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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
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
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?”
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.
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.
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.
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
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
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.
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
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.
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:
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).
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
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
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
• 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
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.
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
Price: $15ENA Member Price: $13.50
Weight: 8 oz.
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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
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
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.
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
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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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.
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.
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].
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?
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.
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