connectionthe Official Magazine of the Emergency Nurses Association

September 2013 Volume 37, Issue 8

5 2013 Annual Award Recipients

6 Treasurer’s Report

16 Vietnamese Nurses Get Extra Training They Seek

20 Lantern Award Recipients

INSIDE FEATURES

THE AFTER BURN

How to Keep Fanning Your Ideas and Energy

Post-ConferenceCODE YOU, Page 13

March 5-9, 2014 Phoenix, AZ Phoenix Convention Center

SAVE THE DATE

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

Follow the action #ENALC14

For the latest news on Leadership Conference 2014, visit www.ena.org

LEADERSHIPCONFERENCE

2014

LC14 SavetheDate Ad_Connection_Full_09 2013.indd 1 7/22/13 3:54 PM

3Official Magazine of the Emergency Nurses Association

The Importance of Saying Thank You

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

The next day I received a handwritten

thank-you note and a bar of chocolate from

the nurse who had been in charge. All the

members of the leadership team received a

note, as well as the staff who had worked that

day. That had such an incredible impact on

me. I felt as though I should have been the

one giving out candy and thank-you notes.

We all get so caught up in the moment

and in our schedules that we forget what is

important, such as acknowledging others’

contributions. Showing gratitude is our basic

responsibility as humans living in community

with other human beings.

According to a survey by the John

Templeton Foundation, people are less likely

to feel or express gratitude at work than

anyplace else. Almost all of those participating

in the survey reported that saying thank you

‘‘makes me feel happier and more fulfilled.’’

On a given day, however, only 10 percent

acted on that impulse. Sixty percent said they

‘‘either never express gratitude at work or do

so perhaps once a year.’’

Why is saying thank you so important? It

is an emotional act that connects us to each

other. Saying it doesn’t just acknowledge

someone’s effort or thoughtfulness — it

acknowledges the person as someone

unique and of value. It shows you care. It’s

not just about making your peer feel good;

studies show a significant increase in

happiness, greater satisfaction with life and

higher resilience to stress in those who

express thankfulness on a regular basis.

We come to work not only for the money

but because it brings pride, respect, a sense

of accomplishment and a feeling of purpose.

It is nice to know we are appreciated, not

only by our managers and supervisors but

also by our peers.

The impact of saying thank you goes way

beyond the moment in which it is said. It

strengthens relationships, motivates others to

continue engaging in helpful behavior and

sends a strong message about our values and

the professionalism of our organization.

Saying thank you appeals to our human need

to be appreciated and makes us feel better.

Next time a co-worker starts that IV for you

or picks up an open shift, acknowledge him or

her. It just might make you feel good, too. I’d

like to personally thank Traci McGregor, BSN,

RN, CEN, CPEN, the charge nurse who gave

me the thank-you note and candy. Thank you

for making my day better and for making me

realize the importance of saying thank you.

I’d also like to thank the many leaders

within ENA. Thank you for sharing your time,

talents and passion with our profession and

with ENA. You really make a difference!

Resources

Naylor, C. (n.d.) The power of saying thank

you. Retrieved from http://

www.b-betternow.com/blog/2012/10/

the-power-of-saying-thank-you/

Simon-Thomas, E. R., & Smith, J. A. (2013,

January 10). How grateful are Americans?

Retrieved from http://greatergood.

berkeley.edu/article/item/how_grateful_

are_americans

Kaplan, J. (2012). Gratitude survey: Conducted

for the John Templeton Foundation. Retrieved

from http://greatergood.berkeley.edu/

images/uploads/JTF_GRATITUDE_

REPORTpub.doc

Dates to Remember

PAGE 4Free CE of the MonthAsk ENA

PAGE 10ENA Foundation

PAGE 20ENA Connected

PAGE 22Pediatric Update

PAGE 30State Connection

Regular Features

Sept. 17-21, 2013 ENA General Assembly and Annual Conference, Nashville, Tenn.

Oct. 1, 2013 Deadline to apply for the 2013 ENA Foundation/ANIA Research Grant and the 2013 ENA Foundation Industry-Supported Research Grant.

Oct. 14, 2013 Faculty course-proposal deadline for 2014 Annual Conference.

PAGE 5ENA Annual Award Recipients

PAGES 6 - 72013 Treasurer’s Report

PAGE 8The Affordable Care Act: More Patient Coverage Options

PAGE 13Code You: Keep Your Momentum Maximized after Annual Conference

PAGE 14Update From the Executive Director

PAGE 16Missions Giving Vietnamese Nurses the Extra Training They Seek

PAGE 202013 Lantern Award Recipients

PAGE 24Board Writes: Newer Ways of Reaching Safe Practice, Safe Care

ENA Exclusive Content

R ecently, I was on a project as an interim director in an

emergency department in the Northwest when something

gave me pause to reflect. It was a Monday and staffing was

in short supply; patients were not. It was an ‘‘all hands on deck’’ sort of day. The whole

leadership team was on the floor doing what we could to assist with patient flow. We made it

through the shift without any disasters. March 5-9, 2014 Phoenix, AZ Phoenix Convention Center

SAVE THE DATE

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

Follow the action #ENALC14

For the latest news on Leadership Conference 2014, visit www.ena.org

LEADERSHIPCONFERENCE

2014

LC14 SavetheDate Ad_Connection_Full_09 2013.indd 1 7/22/13 3:54 PM

Q: I’d like to pay my ENA dues

by installments. Is this possible?

A: Yes, for certain dues

categories. We are able to accept

four quarterly installments for

payment of three-year, five-year

and lifetime membership plans.

These plans add $1 per

installment as a processing fee to

cover a portion of the additional

costs to process the installments.

Although we’ve received a

few requests to pay one-year

dues by monthly installments, we

are unable to provide that option

for two main reasons: (1) system

limitations and (2) high

processing costs. Our software

system does not currently have

the ability to process monthly

installments and would require

additional programming, which

would be complicated and costly

because dues are shared with

state councils and chapters based

on payments received.

More significant are the high

processing costs for monthly

payments. The quarterly

installments we process now for

the long-term memberships

require manual handling by staff,

as our software system does not

include functions to automate

this process. In addition to the

labor involved, each transaction

processed incurs a fee, whether

paid by credit card, debit card or

check. The $1-per-transaction

processing fee we now charge

for the long-term memberships

covers only a portion of these

labor and transaction costs. If the

$1 per transaction were applied

to the $100 annual membership

for monthly installments, it

would increase the cost to

members to a total of $112 per

year, about the equivalent of a 12

percent finance charge.

— Edward M. Rylko, MBA,

CPA, Deputy Executive Director

Do you have a recent professional or educational success story you want to share about yourself or an ENA member colleague? E-mail the information to connection@ena.org with the subject line “Members in Motion.’’

We’re turning the conversation

to annual competencies with

the next installment of free

continuing education for

ENA members!

Available to you starting Sept. 1 . . .

‘‘The ED Olympics: An Innovative Approach to Annual

Competencies,’’ presented by Martina Petersen, MSN, RN,

ACNP-C. (Credit: 1.0 contact hour.)

Petersen analyzes the current practices and goals of annual

competency assessment, then gives you a look at a

competitive model that emergency department staffs can use

to evaluate annual competencies. Staff response to this model

is discussed, along with the outcomes of using it. This is an

e-learning course recorded during Leadership Conference

2013 in Fort Lauderdale, Fla.

To take these and other CE courses absolutely free as

an ENA member:

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

member (or create an account).

• Add desired courses to your cart and ‘‘check out.’’

• Proceed to your Personal Learning Page to start or

complete any course for which you have registered or

to print a certificate when you’re done.

• To return to your Personal Learning Page at a later

time, go to www.ena.org and find ‘‘Personal Learning

Page’’ under the Courses & Education tab.

Please be sure you are using the e-mail address

associated with your membership when logging in. If you

have questions about any free e-learning course or the

checkout process, e-mail elearning@ena.org.

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

915 Lee Street Des Plaines, IL 60016-6569

and is distributed to members of the association as a direct benefit of membership. Copyright© 2013 by the Emergency Nurses Association. Printed in the U.S.A.Periodicals postage paid at the Des Plaines, IL, Post Office and additional mailing offices.

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

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

Member Services: 800-900-9659

E-mail ‘‘Ask ENA’’ at connection@ena.org with questions about ENA and emergency nursing in general.

Official Magazine of the Emergency Nurses Association 5

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Barbara A. Foley Quality, Safety and Injury Prevention AwardKimberly Wright, BSN, RN

Behind the Scenes AwardRobin Walsh, BSN, RN

Clinical Nurse Specialist AwardPamela Bucaro, MS, RN, PCNS-BC, CPNP, CPEN

Frank L. Cole Nurse Practitioner AwardAndrew Galvin, ACNP-BC, CEN

Judith C. Kelleher AwardAnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN

Media AwardCheryl Tan

Nurse Manager AwardSuszanne Deyke, MSN, RN, CEN

Nurse Researcher AwardKathleen Flarity, DNP, PhD, CEN, CFRN, FAEN

Nursing Education AwardLeah Davis, BSN, RN, CEN

Nursing Practice and Professionalism AwardRhonda Holmstrom, BSN, RN, CEN

Rising Star AwardNicholas Nelson, MS, RN, CEN, CPEN, CPN, NRP

Team AwardForensic Nurse Examiner Team — Christiana Care Health System, Newark, Del.•EricaDempsey,BSN,RN,CEN•AmyDrejka,MS,BSN,RN,SANE-A•MeghanEllis,BSN,RN,CEN•MaryKathleenFillingame,BS,RN•JenniferHenry,BSN,RN,CEN•AmyHensel,BSN,RN,SANE-A, CEN•DonnaLougheed,BSN,RN•AngelaMcNulty,BSN,RN,SANE-A•ChristiMench,RN,SANE-A•BethMiller,BA,RN•NoemiMiranda,RN•JenniferOldham,BS,RN,CEN•KellyGreenO’Shaughnessy,BSN, RN, CEN•ChristineParks,BSN,RN•NicolePossenti,BSN,RN•AmyStier,RN,CEN,SANE-A•AnitaSymonds,MS,BSN,RN, SANE-A, SANE-P•SteaphineTaggart,BSN,BA,RN•ErinVaughn,BSN,RN,SANE-A

2013 Annual Award RecipientsENA is pleased to announce the recipients of the 2013 ENA Annual Awards.

Recipients will be recognized Sept. 21 at the Annual Awards Gala at the 2013

Annual Conference in Nashville, Tenn.

More Award News! Lantern Award recipients, Page 20

September 20136

ENA’s financial results for

2012 showed continued

growth in the programs at

the core of our mission.

Revenue increased from each

of our three major sources,

and expenses were

appropriately aligned with

these programs, yielding

profitable results from

operations. Table 1 shows

the statement of activities,

and the following discussion

refers to that statement.

Total revenue increased

nearly 2 percent in 2012,

growing nearly $186,000 to

$17,096,499. We achieved

growth in all three major

activities: membership dues,

course revenues and

conferences. Membership

continued to grow, adding

344 members for a total of

39,888 at the end of 2012, and

at press time, membership

had reached 40,059. As a

result, membership dues

revenue increased $137,000 to

$3,606,518.

Course revenues grew 5.5

percent, as almost 66,000

nurses took our Trauma

Nursing Core Course or

Emergency Nursing Pediatric

Course. Attendance and

exhibitor participation at our

conferences continued to

grow. Our Leadership

Conference in New Orleans

had record attendance with

1,458 nurses, a 15 percent

increase from 2011. The

Annual Conference in San

Diego drew 2,644 nurses,

about even with the 2011

conference. Exhibit space

increased 7 percent for

Leadership Conference but

decreased about 2 percent

for Annual Conference.

Operating expenses for

2012 totaled $16,978,767,

higher than 2011 by about

$438,000, or about 2 percent.

The largest expense increases

were for conference-related

costs, including higher travel,

food and meeting utilities

expenses at both conferences.

Conversely, wage and benefit

costs decreased in 2012

thanks to better alignment of

staffing resources. Dues and

course assessments provided

By Matthew F. Powers, MS, BSN, RN, MICP, CEN, 2013 ENA Secretary/Treasurer and Edward M. Rylko, MBA, CPA, Deputy Executive Director

2013 Treasurer’s Report

TABLE 1

Official Magazine of the Emergency Nurses Association 7

more than $1.5 million to

fund state council and

chapter activities.

The revenue growth and

controlled expenses yielded

net income from operations

of $117,732, exceeding the

2012 budget target by

$894,000. Activities in 2012

were focused on investing in

the support structure of the

organization, and this was

achieved in a fiscally

responsible manner.

ENA’s investment portfolio

generated an excellent return

of 11.7 percent, supported by

gains from the recovery in

the financial markets along

with dividends and interest.

Our net investment income

for 2012 was $1,195,132,

which, combined with our

operating results, led to an

increase of $1,312,864 in

ENA’s net assets.

Table 2, Supplemental

Statement of Financial

Position, shows assets,

liabilities and net assets as of

Dec. 31, 2012 and 2011. Our

total assets were $20,043,861

at Dec. 31, 2012, an increase

of nearly $1.5 million from a

year earlier, when they were

$18,568,025. The strong

operating and investment

results discussed above were

the reasons for the increase.

This balance sheet continues

to demonstrate that we are in

excellent financial condition,

with high-quality assets and

no debt. Our financial

management policy requires

that our reserves, represented

by our long-term investments,

be at least 50 percent of our

operating expenses. At the

end of 2012, this reserve ratio

stood at a very healthy 65

percent when looking ahead

to budgeted operating

expenses for 2013; in fact,

these reserves exceed the 50

percent threshold by more

than $2.7 million.

The ENA Board of

Directors assigns a high

priority to our stewardship

role, to protect and provide

for the present and future

health of our association. We

work diligently with our

professional staff to ensure

that ENA serves its members

well, fulfills its strategic plan

and achieves its mission. The

2012 financial results further

strengthen ENA’s fiscal

foundation so that we can

confidently continue to

provide resources to our

members and advocate for

our profession and our

patients. We encourage states

to monitor their financial

assets and activities and to

please consult your board

liaison for any questions and

issues, in addition to us and

our national office.

If you have any questions,

please contact us at Matt.

Powers@ena.org or

Ed.Rylko@ena.org.

TABLE 2

September 20138

The Affordable Care Act was

approved by Congress and

signed into law by President

Barack Obama in March

2010. While enacted more

than three years ago, most of

the Act will begin to take full

effect starting Jan. 1, 2014.

The law is designed to

expand health care insurance

and save individuals money

on medical expenses. Many

of its most important provisions deal

with increasing insurance coverage for

millions of Americans, especially those

with lower income or whose employers

do not provide health insurance. In fact,

it is estimated that 33 million Americans

who are currently uninsured will receive

coverage under the law.

As emergency nurses, it is critical for

you to be able to communicate with

your patients about the Affordable Care

Act and provide them with basic

information about some of the

expanded health insurance options

under the law.

Of the 130 million patients visiting

emergency departments each year,

about 21 million have no medical

insurance. Many of these patients

cannot afford the cost of purchasing

their own coverage on the private

market. Others are young or healthy

and do not feel they need medical

insurance. The ACA addresses these

problems in several different ways.

The most direct way in which the

ACA expands health insurance is by

increasing the number of people who

qualify for Medicaid or the Children’s

Health Insurance Exchange Program.

Beginning in 2014, the new law

expands Medicaid to all Americans

under age 65 who earn at or below 133

percent of the federal poverty line

($31,322 for a family of four in 2013).

This change is expected to add 17

million people to the Medicaid

program.

For those who don’t qualify for

Medicaid, the ACA created Health

Insurance Marketplaces (known as

‘‘exchanges’’) to make it easier for

individuals to purchase private health

insurance. The exchanges are entities set

up in each state with the goal of creating

a more organized and transparent

marketplace for purchasing health

insurance. People will be able to

compare insurance plans based on price,

benefits, quality and other features.

Individuals can access information

on exchanges either through their state

government website or by visiting the

federal government website, www.

healthcare.gov. While these websites

provide extensive information on the

ACA, their most important feature is that

they will provide a single forum for

individuals to compare and

evaluate the various

insurance plans.

The state exchanges will

begin with open enrollment

Oct. 1, 2013, with coverage

starting as early as Jan. 1,

2014. It is important that

you encourage people

without insurance to

explore getting coverage

through the exchanges in

the coming months. After open

enrollment ends March 31, 2014,

individuals will not be able to get

health coverage through their exchange

until the next annual enrollment period.

The only exceptions are for qualifying

life events such as marriage, birth or

adoption of a child or a change in

work status.

Another important provision in the

ACA is the requirement that private

insurance plans allow parents to add or

keep their children on their policy until

they turn 26. Even though this policy

took effect in September 2010, many

young patients still might not be aware

they could be covered under a parent’s

health plan.

Finally, you should be aware that

beginning in 2014 under the ACA, if

someone does not have health

insurance coverage, he or she will have

to pay a fee to the federal government.

We hope this article will allow you

to better inform your patients about the

Affordable Care Act. You also can direct

your patients to www.healthcare.gov

or to the U.S. government’s 24-hour

help center at 800-318-2596.

The Affordable Care Act: More Patient Coverage Options

ENA ADVOCACY

By Richard Mereu, JD, MBA, ENA Chief Government Relations Officer, and Ken Steinhardt, Director of Government Relations

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SEPTEMBER

19-21ENA

ANNUALCONFERENCE

ENAANNUAL

CONFERENCENASHVILLE, TENNESSEE

2 0 1 3

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

Follow the action #ENAAC13

Register at www.ena.org/ac or scan the QR code.

REGISTER TODAY!

AC13 Ad_Connection_Half_09 2013.indd 1 7/25/13 2:51 PM

September 201310

As a forensic nurse who has worked

with sexual assault victims since 2007,

Jessica Draughon noticed that most

forensic nursing programs providing

care for this population routinely

offered emergency contraception and

antibiotics for common sexually

transmitted infections but did not offer

non-occupational post-exposure

prophylaxis for HIV.

While wondering how this affected

sexual assault patients, Draughon, MSN,

RN, a predoctoral

fellow at Johns Hopkins

University School of

Nursing, began studying

literature on the

medication and made

another discovery: Many health care

providers had reservations about

offering HIV nPEP to sexual assault

patients because they were concerned

that they would have inadequate

adherence to the medication regimen.

Her response: You wouldn’t skip

giving diabetic patients insulin because

you thought they were non-compliant.

Draughon said it’s a medical decision

the patient should be able to make.

‘‘If we can understand more of

what’s going on with the patient

through the

process, then we

might have a

better idea of

how to intervene to improve

adherence,’’ she said. ‘‘Then, maybe

more health care providers would be

willing to offer these medications to

patients who should be receiving them.’’

To gain a better understanding of

sexual assault victims’ adherence to HIV

nPEP and how to improve it, Draughon

applied for an ENA Foundation research

Helping Sexual Assault Victims Regain a Sense of Control

By Kendra Y. Mims, ENA Connection

Lessons Learned By an ENA Foundation Research Grant Recipient

Jessica Draughon, MSN, RN

Official Magazine of the Emergency Nurses Association 11

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grant and became the 2012 recipient of

the ENA Foundation/Sigma Theta Tau

International Research Grant. She

received $6,000 to assist in developing

research that can improve care and

outcomes for this vulnerable

population. The grant also allowed

Draughon to pilot a newer method of

data collection by using Web-based

surveys that allowed patients to

complete a survey on their own time

without having to talk to someone.

‘‘In previous studies that have

looked at PEP following sexual assault,

most of the information has been

gathered from a chart review, the

phone or a follow-up appointment,’’

Draughon said. ‘‘This population is very

mobile. People move frequently after

experiencing a sexual assault, so using

the traditional mail survey wouldn’t

have been as effective.’’

If HIV nPEP is initiated within 72

hours of a potential exposure and taken

for 28 days, it can decrease the

likelihood that a patient becomes

infected, Draughon said. Because of the

time sensitivity, Draughon and her

study team of forensic nurses recruited

patients at their acute post-assault

exams. Participants were then contacted

via e-mail with instructions on how to

access the Web-based survey. Over the

course of a year, 21 patients completed

the survey out of the 32 who were

recruited for the research project.

‘‘This was a very ambitious research

undertaking that would not have been

possible without the funding from the

ENA Foundation and STTI,’’ Draughon

said. ‘‘With both the findings from this

study, as well as lessons learned from

using the new method of Web-based

surveys for the sexual assault population,

we will be able to improve patient care

and future research studies.’’

Draughon’s findings showed many

of the participants were concerned

about STDs but not necessarily HIV,

and they were unaware that HIV nPEP

was an option. From the interviews, she

found that most participants became

overwhelmed and almost retraumatized

when told about the medication

because they hadn’t considered their

HIV risk. By giving patients enough

information about HIV nPEP, Draughon

said, they were able to choose whether

they wanted to begin the medication

regimen — a choice that allowed them

to regain and assert a sense of control.

‘‘One aspect of my findings that I’ve

been sharing with various programs in

the area is that as the provider, you

may be the first person telling them that

they may have been exposed to HIV,’’

Draughon said. ‘‘It is not a position that

anyone wants to be in, but at the same

time, your patient deserves to know

that.’’ She said some nurses admitted

discomfort in talking about HIV and the

medication option with patients.

‘‘As emergency nurses, it is important

Continued on next page

September 201312

Thank you to the following organizations for

their generous support.

The ENA Strategic Sponsorship Program was designed to create partnerships with

leading organizations whose objectives include supporting the emergency nursing profession.

STRATEGIC SPONSORS

STRATEGIC SUPPORTERS

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to educate ourselves and our patients about the current

available treatments so that we can give our patients accurate,

unbiased information so they can make informed decisions

about their own health care,’’ she said.

Providing HIV nPEP isn’t something an individual nurse can

facilitate if his or her hospital does not provide the medication,

but Draughon said it’s still important to discuss treatment

options with patients and to refer them elsewhere if you

believe a patient is at risk. Every hospital has a protocol when

an employee is exposed to HIV, but not every hospital has a

protocol in place when a patient has been exposed, she said.

Draughon believes her research study can advance the

specialized practice of emergency nursing.

‘‘As a subspecialty of emergency nursing, forensic nurses are

often current or former emergency nurses themselves,’’ she

said. ‘‘Currently, there is a lack of best-practice guidelines for

provision of HIV nPEP following sexual assault. This is an

opportunity for forensic nurses and emergency nurses to work

together at both a policy and practice level to create working

guidelines so our sexual assault patients are able to receive

nPEP if it is both warranted and desired.

‘‘ENA Foundation research grants allow nurses at all levels

to expand their horizons and begin new lines of investigation.

This is an opportunity to impact care for future patients. Even

though patients who have experienced sexual assault are at an

extremely vulnerable juncture when they come to the ED for

care, they deserve to have a voice.’’

The ENA Foundation’s research grants and educational

opportunities are made possible by the generous donations of

individuals, state councils, local chapters and friends of

emergency nursing. Your donation helps to provide funding for

research that can improve the quality of patient care and

advance the profession. Please visit www.enafoundation.org

to find out how you can make a difference.

Continued from previous page

Official Magazine of the Emergency Nurses Association 13

MOMENTUM TO THE MAXENA annual conferences provide

a valuable opportunity to gain

inspiration from keynote

speakers, learn new information in

educational sessions, network with

peers in your profession and reconnect

to your passion.

But does your excitement still run

high when you return home, or do

you find your enthusiasm dwindling as

you get back into your routine?

‘‘Everyone comes home fired up

and ready to take action,’’ said Brian

Ericson, RN, BSN, CEN, ‘‘but there are

times when you come back from

conferences ready to make changes

and then you run into resistance from

colleagues or administration, or you

have day-to-day projects that just

sweep the post-conference buzz right

under the rug. Keeping that

momentum is awesome for emergency

departments and needs to be there on

a regular basis.’’

This year’s Annual Conference will

be held Sept. 19-21 at the Gaylord

Opryland Resort and Convention

Center in Nashville, Tenn. Although it

may be challenging to maintain the

same excitement after returning to

obstacles in your ED, here are five

ways to keep the momentum going.

Stay Tuned In

Ericson, clinical lead ED nurse at

Mercy Hospital in Portland, Maine,

says he uses various facets of social

media to stay inspired.

‘‘One of the ways I manage to keep

that momentum is through podcasts,’’

he said. ‘‘On my way to work, I tune

in to either personal development or

leadership podcasts or emergency

medicine podcasts. I find this very

exciting, and it keeps that buzz of

excitement within me that I always

bring home from ENA national

conferences. Emergency medicine

podcasts help me stay ahead of what’s

new in my profession, and leadership

and personal development podcasts

really can motivate you just like the

inspirational speakers at conferences.

Everybody needs a little daily dose to

keep the fires burning.’’

Share What You LearnedBecause there is so much to learn at

conference, Briana Quinn, MPH, BSN,

RN, ENA senior associate for wellness

injury prevention, recommends taking

a proactive approach to deciding what

and how to share when you get home.

‘‘Before you go to conference,

determine how you will present the

information you have learned to your

department,’’ she said. ‘‘Will you place

some information in a department

newsletter, post to a bulletin board, have

a daily huddle or create a more formal

presentation? Have time carved out of

your post-conference schedule to sit

down and prepare your presentations,

posters or bulletin boards so that the

education is fresh in your mind.’’

After determining a plan, set up a

By Kendra Y. Mims, ENA Connection

Continued on page 28

After Annual Conference in Nashville, Here’s How You Can Stay on a Roll

September 201314

What’s Happening at ENAUPDATE FROM THE EXECUTIVE DIRECTOR | Susan M. Hohenhaus, LPD, RN, CEN, FAEN

Advance Emergency Care at Home and AbroadENA was represented at 21 different

liaison meetings, including four

meetings in Mexico, Australia, Canada

and Spain. Domestic relationships

continue to be strengthened by

collaborating with our colleagues at the

American College of Emergency

Medicine, the National Association of

Student Nurses, the American Hospital

Association and various federal

agencies, including the Health

Resources and Services Administration

(see sidebar below).

ENA’s social media presence

continues to grow. Our Facebook page

had 22,279 “likes” (11 percent increase

vs. Q1) with a peak total reach of

26,428 users per week; 19 percent of

followers are international. ENA’s

Twitter account has 2,743 followers (2.7

percent increase vs. Q1); 29 percent of

our tweets get retweeted. Individuals

from more than 30 countries have made

multiple visits to ENA President JoAnn

Lazarus’ blog, which had 9,489 views

since launching in January. Finally,

ENA’s LinkedIn page has 7,095

members (12 percent increase vs. Q1).

To better serve members and

develop new products, seven new staff

members were hired in Q2, including a

director of marketing, a second

instructional designer, Member and

Course Services representatives and

nurse specialists for American Nurses

Credentialing Center approval-unit

issues and quality and safety.

Define, Identify and Advocate for a Culture of Safe Practice and Safe Care; Champion a Culture of InquiryENA’s government-relations staff

continues to network and represent

ENA and emergency nursing on Capitol

Hill and assist states with legislative and

regulatory issues. In Q2, Richard Mereu,

chief government relations officer, had

a total of 16 congressional meetings and

five congressional hearings in addition

to assisting ENA state leaders with more

than 100 ENA Day on the Hill meetings.

Meetings included conversations with

Rep. David Joyce (R-Ohio) and Rep.

Lois Capps (D-Calif.), co-chairpersons

of the 113th Congressional Nursing

Caucus.

ENA signed on to four letters of

support, including a letter to the House

and Senate appropriations committees

to provide sufficient funding for the

Emergency Medical Services for

Children program in fiscal year 2014.

ENA also co-signed a letter from the

Health Professions and Nursing

Education Coalition to the House and

Senate appropriations committees

recommending $520 million for Title VII

health professions and Title VIII nursing

workforce development programs in FY

2014. Four press statements were issued

and can be found at www.ena.org.

Staff relationship-building resulted in

ENA being formally accepted into The

Nursing Community (www.

thenursingcommunity.org) in April.

On the state level, Ken Steinhardt,

director of government affairs, has been

working with state councils on issues

related to workplace violence, title

protection and state advocacy grants.

Champion a Culture of Inquiry, Learning and CollaborationENA’s institutes are hard at work

scanning the health care landscape and

responding to the needs of emergency

nurses everywhere.

The Institute for Emergency Nursing

Education continues its work on the

latest version of the Emergency Nursing

Pediatric Course by analyzing test

questions (a process typically conducted

at the nine-month mark after a course

launch) and reviewing feedback from

the initial phases of the revised course.

TNCC 7th edition revisions are well

Quarter 2, April - June 2013ENA headquarters continues to be a very busy and productive place. In the second quarter of 2013, the

staff continued to work with the ENA Board of Directors, committees and work teams to operationalize

the second year of the ENA strategic plan. The four organizational priorities remain the focus for our work.

ENA and Dr. Mary Wakefield, HRSA AdministratorIn May and July, ENA leaders participated in calls and meetings with Dr. Mary

Wakefield, Health Resources and Service Administration administrator, to

discuss the importance of emergency nurses in the implementation of the

Affordable Care Act.

Wakefield said emergency nurses are critical to the program’s success

because ‘‘you are the ones who have contact with a significant number of

uninsured patients. You have the opportunity to inform these patients about

how to enroll and how to gain access to primary care.’’

For more information, check out www.HealthCare.gov, www.facebook.

com/Healthcare.gov on Facebook and @HealthCareGov on Twitter.

under way, with pilot activities

scheduled for the ENA Annual

Conference in Nashville, Tenn. The new

interactive Geriatric Emergency Nurse

Education Program is in its final

instructional-design stages, with a launch

scheduled for this fall.

The Institute for Emergency Nursing

Research is working on several studies,

including ED workplace violence,

educational needs of emergency nurses

in rural and critical-access hospitals and

catheter-associated urinary tract

infections.

The Institute for Quality, Safety and

Injury Prevention facilitates the awards

processes, including the Lantern Award,

and coordinates most of the work of

more than 30 ENA committees. Twelve

of these committees met at ENA

headquarters during Q2. Work on

nursing quality indicators and

development of topic briefs and position

statements are shared with state leaders

through an IQSIP newsletter.

ENA’s courses are very strong in

2013. In the first two quarters, 3,323

TNCC courses were conducted, with

more than 23,000 participants. ENPC

courses numbered 1,264, with 7,192

participants.

Expand and Fortify MembershipAt the end of June, ENA’s membership

was holding steady at 40,059, ahead of

the same time in 2012. ENA added

more than 80 new student members at

the NSNA meeting in April, the largest

membership drive in ENA-NSNA

history, thanks to the work of ENA staff

and Lazarus, who met with and

engaged students in the exhibit hall.

ENA also is conducting member surveys

related to military membership and

developing programs and resources for

career wellness for emerging

professionals and emerging leaders in

emergency nursing.

Looking AheadThe new ENA website is mobile friendly

and contains enhanced search function

capabilities. Video-conferencing

hardware and software are being

updated to allow for enhanced virtual

meetings.

ENA’s conference team is focused on

developing content and activities for

Leadership Conference 2014 (Phoenix)

and the 2014 Annual Conference

(Indianapolis) and for the new

combined 2015 conference in Orlando,

Fla. The IENE is working with the

development team to explore

educational opportunities for advanced-

practice and new-graduate nurses. The

IENR continues to explore opportunities

for grant funding through federal grant

applications as well as with our

corporate partners.

ENA staff thanks our members and

emergency nurses everywhere for your

continued membership and engagement

in public policy and emergency nursing

education. We are strong, healthy and

open to exploring new and innovative

opportunities to promote and protect

the practice of emergency nursing.

Official Magazine of the Emergency Nurses Association 15

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September 201316

Most nurses don’t own stethoscopes in

Vietnam.

Mickey Guerrero discovered this

when she arrived for her first medical

mission trip with the Good Samaritan

Dental and Medical Ministry in 2009.

Over the course of her first week,

Guerrero, BSN, RN, clinical supervisor

of the emergency department at Valley

Hospital Medical Center in Las Vegas,

and five other emergency nurses from

the United States provided training for

80 nurses in Hue, Vietnam, focusing on

nursing skills related to cardiac,

respiratory and abdominal emergencies.

They quickly realized there are

significant differences between nursing

practice in the U.S., which is often

driven by state nurse practice acts, and

the practice of Vietnamese nurses,

where the head nurse of each hospital

determines nursing scope of practice.

‘‘We found our Vietnamese nurse

colleagues have an incredible desire to

learn from U.S. emergency nurses,’’

Guerrero said. ‘‘Although they didn’t

have the same responsibilities as U.S.

nurses, they love caring for their

patients and will do anything in their

ability for them.’’

Guerrero fell in love with the

country, the people and the culture. She

eventually was asked to be the nursing

adviser for the Good Samaritan Dental

and Medical Ministry’s Emergency

Medicine Committee & Advisors.

As chairperson of the nursing

conference in Vietnam, held annually in

March, she is in charge of organizing

the event and selecting the topics.

Because she developed relationships

with the nurses in Vietnam and keeps

in touch with them through Facebook,

she is able to find out what training

they need. Per their request, the nursing

conference this year in Hanoi focused

on trauma, including pediatric trauma,

abdominal trauma and more.

‘‘We found that a primary cause of

death in Vietnam is injury from

small-vehicle crashes or incidents

— mostly, everybody there uses motor

scooters or bicycles as the main mode

‘SUCH AN AMAZING THING’Medical Missions Bring Vietnamese Nurses the Extra Training They Seek

By Kendra Y. Mims, ENA Connection

Top: Mickey Guerrero, BSN, RN, (rear, left) poses with some of the 100-plus nurses attending a conference by the Good Samaritan Dental and Medical Ministry in Hanoi, Vietnam, in March. Above: A nurse tests her new stethescope on Guerrero.

Continued on page 18

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September 201318

ADVANCE THE FUTURE OF EMERGENCY NURSING

Our mission is to provide educational scholarships and research grants in the discipline of emergency nursing.

DONATE NOW! www.enafoundation.org

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of transportation,’’ Guerrero said.

‘‘Neurological injuries and orthopedic

injuries are two causes of injury and

death. We focused on teaching

hands-on ways to assess injured

patients and how to bring that

information to the physicians to provide

the best possible care.’’

Guerrero and her nurse colleagues

use specific textbooks to create their

lectures because they want to make

sure the resources they present are of

the highest quality. She also wants the

training to be evidence-based, not

opinion-based — one of the criteria

Guerrero makes sure all nurses adhere

to when they submit their conference

presentations for review. All of the

nurses who travel to Vietnam to teach

emergency nursing with Guerrero must

refer to ENA textbooks and the

Textbook of Adult Emergency Medicine

by Dr. Peter Cameron as resources in

their lectures.

The conference is split into two

parts; the lecture portion takes up half

of the day, and the remainder focuses

on hands-on learning.

‘‘We teach them that the most

important person in the room is the

patient,’’ Guerrero said. ‘‘The doctor,

nurse and the patient’s family are all a

Donated stethescopes are unpacked before being given to the nurses in Hanoi. The Good Samaritan Dental and Medical Ministry distributes more than 120 stethescopes per year — one for every nurse who attends its training conference — in addition to educational materials and other nursing gifts.

Vietnamese Nurses Continued from page 16

Continued on page 20

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September 201320

team working together to care for

the patient and bring the patient

back to optimal health.’’

The conference grows every year.

During the last visit, Guerrero, along

with 12 to 15 emergency nurses,

taught 120 Vietnamese nurses,

rotating through different areas in the

country. In the last couple of years,

bigger cities have taken notice of the

training and are asking for their own

conferences. This year, the lectures

and hands-on labs in Hanoi were

recorded and sent to remote areas.

‘‘The work we’ve put into our

nurses’ conference and the

physicians’ conference, which

happens at the same time, has

highlighted the importance of

emergency nursing and emergency

medicine,’’ Guerrero said. ‘‘For the

first time this year, the ministry of

health officially recognized

emergency medicine as a specialty

and has started the first official

physicians training program for

emergency medicine. Additionally,

the Hanoi University of Medicine

and Pharmacy school has its first

emergency nurse training course.’’

Guerrero gets excited when

nurses contact her to share how the

training from the conference has

helped them transform their practice.

When Guerrero returns from her

medical mission trip, she is

spiritually full, with a renewed

passion for her profession.

‘‘We deal with challenges in the ER

that can be a burden on your soul,’’

she said. ‘‘It’s so amazing to come

home energized with a real purpose

of what you’re doing. It reaffirms why

you’re an emergency nurse.

‘‘One of the nurses sent me a

message that her dad’s heart had

stopped beating. She did CPR on her

dad based on what we had taught

her, and her dad lived. It’s such an

amazing thing.’’

Vietnamese Nurses Continued from page 18

With Annual Conference right around

the corner, we have been working

feverishly to help ensure that we

provide you with the best conference

experience possible.

For the first time at an annual

conference, we are providing the

Annual Conference app, which you will

be able to use soon. For those

unfamiliar with this technology, the app

provides the ability to access session

and speaker information, as well as any

additional handouts. It also features an

alert system for any last-minute

conference changes.

Social media also will play a huge

role at conference. Follow along on

Twitter and Facebook with the

conference hashtag of #ENAAC13. We

have other exciting items in store for

attendees, including photo and video

updates using Instagram.

Last but certainly not least, I will be

on hand at ENA Wired to showcase the

recently launched ENA and ENA

Foundation websites and to answer

your questions. I look forward to seeing

you all in Nashville!

By Thomas Barbee, ENA Digital Marketing Manager

New App Will Let You Keep Conference a Touch Away

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2013 Lantern Award RecipientsENAispleasedtoannouncetherecipientsofthe2013LanternAwards.Recipients will be recognized Sept. 21 at the Annual Awards Gala at the 2013 AnnualConferenceinNashville,Tenn.

• AkronGeneralMedicalCenterEmergencyDepartment(Akron,Ohio)

• BethesdaNorthHospitalEmergencyDepartment(Cincinnati)

• Bon Secours Richmond Community Hospital Emergency Department (Richmond,Va.)

• Children’sHealthcareofAtlantaEmergencyDepartment,EglestonCampus (Atlanta)

• Children’sHospitalLosAngelesEmergencyDepartment&Level1 PediatricTraumaCenter(LosAngeles)

• TheMedicalCenterofAuroraEmergencyDepartment(Aurora,Colo.)

• OSFSaintFrancisMedicalCenterEmergencyDepartment(Peoria,Ill.)

• St. Anthony Hospital Emergency Department (Lakewood,Colo.)

• VirginiaHospitalCenter Emergency Department (Arlington,Va.)

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September 201322

Viral exanthem refers to a generalized

cutaneous eruption (rash) that is

associated with an acute viral syndrome.

Respiratory viruses, such as respiratory

syncytial virus and influenza, have been

linked to nonspecific exanthems. While

a nonspecific diagnosis can be

frustrating to caregivers who bring their

children to the emergency department,

the good news is that most viral

exanthems resolve after several days

without complications or interventions.

Treatment is usually symptomatic and

supportive, focused on keeping the

child comfortable and avoiding

dehydration, which is a specific concern

when painful lesions are present in the

mouth or throat.

Although many viral exanthems

cannot be linked to a specific diagnosis,

a few are easier to identify because of

their presentation or their prevalence.

The following are a few that are likely

to be seen in pediatric patients.

(Information on specific rashes, unless

otherwise noted, is based on content

from Pediatric Emergency Medicine.1 )

Roseola infantum (often caused by

human herpesvirus 6, also known as

sixth disease) is one of the most

common viral exanthems, most

predominant in children age 6 months

to 3 years. One study found that roseola

was responsible for 24 percent of ED

visits by infants between age 6 and 9

months.2 The classic course of

symptoms includes a high fever lasting

three to seven days in a well-appearing

child, with a rash that appears, with

fever cessation up to two days later.

Other symptoms include runny nose,

cough, sore throat, otitis media and eye

redness. The fever often comes on

suddenly; febrile seizures have been

noted at onset in up to 36 percent of

cases. Roseola is most prevalent in the

spring but can occur at any time of

year. The rash usually fades within a

week, and complications from roseola

are uncommon.

Coxsackievirus (hand-foot-mouth

disease) is characterized by a sudden-

onset papular rash that progresses to

quickly rupturing vesicles. The lesions are

typically present in the oral mucosa,

palms of the hands and soles of the feet.

They less often appear on the dorsal

surfaces of the hands and feet and the

buttocks and perineum. The child is

usually well appearing. Other symptoms

which precede the rash may include

low-grade fever, abdominal pain, cough

and malaise. The virus disappears by day

seven after infection and is most

prevalent in late summer and early fall.

The oral lesions are painful, so

dehydration is a common complication,

especially in younger children. Pain

control is key; anesthetic mouthwashes

are often used along with acetaminophen

or ibuprofen to support oral intake. Other

complications are uncommon but may

include risks to the fetuses of pregnant

women in their first trimester.

Fifth disease (caused by human

parvovirus B19, also referred to as

erythema infectiosum) is known for a

fiery redness that begins on both cheeks

(slapped-cheek appearance), typically

followed by a more generalized,

non-pruritic macular rash one to four

days later that fades into a lacy,

web-like pattern. Other symptoms may

include low-grade fever, headache, sore

throat, myalgias, nausea and malaise.

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

Common Viral Rashes Affecting Younger Patients

Official Magazine of the Emergency Nurses Association 23

Fifth disease is most prevalent in winter

and spring and most common in children

age 4 to 10 years. The rash, which

typically lasts three to five days but can

continue for up to four months, waxes

and wanes in intensity based on activity

and environmental conditions.

Complications are unusual in healthy

children. However, since the parvovirus

responsible for fifth disease replicates in

erythroid bone-marrow cells, it can cause

serious complications in patients with

hemolytic anemias or immunocompro-

mise, including infants under age 1.

These patients may develop aplastic crisis

in which their blood counts drop to

dangerously low levels. Pregnant women

exposed to fifth disease are at risk for

fetal loss, especially in the first 20 weeks

of gestation.

Varicella (chicken pox, caused by

human herpesvirus 3) is characterized

by a highly contagious, abrupt-onset,

intensely pruritic vesicular rash that

occurs primarily in children ages 2 to 8

years. Other symptoms that typically

precede the rash may include low-grade

fever, malaise, headache, cough and

sore throat. Varicella is most prevalent

in late winter and early spring. The rash

begins as faint macules, which progress

within 48 hours to delicate vesicles with

a dew-drop appearance. Lesions vary in

number from 10 to more than 100,

appear in crops over the first few days

and disappear within 10 days.

Treatment is focused on comfort

measures, such as decreasing pruritis

and minimizing the risk of secondary

infections, which are the main

complication. Children younger than 6

months or older than 12 years with

varicella are at risk for more severe

disease and may be treated with oral

acyclovir. Although uncommon,

involvement of a few specific areas

such as the eyes can lead to permanent

damage.

It is important for nurses who assess

children to be familiar with common

pediatric rashes and to know which

rashes may be more serious or life-

threatening. The Emergency Nursing

Pediatric Course supports this and

provides information on childhood

rashes. The associated history and

symptoms, in addition to the rash itself,

help to establish the source of rashes.

Information such as exposure to ill

children or adults, a history of tick and

other insect bites, recent antibiotic use,

presence of itching, environmental

exposures and prior immunizations will

provide answers which can offer clues as

to whether the rash is viral.

References

1. Baren, J. M, Rothrock, S. G., Brennan,

J. A., & Brown, L. (Eds.). (2008).

Pediatric emergency medicine.

Philadelphia, PA: Saunders Elsevier.

2. Marcdante, K. J., Kliegman, R. M.,

Jenson, H. B., & Behrman, R. E. (2011).

Nelson essentials of pediatrics (6th ed.).

Philadelphia, PA: Saunders Elsevier.

Don’t miss this exciting event! What began as a simple radio broadcast in 1925 is now a live-entertainment phenomenon. Dedicated to honoring country music’s rich history and dynamic presence, the Grand Ole Opry showcases a mix of country legends and the contemporary chart-toppers who have followed in their footsteps.

Register now at: www.ena.org/ac

JOIN US FOR A NIGHT OF COUNTRY MUSIC & NETWORKING WITH YOUR COLLEAGUES!

SEPTEMBER 20 • 7 PM

SUPPORT ENA FOUNDATION AT THE ENA 2013 ANNUAL CONFERENCE IN NASHVILLE, TN, AND

ENJOY THE SHOW THAT MADE COUNTRY MUSIC FAMOUS

A NIGHT AT THE

GRAND OLE OPRY™

AC13 Foundation Events Opry Ad_Connection_Half_08 2013.indd 1 7/2/13 2:04 PM

September 201324

Newer Ways of Reaching Safe Practice, Safe Care

BOARD WRITES | Joan Somes, PhD, MSN, RN, CEN, CPEN, FAEN, ENA Board of Directors

Recently, while orienting a new nurse, I

was asked, ‘‘Can’t you just download all

the emergency nursing knowledge from

your brain into my brain?’’ For a few

seconds I thought, ‘‘Wow! That would

make orientation easier!’’

Then reality struck. I replied, ‘‘More

would need to be deleted than

downloaded for that to be useful!’’

But it caused me to reflect on how

things have changed over the 40 years I

have been working in the emergency

department.

When I started, the ED was just one

room. Documentation was on paper,

and vital signs were done ‘‘as condition

needed.’’ Blood pressures were taken

manually, and every nurse wore a

closely guarded stethoscope. The

cardiac monitor had a teeny screen with

a small dot of light bouncing up and

down to show the rhythm. There was

no way to ‘‘run’’ a rhythm strip.

There also was no telemetry to the

nurses’ station. If you were

documenting the patient’s rhythm using

the electrocardiograph machine, it was

important to disconnect the ECG

machine if the patient needed to be

defibrillated or the machine would

‘‘short out.’’ Twelve lead ECGs were

obtained by moving a small suction cup

across the chest, recording one lead at

a time, leaving six little red circles on

the chest.

Intravenous needles were bare metal

and secured with the hope that the arm

board would prevent the patient from

moving the extremity and dislodging

the IV. Safety/self-sheathing needles

were unheard of in those early years.

All IVs were in glass bottles and

ordered as ‘‘continuous intravenous

access.’’ They also had to run at least at

30 mL per hour or they would ‘‘clot

off.’’ Big-drip tubing had 10 to 15 drips

per mL; mini-drip tubing had 60 drips

per mL. Nurses counted the number of

drips per minute.

It was a great help when the nurses

would put marks on a piece of tape

and attach the tape to the IV bottle to

identify where the fluid level should be

each hour. There were no pumps or

pump libraries. There were pre-printed

stickers to put on the glass bottles of IV

fluids that identified the drug added by

the nurses and the most common

number of drips per minute to give the

correct dosage.

Medications such as Levophed (that

was our pressor in those days), lidocaine

(the anti-arrhythmic of choice) and

Joan Somes when she first started in emergency nursing in the early 1970s.

Continued on page 26

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September 201326

Become a 2014 Annual Conference Faculty Member Today

Submissions due Monday, October 14, 2013

Share your knowledge in Indianapolis with an international audience of emergency nurses.

Presentations in multiple course areas and course lengths are needed.

2014 Annual Conference ¡ Indianapolis, IN ¡ October 7-11, 2014

For full details including course areas, criteria and submission form, please visit www.ena.org.

For questions, email conferences@ena.org or call 847-460-4117.

AC14 Call for Faculty_Connection Ad_half_09 2013.indd 1 8/1/13 2:34 PM

heparin were placed on a mini-drip

tubing and counted for a full minute to

ensure the correct dose was going into

the patient. Medications such as

aminophylline and Rhenytoin were

given directly IV push into the vein

over a couple minutes.

Gloves were for sterile procedures or

really nasty stuff. The mercury-filled

thermometers were soaked in zephiran

chloride to sterilize between patients.

Smoking was allowed in the nurses’

station and the patient rooms unless the

patient — or his or her roommate

— was on oxygen. The emergency

physician needed good reason to admit

a patient to a private room.

Chest tubes were connected to a

system of three bottles, each about a

gallon, located in the base of a loud,

humming suction machine that took up

about a square yard of floor space.

Nurses routinely ‘‘stripped’’ chest tubes

by grasping the tubing coming from the

patient’s chest to stabilize it and then

squeezing and sliding their thumb and

first finger down the tubing to create a

negative pressure in the tubing. The

purpose was to clear the tubing, even if

there was only air coming from the

chest tube.

If a patient was shocky, there were

4-by-4-inch blocks of wood that the

nurse could place under the legs at the

Newer Ways Continued from page 24

Resources for emergency nurses today include guidelines, practice references, toolkits, free CE and much more at the ENA website.

Official Magazine of the Emergency Nurses Association 27

It’s back-to-school season.Hit the books now.

Earn your BCEN® specialty certification.

Create your own study plan and get started! BCEN offers Prep Exams and resources to help you prepare.

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

nursing care and professional advancement.

Learn more…www.BCENcertifications.org

Visit BCEN at ENA 2013 – Booth #655

BCEN ENA HalfPg Color Ad.9.13.indd 1 7/23/13 7:39 AM

foot of the bed to raise it about six

inches to put the patient into the

Trendelenburg position.

Every patient with chest pain got a

bolus of lidocaine and a lidocaine drip

to ‘‘prevent arrest,’’ and if the patient

did arrest, he or she immediately

received two ampules of sodium

bicarbonate IV push. The ‘‘thumper,’’ an

oxygen-powered device, was used to

do chest compressions in 1974.

Written discharge instructions were

rare. The physician would tell the

patient what to do and generally not in

terms that a layperson would

understand.

Emergency care has changed

significantly over the years. ENA is 41

years old; the American College of

Emergency Physicians is 45 years old.

The first National Registry of

Paramedics exam was administered in

1978. Nurse, physician and paramedic

groups have all worked to improve

emergency patient care over the years.

Patient care guidelines and protocols

are now evidence-based, standardized

and constantly being re-assessed for

safety and improved patient care.

Patient assessment skills and safety

precautions have increased, becoming

an integral part of patient care.

Equipment has been developed to

eliminate much of the guesswork and

provide for safer patient care, not only

for the patient, but for those providing

care for the patients.

ENA has done much to identify the

need for information and to develop

and disseminate this information to help

improve emergency care and safety in

the emergency department. Evidence-

based clinical practice guidelines,

practice references and topic briefs can

be found on the ENA website. The ENA

Institute for Quality, Safety and Injury

Prevention area has many links to solid

practice suggestions, as well as

educational materials, and the Institute

for Emergency Nursing Education offers

free CE. There’s information about ENA

conferences, which offer more learning

opportunities about safe practice, safe

care. Toolkits are also available to help

emergency nurses assess EDs for

violence and to identify patients who

are at risk of being driving-impaired or

are considering suicide.

I wish I’d had access to some of this

information when I started out as an

orientee all those years ago. I now

begin orientation for my new nurses by

taking them to www.ena.org. One

click and I can provide them with

current evidence-based and practical

information.

As these new nurses start to

download information and gather data

on safe practice, safe care, they don’t

need to sort and delete a bunch of

practices that were shown over the

years to be lacking any evidence. They

will download much more useful data

from ENA than they would from my

brain.

September 201328

meeting with a department educator

and leadership to report back on what

you’ve learned.

‘‘Have bullet points prepared, and

discuss what you learned in each

session and any networking

opportunities that you engaged in that

can impact the department,’’ Quinn

said. ‘‘Before the meeting ends,

schedule a plan for a follow-up meeting

to decide if there are any new

initiatives, projects or education that

your department might undertake based

on what you just presented. Make this

second meeting a productive one, with

a proposal and draft timeline for these

new potential educational opportunities

or initiatives.’’

Create a List of GoalsChoose several things you learned from

conference, then write a plan of action,

along with a timeline of how you will

achieve and implement your goals. A

few tips from Quinn:

• Consider something new: While

many sessions will address the specific

educational goals you have for yourself

and your department, pick a topic that

could hold potential for a new line of

thinking for both yourself and your

department.

• Go into each session with a

goal and a purpose: Look at the

sessions a couple of times before

conference, and talk to your department

leadership about them. Find a

combination of sessions that address

specific issues or concerns you have in

your department or areas where you

would like your department to grow.

Also, find some sessions you feel would

address your educational goals or

enrich your career path.

• Take good notes: Before

conference, note the sessions you

would like to attend, the reasons why

you would like to attend and what

questions you would like answered.

When attending the session, take notes

that can be categorized as ‘‘for personal

growth’’ or ‘‘for departmental growth.’’

As the session winds down, look at the

questions you wrote in advance. If

some relevant questions were not

addressed, speak up at the end of the

session.

Get Plugged In

Another way to keep your momentum

after conference is to stay educated on

what’s happening in your association.

Visit the new ENA website (www.ena.

org) to get information about upcoming

events, learn more about online

educational products (ENA members

are encouraged to take advantage of

the free continuing education courses

available), use ENA practice resources

such as the Workplace Violence toolkit

and subscribe to ENA’s public listserv

communities to engage in e-mail

discussion groups with other emergency

nurses. You also can check out ENA’s

Facebook page for up-to-date

information. Don’t forget to relive the

ENA Annual Conference experience by

reading the December issue of ENA

Connection, which will include photos

and highlights from sessions and

networking events.

Maintain Your Connections

Whether it’s attending an emerging

professionals event or a networking

session or chatting with someone in

between sessions or at the welcome

party in Nashville, be sure to build

relationships with your peers while

attending ENA national conferences.

When you return home, use social media

to stay connected to colleagues who

work at hospitals throughout the United

States or in other areas of the world.

Quinn also suggests discussing what

you’ve learned with a colleague over

lunch or dinner or while sight-seeing.

‘‘Conference is a wonderful

opportunity to network with peers and

have meaningful conversation,’’ she

said. ‘‘Make sure you incorporate the

education from the sessions into these

moments.’’

After conference is over, keep in

touch with others so that you can

continue to share what you learned,

swap ideas for solutions to common

problems and discuss how you have

implemented solutions in your

emergency department.

Code You Continued from page 13

Emergency Nurses...Everyday Extraordinary

www.ena.org/enweek

Emergency Nurses Week™

October 6-12, 2013Emergency Nurses Day®

Wednesday, October 9, 2013

EN Week Ad_Connection_full_10 2013.indd 1 7/26/13 2:44 PM

September 201330

Safe Work Environment Intensive

Thanks to all who attended the Safe Work Environment Intensive Workshop.Some of the featured topics were:

The Safe Practice: Workplace Violence Prevention portion of this event was sponsored by:

Safe Practice• Lateral Violence and Bullying• De-escalation Awareness• Advocacy

Safe Care• Risk Analysis• Team Safety• Medication & Procedural Safety• Liability in Emergency Practice

Safe Work Env Int 2013_Connection Ad_Half_09 2013.indd 1 7/25/13 2:50 PM

North Carolina ENA State Council Submitted by Mary Lou Forster

Resch, BSN, RN, CEN

The North Carolina State

Council is pleased to announce

the winners of its Martha Wood

Scholarship. They are Jeff

Strickler, MA, BSN, RN, CEN,

CFRN, who will be pursing his

doctorate, and Shellie Wilkins, RN, who will

be pursing her bachelor’s degree.

The North Carolina State Council also has

been involved in an injury-prevention

program in the Outer Banks, a popular

vacation location in the state. After

numerous accidents and several pedestrian

and bicycle deaths, the Outer Banks Bicycle

& Pedestrian Safety Coalition was formed in

January 2013.

The coalition aims to increase education

and awareness of bicycle and pedestrian

safety not only among drivers, but also

among pedestrians, bicyclists and residents

and visitors to the Outer Banks. The

coalition also has focused on international

students who come to the area to work for

the summer and frequently use bicycles as

transportation.

Outer Banks ENA Chapter member Roger

Dale, RN, CEN, is active in the coalition and

helped to develop educational videos,

brochures and stickers with other

volunteers, as well as posting information

through social media channels.

STATE CONNECTIONENA

Endorses ACEP

Wait-Time Statement

ENA agrees with and endorses the American College of Emergency Physicians policy statement “Standard for Measuring and Reporting Emergency Department Wait Times.” The policy statement can be found at www.acep.org by hovering on the “Clinical & Practice Management” tab, then clicking “Policy Statements” or by visiting tinyurl.com/kdujags.

Official Magazine of the Emergency Nurses Association 31

connectionRecruitment and

Professional Opportunities

For ad rates and information, contact ENA Sales Representative Maureen Nolimal at 847-460-4076 or Maureen.Nolimal@ena.org.

★

It’s an exciting time to join the Emergency Department at NYU Langone Medical Center, as our ED undergoes signifi cant transformation and growth. We are thoroughly upgrading and expanding our ED, more than tripling its size to over 22,000 square feet, and more than doubling the number of patient treatment positions on our team. We’ve involved clinicians in every aspect of planning the new space, to ensure that it maximizes effi ciencies while incorporating the most advanced, new technologies. Our expansion is driven by a dynamic leadership team committed to delivering quality care – and to supporting and enabling rewarding careers. In addition to signifi cant advancement and growth opportunities, we off er a generous tuition remission program, and access to continuing education. We are currently seeking:

Requires current NYS RN licensure, a BSN and a minimum of 2 years of recent ED or critical care experience; ED experience preferred. Psych ED opportunities require Psych experience; Psych ED experience preferred.

Hiring Bonus: $5,000 with two years of recent ED experience (Paid in increments over 1 year)

For additional nursing opportunities and information, please visit our website at www.nyulmc.org/careers or send resume to RNhires@nyumc.org.

It is the policy of NYU Langone Medical Center (“NYULMC”) not to exclude from participation, deny benefi ts to or engage in discrimination against any person employed or seeking employment or patient care on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity or expression, pregnancy, disability, ancestry, marital status, age, citizenship status, veteran status or any other category protected by law. The Nondiscrimination policy is available in Spanish, Chinese and Russian and will be made available through interpreting or translation services for other languages and deaf and hard of hearing individuals.

join the Emergency Department at NYU Langone Medical Center, as our ED undergoes signifi cant transformation and growth.ding our ED, more than tripling its size to over 22,000 square feet, and more than doubling the number of patient treatment pos

i t f l i th t th t it i i ffi i i hil i ti th t d d

exce��enceF I N D YO U R S E L F AT T H E C E N T E R O F

Experienced ED RNs11.5-hour nights

Psych ED RNs11.5-hour days & nights

Pediatric ED RNsFor our new Peds ED

ENA CONNECTION 9/1/20135159602-NJ98144NYULAM7.12” x 4.75”Romona Walcott v.3

WellnessCareerCenter

September 201332

After all the long hours,

you still smile, even at 4am.

Follow us on facebook.com/HCANorthandWestFloridaCareers

Connect with us: linkedin.com/company/hca-west-florida

Follow us on our blog: recruitingatHCAwest.com

EOE

The HCA Total Rewards program provides employees with financial and non-financial rewards – excellent pay, incentives, benefits, a healthy work environment and a variety of others – in an effort to create a valuable employment experience that best fits the needs of you and your family.

HCA North & West Florida Division is a family of award winning hospitals, serving sunny West, Central and North Florida and South Georgia.

Make the Best of Your Career at one of our exceptional hospitals and take advantage of our extraordinary benefits.

To learn more and apply, please visit either of our Divisions depending upon your location:

ʭ HCA West & Central Florida: www.MoreCareerChoices.com

ʭ HCA North Florida: www.MoreCareerChoices.com/NorthFlorida

Hiring ER RNs – Apply Today!

If you’re interested in joining our team, please visit

www.JPSNursing.org

JPS Health Network values highly motivated nurses who want to make a di�erence in people’s lives. Every team member �lls a vital role in providing compassionate care for the patients we serve. A major employer in the Fort Worth area, JPS is a teaching hospital and Level I Trauma Center.

Please visit our website for additional information. Contact Mekka Livingston, mlivings@jpshealth.org or 817-702-3836, to learn more about current nursing opportunities.

There’s no place likeJPS HEALTH NETWORK.

EMERGENCY CARE NURSE SUPERVISOR

EXAMINING PATIENTS USING LEADING–EDGE TECHNOLOGY

8:06AM

EXAMINING THE WONDERS OF THE OCEAN FLOOR

5:06PM

Join a multicultural staff dedicated to the highest standards of clinical

excellence at Saudi Aramco. Seize the opportunity to work in state–of–

the–art facilities designed for optimal patient care. Collaborate with elite

faculty to generate innovative strategies to enhance hospital efficiency.

Experience truly rewarding day–to–day activities. At Saudi Aramco Medical

Services Organization (SAMSO), enjoy a flexible schedule that offers

a chance to explore the wealth of activities offered in the Kingdom.

Advance your medical career while experiencing a work–life balance.

Saudi Aramco provides a chance to do it all.

DREAM BIG at www.Aramco.Jobs/ENA

September 201334

Vancouver IslandThe North

Join the hundreds of registered nurses in specialty practices who have moved to British Columbia, Canada to enjoy a quality of life that is envied around the world. Find out how our nurse recruitment services team can assist you in matching your lifestyle interests with exciting career opportunities. *Visit our website to view current opportunities.

Enrich your career. Enhance your quality of life.

healthmatchbc.orgHealth Match BC is a free health professional recruitment service funded by the Government of British Columbia, Canada

FIND A JOB IN BC

Discover the perfect place to call home.

Toll-Free: 1.877.867.3061 • Tel: 1.604.736.5920 • eMail: welcome@healthmatchbc.org*Priority vacancies are for registered Nurses with a minimum of 2 years full-time experience and currently practising in one of the following areas: Trauma intensive Care, Cardiac intensive Care, open Heart Surgery intensive Care, Neonatal intensive Care, operating room or Theatre, emergency room or accident & emergency, or Post anesthetic Care. Photos: Picture BC

Meet with our teamEmergency Nurses Association

Annual Conference

September 19 – 21, 2013

Gaylord opryland Hotel

& Convention Center

Booth: 906

Nashville, Tennessee

JoB #H104-14336 ClieNT: HealTH MaTCH BC

PuBliCaTioN: eNa CoNNeCTioNad: NurSe oPTioN

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Official Magazine of the Emergency Nurses Association 35

Go the distance at Memorial Hermann.

Choose from locations throughout Houston:• Children’s Memorial

Hermann Hospital• Katy• Memorial City • Northeast • Northwest (Inner Loop)• Southeast • Southwest • Sugar Land • Texas Medical Center • The Woodlands

EOE, M/F/D/V. No agencies, please.

Memorial Hermann is a world-class health system with locations throughout Houston and the surrounding areas. With benefits eligibility that begins the first day of employment, this is a great time to become part of our award-winning organization. Our team of more than 20,000 consistently votes us among Houston’s Best Places to Work Find out why—and take your career to a higher level.

Search current job openings at ENA.MH-jobs.org

CONTACT US

Toll-free1-866-441-4567

e-mailhotcareers@memorialmermann.org

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Challenging ER Nursing Careers!

2013 Annual Conference Walk for Wellness

to support the ENA FoundationFriday, September 206-7 a.m. – NEW time

Nashville, TN

The Walk for Wellness is a 1.2 mile walk, where the funds raised support the ENA Foundation

mission. Walkers are encouraged to raise $150 from their friends and family through social

media, e-mails and personal connections. Walk for your health and for the health of the profession.

Registration fee: $10.

To register or for fundraising information, visit www.ena.org/ac

Walk for Wellness Ad_Connection_Qtr_08 2013.indd 1 6/24/13 10:32 AM

Sponsored by

Join our Community!Are you a nurse who has practiced in an

emergency care setting for 5 years or less? If so, join one or more of our

Emerging Professionals social networking groups and connect with your peers. You will be able to

post discussion topics and share stories.Ready to get started? See below for details:

Facebook: http://on.fb.me/11XdCxv Google+: http://bit.ly/16FnAow LinkedIn: http://linkd.in/11MzNDn We can’t wait to have you join our communities

and look forward to seeing you at ENA’s 2013 Annual Conference for our Speed Mentoring Event

on Friday, September 20, 6-7 p.m. at the Opryland Hotel.

AC13 Emerging Professionals Ad_Connection_Quarter_08 2013.indd 1 7/2/13 9:34 AM

be happy.

You know us as recognized ED leaders who guide hospitals toward real and

effective change. Now we would like to get to know you. Blue Jay Consulting is

looking for professionals with the leadership insight and clinical experience to

bring process improvements to our clients, and the passion and commitment to

enhance the overall quality of emergency care. If you consider yourself among

the best in your field, you’ll find yourself in good company at Blue Jay Consulting.

Join the strongest team in the industry and... be happy.

www.bluejayconsulting.com

Contact Jim Hoelz or Mark Feinberg at 407-210-6570 to discuss how we can capitalize on

one another’s strengths.

“ As a Blue Jay consultant, I bring my 30 years of emergency department leadership experience to each client. Every assignment brings a unique set of challenges, but the tools to solve them are similar. We can often shorten the improvement process from years to months and create an environment that is better for patients, families and staff. I leave each assignment with a good feeling that I have left it better than when I arrived. I love being a Blue Jay consultant.”

— B I L L B R I G G S , M S N , R N , C E N , F A E N

Senior Consultant

Blue Jay Consulting, LLC

When you’re on the right team, happiness ensues.