the Official Magazine of the Emergency Nurses Association connection September 2013 Volume 37, Issue 8 THE AFTER BURN How to Keep Fanning Your Ideas and Energy Post-Conference CODE YOU, Page 13 INSIDE FEATURES 5 2013 Annual Award Recipients 6 Treasurer’s Report 16 Vietnamese Nurses Get Extra Training They Seek 20 Lantern Award Recipients LEADERSHIP CONFERENCE 2014 SAVE THE DATE March 5-9, 2014 Phoenix, AZ Phoenix Convention Center For the latest news on Leadership Conference 2014, visit www.ena.org Follow the action #ENALC14 *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. Dates to Remember 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. ENA Exclusive Content PAGE 5 ENA Annual Award Recipients PAGES 6 - 7 2013 Treasurer’s Report PAGE 8 The Affordable Care Act: More Patient Coverage Options PAGE 13 Code You: Keep Your Momentum Maximized after Annual Conference PAGE 14 Update From the Executive Director PAGE 16 Missions Giving Vietnamese Nurses the Extra Training They Seek PAGE 20 2013 Lantern Award Recipients PAGE 24 Board Writes: Newer Ways of Reaching Safe Practice, Safe Care Regular Features PAGE 4 Free CE of the Month Ask ENA PAGE 10 ENA Foundation PAGE 20 ENA Connected PAGE 22 Pediatric Update PAGE 30 State Connection LETTER FROM THE PRESIDENT | JoAnn Lazarus, MSN, RN, CEN The Importance of Saying Thank You 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. 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 Official Magazine of the Emergency Nurses Association 3 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: •G o 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.’’ •P roceed 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. •T o 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 [email protected] 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. 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 E-mail ‘‘Ask ENA’’ at [email protected] with questions about ENA and emergency nursing in general. 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 [email protected] with the subject line “Members in Motion.’’ POSTMASTER: Send address changes to ENA Connection 915 Lee Street Des Plaines, IL 60016-6569 ISSN: 1534-2565 Fax: 847-460-4002 Website: www.ena.org E-mail: [email protected] Member Services: 800-900-9659 Non-member subscriptions are available for $50 (USA) and $60 (foreign). Editor-in-Chief: Amy Carpenter Aquino Assistant Editor: Josh Gaby Writer: Kendra Y. Mims Editorial Assistant: Renee Herrmann Board of Directors Officers: President: JoAnn Lazarus, MSN, RN, CEN President-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, CEN Michael D. Moon, MSN, RN, CNS-CC, CEN, FAEN Sally K. Snow, BSN, RN, CPEN, FAEN Joan Somes, PhD, MSN, RN, CEN, CPEN, FAEN Karen K. Wiley, MSN, RN, CEN Executive Director: Susan M. Hohenhaus, LPD, RN, CEN, FAEN 2013 Annual Award Recipients ENA 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. Nurse Manager Award Suszanne Deyke, MSN, RN, CEN Barbara A. Foley Quality, Safety and Injury Prevention Award Kimberly Wright, BSN, RN Nurse Researcher Award Kathleen Flarity, DNP, PhD, CEN, CFRN, FAEN Behind the Scenes Award Robin Walsh, BSN, RN Clinical Nurse Specialist Award Pamela Bucaro, MS, RN, PCNS-BC, CPNP, CPEN Frank L. Cole Nurse Practitioner Award Andrew Galvin, ACNP-BC, CEN Nursing Education Award Leah Davis, BSN, RN, CEN Nursing Practice and Professionalism Award Rhonda Holmstrom, BSN, RN, CEN Rising Star Award Nicholas Nelson, MS, RN, CEN, CPEN, CPN, NRP Judith C. Kelleher Award AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN More Award News! Media Award Cheryl Tan Lantern Award recipients, Page 20 Team Award Forensic Nurse Examiner Team — Christiana Care Health System, Newark, Del. •Erica Dempsey, BSN, RN, CEN •Amy Drejka, MS, BSN, RN, SANE-A •Meghan Ellis, BSN, RN, CEN •Mary Kathleen Fillingame, BS, RN •Jennifer Henry, BSN, RN, CEN •Amy Hensel, BSN, RN, SANE-A, CEN •Donna Lougheed, BSN, RN •Angela McNulty, BSN, RN, SANE-A •Christi Mench, RN, SANE-A •Beth Miller, BA, RN •Noemi Miranda, RN •Jennifer Oldham, BS, RN, CEN •Kelly Green O’Shaughnessy, BSN, RN, CEN •Christine Parks, BSN, RN •Nicole Possenti, BSN, RN •Amy Stier, RN, CEN, SANE-A •Anita Symonds, MS, BSN, RN, SANE-A, SANE-P •Steaphine Taggart, BSN, BA, RN •Erin Vaughn, BSN, RN, SANE-A 0.5 mL each An Innovative Non-Aerosol Unit Dose Topical Anesthetic Spray • MeetsJointCommissionStandardforthemostready-to-administerformavailable.* • Fastonset.Shortduration.Virtuallynosystemicabsorption. • Utilizesbarcodemedicationadministration(BCMA)toaccommodatepoint-of-carescanning. • Virtuallyeliminatesadverseeventsresultingfrompreventablemedicationerrors,ensuringthe“5Rights” aremet:√RightDrug√RightPatient√RightDose√RightRoute√RightTime • Singleunit-of-usepackagingeliminatesthepotentialforcross-contamination. • Increasesbillingaccuracyandimprovessupplychaincosts. ORDERING INFORMATION NDC# AMERISOURCE BERGEN CARDINAl HEAlTH MCKESSON MORRIS & DICKSON LLC PRODUCT HurriCaineONE®UnitDoseNon-AerosolSpray Boxof2,0.017fl.oz.(0.5mL)each HurriCaineONEUnitDoseNon-AerosolSpray 0283-0610-26 048-868 CIN4363370 1411925 086629 Boxof25,0.017fl.oz.(0.5mL)each IfHurriCaineONEisnotyetavailablethroughyourwholesaler,requestitbynameandNDCNumber. *JointCommissionStandard:MM.05.01.11,EP4 0283-0610-11 048-855 CIN4362547 1410125 086611 Official Magazine of the Emergency Nurses Association MAKE THE SWITCH TODAY. Call1-800-238-8542toplaceyourorderorfor moreinformation.www.beutlich.com HurriCaineONEisaregisteredtrademarkofBeutlich® Pharmaceuticals,LLC.HOPA6260713B 5 2013 Treasurer’s Report By Matthew F. Powers, MS, BSN, RN, MICP, CEN, 2013 ENA Secretary/Treasurer and Edward M. Rylko, MBA, CPA, Deputy Executive Director 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 6 TABLE 1 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 September 2013 TABLE 2 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 Official Magazine of the Emergency Nurses Association 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. [email protected] or [email protected] 7 ENA ADVOCACY The Affordable Care Act: More Patient Coverage Options By Richard Mereu, JD, MBA, ENA Chief Government Relations Officer, and Ken Steinhardt, Director of Government Relations 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 8 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. September 2013 Less Running, More Patient Time A-SMART ® Broselow ColorCode™ Cart WIRELESS Auto-Locking Cart with optional Proximity Reader and Controlled Substance Drawer Visit Us At ENA Booth #706 Breakaway Emergency Cart Armstrong Medical A-SMART® Carts offer unmatched versatility and feature multiple locking options (Wireless Auto-Locking, Wireless Auto-Locking with optional Proximity Reader, Auto-Locking, Auto-Locking with optional Proximity Reader, Push-Button, Key Locking, Breakaway Locking), many cart and drawer sizes, and hundreds of optional accessories. Plus, all A-SMART® Carts are manufactured to ISO 9001:2008 certified standards, and all full-size A-SMART® Carts come with double side-wall construction, stabilizing frame with bumper, soft-grip handles, swivel casters (two locking, one tracking), and ball bearing drawer slides as standard features. The new-DUET™ is a completely selfcontained suction unit with AC power supply, battery back-up, and internal charger. It meets the American Heart Association recommendations for suction airflow of >30 LPM at the tip of the suction catheter, and the reduced maximum vacuum recommendations for infant or child suctioning of 80-120 mmHg. Armstrong Medical ©2013 Armstrong Medical Ind.,Inc. INDUSTRIES, INC. 800/323-4220 • FAX: 847/913-0138 www.armstrongmedical.com • [email protected] Helping Sexual Assault Victims Regain a Sense of Control Lessons Learned By an ENA Foundation Research Grant Recipient By Kendra Y. Mims, ENA Connection 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 ENA ANNUAL CONFERENCE through the process, then we might have a better idea of Jessica Draughon, MSN, RN 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 SEPTEMBER 19-21 2013 N A S H V I L L E, T E N N ESSEE REGISTER TODAY! Register at www.ena.org/ac or scan the QR code. Follow the action #ENAAC13 *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. 10 AC13 Ad_Connection_Half_09 2013.indd 1 7/25/13 2:51 PM September 2013 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 :00 seconds Patient enters emergency department :10 seconds Morgan Lens inserted :20 seconds Solution flows to eyes Clearly, time is of the essence. • “Hands-free”ocularirrigation–freesstaff • 100%ofsolutiontreatstheeye–nopooling • Eliminatesblinkingreflex • Usesolutionofyourchoice(MorTan recommends L.R.) • Patientrestscomfortablywitheyesclosed Discover why the best solution to pollution is dilution. www.morganlens.com | 800•423•8659 ©2013 MorTan, Inc., PO Box 8719, Missoula, MT 59807 USA Official Magazine of the Emergency Nurses Association 11 Continued from previous page 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.’’ Thank you to the following organizations for their generous support. STRATEGIC SPONSORS 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. STRATEGIC SUPPORTERS Congratulations to the nine 2013 inductees of the Academy of Emergency Nursing. Exciting plans are under way for the 2013 class of fellows induction during the Annual Awards Gala on Sept. 21 at the ENA Annual Conference in Nashville, Tenn. The ENA Strategic Sponsorship Program was designed to create partnerships with leading organizations whose objectives include supporting the emergency nursing profession. 12 Supporter Half Vertical Ad 05_2013.indd 1 6/20/13 11:09 AM Come join the fun! Awards Gala information is available at: www.ena.org/education/ conferences/annual/2013/Pages/Gala.aspx Questions? E-mail [email protected] September 2013 MOMENTUM TO THE MAX E NA 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 Official Magazine of the Emergency Nurses Association After Annual Conference in Nashville, Here’s How You Can Stay on a Roll By Kendra Y. Mims, ENA Connection inspirational speakers at conferences. Everybody needs a little daily dose to keep the fires burning.’’ Share What You Learned Because 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 Continued on page 28 13 UPDATE FROM THE EXECUTIVE DIRECTOR | Susan M. Hohenhaus, LPD, RN, CEN, FAEN What’s Happening at ENA Quarter 2, April - June 2013 ENA 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. Advance Emergency Care at Home and Abroad ENA 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 Inquiry ENA’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 ENA and Dr. Mary Wakefield, HRSA Administrator In 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. 14 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 Collaboration ENA’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 September 2013 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 Membership At 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 Ahead The 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 advancedpractice 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. RAPID RESPONSE– Time is Critical. RAPID RESPONSE Deliver Fluids and Drugs NOW with the EZ-IO.® EZ-IO® Driver and Needle Sets Vascular Access Driver EZ-Stabilizer EZ-Connect® 45mm Needle Set 25mm Needle Set 15mm Needle Set 1 2 Paxton JH, Knuth TE, Klausner HA. Proximal humerus intraosseous infusion: a preferred emergency venous access. The J Trauma 2009;67(3):606-11. Research sponsored by Vidacare Corporation. For alert and conscious patients responsive to pain, consider IO 2% lidocaine without preservatives or epinephrine (cardiac lidocaine). A Medical Director must authorize appropriate dosage range. In emergent situations when your patient needs drugs NOW and you don’t have time to get a difficult IV or resources for a Central Line, the EZ-IO® Intraosseous Vascular Access System gives you the edge, providing access with anesthesia and good flow in 90 seconds.1,2 • Cardiac Emergencies In rapid response, the EZ-IO® can make • Respiratory Emergencies the difference with patients presenting • Neurological Emergencies emergent challenges, such as: • Shock Emergencies Trust the vascular access system utilized worldwide by hospital and pre-hospital personnel for early goal directed therapy. Trust EZ-IO® – EZ-IO® puts time on your patient’s side. Click this QR Code for more information or go to: EZIORapidResponse.com As with any vascular access site, the IO insertion site should be monitored frequently. IO should only be used when landmarks can be clearly identified. Intraosseous Access is recommended by the AHA, ACEP, INS, ENA, AACN and more. Official Magazine of the Emergency Nurses Association 15 ‘SUCH AN AMAZING THING’ Medical Missions Bring Vietnamese Nurses the Extra Training They Seek By Kendra Y. Mims, ENA Connection 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, 16 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. 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 Continued on page 18 September 2013 AGGRESSIVE BEHAVIOR... ...towards staff at work is dramatically on the increase, especially in our Hospitals. Verbal abuse, threats with weapons, cuts, punches, even serious injuries are becoming everyday occurences. The impact on the confidence and morale of staff is damaging and costly and has a serious impact on the caring and commitment that lies at the heart of the staff/patient relationship. Installing an INSTANTalarm®5000 Staff Personal Alarm System will make a dramatic difference ® INSTANTalarm does NOT • track you around the hospital • use radio-frequency • rely on unreliable wi-fi • have a computer controlling it INSTANTalarm,® however, DOES • let you decide when you need help • pinpoint your location, to a room • work instantaneously • make you and your patients feel safer • reduce the frequency and impact of violent incidents Which is why, over 20 years, INSTANTalarm® 5000 has been probably the most widely-installed, staff duress alarm system in the world. ® 205.414.7541 www.pinpointinc.com Vietnamese Nurses Continued from page 16 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 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. 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 Continued on page 20 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 18 ENA Foundation_Connection_half_09 2013.indd 1 8/5/13 10:01 AM September 2013 We’ve questioned the ordinary and redefined extraordinary ® Stryker has been your partner in patient transport for over 70 years. We changed the way patients are transported by introducing Zoom, ® the industry’s first Motorized Drive System, and our exclusive Big Wheel Advanced Mobility. Now, with the latest innovation from Stryker, designed in partnership with the Michael Graves Design Group, we are changing the way patients are transported... again. For more information, stop by Stryker Booth 507 at the ENA Annual Conference or visit www.stryker.com/primetc. Stryker is proud to be an ENA Strategic Sponsor and support nursing excellence through important initiatives such as the ENA Workplace Injury Prevention Toolkit and the ENA Lantern Award. Program Criteria for the ENA Lantern Award funded, in part, by Stryker. Vietnamese Nurses Continued from page 18 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.’’ 20 2013 Lantern Award Recipients ENA is pleased to announce the recipients of the 2013 Lantern Awards. Recipients will be recognized Sept. 21 at the Annual Awards Gala at the 2013 Annual Conference in Nashville, Tenn. • Akron General Medical Center Emergency Department (Akron, Ohio) • Bethesda North Hospital Emergency Department (Cincinnati) • Bon Secours Richmond Community Hospital Emergency Department (Richmond, Va.) • Children’s Healthcare of Atlanta Emergency Department, Egleston Campus (Atlanta) • Children’s Hospital Los Angeles Emergency Department & Level 1 Pediatric Trauma Center (Los Angeles) • The Medical Center of Aurora Emergency Department (Aurora, Colo.) • OSF Saint Francis Medical Center Emergency Department (Peoria, Ill.) • St. Anthony Hospital Emergency Department (Lakewood, Colo.) • Virginia Hospital Center Emergency Department (Arlington, Va.) ENA Connected New App Will Let You Keep Conference a Touch Away By Thomas Barbee, ENA Digital Marketing Manager 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! September 2013 Today’s responsive hospital is facing the demand for improved code performance. Better prepared. Faster response. Constant improvement. The Code Management System from Physio-Control is a comprehensive solution for connecting devices, people and processes across the hospital to optimize outcomes of cardiac arrest. Visit Physio-Control booth #307 at ENA in Nashville to get ready for a more responsive approach to your code management. www.physio-control.com CodeManagement Module™ is 510(k) pending ©2013 Physio-Control, Inc. Redmond, WA Pediatric Update | Elizabeth Stone Griffin, BS, RN, CPEN Common Viral Rashes Affecting Younger Patients 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 22 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 suddenonset 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. September 2013 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 lifethreatening. 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. A NIGHT AT THE GRAND OLE OPRY ™ SUPPORT ENA FOUNDATION AT THE ENA 2013 ANNUAL CONFERENCE IN NASHVILLE, TN, AND ENJOY THE SHOW THAT MADE COUNTRY MUSIC FAMOUS JOIN US FOR A NIGHT OF COUNTRY MUSIC & NETWORKING WITH YOUR COLLEAGUES! SEPTEMBER 20 • 7 PM 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 AC13 Foundation Events Opry Ad_Connection_Half_08 2013.indd 1 Official Magazine of the Emergency Nurses Association 7/2/13 2:04 PM 23 BOARD WRITES | Joan Somes, PhD, MSN, RN, CEN, CPEN, FAEN, ENA Board of Directors Newer Ways of Reaching Safe Practice, Safe Care 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 24 Joan Somes when she first started in emergency nursing in the early 1970s. 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 Continued on page 26 September 2013 visit hill-roM at booth #707 ENa CoNfErENCE 2013 Mobility Made Easy Experience the ease of patient transport and test drive a Hill-Rom® Stretcher today! Force (N) PEAK COMPRESSION FORCE 2 (Average of Conditions at 700 lbs) 4000 3800 3600 3400 -21.7% 3200 3000 Hill-Rom® IntelliDrive® Stryker® Zoom® sMooth ridE lEss straiN CoNvENiENCE 5th Wheel acts like a suspension system absorbing bumps in transport for a smooth patient ride. At maximum weight capacity, the Hill-Rom® Powered Stretcher required 21.7% less peak force than the competition. Integrated scale for immediate and accurate patient weight. ©2013 Hill-Rom Services, Inc. ALL RIGHTS RESERVED. 07/25/2013 ENG – US Zinc Number US-AC-0713-0314 www.hill-rom.com Newer Ways Continued from page 24 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. Resources for emergency nurses today include guidelines, practice references, toolkits, free CE and much more at the ENA website. 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 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 [email protected] or call 847-460-4117. 26 AC14 Call for Faculty_Connection Ad_half_09 2013.indd 1 8/1/13 2:34 PM September 2013 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. Evidencebased 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. 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 Official Magazine of the Emergency Nurses Association 7/23/13 7:39 AM 27 Code You Continued from page 13 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 Goals Choose 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 28 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. September 2013 Emergency Nurses... Everyday Extraordinary Emergency Nurses Week™ Emergency Nurses Day® October 6-12, 2013 Wednesday, October 9, 2013 www.ena.org/enweek ENA 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. STATE CONNECTION 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. Safe Work Environment Intensive Thanks to all who attended the Safe Work Environment Intensive Workshop. Some of the featured topics were: Safe Practice • Lateral Violence and Bullying • De-escalation Awareness • Advocacy Safe Care • • • • Risk Analysis Team Safety Medication & Procedural Safety Liability in Emergency Practice The Safe Practice: Workplace Violence Prevention portion of this event was sponsored by: 30 Safe Work Env Int 2013_Connection Ad_Half_09 2013.indd 1 7/25/13 2:50 PM September 2013 connection Recruitment and Professional Opportunities For ad rates and information, contact ENA Sales Representative Maureen Nolimal at 847-460-4076 or [email protected] s s e n l l e W Career Center exceence F I N D YO U R S E L F AT T H E C E N T E R O F It’s an exciting time to join the Emergency Department at NYU Langone Medical Center, as our ED undergoes signiﬁcant transformation and growth. We are thoroughly ding our ED, more than tripling its size to over 22,000 square feet, and more than doubling the number of patient treatment pos upgrading and expanding positions on our team. i every aspectt off planning l i the th new space, to t ensure that th t it maximizes i i effi fficiencies i i while hil incorporating i ti the th mostt advanced, d d new technologies. We’ve involved clinicians in Our expansion is driven by a dynamic leadership team committed to delivering quality care – and to supporting and enabling rewarding careers. In addition to signiﬁcant advancement and growth opportunities, we offer a generous tuition remission program, and access to continuing education. We are currently seeking: Experienced ED RNs Psych ED RNs Pediatric ED RNs 11.5-hour nights 11.5-hour days & nights For our new Peds ED 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 [email protected] It is the policy of NYU Langone Medical Center (“NYULMC”) not to exclude from participation, deny beneﬁts 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. Official Magazine of the Emergency Nurses Association 31 After all the long hours, you still smile, even at 4am. Hiring ER RNs – Apply Today! Make the Best of Your Career at one of our exceptional hospitals and take advantage of our extraordinary benefits. HCA North & West Florida Division is a family of award winning hospitals, serving sunny West, Central and North Florida and South Georgia. 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. To learn more and apply, please visit either of our Divisions depending upon your location: Follow us on facebook.com/ HCANorthandWestFloridaCareers Connect with us: linkedin.com/ company/hca-west-florida Follow us on our blog: recruitingatHCAwest.com ʭ HCA West & Central Florida: www.MoreCareerChoices.com ʭ HCA North Florida: www.MoreCareerChoices.com/NorthFlorida EOE There’s no place like JPS HEALTH NETWORK. JPS Health Network values highly motivated nurses who want to make a difference in people’s lives. Every team member fills 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, [email protected] or 817-702-3836, to learn more about current nursing opportunities. If you’re interested in joining our team, please visit www.JPSNursing.org 32 September 2013 8:06AM EXAMINING PATIENTS USING LEADING–EDGE TECHNOLOGY 5:06PM EXAMINING THE WONDERS OF THE OCEAN FLOOR EMERGENCY CARE NURSE SUPERVISOR 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 t c e f r e p e h t r e Discov . e m o h ll a c o t place r Isla nd Va nc ouve Me e t wit h our t e a m ion The Nort h Enrich your career. Enhance your quality of life. es Associat Emergency Nurs ce Annual Conferen 21, 2013 September 19 – Hotel Gaylord opryland er nt Ce n tio en nv & Co Booth: 906 see Nashville, Tennes 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. healthmatchbc.org FIND A JOB IN BC Health Match BC is a free health professional recruitment service funded by the Government of British Columbia, Canada Toll-Free: 1.877.867.3061 • Tel: 1.604.736.5920 • eMail: [email protected] *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 34 JoB #H104-14336 ClieNT: HealTH MaTCH BC PuBliCaTioN: eNa CoNNeCTioN September 2013 2013 Annual Conference Walk for Wellness to support the ENA Foundation • Children’s Memorial Hermann Hospital • Katy • Memorial City • Northeast • Northwest (Inner Loop) • Southeast • Southwest • Sugar Land • Texas Medical Center • The Woodlands Chall en ER N ging ur Caree sing rs! CONTACT US Search current job openings at ENA.MH-jobs.org Toll-free 1-866-441-4567 e-mail [email protected] 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 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. 512.328.9000 Choose from locations throughout Houston: Registration fee: $10. September 2013 333814 3.375” x 9.625” (1/2 Pg. V) ENA Connection Front forward, rt-hand side 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. 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. Date: Media Order: Size: Publication: Section: Go the distance at Memorial Hermann. Friday, September 20 6-7 a.m. – NEW time Nashville, TN Sponsored by EOE, M/F/D/V. No agencies, please. AC13 Emerging Professionals Ad_Connection_Quarter_08 2013.indd 1 Official Magazine of the Emergency Nurses Association 35 7/2/13 9:34 AM be happy. When you’re on the right team, happiness ensues. 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. “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 , FA E N Senior Consultant Blue Jay Consulting, LLC www.bluejayconsulting.com Contact Jim Hoelz or Mark Feinberg at 407-210-6570 to discuss how we can capitalize on one another’s strengths.
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