Download - ENA Connection January 2013
connectionthe Official Magazine of the Emergency Nurses Association
January 2013 Volume 37, Issue 1
2013 CAREER GUIDE
Oh, the PlacesYou’ll Grow Keep ENA By Your Side
During Your Career Climb in Emergency Nursing
Stories From Forensics, Flight Nursing and More
There’s a New Word For Our Role: Advocatism
LETTER FROM THE PRESIDENT | JoAnn Lazarus, MSN, RN, CEN
The definition of an advocate is a person who pleads for or on behalf of another; ‘‘ism’’ indicates an action, process or result. Therefore, ‘‘advocatism’’ is my word for what we do for our patients and for the profession of emergency nursing. Whether it’s bringing a potential medication error to the physician’s attention, helping others hear a patient’s voice or shaping policy by speaking to our legislative representatives, advocating for our profession and our patients is our role as emergency nurses.
Our role as an advocate for our patients begins the minute they arrive in our emergency department. Emergency departments are scary and confusing places for our patients and their families. It is our responsibility to minimize some of this by focusing on the patient’s experience, communication and educational needs. As nurses, we must help the patients understand the tests and procedures the physicians order. We should make them aware of
the time it will take for these tests or
procedures to be completed, and we
should educate them on the rationale
for these tests and procedures.
We continue to act as the interpreter and liaison throughout the patient’s stay. Without us to translate the patient’s circumstances into understandable and acceptable terms, patients would not only be confused, but terrified. The patient’s medical, psychological and emotional care is our responsibility. At times, especially in this current health care environment, this may be an overwhelming task.
Florence Nightingale was the first nurse to advocate for patient rights and for our rights as nurses. She is credited with establishing nursing as a profession rather than a domestic service. We still need to help others see the importance and value of what we do as nurses. There are simple things that we can do to demonstrate that our knowledge and education are critical to the care of our patients. Our actions, language and appearance must be professional at all times. We
Continued on page 7
ENA Connection is published 11 times per year from January to December by: The Emergency Nurses Association
915 Lee Street Des Plaines, IL 60016-6569
and is distributed to members of the association as a direct benefit of membership. Copyright© 2012 by the Emergency Nurses Association. Printed in the U.S.A.Periodicals postage paid at the Des Plaines, IL, Post Office and additional mailing offices.
POSTMASTER: Send address changes to ENA Connection915 Lee StreetDes Plaines, IL 60016-6569ISSN: 1534-2565Fax: 847-460-4002 Web Site: www.ena.orgE-mail: [email protected]
Non-member subscriptions are avail-able for $50 (USA) and $60 (foreign).
Editor in Chief:Amy Carpenter AquinoAssistant Editor:Josh GabyWriter:Kendra Y. MimsEditorial Assistant:Renee HerrmannBOARD OF DIRECTORSOfficers:President: JoAnn Lazarus, MSN,
RN, CENPresident-elect: Deena Brecher,
MSN, RN, APRN, ACNS-BC, CEN, CPEN
Member Services: 800-900-9659
Secretary/Treasurer: Matthew F. Powers, MS, BSN, RN, MICP, CEN
Immediate Past President: Gail Lenehan, EdD, MSN, RN, FAEN, FAAN
Directors:Kathleen E. Carlson, MSN, RN, CEN,
FAEN Ellen (Ellie) H. Encapera, RN, CEN Marylou Killian, DNP, RN, FNP-BC,
CENMichael D. Moon, MSN, RN, CNS-CC,
CEN, FAENSally K. Snow, BSN, RN, CPEN, FAENJoan Somes, PhD, MSN, RN, CEN,
CPEN, FAENKaren K. Wiley, MSN, RN, CEN
Executive Director: Susan M. Hohenhaus, LPD, RN, CEN, FAEN
Official Magazine of the Emergency Nurses Association 3
To Enrich Your Career, Enrich Someone Else’s
FUTURE OF YOUR NURSING | Bridget Walsh, Chief Talent Officer
January is traditionally the time of year
when we reflect upon our lives and set
new goals. We start the year with
enthusiasm, dedication and a renewed
commitment to better ourselves. This
January, I challenge you to reflect upon
your accomplishments, skills and
experiences and see how you can pay
it forward. Contributing to the
professional development of an
emerging professional helps the
individual gain experience, helps you
expand your own experience and
advance your career and contributes to
the profession of emergency nursing.
In her column, ENA 2013 President
JoAnn Lazarus talks about ‘‘advocatism.’’
Advocating for the profession can take
many forms, including contributing to
the development of talented, educated
nurses to lead the charge for change.
Mentoring an emerging professional
can be both formal and informal. You
may decide to take that new nurse on
the team under your wing, helping
him or her learn the ropes of your
department and your hospital structure
or talking him through a challenging
patient situation. Investigate the formal
methods for mentoring in your
hospital, perhaps through serving as a
preceptor or in other mentorship roles.
You can take that commitment to
paying it forward outside your
workplace as well. Invite a colleague
to join you at an ENA meeting,
encourage her to participate on a
committee or support her in running
for a state or chapter office. Connect
with a local nursing school and
volunteer as a guest lecturer or as a
resource for a nursing student.
You’ll find that by helping others
with their professional development
you will help yourself as well. Not
only will you have a sense of pride in
contributing to the development of
another, you’ll also develop and refine
skills that contribute to your own
professional development. It might be
just the extra push you need to take
the next step in your own career.
Track all your mentoring and
coaching experiences, along with your
career accomplishments and
membership activities, in your
professional profile in the ENA Career
Center at www.ena.org. You will have
a fully updated career profile for when
you are ready to take that next step.
I hope there will be a fellow ENA
member ready to pay it forward and
mentor you.
Quick Tips: Nail That InterviewThe following are some commonly asked questions that
nurses should be prepared to answer during a job interview,
as well as questions to ask a potential employer.
Standard Interview Questions Nurses Should Be Prepared to Answer:• How would you describe your skills as a team player?
• How will you deal with difficult doctors?
• How will you deal with difficult patients and/or their
families?
• How will you handle unexpected circumstances, such as
being short-staffed and having to perform a treatment you
have not done before?
• What was your best and worst patient experience?
Interview Questions That Nurses Should Ask a Potential Employer:• What is the nurse-to-patient ratio?
• Is there support staff on the unit to assist nurses?
• In what ways are nurses held accountable for high
qualities of practice?
• How much input do nurses have regarding systems,
equipment and the care environment?
• What professional development opportunities are available
to nurses?
Author: Sandy Watkins, Strategic Healthcare Staffing.
Reprinted with permission.
January 20134
Children are amazingly resilient. Those
of us who work with children in the
emergency setting help most of our
patients recover from what ails them
and watch them walk out smiling.
This provides a great deal of instant
gratification. Every day is new and
completely unpredictable, and every
shift brings endless possibilities as to
what we might encounter. In the same
day, we may teach a new mother how
to care for her infant, give a
hemophiliac toddler his Factor VIII so
he does not hemorrhage after a fall,
sedate a preschooler so that his broken
arm can be mended, relieve the pain
of a child suffering from a sickle cell
pain crisis, provide IV hydration for a
dehydrated child and take care of a
child who has fallen out of a second-
story window.
We also care for many older
pediatric patients — the teenagers —
who tend to be more like big kids than
little adults. Some teen patients have
had children of their own before they
are able to legally drive. They often
confront adult issues with child-like
naiveté. With developmentally
appropriate care, we can help meet
their adult needs on a level
appropriate for them.
These are just some of the reasons
why I love pediatric emergency
nursing. In November, I asked other
ENA members (through Facebook)
why they loved pediatric emergency
nursing. The following are some of
their responses:
Milly Glauer (who was taking care
of a scared, tearful 7-year-old boy who
wasn’t cooperating as she tried to
apply cardiac leads for monitoring and
an EKG): EKG leads are so scary [to
some kids]! Out of desperation to calm
him, I touched the jelly on the leads,
gave him a piece, giggled and told him
it felt funny, kind of like boogers. He
took the jelly, calmed down, and I was
quickly able to monitor him. After that,
he stayed calm for his treatment!
Lorettajo Kapinos: I cared for a
5-year-old brought in by her
grandfather. He was concerned she
was having a reaction to her antibiotic.
She had no tongue/lip swelling,
difficulty breathing, vomiting or rash. I
asked what the reaction was. He said,
‘‘She must be uncomfortable because
she won’t stop moving after I give it to
her.’’ The girl was calm, cooperative
and playful. I asked her, ‘‘Does the
medicine make you feel bad, so you
move around a lot?’’ ‘‘No,’’ she replied
as she pointed to the bottle in my hand.
‘‘It says, ‘Shake well while using.’ ”
Jennifer Raymond: My funniest
patient of all time was a kiddo about
age 9 that was seen for testicular pain.
The day-shift nurse had informed me
in a report how funny this patient was,
but I never expected him to ask why his
discharge instructions said to abstain
from sex! (The resident clearly did not
read [the discharge instructions] before
he printed them.) [The patient] made
sure I knew that he did not even have a
girlfriend! Peds ER patients come in all
shapes and sizes. We see the worst of
the worst. We comfort a mother who
has just lost her child and move on to
the patient who just has an earache.
We do it because we love it. We get
PEDIATRIC UPDATE | Elizabeth Stone Griffin, BS, RN, CPEN
Why We Love It, In Our Own Words
The ED staff at Cooley-Dickinson Hospital (Northampton, Mass.) is “ready and happy to take care of pediatric patients,” said team educator and photographer Lorettajo Kapinos, RN (ENA member). From left to right: Jessica Menard, RN; Corine Langevin, RN; Nick Hebert, CNA; Barb Tenanes, LPN; Steven Coughlin, RN (ENA member); and Sharon Duval, RN.
asked often, ‘‘How can you work
there?’’ I always answer, ‘‘I just can.’’
Jesa Orleman: We told a 5-year-
old boy to hold still for [a blood draw]
and his grandmother jumped right in
and said, ‘‘Oh, good, you’re going to
check him. He is old enough [to hold
still]!’’ The little boy asked what we were
checking him for, and Grandma said,
‘‘They need some blood to check and
see if you have super powers!’’ He was
so brave, and everybody was smiling at
how hard he was working to hold still.
I’ll keep that line in my pocket for the
next time!
Camden Kay: At 2 a.m. one night
recently, we had a little man come into
the critical care room in severe
respiratory distress with an extensive
cardiac history. After we were done
with his IVs, X-rays, suctioning and
high flow, I went and shared with my
co-workers that it was his second
birthday and asked if they’d like to
come say happy birthday. With big
smiles and without hesitation, they
grabbed some bubbles as I grabbed a
present, and five-deep we went and
sang ‘Happy Birthday.’ If you’ve ever
seen a sick kiddo smirk with his binky
in his mouth and then smile, then
giggle, you realize everything you do is
so worth it! Love my crew!
Theresa Antley: We had a small
boy [who was crying because he was
very anxious about getting a CT]. So I
went in to [talk to him] and found out
that he was scared of the machine
itself. Well, I went over to CT and
covered the machine with all his
favorite stickers … I picked him up and
put him on the table; he held my hand
and lay down and looked at the
stickers. He was so still looking at all
the stickers that we could do the scan
without even holding him down. After
it was over, I gave him the stickers and
he spent the next 30 minutes looking at
all of them. Peds take a lot of patience
and distractions/innovations! Love
helping them feel better.
What a wonderful testament to why
some emergency nurses choose to
work with children; the funny
moments and positive outcomes far
outweigh the more difficult times.
Thank you for all the wonderful
examples that illustrate the unique
nature of pediatric emergency nursing!
Board of Certification for Emergency Nursing (BCEN®) certifications demonstrate your commitment to excellence.
Make 2013 the year to earn your mark of distinction!
It’s Your Year to Shine!
Learn more… www.BCENcertifications.org
January 20136
The mission of the ENA Foundation,
established in 1991 by the
Emergency Nurses Association, is to
provide educational scholarships
and research grants in the discipline
of emergency nursing. The
foundation achieves its mission by
accepting contributions to fund
academic scholarships, continuing
education and research grants. Over
the last 21 years, the ENA
Foundation has awarded more than
$2 million in academic scholarships
and research grants.
Have you recently returned to school to advance your education? Are you considering returning to school in 2013? Applications are now available for academic scholarships to emergency nurses in four categories: non-RN, undergraduate (RN to BSN), graduate/master and doctoral. The application deadline for all scholarships is June 1. Recipients are notified in early August. With the exception of the non-RN category, all applicants must have been an ENA member for the previous 12 months to qualify. Scholarships and research grants are made possible through the generous donations received in 2012.
Scholarship and research grant applications and qualifications are available at www.ENAFoundation.org.
Supporting Emergency Nursing Through Education and Research ENA Foundation 2013 Scholarship and Research Grant Opportunities
2013 Academic Scholarships
Non-RN CategoryNew York State ENA September 11 Scholarship Two at $2,500 each
Undergraduate (RN to BSN) CategoryCharles Kunz Memorial Undergraduate Scholarship One at $3,000Board Certification of Emergency Nursing (BCEN) Scholarship One at $3,000
Graduate/Master CategoryStryker & ENA Foundation Scholarship - Masters in Healthcare One at $5,000AnnMarie Papa Stretcherside Miracle Scholarship One at $5,000Board of Certification for Emergency Nursing (BCEN) Scholarship One at $5,000Anita Ruiz Contreras Scholarship (California) One at $5,000 Colorado Rocky Mountain Scholarship (Colorado) One at $5,000Darlene Whitlock Trauma Scholarship (Kansas) One at $5,000Kentucky ENA Founders Scholarship (Kentucky) One at $5,000Maryland ENA State Council Scholarship (Maryland) One at $5,000Pathways “V” Scholarship (Minnesota) One at $5,000Dan Burgess Mississippi State Council Scholarship (Mississippi) One at $5,000New Jersey State Challenge Scholarship (New Jersey) One at $5,000Mary Kamienski Scholarship (Northern Chapter-NJ) One at $5,000Jeannette Ash Memorial Scholarship (West Central Chapter-NJ) One at $5,000Renee Jett Memorial Scholarship (South Carolina) One at $5,000Tennessee State Challenge Scholarship (Tennessee) One at $5,000Vicki Patrick Texas Legacy Scholarship (Texas) One at $5,000ENA Foundation State Challenge Scholarship Nine at $3,000 eachPhysio-Control, Inc. Scholarship Two at $3,000 eachGisness Advance Practice Scholarship One at $3,000Karen O’Neil Memorial Scholarship One at $3,000
Doctoral CategoryPamela Stinson Kidd Memorial Scholarship One at $10,000Board of Certification for Emergency Nursing (BCEN) Scholarship Two at $5,000 eachENA Foundation Doctoral State Challenge Scholarship Three at $5,000 eachHill-Rom Doctoral Scholarship Two at $4,000 each
2013 Continuing Education Scholarships
Leadership Tapestry Scholarship 10 at $1,000 eachVidacare Annual Conference Scholarship 20 at $500 each
2013 Research Grants
Emergency Medicine Foundation (EMF)/ENA Foundation Team Research Grant One at $50,000ENA Foundation/Sigma Theta Tau International Research Grant One at $6,000ENA Foundation/ANIA-Caring Research Grant One at $6,000Industry-Supported Research Grant – Sponsored by Stryker One at $5,000
ENA FOUNDATION
Official Magazine of the Emergency Nurses Association 7
Research shows that nursing is the
largest workforce within the health
care industry, with more than 2.6
million registered nurses in the U.S.
According to the Bureau of Labor
Statistics, employment of registered
nurses is expected to grow 26 percent
from 2010 to 2020, primarily because
of technological advancements, an
increased emphasis on preventive care
and the large, aging baby boomer
population, who will demand more
health care services.
This growth will create various
career options and paths for nurses.
Whether you are a new graduate or at
mid-career and want to explore other
options, choosing a nursing specialty
that is right for you and projected to
grow is important for taking your
career to the next level. At right is a list
of the top 10 highest paying nursing
specialties.
Resources
www.braintrack.com/cool-career-
info/articles/
highest-paid-nursing-specialties
www.bls.gov/ooh/Healthcare/
Registered-nurses.htm
Career Outlook for Nursing Specialties Nursing Specialties Average Salary Education Requirements
Certified Registered Nurse Anesthetist
$135,000 CRNA program (24-36 months)
Nurse Researcher $95,000 BSN (advanced nursing research often requires an MSN or a PhD)
Psychiatric Nurse Practitioner
$95,000 RN license with MSN and NP certification
Certified Nurse Midwife $84,000 MSN (certified midwives must also pass a certification exam)
Pediatric Endocrinology Nurse
$81,000 RN license
Orthopedic Nurse $81,000 RN license and orthopedic nursing certification
Nurse Practitioner $78,000 Master’s degree in clinical specialty
Clinical Nurse Specialist $76,000 RN license and graduate from a CNS program
Gerontological Nurse Practitioner
$75,000 Nurse practitioners master’s degree with academic concentration in the field of geriatrics
should not speak negatively about our profession to each other, our family and friends or to our patients. We also must speak up when we see nurses portrayed inaccurately in the media.
Nursing continues to be the most trusted profession. Because of this, we can influence care in our own communities, our states and our nation by taking part in the legislative process. We have important information to share with our governmental representatives and policy makers about the effects of their choices and legislation on individuals and groups. It is our role to shape and influence health care policy.
Advocatism is alive and well in everything we do. As nurses, we need to understand how to harness what we already do into a force to be reckoned with. One way ENA is helping members achieve this goal is by hosting the first ENA
Advocacy Intensive Workshop for state and chapter leaders this month in Des Plaines, Ill. ENA leaders will learn how to take experiences and knowledge and use them to influence practice and policy in their hospital, community and profession.
We have to be the voice to advocate for change.
Resources
Selanders, L. C., & Crane, P. C. (2012). The voice of Florence Nightingale on advocacy. Online Journal of Issues in Nursing, 17(1). Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/No1-Jan-2012/Florence-Nightingale-on-Advocacy.html.
Gallup. (2011). Honesty/ethics in professions. Retrieved from http://www.gallup.com/poll/1654/honesty-ethics-professions.aspx.
Letter From the President Continued from page 2
Plan now on attending ENA Leadership Conference 2013,
February March 27 – March 3 in Fort Lauderdale, FL
to help you advance your career. Gain the knowledge
you need to succeed as a leader in evidence-based
educational sessions across seven key focus areas.
Learn new skills that you can implement immediately
upon your return home. Shape your future today by
leveraging all that ENA Leadership Conference has
to offer. Read how a past attendee has benefited from
attending ENA leadership conference.
Described by your colleagues as a must-attend event,
Leadership Conference can help advance your career
and help you become a better leader.
Network with emergency department leaders from
across the country and the world, make new contacts
and learn about the latest solutions for your emergency
department in the exhibit hall.
Enhance Your Leadership Skills by Attending ENA Leadership Conference 2013
EDUCATION • Presession: Lights, Camera, Action:
Writing and Delivering an Award Winning Conference Presentation
Jam: Competency Validation, How Do You Know That They Know What They are Doing?
• Copyright Law for Academics
• Legal Aspects of Social Media
• The ED Olympics: An Innovative Approach to Annual Competencies
• Clinical Reasoning: What Is It and How Do I Teach It?
FLOW Jam: Out of the Hallways and Into the Hospital:
Throughput, Output and Forward Flow
• Implementation of a Low Acuity Initiative
• Report Wars: Making Peace with Our Inpatient Colleagues
• Losing Wait: Innovative Strategies to Improve Patient Flow In and Out of the ED
• Breaking Down the Cultural Walls Preventing Effective Hospital Throughput
• Impact of a Logistics Manager Program on Admitted Patient Boarders Within an ED
HEALTH • Lateral Violence, It Goes Much Further Than
Those “Who Eat Their Young”
• Healthy Living – For Nurses
• Frazzled to Fantastic: Be More Effective and Less Stressed
• All Stressed Out In the ED: Staying Resilient and Avoiding Burnout
• Field of Dreams or Toxic Wasteland: Keeping Your Work Environment Healthy
MANAGEMENT • Presession: Operational Leadership of the
Emergency Department
• Strategies For Implementing and Utilizing Pharmacy Services in the ED
• Managing an Observation Unit as an Extension of the Emergency Department
• Lurking Secret Shoppers: LWOT and Dissatisfied Customers as Partners for Service Improvement
Deep Dive: Budget Negotiation Made Fun
• Winning Against the Nursing Shortage: Building Your Team Without Losing the Players You Have
PROFESSIONAL DEVELOPMENT• Presession: Charge Nurse: Putting the Team
Back Into Teamwork
• The Seven Principles of Inspiring Leaders
• Tactical Leadership: Military Lessons for Today’s ED in Empowering Staff to Excel
• You Are Finally a New Manager, Now What?
Deep Dive: The Older Emergency Nurse: Retired, Recycled, Revived and a Respected Resource
• Developing Leaders of Tomorrow From New Grads of Today
SAFETY • Fragile – Hand Me Off with Care
• Strategies for Implementing and Utilizing Pharmacy Services Within the ED
• If I Had Passed Out, It Would Have Been a Felony
• Say What? Addressing Communication Styles to Improve Our Work Environment and Patient Safety
• Workplace Violence: Prevent, Respond, Report
• Level I Trauma Centers Journey to a Safe Environment: Fall Prevention in the ED
ENA Leadership Conference 2013 educational offerings will help you advance your career. To help you get more of what you need, Leadership Conference now offers unique learning formats like Hand-off Sessions, Jam Sessions and Deep Dive Sessions.
Below is a small sampling of the educational sessions offered at ENA Leadership Conference 2013. For a complete course listing and conference details, visit www.ena.org/lc.
FOLLOW THE ACTION #ENALC13
Important Dates to Remember
Registration .............................................Now Open
Early Discount Rate Closes ......................... Jan. 16
State and Chapter Leaders Conference ............................. Feb. 27 – 28
Presessions .................................................. Feb. 28
Educational Sessions .............................. Mar. 1 – 3
Exhibit Hall .....................................Feb. 28 – Mar. 2
*No purchase necessary. To view the complete rules, visit www.ena.org/lc. Void where prohibited. Drawing will be held February 4, 2013.
REGISTER TODAY FOR ENA LEADERSHIP CONFERENCE 2013 AT WWW.ENA.ORG/LC
“ With the knowledge and experiences that I have obtained through ENA such as relationship building, collaboration, rejuvenation, inspiration and benchmarking, I am able to bring these experiences and knowledge back to my team. I want my team to have the best, be the best, and achieve the best. If my team is not successful, than I am not successful. Our driving force is exceptional emergency care.”
Norma L. Austin, RN, BSN, CEN, CPEN Emergency Services Executive Director
Carroll Hospital Center, Westminster, MD
DON’T DELAY! REGISTER bEfoRE JaNuaRy 16 To SaVE wITh ThE EaRly DIScouNT RaTE. ScaN ThE QR coDE oR Go To WWW.ENA.ORG/LC
USE SOURCE CODE FC3JC WHEN YOU REGISTER TO ENTER THE ENA LEADERSHIP CONFERENCE 2013 DRAWING*
• Grand Prize: Three nights hotel stay at hyatt Regency Pier 66 in fort lauderdale, fl from february 28 – March 2
• Second Prize: iPad®
• Third Prize: Kindle
Plan now on attending ENA Leadership Conference 2013,
February March 27 – March 3 in Fort Lauderdale, FL
to help you advance your career. Gain the knowledge
you need to succeed as a leader in evidence-based
educational sessions across seven key focus areas.
Learn new skills that you can implement immediately
upon your return home. Shape your future today by
leveraging all that ENA Leadership Conference has
to offer. Read how a past attendee has benefited from
attending ENA leadership conference.
Described by your colleagues as a must-attend event,
Leadership Conference can help advance your career
and help you become a better leader.
Network with emergency department leaders from
across the country and the world, make new contacts
and learn about the latest solutions for your emergency
department in the exhibit hall.
Enhance Your Leadership Skills by Attending ENA Leadership Conference 2013
EDUCATION • Presession: Lights, Camera, Action:
Writing and Delivering an Award Winning Conference Presentation
Jam: Competency Validation, How Do You Know That They Know What They are Doing?
• Copyright Law for Academics
• Legal Aspects of Social Media
• The ED Olympics: An Innovative Approach to Annual Competencies
• Clinical Reasoning: What Is It and How Do I Teach It?
FLOW Jam: Out of the Hallways and Into the Hospital:
Throughput, Output and Forward Flow
• Implementation of a Low Acuity Initiative
• Report Wars: Making Peace with Our Inpatient Colleagues
• Losing Wait: Innovative Strategies to Improve Patient Flow In and Out of the ED
• Breaking Down the Cultural Walls Preventing Effective Hospital Throughput
• Impact of a Logistics Manager Program on Admitted Patient Boarders Within an ED
HEALTH • Lateral Violence, It Goes Much Further Than
Those “Who Eat Their Young”
• Healthy Living – For Nurses
• Frazzled to Fantastic: Be More Effective and Less Stressed
• All Stressed Out In the ED: Staying Resilient and Avoiding Burnout
• Field of Dreams or Toxic Wasteland: Keeping Your Work Environment Healthy
MANAGEMENT • Presession: Operational Leadership of the
Emergency Department
• Strategies For Implementing and Utilizing Pharmacy Services in the ED
• Managing an Observation Unit as an Extension of the Emergency Department
• Lurking Secret Shoppers: LWOT and Dissatisfied Customers as Partners for Service Improvement
Deep Dive: Budget Negotiation Made Fun
• Winning Against the Nursing Shortage: Building Your Team Without Losing the Players You Have
PROFESSIONAL DEVELOPMENT• Presession: Charge Nurse: Putting the Team
Back Into Teamwork
• The Seven Principles of Inspiring Leaders
• Tactical Leadership: Military Lessons for Today’s ED in Empowering Staff to Excel
• You Are Finally a New Manager, Now What?
Deep Dive: The Older Emergency Nurse: Retired, Recycled, Revived and a Respected Resource
• Developing Leaders of Tomorrow From New Grads of Today
SAFETY • Fragile – Hand Me Off with Care
• Strategies for Implementing and Utilizing Pharmacy Services Within the ED
• If I Had Passed Out, It Would Have Been a Felony
• Say What? Addressing Communication Styles to Improve Our Work Environment and Patient Safety
• Workplace Violence: Prevent, Respond, Report
• Level I Trauma Centers Journey to a Safe Environment: Fall Prevention in the ED
ENA Leadership Conference 2013 educational offerings will help you advance your career. To help you get more of what you need, Leadership Conference now offers unique learning formats like Hand-off Sessions, Jam Sessions and Deep Dive Sessions.
Below is a small sampling of the educational sessions offered at ENA Leadership Conference 2013. For a complete course listing and conference details, visit www.ena.org/lc.
FOLLOW THE ACTION #ENALC13
Important Dates to Remember
Registration .............................................Now Open
Early Discount Rate Closes ......................... Jan. 16
State and Chapter Leaders Conference ............................. Feb. 27 – 28
Presessions .................................................. Feb. 28
Educational Sessions .............................. Mar. 1 – 3
Exhibit Hall .....................................Feb. 28 – Mar. 2
*No purchase necessary. To view the complete rules, visit www.ena.org/lc. Void where prohibited. Drawing will be held February 4, 2013.
REGISTER TODAY FOR ENA LEADERSHIP CONFERENCE 2013 AT WWW.ENA.ORG/LC
“ With the knowledge and experiences that I have obtained through ENA such as relationship building, collaboration, rejuvenation, inspiration and benchmarking, I am able to bring these experiences and knowledge back to my team. I want my team to have the best, be the best, and achieve the best. If my team is not successful, than I am not successful. Our driving force is exceptional emergency care.”
Norma L. Austin, RN, BSN, CEN, CPEN Emergency Services Executive Director
Carroll Hospital Center, Westminster, MD
DON’T DELAY! REGISTER bEfoRE JaNuaRy 16 To SaVE wITh ThE EaRly DIScouNT RaTE. ScaN ThE QR coDE oR Go To WWW.ENA.ORG/LC
USE SOURCE CODE FC3JC WHEN YOU REGISTER TO ENTER THE ENA LEADERSHIP CONFERENCE 2013 DRAWING*
• Grand Prize: Three nights hotel stay at hyatt Regency Pier 66 in fort lauderdale, fl from february 28 – March 2
• Second Prize: iPad®
• Third Prize: Kindle
January 201310
Missy Rittinger has hardly paused before she’s recalling the case that sums up what forensic nursing means to her.
An exotic dancer taking a cab home in Cincinnati one January morning was driven instead to a remote area, where she was beaten and raped by the driver. He slit her throat and left her to die. She didn’t. That was in 2002. At the time, Rittinger, BS, RN, CFN, SANE-A, was working in the emergency department at the St. Elizabeth Healthcare facility in Edgewood, Ky. She recently had become a sexual assault nurse examiner, licensed to collect forensic evidence after sexual assaults and, if called upon, to testify about her findings.
‘‘And she was brought in, and this man was convicted, and he got 38 years in prison,’’ Rittinger says.
‘‘That,’’ she notes, ‘‘was my very first case.’’
Terri Vietor chimes in proudly: ‘‘They found the assailant’s DNA under her nails — that Missy had swabbed.’’
The two ENA members have covered a lot of ground together, bringing the relatively young discipline of forensic nursing into their own professional repertoires and recruiting tens of others to do the same. Vietor, MSN, BSN, RN, CEN, CFN, SANE, is now the nurse manager for the St. Elizabeth Edgewood ED and also the manager of the St. Elizabeth forensic nursing program, which serves five EDs in northern Kentucky and greater Cincinnati. Rittinger is Vietor’s program coordinator. Since 2011, she also happens to be a deputy coroner of Boone County, Ky.
Thirteen years ago, the two met
while taking the first SANE training
offered in the area — the result of
grant-funded efforts by local domestic-
violence advocacy groups. By 2000,
both women had SANE certification,
and on Jan. 1 of the following year
they launched the St. Elizabeth
program, providing forensic nursing
services to the three St. Elizabeth
facilities and two others under
competing St. Luke Hospitals. (The
systems merged in 2008.)
Vietor and Rittinger became
Certified Forensic Nurses — the next
step up in forensic nursing — in 2005.
Their program at St. Elizabeth, which
started with six SANE nurses, today is
approaching 30, most of whom work
in the ED, conducting SANE exams
and gathering forensic documentation
of injuries in addition to their regular
job duties. Sexual assaults against
adults and children, domestic violence,
elder abuse and neglect — these are the areas where training in forensics matters.
‘‘For me,’’ Vietor says, ‘‘I went on to get my CFN because I felt like the forensic component of everything that we do in the emergency department, there was so much possibility to do it better, to produce better documentation for our patients and to do a better job taking care of them.’’
Rittinger pins it on ‘‘a very intense desire.’’
‘‘As an ED nurse,’’ she says, ‘‘I always seemed to gravitate toward the sexual-assault patients because everyone else seemed to run from them. I realized there was a significant need for improvement of care for these patients, and I wanted to be part of the improvement.
‘‘Once I received the training, my career went into a whole new direction and has morphed into something very rewarding.’’
At St. Elizabeth, if it involves forensics, it goes through Rittinger. Attorneys and law-enforcement officials will come to her for documentation of abuse or neglect, and if there was any suspicion at all during a patient’s ED visit, you can bet she’ll have pictures. She and Vietor stress education and a forensic component to every nurse’s job, which means that all of their front-line emergency nurses — those with certifications and those without — are encouraged to take photos that could be used in court cases.
Vietor and Rittinger recommend that emergency nurses interested in forensics start by becoming SANEs, which likely will give them the most evidence-gathering experience. Additional education and a CFN will
Missy Rittinger, BS, RN, CFN, SANE-A (above), and Terri Vietor, MSN, BSN, RN, CEN, CFN, SANE, have worked to build forensic nursing into the ED culture.
Evidence of a Higher CallingTake Their Word For It: As a Forensic Emergency Nurse, Your Influence on Outcomes Can Only Grow StrongerBy Josh Gaby, ENA Connection
bring even greater credibility — as an expert giving testimony and as a nurse in general. This is something Rittinger appreciates constantly in her role as deputy coroner. A forensic nurse packs a rare double punch: the certified and specialized technical background combined with the glowing reputation of the nursing profession.
‘‘A lot of the feedback that I get from people that I’m dealing with is very positive, simply because I’m a nurse,’’ Rittinger says. ‘‘There’s a level of compassion that they automatically see. The cops out there, they see me come, and they’re like, ‘Thank goodness.’ They say that all the time.’’
With forensic nursing comes a tendency for burnout, Vietor and Rittinger admit.
‘‘There are a lot of difficult things to see and deal with,’’ Vietor says. ‘‘It’s a very intense nursing practice. For sexual assault, you are one-on-one
with a patient for three hours. You need a lot of support among your team to really keep people involved so that they don’t get discouraged.’’
And you need the ongoing sense of the impact you might have.
Like Rittinger, Vietor instantly remembers the case that drove it home for her.
It was shortly after she received her CFN. A coroner called asking for a forensic nurse to help examine the body of a 3-year-old girl who had died of head and internal injuries. Vietor’s SANE license in Kentucky allowed her only to examine live patients over age 14, but her CFN afforded her more leeway. While she couldn’t conduct a complete exam on the child, she was able to take genital photographs and swabs that the police forensics team would not have taken.
Vietor’s findings showed the child, beaten to death, also had been
sexually abused and sodomized. That forensic evidence pointed to a stepbrother, who later accepted life in prison on a plea.
‘‘Being a part of that whole process,’’ Vietor says, ‘‘made me feel like everything else I’d done before — the 3 a.m. calls that they weren’t going to end up getting prosecuted, the mixed-up stories that we would get — it was all worth it because at this point in time I was qualified and able to contribute to this investigation. In thinking through my scope of practice, because I had certification as a forensic nurse, I was able to do more than I would have been able to do had I not been. And it made a difference.
‘‘Once you’ve got that forensic training,’’ she says, ‘‘every place you turn, there are things in health care that have forensic implications. It’s a young specialty in nursing. It certainly has not reached where it could go.’’
ENA invites you to a FREE WebinarAs a sponsor of The Take Charge of Your Nursing Career™ program, ENA is pleased to invite you to the third webinar in our series.
“How Nursing from the Neck Up Can lead to Success”Presented by Dennis R. Sherrod, EdD, RN, Professor and Forsyth Medical Center Endowed Chair of Recruitment and Retention. Dr. Sherrod will be accompanied byDr. Phyllis Quinlan, Professional Nursing Coach.
This class is available February 7, 21-26, 24 hours a day. Mark your calendars and look for registration information via email at the end of January.
Don’t miss out!
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January 201312
Career Spotlight: Long-Distance Flight Nursing
Carl Bottorf, RN, thought his days of
being a nurse were over after a severe
car accident in 2010 left him in a
wheelchair with significant injuries and
titanium parts in his legs. He
contemplated becoming a
schoolteacher, but three months after
his accident he realized he might get
out of his wheelchair and walk again.
After his recovery, he pursued his
dream career by applying to Airlift
Northwest for a long-distance flight
nurse position in Juneau, Alaska.
Bottorf has specialized in transport
medicine since being trained as an Air
Force flight nurse in 1993. With more
than 17 years of experience, including
numerous deployments and military
tours in Asia, Africa and Europe in the
last decade, he made the transition
from Tampa, Fla., to Juneau in 2011 to
work for Airlift Northwest. He credits
the Air Force for preparing him for the
opportunity and giving him with the
‘‘right tools’’ for his new career path.
‘‘I’m proud to be an Air Force flight
nurse and of the training I received,’’
he said. ‘‘It enabled me to come out
here to get a job and excel. I feel
lucky because all of the things the Air
Force taught me as a nurse come into
play every single day.’’
Bottorf soon realized that flight
nursing in Alaska was completely
different from his previous nursing
experience. Anywhere in the
Southeast, a flight team can get an
unexpectedly unstable patient to a
good hospital within 15 minutes. In
Alaska, there are no trauma centers or
burn centers, so patients are flown
1,000 miles to Seattle.
The missions come from small
hospitals. Bottorf said some of the
clinics and health care facilities
accessed in emergencies are merely a
simple room or several small rooms
located in the same building that
houses the community’s long-term care
residents. The ring of the outside
doorbell transforms the long-term care
nurse into the emergency care
provider. Other times, the ring of the
bell brings staff members in response
from their homes. The lack of acute
care diagnostic and treatment
equipment has spawned the need for a
rapid-response, fixed-wing air
ambulance service within the region,
and Airlift responds quickly.
Bottorf said his skills are challenged
all the time.
‘‘We’ll fly to these remote
communities, pick up the patient and
fly 700 or 1,000 miles to deliver them
to higher levels of care,’’ he said. ‘‘You
have to know your obstetrics, because
By Kendra Y. Mims, ENA Connection
Sky’s the Limit When You’re Caring For Patients Thousands of Feet Up
ENA member Carl Bottorf, RN, with his flight partner, Elise Chamberlain, RN, CEN, standing in front of one of the three Lear-31’s in the fleet of Airlift Northwest. This airframe is based in Juneau, Alaska.
Official Magazine of the Emergency Nurses Association 13
you can transport women who are
having complicated labors. You have to
know your trauma management because
you’re transporting trauma patients. We
don’t fly with a respiratory therapist, so
you have to learn and train and become
sufficient with a ventilator. It’s not as
hard to figure out how to run a
ventilator on a 15-minute transport, but
when you have to run it for two to three
hours and keep the patient alive and
prevent them from getting any sicker,
you have to get really good at it.’’
Bottorf had to relearn many things
about flight nursing when he came to
Airlift Northwest, in addition to taking
Airlift’s seven-week training program.
He currently works with a group of
seven nurses in Alaska and typically
flies one to three shifts each week.
‘‘Flight nurses understand the effects
that flying has on the patient,’’ he said.
‘‘There are nine really specific stressors
of flight that can impact any condition.
For example, if you have a heart attack
and you need to be flown in a jet,
virtually all nine stressors can affect
your heart attack patient because
they’re flying. Flight nurses are trained
to understand what those are and how
they impact patient care. They
understand what to look for and the
remedies to minimize problems
resulting from long-distance
aeromedical transportation. They know
how to apply general nursing to the
aerospace environment.’’
Not all flight nurses are built the
same, Bottorf pointed out. Though he
has a vast amount of experience as a
flight nurse in pressurized fixed-wing
aircraft, he does not have the same
amount of helicopter experience
and requires varying amounts of
different training.
‘‘I am a flight nurse who is
experienced in aerospace medicine,’’ he
said. ‘‘It is a different realm of nursing
for flight nurses who work in jets
compared to those who work in
helicopters. If I’m going to transport a
patient from here to Seattle, it’s 1,000
miles. I’m thinking of different potential
complications than if I was to go across
the city of St. Louis in a helicopter. I’m
flying at 45,000 feet. If something
happens, it’s not like we can land on
the ground and run to the nearest
hospital. You’re up there for two hours
in a small, tight area. It’s just you and
another nurse taking care of the patient.
You have oxygen issues, vibration
issues and pressure issues, and these
are all part of the stressors of flying that
long-distance flight nurses either are
trained for or learn as they go.’’
Bottorf works longer than 12 hours
when he has to take a patient from
bedside in Alaska to bedside in Seattle
and then fly back to Alaska.
‘‘And on the way home, if another
patient needs to be moved, they’ll
divert us and send us there,’’ he said.
‘‘It really impacts your personal life, but
you get used to it. Sometimes you just
get a meal per day, often on the run,
but you make it work.’’
Despite the challenges flight nurses
encounter, Bottorf said the turnover rate
is low.
‘‘It’s not the kind of nursing job
where people get dissatisfied and
leave,’’ he said. ‘‘We have nurses who
are retiring with nearly 30 years on the
job as a flight nurse here. They know
this is a good job. The company trains
us well.’’
His favorite aspect of being a flight
nurse is dealing with the unexpected on
a daily basis.
‘‘When I go to work as a flight
nurse, I don’t know what’s going to
happen,’’ he said. ‘‘Maybe we’ll fly
today, maybe we won’t. Maybe the
weather’s good, maybe it’s not. Maybe
I’ll get a trauma patient today or maybe
I’ll get a heart transplant having
complications. There are a lot of
unknowns, and you never know what
to expect, so you have to be OK with
surprises. I enjoy the clinical challenge.
The missions are fantastic.’’
“A helicopter flight nurse goes to a scene of an accident or trauma and brings emergency room level care to the patient. An aerospace nurse or long distance flight nurse is able to provide intensive critical care to a patient from one hospital
to the next over long distances at high altitudes.” —Carl Bottorf
Carl Bottorf’s advice to nurses interested in a career in long-distance flight nursing:
In addition to getting two to
five years of critical-care
nursing experience, ‘‘Keep
your body healthy, because it’s
physically fatiguing. When
you’re at high altitude or in the
Learjet you get tired faster
because there’s less oxygen
and there’s vibration and
you’re either hot or cold, so
you have to keep your body
healthy to do the job. Good
health, good experience and
flexibility will get you far.’’
This is the typical view when Carl Bottorf is working transport missions.
January 201314
What Can You Do With a PhD in Nursing?
The Institute of Medicine has a stated goal of doubling the number of doctorally prepared nurses by 2020. The role of these doctorally prepared nurses, according to Marion E. Broome (2012) is to direct education reform at all levels and to co-lead patient outcome improvements in specific areas of clinical practice.
At this time, approximately 1 percent of nurses are doctorally prepared, meaning there are about 30,000 PhDs and DNPs in the United States. The American Association of Colleges of Nursing suggests that all faculty teaching in baccalaureate programs have preparation at the doctoral level.
The perception of doctoral work can be that it is difficult, takes a lot of time, costs a lot of money and does not really change the way a nurse would practice. Let’s look at these perceptions a bit more closely:
It’s hard and takes a long time. To be accepted into a doctoral program, generally you have to have at least a Bachelor of Science in Nursing, and many programs like applicants to have a master’s degree in nursing. A PhD is a research degree, not a practice degree (that’s a DNP or Doctorate of Nursing Practice), so PhDs are not necessarily advanced practice nurses.
The training process for a PhD includes two years of class work in the philosophy of nursing, philosophy of science, research methods and practica. Depending on the program, there might also be a focus on policy or theory generation. The last year(s) of the doctoral education process are devoted to the design, completion and
writing of a dissertation study. The objective of the dissertation process is to create new knowledge.
The time it takes to get through a PhD program is dependent on a number of things. The first is your starting point — if you have a master’s degree, it takes less time than if you start at the baccalaureate level. The second is whether you are going full-time or part-time. In general, it’s not advised that you work full-time when you are doing your graduate work. This is not feasible for most people, and it is important to recognize that a PhD is not something you just ‘‘tack on’’ to your current duties. Doctoral work is challenging (the good kind of challeng-ing) and requires attention, focus and adequate time to process information. If you try to maintain your schedule and add doctoral work, everything tends to suffer.
It costs a lot of money.Because of the critical shortage of faculty in nursing programs, there are several funding sources. Many programs have fellowships for doctoral students. I attended Boston College on a university fellowship and received full tuition and a stipend for two years.
I was awarded an ENA Foundation scholarship and a Jonas Fellowship for my third year, so my PhD was essentially free. There are also programs wherein if you teach, a portion of your student loan is forgiven for each year that you teach. Doctoral education does not need to be prohibitively expensive.
It won’t change my practice.The PhD-prepared nurse at the bedside is invaluable. Practicing from a theoretical base with extensive training in research and its evaluation gives you the opportunity to practice at a very high level of both knowledge and application. You are a resource to your peers and patients. You can practice collaboratively with physician colleagues in a different way because the understanding of evidence-based practice is more similar.
Along with bedside practice, the nurse with a PhD is prepared to teach both undergraduate and graduate nursing students. You can do this as an adjunct (part-time) faculty, or you can enter the tenure system as a full time faculty and also engage in research. Doctoral work can open doors to a mix of education, research and practice that is engaging and satisfying.
ENA RESEARCH | Lisa Wolf, PhD, RN, CEN, FAEN, Director of the ENA Institute for Emergency Nursing Research
The Research Column in Connection has been designed to give succinct, useful information about the research process and how research can be useful to the bedside emergency nurse. Please send topic suggestions to [email protected].
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New ENA monthly offering for FREE Continuing Education with contact hours for our members.
• Available December 1Service and Quality1.0 contact hour Jeff Strickler, MA, RN, CEN, CFRN
Don’t miss out on enhancing your education. Go to www.ena.org/FreeCE for additional free continuing education opportunities.
The Emergency Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.