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INSIDE FEATURES the Official Magazine of the Emergency Nurses Association April 2012 Volume 36, Issue 4 c onnection The Younger Games We’re All Writing the Next Chapter in Our Quest for Improved Pediatric Care Pages 3-4, 8, 11-12, 16-17 GAC Workshop: You Learn Something New Every Year PAGE 6 The Importance of Having a SANE Nurse in Your ED PAGE 14 Answering Haiti’s Call, Again and Again PAGE 16 Call for 2012 Award Nominations PAGE 18

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Page 1: ENA Connection April 2012

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INSIDE FEATURES

the Official Magazine of the Emergency Nurses Association

April 2012 Volume 36, Issue 4 connection

The Younger Games We’re All Writing the Next Chapter in Our Quest for Improved Pediatric Care Pages 3-4, 8, 11-12, 16-17

GAC Workshop: You Learn Something New Every Year PAGE 6The Importance of Having a SANE Nurse in Your ED PAGE 14Answering Haiti’s Call, Again and Again PAGE 16Call for 2012 Award Nominations PAGE 18

Page 2: ENA Connection April 2012
Page 3: ENA Connection April 2012

April is National Child Abuse Prevention month, and

as emergency nurses, this is an excellent time to

remember the important role that we play in the

identification and prevention of child abuse. We are

oftentimes the first people to recognize that a child is

being abused. Our education, our skills and our

insight put us in a unique position to save a child, not

just from his or her injuries but from the abuse that

caused those injuries.

We are the advocates for our patients; we are their

voice when they often have no voice of their own. It

was Hillary Clinton who reminded us of the African

proverb, “It takes a village to raise a child.” As

emergency nurses, we live that proverb every time an

abused child arrives in our emergency department.

We are a vital part of that child’s village, and no one

is better suited to start the process of healing for a

victim of child abuse than an emergency nurse.

And emergency nurses also face the clinical

challenges that pediatric patients bring. We know that

they are not just little adults, and ENA recognizes that.

ENA’s widely respected Emergency Nursing Pediatric

Course is designed to help you learn core-level

pediatric knowledge and the psychomotor skills. It

presents a systematic assessment model; integrates

associated anatomy, physiology and pathophysiology;

and identifies appropriate interventions.

Beyond educational products, ENA is working on

critical policy issues that affect emergency pediatric

patient care. For example, ENA is currently drawing

national attention to the compelling need for all

pediatric patients to be weighed in kilograms instead

of pounds. Emergency nurses know that there is

confusion when babies and children are weighed in

pounds. In fact, our Pediatrics Committee looked into

the issue and found a study in which 25 percent of

medication dosage errors were associated with weight

confusion between kilos and pounds. In order to

protect our patients, and emergency nurses, from

devastating medication errors, it was time for ENA to

fulfill one it its primary roles, which is to be an

advocate for its members and their practice.

That is why ENA will have a new position

statement strongly urging, among other things, that

pediatric patients should always be weighed in kilos,

recording systems should only accept kilos, and that,

for pediatric patients, scales should only record

in kilos.

Continuing education, vigilance and a commitment

to excellence can and do make a difference in the

lives of our patients, whether it’s a newborn being

weighed or a 3-year-old who has been abused.

Be proud of the role you play, in your hospital and

in your community, and embrace the critical role you

play in your village for the children who live there.

Dates to Remember

PAGE 3Letter from the President

PAGE 4Sue’s Views: Letter from the Executive Director

PAGE 6Washington Watch

PAGE 8Pediatric Update

PAGE 13ENA on Facebook: What Are Emergency Nurses Saying?

PAGE 15Board Writes

PAGE 19From the Future of Nursing Work Team

PAGE 23Member Benefits and Resources

PAGE 24Ready or Not?

PAGE 26Nominations Committee

PAGE 27ENA Foundation

PAGE 28State Connection

PAGE 29Click Here

PAGE 30Board Highlights

Monthly Features

April 30, 2012 Application deadline for openings on 2013 Annual Conference Committee, Resolutions Committee and International Delegate Review Committee.

April 30, 2012 Application deadline for the ENA Foundation International Exchange Program.

April 30, 2012 Application deadline for mentees in 2012-2013 AEN Eminence Program.

May 1, 2012 Submission deadline for 2012 ENA national awards nominations.

May 10-June 8, 2012 Elections for ENA board of directors and Nominations Committee.

PAGE 11Intranasal Medication: An Alternative to Quickly Treat Pediatric Pain

PAGE 12A Renewed Partnership to Ensure Emergency Department Readiness for All Children

PAGE 14The Importance of Having a SANE Nurse in Your Emergency Department

PAGE 16Epicenter of Pediatric Emergencies:Answering Haiti’s Call, Again and Again

PAGE 20Code You: Taking Steps to a Healthier You

PAGE 21Hospital’s Wellness Program Creates a Healthier Workforce

PAGE 22Academy of Emergency Nursing 2012 Board Announced

ENA Exclusive Content

Official Magazine of the Emergency Nurses Association 3

It Takes a Village

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

The Role We Play For Children

Page 4: ENA Connection April 2012

April 20124

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).

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

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

CEN

4 April 2012

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 H. (Ellie) 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, MA, RN, CEN, FAEN

SUE’S VIEWS: LETTER FROM THE EXECUTIVE DIRECTOR | Susan M. Hohenhaus, MA, RN, CEN, FAEN

Helping Our Members Provide the Best Care for Pediatric Patients

As a child, I remember hearing the

nursery rhyme words, “April showers

bring May flowers,” and I never knew

what they meant. I have my own theory

about what it could mean in relation to

our ENA Connection issue this month.

April brings a focus on children—those

who “shower” us with the promise of

better things to come in the future. Yet,

in the health care world, especially in the

emergency care setting, we continue to

adapt adult devices, medications, equip-

ment, projects, programs and policies to

this vulnerable population that comprises

a significant portion of all emergency

department visits.

In reality, addressing the special needs

of pediatric patients actually can make

the care of adult patients safer. Think

about weighing patients only in kilo-

grams—a critical issue for pediatric

patients, but also for adult patients who

now have many of the same requirements

for medication dosing.

I have said for years, “If you can ‘fix’

things at the level of complexity for kids,

you can ‘fix’ them for anyone.” Whenever

you are creating policies, procedures,

programs and products, when you are

discussing your patient population with

vendors, administrators and others who

impact your emergency care setting,

remember to ask this question: “How is

this complicated for pediatric patients?”

ENA has programs and products that

can assist in your search for quality

education and support to care for pediat-

ric patients. We have our flagship

Emergency Nursing Pediatric Course that

provides resources for the special needs

of children, from triage to trauma. ENA

has an excellent pediatric core curricu-

lum. And it’s not all “technical.” We

always have played a leading role in

work related to family-centered care,

especially family presence during resusci-

tation.

There are promising changes on the

horizon for pediatric patients and their

families and their intersection with the

emergency nursing specialty. ENA

continues to work closely with our

federal partners at the Emergency Medical

Services for Children program, with the

American Academy of Pediatrics, with the

American College of Emergency Physi-

cian’s Committee on Pediatrics and

others. We have begun exciting conversa-

tions with regulatory agencies, including

the Joint Commission, on issues of critical

importance related to safe and effective

pediatric emergency care.

To quote another and favorite song of

mine, “Bless the beasts and the children,

for in this world they have no voice, they

have no choice.”

That line is not entirely true … you

are their voice. You can make the choice

to improve the care and advocacy you

provide to pediatric patients. You can let

us know what matters most to you in

caring for children in your clinical setting.

Your voice matters. And ENA is listening.

Be safe,

40,000 Voices StrongENA hit a membership milestone March 7 when the association reached 40,051 members, which represents a 25 percent membership increase since 2007.

Achieving and sustaining growth in these difficult economic times is a testament to the strength of the Emergency Nurses Association and the value it delivers to our members, said ENA Executive Director Susan M. Hohenhaus, MA, RN, CEN, FAEN.

“As ENA continues to provide information and develop resources that help emergency nurses around the world achieve excellence in patient care, we also continue to combine the voices of our members to legislators, regulators and other key health care stakeholders,” said Hohenhaus. “Recent accomplishments, such as the recognition of emergency nursing as a specialty by the American Nurses Association and ENA’s strong leadership efforts to ensure a safe work environment for emergency nurses, point to the power of our 40,000-plus voices.”

Hohenhaus credited the grassroots recruiting efforts of ENA’s state council and chapter leaders and members.

“Our members are the lifeblood of ENA,” she said. “With their continued dedication and desire to grow our organization, we can achieve even more significant accomplishments while holding true to the vision of our co-founders, Anita Dorr and Judy Kelleher. When we stand together, who can stand against us?”

Page 5: ENA Connection April 2012
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April 20126

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

There is always something new to learn at the ENA

Government Affairs Chairpersons Workshop, said Karen

Wiley, MSN, RN, CEN, a 2012 GAC Workshop attendee and

member of the ENA board of directors. Fifty-nine ENA

members from 41 states attended the 2012 GAC Workshop,

an intensive two-day training program that prepares

attendees for working with their federal, state and local

lawmakers.

Leveraging Efforts on Mental Health PolicyJulie Clements, deputy director of Regulatory Affairs for the

American Psychiatric Association, conducted a session on

how people with behavioral health issues are victims of

disparities and fragmentation in today’s health care system,

making the emergency department one of the few

community resources available for care. Her session

provided an overview of the larger public policy context

and how nurses might leverage their efforts with other

community stakeholders. Clements’ presentation was

timely, as many GAC attendees relayed stories of

mental patients being stuck in the emergency

department for days, and in some cases weeks,

because of a decline in community resources for

patients with mental illnesses.

This session and the subsequent briefing with

GAC participants confirmed that the

emergency department is on the front line

in the continuum of community

resources for mental health patients. As

with many other patients, the emergency

department is the last resort, and most

emergency departments are not equipped

to handle behavioral health patients

for extended amounts of time.

The costs of untreated and

undertreated mental health and

substance-use disorders are

overwhelming. The nation’s

current economic situation has put

a strain on public funding at state

and federal levels, with most states

reducing behavioral health care

services spending by nearly

$3.4 billion over the last three

years. These losses are

exacerbated in a context

where MH/SUD spending

grows more slowly than

all other health spending.

For example, from 2002

to 2005, SUD grew

slowest (5 percent),

followed by MH (6.4

percent) and all health

(7.3 percent).

With one in three

adults currently experiencing a mental disorder and one in

10 children living with a serious mental or emotional

disorder, states and communities cannot tolerate further

cuts to inadequately funded public MH/SUD health care

systems. Reductions resulting in the elimination of inpatient

beds, crisis services and community supports are

shortsighted fiscal policies that inevitably total more in

overall spending as costs are shifted to services, such as

diversion of law-enforcement personnel and correctional

costs, homeless shelters and emergency care.

Highway Safety Laws at the State Level In her session, Jacqueline S. Gillan, president of Advocates

for Highway and Auto Safety, a coalition of national

consumer, health, medical and safety organizations and the

major property and casualty insurance companies and trade

associations, discussed highway safety laws. Her lobbying

and grassroots organizing work have resulted in the

successful enactment of numerous federal and state laws

advancing motor vehicle safety, strengthening impaired

driving laws, requiring safety belt and motorcycle helmet

use, establishing teen driving programs and increasing

traffic safety funding.

Gillan’s session empowered attendees to use ENA’s 2010

National Scorecard on State Roadway Laws and other tools

to engage in collaborative efforts to encourage passage of

research-based state highway and auto safety laws. With an

emphasis on case studies, this session identified how

emergency nurses can use their knowledge and personal

experience in health care to advocate for victims and be

the expert voice for commonsense traffic safety laws.

Nurses Are Important to the Advocacy Process Linda C. DeGutis, DrPH, MSN, director of the National

Center for Injury Prevention and Control at the Centers for

Disease Control and Prevention, reinforced how important

it is for nurses to be involved in advocacy. As a former Hill

staff member and emergency nurse, she discussed her

experiences working for the late Sen. Paul Wellstone

(D-MN). DeGutis recounted successful meetings with

advocates as well as outlining what advocates should not

GAC Workshop: You Learn Something New Every Year

From the Ohio ENA State Council: Nick Chmielewski, MSN, RN, NE-BC, CEN, Government Affairs Committee chairperson, and Marilyn Singleton, BSN, RN, president-elect.

Page 7: ENA Connection April 2012

Official Magazine of the Emergency Nurses Association 7

do when meeting with congressional staff. As

frontline witnesses to what is happening in the

health care system, nurses need to relate their

experiences to members of Congress and their

staffs to ensure that legislation improves the

health care system for all patients.

Advocacy Lessons from Current IssuesEllen-Marie Whelan, PhD, NP, senior adviser at

the Innovation Center at the Centers for

Medicare and Medicaid and a former emergency

nurse, spoke about how policy is established at

the Center. Under the Patient Protection and

Affordable Care Act, the charge of the Innovation

Center is to identify, test, evaluate and scale up

promising initiatives related to patient care.

Participants discussed issues in their emergency

departments and how projects from the

Innovation Center could help with what

workshop attendees experience every day.

NetworkingWorkshop participants were able to share their

experiences and learn that many of the issues on

which they were working were also prominent in

other parts of the country. One such issue is the

drug shortage being experienced by emergency

departments across the nation. Participants

recounted some of the procedures that have been

put into place in their respective emergency

departments to counteract the shortages.

A number of attendees also are working on

violence legislation at the state level and were

able to discuss what works with their legislators

and what collaborations have been successful,

as well as the pitfalls to avoid. One of the

take-away messages for first-time attendee Adam

Bruhn, RN, of the Nebraska ENA State Council

was that his “voice can be heard.”

GACW Lobby DayFollowing their training, participants

spent a day on Capitol Hill visiting with

lawmakers and their legislative staffs. According

to Marilyn Singleton, BSN, RN, president-elect of

the Ohio ENA State Council, the workshop left

her well prepared for meetings with her

congressional delegation and their staff.

The “asks” that the attendees took to their

legislators focused on funding for the Emergency

Medical Services for Children program and the

Substance Abuse and Mental Health Services

Administration, and endorsement of the

Preserving Access to Life-Saving Medications Act

(S. 296/H.R. 2245). ENA members visited more

than 90 legislative offices; highlights included

meetings with Sens. Mark Begich (D-AK) and

Mike Johanns (R-NE).

Report prepared by Christine K. Murphy, ENA

senior public policy specialist.

GAC Workshop attendees Amy Anderson, BSN, RN (left), and Patricia Williams, MSN, RN, of the Alaska ENA State Council with Sen. Mark Begich (D-AK).

Left to right: Karen Wiley, MSN, RN, CEN, ENA board of directors, and Sen. Mike Johanns (R-NE), with GAC Workshop attendees Adam Bruhn, RN, CEN, of the Nebraska ENA State Council and Linda L. Olson, RN, BSN, of the Wisconsin ENA State Council.

GAC Workshop attendees Kieran Mitchell, RN (left), and Terri Freidhoff, BSN, RN, of the North Carolina ENA State Council.

2012 GAC Workshop attendees prepare to hit Capitol Hill.

Page 8: ENA Connection April 2012

April 20128

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

January 2012 was an exciting month for triage

nerds like me. A new version of the Emergency

Severity Index handbook was quietly published

and included, for the first time, a dedicated

pediatrics chapter. The 5-Level ESI is the triage

tool endorsed by ENA and the American

College of Emergency Physicians for emergency

department triage assessment and acuity

assignment.

In February, I had an opportunity to talk with

Debbie Travers, PhD, RN, an ENA member and

one of five project team members who developed

the original ESI for adult use in 1999. A few years

later, due to high demand and funded by a grant

from Emergency Medical Services for Children,

Travers and other researchers evaluated the

reliability and validity of the algorithm for

pediatric use and eventually created the pediatric

chapter. Travers shared the following thoughts

regarding the use of ESI for pediatrics:

1) Pediatric patients are more frequently

mistriaged than adult patients. Infants, rashes,

psychiatric issues and fevers are some of the

most difficult cases to triage for many nurses.

2) Pediatric case scenarios are included in

chapters 6, 9 and 10 and are strongly

recommended for triage training and review.

Case scenario-based teaching has been found

to be more effective than traditional didactic

methods because it mimics the clinical

environment (Hohenhaus, 2008). An

additional set of 25 validated case scenarios is

available through HRSA (webcast.hrsa.gov/

archives/mchb/emsc/20100325/Pediatric_

Case_Studies_Peds_ESI.2010.3.18.pdf).

3) Examples of common pediatric conditions for

each ESI level are listed in table format

within the pediatric chapter (chapter 6). ESI-1

and ESI-5 have been found to be often

under-used in acuity assignment.

4) There is a lack of standard normal vital sign

criteria in pediatric emergency texts and

courses, as well as a lack of a standardized

approach to pediatric assessment and history-

taking.

One thing that has always frustrated me,

especially as a preceptor, was the lack of

pediatric-specific triage resource material. While

several emergency education courses and texts

include content on pediatric emergencies or

pediatric triage, a review of the literature by

Hohenhaus, Travers and Mecham (2008)

confirmed there is not one single course

or textbook that provides a comprehensive,

standardized approach for pediatric triage and

acuity assignment in the emergency department.

While not meant to be a substitute for

emergency education courses, the 2012 ESI

handbook serves as a unique resource which

offers an overview of a standardized approach

to pediatric triage, assessment and acuity

assignment in the emergency department. The

handbook is published by the Agency for

Healthcare Research and and is available free

online (www.ahrq.gov/research/esi) and in

print to individuals who work in emergency

departments.

References

Emergency Nurses Association. Standardized ED

triage scale and acuity categorization: joint

ENA/ACEP statement (2010). Accessed online

February 10, 2012: www.ena.org/

SiteCollectionDocuments/Position%20

Statements/STANDARDIZEDEDTRIAGE

SCALEANDACUITYCATEGORIZATION.pdf

Gilboy, N., Tanabe T., Travers D., Rosenau A.M.

Emergency Severity Index (ESI): A Triage

Tool for Emergency Department Care,

Version 4. Implementation Handbook 2012

Edition. AHRQ Publication No. 12-0014.

Rockville, MD. Agency for Healthcare

Research and Quality. November 2011.

Hohenhaus, S. (2008). Pediatric triage: A review

of emergency education literature. Journal of

Emergency Nursing, 34(4), 308-313.

Hohenhaus, S. (2006). Someone watching over

me: Observations in pediatric triage. Journal

of Emergency Nursing, 32(5), 398-403.

doi:10.1016/j.jen.2006.07.002

Travers, D., Agans, R., Eitel, D., Mecham, N.,

Rosenau, A., Tanabe, P. & Waller,A. (2006).

Reliability evaluation of the Emergency

Severity Index Version 4 [Abstract].

Academic Emergency Medicine, 13(5S), 126.

Travers, D. A., Waller, A. E., Katznelson, J., &

Agans, R. (2009). Reliability and validity of

the emergency severity index for pediatric

triage. Academic Emergency Medicine, 16(9),

843-849. doi:10.1111/j.1553-2712.2009.00494.x

A New Chapter in Triage for Pediatric Emergency Patients

Contact the author

I would like to answer your questions and share your stories. Please e-mail me at [email protected] with questions,

problems and any special stories or learning experiences you would like to share about taking care of children in the emergency department. I will weave them into the

column whenever possible.

Page 9: ENA Connection April 2012
Page 10: ENA Connection April 2012
Page 11: ENA Connection April 2012

Official Magazine of the Emergency Nurses Association 11

It’s a busy Monday evening in the emergency

department and arriving via EMS is a 5-year-old

boy who fell onto his outstretched arms while

rollerblading in his driveway. As he is moved

over to the emergency department stretcher,

you notice his right forearm is obviously

deformed, and he is clearly in severe pain. Is

there something you can use to quickly treat

his acute pain and anxiety that does not

require sticking him with a needle?

In our never-ending quest to help reduce

pain, pediatric emergency nurses are always

looking ahead for new innovations while also

looking into the past to investigate earlier ideas

that may still be viable for current use. More

medications are becoming increasingly child-

friendly, and pediatric emergency nurses

continue to look toward integrating them into

everyday practice. While chewable tablets,

orally disintegrating tablets and improved liquid

medication taste are all great steps in helping

children tolerate oral medications, parenteral

medication delivery for acute pain and

anxiolysis still usually involves the use

of needles.

One option that has recently re-emerged in

popularity as an alternative for initial pain

management and anxiolysis, particularly in the

pediatric emergency department setting, is the

use of intranasal medications. While intranasal

medication delivery has been around for many

decades, its return to emergency nursing has

come about with the growth of the commercial

availability of low-cost atomizer devices. One

excellent example of the simplicity and

widespread use of intranasal medications is the

widely available intranasal influenza vaccine.

A quick review of intranasal medication

administration should include three key ideas:

a) Atomizing the medication vastly increases the

surface area that comes into contact with the

medication;

b) It passes readily through the richly vascular

nasal mucosa into systemic circulation,

increasing immediate bioavailability; and

c) This route also has the advantage of avoiding

the first-pass effect of liver metabolism on

the medication. The optimal absorption is

based on using both the highest

concentration of the medication available and

administering a limited volume of that

medication (less than 1mL per nostril) for

best absorption.

In the case of the 5-year-old boy with the

forearm deformity, the use of intranasal

analgesia is a great alternative for helping with

his acute pain in the short term. This also

reduces the pressure and urgency for starting

intravenous access to administer initial

analgesia. While intravenous access may be

needed later in many cases like this one, using

intranasal analgesia will also make obtaining

intravenous access safer and more successful

with a less anxious child. In addition, his

parents will feel more at ease once his initial

pain is treated.

The most popular uses of intranasal

medication delivery in the pediatric emergency

department are for analgesia, anxiolysis and

seizure control. In addition to these three uses,

there are many published articles involving both

pediatric and adult patients that discuss the use

of intranasal medications for hypoglycemia,

opioid overdose, sedation, nausea, migraines,

hypertension and several other conditions. The

use of intranasal medications is also growing

rapidly in the EMS community, with several

states integrating their use into paramedic

treatment protocols.

In the pre-hospital and emergency

department settings, the use of needle-free

devices and ease of intranasal access reduce

both needlestick injuries and the time it takes to

administer the medication. In these urgent

situations, administering a lifesaving medication

via intranasal route also may improve patient

outcomes. The use of intranasal naloxone for

treatment of opioid overdose and intranasal

midazolam for seizure control both have shown

promise for decreasing administration time over

intravenous routes while also decreasing

opportunities for needlestick injuries in these

high-risk situations.

There are some contraindications and

circumstances where using the intranasal route

isn’t an option. Examples include patients with

facial trauma; nasal trauma; mucous, blood or

foreign bodies in the nostrils; inhaled drug use;

severe congestion; obvious craniofacial

anomalies and inhalation burns.

Intranasal medication is not the answer for

every patient or situation. It is a very reliable

and easy-to-use alternative to intravenous and

intramuscular medications in emergency

departments, especially when immediate pain

control is a priority.

As emergency nurses, it is important that we

explore all options for delivering medications in

the safest and least invasive way while doing

our best to reduce pain and anxiety in both

adult and pediatric patients. The use of

intranasal medication delivery gives us another

tool for providing medication administration

and pain management. I encourage you to

explore the option of adding this medication

delivery method to your emergency

department’s formulary. Through very simple

training, obtaining atomizer devices and

collaborating to update current medication

administration policies, this method can help

the emergency nurse provide better, more

efficient care to some of our patients.

Jason T. Nagle is assistant nurse manager,

Children’s Emergency Department, Vidant

Medical Center in Greenville, N.C. Readers may

contact him at jason.nagle@VidantHealth.

com.

Intranasal Medication Offers Alternative to Quickly Treat Pediatric PainBy Jason T. Nagle, RN, CEN, CPEN, CPN, FNE, EMT, Member, ENA Pediatric Committee

‘Yes’ to the Nose

Page 12: ENA Connection April 2012

April 201212

Each year, nearly 29 million children are treated

in emergency departments across the country1.

Close to 90 percent of those children are treated

in local general hospitals, not dedicated

children’s hospitals. The purpose of the

Emergency Medical Services for Children

Program is to ensure that infants, children and

adolescents receive appropriate care through

the entire spectrum of emergency services,

including prevention of illness and injury, acute

care, and rehabilitation.

As longstanding partners, EMSC and ENA

have recently committed to working together

on two new exciting projects: the National

Pediatric Readiness Project and the Interfacility

Transfer Toolkit. (Read about the Interfacility

Transfer Toolkit in the March 2012 issue of

ENA Connection.)

National Pediatric Readiness ProjectOver the last two decades, several national

organizations have issued consensus

recommendations2 identifying resources for

emergency departments to adequately care for

ill and injured children. In 2002 and 2003,

however, two national surveys3,4, highlighted

discrepancies between these recommendations

and what emergency departments actually have

on hand. Ten years later, the question remains,

“Have hospitals made progress in closing

this gap?”

To address this question, the Pediatric

Readiness Survey was developed through a

collaboration among ENA, the American

Academy of Pediatrics, the American College of

Emergency Physicians, the American Academy

of Family Physicians and EMSC. This first step

toward national pediatric readiness will give all

of us a clearer picture of the current capacity of

emergency departments across the country to

provide effective emergency care for our

children. More important, these organizations

are committed to working together to establish

an infrastructure that helps all hospital

emergency departments engage in continuous

quality improvement by providing education

and resources.

This survey is ambitious. We are asking for

the cooperation and participation of all

organizations with an interest in pediatric

emergency care. Therefore, emergency nurses,

including members of ENA, will be pivotal to

ensuring survey completion.

A few Pediatric Readiness Survey facts:

• The survey is expected to be released in

fall 2012.

• The goal is for every hospital (urban, rural,

frontier or suburban) with an emergency

department that receives children to complete

the survey.

• The survey is anonymous. Your hospital

information will not be released.

• Emergency department nurse leaders (nurse

manager, coordinator, director) are requested

to complete the survey.

• A multi-organization outreach campaign

(including ENA, AAP, ACEP and others) is

planned to raise awareness about this

upcoming survey.

Elizabeth Griffin, BS, RN, CPEN, and Anne

Renaker, RN, two ENA members participating in

the project, said what excited them most about

the project was the possibility of ‘‘a future

where parents and families don’t have to worry

about which facility to take their child during

an emergency.”

Through the National Pediatric Readiness

Survey and related activities planned over the

next few years, we have an unprecedented

opportunity to empower hospitals—regardless

of their size or location—“to do what they want

to do anyway, provide the best possible care

for children seeking their help.”

1. Statistical Brief 52. Healthcare Cost and

Utilization Project. Pediatric Emergency

Department Visits in Community Hospitals

From Selected States, 2005. Agency for

Healthcare Research and Quality, 2008.

Available at: www.hcup-us.ahrq.gov/

reports/statbriefs/sb52.jsp. Accessed

January 23, 2012.

2. Institute of Medicine, Committee on Pediatric

Emergency Medical Services. Institute of

Medicine Report. Emergency Medical Services

for Children. Durch J.S., Lohr K.N., eds.

Washington D.C: National Academies Press;

1993.

3. Burt, C.W., McCaig L.F. Staffing, Capacity,

and Ambulance Diversion in Emergency

Departments: United States, 2003-2004.

4. Gausche-Hill M., Schmitz C., Lewis R.J.

Pediatric Preparedness of US Emergency

Departments: A 2002 Survey. Pediatrics. 2007;

120:1229-1237.

A Renewed Partnership to Ensure ED Readiness for All ChildrenBy Jaclynn Haymon, MPA, RN, Director of Communications and Planning at EMSC National Resource Center

Feedback Frame

Page 13: ENA Connection April 2012

Official Magazine of the Emergency Nurses Association 13

ENA on Facebook. What Are Emergency Nurses Saying?On March 7, ENA asked, “What is the best way to thank an ED nurse? What was the best “thank you” you ever got from a patient or from your institution?”

Elizabeth Adkison The best gift I have ever gotten is a simple thank-you. I think sometimes

institutions forget how much it

means to just say those two simple words. After a long, exhausting day,

sometimes that’s all I want—someone to thank me for my hard work!

Andrew J. VeitchI think the thank-yous I remember the most are those written in a letter/

card. I carry those with me forever to take out and read when I’ve had a

hard day at work. I still keep a written letter from parents of a baby I took

care of in CV ICU post-emergent cardiac surgery. Those words in that

letter meant so much to me back then and still inspire me to continue

making a difference today ... 15 years later.

Sare Barr Gilbert I had a 9-year-old name his kitten after me. His mom told me when she

returned a few days later. Made my night.

On March 14, ENA posted a link to an article in the Seattle Times which explored the problems of psychiatric patient boarding.

Dena Sigman Oh, it gets better than this … boarding PEDIATRIC psych patients in the

ER for days and sometimes WEEKS while we wait on the approximately

4-5 psych hospitals in NC to have bed space for them. How traumatic for

this age group (usually anywhere from 8-14) to witness codes, traumas

and the other usual things that occur on a daily basis in the ED.

Heather Clement We have very similar issues. Pediatric patients have trouble getting placed,

and uninsured patients wait days—the longest was a week. We have an

18-bed ED, but one time we had 11 psych patients at once (that was a

nightmare). They do not get the treatment that they need while sitting in

the ED. We are looking to use telepsychiatric services within the next

three months.

Page 14: ENA Connection April 2012

April 201214

The CDC’s 2010 National Intimate Partner and

Sexual Violence Survey found that 1.3 million

women were raped during the year preceding

the survey and nearly 1 in 5 women have

been raped in their lifetime, with an estimated

80 percent experiencing their first rape by age

25. Research shows that in comparison to

men, women experience high rates of rape,

stalking and severe IPV.1

A health care professional may be the first

person the victim talks to about the assault.

Because of the patient’s traumatic experience,

experts recommend that he or she is treated

by a nurse who is trained properly in

evidence collection, providing advocacy and

treating trauma that can be linked to the

sexual violence. Sexual-assault nurse

examiners (SANEs) play an important role in

treating sexual-abuse patients, as they are

registered nurses who have specialized

forensic training, education and clinical

preparation in treating sexual-assault victims.2

Kim Day, RN, FNE, SANE-A, SANE-P, safe

technical assistance coordinator at the

International Association

of Forensic Nurses, says

there’s a need for hospitals

to have SANEs in their

emergency departments.

‘‘Sexual-assault patients

who come into the

emergency departments

are a really specialized

group of patients,’’ Day

said. “They require

really specific knowledge and skills that will

be helpful in caring for them. For example,

sexual-assault clients not only have the acute

assault to deal with, but also the long-term

ramifications and health impact that sexual

violence can have on their lives, so it’s really

important that trained examiners are able to

care for them at the time of the visit. When

a person is sexually assaulted, they have

to make decisions they never had to

make before.’’

The 2010 ENA Care of Sexual Assault

Patients in the Emergency Department

position statement highly recommends the

employment of SANE nurses in the emergency

department because they provide ‘‘expert

crisis intervention, acute care and treatment,

evidence collection, detailed documentation,

sexually transmitted infection and pregnancy

prophylaxis and appropriate referrals for

follow-up care and counseling for sexual

assault and rape victims.”3

Day believes providing best-practice care

for sexual-assault victims begins with trained

examiners who are specialized in providing the

medical forensic exam and advocacy.

“It’s really distressing to me,” Day said, “to

ENA wishes to express its sincere gratitude to these 2012 sponsors.* Thanks to their generous support, ENA is able to continue to provide relevant services

and educational programs to improve your practice of emergency nursing.

*As of print time

Strategic Supporters

Strategic Sponsors

Conference SupportersConference Sponsor

LC12_SponsorThank_Flyer_Half Page Island.indd 1 1/12/2012 3:18:32 PM

Continued on page 30

The Importance of Having a SANE Nurse in Your ED By Kendra Y. Mims, ENA Connection

Staffing to Treat Sexual-Assault Patients

Kim Day, RN, FNE,

SANE-A, SANE-P

Page 15: ENA Connection April 2012

Official Magazine of the Emergency Nurses Association 15

Mentors and Their Magical Effect

BOARD WRITES | Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN, Secretary/Treasurer

As I sit to write this column, I can’t help but reflect

on the week I spent at ENA Leadership Conference

2012 in February. It was a week of re-energizing,

reflecting and refocusing. As always, it was great to

see old friends, meet new ones and hear about

how my colleagues all over the globe are celebrating their successes.

Of the many moments that were both illuminating and empowering,

there was one which reminded me of how, through the power of one

person, your future can change in an instant.

The moment happened during the closing session of the State Leaders

Conference. A young man shared his journey from being interested in

becoming an EMT to being an emergency nursing leader. He described how

when he shared his dream with one person, she encouraged him to get his

EMT certification. When he expressed his desire to go to nursing school,

she showed him the scholarship opportunities the ENA Foundation has for

EMS professionals becoming RNs and wrote him a recommendation letter.

He shared how this nurse mentored him throughout nursing school,

preparing him for a job as a new graduate in the emergency department. He

said his mentor continues to offer guidance and support,

always sharing her passion for her profession.

This story reminded me of how I became involved in

ENA and what I am passionate about. Although I joined

ENA not long after graduation, I did not become involved

until several years later. While in an emergency

department on a travel nurse assignment, I met a nurse

wearing an ENA pin on her badge. I approached her and

mentioned her pin. She was more than happy to fill me

in on the local ENA chapter and quickly invited me to its

upcoming holiday party.

Eleven years later, here I am. I have had many

incredible mentors over the years and would not be on

the ENA board of directors without their support,

encouragement and sometimes brutal honesty.

As a national ENA leader, it has become my passion to

mentor others. I want each and every emergency nurse to

have the tools, resources and education to be the best

nurse he or she can be.

My passion in the emergency department is the care of

children. I am excited about all of the great tools and

resources ENA will launch this year. The Emergency

Nursing Pediatric Course revision will be out in the

summer. It contains the latest evidence-based practice

related to the care of the pediatric patient in the emergency

department. It also includes a new chapter, “Preparing for

Pediatric Patients,” which includes evidence-based tools

and resources to help you validate that your department

has everything it needs to care for children.

We know there are many preventable medication errors

made in the emergency department that are a direct result

of how we weigh our children. Soon, members will have

access to a position statement that identifies that we should

weigh our patients in kilograms—always.

We have heard from our members that the interfacility

transport of pediatric patients occurs frequently, and there

is no guide or tool available to facilitate this process. We

are working with our partners at the Emergency Medical

Services for Children and the Society of Trauma Nurses to

develop a toolkit for the interfacility transport of pediatric

patients. (See the article on the toolkit’s progress in the March 2012 issue of

ENA Connection.)

It was during State Leaders Conference that Hershaw Davis Jr., BSN, BS,

RN, Maryland ENA State Council Government Affairs chairperson, reminded

me how important it is to mentor others. His enthusiasm, confidence and

passion were very moving. To watch another emergency nurse stand up

and say it was because of one person and one organization that he had

succeeded was an empowering statement. I encourage all of you to go find

a Hershaw Davis Jr., and help that person recognize the power of the

profession of emergency nursing. Mentor an emergency nurse or someone

who wants to become an emergency nurse. Inspire someone to obtain the

skills, education and tools he or she needs to be the best possible nurse.

I am fortunate to have the opportunity to attend the National Student

Nurses Association annual conference in Pittsburgh this month. I will

represent ENA as I share my passion with nursing students from all over the

U.S., and I have the honor of sharing the stage with Hershaw Davis Jr. We

will both share our passion for the profession of emergency nursing with

the goal of inspiring our next generation of emergency nursing leaders.

Page 16: ENA Connection April 2012

April 201216

Since the massive earthquake that reduced

much of Haiti to rubble on Jan. 12, 2010, ENA

member Brian Webster has visited five times.

He’ll make it six at the end of the summer. He’s

seen and treated it all—so much of it affecting

children.

During his last trip in September, his second

with the relief group Project Medishare, “we

saw lots of trauma, lots of sepsis. We even saw

tetanus—something you would never see in the

United States—lots of malaria, lots of yellow

fever,” Webster, BSN, RN, CEN, CPEN, FAWM,

rattles off.

Lots of trauma? Twenty months after the

earthquake?

It’s the violence now, Webster says: muggings

and politically motivated attacks. It’s cars

routinely slamming into other cars and people—

frequently kids—in a country without traffic laws.

Haiti is home to an improving but generally

constant chaos best suited for an emergency

nurse, a military man or a specialist in

wilderness medicine, and Webster, 37, is all

three. Back home in Williamsport, Pa., he’s the

RN clinical supervisor for the Williamsport

Regional Medical Center emergency

department, part of the Susquehanna Health

system. A Navy veteran (1992-95) and a former

member of the Pennsylvania Army National

Guard (1995-98), he was presented with an

Alumni Humanitarian Citizenship Award from

Pennsylvania College, his nursing alma mater,

in December in recognition of his efforts in Haiti.

Webster admits his military days didn’t

completely prepare him for the destruction and

suffering he found when he first arrived, 28 days

after the quake, with three other volunteer nurses

from Williamsport, joining nurses and physicians

from other hospitals in Haiti. “I’d been to a lot of

third-world countries before, but when I got to

Haiti, it was a very surreal experience,” he says.

He turned instinctively to his education from

ENA—the Trauma Nursing Core Course and the

Emergency Nursing Pediatric Course.

“It’s the foundation in Haiti and the foundation

here in the States of the way I approach a

situation,” says Webster, whose work has been

concentrated mostly in Port-au-Prince, the Haitian

capital, and the suburb Carrefour. Of the other

nurses he has traveled with, “almost everyone had

at least TNCC, most had ENPC. Myself and another

nurse, we were CPEN, board-certified pediatric

nurses, so we brought a lot to the table with

regard to the care of children and adolescents

down there. We didn’t feel ill-equipped.”

The local facilities and infrastructure have

been another story altogether.

Relief workers initially had to bring in all of

their own medication, supplies and food, and

they still handle much of that themselves. Haiti

just graduated its first EMT class in Port-au-

Prince, Webster says: “That’s not even at the

paramedic level—these are EMTs, basics, that

were just trained.”

Project Medishare works out of the country’s

only Level I trauma center, also in Port-au-Prince,

with an emergency department, an operating

room and two wells on the property. Elsewhere

in Haiti, running water is usually nonexistent.

You purify it or you buy it—or you do without.

“On a health standard level, that’s kind of

where they’re at,” Webster says. “A lot of our

focus down there is preventative health care. So

many of their ailments and diseases are because

of unsanitary conditions. You could have a lot of

ailments such as pica syndrome, because they

have worms or some type of parasitic infection,

and it just keeps going and going and going.

They become iron-deficient, anemic, and that

leads to other things. It could have all been

prevented with good hand-washing and purified

water. It just shows you how things can escalate

down there and snowball.”

As Webster prepares to head down again,

he’s committed to helping the Haitians help

Answering Haiti’s Call, Again and AgainBy Josh Gaby, ENA Connection

Brian Webster, BSN, RN, CEN, CPEN, FAWM, poses with a group of children in Haiti, where disease and violence have been rampant and recovery painfully slow since a 7.0-magnitude earthquake caused widespread destruction (right) more than two years ago.

Epicenter of Pediatric Emergencies:

Page 17: ENA Connection April 2012

Official Magazine of the Emergency Nurses Association 17

themselves. Miami-Dade County (Fla.), through Project Medishare,

has donated ambulances to Port-au-Prince. Webster is attempting to

arrange a gift of defibrillators and believes he’s close to making it

happen.

Meanwhile, the training of Haitian nurses and physicians by

international volunteers continues. Webster encourages the next

wave to sign on with a reputable non-government organization—

Project Medishare, Partners in Health, Doctors Without Borders or

the Red Cross. These groups stress risk management and positive

experiences while preparing nurses realistically for what they’ll see.

“I think that if somebody has the desire and training to go, they

can definitely be useful and make a huge impact at any facility or

any aid organization that they work with down there,” Webster says.

“The appropriate training is clutch, not just in pediatric nursing but

in wilderness nursing or working in remote areas. It just gets

blended together when you’re there. You kind of have to do things

differently. You do a lot of improvisation, making do with stuff that

you have, trying to make things work.”

What a nurse brings back to the emergency department at home,

he says, is “mostly on the level of critical thinking and being able to

really prioritize an emergency. Of course, I knew how to do that

pretty well before I went to Haiti, but when you’re in a country like

that and you’re working in this ED and all of this bad stuff is coming

to you, you have to really, really prioritize and make sure you’re

taking care of the sickest first and those that can really use your

help. On some levels, it almost reminded me of battlefield triaging—

you’re taking care of the people that you can save. Those are the

things that we’re faced with down there. You can only operate to

the extent of your resources, and the extent of your equipment and

your team.”

Webster returned from his first few trips with what he describes

as “this overwhelming sense of guilt: ‘Oh, my gosh, we have so

much here, and they have so little.’ You know when you’re leaving

the country that these people are still going to be there and these

kids are still going to be there.”

Now he has a reshaped mind-set.

“I’m grateful for the equipment, the resources, the education that

I have here, and I want that for the Haitian people,” he says. “I feel

bad that they don’t have these resources, so I’m going to try to find

a way to provide these resources.

“It’s something that’s planted a fire in me. Once you see a child or

a family in a devastating situation, you want to do all you can to

help them.”

Webster treats a critically ill young girl in September 2010. He chronicles ongoing relief efforts in Haiti at his website, The Humanitarian Group (thehumanitariangroup.org).

Page 18: ENA Connection April 2012

April 201218

Nominations for the 2013 ENA Foundation Board of TrusteesApplication Deadline: June 1Visit www.enafoundation.org for more information.

Do you know someone who deserves an ENA national award? A friend or colleague who made a dramatic difference in your professional

life? This is your opportunity to give the highest praise and recognition to the people you count on and admire, urges Awards Advisory

Committee Chairperson Deborah Ann Taylor, BSN, RN, CEN, SANE.

Honor outstanding members of the emergency nursing community by nominating them to join the prestigious group of ENA national award

recipents. The deadline is 5 p.m. Central time, May 1. Visit the awards tab at www.ena.org/AboutENA for a list of awards, application and

eligibility details. Direct your questions to Chris Siwik, Awards Committee staff liaison, at [email protected] or 847-460-4044.

For most awards, only an ENA member can submit a nomination, and the award nominee must be an ENA member. Information on

submitting nominations, a 2012 application, the specific requirements for each award and tips on how to write letters of support and submit a

nomination can be found at www.ena.org.

Nominations packets must be received no later than 5 p.m. Central time, Monday, May 1. The awards will be presented during the

2012 ENA Annual Conference in San Diego, September 11-15.

ENA Call for…

2012 Award NominationsSubmission Deadline: May 1

ENA Call for…

ENA is looking to fill openings on the 2013 Annual Conference, Resolutions and International Delegate Review committees.

ENA members are invited to submit their applications online. View the Calls and Opportunities area at www.ena.org for details of these calls.

Online applications are being accepted through 5 p.m. Central time, April 30.

The 2013 ENA Annual Conference will be held in Nashville, Tenn., at the Gaylord Opryland Convention Center, September 17–21.

We have enhanced our committee application to allow members to upload a photo to their online application. While this feature is not

mandatory, we highly encourage your photo submission. Look for instructions on how to upload your photo when applying for your

committee choice.

For questions, please contact Nancy Good at [email protected] or 800-900-9659, ext. 4095.

ENA Call for…CommitteesSubmission Deadline: April 30

Page 19: ENA Connection April 2012

Official Magazine of the Emergency Nurses Association 19

Continued on page 29

The Robert Wood Johnson Foundation funded

the Institute of Medicine report The Future of

Nursing: Leading Change, Advancing Health.1

Released in October 2010, it has become one of

the most reviewed reports at www.iom.edu.

This article, part of a series to enhance

awareness of the recommendations outlined in

this critical report, deals with the need for

expanded opportunities for nursing leadership

in collaborative improvement efforts.

Recommendation 2: Expand

opportunities for nurses to lead and diffuse

collaborative improvement efforts. Private

and public funders, health care organizations,

nursing education programs and nursing

associations should expand opportunities for

nurses to lead and manage collaborative efforts

with physicians and other members of the health

care team to conduct research and to redesign

and improve practice environments and health

systems. These entities should also provide

opportunities for nurses to diffuse successful

practices.

The health care environment is rapidly

changing to integrate new technology into

patient care. Practitioners are concurrently

focusing on the integration of evidence-based

practice. These movements are rapidly changing

the patient care environment and have an

intense impact on emergency department care.

Emergency nurses are the “jacks of all

trades.” They must balance the development of

expertise in technological tools and information

management systems while working to use

cutting-edge, evidence-based interventions with

their patients. All of this is done while

collaborating and coordinating care across

teams of health professionals that may be

located in the community, the emergency

department and/or the health care facility.

Emergency nurses must be leaders in the

design, implementation and evaluation of the

ongoing change in their patient care

environment. They must take a leadership role

in building professional partnerships with their

professional colleagues to ensure that the

patient receives optimal care. Emergency nurses

must develop leadership skills and

competencies that assist them with the

demanding professional environment that exists

in the changing emergency department. They

must step forward and work in collegial teams

to enhance the quality of the services provided.

ENA has long recognized the pivotal role the

registered nurse plays in the successful

coordination of care in the emergency

department. The association has developed

many tools and opportunities to help the

individual emergency nurse grow in his or her

leadership role. Two great examples of this

work, the ED Benchmark Collaborative™ 2 and

the development of a consensus statement3 that

defines standardized emergency department

metrics, will help nurses work in collaboration

with other health care professionals to research

strategies to reduce emergency department

crowding and boarding.

Research has demonstrated that a leadership

style that involves working with others as full

partners in a context of mutual respect and

collaboration can result in direct patient care

improvements. Specifically, the IOM report

describes improved patient outcomes, reduced

From the Future of Nursing Work Team

Nurses as Leaders in Collaborative Improvement Efforts By Melinda Mercer Ray, MSN, RN

SubmiSSion DeaDline  auguSt 1, 2012

Research and evidence-based Practice ProjectsDon’t miss this opportunity to showcase your work on emergency department management, leadership and research

Call For Posterabstracts

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 1 3

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

LC13_CallForPosterAbstracts_ConHPIsland.indd 1 2/14/2012 9:36:06 AM

Page 20: ENA Connection April 2012

April 201220

CODE

CODE YOU CODE YOU

CODE YOU

CODE YOU

CODE YOU

By Kendra Y. Mims, ENA Connection Taking Steps to a Healthier YouObesity in the United States has become an

epidemic, with statistics reporting that more

than one-third of U.S. adults (more than 72

million people) are obese; obesity rates for all

population groups have increased significantly

over the last several decades.1 Research shows

that health care professionals are not exempt

from obesity population groups, as long

working hours, inadequate sleep and limited

access to healthy foods during their shifts are

contributing factors to weight gain.

A 2008 study in the Journal of American

Academy of Nurse Practitioners reported that

more than 50 percent of the nurses surveyed

were overweight or obese, and 53 percent

reported that although they are overweight, they

lack the motivation to make lifestyle changes.

Although 93 percent admitted that overweight

and obesity are diagnoses that require

intervention, 76 percent did not pursue the

topic with patients who struggle with obesity.3

Obesity not only increases the risks of heart

disease, high blood pressure, type 2 diabetes,

cancers, liver disease and other health

conditions, it can also increase the risk of

workplace injuries, as research shows nurses

who are overweight and obese have a greater

chance of becoming injured in the workplace.

Jeanne Fogarty, MBA, BSN, RN, TNS, a nurse

manager in St. Louis, Mo., and a member of the

ENA Emergency Department Workplace Injury

Prevention Work Team, said an employee who

has a body-mass index greater than 40 will have

twice as many claims of injury, which will result

in a significant increase in days off from work

and medical costs.

“Our research has shown that nurses who are

overweight tend to be out of shape and they

have weaker back and leg muscles,” said

Fogarty, who spoke on the ENA Toolkit for

Injury Prevention panel at ENA Leadership

Conference 2012. “As a result, they end up

having an increased number of injuries. They

are not able to handle the patients as well as a

nurse who is more physically fit.”

Though time is tight and your schedule is

packed, here are some alternative methods you

can use at work to help prevent and fight obesity.

Scenario: After working for six hours, you

have a break and hear that there is pizza and

cake in the staff lounge. This gives you just

enough time to grab a slice in between patients

and get back to work.

Alternative: Ditch the potluck and takeout

and stock up your staff lounge with healthy,

convenient options such as fruit, nuts and baby

carrots. Create your own stash of healthy treats.

Fogarty says it’s not uncommon for staff lounges

to be filled with unhealthy snacks items and for

fast food to be brought into the workplace

because nurses can’t get to lunch all of the time.

“They can graze the entire shift because they

know they can’t sit down and have an actual

meal,” Fogarty said, “and the snacks that they

bring in aren’t always the healthiest. If I go into

my staff lounge at night, I’m not finding fruit

and cheese. I’m finding chips and dip and

pizza. It’s the grab-and-go food, which always

tends to be a higher calorie.”

When it comes to making healthy choices and

living a healthy lifestyle on a consistent basis,

Fogarty says nurses are no different than the rest

of society.

“We know better. Everybody knows better.

But we don’t always practice what we preach,”

she said.

Off-shift nurses face a particular challenge.

“Nurses who work off shifts will tend to be

heavier because they’re working such bizarre

hours,” Fogarty said, “and it’s not uncommon

for them to work all shift without eating, and

then, after working nights, they’ll have a big

meal at the end of their shift and go to bed

instead of exercising.”

Suggestions for night shift nurses include

keeping an insulated lunch box stocked with

healthy food, eating small, frequent meals

throughout the night to maintain blood sugar

and avoiding heavy carbohydrates during your

shift.4 Other tips that you can use for any shift

are as follows:

• Prepare your meals and snacks in advance for

the week so that you have healthy options on

the go.

• Bring your own snacks and meals to work.

• Monitor how much you eat.

FACT: Adult obesity rates were more than 15% in nearly all but three of the 190 U.S. metropolitan areas that Gallup and Healthways surveyed in 2011. Because of high obesity rates, the estimated additional health care costs increase to $80 billion across all 190 metro areas.2

The American Nurses Association will have

its 2012 Healthy Nurse Conference, “Nurses

as Models of Wellness in Action,” on June

14 in Washington, D.C. This one-day health

and wellness program will teach nurses how

to decrease stress, stay fit and incorporate

healthy habits into their home and work

environment. For more information, visit

https://hnc2012.cistems.net/Public/

registration_home.php.

Fit Together

Page 21: ENA Connection April 2012

• Reduce your coffee intake (which can throw

off your sleep schedule) and substitute

green tea.

• Avoid the vending machine.

Scenario: It’s time for a break, so you use the

elevator to go to the cafeteria to eat a quick

lunch. After your meal, you still have a few

moments left of free time, and you notice your

favorite show is on television.

Alternative: Because time is tight, taking

advantage of any opportunity to exercise is

important to combat obesity, as being physically

active is proven to be essential to maintaining a

healthy weight. Use the stairs in the hospital

instead of the elevator or take a walk with a

colleague on your break. Gary Scholar, author of

Fit Nurse, says some nurses may enjoy more

meditative exercises that are easier on the joints

(such as yoga or tai chi) because they spend a

lot of time on their feet.5 Scrubs magazine also

suggests that nurses squeeze the following

exercises into their workday6:

• Toe rises while you’re standing and

charting. (Rise up onto your toes and then

lower. Squeeze your glutes together as

you rise.)

• Tighten your glutes and release if you’re

sitting to chart. You can also practice

pulling your lower pelvic and abdominal

muscles in and up, and your rib cage in

and down.

• Leg lifts while sitting at the nurse’s station.

Flex your foot and lift, and then lower (using

ankle weights will add more resistance).

• Stand tall and do leg lifts by a wall

whenever you have a few moments of

waiting. Lift your leg sideways with your foot

flexed, 10 times, then to the front 10 times, then

extend behind you 10 times. Do not bend your

knees and keep your foot flexed.

• While in a patient’s room (e.g., while

Official Magazine of the Emergency Nurses Association 21

TIP: It is recommended that you stay hydrated throughout your shift with water by drinking half of your body weight in ounces per day and at least half of this amount during an eight-hour shift.4 Tired of water? Add a lemon for flavor.

Every new employee at Children’s Healthcare of

Atlanta receives a pedometer, wellness

information, access to an online health and

wellness portal—where individuals can track

nutrition, exercise and measurements—and use

of the health library, all for free.

The perks of this health initiative don’t stop

there. Free onsite fitness classes are offered on

all of the campuses, as well as consultations

with trainers and registered dieticians. There is

also an annual health screening in which

biometric testing and a health-risk appraisal are

offered. Employees also receive nutrition

education through healthy cooking

demonstrations.

The Strong4Life program that launched at

Children’s in 2008 was designed to create a

healthier work environment for employees.

“We realized that by serving the community

with their health needs, we really need to serve

as a positive role model,” said Holly Iftner, the

manager of wellness and worklife at Children’s.

“And in order for us to serve as role models

within the community, we really need to focus

on the health of our employees and their

wellness effort.”

Since Strong4Life’s initial launch, Iftner said it

has seen great engagement from employees,

along with changes in the annual screening

results, which include dramatic drops between

2008 and 2011 in the baseline numbers for

cholesterol, BMI, blood-pressure levels and

waist measurements.

When it comes to supporting each other,

Iftner pointed out that the buddy coverage

method is part of the support system. A nurse

can take an onsite fitness class or go for a walk

and have coverage until he or she returns to do

the same for his or her buddy.

“The organization has to make a commitment

to change the environment,” Iftner said. “Having

the organization’s senior leadership buy in is

critical in order to make some of those

environmental changes.”

To help nurses cope with daily stresses,

Children’s has respite rooms available for

relaxation and space to de-stress or meditate.

“Nursing is a stressful position with very long

hours,” she said. “A lot of times if you’re trying

to lose weight, you can get into emotional

eating. Focusing on reducing the amount of

stress that you can control is key, and the

environment has to be conducive to that.”

Even if your hospital doesn’t offer similar

perks, there are steps you can take to

incorporate health and wellness into your work

environment.

“Give yourself permission to focus on your

own health,” Iftner said. “I think particularly in

nursing, you’re such a caregiver and you’re so

focused on the health and wellness of

everybody that you serve in the community that

it’s easy to lose that health focus for yourself

and make it a priority. Focus on being

intentional with your own health and wellness

by setting some goals and reaching those goals

with the support of other nurses in the unit.”

By Kendra Y. Mims, ENA Connection Hospital’s Wellness Program Creates a Healthier Workforce

• Raw vegetables (celery sticks, carrots, bell peppers) with hummus

• Walnuts and almonds

• Fruit

• Olives

• Nonfat yogurt topped with fresh fruit

• Whole-wheat tortilla wrap (with deli meat or vegetables)

• Low-sodium soup

• High protein nutrition bar

• 2 tomato slices with mozzarella

• Part-skim string cheese

• Edamame

• Oatmeal

• Trail mix (unsalted sunflower seeds, raisins, dried fruit)

• Tuna salad with whole wheat crackers

• 1 or 2 deviled eggs

• Unbuttered popcorn

• Low-fat peanut butter and banana sandwich on whole wheat bread

Healthy Shopping List Ideas

FIT NURSE

Gary Scholar, M.D.

Empowering nurses to practice what they preach by taking control

of their own nutrition, fitness

and sleep. Available at the

ENA Marketplace, www.ena.org/

store.

Continued on page 31

Page 22: ENA Connection April 2012

April 201222

Academy of Emergency Nursing 2012 Board AnnouncedThe Academy of Emergency Nursing honors

nurses who have made specific, enduring,

substantial and sustained contributions to the

field of emergency nursing; who advance the

profession of emergency nursing, including the

health care system in which emergency nursing

is delivered; and who provide visionary

leadership to the Emergency Nurses Association.

The body of work created by academy

members goes well beyond being an

outstanding nurse and a devoted ENA member.

The Academy of Emergency Nursing is

pleased to announce the 2012 Academy board

of directors; these directors assumed office

January 1.

2012 Chairperson

Vicki Sweet, MSN, RN,

CEN, CCRN, FAEN

Manager, Emergency

Services and

PreHospital Care, St.

Jude Medical Center,

Fullerton, California.

Member of the

California ENA State Council and the Orange

Coast Chapter.

2012 Chairperson-

elect Kathleen Flarity,

PhD, ARNP, CEN,

CFRN, FAEN

Commander, 34th

Aeromedical Evacuation

Squadron, Peterson Air

Force Base, Colorado,

emergency clinical

nurse specialist, Memorial Health System,

Colorado Springs, Colorado. Member of the

Colorado ENA State Council.

2012 Member-at-Large

Maureen Curtis

Cooper, BSN, RN,

CEN, CPEN, FAEN

Pediatric emergency

department staff nurse,

Boston Medical Center.

Past president of the

Massachusetts ENA State

Council, member of the ENA Beacon Chapter.

2012-2013

Member-at-Large

Edythe McGoff, MSN,

RN, CEN, FAEN

Emergency nurse and a

military nurse officer.

Member of the Virginia

ENA State Council and

the Lord Fairfax

Roadrunners Chapter.

2012-2013

Member-at-Large

Andrea Novak, PhD,

RN-BC, FAEN

Adjunct faculty at the

Schools of Nursing for

Duke University and

the University of North

Carolina Chapel Hill.

Member of the North

Carolina ENA State Council and the ENA

Dogwood Chapter.

Applications Available for Academy of Emergency Nursing EMINENCE Mentoring ProgramThe AEN EMINENCE Mentoring Program

matches experienced Academy fellows with

ENA members who are looking for professional

growth opportunities. Mentees should plan to

commit five to 10 hours per month to their

project.

Mentees must apply for the program with a

specific project in mind. Typical projects

include, but are not limited to, the following

areas:

• Advanced practice role development

• Educational conference planning

• Grant writing

• Health policy

• Injury prevention (SBIRT procedure)

• Professional presentations

• Program development

• Research

• Writing for publication

The program is not intended for new

manager development or projects to meet

academic requirements, nor is it intended to

assist in the application process for acceptance

into the Academy.

Applications for the mentoring program are

available at www.ena.org in the Academy

section. The deadline to submit applications is

April 30. Questions? E-mail [email protected]

or visit www.ena.org/about/academy/

EMINENCE/Pages/Default.

Page 23: ENA Connection April 2012

Official Magazine of the Emergency Nurses Association 23

ENA Position Statements—New Content AvailableENA develops position statements on key topics

affecting emergency nursing practice and health

care trends. ENA has just added the position

statement titled Social Networking. Three

position statements were revised including:

Advanced Practice in Emergency Nursing, All

Hazards, and Nurse Practitioners and Retail

Health Care Clinics. Visit www.ena.org/IQSIP

to view all the position statements.

Three Additional Emergency Nursing Resources ENA develops Emergency Nursing Resources to

bridge the gap between research and everyday

emergency nursing practice. Three new ENRs

have just been added: Difficult IV Access,

Non-invasive Temperature Measurement and

Wound Preparation. To access these new

resources visit www.ena.org/ienr.

Emergency Nursing: Scope and Standards of Practice The American Nurses Association has

recognized emergency nursing as a specialty

and approved the scope and standards of

practice laid out within the book. The 2011

Emergency Nursing Scope and Standards of

Practice is updated to reflect current standards

and best practice for use in developing training

and departmental policies and procedures. Visit

www.ena.org/shop to order your copy today.

ENA Member Savings Opportunities ENA members qualify for discounts on items

such as insurance, travel, wireless products and

services, car rentals, identity theft protection and

prescriptions. To view all available discounts,

visit www.ena.org, click on the Membership

tab and then Member Benefits. Be sure to log in

to see the details.

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

and be notified of new listings while employers

post openings and review a deep pool of

qualified talent. Visit the new ENA Career

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

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

guidelines, FDA drug updates, evidence-based

nursing monographs, skills demonstrations and

competency testing information. To learn more,

visit www.ena.org (login as a member).

ENA Mosby’s Nursing Skills: ENA EditionMosby’s Nursing Skills provides you with

20 new emergency skills each quarter including,

competency, testing information, skills

demonstrations/step-by-step instructions and

checklists. To learn more, visit www.ena.org.

(log in as a member).

Spotlight on Member Benefits and Resources

I’m Here: Compassionate Communication in Patient CareMarcus Engel

Modern medical technology helps patients recover faster than any other time in history. However, the human interaction between patient and care giver is still the essential foundation of healing. I’m Here is a personal narrative from the patient’s perspective. Filled with practical advice, packed with humor and overflowing with appreciation, Marcus Engel encourages health care professionals to practice compassionate communication in all its forms.

ER-IMHERE

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Page 24: ENA Connection April 2012

April 201224

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

Information Management: A Preparedness Priority

In a 2011 survey, emergency nurses

responded that information

management was perceived to be the

No. 2 preparedness priority capability

for the nation (Andress, K., Journal of

Emergency Nursing, Jan. 2012).

Information management,

sometimes referred to as information

technology, can be defined as “the

collection and management of

information from one or more

sources and the distribution of that

information to one or more

audiences. This sometimes involves

those who have a stake in, or a right

to that information. Management

means the organization of and

control over the structure, processing

and delivery of information.” This

includes hardware, software, data

and connecting internal and external

networks.

The Emergency Department Connection

Your emergency department may be dependent

on information management technologies or

cyber resources via data, hardware and

networks. Examples might include desktop

computers; electronic health or medical records;

portable medical devices that communicate with

a network, such as telemetry; networked supply

and pharmacy dispensers; digital radiology

results; door security; and even the computer

control system for the heating, ventilation and

air conditioning or other mechanical systems in

the emergency department.

Recent Cybersecurity Hospital-Related Reports Recent IM threat reports have included incidents

involving malware, infrastructure failure and

data loss or theft.

• The emergency department at Gwinnett

Health System in Lawrenceville and Duluth,

Ga., was placed on diversion for

approximately two days after the hospital

computer network was infected with a

virus affecting systemwide connectivity

(www.wsbtv.com/news/news/local/

hospital-diverting-trauma-cases-due-

computer-probl/nFyYY/).

• The Mount Nittany Medical Center and

Mount Nittany Physician Group

reportedly experienced a disruption in

its computer network, telephone and

voicemail technology after a “technology

infrastructure failure” (www.

centredaily.com/2012/02/23/

3100720/computer-systems-down

-at-mount.html).

• Fierce Health IT reported hospitals

“jumping into” cyber insurance to hedge

their bets over concerns from data

breach incidents. “The reasoning for this

purchase is typically a function of

concern over the financial exposures

that result from data breach incidents,

combined with the growth in data

breaches (32 percent annual growth

rate) being experienced by health care

organizations” (www2.idexpertscorp.

com/blog/single/hospitals-jumping-

into-cyber-insurance-to-hedge-

risks/).

• At the seventh annual “Cyber Watch”

Cyber Threats in the Emergency Department, Part II

Page 25: ENA Connection April 2012

Mid-Atlantic Collegiate Cyber Defense

Competition, at Johns Hopkins University,

the scenario focused on the defense of

a hospital IT system.

USAF Chief Information Officer This month’s column features input from Lt.

Gen. William Lord, U.S. Air Force chief of

warfighting integration and chief information

officer at the Pentagon. He integrates Air Force

warfighting and mission support by networking

space, air and terrestrial assets, including Air

Force hospitals, clinics and their infrastructure,

among many others. Previously, Lord was the

commander of the Air Force Cyberspace

Command (Provisional) or “Cyber Command”

at Barksdale Air Force Base, Bossier City, La.

In 2008, Lord was a guest speaker at

a community infrastructure protection

conference in Louisiana and referenced

a national-level exercise that simulated a

potential threat to our electrical power grid

and the infrastructures that depend upon it,

including hospitals.

An Idaho Power Outage“Many mechanical or industrial systems are

controlled by computer systems that monitor

or control infrastructure functions and are

potentially vulnerable to hacking,” Lord said

in a recent phone interview with “Ready

or Not.”

In 2008, at a Department of Energy laboratory

located in Idaho, the DOE and Department of

Homeland Security tested a surplus 2-megawatt

electrical generator by making it the target of a

simulated cyber attack. The generator’s control

system was hacked and fed computer code that

affected its regulation and operation. The code

injected by the simulated hacking caused the

generator to start knocking and belching smoke

and the machine was eventually destroyed,

eliminating electricity production. (Video/audio

of this test is available at www.youtube.com/

watch?v=fJyWngDco3g.)

Implications“While this exercise was controlled and on a

smaller scale, the implications of potential

effects and repercussions in a larger or

coordinated cyber attack on the nation’s

electrical generating control systems is

sobering,” Lord said.

The generator’s computer control system

will be the initial target while secondary targets

become the critical infrastructures and

populations dependent on that generator’s

power. Communities, including their hospitals

and other critical infrastructures, could be

vulnerable to potential power losses in this

type of cyber attack.

“Simply put, vulnerabilities may potentially

exist in the networks (internal and external),

the devices or hardware and in the data or

information itself,” said Lord.

Data-sharing system networks may be

infiltrated or insecure; devices and hardware

may not meet the current standard, while data

and information may be corrupted with

malware code. The U.S. DHS is working to

improve the nation’s cybersecurity on

multiple fronts.

DHS Cyber ResourcesThe U.S. DHS cybersecurity website offers many

resources and considerations for emergency

nurses, personal and business use along with

events, technical publications and incident

reporting links (www.dhs.gov/files/

cybersecurity.shtm).

Another cyber situational awareness resource

is the DHS Daily Infrastructure Report, which

includes incidents involving the critical

infrastructures as defined in the National

Infrastructure Protection Plan (www.dhs.gov/

files/programs/editorial_0542.shtm).

Readers may contact the author at

[email protected].

Follow Knox Andress @ENAdman.

25

Trauma Nursing Core Course Designed for Nurses by Nurses

For more than 25 years, TNCC has been providing cognitive, core-level trauma knowledge and psychomotor skills experience in an interactive format. The TNCC course will provide a systematic standardized approach to injured patient care. The hands-on psychomotor skill stations help you incorporate cognitive knowledge into application of skills in a safe practice environment.

Highlights Include:

• Systematic standardized approach utilizing the A-I mnemonic

• Pediatric, pregnancy and elder trauma

• Initial assessment and shock

• Spinal immobilization

• Chest and abdominal trauma

• Opportunity to earn 14.42 contact hours

• Offers four year verification of your knowledge and skills upon successful completion

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

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

Page 26: ENA Connection April 2012

April 201226

In just a few short weeks, you will have the

privilege of voting in the ENA national election

and selecting your ENA board of directors and

Nominations Committee for 2013. Access www.

ena.org to learn about and support the

candidates before making this important

decision by doing the following:

• View each candidate’s biographical

information by clicking on the “Meet the

Candidates” link.

• View ENA’s revised Policy 3.12, National

Candidate Campaigning and Publicity.

• View the Candidates Election Forum video

from New Orleans.

• Provide your support and/or interact with the

candidates via ENA’s Facebook page by

posting questions to a candidate(s).

Over the last 10 years, ENA has consistently

seen our voter percentage rate diminish. Only

5.31 percent of our membership voted in the

2011 election. In 2010, the voter turnout was

7.4 percent.

Why don’t members vote? ENA randomly

surveyed more than 5,300 members via e-mail

in November 2011. Of the 243 respondents (4.3

percent) who completed this national election

survey, the No. 1 reason respondents did not

vote was: “Did not know enough about the

candidates to make a decision.” In addition,

28 respondents indicated they simply forgot

to vote.

The Nominations Committee challenges you

to call or ask 10 ENA members to get the vote

out this year. Many of you may have met the

candidates running, or they may be from your

state. Get to know the candidates by

communicating with them via ENA’s Facebook

page. Please encourage your members to read

their May ENA Connection, bring it to work

and to your local, state and regional meetings.

It is our job to keep our members informed.

Some states and local chapters offer

incentives to increase their voter turnout.

Several states and chapters award an ENA

membership or provide financial assistance

to attend a state, regional or national

conference. If you would like to know what

your state/chapter voter turnout was for the

2011 election, contact Executive Services at

[email protected].

Other reasons members said they didn’t vote

included: “They don’t care,” “My vote won’t

make a difference,” “I don’t know any of these

people” and “What difference does it make—we

don’t have any say at the board level.” It does

matter and you can make a difference. In the

past, some of our elections were decided by

fewer than one percent.

Our ENA board of directors is our voice to

move forward in the care of emergency patients

all across the globe. They help find ways to

make our jobs easier and safer and to save

more lives every day.

This year’s election is from May 10 through

June 8. Stay informed and make a difference in

ENA. Get the vote out.

Know the ENA Candidates So You Can Get the Vote Out

NOMINATIONS COMMITTEE | Cathy C. Fox, RN, CEN, CPEN, Region IV

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Page 27: ENA Connection April 2012

The ENA Foundation’s new International

Exchange Program (IEP) is supported by Stryker

Medical and gives U.S. emergency nurses a

unique opportunity to travel to the United

Kingdom for one week to share emergency

nursing practice and build international

relationships with other emergency nurses who

are in the IEP network. In addition, the recipient

hosts a nurse from the United Kingdom in the

United States for one week to experience our

emergency nursing practices. The IEP’s first

recipient shares her experience below.

2011 Recipient: Charlotte Schnakenberg, MSN, BS, RN, CEN, CPEN, CPNLocation: Ipswich, Suffolk County, England

Charlotte Schnakenberg, a clinical educator for

emergency services at Scottsdale Healthcare in

Arizona, felt both excited and nervous when

she arrived in Ipswich last November for a

10-day visit to live with and job shadow Jenny

Edmonds, her hosting emergency nurse.

As Schnakenberg shadowed Edmonds at

Ipswich Hospital, which is operated by the

National Health Service, she noticed huge

differences and striking similarities between the

emergency department care given in the U.K.

and the U.S. She frequently asked questions and

realized that the nurses at Ipswich Hospital also

had a lot of questions as well as misconceptions

about patient care in the U.S. (such as patients

being turned away for care if they don’t have

the money to pay for services). As they

educated each other during her shadowing,

Schnakenberg continued to compare the two

health care delivery systems and discovered that

while some processes surprised her, there were

some she thought could improve challenges in

U.S. emergency nursing.

“I was amazed at the simplicity of their

system,” Schnakenberg said as she recalled the

first time she observed Edmonds discharging a

patient, which required handing him a generic

pamphlet and then dispensing him TTA (to take

away) medication.

“I thought the TTA medication was really

convenient for the patient so that he didn’t have

to go from the ED to a pharmacy,” she said.

“The nurses can dispense certain medications,

like some antibiotics and minor medications,

right out of the emergency department.”

Nursing education in the U.K. is paid for by

the NHS. Schnakenberg said she was surprised

to learn that there are five specialties for nurses

to choose from at the start of their nursing

education and they graduate in only one

specialty (adult, pediatric, behavioral health,

midwifery or learning disabilities).

“This is a challenge in their emergency

department because in an emergency

environment, you see all ages,” Schnakenberg

said. “They only have a handful of nurses who

do both adult and pediatric care. I found that

very interesting because it didn’t seem very

versatile that they specialize so early in their

education, whereas we do things differently.”

When Edmond’s schedule altered between

being a nurse practitioner and a charge nurse,

Schnakenberg was also shocked to learn that

nurses in the U.K. are not required to have an

advanced practice license to be a nurse

practitioner.

“There’s no restriction on who calls

themselves a nurse practitioner,” she said.

“You can do this by taking a weekend course.

I found it interesting that the government’s

stance on this is that they don’t need an

advanced practice license and that they don’t

need to further regulate nursing.”

Schnakenberg said the one method at

Ipswich Hospital she found most effective is the

four-hour time limit the hospital has to follow to

get patients dispositioned and out of the

emergency department, a provision passed by

the NHS. When a patient walks in the door, the

time that he or she presents is noted on a

tracking board along with the breach time,

which is the four-hour limit, Schnakenberg said.

By Kendra Y. Mims, ENA Connection

27

Emergency Nurse Swap: Improving Practice Across the Globe

Continued on page 31

Left to right: Charlotte Schnakenberg, MSN, BS, RN, CEN, CPN, CPEN; 2012 ENA President Gail Lenehan, EdD, MSN, RN, FAEN, FAAN; immediate past president AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN; Emergency Care Association chairperson Andrew Frazier; Mark Gillespie and Jenny Edmonds, EN, RN, DipHE Child, BSc hons Nurse Practitioner, INP.

Page 28: ENA Connection April 2012

April 201228

Arizona ENA State CouncilSubmitted by Paulette Osborne, RN, CEN

Arizona ENA finished a great year in 2011 with

several membership opportunities, including the

following:

• During a state council recruitment campaign,

Susan Kinkade, BSN, RN, CEN, won a state-

sponsored registration to the 2012 ENA

Annual Conference.

• A drawing was held for a student membership

based on state meeting attendance.

• Grant money received from national ENA

funded four student memberships.

• Grant money also was used to purchase ENA

lunch sacks that were filled with membership

materials and provided to the hosting

hospitals of our ENPC/TNCC classes with the

intent of “spreading the word.”

These activities provided an amazing

opportunity for creating interest in emergency

nursing.

First-time attendees to our state council

meetings are also placed in a drawing for a

one-year membership to ENA. In an effort to

make new members feel welcome, committee

members follow up with a call to first-time

attendees, students and new members. Members

ask attendees for their feedback, invite them to

view our website and notify them of upcoming

meetings and educational offerings.

The state council continues to increase

membership by making meetings more

accessible to nurses by offering meetings in

local communities throughout the state as well

as call-in options.

Michigan ENA State CouncilSubmitted by Meri Trajkovski, BSN, RN, SANE,

and Brandi Uren, BSN, RN, CEN

Michigan ENA Huron Valley Chapter is very

proud of its progress and achievements over the

last few years. Our chapter goal has been to

reach out to our current members and recruit

new members by increased communication and

by offering educational opportunities. Some of

our key accomplishments include the following:

1. The creation of an ENA Huron Valley Chapter

Facebook page with more than 130 “friends”

to improve networking and communication.

2. Increased chapter membership.

3. Increased member attendance and

involvement.

4. An updated www.michiganena.org chapter

page.

5. Increased outreach to our members by

rotating meeting sites.

6. Local presenters who speak on topics

relevant to our profession.

7. Collaborating and partnering with our

emergency physicians.

8. Aligning our chapter with the

strategic goals of our state

council.

9. Committed attendance at our

state council meetings.

10. Increased networking and

presence at local, state and

national conferences.

North Carolina ENA State CouncilSubmitted by Mary Lou Forster

Resch, BSN, RN, CEN

North Carolina is very grateful and honored to

have received a State Achievement Award at the

ENA Leadership Conference 2012 in New

Orleans.

North Carolina ENA State Council President

Elaine Marshall, BSN, ADN, RN, was invited to

speak at the State and Chapter Leaders Confer-

ence closing session. Presidents from selected

states were asked to highlight various notable

activities and achievements occurring in their

chapters and throughout their state. Our state’s

leadership knowledge was updated with many

new ideas.

We are very proud to have an injury

prevention article published in the January 2012

issue of the Journal of Emergency Nursing. The

article highlights the ideas of Mary Pelton, BSN,

RN, CEN, and the “ED Beach Reach.” Her ideas

have been presented to the Eastern Tarheel

Chapter, and we hope to expand her ideas to

other chapters and areas. We hope the article

served as an inspiration to all ENA members.

ENA STATE CONNECTION

State Council and Chapter Meetings and Events

Arizona ENA State CouncilAnnual educational conference, Hot Topics: April

Presenter: Matthew F. Powers, MS, BSN, RN, CEN, MICP

For more information: www.azena.org

Kansas ENA State CouncilKansas ENA meets every other month. Meetings start at 10:30 am.

April 13— Galichia Heart Hospital, Wichita

June 8—Hutchinson Regional Medical Center, Hutchinson

Aug. 10 (Annual Meeting)—Children’s Mercy South, Overland Park

Oct. 12—Stormont Vail, Topeka

Dec. 14—University of Kansas, Kansas City

Upcoming education:Annual Trauma Summit (to be announced).

CEN ReviewOct. 15-16—Hutchinson

Oct. 18-19—Lawrence

Presenter: Jeff Solheim, MSN, RN, CEN, CFRN, RN-BC, FAEN

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

Kansas Chapter Meetings:Central Kansas ENAMeetings are planned at 7 p.m. for the fourth Monday of the odd months of the year. Exceptions will be the May, July and December meetings.

Eastern Kansas ENAMay 9—Lawrence

July 11— Topeka

Sept. 19— Lawrence

Nov. 14— Kansas City

Michigan Huron Valley ChapterDinner and safety topic presentation: Aug. 8, 6 p.m.

Location: to be announced.

Presenter: Det. Brian Fountain, Detroit Police Department

Year-end meeting: Oct. 21, 6 p.m.

Location: University of Michigan, Ann Arbor

North Carolina ENA State CouncilState council meeting: Nov. 8

Eighth Annual Fall Conference: Nov. 9

Location: Wrightsville Beach

For more information: www.nc-ena.com

13th Annual Southeastern Emergency Nursing Seaboard Symposium Registration early-bird deadline: April 18

Presessions: May 2-3

SESS Conference: May 4-6

Location: Sheraton Waterside Hotel, Norfolk, Virginia

Presenters: 2012 ENA President Gail Pisarcik Lenehan, EdD, MSN, RN, FAEN, FAAN,

Dr. Robert Lesslie and Allison Zmuda

For more information: www.southeastern-seaboardsymposium.org/register.htm

Nebraska ENA State CouncilCertified Pediatric Emergency Nurse Review Course: May 18

Location: Michael J. Sorrell Center for Health Education, Nebraska Medical Center campus, Omaha

Presenter: Deb Potts, MSN, RN, CEN, CPEN

For more information: amaze610@yahoo.

Page 29: ENA Connection April 2012

Future of Nursing Work Team Continued from page 19

29

The purpose of the summit is to bring together a multidisciplinary team of experts to stimulate collaboration in mitigating workplace violence in the emergency department setting. Learn how to change the equation and reduce violence in your facility at this one-day summit.

View the program and register today at www.ena.org Sponsored by

V i o l e n c e i n v a d e s t h e h e a l t h c a r e w o r k p l a c e e a c h d a y ; V i o l e n c e r a t e s a g a i n s t e m e r g e n c y n u r s e s h o l d s t e a d y 1

Who Should AttendThis one day summit is vital for those individuals responsible for the safety and security of patients and healthcare professionals within their organization.

•Healthcare professionals (nurses, physicians, allied health professionals)

•Healthcare safety and security professionals

•Healthcare facilities management executives

•Healthcare administrative executives

•Architects

•Researchers, educators

During this summit, you will learn to•Implement multi-faceted methods to foster

synergy in the emergency department environment in regards to workplace violence prevention

•Employ effective communication strategies between security and safety professionals and emergency department staff

•Develop interdisciplinary violence prevention policies and procedures in the ED setting

•Integrate design elements that can mitigate violence in the emergency department

Chicago  •  June 22, 2012  •  8 a.m. - 5 p.m.

Workplace Violence Prevention Summit

1 Emergency Nurses Association, Institute for Emergency Nursing Research. (2011). Emergency Department Violence Surveillance Study. Des Plaines, IL

Emergency Nurses Association (ENA) in Collaboration with the International Association for Healthcare Security and Safety (IAHSS) Presents:

Continuing education credits are available for both nursing and security professionals.

WPV Summit Connection Half Island.indd 1 3/9/2012 2:08:15 PM

length of stay, costs savings, a reduction in

medical errors and less staff turnover.4 With this

knowledge, as leaders we can do our part to

create a more collaborative emergency

department environment.

References

1. Institute of Medicine, The Future of Nursing:

Leading Change, Advancing Health. Accessed

September 5, 2011 at: www.iom.edu/

Reports/2010/The-Future-of-Nursing-

Leading-Change-Advancing-Health.aspx.

2. Emergency Nurses Association, ED

Benchmarks Collaborative (EDBC). Accessed

September 5, 2011 at: http://sites.

mckesson.com/edbc/webinars.htm

3. Emergency Nurses Association, National

Health Care Provider Associations Join Forces

to Reduce Emergency Department Crowding.

Accessed September 5, 2011 at: www.ena.

org/media/PressReleases/Pages/

ReduceEDCrowding.aspx.

4. Institute of Medicine, The Future of Nursing:

Leading Change, Advancing Health.

Accessed September 5, 2011 at: www.iom.

edu/Reports/2010/The-Future-of-Nursing-

Leading-Change-Advancing-Health.aspx.

What do you get when you combine the biggest

social network, current technology and the 2012

ENA election? A great opportunity to make your

voice heard with this year’s candidates for the

ENA board and the Nominations Committee

using Facebook.

New this year, ENA will use Facebook to

connect you to the 2012 candidates for the ENA

board and the Nominations Committee. Chances

are you already have a Facebook page and are

among the more than 15,000 people who “like”

ENA. If not, please take a few minutes to create

an account. You don’t want to miss this new

opportunity to interact with the candidates.

The ease of Facebook makes it as simple as

a couple of clicks to begin your interaction

with this year’s candidates. Look for posted

announcements on ENA’s Facebook page about

the election and candidates. Then begin posting

your questions, concerns or thoughts to specific

candidates, or reach out to a group based on

the position for which members are running.

Check back often to view their responses to

your questions. If you haven’t already done so,

set up your Facebook account to alert you on

your mobile device when something new is

posted, keeping you up to date wherever

you are.

All the biographical information about the

ENA board candidates, along with the videos

from the Candidate’s Forum held at Leadership

Conference 2012, are available on the ENA

website at www.ena.org. You will also find

links to those pages within various wall posts

on our Facebook page.

Don’t delay—take a few minutes to get to

know the candidates who are looking for

your vote.

… To Connect with the ENA Candidates and Get Ready to Vote!

Deb Zirkle, ENA Director of Online Services

Readers may contact the author at [email protected].

Page 30: ENA Connection April 2012

April 201230

BOARD HIGHLIGHTS |

Board Meeting Actions and HighlightsThe ENA board of directors met January 18 via teleconference.

All members were present and took the following actions:

• Approved creation of an additional member for the Emergency Nursing

Advanced Critical Thinking Work Team.

• Approved that ENA participate on the Emergency Department Geriatric

Pain Expert Panel initiative.

• Approved moving forward in engaging with the American Society for

Testing and Materials International research study on protective

garments while protecting the ENA mailing list.

• Approved that ENA collaborate with of the American College of

Emergency Physician’s Academic Affairs Committee on gathering data

for its transitions of care tool.

• Approved that ENA become a Supportive Association for the DAISY

Foundation. (DAISY stands for Diseases Attacking the Immune System.)

• ENA’s logo and link to www.ena.org are listed on the DAISY

Foundation’s list of Supportive Organizations.

• ENA will provide space for the DAISY Foundation to exchange

with members at the Annual and Leadership Conferences.

The ENA board of directors took the following actions on Feb. 13 via

e-mail vote:

• Approved the Academy of Emergency Nursing fellow candidates for

induction at the 2012 Annual Conference.

Highlights of the next scheduled board of directors meeting will be

published in a future issue of ENA Connection.

January/February 2012

think that a patient who is probably

experiencing one of the worst days of their life

may come seeking care in the ED, and in many

cases they get someone to take care of them

who is not trained and has to sit and read the

directions on the [evidence] kit before they can

take care of the patient. There is no other

patient that we do this with.”

Day recalled when she wasn’t a trained

examiner and was the nurse who had to read

directions while caring for traumatized patients.

When it was time for the most intimate part of

the exam, the genital assessment, she had to

call in the emergency physician.

“This is after I had already established a

rapport with the patient and had advocacy

there,” she said. “It’s a terrible way to treat a

patient. It’s sad when I think about how many

people are still reading the directions.”

Day said best practice is for the trained

examiner to proceed with evidence collection

based on the patient’s history and not to make

decisions based solely on the evidence kit

directions.

“As a SANE nurse, you can do the entire

medical forensic exam and you establish rapport

with the patient from the beginning and go

through the entire process of working with

the patient,” she said.

Day said having a trained examiner on staff

benefits the emergency department staff.

“It’s really less of a burden on the ED staff

because the exam does take up a lot of time,”

she said. “You need to be able to devote time

to not only make sure the evidence is not

contaminated but also to make sure the patients

get the care they need. In EDs that I worked in

where there were no SANE nurses, the patients

would have to sit for hours waiting for someone

to take care of them. Because they’re not

outward injuries, they can be left to sit for a long

time, and then many of them will leave without

getting the treatment and resources they need.”

Day gives credit to Rebecca Campbell, an

associate professor of psychology at Michigan

State University, whose extensive research

on sexual-assault care, advocacy and SANE

has found that when hospitals have trained

examiners responding to sexual-assault victims,

it increases the chances of a victim continuing

on through the criminal justice process.

(According to RAINN, 54% of rapes/sexual

assaults are not reported to the police based

on a statistical average of the past five years,

making sexual assault one of the most under-

reported crimes).4

“In many cases there is no court trial for these

victims,” Day said. “The only thing that may

impact their outcome is the kind of response they

get at the hospital. Just having one great

responder can really make a difference in the way

the patient can view their entire experience with

the assault. They have someone who believes

them and who has taken care of other people

who have had the same issues, and they’re able

to respond in a caring, compassionate manner

that makes it a better experience overall. No one

can take away what happened to them, but at

least we can respond properly in the end.”

References

1. “The National Intimate Partner and Sexual

Violence Survey.” (2011). Retrieved from the

CDC website: www.cdc.gov/Violence

Prevention/pdf/NISVS_FactSheet-a.pdf

2. IAFN. (2006). Retrieved from http://iafn.org

displaycommon.cfm?an=1&

subarticlenbr=546

3. Emergency Nurses Association. (2010). “Care

of the Sexual Assault and Rape Victims in

the Emergency Department.” Retrieved from

www.ena.org/SiteCollectionDocuments

Position%20Statements/SexualAssault

RapeVictims.pdf

4. “Reporting Rates.” (n.d.). Retrieved from the

RAINN website: www.rainn.org/

get-information/statistics/reporting-rates

The Importance of Having a SANE Nurse Continued from page 14

• April is Sexual Assault Awareness Month.

• Every two minutes, someone in the United

States is sexually assaulted.1

• Forty-four percent of sexual assault and rape

victims are under age 18; 80 percent are

under age 30.1

• Victims of sexual assault are three times

more likely to suffer from depression, six

times more likely to suffer from post-trau-

matic stress disorder and four times more

likely to contemplate suicide.1

• Out of every 100 rapes, approximately 3

rapists will spend even a day in jail while

the other 97 percent will walk free.1

• Rape is down by 60 percent since 1993.1

• About two-thirds of assaults are committed

by someone known to the victim.1

• The federal government has adopted a

revised, expanded definition of rape for

nationwide data collection to include any

gender of victim and perpetrator, rape with

any body part or object and circumstances in

which the victim is unable to give consent

due to temporary or permanent mental or

physical incapacity.2

References

1. www.rainn.org/statistics

2. http://blogs.usdoj.gov/blog/archives/1801

Did You Know?

Page 31: ENA Connection April 2012

31

“Every person in that department, from the

doctors to the nurses and anyone else involved

in the care of the patient, was focused on getting

that patient out in four hours,’’ she said. ‘‘That

was their priority. They pay so much attention

to it because the NHS says if they don’t have

96 percent of their patients out of the ED in

four hours, the hospital is penalized financially.’’

Schnakenberg believes that using a breach

time could improve one of the challenges in

U.S. emergency departments.

“I think one of the biggest complaints that

a lot of nurses have in the U.S. is that we can’t

get patients out of our EDs to where they need

to go,” Schnakenberg said. “I feel it would be

beneficial here if the entire hospital was

focused on getting patients out of the ED.”

Despite other differences she found,

Schnakenberg learned that the nurses in the

U.K. are similar to nurses in the U.S.

“A nurse is a nurse is a nurse,” Schnakenberg

said. “No matter where you are, we all want the

same things for our patients. We want to help

make them better with the problem they are

currently having. We want them to be healthy.

“The same conversation and camaraderie

that happens in the U.S. happens in their break

rooms too. That really gave me a bigger

perspective on nursing as a profession. There are

probably a lot of things that we can learn from

other countries, and I would love to see the IEP

expanded to include other countries where the

health care delivery system is also different. …

There are nurses all over the world who are

doing great things.”

Schnakenberg describes being selected for the

ENA Foundation International Exchange Program

as one of the most valuable experiences of her

career and encourages other emergency nurses

to do it.

“It was an honor to be the first person who

got to do this,” she said. “It was everything I

thought it would be and more. I wish that every

nurse could have an experience like this. It will

only help you to grow and to see what a

fabulous profession we have chosen.”

Schnakenberg’s favorite aspect of the IEP was

building relationships, as she describes Edmonds

as “a wealth of information, but more important,

a friend.” She is really excited to become a

hosting emergency nurse when Edmonds visits

Arizona this year.

“I hope the ENA Foundation continues this

program,” Schnakenberg said. “It’s an experience

I will draw on professionally for the rest of my

career, because I’ve seen another world of health

care and having that perspective makes me think

differently about our world of health care, the

changes and how things may be some day.”

** The ENA Foundation International Exchange

Program provides a scholarship for airfare

and incidentals up to USD $1,000 for the

one-week exchange. If you are interested in this

exceptional opportunity, applications for the 2012

International Exchange scholarship are currently

available on the ENA Foundation Website:

www.enafoundation.org.

Emergency Nurse Swap Continued from page 27

Charlotte Schnakenberg (right) poses with Jenny Edmonds at Ipswich Hospital, Suffolk, England.

making a bed), do five to 10 squats holding

onto the end of the bed. Squeeze your glutes

together as you rise up, and make sure your

toes don’t go past your knees (you should be

sitting back into an invisible chair).

If your lack of motivation prevents you from

exercising, become involved in group activities

or create a team at work that is focused on

healthy living. You and your colleagues can

motivate each other and hold each other

accountable. Whether it’s gathering a team

together to participate in a heart walk or

motivating them to join a gym, Fogarty

encourages her staff to stay physically active

and to participate in group activities.

“They need to go out and get the exercise,”

she said. “We see on a daily basis that the

people who are having heart attacks and strokes

are getting younger and younger because of the

sedentary lifestyle that we have, and you need

to be proactive to try to prevent some of that.

“I try to motivate my staff and teach them to

take care of themselves so that they can take

care of their families. We encourage them to join

gyms or participate in the annual heart walk and

kidney walk. Last summer, we had

a group put together a kickball team for the

first time.”

Engage your colleagues in making a

difference in your workplace. Children’s

Healthcare of Atlanta designed a program that

specifically focuses on the health and wellness

of its employees (see sidebar for further details

on how this organization created a healthier

work environment).

Becoming proactive in creating a healthier

work environment can create changes that will

benefit you and your patients. Because you

educate the public about health and wellness as

an emergency nurse, making healthier choices

will not only help you to feel great, but you can

also share the benefits of living a healthy lifestyle

with your patients.

References

1. Obesity—At a Glance 2011. (2011). Retrieved

from the CDC Website: www.cdc.gov/

chronicdisease/resources/publications/

aag/pdf/2011/Obesity_AAG_WEB_508.pdf

2. Witters, D. (2012). More Than 15% Obese in

Nearly All U.S. Metro Areas. Retrieved from

Gallup Website: www.gallup.com/

poll/153143/Obese-Nearly-Metro-Areas.

aspx

3. Miller S.K., Alpert P.T., Cross C.L. (2008)

Overweight and obesity in nurses, advanced

practice nurses, and nurse educators.

Retrieved from www.ncbi.nlm.nih.gov/

pubmed/18460166

4. Scrubs magazine. (2011). Retrieved from

http:/scrubsmag.com/

5. Krischke, M. (2011). Fitting Fitness Goals into

Your Nursing Schedule. Retrieved from the

NurseZone.com Website: www.nursezone.

com/Nursing-News-Events/more-news/

Fitting-Fitness-Goals-into-Your-Nursing-

Schedule_36000.aspx

6. McElroy, L. (2010). Six Exercises You Can

Sneak into Your Workday. Retrieved from

http://scrubsmag.com/exercises-you-can-

sneak-into-your-workday/

Steps to a Healthier You Continued from page 21

TIP: Take the stairs to/from any place you have to go in your hospital. Use a pedometer to see if you are reaching the recommended 10,000 steps per day. Go up a flight of stairs wearing ankle weights to add resistance.

Page 32: ENA Connection April 2012

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