connectionSeptember 2014 Volume 38, Issue 8

the Official Magazine of the Emergency Nurses Association

PLUS!Treasurer’s Report 6

Member Has Just the Place to Ditch Your Stress 18

AwArd SeASon

Announcing the 2014 Annual and Lantern Award Recipients & Academy Inductees

16 - 17

§Attend a wide range of educational sessions covering 9 key practice areas

§Earn over 25.5 contact hours, depending on sessions attended

§Learn about innovative products and services

§Network with colleagues from around the world

For the latest updates, visit www.ena.org/AC

Follow the action on #ENAAC14

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

REGISTER NOW

INDIANAPOLIS Indiana Convention Center  October 7-11, 2014

AC14_Connection_full_09 2014.indd 1 7/23/14 4:39 PM

Why We Must Persist in Reporting, Despite Threat of Retaliation

FROM THE PRESIDENT | Deena Brecher, MSN, RN, APN, ACNS-BC, CEN, CPEN

I had never given much thought to what

happens if a nurse suffers retaliation after

reporting a safety issue. I have a hard time

imagining an environment where emergency

nurses would be retaliated against for raising

a safety concern. However, there are

environments where a ‘‘culture of blame’’

exists, both inside and outside of health care.

While most nursing practice acts identify

nurses as mandatory reporters if

they have knowledge of an

impaired colleague, many

do not require nurses to

report unsafe practices or

conditions. Unfortunately,

there have been several

cases where nurses have

been prosecuted for

reporting unsafe practice.

How is this possible? The

ENA Code of Ethics states, ‘‘The

emergency nurse acts to protect

the individual when health care and

safety are threatened by incompetent,

unethical or illegal practice.’’ In my

interpretation, ‘‘acts to protect the

individual’’ means reporting unsafe practice.

How can I, as the ENA president, continue

to advocate for safe practice and safe care,

work to help nurses understand their role in

preventing errors in the ED and ask nurses to

hold each other accountable for reporting

unsafe practices when I know nurses are

being retaliated against for doing just

that? My answer is that I must

continue to do it.

We need to own our practice.

Dates to Remember

PAGE 4Free CE of the Month Letters to the Editor

PAGE 10ENA Research

PAGE 12ENA Foundation

PAGE 30Ask ENA

Regular Features

Oct. 5-11, 2014 Emergency Nurses Week (Emergency Nurses Day is Oct. 8)

Oct. 7-11, 2014 ENA 2014 Annual Conference, Indianapolis

PAGE 6Treasurer’s Report

PAGE 7Meet ENA’s Parliamentarian

PAGES 8 - 9Progress Report on Past Resolutions From ENA General Assembly

PAGE 14Nurses and Higher Education: The Numbers Are Growing

PAGE 162014 Award Announcements: • ENA Annual Awards • Lantern Awards • Academy of Emergency Nursing Inductions

PAGE 17Judith C. Kelleher Award Winner

PAGE 18Code You: Member Carves Out a Place for Nurses to De-Stress

PAGE 22When an Emergency Nurse Becomes the Patient: Five Lessons

PAGES 24 - 26Updates From ENA’s Geriatric, Pediatric and Trauma Committees

PAGE 28When the ADC is Bare: Combating Drug Shortages in the ED

ENA Exclusives

I have spent the better part of this year trying to encourage emergency nurses to report

potential safety concerns, change their attitude regarding patient safety and embrace a

culture of safe practice and safe care. Recently I read an article about a nurse’s duty to report

unsafe situations in the practice environment. That article has caused me to take a harder

look at the realities of reporting.

I travel quite often as the ENA president, and at airports and train stations, I see the same

message: ‘‘If you see something, say something.’’ I translate that message to the emergency

care environment: If you see something that’s unsafe, say or do something about it. If the

child is lying on the stretcher, and the stretcher is raised and the side rails are down, lower

the bed, raise the rails and let the team taking care of the patient know someone walked out

of the room and left the patient in an unsafe situation. If the computer in the patient room

will not let you scan the medication, report the issue. If you feel that a co-worker’s practice is

unsafe — whether it may be caused by a controlled substance, behavioral health issue or

poor judgment — report that co-worker and hope he gets the help he needs.

3

Continued on page 6

Take advantage

of ENA’s latest

free continuing

education offering

to earn CE credit

while you explore

care of the behavioral health patient in the ED.

Available to you starting Sept. 1 . . .‘‘Facilitators and Challenges to the Care of

Behavioral Health Patients in the

Emergency

Department: A

National Study,’’

presented by Lisa

Wolf, PhD, RN,

CEN, FAEN.

This session

explores potential

solutions for the behavioral health patient population

by laying out the findings of the critical-access

hospital educational study and identifying the

significance of the educational barriers for

emergency nurses at CAHs.

To take this and other eLearning courses free as

an ENA member:

• Go to www.ena.org/freeCE, where you’ll log

in as a member (or create an account).

• Add desired courses to your cart and

‘‘check out.’’

• Proceed to your Personal Learning Page to

start or complete any course for which you

have registered or to print a final certificate.

• To return to your Personal Learning Page later,

go to www.ena.org and find ‘‘Go to Personal

Learning Page’’ under the Education tab.

Please be sure you are using the e-mail address

associated with your membership when logging in.

If you have questions about any free eLearning

course or the checkout process, e-mail

elearning@ena.org.

ENA Connection is published 11 times per year from January to December by: The Emergency Nurses Association

915 Lee Street Des Plaines, IL 60016-6569

and is distributed to members of the association as a direct benefit of membership. Copyright ©2014 by the Emergency Nurses Association. Printed in the U.S.A.Periodicals postage paid at the Des Plaines, IL, Post Office and additional mailing offices.

POSTMASTER: Send address changes to ENA Connection915 Lee StreetDes Plaines, IL 60016-6569ISSN: 1534-2565Fax: 847-460-4002 Website: www.ena.orgE-mail: membership@ena.org

Non-member subscriptions are available for $50 (USA) and $60 (foreign). For editorial inquiries, e-mail connection@ena.org

Publisher:Kathy Szumanski, MSN, RN, NE-BCEditor-in-Chief:Amy Carpenter AquinoAssociate Editor:Josh GabySenior Writer:Kendra Y. Mims

BOARD OF DIRECTORSOfficers:President:

Deena Brecher, MSN, RN, APN, ACNS-BC, CEN, CPEN

President-elect: Matthew F. Powers, MS, BSN, RN, MICP, CEN

Secretary/Treasurer: Kathleen E. Carlson, MSN, RN, CEN, FAEN

Immediate Past President: JoAnn Lazarus, MSN, RN, CEN

Directors:

Ellen (Ellie) H. Encapera, RN, CENMitch Jewett, AA, RN, CEN, CPEN Michael D. Moon, PhD, MSN, RN,

CNS-CC, CEN, FAENSally K. Snow, BSN, RN, CPEN, FAENJeff Solheim, MSN, RN-BC, CEN,

CFRN, FAENJoan Somes, PhD, MSN, RN-BC, CEN,

CPEN, FAEN, NREMT-PKaren K. Wiley, MSN, RN, CEN

Executive Director: Susan M. Hohenhaus, LPD, RN, CEN, FAEN

Member Services: 800-900-9659

I just received the January 2014

issue of ENA Connection from a

friend who is an ER nurse. I was so

thrilled to see the cover

and read the lovely

story inside (‘‘Guided

Tours,’’ page 5)! Thank

you so much for the

wonderful tribute to

Vietnam nurses and the

Vietnam Women’s

Memorial! This article

will be placed with our

archives at the Library of

Congress.

In the 1980s, I contacted ENA

and asked for their help in support

of building the Vietnam Women’s

Memorial on the Mall in

Washington, D.C. They got behind

it immediately and became

legislative and financial supporters.

All of us at the Vietnam Women’s

Memorial Foundation (formerly

‘‘Project’’) are ever grateful to the

Emergency Nurses Association.

I have known Marilyn Rice for

many years and was so happy to

have the opportunity to visit with

her again at the 20th

commemoration activities over

Veterans Day 2013 last

fall. We appreciate the

beautiful wreath

presented on behalf of

ENA at the Vietnam

Women’s Memorial on

Veterans Day.

We send our

deepest appreciate for

your years of ongoing

support, and special thanks to

Marilyn Rice, Lt. Col. Peggy

McMahon and Deena Brecher for

being with us on that beautiful day.

Kendra Y. Mims’ story ‘‘Guided

Tours’’ is beautifully written and

takes its place among the rich

legacy of our Vietnam-era veteran

nurses. Thank you!

Diane Carlson Evans,Founder and President,

Vietnam Women’s Memorial Foundation,

Washington, D.C.

ENA Connection welcomes letters from members. Letters should address content previously published in the magazine. Letters may be edited for space and clarity. Submission does not guarantee publication. Please include your name, credentials and contact information for verification. Send letters to connection@ena.org.

HELD DEARA Trip Back Through Time

at the Vietnam Women’s Memorial

connectionJanuary 2014 Volume 38, Issue 1

the Official Magazine of the Emergency Nurses Association

2014 ENA CAREER GUIDE

PAGES 4 - 9

THE RIGHT TRAININGSAVES MORE LIVES.In-hospital cardiac arrest survival rates can improve dramatically. ACLS-trained nurses can more than triple survival rates, according to the recent American Heart Association Consensus Recommendations, “Strategies for Improving Survival After In-Hospital Cardiac Arrest in the United States: A Consensus Statement from the American Heart Association.”

Download the AHA Consensus Statement to get the tools you need to boost survival rates.

Morrison L, Neumar R, Zimmerman J, et al. Strategies for improving survival after in-hospital cardiac arrest in the United States: 2013 consensus recommendations: A consensus statement from the American Heart Association. Circulation. 2013;127:1538–1563.

©2014 Physio-Control, Inc. GDR 3319301_A

37.5%SURVIVAL RATE WITH ACLS- TRAINED NURSES.10.3%

SURVIVAL RATE WITH NON-ACLS- TRAINED NURSES.

Visit www.physio-control.com/Training to get the report.

We need to understand our duty to

report as outlined in our state nurse

practice act. We must continue to work

to reduce the number of avoidable

errors in our departments. We must

report unsafe practices, procedures,

policies, actions, conditions and

environments.

We also must understand where the

gaps are in protection for nurses who

report these conditions, and we must

close those gaps. Creating, advocating

for and supporting a just culture is a

first step toward removing fear of

retaliation as a barrier to reporting.

Understanding the role of the

emergency nurse in decreasing

preventable errors is another.

Other steps include becoming

familiar with state laws that govern

mandatory reporting; understanding the

protections, if any, that are in place for

nurses; and advocating to create or

strengthen existing protections. The

most important step is to never, ever

give up the drive to advocate for safe

practice and safe care.

6 September 2014

TREASURER’S REPORT | Kathleen E. Carlson, MSN, RN, CEN, FAEN, 2014 ENA Secretary/Treasurer

A Healthy Picture to ShareF inancial results for 2013

supported the

advancement of ENA’s

programs and

advocacy initiatives,

both in the current year and well into

the future. Among ENA’s strengths is

its diverse set of revenue sources:

membership, courses, conferences

and other products and programs.

Membership remains stable, and

continuing education courses exhibit

growth as courses are updated and

extended to a broadening base of

nurses. More diversity resides within

those courses, with Trauma Nursing

Core Course, Emergency Nursing

Pediatric Course, Geriatric Emergency

Nursing Education, Emergency Nursing

Orientation, Emergency Nursing Triage,

Handling Psychiatric Emergencies and certification

review courses all contributing.

Total revenue was $17.2 million in 2013, reflecting annual

growth of about 1 percent. Membership held steady at just

under 40,000, generating $3.6 million in dues, of which

$371,000 went directly to support ENA state councils and local

chapters. Course revenue exceeded $8.4 million, increasing

about 7 percent from 2012, and also provided $1.2 million to

the state councils to support TNCC and ENPC. A record 51,000

nurses took the TNCC provider course, and nearly 16,000 took

the ENPC provider course. More than 5,000 people attended

our Leadership and Annual conferences.

Operating expenses totaled just over $17.2 million for the

year, so the net result was a slight operating loss of only

$29,000. The expenses supported the core activities of

membership, courses and

conferences, and also provided

additional support to state councils

through grants totaling $45,000. In addition, the

ENA Board of Directors acted to provide $25,000 to the ENA

Foundation’s Judith Kelleher Memorial Endowment.

ENA’s investment portfolio grew to $13.5 million,

increasing the reserve ratio to 73 percent, or $4.2 million

more than required by ENA’s reserve policy. This prudently

invested portfolio is now providing substantial income,

further strengthening ENA’s financial foundation.

A complete copy of ENA’s audited financial

statements is posted in the members-only section

of the ENA website at tinyurl.com/ENAfinance

or by scanning the QR code at left.

From the President Continued from Page 3

ENA 2013 REVENUE

$8,415,50149%

$3,589,838 21%

$2,868,957 17%

$2,343,307 13%

Membership

Courses

Conferences

Other

Official Magazine of the Emergency Nurses Association 7

GOVERNANCE

More than 700 delegates and

emergency nurses convene

every year for the ENA General

Assembly to witness the installation

of board members, hear reports on

association activities and debate and

vote on proposed bylaws,

amendments and resolutions. From

keeping track of time to providing

clarification and assisting the ENA

president during the assembly,

Colette Collier Trohan is the ENA

parliamentarian who keeps the

two-day business meeting in order.

Trohan, president and CEO of

A Great Meeting Inc., has more than

20 years of experience as a

professional parliamentarian. Her

first meeting as ENA’s General Assembly parliamentarian

was at the 2008 Annual Conference in Minneapolis.

Trohan describes herself as the meeting process guru.

‘‘As the parliamentarian, I am the one who remains totally

impartial,’’ she said. ‘‘I help everyone put their ideas together

in the best form for a large group of delegates to look at.’’

As soon as the meeting is adjourned, Trohan starts

preparing for the next General Assembly. She says 80 percent

of the meeting actually happens before it is called to order.

That includes preparing a script with the ENA president and

developing orientation and training for delegates.

‘‘There’s a tremendous amount of preparation to make

sure that the delegates have everything they need to make

decisions, and making sure it’s as clear as possible so that we

don’t take up time wordsmithing on the floor, which is one

of the most painful experiences a delegate can go through,’’

Trohan said.

Trohan meets with the Resolutions Committee the day

after General Assembly to examine the bylaws and make

sure all of the amendments adopted are organized so that a

new governance document can be released. The committee

also debriefs on what worked well and what it could

improve for future meetings.

Trohan also

provides amendments

assistance to delegates

after the first day of

General Assembly.

‘‘We hold a group

hearing where

everyone gets the

opportunity to discuss

every bylaw

amendment and every

resolution,’’ she said.

‘‘We help anyone who

wants to propose an

amendment with the

writing to make sure

it’s clear and legal. It

gets signed off by the

lawyer and by me, the

parliamentarian, and

then it gets published so that on Day 2 of GA, everybody

sees what else might come up on the agenda that day. It’s a

big production.’’

Trohan says the two challenges she faces in her

parliamentarian role are time and confusion.

‘‘If there is one misspoken phrase in front of all of those

attendees, it can create confusion that becomes difficult to

change,’’ she said. ‘‘I spend most of my time making sure

everything is presented as clear as possible so there is no

confusion on the floor and we don’t waste any time. We

designed the amendments assistance process because the

time the delegates have in that room is so precious, and we

have to be sure that they are set for success.’’

Trohan’s favorite part of General Assembly is watching

the process unfold.

‘‘When I see the delegates in that room really discussing

the important issues of ENA, and when I see all of the

viewpoints coming out, no matter what they are, it’s just

wonderful to watch that decision being made,’’ she said. ‘‘I

like to tell everybody I don’t care what they do — I just care

how they do it. If I feel the General Assembly has looked at

all the viewpoints and they have arrived at a decision, then

it’s a fantastic feeling. It’s magical.’’

ALL IN ORDERMeet the Parliamentary Maestro Behind ENA’s General Assemblies

Parliamentarian Colette Collier Trohan clarifies a procedure during the 2013 General Assembly in Nashville. She’ll oversee her seventh General Assembly for ENA next month.

By Kendra Y. Mims, ENA Connection

2013 GA13-014: Evidence-Based Standards for Lifelong LearningENA met and advised the LACE team

(Licensing, Accreditation, Certification

and Education) of ENA’s

recommendations in Q1 2014.

2012GA12-017: Use of Protocols in the ED Setting

ENA’s Government Relations staff

investigated and provided details to

assist in the development of the

position statement titled ‘‘Use of

Protocols in the ED Setting’’ in Q1 2014.

GA12-015: Safe Discharge From the EDA position statement titled ‘‘Safe

Discharge from the Emergency Setting”

was completed in Q4 2013.

The development of a research

proposal identifying high-risk

discharges and potential interventions

has been added to the IENR research

agenda. Study development is pending.

GA12-014: Palliative Care in the Emergency Setting

A position statement titled ‘‘Palliative

and End of Life Care in the Emergency

Setting’’ was completed in Q3 2013.

ENA continues to actively solicit

faculty abstracts.

GA12-013: Health Care Worker Fatigue A sleep study proposal has been

developed and is pending

implementation. A white paper titled

‘‘Nurse Fatigue’’ was completed in Q4

2013. ENA has met with affiliate

organizations in Washington, D.C., to

review current issues regarding the

topic of health care worker fatigue.

GA12-012: Defining Wait Times The ENA Board of Directors supported

the American College of Emergency

Physician’s policy statement titled

‘‘Standards for Measuring and

Reporting Emergency Department Wait

Times’’ in Q3 2013.

GA12-011: Care of the Patient With Chronic Pain A clinical practice guideline for acute

pain management is in development. A

8 September 2014

As ENA delegates prepare to debate and vote on several proposed resolutions at the 2014 General Assembly on Oct. 8-9 in

Indianapolis, here is a progress update on previously approved resolutions.

ENA departments assigned to work on resolutions include the Institute for Emergency Nursing Research; the Institute for

Emergency Nursing Education; the Institute for Quality, Safety and Injury Prevention; Government Relations; and Meetings and

Conferences.

RESOLUTION CENTERThe Latest Work on ENA General Assembly Initiatives

Official Magazine of the Emergency Nurses Association 9

position statement titled ‘‘Care of

Patients with Chronic/Persistent Pain in

the Emergency Setting’’ was completed

in Q1 2014.

GA12-010: Care of the Bariatric/Obese Patient A topic brief titled ‘‘The Bariatric/

Obese Patient’’ was completed in Q4

2013.

2011

GA11-020: Emergency Nursing and Forensic Nursing

ENA and the International Association

of Forensic Nurses have a formal

relationship through the Nursing

Organizations Alliance. This has led to

collaborative efforts related to position

statements for emergency and forensic

nursing, including the development of

the position statement ‘‘Intimate Partner

Violence,’’ completed in Q3 2013.

GA11-019: Task Force on Chronically Impaired

The Alcohol Screening, Brief

Intervention and Referral to Treatment

toolkit was developed in collaboration

with ENA members and the National

Highway Traffic Safety Administration

in 2013. A discharge instruction

template is included within the SBIRT

supplemental materials located at

www.ena.org.

GA11-018: Advancing the IOM Recommendations for Future of NursingENA continues to collaborate with the

Nursing Organizations Alliance, the

American College of Emergency

Physicians, The Joint Commission and

the National Quality Forum. Through

ENA’s public policy efforts in 2013,

one of the primary focus areas was an

increase in Title VIII funding which

supports a major recommendation for

the future of nursing.

GA11-017: Firearm Safety Education for Children

Based on the recommendation of the

IENR, the position statement ‘‘Firearm

Safety and Injury Prevention’’ was

developed in Q1 2013. The IQSIP is

currently developing a topic brief in

collaboration with the ENA Pediatric

Committee. (See article on page 25 of

this issue.)

GA11-015: Care of Patient Presenting with Stroke Symptoms The Position Statement Review

Committee reviewed the resolution and

recommended a more comprehensive

piece be available; a recommendation

was made to develop an educational

module. An online education module

titled ‘‘Partnering in the Fight Against

Stroke’’ was completed in Q2 2014 and

is available at www.ena.org.

GA11-013: Care of the Pediatric Patient with Dehydration The Clinical Practice Guideline

Committee is actively developing a

resource.

2010

GA10-010: Helicopter Shopping

Accomplishments completed in

2011-2012 include: 1) A joint

consensus statement on helicopter

shopping; 2) ENA and the Air &

Surface Transport Nurses Association

recorded and disseminated a video

message at the 2012 ENA Annual

Conference; and 3) IENR and ASTNA

developed a communication regarding

research and dissemination.

In Q2 2014, ENA’s Government

Relations staff sent a joint letter to the

Federal Aviation Administration in

support of issuing new rules regarding

the safety of air medical transportation

helicopters. However, the letter also

states ENA’s concern with the delay in

implementation of the rules and urges

against further delays.

Note: All position statements, white papers, support statements, online courses, etc., listed above are available at www.ena.org at no charge.

September 201410

ENA RESEARCH | Lisa Wolf, PhD, RN, CEN, FAEN, Director, Institute for Emergency Nursing Research

You are the manager of an

emergency department and in

charge of reviewing practices around

sepsis identification and treatment. You

find that the time to antibiotics measure

is much longer than you would like it

to be. The problem is, you’re not sure

under what circumstances delays are

occurring or why. This makes it very

difficult to figure out how to fix the

problem and lower time to antibiotics

for these patients.

When clinical problems present

themselves, it’s important to understand

that the question drives the method. If

you want to understand how many,

how long or how often, it’s best to use

methods that give numbers; in short,

use a quantitative approach. To obtain

this information, you may do a chart

review, looking for specific variables,

or measure time between stages of the

ED visit. You could also send a survey

to nurses and providers who work in

your ED or hospital system to get

information about the problem you are

studying. In this case, you’d want to

look at data points such as triage time,

time of provider evaluation, time of

diagnosis and time to first antibiotic.

You want actual times, not recalled

times, so a chart review would be

appropriate for this set of questions.

When you get the answers to these

types of questions, you will understand

what is happening. What may not be

so clear is why it’s happening. This is

where a mixed-methods approach can

be very useful.

Mixed-methods research is a

methodology for conducting research

that involves collecting, analyzing and

combining quantitative

and qualitative methods

and data in a single

study. The

purpose of this

type of research

methodology is

that using

qualitative and

quantitative research

together provides a better

understanding of a research problem

than either research approach alone.

The qualitative data you collect, via

focus groups or interviews, can help to

explain your quantitative findings; in

short, you may get a better idea of why

the time to antibiotics is longer than

you want, and you can probably design

a better intervention to fix it.

Consider what you possibly might

discover in your chart review. If you

start by pulling all the charts with a

diagnosis of sepsis, you might want to

collect the following data:

1. The initial vital signs and when they

were obtained

2. Triage level assignment (is it

accurate and appropriate?)

3. Time to room

4. Time to diagnostics (and what they

were, e.g., labs like CBC and BMP

— were blood cultures and lactate

drawn immediately?) and time

of results

5. Time to provider evaluation

6. Time to orders for antibiotics

7. Time of administration

Once you have data on what’s

happening in your department, you

must determine why those things are

happening. You may want to

convene a focus group of

nursing staff and

possibly a

second one

composed of

providers. You

can ask them

very open-ended

questions. Some

possible ways to start

are to ask about process:

1. How do you identify septic patients

in triage?

2. Is there a protocol or guideline to

begin treatment once the patient is

identified? If so, what’s the

implementation process?

3. How do you communicate with

providers/nurses? Do you find this

effective? Why or why not?

4. What is the process of implementing

protocols or treatment orders for

these patients?

Once all these data have been

analyzed, you will have a better sense

of not only what is happening in your

department but also why. Possibly you

will learn that communication between

providers and nurses is ineffective, or

that the pharmacy system isn’t

responsive to the immediate need. You

may also discover your triage and staff

nurses are having difficulty recognizing

sepsis at initial presentation. The issue

may be a combination of three. This

mixed-methods approach adds a

number of parts of the puzzle,

facilitating how to address the problem

and improve patient care.

Mixed-Methods Studies: Why They Can Be Awesome

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September 201412

“Storytelling can change a

room. It can change lives. It

can change the world.”Gwenda LedBetter

Every one of us has a story to tell.

I believe it is essential for

emergency nurses to share their

stories with each other. Whether you

are treating patients at a rural hospital or in an inner city,

holding a child’s hand at the bedside or providing critical

care during a rescue operation, we all have a common goal

to provide high-quality care to our patients and advance our

profession. Sharing our experiences connects us to our

purpose as emergency nurses and builds a sense of

community. It lets us know that no matter how different the

circumstances, we are not alone in the challenges we face.

Our stories inspire us to grow as individuals and together.

I personally want to invite you to attend the ENA

Foundation Event on Friday, Oct. 10, at the 2014 ENA

Annual Conference in Indianapolis for an inspirational

evening of storytelling from ENA members who are making

a difference around the world. The ENA Foundation’s

exclusive event, ‘‘The Power of One: Engaging Generations

of Nurses to Give Back and Do Incredible Things,’’ will

feature internationally recognized speaker and emergency

nurse Jeff Solheim, MSN, RN-BC, CEN, CFRN, FAEN, along

with six heroes from around the world who are dedicated to

improving the quality of life for others who are less

fortunate. From providing medical care to orphans in

underserved areas in Africa to building the only health care

clinic in the slums of Uganda, these heroes will share their

personal journeys of sacrifice and commitment and inspire

you to do incredible things that will have a lasting impact.

• Robert Nabulere was born in northern Uganda in a

poor village. Although he was able to move his family into a

bountiful two-story house in an upscale neighborhood in

Kampala, he felt the need to return to his roots and help

those in poverty 10 years ago. He moved his family to the

slum and started a church and a school, which now serves

hundreds of children. He also has plans to build a clinic

there to provide medical care.

• Greg Higgins is an emergency physician from

California. He sold his practice and relocated to Africa to

start an orphanage near the base of Mount Kilimanjaro. His

orphanage provides a home to more than 100 orphaned

children. He works hard to provide medical care to this

underserviced area of Africa.

• Shannon Ward is an emergency nurse and also the

wife of Greg Higgins. She sold her home and relocated to

Tanzania and works in the orphanage to provide nursing

care to the orphans. She and Higgins travel through the

area as a team to provide medical care to the

underprivileged.

• Laurie Freeman is a pediatric nurse. During a trip to

Uganda, she learned that young girls dropped out of high

school because of a lack of feminine hygiene products.

Determined to change that, she became committed to

providing them with cotton underwear as well as reusable

feminine hygiene products. Her efforts have provided girls

with an opportunity to stay in school and obtain their high

school educations.

• During one of their trips to Cochabamba, Bolivia, ENA

members Joan Eberhardt and Helen Sandkuhl found a

young boy with second- and third-degree burns. They raised

funds to fly him to St. Louis and found a hospital and

physician to provide free care for nine months, helping the

young boy survive.

With your support, we can do something incredible to

help shape the future of emergency nursing. The goal of the

‘‘Power of One’’ event is to raise money to send 10 emerging

professionals to the Emergency Nursing 2015 Conference.

One hundred percent of the ticket value will be used to fund

scholarships for nurses just starting out in their careers. Your

$50 tax-deductible donation will help to empower and equip

your peers with education and advocacy skills needed to

advance the emergency nursing profession. Dinner, dessert

and beverages will be served after the program, and

attendees will earn 1.30 contact hours. You won’t want to

miss this amazing networking opportunity.

Through your support onsite at conference and through

online giving, the ENA Foundation has helped hundreds of

ENA members advance the emergency nursing profession

through our educational and research opportunities. As the

2014 ENA Foundation chairperson, I always feel honored

when an ENA member shares how the foundation has

helped them improve their practice or enhance their career.

Your stories renew my passion for the ENA Foundation and

for the work we do every day. Thank you for your

continued support. I look forward to seeing you in

Indianapolis.

My Invitation to YouENA FOUNDATION | Seleem Choudhury, MBA, MSN, RN, CEN, 2014 ENA Foundation Chairperson

ENA Foundation Event

“A single person can do incredible things when they set their heart to it. That’s the power of one.”

- Jeff Solheim

The Power of One: Engaging Generations of Nurses to Give Back and Do Incredible Things

Friday, October 106 – 8:30 pm2014 ANNUAL CONFERENCE INDIANA CONVENTION CENTER 1.30 CONTACT HOURS

Join the ENA Foundation and Jeff Solheim, Internationally Recognized Motivational Speaker, for an evening of exploring the Power of One—Inspiring stories of our heroes—100% of your ticket value goes to the Emergency Nursing 2015 Conference scholarship fund.

The goal of the Foundation Event is to raise money to send 10 emerging professionals to the Emergency Nursing 2015 Conference. Empowering young nurses with education, networking, and advocacy skills will give them the tools to do incredible things.

$50 (tax deductible) Dinner, dessert bar, and beverages following the program.

THE POWER OF ONE

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

AC14 ENA Foundation Event Ad_JEN_Full_07 2014.indd 1 6/25/14 8:37 AM

September 201414

EDUCATION

T he nation’s nurses are responding

to the call to pursue higher levels

of education to provide improved

patient care. ‘‘The Future of Nursing:

Campaign for Action,’’ led by the

Robert Wood Johnson Foundation and

AARP, has shown meaningful progress

in nursing education since launching

in late 2010.

The campaign was created in

response to the Institute of Medicine

report ‘‘The Future of Nursing: Leading

Change, Advancing Health,’’ which

recommended that 80 percent of RNs

should hold a bachelor’s degree or

higher by 2020.

The campaign dashboard shows

that the number of nurses enrolled in

doctoral programs rose 43 percent

from 2010 to 2012. The IOM report

called for a doubling of doctorate-

prepared nurses. Enrollment in

research-oriented PhD programs has

also grown.

The Future of Nursing Campaign

for Action dashboard indicators can be

found at tinyurl.com/

futuredashboard or by

scanning the QR code

here.

More good news about nursing and

higher education is found in the

October 2013 Health Resources and

Services Administration report, ‘‘The

U.S. Nursing Workforce: Trends in

Supply and Education.’’ According to

the report, the number of nurse

practitioners in the United States

increased by 69 percent between 2001

and 2011. The number of licensed RNs

graduating with BSN qualifications

increased by more than 86 percent in

just four years, from 2007 to 2011.

In addition to the benefit of

improving patient care, higher

education for nurses often translates

into new opportunities and a bigger

salary. According to data from

salary.com, an emergency nurse State and Chapter Ad_Connection_half_0607 2014_print.pdf 1 5/7/14 9:51 AM

Good News: The Numbers Are GrowingIndicators Show Nurses Are Aiming Higher, With Widespread BenefitsBy Amy Carpenter Aquino, ENA Connection

Official Magazine of the Emergency Nurses Association 15

¡ Work with the “crew” – network with experienced nurse leaders and connect with your peers ¡ “Accelerate” your career – learn about ENA’s Career Wellness resources ¡ Take part in this great opportunity – “geared” toward your professional development

New to the Emergency Care Field?Get on the right track with Emerging Professionals at ENA’s Annual Conference

Start Your Engines… Race over to the reception!Appetizers and cash bar

Thursday, October 9, 20146:30 – 7:30 pmJW Marriott Indianapolis

Visit www.ena.org/AC

Emerging Professionals Ad_Connection_half_09 2014.indd 1 7/23/14 4:41 PM

practitioner working in the Chicago

area stands to earn about $35,000 more

than a staff emergency nurse, based on

the median salary listed for both

positions.

ENA Foundation Scholarship OpportunitiesENA members who want to pursue a

higher degree, whether it’s a

bachelor’s, master’s or doctorate, have

a wealth of scholarship opportunities

available through the ENA Foundation.

The mission of the ENA Foundation

is to provide educational scholarships

and research grants in the discipline of

emergency nursing. Since its inception

in 1991, the ENA Foundation has

awarded more than $2 million in

academic scholarships to emergency

nurses. These academic scholarships

are made possible because of the

generous donations received from

individuals, state councils, local

chapters, industry and friends of

emergency nursing.

The ENA Foundation annually

offers more than 30 academic

scholarships. The list of previous

scholarship recipients is available at

www.enafoundation.org. The next

scholarship application period will

open in late January 2015.

For additional information about the

ENA Foundation, please e-mail

ENA.Foundation@ena.org or contact a

member of the Development

Department at 847-460-4100.

MORE OPPORTUNITIESThe ENA Foundation has the following upcoming calls:

• ENA Foundation/ANIA Research Grant. Submission deadline: Oct. 1, 2014.

• ENA Industry-Supported Grants. Submission deadline: Oct. 1, 2014.

• ENA Seed Grants. Submission deadline: Nov. 1, 2014.

Visit enafoundation.org for details.

September 201416

2014 Annual Award RecipientsBarbara A. Foley Quality, Safety and Injury Prevention Award

Charlotte O’Neal, MSN, RN, CEN (Kentucky)

Behind the Scenes AwardRichard Gary Fox (Maryland)

Clinical Nurse Specialist AwardMichael Allain, MS, RN, CEN, CCRN (New York)

Frank L. Cole Nurse Practitioner AwardDenise Ramponi, DNP, FNP-BC, ENP-BC, CEN, FAEN, FAANP (Pennsylvania)

Gail P. Lenehan Advocacy AwardMary A. Leblond, MSN, RN, CEN (Texas)

*Judith C. Kelleher AwardVicki A. Keough, PhD, APRN-BC, ACNP, FAAN (Illinois) * to be presented Wednesday, Oct. 8

Media AwardKelly Owen, ADN, RN, CEN (Oregon)

Nurse Manager AwardJennifer Granata, MSN, FNP-C, CEN, CPEN, CNML, EMT-P (Maine)

Nursing Education AwardKay-Ella Bleecher, MSN, RN, CEN, CRNP, PHRN (Pennsylvania)

Nursing Practice and Professionalism AwardHeather Matthew, MSN, RN, CEN (Pennsylvania)

State Council/Chapter Government Affairs AwardTexas ENA State Council

Team AwardInova Springfield Healthplex Emergency Department (Virginia)

Patient Flow Team• Winifred Frempong-Boye, BSN, RN• Valerie Hyde, BSN, RN, CEN• Carolyn Miller, RN• Shannon North-Giles, MBA, RN, CEN• Susan Oney Dungan, BA, RN, CEN

2014 Academy Candidates for Induction• Roger Casey, MSN, RN, CEN (Washington)

• Rita Celmer, RN, CRNA, CEN (Pennsylvania) – Posthumous

• Nicholas Chmielewski, MSN, RN, CEN, CNML, NE-BC (Ohio)

• Seleem Choudhury, MSN, MBA, RN, CEN (Vermont)

• Ruth E. Rea, PhD, RN (Washington)

• Robert Ready, MN, RN-C, CPEN, NEA-BC (Rhode Island)

• Stephen J. Stapleton, PhD, MS, RN, CEN (Illinois)

• Tiffiny Strever, BSN, RN, CEN (Arizona)

• Mary Alice Vanhoy, MSN, RN, CEN, CPEN, NR-P (Maryland)

• Cheryl Wraa, MSN, RN (California)

The Academy extends its congratulations and appreciation to the candidates for their outstanding contributions to emergency nursing and ENA.

Presentations and inductions will be held Saturday, Oct. 11, at the Annual Awards Gala at the 2014 Annual Conference in Indianapolis.

2014 Lantern Award Recipients• Advocate Children’s Hospital Pediatric Emergency Department – Oak Lawn Campus (Illinois)

• Ann & Robert H. Lurie Children’s Hospital of Chicago Emergency Department (Illinois)

• Bethesda Arrow Springs Emergency Department (Ohio)

• Bon Secours St. Mary’s Hospital Pediatric Emergency Department (Virginia)

• Cincinnati Children’s Hospital Medical Center Emergency Department – Liberty Campus (Ohio)

• Edward Hospital Emergency Department (Illinois)

• Franciscan St. Francis Health Indianapolis Emergency Department (Indiana)

• Oak Hill Hospital Emergency Care Center (HCA) (Florida)

• Nemours Children’s Hospital Emergency Department (Florida)

• Northwestern Lake Forest Hospital Emergency Department (Illinois)

• Overlook Medical Center Emergency Services – Union Campus, Atlantic Health System (New Jersey)

• Sharp Memorial Hospital Emergency Department (California)

• Swedish Edmonds Emergency Department (Washington)

• Swedish Medical Center/Ballard Emergency Department (Washington)

• UH Rainbow Babies & Children’s Pediatric Emergency Department (Ohio)

• University of Michigan Hospital & Health Centers – C.S. Mott Children’s Hospital, Children’s Emergency Services (Michigan)

• University of Wisconsin Hospital & Clinics Emergency Department (Wisconsin)

Official Magazine of the Emergency Nurses Association 17

to register visit www.ena.org/ac

A Celebration of Ínductees to the Academy of Emergency Nursing, Lantern Awards, and Annual Achievement Awards

Saturday, October 117:30 pm

JW Marriott Indianapolis

Gala 2014 AD_CONN_Half_08 2014_print.pdf 1 6/25/14 3:59 PM

2014 Judith C. Kelleher Award Winner: Vicki A. KeoughENA is pleased to name Vicki A.

Keough, PhD, APRN-BC, ACNP,

FAAN, as the 2014 Judith C. Kelleher

award recipient. Keough will receive

the award Oct. 8 at the ENA Annual

Conference in Indianapolis during the

Anita Dorr Memorial Lecture and

Luncheon.

This prestigious award, named for

one of ENA’s co-founders, recognizes

a member who has consistently

demonstrated excellence in the

emergency nursing profession and

made significant contributions to ENA.

Keough serves as dean of Loyola

University Chicago’s Niehoff School of

Nursing. Before joining Loyola, she

served as an emergency department

clinical nurse specialist at Good

Samaritan Hospital in Downers Grove,

Ill., and as a staff nurse in the

Department of Emergency

Medical Services at Loyola

University Health System.

Through ENA she worked

with the late Frank Cole,

PhD, RN, FNP, FAAN, FAANP,

FAEN, and Elda Ramirez,

PhD, RN, FNP-BC, FAANP,

FAEN, to open the second

emergency nurse practitioner

program in the nation at Loyola. In

2007, she received the Frank L. Cole

NP Award, which she calls one of the

greatest honors of her life. She has

served on ENA’s Research Committee

and in 2012 and 2013 chaired the

Advanced Practice Nurses in

Emergency Care Committee, which

promoted the first Emergency Nurse

Practitioner Certification,

launched by ANCC in 2013.

Through Keough’s career,

she has presented and

published studies and received

numerous research grants and

honors. Beyond ENA, she is a

member of the American Nurses

Association, the Illinois Nurses

Association, the American

Association of Critical Care

Nurses and the Illinois ENA, which has

recognized her as a distinguished leader.

‘‘Judith Kelleher was a visionary

leader who gave voice to all

emergency nurses across the country,’’

Keough said. ‘‘I am humbled to receive

this award that honors the work of

Judith Kelleher.’’

Kendra Y. Mims

Vicki A. Keough, PhD, APRN-BC, ACNP, FAAN

September 201418

After only one year as an

emergency department nurse,

Justin Carpenter, RN, BA, HN-BC, was

already burnt out. One of the common

stressors he discovered while working

in the fast-paced environment was that

emergency nurses are pulled in a lot of

different directions, managing patients,

family members and physicians at the

same time.

‘‘We also have certain time

constraints, like getting our antibiotics

and CT scans in on time,’’ Carpenter

said. ‘‘We also have to deal with people

in the acute stage of illness. They’re just

getting sick or they are getting worse. If

it’s a new diagnosis, patients and

families haven’t had time to process

what’s going on, and their emotions are

really high, so it’s a very emotionally

charged environment all around,

especially if it’s a pediatric trauma.’’

Carpenter, a staff nurse at St. John

Hospital and Medical Center in Detroit,

felt nurses were trained to take care of

patients physically but not how to take

care of their minds, bodies and spirits

as a whole, which made him feel

disconnected from his patients. He

eventually reached out to an

integrative nurse in his hospital and

learned about self-care and how to

make connections with patients, which

renewed his passion for emergency

nursing and sparked a new interest in

holistic nursing.

‘‘It was able to help me bounce

back from burnout, because not only

was I connecting with patients but I

was also connecting with myself

without having a wall up,’’ he said.

‘‘We have a tendency in ER nursing to

build this wall around us to block us

off from the emotional issues around

us, but it also closes us off, which can

ROOM TO BREATHEMember Uses Holistics to Carve Out a Space For Nurses to De-StressBy Kendra Y. Mims, ENA Connection

‘‘The renewal room is an area where any staff can go and sit down and renew themselves if they’re feeling stressed out. It’s whatever you need to do to get you

back to being able to take care of people again.”

JUSTIN CARPENTER, RN, BA, HN-BC

Official Magazine of the Emergency Nurses Association 19

17 Interactive Modules15.21 Contact Hours

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GENE provides: § Best geriatric practices from triage

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www.ena.org/geneThe Emergency Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

GENE Ad_Connection_half vertical_0607 2014.indd 1 5/6/14 1:42 PM

lead to burnout. It really disconnects us from the patients.’’

Carpenter became committed to integrating holistic nursing

practices into his personal and professional life. After noticing

that St. John’s had several ‘‘renewal rooms’’ available for staff

throughout the hospital, he decided to implement the same

concept in the ED three years ago, giving emergency nurses a

place to recharge. He and his peers painted and transformed

an old storage closet in the ED into a renewal room with a

chair and a CD player with relaxing music. A sign-up board

allows only one person to occupy the room at a time.

Although staff were skeptical in the beginning, Carpenter says

everyone enjoys using the room now.

‘‘I had one nurse tell me that she doesn’t go home crying

anymore because she has a place to let go of the stress before

she goes home,’’ he said. ‘‘As nurses, if we are agitated or

rushed, it has an effect on the patient. The renewal room is an

area where any staff can go and sit down and renew

themselves if they’re feeling stressed out. It’s a place to go

back to and re-center yourself and let go of everything,

whether it’s through crying, journaling or sitting there in

silence. It’s whatever you need to do to get you back to being

able to take care of people again.’’

As a board-certified holistic nurse, Carpenter continues to

educate staff about holistic nursing, stressing the importance of

self-care. In 2012, he presented his poster ‘‘Creating a Healing

Environment in the Midst of Chaos’’ at the ENA Annual

Conference in San Diego. He also recently integrated

aromatherapy and guided imagery into his ED’s treatment

processes.

The American Holistic Nurses Association has recognized

Carpenter’s leadership in advancing holistic nursing and

recently awarded him the Charlotte McGuire Scholarship for

SELF-CARE MADE SIMPLEWhether it’s an overcrowded emergency department or dealing with an upset family member, sources of stress can lead to burnout. Here are some ways ENA member Justin Carpenter manages stress on a daily basis.

• BEDTIME FOR YOU: “Adequate rest is really huge. I make time to rest.”

• WORK IT OUT: “I like to exercise. I find it is very centering for me.”

• THE GREAT OUTDOORS: “Getting out into nature is definitely a big thing for me. I work in an inner city, so it’s important to get away sometimes.”

• INNER PEACE: “I try to do daily meditations so that I’m able to be more compassionate.”

Continued on next page

September 201420

Visit the IENR Research Lounge at ENA’s Annual ConferenceLet the experts guide you through the research process

§ Ask questions related to patient care

§ Present your ideas for valuable feedback

§ Get advice for future projects

Saturday, October 119:30 am – 3:30 pmIndiana Convention Center

Visit www.ena.org/ienr for details.

IENR Lounge Ad_Connection_Half_09 2014.indd 1 7/23/14 4:36 PM

2014 to assist him in pursuing his

master’s of science in nursing. Holistic

health care was a driving factor in

choosing to further his education

because it has helped him in his role

as an emergency nurse.

‘‘The most important thing and the

basic premise of holistic nursing is

self-care, which is an idea that is pretty

foreign to nurses,’’ Carpenter said. ‘‘It’s

the idea of taking care of yourself,

because if you’re putting yourself first,

then you’re also allowing yourself to

renew and be at your best for when

you are taking care of other people. If

you’re not taking care of yourself, then

you’re tired, burnt out and crabby, and

you’re not in position to take care of

others. You’re not compassionate.

You’re apathetic.

‘‘The first thing to do is take care of

yourself — really make time to rest

and do things that make you happy.

The concept is sometimes the hardest

for us to grasp.’’

Carpenter promotes the idea of

centering — just taking a deep breath

and letting go of everything around you.

It’s especially beneficial for Carpenter

when he’s making patient rounds.

‘‘In the ER, we have so much going

on around us, and sometimes it’s

difficult to focus in on the patient,’’ he

said. ‘‘Before I walk into a room, I’ll

stop, pause, take a deep breath and let

go of all those other demands I have.

When I go in to see the patient, I’ll sit

down and genuinely listen to what

they are saying. It’s a simple act, but

the patients really notice you are there

for them, and it shows you have the

time to talk to them. It builds a trusting

relationship with the patient. I find that

when I do that, it really makes the day

go easier.’’

Carpenter says holistic nursing

practice and philosophy have made a

huge difference in his career.

‘‘When you’re helping someone [in]

body, mind and spirit, it makes a

difference. Every encounter has an

emotional and mental aspect to it, so

we just can’t treat the physical part. It

leaves you feeling a lot more gratified at

the end of the day when you’re making

connections with people because that’s

why most of us got into nursing. We

want to help other people. That is why

self-care is so important.’’

Room to Breathe Continued from previous page

Justin Carpenter

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IMPROVED PRACTICE

September 201422

Suzanne O’Connor, RN, MSN, APN, was 26 and at the

beginning of her nursing career when she unexpectedly

became a patient and found herself on the other side of

emergency care. Years later, she has never forgotten the

lessons she learned as a patient.

Today, as a nationally known speaker and consultant,

O’Connor helps organizations improve their patient and staff

satisfaction by sharing how her experience helped her to

become a better emergency nurse. Here are five ways she

says emergency nurses can improve their patients’

experiences in the emergency department:

1. BELIEVE THE PATIENTO’Connor presented to the emergency

department on Christmas Eve with acute

abdominal pain, but her vital signs fell

within the normal range. She felt no one

believed the intensity of her symptoms.

‘‘I had never experienced such intense,

excruciating stomach pain,’’ she said. ‘‘My

white blood cell count was normal, so everyone thought I

had ovarian cysts. I thought no one believed me.’’

The senior physician was called in. He diagnosed

O’Connor with appendicitis, and she was admitted to the

hospital immediately. Her appendix ruptured before the

operation; she believes the delay in diagnosis contributed.

‘‘As I was lying there, I was finally relieved that someone

believed that I wasn’t faking the pain, and that made a big

impression on me as a nurse,’’ she said. ‘‘I realized that you

have to believe in the patient and believe that the symptoms

are what they say they are. Don’t automatically think they’re

just malingering because the numbers aren’t right. In my

case, the credibility of my symptoms wasn’t as valued as the

white blood cell count. I learned to give my patients the

benefit of doubt. If it’s pain to them, it’s pain. The numbers

could change over time.’’

2. MAKE THE PATIENT’S NEEDS A PRIORITYWhile O’Connor was being prepped for surgery, the

emergency nurse in the operating room denied her request to

speak to her parents, who were in the waiting area. It taught

her how a nurse’s lack of empathy during a crisis could affect

a patient:

‘‘When I asked to see my parents, the nurse emphatically

said, ‘No, I have to get you ready for the OR.’ I recall the

nurse being indifferent to my needs, but I was scared to

stand up to her. I felt so vulnerable at the time, and I would

have been happier if I had someone I was comfortable with.

She was so aggressive, cold and very task-oriented rather

than focused on connecting with me. It seemed like her

agenda was more important than mine as the patient, and I

wondered why she couldn’t get me ready for the OR while

my parents briefly visited. Both my parents and I were

nervous, so no one’s needs were getting met.’’

3. KEEP THE FAMILY INVOLVEDIn not being allowed to see her parents before her surgery,

O’Connor realized how families can make a difference in a

crisis, so throughout her nursing career she constantly made

an effort to keep patients’ families involved.

‘‘If my patient asked for their family, I felt it was important

to that patient, so I was going to do everything I could to say

The Other Side of the Stretcher5 Lessons From an Emergency Nurse Who Saw It Differently as a Patient

By Kendra Y. Mims, ENA Connection

Suzanne O’Connor

Official Magazine of the Emergency Nurses Association 23

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yes and accommodate their request,’’ she said.

O’Connor personally felt the importance of family

presence later in her career when she took her son to the ED

for a staph infection and saw a drastic change in him that the

oncoming nurse didn’t notice.

‘‘I asked the nurse to check his temperature, and she

listened. As the oncoming nurse, she didn’t see the before

and after like I did,’’ O’Connor said. ‘‘The perception of a

family member can enhance the nursing assessment since

families are focused only on their loved one and can notice

subtle changes. Because it is change of shift, nurses may not

see a difference, but believe in a parent or loved one’s

observations. The parent or loved one knows that there is a

difference. Believe them.’’

Family members can be your allies, O’Connor said.

‘‘They are the ones who can provide emotional support

while the nurse is doing different tasks, like hanging IVs,’’

she said. ‘‘They can help keep the patient safe because that’s

the only person they focus on. You might have four patients,

but they are only looking at one, and they notice things that

we might not notice, like a change in the color of the skin.’’

4. REASSESS FREQUENTLYBecause of her experience, O’Connor urges emergency

nurses not to focus solely on the numbers. Reassessing the

patient’s condition frequently can help to improve the

patient’s safety.

‘‘Sometimes you have to look at the patient,’’ she said.

‘‘Are they sweaty and turning red? Does their temperature

need re-checking? You need to look at everything, from the

patient’s face to their body language.’’

5. UPDATE THE PATIENT REGULARLY

‘‘In my career, I witnessed a lack of updating,’’ O’Connor

said. ‘‘I tried to be sensitive to those issues because I

personally experienced the other side of that, and it made me

a much more sensitive nurse who stepped into the patient’s

shoes instead of focusing on my own agenda.’’

She made it a priority to update her patients at least once

every hour and inform them of the next steps of their

treatment. That seemed to relieve anxiety.

‘‘Just a three-minute visit can help,’’ she said. ‘‘The wait is

perceived as so much longer when there’s nothing

happening and you’re just waiting and hoping someone

would come in. Usually the ED nurse knows more than the

patient knows regarding the next steps. When we walk by

our patient’s room, we can just stop and give them a quick

update. They’ll feel like someone paid attention. I would

suggest taking the extra 30 seconds to say, ‘This is what

we’re waiting for. We haven’t forgotten about you.’ ’’

T he ENA Geriatric Committee is

working diligently to contribute to

the growing list of informative topic

briefs available at www.ena.org.

‘‘We had set a priority early on in

the year that we were going to provide

subject-matter expertise on geriatric

concerns for our ENA members,’’ said

chairperson Anna May, MSN, RN-BC,

CEN, CPEN.

The committee’s main focus this

year is to develop a topic brief titled

‘‘Collaborative Care for the Older

Adult.’’

‘‘We recognized that there was an

opportunity for teaching, education

and information-sharing that we could

do with long-term care facilities,

nursing homes — that kind of patient

population — as they enter the

emergency department,’’ said May,

who is the nurse manager of

emergency services at Bellevue

Medical Center in Bellevue, Neb.

The topic brief will focus on how

emergency nurses can collaborate with

nursing home personnel in their

communities ‘‘to open that dialogue,

work a little closer with extended-care

facilities, recognizing that there are

many, many levels to which patients

are discharged from the emergency

room,’’ from independent living to

nursing home complete-care facilities,

May said.

There are many things emergency

nurses can do to tailor care to older

patients, including speaking a little

slower to ensure they can hear

discharge instructions, making sure

precautions are in place to prevent

slips and falls and taking into account

that busy, teaching hospital EDs —

with students and residents entering

patients’ rooms — can be

overwhelming for this population.

‘‘Introduce yourself, let them ask

questions and encourage them to ask

questions,’’ May suggested.

At the same time, it’s just as

important to realize that not all

geriatric patients are infirm and they

may not need as much reinforcement.

EDs see many older patients who are

‘‘very healthy, reaching the prime of

their lives and beyond, which is

wonderful,’’ May said.

Committee members met at ENA

headquarters in July to work on the

topic brief. They plan to submit the

finished product to the ENA Board of

Directors by the October board

meeting. If approved, the topic brief

could be available on the ENA website

before the end of the year.

May said the committee sees the

topic brief as a foundation for future

work, which could include a transfer

tool. She has particularly enjoyed

working with ENA members from

different geographic regions and with

varying backgrounds in geriatric

emergency care.

‘‘I’m from Nebraska, and we had

somebody from Florida, Arizona and

Pennsylvania, and it’s just fun — it’s

different perspectives,’’ she said.

‘‘Some of the members weren’t in the

ED anymore, so it was nice to see

nurses in case management who were

still ENA members bringing their

expertise to the table.’’

September 201424

Driving the Dialogue for Older Patients

THE ENA GERIATRIC COMMITTEE: Front row, from left: Linda Yee, MSN, RN, FAEN; Anna May, MSN, RN-BC, CEN, CPEN (chairperson). Middle row: Deborah Clark, MS, BSN, RN, CEN, CPEN; Briana Quinn, MPH, BSN, RN (staff liaison, Institute for Quality, Safety and Injury Prevention). Back row: Leslie Talbert (senior administrative assistant, IQSIP); Susan G. Thornton, RN; Joan Somes, PhD, MSN, RN-BC, CEN, CPEN, FAEN, NREMT-P (ENA Board of Directors liaison). Not pictured: Cynthia J. Brooks, BSN, RN, CEN.

By Amy Carpenter Aquino, ENA Connection

Official Magazine of the Emergency Nurses Association 25

As ENA delegates prepare to vote

on several new resolutions at the

2014 General Assembly on Oct. 8-9 in

Indianapolis, the Pediatric Committee

is continuing work on the 2011

resolution ‘‘Firearm Safety Education

for Children.’’

‘‘We were charged to find out what

is going on with education as far as

who does it, when they do it and how

they do it,’’ said committee member

Rose M. Johnson, RN, who took on the

research duties with Warren Daniel

Frankenberger, MSN, RN, CCNS. The

full committee met at ENA

headquarters in July.

The committee’s charges stem from

a position statement, ‘‘Firearm Safety

and Injury Prevention,’’ revised in

2013. The position statement includes

the following points:

1. Emergency nurses support and

promote the ENA Mission Statement to

advocate for patient safety and

excellence in emergency nursing

practice.

2. Emergency nurses serve as health

care consumer advocates, educating

the public about the risks of

improperly stored firearms and

supporting the creation and evaluation

of community and school-based

programs targeting the prevention of

firearm injuries.

3. Emergency nurses support the

establishment of a national database of

reportable firearm injuries in order to

make evidence-based decisions

regarding patient care, safety, and

prevention.

4. Emergency nurses recognize the

most effective way to keep children

from unintentional firearm injury is to

limit access.

The Pediatric Committee is

conducting a research review before

developing a topic brief and a toolkit

with the Institute for Quality, Safety

and Injury Prevention.

Johnson, the Emergency Medical

Services for Children program manager

for Louisiana, conducted about 10

hours of searches on the topic but

found there was no outcomes-based

firearm safety education for school-age

children.

An injury prevention provider from

the days of EN CARE, Johnson said

firearm safety has been a longtime

concern. Before become the EMSC

program manager, she worked for 15

years in an ED in rural Louisiana.

‘‘It’s such a huge topic and a huge

issue,’’ she said. ‘‘Politics aside, we’ve

got to educate because what’s being

done so far is not working. If we can

educate the kids and the parents,

because we need to include them, then

maybe we can make a difference. And

we have to keep the politics out of it.’’

At press time, Johnson and

Frankenberger planned to present their

findings to the entire committee in

August before planning next steps.

‘‘It’s going to be a long process, but

we’re making a start and that’s

important — just taking that first step,’’

Johnson said.

Firearm Safety: An Education EffortBy Amy Carpenter Aquino, ENA Connection

THE ENA PEDIATRIC COMMITTEE: Clockwise from top left: Warren Daniel Frankenberger, MSN, RN, CCNS; Rose M. Johnson, RN; Jerri Lynn Zinkan, MPH, BSN, RN, CPEN; Sally Snow, BSN, RN, CPEN, FAEN (board liaison); Marlene Bokholdt, MS, RN, CPEN, nursing education editor (staff liaison); Robin Goodman, MSN, RN, CPEN (chairperson). Not pictured: Mindi Lynne Johnson, MSN, RN.

September 201426

C ervical collars are routinely

used to immobilize and protect

a trauma patient’s neck and spine in

the field, but keeping a patient in

this type of collar for too long can

have negative effects, including skin

breakdown. The ENA Trauma

Committee researched the benefits of

early removal of hard neck collars

from trauma patients who arrive to the

ED and the emergency nurse’s role in

advocating this practice. Committee

members discussed results from their

research at their June meeting at ENA

headquarters.

The cervical collars placed in the

field, also called extrication collars, are

plastic, harder collars with minimal

padding, said Kimberly Anne Murphy,

MSN, RN, CEN, ACNP-BC, MICN, PHN.

‘‘They’re cheap, they’re not meant

for long term, and they’re sort of

one-size-fits-all,’’ she said.

The committee conducted a

literature search to find the best time to

switch the patient from the rigid,

pre-hospital collar to a long-term one

with more padding, said committee

member Pete Benolken, MSN, RN,

CEN, CPEN, EMT-B.

‘‘The literature basically tells us two

things: one, everybody’s doing it a little

different, and [two], that there’s some

very good research that says you need

to do the switch within 24 hours,’’

Benolken said. ‘‘However, that is still a

very long time. There is also some

research that says the skin breakdown

does start within six hours.”

Emergency medical services personnel

put patients in extrication collars if there’s

suspicion of a neck or spine injury.

‘‘There’s no CT scan available in an

ambulance,

no X-ray, so they

do what’s best for

the patient based

on the criteria that

they live by,

their protocols,’’

Benolken said.

Once the patient

arrives at the ED,

hospital providers

follow their facility’s

guidelines. Many

trauma centers have an algorithm to

follow, and most times, if the patient

meets the criteria, the hard collar can

be removed.

If the patient is unable to be cleared,

however, and the collar remains on in

the ED, that’s when the issues can

begin. Skin breakdown can occur within

a few hours from moisture buildup and

lying in a flat, immobile position.

‘‘The driving-home point for me in

this is to make the emergency nurse

aware that changing the collar

— sooner rather than later —

is very beneficial, and for

those of us who work in

urban, larger-receiving

hospitals, that those time

frames start the minute

that the hard collar’s put

on,’’ Benolken said.

Benolken’s Level II

trauma center in Minnesota often

receives patients from North Dakota

or other states who may have

started their emergency care

journey at a small hospital before

being transferred to another

facility and then to his ED.

‘‘Those hours are ticking away,’’

he said, ‘‘and by the time they get

to my door, four, six, eight hours,

sometimes more time, has gone by.’’

When Benolken went to the ENA

listserv to ask other members when

their facilities switch patients from

rigid, pre-hospital collars, some said

the switch is not made until the patient

arrives on the inpatient unit.

‘‘There is evidence to show that

skin breakdown and changes occur

within six hours,’’ Murphy said. ‘‘We

suspect that there are a lot of facilities

where the collars are staying on longer

than those six hours,’’ which is why

the committee is putting out the call to

be more vigilant about collar removal.

Skin breakdown can result in the

development of wounds such as

decubitus ulcers, Benolken said.

‘‘Say they’re intubated and sedated

and they have to go to the ICU. Well,

then, it’s a really easy choice,’’ he said.

‘‘You need to switch them sooner

rather than later to this longer-term,

more-padding, better collar to decrease

the skin breakdown issues. And that’s

Collars, With an Eye on the ClockBy Amy Carpenter Aquino, ENA Connection

Kimberly Anne Murphy

Pete Benolken

Official Magazine of the Emergency Nurses Association 27

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where the ER nurse can play a very

important role.’’

As patient advocates, emergency

nurses are in the best position to

promote the earlier removal.

‘‘If the patient’s stable, let’s do it in

the ED. We’re smart people. We can

figure it out,’’ Benolken said.

The Trauma Committee also has

been researching the issue of spinal

board removal, Murphy said.

‘‘There is a lot of evidence, which is

being drafted into education programs

already, that the backboard needs to

be removed as soon as possible,’’ she

said, adding that a similar pathology of

low blood pressure, moisture and

immobility is present with the patients

on backboards.

The committee also worked on a

translation-into-practice document

regarding tourniquets and met with the

team developing the online Course in

Advanced Trauma Nursing (CATN).

Murphy and Benolken said they

have appreciated the chance to serve

on the committee, one of ENA’s

newest. Murphy, who works in Los

Angeles County, which has 14 trauma

centers, joined to get a more global

perspective of trauma-care challenges.

‘‘Everybody else on the committee

has a very different perspective as far

as transferring into tertiary centers,’’

she said.

She hopes to impact other topics

that need to be translated into practice

or urged for more research.

An ENA member for eight years,

Benolken has been active at the local

level and felt the time was right to

begin participating on a national level,

especially after his colleagues

encouraged him to answer the call for

Trauma Committee applicants.

‘‘This is what I do — my title is

trauma resource nurse and injury

prevention coordinator, and I work

with the trauma doctors in our trauma

program,’’ he said. ‘‘I thought this was a

good way for me to give back to ENA

on a national level for the first time.

‘‘It’s been a wonderful experience. I

will, I hope, consistently apply for

other things now because I’ve had a

taste of the impact you can offer. ENA

has given to me, and I want to give

back to ENA.’’

ENA TRAUMA COMMITTEEPatricia Kunz Howard, PhD, RN, CEN, CPEN, NE-BC, FAEN, FAAN, chairperson

Pete Benolken, MSN, RN, CEN, CPEN, EMT-B

Stacey M. Hill, BSN, RN

Kimberly Anne Murphy, MSN, RN, CEN, ACNP-BC, MICN, PHN

Maria K. Tackett, EdD, MSN, RN, CEN, CCRN

Ellen Encapera, RN, CEN, board liaison

September 201428

F or more than a

decade, hospitals

across the nation have experienced significant

shortages of various drugs, including those

used for critical health conditions.1,3 This

epidemic has presented serious patient safety

implications in emergency department

settings. The shortage of generic injectables

has had the most impact, namely epinephrine 1:10,000

syringes, sodium bicarbonate, morphine sulfate,

hydromorphone, electrolyte solutions, antiemetics and

sedatives.1,3

In a 2010 national survey by the Institute for Safe

Medication Practices, more than 1,800 health care workers

reported medication errors, near misses and even patient

deaths related to drug shortages.2,3 For example, many

facilities are diluting the readily available 1:1000 ampules of

epinephrine with 0.9 percent normal saline to make 1:10,000

syringes for use in resuscitation.2,3 One respondent in the

ISMP survey reported that a patient died in a code after a

nurse drew up and administered 10 mL of a 1:1000

epinephrine concentration, thinking it had been diluted to

the alternative 1:10,000 concentration.2

Since there are a limited number of manufacturers who

produce generic drugs, the demand for

these lower-priced medications can lead

to delays in distribution across the board.

Quality-control issues such as

compromised sterility and factories cutting

corners to keep up with supply and

demand can cause an abrupt stop or delay

in production.1,3,5 Also, some

manufacturers have been known to discontinue production

of older generics without proper notice to develop first-line

drugs that are more profitable.1,5

Many resources are available for guidance in preventing

and mitigating drug shortages, but the FDA has, within its

scope of authority, primary responsibility for reducing the

impact of drug shortages. On July 9, 2012, the Food and

Drug Administration Safety and Innovation Act was signed

into law by President Obama. In compliance with FDASIA’s

Title X, the FDA established a task force on drug shortages

and submitted a strategic plan to Congress to enhance the

FDA’s response in preventing and mitigating drug shortages.5

The FDA now requires drug manufacturers to report

potential supply issues at least six months in advance. This

early-warning system has helped to decrease shortages by

more than 50 percent between 2011 and 2012.1,3,5 Even so,

When the ADC is BarePERSPECTIVES | Catherine Olson, MSN, RN, Director, Institute for Quality, Safety and Injury Prevention

Combating Drug Shortages in the Emergency Department

Helpful Resources

www.ashp.org/shortagewww.ismp.orgwww.fda.gov/Drugs/ drugsafety/DrugShortages

Official Magazine of the Emergency Nurses Association 29

Updated Teaching

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the FDA’s influence is limited in that it

cannot require drug manufacturers to

produce or increase production of any

particular medication.1,5

Meanwhile, many other shortages

require close tracking and alternative

solutions. Health care facilities still

encounter last-minute notifications of

drug shortages by manufacturers, which

results in extensive staff time and effort

to internally develop a temporary fix.3

Emergency nurses have expressed

frustration and concern as they strive to

provide safe and efficient care — they

must become familiar with new

packaging, dosing, indications, side

effects and contraindications of

alternative medications, which, in the

end, means less time at the bedside.2,3

The impact on emergency medical

services is also cause for concern.

Challenges include limited flexibility

within multi-agency protocols, minimal

training on alternative drugs, no direct

access to pharmacy and difficulty

maintaining inventory.3

When clinical leaders, hospitals and

other agencies work to reduce the

impact of this crisis, the focus must be

on patient safety. The American Society

of Health-System Pharmacists’

Guidelines on Managing Drug Product

Shortages in Hospitals and Health

Systems, as well as ISMP resources, are

available to help tackle the internal

management of these shortages.1,4 Some

recommended solutions include:

• Extending drug expiration dates

• Use of alternative medications with

different dosing regimens

• Use of second- or third-line products

• Diverting critical medications to

specific patients by priority

Although there has been some

improvement in the number of shortages,

constant vigilance is still required. Also,

early notification by manufacturers,

awareness of resources, action plans that

include appropriate alternatives, as well

as excellent internal communication of

changes to staff, will aid in minimizing

error and adverse outcomes.

References

1. Fox, E. & Wheeler, M. (2013). Drug shortages in

the US: Causes and what the FDA is doing to

prevent new shortages. AccessMedicine from

McGraw-Hill. Retrieved from http://www.

medscape.com/viewarticle/780328

2. Institute for Safe Medication Practices. (2010).

Drug shortages: National survey reveals high level

of frustration, low level of safety. ISMP Medication

Safety Alert! newsletter. Retrieved from https://

www.ismp.org/newsletters/acutecare/

articles/20100923.asp

3. George Washington University, School of

Medicine & Health Sciences. (2014). Medication

shortages: Why they happen and what to do

[webinar]. Retrieved from http://smhs.gwu.edu/

urgentmatters/sites/urgentmatters/files/Drug%20

Shortages%20Webinar.pdf

4. Institute for Safe Medication Practices. (2010).

Weathering the storm: Managing the drug shortage

crisis. ISMP Medication Safety Alert! newsletter.

Retrieved from https://www.ismp.org/newsletters/

acutecare/articles/20101007.asp

5. Food and Drug Administration. (2013). Strategic

plan for preventing and mitigating drug shortages.

Retrieved from http://www.fda.gov/downloads/

Drugs/DrugSafety/DrugShortages/UCM372566.pdf

September 201430

Q: Why is it so important to update my ENA member profile? And when and how do I do that? – Melissa, Texas

A: It’s very important to keep your membership

profile updated for a number of reasons. Let’s start

with your e-mail address. Having a current primary

e-mail address on file not only ensures you’ll receive

critical member communication throughout the year,

but it’s the key to logging into the ENA website and

accessing the full range of your benefits. Just as

important is your physical mailing address. If your

primary address is not kept up to date, you likely

will miss your mailings of ENA Connection and the

Journal of Emergency Nursing, two essential member

benefits. In addition to these publications, ENA also

sends important member correspondence

periodically, including renewal information and

national announcements.

The other details of your profile (credentials, ED

roles, experience, chapter affiliations and the like)

are important not just because they help us to know

who you are, but because the various ENA

departments can use this information to tailor and

enrich your member experience through courses,

national and regional connections, professional

opportunities and more.

How do you update? The first and fastest way is

to log into the website via the link at the top of the main

page, then select “Update Your Profile” under the

Membership tab. (Note: This login is not to be confused with

myENA, which is a social platform separate from your

member profile.) You also can send your profile changes by

e-mail to membership@ena.org or give us a call at 800-900-

9659, Monday-Friday, 8:30 a.m.-5 p.m. Central time. We’ll be

happy to make the updates for you. Remember, if you are

having trouble logging into the ENA website, let us know

immediately so we can correct the issue.

When should you update? It’s recommended that you

check your profile about once a quarter. If there’s a big

change such as your e-mail, home address, a name change or

a new credential, try to update that right away. The more

current the information on file, the better we can serve you as

a member. Also, when you update regularly, you’re ensuring

that your ENA website login works, meaning no interruptions

as you access vital members-only areas of the website such as

your Personal Learning Page and eCourse Ops.

— Lindsay Paxton, ENA Member Services supervisor

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

Do you have a recent professional or educational success story you want to share about yourself or an ENA member colleague? Have you won an award or earned a promotion? Has another member you know been recognized for outstanding work?

Tell us! Send an e-mail to connection@ena.org with the subject line “Members in Motion.” Be sure to include names, credentials and, if applicable, photos of the nurse(s) being recognized. ENA staff may follow up with you for additional details.

Official Magazine of the Emergency Nurses Association 31

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