ENA Connection November 2009

the Official Magazine of the Emergency Nurses Association

connection November 2009 Volume 33, Issue 10

INJURY PREVENTION IN THE ED: THINKING BEYOND THE VIOLENCE PAGE 10

PANDEMIC FLU IN PEDIATRIC PATIENTS PAGE 8

PREVIEW:

LEADERSHIP CONFERENCE 2010 FEBRUARY 17 – 21 PAGES 27 – 29

INSIDE FEATURES

We’re All in This Together It Takes Two to Tango Hand Hygiene in the ED ENA, BCEN and NSO Team Up to Offer Discount to BCENCertified ENA Members

PAGE 5 PAGE 16 PAGE 22

PAGE 32

Dates to Remember November 30, 2009

BOARD WRITES |

Tiffiny Strever, RN, BSN, CEN

Postmark Date for THRIVE Emergency Nurse Manager Recruitment Campaign

January 6, 2010 Early Bird Registration Ends for ENA Leadership Conference 2010 in Chicago

January 15, 2010 Submission Deadline for 2010 Scientific Assembly Paper and Poster Abstracts

February 17 – 21 ENA Leadership Conference 2010, Chicago

Features PAGE 16 It Takes Two to Tango PAGE 18 If I Were a Candidate for a National ENA Elected Post PAGE 20 St. Anthony’s Supports ENA Membership PAGE 22 Hand Hygiene in the Emergency Department PAGE 26 A Tale of Two Courses: ENPC vs. PALS PAGE 27 ENA Leadership Conference 2010 Preview

Departments PAGE 3 Board Writes PAGE 4 Letter From the Executive Director PAGE 5 Ready or Not? PAGE 6 Washington Watch PAGE 8 Pediatric Update

Injury Prevention:

Not Just in the Community Anymore When people talk to me about injury prevention, they say things like, “I don’t like to talk to teenagers, I can’t relate.” “I’m not good with big groups.” “I don’t have time.” I think that is what I used to say, too.

Now that I’ve been involved in injury prevention for close to a decade, I have seen a lot of changes.

First, injury prevention is more than just going out into the community to talk to teens or big groups.

It can mean making a call to your legislators about an important bill that is being considered. That phone call actually could turn into speaking before a subcommittee. Maybe your niche is more behind the scenes and making copies of a bill to pass out at an ENA or other nursing meeting you attend is more your style.

Second, injury prevention has become so important that now the American College of Surgeons’ Committee on Trauma has said that for a facility to reach specific levels of trauma verification, it must have a designated injury prevention coordinator. This means that there should be a resource, if not in your own hospital, at least somewhere in your state on how to get involved in injury prevention.

Third, it is time to shift, or add to, our idea of where injury prevention should take place. The idea has always been in the community. Whether the activity is helping coordinate a docudrama at high schools, talking to older adults about falls and medication safety, working with legislators to pass tougher laws, it all takes place outside the walls of the hospital. But as emergency nurses we are missing a huge opportunity—the patients we see every day.

What about the patients sitting in the waiting room, what can we do to promote injury prevention there?

PAGE 10 Injury Prevention PAGE 24 State Connection PAGE 30 ENA Foundation PAGE 31 BCEN PAGE 35 Board Highlights

The mom that brings the toddler in for an ear infection: Isn’t this a perfect time to take five minutes to discuss falls and home safety and appropriate child safety-restraint use? Talk to the older patient who is on multiple medications about the fall risk and provide the “Home Safety Survey.” What about the patients sitting in the waiting room, what can we do to promote injury prevention there? Have pamphlets on a variety of topics; if the hospital has a patient education channel, there are videos that can be uploaded. Incorporate injury prevention into the discharge instructions, even just a line or two.

Finally, one area to think of for the future is injury prevention for us. Whether that be related to workplace violence or just awareness that people are watching whether we wear our seat belts.

We lead by example. Injury prevention should not just be in the community by the trauma centers.

It is something that every emergency nurse can and should consider as part of his or her patient care and safety.

Official Magazine of the Emergency Nurses Association

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LETTER FROM THE EXECUTIVE DIRECTOR |

David A. Westman, CPA, MBA

CONNECTIONS When ENA named this publication Connection so many years ago, we never could have foreseen how visionary that word would seem today. New technologies, our growing desire for real-time information and, above all the ever-increasing need to connect with others have converged. Yes, today, communication is all about connection.

While more and more of our membership becomes adopters of emerging technologies and the later-adopters follow, ENA is offering more Web tools to facilitate your connections.

Just a couple of months ago, ENA completed a yearlong retooling and launched an updated and revamped Web site with improved viewing and navigation, making it easier for you to access education, conferences, shopping and other key association areas. Added benefits will appear as the rollout progresses.

Recently, ENA jumped into the social media realm with Facebook, Twitter and YouTube, and soon will be coming out with new social media tools that will make it easier for members to interact with each other. Using the computer or your hand-held device, you now can interact, network or simply browse the posts to see what others are saying. Sometimes the posts contain friendly chatter, but more often they point to resources such as books, Web sites and emergency nurse experiences. You can post a

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

Copyright© 2009 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.

question and get answers quickly from other emergency nurses. If you don’t already know how to use or access these social media networking sites, find them on the homepage of the ENA Web site at www.ena.org.

ENA is launching this month ENA Newsline, an exciting new venture with additional benefits.

At the 2009 ENA Annual Conference in Baltimore, Maryland, this past October, ENA posted its first conference blog, ENA Live From Baltimore, on the ENA Web site. For the first time, those attending and those at home could see the action, updates, photos and news as they happened, and were able to post comments on what they read and saw. This first ENA blog was a huge success and will be repeated at following conferences—another opportunity for our members to connect.

Going on hiatus, ENA Dateline, the association’s online newsletter has been keeping members up-to-date for almost two years on timely news, opportunities and information.

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

Member Services: 800-243-8362 Non-member subscriptions are available for $50 (USA) and $60 (foreign).

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ENA is launching this month ENA Newsline, an exciting new venture with additional benefits. ENA Newsline is a weekly electronic newsfeed direct to members featuring national news relevant to emergency nurses plus ENA news—with fewer click-throughs and more topical reporting.

These days, life is fast, especially the lives of emegency nurses. ENA knows that your time is limited, your time is precious and your time is yours alone. How and when you connect with ENA and your colleagues is a matter of time, as well. ENA is giving you more choices to connect and making it easier, faster and more suitable for the different times in your day.

This magazine, ENA Connection, will continue to keep you in-the-know about important matters related to your profession, the association and your colleagues. This is where you will read about new tips and trends, studies and opportunities, government affairs and how ENA is making the profession better for you and your patients.

Connecting will be the operative concept in all of our communication tools. It is in connecting that knowledge is shared, relationships are built, growth is nurtured and change is understood.

It also breeds joy, humor and the occasional “Now, that made my day!”

Communications and Public Affairs Officer M. Anthony Phipps Managing Editors Amy Carpenter Aquino Jill Lewis Board of Directors Officers: President: William T. Briggs, RN, MSN, CEN, FAEN President-Elect: Diane Gurney, RN, MS, CEN Secretary/Treasurer: Sherri-Lynne A. Almeida, RN, DrPH, MSN, MEd, CEN, FAEN Immediate Past President: Denise King, RN, MSN, CEN

Directors: Christine Gisness, RN, APRN, MSN, CEN, FNP Mitch Jewett, RN, CEN JoAnn Lazarus, RN, MSN, CEN Gail Pisarcik Lenehan, RN, MSN, EdD, FAEN, FAAN Jason Moretz, RN, BSN, CEN, CTRN AnnMarie R. Papa, RN, MSN, CEN, NEBC, FAEN Tiffiny Strever, RN, BSN, CEN Executive Director: David A. Westman, CPA, MBA

November 2009

READY OR NOT?

We’re ALL in This Together Knox Andress, RN, BA, AD, FAEN, Emergency Management and Preparedness Committee Chair

Disaster’s Front Door The emergency department is the front door and gateway to the hospital in external disaster-related events. This is certainly true in the current pandemic.

Patty Skoglund, RN, emergency preparedness coordinator for the Scripps Health System in San Diego, California, reports that many times the community comes to the ED for influenza-like illness (ILI) and H1N1 evaluation. Drawing on her ED background, Skoglund said, “Emergency nurses really need to protect themselves and their patients by getting vaccinated, wearing appropriate PPE (personal protection equipment) and isolating patients who might be infectious.”

Proper protections are important and necessary to prevent illness transmission between patients and staff, ultimately supporting staffing needs in the ED. Infectious disease impacts to hospital staffing were very evident in the 2003 Sudden Acute Respiratory Syndrome (SARS) epidemic when approximately 50 percent of those infected were health care workers and hospital associates.

The emergency department (ED) is the first area in the hospital impacted during an external or mass casualty event, with the effects rippling back into other hospital departments. The term first receivers, in OSHA’s “Best Practices for Hospital Based First Receivers,” was coined with the knowledge that contaminated and potentially contaminated patients many times initially go directly to the ED, making ED staff first receivers.

The ED is the hospital’s disaster front door and should always be prepared, but other departments are also required to make planning investments.

ED Impacts The 1995 sarin nerve agent attack on the Tokyo subway resulted in more than 500 patients acutely presenting to the St. Lukes Hospital in Tokyo. The 2004 Madrid train bombings included more than 1,500 casualties being evaluated in 13 hospitals, one of which received more than 270 patients in three hours.

The ED is the first receiver of mass casualty or disaster events. EDs can be the primary impact or threat site in an uncontrolled hazmat presenta-

tion, weapons/hostage crisis or severe weather event. Many times community perception may be that the hospital and ED have unlimited resources or capabilities during disaster events.

In a benchmarking of Texas and Louisiana hospitals evacuated during 2005’s Hurricane Rita, simultaneous events occurred: Hospitals found patients presenting to their EDs for sheltering and evaluation while they were actively evacuating the facility.

The disaster and hospital front door relationship is certainly seen in the current H1N1 pandemic as patients with ILI, related symptoms or perhaps flu concerns present in EDs across the country. The federally declared public health emergency’s ED impact includes issues of and needs for staffing; physical space and alternate treatment areas; triage; appropriate PPE; and pharmaceuticals, antivirals and vaccine. Similar medical material and human resource needs and impacts may be reflected on the hospital floor and other departments including infection control, laboratory, respiratory therapy, radiology, surgery and critical care.

Silos Are for Farms Depending on the size and scope, disasters impact not only the ED but also other hospital departments, other area hospitals, partner community response agencies, businesses, industry, infrastructure and government. “The right hand not knowing what the left hand is doing” does not work in an emergency or disaster response. Ongoing ED and hospital disaster planning with ED partners is a key element of response coordination and communication. The ED should always be a participant, if not a leader, of the hospital disaster preparedness committee.

Linda Seger, RN, an emergency nurse and emergency preparedness coordinator at Island Hospital, Washington, explained her coordination with public health, pharmacy and other hospital departments as she prepped a refrigerator for influenza vaccine.

Official Magazine of the Emergency Nurses Association

“Members of my hospital preparedness committee help plan disaster drills and discuss their potential impacts, because disaster and larger emergencies are not limited to the emergency department,” said Seger, who also helps lead local Red Cross vaccination clinics.

“You can’t plan in a silo or vacuum.”

Susan Cash, RN, ED director for the WillisKnighton Health System in Shreveport, Louisiana, engages and leads her four hospitals in regional hospital planning by regularly participating in local emergency preparedness committee (LEPC), as well as multiparish hospital preparedness program planning, meetings.

“Regional planning meetings have helped me appreciate common preparedness challenges, new resources and coordinate actual disaster responses within our hospital community,” said Cash.

The Tipping Point A September 13, 2009, article in the Washington Post described the potential impact of H1N1 by saying, “Even if swine flu remains a mild infection, the pandemic could be the tipping point for an emergency medical system teetering on the edge,” while pointing out “the healthcare delivery system…could be overwhelmed by the sick or those who think they are sick.”

Strategies and policies are being drafted, revised and sometimes entirely rewritten to accommodate needs for more medical and human resources, including PPE, vaccine, staff, pharmaceuticals and respiratory therapy.

Whether it is H1N1, H5N1, bombings or hurricanes, it will be important to coordinate and communicate disaster planning needs and resources with other departments and agencies.

We’re all in this together.

Using the ENA emergency preparedness listserv is a great way to discuss relevant topics, problems and find answers to disaster preparedness related issues. Login at http://admin.ena. org/members/listserv/Subscription-default. asp today.

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WASHINGTON WATCH |

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

Report Released on ED Use and Payers According to a recent News and Numbers report from the Agency for Healthcare Research and Quality (AHRQ), Americans made a total of 120 million visits to hospital EDs in 2006. Of that number, more than 40 percent (about 50 million) were billed to Medicare and Medicaid. The uninsured accounted for 18 percent of the visits; 34 percent of the visits were billed to private insurance companies and the rest were billed to workers compensation, military; health plan administrator Tricare and other payers.

The report is based on AHRQ’s Nationwide Emergency Department Sample, a database nationally representative of ED visits in all non-federal hospitals. Other findings include: • About 38 percent of the 24.2 million visits billed to Medicare ended with the patient being admitted, compared with 11 percent of the 41.4 million visits billed to private insurers, 9.5 percent of the 26 million visits billed to Medicaid and 7 percent of the 21.2 million visits by the uninsured.

• The uninsured were the most frequent users of EDs. Their use rate was 1.2 times greater than that of individuals with either public or private insurance (452 visits per 1,000 population vs. 367 visits per 1,000 population, respectively).

• The uninsured were also the most likely to be treated and released (a possible indication that EDs are their usual source of care). Their “treat and release” rate was 421 visits per 1,000 population vs. 301 visits per 1,000 population for those with insurance.

In view of these findings, many policy experts say that reducing the number of ED visits billed to public insurance plans would be an important way to lower the high, and growing, expense of U.S. health care.

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Congress Considers Bill Mandating IgnitionInterlock Devices A federal transportation bill being debated in Congress would compel all states to require convicted drunk drivers to install alcohol-detecting ignition-interlock devices on their vehicles. The devices require the driver to provide a breath sample, proving they have no alcohol in their system before the car will start. Under the legislation, states that fail to comply would lose a portion of their federal highway money. Currently, 11 states are in full compliance, and 36 states and the District of Columbia require the devices in at least some drunk-driving cases. The remaining three—Alabama, South Dakota and Vermont— lack such laws. If passed, the law could result in up to one million devices being installed.

While the legislation is backed by Mothers Against Drunk Driving, the Insurance Institute for Highway Safety and the Governors Highway Safety Association, the American Beverage Institute expressed concerns. The Institute’s managing director said, “As this creeping mentality about ‘don’t drink and drive’ as opposed to ‘don’t drive drunk’ takes over, you’re seeing more officers inclined to arrest people” who are not over the presumed threshold for intoxication. Critics also say the devices could present a financial hardship for first-time offenders.

From the States . . .

California Enacts Laws Extending Good Samaritan Protections August 7, 2009, California Governor Arnold Schwarzenegger (R) signed into law two bills, SB 39 and AB 83, which clarify the state’s 1980 Good Samaritan Law. The immediately effective measures were sponsored by Senator John J. Benoit (R-Bermuda Dunes) and Assemblyman Mike Feuer (D-Los Angeles). SB 39 provides legal immunity to emergency service volunteer workers who perform disaster services during a state of emergency; and AB 83 immunizes Good Samaritans from liability when they assist others at the scene of an emergency, regardless of whether the care provided is of a medical or non-medical nature, unless the person providing assistance acts in a reckless or grossly negligent manner.

Benoit and Feuer worked together to craft the bills following a December 2008 decision by the California Supreme Court that uncovered significant shortfalls in legal protections for Good Samaritans. The bills were sponsored by a wide coalition of supporters (including CAL-ENA) and received unanimous votes in both houses. According to Rancho Mirage physician Max Weil, “the Father of Critical Care Medicine,” the bills made “. . . an important correction of an anomaly in the earlier California law. Society depends on individuals willing to take care of each other as our brothers’ and sisters’ keepers without any fear of liability.”

Massachusetts Nurse-Assault Bill Progresses During a July hearing on the nurse-assault bill in Massachusetts, the Joint Committee on the Judiciary heard testimony

November 2009

Washington Watch Continued from page 6 on behalf of the bill, including that of Essex County District Attorney Jonathan Blodgett, who told the panel that nurses can be “spit at, punched and kicked.” In his prepared statement given to the committee, Blodgett detailed the experience of Charlene Richardson, RN, who was brutally assaulted in March 2003 by a patient she was treating in the Beverly Hospital ED. He wrote, “Three security guards, another nurse, two emergency room patients and a visitor intervened to pull the drunken and violent attacker off the nurse.”

Blodgett also said, “While we rightfully think of law enforcement and firefighting as being high-risk jobs, it is a fact that among those most susceptible to workplace violence are health care professionals.”

As it is, an assault and battery on a nurse is essentially seen as part of the job, and hospitals tend to discourage workers from filing charges, Richardson said. She had to press charges privately and waited 16 months before her attacker was convicted.

After the incident, Richardson would only work in the locked recovery room, and once vowed never to return to the ED. She now works to help others who have been attacked by patients and, having grown stronger emotionally, splits her time between the ED and the recovery room.

Senate majority leader Fred Berry (D-Peabody), one of the bill’s three sponsors, said, “This is very necessary.” He also said the statistics on violence toward health care workers speak volumes and that he was confident the bill would be an “easy pass.” He added, “I do think nurses are in danger. I think it’s a very hard bill to ignore.” If the Massachusetts nurse-assault bill passes, a person who attacks a health care worker could face up to two and one-half years of jail time, a fine of up to $5,000, or both.

Association of Staff Nurses and Allied Professionals, one of the bill’s sponsors, SB 742 complements the National Nursing Shortage Reform and Patient Advocacy Act (S.1031), which was introduced in Congress by Senator Barbara Boxer (D-CA) and seeks to standardize nurse-to-

patient ratios across states. A similar bill, HB 147, sponsored by State Representative Tim Solobay (D-Washington), is currently in the House Committee on Health and Human Services.

Pennsylvania Hospitals and their associations are opposed to the bills.

Advocates Press for Pennsylvania’s Staff Ratio Bill In Pennsylvania, advocates of SB 742, the Pennsylvania Hospital Patient Protection Act of 2009, are pressing for hearings. The bill would guarantee a minimum safe-staffing ratio of RNs per patient, similar to California’s law. Introduced by Senator Daylin Leach (D-Delaware/Montgomery), the bill is currently in the Public Health & Welfare Committee. According to Patricia Eakin, RN, president of the Pennsylvania

Official Magazine of the Emergency Nurses Association

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PEDIATRIC UPDATE |

Susan M. Hohenhaus, RN, MA, FAEN

RESPONDING TO THE THREAT OF PANDEMIC FLU IN PEDIATRIC PATIENTS I represented ENA and met with other pediatric stakeholders at the Center for Disease Control’s meeting, “Pediatric Healthcare Response to Pandemic H1N1 Influenza” in September 2009.

At that time, I posted an ENA pediatric listserv question, and, in response, the following early influenza season scenario was one of the first shared by one of our pediatric emergency nursing colleagues: 11:20 a.m.

• Every bed in the emergency department is full (60 kids); 14 kids are in the waiting room.

These numbers are fairly high for this time of the morning. These generally are our early afternoon numbers.

• There are four sets of 2-fers (2 kids in the family), two sets of 3-fers and two sets of 4-fers, so the entire family is coming in.

• None of the families is emergent, and all are here for either cough or fever, except for one of the 2-fers, who has abdominal pain.

The volume and passionate cries from our colleagues, especially those in pediatric emergency departments regarding this post, were the most overwhelming responses I have seen yet. Many issues came to mind: • Staffing • Separation of children and families with flu symptoms from other well children and families • Supplies needed for respiratory isolation (surgical masks in adult and pediatric sizes) as well as any other CDC-recommended personal protective equipment (PPE) for staff • Risk for misidentification of children because of sibling presentation.

Though the flu season is already well along, I think there may be many emergency nurses who will value my perspectives gained from many sources during the last few months.

Caring for Kids During Flu Season • It may be helpful that appropriate child-sized masks also are child-friendly. The child may be more willing to wear the mask when it is fun. It also is helpful for younger children to see older children wearing the masks.

• Consider how you will separate well from

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ill. Some facilities do not have the ability to separate patients, so they mask everyone; the well patients to protect them and the ill patients to prevent spread. Current guidelines suggest that a distance of 3 to 5 feet between patients will be helpful to decrease spread.

Other colleagues repurpose conference rooms to accommodate for high-risk well patients (cancer or other immune-compromised patients and their families, neonates, children with multiple medical problems and pregnant women). Most clinicians have patients and families remove masks when in the room because staff are implementing isolation guidelines; just remember that these children may leave the room at times (and sometimes unobserved by the nurse) perhaps to use the restroom or to have a diagnostic test performed such as an X-ray.

• Be aware that traditional nebulizer treatments used for respiratory illness may further spread

virus. A multi-dose, metered inhaler (MDI) may be more appropriate during active flu season.

• Someone needs to be responsible for assessing the “burn rate” for critical pediatric supplies. Patient mask inventory can be quickly depleted, especially if this is an unusually long flu season.

• During surge times, consider having a skilled pediatric triage nurse at the point of entry to the ED. This nurse can utilize a “simple” tool such as the Pediatric Assessment Triangle (PAT) to determine if a child is sick or not sick by using this simple, no-touch assessment tool (there’s a great YouTube video showing the use of this tool at: http://www.youtube.com/. Search watch?v=ssqwGjwSI_8. This is particularly important in small children, especially those younger than 6 months of age, who are at higher risk and will not receive vaccine.

November 2009

Younger children may have much more subtle signs and symptoms of flu than the traditional fever, cough and sore throat and need a skilled professional to assess their status.

Partnering Questions and Possible Solutions Question: How will you partner with the community to keep the worried well out of your ED and convince families that the ED is the wrong place to come for preventive/screening visits and mild symptoms?

Possible solutions: • Public service announcements (PSAs): Include signs and symptoms of flu virus infection—fever, chills, headache, upper respiratory tract symptoms (cough, sore throat, rhinorrhea, shortness of breath, myalgias, arthralgias, fatigue, vomiting or diarrhea), instructions on how to read a thermometer, importance of fluids and when to stay home/when to seek medical consultation.

• Teleconference daily briefings among pediatric care providers in the area.

• Implement social media tools such as Twitter to provide updates throughout the day highlighting capacity and critical needs.

• Work with local businesses (including your own hospital) about developing a non-punitive absenteeism culture for employees who have signs and symptoms of flu or who must care for family members who are ill and would pose a spread threat to schools or daycare centers.

Question: How will you communicate and partner with other pediatric care partners?

Possible solutions: • ENA connections can help facilitate partnership discussions. There are precious few pediatric resources available, especially those that are for children with critical care needs. We need to work together to use them for safe, efficient and just care for our pediatric patients.

For example, shortly after 9/11/2001, the American Burn Association (ABA) strengthened its national response plan, built burn response teams and now keeps track of burn beds nationally as part of the National Response Plan.

Even if you only know what the pediatric bed capacity is in your area, it’s a start. Knowing the pediatric capabilities of community hospitals will also be important. Some of you will need to care for sick kids even though it’s not what you normally do, simply because there is no one else to do it. Think of who your pediatric champions are—those nurses who do feel comfortable taking care of kids—and form mentoring relationships between them and those with less comfort levels.

Question: How will you partner with each other?

Possible solutions: • Routinely schedule status briefings about capacity, staffing and other needs, especially needs of children.

• Encourage “huddles” for key staff for problem-solving, which can include issues such as which team member may be overwhelmed, who may be exhibiting signs and symptoms of illness and others.

Resources • H1N1 Flu (Swine Flu): Resources for State and Local Health Officials http://www.cdc.gov/h1n1flu/statelocal/ • 2009 H1N1 Flu Situation Updates and FluView http://www.cdc. gov/h1n1flu/ • Locate all H1N1 Flu guidance document http://www.cdc.gov/ h1n1flu/guidance/ • Novel H1N1 Influenza: Resources for Clinicians http://www.cdc. gov/h1n1flu/clinicians/ • AAP’s Pediatric Disaster Preparedness http://www.aap.org/ disasters Susan M. Hohenhaus, RN, MA, FAEN, president, Hohenhaus & Associates Inc., shohenha@ptd.net

Join the Dialog As we work through this challenging time, remember that there should also be a level of professional and personal and family preparedness. Care for each other as we care for our patients. Keep the conversation going. Join the ENA pediatric listserv and monitor/ contribute to the dialog.

Official Magazine of the Emergency Nurses Association

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INJURY PREVENTION

ED Experts Reflect on Injury Prevention in the ED: THINKING BEYOND THE VIOLENCE A New Direction in the Works for Injury Prevention at ENA Practicing injury prevention with patients is part of the emergency nurse’s role and required for compliance with The Joint Commission’s Patient Safety Goals. Here, experts, including emergency nurses and an emergency department physician, address the state of injury prevention practice in our nation’s emergency departments and why ENA will be adjusting its focus relative to injury prevention initiatives.

In recent years, it has become clear that, while other organizations have programs and learning materials geared toward mitigating alcohol abuse, safe driving practices, enhancing gun safety and the like, they don’t have programs and learning materials geared toward emergency nurses as a profession and nurse/patient interactions in the ED. In response to this need, ENA has begun integrating ED-focused components in its injury prevention programs, along with the community-based component. These initiatives will include tools to help ED nurses recognize and develop healthy lifestyles and safe workplace environments. Based on guidance provided by the ENA board of directors, ENA will focus future injury prevention initiatives in a new direction, helping emergency nurses hold up a mirror, so to speak, to themselves regarding how to better take care of themselves so they can take care of their patients. While emergency nurses counsel patients on injury prevention, they rarely do the same for themselves.

“Nurses don’t do that very well [self-care],” says Sue Cadwell, RN, MSN, BSN, nurse manager, Hospital Corporation of America, and member of the ENA Injury Prevention Advisory Council (IPAC). “When we are educating our patients, we are sort of ‘the pot calling the kettle black.’ Another member of IPAC said that some of the highest risk-takers he has seen have been among ED personnel. We know better, but we smoke; a lot of us engage in unsafe driving practices…we do silly things, and I am not quite sure why that is.”

Another key emphasis will be a continued focus on practicing injury prevention inside the walls of the ED, and ENA is retooling current

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November 2009

products and developing new ones to support this unmet need.

“I think the nurses are providing injury prevention education to patients, but they don’t realize they are,” says Cindy Magnole, RN, injury prevention coordinator, Jackson Memorial Hospital, Miami Springs, Florida, and a member of IPAC. “I think we all do it, but I don’t think there has been any formal leadership or education in this, saying ‘this is how you do it’; education pieces like how you do it, why you do it. It needs to be more formalized.”

Cindy Magnole, RN “Change going into the ED in addition to the community, speculated Wendy St. John, RN, BSN, injury prevention coordinator, Wishard Health Services, Indianapolis, Indiana, “I think it is a good change for our patient population. When you are talking about emergency room nurses taking care of themselves…When you are talking about the emergency nurse profession… you are talking about taking care of other people, so we often forgot to take care of ourselves. It will be a big culture change for an emergency nurse to stop and take care of him or herself.

It will be changing a habit.”

Wendy St. John, RN, BSN

“I haven’t been at the bedside in years, and I do miss it. But I don’t miss the other stuff. I don’t miss the lateral violence; I don’t miss the physicians yelling at me. I don’t miss any of that. But I think there are people who lack the confidence to escape that or lack the confidence to address it right there, to address an ED worker or a physician and say it’s not acceptable for you to talk to me that way and to take it any further. It’s hard. It’s very hard to do that. And it’s one of the goals…We have to strengthen our membership to be healthy and safe, because we can’t take care of people if we lose compassion, if we are ill or mood-altered on the job or if we become impaired. We just can’t do it. So I think that is at the core of what ENA is looking at, embracing, in going forward.

“We are going to give the membership useful tools to help them move forward with growth and support…concrete things that they can cleave to that will help them address the problems better. We need them to understand that they need it. We need them to acknowledge that they are not alone out there.

“That acknowledgement will help some of them say, ‘Yes, this is not what it is cracked up to be. I have to do something to change my condition.’ That realization is absolutely key. So it’s an ongoing emphasis.

It’s funny that violence in the workplace has sort of morphed into more.

We’re not just thinking of violence anymore. We’re thinking about the overall health and wellbeing of our workforce. We have to. There are going to have to be some very concrete tools going forward. The goals that the institute put together will help it come up with the tools.”

Mary Pat McKay, MD, MPH, member of the American College of Emergency Physicians (ACEP) and associate professor, Emergency

Reflections on Nurse Health and Safety in the ED Stress may be part of the reason that emergency nurses do not always practice what they preach, says Cadwell. “We don’t debrief well after critical incidents, and I know there are some people who doubt the value of debriefing, but I don’t think we pay enough attention to the accumulating effects of that sort of relentless stress day after day after day that both our psyches and our bodies go through that is so difficult to manage…I think it is the unpredictability that is so difficult to manage. You never know when something is going to come through the door that is absolutely hideous and, god forbid, you may know the patient. It is difficult to prepare for that.

You never know when something is going to come through the door that is absolutely hideous…

“If you work on an ICU or Med-Surg floor, and I have done both so I can speak to this, you know what to expect for the day. But in the ED, you learn to expect the unexpected, and sometimes that unexpected turns into dread and then a little bit afterward the proverbial blowing off of steam.

“We are not very well-equipped as a profession to recognize when we may be feeling this kind of stress. I think we have to pay more attention to that in the educational process and not just take a token hour at a conference, but really deal with stress—taking a good look at your behaviors and what those behaviors entail and what is the genesis of those. Turnover of ED leadership is well-documented, and I think that the ENA is looking at what drives that in regard to stress, either on or off the job, and will address some of that.

Official Magazine of the Emergency Nurses Association

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ED Experts Reflect On Injury Prevention Continued from page 11 Medicine and Public Health, director, Center for Injury Prevention and Control, George Washington University, sees nurses being negligent with their own wellbeing in the ED every day. “The lifting issue and pulling,” she notes, “all of those are big issues when you look at lost days and productivity. When someone is out with an injury, and, certainly it is no fun for the person who is hurt, it is a problem for everyone else.

When that person is out or on light duty, it is more work for everyone else.

“Is the issue that people are asked to do things that are physically difficult for them, or is the issue that people are going about the process in a physically inefficient manner? I would suggest that it probably is a combination of both things. I don’t know if they [emergency nurses] are getting any training on this. It certainly sounds like a reasonable thing to do, particularly since, in nursing school, they learn how to give a bath, log roll a person and put in a Foley, and this kind of stuff, particularly large patients who have body parts hanging in the way. I don’t know if it formally is a part of nursing education.

It sort of is a no-brainer to me that it should be.”

McKay suggests that EDs build a culture of collegiality where everyone helps each other. “It is creating a social work environment where it is viewed as you don’t do this by yourself. You get someone to help you, and when someone asks you to help them, you go help them, whether it’s getting a patient back in bed, out of bed or whatever. I think the nurses who run into physical difficulty have to deal with the obstreperous patient, the person who is demented or is high on PCP or is psychotic and needs to be restrained. I think that it is the time when there is a risk of injury for nurses. It’s being willing to say ‘This isn’t right, this isn’t safe, I need help.’

There are EDs like the one in which I work now where you say you need help, and, no problem, everyone is right there. In other places I have worked, it is less collegial, frankly, and you hear ‘I’ll be there in a minute’ or ‘Why do you keep interrupting me?’ I think it’s a matter of working so that these are recognized as safety issues so they are important rather than ‘Why can’t you do it yourself?’

“There are injuries that happen at work that affect productivity and those that don’t happen at work that affect productivity,” McKay adds. “If it does happen when they are on duty, it may be a nurse who says ‘I’m not going to do that anymore because I got hurt the last time.’ It’s not unreasonable. It clearly has an effect on the workflow and the pattern of work for other people in the department. ‘I’m not going to put this 400-lb person on the bedpan, particularly if there is no one to help me, because last time I pulled my back out.’ But, of course, he/she shouldn’t do it by her or himself in the first place. If you have [a patient] who can help lift

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himself it’s one thing. But if he can’t, then obviously it’s a different endeavor.”

Reflections on IP Within the Walls of the ED “The opportunity for addressing some patient behavior in the ED is significant,” says McKay. “It does appear that there is time for the patient who is not dependent on a substance. So if they are truly dependent on alcohol, talking to them in the ED is not going to change their behavior, but if they are not dependent and they have had an injury as a result of poor judgment, there is an opportunity for making the relationship between the event and the error in judgment very clear to them. About one-third of people will change behavior after that, even without a lot of other interaction. Now do we know what the best way to convey the information to the patient is? No. “For some patients, one conversation is not going to motivate them to quit smoking, for instance. But receiving the same [information] different times from multiple people does help some people move through the process of changing their intentions and then changing their behavior. And it really applies to smoking, seat belts, even safe gun storage and, obviously, driving issues and motor vehicle injuries. So there is an opportunity during the visit or during discharge that the nurse can have a conversation with the patient about their understanding of how their behaviors were associated with the act …The nurse really is perceived by most patients as being a little bit more addressable, a little bit more like them, than the doctor, who may seem less approachable, and so if the patient gets the same kind of message from the nurse, from the doctor and maybe from the parents, from their partners or sibling or spouse, those are the kinds of things that we know leads them to address the behavior piece.”

“Integrating injury prevention into everyday practice is something that I hope all nurses are doing,” says Barbara Foley, RN, MS, founder of EN CARE. “We always think it is too late when they come to our doors, but we can help prevent injuries. We have many teachable moments while providing care to patients and their families. We can certainly advocate for safe and proper child car-seat usage and things like that in our ED. When I first became an emergency nurse in New England, kids would come in placed in their car carrier in big bulky snowsuits, but I did not know that if in a crash, the harness would not hold them in the seat with the snowsuit on. I had to learn that that was improper usage.”

“Two-thirds of ED visits are related to injuries,” adds Magnole “They keep surging our EDS, so why do we want to do it [injury prevention], how do we want to do it? When is it the right time? Is it during triage? No. It’s once the patient is stable, and you have established that relationship with that patient. You don’t want to hit them with it: ‘Why weren’t you wearing your seat belt?’ We want to do it throughout the course of their stay. But we have to arm our nurses with the knowledge and the tools in order to be effective—either to provide them with the literature that they can hand to the patient to take home or that they can review while they are in the ED. “If you say you don’t have time to do this, it is like saying you don’t have time to give medication, because IP education is providing care. It literally only takes moments to do this, and you don’t have to set time apart to do this. Providing IP education should be done while you are providing routine care, while you are doing your assessment or while you are doing your vital signs. You are not going to do this while the patient is crashing. This is going to be done while the patient is somewhat stable, but it should not be done at time of discharge. At time of discharge, all the patient wants to do is to get out of the ED. You want to do it beforehand.

That’s true with any education.”

“I think it is good to be connected to injury prevention activities in the community, but most emergency nurses are busy,” says Anne Manton, RN, APRN, PhD, FAEN, FAAN, mental health nurse practitioner Cape Cod Hospital, Cape Cod, Massachusetts, and former ENA president. ”They may be working and going Anne Manton, RN, APRN, to school or have PhD, FAEN, FAAN

November 2009

family responsibilities or have other outside interests, and, while I certainly admire those who do it, I think that most of us don’t do it because of other commitments in our lives… I think a lot of times, we are redundant in some of our efforts. An example is our IP activities with children’s car seats: Safe Kids has been doing that for a long time. So we are doing it, too, but we don’t get the same PR, the same kind of reception, and then we get frustrated.

“I think that what might be better to do…is to create a list of community resources for patients that emergency nurses can refer patients to. I run into that all the time, and I have lived and worked in my current setting for five years now. I am still constantly finding out there is such and such a group in my surrounding communities that provide services that would be helpful to the patient. I think that if emergency nurses did have a little extra time, just creating a list of agencies and resources that nurses could refer people to would be extremely useful. Then nurses could give patients two or three places to contact to meet their needs. It could be posted in the nurses station for easy access for all.”

“Emergency nurses do injury prevention,” says St. John. “A lot of times they don’t realize it, and a lot of times they don’t take credit for it—talking about what changes the patients make in their lives. Sometimes in a quick scenario you have to do something that is lifesaving and you forget about using your legs when lifting a patient to put pads underneath him or her. I really think that some bullet-point education and re-education like ‘Remember that six months ago we did this and…’ would help.

“I think what is feasible to do in the ED is up to the department. I work in a larger facility where we see more than 350 patients in the department a day with more than a hundred and some employees. There is a lot of information that has to go out, and it seems that at a staff meeting that is supposed to last no longer than 10 or 15 minutes, it is really hard to get all of the information out.

“You are going to laugh at this, but probably one of our best communication tools is putting an announcement in the bathroom on the toilet stalls. It depends on the age of the nurses. Some of our younger nurses are very connected electronically, and they would rather have it in an e-mail message, in a PowerPoint™ presentation with an opportunity to ask

questions, than they would in a paper handout.

“I think you have to tailor the education to your department. If it is a small number of staff members, I think you can absolutely expect the manager to provide that information, and with our staff, I think we would probably do a couple of different things to make sure that we are reaching all of our staff. We would use the different media as well.

“I will tell you that one of the biggest things that I hear from the staff is that they are so focused on taking care of injuries that they don’t

Official Magazine of the Emergency Nurses Association

have time for injury prevention. ‘I barely have time to do all my meds and what have you, let alone adding some injury prevention.’ They do it but they don’t realize it sometimes. It is not necessarily formal.

“But on the other side of that, they have to capitalize on the teachable moment. If they take two minutes of a person’s life, that could change a person’s life. We are not talking about a half-hour presentation. If you ask a patient about Continued on page 14

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Injury Prevention Continued from page 13

their behaviors and why they ended up in the ED, maybe that will get that person thinking about making some changes in his or her life, and it could only be a one- or two-minute conversation, especially since the bedside nurses care for that patient. The patient trusts them; they are open and listening to them.

“If it’s a matter of trauma injury, no one expects to walk out the door and be hit by a car or be shot or stabbed or what have you, and so they are quite afraid a lot of times…Take that teachable moment when they are attentive and open to make changes in their life. Those two minutes can make a huge difference in a person’s life. That could change everybody, that’s for sure. I have always told the nurses, if you change one person’s life, isn’t that enough?”

Reflections on Patient Safety Goals In reference to Patient Safety Goals, Manton says, ”I have heard nurses be frustrated with medication reconciliation because it is time-consuming, but it is also a wonderful opportunity to get some teaching done, for preventing problems, so there is a silver lining. IP would not usually be a formal program in the ED, but I think just raising the nurses’ consciousness that what they are doing is in fact injury prevention is important. Discussing how people are taking medication, where they are keeping it, whether there are any side effects is, in fact, injury prevention. So, even the things that you have to do, perhaps with some reluctance, can be made more palatable and rewarding. The emergency nurses are then not just creating this list of medications, but doing some patient safety education at the same time.”

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“Every time emergency nurses do screenings for alcohol or abuse or risk assessments for suicide or simple injury prevention, they are using opportunities to provide education at these teachable moments,” says Pierre Désy, MPH, CAE, director of the ENA Injury Prevention Institute. But, it has to be documented, because the document-record codes end up in state trauma systems, which become part of the national trauma system.

“The Centers for Disease Control (CDC) collect the data: Was it a suicide attempt or overmedication? Suicide or a bad reaction? If the nurse does not ask these questions and document it, proper coding does not result and appropriate inventions are not developed,” Désy adds.

ENA has been proactive in addressing many ED issues by developing products to help emergency nurses practice IP in the ED, for example: The Joint Commission’s National Patient Safety Goals: • Goal #3: Improve the Safety of Using Medications. ENA Product: SAFER Med Use program • Goal #9: Reduce the risk of patient harm resulting from falls. ENA Stand Strong for Life Product: Falls Prevention program • Goal #15: The organization identifies safety risks inherent in its patient population. ENA Products: SBIRT Toolkit; Suicide Prevention Web Seminar

Reflections on the Big Picture “Injury prevention goes beyond the ED,” says Magnole. “You are decreasing hospital admis-

sions and freeing up hospital beds when you prevent avoidable injuries in addition to doing what’s best for your community.

“I think both nurses and administrators must buy into it and support this educational component of the patient and staff, Magnole adds, “and I think the way you do that is by showing them the numbers. You know, ‘Injuries cost this much money…,’ and you add that ‘with the economic downturn and the health care crisis, how many of these patients are uninsured?’ Injury prevention needs to be addressed throughout the hospital, just as we would address a hypertensive or diabetic patient.

You continually remind them of the reasons why they have to continue to take their medicine and monitor their diet; and injury prevention is not being treated the same way.

“I think that ENA has to be the leader in injury prevention, out front for everyone, not just for the nurses. No one is talking about injury prevention as a whole and how it affects not just the ED but the whole hospital, and I think that ENA should serve that role. Emergency nurses are well-respected. You go to a community meeting, and when you say you are a nurse, and you are looked upon with this new-found respect, the community will defer to you. And when you say that you are from the emergency department, it raises the level completely. I think we need to empower our nurses to understand that we have influence. ENA can empower our nurses to go out and do something about it, but we must teach them how.

“We can be the leaders. We are in every community across this country. We are in every neighborhood. We are like libraries in that sense, plus we are open 24 hours a day, seven days a week.”

“We [ENA] are helping emergency nurses find purpose in doing IP,” Manton adds.” Yes, they [emergency nurses] certainly can take this to the next level by formalizing it... They can do seminars for staff in the hospital... Most hospitals have newsletters that let people be recognized (not to pat people on the back, though that always is a good idea) to let others know what emergency nurses are doing both for themselves and patients to prevent injuries and maybe give little suggestions as to how others can follow their example.”

ENA Looking Forward ENA conducted a survey on workplace injuries among emergency nurses and will release its findings in February 2010. ENA staff will continue to work with the ENA Injury Prevention Advisory Council and the ED Workplace Injury Work Team to develop new initiatives that will provide tools to prevent workplace injuries among emergency nurses.

November 2009

It Takes Two to Tango Mary Kamienski, RN, PhD, APN, CEN, FAEN Jack Rodgers, RN, BSN, NREMT-P

The Academy of Emergency Nursing EMINENCE Mentoring Program facilitates mentoring relationships between a limited number of active ENA members and academy fellows. During a structured mentorship of up to one year, experienced emergency nurses looking for professional development opportunities are matched with fellows who have similar interests and appropriate experiences.

View From the Perspective of the Mentor A marriage made in heaven? Or would this result in a no-fault divorce? That was the big question when Jack and I met in Minneapolis a year ago.

I was unsure if I really had anything to offer him. As we chatted, my anxiety level rose even higher. It definitely was unclear who would be the mentor in this relationship. In spite of my many years of developing and delivering presentations, I wasn’t convinced I could really help Jack achieve his goal to become a presenter at ENA conferences.

After a few minutes, Jack told me he was a paramedic turned nurse, which already brings a different perspective to his knowledge base. But the most alarming piece of information came when Jack handed me a card that said his third career was as a local television sports broadcaster. Now what in the world was I going to offer a professional speaker?

We both decided that it was definitely worth a try, and it has been a marvelous trip. My expertise lies in developing objectives and content that meets the needs of the identified audience. In other words, who was his intended

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audience and what did he want to say to them?

Jack had many wonderful ideas and even some already-developed programs.

We both decided to quickly prepare and submit proposals for the ENA Annual Conference, as the deadline for these proposals was imminent. Using electronic communication, we accomplished so much and submitted proposals on time. Although we were not successful this first time around, we will try again. However, Jack developed and submitted proposals to the Southeastern Seaboard Symposium (SESS) and was accepted.

His speaker evaluations were outstanding.

He has developed presentations on DUI, family presence and several other topics. His presentation on the impact of DUI on adolescent populations was made into a CD, and he shared this with me. I, in turn, shared this with my grandson for his high school health fair, and it was a smash hit (no pun intended).

View From the Perspective of the Mentee I get e-mails from ENA all of the time announcing committee and faculty calls and educational and conference opportunities. I read them all, but have never really felt compelled to act on any of them. When I got one last summer announcing the new EMINENCE mentoring program, I responded.

I do not know what made me think I had any chance to be chosen. After all, there are more than 36,000 members in this organization, many of them with years and years of experience in both the profession and the association. I was a newcomer only three years out of nursing school and had been an ENA member for less than a year.

I went on with life after submitting that application in June 2008, never expecting to hear anything more about it. Then, a phone message

came in early August. The voice on the answering machine was not a familiar one. The lady on the other end of the phone identified herself as Dr. Mary Kamienski, a member of the Academy of Emergency Nursing. She told me that my application to the EMINENCE program had been received and reviewed, going on to say that there were many applicants for the few available spots. When I heard that, I figured it was nice of her to call with that rejection notice, and I reached for the erase button on the answering machine. At that point, I heard the part of the message from Dr. Mary I was not expecting: “I’ve been assigned to be your mentor, that is, if you’ll have me.”

That phone call was just the beginning of an incredible yearlong educational experience.

We e-mailed a couple of times during August as we prepared for our first face-to-face meeting, scheduled for the day after the 2008 Scientific Assembly in Minneapolis. But I am an impatient guy. I couldn’t wait a week to find Dr. Mary. So I found a picture of her on the ENA Web site and set off in search of my new mentor as we both opened the week serving as delegates represent-

November 2009

ing our respective states at General Assembly.

I ran into her before lunch on Wednesday, so she could put a face with my name. I spent the rest of the week being led by the hand and introduced to everybody who moved as “my mentee.”

Our first official get-together as mentor and mentee came the following Sunday. While conference attendees were heading to the airport to make their way home, the new crop of mentors and mentees huddled at a nearby hotel. I realized when I walked into that meeting room how fortunate I was to be one of the 10 selected from across the country for the EMINENCE program. You cannot imagine how humbling and stressful that was all at the same time. I was in awe of the quality and character of the nursing leadership in that meeting room.

Also, I had an overwhelming sense that there were going to be some big expectations to live up to as I took part in the program. After spending a few minutes getting to know everybody in the room, Dr. Mary and I got to work.

We were paired together because of a mutual interest in developing professional educational presentations. I think my fascination with the subject had been piqued listening to a number of excellent speakers at the previous year’s Scientific Assembly in Salt Lake City. I have been an instructor for a long time in several EMS disciplines, as well CPR and ACLS, but I have never taught or presented material that I had developed on my own. I wanted to give it a try, but I had no idea where to start when it came to putting something like that together.

We spent three hours together getting to know each other that Sunday morning. We talked about interests and hobbies and experiences. Then, we set goals, both short-term and long-term. As for the near future, Dr. Mary asked me to think about some topics that I had an interest in developing into presentations. We would talk about those interests and refine some initial ideas over the coming months, all of it with the long-term goal of presenting a topic at an educational conference at some point during our new working relationship.

We had a chance to spend some time together again as we both made the trip to Reno for Leadership Conference 2009. We talked about our progress toward the goals we had set a few months before, but we also spent a lot of time talking about the things we face on a daily basis when we go to work. We talked about our organization and offered thoughts on its challenges and direction. Dr. Mary also introduced me to the people who ran the show—board members, past presidents, committee leaders, conference speakers. You know, the kind of folks new members like me think we will never get to meet, much less have dinner with and

spend quality time with. That week in Nevada offered me more networking opportunities than I ever thought I would ever be able to develop on my own over the course of my career, thanks to Dr. Mary.

The next few months brought tons of contact through e-mail. We bounced ideas off of each other. I would dream up a concept and develop an outline, then forward everything to Dr. Mary for her input. She offered opinions and guidance and was a huge help as a resource, having presented and published herself on many occasions. She was supportive to the point of being a cheerleader, encouraging me to push on, even though my first few submissions were not accepted for presentation.

The perseverance paid off in May of this year. Two of my submissions were selected for presentation at the Southeastern Seaboard Symposium (SESS) in Orlando. I was honored to be listed as faculty alongside notables like ENA President William T. Briggs, Jeff Solheim and AnnMarie Papa. I do not think any of it would have been possible without the support of a mentor such as Dr. Mary.

Not only have we developed a strong professional relationship because of our mentormentee partnership and desire to develop professional presentations, we have become friends. I hope that at some point in the future, I will have the opportunity to serve as a mentor to someone with the passion to step up and take advantage of a program like EMINENCE and assist him or her in achieving goals. Just like Dr. Mary has done with me.

Official Magazine of the Emergency Nurses Association

From the Mentor Our year is over now. We met our goals and more. We are now contemplating a shared presentation on the relationship between the paramedic and the nurse in the emergency department and the mentor-mentee relationship.

We also are considering writing an article or developing a presentation titled “A Redneck Guide to Medical Terminology” (Jack’s idea).

Jack and I have bonded beyond the mentormentee relationship. We will continue to try to develop shared work. We will continue to review each other’s ideas and program proposals. Our pre-nuptial agreement said we would be done in 12 months, but we have moved beyond that into a different realm.

Becoming involved in a mentor-mentee relationship ideally should be a two-way street.

Both parties should gain something from the arrangement. We highly recommend taking a chance and becoming a mentor or a mentee.

The rewards have been far greater than we anticipated. Our horizons have expanded, but we also feel that we have made a contribution by helping each other take the next step. Electronics makes it a very doable project. We met in Minneapolis and again at Leadership in Reno.

All of the rest of our communication was online.

It is your turn now. EMINENCE will be seeking applicants in the first quarter of 2010 who are interested in being mentored and individuals who have expertise in certain areas and are willing to share that experience. It is worth every minute!

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IF I WERE A CANDIDATE FOR A

NATIONAL ENA ELECTED POST Benny Marett, RN-BC, MSN, CEN, CCRN, FAEN, 2000 ENA President, 2008-09 Nominations Committee Chair If I were a candidate for the upcoming national ENA election, I would ask a few favors of you as ENA members. I am officially not a candidate, but if I were a candidate, I would first ask you to read about each candidate and learn all that you can before the voting begins. Candidates are asked to submit vital information, including ENA activity, answer ENA-related questions and describe their views on selected topics. I would ask members to read about each candidate thoroughly and vote for the most-qualified,

best-prepared candidate. As a candidate, a great deal of work is required to prepare all the necessary information. To best serve ENA and its members, an elected official must be the best for the job. Read every word, look at every qualification, look at ENA history and make an informed decision as to who can best represent you, the member, and the profession of emergency nursing.

Second, I would ask you to review the National Candidate Publicity and Campaigning

Call for Paper and Poster Abstracts

2010 S CIENTIFIC A SSEMBLY Research

San Antonio, Texas September 22-25, 2010

Evidence-Based Practice

Poster Award Program

Submission Deadline: January 15, 2010 Online: www.ena.org/research/abstracts E-mail: abstracts@ena.org Telephone: 800/900-9659, ext. 4119

Policy. Other than the spoken word, ENA friends cannot campaign for candidates. Items including, but not limited to, broadcast e-mails, posters in every mailbox, mailings to 36,000 members and even personalized pencils are prohibited. The rules are very well-defined, and the National Candidate Publicity and Campaigning Policy is on the ENA Web site, easily accessible to all members. Please help all candidates by following the rules.

Third, as a candidate, a great deal of effort and humility is required to participate in the Candidates Election Forum during the ENA Leadership Conference. In February 2010 in Chicago, all board candidates are invited to participate in a question-and-answer session, and are given high visibility with members for individual consultation. Please make plans to attend this wonderful event and think positively about the beautiful weather in Chicago in February. If you are not able to attend, you may view the audio and video of the forum from the comfort of your home or office via posting on the ENA Web site following the Leadership Conference.

Fourth, you as an ENA member can ask candidates specific questions during the election period. The Members Only section of the ENA Web site has a designated area for candidate questions and responses during the election voting period. This is a great time to learn about each candidate’s specific views on topics you feel are important for our profession and to our ENA leaders. All ENA members are encouraged to take advantage of this opportunity.

Finally, the favor a candidate really needs is for ENA members to vote. In our past few elections, our elected officials have been elected by about 10 percent of our membership. Again, if I were a candidate, I would really want to know that I had the support of a majority of ENA members, although I would definitely appreciate the 10 percent, or maybe 12 percent. As stated earlier, I am officially not a candidate, but the favors still apply to all candidates. I look forward to sitting back and watching a fair, honest election, reading about each candidate, listening to all information and voting for the best future leaders of ENA. Good luck to all candidates. May the best candidates win!

081109

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November 2009

ST. ANTHONY’S SUPPORTS ENA MEMBERSHIP

ENA enrolled 31 new members from St. Anthony’s Medical Center in St. Louis, Missouri, in July 2009.

“St. Anthony’s has committed to an initiative to provide educational opportunities for its employees,” said Dawn Wotawa Bennett, RN, BSN, staff development educator for Emergency and Pediatric Services.

“Under the guidance of Sherry Nelson, RN, JD, MS, vice president of Patient Care Services and chief nursing officer, the plan is to assure that what nurses do is seen as a profession, not just a job.”

When ENA launched its membership drive, Bennett helped launch a similar drive at St. Anthony’s. Out of a staff of some 80 emergency nurses, only about 10 were ENA members. In a gesture of support, the St. Anthony’s administration offered to pay the membership fee for any emergency nurses who wanted to join. Thirty-one nurses Fifteen of the 31 St. Anthony’s emergency nurses who recently joined ENA posed for a photo in one of the medical center’s trauma took advantage of that opportunity, rooms. Pictured (front row, L to R) are: Amanda Weathers, RN; Nancy Hamburg, RN; and Deb Weingartner, RN; (middle row, L to R): Jennifer Jarvis, RN; Jennifer Earley, RN; Kim Smithee, RN; Dawn Wotawa-Bennett, RN, BSN; Rita Srum, RN, BSN; and and seven more have since joined, bringing the total membership to 48, Krista Vincent, RN, BSN, EMT-P; and (back row, L to R): Kim Najbar, RN, MSN, FNP; Stacia Smith, RN; Douglas Gibson, RN; Barb which is more than half of the entire Houska, RN, CEN; Carrie Balance, RN, and Linda Pullen, RN. emergency nursing staff.

“We felt it was important to have Besides publishing its own magazine, which “The CEN certification is important, because a professional organization that emergency nurses offers nurses a national forum to discuss their it recognizes that a nurse has received extra could look to to receive education, support and ideas and methodology, ENA also provides education and has passed a test,” Bennett said. evidence-based practices,” Bennett said. research grants and educational scholarships “A CEN is considered a certified expert in “Emergency nursing is so different from other through the ENA Foundation. Members provide emergency nursing.” nursing experiences. Patients don’t plan on government and community awareness and coming—they don’t wake up in the morning and advocacy through work groups, special interest say, ‘I’m going to the emergency department groups, committees and public policy settings. today.’ We get some of the sickest patients The Board of Certification for Emergency walking in the door—trauma, cardiac and stroke Nursing helps support nurses in their efforts to The article, “ENA’s Staffing Standards,” in the patients. We see every type of disease and injury. achieve their Certified Emergency Nurse (CEN®) October 2009 issue of ENA Connection Sherry and Rita Srum, RN, BSN, our ED director, credential, a worldwide professional recognition. incorrectly stated that United American agreed that it is very important that our nurses Bennett helped organize a committee at Nurses (UAN) and National Nurses Organizbecome part of a professional nurse organization.” St. Anthony’s to design a review course that will ing Committee (NNOC) had advocated for All of St. Anthony’s emergency department help prepare emergency nurses to sit for the nurse ratios in the state of Oregon. While nurses currently hold the internationally recogCEN exam. They plan to offer the CEN review UAN and NNOC support nurse ratios nationnized trauma certification TNCC (Trauma Nursing course and testing some day to nurses outside ally, they have made no specific legislative Core Course), an ENA course designed by nurses the hospital and also to offer a Certified Pediatric efforts in the state of Oregon. ENA Connecfor nurses.

Emergency Nurse (CPEN™) review course. tion apologizes for the misinformation.

Correction

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November 2009

HAND HYGIENE IN THE EMERGENCY DEPARTMENT: A Fun, Participative Approach to Promote Good Practice Amy E. Kaiser, RN, BSN, Supervisor, Emergency Department, North Memorial Medical Center, Robbinsdale, Minnesota Promote Hand Hygiene Week in the ED—“Germbusters” theme Place additional signage in ED as visual reminders of good hand hygiene practices

E. coli, klebsiella, enterococcus, staphylococcus: What do these all have in common? These organisms are found in most patient care areas, are spread to patients and can be the source of many patient deaths in hospitals around the country. That is why it is vital to perform good hand hygiene practices to prevent the spread of infection to ourselves and to our patients.

In a recent informal phone survey by the emergency department leadership team at North Memorial Medical Center in Robbinsdale, Minnesota, it was noted that many EDs struggle with good hand hygiene practices, primarily due to the frequency of moving about from patient to patient and the reluctance of staff to use alcohol-based rubs or soap and water after each contact with a patient and/or environment.

During an impromptu audit of ED staff composed of emergency nurses, physicians and technicians, the ED leadership team learned that staff was not as compliant with good hand hygiene practices as it should be. Staff was using an alcohol-based foam product, but not before or after each encounter with the patient or environment.

The staff seemed to know that hand washing was important, but was not consistent in how it practiced good hand hygiene. We also identified a need for more opportunities for staff to use the alcohol-based foam.

During a subsequent audit, staff received a survey to test its knowledge of good hand hygiene practices and the process by which we prevent the spread of infection. It was concluded that the ED staff needed more information about

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good hand hygiene practices, including descriptors of how to use an alcohol-based foam and gentle reminders of the importance of this process in general.

A Hand Hygiene Initiative was established, and a team consisting of nurses, physicians, technicians and health unit coordinators was formed to continue to gather information about staff’s knowledge of good hand hygiene practices and to create a plan to improve compliance with good hand hygiene.

This team met weekly, generating ideas about how to involve the staff and engage members to the fullest. It was decided that a fun and participative approach was necessary to capture the audience’s attention and hold staff accountable for making good hand hygiene a way of life in our ED. The plan was created based on information gathered from the Institute of Health Care Improvement, Centers for Disease Control and the World Health Organization. Plan elements included: Evaluate alcohol-based foam locations and add foam and holders in various areas in ED: • All dirty utility rooms • At entrances and exits to all patient rooms and patient contact areas • Other areas at request of staff Add lotion to be placed throughout the ED • At all sinks alongside soap dispenser, including private and public bathrooms • At all workstations

Over the course of a month, areas in the ED and patient rooms were cultured, alerting staff to the importance of cleaning hands and noting the possibility of the spread of infection just by touching the environment. Staphylococcus and fungus were found on various items that the staff touched, including phones, keyboards, countertops and door handles. We posted pictures of the cultures to accentuate our message.

Our leadership team approved the Hand Hygiene Week concept. We chose to hold the event during August to be able to manage staffing and to not coincide with any other ED initiatives. We planned Hand Hygiene Week as a fun, educational event that would require participation of all staff and reinforce the importance of good hand hygiene practices.

Hand Hygiene Week involved moving all staff through stations focused on various topics. Our vendor provided product samples, which we distributed to each staff member upon completion of the stations. Stickers, balloons, candy and other items promoted our fun-filled week of events.

Stations were set up in three patient care rooms used infrequently. We decorated rooms with the posters we intended to place strategically throughout the ED after the promotional week, and we decorated entrances with balloons and streamers to attract our audience. ED charge nurses helped staff, including physicians, rotate through all the stations. Each staff member received a game board to be stamped at the completion of each station; all stamped game boards were entered into a daily drawing for candy.

We also chose to adopt the “5 Moments of Hand Hygiene” by the World Health Organization to promote good hand hygiene practices in the ED. The elements of our promotional week are listed below:

North Memorial Emergency Department Hand Hygiene Initiative—Hand Hygiene Week, August 2009 Knowledge Assessment (test questions) Demonstrations • Ask each staff member to review the knowledge assessment and complete questions • Review questions and answers with staff members

November 2009

Topics of Discussion • Engage in discussion about: – The importance of good hand hygiene practices – Opportunities to learn about how germs are spread throughout the department and to our patients Tips for improvement • Utilize proper hand hygiene techniques at all times • Use alcohol-based foam as standard hand hygiene product, using soap and water as indicated • Promote culture change to remind each other to use proper hand hygiene practices • In future, annual hand hygiene competencies will be created for I-Learn Evaluation and Discussion • Give each staff member stickers to promote good hand hygiene and proper foam use • Inform staff that permanent posters will be displayed throughout the department as reminders for good hygiene practice Glo-Soap Demos Demonstrations • Ask each staff member to hold out his or her hands while you squirt one pump of the glo-soap lotion on his or her hands.

• Ask staff members to rub the glo-soap on their hands.

• Ask staff members to wash their hands with soap and water.

• Use black light to provide proof of effectiveness of hand hygiene practice.

Topics of Discussion • Engage in discussion about: – Understanding the importance of adequate and necessary hand washing – When to wash with soap and water and when to use foam – Understanding the ED standard (“5 Moments”) is essential Tips for improvement • Make sure that staff understands the need to perform hand hygiene adequately using the “5 Moments of Hand Hygiene” • Inform staff that it will be audited daily on hand hygiene practice • Audit results will be posted weekly to monitor compliance • Rewards will be given to good performers and role models Evaluation and Discussion • Give each staff member the “5 Moments” badge card • Inform staff that the “5 Moments” will be posted in every patient room and throughout the department “Guess Your Germ” Jeopardy®/Infection Prevention Demonstrations • Ask each staff member to review the pictures you have displayed from cultures taken in the ED to those found in literature.

• Staff must try to guess which germ is associated with each picture, using a multiple-choice option (like Jeopardy® game) • Show staff member results of his or her guesses, discuss the diseases associated with each organism displayed Topics of Discussion • Engage in discussion about: – The cost of MRSA and other hospital acquired infections, regarding the cost to the patient, as well as the facility, including CMS reimbursement information – Discuss scenarios where staff can contaminate hands and transfer the contaminate to another object – Current hospital MRSA rates – Review hospital policy on Principles and Practices of Infection Control Tips for improvement • Utilize proper hand hygiene techniques at all times • Use alcohol-based foam as standard hand hygiene product, using soap and water as indicated

• Remove all artificial nails, and natural nails must be short, clean and neat • Wipe down surfaces frequently Evaluation and Discussion • Utilize Infection Prevention staff as able • Give each staff member stickers to promote good hand hygiene and proper foam use • Inform staff that permanent posters will be displayed throughout the department as reminders for good hygiene practice Foam Demos Demonstrations • Ask each staff member to place in his or her hands the amount of foam he or she typically uses.

• Explain to staff member the desired amount of foam product. Show pictures of desired amount of foam product.

• Ask staff member to practice applying desired amount to his or her hands.

Topics of Discussion • Engage in discussion about: Continued on page 25

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Official Magazine of the Emergency Nurses Association

10/22/2009 2:29:15 PM

23

STATE CONNECTION Illinois State Council Submitted by Sharon Iben, RN, BSN, CEN The Illinois State Council is pleased to announce a new educational opportunity in Springfield, Illinois: Our fall symposium will be held November 13, 2009. This one-day continuing education opportunity for nurses will cover such topics as sepsis, trauma, pediatrics, ED bouncebacks and more. Our keynote speaker, Donna A. Redding, RN-BC, PhD, will address gallows humor in her presentation, “That’s Not Funny… or Is It? Gallows Humor in Emergency Health Care.” More information and registration are available on the Illinois ENA Web site at www.illinoisena.org.

The Illinois State Council is gearing up for ENA Leadership Conference 2010 in Chicago February 17 – 21. Even though the weather may be frightful, Illinois members will make our Windy City guests feel delightful.

The Illinois State Council will host a blog on our state Web site to share insights about Chicago events. Several members will be available at a welcome desk to direct attendees to the best places to eat and shop and all the famous Chicago tourist spots. If you plan to attend Leadership Conference 2010, visit www.illinoisena.org to get a glimpse of what Chi-Town can do for you.

Minnesota State Council Submitted by Joan Somes, RN, PhD, CEN, FAEN The Minnesota State Council Pediatric and Trauma Committees held their annual TNCC/ ENPC (Trauma Nursing Core Course/Emergency Nursing Pediatric Course) instructor luncheon August 20, 2009, in Hugo, Minnesota. Approximately 35 instructors enjoyed a meal and the opportunity to visit and be updated on teaching ENA courses in the state.

Attendees also received a thank-you gift. In keeping with the flip-flops theme, which started

24

when ENA members wearing flip-flop sandals stormed the state capitol earlier in the year to promote seat-belt legislation, each instructor received a flip-flops coaster from Minnesota State Council President Joan Somes, RN, PhD, CEN, FAEN. Somes is a TNCC, ENPC and CATN (Course in Advanced Trauma Nursing) instructor.

North Carolina State Council Submitted by Mary Lou Forster Resch, RN, BSN, CEN It was wonderful to see so many members at the 2009 ENA Annual Conference in Baltimore, Maryland, last month. Delegates from North Carolina are grateful to have had the privilege of helping steer the path of our profession while representing the members of our state. Please consider being a delegate next year to get a bird’s eye view of how our organization works.

This year, the North Carolina State Council assigned a mentor to each first-time delegate so that no one felt on his or her own. Serving as a General Assembly delegate is valuable experience and can greatly influence a member’s future in ENA. We are pleased to announce the Martha Wood Scholarship winners: Diane Steele, RN, CEN; Monica De Rui, RN, CEN; and Becky Crews, RN, FNE, CEN. Congratulations to all the winners.

The North Carolina State Council is proud to foster education in emergency nursing. This

scholarship is awarded every year from profits derived from donations and our fund-raising endeavors. Members who are returning to school or are already in school can review the scholarship information on our Web site at www.nc-ena.com.

There is still time to make it to our Annual State Education Day in Wrightsville Beach, North Carolina, November 13, 2009. Our presessions include TNCC and ENPC instructor courses.

Come join us for our state meeting November 12 and stay for the education and networking.

The North Carolina State Council is grateful for everything our members do to promote emergency nursing and to keep ENA strong in North Carolina. We wish everyone a happy and safe Thanksgiving.

Central Ohio Chapter Submitted by Beverly Clensey, RN The Central Ohio Chapter started a friendly competition to help increase meeting participation from local hospitals. The state council is tracking attendees from each hospital at our June, September and December 2009 chapter meetings. At our December 2009 meeting, we will award an ENA membership to the hospital that had the best representation throughout the three meetings. The winning hospital can give this membership to an employee who is not currently an ENA member. This incentive has quadrupled our meeting attendance.

November 2009

Hand Hygiene Continued from page 23 – Applying desired amount of foam – Rubbing on hands until dry (one of the most important steps) Tips for improvement • Too much foam product actually dries hands • Wet hands can indicate too much Evaluation and Discussion • Offer further discussion with EcoLab representative or Hand Hygiene Group • Incorporate EcoLab representative as able • Give each staff member stickers to promote good hand hygiene and proper foam use Hand Hygiene Video • All staff to watch hand hygiene video about hand washing and alcohol-based rub use, sponsored by EcoLab. Staff also received badge cards listing the “5 Moments of Hand Hygiene,” and members were asked to wear the badge in support of the Hand Hygiene Initiative. Staff was informed of the initial compliance rate of 48 percent and was asked to assist each other in achieving better compliance and providing safe patient care practices.

The promotional Hand Hygiene Week was enjoyable and exciting for staff. Hand Hygiene Week was extended for another week so we could get most staff through the stations. There

was a lot of interest in the event, and other ancillary staff—such as housekeeping, radiology and patient registration—participated, even though it was not required.

To take this initiative a step further, we determined that we needed to keep the momentum going. We established the following opportunities for continued growth and improvement for our ED staff:

Feedback Frame

Provide monthly educational opportunities; reward staff for completion by adding name in drawing • Crossword puzzles, word games, bingo • Learning packet Continue with monthly audits • Post results each week/month • Monitor good performers and post weekly, rewarding those who are good performers Continued Improvement For 2010 • I-Learn yearly competency on hand hygiene in the ED • Hand Hygiene Week (yearly) with varying themes Over the course of the past few months, the ED staff at North Memorial has proven its knowledge of good hand hygiene practices and Continued on page 33

.

Have you ever used any social networking, video-sharing, status updating sites/tools such as the ones shown above?

Yes No

32%

68%

Source: ENA Omnibus Survey September 2009

A Tale of Two Courses:

ENPC vs. PALS Justin Milici, RN, MSN, CCRN, CEN, CFRN, TNS, ENA Course Administration Faculty

Emergency nurses frequently ask, “Which pediatric course should I take, PALS or ENPC?” The response is not as cut and dry as you might think.

Both PALS (Pediatric Advanced Life Support) and ENPC (Emergency Nursing Pediatric Course) offer nurses and other health care providers essential and vital information on pediatric emergency care using the latest evidence-based guidelines. While there are many similarities between the two courses, several distinct differences make each course unique.

PALS is a 14-hour American Heart Association course that teaches pediatric resuscitation theory and skills to a variety of health care professionals.

“The American Heart Association Pediatric Advanced Life Support course is based on scientific evidence from the 2005 AHA Guidelines for CPR and Emergency Cardiac Care. The goal of the PALS course is to aid the pediatric health care provider in developing the knowledge and skills necessary to efficiently and effectively manage critically ill infants and children, resulting in improved outcomes. Skills taught include recognition and treatment of infants and children at risk for cardiopulmonary arrest; the systematic approach to pediatric assessment; effective respiratory management; defibrillation and synchronized cardioversion; intraosseous access and fluid bolus administration; and effective resuscitation team dynamics.”1 Although PALS covers a variety of topics, the primary focus is resuscitation. A variety of learning approaches are used including interactive videos, hands-on skills stations and case studies. There is also a testing component leading to a two-year verification.

The target audience for PALS is “pediatricians, emergency physicians, family physicians, physician assistants, nurses, nurse practitioners, paramedics, respiratory therapists and other health care providers who initiate and direct advanced life support in pediatric emergencies.”

In a nutshell, it benefits a broad spectrum of health care professionals.

ENPC is a 16-hour ENA course specifically for nurses, which focuses on initial and ongoing

ENPC Focuses on specific pathologies of pediatric patients and provides critical integration of information specifically geared towards the emergency nursing staff.

PALS Extremely beneficial in providing information on pediatric emergent situations. The scope of PALS is resuscitation and geared to a variety of health care providers.

Assessment/Treatmentbased

Assessment-based

Treatment-based

Target Audience

Registered Nurses

A variety of health care providers including physicians, physician assistants, nurses, nurse practitioners, paramedics and respiratory therapists.

Lectures Skills Stations Child Maltreatment Covered Cultural/Religious Diversity Testing/Verification Verification Length Continuing Education

Multiple Lectures Yes Yes Yes Yes Four Years Yes

Minimal Lectures Yes No No Yes Two Years Varies

General Information

assessments and interventions for critically ill or injured pediatric patients.

“ENPC is a 16-hour course designed to provide core-level knowledge and psychomotor skills needed to care for pediatric patients in the emergency setting. The course presents a systematic assessment model, integrates the associated anatomy, physiology and pathophysiology, and identifies appropriate interventions.

Triage categorization and prevention strategies are included in the course content. ENPC is taught using a variety of formats, including lectures, videotapes and includes skills stations that encourage participants to integrate their psychomotor abilities into a patient situation in a risk-free setting.”3 ENPC covers an even greater variety of pediatric topics, including children with special health needs and psychiatric emergencies.

What is the difference? PALS primarily focuses on resuscitation of the pediatric patient and is

more “treatment-based.” ENPC focuses not only on resuscitation but continuing assessment and intervention prior to resuscitation; therefore, it is more “assessment-based.”

Some other differences to consider are:

Target Audience ENPC is a nursing-focused course, created for nurses by nurses. It emphasizes the nursing process in both the lectures and skills stations and does not focus on specific treatments or procedures.

PALS targets a variety of health care professionals including nurses, physicians and other allied health professionals. The primary focus is pediatric resuscitation in a variety of clinical settings, which is covered in the practice scenarios.

Course Content Both courses cover pediatric resuscitation and cardiopulmonary arrest. PALS uses a variety of Continued on page 34

26

November 2009

ENA Leadership Conference

Hyatt Regency Chicago t Chicago, IL February 17 – 21, 2010

Mark your calendar: February 17 – 21, 2010 27

2010 LEADING INTO THE FUTURE It is going to be a BIG year for ENA as we open with Leadership Conference 2010, February 17 – 21, 2010, in Chicago. Join your colleagues at Leading Into the Future, a dynamic skill-building conference open to all emergency nurses in any leadership position, nurse educators and staff nurses.

Leading Into the Future says it all: You will have the rare opportunity to learn about upcoming trends and hear forwardthinking perspectives on what leaders will need to know about leadership in today’s changing health care environment. Return to your emergency department with new knowledge and practices that you can implement immediately.

Register by Jan. 6 and Save More Don’t forget, taking advantage of the reduced early-bird conference fees will save you an additional $90. Early bird ends January 6, 2010. For more information, visit the ENA Web site at www.ena.org.

Leaders Keep Learning Leaders, by definition, guide or inspire others. To lead in a world of change, you need as much cutting-edge information, tools, tips and ideas that you can get. In a world of continuous change facing health care reform amid budgetary restraints, you need even more.

Leadership Conference 2010 will give you access to other nurse leaders from the United States and around the world for sharing best practices. To become and to continue to be an effective leader, you need to continue learning.

Chicago’s theatre district offers entertainment for all.

Hyatt Regency Chicago Hotel overlooks the Chicago River.

Chicago’s Cloud Gate sculpture (aka, The Bean) welcomes visitors to Millennium Park.

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

October 2009

HYATT REGENCY, CHICAGO, FEBRUARY 17–21, 2010 Leadership Conference 2010: A Powerful Catalyst for…

Leading Into the Future…With Education • More than 14 Contact Hours of evidence-based and best practice information known to improve, facilitate and foster emergency nurse leadership: education, management professional development, personnel, quality and safety. For more information on educational sessions and other offerings review your Advance Program or online at www.ena.org.

• NEW Power Hour Sessions. New for 2010, two related topics presented in a concise, 30-minute format to form one information-packed hour with the must-knows that are most important to you.

1. Critical Thinking Principles for Frontline Leaders/How to Pick, Prep and Polish Your Preceptors 2. Your Time for Leadership Growth/The Doctorate of Nursing Practice (DNP): Is it for Me? 3. Demystifying the Continuing Nursing Education Application Process/Getting Your Proposal Accepted—Tips From a Former Committee Member 4. Emotional Intelligence/Professional Work/Personal Life Balance: Is it Utopia?

5. Numbers, Data and Detail: What Every Emergency Department Leader Needs to Know/Crunching Numbers Into Clinician Commitments • Poster Sessions: Research and Evidence-Based Presentations. Management and research project posters are on display during Leadership Conference 2010. Take advantage of this opportunity to review current studies on relevant emergency nursing topics. The researchers will be present to discuss their studies at specified times. Viewing the poster session earns participants 1.0 Contact Hour.

Leading Into the Future…With Networking • Welcome to Chicago Dance Party! “Dance Through the Decades” • “Blast to the Past at Ed Debevic’s”—An ENA Foundation Event

Leading Into the Future…With General Session Keynote Speakers • Never Fly Solo, Lt. Col. Rob “Waldo” Waldman, MBA, CSP • Ignite Your Life, John O’Leary • You Don’t Need a Title to Be a Leader: Leading at Every Level, Mark Sanborn, CSP, CPAE

AND THERE IS MORE . . .

ENA Live From Chicago Blog Exhibit Hall Cyber Café Town Hall Meeting

40th Anniversary: Transforming Practice Together honors leadership in all of us. This yearlong celebration will acknowledge ENA’s 40 years carrying out its mission for emergency nurses and the profession. You will have an inside look at the how we build a strong and growing future based on the past.

ENA Marketplace Express ENA Foundation Fun-raising ENA Campaign Headquarters and Reception

Register at www.ena.org.

Official Magazine of the Emergency Nurses Association

29

MESSAGE FROM THE ENA FOUNDATION CHAIR |

Patricia Kunz Howard, RN, PhD, CEN, FAEN

Holiday Giving More Important Now Than Ever The ENA Foundation was pleased to award more than $173,500 in educational scholarships and research grants in 2009. Congratulations and thank you to all who donated or worked hard to gather donations that we distributed in a very difficult economic climate. Unfortunately, we were only able to award scholarships to 22 percent of the qualified applicants. There were just not enough funds available.

As we enter the holiday season, you will

undoubtedly receive many requests from your local charities, alumni associations and other special causes you would like to support. Please support as many organizations as possible, but try to put aside some funds to assist a fellow ENA member in continuing his or her education.

Here, I am sharing a few comments from our recent scholarship recipients that demonstrate the importance of the ENA Foundation scholarship program:

Prevention Can Be The Cure

“Ultimately, I love being a nurse. I feel a sense of peace and purpose when holding the hand of a sick person during a painful procedure, when administering medicine that relieves wrenching pain, or when crying with and comforting family members of a very ill child. I cannot fathom any greater purpose or mission in life than to have the opportunity to help instill and promote the same passion and fervor in America’s next generation of nurses. Being selected as a recipient of this scholarship allows me to continue my journey towards becoming a passionate devoted nurse educator who will play an important role in molding the future of nursing in America.”

Kelly Gleason, RN, BS 2009 ENA Foundation State Challenge Scholarship Alabama

Healthy Aging Programs for Mature Adults and Caregivers Power up your Injury Prevention efforts with programs on CD-ROM: Stand Strong for Life — Falls Prevention* Evidence-based program guides and educates

SAFER Medication Use — Adverse Drug Event Prevention* Educational program empowers yourself and your patients Each program includes: s (EALTH #ARE -ODULE

“I first became interested in emergency medical care while serving as an infantryman for the U.S. Army in Iraq in 2003. I had been taught basic first aid, but repeatedly seeing civilians and fellow soldiers injured and killed, sparked a passion to learn more about emergency care , so that I could be of more service to people suffering from various traumatic injuries. Upon completing my enlistment, I entered a nursing program with the goal of one day working in some aspect of emergency nursing, and hope to graduate with a BSN from the University of San Francisco in December of 2010. This scholarship will help me improve the quality of care I am able to provide as a student, and after graduation, by allowing me to focus more on my studies and clinical skill development.

Richard Hackett, NREMT-I 2009 New York State ENA September 11 Scholarship California

s #OMMUNITY "ASED -ODULE s 0RESENTATIONS s 0RINTABLE "ROCHURES

Emergency Nurses Association Injury Prevention Institute/EN CARE Changing behavior, Saving lives

30

Members: b $24.95 $ per program Nonmembers: $50 per program For more information or to purchase these programs, visit ENA Marketplace at http://admin.org/store/ or call (800) 243-8362. *These programs provide tools to assist you in meeting The Joint Commission’s 2009 National Patient Safety Goals...numbers 3 and 8.

10/26/09

It is easy to make yourself feel great by making a small donation to the ENA Foundation this holiday season. Donations can be made directly on the ENA Web site at http://www. ena.org/foundation/contribution.

Or simply call Terri Bruce, foundation coordinator, at 847-460-4103, or Mike Konstant, foundation director, at 847-460-4102. Thank you and best wishes to you and your family during the upcoming holidays.

November 2009

BCEN BOARD WRITES |

Janie Schumaker, RN, BSN, MBA, CEN, BCEN Director-at-Large

The Certification and Injury Prevention Connection I have been so fortunate in my health care career to work beside some of the best and brightest people in the world. I live in the Midwest and am very close to the state line, affording me the pleasure of participating in local and state meetings for both the Kansas and Missouri ENA state councils.

In addition, through my involvement with the Board of Certification for Emergency Nursing (BCEN) and ENA, I have met many people and have sustained friendships across the nation.

I am amazed at all of the hours my colleagues put into volunteer activities, such as injury prevention. It seems there is never a shortage of emergency nurses putting on a docu-drama at the local high school, organizing a Battle of the

Belt across their state, ensuring car seats are safe or that children have a helmet. Not only do these exceptional nurses volunteer their time outside of their normal workday, they also take an additional moment while discharging their patients to give extra teaching to a family.

Recently, while attending a local ENA chapter meeting, I once again found myself listening to a lengthy report about several exciting injury prevention activities. This prompted me to think about these extraordinary individuals who volunteer their time tirelessly. It occurred to me there was something that differentiated them.

As I thought it through, I realized that most of them had earned a BCEN certification: Certified Emergency Nurse (CEN®), Certified Pediatric

Emergency Nurse (CPEN™), Certified Flight Registered Nurse (CFRN®) or Certified Transport Registered Nurse (CTRN®). I had not made this connection before. I am convinced that nurses who achieve certification demonstrate the desire to provide the best to their patients, communities and each other. Injury prevention is just one example of how these individuals go the extra mile. They are the cream of the crop.

I have always viewed the emergency nurse as special. I don’t know of any other specialty that requires you to know something about everything, prioritize and triage patients and tasks constantly, and always be 10 steps ahead of everyone else while completing several things at once, manage all of this with a smile in your busy, overcrowded environment. That is the snapshot of an emergency nurse’s day.

The people that stand out in my mind, however, are those who take the extra five minutes during discharge to teach a family how to prevent an injury.

They have probably saved lives and prevented more emergency department visits than they will ever realize. They give their time on their day off to teach injury prevention or to mentor a colleague working toward a BCEN certification, not because they are getting paid well, but because they care and value emergency nursing certifications. Their communities and schools are safer because they take on leadership roles in preventing unfortunate injuries and educating about drug and alcohol use. On top of all of this, they likely hold CEN, CPEN, CFRN or CTRN credentials, which validate their The Board of Certification for Emergency Nursing (BCEN) welcomed new Certified Emergency Nurse (CEN®) and Certified Flight Registered Nurse (CFRN®)/Certified Transport Registered Nurse (CTRN®) Item Writers. The following individuals participated in a emergency nursing, pediatric BCEN two-day item writing workshop in August 2009: (Pictured from top to bottom) John Camuso, RN, BSN, CFRN, CCRN; Coralee emergency nursing, flight Lane Gehrt, RN, BSN, CEN; Robin Baker, RN, BSN, SANE, CEN; Tina Taylor, RN, BSN, CFRN, CCRN; Laurie Soper, RN, MS, CFRN; nursing or critical care ground Emily Colyer, RN, BSN, CEN; Michael Moon, RN, MSN, CEN, CNS-CC, FAEN; Melinda Day, RN, BSN, CEN, CCRN; Robin Gilbert, RN, MSN, CEN, CPEN, BCEN chairperson; Kathy Albert, RN, MSN, CEN, CNS; Allen Wolfe, RN, MSN, CFRN, CCRN; Rebecca Wilson, RN, transport nursing knowledge.

BSN, CFRN; Michael Frakes, APRN, MS, CFRN, CTRN, CCRN, CCNS, EMTP, CFRN/CTRN Exam Committee chairperson; Andrew Veitch, RN, BSc, CFRN; Bill Fanning, RN, BSN, CCRN, CFRN, EMTP; Tancy Stanbery, MSEd, CAE, BCEN certification officer; Darleen Williams, RN, MSN, CEN, CCNS, BCEN chairperson-elect; and Shari Rybak, RN, MSN, CEN.

Official Magazine of the Emergency Nurses Association

31

ENA, BCEN and NSO Team Up to Offer Discount to BCEN- Join the Growing List of Certified ENA Members Certified Pediatric ENA, the Board of Certification for Emergency Nursing (BCEN) and Nurses Service Organization (NSO) have enhanced an important member benefit program. ENA and NSO, the endorsed professional liability insurance program provider for ENA, have enjoyed a long-term partnership for more than six years. ENA, BCEN and NSO have extended this partnership to offer a 10-percent risk-management discount on liability insurance premiums to individual ENA members who hold at least one BCEN certification.

BCEN offers four certifications for emergency nurses: Certified Emergency Nurse (CEN®), Certified Flight Registered Nurse (CFRN®), Certified Transport Registered Nurse (CTRN®) and Certified Pediatric Emergency Nurse (CPEN™).

This is the first time that NSO has offered a

discount to members of a professional association who also hold a board certification, said an NSO representative. ENA proposed the idea during recent contract renewal discussions, and NSO agreed to present it to their underwriter, CNA, after careful consideration of both ENA membership and BCEN certification standards.

“ENA members have professional standards to uphold, and there is a rigorous educational and training requirement in risk-management practices for the BCEN certifications,” noted the representative. “Our carrier partner, CNA, reviewed the materials we provided detailing the professional standards that come with being a member of ENA, in addition to the requirements and training Continued on page 33

This new credential is for nurses who provide emergent or urgent care to pediatric patients.

Jointly developed and offered by the Board of Certification for Emergency Nursing and the Pediatric Nursing Certification Board

For additional information about this new credential, visit www.BCENcertifications.org www.pncb.org/cpen.html

Emergency Nurses The Certified Pediatric Emergency Nurse (CPEN™) exam, developed jointly by the Board of Certification for Emergency Nursing (BCEN) and the Pediatric Nursing Certification Board (PNCB®), is for pediatric emergency nurses who recognize the value of achieving certification in their specialty.

As of October 2009, there were 527 CPENs. If you are a pediatric emergency nurse who provides urgent and emergent nursing care to pediatric patients and their families, you will want to learn more about becoming a CPEN. Earning your CPEN credential demonstrates that you have extensive experience and the knowledge and abilities related to pediatric emergency nursing care beyond basic RN licensure.

“I’m very conscious of professional responsibility and professional recognition for what we do,” said Deneen Dougherty, RN, BSN, CEN, CPN, CPEN, emergency department assistant nurse manager at A.I. Dupont Hospital for Children in Wilmington, Delaware. “I was an adult nurse for 16 years before I came here. The pediatric world is now my place, and getting my CPEN was the next professional step to take.”

Dougherty said she was shocked when she passed the CPEN beta exam in October 2008.

“I had not been a pediatric nurse very long when I took the exam,” she explained.

“I was comfortable with a lot of the questions, but for some I narrowed it down to two answers and went with my gut. I was very excited when I found out I passed.”

Dougherty and other CPENs in A.I. Dupont’s ED receive recognition on a wall reserved for acknowledgement for all certifications.

“Many times, if families are walking past the wall, they will notice my name and say, ‘Wow, you have three,’” she noted, adding, “It’s a conversation starter.”

For more information about CPEN exam eligibility, registration, dates and a content outline, visit www.BCENcertifications.org.

To see the list of nurses who successfully passed the CPEN beta exam in October 2008 and complete lists of those who have earned the CPEN credential, visit www.BCENcertifications.org.

10/09

32

November 2009

Hand Hygiene Continued from page 25 the importance of making the environment safe for patients. The compliance for hand hygiene has now grown to 89 percent.

It was very enjoyable to bring a serious and concerning issue to the forefront while addressing it in a fun and engaging manner.

Staff is not afraid to be approached about hand cleansing, and more staff is now issuing reminders of the “5 Moments of Hand Hygiene.”

Many staff members have brought forth ideas of how to continue this initiative throughout the year. This initiative has been engaging for staff and indicative of how much we care about our patients. It was very enjoyable to bring a serious and concerning issue to the forefront while

addressing it in a fun and engaging manner.

Safe practices and consistent practices benefit our patients but also support our roles as health care providers.

North Memorial ED Hand Hygiene Initiative Team members included Amy Kaiser, RN (co-champion); Jennifer Kohls, HUC (co-champion); Robin Talley, RN; Janell Villavicencio, RN; Jandee Meister, RN; Jeff Nordlinder, RN (nurse manager); Chris Cardinal, material management; and Dr. Parissa Delavari.

References: 1. http://www.ihi.org/IHI/Topics/CriticalCare/IntensiveCare/Tools/ HowtoGuideImprovingHandHygiene.htm 2. http://www.cdc.gov/mmwr/PDF/rr/ rr5116.pdf 3. http://www.cdc.gov/handhygiene/ 4. http://www.who.int/gpsc/5may/ background/5moments/en/

ENA and NSO Team Up Continued from page 32 involved with obtaining a BCEN certification, and felt that the two factors combined are enough to warrant a 10-percent professional liability premium risk-management discount.”

The discount became effective for new NSO insureds October 31, 2009. Members of ENA who wish to take advantage of the 10-percent discount simply need to submit their ENA membership number and a copy of their BCEN certification card or certificate (or a written statement if the card or certificate are not available) with their NSO application.

Current ENA members who have NSO liability insurance and a BCEN certification— and would therefore be eligible for the discount—would begin to have the discount processed on their next renewal date. In compliance with state laws, NSO must send out renewal notices in advance of the renewal effective date. This timing impacts when a discount will apply, and currently insured members will begin receiving their discount as early as January 2010. The NSO representative confirmed that the discount would be automatically applied to each eligible account, with the timeframe depending on the advance notice requirements in the state where the member lives. This discount can not be combined with any other discount that NSO offers on professional liability insurance premiums.

NSO provides the only official professional liability insurance program endorsed for ENA members and has been providing professional liability solutions to nursing professionals for more than 30 years. For more information, visit the NSO Web site (www.nso.com/ena), call 800-247-1500 or send an e-mail to service@nso.com.

Official Magazine of the Emergency Nurses Association

Do More than Survive

With the Benefits of ENA Membership During the month of November, ENA is holding a membership recruitment drive targeted to Emergency Nurse Managers.

We need your help! As an incentive, for each new nurse manager you recruit, you will be entered into a drawing for a $100 American Express Gift Certificate, in addition to your Member-Get-a-Member points.

To be eligible for the drawing, your name must be listed as the sponsor on the membership application and your recruit’s title must be on the membership application.

All new member Emergency Nurse Manager applications must be sent to ENA National Headquarters, 915 Lee Street, Des Plaines, Illinois 60016, and postmarked by November 30, 2009.

For membership applications and more information about this program, visit www.ena.org.

Help your Emergency Nurse Manager THRIVE with the benefits ENA has to offer.

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A Tale of Two Courses Continued from page 26 teaching tools, such as interactive videos, small group case studies and hands-on skills stations.

PALS also uses a common language, which can be shared by all involved health care professionals; this is evident in a section covering resuscitation team dynamics. ENPC covers not only resuscitation, but also ongoing assessment and interventions aimed at preventing an arrest situation. Lectures, hands-on skills stations and a triage priorities station are just some of the methods ENPC uses throughout the course.

Unlike PALS, however, the language is nursing-focused.

Testing and Verification ENPC and PALS both have testing and verification components, including a written exam and skills check-off. Again however, the PALS test and skills check-off is targeted to a broader spectrum of health care professionals, and ENPC is targeted to nurses.

Another major difference is the length of verification: ENPC is valid for four years, while PALS is valid for two years. Some nurses have even suggested getting more “bang for your buck” with ENPC due to the longer verification period, and in fact, many institutions look at this from a financial perspective.

Job Requirements Health care professionals working in clinical settings that include pediatric acute care are often required to have completed a course in pediatric emergency care. Most institutions require either PALS or ENPC, and some may even require both. While physicians, paramedics and other non-nursing professionals may not have much of a choice when it comes to taking a required pediatric course, nurses have the option of taking either PALS or ENPC, depending on individual institutional requirements.

NEW Fourth Edition CEN® Review Manual

Continuing Education Most health care professionals require a certain number of continuing education hours to maintain a valid license, among other requirements. ENPC offers nurses 15.33 nursing contact hours through ENA. The American Heart Association does not offer educational contact hours for PALS, ACLS (Advanced Cardiac Life Support) or BLS (Basic Life Support). Therefore, individual institutions must apply for contact hours for both nurses and other health care professionals. Not every institution offers contact hours for PALS.

Cost Effectiveness Many institutions require health care professionals working in the emergency setting to have taken either PALS or ENPC. In addition, these units often pay for their employees to attend one of the courses. This can get pricey, especially if there is a large number of staff. PALS verification is valid for two years, while ENPC is valid for four years. Unit managers may choose to have their staff take ENPC over PALS, simply because the verification period is longer and, thus, more cost effective. However, this “four-year deal” is only applicable to nurses, which is a disadvantage to other health care professionals.

Conclusion Quality pediatric emergency education requires up-to-date, evidence-based information to teach health care providers best practices in caring for the critically ill or injured pediatric patient. Both PALS and ENPC provide excellent education and are excellent resources.

ENPC is assessment-based, PALS is treatmentbased. In the end, both complement each other to obtain the same goal: to achieve the best outcome of care for the pediatric patient.

Content Consistent with the CEN Exam 6 Contact Hours Available Prepare to Sit for the CEN Exam and Utilize One of the Most Sought After Resources

Fourth Edition

The CEN Review Manual The Fourth Edition offers all new exams that follow the

BCEN blueprint for the CEN exam. This edition offers: BC s Five exams contained within the book. s Answers, rationales and references are provided for each and every question. s Two exams are accessible online. These exams are timed to simulate the CEN testing environment.

For those individuals scoring 70% or higher on the online exams 3 contact hours are available per exam.

Please note contact hours are only available one time.

NEW C COMPLETE CO O DIGITAL VERSION The entire CEN Review Manual is also available in a digital format.

This format offers all the same benefits only it is completely digital.

For more information and to purchase visit www.ena.org and click on shop.

References 1. American Heart Association. Pediatric Assessment. In: Pediatric Advanced Life Support Provider Manual. Dallas, TX: Author; 2006.

2. American Heart Association. Course Overview.

In: Pediatric Advanced Life Support Course Guide. Dallas, TX: Author; 2006.

3. Emergency Nurses Association. The Emergency Nursing Pediatric Course. In: Emergency Nursing Pediatric Course Provider Manual 3rd ed. Des Plaines, IL: Author; 2003.

Resources • http://www.enpc.bc.ca/enpc_pals_ comparison.php • http://www.americanheart.org/print_ presenter.jhtml?identifier=3012001 • http://www.ena.org/coursesandeducation/ CATNII-ENPC-TNCC/enpc/Pages/ aboutcourse.aspx.

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

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November 2009

BOARD HIGHLIGHTS |

August 2009 Board Meeting Actions and Highlights The ENA board of directors participated in an e-mail vote August 5, 2009. The board took the following action: • Approved support of the Infusion Nurses Society (INS) position statement “The Role of the Registered Nurse in the Insertion of Intraosseous (IO) Access Devices.

The ENA board of directors met via conference call August 26, 2009. All members of the board of directors were present. The board took the following actions:

• Approved to collaborate with the Hospital Corporation of America (HCA) to increase the number of emergency departments in the Staffing Guidelines Revision study and seek additional data sources from other companies to increase diversity of EDs in the study.

If unsuccessful seeking additional data sources after a two- three-month period, ENA will open recruitment to the entire ENA membership.

• Approved support of the National Association of Clinical Nurse Specialists (NACNS) Core

Practice Doctorate Clinical Nurse Specialist Competencies.

• Approved remaining consent agenda items, including: • Approved the July 30, 2009, board e-mail vote minutes.

• Approved the August 5, 2009, board e-mail vote minutes.

The minutes of the next meeting of the ENA board of directors will appear in the December issue of ENA Connection.

Statement of Ownership, Management and Circulation (Required by 39 U.S.C. 3685). Title of publication: ENA Connection. Publication no.: 1534-2565. Date of filing: October 1, 2009. Frequency of issue: Monthly. Number of issues published annually: 11. Annual subscription price: members, free; non-members, $50 U.S., $60 foreign. Complete mailing address of known office of publication: 915 Lee Street, Des Plaines, Cook County, Illinois 6569. Complete mailing address of the headquarters of the general business office of the publisher: 915 Lee Street, Des Plaines, Cook County, Illinois 6569. Publisher: Emergency Nurses Association, 915 Lee Street, Des Plaines, Cook County, Illinois 6569.

Managing Editors: Amy Carpenter Aquino/Jill Lewis, 915 Lee Street, Des Plaines, Cook County, Illinois 6569. Owner: Emergency Nurses Association, 915 Lee Street, Des Plaines, Cook County, Illinois 6569.

Known bondholders, mortgagees, and other security holders: None. Issue Date for Circulation Data: September 2009. Extent and nature of circulation: A. Total Number of Copies: Average number of copies each issue during preceding 12 months (hereinafter “Average”), 39,047. Actual number of copies of single issue published nearest to filing date (hereinafter “Most recent”), 38,143. B. Paid circulation: B1. Outside-county paid subscriptions stated on Form 3541: Average, 38,270. Most recent, 37,292. B2. In-county paid subscriptions stated on Form 3541: Average 0. Most recent, 0. B3. Paid distribution outside the mail including sales through dealers and carriers, street vendors, counter sales, and other paid distribution outside USPS: Average 0. Most recent, 0. B4. Paid distribution by other classes of mail through the USPS: Average, 0. Most recent, 0. C. Total paid distribution (sum of B1, B2, B3, and B4): Average 38,270. Most recent, 37,292. D. Free or nominal fee rate distribution.

D1. Outside—county copies included on Form 3541: Average, 26. Most recent, 16. D2. In-county copies included on Form 3541: Average, 0. Most recent, 0. D3.

Copies distributed through the USPS by other classes of mail: Average, 0. Most recent, 0. D4. Copies distributed outside the mail: Average, 447. Most recent, 436. E. Total. Free or nominal rate distribution (sum of D1, D2, D3, D4): Average 473. Most recent 452. F. Total distribution (sum of C and E): Average: 38,743. Most recent, 37,744. G. Copies not distributed: Average, 304.

Most recent, 415. H. Total (sum of F and G): Average 39,047. Most recent, 38,159. I. Percent paid (C divided

by F times 100): Average, 98.7%. Most recent, 98.8%.

This Statement of Ownership will be printed in the November 2009 issue of this publication. I certify that the statements made by me above are true and complete. Amy Carpenter Aquino, Managing Editor.

Date: October 1, 2009.

W E !

N dition E d n m o

Sec

culu Curri Core Pediatrics ing for Nurs h it gency Emer Consistent w nt Conte PEN™ Exam the C

Official Magazine of the Emergency Nurses Association

Get the knowledge you need to care for pediatric patients with the new revised Core Curriculum for Pediatric Emergency Nursing The Second Edition of Core Curriculum for Pediatric Emergency Nursing was developed for both new and experienced emergency department nurses.

This sought after resource offers: s The latest evidence-based practice information to care for pediatric patients s Comprehensive topic coverage to o prepare for the CPEN exam s Uniform chapters offering easy navigation of information from one chapter to the next s Information for emergency nurse managers regarding staffing, training and management for pediatric patients s New chapter on how to handle crisis issues with pediatric patients, s, their families, and including information mat atio i n on how to care for staff s The option to review only selected chapter topics.

Obtain the knowledge you need to successfully care for emergency pediatric patients.

To order visit www.ena.org and click on shop....

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