ENA Connection October 2013 by ENA Connection

the Official Magazine of the Emergency Nurses Association

connection

October 2013 Volume 37, Issue 9

NO CAPE NECESSARY Recognizing You, The Real-Life Heroes PAGES 3, 10 - 11

INSIDE

FEATURES 6 The CAUTI Prevention Project 14 Getting Trauma Care to the Rural Heartland 18 ENA Foundation 2013 Scholarship and Research Grant Recipients

Emergency Nurses...

Everyday Extraordinary Emergency Nurses Week™

Emergency Nurses Day®

October 6-12, 2013

Wednesday, October 9, 2013

www.ena.org/enweek

Dates to Remember Oct. 14, 2013 Faculty course-proposal deadline for 2014 Annual Conference in Indianapolis. Nov. 1, 2013 Deadline to apply for 2013 ENA Foundation Seed Research Grants. Dec. 6, 2013 Deadline to apply for Leadership Tapestry Scholarship to attend Leadership Conference 2014 in Phoenix.

ENA Exclusive Content PAGE 6 The CAUTI Prevention Project: Translational Research in Action PAGE 8 Safety Through Vaccines and Our Role as Teachers PAGES 10 - 11 ENA Corkboard: Your Emergency Nurse Heroes PAGE 12 Board Writes: ENPC at 20 Years PAGE 14 Getting Trauma Care to the Rural Heartland PAGES 18 - 19 ENA Foundation 2013 Scholarship and Research Grant Recipients PAGE 26 Don’t Wait For a New ED Design PAGE 27 Update on Logrolling

Regular Features PAGE 4 Free CE of the Month PAGES 4 - 5 Members in Motion PAGE 9 Ask ENA PAGE 20 Academy of Emergency Nursing PAGE 22 Future of Your Nursing PAGE 24 Ready or Not?

LETTER FROM THE PRESIDENT | JoAnn Lazarus, MSN, RN, CEN

A Time to Remember That ‘Hero’ Means Us

his month as we celebrate Emergency Nurses Week, I would like to thank each and every one of you for being everyday heroes. As emergency nurses, you are there at the beginning of life, at the end of life and for all of the experiences in between. There is no way for others outside the profession of emergency nursing to truly understand what it means to be an emergency nurse. In a 2006 ACEP News guest editorial, David Baehren, MD, wrote, ‘‘I believe that when emergency nurses go to heaven, they get in the fast lane, flash their hospital ID and get the thumbs-up at the gate. They earn this privilege after being sworn at, demeaned, spit on, threatened and sometimes kicked, choked, grabbed or slugged. After this, they go on to the next patient as if they had just stopped to smell a gardenia for a moment.’’ No one but an emergency nurse would understand and appreciate Baehren’s words. It is interesting that Baehren would choose the gardenia as a descriptor for his commentary. Most would mention the rose as something we should stop and smell. The gardenia class has more than 140 species and is in the coffee family. It is difficult to grow but quite resilient. It is strong and requires bright light. Sound familiar? Emergency nurses, the everyday heroes, come to the profession with a variety of experiences, backgrounds and values, yet we work together as one team, one voice of a heroic, compassionate profession. A gardenia isn’t something that will just grow overnight; this is a tree that is going to need some work. It may be a season or two or three before you actually see a flower. We don’t become expert emergency nurses overnight, either. We undergo demanding education and training and require

The ENA Board of Directors congratulates all emergency nurses as we celebrate

Emergency Nurses Week ™ Oct. 6-12 Emergency Nurses Day ® Oct. 9 Emergency Nurses ... Everyday Extraordinary mentoring to become really good at what we do. Just like the gardenia, we are strong, work well in the spotlight and are a beautiful

Continued on page 7

Official Magazine of the Emergency Nurses Association

Oct. 6-12 is Emergency Nurses Week, and in celebration, ENA is adding a double dose of free continuing education in October.

Available to you starting Oct. 1 . . . ‘‘Leaders of the Future: Plan Your Success,’’ presented by AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN. (Credit: 1.0 contact hour) Whether you’re the mentor or the mentee, this eLearning course recorded at Leadership Conference 2013 will put you on your way to developing a successful mentorship for a front-line ED nurse manager. Papa discusses ways to create an action plan with feedback and to use that feedback to enhance the mentoring of nurse managers.

Available beginning Emergency Nurses Week . . . ‘‘Healthy Living For Nurses,’’ Mary Ann House-Fancher, MSN, ACNP, CSC. (Credit: 1.0 contact hour) Focus on your own health and wellness as a busy professional in this bonus e-learning course. You’ll come away knowing the essentials of exercise and nutrition physiology and be on your way to developing a total fitness program you can use. To take these and other CE courses 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 final certificate. • To return to your Personal Learning Page at a later time, go to www.ena.org and find ‘‘Personal Learning Page’’ under the 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).

Challenging Attitudes on Workplace Safety India Owens, MSN, RN, CEN, NE-BC, FAEN, Director of Emergency Services at Franciscan Alliance St. Francis Health and Hospital in Indianapolis, recently presented “Assessing Workplace Safety” at the Indianapolis Coalition for Patient India Safety’s nursing leadership forum, Owens attended by 150 nurses from coalition hospitals. Owens used the emergency department assessment tool from the ENA Violence Toolkit to identify ways to evaluate the current states of attendees’ hospitals, not just their emergency departments. She also discussed the importance of changing a culture and attitude of accepting violence and aggression as part of the job. Owens challenged chief nursing officers and directors in the room to include violence in RN job descriptions and to give hazard pay if they honestly felt violence was a part of a nurse’s job. The Indianapolis Coalition for Patient Safety was borne of the idea that hospitals in the Indianapolis area should never compete on safety. Membership consists of all six health systems in Indianapolis. Coalition members achieve accelerated outcomes by sharing resources, performance targets, accountability, funding and best practice. Do you have a recent professional or educational success story you want to share about yourself or an ENA member colleague? E-mail the information to connection@ena.org with the subject line “Members in Motion.’’

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

Writing Award for Charleston Nurse

leadership, which she achieved while working full-time as an emergency nurse at the Ralph H. Joanne Senn, MSN, CEN, CNL, Johnson VA Medical received the prestigious Donna Packa Center in Charleston, S.C. Excellence in Writing Award from the Joanne Earlier this year, Senn graduate faculty of the University of Senn published a manuscript Alabama Capstone College of Nursing. in Nursing Science Quarterly entitled The school presented the award at a nursing graduate reception Aug. 2. Senn “Peplau’s theory of interpersonal relations: Application in emergency and graduated Aug. 3 with a masters of rural nursing.” She also was featured in nursing science in clinical nurse

B-Metro: The Magazine of Metro Birmingham Living, as a recipient of the Excellence in Nursing Award. The clinical nurse leader is a nursing role that emphasizes improving the quality and safety of care for underserved and diverse populations. Senn’s goal is to provide the best care possible to veterans. “My father served in World War II, Korea and Vietnam, and my brother is a Vietnam War survivor,” she said.

Daniel Misa, BS, RN, CEN (third from left), an ENA Northern New Jersey chapter member and ED staff nurse at Chilton Hospital in Pompton Plains, N.J., was recognized for ‘‘Excellence in Patient-Centered Care by a Staff Nurse’’ during Chilton’s ‘‘Circle of Excellence’’ ceremony for National Nurses Week in May. Also pictured are the other Circle of Excellence winners, along with president and chief executive officer Deborah Zastocki, DNP, RN, FACHE (far left) and chief nursing officer Joanne Reich, MA, RN, NEA-BC (far right).

SHOCk EmErgENCIES–

Time is Critical. rAPID rESPONSE

Deliver Fluids and Drugs NOW with the EZ-IO.®

EZ-IO® Driver and Needle Sets Vascular Access Driver EZ-Stabilizer

EZ-Connect®

In emergent situations when your patient needs drugs NOW and you don’t have time to get a difficult IV or resources for a Central Line, the EZ-IO® Intraosseous Vascular Access System gives you the edge, providing access with anesthesia and good flow in 90 seconds.1,2 • Hemorrhage In rapid response, the EZ-IO® can make the difference with patients presenting • Hypovolemia shock challenges, such as: • Anaphylaxis Trust the vascular access system utilized worldwide by hospital and pre-hospital personnel for early goal directed therapy. Trust EZ-IO® – EZ-IO® puts time on your patient’s side.

45mm Needle Set 25mm Needle Set 15mm Needle Set 1 2

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.

Click this Qr Code for more information or go to: EZIORapidResponse.com

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

Official Magazine of the Emergency Nurses Association

RESEARCH

The CAUTI Prevention Project: Translational Research in Action

By Lisa Wolf, PhD, RN, CEN, FAEN, Director of the Institute for Emergency Nursing Research, and Marlene Bokholdt, MSN, RN, CPEN, CCRN, Nursing Education Editor, Institute for Nursing Education

or the last year, ENA has been working with the American Hospital Association and the Health Research and Educational Trust on a project to reduce catheter-associated urinary tract infections. ENA has produced educational materials specific to the emergency nurse, encouraged culture change in the emergency department and collaboratively developed a survey that sheds important light on practices around catheter placement, management and removal in the ED patient. Isn’t that something that happens on the floors? About 15 to 25 percent of patients will have a urinary catheter placed during hospitalization. Many are placed in the intensive care unit, emergency department and operating room. Because catheters are commonly placed in the ED as part of protocols for congestive heart failure, trauma and critical care, the involvement of emergency nurses is significant in this effort. The first cohorts of emergency departments are now being recruited into this project, and we hope that reduced numbers of urinary catheters will translate into fewer UTIs on the floors 48 to 72 hours later. Some reasons we insert catheters in the ED are to facilitate intake and output measurement, to keep patients from having to get up to urinate, protecting them from injury, and to protect the skin in the incontinent patient. It also saves time for the bedside nurse. The reasons we actually should insert catheters are a bit different and include the following: • Patient is critically ill and will require accurate output measurement

• • • • •

Urinary retention/obstruction Immobilization needed for trauma or surgery Incontinence with open sacral/perineal wounds End of life/hospice Chronic or existing catheter use

Two major points are stressed in our education for emergency nurses: 1. In the decision to insert, it’s important to be sure there is a strong indication for use and to identify the reasons for placement, as that will help at the second decision point. 2. Remove the catheter as soon as possible. If the indication is clear, the point at which it has served its purpose and is ready for removal also will be clear. Another important component affecting the decision to remove the catheter is the communication between the emergency nurse and the admitting nurse. The nurse in the ICU or medical floor must know the indication to facilitate the decision to remove. These two foundational points of decision are why the ED is critical in reducing the incidence of CAUTI. The environment in which emergency nursing is practiced is different in a lot of ways from the practice culture of the inpatient environment. It is nurse-driven, where we often assume the worst until proven otherwise, and so we intervene quickly and in ‘‘bundles’’ to improve the chance of a good patient outcome. This process works well, but it

October 2013

needs to be a thoughtful and considered one for the majority of patients, for whom a catheter is not a necessary intervention.

Safe Practice, Safe Care We are taking evidence that unnecessary catheter placement causes patient harm and how to narrow the criteria for which patients need a catheter to reduce the number of catheterassociated UTIs. We’re doing this by raising awareness about the incidence of CAUTI, how the consequences of catheter placement are not felt necessarily in the ED but several days later on the floor and by giving nurses a clear set of criteria to guide their decision-making. How does this reduce harm to patients? 1. CAUTI rates will drop with fewer catheters; eliminating those procedures that are unnecessary will eliminate the risk of infection for those patients. It seems simple because it is. In many cases it is not just the UTI that is avoided — the risk of urosepsis is also avoided. 2. With decreased infection rates, costs for extended stays and additional treatment are also decreased. 3. The use of antibiotics is scrutinized more than ever, and each time we can avoid the need to give antibiotics, the better result for our patients. Other components of CAUTI reduction include reinforcement of sterile technique and the decision to remove while the patient remains in the ED. We learned the procedure for catheter insertion and sterile technique in school, and for many of us, the technique has become less strict over the years. Simple changes can be made to improve this practice:

Letter From the President Continued from page 3 sight to patients and families who need our care. We are heroes. Most of you would not describe yourselves as heroes, saying, ‘‘We are just doing our job.’’ But if your job were easy, would there be a shortage of emergency nurses? It takes someone special to work in our chaotic environment. Emergency nurses must possess both general and specific knowledge about health care to provide quality patient care for people of all ages. We are expected to quickly recognize life-threatening problems, and we are trained to help solve them. We are heroes. By most definitions, a hero is someone who saves others at great risk to him- or herself. Sometimes the risk for us is physical, such as when we encounter incidents of workplace violence, and sometimes the risk is emotional exhaustion. Most emergency nurses are willing to ‘‘rush into a burning building’’ if we think someone needs us. We do this without thought for ourselves. We are heroes. As emergency nurses, we need to be more public in celebrating our heroes and the transformative power of nursing achievements. What better time than during Emergency Nurses Week? We are heroes!

• Incorporate catheter placement into annual competencies. • Place straight-catheter kits next to the indwelling kits for convenience. • Promote catheterization as a two-person procedure to have an observer for breaks in sterility. • Encourage the nurse to bring two kits to the bedside to make it easier to start over when there is a break in sterility. • Invest in bladder scanners to provide accurate information regarding urinary retention. • Encourage the use of smaller sizes and proper securement devices to limit tissue trauma. Finally, the decision to remove the catheter has never really been a part of emergency nursing practice. That is the responsibility of the inpatient nurse. But we suggest that if the interventions completed have had the intended effect, it is reasonable to re-evaluate the need for continued use of the urinary catheter. Reassess to determine if the need still exists. If there is no longer a need, be bold and remove the urinary catheter before admission.

Official Magazine of the Emergency Nurses Association

IMPROVING HOW & WHERE YOU WORK

The FreemanWhite ED Design Team partners with ED clinicians to improve operational efficiency and create patient-focused designs. Request information from info@freemanwhite.com.

PERPSECTIVES |

Kathy Szumanski, MSN, RN, NE-BC, Director, Institute for Quality, Safety and Injury Prevention

Safety Through Vaccines and Our Role as Teachers I

mmunization is a highly successful way to protect oneself against communicable diseases while providing a protective barrier around others in the community who have not been vaccinated. While immunization rates for children are high in the United States, the level of vaccination for adults remains low. Nearly 50,000 adults die annually from diseases that could have been prevented by vaccination. According to Healthy People 2020, vaccine-preventable diseases such as pneumococcal pneumonia continue to be a leading cause of hospital admissions, medical costs and morbidity and mortality.1 How knowledgeable are you about immunity and the recommended protection for adults against vaccinepreventable diseases? Immunity to a disease occurs when there are antibodies to that disease in the individual’s system. These antibodies are diseasespecific proteins that respond when the disease-carrying organism is present. A person can achieve immunity actively or passively. Active immunity is reached when the person has been infected with the disease or when a killed or weakened form of

the disease is added through vaccination. Immunity achieved through an active means is very long-lasting, perhaps even persisting through a lifetime. Passive immunity occurs when the individual is given the antibodies to the disease; this type of immunity lasts a short time (weeks or months). All vaccines, like any medication, can have adverse reactions. Adverse reactions are unintended consequences of that vaccine. These adverse reactions tend to be minor and self-limiting. Redness, swelling and pain at the actual injection site can occur, as well as low-grade fever, muscle pain and malaise. It is not uncommon

for some individuals to attribute illness caused by concurrent infections from another source to the vaccine. If the vaccine being used does not contain live attenuated virus, it cannot cause the disease. Occasionally, live attenuated viruses are used in a vaccine to produce immunity. This can cause a mild form of the disease that may last seven to 21 days. Anaphylactic reactions to vaccines are possible but can be prevented by appropriate screening. Vaccinepreventable diseases can be far more dangerous, as history has demonstrated with smallpox and polio. Vaccines may contain additives that are needed for

the production process. Details on those additives can be found on vaccine information sheets. The U.S. Food and Drug Administration and the Center for Disease Control and Prevention takes vaccine safety seriously and have established a monitoring system called the Vaccine Adverse Event Reporting System. Health professionals, manufacturers and the general public can report events to VAERS, which relays information to scientists who study the details to determine if the adverse-event report can be linked to a specific vaccine. For questions or to obtain a VAERS form, call 800-8227967. Reports of adverse

October 2013

Q: Do infant warmers have a place in the emergency department? A: This is an excellent question. Infant warmers are an important piece of equipment to have available. First and foremost is anticipating an emergent delivery that can occur either in the ED or in the field. Warming the infant is extremely important, as the infant’s internal temperature control is not adequate at birth. Most warmers come with temperature probes that help regulate infant temperature. The warmer allows for open access to the infant and good visualization. As the infant is being warmed, necessary assessment and procedures can be performed expeditiously. Not only can the warmer be used for newborns, but it also can accommodate babies up to six months old. Warmers can and should be used if there is a question of temperature control and routinely in very young babies or newborns.

Remember to keep your infant warmer at the ready and in good repair and to use it often. Access the Guidelines for Care of Children in the Emergency Department at tinyurl.com/kb3499w. — Paula M. Karnick, PhD, ANP-BC, CPNP Director of the Institute for Nursing Education

Use ‘‘Ask ENA’’ to ask about the organization and emergency nursing in general. Questions will be referred to the appropriate ENA staff or department. Submission does not guarantee publication. E-mail questions to connection@ena.org.

about health topics, including vaccination. You can promote

12006-Chamberlain_12006_ENA_Connection_Ad Size: 3.25" x 4.75"

reactions can also be submitted at vaers.hhs.gov. The ongoing mutation and adaptation of viruses in the environment presents a continual challenge in the battle to reach long-lasting immunity. Vaccination needed to prevent seasonal influenza is an example. In 2012, there were 41,000 cases of whooping cough2 reported in the U.S. that alerted us all to the sobering fact that the vaccine-preventable diseases are still a health threat in the nation. The ENA Topic Brief Adult Immunization that is posted under the ‘‘Practice’’ tab at www.ena.org provides the 2013 CDC Advisory Committee on Immunization Practices recommendations for adult immunizations. Consumers view nurses as trusted sources of information

safety both for the patients you encounter as well as the people around them by providing accurate information on the importance of vaccines in the prevention of disease. Take a moment to check

Extraordinary Advantage

your own safety level of vaccination. References 1. U.S. Department of Health and Human Services, Healthy People 2020. (2013). Immunizations and infectious diseases. Retrieved from http:// healthypeople.gov/2020.

Take advantage of your ENA membership beneﬁts at Chamberlain College of Nursing. • 15% savings of current tuition rate • Online coursework • No mandatory login times

Find your extraordinary at chamberlain.edu/enaorg RN to BSN

2. National Public Health Information Coalition. (2013). Not just for kids: Adults. Retrieved from http://www. nphic.org/niam/adults

MSN

DNP

Chamberlain College of Nursing | National Management Offices 3005 Highland Parkway | Downers Grove, IL 60515 | 888.556.8CCN (8226) | chamberlain.edu Comprehensive program-specific consumer information: chamberlain.edu/studentconsumerinfo. Program/program option availability varies by state/location. The Bachelor of Science in Nursing degree program and the Master of Science in Nursing degree program are accredited by the Commission on Collegiate Nursing Education (CCNE, One Dupont Circle, NW, Suite 530, Washington, DC 20036, 202.887.6791). Chamberlain College of Nursing, 2450 Crystal Drive, Arlington, VA 22202 is certified to operate by the State Council of Higher Education for Virginia, 101 N. 14th Street, 10th Floor, James Monroe Building, Richmond, VA 23219, 804.225.2600. Chamberlain College of Nursing has provisional approval from the Virginia Board of Nursing, Perimeter Center, 9960 Mayland Drive, Suite 300, Henrico, VA 23233-1463, 804.367.4515. ©2013 Chamberlain College of Nursing, LLC. All rights reserved.

12006 ENA Connection Ad (CCN #20421)

Official Magazine of the Emergency Nurses Association Date 8-21-2013 Printed At Time 12:00 PM Round 1

100%

Agency JR

FINAL CHECKLIST

INITIALS

Accreditation Legal Line

INITIALS

ENA Corkboard We asked ENA members on Facebook to tell us about their emergency nurse heroes. Here are some of the responses:

Just being h ome with the MnydsER family and frie nu rela rsgeahnedro x in is e D n egbeoara Taeyr’lo jo y in oth r. h ch s coSmhpeanisy th ethm o b s y t k n e o la w k le the deck — dgek able, com e or on nowing nopoassionate yoaunbdahckard w orking nursne will call in to e I’ve ever had the ple w ork!

a co-worker, I’vsure to know. As her patients wh e seen he– rJane coMnatstiolale o a re h a v in worst days g the also a SANEof their lives. Deb is best to mak nurse; she does her comfortable e these victims feel nursing, Deb. After 30 years of around every still runs circles department. one in our wear capes Real heroes don’t — they wea and Deb is th r e perfect ex scrubs, ample! — Elizabeth Adkison

My emergency nurse hero is Bertha Somoano , who is the mos t knowledgeable nurse I’ve ever worked with. Bertha go es the extra m ile to learn and share her knowledge and expertise. She is one of the calm est under pressure and exemplifies everything abou t nursing that honors the profession. Regardless of her personal feelings , she maintains a non-judgmenta l attitude tow ard her patients and t he staff she w orks with; an excelle nt mentor and patient advoca te. She is my nu rse hero. -Cheryl Ca mpos

Al Graham . The man has forgotten more abou t nursing t han I cou h, et B et m I ld hope n he W . s t e o b m k o n o ow. He ca C th e B is be ro to r he e n e s fu rs , u more about the ways calm My emergency n ergency room, al p a em t e i th e s in n r ay t w ke al t or han managemen w busy, she she was my co-w t or pape d. No matter ho se cu fo ten ry ti r ve w pa r ork or d ou policy. He on shift with an me manager of co be i to s on a t en t eacher, nd. Beth w a role mo ected her. had time to be ki del, a fa urse I know resp n y er ev d an t, ther figure, a departmen t-in to make peer. He busy emergency ed of doing a si lk ta le op pe c , an laugh re at himsel tried to reti and returned g in rs f u n a Even when she n om d fr laugh wit away others. E h she couldn’t stay our ENA of v r e be r y em m her stay on. But d ve a ti y ac I an g is e h t et w ork with to aff nurse. B y. When a him I bec per diem as a st e council secretar at st o m as e ed b a rv e se tter nurs en having Beth do?” e. But Al state council, ev r, “What would de on w would ld n u e co v I e k, r or w a d at m p i u t to bein problem comes g. g in a th s great as right we all kn ld be doing the – Bee Potter ow he is. and know I wou Theresa H eberling

rse hero gives nu y nc ge er em y M d more. She all of herself an tell patients does not always to hear. what they want s them to a Rather, she hold be advocates high standard to alth if able. for their own he ose around She encourages th gh level of her to be at a hi r compromises practice and neve care. She is on good nursing ve to be. My everything I stri hero is Lisa emergency nurse s M. Kear. – Chelsea Adam

My emergency nurse hero is Guilliams. She has been a nuSusan M. plus years, most of them in thrse for 30prefers to be at the bedside, w e ED. Susan bring her knowledge, compasshere she can caring to each and every patie ion and goes out of her way to help no nt. Susan patients but her co-workers, t only her community. She is an ENPC family and instructor with certifications and TNCC CPEN. She volunteers her timin CEN and scouts and giving lectures to e with the She has been an outstandingthe elderly. the staff. I would trust Susan resource to with tbe life of myself and my family! Linda Curtis

My emerg ency nurs e hero is amazing te actually th am of em e ergency n are alway u r s e s s th th e a re to assis t ro is Kim trauma ar t when th My emergency nurse he r iv e e pl e am s or the bad ining ex pediatric c is called. N Palestis. She is a sh to o d nt o wa e I one can b blue of the kind of nurse e a hero We are th a ng ri su en in a rd ll ha e bedside alone. be. She works champions our patien elf as rs he r fo n io at f uc o ed ts. We en r all of higher courage e CEN. She to further a c h well as achieving her other our educa ledgeable tional goals certificatio is compassionate, know and obtain ns. We a her fellow re the ‘‘ h th and always there for a t b e e ro ’’ teams at off the never gives angel of d emergency nurses. Kim o u r d s e an kills. With ath by rsity that same up in the face of adve s u xt f ne s f e k e ill, we eas ring and is always ready for th e comfort fa r de un lm c m ca r is ili is es in time is. No one challenge. Kim s of plans a h knowledge crash or eart attac pressure and exhibits k, a car an append r patients. icit is. Bu t te and empathy toward he a m y o f heroes ou want m to her in your co y She is an inspiration ti m r e n e o r r f fo h n in ac re e to e your d. —Leigh fellow nurses Doles Mon up ve gi r ve ne d an s tg al go omery their Scaletti their dreams. Tracy

BOARD WRITES |

Sally K. Snow, BSN, RN, CPEN, FAEN

ENPC at 20 Years: Celebrating as a Family P

reparing for a family reunion is something all of us may look forward to every year. This year, the ENA family reunion was at the Gaylord Opryland Resort and Convention Center in Nashville, Tenn. After more than a quarter-century of ENA annual conferences, I prepared with great anticipation for the hugs, kisses and opportunities to catch up with people who have been as much a part of my life as any blood relative. I was anxious to see what new members of the family had been added since we last met. I am thinking about those new members

who will surely carry on the legacy of this family that we all love and cherish. When I think about the moments that have bonded so many of us together for life, I am reminded that we all have something else to celebrate. Happy Birthday, ENPC. The Emergency Nursing Pediatric Course turned 20 years old this year. ENPC is the result of the work of some visionary women and their commitment to establishing a standard for pediatric emergency nursing education. In January 1993, one nurse from each state came to Texas to participate in the first ENPC course. Our faculty team was the very group of women who not only had the vision but wrote the course and moved it from a vision to a reality. They were as anxious as any of the participants taking the course. The CIAMPEDS mnemonic (complaint, immunization, allergies, medications, past history/pain, events surrounding, diet/diapers, symptoms) was born that weekend and set the standard for pediatric triage. We all left that weekend as instructor candidates and committed to participating in the five regional rollouts of the course over the next year. We left Texas to educate emergency nurses across the nation about pediatric emergency nursing care. At the regional courses, we huddled between skill

stations to review our goals and talk about how we would teach the station. Afterward, we talked about what worked and didn’t work. Changes and refinements took place at each regional course that strengthened the final product. Many of us went on to serve on the ENPC international faculty and helped to shape the administrative procedures that exist today. We took a team to Toronto in 1994 to introduce ENPC to our Canadian colleagues. We learned that ‘‘cervical’’ and ‘‘musculoskeletal’’ may look alike but sound very different when our neighbors to the north were lecturing. The course was taught in Australia and overseen by our ENPC international faculty colleague Liz Cloughessy. Hours of meetings in Chicago went into the refinement of the 2nd edition provider and instructor courses. Many of those original pilot course participants remained involved in subsequent course revisions. Since that Super Bowl weekend in 1993, emergency nurses have participated in hundreds of Emergency Nursing Pediatric Courses, and thousands of emergency nurses have gone back to their emergency departments with the confidence they needed to better care for ill and injured children. Thank you, ENA, and thank you to the 1992 task force — Lisa Bernardo, Jan Erickson, Jan Rogers, Renee Semonin-Holleran, Donna Thomas and editor Kathy Haley — for making your vision a reality. My children and grandchildren are safer because you had the vision to let the world of emergency nursing know that children are not little adults.

October 2013

AGGRESSIVE BEHAVIOR...

...towards staff at work is dramatically on the increase, especially in our Hospitals. Verbal abuse, threats with weapons, cuts, punches, even serious injuries are becoming everyday occurences.

The impact on the confidence and morale of staff is damaging and costly and has a serious impact on the caring and commitment that lies at the heart of the staff/patient relationship.

Installing an INSTANTalarm®5000 Staff Personal Alarm System will make a dramatic difference

® INSTANTalarm does NOT • track you around the hospital • use radio-frequency • rely on unreliable wi-fi • have a computer controlling it INSTANTalarm,® however, DOES

• let you decide when you need help • pinpoint your location, to a room • work instantaneously • make you and your patients feel safer • reduce the frequency and impact of violent incidents

Which is why, over 20 years, INSTANTalarm® 5000 has been probably the most widely-installed, staff duress alarm system in the world.

205.414.7541 www.pinpointinc.com

GETTING TRAUMA CARE TO THE RURAL HEARTLAND

CLOSER TO THE DREAM By Amy Carpenter Aquino, ENA Connection

NDIANAPOLIS — ‘‘Injury is the No. 1 killer of Hoosiers under age 45,’’ said Art Logsdon, JD, assistant commissioner of health and human services for the Indiana State Department of Health. Speaking to rural health care providers at the Aug. 8 plenary session, ‘‘A Statewide Trauma System: What It Would Mean for Indiana,’’ Logsdon shared that the development of a statewide trauma system would address the problem of timely treatment of traumatic injuries in a state where 36 percent of the hospitals are located in rural areas and 16 counties do not have Meredith Addison, MSN, RN, CEN, FAEN, speaks with fellow panelist Timothy Pohlman, MD, a hospital. before their session Aug. 8 at the Indiana Rural Health Association Annual Conference. ENA member Meredith Addison, MSN, RN, CEN, FAEN, had long interstate highway miles per land area adopted by the state EMS Commission envisioned a panel session on the — to join the 44 U.S. states that have in 2012, which says that emergency development of a statewide trauma statewide trauma systems. In 2010, medical service providers must transport system. That session became a reality Addison was named to the Indiana State the most seriously injured patients to a with the combined efforts of the Trauma Care committee by then-Gov. trauma center unless one is more than Indiana Rural Health Association and Mitch Daniels. Gov. Michael R. Pence 45 minutes away or the delay in care the ISDH, which coordinated the continued the committee in 2013, citing would endanger the life of the patient. session at the IRHA Annual Conference the fact that ‘‘more than 86,000 Hoosiers If these conditions exist, the patient is to in Indianapolis. In addition to Logsdon, are hospitalized each year due to be transported to the nearest hospital. panelists included Addison; Kayur Patel, traumatic injuries.’’ Addison is one of Despite the challenges of providing MD, MRO, FACP, FACPE, FACEP, two nurses on the state committee. trauma care in rural areas, ‘‘our secret medical director at Health Care Excel; ‘‘When we go to the Trauma Care weapon is our nine trauma centers,’’ Timothy Pohlman, MD, professor of committee meetings, we’re already Logsdon said. ‘‘When seriously injured surgery at Indiana University Healthtalking to the choir,’’ Addison said, people are taken to trauma centers, the Methodist; and facilitator Spencer ‘‘whereas at the Indiana Rural Health death rate drops.’’ Grover, MHA, FACHE, of the Indiana Association conference, we’re talking to The problem is that Indiana’s trauma Hospital Association. all 35 critical access hospitals and, in system is years, if not decades, behind Addison has been striving toward this case, an audience of 600 people, other states. Ohio, for example, has 40 the creation of a statewide trauma some of whom may be CEOs who can trauma centers, Logsdon said. system for more than 10 years. An ED bring this information back to their ‘‘Ohio has a bigger population, but it staff nurse at Terre Haute Regional departments.’’ illustrates how far other states are ahead Hospital in Terre Haute, Ind., she has Progress toward a statewide trauma of us,’’ he said. system has been made, Logsdon said, Indiana has the components for a long championed the need for Indiana citing the Triage and Transport rule statewide system, Logsdon added, — which ranks first in the nation for

October 2013

EMINENCE Project Inspired By Fellow’s Passion When it came time for Academy of Emergency Nursing fellow Meredith Addison, MSN, RN, CEN, FAEN, to take on an EMINENCE project, the direction was clear. She told her mentor, fellow Thelma Kuska, BSN, RN, CEN, FAEN, that she wanted to focus on trauma system development. Kuska was an enthusiastic supporter, driving from Chicago to Indianapolis to hear Addison present as part of a panel session on the topic. The EMINENCE program is designed to facilitate mentoring relationships between a limited number of current ENA members and AEN fellows. During a From left: Yonna Heath, BSN, RN, CEN, president of the Indiana ENA State Council, structured mentorship of up to Larry Addison, RN, treasurer of the Indiana ENA State Council, Meredith Addison and one year (beginning at Annual Thelma Kuska at the Indiana Rural Health Association Annual Conference in Conference and concluding the Indianapolis, where Meredith Addison spoke as part of her AEN EMINENCE project. following Sept. 30), ENA • Injury prevention (SBIRT procedure) members looking for professional • Professional presentations growth opportunities are matched with fellows who have • Program development similar interests and appropriate experiences. Typical • Research projects include, but are not limited to, the following areas: • Writing for publication • Advanced practice role development For more information about the EMINENCE program, • Educational conference planning e-mail academy@ena.org. • Grant writing Amy Carpenter Aquino • Health policy including emergency medical services, its trauma centers, a trauma registry and rehabilitative services. The key is to add more trauma centers where they are needed most, shortening the distance between rural residents and the nearest available trauma center to a 45-minute ambulance ride, shortening the transport time. Only 58 percent of the population lives within 45-minute access. Treating the other 42 percent of the population is where Addison steps in. ‘‘Which doors are open 24/7?’’ she said. ‘‘It’s the ERs.’’ ‘‘Lives are actually saved at our local

facility on a day-to-day basis,’’ said Patel, who worked in Terre Haute with Addison. ‘‘How to get the patients to the hands of a trauma surgeon is the key question, along with what resources are we giving to nurses and physicians in local ERs.’’ Hospitals that inappropriately transport patients to other facilities run the risk of EMTALA violations, so they need to ensure they can care for traumatic-injury patients. For emergency nurses in Addison’s 14-bed ED, ENA’s Trauma Nursing Core Course and Emergency Nursing

Official Magazine of the Emergency Nurses Association

Pediatric Course are crucial resources. ‘‘TNCC and ENPC are the courses that we have taken statewide for the last 15 years to give nurses who are caring for their own communities,’’ she said after the conference. ‘‘It doesn’t matter if you’re military or civilian — it’s basic, standardized care for how to do a treatment and assessment on a trauma patient. It’s still not mandatory in our state, but we will go anywhere and provide the courses to anyone who asks.’’

Continued on next page

Indiana Statewide Trauma

problems in all of surgery. I think it’s

she asked the IRHA session attendees.

Continued from previous page

unconscionable that people suffer

‘‘Then it’s real important to have a

serious injury just because they choose

statewide trauma system.

Pohlman spoke to the urgency of having trauma centers within reach of critically injured patients, using a ‘‘rural triangle of death’’ slide to illustrate how far many Indiana residents live from a trauma center. ‘‘If you’re that distance away from a trauma center, you are in a world of hurt,’’ he said. ‘‘The idea of a trauma system solves one problem: disproportionate death in rural counties.’’ Later, Pohlman clarified a point made by another panelist. ‘‘There is no such thing as a ‘golden hour,’ ’’ he said. ‘‘The clock starts ticking at the time of injury. The faster you get the patient stabilized, the better the care. Trauma systems are not for the inner city — they’re for you here in rural Indiana. The American College of Surgeons recognizes why it is a problem. I’ve come here today because I think this is one of the most serious

to live in a rural area.’’

‘‘The dots are out there. We just

Grover shared the story of how his

need to connect them.”

mother drove his brother — honking her horn the entire way — to the hospital after he lost his leg in a grain elevator accident.

ENA Call for…

‘‘We need to create a better system for all of Indiana,’’ he said. He questioned whether teletrauma medicine could benefit rural residents. ‘‘For him to speak up and talk about his personal experience with trauma, that ties right in with what I’ve been saying all along,’’ Addison said later. ‘‘You’ve got to make it personal. Trauma is personal — it’s not about the bricks and mortars, it’s about blood and guts, it’s about your family and your loved ones. And once you get it to that level, there’s no argument that we’re going to do this.’’ ‘‘What if it’s your 2-year-old who

2014 ENA Election Candidates Coming this fall, watch for ENA’s call for candidates seeking election in 2014 to serve on the ENA Board of Directors and on the Nominations Committee. Application information will be available at www.ena.org. If you have questions, please contact Executive Services at 800-900-9659, ext. 4095, or e-mail elections@ena.org.

falls off a quarter horse onto bedrock?’’

A New, Updated Online Learning Geriatric Emergency Nursing Educational Course

Coming Soon! For additional details please visit: www.ena.org

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

GENE Coming Soon_Connection_half_10 2013.indd 1

8/30/13 1:12 PM

October 2013

Your hospital is facing the demand for improved code performance. Better prepared. Faster response. Constant improvement. The Code Management System from Physio-Control is a comprehensive solution for connecting devices, people and processes across the hospital to optimize outcomes of cardiac arrest.

Get ready for a more responsive approach to your code management at www.physio-control.com

CodeManagement Moduleâ&#x201E;˘ is 510(k) pending ÂŠ2013 Physio-Control, Inc. Redmond, WA

2013 Scholarship and Research Grant Recipients T

he ENA Foundation would like to extend a special thank you to the individuals, state councils, local chapters, industry and friends of emergency nursing who have supported the profession through their generous donations. Because of your contributions and passion to promote the advancement of the profession, our

Academic Scholarship Recipients Non-RN Scholarships • New York State ENA September 11 Scholarships – $2,500 each Donald Mills, EMT-B, Montana Camela Slaight, EMT-I, Colorado • ENA Foundation Non-RN Scholarships – $2,500 each Elizabeth Durovich, New York Derek Hammermeister, EMT-B, Montana

Undergraduate Scholarships • Charles Kunz Memorial Undergraduate Scholarship – $3,000 Bernice Potter, RN, Massachusetts • Board of Certification for Emergency Nursing (BCEN) Scholarship – $3,000 Anne Desiree-Parise Duhs, RN, CEN, Nebraska • ENA Foundation State Challenge Undergraduate Scholarships – $3,000 each Caroline Doyle, RN, CEN, Maryland Madalynn Tenney, ADN, RN, Maryland

Graduate Scholarships • Stryker Masters in Healthcare Scholarship – $5,000 Colleen Desai, MSN, RN, CEN, CPEN, Connecticut

applicants are afforded the opportunity to receive educational scholarships and research grants in the discipline of emergency nursing. The ENA Foundation is excited to announce the following 2013 scholarship and research grant recipients and share how our donors are making a difference:

• Judith C. Kelleher Memorial Scholarship – $5,000 Andi Foley, MSN, RN, CEN, Washington • AnnMarie Papa Stretcherside Miracle Scholarship – $5,000 Nancy Reeve, BSN, CEN, Virginia • Board of Certification for Emergency Nursing (BCEN) Scholarship – $5,000 Jennifer Tabak, BSN, RN, CEN, CPEN, Connecticut • ENA Foundation State Challenge Scholarships – $5,000 each Mary Beth Farah, BSN, RN, CEN, CFRN, Pennsylvania Cinnamon Jones, BSN, RN, CEN, Missouri Sherry Love, MBA, BSN, RN, CEN, Tennessee Kimberly Mikula, BSN, RN, CEN, Pennsylvania

• Kentucky State Council – Kentucky ENA Founders Scholarship – $5,000 Sarah Abel, BSN, RN, CEN, Indiana • Maryland State Council – Maryland ENA State Council Scholarship – $5,000 Natalie Briggs, BSN, RN, CEN, Florida • Minnesota State Council – “Pathways V” Scholarship – $5,000 Nicholle Bruhn, BSN, RN, Nebraska • Mississippi State Council – Dan Burgess Scholarship – $5,000 Helen Kenny, BSN, RN, CEN, Connecticut • New Jersey State Council – State Challenge Scholarship – $5,000 William Schueler, BSN, RN, CEN, Oregon • Northern Chapter (NJ) – Mary Kamienski Scholarship – $5,000 Lauren Vickerson, BSN, RN, CEN, CPEN, Maine

• California State Council – Anita Ruiz Contreras Scholarship – $5,000 Lisa Jamerson, BSN, RN – Virginia

• West Central Chapter (NJ) – Jeanette Ash Memorial Scholarship – $5,000 Wendi Brown, BSN, RN, Michigan

• Colorado State Council – Colorado Rocky Mountain Scholarship – $5,000 Melissa Anderson, BSN, RN, CEN, Indiana

• South Carolina State Council – Renee Jett Memorial Scholarship – $5,000 Roseann Teckman, BSN, RN, South Carolina

• Kansas State Council – Darlene Whitlock Trauma Scholarship – $5,000 Carla Grasso, BSN, RN, CEN, Pennsylvania

• Tennessee State Council – Tennessee State Challenge Scholarship – $5,000 Gari Leigh Adams, BSN, RN, CEN, North Carolina

October 2013

As a donor, you can make a difference in the future of emergency nursing. Your donation will help to provide funding for research that can improve the quality of patient care, build future leaders, support education that can change the practice of medicine in the future and much more. If you would like to join others in making a difference in emergency nursing, the ENA Foundation has opportunities in which you can become involved. Please visit www.enafoundation.org to find out how you can contribute to advancing emergency nursing.

• Texas State Council – Vicki Patrick Texas Legacy Scholarship – $5,000 Dana Hamilton, BSN, RN, CEN, CPEN, EMT-B, Texas • Vidacare Graduate Scholarship – $5,000 Donna Matwiejewicz, BSN, RN, CCRN, CEN, CPEN, Pennsylvania • Physio-Control Inc. Scholarships – $3,000 each Kasey May, BSN, RN, Indiana Lisa McCoy, BSN, RN, Indiana • Gisness Advance Practice Scholarship – $3,000 Jesseca Keefe, MSN, RN, CEN, MICN, California • Karen O’Neil Memorial Scholarship – $3,000 Candice Palmisano, BSN, PHN, CEN, MICN – California

Doctoral Scholarships • Pamela Stinson Kidd Memorial Doctoral Scholarship – $10,000 Pamela Bourg, MS, RN, FAEN, Colorado • Board of Certification for Emergency Nursing (BCEN) Doctoral Scholarships – $5,000 each Cindi Warburton, MSN-FNP, CEN, Oregon Robin Weingarten, MSN, RN, CEN, Pennsylvania • ENA Foundation State Challenge Doctoral Scholarships – $5,000 each Pamela Assid, MSN, RN, CEN, CPEN, Colorado Mary Howlett, MS, RN, FNP-BC, CEN, Massachusetts

Sharon Schultz, MS, RN, CEN, CPEN, Colorado • ENA Foundation Doctoral Scholarship – $5,000 Meredith Scannell, MSN, MPH, RN, Massachusetts • Hill-Rom Doctoral Scholarships – $4,000 each Diana Elwell, BSN, RN, New York Nycole Oliver, BSN, RN, CEN, Arkansas

Continuing Education Scholarships • Leadership Tapestry Conference Scholarships – $1,000 each Brian Ericson, BSN, RN, CEN, Maine Madeline Gehrig, BSN, RN, CPEN, South Carolina Donna Keyes, BSN, RN, CEN, Florida Lucie Lafontaine, RN, Virginia Jane McAuliff, BSN, RN, CEN, EMT-P, Michigan Lisa Destrampe McCarthy, MSN, RN, CEN, Arizona Jack Rodgers, BSN, RN, CEN, NREMT-P, Georgia Veronica Sikula, RN, CEN, Colorado Jennifer Wall, RN, BSN, EMT, Virginia • ENA Foundation Annual Conference Scholarships – $500 each Judith Becker, BSN, RN, Arizona Barbara Berenz, ADN, RN, Ohio Barbara Black, MSN, RN, Ohio Sheila Brown, RN, CEN, Nebraska Vicki Celenza, RN, Ohio Lauren Crockett, BSN, RN, Kentucky Lisa Eckenrode, MSN, MBA, RN, EMT-P, Pennsylvania Michael Hastings, MS, RN, CEN, Kansas

Official Magazine of the Emergency Nurses Association

Maria Johnson, MSN, RN, CEN, North Carolina David McDonald, MSN, RN, CEN, Virginia Nicole Merritt, ADN, RN, New Hampshire Dixie Norris, BSN, RN, Mississippi Sonia Pipkin, BSN, RN, Texas Barry Swanner, BSN, RN, CPEN, NREMT-P, North Carolina Lisa Waite, BSN, RN, Idaho Amanda Ward, MSN, RN, Indiana Margaret Wolfred, BSN, RN, Indiana Barbara Young, BSN, RN, CEN, Pennsylvania Tiffany Young, MA, BSN, RN, North Carolina Melissa Ziesman, BSN, RN, CEN, Nebraska

Research Grant Recipients • Emergency Medicine Foundation/ ENA Foundation Team Grant $50,000 AnnMarie R. Papa, DNP, RN, CEN, NE-BC, FAEN, Pennsylvania Kristin L. Rising, MD, and Brendan G. Carr, MD, MA, MS, FACEP • ENA Foundation / Sigma Theta Tau International Research Grant – $6,000 Chris Burchill, PhD, RN, CEN, Pennsylvania

Research Grant Opportunities visit www.enafoundation.org Applications due Oct. 1 for • Industry Supported Research Grant – Supported by FreemanWhite ED Design – $5,000 • Industry Supported Research Grant – Supported by Stryker – $5,000 • ENA Foundation/ANIA Research Grant – $6,000 Applications due Nov. 1 for • ENA Foundation Seed Grants – $500 each

Take Your Connection Even Further as a Fellow By Andrea Novak, PhD, RN-BC, FAEN, AEN Board Member at Large

t is almost prophetic that the name of this monthly magazine is ENA Connection, as connection is what the Academy of Emergency Nursing is all about. The Oxford dictionary defines ‘‘fellow’’ as ‘‘a member of a learned society . . . a person in the same position, involved in the same activity or otherwise associated with another’’ and described as ‘‘sharing a particular activity, quality or condition with someone or something.’’ As members of ENA, we are all connected by sharing these areas of interest: leadership, education, research, practice and/or public policy. Whatever our professional role is, we all share this passion and fellowship of emergency nursing. The Academy of Emergency Nursing has higher expectations for those who become fellows. These nurses are expected to provide visionary leadership for the Academy as well as support the vision and goals of ENA. It is not enough that these incredible nurses have been actively involved in the association for at least three years and that they have demonstrated substantial and enduring contributions that have had a significant impact upon our profession; they are also expected to continue making contributions after their induction. Each year we ask our fellows to give us an update on what they have been doing and how it makes an impact on emergency nursing. You can read their stories in upcoming articles in this

he Academy of Emergency Nursing was established by the Emergency Nurses Association on Sept. 28, 2004, to: • Honor emergency nurses who have made enduring, substantial contributions to emergency nursing; • Advance the profession of emergency nursing, including the health care system in which emergency nursing is delivered; and • Provide visionary leadership to ENA and AEN. The body of work left by AEN fellows goes well beyond being an outstanding nurse and a devoted ENA member.

magazine as well as in future posts in the Academy section of www.ena.org. Examples of fellows’ contributions to the advancement of emergency nursing have included actively working to have state legislation initiated to make it a felony to assault a health care professional; authoring textbooks on emergency nursing skills and/or practice; conducting research in pediatric pain management in the emergency department; designing educational programs in geriatrics; serving as mentors and preceptors; and teaching and bringing emergency nursing education to underserved areas. Fellows also connect with members through the EMINENCE program, which is a formal, year-long mentoring program, and assisting the mentee with realizing a particular goal. Many of these connections have transformed into lasting friendships and collegialities between the mentor and mentee. I was fortunate to gain a new friend with my mentee, Lynn Visser, BSN, RN, CEN, CPEN (California ENA State Council), who took a PowerPoint education program and expanded it to include outcome measurements related to

organ donation. She took this information and created her first poster presentation, which was so well done that it was accepted for presentation at the 2013 ENA Annual Conference. I think I learned as much from the experience as she did. This September, we inducted nine exceptional nurses into the Academy, which brings our total membership to 110. Induction is a culmination of what many nurses have worked toward for their entire careers — to be recognized for what and how much they do for their peers and for emergency nursing. There is no limit to the number of Academy fellows, nor to how many may be inducted each year. Will 2014 be your year to become a member of this august body? The information and call for applicants will be posted on the ENA website under the Academy tab, along with the criteria for submission, application deadlines and tips for writing a successful application. If you have questions about the application process and how you can continue to contribute to advancing the practice of emergency nursing by becoming a member of this connection, please e-mail academy@ena.org.

October 2013

LEADERSHIP CONFERENCE

2014

March 5-9, 2014 Phoenix, AZ

Phoenix Convention Center

Registration Opens Late October

For the latest news on Leadership Conference 2014, visit www.ena.org Follow the action

#ENALC14

*Accreditation statement: The Emergency Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Centerâ&#x20AC;&#x2122;s Commission on Accreditation.

FUTURE OF YOUR NURSING |

Bridget Walsh, Chief Talent Officer

‘Why Am I Doing This?’ W

e all have those days, the ones that make us ask the question, ‘‘Why am I doing this?’’ Hopefully for most of us, those days are few and far between. What we have to remember is that those days and that question serve a greater purpose. It is important to truly ask yourself that question — not because it has been a bad, exhausting and completely frustrating day, but to keep you focused on your goals. Career goals are important and constantly evolving. At different points in your life, you may want different things from your job: security, growth, personal achievement or global impact. Each year you should find time to assess your goals and your progress in accomplishing them. You may have one long-term goal and several different goals that lead you toward the successful accomplishment of that goal. In order to get the most out of

your career, make sure you are doing what rewards and inspires you. Don’t be afraid to chart a new course. Try something new and challenge yourself; it might be scary, but it can be very rewarding. Look for opportunities to try new things through your volunteer opportunities or short-term commitments. Apply for a committee or project team at work, volunteer with a local non-profit or take on a new ENA role at the state or national level. For more career resources and tips, visit the Career Wellness page at www.ena.org. When those days come that make you ask why, remember that the work you do every day makes a difference in the lives of others. In the month of celebration of the specialty of emergency nursing, remember that you are, every day, extraordinary.

ADVANCE THE FUTURE

OF EMERGENCY NURSING

Our mission is to provide educational scholarships and research grants in the discipline of emergency nursing. DONATE NOW! www.enafoundation.org

ENA Foundation_Connection_half_09 2013.indd 1

8/5/13 10:01 AM

October 2013

MARKETPLACE

ENAâ&#x20AC;&#x2122;s store for all your educational and product needs.

Celebrate EN Week by Purchasing an ENA Product Items at www.ena.org/shopenweek are eligible for 10% discount and free shipping for EN week product orders. Order must be placed before October 12, 2013.

Great products available like...

Nurses Rock Pin

nd ther E pe O e h T co ethos t S e h of t

ENA p

ocket

notep

ads

To order call 800-900-9659 or visit us online at www.ena.org/shopenweek Only items in www.ena.org/shopenweek are eligible for discount and free shipping; all other products on ENA Marketplace are not eligible. Domestic orders must be placed on or before September 25, 2013 to ensure delivery for EN Week. International order shipping time may vary.

READY OR NOT? |

Knox Andress, BA, RN, AD, FAEN

Mass Casualties in a Flash Explosion at La. Chemical Plant Creates MCI With Hazmats For Area EDs

ore than 110 people were reported injured and two workers died after an industrial explosion and fire June 13 at the Williams Olefins chemical refinery in Geismar, La., about 15 miles south of Baton Rouge. Located in rural Ascension Parish, the large petrochemical refinery ‘‘cracks’’ the highly flammable hydrocarbons ethane and propane to produce ethylene and propylene for the plastics industry. The explosion occurred about 8:37 a.m. and was reported to have felt like an earthquake to residents more than five miles away.

Explosion Pathophysiology Explosions can be related to a variety of sources and environments. An explosion is caused by the sudden chemical conversion of a solid or liquid into a gas, resulting in energy release. Highexplosive detonation involves supersonic, instantaneous transformation of the solid or liquid into a gas occupying the same physical space under extremely high pressure. These highpressure gases rapidly expand outward in all directions from their point of formation as an overpressure blast wave. Explosions have characteristic injury patterns that may be seen at ED triage or later during evaluation. They include: • Primary blast injuries result from the over-pressure force (blast wave) impacting body surfaces and include tympanic membrane rupture, pulmonary damage, air embolization and/or hollow viscus injury. • Secondary blast injuries result from projectiles and include penetrating trauma, fragmentation injuries and/or blunt trauma. • Tertiary injuries result from the body’s displacement by the blast wave, including blunt/penetrating trauma, fractures and traumatic amputations. • Quaternary injuries include all other injuries related to the blast incident, such as burns.

ED Response Casualties associated with the Williams Olefins blast and fire were transported via ground and air emergency medical services from triage locations near the burning plant to several hospital emergency departments across a multi-parish

area, including St. Elizabeth Hospital in Gonzales, La., Our Lady of the Lake Regional Medical Center and Baton Rouge General Medical Center. Baton Rouge General provided trauma and needed burn care resources. The closest ED was St. Elizabeth Hospital, about 10 miles away, which received the greatest number of patients as triaged by providers on the scene and coordinated by the Louisiana Emergency Response Network. Louisiana hospital and EMS providers are connected 24/7 to an emergency communications and coordination network called LERN, which focuses on improving outcomes for trauma and time-sensitive illnesses in a number of ways but initially guides and communicates injuries to appropriate hospitals and medical resources that are ready to provide treatment.

The Mass Casualty Bus The St. Elizabeth Hospital ED has 18 beds and receives about 36,000 visits each year. ED director Tammy O’Conner, BSN, RN, CEN; Jennifer Sing, BSN, RN. and Lindsay LeBlanc, BSN,

October 2013

RN, CEN, shared that their initial notification about incoming patients came at 9:10 a.m. In preparation to receive chemically contaminated mass casualties, the hospital activated its hospital command center and emergency operations plan. Triage and decontamination were set up outside the ED. The first of 50 patients arrived via privately owned vehicle at 9:40 a.m. and were decontaminated. EMS units began arriving 30 minutes later with three and four casualties each. Not long after, a bus loaded with 25 casualties arrived from the scene. Most patients were triaged ‘‘green’’ or ‘‘yellow’’ and suffered from lacerations, sprains or musculoskeletal injuries from falls or trauma experienced while trying to flee the scene.

Waiting Trauma Teams Located in metropolitan Baton Rouge, Our Lady of the Lake is a Level 1 trauma facility, with its ED receiving about 98,000 visits a year. The morning of the blast, American College of Surgeons surveyors were in the facility for its first credentialing visit. Amanda McMichael, RN, nurse manager of the adult ED; Eric Neal, RN, the ED treatment center manager and Katie Sheets, RN, trauma program manager, shared their experiences. Upon notification from LERN of a chemical exposure incident at a large refinery, a ‘‘code orange,’’ or mass casualty involving a hazardous material response, was initiated. ‘‘LERN did a great job triaging the most acutely injured to us,’’ McMichael said. Triage and decontamination assets were established outside the ED, with a physician leading the triage team. Trauma rooms were cleared and trauma teams, including three nurses and a physician, were staged to each. Twelve patients arrived at OLOL, including five transported via helicopter. The first two patients transported by helicopter were decontaminated at the hospital.

Thank you to the following organizations for their generous support. Strategic SponSorS

If You Had $5,000 If you had $5,000 for emergency preparedness, what would you purchase? Here are responses from the ED staff interviewed for this article: • Hand-held radios for communicating with triage outside the hospital ED • A decontamination system that provides for patient modesty • A complete decontamination system that is always on standby outside the ED • Better communication systems from the plant to know the potential chemical contaminant • An electronic emergency alert system for hospital personnel • Baby powder for the nurses • Thank-you cards for the many people who rise up to the response challenge Emergency departments should be prepared to receive mass casualty surges that may be contaminated with hazardous materials. What commercial or industrial threats exist in your community?

Strategic SUpporterS

The ENA Strategic Sponsorship Program was designed to create partnerships with leading organizations whose objectives include supporting the emergency nursing profession.

Official Magazine of the Emergency Nurses Association

Don’t Wait for a New ED Design Top 5 Operational Considerations You Can Tackle Today By Kathy Clarke, BSN, RN, CEN, FreemanWhite Catalyst

need to place patients back in a general waiting area, where their safety or the safety of

others could be in jeopardy.

s emergency nurses try to understand the impacts of accountable care organizations and health care reform, we still have patients in need of medical care and treatment presenting to our emergency departments. If an ED redesign project is not in your immediate future, consider these operational recommendations to support the delivery of timely and efficient medical care.

General waiting areas often have obstructed views, making it difficult for clinical staff to monitor waiting patients for changes in their conditions. As an alternative, identify internal waiting spaces with unobstructed views to ensure patient and staff safety and security. Patient privacy and confidentiality are prime

1. Streamline Your Intake Process

considerations in determining

Since about 80 percent of your total patient volume (including very sick or injured patients) presents ambulatorily, an RN-first model facilitates correct placement of the patient within the ED. Clinical staff performs a quick registration and initial set of vital signs, allowing the RN to assign an emergency severity index acuity score and room assignment for the patient. The patient is escorted to the treatment area, where the clinical team assigned to that location continues with nursing assessments and initial care and treatment per protocol as needed. If the ED is operating at capacity, the patient can be staged to sub-wait if clinically appropriate or to a rapid medical exam zone for treatment, protocol initiation and possible discharge. This streamlined method supports 100 percent electronic bedside registration with an immediate focus on the patient’s medical condition.

immediate sorting discussed earlier separates very sick patients from less acute patients, helping clinical staff prioritize nursing tasks. A team-staffing ratio of one RN to four patients, supported by ED technical staff, allows staff to greet, settle and prepare patients for physician exam and/or protocol implementation. Working as a team divides the patient-care tasks and allows the nurses to focus on patient acuity and stabilizing measures. Anecdotal evidence suggests physician zoning improves door-tophysician times, patient and family access to physicians and organized care and treatment of the patient when teamed with the clinical staff for that zone. Physicians can focus on organizing the patient’s medical care, thus improving the patient experience by limiting involvement of other ED medical providers.

2. Team Staffing and Physician Zoning

3. Safety and Security

Patients expedited through the intake process no longer will have nursing assessments completed as they do in current traditional triage models. The

Immediately greeting and directing patients to the appropriate area for treatment moves patients forward in the ED process. This method limits the

sub-waiting zones.

4. Maximize Flexibility By Managing Patient Volume and Acuity As emergency nurses, we know patient volume ebbs and flows according to the day of the week, hour of the day and the season. The ability to accordion your physical capacity up and down to manage patient volume is essential. Identifying the right patient in the right area for care, keeping vertical patients vertical and staging patients to sub-wait zones are ways to manage patient volumes that tend to exceed physical capacity.

5. Understand Your Unique Data When making any operational changes in your ED, be sure to know and understand your existing ED data as a baseline for current operations. Comparing the outcome of your improvement efforts with your baseline model of existing conditions will help identify process areas that may require small changes to achieve optimal results.

October 2013

Update on Logrolling By Lisa Wolf, PhD, RN, CEN, FAEN, Director of the Institute for Emergency Nursing Research

here are approximately 12,000 spinal cord injuries per year in North America, many involving the cervical spine region. Males are about four times more likely than females to have spinal cord injuries. Overall, males account for 80.7 percent of reported injuries in the national database.1 Currently, up to 25 percent of patients with SCIs may sustain further (secondary) neurologic damage during the initial management of their injuries.2 The proper prehospital and inpatient management of patients with unstable spinal injuries is critical for prevention of secondary neurologic compromise.3 Although Chin et al. maintain that ‘‘logrolling the patient to the supine position is safe to facilitate diagnostic evaluation and treatment,’’1 the current literature may suggest otherwise. Using a cadaver model, Prasarn et al.3 found that when placing a spine board, there was more motion in all three planes with the logroll technique. This was statistically significant for axial rotation

(p = 0.018) and lateral bending (p = 0.003). Using logrolling for spine board removal also resulted in increased motion statistically significant for flexionextension (p = 0.014). The total motion was decreased by almost 50 percent in each plane when using an alternative to the logroll techniques during the complete sequence (p ≤ 0.007). Earlier, researchers had found that the logroll technique caused significantly greater cervical motion during body position changes than turning using a kinetic turn table.4 Conrad et al.2 report that alternative maneuvers that produced less motion included the straddle lift and slide, six-plus lift and slide, scoop stretcher, mechanical kinetic therapy, mechanical transfers and the use of the operating table to rotate the patient to the prone position for surgical stabilization. A review of 10 years of research suggests that the logroll maneuver should be removed from the trauma response guidelines for patients with suspected spine injuries, as it creates significantly more motion in the unstable spine than the readily available alternatives.2 The only exception is the

patient who is found prone, in which case the patient should then be logrolled directly on to the spine board using a push technique. References 1. Chin, L. S., Mesfin, F. B., & Dawodu, S. T. (2013, May 21). Spinal cord injuries. Retrieved from http:// emedicine.medscape.com/ article/793582-overview 2. Conrad, B. P., Del Rossi, G., Horodyski, M. B., Prasarn, M. L., Alemi, Y., & Rechtine, G. R. (2012). Eliminating log rolling as a spine trauma order. Surgical Neurology International, 3(Suppl 3), S188–S197. 3. Prasarn, M. L., Zhou, H., Dubose, D., Rossi, G. D., Conrad, B. P., Horodyski, M., & Rechtine, G. R. (2012). Total motion generated in the unstable thoracolumbar spine during management of the typical trauma patient: A comparison of methods in a cadaver model. Journal of Neurosurgery. Spine, 216(5), 504–508. 4. Conrad, B. P., Horodyski, M., Wright, J., Ruetz, P., & Rechtine, G. R. 2nd. (2007). Log-rolling technique producing unacceptable motion during body position changes in patients with traumatic spinal cord injury. Journal of Neurosurgery. Spine, 6(6), 540–543.

connection

Recruitment & Professional Opportunities

For ad rates and information, contact ENA Sales Representative Maureen Nolimal at 847-460-4076 or Maureen.Nolimal@ena.org. Official Magazine of the Emergency Nurses Association

28 41 55 68 %

Average improvement in throughput for admitted and discharged patients

Average improvement in time from arrival to seeing a physician.

Typical improvement in patient satisfaction scores and likelihood to recommend

Improve emergency care, improve your career You know us as recognized ED leaders who guide hospitals toward real and effective change. Now we would like to get to know you. Blue Jay Consulting is looking for professionals with the leadership insight and clinical experience to bring process improvements to our clients, and the passion and commitment to enhance the overall quality of emergency care. If you consider yourself among the best in your field, you’ll find yourself in good company at Blue Jay Consulting. Join the strongest team in the industry and improve your career. Contact Jim Hoelz or Mark Feinberg at 407-210-6570 to discuss how we can capitalize on one another’s strengths.

www.bluejayconsulting.com

Average improvement in LWBS rates, resulting in an additional $1.6 million in collected revenue

“As a Blue Jay consultant, I bring my 30 years of emergency department leadership experience to each client. Every assignment brings a unique set of challenges, but the tools to solve them are similar. We can often shorten the improvement process from years to months and create an environment that is better for patients, families and staff. I leave each assignment with a good feeling that I have left it better than when I arrived. I love being a Blue Jay consultant.” —

B I L L B R I G G S , M S N , R N , C E N , FA E N

Senior Consultant Blue Jay Consulting, LLC