Download - ENA Connection March 2013
connectionthe Official Magazine of the Emergency Nurses Association
March 2013 Volume 37, Issue 3
5 ENA Co-Founder Judith C. Kelleher, 1923-2013
22 No Career Wasted: A Nurse’s Path Back After Substance Abuse
32 Member Finds Paradise Needs Good Teachers
INSIDE FEATURES
All Together, PULL!
Every Bit of Muscle Matters As We Take Bold New Steps
Through AdvocacyPages 14-20
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Official Magazine of the Emergency Nurses Association 3
With Mentoring, We Make Magic
LETTER FROM THE PRESIDENT | JoAnn Lazarus, MSN, RN, CEN
In Greek mythology, Mentor was the
trusted guardian Odysseus appointed
to watch over his son Telemachus
when Odysseus left for the Trojan
War. Mentor played a pivotal role in
the development of Telemachus,
providing encouragement and
practical plans for Telemachus to
deal with his personal dilemmas.
Because of this story, the term
‘‘mentor’’ has taken on the meaning
of someone who imparts wisdom to
and shares knowledge with a less
experienced colleague.
Most of us can think of a more
experienced person in our lives who
has provided information, given
advice, presented us with a
challenge, initiated a friendship or
simply expressed an interest in our
personal development. Very often
our first mentor was a parent or
another relative who taught and
demonstrated some essential
knowledge or understanding.
Now, a mentor is someone who can
help you move to the next level in your
career or view new possibilities, open doors
for you by introducing you to new people,
act as a sounding board and share the good
and bad of their past experiences to
potentially keep you from making the same
mistakes.
Choose WiselyWhat do you look for in a mentor? A
mentor is usually someone you admire and
whose footsteps you might like to follow. A
good mentor possesses all or most of the
following qualities: willingness to share
skills, knowledge and expertise; a positive
attitude and respect as a positive role
model; and a personal interest in the
mentoring relationship. In addition, a good
mentor exhibits enthusiasm for your
interests, values ongoing learning and
growth; provides guidance and constructive
feedback; is respected by colleagues; has
ongoing personal and professional goals;
values the opinions of others and motivates
others by setting a good example. It is
crucial that a good mentor must also have
the desire and time to take on a mentee.
In my own career, I can think of one
person who was important in my decision
to become an emergency department
director. She encouraged me to return to
Dates to Remember
PAGE 4Members in Motion
PAGE 10ENA Foundation
PAGE 11NEW! Ask ENA
PAGE 12Pediatric Update
PAGE 21Ready or Not?
PAGE 26CourseBytes
Monthly Features
March 11, 2013 Deadline for proposed bylaws and resolutions for 2013 General Assembly at Annual Conference in Nashville, Tenn.
March 25, 2013 Deadline for faculty course proposals for Leadership Conference 2014 in Phoenix (March 5-9, 2014).
PAGE 5Judith C. Kelleher, 1923-2013
PAGE 6Board Writes: In-Flight Medical Emergencies
PAGE 8ENA’s Resource Pathway to Safe Practice, Safe Care
PAGES 14 - 20Advocacy Section
14 Ohio Efforts Pay Off With New Law Against Assaulting Health Care Workers
16 ENA Hosts Its First Emergency Nursing Advocacy Intensive
18 We’ve Come a Long Way, Baby — Or Have We?
20 New ENA Advocacy Department
PAGE 22No Career Wasted: A Member’s Path Back From Workplace Substance Abuse
PAGE 30The AEN EMINENCE Program
PAGE 32ENA Member Finds Paradise Needs Good Teachers
ENA Exclusive Content
Continued on page 28
Steve Stapleton, PhD, RN, CEN, the
immediate past president of the Illinois
ENA State Council and an assistant
professor at Illinois State
University’s Mennonite
College of Nursing, has
received a Nurse
Educator Fellowship
from the Illinois Board of
Education.
The award is aimed at retaining top
nursing faculty at Illinois nursing
colleges and universities. It includes a
$10,000 grant for continuing research.
Stapleton’s research centers on
managing pain for emergency
department patients, particularly after
discharge, with the goals of better
practice, better outcomes and fewer
readmissions. Self-described as a ‘‘strong
proponent of lifelong learning,’’ he
previously has received research grants
from the ENA Foundation and the
National Institutes of Health. His findings
have been published in the Journal of
Emergency Nursing, the Journal of
Clinical Nursing and the Journal of Pain
and Symptom Management.
He’s been at Mennonite in a tenure
track since 2010.
‘‘It is through my own academic
achievement,” Stapleton wrote in his
fellowship application, ‘‘that I will
accomplish my objectives while
inspiring others to seek rewarding
professional and/or academic careers.’’
THREE ENA MEMBERS AT THE
University of Texas Medical Branch in
Galveston were among 11 co-authors of
an article on UTMB’s revised annual
evaluation process.
Valerie Brumfield, MSN, RN, CCRN, a
clinical nurse specialist in the emergency
department; Leanne Ledoux, BSN, RN,
CEN, SANE, the assistant nurse manager
in the ED; and Ruth A. Sathre, MSN, RN,
CEN, a former ED staff nurse who’s now
in the Doctor of Nursing Practice
program at Walden University, helped to
develop ‘‘Enhancing RN Professional
Engagement and Contribution: An
Innovative Competency and Clinical
Advancement Program,’’ which was
published in June 2012 in Nurse Leader.
The article describes the revision
process, which involved a new system
for bedside staff evaluations across
diverse settings and specialties.
Make time in March to slide up to
your computer and take ENA’s latest
free continuing education course.
‘‘GU: It’s More Than Just P,’’ by
Michael D. Gooch, MSN, RN, CEN,
CFRN, ACNP-BC, FNP-BC, EMT-P, is
an e-learning program worth 1
contact hour. It reviews the anatomy
and physiology of the genitourinary
tract, the clinical manifestations
associated with common GU
disorders and patient management.
To take this and other courses in the
CE catalog:
• Go to www.ena.org/freeCE,
where you’ll log in as an ENA
member (or create a new
account).
• Add desired courses to your
cart and ‘‘check out’’ (courses
are completely free for
members only).
• 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
‘‘Go to Personal Learning
Page’’ under the Courses &
Education tab.
If you have questions about any
free e-learning course or the
checkout process, e-mail
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 Connection915 Lee StreetDes Plaines, IL 60016-6569ISSN: 1534-2565Fax: 847-460-4002 Website: www.ena.orgE-mail: [email protected]
Non-member subscriptions are avail-able for $50 (USA) and $60 (foreign).
Editor in Chief:Amy Carpenter AquinoAssistant Editor:Josh GabyWriter:Kendra Y. MimsEditorial Assistant:Renee HerrmannBOARD OF DIRECTORSOfficers:President: JoAnn Lazarus, MSN,
RN, CENPresident-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,
CENMichael D. Moon, MSN, RN, CNS-CC,
CEN, FAENSally K. Snow, BSN, RN, CPEN, FAENJoan Somes, PhD, MSN, RN, CEN,
CPEN, FAENKaren K. Wiley, MSN, RN, CEN
Executive Director: Susan M. Hohenhaus, LPD, RN, CEN, FAEN
Member Services: 800-900-9659
WHAT’S NEW WITH YOU?E-mail [email protected] to
tell us about your recent successes or
to celebrate those of a member
colleague. Include names, credentials
and, if applicable, photos of the
nurse(s) being recognized.
Fellowship Adds Fuel to Illinois Nursing Leader’s Research
Her Dream Lives On
Sometimes, it only takes a handful of people with courage to step out on faith
and create a change … those who dare to dream big for what they believe in . . . those who spark a revolution to improve the lives of others.
For ENA it took two, and one of them was Judith Kelleher. Judy has touched the lives of many, and she has left an imprint on our organization and in our hearts. There are no adequate words to express how grateful we are for the contributions she has made to our profession.
She joined forces with Anita Dorr, RN, FAEN, and they formed the national Emergency Department Nurses Association in December 1970. After Anita’s passing in 1972, Judy carried on their shared vision. She was undaunted by obstacles and determined that emergency nursing would be recognized as a specialty.
She famously said, ‘‘I think the thing that typifies ENA in those early years is that we began to speak out and speak up for emergency nursing, for emergency nursing education, for emergency nursing recognition.’’
Judy led the organization to national prominence and recognition as the only
association dedicated to the advancement of the specialty through education and advocacy. One of her dreams was realized in 2012 when the American Nurses Association recognized emergency nursing as a specialty.
More than 40 years have passed since its creation, and every single member of ENA is still impacted today by Judy’s accomplishments. As an organization, we are truly blessed
to have been founded by a true leader and trendsetter whose dream raised the standards of how we practice. As individuals, we are inspired by her dream to make a difference in the lives of patients and emergency nurses everywhere.
It is a blessing that Judy was able to see the difference she made in our organization … from the 40,000 emergency nurses who have united to become a voice in our profession to the thousands of patients who are receiving better treatments in emergency departments around the country because of her passion to improve emergency care for everyone.
As one ENA member wrote on our Facebook page this week, ‘‘Rest in peace, Judith. Your work here may be done, but your legacy will live on for generations.’’
ENA Co-Founder Judith C. Kelleher
MSN, RN, FAEN
1923-2013
Official Magazine of the Emergency Nurses Association 5
Look for an expanded tribute to the career and impact of Judith C. Kelleher in the May issue of ENA Connection.
Below is an excerpt of the eulogy that Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN,
2013 ENA president-elect, delivered at services for Judith C. Kelleher on Feb. 1.
March 20136
In-Flight Medical Emergencies
Ding! ‘‘If there is doctor, nurse,
paramedic or anyone with medical
training on board who can assist with
a medical emergency, please ring your
flight attendant call bell.’’
When emergency nurses hear this
request, some may hope someone else
will ring in; however, there is no
guarantee of a physician being on
board, which occurs between 40 and
90 percent of the time.
Commercial aircraft emergencies
occur daily in the United States, in
roughly 1 in 39,600 passengers. It is
difficult to clarify the actual number of
medical emergencies due to a lack of
mandated reporting.
Emergency nurses who hear the
call to assist may be the most prepared
based on our knowledge and skill. In
my experiences assisting patients
requiring in-flight medical intervention,
I have found that the term ‘‘doctor’’
can be applied to an array of positions,
including emergency physician,
Doctorate in Public Health Quality,
podiatrist, pediatrician, dentist and
chiropractor. Ascertaining a doctor’s
specialty will better prepare a team to
care for an in-flight patient. Incorporate
the flight attendants into your care, as
they have the direct link to the captain,
who is the ultimate decision-maker
and has contact with ground medical
control.
Medical emergencies that occur
during flight are often related to travel
or stress. Hypoxia, barometric pressure
changes, temperature changes,
dehydration, noise, vibration and
fatigue are environmental conditions
causing physiological stress. Along
with these factors come the signs and
symptoms of nausea, vomiting,
headache, abdominal pain, dizziness,
hypotension and syncope. Although
other medical conditions, such as
myocardial infarction or stroke, can
occur at any time, most in-flight
medical emergencies are related to the
environment and stress of travel.
What do you do? First, make
yourself known to the flight attendant.
Once you have been escorted to the
patient and have made your initial
assessment and general impression,
ask if the patient can be moved to a
more quiet and confidential area, such
as the bulkhead or rear of the cabin. If
this is not an option, ask the flight
attendant to try to reseat passengers or
allow your patient to walk the aisles so
you can best complete a confidential
assessment. Based on the medical
complaint and condition, your patient
may need to lie as flat as possible
across three seats. Do not be afraid to
ask for comfort packages that include
a pillow and blanket.
Today’s airlines in the U.S. are
equipped with an automatic external
defibrillator and robust medical kit,
thought they are kept under lock and
key. Basic equipment, such as a blood
pressure cuff, stethoscope and oxygen,
is readily available. Additional
equipment and advanced cardiac
equipment, not limited to IV solutions
and medications, are available for use
with consultation through ground
medical control. Under Federal
Aviation Regulations, Appendix A to
Part 121, airlines must display the
required equipment. Many airlines
carry additional equipment, including
obstetrical kits and anti-nausea and
over-the-counter pain medications.
A question of liability often arises.
Congress passed the 1988 Aviation
Medical Assistance Act, which allows
medical professionals to operate under
their scope of practice as long as the
professional is practicing in good faith.
According to the Act, ‘‘An individual
shall not be liable for damages in any
action brought in by Federal or State
court arising out of acts or omissions
of the individual in providing or
attempting to provide assistance in the
case of an in-flight medical emergency
unless the individual, while rendering
such assistance, is guilty of gross
negligence or willful misconduct.’’
While rendering medical care, you
should never feel alone. Flight
attendants are trained in first aid and
CPR/AED and welcome any assistance.
Ground medical control is available
through the captain as a joint decision
is made whether to continue to the
final destination or divert. Many times,
with comforting medical and nursing
care, patients make it to their
destination to awaiting EMS personnel.
Next time you answer the ding
asking for assistance, your flight crew
will be quite appreciative, and you
may even receive a token of gratitude
for your willingness to help.
BOARD WRITES | Matthew F. Powers, MS, BSN, RN, MICP, CEN, ENA Secretary/Treasurer
Visit www.ENAFoundation.org for more detailed information on the State Challenge campaign and for updates on
where your state stands in the challenge race.
The Goal is SimpleHelp emergency nurses get the education they need.
Shout out for the future of your profession by making a donation to the ENA Foundation.
Your donation will help your state council’s chances towards the following awards.
Challenge AwardsLargest percentage increase per capita:
1st Place - $250 ENA Marketplace gift certificate2nd Place - $100 ENA Marketplace gift certificate
Largest number of individual donations per state:
1st Place - $250 ENA Marketplace gift certificate2nd Place - $100 ENA Marketplace gift certificate
Donate Now
EN
A F
oun
dation
2013 State Ch
alleng
e
Emergency Nursing EducationSHOUT Out for
Emergency Nursing
Education
2013_ENAF_StateChallengeAd_fullpg.indd 1 1/30/13 1:32 PM
March 20138
ENA’s Resource Pathway to Safe Practice, Safe Care
ENA’s Strategic Plan for 2012-2014 includes four priority
areas that benefit the stretcherside nurse and contribute
to providing safe practice, safe care. Those priorities are
1) advancing emergency care at home and abroad; 2)
advocating for a culture of safe practice and safe care; 3)
championing for a culture of inquiry, learning and
collaboration within our profession; and 4) expanding
and fortifying ENA’s membership. One integrating
concept that encompasses these four philosophies is the
sharing of pertinent information on patient care, patient
and staff safety and a means to further the specialty of
emergency nursing.
Access to EducationTo strengthen the nurse’s ability to provide safe practice,
safe care, ENA provides education in both formal and
informal ways, has developed a scope and standards for
the emergency nurse and offers a wealth of information
through products available at the ENA Marketplace
(admin.ena.org/store). ENA provides educational
programs to support and strengthen the excellent care
delivered by emergency nurses. Courses, seminars and
conferences are based on knowledge from experts in
the field and designed to help you achieve your
professional development goals.
ENA’s Center for e-Learning provides on-demand online
courses through its learning management system. Each
month, a new online course is launched and is free to all
members as a value-added benefit and for continuing
education credits.
ENA’s Annual Conference is the largest educational
gathering for emergency health care professionals. It is a
comprehensive learning experience designed to enhance the
knowledge and skill level of emergency nurses, nurse
managers, ED directors, clinical educators and more. ENA’s
Leadership Conference is the premier educational gathering
for emergency health care leaders, which offers an
unparalleled learning experience, networking opportunities
and exposure to the most cutting-edge tools and products in
emergency care services.
Member ResourcesThe Journal of Emergency Nursing, the official journal of
ENA, reaches the greatest number of emergency nurses,
emergency/trauma departments and ED managers of any
journal. The journal covers practice and professional issues,
based on current evidence, that challenge emergency nurses
every day and features original research and updates from
the field. ENA’s news magazine, ENA Connection, is
published 11 times annually and provides current
information on association activities and emergency nursing
issues.
Emergency Nursing Scope and Standards of Practice is a
landmark publication that describes the competent level of
behavior expected for nurses practicing in the specialty of
emergency nursing. The book provides a guide for the
practitioner to understand the knowledge, skills, attitudes
and judgment that are required for practicing safely in the
By Dale Wallerich, MBA, BSN, RN, CEN, Senior Associate, ENA Institute for Quality, Safety and Injury Prevention
An attendee taps into one of the educational opportunities that have come to define ENA’s annual Leadership Conference.
Official Magazine of the Emergency Nurses Association 9
emergency setting. This book is available at the ENA
Marketplace (admin.ena.org/store) along with a full
selection of resources covering a wide range of the topics in
the practice of emergency nursing.
ENA continues to share pertinent information through its
position statements, which ENA defines as an assertion of
the beliefs held, encouraged and supported by ENA.
Position statements provide concise information and material
for understanding and analysis of the problem. Joint and
consensus position statements are an assertion of the beliefs
held, encouraged and supported by ENA developed in
collaboration with external professional organizations with
mutual interest in providing safe practice, safe care. All
position statements are written in accordance with the
bylaws, strategic plan and code of ethics of the organization
and are officially endorsed by ENA as authorized by the ENA
Board of Directors.
Emergency nursing resources are evidence-based
documents that facilitate the application of current evidence
into everyday emergency nursing practice. ENRs are created
following a rigorous process included in ENA’s Guidelines
for the Development of Evidence-Based Emergency Nursing
Resources. ENA believes that ENRs have a positive impact on
patient care and emergency nursing practice by bridging the
gap between practice and currently available evidence.
New ToolsENA Practice References are a new resource from ENA. They
are succinct practice statements that are based on current
scientific evidence available at the time the documents are
developed. They are related to a clearly identified
circumstance and provide best practice information. They
are not meant to be a substitute for a nurse’s best judgment
in a given situation of care.
The concept of the practice reference came out of the
need to respond to member requests for a quick resource
that can assist in applying appropriate or available evidence
in a given clinical situation. It is anticipated that many of the
practice reference topics will come from ENA listserv
discussions and direct e-mail inquiries.
Two of the several EPRs drafted by the ENA Clinical
Practice Committee in 2012 were reviewed and approved by
the ENA Board of Directors. These first two practice
references focus on hemolysis and right-sided/posterior
ECGs and are available at www.ena.org/IQSIP/Practice/
Pages.
Topic Briefs are informative documents that provide
detailed, accurate and current information on a given subject
of importance to safe practice, safe care. The subjects
selected for topic briefs come from inquiries from members
or as a result of committee work on a particular subject.
Two Topic Briefs, one on health information technology and
the other on health literacy, are currently available at
www.ena.org/IQSIP/Practice/Pages/, along with other
informational tools available for download.
Reference
Emergency Nurses Association. (2012). ENA strategic plan
2012 - 2014 and beyond. Retrieved from www.ena.org/
about/Documents/ENAStrategicPlan2012-2014.pdf
Contributing: Kathy Szumanski, MSN, RN, NE-BC; Jessica
Gacki-Smith, MPH; Altair Delao, MPH; Maureen Howard
and Bree Sutherland.
POSITION STATEMENTSwww.ena.org/about/position
EMERGENCY NURSING RESOURCESwww.ena.org/IENR/ENR
OTHER USEFUL LINKS
www.ena.org/COURSESANDEDUCATION
www.ena.org/publications/jen
www.ena.org/publications/connection
admin.ena.org/store
EMERGENCYCARE SUMMIT
A NATIONAL CONFERENCE FOR EMERGENCY DEPARTMENTNURSES, PHYSICIANS AND PHYSICIAN ASSISTANTS
SNOWMASS, CO
Register online at www.ContemporaryForums.com
Or By Calling 800-377-7707
July 21-24, 2013
EARN UP TO 17.5 CE HOURS
March 201310
Hello, fellow ENA members. I am Julie Jones from South
Carolina, and it gives me great pleasure to introduce myself
as your 2013 ENA Foundation chairperson.
Many years ago, as a member of the South Carolina state
council, I knew I wanted to make a difference in emergency
nursing. My colleagues and I realized we had the
opportunity to give back and do more for others by giving
to the ENA Foundation through the State
Challenge. After the loss of a colleague,
Antoinette Ruff-Johnson, BSN, RN, CEN,
we all wanted to do something in her
honor. Raising money to name a state
council scholarship after her was the
perfect idea. We asked how much we
needed to raise through the State
Challenge to name a scholarship, and
sticker shock hit when we learned the
amount was $5,000. How was our
little state with 500 members going to come up with that
much? We continued passing the hat for the State Challenge
but knew that would not be enough. One chapter donated
10 percent of the proceeds from its oyster roast. We began
e-mailing members in South Carolina, telling the story of
what and why we were doing this. I expanded my e-mail
requests to friends and family, who gladly contributed. Our
state council also informed Ruff-Johnson’s family of our
intentions, as well as her former emergency department, to
encourage donations in her honor.
We succeeded and named our first scholarship in 2011.
I am happy to say that we were able to sustain the how
and why of gaining donations and named the Antoinette
Ruff-Johnson Memorial Scholarship in 2012. I share this story
to show that even a smaller state can make a great
contribution and honor someone who has touched its
members’ lives.
South Carolina is not the only small state to have made
this commitment. Mike Hastings, MS, RN, CEN, of the Kansas
ENA State Council (membership: 393) shared KENA’s story
with me.
‘‘We join the Foundation’s focus to expand the
knowledge of emergency nurses by offering education,
scholarships and funding research opportunities,’’ he said.
KENA members do this in several ways. First, they pass
the hat at each state meeting. Second, they purchase jewelry
from the ENA Foundation Jewelry Auction at the Annual
Conference. At each state meeting, members can buy tickets
for chances to win the jewelry. Most recently, Kansas
honored one of its members, Darlene Whitlock, MSN, MA,
RN, APRN, ACNP, EMT-B, CEN, CPEN, by naming a
scholarship after her. Members wanted to do something
special to recognize her efforts in Kansas
regarding the trauma system, as well as
her years of dedication and service to the
Kansas ENA Board of Directors. State
Council and chapter contributions made
this possible.
Seleem Choudhury, MSN, RN, CEN,
the ENA Foundation chairperson-elect,
shared how the Colorado ENA State
Council (membership: 860) conducted its
successful fundraising effort the last few
years. In 2010, Colorado ENA began its journey to becoming
more involved in the ENA Foundation. Before then, the
council had not contributed; when Choudhury became
council president, he made it a priority.
Colorado ENA started with simply making an ENA
Foundation donation a line item in its budget and its
strategic plan. It noticed a corresponding increase in
individual donations. Colorado did some unique fundraising
as well. It purchased 20 CEN review manuals, sold them at a
discounted rate and gave 100 percent of the proceeds to the
ENA Foundation. At its state conference, it asked for ENA
Foundation donations at its state booth.
At the end of 2011, Choudhury went to the board with the
idea of increasing the donation for 2012 to $5,000 to name a
scholarship. This will be given out in 2013 in remembrance
of the victims of the Aurora movie theater shooting.
Every state has a story. Now is the time to tell your story
and connect it to your purpose by giving to the ENA
Foundation. Let’s support our profession and each other.
Reach out to other state chapters to brainstorm fundraising
ideas. I can’t wait to hear about some of your ideas as we
strive to make the 2013 ENA Foundation State Challenge the
most successful ever. For more information on the State
Challenge and how you can contribute to the ENA
Foundation, please visit www.enafoundation.org.
Mike Hastings, MS, RN, CEN (left) and Seleem Choudhury, MSN, RN, CEN, of the Kansas and Colorado state councils.
The Many Ways We Can Do More
ENA FOUNDATION | Julie Jones, BSN, RN, CEN, 2013 ENA Foundation Chairperson
Q: I am an ED nurse finishing up
my bachelor’s degree in nursing,
and I plan on pursuing a master’s
degree. I have heard about forensic
nursing, and it has intrigued me. Is it
a female specialty due to the high
percentage of female sexual assaults?
Would a male have the same
opportunities afforded to him?
– Jared from Boston
A: Jared, thank you for reaching out
to ENA. The term ‘‘forensic nurse’’ is
relatively new — the field has only been
around for approximately 20 years.
Because forensic nursing encompasses a
wide variety of issues, gender really
does not matter.
A forensic nurse is a nurse with
specialized training in forensic evidence
collection, criminal procedures, legal
testimony expertise and much more as
the job description continues to expand.
Other career branches for this job
outside of the hospital include medical
expert witness, nurse death investigator
and community education.
If you decide to stay within the
hospital setting, you may share your
expertise with your peers to help them
provide not only quality care but expert
documentation for the patient who has
been injured, assaulted or abused.
There are numerous master’s degree
programs across the country, with
several on the East Coast that specialize
in forensic nursing. I would encourage
you to contact the International
Association of Forensic Nurses at iafn.
org to find out more about the specialty
and to seek their assistance in finding
an advanced program that meets your
needs.
I hope I have answered your
questions. Please feel free to contact me
— Dale Wallerich, MBA, BSN, RN, CEN, Senior Associate,
ENA Institute for Quality, Safety and Injury Prevention
In response to member requests
for more interactive opportunities,
ENA Connection is proud to debut
its newest feature, Ask ENA.
Members are encouraged to submit
questions about the organization
and emergency nursing in general.
Questions should be no longer
than 200 words. For verification
purposes, you must include your full
name, address and e-mail address.
(We will accommodate requests to
not print full names.)
Questions will be referred to the
appropriate ENA staff or department.
Submission of a question does not
guarantee publication. Submissions
may be edited for clarity or
shortened for space.
E-mail questions to
[email protected], fax to
847-460-4005 or mail to ENA
Connection, 915 Lee St., Des Plaines,
IL 60016.
Job seekers can post their resume, search for jobs and most importantly create an online profile for employers to find. You can maintain total privacy about your job search by selecting to keep your resume and profile confidential in our database.
To create an online profile, go to www.ena.org and go to the Career Center to log-on and get started today. Be sure to come back frequently to keep your profile current!
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March 201312
Fact: Children get hurt and often require minor procedures
performed in the emergency setting.
Fact: Simple strategies can eliminate or drastically reduce
pain in pediatric minor procedures.
Pediatric pain is often under-recognized and undertreated
in the emergency setting. One study examining more than
1,000 pediatric patients undergoing minor procedures found
that almost none of the children received any pain
management strategies.1 Children can have long-lasting
negative psychological effects from a painful procedure.
Infant males who were circumcised shortly after birth
without pain control demonstrated higher levels of pain
when receiving their infant immunizations.2 Using simple
strategies can reduce pain and fear while increasing child
and parent satisfaction.
Evidence confirms that parents should be permitted to stay
with their children when undergoing minor procedures.3
Parental presence is helpful for children, yet it is not
consistently implemented. Parents should be provided
instructions on how to help maintain a calm and positive
atmosphere along with suggestions for distraction
techniques.
The position of the child can make a significant difference
in the child’s stress during the procedure. Comforting
positions, such as the child sitting in the parent’s lap or sitting
in the “chest-to-chest” position with the parent (see Figure 1),
provide positive support as opposed to having the child lie
supine, which often results in panic and struggling.
Words can either comfort the child or invoke fear.
Warning a child about anticipated pain often results in greater
pain and anxiety in the child. Reassuring comments, such as
‘‘You can do this’’ or ‘‘Don’t worry’’ can increase distress in
children and should be avoided. Avoid telling the child what
you do not want the child to do: ‘‘Don’t move,’’ which can
also evoke fear in the child. Instead, tell the child what you
want him or her to do: ‘‘I want you to try to hold your arm
very still and take some deep breaths like Mommy.’’
Distraction can direct the child’s attention away from the
pain related to the procedure. Distracters such as books,
toys, music, video games, singing and deep breathing should
be developmentally appropriate and able to capture the
child’s interest. The I-Spy book series is an excellent
distracter for children. Talking and touch have been found to
be the most helpful distracters.
The application of pressure (rubbing near the site or
vibration in close proximity to the location where the
PEDIATRIC UPDATE
Reducing Needless Pain in Pediatric Minor Procedures
By Denise R. Ramponi, DNP, NP-C, CEN, FAEN, Assistant Professor, Robert Morris University, and Nurse Practitioner, Heritage Valley Sewickley Emergency Department, Pittsburgh ♦ Edited by Elizabeth Stone Griffin, BS, RN, CPEN
Figure 1: Mother holding child in the “chest-to-chest” position.
Fewer Tears and Fears
Official Magazine of the Emergency Nurses Association 13
procedure is being
performed) can also be
an effective method to
reduce pain. This
method demonstrates
use of the Gate Theory,
similar to the method
used by dentists who
jiggle the lip before
giving intraoral
injections.
There are a number
of non-invasive agents
that can be used to
reduce pain in the
emergency setting.
Some can be applied
immediately prior to
procedures, and others
must be applied 20 to
30 minutes in advance
of a procedure to
engage maximum
benefit. Topical
vapocoolant spray is
an anesthetic skin refrigerant that instantly reduces pain for
needlesticks and other skin punctures. It can be applied to
minor open wounds or intact skin (such as abscesses). It is
sprayed for 4 to 10 seconds or until the skin is blanched,
with a resultant 60 seconds of transient anesthesia to
perform the procedure. Liposomal lidocaine
(4 percent) cream can be applied to intact skin to reduce
pain from venipunctures. It can be placed over two areas
where the vein is most prominent, often the antecubital area
and dorsum of the hand, for approximately 20 to 30 minutes
before IV starts. Two areas are typically used in case the first
IV attempt is unsuccessful.
For open wounds, mixtures of lidocaine, epinephrine and
tetracaine can be applied to lacerations in the triage area.
LET is applied to a cotton ball or other nonabsorbent
dressing and taped in place. As an alternative to using tape
over the dressing, the parent can wear a glove and apply
pressure to the dressing over the wound for approximately
20 to 30 minutes before laceration cleansing and repair. The
skin will become blanched from the epinephrine in the LET
(see Figure 2).
Other considerations include application of viscous
lidocaine jelly to the urethra for approximately 10 minutes
before urethral catheterization attempts in infants. Infants
can be provided sucrose solution by dipping a pacifier in the
sucrose and giving it to the infant before, during and after
painful procedures.
The sucrose causes the
release of endogenous
endorphins and thus
reduces the pain.
Infants provided
sucrose were found to
cry less and returned to
their baseline condition
quicker after
procedures. Pacifiers
alone can also be
effective for analgesia.
There are a number
of other pain-reducing
strategies that are
beyond the scope of
this article. The methods
discussed can take a
minimal amount of time
and can significantly
reduce pain effectively
in the pediatric patient.
References
1. MacLean, S., Obispo, J., & Young, K.D. (2007.) The gap
between pediatric emergency department procedural pain
management treatments available and actual practice.
Pediatric Emergency Care, 23(2): 87-93.
2. Taddio, A., Katz, J., Ilersich, A. L., & Koren, G. (1997.)
Effect of neonatal circumcision on pain response during
subsequent routing vaccination. The Lancet, 349(9052),
599-603.
3. Broome, M. (2000.) Helping parents support their child in
pain. Pediatric Nursing, 26(3), 315-317.
Head to enajoann.wordpress.com or
the ENA website, www.ena.org, to read the
latest posts from 2013 ENA President JoAnn Lazarus,
MSN, RN, CEN, in her new ENA President’s Blog.
Figure 2: Skin blanched after 20 minutes of LET application.
BLOG ON
March 201314
On Dec. 20, Ohio Gov. John
Kasich signed Amended
Substitute House Bill 62 into
law. Taking effect March 22, the
Health Care Worker’s Protection
Act will increase the penalty for
assault against nurses and other
health care professionals.
Sponsored by state Rep. Anne
Gonzales (R-Westerville), HB62
is a much-needed first step
toward reducing the incidence
of violence in Ohio’s hospitals.
Key elements of the new law
are illustrated in the table below.
‘‘Nurses and other hospital
health care workers now have
the opportunity and safeguard to
keep the work environment a
safer and more secure place to
deliver care,’’ said Beverly Clensey, MS,
RN, CCRN, CEN, immediate past
president of the Ohio ENA State Council.
The passage of HB62 is the
culmination of several years of work by
the Ohio Emergency Nurses Association
and the Ohio Nurses Association. Our
grassroots passion for the topic and
expertise on the phenomena, combined
with the political power of ONA, proved
a most successful coalition. Letters of
support also were received from the
Ohio Hospital Association, American
College of Emergency Physicians, Ohio
State Medical Association and the Ohio
chapter of the American Psychiatric
Nurses Association.
State Sen. Scott Oelslager, then-chair
of the Senate Health Committee and
sponsor of companion legislation Senate
Bill 111, was instrumental in the bill’s
successful 18-month journey through the
Ohio Senate. Oelslager
recognized Ohio ENA
during a Nov. 27 debate on
HB62 on the Senate floor by
saying, ‘‘In particular, I
would like to thank and
recognize the Ohio
Emergency Nurses
Association. The statistics,
research and national
expertise they brought to
the table on this issue was
incredible.’’
In addition to strong
work by Ohio ENA, the
actions of our individual
members largely contributed
to HB62’s passage. The
table on the next page lists
the individual members
who provided HB62 proponent
testimony. In particular, Central Ohio
emergency nurse Libby Robb, RN,
testified before the Senate Judiciary’s
hearing on companion legislation
(SB111) to share her tearful experience
of being assaulted by a patient. With the
help of Ohio ENA member Gordon
Gillespie, PhD, RN, CEN, CPEN, FAEN,
we brought national expert Donna
Gates, EdD, MSPH, MSN, FAAN, to
testify before the Senate Judiciary’s
hearing on HB62. Also, an article by
ENA past president Diane Gurney, MS,
RN, CEN, FAEN, in the April 2011 issue
of ENA Connection was a catalyst to
introduce language in the bill permitting
standardized hospital signage on the
issue.
‘‘All emergency nurses are indebted
to the Ohio Emergency Nurses
Association, the Ohio Nurses
Association, Rep. Gonzalez and Sen.
By Nicholas Chmielewski, MSN, RN, CEN, NE-BC, Ohio ENA State Council Government Affairs Liaison
Ohio Efforts Pay Off With New Law Against Assaulting Health Care Workers
Key Elements of HB62• Directs the Ohio Department of Health to create standardized signage in the
shape of a stop sign. The signage will state that abuse or assault of hospital
staff will not be tolerated and could result in a felony conviction. Authorizes
hospitals to post the signage in public areas.
• If the hospital offers de-escalation training to its staff, HB62:
° Authorizes a $5,000 fine for assault against healthcare professionals, health
care workers and security officers of a hospital for a first-time offense.
° Increases the penalty for assault to a fifth-degree felony when the offender
has previously been convicted of an assault against a health care worker.
ADVOCACY
Pictured at the signing of HB62 with Ohio Gov. John Kasich (seated) are (from left) state Rep. Anne Gonzales; Ohio ENA State Council Immediate Past President Beverly Clensey, MS, RN, CCRN, CEN; Ohio ENA Government Affairs Liaison Nicholas Chmielewski, MSN, RN, CEN, NE-BC; state Sen. Scott Oelslager; and ONA President Paula K. Anderson, RNC.
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• Strategies for health promoti on
• Orientati on and conti nuing educati on programs
• Quality improvement programs and acti viti es
• Content experti se on the scope of emergency nursing practi ce
• And American Nurses Associati on now recognized emergency nursing as a speciality
Oelslager for all their work on
this legislation,’’ said Gail
Lenehan, EdD, MSN, RN, FAEN,
FAAN, immediate past president
of ENA. ‘‘The legislation will help
to protect the nurses of Ohio, but
also provides inspiration for
similar legislation in other states
as well. Importantly, it sends a
message that will hopefully be
heard beyond the boundaries of
Ohio — that violence against
nurses and other health care
workers will not be tolerated,
that it is no more acceptable than
violence against police or firefighters.’’
It took the introduction of many
bills over several sessions to realize the
passage of HB62. In the 128th Ohio
General Assembly, state Rep. Denise
Driehaus introduced HB450 to restart
the conversation. Similar legislation
was introduced in that session by Rep.
Stephen Slesnick and then by
Oelslaeger. In the 129th Assembly,
Slesnick and Driehaus re-introduced
legislation. There were several
discussions and changes to HB62
during its journey to becoming law.
Key discussions included:
• The philosophy of ‘‘protected classes.”
• Explaining the need for this
legislation and helping legislators
understand the prevalence of this
violence.
• Explaining that this bill is not about
‘‘locking up’’ an elderly patient with
Alzheimer’s or a patient waking up
from anesthesia in a combative state.
• The scope of who should receive
protection.
• Individuals under the influence of
drugs or alcohol.
• Individuals with mental
impairments.
• The degree of penalty that
should be applied to offenders.
• Hospitals’ responsibility to
provide de-escalation training.
• The need for signage to
promote awareness and
discussion on the issue.
• The cost of implementation.
We were extremely grateful for
the expertise, support and
guidance of ENA’s national office
staff during the last several years.
This support was highlighted when
Lenehan joined us at the Ohio State
Capitol to celebrate HB62’s signing.
One important lesson learned is that
successful legislative policy requires
collaboration and compromise. Most
important, however, is persistence. It
was the unrelenting persistence of our
members — through letter-writing and
phone calls — that resulted in HB62
receiving a crucial floor vote in the
Senate. To each of our members across
the state who contributed, I say thank
you and congratulations!
Emergency Nurses Contributing at HB62 Hearings
House Criminal Justice, April 2011
Dan Abbey ♦ Tammy Brassler ♦ Nancie Bechtel ♦ Nick Chmielewski ♦
Ivy Cook ♦ Meghan Long ♦Nicole McGarity
Senate Judiciary, November 2011
Nick Chmielewski ♦ Beverly Clensey ♦Megan Long ♦ Nicole McGarity
March 201316
More than 90 ENA state council leaders representing more
than 30 states attended ENA’s first Emergency Nursing
Advocacy Intensive in Chicago on Jan. 10-12. Sponsored by
Vidacare, this unique event provided attendees with an
exciting opportunity to learn more about advocating for the
emergency nursing profession to make a difference for their
patients and colleagues.
The three-day event kicked off with a welcoming
reception at ENA national headquarters, where attendees
were able to reconnect and network with their peers. 2013
ENA President JoAnn Lazarus, MSN, RN, CEN, opened the
second day with a presentation on ENA’s priorities and its
2013-2014 Public Policy. She explained that the ENA Board
of Directors determined that the new ENA Public Policy
would be more nurse-focused.
‘‘This is an organization about you and advocating for all
of you,’’ Lazarus said. ‘‘We know that safe practice advocates
for safe care. By taking care of all of you, you’ll be able to
take care of your patients.’’
Lazarus discussed the meaning of her newly coined term
‘‘advocatism’’ and the importance of image, from appearance
to communication.
‘‘To me, advocatism is what we do for our patients and
for the profession of nursing. Advocatism is really at the
heart and soul of what we do as emergency nurses,’’ she
said. ‘‘As ENA, we are held in high esteem because of the
image we have with the public and because of the
perception of what we do for others. Advocacy is not just
about influencing public policy. From a nursing image
perspective, it’s our responsibility that the public sees us in
the best light.’’
Attendees learned about the importance of networking
from keynote speaker Laura Schwartz during her ‘‘Eat, Drink
and Empower’’ presentation. As the former White House
director of events for the Clinton administration, Schwartz
shared effective techniques for networking, communication
and mentoring.
‘‘No matter where we are . . . we have opportunity
everywhere we look to be ourselves and empower others
through our own background and stories, as well as to
advocate for ENA in all places, both on and off the clock,
with those professionally in your field and those who are
curious about it,’’ Schwartz said.
Schwartz urged the audience members to attend
conferences and networking sessions to connect with and
build bridges for others. She said networking is the best way
to effectively communicate the message of ENA.
‘‘ENA really provides an incredible bridge for you,’’ she
said. ‘‘ENA has the tools, resources, research and incredible
staff within ENA for you to go to and get that information to
help build that bridge for your hospital, a colleague or in
your community. They are there for you, so use that bridge
when you lobby for that safer work environment. . . . You
are so used to advocating for your patients all day every day,
but you also have to advocate for yourselves. As you
advocate for yourselves, you advocate for every one of your
patients at the same time.’’
‘‘The power of ENA and you the member is amazing,’’
Schwartz continued. ‘‘When you’ve got a critical patient that
you’re administering to, when you’re in the meeting with the
CFO talking about purchasing safer equipment, or when
you’re out in the community to meet with legislators, you’re
not in that room with the patient or on Capitol Hill alone.
You are in there with the other 39,999 members of ENA.
ENA Hosts Its First Emergency Nursing Advocacy IntensiveBy Kendra Y. Mims, ENA Connection
ADVOCACY
JoAnn Lazarus, MSN, RN, CEN, the 2013 ENA president, shares her concept of ‘‘advocatism’’ during remarks on the second day of the Emergency Nursing Advocacy Intensive.
Official Magazine of the Emergency Nurses Association 17
You are never alone.’’
Susan Hohenhaus, LPD, RN, CEN, FAEN, ENA’s executive
director, led an informative session on public relations and
media training. Attendees learned how to effectively work with
the media and connect with their communities. Hohenhaus
discussed two types of media relations (proactive and reactive);
how to deal with print reporters and broadcast reporters based
on their differences; knowing the rules of engagement when
working with journalists; and how to conduct a successful
interview by knowing who you are, what ENA represents and
the definition of an emergency nurse. Attendees learned the
advantages of using the media to advocate.
‘‘Nursing is incredibly well-positioned in today’s health
care environment,’’ Hohenhaus said. ‘‘In order to take care
of your patients, you have to make sure that you’re in a safe
place, that your scope and practice are protected and you’re
able to leverage federal and state funding to actually drive
health care policy. You’re at the beginning of a revolution
that I feel is exciting.’’
Richard Mereu, JD, MBA, ENA’s new chief government
relations officer, discussed the current situation in
Washington, D.C., to raise awareness on becoming effective
government relation advocates. (Learn more about Richard
Mereu and his extensive legislative background on page 20.)
Mereu’s session was followed by the expert panel on
advocacy, which included the following guest speakers:
ACEP Advocacy: Gordon Wheeler, ACEP associate
executive director, public affairs
Nurses CAN 2012: Adrianne Drollette, American Nurses
Association, senior political action specialist
State and Federal Regulatory Agencies Weighing in on
Health Care Scope of Practice: Anna Polyak, JD, RN,
American Association of Nurse Anesthetists, senior director
State Council/Chapter/State Legislative Coordinator
Structure: Amy L. Hader, JD, Association of
periOperative Registered Nurses, director, legal and
government affairs
Vidacare Corporation — Representation of the
Industry Perspective: Michelle Fox, BSN, RN,
Vidacare senior director clinical affairs
Top photo: Jeff Strickler, MA, RN, CEN, CFRN (foreground), and other emergency nurses from around the country take in the messages of the advocacy intensive. Below, left: Michelle Fox, BSN, RN, senior director of clinical affairs for Vidacare, shares industry perspective on the importance of advocacy. At right are Gordon Wheeler, associate executive director of public affairs for ACEP, and Adrianne Drollette, senior political action specialist for the American Nurses Association. Below: Lazarus with keynote speaker Laura Schwartz (center) and ENA Executive Director Susan Hohenhaus, LPD, RN, CEN, FAEN.
Continued on next page
March 201318
We’ve Come a Long Way, Baby … Or Have We?
I was fresh off the
plane from Chicago,
where I spent a
spirit-lifting
weekend with my
ENA peers at the
Advocacy Intensive. Energized and ready
to get to work with my Virginia colleagues
to enable us all to have safe practice and
provide safe care, I was handed a copy of
a 1961 newspaper article titled ‘‘Night in
Emergency Rooms: Hospital Nerve Centers
Stay Alert.”1
The article included photographs of
patients lining the hallway head to feet
while they waited for an intern to evaluate
them further; police, nurses and doctors
huddled around a receiving desk, sifting
through patient information following an
accident. Details of the latest and greatest
technology, the electrocardiogram, which
‘‘produces a photographic record of the
heart’s actions,’’ was highlighted for readers.
My attention was drawn to a section
that outlined the violence that provides the
emergency room with much of our
business and another section that read,
‘‘These are the emergency rooms. These
are the places where lives are saved,
people helped, doctors and staff abused.’’
That sentence really hit home. As a
member of the Virginia ENA State Council
and the Virginia Nurses Association, I
testified before five committees during the
2011 Virginia General Assembly, where HB
1690, a bill that provides some guaranteed
ramification to abusing or hitting any
emergency department worker, was
eventually passed into law. While preparing
to testify on one of the later hearings, I
asked Virginia emergency nurses to share
their stories as to why they did not press
charges after being assaulted in the ED.
One answer especially disturbed me.
This particular nurse was punched in the
face by a patient. She subsequently went
to the magistrate to press charges and was
denied her request because, she was told,
‘‘this was part of her job.’’ Reading this
article and reflecting back on my own
experiences and testimony, I now see why
this abuse is often seen as just part of the
job. Well, it’s not.
Reading this piece led me to ask, ‘‘What
has changed?’’ The answer is not much. In
1961, patients lay on gurneys in hallways
waiting for treatment; violence was a big
part of the reason for visits; and abuse of
staff was a regular occurrence. The real
changes are that patient volume has more
than tripled, technology allows staff to treat
more complex diseases and emergency
nurses and physicians stand united in their
pursuit of safe work environments while
they lobby together, all with the thought of
being able to better serve those in need.
During her opening lecture at the
Advocacy Intensive, 2013 ENA President
JoAnn Lazarus explained advocatism as the
actions around advocating for others. I
submit to you that we all need to take this
to heart and practice advocatism for each
other every day. Don’t let another nurse in
40-plus years read an article that highlights
the waiting and the violence toward ED
staff. We need to change what future
emergency nurses read. Let them see what
you and I did to foster a safe environment
for them and the patients who need our
services each and every day.
Reference
Lindsay, G. (1961, July 23). Night in
emergency rooms: Hospital nerve centers
stay alert. Richmond Times Dispatch.
By Mary Menafra, MSN, RN, CEN
Attendees were able
to share important
issues affecting their
profession and
emergency departments
during the interactive
‘‘What’s Happening in
Your State?’’ session.
The event ended with
informative sessions led
by guest speakers
Hershaw Davis, Jr.,
MSN, RN, the ENA
Government Affairs
Committee chairperson;
Rita Anderson, RN, CEN,
FAEN, ENA Government
Affairs Committee; Lisa
Wolf, PhD, RN, CEN,
FAEN, ENA Institute for
Emergency Nursing
Research director;
Elisabeth Weber, MA,
RN, CEN, ENA
Government Affairs
Committee; Kathleen
Conboy, BS, RN, CEN,
ENA Government Affairs
Committee; and Deena
Brecher, MSN, RN,
APRN, ACNS-BC, CEN,
CPEN, 2013 ENA
president-elect.
Attendees left the
intensive empowered
with knowledge and
strategies to advocate
for their patients and
themselves.
‘‘We have to help the
patient’s voice be
heard,’’ Lazarus said.
‘‘We need to be the
voice of nursing and
inform legislatures. I
look to all of us to be
able to change the
world.’’
ENA Advocacy Intensive Continued from page 17
ADVOCACY
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ENA is shaping its new advocacy
department with the hiring of its first
chief government relations officer.
Richard Mereu, JD, MBA, who
began his new position with ENA on
Dec. 24, has worked in Washington,
D.C, for more than 20 years and brings
an extensive legislative background
and congressional experience to ENA.
Susan Hohenhaus, LPD, RN, CEN,
FAEN, ENA’s executive director,
describes the new position as
instrumental in overseeing federal and
state advocacy efforts and government
relations related to emergency nursing.
‘‘This is the perfect time for ENA to
make advocacy for the profession of
emergency nursing a priority,’’
Hohenhaus said, ‘‘and Mr. Mereu is the
perfect professional to begin this
journey with us.’’
Mereu has a JD from Albany Law
School and an MBA from The Wharton
School. He has worked on a variety of
health care issues as chief of staff to
Rep. Elton Gallegly (R-Calif.) and staff
director for two subcommittees of the
House Foreign Affairs Committee, as
well as serving as a professional staff
member on the House Judiciary
Committee. He believes his vast
background is essential to helping ENA
shape the new Advocacy Department.
‘‘Throughout my career I’ve had a lot
of roles and worked on many issues,
everything from health care and budget
issues to criminal law matters and
immigration,’’ he said. ‘‘We were able to
pass several bills that dealt with those
issues and fund programs in those areas.
‘‘I think my background is
important because the issues that ENA
is facing now are so diverse. I know
the legislative process very well from
having worked in Congress for all of
those years. That’s important in terms
of trying to get the initiatives that ENA
cares about passed through Congress.’’
ENA’s mission to advocate for
patient safety and excellence in
emergency nursing practice is one of
the factors that attracted Mereu to the
position. Based in ENA’s Washington,
D.C. office, he looks forward to
working on ENA’s top priorities,
including workplace violence in the
emergency care setting, which he
describes as one of the most ‘‘important
issues affecting the functioning of
emergency departments.’’
‘‘The primary goal is to establish a
very visible presence for ENA on
Capitol Hill, to advocate for our
priorities in Congress and in front of
the whole federal government and to
move forward on legislation to the
benefit of our members,’’ he said.
Mereu had the opportunity to
connect with members at ENA’s
Emergency Nursing Advocacy
Intensive in January when he
presented a session on building
relationships with legislators and
developing an authoritative voice on
Capitol Hill to meet the needs of
patients and emergency nurses.
JoAnn Lazarus, MSN, RN, CEN, the
2013 ENA president, said, ‘‘I look
forward to working with and learning
more from Mr. Mereu about legislative
and regulatory issues and expanding
ENA’s influence.’’
Mereu said his position will allow
him to delve much deeper into health
care issues.
‘‘I’m extremely excited, especially
now that health care reform is passed
and it was upheld by the Supreme
Court last year,’’ he said. ‘‘That will
create opportunities for ENA. Also,
everybody recognizes that the role of
emergency nurses is so important to
our overall health care system, so I’m
starting at a very good time in terms of
being able to get in at the ground floor
as these changes are being implemented
at the federal level. I can really
influence some of the direction that our
health care system is going to go in on
behalf of ENA.’’
March 201320
ENA Shaping New Advocacy Department By Kendra Y. Mims, ENA Connection
ADVOCACY
Richard Mereu, JD, MBA, the new ENA chief government relations officer, uses Skype to confer with staff at ENA headquarters from his office in Washington, D.C.
Official Magazine of the Emergency Nurses Association 21
In an act of defiance and revolution,
representatives of the 13 American
colonies broke from the British
Empire, signing the Declaration of
Independence on July 4, 1776.
Benjamin Franklin’s warning to his colleagues at that signing,
“We must hang together, gentlemen ... else, we shall most
assuredly hang separately,” highlighted the importance of
unity and coalition in the face of overwhelming odds.
Coalitions were crucial for nation-building then and to health
care emergency preparedness today.
Future Needs Joint Commission emergency management standards and the
lessons of Hurricanes Katrina and Sandy and the Joplin, Mo.
tornado remind us that hospitals and their emergency
departments must ultimately plan for overwhelming threat
scenarios requiring them to stand alone or evacuate. The
recent threat of a highly infectious H5N1 pandemic, with its
projected 50 percent mortality rate, would overwhelm most
U.S. hospital intensive care units.
Pandemics have occurred four times during the last 100
years. Concerns for certain and future natural, technological
or terrorism catastrophes are ever present. Emergency
department and hospital capacity and capability must be
maximized and coordinated with community health care
resources.
Nationally, hospitals have been building their surge
capacity and capability by organizing and reaching out to
community health care response partners, forming emergency
response alliances, networks and coalitions. Since 2001,
emergency preparedness, surge capacity and resilience in
U.S. hospitals and health care systems have been facilitated
and supplemented by the mechanisms and associated
funding of the U.S. Department of Health and Human
Services, Office of the Assistant Secretary for Preparedness
and Response Hospital Preparedness Program.
How are health care preparedness coalitions organized,
funded and sustained over time? What benefits are there to
being a member of a health care preparedness coalition?
What are best practice examples of existing coalitions? When
have health care preparedness coalitions lessened or
mitigated emergency department impacts during disasters? To
answer these questions, enter the 2012 National Healthcare
Preparedness Coalition conference.
A Successful ConferenceThe inaugural National Healthcare Preparedness Coalition
conference was held Nov. 26-27, 2012, in Arlington, Va., with
a mission of providing coalition-building strategies and best
practices. Organized and hosted by the Northern Virginia
Hospital Alliance, Seattle King County Healthcare Coalition,
and MESH, Inc. of Indianapolis, the conference was an
opportunity for stakeholders from around the country to
share best practices and lessons learned from building and
sustaining health care coalitions focused on health care
preparedness. Attendees came from Guam and most U.S.
states and included hospital emergency preparedness and
Hospital Preparedness Program grant leadership from local,
state and federal levels.
Attendees included the following ENA members: Elisabeth
Weber, MA, RN, CEN, of Chicago; Doris Neumeyer, BSN, RN,
of Washington, Mich.; Lori Upton, MS, BSN, RN, of Houston;
and Knox Andress, BA, RN, AD, FAEN, of Shreveport, La.
Upton presented “How Coalitions Can Support Recovery
Operations” while Andress shared “How Coalitions Can
Develop Evacuation Plans for Hospitals and Nursing Homes.”
Dr. Nicole Lurie, assistant secretary for Preparedness and
Response, U.S. Department of Health and Human Services,
welcomed attendees to a wide range of intriguing health care
preparedness coalition-building topics and panel discussions,
including the following:
• Building and Sustaining Coalitions
• Crisis Standards of Care
• How Coalitions Support Response
• How Coalitions Can Develop Information Sharing Systems
and Plans
• How Coalitions Can Develop Evacuation Plans for Hospitals
and Nursing Homes
• Engaging Coalition Partners and Participants
• How Coalitions Can Develop Behavioral Health Operations
Plans/Triage
• How Coalitions Can Support Recovery Operations
• ASPR Grant Metrics and Reporting Discussion
READY OR NOT? | Knox Andress, BA, RN, AD, FAEN
Hang Together or Separately
March 201322
Mother Nature’s gift to
Mobile, Ala., on
Christmas Day was a
large EF2 tornado
dropping in on the
downtown. The Mobile Infirmary
Medical Center took a hit: some broken
windows, uprooted trees and
overturned cars. Next door at the
University of South Alabama Children’s
and Women’s Hospital, where ENA
member John Marshall, BSN, RN, is the
3-to-11 supervisor, the tornado did
minimal damage as it rolled past.
No serious injuries were reported in
the community.
‘‘That’s the first time I ever met a
tornado face-to-face,’’ Marshall says in
his easy drawl. ‘‘It had my attention.’’
But as storms go for Marshall, this
was nothing. The biggest and scariest
he’d faced came more than a generation
earlier, some 350 miles away in his
hometown of Macon, Ga.
In April 1985, Marshall, then 34 and
married with a young son, already had
been fired from three area hospitals as
rampant substance abuse ripped a hole
in his life and nursing career.
‘‘This was before the days of
computers,’’ he says, ‘‘so you could still
go next door and get a job and they
didn’t know that you were in trouble
other places.’’
He’d lost a job in an emergency
department the previous year and spent
six weeks in rehab after introducing
methamphetamines into a buffet of
drugs that already included marijuana,
booze and pills. Now he was working
in a different hospital’s intensive care
unit, training to become a supervisor,
which meant he’d been given a key to
the pharmacy — and its narcotics. To
beat the regular drug screens, he knew
the exact day each month that he
needed to stop shooting dope, stop
smoking pot, stop popping pills. But his
fix still had to come from somewhere.
So he found himself breaking into the
operating room.
Nitrous oxide. It wouldn’t show up
on the screens. He took care to mix in
enough oxygen.
‘‘Eventually,’’ he says, ‘‘they found me
unconscious in the operating room and I
couldn’t let go of the hose. And that’s
the night I got in trouble that last time.
I’d been on the nitrous about six hours.’’
Colleagues were in disbelief. John
Marshall, a guy who could walk in and
right away be pegged for bigger things
in nursing, had become a surprise
tornado under their noses.
‘‘It was a nasty, nasty scene,’’ he
says. ‘‘That’s when I hit my bottom and
I realized, ‘You’re gonna die if you
don’t stop.’ ”
♦ ♦ ♦ ♦ ♦
Feb. 25, 2012, New Orleans. It wasn’t
the first time Marshall had heard Allison
Bolin dig into this topic. Here at ENA’s
Leadership Conference, he sat in again
as Bolin, BSN, RN, CEN, CPEN, laid out
the warning signs of employee
substance abuse and drug diversion in
hospitals. Emergency nurses can be
particularly susceptible, Bolin cautioned,
because of their special risk factors: high
job stress, access to medications, a
tendency to feel invulnerable.
At the end of her presentation, Bolin
invited questions at an open
microphone. Marshall stood. He had not
a question but a story — his. He’d been
there. He’d been the nurse Bolin was
urging others to identify, to report, to
help, to save. He’d become a new breed
of nurse: one who’d widened his scope
Official Magazine of the Emergency Nurses Association 23
from helping patients to also helping
other health care workers escape the
nightmare he’d known first-hand.
The room applauded.
John Marshall hasn’t had a fix in 27
years, but he’s made a life of fixing. As
facilitator of the Mobile Professional
Group, with which he’s been involved
since 1987, he sits in every other week
with anywhere from six to 26 health
care professionals whose encounters
with drugs and alcohol have led them
into his circle. The group is run like a
12-step program, the same way Marshall
got clean. Meeting topics rotate. New
members are worked in as they come.
It’s a casual, safe, free place where
people who handle narcotics as part of
their jobs can find the peer support to
keep themselves straight.
It’s also non-punitive — a way for
nurses to manage their recoveries
without being put on probation by the
Alabama Board of Nursing.
‘‘Most states have some kind of
nondisciplinary program now,” says
Marshall, who didn’t have that option in
1985 and spent the next several years
on probation in Georgia and Alabama.
‘‘Usually it’s required that the person
call [the board] and report themselves:
‘I’ve got a problem, I need some help.’
If people wait until an employer calls
and says, ‘We’ve got somebody with a
problem,’ a lot of times they end up on
probation.’’
No one wants that. Probation opens
the door to legal consequences for
diversion or writing self-prescriptions. It
offers no anonymity. In Alabama,
Marshall says, it means ‘‘their license is
stamped with ‘probation.’ It goes out in
the state newsletter who’s in trouble
with drugs, where in the nondisciplinary
program, none of that’s done.’’
Some in Marshall’s group, after
reaching their crisis points, were
referred to him by the Alabama board.
Others were invited by active members
or pointed there by treatment centers.
Most who attend are nurses; he
currently has two from EDs. Doctors
have their own group for recovery —
the International Doctors of Alcoholics
Anonymous — but two or three docs
still come to Marshall’s meetings. He
has nurse anesthetists, a pharmacist.
He’s had surgeons, even veterinarians.
Some are there to satisfy the
nondisciplinary requirement after one
failed drug screening. Their problem is
that they used casually, not abusively,
and got caught. Some, like Marshall, are
there because they became true
chemical addicts, no longer wanting the
fix but physically needing it; they
‘‘crossed the wall,’’ as he puts it. That’s
the other end of the spectrum.
There’s a large middle area — nurses
who aren’t chemically dependent but
who face the grim risks of denial, relapse
and career derailment.
‘‘We have a disease that tells us we
don’t have it, that we’re OK, that we’re
too smart, that I should be well by
now,’’ Marshall says. ‘‘And that’s just the
nature of the disease of addiction — it’s
a liar. It’ll lie to you. So after you’re not
being monitored and you don’t have to
go after a while, if you happen to be
one of those people that hadn’t crossed
the wall, you kind of phase out.’’
His mission is to see that as many as
possible don’t. He stresses a spiritual
philosophy of finding a ‘‘higher power’’
— a touchstone bigger than the drugs or
alcohol. For some, that’s religion. For
some, it’s a symbol — a tree, for
instance, or perhaps the group itself. A
few in the group, long after rescuing
their careers in health care, continue to
attend meetings 10 or 15 years later.
Some have lived out their natural lives
as members.
‘‘With addiction,’’ Marshall says,
‘‘they say once a cucumber’s a pickle,
it’s always a pickle — it’s never a
cucumber again.’’
♦ ♦ ♦ ♦ ♦
By early 1985, John Marshall knew he
was a pickle, or what he’d later call
one. More aptly, he says, he was ‘‘a
nurse manager’s nightmare.’’ Three
years earlier, his first shot of Demerol
John Marshall in 1974 at the start of a career that fell into chaos a decade later.
Continued on next page
“I got to a point where it didn’t work anymore. I couldn’t do enough dope to feel good. I could do enough
to pass out and get sick, but I couldn’t stop.”
March 201324
had been 50 mg. Now 50 mg wouldn’t
touch him.
‘‘I got to a point where it didn’t work
anymore,’’ he said. ‘‘I couldn’t do
enough dope to feel good. I could do
enough to pass out and get sick, but I
couldn’t stop. I tried everything I could
do to stop, and I couldn’t stop.
‘‘The manager that fired me in the
ED [in 1984] told me, ‘You are not the
same person I hired.’ And I wasn’t. You
know, the meth made me crazy. So then
I thought it was just the meth — ‘It’s the
meth that’s doing it. As long as I just
drink beer and smoke pot, I’ll be OK.’ ’’
By February, less than six months
after his dismissal from that ED and his
short rehab stint, he had relapsed,
driven into a frightening tailspin by the
access to narcotics at his new hospital,
where he’d been hired as a relief
supervisor. He diverted more and more,
never denying patients their medications
but instead measuring out more so that
he could ‘‘save scraps.’’
‘‘Eventually I knew I was gonna get
caught,’’ he says. ‘‘I knew that. It wasn’t
a surprise.’’
The surprise, he says, came after his
final nosedive with the nitrous oxide,
when he returned to the treatment center
where he’d completed his first rehab.
‘‘Get out,’’ the addictionologist told
him. ‘‘I can’t help you.’’
Marshall, he said, had conned his
way through the program once already.
It got worse. The Georgia Board of
Nursing had been notified. The Drug
Enforcement Administration had been
notified. Marshall was looking at a
possible six to 10 years in jail.
‘‘And if you’re here when I get out
of group,’’ the addictionologist told him,
‘‘I’m going to have you arrested for
trespassing.’’
Marshall slumped in a chair, stunned.
Bottom was even lower than he thought.
The only morsel he was offered was
a phone number for a treatment center
in Atlanta, the Ridgeview Institute,
which specialized in recovery for health
care professionals.
So that’s where his recovery began.
He checked into a three-month
program at Ridgeview.
He stayed for six.
♦ ♦ ♦ ♦ ♦
The first year after rehab was the
hardest. Probation meant hospitals in
Atlanta didn’t want to talk to him. A
doctor he’d worked with during his
treatment offered him a job at a halfway
house for head-injury patients. That
gave him a foot back in the door as a
nurse, though ‘‘the only nursing thing I
really did was give Dilantin for the
seizures,’’ he says. ‘‘The rest of it was
trying to manage a community of
head-injury patients, which is a different
world all in itself.’’
Still, a chance was a chance. And
others would follow.
Another of Marshall’s former
counselors needed a nurse in recovery
to work in an alcohol-dependency
program at a Mobile hospital. That job
took him to Alabama — resetting his
five-year probation — in 1986. When
the hospital folded after a few months,
he decided to stay near the Gulf rather
than transfer north to Birmingham. But
finding work at another local hospital
proved tough.
‘‘They would look at my résumé and
go, ‘Oh, you were critical care — this is
good. Oh, you were a paramedic — this
is good. Oh, you’ve got emergency
— this is good,’ ’’ he says. ‘‘But then
they’d hit that last page about the drug
treatment, and it was like the paper
caught fire in their hands or something.’’
Committed to his recovery, Marshall
fell in with the Mobile Professional
Group. He remarried.
One hospital, Knollwood Park in
Mobile, snapped the pattern of rejection
and decided to take a chance on him.
He was hired to work in the head-injury
unit. He was still there in 1991 when
his probation was lifted and he again
was licensed to handle narcotics.
♦ ♦ ♦ ♦ ♦
Marshall’s job history since the late
1980s is the sort of career climb others
expected for him before his collapse.
His employment at Knollwood Park
evolved from a happy break to a
17-year stay until the hospital was sold.
From the head-injury division, he moved
to the emergency department, where he
eventually rose to ED nurse manager in
Marshall stands before the room to discuss his recovery and his work with the Mobile Professional Group after a presentation by Allison Bolin, BSN, RN, CEN, CPEN (right), during last year’s Leadership Conference in New Orleans.
Official Magazine of the Emergency Nurses Association 25
2000. He became house supervisor in
2003, then started with the Children’s
and Women’s Hospital in 2007.
Never far away was the group.
Marshall had made contacts in his
treatment that afforded him clean slates.
His end of the bargain, he realized, was
to advocate for others in turn. A nurse
in recovery whose license has been
revoked might list him as a reference on
a job application. He has been to court
on another nurse’s behalf in a child-
custody case.
‘‘The group helps me do that,’’ he
says. ‘‘We do things to help our
members get back on track in several
aspects of their life, not just in
employment. Somebody was there for
me when I was in trouble and needed
help, so now my job is when somebody
needs help, I’m there for them.
‘‘In my groups and meetings that I
go to with 12-step, when somebody
asks you to do something, you say yes.
These people call me 24/7.’’
Sometimes he has dreams that he’s
still using — the ol’ ‘‘drinkin’ and
druggin’ dreams,’’ he calls them. Though
he’s not in an emergency department
officially, he sees trauma. He sees
children going through chemotherapy.
Sometimes elements in his life don’t feel
balanced. Steps feel out of sync. That’s
when he makes a few calls, too.
Recovering and fixing go both ways.
‘‘I’m in recovery, but my disease is in
the parking lot doing pushups,’’
Marshall says. ‘‘I still do those things
because if I don’t do those things, I’m
going to be acting like a pickle again,
and I don’t know if I could live through
that. Twenty-eight years ago, I’d have
just taken something to change the way
I feel and keep on going. And I don’t
do that now.
‘‘And my life is so much better now,
truly a miracle. Staying high all the time
is a full-time job. When you wake up in
the morning and say, ‘Oh, my God,
what have I got? Have I got enough?
Where am I getting more?’, that’s a
full-time job. It’s so much easier now
living life on life’s terms.’’
His grown son from his first
marriage has seen his perseverance,
has seen him guiding others through.
He has a daughter, 23, who grew up
a witness to his recovery.
Life is good. His mornings are
only about one vice now — coffee.
He asked a counselor about that
once. Was it a problem?
‘‘As long as you’re not shootin’ up
freeze-dried Folgers,’’ he was told,
‘‘you’ll be fine.’’
Readers can contact John
Marshall at [email protected].
Workplace Violence Prevention Online Courses
Now available free to ENA members are three webinars that discuss violence in the workplace and mitigation strategies.
FREE for ENA
Members
Stay tuned for upcoming workplace violence educational opportunities.
Thank you to our sponsor
These webinars are brought to you by
In collaboration with
Visit www.ena.org and sign up today.
Non-members can purchase these continuing education courses by visiting ENA’s LMS
Not a member? Join ENA today!
WVP_3by3.indd 1 2/7/13 10:45 AM
ENA conference faculty presenter
Allison Bolin, BSN, RN, CEN, CPEN,
a rapid-response nurse at Dominican
Hospital in Santa Cruz, Calif., offers
these red flags for substance abuse
or drug diversion in the ED:
Behavioral extremes: Some
with substance-abuse issues become
sloppy and don’t seem to care about
their work. Others, particularly those
diverting drugs, become hypervigilant,
paying extra attention to who is
receiving medications, offering to
medicate other nurses’ patients and
spending more time than normal in
the dispensing areas.
Personality changes: Substance
abusers tend to withdraw socially
and show increased irritability.
Absenteeism: Often seen in
employees with alcohol problems.
Coming in on days off or
frequently volunteering for extra
shifts: Often seen in drug diversion.
Fishy reports: Most hospitals
have anomalous usage reports that
identify who’s dispensing which
drugs the most. Abnormally high
numbers can indicate diversion.
Difficult life problems: Has
your co-worker had a recent back
injury? Is he or she going through a
divorce? These kinds of situations, in
combination with some of the signs
above, can point to a larger problem.
If you’re worried that a colleague
is battling substance abuse, report
your suspicions to your supervisor (it
could save a life, Bolin stressed) and
let the department proceed according
to policy. If you’re a supervisor, she
said, make sure you have the
documentation to support a
reasonable suspicion and involve the
human resources department before
confronting the employee.
Often the most respected nurses
are the ones most in trouble, Bolin
said. She herself has been in recovery
since 1990 and runs a support group
for nurses in two counties.
‘‘So many nurses don’t even
recognize it could be a problem,’’
she said. ‘‘We’re not any less
immune because of our education.
In fact, we’re probably at greater
risk, especially in the emergency
department.’’
Josh Gaby
Is Your Co-Worker in Trouble?
March 201326
Updated Administrative ProceduresThe Administrative Procedures have
been updated with two items, effective
immediately:
1. TNCC Reverification courses can
continue to be held; however no
contact hours can be awarded for
attending the course.
2. Non-RN health care providers
who work in an emergency setting can
participate in the written and skill
station testing of both the ENPC and
TNCC Provider courses. The non-RN
health care worker who attends a
Provider course will receive a
certificate of attendance with the
appropriate number of contact hours,
but will not receive a verification card
or verification status.
Please refer to the Administrative
Procedures posted on the TNCC and
ENPC pages of www.ena.org for
further details.
ENPC Provider Manual ErrataAll ENPC 4th Edition Provider
manuals that are shipped will have an
errata document included, until the
next reprint is needed. This errata
document can also be found at:
www.ena.org/coursesandeducation/
ENPC-TNCC/enpc
We anticipate reprinting the ENPC
4th Edition Provider manuals in the
spring. We appreciate everyone’s
assistance in identifying these changes.
ENPC 4th Edition Instructor UpdateThe deadline for completing the
ENPC 4th Edition Instructor Update is
Feb. 28. The update can be found on
your Personal Learning Page under the
Courses and Education tab at www.
ena.org. It is necessary to indicate that
you reviewed the video/modules
before you can access the 50-question
exam. This can be found under the
Assessment tab within each module.
ENPC 4th Edition InformationENPC course directors received an
e-mail in November 2012, providing
information regarding corrections
being made to the ENPC 4th Edition
Instructor Supplement and the course
slides. Corrected copies of the
instructor supplement will be provided
to all instructors who had previously
purchased it at no additional charge.
Shipments started in January. Those
instructors who had previously
purchased a downloadable instructor
supplement are being contacted to
advise them that they can now
download a corrected copy.
All course directors who had
previously requested and received the
4th edition CD-ROM will be
automatically sent a new copy as well.
The Course Directors Only section of
www.ena.org reflects the updated,
corrected information.
The new CD-ROM and Course
Directors Only web page will include
a practice test and answer key. This
will help the students prepare for the
provider course. Also included in the
instructor course folder are the scored
teaching scenarios related to the
examples played during the instructor
course from the course DVD.
TNCC Reverification Courses TNCC course directors were notified via
e-mail in November 2012 that the ENA
Board of Directors met on Oct. 24,
2012, and decided that the 6th edition
TNCC Reverification courses can
continue to be held after Dec. 31, 2012.
As of Jan. 1, however, no contact hours
can be awarded for attending a TNCC
Reverification course. This decision was
made after receiving quite a bit of
feedback from course directors
indicating that the availability of the
one-day reverification course option,
even without the ability to award
contact hours, would provide a much
needed option for many institutions.
First AnniversaryECourseOps is celebrating its one-year
anniversary as course directors
increasingly take advantage of its
capabilities. About 65 percent of the
course applications submitted to ENA
come through eCourseOps. We have
received a lot of very positive
feedback indicating that eCourseOps is
easy to use for adding a course,
ordering books and paying invoices. A
very popular feature is the “copy”
course icon that allows instructors to
create a new course by copying an
existing course while making
necessary small changes, such as new
course dates.
Log in to www.ena.org to access
eCourseOps via the Courses &
Education tab’s dropdown menu.
There are frequently asked questions
and help documents on the landing
page. Course Operations is available
for assistance at 800-942-0011 or
[email protected]. If you haven’t
yet used eCourseOps, give it a try. We
think you’ll like it.
Your Input is WelcomeCourseBytes is the official
communication to all TNCC and ENPC
directors and instructors. Topic ideas for
future issues and feedback are welcome
COURSE BYTES
March 201328
New Jersey ENA State Council New Jersey ENA will hold the 35th
Annual Emergency Care Conference,
March 13 – 15. This is the third
largest emergency care conference
in the nation. For more information,
contact Cheryl Newmark, RN, NJ
ENA media relations, at [email protected].
Share your state council and chapter news with emergency
nursing colleagues from around the world in State
Connection. Highlight council and chapter activities,
announcements and other initiatives by submitting a short
article to ENA Connection.
Suggested topics include:
• Volunteer opportunities to solicit, encourage and welcome
members to get involved in your state or chapter
• State council or chapter successes, achievements
or accomplishments
• Membership drive campaigns and updates
• Award announcements or call for awards
• Innovated projects, ideas or best
practices
Articles should be under 400
words and will be edited for length
and clarity. High-resolution digital
photos or images that can be scanned
are welcome with your submission.
State Connection also offers an opportunity to announce
upcoming educational programs, state council or chapter
meetings or special events in the “Meetings and Events”
section. Include the following information with your
submission:
• State/Chapter name
• Event/Conference name
• Date of the event
• Time
• Location
• Presenter(s)
• Website or contact information
To submit an article or event or for more information,
contact us at [email protected].
ENA STATE CONNECTION
school to obtain my master’s degree
and then encouraged me to apply for
her position when she left. But more
important than her words were her
actions. I witnessed her every day
modeling the behaviors of someone I
wanted to become: She was graceful
under pressure, politically savvy and
had the respect of the emergency
department staff. I am just sorry
that I never had the opportunity to
thank her.
Two-Way StreetWhat does it take to be a good
mentee? The mentee should drive the
relationship. As the mentee, you must
be comfortable in communicating
openly with your mentor. You must be
clear about what you expect to
accomplish by partnering with this
person. Be committed to the
mentoring relationship and don’t forget
to acknowledge your mentor.
One of my goals as ENA president
is to provide more opportunities for
mentoring within our organization. We
already have one great mentoring
program in EMINENCE. The
EMINENCE program is designed to
pair ENA members with experienced
Academy of Emergency Nursing
fellows. AEN fellow mentors volunteer
their time and talents to work with
up-and-coming ENA members.
This provides a wonderful
opportunity to share knowledge and
experience with the next generation of
emergency nurse leaders.
The ENA Board of Directors has
implemented a new program to pair
an emerging leader with a board
mentor. The mentors will spend the
year helping their mentee develop
their leadership goals and determine
an action plan for national ENA
contributions.
I encourage all of you to
acknowledge your mentors, find a
mentor or become a mentor.
Resources
Loretto, P. (n.d.). Top 10 Qualities of a
Good Mentor. Retrieved from www.
interships.about.com
Roberts, A. (1999). Homer’s mentor:
Duties fulfilled or misconstrued.
Retrieved from www.peermentor.net.
Letter From the President Continued from page 3
‘‘Mentoring is a brain to pick, an ear to listen
and a push in the right direction.”
John Crosby
New ENA monthly offering for FREE Continuing Education with contact hours for our members.
• Available March 1 GU: It’s More Than Just P, 1.0 contact hourMichael D. Gooch, MSN, RN, CEN, CFRN, ACNP-BC, FNP-BC, EMT-P
Don’t miss out on enhancing your education by registering and completing the offering. Go to www.ena.org/FreeCE for additional free continuing education opportunities.
The Emergency Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
FreeCEConnection_March.indd 1 1/18/13 9:37 AM
March 201330
The AEN EMINENCE ProgramThe Academy of Emergency Nursing is proud to report its fifth group of mentors
and mentees are currently working on projects for the 2012-2013 program. The
EMINENCE program is designed to pair ENA members with experienced Academy
fellows. AEN fellow mentors volunteer their time and talents to work with
up-and-coming ENA members. This provides a wonderful opportunity to share
knowledge and experience with the next generation of emergency nurse leaders.
Applicants submit project descriptions and are matched with fellows who have
expertise in the subject matter. Project topics include professional presentation,
writing for publication, research, educational conference planning and program
development. Upon acceptance into the program, mentees pay a $100
administrative fee.
The following mentee/mentor pairs are participating in the 2012-2013 program:
Mentee Mentor Area of InterestMeredith Addison, MSN, RN, CEN
Kiefah Awadallah, MSN, BS, RN
Kimberly Brandenburg, BSN, RN, CEN
Colleen Connors, MSN, RN, CEN
Hershaw Davis Jr., BSN, RN
Siegfried Emme, MSN, RN, NP-C, CEN,
CCRN
Michael Franks, BSN, RN, CEN
Marites Gonzaga-Reardon, MSN, RN, APN, CEN, CCNS
Jerry Jones, MBA, BSN, RN
Jennifer Morris, RN, CPEN, CPN
Curtis Olson, BSN, BA, RN, EMT-P, CEN
Charlann Staab, MSN, RN, CFRN, CHC-C
Kathy Van Dusen, BSN, RN, CEN
Belinda Watkins, BSN, RN, CPEN
Thelma Kuska, BSN, RN, CEN, FAEN
Rebecca Steinmann, MS, RN, APN, CEN, CPEN, FAEN
Patricia Kunz Howard, PhD, RN, CEN, CPEN, NE-BC, FAEN
Anne Manton, PhD, APRN, FAEN, FAAN
Susan Hohenhaus, LPD, RN, CEN, FAEN
Jean Proehl, MN, RN, CEN, CPEN, FAEN
Gordon Gillespie, PhD, RN, PHCNS-BC, CEN, CPEN, FAEN
Gail Lenehan, EdD, MSN, RN, FAEN, FAAN
Andrea Novak, PhD, RN-BC, FAEN
Jeff Solheim, MSN, RN-BC, CEN, CFRN, FAEN
Laura Criddle, PhD, RN, CEN, CPEN, FAEN
Carole Rush, MEd, BSN, RN, CEN, FAEN
Diana Meyer, DNP, MSN, RN, CEN, CCRN, FAEN
Harriet Hawkins, RN, CPEN, CCRN, FAEN
Trauma Systems
Program Development
Injury Prevention (SBIRT)
Program Development
Professional Presentations
Program Development
Writing for Publication
Writing for Publication
Educational Conference Planning
Professional Presentations
Writing for Publication
Writing for Publication
Advanced Practice Role Development
Program Development
If you would like to participate in the 2014-2015 EMINENCE program, watch for application information posted at
www.ena.org/about/academy/EMINENCE in mid-March 2013. Applications are due April 30.
Provider Manual
Fourth Edition
Provider Manual
Fourth Edition
ISBN 978-0-9798307-4-7
915 South Lee Street
Des Plaines, IL 60016
Emergency Nursing
Pediatric Course
The Emergency Nurses Association is proudto present the release of the 4th edition ofthe Emergency Nursing Pediatric Course.It has been revised and updated, evidence-based, and continues to incorporate various teaching and learning styles.
• A portion of the course will be presented in an online format through ENA’s Center for e-Learning.
• Pediatric Clinical Considerations is nowcase-based using group discussion.
• The adolescent patient is addressed witha separate chapter and lecture.
• Triage is now Prioritization with a focus on the process, rather than the place.
Upon successful completion of ENPC, RN participants are veri� ed for four years, receive a veri� cation card and earn up to 16 contact hours.
This course brings the emergency nurse a resource for treating the pediatric patients arriving to emergency
departments every day.
To verify why ENPC is right for you and toview course schedules, please visit
www.ena.org/coursesandeducation
departments every day.
The Emergency Nurses Association is
accredited as a provider of continuing nursing
education by the American Nurses Credentialing
Center’s Commission on Accreditation.
March 201332
AC13
ENA Member Finds Paradise Needs Good Teachers
Offering educational and networking opportunities for professionals caring for emergency patients.
For more information, visit www.ena.org.
Lee Singer, RN, CEN, is a woman of many talents. An
emergency nurse since 1987 and an EMT since 1978, she is a
member of her local disaster medical assistance team, an avid
surfer and a concert flutist. She is a provider for the Trauma
Nursing Core Course and an instructor for the Emergency
Nursing Pediatric Course and for a Rhode Island emergency
medical services training program. She has saved lives on
both coasts, from conducting air evacuations in California to
assisting an urban search and rescue team in Rhode Island,
performing assessments on people stranded in their homes
after Hurricane Sandy devastated Misquamicut last October.
In 2012, Singer extended her emergency care and training
reach to St. John in the U.S. Virgin Islands. During a
vacation, Singer and her boyfriend, who is also an EMT,
were on a St. John beach when they met a member of the
local rescue squad.
‘‘I asked her what kind of training she had, and she said
they were always looking for people to do training,’’ said
Singer, an emergency department charge nurse at South
County Hospital in Wakefield, R.I.
Six months later, Singer returned to St. John for a week to
train rescue workers, including EMTs from the island and
from St. Thomas, as well as members of the National Parks
Department. Two-thirds of St. John is dedicated park space.
The rescue workers’ usual training consisted of videos from
their training officer, some outdated lectures and occasional
EMT training by instructors from the U.S.
Singer incorporated TNCC and ENPC information into her
training lectures, as well as an extensive review of anatomy
and physiology.
‘‘I’m a firm believer that if you know what you’re looking
at and what parts you’re looking at, you can understand
what’s going on in a trauma situation or a burn situation,’’
Singer said. ‘‘We did a lot of the basic scene material. I used
the TNCC method for airway, breathing and circulation, and
I taught them the CIAMPEDS mnemonic we use in ENPC for
complaint, immunization and allergies, which they loved.’’
As a beach vacation destination, St. John sees its share of
drunk-driving traumas, water injuries and coral cuts, while
other islands also see surfing injuries. The local population
Vocation in Her Vacation
By Amy Carpenter Aquino, ENA Connection
marketplace ExprEssNEW! Comprehensive systematic review for Advanced Nursing practice Cheryl Holly, EdD, R Susan Salmond, EdD, RN, FAAN, Marie K.Saimbert. BPharm, MSN, MLIS, RN (Editor)
In an age of rapidly expanding knowledge, it is crucial for health professionals to stay abreast of the most current evidence-based information when making clinical decisions. The text sets forth a rigorous, step-by-step approach to the process of conducting a literature search, including both quantitative and qualitative studies, as well as “grey” literature. It describes how to extract and synthesize the most relevant data, how to integrate systematic reviews into practice, and how to disseminate the results.
Take $10 off during the month of March!
retail (Non-Member) price: $70.00ENA Member price: $59.00
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360 pagesISBN: 9780826117786© 2011Weight: 2 lb.
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Official Magazine of the Emergency Nurses Association 33
suffers from a very high incidence of asthma, as well as some
obesity and those comorbidities, such as diabetes and high
blood pressure, in addition to some alcoholism, Singer said.
In addition to addressing those emergencies, Singer said
she incorporated training with familiar prehospital elements,
such as the MIVT report (mechanism of injury, vital signs
and treatment) and the PQRST (provokes, quality, radiates,
severity and time) pain pathway assessment.
‘‘You need to dig below the surface,’’ she said. ‘‘This
person had a broken bone, but you need to dig underneath
this, so I would go into the structures and say, ‘OK, this is
what happened, this person fell over the handlebars, and
you see a bruise on this side. What do you suspect? What do
you think is under there?’ And they start more critical
thinking, and when they really caught on it was wonderful.’’
Singer’s students benefitted so much that the training
officer asked her to return this April. Singer plans to bring
‘‘tons of new information that is going to blow their minds,’’
including pediatric standards and a toxicology lecture on
bath salts and some of the poisonous plants used by locals
in folk medicine treatments.
A ‘‘win-win’’ exchange is how Singer described her
Caribbean teaching experience. While her students gained
new knowledge and skills, Singer said she returned with
renewed energy to pursue her own education and
certifications.
‘‘I’ve gotten better in my practice as a nurse also,’’ she
said, ‘‘by doing some of the research and putting it into
practice. I’ve learned a lot of tricks of trade from the rescue
down there. For instance, they do what they call high-angle
rescues, because it’s all pretty mountainous, so I can take
some of that back for our EMTs.’’
Singer encouraged other ENA members to remain open to
new prospects, wherever they are.
‘‘If you have an opportunity, you’d better take that
opportunity and do the best that you can with it,’’ she said.
‘‘I would offer that not just to nurses but to anybody. ‘Oh,
the places you’ll go,’ as Dr. Seuss wrote.’’
ENA member Lee Singer, RN, CEN, with Bob Malacarne, training officer for the St. John rescue corps, in St. John.
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