ENA Connection December 2012

If You Build It, They Will Drum

the Official Magazine of the Emergency Nurses Association

December 2012 Volume 36, Issue 11

connection

Members in Motion: Emergency Nurse From Kentucky Wins Top Magnet Honor PAGE 4

Nurses Don’t Forget Each Other After Colorado Theater Massacre PAGE 8

Colleagues in Mexico See ENA As Having the Answers PAGE 37

INSIDE FEATURES

The Beat Goes On From the 2012 Annual Conference

Coverage and Photos From San Diego

Pages 18-34

Official Magazine of the Emergency Nurses Association 3

It seems like yesterday that I began the year as your

2012 ENA president. So much has been done to move

our specialty forward in the short space of one year,

all due to the extraordinary team of which I was

privileged to be a part.

Many of ENA’s accomplishments are described in

ENA’s Annual Report, but there are some very special

people behind the accomplishments whom I would

like to thank:

• First and foremost, ENA members — thank you for

your membership! When we are talking to regulators

and legislators, being able to say that we represent

more than 41,000 emergency nurses is powerful, and

they listen.

• Members of the national ENA Board of Directors,

who make sacrifices and devote many hours to the

mission of our association.

• ENA staff at national headquarters. Behind every

successful year at ENA, there are great ENA staff

members.

• Our corporate sponsors and supporters.

• Colleagues, and especially the Massachusetts

ENA State Council for its unwavering, unconditional

support. (I will be home soon!)

• The President’s Advisory Group for its wise

counsel and problem-solving skills.

• The ED nursing director of the ED where I work

for all her wisdom and support during this year.

• The members, staff and board liaisons

comprising 34 committees, work teams and special-

interest groups working on many critical projects.

• State council and chapter leaders. Your

leadership and hard work is appreciated.

• The ENA members at the state and local chapters

who create ‘‘family’’ and silently, selflessly volunteer

their time and energy to our association.

• Emergency nurses everywhere who work on the

front lines to deliver safe practice, safe care.

• The 2012 Leadership and Annual Conference

committee members, staff, hospitality volunteers and

corporate support for two very successful conferences.

• The team effort of the staff, partnering with key

government agencies and associations, to put on the

first Workplace Violence Prevention Summit. We had

several ‘‘firsts’’ this year of which we can be proud.

• Our nursing organization partners who have

collaborated on position statements, legislative

initiatives, advocacy projects and ENA products and

toolkits.

• And last, but not the least, my family and the

home and work families of all of our national board

members who pitch in to allow us to travel and work

as hard as we do all year.

As important as what ENA members contributed to

our specialty, their support for each other was equally

impressive.

At times our own light goes out and is rekindled by

a spark from another person. Each of us has cause to

think with deep gratitude of those who have lighted the

flame within us.

– Albert Schweitzer

When I recently called an ENA state president in

the hospital after a bad car crash, another emergency

nurse answered the phone. She was ‘‘specialing’’ the

state president, along with other emergency nurses

who took turns around the clock. They would plan

another schedule when she was discharged and take

turns bringing her meals. This state president had

always taken care of the ENA members in her state,

and it went without saying that she would have done

the same for them in a heartbeat.

At the wake of a friend, a friend I never would

have known if it were not for ENA, members from

across the state were there to honor his life and say

goodbye. Each laid a white rose on his casket and

read from the moving ‘‘Nightingale Tribute’’ in a show

of solidarity, similar to the solidarity that police and

firefighters possess. In the aftermath of Hurricane

Sandy, I heard from two members who had lost their

homes during the storm, and we were able to put

Dates to Remember

PAGE 4Free CE of the Month

PAGE 4Members in Motion

PAGE 6Pediatric Update

PAGE 10ENA Research

PAGE 11ENA Committee Spotlight: Historical Perspectives Work Team

PAGE 16Academy of Emergency Nursing

PAGE 35ENA Foundation

PAGE 36State Connection

PAGE 38Board Highlights

Monthly Features

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

March 11, 2013 Deadline for proposed bylaws and resolutions for 2013 General Assembly at Annual Conference in Nashville, Tenn.

PAGE 7Board Writes: Changing the Triage Paradigm

PAGE 8After the Aurora Theater Massacre: In Tending to Shooting Victims, Nurses Don’t Forget Each Other

PAGES 12-13What’s to Come at Leadership Conference

PAGES 14-15Advocacy Section

14 Reaping What’s Been Sown

14 New Hampshire ENA Helps Pass Prescription Drug Monitoring Legislation

15 What Does My Neighbor, the Nurse, Think About Health Care Reform?

PAGE 17Preparing to Present Your Resolution at General Assembly

PAGES 18-342012 Annual Conference Section

18 General Assembly Speeches and Debate

23 IENR Research and Evidence-Based Poster Winners

24 National ENA Award Winners 25 Lantern Award Winners

26 Opening Session

27 Closing Session

28 ENA Foundation

29 Concurrent Sessions

32 Town Hall Meeting

PAGE 37Colleagues in Mexico See ENA as Having the Answers

ENA Exclusive Content

Thank You For an Amazing Year!

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

We make a living by what we get. We make a life by what we give. – Sir Winston Churchill

2012 ENA President Gail Lenehan presents the State President’s Award to Maureen Curtis Cooper, BSN, RN, CEN, CPEN, FAEN, Massachusetts ENA State Council president, at General Assembly in San Diego in September.

Continued on page 9

December 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).

Editor in Chief:Amy Carpenter AquinoAssistant Editor:Josh GabyWriter:Kendra Y. MimsEditorial Assistant:Renee HerrmannBOARD OF DIRECTORSOfficers:President: Gail Lenehan, EdD, MSN, RN,

FAEN, FAANPresident-elect: JoAnn Lazarus, MSN,

RN, CEN

Member Services: 800-900-9659

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

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

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

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

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

Sen. Tom Jensen, chairman of the

Kentucky Senate Judiciary

Committee, leaned over the table.

“Tell me, Ms. Robinson, what

do you want?” he asked.

Linda Robinson, BSN, RN,

CEN, CFN, a staff and charge

nurse with the St. Elizabeth

Healthcare Emergency

Department in Covington, Ky.,

had come before the Judiciary

Committee last summer seeking

support for a bill that would

make it a felony to attack an ED

health care worker in Kentucky.

But after testimony from Robinson and a cadre of

supporters she’d assembled for her cause, the

trouble was this: Kentucky simply wasn’t putting any

more felony laws on the books.

What Robinson wanted, she answered, was to

give police the authority to remove a violent person

from the ED without witnessing the incident

themselves or requiring the assaulted health care

worker to sign a complaint. Jensen’s response: Write

that up and I’ll sign it.

So Robinson regrouped. A little more than a year

later, attacking an ED health care

worker is now a fourth-degree

probable-cause misdemeanor in

Kentucky, punishable by a $1,000

fine and up to a year in jail.

Kentucky emergency departments

can return to safety a whole lot

easier now.

And Robinson, the driving force

behind the law, is a 2012 Magnet

Nurse of the Year. She received her

award from the American Nurse

Credentialing Center on Oct. 12 in

Los Angeles, where she also spoke

at the ANCC National Magnet

Conference on the topic of creating

a successful workplace violence

prevention program.

Robinson’s Magnet honor — one of five

bestowed annually — is in the category of Structural

Empowerment, and one need only examine her

long crusade against ED violence to understand

what that means. Fed up with the violence she saw

in her department, she began developing an

in-house violence-prevention program at St.

Elizabeth Covington in 2003. In 2007, she answered

a call in ENA Connection and found herself a key

player on the ENA Workplace Violence Work Team.

Two years later, she became an expert adviser for a

NIOSH-funded study on workplace violence

interventions with the University of Cincinnati.

“What I found, with all the work that I had done,

is that the violence was not really getting a whole

lot better,” she said. “The police would come and

they weren’t able to remove the violent person. And

then it dawned on me: The community has no idea

how violent the ER is. The ER is a microcosm of the

community — it’s a reflection of the community you

serve. And I said, ‘You know, we need to reach out

to the community.’ ”

She started with local legislators. After

approaching State Sen. John Schickel at a football

Kentucky Nurse’s Quest for Protection Earns Her Magnet Nurse of the Year Honor

Linda Robinson, BSN, RN, CEN, CFN

Continued on page 7

Head over to www.ena.org today to

take this month’s new free continuing

education course, ‘‘Service and Quality,’’

presented by Jeff Strickler, MA, RN, CEN,

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can use to

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To take the course and earn your

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• Go to www.ena.org/freeCE,

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• Proceed to your personal learning

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ENA’s back catalog of free CE covers

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same checkout process for any course

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many ways we’re committed to helping

you be the best at what you do.

Questions? Send an e-mail to

[email protected].

SPOTLIGHT ON YOU!Do you have a professional or educational

achievement you want your fellow ENA

members to know about? Do you want to sing

the praises of a member colleague who has

received a new degree, promotion or award?

We encourage you to submit these items to

[email protected] for inclusion in monthly

roundups in the new “Members in Motion”

section. Include names, credentials, a short

explanation of the accomplishment and a

high-resolution photo (if available), along with

contact information for follow-up by the ENA

Connection staff for select features.

By Josh Gaby, ENA Connection

December 20126

The 2012 ENA Annual Conference included a variety of pediatric content,

ranging from the unexpected (‘‘Strokes in Little Folks’’ by Rhonda Morgan)

to the mysterious (‘‘Things Are Not Always As They Seem’’ by Deena

Brecher) to the higher-frequency presentations (‘‘You Stuck What,

Where?’’ by Jeff Solheim). This year I was only able to attend a fraction of

the courses that interested me (because of the number of great sessions

offered) so for the first time, I decided to purchase a DVD of the entire

Annual Conference.* I am enjoying Annual Conference again at my

convenience.

I’d like to share some random pediatric ‘‘takeaway points’’ from three

of the 2012 Annual Conference sessions, with brief implications for

practice. In the words of Solheim, ‘‘It’s all about sharing knowledge and

advancing practice.’’ Consider this a small gift of knowledge, courtesy of

ENA’s 2012 Annual Conference, in the spirit of the holiday season.

From “Challenging Pediatric Presentations: What the Horses Can Teach Us About These ‘Zebras,’” presented by Barbara Weintraub, MPH, MSN, RN, APN, CEN, CPEN, FAENDon’t stress about the fact that you may not be an expert about every

specific and/or exotic pediatric condition. Apply what you know about

healthy, ‘‘normal’’ kids. Having a strong knowledge base of pediatric and

adult norms (in development, anatomy and physiology and vital signs)

will help when you are confronted with more challenging presentations.

For example, if a well-looking 4-year-old child presents with a history

of intermittent vomiting for one day, but his labs reveal a glucose of 30

and a bicarbonate level of 8, a red flag should go up to say, ‘‘These labs

are out of proportion to his illness.’’ Children’s glucose levels rarely go

below 50, even when they are ill. When the labs ‘‘don’t make sense,’’

such as in this scenario, metabolic disorders must be ruled out.

Although metabolic disorders (a.k.a. inborn errors of metabolism) are

individually rare, they are collectively fairly common, and children with

metabolic disorders can get sick very quickly, especially when they are

experiencing vomiting or diarrhea. Any sick child with a known history

of a metabolic disorder should be considered high-risk until proven

otherwise.

From “You Stuck What, Where? How? Why? Chatting About Foreign Objects,” presented by Jeff Solheim, MSN, RN-BC, CEN, CFRN, FAENMost of us know by now that batteries and magnets of any type are

high-risk foreign bodies (batteries can release toxic acid within hours, and

if more than one magnet is ingested, they can attract one another and

cause intestinal necrosis). However, vegetative foreign bodies (fruits,

vegetables, seeds) also can be quite high-risk. Vegetative matter expands

and absorbs surrounding fluid, becoming not only a high infection risk

but also more difficult to remove with time. Adding to the challenge is the

fact that vegetative matter is typically not visible on X-ray (neither are

aluminum and some wooden objects).

The new copper zinc pennies are toxic to the GI tract and need to pass

within 24 hours. In adults, objects longer than 6 cm typically cannot turn

the corner of the duodenum, and objects wider than 2 cm typically won’t fit

through the pylorus. Small foreign bodies in the nose can be ‘‘sucked up’’

and aspirated, especially if the patient cries or snorts (which is difficult to

control with children, especially, so expedite their treatment when possible).

From “Things Are Not Always As They Seem,’’ presented by Deena Brecher, MSN, RN, APRN, CEN, CPEN, ACNS-BCInfants: Make sure you unwrap swaddled babies so that you can fully

assess them (work of breathing, color, etc.). Infants are obligate nose

breathers until about 2 months of age; if their nose is full of mucous, they

will choose not to eat. Nasal congestion alone can cause respiratory

distress in infants. Glucose should be considered a vital sign in any very

ill-appearing infant; they release glucose into the bloodstream in response

to stress, and they also metabolize it quickly.

Children in general: Children compensate very well when they are ill,

until they don’t anymore. They typically ‘‘hold on to’’ normal blood

pressures until they have lost about 25 percent of their blood volume, so a

low BP is a late sign of deterioration. Pediatric vital signs (especially heart

rates) vary a great deal in response to fever, crying, pain, etc. If you find

yourself ‘‘rationalizing’’ an abnormal set of vital signs, be sure to reassess

them later. Do not let yourself rationalize more than once, because

sometimes the abnormal vital signs offer a clue to what is really going on

inside the child.

Brecher also shared some advice that could benefit us all: ‘‘We all make

mistakes … we need to admit them, share them with one another, learn

from them and report them (including near-misses) so that systems can be

improved and others may avoid making the same mistakes.’’ Sounds like a

great New Year’s resolution to me.

Happy holidays,

Elizabeth

* DVDs of 2012 Annual Conference presentations are available

at www.AVMGonline.com or 800-283-2864.

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

Pediatric Content at 2012 Annual Conference

A Gift of Knowledge


‘‘Triage is a process, not a place.’’ How many

times have you heard that phrase?

As I travel around the country in my role

as a consultant, I have the opportunity to visit

many emergency departments. A theme I see

in most is the mandatory triage process. No matter how busy the

department, patients are required to stop and be ‘‘triaged.’’ Why is that? Is

it because we always have done it this way, or is it because it is the best

care for our patients?

We all know that triage means ‘‘to sort.’’ The triage process is

something we adopted from the military. It was used in battle to

determine who could be treated and returned to battle. Emergency

departments began using triage to determine the sickest patients who

needed immediate attention when we didn’t have enough resources to

care for all. That process has evolved into triage being a place where all

patients walking into the ED must stop to be screened before being

placed in a bed in the ‘‘back.’’

Triage has become a bottleneck. The triage nurse is collecting

information not to decide acuity but to fulfill regulatory requirements,

with such questions as: ‘‘Do you feel safe at home? Do you use drugs or

alcohol? Are you sexually active?’’

In many emergency departments, the triage nurse knows more about

the patient than the primary care nurse. The triage nurse becomes the

person who bonds with the patient. I ask you to consider what happens

when we try to change this process, when we try to move to a rapid

triage process and when we expect the primary care nurse to ask the

assessment questions. As emergency nurses, we revolt. We say: ‘‘What is

the triage nurse doing? How can I be expected to ask all of these

questions? I’m too busy!’’

If we, as a profession, are going to respond to the changes in the

health care environment, we have to be open to changing the way we do

business. We have to be open to innovation and be willing to change the

status quo. Why do patients need to stop in triage when there are open

beds in the back? Why should the triage nurse collect all of the patient

information when the primary care nurse should be the one asking those

questions?

If we want to be part of the solution to throughput issues, we have to

be willing to change our practice, to change our paradigm. This is an

exciting time for change. There are many new processes being

implemented — such as nurse first, pivot nurse, team triage, input process

and split flow — that will impact what we now know as triage.

Obviously, there is no perfect process, no process that will work in all

emergency departments. ENA’s responsibility as an organization is to

provide you with the information and the data about these processes, to

enable you to make informed decisions about what will work best in your

emergency department. We are doing just that by providing educational

opportunities at our conferences related to best practices in triage. We

have partnered with Elsevier to bring you online triage education, and

most recently we added a special assessment category to the ENA

Emergency Nursing Scope and Standards of Practice. It is your

responsibility to become familiar with these resources and make us aware

of new ones. Help us to help you.

Changing the Triage Paradigm

BOARD WRITES | JoAnn Lazarus, MSN, RN, CEN, 2012 President-elect

game in the fall of 2010, she

outlined her plans to him in a

meeting a week later and won his

fervid cooperation. The Kentucky

ENA, the Kentucky Hospital

Association, the Kentucky American

College of Emergency Physicians,

the Kentucky Association of Chiefs

of Police, jailers, St. Elizabeth

Healthcare, domestic violence

groups and nurses across the state

all lined up behind their bill.

Despite the “no more felonies”

obstacle, which Jensen warned of

ahead of time, Robinson worked

the phones, urging emergency

nurses all over the state to call their

legislators and demand the bill be

heard. It worked. And now that it’s

law, she believes it can work for

more people. The next step in her

efforts isn’t to purse felony status

— which remains unlikely — but to

expand the probable-cause

component to include all Kentucky

hospital staff, not just those in

the ED.

“We have to keep our nurses

safe. We have to keep our health

care staff safe,” Robinson said.

“These are givers. These are people

who want to give. They’re people

who care.

“We created this culture of

allowing people to behave however

they wanted to behave in the

emergency room. And you’ve heard

that term: ‘It’s part of your job.’ It’s

not part of the job, and the culture’s

changing.”

In nominating Robinson for

Magnet recognition, Jane Swaim,

MS, RN, St. Elizabeth’s senior vice

president and chief nursing officer,

said Robinson “exemplifies the true

meaning of being a Magnet Nurse.”

Wrote Swaim: “She is passionate

about nursing, committed to the

issue of workplace violence

prevention and makes us all realize

that one nurse really can make a

difference.”

Kentucky Gov. Steve Beshear (seated) signs Senate Bill 58 into law on June 11, with Linda Robinson standing behind him.

Members in Motion Continued from page 4

December 20128

In Tending to Shooting Victims, Nurses Don’t Forget Each Other‘‘Can you come in? There’s been a shooting at

the Aurora mall.’’

That was the only information Cheryl Stiles,

MAOM, RN, CPEN, director of emergency

services at Children’s Hospital Colorado,

received when her unit secretary called shortly

after 1 a.m. July 20 to inform her that a mass

casualty shooting had occurred. Stiles realized

the shooting was a large-scale event before she

made it to the hospital. As she drove by the

Town Center at Aurora shopping mall, she saw

flashing lights, police cars and EMS vehicles

everywhere.

When Stiles arrived

at the hospital, she

witnessed what she

described as one of the

‘‘most compelling

moments of the night.’’

A portion of her team

— nurses, physicians

and techs — was

huddled outside of the

ambulance entrance.

They had just stabilized the final patient from

the shooting — a multi-weapon assault by an

apparent lone gunman in a packed movie

theater — and had taken a brief moment to

support each other as a team.

‘‘When I arrived, they were hugging each

other and taking a moment to pause and reflect

on the events of the night,’’ she said. ‘‘They

were taking care of each other and then quickly

moved back inside to continue their efforts.

Witnessing the teamwork, mutual respect and

the staff reaching out to each other in support

so that they could continue to take care of the

patients who were involved in the shooting, as

well as the patients already in the emergency

department, was undoubtedly one of the most

touching moments in my career.’’

After being briefed, Stiles immediately

assessed the situation, examined resources and

supplies to make sure the ED was prepared for

possible additional patients and examined the

ongoing needs of patients, families and staff.

Along with the 11 emergency nurses who

worked during the crisis, there were physicians,

advanced practice nurses, critical-care and float

nurses, mental health counselors, clinical

medical technicians, unit secretary staff, licensed

clinical social workers, the ED clinical manager

and the nursing disaster preparedness/mass

casualty representative.

‘‘When I came upon the event, it was

overwhelming, and I felt like the proud ‘mother’

of the unit,’’ Stiles said. ‘‘I was proud of every

individual and honored to witness the

unparalleled teamwork on behalf of our patients

and their families and driven by our hospital

mission. The priority was providing safe patient

care, keeping communication lines open and

assessing the ongoing physical and emotional

needs of patients, families and staff.’’

The ED staff consists of providers, nurses,

techs, mental health counselors and

administrative and support staff who are very

invested in mass casualty and disaster

preparedness. All nursing staff members are

certified in Basic Life Support, the Trauma

Nursing Core Course, Pediatric Advanced Life

Support and Advanced Cardiac Life Support,

and the majority are also Emergency Nursing

Pediatric Course-certified. Additionally, 58

percent of the ED RN staff members are

certified in their specialty area.

From the moment the first victim walked into

the ED and told the triage nurse about the

shooting, the staff focused and placed calls to

mobilize internal resources in order to prepare

for a mass influx of patients. Patients who were

not critical and not part of the shooting were

moved from the ED trauma/resuscitation area to

exam rooms within the department.

After the Aurora Theater Massacre

By Kendra Y. Mims, ENA Connection

The ED staff at Children’s Hospital Colorado, where six victims of the July 20 theater shooting were taken.

Beth Maldonado, LCSW, the employee assistance program manager at Children’s Hospital Los Angeles, delivers cards signed by hundreds of employees from Children’s Hospital Los Angeles to Bob Flory, director of spiritual care and bereavement services at Children’s Hospital Colorado.

Cheryl Stiles, MAOM, RN, CPEN

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Letter From the President Continued from page 3

As patients began arriving, there were many unanswered questions and

very limited information from the scene. People were concerned about

the possibility of multiple shooters. The total number of victims was

unknown. There were rumors of gas canisters and unknown chemicals

that may have been released in the theater. Stiles said they eventually

learned that the alleged shooter’s apartment — located a few blocks west

of the medical campus — was booby-trapped with explosives, which

heightened everyone’s awareness.

‘‘We are a Level 1 pediatric trauma center, and we see some of the

most severely injured patients who are referred from within a six-state

region, so we constantly prepare to care for patients who are critically ill

or injured,’’ Stiles said. ‘‘We train and prepare our entire emergency

careers for mass casualty events and attend drill after drill. We expect to

provide exceptional care to our patients. However, I am not sure that you

can ever adequately prepare for the global effects that result from a tragic

event such as the one that our community endured. We are very flexible,

by nature, and always expect the unexpected — we are great at this. But

the ramifications of this event were so large-scale.’’

Children’s Hospital Colorado received six patients — one child and five

adults — who ranged from fair to critical condition upon arrival. One of the

biggest challenges for Stiles and her staff was not being able to adhere to

their philosophy of family-centered care due to extenuating circumstances.

‘‘We whole-heartedly believe in family-centered care, and we support

and advocate for family presence at the bedside. The family is an integral

part of their child’s care plan and decision-making,’’ she said. ‘‘Personally,

it was exceedingly difficult to have families that had arrived and to not be

able to immediately reunite them with their respective family member

because of the active crime scene. In this case, the police followed crime

scene protocols and made the decision as to when we could

reunite families. While we understood the rationale, we were

challenged by the gut-wrenching feelings that resulted.’’

Although other incidents have sent more patients to Children’s

Hospital Colorado at one time, the theater shooting was on a

different level. The hospital was flooded with more than 1,000

phone calls (about 200 per hour) from as far away as Egypt and

Paris; many came directly into the emergency department. Some

were calls of support, while others were frantic calls from families

who wanted to know if a loved one had been involved in the

shooting. Calls and e-mails poured in from peers across the

country, local hospitals and many ENA members, including

several supportive calls from 2012 ENA President Gail Lenehan,

EdD, MSN, RN, FAEN, FAAN.

In addition, staff also received more than 30 different cards with

hundreds of notes of support from Children’s Hospital Los Angeles.

‘‘These words of encouragement and support meant so much to our

team,’’ Stiles said.

She still has difficulty finding words to describe the support.

‘‘One of the things that really affected us when we received this

outpouring of support was to look at paying it forward the next time

something unimaginable happens,’’ she said. ‘‘We can show that same

love and support that we received from others and pay it forward.’’

Some of her staff were very affected by the shooting days and weeks

after the incident and experienced difficulty being alone. Children’s

Hospital Colorado offered support through its Resiliency Education &

Support Team and the ED’s Resiliency Committee. Staff also had the

opportunity to meet with social workers and attend debriefings.

‘‘We had some staff that took some time off and took care of

themselves,’’ Stiles said. ‘‘We were very supportive.’’

She’s proud of how the ED staff responded and believes everyone on

the team did a ‘‘tremendous job’’ in taking care of the patients.

‘‘Our staff, and emergency staff in general, work very well under

pressure. They’re always an amazing, compassionate team,’’ Stiles said.

‘‘But the team spirit is heightened when you’re going through something

like this together. It was clearly evident that night. The support we

received internally from our hospital and our network of care was

overwhelming.

‘‘In those situations, you do what you need to, you focus, and you care

for the patients the way you should — the manner in which you would

expect to be treated and the way you’ve been trained. The last thing you

think about is yourself.’’

them in touch with each other.

During visits to emergency departments across the country, as

well as internationally, there was always an immediate

connection, a strong sense of camaraderie, a genuine caring . . .

and virtually all of the very same challenges.

From day one, serving as your president has been busier than

I could have imagined, and equally rewarding. None of us

reaches a destination or makes a difference by traveling the road

alone. As my 2012 ENA presidency comes to a close, I appreciate

the full power of the collective hard work of the board of

directors and the ENA staff at national headquarters, and the

wisdom of individual members.

I am grateful to all those who placed your trust in me. Your

commitment and passion to emergency nursing have inspired me

and our organization to stay strong. Be proud of the difference

you make for patients and for one another.

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December 201210

You’re working in

the ED when a

10-year-old patient

comes in with a

head injury

sustained playing soccer. He’s alert and

oriented, with a mild headache, no loss of

consciousness and no vomiting. He’s got a little

retrograde amnesia. The child looks a little pale,

but he’s mentating well.

In triage, his vital signs are within expected

limits. His parents tell you, ‘‘We’re here for the

CT scan.’’

You know that a CT scan delivers a large

dose of radiation, and that given his

presentation, he may not need to undergo the

risks of CT scanning. But how do you make that

case to the parents, who are worried about their

child, and the provider, who may defer to the

parents’ wishes in the interest of patient

satisfaction?

Evidence to support best practices is critical,

and the type of research evidence that you look

for and can use to support practice changes is

important. In the age of nearly unlimited access

to information, sifting through evidence to

decide what is valid and valuable can be

challenging.

Appropriate literature can be found in several

places. In terms of practice issues, a database

that holds clinical nursing and medical articles is

the most useful. CINAHL, PubMed and

Journals@OVID are all good sources. Another

good source, the Centers for Disease Control

website (www.cdc.gov), often has up-to-date

information, epidemiological data and practice

guidelines.

Searching the LiteratureThe search terms you choose will help you find

articles on your topic of interest. In this case,

you’re interested in the benefits vs. risks of

scanning children’s heads. Start with, ‘‘Head

injury, pediatric head injury and computed

tomography scanning in head injury.’’ It’s also

helpful to look at guidelines from the American

Academy of Pediatrics, the Academy of

Emergency Physicians and the American

College of Radiology.

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

What Is ‘Evidence’?

The Emergency Nurses Association is proud to present the release of the 4th edition of the Emergency Nursing Pediatric Course.It has been revised and updated, evidence-based, and continues to incorporate various teaching and learning styles.

• A portion of the course will be presented in an online format through ENA’s Center for e-Learning.

• Pediatric Clinical Considerations is nowcase-based using group discussion.

• The adolescent patient is addressed witha separate chapter and lecture.

• Triage is now Prioritization with a focus on the process, rather than the place.

Upon successful completion of ENPC, RN participants are veri� ed for four years, receive a veri� cation card and earn up to 16 contact hours.

This course brings the emergency nurse a resource for treating the pediatric patients arriving to emergency departments every day.

To verify why ENPC is right for you and toview course schedules, please 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.


Evaluating EvidenceResearch articles are structured to tell you about

the research question, the background of the

problem or what’s already been studied, and the

way in which the problem was studied (the

methods). Part of the value of the evidence is

how well the study was done. In other words,

was the question useful and well-framed? Was

the number of people studied (the sample size)

adequate to say anything about the problem? Did

the researchers answer the question? Was their

answer similar to or different from other

researchers studying the same thing?

What’s Out There?In this case, there are a large number of articles

in the PubMed database reporting the usefulness

of clinical-decision rules for this population. All

report that clinical decision-making tools to

determine high- and low-risk pediatric head

injury patients are sensitive enough to find the

children for whom benefit outweighs risk.

These studies tend to have large numbers of

patients and identify risk factors that would

direct a clinician to obtain a head CT, while

noting that in the absence of these factors, the

child has a very low risk of clinically important

head injury.

How to Incorporate Findings Into PracticeOnce you have a number of research reports that

seem to suggest the same thing, and are the

result of well-planned, well-done studies, you

can draw some conclusions about changing

practice. It is important to not base the decision

to implement change on the results of one study,

unless the study is so large and so well-done that

professional practice organizations are suggesting

changes.

What Next?Present these findings to your nursing manager

and medical staff and suggest implementation of

these guidelines. You may also want to contact

your local pediatric groups and discuss the

process, so that they don’t send patients to the

ED ‘‘for a CT scan.’’

Evidence-guided practice can streamline

processes and reduce risk for patients. Keeping

current with research that provides a practice

framework also can foster more collegial

communication with providers and improve

emergency nursing practice.

The Research Column in Connection has

been designed to give succinct, useful

information about the research process and

how research can be useful to the bedside

emergency nurse. Please send topic

suggestions to [email protected].

ENA COMMITTEE SPOTLIGHT

Historical Perspectives Work Team

Members of the Historical Perspectives Work Team who met in October stop at the Anita Dorr crash cart and 25th anniversary quilt displayed in the ENA headquarters lobby. From left, 1990 President Joanne Fadale, BSN, RN, FAEN; Audrey Snyder, PhD, RN, CEN, ACNP-BC, CCRN, FAEN, FAANP; board liaison Kathleen Carlson, MSN, RN, CEN, FAEN; and co-chairperson Diane Schertz, BS, RN, FAEN. Not pictured are co-chairperson Kay McClain, MS, RN, CEN, FAEN; and Mildred Fincke, BSN, RN.

When did ENA get started? What’s Etcetera?

Why is there a quilt hanging in the lobby of

ENA headquarters? How many members did

ENA have in 1989?

If you have questions about ENA’s history

or if you need background information for

committee work or a research project, you’ll

soon be able to obtain this information from

www.ena.org.

In May, ENA President Gail Lenehan,

EdD, MSN, RN, FAEN, FAAN, named a

Historical Perspectives Work Team

comprised of ENA Academy members (Kay

McClain, MS, RN, CEN, FAEN and Diane

Schertz, BS, RN, FAEN, co-chairpersons;

Patricia Clutter, MEd, RN, CEN, FAEN;

Joanne Fadale, BSN, RN, FAEN; and Audrey

Snyder, PhD, RN, CEN, ACNP-BC, CCRN,

FAEN, FAANP) to make recommendations

regarding the development of a sustainable

system that ensures the appropriate retention

of important ENA documents and other

historical materials.

Many documents, publications,

photographs, memorabilia, audiovisual items

and speeches will be posted to ENA’s website

in early 2013.

In addition, duplicate materials are sent to

the archives at the University of Virginia

School of Nursing, Center for Nursing

Historical Inquiry, established in 1991 to

support historical scholarship in nursing.

ENA makes an annual financial

contribution toward support of UVA’s work

in processing, preserving and making ENA’s

collection open to scholars, historians,

faculty and students, and materials sent from

ENA are described and catalogued in the

Center by an archivist and stored in secure,

climate-controlled rooms. The Center is a

national resource open to visiting scholars,

faculty, students and others interested in the

history of nursing and is open to visitors

Monday through Friday. Contact www.

nursing.virignia.edu/research/cnhi to

schedule a visit or to obtain more

information.

If you need any early history or

background information, contact Ginger

Burns, special projects manager, who serves

as ENA’s archivist, at [email protected].

ENA Reception Featuring Ignite® Sessions

What is Ignite®? Imagine that you’re in front of an audience made up of your friends and fellow colleagues

in emergency nursing; about to present a 5-minute talk on the thing you’re most passionate about – emergency nursing! Specifically; “What Makes an Emergency Nurse Unique.” You’ve brought 20 slides, which advance every 15 seconds whether you’re ready or not. You have a few last-minute butterflies, but off you go—and the crowd loves it. Welcome to Ignite.

Do you wish to share your take on “What Makes an Emergency Nurse Unique” through this rapid-paced presentation style? Be a part of this unique opportunity as ENA will be hosting a reception, February 28 from 6-8 p.m. in the exhibit hall.

To participate, speakers must agree to be video recorded and understand their video will be posted publicly to the internet. For complete details on participating, visit www.ena.org/lc and click the “Participate in Ignite” link before January 11, 2013.

Register today for ENA Leadership Conference 2013 by scanning the QR code or at www.ena.org/lc

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

Important Dates to Remember

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

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

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

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

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

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

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

ENA lEADERShIp CoNFERENCE 2014 Phoenix, AZ • Mar. 5 – 9, 2014

Each year, ENA Leadership Conference attracts emergency nurse leaders from across the United States as well as across the globe. Each attendee, new or returning, comes to conference with one common goal in mind; to strengthen their leadership knowledge. Regardless of the location, we know you choose Leadership Conference for the experienced faculty, the engaging and insightful educational sessions giving you the information crucial to your practice. You will have the opportunity to earn contact hours and to gain a new outlook on existing emergency department procedures.

Each one of these factors helps you strengthen your leadership skills and helps you elevate your career today, tomorrow and in the future. Join us for ENA Leadership Conference, February 27 – March 3, 2013 in Fort Lauderdale, FL to take advantage of:

• NEW! Jam, Hand-off and Deep Dive Sessions providing a variety of course length and formats for a unique learning experience

• NEW! ENA Reception Featuring Ignite® Sessions

• Innovative Opening Keynote Speaker – Carmine Gallo presenting “The 7 Principles of Inspiring Leaders”

• And much more…

SAVE

– T h E –

DATE

FOLLOW THE ACTION #ENALC13

Social Media presence at ENA leadership Conference 2013

Our social media presence will be even larger than ever. You will want to follow the ENA Facebook and Twitter pages for the latest information about conference. In addition, we will have Foursquare restaurant deals near the Fort Lauderdale convention center and hotels.

Tell us what is important for you. We would love to hear from you. Please share your thoughts on our Facebook page at facebook.com/enaorg or on our Twitter page at twitter.com/enaorg.

Networking 101: The Challenge of Networking

Attending for the first time or attending alone? The key to a successful meeting experience is connecting with peers and colleagues to exchange ideas and

solutions about common challenges. Networking opportunities are available to you at every turn. From the classroom to the social functions and in between.

NEW FOR 2013! Take advantage of a special opportunity at the Welcome party to connect with leaders and attendees from your state early in the evening. To find out all the exciting things happening at ENA Leadership Conference 2013, go to www.ena.org/lc.

WWW.ENA.ORG/LC

ENA

WHY YOU NEED TO ATTEND ENA LEADERSHIP CONFERENCE 2013

REGISTER TODAY FOR ENA LEADERSHIP CONFERENCE 2013 AT WWW.ENA.ORG/LC

ENA Reception Featuring Ignite® Sessions

What is Ignite®? Imagine that you’re in front of an audience made up of your friends and fellow colleagues

in emergency nursing; about to present a 5-minute talk on the thing you’re most passionate about – emergency nursing! Specifically; “What Makes an Emergency Nurse Unique.” You’ve brought 20 slides, which advance every 15 seconds whether you’re ready or not. You have a few last-minute butterflies, but off you go—and the crowd loves it. Welcome to Ignite.

Do you wish to share your take on “What Makes an Emergency Nurse Unique” through this rapid-paced presentation style? Be a part of this unique opportunity as ENA will be hosting a reception, February 28 from 6-8 p.m. in the exhibit hall.

To participate, speakers must agree to be video recorded and understand their video will be posted publicly to the internet. For complete details on participating, visit www.ena.org/lc and click the “Participate in Ignite” link before January 11, 2013.

Register today for ENA Leadership Conference 2013 by scanning the QR code or at www.ena.org/lc

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

Important Dates to Remember

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

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

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

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

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

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

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

ENA lEADERShIp CoNFERENCE 2014 Phoenix, AZ • Mar. 5 – 9, 2014

Each year, ENA Leadership Conference attracts emergency nurse leaders from across the United States as well as across the globe. Each attendee, new or returning, comes to conference with one common goal in mind; to strengthen their leadership knowledge. Regardless of the location, we know you choose Leadership Conference for the experienced faculty, the engaging and insightful educational sessions giving you the information crucial to your practice. You will have the opportunity to earn contact hours and to gain a new outlook on existing emergency department procedures.

Each one of these factors helps you strengthen your leadership skills and helps you elevate your career today, tomorrow and in the future. Join us for ENA Leadership Conference, February 27 – March 3, 2013 in Fort Lauderdale, FL to take advantage of:

• NEW! Jam, Hand-off and Deep Dive Sessions providing a variety of course length and formats for a unique learning experience

• NEW! ENA Reception Featuring Ignite® Sessions

• Innovative Opening Keynote Speaker – Carmine Gallo presenting “The 7 Principles of Inspiring Leaders”

• And much more…

SAVE

– T h E –

DATE

FOLLOW THE ACTION #ENALC13

Social Media presence at ENA leadership Conference 2013

Our social media presence will be even larger than ever. You will want to follow the ENA Facebook and Twitter pages for the latest information about conference. In addition, we will have Foursquare restaurant deals near the Fort Lauderdale convention center and hotels.

Tell us what is important for you. We would love to hear from you. Please share your thoughts on our Facebook page at facebook.com/enaorg or on our Twitter page at twitter.com/enaorg.

Networking 101: The Challenge of Networking

Attending for the first time or attending alone? The key to a successful meeting experience is connecting with peers and colleagues to exchange ideas and

solutions about common challenges. Networking opportunities are available to you at every turn. From the classroom to the social functions and in between.

NEW FOR 2013! Take advantage of a special opportunity at the Welcome party to connect with leaders and attendees from your state early in the evening. To find out all the exciting things happening at ENA Leadership Conference 2013, go to www.ena.org/lc.

WWW.ENA.ORG/LC

ENA

WHY YOU NEED TO ATTEND ENA LEADERSHIP CONFERENCE 2013

REGISTER TODAY FOR ENA LEADERSHIP CONFERENCE 2013 AT WWW.ENA.ORG/LC

December 201214

One benefit of going to a

national meeting such as

the ENA Annual Conference is the networking

opportunity. You meet emergency nurses from

all over the country and the world. Engaging

with each other, we realize we do not exist in

isolation. Big inner-city hospital or small, rural

critical access facility, we all seem to have

similar concerns. Too many patients, limited

staffing, impossible demands and learning new,

paperless documentation systems are a few of

the common difficulties.

Hardly a few minutes are spent without

hearing a conversation about emergency

department care of patients who are mentally

ill. The volume of patients presenting with

mental health issues, and the care required, are

additional pressures on already under-resourced

EDs challenged by de facto mission creep. How

did health care professionals and workplaces,

communities, voters and governments ignore

the fractured aspects of health care, allowing

inequities in care delivery to get so skewed?

This article revisits past policies to understand

what transpired, bringing us to the present.

The movement to deinstitutionalize mental

health patients began around 1956 when the

state and local public mental hospital patient

population was 559,000.1 Of this total, a

substantial number of patients were housed in

‘‘back wards’’ for many years. Back wards were

notorious for inhumane treatment; patients were

not expected to recover, and custodial care was

provided, with no actual treatment taking place.

By 1980, the process of moving people out of

these facilities to care in community-based

services reduced the number of patients in

public mental hospitals to 154,000.

While states initiated transferring patients out

of public institutions, the progress was slow.

The process only quickened during the 1960s

and 1970s with the involvement of the federal

government. Created by Congress and

appointed by President Dwight D. Eisenhower,

the Joint Commission on Mental Illness and

Health reported in 1961 the need for a national

mental health program of research and of ‘‘fully

staffed, full-time mental health clinics (later

called community mental health centers), to be

available to each population of 50,000, or

approximately 3,000 to cover the nation.”2 The

thought was that with promising medications

(e.g., thorazine) and better treatment modalities,

people could be treated in community facilities.

In 1963, the CMHC legislation was enacted

with funding for construction of CMHCs. In

1965, CMHC staffing legislation finally was

enacted. The CMHCs were to provide only five

essential services: inpatient, outpatient,

emergency, partial hospitalization, consultation

and education on mental health. No

pre-admission and post-discharge services for

state mental hospital patients, nor rehabilitation

or case management services, were mandated

for the transition. While deinstitutionalization

accelerated, the funds did not follow the

patients.

Many state budget directors saw the decision

to put patients out into the field as a chance to

decrease their budgets. Exacerbating the fiscal

failure was a naïveté for what would be needed

to help people exiting state hospitals, e.g.,

wraparound services, including job training,

housing and continued counseling.

What finally has resulted is the continuing

elimination of state institutions with the majority

of the financial burden falling on Medicaid

rather than a mental health funding stream.

State funding of mental health services in 2005

was 30 percent less — when adjusted for

inflation — than in 1955.

As emergency nurses, we are faced with

caring for these patients in a fragmented,

broken system. This is not just a mental health

crisis; this unfinished business plays out in the

ED. ENA, in collaboration with other

stakeholder organizations, must stand together

nationally and locally, advocating for access to

quality care for all our patients, lobbying for

remedies to problems still in need of system

change.

References

1. Koyanagi, C. (2007, August.) Learning from

history: Deinstitutionalization of people with

mental illness as precursor to long-term care

reform. Retrieved from www.kff.org/

medicaid/upload/7684.pdf.

2. Smucker, B. (2007, July.) Promise, progress,

and pain – a case study of America’s

community mental health movement from

1960 to 1980. Retrieved from

mentalhealthhistory.org/Promise_

Progress_Pain.pdf.

Reaping What’s Been Sown

ADVOCACY

By M. Ben Melnykovich, BSAS, RN, Member, ENA Government Affairs Committee

Prescription drug abuse has

become a leading health problem

in the United States. In 2010, New

Hampshire alone had 174 deaths

as a result of prescription

overdoses. There are now more

deaths in New Hampshire from

prescription drug overdose than

motor vehicle crashes. Opiods,

specifically methadone and

oxycodone, are the most prevalent

drugs leading to death. To aid in

the detection of fraudulent

requests for controlled substances,

48 states have prescription drug

monitoring programs in place,

with New Hampshire and Missouri

being the only exceptions. This

means that savvy patients in the

Northeast take a short trip to New

Hampshire not only for tax-free

shopping but also to avoid

detection in their quest for opiates.

After several years attempting to

pass legislation establishing a PDM

in New Hampshire, bills were again

introduced in 2012. New

Hampshire ENA had identified this

bill as a high legislative priority

early in the year. Members

contacted their legislators,

encouraging them to support the

bill. In April, New Hampshire

Government Affairs Chairperson

Jean Proehl, MN, RN, CEN, CPEN,

FAEN, testified at a legislative

hearing to describe the impact of

prescription drug abuse in New

Hampshire emergency departments.

Success was realized in the

spring when the bill passed in

both houses of the legislature. On

June 12, NH-ENA President Stacey

Savage, BSN, RN, CPEN, watched

as Gov. John Lynch signed this

bill in to law. (Search for Gov.

Lynch and SB 286 at Youtube.com

to view the signing video.)

In October, New Hampshire

ENA and three other nursing

organizations received Advocacy

in Action awards for their work

toward the passage of this bill.

NH-ENA is now participating in

committee work to accomplish the

goals of the legislation.

Reference

Governor’s Commission on Alcohol

and Drug Abuse Prevention,

Intervention, and Treatment. (2012,

Jan). A Call to Action: Responding

to New Hampshire’s Prescription

Drug Abuse Epidemic. Concord,

NH: Author.

New Hampshire ENA Helps Pass Prescription Drug Monitoring Legislation


Every nurse knows the experience of being

asked a general health question by a neighbor,

friend or patient with the expectation that your

knowledge, education or clinical expertise will

clarify a complicated topic. What is more

complex than the Patient Protection and

Affordable Care Act? Since its enactment in

March 2010, and more recently, since the

Supreme Court decision in June 2012, nurses

have been asked to comment, explain or clarify

PPACA issues.

According to the ENA 411 Key Contact

program, ‘‘As an emergency nurse, you speak

with the authority of one whose perspective is

broad, observing and connected with people

from throughout the community, touching

individuals from all types of families and

situations, economic strata, occupations and

education.”1 Are you ready for that

responsibility? This article, though expressing

my opinion only, may be helpful when you are

asked the inevitable questions.

If you are anything like I am, you had good

intentions of reading the PPACA when it was

adopted and then when it was published as the

906-page Public Law 111–148.2 ENA

summarized the law for members at members.

ena.org/government/healthcarereform/

Pages/Default.aspx. The March 2010 ENA

Washington Update described the law’s reform

elements (www.ena.org/government/

washington/Documents/2010/03-2010.pdf).

The following is what I was thinking in

early July 2012 based on the 10 titles in the

PPACA3:

Title I: Quality, Affordable Health Care For All Americans• Pre-existing illnesses won’t prevent you from

obtaining insurance coverage.

• Lifetime or annual limits no longer will be an

issue for those with chronic, lifetime illnesses

or injuries and for the families of those

patients.

• Preventive health services are now being

covered.

• Insurance coverage will extend to young

adults on their parents’ plan.

Title II: Role of Public Programs• It’s beneficial that the Children’s Health

Insurance Program will be expanded

Title III: Improving the Quality and Efficiency of Health Care• It’s interesting to consider what types of new

Patient Care Models will be developed.

Title IV: Prevention of Chronic Disease and Improving Public Health• It’s exciting to consider how prevention and

public health innovation and expansion of

primary care options will improve the nation’s

health, relieving some ED pressure.

Title V: Health Care Workforce• It’s about time the health care workforce

received appropriate educational funding.

Title VI: Transparency and Program Integrity• It goes without saying that the law must

include integrity in all issues.

Title VII: Improving Access to Innovative Medical Therapies• It’s fascinating that access to innovation in

medical therapies will be expanded to include

a broader patient population.

Title VIII: Class Act• I’m a nurse, not an attorney or legislator, so I

cannot at this time begin to comment on this

title, which describes a self-funded, voluntary

long-term care insurance choice in the event

of a disability.

Title IX: Revenue Provisions• Unless we find the funding, progress will

not occur. This title makes health care more

affordable for families and small business

owners.4

Title X: Strengthening Quality, Affordable Health Care for All Americans• It’s a goal for all of us because we are going

to be patients one day.

As sure as nothing is perfect, there are still

many features in the PPACA that will benefit us as

providers of health care. On the day after the

Supreme Court decision, a few neighbors were

enjoying a lovely evening in our common

courtyard, and though two of them were

attorneys, they were interested in what I had to

say about the PPACA because I am a nurse.

References

1. Emergency Nurses Association. (n.d.). EN411.

Retrieved from www.ena.org/government/

EN_411/Pages/Default.aspx.

2. The Patient Protection and Affordable Care

Act (P.L. 111–148). (2010, March.) Retrieved

from www.gpo.gov/fdsys/pkg/PLAW-

111publ148/pdf/PLAW-111publ148.pdf.

3. HealthCare.gov. (n.d.). The health care law &

you: Read the law. Retrieved from www.

healthcare.gov/law/full/index.html.

4. The Congressional Budget Office. (n.d.).

Affordable Care Act. Retrieved from www.

cbo.gov/topics/health-care/affordable-

care-act/reports.

What Does My Neighbor, the Nurse, Think About Health Care Reform?By Elisabeth K. Weber, MA, RN, CEN, Member, ENA Government Affairs Committee

ADVOCACY

December 201216

Congratulations to the 14 new

fellows in the Academy of

Emergency Nursing, who were

inducted during the regal 1st

Annual Awards Gala in San

Diego. This black-tie optional

event, hosted by the always humorous Terry Foster, MSN, RN, CEN, FAEN,

was a fitting venue to celebrate the lifetime contributions of these new

fellows.

The Academy of Emergency Nursing honors nurses who have made

enduring, substantial contributions to emergency nursing and who

continue to advance the profession of emergency nursing.

Induction as a fellow into the Academy often marks the pinnacle of the

inductee’s career. The collective wisdom and contributions of the AEN’s

101 fellows is astounding. This 2012

cohort is no exception; the caliber of

each of these inductee’s is amazing, and

as a group, unstoppable.

To our new FAENs, I hope that you

take your induction into the AEN not just

as a remarkable achievement, but as a challenge to recognize your

continued potential.

2012 Academy Inductees

• Meredith Jaye Addison, MSN, RN, CEN, FAEN — Hillsdale, Ind.

• Rita T. Anderson, RN, CEN, FAEN — Surprise, Ariz.

• Liz Cloughessy, AM, MHM, RN, FAEN — Glenwood, NSW, Australia

• Christine M. Gisness, MSN, RN, BC, FNP-C, CEN, FAEN — Roswell, Ga.

• Diane Gurney, MS, RN, CEN, FAEN — Hyannis,

Mass.

• Andrew D. Harding, MS, RN, CEN, NEA-BC,

FACHE, FAHA, FAEN — Bridgewater, Mass.

• Cindy L. Hearrell, MSN, RN, CEN, FAEN —

Fredericksburg, Va.

• J. Jeffery Jordan, MS, MBA, RN, CEN, CNE, EMT-P,

FAEN — Macomb, Okla.

• Fred Neis, MS, RN, CEN, FACHE, FAEN — Prairie

Village, Kan.

• India J. Taylor Owens, MSN, RN, CEN, NE-BC,

FAEN — Fairland, Ind.

• Gwyn Parris-Atwell, MSN, RN, FNP-BC, CS, CEN,

FAEN — Alloway, N.J.

• Judith A. Scott, MHA, BSN, RN, PHN, FAEN

— Penn Valley, Calif.

• Paula Tanabe, PhD, MPH, MSN, RN, FAEN —

Durham, N.C.

• Mary Ann Teeter, MEd, RN, FNP-C, CEN, CNRN,

FAEN — Elmira, N.Y.

A segment of the fellow application weight is ‘‘the

potential for sustained contributions to the Academy

of Emergency Nursing and the advancement of the

emergency nursing profession.’’ John F. Kennedy

once said, ‘‘The ancient Greek definition of happiness

was the full use of your powers along lines of

excellence.’’

Your powers of excellence have been

acknowledged. Serving as a FAEN provides a

tremendous opportunity to make a difference at the

local, state, national and international levels.

Congratulations on your induction into this prestigious

group. You decide whether it is a final achievement

or a sign of the amazing things yet to come.

Look for profiles and photos of the 2012

fellows in the February issue of ENA Connection.

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

Two easy ways to order:Phone: 800-900-9659 Monday through Friday 8:30 a.m. - 5:00 p.m. CT www.ena.org/shop

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By Kathleen Flarity, ARNP, PhD, CEN, CFRN, FAEN, Chairperson-elect, Academy of Emergency Nursing

101 Fellows in the Academy of Emergency Nursing


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Have you ever considered

proposing a resolution for General

Assembly? The opportunity is open

to any member of our professional

organization; however, it is not as

easy as merely identifying a need.

How does one go about putting

together the proposed resolution

and moving it through to successful

adoption by the General Assembly?

In Louisiana, we began by

discussing the challenge with our

ENA board liaison, Mitch Jewett,

RN, CEN, CPEN. He suggested we

poll our members about their

concerns. From that assessment, we

developed a proposal to submit to

the ENA Resolutions Committee.

The resolution was vetted, and

recommendations for change were

relayed. Based upon those

suggestions, we worked with the

committee to firm up the statements

and supporting research.

Upon notification that our

resolution had been accepted,

preparations began for presentation

to General Assembly and defense

of the resolution during debate.

Finally, the day for presentation

arrived. We expected lively debate,

remembering to remain professional

and not take the statements made by

the opposition personally. This may

have been the most difficult of all

tasks associated with the process

and required both mental preparation and patience. During the debate, our

delegation took notes of the remarks and the state represented, along with the

names of those speaking either in support or in opposition. These notes were

vital in the resolution assistance session and for caucusing the next morning.

During the resolution amendment assistance session held that evening,

other delegates and Resolutions Committee members provided input. The

statements were amended to more clearly define the resolution and request.

Our next tasks were to explain the amendments to our delegates, have them

prepared to introduce those when appropriate, and to supply the

amendments and explanation for all delegates.

We successfully moved our resolution forward, and now ENA will

address the issue that we identified: defining the components of safe

discharge from the emergency department.

This process engaged all of our members, especially our delegates. It is

impressive to see the renewed spirit of ownership that has been evidenced

since we began the journey.

ENA has issued the next call for resolutions, which are due March 11,

2013. Why don’t you resolve to get involved?

At Your FingertipsSeveral resources for members

interested in writing a

resolution are at www.ena.

org/statecouncils/

GeneralAssembly/Pages/

ResolutionsBylaws.aspx.

Topics include the following:

• Call for Bylaws and

Resolution Proposals: Deadline

March 11, 2013, 5 p.m. CST

• Bylaws Amendments and

Resolutions Guidelines —

Revised October 2012

• Bylaws Amendment

Proposal 2013 - Template

• Resolution Proposal 2013

– Template

• General Assembly Standing

Rules of Procedure —

Amended Sept. 12, 2012

• Tips On Using References

• Parliamentary Procedure

Basics: “Speaking the Delegate’s

Language”

• Examples: Bylaws

Amendments and Resolutions

Proposals

• ENA Position Statements

– Reviewing current position

statements before drafting

proposals is recommended.

Preparing to Present Your Resolution at General AssemblyBy Deborah Spann, RN-BC, CEN, Louisiana ENA State Council

December 201218

By focusing on engaging members and the

profession of emergency nursing, ENA has

amassed an impressive list of accomplishments.

In her Sept. 12 address to the 697 delegates

comprising this year’s General Assembly, 2012

President Gail Lenehan, EdD, MSN, RN, FAEN,

FAAN, announced several initiatives that have

elevated ENA’s status among emergency nurses

and outside organizations.

‘‘Our Nurse Practitioner in Emergency Care

Committee’s dream has come true,’’ Lenehan

said. ‘‘Today we are formally announcing that the

American Nurses Credentialing Center and ENA

will embark on a new portfolio credentialing

program for emergency nurse practitioners.

Credentialing by portfolio is a growing trend that

allows for a more robust proof of competency,

and ANCC is the authority in this method.’’

After inviting the committee members present

to stand and be recognized for their hard work,

Lenehan said the credential could become reality

within a year.

Some of the other accomplishments Lenehan

highlighted were the release of the ENPC 4th

edition; the current TNCC revision; a landmark

position statement on weighing pediatric patients

in kilos only; the creation of a Conference Site

Selection Committee, which selected Phoenix as

the Leadership Conference 2014 venue; the first

Workplace Violence Prevention Summit and the

new member benefit of monthly free CE. She

noted that ENA’s landmark position paper on

weighing children in kilos only also has been

signed by the American College of Emergency

Physicians, the Institute for Safe Medication

Practices and the American Academy of Pediatrics.

‘‘It’s rare to have a physician group sign on to

a nursing group’s position unless it’s a joint

consensus statement,’’ she said.

The National Quality Forum is also

considering adding its endorsement.

She reported on other collaborations with the

Centers for Disease Control on traumatic brain

injury, Emergency Medical Services for Children

on the pediatric toolkit and the NQF on

regionalization of emergency care.

‘‘The general direction of this organization is

one that everyone in this room should leave

feeling very excited about,’’ Lenehan said. ‘‘The

high-level connections we’re shoring up — with

colleagues at associations and regulators in key

positions — have already elevated us to new

positions.’’

On a personal note, Lenehan shared that one

of the most gratifying aspects of the year was the

opportunity to reach out and connect with

nurses involved in crisis situations, to make that

crucial connection and to represent ENA.

‘‘I’ve been reminded as I visit EDs across the

country and beyond that there is so much more

that binds us together than pulls us apart,’’ she

said, ‘‘so many of the common struggles and

successes. The commonalities are everywhere.’’

Lenehan closed by thanking several people,

including the ENA Board of Directors, Executive

Director Susan M. Hohenhaus, LPD, RN, CEN,

FAEN, ENA staff, state and chapter presidents, the

Massachusetts ENA State Council and her family.

‘‘Thank you for the privilege of serving as

your 2012 president,’’ she said. ‘‘It’s been quite

a ride!’’

President’s Address: Elevating ENAGENERAL ASSEMBLY: SAN DIEGO

Past ENA presidents listen as Gail Lenehan, EdD, MSN, RN, FAEN, FAAN, addresses the General Assembly.

By Amy Carpenter Aquino, ENA Connection

Bringing greetings from ‘‘the fabulous staff at

ENA headquarters,’’ Executive Director Susan M.

Hohenhaus, LPD, RN, CEN, FAEN, reported on

the business of the association to the General

Assembly delegates Sept. 12.

‘‘If you had any doubts about the road map

for the future of ENA, please download our

strategic plan from the ENA website,’’

Hohenhaus said. She pointed out that the first

arm of the plan’s triangle is investment, and

explained that while the 2012 budget shows a

deficit, it was intentional and will enable the

organization to focus on developing the two

main areas of human resources and technology.

Executive Director: Talent, Technology Investments Add Up to a Stronger ENABy Amy Carpenter Aquino, ENA Connection

Susan M. Hohenhaus, LPD, RN, CEN, FAEN


‘‘This moment is a mountain-top experience for

me, and I thank God for this honor,’’ said 2012

President-elect JoAnn Lazarus, MSN, RN, CEN, as

she addressed the 697 General Assembly

delegates gathered at the San Diego Convention

Center on Sept. 13. Giving special recognition to

her family and friends, Lazarus thanked everyone

who supported her on her leadership journey.

‘‘Because of you, I am here today,’’ she said.

Mentoring and leadership form the basis of

Lazarus’ 2013 vision for ENA, with a special focus

on providing members with the resources they

need to be effective leaders. She emphasized the

importance of mentors to emergency nurses, who

are shaped by preceptors, managers and others

who supported them early in their career. She

asked attendees to consider what they are doing

to leave a legacy, how they want others to

remember them.

‘‘The fact that each of you is in this room, that

makes you a part of the leadership of ENA of

more than 40,000 emergency nurses,’’ Lazarus

said. ‘‘Leadership is at the core of what we do,

whether it is formal or informal.’’

Lazarus said creating opportunities for

mentorship and leadership development for

members, as well as strengthening strategic

partnerships, will help ensure ENA’s future.

‘‘Many of you find yourselves as leaders in your

state organization or in your hospitals without the

support and/or tools to do the job you want to

do,’’ she noted. ‘‘You may feel you do not have

the knowledge or resources to be successful. . . . I

believe it is our responsibility as your professional

organization to provide you with those tools and

resources. The viability of this organization is

dependent upon it.’’

Lazarus invited delegates to help her continue

the ENA legacy by spreading awareness of both

the organization’s mission to advocate for patient

safety and excellence in emergency nursing

practice, and its strategic initiatives.

‘‘I believe we need to focus more on taking

care of the needs of our membership,’’ she said.

‘‘If we work together to create a safe environment

where we can give quality patient care, and at the

end of the day feel good about what we have

done, we have been successful.’’

Lazarus also prepared members for changes,

including revising and redesigning organizational

operations. These changes are vital to attracting

and developing new leaders, she said.

‘‘People want to be part of something that is

meaningful and purposeful,’’ she said. ‘‘So how

do we ensure that ENA meets those needs? We

have to become more innovative if we are to

survive. We have to take risks.’’

Lazarus explained the meaning of the small

turtle pins handed out to each delegate as she

urged attendees to reflect on their roles as leaders

and mentors once they returned home.

‘‘Behold the turtle,’’ she said, quoting James B.

Conant. ‘‘He makes progress only when he sticks

neck out.’’

Taking Care of Our Members General Assembly Talks TNCC, Pain Management in the ED and More

Executive Director: Talent, Technology Investments Add Up to a Stronger ENAThese fortifications will leave ENA better prepared

to enter the implementation stage of its strategic

plan in 2013, guided by its four organizational

priorities.

In the area of talent, Hohenhaus reported on

the recent addition of key staff, including Betty

Mortensen, MS, BSN, RN, FACHE, chief nursing

officer; Dr. Paula Karnick, PhD, ANP-BC, CPNP,

director of education; and Dr. Lisa Wolf, PhD, RN,

CEN, FAEN, director of the Institute for

Emergency Nursing Research. They join Kathy

Szumanski, MSN, RN, NE-BC, director of the

Institute for Quality, Safety and Injury Prevention.

‘‘We are now fully staffed in our nursing

Continued on page 34


JoAnn Lazarus, MSN, RN, CEN

The delegates of the 2012 ENA General

Assembly considered several

resolutions concerning such issues as

TNCC eligibility, use of protocols in

the ED setting, health care worker

fatigue and care of the bariatric and

obese patient.

‘‘Today we need to do the serious

business of the General Assembly,’’ said

Jeffery J. Jordan, MS, MBA, RN, EMT-P,

CEN, chairperson of the Resolutions

Committee, as he presented the first of

several bylaw amendments and

resolutions for delegates’ consideration

Sept. 13, following a day of proposal

hearings in San Diego.

The assembly voted to postpone

indefinitely a proposal to allow the

General Assembly to elect the ENA

Board of Directors and Nominations

Committee. During the initial hearing

of the proposed resolution Sept. 12,

co-author Jason Moretz, BSN, RN, CEN,

CTRN, said the amendment was ‘‘not

about taking something away from our

members. This is about making sure

we get the greatest leaders elected.

Despite our greatest efforts, our voting

percentage remains low. As members,

we entrust this body with defining our

practice; it is reasonable that we would

trust them to elect the leaders that

would lead us into the future.’’

Several delegates said they could

not support denying members the

right to vote in their national election,

but some offered ideas to encourage

voting.

‘‘Voting is a problem, but this is not

the solution,’’ said delegate Teresa

Sullivan, who suggested moving the

national election voting to the Annual

Conference and offering live, online

voting for members at home. Other



December 201220

In choosing the 2012 Anita Dorr Memorial

Lecture speaker, ENA President Gail Lenehan,

EdD, MSN, RN, FAEN, FAAN, wanted ‘‘someone

with the same vision, passion and commitment

as the leaders and extraordinary talent I see

throughout this room — someone who can

speak on prevalent issues that we face in our

health care settings on a daily basis.’’

ANA President Karen Daley, PhD, MPH, RN,

FAAN, more than fit the bill. With 26 years of

emergency nursing experience and as a vocal

advocate for legislation mandating the use of

safer needles in the health care setting, Daley

has demonstrated unwavering resolve toward

improving occupational safety health.

Daley shared her riveting story of suffering a

1988 needlestick injury following a blood draw

on a patient in the ED. Recalling that she was

able to get the patient’s blood on the first draw,

Daley said she deposited the used needle in the

box on the wall behind her.

‘‘I felt a sharp stick in my index finger, and I

knew right away that it was a pretty deep

puncture,’’ she said. ‘‘The blood came out of the

side of the glove.’’

Three months later, after suffering vague

symptoms of nausea, weight loss and abdominal

pains, Daley received life-changing news: She

tested positive for both HIV and hepatitis C.

Daley recalled that with the shock fresh in

her mind, ‘‘All I could think about was that I

was never going back to the ED again.’’

During her recovery, while under the care of

an infectious disease specialist at Massachusetts

General Hospital, Daley worked with her state

nurses association to propose legislation

requiring hospitals to report every workplace

injury. The bill passed into law within the year

and remains one of the strongest workplace

injury reporting laws in the country, she said.

Daley then turned her attention to the

national level because ‘‘I knew what had

happened to me was happening at EDs all

around the country,’’ she said. When she

received the opportunity to address the ANA

constituency, Daley said it illustrated for her the

collective power of a national organization.

‘‘I said, ‘I’ll go anywhere, anytime to address

nurses on this issue, because we have safety

devices and only 15 percent of hospitals are

using them.’ ”

After years of advocacy work, Daley was

invited to the White House to witness President

Bill Clinton sign the Needlestick Safety and

Prevention Act in November 2000.

‘‘I wish that 12 years later I could say this

was a past issue, but the work continues,’’

Daley said, urging emergency nurses to follow

through with reporting all sharps injuries, as

data collection is necessary to benchmark

progress. ‘‘We know the injuries are still

occurring, and we still know that under-

reporting is a huge issue,’’ she said.

‘‘We as nurses should never underestimate

our individual power as a constituent or the

power of a collective voice,’’ she said, adding

that nurses need to add their voices to the

political process to remain engaged and

empowered. ‘‘Our strength is in our numbers,

expertise and credibility.

‘‘Thank you again for the opportunity to

speak to you about an issue that affects all of us

in our practice.’’

The 2012 Judith C. Kelleher Award Goes to ...

The Road to Sharps Injury Prevention

Every year during ENA’s Annual Conference, the

Judith C. Kelleher Award is given to a member

who has consistently demonstrated excellence in

emergency nursing and has made significant

contributions to the profession that are destined

to impact the future of emergency nursing. ENA

President Gail Lenehan, EdD, MSN, RN, FAEN,

FAAN, proudly presented this award to Diane

Gurney, MS, RN, CEN, FAEN, during this year’s

Anita Dorr Memorial Lecture and Luncheon.

Lenehan shared Gurney’s many

accomplishments and contributions to the

emergency nursing profession on a state and

national level, as well as the common themes of

inspiration and admiration found throughout her

nomination letters.

‘‘I personally witnessed Diane’s hard work and

dedication, and the excellence in the results of

that hard work. Others have as well,’’ Lenehan

stated. ‘‘Diane is exactly who the Kelleher Award

was meant to honor and is truly deserving.’’

Gurney cheerfully accepted her award, stating

that she felt honored as the 33rd award recipient.

She shared the overwhelming feeling she

experienced when she received the phone call

that she was the 2012 winner — which happened

at the ENA headquarters office while she was

sitting next to the Anita Dorr crash cart.

Gurney’s work for ENA not only has inspired

others — it also has inspired her.

‘‘During some difficult hours and days, my

work with ENA kept me focused and moving

forward,’’ she said. ‘‘I’m humbled to be accepting

such a prestigious award. Thanks to all who have

shared my journey.’’


ANITA DORR MEMORIAL LECTURE

Diane Gurney, MS, RN, CEN, FAEN, (right) with 2012 President Gail Lenehan, EdD, MSN, RN, FAEN, FAAN.

Karen Daley, PhD, MPH, RN, FAAN, president of the American Nurses Association, with Susan M. Hohenhaus, LPD, RN, CEN, FAEN, at the Anita Dorr Memorial Lecture and Luncheon.



What Lisa Wolf saw in San Diego

convinced her: The research bug is

spreading among ENA nurses.

Wolf, PhD, RN, CEN, FAEN, is director

of the Institute for Emergency Nursing

Research, which hosted its third ‘‘IENR

Research Lounge’’ on Sept. 15 at Annual

Conference — a place for novices and

experienced researchers to get guidance

from members of the IENR Advisory

Council and other doctorally prepared

nurses. More than 40 nurses shared ideas

with the 12 consultants during the

three-hour Lounge. And while a few were

simply curious about research in general,

Wolf said, most already had topics and came looking to form their plans.

‘‘Of course, this is observational data and must be confirmed with

further work, but they were pretty clear on what they were looking for,’’

said Wolf, who advised three or four visitors on their research paths. ‘‘I

think the level of interest is growing. We’re bringing research forward as a

real, viable tool or method to help people

solve their clinical problems. I think people

are beginning to say, basically, ‘I need to

go and find out the answer for myself.’

Rather than say, ‘I can’t find anything

anywhere,’ they see that now as more of

an opportunity than a barrier.’’

Beyond the walls of the Lounge, the

spirit of research was thick. IENR got high

participation for a focus-group study on

critical access in rural heath, which shed

new light on the problems that come with

limited resources and geographic isolation.

Research and poster presentations during

the conference were well-attended.

Wolf, who explained IENR’s role during

General Assembly and later led

educational sessions, said she found herself stopped repeatedly in the

halls by emergency nurses who wanted IENR to look into specific issues

affecting their practices. They offered to help in any way they could.

‘‘The atmosphere in general,’’ Wolf said, ‘‘has just gotten a lot more

research-friendly.’’

Presession: Advanced Wound Repair

Research Lounge the Place for Nurses Who Want Answers

Attendees of this presession Sept. 12 were

able to refresh their wound closure

techniques, as well as learn complex

wound repair procedures. Designed for

the experienced advance practice nurse,

the class included a brief informative

lecture on problematic wounds

encountered in the urgent and acute care

setting, followed by a hands-on skills

session in which the lecturers, Andrew

Galvin, ACNP-BC, CEN, and Nancy

Denke, MSN, FNP-BC, ACNP-BC, CEN,

CCRN, FAEN, used a bovine model to

demonstrate wound repair techniques.

Attendees had an opportunity to practice

the suturing techniques (such as running

subcuticular sutures and deep/buried

sutures), as well as vermilion border closures. Galvin also talked about

complex lip lacerations, ear lacerations and parallel lacerations.

Because of the intimate group setting, attendees were able to ask

questions and receive one-on-one help and feedback while practicing the

techniques, an aspect of the session that attendee Mary Pat, MSN, FNP,

CEN, found helpful.

Pat enjoyed when Galvin ‘‘specifically described and demonstrated

exactly how to do the suture and the scenarios where you would use that

suture technique.’’

Lizzie Dyer, BS, RN, CEN, of London, England, found that the session’s

informality and Galvin’s straightforward style made the lecture easy to

understand. The information she learned in the presession will be useful

when she returns home.

‘‘I’m an independent A&E nurse, so I

travel around the south of England to a

lot of hospitals,’’ she said. ‘‘I can take this

knowledge with me — it means I’m

more employable as an agency nurse.

I’ve learned loads today.’’

Attendee Matthew Rist, BSN, RN, tried

to get into the Basic Wound Repair

presession but switched to the Advanced

Wound Repair presession when the basic

session was filled to capacity.

‘‘The instructor seemed pretty

knowledgeable on different scenarios we

would run into and the best way to deal

with it,’’ he said. ‘‘He knows his stuff

really well. This was my first time taking

a session at conference like this. I got a lot out of it. I would definitely

recommend it to someone else.’’

Sandra Estes, MSN, RN, CEN, from New York, said the session provided

useful information and motivated her to advance her skills to a new level.

‘‘The instructor was great,’’ Estes said. ‘‘I learned new techniques. I

always practice simple interrupted suturing, but now I can try the running

suture, so I’ve learned a few steps prior to what I already knew. I knew

about the techniques done today, but I’ve never really practiced them.

Now I have a chance and a better grasp of it, so I will definitely put it into

practice. I’ve worked in the ER for 10 years, but I’ve never stepped out of

my comfort zone with suturing. Now I can definitely step out of my

comfort zone.”


Andrew Galvin, ACNP-BC, FAANP, instructs a presession participant on a suturing technique.

Lisa Wolf, PhD, RN, CEN, FAEN (standing, left) chats in the IENR Lounge with 2012 President Gail Lenehan (center) and board member Michael Moon, MSN, RN, CNS-CC, CEN, FAEN (seated).


December 201222

ENA Presents the First Advanced Practice Cadaver Lab

For the first time at the ENA Annual Conference,

advanced practice registered nurses had the

opportunity to register for the Advanced

Practice Cadaver Lab. Through the expertise of

ENA faculty members Robert A. Leach, MSN,

RN; Kathleen M. Flarity, PhD, ARNP, CEN,

CFRN, FAEN; and Arlo F. Weltge, MD, MPH,

FACEP, along with the support offered by

Vidacare, an ENA Strategic Sponsor, attendees

were able to participate in this exciting new

opportunity and receive CEs.

The two sold-out sessions gave participants

a chance to improve practitioner skills using

unembalmed cadavers to simulate the anatomy

and feel of an actual patient. Attendees learned

advanced emergency procedural skills through

hands-on labs in a small group setting, which

allowed one-on-one interaction with the

instructors. Some of the procedures covered in

the three skills stations included intraosseous

catheter placements, venous cutdowns, tube

thoracostomy, lateral canthotomy, advanced

airway insertion and central venous access.

Although Darryl Sol, MSN, CNS, FNP-C, has

attended several ENA conferences over the

years, he began attending more emergency

medicine conferences instead to refresh his

advanced nursing skills. He said the opportunity

to participate in an advanced cadaver lab this

year attracted him back to the ENA Annual

Conference.

‘‘The advanced cadaver lab was a great

opportunity,’’ Sol said. ‘‘It’s one of those things

where you’re proud of the organization and you

want to participate, but sometimes those

advanced skills aren’t there, so this was a great

thing. The course itself was great. The instructors

were very knowledgeable and helped us one-on-

one even though we were in a group. They were

willing to take us to the side and help us. All the

skills that we learned were important, and we

don’t often use them a lot, so I was happy to

revisit them. It was a great review.’’



IENR Presents 2012 Poster AwardsThe Institute for Emergency Nursing

Research presented the 2012

Research and Evidence-Based

Practice Poster Awards on Sept. 14

at the ENA Annual Conference in

San Diego. Recipients were chosen

from 44 Evidence-Based Practice

topics and 10 research topics.

Evidence-based Practice Poster Award WinnerNancy Homan, MSN, MBA, RN,

APRN-BC, an advanced practice

nurse for Emergency Services,

Christiana Care Health System in

Newark, Del., received the

Evidence-Based Practice Poster

Award for “We All Fall Down, But

for Very Different Reasons.”

“We had a serious fall with

injury,” Homan said, “and I was part

of the root cause analysis. Then, I

was assigned falls for the whole

unit. It was just something that fell

into my lap.”

Homan’s experience with her

hospital’s falls committee led to a

year-long study of all the factors

surrounding falls in her ED,

including age, shift and sight, as

well as possible causes such as

mobility, reason, cognition and

intoxication. She also began

including the story that accompa-

nied each report of an ED fall, to

give her a more complete picture.

As a result, her ED added a falls

icon to its ED tracker, which she

said was a helpful way to communi-

cate patient information. Her ED

also added its own scale, based on

red, yellow and green stoplight

colors, as a quick visual method for

categorizing patients regarding their

potential for sustaining a falls injury.

Homan’s goal of sharing her data

with emergency nursing colleagues

was amplified by the fact that there

is little data available on ED falls.

“I only found one article related

to emergency department falls.” she

said. “When I got to the conference,

people were very excited because

there just isn’t much out there on

falls.”

Homan was so surprised to

receive the award for the best

Evidence-Based Practice Poster that

she did not even

realize she won,

even after seeing

the blue ribbon

tacked to her

poster.

“It was a really

neat experience,”

she said. “This

was my first

national ENA

conference. It was great to meet

with people who have a like

mind-set and see people from

different parts of the country, and

also to see that my hospital is pretty

progressive. You don’t appreciate

that until you look at other

hospitals.”

Homan appreciated the positive

feedback her poster received from

attendees, including several who

asked her to send them the infor-

mation. She was also contacted by

the author of the only other article

she found on the topic of falls in

the ED.

Homan is already working on

another project to submit for the

2013 ENA Annual Conference in

Nashville, Tenn.

Research Poster AwardThe Research Poster award went to

Elizabeth T. Dugan, PhD, RN, chief

nurse executive of Inova Loudon

Hospital in Leesburg, Va., who

presented “The Relationship

Between Quality of Care in the

Emergency Department and

Timeliness of Intervention for

Patients with Severe Sepsis.”

Dugan’s poster, based on her

doctoral dissertation study,

focused specifically on “how the

timeliness of care impacted

outcomes – such as length of stay

and mortality – but also how the

volume of the ED at the time

impacted the timeliness of care for

the septic patient.”

Dugan’s study included all five

hospitals within the Inova Health

System and was sparked by the

system’s initiative to reduce

mortality in specific categories,

including sepsis. She collected data

for 14 months and was surprised by

the results.

“I really thought that I would

find that crowding increased length

of stay, increased mortality,” she

said. “I did not find that. What I

found – and it was an unexpected

finding – was that what really

impacted timeliness of care, more

than crowding, was the identifica-

tion of sepsis in triage.”

“We implemented several years

ago, as well as many other

hospitals, a sepsis screening process

in triage,” Dugan said. “What I

found was, if the sepsis screening

triage process works, and the nurse

identifies the patient positive for

sepsis or potentially for severe

sepsis, they will alert the doctor and

get things rolling according to the

interventions that have been

identified.”

Dugan said she also found that a

delay in triage in recognition of

sepsis caused a delay in treatment.

“I found that only a third of the

patients were accurately identified

with a positive sepsis screen in

triage,” she said. “So we are really

missing a lot of people.”

Dugan said she felt honored and

surprised to receive the poster

award and enjoyed the opportunity

to present to ENA members.

“You know, you do a lot of

work, and then you put it on a shelf

in a dissertation book,” she said.

“So I really appreciated being able

to share my findings at the confer-

ence via the poster, and really had

a great time engaging with the

attendees. Everyone that came out

was having the same concerns and

issues, and they were really

engaged around the screening

process.

“This was probably the best

poster session I have seen, and I go

to a lot of different conferences.”

IENR Thanks 2012 Poster JudgesThe IENR gratefully acknowledges the

following individuals for serving as

poster judges for the 2012 ENA Poster

Awards Program:

James Bockeloh, DNP, RN, APRN-BC,

FNP-BC; Darlene Bradley, PhD, MSN,

RN, CEN, CCRN, FAEN; Laura Criddle,

PhD, RN, CEN, CPEN, CFRN, ACNP-BC,

CCNS, CCRN, FAEN; Renee Holleran,

PhD, APRN, FNP, CEN, CFRN, CCRN,

FAEN; Mary Kamienski, PhD, APRN,

CEN, FAEN; Elyse Kemmerer, PhD; Anne

Manton, PhD, RN, APRN, FAEN, FAAN;

Diana Meyer, DNP, RN, CEN, CCRN,

FAEN; Elizabeth Mizerek, MSN, RN,

EMT-B, CEN, CPEN; Patricia Normandin,

DNP, MSN, RN, CEN, CPEN; Andrea

Novak, PhD, RN-BC, FAEN; Ryan

Oglesby, PhD, MHA, RN, CEN, NEA-BC;

Diane Salentiny-Wrobleski, PhD, RN,

APRN, CEN, ACNS-BC, CCNS; Mary

Sigler, EdD, RN, CRNP; Audrey Snyder,

PhD, RN, ACNP-BC, CEN, CCRN, FAEN,

FAANP; Dawn Specht, PhD, MSN, RN,

CNS, CEN, CCNS, CCRN; Stephen

Stapleton, PhD, MSN, MS, BSN, BS, RN,

CEN; Debbie A. Travers, PhD, RN, CEN,

FAEN; Jeanne Venella, DNP, MS, RN,

CEN, CPEN; and Sarah Wilkey, DNP,

FNP, RN.


Nancy Homan, MSN, MBA, RN, APRN-BC

Elizabeth T. Dugan, PhD, RN

December 201224

National ENA Awards

President’s Award— 2012 ENA President Gail Lenehan, EdD, MSN, RN, FAEN,

FAAN, is pictured with her husband, Joseph M. Lenehan, MD, recipient of the

President’s Award, and their daughter, Kate Lenehan.

Nursing Professionalism Award — Anne Stefanoski, BSN, RN, CEN

Frank L. Cole Nurse Practitioner Award— Kathy J. Morris, DNP, APRN, FNP-C, FAANP

Behind the Scenes Award — Robert Breese, CCEMTP, FP-C

Nurse Manager Award— Leslie A. Christiansen, BS, RN, CEN

Rising Star Award — Kristen Connor, BSN, RN, PHN, CEN

Nursing Practice Award— Judith Common, RN, CEN, CPEN, CA/CP SANE, SANE-A, SANE-P

Nursing Research Award — Michelle A. Marini, MSN, RN, CPNP, CPEN, and Amy W. Truog, BSN, RN, CPEN

Nursing Education Award — Timothy J. Murphy, MSN, RN, ACNP - BC, CEN

Team Award — Mid Maryland Chapter, Annual Barbara Proctor Memorial Educational Day Team Members: Sandra M. Waak, RN, CEN; Linda Arapian, MSN, RN, CEN, CPEN, EMT-B; Lisa Tenney, BSN, RN, CEN, CPHRM; Anne May, BSN, RN. Not pictured: Emilie Crown, BA, RN, CEN; Pamela S. Fox, BSN, RN, CEN, CPEN; and Lucy McDonald, RN, CPEN, CPN, EMT-B.

Lifetime Achievement Award— Sharon McGonigal, RN, CEN

Not pictured:

Gail P. Lenehan Advocacy Award — Joyce Foresman-Capuzzi, MSN, RN, CCNS, CEN, CPN, CTRN, CCRN, CPEN, SANE-A, EMT-P

Nursing Competence in Aging Award — Donna M. Roe, DNP, ARNP-BC, CEN

ENA Foundation State Challenge Awards — Left: Mike Hastings, MS, RN, CEN, president of Kansas ENA State Council, which raised highest amount per capita. Right: Pat Nierstedt, MS, RN, CEN, president of New Jersey ENA State Council, which raised the highest total.


Lantern Awards

Advocate Good Shepherd Hospital Emergency Department — Barrington, Ill.

Boston Children’s Hospital Emergency Department — Boston

Indiana University Health Methodist Hospital Emergency Medicine and Trauma Center — Indianapolis

Beaumont Health System – Grosse Pointe Emergency Center — Grosse Pointe, Mich.

Cedars Sinai Medical Center, Ruth and Harry Roman Emergency Department — Los Angeles

Chandler Regional Medical Center Emergency Department — Chandler, Ariz.

Children’s Medical Center Dallas, Seay Emergency Center — Dallas

Cincinnati Children’s Hospital Emergency Department – Burnet Campus — Cincinnati

ENA Celebrates the ‘Best In Class’ at GalaMore than 300 people walked down

the red carpet in their finest attire

for ENA’s first annual Awards Gala

on Sept. 15. The evening started

with a reception with hors

d’oeuvres, followed by pictures

taken by ENA’s ‘‘paparazzi,’’ red

carpet interviews by the master of

ceremonies, Terry Foster, MSN, RN,

CEN, CCRN, FAEN, and a delicious

dinner.

It was a proud night for many in

the ballroom. The special evening

honored individuals for their

accomplishments over the last year.

The awards program included

commemorating ENA Individual

Award winners, Lantern Award

recipients, Academy of Emergency

Nursing inductees and the ENA

Foundation State Challenge Award

winners.

ENA President Gail Lenehan,

EdD, MSN, RN, FAEN, FAAN, hosted

the event with Foster and presented

the awards. Foster’s humor and

jokes provided comedy for the

evening and kept the audience

entertained and amused.

‘‘Madame President, with all due

respect, I did not see an award for

Best in Humor!’’ Foster told

Lenehan. ‘‘But seriously, heartfelt

congratulations to all of you . . .

especially those who were induced,

I mean inducted into the Academy.’’

As the event ended, Lenehan and

Foster expressed their appreciation

to the attendees and

congratulated them for their

achievements and successes.

‘‘We’ve come to the close of the

best event of the whole week, and

the best group to share it with.

Thank you all for being part of

ENA’s First Annual Gala!’’ Lenehan

said. ‘‘We are so much better for

knowing you all, and emergency

nursing is so much better for your

accomplishments.’’

Kendra Y. Mims

December 201226

2012 ENA President Gail Lenehan, EdD, MSN,

RN, FAEN, FAAN, welcomed attendees to the

Annual Conference after the Drum Café

performance, announcing exciting initiatives and

highlights from throughout the year.

Among them were ENA’s improvement of

access to information through new technology,

the advancement of emergency nursing globally

(TNCC is being taught in 13 countries) and ENA’s

advancement of the future of emergency nursing

through 34 committees, education and an

investment in staff (ENA now has nine highly

qualified nurses on staff).

Lenehan also was excited to announce that

ENA is offering free CEs for members and

moving to one national conference in 2015.

Lenehan shared that right before she took the

stage, ENA Executive Director Susan M.

Hohenhaus, LPD, RN, CEN, FAEN, told her that

ENA had been awarded the 2012 Susan Harwood

Training grant from the Occupational Health and

Safety Administration, which provides funds to

develop workplace violence training materials.

‘‘We have the blueprint to move our

organization from great to greatest,’’ she said. ‘‘I

know that we have the right professionals with

the right talents to accomplish this together and

we will continue to develop and enhance

strategic partnerships.’’

After acknowledging ENA’s partnerships with

organizations such as The Joint Commission, the

American Nurses Association and the American

College of Emergency Physicians, Lenehan also

acknowledged all of the delegates who

convened for the two-day General Assembly.

‘‘These are [nearly] 700 of our most engaged

emergency nurses, and you would have been so

proud of their thoughtful, very informed and

very intelligent debate on our resolutions and

bylaws,’’ she said. ‘‘We came up with some very

good decisions which will move our specialty

profession forward.’’

Lenehan presented the President’s Award to

the individual who gave her inspiration and

unconditional support throughout the year.

‘‘This award goes to my husband, Dr. Joe

Lenehan, and to all of the other spouses,

partners and significant others for whom ENA

stands for ‘Every Night Alone,’ ’’ Lenehan said.

She closed her speech by urging the audience

to make the most of the conference.

‘‘Thank you for coming, thank you for being

an important part of this conference and thank

you to those who are members,’’ she said. ‘‘You

make this conference and all that ENA does

possible.’’

‘We Have the Blueprint to Move Our Organization From Great to Greatest’By Kendra Y. Mims, ENA Connection

OPENING SESSION

Proof That We’re All Beating the Same Drum

The hall exploded with the sound

of hundreds of drums and

boomwhackers Sept. 13 as

conference attendees participated in

the Opening Session’s highly

acclaimed entertainment, the Drum

Café, the global leader in interactive

drumming.

After ENA’s Executive Director

Sue Hohenhaus, LPD, RN, CEN,

FAEN, welcomed attendees to the

conference, Drum Café took the

stage and began its world-

renowned performance, which

provided a fun atmosphere and

engaged the audience in team-

building through music. Every seat

in the room was equipped with a

drum or boomwhacker, which

emergency nurses used to create

music with Drum Café for the first

hour of the session.

Natalie Spiro, leader of Drum

Café, discussed the importance of

using music as a universal language.

‘‘What you just experienced right

now was harmonizing as one ENA

to this universal language of rhythm

and drumming,’’ she said. ‘‘This is a

language that transcends all barriers

and boundaries across geography,

across job function to effective

communication, collaboration and

teamwork. For every single person

in this room, it’s all about refresh,

revitalize and invigorate.’’

Before beginning the

performance, audience members

raised their hands and recited: ‘‘We

have compassion and respect, we

work to improve public health, we

exercise sound judgment, and

we’ve got rhythm. We are

drummers.’’ Chants of, ‘‘We are ENA

and we’re No. 1; yes, we are ENA

and we rock,’’ filled the room as the

audience followed Drum Café’s lead

to play the ‘‘heartbeat, pulse and

infrastructure of ENA’’ in the center

of their drums.

Drum Café integrated ENA’s

tagline and vision into the team-

building event, along with the

conference’s theme. As the

audience chanted ‘‘refresh,

revitalize, invigorate,’’ some were

pulled out of their seats to join

Drum Café in the front of the room.

‘‘I’m amazed at what you do

every day,’’ Spiro said. ‘‘Some of you

are seeing over 300 patients a day.

You are so special, so valued and so

critical to providing the care for the

people in your community.’’


Natalie Spiro, who leads the Drum Café, moves up the aisle during Opening Session as conference attendees follow along.


Refreshing Message From Wine to Water FounderClosing out the 2012 Annual Conference with

keynote speaker Doc Hendley was a refreshing

way to conclude the fun-filled and exciting week

of learning, growing and reconnecting in San

Diego.

Like every attendee in the audience, Hendly

also has experience in making a difference and

changing lives. The Harley-riding bartender

created Wine to Water, a non-profit organization

that has provided tens of thousands of people

around the world with clean drinking water. He

opened up his talk with a brief video that

showed work he has done in Haiti and other

areas, such as digging wells.

Hendley’s intense, emotional stories of taking

personal risks in places such as Darfur to provide

people with clean water highlighted the power of

having courage even in the most dangerous

situations. His down-to-earth and humble attitude

and his evident passion for helping those who are

less fortunate captivated and invigorated the

audience. He also shared the concepts of building

relationships that he learned while bartending and

the importance of focusing on people.

‘‘It doesn’t matter how passionate you are

about what you’re doing or what reasons you

got into something at the beginning — there’s

going to come those days when you just don’t

want to get out of bed,’’ he said. ‘‘There’s going

to come those days when you say, ‘I didn’t sign

up for this.’ But it’s at those times when it’s so

vital to surround ourselves with people who

believe in us more than we believe in ourselves.

That was a huge lesson for me to learn.’’

Hendley pointed out the usual questions that

people ask themselves when they look into a

mirror: What have I done? What can I do? Who

am I?

‘‘You have a unique ability with what you do

every single day to change the world around you

through people, through relationships, through

the lives that you touch every day,’’ he told the

audience. ‘‘I want to encourage you. When you

get back, don’t look at all the stuff in the past.

Start with today. Start with tomorrow. And use

the resources that you have to make a huge

impact on your community and your world.’’

Attendee Cindy Lefton, PhD, RN, from

Missouri, described the closing speaker in three

words: dynamic, humble and passionate.

Although Hendley is not an emergency nurse,

Lefton felt the audience could definitely relate to

his message.

‘‘He talked about helping people when times

are really difficult and resources are difficult,’’ she

said. ‘‘It’s all about digging deeper in yourself to

find that skill set and energy to face whatever

adversity is before you.’’


CLOSING SESSION

Closing Session speaker Doc Hendley, founder of Wine to Water, encourages emergency nurses to use their resources and look only to the future.

December 201228

Creating a Bigger Boom By Kendra Y. Mims, ENA Connection

Laura Giles, BS, RN, 2012 ENA Foundation chairperson, asked audience members to sound

their instruments if they either made a contribution or were the recipient of an ENA

Foundation scholarship or research grant. The sounds of drums and boomwhackers, used

during the Opening Session Drum Café presentation, could be heard throughout the room.

‘‘Wow, I am impressed,’’ Giles said. ‘‘But I must say, wouldn’t it be fantastic if we could

make even more noise? I would love to hear this room explode with the sound of every

drum. And I’m confident that we have the ability to create a bigger boom.’’

Attendees continued banging their drums in excitement as Giles shared how the

generous contributions and the dedication of donors have helped the ENA Foundation

achieve many accomplishments in 2012, including providing 20 Annual Conference

scholarships, 47 academic scholarships and five research grants to members. Giles also

discussed the success of the 2012 State Challenge.

‘‘We reached our goal and raised over $116,000,’’ she said. ‘‘One hundred percent of these

funds will go toward supporting scholarship applications and research grants in 2013.

Because we raised more money this year, we will have more to give back to you next year.’’

Giles ended her speech by sounding her drum for the members, the ENA Foundation

Board of Trustees and Management Board and everyone else who contributed to making

2012 a successful year.

‘‘It all adds up,’’ she said. ‘‘Your donation — large or small — makes a difference in the

number of scholarships and research grants we can fund. Please consider making the ENA

Foundation one of your charities of choice today and in the future.’’

ENA FOUNDATION

SPARKLE AND SHINE: Attendees fill out bids for jewelry items during the ENA Foundation Jewelry Auction held at Annual Conference in San Diego. States, chapters and individuals donated 171 pieces of jewelry, which raised more than $20,500 for the ENA Foundation to be used toward grants and scholarships for emergency nurses.

TAKE ME OUT TO THE

BALLGAMEIt was root, root, root for the ENA Foundation on Friday night, Sept. 14, at Petco Park, where more

than 740 emergency nurses joined the ENA Foundation in watching the San Diego Padres

host the Colorado Rockies.


Tales from the ED: Creating Your Happily Ever AfterAttendees of the ‘‘Plot or Character?’’ session

learned how to identify and solve clinical

problems by using storytelling to determine if

the problems derive from a character-driven or

plot-driven story.

‘‘Storytelling is a valuable source of

information. It can highlight processes or

players that are problematic,’’ said Lisa Wolf,

PhD, RN, CEN, FAEN, director of the ENA

Institute for Emergency Nursing Research.

“Storytelling is powerful. It helps us connect

and recognize each other as one of us. It helps

us to vent and helps relieve stress.’’

When using stories to identify problems,

Wolf said, the first step is recognizing whether

you are dealing with a process or character

problem.

‘‘Read the story — the chart — to find the

villain,’’ she told the audience.

A character or villain could include anyone

from personnel, septic patients or heroic nurses

to colleagues, visitors, unaware nurses or

inattentive doctors. On the other hand, plot-

driven problems can stem from the environment

of care, terrible dialogue, procedures, props, the

setting or individual and environmental factors.

What are some solutions for these stories?

Wolf recommended fixing processes (such as

hand-offs) for plot-driven stories or educating,

disciplining or removing the villains in character

stories.

She encouraged the audience to write down

critical elements of their stories and compare

them with others to discover similarities in

characters, plots, villains and settings. She also

reminded attendees to remember the ‘‘moments

of grace’’ stories, which include good processes,

good staffing and good knowledge, and to

recognize the heroes in these stories.

‘‘These are equally important stories to

analyze because they tell you things that are

going well,’’ Wolf said.

Kendra Y. Mims

You Stuck What Where?Have you ever come across a patient who had a

flying insect in his ear or had to treat a child

with a bead lodged in her nose?

‘‘You Stuck What Where? Chatting About

Foreign Objects,’’ a fast-track session, was

packed with audience members interested in

exploring the recognition and treatment of

patients presenting with foreign bodies. Jeff

Solheim, MSN, RN-BC, CEN, CFRN, showed

vivid pictures of patients who experienced

foreign bodies in their nose, ears, eyes and GI

tracts. Solheim discussed how to detect

the symptoms of foreign objects in these

areas, as well as upper-airway

obstruction for children and adults.

Attendees received a brief overview

on the removal of foreign bodies, as

well on as the removal of insects from

the external ear. The session also

included esophageal vs. tracheal

obstruction x-rays and how to identify

the differences between the two, and a

brief discussion on the complications of

GU and rectal insertions and symptoms

of toxic shock syndrome.

Attendee Erin Scarlett, BS, RN, CEN, said

Solheim kept the session interesting by covering

a number of different areas as well as treatment

options. Attendees left the session knowing

some of the symptoms of foreign bodies and

how to remove them.

Kendra Y. Mims

Emergency Nurses Play ‘Jeopardy’ From naming famous fictional doctors on

television to identifying medication that has

resulted in more deaths than illegal drugs,

attendees of the ‘‘Emergency Nursing Jeopardy’’

session had a chance to learn about emergency

medicine topics in a game format. Some

attendees volunteered to play on teams to earn

points, while the majority played along silently

as audience members. Active players were

drawn from the list of volunteers and split into

three teams based on work shift: the AMs, the

PMs and the Nights.

Nurses took well to the fun, interactive

session in which the teams played two rounds

that included categories of Too Fast, Too Slow,

Pretend RNs, Eponyms, Pretend MDs,

Toxicology, Math is Hard and more. As the

session’s lecturer and game host, William

Hampton, DO, MM, BA, AS, presented the

questions, players used an electronic game

system to buzz in and earn points.

Trauma was the category of the ‘‘Final

Jeopardy’’ round. The big question of the game

was, ‘‘What is the

second-most

common cause of

traumatic death in

the age group of 1

to 4 years old?’’

The Nights were

the only team to

answer correctly

(drowning);

however, all team

players walked

away with a prize.

‘‘I come to these conferences because I love

all of you dearly — I love working with nurses,

and I feel a great camaraderie here,’’ Hampton

said as he presented gifts to all of the team

players at the end of the game. The AMs

received coffee mugs, the PMs took home

inspirational notebooks with ‘‘Lost Proverbs of

the ED’’ and the Nights received Snuggies with

the ENA logo.

Christine McEachin, MBA, RN, of Michigan,

said she enjoyed how the session used a

game-style approach as a learning tool.

‘‘I like that it was a light-hearted approach

to a serious topic of what we do in emergency

nursing,’’ she said. ‘‘I learned a ton of stuff

— for example, the antidote for calcium

channel blocker. I do mostly trauma now, so for

Concurrent Sessions


The Nights wearing their Snuggies qfter “Emergency Nursing Jeopardy.”

me that was great because I didn’t know that.

There were some things we did definitely

know, but then other things we learned, like

the rhythms, because he picked rhythms that

are not as common of presentation, and it was

good to realize they don’t all look the same.’’

Kendra Y. Mims

‘The No. 1 Suicide Magnet’In ‘‘A View From the Golden Gate Bridge: A

Forensic Look at Suicide,’’ speaker Cheryl

Randolph, MSN, RN, CEN, CPEN, CCRN,

FNP-BC, opened with scenes from ‘‘The

Bridge,’’ a 2006 documentary by Eric Steel

which included one year’s worth of filming at

the iconic bridge, focusing on the suicides and

attempted suicides.

‘‘The Golden Gate Bridge is what we call a

suicide magnet,’’ Randolph said, ‘‘meaning that

it’s a specific geographic area that tends to draw

those individuals who are contemplating or

want to kill themselves. It indeed is the No. 1

suicide magnet on planet Earth.’’

Randolph pointed out that in the medical

literature, the term ‘‘commit suicide’’ is not used.

‘‘One either attempts suicide, or they

complete suicide, meaning that they did die,’’

she said. Patients also may make a suicide

gesture, which has low lethality and is often

made to seek attention.

There is no exact count, but estimates put the

number of people who have jumped off the

Golden Gate Bridge and ended their lives since

1937 at 1,500, with an average of 27 per year.

This does not include unconfirmed suicides.

The 240-foot plunge from the pedestrian area

of the bridge takes about four seconds, and

people fall at a rate of 75 miles per hour, with

an impact force of 15,000 pounds per square

inch. Randolph showed slides of some of the

types of devastating injuries suffered by people

who have jumped, including burst lacerations,

internal hemorrhage and burst evulsions.

‘‘By jumping at these great forces, injuries are

catastrophic,’’ she said. ‘‘Organs burst, bones

break, great vessels are pierced. Sometimes

there is not a lot of outward trauma on the

body, but the body will be just covered in

hematoma. The body will be black and blue.’’

In addition to the injuries, people who jump

from the bridge are also at risk of dying from a

combination of drowning and hypothermia,

Randolph said. The water near the bridge is

generally about 47 degrees, and those who

plunge in tend to go to a significant depth of at

least 100 feet.

While the California Coast Guard has two

ships standing by 24 hours a day to respond to

people who jump from the bridge and can

reach the area within five minutes, ‘‘as you

know, five minutes, with someone who has

these catastrophic injuries, more likely than not,

the damage is already done and this person has

expired,’’ Randolph said.

‘‘Initially I was disappointed that it was a

replacement session,’’ said attendee Linda Whitt,

BSN, RN, CEN, of Virginia. ‘‘But I did learn a lot

about the etiology of death from this particular

mechanism. I was enlightened, also, about the

increased likelihood of people in my profession

committing suicide — the doctors and nurses

— and that it’s the fourth-leading cause of

death. So I’m glad I stayed.’’

Amy Carpenter Aquino

Connecting with Patients and Families in Tough SituationsThis fast-track session focused on helping

families and patients work through crisis,

sudden death and end-of-life decisions and how

emergency nurses can improve their experience

during difficult times.

Presenter Suzanne O’Connor, MSN, RN, APN,

shared her experience with comforting the

parents of patients in critical condition.

Though O’Connor talked about the

importance of assuring families that their loved

one is in good hands, she also warned the

about making promises.

‘‘I would never say to someone, ‘He’s going

to be all right,’ because they will hold you to

that,’’ she said.

“When a loved one is dying in the ED,

always switch your care from intensive help

with the patient to now taking care of the

family. Focus on the family. They are the ones

who are going to remember this night. The

patient is going to die, so we need to transfer

our care over to the wife, the mother

or whoever you’re working with.’’

O’Connor also offered tips on gaining a

patient’s trust: listening to his or her perspective

before offering one; underpromising and

overdelivering (e.g., estimating wait times);

following through and being consistent as a

team; being honest; building confidence,

managing priorities and never losing hope.

‘‘Patients need to feel confident and trust us,’’

O’Connor said. ‘‘The No. 1 person is you, the

consistent relationship. You are the No. 1

consistent voice and face that they want to

connect with and the face and voice of that ER

experience. Update them often about what you

know. Information is the No. 1 need.’’

She also discussed studies showing that

patients find it comforting when nurses explain

the benefits of medications and tests, as well as

when they address them by their first name.

The session ended with a brief Q&A.

Attendees asked about approaching families to

donate organs, working with social workers and

dealing with denial about a dying loved one.

‘‘I do it slowly and in increments and through

pictures and drawings,’’ O’Connor told the

attendee who asked for advice about denial. ‘‘I

say, ‘It’s pretty serious and here’s what we are

worried about.’ Let them stay with their denial,

but talk about your concerns for their loved one.

Ease into it as slowly as you can. Use a key

family member who has the most influence.

‘‘They will never, ever forget you as an ED

nurse,’’ she told attendees. ‘‘You will always be

a valuable memory for them.’’

Kendra Y. Mims

December 201230

Concurrent Sessions

Concurrent Sessions Continued from page 29


Killer Headache‘‘I was looking at my colleague, and pieces of her started to disappear.’’

Thinking that her retinas were detaching, Mary Ann Teeter, MSEd., RN,

CEN, CNRN, FNP-C, immediately called her ophthalmalogist, who

examined her and diagnosed her with an ocular migraine.

‘‘I thought, ‘I need to find out more about this,’ ” said Teeter, an

emergency nurse since 1976, who presented this fast-track session with a

focus on how migraine is related to stroke.

Migraine is the result of cranial blood vessel vasodilation, and the

neurogenic inflammation exacerbates the pain, she said. She described the

two types of migraines — with aura and without aura — and the four

stages of migraine, with slide illustrations of the brain affected by migraine.

Patent foramen ovale — a hole between the left and right atria of the

heart that fails to close after birth — is the main stroke risk factor for

patients with a history of migraine, Teeter said.

‘‘We find that a lot of our younger patients — 30s, 40s, 50s — who

come in with symptoms of stroke have PFO,’’ she said.

Teeter showed a slide of a CT scan of brain showing hydopense areas

in the right occipital lobe consistent with a recent posterior cerebral artery

ischemic infarct. She pointed out the dying and dead brain tissue of the

infarct.

She shared common triggers for migraine as well as management

medications and techniques.

‘‘There are apps out there for migraine management,’’ Teeter

said. ‘‘You can be mobile and manage that as well.’’

“I thought it was really good,” attendee Deborah Skeen, BSN,

RN, CEN, of Colorado, said of the session. ‘‘I never realized there

was a connection between migraine and stroke. It was helpful

for me to learn that it’s the patients who have auras that are

especially the ones to look out for. … I thought it was good to

point out the symptoms that could come across for an ocular

stroke or a hemiplegic migraine or a real stroke; it helps you

keep the good differentials in your mind when people come in

with those symptoms.’’


The Most Bizarre and Unusual Trauma Case Studies in Emergency Medicine 2012 Nearly every seat was filled for this concurrent session jam-

packed with information on how to treat the most difficult

trauma cases, culminating with a review of the care of victims

from the 9/11 terrorist attack on the Pentagon.

Allen C. Wolfe, MSN, RN, CFRN, CCRN, CMTE, focused on

airway management — which he called ‘‘the defining skill in

emergency medicine’’ — in many of the case studies he presented.

In the case of a 24-year-old male who blew off his face with a

shotgun, Allen described the difficulty of intubating a patient

with no facial structure. During the treatment, a nurse suggested

intubating the patient from the front, and Allen showed the

actual video made of the inverse intubation of a gunshot wound

to the face. He also showed slides of CT scans taken following

several hours of surgery, showing the reconstruction of the

patient’s jaw from his fibia.

Allen also presented the case of a male construction worker

who was brought into the ED after surviving a plaster explosion.

Photos showed the man’s face completely covered by a white

plaster used for bridge construction. Concerned about the

patient’s airway, Allen described how he and another nurse pulled enough

of the hardened plaster away to intubate him. Allen then called the

hospital’s burn unit for advice on how to approach removing the rest of

the hardened plaster, and was told to apply mayonnaise. He ran down to

the cafeteria, got a tub of mayo, ‘‘and believe it or not, we put it on and

the plaster came right off his face,’’ Allen said.

Allen concluded his lecture with a review of the treatment of nine victims

from the 9/11 attack on the Pentagon, from the initial call to Washington

Hospital Center to patient resuscitation in the ED and their outcomes.

‘‘There was not one broken bone, not one brain injury — only burns,’’

Allen said. All the patients suffered severe damage to their hands from

using them to find their way out of the building.

While the physical and emotional toll on emergency staff caring for

those patients on that day cannot be overstated, ‘‘the rewards are

immense,’’ he said.


Whatcha Lookin’ At, Doc?There is never one right answer, only a better answer, when deciding

which test to run on a patient who presents to the emergency department

with unexplained pain or illness. In this session, William A. Gluckman,

S e p t e m b e r 1 1 - 1 5 • S a n D i e g o

2 0 1 2 A n n u a l C o n f e r e n c e

RefreshRevitalizeInvigorate

Concurrent Sessions


Hundreds of Annual Conference attendees filled

the room for the Sept. 15 town hall meeting in San

Diego. Members brought several questions and

comments to the ENA Board of Directors on topics

ranging from the Government Affairs Committee

annual workshop and recognition of ENA national

award winners to General Assembly resolutions

and access to ENA staff in the exhibit hall.

The board, led by 2012 ENA President Gail

Lenehan, EdD, MSN, RN, FAEN, FAAN, extended

the time allotted by 30 minutes to accommodate

all members who wished to express their views.

‘‘We know people have a lot on their mind, and we want to hear about

anything you want to talk about,’’ she said.

Before hearing questions, Lenehan explained that JoAnn Lazarus, MSN,

RN, CEN, 2012 president-elect, and Deena Brecher, MSN, RN, APRN,

ACNS-BC, CEN, CPEN, had met

previously with several GAC

chairpersons, who had given the board

members ‘‘quite a bit of feedback.’’

Because that discussion was held

separately, questions about the GAC

workshop would be heard at the end of

the town hall meeting.

One member asked why there was not

more recognition of the national ENA

award winners.

‘‘I will be at the Gala, but for the rest

of my colleagues who cannot make the

event tonight, they should be aware of

who the winners are,’’ she said.

In addition to recognition at the Sept. 15 Gala, all national ENA award

winners are recognized on page 24 in this issue of ENA Connection.

Member Elizabeth Whetzel, RN, asked the board about progress on her

resolution, Emergency Nursing and Forensic Nursing, which was

approved by the 2011 General Assembly.

‘‘We don’t seem to have a good process for providing

feedback on resolutions that have gone through,’’ she said.

Lenehan said ENA was working on improving the process of

reporting progress on resolutions, while board member Ellen H.

Encapera, RN, CEN, reported that the forensic nursing resolution

had inspired ENA to work with the International Association of

Forensic Nursing. ENA Executive Director Susan M. Hohenhaus,

LPD, RN, CEN, FAEN, explained that ENA began a dialogue with

IAFN halfway through the year and that the organizations were

working to share resources and expertise.

A member from Louisiana asked why ENA staff did not have a

designated spot in the Exhibit Hall at this conference, in contrast

with previous ENA conferences. Nancy Bonalumi, MS, RN, CEN,

FAEN, an ENA past president, added that she and other members

missed the opportunity for face-to-face contact with staff.

Hohenhaus explained that ENA has been scaling back on the

ENA Pavilion area of the Exhibit Hall as attendee evaluations

showed that traffic in the pavilion did not justify the amount of

staff resources dedicated to maintaining the space. A member of

the new ED Operations Work Team suggested posting times

when staff would be available to meet with members, similar to

how poster presenters are scheduled to meet with attendees. Jill

McLaughlin, BSN, RN, CEN, CPEN, suggested taking advantage

of technology, such as Web conferencing and Skype, to connect

attendees and ENA staff at the new Digital Den.

Kay Ella Bleecher, MSN, RN, CEN, FNP-C, NREMT-P, PHRN,

requested that board members share notice of when they plan

to represent ENA at other organizational conferences.

‘‘If you’re sending someone from national to our state, we

would like to meet and greet them,’’ she said.

The board heard attendees’ comments on nine different

topics and also encouraged members to send additional

questions, concerns and feedback to them via e-mail.

‘‘Know that we take your comments to heart,’’ Lenehan said.

Attendees Turn Out For Spirited Town Hall Meeting

ENA Foundation Thanks You for Your 2012 Jewelry Auction SupportThe 2012 ENA Foundation board sincerely thanks you for your support for this year’s successful jewelry auction. From necklaces to watches to duck calls, the jewelry auction was a success.

The jewelry auction received 171 donated items and raised over $20,580. Proceeds from this fundraising event will directly support the mission of the ENA Foundation to provide education scholarships and research grants in the discipline of emergency nursing.

Your support makes a difference. We look forward to the next Jewelry Auction at the 2013 ENA Annual Conference, September 19-21 in Nashville, TN.

December 201232


Conference attendees fill the room Sept. 15 for the annual town hall meeting, which shed light on a variety of topics.


delegates suggested returning to paper ballots.

‘‘Thank you, everyone, for your great

comments yesterday concerning strategies for

how to move our election forward,’’ Moretz said.

The assembly passed as amended the

resolution Care of the Bariatric/Obese

Patient, authored by Joan Somes and the

Minnesota ENA State Council. The amended

clause called for ENA to ‘‘identify currently

available literature/education related to

prevention, assessment and safe care of the

bariatric/obese patient so that these concepts

can be incorporated into the appropriate new

and revised ENA products and programs.’’

The proposed resolution, TNCC Eligibility,

authored by the Massachusetts ENA State

Council and Diane Gurney, MS, RN, CEN, FAEN,

elicited impassioned debate culminating in

approval of wording that went beyond the

original language in supporting the resolution,

to say ‘‘only RNs or international equivalents

may hold TNCC provider status.’’ The Assembly

voted down a clause which would have allowed

upper-level nursing students to ‘‘take TNCC

content and testing over the course of a college

term as an emergency nursing elective taught by

a TNCC instructor without receiving verification

status/provider card.’’

The General Assembly passed as amended

the resolution Care of the Patient With

Chronic Pain, authored by the Arizona ENA

State Council, Tiffiny Strever, BSN, RN, CEN,

and Maureen O’Reilly Creegan, MSN, RN,

CNS-C, CEN, CCRN, FAEN. This resolution

asked for a review of the current research on

the care of patients with chronic pain in the

emergency department and dissemination of the

information as appropriate.

‘‘This proposed resolution is meant to

address our knowledge deficit related to best

practice to meet the needs of the pain patient in

the ED,’’ said supporter Charlann Staab, MSN,

BSN, RN, CFRN, of Arizona. ‘‘Chronic pain

management has drastically changed over the

last 10 years. Without having that current

information validated, it’s difficult to share and

incorporate it to reach optimal care.’’

The amendment inserted words ‘‘taking into

consideration state regulatory concerns that

affect the emergency care management of

chronic pain,’’ explained Deborah Spann, ADN,

RN, CEN, of Louisiana.

Delegates approved as amended the

resolution Use of Protocols in the ED Setting,

authored by Barry Hudson, BSN, RN, CPEN, and

Cam Brandt, MS, RN, CEN, CPEN, which called

for ‘‘collaboration with other professional

groups to develop operational definitions for

protocols and their impact on emergency

nursing practice and therefore the development

of a position statement supporting the use of

protocols in the ED setting.’’

‘‘I think this is extremely timely,’’ said

Maryland delegate Mary Alice Vanhoy, MSN,

RN, CEN, CPEN, NREMT-P. ‘‘For those of you

who follow the managers listserv, there are

consistent questions about who has protocols

and how to implement them.’’

‘‘Without protocols, my practice would be

dead in the water,’’ said a delegate who

identified himself as a flight nurse. ‘‘I’d be

forced to put oxygen on people and put them

on backboards. There is no need to go back to

the 1970s in our practice.’’

The General Assembly approved as amended

Defining Wait Time for ED Services,

authored by Meghan Long, BSN, RN, CEN, and

Nicole McGarity, RN, CEN, which called for ‘‘the

development of consensus statement definition,

in collaboration with appropriate emergency

care stakeholders, for a consistent ED metric

regarding the term ‘wait time’ as used in

emergency care settings.’’

McGarity said that after discussions with ENA

Executive Director Susan M. Hohenhaus, LPD,

RN, CEN, FAEN, about using technology to

facilitate meetings, the financial implications of

the resolution would be nominal.

‘‘I really think this is important work, and I

appreciate you working on the price tag,’’ said

Marcus Godfrey, RN, president of the California

ENA State Council.

The General Assembly passed as amended

the resolution Safe Discharge From the ED,

authored by Dawn McKeown, RN, CEN, CPEN,

and Deborah Spann, ADN, RN, CEN. The

original proposal called for the ENA Institute for

Emergency Nursing Research to ‘‘investigate

options for outside grant funding for the

research needed to promote nursing

competence for discharging patients; and

publish the findings for use as resources in the

development of ED policies and procedures.’’

The amendment, suggested by IENR Director

Lisa Wolf, PhD, RN, CEN, FAEN, allows ENA to

expand the resources used in the investigation

to other ENA departments and personnel.

The General Assembly also passed the

resolutions Healthcare Worker Fatigue,

authored by the Tennessee ENA State Council,

the Utah ENA State Council and Beth Broering,

MSN, RN, CEN, CPEN, CCNS, CCRN, FAEN; and

Palliative Care, authored by Colleen Vega, RN,

CEN; Kim Sickler, MS, RN, CEN; and Garrett

Chan, PhD, RN, CNS, CEN, FAEN, as well as a

number of consent agenda items consisting of

various bylaws amendments. It rejected the

proposed bylaws amendment Resolutions

Committee Responsibility, authored by the

ENA Board of Directors, which would have let

the committee independently propose

amendments.

The deadline for 2013 proposed bylaws

amendments and resolutions is March 11.

General Assembly Debate Continued from page 19

December 201234

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

• Available December 1Service and Quality1.0 contact hour Jeff Strickler, MA, RN, CEN, CFRN

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

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

DO, MBA, FACEP, presented several different

cases to attendees, asked them which test they

would perform, then showed them what to look

for on the corresponding radiograph.

Attendees correctly guessed that a 23-year-old

female patient presenting with RLQ pain for two

days could be suffering from an ectoptic

pregnancy. After running a lab test to confirm that

the patient is pregnant, an ultrasound should be

performed, said Gluckman.

‘‘Ultrasound is the best test for evaluating

gynecological and ovarian cases,’’ he said. ‘‘CT is

better for bowel and most solid organs.’’

Gluckman showed attendees ultrasounds of a

normal-looking early pregnancy and then showed

the difference in the ultrasound of an ectopic

pregnancy, pointing out the pseudo-gestational

sac in the ectopic pregnancy.

Attendees shouted ‘‘Gallbladder!’’ when

Gluckman presented the case of a premenopausal

42-year-old female patient who weighed 240

pounds, had recently eaten a fast food meal and

complained of several hours of pain and vomiting.

Gluckman showed a normal ultrasound of a

gallbladder filled with bile fluid and explained

that fluid appears black on an ultrasound. He then

showed an abnormal ultrasound of a gallbladder,

which showed no free fluid and pinpointed the

shadowing that indicated a gallstone.

‘‘It was good, it was informative,’’ said Emma

Gonzalez, RN, of Texas. ‘‘Usually it’s just the doctors

reading the X-rays, and sometimes they don’t get to

it quite right away, so if you know what to look for

you can grab your doc and go, ‘Hey, this is weird.

Can you come look at this with me?’ ’’


leadership,’’ Hohenhaus said, adding that Wolf is ENA’s first

remote employee, telecommuting from her home on the

East Coast.

ENA spent significant time investigating its information

technology capabilities and limitations this year and found

that the organization was lacking in some areas, Hohenhaus

said. Guided by the principles of simplicity and constant

communication, ENA introduced several new devices and

technologies, including video conferencing and team sites

for committees, which reduced travel requirements and

lowered costs. Other advancements, such as a more

integrated use of ENA’s social media platforms, have

propelled the organization forward, she said. Further

technological enhancements and a focus on leadership

development and teamwork training — with new advocacy

and increased educational opportunities — will ensure an

even stronger future for ENA.

Noting that ‘‘ENA’s financial health matters to you,’’

Hohenhaus described the organization’s commitment to

revenue-sharing with state councils and developing an

educational design that includes blended learning, as well

as plans to revive the GENE and CATN programs.

‘‘We learned that we were a bit hasty in retiring CATN,’’

she said. ‘‘Our team is working on revising, refreshing and

renewing the program. GENE is also being revised and will

be more interactive.’’

Noting that the date of her presentation, Sept. 12, was

her one-year anniversary as ENA’s executive director,

Hohenhaus thanked the ENA Board of Directors, especially

2012 President Gail Lenehan, for their leadership and

support during ‘‘an incredibly fast-paced year.’’

Concurrent Sessions Continued from page 31

Talent and Technology Continued from page 19

Photo coverage of 2012 Annual Conference supplemented by Bruce Hood of Stryker.


A Gift That Keeps Giving The holiday season is the perfect time to give

back and make a difference. If you are among

the many shoppers searching for special gifts for

family, friends or colleagues, consider making a

holiday donation to the ENA Foundation.

Donations are a great gift to

honor a special nurse, mentor

or another important person

in your life. Your contribution

to the ENA Foundation makes

a difference in your profession

and can make someone’s

holiday even more special.

ENA member Dorothy Duncan, DNP, RN,

CEN, ACNP-BC, CCRN, said she and her

husband engage in philanthropy usually by

donating to schools. This year, they decided to

place the ENA Foundation on their holiday list

as a charity of choice. At the 2012 ENA Annual

Conference, Duncan noticed that the New York

ENA State Council had established the academic

scholarship to remember fellow first responders

who lost their lives on Sept. 11, 2001.

In 2011, the New York State Council decided

to begin fundraising efforts to permanently

endow the 9/11 scholarship. They recently

reached the halfway mark to ensure that

emergency nurses never forget that fateful day

by honoring its memory.

Duncan felt the cause was very honorable,

and it inspired her to make a donation to the

ENA Foundation in honor of all 13 nurses in her

emergency department’s leadership group. Each

nurse received a Never Forget commemorative

pin. The rest of her staff, which consists of about

35 workers, received a Stretcherside Miracle pin.

Duncan’s staff was moved. As she explained why

she felt compelled to give

back, several were in tears.

Duncan said her staff felt

honored to wear their pins,

and she is proud to see

them displayed on their IDs.

Duncan also wears her pin

with pride as she believes

people should never forget about September 11.

‘‘That is the biggest thing,’’ Duncan said. ‘‘I

just think it’s very important to never forget

these kinds of very noble acts on the behalf of

first responders and emergency personnel,

HAZMAT and all types of response personnel.

This is a wonderful way to remember. This is a

very worthwhile cause. I would recommend

that people give back to the ENA Foundation all

the way.’’

As you reflect on those who have crossed

your path this past year, do you recall someone

who has motivated or inspired you? Mentored

or helped you to grow professionally or

personally? Paying homage to others by making

a contribution to the ENA Foundation is a gift

that definitely keeps giving.

Your donation

makes a difference.

Since 1991, the ENA

Foundation has given more

than $2 million in educational

scholarships and research grants to

emergency nurses. This year alone,

the ENA Foundation has funded 86

educational scholarships and research grants

in the total amount of $246,800. This could not

have been possible without the generous

donations received from individuals, ENA state

councils and chapters, corporations and friends of

emergency nursing.

The ENA Foundation offers the following

premium items, which make great holiday gifts

for your friends, family or colleagues:

• Donate $30 and you can elect to receive a

4GB thumb drive.

• Make a $10 donation to receive the Never

Forget commemorative pin.

• Make a $5 donation and you can select the

Stretcherside Miracle Pin.

There is still time to make your year-end gift.

You can make your donation on behalf of

yourself, or you can honor or remember

someone special to you by visiting

www.enafoundation.org today.

Every dollar counts toward advancing the

emergency nursing profession, this holiday

season and beyond.


December 201236

ENA STATE CONNECTION

San Antonio ENA Chapter Submitted by Steven J. Jewell, RN

The San Antonio ENA marked a busy three months. The chapter hosted

an excellent CEN Review course in August for more than 78 nurses,

presented by Jeff Solheim, MSN, RN, CEN, CFRN, RN-BC, FAEN. In

September, the SA ENA held a two-hour Forensic Nursing in the ER

seminar that hosted 47 members.

With TNCC, ENPC, monthly meetings, seminars, Safety Whys

babysitting training courses and certification review courses, San Antonio

has provided more than 250 hours of continuing education and

community education for the region.

On Nov. 11, more than 40 medical and nursing professionals, provided

by the SA ENA, provided care for the San Antonio Rock & Roll Marathon.

The SA ENA is also excited to announce that its board of directors

approved a 2-1/2 day educational conference scheduled for May 8-10, 2013,

to be held at the Historic Menger Hotel. The conference will include a

three-hour educational seminar for managers, directors and chief nursing

officers, covering topics such as management, education and retention/

recruiting. The next two days will provide 11.75 continuing education

hours on topics including trauma, pediatrics, adults and forensics.

For more information, contact Steven J. Jewell, RN, at

[email protected].

Utah ENA Dixie Chapter Submitted by Debbie Young, BSN, RN

The Utah ENA Dixie Chapter held its sixth annual Southwest

Emergency/Trauma Conference Sept. 29 in St. George, Utah. This

anticipated all-day event was well-attended by emergency nurses and local

EMS and paramedics interested in the latest and greatest in emergency and

trauma care.

Topics this

year included

life flight in

Southern Utah,

pediatric triage

and

assessment,

rapid ECG

interpretation,

massive

transfusion protocol, respiratory emergencies and trauma assessment and

treatment. Many thanks to Cindy Hurst, ADN, RN, chapter president, and

Vikki Webster, BSN, RN, CEN, president-elect (both pictured below), who

spent countless hours preparing and organizing the conference. Not only

was it a success and offered the opportunity to earn continuing education

credits, it gave attendees a chance to network and see colleagues.

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

B ecome a Lantern Award recipient

Apply today. Applications are due February 20, 2013.

DOES YOUR EMERGENCY DEPARTMENT

DESERVE RECOGNITION FOR

Exemplary Practice and Innovation?

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

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

• Leadership

• Practice

• Education

• Advocacy

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


ENA board member Karen Wiley

was in Mazatlán, Mexico, in

October and wasn’t just welcomed

— she was sought out.

The occasion was the 8th

International Congress of Nursing

in ER, Emergencies and Disasters,

held Oct. 4-6 by the Asociación

Mexican de Enfermeria en

Urgencias — the Mexican

Association of Emergency Nurses.

A few hundred nurses from

Mexico, Brazil, Spain, Panama and

Canada attended, including

leaders from the World Alliance of

Emergency Nurses. Educational

sessions were offered on trauma,

cardiopulmonary issues, vascular

access, pediatric populations and

standardization of triage, among

other topics. Wiley, MSN, RN,

CEN, represented ENA and spoke

about why hospitals should train

all nurses in emergency nursing.

But some of the greatest ideas

from those three days didn’t come

from the podium.

For starters, Wiley was

approached by Gerardo Jasso

Ortega, BSN, RN, president and

chairman of the Mexico City-based

AMEU, and Daniella Ortiz, an

associate dean at the University of

Mexico, who proposed a cultural

exchange program between ENA

and AMEU nurses. An emergency

nurse from the United States

would live with and shadow one

from Mexico for one to two

weeks, and then they’d switch,

with the U.S. nurse hosting. Meals

and living arrangements would be

provided by the host nurse. The

only expense would be travel.

The concept is nothing new for

Mexican nurses, who have lived

with and hosted nurses from

Croatia, Spain, Panama and

several of the South American

nations through similar

arrangements.

‘‘They have an exchange

program with these other

countries, so they’re already doing

it but haven’t connected with the

U.S.,’’ Wiley said.

The learning potential there is

huge, but it’s hardly ENA’s biggest

opportunity to educate. Wiley said

there’s a focus on ENA contracting

to bring the TNCC and ENPC

courses to Mexico, starting with a

core group of emergency nurses

assembled by Jasso. Those nurses

would then spread the teachings

to nurses across Mexico, as well

as to other countries in the World

Alliance.

Opportunities to help reduce

other countries’ ED violence have

emerged, too. AMEU’s Horacio

Flores Nava, an emergency nurse

from Chihuahua, Mexico, is

planning a first binational

conference on violence in the

workplace next April. He found

Wiley and asked about acquiring

resources from ENA, which has

made workplace violence

prevention a cornerstone of its

Strategic Plan. The situation Flores

described to Wiley is chilling:

gunmen walking into Mexican

hospitals along the Texas and

Arizona borders and shooting

patients in drug-related vendettas.

‘‘It’s our worst-case scenario

— we have an active shooter

dropped off,’’ Wiley said. ‘‘We try

to prevent that with security

measures, as far as our metal

detectors or at least the presence

of security on the property and

within our facility. Doesn’t mean it

doesn’t happen in the U.S., but it’s

more frequent [in Mexico] — it

sounds like it’s out of control —

and they’re asking for assistance

in violence prevention tools that

they can use, and also to educate

them on violence prevention.’’

There are other challenges in

Mexico, so many of them shared

by U.S. emergency departments.

Nurses have to contend with

crowding, long wait times

Emergency Nurses Under a Common Flag


Colleagues in Mexico See ENA As Having the Answers

ENA board member Karen Wiley, MSN, RN, CEN, presents TNCC and ENPC manuals to Gerardo Jasso Ortega, BSN, RN, president of the Mexican Association of Emergency Nurses, during her visit in October. Below: Attendees gather at the 8th International Congress of Nursing in ER, Emergencies and Disasters, including Jasso (purple shirt, seated) and global emergency nursing leaders from Canada, Spain and Brazil (seated to left of Jasso).


December 201238

Board Meeting Actions and HighlightsThe ENA Board of Directors met Aug. 22 via teleconference. All members

of the board were present and took the following actions:

• Approved the July 18 board of directors meeting minutes as corrected.

• Adopted the independent auditors’ report on the 2011 financial

statements as presented.

• Approved that ENA continue membership in the Institute of Medicine

Forum on Medical and Public Health Preparedness for Catastrophic

Events for one year.

• Referred the Rapid Practice Reference on Hemolysis back to the Clinical

Practice Committee for reconsideration because of the board’s concerns.

• Ratified Joanne Fadale, BSN, RN, as the replacement Retired Emergency

Nurses Special Interest Group facilitator, as presented.

The ENA Board of Directors met Sept. 11 in San Diego. All board

members were present and took the following actions:

• Approved development of a project plan for an Institute for Emergency

Nursing Education.

• Approved the following board governance policies:

° Conducting ENA Board of Director Business that Requires a Vote via

E-mail

° Etiquette for Electronic Communication

• Approved the newly created position statement definitions, including

joint and consensus statements, as written.

• Approved the new Weighing Patients in Kilograms position statement as

written.

• Approved the following revised position statements as written:

° Specialty Certification in Emergency Nursing

° Professional Liability and Risk Management

• Approved sunsetting the following position statements:

° Autonomous Emergency Nursing Practice (3/2005)

° Care of the Older Adult (5/2012)

° Family Presence (9/2010)

° Hazardous Material Exposure (10/2009)

° Improving External Coding In Hospital Discharge and ED Data

Systems (4/2009)

° Prehospital EMS (12/2008)

° Smallpox Vaccination (12/2005)

° Substance Abuse (7/2010)

• Approved the following topics for Emergency Nursing Resources

in 2013:

° Acute Pain Management

° De-escalation

° Pediatric Dehydration

• Supported the Position Statement Review Committee’s request to decline

the development of an ENA position statement on the care of the stroke

patient in the ED as outlined in General Assembly Resolution 11-105,

and charged the Clinical Practice Committee with developing a clinical

practice rapid practice reference related to the care of the stroke patient

in the ED.

• The following represent actions to various requests from external

organizations that were supported by the Executive Committee:

° An invitation from Emergency Medical Services for Children to have an

ENA representative on the Organizational Panel during its Annual

Program Meeting, May 8-11, in Bethesda, Md. Deena Brecher, MSN,

RN, APRN, ACNS-BC, CEN, CPEN, represented ENA.

° An invitation from the Forum of Nursing Workforce Centers to attend

its 2012 Annual Conference June 27–29, in Indianapolis. Gail Lenehan,

EdD, MSN, RN, FAEN, FAAN, represented ENA.

° An invitation to attend the Department of Health/Human Services and

Assistant Secretary for Preparedness and Response Meeting on The

Impact of Drug Shortages on Emergency Care April 16, in Washington,

D.C. A workgroup was established from the attendees of this meeting

and a subsequent meeting was held July 12 – 13, in Washington, D.C.

Mary Alice VanHoy, MSN, RN, CEN, CPEN, NREMT-P, represented ENA

at these events.

° An invitation to attend a Health Resources and Service Administration

Affordable Care Act Discussion with Nursing Organizations hosted by

Dr. Mary K. Wakefield, April 30, in Washington, D.C. Susan M.

Hohenhaus, LPD, RN, CEN, FAEN, represented ENA.

° A request from the American Psychiatric Nurses Association for a letter

of support for an AHRQ grant application for a three-year project to

compile a toolkit of materials on pain assessment.

° An invitation to participate in the American College of Emergency

Physicians Geriatric ED Work Group to describe the standards for a

geriatric ED. Betty Mortensen, MS, BSN, RN, FACHE, represented ENA.

° An invitation from the National Council of State Boards of Nursing to

attend its APRN Roundtable meeting April 25 in Chicago. Betty

Mortensen, MS, BSN, RN, FACHE, represented ENA.

° An invitation from the National Institute of Occupational Safety and

Health to attend the National Conference for Workplace Violence

Prevention and Management in Healthcare Settings May 11 – 13, in

Cincinnati. AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN, represented

ENA.

° An invitation from Dignity Health to present at its ED Summit May 31

– June 1, in Las Vegas. Gail Lenehan, EdD, MSN, RN, FAEN, FAAN,

represented ENA.

° An invitation from the American Nurses Association to support the

Joining Forces initiative of the White House and the first lady.

° A request from the American Nurses Association to endorse the

document Professional Nurse Coach Role: Defining Scope of Practice

and Competencies.

° A request to send a letter of support for a SAMHSA grant application

from the ENA president on behalf of the Center for Pediatric Traumatic

Stress, Children’s Hospital of Philadelphia, which will serve as a Level

II center in the National Child Traumatic Stress Network.

° A request from Duke University and the University of Cincinnati to

support a grant application for “Comparing Pain Management

Protocols for Sickle Cell Disease Patients in the Emergency

Department” with a letter from the ENA president.

° A request for a letter of endorsement from the Centers for Disease

Control and Prevention regarding its National Hospital Ambulatory

Medical Care survey.

° An invitation from the Pediatric Nursing Certification Board to attend

the Institute of Pediatric Nursing Invitational Forum, Nov. 1-2, in

August and September 2012

(particularly in the public hospitals), geriatric and pediatric issues and

the puzzle of accommodating behavioral health patients, most of

whom end up on regular hospital floors. The suicide rate among these

patients is high, Wiley said.

What hampers Mexican emergency nurses is a lack of resources,

from air conditioning to continued education. But they make up for it

in the simple stuff that bonds the profession. Wiley is recommending

including Jasso and other international colleagues in educational

sessions at Leadership Conference 2013 in Fort Lauderdale, Fla., and at

next year’s General Assembly in Nashville, Tenn., with interpreters on

hand to help them share their insights and experiences.

The lesson is that there’s much to be learned from each other. So

different, yet so alike.

‘‘I wasn’t aware of how unified emergency nurses are in their

passion,’’ Wiley said. ‘‘When I was asked to go to Mexico, I felt a crack

in the door — a door opened partway to the international community

and to Mexico. But once I arrived and met them and saw all the nurses

that attended from the other countries as well as throughout Mexico, I

thought, ‘Oh!’ — an entire door just kind of opened onto another

world. We had the same connection with emergency nursing and ENA

because they were just as passionate about emergency nursing as we

are. To me, it was like you never left your own emergency department.

It was like meeting people that you worked with daily. You just felt

that same connection.’’

Washington, D.C. Paula Karnick, PhD, ANP-BC, CPNP will represent

ENA.

° An invitation from RAND Health (under contract with the Centers for

Medicare and Medicaid Services) to suggest topic areas and items for

inclusion in a survey of patient experiences with emergency

department services.

° An invitation from Urgent Matters to designate two representatives to

its editorial board. AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN, and

JoAnn Lazarus, MSN, RN, CEN, will represent ENA.

• The following requests were not supported by the Executive Committee:

° An invitation from the Commission on Collegiate Nursing Education to

nominate candidates for its Board of Commissioners and the 2013

Nominating Committee.

° An invitation from the American Association for Emergency Psychiatry

to attend and speak at its Third Annual National Update on Behavioral

Emergencies Dec. 5-7, in Las Vegas.

° A request from the Society for Academic Emergency Medicine for

endorsement of its 2012 Consensus Conference, May 9-12, in Chicago.

° An invitation from the Vascular Disease Foundation to attend and

speak at the 2012 VESSEL Annual Meeting Sept. 21-23, in Tyson’s

Corner, Va.

° A request from the American Academy of Neurology for endorsement

of the guideline, ‘‘Update: Evaluation and Management of Concussion

in Sports.’’

Highlights of the next scheduled board of directors meeting will be

published in a future issue of ENA Connection.

Emergency Nurses Under a Common Flag Continued from page 37

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Find out more...www.BCENcertifications.org

December 201240

During a recent conversation with a friend and co-worker, we were

discussing how we dealt with the uncertainty caused by the economic

meltdown in 2009. He said, ‘‘There was so much that I knew I couldn’t

control. I couldn’t control what was happening to the stock market, the

value of my home or to the employment status of my loved ones, so I

simply focused on what I could control. I did everything I could to

increase and enhance quality time with my family. I started running and

eating better so I could get in better control of my body. I devoured all

kinds of books to keep my mind sharp. We started paying closer attention

to our family finances. Basically I ‘cleaned my house’ and controlled my

controllables, hoping that the rest would work itself out, and my family

would be in a better place when it did.’’

This was an interesting perspective, and I often find myself applying

the same principle. When I have a big project, sometimes the best place

for me to focus is at home, and away from the distractions at the office.

However, pulling out my laptop is not the first thing I do — I clean my

house. I have to get everything else in order before I can focus on the

task at hand.

It’s no secret that the health care environment is undergoing drastic

change. We have reached the point where one Baby Boomer turns 65

every 10 seconds 1, obesity has risen to over 30 percent in some states 2,

nine out of 10 hospitals report ED boarding 3 and in 2020 we will have a

nursing shortage that is projected to reach 1 million.4 To pile on, the many

models of care and the uncertainty surrounding the Affordable

Care Act are causing more questions than answers.

In a time of such uncertainty, and when the issues and

complexities in health care seem so daunting, maybe the best

thing we can do is get back to the basics. What are the things in

your daily activities that you have complete control over? What

can you focus on doing better? Are you doing the things necessary

to take better care of yourself so you can take better care of your patients?

Of course, controlling the controllables sounds simple enough, but

making a change and sticking to it is often easier said than done. One of

the most difficult challenges with change is breaking old habits. As a

medical device manufacturer, we are constantly under regulatory scrutiny,

and compliance is key. We have found that the secret to compliance is to

make the complex problem as simple as possible. If those implementing it

realize it is to their direct benefit, and that the change will make their daily

activities simpler, safer and more efficient, it becomes very natural.

2012 will be wrapping up before we know it, and the only guarantee in

the coming year is that there will be change. As we set our goals for 2013,

let’s focus on controlling the controllables and making the complexities of

our personal and professional lives as simple as possible, so we are ready

to embrace the changes ahead.

References

1. AARP. (n.d). Boomers at 65: Celebrating a milestone birthday. Retrieved

from www.aarp.org/personal-growth/transitions/boomers_65/

2. Centers for Disease Control and Prevention, Vital Signs. (n.d). U.S. state

info: Adult obesity. Retrieved from www.cdc.gov/vitalsigns/

AdultObesity/StateInfo.html

3. Rabin, E., Kocher, K., McClelland, M., Pines, J., Hwang, U., Rathlev, N.,

... Weber, E. (2012). Solutions to emergency department ‘boarding’ and

crowding are underused and may need to be legislated. Health Affairs,

31(8), 1757–1766.

4. American Hospital Association. (2007.) When I’m 64: How Boomers will

change healthcare. Retrieved from www.aha.org/content/00-

10/070508-boomerreport.pdf

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

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

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

Do you have experience dealing with leadership challenges and issues?

Establish Yourself as a Leader

Submission Deadline is March 25, 2013

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

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

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

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

Topic areas:

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

Controlling the Controllables

2012 ENA State Council and Chapter Innovation Grant Recipients AnnouncedThe recipients of the ENA

Innovation Grant awards for

state councils and chapters

have been announced.

Selection of the award

recipients involved many

factors to ensure alignment

with ENA’s mission, strategic

plan, goals, activities, budget

and sustainability. The

winners are:

• Head Injury Prevention

Campaign – Alabama State

Council, Audra Lowery Ford,

president: $5,490

• Violence Survey in

California’s Emergency

Departments – California

State Council, Marcus

Godfrey, president: $7,118

• Injury Prevention Radio

Ads – Central Minnesota

Chapter, Colleen Seelen,

immediate past president:

$5,412

• Multi-faceted Video

Communication – Talk

Fusion – Missouri State

Council, Teresa M. Coyne,

president-elect: $10,000

• Web/Virtual Meeting

Plan and System – New York

State Council, Kathy Conboy,

president-elect: $5,000

• Web Conferencing –

Texas State Council, Rhonda

Manor-Coombes, web

chairperson: $1,980

• Trauma Trot and Kids

Safety Expo – Shenandoah

Chapter, Brenda Hoops,

president, and Paula Neher,

chapter member: $5,000

• Washington ENA and

British Columbia ENA

Emergency Nursing Confer-

ence – Washington State

Council, Roger Casey,

president: $10,000

By Kim Edwards, Associate Marketing Communications Manager, Stryker Medical

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