anyone from personnel, septic patients or heroic nurses to colleagues, visitors, unaware nurses or inattentive doctors. On the other hand, plotdriven problems can stem from the environment of care, terrible dialogue, procedures, props, the setting or individual and environmental factors. What are some solutions for these stories? Wolf recommended fixing processes (such as hand-offs) for plot-driven stories or educating, disciplining or removing the villains in character stories. She encouraged the audience to write down critical elements of their stories and compare them with others to discover similarities in characters, plots, villains and settings. She also reminded attendees to remember the ‘‘moments of grace’’ stories, which include good processes, good staffing and good knowledge, and to recognize the heroes in these stories. ‘‘These are equally important stories to analyze because they tell you things that are going well,’’ Wolf said. Kendra Y. Mims

You Stuck What Where?

three teams based on work shift: the AMs, the PMs and the Nights. Have you ever come across a patient who had a Nurses took well to the fun, interactive flying insect in his ear or had to treat a child session in which the teams played two rounds with a bead lodged in her nose? that included categories of Too Fast, Too Slow, ‘‘You Stuck What Where? Chatting About Pretend RNs, Eponyms, Pretend MDs, Foreign Objects,’’ a fast-track session, was Toxicology, Math is Hard and more. As the packed with audience members interested in session’s lecturer and game host, William exploring the recognition and treatment of Hampton, DO, MM, BA, AS, presented the patients presenting with foreign bodies. Jeff questions, players used an electronic game Solheim, MSN, RN-BC, CEN, CFRN, showed system to buzz in and earn points. vivid pictures of patients who experienced Trauma was the category of the ‘‘Final foreign bodies in their nose, ears, eyes and GI Jeopardy’’ round. The big question of the game tracts. Solheim discussed how to detect was, ‘‘What is the the symptoms of foreign objects in these second-most areas, as well as upper-airway common cause of obstruction for children and adults. traumatic death in Attendees received a brief overview the age group of 1 on the removal of foreign bodies, as to 4 years old?’’ well on as the removal of insects from The Nights were the external ear. The session also the only team to included esophageal vs. tracheal answer correctly obstruction x-rays and how to identify (drowning); the differences between the two, and a however, all team brief discussion on the complications of The Nights wearing their Snuggies qfter “Emergency Nursing Jeopardy.” players walked GU and rectal insertions and symptoms away with a prize. of toxic shock syndrome. ‘‘I come to these conferences because I love Attendee Erin Scarlett, BS, RN, CEN, said all of you dearly — I love working with nurses, Solheim kept the session interesting by covering and I feel a great camaraderie here,’’ Hampton a number of different areas as well as treatment options. Attendees left the session knowing said as he presented gifts to all of the team some of the symptoms of foreign bodies and players at the end of the game. The AMs how to remove them. received coffee mugs, the PMs took home Kendra Y. Mims inspirational notebooks with ‘‘Lost Proverbs of the ED’’ and the Nights received Snuggies with Emergency Nurses Play ‘Jeopardy’ the ENA logo. Christine McEachin, MBA, RN, of Michigan, From naming famous fictional doctors on said she enjoyed how the session used a television to identifying medication that has game-style approach as a learning tool. resulted in more deaths than illegal drugs, ‘‘I like that it was a light-hearted approach attendees of the ‘‘Emergency Nursing Jeopardy’’ to a serious topic of what we do in emergency session had a chance to learn about emergency nursing,’’ she said. ‘‘I learned a ton of stuff medicine topics in a game format. Some — for example, the antidote for calcium attendees volunteered to play on teams to earn channel blocker. I do mostly trauma now, so for points, while the majority played along silently as audience members. Active players were drawn from the list of volunteers and split into

Official Magazine of the Emergency Nurses Association

Continued on page 30

Concurrent Sessions Concurrent Sessions Continued from page 29 me that was great because I didn’t know that. There were some things we did definitely know, but then other things we learned, like the rhythms, because he picked rhythms that are not as common of presentation, and it was good to realize they don’t all look the same.’’ Kendra Y. Mims

‘The No. 1 Suicide Magnet’ In ‘‘A View From the Golden Gate Bridge: A Forensic Look at Suicide,’’ speaker Cheryl Randolph, MSN, RN, CEN, CPEN, CCRN, FNP-BC, opened with scenes from ‘‘The Bridge,’’ a 2006 documentary by Eric Steel which included one year’s worth of filming at the iconic bridge, focusing on the suicides and attempted suicides. ‘‘The Golden Gate Bridge is what we call a suicide magnet,’’ Randolph said, ‘‘meaning that it’s a specific geographic area that tends to draw those individuals who are contemplating or want to kill themselves. It indeed is the No. 1 suicide magnet on planet Earth.’’ Randolph pointed out that in the medical literature, the term ‘‘commit suicide’’ is not used. ‘‘One either attempts suicide, or they complete suicide, meaning that they did die,’’ she said. Patients also may make a suicide gesture, which has low lethality and is often made to seek attention. There is no exact count, but estimates put the number of people who have jumped off the Golden Gate Bridge and ended their lives since 1937 at 1,500, with an average of 27 per year. This does not include unconfirmed suicides. The 240-foot plunge from the pedestrian area of the bridge takes about four seconds, and people fall at a rate of 75 miles per hour, with an impact force of 15,000 pounds per square inch. Randolph showed slides of some of the types of devastating injuries suffered by people who have jumped, including burst lacerations, internal hemorrhage and burst evulsions.

‘‘By jumping at these great forces, injuries are catastrophic,’’ she said. ‘‘Organs burst, bones break, great vessels are pierced. Sometimes there is not a lot of outward trauma on the body, but the body will be just covered in hematoma. The body will be black and blue.’’ In addition to the injuries, people who jump from the bridge are also at risk of dying from a combination of drowning and hypothermia, Randolph said. The water near the bridge is generally about 47 degrees, and those who plunge in tend to go to a significant depth of at least 100 feet. While the California Coast Guard has two ships standing by 24 hours a day to respond to people who jump from the bridge and can reach the area within five minutes, ‘‘as you know, five minutes, with someone who has these catastrophic injuries, more likely than not, the damage is already done and this person has expired,’’ Randolph said. ‘‘Initially I was disappointed that it was a replacement session,’’ said attendee Linda Whitt, BSN, RN, CEN, of Virginia. ‘‘But I did learn a lot about the etiology of death from this particular mechanism. I was enlightened, also, about the increased likelihood of people in my profession committing suicide — the doctors and nurses — and that it’s the fourth-leading cause of death. So I’m glad I stayed.’’ Amy Carpenter Aquino

Connecting with Patients and Families in Tough Situations This fast-track session focused on helping families and patients work through crisis, sudden death and end-of-life decisions and how emergency nurses can improve their experience during difficult times. Presenter Suzanne O’Connor, MSN, RN, APN, shared her experience with comforting the parents of patients in critical condition. Though O’Connor talked about the importance of assuring families that their loved one is in good hands, she also warned the about making promises.

‘‘I would never say to someone, ‘He’s going to be all right,’ because they will hold you to that,’’ she said. “When a loved one is dying in the ED, always switch your care from intensive help with the patient to now taking care of the family. Focus on the family. They are the ones who are going to remember this night. The patient is going to die, so we need to transfer our care over to the wife, the mother or whoever you’re working with.’’ O’Connor also offered tips on gaining a patient’s trust: listening to his or her perspective before offering one; underpromising and overdelivering (e.g., estimating wait times); following through and being consistent as a team; being honest; building confidence, managing priorities and never losing hope. ‘‘Patients need to feel confident and trust us,’’ O’Connor said. ‘‘The No. 1 person is you, the consistent relationship. You are the No. 1 consistent voice and face that they want to connect with and the face and voice of that ER experience. Update them often about what you know. Information is the No. 1 need.’’ She also discussed studies showing that patients find it comforting when nurses explain the benefits of medications and tests, as well as when they address them by their first name. The session ended with a brief Q&A. Attendees asked about approaching families to donate organs, working with social workers and dealing with denial about a dying loved one. ‘‘I do it slowly and in increments and through pictures and drawings,’’ O’Connor told the attendee who asked for advice about denial. ‘‘I say, ‘It’s pretty serious and here’s what we are worried about.’ Let them stay with their denial, but talk about your concerns for their loved one. Ease into it as slowly as you can. Use a key family member who has the most influence. ‘‘They will never, ever forget you as an ED nurse,’’ she told attendees. ‘‘You will always be a valuable memory for them.’’ Kendra Y. Mims

December 2012

Concurrent Sessions Killer Headache ‘‘I was looking at my colleague, and pieces of her started to disappear.’’ Thinking that her retinas were detaching, Mary Ann Teeter, MSEd., RN, CEN, CNRN, FNP-C, immediately called her ophthalmalogist, who examined her and diagnosed her with an ocular migraine. ‘‘I thought, ‘I need to find out more about this,’ ” said Teeter, an emergency nurse since 1976, who presented this fast-track session with a focus on how migraine is related to stroke. Migraine is the result of cranial blood vessel vasodilation, and the neurogenic inflammation exacerbates the pain, she said. She described the two types of migraines — with aura and without aura — and the four stages of migraine, with slide illustrations of the brain affected by migraine. Patent foramen ovale — a hole between the left and right atria of the heart that fails to close after birth — is the main stroke risk factor for patients with a history of migraine, Teeter said. ‘‘We find that a lot of our younger patients — 30s, 40s, 50s — who come in with symptoms of stroke have PFO,’’ she said. Teeter showed a slide of a CT scan of brain showing hydopense areas in the right occipital lobe consistent with a recent posterior cerebral artery ischemic infarct. She pointed out the dying and dead brain tissue of the infarct. She shared common triggers for migraine as well as management medications and techniques. ‘‘There are apps out there for migraine management,’’ Teeter said. ‘‘You can be mobile and manage that as well.’’ “I thought it was really good,” attendee Deborah Skeen, BSN, RN, CEN, of Colorado, said of the session. ‘‘I never realized there was a connection between migraine and stroke. It was helpful for me to learn that it’s the patients who have auras that are especially the ones to look out for. … I thought it was good to point out the symptoms that could come across for an ocular stroke or a hemiplegic migraine or a real stroke; it helps you keep the good differentials in your mind when people come in with those symptoms.’’ Amy Carpenter Aquino

patient’s airway, Allen described how he and another nurse pulled enough of the hardened plaster away to intubate him. Allen then called the hospital’s burn unit for advice on how to approach removing the rest of the hardened plaster, and was told to apply mayonnaise. He ran down to the cafeteria, got a tub of mayo, ‘‘and believe it or not, we put it on and the plaster came right off his face,’’ Allen said. Allen concluded his lecture with a review of the treatment of nine victims from the 9/11 attack on the Pentagon, from the initial call to Washington Hospital Center to patient resuscitation in the ED and their outcomes. ‘‘There was not one broken bone, not one brain injury — only burns,’’ Allen said. All the patients suffered severe damage to their hands from using them to find their way out of the building. While the physical and emotional toll on emergency staff caring for those patients on that day cannot be overstated, ‘‘the rewards are immense,’’ he said. Amy Carpenter Aquino

Whatcha Lookin’ At, Doc? There is never one right answer, only a better answer, when deciding which test to run on a patient who presents to the emergency department with unexplained pain or illness. In this session, William A. Gluckman, Continued on page 34

2012 Annual Conference

Refresh Revitalize Invigorate September 11-15 • San Diego

The Most Bizarre and Unusual Trauma Case Studies in Emergency Medicine 2012 Nearly every seat was filled for this concurrent session jampacked with information on how to treat the most difficult trauma cases, culminating with a review of the care of victims from the 9/11 terrorist attack on the Pentagon. Allen C. Wolfe, MSN, RN, CFRN, CCRN, CMTE, focused on airway management — which he called ‘‘the defining skill in emergency medicine’’ — in many of the case studies he presented. In the case of a 24-year-old male who blew off his face with a shotgun, Allen described the difficulty of intubating a patient with no facial structure. During the treatment, a nurse suggested intubating the patient from the front, and Allen showed the actual video made of the inverse intubation of a gunshot wound to the face. He also showed slides of CT scans taken following several hours of surgery, showing the reconstruction of the patient’s jaw from his fibia. Allen also presented the case of a male construction worker who was brought into the ED after surviving a plaster explosion. Photos showed the man’s face completely covered by a white plaster used for bridge construction. Concerned about the

Official Magazine of the Emergency Nurses Association

Attendees Turn Out For Spirited Town Hall Meeting By Amy Carpenter Aquino, ENA Connection

ACNS-BC, CEN, CPEN, had met previously with several GAC chairpersons, who had given the board members ‘‘quite a bit of feedback.’’ Because that discussion was held separately, questions about the GAC workshop would be heard at the end of the town hall meeting. One member asked why there was not more recognition of the national ENA award winners. ‘‘I will be at the Gala, but for the rest of my colleagues who cannot make the event tonight, they should be aware of

Hundreds of Annual Conference attendees filled the room for the Sept. 15 town hall meeting in San Diego. Members brought several questions and comments to the ENA Board of Directors on topics ranging from the Government Affairs Committee annual workshop and recognition of ENA national award winners to General Assembly resolutions and access to ENA staff in the exhibit hall. The board, led by 2012 ENA President Gail Lenehan, EdD, MSN, RN, FAEN, FAAN, extended Conference attendees fill the room Sept. 15 for the annual town hall meeting, which shed light on a variety of topics. the time allotted by 30 minutes to accommodate all members who wished to express their views. ‘‘We know people have a lot on their mind, and we want to hear about who the winners are,’’ she said. anything you want to talk about,’’ she said. In addition to recognition at the Sept. 15 Gala, all national ENA award Before hearing questions, Lenehan explained that JoAnn Lazarus, MSN, winners are recognized on page 24 in this issue of ENA Connection. RN, CEN, 2012 president-elect, and Deena Brecher, MSN, RN, APRN, Member Elizabeth Whetzel, RN, asked the board about progress on her

ENA Foundation Thanks You for Your 2012 Jewelry Auction Support The 2012 ENA Foundation board sincerely thanks you for your support for this year’s successful jewelry auction. From necklaces to watches to duck calls, the jewelry auction was a success. The jewelry auction received 171 donated items and raised over $20,580. Proceeds from this fundraising event will directly support the mission of the ENA Foundation to provide education scholarships and research grants in the discipline of emergency nursing. Your support makes a difference. We look forward to the next Jewelry Auction at the 2013 ENA Annual Conference, September 19-21 in Nashville, TN.

resolution, Emergency Nursing and Forensic Nursing, which was approved by the 2011 General Assembly. ‘‘We don’t seem to have a good process for providing feedback on resolutions that have gone through,’’ she said. Lenehan said ENA was working on improving the process of reporting progress on resolutions, while board member Ellen H. Encapera, RN, CEN, reported that the forensic nursing resolution had inspired ENA to work with the International Association of Forensic Nursing. ENA Executive Director Susan M. Hohenhaus, LPD, RN, CEN, FAEN, explained that ENA began a dialogue with IAFN halfway through the year and that the organizations were working to share resources and expertise. A member from Louisiana asked why ENA staff did not have a designated spot in the Exhibit Hall at this conference, in contrast with previous ENA conferences. Nancy Bonalumi, MS, RN, CEN, FAEN, an ENA past president, added that she and other members missed the opportunity for face-to-face contact with staff. Hohenhaus explained that ENA has been scaling back on the ENA Pavilion area of the Exhibit Hall as attendee evaluations showed that traffic in the pavilion did not justify the amount of staff resources dedicated to maintaining the space. A member of the new ED Operations Work Team suggested posting times when staff would be available to meet with members, similar to how poster presenters are scheduled to meet with attendees. Jill McLaughlin, BSN, RN, CEN, CPEN, suggested taking advantage of technology, such as Web conferencing and Skype, to connect attendees and ENA staff at the new Digital Den. Kay Ella Bleecher, MSN, RN, CEN, FNP-C, NREMT-P, PHRN, requested that board members share notice of when they plan to represent ENA at other organizational conferences. ‘‘If you’re sending someone from national to our state, we would like to meet and greet them,’’ she said. The board heard attendees’ comments on nine different topics and also encouraged members to send additional questions, concerns and feedback to them via e-mail. ‘‘Know that we take your comments to heart,’’ Lenehan said.

December 2012

General Assembly Debate Continued from page 19 delegates suggested returning to paper ballots. ‘‘Thank you, everyone, for your great comments yesterday concerning strategies for how to move our election forward,’’ Moretz said. The assembly passed as amended the resolution Care of the Bariatric/Obese Patient, authored by Joan Somes and the Minnesota ENA State Council. The amended clause called for ENA to ‘‘identify currently available literature/education related to prevention, assessment and safe care of the bariatric/obese patient so that these concepts can be incorporated into the appropriate new and revised ENA products and programs.’’ The proposed resolution, TNCC Eligibility, authored by the Massachusetts ENA State Council and Diane Gurney, MS, RN, CEN, FAEN, elicited impassioned debate culminating in approval of wording that went beyond the original language in supporting the resolution, to say ‘‘only RNs or international equivalents may hold TNCC provider status.’’ The Assembly voted down a clause which would have allowed upper-level nursing students to ‘‘take TNCC content and testing over the course of a college term as an emergency nursing elective taught by a TNCC instructor without receiving verification status/provider card.’’ The General Assembly passed as amended the resolution Care of the Patient With Chronic Pain, authored by the Arizona ENA State Council, Tiffiny Strever, BSN, RN, CEN, and Maureen O’Reilly Creegan, MSN, RN, CNS-C, CEN, CCRN, FAEN. This resolution asked for a review of the current research on the care of patients with chronic pain in the emergency department and dissemination of the information as appropriate. ‘‘This proposed resolution is meant to address our knowledge deficit related to best practice to meet the needs of the pain patient in the ED,’’ said supporter Charlann Staab, MSN, BSN, RN, CFRN, of Arizona. ‘‘Chronic pain management has drastically changed over the last 10 years. Without having that current information validated, it’s difficult to share and incorporate it to reach optimal care.’’ The amendment inserted words ‘‘taking into consideration state regulatory concerns that affect the emergency care management of chronic pain,’’ explained Deborah Spann, ADN, RN, CEN, of Louisiana. Delegates approved as amended the resolution Use of Protocols in the ED Setting, authored by Barry Hudson, BSN, RN, CPEN, and Cam Brandt, MS, RN, CEN, CPEN, which called

for ‘‘collaboration with other professional groups to develop operational definitions for protocols and their impact on emergency nursing practice and therefore the development of a position statement supporting the use of protocols in the ED setting.’’ ‘‘I think this is extremely timely,’’ said Maryland delegate Mary Alice Vanhoy, MSN, RN, CEN, CPEN, NREMT-P. ‘‘For those of you who follow the managers listserv, there are consistent questions about who has protocols and how to implement them.’’ ‘‘Without protocols, my practice would be dead in the water,’’ said a delegate who identified himself as a flight nurse. ‘‘I’d be forced to put oxygen on people and put them on backboards. There is no need to go back to the 1970s in our practice.’’ The General Assembly approved as amended Defining Wait Time for ED Services, authored by Meghan Long, BSN, RN, CEN, and Nicole McGarity, RN, CEN, which called for ‘‘the development of consensus statement definition, in collaboration with appropriate emergency care stakeholders, for a consistent ED metric regarding the term ‘wait time’ as used in emergency care settings.’’ McGarity said that after discussions with ENA Executive Director Susan M. Hohenhaus, LPD,

Official Magazine of the Emergency Nurses Association

RN, CEN, FAEN, about using technology to facilitate meetings, the financial implications of the resolution would be nominal. ‘‘I really think this is important work, and I appreciate you working on the price tag,’’ said Marcus Godfrey, RN, president of the California ENA State Council. The General Assembly passed as amended the resolution Safe Discharge From the ED, authored by Dawn McKeown, RN, CEN, CPEN, and Deborah Spann, ADN, RN, CEN. The original proposal called for the ENA Institute for Emergency Nursing Research to ‘‘investigate options for outside grant funding for the research needed to promote nursing competence for discharging patients; and publish the findings for use as resources in the development of ED policies and procedures.’’ The amendment, suggested by IENR Director Lisa Wolf, PhD, RN, CEN, FAEN, allows ENA to expand the resources used in the investigation to other ENA departments and personnel. The General Assembly also passed the resolutions Healthcare Worker Fatigue, authored by the Tennessee ENA State Council, the Utah ENA State Council and Beth Broering, MSN, RN, CEN, CPEN, CCNS, CCRN, FAEN; and Palliative Care, authored by Colleen Vega, RN, CEN; Kim Sickler, MS, RN, CEN; and Garrett Chan, PhD, RN, CNS, CEN, FAEN, as well as a number of consent agenda items consisting of various bylaws amendments. It rejected the proposed bylaws amendment Resolutions Committee Responsibility, authored by the ENA Board of Directors, which would have let the committee independently propose amendments. The deadline for 2013 proposed bylaws amendments and resolutions is March 11.

Concurrent Sessions Continued from page 31 DO, MBA, FACEP, presented several different cases to attendees, asked them which test they would perform, then showed them what to look for on the corresponding radiograph. Attendees correctly guessed that a 23-year-old female patient presenting with RLQ pain for two days could be suffering from an ectoptic pregnancy. After running a lab test to confirm that the patient is pregnant, an ultrasound should be performed, said Gluckman. ‘‘Ultrasound is the best test for evaluating gynecological and ovarian cases,’’ he said. ‘‘CT is better for bowel and most solid organs.’’ Gluckman showed attendees ultrasounds of a normal-looking early pregnancy and then showed the difference in the ultrasound of an ectopic pregnancy, pointing out the pseudo-gestational

sac in the ectopic pregnancy. Attendees shouted ‘‘Gallbladder!’’ when Gluckman presented the case of a premenopausal 42-year-old female patient who weighed 240 pounds, had recently eaten a fast food meal and complained of several hours of pain and vomiting. Gluckman showed a normal ultrasound of a gallbladder filled with bile fluid and explained that fluid appears black on an ultrasound. He then showed an abnormal ultrasound of a gallbladder, which showed no free fluid and pinpointed the shadowing that indicated a gallstone. ‘‘It was good, it was informative,’’ said Emma Gonzalez, RN, of Texas. ‘‘Usually it’s just the doctors reading the X-rays, and sometimes they don’t get to it quite right away, so if you know what to look for you can grab your doc and go, ‘Hey, this is weird. Can you come look at this with me?’ ’’ Amy Carpenter Aquino

Talent and Technology Continued from page 19

New ENA monthly offering for FREE Continuing Education with contact hours for our members. • Available December 1 Service and Quality 1.0 contact hour Jeff Strickler, MA, RN, CEN, CFRN

Don’t miss out on enhancing your education. Go to www.ena.org/FreeCE for additional free continuing education opportunites.

leadership,’’ Hohenhaus said, adding that Wolf is ENA’s first remote employee, telecommuting from her home on the East Coast. ENA spent significant time investigating its information technology capabilities and limitations this year and found that the organization was lacking in some areas, Hohenhaus said. Guided by the principles of simplicity and constant communication, ENA introduced several new devices and technologies, including video conferencing and team sites for committees, which reduced travel requirements and lowered costs. Other advancements, such as a more integrated use of ENA’s social media platforms, have propelled the organization forward, she said. Further technological enhancements and a focus on leadership development and teamwork training — with new advocacy and increased educational opportunities — will ensure an even stronger future for ENA. Noting that ‘‘ENA’s financial health matters to you,’’ Hohenhaus described the organization’s commitment to revenue-sharing with state councils and developing an educational design that includes blended learning, as well as plans to revive the GENE and CATN programs. ‘‘We learned that we were a bit hasty in retiring CATN,’’ she said. ‘‘Our team is working on revising, refreshing and renewing the program. GENE is also being revised and will be more interactive.’’ Noting that the date of her presentation, Sept. 12, was her one-year anniversary as ENA’s executive director, Hohenhaus thanked the ENA Board of Directors, especially 2012 President Gail Lenehan, for their leadership and support during ‘‘an incredibly fast-paced year.’’

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

Photo coverage of 2012 Annual Conference supplemented by Bruce Hood of Stryker.

December 2012

A Gift That Keeps Giving By Kendra Y. Mims, ENA Connection The holiday season is the perfect time to give back and make a difference. If you are among the many shoppers searching for special gifts for family, friends or colleagues, consider making a holiday donation to the ENA Foundation. Donations are a great gift to honor a special nurse, mentor or another important person in your life. Your contribution to the ENA Foundation makes a difference in your profession and can make someone’s holiday even more special. ENA member Dorothy Duncan, DNP, RN, CEN, ACNP-BC, CCRN, said she and her husband engage in philanthropy usually by donating to schools. This year, they decided to place the ENA Foundation on their holiday list as a charity of choice. At the 2012 ENA Annual Conference, Duncan noticed that the New York ENA State Council had established the academic scholarship to remember fellow first responders who lost their lives on Sept. 11, 2001. In 2011, the New York State Council decided to begin fundraising efforts to permanently endow the 9/11 scholarship. They recently reached the halfway mark to ensure that emergency nurses never forget that fateful day by honoring its memory. Duncan felt the cause was very honorable,

and it inspired her to make a donation to the ENA Foundation in honor of all 13 nurses in her emergency department’s leadership group. Each nurse received a Never Forget commemorative pin. The rest of her staff, which consists of about 35 workers, received a Stretcherside Miracle pin. Duncan’s staff was moved. As she explained why she felt compelled to give back, several were in tears. Duncan said her staff felt honored to wear their pins, and she is proud to see them displayed on their IDs. Duncan also wears her pin with pride as she believes people should never forget about September 11. ‘‘That is the biggest thing,’’ Duncan said. ‘‘I just think it’s very important to never forget these kinds of very noble acts on the behalf of first responders and emergency personnel, HAZMAT and all types of response personnel. This is a wonderful way to remember. This is a very worthwhile cause. I would recommend that people give back to the ENA Foundation all the way.’’ As you reflect on those who have crossed your path this past year, do you recall someone who has motivated or inspired you? Mentored or helped you to grow professionally or personally? Paying homage to others by making a contribution to the ENA Foundation is a gift that definitely keeps giving.

Official Magazine of the Emergency Nurses Association

Your donation makes a difference. Since 1991, the ENA Foundation has given more than $2 million in educational scholarships and research grants to emergency nurses. This year alone, the ENA Foundation has funded 86 educational scholarships and research grants in the total amount of $246,800. This could not have been possible without the generous donations received from individuals, ENA state councils and chapters, corporations and friends of emergency nursing. The ENA Foundation offers the following premium items, which make great holiday gifts for your friends, family or colleagues: • Donate $30 and you can elect to receive a 4GB thumb drive. • Make a $10 donation to receive the Never Forget commemorative pin. • Make a $5 donation and you can select the Stretcherside Miracle Pin. There is still time to make your year-end gift. You can make your donation on behalf of yourself, or you can honor or remember someone special to you by visiting www.enafoundation.org today. Every dollar counts toward advancing the emergency nursing profession, this holiday season and beyond.

ENA STATE CONNECTION San Antonio ENA Chapter Submitted by Steven J. Jewell, RN The San Antonio ENA marked a busy three months. The chapter hosted an excellent CEN Review course in August for more than 78 nurses, presented by Jeff Solheim, MSN, RN, CEN, CFRN, RN-BC, FAEN. In September, the SA ENA held a two-hour Forensic Nursing in the ER seminar that hosted 47 members. With TNCC, ENPC, monthly meetings, seminars, Safety Whys babysitting training courses and certification review courses, San Antonio has provided more than 250 hours of continuing education and community education for the region. On Nov. 11, more than 40 medical and nursing professionals, provided by the SA ENA, provided care for the San Antonio Rock & Roll Marathon. The SA ENA is also excited to announce that its board of directors approved a 2-1/2 day educational conference scheduled for May 8-10, 2013, to be held at the Historic Menger Hotel. The conference will include a three-hour educational seminar for managers, directors and chief nursing officers, covering topics such as management, education and retention/ recruiting. The next two days will provide 11.75 continuing education hours on topics including trauma, pediatrics, adults and forensics. For more information, contact Steven J. Jewell, RN, at Jst4jstn@gmail.com.

trauma care. Topics this year included life flight in Southern Utah, pediatric triage and assessment, rapid ECG interpretation, massive transfusion protocol, respiratory emergencies and trauma assessment and treatment. Many thanks to Cindy Hurst, ADN, RN, chapter president, and Vikki Webster, BSN, RN, CEN, president-elect (both pictured below), who spent countless hours preparing and organizing the conference. Not only was it a success and offered the opportunity to earn continuing education credits, it gave attendees a chance to network and see colleagues.

Utah ENA Dixie Chapter Submitted by Debbie Young, BSN, RN The Utah ENA Dixie Chapter held its sixth annual Southwest Emergency/Trauma Conference Sept. 29 in St. George, Utah. This anticipated all-day event was well-attended by emergency nurses and local EMS and paramedics interested in the latest and greatest in emergency and

DOES YOUR EMERGENCY DEPARTMENT DESERVE RECOGNITION FOR

Exemplary Practice and Innovation? T he ENA Lantern Award recognizes exemplary emergency departments that demonstrate exceptional performance and innovative practice in the core areas of: • Leadership • Practice • Education • Advocacy • Research

B ecome a Lantern Award recipient Apply today. Applications are due February 20, 2013.

A Coaching Guide is now available to help you identify how best to demonstrate your emergency department’s achievements. To learn more and apply, visit : www.ena.org/IQSIP/LanternAward Development of the Lantern Award program criteria funded in part by Stryker, an ENA Strategic Sponsor.

December 2012

Emergency Nurses Under a Common Flag

Colleagues in Mexico See ENA As Having the Answers By Josh Gaby, ENA Connection ENA board member Karen Wiley was in Mazatlán, Mexico, in October and wasn’t just welcomed — she was sought out. The occasion was the 8th International Congress of Nursing in ER, Emergencies and Disasters, held Oct. 4-6 by the Asociación Mexican de Enfermeria en Urgencias — the Mexican Association of Emergency Nurses. A few hundred nurses from Mexico, Brazil, Spain, Panama and Canada attended, including leaders from the World Alliance of Emergency Nurses. Educational sessions were offered on trauma, cardiopulmonary issues, vascular access, pediatric populations and standardization of triage, among other topics. Wiley, MSN, RN, CEN, represented ENA and spoke about why hospitals should train all nurses in emergency nursing. But some of the greatest ideas from those three days didn’t come from the podium. For starters, Wiley was approached by Gerardo Jasso Ortega, BSN, RN, president and chairman of the Mexico City-based AMEU, and Daniella Ortiz, an associate dean at the University of Mexico, who proposed a cultural exchange program between ENA and AMEU nurses. An emergency nurse from the United States would live with and shadow one from Mexico for one to two weeks, and then they’d switch, with the U.S. nurse hosting. Meals and living arrangements would be provided by the host nurse. The only expense would be travel. The concept is nothing new for Mexican nurses, who have lived with and hosted nurses from Croatia, Spain, Panama and several of the South American nations through similar arrangements. ‘‘They have an exchange

ENA board member Karen Wiley, MSN, RN, CEN, presents TNCC and ENPC manuals to Gerardo Jasso Ortega, BSN, RN, president of the Mexican Association of Emergency Nurses, during her visit in October. Below: Attendees gather at the 8th International Congress of Nursing in ER, Emergencies and Disasters, including Jasso (purple shirt, seated) and global emergency nursing leaders from Canada, Spain and Brazil (seated to left of Jasso).

program with these other countries, so they’re already doing it but haven’t connected with the U.S.,’’ Wiley said. The learning potential there is huge, but it’s hardly ENA’s biggest opportunity to educate. Wiley said there’s a focus on ENA contracting to bring the TNCC and ENPC courses to Mexico, starting with a core group of emergency nurses assembled by Jasso. Those nurses would then spread the teachings to nurses across Mexico, as well as to other countries in the World Alliance. Opportunities to help reduce other countries’ ED violence have emerged, too. AMEU’s Horacio Flores Nava, an emergency nurse from Chihuahua, Mexico, is planning a first binational conference on violence in the workplace next April. He found Wiley and asked about acquiring resources from ENA, which has made workplace violence prevention a cornerstone of its

Official Magazine of the Emergency Nurses Association

Strategic Plan. The situation Flores described to Wiley is chilling: gunmen walking into Mexican hospitals along the Texas and Arizona borders and shooting patients in drug-related vendettas. ‘‘It’s our worst-case scenario — we have an active shooter dropped off,’’ Wiley said. ‘‘We try to prevent that with security measures, as far as our metal detectors or at least the presence of security on the property and within our facility. Doesn’t mean it

doesn’t happen in the U.S., but it’s more frequent [in Mexico] — it sounds like it’s out of control — and they’re asking for assistance in violence prevention tools that they can use, and also to educate them on violence prevention.’’ There are other challenges in Mexico, so many of them shared by U.S. emergency departments. Nurses have to contend with crowding, long wait times Continued on page 39

August and September 2012

Board Meeting Actions and Highlights The ENA Board of Directors met Aug. 22 via teleconference. All members of the board were present and took the following actions: • Approved the July 18 board of directors meeting minutes as corrected. •A dopted the independent auditors’ report on the 2011 financial statements as presented. •A pproved that ENA continue membership in the Institute of Medicine Forum on Medical and Public Health Preparedness for Catastrophic Events for one year. •R eferred the Rapid Practice Reference on Hemolysis back to the Clinical Practice Committee for reconsideration because of the board’s concerns. •R atified Joanne Fadale, BSN, RN, as the replacement Retired Emergency Nurses Special Interest Group facilitator, as presented. The ENA Board of Directors met Sept. 11 in San Diego. All board members were present and took the following actions: •A pproved development of a project plan for an Institute for Emergency Nursing Education. • Approved the following board governance policies: ° Conducting ENA Board of Director Business that Requires a Vote via E-mail ° Etiquette for Electronic Communication •A pproved the newly created position statement definitions, including joint and consensus statements, as written. •A pproved the new Weighing Patients in Kilograms position statement as written. • Approved the following revised position statements as written: ° Specialty Certification in Emergency Nursing ° Professional Liability and Risk Management • Approved sunsetting the following position statements: ° Autonomous Emergency Nursing Practice (3/2005) ° Care of the Older Adult (5/2012) ° Family Presence (9/2010) ° Hazardous Material Exposure (10/2009) ° Improving External Coding In Hospital Discharge and ED Data Systems (4/2009) ° Prehospital EMS (12/2008) ° Smallpox Vaccination (12/2005) ° Substance Abuse (7/2010) •A pproved the following topics for Emergency Nursing Resources in 2013: ° Acute Pain Management ° De-escalation ° Pediatric Dehydration • S upported the Position Statement Review Committee’s request to decline the development of an ENA position statement on the care of the stroke patient in the ED as outlined in General Assembly Resolution 11-105, and charged the Clinical Practice Committee with developing a clinical practice rapid practice reference related to the care of the stroke patient in the ED. •T he following represent actions to various requests from external organizations that were supported by the Executive Committee: ° An invitation from Emergency Medical Services for Children to have an ENA representative on the Organizational Panel during its Annual Program Meeting, May 8-11, in Bethesda, Md. Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN, represented ENA. ° An invitation from the Forum of Nursing Workforce Centers to attend its 2012 Annual Conference June 27–29, in Indianapolis. Gail Lenehan, EdD, MSN, RN, FAEN, FAAN, represented ENA.

°A n invitation to attend the Department of Health/Human Services and Assistant Secretary for Preparedness and Response Meeting on The Impact of Drug Shortages on Emergency Care April 16, in Washington, D.C. A workgroup was established from the attendees of this meeting and a subsequent meeting was held July 12 – 13, in Washington, D.C. Mary Alice VanHoy, MSN, RN, CEN, CPEN, NREMT-P, represented ENA at these events. ° An invitation to attend a Health Resources and Service Administration Affordable Care Act Discussion with Nursing Organizations hosted by Dr. Mary K. Wakefield, April 30, in Washington, D.C. Susan M. Hohenhaus, LPD, RN, CEN, FAEN, represented ENA. ° A request from the American Psychiatric Nurses Association for a letter of support for an AHRQ grant application for a three-year project to compile a toolkit of materials on pain assessment. ° An invitation to participate in the American College of Emergency Physicians Geriatric ED Work Group to describe the standards for a geriatric ED. Betty Mortensen, MS, BSN, RN, FACHE, represented ENA. ° An invitation from the National Council of State Boards of Nursing to attend its APRN Roundtable meeting April 25 in Chicago. Betty Mortensen, MS, BSN, RN, FACHE, represented ENA. ° An invitation from the National Institute of Occupational Safety and Health to attend the National Conference for Workplace Violence Prevention and Management in Healthcare Settings May 11 – 13, in Cincinnati. AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN, represented ENA. ° An invitation from Dignity Health to present at its ED Summit May 31 – June 1, in Las Vegas. Gail Lenehan, EdD, MSN, RN, FAEN, FAAN, represented ENA. ° An invitation from the American Nurses Association to support the Joining Forces initiative of the White House and the first lady. ° A request from the American Nurses Association to endorse the document Professional Nurse Coach Role: Defining Scope of Practice and Competencies. ° A request to send a letter of support for a SAMHSA grant application from the ENA president on behalf of the Center for Pediatric Traumatic Stress, Children’s Hospital of Philadelphia, which will serve as a Level II center in the National Child Traumatic Stress Network. ° A request from Duke University and the University of Cincinnati to support a grant application for “Comparing Pain Management Protocols for Sickle Cell Disease Patients in the Emergency Department” with a letter from the ENA president. ° A request for a letter of endorsement from the Centers for Disease Control and Prevention regarding its National Hospital Ambulatory Medical Care survey. ° An invitation from the Pediatric Nursing Certification Board to attend the Institute of Pediatric Nursing Invitational Forum, Nov. 1-2, in

December 2012

Washington, D.C. Paula Karnick, PhD, ANP-BC, CPNP will represent ENA. ° An invitation from RAND Health (under contract with the Centers for Medicare and Medicaid Services) to suggest topic areas and items for inclusion in a survey of patient experiences with emergency department services. ° An invitation from Urgent Matters to designate two representatives to its editorial board. AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN, and JoAnn Lazarus, MSN, RN, CEN, will represent ENA. • The following requests were not supported by the Executive Committee: ° An invitation from the Commission on Collegiate Nursing Education to nominate candidates for its Board of Commissioners and the 2013 Nominating Committee. ° An invitation from the American Association for Emergency Psychiatry to attend and speak at its Third Annual National Update on Behavioral Emergencies Dec. 5-7, in Las Vegas. ° A request from the Society for Academic Emergency Medicine for endorsement of its 2012 Consensus Conference, May 9-12, in Chicago. ° An invitation from the Vascular Disease Foundation to attend and speak at the 2012 VESSEL Annual Meeting Sept. 21-23, in Tyson’s Corner, Va. ° A request from the American Academy of Neurology for endorsement of the guideline, ‘‘Update: Evaluation and Management of Concussion in Sports.’’ Highlights of the next scheduled board of directors meeting will be published in a future issue of ENA Connection.

Emergency Nurses Under a Common Flag Continued from page 37 (particularly in the public hospitals), geriatric and pediatric issues and the puzzle of accommodating behavioral health patients, most of whom end up on regular hospital floors. The suicide rate among these patients is high, Wiley said. What hampers Mexican emergency nurses is a lack of resources, from air conditioning to continued education. But they make up for it in the simple stuff that bonds the profession. Wiley is recommending including Jasso and other international colleagues in educational sessions at Leadership Conference 2013 in Fort Lauderdale, Fla., and at next year’s General Assembly in Nashville, Tenn., with interpreters on hand to help them share their insights and experiences. The lesson is that there’s much to be learned from each other. So different, yet so alike. ‘‘I wasn’t aware of how unified emergency nurses are in their passion,’’ Wiley said. ‘‘When I was asked to go to Mexico, I felt a crack in the door — a door opened partway to the international community and to Mexico. But once I arrived and met them and saw all the nurses that attended from the other countries as well as throughout Mexico, I thought, ‘Oh!’ — an entire door just kind of opened onto another world. We had the same connection with emergency nursing and ENA because they were just as passionate about emergency nursing as we are. To me, it was like you never left your own emergency department. It was like meeting people that you worked with daily. You just felt that same connection.’’

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Controlling the Controllables By Kim Edwards, Associate Marketing Communications Manager, Stryker Medical During a recent conversation with a friend and co-worker, we were discussing how we dealt with the uncertainty caused by the economic meltdown in 2009. He said, ‘‘There was so much that I knew I couldn’t control. I couldn’t control what was happening to the stock market, the value of my home or to the employment status of my loved ones, so I simply focused on what I could control. I did everything I could to increase and enhance quality time with my family. I started running and eating better so I could get in better control of my body. I devoured all kinds of books to keep my mind sharp. We started paying closer attention to our family finances. Basically I ‘cleaned my house’ and controlled my controllables, hoping that the rest would work itself out, and my family would be in a better place when it did.’’ This was an interesting perspective, and I often find myself applying the same principle. When I have a big project, sometimes the best place for me to focus is at home, and away from the distractions at the office. However, pulling out my laptop is not the first thing I do — I clean my house. I have to get everything else in order before I can focus on the task at hand. It’s no secret that the health care environment is undergoing drastic change. We have reached the point where one Baby Boomer turns 65 every 10 seconds 1, obesity has risen to over 30 percent in some states 2, nine out of 10 hospitals report ED boarding 3 and in 2020 we will have a nursing shortage that is projected to reach 1 million.4 To pile on, the many models of care and the uncertainty surrounding the Affordable Care Act are causing more questions than answers. In a time of such uncertainty, and when the issues and complexities in health care seem so daunting, maybe the best thing we can do is get back to the basics. What are the things in your daily activities that you have complete control over? What can you focus on doing better? Are you doing the things necessary

2012 ENA State Council and Chapter Innovation Grant Recipients Announced The recipients of the ENA Innovation Grant awards for state councils and chapters have been announced. Selection of the award recipients involved many factors to ensure alignment with ENA’s mission, strategic plan, goals, activities, budget and sustainability. The winners are: • Head Injury Prevention Campaign – Alabama State Council, Audra Lowery Ford, president: $5,490 • Violence Survey in California’s Emergency Departments – California State Council, Marcus Godfrey, president: $7,118 • Injury Prevention Radio Ads – Central Minnesota Chapter, Colleen Seelen, immediate past president: $5,412

• Multi-faceted Video Communication – Talk Fusion – Missouri State Council, Teresa M. Coyne, president-elect: $10,000 • Web/Virtual Meeting Plan and System – New York State Council, Kathy Conboy, president-elect: $5,000 • Web Conferencing – Texas State Council, Rhonda Manor-Coombes, web chairperson: $1,980 • Trauma Trot and Kids Safety Expo – Shenandoah Chapter, Brenda Hoops, president, and Paula Neher, chapter member: $5,000 • Washington ENA and British Columbia ENA Emergency Nursing Conference – Washington State Council, Roger Casey, president: $10,000

to take better care of yourself so you can take better care of your patients? Of course, controlling the controllables sounds simple enough, but making a change and sticking to it is often easier said than done. One of the most difficult challenges with change is breaking old habits. As a medical device manufacturer, we are constantly under regulatory scrutiny, and compliance is key. We have found that the secret to compliance is to make the complex problem as simple as possible. If those implementing it realize it is to their direct benefit, and that the change will make their daily activities simpler, safer and more efficient, it becomes very natural. 2012 will be wrapping up before we know it, and the only guarantee in the coming year is that there will be change. As we set our goals for 2013, let’s focus on controlling the controllables and making the complexities of our personal and professional lives as simple as possible, so we are ready to embrace the changes ahead. References 1. A ARP. (n.d). Boomers at 65: Celebrating a milestone birthday. Retrieved from www.aarp.org/personal-growth/transitions/boomers_65/ 2. Centers for Disease Control and Prevention, Vital Signs. (n.d). U.S. state info: Adult obesity. Retrieved from www.cdc.gov/vitalsigns/ AdultObesity/StateInfo.html 3. Rabin, E., Kocher, K., McClelland, M., Pines, J., Hwang, U., Rathlev, N., ... Weber, E. (2012). Solutions to emergency department ‘boarding’ and crowding are underused and may need to be legislated. Health Affairs, 31(8), 1757–1766. 4. American Hospital Association. (2007.) When I’m 64: How Boomers will change healthcare. Retrieved from www.aha.org/content/0010/070508-boomerreport.pdf

Establish Yourself as a Leader Join the faculty for ENA Leadership Conference 2014, Phoenix, March 5-9

Grow your career when you become part of ENA Leadership Conference Faculty. Share your leadership knowledge, experience and skills to help grow the profession of emergency nursing. Do you have specific knowledge in a particular area of emergency nursing, management or policy? Has a particular experience given you new insights into a current issue or trend and led to new best practices? Do you have experience dealing with leadership challenges and issues?

Share your insights related to current issues, trends, and best practices as a faculty member at ENA Leadership Conference 2014, March 5-9 in Phoenix, Arizona

Topic areas: • Management • Operations • Government affairs • Technology • Team building • Research • Education

Submission Deadline is

March 25, 2013

• Advance practice • Orientation • Retention • Community relationship building • Customer satisfaction • Personal and professional development

Find full information and course proposal guidelines at www.ena.org and click on Leadership Conference 2014 Call for Course Proposals in the Calls and Opportunities Section. We look forward to hearing your cutting-edge course ideas.

December 2012

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