ena connection june/july 2014

connectionJune/July 2014 Volume 38, Issue 6

the Official Magazine of the Emergency Nurses Association

CLASSINCOMING

Tomorrow’s Looking Even Brighter as ENA Attracts

Surge of Students at NSNA Convention

14 - 15

PLUS ...♦ Record Number of Emergency Nurses at Day on the Hill 8

♦ How GENE Course Will Help a Hundred Times Over 24

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

Available Now Visit www.ena.org/TNCC to find a course near you.

2 Day Intensive Course § 24 Chapter Comprehensive Manual § Hands-on Skill Stations 5 Online Modules § Special Population Chapters § 17.65 Contact Hours

TNCC offers interactive learning with scenario-based assessments. § A Systematic Approach to the Initial Assessment § Hands-on Training to Provide Expert Care § Evidence-based Content Developed by Trauma Experts § Patient Advocacy Regarding Pain Management and Family Presence

SEVENTH EDITIONThe Premier Course for Trauma Care

TNCC Ad_Connection_Full_05 2014.indd 1 4/7/14 10:32 AM

3

Advocating For Children Who Need Emergency Care

FROM THE PRESIDENT | Deena Brecher, MSN, RN, APN, ACNS-BC, CEN, CPEN

ENA has made support for the EMSC

program one of its top priorities. In fiscal

year 2014, ENA worked closely with other

national health care groups, especially the

American Academy of Pediatrics, to prevent

further devastating cuts for EMSC. For fiscal

year 2015, which starts Oct. 1, we joined our

coalition partners in sending a letter to the

House and Senate Appropriations Committee

requesting $21.1 million for EMSC.

In addition to protecting federal funding

for the EMSC program, ENA is actively

supporting House and Senate bills (H.R.

4290 and S. 2154) that would continue the

EMSC program until 2019. Without the

passage of the reauthorization legislation,

the EMSC program will expire at the end of

the fiscal year on Sept. 30.

In 2013, ENA supported two

major EMSC initiatives, the

National Pediatric Readiness

Project (left) and the Pediatric

Interfacility Transport Toolkit (below,

left). The toolkit was a joint venture

between EMSC, ENA and the Society of

Trauma Nurses and provides

resources to facilitate the safe

transfer and transport of a

pediatric patient.

The National Pediatric Readiness Project

was an effort vigorously supported by ENA

on the national, state and local levels. The

goal of this project was to measure an ED’s

readiness to care for a child in an emergency

situation. ENA joined the AAP and the

American College of Emergency Physicians

as strong supporters of this effort. In 2013,

we asked members to identify departmental

leaders and encourage their EDs to

participate in the survey. We encouraged

our members to partner with

their state EMSC program

manager (left) to identify ways

to work together to increase

participation in the survey.

All of the partnering and support paid

off. The results are in, and more than 4,000

EDs participated in the survey. As a nation,

the average readiness score was 69. The

Dates to Remember

PAGE 4Free CE of the Month Members in Motion

PAGE 25Future of Your Nursing

PAGE 28ENA Foundation

PAGE 36Academy of Emergency Nursing

Regular Features

Through June 11, 2014, noon CDT Voting for ENA National Elections (www.ena.org/about/elections)

June 13, 2014 Application deadline for Emergency Nursing 2015 Conference Planning Committee

PAGE 6Update From ENA Headquarters

PAGE 8Day on the Hill 2014

PAGE 10Washington Watch: New Bipartisan Law Expands Access For Mentally Ill

PAGES 12ENA Merging Conferences in 2015 to Create Single Amazing Experience

PAGE 14Student Nurses Swarm Up to ENA

PAGE 21Survey Says! Your Voice Carries

PAGE 222014 Proposed Resolutions and Bylaws Amendments

PAGE 24Texas Health System Buys GENE Course in Bulk for ED Nurses

PAGE 26ENA Partners With Genentech to Launch Stroke Management Course

PAGE 27Know Your ENA Practice Resources

PAGE 34Military, ED Nurses Not So Different

ENA Exclusives

I recently had the opportunity to represent ENA at the Emergency Medical Services for

Children National Resource Center Advisory Council meeting. The mission of EMSC is to

reduce child and youth mortality and morbidity caused by severe illness or trauma.

Administered through the Health Resources and Service Administration, EMSC funds and

supports state grants to improve pediatric emergency care throughout the prehospital and

emergency department environments. The EMSC program has provided funding to

all 50 states, the District of Columbia and U.S. territories to support pediatric

emergency care improvement projects and initiatives. If you are unfamiliar with

EMSC, the QR code at left will take you to resources and information.

Official Magazine of the Emergency Nurses Association

Continued on page 11

Treatment methods

for hemorrhagic

shock have changed,

and the latest free

continuing

education session

from ENA will help you stay on top of the situation.

Available to you starting June 1 . . .‘‘Stop the Fluid! Permissive Hypotension and

Blood in the Shock Room,’’ presented by

Elda G. Ramirez,

PhD, RN,

FNP-BC, FAEN,

FAANP. (Credit:

1.0 contact hour.)

Ramirez leads a

review of the old

methods of

managing hemorragic shock and the current

research that changed the practice. From there,

you’ll revisit pathophysiology of shock and

coagulation factors and review the rationale for

how the new methods save trauma patients’ lives.

To take this and other eLearning courses free as

an ENA member:

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

in as a member (or create an account).

• Add desired courses to your cart and

‘‘check out.’’

• Proceed to your Personal Learning Page to

start or complete any course for which you

have registered or to print a final certificate.

• To return to your Personal Learning Page later,

go to www.ena.org and find ‘‘Go to Personal

Learning Page’’ under the Education tab.

Please be sure you are using the e-mail address

associated with your membership when logging in.

If you have questions about any free eLearning

course or the checkout process, e-mail

[email protected].

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

915 Lee Street Des Plaines, IL 60016-6569

and is distributed to members of the association as a direct benefit of membership. Copyright ©2014 by the Emergency Nurses Association. Printed in the U.S.A.Periodicals postage paid at the Des Plaines, IL, Post Office and additional mailing offices.

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

Non-member subscriptions are available for $50 (USA) and $60 (foreign). For editorial inquiries, e-mail [email protected]

Publisher:Kathy Szumanski, MSN, RN, NE-BCEditor-in-Chief:Amy Carpenter AquinoAssociate Editor:Josh GabySenior Writer:Kendra Y. MimsEditorial Assistant:Renée Herrmann

BOARD OF DIRECTORSOfficers:President:

Deena Brecher, MSN, RN, APN, ACNS-BC, CEN, CPEN

President-elect: Matthew F. Powers, MS, BSN, RN, MICP, CEN

Secretary/Treasurer: Kathleen E. Carlson, MSN, RN, CEN, FAEN

Immediate Past President: JoAnn Lazarus, MSN, RN, CEN

Directors:

Ellen (Ellie) H. Encapera, RN, CENMitch Jewett, AA, RN, CEN, CPEN Michael D. Moon, PhD, MSN, RN,

CNS-CC, CEN, FAENSally K. Snow, BSN, RN, CPEN, FAENJeff Solheim, MSN, RN-BC, CEN,

CFRN, FAENJoan Somes, PhD, MSN, RN-BC, CEN,

CPEN, FAEN, NREMT-PKaren K. Wiley, MSN, RN, CEN

Executive Director: Susan M. Hohenhaus, LPD, RN, CEN, FAEN

Member Services: 800-900-9659

Nightingale Honor for Direct CareDonna Gorman, BSN, RN, a staff

nurse at Bethesda Butler Hospital

Emergency Department in

Hamilton, Ohio, shares that

colleague David Sens, RN, has

received the Florence Nightingale

Award recognizing professional

nurses in the

greater Cincinnati

area for their

contributions to

direct patient care.

Sens is co-leader of

the ED’s shared

leadership and

patient satisfaction committees. He

also participates in two to three

nursing mission trips per year and

recently returned from Haiti.

◆ The emergency department of

Terra Haute Regional Hospital in

Terre Haute, Ind., was the

department with the greatest

number of certified nurses — 11,

up from two — and was treated to

breakfast by the hospital as part of

its Certified Nurses Day observance

March 19. ED staff nurse Merry

Addison, RN, MSN, CEN, FAEN,

also reports that the ED staff has

reached out to the critical care unit,

sponsoring one CCRN exam each

year for the last three years. The

number of CCRN nurses in the

intensive care unit has jumped

from one to four, with six other

nurses studying for the exam.

◆ Kristine Kenney Powell, RN,

MSN, CEN, NEA-BC, director of

emergency services for Baylor

Health Care System, has been

appointed to represent ENA on the

Joint Commission’s Professional and

Technical Advisory Committee

(PTAC), which reviews

recommendations for the

commission’s Hospital Accreditation

Program. More than 40 national

health care associations and the

public are represented on the

committee. Powell’s term runs

through 2019. Deena Brecher,

MSN, RN, APN, ACNS-BC, CEN,

CPEN, the 2014 ENA president, is

the alternate representative, and

ENA Chief Nursing Officer Kathy

Szumanski, MSN, RN, NE-BC,

serves as the ENA liaison. The

PTAC’s first call was April 2, with

the next scheduled for June 25.

Do you have a recent professional or educational success story you want to share about yourself or an ENA member colleague? E-mail it to [email protected] with the subject line “Members in Motion.”

David Sens

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Potential complications may include local or systemic infection, hematoma, extravasations or other complications associated with percutaneous insertion of steri le devices.

References: 1. Rogers JJ, Fox M, Miller LJ, Philbeck TE. Safety of intraosseous vascular access in the 21st century [WoCoVA abstract O-079]. J Vasc Access. 2012;13(2): 1A-40A. 2. Paxton JH, Knuth TE, Klausner HA. Proximal humerus intraosseous infusion: a preferred emergency venous access. J Trauma. 2009;67(3):1-7. 3. Cooper BR, Mahoney PF, Hodgetts TJ, Mellor A. Intra-osseous access (Ez-IO®) for resuscitation: UK military combat experience. J R Army Med Corps. 2007; 153(4):314-316. 4. Dolister M, Miller S, Borron S, et al. Intraosseous vascular access is safe, effective and costs less than central venous catheters for patients in the hospital setting [published online ahead of print January 3, 2013]. J Vasc Access. doi:10.5301/jva.5000130.

*Research sponsored by the Vidacare Corporation.

Teleflex and EZ-IO are trademarks or registered trademarks of Teleflex Incorporated or its affiliates. © 2014 Teleflex Incorporated. 2014-2673

Intraosseous Vascular Access

2014-2673 - EZ-IO CCM-ENA ad-7.indd 1 1/24/14 3:46 PM

6 June/July 2014

After surviving

the coldest

and snowiest

winter in

Chicagoland’s

documented

history, ENA staff

are settled back

into the spring and

summer seasons, providing the warm

and excellent service that ENA members

have come to expect. Here are just a

few of the highlights of what’s

happening at ENA headquarters:

Strategic PartnershipsThe ENA Board of Directors appointed

liaisons to:

• The American Academy of

Pediatrics Pediatric Education for

Prehospital Professionals

course steering committee

(Jaclynn Haymon, RN,

Maryland)

• American College of Emergency

Physicians Hurricane Sandy Recovery

Research Project (Deb Cioffi, MSN, RN,

New Jersey)

• National Association of EMS

Physicians Prehospital Evidence-Based

Guidelines Project (Matthew F. Powers,

MS, BSN, RN, MICP, CEN, California)

• U.S. Department of Health and

Human Services Office of the Assistant

Secretary for Preparedness and

Response Pediatric Transport

Roundtable (Jerri Lynn Zinkan, MPH,

BSN, RN, CPEN, Alabama)

The ENA Board of Directors also

reviewed and commented on the AAP

draft policy Updated Guidelines for

Palivizumah Prophylaxis Among

Infants and Young Children at

Increased Risk of RSV Hospitalization.

The board also endorsed the ACEP

clinical policy Critical Issues in the

Evaluation and Management of

Adult Patients Presenting

to the Emergency

Department with Seizures.

Government RelationsENA’s Government Relations staff

focused on the following federal issues

in the first quarter of 2014: Poison

Control Network Act, Omnibus

Appropriation Bill, Excellence in Mental

Health Act and Trauma Care Legislation.

Government relations staff also

monitored and contacted regulators and

other stakeholders regarding the

shortage of IV saline solution.

At the state level, ENA government

affairs staff assisted the following state

councils:

• Idaho ENA, as the state became the

30th to make the crime of assault/

battery on an emergency nurse a felony

• Kansas ENA and Louisiana ENA,

to assist those states in introducing

similar bills

• Illinois ENA on issues related to

protecting Poison Center funding and

legislation related to credentialing vs.

licensing for emergency RNs,

pre-hospital RNs and trauma nurse

specialists.

Social MediaENA’s Facebook page climbed to

almost 27,000 ‘‘likes,’’ an increase of

7 percent over Q4 2013; Twitter

followers increased to 3,448 (up

8 percent); ENA’s LinkedIn account

grew to 3,118 followers. ENA’s e-mail

open rate also increased significantly

in Q1 2014 at 46.6 percent (Q4 2013

was 33 percent), and there were

171,288 unique visits to ENA’s website,

with 19 percent as mobile viewers.

Conferences and MeetingsENA’s Conferences and Meetings team

is working on the negotiations for

ENA’s 2016 Emergency Nursing

Conference in Los Angeles and the 2017

Emergency Nursing Conference in St.

Louis. The team is also finalizing details

for the 2014 ENA Annual Conference in

Indianapolis and the 2015 Emergency

Nursing Conference in Orlando, Fla., as

well as the 2015 ENA State and Chapter

Leaders Conference, the first time this

will be offered as a stand-alone

meeting. Details will be available soon

for state and chapter leaders.

Institute for Emergency Nursing Research (IENR)IENR staff completed a national

behavioral health study which has

been submitted to the Journal of

Emergency Nursing. A second study on

determining the criteria for discharge

for patients who receive narcotics in

the ED also has been completed. IENR

studies in progress include: Acuity

Assignment (exploring the minimum

data set required to make an accurate

acuity decision); Fatigue and Cognitive

Ability (exploring how fatigue impacts

cognitive ability in calculating weight-

based drug dosages); and Moral

Distress in Emergency Nursing

(exploring what circumstances cause

moral distress in emergency nurses).

Institute for Quality, Safety and Injury Prevention (IQSIP)IQSIP staff completed reviewer training

for Lantern Award cycle 4. IQSIP staff

UPDATE FROM ENA HEADQUARTERS | Susan M. Hohenhaus, LPD, RN, CEN, FAEN, Executive Director

There’s No Freezing ENA’s Progress

Official Magazine of the Emergency Nurses Association 7

State and Chapter Ad_Connection_half_0607 2014_print.pdf 1 5/7/14 9:51 AM

also facilitated committee work related

to ongoing development of a

community injury prevention toolkit, a

primer on implementation of electronic

health records in the ED and an ED

manager’s survival guide.

Institute for Emergency Nursing Education (IENE)Q1 registration for ENA’s free CE

member benefit was 1,357 for three

courses. Ninety-nine nurses purchased

ENA’s staffing guidelines online tool.

ENA’s newly revised

Geriatric Emergency

Nursing Education program,

which launched at the end

of 2013, had 86 registrants in Q1. TNCC

Seventh Edition launched in Q1 with a

total of 1,094 registered for the

eLearning modules and 2,423 registered

for the instructor update rollout.

Course OperationsWith the launch of the TNCC Seventh

Edition, Course Operations is working

with course directors and instructors to

ship new instructor supplements and

provider manuals and to schedule

Seventh Edition provider courses. From

January to March, the department’s

number of phone calls nearly doubled,

call time nearly tripled, and we expect

to see continued high activity through

the instructor update period that runs

through June.

ENPC Fourth Edition continues to

grow, with 12 percent more provider

courses already scheduled for this year.

Updated copies of the provider manual

were sent to all ENPC instructors at the

end of March, and updated copies of

the instructor supplement will go to

them this summer.

MembershipAt the end of Q1 2014, 40,870 members

were on the ENA membership roster.

So far this year we’ve added more than

1,100 members, an annualized growth

rate of more than 11 percent. More and

more emergency nurses are seeing the

value of joining their colleagues in this

member-centered association focused

on providing safe, quality care for

patients.

Financial PositionENA’s first quarter 2014 yielded

healthy, vibrant financial results. ENA’s

revenue growth was 7 percent over the

same time period in the first quarter of

2013, and operating income was more

than double last year’s first quarter,

thanks to growing membership and

courses and a successful Leadership

Conference. ENA staff have managed

expenses well in order to protect and

reinvest member dues and education

revenue in the profession and the

association.

8 June/July 2014

More than 100 ENA members descended upon Washington, D.C., for the association’s annual Day on the Hill event. On Tuesday, May 6, attendees were briefed by Capitol Hill staff and experts on ENA’s two Congressional requests for their meetings. The next day, they met with their senators and representatives in support of S. 153/H.R. 274, the Mental

Health First Aid Act, and H.R. 4080, the Trauma Care Systems and Regionalization of Emergency Care Reauthorization Act.

The morning of May 7 started with the ‘‘Coffee with Congress’’ event on Capitol Hill. Reps. Michael Burgess (R-Texas), the sponsor of H.R. 4080, Lois Capps (D-Calif.), a former nurse and co-chair of the House Nursing Caucus, and Diane Black (R-Tenn.), the only former emergency nurse serving in Congress, addressed ENA attendees.

In their meetings on Capitol Hill, ENA members met with more than 120 senators and representatives and their staffs. These meetings went a long way toward advancing ENA’s public policy agenda and, specifically, the prospects for enacting significant mental health and trauma care bills.

— Marie Grimaldi, ENA communication and PR manager

CAPITAL GAINSRecord Number of Emergency Nurses Attend Annual Day on the Hill

PHOTOS BY JULES CLIFFORD


ENA President Deena Brecher, MSN, RN, APN, ACNS-BC, CEN, CPEN, discusses ENA goals with a staff member for Sen. Kelly Ayotte (R-N.H.).

Rep. Leonard Lance (R-N.J.) meets with a group that includes 2014 ENA President-Elect Matthew F. Powers, MS, BSN, RN, MICP, CEN (front, left).

Mitch Jewett, AA, RN, CEN, CPEN (left), of the ENA Board of Directors chats with Stanley Watkins, chief of staff for Rep. Bobby Rush (D-Ill.).

Look for expanded

coverage from Day on the Hill in the

August issue of ENA

Connection.

June/July 201410

WASHINGTON WATCH | Richard Mereu, JD, ENA Chief Government Relations Officer

As emergency nurses know all too

well, the demand for mental

health services is greater than ever as

untreated mental illness is a major

public health concern in the U.S.

According to the Substance Abuse

and Mental Health Services

Administration, more than 41 million

U.S. adults experienced mental illness

in 2011, and the majority of adults who

have mental health or substance use

disorders do not get the ongoing care

they need. Often, these patients seek

treatment in emergency departments.

This leads to boarding in EDs, as bed

space for psychiatric patients is often

difficult to locate, especially for patients

who lack insurance.

Community mental health clinics

attempt to address this crisis by

providing comprehensive treatment for

children and adults with serious

mental illnesses and addictions. These

facilities, which treat 8 million

Americans each year, are on the front

lines of improving health outcomes,

providing crisis response and

prevention and administering

outpatient mental health services.

Unfortunately, after decades of budget

cuts, these clinics are struggling to

meet the ever-increasing demand for

behavioral health services.

In response to the need for

community-based mental health

services, Sens. Debbie Stabenow

(D-Mich.) and Roy Blunt (R-Mo.) and

Reps. Doris Matsui (D-Calif.) and

Leonard Lance (R-N.J.) introduced the

Excellence in Mental Health Act. The

legislation was designed to improve

quality standards and expand access to

community mental health clinics. It

requires clinics to cover a broad range

of mental health services, including

24-hour psychiatric crisis care, full

assessments and better integration of

physical, mental and substance abuse

treatment.

The bill also addresses the issue of

inadequate funding by allowing

community mental health clinics to be

adequately reimbursed under Medicaid,

just as federally qualified community

health centers are reimbursed for

comprehensive primary care services.

This will give these clinics the financial

resources to provide care for a much

wider population.

Following its introduction, the

Excellence in Mental Health Act

received broad, bipartisan support. In

the House of Representatives, the bill

was co-sponsored by 45

representatives. A similar Senate

version of the bill had 24 co-sponsors.

The bill also was backed by more than

50 mental health, veteran and law

enforcement organizations.

ENA was a strong supporter of the

Excellence in Mental Health Act and

worked closely with both elected

representatives and other national

health care organizations as it made its

way through the House and Senate. In

New Bipartisan Law Expands Access For Mentally Ill

survey also provided a national

perspective about pediatric patient

volume in our EDs. Sixty-nine

percent of the EDs surveyed treat

fewer than 5,000 pediatric patients

per year, or fewer than 14 per day.

Why is this information important?

Expertise comes with experience. We

need to provide tools and resources

to help emergency nurses improve

pediatric emergency care. There are

some great ENA resources that every

emergency nurse who cares for

children should be aware of.

The first is the ‘‘Guidelines for

the Care of Children in the ED’’

(below, left). A joint policy statement

by ENA, ACEP and AAP, it provides a

primer for resources that every ED

that cares for children

should have. There is a

checklist that you can use

to identify strengths and

opportunities in your own ED.

A second resource that directly

impacts pediatric patient safety is the

ENA position statement

“Weighing Pediatric

Patients in Kilograms’’

(left).

There are two clinical

practice guidelines that

directly address pediatric

emergency care: Noninvasive

Temperature Measurement in the

ED (above, right) and Needle-

Related Procedural

Pain in Pediatric

Patients in the ED (left).

The EMSC National

Resource Center has educational

resources, toolkits, disaster

preparedness information and

many other resources (below,

right) available to the public. The

National Pediatric

Readiness Project website

is also a wealth of

information and resources.

How can you help support the

national effort to improve pediatric

emergency care? I ask you to do two

things:

1. Urge your state representatives

to co-sponsor H.R. 4290 and your

senators to co-sponsor S. 2154. Both

of these bills are bipartisan

legislation, co-sponsored by Rep.

Peter King and Sen. Orrin Hatch.

Not sure how to contact your

representatives? Visit the

EN411 Advocacy

Engagement Page (left)

and find your elected

officials. Let your representatives

know how important this program is

to the emergency care of children in

this country.

2. Find out if your ED participated

in the National Pediatric Readiness

Survey. Each hospital received its

score when it submitted the survey.

The EMSC program managers are

able to provide comparison data for

each state. Talk to your manager

about your ED’s strengths and

opportunities. Then commit to taking

an opportunity to work on a project

or initiative to improve pediatric

emergency care in your department.

Using the resources here, in the

Emergency Nursing Pediatric Course

or from your local or regional

pediatric hospital, I have no doubt

you will have the tools to safely care

for the pediatric patients in your ED.

Each of us has a voice and a role in

improving pediatric emergency care.

How will you use your voice?

March, the Excellence in Mental Health

Act was added to a larger piece of

legislation dealing with Medicare

payments for physicians. Attaching it to

a ‘‘must-pass’’ bill greatly improved the

chances that these important mental

health provisions would become law.

On March 27, the physician

Medicare payment legislation, which

included the Excellence in Mental

Health Act, passed the House of

Representatives on a voice vote. In the

Senate, the bill was approved on a

64-35 vote March 31. It was signed into

law by President Obama on April 1.

The enacted version of the

Excellence in Mental Health Act

establishes an eight-state

demonstration project to expand

mental health services in community-

based clinics. States will be able to

apply through the Department of

Health and Human Services.

The new law could help as many as

750,000 uninsured and low-income

Americans with the most serious and

persistent mental health conditions,

including 100,000 veterans returning

from Iraq and Afghanistan. After an

initial two-year period, the

demonstration program could be

extended to additional states.

The passage of the Excellence in

Mental Health Act is an important

milestone in enhancing the treatment

options for mentally ill patients. It also

represents a significant accomplishment

for ENA’s government relations efforts.

‘‘Many ENA members work in

emergency departments where

behavioral health patients often seek

treatment because of a lack of

community-based mental health

facilities,’’ said ENA President Deena

Brecher, MSN, RN, APN, ACNS-BC,

CEN, CPEN. ‘‘This new law will

improve the quality of care and

increase access for those who need

treatment.’’

From the President Continued from Page 3


June/July 201412

CONFERENCES

From 2 to 1By Amy Carpenter Aquino, ENA Connection

T he land of innovation and celebration is the perfect

setting for ENA’s Emergency Nursing Conference.

Orlando, Fla., home to seven of the world’s top theme

parks, including Walt Disney World, is the host city for the

first ENA Emergency Nursing Conference. From Sept. 28 to

Oct. 3, 2015, ENA’s two conference experiences — Annual

and Leadership conferences — will become one integrated

event in Orlando.

‘‘We are all looking forward to providing our members

and guests an exciting and innovative Emergency Nursing

2015 Conference,’’ said Matthew F. Powers, MS, BSN, RN,

MICP, CEN, the 2014 ENA president-elect. ‘‘A few years

back, our members and vendors responded to a survey

about combining both our Leadership and Annual

conferences into one great conference. We are working

diligently to provide you the best experience in 2015, which

will address both leadership and clinical topics. There will

be opportunities for everyone to learn and grow with new

educational offerings and activities planned in Orlando.

Please join me and your ENA Board of Directors at our first

combined ENA Emergency Nursing Conference.’’

The combined conference will help ENA achieve its goal

of promoting safe practice and safe care through education,

networking and

advocacy. It

promises more

education, more

hands-on

learning labs,

more networking

opportunities and

more fun, all in

one conference.

Attendees can choose courses from both leadership and

clinical practice tracks in an expanded, six-day conference

schedule. The ENA General Assembly will still be held at the

beginning of the conference, but it will be divided into three

half-day formats, giving state leaders and delegates a more

flexible schedule. The new format will free up General

Assembly attendees to attend afternoon educational sessions

or connect and caucus with their states. Authors who need

to revise proposed bylaws amendments and resolutions will

have more focused time to spend on rewrites.

Special-interest groups and networking sessions will be

expanded as well, allowing members to visit two or three

sessions instead of only one.

ENA Combining Conferences in 2015 to Create Single Amazing Experience


ANNUALCONFERENCE

2014

For the latest updates and event details, please visit www.ena.org/AC

Registration Opens June 5§Attend a wide range of educational sessions

§Learn about innovative products and services

§Network with colleagues from around the world

JOIN USINDIANAPOLIS

Indiana Convention Center

October 7-11, 2014

AC14_Connection_half_0607 2014.indd 1 5/8/14 3:36 PM

Expanded educational opportunities, formerly called

presessions, will be presented differently. Instead of being

scheduled before the educational portion of the conference,

these longer-format sessions will be held at different times

throughout the conference to be accessible to more attendees.

Attendees will have more social events for networking

with colleagues, including both an opening and closing

reception. Beginning in 2015, the ENA Awards Gala will

be held in the middle of the conference to give attendees

more opportunities to congratulate the award winners

throughout the week.

The new conference provides all attendees with more

time to take advantage of Orlando’s various attractions,

activities and nightlife.

For ENA staff, the switch to one conference allows

more time to explore new options and focus on

preparing the best

educational and

networking

opportunities for

emergency nurse

professionals.

For a sneak

peek of the ENA

Emergency Nursing

2015 Conference,

look up “Emergency

Nursing 2015 Trailer”

at www.youtube.

com.

June/July 201414

MEMBERSHIP

H ow excited is 23-year-old Carly

Campbell to be a new ENA

member?

She could cry.

Campbell, on the verge of

graduating May 10 from the Palm

Beach Atlantic University nursing

program in West Palm Beach, Fla.,

traveled with three friends to the

National Student Nurses’ Association

annual convention April 9-13 in

Nashville, Tenn. — her first time

attending. She already had visited

ENA’s booth and applied for a student

membership when she heard a

capacity-crowd presentation by ENA

President Deena Brecher, MSN, RN,

APN, ACNS-BS, CEN, CPEN, on what it

means to be an emergency nurse.

The ED is the only place in the

hospital we don’t say no to people. We

take care of every person who comes in

the door.

That, said Campbell, who did her

preceptorship in the emergency

department, was ‘‘the highlight of the

whole conference for me.’’

‘‘It totally clicked a lot of things for

me in my nursing career,’’ she said,

‘‘and I teared up a little bit, I loved it

so much. . . . There’s definitely a

specific personality of people that

gravitate toward the emergency room.

And so to be connected to people who

are actually passionate about

emergency nursing as a whole, and

not just addicted to adrenaline, is

really an amazing resource.’’

Lines of inspired students agreed.

Over three days, ENA signed up 163

new members from 40 states, about

double the signups from last year’s

convention, and added three more

through membership drawings. Traffic

spiked after Brecher’s presentations.

‘‘It was just like a mob,’’ said

Tennessee ENA State Council President

Randy Mitchell, MBA, RN, CEN, who

arranged for pairs of council

volunteers, himself included, to join

Brecher and ENA Member & Course

Services supervisor Lindsay Paxton in

fielding questions and handing out

materials. Answering the call were

Barbara Gibson, RN; Mona Kelley,

MSN, RN; Holly Kunz, MSN, RN, CEN,

CCRN; and Donna Mason, MS, RN,

CEN, FAEN.

By Josh Gaby, ENA Connection

SWARMING UP TO ENAStudent nurses fill the room to hear ENA President Deena Brecher, MSN, RN, APN, ACNS-BC, CEN, CPEN, who snapped this photo from the stage on April 11 and later shared it on her president’s blog (enapresident.wordpress.com).

Message Resonates at NSNA Convention, Leading to More Than 160 New Student Memberships Carly Campbell

‘‘There were so many people

[Saturday], they just filled the booths

next to us and in front of our booth,

and that’s how much of a crowd we

had,’’ Mitchell said. ‘‘It’s really nice to

see the excitement and the enthusiasm

of these young, to-be nurses. A lot of

them are in their last semesters, so

they’re seeing that light at the end of

the tunnel that they’re going to be able

to get out and start doing something.’’

One of those students was Jamie

Scoff, then a month from graduating

from the four-year nursing program at

Salisbury University in Salisbury, Md.

Though her internship the last seven

weeks of school was in an ED, the

NSNA convention was her first

exposure to ENA. Hearing Brecher

sold her on joining. She already is

applying what she’s learning.

‘‘[Brecher] had discussed jumping

right in and trying to impress and wow

everybody that you’re working with,

and so I’ve started arriving 15 minutes

earlier than they want me to come in

and really not holding back at all,’’

Scoff said.

Emily Anderson, who will get her

BSN in August from the nursing

program at Herzing University in

suburban Minneapolis, attended her

first NSNA convention with three

classmates, all of whom joined her in

becoming ENA members after hearing

about ENA’s courses, continuing

education and networking.

‘‘I was kind of in between

emergency nursing and ICU nursing,

and [Brecher] really cleared up a lot of

things about emergency room nursing

that I was a little unclear about,’’

Anderson said.

What no one should be unclear

about is why spreading the word at

NSNA matters.

‘‘When we look at membership and

our membership demographics, we are

starting to see a growth in the

under-30 nurse, which is incredibly

important,’’ Brecher said. ‘‘So I think

we’re starting to really recognize the

value of engaging nurses while they’re

still students.’’

Many of the visitors to the ENA

booth wanted to know how they

might be included as they start out in

emergency nursing. The answer: by

making the ED a mutual teaching

environment.

‘‘I looked at all of them and said,

‘You guys are all experts at evidence-

based practice and doing a lit search,

and that’s a skill that a lot of

experienced nurses that have been

practicing a while don’t have,’ ’’

Brecher said. ‘‘While I, as a new nurse,

might not have the experience to pick

out the sick patient just by looking at

them, I certainly have skills that will

help improve the practice in the

department.’’

Brecher stressed the importance of

ENA state councils and chapters

‘‘harnessing the pixie dust’’ by

including younger members in their

activities. Carly Campbell was already

ahead of her. She attended her first

meeting with the Palm Beach County

Chapter on April 22, less than two

weeks after joining ENA, and was

welcomed by chapter president Janine

Mangold, RN, and about 50 members.

Among them were Campbell’s charge

nurse and a trauma nurse from the

same ED who happens to be on the

chapter board. The topic of the night

was waveform capnography

monitoring — information that came

up the next week when Campbell was

getting ACLS-certified.

ENA is opening doors already.

‘‘As a student getting my footing in

emergency nursing in that career

choice, I was like, ‘Hey, what can you

teach me?’ ’’ Campbell said.

‘‘It was wonderful. I skipped home.

I was like, ‘This is the best.’ ’’


Top: Brecher connects with students at the ENA booth in Nashville, which was staffed by a team of ENA enthusiasts that included (left, from left) Mona Kelley, MSN, RN; Brecher; Tennessee ENA President Randy Mitchell, MBA, RN, CEN; and ENA Member & Course Services supervisor Lindsay Paxton.

THE FIRST AND ONLY…

©2014 Teva Pharmaceuticals USA, Inc. All rights reserved. April 2014 Printed in USA. ADA-40010

When agitation escalates…

HOW LONG CAN YOU WAIT?

INDICATIONS AND USAGEADASUVE® (loxapine) inhalation powder, for oral inhalation use, is a typical antipsychotic indicated for the acute treatment of agitation associated with schizophrenia or bipolar I disorder in adults. Ef� cacy was demonstrated in 2 trials in acute agitation: one in schizophrenia and one in bipolar I disorder.Limitations of Use: As part of the ADASUVE Risk Evaluation and Mitigation Strategy (REMS) Program to mitigate the risk of bronchospasm, ADASUVE must be administered only in an enrolled healthcare facility.

IMPORTANT SAFETY INFORMATION (continued)• After ADASUVE administration, patients must be monitored for signs and symptoms of bronchospasm at

least every 15 minutes for at least 1 hour• ADASUVE can cause sedation, which can mask the symptoms of bronchospasm• Antipsychotic drugs can cause a potentially fatal symptom complex called Neuroleptic Malignant

Syndrome (NMS), manifested by hyperpyrexia, muscle rigidity, altered mental state, irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmia. Associated features can include escalated serum creatine phosphokinase (CPK) concentration, rhabdomyolysis, elevated serum and urine myoglobin concentration, and renal failure. If NMS occurs, immediately discontinue antipsychotic drugs and other drugs that may contribute to the underlying disorder, monitor and treat symptoms, and treat any concomitant serious medical problems

• ADASUVE can cause hypotension, orthostatic hypotension, and syncope. Use with caution in patients with known cardiovascular disease, cerebrovascular disease, or conditions that would predispose patients to hypotension. In the presence of severe hypotension requiring vasopressor therapy, epinephrine should not be used

• Use ADASUVE with caution in patients with a history of seizures or with conditions that lower the seizure threshold. ADASUVE lowers the seizure threshold. Seizures have occurred in patients treated with oral loxapine and can also occur in epileptic patients

• Use caution when driving or operating machinery. ADASUVE can impair judgment, thinking, and motor skills• The potential for cognitive and motor impairment is increased when ADASUVE is administered

concurrently with other CNS depressants• Treatment with antipsychotic drugs caused an increased incidence of stroke and transient ischemic

attack in elderly patients with dementia-related psychosis; ADASUVE is not approved for the treatment of patients with dementia-related psychosis

• Use of ADASUVE may exacerbate glaucoma or cause urinary retention• The most common adverse reactions (incidence ≥2% and greater than placebo) in clinical studies in

patients with agitation treated with ADASUVE were dysgeusia, sedation, and throat irritation• Pregnancy Category C. Neonates exposed to antipsychotic drugs during the third trimester of pregnancy

are at risk of extrapyramidal and/or withdrawal symptoms after delivery. ADASUVE should be used during pregnancy only if the potential bene� t justi� es the potential risk to the fetus

• Nursing mothers: Discontinue drug or nursing, taking into account the importance of the drug to the mother• The safety and effectiveness of ADASUVE in pediatric patients have not been established

• ADASUVE is contraindicated in patients with the following:— Current diagnosis or history of asthma, chronic obstructive pulmonary disease (COPD), or other lung

disease associated with bronchospasm— Acute respiratory signs/symptoms (eg, wheezing)— Current use of medications to treat airways disease, such as asthma or COPD— History of bronchospasm following ADASUVE treatment— Known hypersensitivity to loxapine or amoxapine. Serious skin reactions have occurred with oral

loxapine and amoxapine• ADASUVE must be administered only by a healthcare professional• Prior to administration, all patients must be screened for a history of pulmonary disease and examined

(including chest auscultation) for respiratory abnormalities (eg, wheezing)• Administer only a single 10 mg dose of ADASUVE within a 24-hour period by oral inhalation using the

single-use inhaler

IMPORTANT SAFETY INFORMATION

WARNING: BRONCHOSPASM andINCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS

BronchospasmADASUVE can cause bronchospasm that has the potential to lead to respiratory distress and respiratory arrest. Administer ADASUVE only in an enrolled healthcare facility that has immediate access on-site to equipment and personnel trained to manage acute bronchospasm, including advanced airway management (intubation and mechanical ventilation). Prior to administering ADASUVE, screen patients regarding a current diagnosis, history, or symptoms of asthma, COPD and other lung diseases, and examine (including chest auscultation) patients for respiratory signs. Monitor for signs and symptoms of bronchospasm following treatment with ADASUVE.Because of the risk of bronchospasm, ADASUVE is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the ADASUVE REMS.Increased Mortality in Elderly Patients With Dementia-Related PsychosisElderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. ADASUVE is not approved for the treatment of patients with dementia-related psychosis.

ADASUVE® (loxapine) inhalation powder 10 mg

Please see Brief Summary of Prescribing Information, including Boxed Warnings, on following pages.

For REMS Program information, visit

ADASUVEREMS.COM or call 855-755-0492

For more information about ADASUVE,

visit ADASUVE.COM

ADASUVE® (loxapine) inhalation powder

HELP DEFUSE THE SITUATION BEFORE AGITATION ESCALATES FURTHER

Breath-actuated, single-use, ready-to-use inhaler1

ORAL INHALATION

FAST ONSET

Statistically signifi cant reduction in agitation at 2 hours, with improvement rapidly achieved at 10 minutes post-dose1

References: 1. ADASUVE [package insert]. Horsham, PA: Teva Select Brands, a division of Teva Pharmaceuticals USA, Inc; December 2013. 2. Data on fi le. Clinical Study Report 004-301. Teva Pharmaceuticals. 3. Data on fi le. Clinical Study Report 004-302. Teva Pharmaceuticals.

Orally inhaled medicine indicated for the acute treatment of agitation associated with schizophrenia or bipolar I disorder in adults

The mean baseline PEC scores in all treatment groups were 17.3 to 17.7.

BIPOLAR I DISORDERSCHIZOPHRENIAENDPOINT

AT 2 HOURS(PRIMARY)

AT 10 MINUTES (SECONDARY)

Reduction from baseline in agitation symptoms2,3

PEC=Positive and Negative Syndrome Scale-Excited Component. Intent-to-treat population with last observation carried forward. Agitation symptoms measured: tension, excitement, poor impulse control, uncooperativeness, hostility. Each item is scored on a scale from 1 to 7 (1=absent, 4=moderate, 7=extreme). Patient total PEC scores ranged from 14 to 31 out of a possible 35.The efficacy of ADASUVE 10 mg in the acute treatment of agitation associated with schizophrenia or bipolar I disorder was established in a short-term (24-hour), randomized, double-blind, placebo-controlled, fixed-dose trial including 344 patients who met DSM-IV criteria for schizophrenia and in another study, 314 patients who met DSM-IV criteria for bipolar I disorder, manic or mixed episodes with or without psychotic features.

ADASUVE ADASUVEPLACEBO PLACEBO

33%49%

10%19%

27%53%

10%23%

10min

S:9.5”

T:14”

T:10”

B:17”

B:12”

S:13.5”






















single-use inhaler









visit ADASUVE.COM




ORAL INHALATION

FAST ONSET






AT 2 HOURS(PRIMARY)





33%49%

10%19%

27%53%

10%23%

10min

S:9.5”

T:14”

T:10”

B:17”

B:12”

S:13.5”






















single-use inhaler









visit ADASUVE.COM




ORAL INHALATION

FAST ONSET






AT 2 HOURS(PRIMARY)





33%49%

10%19%

27%53%

10%23%

10min

S:9.5”

T:14”

T:10”

B:17”

B:12”

S:13.5”






















single-use inhaler









visit ADASUVE.COM




ORAL INHALATION

FAST ONSET






AT 2 HOURS(PRIMARY)





33%49%

10%19%

27%53%

10%23%

10min

S:9.5”

T:14”

T:10”

B:17”

B:12”

S:13.5”






















single-use inhaler









visit ADASUVE.COM




ORAL INHALATION

FAST ONSET






AT 2 HOURS(PRIMARY)





33%49%

10%19%

27%53%

10%23%

10min

S:9.5”

T:14”

T:10”

B:17”

B:12”

S:13.5”






















single-use inhaler









visit ADASUVE.COM




ORAL INHALATION

FAST ONSET






AT 2 HOURS(PRIMARY)





33%49%

10%19%

27%53%

10%23%

10min

S:9.5”T:14”

T:10”B:17”

B:12”

S:13.5”

BRIEF SUMMARYADASUVE® (loxapine) inhalation powder, for oral inhalation use The following is a brief summary only; see full prescribing informa-tion, included Boxed Warnings for complete product information.

WARNING: BRONCHOSPASM and INCREASED MORTALITYIN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS

Bronchospasm ADASUVE can cause bronchospasm that has the potential to lead to respiratory distress and respiratory arrest. Administer ADASUVE only in an enrolled healthcare facility that has immediate access on-site to equipment and personnel trained to manage acute bron-chospasm, including advanced airway management (intubation and mechanical ventilation) [see Warnings and Precautions (5.1, 5.2)]. Prior to administering ADASUVE, screen patients regarding a current diagnosis, history, or symptoms of asthma, COPD and other lung diseases, and examine (including chest auscultation) patients for respiratory signs. Monitor for signs and symptoms of bronchospasm following treatment with ADASUVE [see Dosage and Administration (2.2, 2.4) and Contraindications (4)].Because of the risk of bronchospasm, ADASUVE is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the ADASUVE REMS [see Warnings and Pre-cautions (5.2)]. Increased Mortality in Elderly Patients with Dementia-Related Psychosis Elderly patients with dementia-related psychosis treated with anti-psychotic drugs are at an increased risk of death. ADASUVE is not approved for the treatment of patients with dementia-related psycho-sis [see Warnings and Precautions (5.3)].

1 INDICATIONS AND USAGEADASUVE is a typical antipsychotic indicated for the acute treatment of agitation associated with schizophrenia or bipolar I disorder in adults.“Psychomotor agitation” is defined in DSM-IV as “excessive motor activity associated with a feeling of inner tension.” Patients experiencing agitation often manifest behaviors that interfere with their care (e.g., threatening behaviors, escalating or urgently distressing behavior, self-exhausting behav-ior), leading clinicians to the use of rapidly absorbed antipsychotic medica-tions to achieve immediate control of the agitation [see Clinical Studies (14)].The efficacy of ADASUVE was established in one study of acute agitation in patients with schizophrenia and one study of acute agitation in patients with bipolar I disorder [see Clinical Studies (14)]. Limitations of Use:As part of the ADASUVE REMS Program to mitigate the risk of broncho-spasm, ADASUVE must be administered only in an enrolled healthcare facility [see Warnings and Precautions (5.2)].4 CONTRAINDICATIONSADASUVE is contraindicated in patients with the following:• Current diagnosis or history of asthma, COPD, or other lung disease

associated with bronchospasm [see Warnings and Precautions (5.1)]• Acute respiratory symptomsor signs (e.g., wheezing) [see Warnings

and Precautions (5.1)]• Currentuseofmedicationstotreatairwaysdisease,suchasasthmaorCOPD[see Warnings and Precautions (5.1)]

• HistoryofbronchospasmfollowingADASUVEtreatment[see Warnings and Precautions (5.1)]

• Knownhypersensitivityto loxapineoramoxapine.Seriousskinreac-tions have occurred with oral loxapine and amoxapine.

5 WARNINGS AND PRECAUTIONS5.1 BronchospasmADASUVE can cause bronchospasm that has the potential to lead to respi-ratory distress and respiratory arrest [see Adverse Reactions (6.1)]. Administer ADASUVE only in an enrolled healthcare facility that has immediate access on-site to equipment and personnel trained to manage acute bronchospasm, including advanced airway management (intuba-tion and mechanical ventilation) [see Boxed Warning and Warnings and Precautions (5.2)].Prior to administering ADASUVE, screen patients regarding a current diagnosisorhistoryofasthma,COPD,andotherlungdiseaseassociatedwith bronchospasm, acute respiratory symptoms or signs, current use of medicationstotreatairwaysdisease,suchasasthmaorCOPD;andexam-ine patients (including chest auscultation) for respiratory abnormalities (e.g., wheezing) [See Dosage and Administration (2.2) and Contraindi-cations (4)]. Monitor patients for symptoms and signs of bronchospasm (i.e., vital signs and chest auscultation) at least every 15 minutes for a minimum of one hour following treatment with ADASUVE [see Dosage and Administration (2.4)]. ADASUVE can cause sedation, which can mask the symptoms of bronchospasm.

BecauseclinicaltrialsinpatientswithasthmaorCOPDdemonstratedthatthe degree of bronchospasm, as indicated by changes in forced expira-tory volume in 1 second (FEV1), was greater following a second dose of ADASUVE, limit ADASUVE use to a single dose within a 24 hour period. Advise all patients of the risk of bronchospasm. Advise them to inform the healthcare professional if they develop any breathing problems such as wheezing, shortness of breath, chest tightness, or cough following treatment with ADASUVE.5.2 ADASUVE REMS to Mitigate Bronchospasm Because of the risk of bronchospasm, ADASUVE is available only through a restricted program under a REMS called the ADASUVE REMS. [see Boxed Warning and Warnings and Precautions (5.1)] Required compo-nents of the ADASUVE REMS are:• Healthcarefacilities thatdispenseandadministerADASUVEmustbeenrolled and comply with the REMS requirements. Certified health-care facilities must have on-site access to equipment and personnel trained to provide advance airway management, including intubation and mechanical ventilation.

• WholesalersanddistributorsthatdistributeADASUVEmustenroll inthe program and distribute only to enrolled healthcare facilities.

Further information is available at www.adasuverems.com or 1-855-755-0492.5.3 Increased Mortality in Elderly Patients with Dementia-Related Psychosis Elderly patients with dementia-related psychosis treated with antipsy-chotic drugs are at increased risk of death. Analyses of 17 placebo- controlled trials (modal duration of 10 weeks), largely in patients tak-ing atypical antipsychotic drugs, revealed a risk of death in drug-treated patients of 1.6 to 1.7 times the risk of death in placebo-treated patients. Overthecourseofatypical10-weekcontrolledtrial,therateofdeathindrug-treated patients was about 4.5%, compared to a rate of about 2.6% in the placebo group. Although the cases of death were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sud-dendeath)orinfectious(e.g.,pneumonia)innature.Observationalstud-ies suggest that, similar to atypical antipsychotic drugs, treatment with conventional antipsychotic drugs may increase mortality. The extent to which the findings of increased mortality in observational studies can be attributed to the antipsychotic drug as opposed to some characteristic(s) of the patients is not clear. ADASUVE is not approved for the treatment of elderly patients with dementia-related psychosis [see Boxed Warning].5.4 Neuroleptic Malignant Syndrome Antipsychotic drugs can cause a potentially fatal symptom complex termedNeurolepticMalignantSyndrome(NMS).Clinicalmanifestationsof NMS include hyperpyrexia, muscle rigidity, altered mental status, and autonomic instability (irregular pulse or blood pressure, tachycardia, dia-phoresis, and cardiac dysrhythmia). Associated features can include ele-vatedserumcreatinephosphokinase(CPK)concentration,rhabdomyoly-sis, elevated serum and urine myoglobin concentration, and renal failure. NMS did not occur in the ADASUVE clinical program.The diagnostic evaluation of patients with this syndrome is complicated. It is important to consider the presence of other serious medical con-ditions (e.g.,pneumonia,systemic infection,heatstroke,primaryCNSpathology, central anticholinergic toxicity, extrapyramidal symptoms, or drug fever). The management of NMS should include: 1) immediate discontinua-tion of antipsychotic drugs and other drugs that may contribute to the underlying disorder, 2) intensive symptomatic treatment and medical mon-itoring, and 3) treatment of any concomitant serious medical problems. There is no general agreement about specific pharmacological treatment regimens for NMS.If a patient requires antipsychotic drug treatment after recovery from NMS, the potential reintroduction of drug therapy should be carefully considered. The patient should be carefully monitored, since recurrences of NMS have been reported. 5.5 Hypotension and SyncopeADASUVE can cause hypotension, orthostatic hypotension, and syncope. Use ADASUVE with caution in patients with known cardiovascular dis-ease (history of myocardial infarction or ischemic heart disease, heart failure or conduction abnormalities), cerebrovascular disease, or condi-tions that would predispose patients to hypotension (dehydration, hypo-volemia, or treatment with antihypertensive medications or other drugs that affect blood pressure or reduce heart rate).In the presence of severe hypotension requiring vasopressor therapy, the preferred drugs may be norepinephrine or phenylephrine. Epinephrine should not be used, because beta stimulation may worsen hypotension in the setting of ADASUVE-induced partial alpha blockade.In short-term (24-hour) placebo-controlled trials of patients with agitation associated with schizophrenia or bipolar I disorder, hypotension occurred in 0.4% and 0.8% in the ADASUVE 10 mg and placebo groups, respec-tively. There were no cases of orthostatic hypotension, postural symptoms,

Table 1. Adverse Reactions in 3 Pooled Short-Term, Placebo-Controlled Trials (Studies 1, 2, and 3) in Patients with Schizophrenia or Bipolar Disorder

Adverse ReactionPlacebo(n = 263)

ADASUVE(n = 259)

Dysgeusia 5% 14%Sedation 10% 12%Throat Irritation 0% 3%

Airway Adverse Reactions in the 3 Trials in Acute Agitation Agitated patients with Schizophrenia or Bipolar Disorder: In the 3 short-term (24-hour), placebo-controlled trials in patients with agitation asso-ciated with schizophrenia or bipolar disorder (Studies 1, 2, and 3), bron-chospasm (which includes reports of wheezing, shortness of breath and cough) occurred more frequently in the ADASUVE group, compared to the placebo group: 0% (0/263) in the placebo group and 0.8% (2/259) intheADASUVE10mggroup.Onepatientwithschizophrenia,withouta history of pulmonary disease, had significant bronchospasm requiring rescue treatment with a bronchodilator and oxygen. Bronchospasm and Airway Adverse Reactions in Pulmonary Safety TrialsClinicalpulmonarysafetytrialsdemonstratedthatADASUVEcancausebronchospasm as measured by FEV1, and as indicated by respiratory signs and symptoms in the trials. In addition, the trials demonstrated thatpatientswithasthmaorotherpulmonarydiseases,suchasCOPDare at increased risk of bronchospasm. The effect of ADASUVE on pulmonary function was evaluated in 3 randomized, double-blind, placebo-controlled clinical pulmonary safety trials in healthy volunteers, patientswithasthma,andpatientswithCOPD.Pulmonaryfunctionwasassessed by serial FEV1 tests, and respiratory signs and symptoms were assessed.IntheasthmaandCOPDtrials,patientswithrespiratorysymp-toms or FEV1 decrease of ≥ 20% were administered rescue treatment with albuterol (metered dose inhaler or nebulizer) as required. These patientswerenoteligibleforaseconddose;however,theyhadcontinuedFEV1 monitoring in the trial. HealthyVolunteers: In the healthy volunteer crossover trial, 30 subjects received 2 doses of either ADASUVE or placebo 8 hours apart, and 2 doses of the alternate treatment at least 4 days later. The results for maximum decrease in FEV1 are presented in Table 2. No subjects in this trial devel-oped airway related adverse reactions (cough, wheezing, chest tightness, or dyspnea).Asthma Patients: In the asthma trial, 52 patients with mild-moderate persistent asthma (with FEV1 ≥ 60% of predicted) were randomized to treatment with 2 doses of ADASUVE 10 mg or placebo. The second dose was to be administered 10 hours after the first dose. Approximately 67% of these patients had a baseline FEV1 ≥ 80% of predicted. The remaining patients had an FEV1 60-80% of predicted. Nine patients (17%) were former smokers. As shown in Table 2 and Figure 7, there was a marked decrease in FEV1 immediately following the first dose (maximum mean decreases in FEV1 and % predicted FEV1 were 303 mL and 9.1%, respec-tively). Furthermore, the effect on FEV1 was greater following the second dose (maximum mean decreases in FEV1 and % predicted FEV1 were 537 mL and 14.7 %, respectively). Respiratory-related adverse reactions (bronchospasm, chest discomfort, cough, dyspnea, throat tightness, and wheezing) occurred in 54% of ADASUVE-treated patients and 12% of placebo-treated patients. There were no serious adverse events. Nine of 26 (35%) patients in the ADASUVE group, compared to one of 26 (4%) in the placebo group, did not receive a second dose of study medication, because they had a ≥ 20% decrease in FEV1 or they developed respiratory symptoms after the first dose. Rescue medication (albuterol via metered dose inhaler or nebulizer) was administered to 54% of patients in the ADASUVE group [7 patients (27%) after the first dose and 7 of the remain-ing 17 patients (41%) after the second dose] and 12% in the placebo group (1 patient after the first dose and 2 patients after the second dose).COPDPatients:IntheCOPDtrial,53patientswithmildtosevereCOPD(withFEV1 ≥ 40% of predicted) were randomized to treatment with 2 doses of ADASUVE 10 mg or placebo. The second dose was to be administered 10 hours after the first dose. Approximately 57% of these patients had moderateCOPD[Global Initiative forChronicObstructiveLungDisease(GOLD)StageII];32%hadseveredisease(GOLDStageIII);and11%hadmilddisease(GOLDStageI).AsillustratedinTable2therewasadecreasein FEV1 soon after the first dose (maximum mean decreases in FEV1 and % predicted FEV1 were 96 mL and 3.5%, respectively), and the effect on FEV1 was greater following the second dose (maximum mean decreases in FEV1 and % predicted FEV1 were 125 mL and 4.5%, respectively). Respi-ratory adverse reactions occurred more frequently in the ADASUVE group (19%) than in the placebo group (11%). There were no serious adverse events. Seven of 25 (28%) patients in the ADASUVE group and 1of 27 (4%) in the placebo group did not receive a second dose of study medication because of a ≥ 20% decrease in FEV1 or the development of respiratory symptoms after the first dose. Rescue medication (albuterol via MDI or

presyncope or syncope. A systolic blood pressure ≤90mmHgwithadecrease of ≥20mmHgoccurredin1.5%and0.8%oftheADASUVE10 mg and placebo groups, respectively. A diastolic blood pressure ≤50mmHgwithadecreaseof≥15mmHgoccurredin0.8%and0.4%of the ADASUVE 10 mg and placebo groups, respectively.In 5 Phase 1 studies in normal volunteers, the incidence of hypotension was 3% and 0% in ADASUVE 10 mg and the placebo groups, respec-tively. The incidence of syncope or presyncope in normal volunteers was 2.3% and 0% in the ADASUVE and placebo groups, respectively. In nor-mal volunteers, a systolic blood pressure ≤90mmHgwithadecreaseof ≥20mmHgoccurredin5.3%and1.1%intheADASUVEandplacebogroups, respectively. A diastolic blood pressure ≤ 50 mm Hg with adecrease of ≥15mmHgoccurredin7.5%and3.3%intheADASUVEandplacebo groups, respectively.5.6 SeizuresADASUVE lowers the seizure threshold. Seizures have occurred in patients treated with oral loxapine. Seizures can occur in epileptic patients even during antiepileptic drug maintenance therapy. In short term (24 hour), placebo-controlled trials of ADASUVE, there were no reports of seizures. 5.7 Potential for Cognitive and Motor ImpairmentADASUVE can impair judgment, thinking, and motor skills. In short-term, placebo-controlled trials, sedation and/or somnolence were reported in 12% and 10% in the ADASUVE and placebo groups, respectively. No patients discontinued treatment because of sedation or somnolence.The potential for cognitive and motor impairment is increased when ADASUVEisadministeredconcurrentlywithotherCNSdepressants[see Drug Interactions (7.1)]. Caution patients about operating hazardousmachinery, including automobiles, until they are reasonably certain that therapy with ADASUVE does not affect them adversely. 5.8 Cerebrovascular Reactions, Including Stroke, in Elderly Patients with Dementia-Related PsychosisIn placebo-controlled trials with atypical antipsychotics in elderly patients with dementia-related psychosis, there was a higher incidence of cere-brovascular adverse reactions (stroke and transient ischemic attacks), including fatalities, compared to placebo-treated patients. ADASUVE is not approved for the treatment of patients with dementia-related psycho-sis [see Boxed Warning and Warnings and Precautions (5.3)].5.9 Anticholinergic Reactions Including Exacerbation of Glaucoma and Urinary RetentionADASUVE has anticholinergic activity, and it has the potential to cause anticholinergic adverse reactions including exacerbation of glaucoma or urinary retention. The concomitant use of other anticholinergic drugs (e.g., antiparkinson drugs) with ADASUVE could have additive effects. 6 ADVERSE REACTIONSThe following adverse reactions are discussed in more detail in other sections of the labeling:• Hypersensitivity(seriousskinreactions)[see Contraindications (4)] • Bronchospasm[see Warnings and Precautions (5.1)]• IncreasedMortalityinElderlyPatientswithDementia-RelatedPsycho-

sis [see Warnings and Precautions (5.3)]• NeurolepticMalignantSyndrome[see Warnings and Precautions (5.4)]• Hypotensionandsyncope[see Warnings and Precautions (5.5)]• Seizure[see Warnings and Precautions (5.6)]• Potential forCognitiveandMotorImpairment[see Warnings and Pre-

cautions (5.7)]• CerebrovascularReactions, IncludingStroke, inElderlyPatientswith

Dementia-Related Psychosis [see Warnings and Precautions (5.8)]• AnticholinergicReactionsIncludingExacerbationofGlaucomaandUri-

nary Retention [see Warnings and Precautions (5.9)]6.1 Clinical Trials ExperienceBecause clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.The following findings are based on pooled data from three short-term (24-hour), randomized, double-blind, placebo-controlled clinical trials (Studies 1, 2, and 3) of ADASUVE 10 mg in the treatment of patients with acute agitation associated with schizophrenia or bipolar I disorder. In the 3 trials, 259 patients received ADASUVE 10 mg, and 263 received placebo [see Clinical Studies (14)].Commonly Observed Adverse Reactions: In the 3 trials in acute agita-tion, the most common adverse reactions were dysgeusia, sedation, and throat irritation. These reactions occurred at a rate of at least 2% of the ADASUVE group and at a rate greater than in the placebo group. (Refer to Table 1).

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nebulizer) was administered to 23% of patients in the ADASUVE group: 8% of patients after the first dose and 21% of patients after the second dose, and to 15% of patients in the placebo group.Table 2: Maximum Decrease in FEV1 from Baseline in the Healthy Volun-teer, Asthma, and COPD Trials

Healthy Volunteer Asthma COPDMaximum% FEV ↓

Placebon (%)

ADASUVE10 mgn (%)

Placebon (%)

ADASUVE10 mgn (%)

Placebon (%)

ADASUVE10 mgn (%)

After any Dose

N=26 N=26 N=26 N=26 N=27 N=25

≥10 7 (27) 7 (27) 3 (12) 22 (85) 18 (67) 20 (80)

≥15 1 (4) 5 (19) 1 (4) 16 (62) 9 (33) 14 (56)

≥20 0 1 (4) 1 (4) 11 (42) 3 (11) 10 (40)

After Dose 1

N=26 N=26 N=26 N=26 N=27 N=25

≥10 4 (15) 5 (19) 2 (8) 16 (62) 8 (30) 16 (64)

≥15 1 (4) 2 (8) 1 (4) 8 (31) 4 (15) 10 (40)

≥20 0 0 1 (4) 6 (23) 2 (7) 9 (36)

After Dose 2

N=26 N=25 N=25 N=17 N=26 N=19

≥10 5 (19) 6 (24) 3 (12) 12 (71) 15 (58) 12 (63)

≥15 0 5 (20) 1 (4) 9 (53) 6 (23) 10 (53)

≥20 0 1 (4) 1 (4) 5 (30) 1 (4) 5 (26)

FEV1categoriesarecumulative;i.e.asubjectwithamaximumdecreaseof 21% is included in all 3 categories. Patients with a ≥ 20% decrease in FEV1 did not receive a second dose of study drug.Figure 7: LS Mean Change from Baseline in FEV1 in Patients with Asthma

Patients with a ≥ 20% decrease in FEV1 did not receive a second dose of study drug and are not included in the curves beyond hour 10.Extrapyramidal Symptoms (EPS): Extrapyramidal reactions have occurred during the administration of oral loxapine. In most patients, these reactions involved parkinsonian symptoms such as tremor, rigidity, and masked facies. Akathisia (motor restlessness) has also occurred.In the 3 short-term (24-hour), placebo-controlled trials of ADASUVE in 259 patients with agitation associated with schizophrenia or bipolar disorder, extrapyramidalreactionsoccurred.Onepatient(0.4%)treatedwithADASUVEdeveloped neck dystonia and oculogyration. The incidence of akathisia was 0% and 0.4% in the placebo and ADASUVE groups, respectively. Dystonia (Antipsychotic Class Effect): Symptoms of dystonia, prolonged abnormal contractions of muscle groups, may occur in susceptible indi-viduals during treatment with ADASUVE. Dystonic symptoms include spasm of the neck muscles, sometimes progressing to tightness of the throat, difficulty swallowing or breathing, and/or protrusion of the tongue. Acute dystonia tends to be dose-related, but can occur at low doses, and occurs more frequently with first generation antipsychotic drugs such as ADASUVE. The risk is greater in males and younger age groups.Cardiovascular Reactions: Tachycardia, hypotension, hypertension, ortho-static hypotension, lightheadedness, and syncope have been reported with oral administration of loxapine.7 DRUG INTERACTIONS7.1 CNS DepressantsADASUVEisacentralnervoussystem(CNS)depressant.TheconcurrentuseofADASUVEwithotherCNSdepressants(e.g.,alcohol,opioidanal-gesics, benzodiazepines, tricyclic antidepressants, general anesthetics, phenothiazines,sedative/hypnotics,musclerelaxants,and/or illicitCNSdepressants) can increase the risk of respiratory depression, hypoten-sion, profound sedation, and syncope. Therefore, consider reducing the doseofCNSdepressantsifusedconcomitantlywithADASUVE.

7.2 Anticholinergic DrugsADASUVE has anticholinergic activity. The concomitant use of ADASUVE and other anticholinergic drugs can increase the risk of anticholinergic adverse reactions including exacerbation of glaucoma and urinary retention.8 USE IN SPECIFIC POPULATIONSIn general, no dose adjustment for ADASUVE is required on the basis of a patient’s age, gender, race, smoking status, hepatic function, or renal function.8.1 PregnancyPregnancyCategoryCRisk SummaryThere are no adequate and well-controlled studies of ADASUVE use in pregnant women. Neonates exposed to antipsychotic drugs during the third trimester of pregnancy are at risk for extrapyramidal and/or with-drawal symptoms following delivery. Loxapine, the active ingredient in ADASUVE, has demonstrated increased embryofetal toxicity and death in rat fetuses and offspring exposed to doses approximately 0.5-fold themaximum recommendedhumandose (MRHD) on amg/m2 basis. ADASUVE should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.HumanDataNeonates exposed to antipsychotic drugs during the third trimester of pregnancy are at risk for extrapyramidal and/or withdrawal symptoms following delivery. There have been reports of agitation, hypertonia, hypo-tonia, tremor, somnolence, respiratory distress, and feeding disorders intheseneonates.Thesecomplicationshavevariedinseverity;insomecases symptoms have been self-limited, but in other cases neonates have required intensive care unit support and prolonged hospitalization.Animal DataIn rats, embryofetal toxicity (increased fetal resorptions, reduced weights, and hydronephrosis with hydroureter) was observed following oral administration of loxapine during the period of organogenesis at a doseof1mg/kg/day.ThisdoseisequivalenttotheMRHDof10mg/dayon a mg/m2 basis. In addition, fetal toxicity (increased prenatal death, decreased postnatal survival, reduced fetal weights, delayed ossifica-tion, and/or distended renal pelvis with reduced or absent papillae) was observed following oral administration of loxapine from mid-pregnancy through weaning at doses of 0.6 mg/kg and higher. This dose is approxi-matelyhalftheMRHDof10mg/dayonamg/m2 basis. No teratogenicity was observed following oral administration of loxapine during the period of organogenesis in the rat, rabbit, or dog at doses up to 12, 60, and 10 mg/kg, respectively. These doses are approximately 12-, 120-,and32-foldtheMRHDof10mg/dayonamg/m2 basis, respectively.8.3 Nursing Mothers It is not known whether ADASUVE is present in human milk. Loxapine and its metabolites are present in the milk of lactating dogs. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from ADASUVE, a decision should be made whether to discontinue nursing or discontinue ADASUVE, taking into account the importance of the drug to the mother.8.4 Pediatric UseThe safety and effectiveness of ADASUVE in pediatric patients have not been established.8.5 Geriatric UseElderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death [see Boxed Warning and Warn-ings and Precautions (5.3)]. ADASUVE is not approved for the treatment of dementia-related psychosis. Placebo-controlled studies of ADASUVE in patients with agitation associated with schizophrenia or bipolar disorder did not include patients over 65 years of age.10 OVERDOSAGESigns and Symptoms of OverdosageAs would be expected from the pharmacologic actions of loxapine, the clinicalfindingsmayincludeCNSdepression,unconsciousness,profoundhypotension, respiratory depression, extrapyramidal symptoms, and seizure.Management of OverdosageFor the most up to date information on the management of ADASUVE overdosage, contact a certified poison control center (1-800-222-1222 or www.poison.org). Provide supportive care including close medical supervision and monitoring. Treatment should consist of general mea-suresemployedinthemanagementofoverdosagewithanydrug.Con-sider the possibility of multiple drug overdosage. Ensure an adequate airway, oxygenation, and ventilation. Monitor cardiac rhythm and vital signs. Use supportive and symptomatic measures.Manufacturedby:AlexzaPharmaceuticals,Inc.,MountainView,CA94043Manufacturedfor:TevaSelectBrands,Horsham,PA19044,DivisionofTeva Pharmaceuticals USA, Inc.Iss.12/2013ADA-40059

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Call for 2015 ENA National Committees

Bring your passion for nursing to the national level! ENA

2014 President-elect Matthew F. Powers, MS, BSN, RN,

MICP, CEN, would like to invite you as an ENA member

to share your knowledge and experience on a national

ENA committee in 2015. We will be accepting applications

for each of our national committees July 1 - 31, 2014.

For a full description of each committee and to

apply beginning July 1, go to www.ena.org, then click

on ‘‘Get Involved.’’

National Committee applications must be submitted

online by 5 p.m. Central time Thursday, July 31.

While not required, a photo is requested with your

application. Photos do not have to be professionally done;

a quick snap from your smartphone will work. Look for

instructions on how to upload your photo in the

committee application.

MEMBER FEEDBACK

ENA values its members’ opinions

and provides several

opportunities for members to provide

feedback to the organization,

including via social media and directly

to their ENA Board of Directors state

liaisons at local and national meetings.

Another increasingly effective method

of gathering member feedback is

through market research surveys.

‘‘It is very important to us to

engage our members,’’ said Laura

Jiggens, who joined ENA in February

as market research manager.

Originally from England, Jiggens

came to ENA with more than 16 years

of market research experience, most

recently in the pharmaceutical

industry. While her involvement with

research findings typically concludes

with the delivery of a final report,

Jiggens was keen to ‘‘take market

research that next step further and

actually implement results and see the results come to life.’’

A number of ENA market research initiatives planned for

this year will help Jiggens realize that goal as she creates and

sends surveys on various topics to ENA members throughout

this year and beyond. Membership satisfaction and national

conference preferences are two of the topics that ENA

surveys will address in 2014.

Feedback from member surveys helps ENA headquarters

better connect with members and

make informed decisions. Member

opinions influence and guide

decisions on educational offerings,

organizational issues, strategic

planning, national conferences

and member services.

The majority of surveys will

not be sent to all 40,000 ENA

members, Jiggens said. ENA

realizes its members lead busy

lives and aims to minimize the

impact of being selected too

frequently for surveys.

‘‘For each study, we will select

a specific or random sample of

members,’’ she said. That makes it

even more critical that as many

ENA members as possible respond

when asked to participate. One

ENA member could represent

thousands of colleagues.

ENA plans to share some key

insights from survey results with

members in the pages of

ENA Connection, as well as

keep members updated on what the organization is doing

with the findings.

‘‘ENA wants members to know that we are really

listening,’’ Jiggens said.

Note: ENA respects members’ privacy and will never divulge

a respondent’s identity, personal information or individual

answers unless specifically given permission to do so.

By Amy Carpenter Aquino, ENA Connection

Survey Says! Your Voice Carries

“ENA wants members to know that we are really listening.’’

LAURA JIGGENS, ENA Market Research Manager

22

GOVERNANCE

T he 2014 ENA General Assembly

will be held Oct. 7-8 in

Indianapolis. ENA President Deena

Brecher, MSN, RN, APN, ACNS-BC,

CEN, CPEN, will preside.

Approximately 700 delegates

representing ENA’s state councils and

international members will debate and

vote on issues that affect the

emergency nursing profession.

Attending the 2014 General

Assembly is a wonderful opportunity

for members to understand how

decisions are made concerning the

direction and stewardship of the

association. The General Assembly

agenda includes the installation of the

2015 ENA Board of Directors and

Nominations Committee, with reports

by the president, president-elect,

treasurer and executive director.

Delegates will also consider and act on

proposed resolutions and bylaws

amendments.

At its May meeting, the ENA Board

of Directors reviewed this year’s

proposals. Final proposals, including

any additional bylaws amendments

submitted by the July 10, 2014,

deadline, will be posted in August in

the online General Assembly

Handbook at www.ena.org for

viewing by all state councils, chapters

and assigned delegates.

Summaries of the proposed

resolutions and bylaws

amendments follow:

ENA ResolutionsUpdate the “Consensus

Statement on

Definitions for

Consistent Emergency

Department Metrics”:

This resolution recommends

that ENA work with stakeholder

organizations to revise and update the

‘‘Consensus Statement on Definitions

for Consistent Emergency Department

Metrics’’ to minimally include

definitions for the terms ‘‘disposition

decision time,’’ ‘‘admit decision time’’

and ‘‘boarded admitted patient.’’

ENA’s Role in Firearms Safety:

This resolution recommends that ENA

advocate for the creation of a national

background check before all firearm

purchases, a five-day waiting period

before purchase and support for

evidence-based education on firearm

safety. The General Assembly has

previously adopted resolutions

regarding firearms: GA01-02 and

GA10-13.

Emergency Nurses Advocate for

Reduction in Prescription Drug

Abuse: This resolution recommends

that ENA develop resources in the

areas of pain management, medication

storage and medication disposal;

encourage ongoing research on

evidence-based pain management

strategies; and collaborate with

organizations to reduce the incidence

of prescription drug recreational use

and overdose events.

Patient Education for Mild

Traumatic Brain Injury/

Concussion: This resolution

recommends that ENA

update the position

statement on Unintentional

Sport and Recreational

Injuries to recommend that emergency

departments provide 1) patient

education on post-concussive syndrome

and 2) cognitive rest and return-to-play

guidelines, and that ENA explore or

develop an educational resource on

mild traumatic brain injuries.

Use of Orientation Guidelines:

This resolution recommends that ENA

identify best practices for orientation

timelines, delivering content and

tracking the progress of new graduate

or new-to-the-specialty nurses.

Support of Creating a National

Trauma System: This resolution

recommends that ENA support

development of a national trauma

system across the continuum of

integrated care, including injury

prevention, and express support of this

endeavor through a position statement.

Meaningful Use and Nurse

Protocols: This resolution

recommends that ENA’s protocol

position statement be revised to

include identifying emergency

registered nurses as licensed health

care providers and verbiage regarding

the entry of protocols into the

electronic health record.

ENA Board of Directors Support:

This resolution recommends that the

2014 ENA General Assembly

acknowledge the ENA Board of

Directors’ diligence in performing its

leadership role, appreciate its efforts to

continue ENA’s growth and

We Have Much to Discuss in Indianapolis2014 Proposed Resolutions and Bylaws Amendments


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development as a leader among

specialty associations and value its

efforts in ensuring a clear vision of

ENA’s future.

Standardization of Emergency

Codes Nationwide: This resolution

recommends that ENA advocate for

and take a leadership role in the

development and nationwide

implementation of standardized plain

language hospital emergency code

terminology.

Bylaws AmendmentsArticle VIII – Resolutions

Committee Name: The authors offer

this amendment to change the

committee name to properly reflect its

responsibilities.

Article VIII – Resolutions

Committee Composition: The authors

recommend this amendment to add an

additional member to the committee for

effective leadership succession planning

and increased productivity.

Article V – State Captains: The

authors propose this language for

consistent language throughout ENA

documents, with ‘‘state captains’’ in

place of ‘‘lead delegate.’’

Articles VIII and XII – Bylaws and

Election Rules Submission

Deadline: The intent of this

amendment is to standardize and

streamline the deadlines for submitting

materials for the General Assembly

meeting. The bylaws, resolutions,

election rules and General Assembly

Standing Rules of Procedure currently

have different timeframes. Standardized

submission dates will be clearer for the

members.

Article III – Dues Waiver

Eligibility for Senior Members: The

authors offer this proposal to retain

member benefits for senior members

without cost to the member.

Articles IV, VI and VIII —

Eligibility Requirements:

Background Checks: The authors

want to streamline the election process

by eliminating the employment

verification and highest academic

achievement verification from the

background check process.

Article VIII – Nominations

Committee Chairperson Election:

Adopting this proposal will allow the

committee to select its chairperson

without being attached to a specific

event.

Articles VIII – Nominations

Committee Name: The authors offer

this amendment to change the

committee name to properly reflect its

responsibilities.

Article III – Suspension and

Termination of Membership: The

authors offer this amendment to more

clearly define the grounds and

procedures for disciplinary action

against a member.

24

COURSES

In an effort to provide its emergency

nurses with proper training and

knowledge on caring for the elderly

population, Baylor Scott & White

Health-North Texas ordered 100

licenses of ENA’s Geriatric Emergency

Nursing Education online course in

March, making it ENA’s largest

GENE order to date.

ENA member Kristine

Powell, MSN, RN, CEN,

NEA-BC, director of emergency

services at Baylor Scott &

White-North Texas, said

improving care for the elderly

has been a strong focus at

Baylor for several years.

‘‘From the ED perspective, we are

looking at issues such as how to

prevent readmissions because a large

number of our elderly patients are at

high risk of avoidable readmissions,’’

she said. ‘‘We want to improve care

and reach out to them out in the

community to prevent exacerbations of

their chronic disease so that they don’t

end up back in the hospital. We are

really looking at patient-centered care

and want the quality of life for our

patients as optimal as possible. Part of

that has to do with education in the

emergency department. It’s one piece

of the larger puzzle.’’

According to the Deerbrook

Charitable Trust, more than 40 percent

of hospital patients are over 65, but

fewer than 2 percent of nurses have

certifications in geriatrics. Recognizing

the need to improve education for this

population, in 2011 the Deerbrook

Charitable Trust awarded Baylor

Health Care System a three-year grant

totaling $12.4 million. Powell said the

grant allowed the purchase of the 100

GENE licenses for emergency nurses,

reflecting about 20 percent of Baylor’s

emergency nurse population.

‘‘Baylor has been very innovative

and proactive in helping to manage

health care for this population,’’ she

said. ‘‘We received the grant

specifically to do work around

elderly care at Baylor, not just

in the hospital but also out in

the community. We’re trying to

build subject-matter experts in

our emergency department and

get them engaged with being a

clinical resource for frontline

staff. We have a definite need

within the ED for this knowledge, and

a focus on ED nursing education is

essential.’’

One of Powell’s priorities is to have

her nurse educators incorporate four of

the GENE licenses into their ED

internship program so new nurses can

receive the course content immediately.

‘‘As we continue to do this work,

we want to embed this clinical

information about the care of elderly

patients in the ED as standard practice

and standard knowledge,’’ she said.

‘‘We’re really taking it down two paths

— one is for nurses who are new to

the ED, and the other is a refresher for

our current nurses.’’

The average age of an

emergency nurse at Baylor

University Medical Center is 32,

Powell noted, adding that the ED

has a high number of Generation Y

nurses who haven’t received

education in geriatric care.

Powell is looking forward to

raising awareness of elderly

patients’ special needs and having

emergency nurses on the front lines as

subject-matter experts and clinical

resources for other nurses. But she is

also looking to do more.

‘‘I’m also looking to step it up a

notch to give a hundred of our nurses

that foundational education,’’ she said.

‘‘I want to be able to pull them

together to look at how we care for

elderly patients in our ED and really

start building better workflows.’’

Powell attended the previous GENE

pilot program, delivered in a classroom

setting at the 2004 ENA Annual

Conference in San Diego. She is

confident the new online course will

be beneficial to emergency nurses.

‘‘I’m an ER nurse, and I am a lifetime

member of ENA,’’ she said. ‘‘I have

been active in ENA for 25 years. This is

an evidenced-based program developed

by my professional organization. I am

also a TNCC and ENPC instructor and

course director, so I know the caliber of

the programs that ENA puts out, and I

trust ENA’s products.’’

For more information on the new

GENE online course or to find out how

you can purchase it for your

emergency department, e-mail

[email protected], call 847-460-4055 or

visit www.ena.org/education/

education/GENE.

BETTER CARE x100By Kendra Y. Mims, ENA Connection

Texas Health System Buys GENE Course in Bulk for ED Nurses

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W hen the time for your annual

performance evaluation rolls

around, do you dread it and consider

calling in sick to avoid it, or do you

welcome it? Many individuals take a

let’s-just-get-it-over-with approach. But I

challenge you to welcome your annual performance

evaluation, to take it as an opportunity to own your career

and take charge of your professional development.

Here are a few tips as you enter into your own annual

evaluation period:

• Spend time on self-assessment; honestly reflect on

your accomplishments and your challenges during the year.

• Be prepared to have a detailed discussion with your

supervisor about your goals, your questions and your

opportunities.

• Remember that feedback is a gift; be accepting of the

gift being given to you and figure out how to make the

most of it for your personal and professional development.

• Make a plan for the upcoming year and obtain support

and guidance from your supervisor and other mentors.

• Stay focused on your plan; schedule checkpoints,

look for opportunities to accomplish stretch goals and add

to your professional experiences.

As your professional organization, ENA is committed to

helping you accomplish your professional goals. For more

resources and information, visit the career wellness page at

www.ena.org/membership/Career Center or e-mail

[email protected].

FUTURE OF YOUR NURSING Bridget Walsh, PHR, Chief Talent Officer

Performance Evaluation: Love It or Hate It

Call for Memorial Requests at 2014 ENA General Assembly

Deadline: Wednesday, Aug. 20, 5 p.m. Central time

ENA will honor our members who have died in the last

year during a special memoriam presentation during the

2014 General Assembly in Indianapolis. If you would like

to recognize a member who has died, please complete

the request form found in the General Assembly area

(members only) at www.ena.org. All requests must be

submitted electronically to [email protected].

June/July 201426

ONLINE LEARNING

Stroke is a leading cause of death

and disability in the United States.

ENA and Genentech have joined forces

to provide online training, with critical

educational resources to help

emergency nurses better identify,

diagnose and treat stroke.

ENA launched the free online

training modules on its learning

management system at www.ena.org

in April. The stroke management

learning system will be available for

one year until April 2015.

The program is divided into three

modules designed to introduce

emergency nurses to some key

concepts surrounding stroke with an

emphasis on acute ischemic stroke.

Module 1 covers basic stroke

education. Topics include stroke

epidemiology, ischemic

pathophysiology and brain anatomy.

Participants will learn how to identify

risk factors for stroke as well as

potentially modifiable risk factors such

as hypertension, diabetes, obesity,

high cholesterol and smoking, and

non-modifiable risk factors such as

previous stroke, family history, age

and hypercoaguable states. The

modules also cover the two different

types of stroke.

Module 2 focuses on in-hospital

diagnosis of acute ischemic stroke.

Learners will discover effective ways to

rapidly recognize stroke symptoms,

apply time-saving recommendations

and determine treatment options.

Vibrant graphics illustrate the

differences between what happens to

the body during a large vessel

ischemic stroke and during a transient

ischemic attack. Participants also will

learn how delays in medical

management of acute ischemic stroke

patients can affect their outcome.

Module 3 teaches stroke treatment

and management of acute ischemic

stroke, with an emphasis on the

management of confirmed acute

ischemic stroke. It includes review of

patient eligibility for treatment,

potential risks and benefits of therapy,

dosing and administration, and

post-treatment monitoring and care.

The modules provide a variety of

teaching techniques, including videos

and an option to click on new or

unfamiliar terms for pop-up

definitions.

“This program will provide an

overview of stroke basics; review the

assessment of a patient with suspected

stroke; and comprehensive treatment

guidelines with fibrinolytic therapy for

a patient with an ischemic stroke,’’ said

Alyssa Kelly, MSN, RN, CNS, CEN,

senior associate, ENA Institute for

Emergency Nursing Education. ‘‘It will

assist the learner in meeting the NINDS

in-hospital time goals for patients with

suspected stroke, thus improving

patient outcomes.’’

ENA Partners With Genentech to Launch Stroke Management Learning System

How to Take the CourseMembers can access the online education modules at www.ena.org/education/onlinelearning/Pages/Stroke.aspx or learn.healthstream.com/accesspoint/genentech.

Note: No continuing education credits are offered for this course. Participants will receive a certificate of completion.

By Amy Carpenter Aquino, ENA Connection


T he influence of

evidence-based practice

resonates throughout

nursing, impacting education, practice and research.

The demand for evidence-based quality

improvement and performance requires nurses to

have the best tools and resources for success.

Applying research evidence and integrating the

knowledge into clinical practice is now the expected

standard of performance for a majority of health care

organizations. Understanding the various levels of

evidence assists nurses in evaluating and

determining its relevance and how it can be

incorporated into best practices. EBP is a systematic

and scientific approach that is constantly changing

but is compulsory for safe practice, safe care and

clinical decision-making.

As stated by Baker, et al.,1 emergency nurses are

in an exclusive position to not only improve care

but also improve nursing practice by implementing

and using several forms of scientific inquiry.

However, finding the right tools and resources can

be daunting; the overwhelming amount of

information available can make it difficult to know

what is authoritative, current and scholarly.

Fortunately, ENA has developed user-friendly clinical

resources and publications that provide electronic

and print materials to support nursing education,

practice and research. A variety of essential

information can be obtained from ENA’s practice

website: www.ena.org/practice-research/

Practice/Pages/PracticeResources.aspx.

Among these practice resources are clinical

practice guidelines, position statements, emergency

nursing scope and standards of practice, ENA’s

translation into practice, toolkits, topic briefs and

white papers. These tools and resources provide

current, scholarly and evidence-based information

which supports emergency nursing practice.

Practice resources have substantial supportive

information that can be used to not only guide

practice but also to improve health care delivery.2

The information obtained from the practice

Clinical Practice Guidelines• Evidence-based; assist in translating research into practice• Recommendations based on systematic review and critical analysis of current and scholarly literature• Formerly known as Emergency Nursing Resources

Position Statements• Statements of beliefs that reflect ENA’s stance on issues relating to safe practice, safe care and patient outcomes• ENA position statements, including joint statements and supported statements• Archived position statements

Emergency Nursing Scope and Standards of Practice• Benchmark guide for professional emergency nursing• Resource for practice, standards and competencies expected• Establish nursing professional performance standards

ENA’s Transitions into Practice • Quick reference with level of evidence recommendations• Assist in facilitating and applying current evidence into practice• Examine current topics in everyday emergency nursing practice and make recommendations for transition into practice

Toolkits• Collective resources that include education, forms, links and valuable material useful in implementing change and improving practice• Contain documents that will assist an individual to champion a project or implement a program

Topic Briefs• Supportive documents that provide detailed information on a given subject of importance, particularly to safe practice and safe care• Examine relevant issues: adult immunizations, the bariatric/obese patient, health literacy, health information technology and the health work environment

White Papers• Distinctive and authoritative reports focused on specific topics• Presentation of research with a specific purpose, audience and organization• Current white papers address care of the psychiatric patient in the ED and nurse fatigue

ENA PRACTICE RESOURCES

A Toolbox of Tips For SuccessBy Monica Escalante, MSN, RN, Senior Associate, Institute for Quality, Safety and Injury Prevention

Continued on page 31

June/July 201428

“Appreciation is a

wonderful thing. It makes

what is excellent in others

belong to us as well.”

Could Voltaire’s words be applied to the ENA

Foundation and its ongoing journey toward

building a strong foundation?

Since January, I have spoken with and written to many

ENA members to share my appreciation for their

contribution to our mission of enhancing emergency care

through education and research. We know and celebrate our

differences — various values, motivations and passion.

However, we are all linked inextricably by a common thread

of emergency nursing. The fact that you are drawn to

emergency nursing makes you committed to excellence, and

excellence is never an accident — it is a standard to which

we hold ourselves and others. We should all be involved in

building a strong foundation so that we can ensure the

integrity of not just the ideals of excellence for ourselves, but

also for our colleagues who work in the triage room, the

nurse who covers our break, the educator who teaches us,

the charge nurse who runs interference and the manager

who helps lead us inside and outside the ED. Virtually every

aspect of emergency care is entwined in the excellence of

those around us. If they perform well, we all perform well.

When we appreciate and help those around us, we all

succeed.

Let me share how scholarship recipients — and your

colleagues — praised your ENA Foundation at a recent

Maine ENA State Council meeting.

‘‘I am very proud to be a part of an organization that

supports and promotes its members through continuing

higher education,’’ said ED educator Lauren Vickerson, BSN,

RN, CEN.

‘‘I owe success to those who support the ENA Foundation

and who support emergency nurses throughout the country

. . . I am proud to be a part of such a professional and

well-respected group of peers,’’ said Jennifer Granata, MSN,

RN, CEN, an ED manager.

In Colorado, emergency physician Lee Shockley, MD,

described why he donates to the ENA Foundation: ‘‘Effective

emergency care requires teamwork and highly skilled

professionals. . . . As an emergency physician, I believe that

support for emergency nurses is one of my duties. The ENA

Foundation’s scholarships for emergency nursing education

are a way that I can help provide that support.’’

I would like to let you in on a badly kept secret: It’s not

only your peers who want to see you succeed. We receive

gifts from members of the public (yes, your patients) who

donate simply because they wish to pay it

forward and they see the benefit of having a

highly educated emergency team. On the ENA

Foundation Board of Trustees, highly engaged

corporate trustees participate to ensure that you

can continue to learn and that you get an opportunity to

grow.

Ken Craig, MBA, corporate trustee-at-large from Physio-

Control Inc., shared an experience with me: ‘‘I recently sat

next to someone at dinner that had benefited from an ENA

Foundation academic scholarship that helped her complete

her master’s degree and advance her hospital career. It was

heartwarming to hear how grateful she was to the ENA

Foundation and to those companies that provide funding for

those scholarships. The ENA Foundation really does make a

difference!’’

John Proctor, MD, MBA, FACEP, FAAP, American College

of Emergency Physicians Emergency Medicine Foundation

representative, said, ‘‘I know the foundation to be committed

to the welfare and success not only of the nursing providers

of emergency care, but to the patients we serve.’’

I hope you can see what is happening here: It’s Voltaire’s

excellence in motion. It is us appreciating our job, our

practice and each other by helping us become better at what

we do. This is a movement that you are either part of or not.

If you believe in it, donate today. You can become the

ultimate colleague by making a conscious decision to help

your team by making a donation. It’s you who is defining

our practice, it’s you who is creating the increase in

knowledge, it’s you who should also be donating to help

those who help you every day. I believe that you want

to continue to work with the best, so let’s give

the best a chance by supporting the ENA

Foundation so it can keep providing

scholarships and research grants.

This is building a strong foundation,

this is emergency nursing, this is excellence

in motion, this is your ENA Foundation and

this is why you should get involved and

make a donation. For the sake of excellence

and your colleagues, please make a donation

at www.enafoundation.org or call the ENA

Foundation at 847-460-4100.

Be the Ultimate ColleagueENA FOUNDATION | Seleem Choudhury, MBA, MSN, RN, CEN, 2014 ENA Foundation Chairperson

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June/July 201430

EMERGENCY NURSING RESEARCH

Every day, in every emergency

department throughout the United

States, emergency nurses are faced with

questions about how to provide the

safest, best-quality care to patients.

Nurses already adjust their practices

based on the latest evidence and

practice experience to deliver better

care to emergency patients. However,

what happens when nurses seek

answers to questions and find there is

no current evidence to answer these

questions?

Working with emergency nurses to

unearth evidence answering these

questions is the goal of the Institute for

Emergency Nursing Research. The IENR

seeks knowledge through research

studies that answer questions about

improving the safety and quality of

patient care.

The mission of the IENR is to

conduct and facilitate research and evidence-based practice

in emergency nursing, with a vision to be a source of

research and information for evidence-based emergency

nursing practice and care. Our mission and vision are active

in our many activities, such as authoring a series of research

articles in the Journal of Emergency Nursing and research

projects, such as seeking answers to help emergency nurses

deal with violence in the emergency department, identifying

educational needs in rural hospitals and recognizing issues

with behavioral health patients.

The IENR also organizes and staffs the Research Lounge

at the ENA national conference. The Research Lounge is

staffed with doctorally prepared emergency nurses who help

stretcherside nurses develop research projects. Research

Lounge attendees receive support creating research

questions, developing strategies to sample a target

population, developing a specific research methodology and

other assistance.

On April 22-23, the IENR advisory council met at ENA

headquarters in Des Plaines, Ill., to discuss burning questions

in emergency nursing. Studies carried out under the leadership

of director Lisa Wolf, PhD, RN, CEN, FAEN, include:

• Understanding current ED discharge processes for

patients receiving Schedule II and III pain medications (study

in data analysis phase).

• Investigating the relationship between emergency

nurses’ reported sleep and their perceived fatigue and

cognitive ability (study in preliminary development phase).

• Seeking out the nature of moral distress/despair

experienced by emergency nurses (study in preliminary

development phase).

IENR members were also updated on the March 2014

National Nursing Research Roundtable at the National

Institutes of Health, sponsored each year by the National

The 2014 IENR Advisory Council: Front row, from left: Gail Lenehan, EdD, MSN, RN, FAEN, FAAN; Board of Directors liaison Michael Moon, PhD, MSN, RN, CEN, CNS-CC, FAEN; IENR senior administrative assistant Leslie Gates; middle row: IENR senior associate Cydne Perhats, MPH, IENR; Kathleen E. Zavotsky, MS, RN, CEN, ACNS-BC, CCRN; Kathy M. Baker, PhD, RN, NE-BC; back row: Margaret J. Carman, DNP, MSN, RN, CEN, ACNP-BC; IENR senior associate Altair Delao, MPH; Paul R. Clark, PhD, MA, RN; IENR director Lisa Wolf, PhD, RN, CEN, FAEN; Kevin Langkiet, MSN, RN.

Better Care Through the IENRBy Paul R. Clark, PhD, MA, RN


resources can be used as references for research,

educational purposes and to assist in implementing

change. For example, reviewing CPGs may influence

further investigation into an organization’s procedure

for using capnography during procedural sedation/

analgesia. Reviewing CPGs for prevention of blood

culture contamination might impact hospital policies

and protocols.

TIPs can act as a quick reference to simplify

applying current evidence in emergency nursing.

ENA’s available toolkits are valuable materials that can

assist individual champions to implement a program or

function as support for projects. Position statements,

the Emergency Nursing Scope and Standards of

Practice, topic briefs and white papers are also

essential practice resources with detailed evidence that

may serve as a reference or inspire change.

Diane Gurney, MS, RN, CEN, 2010 ENA president,

shared how ENA’s practice resources have helped her

provide safe care to her patients.

‘‘The ENA website is my ‘go-to’ place for emergency

nursing practice information,’’ Gurney said. ‘‘For years

I have relied on ENA for current, evidence-based

knowledge to support my emergency nursing practice.

The clinical practice guidelines have been invaluable

in assisting me with current scientific knowledge

regarding such practice issues as orthostatic vital signs,

non-invasive blood measurement and gastric tube

placement verification. As a manager, I used the ENA

position statements to help justify the need for trauma

nursing education, standards for triage nursing and the

importance of a hospital-wide multidisciplinary

approach to implementing strategies for holding and

crowding. It is all in one place, easy to use,

comprehensive and evidence-based.’’

References

1. Baker, K.M., Clark, P.R., Henderson, D., Wolf, L.A.,

Carman, M.J., Manton, A., & Zavotsky, K.E. (2014).

Identifying the differences between quality

improvement, evidence-based practice, and original

research. The Journal of Emergency Nursing, 40(2),

195-197. doi: 10.1016/j.jen.2013.12.016

2. Peterson, M.H., Barnason, S., Donnelly, B., Hill, K.,

Miley, H., Riggs, L., & Whitemand, K. (2014). Choosing

the best evidence to guide clinical practice: Application

of AACN levels of evidence. Critical Care Nurse, 34(2),

58-68. doi:10.4037/ccn2014411

ENA Practice Resources Continued from Page 27

Institute of Nursing Research. We also discussed ways to

improve ENA members’ access to research tools through the

research section of the ENA website and how to develop the

Research Lounge at the 2014 ENA Annual Conference in

Indianapolis.

The IENR encourages emergency nurses to seek answers to

questions that are not answered by current evidence. If you

have questions about initiating a research project in your

emergency department, contact Lisa Wolf at [email protected]

and visit the IENR website: www.ena.org/practice-

research/research.

2014 ED Operations CommitteeThe Emergency Department Operations Committee

convened at ENA headquarters for an onsite meeting

March 27-28. Members focused on committee charges by

reviewing and recommending topics for the Key Concepts

in ED Management program and developing content for

an ED manager survival guide.

The ED Operations Committee charges for 2014 are as

follows:

1. Provide subject-matter expertise related to

emergency department operations.

2. Identify and recommend resources for emergency

department operations/management.

Committee Members

Fred Neis, MS, RN, CEN, FACHE, FAEN, chairperson

Frances Damian, MS, RN, NEA-BC

Mark Mayes, MHA, BSN, RN, CEN

Kristine Powell, MS, RN, CEN, NEA-BC

Maryfran Hughes, MSN, RN (not pictured)

Board Liaison

Kathleen Carlson, MSN, RN, CEN, FAEN

June/July 201432

CERTIFICATION

ENA collaborated with the American Nurses Credentialing

Center in 2012 on a new methodology for assessment of

emergency nurse practitioners with the development of

certification by portfolio. A portfolio contains evidence of

professional practice. The ANCC portfolio program contains

requirements in four domains of practice: professional

development, professional and ethical nursing practice,

teamwork and collaboration, and quality and safety. No

examination is required. All portfolios submitted in this

certification program are subject to peer review. If the APRN

application is approved and passes the peer review program,

the certification of ENP-BC is awarded.

Nurses credentialed through the ANCC program are

established as experts in their specialty. Advanced practice

nurses practicing within an institution are required to comply

with the credentialing and privileging process in their facility,

which includes the common elements documented in this

ANCC portfolio certification. This certification is renewable

every five years.

As the momentum proceeds toward full implementation of

the Consensus Model for APRN Regulation, dialogue is

occurring in many states on aligning the necessary elements of

the model. Discussion on professional portfolios occurred this

year in Nevada, where a regulation passed in February

indicates all Nevada APRNs must maintain a professional

portfolio subject to audit by the board. Nevada further explains

that it may deny the renewal of a license to practice if it finds

an APRN has failed to maintain the portfolio required.

In a ‘‘President’s Blog’’ posted last fall, JoAnn Lazarus,

MSN, RN, CEN, the ENA 2013 president,

announced the launch of the ANCC

ENP-BC credential.

‘‘For advanced practice RNs,

credentialing by portfolio is an opportunity

to be recognized for meeting the criteria

established by emergency nurse

practitioner peers as having the

skill and knowledge

to practice,’’

Lazarus wrote.

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T he appearance of

the Middle East

Respiratory Syndrome in

the United States has

prompted emergency

clinicians to take a critical

look at patients who have

a recent history of travel

to the countries in the

Saudi Arabian peninsula

and are presenting to

emergency departments

with respiratory illness.

MERS-CoV is caused

by a coronavirus. To

date, the Centers for

Disease Control and

Prevention have limited

information on the

pathogenic potential and

the transmission

dynamics of MERS-CoV

but note that the

incubation period is often

five days, with an outer

limit of 14 days.

CDC recommends

collecting multiple

specimens from different

sites after symptom onset.

The CDC guidelines for

collecting, handling and

testing clinical specimens

from suspected cases can

be found at www.ded.

gov. Many state health

departments are approved

for MERS-CoV testing.

Clinicians Advised to Watch for MERS

T he Consensus Model for APRN Regulation was crafted

five years ago to address issues related to practice for

advance practice registered nurses. The model provided a

framework for creating a uniform structure of APRN

regulation for use across the United States. It also aimed to

align the relationships among licensure, accreditation,

certification and education. This alignment would allow

APRNs to practice to the full extent of their education and to

move easily from state to state in order to increase access to

much-needed care for many patients. The model was

endorsed by ENA as well as 47 other nursing organizations.

The four APRN roles defined in the Consensus Model are:

• Certified Registered Nurse Anesthetist

• Certified Nurse Midwife

• Certified Clinical Nurse Specialist

• Certified Nurse Practitioner

Since the publication of the Consensus Model,

organizations representing licensure, accreditation,

certification and education have strived to make the changes

required to align with the Consensus Model, with an

intended full implementation target of January 2015. The

January publication of the Journal of Nursing Regulation

noted there are 229,955 individuals in the U.S. who currently

hold advanced practice nursing licenses, Maureen Cahill,

MSN, RN, APN-CNS, associate director of nursing regulation

at the National Council of State Boards of Nursing, said at a

LACE meeting in Chicago in April.

The APRN Campaign for Consensus initiative is focused on

assisting states in aligning their APRN regulation with the major

elements of the Consensus Model. Those major elements are:

• State recognition of each of the four described roles

• Licensure and title of APRN in the roles

• Graduate or post-graduate education from an

accredited program

• Certification at an advanced level from an accredited

program that is maintained

• Independent practice

• Independent prescribing

Cahill acknowledges the journey is 69 percent complete.

The status of individual states related to full implementation of

the consensus model can be found on the National Council of

State Boards of Nursing website at www.ncsb.org/aprn.

htm. The National Council 2012 document, A Health Care

Consumer’s Guide to Advanced Practice Registered Nurses, can

be downloaded for free from the website.

The Consensus Model for APRN Regulation: Status 2014

June/July 201434

MILITARY NURSING

Lt. Col. Kathleen Richardson still

remembers seeing her first

explosive injury during her first

deployment in Iraq. Although she had

seen amputations and partially injured

limbs before, this particular injury

pattern was unlike anything she had

ever witnessed during her 18-year

Army nursing career.

‘‘It was very graphic to me,’’ she

said. ‘‘I remember looking at that leg

and thinking that the bone reminded

me of slivers of wood.’’

Richardson, DNP, RN, ARNP, CNS,

NP-C, CEN, deployed to Iraq in 2007

for 15 months with a forward surgical

team. As the emergency medical

treatment officer in charge, she was

responsible for the entire management

and oversight of the 102nd Forward

Surgical Team emergency treatment

section. During the first part of the

deployment, her team was co-located

with the 86th Combat Support Hospital

during the troop surge, where they

worked alongside the hospital’s

physicians and nurses to treat various

traumas and illnesses, including a high

number of patients with appendicitis

and tuberculosis.

Richardson and her team found

themselves treating soldiers, coalition

forces and insurgents in the emergency

area at the same time.

‘‘We cared for everybody who came

into the hospital, and that was an

interesting thing to deal with,’’ she

said. ‘‘Some of the patients who came

in were afraid that we were going to

hurt them instead of treat them. You

could tell they were apprehensive and

hypervigilant until they realized that

we weren’t going to hurt them, and

then you could visibly see them relax.

It was an ongoing process to gain their

trust. They got the same standard of

care that we gave to everyone else.’’

Richardson discussed the danger of

having the interpreters there to help

them communicate. Sometimes the

interpreters had to hide from the

insurgents to protect their identities.

‘‘If one of the insurgents came in,

we made efforts to ensure that the

interpreters’ faces were not seen so

that they wouldn’t be identified,

because if the interpreters were

identified, their families could be at

risk,’’ Richardson said. ‘‘As we were

there longer, we started learning the

language so that we could

communicate without the interpreters.’’

Richardson described her

experience in Iraq as both rewarding

and challenging.

‘‘It was a growth experience, both

personally and professionally, and the

first time I had the opportunity to do

what I had joined the military to do

and what I was trained for,’’ she said.

‘‘I had the chance to meet a lot of

people from different walks of life,

whether they were from Iraq or the

coalition forces. We were able to learn

from some of the other health care

providers, and we taught trauma

training to some of the doctors and

nurses in Iraq who were going to be

stationed in hospitals out in the

population. That was very rewarding.’’

When Richardson returned from

Iraq she became the emergency and

critical care career manager/U.S. Army

Human Resources Command for

VETERAN OF TWO FRONTSBy Kendra Y. Mims, ENA Connection

Member Finds Military Nurses, Emergency Nurses Not So Different in Their Roles

Lt. Col. Kathleen Richardson, DNP, RN, ARNP, CNS, NP-C, CEN.


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several years. She enjoyed her role as

the assignment officer and career

manager for emergency and critical

care nursing officers in the U.S. Army.

‘‘In the Army, you are managed by

an individual who looks at all of the

assignments across the world,’’ she

said. ‘‘We would make visits to

different hospitals to talk to individuals

face-to-face to learn more about their

personal and professional goals and

pair their goals with the training they

needed to be successful. We would

help them plan their careers, whether

it was moving up or getting out of the

Army and help them work through

making those decisions. We worked

closely to make sure that we had the

right people in the right places at the

right times, while ensuring that the

hospitals could still run efficiently

during their leave of absence.

Balancing that was the hard part.’’

Today, Richardson is the Uniformed

Services University, Doctor of Nursing

Practice phase II Residency director

and a practicing nurse practitioner at

Madigan Army Medical Center.

Looking back at her career, she

says becoming an Army nurse gave

her the opportunity to do things she

wouldn’t have accomplished if she had

worked in the civilian sector, such as

transporting patients via helicopter as a

flight nurse and developing flight

protocols.

‘‘I’ve had the opportunity to teach

and meet people from different

branches of the service,’’ she said.

‘‘Every time that I’ve met a new person

or went to a new facility, it’s helped

me grow and understand what my role

as a military nurse really means.

‘‘I think being an Army nurse is

really looking at what you want to do,

who you want to be and what you want

to contribute. Being an Army nurse has

helped me continue to strive to reach

my full potential and give back to the

nurses who are coming up behind me

to ensure they are getting the support

they need. They are going to take care

of me and my family someday, and if

they can use what I’ve learned to grow

even further, then we are bettering

nursing and health care as a whole.’’

Richardson believes the roles of

emergency and military nurses go

hand in hand.

‘‘The emergency nurse is that

frontline health care provider who is

there to ensure that individuals get the

support and care that they need,

whether it’s for a trauma or a cold,’’

she said. ‘‘I think the goal of the

military health system is to make sure

that soldiers are healthy and get the

care they need to do their jobs. When

it comes down to it, the army nurse

and emergency nurse are both there to

help the individual who is in need

right now get back to their life.

Whether it’s being a nurse in the ED in

the civilian sector or in the military

sector, it’s the same mission.’’

T he Academy of Emergency

Nursing launched the EMINENCE

(Establishing Mentors InterNationally

for Emergency Nurses Creating

Excellence) program in 2008 to pair

ENA emerging professionals with

experienced AEN fellows to work on

specific projects for one year. Previous

project topics have included writing for

publication, professional presentation,

research, program development,

advanced practice role development,

injury prevention and educational

conference planning.

ENA member Charlann Staab, MSN,

RN, CFRN, CHC, CHPC, clinical

services manager for Phi Air Medical,

LLC, always had wanted to write an

article for a publication but didn’t

know where to begin. In 2012, she

was one of 15 mentees selected to

participate in the EMINENCE program.

That gave her an opportunity to learn

from an emergency nurse who had

expertise in writing and editing for

publication.

She was paired with Carole Rush,

RN, M.Ed., CEN, FAEN, clinical nurse

educator at Okotoks Urgent Care, who

has more than 20 years of experience

in writing and editing for publications.

Rush was a co-section editor, with

Patricia Clutter, for the ‘‘International

Nursing’’ column in the Journal of

Emergency Nursing from 2007 to 2013

and is the case study section editor of

the International Emergency Nursing

Journal, based in the United Kingdom.

Several years ago, Staab developed

an interest in writing on the challenges

of pain management for patients taking

methadone. Once she became a

mentee in the EMINENCE program,

she discussed her aspirations with

Rush, who supported Staab’s goal and

provided her with writing guidance.

Staab is grateful for the support and

direction and said the EMINENCE

opportunity allowed them to build a

lasting relationship beyond the program.

‘‘I was attracted to the EMINENCE

program because you could be

matched with someone who is skilled

and is willing to give you that push,

direction and feedback,’’ she said.

‘‘That was the part I was interested in,

and Carole did that and so much more.

Carole is an editor and has been for

years, along with many other things,

and she was a natural to give me

insight into the writing process. She

gave me the pros and cons and helped

me learn the writing guidelines for

publications. She’s very honest, and

you need a mentor who can be honest

with you, who knows the ropes and

the process and who will help your

project be successful.’’

Rush also participated in the

2010-2011 program as a mentor for an

educational conference-planning

project topic.

‘‘It is challenging to start and

complete a project on one’s own,’’

Rush said. ‘‘The EMINENCE mentoring

program is a good opportunity to work

with emergency nurses who have

common interests and experiences and

who are willing to share their

knowledge and experience, time and

contacts. Everyone can benefit from

both being a mentor and a mentee, so

seek out those opportunities for a

specific project/goal.’’

As Staab’s mentor, Rush said she

learned a lot about the article’s focus,

methadone, and its impact on pain

management in emergency care.

‘‘By helping Charlann through the

writing process, I improved my editing

skills,’’ Rush said. ‘‘Working with

another nurse who is keen to learn and

complete a project is very motivating.

The most satisfying part is giving back

and helping another emergency nurse,

as I have been helped by many nurses

throughout my career.’’

Staab’s article has been accepted for

publication and will appear in the

‘‘Toxicology’’ column of JEN. She also

presented the article at the Arizona

ENA State Council’s ‘‘Hot Topics’’

conference in April.

Staab encourages members to share

their knowledge through the

mentoring program.

‘‘I highly recommend the

EMINENCE program to anyone who

has interest,’’ she said. ‘‘This program

provides you with networking

opportunities and resources, and it

matches you with a knowledgeable

mentor who is accessible and has the

expertise to help you reach your goal.

‘‘I think sharing knowledge is crucial

to our profession. There are a lot of ENA

members who have expertise in a

certain area, or they’ve had an

experience that other members can

learn from, but we’ve got to get it into a

medium where we can share it. Whether

it’s writing for publication, prepping you

to do a dynamite presentation or helping

you to achieve another goal, this

program has the best networking

resources of experts and members.’’

For more information on the

program, please visit www.ena.org/

about/academy/EMINENCE.

June/July 201436

By Kendra Y. Mims, ENA Connection

Find a Perfect Pairing Through EMINENCE

Charlann Staab

Carole Rush

For more than six years, ENA has

administered a State Council

Achievement Award program,

designed to assist ENA state

organizations in developing best

practices and to recognize the states

that have met or exceeded the

necessary requirements. This summer,

ENA will launch a new application

program to reward accountability and

recognize state councils for achieving

best practices and organizational

excellence beyond basic compliance.

The new program will improve

recognition of the states for their

efforts to 1) improve networking

and professional development

opportunities for members and

2) conduct state council affairs in a

sound business manner. State Council

Achievement Award recipients will be

honored based on their outstanding

performance and accomplishments.

The ENA Board of Directors

appointed the ENA State Council

Achievement Award Work Team to

review and recommend the new

application objective. Additionally, the

work team is charged with developing

the application and evaluation tool

and ultimately will be reviewing and

ratifying the applicants.

State councils must meet basic

compliance requirements to be

eligible to complete the award

application.

Standards Changing for State Council Achievement Awards

T he New England Regional Symposium celebrated its

40th anniversary April 16-18 in Mystic, Conn. Each year,

a different ENA state council plans the event, and this year

was the Connecticut ENA State Council’s turn.

Kara Cleveland, BSN, RN, CEN, and Mary Davis, BS, RN,

CEN, were co-chairs of the event. The theme was

‘‘Navigating Change,’’ inspired by the seaport setting of

Mystic along with trends in the current industry.

‘‘Change is all around, and everything is changing in

health care with the Affordable Care Act, high reliability and

hospitals becoming more transparent,’’ Cleveland said. ‘‘We

then focused on the nautical theme.’’

The planning committee worked diligently to create a

successful event. Cleveland noted that one unforeseen issue

was that the conference fell during Easter week.

‘‘We booked the venue in October 2012

and were hoping that since it was during

April break, people could bring their

families. When we realized it was Easter, it

put pressure on us to get the attendees,’’ she

said.

Because of the committee’s efforts

and a strong push during the weeks

leading up to

the event, about

160 nurses registered for the 2014 NERS.

For NERS’s ruby anniversary, the planning committee

focused on the color red. Bags and conference materials

were colored red, and attendees were entered into a raffle

for a ruby necklace. The committee also worked to bring in

presenters who have spoken on a national level, including

ENA President Deena Brecher, MSN, RN, APN, ACNS-BC,

CEN, CPEN, who delivered the keynote address, and ENA

Secretary/Treasurer Kathleen Carlson, MSN, RN, CEN, FAEN.

Feedback for the symposium has been positive, Cleveland

said. A highlight for her was Brecher’s keynote presentation.

‘‘It set the tone for the event,’’ she said. ‘‘The title was

‘My Patients Are Fine, I Am Going to Lunch,’ and it focused

on high reliability, transparency and patient safety.’’

Two events were held for attendees to take in the sights

of Mystic and network with colleagues. A welcome ‘‘Mystic

Pizza Party’’ was well received. ‘‘Drop Anchor at the

Aquarium’’ featured catered hors d’oeuvres and access to the

aquarium at night.

‘‘I think when you’re planning, it takes a whole team,’’

Cleveland said, ‘‘and we had a fantastic committee. They say

‘it takes a village,’ which may be a cliché, but it was our

whole team that pulled together [to make the event a

success].’’

Brecher agreed: ‘‘To have an emergency nursing

conference that spans 40 years is a tremendous

accomplishment. From the emergency nurses

who planned the events to the nurses who

attended, the focus on safe practice and safe

care was clear. It was exciting to be with ENA

members from New England as they

celebrated this great achievement.’’

The Maine ENA State

Council will host the 2015

event.

By Renée Herrmann, ENA Connection

40th Anniversary Celebration for NERS Truly Something to Sea

37

June/July 201438

connectionRecruitment & Professional

Opportunities

For ad rates and information, contact ENA Sales Representative Maureen Nolimal at 847-460-4076 or [email protected].

40 Blue Jay Consulting LLC www.bluejayconsulting.com

33 Chamberlain College of Nursing www.chamberlain.edu

29 Gebauer Company www.gebauer.com

38 JPS Health Network www.JPSNursing.org

39 New Hanover Regional Medical Center www.newhanovered.com

23 Pinpoint Inc. www.pinpointinc.com

5 Teleflex Incorporated www.teleflex.com

16- Teva20 www.tevausa.com

38 University of Virginia Health System www.uvajobsbeyondmeasure.com

ADVERTISER INDEXThese advertisers support ENA Connection. Let them know you saw their ad in this issue.

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When experience meets opportunity, great things happen. University of Virginia Medical Center seeks experienced, caring registered nurses for its emergency department, a Level I Trauma Center.

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• AHA Mission LifeLine Gold Award Recipient in STEMI Care.

• Staff involvement in decision making. Lean incremental improvement, self scheduling, and shared governance.

New stand-alone ED opens in May of 2015! This new ED will include 10 treatment rooms, 2 observation rooms, 5 triage/low acuity spaces and a disposition lounge. Come be a part of our growth!

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ena connection june/july 2014

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