ENA Connection June/July 2013 by ENA Connection

the Official Magazine of the Emergency Nurses Association

connection

June/July 2013 Volume 37, Issue 6

HILL TOPPERS ENA Takes Advocacy Straight to D.C. Legislators’ Doors Pages 8 - 9

INSIDE

FEATURES 6 Interactive GENE Content Coming to You Online 22 Five Ways to Relax at Annual Conference 26 Student Nurses Get an Education in ENA, Professionalism

Join us in Nashville, “music City” As a registered attendee earn up to over 20 contact hours.* Additional contact hours can be obtained by: 1. Attending pre-sessions 2. Attending the Anita Dorr Memorial Luncheon 3. Accessing online articles through the Annual Conference portal ENA provides practicing emergency nurses with the vital resources they need. During 2013 Annual Conference, ENA is proud to present the following: ¡ Advanced Practice Sessions: Aimed at providing progressive clinical information and diagnostic education. ¡ Advanced Clinical Sessions: Aimed at experienced emergency nurses wanting more in-depth education. ¡ Fast Track Sessions: 30 minute sessions provide the opportunity to hear the latest, cutting-edge information. ¡ Paper and Poster Sessions: Explore emergency nursing research and the application of research for your clinical practice by attending the research paper sessions or viewing the research and evidence-based practice poster presentations. The schedule at-a-glance provides dates, times and number of contact hours. Join us in the songwriting capitol of the world, where music will be playing and learning opportunities will abound, providing an experience to remember.

ImPorTANT DATES To rEmEmbEr registration Now Open Early rate registration Closes July 25 ENA board of Directors meeting Sept 17 Pre-sessions & General Assembly Sept 18–19 Educational Sessions Sept 19–21 Awards Gala Sept 21

Save the Date: eNa Leadership Conference Phoenix, aZ March 5–9, 2014

To register for ENA 2013 ANNuAl CoNFErENCE, please go to www.ena.org/ac or scan the Qr code.

#ENAAC13

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

Dates to Remember July 1 - 31, 2013 Application period for 2014 ENA national committees. Aug. 1, 2013 Deadline for research and evidence-based practice poster abstacts for Leadership Conference 2014 in Phoenix.

ENA Exclusive Content PAGE 6 Get Ready for Interactive GENE PAGE 8 Day on the Hill in Washington, D.C. PAGES 10-11 State and Chapter Advocacy Updates PAGE 12 Update From the Executive Director: What Happened to That Resolution? PAGE 14 Early Doxycycline Prevents Death From Rocky Mountain Spotted Fever PAGE 17 2013 Proposed Bylaws Amendments and Resolutions PAGE 22 Code You: 5 Easy Ways to Relax During ENA Annual Conference PAGE 26 Student Nurses Get an Education in ENA, Professionalism

Regular Features PAGES 4-5 Free CE of the Month Members in Motion Ask ENA PAGE 13 State Connection PAGE 16 Board Writes PAGE 18 Pediatric Update PAGE 20 ENA Corkboard PAGE 24 ENA Foundation PAGE 25 Future of Your Nursing

LETTER FROM THE PRESIDENT |

JoAnn Lazarus, MSN, RN, CEN

Supporting Our Own When Crisis Hits

he Boston Marathon bombings on April 15 were followed two days later by the explosion at the West Fertilizer Company in West, Texas, and the EF5 tornado in Moore, Okla., on May 20. Although different events, they were also very similar, marked by death, injuries and heroes. I can only imagine how overwhelming these events were for everyone. The media reported that more than 175 people were treated at emergency departments throughout the Boston area on April 15. More than 200 were treated at area hospitals after being injured in the West blast, and more than 350 were injured in Moore. We know these are the days we train for, with the hope that the day never arrives. For Boston, West and Moore, that day did come, and everyone was ready. We thank all of the people who responded on the scene and in the hospitals in the hours and days afterward. In times of crisis, we all come together like a family. Like a family, we share the pain of those on the front lines. We pray for them and call them heroes. Our thoughts and prayers remain not only with the victims, families and friends but with everyone involved. As emergency nurses, we like to think we are prepared for anything. We never know the real answer to that until the test comes. We all wish we could be there to support our peers in these times of crisis. I received e-mails from a few of the ED directors in Boston who said they felt very supported by all of you and proud to be emergency nurses. To the emergency nurses and other emergency health care workers, police and firefighters of Boston, West and Oklahoma, thank you for all you do every day, but especially for the care you gave to these victims. We salute you! At right are some of the messages of support posted on ENA’s Facebook page April 15.

Prayers and strength to our ENA colleagues who are saving lives in Boston today. — Bobby Winters NJ ENA sending thoughts & prayers. We are here to support our colleagues. — Pat Nierstedt God bless all the EMS, firefighters, police, doctors, nurses and the hospital staff! And of course the patients and their family members! — Melanie DeVries Our prayers are with you all. — Penny Strachan Blake Let us know what we can do to help from here in NC. — Cristi Jewell May all those caring for the people in Boston have God’s blessing with them. — Melinda Creed-Waymire Godspeed to the health care teams and prayers for all victims and their loved ones. — Ellie Encapera Praying for strength and clarity of thought for our colleagues to endure this mass casualty as they provide care to those in need . . . — Ava Marie Clarke Praying for strength and comfort for victims, families and our colleagues. This is a difficult time for all, and we find our strength in one another through support and a caring heart. Please know that we are here for all of you! — Cindy Raynes I’m 1.5 hours from Boston if emergency RNs needed! — Kristin Seaman Sending prayers from Tennessee. — Vanessa Canady Clinkenbeard Angels of comfort, strength and healing to all the EMS, first responders, volunteers, bystanders and emergency staff who are caring for the injured from an AZ colleague. God bless each of you. — Ginny Orcutt I can’t imagine what they must be experiencing. My thoughts always go to the emergency departments that deal with these horrible acts and tragedies. Praying for all of you; thank you for doing what you do. — Sara Barr Gilbert My thoughts and prayers with everyone involved! Know the trauma teams involved in this tragedy are working near miracles! — Victoria Morgan

Official Magazine of the Emergency Nurses Association

Keep up on your free continuing education as an ENA member this summer!

Available starting June 1 . . . ‘‘Confidently Dissolving Conflict: Achieve Better Solutions and Relationships,’’ presented by Suzanne O’Connor, MSN, RN, APN (Credit: 1.0 contact hour) Do you need stronger relationships, better solutions and less defensiveness in your emergency department? In this e-learning course, taken from Leadership Conference 2013, O’Connor helps you to identify your conflict resolution style and use easy, proven models to make yourself a better communicator and positive influence on co-workers.

Available starting July 1 . . . ‘‘How Do I Answer That? Smart Answers to ED Leaders’ Tough Questions,’’ presented by Stephanie J. Baker, MBA, RN, CEN. (Credit: 1.0 contact hour) When you’re facing staff shortages, boarding issues, financial restrictions, resistance to change and lack of buy-in, how do you know ‘‘what looks right’’? What do you say to specific questions from department leaders? Baker helps you anticipate and answer those questions in another e-learning installment from Leadership Conference. To take these and other CE courses absolutely free as an ENA member: • Go to www.ena.org/freeCE, where you’ll log in as a member (or create an account). • Add desired courses to your cart and ‘‘check out.’’ • Proceed to your Personal Learning Page to start or complete any course for which you have registered or to print a certificate when you’re done. • To return to your Personal Learning Page at a later time, go to www.ena.org and find ‘‘Personal Learning Page’’ under the Courses & Education tab. Please be sure you are using the e-mail address associated with your membership when logging in. If you have questions about any free e-learning course or the checkout process, e-mail elearning@ena.org.

ENA Connection is published 11 times per year from January to December by: The Emergency Nurses Association 915 Lee Street Des Plaines, IL 60016-6569 and is distributed to members of the association as a direct benefit of membership. Copyright© 2013 by the Emergency Nurses Association. Printed in the U.S.A. Periodicals postage paid at the Des Plaines, IL, Post Office and additional mailing offices.

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

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

A Data Watchdog Worth Watching ENA member Ashel Kruetzkamp, MSN, RN, SANE, nurse manager for the St. Elizabeth Healthcare Fort Thomas emergency department in Fort Thomas, Ky., was recognized by the Cincinnati Enquirer in March as one of greater Cincinnati’s 13 ‘‘Women to Watch.’’ Kruetzkamp cast a light on a growing heroin crisis in the region by compiling data that indicated a 77 percent rise in heroin overdoses from 2011 to 2012. Kruetzkamp is part of the Northern Kentucky Heroin Impact Committee Leadership Team, whose first step was to raise community awareness, with data shared via the Enquirer and town hall meetings. The next steps are community prevention and advocacy, along with treatment and harm reduction, Kruetzkamp said. ‘‘The community needs to know what’s going on,’’ she told the Enquirer. ‘‘When they start seeing the numbers, they’ll start looking at their own houses and their own neighborhoods. If you have children, you should be worried about this every day. Because these are not bad kids.’’ An Enquirer reader later wrote her: ‘‘Indeed, my daughter — and I’m sure many other young adults — are not bad kids. They just got caught up in something bad, whether due to peer pressure, curiosity, emotional troubles, etc. At any rate, I am very happy to see this issue being discussed and brought to the attention of the public.’’ Do you have a recent professional or educational success story you want to share about yourself or an ENA member colleague? E-mail connection@ena.org with the subject line “Members in Motion.’’

Editor in Chief: Amy Carpenter Aquino Assistant Editor: Josh Gaby Writer: Kendra Y. Mims Editorial Assistant: Renee Herrmann BOARD OF DIRECTORS Officers: President: JoAnn Lazarus, MSN, RN, CEN President-elect: Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN

Secretary/Treasurer: Matthew F. Powers, MS, BSN, RN, MICP, CEN Immediate Past President: Gail Lenehan, EdD, MSN, RN, FAEN, FAAN Directors: Kathleen E. Carlson, MSN, RN, CEN, FAEN Ellen (Ellie) H. Encapera, RN, CEN Marylou Killian, DNP, RN, FNP-BC, CEN Michael D. Moon, MSN, RN, CNS-CC, CEN, FAEN Sally K. Snow, BSN, RN, CPEN, FAEN Joan Somes, PhD, MSN, RN, CEN, CPEN, FAEN Karen K. Wiley, MSN, RN, CEN Executive Director: Susan M. Hohenhaus, LPD, RN, CEN, FAEN

Q: Are TNCC and ENPC intended to replace the CEN exam, and will a candidate for TNCC or ENPC be required to be actively working in emergency nursing before taking the exam? CEN does not have such a requirement. — D. in Virginia A: Great question! Both Trauma Nursing Core Course and Emergency Nursing Pediatric Course are comprehensive courses designed for the nurse with two or more years of emergency nursing experience. These are not basic courses. There is no

What’s Your Question? Use ‘‘Ask ENA’’ to ask questions about the organization and emergency nursing in general. Questions should be no longer than 200 words and will be referred to the appropriate ENA staff or department. Submission does not guarantee publication. Questions may be edited. E-mail questions to connection@ena.org.

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goal of safe practice, safe care. Skill, knowledge and ability levels are challenged to ensure patients receive the gold standard of care to achieve optimal outcomes. The Certified Emergency Nurse® exam is different from any ENA course. This exam is offered through the Board of Certification for Emergency Nursing, a separate entity from ENA. I hope this makes things more clear. Remember, ENA is always here to assist you with questions. — Paula Karnick, Ph.D ANP-BC, CPNP, Director, Institute for Emergency Nursing Education

RESPIRATORY EMERGENCIES–

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Paxton JH, Knuth TE, Klausner HA. Proximal humerus intraosseous infusion: a preferred emergency venous access. The J Trauma 2009;67(3):606-11. Research sponsored by Vidacare Corporation. For alert and conscious patients responsive to pain, consider IO 2% lidocaine without preservatives or epinephrine (cardiac lidocaine). A Medical Director must authorize appropriate dosage range. As with any vascular access site, the IO insertion site should be monitored frequently. IO should only be used when landmarks can be clearly identiﬁed.

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Intraosseous Access is recommended by the AHA, ACEP, INS, ENA, AACN and more.

Geriatric Education Transformed

Get Ready for Interactive GENE By Kendra Y. Mims, ENA Connection

Left: A screen shot from one of the 17 new interactive GENE modules.

According to the Centers for Disease Control and Prevention, the population The new interactive of Americans aged 65 and older will format is suited to various double in the next 25 years because of learning styles, so nurses longer life spans and aging baby don’t have to consider boomers, and 71 million older adults themselves tech-savvy to will account for about 20 percent of benefit, said Briana Quinn, the U.S. population.1 Research also MPH, BSN, RN, ENA’s senior shows that about 80 percent of older associate for wellness and Americans are currently living with at designer, started developing the injury prevention, IQSIP, and a nurse least one chronic condition.1 multi-media revised version of GENE planner for the GENE course revision. ENA offers emergency nurses an last September, converting the content ‘‘You can absorb the material opportunity to update their ability to from the subject-matter experts into an because of the way it’s been designed care for older adults through its interactive format, with each by Matt,” Quinn said. ‘‘This GENE Geriatric Emergency Nursing module taking about three course provides in-depth information, Education course. ENA is weeks to develop. The updated and it highlights that geriatrics is a proud to announce that a online course will feature 17 specialty. Caring for older adults revised version of GENE will modules, improvements such requires a specific set of nursing skills, be available in late 2013. as video, animation, voice-over knowledge and background. The revision process began narration, images, music and “I think emergency nurses will be two years ago and involved knowledge checks. Contact excited about learning the atypical more than 18 subject-matter Donna Roe, hours will be offered. presentations for the older adult experts from the United DNP, APRN, BC, ‘‘We basically took chapters population, which is essential. The States and Canada, in CEN in a textbook format and emergency nurse can use this evidenceaddition to the ENA Geriatric transformed the material for based practice and advocate for patients Work Team. Chairperson online learning,’’ Smith said. of this population.’’ Donna Roe, DNP, APRN, BC, ‘‘The content is narrated and The revision will be demonstrated at CEN, said there was a need supplemented by images, the 2013 ENA Annual Conference in to update the GENE modules animation and Nashville, Tenn. Roe to include evidence-based slideshows along anticipates that nurses will practices in an interactive with questions in enjoy the interactive format format. Matt Smith various formats.’’ and find it more user-friendly. ‘‘Our committee The revised ‘‘This revision will give ED members, who all specialize nurses an opportunity to learn in geriatric care and emergency nursing, version gives users more control over their learning in ways it didn’t before,’’ Roe knew that we had to do something to said. ‘‘The material is make sure that the older adult patient is experience. Briana Quinn, ‘‘We were able to take the engaging. I think the learner cared for effectively and efficiently MPH, BSN, RN original GENE course, which will walk away with a lot while in the ED environment,’’ Roe itself is a great online course, more and apply it directly in their said. ‘‘We needed a means to provide and make it even better by converting it everyday practice.’’ solid educational material for the ED into a highly interactive online course The content, which includes more nurse that would focus on the that will lead to the intended learning evidence-based best practices and increasing aging population.’’ Matt Smith, ENA’s senior instructional outcomes.’’ injury prevention, is Roe’s favorite

June/July 2013

aspect. The Geriatric Work Team and authors reviewed best practices across the U.S. and Canada. Special considerations in the course include involving patients and their families in patient education and discharge planning; instructions for transitions of care; and information on legal and ethical issues, such as advanced directives and palliative care. ‘‘With the geriatric population increasing at such a rapid rate, the emergency department has become the primary care center for a lot of older adults,’’ Roe said. ‘‘Providing emergency nurses with the tools to give the best possible care for that older adult patient is really what this course is about.’’ Reference Centers for Disease Control and Prevention & Merck Company Foundation. (2007). The state of aging and health in America 2007. Retrieved from http://www.cdc.gov/Aging/pdf/ saha_2007.pdf

ENA Connected

A Technology Touchpoint By Thomas Barbee, ENA Digital Marketing Manager It was an absolute pleasure meeting with so many of you at the Leadership Conference in Fort Lauderdale, Fla. Having the opportunity to talk with many of you provided insights to not only what you expect from your digital experience but what you are trying to accomplish on a state and chapter level. The conference served as an important touchpoint for ENA in terms of technology. It marked the first time that we were able to provide a conference app for mobile devices. We offered a sneak peek of the new website design at ENA Wired, and I had the opportunity to talk with many of our state leaders about their respective website and social media initiatives.

In this ever-changing landscape of technology, the sheer number of possibilities is daunting; even here at ENA headquarters, we are constantly investigating the latest technologies and resources to help better serve our members. What I appreciated most about seeing members’ needs firsthand is how we are able to work together to provide solutions to common problems. We all offer invaluable insights. As we continue to build a useful infrastructure and employ key technologies to more conveniently provide the services you need, I hope you consider us to be your ally and resource in this dynamic landscape.

A Night At the

grANd Ole Opry

™

support ena foundation and enJoy the show that made country music famous

Join us for a night of country music & networking with your colleagues!

September 20 • 7 pm Don’t miss this exciting event! What began as a simple radio broadcast in 1925 is now a live-entertainment phenomenon. Dedicated to honoring country music’s rich history and dynamic present, the Grand Ole Opry showcases a mix of country legends and the contemporary chart-toppers who have followed in their footsteps.

Registration now open at: www.ena.org/ac

Official Magazine of the Emergency Nurses Association

DAY ON THE HILL — 2013 —

ore than 70 ENA leaders attended ENA’s first Day on the Hill on May 14-15. Sponsored by Vidacare, an ENA sident JoAnn Lazarus, Above and right: ENA Pre Strategic Sponsor, the activities h Rep. Diane Black MSN, RN, CEN, meets wit included an advocacy briefing with ie Gohmert (R-Texas). (R-Tenn.) and Rep. Lou Capitol Hill staffers and Richard sident-elect Deena Above, left: 2013 ENA Pre ACNS-BC, CEN, , RN Mereu, ENA’s chief government AP , Brecher, MSN, RN member of Sen. John relations officer. Attendees networked CPEN, talks with a staff at an evening reception and took in Cornyn (R-Texas). the sights of Washington, D.C., during a ‘‘Monuments by Moonlight’’ tour, which was a fundraiser for the ENA Foundation. The second day of the event was devoted to meeting with Congressional leaders regarding public policy issues that most closely impact emergency nursing. Visit ENA’s Facebook page to see more than 150 event photos, and look for more coverage in Mereu’s column in the August issue of ENA Connection.

June/July 2013

Safe Work Environment Intensive Thanks to all who attended the Safe Work Environment Intensive Workshop on June 5-6 in Illinois. Some of the featured topics were: Safe Practice

• Lateral Violence and Bullying • De-escalation Awareness • Advocacy

Safe Care • • • •

Risk Analysis Team Safety Medication & Procedural Safety Liability in Emergency Practice

Watch for coverage of this workshop in a future issue of ENA Connection.

The Safe Practice: Workplace Violence Prevention portion of this event was sponsored by:

Official Magazine of the Emergency Nurses Association

State and Chapter Advocacy Updates Florida ENA State Council Submitted by Penny Blake, RN, CCRN, CEN, Government Affairs Committee Chairperson Emergency nurses and physicians have a long history of collaboration and working together for the welfare of patients. In the spirit of that philosophy, four Florida ENA members participated in the Florida College of Emergency Physicians Emergency Medicine Days on March 11-14 in Tallahassee. Participants later exchanged ideas related to ED crowding, the future role of the emergency department physician and the increasing problem of violence in our emergency departments. FENA members Penny Blake, RN, CCRN, CEN, Government Affairs Committee chairperson; Sharon Reuter, RN, immediate past chairperson; Terri Repasky, RN, president; and Lynda Tiefel, BSN, RN, CEN, Tallahassee Chapter secretary/treasurer joined FCEP members in informational sessions, visiting legislators and attending the FCEP Board of Directors meeting. FENA and FCEP identified several common areas of focus for their public policy agendas: • HB 3 and SB 66 (Child Safety Devices in Motor Vehicles). FENA is working with the Florida Booster Seat Coalition and other groups to get this legislation passed this year. FENA members attended a news conference held by the Booster Seat Coalition at the capitol during EM Days. • HB 13 and SB 52 (Wireless Communication While Driving). Both groups are supporting texting and driving legislation by lobbying legislators and providing education on the effects of texting and driving. • Conscious procedural sedation. Together we continue to monitor the situation with the state Board of

Nursing and prepare to intervene if legislation looks imminent. During the FCEP Board meeting, Repasky presented an update of FENA activities and the FENA strategic plan. Activities included educational endeavors with the Emergency Medicine Learning & Resource Center; advocacy promoting safety and well-being of Florida citizens, children and health care providers; and strategies to promote the awareness of and to decrease workplace violence. FENA also monitors issues related to care of behavioral health patients in the ED and professional practice and provides scholarships to members for trauma and emergency care-related education and certifications. A topic which engendered a great deal of discussion during the wrap-up session was the failure to enforce and prosecute the law relating to violence against health care workers. I spoke at the Florida Senate Appropriations Subcommittee on Criminal and Civil Justice about workplace violence and shared personal stories of substantial injuries sustained by my ED colleagues

in the workplace. I also shared that ENA has collected data on violence in the ED over the last five years and that 70 percent of responding emergency nurses had been battered or assaulted within the last year. In 2012, the Florida Hospital Association, in collaboration with Florida ENA and other stakeholders, collected data specific to Florida. Fifty-two hospitals responded to the survey, reporting almost 3,500 incidences of workplace violence, an average of 67 per hospital. More than 75 percent of the incidents occurred in the ED. Because many of these events go unreported, or are reported and go unprosecuted, I challenged the committee to recommend an interim study to investigate why Florida’s Statute 784.07 is so often not enforced. After learning of this testimony, FCEP members requested more information and offered their support. FENA members met with four representatives and six senators to discuss FENA’s Public Policy Agenda and left information packets with other key legislators. Education was provided regarding the following issues of importance to FENA members: 1. Funding and support for behavioral health care in Florida, especially prevention and follow-up. Cuts to behavioral health funding tend to shift financial responsibility to emergency departments, community hospitals, law-enforcement agencies, correctional facilities and homeless shelters. The result is a delay in care, possibly up to 72 hours, while transfer to appropriate mental health facilities is being arranged. In the meantime, these behavioral health patients occupy ED beds, delaying treatment of incoming patients. 2. HB 3 and SB 66 (Child Safety Devices in Motor Vehicles)/HB 013

June/July 2013

Members of the Ohio ENA State Council chat with state Sen. Scott Oelslager, the recipient of their 2012 Legislator of the Year Award. and SB 52 (Use of Wireless Communication Device while Driving), supported by FENA and FCEP. Data was provided that shows that booster seats save lives, and according to the National Highway Traffic Safety Administration, the proper use of a safety seat can reduce a child’s fatality risk by up to 71 percent.

Michigan ENA Huron Valley Chapter Submitted by Brandi Uren, BSN, RN, CEN, President On March 20, the Michigan ENA Huron Valley Chapter visited the state capital of Lansing. The day began with an introduction and orientation to effective

state-based advocacy. Brad Uren, MD, FACEP, president and Legislative Committee chairperson of the Michigan College of Emergency Physicians, also met the participants. The group toured the Capitol and sat in the gallery to watch the Michigan House of Representatives in session. Reps. Gail Haines and Klint Kesto introduced the group from the floor. Kesto met with the group to discuss violence against health care workers, and members shared personal stories and asked for support for SB 250, a bill to increase penalties for assaulting a health care worker. The group also learned of the common misconception that the emergency department is a source of wasteful spending and was encouraged to educate lawmakers about this misconception. The chapter learned much from watching the Legislature in action and encourages others to get involved.

Ohio ENA State Council Submitted by Nicholas Chmielewski, MSN, RN, CEN, NE-BC, Government Affairs Liaison On Feb. 22, the Ohio ENA met with and

Official Magazine of the Emergency Nurses Association

recognized legislators of the 129th Ohio General Assembly. In conjunction with the annual ‘‘Nurses Day at the Statehouse’’ event, Ohio ENA presented state Sen. Scott Oelslager (R-Canton) with the 2012 Legislator of the Year Award. During Oelslager’s tenure as chairperson of the Health Committee (2011-2012), significant legislation was passed to improve Ohio’s health care delivery system, specifically the following: • Protecting Ohio’s health care workers • Expanding prescriptive authority for advance-practice nurses • Banning synthetic drugs • Modernizing the tracking of unlawful drug purchases • Preventing “pill mills” • Updating practice regulations State Rep. Anne Gonzales (R-Westerville) was presented with a legislator appreciation award in recognition of sponsoring enacted legislation that promotes zero tolerance for violence against emergency nurses. Ohio ENA presented appreciation awards to state Reps. Denise Driehaus (D-Cincinnati) and Stephen Slesnick (D-Canton), sponsors of similar companion legislation in both the 128th and 129th Ohio General Assemblies.

UPDATE FROM THE EXECUTIVE DIRECTOR |

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

Whatever Happened to That Resolution? ENA’s role is to promote the specialty of emergency nursing and to define and uphold standards for emergency nursing practice. ENA members have many opportunities to participate in activities that may determine the future of their profession. One of the most important is the annual ENA General Assembly. Delegates to the General Assembly are chosen by state councils, typically after an application procedure, review and selection by state leaders. Delegate numbers are determined by the number of members in each state, providing for representation of that state’s membership body. 2012 Resolution Title

Impact Factor

The role of the General Assembly is to ‘‘provide direction and stewardship for the organization, and shall develop and adopt policies and positions affecting the emergency nursing professional and furtherance of ENA’s purposes’’ (ENA Bylaws, Section 2, Authority). There are two key items addressed by ENA General Assembly: the first are bylaws amendments, which govern how the association conducts business. The second are resolutions, where new policies and changes to existing policy are recommended. Resolutions typically focus on professional issues

Dept. Assigned

Progress

Proj. Completion

GA12-010 Care of the Bariatric/Obese Patient Moderate impact IQSIP Topic brief in development. Q4 2013 GA12-011 Care of the Patient with Chronic Pain Moderate impact IENR Clinical practice guideline for acute Q4 2013 pain management in development.

IQSIP

Position statement on chronic pain in development.

Q2 2013

GA12-012 Defining Wait Times

Collaboration with ACEP

Anticipating document for board review/approval.

Q2 2013

Minimal impact

GA12-013 Health Care Worker Fatigue 1. Moderate impact IQSIP Wellness Sleep Initiative Challenge (collaborative with ANA). 2. Moderate impact IQSIP

White paper on impact of nurse fatigue on patient safety in the ED is being developed by ENA Wellness Committee.

3. Significant impact ENA Nursing Department; Government Relations

Collaboration to identify and implement fatigue countermeasures. Task force development will require significant funding.

GA12-014 Palliative Care in the Emergency Setting Moderate impact IQSIP

End of Life position statement has been completed. Public comment, revision and ENA board review/approval required.

Education; Meetings and Conferences

Dependent on proposals submitted and recommendation of conference committees.

GA12-015 Safe Discharge from the ED

IQSIP

Review of current position statements for content.

1. Moderate impact

Q4 2013 2014

Q3 2013

Ongoing

Q3 2013

2. Significant impact IENR

Developing research proposal identifying “high risk” discharges and potential interventions. Requires significant external funding to actualize.

GA12-016 TNCC Eligibility

Outcome: Only RNs or international equivalents Completed may hold TNCC provider status.

ENA board decision, December 2012

GA12-017 Use of Protocols in the ED Setting Moderate impact IENR/Government Relations

Q3-4 2013

Survey of state laws, operational definitions. CMS Condition of Participation related to use of nurse-driven protocols to be conducted.

Q4 2013

June/July 2013

affecting emergency nursing practice, advocacy and regulatory issues. Resolutions are sent to the ENA Board of Directors for the purpose of defining the profession and emergency nursing practice. The board works with ENA headquarters staff to determine appropriate methods for operational management of the recommendations. Some resolutions can be implemented fairly quickly (in the form of a position statement) but others may take months, even years (certain research projects, for example). Some resolutions have minimal financial and workload impact on the association and others have significant resource allocation requirements.

What Happens to Resolutions After the General Assembly Approves Them? After the General Assembly meeting, adopted resolutions are collated by the ENA Executive Services staff. These documents are presented to the ENA Board of Directors, typically at the final board meeting of the year. The board reviews the resolutions, discusses budget implications, staff resources and alignment with ENA mission, vision and strategic plan. The board then works collaboratively with the ENA executive director to establish strategic priorities and operational implications related to the resolutions.

Where Do I Find Past Resolutions and Updates? Results and progress can be found at www.ena. org/statecouncils/GeneralAssembly.

What Progress Has Been Made With 2012 Resolutions? The 2012 General Assembly resolutions were reviewed by the ENA Board of Directors at the final meeting in November 2012. Each resolution was reviewed for alignment with the ENA mission and vision, the strategic plan and organizational resources and was given an operational impact factor category: minimal, moderate or significant. Some resolutions are multi-factorial and so may fall into more than one category. Each resolution also was tasked to an ENA staff department for further investigation and recommendations. The chart at left provides an overview of the 2012 resolutions, their categories, ENA department(s) assigned, progress and projected target completion.

ENA STATE CONNECTION Loma Prieta (Calif.) ENA Chapter Submitted by Diane St. Denis, BSN, RN, PHN, MICN, president-elect The Loma Prieta ENA Chapter remembers Antoinette ‘‘Toni’’ Robinson, who lost her six-year battle with breast cancer on March 1. Robinson was committed to serving as an advocate for both the nurse and the patient. She was dedicated to Antoinette nursing and Robinson, MSN, nurses, and her RN, CCRN first priority at work was her patients. When Robinson was diagnosed with stage 4 breast cancer, she used her knowledge, will and faith to fight the disease. Just as she advocated for her patients, she was an advocate for her own care. Robinson never complained about her treatment, always had a smile on her face and continued to attend and contribute to Loma Prieta ENA meetings.

North Carolina ENA State Council Submitted by Mary Lou Forster Resch, BSN, RN, CEN National ENA election voting is in progress until June 12. North Carolina ENA is offering a drawing for a free educational offering to NC ENA members who vote in both national and state elections. Submit your voter confirmation to Terri Friedhoff, BSN, RN, president. We are accepting nominations

Meetings and Events Missouri ENA The second annual Missouri ENA Conference on Management, Clinical & Skills Education will be held July 25-26. Key presenters include JoAnn Lazarus, MSN, RN, CEN; AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN; and Michael Moon, MSN, RN, CNS-CC, CEN, FAEN. For more info, contact conference chairperson Carol Pettit at carolfestus@ aol.com or visit www. missouriena.org.

Seagate (Ohio) Chapter ProMedica and the Seagate ENA Chapter will hold the second annual Northwest Ohio Emergency Nursing Conference on Oct. 4 at ProMedica Toledo Hospital. Topics covered will include LVADs, sepsis, interventional neurology, disaster readiness, cardiology, traumatic injury patterns and bullying in health care. Contact Jenny Carpenter at jennifer.carpenter@ promedica.org or Kristie Gallagher at kristie. gallagher@promedica.org to learn more.

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Official Magazine of the Emergency Nurses Association

Tick Tock, Beat the Clock

Early Doxycycline Prevents Death From Rocky Mountain Spotted Fever By Naomi Drexler, MPH, Epidemiologist, Rickettsial Zoonosis Branch, Centers for Disease Control and Prevention Rocky Mountain spotted fever is a potentially fatal tickborne bacterial infection reported throughout the United States, Mexico and South America. In the U.S., most cases of RMSF are reported in North Carolina, Tennessee, Missouri and Oklahoma and also have become increasingly prevalent in the Southwest over the last decade. Anyone can become infected, but a higher rate of RMSF has been noted among Native American populations; in the U.S., children are four times more likely to die from RMSF. 1,2 RMSF begins with fairly minor symptoms but can progress rapidly. The median time from onset to death is only eight days, making every clinical visit important in terms of possible intervention. The key to keeping RMSF a mild illness is treating it early with doxycycline. In a recent chart review, more than 80 percent of cases reported to the emergency department during the course of their illness; of those, more than 40 percent presented to the ED on more than one occasion. 3 As a result, ED staff is often the first, and sometimes only, line of defense against severe and fatal cases of RMSF. Early signs and symptoms of RMSF (days 1-3) include fever, headache and myalgia; gastrointestinal symptoms (abdominal pain, nausea) and respiratory symptoms (cough, difficulty breathing) may also occur. While most people with RMSF (90 percent) develop a rash during the course of illness, some do not develop the rash until after day five, when treatment already should have begun. The rash may be asymmetric, localized or absent and should not be relied upon for clinical diagnosis. Many people who are diagnosed with RMSF do not recall being bitten by a tick because the bite is painless and often in hard-to-see locations. However, seeing ticks on dogs or visiting grassy or wooded areas should be considered risk factors for RMSF. Patients with RMSF who are treated with oral doxycycline

in the first three days of illness usually recover quickly, while those treated later may require intravenous doxycycline and hospitalization. Severe clinical presentations may include respiratory distress, neurologic symptoms or clotting disorders. Patients with severe infections may have permanent and irreversible sequelae, including loss of fingers and toes, neurologic impairment (hearing loss) and cognitive deficits. Treating early, when RMSF is first suspected, is the key to ensuring a mild clinical course. Unfortunately, there is no timely diagnostic laboratory test that can be used to make a treatment decision. Treatment should be started as soon as RMSF is suspected, based on clinical signs and symptoms alone. Doxycycline is the only antibiotic recommended by the Centers for Disease Control and Prevention and the American Academy of Pediatrics for the treatment of suspected RMSF in children and adults. Other antibiotics, including broad-spectrum antibiotics, are not effective in treating RMSF. In the dose and duration prescribed for RMSF, doxycycline is generally well-tolerated and has not been shown to cause dental staining in children. RMSF is usually confirmed by observing a fourfold rise in antibody tiers among paired serology samples taken 2-4 weeks apart. Polymerase chain reaction of whole blood or skin biopsies also may be done when the patient is acutely ill but is most sensitive in severe cases. Prompt treatment of suspected RMSF with doxycycline is effective and saves lives. Some health care providers hesitate to prescribe doxycycline to children without a confirmation of a diagnosis, but in the case of RMSF, delay in treatment can result in a fatal outcome. If RMSF is considered in the differential diagnosis, give doxycycline immediately. References 1. Holman, R. C., McQuiston, J. H., Haberling, D. L., & Cheek, J. E. (2009). Increasing incidence of Rocky Mountain spotted fever among the American Indian population in the United States. American Journal of Tropical Medicine and Hygiene, 80(4), 601–605. 2. Dahlgren, F. S., Holman, R. C., Paddock, C. D., Callinan, L. S., & McQuiston, J. H. (2012). Fatal Rocky Mountain spotted fever in the United States, 1999–2007. American Journal of Tropical Medicine and Hygiene, 86(4), 713–719. 3. CDC, 2012. Arizona Chart Review 2001-2011.

June/July 2013

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BOARD WRITES | Ellen (Ellie) H. Encapera, RN, CEN Risky Behavior and the Adolescent Brain

Guidance Through a Construction Zone Merriam-Webster defines adolescence as the period of growth and development between childhood and maturity, spanning from approximately ages 12 through 18. During this period, rapid changes are occurring physically, hormonally and psychosocially. Adolescents are dealing with issues of personal body image, privacy, independence, an intense need for socialization with peers and a driving desire for normalcy. Peer pressure and the desire to fit in, experimentation with ‘‘forbidden’’ substances such as drugs and/or alcohol and a strong hormonal drive to engage in sexual activity impel adolescents toward thrill-seeking without consideration of future consequences. Torn between childhood and adulthood, teens are often rebellious and seek independence from parental controls, leading to impulsive behavior with sometimes risky and dangerous outcomes. Why do they make risky choices, leading to possible harm? What are they thinking? As you well remember, the human brain develops from back to front, supporting the most vital bodily functions first, then moving on to reflexes, motor functions and senses and, finally, developing the more complex thinking processes of decisions and controls. During the adolescent growth period, the brain is still under construction. The frontal-cortical areas that oversee behavioral and executive functions — such as abstract thinking, motivation, attention to planning and the inhibition of impulsive responses — are not yet fully developed. Brain pathways and circuitry that play a key

role in emotional regulation and cognitive function are underdeveloped in the adolescent brain and, as a result, impulse choices and risky behaviors go unchecked. Typically, adolescents seek higher levels of more immediate rewards and engage in risky behaviors without considering future outcomes and consequences. The adolescent’s feelings of invincibility and excitement of living for the moment are thrillseeking motivators that underplay the cautions against and consequences of their actions. Almost daily in our emergency departments, we treat victims of trauma resulting from risky behaviors — distracted driving, failure to use recommended safety devices and speeding. Addictive and behavioral disorders, teen pregnancy and sexually transmitted infections are commonplace, and we as emergency practitioners are faced with not only the physical healing but the emotional healing for both patients and their parents. The opportunity for meaningful interventions with teens and their families begins with the registered nurses and support staff of the emergency setting. We are poised at that all-important starting point, with the knowledge and ability to provide overall comfort, support and ongoing strategies for coping with the situation at hand and beyond. Emergency nurses are great listeners, analyzers and communicators who can adapt to the role of compassionate adviser when the opportunity arises. As experts in safety and injury prevention, emergency nurses are

capable of reaching out far beyond the walls of their institutions. Around the country, we hear inspiring stories of ENA volunteers staging realistic, life-saving injury-prevention programs at local schools designed to impact and influence the lives of children and teens, to inspire them to listen to reason, weigh their options and make better choices. Let’s reach out and make a difference now, rather than later. Resources Dayan, J., Bernard, A., Olliac, B., Mailhes, A. S., & Kermarrec, S. (2010). Adolescent brain development, risk-taking and vulnerability to addiction. Journal of Physiology, 104(5), 279–286. Crews, F. T., & Boettiger, C. A. (2009). Impulsivity, frontal lobes and risk for addiction. Pharmacology, Biochemistry, and Behavior, 93(3), 237–247. Fareri, D. S., Martin, L. N., & Delgado, M. R. (2008). Reward-related processing in the human brain: Developmental considerations. Development and Psychopathology, 20(4), 1191–1211. Van Leijenhorst, L., Zanolie, K., Van Meel, C. S., Westenberg, P. M., Rombouts, S. A., & Crone, E. A. (2010). What motivates the adolescent? Brain regions mediating reward sensitivity across adolescence. Cerebral Cortex, 20(1), 61–69.

Board Activity Now Online Highlights from ENA Board of Directors meetings are published exclusively in the members-only section of the ENA website. Log on to www.ena.org each month to keep up with the latest happenings.

June/July 2013

2013 Proposed Bylaws Amendments and Resolutions

Here’s What’s on the Docket for Nashville The ENA General Assembly will be held Sept. 18-19 in Nashville, Tenn. ENA President JoAnn Lazarus, MSN, RN, CEN, will preside as speaker of the house. Roughly 700 delegates representing ENA’s state councils and international members will debate and vote on emergency nursing issues that affect the emergency nursing profession. Attending the 2013 General Assembly is a great opportunity to learn and understand how decisions concerning the direction and stewardship of the association are made. The General Assembly includes the installation of the 2014 ENA Board of Directors and Nominations Committee, reports by the president and president-elect and consideration of, and action on, proposed bylaws amendments and resolutions. At its May meeting, the ENA Board of Directors reviewed all of the proposals for the 2013 General Assembly. Final proposals will be posted in July at www.ena.org in the online General Assembly Handbook for viewing by all state councils, chapters and assigned delegates before General Assembly. Proposals will be available online only. Summaries of the proposed bylaws amendments and resolutions are described below.

Bylaws Amendments Article V – Immediate Past President on Executive Committee: The ENA Board of Directors offers this amendment to include the immediate past president on the Executive Committee. Adding this role will provide guidance, experience and wisdom for making necessary decisions of the association. Article III – Military Membership: The authors offer this amendment to

ensure that members serving in all branches of the United States military clearly qualify for this membership category. Article VI – Eligibility Requirements – Board of Directors: The authors offer this proposal to provide clarity and consistency of language within ENA’s bylaws and the election rules. Articles IV, VI, VIII – Eligibility Requirements – Background Checks: The authors offer this amendment to streamline the election process by eliminating background checks being conducted for election candidates. This proposal is based on a survey of other nursing organizations that shows ENA is the only organization conducting background checks for its elections. Adoption of this amendment will result in financial savings to the association. Article VIII – Eligibility Requirements – Nominations Committee: The authors offer this proposal to provide clarity and consistency of language within the ENA bylaws as it pertains to a candidate for the Nominations Committee being a voting member (an ENA member) during the previous five years. Articles IV, VI – Eligibility Requirements – Nominations Committee (Amendment): The authors are presenting this amendment to eliminate redundancy, as bylaw requirements may only be made by a bylaws amendment. Article VIII – Nominations Committee Responsibilities: The authors offer these amendments to provide clarity and consistency in accordance with the election rules. Articles IV, VI – Preliminary Applications: The authors are

Official Magazine of the Emergency Nurses Association

presenting this amendment to remove ‘‘preliminary’’ from the language. This will provide consistency between policy and practice, as preliminary candidate applications were discontinued in 2011. Article III – Suspension and Termination: The authors offer this amendment to allow the ENA Board of Directors the ability to set a lesser penalty in a disciplinary matter, if appropriate. Article XII – Bylaws Submission Deadline: The authors offer this amendment to provide sufficient time for processing, reviewing and preparing the proposals for presentation to the General Assembly. Article XII – Membership Notice: The authors offer this amendment to provide consistency with the bylaws amendment process and to increase clarity and consistency with existing bylaws language. Article V – Remove Redundant Language for General Assembly: The authors offer this amendment to eliminate redundancy, as bylaws requirements may only be made by a bylaws amendment. Articles V, VIII – ENA Publications: The authors offer this amendment to provide clarity and consistency with existing bylaws language.

ENA Resolution Evidence-Based Standards for Lifelong Learning. This resolution recommends that ENA conduct research studies examining the relationships between continuing education and patient outcomes, develop a standard based on this research and engage with other stakeholders in discussions on the role of continuing education in validating competence and re-licensure.

PEDIATRIC UPDATE | Elizabeth Stone Griffin, BS, RN, CPEN

Why ‘Fever Phobia’ Exists and How We Can Help Fever accounts for almost one-third of all urgent care and emergency department visits among children.1 Public misconceptions abound, regarding everything from what constitutes a fever to how to treat it. In 1980, Dr. Barton Schmitt coined the term ‘‘fever phobia’’ to describe the widespread fears related to fever; he found that most parents and caregivers believed that fever itself caused physical harm to their children.2 Twenty years later, little progress had been made in dispelling the myths surrounding fever. A 2000 survey found that more than 21 percent of parents still believed that fever alone could cause physical harm, such as brain damage or death.3 Fever phobia stems from multiple sources, including advice from family members, previous teaching by health care providers and misunderstandings over what has happened to other sick children they have known or heard about.

The Reality Nelson states, ‘‘How sick the child looks is most important. It is far more important than any number on a thermometer.’’ 4 Fever is part of the body’s normal response to infection, and it serves a purpose — it helps the body kill and halt the replication of live microorganisms that are causing illness. There is no evidence that fever (not to be confused with hyperthermia) causes brain damage.1 Some degree of fatigue is a normal response to fever, especially if no antipyretics have been given. In my practice, I have heard many parents express this as their primary concern and the reason for bringing their child to the ED. Caregivers often describe their febrile child as ‘‘lethargic … just wanting to lie around all day,’’ and it is up to the health care providers to probe deeper to obtain a more detailed description of the child’s responsiveness and behavior.

To Treat or Not to Treat? There is no evidence that treating fever reduces morbidity or mortality in otherwise-healthy children. 5 In fact, the American Academy of Pediatrics has concluded that there is also no evidence to recommend the routine use of antipyretics to reduce temperature. Instead, they state that the main goal in treating pediatric fever should be to make the child more comfortable.6 Some children, for example, will have difficulty sleeping and/or refuse to drink fluids when they have a fever. In those cases, treating the fever may help avoid secondary

problems, such as dehydration. This may be a point worth explaining to caregivers before giving children antipyretics in the ED so that they don’t perceive mixed messages regarding antipyretic use.

Educating the Caregivers Ask caregivers more specific questions, such as, ‘‘What was your child’s temperature at home?’’ rather than, ‘‘Does your child have a fever?’’ 1 This can help avoid erroneous reporting of fever while simultaneously educating the caregiver about what actually constitutes a fever. Provide focused education to meet the needs of each family. The following are common questions and situations related to fever phobia, with suggested responses: • ‘‘His temperature keeps coming back.’’ Antipyretics only reduce the symptoms of the illness; they do not cure it. If the illness is still present, the fever should come back. Also, if the child hasn’t received the correct dose of antipyretic, the fever likely will return sooner than expected. • ‘‘Why is her heart racing? Why is she breathing faster?’’ Fever increases both the heart rate and the respiratory rate. A child’s heart rate increases by approximately 10 beats per minute per degree centigrade.6 It is part of the body’s natural response to fever, and you

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should notice both rates decrease after the fever subsides (naturally or as a result of antipyretics). • ‘‘Why are his hands and feet cool while the rest of his body is hot?’’ Since fever increases the heart rate, the blood is circulating faster; the hands and feet may not receive as much blood as usual, hence the cooler temperatures. • ‘‘Should I put him in an alcohol bath or a cold bath to cool him down?’’ No to both; alcohol could be harmful if absorbed through the skin, and cold baths could cause unnecessary shivering and energy consumption. For high fevers, tepid baths or towels can safely help cool the body. • ‘‘I am afraid he will have a seizure from the fever.’’ Simple febrile seizures (defined as primary generalized febrile seizures lasting for less than 15 minutes and not recurring within 24 hours) generally have good outcomes. Their cause is not completely understood, but they seem to have a genetic component, occur in 2 to 5 percent of all children (typically under 5 years of age) and have not been associated with any long-term delays or damage. Children with a history of febrile seizures stand a 30 to 50 percent chance of recurrence.

Empathy and Reassurance Validate the caregivers’ concerns and praise them for what they have done well, such as recognizing their child was ill. 4 Being aware of what not to say to caregivers is also very important; it is never appropriate to imply that parents were wrong to bring their child to the ED.4 Because pediatric medications are weight-based and children’s weights change frequently as they grow, caregivers often are not aware of their child’s current dose. Consider having weight-based dosing instructions and other fever education available at triage (or the point of initial assessment) because that is the time when dosing confusion, and fever phobia, is likely to be revealed.

ENA Call for… Memorial Requests, 2013 ENA General Assembly ENA will honor our members who have died in the last year during a special memoriam presentation at the 2013 General Assembly in Nashville, Tenn. If you would like to recognize a member who has died, please complete the request form in the General Assembly area (members only) at www.ena.org. All requests must be submitted to componentrelations@ena.org no later than 5 p.m. Central time Wednesday, Aug. 21.

References 1. Wallenstein, M. B., Schroeder, A. R., Hole, M. K., Ryan, C., Fijalkowski, N., Alvarez, E., & Carmichael, S. L. (2013). Fever literacy and fever phobia. Clinical Pediatrics, 52(3), 254–259. 2. Schmitt, B. D. (1980). Fever phobia: Misconceptions of parents about fevers. American Journal of Diseases of Children, 134(2), 176–181. 3. Sullivan, M. G. (2010, June). Education cuts repeat fever visits. ACEP News. Retrieved from http://www.acep.org/ Clinical---Practice-Management/Education-Cuts-RepeatFever-Visits/ 4. Nelson, D. S. (1998). Emergency treatment of fever phobia. Journal of Emergency Nursing, 24(1), 83–84. 5. Sullivan, J. E., Farrar, H. C.; Section on Clinical Pharmacology and Therapeutics; Committee on Drugs. (2011). Fever and antipyretic use in children. Pediatrics, 127(3), 580–587. 6. Subcommittee on Febrile Seizures. (2011). Febrile seizures: Guideline for the neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics, 127(2), 389–394.

Call For Poster Abstracts Leadership Conference 2014

Research and Evidence-based Practice Projects Don’t miss this opportunity to showcase your work on emergency department management, leadership and research

Submission Deadline: August 1, 2013

For further information regarding guidelines, please visit www.ENA.org/IENR

Official Magazine of the Emergency Nurses Association

ENA Corkboard

Sai li stre ng. Re ss f al s and o a in t r me. I iling. I he t is g o tim ing wher the op e of n p atu the wi osite o re. nd tak f work es me – Vi ctor ia P oole y

ENA recently asked its Facebook fans: What’s the ideal vacation for an emergency nurse? Here are some of the responses:

palm under a es k c o m my to a ham Lying in the beach with hedule n sc tree or o er without any at in the w . . . amerato – Gina C s t n of eve

I took a 10-day cruis e, and I was frustrated the first tw o days — no pager, no e-mail, no Internet! I forgot what it was like to re lax! We should all take a break from the stresses, whatever they may be , to slow down and enjoy talking an d relaxing! – Dede Koenekamp

Ar Ita enta wo ly. (I l car uld gu an be ess d a he a p ma lpf p ul, lane of too trip .) –A bb

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and the family h it w e m o h g each Just being and enjoyin r on g in x la re friends e lake o pany by th m o c ill call s r’ e th o g no one w in w o n k — the deck to work! you back in Jane Mattila –

ask

! k from India Just got bac lity see the rea We went to e nd travel th of poverty a g/half-sight-seein lf a H . y tr n u co re able ork! We we volunteer w other ith one of M to connect w also anages and h rp o ’s a s Tere its to 0 hygiene k 0 1 te u ib tr is d ! With n. Amazing slum childre take aid, we also that being s en ips in-betwe lots of girl tr , which n vacations a ri a it n a m u h where , NV, FL . . . includes AZ sun! uthrie we can find – Heather G

A Jee p. My fa A tank of g mily. as an No d a ga and le sc t us ju cell service st driv . Drop ard. A map comp e and any U . us an NINT e ERRU njoy each ywhere ot PTED by life her’s . – Lori Baker Craig

State Connection Anywher e text mes where I can’t rec eiv sa my boss ges or phone call e saying so s from m sick and the depa eone called in rtment is nurses s X hort. “Ple ase help many can.’’ No if y ,I VACATIO cannot help — I’ ou m on N! – Jessica R iddick-Tr aylor

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for our NC ENA officers. If you are interested or would like to nominate someone, please check www.nc-ena.com for details. Our delegate application for the 2013 General Assembly is online until June 30. We encourage our members to consider becoming delegates. It is a wonderful opportunity to have a true voice in the direction of your professional organization. You will meet people from all over the world, including our international delegates. Never been a delegate? A little fearful? Seems like an overwhelming endeavor? Don’t worry. You will have your very own personal mentor constantly by your side to guide you through it all. Our newsletter is available online at www.nc-ena.com.

ssd stre . Do n a g axin ning is rel g or clea want e s i A cru o cookin hen you y wait e N w free. ou want want. Th who y nd you what long nd foot. A e man w o h th a for hand ay meet . I highly u o y on ou m like I did t wait s? Y ’ know r dreams uise. Can r u c of yo mend a ishop . tha B r recom next one a M – e ’til th Members of the South Dakota ENA State Council attended the South Dakota American College of Emergency Physicians Winter Conference in Sioux Falls.

South Dakota ENA State Council Submitted by Karla Nygren, BSN, RN, CEN, president-elect The South Dakota ENA State Council had the recent opportunity to be represented in the SD American College of Emergency Physicians Winter Conference. SD ACEP President-elect Dr. John Travnicek approached SD ENA President-elect Karla Nygren about this collaborative opportunity. The conference was held in Sioux Falls in March. Of more than 100 attendees, more than 20 were emergency nurses. The council had excellent opportunities for networking and dialogue. SD ENA provided a booth and door prizes. Nurses received continuing education credits for their attendance. A joint SD ACEP/ENA conference is in the early stages of development, with the hope of holding the program in the next one to two years.

Easy Ways to Relax During ENA Annual Conference

By Kendra Y. Mims, ENA Connection

ill you be one of the thousands of emergency nurses attending the ENA 2013 Annual Conference in Nashville, Tenn., this September? The conference, with a theme of ‘‘Safe Practice, Safe Care,’’ is an opportunity to network at events, connect with your fellow colleagues and learn valuable knowledge from experts in emergency nursing. You may find yourself dashing from one educational session or networking event to the next with little time in between to take a breather. Attending an ENA conference is an exciting experience that should leave you invigorated, not overwhelmed. Here are five tips to help you relax and make the most of your experience in Nashville.

Walk for Wellness to Support the ENA Foundation* Walking is a great way to relax, de-stress and improve your overall health, so if you’re between sessions and need to recharge your batteries with a leisure activity, join your colleagues for the new Walk for Wellness to support the ENA Foundation. The 1.2-mile walk will take place Friday, Sept. 20, from 10:15 to 11:30 a.m. (not too early for the night owls). Registration is $10. Walkers will

be encouraged to raise $150 in pledges from their friends and family, and all funds raised will be designated for ENA Foundation scholarship and research grant programs.

Rise and Shine If you’re an early bird who likes to begin your day with a boost of energy beyond a cup of coffee, join your colleagues for the rise-and-shine wellness Qigong workout on Saturday, Sept. 21 at 8:15 a.m. Qigong is the study and practice of various posture, breathing, meditation and mental-focus techniques and is known to reduce stress and increase stamina. Begin your busy morning with a clearer head and stay focused throughout your day as you soak up knowledge from educational sessions. Registration is at the door and on a first-come, firstserved basis, with limited participation.

Attend the ENA Foundation Event* Wind down from a busy day by joining the ENA Foundation on Friday, Sept. 20,

* For more information on these events and many more, please visit www.ena.org/ac. Register by July 25 for the early discount rate. for a night of country music and networking with your colleagues at the Grand Ole Opry. Those attending this ENA Foundation event will enjoy a live show at the Opry, an American icon and Nashville’s No. 1 attraction, world-famous for creating one-of-a-kind entertainment experiences. Seats are limited, so sign up today. You never know which star will take ‘‘country’s most famous stage.’’

Get a Massage It can be hard to enjoy Nashville and

June/July 2013

Cut Stress After Conference Briana Quinn, MPH, BSN, RN, ENA’s senior associate, wellness injury prevention, IQSIP, offers these tips for reducing post-conference stress: 1. Keep track of each session you attend. Take notes and keep a list of information you can share with your peers and co-workers when you return from conference. It can be difficult to sort through this once conference is over. Keep up with it at conference and have less work afterward.

walk around at conference with a sore back and tired feet. Stop by the exhibit hall and visit the ENA Relaxation Station to get a complimentary massage. Sponsored by Hill-Rom, an ENA Strategic Sponsor, the Relaxation Station will have professional massage therapists available to address tension in the neck, back, shoulders and arms in five- to 10-minute, upper-body,

2. Fill out your credit hours as you go. It can be difficult to keep track of each session attended and fully answer each post-session evaluation when you return home. By completing the evaluations daily in Nashville, you can avoid the stress of doing this after conference. 3. Tap into your peers at conference for innovative and catchy ways of presenting information you’ve gained when you get back. ‘‘Our goal is for each conference attendee to network with peers and increase his/her knowledge related to emergency nursing while being as stress-free, relaxed and excited about the experience as possible,’’ Quinn said.

seated massages. Complimentary foot massages also will be available. After you leave the Relaxation Station, you’ll be refreshed with a boost of energy.

Marketplace Express Nothing says relaxation like shopping. Be sure to swing by Marketplace Express during your down time and browse through more than 150 items,

all priced at ENA member rates. Choose from numerous educational products geared toward equipping you with the right tools to become a better emergency nurse. Don’t forget to add the 2013 Annual Conference souvenir T-shirt and other ENA logo merchandise to your shopping list as souvenirs for your colleagues back in your emergency department.

Saturday, September 21, 7:30 p.m.

Celebration of Inductees to the Academy of Emergency Nursing, National Awards and Lantern Awards Registration now open at: www.ena.org/ac

Official Magazine of the Emergency Nurses Association

ENA FOUNDATION

The Medicine of Giving Helping Other Nurses Is Member’s Formula While Fighting Illness By Kendra Y. Mims, ENA Connection

emergency nurses to advance their education and conduct research could play a part in discovering a cure for cancer one day, Taylor-Wynkoop said. That thought kept her focused and motivated to raise funds. Taylor-Wynkoop is a longtime ENA Foundation donor whose passion for fundraising helped the New Jersey ENA State Council understand the importance of supporting the foundation’s mission and purpose. In March, she received the

reast cancer. Jackie Taylor-Wynkoop received the life-changing diagnosis a week before she attended the 2012 ENA Annual Conference in San Diego: Her breast cancer had returned, and she would have to undergo surgery and chemotherapy. Although TaylorWynkoop, MSN, RN, PHRN, ‘It’s almost like the was overwhelmed and John Lennon song scared, she decided not to ‘Imagine.’ Except focus on any negative imagine all of the outcomes as she started the emergency nurses difficult treatment. No being educated to a matter what the future had higher level.’ in store, she was determined to focus on JACKIE TAYLOR-WYNKOOP, MSN, RN, PHRN something positive that would impact the future of emergency nursing. Her passion for first New Jersey State Council making a difference in the lives of her Outstanding Fundraising Award. fellow emergency nurses as an ENA When it comes to fundraising and Foundation donor and ENA Foundation motivating others to donate, TaylorBoard member-trustee gave her a Wynkoop believes emergency nurses reason to stay upbeat and kept her from are all in this together. dwelling on the cancer. ‘‘We all have a responsibility to ‘‘If I focused on me, I was afraid that support the ENA Foundation,’’ she said. I was going to break down, so I was ‘‘We can help. It’s about the profession. taking the time to focus on my fellow It’s not about each individual — it’s emergency nurses and raising money about the entire pie. for the ENA Foundation,’’ she said. ‘‘When I send my e-mails to state ‘‘Regardless of my situation, I thought leaders, I tell them that no amount is more about educating and paving the too small. I realize smaller states may way for our future emergency nurses.’’ not have $5,000 to donate every year. The ENA Foundation provides They may have $200, and that is still educational scholarships and research important and it makes a difference.’’ grants in the discipline of emergency She encourages her fellow nursing. Providing a means for emergency nurses to help by donating

individually. ‘‘Any amount is of the utmost importance,’’ she said. ‘‘It’s about what you can give.’’ As a longtime donor, Taylor-Wynkoop finds it rewarding to hear about how the ENA Foundation has impacted the emergency nursing profession and her colleagues. ‘‘I know quite a few colleagues who have received educational opportunities because of the ENA Foundation,’’ she said. ‘‘One of my nursing instructors was a recipient of an ENA Foundation educational scholarship, and now he’s educating our future nurses.’’ As for her cancer scare, TaylorWynkoop is on the road to recovery, and she continues to work hard to pave the way for emergency nurses who will travel a career path behind her. ‘‘It’s almost like the John Lennon song ‘Imagine,’ ’’ she said. ‘‘Except imagine all of the emergency nurses being educated to a higher level. Emergency nursing has changed. Nurses will need the higher level of education now and in the future to advance the profession, and we have to help them get it. I believe it’s paying it forward for the future.’’

Would you like to join Jackie Taylor-Wynkoop in paying it forward for your fellow emergency nurses and your profession? The ENA Foundation has opportunities for you to become involved. Visit www.enafoundation.org to find out how you can become a donor and make a difference in emergency departments, health care and the lives of your patients and colleagues.

June/July 2013

FUTURE OF YOUR NURSING |

Bridget Walsh, Chief Talent Officer

‘Are You My Mentor?’ Have you asked this question recently? Throughout your career, you will have to ask this question many times of multiple individuals. Mentors can take many forms and serve many purposes. Your need for mentorship will change based on the stage you are at in your career and in your life. What will remain constant is your need to seek out mentors and learn from their experience. While some organizations have formal mentorship programs where individuals are paired with mentors for specific purposes based on their positions, seeking a mentor is more often an individual responsibility. Before you can identify a mentor, you need to conduct a personal career assessment by determining where you are in your professional development and what your goals are. Are you considering applying for a manager position? Find a manager whose style and approach you admire and invite him or her to meet for coffee. Ask the manager to discuss his or her duties and how he or she prepared for the role. Perhaps you want to conduct research, write professionally or develop as a leader of the association. Whatever your professional goal, try to connect with individuals from whom you can learn. When you ask someone to serve as your mentor, explain your goals and how you think that person can help you. You also should investigate formal mentorship programs. There may be programs for aspiring leaders at your hospital

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or through a local university. As your professional membership association, ENA offers a variety of opportunities for mentorship, both formal and informal. Formal mentorship exists through the Academy of Emergency Nursing EMINENCE Mentoring program and the new Board Mentoring program. The EMINENCE program is designed to facilitate mentoring relationships between ENA members and Academy of Emergency Nursing fellows. The Board Mentoring program is designed to help emerging association leaders, pairing individuals who have been active in their state chapter with a board mentor to develop an action plan for a national leadership role within ENA. To obtain more information on these formal mentor programs, visit www.ena.org. Informal mentorship opportunities come in the form of networking and participation in local ENA chapter and state council meetings, by attending conferences and educational sessions and through the Emerging Professionals group. You may not even realize you have a mentor. Is there an individual you admire at work, someone you call to mind when you need advice or want to discuss a challenging situation? That individual may be serving as an informal mentor. If you can picture that person right now, you may want to consider better defining the relationship and asking him or her to serve as your mentor. Whether formal or informal, ask yourself, ‘‘Who is my mentor?’’ and ‘‘What help do I need to achieve my goals?’’ and start connecting.

2014 ENA National Committees Deadline: July 31, 2013

Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN, 2014 ENA president, would like to invite you as an ENA member to share your knowledge by participating on a national ENA committee. Bring your passion to the national level. We will fill openings on each of our national committees. The application period is July 1 - 31. While not required, a photo is requested with your application. Photos do not need to

be professionally done; a quick snap from your smartphone will work. Look for instructions on how to upload your photo when applying for your committee choice. For a full description of each committee and to submit your application beginning July 1, go to www.ena.org/ committeecall. Committee applications must be submitted online by 5 p.m. Central time Wednesday, July 31.

Official Magazine of the Emergency Nurses Association

GREETINGS FROM THE FUTURE Student Nurses Get an Education in ENA, Professionalism By Kendra Y. Mims, ENA Connection ENA 2013 President JoAnn Lazarus, MSN, RN, CEN, convened with nursing leaders and hundreds of nursing students from across the nation in April at the 61st annual convention of the National Student Nurses’ Association in Charlotte, N.C. Lazarus led two focus sessions in which she discussed her own personal journey as an emergency nurse, the history of emergency nursing, nursing certifications, interviewing skills and ENA membership. Lazarus described her opportunity to speak to student nurses about the emergency nursing profession and ENA as the highlight of her presidency thus far. Because some emergency departments do not hire new graduates, she also discussed the knowledge and skills that new grads will need to obtain ED positions, as well as the importance of maintaining a professional image. ‘‘We are a profession, but we are not always professional,’’ Lazarus said. ‘‘Professionalism does a lot for us as nurses. It sends a message of respect for each other and respect for our profession, and that spills over into the care we provide for our patients. Being professional is in our appearance, how we talk to each other and our involvement in organizations, like ENA.’’ Jesus Resendiz, a student nurse from California, said he enjoyed Lazarus’ presentation and her message. ‘‘As a student, I would really like to thank her for giving us all such valuable information that we as students should Jesus Resendiz know about, such

ENA President JoAnn Lazarus, MSN, RN, CEN, met with Taylor Harrison (left) and Marlee Flynt, students from James Madison University in Harrisonburg, Va., after her presentation at the National Student Nurses’ Association conference on April 4. as what to expect when applying, certifications that could make us more marketable and [training] expectations of a new grad,’’ Resendiz said. He was one of 82 nursing students who signed up to become ENA members during the convention. He believes ENA will guide him toward becoming a successful new-graduate emergency nurse. ‘‘I joined ENA because I know it will help me further my knowledge on what is expected of me as a future ER nurse,’’ Resendiz said. ‘‘As nurses, having the right resources and guidance is

extremely important, and ENA has that. It provides us with key education, courses and connections that we as nurses need to stay among the elite in this competitive field. ‘‘What I hope to gain out of my ENA membership is increased knowledge on what ER nursing is all about and to capitalize by becoming an expert on any ER task/concern that may arise regarding ER care.’’ Raveesh Bathra, a student nurse from Georgia, is interested in becoming an emergency nurse and joined ENA for career guidance and to meet other

June/July 2013

emergency nurses. specifically for the ED. ‘‘I thought it would be good Your advice today has to take advantage of ENA’s given me such resources, such as its online encouragement, whether I classes and the [association’s] receive an ED new magazine, to graduate job or not.’’ stay current Lazarus said she on different enjoyed the opportunity issues in to interact with a room emergency filled with more than 300 nursing,’’ energetic, enthusiastic Bathra said. nursing students. ‘‘I spoke to a ‘‘Having the Raveesh Bathra couple of opportunity to talk to Student nurses (from left) Cori Avery, Amy Shapen, Jesus nurses from the North Carolina these student nurses and Resendiz, Jay Zuno and Sara Spriggs grab seats for one of chapter, and they encouraged knowing that they are our Lazarus’ focus sessions on emergency nursing. and inspired me as well. I hope future was one of the best to gain some more clarity on where my president of the James Madison feelings for me,’’ she said. ‘‘It niche is in the nursing world and also University Nursing Student Association, re-energized me about what I do and learn skills that I can utilize whether I e-mailed Lazrus to thank her for the how important it is as leaders in our am an ER nurse or a nurse in a different valuable information she presented. profession to recognize that there are field.’’ ‘‘I was so impressed with your young nurses out there who we really Lazarus said she’s still in shock from presentation,’’ Flynt wrote. ‘‘As I need to mentor and help along, because the outpouring of positive feedback she graduate in May, I have applied to a few they’re our future and will be taking care received from students. Marlee Flynt, nurse residency programs and one of us in the years to come.’’

2013 Academy Candidates for Induction ENA and the Academy of Emergency Nursing are pleased to announce the 2013 academy candidates for induction: • Linda Arapian, MSN, RN, EMT-B, CEN, CPEN (Maryland) • Susan Barnason, PhD, RN, APRN, CNS, CEN, FAHA, FAAN (Nebraska) • Nancy Stephens Donatelli, MS, RN, CEN, NE-BC (Pennsylvania) • Joyce Foresman-Capuzzi, MSN, RN, CCNS, EMT-P, CEN, CPEN, CPN, CTRN, CCRN, SANE-A, AFN-BC (Pennsylvania) • Cathy Fox, RN, CEN, CPEN (Virginia) • Lynne Gagnon, MS, BSN, RN, CPHQ, NEA-BC (Maine) • Louise Hummel, MSN, RN, CNS, CEN (California) • Elizabeth Nolan, MA, BSN, RN, CEN (Kentucky) • Elda Ramirez, PhD, RN, FNP-BC, FAANP (Texas) The candidates will be inducted as fellows on Sept. 21 at the 2013 Annual Conference in Nashville, Tenn. We extend our congratulations and appreciation to the candidates for their outstanding contributions to emergency nursing and ENA.

AccelerAte your cAreer At the emerging ProfessionAls* sPeed mentoring event! Join us in Nashville on Friday, September 20 from 6-7 p.m. at the Opryland Hotel. ¡ Meet and network with experienced nurses, willing to share their wisdom and talent ¡ Cash bar and light appetizers will be served ¡ Stay tuned for more registration information in mid-July Sponsored by

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Emerging Professionals are nurses with five years or less of emergency nursing experience. *

Official Magazine of the Emergency Nurses Association

COURSEBYTES ENPC 4th Edition Clinical Considerations

ENPC Instructor Team Site Launched

Here is an excellent tip from one of our dedicated ENPC course directors regarding the Clinical Considerations skill station. Using small-group interactive learning environments is a great way to present the vignette skill station scenarios. This is also a good way to use a different teaching strategy that allows students to interact with others and get some hands-on practice. This teaching strategy allows students to use what they are learning in a simulated situation. Break your class into small groups of three to five people each. Have each group practice the vignette together, changing roles and assignments within each vignette. If time allows, switch the groups so they can work with more than one scenario. Have a short debrief afterward to see what worked best and what students learned from this activity.

All current ENPC 4th Edition instructors now have access to a shared team site on the ENA website. Go to www.ena. org and hover over the purple Membership tab. Select ‘‘Committees’’ from the dropdown menu. From that page, click on ‘‘Committee Members Only.’’ You will be prompted to log in if you haven’t already done so. If you have never logged in to the ENA website, click on the ‘Need to create an account?’ link using the e-mail address that ENA uses to send you Coursebytes. Once logged in, you will see a list of committees on the left side of the screen. Click on ‘‘ENPC Instructors 4.0.’’ The optional modules that were available as part of the ENPC 4th Edition update modules have been added to the ‘‘Shared Documents’’ section so that you can reference them when preparing to teach your ENPC

provider courses. The Education and Member and Course Services departments will continue to use this team site to post information that is meaningful to all ENPC instructors. Watch for news on a new team site for TNCC instructors!

Your Input Is Welcome CourseBytes is the official communication to all TNCC and ENPC course directors and instructors. Send topic ideas for future issues and feedback to CourseBytes@ena.org.

Become a 2014 Annual Conference Faculty Member Today Submissions due Monday, October 14, 2013 Share your knowledge in Indianapolis with an international audience of emergency nurses. Presentations in multiple course areas and course lengths are needed.

For full details including course areas, criteria and submission form, please visit www.ena.org.

For questions, email conferences@ena.org or 847-460-4117.

June/July 2013

RECRUITMENT

Official Magazine of the Emergency Nurses Association

RECRUITMENT

June/July 2013

RECRUITMENT

Official Magazine of the Emergency Nurses Association

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