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Transcript of ENA Connection November 2012
INSIDE FEATURES
the Official Magazine of the Emergency Nurses Association
November 2012 Volume 36, Issue 10
connection
NEW THIS MONTH: Members in Motion PAGE 4
Leadership Conference 2013 What’s to Come PAGE 14
The Emotional Rewards of the ENA Foundation PAGE 16
What We’re Doing to Make It Better for Behavioral Health Patients in the ED Pages 6-7, 11-13
PLUS: Emergency Nurses Spring Into Action After Aurora Theater Shooting Pages 8-10
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Stryker is proud to be an ENA Strategic Sponsor and support nursing excellence through important initiatives such as the ENA Workplace Injury Prevention Toolkit and the ENA Lantern Award. Program Criteria for the ENA Lantern Award funded, in part, by Stryker.
Official Magazine of the Emergency Nurses Association 3
The holiday season is just around
the corner, and people soon will
be decorating, gathering at parties,
carving turkeys and shopping for
that perfect gift. While some will
be enjoying the excitement of the
holidays with loved ones,
others may not be as fortunate.
Television, film and
advertisements may depict
expectations for the holidays that
seem unrealistic to many of us.
Some of us – staff and patients –
face challenges and may not be
able to afford those holiday
celebrations. Some of us may be
remembering the loss of loved
ones. For others, there may be no
family, or only an estranged one,
and holidays can bring to mind
what is forgotten the rest of the
year.
During the holidays, some
won’t be able to shake the
depression that descends and
engulfs them, either because of
sad reminders or because of SAD,
seasonal affective disorder, a form
of depression that may be related
to a season, in this case, one with
shorter days, less sunlight and/or
inclement weather interfering with
normal activities. A problem for
people around the globe, 5
percent, or 15 million, Americans
suffer severely from SAD, with
symptoms of hopelessness,
increased appetite and weight
gain, increased sleep, less energy,
an inability to focus, loss of
interest in work and activities,
social withdrawal, irritability and
feelings of depression. Another 33
million feel some moodiness or
loss of creativity or productivity
during the winter, according to
the National Institute of Mental
Health.
If you or your patients are
severely affected, there is a wide
variety of effective therapies,
such as medication, hormone
supplements, light therapy,
cognitive behavioral therapy,
vitamin regimens and physical
exercise of which to be aware. If
you are mildly affected, begin to
make plans with friends or
co-workers ahead of time to keep
yourself busy during the holiday
season. Volunteer to help people
less fortunate than you – on a
medical mission, in a homeless
shelter or with a parish nurse.
Your ED staff may have cared for
patients this past year with
devastating injuries, or victims of
mass casualties and their families
who may appreciate being
remembered in some meaningful
way. Lastly, summon the energy
to share feelings of isolation and
seek support during this difficult
time.
This particular holiday season,
more people may be vulnerable
to sadness and situational
depression, given the loss of jobs
and financial hardship as a result
of the current economy, so be
alert for subtle changes in the
mood of those around you, and
offer a lifeline when it is needed.
In the end, the very best gift of
the season may be the support we
give to others, something at which
emergency nurses excel!
Reference
Nursing Care Plan Seasonal
Affective Disorder. (2010).
Retrieved from www.enurse-
careplan.com/2010/10/
nursing-care-plan-ncp-
seasonal.html.
Dates to Remember
PAGE 3Letter from the President
PAGE 4NEW! Free CE of the Month
PAGE 4NEW! Members in Motion
PAGE 5ENA Connected
PAGE 16ENA Foundation
PAGE 17Course Bytes
PAGE 18Washington Watch
PAGE 20Ready or Not?
PAGE 22State Connection
PAGE 23ENA Call For . . .
Monthly Features
Nov. 12, 2012 Deadline for applications for the Blue Jay Consulting/ENA Award for Outstanding Nurse Leader of the Year, to be presented Feb. 28, 2013, in Fort Lauderdale, Fla., at Leadership Conference 2013.
Nov. 30, 2012 Deadline for applications for the Academy of Emergency Nursing’s 2013 class of fellows.
Jan. 15, 2013 Deadline for poster submissions for 2013 Annual Conference in Nashville, Tenn.
March 15, 2013 Deadline for proposed bylaws and resolutions for 2013 General Assembly at Annual Conference in Nashville, Tenn.
PAGE 8A Special Midnight Showing: Colorado Theater Tragedy Brings Out the Best in ED Staff Reponse
PAGE 11Board Writes: Caring for Behavioral Health Patients in the ED
PAGE 12The National Council Mental Health and Addictions Conference
PAGE 14What’s to Come at Leadership Conference 2013
PAGE 23ENA Report from NEMSAC
ENA Exclusive Content
The (Not So) Happy Holidays
LETTER FROM THE PRESIDENT | Gail Lenehan, EdD, MSN, RN, FAEN, FAAN
Coming in December
• 2012 Annual Conference Coverage from San Diego• Spotlight on the Historical Perspectives Work Team• More Coverage of ED Response to the Colorado Theater Shooting
November 20124
On her mission to improve medication safety, Susan
Paparella observes and advises health care
professionals around the country. This year, her
work couldn’t have brought her closer to home.
Paparella, MSN, RN, who earned both her
nursing degree and master’s at Villanova University,
was honored April 14 with a Villanova College of
Nursing Medallion — the college’s highest
recognition — for ‘‘Distinguished Contributions to
Clinical Practice.’’ The presentation occurred during
the 23rd Annual Mass and Alumni Awards program
held at St. Thomas of Villanova church, where
Paparella was married and where her first son was
baptized. She’d only days earlier learned her second
son had been accepted as a Villanova student.
The experience, she said, was ‘‘wonderful.’’
‘‘It was a little intimidating to be standing in front
of Villanova faculty members, all experts in the field
of nursing,’’ Paparella said. ‘‘It was because of their
encouragement and mentorship that I have been
able to accept challenges throughout my career.
The faculty at Villanova was instrumental in helping
me recognize how essential clinical inquiry is to
advancing nursing practice and patient safety
science. They shaped my values and gave me a
voice as a professional nurse.’’
Today she’s educating practitioners far and wide.
As vice president of the Horsham, Pa.-based Institute
for Safe Medication Practices, Paparella develops
consulting and educational services and travels in
that role, helping hospitals to adopt safe medication
practices to avoid harmful errors. ISMP is a
non-profit 501(c)(3) charity and operates the only
practitioner-based medication error reporting
program in the U.S. While it doesn’t set standards for
medication use, it collaborates with the bodies that
do (including the FDA and the Joint Commission).
‘‘I feel lucky because I get to connect with my
ED colleagues regularly and understand what their
challenges are,’’ Paparella said. ‘‘ED nurses face a
number of issues that have the potential to impact
safe clinical practice. We need to understand: How
do you combine the complex task of medication
use within a challenging ED environment and do it
in a way that will avoid inadvertent patient harm?’’
Paparella’s ties to her alma mater have become
stronger over the years. She has lectured to
undergraduate students and is working with faculty
on a safety-related research project.
‘‘I see their graduates on a regular basis, and
they’re always such high caliber, which makes me
very proud to be one of them,’’ she said.
An ENA member since 1994, Paparella is a former
chairperson of ENA’s Patient Safety Work Group.
Currently she is a member of the Advisory Committee
for ENA’s Institute for Quality, Safety & Injury
Prevention. She is an adjunct assistant professor at
the Temple University School of Pharmacy and the
author of ‘‘Danger Zone,’’ a column on medication
safety in the Journal of Emergency Nursing.
‘‘Susan Paparella is a leader in patient safety on a
national and global stage,’’ said M. Louise Fitzpatrick,
EdD, RN, FAAN, a dean and professor of the College
of Nursing. ‘‘She uses her comprehensive knowledge
and background to influence changes in practice and
improve patient care outcomes. We are proud to say
she is a Villanova nurse.’’
Josh Gaby
ENA Connection is published 11 times per year from January to December by: The Emergency Nurses Association
915 Lee Street Des Plaines, IL 60016-6569
and is distributed to members of the association as a direct benefit of membership. Copyright© 2012 by the Emergency Nurses Association. Printed in the U.S.A.Periodicals postage paid at the Des Plaines, IL, Post Office and additional mailing offices.
POSTMASTER: Send address changes to ENA Connection915 Lee StreetDes Plaines, IL 60016-6569ISSN: 1534-2565Fax: 847-460-4002 Web Site: www.ena.orgE-mail: [email protected]
Non-member subscriptions are available for $50 (USA) and $60 (foreign).
Editor in Chief:Amy Carpenter AquinoAssistant Editor, Online Publications:Josh GabyWriter:Kendra Y. MimsEditorial Assistant:Dana O’DonnellBOARD OF DIRECTORSOfficers:President: Gail Lenehan, EdD, MSN, RN,
FAEN, FAANPresident-elect: JoAnn Lazarus, MSN, RN,
CEN
Member Services: 800-900-9659
Secretary/Treasurer: Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN
Immediate Past President: AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN
Directors:Kathleen E. Carlson, MSN, RN, CEN, FAEN Ellen (Ellie) H. Encapera, RN, CEN Mitch Jewett, RN, CEN, CPEN Marylou Killian, DNP, RN, FNP-BC, CENMichael D. Moon, MSN, RN, CNS-CC, CEN,
FAENMatthew F. Powers, MS, BSN, RN, MICP, CENKaren K. Wiley, MSN, RN, CEN
Executive Director: Susan M. Hohenhaus, LP.D., RN, CEN, FAEN
‘Leader in Patient Safety’ Makes Villanova Proud
SPOTLIGHT ON YOU!Do you have a professional or educational
achievement you want your fellow ENA
members to know about? Do you want to sing
the praises of a member colleague who has
received a new degree, promotion or award?
We encourage you to submit these items to
[email protected] for inclusion in monthly
roundups in the new “Members in Motion”
section. Include names, credentials, a short
explanation of the accomplishment and a
high-resolution photo (if available), along with
contact information for follow-up by the ENA
Connection staff for select features.
With a new month comes a new
opportunity for free continuing
education through ENA. Our
November offering, worth 1.0 contact
hours, is “Prevention of Health
Care-Associated Infections,” a
webinar presented by Rhonda
Morgan,
DNP, RN,
CEN,
CNRN,
CCNS,
APN. The
course
focuses on the major types of health
care-associated infections, identifies
the causes and risks and explores
prevention strategies the emergency
nurse can use to keep them from
developing.
To take the course and earn
your credit:
• Go to www.ena.org/freeCE,
where you’ll log in as an ENA
member (or create a new
account).
• Add the course to your cart and
“check out” (no charge for
members).
• Proceed to your personal
learning page to start or
complete a course for which
you have registered or to print
a certificate when you’re done.
It’s as simple as that.
ENA has a growing back catalog
of free CE courses on a range of
topics, so if you haven’t yet taken
them, complete the checkout process
for each course you want.
Free education at your leisure, at
the comfort of your computer, is just
one of the perks available to you as
an ENA member, and response has
been enormous. Take full advantage!
Susan Paparella, MSN, RN, at her award presentation.
The Board of Certification for Emergency Nursing (BCEN®) certifications help you take the next step in your career.Demonstrate your commitment to competency; earn a BCEN certification today.
Earn Your Mark of Distinction
Find out more...www.BCENcertifications.org
It was great having the opportunity to meet so many of you at the ENA
Wired lounge at the Annual Conference in San Diego. For the first time,
we were able to provide an immersive social media experience for not
only those who attended but also for many who were unable to make
the conference. Using Facebook, Twitter and Foursquare, you were able
to follow what was happening at conference, participate by posting or
tweeting your experience and even check in at various conference
events.
Fast-forward to what we have in store for Leadership Conference,
where social media will be even further integrated with your overall
conference experience — right down to being able to share the website
(www.ena.org/lc) with your colleagues through Twitter or Facebook.
Providing this level of experience allows you to use your mobile
devices and network on the fly without taking away from your ability to
attend all the sessions you want. Meet up with colleagues, discuss
experiences, share photos or stories with your peers back home — all
of these possibilities are simply a click away through any of our social
media avenues.
As ENA continues to advance and grow technologically, we look for
ways to enhance your experience as members. This is just one of the
many ways we hope to shape the future and provide you with the
ultimate networking experience, whether during conference or
throughout the rest of the year.
ENA Connected
By Thomas Barbee, ENA Digital Marketing Manager
Taking the Next Steps With Social Media
The Board of Certification for Emergency Nursing (BCEN®) certifications help you take the next step in your career.Demonstrate your commitment to competency; earn a BCEN certification today.
Earn Your Mark of Distinction
Find out more...www.BCENcertifications.org
November 20126
A few weeks ago, ENA member Claudia Ayala-
Rivera, RN, CPEN,* was preparing to start an IV
on a 15-year-old female when she noticed an
unusual number of cuts on the girl’s forearm.
They appeared to be fairly superficial and in
various stages of healing. Ayala-Rivera pulled
the patient’s mother aside and asked her about
the wounds. The mother explained very matter-
of-factly, ‘‘She and her sister think it’s fun to cut
on their arms like that.’’ It was a form of play
for them, the mother explained. However,
Ayala-Rivera recognized this behavior as a
method of stress relief and a symptom of a
larger problem.
She discussed this with the emergency
physician, who then helped Ayala-Rivera
educate the family about cutting, a common
form of non-suicidal self-injury. The patient
received a behavioral health assessment in the
ED and was later discharged with a referral for
outpatient psychiatric treatment.
What is Non-Suicidal Self Injury? Self-harm behaviors such as cutting and burning
are impulsive behaviors which involve
conscious decisions to mutilate or hurt oneself
without suicidal intent.1,2,3 Injuring oneself can
stimulate endorphins (naturally occurring
opiates) which are produced by the brain in
response to pain.4 These acts provide instant,
temporary release and relief from stress, anger
and other negative feelings.2,4 Common sites for
cutting and other forms of NSSI are the arms,
wrist, ankles and lower legs.2 NSSI is usually
performed at least once a week in a private
setting, such as a bedroom.2 Occasionally, such
as in the case of Ayala-Rivera’s patient, the
family is aware of the self-injury and accepts the
behavior as a form of play or a harmless coping
mechanism.
Self-injury can be extremely addictive, and
without psychiatric treatment it often continues
for several years, even into adulthood.2 Due
largely to a lack of understanding about self-
injury and to the stigmas that surround it, this
behavior is often perceived by others (including
health care professionals) as being manipulative
or attention-seeking.5
Looking Beyond the Scars The rate of NSSI is higher in adolescents and
young adults than in the general population
— 14-21 percent vs. about 4 percent,
respectively.1 Females are more likely to engage
in NSSI than males.2 The rate is also up to
six-fold higher in people who have been
exposed to physical violence or threat to life.1
NSSI, while not currently recognized by major
medical classification systems as a separate
mental health disorder, is recognized as a
symptom of borderline personality disorder.3,4
(While searching online for website resources to
list in this column, I noticed that NSSI was
PEDIATRIC UPDATE | Elizabeth Stone Griffin, BS, RN, CPEN
Coping Mechanism, or a Cry For Help?
Non-Suicidal Self-Injury in Adolescents
Official Magazine of the Emergency Nurses Association 7
usually found only under the heading of BPD.)
However, according to the research, NSSI in
adolescence, especially, does not seem to be
limited to those to suffer from BPD. It is a
behavior found not only in adolescents who
suffer from other psychopathologies but also in
those who practice various forms of ‘‘indirect
self-injury,’’ such as substance abuse, eating
disorders and abusive relationships.1 NSSI can
even be found in adolescents with no history of
any of the above behaviors or conditions.1
NSSI and Suicide RiskA 2011 study by St. Germain and Hooley found
that compared to individuals who engage only
in indirect self-injury (risky behaviors/lifestyles),
those who engage in NSSI are ‘‘much more
harshly self-critical … the individuals who
engage in NSSI may regard suffering and pain
as something that they deserve’’ (page 81). Not
surprisingly, they are also more prone to
suicidal tendencies and have higher rates of
suicide attempts.1,6 The time immediately after
an episode of NSSI holds the greatest risk of both
repeated NSSI and completed suicide.6
Attitudes, Assessments and ReferralsSometimes, as in Ayala-Rivera’s case, the
patient’s family is unconcerned about the
behavior. Often the NSSI is not the primary
reason for the ED visit but a secondary finding
during the nurse or physician assessment.
Health care providers who identify a self-
cutting injury need to determine whether the
injury was part of a suicide attempt or a
self-cutting episode.
Asking nonjudgmental questions about the
length of time the behavior has been used, and
how, when and why it is performed is
appropriate and will help ED providers guide
the patient toward the appropriate referral and
subsequent care.2 Much inconsistency exists in
the frequency of both ED mental health
assessments and outpatient mental health
treatment for patients who engage in NSSI.6
Emergency departments are in a position to
help close these gaps in care by providing
mental health assessments while the patient is
in the ED, when possible, and by providing
potentially life-saving referrals for follow-up
mental health services.
Finally, staff knowledge and attitudes are
also vital to the effective management of
patients who self-injure; those who lack
knowledge on the subject of NSSI are most
likely to exhibit negative attitudes toward these
patients.5 Health care professionals, as well as
school staff (both are often the first to identify
self-injurous behavior) can help de-stigmatize
self-harm behavior by educating themselves
and thereby becoming more effective providers
of support and care.5 We should all focus not
on the scars themselves, but on the people
behind the scars.
Resources and References
1. St Germain, S. A., & Hooley, J. M. (2012).
Direct and indirect forms of non-suicidal
self-injury: Evidence for a distinction.
Psychiatry Research, 197(1-2), 78-84. doi:
10.1016/j.psychres.2011.12.050
2. Puskar, K. B., Bernardo, L., Hatam, M., Geise,
S., Bendik, J., & Grabiak, B. R. (2006). Self-
cutting behaviors in adolescents. Journal of
Emergency Nursing, 32(5), 444-446. doi:
10.1016/j.jen.2006.05.025
3. Plener, P. et al, Prone to excitement:
Adolescent females with non-suicidal self-
injury (NSI) show altered cortical pattern to
emotional and NSS-related material,
Psychiatry Research: Neuroimaging(2012),
doi:10.1016/j.
pscychresns.2011.12.012
4. National Alliance on Mental Illness Website.
Accessed 10/1/2012: www.nami.org
5. Timson, D., Priest, H., & Clark-Carter, D.
(2012). Adolescents who self-harm:
Professional staff knowledge, attitudes and
training needs. Journal of Adolescence, 35,
1307-1314
6. Olfson, M., Marcus, S. C., & Bridge, J. A.
(2012). Emergency treatment of deliberate
self-harm. Archives of General Psychiatry,
69(1), 80-88. doi: 10.1001/
archgenpsychiatry.2011.108
7. Helpguide.org (a great website for patients
who self-harm as well as the health care
providers who care for them). Accessed
10/1/2012.
* Claudia Ayala-Rivera’s name and story used
with her permission.
Grow your career when you become part of ENA Leadership Conference Faculty. Share your leadership knowledge, experience and skills to help grow the profession of emergency nursing.
Do you have specific knowledge in a particular area of emergency nursing, management or policy?
Has a particular experience given you new insights into a current issue or trend and led to new best practices?
Do you have experience dealing with leadership challenges and issues?
Establish Yourself as a Leader
Submission Deadline is March 25, 2013
• Management• Operations• Government affairs• Technology• Team building• Research• Education
• Advance practice• Orientation• Retention• Community relationship building• Customer satisfaction• Personal and professional development
Find full information and course proposal guidelines at www.ena.org and click on Leadership Conference 2014 Call for Course Proposals in the Calls and Opportunities Section. We look forward to hearing your cutting-edge course ideas.
Share your insights related to current issues, trends, and best practices as a faculty member at ENA Leadership Conference 2014, March 5-9 in Phoenix, Arizona
Topic areas:
Join the faculty for ENA Leadership Conference 2014, Phoenix, March 5-9
November 20128
July 20, 2012, Aurora, Colo. 12:30 a.m.When Jennifer Hahn-Farris, RN, charge nurse at the Medical Center of
Aurora, received word from the onsite emergency department police
officer that a shooting had occurred at the Town Center at Aurora
shopping mall, she figured it was gang-related and organized her trauma
nurses to prepare the trauma rooms for gunshot wounds. Because the
hospital is located about two miles from the mall, Hahn-Farris expected to
receive two or three patients, so she also notified the lab, along with the
ICU charge nurse. It wasn’t until she returned to triage five minutes later for
an update that Hahn-Farris realized the magnitude of the shooting: More
than 20 victims had been shot at close range in a crowded movie theater.
Hahn-Farris took a deep breath and received the first victim in triage at
the same time she received the update. The
patient was eight months pregnant with
significant injury to her face. With limited time to
assess the patient, the patient was categorized as
their highest level of trauma team activation and
taken back to the trauma room.
Hahn-Farris immediately huddled with her
triage nurses and told them there were unknown
severities and that they needed to be ready for
the worst-case scenario. Her nurses began
moving all of the stable patients out of the
rooms as quickly as possible to make room for the ones soon to come.
The triage nurse moved all of the patients who were already in the
waiting room before the shooting incident to an urgent-care area so that
they could be spared from seeing any traumatic visual images caused by
the mass shooting. Hahn-Farris called ICU, requesting every ICU nurse
who was available, and contacted her emergency department director to
inform him of the situation.
Patients started arriving two to three at a time via police cars. Hahn-
Farris said her team was able to quickly identify which patients could be
in the hallway vs. which patients that needed to be in the trauma room.
‘‘My team was phenomenal, and they did a great job at assessing the
patients and their GCS levels immediately,’’ she said. ‘‘At no time did my
staff become unorganized or chaotic. We took every single patient and
moved them on a constant basis for acuity and straight to the OR.
Everyone just did what they needed to do for the best of the patient.’’
Many patients arriving needed immediate life-saving interventions.
Thoracostomies were started instantly. Hahn-Farris assigned ED nurses
and ICU nurses to work one-on-one with every victim. She quickly
realized that doctors were not able to go from the patients to the
computer to enter orders as usual, so she switched to an efficient system
for communicating orders. Order sheets and labels went on the patients so
that physicians could write orders and give them directly to her secretary.
Hahn-Farris and her nurses didn’t have time to prepare for the obstacles
they would encounter during the next several hours.
‘‘We were already full, but we had life-threatening emergencies,’’ she
said. ‘‘Gunshot wounds can’t wait.’’
12:55 a.m.Emergency department director Mark Mayes was asleep when he received
the phone call. Hahn-Farris informed him that a mass shooting had
occurred and victims were coming in by police cars. There was also a
possibility of gas exposure. Mayes, MHA, RN, CEN, immediately threw on
scrubs and headed to the hospital and notified the hospital’s house
supervisor to use the external disaster page.
By the time Mayes arrived at 1:05 a.m., the hospital had already
received 11 patients from the shooting, and two were in the OR. He
huddled with Hahn-Farris to reassess patients and determine which ones
needed to go to surgery immediately with which surgeon. Mayes had an
administrative worker send out an all-response page to every ED
employee via text message, and staff immediately responded.
‘‘We got eight staff members that showed up to the ED to help, and
that was a perfect number for us to make sure we had plenty of people to
take care of the extra patients, as well as the patients who were not
involved in the tragedy but still needed ED care,’’ Mayes said.
Mayes also called in Justin Mast, RN, BSN, CEN, FAWM, the hospital
emergency response team coordinator, for
assistance with running incident command within
the ED. When Mast arrived, the ED was very full
and busy. The injuries were caused by range of
weapons, from large-caliber to small shotgun
pellets. There were limb and extremity injuries.
Torso, head and dental injuries. Shrapnel injuries.
Inhalation injuries. Twisted knees from running
and falling. Lodged bullets. Blowout shotgun
wounds to the leg.
Patients who needed immediate surgery were
already in the OR. Mast quickly assisted a patient
who needed a CT scan and evaluated several others
who complained of burning and itching before he
headed to the command center to facilitate what
was going on throughout the hospital.
Although the Medical Center of Aurora had
received an influx of patients from a plane crash
in 2009, the emergency response team and ED
staff had never dealt with a disaster of this
magnitude.
‘‘In the plane crash, we had advance notice and
16 patients who came scattered over an hour,’’
Mast said. ‘‘They were definitely less severely
injured, and the time frame of their arrival was spread out. This event had
really high-acuity patients arriving in a short period of time and a number of
them at the same time. There were multiple patients in police cars. The
immediate response of the staff with little notice was phenomenal.’’
Staff came to the ED from all over the hospital to help manage the
surge throughout the night.
‘‘I had folks come down to tell me, ‘I don’t know what to do, but I’ll do
whatever you need me to,’ ” Mast said. ‘‘The ED was hit hard and fast.
Everyone that was there did a superb job of trying to get people shifted
around to make extra room. We knew the patients were getting the care
they needed, and we were supporting them in the operating room.’’
The hospital typically runs a maximum of two ORs a night.
‘‘We received 18 patients from the incident. We opened up five ORs
that night,’’ Mayes said. ‘‘That was a big challenge that we had a lot of
help with. Our sister hospital, Swedish Medical Center, sent us OR nurses
By Kendra Y. Mims, ENA Connection
A Special Midnight Showing
Jennifer Hahn-Farris, RN
Mark Mayes, MHA, RN, CEN
Justin Mast, BSN, RN, CEN, FAWM
Colorado Theater Tragedy Brings Out the Best in ED Staff Response
Official Magazine of the Emergency Nurses Association 9
and scrub techs to help us because they knew we
would get the brunt of the patients. It’s amazing
how everyone came together to send resources.
We had staff from the labor and delivery
department, ICU and our trauma floor come down
to the ED to help. There were no walls up. All of
the walls were knocked down instantly when
people heard of this tragedy. People came from all
directions willing and wanting to help.’’
Another challenge for staff was the limited
amount of space in the ED. Not only was the
Medical Center of Aurora’s emergency department
full before the shooting victims arrived, but it also
was under construction for remodeling. The four
main trauma rooms were shut down, leaving only
two temporary trauma rooms in service. A total of
12 beds were out of service, and a third of the ED
was walled off for construction. As patients
arrived, they were treated in every area of the ED,
including the hallways. Mayes recalled one of the
patients losing his pulse in the hallway. The ED
physician didn’t have a trauma surgeon with him
at the time, so he inserted a chest tube himself,
decompressed the patient’s chest and revived him.
‘‘Every patient was able to get the care they
needed,’’ Mayes said. ‘‘All of that is because of
how our emergency nurses and physicians worked
together. One thing that was very impressive is that
everybody clicked into mass casualty triage mode
and they still took good care of the patients.’’
Despite the severity of the injuries and how
they arrived at the hospital, all of the victims
treated at the Medical Center of Aurora survived.
Still, the night took a physical and emotional
toll. Some patients already knew their loved ones
were dead or missing. Along with treating patients
medically, the staff had to help them emotionally
and comfort concerned loved ones who arrived
looking for answers.
Separated and Searching Hahn-Farris remembers seeing patients
screaming in pain while bleeding all over — many
calling out for loved ones they could not find.
Because of the number of critically injured people
at the scene, police officers transported victims to
different hospitals in the area, and many patients
were separated from their loved ones. Others had
died at the scene.
‘‘When we were trying to help people find
loved ones, we didn’t even comprehend that there
were that many people dead on scene,’’ Hahn-
Farris said. ‘‘We were trying to be optimistic and
help them, and it started to hit us that we weren’t
going to find everybody because not everybody
was going to make it to an ER. It was difficult.
‘‘At some point we received a lot of advocates,
which I directed to the patients who I felt needed
the advocates the most.’’
The waiting room was quickly filled with
concerned parents and loved ones. The shooting
victims at the Medical Center of Aurora ranged
from 13 to 31 years old. Hahn-Farris did not know
many by name — she only knew them by injury.
But she also knew that all of the patients in her
ED were alive, and she went into the waiting
room to reassure the families.
‘‘Being a mom myself, I knew they were
terrified,’’ she said. ‘‘But I promised them that we
were taking care of them, and if they were
contacted via phone and they knew for a fact that
their loved one was in my ED, then everyone I
had was alive. I let them know that it’s a scary
situation, but to please stay calm so that we could
take care of them efficiently and quickly. They
responded well to that.
‘‘We connected the families as quickly as we
Mark Mayes, MHA, RN, CEN,
emergency department director of
the Medical Center of Aurora, said
the TeamSTEPPS implementation
that began in his ED two years ago
gave the staff tools to help increase
communication and accomplish
everything in a systematic manner
after the theater shooting July 20.
‘‘Because we already had this
framework in practice, one of the
simple things from TeamSTEPPS that
came out and really helped us was
having ‘huddles,’ situational
awareness, leaders in place and
using repeat back communication,’’
Mayes said. ‘‘Those things just
happened naturally.
‘‘I think the best part of the night,
as far as the ED was concerned, was
that all of the people who needed to
know what was going on were
aware. Our medical director, Frank
Lansville, was there, working hard
and informed. Our charge nurse,
Jennifer, was aware of everything.
Justin [Mast, emergency response
coordinator] knew. The doctors
knew. The surgery team knew. And
that’s because we had those
communication pieces like ‘huddles’
in place. That was our real saving
grace. There wasn’t uncontrolled
chaos or mass confusion. Our
communication was excellent in the
ED in such a chaotic situation.’’
Mayes commended his charge
nurse, Jennifer Hahn-Farris, RN, for
maintaining situational awareness
and for keeping her team going.
‘‘She took primary role of patient
flow and really did a very good job
with that,’’ he said. ‘‘Through the
TeamSTEPPS process, we developed
a team leader structure. That gave us
the right kind of communication
structure and the oversight we
needed to run the place as
efficiently as possible, to not lose
track of people and to not forget
about patients. We didn’t miss
something. I think it had a lot to do
with TeamSTEPPS.’’
Kendra Y. Mims
TeamSTEPPS Helps ED Staff Keep Order
Continued on page 10
Ph
oto
by K
arl
Geh
rin
g, D
enve
r P
ost,
for
th
e A
ssoc
iate
d P
ress
The mass shooting by a lone gunman at the Century 16 theater in Aurora, Colo., shortly after midnight July 20 resulted in 12 deaths and scores wounded. No victims taken to the Medical Center of Aurora died of their injuries.
November 201210
could. That was really important to us. I
found my youngest patients and walked
parents back personally. It meant a lot to
me to really reassure these parents as a
mother, as their nurse and as the charge
nurse of the department that their
children had been cared for, and though
their injuries looked significant, they
were doing OK.’’
Administration quickly developed a
separate room for families to help support
them. Refreshments and counselors were
brought in. The Medical Center of Aurora
was the first hospital to set up a public
hotline to increase communication.
‘‘I think we can say that was a big
challenge for us,’’ Mayes said. ‘‘Multiple
patients went to different hospitals, so in
the beginning, we didn’t have a good
way to communicate where that family
member was or how they could find
their loved ones. It was tough because it
happened so quickly.’’
The AftermathHahn-Farris is proud of how her team
and colleagues responded and took care
of all of the patients despite the many
obstacles they faced throughout the night.
‘‘I don’t think we realized as
caregivers how big this was going to
be,’’ she said. ‘‘It’s amazing to me how
well everything flowed. My nurses
stayed focused. They stayed on point
and were able to give me all of the
information that I needed one-on-one
every time we huddled. We have a great
disaster team, and Justin is phenomenal
at what he does. It has changed us as a
team, it changed us as nurses, and it
changed me as a leader. This makes me
realize what our ED is capable of.’’
She says the shooting has created
some anxiety in some of her nurses who
treated patients that night.
‘‘For my nurses who smelled it and
heard it and who washed the blood off
of these patients and listened to their
stories, it increased their own anxiety of
why this happened and how many lives
were forever changed,’’ said Hahn-Farris,
who made sure she focused on her
nurses’ emotional status after the
incident. ‘‘We will forever have a
connection with these patients and hold
a special bond with each other.
‘‘It’s been a roller coaster of emotions
for a lot of our nurses, but I think that in
the end, everyone is doing well knowing
that every patient we received survived.
They all stepped up and listened to me
and had faith in me, but they also had
faith within themselves and faith in their
team. We got through all of it.’’
Hahn-Farris feels the nurses who
weren’t working that night also hold a
lot of pride in knowing they work for a
facility that provides support to staff and
high-quality care to patients.
‘‘I know they would have stepped up
and done the same thing,’’ she said. ‘‘As a
leader, I know that we are capable of a
lot. I’m very proud of what I do. I’m very
proud of my nurses. I’m very proud of
where I work, and I’m very proud of the
director [Mayes] that I have. We had
absolutely nothing to do with what
happened and had no control over what
happened, but I feel like we certainly
proved ourselves to the community that
above all else, when we are in that
position, we take it very seriously and
very close to our hearts. We are there for
a reason, and we are very available for
our city, and we will take care of
anybody to the best of our ability that
needs us.’’
Critical Incident ReviewMedical Center of Aurora – Mass Shooting, July 20
(Times shown are estimates)
Time Event Description
00:15 Suspect enters theater 9 and begins shooting
00:30 Ocean 1 in ED relays radio traffic to ED Charge
Nurse
00:51 1st patient arrival Patient Arrival Timeline
00:55 ED Charge RN Calls ED Director
00:57 ED Director calls House Supervisor, requests
disaster page
01:02 Page sent out “Internal disaster in ED”
01:05 ED Director arrived in ED
01:16 Text sent out to all ED staff to respond if
available
01:34 Call to open incident command made
01:48 1st conference call made
02:00 Level 2 lockdown initiated
02:00 1st patient decontaminated
02:30 All directors to respond, page sent out
03:00 Disaster radios dispersed
03:45 ED phone calls overwhelming, hotline requested
03:58 AFD I.C. confirms no more patient transports at
this time
04:06 9 News on site at TMCA
04:20 Decon of last contaminated patient
04:26 Decon team ceases operations
04:28 Hotline number set up
04:38 Live BBC phone interview- Frank Lansville
04:46 Increasing radio traffic, switch made to
Channel 2
05:20 Staff voicemail/emotional support set up
05:25 Possible volatile family situation, increased
security and APD presence
Media staging in 020
Spanish interpreter requested, EMT sent from ED
Meeting Room 1 & 2 open for patient families
05:45 Media Update at I.C.
06:20 Ryan Simpson, COO designated as Interfacility
Liaison
06:45 Hospital census update given at I.C.
Family update given to families waiting in
physician conference room
06:50 Hotline number found to be routing to voicemail
at patient billing
07:00 Update sent to media on hotline number
07:15 ED/OR/L&D staff and physician debrief in ED
Oasis room
08:57 I.C. Command to ED Director
09:20 I.C. Command to Administrator On-Call,
Roberta Barton-Joe
09:27 Jennifer Barry assigned as Logistics Chief
10:00 Some position transfers of command begin
211 and state-wide hotline set up
TV requested at family support center
10:36 Incident Command roles assigned and
communication structure reviewed
From left: Cassandra Hixson, RN; Justin Mast, BSN, RN, CEN, FAWM; Jocelyn Hubbach, RN; Marian Bezio; Karen Nerger, RN, SANE; Corey Casarez, EMT; Hal Anderson, EMT; Mark Wissman, RN; Jennifer Hahn-Farris, RN; Mark Mayes, MHA, RN, CEN.
Aurora Shooting Continued from page 9
Official Magazine of the Emergency Nurses Association 11
BOARD WRITES | Kathleen E. Carlson, MSN, RN, CEN, FAEN
Across our country, as inpatient behavioral
health beds have closed, emergency
departments have become the default location
for patients requiring psychiatric care.
However, caring for these patients in the ED is
expensive and places an additional burden on
crowded facilities. Most hospitals are holding
involuntary emergency psychiatric patients for
several days as they await placement. This
article will share some strategies being used by
our nursing colleagues to care for patients
and caregivers in this difficult situation.
The New Hampshire ENA State Council
recently hosted a breakfast for emergency
nursing leaders with a panel of psychiatric
experts. New Hampshire has only one state
hospital that admits psychiatric patients, and
most of the attendees were unclear about
how many beds the state has and the process
to admit patients. The attendees had a
passionate discussion about the problem and
shared practical tools to help the staff caring
directly for these patients. Stacey Savage,
BSN, RN, CPEN, New Hampshire ENA state
president, felt this discussion was ‘‘a major
step toward collaboration and, hopefully,
some support.’’
Vermont’s state forensic hospital was
destroyed by Hurricane Irene last year,
causing patients to be immediately moved
into outpatient settings, lower-acuity
psychiatric inpatient units and even into the
correctional system. Without the state
hospital to house the highly acute forensic
behavioral health patients, Vermont’s
emergency departments have been severely
impacted. Many EDs are finding themselves
holding multiple psychiatric patients awaiting
‘‘appropriate’’ placement for days at a time.
Derek Kouwenhoven, RN, CEN, Vermont
ENA State Council president, reports that ‘‘a
few months ago, it appeared that the
long-term plan was to use community health
centers and stretch the outpatient settings for
these forensic patients, which would, in turn,
continue the impact on emergency
departments throughout Vermont’’ with
overcrowding and violence.
Vermont ENA members, ED staff and
members from the remaining inpatient
behavioral health units lobbied their
legislators, and the state is now well on its way
toward building a 25-bed facility to care for the
state’s forensic psychiatric patients.
‘‘There is now light at the end of the tunnel
with the state agreeing to build a new facility
due to open late 2013 or early 2014,’’
Kouwenhoven said.
Christy Spivey, RN, administrator of
Emergency Department and Trauma Services at
New Hanover Regional Medical Center, a
Level II trauma center in Wilmington, N.C.,
reports that they have a designated eight-bed
pod where boarded behavioral health patients
are cared for as they await placement.
‘‘We’ve created a care model where an ED
RN provides care to the patients, and a BH RN
provides a psychiatric screening, while other
staff assists with patient placements,’’ she said.
Caring for Behavioral Health Patients in the ED
Continued on page 24
Searching for Solutions to Unfortunate Holding Pattern
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Offering Educational and Networking Opportunities for Current and Future Emergency Nurse Leaders.
E N A L E A D E R S H I P C O N F E R E N C E 2 0 13
F O RT L A U D E R DA L E , F L F E B R U A RY 2 7 – M A R C H 3
For more information, scan QR code, or visit
www.ena.org/lc
November 201212
Mental health and addictions experts, clinicians,
community-based advocates, researchers, social
workers, direct care staff and many more health
care professionals and organizations convened
in Chicago in April for the 42nd National
Council Mental Health and Addictions
Conference. ENA Connection covered the
following sessions:
Addressing Secondary Traumatic Stress: A Guide to Caring for StaffIn this trauma-informed care session, Dr. Richard
Mollica, MD, MAR, director, Harvard Program in
Refugee Trauma, Harvard Medical School,
discussed how caring for consumers who suffer
from the impact of trauma can affect health care
professionals. He also talked about the
importance of health care professionals
developing a self-care program, which plays a
role in providing effective care.
‘‘This is an exciting topic because we all
know that the pain of others becomes our pain,’’
Mollica said. ‘‘You can’t do this work, working
with highly traumatized people, unless you have
a model of self-care.’’
Although a majority of the attendees raised a
hand when asked if they had experienced
burnout, very few raised a hand when asked if
their organization had a written, efficient
self-care protocol.
‘‘One of the things I want you to understand
here is that the symptoms and the problems of
self-care are essential to the treatment,’’ Mollica
said. ‘‘They are part of the treatment. They are
part of the diagnosis. You’re going to see from
the neuroscience that your experience of the
patient that often leads to burnout and
compassion fatigue is a diagnostic experience.’’
As Mollica talked about the differences
between burnout (more organizational) and
compassion fatigue (more personal), he also
shared stories of how he and his team have
previously been affected when caring for highly
traumatized patients, including experiencing the
same nightmares as their patients..
‘‘Our hopelessness about the patients came
from the patients. We felt hopeless because the
patients felt hopeless,’’ he said.
Attendees also learned about empathy and its
impact on self-care and healing.
‘‘You can’t understand self-care unless you
understand empathy,’’ Mollica said, challenging
the audience to embrace the new concept of
empathy, which no longer involves putting
yourself in other people’s shoes. ‘‘Empathy is
the key to our treatment and to our healing. If
one believes empathy heals, then self-care is
essential.
‘‘This idea of putting yourself in the shoes of
other people is aggressive in some cultures. It
goes against the neuroscience, because what the
neuroscience research has shown is to imagine
the self as the other.’’ He said this concept of
maintaining independence causes less distress
and higher empathy.
The session ended with a discussion on the
effectiveness of using Balint groups in all health
care settings (peer supervision on relationships
and not techniques). Mollica also engaged the
audience in a conversation about lifestyle
practices to prevent compassion fatigue and
burnout (such as diet, exercise, sleep, spiritual
health, etc.) and the importance of making these
practices a reality.
Preventing the Use of Seclusion and Restraint Conference attendees learned about promoting
alternatives to seclusion and restraints through
12
By Kendra Y. Mims, ENA Connection
The National Council Mental Health and Addictions Conference
Development of the Lantern Award program criteria funded in part by Stryker, an ENA Strategic Sponsor.
B ecome a Lantern Award recipient
Apply today. Applications are due February 20, 2013.
DOES YOUR EMERGENCY DEPARTMENT
DESERVE RECOGNITION FOR
Exemplary Practice and Innovation?
To learn more and apply, visit : www.ena.org/IQSIP/LanternAward
T he ENA Lantern Award recognizes exemplary emergency departments that demonstrate exceptional performance and innovative practice in the core areas of:
• Leadership
• Practice
• Education
• Advocacy
• Research A Coaching Guide is now available to help you identify how best to demonstrate your emergency department’s achievements.
Official Magazine of the Emergency Nurses Association 13
trauma-informed care practices. Joan Gillece,
PhD, project manager, National Association of
State Mental Program Directors/National Center
for Trauma-Informed Care, discussed SAMHSA-
sponsored technical assistance and support to
publicly funded systems to prevent the
use of seclusions and restraints and to
create a culture change.
‘‘We know that there is nothing
therapeutic about seclusion. We know it
is treatment failure,’’ Gillece said. ‘‘…
Seclusion and restraint is awful for the
staff, it’s awful for the other people
observing it, and it’s clearly awful for the
person being restrained.’’
Gillece said almost every seclusion and
restraint boils down to a staff member
trying to enforce a rule. When she asked
attendees to identify the most volatile
times for seclusion and restraint, one
audience member suggested shift change.
Audience members who worked in
facilities that use seclusion and restraint
ranged from residential treatment
programs to hospitals and crisis centers.
Raul Almazar, MA, RN, a senior
consultant to SAMHSA’s Promoting
Alternatives to Seclusion and Restraints
through Trauma Informed Practices,
shared his input on the importance of
helping organizations seek alternatives.
He said the only way to effectively
change the culture is to understand the
amount of trauma in that culture.
‘‘The majority of clients in our mental
health system have experienced trauma,’’
Alazae said. ‘‘When we begin to look at
what people do to manage the world, we
understand that what we are trying to
treat are actually adaptations. … The
common bond amongst all of us —
providers and the people we provide
services to — is that we’re all just trying
to manage in this world. We should never
compare people’s trauma.’’
Almazar challenged the audience to
understand patient behavior.
‘‘We wonder why people are agitated,’’ he
said. ‘‘We take away everything people use
outside to manage the world, we bring them into
our systems and say, ‘Behave like an angel, and
if you don’t, we take privileges away.’ For a
lot of people, that’s their connection to the
outside world.’’
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
Keynote speaker David Satcher, MD, PhD,
director of the Satcher Health Leadership
Institute and former U.S. surgeon general,
presented his vision to nurture leaders in
public health and medicine who can contribute
to eliminating disparities in health. He also
discussed the importance of integrating mental
health and primary care.
Satcher promoted leadership partnership to
meet the challenge of ensuring a health system
that provides access to quality health care for all.
‘‘We have to find other people who share
our mission but perhaps who bring different
talents and resources to the table, and we have
to work together, especially true when dealing
with social determinants of health,’’ he said.
‘‘Regardless of how good we are, we need to
be part of an effective team.’’
Satcher encouraged attendees to talk more
about the importance of mental health.
‘‘We think a lot about mental illness, but I
don’t think we talk enough about mental health,’’
he said. ‘‘We want people to think about mental
health and to appreciate what it really means to
have mental health and how to promote mental
health and prevent mental illness.’’
He shared statistics showing 1 in 5
Americans is diagnosed with a mental disorder
and the World Health Organization’s prediction
that mental disorders will be the leading cause
of disability by 2020. He said many patients
diagnosed with a mental disorder don’t receive
treatment until they are in a crisis.
‘‘A mental health emergency in the ED can
be a disaster,’’ Satcher said. However, “we
found that it is possible to dramatically
improve the experience of people in the ER
when they go in for mental health
emergencies, or we found that, in fact, we can
improve the waiting times.’’
‘‘Maybe we can’t cure mental disorders,’’ he
concluded, ‘‘but we can help people recover in
the sense that they return to productivity,
fulfilling relationships with others and they’re
able to deal with challenges in their lives.’’
Building New Leaders and a Commitment to Mental Health
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ENA LEADERSHIP CONFERENCE 2013
FOR COMPLETE ENA LEADERSHIP CONFERENCE 2013 DETAILS, PLEASE VISIT WWW.ENA.ORG/LC
Strengthen your leadership skills and empower your career today, tomorrow and for the future at ENA Leadership Conference, February 27- March 3, 2013 in Fort Lauderdale, FL
Shape the Future is about you shaping your future by gaining the knowledge and leadership skills you need to succeed. You can begin to shape your conference experience by participating in illuminating presessions that cover diverse and crucial information. Learn the skills you need to succeed as a leader from developing budgets and appropriate staffing to developing a mission/vision statement with your team. For those aspiring future
speakers you will learn how to write and deliver an award-worthy presentation. These presessions are designed to strengthen your existing knowledge base and provide you with new information that will help you as a leader.
Continue shaping your future with evidence-based sessions providing vital knowledge in several focus areas including: safety, professional development, health, quality and management.
WHAT’S NEW @ CONFERENCE
IgNITE® SESSIONSWatch your colleagues present their own take on “What Makes an Emergency Nurse Unique?” in these fast-paced 5-minute sessions packed with creativity, humor and insight.
JAm SESSIONSThese instructor-led, open forum sessions encourage expanded interactivity between attendees and instructors well beyond the classroom atmosphere of a traditional session. Expert faculty will guide the discussion by providing a base presentation of ideas and soliciting the experience, stories and ideas from you the attendee.
HANd-OFF SESSIONSThese unique sessions encompass two related topics in a concise 35-minute format to form one information packed session with must-knows that are important to you.
dEEp dIvE SESSIONSExperience in-depth exploration of topics that simply can’t be covered in a traditional course length.
ENA WIREdA self-serve computerized system area, Social Media and Wi-Fi hotspot available to all attendees. Access your e-mail, record the educational sessions you attend and print a completed certificate onsite.
To view the new conference offerings and complete details on conference sessions and keynote speakers, please scan the QR code or visit www.ena.org/lc
FOR COMPLETE ENA LEADERSHIP CONFERENCE 2013 DETAILS, PLEASE VISIT WWW.ENA.ORG/LC
ENA
SHAPE THE FUTURE
Important dates to Remember
Registration .....................................Now Open
Early Discount Rate Closes ....... Jan. 16, 2013
State and Chapter Leaders Conference ........... Feb. 27 – 28, 2013
Presessions ................................ Feb. 28, 2013
Educational Sessions ............ Mar. 1 – 3, 2013
Exhibit Hall ...................Feb. 28 – Mar. 2, 2013
2013 ENA ANNuAl CONFERENCE Nashville, TN • Sept. 17 – 21, 2013
ENA lEAdERSHIp CONFERENCE 2014 Phoenix, AZ • Mar. 5 – 9, 2014
SAVE
– T h E –
DATE
New this year are three unique learning experiences, including: Jam sessions, Hand-off sessions and Deep Dive sessions. Become inspired with the general session speakers; Carmine Gallo, Jon Gordon and Marcus Engel have been specifically selected to compliment the educational experience presented throughout each day. Each speaker offers their unique perspective on leadership skills ranging from how to inspire leaders, methods to overcome life obstacles and changing the things that you can.
This leadership conference is a must attend event as these impactful sessions are truly geared toward you shaping your future.
FOLLOW THE ACTION #ENALC13
November 201216
This year I have been promoting
the idea of the ENA Foundation as
your charity of choice. In 2012, the
board of trustees and I have endeavored
to establish a culture of philanthropy in our
appeals to our membership. We want you to
think of the ENA Foundation as a valued and
trusted charity. We seem to be on the right
path. In the past year, individual giving by ENA
members has increased. Despite the challenges
we faced in 2012, we still had the most success-
ful State Challenge ever. And we can do even
better in the coming years.
If you read ENA Connection from cover to
cover, as I do, then you certainly have read
how your contributions have helped support
research in the field of emergency nursing and
provided emergency nursing education. The
August 2012 article about the effects of sexual
assault on sex workers was a significant
milestone. Researcher Dr. Lola Prince has made
a contribution to the literature and opened the
eyes of ENA members with her study; her
research affects the lives of patients as a result.
The ENA Foundation provided support to Dr.
Prince to conduct her research.
An article in the March 2012 issue paid
tribute to paramedic Bryan Stow, whose
poignant story of recovery after being brutally
attacked after a baseball game touched people
nationwide. The California ENA State Council
stepped up and used funds it raised during the
2011 ENA Foundation State Challenge to name a
2012 academic scholarship in Stow’s honor.
In the April 2012 issue, Charlotte
Schnakenberg, the first recipient of the ENA
Foundation’s new International Exchange
Program, supported by Stryker, shared her
10-day experience in Ipswich, Suffolk County,
England. The ENA Foundation provided
Schnakenberg
with a scholarship
that helped her
enhance her
professional
development
and knowledge of emergency care and build
international relationships with other
emergency nurses.
Let me assure you that the ENA Foundation
is an excellent steward of your contributions.
The results of the 2012 State Challenge
campaign mean that 2013 will see 100
percent of the $116,000 raised go to our
members for scholarships and research grants.
We have an experienced scholarship review
team and a set of specific criteria. This year, 47
scholarships in the total amount of $194,000
were disbursed to our fellow ENA members,
as well as multiple research grants and
continuing educational scholarships. (To view
the list of scholarship and grant recipients,
visit www.ena.org/foundation/Pages/
Default.aspx).
Typically, the development staff informs the
scholarship recipients. This year, I asked to
‘‘puh-lease let me make two of the calls to
recipients myself.’’ When I called one recipient,
he took a long and very deep breath and stated,
‘‘I can’t tell you how much this means to me.
I was reviewing my finances for the coming
school year and was wondering how I was
going to make it. What an impact! Thank you!
Thank you! Thank you!’’
Wow! I felt tears come to my eyes as I heard
his response to the good news. I was walking
Your Generosity Has Moving Results
MESSAGE FROM THE CHAIR | Laura Giles, BS, RN, 2012 ENA Foundation Chairperson
New ENA monthly offering for FREE Continuing Education with contact hours for our members.
• Available November 1Prevention of Healthcare-associated Infections1.0 contact hour Rhonda Morgan, RN, DNP, CEN, CNRN, CCNS, APN
Don’t miss out on enhancing your education. Go to www.ena.org/FreeCE for additional free continuing education opportunites.
The Emergency Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
Continued on page 23
Official Magazine of the Emergency Nurses Association 17
Course Administrative Procedures UpdatedThe Course Administrative Procedures have been
updated and posted on the ENPC and TNCC
pages of www.ena.org. The procedures and the
4th edition of ENPC were effective Sept. 1.
ENPC 4th EditionInstructions have been sent to all current ENPC
3rd edition instructors regarding how to access
the Instructor Update modules and test through
ENA’s online Center for e-Learning. The letter is
also posted on the ENPC page of www.ena.
org. Access to the update modules and test
opened Aug. 27, and
several instructors
have already passed.
Upon successful
completion, the instructor may print a certificate
of completion; a new ENPC 4th edition provider
and instructor status will be issued within the
ENA database.
Instructors may call ENA Course Operations
at 800-942-0011 to order an ENPC 4th edition
provider manual to study for the update test.
ENPC 4th Edition Course DVDThe demonstrations of the ill and injured child
skill stations that are used for the provider and
instructor courses are located in the Center for
e-Learning, along with the instructor update
modules. Course directors who are teaching
ENPC 4th edition instructor and/or provider
courses in areas that have limited classroom
Internet access may download the Management
of the Ill or Injured Pediatric Patient Skill Station
Demonstration videos. The link to the ENPC 4th
edition material is within the Course Directors
Only section of www.ena.org. The videos are
available as large MP4 files; ENA recommends
that you download them from a location with
high-speed Internet access. Click on the link to
download the files to your computer.
New Functionality for Course DirectorsAlong with the rollout of the ENPC 4th edition
course is new functionality available through
eCourseOps:
• Purchase downloadable ENPC 4th edition
instructor supplements by clicking on the
“Manage E-books” menu item on the left side
of the screen.
• Assign course participants to your specific
ENPC 4th edition provider course to enable
them to view the pre-course modules by
clicking on the “Pre-course” icon on the far
right-hand side of the related course. You will
find it listed under “Upcoming Courses.” In
order to assign the downloadable books or
the participants of the provider course, the
course director will receive an online form in
which to enter the recipient’s name and e-mail
address. Both of the above are distributed to
the recipient by an e-mail that includes a link
to access either the downloadable PDF
instructor supplement or the online pre-course
modules. More directions will be added to the
eCourseOps landing page. These functions
are separate but work in a similar format.
Your Input Is WelcomeCoursebytes is the official communication to all
TNCC and ENPC course directors and instructors.
Topics for future issues and feedback are
welcome at [email protected].
WellnessCareerCenter
Looking to expand your experience,your reach or your knowledge base?
Develop a PlanAchieving your goal requires time and commitment. It also requires a plan. Determine what opportunities exist that you could participate in to reach that goal.
Use the Right EquipmentLeverage the tools and resources of your ENA membership to help you achieve your goals.
Build a professional profi le and resume and look for new opportunities through ENA’s Career Center.Access Career Wellness resources online at www.ena.org
Participate in ENA Educational OpportuntiesENA is pleased to partner with the National Healthcare Career Network to offer a series of webinars that can help you TAKE CHARGE OF YOUR NURSING CAREER!The November class titled “How You Can Enable Excellence” is on November 29, 2012 and is available for 24 hours.
Additional sessions will be held in January and February 2013.
Don’t miss out!
Powered by the ENA Career Center
AdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingAdvancingyourCareer
2012 Advancing Your Career AD Nov.indd 1 10/24/2012 11:31:52 AM
WASHINGTON WATCH | Kathleen Ream, MBA, BA, Director, ENA Government Affairs
In September, the American Hospital Association, the
American Medical Association and the American Nurses
Association released a new report that found up to
766,000 health care and related jobs could be lost by 2021
as a result of the 2 percent sequester of Medicare
spending mandated by the Budget Control Act of 2011,
scheduled to begin Jan. 2.
The report measures the anticipated effect of the cuts
in Medicare payments on health care providers and
reflects how reductions in Medicare payment for health
care services will lead to direct job losses in the health
care sector and reduced purchases by health care entities
of goods and services from other businesses. As the
impact of these cuts ripples through the economy, jobs
will be lost across many sectors beyond health care.
In the press release announcing the report, ANA
First Vice President Cindy R. Balkstra noted that
‘‘nurses have always strived to put patients at the
center of a health care system that emphasizes
prevention, wellness and coordination of care,
the kinds of services that experts agree are
essential to not only improving the health
status of patients but also lowering overall
health care costs. Cutting Medicare
spending in a way that eliminates health care
jobs is an extremely short-sighted way to
contain the high cost of health care.’’
The report estimates that during
the first year of the sequester, more
than 496,000 jobs will be lost. It also
found that the job losses will affect
many economic sectors beyond
health care and will be spread across
every state, with more than 78,000
jobs lost in California alone by 2021.
The health care sector has long
been an economic mainstay,
providing stability and
growth even during times of
recession. The Bureau of
Labor Statistics’ data show
that health care created
169,800 jobs in the first half
of 2012 and accounted for
one out of every five new
jobs created this year.
Last year’s budget deal
requires $1.2 trillion over
a decade in automatic
across-the-board cuts for some federal programs to take
effect unless Congress finds an alternative. Most policy
analysts expect lawmakers to get more serious about
funding and tax decisions after the November elections.
Nation’s EMS Policy AdvancesWith the nation’s emergency medical services systems
facing challenging problems, two multidisciplinary
committees have been working collaboratively to define
the direction of federal research and initiatives for the EMS
community. Both the Federal Interagency Committee for
Emergency Medical Services and the National EMS Advisory
Council held summer 2012 meetings, providing updates on
the significant accomplishments they have achieved.
FICEMSFICEMS specifically is charged with coordinating federal
EMS efforts for the purposes of identifying state and local
EMS needs, recommending new or expanded programs
for improving EMS at all levels and streamlining the
process through which federal agencies support EMS
(www.ems.gov/FICEMS.htm). At its last meeting in
June, FICEMS noted that much progress had been made
through its use of Technical Working Groups comprising
interagency staff-level employees who meet monthly
conducting the work of FICEMS’s eight standing
committees. While each committee has developed
two-year work plans to help guide FICEMS’s ongoing EMS
projects (www.ems.gov/pdf/2011/December/11-TWG_
Committee_Updates_Dec2011_Final.pdf), one of the
many projects discussed at the June meeting was a model
uniform core criteria for mass casualty triage.
Model Uniform Core Criteria FICEMS’s TWG on preparedness has been assessing the
feasibility and efficacy in promoting the implementation
of a consensus-based national guideline for model
uniform core criteria for mass casualty triage. Jurisdictions
at a mass casualty incident use various triage methods,
such as Simple Triage and Rapid Treatment and
JumpSTART, the pediatric equivalent to START. At issue
are MCIs crossing jurisdictional lines and involving
responders from multiple agencies that may be using
different triage methods. Were all the responders at a
given MCI to use the same triage method, operational
simplicity, communications interoperability and clinical
efficiency may be more readily attained. However,
accepting MUCC as the national triage system has a
number of hurdles to overcome, such as the lack of
Sequester Could Lead to More than 760,000 Lost Health Care Jobs
November 201218
evidence regarding the impact of using a
MUCC-compliant MCI triage method vs. a
non-MUCC-compliant MCI triage method.
The MUCC project had its beginnings in 2006
when the Centers of Disease Control and
Prevention convened a workgroup of subject
matter experts to examine the science
supporting existing mass-casualty triage systems
and make a recommendation for the adoption
of a single system as a national standard for MCI
triage. In September 2008, an article, ‘‘Mass
casualty triage: an evaluation of the data and
development of a proposed national guideline,”
(Disaster Medicine and Public Health
Preparedness) was published, proposing
national guidelines that became known as SALT
triage: Sort – Assess – Lifesaving Interventions
– Treatment/Triage. SALT, a non-proprietary
free system, was developed from available
research, widely accepted best practices of
existing mass-triage systems and consensus
opinion from the workgroup. The SALT
workgroup considered the development of
SALT to be a first step in creating a national
guideline for MCI triage systems.
Expanding upon the SALT workgroup, MUCC
was created by a 30-member CDC-funded
group. The MUCC comprises 24 specific
criteria, which the MUCC workgroup
recommended as model minimum elements that
all MCI triage systems should include.
According to FICEMS, although ‘‘the MUCC is
supported by the best available science, the
evidence base for evaluating MCI triage
systems in prehospital settings is limited. The
majority of MUCC’s criteria — www.ems.gov/
pdf/2011/December/10-MUCC_Options_
Paper_Final.pdf — are supported by indirect
evidence (i.e., evidence that comes from
different situations or different patient
populations) and consensus decisions, meaning
the SALT and MUCC workgroups found gaps in
the science.’’
While a number of EMS stakeholder
organizations (e.g., American Academy of
Pediatrics, American College of Emergency
Physicians, American College of Surgeons–
Committee on Trauma, National Association of
EMS Physicians, National Association of State
EMS Officials) endorsed MUCC, a national
model would necessitate everyone at every
level changing current practices.
NEMSACThe National EMS Advisory Council provides
expert advice and recommendations to the
National Highway Traffic Safety Administration
and its federal partners on key issues, including
recruitment and retention of EMS personnel,
quality assurance, data collection and EMS.
NEMSAC held an orientation meeting at the end
of August 2012 with its newly appointed experts
from various EMS disciplines, including Michael
A. Hastings, MS, RN, CEN, who was nominated
by ENA. (See Hastings’ NEMSAC meeting report
on page 23.)
To assist the new members, the meeting
covered NEMSAC accomplishments including
various council advisories, such as:
• EMS System Performance-based Funding and
Reimbursement Model to sponsor a
comprehensive:
o EMS System Design project that will
identify the essential components and
functions of EMS systems, standardize
terminology, and establish performance
standards for minimum levels of service;
o EMS System finance study that accounts for
all costs and revenues.
• The Next Steps for Prehospital Care Evidence-
Based Guidelines to include urging NHTSA to
lead the effort in forming relationships with
stakeholder organizations and academic
journals in order to hasten the process of
publishing EBGs, as well as to assist in
decreasing the time to implementing EBGs in
the field through measures such as
developing implementation toolkits or training
curricula to ensure that the EBG is
incorporated into providers’ clinical practice.
More details about the NEMSAC meeting can
be accessed at www.ems.gov/NEMSAC.htm.
Article prepared by Terri L. Nally, ENA senior
public policy specialist.
Official Magazine of the Emergency Nurses Association 19
Real Stories of Nursing Research M. Maureen Kirkpatrick McLaughlin, PhD, RNSally A. Bulla, PhD, RN
This book demonstrates how direct care nurses in clinical settings can overcome their fear and conduct nursing research studies that impact and improve patient care. Highlighting research in Magnet-designated hospitals located in all types of settings, this reference includes studies that have used quantitative, qualitative, and mixed-method designs from a variety of experts like librarians, statisticians and IRB reviewers.
362 pagesISBN: 978-0-7637-6166-0©2010
Price: $70.95ENA Member Price: $64.00
Free Shipping! Offer ends November 30, 2012
To order, visit www.ena.org/shop and mention this ad in the comment section or call 800-900-9659 (M-F 9 a.m. - 5 p.m. CT).
Special Offer for the MonthMarketplace
November 201220
A mass casualty incident in the emergency
department has many requirements for processes,
procedures and resources including personnel,
medical materials, supplies and equipment. An
important process includes patient tracking.
MCI Incidents – Tracking Them DownOn Aug. 28 in Louisville, Ky., 48 children were
sent to multiple hospital emergency
departments after an automobile ‘‘T-boned’’
their school bus, causing it to roll. Local news
media reported the frustrations of frantic parents
searching area hospitals trying to locate their
children after learning of the accident.1 School
and commercial bus wrecks are not uncommon
and are a source of mass casualty incidents. In
2010, there were 249 fatalities and 12,000
persons reported injured in U.S. bus crashes.
On July 20 in Aurora, Colo., 59 movie-goers
suddenly became casualties during the early-
morning mass shooting at a movie theater (see
article on page 8). Justin Mast, RN, of The
Medical Center of Aurora emergency
department, reported several casualties arrived
via police vehicles. Consequently, they were not
entered into the community patient tracking
system before their arrival. Communications
between responding hospitals helped account
for patients. Emergency department director
Mark Mayes, MHA, RN, CEN, reports what
seemed like thousands of calls to a hospital
hotline as worried friends and family tracked
down loved ones. The hospital command center
at Swedish Medical Center in Englewood, Colo.,
reportedly handled hundreds of phone calls
from panicked people looking for family
members and friends.
Benefits to MCI Patient TrackingThere are multiple reasons for patient tracking
in an MCI. Tracking will facilitate family and
loved-one reunification. Patient tracking can
improve resource management. Many
Web-based, patient-tracking applications can
provide ED and hospital leadership with
visibility of incoming casualties and casualty
characteristics, including injury types, acuities,
gender, age and others. Having incoming
casualty visibility allows prepositioning of
medical resources and can ‘‘buy’’ prep time.
Sharing patient tracking data with the hospital
command center and hospital leadership will
provide situational awareness of the MCI’s
impact based on the facility and community.
Considerations for TrackingPlanning for MCI patient tracking in the
emergency department and hospital includes
making decisions regarding the following:
1. The person and team responsible for the
plan.
2. Technology (paper, electronic or both).
3. The trigger for activating the tracking process.
4. The forms used and how will they be
deployed.
5. What patient identifiers will be assigned.
READY OR NOT? | Knox Andress, BA, RN, AD, FAEN
Mass Casualty Incident: ‘Where’s My Child?’
Rescue workers practice at a 2008 school bus mass casualty incident workshop in Clark County, Wash.
Ph
oto
by E
d M
un
d, B
A, F
F/EM
T
Official Magazine of the Emergency Nurses Association 21
6. How forms will be collected.
7. How often forms will be collected.
8. Where tracked patient data will be collated.
9. Who is responsible for data collation during an incident.
10. How patient tracking data will be shared.
11. Who will share the data.
12. Who will be the point-of-contact for community providers and
inquiries.
Important considerations include coordination with regional patient
tracking systems that may already be in place within your region or state.
Tracking TechnologiesTracking technologies for emergency departments include variations of
electronic and paper-based tools. Many electronic versions include an
Internet, Web-based application that collects data facilitated by a patient’s
assigned, scannable bar code, radio frequency identification chip or
infrared transmission. These tags, chips and barcodes are associated with a
patient-specific number or identifier. Many times the Web-based
applications offer impressive reporting and data-sharing capabilities.
Paper systems are perhaps the most prevalent MCI tracking system.
Paper tracking systems may be considered rudimentary but are
inexpensive, function without electricity and do not have
password requirements. Many times the paper system
incorporates a ready-to-assign armband that is part of a
disaster registration package
Lawrence ‘‘Jeff’’ Jeffries, RN, the ED clinical and
preparedness coordinator at Jefferson Memorial Hospital,
Ranson, W.Va., recalled the school bus fire impacting his
emergency department.
‘‘Fortunately there were no serious injuries, but we were
getting calls from parents before the 50 children arrived. Our
paper-based tracking system helped manage and track the
children once they arrived in our ED,” he said.
The Hospital Emergency Incident Command System offers
a substantial paper patient-tracking procedure which
includes the Mass Casualty Tracking Chart, MCI Chart, Flow
Tags and Flow Tag Boxes.2
Other patient tracking resources and procedures are
found in the Hospital Incident Command System. Roles and
responsibility for patient tracking in an ICS-type response
are established. Patient tracking procedures are outlined in
the accompanying Patient Tracking Job-Action-Sheet and
reference tracking logs and forms necessary.3
National EffortsIn 2005, the U.S. DHHS’s Agency for Health and Research
Quality convened an expert panel and began studying and
developing the needs for a national patient tracking system.
In 2009, AHRQ released ‘‘Recommendations for a National
Mass Patient and Evacuee Tracking, Transportation and
Regulating System.”4
The U.S. DHHS’s Joint Patient Assessment and Tracking
System tracks patients through the federal patient movement
system and is being made available to states.
To assist in consistent communications from a prehospital
to the hospital or final point of care setting, the DHS, with
the guidance of an expert provider group developed the
Tracking Emergency Patients, EDXL messaging standard.
TEP is in the final stages of international standards
evaluation and acceptance.5
SummaryBenefits to patient tracking include family and loved-one reunification,
improved resource allocation and management, among others. Patient
tracking will provide leadership, improved surveillance and situational
awareness of an MCI’s impact. Are you ready to track?
Resources
1. Exhibit 4, FARS/GES 2010 Data Summary
2. www.courier-journal.com/article/20120928/
NEWS0105/309280109/Frantic-parents-frustrated-trying-find-
children-JCPS-bus-wreck.
2. http://www.heics.com.
3. http://www.emsa.ca.gov/HICS/files/JAS_Plan.pdf.
4. http://www.ahrq.gov/prep/natlsystem/.
5. http://www.integratedtrainingsummit.org/presentations/2012/
main_training_summit/10-esf8_patient_tracking_force_multiplier.
pdf.
Research and Evidence-based Practice Projects
Don’t Miss this Opportunity to Showcase
Your Work on Emergency Department
Management, Leadership and Research
Submission Deadline: January 15, 2013
Online: www.ena.org/IENR/abstractsE-mail: [email protected]: 800-900-9659, ext. 4119
Call For Paper and Poster Abstracts
Readers may contact the author at [email protected].
Follow Knox Andress @ENAdman.
November 201222
ENA STATE CONNECTION
State Council and Chapter Meetings and Events
Kansas ENA State Council State Meeting:KENA (Kansas Emergency Nurses Association) meets every other month. Meetings start at 10:30 am.
Dec. 14 - University of Kansas, Kansas City
For more information: www.kansasena.org and visit us on Facebook.
Kansas Chapter Meeting: Central Kansas ENAMeetings are planned for the fourth Monday of the odd months of the year at 7 pm.
Nov. 14 - Kansas City
Nebraska ENA State Council Submitted by Sue Deyke, MSN, RN, CEN,
The Nebraska ENA State Council attended a
political reception held at the Thompson Center
on the University of Nebraska Campus in
Omaha. This session was sponsored by the
Nebraska Nurses Association, and the Nebraska
ENA State Council was one of the silver
champion sponsors. The members had an
opportunity to hear bipartisan speakers on the
local, state and national levels. The members
felt it was important to hear the candidates’
stances on health care reform and used this day
for advocacy.
On Sept. 29, the Nebraska
ENA State Council collaborated
with the Nebraska Nurses
Association to address the
issue of nursing fatigue. The
issue of safety and professional
practice has become a topic
very near and dear to
emergency department staff.
This workshop featured two
national speakers on nursing
fatigue: Ann Rodgers, PhD, RN, FAAN,
and Karlene Kerfoot, PhD, RN. There was
also an opportunity for panel discussion to
discuss best practices to achieve safe staffing.
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 1, 2012. 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”), 41,720. Actual number of copies of single
issue published nearest to filing date (hereinafter “Most
recent”), 41,820. B. Paid circulation: B1. Outside-county
paid subscriptions stated on Form 3541: Average, 40,832.
Most recent, 40,399. 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 400. Most
recent, 443. 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
41,232. Most recent, 40,842. D. Free or nominal fee rate
distribution. D1. Outside-county copies included on
Form 3541: Average, 18. 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, 273. Most recent,
850. E. Total. Free or nominal rate distribution (sum of
D1, D2, D3, D4): Average 291. Most recent 875. F. Total
distribution (sum of C and E): Average: 41,523. Most
recent, 41,717. G. Copies not distributed: Average, 197.
Most recent, 103. H. Total (sum of F and G): Average
41,720. Most recent, 41,820. I. Percent paid (C divided
by F times 100): Average, 99%. Most recent, 98%. This
Statement of Ownership will be printed in the November
2012 issue of this publication. I certify that the state-
ments made by me above are true and complete.
Amy Carpenter Aquino, Editor in Chief. Date:
October 1, 2012.
From left: Karen Wiley, MSN, RN, CEN; Adam Bruhn, RN; Sue Deyke, MSN, RN, CEN; and Cindy Slone, RN, CEN, of the Nebraska ENA State Council.
It’s not too late to wear the 2012 ENA Annual Conference
close to your heart.
The Greater Los Angeles Chapter of California ENA has
about 200 souvenir conference pins remaining from
September’s extravaganza in San Diego and is offering them
to ENA members via mail order at a cost of $10 each. The
pins are the size and style of a postage stamp and feature
the Annual Conference logo below a trio of Pacific palms
(see photo at left). Fasten the pin to your clothing, coat or
bag using the tie-tack clasp on the back.
To purchase a pin, contact Barbara VanEck, the Greater
L.A. Chapter secretary, at [email protected].
Limited Annual Conference Pins Still Available
Official Magazine of the Emergency Nurses Association 23
The Academy of Emergency Nursing will
accept online applications for the 2013
class of fellows through 5 p.m. CST,
Nov. 30, 2012.
Information and a link to the applica-
tions are available under “Calls and
Opportunities” at: www.ena.org/Pages/
default.aspx.
If you have
questions,
please contact
Ellen
Siciliano,
board
relations
manager, at
academy@
ena.org.
ENA Call for…
Applications for the 2013 Class of Fellows
ENA Report from NEMSAC
I had the privilege of attending my first National
Emergency Medical Services Advisory Council
meeting in Washington, D.C., on Aug. 28-29.
This was the first meeting since the 26 members
were appointed or reappointed to two-year
terms by Ray LaHood, Secretary of the
Department of Transportation. Each person on
the committee represents a different area of
interest, though not a particular agency. As a
committee member, I represent emergency
nurses, not the Emergency Nurses Association.
For the next two years, I will be the only nurse
on the committee.
The NEMSAC charter states that the scope of
its activities is to ‘‘provide advice and
recommendations regarding EMS to DOT’s
National Highway Traffic Safety Administration
(NHTSA).’’ Some areas this committee covers
include patient and provider safety, research
and EMS system improvement and
sustainability.
This meeting was an introductory meeting
for the 12 new members on the committee. In
addition, we were given an update on NEMSAC
projects and on the transition of the committee
from a discretionary to a statutory committee.
This transition makes this committee a standing
committee, which means the charter does not
have to be renewed every two years. Making
this transition also provides a direct reporting
structure to the DOT and to the Federal
Interagency Committee on EMS.
Our next meeting will be held in the coming
months. As this committee continues its
previous projects and begins work on new
projects, I will provide updates through ENA
Connection.
If you have any questions or feedback,
e-mail me at [email protected]. You can
also find details about the NEMSAC meeting at
www.ems.gov/NEMSAC.htm.
By Mike Hastings, MSN, RN, CEN
on air after that. Trust me, we
make a difference.
Support emergency nursing
by choosing the ENA
Foundation as your charity of
choice. Let’s all foster the culture
of philanthropy by making a
year-end contribution to the
ENA Foundation. As we
approach the holiday season
with Thanksgiving looming
around the corner, it is the
perfect time to reflect on all of
the things for which to be
grateful. I am thankful for each
and every one of you who has
made this year a success by
providing means for many
others in our profession; and, in
turn, those people will be
thankful for these educational
opportunities and your support.
The holiday season gives
everyone an opportunity to pay
it forward — those who donate
and those who receive. Together
we all can do more!
Your Generosity Has Moving Results Continued from page 16
November 201224
They also have a consulting psychiatrist
available.
‘‘We have worked with staff and leadership
from our organization’s behavioral health
hospital to develop a comprehensive care policy
and ED BH orders to safely manage these
patients,’’ she said. ‘‘We’ve even been able to
stabilize patients who were awaiting placement
over several days and actually discharge them.’’
As they have a large population of BH
patients, they are also implementing the ENA
workplace violence toolkit to make sure they
have a safe environment.
Kerry O’Neill, RN, clinical educator, City
Hospital, Martinsburg, W.Va., reports that her
institution employs ‘‘crisis workers’’ who come
to the ED for psychiatric interventions.
‘‘We have a 16-bed in-house adult psychiatric
unit in which they work with the inpatient
population but respond to pages from the ED,’’
she said. There is a crisis worker on call 24 hours
a day to provide acute interventions and facilitate
the admission and transfer for these patients.
Steven Fraime, assistant manager, Emergency
& Trauma Services at WellStar Health System
Greater Atlanta Area, reports that at his facility,
every potential mental health patient is triaged
as an ESI level 2, placed in a safe room with a
specially trained MH sitter, seen by the MD
within 10 minutes of arrival (goal), and screened
by a certified mental health evaluator within two
hours. All home medications are reconciled and
provided through the main pharmacy so that
any psychiatric medication regimen is not
interrupted during an extended stay.
A new trend is the use of telepsychiatry. With
this medium, psychiatric evaluations take place
with the use of televideo equipment.
Consultations are conducted and treatment
plans are initiated in a timely manner and
access to proper care is initiated. This method is
said to be cost effective, especially in rural areas
where care is not readily available.1 However,
‘‘although telepsychiatry is one of the most
common uses of telemedicine, the use of ED
telepsychiatry is rare.”2 The research that is
needed to prove efficiency and efficacy to
establish evidence-based practice is waiting to
be done.
Some hospitals have a separate psychiatric
area staffed with psychiatric nurses and a
psychiatrist.
Denver’s HealthOne hospital chain is
opening a new psychiatric ward with 40 beds.
According to Dr. George Bussey, chief medical
officer, ‘‘psychiatric patients with no place to go
can really slow things down.’’ He admits that
HealthOne might lose money on its new
psychiatric unit, but he believes it will be able
to ‘‘recoup the losses if it can provide speedier
service’’ in the ED.3
Alegent Health’s Omaha, Neb., campus
includes inpatient care for patients ages 4 to
100. It also has several offsite clinics and
psychiatric offices that provide partial care and
day programs for various ages. There is an
initiative to reach the goal of two hours to admit
patients to an inpatient bed. The ED has a
locked six-bed assessment area staffed by
experienced psychiatric nurses, and the
psychiatrist is on call to determine the patient’s
disposition. Bed placement can be obtained as
far as 250 miles if the campus is full. Lasting
Hope, an inpatient adult assessment facility, also
coordinates patient disposition into inpatient
beds in the community.
The Sentara Virginia Beach General Hospital,
where I work, is investigating such an option.
We are seeing 180 to 200 psychiatric patients a
month in our ED, averaging a length of stay of
approximately 10 hours. As we have electronic
charting, we are gathering data from newly
created behavioral health flow sheets as a key
to implementing change.
While it is obvious that the care of these
patients is labor intensive, the data show that
more than 90 percent of our safety events,
including elopements, patient or staff injury and
the need for a ‘‘take down’’ can be attributed to
patients with behavioral health needs. We are
part of a system that includes nine hospitals and
three free-standing facilities, so a system-wide
team was formed to seek solutions. The team
met with ED directors and in-house behavioral
health representatives in our system and
magistrates from our jurisdictions to focus on
standardizing behavioral health care. An outside
consultant recommended an inpatient
behavioral health unit, and there is currently an
application in process for a certificate of need to
add such a unit. Under the proposal, 24
currently licensed inpatient beds will be
converted into licensed beds for geriatric and
general adult psychiatric patients. These beds
also will include the capability to serve medical
psychiatric patients. The data we are collecting
is an important part of the application.
Caring for this special population of patients
is indeed challenging. We can help each other
and our patients by sharing with our colleagues
our success stories as well as our failed trials.
Above are just a few strategies. What are you
doing in your state, hospital system or
department to meet the needs of behavioral
health patients while limiting their hospital stays
and maximizing their health care delivery?
References
1. www.chcf.org/~/media/MEDIA%20
LIBRARY%20Files/PDF/T/PDF%20
TelepsychiatryProgramsED.pdf accessed
July 23, 2012.
2. ibid
3. www.npr.org/blogs/health/2012/05/31/
154004864/as-psychiatric-wards-close-
patients-languish-in-emergency-rooms
accessed August 7, 2012.
Caring for Behavioral Health Patients in the ED Continued from page 11
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