ena connection november 2012

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INSIDE FEATURES the Official Magazine of the Emergency Nurses Association November 2012 Volume 36, Issue 10 c onnection NEW THIS MONTH: Members in Motion PAGE 4 Leadership Conference 2013 What’s to Come PAGE 14 The Emotional Rewards of the ENA Foundation PAGE 16 What We’re Doing to Make It Better for Behavioral Health Patients in the ED Pages 6-7, 11-13 PLUS: Emergency Nurses Spring Into Action After Aurora Theater Shooting Pages 8-10 Help Is On the Way

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ENA Connection November 2012

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Page 1: ENA Connection November 2012

INSIDE FEATURES

the Official Magazine of the Emergency Nurses Association

November 2012 Volume 36, Issue 10

connection

NEW THIS MONTH: Members in Motion PAGE 4

Leadership Conference 2013 What’s to Come PAGE 14

The Emotional Rewards of the ENA Foundation PAGE 16

What We’re Doing to Make It Better for Behavioral Health Patients in the ED Pages 6-7, 11-13

PLUS: Emergency Nurses Spring Into Action After Aurora Theater Shooting Pages 8-10

Help Is On the Way

Page 2: ENA Connection November 2012

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Stryker is proud to be an ENA Strategic Sponsor and support nursing excellence through important initiatives such as the ENA Workplace Injury Prevention Toolkit and the ENA Lantern Award. Program Criteria for the ENA Lantern Award funded, in part, by Stryker.

Page 3: ENA Connection November 2012

Official Magazine of the Emergency Nurses Association 3

The holiday season is just around

the corner, and people soon will

be decorating, gathering at parties,

carving turkeys and shopping for

that perfect gift. While some will

be enjoying the excitement of the

holidays with loved ones,

others may not be as fortunate.

Television, film and

advertisements may depict

expectations for the holidays that

seem unrealistic to many of us.

Some of us – staff and patients –

face challenges and may not be

able to afford those holiday

celebrations. Some of us may be

remembering the loss of loved

ones. For others, there may be no

family, or only an estranged one,

and holidays can bring to mind

what is forgotten the rest of the

year.

During the holidays, some

won’t be able to shake the

depression that descends and

engulfs them, either because of

sad reminders or because of SAD,

seasonal affective disorder, a form

of depression that may be related

to a season, in this case, one with

shorter days, less sunlight and/or

inclement weather interfering with

normal activities. A problem for

people around the globe, 5

percent, or 15 million, Americans

suffer severely from SAD, with

symptoms of hopelessness,

increased appetite and weight

gain, increased sleep, less energy,

an inability to focus, loss of

interest in work and activities,

social withdrawal, irritability and

feelings of depression. Another 33

million feel some moodiness or

loss of creativity or productivity

during the winter, according to

the National Institute of Mental

Health.

If you or your patients are

severely affected, there is a wide

variety of effective therapies,

such as medication, hormone

supplements, light therapy,

cognitive behavioral therapy,

vitamin regimens and physical

exercise of which to be aware. If

you are mildly affected, begin to

make plans with friends or

co-workers ahead of time to keep

yourself busy during the holiday

season. Volunteer to help people

less fortunate than you – on a

medical mission, in a homeless

shelter or with a parish nurse.

Your ED staff may have cared for

patients this past year with

devastating injuries, or victims of

mass casualties and their families

who may appreciate being

remembered in some meaningful

way. Lastly, summon the energy

to share feelings of isolation and

seek support during this difficult

time.

This particular holiday season,

more people may be vulnerable

to sadness and situational

depression, given the loss of jobs

and financial hardship as a result

of the current economy, so be

alert for subtle changes in the

mood of those around you, and

offer a lifeline when it is needed.

In the end, the very best gift of

the season may be the support we

give to others, something at which

emergency nurses excel!

Reference

Nursing Care Plan Seasonal

Affective Disorder. (2010).

Retrieved from www.enurse-

careplan.com/2010/10/

nursing-care-plan-ncp-

seasonal.html.

Dates to Remember

PAGE 3Letter from the President

PAGE 4NEW! Free CE of the Month

PAGE 4NEW! Members in Motion

PAGE 5ENA Connected

PAGE 16ENA Foundation

PAGE 17Course Bytes

PAGE 18Washington Watch

PAGE 20Ready or Not?

PAGE 22State Connection

PAGE 23ENA Call For . . .

Monthly Features

Nov. 12, 2012 Deadline for applications for the Blue Jay Consulting/ENA Award for Outstanding Nurse Leader of the Year, to be presented Feb. 28, 2013, in Fort Lauderdale, Fla., at Leadership Conference 2013.

Nov. 30, 2012 Deadline for applications for the Academy of Emergency Nursing’s 2013 class of fellows.

Jan. 15, 2013 Deadline for poster submissions for 2013 Annual Conference in Nashville, Tenn.

March 15, 2013 Deadline for proposed bylaws and resolutions for 2013 General Assembly at Annual Conference in Nashville, Tenn.

PAGE 8A Special Midnight Showing: Colorado Theater Tragedy Brings Out the Best in ED Staff Reponse

PAGE 11Board Writes: Caring for Behavioral Health Patients in the ED

PAGE 12The National Council Mental Health and Addictions Conference

PAGE 14What’s to Come at Leadership Conference 2013

PAGE 23ENA Report from NEMSAC

ENA Exclusive Content

The (Not So) Happy Holidays

LETTER FROM THE PRESIDENT | Gail Lenehan, EdD, MSN, RN, FAEN, FAAN

Coming in December

• 2012 Annual Conference Coverage from San Diego• Spotlight on the Historical Perspectives Work Team• More Coverage of ED Response to the Colorado Theater Shooting

Page 4: ENA Connection November 2012

November 20124

On her mission to improve medication safety, Susan

Paparella observes and advises health care

professionals around the country. This year, her

work couldn’t have brought her closer to home.

Paparella, MSN, RN, who earned both her

nursing degree and master’s at Villanova University,

was honored April 14 with a Villanova College of

Nursing Medallion — the college’s highest

recognition — for ‘‘Distinguished Contributions to

Clinical Practice.’’ The presentation occurred during

the 23rd Annual Mass and Alumni Awards program

held at St. Thomas of Villanova church, where

Paparella was married and where her first son was

baptized. She’d only days earlier learned her second

son had been accepted as a Villanova student.

The experience, she said, was ‘‘wonderful.’’

‘‘It was a little intimidating to be standing in front

of Villanova faculty members, all experts in the field

of nursing,’’ Paparella said. ‘‘It was because of their

encouragement and mentorship that I have been

able to accept challenges throughout my career.

The faculty at Villanova was instrumental in helping

me recognize how essential clinical inquiry is to

advancing nursing practice and patient safety

science. They shaped my values and gave me a

voice as a professional nurse.’’

Today she’s educating practitioners far and wide.

As vice president of the Horsham, Pa.-based Institute

for Safe Medication Practices, Paparella develops

consulting and educational services and travels in

that role, helping hospitals to adopt safe medication

practices to avoid harmful errors. ISMP is a

non-profit 501(c)(3) charity and operates the only

practitioner-based medication error reporting

program in the U.S. While it doesn’t set standards for

medication use, it collaborates with the bodies that

do (including the FDA and the Joint Commission).

‘‘I feel lucky because I get to connect with my

ED colleagues regularly and understand what their

challenges are,’’ Paparella said. ‘‘ED nurses face a

number of issues that have the potential to impact

safe clinical practice. We need to understand: How

do you combine the complex task of medication

use within a challenging ED environment and do it

in a way that will avoid inadvertent patient harm?’’

Paparella’s ties to her alma mater have become

stronger over the years. She has lectured to

undergraduate students and is working with faculty

on a safety-related research project.

‘‘I see their graduates on a regular basis, and

they’re always such high caliber, which makes me

very proud to be one of them,’’ she said.

An ENA member since 1994, Paparella is a former

chairperson of ENA’s Patient Safety Work Group.

Currently she is a member of the Advisory Committee

for ENA’s Institute for Quality, Safety & Injury

Prevention. She is an adjunct assistant professor at

the Temple University School of Pharmacy and the

author of ‘‘Danger Zone,’’ a column on medication

safety in the Journal of Emergency Nursing.

‘‘Susan Paparella is a leader in patient safety on a

national and global stage,’’ said M. Louise Fitzpatrick,

EdD, RN, FAAN, a dean and professor of the College

of Nursing. ‘‘She uses her comprehensive knowledge

and background to influence changes in practice and

improve patient care outcomes. We are proud to say

she is a Villanova nurse.’’

Josh Gaby

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© 2012 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: [email protected]

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

Editor in Chief:Amy Carpenter AquinoAssistant Editor, Online Publications:Josh GabyWriter:Kendra Y. MimsEditorial Assistant:Dana O’DonnellBOARD OF DIRECTORSOfficers:President: Gail Lenehan, EdD, MSN, RN,

FAEN, FAANPresident-elect: JoAnn Lazarus, MSN, RN,

CEN

Member Services: 800-900-9659

Secretary/Treasurer: Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN

Immediate Past President: AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN

Directors:Kathleen E. Carlson, MSN, RN, CEN, FAEN Ellen (Ellie) H. Encapera, RN, CEN Mitch Jewett, RN, CEN, CPEN Marylou Killian, DNP, RN, FNP-BC, CENMichael D. Moon, MSN, RN, CNS-CC, CEN,

FAENMatthew F. Powers, MS, BSN, RN, MICP, CENKaren K. Wiley, MSN, RN, CEN

Executive Director: Susan M. Hohenhaus, LP.D., RN, CEN, FAEN

‘Leader in Patient Safety’ Makes Villanova Proud

SPOTLIGHT ON YOU!Do you have a professional or educational

achievement you want your fellow ENA

members to know about? Do you want to sing

the praises of a member colleague who has

received a new degree, promotion or award?

We encourage you to submit these items to

[email protected] for inclusion in monthly

roundups in the new “Members in Motion”

section. Include names, credentials, a short

explanation of the accomplishment and a

high-resolution photo (if available), along with

contact information for follow-up by the ENA

Connection staff for select features.

With a new month comes a new

opportunity for free continuing

education through ENA. Our

November offering, worth 1.0 contact

hours, is “Prevention of Health

Care-Associated Infections,” a

webinar presented by Rhonda

Morgan,

DNP, RN,

CEN,

CNRN,

CCNS,

APN. The

course

focuses on the major types of health

care-associated infections, identifies

the causes and risks and explores

prevention strategies the emergency

nurse can use to keep them from

developing.

To take the course and earn

your credit:

• Go to www.ena.org/freeCE,

where you’ll log in as an ENA

member (or create a new

account).

• Add the course to your cart and

“check out” (no charge for

members).

• Proceed to your personal

learning page to start or

complete a course for which

you have registered or to print

a certificate when you’re done.

It’s as simple as that.

ENA has a growing back catalog

of free CE courses on a range of

topics, so if you haven’t yet taken

them, complete the checkout process

for each course you want.

Free education at your leisure, at

the comfort of your computer, is just

one of the perks available to you as

an ENA member, and response has

been enormous. Take full advantage!

Susan Paparella, MSN, RN, at her award presentation.

The Board of Certification for Emergency Nursing (BCEN®) certifications help you take the next step in your career.Demonstrate your commitment to competency; earn a BCEN certification today.

Earn Your Mark of Distinction

Find out more...www.BCENcertifications.org

Page 5: ENA Connection November 2012

It was great having the opportunity to meet so many of you at the ENA

Wired lounge at the Annual Conference in San Diego. For the first time,

we were able to provide an immersive social media experience for not

only those who attended but also for many who were unable to make

the conference. Using Facebook, Twitter and Foursquare, you were able

to follow what was happening at conference, participate by posting or

tweeting your experience and even check in at various conference

events.

Fast-forward to what we have in store for Leadership Conference,

where social media will be even further integrated with your overall

conference experience — right down to being able to share the website

(www.ena.org/lc) with your colleagues through Twitter or Facebook.

Providing this level of experience allows you to use your mobile

devices and network on the fly without taking away from your ability to

attend all the sessions you want. Meet up with colleagues, discuss

experiences, share photos or stories with your peers back home — all

of these possibilities are simply a click away through any of our social

media avenues.

As ENA continues to advance and grow technologically, we look for

ways to enhance your experience as members. This is just one of the

many ways we hope to shape the future and provide you with the

ultimate networking experience, whether during conference or

throughout the rest of the year.

ENA Connected

By Thomas Barbee, ENA Digital Marketing Manager

Taking the Next Steps With Social Media

The Board of Certification for Emergency Nursing (BCEN®) certifications help you take the next step in your career.Demonstrate your commitment to competency; earn a BCEN certification today.

Earn Your Mark of Distinction

Find out more...www.BCENcertifications.org

Page 6: ENA Connection November 2012

November 20126

A few weeks ago, ENA member Claudia Ayala-

Rivera, RN, CPEN,* was preparing to start an IV

on a 15-year-old female when she noticed an

unusual number of cuts on the girl’s forearm.

They appeared to be fairly superficial and in

various stages of healing. Ayala-Rivera pulled

the patient’s mother aside and asked her about

the wounds. The mother explained very matter-

of-factly, ‘‘She and her sister think it’s fun to cut

on their arms like that.’’ It was a form of play

for them, the mother explained. However,

Ayala-Rivera recognized this behavior as a

method of stress relief and a symptom of a

larger problem.

She discussed this with the emergency

physician, who then helped Ayala-Rivera

educate the family about cutting, a common

form of non-suicidal self-injury. The patient

received a behavioral health assessment in the

ED and was later discharged with a referral for

outpatient psychiatric treatment.

What is Non-Suicidal Self Injury? Self-harm behaviors such as cutting and burning

are impulsive behaviors which involve

conscious decisions to mutilate or hurt oneself

without suicidal intent.1,2,3 Injuring oneself can

stimulate endorphins (naturally occurring

opiates) which are produced by the brain in

response to pain.4 These acts provide instant,

temporary release and relief from stress, anger

and other negative feelings.2,4 Common sites for

cutting and other forms of NSSI are the arms,

wrist, ankles and lower legs.2 NSSI is usually

performed at least once a week in a private

setting, such as a bedroom.2 Occasionally, such

as in the case of Ayala-Rivera’s patient, the

family is aware of the self-injury and accepts the

behavior as a form of play or a harmless coping

mechanism.

Self-injury can be extremely addictive, and

without psychiatric treatment it often continues

for several years, even into adulthood.2 Due

largely to a lack of understanding about self-

injury and to the stigmas that surround it, this

behavior is often perceived by others (including

health care professionals) as being manipulative

or attention-seeking.5

Looking Beyond the Scars The rate of NSSI is higher in adolescents and

young adults than in the general population

— 14-21 percent vs. about 4 percent,

respectively.1 Females are more likely to engage

in NSSI than males.2 The rate is also up to

six-fold higher in people who have been

exposed to physical violence or threat to life.1

NSSI, while not currently recognized by major

medical classification systems as a separate

mental health disorder, is recognized as a

symptom of borderline personality disorder.3,4

(While searching online for website resources to

list in this column, I noticed that NSSI was

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

Coping Mechanism, or a Cry For Help?

Non-Suicidal Self-Injury in Adolescents

Page 7: ENA Connection November 2012

Official Magazine of the Emergency Nurses Association 7

usually found only under the heading of BPD.)

However, according to the research, NSSI in

adolescence, especially, does not seem to be

limited to those to suffer from BPD. It is a

behavior found not only in adolescents who

suffer from other psychopathologies but also in

those who practice various forms of ‘‘indirect

self-injury,’’ such as substance abuse, eating

disorders and abusive relationships.1 NSSI can

even be found in adolescents with no history of

any of the above behaviors or conditions.1

NSSI and Suicide RiskA 2011 study by St. Germain and Hooley found

that compared to individuals who engage only

in indirect self-injury (risky behaviors/lifestyles),

those who engage in NSSI are ‘‘much more

harshly self-critical … the individuals who

engage in NSSI may regard suffering and pain

as something that they deserve’’ (page 81). Not

surprisingly, they are also more prone to

suicidal tendencies and have higher rates of

suicide attempts.1,6 The time immediately after

an episode of NSSI holds the greatest risk of both

repeated NSSI and completed suicide.6

Attitudes, Assessments and ReferralsSometimes, as in Ayala-Rivera’s case, the

patient’s family is unconcerned about the

behavior. Often the NSSI is not the primary

reason for the ED visit but a secondary finding

during the nurse or physician assessment.

Health care providers who identify a self-

cutting injury need to determine whether the

injury was part of a suicide attempt or a

self-cutting episode.

Asking nonjudgmental questions about the

length of time the behavior has been used, and

how, when and why it is performed is

appropriate and will help ED providers guide

the patient toward the appropriate referral and

subsequent care.2 Much inconsistency exists in

the frequency of both ED mental health

assessments and outpatient mental health

treatment for patients who engage in NSSI.6

Emergency departments are in a position to

help close these gaps in care by providing

mental health assessments while the patient is

in the ED, when possible, and by providing

potentially life-saving referrals for follow-up

mental health services.

Finally, staff knowledge and attitudes are

also vital to the effective management of

patients who self-injure; those who lack

knowledge on the subject of NSSI are most

likely to exhibit negative attitudes toward these

patients.5 Health care professionals, as well as

school staff (both are often the first to identify

self-injurous behavior) can help de-stigmatize

self-harm behavior by educating themselves

and thereby becoming more effective providers

of support and care.5 We should all focus not

on the scars themselves, but on the people

behind the scars.

Resources and References

1. St Germain, S. A., & Hooley, J. M. (2012).

Direct and indirect forms of non-suicidal

self-injury: Evidence for a distinction.

Psychiatry Research, 197(1-2), 78-84. doi:

10.1016/j.psychres.2011.12.050

2. Puskar, K. B., Bernardo, L., Hatam, M., Geise,

S., Bendik, J., & Grabiak, B. R. (2006). Self-

cutting behaviors in adolescents. Journal of

Emergency Nursing, 32(5), 444-446. doi:

10.1016/j.jen.2006.05.025

3. Plener, P. et al, Prone to excitement:

Adolescent females with non-suicidal self-

injury (NSI) show altered cortical pattern to

emotional and NSS-related material,

Psychiatry Research: Neuroimaging(2012),

doi:10.1016/j.

pscychresns.2011.12.012

4. National Alliance on Mental Illness Website.

Accessed 10/1/2012: www.nami.org

5. Timson, D., Priest, H., & Clark-Carter, D.

(2012). Adolescents who self-harm:

Professional staff knowledge, attitudes and

training needs. Journal of Adolescence, 35,

1307-1314

6. Olfson, M., Marcus, S. C., & Bridge, J. A.

(2012). Emergency treatment of deliberate

self-harm. Archives of General Psychiatry,

69(1), 80-88. doi: 10.1001/

archgenpsychiatry.2011.108

7. Helpguide.org (a great website for patients

who self-harm as well as the health care

providers who care for them). Accessed

10/1/2012.

* Claudia Ayala-Rivera’s name and story used

with her permission.

Grow your career when you become part of ENA Leadership Conference Faculty. Share your leadership knowledge, experience and skills to help grow the profession of emergency nursing.

Do you have specific knowledge in a particular area of emergency nursing, management or policy?

Has a particular experience given you new insights into a current issue or trend and led to new best practices?

Do you have experience dealing with leadership challenges and issues?

Establish Yourself as a Leader

Submission Deadline is March 25, 2013

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

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

Find full information and course proposal guidelines at www.ena.org and click on Leadership Conference 2014 Call for Course Proposals in the Calls and Opportunities Section. We look forward to hearing your cutting-edge course ideas.

Share your insights related to current issues, trends, and best practices as a faculty member at ENA Leadership Conference 2014, March 5-9 in Phoenix, Arizona

Topic areas:

Join the faculty for ENA Leadership Conference 2014, Phoenix, March 5-9

Page 8: ENA Connection November 2012

November 20128

July 20, 2012, Aurora, Colo. 12:30 a.m.When Jennifer Hahn-Farris, RN, charge nurse at the Medical Center of

Aurora, received word from the onsite emergency department police

officer that a shooting had occurred at the Town Center at Aurora

shopping mall, she figured it was gang-related and organized her trauma

nurses to prepare the trauma rooms for gunshot wounds. Because the

hospital is located about two miles from the mall, Hahn-Farris expected to

receive two or three patients, so she also notified the lab, along with the

ICU charge nurse. It wasn’t until she returned to triage five minutes later for

an update that Hahn-Farris realized the magnitude of the shooting: More

than 20 victims had been shot at close range in a crowded movie theater.

Hahn-Farris took a deep breath and received the first victim in triage at

the same time she received the update. The

patient was eight months pregnant with

significant injury to her face. With limited time to

assess the patient, the patient was categorized as

their highest level of trauma team activation and

taken back to the trauma room.

Hahn-Farris immediately huddled with her

triage nurses and told them there were unknown

severities and that they needed to be ready for

the worst-case scenario. Her nurses began

moving all of the stable patients out of the

rooms as quickly as possible to make room for the ones soon to come.

The triage nurse moved all of the patients who were already in the

waiting room before the shooting incident to an urgent-care area so that

they could be spared from seeing any traumatic visual images caused by

the mass shooting. Hahn-Farris called ICU, requesting every ICU nurse

who was available, and contacted her emergency department director to

inform him of the situation.

Patients started arriving two to three at a time via police cars. Hahn-

Farris said her team was able to quickly identify which patients could be

in the hallway vs. which patients that needed to be in the trauma room.

‘‘My team was phenomenal, and they did a great job at assessing the

patients and their GCS levels immediately,’’ she said. ‘‘At no time did my

staff become unorganized or chaotic. We took every single patient and

moved them on a constant basis for acuity and straight to the OR.

Everyone just did what they needed to do for the best of the patient.’’

Many patients arriving needed immediate life-saving interventions.

Thoracostomies were started instantly. Hahn-Farris assigned ED nurses

and ICU nurses to work one-on-one with every victim. She quickly

realized that doctors were not able to go from the patients to the

computer to enter orders as usual, so she switched to an efficient system

for communicating orders. Order sheets and labels went on the patients so

that physicians could write orders and give them directly to her secretary.

Hahn-Farris and her nurses didn’t have time to prepare for the obstacles

they would encounter during the next several hours.

‘‘We were already full, but we had life-threatening emergencies,’’ she

said. ‘‘Gunshot wounds can’t wait.’’

12:55 a.m.Emergency department director Mark Mayes was asleep when he received

the phone call. Hahn-Farris informed him that a mass shooting had

occurred and victims were coming in by police cars. There was also a

possibility of gas exposure. Mayes, MHA, RN, CEN, immediately threw on

scrubs and headed to the hospital and notified the hospital’s house

supervisor to use the external disaster page.

By the time Mayes arrived at 1:05 a.m., the hospital had already

received 11 patients from the shooting, and two were in the OR. He

huddled with Hahn-Farris to reassess patients and determine which ones

needed to go to surgery immediately with which surgeon. Mayes had an

administrative worker send out an all-response page to every ED

employee via text message, and staff immediately responded.

‘‘We got eight staff members that showed up to the ED to help, and

that was a perfect number for us to make sure we had plenty of people to

take care of the extra patients, as well as the patients who were not

involved in the tragedy but still needed ED care,’’ Mayes said.

Mayes also called in Justin Mast, RN, BSN, CEN, FAWM, the hospital

emergency response team coordinator, for

assistance with running incident command within

the ED. When Mast arrived, the ED was very full

and busy. The injuries were caused by range of

weapons, from large-caliber to small shotgun

pellets. There were limb and extremity injuries.

Torso, head and dental injuries. Shrapnel injuries.

Inhalation injuries. Twisted knees from running

and falling. Lodged bullets. Blowout shotgun

wounds to the leg.

Patients who needed immediate surgery were

already in the OR. Mast quickly assisted a patient

who needed a CT scan and evaluated several others

who complained of burning and itching before he

headed to the command center to facilitate what

was going on throughout the hospital.

Although the Medical Center of Aurora had

received an influx of patients from a plane crash

in 2009, the emergency response team and ED

staff had never dealt with a disaster of this

magnitude.

‘‘In the plane crash, we had advance notice and

16 patients who came scattered over an hour,’’

Mast said. ‘‘They were definitely less severely

injured, and the time frame of their arrival was spread out. This event had

really high-acuity patients arriving in a short period of time and a number of

them at the same time. There were multiple patients in police cars. The

immediate response of the staff with little notice was phenomenal.’’

Staff came to the ED from all over the hospital to help manage the

surge throughout the night.

‘‘I had folks come down to tell me, ‘I don’t know what to do, but I’ll do

whatever you need me to,’ ” Mast said. ‘‘The ED was hit hard and fast.

Everyone that was there did a superb job of trying to get people shifted

around to make extra room. We knew the patients were getting the care

they needed, and we were supporting them in the operating room.’’

The hospital typically runs a maximum of two ORs a night.

‘‘We received 18 patients from the incident. We opened up five ORs

that night,’’ Mayes said. ‘‘That was a big challenge that we had a lot of

help with. Our sister hospital, Swedish Medical Center, sent us OR nurses

By Kendra Y. Mims, ENA Connection

A Special Midnight Showing

Jennifer Hahn-Farris, RN

Mark Mayes, MHA, RN, CEN

Justin Mast, BSN, RN, CEN, FAWM

Colorado Theater Tragedy Brings Out the Best in ED Staff Response

Page 9: ENA Connection November 2012

Official Magazine of the Emergency Nurses Association 9

and scrub techs to help us because they knew we

would get the brunt of the patients. It’s amazing

how everyone came together to send resources.

We had staff from the labor and delivery

department, ICU and our trauma floor come down

to the ED to help. There were no walls up. All of

the walls were knocked down instantly when

people heard of this tragedy. People came from all

directions willing and wanting to help.’’

Another challenge for staff was the limited

amount of space in the ED. Not only was the

Medical Center of Aurora’s emergency department

full before the shooting victims arrived, but it also

was under construction for remodeling. The four

main trauma rooms were shut down, leaving only

two temporary trauma rooms in service. A total of

12 beds were out of service, and a third of the ED

was walled off for construction. As patients

arrived, they were treated in every area of the ED,

including the hallways. Mayes recalled one of the

patients losing his pulse in the hallway. The ED

physician didn’t have a trauma surgeon with him

at the time, so he inserted a chest tube himself,

decompressed the patient’s chest and revived him.

‘‘Every patient was able to get the care they

needed,’’ Mayes said. ‘‘All of that is because of

how our emergency nurses and physicians worked

together. One thing that was very impressive is that

everybody clicked into mass casualty triage mode

and they still took good care of the patients.’’

Despite the severity of the injuries and how

they arrived at the hospital, all of the victims

treated at the Medical Center of Aurora survived.

Still, the night took a physical and emotional

toll. Some patients already knew their loved ones

were dead or missing. Along with treating patients

medically, the staff had to help them emotionally

and comfort concerned loved ones who arrived

looking for answers.

Separated and Searching Hahn-Farris remembers seeing patients

screaming in pain while bleeding all over — many

calling out for loved ones they could not find.

Because of the number of critically injured people

at the scene, police officers transported victims to

different hospitals in the area, and many patients

were separated from their loved ones. Others had

died at the scene.

‘‘When we were trying to help people find

loved ones, we didn’t even comprehend that there

were that many people dead on scene,’’ Hahn-

Farris said. ‘‘We were trying to be optimistic and

help them, and it started to hit us that we weren’t

going to find everybody because not everybody

was going to make it to an ER. It was difficult.

‘‘At some point we received a lot of advocates,

which I directed to the patients who I felt needed

the advocates the most.’’

The waiting room was quickly filled with

concerned parents and loved ones. The shooting

victims at the Medical Center of Aurora ranged

from 13 to 31 years old. Hahn-Farris did not know

many by name — she only knew them by injury.

But she also knew that all of the patients in her

ED were alive, and she went into the waiting

room to reassure the families.

‘‘Being a mom myself, I knew they were

terrified,’’ she said. ‘‘But I promised them that we

were taking care of them, and if they were

contacted via phone and they knew for a fact that

their loved one was in my ED, then everyone I

had was alive. I let them know that it’s a scary

situation, but to please stay calm so that we could

take care of them efficiently and quickly. They

responded well to that.

‘‘We connected the families as quickly as we

Mark Mayes, MHA, RN, CEN,

emergency department director of

the Medical Center of Aurora, said

the TeamSTEPPS implementation

that began in his ED two years ago

gave the staff tools to help increase

communication and accomplish

everything in a systematic manner

after the theater shooting July 20.

‘‘Because we already had this

framework in practice, one of the

simple things from TeamSTEPPS that

came out and really helped us was

having ‘huddles,’ situational

awareness, leaders in place and

using repeat back communication,’’

Mayes said. ‘‘Those things just

happened naturally.

‘‘I think the best part of the night,

as far as the ED was concerned, was

that all of the people who needed to

know what was going on were

aware. Our medical director, Frank

Lansville, was there, working hard

and informed. Our charge nurse,

Jennifer, was aware of everything.

Justin [Mast, emergency response

coordinator] knew. The doctors

knew. The surgery team knew. And

that’s because we had those

communication pieces like ‘huddles’

in place. That was our real saving

grace. There wasn’t uncontrolled

chaos or mass confusion. Our

communication was excellent in the

ED in such a chaotic situation.’’

Mayes commended his charge

nurse, Jennifer Hahn-Farris, RN, for

maintaining situational awareness

and for keeping her team going.

‘‘She took primary role of patient

flow and really did a very good job

with that,’’ he said. ‘‘Through the

TeamSTEPPS process, we developed

a team leader structure. That gave us

the right kind of communication

structure and the oversight we

needed to run the place as

efficiently as possible, to not lose

track of people and to not forget

about patients. We didn’t miss

something. I think it had a lot to do

with TeamSTEPPS.’’

Kendra Y. Mims

TeamSTEPPS Helps ED Staff Keep Order

Continued on page 10

Ph

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by K

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Geh

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The mass shooting by a lone gunman at the Century 16 theater in Aurora, Colo., shortly after midnight July 20 resulted in 12 deaths and scores wounded. No victims taken to the Medical Center of Aurora died of their injuries.

Page 10: ENA Connection November 2012

November 201210

could. That was really important to us. I

found my youngest patients and walked

parents back personally. It meant a lot to

me to really reassure these parents as a

mother, as their nurse and as the charge

nurse of the department that their

children had been cared for, and though

their injuries looked significant, they

were doing OK.’’

Administration quickly developed a

separate room for families to help support

them. Refreshments and counselors were

brought in. The Medical Center of Aurora

was the first hospital to set up a public

hotline to increase communication.

‘‘I think we can say that was a big

challenge for us,’’ Mayes said. ‘‘Multiple

patients went to different hospitals, so in

the beginning, we didn’t have a good

way to communicate where that family

member was or how they could find

their loved ones. It was tough because it

happened so quickly.’’

The AftermathHahn-Farris is proud of how her team

and colleagues responded and took care

of all of the patients despite the many

obstacles they faced throughout the night.

‘‘I don’t think we realized as

caregivers how big this was going to

be,’’ she said. ‘‘It’s amazing to me how

well everything flowed. My nurses

stayed focused. They stayed on point

and were able to give me all of the

information that I needed one-on-one

every time we huddled. We have a great

disaster team, and Justin is phenomenal

at what he does. It has changed us as a

team, it changed us as nurses, and it

changed me as a leader. This makes me

realize what our ED is capable of.’’

She says the shooting has created

some anxiety in some of her nurses who

treated patients that night.

‘‘For my nurses who smelled it and

heard it and who washed the blood off

of these patients and listened to their

stories, it increased their own anxiety of

why this happened and how many lives

were forever changed,’’ said Hahn-Farris,

who made sure she focused on her

nurses’ emotional status after the

incident. ‘‘We will forever have a

connection with these patients and hold

a special bond with each other.

‘‘It’s been a roller coaster of emotions

for a lot of our nurses, but I think that in

the end, everyone is doing well knowing

that every patient we received survived.

They all stepped up and listened to me

and had faith in me, but they also had

faith within themselves and faith in their

team. We got through all of it.’’

Hahn-Farris feels the nurses who

weren’t working that night also hold a

lot of pride in knowing they work for a

facility that provides support to staff and

high-quality care to patients.

‘‘I know they would have stepped up

and done the same thing,’’ she said. ‘‘As a

leader, I know that we are capable of a

lot. I’m very proud of what I do. I’m very

proud of my nurses. I’m very proud of

where I work, and I’m very proud of the

director [Mayes] that I have. We had

absolutely nothing to do with what

happened and had no control over what

happened, but I feel like we certainly

proved ourselves to the community that

above all else, when we are in that

position, we take it very seriously and

very close to our hearts. We are there for

a reason, and we are very available for

our city, and we will take care of

anybody to the best of our ability that

needs us.’’

Critical Incident ReviewMedical Center of Aurora – Mass Shooting, July 20

(Times shown are estimates)

Time Event Description

00:15 Suspect enters theater 9 and begins shooting

00:30 Ocean 1 in ED relays radio traffic to ED Charge

Nurse

00:51 1st patient arrival Patient Arrival Timeline

00:55 ED Charge RN Calls ED Director

00:57 ED Director calls House Supervisor, requests

disaster page

01:02 Page sent out “Internal disaster in ED”

01:05 ED Director arrived in ED

01:16 Text sent out to all ED staff to respond if

available

01:34 Call to open incident command made

01:48 1st conference call made

02:00 Level 2 lockdown initiated

02:00 1st patient decontaminated

02:30 All directors to respond, page sent out

03:00 Disaster radios dispersed

03:45 ED phone calls overwhelming, hotline requested

03:58 AFD I.C. confirms no more patient transports at

this time

04:06 9 News on site at TMCA

04:20 Decon of last contaminated patient

04:26 Decon team ceases operations

04:28 Hotline number set up

04:38 Live BBC phone interview- Frank Lansville

04:46 Increasing radio traffic, switch made to

Channel 2

05:20 Staff voicemail/emotional support set up

05:25 Possible volatile family situation, increased

security and APD presence

Media staging in 020

Spanish interpreter requested, EMT sent from ED

Meeting Room 1 & 2 open for patient families

05:45 Media Update at I.C.

06:20 Ryan Simpson, COO designated as Interfacility

Liaison

06:45 Hospital census update given at I.C.

Family update given to families waiting in

physician conference room

06:50 Hotline number found to be routing to voicemail

at patient billing

07:00 Update sent to media on hotline number

07:15 ED/OR/L&D staff and physician debrief in ED

Oasis room

08:57 I.C. Command to ED Director

09:20 I.C. Command to Administrator On-Call,

Roberta Barton-Joe

09:27 Jennifer Barry assigned as Logistics Chief

10:00 Some position transfers of command begin

211 and state-wide hotline set up

TV requested at family support center

10:36 Incident Command roles assigned and

communication structure reviewed

From left: Cassandra Hixson, RN; Justin Mast, BSN, RN, CEN, FAWM; Jocelyn Hubbach, RN; Marian Bezio; Karen Nerger, RN, SANE; Corey Casarez, EMT; Hal Anderson, EMT; Mark Wissman, RN; Jennifer Hahn-Farris, RN; Mark Mayes, MHA, RN, CEN.

Aurora Shooting Continued from page 9

Page 11: ENA Connection November 2012

Official Magazine of the Emergency Nurses Association 11

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

Across our country, as inpatient behavioral

health beds have closed, emergency

departments have become the default location

for patients requiring psychiatric care.

However, caring for these patients in the ED is

expensive and places an additional burden on

crowded facilities. Most hospitals are holding

involuntary emergency psychiatric patients for

several days as they await placement. This

article will share some strategies being used by

our nursing colleagues to care for patients

and caregivers in this difficult situation.

The New Hampshire ENA State Council

recently hosted a breakfast for emergency

nursing leaders with a panel of psychiatric

experts. New Hampshire has only one state

hospital that admits psychiatric patients, and

most of the attendees were unclear about

how many beds the state has and the process

to admit patients. The attendees had a

passionate discussion about the problem and

shared practical tools to help the staff caring

directly for these patients. Stacey Savage,

BSN, RN, CPEN, New Hampshire ENA state

president, felt this discussion was ‘‘a major

step toward collaboration and, hopefully,

some support.’’

Vermont’s state forensic hospital was

destroyed by Hurricane Irene last year,

causing patients to be immediately moved

into outpatient settings, lower-acuity

psychiatric inpatient units and even into the

correctional system. Without the state

hospital to house the highly acute forensic

behavioral health patients, Vermont’s

emergency departments have been severely

impacted. Many EDs are finding themselves

holding multiple psychiatric patients awaiting

‘‘appropriate’’ placement for days at a time.

Derek Kouwenhoven, RN, CEN, Vermont

ENA State Council president, reports that ‘‘a

few months ago, it appeared that the

long-term plan was to use community health

centers and stretch the outpatient settings for

these forensic patients, which would, in turn,

continue the impact on emergency

departments throughout Vermont’’ with

overcrowding and violence.

Vermont ENA members, ED staff and

members from the remaining inpatient

behavioral health units lobbied their

legislators, and the state is now well on its way

toward building a 25-bed facility to care for the

state’s forensic psychiatric patients.

‘‘There is now light at the end of the tunnel

with the state agreeing to build a new facility

due to open late 2013 or early 2014,’’

Kouwenhoven said.

Christy Spivey, RN, administrator of

Emergency Department and Trauma Services at

New Hanover Regional Medical Center, a

Level II trauma center in Wilmington, N.C.,

reports that they have a designated eight-bed

pod where boarded behavioral health patients

are cared for as they await placement.

‘‘We’ve created a care model where an ED

RN provides care to the patients, and a BH RN

provides a psychiatric screening, while other

staff assists with patient placements,’’ she said.

Caring for Behavioral Health Patients in the ED

Continued on page 24

Searching for Solutions to Unfortunate Holding Pattern

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Offering Educational and Networking Opportunities for Current and Future Emergency Nurse Leaders.

E N A L E A D E R S H I P C O N F E R E N C E 2 0 13

F O RT L A U D E R DA L E , F L F E B R U A RY 2 7 – M A R C H 3

For more information, scan QR code, or visit

www.ena.org/lc

Page 12: ENA Connection November 2012

November 201212

Mental health and addictions experts, clinicians,

community-based advocates, researchers, social

workers, direct care staff and many more health

care professionals and organizations convened

in Chicago in April for the 42nd National

Council Mental Health and Addictions

Conference. ENA Connection covered the

following sessions:

Addressing Secondary Traumatic Stress: A Guide to Caring for StaffIn this trauma-informed care session, Dr. Richard

Mollica, MD, MAR, director, Harvard Program in

Refugee Trauma, Harvard Medical School,

discussed how caring for consumers who suffer

from the impact of trauma can affect health care

professionals. He also talked about the

importance of health care professionals

developing a self-care program, which plays a

role in providing effective care.

‘‘This is an exciting topic because we all

know that the pain of others becomes our pain,’’

Mollica said. ‘‘You can’t do this work, working

with highly traumatized people, unless you have

a model of self-care.’’

Although a majority of the attendees raised a

hand when asked if they had experienced

burnout, very few raised a hand when asked if

their organization had a written, efficient

self-care protocol.

‘‘One of the things I want you to understand

here is that the symptoms and the problems of

self-care are essential to the treatment,’’ Mollica

said. ‘‘They are part of the treatment. They are

part of the diagnosis. You’re going to see from

the neuroscience that your experience of the

patient that often leads to burnout and

compassion fatigue is a diagnostic experience.’’

As Mollica talked about the differences

between burnout (more organizational) and

compassion fatigue (more personal), he also

shared stories of how he and his team have

previously been affected when caring for highly

traumatized patients, including experiencing the

same nightmares as their patients..

‘‘Our hopelessness about the patients came

from the patients. We felt hopeless because the

patients felt hopeless,’’ he said.

Attendees also learned about empathy and its

impact on self-care and healing.

‘‘You can’t understand self-care unless you

understand empathy,’’ Mollica said, challenging

the audience to embrace the new concept of

empathy, which no longer involves putting

yourself in other people’s shoes. ‘‘Empathy is

the key to our treatment and to our healing. If

one believes empathy heals, then self-care is

essential.

‘‘This idea of putting yourself in the shoes of

other people is aggressive in some cultures. It

goes against the neuroscience, because what the

neuroscience research has shown is to imagine

the self as the other.’’ He said this concept of

maintaining independence causes less distress

and higher empathy.

The session ended with a discussion on the

effectiveness of using Balint groups in all health

care settings (peer supervision on relationships

and not techniques). Mollica also engaged the

audience in a conversation about lifestyle

practices to prevent compassion fatigue and

burnout (such as diet, exercise, sleep, spiritual

health, etc.) and the importance of making these

practices a reality.

Preventing the Use of Seclusion and Restraint Conference attendees learned about promoting

alternatives to seclusion and restraints through

12

By Kendra Y. Mims, ENA Connection

The National Council Mental Health and Addictions Conference

Development of the Lantern Award program criteria funded in part by Stryker, an ENA Strategic Sponsor.

B ecome a Lantern Award recipient

Apply today. Applications are due February 20, 2013.

DOES YOUR EMERGENCY DEPARTMENT

DESERVE RECOGNITION FOR

Exemplary Practice and Innovation?

To learn more and apply, visit : www.ena.org/IQSIP/LanternAward

T he ENA Lantern Award recognizes exemplary emergency departments that demonstrate exceptional performance and innovative practice in the core areas of:

• Leadership

• Practice

• Education

• Advocacy

• Research A Coaching Guide is now available to help you identify how best to demonstrate your emergency department’s achievements.

Page 13: ENA Connection November 2012

Official Magazine of the Emergency Nurses Association 13

trauma-informed care practices. Joan Gillece,

PhD, project manager, National Association of

State Mental Program Directors/National Center

for Trauma-Informed Care, discussed SAMHSA-

sponsored technical assistance and support to

publicly funded systems to prevent the

use of seclusions and restraints and to

create a culture change.

‘‘We know that there is nothing

therapeutic about seclusion. We know it

is treatment failure,’’ Gillece said. ‘‘…

Seclusion and restraint is awful for the

staff, it’s awful for the other people

observing it, and it’s clearly awful for the

person being restrained.’’

Gillece said almost every seclusion and

restraint boils down to a staff member

trying to enforce a rule. When she asked

attendees to identify the most volatile

times for seclusion and restraint, one

audience member suggested shift change.

Audience members who worked in

facilities that use seclusion and restraint

ranged from residential treatment

programs to hospitals and crisis centers.

Raul Almazar, MA, RN, a senior

consultant to SAMHSA’s Promoting

Alternatives to Seclusion and Restraints

through Trauma Informed Practices,

shared his input on the importance of

helping organizations seek alternatives.

He said the only way to effectively

change the culture is to understand the

amount of trauma in that culture.

‘‘The majority of clients in our mental

health system have experienced trauma,’’

Alazae said. ‘‘When we begin to look at

what people do to manage the world, we

understand that what we are trying to

treat are actually adaptations. … The

common bond amongst all of us —

providers and the people we provide

services to — is that we’re all just trying

to manage in this world. We should never

compare people’s trauma.’’

Almazar challenged the audience to

understand patient behavior.

‘‘We wonder why people are agitated,’’ he

said. ‘‘We take away everything people use

outside to manage the world, we bring them into

our systems and say, ‘Behave like an angel, and

if you don’t, we take privileges away.’ For a

lot of people, that’s their connection to the

outside world.’’

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

Keynote speaker David Satcher, MD, PhD,

director of the Satcher Health Leadership

Institute and former U.S. surgeon general,

presented his vision to nurture leaders in

public health and medicine who can contribute

to eliminating disparities in health. He also

discussed the importance of integrating mental

health and primary care.

Satcher promoted leadership partnership to

meet the challenge of ensuring a health system

that provides access to quality health care for all.

‘‘We have to find other people who share

our mission but perhaps who bring different

talents and resources to the table, and we have

to work together, especially true when dealing

with social determinants of health,’’ he said.

‘‘Regardless of how good we are, we need to

be part of an effective team.’’

Satcher encouraged attendees to talk more

about the importance of mental health.

‘‘We think a lot about mental illness, but I

don’t think we talk enough about mental health,’’

he said. ‘‘We want people to think about mental

health and to appreciate what it really means to

have mental health and how to promote mental

health and prevent mental illness.’’

He shared statistics showing 1 in 5

Americans is diagnosed with a mental disorder

and the World Health Organization’s prediction

that mental disorders will be the leading cause

of disability by 2020. He said many patients

diagnosed with a mental disorder don’t receive

treatment until they are in a crisis.

‘‘A mental health emergency in the ED can

be a disaster,’’ Satcher said. However, “we

found that it is possible to dramatically

improve the experience of people in the ER

when they go in for mental health

emergencies, or we found that, in fact, we can

improve the waiting times.’’

‘‘Maybe we can’t cure mental disorders,’’ he

concluded, ‘‘but we can help people recover in

the sense that they return to productivity,

fulfilling relationships with others and they’re

able to deal with challenges in their lives.’’

Building New Leaders and a Commitment to Mental Health

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ENA LEADERSHIP CONFERENCE 2013

FOR COMPLETE ENA LEADERSHIP CONFERENCE 2013 DETAILS, PLEASE VISIT WWW.ENA.ORG/LC

Strengthen your leadership skills and empower your career today, tomorrow and for the future at ENA Leadership Conference, February 27- March 3, 2013 in Fort Lauderdale, FL

Shape the Future is about you shaping your future by gaining the knowledge and leadership skills you need to succeed. You can begin to shape your conference experience by participating in illuminating presessions that cover diverse and crucial information. Learn the skills you need to succeed as a leader from developing budgets and appropriate staffing to developing a mission/vision statement with your team. For those aspiring future

speakers you will learn how to write and deliver an award-worthy presentation. These presessions are designed to strengthen your existing knowledge base and provide you with new information that will help you as a leader.

Continue shaping your future with evidence-based sessions providing vital knowledge in several focus areas including: safety, professional development, health, quality and management.

Page 15: ENA Connection November 2012

WHAT’S NEW @ CONFERENCE

IgNITE® SESSIONSWatch your colleagues present their own take on “What Makes an Emergency Nurse Unique?” in these fast-paced 5-minute sessions packed with creativity, humor and insight.

JAm SESSIONSThese instructor-led, open forum sessions encourage expanded interactivity between attendees and instructors well beyond the classroom atmosphere of a traditional session. Expert faculty will guide the discussion by providing a base presentation of ideas and soliciting the experience, stories and ideas from you the attendee.

HANd-OFF SESSIONSThese unique sessions encompass two related topics in a concise 35-minute format to form one information packed session with must-knows that are important to you.

dEEp dIvE SESSIONSExperience in-depth exploration of topics that simply can’t be covered in a traditional course length.

ENA WIREdA self-serve computerized system area, Social Media and Wi-Fi hotspot available to all attendees. Access your e-mail, record the educational sessions you attend and print a completed certificate onsite.

To view the new conference offerings and complete details on conference sessions and keynote speakers, please scan the QR code or visit www.ena.org/lc

FOR COMPLETE ENA LEADERSHIP CONFERENCE 2013 DETAILS, PLEASE VISIT WWW.ENA.ORG/LC

ENA

SHAPE THE FUTURE

Important dates to Remember

Registration .....................................Now Open

Early Discount Rate Closes ....... Jan. 16, 2013

State and Chapter Leaders Conference ........... Feb. 27 – 28, 2013

Presessions ................................ Feb. 28, 2013

Educational Sessions ............ Mar. 1 – 3, 2013

Exhibit Hall ...................Feb. 28 – Mar. 2, 2013

2013 ENA ANNuAl CONFERENCE Nashville, TN • Sept. 17 – 21, 2013

ENA lEAdERSHIp CONFERENCE 2014 Phoenix, AZ • Mar. 5 – 9, 2014

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New this year are three unique learning experiences, including: Jam sessions, Hand-off sessions and Deep Dive sessions. Become inspired with the general session speakers; Carmine Gallo, Jon Gordon and Marcus Engel have been specifically selected to compliment the educational experience presented throughout each day. Each speaker offers their unique perspective on leadership skills ranging from how to inspire leaders, methods to overcome life obstacles and changing the things that you can.

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Page 16: ENA Connection November 2012

November 201216

This year I have been promoting

the idea of the ENA Foundation as

your charity of choice. In 2012, the

board of trustees and I have endeavored

to establish a culture of philanthropy in our

appeals to our membership. We want you to

think of the ENA Foundation as a valued and

trusted charity. We seem to be on the right

path. In the past year, individual giving by ENA

members has increased. Despite the challenges

we faced in 2012, we still had the most success-

ful State Challenge ever. And we can do even

better in the coming years.

If you read ENA Connection from cover to

cover, as I do, then you certainly have read

how your contributions have helped support

research in the field of emergency nursing and

provided emergency nursing education. The

August 2012 article about the effects of sexual

assault on sex workers was a significant

milestone. Researcher Dr. Lola Prince has made

a contribution to the literature and opened the

eyes of ENA members with her study; her

research affects the lives of patients as a result.

The ENA Foundation provided support to Dr.

Prince to conduct her research.

An article in the March 2012 issue paid

tribute to paramedic Bryan Stow, whose

poignant story of recovery after being brutally

attacked after a baseball game touched people

nationwide. The California ENA State Council

stepped up and used funds it raised during the

2011 ENA Foundation State Challenge to name a

2012 academic scholarship in Stow’s honor.

In the April 2012 issue, Charlotte

Schnakenberg, the first recipient of the ENA

Foundation’s new International Exchange

Program, supported by Stryker, shared her

10-day experience in Ipswich, Suffolk County,

England. The ENA Foundation provided

Schnakenberg

with a scholarship

that helped her

enhance her

professional

development

and knowledge of emergency care and build

international relationships with other

emergency nurses.

Let me assure you that the ENA Foundation

is an excellent steward of your contributions.

The results of the 2012 State Challenge

campaign mean that 2013 will see 100

percent of the $116,000 raised go to our

members for scholarships and research grants.

We have an experienced scholarship review

team and a set of specific criteria. This year, 47

scholarships in the total amount of $194,000

were disbursed to our fellow ENA members,

as well as multiple research grants and

continuing educational scholarships. (To view

the list of scholarship and grant recipients,

visit www.ena.org/foundation/Pages/

Default.aspx).

Typically, the development staff informs the

scholarship recipients. This year, I asked to

‘‘puh-lease let me make two of the calls to

recipients myself.’’ When I called one recipient,

he took a long and very deep breath and stated,

‘‘I can’t tell you how much this means to me.

I was reviewing my finances for the coming

school year and was wondering how I was

going to make it. What an impact! Thank you!

Thank you! Thank you!’’

Wow! I felt tears come to my eyes as I heard

his response to the good news. I was walking

Your Generosity Has Moving Results

MESSAGE FROM THE CHAIR | Laura Giles, BS, RN, 2012 ENA Foundation Chairperson

New ENA monthly offering for FREE Continuing Education with contact hours for our members.

• Available November 1Prevention of Healthcare-associated Infections1.0 contact hour Rhonda Morgan, RN, DNP, CEN, CNRN, CCNS, APN

Don’t miss out on enhancing your education. Go to www.ena.org/FreeCE for additional free continuing education opportunites.

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

Continued on page 23

Page 17: ENA Connection November 2012

Official Magazine of the Emergency Nurses Association 17

Course Administrative Procedures UpdatedThe Course Administrative Procedures have been

updated and posted on the ENPC and TNCC

pages of www.ena.org. The procedures and the

4th edition of ENPC were effective Sept. 1.

ENPC 4th EditionInstructions have been sent to all current ENPC

3rd edition instructors regarding how to access

the Instructor Update modules and test through

ENA’s online Center for e-Learning. The letter is

also posted on the ENPC page of www.ena.

org. Access to the update modules and test

opened Aug. 27, and

several instructors

have already passed.

Upon successful

completion, the instructor may print a certificate

of completion; a new ENPC 4th edition provider

and instructor status will be issued within the

ENA database.

Instructors may call ENA Course Operations

at 800-942-0011 to order an ENPC 4th edition

provider manual to study for the update test.

ENPC 4th Edition Course DVDThe demonstrations of the ill and injured child

skill stations that are used for the provider and

instructor courses are located in the Center for

e-Learning, along with the instructor update

modules. Course directors who are teaching

ENPC 4th edition instructor and/or provider

courses in areas that have limited classroom

Internet access may download the Management

of the Ill or Injured Pediatric Patient Skill Station

Demonstration videos. The link to the ENPC 4th

edition material is within the Course Directors

Only section of www.ena.org. The videos are

available as large MP4 files; ENA recommends

that you download them from a location with

high-speed Internet access. Click on the link to

download the files to your computer.

New Functionality for Course DirectorsAlong with the rollout of the ENPC 4th edition

course is new functionality available through

eCourseOps:

• Purchase downloadable ENPC 4th edition

instructor supplements by clicking on the

“Manage E-books” menu item on the left side

of the screen.

• Assign course participants to your specific

ENPC 4th edition provider course to enable

them to view the pre-course modules by

clicking on the “Pre-course” icon on the far

right-hand side of the related course. You will

find it listed under “Upcoming Courses.” In

order to assign the downloadable books or

the participants of the provider course, the

course director will receive an online form in

which to enter the recipient’s name and e-mail

address. Both of the above are distributed to

the recipient by an e-mail that includes a link

to access either the downloadable PDF

instructor supplement or the online pre-course

modules. More directions will be added to the

eCourseOps landing page. These functions

are separate but work in a similar format.

Your Input Is WelcomeCoursebytes is the official communication to all

TNCC and ENPC course directors and instructors.

Topics for future issues and feedback are

welcome at [email protected].

WellnessCareerCenter

Looking to expand your experience,your reach or your knowledge base?

Develop a PlanAchieving your goal requires time and commitment. It also requires a plan. Determine what opportunities exist that you could participate in to reach that goal.

Use the Right EquipmentLeverage the tools and resources of your ENA membership to help you achieve your goals.

Build a professional profi le and resume and look for new opportunities through ENA’s Career Center.Access Career Wellness resources online at www.ena.org

Participate in ENA Educational OpportuntiesENA is pleased to partner with the National Healthcare Career Network to offer a series of webinars that can help you TAKE CHARGE OF YOUR NURSING CAREER!The November class titled “How You Can Enable Excellence” is on November 29, 2012 and is available for 24 hours.

Additional sessions will be held in January and February 2013.

Don’t miss out!

Powered by the ENA Career Center

AdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingyourCareer

2012 Advancing Your Career AD Nov.indd 1 10/24/2012 11:31:52 AM

Page 18: ENA Connection November 2012

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

In September, the American Hospital Association, the

American Medical Association and the American Nurses

Association released a new report that found up to

766,000 health care and related jobs could be lost by 2021

as a result of the 2 percent sequester of Medicare

spending mandated by the Budget Control Act of 2011,

scheduled to begin Jan. 2.

The report measures the anticipated effect of the cuts

in Medicare payments on health care providers and

reflects how reductions in Medicare payment for health

care services will lead to direct job losses in the health

care sector and reduced purchases by health care entities

of goods and services from other businesses. As the

impact of these cuts ripples through the economy, jobs

will be lost across many sectors beyond health care.

In the press release announcing the report, ANA

First Vice President Cindy R. Balkstra noted that

‘‘nurses have always strived to put patients at the

center of a health care system that emphasizes

prevention, wellness and coordination of care,

the kinds of services that experts agree are

essential to not only improving the health

status of patients but also lowering overall

health care costs. Cutting Medicare

spending in a way that eliminates health care

jobs is an extremely short-sighted way to

contain the high cost of health care.’’

The report estimates that during

the first year of the sequester, more

than 496,000 jobs will be lost. It also

found that the job losses will affect

many economic sectors beyond

health care and will be spread across

every state, with more than 78,000

jobs lost in California alone by 2021.

The health care sector has long

been an economic mainstay,

providing stability and

growth even during times of

recession. The Bureau of

Labor Statistics’ data show

that health care created

169,800 jobs in the first half

of 2012 and accounted for

one out of every five new

jobs created this year.

Last year’s budget deal

requires $1.2 trillion over

a decade in automatic

across-the-board cuts for some federal programs to take

effect unless Congress finds an alternative. Most policy

analysts expect lawmakers to get more serious about

funding and tax decisions after the November elections.

Nation’s EMS Policy AdvancesWith the nation’s emergency medical services systems

facing challenging problems, two multidisciplinary

committees have been working collaboratively to define

the direction of federal research and initiatives for the EMS

community. Both the Federal Interagency Committee for

Emergency Medical Services and the National EMS Advisory

Council held summer 2012 meetings, providing updates on

the significant accomplishments they have achieved.

FICEMSFICEMS specifically is charged with coordinating federal

EMS efforts for the purposes of identifying state and local

EMS needs, recommending new or expanded programs

for improving EMS at all levels and streamlining the

process through which federal agencies support EMS

(www.ems.gov/FICEMS.htm). At its last meeting in

June, FICEMS noted that much progress had been made

through its use of Technical Working Groups comprising

interagency staff-level employees who meet monthly

conducting the work of FICEMS’s eight standing

committees. While each committee has developed

two-year work plans to help guide FICEMS’s ongoing EMS

projects (www.ems.gov/pdf/2011/December/11-TWG_

Committee_Updates_Dec2011_Final.pdf), one of the

many projects discussed at the June meeting was a model

uniform core criteria for mass casualty triage.

Model Uniform Core Criteria FICEMS’s TWG on preparedness has been assessing the

feasibility and efficacy in promoting the implementation

of a consensus-based national guideline for model

uniform core criteria for mass casualty triage. Jurisdictions

at a mass casualty incident use various triage methods,

such as Simple Triage and Rapid Treatment and

JumpSTART, the pediatric equivalent to START. At issue

are MCIs crossing jurisdictional lines and involving

responders from multiple agencies that may be using

different triage methods. Were all the responders at a

given MCI to use the same triage method, operational

simplicity, communications interoperability and clinical

efficiency may be more readily attained. However,

accepting MUCC as the national triage system has a

number of hurdles to overcome, such as the lack of

Sequester Could Lead to More than 760,000 Lost Health Care Jobs

November 201218

Page 19: ENA Connection November 2012

evidence regarding the impact of using a

MUCC-compliant MCI triage method vs. a

non-MUCC-compliant MCI triage method.

The MUCC project had its beginnings in 2006

when the Centers of Disease Control and

Prevention convened a workgroup of subject

matter experts to examine the science

supporting existing mass-casualty triage systems

and make a recommendation for the adoption

of a single system as a national standard for MCI

triage. In September 2008, an article, ‘‘Mass

casualty triage: an evaluation of the data and

development of a proposed national guideline,”

(Disaster Medicine and Public Health

Preparedness) was published, proposing

national guidelines that became known as SALT

triage: Sort – Assess – Lifesaving Interventions

– Treatment/Triage. SALT, a non-proprietary

free system, was developed from available

research, widely accepted best practices of

existing mass-triage systems and consensus

opinion from the workgroup. The SALT

workgroup considered the development of

SALT to be a first step in creating a national

guideline for MCI triage systems.

Expanding upon the SALT workgroup, MUCC

was created by a 30-member CDC-funded

group. The MUCC comprises 24 specific

criteria, which the MUCC workgroup

recommended as model minimum elements that

all MCI triage systems should include.

According to FICEMS, although ‘‘the MUCC is

supported by the best available science, the

evidence base for evaluating MCI triage

systems in prehospital settings is limited. The

majority of MUCC’s criteria — www.ems.gov/

pdf/2011/December/10-MUCC_Options_

Paper_Final.pdf — are supported by indirect

evidence (i.e., evidence that comes from

different situations or different patient

populations) and consensus decisions, meaning

the SALT and MUCC workgroups found gaps in

the science.’’

While a number of EMS stakeholder

organizations (e.g., American Academy of

Pediatrics, American College of Emergency

Physicians, American College of Surgeons–

Committee on Trauma, National Association of

EMS Physicians, National Association of State

EMS Officials) endorsed MUCC, a national

model would necessitate everyone at every

level changing current practices.

NEMSACThe National EMS Advisory Council provides

expert advice and recommendations to the

National Highway Traffic Safety Administration

and its federal partners on key issues, including

recruitment and retention of EMS personnel,

quality assurance, data collection and EMS.

NEMSAC held an orientation meeting at the end

of August 2012 with its newly appointed experts

from various EMS disciplines, including Michael

A. Hastings, MS, RN, CEN, who was nominated

by ENA. (See Hastings’ NEMSAC meeting report

on page 23.)

To assist the new members, the meeting

covered NEMSAC accomplishments including

various council advisories, such as:

• EMS System Performance-based Funding and

Reimbursement Model to sponsor a

comprehensive:

o EMS System Design project that will

identify the essential components and

functions of EMS systems, standardize

terminology, and establish performance

standards for minimum levels of service;

o EMS System finance study that accounts for

all costs and revenues.

• The Next Steps for Prehospital Care Evidence-

Based Guidelines to include urging NHTSA to

lead the effort in forming relationships with

stakeholder organizations and academic

journals in order to hasten the process of

publishing EBGs, as well as to assist in

decreasing the time to implementing EBGs in

the field through measures such as

developing implementation toolkits or training

curricula to ensure that the EBG is

incorporated into providers’ clinical practice.

More details about the NEMSAC meeting can

be accessed at www.ems.gov/NEMSAC.htm.

Article prepared by Terri L. Nally, ENA senior

public policy specialist.

Official Magazine of the Emergency Nurses Association 19

Real Stories of Nursing Research M. Maureen Kirkpatrick McLaughlin, PhD, RNSally A. Bulla, PhD, RN

This book demonstrates how direct care nurses in clinical settings can overcome their fear and conduct nursing research studies that impact and improve patient care. Highlighting research in Magnet-designated hospitals located in all types of settings, this reference includes studies that have used quantitative, qualitative, and mixed-method designs from a variety of experts like librarians, statisticians and IRB reviewers.

362 pagesISBN: 978-0-7637-6166-0©2010

Price: $70.95ENA Member Price: $64.00

Free Shipping! Offer ends November 30, 2012

To order, visit www.ena.org/shop and mention this ad in the comment section or call 800-900-9659 (M-F 9 a.m. - 5 p.m. CT).

Special Offer for the MonthMarketplace

Page 20: ENA Connection November 2012

November 201220

A mass casualty incident in the emergency

department has many requirements for processes,

procedures and resources including personnel,

medical materials, supplies and equipment. An

important process includes patient tracking.

MCI Incidents – Tracking Them DownOn Aug. 28 in Louisville, Ky., 48 children were

sent to multiple hospital emergency

departments after an automobile ‘‘T-boned’’

their school bus, causing it to roll. Local news

media reported the frustrations of frantic parents

searching area hospitals trying to locate their

children after learning of the accident.1 School

and commercial bus wrecks are not uncommon

and are a source of mass casualty incidents. In

2010, there were 249 fatalities and 12,000

persons reported injured in U.S. bus crashes.

On July 20 in Aurora, Colo., 59 movie-goers

suddenly became casualties during the early-

morning mass shooting at a movie theater (see

article on page 8). Justin Mast, RN, of The

Medical Center of Aurora emergency

department, reported several casualties arrived

via police vehicles. Consequently, they were not

entered into the community patient tracking

system before their arrival. Communications

between responding hospitals helped account

for patients. Emergency department director

Mark Mayes, MHA, RN, CEN, reports what

seemed like thousands of calls to a hospital

hotline as worried friends and family tracked

down loved ones. The hospital command center

at Swedish Medical Center in Englewood, Colo.,

reportedly handled hundreds of phone calls

from panicked people looking for family

members and friends.

Benefits to MCI Patient TrackingThere are multiple reasons for patient tracking

in an MCI. Tracking will facilitate family and

loved-one reunification. Patient tracking can

improve resource management. Many

Web-based, patient-tracking applications can

provide ED and hospital leadership with

visibility of incoming casualties and casualty

characteristics, including injury types, acuities,

gender, age and others. Having incoming

casualty visibility allows prepositioning of

medical resources and can ‘‘buy’’ prep time.

Sharing patient tracking data with the hospital

command center and hospital leadership will

provide situational awareness of the MCI’s

impact based on the facility and community.

Considerations for TrackingPlanning for MCI patient tracking in the

emergency department and hospital includes

making decisions regarding the following:

1. The person and team responsible for the

plan.

2. Technology (paper, electronic or both).

3. The trigger for activating the tracking process.

4. The forms used and how will they be

deployed.

5. What patient identifiers will be assigned.

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

Mass Casualty Incident: ‘Where’s My Child?’

Rescue workers practice at a 2008 school bus mass casualty incident workshop in Clark County, Wash.

Ph

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by E

d M

un

d, B

A, F

F/EM

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Page 21: ENA Connection November 2012

Official Magazine of the Emergency Nurses Association 21

6. How forms will be collected.

7. How often forms will be collected.

8. Where tracked patient data will be collated.

9. Who is responsible for data collation during an incident.

10. How patient tracking data will be shared.

11. Who will share the data.

12. Who will be the point-of-contact for community providers and

inquiries.

Important considerations include coordination with regional patient

tracking systems that may already be in place within your region or state.

Tracking TechnologiesTracking technologies for emergency departments include variations of

electronic and paper-based tools. Many electronic versions include an

Internet, Web-based application that collects data facilitated by a patient’s

assigned, scannable bar code, radio frequency identification chip or

infrared transmission. These tags, chips and barcodes are associated with a

patient-specific number or identifier. Many times the Web-based

applications offer impressive reporting and data-sharing capabilities.

Paper systems are perhaps the most prevalent MCI tracking system.

Paper tracking systems may be considered rudimentary but are

inexpensive, function without electricity and do not have

password requirements. Many times the paper system

incorporates a ready-to-assign armband that is part of a

disaster registration package

Lawrence ‘‘Jeff’’ Jeffries, RN, the ED clinical and

preparedness coordinator at Jefferson Memorial Hospital,

Ranson, W.Va., recalled the school bus fire impacting his

emergency department.

‘‘Fortunately there were no serious injuries, but we were

getting calls from parents before the 50 children arrived. Our

paper-based tracking system helped manage and track the

children once they arrived in our ED,” he said.

The Hospital Emergency Incident Command System offers

a substantial paper patient-tracking procedure which

includes the Mass Casualty Tracking Chart, MCI Chart, Flow

Tags and Flow Tag Boxes.2

Other patient tracking resources and procedures are

found in the Hospital Incident Command System. Roles and

responsibility for patient tracking in an ICS-type response

are established. Patient tracking procedures are outlined in

the accompanying Patient Tracking Job-Action-Sheet and

reference tracking logs and forms necessary.3

National EffortsIn 2005, the U.S. DHHS’s Agency for Health and Research

Quality convened an expert panel and began studying and

developing the needs for a national patient tracking system.

In 2009, AHRQ released ‘‘Recommendations for a National

Mass Patient and Evacuee Tracking, Transportation and

Regulating System.”4

The U.S. DHHS’s Joint Patient Assessment and Tracking

System tracks patients through the federal patient movement

system and is being made available to states.

To assist in consistent communications from a prehospital

to the hospital or final point of care setting, the DHS, with

the guidance of an expert provider group developed the

Tracking Emergency Patients, EDXL messaging standard.

TEP is in the final stages of international standards

evaluation and acceptance.5

SummaryBenefits to patient tracking include family and loved-one reunification,

improved resource allocation and management, among others. Patient

tracking will provide leadership, improved surveillance and situational

awareness of an MCI’s impact. Are you ready to track?

Resources

1. Exhibit 4, FARS/GES 2010 Data Summary

2. www.courier-journal.com/article/20120928/

NEWS0105/309280109/Frantic-parents-frustrated-trying-find-

children-JCPS-bus-wreck.

2. http://www.heics.com.

3. http://www.emsa.ca.gov/HICS/files/JAS_Plan.pdf.

4. http://www.ahrq.gov/prep/natlsystem/.

5. http://www.integratedtrainingsummit.org/presentations/2012/

main_training_summit/10-esf8_patient_tracking_force_multiplier.

pdf.

Research and Evidence-based Practice Projects

Don’t Miss this Opportunity to Showcase

Your Work on Emergency Department

Management, Leadership and Research

Submission Deadline: January 15, 2013

Online: www.ena.org/IENR/abstractsE-mail: [email protected]: 800-900-9659, ext. 4119

Call For Paper and Poster Abstracts

Readers may contact the author at [email protected].

Follow Knox Andress @ENAdman.

Page 22: ENA Connection November 2012

November 201222

ENA STATE CONNECTION

State Council and Chapter Meetings and Events

Kansas ENA State Council State Meeting:KENA (Kansas Emergency Nurses Association) meets every other month. Meetings start at 10:30 am.

Dec. 14 - University of Kansas, Kansas City

For more information: www.kansasena.org and visit us on Facebook.

Kansas Chapter Meeting: Central Kansas ENAMeetings are planned for the fourth Monday of the odd months of the year at 7 pm.

Nov. 14 - Kansas City

Nebraska ENA State Council Submitted by Sue Deyke, MSN, RN, CEN,

The Nebraska ENA State Council attended a

political reception held at the Thompson Center

on the University of Nebraska Campus in

Omaha. This session was sponsored by the

Nebraska Nurses Association, and the Nebraska

ENA State Council was one of the silver

champion sponsors. The members had an

opportunity to hear bipartisan speakers on the

local, state and national levels. The members

felt it was important to hear the candidates’

stances on health care reform and used this day

for advocacy.

On Sept. 29, the Nebraska

ENA State Council collaborated

with the Nebraska Nurses

Association to address the

issue of nursing fatigue. The

issue of safety and professional

practice has become a topic

very near and dear to

emergency department staff.

This workshop featured two

national speakers on nursing

fatigue: Ann Rodgers, PhD, RN, FAAN,

and Karlene Kerfoot, PhD, RN. There was

also an opportunity for panel discussion to

discuss best practices to achieve safe staffing.

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 1, 2012. 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”), 41,720. Actual number of copies of single

issue published nearest to filing date (hereinafter “Most

recent”), 41,820. B. Paid circulation: B1. Outside-county

paid subscriptions stated on Form 3541: Average, 40,832.

Most recent, 40,399. 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 400. Most

recent, 443. 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

41,232. Most recent, 40,842. D. Free or nominal fee rate

distribution. D1. Outside-county copies included on

Form 3541: Average, 18. 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, 273. Most recent,

850. E. Total. Free or nominal rate distribution (sum of

D1, D2, D3, D4): Average 291. Most recent 875. F. Total

distribution (sum of C and E): Average: 41,523. Most

recent, 41,717. G. Copies not distributed: Average, 197.

Most recent, 103. H. Total (sum of F and G): Average

41,720. Most recent, 41,820. I. Percent paid (C divided

by F times 100): Average, 99%. Most recent, 98%. This

Statement of Ownership will be printed in the November

2012 issue of this publication. I certify that the state-

ments made by me above are true and complete.

Amy Carpenter Aquino, Editor in Chief. Date:

October 1, 2012.

From left: Karen Wiley, MSN, RN, CEN; Adam Bruhn, RN; Sue Deyke, MSN, RN, CEN; and Cindy Slone, RN, CEN, of the Nebraska ENA State Council.

It’s not too late to wear the 2012 ENA Annual Conference

close to your heart.

The Greater Los Angeles Chapter of California ENA has

about 200 souvenir conference pins remaining from

September’s extravaganza in San Diego and is offering them

to ENA members via mail order at a cost of $10 each. The

pins are the size and style of a postage stamp and feature

the Annual Conference logo below a trio of Pacific palms

(see photo at left). Fasten the pin to your clothing, coat or

bag using the tie-tack clasp on the back.

To purchase a pin, contact Barbara VanEck, the Greater

L.A. Chapter secretary, at [email protected].

Limited Annual Conference Pins Still Available

Page 23: ENA Connection November 2012

Official Magazine of the Emergency Nurses Association 23

The Academy of Emergency Nursing will

accept online applications for the 2013

class of fellows through 5 p.m. CST,

Nov. 30, 2012.

Information and a link to the applica-

tions are available under “Calls and

Opportunities” at: www.ena.org/Pages/

default.aspx.

If you have

questions,

please contact

Ellen

Siciliano,

board

relations

manager, at

academy@

ena.org.

ENA Call for…

Applications for the 2013 Class of Fellows

ENA Report from NEMSAC

I had the privilege of attending my first National

Emergency Medical Services Advisory Council

meeting in Washington, D.C., on Aug. 28-29.

This was the first meeting since the 26 members

were appointed or reappointed to two-year

terms by Ray LaHood, Secretary of the

Department of Transportation. Each person on

the committee represents a different area of

interest, though not a particular agency. As a

committee member, I represent emergency

nurses, not the Emergency Nurses Association.

For the next two years, I will be the only nurse

on the committee.

The NEMSAC charter states that the scope of

its activities is to ‘‘provide advice and

recommendations regarding EMS to DOT’s

National Highway Traffic Safety Administration

(NHTSA).’’ Some areas this committee covers

include patient and provider safety, research

and EMS system improvement and

sustainability.

This meeting was an introductory meeting

for the 12 new members on the committee. In

addition, we were given an update on NEMSAC

projects and on the transition of the committee

from a discretionary to a statutory committee.

This transition makes this committee a standing

committee, which means the charter does not

have to be renewed every two years. Making

this transition also provides a direct reporting

structure to the DOT and to the Federal

Interagency Committee on EMS.

Our next meeting will be held in the coming

months. As this committee continues its

previous projects and begins work on new

projects, I will provide updates through ENA

Connection.

If you have any questions or feedback,

e-mail me at [email protected]. You can

also find details about the NEMSAC meeting at

www.ems.gov/NEMSAC.htm.

By Mike Hastings, MSN, RN, CEN

on air after that. Trust me, we

make a difference.

Support emergency nursing

by choosing the ENA

Foundation as your charity of

choice. Let’s all foster the culture

of philanthropy by making a

year-end contribution to the

ENA Foundation. As we

approach the holiday season

with Thanksgiving looming

around the corner, it is the

perfect time to reflect on all of

the things for which to be

grateful. I am thankful for each

and every one of you who has

made this year a success by

providing means for many

others in our profession; and, in

turn, those people will be

thankful for these educational

opportunities and your support.

The holiday season gives

everyone an opportunity to pay

it forward — those who donate

and those who receive. Together

we all can do more!

Your Generosity Has Moving Results Continued from page 16

Page 24: ENA Connection November 2012

November 201224

They also have a consulting psychiatrist

available.

‘‘We have worked with staff and leadership

from our organization’s behavioral health

hospital to develop a comprehensive care policy

and ED BH orders to safely manage these

patients,’’ she said. ‘‘We’ve even been able to

stabilize patients who were awaiting placement

over several days and actually discharge them.’’

As they have a large population of BH

patients, they are also implementing the ENA

workplace violence toolkit to make sure they

have a safe environment.

Kerry O’Neill, RN, clinical educator, City

Hospital, Martinsburg, W.Va., reports that her

institution employs ‘‘crisis workers’’ who come

to the ED for psychiatric interventions.

‘‘We have a 16-bed in-house adult psychiatric

unit in which they work with the inpatient

population but respond to pages from the ED,’’

she said. There is a crisis worker on call 24 hours

a day to provide acute interventions and facilitate

the admission and transfer for these patients.

Steven Fraime, assistant manager, Emergency

& Trauma Services at WellStar Health System

Greater Atlanta Area, reports that at his facility,

every potential mental health patient is triaged

as an ESI level 2, placed in a safe room with a

specially trained MH sitter, seen by the MD

within 10 minutes of arrival (goal), and screened

by a certified mental health evaluator within two

hours. All home medications are reconciled and

provided through the main pharmacy so that

any psychiatric medication regimen is not

interrupted during an extended stay.

A new trend is the use of telepsychiatry. With

this medium, psychiatric evaluations take place

with the use of televideo equipment.

Consultations are conducted and treatment

plans are initiated in a timely manner and

access to proper care is initiated. This method is

said to be cost effective, especially in rural areas

where care is not readily available.1 However,

‘‘although telepsychiatry is one of the most

common uses of telemedicine, the use of ED

telepsychiatry is rare.”2 The research that is

needed to prove efficiency and efficacy to

establish evidence-based practice is waiting to

be done.

Some hospitals have a separate psychiatric

area staffed with psychiatric nurses and a

psychiatrist.

Denver’s HealthOne hospital chain is

opening a new psychiatric ward with 40 beds.

According to Dr. George Bussey, chief medical

officer, ‘‘psychiatric patients with no place to go

can really slow things down.’’ He admits that

HealthOne might lose money on its new

psychiatric unit, but he believes it will be able

to ‘‘recoup the losses if it can provide speedier

service’’ in the ED.3

Alegent Health’s Omaha, Neb., campus

includes inpatient care for patients ages 4 to

100. It also has several offsite clinics and

psychiatric offices that provide partial care and

day programs for various ages. There is an

initiative to reach the goal of two hours to admit

patients to an inpatient bed. The ED has a

locked six-bed assessment area staffed by

experienced psychiatric nurses, and the

psychiatrist is on call to determine the patient’s

disposition. Bed placement can be obtained as

far as 250 miles if the campus is full. Lasting

Hope, an inpatient adult assessment facility, also

coordinates patient disposition into inpatient

beds in the community.

The Sentara Virginia Beach General Hospital,

where I work, is investigating such an option.

We are seeing 180 to 200 psychiatric patients a

month in our ED, averaging a length of stay of

approximately 10 hours. As we have electronic

charting, we are gathering data from newly

created behavioral health flow sheets as a key

to implementing change.

While it is obvious that the care of these

patients is labor intensive, the data show that

more than 90 percent of our safety events,

including elopements, patient or staff injury and

the need for a ‘‘take down’’ can be attributed to

patients with behavioral health needs. We are

part of a system that includes nine hospitals and

three free-standing facilities, so a system-wide

team was formed to seek solutions. The team

met with ED directors and in-house behavioral

health representatives in our system and

magistrates from our jurisdictions to focus on

standardizing behavioral health care. An outside

consultant recommended an inpatient

behavioral health unit, and there is currently an

application in process for a certificate of need to

add such a unit. Under the proposal, 24

currently licensed inpatient beds will be

converted into licensed beds for geriatric and

general adult psychiatric patients. These beds

also will include the capability to serve medical

psychiatric patients. The data we are collecting

is an important part of the application.

Caring for this special population of patients

is indeed challenging. We can help each other

and our patients by sharing with our colleagues

our success stories as well as our failed trials.

Above are just a few strategies. What are you

doing in your state, hospital system or

department to meet the needs of behavioral

health patients while limiting their hospital stays

and maximizing their health care delivery?

References

1. www.chcf.org/~/media/MEDIA%20

LIBRARY%20Files/PDF/T/PDF%20

TelepsychiatryProgramsED.pdf accessed

July 23, 2012.

2. ibid

3. www.npr.org/blogs/health/2012/05/31/

154004864/as-psychiatric-wards-close-

patients-languish-in-emergency-rooms

accessed August 7, 2012.

Caring for Behavioral Health Patients in the ED Continued from page 11

Page 25: ENA Connection November 2012

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Page 28: ENA Connection November 2012

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