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INSIDE FEATURES

the Official Magazine of the Emergency Nurses Association

November 2011 Volume 35, Issue 10

connection

Vanderbilt’s Adult Emergency Department Initiates New Program to Protect Staff PAGE 12After Deadly Indiana Stage Collapse, It’s Showtime for Emergency Nurses PAGE 14A Close One for Nurses as Disaster Drops on Reno PAGE 18ENA Leadership Conference 2012: Illuminate & Empower PAGE 28

Don’t Look Away

Behavorial Health Patients Can’t Be an Afterthought — and Neither Can Our Safety PAGES 4, 12

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Official Magazine of the Emergency Nurses Association 3

Dates to Remember

PAGE 3Letter From the President

PAGE 4Board Writes

PAGE 6Washington Watch

PAGE 8Pediatric Update

PAGE 20Click Here

PAGE 24ENA on Facebook. What Are Emergency Nurses Saying?

PAGE 25Nominations Committee

PAGE 26Ready or Not?

PAGE 30State Connection

PAGE 32Member Benefits and Resources

PAGE 33ENA Foundation

PAGE 34BCEN

PAGE 36Board Highlights

Departments

November 14, 2011Submission deadline for Blue Jay Consulting/ENA Award for Outstanding Emergency Department Nurse Leader of the Year

January 11, 2012Early bird registration closes for ENA Leadership Conference 2012

January 16, 2012Submission deadline for Academy of Emergency Nursing 2012 class of fellows

March 2, 2012 Submission deadline for 2012 bylaws proposals and resolutions

PAGE 3Collaboration Is Key to New Award

PAGE 10Use ENA’s Emergency Nursing Resources to Improve Your Practice

PAGE 12Vanderbilt’s Adult Emergency Department Initiates New Program to Protect StaffENA Workplace Violence ToolkitHow Are You Staying Safe?

PAGE 14After Deadly Indiana Stage Collapse, It’s Showtime for Emergency Nurses

PAGE 15Redefining Travel Nurse: Conference Attendees Run Code in Airport

PAGE 16One Emergency Department Covers Another After Tragic Helicopter Crash

PAGE 18A Close One for Nurses as Disaster Drops on Reno

PAGE 24ENA Call for 2012 Bylaws Proposals and Resolutions

PAGE 28ENA Leadership Conference 2012: Illuminate & Empower

PAGE 35Certified Emergency Nurse Named Air Force Nurse of the Year

Features

As all emergency nurses know, quality care is a team effort. No single member of the emergency

department can do it alone. It takes a cohesive team approach to meet the ever-changing challenges

and complexity of emergency care.

The Emergency Nurses Association is no different. It takes a team approach to continuously meet the

needs of our members and your profession. It takes a combination of skills, a wide variety of expertise

and quite frankly, it takes financial support.

That is why ENA is committed to bringing strong corporate partners into a sponsorship role. By

leveraging the leadership that ENA members have in the emergency health care system, we are able to

share expertise, influence product development and help defray costs that keep our conferences and our

membership dues affordable.

ENA’s sponsors are chosen for tangible and intangible corporate qualities that integrate with the

mission and vision of the association and with you. Sponsors are attracted to ENA for its marketing

potential based on the association’s leadership role and the membership’s ability to affect its bottom line.

A plus for the association and for the sponsors, sponsorship is a giant plus for ENA members.

Since the economy burst its bubble in 2008, we have met our challenges, maintaining business

excellence, offering members more and improved educational experiences, affinity programs, a new and

improved ENA Career Center and other benefits in the face of rising costs. We are proud of the fact that

with the support of our sponsors, we have been able to continue championing you with the same gusto

we have in the past.

With that in mind, we would like to thank Stryker, Vidacare, GE Healthcare and Hill-Rom for

their generous and ongoing support. Together we are shaping the future of emergency nursing

and emergency health care in general. From the support of our conferences to support of the ENA

Foundation, from specific sponsorships of research and courses to general support throughout the year,

these corporate leaders have reached out to ENA and its members to help ensure that we meet our

ultimate goal of Safe Practice, Safe Care.

We hope that you will speak with the representatives of these fine organizations at the 2012 ENA

conferences or wherever you may find them and express how they make a difference to you and your

colleagues. They are a member of the ENA team that represents you, your practice and your profession.

Their generous financial support gives added strength to the voice of ENA, a voice whose overriding

goal is to support emergency nurses everywhere.

Strength Through Partnership and Sponsorship

LETTER FROM THE PRESIDENT | AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN, President, with Pierre Désy, Chief Development Officer

Collaboration Is Key to New Award

Is there an outstanding nursing leader on staff in your emergency department? Does he or she demon-

strate highly collaborative behaviors with medicine?

If this person is an ENA member, you can nominate this individual for the new Blue Jay Consulting/

ENA Award for Outstanding Emergency Department Nurse Leader of the Year to be presented February

23 in New Orleans at Leadership Conference 2012.

This award will bring forth some of the best examples of teamwork and the highest quality collabora-

tive patient care for all of us to learn from, said Mark Feinberg, managing partner of Blue Jay Consulting,

sponsor of the award.

“This discovery will undoubtedly help others improve the way care is provided and ultimately help

improve emergency care overall,” he said.

Nomination forms are available to download at www.bluejayconsulting.com. The submission deadline is

Monday, November 14, 2011.

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© 2011 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 Web Site: www.ena.orgE-mail: connection@ena.org

Non-member subscriptions are available for $50 (USA) and $60 (foreign).

Chief Communications Strategist: M. Anthony PhippsEditor in Chief:Amy Carpenter AquinoAssistant Editor, Online Publications:Josh GabyWriter:Kendra Y. MimsEditorial Assistant:Dana O’DonnellBoard of direcTorSofficers:President: AnnMarie Papa, DNP, RN,

CEN, NE-BC, FAENPresident-elect: Gail Lenehan, EdD, MSN,

RN, FAEN, FAAN

4 November 2011

Member Services: 800-900-9659

Secretary/Treasurer: Jason Moretz, BSN, RN, CEN, CTRN

Immediate Past President: Diane Gurney, MS, RN, CEN

directors:Deena Brecher, MSN, RN, APRN, ACNS-BC,

CEN, CPEN Kathleen E. Carlson, MSN, RN, CEN, FAENEllen H. Encapera, RN, CEN Mitch Jewett, RN, CEN, CPEN Marylou Killian, DNP, RN, FNP-BC, CENJoAnn Lazarus, MSN, RN, CENMatthew F. Powers, MS, BSN, RN, MICP, CENExecutive Director: Susan M. Hohenhaus,

MA, RN, CEN, FAEN

What Is Best for the Patient

BOARD WRITES | Kathleen E. Carlson, MSN, RN, CEN, FAEN, Director

As emergency care

professionals, we are

all aware of the

problems caused by

boarding patients on

a daily basis in our emergency departments.

Of growing concern are the issues associated

specifically with the increase in boarding

patients with behavioral health problems.

The number of patients with mental health and

substance use disorders treated in emergency

departments has been on the rise for more than

a decade. In 2007, 12 million emergency

department visits involved a diagnosis related

to a MH or SUD, accounting for 12.5 percent,

or one out of every eight emergency

department visits.1

Patients with behavioral health issues

encompass all socioeconomic and age groups,

from pediatric to the elderly. It is estimated that

approximately one-third of adults and one-fifth

of children had a “diagnosable substance use

or mental health problem in the last year.2”

Stressors from the current economic situation

and increasing unemployment cause patients

anxiety. Patients often stop counseling and

taking prescribed psychiatric medications due to

the cost. While patients may not present with a

chief complaint related to a psychiatric problem,

careful screening and assessment may reveal the

patient’s underlying behavioral health problems.

For example, one in three veterans and military

personnel returning from combat suffers

behavioral health problems that may not be

obvious, impacting the patient’s health and that

of his or her family.3

In 2003 the President’s New Freedom

Commission on Mental Health reported that the

total number of inpatient psychiatric beds per

capita had declined 62 percent since 1970, and

that state and county psychiatric hospital beds

per capita had decreased 89 percent.4 Funding

for necessary services is not adequate to meet

the needs caused by the closure of these beds.

Consequently, the emergency department,

the most expensive place to receive care, has

become the safety net in caring for patients

with behavioral health needs. Under the

Emergency Medical Treatment and Active Labor

Act, emergency departments are required to

stabilize all patients, which places a financial

burden on the hospital to properly diagnose

them. At times, patients may be discharged

home with prescriptions and instructions for

follow-up, only to return later.

It is the patients who suffer. Most emergency

departments do not have the resources

necessary to treat behavioral health needs.

Instead, patients are boarded in a department

that is fast-paced, hectic and noisy. A patient is

stripped of belongings and placed on a stretcher

in a sterile, drab space that has been emptied

for the safety of the patient. Medical clearance

is completed, and the wait for appropriate

placement begins. As the hours go by, little or

no therapy is provided, care may be handed off

to several different practitioners, and the

potential for the patient to deteriorate increases.

There must be a better way.

This should not be an emergency department

problem—but it is, so ENA is taking action.

ENA’s strategic plan focuses on three clinical

priorities: emergency department crowding,

violence in the emergency department and the

care of psychiatric patients. Under current

workplace conditions, the problem of boarding

patients with behavioral health problems is

often related to all three clinical priorities.

Let’s review some of ENA’s current efforts.

The ENA Emergency Department Psychiatric

Care Committee presented the board with three

public policy recommendations and an action

plan for ENA implementation. They were

approved last September.

The first priority is that patients with

symptoms of mental health or substance use

disorders be given priority of care equivalent to

that given to other medical conditions. The

committee notes the prevalence of a “stigma –

which erodes confidence that mental illnesses

are real, treatable health conditions – tolerates

attitudinal, structural, and financial barriers to

effective treatment and recovery.5” One strategy

recommended for attaining this priority goal is

to develop a standardized approach to assessing

behavioral health in the emergency department.

In addition to the initial screening, the goal

would be to standardize an ongoing assessment

of boarded emergency department patients with

behavioral health or substance use disorders,

including disorders such as prescription drug

misuse and abuse and agitation. As this is just

not “our emergency department problem,” ENA

is seeking to work with various stakeholders to

define this standardized approach.

The second priority addresses access to

quality patient care by collaborating with

community agencies and linking services.

Access includes continued improvement in

financing and integrated delivery of prevention,

treatment and recovery support services.

Increased funding for the Substance Abuse and

Mental Health Services Association and other

federal programs that provide state block grants

for community-based behavioral health services

is incorporated into ENA’s Public Policy Agenda

(www.ena.org/government/Documents/2011PublicPolicyAgenda.pdf).

In addition, ENA is a member of the Mental

Health Liaison Group (www.mhlg.org),

a coalition to promote health system capacity

building through the health reform law and the

parity law focusing on behavioral health.

To date, ENA has been a signatory to various

public policy MH/SUD initiatives.

In another strategy to support the

systems and collaboration priority, ENA is

developing an advocacy packet

Continued on page 38

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November 20116

WASHINGTON WATCH | Kathleen Ream, MBA, BA, Director, ENA Government Affairs

According to testimony given at a hearing held by the House

Energy and Commerce Committee’s Health Subcommittee

September 23, early warnings from drug companies about

looming shortages of pharmaceuticals, along with better

manufacturing practices, would help address the growing

problem of drug shortages. The problem is quickly becoming a

national health care crisis, as shortages of cancer, anti-infection

and anesthesia drugs occur without warning when patients are

in desperate need.

Subcommittee Chairperson Joe Pitts (R-PA) noted that the

number of drug shortages reported to the Food and Drug

Administration increased from 61 in 2005 to 178 in 2010.

“So far this year, FDA has continued to see an increasing

number of shortages, especially those involving older,

sterile, injectable drugs,” he added. In addition to cancer

and anesthesia drugs, the products include “drugs

needed for emergency medicine and electrolytes

needed for patients on IV feeding,” he said. A staff

memo Pitts released at the hearing said that more

than 240 drugs in 2010 were either in short supply

or completely unavailable, and “these shortages

cause delays in treatment and surgery, compel

physicians to make changes in care plans

and force patients to receive substitute

therapies that add expense to patient

care.”

Administration witnesses included

Howard Koh, assistant secretary for health

at the Department of Health and

Human Services, and Sandra Kweder

of the FDA. Koh said the number

of drug shortages has been rising

steadily over the past five years

and added, “This trend has

continued into 2011 with an even

greater number of shortages.”

Koh and Kweder suggested some

remedies for the problem, but

neither voiced confidence that it

would be solved anytime soon

because of the complex

reasons for the shortages.

One reason they cited is

that consolidation of the

pharmaceutical industry

has left fewer suppliers of

the drugs subject to

shortages, which in turn

results in fewer plants

forced to make more of

the drugs. With plants

busy filling orders for so many different types of drugs, they

are not taking time for needed maintenance; this leads to break-

downs in manufacturing, which ultimately cause supply

problems.

Other reasons included changes in inventory and distribution

practices (e.g., “just in time” methods whereby hospitals save

on inventory costs by ordering only small quantities of drugs,

leaving providers less able to deal with shortages when they

occur); shortages of underlying raw materials; and unantici-

pated demand.

One major reason cited in the hearing was that manufactur-

ers are losing interest in producing drugs that are off-patent and

sold as generics at prices that leave little room for profits. This

brought up a question of whether government policy is in some

way interfering with the forces of supply and demand. Rep.

Tim Murphy (R-PA) asked, “In our push to make products more

affordable, are we tripping over ourselves?” In essence, his

question was: Are prices being cut so much that manufacturers

don’t want to make the drugs? In response Koh said, “Those are

precisely the issues that we are wrestling with,” and “Further

economic analysis is intensely underway right now.”

The administration officials also mentioned a disturbing

aspect of the issue — development of a “gray market” in which

some suppliers have been able to come up with quantities of

drugs in shortage and sell them to hospitals at exorbitant prices.

Some of those drugs are counterfeit and in other cases, their

quality is suspect.

As for solutions, Koh and Kweder said earlier warnings that

manufacturers expect shortages would help. A bipartisan bill

— H.R. 2445 — introduced by Rep. Diana DeGette (D-CO)

addresses that issue. The measure requires companies to alert

the FDA when they expect shortfalls. Kweder pointed out that

when FDA does hear about a potential shortage, it is able to

work with the company to solve the problem or with other

manufacturers to increase their supplies of the drug. Koh added

that through this FDA drug shortages program, the agency

prevented 99 drug shortages in 2011.

Witnesses representing industry included Jonathan Kafer of

Teva Pharmaceuticals and Mike Alkire of Premier Healthcare

Alliance. Kafer said drug shortages are a complex and multi-

stakeholder issue and that all involved must work together to

resolve it. He called for greater communication among all the

stakeholders (active ingredient suppliers, generic and brand

manufacturers, wholesalers and distributors, health care

providers and government agencies), along with expedited FDA

review of new manufacturing facilities and active ingredient

suppliers when a drug shortage occurs. In addition, Kafer said

the FDA should collaborate with the Drug Enforcement Admin-

istration to establish a process that would streamline DEA’s

quotas of active drug ingredients in response to shortages of

controlled substances. Currently, DEA limits the amount of

At Drug Shortages Hearing, a Fresh Supply of Concern

Official Magazine of the Emergency Nurses Association 7

active ingredients manufacturers may purchase

for controlled substances.

Alkire’s suggestions for dealing with drug

shortages included the following:

• Shorten the approval process for medically

necessary generic drugs that appear to be

in shortage.

• Encourage the FDA’s drug shortage program

to engage members of the health care

community in discussions to prioritize which

drugs are critically necessary for treatment

that may be at risk for shortage due to

insufficient manufacturing capacity.

• Enable more flexibility in regulations that

apply to quotas for registered manufacturers

of controlled substances.

• Create a fast-track approval of new active

pharmaceutical ingredient suppliers for

medically necessary drugs in shortage.

• Work with manufacturers to slow the trend

of acquiring the bulk of raw materials used

in pharmaceuticals outside the U.S.

• Require manufacturers to notify the FDA of

planned discontinuation or interruption in the

manufacture of drugs as soon as practicable.

• Create a stakeholder committee to advise

the FDA on market conditions.

ENA endorsed the companion bill to H.R.

2445 — S. 296, the Preserving Access to Life

Saving Medications Act — on August 22, 2011.

From the States Four States Form Prescription Drug Task ForceLast April, the federal government announced

a new strategy that aims to cut the use of

prescription painkillers by 15 percent in five

years. A major part of the proposal is a push

for prescription drug databases in every state.

Four states — Kentucky, Ohio, Tennessee and

West Virginia — have created the Interstate

Prescription Drug Task Force to fight the

region’s prescription drug abuse problem.

Comprising about 30 experts from drug

agencies and law enforcement, the task force

will develop strategies to reduce the sale and

abuse of prescription drugs and will make

recommendations to improve cooperation in

sharing data, educational campaigns and police

investigations.

All four states use electronic drug monitoring

systems to collect information on who receives

and prescribes certain medications.

“Kentucky isn’t an island,” Gov. Steve

Beshear (D) said in a statement released August

24. “We have to attack this problem on a

nationwide basis and work with other states to

share information if we hope to turn around the

prescription drug problem.”

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• Membership recruitment materials are available through Member Services

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That’s right—a group membership will save you

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Here’s the Real Deal

November 20118

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

Children and adolescents present to emergency

departments with a large variety of mental health

disorders and emergencies, which include

depression, suicide attempts and ideations,

attention deficit disorder/hyperactivity, violent

behavior and substance abuse. According to the

World Health Organization, epidemiological data

suggest a worldwide prevalence of child and

adolescent mental health disorders of approxi-

mately 20 percent, and approximately half of all

lifetime cases of mental disorders start by age 14

(Kessler et al, 2005). Changes in private and

public insurance, state mental health programs

and community mental health resources, as well

as reductions in pediatric-trained mental health

specialists, have all contributed to a critical

shortage of inpatient and outpatient mental

health services for children (AAP, 2006).

This has resulted in an unbudgeted mandate for

emergency departments and emergency nurses

to act as the safety net for children in crisis.

Children with psychiatric illness may not

present with overt mental health symptoms.

Therefore, staff education and training regarding

identification and management of these patients

is crucial. Pediatric mental health conditions

often present as irritability or dysphoria rather

than the sadness seen in adult depression (Daly,

2011). Other common presenting complaints in

these children include sleep or appetite distur-

bances, stomach pain and refusal to go to

school (NIMH, 2011).

Whether a mental health condition is

suspected or known, screening the child or

adolescent thoroughly for past sexual/physical

abuse, traumatic events or other stressors can

help in the diagnosis and initiation of appropri-

ate treatment. A growing body of evidence

indicates that emotional and physical trauma in

childhood can cause changes in the developing

brain resulting in post-traumatic stress disorder

and can affect children well into their adult lives

(AAP, 2006). Emotional trauma can be reduced

by timely, developmentally appropriate inter-

ventions implemented in the initial hours after

the trauma (AAP, 2006).

Screening Tools and Standing OrdersIn one state, up to 23 percent of patients (of

any age) who presented to the emergency

department with suicide-related complaints

were discharged home without a mental health

evaluation (Cooper & Masi, 2007). Department-

wide resources and protocols that standardize

the approach and process when caring for a

child with mental health issues should be

developed (in collaboration with mental health

professionals) if they don’t already exist. A brief

screening tool for mental illness and/or suicidal

or homicidal ideation can be implemented at

triage, which, if appropriate, can initiate a

standing order for a sitter to ensure patient and

staff safety, as well as order a mental health

evaluation if available. These measures can

increase quality and efficiency of care, expedite

referrals and/or bed requests and help decrease

boarding times.

Education and TrainingHospital nursing education programs have

opportunities to improve pediatric psychiat-

ric and substance abuse education within

their curriculum. ENA’s Emergency Nurse

Pediatric Course includes a chapter on

psychiatric emergencies, which offers useful

information regarding the primary goals in

the care of these patients in the emergency

department setting. Emergency nurses

should be able to identify local and regional

resources, such as pediatric psychologists

and psychiatrists, suicide help lines and

primary care clinics.

Hope for the FutureThe National Institute of Mental Health

recently announced The Grand Challenges

in Global Mental Health Initiative. This

international research initiative identified

the top 40 barriers to better mental health

care around the world and will support

much needed research aimed at improving

the lives of people of all ages with mental

health, neurological and substance abuse

disorders within the next 10 years (NIMH,

2011). On the horizon are therapies—such as a

new, faster-acting generation of antidepressant

medications and advances in telemedicine—that

may result in more collaborative, specialized

and team-based care. These innovative

treatment methods and others that result from

the surge of new research in the specialty of

mental health hold much promise in improving

the quality of mental health care for youth as

well as adults (NIMH, fact sheet, 2011).

Emergency nurses can improve the quality of

care for these patients today and into the future

by taking measures, such as actively pursuing

education in mental health disorders, screening

for suicidal and homicidal ideation at triage to

help ensure the safety of patients and staff and

using standing orders to initiate care and

consults as quickly as possible.

Children in Crisis:

You May Be the Difference

Official Magazine of the Emergency Nurses Association 9

Resources Emergency Care Psychiatric Clinical Framework.

ENA. Accessed 8/11/11: www.ena.org/SiteCollectionDocuments/Position% 20Statements/ClinicalFramework.pdf

Medical Evaluation of Psychiatric Patients.

Position Statement: ENA. Accessed 8/11/11.

www.ena.org/SiteCollectionDocuments/Position%20Statements/MEDICAL%20EVALUATION%20OF%20PSYCHIATRIC% 20PATIENTS.pdf

National Institute of Mental Health Web site:

www.nimh.nih.gov

References American Academy of Pediatrics. Pediatric

Mental Health Emergencies in the Emergency

Medical Services System. (2006). Pediatrics.

1925, 1764-1767.

Bonham, Elizabeth. Role of child and adolescent

psychiatric nursing in health care reform.

(2010). Journal of Child and Adolescent

Psychiatric Nursing. 23, 2, 119-120.

Baren, J., Mace, S., Hendry, P., et.al. Children’s

mental health emergencies – Part 1. Chal-

lenges inc are: Definition of the problem,

barriers to care, screening, advocacy, and

resources. Pediatric Emergency Care. 2008

24(6) 399-408

Baren, J., Mace, S., Hendry, P., et.al. Children’s

mental health emergencies – Part 2. Chal-

lenges inc are: Emergency department

evaluation and treatment of children with

mental health disorders. Pediatric Emergency

Care. 2008 24(7). 485-498.

Daly, Rich. Pediatric depression, anxiety

symptoms often overlooked. (2008). Psychiat-

ric News, American Psychiatric Association,

43, 13, 7.

Dolan, M., Fein, J., and The Committee on

Pediatric Emergency Medicine. Pediatric and

adolescent mental health emergencies in the

emergency medical services system. (2011).

Pediatrics. 127, e1356-e1366.

Grupp-Phelan, J., Harman, J., and Kelleher, K.

Trends in mental health and chronic condition

visits by children presenting for care at U.S.

emergency departments. Public Health

Reports. 2007 122. 55-61.659.

Newton, A., Hamm, M., Bethell, J., Rhodes, A.,

Bryan, C., Tjosvold, L., et al (2010). Pediatric

suicide-related presentations: a systematic

review of mental health care in the

emergency department. Annals of Emergency

Medicine, 56, 6, 649-659.

National Institute of Mental Health. Depression

in children and adolscents (fact sheet).

Accessed 8/6/2011: gopher.nimh.nig.gov/health/publications/depression-in- children-and-adolescents

Horowitz, L., Wang, P., Koocher, G., Burr, B.,

Smith, M., Klavon, S., & Cleary, P. Detecting

suicide risk in a pediatric emergency depart-

ment: development of a brief screening tool.

(2001). Pediatrics 107, 5, 1133-1137.

Kessler RC, Berglund P, Demler, O, et al.

Lifetime prevalence and age-of-onset distribu-

tions of DSM-IVdisorders in the National

Comorbidity Study Replication. Arch Gen

Psychiatry, 2005, 62(6):593-602.

Cooper, J., & Masi, R. (2007). National Center

for Children in Poverty. Child and Youth

Emergency Mental Health Care: A National

Problem. Accessed online 8/8/2011.

World Health Organization. Atlas: child and

adolescent mental health resources: global

concerns, implications for the future (2005).

Accessed online 8/12/2011. www.who.int/mental_health/resources/Child_ado_atlas.pdf.

CorrectionThe title for Wendy Hums, BSN, RN,

was stated incorrectly in the ENA Connection

October issue article “Indiana Receives Its

First Trauma Program Manager Course.”

Her correct title is the course director for

American Trauma Society’s Trauma Program

Manager Course. ENA Connection regrets

the error.

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Highlights Include:

• Systematic standardized approach utilizing the A-I mnemonic

• Pediatric, pregnancy and elder trauma

• Initial assessment and shock

• Spinal immobilization

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• Opportunity to earn 14.42 contact hours

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Take the Course TodayTo verify why TNCC is right for you and to view course schedules, visit www.ena.org/coursesandeducation.

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

Contact the author I would like to answer your questions

and share your stories. Please e-mail me at ELGriffin@WakeMed.org with questions, problems and any special stories or learning experiences

you would like to share about taking care of children in the emergency department. I will weave them into the

column whenever possible.

October 201110

Since the development of ENA’s first Emergency

Nursing Resource in 2009, emergency nurses

have been using ENRs to provide safe, quality

patient care.

ENRs are developed through review and

critical analysis of the evidence for clinical

emergency nursing practices. ENRs contain

tables of evidence that grade each relevant

article according to level and quality of

evidence and provide final recommendations

for practice. They also contain an overview of

relevance and methodology. Topics for ENRs

are issues of great significance to stretcherside

emergency nurses and come from ENA member

surveys, resolutions and expert consensus. Once

published, ENRs are available at www.ena.org

and published in the Journal of Emergency

Nursing.

The four ENRs currently available address

the following issues:

• Capnography during procedural sedation

• Family presence during resuscitation and

invasive procedures

• Gastric tube placement verification

• Needle-related procedural pain in pediatric

patients

These four ENRs were accepted and posted

at the Agency for Healthcare Research and

Quality’s National Guideline Clearinghouse

(www.guideline.gov) in 2011. Acceptance of the

ENRs in the National Guideline Clearinghouse

validates the methodological evidence-based

process that the ENR Development Committee

used to create them, along with input from the

Institute for Emergency Nursing Research

Advisory Council, Institute for Emergency

Nursing Research staff and content experts.

The ENR Development Committee uses the

Guidelines for the Development of Evidence

Based Emergency Nursing Resources (www.ena.org/IENR/ENR/Documents/Guidelinesfor theDevelopmentofENRs.pdf) to develop ENRs.

The ENR development process includes

selecting the topic area, defining the clinical

question using the PICOT (Patient Population,

Intervention, Comparison, Outcome, Time)

format, searching the relevant literature for

review, critically appraising the literature to

grade the levels and quality of evidence,

developing the evidence-appraisal table and

interpreting the summative evidence to

determine levels of recommendation.

The 2011 ENR Committee is completing four

new ENRs. ENR topics in progress include

laceration cleansing, temperature measurement

across the lifespan, orthostatic vital signs and

difficult intravenous access.

The ENR on laceration cleansing and irriga-

tion evaluates the scientific evidence regarding

type of cleansing fluid, irrigating pressures and

patient comfort measures necessary to promote

effective wound healing and deter infection.

A review and critical analysis of the evidence

evaluated several irrigation techniques that the

emergency nurse can use in practice to promote

optimal wound healing. The ENR will include

an analysis of various irrigation methods, such

as bulb syringes and syringe with needle/

catheters, irrigation solutions and irrigation

temperatures. Emergency departments have the

potential to save thousands of dollars annually

on irrigation solutions, as well as increase

patient comfort and decrease infection, once the

ENR is published and emergency nurses

implement the recommendations.

The ENR on temperature measurement

focuses on temperature measurement of

patients across the lifespan. The ENR will

evaluate, appraise and give recommendations

for multiple methods of body temperature,

including oral, tympanic, rectal, axillary and

temporal. Emergency nurses will be able to use

a quick reference table to implement the

recommendations in daily practice.

The ENR on orthostatic vital signs evaluates

the indications, methods and utility for perform-

ing orthostatic vital signs to detect alteration in

fluid status. The ENR will evaluate and critically

appraise literature on body positioning, fluid

volume alteration, various vital sign measure-

ments and timing, and equipment.

The ENR on difficult intravenous access will

evaluate, appraise and recommend alternatives,

such as intraosseous access, ultrasound-guided

access, vein illumination devices and subcutane-

ous rehydration therapy.

It is hoped that ENA’s ENRs will positively

impact both emergency nurses and patients

by helping to translate research findings into

practice and to ensure that patients receive

quality, evidence-based and safe care.

Look for them at www.ena.org/IENR/ENR/

Use ENA’s Emergency Nursing Resources to Improve Your PracticeBy Andrew Storer, DNP, RN, ACNP, CRNP, FNP, ENR Development Committee MemberEdited by Jean Proehl, MN, RN, CEN, CPEN, FAEN, ENR Development Committee Chairperson

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November 201112

Vanderbilt’s Adult Emergency Department Initiates New Program to Protect StaffBy Kendra Y. Mims, ENA Connection

Michelle Ingram’s patient tried to stab her with

a pen.

He was a larger man—much too big for

Ingram to easily restrain by herself. Although

sharp instruments and other harmful items are

kept out of patients’ reach for safety reasons,

he had managed to jump across the counter to

retrieve the pen. He was acutely manic, agitated

and having a manic episode. The option of

verbal de-escalation had disappeared. Ingram,

a mental health specialist at Vanderbilt

University Medical Center, knew he was

dangerous and needed to be medicated.

Fortunately, she didn’t have to disarm her

patient. He eventually threw the pen down.

Recent studies show that Ingram’s experience

is unfortunately all too familiar in emergency

departments nationwide. A 2010 ENA study

reported that every week in the United States,

between 8 and 13 percent of emergency

department nurses are victims of physical

violence (Rates of Violence, 2010). Other studies

show that violence in emergency departments is

increasing, and they are considered a dangerous

place to work.

Taking New MeasuresENA member Brent Lemonds, MS, RN, FACHE,

Vanderbilt administrative director of emergency

services, says the

Joint Commission

Sentinel Event Alert,

Issue 43, regarding

violence elevating

in emergency

departments was an

eye-opener for

Vanderbilt’s Adult

Emergency Depart-

ment to re-evaluate

its safety measures.

Vanderbilt had already taken several actions

to reduce violence: metal detectors in its front

door, armed police in its emergency depart-

ment, a no-tolerance policy posted in the

emergency department and annual training for

staff. However, there was still a need to reduce

violence in the emergency department and to

increase protection for staff and patients.

“We still had increasing instances of violence

inside of our Emergency Department,”

Lemonds said. “The nurses were coming to us,

saying they were getting tired of being cussed

at on every shift. We had a triage nurse that

was clawed by one of the patients, and we

pressed charges against that patient. With these

increasing incidents in the ED, we looked at

what else we could we do. We thought the

thing that we could spend the best effort on

was additional training for our staff.”

Vanderbilt’s Adult Emergency Department

launched the Handle with Care training program

in April 2011. The crisis intervention and

behavioral management program includes four

hours of verbal de-escalation techniques and

four hours of physical self-protection tech-

niques, such as the primary restraint technique.

Training is mandatory for staff and has been

offered weekly since the program launched to

ensure that everyone completes the program.

Lemonds said staff members have responded

favorably to the new initiative because they felt

management was concerned about their safety.

“We’ve had some instances since we imple-

mented the training where it has proven to be

helpful and where staff members have walked

out of situations and said the training has really

helped. One of our patients attacked one of our

police officers, and the nurse who had the

training was able to put a hold on the patient

and rescue the police officer,” Lemonds said.

“I think the major benefit is the attitude of the

staff. Staff members say their self-confidence

level in being able to deal with situations has

improved.”

Vanderbilt staff nurse Nakeisha Jenkins, RN,

found the training helpful when she had to

perform a two-person PRT hold with her

colleague on a threatening, alcohol-dependent

patient who went into a rage and attempted to

destroy the

computer and other

equipment on the

registration desk.

The patient became

cooperative once

they placed her in

the PRT hold and

held her in that

position until they

were able to obtain

a stretcher and a physician at the bedside.

“I think the class was very beneficial,

especially in that case,” Jenkins said. “There

was no verbally de-escalating the patient in that

situation. The class not only protects us as staff,

but another patient in the waiting room could

have been injured by her behavior. We often

have psych patients who may behave

inappropriately, so this behavior is often

seen in the ER.”

Lemonds pointed out that there is no

shortage of mental health patients and drug

abuse patients in the emergency department; he

said 250 psych patients are treated every month

at Vanderbilt and 30 percent end up being

committed for further mental health treatment.

Although Lemonds and Ingram feel the high

population of mental health patients is

frequently responsible for the violent incidents

that occur in their emergency department, from

assaulting nurses to attacking the hospital’s

on-duty police officers, both said it is difficult to

ENA Workplace Violence ToolkitThe ENA Workplace Violence Toolkit, released in February 2011, was designed

to take a practical approach to eliminating violent behavior in emergency departments

nationwide. Created specifically for emergency department managers and team leaders,

the toolkit provides resources, templates and tools so that they can understand the issue

of emergency department violence, customize a violence prevention plan and develop

goals.

Karen Wiley, MSN, RN, CEN, contributed to the development of the toolkit and said it

can be applied to any health care setting or unit.

“The Workplace Violence Toolkit is a step-by-step quality improvement process to

decrease or prevent violence in the emergency department. It provides comprehensive

evaluation of the current status of violence in your emergency department,” Wiley said.

“The toolkit identifies your response to the high-risk areas that were identified in the

assessment phase. Project plan templates are included to assist you with developing goals

and outcomes of your violence prevention initiative. The beauty of it is that it was

developed for the emergency department setting. When it was developed, we wanted

nurses to use it and change it to fit their culture and institution.”

For more information on learning more about this innovative online resource and how

it can benefit your emergency department’s effort in protecting staff against violence, visit

http://www.ena.org/IENR/ViolenceToolKit/Documents/toolkitpg1.htm.

Nakeisha Jenkins, RN

Brent Lemonds, MS, RN, FACHE

Official Magazine of the Emergency Nurses Association 13

prosecute mental health patients because of their

condition.

“The legal system will not usually deal with

prosecution if the patients have a mental health

history. So the nurses get assaulted, but there is

no recourse for dealing with the patient’s

behavior,” Lemonds said.

Ingram, who deals with violent mental health

patients frequently, found the physical training to

be the most effective part of the Handle with

Care program.

“I think knowing how to do it with proper

body mechanics helps to protect us,” Ingram

said. “I think that a lot of nurses are afraid to do

things like that, because they don’t want to hurt

themselves or hurt the patient, but having that

extensive class really helped us to understand

that it is necessary sometimes to keep them

from hurting themselves.”

Several times, Ingram has used the PRT hold

she learned in Handle with Care on a self-

abusing patient. This patient walks around the

unit actively trying to hurt herself, from digging

and ripping open existing wounds to jumping off

of things in an attempt to break her neck.

Because this behavior happens every time

Ingram is with this patient, Ingram uses the

physical techniques she learned in Handle with

Care, which sometimes includes taking the

patient down to the floor.

“There are times when you just can’t verbally

de-escalate someone based on their psychosis,”

Ingram said. “The verbal part of the class will

give our nursing staff the ability to verbally

de-escalate people, and that will really decrease

them having to take it to the next level. Once

staff has to take it to the physical level, the

training will help them deal with it.”

Lemonds believes Handle with Care is

effective for staff dealing with mental health

patients who are threatening to themselves, staff

or other patients and will help staff react appro-

priately when physical restraint is needed.

“The key to dealing with mental health

patients or any patient who is out of control is

helping them to regain control. The de-escalation

training addresses that. When it comes to

physical techniques, you say to the patient,

‘We’re only going to use these techniques until

you’re able to regain control,’” Lemonds said.

“I think the de-escalation part of it is the most

helpful part because over my career, I’ve seen

untrained health care providers get angry. I think

in many situations

when health care

providers get to a

point of using force,

everyone is frus-

trated and angry. If

you get angry with

someone who is

having a behavioral

problem, they get

worse. When you have this training, it helps you

remain in a professional position and it helps

you to become knowledgeable about what’s

going on in the patient’s head.”

Lemonds said they have already requested to

expand the program to their pediatric emergency

department colleagues and their trauma unit—

two areas at risk for violence. Refresher courses

will be available for employees next year, and he

anticipates the program will be expanded. He

believes combining the training with other

strategies will help to reduce violence in

emergency rooms.

“I think it’s a combination approach,” he said.

“You must have the staff training. We also

support the use of a metal detector. I’ve had

many emergency departments call me about our

metal detector, and they’re afraid to implement

it, afraid that it will scare off patients. The

majority of the patients who talk to me feel like

it’s a safer environment because we have a metal

detector. There is not only one strategy that you

can do. There are many different strategies that

you can use to make your department safe.”

Emergency Nurses Can Protect Themselves Jacki Ashburn, RN,

quality consultant at

Vanderbilt, volun-

teered to become a

certified Handle with

Care instructor to

inspire nurses to

protect themselves.

She noticed a cultural

change when she

came to work in the

emergency department 15 years ago and realized

that verbal and physical abuse were normal

behavior in the environment.

“As society has become more violent, so has

the emergency department, and as new nurses

come into emergency nursing, they just needed

something to say, ‘This is appropriate, this is not

appropriate, and this is how you handle it,’”

Ashburn said.

Ashburn said there are two other instructors

who assist with the training and 20 employees

per class. The verbal de-escalation training

involves how to identify signs of stress, what you

can say to de-escalate patients and options if

they don’t cooperate. The physical training

Continued on page 20

How Are You Staying Safe?ENA asked its members on Facebook to describe the security measures their emergency departments have enacted to handle violence. A vocal majority said their administrations are not doing enough and that their emergency department security ranges from ineffective to nonexistent. But not every hospital is lax on this issue. Here are some of the positive testimonials:

“We are trained in Nonviolent Crisis Intervention. In addition, we have our own armed police department on campus. Officers are stationed in the ED, and a two-way mirror is in the ED, allowing officers to monitor activity in the waiting room. We have panic buttons in the ED, also.”

Cyndy Williams, BSN, RNStaff Nurse, Ocean Springs Hospital

Emergency Department, Ocean Springs, Miss.

“We have done unannounced mock drills with after-action reviews to evaluate the effectiveness of our violence prevention and violence response program.”

Nicholas Chmielewski, MSN, RN, CEN, NE-BC

Clinical Information Systems Coordinator,Mount Carmel West

Emergency Department, Columbus, Ohio

“We all wear locators, and there are panic buttons located in all rooms and various other locations in the ED. I pushed the panic button one day, of course to see what would happen, and within 30 seconds or so, I had three security guards as well as two CMTs at my side asking if I was OK. Our security guards also have been trained with tasers. Some people take offense at the locators and don’t want to wear them. However, I’ve been kicked, punched and threatened in my 20-plus years in the ED. I WANT my employer to know where I am at all times!”

Susan Wallace-Vernetter,

BS, RN, CEN, CPENStaff Nurse, King’s

Daughters Medical Center Emergency Depart-ment, Ashland, Ky.

“We repeated the ENA violence study and found our staff really didn’t know what safeguards we had in place and which ones we didn’t. We have implemented from this data CPI yearly training and a visitor policy and are currently working on a mandatory reporting tool. As a downtown Level I trauma center, we see quite a bit of violence.”

Shellie Scribner, BSN, RN, CENStaff Nurse, Clinical Educator

Grant Medical Center ED, Columbus, Ohio

Jackie Ashburn, RN

November 201114

After Deadly Indiana Stage Collapse, It’s Showtime for Emergency Nurses By Kendra Y. Mims, ENA Connection

On August 13, 2011, thousands of Sugarland

fans packed the Indiana State Fairgrounds in

Indianapolis around 8:45 p.m. waiting for the

show to begin.

The popular country duo never made it to

the stage.

An anticipated evening of fun and music

suddenly turned into tragedy when a reported

wind gust of 60 mph caused the metal scaffold-

ing that held the lights and stage equipment to

fall on top of fans closest to the stage.

People in the audience, including numerous

first responders, rushed to help those who were

injured. Victims were trapped under equipment.

More than 40 people were affected by the stage

collapse. Some had minor injuries. Some were

unconscious. Some were dead.

The victims were transported to different

hospitals in the city.

Indiana University Health Methodist Hospital It was a regular Saturday at Indiana University

Health Methodist Hospital located in downtown

Indianapolis. Wait times were relatively short

in the waiting room. The non-critical area

was full, and all rooms were occupied in the

critical care area. A few patients had been

made comfortable in hallway beds.

Around 8:47 p.m.,

Ann Duffy, JD, BSN,

RN, a shift coordina-

tor working that

evening, received

a call from her

colleague, a nurse

whose husband was

at the scene when

the stage collapsed.

Shortly after, Duffy

and the hospital

administrator started receiving text messages

and phone calls about the incident on their

personal cell phones.

“We received all of this informal information

before we received any official notification

through the regular EMS channel,” Duffy said.

Kathy Hender-

shot, MSN, RN,

ANP-BC, director of

clinical operations

said the information

Duffy received was

informal but

accurate.

“What was ironic

is that there were so

many health care

providers at the

incident itself. That’s really how we got commu-

nication. It’s pretty official when your friends

are calling you and telling you they are standing

right there and the canopy blew down on 100

people. We had that information right away

from the text messages,” Hendershot said.

Because IU Health Methodist Hospital is a

Level I trauma center and located approximately

four miles from the state fairgrounds, Duffy and

Hendershot knew they would receive patients.

Although Duffy had not received official

notification and was unaware of the amount of

injuries, she decided to operationalize their

call-in system by sending out pages to all staff,

a decision that helped them to prepare before

the first patient’s arrival, 30 minutes after the

stage collapsed.

“We started getting patients so quickly,

and they came en masse. They seemed to be

arriving two at a time. We were expecting a

variety of acuity levels. We received the first

eight trauma patients within a 10–15 minute

period, back-to-back. All of them were very

critical,” Duffy said.

The other patients who trickled into triage

throughout the night were less critical, with

minor injuries, bumps and bruises. Hendershot

said that although they received a total of 28

patients, it was not enough to activate their

housewide plan and use their resources.

“IU Health Methodist received the sickest of

the sick patients,” Hendershot said. The airways

of all but two of the critical patients had been

secured by intubation of the trachea prior to

arrival. Several of the patients required

immediate life-saving procedures, which

included central line insertion for fluids and

blood to combat hypotension and shock. One

patient required an emergency department

thoracotomy prior to going to the operating

room. The entire trauma team was affected by

the story of one of their critical teenage patients

who was now a paraplegic.

“We’ve had other incidents, such as school

bus crashes, tornadoes and a truck that caught

on fire on the interstate, but never to this

degree have we had this many severely injured

patients,” Hendershot added.

Wishard Memorial Hospital Nicole Olson, BSN,

RN, emergency

department clinical

manager at Wishard

Memorial Hospital in

Indianapolis,

received notification

about the stage

collapse around

9 p.m. from a

hospital security

officer who had

heard it over the radio. There were 66 patients

already in the emergency department that night.

Wishard Memorial, the only adult Level I trauma

center in Indiana besides IU Health Methodist,

is usually at full capacity. Olson notified her

staff, the physician coordinator, the emergency

nursing staff, the house supervisor and the bed

coordinator to prepare for an influx of patients.

A total of 18 nursing staff responded—six from

in-house and 12 from home, which consisted

of their management team and trauma team

members.

Ann Duffy, JD, BSN, RN

Kathy Hendershot, MSN, RN, ANP-BC

Nicole Olson, BSN, RN

The following stories show the spirit of emergency nurses in spite of unexpected adversities they often face, whether it’s caring for a patient in

an emergency situation and not knowing the outcome, helping a family cope with a loss, losing a colleague or witnessing a catastrophic situation.

While each story deals with its own challenge or tragedy, it is our hope that the focus is not solely on the tragedy but on the dedication of

emergency nurses and the camaraderie that is found in the aftermath, as emergency nurses are brought together to save lives and to support each other.

Anytime. Anywhere.

Official Magazine of the Emergency Nurses Association 15

Redefining Travel Nurse: Conference Attendees Run Code in Airport By Kendra Y. Mims, ENA Connection

Similar to IU Health Methodist, there was

only a 30-minute time lapse from when Olson

received notification of the stage collapse and

when the first patients showed up at the

hospital for treatment. They identified six

patients as critical. Other injuries included facial

fractures, head injuries and broken bones.

Initially, Olson was uncertain about activating

the hospital’s disaster plan until she received

new notification from the scene: There were 40

people unaccounted for and possibly still

trapped under the stage. At that point, Olson

knew they would need resources outside of the

emergency department if those critical patients

showed up at their hospital. The disaster plan

was activated. Although those 40 people were

eventually accounted for, Olson felt that

activating the plan helped them to prepare

for the worst-case scenario.

“We are typically used to dealing with

disasters every night. A large influx of patients

coming in the emergency department is not

uncommon. We had 18 patients who were

injured, and I think activating the disaster plan

was beneficial,” Olson said. “We brought in our

extra OR team, extra ICU physician team, extra

trauma team, our

orthopedic call

team, and our

neurosurgery call

team, and all of the

backup trauma

nurse team members

were notified. I

think that’s what

helped us. We were

all ready.”

Teri Joy, BSN,

RN, CEN, trauma program director at Wishard

Memorial Hospital, had just returned home from

vacation an hour before the stage collapsed.

After watching the tragedy on television, she

received a phone call from Olson and Dr.

Hayward, trauma faculty on call.

When Joy arrived, she immediately noticed

everything was organized. She said that their

system works well because one person is in

charge of giving staff direction during a disaster.

She said that Olson, who was in charge that

night and appointed Joy to be a staff nurse, had

everything under control. Joy pointed out that

the emergency department charge nurse and

the physician coordinator can activate the

disaster plan at their hospital because they are

the frontline people receiving the patients and

in this situation are the most knowledgeable of

the current situation and needs. She felt Olson

had made the right decision.

“I think activating our disaster plan was

beneficial to the patients because you had all of

the decision-makers at the hospital to allocate

resources and provide the best care possible.

The emergency department management team,

emergency department nurses, the surgeons and

all of the trauma team nurses were here,”

Joy said.

Tammy McLemore was standing within 15 feet

of the airplane in the passenger walkway, about

to board her connecting flight from Atlanta to

ENA’s 2011 Annual Conference in Tampa,

Florida, when the man standing in front of her

stiffened up, collapsed and became unresponsive.

He appeared to be fairly young. Because

McLemore, RN, CEN, president of the Louisiana

ENA State Council, was positioned behind him

in line, she was the first person to arrive on the

scene. McLemore and an off-duty flight

attendant, who was boarding the same plane,

immediately yelled for help, rolled the patient

over and stabilized his neck.

Several conference-bound nurses standing in

line to board the same flight stepped forward to

assist the patient. They quickly fell into their

roles. McLemore started an IV and rotated the

compression with other nurses. A flight nurse

took control of the patient’s head and his

airway. Oxygen and resuscitative equipment

were removed from the plane for the nurses to

use. The nurses came together and worked with

the unfamiliar equipment in an attempt to save

the patient’s life.

“There was no equipment that was familiar to

us, but we were able to do the job with what

we had in an attempt to resuscitate the patient,”

McLemore said.

The fire department and a doctor were on

the scene. The paramedics handed the nurses

their equipment. Although everything had

become chaotic in a matter of minutes,

McLemore said the nurses ran the code while

the paramedics and the doctor fell back and

let the nurses take charge. Although codes

can sometimes be chaotic, there was a sense

of discipline.

“It was a very sudden thing. It was one of

those moments as a nurse when you think

you’re off duty, but then your adrenaline kicks

in and you start doing the things you are trained

to do,” McLemore said. “Of course the nurses

who are your support team that’s normally at a

bedside in an emergency room were not there,

but the nurses who happened to be in line were

working, and at the moment you saw all of the

nurses fall into their roles. I started an IV while

others were managing the airway. It was just

like working on a stretcherside patient in the

ER, except we were

in the middle of a jetway. I don’t know if

anyone knew each other.

We all just knew we were emergency nurses.”

McLemore said the code was run appropri-

ately by the time EMS arrived, and the patient

still had a shockable rhythm. The paramedics

were still performing CPR and resuscitating the

patient as they left the scene, taking him to a

local hospital. Although she was not sure of the

patient’s outcome, McLemore commended all

of the nurses on the flight for their quick

response and efforts in attempting to save

the patient’s life.

“All of the nurses did an awesome job and

were responsive. Nobody ignored the situation

and said, ‘I’m not a nurse today.’ You are an

emergency nurse no matter what, on duty or off

duty. It’s all the time. You may not have your

scrubs on at the jetway, but in your mind,

you’re always that emergency nurse watching,

appraising and assessing people. Your instincts

kick in and you fulfill that role for whatever

happens today,” McLemore said.

Teri Joy, BSN, RN, CEN

Continued on page 37

November 201116

On August 26, 2011, the LifeNet helicopter crash

that happened just east of Kearney, Missouri,

claiming the lives of everyone on board, left

Heartland Health’s staff devastated. Among the

four victims were Heartland Health caregivers

Chris Frakes, EMT-P, and ENA member Randy

Bever, RN, EMT-P, CFRN, both well-known

throughout several hospitals in the area. Bever

was a lead RN in Heartland Health’s emergency

department, as well as the TNCC coordinator,

ACLS and PALS instructor. He had worked for

Heartland Health for 23 years. Frakes had

worked for Heartland Health for five years and

was engaged to be married in September to a

Heartland Health emergency department

technician. No one had imagined that a routine

patient transport from Bethany to Liberty,

Missouri, would result in a loss that would

impact the whole medical community.

Tami Easton, RN,

Cameron Regional

Medical Center’s

director of nursing,

felt ill when she

received a phone

call from her staff

that a LifeNet

helicopter had

crashed while

transporting a

patient from

Bethany. The victims were unknown at the

time, and initial thoughts of Bever and Frakes

crossed her mind. When Easton later received

confirmation of the victims, she called Heartland

Health to offer coverage for its emergency

department for two days so that Heartland

Health’s staff could attend the memorial services

for Bever and Frakes.

Easton said CRMC’s staff was also devastated

and wanted to help. Twelve nurses in CRMC’s

emergency department, including Easton, went

to Heartland Health to provide coverage for

both days. CRMC’s personnel spent a full day

gathering staff’s nursing licenses, vaccinations,

criminal background checks and certifications

for Heartland Health’s human resources depart-

ment for verification that everyone providing

coverage was properly trained. Although they

were offered a monetary incentive for coverage,

Easton declined the offer.

“I never thought about it being a big deal.

Heartland is just 40 miles from us.

Of course we’ll go and help. My staff

jumped on board and thought it

would be great. I told Heartland that

we didn’t want to be compensated.

This is a really hard time for you,

and we just want to come and help

out,” Easton said. “I think that’s what

it’s all about. Being a nurse, we’re

here to help each other.”

Kelli Jackson, RN, an emergency

department nurse manager at CRMC

who volunteered, said the transition

process went smoothly when they

arrived, and they were able to effectively

provide patient care.

“It was a wonderful experience. I think we

gained a lot of camaraderie with the nurses who

were there. We transfer patients there a lot.

They were so appreciative. It made us feel that

we could actually do something physically for

them. I think it gave a lot of closure that we

could help out,” Jackson said.

Cameron staff nurse Barb Patton, RN, had

briefly assisted the patient who was being

transported. Although Patton knew it would

be difficult and emotional, she felt she needed

to volunteer.

“There was no choice. I went and had an

excellent experience, an experience I will have

for the rest of my life,” Patton said. “In the

health care field, especially in the emergency

room, there is a true camaraderie, and there is

a one-for-all-and-all-for-one attitude. Everyone

there was just excellent. We did a lot of patient

care. We didn’t know the computer system, so

we couldn’t chart, but anything that they

needed done, we all worked together as a team.

It was a real team effort.”

Putting the Plan into ActionHeartland Health’s HR department developed a

committee to determine which of its staff was

available to assist CRMC nurses during the

memorial services. Sabrina Vega, RN, associate

team leader at Heartland Health, volunteered to

stay behind and became the go-to person for

the CRMC nurses for the two days they covered

at Heartland Health. Vega spent two full nights

developing a plan for CRMC nurses, which

included mapping out their designated locations

and their tasks. Three other nurses from

Heartland Health also stayed behind with her.

They created cheat sheets that included main

phone numbers, as well as codes for supplies

and locked doors.

CRMC nurses were given a brief orientation,

cheat sheets and a tour before starting their

shifts. Although Vega anticipated charting would

be difficult due to their computerized charting

system, she felt their established plan worked in

providing patients with excellent care.

“We came up with a system where we

assigned each Cameron nurse three rooms

where they would be responsible for patient

care. Everybody showed up and took their

assignments without hesitation,” Vega said.

“Everybody would do anything you would ask.

There wasn’t a task that would go incomplete.

You had anybody there willing to do anything.”

Vega says CRMC’s support really helped

Heartland Health’s staff during their time of

One Emergency Department Covers Another After Tragic Helicopter CrashBy Kendra Y. Mims, ENA Connection

Several Cameron Regional Medical Center nurses who provided coverage for Heartland Health are pictured above. Back row (L to R): Roy Estes, RN; Barb Patton, RN; Kelli Jackson, RN, ER supervisor; Terri Keatley, RN; Front row: Pam Tuia, RN; Christi Coates, RN; and Ginger Graham, RN.

Tami Easton, RN

Left to right: Chris Frakes, EMT-P and Randy Bever, RN, EMT-P, CFRN.

Official Magazine of the Emergency Nurses Association 17

need, and she had

full confidence in

their ability to

perform.

“I know our staff

here felt more at

ease that they could

go to the funeral. No

one had really dealt

with anything like

this all at once. It

was a really hard

thing for everyone to go through. Just knowing

that you have people out in the community

willing to come to help really gives you goose

bumps,” Vega said. “An emergency nurse can

just about take care of anything. They are

responsible for the same certifications as we

are, so we knew that they would be able to

do it.”

Debra Delaney, MS, RN, CEN, Blue Jay

Consulting’s process improvement coordinator

and emergency department consultant for

Heartland Health, watched in awe as CRMC

nurses arrived and covered the unit.

“There were poignant moments, tearful

moments and a few of those moments that only

emergency nurses can laugh at. Through it all,

these nurses exemplified what it means to be an

emergency nurse anywhere in the USA. It was

so humbling for me personally to have the

privilege of witnessing these two days,”

Delaney said.

Delaney was even more amazed at how the

nurses were adamant about their time being

strictly voluntary, as they were there to support

their colleagues.

“When it was time for them to leave, there

were tears, hugs, smiles and thanks from the

Heartland nurses for being able to attend the

services of their friends. It was again the

Cameron nurses who became tearful and stated

‘No, thank you for allowing us to be there to

support Randy and Chris as well,’” Delaney

said. “It really was overwhelming and reaffirms

for me once again why I love being proud to

call myself an emergency nurse.”

The Gift of Giving As director of nursing, Easton felt rewarded

for the opportunity to provide hands-on patient

care. She said each of her nurses who

volunteered contacted her immediately

afterward to thank her for the opportunity,

as they also felt rewarded by the experience.

“It was so rewarding to each of us. We were

so touched by the genuine gratitude of each

person, from their administration to their floor

care people. Everybody there was so gracious,

welcoming and genuinely appreciative,” Easton

said. “Anytime you go to another facility to

help, you take something away. We took away

a lot more than we gave.”

Debra Delaney, MS, RN, CEN

Established in 1991, the mission of the ENA Foundation is to provide educational scholarships and research grants in the discipline of emergency nursing.

Your Dollars = Your Future Investing in a nurse today is an immeasurable

contribution to the future of emergency nursing and patient care.

Invest in the future of your profession.Support the ENA Foundation.

Donate Now.

www.enafoundation.org

Heartland Health nurses who assisted Cameron Regional Medical Center nurses (L to R): Jacob Barton, BSN, RN;

Michelle Doolan, BSN, RN; Machelle Skinner, BSN, RN, CEN; and Sabrina Vega, RN.

November 201118

Amateur videos on YouTube offer different

angles of the same horror from the Reno Air

Races on September 16. There it is: Jimmy

Leeward’s vintage World War II-era fighter

plane, the Galloping Ghost, pitching straight

up and nearly out of sight as it turns in front

of the grandstands at Reno-Stead Airport

outside Reno, Nevada. And there it is again,

spiking violently into the tarmac, gobbling up

a section of reserved seating in a swirl of

disintegrating steel.

Obscured among the chairs and debris:

at least five or six instantly dead, including

Leeward, the 74-year-old pilot of the

malfunctioning craft. Dozens more injured,

many critically. Severed arms. Legs.

This is where the audio introduces the

next phase of the story: Above the disbelieving

groans of onlookers, a race official on a loud-

speaker instructs the uninjured to stay back,

except for those with medical training.

To those spectators, the message is:

Yes. Come down. We’ll need your help.

As clearly as

Tricia Lillibridge, RN,

CEN, heard the

hellish screech of

Leeward’s plane

slamming back to

earth that Friday

afternoon, she heard

the call to action

from her seat in the

grandstands.

“As I ran down

the steps, I had gone from being Tricia,

spectator, to Tricia, emergency nurse,” she said.

“And that’s what I said to people: ‘Let me

through, I’m an ER nurse, I’m an ER nurse,

I’m an ER nurse. How can I help?’”

September 16 was supposed to be a vacation

stop for Lillibridge and her husband, Clint—

their annual day at the races as they made their

way from their home in Homer, Alaska, to ENA

Annual Conference in Tampa, Fla. Instead,

while Clint, a retired pediatric gastroenterolo-

gist, tended to dazed survivors wandering the

grounds, Tricia entered a veritable warzone.

Her patient was a man in his 50s whose right

leg was gone, sliced off at the thigh. She

applied double manual pressure on his femoral

artery and waited the agonizing minutes for IVs,

oxygen and transport to reach her while the

Reno-based Regional Emergency Medical

Services Authority coordinated triage and doled

out supplies.

“I never worked so hard, so fast, in my life,”

Lillibridge said. “I was bound and determined

to put enough pressure on this thing where

I wouldn’t be responsible for him (exsanguinat-

ing). I said, ‘I’m not giving up on him until

somebody gets over here with two hands.’”

The man awoke suddenly and began flailing.

Lillibridge maintained her pressure, extracted

the most basic information from him: first

name George, no allergies. All around her

were graphic images of trauma—the sort of

event she’d prepared students for as a TNCC

instructor but never imagined she’d see

like this, here, on this scale.

First responders

poured in—physi-

cians, surgeons,

nurses, some from

the emergency

response crews,

others straight out

of the stands. Nic

Eisenbarth, RN, was

among five nurses

and two technicians

from Saint Mary’s

Regional Medical Center who were staffing the

onsite medical clinic. He and another nurse had

watched, perplexed, as Leeward’s plane pitched

overhead before missiling into the pavement on

the other side of the grandstands. They rushed

for the medical tent, where two of REMSA’s

advanced life-support ambulances were heading

out. The other two ambulances, designated as

crash units, already were arriving at the edge of

the debris zone.

REMSA’s onsite supervisor ordered all but

one of the Saint Mary’s nurses to the field.

Eisenbarth bounced from victim to victim as

red, yellow and green triage tarps were laid

down and patients quickly assessed and

organized. He first encountered a man with a

fractured skull. A local ear, nose and throat

specialist was attempting to intubate him.

“We had a lot of people coming up and

saying that they were first responders, asking

how they could help,” Eisenbarth said. “I

handed one guy my trauma shears and asked

him to start cutting up the [reserved-seat

curtains] to make tourniquets. … As soon as we

got everybody kind of stable enough to get

them over to the tarps, we started working on

the reds, getting lines in the reds, started taking

fluids, making sure that their tourniquets were

holding.”

The airport authority’s bus, at REMSA’s

disposal, was packed with enough backboards,

IVs, oxygen, bandages and tourniquets to treat

300 people. Eisenbarth said it didn’t have the

advanced diagnostic tools, blood products or

narcotics he needed, but transport wasn’t far

off. Nineteen more ambulances and three

helicopters were sent to help take away 54

patients, including a notably high number of

reds, said Kevin Romero, the EMS director for

REMSA. The first six reds went to Renown, the

A Close One for Nurses as Disaster Drops on RenoBy Josh Gaby, ENA Connection

Tricia Lillibridge, RN, CEN

Nic Eisenbarth, RN

The Galloping Ghost, a vintage fighter plane, becomes a bomb of deadly shrapnel as it crashes into the tarmac just in front of spectators September 16 at the Reno Air Races in Reno, Nevada.

Ph

oto

cred

it:

Wa

rd H

owes

, A

ssoc

iate

d P

ress

Official Magazine of the Emergency Nurses Association 19

Level II trauma center in Reno, while the other

patients were distributed among Renown, Saint

Mary’s and the Northern Nevada Medical

Center. The northbound lanes of the 395

freeway were shut down to clear a path into

Reno for southbound ambulances.

Total time to remove all of the injured from

the scene: 62 minutes, Romero said.

“Just the amount of people that we got off

the tarmac is just amazing, how quickly and

smoothly that all went,” Eisenbarth said. “It

seemed like as soon as we had everybody to

the tarps, triaged, starting to get lines in them,

you look up and there’s REMSA showing up

with their rigs asking who goes first, who goes

next, ‘I can take two,’ ‘I can take three’ …”

Lillibridge’s patient, George, was loaded

into an ambulance bound for Renown, still

conscious. It was the last she saw of him.

Eisenbarth caught a ride with some Air Force

personnel headed for Saint Mary’s. His lasting

memory from the scene is of an older man

with a grotesquely bent ankle—an apparent

tibia-fibula fracture.

“He was very, very adamant that we take

other people first,” Eisenbarth said. “On normal

days, someone has to wait in the emergency

room and they’re pretty upset about it. I don’t

think they understand that the only reason

somebody’s coming before them is because

they’re actually worse off. And this guy totally

got it.”

* * *

Melané Marsh, BSN, RN, CEN, was at home

packing with the television on. Like Tricia

Lillibridge, she

would be in Tampa

soon for Annual

Conference. The live

news coverage

broke in: a plane

crash at the air

races. There had

been others over

the years, but never

involving spectators.

In the background,

she heard the racing officials’ call for medical

personnel.

“And that was kind of a cue,” said Marsh,

the Nevada ENA president and a Saint Mary’s

charge nurse. “Mentally, I just said, ‘Something’s

not going right.’”

She called emergency department director

Shelby Hunt, BSN, RN, MHA, CEN, who already

had her team bracing for a surge of patients,

despite Saint Mary’s not being a designated

trauma hospital.

Hunt’s husband,

Bryon, a firefighter/

paramedic who had

been at the races,

had phoned to warn

her of a mass-casu-

alty incident. Minutes

later, the radios put

the area hospitals on

alert. Calls to the

Saint Mary’s staff at

the medical tent

confirmed: This is for real. Reds and yellows

would be arriving soon. Hunt’s staff lined the

halls with gurneys, wheelchairs, charts, buckets

of medicine. Off-duty nurses and techs were

summoned.

Marsh was

already on her way.

So was Jen

Boscovich, RN,

SANE, who had just

left the airport with

her husband, Brock,

a Saint Mary’s

emergency

physician, and

several of his

flight-doc friends

when they heard the plane had gone down.

The Boscoviches grabbed scrubs and dropped

their 15-month-old son off with a babysitter.

About 20 minutes later, just as they were

arriving, so were the wounded, three or four

at a time.

“They just started piling them on gurneys and

bringing them in,” Hunt said. “Other than we

knew we would be getting patients, we had no

idea what was going to be walking through our

doors, though you anticipate you could get

anything.”

A secondary triage center was set up outside

to make sure patients were still categorized

properly. Surgeons stood by waiting to treat

those with missing limbs and shards of plane

buried in their flesh.

“To me, it was a perfect impression of

war-type injuries of shrapnel,” Marsh said.

“I mean, it was just limbs cut off, wide-open

lacerations.”

Hanging in the air was the stench of jet fuel.

“Never smelled it before,” Marsh said. “That

was just overpowering. It didn’t irrigate off. You

couldn’t wash it off. I mean, it was just there.”

So were the hands of volunteers, more than

the staff could keep up with at times.

“Even the physicians that have nothing to do

with the ER just came,” Marsh said. “We had

cardiac surgeons and cardiologists. We had a

plastic surgeon walk into the ER with his own

bucket of sutures and numbing medicine and

ask us where we wanted him to start.”

Labor and delivery nurses. Floor nurses.

Pharmacists. Employees from Renown ended up

at Saint Mary’s because they couldn’t reach

Renown fast enough, Boscovich said. More

support came from military personnel and

random community members. Medical students

were on hand to help with sutures.

“Everybody needed something sewed up,”

Boscovich said.

For some, the suturing was emotional.

Boscovich helped treat a young man from Italy

with lacerations across his back. The people

he’d been sitting with at the show had been

killed. Though his vitals were stable, he was

terrified the critical hour would be the end for

him.

“‘Jen, don’t leave me. Don’t let me die, Jen.

Stay with me.’ He was so afraid,” Boscovich

said. “He was convinced that at that hour mark,

no matter what happened, he was going to die,

no matter how much we reassured him. He was

so alone, he was in a foreign country, and

scared to death. That fear will never leave me.

There was nothing, nothing to take that away

from him.”

They worked into the night, with a strange

peace slowly replacing what Hunt called

“organized chaos.”

“I remember, about 10:30, just kind of

scanning the department with my manager,”

Hunt said, “and we were blown away because

you would truly have never known just a few

hours earlier what this place looked like, and

they got it right back into operational, day-to-

day mode. It truly was like what had happened

had never happened.”

Marsh, like most, was moved by the effi-

ciency and selflessness she saw. Of all the

patients treated at Saint Mary’s, including four

reds, only one died—a man with a head injury.

“That’s the biggest thing for me,” Marsh said,

“walking in and knowing I had that team of

people working and just seeing that visual of

the hallways lined with gurneys, there’s tons of

people there, everybody’s doing a job of some

sort, and if they’re not, they’re asking you what

they can do. … It’s awe-inspiring to know that

as a community and as a hospital, we can come

together like that, and, as I kept saying, we

rocked it.”

Said Hunt, who, like Marsh, has a back-

ground as a trauma nurse: “It just proved you

Melané Marsh, BSN, RN, CEN

Shelby Hunt, BSN, RN, MHA,

CEN

Jen Boscovich, RN, SANE

Continued on page 37

November 201120

involves learning the PRT hold, as well as how

to deal with wrist grabs, hair pulls and choking

and learning how to take a patient to the ground

safely.

“Our whole goal with this was to keep

everyone safe and not to injure anyone—staff or

patients—and to be able to carefully take our

patients to a point where we can restrain them

enough to let them know we are not going to

hurt them but their behavior is inappropriate

and they need to regain composure,” Ashburn

said. “Handle with Care teaches you how to

restrain them and how to escort them back

to a safe place.”

Ashburn points out that there have been five

incidents where staff members have used the

training from the class. She feels the class has

empowered staff and is helping them deal with

their mental health patients effectively.

“Handle with Care says there is no dignity in

allowing a patient to hurt himself or others. You

have to set your limitations and be able to help

those people regain their control, because

they’ve lost it,” Ashburn said. “Once our mental

health patients realize that you are trying to help

them and that there are limits, they respond

fairly well, unless they are totally out of control,

and then at that particular point, it does require

restraint.”

In an effort to support each other, Ashburn

says staff members have created several trigger

phrases, such as “Your lunch is ready,” to help

one another identify when it is time to walk

away from a situation.

“We talk about how all of us have buttons and

these people find our buttons. Our goal is to

keep ourselves focused and not allow our anger

to surface, because with anger and fear you

increase tension without reducing the tension.

So you need to know what your triggers are,”

Ashburn said.

Ashburn has enjoyed teaching the class and is

glad she volunteered to become an instructor.

Her goal is to continue as an instructor and

show nurses that they can protect themselves.

“I have felt over the years that nurses weren’t

given the tools they needed to learn to verbally

de-escalate and to protect themselves. As

emergency nurses, this is one thing that you’re

just not taught. I volunteered to show nurses

that they can do this and to empower nurses to

take care of themselves,” Ashburn said.

Reference Rates of Violence. (2010). Retrieved from

Emergency Nurses Association Web site:

www.ena.org/media/PressReleases/Pages/ RateofViolence.aspx

Get ready to find out all you need to know

about attending ENA Leadership Conference

2012 in New Orleans, February 22–26. To make

your online experience easy and informative,

we’ve completely redesigned this area into a

one-stop shop for all your conference needs.

As you navigate through the new conference

site, quickly find information for attendees by

hovering over the Attendees tab and making

your selection from the items in the drop-down

list. Review the Advance Program online or

download it as a PDF. Look over the Focus Grid

for sessions in education, management or

personnel. Take advantage of our trip-planning

tips and information to help make your trip a

great experience. Are you coming early to enjoy

Mardi Gras? Be sure to read Join Us in New

Orleans under the Conference Planning area.

Looking for resources, such as a justification

letter or international invitation letter? Do you

want to help promote the conference to your

peers, using our official conference sticker in

your e-mail footer and post to your social

networking sites, such as Facebook or Twitter?

Find all of these and more under Resources,

also under the Attendees tab.

When you are ready to book your airfare or

secure a hotel, go to the Travel/Lodging tab and

find information on the ENA block of rooms,

airfare, shuttle and cab services.

Don’t miss out on any of the fun or special

events while at the conference. Visit the Special Events tab, where you will find information on

the Welcome to New Orleans Party, the ENA

Candidates Election Forum, the ENA Town Hall

Meeting, the ENA Foundation Exclusive Event,

Masked on the Mighty Miss, and sponsored

events and focus groups.

Get the best information to help you have a

wonderful experience at the ENA Leadership

Conference 2012 — visit the conference site

often to answer your questions and stay

informed. See you in New Orleans!

Readers may contact the author at

dzirkle@ena.org.

…For ENA Leadership Conference 2012 Information

Vanderbilt’s Adult Emergency Department Continued from page 13

References Emergency Department Violence Surveillance Study. (2010, August). Retrieved from

Emergency Nurses Association web site: www.ena.org/IENR/Documents/ENAEDVSReportAugust2010.pdf

Gacki-Smith, J., Juarez, A., Boyett, L., Homeyer, C., Robinson, L., & MacLean, S. (2009, July/

August). Violence Against Nurses Working in the U.S. Emergency Departments. The Journal of

Nursing Administration, 39(7/8), 340–349. Retrieved from the Lippincott’s NursingCenter.com

web site: www.nursingcenter.com/library/JournalArticle.asp?Article_ID=927697

U.S. Department of Justice Workplace Violence, 1993–2009. (2011). Retrieved from the CPPS

web site: www.cppssite.com/blog/wp-content/uploads/2011/04/Nonfatal-workplace-violence-BJS-2009.pdf

• Patients and their relatives were the main perpetrators in all incidents of physical and verbal violence, with 97.1 percent of physical incidents and 91.0 percent of verbal incidents having involved a patient.¹

• A 2005–2009 study reported that nurses have the highest percentage of workplace violence at 3.9 percent when compared with other medical occupations.²

• Each year, almost 500,000 nurses are victims of violent crimes in the workplace.³

• In 2009, ENA reported that more than 50 percent of emergency room nurses had experienced violence by patients on the job and 25 percent of ER nurses had experienced 20 or more violent incidents in the past three years.³

Deb Zirkle, ENA Director of Online Services

Did You Know

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For more information visit www.ena.org.

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November 201124

ENA Call for…

ENA on Facebook. What Are Emergency Nurses Saying?

The 2011 General Assembly held in Tampa,

Florida, in September was an overwhelming

success. The delegates were presented with 10

bylaw proposals and 12 resolutions for consid-

eration. Delegates from across the nation and

for the first time, international delegates partici-

pated in lively debate over these issues that

affect our emergency nursing practice.

President AnnMarie Papa, DNP, RN, CEN,

NE-BC, FAEN, empowered by her understand-

ing of Robert’s Rules of Order, kept the delegates

in order and on time. Congratulations to our

president for an outstanding meeting that

allowed the business of the association to be

carried out with a little humor integrated into

the proceedings.

Credit for a successful meeting also goes to

our delegates. Delegates participated in our

second annual online delegate orientation led by

our parliamentarian, Colette Collier Trohan. For

the third year in a row, voting keypads assisted

delegates in the debate and voting process.

Familiarity with the process allowed for smooth

transitions for speakers and voting counts.

The Resolutions Committee would like to

thank all of the authors who submitted bylaw

proposals and resolutions. For several, this was

the first time submitting a bylaw proposal or

resolution. Their courage in engaging emergency

nurses in important dialogue about emergency

nursing issues is commendable. If you know

someone who authored a bylaw proposal or

resolution, please share your gratitude.

It is hard to believe, but it is already time to

begin thinking about preparing bylaw proposals

and resolutions for next year. The Resolutions

Committee would like to challenge you to write

resolutions that address clinical topics affecting

your practice. We are available to assist you

in this process. Please feel free to contact

Kari Zick at the ENA national office at

componentrelations@ena.org to reach committee

members.

The Resolutions and Bylaw Guidelines

(recently revised) and proposal templates are

available in the General Assembly area under

Members Only at www.ena.org.

The submission deadline is 5 p.m.

Central time,

March 2, 2012.

Remember, in

order to ensure that

emergency nursing

uses best practices

to care for our patients, it is important that our

members help guide ENA in addressing issues

that are important to your practice. Help put

these issues on the front burner and get

emergency nurses engaged in dialogue by

writing a resolution.

On behalf of your 2011-2012 Resolutions

Committee — Nicholas A. Chmielewski, MSN,

BSN, RN, CEN; Jill C. McLaughlin, BSN, RN,

CEN; Gordon C. Rogers, RN, CEN; and E. Marie

Wilson, RN — we thank you in advance for

taking the initiative to write a resolution. Feel

free to use the expertise of the committee. This

process is what helps empower you to change

the emergency nursing practice. Let your voice

be heard.

2012 Bylaws Proposals and ResolutionsDeadline: March 2, 2012

By J. Jeffery Jordan, MS, RN, MBA, CEN, CNE, EMT-LP, Resolutions Committee Chairperson

Emergency nursing is hard. This is Emergency Nurses Week, so why don’t

you all share with others what you do to help keep your passion for the

work alive and well.

Barbara Larrabee Duarte Orienting new superstar graduate nurses keeps me motivated.

Rachel HansonHelped a new grad nurse with a code a while back. I thought it was a lost

cause. The patient was a mess and based on her labs, etc, it seemed

clearly to be a non-survivable incident. Nonetheless, we worked the code

and took care of the patient. I was completely AMAZED to know that that

patient WALKED out of the hospital!!!! That is why we do what we do!!!

Hoorah for ER nurses!! We really do save lives!!!

Elizabeth Balota When you get through the barrier and are able to connect with the

patient. It’s the most rewarding feeling.

Ruth L. Citroni Richardson Working with great nurses and docs that support each other helps. I also

make a point of taking time to recharge my batteries. We need to take

care of ourselves so we can be there for our patients.

Linda Guy Heilman I think it has to be the family that says thank you after they watch you

struggle to do everything for their loved one.s

Krista Brancel Mentoring is great ... also having those times when being stopped outside

if the ER, “You are a nurse right?” Why yes. “I know you don’t remember

me but you were the one who took care of me, thank you.” It makes it all

worthwhile. We all began this profession for a reason. ER nurses make a

difference and save lives. Thank you to past, present and future ER nurses!

ENA posted the following during Emergency Nurses Week, October 9-15:

Official Magazine of the Emergency Nurses Association 25

As a member of the

Nominations

Committee, I was

disappointed by the

low voter turnout for our 2011 national election.

ENA is approximately 40,000 members strong,

but only 2,134 members cast ballots, for a 5.31

percent participation rate. In my home state of

Missouri, out of a total of 795 members, only

36 cast ballots. Thank you to those who took

the time to vote.

This means that only 5 percent of the

membership decides who leads our organiza-

tion and makes crucial decisions that impact our

patients, their loved ones and us as profession-

als and practitioners. Is that a good thing?

I think not.

We are a member-driven organization. As

emergency nurses, we must have a vested

interest in our organization. We must be willing

to invest time and energy toward the perpetua-

tion of our organization that is considered to be

the voice of emergency nursing by so many

individuals. We have enormous clout in our

society in both the professional realm and the

nation at large. We are a major player in many

facets of our world: political, research,

education, nursing practice, emergency

preparedness and publications, to name a few.

Our leadership speaks for us in many delicate

and powerful situations and represents each

and every one of us. An organization of our size

and caliber needs input from all of its members,

because neither the board of directors nor the

Nominations Committee nor any other

committee within our organization makes all the

decisions. We need membership involvement to

be a powerful voice in our chosen profession,

emergency nursing.

The Nominations Committee has been

working hard for several years to improve the

voting process and to bring new ideas to the

membership. We have searched for answers to

this problematic situation and listened intently

to anyone who has ideas for improvements.

Obviously, we need to hear more.

My challenge to you is to e-mail the Nomina-

tions Committee at execoffice@ena.org with your

ideas on how to improve voter turnout and how

ENA can help the membership know more

about the candidates.

We frequently hear, “I don’t know the

candidates, so I don’t vote.” During Leadership

Conference 2011, we hosted the annual live

Candidates Election Forum where each

candidate answered questions pertinent to our

organization’s needs and growth. At this venue,

you can see, meet and hear the candidates’

views on topics that affect our organization.

The ENA Connection and www.ena.org provide

biographical information on every candidate far

in advance of the voting process and through-

out the election. During the election voting

time-frame, the membership is invited to ask

questions or post comments of support and

view responses by the candidates via the Ask

the Candidate area of www.ena.org.

Please help us by providing more input so

that we can continue to be a member-driven

organization. We are a powerful and exciting

organization. Help us help you to keep our

organization at the top. As your Nominations

Committee, we are committed to helping our

organization grow through our leadership. That

leadership must come from you, through you,

by you. We’re waiting anxiously to hear some

incredible ideas. As we begin the cycle for the

2012 election, I encourage you to become

informed, consider who will be the best leaders

for ENA and, above all, remember to vote.

We’re Emergency Nurses— We Can Do Better Than 5 Percent

NOMINATIONS COMMITTEE | Gail Carroll, BSN, RN, CEN, Nominations Committee, Region 3

Now Available!ENA’s Certified Pediatric Emergency

Nurse Review Manual

We want to help you succeed on the CPEN™ exam and earn your certification. The ENA CPEN Review Manual follows the blueprint of the CPEN Exam.

This manual offers:

• More than 600 practice questions founded in current, evidence-based literature• Answers and rationales are provided for each and every question• An extensive list of references is included to supplement your preparation

for the CPEN exam• Access codes to two online practice tests, worth three continuing education

contact hours each• A succinct, comprehensive review of the core material• Material meant for both those certifying for the first time and recertifying nurses

For more information and to purchase either the print or electronic version visit www.ena.org and click on shop.

The Emergency Nurses Association is accredited as a provider of continuing nursing education by the

American Nurses Credentialing Center’s on Accrediation.

November 201126

READY OR NOT? | Knox Andress, BA, RN, AD, FAEN

‘Something’s Happened’

“Little did I know that September 11, 2001,

would be the most important day of my news

reporting career.” Charles (Charlie) Gibson, the

now-retired anchor for ABC’s “Good Morning

America” and “World News Tonight,” shared

his personal reflections, perspectives and

recommendations for disasters and media

reporting during the 5th National Emergency

Management Summit in Brooklyn, New York,

September 14, 2011.

“At 8:46 a.m., Diane (Sawyer) and I were

delivering the morning news program on

‘Good Morning America’ when the first plane,

American Airlines Flight 11, hit the World Trade

Center’s North Tower. Then, at 8:48 a.m., just

two minutes later, I hear a message in my

earbud … ‘Something’s happened.’ Our video

feed immediately switched to a traffic camera

focused on the World Trade Center’s North

Tower now belching thick black smoke. Rarely

in my broadcast career have I been at a loss

for words, but for 15–20 seconds there I was

struggling to comprehend what I was seeing

on the monitor.”

For many people across the country watching

their usual morning television, Gibson, Sawyer

and ABC News were the initial alert and

messengers of the 9/11 attacks and the heroic

responses that followed. Similar electronic and

print media reporting’s occurred in the days,

weeks and months that followed.

Role of the Media in Emergencies Both electronic and print forms of news media

are key components of crisis communications

and can play a vital role in incident manage-

ment by alerting, warning and educating the

public about emergencies and disaster events.

During severe weather, the National Weather

Service partners with television station broad-

casters to alert the community. Accurate and

timely reporting is a means to saving lives,

mitigating property damage and helping people

to help themselves in the face of an emergency.

The electronic news media, including

broadcast and Web-based, is a resource for

disaster managers and responders. A fundamen-

tal component of any hospital or community

command center includes at least one television

monitor and a computer with emergency

power.

DHS Daily Open Source Reports Media reports can provide situational awareness

of threats and hazards to emergency depart-

ments and hospitals. Each business day, the U.S

Department of Homeland Security’s Daily Open

Source Infrastructure Report provides a

summary of threat news from open media

sources. The Daily Report gives a synopsis of

threats to the 18 infrastructure sectors identified

in the National Infrastructure Protection Plan

www.dhs.gov/files/programs/editorial_0542.shtm.

Each day visitors to the DHS Web site can

potentially read about hazmat events, mass

casualty incidents and other events impacting

emergency departments and hospitals.

Critical infrastructure sectors include public

health and health care; energy; chemical;

nuclear reactors, materials and waste; critical

manufacturing; defense industrial base; dams;

agriculture and food; water; banks and finance;

transportation; postal and shipping; information

technology; communications; commercial

facilities; government facilities; emergency

services; and national monuments and icons.

Plan for MediaHospitals and emergency departments should

plan for news media engagement during

emergency and disaster events. Like the cable

news weather reporter broadcasting during the

hurricane’s landfall, many times, a reporter will

want to visit the “scene of the action,” which

may be the emergency department. Policies

should be in place for receiving and directing

media to the hospital’s public information

officer, a command staff role described in the

Hospital Incident Command System.

Develop a relationship with local media to

build mutual trust. When a newsworthy event

occurs, provide reliable, concise, understand-

able information to media contacts as soon as

L to R: Former ABC anchor Charles (Charlie) Gibson with Ready or Not? columnist Knox Andress, BA, RN, AD, FAEN.

Ground Zero after the collapse of the Twin Towers September 11, 2001.

Official Magazine of the Emergency Nurses Association 27

possible. Understand and engage the hospital

PIO when needed.

The mission statement for the HICS, PIO job

action sheet reads “serve as the conduit for

information to internal and external stakehold-

ers, including staff, visitors and families and the

news media, as approved by the Incident

Commander” (www.emsa.ca.gov/HICS/files/JAS_Command.pdf ).

Having a pre-identified location for media to

assemble or stage will assist the PIO and help

prevent reporters from straying. Monitor the

news media, television, radio, Internet and

social media. If the hospital has a Facebook

page, plan on monitoring and responding to

questions that will come from the community

during an emergency event.

Craft the Right MessagePIOs will be assisted by developing preplanned

messages to be delivered by the appropriate

spokesperson when needed. To aid in crisis

communication planning and response, the

Centers for Disease Control has developed a

training program Web site, Crisis and

Emergency Risk Communications, which draws

from best practices learned during previous

emergency and disaster events. Crisis and

emergency risk communication has been

defined as “the strategy used to provide infor-

mation that allows an individual, stakeholders

or an entire community, to make the best

possible decision in a crisis emergency event”

(www.bt.cdc.gov/CERC/).

Readers may contact the author at

wandr1@lsuhsc.edu.

Follow Knox Andress

@ENAdman.

Are you a guru in a particular area of emergency nursing, management or policy? Have you developed a successful approach to a common challenge in emergency nursing? Has a particular experience given you new insights into a current issue, trend or best practice that could benefit other nursing leaders?

Share your insights related to current issues, trends, and best practices as a faculty memberat ENA Leadership Conference 2013, February 27 – March 3 in Fort Lauderdale!

Topic areas:

Join the ENA Leadership Conference Faculty

Establish YourselfLeader among Nursing Leaders

as a

Submission Deadline is March 19, 2012

• Management• Operations• Government affairs• Technology• Team building• Research• Education

• Advance practice• Orientation• Retention• Community relationship building• Customer satisfaction• Personal and professional development

In addition to the recognition as a nurse leader, faculty members receive complimentary registration, airfare, hotel and per diem reimbursement.

Find full information and course proposal guidelines at www.ena.org and click on Leadership Conference 2013 Call for Course Proposals in the Calls and Opportunities Section. We look forward to hearing your cutting-edge course ideas.

Important Dates to rememberEarly Bird Registration Closes ............................. January 11, 2012

ENA Board of Directors Meeting .........................February 22, 2012

State and Chapter Leaders Conference ...............February 23, 2012

Presessions ......................................................February 23, 2012

Educational Sessions .................................. February 24 – 26, 2012

Information From past attendees*

• Thank you for a wonderful conference. Such a renewing experience. I am full of ideas that sparked from the sessions I attended. Here’s to happy changes! Thank you again! I’ll be looking to attend another conference!

• I cannot begin to tell you how powerful this conference was for me. I feel as though I am personally and professionally changed by the things I learned and the people I met. I learned so much and treasure all of the pearls of wisdom imparted at Leadership 2011. Thank you for the strength of this organization!

• I went to learn more and to be better able to support my leaders and educate other nurses to make change easier. Now I am very enthusiastic in “working the crowd.” Emergency department directors to send their staff when they can’t attend is a good idea.

ENA Leadership Conference 2012 will Illuminate, providing a beacon of light with

new information and skills. It also will empower, offering the support, strength and

knowledge to move forward as an emergency nursing leader. ena Leadership

Conference provides the tools to help emergency nurses be the leaders

they want to be and unite as one voice for our profession.

be the nursing Leader You Want to beAny emergency nurse who holds or seeks a leadership role at any level will

benefit from ENA Leadership Conference 2012. With 70 general sessions to

choose from across six focus areas and 17 contact hours, bedside staff nurses

who lead colleagues, charge nurses, nurse managers, directors and CNOs

all will find relevant information they can apply as soon as they return to

their organizations.

Leadership Conference 2012 offers even more educational opportunities

through presessions as well as the chance to network and share best practices

with nursing leaders from around the world. Learn how your colleagues address

challenges that concern you now and see familiar topics in a new light so you can

do something about them.

Scan this QR code with your mobile device to learn more about our conference.

November 201128

REGISTER BY JANUARY 11 TO SAVEby taking advantage of the reduced early-bird conference fees, you save $90 on a three-day registration. that’s more than 20 percent off the regular registration fee!

29

the Leadership Conference 2012 keynote speakers are sure to Illuminate the crowd with unique perspectives.

All’s Fair in Love, War… and Running for PresidentJames C. Carville, Jr. and Mary J. Matalin

These New Orleans residents each has more than 30 years of experience in politics and has individually worked for Presidents Ronald Reagan, George H.W. Bush, Bill Clinton and George W. Bush. These two will candidly share their views on the turbulent political landscape and how it will affect health care in the coming years.

Balancing Life in Your War ZonesLeAnn Thieman, LPN, CSP, CPAE

Recounting her dramatic experiences from the Vietnam Orphan Airlift, LeAnn shares life-changing lessons for coping in our “war zones” today. In this poignant and humorous presentation, learn how to balance your life, live your priorities and make a difference in the world.

Eat, Drink and Succeed! Climb Your Way to the Top Using the Networking Power of Social EventsLaura Schwartz

Harness your social power and increase productivity “after hours” with the tools you need to turn your social scenes into professional and personal successes.

Educational opportunities promise to empower through information and relevance

• Earn more than 17 contact hours during the general educational sessions offered in six focus areas. Earn even more through presessions

• Add to your leadership skills with practices or techniques you can apply immediately

• Strengthen your position within your organization and as a valued member of the leadership team

• Expand your career options by adding to your base of knowledge and skills, becoming a valuable asset for your organization

register at www.ena.org.

November 201130

California ENA State CouncilSubmitted by Marcus Godfrey, RN, President-elect

All Leftovers Go to the Emergency DepartmentIt is common practice in most hospitals that all leftovers go to the

emergency department. There is often no greater saving grace on a hard

shift than word that food has arrived.

After the first day of delegation at the 2011 General Assembly in

Tampa, Florida, the California delegates met for a reception. Just as we

were wrapping up the event, I mentioned to Linda Broyles, MSN, RN,

CEN, MICN, Cal ENA president, that there was a lot of food left over. She

jokingly commented that we should take it to the local emergency depart-

ment, which is exactly what we did.

When we arrived in the emergency department at Tampa General, the

staff was slammed. They saw us in all our Cal ENA gear and rolled their

eyes. I’m sure the last thing they wanted was to have to give some

out-of-state association a tour. I held up the food and told them we were

only here to feed them, and their faces lit up. We were quickly brought

back to the break room where we dropped off the food, met the charge

nurse, shamelessly left some Cal ENA magnets and pens and were back in

the cab in less than 10 minutes.

How often do we have large meetings in our state? How often do we

have them catered? And how often do we just leave that

food behind? Cal ENA has started a tradition of taking

any leftovers to the local emergency department and will

do the same in our home state next year. Who knows?

Maybe someone will come to the next meeting because a

member thought enough to bring food to his or her busy

shift.

Louisiana ENA State CouncilSubmitted by Alicia R. Dean, RN, MSN, APRN, CNS

Louisiana ENA State Council members, please keep

checking future issues of ENA Connection for information

on volunteering for ENA Leadership Conference 2012 in

New Orleans. We will need many ambassadors of

ENA STATE CONNECTION

State Council and Chapter Meetings and Events

Kentucky ENA State CouncilThree Rivers Chapter Meeting December 1, 2011Owensboro, Kentucky

North Carolina State ENA CouncilNorth Carolina’s Seventh Annual Education DayNovember 10 - 11, 2011Wrightsville Beach, North CarolinaFor more information, go to www.nc-ena.com.

Minnesota ENA State CouncilCentral Minnesota Chapter Meeting December 12, 2011 Location to be announced. For more information, go to www.minnnesotaena.com or e-mail colleen.seelen@gmail.com.

Check out great gift ideas for friends and colleagues this holiday season.

Two easy ways to order:Phone: 800-900-9659 Monday through Friday 9:00 a.m. - 4:30 p.m. CTOnline: www.ena.org/shop

Shop Marketplace

Official Magazine of the Emergency Nurses Association 31

Louisiana to help make Leadership Conference

2012 the best ever. Save your Mardi Gras beads

so we can all show the rest of the country what

“Throw me something, mister” and “lassiez le

bon temps rouler” really mean!

Maine ENA State CouncilSubmitted by Robin Matthews, RN, President

We had a wonderful turnout September 10,

2011, for our annual meeting and educational

day.

Several annual awards were presented:

Emergency Nurse Provider Award: Wynne

Sholl, MS, BSN, BA, RN, CEN, of Southern

Maine Medical Center

Emergency Nurse Leadership Award: Jane

Rioux, RN, of Northern Maine Medical Center

Emergency Nurse Leadership Award: Robin

Matthews, RN, of Maine Medical Center

Emergency Nurse Educator Award: Carol

Minnis, RN, CEN, of Maine General Hospital-

Waterville

Emergency Nursing Special Merit Award: Andrea Varnum, BSN, RN, CEN, of Maine

Medical Center

Emergency Nursing Special Merit Award: Carmen Hetherington, BSN, RN, CEN, CPEN,

of Central Maine Medical Center

Emergency Nursing Special Merit Award: Karen

Taylor, RN, of Maine Medical Center

Maine ENA and many emergency nurses

throughout our state were busy this year,

petitioning our legislature for changes in the

laws regarding violence in the workplace. We

currently have a felony statute but were

working to broaden this to encompass all

employees who work in our departments.

While at this time the changes proposed were

not passed, Maine ENA was awarded a Joint

Resolution Recognizing the Dedication and

Resolve of Medical Care Professional in

Hospitals. Our legislature recognized that

emergency medical care providers and

emergency medical care professionals in

hospitals are committed to providing treatment

to any injured or ill person, regardless of

circumstance. Whereas our work with our

legislature continues through education and

reporting workplace violence, we are thankful

that our voices were recognized.

A copy of this resolution was sent to each

emergency room throughout our state.

Minnesota ENA State CouncilSubmitted by Colleen Seelen, RN, CEN

Lake Superior ENA Chapter is a catalyst for

seasonal public service announcements on

Minnesota public radio. The announcements are

made on Friday evenings when travelers are

frequently on the road. Messages on distracted

driving and wearing your helmet while riding

are just a couple of the messages going out.

Zumbro Valley ENA Chapter, Greater Twin

Cities ENA Chapter and Central Minnesota

ENA Chapter have contributed funds to this

great idea of educating the public.

New York ENA State CouncilSubmitted by Mickey Forness, RN, CEN

The New York State Council would like to

thank all the contributors to the ENA Founda-

tion endowment of the 9/11 scholarship. This

scholarship has been awarded to 17 individuals

from many different states. Special gratitude

goes to the Mississippi ENA State Council for

issuing the challenge to all delegates to donate

their dollar coins handed out by President-elect

Gail Lenehan, EdD, MSN, RN, FAEN, FAAN,

to this fund. The New Hampshire ENA State

Council has issued a challenge to all state

councils to match its $1,000 donation.

To donate, go to www.nysena.org/911.html.

Members of the California ENA State Council with a staff RN from Tampa General Hospital.

AS A JOB SEEKER: • Search for jobs and

receive automatic e-mail notifications of new listings

• Post your résumé and make it available to top-notch employers

AS AN EMPLOYER:• Post openings and

review a deep pool of qualified talent

ENA Career CenterYour path to lifelong career success

The ENA Career Center provides personalized career guidance and showcases over 200 health care associations and professional organizations within the National Healthcare Career Network.

Learn more about this valuable resource at www.ena.org.

CareerCenter

November 201132

New ENA Position Statement Supporting Next Generation 9-1-1ENA develops position statements on key topics

affecting emergency nursing practice and health

care trends. The most recently approved

position statement, Enhanced/Next Generation

9-1-1 Systems, is in favor of research to upgrade

9-1-1 systems to support additional communica-

tion formats such as text, video, photo and

e-mail available on mobile devices, which are

used most frequently to call for emergency

assistance. Visit www.ena.org/About/Position

to see all ENA position statements.

ANA Recognizes Emergency Nursing as a SpecialtyThe American Nurses Association has recog-

nized emergency nursing as a nursing specialty

and accepted ENA’s revised Emergency Nursing:

Scope and Standards of Practice, available later

this year.

New Member BenefitsENA members qualify for discounts on items

such as insurance, travel, wireless products and

services, car rentals, identity theft protection and

prescriptions. To view all available discounts,

visit www.ena.org, click on the membership tab

and then member benefits. Log in to see the

details.

Mosby’s Nursing Consult: ENA EditionMosby’s Nursing Consult offers users practice

guidelines, FDA drug updates, evidence-based

nursing monographs, skills demonstrations and

competency testing information. To learn more,

visit www.ena.org.

ENA Career Center: Your Path to Lifelong Career Success Job seekers may post a résumé, search for jobs

and be notified of new listings while employers

post openings and review a deep pool of

qualified talent. Visit the new ENA Career

Center at http://enacareercenter.ena.org/.

ENA Toolkit Combating Workplace Violence: Prevent, Respond and ReportBecause more than half of surveyed nurses

reported experiencing abuse within the

previous seven days, this toolkit is designed to

help emergency department staff create a

culture of safety. To access the toolkit, visit

www.ena.org/IENR.

ENA Emergency Nursing ResourcesENA develops Emergency Nursing Resources

to bridge the gap between research and

everyday emergency nursing practice. Go to

www.ena.org/IENR.

Spotlight on Member Benefits and Resources

Shop MarketplaceSpecial Offer for the Month

When Nurses Hurt Nurses: Recognizing and Overcoming the Cycle of BullyingCheryl Dellasega, PhD, CRNP

Outside of nursing, most people believe bullies are native only to playgrounds and high school locker rooms. Unfortunately, bullies also frequent hospital units, ambulatory care centers, clinics and even emergency departments. Their targets? Their own colleagues and peers. This conflict has the potential to destroy a nurse’s morale, interfere with the ability to trust colleagues and erode quality of care. When Nurses Hurt Nurses: Recognizing and Overcoming the Cycle of Nurse Bullying confronts this problem by examining the causes and providing ways to diffuse a confrontational situation. When Nurses Hurt Nurses is at the forefront of addressing the issue of bullying within the nursing profession.

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Official Magazine of the Emergency Nurses Association 33

ENA Foundation Announces 2011 Scholarship Recipients

What is the ENA Foundation? Even if you see

this column every month in ENA Connection, or

hear someone talk about an ENA Foundation

scholarship, the State Challenge or the jewelry

auction, you may not know what the ENA

Foundation does.

The ENA Foundation is a charitable, non-

profit organization that aims to promote

emergency nursing through research and

education to enhance the overall delivery of

emergency care. Our mission is to provide

educational scholarships and research grants in

the discipline of emergency nursing. If you have

bought a thumb drive or pin, made a purchase

during the online auction or at the annual

jewelry auction or participated in your State

Challenge campaign, you have supported the

ENA Foundation. The foundation is here for

you, our members, and is supported by you,

your friends and family, and our corporate

sponsors.

Each year, the ENA Foundation makes a

difference in the lives of patients and

emergency nurses across the United States. This

year, the foundation awarded research grants

and scholarships to more than 75 emergency

nurses. The care we provide will be enhanced

through the knowledge and skills developed

through this funding. I would like to commend

each one of you who has taken the challenge to

further your knowledge through education or

research. I would also like this opportunity to

recognize those who recently received an ENA

Foundation scholarship.

Thank you to all of our generous donors.

You are the reason we have helped ensure the

future of emergency nursing for so many. Please

continue to ensure the best care for all by

supporting your charitable organization, the

ENA Foundation.

Non-RN Scholarships• New York State ENA September 11 Scholarships

– $2,500 each Tamera Dekeyser – Wisconsin Clifford Payne, EMT-B – California

Undergraduate Scholarships• Charles Kunz Memorial Undergraduate Scholarship

– $3,000 Kimberly Travis-Carter, RN – Washington

• Hill-Rom Undergraduate Scholarship – $3,000 Mary Otting, RN, CEN – Illinois

Graduate Scholarships• Stryker Masters in Healthcare Scholarship – $5,000

Barbara Buckley, RN – Illinois• ENA Foundation Masters in Healthcare Scholarship

– $5,000 Kelly Johnson, BSN, RN, CEN – Wisconsin

• Board of Certification for Emergency Nursing (BCEN) Scholarship – $5,000 Donna Hamilton, BSN, RN, CEN – Pennsylvania

• Hill-Rom Graduate Scholarship – $5,000 Charlotte Schnakenberg, BSN, RN, CEN, CPEN – Arizona

• California State Council – Karen Grove Memorial Scholarship – $5,000 Vicki Dippner-Robertson, BSN, RN-BC, CEN, CPEN – California

• Kentucky State Council – Kentucky ENA Founders Scholarship – $5,000 Leigh Parker, BSN, RN, CEN – Alabama

• Maryland State Council – Maryland ENA State Council Scholarship- $5,000 Pamela Pourciau, BSN, RN, BC, CEN, CCRN, CPE – Louisiana

• Minnesota State Council – Pathways III Scholarship – $5,000 Karla Hosick, BSN, RN, CEN – Nebraska

• Mississippi State Council – Mississippi Magnolia Scholarship – $5,000 Amy Lowery, BSN, RN – Mississippi

• New Jersey State Council – Emergency Care Scholarship – $5,000 Florence Vanek, BSN, RN – New Jersey

• New Jersey State Council – New Jersey State Challenge Scholarship – $5,000 Elizabeth Griffin, BS, RN, CPEN – North Carolina

• West Central Chapter (NJ) Jeanette Ash Scholarship – $5,000 Trisha Ann Williams, BSN, RN, CEN, NREMT-B – Missouri

• New York Empire State Challenge Scholarship – $5,000 Stacie Hunsaker, BSN, RN – Utah

• Tennessee State Council – Bright Angels Memorial Scholarship – $5,000 Deborah Elliot, RN, CEN – Pennsylvania

• Texas State Challenge – Vicki Patrick Legacy Scholarship – $5,000 Marlene Siton-Thai, MSN, RN, CEN – Texas

• ENA Foundation Scholarships – $5,000 each Rita Cox, BSN, RN – Michigan Diane Hochstetler, BSN, RN, CEN – Indiana Laurie Wegner-Burns, BSN, RN – Wisconsin Jennifer Zachariah, BSN, RN, CEN – California

• Board of Certification for Emergency Nursing (BCEN) Scholarship – $3,000 Alexandra Kinzer, BSN, RN, CPEN – Virginia

• Physio-Control, Inc. Scholarships – $3,000 each Stephanie Borkowski, BSN, RN – Pennsylvania Shannon Mims, BSN, RN, CEN – Texas

• Gisness Advance Practice Scholarship – $3,000 Karyn Roberts, BSN, RN, CPEN – Illinois

• Karen O’Neil Memorial Scholarship – $3,000 Melinda Dixson, MSN, RN, CEN, CPEN, FNPC – Maryland

• ENA Foundation State Challenge Scholarship – $3,000 each Tyler Blomquist, BSN, RN, CEN – Georgia Amanda Cook, BSN, RN, NREMT – Tennessee Denise Evans, BSN, RN – Michigan Mary Catherine Feiler, BSN, RN – New York Amanda Lier, BSN, RN, CEN, EMT-B – Alabama Cary VanDyke, BSN, RN, CEN – Alaska Lynn Sayre Visser, BSN, RN, CEN, CPEN – California

Doctoral Scholarships• Pamela Stinson Kidd Memorial Doctoral

Scholarship – $10,000 Diana Meyer, MSN, RN, CCRN, CEN, FAEN – Washington

• Board of Certification for Emergency Nursing (BCEN) Doctoral Scholarships – $5,000 each Kari Evans, BSN, RN, CEN – Indiana Margaret Miller, MSN, RN, FNP-BC, CEN – New York

• ENA Foundation Doctoral Scholarship – $5,000 Angelia Mickle, MSN, RN, CEN – Ohio

Continuing Education Scholarships Recipients• Stryker International Exchange Scholarship – $1,000

each Denise King, MSN, RN, CEN – California Charlotte Schnakenberg, BSN, RN, CEN – Arizona

• Vidacare Annual Conference Scholarships – $500 each Tammy Andrews, RN, CEN – Kentucky Barbara Buckley, RN – Illinois Marianne Bundy, MSN, RN, CEN – Florida Kristen Connor, BSN, RN, CEN, PHRN – California Debra Cremens, RN, CEN – Massachusetts Mare Eichmann, RN, CEN, NREMT-P – North Carolina Carla Marie Grasso, RN, CEN – Pennsylvania Maha Habre, BSN, RN, CEN – Lebanon Abigail Hasan, RN, CEN – New York Katherine Hunt, BSN, RN, CPEN – Maryland Brant Jacobson, RN, CEN – Washington CherylAnn MacDonald-Sweet, BS, RN, CEN, CPEN – Pennsylvania Matt Andrew Magto, BSN, RN – Philippines Kelly Mills, RN, CEN – Indiana Julie Mount, MSN, RN, EMT-P, CEN – New York Anne Pendleton, RN – Massachusetts Jan Michael Vincent Reyes, RN – California Carolyn Sutch, BSN, RN – Maryland Joan Tiska, RN – New York Lorraine Weigand, BSN, RN, CEN – Virginia

MESSAGE FROM THE CHAIRPERSON | Beth Broering, MSN, RN, CEN, CPEN, CCRN, FAEN

Readers may contact the author at babroering@mindspring.com.

November 201134

Could these scenarios occur in your emergency

department?

• EMS calls to advise the emergency depart-

ment of the need for immediate assistance

upon their arrival to restrain a violent patient

who has threatened his family members.

• A 45-year-old father who has just lost his job

arrives after attempting suicide by hanging.

• A homeless person, with PMH of schizophre-

nia, is agitated and pacing, stating that he has

not been taking his prescribed medications.

As emergency nurses, we encounter daily

patients and their families as they struggle with

mental health issues. The resulting impact on

the emergency department, inclusive of the

potential for harm to self and others, can be

disruptive and at times devastating. These are

the cases that become headlines in newspapers,

and the outcomes have a huge impact on

caregivers, as well as on the hospital’s reputa-

tion within the community. Often, we would

like to consider these patients low priority, but

current triage guidelines, such as the Emergency

Severity Index, classify these patient types as

ESI level 2, requiring immediate advisement of

others and placement in a treatment area.

When situations go awry, retrospective

review often reveals many options that may

have minimized risk. Do you truly know how to

achieve the best outcome? Patient safety, as well

as your own personal safety, is paramount to all

we do. As competent emergency caregivers, we

must be aware of evidence-based strategies to

best manage patients who present with these

types of challenging, high-risk complaints.

Preparation for the Certified Emergency

Nurse exam will include review of psycho-social

issues along with the best tactics to de-escalate

situations, ensuring the well-being of all

involved. It is important that a review of the

behaviors proven to achieve the best outcomes

be undertaken to ensure that you are successful

with test taking. However, should not every

emergency nurse be aware and implement

these proven strategies every day at work? Do

we not owe our patients and ourselves the

obligation to bring best practice to the bedside?

I certainly believe so.

Preparing for specialty certification validates

your commitment to lifelong learning, to

ensuring that your patients get the best they can

at your hands. Reviewing and contemplating the

best proactive approach to de-escalate situations

and the finest response to serve this high-risk

patient population can allow for a better patient

care experience and ultimately an optimal

outcome for the patient and for the staff

member. It is vital that we as nurses accept this

challenge, prepare for the exam, become

certified and thus bring the best to our patients

every shift. As a certified emergency nurse, with

the enhanced knowledge you gain from prepa-

ration and experience, you will personally have

an impact on those patients who seek care

related to mental health illnesses. This goal,

in itself, validates the need to begin the pursuit

of CEN®.

In addition to addressing mental health

disease within our health care environment,

it is equally important that we aim to promote

mental health. Promotion focuses on enhancing

one’s ability to achieve a positive sense of

self-esteem, mastery of a chosen skill set and

inclusion within a social sect. Specialty certifica-

tion (CEN, Certified Pediatric Emergency Nurse,

Certified Flight Registered Nurse and Certified

Transport Registered Nurse) allows the individ-

ual to validate these intrinsic traits that have

been carefully developed and refined over time.

The Accreditation Board for Specialty Nursing

Certification defines certification as “the formal

recognition of the specialized knowledge, skills

and experience demonstrated by the achieve-

ment of standards identified by a nursing

specialty to promote optimal health outcomes.”

The certified RN, therefore, is more self-confi-

dent, a master of the practice environment and

included in the elite group of nurses who

choose to become certified.

In an ABSNC study, nurse administrators

clearly indicated that they value specialty

nursing certification. It is cited that certification

truly does reflect a commitment to lifelong

learning, supporting the theory that certified

nurses are perceived as more motivated and

committed to nursing as a career. Certified

nurses also score higher on levels of profession-

alism. Incentives provided by many

organizations support the high value of certifica-

tion within the nursing community. Magnet

designation endorses specialty certification for

the best practice it promotes and the resulting

improved outcomes that patients deserve.

Lastly, nurses who seek and attain certifica-

tion tend to encourage others to achieve this

goal. These mentors will also recognize others

for earning specialty certification, yet another

tactic that builds self-esteem and self-confi-

dence. Without a doubt, the benefits of

achieving certification are countless, and your

commitment to this goal will not only affect

your patients’ outcomes but also promote your

own mental health, something we do not often

consider.

Board of Certification for Emergency Nursing

certifications provide proof of your dedication

to the practice of emergency nursing to

yourself, your coworkers and the community

you serve. Make no further excuses. Take the

time to prepare, determine a timeline and

commit to taking the exam. Become certified.

You owe it to yourself.

ReferencesGilboy, N., Tanabe, P., Travers, D., Rosenau, A.,

and Eitel, D. Emergency Severity Index,

Version 4: Implementation Handbook. AHRQ

Publication no. 05-0046-2. Rockville,

Maryland: Agency for Healthcare Research

and Quality. May 2005.

Power, K. (2010, December). Transforming the

Nation’s Health: Next Steps in Mental Health

Promotion. American Journal of Public

Health.

Stromborg, M., Niebuhr, B., Prevost, S., Fabrey,

L., Muenzen, P., Spence, C., Towers, J., and

Valentine, W. (2005, May). Specialty Certifica-

tion. Nursing Management.

Transforming Mental Health with Specialty Certification

BCEN BOARD WRITES | Mary Whelan, MSN, RN, CEN, Member-at-large

Official Magazine of the Emergency Nurses Association 35

When Artemus Armas, RN, CEN, returned home

from his deployment in 2010, from a non-

disclosed base in Southwest Asia, he received

surprising news from his commander: Armas

won the Air Force Flight Nurse of the Year

award and the Air Force Nurse of the Year

award for 2010.

Armas already knew that his supervisor had

entered a nomination package for him for the

Flight Nurse of the Year award when he was

deployed, but Air Mobility Command—their

higher command—believed his accomplish-

ments were strong enough to compete for the

overall winner, the Air Force Nurse of the Year

award. Armas felt shocked and happy that he

won both awards.

“It was a double bonus. It’s not typical for a

person to win both awards. The Air Force Nurse

of the Year award is the top award for all of the

nursing categories. It is a prestigious award for

the Air Force. It took a moment for me to

realize that I had won a major award. I felt

honored,” Armas said.

His career in Air Force nursing began in

2002. Armas became a flight nurse in 2007

and obtained his Certified Emergency Nurse

certification in 2009. He felt becoming Board

of Certification for Emergency Nursing

certified would benefit him from an

educational standpoint.

“I had already worked in the ER and ICU

when I first started striving for it, and I thought

it would get me to that next level. It helped me

to see where my level was in comparison to

others in the field. It had always been a goal of

mine to get my CEN certification, and it also

showed what my knowledge was and that

I could pass the test,” Armas said.

Armas currently works in a new high-level

position for Headquarters Air Mobility

Command at Scott Air Force base, Illinois.

He oversees 32 aeromedical evacuation (AE)

squadrons’ training and ensures it is done

properly from an operational aspect.

“I think it gives me a little more clout when

I’m going in to inspect these squadrons and

personnel. It also shows that I’ve put in that

extra effort,” he said.

Armas points out that there is a shortage

of flight nurses in the Air Force. Winning his

awards has helped him to promote flight

nursing and the different leadership opportuni-

ties that are available for Air Force flight

nurses—opportunities he feels may not

be obtainable in a hospital or clinic.

Being a flight nurse has been the most

satisfying job for Armas in his nursing

career.

“My favorite aspect is dealing with the

wounded warrior and dealing with the

patients who are Soldiers, Airmen and

Marines. We even deal with civilians from

NATO countries and make sure we can

get them from one level of care to a

higher level of care,” Armas said. “Not all

of my positions have been flying. As an

officer in charge of the aeromedical

evacuation operations team, I have also

ensured that aeromedical evacuation crews

were prepared to transport patients, and

I was on a liaison team where I coordinated

with the British on getting injured troops

aeromedically evacuated out of Afghanistan.

I think it’s more of the interaction with the

troops to make sure they are receiving proper

care and knowing that we are doing the right

thing that I enjoy.” When Armas started his

flight nursing career, he discovered that there

was a Certified Flight Registered Nurse certifica-

tion available. The thought of obtaining his

CFRN certification stayed in the back of his

mind over the years, and it has become his goal

to take the exam. He believes becoming a CFRN

would be advantageous to his new position,

because it would show that he is certified in his

specialty. He is studying for the exam and has

set a goal to take it next year.

“I think the CFRN certification would give me

more credibility if I am out inspecting someone.

A lot of time people will look at titles and ask

about your background. The good thing about

me is that I’m well-versed. I’ve had ICU and

ER experience, and when you have that CFRN

certification, it gives you more clout,”

Armas said.

Certified Emergency Nurse Named Air Force Nurse of the YearBy Kendra Y. Mims, ENA Connection

Artemas Armas, RN, CEN, with the 379th Expeditionary aeromedical evacuation squadron.

From left to right: Major General Kimberly A. Siniscalchi;

Artemus Armas, RN, CEN; Chief Master Sergeant Joseph L.

Potts.

November 201136

The ENA board of directors met August 24,

2011, via conference call. All members of the

board of directors were present. The board took

the following actions:

• Approved the revised ENA Procedures as

presented.

• Approved that the ENA board of directors

have laptop computer access at the 2011

General Assembly.

The ENA board of directors met September 20,

2011, at the Tampa Convention Center. All

members of the board of directors were present.

The board took the following actions:

• Approved 2012 committee, advisory council

and work team members.

• Accepted the secretary/treasurer’s report as

presented.

• Approved board governance policy 3.09,

Board Ethics Statement, as presented.

• Approved board governance policy 8.01,

Contributions from ENA, as presented.

• Approved board governance policy 8.03,

Expenditures by ENA for Incidental Contribu-

tions or Gifts, as presented.

• Established an Emergency Department

Operations Work Team.

• Established an Emergency Nursing Technol-

ogy and Informatics Work Team.

• Approved the Emergency Nursing Resources

Committee requests for 2012 as presented.

• Approved the Emergency Department

Crowding Committee recommendations to

dialogue with the Centers of Medicare and

Medicaid Services officials to help alleviate

crowding in the emergency department.

• Approved the following consent agenda items:

• Approved the July 22, 2011, board of

directors meeting minutes as written.

• Approved the August 24, 2011, board of

directors conference call minutes as written.

• Approved the Executive Committee Actions

report as presented including:

• An invitation from the American Academy

of Pediatrics to review and provide

comment on the American Academy of

Pediatrics draft report on Death of a Child

in the Emergency Department. Deena

Brecher, MSN, RN, APRN, ACNS-BC, CEN,

CPEN, and Sally Snow, BSN, RN, CPEN,

FAEN, will provide comments on behalf

of ENA.

• An invitation to attend the American

Psychiatric Nurses Association’s 25th

Annual Conference, October 19-22, 2011,

in San Francisco. Gail Lenehan, EdD, MSN,

RN, FAEN, FAAN, is ENA’s representative.

• An invitation to attend the National

Association of Clinical Nurse Specialist

Summit on July 14, 2011, in Philadelphia.

Deena Brecher, MSN, RN, APRN,

ACNS-BC, CEN, CPEN, represented ENA.

• An invitation from the National Quality

Forum regarding the Call for Nominations

for the Care Coordination Endorsement.

The name of Diane Gurney, MS, RN,

CEN, was submitted for consideration.

• An invitation from the National Quality

Forum regarding the Call for Nominations

for the National Priorities Partnership.

ENA was submitted for consideration as

an organizational member. Sue

Hohenhaus, MA, RN, CEN, FAEN, is the

ENA contact.

• An invitation from the American Nurses

Association to submit public comments

on the individual nomination for the

National Quality Forum’s Regionalized

Emergency Care Services Steering

Committee.

• An invitation to support and contribute to

the 2012 Foundation of the National

Student Nurses Association Scholarship

fund.

• An invitation from the Pediatric Nursing

Certification Board to attend the 3rd Annual

Invitational Forum for Pediatric Nursing on

October 27-28, 2011, in Washington, D.C.

Michael Vicioso, MSN, BS, RN, CPEN,

CCRN, is ENA’s representative.

• An invitation to attend the Southern

Nevada’s Black Nurses Association’s 15th

Anniversary reception. The invitation was

forwarded to the Nevada ENA State

Council president for consideration.

• An invitation from the Substance Abuse

and Mental Health Services Administra-

tion to participate at the Conference on

Improving Care for Child and Adult

Behavioral Health Clients with Suicidal

Ideation and Behavior in Emergency

Department Settings, July 26-28, 2011, in

Baltimore. Karen Wiley, MSN, RN, CEN,

represented ENA.

• An invitation from the U.S. Department of

Homeland Security\FEMA Ready

Campaign to participate in its National

Preparedness Month Coalition.

• Agreed not to support the following

initiatives:

• An invitation to attend the American

Association of Colleges of Nursing’s Fall

Semiannual Meeting reception on

October 23, 2011, in Washington, D.C.

• An invitation to sponsor or provide

contributions for the reunion of

1965–1973 Vietnam veterans and their

families of the 3rd Field Hospital in

Saigon.

• Approved the Enhanced Next Generation

9-1-1 Systems position statement as

presented.

• Approved the list of Emergency Nursing

Resources topics slated for completion in

2012.

The ENA board of directors met September 23,

2011, at the Tampa Convention Center. All

members of the board of directors were present.

The board took the following actions:

• Approved board governance policy 3.12,

National Candidate Publicity and Campaign-

ing, as amended.

• Approved board governance policy 3.17,

National ENA Voting Process, as amended.

• Approved board governance policy 3.18,

Candidate Background Screening, as amended.

The next meeting of the ENA board of directors

will be held at ENA headquarters in Des Plaines,

Illinois, December 9, 2011.

BOARD HIGHLIGHTS |

August and September 2011

Board Meeting Actions and Highlights

ENA Call for…

Applications for the 2012 Class of FellowsThe Academy of Emergency Nursing will

accept applications for the 2012 class of

fellows through 5 p.m. CST, January 16, 2012.

Information and a link to the applica-

tions are available under “Calls and

Opportunities” at www.ena.org/Pages/default.aspx.

Questions? Please contact Ellen Siciliano,

practice specialist, at academy@ena.org.

Official Magazine of the Emergency Nurses Association 37

Joy believes support is essential when

dealing with disaster preparedness.

“You react to disaster because that’s your job.

Some of our nurses who are administrators

were at the concert. Some of our friends were at

the concert, so you’re trying to be the nurse and

think about where your family and friends are

and if they are OK. It takes a strong team to

handle a situation like this, and I think we all

worked really well together. The support

provided for the staff and patients that night

was important and executed well by a very

skilled team of care providers. I am so proud to

work with this group of individuals,” Joy said.

Making A Difference Allison Tann, BSN,

RN, CEN, a charge

nurse at Indiana

University Health,

Methodist, saw a

mother of one of the

stage collapse

victim’s standing

alone outside of the

ICU a week after the

tragedy. As Tann headed to the elevators, she

felt an urge to talk to her. The two made eye

contact, and in that moment, Tann made

a connection with her.

“I gave her a hug and let her know that I was

praying for her and her family. We both cried.

Unfortunately, we don’t get to connect much

with the patients because we’re in such a

fast-paced environment and we know that we

need to perform life-saving measures in order

for these patients to even make it out of our

department,” Tann said. “We don’t know their

story, we don’t know their family, but our role

is extremely important in their survival and

how they are treated throughout their stay in

the hospital.”

Tann says that working the State Fair tragedy

was an experience she won’t forget. She found

herself in awe as staff came together during the

tragedy.

“That’s why we do what we do. These events

that happen—they are moments in our careers

that we will never forget. It’s amazing that I had

the opportunity to be a part of this profoundly

exciting team of individuals. I know that I

belong here,” Tann said.

Duffy also had an opportunity to speak with

the parents of one of the victims and explain to

them what occurred in the emergency depart-

ment.

“It became pretty apparent that they were

settling in for a long visit at our hospital and

they realized it very early on. I think allowing

them to see our department and hearing what

their loved one went through initially helped to

create a better picture for them because it was

something that was just so shocking and

unexpected. They were very grateful for the

care that the patient received in the ER,” Duffy

said. “I think that once all of us have that initial

connection with our patient, especially during a

night like that, we feel that bond continue.”

Another mother of one of the injured young

men came down a couple days after the

incident to bring a cake and express her

appreciation for the care her son received in

the emergency department.

“Something that’s interesting is that the

grieving has been so public with this and it’s

been across the community. I think that the

entire hospital as a community has grieved

along with the families, and from what I can

gather, I think the families felt they have

become part of the Methodist family as well,”

Duffy said. “I think we also have a very high

performing team of health care professionals,

from our respiratory therapist to our nurses.

We had valuable resources available for all of

our patients, especially our critically-ill patients,

and great technology that these families were

able to benefit from.”

Although the disaster happened so quickly,

Hendershot believes that emergency nurses are

well-equipped and prepared to handle disaster

situations.

“I think an emergency nurse is trained to

respond to such disasters and brings a skill level

that no others have. They were calm, organized

and purposeful. It may have seemed chaotic to

others not used to the pace, but to an

emergency nurse, it was a perfect example of

the performance of a highly functioning team.

At the end of it all, the emergency nurse knows

that he or she made a difference and is part of

something much bigger than himself or herself,”

Hendershot said.

don’t have to be a trauma center to deliver

awesome care to trauma patients.”

* * *

Reno is a close-knit community, and the air

races have been a part of its fabric for nearly

half a century. Debriefing, defusing and collec-

tive healing have been ongoing for the

emergency workers who responded to the

accident, which ultimately claimed 11 lives.

Boscovich, who has worked at a Level I

trauma center, said she pressed a “mute button”

on her feelings while treating patents that day.

Later she was able to reflect more emotionally

on her own circumstances. Her son had fallen

asleep as they were approaching the gate to

enter the air show that afternoon. No one

wanted to wake him, so her husband and his

friends, already inside, agreed to leave early.

Had they stayed, they all would have been

sitting in the box-seat area, directly in the

damage path.

At a restaurant afterward, “We were just

really grateful to have each other and to all be

OK,” Boscovich said. “We could have lost

everyone at that table.”

Hunt had similar reason to be thankful. Not

only had her husband, his father and his best

friend been sitting 200 feet from the crash site,

but in those uncertain moments after the first

alerts went out, there was her staff to think

about. Saint Mary’s had seats set aside in the

reserved area, and some of the nurses, including

Eisenbarth, had been taking turns checking out

the action. The “what if” haunts Hunt.

“I could have lost my own personal blood

family, but this could even have been a bigger

impact because we could have lost our family

in the department or family within our hospital

system,” she said.

Lillibridge and her husband, air enthusiasts

from thousands of miles away, don’t think

they’ll return to Reno next year, assuming the

races go on. Their recovery required leaving

town the next day for Lake Tahoe, where they

had stayed at a bed-and-breakfast nine years

earlier. In need of a safe shelter where they

could be alone together with their feelings, they

struggled to remember the name and location of

that peaceful place with the wonderful owners.

Finally they just chose a B&B with an available

room and drove to find it.

It ended up being the same place they

remembered.

“I think it was divinely inspired,” Lillibridge

said.

That’s the spiritual side of her story. But her

takeaway message to emergency nurses is about

controlling their own destinies: being prepared

for that moment when mass trauma might

literally drop out of the sky. That means getting

TNCC verification and keeping it current.

“The emphasis is, our training works,”

Lillibridge said. “Just do it. You never know

where you’re going to be. I never expected that

I would be doing this, and yet I had all my

skills. I had what I needed. I told people, ‘I’m

coming to the ENA Conference and I just

wound up being a field nurse.’”

Deadly Indiana Stage Collapse Continued from page 15

Allison Tann, BSN, RN, CEN

Disaster Drops on Reno Continued from page 19

November 201138

(www.ena.org/government/Advocacy/Pages/ Default.aspx) to help ENA members develop

policies and programs to promote collaboration in

their local communities.

Quality patient care and staff safety is the third

priority. ENA believes that evidence-based

policies for preventive and protective measures

can enhance a culture of safety and reduce the

impact of violence in the workplace. As example,

the ENA Workplace Violence Toolkit (www.ena.org/IENR/ViolenceToolKit/Documents/ toolkitpg1.htm ) provides information and

guidance for developing and implementing

a comprehensive plan to manage violent

behaviors in the emergency department.

Another prevention strategy coincides with the

EDPCC recommendation to use screening, brief

intervention, referral and recovery treatment

services for all emergency patients at risk of

suicide, violence and SUD.

We do know what is best for our behavioral

health patients. Together we must act to:

1. Incorporate SBIRT for all emergency

patients into our everyday practice.

2. Promote the use of the ENA Workplace

Violence Toolkit.

3. Advocate for increased funding for the

Substance Abuse and Mental Health Services

Administration and other federal programs

that provide state block grants for behavioral

health services.

4. Advocate for care equivalent to that given

to other medical conditions.

5. Advocate for adequate community-based

systems to provide comprehensive care.

6. Advocate for research funding to identify

best practices for creating a safe work

environment.

Patients with mental health and substance use

disorders deserve to have the same priority of

care as patients with medical/surgical problems.

Join your ENA colleagues—decide what your

action will be and begin today.

References 1. AHRQ statistical brief #92 of July 2010 on

Mental Health and Substance Abuse-Related

Emergency Department Visits among Adults,

2007. Available at: www.hcup-us.ahrq.gov/reports/statbriefs/sb92.pdf. Accessed July 26, 2011.

2. Mental Health Financing in the United States:

A Primer. Kaiser Commission on Medicaid

and the Uninsured. April 2011. Available at

www.kff.org/medicaid/upload/8182.pdf. Accessed July 22, 2011.

3. Substance Abuse and Mental Health Services

Administration, Leading Change:

A Plan for SAMHSA’s Roles and Actions

2011-2014. HHS Publication No. (SMA)

11-4629. Rockville, MD: Substance Abuse

and Mental Health Services Administration,

2011. Available at store.samhsa.gov/product/SMA11-4629. Accessed July 15, 2011.

4. The President’s New Freedom Commission

on Mental Health. Achieving the Promise:

Transforming Mental Health Care in America.

Available at govinfo.library.unt.edu/mental-healthcommission/reports/FinalReport/downloads/downloads.html. Accessed July 14,

2011.

5. Ibid

Board Writes Continued from page 4

PROVE YOUR KNOWLEDGE...

BECOME A CERTIFIED EMERGENCY NURSE

To learn more about becoming a Certifi ed Emergency Nurse,

visit www.BCENcertifi cations.org.

Validate your expertise to your employer, your colleagues and yourself.

EMERGENCY NURSE

CEN_BCEN_recruitment Connections HP Island Ad.indd 1 12/21/2009 9:54:43 AM

Statement of Ownership, Management and Circulation(Required by 39 U.S.C. 3685). Title of publication: ENA Connection. Publication no.: 1534-2565. Date of filing: October 4, 2010. Frequency of issue: Monthly. Number of issues published annually: 11. Annual subscription price: members, free; non-members, $50 U.S., $60 foreign. Complete mailing address of known office of publication: 915 Lee Street, Des Plaines, Cook County, Illinois 60016-6569. Complete mailing address of the headquarters or the general business office of the publisher: 915 Lee Street, Des Plaines, Cook County, Illinois, 60016-6569. Publisher: Emergency Nurses Association, 915 Lee Street, Des Plaines, Cook County, Illinois, 60016-6569. Amy Carpenter Aquino, Editor in Chief: 915 Lee Street, Des Plaines, Cook County, Illinois, 60016-6569. Owner: Emergency Nurses Association, 915 Lee Street, Des Plaines, Cook County, Illinois, 60016-6569. Known bondholders, mortgagees, and other security holders: None. Issue Date for Circulation Data: September 2011. Extent and nature of circulation: A. Total Number of Copies: Average number of copies each issue during preceding 12 months (hereinafter “Average”), 40,829. Actual number of copies of single issue published nearest to filing date (hereinafter “Most recent”), 40,065. B. Paid circulation: B1. Outside-county paid subscriptions stated on Form 3541: Average, 39,553. Most recent, 38,712. B2. In-county paid subscriptions stated on Form 3541: Average 0. Most recent, 0. B3. Paid distribution outside the mail including sales through dealers and carriers, street vendors, counter sales, and other paid distribution outside USPS: Average 383. Most recent, 376. B4. Paid distribution by other classes of mail through the USPS: Average, 0. Most recent, 0. C. Total paid distribution (sum of B1, B2, B3, and B4): Average 39,935. Most recent, 39,088. D. Free or nominal fee rate distribution. D1. Outside-county copies included on Form 3541: Average, 21. Most recent, 25. D2. In-county copies included on Form 3541: Average, 0. Most recent, 0. D3. Copies distributed through the USPS by other classes of mail: Average, 0. Most recent, 0. D4. Copies distributed outside the mail: Average, 18. Most recent, 200. E. Total. Free or nominal rate distribution (sum of D1, D2, D3, D4): Average 43. Most recent 217. F. Total distribution (sum of C and E): Average: 39,978. Most recent, 39,305. G. Copies not distributed: Average, 851. Most recent, 760. H. Total (sum of F and G): Average 40,829. Most recent, 40,065. I. Percent paid (C divided by F times 100): Average, 100.0%. Most recent, 99.0%. This Statement of Ownership will be printed in the November 2011 issue of this publication. I certify that the statements made by me above are true and complete. Amy Carpenter Aquino, Editor in Chief. Date: October 4, 2011.

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