ena connection march 2014
DESCRIPTION
ENA Connection March 2014TRANSCRIPT
connectionMarch 2014 Volume 38, Issue 3
the Official Magazine of the Emergency Nurses Association
at workFORCES
Even in a Battle Zone, Heart and Humanity Are
Most Central to Our MissionPAGE 6
PLUS . . .
Lantern Award Taken Literally 8 TNCC, ENPC on Top of the World 20
The Emergency Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
Available Now Visit www.ena.org/TNCC to find a course near you.
SEVENTH EDITION
TNCC, widely recognized as the premier course for hospitals and trauma centers worldwide, empowers nurses with the knowledge, critical thinking skills, and hands-on training to provide expert care for trauma patients.
§ Rapid identification of life-threatening injury and disease
§ Comprehensive patient assessment
§ Enhanced intervention for better patient outcomes
2 Day Intensive Course § 24 Chapter Comprehensive Manual § 6 Hands-on Skill Stations 5 Online Modules § Special Population Chapters
TNCC Ad_Connection_Full_03 2014.indd 1 1/27/14 4:48 PM
The Emergency Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
Available Now Visit www.ena.org/TNCC to find a course near you.
SEVENTH EDITION
TNCC, widely recognized as the premier course for hospitals and trauma centers worldwide, empowers nurses with the knowledge, critical thinking skills, and hands-on training to provide expert care for trauma patients.
§ Rapid identification of life-threatening injury and disease
§ Comprehensive patient assessment
§ Enhanced intervention for better patient outcomes
2 Day Intensive Course § 24 Chapter Comprehensive Manual § 6 Hands-on Skill Stations 5 Online Modules § Special Population Chapters
TNCC Ad_Connection_Full_03 2014.indd 1 1/27/14 4:48 PM
3Official Magazine of the Emergency Nurses Association
‘Are You the Patient in Bed 12?’
FROM THE PRESIDENT | Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN
We know that two-thirds of
all sentinel events are caused
by communication failures. In
the ED, when we are busy,
stressed and trying to
multitask, we resort to
communication shortcuts that
ultimately can have disastrous
consequences.
‘‘Hey, John, can you please
take the patient in Bed 1 to CT
scan?’’
‘‘Judy, do you mind
throwing a line in and drawing
labs on the guy in Bed 12?’’
‘‘Anyone know where the
patient in Bed 5 went?’’
Does any of this sound
familiar to you? Many of us
commonly refer to room
numbers rather than distinct
patient identifiers when giving
or receiving direction in our
departments.
Now imagine if the patient
needing the CT scan was in
Bed 2, not Bed 1. And the
patient in Bed 1 not only
received an unnecessary dose
of radiation but received IV
contrast, had an anaphylactic
reaction and ended up in the
intensive care unit in multisystem organ
failure — devastating consequences from an
innocent attempt at getting a patient where
he or she needs to be. While we might be
religious about checking two patient
identifiers when administering a medication
(and we should be) those identifiers are
equally as important every time we are
interacting with a patient.
Another common situation in which we
tend to let our communication skills slack
off a bit is during a critical patient situation.
In the best of situations, these events tend
to feel like organized chaos. To facilitate
Dates to Remember
PAGE 4Free CE of the Month Letters to the Editor
PAGE 10ENA Foundation
PAGE 12CourseBytes
PAGE 19ENA Connected
PAGE 23Board Writes
PAGE 26Ask ENA
Regular Features
March 1, 2014 Deadline for resolution proposals for the 2014 ENA Annual Conference in Indianapolis
March 5-9, 2014 Leadership Conference, Phoenix
March 31, 2014 Deadline for nominations for ENA annual awards
May 6-7, 2014 Day on the Hill, Washington, D.C.
PAGE 6Risk Meets Reward: Making a Difference in a Combat Zone
PAGE 8Lighting the Way: Physicians Group Gives Colorado ED a Literal Lantern
PAGE 14A Common Syndrome Presenting With a Dramatic Event
PAGE 17Hazmat Incident Resource Upgraded
PAGE 18ENA Corkboard: What Makes a Great Emergency Nursing Leader?
PAGE 20Cold Fusion: TNCC, ENPC Reach the Top of the World in Nunavut
PAGE 24Code You: 6 Ways to Maintain a Positive Mental Attitude
ENA Exclusives
Excellent communication skills are essential in an emergency
department. We are under pressure to assess our patients,
complete orders and interventions and work to move our patients
toward a timely disposition decision. To do that safely and efficiently, we need to make sure
we are communicating effectively with the entire ED team.
Continued on Page 27
Stay current in treating
patients who have
had bariatric surgery
with this month’s free
continuing education
offering from ENA!
Available to you starting March 1 . . .‘‘Bariatric Surgery: Evidence-Based Updates,’’ presented
by Ruth E. Rea, PhD, RN. (Credit: 1.0 contact hour.)
Rea outlines the
types, benefits and
complications of
bariatric surgery,
then explains how
to modify
assessments and
interventions
associated with
specific problems
of patients who have had bariatric surgery. The course
includes a case study of a patient who had bariatric surgery
with a life-threatening emergency. Recorded at the 2013
Annual Conference in Nashville, Tenn.
To take this and other eLearning courses free as an ENA
member:
• Go to www.ena.org/freeCE, where you’ll log in as
a member (or create an account).
• Add desired courses to your cart and
‘‘check out.’’
• Proceed to your Personal Learning Page to start or
complete any course for which you have registered
or to print a final certificate.
• To return to your Personal Learning Page later, go to
www.ena.org and find ‘‘Go to Personal Learning
Page’’ under the Education tab.
Please be sure you are using the e-mail address
associated with your membership when logging in. If you
have questions about any free eLearning course or the
checkout process, e-mail [email protected].
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 ©2014 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 available for $50 (USA) and $60 (foreign).
Publisher:Kathy Szumanski, MSN, RN, NE-BCEditor-in-Chief:Amy Carpenter AquinoAssociate Editor:Josh GabySenior Writer:Kendra Y. MimsEditorial Assistant:Renée Herrmann
BOARD OF DIRECTORSOfficers:President:
Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN
President-elect: Matthew F. Powers, MS, BSN, RN, MICP, CEN
Secretary/Treasurer: Kathleen E. Carlson, MSN, RN, CEN, FAEN
Immediate Past President: JoAnn Lazarus, MSN, RN, CEN
Directors:
Ellen (Ellie) H. Encapera, RN, CENMitch Jewett, AA, RN, CEN, CPEN Michael D. Moon, PhD, MSN, RN,
CNS-CC, CEN, FAENSally K. Snow, BSN, RN, CPEN, FAENJeff Solheim, MSN, RN-BC, CEN,
CFRN, FAENJoan Somes, PhD, MSN, RN-BC, CEN,
CPEN, FAEN, NREMT-PKaren K. Wiley, MSN, RN, CEN
Executive Director: Susan M. Hohenhaus, LPD, RN, CEN, FAEN
Member Services: 800-900-9659
ENA Connection welcomes letters from members. Letters should address content previously published in the magazine. Letters may be edited for space and clarity. Submission does not guarantee publication. Please include your name, credentials and contact information for verification. Send letters to [email protected].
I just got home and pulled my
ENA Connection out of the
mail. Browsing through it, I
found “Guided Tours” [January
2014, page 5] and started
reading it immediately.
I have visited the Vietnam
Women’s Memorial in D.C.
because it held a special
connection for me. My aunt, Lt.
Col. Shirley A. Strachan, USAF,
was one of the women honored
by that memorial. She, too, was
an RN and served during the
Vietnam War. She was stationed
in Okinawa and Tokyo, among
other places. I did not realize it
when I decided to go into
nursing, but after transitioning
to the ER, I understood that she
had influenced me a great deal
in that decision. My aunt died of
cancer at age 68; I still miss her.
Thank you for a moving story
about a few of the women who
served during that controversial
war, and the steps we are taking
to honor them today.
Penny Blake, RN, CCRN, CEN
Do you have a recent professional or educational success story you want to share about yourself or an ENA member colleague? Have you won an award or earned a promotion? Has another member you know been recognized for outstanding work?
Tell us! Send an e-mail to [email protected] with the subject line “Members in Motion.” Be sure to include names, credentials and, if applicable, photos of the nurse(s) being recognized. ENA staff may follow up with you for additional details.
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References: 1. Rogers JJ, Fox M, Miller LJ, Philbeck TE. Safety of intraosseous vascular access in the 21st century [WoCoVA abstract O-079]. J Vasc Access. 2012;13(2): 1A-40A. 2. Paxton JH, Knuth TE, Klausner HA. Proximal humerus intraosseous infusion: a preferred emergency venous access. J Trauma. 2009;67(3):1-7. 3. Cooper BR, Mahoney PF, Hodgetts TJ, Mellor A. Intra-osseous access (Ez-IO®) for resuscitation: UK military combat experience. J R Army Med Corps. 2007; 153(4):314-316. 4. Dolister M, Miller S, Borron S, et al. Intraosseous vascular access is safe, effective and costs less than central venous catheters for patients in the hospital setting [published online ahead of print January 3, 2013]. J Vasc Access. doi:10.5301/jva.5000130.
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March 20146
MILITARY NURSING
‘Incoming, incoming, incoming!”
Lt. Col. Gwyn Parris-Atwell
heard the alarm right before the
sound of an explosion. Her natural
instincts as a military and emergency
nurse were to respond, but Parris-
Atwell, MSN, RN, CEN, FAEN, was in a
hospital bed, her blood pressure in the
low 50s, leaving her physically unable
to help.
It was her first night in ICU after
becoming severely ill with food
poisoning, and she was in contact
isolation. She knew a situation had
occurred but was unaware of the
details. When both her ICU nurse and
one of her senior nurses walked into
her room dressed in their full combat
gear, which included a helmet and
individual body armor (IBA), she
learned that an indirect fire attack
(IDF) had occurred close to the Craig
Joint Theatre Hospital Bagram Airfield,
Afghanistan, killing four U.S. soldiers.
Unable to walk and without her
combat gear, Parris-Atwell had never
felt so vulnerable in her life. She was
informed there were some very serious
injuries in the emergency department.
‘‘It’s odd being on the other side of
terror,’’ she said. ‘‘While lying in the
hospital bed, I felt like I needed to
have my combat gear on. I laid there
and felt guilty and helpless that I could
not get up and help in this particular
situation because that’s what I do. I
would have responded.’’
Parris-Atwell deployed to Bagram
Airfield, the largest U.S. military base
in Afghanistan, in May 2013 with the
455th Expeditionary Medical Group as
the Flight Commander in the
Contingency Aeromedical Staging
Facility. She became ill 30 days after
her arrival. Despite the IDF attack and
being in ICU for several nights, her
biggest fear was being sent home.
‘‘Most people may ask or volunteer
to go home, but I’m thankful they didn’t
send me home,’’ she said. ‘‘I wasn’t
ready to go. I hadn’t done my job yet,
and I didn’t want to leave my medics. I
had 30 medics who worked for me, and
I had the best of the best. I wanted to
make sure that the people who worked
with me were taken care of.’’
She believes the combat zone has
changed. There is no longer a defined
perimeter for a battlefield, she said.
‘‘There used to be a thought that
medical assets were not in the combat
zone, but the combat zone is so fluid
today that you are at risk wherever
you are serving,’’ she said. ‘‘Hospitals,
wherever they are located, are at risk
for an IDF attack or arms fire attack. I
just don’t think it is safe anywhere
anymore.’’
Despite increased dangers in the
combat zone, Parris-Atwell usually felt
well-protected because of her battle
gear — roughly an extra 75 pounds.
‘‘The advances in our battle gear
today make me feel more secure,’’ she
said. ‘‘Our torso, head and the major
vascular areas of our bodies are
protected. I think the advances in our
special protective equipment have
certainly saved a lot of lives on our
part and on our troops’ part. Eye
protection alone can make a difference
in someone’s injury.’’
She also has seen protective gear
such as the newer Advanced Combat
Helmet save a soldier from severe
head trauma in Afghanistan.
Parris-Atwell credits leadership for
taking an active role in increasing the
team’s protection by having a specific
procedure in place when it came time
to wear full battle gear and take care
of patients during an IDF.
‘‘Every time we had an indirect fire
attack, there was a full procedure we
would follow,’’ she said. ‘‘We would
immediately take cover, put on our
helmets and IBAs and go directly to
the hospital to report for duty and
prepare for incoming wounded. That
was so important to me because that’s
Dangers of Nursing in a Combat Zone Offset By the Chance to Make a Difference
rewardrisk meets
The viewpoints expressed in this story
are those of the individual and do not
necessarily reflect the positions of the
U.S. Armed Forces.
By Kendra Y. Mims, ENA Connection
“The human factor is not only in the
civilian world, but it’s also in the
military world.’’
Lt. Col. Gwyn Parris-Atwell, MSN, RN, CEN, FAEN (right,
pictured in Afghanistan)
Official Magazine of the Emergency Nurses Association 7
what we were there for. We were
always ready.’’
Parris-Atwell has been an emergency
nurse since 1983. She always had a
passion for disaster nursing and triage,
and it was the mentoring of nurses in
the Army Nurse Corps that motivated
her to join the army. One of the nurses
who inspired her was ENA past
president Lt. Col. Peggy McMahon, MN,
RN, CEN, whom Parris-Atwell describes
as her hero. Parris-Atwell was
commissioned in the Army Nurse Corps
in 1991 as a reservist and served 10
years before switching over to the Air
Force Nurse Corps in 2000 as a captain.
Afghanistan was Parris-Atwell’s third
deployment after being sent to Iraq in
2010 and Germany in 2012.
Though she has witnessed graphic
and severe injuries while working in a
combat zone, including wounds from
improvised explosive devices, and she
carries a weapon in the military,
Parris-Atwell says it’s still very similar
to providing emergency care in the
civilian world.
‘‘I think the best military nurses are
emergency nurses because we are the
best at emergency preparedness — we
have to quickly react to things,’’ she
said. ‘‘I feel you’re just as vulnerable in
the ED as we are in the battlefield and
combat zone on a daily basis. I think it
can be a little more graphic in the
combat zone, but I think it’s very
graphic in the civilian world, especially
Level 1 trauma centers or basic
community EDs that get Level 1 trauma.’’
Family presence is different when
taking care of patients in civilian
emergency departments.
‘‘In the civilian ED, you can go out
into the waiting room to get the family,
but in a combat zone there is no
family there, so you are their family
until you can get them back to their
loved ones,’’ she said. ‘‘I always think
about who’s home waiting for them
— is it a child, spouse, parents?’’
She recalls caring for severely
wounded patients who were not going
to live and others who had minor
injuries during her deployment in
Germany. The patients’ families were
brought in to be with them or to fly
back home with them on the aircraft.
‘‘It was very rewarding to also be
able to take care of the family when I
was stationed in Germany,’’ she said.
‘‘It’s something you normally don’t do in
the combat zone. The human factor is
not only in the civilian world, but it’s
also in the military world.’’
Parris-Atwell also felt the
camaraderie during her last deployment
in Afghanistan while serving with
NATO forces. She cared for Spanish
and British troops, the Afghanistan
National Army and civilians, including
prisoners. She shared advice from her
hospital commander: It doesn’t matter
what you’re doing, who you’re taking
care of or what their diagnosis is. They
may have a simple sprained knee, a
severe head injury or amputations. No
matter what it is, take them by the
hand and give them excellent care.
She treated several troops from
different countries. Though some of
their injuries were not severe, a
Spanish medic told her his troops had
Continued on page 13
Photo cropped to emphasize subject.
Patients entering the emergency department at St. Anthony
Hospital in Lakewood, Colo., likely don’t realize that the
elegant iron lantern adorning the entrance is no mere
decoration. Unless they have time to read the accompanying
plaque, they won’t know this lantern is a symbol of the
excellence achieved by the ED staff.
Dr. Winston Tripp, SAH ED medical director, was
inspired by the staff’s achievement to install the lantern and
plaque, gifted by the Apex Emergency Physicians & Allied
Health Professionals. The plaque reads, ‘‘You are entering a
Lantern Award Emergency Department. The Lantern Award
is a recognition award given to emergency departments that
exemplify exceptional practice and innovative performance
in the core areas of leadership, education, advocacy and
research. This lantern is dedicated in honor of the
exceptional staff of the St. Anthony Hospital Emergency
Department and is light to all who seek our services.’’
Once they enter the hospital doors, patients experience
for themselves the commitment to quality, safety, a healthy
work environment and innovation in nursing practice and
emergency care that distinguishes each Lantern Award ED.
‘‘It was so extremely touching and very supportive of our
doctor group,’’ said Elizabeth Dunn, BSN, RN, CEN,
administrative director of the St. Anthony ED. ‘‘They are so
proud of us, but we could not have done it without them
— we are a team.’’
The St. Anthony ED was one of nine national recipients
of the 2013 ENA Lantern Awards and was recognized at the
Awards Gala in Nashville, Tenn., in September. For Dunn
and her staff, the journey to Lantern began two years earlier.
Dunn was ED manager in 2011, the year the Lantern
Awards were first given and the year that St. Anthony
Hospital moved to a new facility six miles from its previous,
119-year-old home. She heard about the Lantern Award and
began thinking that with all its strides toward improving
patient satisfaction scores and the overall patient experience,
the St. Anthony Hospital ED had a good chance of meeting
the award criteria. She discussed the prospect with Sally
Cowan, the ED director at the time, as well as Dr. Chris Ott,
the 2011 ED medical director, who agreed that the staff was
on the right track for clinical and professional excellence.
‘‘The staff had really started to shift their culture and
attitude toward a patient-centered process before the 2011
move, and as we got to the new campus, that momentum of
culture change continued to evolve,’’ she said. ‘‘At the same
time, there was quite a bit of staff-driven engagement for
evidence-based changes occurring, such as a unit-based
council, and it seemed like the right time to pursue the
Lantern application. It felt like we had transcended to the
point of excellence with our patient experiences in addition
to their clinical outcomes.’’
The staff continued building its professionalism and
positivity within both the nursing and medical staff
throughout 2012. Being in a new facility, it focused on
engaging with patients and their families to the point that ‘‘it
became the drive for the staff to excel with their experiences
March 20148
LIGHTING THE WAYBy Amy Carpenter Aquino, ENA Connection
Physicians Group Gives Colorado ED a Literal Lantern to Celebrate Award-Winning Care
Pictured at the Lantern dedication ceremony Dec. 17 are Dr. Christopher Ott (left), St. Anthony Hospital chief medical officer and former ED medical director; Elizabeth Dunn, BSN, RN, CEN, administrative director of the ED; and Dr. Winston Tripp, ED medical director and chief medical officer for the Apex Emergency Group.
Who: Emerging LeadersWhen: March 8, 2014, 6 pmWhere: 2014 Leadership Conference, Phoenix, AZ
enacareercenter.ena.org
§ Integrity § Communication § Creativity
§ Passion § Confidence § Sense of Humor
Please join us for a panel discussion on the traits and qualities of successful nurse leaders. Followed by small group networking with the panelists.
CareerCenter
Presents:What it means to be a leader
Career Center Ad_Connection_half_02 2014.2.indd 1 12/20/13 3:55 PM
Official Magazine of the Emergency Nurses Association 9
and their outcomes,’’ Dunn said.
Where the ED staff had always been
confident in patient outcomes, it now
shifted its focus to realizing the full
patient experience, as well as fully
engaging with the community and
pre-hospital agencies.
‘‘We know we provide optimal
patient care, but the full realization of
understanding how much we impact
patient experiences, especially by
treating them and their family members
as a whole person, began to come full
circle for the nursing and medical
staff,’’ Dunn said. ‘‘We also started
working on a variety of things besides
the patient experiences, with our
internal surge plan, discharge callbacks
and ED safety initiative committee.’’
By mid-2012, the staff felt ready to
tackle the 21-page Lantern Award
application.
‘‘It was quite a bit of fun,’’ Dunn
said. ‘‘I enjoyed it a lot because I could
see the excellence in the staff. I think
sometimes what happens with care
providers is that they are so used to
doing what they do that they don’t see
how incredible it is.’’
Filling out the application and
laying out all the statistics allowed for
introspection on how far the staff had
come in the last few years. Some of the
application questions were assigned to
staff nurses with different experience
levels and who worked different shifts.
A question in the current application
requires a staff nurse to provide an
exemplar from the last two years that
highlights factors that contribute to
each of the following:
1. Your professional satisfaction,
growth and development
2. Your willingness to stay in your
emergency department
3. The impact you feel you make
on safe patient care
‘‘Speaking specifically to the
exemplar questions, it really transforms
a nurse to reflect within and say, wow,
we are actually applying ourselves to
exemplary care here,’’ Dunn said. ‘‘By
their participation in the application, it
empowered them — it gave them
confidence to see that the things they
did were of very high performance.’’
Dunn shared advice for
departments considering applying for a
Lantern Award:
‘‘Quite often, clinicians embody a
fair amount of excellence that they
don’t realize, typically because they
think that this is the expected norm,’’
she said. What the Lantern Award
offers is the chance to ‘‘really stop,
take a breather and look at what
you’re doing. Start writing about it and
take the credit for your efforts
regarding process improvement,
recognition and professionalism. I
think people will discover there is
more evidence of excellence within
their practice than they give
themselves credit for.’’
March 201410
Early in my career, I fell in love
with a Jewish proverb quoted
by a mentor: ‘‘I ask not for a lighter
burden but for broader shoulders.’’
It reminded me of our aspiration
and calling as nurses to engage in lifelong learning.
Nursing is not and never will be a destination — it is a
journey to ensure first-rate patient care through developing
our skills, growing our practice and attaining education.
Nurses need broad shoulders to accomplish each of these
goals.
Part of the burden is the cost of obtaining an education,
which is one of the most important investments
you can make in yourself or in others. The ENA
Foundation is here to help emergency nurses
make this investment. Every year, the
foundation raises record-breakings sums so that
each of you can pursue the opportunity to
increase your knowledge, realize your dreams
and ultimately contribute toward first-rate
emergency care. Your ENA Foundation is
helping you build a strong career foundation.
The ENA Foundation holds the annual State
Fundraising Challenge to fund scholarships all
across the United States. The math is quite
simple: The more money we raise, the more
educational scholarships we can dispense. We
have generous donors and members who
participate and donate every year; however, I
often feel we are only scratching the surface. I
believe there are some who do not donate or
who are simply unaware of the role of the
ENA Foundation.
The State Fundraising Challenge
typically has been the backbone of
funding for your ENA Foundation.
However, if you compare the amount raised
to the number of ENA members, it is clear we
can raise much more money. This year’s
theme is ‘‘Building a Strong
Foundation,’’ and the best way to build
any structure is to start with what
underpins the foundation. I believe our
strength lies in the individual ENA
member. You are what holds this
professional organization
together. We could not
exist without you.
The ENA Foundation
belongs to you. Its
future is entwined with
your future and the
future of emergency
nursing. As an ENA member, you can apply for a scholarship
and are not bound by geography, education or money. It
requires a simple application, which is reviewed and scored.
Awards are given on merit, not on previous donations from
either individuals or states. High-scored applications are
awarded scholarships.
If we can increase the number of donors, then we
would increase the amount of money we can award. This
ripple effect would truly help us build a stronger
foundation.
A rewarding part of my ENA Foundation role has been
talking to scholarship recipients and hearing about how a
scholarship changed their lives and sustained their passion
for emergency nursing. Last year I was fortunate enough
to call three doctoral scholarship recipients and hear
firsthand as they exhaled with gratitude and excitedly told
me how they were going to pay it forward to patients,
fellow nurses, clinicians and the ENA Foundation.
Frequently we hear of how recipients have paid back this
investment by advancing care through research or
changing the care we provide at the stretcherside. This is
my fuel for working with the ENA Foundation.
A specific question asked of all applicants is,
‘‘What will you provide to the future of
emergency nursing?’’ If you truly reflect upon
the impact of a scholarship or further
education in nursing, it’s an opportunity to
create a legacy. We can all be a part of that
magnificence.
I am a firm believer in action. Help your ENA
Foundation create hundreds of legacies.
Consider investing in the ENA Foundation and
help us broaden the shoulders of emergency
nurses throughout our great country. Go to
www.enafoundation.org and donate
today. Your donation will make a huge
difference to your ENA Foundation, your
colleagues and your patients. It’s the
ultimate investment in emergency
nursing, and it begins
with you.
Building Broader ShouldersENA FOUNDATION | Seleem Choudhury, MSN, MBA, RN, CEN, 2014 ENA Foundation Chairperson
March 201412
ENA Foundation State Fundraising Challenge
Building a Strong FoundationFebruary 1 – May 31
How will your state stack up? þ Largest percentage increase per capita
þ Largest number of individual donations per state
þ Can your state raise more than $5000?
How high can we go?
2014 State Fundraising Challenge visit www.enafoundation.org
ENA Foundation State Challenge_Connection_half_03 2014.indd 1 1/22/14 4:45 PM
ENPC Provider ManualsENPC provider manuals shipped on or after Dec. 19, 2013,
no longer require an errata sheet. All corrections have been
made. The new manuals have ‘‘Updated November 2013’’
printed on the cover and the inside page of the cover.
Holding a Course in Another StatePlease remember to contact the trauma or pediatric state
chair of the state where you plan to teach if you are
planning to hold a course in a state other than your home
state. This is a requirement of administrative procedures.
State chairs are responsible for the quality of courses held in
their state and for the scheduling of the monitoring of
instructor candidates within their state. This responsibility
requires that they are kept well informed of the courses
planned within their state.
TNCC 7th Instructor Launch DatesAll current TNCC instructors were recently notified via
e-mail that in order to carefully consider all of the pilot
feedback and results and provide high-quality materials for
the courses, the previously published dates for the
availability of the course and course products have changed
by a few weeks.
They are as
follows:
• TNCC 7th edition provider manuals available to ship:
Feb. 3
• TNCC 7th edition instructor supplement available to ship:
Feb. 24
• TNCC 7th edition instructor update modules available:
Feb. 24
• TNCC 7th edition courses can be held by updated
instructors, as of: Feb. 24
• All 6th edition TNCC instructors must be updated to 7th
edition by: June 30
• No TNCC 6th edition courses can be held after:
June 30
Instructions regarding the TNCC 7th edition update
materials, which will be available through the ENA website,
will be sent closer to the Feb. 24 launch date.
Orders for the 7th edition provider manuals can be
placed currently by e-mailing [email protected], accessing
the instructor order form on the website, in the TNCC 6th
edition instructor team site, through the course director’s
COURSEBYTES
Official Magazine of the Emergency Nurses Association 13
2014 Call for Nominations
Do you know someone who has made outstanding
contributions to emergency nursing? Past award
recipients have been described as role models, mentors
and emergency nursing at its finest. Do you know
someone who deserves to join this exclusive and
prestigious group?
This is an opportunity to recognize members’
accomplishments as innovators, leaders and those who
continually go above and beyond the call of duty in
the emergency nursing profession.
Award descriptions, requirements and criteria are
posted online. The online nomination form will be
available from March 3 to March 31 at www.ena.org/
about/annualawards/Pages/Annual.aspx.
The submission deadline is Monday, March 31, at
noon CST.
AWARD CATEGORIESClinical/Practice• Clinical Nurse Specialist Award• Frank L. Cole Nurse Practitioner Award• Nurse Manager Award• Nurse Researcher Award • Nursing Competency in Aging Award • Nursing Practice and Professionalism Award
Education/Advocacy• Barbara A. Foley Quality, Safety and Injury Prevention Award• Gail P. Lenehan Advocacy Award• Nursing Education Award• Rising Star Award
Special Categories• Judith C. Kelleher Award• Lifetime Achievement Award
Other• Behind the Scenes Award• Media Award• State Council/Chapter Government Affairs Award• Team Award
For questions, please contact [email protected].
ENA Annual Awards for Nursing Excellence in Emergency Care
access to eCourseOps or by calling Member and Course
Services at 800-942-0011.
Individual orders for the 7th edition instructor
supplements can be submitted once an instructor has passed
the online update test. A form will also become available on
the same team site by Feb. 24.
Your Input Is WelcomeCourseBytes is the official communication to all TNCC and
ENPC course directors and instructors. Topic ideas and
feedback are welcome at [email protected].
never received better care, and he presented her with the
Spanish flag to show his appreciation.
‘‘To have someone say that to me touched my heart,’’ she
said. ‘‘From British to Spanish, you name it, we had the
opportunity to take care of a lot of people. It was so rewarding
to make a difference, and that’s what we’re there for.
‘‘That’s what I love about military nursing. You can make
a difference. If you’re not making a difference in somebody’s
life by being a leader and mentoring them, then you’re
making a difference in a patient’s life, and that’s huge to me.’’
Going from taking care of patients to becoming one in
Afghanistan was a humbling experience for Parris-Atwell. It
reminded her that she had a husband and son at home
waiting for her.
‘‘It reminds you that your patients are somebody’s son,
brother, mother — they’re somebody’s family member,’’ she
said. ‘‘They are not just your patient.’’
The ED physician, nurses and tech saved her life, she
said, and she will never forget it.
‘‘The reality is I could have not survived,’’ she said. ‘‘It
reminded me how vulnerable we are, and we’re all human.’’
She also was reminded of her Air Force nursing motto,
“Trusted care anywhere” and the core value of ‘‘Excellence
in all we do.’’
If Parris-Atwell had to take this journey all over again,
she said she would do it the same way. She loves having the
ability to work as a civilian nurse and use her skills in the
military as a clinician and leader.
‘‘There are leadership lessons learned on every
deployment,’’ she said, ‘‘and from having three, I learned so
much about myself as a clinician and as a leader and a
mentor. If we can get to soldiers, Marines, etc., and treat
their injuries in that golden hour and give them life support
care, we can save their lives and have excellent patient care
outcomes when they eventually make it home. It still
amazes me how far we have come with an exceptional 99.7
percent U.S. service member’s survival rate. I’m so privileged
to be involved in that.’’
Risk Meets Reward Continued from page 7
March 201414
EYE EMERGENCIES
T he staff speculated that the below-
zero temperatures and piles of
new snow on the roads reduced the
typical flow of patient traffic at the
beginning of the Saturday night shift.
When Margaret arrived at the ED
registration area, there were very few
patients in the waiting room.
Margaret was holding a clean white
handkerchief against her left eye and explained that she had
a sudden loss of vision while reading at home. She was
taken back to the examination area, and when the
handkerchief was removed, the nurse noted the eye to be
reddened and the lids crusted with dried secretion. Margaret
admitted to rubbing her eye to wipe away the drainage. The
eye also appeared sunken back in the socket.
Margaret’s daughter explained that her mother was active
and cared for herself but suffered from rheumatoid arthritis,
for which she took the typical over-the-counter pain
medication on most days. She added that her mother suffered
from chronically dry eyes and mouth for the last several years
and had recent bouts of swollen glands along her jaw. When
the physician arrived to exam Margaret’s eye, he found a
corneal perforation which showed aqueous leakage when a
fluorescence strip was applied to the eye surface.
When the physician reviewed Margaret’s history, he
determined she had Sjögren’s syndrome and notified an
ophthalmologist for a consult. The ophthalmologist who
came to examine Margaret explained she would need urgent
treatment and possible surgery and admitted her to the
hospital. He documented in the record a full thickness defect
in the cornea, with an opening between the outer chamber
of the eye and the eye surface with the presence of Sjögren’s
syndrome.
Sjögren’s syndrome is a chronic autoimmune disease, and
one variant is associated with rheumatologic disorders such
as rheumatoid arthritis or systemic lupus erthematosus.1 Its
cause is unknown. The symptoms are typically dry eyes and
mouth with occasional swelling of the salivary glands. Oral
yeast infections can occur, and dental caries due to profound
mouth dryness are common. Individuals may experience
corneal ulcerations or melting, and on occasion a corneal
perforation occurs due to the severe
dryness of the eye. Individuals with
Sjögren’s syndrome show abnormal
levels of proteins in their blood,
which demonstrates that the body is
reacting against its own tissue.
Because symptoms vary, it can be
difficult to diagnose this syndrome,
and more than one diagnostic
approach may be used. The persistent complaints of dry
mouth and eyes may provide a hint, but other tests may be
needed to confirm the suspicion of the disorder. There are
routine blood tests to look for the presence of immune
system proteins such as antinuclear antibody, rheumatoid
factor, anti-SSA and SS-B, erythrocyte sedimentation rate and
immunoglobulin. Several eye tests are added to the lab
evaluation. The Schirmer test that measures tear production
may be used, and various dyes may be employed to look for
overly dry spots on the eye. A punctual occlusion may be
attempted to seal the tear ducts, which drain tears away from
the eye. Physicians may do imaging evaluations of the
salivary glands or perform a biopsy of the glands.
Treatment of Sjögren’s syndrome is generally directed at
eliminating the annoying symptoms. Simple remedies such as
artificial tears may be useful. More severe problems may be
treated by medications such as cyclosporine (Restasis) to
reduce inflammation around the eye. Medications that increase
saliva flow, such as pilocarpine (Salagan) or cevimuline
(Evoxac), may be helpful for mouth symptoms. When more
serious symptoms appear, such as generalized rashes,
abdominal pain or lung and kidney problems, corticosteroids
are prescribed. Sjögren’s syndrome is not life-threatening, but
treatment may be needed to support the quality of life.
Margaret had an elevated ANA titer and a rheumatoid
factor that demonstrated significant disease. While the
surgeon anticipated using cyanoacrylate glue to close the
defect2, he opted instead for a corneal transplant. Margaret
did well and ultimately left the hospital with no further
complications.
The American College of Rheumatology notes that
Sjögren’s syndrome can affect any individual but generally
begins between ages 45-55, primarily in women. The ACR
A Common Syndrome Presenting With a Dramatic EventBy Kathy Szumanski, MSN, RN, NE-BC, Chief Nursing Officer
Official Magazine of the Emergency Nurses Association 15
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Which is why, over 20 years, INSTANTalarm 5000 has been probably the most widely-installed, staff duress alarm system in the world.
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ENA is collaborating with the American Hospital
Association and the Health Research and Education
Trust to support a national catheter-associated urinary tract
infection (CAUTI) fellowship opportunity. The purpose is to
provide enriched training, leadership development and
expert mentorship to foster the growth of dedicated leaders
and CAUTI champions committed to a culture of patient
safety. This group of multidisciplinary professionals also will
serve to translate these efforts to their organizations and
communities through development and completion of a
CAUTI-focused capstone project.
The 12-month fellowship includes a stipend to participate
in fellowship activities, including in-person meetings,
networking events, mentorship activities and a Web seminar
series on relevant topics. To learn more about eligibility criteria
and how to apply by the March 7 deadline, please go to
www.onthecuspstophai.org/on-the-cuspstop-cauti/
Fellowship Opportunity
National CAUTI Champions Wanted
estimates that more than 3 million adults may suffer from
this disorder and that about one half have other significant
rheumatologic diseases. There does appear to be a genetic
influence in Sjögren’s syndrome, but the onset of active
disease may be due to an environmental trigger that may
be viral or bacterial in nature.
Active research into this disorder is being conducted
by National Institute for Dental and Craniofacial Research
teams. In 2009, one of these teams reported that an
experimental lab test it designed had correctly identified a
key antibody associated with Sjörgren’s syndrome three
out of four times accurately.3
References
1. Fox, R.I. (2005). Sjogren’s syndrome. Lancet, 368,
321-331.
2. Jhanil, V., Young, A.L., Mehta, J.S., Sharma, N., Agarwai,
T., & Vaipayee, R.B. (2011). Management of corneal
perforation. Survey of Ophthalmology, 56, 522-538.
3. Burbelo, P., Ching, K.H., Issa, A.T., Loftus, C.M., Satoh,
M., Reeves, W.H., & Iadarola, M.J. (2009). Rapid
serological detection of autoantibodies associated with
Sjogren’s syndrome. Journal of Translational Medicine,
24, 7-83.
March 201416
If you would like to be part of the EMINENCE program in 2014-15, application information will be posted at www.ena.org
in mid-March. Applications are due April 30.
T he Academy of Emergency Nursing is proud to report that its sixth
group of mentors and mentees is currently working on projects for
the 2013-2014 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 2013-2014 program mentee/mentor pairs are as follows.
Announcing the EMINENCE Pairs
MENTEE MENTOR AREA OF INTEREST
Marilee Bennington Arnold, MSN, RN, EMT-P Laura Criddle, PhD, RN, CEN, FAEN Writing for Publication
Kathy Beckett, BSN, RN Gordon Gillespie, PhD, RN, PHCNS-BC, Research CEN, CPEN, FAEN
Anne Blevins, MSN, RN, CEN Cindy Hearrell, MSN, RN, CEN, FAEN Writing for Publication
Jessica Castner, PhD, RN, CEN Gail Lenehan, EdD, MSN, RN, FAAN, FAEN Research Section Editing
Royelle Clark, BSN, RN Vicki Patrick, MS, RN, ACNP-BC, CEN, FAEN Advanced Practice Role Development
Jo-Ann Cummings, PhD, RN, PNP-C, CEN Lisa Wolf, PhD, RN, CEN, FAEN Research
Leah Davis, BSN, RN, CEN Vicki Sweet, MSN, RN, CEN, CCRN, FAEN Writing for Publication
Emily DeJonge, MSN, RN, CNL Maureen O’Reilly Creegan, MSN, RN, CNS,C, Professional Presentations CEN, CCRN, FAEN
Marie Hankinson, MSN, RN Audrey Snyder, PhD, RN, ACNP-BC, FAANP, FAEN Research
Cathleen Harrington, RN Kathleen Flarity, DNP, PhD, CEN, CFRN, FAEN Program Development
John Lunde, MSN, ARNP, CEN, CCRN, Patricia Kunz Howard, PhD, RN, CEN, CPEN, Writing for Publication CFRN, NREMT-P NE-BC, FAAN, FAEN
Sonny Ruff, DNP, RN, FNP-C, CEN Harriet Hawkins, RN, CCRN, CPN, CPEN, FAEN Professional Presentations
Hemant Sule, BSN, RN, CEN Jeff Solheim, MSN, RN-BC, CEN, CFRN, FAEN Professional Presentations
John Sullivan, BSN, RN, CEN, CPEN Andrea Novak, PhD, RN-BC, FAEN Writing for Publication
Nancy Taylor, BSN, RN, CEN Andrea Novak, PhD, RN-BC, FAEN Program Development
Elizabeth Tedesco, MSN, RN, CEN, PHRN Peggy McMahon, MN, APN, NP-C, CEN, FAEN Writing for Publication
Sean Varricchio, MSN, RN, CEN Mary Jagim, BSN, RN, CEN, FAEN Emergency Management
Official Magazine of the Emergency Nurses Association 17
Your Patient is Proof...You have what it takes. Validate your expertise. Get certified.
Visit www.BCENcertifications.org for more information about becoming a: Certified Emergency Nurse (CEN®) Certified Flight Registered Nurse (CFRN®) Certified Pediatric Emergency Nurse (CPEN®) Certified Transport Registered Nurse (CTRN®)
BCEN ENA AD.3.14_FNL.indd 1 1/24/14 8:04 AM
T he National Library of Medicine has
released WebWISER 4.5, the
upgrade to the Internet-based version of
its Wireless Information System for
Emergency Responders. This version
includes integrated Chemical Hazards
Emergency Medical Management
content, as well as the updated 2012
Emergency Response Guidebook.
Highlights of the CHEMM integration
include new WISER features such as:
• New hospital provider and
preparedness planner profiles and
customized home screens
• Acute care guidelines for six of the
known mass casualty agents or agent
classes
• CHEMM reference materials
• The CHEMM Intelligent Syndrome
Tool, designed to help identify and
diagnose the type of chemical exposure
seen after a mass casualty incident
WISER is designed to help emergency
responders in hazardous material
incidents. It provides quick access to
information about hazardous substances,
including tools and reference materials.
Its Substance ID Support can help
identify an unknown hazardous material
based on signs and symptoms of exposed
patients and physical properties gathered
by observation, as well as with other key
pieces of information.
Users also can create profiles based
on the role they play in a hazardous
materials incident, allowing WISER to
provide the information needed for that
particular role.
WISER is available as a free stand-
alone application for mobile devices,
including BlackBerry, Android, Apple
iOS and Windows mobile devices. You
can access WISER and WebWISER at
wiser.nlm.nih.gov.
New ED Toolkit Takes Aim at Atrial FibrillationMore than 2 million Americans
suffer from atrial fibrillation, with
the number expected to rise to
more than 12 million by 2050.
A new toolkit, Urgent Matters
and the American College of
Emergency Physicians, provides
step-by-step guidelines for
treating a patient who presents
to the emergency department
with atrial fibrillation, including
taking providers through the
process of determining a
patient’s stroke risk.
The free AFIB Toolkit is
available for download at smhs.
gwu.edu/urgentmatters/
resources/discharge-toolkit.
Upgrades to Hazmat Incident Resource
The most impactful leadership quality is the ability to develop and motivate people… Leaders that develop and motivate others by believing in them and the work they do will have a rippling effect not only in a department but in the people’s lives that are touched through them.
Sarah Abel
ENA Corkboard
With Leadership Conference 2014 coming to Phoenix on March 5-9, we asked ENA members on Facebook to name their top qualifications for an emergency nursing leader.
The ability to treat all staff equally. The staff in an ER must work very closely together and depend heavily on each other. If you don’t treat them equally, you cause divides that can rip a department apart.Vonne Tucker
Recognition of the power of education. Not just vocational, collegiate or classroom education, but how it can empower others, prevent injury, prevent disease, promote healing . . . All the things that are embodied in nursing all come back to recognizing the power
and importance of education.
Elizabeth Ramirez
Being willing to put on a pair of scrubs and work alongside their crew when things hit the fan! Not only does that help with the staffing crisis, it boosts morale and makes a more cohesive unit. Also, it makes you have a deep respect for your leader when she or he is working as hard as you are and showing how much they care by action instead of words.-Kim Drennen
An exceptional nurse leader is someone
who does not pigeonhole nurses,
appreciates multiculturalism and
remembers life is always a learning
experience. Also is one that can lead by
positive example and energy, understands
that nurses are humans and is able to
see the diamond in the rough.
—Joe Kubitschek
19
Each new year
brings exciting
opportunities,
especially in the
world of technology.
Last year was
particularly busy for ENA with the
launch of the new mobile-friendly ENA
website. We look forward to continuing
to enhance your experience in 2014 in
the following ways:
Social MediaWith more than 25,000 users on our
Facebook page and a blooming
international presence, we will
continue to expand the reach of ENA
as a networking opportunity for not
only members but anyone with an
interest in emergency nursing.
We also recently began using
Instagram as part of our Emergency
Nurses Week™ contest and will
continue to use that platform in
addition to Twitter, LinkedIn and
Google+ as a means to reach out to
individuals from all over the world.
Web ExperienceWhile the official launch might have
occurred last year, we have been
making constant tweaks to improve
your user experience. Have a
suggestion? You can reach us at
[email protected], as we always
encourage feedback.
This is just a peek at what you can
look forward to in the coming year.
We are excited for all that 2014 has in
store!
ENA CONNECTEDThomas Barbee, Digital Marketing Manager
Branching Out Through Website, Social Platforms
sets the bar high, gives the staff the right tools
to do their job and then holds each staff member accountable to that same
standard across the board with integrity and fairness.
— kevin herm
A strong sense of humor is a must,
but also the trust of your staff that
you are behind them and willing to go
to bat for them every time.
Jen Nelson
To be able to lead and make policy from the bedside caring for patients with the staff, not from an office or a meeting room. Larry Loewy
Belief in the younger generation
because without them, there would be
no future of nursing. Learn to guide
them. -Jennifer Marie Koehlmoos
March 201420
T hirteen-hundred miles north of
Cornwall, Ontario, in Iqaluit, the
capital of Canada’s vast, sea-divided
Nunavut territory, Colleen Andrews,
RN, CEN, and her teaching partner
split an airport cab with a young man
heading to his home last November.
After a three-hour flight, the two
nurses were making their way to their
hotel. But that could wait a few more
minutes.
‘‘Would you mind dropping him off
first?” Andrews asked the driver.
They wanted to see the street
where the young man lived: The Road
to Nowhere.
It was real, and a funny story to tell
friends and colleagues back home in
Cornwall. For Andrews, though, this
remote corner of the world is anything
but nowhere.
She and her ‘‘tag team’’ partner,
Victoria Fortier, MN:AP, CCRN, taught
ENA’s Trauma Nursing Core Course to
12 nurses in Iqaluit (pop. 6,600) in
November. In January 2013, they
brought TNCC to Igloolik (pop. 2,000),
another 600 miles northwest, inside the
Arctic Circle. And this February, they
were back in Iqaluit to teach ENA’s
Emergency Nursing Pediatric Course.
‘‘It’s two courses that I’m very
passionate in teaching,’’ said Andrews,
a 30-year emergency nursing veteran
who first took TNCC in the early
1990s, became a course
director in 1996 and has been
a faculty member since 2003.
TNCC — the seventh edition
of which became available last
month — has worldwide reach,
having been taught
contractually in 13 countries
from Kenya to South Korea,
and in one-off classes on five
continents. But none of those locales is
quite like Iqaluit, and closer still to the
edge of the earth is Igloolik, a veritable
postcard image for outpost nursing.
Start with the obvious: It’s cold.
Really cold. Wind chills whipped to
minus-68 in Igloolik (pictured above)
during Andrews’ three days in the
island hamlet, where there are no taxis
and most residents get where they’re
going on foot or by snowmobile.
‘‘You have to dress appropriately.
There’s no ifs, buts, maybes about
that,’’ Andrews said. ‘‘So I had my
Sorel winter boots and my down coat,
mitts, and the only part that was
showing was the eyes.’’
Iqaluit has a ‘‘lovely,
colorful interior hospital,’’
Andrews said, but in Igloolik,
as with many of Nunavut’s
isolated seaside communities,
there is only a clinic with a
resuscitation room and a
mandate as real as the
temperature outside: The
nurses here must handle it
all. Every illness, every injury, every
special need. Pediatric and elderly
care. Delivering babies. And, of
course, any manner of trauma.
Some of the nurses are locals; others
are willingly stationed at these clinics to
fill a need or gain experience. Among
Colleen Andrews, RN, CEN
By Josh Gaby, ENA Connection
§ 17 Interactive Modules § Up to 15.21 Credit Hours § Geriatric Evidence-based Research
Purchase Today! Group Pricing Available
www.ena.org/gene
The Emergency Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
Comprehensive Online Course to Help Improve Patient Outcomes for Older Adults
The New Geriatric Course Provides the Tools to: § Assess special needs of older adults § Implement best geriatric practices § Coordinate care for better patient outcomes
GENE_JEN_half_0102 2014.indd 1 12/17/13 3:48 PM
Official Magazine of the Emergency Nurses Association 21
those Andrews taught in Igloolik were
two from Newfoundland and Nova
Scotia. The nurses have medical
directives to follow and can get further
instructions from physicians by phone
when treating a critically injured
patient, but in terms of execution,
they’re on their own.
‘‘You have to be very confident in
your nursing to work in these areas,’’
Andrews said. ‘‘It takes special nurses
to go to outpost nursing — skilled
nurses willing to learn. These nurses,
they rely on each other, and they’re
also a phone call away. However,
what happens if they can’t get
through? Then it’s their knowledge,
their skills that they have been trained
[in] before going up or have received
while up there by another senior nurse
that’s been up there.’’
It’s clear where TNCC and ENPC fit
in. Some of Andrews and Fortier’s
students had taken TNCC before. Some
had merely heard of it but never had
an opportunity to take it. The courses
don’t change what the nurses are
doing in Igloolik and Iqaluit, but they
reinforce the universal essentials.
‘‘I can quickly see nurses who have
actually taken the TNCC and ENPC vs.
nurses who have not taken the
course,’’ Andrews said. ‘‘You walk into
a trauma and you have been taught a
very easy, systematic approach, and
you are focused on airway, breathing,
circulation and so forth, down the
mnemonic.’’
Skill stations, a staple of the
two-day TNCC course, prepare the
nurses for ‘‘what-ifs’’ in the context of
the area’s lifestyle.
‘‘They might not ever see that type
of trauma victim coming into their
area,’’ Andrews said, ‘‘but what if a
snowmobile person comes in with
head trauma? Even if they might have
been up there for X number of
months, they may not have had a
snowmobile injury head trauma. By
giving them this skill-station scenario,
it locks it into the back of their brain:
‘OK, this is what I have to do if this
person comes in unresponsive,
wearing a helmet.’ ’’
Getting course materials so far north
Continued on next page
TNCC Ad_Connection_2.19x3_03 2014_print.pdf 1 2/3/14 3:47 PM
You Can Make A Difference!Come to Washington D.C.
On May 6-7, 2014, please join emergency nursing leaders from across the country for ENA’s Day on the Hill event at the Crystal Gateway Marriott in Crystal City, VA, located just
minutes from Washington D.C. and Capitol Hill.
Meet with your members of the U.S. Congress and their Capitol Hill Staff. Learn more about advocacy and how you can make a difference in current emergency nursing legislative issues.
Contact your ENA State President or Government Affairs Chair for details and reservations or email [email protected] with any questions.
DayontheHill 2014_Connection_half_02 2014.indd 1 1/9/14 1:09 PM
March 201422
requires patience and planning;
Andrews starts preregistration eight
weeks ahead of a scheduled course
because it can take that long for TNCC
and ENPC manuals to make it from the
United States through Canada Post and
onto flights bound for Nunavut.
It’s the only hiccup in a continually
warm experience for Andrews, never
mind the thermometer. She started her
career in the deep freeze of Alberta in
the winter and later spent three years
as a nurse in the Virgin Islands, so she
adjusts to any temperature. What
attracts her to Iqaluit, Igloolik and
outpost nursing is the beauty of new
places, the friendly faces, ‘‘the nurses,
the doctors that I talk to, and hearing
their stories of what brought them up
here, too.’’
There’s the locals’ retelling of the
day a small polar bear wandered into
Igloolik. The ‘‘fashion show’’ of
homemade clothing and carvings for
guests of the Iqaluit hotel. Gorgeous,
endless white against a bright blue sky
— landscapes that don’t look like
anywhere else.
Andrews is delivering the
knowledge for better nursing not just
somewhere, but somewhere special.
‘‘I knew that nursing opened up a
lot of doors,’’ she said. ‘‘It was one
profession that did not just limit you to
working in a hospital. You can get into
research, teaching, travel.
‘‘I would say to everyone, if you ever
get the golden opportunity to travel into
these northern areas, bundle yourself
up and take your first adventure.
Because you have to walk the walk in
order to appreciate this.’’
Cold Fusion Continued from previous page
The 35-bed Qikiqtani General Hospital in Iqaluit, Nunavut, where Colleen Andrews has taught TNCC and ENPC. The inside is toasty and brightly colored.
• Share everything.
• Play fair.
• Put things back where you found
them.
• Clean up you own mess.
• Wash your hands before eating.
• Live a balanced life.
I began to think about some of the
lessons I’ve learned during the course
of my emergency nursing career. I’d
like to share a few.
Caring Begins With Us As caring individuals, we tend to put
ourselves last. When I entered nursing
school, we were taught to take care of
ourselves. ‘‘If you get sick, you’re no
good to yourselves or your patients.’’
I’ve learned to listen to my body.
Leading a healthy lifestyle, managing
stress and finding ways to enjoy life
help me adapt to the adverse
conditions that come my way. We
need to maintain a sense of purpose
and have a positive attitude. Finally, if
the work environment is too stressful,
I’ve learned to exit gracefully.
Safety Trumps AllIn our hectic environment, it is
tempting at times to take
shortcuts in order to
keep up. Nursing care
has become very
technical, and it is
easy to rely heavily
on properly
functioning
equipment. Safety
processes are integral
to safe patient care. I
am human, and errors
can happen. I need to stay focused
and follow protocols to prevent
mistakes.
Stress, interruptions and poor
communication affect safe care. When
I scan the patient and the medication
before administration or call a
‘‘timeout,’’ I am helping my colleagues
and myself be compliant. Above all,
I’ve learned to trust my instincts and
have a questioning attitude when the
situation just doesn’t feel right.
Teamwork Is ValuableWhen I am part of a fully effective and
engaged team, I am able to deliver
safe, efficient, quality care in situations
that are often stressful and complex.
An effective team member works
collaboratively, has mutual respect, has
positive communication skills and is
willing to work with others. This
environment enables me to accomplish
more than I ever could achieve
individually. It also provides a positive
learning environment for new
members of the team.
It is important that we trust each
other and that I
feel able to
voice my feelings and concerns when
that trust is called into question.
Without trust, the environment quickly
deteriorates to one of low morale,
conflict, dissatisfied staff and patients
and, ultimately, increased staff
turnover.
Embrace Our New Nurses We all need encouragement and
nurturing. New nurses come to the
department with a lot of book
knowledge but need guidance to
develop their skills and manage their
time. One of my responsibilities as a
professional is to welcome and
support them in their journey.
Knowledge-sharing is key. I encourage
their questions and help them know
when to ask for help. After all, these
are the nurses who will be caring for
me someday.
I am very proud to be an
emergency nurse, and I have profound
respect and thanks for those who
guided me along my journey. What
lessons have you learned and what
will you pass along to those who
follow?
Official Magazine of the Emergency Nurses Association 23
BOARD WRITES | Kathleen E. Carlson, MSN, RN, CEN, FAEN, Secretary/Treasurer
Emergency Nursing Life LessonsAfter a particularly challenging shift, I shared with a colleague that ‘‘although it was busy, we all
played nice in the sandbox.’’ She introduced me to All I Really Need to Know I Learned in
Kindergarten, by Robert Fulghum. In this book of essays, Fulghum discusses his kindergarten days
and shares the life lessons he learned, which included:
March 201424
Some workdays may come with
unforeseen obstacles that can throw
off your schedule and make the day
difficult. Maybe your emergency
department is understaffed, so you find
yourself working longer hours. Or
maybe you’ve spent the majority of your
day dealing with a difficult co-worker or
an irate patient, or you’ve had to
comfort a family who lost a loved one.
In spite of the challenges you face,
choosing to maintain a positive mental
attitude can make a chaotic or stressful
day more manageable.
1. AVOID NEGATIVE TALKPerhaps you work with someone who
provides unnecessary criticism, belittles
others or always points out the problem
without offering a solution. Negative
energy is draining. Surround yourself
with people who will encourage you. If
you need to vent your frustrations, seek
out someone you trust. ENA’s healthy
work environment position statement
says that ‘‘health care workers and
leadership share the responsibility for
respectful, professional and effective
communication with zero tolerance for
intimidation, abusiveness or bullying.’’ If
lateral violence is an issue in your ED,
identify ways to create a healthy work
environment and become a role model
of fostering positive communication.
2. TAKE A MOMENT TO REFLECTWhy did you choose to become an
emergency nurse? Reflecting on what’s
important can help put a bad day into
perspective and renew your passion for
your profession. You also can keep a
journal nearby to write down the events
you encounter on a daily basis and use
them as learning opportunities.
3. SURROUND YOURSELF WITH POSITIVE AFFIRMATIONSKeep inspirational quotes in a place
where you can see them, such as at
your workstation or in your car, or
encourage your colleagues to create a
positive environment in your nurses’
lounge. Briana Quinn, MPH, BSN, RN,
senior associate for wellness and injury
prevention for the ENA Institute for
Quality, Safety and Injury Prevention,
suggests creating a positive-only break
room: Anyone complaining is made
aware of what he or she is doing; those
who persist have to dine elsewhere. To
help foster a positive environment,
Quinn says, emergency nurses also can
post positive comments from patients to
staff or from peer to peer on a
recognition board and use the board to
recognize and award staff who have
been praised by patients or their peers.
4. CREATE A LIST OF GOALS
Knowing what you want to accomplish
and creating a plan to pursue your goals
— career, vacation, volunteering/hobbies
and family/friends — can keep you
motivated even in challenging moments.
‘‘Chart out what you will need to do
financially and educationally and
include a timeline to achieve these
goals,’’ Quinn said. ‘‘Strive for a balance
between each of these categories in
your life. Think of a stool. Each of these
categories is one leg of the stool, and
you need to have all four in place to
How Do You Talk to Yourself?Do your sentences often begin with “I can’t” or “I’ll never”? Staying positive isn’t
just about conversations that happen with others. Being aware of internal dialogue is also key to avoiding negative thinking. According to the Mayo Clinic, self-talk is the endless stream of unspoken thoughts that run through your head every day, whether it’s from logic or misconceptions due to lack of information.
Mayo Clinic lists the following as common forms of negative self-talk:
• Filtering. When you dwell on and magnify the negative aspects of a situation and filter out the positive factors.
• Personalizing. When something bad happens, you assume it is your fault. • Catastrophizing. You expect the worst, which can set the tone for your day. • Polarizing. You often don’t see a happy medium. For example, your work is
either a success or a disappointment.
C’MON, GET HAPPY6 Ways to Maintain a Positive Mental AttitudeBy Kendra Y. Mims, ENA Connection
Official Magazine of the Emergency Nurses Association 25
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hold yourself up.’’
Having hobbies and goals can be
beneficial during stressful days.
‘‘If you are having a rough patch
with family life and difficulties at work,
you can escape productively and
positively with a hobby or talent you are
nurturing,’’ Quinn said. ‘‘Having goals
and actively working toward them will
help you move forward in a purposeful
direction instead of feeling helpless.’’
5. GET PLUGGED IN SPIRITUALLYSpiritual health is often linked to
emotional, mental and physical health.
Whether it’s prayer, attending a place
of worship, meditation or nature, the
definition of spiritual wellness is
different for everyone, as it is often
connected to discovering a sense of
one’s purpose in life.
Quinn said spiritual wellness also
includes volunteering and connecting
to others.
‘‘Take time each day to reflect on
what is important to you and what
holds meaning in your life,’’ she said.
‘‘Could you be a better person in ‘x’
category? Is there a relative you haven’t
corresponded with in a meaningful
manner in some time beyond social
media? Do you feel that you could give
back more to your community, or have
you seen a neighbor who could use a
helping hand?’’
6. LAUGHLaughter is a natural mood booster. As
an emergency nurse, you can
experience a traumatic situation on any
given day. Sometimes a good laugh is
the refreshing break we all need,
Quinn said. She encourages emergency
nurses to develop self-awareness and
identify ways they can improve
themselves without feeling guilt.
‘‘Remember that the emergency
department is an ever-changing place,’’
she said, ‘‘and one rough shift is just
that . . . one rough shift.’’
References
Gokenbach, V. (2012). Nursing
wellness: Toolkit to a happy work life.
Retrieved from www.nursetogether.
com/nursing-wellness-toolkit-to-a-
happy-work-life-
Positive thinking: Reduce stress by
eliminating negative self-talk. (2011).
Retrieved from www.mayoclinic.org/
positive-thinking/ART-20043950
If you’re attending Leadership Conference 2014 in Phoenix, be sure to join your colleagues Friday, March 7, from 6:30 to 7:30 a.m. for ENA’s first offered course on meditation. Learn to de-stress at work in less than one minute, as well as longer meditation techniques. No special clothing is required. Come dressed ready to head straight to the Opening Session!
March 201426
Q: Recently, patients have been using smartphone apps to identify wait times before coming to be seen in emergency departments. When the patient comes in expecting to be seen in 15 minutes because ‘‘the app says so,’’ it puts registered nurses and other health care workers in the ED in an awkward position. We are challenged to provide answers to the patient regarding a longer wait time than anticipated. Any suggestions?
A: With patient access to technological advances,
patient care delivery challenges arise. Since most
EDs are not providing this information to patients,
it becomes difficult for the patient to
understand. The patient needing an ED visit
looks at the information on the app, sees a
hospital close by has a 15-minute wait time
and speeds off to the hospital, not realizing
that in the five minutes it takes him to get there,
two traumas and five other patients have come in
before he arrives. Of course, the patient is confused
about the delay and unhappy he has to wait
longer than anticipated.
Every organization would like its patients to be happy and
well taken care of. ENA supports the American College of
Emergency Physicians policy statement that the
reporting of emergency department patient
waiting times for initial evaluation should be
standardized — for example, that the ED
patient wait time should be defined as
door-to-provider contact time.
The full policy statement provides
additional useful information. It can be
found at tinyurl.com/EDWaiting.
— Paula M. Karnick,
PhD, ANP-BC, CPNP,
Director of the Institute
for Emergency Nursing Education
Use ‘‘Ask ENA’’ to ask about the organization and emergency nursing in general. Questions will be referred to the appropriate ENA staff or department. Submission does not guarantee publication. E-mail questions to [email protected].
ANNUALCONFERENCE
2014 SAVE THE DATEINDIANAPOLIS, IN
Indiana Convention Center
October 7-11, 2014
For the latest news about 2014 Annual Conference, please visit www.ena.org
AC14_Connection_half_03 2014.indd 1 1/22/14 4:40 PM
Official Magazine of the Emergency Nurses Association 27
connectionRecruitment & Professional
Opportunities
For ad rates and information, contact ENA Sales Representative Maureen Nolimal at 847-460-4076 or [email protected].
17 BCEN www.bcencertifications.org
28 Blue Jay Consulting LLC www.bluejayconsulting.com
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ADVERTISER INDEXThese advertisers support ENA Connection.
Let them know you saw their ad in this issue.
Wellness
Career Center
,
enacareercenter.ena.org
clear communication, there should be no unnecessary
conversation in the room. The team leader should be
clearly identified, and orders should be given by the team
leader and directed to a particular member of the team.
That team member should repeat back the order to ensure
it was received correctly.
For example, the team is treating a patient in septic
shock. The team leader says, ‘‘Judy, please give the patient
1 liter of normal saline on the rapid infuser.’’ Judy should
respond, ‘‘I will give the patient 1 liter of normal saline on
the rapid infuser.” All too often, an order is called out to
no one in particular, and it’s assumed someone heard and
will carry it out. Other times, the order is directed at a
specific team member; however, that team member might
be distracted with another task and miss the message or
not hear the message correctly. Using this check-back
ensures the message was received by the correct person at
the correct time and was heard correctly. This simple step
can help reduce the likelihood we will make an error.
Who is going to make sure this gets done in my
department? While sentinel events in the ED often are
caused by catastrophic failures in communication between
multiple team members, the good news is that it just takes
one person to stop the line and speak up. We cannot wait
for system overhauls and staff buy-in to change. We each
need to commit to changing the way we communicate in
the ED now. Make a conscious choice to stop referring to
patients by their room number. Champion the use of
check-backs in critical situations. It takes courage to be a
role model and commit to changing your own practice.
Sitting back and waiting until someone tells you that you
must change ensures that the mistake will happen. I don’t
know about you, but I don’t want to be the patient in the
bed when it does.
From the President Continued from Page 3
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