ena connection november 2011
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ENA Connection November 2011TRANSCRIPT
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INSIDE FEATURES
the Official Magazine of the Emergency Nurses Association
November 2011 Volume 35, Issue 10
connection
Vanderbilt’s Adult Emergency Department Initiates New Program to Protect Staff PAGE 12After Deadly Indiana Stage Collapse, It’s Showtime for Emergency Nurses PAGE 14A Close One for Nurses as Disaster Drops on Reno PAGE 18ENA Leadership Conference 2012: Illuminate & Empower PAGE 28
Don’t Look Away
Behavorial Health Patients Can’t Be an Afterthought — and Neither Can Our Safety PAGES 4, 12
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Official Magazine of the Emergency Nurses Association 3
Dates to Remember
PAGE 3Letter From the President
PAGE 4Board Writes
PAGE 6Washington Watch
PAGE 8Pediatric Update
PAGE 20Click Here
PAGE 24ENA on Facebook. What Are Emergency Nurses Saying?
PAGE 25Nominations Committee
PAGE 26Ready or Not?
PAGE 30State Connection
PAGE 32Member Benefits and Resources
PAGE 33ENA Foundation
PAGE 34BCEN
PAGE 36Board Highlights
Departments
November 14, 2011Submission deadline for Blue Jay Consulting/ENA Award for Outstanding Emergency Department Nurse Leader of the Year
January 11, 2012Early bird registration closes for ENA Leadership Conference 2012
January 16, 2012Submission deadline for Academy of Emergency Nursing 2012 class of fellows
March 2, 2012 Submission deadline for 2012 bylaws proposals and resolutions
PAGE 3Collaboration Is Key to New Award
PAGE 10Use ENA’s Emergency Nursing Resources to Improve Your Practice
PAGE 12Vanderbilt’s Adult Emergency Department Initiates New Program to Protect StaffENA Workplace Violence ToolkitHow Are You Staying Safe?
PAGE 14After Deadly Indiana Stage Collapse, It’s Showtime for Emergency Nurses
PAGE 15Redefining Travel Nurse: Conference Attendees Run Code in Airport
PAGE 16One Emergency Department Covers Another After Tragic Helicopter Crash
PAGE 18A Close One for Nurses as Disaster Drops on Reno
PAGE 24ENA Call for 2012 Bylaws Proposals and Resolutions
PAGE 28ENA Leadership Conference 2012: Illuminate & Empower
PAGE 35Certified Emergency Nurse Named Air Force Nurse of the Year
Features
As all emergency nurses know, quality care is a team effort. No single member of the emergency
department can do it alone. It takes a cohesive team approach to meet the ever-changing challenges
and complexity of emergency care.
The Emergency Nurses Association is no different. It takes a team approach to continuously meet the
needs of our members and your profession. It takes a combination of skills, a wide variety of expertise
and quite frankly, it takes financial support.
That is why ENA is committed to bringing strong corporate partners into a sponsorship role. By
leveraging the leadership that ENA members have in the emergency health care system, we are able to
share expertise, influence product development and help defray costs that keep our conferences and our
membership dues affordable.
ENA’s sponsors are chosen for tangible and intangible corporate qualities that integrate with the
mission and vision of the association and with you. Sponsors are attracted to ENA for its marketing
potential based on the association’s leadership role and the membership’s ability to affect its bottom line.
A plus for the association and for the sponsors, sponsorship is a giant plus for ENA members.
Since the economy burst its bubble in 2008, we have met our challenges, maintaining business
excellence, offering members more and improved educational experiences, affinity programs, a new and
improved ENA Career Center and other benefits in the face of rising costs. We are proud of the fact that
with the support of our sponsors, we have been able to continue championing you with the same gusto
we have in the past.
With that in mind, we would like to thank Stryker, Vidacare, GE Healthcare and Hill-Rom for
their generous and ongoing support. Together we are shaping the future of emergency nursing
and emergency health care in general. From the support of our conferences to support of the ENA
Foundation, from specific sponsorships of research and courses to general support throughout the year,
these corporate leaders have reached out to ENA and its members to help ensure that we meet our
ultimate goal of Safe Practice, Safe Care.
We hope that you will speak with the representatives of these fine organizations at the 2012 ENA
conferences or wherever you may find them and express how they make a difference to you and your
colleagues. They are a member of the ENA team that represents you, your practice and your profession.
Their generous financial support gives added strength to the voice of ENA, a voice whose overriding
goal is to support emergency nurses everywhere.
Strength Through Partnership and Sponsorship
LETTER FROM THE PRESIDENT | AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN, President, with Pierre Désy, Chief Development Officer
Collaboration Is Key to New Award
Is there an outstanding nursing leader on staff in your emergency department? Does he or she demon-
strate highly collaborative behaviors with medicine?
If this person is an ENA member, you can nominate this individual for the new Blue Jay Consulting/
ENA Award for Outstanding Emergency Department Nurse Leader of the Year to be presented February
23 in New Orleans at Leadership Conference 2012.
This award will bring forth some of the best examples of teamwork and the highest quality collabora-
tive patient care for all of us to learn from, said Mark Feinberg, managing partner of Blue Jay Consulting,
sponsor of the award.
“This discovery will undoubtedly help others improve the way care is provided and ultimately help
improve emergency care overall,” he said.
Nomination forms are available to download at www.bluejayconsulting.com. The submission deadline is
Monday, November 14, 2011.
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© 2011 by the Emergency Nurses Association. Printed in the U.S.A.Periodicals postage paid at the Des Plaines, IL, Post Office and additional mailing offices.
POSTMASTER: Send address changes to ENA Connection915 Lee StreetDes Plaines, IL 60016-6569ISSN: 1534-2565Fax: 847-460-4002 Web Site: www.ena.orgE-mail: [email protected]
Non-member subscriptions are available for $50 (USA) and $60 (foreign).
Chief Communications Strategist: M. Anthony PhippsEditor in Chief:Amy Carpenter AquinoAssistant Editor, Online Publications:Josh GabyWriter:Kendra Y. MimsEditorial Assistant:Dana O’DonnellBoard of direcTorSofficers:President: AnnMarie Papa, DNP, RN,
CEN, NE-BC, FAENPresident-elect: Gail Lenehan, EdD, MSN,
RN, FAEN, FAAN
4 November 2011
Member Services: 800-900-9659
Secretary/Treasurer: Jason Moretz, BSN, RN, CEN, CTRN
Immediate Past President: Diane Gurney, MS, RN, CEN
directors:Deena Brecher, MSN, RN, APRN, ACNS-BC,
CEN, CPEN Kathleen E. Carlson, MSN, RN, CEN, FAENEllen H. Encapera, RN, CEN Mitch Jewett, RN, CEN, CPEN Marylou Killian, DNP, RN, FNP-BC, CENJoAnn Lazarus, MSN, RN, CENMatthew F. Powers, MS, BSN, RN, MICP, CENExecutive Director: Susan M. Hohenhaus,
MA, RN, CEN, FAEN
What Is Best for the Patient
BOARD WRITES | Kathleen E. Carlson, MSN, RN, CEN, FAEN, Director
As emergency care
professionals, we are
all aware of the
problems caused by
boarding patients on
a daily basis in our emergency departments.
Of growing concern are the issues associated
specifically with the increase in boarding
patients with behavioral health problems.
The number of patients with mental health and
substance use disorders treated in emergency
departments has been on the rise for more than
a decade. In 2007, 12 million emergency
department visits involved a diagnosis related
to a MH or SUD, accounting for 12.5 percent,
or one out of every eight emergency
department visits.1
Patients with behavioral health issues
encompass all socioeconomic and age groups,
from pediatric to the elderly. It is estimated that
approximately one-third of adults and one-fifth
of children had a “diagnosable substance use
or mental health problem in the last year.2”
Stressors from the current economic situation
and increasing unemployment cause patients
anxiety. Patients often stop counseling and
taking prescribed psychiatric medications due to
the cost. While patients may not present with a
chief complaint related to a psychiatric problem,
careful screening and assessment may reveal the
patient’s underlying behavioral health problems.
For example, one in three veterans and military
personnel returning from combat suffers
behavioral health problems that may not be
obvious, impacting the patient’s health and that
of his or her family.3
In 2003 the President’s New Freedom
Commission on Mental Health reported that the
total number of inpatient psychiatric beds per
capita had declined 62 percent since 1970, and
that state and county psychiatric hospital beds
per capita had decreased 89 percent.4 Funding
for necessary services is not adequate to meet
the needs caused by the closure of these beds.
Consequently, the emergency department,
the most expensive place to receive care, has
become the safety net in caring for patients
with behavioral health needs. Under the
Emergency Medical Treatment and Active Labor
Act, emergency departments are required to
stabilize all patients, which places a financial
burden on the hospital to properly diagnose
them. At times, patients may be discharged
home with prescriptions and instructions for
follow-up, only to return later.
It is the patients who suffer. Most emergency
departments do not have the resources
necessary to treat behavioral health needs.
Instead, patients are boarded in a department
that is fast-paced, hectic and noisy. A patient is
stripped of belongings and placed on a stretcher
in a sterile, drab space that has been emptied
for the safety of the patient. Medical clearance
is completed, and the wait for appropriate
placement begins. As the hours go by, little or
no therapy is provided, care may be handed off
to several different practitioners, and the
potential for the patient to deteriorate increases.
There must be a better way.
This should not be an emergency department
problem—but it is, so ENA is taking action.
ENA’s strategic plan focuses on three clinical
priorities: emergency department crowding,
violence in the emergency department and the
care of psychiatric patients. Under current
workplace conditions, the problem of boarding
patients with behavioral health problems is
often related to all three clinical priorities.
Let’s review some of ENA’s current efforts.
The ENA Emergency Department Psychiatric
Care Committee presented the board with three
public policy recommendations and an action
plan for ENA implementation. They were
approved last September.
The first priority is that patients with
symptoms of mental health or substance use
disorders be given priority of care equivalent to
that given to other medical conditions. The
committee notes the prevalence of a “stigma –
which erodes confidence that mental illnesses
are real, treatable health conditions – tolerates
attitudinal, structural, and financial barriers to
effective treatment and recovery.5” One strategy
recommended for attaining this priority goal is
to develop a standardized approach to assessing
behavioral health in the emergency department.
In addition to the initial screening, the goal
would be to standardize an ongoing assessment
of boarded emergency department patients with
behavioral health or substance use disorders,
including disorders such as prescription drug
misuse and abuse and agitation. As this is just
not “our emergency department problem,” ENA
is seeking to work with various stakeholders to
define this standardized approach.
The second priority addresses access to
quality patient care by collaborating with
community agencies and linking services.
Access includes continued improvement in
financing and integrated delivery of prevention,
treatment and recovery support services.
Increased funding for the Substance Abuse and
Mental Health Services Association and other
federal programs that provide state block grants
for community-based behavioral health services
is incorporated into ENA’s Public Policy Agenda
(www.ena.org/government/Documents/2011PublicPolicyAgenda.pdf).
In addition, ENA is a member of the Mental
Health Liaison Group (www.mhlg.org),
a coalition to promote health system capacity
building through the health reform law and the
parity law focusing on behavioral health.
To date, ENA has been a signatory to various
public policy MH/SUD initiatives.
In another strategy to support the
systems and collaboration priority, ENA is
developing an advocacy packet
Continued on page 38
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November 20116
WASHINGTON WATCH | Kathleen Ream, MBA, BA, Director, ENA Government Affairs
According to testimony given at a hearing held by the House
Energy and Commerce Committee’s Health Subcommittee
September 23, early warnings from drug companies about
looming shortages of pharmaceuticals, along with better
manufacturing practices, would help address the growing
problem of drug shortages. The problem is quickly becoming a
national health care crisis, as shortages of cancer, anti-infection
and anesthesia drugs occur without warning when patients are
in desperate need.
Subcommittee Chairperson Joe Pitts (R-PA) noted that the
number of drug shortages reported to the Food and Drug
Administration increased from 61 in 2005 to 178 in 2010.
“So far this year, FDA has continued to see an increasing
number of shortages, especially those involving older,
sterile, injectable drugs,” he added. In addition to cancer
and anesthesia drugs, the products include “drugs
needed for emergency medicine and electrolytes
needed for patients on IV feeding,” he said. A staff
memo Pitts released at the hearing said that more
than 240 drugs in 2010 were either in short supply
or completely unavailable, and “these shortages
cause delays in treatment and surgery, compel
physicians to make changes in care plans
and force patients to receive substitute
therapies that add expense to patient
care.”
Administration witnesses included
Howard Koh, assistant secretary for health
at the Department of Health and
Human Services, and Sandra Kweder
of the FDA. Koh said the number
of drug shortages has been rising
steadily over the past five years
and added, “This trend has
continued into 2011 with an even
greater number of shortages.”
Koh and Kweder suggested some
remedies for the problem, but
neither voiced confidence that it
would be solved anytime soon
because of the complex
reasons for the shortages.
One reason they cited is
that consolidation of the
pharmaceutical industry
has left fewer suppliers of
the drugs subject to
shortages, which in turn
results in fewer plants
forced to make more of
the drugs. With plants
busy filling orders for so many different types of drugs, they
are not taking time for needed maintenance; this leads to break-
downs in manufacturing, which ultimately cause supply
problems.
Other reasons included changes in inventory and distribution
practices (e.g., “just in time” methods whereby hospitals save
on inventory costs by ordering only small quantities of drugs,
leaving providers less able to deal with shortages when they
occur); shortages of underlying raw materials; and unantici-
pated demand.
One major reason cited in the hearing was that manufactur-
ers are losing interest in producing drugs that are off-patent and
sold as generics at prices that leave little room for profits. This
brought up a question of whether government policy is in some
way interfering with the forces of supply and demand. Rep.
Tim Murphy (R-PA) asked, “In our push to make products more
affordable, are we tripping over ourselves?” In essence, his
question was: Are prices being cut so much that manufacturers
don’t want to make the drugs? In response Koh said, “Those are
precisely the issues that we are wrestling with,” and “Further
economic analysis is intensely underway right now.”
The administration officials also mentioned a disturbing
aspect of the issue — development of a “gray market” in which
some suppliers have been able to come up with quantities of
drugs in shortage and sell them to hospitals at exorbitant prices.
Some of those drugs are counterfeit and in other cases, their
quality is suspect.
As for solutions, Koh and Kweder said earlier warnings that
manufacturers expect shortages would help. A bipartisan bill
— H.R. 2445 — introduced by Rep. Diana DeGette (D-CO)
addresses that issue. The measure requires companies to alert
the FDA when they expect shortfalls. Kweder pointed out that
when FDA does hear about a potential shortage, it is able to
work with the company to solve the problem or with other
manufacturers to increase their supplies of the drug. Koh added
that through this FDA drug shortages program, the agency
prevented 99 drug shortages in 2011.
Witnesses representing industry included Jonathan Kafer of
Teva Pharmaceuticals and Mike Alkire of Premier Healthcare
Alliance. Kafer said drug shortages are a complex and multi-
stakeholder issue and that all involved must work together to
resolve it. He called for greater communication among all the
stakeholders (active ingredient suppliers, generic and brand
manufacturers, wholesalers and distributors, health care
providers and government agencies), along with expedited FDA
review of new manufacturing facilities and active ingredient
suppliers when a drug shortage occurs. In addition, Kafer said
the FDA should collaborate with the Drug Enforcement Admin-
istration to establish a process that would streamline DEA’s
quotas of active drug ingredients in response to shortages of
controlled substances. Currently, DEA limits the amount of
At Drug Shortages Hearing, a Fresh Supply of Concern
Official Magazine of the Emergency Nurses Association 7
active ingredients manufacturers may purchase
for controlled substances.
Alkire’s suggestions for dealing with drug
shortages included the following:
• Shorten the approval process for medically
necessary generic drugs that appear to be
in shortage.
• Encourage the FDA’s drug shortage program
to engage members of the health care
community in discussions to prioritize which
drugs are critically necessary for treatment
that may be at risk for shortage due to
insufficient manufacturing capacity.
• Enable more flexibility in regulations that
apply to quotas for registered manufacturers
of controlled substances.
• Create a fast-track approval of new active
pharmaceutical ingredient suppliers for
medically necessary drugs in shortage.
• Work with manufacturers to slow the trend
of acquiring the bulk of raw materials used
in pharmaceuticals outside the U.S.
• Require manufacturers to notify the FDA of
planned discontinuation or interruption in the
manufacture of drugs as soon as practicable.
• Create a stakeholder committee to advise
the FDA on market conditions.
ENA endorsed the companion bill to H.R.
2445 — S. 296, the Preserving Access to Life
Saving Medications Act — on August 22, 2011.
From the States Four States Form Prescription Drug Task ForceLast April, the federal government announced
a new strategy that aims to cut the use of
prescription painkillers by 15 percent in five
years. A major part of the proposal is a push
for prescription drug databases in every state.
Four states — Kentucky, Ohio, Tennessee and
West Virginia — have created the Interstate
Prescription Drug Task Force to fight the
region’s prescription drug abuse problem.
Comprising about 30 experts from drug
agencies and law enforcement, the task force
will develop strategies to reduce the sale and
abuse of prescription drugs and will make
recommendations to improve cooperation in
sharing data, educational campaigns and police
investigations.
All four states use electronic drug monitoring
systems to collect information on who receives
and prescribes certain medications.
“Kentucky isn’t an island,” Gov. Steve
Beshear (D) said in a statement released August
24. “We have to attack this problem on a
nationwide basis and work with other states to
share information if we hope to turn around the
prescription drug problem.”
• Group discount rate applies to registered nurses only
• A group must consist of five or more new members
• Membership recruitment materials are available through Member Services
• Here’s the BIG BONUS: renewing members can take advantage of the group rate! Call for details.
Group memberships must be pre-approved. Contact Member Services at 800-900-9659 to obtain an authorization letter, to qualify for the group rate.
Gather a group of five or more new members,
and save money on membership dues.
That’s right—a group membership will save you
money and still give you all the great benefits that ENA membership offers.
ENA Group Membership
Here’s the Real Deal
November 20118
PEDIATRIC UPDATE | Elizabeth Stone Griffin, BS, RN, CPEN
Children and adolescents present to emergency
departments with a large variety of mental health
disorders and emergencies, which include
depression, suicide attempts and ideations,
attention deficit disorder/hyperactivity, violent
behavior and substance abuse. According to the
World Health Organization, epidemiological data
suggest a worldwide prevalence of child and
adolescent mental health disorders of approxi-
mately 20 percent, and approximately half of all
lifetime cases of mental disorders start by age 14
(Kessler et al, 2005). Changes in private and
public insurance, state mental health programs
and community mental health resources, as well
as reductions in pediatric-trained mental health
specialists, have all contributed to a critical
shortage of inpatient and outpatient mental
health services for children (AAP, 2006).
This has resulted in an unbudgeted mandate for
emergency departments and emergency nurses
to act as the safety net for children in crisis.
Children with psychiatric illness may not
present with overt mental health symptoms.
Therefore, staff education and training regarding
identification and management of these patients
is crucial. Pediatric mental health conditions
often present as irritability or dysphoria rather
than the sadness seen in adult depression (Daly,
2011). Other common presenting complaints in
these children include sleep or appetite distur-
bances, stomach pain and refusal to go to
school (NIMH, 2011).
Whether a mental health condition is
suspected or known, screening the child or
adolescent thoroughly for past sexual/physical
abuse, traumatic events or other stressors can
help in the diagnosis and initiation of appropri-
ate treatment. A growing body of evidence
indicates that emotional and physical trauma in
childhood can cause changes in the developing
brain resulting in post-traumatic stress disorder
and can affect children well into their adult lives
(AAP, 2006). Emotional trauma can be reduced
by timely, developmentally appropriate inter-
ventions implemented in the initial hours after
the trauma (AAP, 2006).
Screening Tools and Standing OrdersIn one state, up to 23 percent of patients (of
any age) who presented to the emergency
department with suicide-related complaints
were discharged home without a mental health
evaluation (Cooper & Masi, 2007). Department-
wide resources and protocols that standardize
the approach and process when caring for a
child with mental health issues should be
developed (in collaboration with mental health
professionals) if they don’t already exist. A brief
screening tool for mental illness and/or suicidal
or homicidal ideation can be implemented at
triage, which, if appropriate, can initiate a
standing order for a sitter to ensure patient and
staff safety, as well as order a mental health
evaluation if available. These measures can
increase quality and efficiency of care, expedite
referrals and/or bed requests and help decrease
boarding times.
Education and TrainingHospital nursing education programs have
opportunities to improve pediatric psychiat-
ric and substance abuse education within
their curriculum. ENA’s Emergency Nurse
Pediatric Course includes a chapter on
psychiatric emergencies, which offers useful
information regarding the primary goals in
the care of these patients in the emergency
department setting. Emergency nurses
should be able to identify local and regional
resources, such as pediatric psychologists
and psychiatrists, suicide help lines and
primary care clinics.
Hope for the FutureThe National Institute of Mental Health
recently announced The Grand Challenges
in Global Mental Health Initiative. This
international research initiative identified
the top 40 barriers to better mental health
care around the world and will support
much needed research aimed at improving
the lives of people of all ages with mental
health, neurological and substance abuse
disorders within the next 10 years (NIMH,
2011). On the horizon are therapies—such as a
new, faster-acting generation of antidepressant
medications and advances in telemedicine—that
may result in more collaborative, specialized
and team-based care. These innovative
treatment methods and others that result from
the surge of new research in the specialty of
mental health hold much promise in improving
the quality of mental health care for youth as
well as adults (NIMH, fact sheet, 2011).
Emergency nurses can improve the quality of
care for these patients today and into the future
by taking measures, such as actively pursuing
education in mental health disorders, screening
for suicidal and homicidal ideation at triage to
help ensure the safety of patients and staff and
using standing orders to initiate care and
consults as quickly as possible.
Children in Crisis:
You May Be the Difference
Official Magazine of the Emergency Nurses Association 9
Resources Emergency Care Psychiatric Clinical Framework.
ENA. Accessed 8/11/11: www.ena.org/SiteCollectionDocuments/Position% 20Statements/ClinicalFramework.pdf
Medical Evaluation of Psychiatric Patients.
Position Statement: ENA. Accessed 8/11/11.
www.ena.org/SiteCollectionDocuments/Position%20Statements/MEDICAL%20EVALUATION%20OF%20PSYCHIATRIC% 20PATIENTS.pdf
National Institute of Mental Health Web site:
www.nimh.nih.gov
References American Academy of Pediatrics. Pediatric
Mental Health Emergencies in the Emergency
Medical Services System. (2006). Pediatrics.
1925, 1764-1767.
Bonham, Elizabeth. Role of child and adolescent
psychiatric nursing in health care reform.
(2010). Journal of Child and Adolescent
Psychiatric Nursing. 23, 2, 119-120.
Baren, J., Mace, S., Hendry, P., et.al. Children’s
mental health emergencies – Part 1. Chal-
lenges inc are: Definition of the problem,
barriers to care, screening, advocacy, and
resources. Pediatric Emergency Care. 2008
24(6) 399-408
Baren, J., Mace, S., Hendry, P., et.al. Children’s
mental health emergencies – Part 2. Chal-
lenges inc are: Emergency department
evaluation and treatment of children with
mental health disorders. Pediatric Emergency
Care. 2008 24(7). 485-498.
Daly, Rich. Pediatric depression, anxiety
symptoms often overlooked. (2008). Psychiat-
ric News, American Psychiatric Association,
43, 13, 7.
Dolan, M., Fein, J., and The Committee on
Pediatric Emergency Medicine. Pediatric and
adolescent mental health emergencies in the
emergency medical services system. (2011).
Pediatrics. 127, e1356-e1366.
Grupp-Phelan, J., Harman, J., and Kelleher, K.
Trends in mental health and chronic condition
visits by children presenting for care at U.S.
emergency departments. Public Health
Reports. 2007 122. 55-61.659.
Newton, A., Hamm, M., Bethell, J., Rhodes, A.,
Bryan, C., Tjosvold, L., et al (2010). Pediatric
suicide-related presentations: a systematic
review of mental health care in the
emergency department. Annals of Emergency
Medicine, 56, 6, 649-659.
National Institute of Mental Health. Depression
in children and adolscents (fact sheet).
Accessed 8/6/2011: gopher.nimh.nig.gov/health/publications/depression-in- children-and-adolescents
Horowitz, L., Wang, P., Koocher, G., Burr, B.,
Smith, M., Klavon, S., & Cleary, P. Detecting
suicide risk in a pediatric emergency depart-
ment: development of a brief screening tool.
(2001). Pediatrics 107, 5, 1133-1137.
Kessler RC, Berglund P, Demler, O, et al.
Lifetime prevalence and age-of-onset distribu-
tions of DSM-IVdisorders in the National
Comorbidity Study Replication. Arch Gen
Psychiatry, 2005, 62(6):593-602.
Cooper, J., & Masi, R. (2007). National Center
for Children in Poverty. Child and Youth
Emergency Mental Health Care: A National
Problem. Accessed online 8/8/2011.
World Health Organization. Atlas: child and
adolescent mental health resources: global
concerns, implications for the future (2005).
Accessed online 8/12/2011. www.who.int/mental_health/resources/Child_ado_atlas.pdf.
CorrectionThe title for Wendy Hums, BSN, RN,
was stated incorrectly in the ENA Connection
October issue article “Indiana Receives Its
First Trauma Program Manager Course.”
Her correct title is the course director for
American Trauma Society’s Trauma Program
Manager Course. ENA Connection regrets
the error.
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• Systematic standardized approach utilizing the A-I mnemonic
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Take the Course TodayTo verify why TNCC is right for you and to view course schedules, visit www.ena.org/coursesandeducation.
The Emergency Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
Contact the author I would like to answer your questions
and share your stories. Please e-mail me at [email protected] with questions, problems and any special stories or learning experiences
you would like to share about taking care of children in the emergency department. I will weave them into the
column whenever possible.
October 201110
Since the development of ENA’s first Emergency
Nursing Resource in 2009, emergency nurses
have been using ENRs to provide safe, quality
patient care.
ENRs are developed through review and
critical analysis of the evidence for clinical
emergency nursing practices. ENRs contain
tables of evidence that grade each relevant
article according to level and quality of
evidence and provide final recommendations
for practice. They also contain an overview of
relevance and methodology. Topics for ENRs
are issues of great significance to stretcherside
emergency nurses and come from ENA member
surveys, resolutions and expert consensus. Once
published, ENRs are available at www.ena.org
and published in the Journal of Emergency
Nursing.
The four ENRs currently available address
the following issues:
• Capnography during procedural sedation
• Family presence during resuscitation and
invasive procedures
• Gastric tube placement verification
• Needle-related procedural pain in pediatric
patients
These four ENRs were accepted and posted
at the Agency for Healthcare Research and
Quality’s National Guideline Clearinghouse
(www.guideline.gov) in 2011. Acceptance of the
ENRs in the National Guideline Clearinghouse
validates the methodological evidence-based
process that the ENR Development Committee
used to create them, along with input from the
Institute for Emergency Nursing Research
Advisory Council, Institute for Emergency
Nursing Research staff and content experts.
The ENR Development Committee uses the
Guidelines for the Development of Evidence
Based Emergency Nursing Resources (www.ena.org/IENR/ENR/Documents/Guidelinesfor theDevelopmentofENRs.pdf) to develop ENRs.
The ENR development process includes
selecting the topic area, defining the clinical
question using the PICOT (Patient Population,
Intervention, Comparison, Outcome, Time)
format, searching the relevant literature for
review, critically appraising the literature to
grade the levels and quality of evidence,
developing the evidence-appraisal table and
interpreting the summative evidence to
determine levels of recommendation.
The 2011 ENR Committee is completing four
new ENRs. ENR topics in progress include
laceration cleansing, temperature measurement
across the lifespan, orthostatic vital signs and
difficult intravenous access.
The ENR on laceration cleansing and irriga-
tion evaluates the scientific evidence regarding
type of cleansing fluid, irrigating pressures and
patient comfort measures necessary to promote
effective wound healing and deter infection.
A review and critical analysis of the evidence
evaluated several irrigation techniques that the
emergency nurse can use in practice to promote
optimal wound healing. The ENR will include
an analysis of various irrigation methods, such
as bulb syringes and syringe with needle/
catheters, irrigation solutions and irrigation
temperatures. Emergency departments have the
potential to save thousands of dollars annually
on irrigation solutions, as well as increase
patient comfort and decrease infection, once the
ENR is published and emergency nurses
implement the recommendations.
The ENR on temperature measurement
focuses on temperature measurement of
patients across the lifespan. The ENR will
evaluate, appraise and give recommendations
for multiple methods of body temperature,
including oral, tympanic, rectal, axillary and
temporal. Emergency nurses will be able to use
a quick reference table to implement the
recommendations in daily practice.
The ENR on orthostatic vital signs evaluates
the indications, methods and utility for perform-
ing orthostatic vital signs to detect alteration in
fluid status. The ENR will evaluate and critically
appraise literature on body positioning, fluid
volume alteration, various vital sign measure-
ments and timing, and equipment.
The ENR on difficult intravenous access will
evaluate, appraise and recommend alternatives,
such as intraosseous access, ultrasound-guided
access, vein illumination devices and subcutane-
ous rehydration therapy.
It is hoped that ENA’s ENRs will positively
impact both emergency nurses and patients
by helping to translate research findings into
practice and to ensure that patients receive
quality, evidence-based and safe care.
Look for them at www.ena.org/IENR/ENR/
Use ENA’s Emergency Nursing Resources to Improve Your PracticeBy Andrew Storer, DNP, RN, ACNP, CRNP, FNP, ENR Development Committee MemberEdited by Jean Proehl, MN, RN, CEN, CPEN, FAEN, ENR Development Committee Chairperson
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November 201112
Vanderbilt’s Adult Emergency Department Initiates New Program to Protect StaffBy Kendra Y. Mims, ENA Connection
Michelle Ingram’s patient tried to stab her with
a pen.
He was a larger man—much too big for
Ingram to easily restrain by herself. Although
sharp instruments and other harmful items are
kept out of patients’ reach for safety reasons,
he had managed to jump across the counter to
retrieve the pen. He was acutely manic, agitated
and having a manic episode. The option of
verbal de-escalation had disappeared. Ingram,
a mental health specialist at Vanderbilt
University Medical Center, knew he was
dangerous and needed to be medicated.
Fortunately, she didn’t have to disarm her
patient. He eventually threw the pen down.
Recent studies show that Ingram’s experience
is unfortunately all too familiar in emergency
departments nationwide. A 2010 ENA study
reported that every week in the United States,
between 8 and 13 percent of emergency
department nurses are victims of physical
violence (Rates of Violence, 2010). Other studies
show that violence in emergency departments is
increasing, and they are considered a dangerous
place to work.
Taking New MeasuresENA member Brent Lemonds, MS, RN, FACHE,
Vanderbilt administrative director of emergency
services, says the
Joint Commission
Sentinel Event Alert,
Issue 43, regarding
violence elevating
in emergency
departments was an
eye-opener for
Vanderbilt’s Adult
Emergency Depart-
ment to re-evaluate
its safety measures.
Vanderbilt had already taken several actions
to reduce violence: metal detectors in its front
door, armed police in its emergency depart-
ment, a no-tolerance policy posted in the
emergency department and annual training for
staff. However, there was still a need to reduce
violence in the emergency department and to
increase protection for staff and patients.
“We still had increasing instances of violence
inside of our Emergency Department,”
Lemonds said. “The nurses were coming to us,
saying they were getting tired of being cussed
at on every shift. We had a triage nurse that
was clawed by one of the patients, and we
pressed charges against that patient. With these
increasing incidents in the ED, we looked at
what else we could we do. We thought the
thing that we could spend the best effort on
was additional training for our staff.”
Vanderbilt’s Adult Emergency Department
launched the Handle with Care training program
in April 2011. The crisis intervention and
behavioral management program includes four
hours of verbal de-escalation techniques and
four hours of physical self-protection tech-
niques, such as the primary restraint technique.
Training is mandatory for staff and has been
offered weekly since the program launched to
ensure that everyone completes the program.
Lemonds said staff members have responded
favorably to the new initiative because they felt
management was concerned about their safety.
“We’ve had some instances since we imple-
mented the training where it has proven to be
helpful and where staff members have walked
out of situations and said the training has really
helped. One of our patients attacked one of our
police officers, and the nurse who had the
training was able to put a hold on the patient
and rescue the police officer,” Lemonds said.
“I think the major benefit is the attitude of the
staff. Staff members say their self-confidence
level in being able to deal with situations has
improved.”
Vanderbilt staff nurse Nakeisha Jenkins, RN,
found the training helpful when she had to
perform a two-person PRT hold with her
colleague on a threatening, alcohol-dependent
patient who went into a rage and attempted to
destroy the
computer and other
equipment on the
registration desk.
The patient became
cooperative once
they placed her in
the PRT hold and
held her in that
position until they
were able to obtain
a stretcher and a physician at the bedside.
“I think the class was very beneficial,
especially in that case,” Jenkins said. “There
was no verbally de-escalating the patient in that
situation. The class not only protects us as staff,
but another patient in the waiting room could
have been injured by her behavior. We often
have psych patients who may behave
inappropriately, so this behavior is often
seen in the ER.”
Lemonds pointed out that there is no
shortage of mental health patients and drug
abuse patients in the emergency department; he
said 250 psych patients are treated every month
at Vanderbilt and 30 percent end up being
committed for further mental health treatment.
Although Lemonds and Ingram feel the high
population of mental health patients is
frequently responsible for the violent incidents
that occur in their emergency department, from
assaulting nurses to attacking the hospital’s
on-duty police officers, both said it is difficult to
ENA Workplace Violence ToolkitThe ENA Workplace Violence Toolkit, released in February 2011, was designed
to take a practical approach to eliminating violent behavior in emergency departments
nationwide. Created specifically for emergency department managers and team leaders,
the toolkit provides resources, templates and tools so that they can understand the issue
of emergency department violence, customize a violence prevention plan and develop
goals.
Karen Wiley, MSN, RN, CEN, contributed to the development of the toolkit and said it
can be applied to any health care setting or unit.
“The Workplace Violence Toolkit is a step-by-step quality improvement process to
decrease or prevent violence in the emergency department. It provides comprehensive
evaluation of the current status of violence in your emergency department,” Wiley said.
“The toolkit identifies your response to the high-risk areas that were identified in the
assessment phase. Project plan templates are included to assist you with developing goals
and outcomes of your violence prevention initiative. The beauty of it is that it was
developed for the emergency department setting. When it was developed, we wanted
nurses to use it and change it to fit their culture and institution.”
For more information on learning more about this innovative online resource and how
it can benefit your emergency department’s effort in protecting staff against violence, visit
http://www.ena.org/IENR/ViolenceToolKit/Documents/toolkitpg1.htm.
Nakeisha Jenkins, RN
Brent Lemonds, MS, RN, FACHE
Official Magazine of the Emergency Nurses Association 13
prosecute mental health patients because of their
condition.
“The legal system will not usually deal with
prosecution if the patients have a mental health
history. So the nurses get assaulted, but there is
no recourse for dealing with the patient’s
behavior,” Lemonds said.
Ingram, who deals with violent mental health
patients frequently, found the physical training to
be the most effective part of the Handle with
Care program.
“I think knowing how to do it with proper
body mechanics helps to protect us,” Ingram
said. “I think that a lot of nurses are afraid to do
things like that, because they don’t want to hurt
themselves or hurt the patient, but having that
extensive class really helped us to understand
that it is necessary sometimes to keep them
from hurting themselves.”
Several times, Ingram has used the PRT hold
she learned in Handle with Care on a self-
abusing patient. This patient walks around the
unit actively trying to hurt herself, from digging
and ripping open existing wounds to jumping off
of things in an attempt to break her neck.
Because this behavior happens every time
Ingram is with this patient, Ingram uses the
physical techniques she learned in Handle with
Care, which sometimes includes taking the
patient down to the floor.
“There are times when you just can’t verbally
de-escalate someone based on their psychosis,”
Ingram said. “The verbal part of the class will
give our nursing staff the ability to verbally
de-escalate people, and that will really decrease
them having to take it to the next level. Once
staff has to take it to the physical level, the
training will help them deal with it.”
Lemonds believes Handle with Care is
effective for staff dealing with mental health
patients who are threatening to themselves, staff
or other patients and will help staff react appro-
priately when physical restraint is needed.
“The key to dealing with mental health
patients or any patient who is out of control is
helping them to regain control. The de-escalation
training addresses that. When it comes to
physical techniques, you say to the patient,
‘We’re only going to use these techniques until
you’re able to regain control,’” Lemonds said.
“I think the de-escalation part of it is the most
helpful part because over my career, I’ve seen
untrained health care providers get angry. I think
in many situations
when health care
providers get to a
point of using force,
everyone is frus-
trated and angry. If
you get angry with
someone who is
having a behavioral
problem, they get
worse. When you have this training, it helps you
remain in a professional position and it helps
you to become knowledgeable about what’s
going on in the patient’s head.”
Lemonds said they have already requested to
expand the program to their pediatric emergency
department colleagues and their trauma unit—
two areas at risk for violence. Refresher courses
will be available for employees next year, and he
anticipates the program will be expanded. He
believes combining the training with other
strategies will help to reduce violence in
emergency rooms.
“I think it’s a combination approach,” he said.
“You must have the staff training. We also
support the use of a metal detector. I’ve had
many emergency departments call me about our
metal detector, and they’re afraid to implement
it, afraid that it will scare off patients. The
majority of the patients who talk to me feel like
it’s a safer environment because we have a metal
detector. There is not only one strategy that you
can do. There are many different strategies that
you can use to make your department safe.”
Emergency Nurses Can Protect Themselves Jacki Ashburn, RN,
quality consultant at
Vanderbilt, volun-
teered to become a
certified Handle with
Care instructor to
inspire nurses to
protect themselves.
She noticed a cultural
change when she
came to work in the
emergency department 15 years ago and realized
that verbal and physical abuse were normal
behavior in the environment.
“As society has become more violent, so has
the emergency department, and as new nurses
come into emergency nursing, they just needed
something to say, ‘This is appropriate, this is not
appropriate, and this is how you handle it,’”
Ashburn said.
Ashburn said there are two other instructors
who assist with the training and 20 employees
per class. The verbal de-escalation training
involves how to identify signs of stress, what you
can say to de-escalate patients and options if
they don’t cooperate. The physical training
Continued on page 20
How Are You Staying Safe?ENA asked its members on Facebook to describe the security measures their emergency departments have enacted to handle violence. A vocal majority said their administrations are not doing enough and that their emergency department security ranges from ineffective to nonexistent. But not every hospital is lax on this issue. Here are some of the positive testimonials:
“We are trained in Nonviolent Crisis Intervention. In addition, we have our own armed police department on campus. Officers are stationed in the ED, and a two-way mirror is in the ED, allowing officers to monitor activity in the waiting room. We have panic buttons in the ED, also.”
Cyndy Williams, BSN, RNStaff Nurse, Ocean Springs Hospital
Emergency Department, Ocean Springs, Miss.
“We have done unannounced mock drills with after-action reviews to evaluate the effectiveness of our violence prevention and violence response program.”
Nicholas Chmielewski, MSN, RN, CEN, NE-BC
Clinical Information Systems Coordinator,Mount Carmel West
Emergency Department, Columbus, Ohio
“We all wear locators, and there are panic buttons located in all rooms and various other locations in the ED. I pushed the panic button one day, of course to see what would happen, and within 30 seconds or so, I had three security guards as well as two CMTs at my side asking if I was OK. Our security guards also have been trained with tasers. Some people take offense at the locators and don’t want to wear them. However, I’ve been kicked, punched and threatened in my 20-plus years in the ED. I WANT my employer to know where I am at all times!”
Susan Wallace-Vernetter,
BS, RN, CEN, CPENStaff Nurse, King’s
Daughters Medical Center Emergency Depart-ment, Ashland, Ky.
“We repeated the ENA violence study and found our staff really didn’t know what safeguards we had in place and which ones we didn’t. We have implemented from this data CPI yearly training and a visitor policy and are currently working on a mandatory reporting tool. As a downtown Level I trauma center, we see quite a bit of violence.”
Shellie Scribner, BSN, RN, CENStaff Nurse, Clinical Educator
Grant Medical Center ED, Columbus, Ohio
Jackie Ashburn, RN
November 201114
After Deadly Indiana Stage Collapse, It’s Showtime for Emergency Nurses By Kendra Y. Mims, ENA Connection
On August 13, 2011, thousands of Sugarland
fans packed the Indiana State Fairgrounds in
Indianapolis around 8:45 p.m. waiting for the
show to begin.
The popular country duo never made it to
the stage.
An anticipated evening of fun and music
suddenly turned into tragedy when a reported
wind gust of 60 mph caused the metal scaffold-
ing that held the lights and stage equipment to
fall on top of fans closest to the stage.
People in the audience, including numerous
first responders, rushed to help those who were
injured. Victims were trapped under equipment.
More than 40 people were affected by the stage
collapse. Some had minor injuries. Some were
unconscious. Some were dead.
The victims were transported to different
hospitals in the city.
Indiana University Health Methodist Hospital It was a regular Saturday at Indiana University
Health Methodist Hospital located in downtown
Indianapolis. Wait times were relatively short
in the waiting room. The non-critical area
was full, and all rooms were occupied in the
critical care area. A few patients had been
made comfortable in hallway beds.
Around 8:47 p.m.,
Ann Duffy, JD, BSN,
RN, a shift coordina-
tor working that
evening, received
a call from her
colleague, a nurse
whose husband was
at the scene when
the stage collapsed.
Shortly after, Duffy
and the hospital
administrator started receiving text messages
and phone calls about the incident on their
personal cell phones.
“We received all of this informal information
before we received any official notification
through the regular EMS channel,” Duffy said.
Kathy Hender-
shot, MSN, RN,
ANP-BC, director of
clinical operations
said the information
Duffy received was
informal but
accurate.
“What was ironic
is that there were so
many health care
providers at the
incident itself. That’s really how we got commu-
nication. It’s pretty official when your friends
are calling you and telling you they are standing
right there and the canopy blew down on 100
people. We had that information right away
from the text messages,” Hendershot said.
Because IU Health Methodist Hospital is a
Level I trauma center and located approximately
four miles from the state fairgrounds, Duffy and
Hendershot knew they would receive patients.
Although Duffy had not received official
notification and was unaware of the amount of
injuries, she decided to operationalize their
call-in system by sending out pages to all staff,
a decision that helped them to prepare before
the first patient’s arrival, 30 minutes after the
stage collapsed.
“We started getting patients so quickly,
and they came en masse. They seemed to be
arriving two at a time. We were expecting a
variety of acuity levels. We received the first
eight trauma patients within a 10–15 minute
period, back-to-back. All of them were very
critical,” Duffy said.
The other patients who trickled into triage
throughout the night were less critical, with
minor injuries, bumps and bruises. Hendershot
said that although they received a total of 28
patients, it was not enough to activate their
housewide plan and use their resources.
“IU Health Methodist received the sickest of
the sick patients,” Hendershot said. The airways
of all but two of the critical patients had been
secured by intubation of the trachea prior to
arrival. Several of the patients required
immediate life-saving procedures, which
included central line insertion for fluids and
blood to combat hypotension and shock. One
patient required an emergency department
thoracotomy prior to going to the operating
room. The entire trauma team was affected by
the story of one of their critical teenage patients
who was now a paraplegic.
“We’ve had other incidents, such as school
bus crashes, tornadoes and a truck that caught
on fire on the interstate, but never to this
degree have we had this many severely injured
patients,” Hendershot added.
Wishard Memorial Hospital Nicole Olson, BSN,
RN, emergency
department clinical
manager at Wishard
Memorial Hospital in
Indianapolis,
received notification
about the stage
collapse around
9 p.m. from a
hospital security
officer who had
heard it over the radio. There were 66 patients
already in the emergency department that night.
Wishard Memorial, the only adult Level I trauma
center in Indiana besides IU Health Methodist,
is usually at full capacity. Olson notified her
staff, the physician coordinator, the emergency
nursing staff, the house supervisor and the bed
coordinator to prepare for an influx of patients.
A total of 18 nursing staff responded—six from
in-house and 12 from home, which consisted
of their management team and trauma team
members.
Ann Duffy, JD, BSN, RN
Kathy Hendershot, MSN, RN, ANP-BC
Nicole Olson, BSN, RN
The following stories show the spirit of emergency nurses in spite of unexpected adversities they often face, whether it’s caring for a patient in
an emergency situation and not knowing the outcome, helping a family cope with a loss, losing a colleague or witnessing a catastrophic situation.
While each story deals with its own challenge or tragedy, it is our hope that the focus is not solely on the tragedy but on the dedication of
emergency nurses and the camaraderie that is found in the aftermath, as emergency nurses are brought together to save lives and to support each other.
Anytime. Anywhere.
Official Magazine of the Emergency Nurses Association 15
Redefining Travel Nurse: Conference Attendees Run Code in Airport By Kendra Y. Mims, ENA Connection
Similar to IU Health Methodist, there was
only a 30-minute time lapse from when Olson
received notification of the stage collapse and
when the first patients showed up at the
hospital for treatment. They identified six
patients as critical. Other injuries included facial
fractures, head injuries and broken bones.
Initially, Olson was uncertain about activating
the hospital’s disaster plan until she received
new notification from the scene: There were 40
people unaccounted for and possibly still
trapped under the stage. At that point, Olson
knew they would need resources outside of the
emergency department if those critical patients
showed up at their hospital. The disaster plan
was activated. Although those 40 people were
eventually accounted for, Olson felt that
activating the plan helped them to prepare
for the worst-case scenario.
“We are typically used to dealing with
disasters every night. A large influx of patients
coming in the emergency department is not
uncommon. We had 18 patients who were
injured, and I think activating the disaster plan
was beneficial,” Olson said. “We brought in our
extra OR team, extra ICU physician team, extra
trauma team, our
orthopedic call
team, and our
neurosurgery call
team, and all of the
backup trauma
nurse team members
were notified. I
think that’s what
helped us. We were
all ready.”
Teri Joy, BSN,
RN, CEN, trauma program director at Wishard
Memorial Hospital, had just returned home from
vacation an hour before the stage collapsed.
After watching the tragedy on television, she
received a phone call from Olson and Dr.
Hayward, trauma faculty on call.
When Joy arrived, she immediately noticed
everything was organized. She said that their
system works well because one person is in
charge of giving staff direction during a disaster.
She said that Olson, who was in charge that
night and appointed Joy to be a staff nurse, had
everything under control. Joy pointed out that
the emergency department charge nurse and
the physician coordinator can activate the
disaster plan at their hospital because they are
the frontline people receiving the patients and
in this situation are the most knowledgeable of
the current situation and needs. She felt Olson
had made the right decision.
“I think activating our disaster plan was
beneficial to the patients because you had all of
the decision-makers at the hospital to allocate
resources and provide the best care possible.
The emergency department management team,
emergency department nurses, the surgeons and
all of the trauma team nurses were here,”
Joy said.
Tammy McLemore was standing within 15 feet
of the airplane in the passenger walkway, about
to board her connecting flight from Atlanta to
ENA’s 2011 Annual Conference in Tampa,
Florida, when the man standing in front of her
stiffened up, collapsed and became unresponsive.
He appeared to be fairly young. Because
McLemore, RN, CEN, president of the Louisiana
ENA State Council, was positioned behind him
in line, she was the first person to arrive on the
scene. McLemore and an off-duty flight
attendant, who was boarding the same plane,
immediately yelled for help, rolled the patient
over and stabilized his neck.
Several conference-bound nurses standing in
line to board the same flight stepped forward to
assist the patient. They quickly fell into their
roles. McLemore started an IV and rotated the
compression with other nurses. A flight nurse
took control of the patient’s head and his
airway. Oxygen and resuscitative equipment
were removed from the plane for the nurses to
use. The nurses came together and worked with
the unfamiliar equipment in an attempt to save
the patient’s life.
“There was no equipment that was familiar to
us, but we were able to do the job with what
we had in an attempt to resuscitate the patient,”
McLemore said.
The fire department and a doctor were on
the scene. The paramedics handed the nurses
their equipment. Although everything had
become chaotic in a matter of minutes,
McLemore said the nurses ran the code while
the paramedics and the doctor fell back and
let the nurses take charge. Although codes
can sometimes be chaotic, there was a sense
of discipline.
“It was a very sudden thing. It was one of
those moments as a nurse when you think
you’re off duty, but then your adrenaline kicks
in and you start doing the things you are trained
to do,” McLemore said. “Of course the nurses
who are your support team that’s normally at a
bedside in an emergency room were not there,
but the nurses who happened to be in line were
working, and at the moment you saw all of the
nurses fall into their roles. I started an IV while
others were managing the airway. It was just
like working on a stretcherside patient in the
ER, except we were
in the middle of a jetway. I don’t know if
anyone knew each other.
We all just knew we were emergency nurses.”
McLemore said the code was run appropri-
ately by the time EMS arrived, and the patient
still had a shockable rhythm. The paramedics
were still performing CPR and resuscitating the
patient as they left the scene, taking him to a
local hospital. Although she was not sure of the
patient’s outcome, McLemore commended all
of the nurses on the flight for their quick
response and efforts in attempting to save
the patient’s life.
“All of the nurses did an awesome job and
were responsive. Nobody ignored the situation
and said, ‘I’m not a nurse today.’ You are an
emergency nurse no matter what, on duty or off
duty. It’s all the time. You may not have your
scrubs on at the jetway, but in your mind,
you’re always that emergency nurse watching,
appraising and assessing people. Your instincts
kick in and you fulfill that role for whatever
happens today,” McLemore said.
Teri Joy, BSN, RN, CEN
Continued on page 37
November 201116
On August 26, 2011, the LifeNet helicopter crash
that happened just east of Kearney, Missouri,
claiming the lives of everyone on board, left
Heartland Health’s staff devastated. Among the
four victims were Heartland Health caregivers
Chris Frakes, EMT-P, and ENA member Randy
Bever, RN, EMT-P, CFRN, both well-known
throughout several hospitals in the area. Bever
was a lead RN in Heartland Health’s emergency
department, as well as the TNCC coordinator,
ACLS and PALS instructor. He had worked for
Heartland Health for 23 years. Frakes had
worked for Heartland Health for five years and
was engaged to be married in September to a
Heartland Health emergency department
technician. No one had imagined that a routine
patient transport from Bethany to Liberty,
Missouri, would result in a loss that would
impact the whole medical community.
Tami Easton, RN,
Cameron Regional
Medical Center’s
director of nursing,
felt ill when she
received a phone
call from her staff
that a LifeNet
helicopter had
crashed while
transporting a
patient from
Bethany. The victims were unknown at the
time, and initial thoughts of Bever and Frakes
crossed her mind. When Easton later received
confirmation of the victims, she called Heartland
Health to offer coverage for its emergency
department for two days so that Heartland
Health’s staff could attend the memorial services
for Bever and Frakes.
Easton said CRMC’s staff was also devastated
and wanted to help. Twelve nurses in CRMC’s
emergency department, including Easton, went
to Heartland Health to provide coverage for
both days. CRMC’s personnel spent a full day
gathering staff’s nursing licenses, vaccinations,
criminal background checks and certifications
for Heartland Health’s human resources depart-
ment for verification that everyone providing
coverage was properly trained. Although they
were offered a monetary incentive for coverage,
Easton declined the offer.
“I never thought about it being a big deal.
Heartland is just 40 miles from us.
Of course we’ll go and help. My staff
jumped on board and thought it
would be great. I told Heartland that
we didn’t want to be compensated.
This is a really hard time for you,
and we just want to come and help
out,” Easton said. “I think that’s what
it’s all about. Being a nurse, we’re
here to help each other.”
Kelli Jackson, RN, an emergency
department nurse manager at CRMC
who volunteered, said the transition
process went smoothly when they
arrived, and they were able to effectively
provide patient care.
“It was a wonderful experience. I think we
gained a lot of camaraderie with the nurses who
were there. We transfer patients there a lot.
They were so appreciative. It made us feel that
we could actually do something physically for
them. I think it gave a lot of closure that we
could help out,” Jackson said.
Cameron staff nurse Barb Patton, RN, had
briefly assisted the patient who was being
transported. Although Patton knew it would
be difficult and emotional, she felt she needed
to volunteer.
“There was no choice. I went and had an
excellent experience, an experience I will have
for the rest of my life,” Patton said. “In the
health care field, especially in the emergency
room, there is a true camaraderie, and there is
a one-for-all-and-all-for-one attitude. Everyone
there was just excellent. We did a lot of patient
care. We didn’t know the computer system, so
we couldn’t chart, but anything that they
needed done, we all worked together as a team.
It was a real team effort.”
Putting the Plan into ActionHeartland Health’s HR department developed a
committee to determine which of its staff was
available to assist CRMC nurses during the
memorial services. Sabrina Vega, RN, associate
team leader at Heartland Health, volunteered to
stay behind and became the go-to person for
the CRMC nurses for the two days they covered
at Heartland Health. Vega spent two full nights
developing a plan for CRMC nurses, which
included mapping out their designated locations
and their tasks. Three other nurses from
Heartland Health also stayed behind with her.
They created cheat sheets that included main
phone numbers, as well as codes for supplies
and locked doors.
CRMC nurses were given a brief orientation,
cheat sheets and a tour before starting their
shifts. Although Vega anticipated charting would
be difficult due to their computerized charting
system, she felt their established plan worked in
providing patients with excellent care.
“We came up with a system where we
assigned each Cameron nurse three rooms
where they would be responsible for patient
care. Everybody showed up and took their
assignments without hesitation,” Vega said.
“Everybody would do anything you would ask.
There wasn’t a task that would go incomplete.
You had anybody there willing to do anything.”
Vega says CRMC’s support really helped
Heartland Health’s staff during their time of
One Emergency Department Covers Another After Tragic Helicopter CrashBy Kendra Y. Mims, ENA Connection
Several Cameron Regional Medical Center nurses who provided coverage for Heartland Health are pictured above. Back row (L to R): Roy Estes, RN; Barb Patton, RN; Kelli Jackson, RN, ER supervisor; Terri Keatley, RN; Front row: Pam Tuia, RN; Christi Coates, RN; and Ginger Graham, RN.
Tami Easton, RN
Left to right: Chris Frakes, EMT-P and Randy Bever, RN, EMT-P, CFRN.
Official Magazine of the Emergency Nurses Association 17
need, and she had
full confidence in
their ability to
perform.
“I know our staff
here felt more at
ease that they could
go to the funeral. No
one had really dealt
with anything like
this all at once. It
was a really hard
thing for everyone to go through. Just knowing
that you have people out in the community
willing to come to help really gives you goose
bumps,” Vega said. “An emergency nurse can
just about take care of anything. They are
responsible for the same certifications as we
are, so we knew that they would be able to
do it.”
Debra Delaney, MS, RN, CEN, Blue Jay
Consulting’s process improvement coordinator
and emergency department consultant for
Heartland Health, watched in awe as CRMC
nurses arrived and covered the unit.
“There were poignant moments, tearful
moments and a few of those moments that only
emergency nurses can laugh at. Through it all,
these nurses exemplified what it means to be an
emergency nurse anywhere in the USA. It was
so humbling for me personally to have the
privilege of witnessing these two days,”
Delaney said.
Delaney was even more amazed at how the
nurses were adamant about their time being
strictly voluntary, as they were there to support
their colleagues.
“When it was time for them to leave, there
were tears, hugs, smiles and thanks from the
Heartland nurses for being able to attend the
services of their friends. It was again the
Cameron nurses who became tearful and stated
‘No, thank you for allowing us to be there to
support Randy and Chris as well,’” Delaney
said. “It really was overwhelming and reaffirms
for me once again why I love being proud to
call myself an emergency nurse.”
The Gift of Giving As director of nursing, Easton felt rewarded
for the opportunity to provide hands-on patient
care. She said each of her nurses who
volunteered contacted her immediately
afterward to thank her for the opportunity,
as they also felt rewarded by the experience.
“It was so rewarding to each of us. We were
so touched by the genuine gratitude of each
person, from their administration to their floor
care people. Everybody there was so gracious,
welcoming and genuinely appreciative,” Easton
said. “Anytime you go to another facility to
help, you take something away. We took away
a lot more than we gave.”
Debra Delaney, MS, RN, CEN
Established in 1991, the mission of the ENA Foundation is to provide educational scholarships and research grants in the discipline of emergency nursing.
Your Dollars = Your Future Investing in a nurse today is an immeasurable
contribution to the future of emergency nursing and patient care.
Invest in the future of your profession.Support the ENA Foundation.
Donate Now.
www.enafoundation.org
Heartland Health nurses who assisted Cameron Regional Medical Center nurses (L to R): Jacob Barton, BSN, RN;
Michelle Doolan, BSN, RN; Machelle Skinner, BSN, RN, CEN; and Sabrina Vega, RN.
November 201118
Amateur videos on YouTube offer different
angles of the same horror from the Reno Air
Races on September 16. There it is: Jimmy
Leeward’s vintage World War II-era fighter
plane, the Galloping Ghost, pitching straight
up and nearly out of sight as it turns in front
of the grandstands at Reno-Stead Airport
outside Reno, Nevada. And there it is again,
spiking violently into the tarmac, gobbling up
a section of reserved seating in a swirl of
disintegrating steel.
Obscured among the chairs and debris:
at least five or six instantly dead, including
Leeward, the 74-year-old pilot of the
malfunctioning craft. Dozens more injured,
many critically. Severed arms. Legs.
This is where the audio introduces the
next phase of the story: Above the disbelieving
groans of onlookers, a race official on a loud-
speaker instructs the uninjured to stay back,
except for those with medical training.
To those spectators, the message is:
Yes. Come down. We’ll need your help.
As clearly as
Tricia Lillibridge, RN,
CEN, heard the
hellish screech of
Leeward’s plane
slamming back to
earth that Friday
afternoon, she heard
the call to action
from her seat in the
grandstands.
“As I ran down
the steps, I had gone from being Tricia,
spectator, to Tricia, emergency nurse,” she said.
“And that’s what I said to people: ‘Let me
through, I’m an ER nurse, I’m an ER nurse,
I’m an ER nurse. How can I help?’”
September 16 was supposed to be a vacation
stop for Lillibridge and her husband, Clint—
their annual day at the races as they made their
way from their home in Homer, Alaska, to ENA
Annual Conference in Tampa, Fla. Instead,
while Clint, a retired pediatric gastroenterolo-
gist, tended to dazed survivors wandering the
grounds, Tricia entered a veritable warzone.
Her patient was a man in his 50s whose right
leg was gone, sliced off at the thigh. She
applied double manual pressure on his femoral
artery and waited the agonizing minutes for IVs,
oxygen and transport to reach her while the
Reno-based Regional Emergency Medical
Services Authority coordinated triage and doled
out supplies.
“I never worked so hard, so fast, in my life,”
Lillibridge said. “I was bound and determined
to put enough pressure on this thing where
I wouldn’t be responsible for him (exsanguinat-
ing). I said, ‘I’m not giving up on him until
somebody gets over here with two hands.’”
The man awoke suddenly and began flailing.
Lillibridge maintained her pressure, extracted
the most basic information from him: first
name George, no allergies. All around her
were graphic images of trauma—the sort of
event she’d prepared students for as a TNCC
instructor but never imagined she’d see
like this, here, on this scale.
First responders
poured in—physi-
cians, surgeons,
nurses, some from
the emergency
response crews,
others straight out
of the stands. Nic
Eisenbarth, RN, was
among five nurses
and two technicians
from Saint Mary’s
Regional Medical Center who were staffing the
onsite medical clinic. He and another nurse had
watched, perplexed, as Leeward’s plane pitched
overhead before missiling into the pavement on
the other side of the grandstands. They rushed
for the medical tent, where two of REMSA’s
advanced life-support ambulances were heading
out. The other two ambulances, designated as
crash units, already were arriving at the edge of
the debris zone.
REMSA’s onsite supervisor ordered all but
one of the Saint Mary’s nurses to the field.
Eisenbarth bounced from victim to victim as
red, yellow and green triage tarps were laid
down and patients quickly assessed and
organized. He first encountered a man with a
fractured skull. A local ear, nose and throat
specialist was attempting to intubate him.
“We had a lot of people coming up and
saying that they were first responders, asking
how they could help,” Eisenbarth said. “I
handed one guy my trauma shears and asked
him to start cutting up the [reserved-seat
curtains] to make tourniquets. … As soon as we
got everybody kind of stable enough to get
them over to the tarps, we started working on
the reds, getting lines in the reds, started taking
fluids, making sure that their tourniquets were
holding.”
The airport authority’s bus, at REMSA’s
disposal, was packed with enough backboards,
IVs, oxygen, bandages and tourniquets to treat
300 people. Eisenbarth said it didn’t have the
advanced diagnostic tools, blood products or
narcotics he needed, but transport wasn’t far
off. Nineteen more ambulances and three
helicopters were sent to help take away 54
patients, including a notably high number of
reds, said Kevin Romero, the EMS director for
REMSA. The first six reds went to Renown, the
A Close One for Nurses as Disaster Drops on RenoBy Josh Gaby, ENA Connection
Tricia Lillibridge, RN, CEN
Nic Eisenbarth, RN
The Galloping Ghost, a vintage fighter plane, becomes a bomb of deadly shrapnel as it crashes into the tarmac just in front of spectators September 16 at the Reno Air Races in Reno, Nevada.
Ph
oto
cred
it:
Wa
rd H
owes
, A
ssoc
iate
d P
ress
Official Magazine of the Emergency Nurses Association 19
Level II trauma center in Reno, while the other
patients were distributed among Renown, Saint
Mary’s and the Northern Nevada Medical
Center. The northbound lanes of the 395
freeway were shut down to clear a path into
Reno for southbound ambulances.
Total time to remove all of the injured from
the scene: 62 minutes, Romero said.
“Just the amount of people that we got off
the tarmac is just amazing, how quickly and
smoothly that all went,” Eisenbarth said. “It
seemed like as soon as we had everybody to
the tarps, triaged, starting to get lines in them,
you look up and there’s REMSA showing up
with their rigs asking who goes first, who goes
next, ‘I can take two,’ ‘I can take three’ …”
Lillibridge’s patient, George, was loaded
into an ambulance bound for Renown, still
conscious. It was the last she saw of him.
Eisenbarth caught a ride with some Air Force
personnel headed for Saint Mary’s. His lasting
memory from the scene is of an older man
with a grotesquely bent ankle—an apparent
tibia-fibula fracture.
“He was very, very adamant that we take
other people first,” Eisenbarth said. “On normal
days, someone has to wait in the emergency
room and they’re pretty upset about it. I don’t
think they understand that the only reason
somebody’s coming before them is because
they’re actually worse off. And this guy totally
got it.”
* * *
Melané Marsh, BSN, RN, CEN, was at home
packing with the television on. Like Tricia
Lillibridge, she
would be in Tampa
soon for Annual
Conference. The live
news coverage
broke in: a plane
crash at the air
races. There had
been others over
the years, but never
involving spectators.
In the background,
she heard the racing officials’ call for medical
personnel.
“And that was kind of a cue,” said Marsh,
the Nevada ENA president and a Saint Mary’s
charge nurse. “Mentally, I just said, ‘Something’s
not going right.’”
She called emergency department director
Shelby Hunt, BSN, RN, MHA, CEN, who already
had her team bracing for a surge of patients,
despite Saint Mary’s not being a designated
trauma hospital.
Hunt’s husband,
Bryon, a firefighter/
paramedic who had
been at the races,
had phoned to warn
her of a mass-casu-
alty incident. Minutes
later, the radios put
the area hospitals on
alert. Calls to the
Saint Mary’s staff at
the medical tent
confirmed: This is for real. Reds and yellows
would be arriving soon. Hunt’s staff lined the
halls with gurneys, wheelchairs, charts, buckets
of medicine. Off-duty nurses and techs were
summoned.
Marsh was
already on her way.
So was Jen
Boscovich, RN,
SANE, who had just
left the airport with
her husband, Brock,
a Saint Mary’s
emergency
physician, and
several of his
flight-doc friends
when they heard the plane had gone down.
The Boscoviches grabbed scrubs and dropped
their 15-month-old son off with a babysitter.
About 20 minutes later, just as they were
arriving, so were the wounded, three or four
at a time.
“They just started piling them on gurneys and
bringing them in,” Hunt said. “Other than we
knew we would be getting patients, we had no
idea what was going to be walking through our
doors, though you anticipate you could get
anything.”
A secondary triage center was set up outside
to make sure patients were still categorized
properly. Surgeons stood by waiting to treat
those with missing limbs and shards of plane
buried in their flesh.
“To me, it was a perfect impression of
war-type injuries of shrapnel,” Marsh said.
“I mean, it was just limbs cut off, wide-open
lacerations.”
Hanging in the air was the stench of jet fuel.
“Never smelled it before,” Marsh said. “That
was just overpowering. It didn’t irrigate off. You
couldn’t wash it off. I mean, it was just there.”
So were the hands of volunteers, more than
the staff could keep up with at times.
“Even the physicians that have nothing to do
with the ER just came,” Marsh said. “We had
cardiac surgeons and cardiologists. We had a
plastic surgeon walk into the ER with his own
bucket of sutures and numbing medicine and
ask us where we wanted him to start.”
Labor and delivery nurses. Floor nurses.
Pharmacists. Employees from Renown ended up
at Saint Mary’s because they couldn’t reach
Renown fast enough, Boscovich said. More
support came from military personnel and
random community members. Medical students
were on hand to help with sutures.
“Everybody needed something sewed up,”
Boscovich said.
For some, the suturing was emotional.
Boscovich helped treat a young man from Italy
with lacerations across his back. The people
he’d been sitting with at the show had been
killed. Though his vitals were stable, he was
terrified the critical hour would be the end for
him.
“‘Jen, don’t leave me. Don’t let me die, Jen.
Stay with me.’ He was so afraid,” Boscovich
said. “He was convinced that at that hour mark,
no matter what happened, he was going to die,
no matter how much we reassured him. He was
so alone, he was in a foreign country, and
scared to death. That fear will never leave me.
There was nothing, nothing to take that away
from him.”
They worked into the night, with a strange
peace slowly replacing what Hunt called
“organized chaos.”
“I remember, about 10:30, just kind of
scanning the department with my manager,”
Hunt said, “and we were blown away because
you would truly have never known just a few
hours earlier what this place looked like, and
they got it right back into operational, day-to-
day mode. It truly was like what had happened
had never happened.”
Marsh, like most, was moved by the effi-
ciency and selflessness she saw. Of all the
patients treated at Saint Mary’s, including four
reds, only one died—a man with a head injury.
“That’s the biggest thing for me,” Marsh said,
“walking in and knowing I had that team of
people working and just seeing that visual of
the hallways lined with gurneys, there’s tons of
people there, everybody’s doing a job of some
sort, and if they’re not, they’re asking you what
they can do. … It’s awe-inspiring to know that
as a community and as a hospital, we can come
together like that, and, as I kept saying, we
rocked it.”
Said Hunt, who, like Marsh, has a back-
ground as a trauma nurse: “It just proved you
Melané Marsh, BSN, RN, CEN
Shelby Hunt, BSN, RN, MHA,
CEN
Jen Boscovich, RN, SANE
Continued on page 37
November 201120
involves learning the PRT hold, as well as how
to deal with wrist grabs, hair pulls and choking
and learning how to take a patient to the ground
safely.
“Our whole goal with this was to keep
everyone safe and not to injure anyone—staff or
patients—and to be able to carefully take our
patients to a point where we can restrain them
enough to let them know we are not going to
hurt them but their behavior is inappropriate
and they need to regain composure,” Ashburn
said. “Handle with Care teaches you how to
restrain them and how to escort them back
to a safe place.”
Ashburn points out that there have been five
incidents where staff members have used the
training from the class. She feels the class has
empowered staff and is helping them deal with
their mental health patients effectively.
“Handle with Care says there is no dignity in
allowing a patient to hurt himself or others. You
have to set your limitations and be able to help
those people regain their control, because
they’ve lost it,” Ashburn said. “Once our mental
health patients realize that you are trying to help
them and that there are limits, they respond
fairly well, unless they are totally out of control,
and then at that particular point, it does require
restraint.”
In an effort to support each other, Ashburn
says staff members have created several trigger
phrases, such as “Your lunch is ready,” to help
one another identify when it is time to walk
away from a situation.
“We talk about how all of us have buttons and
these people find our buttons. Our goal is to
keep ourselves focused and not allow our anger
to surface, because with anger and fear you
increase tension without reducing the tension.
So you need to know what your triggers are,”
Ashburn said.
Ashburn has enjoyed teaching the class and is
glad she volunteered to become an instructor.
Her goal is to continue as an instructor and
show nurses that they can protect themselves.
“I have felt over the years that nurses weren’t
given the tools they needed to learn to verbally
de-escalate and to protect themselves. As
emergency nurses, this is one thing that you’re
just not taught. I volunteered to show nurses
that they can do this and to empower nurses to
take care of themselves,” Ashburn said.
Reference Rates of Violence. (2010). Retrieved from
Emergency Nurses Association Web site:
www.ena.org/media/PressReleases/Pages/ RateofViolence.aspx
Get ready to find out all you need to know
about attending ENA Leadership Conference
2012 in New Orleans, February 22–26. To make
your online experience easy and informative,
we’ve completely redesigned this area into a
one-stop shop for all your conference needs.
As you navigate through the new conference
site, quickly find information for attendees by
hovering over the Attendees tab and making
your selection from the items in the drop-down
list. Review the Advance Program online or
download it as a PDF. Look over the Focus Grid
for sessions in education, management or
personnel. Take advantage of our trip-planning
tips and information to help make your trip a
great experience. Are you coming early to enjoy
Mardi Gras? Be sure to read Join Us in New
Orleans under the Conference Planning area.
Looking for resources, such as a justification
letter or international invitation letter? Do you
want to help promote the conference to your
peers, using our official conference sticker in
your e-mail footer and post to your social
networking sites, such as Facebook or Twitter?
Find all of these and more under Resources,
also under the Attendees tab.
When you are ready to book your airfare or
secure a hotel, go to the Travel/Lodging tab and
find information on the ENA block of rooms,
airfare, shuttle and cab services.
Don’t miss out on any of the fun or special
events while at the conference. Visit the Special Events tab, where you will find information on
the Welcome to New Orleans Party, the ENA
Candidates Election Forum, the ENA Town Hall
Meeting, the ENA Foundation Exclusive Event,
Masked on the Mighty Miss, and sponsored
events and focus groups.
Get the best information to help you have a
wonderful experience at the ENA Leadership
Conference 2012 — visit the conference site
often to answer your questions and stay
informed. See you in New Orleans!
Readers may contact the author at
…For ENA Leadership Conference 2012 Information
Vanderbilt’s Adult Emergency Department Continued from page 13
References Emergency Department Violence Surveillance Study. (2010, August). Retrieved from
Emergency Nurses Association web site: www.ena.org/IENR/Documents/ENAEDVSReportAugust2010.pdf
Gacki-Smith, J., Juarez, A., Boyett, L., Homeyer, C., Robinson, L., & MacLean, S. (2009, July/
August). Violence Against Nurses Working in the U.S. Emergency Departments. The Journal of
Nursing Administration, 39(7/8), 340–349. Retrieved from the Lippincott’s NursingCenter.com
web site: www.nursingcenter.com/library/JournalArticle.asp?Article_ID=927697
U.S. Department of Justice Workplace Violence, 1993–2009. (2011). Retrieved from the CPPS
web site: www.cppssite.com/blog/wp-content/uploads/2011/04/Nonfatal-workplace-violence-BJS-2009.pdf
• Patients and their relatives were the main perpetrators in all incidents of physical and verbal violence, with 97.1 percent of physical incidents and 91.0 percent of verbal incidents having involved a patient.¹
• A 2005–2009 study reported that nurses have the highest percentage of workplace violence at 3.9 percent when compared with other medical occupations.²
• Each year, almost 500,000 nurses are victims of violent crimes in the workplace.³
• In 2009, ENA reported that more than 50 percent of emergency room nurses had experienced violence by patients on the job and 25 percent of ER nurses had experienced 20 or more violent incidents in the past three years.³
Deb Zirkle, ENA Director of Online Services
Did You Know
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For more information visit www.ena.org.
LEADERSHIP CONFERENCE 2012
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November 201124
ENA Call for…
ENA on Facebook. What Are Emergency Nurses Saying?
The 2011 General Assembly held in Tampa,
Florida, in September was an overwhelming
success. The delegates were presented with 10
bylaw proposals and 12 resolutions for consid-
eration. Delegates from across the nation and
for the first time, international delegates partici-
pated in lively debate over these issues that
affect our emergency nursing practice.
President AnnMarie Papa, DNP, RN, CEN,
NE-BC, FAEN, empowered by her understand-
ing of Robert’s Rules of Order, kept the delegates
in order and on time. Congratulations to our
president for an outstanding meeting that
allowed the business of the association to be
carried out with a little humor integrated into
the proceedings.
Credit for a successful meeting also goes to
our delegates. Delegates participated in our
second annual online delegate orientation led by
our parliamentarian, Colette Collier Trohan. For
the third year in a row, voting keypads assisted
delegates in the debate and voting process.
Familiarity with the process allowed for smooth
transitions for speakers and voting counts.
The Resolutions Committee would like to
thank all of the authors who submitted bylaw
proposals and resolutions. For several, this was
the first time submitting a bylaw proposal or
resolution. Their courage in engaging emergency
nurses in important dialogue about emergency
nursing issues is commendable. If you know
someone who authored a bylaw proposal or
resolution, please share your gratitude.
It is hard to believe, but it is already time to
begin thinking about preparing bylaw proposals
and resolutions for next year. The Resolutions
Committee would like to challenge you to write
resolutions that address clinical topics affecting
your practice. We are available to assist you
in this process. Please feel free to contact
Kari Zick at the ENA national office at
[email protected] to reach committee
members.
The Resolutions and Bylaw Guidelines
(recently revised) and proposal templates are
available in the General Assembly area under
Members Only at www.ena.org.
The submission deadline is 5 p.m.
Central time,
March 2, 2012.
Remember, in
order to ensure that
emergency nursing
uses best practices
to care for our patients, it is important that our
members help guide ENA in addressing issues
that are important to your practice. Help put
these issues on the front burner and get
emergency nurses engaged in dialogue by
writing a resolution.
On behalf of your 2011-2012 Resolutions
Committee — Nicholas A. Chmielewski, MSN,
BSN, RN, CEN; Jill C. McLaughlin, BSN, RN,
CEN; Gordon C. Rogers, RN, CEN; and E. Marie
Wilson, RN — we thank you in advance for
taking the initiative to write a resolution. Feel
free to use the expertise of the committee. This
process is what helps empower you to change
the emergency nursing practice. Let your voice
be heard.
2012 Bylaws Proposals and ResolutionsDeadline: March 2, 2012
By J. Jeffery Jordan, MS, RN, MBA, CEN, CNE, EMT-LP, Resolutions Committee Chairperson
Emergency nursing is hard. This is Emergency Nurses Week, so why don’t
you all share with others what you do to help keep your passion for the
work alive and well.
Barbara Larrabee Duarte Orienting new superstar graduate nurses keeps me motivated.
Rachel HansonHelped a new grad nurse with a code a while back. I thought it was a lost
cause. The patient was a mess and based on her labs, etc, it seemed
clearly to be a non-survivable incident. Nonetheless, we worked the code
and took care of the patient. I was completely AMAZED to know that that
patient WALKED out of the hospital!!!! That is why we do what we do!!!
Hoorah for ER nurses!! We really do save lives!!!
Elizabeth Balota When you get through the barrier and are able to connect with the
patient. It’s the most rewarding feeling.
Ruth L. Citroni Richardson Working with great nurses and docs that support each other helps. I also
make a point of taking time to recharge my batteries. We need to take
care of ourselves so we can be there for our patients.
Linda Guy Heilman I think it has to be the family that says thank you after they watch you
struggle to do everything for their loved one.s
Krista Brancel Mentoring is great ... also having those times when being stopped outside
if the ER, “You are a nurse right?” Why yes. “I know you don’t remember
me but you were the one who took care of me, thank you.” It makes it all
worthwhile. We all began this profession for a reason. ER nurses make a
difference and save lives. Thank you to past, present and future ER nurses!
ENA posted the following during Emergency Nurses Week, October 9-15:
Official Magazine of the Emergency Nurses Association 25
As a member of the
Nominations
Committee, I was
disappointed by the
low voter turnout for our 2011 national election.
ENA is approximately 40,000 members strong,
but only 2,134 members cast ballots, for a 5.31
percent participation rate. In my home state of
Missouri, out of a total of 795 members, only
36 cast ballots. Thank you to those who took
the time to vote.
This means that only 5 percent of the
membership decides who leads our organiza-
tion and makes crucial decisions that impact our
patients, their loved ones and us as profession-
als and practitioners. Is that a good thing?
I think not.
We are a member-driven organization. As
emergency nurses, we must have a vested
interest in our organization. We must be willing
to invest time and energy toward the perpetua-
tion of our organization that is considered to be
the voice of emergency nursing by so many
individuals. We have enormous clout in our
society in both the professional realm and the
nation at large. We are a major player in many
facets of our world: political, research,
education, nursing practice, emergency
preparedness and publications, to name a few.
Our leadership speaks for us in many delicate
and powerful situations and represents each
and every one of us. An organization of our size
and caliber needs input from all of its members,
because neither the board of directors nor the
Nominations Committee nor any other
committee within our organization makes all the
decisions. We need membership involvement to
be a powerful voice in our chosen profession,
emergency nursing.
The Nominations Committee has been
working hard for several years to improve the
voting process and to bring new ideas to the
membership. We have searched for answers to
this problematic situation and listened intently
to anyone who has ideas for improvements.
Obviously, we need to hear more.
My challenge to you is to e-mail the Nomina-
tions Committee at [email protected] with your
ideas on how to improve voter turnout and how
ENA can help the membership know more
about the candidates.
We frequently hear, “I don’t know the
candidates, so I don’t vote.” During Leadership
Conference 2011, we hosted the annual live
Candidates Election Forum where each
candidate answered questions pertinent to our
organization’s needs and growth. At this venue,
you can see, meet and hear the candidates’
views on topics that affect our organization.
The ENA Connection and www.ena.org provide
biographical information on every candidate far
in advance of the voting process and through-
out the election. During the election voting
time-frame, the membership is invited to ask
questions or post comments of support and
view responses by the candidates via the Ask
the Candidate area of www.ena.org.
Please help us by providing more input so
that we can continue to be a member-driven
organization. We are a powerful and exciting
organization. Help us help you to keep our
organization at the top. As your Nominations
Committee, we are committed to helping our
organization grow through our leadership. That
leadership must come from you, through you,
by you. We’re waiting anxiously to hear some
incredible ideas. As we begin the cycle for the
2012 election, I encourage you to become
informed, consider who will be the best leaders
for ENA and, above all, remember to vote.
We’re Emergency Nurses— We Can Do Better Than 5 Percent
NOMINATIONS COMMITTEE | Gail Carroll, BSN, RN, CEN, Nominations Committee, Region 3
Now Available!ENA’s Certified Pediatric Emergency
Nurse Review Manual
We want to help you succeed on the CPEN™ exam and earn your certification. The ENA CPEN Review Manual follows the blueprint of the CPEN Exam.
This manual offers:
• More than 600 practice questions founded in current, evidence-based literature• Answers and rationales are provided for each and every question• An extensive list of references is included to supplement your preparation
for the CPEN exam• Access codes to two online practice tests, worth three continuing education
contact hours each• A succinct, comprehensive review of the core material• Material meant for both those certifying for the first time and recertifying nurses
For more information and to purchase either the print or electronic version visit www.ena.org and click on shop.
The Emergency Nurses Association is accredited as a provider of continuing nursing education by the
American Nurses Credentialing Center’s on Accrediation.
November 201126
READY OR NOT? | Knox Andress, BA, RN, AD, FAEN
‘Something’s Happened’
“Little did I know that September 11, 2001,
would be the most important day of my news
reporting career.” Charles (Charlie) Gibson, the
now-retired anchor for ABC’s “Good Morning
America” and “World News Tonight,” shared
his personal reflections, perspectives and
recommendations for disasters and media
reporting during the 5th National Emergency
Management Summit in Brooklyn, New York,
September 14, 2011.
“At 8:46 a.m., Diane (Sawyer) and I were
delivering the morning news program on
‘Good Morning America’ when the first plane,
American Airlines Flight 11, hit the World Trade
Center’s North Tower. Then, at 8:48 a.m., just
two minutes later, I hear a message in my
earbud … ‘Something’s happened.’ Our video
feed immediately switched to a traffic camera
focused on the World Trade Center’s North
Tower now belching thick black smoke. Rarely
in my broadcast career have I been at a loss
for words, but for 15–20 seconds there I was
struggling to comprehend what I was seeing
on the monitor.”
For many people across the country watching
their usual morning television, Gibson, Sawyer
and ABC News were the initial alert and
messengers of the 9/11 attacks and the heroic
responses that followed. Similar electronic and
print media reporting’s occurred in the days,
weeks and months that followed.
Role of the Media in Emergencies Both electronic and print forms of news media
are key components of crisis communications
and can play a vital role in incident manage-
ment by alerting, warning and educating the
public about emergencies and disaster events.
During severe weather, the National Weather
Service partners with television station broad-
casters to alert the community. Accurate and
timely reporting is a means to saving lives,
mitigating property damage and helping people
to help themselves in the face of an emergency.
The electronic news media, including
broadcast and Web-based, is a resource for
disaster managers and responders. A fundamen-
tal component of any hospital or community
command center includes at least one television
monitor and a computer with emergency
power.
DHS Daily Open Source Reports Media reports can provide situational awareness
of threats and hazards to emergency depart-
ments and hospitals. Each business day, the U.S
Department of Homeland Security’s Daily Open
Source Infrastructure Report provides a
summary of threat news from open media
sources. The Daily Report gives a synopsis of
threats to the 18 infrastructure sectors identified
in the National Infrastructure Protection Plan
www.dhs.gov/files/programs/editorial_0542.shtm.
Each day visitors to the DHS Web site can
potentially read about hazmat events, mass
casualty incidents and other events impacting
emergency departments and hospitals.
Critical infrastructure sectors include public
health and health care; energy; chemical;
nuclear reactors, materials and waste; critical
manufacturing; defense industrial base; dams;
agriculture and food; water; banks and finance;
transportation; postal and shipping; information
technology; communications; commercial
facilities; government facilities; emergency
services; and national monuments and icons.
Plan for MediaHospitals and emergency departments should
plan for news media engagement during
emergency and disaster events. Like the cable
news weather reporter broadcasting during the
hurricane’s landfall, many times, a reporter will
want to visit the “scene of the action,” which
may be the emergency department. Policies
should be in place for receiving and directing
media to the hospital’s public information
officer, a command staff role described in the
Hospital Incident Command System.
Develop a relationship with local media to
build mutual trust. When a newsworthy event
occurs, provide reliable, concise, understand-
able information to media contacts as soon as
L to R: Former ABC anchor Charles (Charlie) Gibson with Ready or Not? columnist Knox Andress, BA, RN, AD, FAEN.
Ground Zero after the collapse of the Twin Towers September 11, 2001.
Official Magazine of the Emergency Nurses Association 27
possible. Understand and engage the hospital
PIO when needed.
The mission statement for the HICS, PIO job
action sheet reads “serve as the conduit for
information to internal and external stakehold-
ers, including staff, visitors and families and the
news media, as approved by the Incident
Commander” (www.emsa.ca.gov/HICS/files/JAS_Command.pdf ).
Having a pre-identified location for media to
assemble or stage will assist the PIO and help
prevent reporters from straying. Monitor the
news media, television, radio, Internet and
social media. If the hospital has a Facebook
page, plan on monitoring and responding to
questions that will come from the community
during an emergency event.
Craft the Right MessagePIOs will be assisted by developing preplanned
messages to be delivered by the appropriate
spokesperson when needed. To aid in crisis
communication planning and response, the
Centers for Disease Control has developed a
training program Web site, Crisis and
Emergency Risk Communications, which draws
from best practices learned during previous
emergency and disaster events. Crisis and
emergency risk communication has been
defined as “the strategy used to provide infor-
mation that allows an individual, stakeholders
or an entire community, to make the best
possible decision in a crisis emergency event”
(www.bt.cdc.gov/CERC/).
Readers may contact the author at
Follow Knox Andress
@ENAdman.
Are you a guru in a particular area of emergency nursing, management or policy? Have you developed a successful approach to a common challenge in emergency nursing? Has a particular experience given you new insights into a current issue, trend or best practice that could benefit other nursing leaders?
Share your insights related to current issues, trends, and best practices as a faculty memberat ENA Leadership Conference 2013, February 27 – March 3 in Fort Lauderdale!
Topic areas:
Join the ENA Leadership Conference Faculty
Establish YourselfLeader among Nursing Leaders
as a
Submission Deadline is March 19, 2012
• Management• Operations• Government affairs• Technology• Team building• Research• Education
• Advance practice• Orientation• Retention• Community relationship building• Customer satisfaction• Personal and professional development
In addition to the recognition as a nurse leader, faculty members receive complimentary registration, airfare, hotel and per diem reimbursement.
Find full information and course proposal guidelines at www.ena.org and click on Leadership Conference 2013 Call for Course Proposals in the Calls and Opportunities Section. We look forward to hearing your cutting-edge course ideas.
Important Dates to rememberEarly Bird Registration Closes ............................. January 11, 2012
ENA Board of Directors Meeting .........................February 22, 2012
State and Chapter Leaders Conference ...............February 23, 2012
Presessions ......................................................February 23, 2012
Educational Sessions .................................. February 24 – 26, 2012
Information From past attendees*
• Thank you for a wonderful conference. Such a renewing experience. I am full of ideas that sparked from the sessions I attended. Here’s to happy changes! Thank you again! I’ll be looking to attend another conference!
• I cannot begin to tell you how powerful this conference was for me. I feel as though I am personally and professionally changed by the things I learned and the people I met. I learned so much and treasure all of the pearls of wisdom imparted at Leadership 2011. Thank you for the strength of this organization!
• I went to learn more and to be better able to support my leaders and educate other nurses to make change easier. Now I am very enthusiastic in “working the crowd.” Emergency department directors to send their staff when they can’t attend is a good idea.
ENA Leadership Conference 2012 will Illuminate, providing a beacon of light with
new information and skills. It also will empower, offering the support, strength and
knowledge to move forward as an emergency nursing leader. ena Leadership
Conference provides the tools to help emergency nurses be the leaders
they want to be and unite as one voice for our profession.
be the nursing Leader You Want to beAny emergency nurse who holds or seeks a leadership role at any level will
benefit from ENA Leadership Conference 2012. With 70 general sessions to
choose from across six focus areas and 17 contact hours, bedside staff nurses
who lead colleagues, charge nurses, nurse managers, directors and CNOs
all will find relevant information they can apply as soon as they return to
their organizations.
Leadership Conference 2012 offers even more educational opportunities
through presessions as well as the chance to network and share best practices
with nursing leaders from around the world. Learn how your colleagues address
challenges that concern you now and see familiar topics in a new light so you can
do something about them.
Scan this QR code with your mobile device to learn more about our conference.
November 201128
REGISTER BY JANUARY 11 TO SAVEby taking advantage of the reduced early-bird conference fees, you save $90 on a three-day registration. that’s more than 20 percent off the regular registration fee!
29
the Leadership Conference 2012 keynote speakers are sure to Illuminate the crowd with unique perspectives.
All’s Fair in Love, War… and Running for PresidentJames C. Carville, Jr. and Mary J. Matalin
These New Orleans residents each has more than 30 years of experience in politics and has individually worked for Presidents Ronald Reagan, George H.W. Bush, Bill Clinton and George W. Bush. These two will candidly share their views on the turbulent political landscape and how it will affect health care in the coming years.
Balancing Life in Your War ZonesLeAnn Thieman, LPN, CSP, CPAE
Recounting her dramatic experiences from the Vietnam Orphan Airlift, LeAnn shares life-changing lessons for coping in our “war zones” today. In this poignant and humorous presentation, learn how to balance your life, live your priorities and make a difference in the world.
Eat, Drink and Succeed! Climb Your Way to the Top Using the Networking Power of Social EventsLaura Schwartz
Harness your social power and increase productivity “after hours” with the tools you need to turn your social scenes into professional and personal successes.
Educational opportunities promise to empower through information and relevance
• Earn more than 17 contact hours during the general educational sessions offered in six focus areas. Earn even more through presessions
• Add to your leadership skills with practices or techniques you can apply immediately
• Strengthen your position within your organization and as a valued member of the leadership team
• Expand your career options by adding to your base of knowledge and skills, becoming a valuable asset for your organization
register at www.ena.org.
November 201130
California ENA State CouncilSubmitted by Marcus Godfrey, RN, President-elect
All Leftovers Go to the Emergency DepartmentIt is common practice in most hospitals that all leftovers go to the
emergency department. There is often no greater saving grace on a hard
shift than word that food has arrived.
After the first day of delegation at the 2011 General Assembly in
Tampa, Florida, the California delegates met for a reception. Just as we
were wrapping up the event, I mentioned to Linda Broyles, MSN, RN,
CEN, MICN, Cal ENA president, that there was a lot of food left over. She
jokingly commented that we should take it to the local emergency depart-
ment, which is exactly what we did.
When we arrived in the emergency department at Tampa General, the
staff was slammed. They saw us in all our Cal ENA gear and rolled their
eyes. I’m sure the last thing they wanted was to have to give some
out-of-state association a tour. I held up the food and told them we were
only here to feed them, and their faces lit up. We were quickly brought
back to the break room where we dropped off the food, met the charge
nurse, shamelessly left some Cal ENA magnets and pens and were back in
the cab in less than 10 minutes.
How often do we have large meetings in our state? How often do we
have them catered? And how often do we just leave that
food behind? Cal ENA has started a tradition of taking
any leftovers to the local emergency department and will
do the same in our home state next year. Who knows?
Maybe someone will come to the next meeting because a
member thought enough to bring food to his or her busy
shift.
Louisiana ENA State CouncilSubmitted by Alicia R. Dean, RN, MSN, APRN, CNS
Louisiana ENA State Council members, please keep
checking future issues of ENA Connection for information
on volunteering for ENA Leadership Conference 2012 in
New Orleans. We will need many ambassadors of
ENA STATE CONNECTION
State Council and Chapter Meetings and Events
Kentucky ENA State CouncilThree Rivers Chapter Meeting December 1, 2011Owensboro, Kentucky
North Carolina State ENA CouncilNorth Carolina’s Seventh Annual Education DayNovember 10 - 11, 2011Wrightsville Beach, North CarolinaFor more information, go to www.nc-ena.com.
Minnesota ENA State CouncilCentral Minnesota Chapter Meeting December 12, 2011 Location to be announced. For more information, go to www.minnnesotaena.com or e-mail [email protected].
Check out great gift ideas for friends and colleagues this holiday season.
Two easy ways to order:Phone: 800-900-9659 Monday through Friday 9:00 a.m. - 4:30 p.m. CTOnline: www.ena.org/shop
Shop Marketplace
Official Magazine of the Emergency Nurses Association 31
Louisiana to help make Leadership Conference
2012 the best ever. Save your Mardi Gras beads
so we can all show the rest of the country what
“Throw me something, mister” and “lassiez le
bon temps rouler” really mean!
Maine ENA State CouncilSubmitted by Robin Matthews, RN, President
We had a wonderful turnout September 10,
2011, for our annual meeting and educational
day.
Several annual awards were presented:
Emergency Nurse Provider Award: Wynne
Sholl, MS, BSN, BA, RN, CEN, of Southern
Maine Medical Center
Emergency Nurse Leadership Award: Jane
Rioux, RN, of Northern Maine Medical Center
Emergency Nurse Leadership Award: Robin
Matthews, RN, of Maine Medical Center
Emergency Nurse Educator Award: Carol
Minnis, RN, CEN, of Maine General Hospital-
Waterville
Emergency Nursing Special Merit Award: Andrea Varnum, BSN, RN, CEN, of Maine
Medical Center
Emergency Nursing Special Merit Award: Carmen Hetherington, BSN, RN, CEN, CPEN,
of Central Maine Medical Center
Emergency Nursing Special Merit Award: Karen
Taylor, RN, of Maine Medical Center
Maine ENA and many emergency nurses
throughout our state were busy this year,
petitioning our legislature for changes in the
laws regarding violence in the workplace. We
currently have a felony statute but were
working to broaden this to encompass all
employees who work in our departments.
While at this time the changes proposed were
not passed, Maine ENA was awarded a Joint
Resolution Recognizing the Dedication and
Resolve of Medical Care Professional in
Hospitals. Our legislature recognized that
emergency medical care providers and
emergency medical care professionals in
hospitals are committed to providing treatment
to any injured or ill person, regardless of
circumstance. Whereas our work with our
legislature continues through education and
reporting workplace violence, we are thankful
that our voices were recognized.
A copy of this resolution was sent to each
emergency room throughout our state.
Minnesota ENA State CouncilSubmitted by Colleen Seelen, RN, CEN
Lake Superior ENA Chapter is a catalyst for
seasonal public service announcements on
Minnesota public radio. The announcements are
made on Friday evenings when travelers are
frequently on the road. Messages on distracted
driving and wearing your helmet while riding
are just a couple of the messages going out.
Zumbro Valley ENA Chapter, Greater Twin
Cities ENA Chapter and Central Minnesota
ENA Chapter have contributed funds to this
great idea of educating the public.
New York ENA State CouncilSubmitted by Mickey Forness, RN, CEN
The New York State Council would like to
thank all the contributors to the ENA Founda-
tion endowment of the 9/11 scholarship. This
scholarship has been awarded to 17 individuals
from many different states. Special gratitude
goes to the Mississippi ENA State Council for
issuing the challenge to all delegates to donate
their dollar coins handed out by President-elect
Gail Lenehan, EdD, MSN, RN, FAEN, FAAN,
to this fund. The New Hampshire ENA State
Council has issued a challenge to all state
councils to match its $1,000 donation.
To donate, go to www.nysena.org/911.html.
Members of the California ENA State Council with a staff RN from Tampa General Hospital.
AS A JOB SEEKER: • Search for jobs and
receive automatic e-mail notifications of new listings
• Post your résumé and make it available to top-notch employers
AS AN EMPLOYER:• Post openings and
review a deep pool of qualified talent
ENA Career CenterYour path to lifelong career success
The ENA Career Center provides personalized career guidance and showcases over 200 health care associations and professional organizations within the National Healthcare Career Network.
Learn more about this valuable resource at www.ena.org.
CareerCenter
November 201132
New ENA Position Statement Supporting Next Generation 9-1-1ENA develops position statements on key topics
affecting emergency nursing practice and health
care trends. The most recently approved
position statement, Enhanced/Next Generation
9-1-1 Systems, is in favor of research to upgrade
9-1-1 systems to support additional communica-
tion formats such as text, video, photo and
e-mail available on mobile devices, which are
used most frequently to call for emergency
assistance. Visit www.ena.org/About/Position
to see all ENA position statements.
ANA Recognizes Emergency Nursing as a SpecialtyThe American Nurses Association has recog-
nized emergency nursing as a nursing specialty
and accepted ENA’s revised Emergency Nursing:
Scope and Standards of Practice, available later
this year.
New Member BenefitsENA members qualify for discounts on items
such as insurance, travel, wireless products and
services, car rentals, identity theft protection and
prescriptions. To view all available discounts,
visit www.ena.org, click on the membership tab
and then member benefits. Log in to see the
details.
Mosby’s Nursing Consult: ENA EditionMosby’s Nursing Consult offers users practice
guidelines, FDA drug updates, evidence-based
nursing monographs, skills demonstrations and
competency testing information. To learn more,
visit www.ena.org.
ENA Career Center: Your Path to Lifelong Career Success Job seekers may post a résumé, search for jobs
and be notified of new listings while employers
post openings and review a deep pool of
qualified talent. Visit the new ENA Career
Center at http://enacareercenter.ena.org/.
ENA Toolkit Combating Workplace Violence: Prevent, Respond and ReportBecause more than half of surveyed nurses
reported experiencing abuse within the
previous seven days, this toolkit is designed to
help emergency department staff create a
culture of safety. To access the toolkit, visit
www.ena.org/IENR.
ENA Emergency Nursing ResourcesENA develops Emergency Nursing Resources
to bridge the gap between research and
everyday emergency nursing practice. Go to
www.ena.org/IENR.
Spotlight on Member Benefits and Resources
Shop MarketplaceSpecial Offer for the Month
When Nurses Hurt Nurses: Recognizing and Overcoming the Cycle of BullyingCheryl Dellasega, PhD, CRNP
Outside of nursing, most people believe bullies are native only to playgrounds and high school locker rooms. Unfortunately, bullies also frequent hospital units, ambulatory care centers, clinics and even emergency departments. Their targets? Their own colleagues and peers. This conflict has the potential to destroy a nurse’s morale, interfere with the ability to trust colleagues and erode quality of care. When Nurses Hurt Nurses: Recognizing and Overcoming the Cycle of Nurse Bullying confronts this problem by examining the causes and providing ways to diffuse a confrontational situation. When Nurses Hurt Nurses is at the forefront of addressing the issue of bullying within the nursing profession.
Price: $29.95ENA Member Price: $26.95
Free Shipping! Call 800-900-9659Monday–Friday (9 a.m. –5 p.m. CT)
Official Magazine of the Emergency Nurses Association 33
ENA Foundation Announces 2011 Scholarship Recipients
What is the ENA Foundation? Even if you see
this column every month in ENA Connection, or
hear someone talk about an ENA Foundation
scholarship, the State Challenge or the jewelry
auction, you may not know what the ENA
Foundation does.
The ENA Foundation is a charitable, non-
profit organization that aims to promote
emergency nursing through research and
education to enhance the overall delivery of
emergency care. Our mission is to provide
educational scholarships and research grants in
the discipline of emergency nursing. If you have
bought a thumb drive or pin, made a purchase
during the online auction or at the annual
jewelry auction or participated in your State
Challenge campaign, you have supported the
ENA Foundation. The foundation is here for
you, our members, and is supported by you,
your friends and family, and our corporate
sponsors.
Each year, the ENA Foundation makes a
difference in the lives of patients and
emergency nurses across the United States. This
year, the foundation awarded research grants
and scholarships to more than 75 emergency
nurses. The care we provide will be enhanced
through the knowledge and skills developed
through this funding. I would like to commend
each one of you who has taken the challenge to
further your knowledge through education or
research. I would also like this opportunity to
recognize those who recently received an ENA
Foundation scholarship.
Thank you to all of our generous donors.
You are the reason we have helped ensure the
future of emergency nursing for so many. Please
continue to ensure the best care for all by
supporting your charitable organization, the
ENA Foundation.
Non-RN Scholarships• New York State ENA September 11 Scholarships
– $2,500 each Tamera Dekeyser – Wisconsin Clifford Payne, EMT-B – California
Undergraduate Scholarships• Charles Kunz Memorial Undergraduate Scholarship
– $3,000 Kimberly Travis-Carter, RN – Washington
• Hill-Rom Undergraduate Scholarship – $3,000 Mary Otting, RN, CEN – Illinois
Graduate Scholarships• Stryker Masters in Healthcare Scholarship – $5,000
Barbara Buckley, RN – Illinois• ENA Foundation Masters in Healthcare Scholarship
– $5,000 Kelly Johnson, BSN, RN, CEN – Wisconsin
• Board of Certification for Emergency Nursing (BCEN) Scholarship – $5,000 Donna Hamilton, BSN, RN, CEN – Pennsylvania
• Hill-Rom Graduate Scholarship – $5,000 Charlotte Schnakenberg, BSN, RN, CEN, CPEN – Arizona
• California State Council – Karen Grove Memorial Scholarship – $5,000 Vicki Dippner-Robertson, BSN, RN-BC, CEN, CPEN – California
• Kentucky State Council – Kentucky ENA Founders Scholarship – $5,000 Leigh Parker, BSN, RN, CEN – Alabama
• Maryland State Council – Maryland ENA State Council Scholarship- $5,000 Pamela Pourciau, BSN, RN, BC, CEN, CCRN, CPE – Louisiana
• Minnesota State Council – Pathways III Scholarship – $5,000 Karla Hosick, BSN, RN, CEN – Nebraska
• Mississippi State Council – Mississippi Magnolia Scholarship – $5,000 Amy Lowery, BSN, RN – Mississippi
• New Jersey State Council – Emergency Care Scholarship – $5,000 Florence Vanek, BSN, RN – New Jersey
• New Jersey State Council – New Jersey State Challenge Scholarship – $5,000 Elizabeth Griffin, BS, RN, CPEN – North Carolina
• West Central Chapter (NJ) Jeanette Ash Scholarship – $5,000 Trisha Ann Williams, BSN, RN, CEN, NREMT-B – Missouri
• New York Empire State Challenge Scholarship – $5,000 Stacie Hunsaker, BSN, RN – Utah
• Tennessee State Council – Bright Angels Memorial Scholarship – $5,000 Deborah Elliot, RN, CEN – Pennsylvania
• Texas State Challenge – Vicki Patrick Legacy Scholarship – $5,000 Marlene Siton-Thai, MSN, RN, CEN – Texas
• ENA Foundation Scholarships – $5,000 each Rita Cox, BSN, RN – Michigan Diane Hochstetler, BSN, RN, CEN – Indiana Laurie Wegner-Burns, BSN, RN – Wisconsin Jennifer Zachariah, BSN, RN, CEN – California
• Board of Certification for Emergency Nursing (BCEN) Scholarship – $3,000 Alexandra Kinzer, BSN, RN, CPEN – Virginia
• Physio-Control, Inc. Scholarships – $3,000 each Stephanie Borkowski, BSN, RN – Pennsylvania Shannon Mims, BSN, RN, CEN – Texas
• Gisness Advance Practice Scholarship – $3,000 Karyn Roberts, BSN, RN, CPEN – Illinois
• Karen O’Neil Memorial Scholarship – $3,000 Melinda Dixson, MSN, RN, CEN, CPEN, FNPC – Maryland
• ENA Foundation State Challenge Scholarship – $3,000 each Tyler Blomquist, BSN, RN, CEN – Georgia Amanda Cook, BSN, RN, NREMT – Tennessee Denise Evans, BSN, RN – Michigan Mary Catherine Feiler, BSN, RN – New York Amanda Lier, BSN, RN, CEN, EMT-B – Alabama Cary VanDyke, BSN, RN, CEN – Alaska Lynn Sayre Visser, BSN, RN, CEN, CPEN – California
Doctoral Scholarships• Pamela Stinson Kidd Memorial Doctoral
Scholarship – $10,000 Diana Meyer, MSN, RN, CCRN, CEN, FAEN – Washington
• Board of Certification for Emergency Nursing (BCEN) Doctoral Scholarships – $5,000 each Kari Evans, BSN, RN, CEN – Indiana Margaret Miller, MSN, RN, FNP-BC, CEN – New York
• ENA Foundation Doctoral Scholarship – $5,000 Angelia Mickle, MSN, RN, CEN – Ohio
Continuing Education Scholarships Recipients• Stryker International Exchange Scholarship – $1,000
each Denise King, MSN, RN, CEN – California Charlotte Schnakenberg, BSN, RN, CEN – Arizona
• Vidacare Annual Conference Scholarships – $500 each Tammy Andrews, RN, CEN – Kentucky Barbara Buckley, RN – Illinois Marianne Bundy, MSN, RN, CEN – Florida Kristen Connor, BSN, RN, CEN, PHRN – California Debra Cremens, RN, CEN – Massachusetts Mare Eichmann, RN, CEN, NREMT-P – North Carolina Carla Marie Grasso, RN, CEN – Pennsylvania Maha Habre, BSN, RN, CEN – Lebanon Abigail Hasan, RN, CEN – New York Katherine Hunt, BSN, RN, CPEN – Maryland Brant Jacobson, RN, CEN – Washington CherylAnn MacDonald-Sweet, BS, RN, CEN, CPEN – Pennsylvania Matt Andrew Magto, BSN, RN – Philippines Kelly Mills, RN, CEN – Indiana Julie Mount, MSN, RN, EMT-P, CEN – New York Anne Pendleton, RN – Massachusetts Jan Michael Vincent Reyes, RN – California Carolyn Sutch, BSN, RN – Maryland Joan Tiska, RN – New York Lorraine Weigand, BSN, RN, CEN – Virginia
MESSAGE FROM THE CHAIRPERSON | Beth Broering, MSN, RN, CEN, CPEN, CCRN, FAEN
Readers may contact the author at [email protected].
November 201134
Could these scenarios occur in your emergency
department?
• EMS calls to advise the emergency depart-
ment of the need for immediate assistance
upon their arrival to restrain a violent patient
who has threatened his family members.
• A 45-year-old father who has just lost his job
arrives after attempting suicide by hanging.
• A homeless person, with PMH of schizophre-
nia, is agitated and pacing, stating that he has
not been taking his prescribed medications.
As emergency nurses, we encounter daily
patients and their families as they struggle with
mental health issues. The resulting impact on
the emergency department, inclusive of the
potential for harm to self and others, can be
disruptive and at times devastating. These are
the cases that become headlines in newspapers,
and the outcomes have a huge impact on
caregivers, as well as on the hospital’s reputa-
tion within the community. Often, we would
like to consider these patients low priority, but
current triage guidelines, such as the Emergency
Severity Index, classify these patient types as
ESI level 2, requiring immediate advisement of
others and placement in a treatment area.
When situations go awry, retrospective
review often reveals many options that may
have minimized risk. Do you truly know how to
achieve the best outcome? Patient safety, as well
as your own personal safety, is paramount to all
we do. As competent emergency caregivers, we
must be aware of evidence-based strategies to
best manage patients who present with these
types of challenging, high-risk complaints.
Preparation for the Certified Emergency
Nurse exam will include review of psycho-social
issues along with the best tactics to de-escalate
situations, ensuring the well-being of all
involved. It is important that a review of the
behaviors proven to achieve the best outcomes
be undertaken to ensure that you are successful
with test taking. However, should not every
emergency nurse be aware and implement
these proven strategies every day at work? Do
we not owe our patients and ourselves the
obligation to bring best practice to the bedside?
I certainly believe so.
Preparing for specialty certification validates
your commitment to lifelong learning, to
ensuring that your patients get the best they can
at your hands. Reviewing and contemplating the
best proactive approach to de-escalate situations
and the finest response to serve this high-risk
patient population can allow for a better patient
care experience and ultimately an optimal
outcome for the patient and for the staff
member. It is vital that we as nurses accept this
challenge, prepare for the exam, become
certified and thus bring the best to our patients
every shift. As a certified emergency nurse, with
the enhanced knowledge you gain from prepa-
ration and experience, you will personally have
an impact on those patients who seek care
related to mental health illnesses. This goal,
in itself, validates the need to begin the pursuit
of CEN®.
In addition to addressing mental health
disease within our health care environment,
it is equally important that we aim to promote
mental health. Promotion focuses on enhancing
one’s ability to achieve a positive sense of
self-esteem, mastery of a chosen skill set and
inclusion within a social sect. Specialty certifica-
tion (CEN, Certified Pediatric Emergency Nurse,
Certified Flight Registered Nurse and Certified
Transport Registered Nurse) allows the individ-
ual to validate these intrinsic traits that have
been carefully developed and refined over time.
The Accreditation Board for Specialty Nursing
Certification defines certification as “the formal
recognition of the specialized knowledge, skills
and experience demonstrated by the achieve-
ment of standards identified by a nursing
specialty to promote optimal health outcomes.”
The certified RN, therefore, is more self-confi-
dent, a master of the practice environment and
included in the elite group of nurses who
choose to become certified.
In an ABSNC study, nurse administrators
clearly indicated that they value specialty
nursing certification. It is cited that certification
truly does reflect a commitment to lifelong
learning, supporting the theory that certified
nurses are perceived as more motivated and
committed to nursing as a career. Certified
nurses also score higher on levels of profession-
alism. Incentives provided by many
organizations support the high value of certifica-
tion within the nursing community. Magnet
designation endorses specialty certification for
the best practice it promotes and the resulting
improved outcomes that patients deserve.
Lastly, nurses who seek and attain certifica-
tion tend to encourage others to achieve this
goal. These mentors will also recognize others
for earning specialty certification, yet another
tactic that builds self-esteem and self-confi-
dence. Without a doubt, the benefits of
achieving certification are countless, and your
commitment to this goal will not only affect
your patients’ outcomes but also promote your
own mental health, something we do not often
consider.
Board of Certification for Emergency Nursing
certifications provide proof of your dedication
to the practice of emergency nursing to
yourself, your coworkers and the community
you serve. Make no further excuses. Take the
time to prepare, determine a timeline and
commit to taking the exam. Become certified.
You owe it to yourself.
ReferencesGilboy, N., Tanabe, P., Travers, D., Rosenau, A.,
and Eitel, D. Emergency Severity Index,
Version 4: Implementation Handbook. AHRQ
Publication no. 05-0046-2. Rockville,
Maryland: Agency for Healthcare Research
and Quality. May 2005.
Power, K. (2010, December). Transforming the
Nation’s Health: Next Steps in Mental Health
Promotion. American Journal of Public
Health.
Stromborg, M., Niebuhr, B., Prevost, S., Fabrey,
L., Muenzen, P., Spence, C., Towers, J., and
Valentine, W. (2005, May). Specialty Certifica-
tion. Nursing Management.
Transforming Mental Health with Specialty Certification
BCEN BOARD WRITES | Mary Whelan, MSN, RN, CEN, Member-at-large
Official Magazine of the Emergency Nurses Association 35
When Artemus Armas, RN, CEN, returned home
from his deployment in 2010, from a non-
disclosed base in Southwest Asia, he received
surprising news from his commander: Armas
won the Air Force Flight Nurse of the Year
award and the Air Force Nurse of the Year
award for 2010.
Armas already knew that his supervisor had
entered a nomination package for him for the
Flight Nurse of the Year award when he was
deployed, but Air Mobility Command—their
higher command—believed his accomplish-
ments were strong enough to compete for the
overall winner, the Air Force Nurse of the Year
award. Armas felt shocked and happy that he
won both awards.
“It was a double bonus. It’s not typical for a
person to win both awards. The Air Force Nurse
of the Year award is the top award for all of the
nursing categories. It is a prestigious award for
the Air Force. It took a moment for me to
realize that I had won a major award. I felt
honored,” Armas said.
His career in Air Force nursing began in
2002. Armas became a flight nurse in 2007
and obtained his Certified Emergency Nurse
certification in 2009. He felt becoming Board
of Certification for Emergency Nursing
certified would benefit him from an
educational standpoint.
“I had already worked in the ER and ICU
when I first started striving for it, and I thought
it would get me to that next level. It helped me
to see where my level was in comparison to
others in the field. It had always been a goal of
mine to get my CEN certification, and it also
showed what my knowledge was and that
I could pass the test,” Armas said.
Armas currently works in a new high-level
position for Headquarters Air Mobility
Command at Scott Air Force base, Illinois.
He oversees 32 aeromedical evacuation (AE)
squadrons’ training and ensures it is done
properly from an operational aspect.
“I think it gives me a little more clout when
I’m going in to inspect these squadrons and
personnel. It also shows that I’ve put in that
extra effort,” he said.
Armas points out that there is a shortage
of flight nurses in the Air Force. Winning his
awards has helped him to promote flight
nursing and the different leadership opportuni-
ties that are available for Air Force flight
nurses—opportunities he feels may not
be obtainable in a hospital or clinic.
Being a flight nurse has been the most
satisfying job for Armas in his nursing
career.
“My favorite aspect is dealing with the
wounded warrior and dealing with the
patients who are Soldiers, Airmen and
Marines. We even deal with civilians from
NATO countries and make sure we can
get them from one level of care to a
higher level of care,” Armas said. “Not all
of my positions have been flying. As an
officer in charge of the aeromedical
evacuation operations team, I have also
ensured that aeromedical evacuation crews
were prepared to transport patients, and
I was on a liaison team where I coordinated
with the British on getting injured troops
aeromedically evacuated out of Afghanistan.
I think it’s more of the interaction with the
troops to make sure they are receiving proper
care and knowing that we are doing the right
thing that I enjoy.” When Armas started his
flight nursing career, he discovered that there
was a Certified Flight Registered Nurse certifica-
tion available. The thought of obtaining his
CFRN certification stayed in the back of his
mind over the years, and it has become his goal
to take the exam. He believes becoming a CFRN
would be advantageous to his new position,
because it would show that he is certified in his
specialty. He is studying for the exam and has
set a goal to take it next year.
“I think the CFRN certification would give me
more credibility if I am out inspecting someone.
A lot of time people will look at titles and ask
about your background. The good thing about
me is that I’m well-versed. I’ve had ICU and
ER experience, and when you have that CFRN
certification, it gives you more clout,”
Armas said.
Certified Emergency Nurse Named Air Force Nurse of the YearBy Kendra Y. Mims, ENA Connection
Artemas Armas, RN, CEN, with the 379th Expeditionary aeromedical evacuation squadron.
From left to right: Major General Kimberly A. Siniscalchi;
Artemus Armas, RN, CEN; Chief Master Sergeant Joseph L.
Potts.
November 201136
The ENA board of directors met August 24,
2011, via conference call. All members of the
board of directors were present. The board took
the following actions:
• Approved the revised ENA Procedures as
presented.
• Approved that the ENA board of directors
have laptop computer access at the 2011
General Assembly.
The ENA board of directors met September 20,
2011, at the Tampa Convention Center. All
members of the board of directors were present.
The board took the following actions:
• Approved 2012 committee, advisory council
and work team members.
• Accepted the secretary/treasurer’s report as
presented.
• Approved board governance policy 3.09,
Board Ethics Statement, as presented.
• Approved board governance policy 8.01,
Contributions from ENA, as presented.
• Approved board governance policy 8.03,
Expenditures by ENA for Incidental Contribu-
tions or Gifts, as presented.
• Established an Emergency Department
Operations Work Team.
• Established an Emergency Nursing Technol-
ogy and Informatics Work Team.
• Approved the Emergency Nursing Resources
Committee requests for 2012 as presented.
• Approved the Emergency Department
Crowding Committee recommendations to
dialogue with the Centers of Medicare and
Medicaid Services officials to help alleviate
crowding in the emergency department.
• Approved the following consent agenda items:
• Approved the July 22, 2011, board of
directors meeting minutes as written.
• Approved the August 24, 2011, board of
directors conference call minutes as written.
• Approved the Executive Committee Actions
report as presented including:
• An invitation from the American Academy
of Pediatrics to review and provide
comment on the American Academy of
Pediatrics draft report on Death of a Child
in the Emergency Department. Deena
Brecher, MSN, RN, APRN, ACNS-BC, CEN,
CPEN, and Sally Snow, BSN, RN, CPEN,
FAEN, will provide comments on behalf
of ENA.
• An invitation to attend the American
Psychiatric Nurses Association’s 25th
Annual Conference, October 19-22, 2011,
in San Francisco. Gail Lenehan, EdD, MSN,
RN, FAEN, FAAN, is ENA’s representative.
• An invitation to attend the National
Association of Clinical Nurse Specialist
Summit on July 14, 2011, in Philadelphia.
Deena Brecher, MSN, RN, APRN,
ACNS-BC, CEN, CPEN, represented ENA.
• An invitation from the National Quality
Forum regarding the Call for Nominations
for the Care Coordination Endorsement.
The name of Diane Gurney, MS, RN,
CEN, was submitted for consideration.
• An invitation from the National Quality
Forum regarding the Call for Nominations
for the National Priorities Partnership.
ENA was submitted for consideration as
an organizational member. Sue
Hohenhaus, MA, RN, CEN, FAEN, is the
ENA contact.
• An invitation from the American Nurses
Association to submit public comments
on the individual nomination for the
National Quality Forum’s Regionalized
Emergency Care Services Steering
Committee.
• An invitation to support and contribute to
the 2012 Foundation of the National
Student Nurses Association Scholarship
fund.
• An invitation from the Pediatric Nursing
Certification Board to attend the 3rd Annual
Invitational Forum for Pediatric Nursing on
October 27-28, 2011, in Washington, D.C.
Michael Vicioso, MSN, BS, RN, CPEN,
CCRN, is ENA’s representative.
• An invitation to attend the Southern
Nevada’s Black Nurses Association’s 15th
Anniversary reception. The invitation was
forwarded to the Nevada ENA State
Council president for consideration.
• An invitation from the Substance Abuse
and Mental Health Services Administra-
tion to participate at the Conference on
Improving Care for Child and Adult
Behavioral Health Clients with Suicidal
Ideation and Behavior in Emergency
Department Settings, July 26-28, 2011, in
Baltimore. Karen Wiley, MSN, RN, CEN,
represented ENA.
• An invitation from the U.S. Department of
Homeland Security\FEMA Ready
Campaign to participate in its National
Preparedness Month Coalition.
• Agreed not to support the following
initiatives:
• An invitation to attend the American
Association of Colleges of Nursing’s Fall
Semiannual Meeting reception on
October 23, 2011, in Washington, D.C.
• An invitation to sponsor or provide
contributions for the reunion of
1965–1973 Vietnam veterans and their
families of the 3rd Field Hospital in
Saigon.
• Approved the Enhanced Next Generation
9-1-1 Systems position statement as
presented.
• Approved the list of Emergency Nursing
Resources topics slated for completion in
2012.
The ENA board of directors met September 23,
2011, at the Tampa Convention Center. All
members of the board of directors were present.
The board took the following actions:
• Approved board governance policy 3.12,
National Candidate Publicity and Campaign-
ing, as amended.
• Approved board governance policy 3.17,
National ENA Voting Process, as amended.
• Approved board governance policy 3.18,
Candidate Background Screening, as amended.
The next meeting of the ENA board of directors
will be held at ENA headquarters in Des Plaines,
Illinois, December 9, 2011.
BOARD HIGHLIGHTS |
August and September 2011
Board Meeting Actions and Highlights
ENA Call for…
Applications for the 2012 Class of FellowsThe Academy of Emergency Nursing will
accept applications for the 2012 class of
fellows through 5 p.m. CST, January 16, 2012.
Information and a link to the applica-
tions are available under “Calls and
Opportunities” at www.ena.org/Pages/default.aspx.
Questions? Please contact Ellen Siciliano,
practice specialist, at [email protected].
Official Magazine of the Emergency Nurses Association 37
Joy believes support is essential when
dealing with disaster preparedness.
“You react to disaster because that’s your job.
Some of our nurses who are administrators
were at the concert. Some of our friends were at
the concert, so you’re trying to be the nurse and
think about where your family and friends are
and if they are OK. It takes a strong team to
handle a situation like this, and I think we all
worked really well together. The support
provided for the staff and patients that night
was important and executed well by a very
skilled team of care providers. I am so proud to
work with this group of individuals,” Joy said.
Making A Difference Allison Tann, BSN,
RN, CEN, a charge
nurse at Indiana
University Health,
Methodist, saw a
mother of one of the
stage collapse
victim’s standing
alone outside of the
ICU a week after the
tragedy. As Tann headed to the elevators, she
felt an urge to talk to her. The two made eye
contact, and in that moment, Tann made
a connection with her.
“I gave her a hug and let her know that I was
praying for her and her family. We both cried.
Unfortunately, we don’t get to connect much
with the patients because we’re in such a
fast-paced environment and we know that we
need to perform life-saving measures in order
for these patients to even make it out of our
department,” Tann said. “We don’t know their
story, we don’t know their family, but our role
is extremely important in their survival and
how they are treated throughout their stay in
the hospital.”
Tann says that working the State Fair tragedy
was an experience she won’t forget. She found
herself in awe as staff came together during the
tragedy.
“That’s why we do what we do. These events
that happen—they are moments in our careers
that we will never forget. It’s amazing that I had
the opportunity to be a part of this profoundly
exciting team of individuals. I know that I
belong here,” Tann said.
Duffy also had an opportunity to speak with
the parents of one of the victims and explain to
them what occurred in the emergency depart-
ment.
“It became pretty apparent that they were
settling in for a long visit at our hospital and
they realized it very early on. I think allowing
them to see our department and hearing what
their loved one went through initially helped to
create a better picture for them because it was
something that was just so shocking and
unexpected. They were very grateful for the
care that the patient received in the ER,” Duffy
said. “I think that once all of us have that initial
connection with our patient, especially during a
night like that, we feel that bond continue.”
Another mother of one of the injured young
men came down a couple days after the
incident to bring a cake and express her
appreciation for the care her son received in
the emergency department.
“Something that’s interesting is that the
grieving has been so public with this and it’s
been across the community. I think that the
entire hospital as a community has grieved
along with the families, and from what I can
gather, I think the families felt they have
become part of the Methodist family as well,”
Duffy said. “I think we also have a very high
performing team of health care professionals,
from our respiratory therapist to our nurses.
We had valuable resources available for all of
our patients, especially our critically-ill patients,
and great technology that these families were
able to benefit from.”
Although the disaster happened so quickly,
Hendershot believes that emergency nurses are
well-equipped and prepared to handle disaster
situations.
“I think an emergency nurse is trained to
respond to such disasters and brings a skill level
that no others have. They were calm, organized
and purposeful. It may have seemed chaotic to
others not used to the pace, but to an
emergency nurse, it was a perfect example of
the performance of a highly functioning team.
At the end of it all, the emergency nurse knows
that he or she made a difference and is part of
something much bigger than himself or herself,”
Hendershot said.
don’t have to be a trauma center to deliver
awesome care to trauma patients.”
* * *
Reno is a close-knit community, and the air
races have been a part of its fabric for nearly
half a century. Debriefing, defusing and collec-
tive healing have been ongoing for the
emergency workers who responded to the
accident, which ultimately claimed 11 lives.
Boscovich, who has worked at a Level I
trauma center, said she pressed a “mute button”
on her feelings while treating patents that day.
Later she was able to reflect more emotionally
on her own circumstances. Her son had fallen
asleep as they were approaching the gate to
enter the air show that afternoon. No one
wanted to wake him, so her husband and his
friends, already inside, agreed to leave early.
Had they stayed, they all would have been
sitting in the box-seat area, directly in the
damage path.
At a restaurant afterward, “We were just
really grateful to have each other and to all be
OK,” Boscovich said. “We could have lost
everyone at that table.”
Hunt had similar reason to be thankful. Not
only had her husband, his father and his best
friend been sitting 200 feet from the crash site,
but in those uncertain moments after the first
alerts went out, there was her staff to think
about. Saint Mary’s had seats set aside in the
reserved area, and some of the nurses, including
Eisenbarth, had been taking turns checking out
the action. The “what if” haunts Hunt.
“I could have lost my own personal blood
family, but this could even have been a bigger
impact because we could have lost our family
in the department or family within our hospital
system,” she said.
Lillibridge and her husband, air enthusiasts
from thousands of miles away, don’t think
they’ll return to Reno next year, assuming the
races go on. Their recovery required leaving
town the next day for Lake Tahoe, where they
had stayed at a bed-and-breakfast nine years
earlier. In need of a safe shelter where they
could be alone together with their feelings, they
struggled to remember the name and location of
that peaceful place with the wonderful owners.
Finally they just chose a B&B with an available
room and drove to find it.
It ended up being the same place they
remembered.
“I think it was divinely inspired,” Lillibridge
said.
That’s the spiritual side of her story. But her
takeaway message to emergency nurses is about
controlling their own destinies: being prepared
for that moment when mass trauma might
literally drop out of the sky. That means getting
TNCC verification and keeping it current.
“The emphasis is, our training works,”
Lillibridge said. “Just do it. You never know
where you’re going to be. I never expected that
I would be doing this, and yet I had all my
skills. I had what I needed. I told people, ‘I’m
coming to the ENA Conference and I just
wound up being a field nurse.’”
Deadly Indiana Stage Collapse Continued from page 15
Allison Tann, BSN, RN, CEN
Disaster Drops on Reno Continued from page 19
November 201138
(www.ena.org/government/Advocacy/Pages/ Default.aspx) to help ENA members develop
policies and programs to promote collaboration in
their local communities.
Quality patient care and staff safety is the third
priority. ENA believes that evidence-based
policies for preventive and protective measures
can enhance a culture of safety and reduce the
impact of violence in the workplace. As example,
the ENA Workplace Violence Toolkit (www.ena.org/IENR/ViolenceToolKit/Documents/ toolkitpg1.htm ) provides information and
guidance for developing and implementing
a comprehensive plan to manage violent
behaviors in the emergency department.
Another prevention strategy coincides with the
EDPCC recommendation to use screening, brief
intervention, referral and recovery treatment
services for all emergency patients at risk of
suicide, violence and SUD.
We do know what is best for our behavioral
health patients. Together we must act to:
1. Incorporate SBIRT for all emergency
patients into our everyday practice.
2. Promote the use of the ENA Workplace
Violence Toolkit.
3. Advocate for increased funding for the
Substance Abuse and Mental Health Services
Administration and other federal programs
that provide state block grants for behavioral
health services.
4. Advocate for care equivalent to that given
to other medical conditions.
5. Advocate for adequate community-based
systems to provide comprehensive care.
6. Advocate for research funding to identify
best practices for creating a safe work
environment.
Patients with mental health and substance use
disorders deserve to have the same priority of
care as patients with medical/surgical problems.
Join your ENA colleagues—decide what your
action will be and begin today.
References 1. AHRQ statistical brief #92 of July 2010 on
Mental Health and Substance Abuse-Related
Emergency Department Visits among Adults,
2007. Available at: www.hcup-us.ahrq.gov/reports/statbriefs/sb92.pdf. Accessed July 26, 2011.
2. Mental Health Financing in the United States:
A Primer. Kaiser Commission on Medicaid
and the Uninsured. April 2011. Available at
www.kff.org/medicaid/upload/8182.pdf. Accessed July 22, 2011.
3. Substance Abuse and Mental Health Services
Administration, Leading Change:
A Plan for SAMHSA’s Roles and Actions
2011-2014. HHS Publication No. (SMA)
11-4629. Rockville, MD: Substance Abuse
and Mental Health Services Administration,
2011. Available at store.samhsa.gov/product/SMA11-4629. Accessed July 15, 2011.
4. The President’s New Freedom Commission
on Mental Health. Achieving the Promise:
Transforming Mental Health Care in America.
Available at govinfo.library.unt.edu/mental-healthcommission/reports/FinalReport/downloads/downloads.html. Accessed July 14,
2011.
5. Ibid
Board Writes Continued from page 4
PROVE YOUR KNOWLEDGE...
BECOME A CERTIFIED EMERGENCY NURSE
To learn more about becoming a Certifi ed Emergency Nurse,
visit www.BCENcertifi cations.org.
Validate your expertise to your employer, your colleagues and yourself.
EMERGENCY NURSE
CEN_BCEN_recruitment Connections HP Island Ad.indd 1 12/21/2009 9:54:43 AM
Statement of Ownership, Management and Circulation(Required by 39 U.S.C. 3685). Title of publication: ENA Connection. Publication no.: 1534-2565. Date of filing: October 4, 2010. Frequency of issue: Monthly. Number of issues published annually: 11. Annual subscription price: members, free; non-members, $50 U.S., $60 foreign. Complete mailing address of known office of publication: 915 Lee Street, Des Plaines, Cook County, Illinois 60016-6569. Complete mailing address of the headquarters or the general business office of the publisher: 915 Lee Street, Des Plaines, Cook County, Illinois, 60016-6569. Publisher: Emergency Nurses Association, 915 Lee Street, Des Plaines, Cook County, Illinois, 60016-6569. Amy Carpenter Aquino, Editor in Chief: 915 Lee Street, Des Plaines, Cook County, Illinois, 60016-6569. Owner: Emergency Nurses Association, 915 Lee Street, Des Plaines, Cook County, Illinois, 60016-6569. Known bondholders, mortgagees, and other security holders: None. Issue Date for Circulation Data: September 2011. Extent and nature of circulation: A. Total Number of Copies: Average number of copies each issue during preceding 12 months (hereinafter “Average”), 40,829. Actual number of copies of single issue published nearest to filing date (hereinafter “Most recent”), 40,065. B. Paid circulation: B1. Outside-county paid subscriptions stated on Form 3541: Average, 39,553. Most recent, 38,712. B2. In-county paid subscriptions stated on Form 3541: Average 0. Most recent, 0. B3. Paid distribution outside the mail including sales through dealers and carriers, street vendors, counter sales, and other paid distribution outside USPS: Average 383. Most recent, 376. B4. Paid distribution by other classes of mail through the USPS: Average, 0. Most recent, 0. C. Total paid distribution (sum of B1, B2, B3, and B4): Average 39,935. Most recent, 39,088. D. Free or nominal fee rate distribution. D1. Outside-county copies included on Form 3541: Average, 21. Most recent, 25. D2. In-county copies included on Form 3541: Average, 0. Most recent, 0. D3. Copies distributed through the USPS by other classes of mail: Average, 0. Most recent, 0. D4. Copies distributed outside the mail: Average, 18. Most recent, 200. E. Total. Free or nominal rate distribution (sum of D1, D2, D3, D4): Average 43. Most recent 217. F. Total distribution (sum of C and E): Average: 39,978. Most recent, 39,305. G. Copies not distributed: Average, 851. Most recent, 760. H. Total (sum of F and G): Average 40,829. Most recent, 40,065. I. Percent paid (C divided by F times 100): Average, 100.0%. Most recent, 99.0%. This Statement of Ownership will be printed in the November 2011 issue of this publication. I certify that the statements made by me above are true and complete. Amy Carpenter Aquino, Editor in Chief. Date: October 4, 2011.
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