connectionthe Official Magazine of the Emergency Nurses Association

January 2013 Volume 37, Issue 1

2013 CAREER GUIDE

Oh, the PlacesYou’ll Grow Keep ENA By Your Side

During Your Career Climb in Emergency Nursing

Stories From Forensics, Flight Nursing and More

There’s a New Word For Our Role: Advocatism

LETTER FROM THE PRESIDENT | JoAnn Lazarus, MSN, RN, CEN

The definition of an advocate is a person who pleads for or on behalf of another; ‘‘ism’’ indicates an action, process or result. Therefore, ‘‘advocatism’’ is my word for what we do for our patients and for the profession of emergency nursing. Whether it’s bringing a potential medication error to the physician’s attention, helping others hear a patient’s voice or shaping policy by speaking to our legislative representatives, advocating for our profession and our patients is our role as emergency nurses.

Our role as an advocate for our patients begins the minute they arrive in our emergency department. Emergency departments are scary and confusing places for our patients and their families. It is our responsibility to minimize some of this by focusing on the patient’s experience, communication and educational needs. As nurses, we must help the patients understand the tests and procedures the physicians order. We should make them aware of

the time it will take for these tests or

procedures to be completed, and we

should educate them on the rationale

for these tests and procedures.

We continue to act as the interpreter and liaison throughout the patient’s stay. Without us to translate the patient’s circumstances into understandable and acceptable terms, patients would not only be confused, but terrified. The patient’s medical, psychological and emotional care is our responsibility. At times, especially in this current health care environment, this may be an overwhelming task.

Florence Nightingale was the first nurse to advocate for patient rights and for our rights as nurses. She is credited with establishing nursing as a profession rather than a domestic service. We still need to help others see the importance and value of what we do as nurses. There are simple things that we can do to demonstrate that our knowledge and education are critical to the care of our patients. Our actions, language and appearance must be professional at all times. We

Continued on page 7

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: connection@ena.org

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

Editor in Chief:Amy Carpenter AquinoAssistant Editor:Josh GabyWriter:Kendra Y. MimsEditorial Assistant:Renee HerrmannBOARD OF DIRECTORSOfficers:President: JoAnn Lazarus, MSN,

RN, CENPresident-elect: Deena Brecher,

MSN, RN, APRN, ACNS-BC, CEN, CPEN

Member Services: 800-900-9659

Secretary/Treasurer: Matthew F. Powers, MS, BSN, RN, MICP, CEN

Immediate Past President: Gail Lenehan, EdD, MSN, RN, FAEN, FAAN

Directors:Kathleen E. Carlson, MSN, RN, CEN,

FAEN Ellen (Ellie) H. Encapera, RN, CEN Marylou Killian, DNP, RN, FNP-BC,

CENMichael D. Moon, MSN, RN, CNS-CC,

CEN, FAENSally K. Snow, BSN, RN, CPEN, FAENJoan Somes, PhD, MSN, RN, CEN,

CPEN, FAENKaren K. Wiley, MSN, RN, CEN

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

Official Magazine of the Emergency Nurses Association 3

To Enrich Your Career, Enrich Someone Else’s

FUTURE OF YOUR NURSING | Bridget Walsh, Chief Talent Officer

January is traditionally the time of year

when we reflect upon our lives and set

new goals. We start the year with

enthusiasm, dedication and a renewed

commitment to better ourselves. This

January, I challenge you to reflect upon

your accomplishments, skills and

experiences and see how you can pay

it forward. Contributing to the

professional development of an

emerging professional helps the

individual gain experience, helps you

expand your own experience and

advance your career and contributes to

the profession of emergency nursing.

In her column, ENA 2013 President

JoAnn Lazarus talks about ‘‘advocatism.’’

Advocating for the profession can take

many forms, including contributing to

the development of talented, educated

nurses to lead the charge for change.

Mentoring an emerging professional

can be both formal and informal. You

may decide to take that new nurse on

the team under your wing, helping

him or her learn the ropes of your

department and your hospital structure

or talking him through a challenging

patient situation. Investigate the formal

methods for mentoring in your

hospital, perhaps through serving as a

preceptor or in other mentorship roles.

You can take that commitment to

paying it forward outside your

workplace as well. Invite a colleague

to join you at an ENA meeting,

encourage her to participate on a

committee or support her in running

for a state or chapter office. Connect

with a local nursing school and

volunteer as a guest lecturer or as a

resource for a nursing student.

You’ll find that by helping others

with their professional development

you will help yourself as well. Not

only will you have a sense of pride in

contributing to the development of

another, you’ll also develop and refine

skills that contribute to your own

professional development. It might be

just the extra push you need to take

the next step in your own career.

Track all your mentoring and

coaching experiences, along with your

career accomplishments and

membership activities, in your

professional profile in the ENA Career

Center at www.ena.org. You will have

a fully updated career profile for when

you are ready to take that next step.

I hope there will be a fellow ENA

member ready to pay it forward and

mentor you.

Quick Tips: Nail That InterviewThe following are some commonly asked questions that

nurses should be prepared to answer during a job interview,

as well as questions to ask a potential employer.

Standard Interview Questions Nurses Should Be Prepared to Answer:• How would you describe your skills as a team player?

• How will you deal with difficult doctors?

• How will you deal with difficult patients and/or their

families?

• How will you handle unexpected circumstances, such as

being short-staffed and having to perform a treatment you

have not done before?

• What was your best and worst patient experience?

Interview Questions That Nurses Should Ask a Potential Employer:• What is the nurse-to-patient ratio?

• Is there support staff on the unit to assist nurses?

• In what ways are nurses held accountable for high

qualities of practice?

• How much input do nurses have regarding systems,

equipment and the care environment?

• What professional development opportunities are available

to nurses?

Author: Sandy Watkins, Strategic Healthcare Staffing.

Reprinted with permission.

January 20134

Children are amazingly resilient. Those

of us who work with children in the

emergency setting help most of our

patients recover from what ails them

and watch them walk out smiling.

This provides a great deal of instant

gratification. Every day is new and

completely unpredictable, and every

shift brings endless possibilities as to

what we might encounter. In the same

day, we may teach a new mother how

to care for her infant, give a

hemophiliac toddler his Factor VIII so

he does not hemorrhage after a fall,

sedate a preschooler so that his broken

arm can be mended, relieve the pain

of a child suffering from a sickle cell

pain crisis, provide IV hydration for a

dehydrated child and take care of a

child who has fallen out of a second-

story window.

We also care for many older

pediatric patients — the teenagers —

who tend to be more like big kids than

little adults. Some teen patients have

had children of their own before they

are able to legally drive. They often

confront adult issues with child-like

naiveté. With developmentally

appropriate care, we can help meet

their adult needs on a level

appropriate for them.

These are just some of the reasons

why I love pediatric emergency

nursing. In November, I asked other

ENA members (through Facebook)

why they loved pediatric emergency

nursing. The following are some of

their responses:

Milly Glauer (who was taking care

of a scared, tearful 7-year-old boy who

wasn’t cooperating as she tried to

apply cardiac leads for monitoring and

an EKG): EKG leads are so scary [to

some kids]! Out of desperation to calm

him, I touched the jelly on the leads,

gave him a piece, giggled and told him

it felt funny, kind of like boogers. He

took the jelly, calmed down, and I was

quickly able to monitor him. After that,

he stayed calm for his treatment!

Lorettajo Kapinos: I cared for a

5-year-old brought in by her

grandfather. He was concerned she

was having a reaction to her antibiotic.

She had no tongue/lip swelling,

difficulty breathing, vomiting or rash. I

asked what the reaction was. He said,

‘‘She must be uncomfortable because

she won’t stop moving after I give it to

her.’’ The girl was calm, cooperative

and playful. I asked her, ‘‘Does the

medicine make you feel bad, so you

move around a lot?’’ ‘‘No,’’ she replied

as she pointed to the bottle in my hand.

‘‘It says, ‘Shake well while using.’ ”

Jennifer Raymond: My funniest

patient of all time was a kiddo about

age 9 that was seen for testicular pain.

The day-shift nurse had informed me

in a report how funny this patient was,

but I never expected him to ask why his

discharge instructions said to abstain

from sex! (The resident clearly did not

read [the discharge instructions] before

he printed them.) [The patient] made

sure I knew that he did not even have a

girlfriend! Peds ER patients come in all

shapes and sizes. We see the worst of

the worst. We comfort a mother who

has just lost her child and move on to

the patient who just has an earache.

We do it because we love it. We get

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

Why We Love It, In Our Own Words

The ED staff at Cooley-Dickinson Hospital (Northampton, Mass.) is “ready and happy to take care of pediatric patients,” said team educator and photographer Lorettajo Kapinos, RN (ENA member). From left to right: Jessica Menard, RN; Corine Langevin, RN; Nick Hebert, CNA; Barb Tenanes, LPN; Steven Coughlin, RN (ENA member); and Sharon Duval, RN.

asked often, ‘‘How can you work

there?’’ I always answer, ‘‘I just can.’’

Jesa Orleman: We told a 5-year-

old boy to hold still for [a blood draw]

and his grandmother jumped right in

and said, ‘‘Oh, good, you’re going to

check him. He is old enough [to hold

still]!’’ The little boy asked what we were

checking him for, and Grandma said,

‘‘They need some blood to check and

see if you have super powers!’’ He was

so brave, and everybody was smiling at

how hard he was working to hold still.

I’ll keep that line in my pocket for the

next time!

Camden Kay: At 2 a.m. one night

recently, we had a little man come into

the critical care room in severe

respiratory distress with an extensive

cardiac history. After we were done

with his IVs, X-rays, suctioning and

high flow, I went and shared with my

co-workers that it was his second

birthday and asked if they’d like to

come say happy birthday. With big

smiles and without hesitation, they

grabbed some bubbles as I grabbed a

present, and five-deep we went and

sang ‘Happy Birthday.’ If you’ve ever

seen a sick kiddo smirk with his binky

in his mouth and then smile, then

giggle, you realize everything you do is

so worth it! Love my crew!

Theresa Antley: We had a small

boy [who was crying because he was

very anxious about getting a CT]. So I

went in to [talk to him] and found out

that he was scared of the machine

itself. Well, I went over to CT and

covered the machine with all his

favorite stickers … I picked him up and

put him on the table; he held my hand

and lay down and looked at the

stickers. He was so still looking at all

the stickers that we could do the scan

without even holding him down. After

it was over, I gave him the stickers and

he spent the next 30 minutes looking at

all of them. Peds take a lot of patience

and distractions/innovations! Love

helping them feel better.

What a wonderful testament to why

some emergency nurses choose to

work with children; the funny

moments and positive outcomes far

outweigh the more difficult times.

Thank you for all the wonderful

examples that illustrate the unique

nature of pediatric emergency nursing!

Board of Certification for Emergency Nursing (BCEN®) certifications demonstrate your commitment to excellence.

Make 2013 the year to earn your mark of distinction!

It’s Your Year to Shine!

Learn more… www.BCENcertifications.org

January 20136

The mission of the ENA Foundation,

established in 1991 by the

Emergency Nurses Association, is to

provide educational scholarships

and research grants in the discipline

of emergency nursing. The

foundation achieves its mission by

accepting contributions to fund

academic scholarships, continuing

education and research grants. Over

the last 21 years, the ENA

Foundation has awarded more than

$2 million in academic scholarships

and research grants.

Have you recently returned to school to advance your education? Are you considering returning to school in 2013? Applications are now available for academic scholarships to emergency nurses in four categories: non-RN, undergraduate (RN to BSN), graduate/master and doctoral. The application deadline for all scholarships is June 1. Recipients are notified in early August. With the exception of the non-RN category, all applicants must have been an ENA member for the previous 12 months to qualify. Scholarships and research grants are made possible through the generous donations received in 2012.

Scholarship and research grant applications and qualifications are available at www.ENAFoundation.org.

Supporting Emergency Nursing Through Education and Research ENA Foundation 2013 Scholarship and Research Grant Opportunities

2013 Academic Scholarships

Non-RN CategoryNew York State ENA September 11 Scholarship Two at $2,500 each

Undergraduate (RN to BSN) CategoryCharles Kunz Memorial Undergraduate Scholarship One at $3,000Board Certification of Emergency Nursing (BCEN) Scholarship One at $3,000

Graduate/Master CategoryStryker & ENA Foundation Scholarship - Masters in Healthcare One at $5,000AnnMarie Papa Stretcherside Miracle Scholarship One at $5,000Board of Certification for Emergency Nursing (BCEN) Scholarship One at $5,000Anita Ruiz Contreras Scholarship (California) One at $5,000 Colorado Rocky Mountain Scholarship (Colorado) One at $5,000Darlene Whitlock Trauma Scholarship (Kansas) One at $5,000Kentucky ENA Founders Scholarship (Kentucky) One at $5,000Maryland ENA State Council Scholarship (Maryland) One at $5,000Pathways “V” Scholarship (Minnesota) One at $5,000Dan Burgess Mississippi State Council Scholarship (Mississippi) One at $5,000New Jersey State Challenge Scholarship (New Jersey) One at $5,000Mary Kamienski Scholarship (Northern Chapter-NJ) One at $5,000Jeannette Ash Memorial Scholarship (West Central Chapter-NJ) One at $5,000Renee Jett Memorial Scholarship (South Carolina) One at $5,000Tennessee State Challenge Scholarship (Tennessee) One at $5,000Vicki Patrick Texas Legacy Scholarship (Texas) One at $5,000ENA Foundation State Challenge Scholarship Nine at $3,000 eachPhysio-Control, Inc. Scholarship Two at $3,000 eachGisness Advance Practice Scholarship One at $3,000Karen O’Neil Memorial Scholarship One at $3,000

Doctoral CategoryPamela Stinson Kidd Memorial Scholarship One at $10,000Board of Certification for Emergency Nursing (BCEN) Scholarship Two at $5,000 eachENA Foundation Doctoral State Challenge Scholarship Three at $5,000 eachHill-Rom Doctoral Scholarship Two at $4,000 each

2013 Continuing Education Scholarships

Leadership Tapestry Scholarship 10 at $1,000 eachVidacare Annual Conference Scholarship 20 at $500 each

2013 Research Grants

Emergency Medicine Foundation (EMF)/ENA Foundation Team Research Grant One at $50,000ENA Foundation/Sigma Theta Tau International Research Grant One at $6,000ENA Foundation/ANIA-Caring Research Grant One at $6,000Industry-Supported Research Grant – Sponsored by Stryker One at $5,000

ENA FOUNDATION

Official Magazine of the Emergency Nurses Association 7

Research shows that nursing is the

largest workforce within the health

care industry, with more than 2.6

million registered nurses in the U.S.

According to the Bureau of Labor

Statistics, employment of registered

nurses is expected to grow 26 percent

from 2010 to 2020, primarily because

of technological advancements, an

increased emphasis on preventive care

and the large, aging baby boomer

population, who will demand more

health care services.

This growth will create various

career options and paths for nurses.

Whether you are a new graduate or at

mid-career and want to explore other

options, choosing a nursing specialty

that is right for you and projected to

grow is important for taking your

career to the next level. At right is a list

of the top 10 highest paying nursing

specialties.

Resources

www.braintrack.com/cool-career-

info/articles/

highest-paid-nursing-specialties

www.bls.gov/ooh/Healthcare/

Registered-nurses.htm

Career Outlook for Nursing Specialties Nursing Specialties Average Salary Education Requirements

Certified Registered Nurse Anesthetist

$135,000 CRNA program (24-36 months)

Nurse Researcher $95,000 BSN (advanced nursing research often requires an MSN or a PhD)

Psychiatric Nurse Practitioner

$95,000 RN license with MSN and NP certification

Certified Nurse Midwife $84,000 MSN (certified midwives must also pass a certification exam)

Pediatric Endocrinology Nurse

$81,000 RN license

Orthopedic Nurse $81,000 RN license and orthopedic nursing certification

Nurse Practitioner $78,000 Master’s degree in clinical specialty

Clinical Nurse Specialist $76,000 RN license and graduate from a CNS program

Gerontological Nurse Practitioner

$75,000 Nurse practitioners master’s degree with academic concentration in the field of geriatrics

should not speak negatively about our profession to each other, our family and friends or to our patients. We also must speak up when we see nurses portrayed inaccurately in the media.

Nursing continues to be the most trusted profession. Because of this, we can influence care in our own communities, our states and our nation by taking part in the legislative process. We have important information to share with our governmental representatives and policy makers about the effects of their choices and legislation on individuals and groups. It is our role to shape and influence health care policy.

Advocatism is alive and well in everything we do. As nurses, we need to understand how to harness what we already do into a force to be reckoned with. One way ENA is helping members achieve this goal is by hosting the first ENA

Advocacy Intensive Workshop for state and chapter leaders this month in Des Plaines, Ill. ENA leaders will learn how to take experiences and knowledge and use them to influence practice and policy in their hospital, community and profession.

We have to be the voice to advocate for change.

Resources

Selanders, L. C., & Crane, P. C. (2012). The voice of Florence Nightingale on advocacy. Online Journal of Issues in Nursing, 17(1). Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/No1-Jan-2012/Florence-Nightingale-on-Advocacy.html.

Gallup. (2011). Honesty/ethics in professions. Retrieved from http://www.gallup.com/poll/1654/honesty-ethics-professions.aspx.

Letter From the President Continued from page 2

Plan now on attending ENA Leadership Conference 2013,

February March 27 – March 3 in Fort Lauderdale, FL

to help you advance your career. Gain the knowledge

you need to succeed as a leader in evidence-based

educational sessions across seven key focus areas.

Learn new skills that you can implement immediately

upon your return home. Shape your future today by

leveraging all that ENA Leadership Conference has

to offer. Read how a past attendee has benefited from

attending ENA leadership conference.

Described by your colleagues as a must-attend event,

Leadership Conference can help advance your career

and help you become a better leader.

Network with emergency department leaders from

across the country and the world, make new contacts

and learn about the latest solutions for your emergency

department in the exhibit hall.

Enhance Your Leadership Skills by Attending ENA Leadership Conference 2013

EDUCATION • Presession: Lights, Camera, Action:

Writing and Delivering an Award Winning Conference Presentation

Jam: Competency Validation, How Do You Know That They Know What They are Doing?

• Copyright Law for Academics

• Legal Aspects of Social Media

• The ED Olympics: An Innovative Approach to Annual Competencies

• Clinical Reasoning: What Is It and How Do I Teach It?

FLOW Jam: Out of the Hallways and Into the Hospital:

Throughput, Output and Forward Flow

• Implementation of a Low Acuity Initiative

• Report Wars: Making Peace with Our Inpatient Colleagues

• Losing Wait: Innovative Strategies to Improve Patient Flow In and Out of the ED

• Breaking Down the Cultural Walls Preventing Effective Hospital Throughput

• Impact of a Logistics Manager Program on Admitted Patient Boarders Within an ED

HEALTH • Lateral Violence, It Goes Much Further Than

Those “Who Eat Their Young”

• Healthy Living – For Nurses

• Frazzled to Fantastic: Be More Effective and Less Stressed

• All Stressed Out In the ED: Staying Resilient and Avoiding Burnout

• Field of Dreams or Toxic Wasteland: Keeping Your Work Environment Healthy

MANAGEMENT • Presession: Operational Leadership of the

Emergency Department

• Strategies For Implementing and Utilizing Pharmacy Services in the ED

• Managing an Observation Unit as an Extension of the Emergency Department

• Lurking Secret Shoppers: LWOT and Dissatisfied Customers as Partners for Service Improvement

Deep Dive: Budget Negotiation Made Fun

• Winning Against the Nursing Shortage: Building Your Team Without Losing the Players You Have

PROFESSIONAL DEVELOPMENT• Presession: Charge Nurse: Putting the Team

Back Into Teamwork

• The Seven Principles of Inspiring Leaders

• Tactical Leadership: Military Lessons for Today’s ED in Empowering Staff to Excel

• You Are Finally a New Manager, Now What?

Deep Dive: The Older Emergency Nurse: Retired, Recycled, Revived and a Respected Resource

• Developing Leaders of Tomorrow From New Grads of Today

SAFETY • Fragile – Hand Me Off with Care

• Strategies for Implementing and Utilizing Pharmacy Services Within the ED

• If I Had Passed Out, It Would Have Been a Felony

• Say What? Addressing Communication Styles to Improve Our Work Environment and Patient Safety

• Workplace Violence: Prevent, Respond, Report

• Level I Trauma Centers Journey to a Safe Environment: Fall Prevention in the ED

ENA Leadership Conference 2013 educational offerings will help you advance your career. To help you get more of what you need, Leadership Conference now offers unique learning formats like Hand-off Sessions, Jam Sessions and Deep Dive Sessions.

Below is a small sampling of the educational sessions offered at ENA Leadership Conference 2013. For a complete course listing and conference details, visit www.ena.org/lc.

FOLLOW THE ACTION #ENALC13

Important Dates to Remember

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

Early Discount Rate Closes ......................... Jan. 16

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

Presessions .................................................. Feb. 28

Educational Sessions .............................. Mar. 1 – 3

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

*No purchase necessary. To view the complete rules, visit www.ena.org/lc. Void where prohibited. Drawing will be held February 4, 2013.

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

“ With the knowledge and experiences that I have obtained through ENA such as relationship building, collaboration, rejuvenation, inspiration and benchmarking, I am able to bring these experiences and knowledge back to my team. I want my team to have the best, be the best, and achieve the best. If my team is not successful, than I am not successful. Our driving force is exceptional emergency care.”

Norma L. Austin, RN, BSN, CEN, CPEN Emergency Services Executive Director

Carroll Hospital Center, Westminster, MD

DON’T DELAY! REGISTER bEfoRE JaNuaRy 16 To SaVE wITh ThE EaRly DIScouNT RaTE. ScaN ThE QR coDE oR Go To WWW.ENA.ORG/LC

USE SOURCE CODE FC3JC WHEN YOU REGISTER TO ENTER THE ENA LEADERSHIP CONFERENCE 2013 DRAWING*

• Grand Prize: Three nights hotel stay at hyatt Regency Pier 66 in fort lauderdale, fl from february 28 – March 2

• Second Prize: iPad®

• Third Prize: Kindle

Plan now on attending ENA Leadership Conference 2013,

February March 27 – March 3 in Fort Lauderdale, FL

to help you advance your career. Gain the knowledge

you need to succeed as a leader in evidence-based

educational sessions across seven key focus areas.

Learn new skills that you can implement immediately

upon your return home. Shape your future today by

leveraging all that ENA Leadership Conference has

to offer. Read how a past attendee has benefited from

attending ENA leadership conference.

Described by your colleagues as a must-attend event,

Leadership Conference can help advance your career

and help you become a better leader.

Network with emergency department leaders from

across the country and the world, make new contacts

and learn about the latest solutions for your emergency

department in the exhibit hall.

Enhance Your Leadership Skills by Attending ENA Leadership Conference 2013

EDUCATION • Presession: Lights, Camera, Action:

Writing and Delivering an Award Winning Conference Presentation

Jam: Competency Validation, How Do You Know That They Know What They are Doing?

• Copyright Law for Academics

• Legal Aspects of Social Media

• The ED Olympics: An Innovative Approach to Annual Competencies

• Clinical Reasoning: What Is It and How Do I Teach It?

FLOW Jam: Out of the Hallways and Into the Hospital:

Throughput, Output and Forward Flow

• Implementation of a Low Acuity Initiative

• Report Wars: Making Peace with Our Inpatient Colleagues

• Losing Wait: Innovative Strategies to Improve Patient Flow In and Out of the ED

• Breaking Down the Cultural Walls Preventing Effective Hospital Throughput

• Impact of a Logistics Manager Program on Admitted Patient Boarders Within an ED

HEALTH • Lateral Violence, It Goes Much Further Than

Those “Who Eat Their Young”

• Healthy Living – For Nurses

• Frazzled to Fantastic: Be More Effective and Less Stressed

• All Stressed Out In the ED: Staying Resilient and Avoiding Burnout

• Field of Dreams or Toxic Wasteland: Keeping Your Work Environment Healthy

MANAGEMENT • Presession: Operational Leadership of the

Emergency Department

• Strategies For Implementing and Utilizing Pharmacy Services in the ED

• Managing an Observation Unit as an Extension of the Emergency Department

• Lurking Secret Shoppers: LWOT and Dissatisfied Customers as Partners for Service Improvement

Deep Dive: Budget Negotiation Made Fun

• Winning Against the Nursing Shortage: Building Your Team Without Losing the Players You Have

PROFESSIONAL DEVELOPMENT• Presession: Charge Nurse: Putting the Team

Back Into Teamwork

• The Seven Principles of Inspiring Leaders

• Tactical Leadership: Military Lessons for Today’s ED in Empowering Staff to Excel

• You Are Finally a New Manager, Now What?

Deep Dive: The Older Emergency Nurse: Retired, Recycled, Revived and a Respected Resource

• Developing Leaders of Tomorrow From New Grads of Today

SAFETY • Fragile – Hand Me Off with Care

• Strategies for Implementing and Utilizing Pharmacy Services Within the ED

• If I Had Passed Out, It Would Have Been a Felony

• Say What? Addressing Communication Styles to Improve Our Work Environment and Patient Safety

• Workplace Violence: Prevent, Respond, Report

• Level I Trauma Centers Journey to a Safe Environment: Fall Prevention in the ED

ENA Leadership Conference 2013 educational offerings will help you advance your career. To help you get more of what you need, Leadership Conference now offers unique learning formats like Hand-off Sessions, Jam Sessions and Deep Dive Sessions.

Below is a small sampling of the educational sessions offered at ENA Leadership Conference 2013. For a complete course listing and conference details, visit www.ena.org/lc.

FOLLOW THE ACTION #ENALC13

Important Dates to Remember

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

Early Discount Rate Closes ......................... Jan. 16

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

Presessions .................................................. Feb. 28

Educational Sessions .............................. Mar. 1 – 3

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

*No purchase necessary. To view the complete rules, visit www.ena.org/lc. Void where prohibited. Drawing will be held February 4, 2013.

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

“ With the knowledge and experiences that I have obtained through ENA such as relationship building, collaboration, rejuvenation, inspiration and benchmarking, I am able to bring these experiences and knowledge back to my team. I want my team to have the best, be the best, and achieve the best. If my team is not successful, than I am not successful. Our driving force is exceptional emergency care.”

Norma L. Austin, RN, BSN, CEN, CPEN Emergency Services Executive Director

Carroll Hospital Center, Westminster, MD

DON’T DELAY! REGISTER bEfoRE JaNuaRy 16 To SaVE wITh ThE EaRly DIScouNT RaTE. ScaN ThE QR coDE oR Go To WWW.ENA.ORG/LC

USE SOURCE CODE FC3JC WHEN YOU REGISTER TO ENTER THE ENA LEADERSHIP CONFERENCE 2013 DRAWING*

• Grand Prize: Three nights hotel stay at hyatt Regency Pier 66 in fort lauderdale, fl from february 28 – March 2

• Second Prize: iPad®

• Third Prize: Kindle

January 201310

Missy Rittinger has hardly paused before she’s recalling the case that sums up what forensic nursing means to her.

An exotic dancer taking a cab home in Cincinnati one January morning was driven instead to a remote area, where she was beaten and raped by the driver. He slit her throat and left her to die. She didn’t. That was in 2002. At the time, Rittinger, BS, RN, CFN, SANE-A, was working in the emergency department at the St. Elizabeth Healthcare facility in Edgewood, Ky. She recently had become a sexual assault nurse examiner, licensed to collect forensic evidence after sexual assaults and, if called upon, to testify about her findings.

‘‘And she was brought in, and this man was convicted, and he got 38 years in prison,’’ Rittinger says.

‘‘That,’’ she notes, ‘‘was my very first case.’’

Terri Vietor chimes in proudly: ‘‘They found the assailant’s DNA under her nails — that Missy had swabbed.’’

The two ENA members have covered a lot of ground together, bringing the relatively young discipline of forensic nursing into their own professional repertoires and recruiting tens of others to do the same. Vietor, MSN, BSN, RN, CEN, CFN, SANE, is now the nurse manager for the St. Elizabeth Edgewood ED and also the manager of the St. Elizabeth forensic nursing program, which serves five EDs in northern Kentucky and greater Cincinnati. Rittinger is Vietor’s program coordinator. Since 2011, she also happens to be a deputy coroner of Boone County, Ky.

Thirteen years ago, the two met

while taking the first SANE training

offered in the area — the result of

grant-funded efforts by local domestic-

violence advocacy groups. By 2000,

both women had SANE certification,

and on Jan. 1 of the following year

they launched the St. Elizabeth

program, providing forensic nursing

services to the three St. Elizabeth

facilities and two others under

competing St. Luke Hospitals. (The

systems merged in 2008.)

Vietor and Rittinger became

Certified Forensic Nurses — the next

step up in forensic nursing — in 2005.

Their program at St. Elizabeth, which

started with six SANE nurses, today is

approaching 30, most of whom work

in the ED, conducting SANE exams

and gathering forensic documentation

of injuries in addition to their regular

job duties. Sexual assaults against

adults and children, domestic violence,

elder abuse and neglect — these are the areas where training in forensics matters.

‘‘For me,’’ Vietor says, ‘‘I went on to get my CFN because I felt like the forensic component of everything that we do in the emergency department, there was so much possibility to do it better, to produce better documentation for our patients and to do a better job taking care of them.’’

Rittinger pins it on ‘‘a very intense desire.’’

‘‘As an ED nurse,’’ she says, ‘‘I always seemed to gravitate toward the sexual-assault patients because everyone else seemed to run from them. I realized there was a significant need for improvement of care for these patients, and I wanted to be part of the improvement.

‘‘Once I received the training, my career went into a whole new direction and has morphed into something very rewarding.’’

At St. Elizabeth, if it involves forensics, it goes through Rittinger. Attorneys and law-enforcement officials will come to her for documentation of abuse or neglect, and if there was any suspicion at all during a patient’s ED visit, you can bet she’ll have pictures. She and Vietor stress education and a forensic component to every nurse’s job, which means that all of their front-line emergency nurses — those with certifications and those without — are encouraged to take photos that could be used in court cases.

Vietor and Rittinger recommend that emergency nurses interested in forensics start by becoming SANEs, which likely will give them the most evidence-gathering experience. Additional education and a CFN will

Missy Rittinger, BS, RN, CFN, SANE-A (above), and Terri Vietor, MSN, BSN, RN, CEN, CFN, SANE, have worked to build forensic nursing into the ED culture.

Evidence of a Higher CallingTake Their Word For It: As a Forensic Emergency Nurse, Your Influence on Outcomes Can Only Grow StrongerBy Josh Gaby, ENA Connection

bring even greater credibility — as an expert giving testimony and as a nurse in general. This is something Rittinger appreciates constantly in her role as deputy coroner. A forensic nurse packs a rare double punch: the certified and specialized technical background combined with the glowing reputation of the nursing profession.

‘‘A lot of the feedback that I get from people that I’m dealing with is very positive, simply because I’m a nurse,’’ Rittinger says. ‘‘There’s a level of compassion that they automatically see. The cops out there, they see me come, and they’re like, ‘Thank goodness.’ They say that all the time.’’

With forensic nursing comes a tendency for burnout, Vietor and Rittinger admit.

‘‘There are a lot of difficult things to see and deal with,’’ Vietor says. ‘‘It’s a very intense nursing practice. For sexual assault, you are one-on-one

with a patient for three hours. You need a lot of support among your team to really keep people involved so that they don’t get discouraged.’’

And you need the ongoing sense of the impact you might have.

Like Rittinger, Vietor instantly remembers the case that drove it home for her.

It was shortly after she received her CFN. A coroner called asking for a forensic nurse to help examine the body of a 3-year-old girl who had died of head and internal injuries. Vietor’s SANE license in Kentucky allowed her only to examine live patients over age 14, but her CFN afforded her more leeway. While she couldn’t conduct a complete exam on the child, she was able to take genital photographs and swabs that the police forensics team would not have taken.

Vietor’s findings showed the child, beaten to death, also had been

sexually abused and sodomized. That forensic evidence pointed to a stepbrother, who later accepted life in prison on a plea.

‘‘Being a part of that whole process,’’ Vietor says, ‘‘made me feel like everything else I’d done before — the 3 a.m. calls that they weren’t going to end up getting prosecuted, the mixed-up stories that we would get — it was all worth it because at this point in time I was qualified and able to contribute to this investigation. In thinking through my scope of practice, because I had certification as a forensic nurse, I was able to do more than I would have been able to do had I not been. And it made a difference.

‘‘Once you’ve got that forensic training,’’ she says, ‘‘every place you turn, there are things in health care that have forensic implications. It’s a young specialty in nursing. It certainly has not reached where it could go.’’

ENA invites you to a FREE WebinarAs a sponsor of The Take Charge of Your Nursing Career™ program, ENA is pleased to invite you to the third webinar in our series.

“How Nursing from the Neck Up Can lead to Success”Presented by Dennis R. Sherrod, EdD, RN, Professor and Forsyth Medical Center Endowed Chair of Recruitment and Retention. Dr. Sherrod will be accompanied byDr. Phyllis Quinlan, Professional Nursing Coach.

This class is available February 7, 21-26, 24 hours a day. Mark your calendars and look for registration information via email at the end of January.

Don’t miss out!

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January 201312

Career Spotlight: Long-Distance Flight Nursing

Carl Bottorf, RN, thought his days of

being a nurse were over after a severe

car accident in 2010 left him in a

wheelchair with significant injuries and

titanium parts in his legs. He

contemplated becoming a

schoolteacher, but three months after

his accident he realized he might get

out of his wheelchair and walk again.

After his recovery, he pursued his

dream career by applying to Airlift

Northwest for a long-distance flight

nurse position in Juneau, Alaska.

Bottorf has specialized in transport

medicine since being trained as an Air

Force flight nurse in 1993. With more

than 17 years of experience, including

numerous deployments and military

tours in Asia, Africa and Europe in the

last decade, he made the transition

from Tampa, Fla., to Juneau in 2011 to

work for Airlift Northwest. He credits

the Air Force for preparing him for the

opportunity and giving him with the

‘‘right tools’’ for his new career path.

‘‘I’m proud to be an Air Force flight

nurse and of the training I received,’’

he said. ‘‘It enabled me to come out

here to get a job and excel. I feel

lucky because all of the things the Air

Force taught me as a nurse come into

play every single day.’’

Bottorf soon realized that flight

nursing in Alaska was completely

different from his previous nursing

experience. Anywhere in the

Southeast, a flight team can get an

unexpectedly unstable patient to a

good hospital within 15 minutes. In

Alaska, there are no trauma centers or

burn centers, so patients are flown

1,000 miles to Seattle.

The missions come from small

hospitals. Bottorf said some of the

clinics and health care facilities

accessed in emergencies are merely a

simple room or several small rooms

located in the same building that

houses the community’s long-term care

residents. The ring of the outside

doorbell transforms the long-term care

nurse into the emergency care

provider. Other times, the ring of the

bell brings staff members in response

from their homes. The lack of acute

care diagnostic and treatment

equipment has spawned the need for a

rapid-response, fixed-wing air

ambulance service within the region,

and Airlift responds quickly.

Bottorf said his skills are challenged

all the time.

‘‘We’ll fly to these remote

communities, pick up the patient and

fly 700 or 1,000 miles to deliver them

to higher levels of care,’’ he said. ‘‘You

have to know your obstetrics, because

By Kendra Y. Mims, ENA Connection

Sky’s the Limit When You’re Caring For Patients Thousands of Feet Up

ENA member Carl Bottorf, RN, with his flight partner, Elise Chamberlain, RN, CEN, standing in front of one of the three Lear-31’s in the fleet of Airlift Northwest. This airframe is based in Juneau, Alaska.

Official Magazine of the Emergency Nurses Association 13

you can transport women who are

having complicated labors. You have to

know your trauma management because

you’re transporting trauma patients. We

don’t fly with a respiratory therapist, so

you have to learn and train and become

sufficient with a ventilator. It’s not as

hard to figure out how to run a

ventilator on a 15-minute transport, but

when you have to run it for two to three

hours and keep the patient alive and

prevent them from getting any sicker,

you have to get really good at it.’’

Bottorf had to relearn many things

about flight nursing when he came to

Airlift Northwest, in addition to taking

Airlift’s seven-week training program.

He currently works with a group of

seven nurses in Alaska and typically

flies one to three shifts each week.

‘‘Flight nurses understand the effects

that flying has on the patient,’’ he said.

‘‘There are nine really specific stressors

of flight that can impact any condition.

For example, if you have a heart attack

and you need to be flown in a jet,

virtually all nine stressors can affect

your heart attack patient because

they’re flying. Flight nurses are trained

to understand what those are and how

they impact patient care. They

understand what to look for and the

remedies to minimize problems

resulting from long-distance

aeromedical transportation. They know

how to apply general nursing to the

aerospace environment.’’

Not all flight nurses are built the

same, Bottorf pointed out. Though he

has a vast amount of experience as a

flight nurse in pressurized fixed-wing

aircraft, he does not have the same

amount of helicopter experience

and requires varying amounts of

different training.

‘‘I am a flight nurse who is

experienced in aerospace medicine,’’ he

said. ‘‘It is a different realm of nursing

for flight nurses who work in jets

compared to those who work in

helicopters. If I’m going to transport a

patient from here to Seattle, it’s 1,000

miles. I’m thinking of different potential

complications than if I was to go across

the city of St. Louis in a helicopter. I’m

flying at 45,000 feet. If something

happens, it’s not like we can land on

the ground and run to the nearest

hospital. You’re up there for two hours

in a small, tight area. It’s just you and

another nurse taking care of the patient.

You have oxygen issues, vibration

issues and pressure issues, and these

are all part of the stressors of flying that

long-distance flight nurses either are

trained for or learn as they go.’’

Bottorf works longer than 12 hours

when he has to take a patient from

bedside in Alaska to bedside in Seattle

and then fly back to Alaska.

‘‘And on the way home, if another

patient needs to be moved, they’ll

divert us and send us there,’’ he said.

‘‘It really impacts your personal life, but

you get used to it. Sometimes you just

get a meal per day, often on the run,

but you make it work.’’

Despite the challenges flight nurses

encounter, Bottorf said the turnover rate

is low.

‘‘It’s not the kind of nursing job

where people get dissatisfied and

leave,’’ he said. ‘‘We have nurses who

are retiring with nearly 30 years on the

job as a flight nurse here. They know

this is a good job. The company trains

us well.’’

His favorite aspect of being a flight

nurse is dealing with the unexpected on

a daily basis.

‘‘When I go to work as a flight

nurse, I don’t know what’s going to

happen,’’ he said. ‘‘Maybe we’ll fly

today, maybe we won’t. Maybe the

weather’s good, maybe it’s not. Maybe

I’ll get a trauma patient today or maybe

I’ll get a heart transplant having

complications. There are a lot of

unknowns, and you never know what

to expect, so you have to be OK with

surprises. I enjoy the clinical challenge.

The missions are fantastic.’’

“A helicopter flight nurse goes to a scene of an accident or trauma and brings emergency room level care to the patient. An aerospace nurse or long distance flight nurse is able to provide intensive critical care to a patient from one hospital

to the next over long distances at high altitudes.” —Carl Bottorf

Carl Bottorf’s advice to nurses interested in a career in long-distance flight nursing:

In addition to getting two to

five years of critical-care

nursing experience, ‘‘Keep

your body healthy, because it’s

physically fatiguing. When

you’re at high altitude or in the

Learjet you get tired faster

because there’s less oxygen

and there’s vibration and

you’re either hot or cold, so

you have to keep your body

healthy to do the job. Good

health, good experience and

flexibility will get you far.’’

This is the typical view when Carl Bottorf is working transport missions.

January 201314

What Can You Do With a PhD in Nursing?

The Institute of Medicine has a stated goal of doubling the number of doctorally prepared nurses by 2020. The role of these doctorally prepared nurses, according to Marion E. Broome (2012) is to direct education reform at all levels and to co-lead patient outcome improvements in specific areas of clinical practice.

At this time, approximately 1 percent of nurses are doctorally prepared, meaning there are about 30,000 PhDs and DNPs in the United States. The American Association of Colleges of Nursing suggests that all faculty teaching in baccalaureate programs have preparation at the doctoral level.

The perception of doctoral work can be that it is difficult, takes a lot of time, costs a lot of money and does not really change the way a nurse would practice. Let’s look at these perceptions a bit more closely:

It’s hard and takes a long time. To be accepted into a doctoral program, generally you have to have at least a Bachelor of Science in Nursing, and many programs like applicants to have a master’s degree in nursing. A PhD is a research degree, not a practice degree (that’s a DNP or Doctorate of Nursing Practice), so PhDs are not necessarily advanced practice nurses.

The training process for a PhD includes two years of class work in the philosophy of nursing, philosophy of science, research methods and practica. Depending on the program, there might also be a focus on policy or theory generation. The last year(s) of the doctoral education process are devoted to the design, completion and

writing of a dissertation study. The objective of the dissertation process is to create new knowledge.

The time it takes to get through a PhD program is dependent on a number of things. The first is your starting point — if you have a master’s degree, it takes less time than if you start at the baccalaureate level. The second is whether you are going full-time or part-time. In general, it’s not advised that you work full-time when you are doing your graduate work. This is not feasible for most people, and it is important to recognize that a PhD is not something you just ‘‘tack on’’ to your current duties. Doctoral work is challenging (the good kind of challeng-ing) and requires attention, focus and adequate time to process information. If you try to maintain your schedule and add doctoral work, everything tends to suffer.

It costs a lot of money.Because of the critical shortage of faculty in nursing programs, there are several funding sources. Many programs have fellowships for doctoral students. I attended Boston College on a university fellowship and received full tuition and a stipend for two years.

I was awarded an ENA Foundation scholarship and a Jonas Fellowship for my third year, so my PhD was essentially free. There are also programs wherein if you teach, a portion of your student loan is forgiven for each year that you teach. Doctoral education does not need to be prohibitively expensive.

It won’t change my practice.The PhD-prepared nurse at the bedside is invaluable. Practicing from a theoretical base with extensive training in research and its evaluation gives you the opportunity to practice at a very high level of both knowledge and application. You are a resource to your peers and patients. You can practice collaboratively with physician colleagues in a different way because the understanding of evidence-based practice is more similar.

Along with bedside practice, the nurse with a PhD is prepared to teach both undergraduate and graduate nursing students. You can do this as an adjunct (part-time) faculty, or you can enter the tenure system as a full time faculty and also engage in research. Doctoral work can open doors to a mix of education, research and practice that is engaging and satisfying.

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

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 LWolf@ena.org.

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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 opportunities.

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