Professional Documents
Culture Documents
connection
March 2013 Volume 37, Issue 3
All Together,
PULL!
Every Bit of Muscle Matters
As We Take Bold New Steps
Through Advocacy
Pages 14-20
5 ENA Co-Founder
Judith
Judith C. Kelleher,
1923-2013
22 No Career Wasted:
A Nurse’s Path Back
After Substance Abuse
INSIDE 32 Member Finds Paradise
FEATURES Needs Good Teachers
The responsive
hospital delivers
exceptional CPR
And they choose Physio-Control
to help make it happen.
With Mentoring,
Assembly at Annual Conference in
Nashville, Tenn.
We Make Magic
for Leadership Conference 2014 in
Phoenix (March 5-9, 2014).
PAGE 26
CourseBytes Official Magazine of the Emergency Nurses Association 3
Fellowship Adds Fuel WHAT’S NEW WITH YOU?
Make time in March to slide up to
to Illinois Nursing E-mail connection@ena.org to
tell us about your recent successes or
your computer and take ENA’s latest
free continuing education course.
Leader’s Research to celebrate those of a member
colleague. Include names, credentials
‘‘GU: It’s More Than Just P,’’ by
Steve Stapleton, PhD, RN, CEN, the and, if applicable, photos of the
Michael D. Gooch, MSN, RN, CEN,
CFRN, ACNP-BC, FNP-BC, EMT-P, is immediate past president of the Illinois nurse(s) being recognized.
an e-learning program worth 1 ENA State Council and an assistant
contact hour. It reviews the anatomy professor at Illinois State achievement,” Stapleton wrote in his
and physiology of the genitourinary University’s Mennonite fellowship application, ‘‘that I will
tract, the clinical manifestations
College of Nursing, has accomplish my objectives while
associated with common GU
disorders and patient management. received a Nurse inspiring others to seek rewarding
Educator Fellowship professional and/or academic careers.’’
To take this and other courses in the
CE catalog:
from the Illinois Board of
Education. THREE ENA MEMBERS AT THE
o to www.ena.org/freeCE,
•G
The award is aimed at retaining top University of Texas Medical Branch in
where you’ll log in as an ENA
member (or create a new nursing faculty at Illinois nursing Galveston were among 11 co-authors of
account). colleges and universities. It includes a an article on UTMB’s revised annual
•A
dd desired courses to your $10,000 grant for continuing research. evaluation process.
cart and ‘‘check out’’ (courses Stapleton’s research centers on Valerie Brumfield, MSN, RN, CCRN, a
are completely free for managing pain for emergency clinical nurse specialist in the emergency
members only). department patients, particularly after department; Leanne Ledoux, BSN, RN,
•P
roceed to your Personal discharge, with the goals of better CEN, SANE, the assistant nurse manager
Learning Page to start or practice, better outcomes and fewer in the ED; and Ruth A. Sathre, MSN, RN,
complete any course for which readmissions. Self-described as a ‘‘strong CEN, a former ED staff nurse who’s now
you have registered or to print a
proponent of lifelong learning,’’ he in the Doctor of Nursing Practice
certificate when you’re done.
previously has received research grants program at Walden University, helped to
•T
o return to your Personal
from the ENA Foundation and the develop ‘‘Enhancing RN Professional
Learning Page at a later time,
go to www.ena.org and find National Institutes of Health. His findings Engagement and Contribution: An
‘‘Go to Personal Learning have been published in the Journal of Innovative Competency and Clinical
Page’’ under the Courses & Emergency Nursing, the Journal of Advancement Program,’’ which was
Education tab. Clinical Nursing and the Journal of Pain published in June 2012 in Nurse Leader.
If you have questions about any and Symptom Management. The article describes the revision
free e-learning course or the He’s been at Mennonite in a tenure process, which involved a new system
checkout process, e-mail track since 2010. for bedside staff evaluations across
elearning@ena.org.
‘‘It is through my own academic diverse settings and specialties.
S
ometimes, it only takes a association dedicated to the
handful of people with advancement of the specialty
courage to step out on faith through education and
and create a change … those advocacy. One of her dreams
who dare to dream big for what was realized in 2012 when the
they believe in . . . those who American Nurses Association
spark a revolution to improve recognized emergency nursing as
the lives of others. a specialty.
For ENA it took two, and one More than 40 years have
of them was Judith Kelleher. passed since its creation, and
Judy has touched the lives of every single member of ENA is
many, and she has left an still impacted today by Judy’s
imprint on our organization and accomplishments. As an
in our hearts. There are no organization, we are truly blessed
adequate words to express how grateful we are to have been founded by a true leader and
for the contributions she has made to our trendsetter whose dream raised the standards of
profession. how we practice. As individuals, we are inspired
She joined forces with Anita Dorr, RN, FAEN, by her dream to make a difference in the lives of
and they formed the national Emergency patients and emergency nurses everywhere.
Department Nurses Association in December It is a blessing that Judy was able to see the
1970. After Anita’s passing in 1972, Judy carried difference she made in our organization … from
on their shared vision. She was undaunted by the 40,000 emergency nurses who have united to
obstacles and determined that emergency nursing become a voice in our profession to the
would be recognized as a specialty. thousands of patients who are receiving better
She famously said, ‘‘I think the thing that treatments in emergency departments around the
typifies ENA in those early years is that we began country because of her passion to improve
to speak out and speak up for emergency emergency care for everyone.
nursing, for emergency nursing education, for As one ENA member wrote on our Facebook
emergency nursing recognition.’’ page this week, ‘‘Rest in peace, Judith. Your
Judy led the organization to national work here may be done, but your legacy will live
prominence and recognition as the only on for generations.’’
Look for an expanded tribute to the career and impact of Judith C. Kelleher in the May issue of ENA Connection.
In-Flight Medical
Emergencies
Ding! ‘‘If there is doctor, nurse, with these factors come the signs and
paramedic or anyone with medical symptoms of nausea, vomiting,
training on board who can assist with headache, abdominal pain, dizziness,
a medical emergency, please ring your hypotension and syncope. Although
flight attendant call bell.’’ other medical conditions, such as
When emergency nurses hear this myocardial infarction or stroke, can
request, some may hope someone else occur at any time, most in-flight
will ring in; however, there is no medical emergencies are related to the carry additional equipment, including
guarantee of a physician being on environment and stress of travel. obstetrical kits and anti-nausea and
board, which occurs between 40 and What do you do? First, make over-the-counter pain medications.
90 percent of the time. yourself known to the flight attendant. A question of liability often arises.
Commercial aircraft emergencies Once you have been escorted to the Congress passed the 1988 Aviation
occur daily in the United States, in patient and have made your initial Medical Assistance Act, which allows
roughly 1 in 39,600 passengers. It is assessment and general impression, medical professionals to operate under
difficult to clarify the actual number of ask if the patient can be moved to a their scope of practice as long as the
medical emergencies due to a lack of more quiet and confidential area, such professional is practicing in good faith.
mandated reporting. as the bulkhead or rear of the cabin. If According to the Act, ‘‘An individual
Emergency nurses who hear the this is not an option, ask the flight shall not be liable for damages in any
call to assist may be the most prepared attendant to try to reseat passengers or action brought in by Federal or State
based on our knowledge and skill. In allow your patient to walk the aisles so court arising out of acts or omissions
my experiences assisting patients you can best complete a confidential of the individual in providing or
requiring in-flight medical intervention, assessment. Based on the medical attempting to provide assistance in the
I have found that the term ‘‘doctor’’ complaint and condition, your patient case of an in-flight medical emergency
can be applied to an array of positions, may need to lie as flat as possible unless the individual, while rendering
including emergency physician, across three seats. Do not be afraid to such assistance, is guilty of gross
Doctorate in Public Health Quality, ask for comfort packages that include negligence or willful misconduct.’’
podiatrist, pediatrician, dentist and a pillow and blanket. While rendering medical care, you
chiropractor. Ascertaining a doctor’s Today’s airlines in the U.S. are should never feel alone. Flight
specialty will better prepare a team to equipped with an automatic external attendants are trained in first aid and
care for an in-flight patient. Incorporate defibrillator and robust medical kit, CPR/AED and welcome any assistance.
the flight attendants into your care, as thought they are kept under lock and Ground medical control is available
they have the direct link to the captain, key. Basic equipment, such as a blood through the captain as a joint decision
who is the ultimate decision-maker pressure cuff, stethoscope and oxygen, is made whether to continue to the
and has contact with ground medical is readily available. Additional final destination or divert. Many times,
control. equipment and advanced cardiac with comforting medical and nursing
Medical emergencies that occur equipment, not limited to IV solutions care, patients make it to their
during flight are often related to travel and medications, are available for use destination to awaiting EMS personnel.
or stress. Hypoxia, barometric pressure with consultation through ground Next time you answer the ding
changes, temperature changes, medical control. Under Federal asking for assistance, your flight crew
dehydration, noise, vibration and Aviation Regulations, Appendix A to will be quite appreciative, and you
fatigue are environmental conditions Part 121, airlines must display the may even receive a token of gratitude
causing physiological stress. Along required equipment. Many airlines for your willingness to help.
6 March 2013
ENA Foundation 2013 State Challenge
Emergency T O ut forNursing
S HOU y Nursing
e r g e nEducation
c
E m c a t io n
E du
Challenge Awards
Largest percentage increase per capita:
1st Place - $250 ENA Marketplace gift certificate
2nd Place - $100 ENA Marketplace gift certificate
Largest number of individual donations per state:
1st Place - $250 ENA Marketplace gift certificate
2nd Place - $100 ENA Marketplace gift certificate
Donate Now
Visit www.ENAFoundation.org for more detailed information
on the State Challenge campaign and for updates on
where your state stands in the challenge race.
Access to Education
To strengthen the nurse’s ability to provide safe practice,
safe care, ENA provides education in both formal and
informal ways, has developed a scope and standards for
the emergency nurse and offers a wealth of information
through products available at the ENA Marketplace
(admin.ena.org/store). ENA provides educational
programs to support and strengthen the excellent care An attendee taps into one of the educational opportunities that
delivered by emergency nurses. Courses, seminars and have come to define ENA’s annual Leadership Conference.
conferences are based on knowledge from experts in
the field and designed to help you achieve your Member Resources
professional development goals. The Journal of Emergency Nursing, the official journal of
ENA’s Center for e-Learning provides on-demand online ENA, reaches the greatest number of emergency nurses,
courses through its learning management system. Each emergency/trauma departments and ED managers of any
month, a new online course is launched and is free to all journal. The journal covers practice and professional issues,
members as a value-added benefit and for continuing based on current evidence, that challenge emergency nurses
education credits. every day and features original research and updates from
ENA’s Annual Conference is the largest educational the field. ENA’s news magazine, ENA Connection, is
gathering for emergency health care professionals. It is a published 11 times annually and provides current
comprehensive learning experience designed to enhance the information on association activities and emergency nursing
knowledge and skill level of emergency nurses, nurse issues.
managers, ED directors, clinical educators and more. ENA’s Emergency Nursing Scope and Standards of Practice is a
Leadership Conference is the premier educational gathering landmark publication that describes the competent level of
for emergency health care leaders, which offers an behavior expected for nurses practicing in the specialty of
unparalleled learning experience, networking opportunities emergency nursing. The book provides a guide for the
and exposure to the most cutting-edge tools and products in practitioner to understand the knowledge, skills, attitudes
emergency care services. and judgment that are required for practicing safely in the
8 March 2013
emergency setting. This book is available at the ENA the other on health literacy, are currently available at
Marketplace (admin.ena.org/store) along with a full www.ena.org/IQSIP/Practice/Pages/, along with other
selection of resources covering a wide range of the topics in informational tools available for download.
the practice of emergency nursing.
ENA continues to share pertinent information through its POSITION STATEMENTS
position statements, which ENA defines as an assertion of www.ena.org/about/position
the beliefs held, encouraged and supported by ENA.
Position statements provide concise information and material EMERGENCY NURSING RESOURCES
for understanding and analysis of the problem. Joint and www.ena.org/IENR/ENR
consensus position statements are an assertion of the beliefs
held, encouraged and supported by ENA developed in OTHER USEFUL LINKS
collaboration with external professional organizations with
www.ena.org/COURSESANDEDUCATION
mutual interest in providing safe practice, safe care. All
position statements are written in accordance with the www.ena.org/publications/jen
bylaws, strategic plan and code of ethics of the organization www.ena.org/publications/connection
and are officially endorsed by ENA as authorized by the ENA
admin.ena.org/store
Board of Directors.
Emergency nursing resources are evidence-based
Reference
documents that facilitate the application of current evidence
Emergency Nurses Association. (2012). ENA strategic plan
into everyday emergency nursing practice. ENRs are created
2012 - 2014 and beyond. Retrieved from www.ena.org/
following a rigorous process included in ENA’s Guidelines
about/Documents/ENAStrategicPlan2012-2014.pdf
for the Development of Evidence-Based Emergency Nursing
Resources. ENA believes that ENRs have a positive impact on Contributing: Kathy Szumanski, MSN, RN, NE-BC; Jessica
patient care and emergency nursing practice by bridging the Gacki-Smith, MPH; Altair Delao, MPH; Maureen Howard
gap between practice and currently available evidence. and Bree Sutherland.
New Tools
ENA Practice References are a new resource from ENA. They
are succinct practice statements that are based on current
A NATIONAL CONFERENCE FOR EMERGENCY DEPARTMENT
scientific evidence available at the time the documents are
EMERGENCY
NURSES, PHYSICIANS AND PHYSICIAN ASSISTANTS
developed. They are related to a clearly identified
circumstance and provide best practice information. They
CARE SUMMIT
are not meant to be a substitute for a nurse’s best judgment
in a given situation of care.
The concept of the practice reference came out of the
need to respond to member requests for a quick resource
that can assist in applying appropriate or available evidence
in a given clinical situation. It is anticipated that many of the
practice reference topics will come from ENA listserv
discussions and direct e-mail inquiries.
Two of the several EPRs drafted by the ENA Clinical
Practice Committee in 2012 were reviewed and approved by
the ENA Board of Directors. These first two practice
references focus on hemolysis and right-sided/posterior
EARN UP TO 17.5 CE HOURS
ECGs and are available at www.ena.org/IQSIP/Practice/
Pages. SNOWMASS, CO
Topic Briefs are informative documents that provide July 21-24, 2013
detailed, accurate and current information on a given subject
of importance to safe practice, safe care. The subjects
Register online at
selected for topic briefs come from inquiries from members
www.ContemporaryForums.com
or as a result of committee work on a particular subject.
Or By Calling 800-377-7707
Two Topic Briefs, one on health information technology and
10 March 2013
Q: I am an ED nurse finishing up expert witness, nurse death investigator
In response to member requests
my bachelor’s degree in nursing, and community education.
for more interactive opportunities,
and I plan on pursuing a master’s If you decide to stay within the
ENA Connection is proud to debut
degree. I have heard about forensic hospital setting, you may share your
its newest feature, Ask ENA.
nursing, and it has intrigued me. Is it expertise with your peers to help them
Members are encouraged to submit
a female specialty due to the high provide not only quality care but expert
questions about the organization
percentage of female sexual assaults? documentation for the patient who has
and emergency nursing in general.
Would a male have the same been injured, assaulted or abused.
Questions should be no longer
opportunities afforded to him? There are numerous master’s degree
than 200 words. For verification
– Jared from Boston programs across the country, with
purposes, you must include your full
several on the East Coast that specialize
name, address and e-mail address.
A: Jared, thank you for reaching out in forensic nursing. I would encourage
(We will accommodate requests to
to ENA. The term ‘‘forensic nurse’’ is you to contact the International
not print full names.)
relatively new — the field has only been Association of Forensic Nurses at iafn.
Questions will be referred to the
around for approximately 20 years. org to find out more about the specialty
appropriate ENA staff or department.
Because forensic nursing encompasses a and to seek their assistance in finding
Submission of a question does not
wide variety of issues, gender really an advanced program that meets your
guarantee publication. Submissions
does not matter. needs.
may be edited for clarity or
A forensic nurse is a nurse with I hope I have answered your
shortened for space.
specialized training in forensic evidence questions. Please feel free to contact me
E-mail questions to
collection, criminal procedures, legal at dwallerich@ena.org.
connection@ena.org, fax to
testimony expertise and much more as
847-460-4005 or mail to ENA — Dale Wallerich, MBA, BSN,
the job description continues to expand.
Connection, 915 Lee St., Des Plaines, RN, CEN, Senior Associate,
Other career branches for this job ENA Institute for Quality, Safety
IL 60016.
outside of the hospital include medical and Injury Prevention
Take charge of
Your Nursing Career
Are You Looking for a New Job Opportunity?
Job seekers can post their resume, search for jobs and most importantly create
an online profile for employers to find. You can maintain total privacy about
your job search by selecting to keep your resume and profile confidential in our
database.
To create an online profile, go to www.ena.org and go to the Career Center to log-on
and get started today. Be sure to come back frequently to keep your profile current!
12 March 2013
procedure is being painful procedures.
performed) can also be The sucrose causes the
an effective method to release of endogenous
reduce pain. This endorphins and thus
method demonstrates reduces the pain.
use of the Gate Theory, Infants provided
similar to the method sucrose were found to
used by dentists who cry less and returned to
jiggle the lip before their baseline condition
giving intraoral quicker after
injections. procedures. Pacifiers
There are a number alone can also be
of non-invasive agents effective for analgesia.
that can be used to There are a number
reduce pain in the of other pain-reducing
emergency setting. strategies that are
Some can be applied beyond the scope of
immediately prior to this article. The methods
procedures, and others discussed can take a
must be applied 20 to minimal amount of time
30 minutes in advance and can significantly
of a procedure to reduce pain effectively
engage maximum in the pediatric patient.
benefit. Topical Figure 2: Skin blanched after 20 minutes of LET application.
vapocoolant spray is
an anesthetic skin refrigerant that instantly reduces pain for References
needlesticks and other skin punctures. It can be applied to 1. MacLean, S., Obispo, J., & Young, K.D. (2007.) The gap
minor open wounds or intact skin (such as abscesses). It is between pediatric emergency department procedural pain
sprayed for 4 to 10 seconds or until the skin is blanched, management treatments available and actual practice.
with a resultant 60 seconds of transient anesthesia to Pediatric Emergency Care, 23(2): 87-93.
perform the procedure. Liposomal lidocaine
2. Taddio, A., Katz, J., Ilersich, A. L., & Koren, G. (1997.)
(4 percent) cream can be applied to intact skin to reduce
Effect of neonatal circumcision on pain response during
pain from venipunctures. It can be placed over two areas
subsequent routing vaccination. The Lancet, 349(9052),
where the vein is most prominent, often the antecubital area
599-603.
and dorsum of the hand, for approximately 20 to 30 minutes
before IV starts. Two areas are typically used in case the first 3.Broome, M. (2000.) Helping parents support their child in
IV attempt is unsuccessful. pain. Pediatric Nursing, 26(3), 315-317.
For open wounds, mixtures of lidocaine, epinephrine and
tetracaine can be applied to lacerations in the triage area.
LET is applied to a cotton ball or other nonabsorbent
dressing and taped in place. As an alternative to using tape BLOG
ON
over the dressing, the parent can wear a glove and apply
pressure to the dressing over the wound for approximately
20 to 30 minutes before laceration cleansing and repair. The
skin will become blanched from the epinephrine in the LET
(see Figure 2).
Other considerations include application of viscous Head to enajoann.wordpress.com or
lidocaine jelly to the urethra for approximately 10 minutes the ENA website, www.ena.org, to read the
before urethral catheterization attempts in infants. Infants latest posts from 2013 ENA President JoAnn Lazarus,
can be provided sucrose solution by dipping a pacifier in the MSN, RN, CEN, in her new ENA President’s Blog.
sucrose and giving it to the infant before, during and after
14 March 2013
Oelslager for all their work on • Individuals with mental
this legislation,’’ said Gail Emergency Nurses Contributing at HB62 Hearings impairments.
Lenehan, EdD, MSN, RN, FAEN, • The degree of penalty that
FAAN, immediate past president House Criminal Justice, April 2011 should be applied to offenders.
of ENA. ‘‘The legislation will help Dan Abbey ♦ Tammy Brassler ♦ • Hospitals’ responsibility to
to protect the nurses of Ohio, but Nancie Bechtel ♦ Nick Chmielewski ♦ provide de-escalation training.
also provides inspiration for Ivy Cook ♦ Meghan Long ♦ • The need for signage to
similar legislation in other states Nicole McGarity promote awareness and
as well. Importantly, it sends a discussion on the issue.
message that will hopefully be
Senate Judiciary, November 2011 • The cost of implementation.
heard beyond the boundaries of Nick Chmielewski ♦ Beverly Clensey ♦ We were extremely grateful for
Ohio — that violence against Megan Long ♦ Nicole McGarity the expertise, support and
nurses and other health care guidance of ENA’s national office
workers will not be tolerated, during its journey to becoming law. staff during the last several years.
that it is no more acceptable than Key discussions included: This support was highlighted when
violence against police or firefighters.’’ • The philosophy of ‘‘protected classes.” Lenehan joined us at the Ohio State
It took the introduction of many • Explaining the need for this Capitol to celebrate HB62’s signing.
bills over several sessions to realize the legislation and helping legislators One important lesson learned is that
passage of HB62. In the 128th Ohio understand the prevalence of this successful legislative policy requires
General Assembly, state Rep. Denise violence. collaboration and compromise. Most
Driehaus introduced HB450 to restart • Explaining that this bill is not about important, however, is persistence. It
the conversation. Similar legislation ‘‘locking up’’ an elderly patient with was the unrelenting persistence of our
was introduced in that session by Rep. Alzheimer’s or a patient waking up members — through letter-writing and
Stephen Slesnick and then by from anesthesia in a combative state. phone calls — that resulted in HB62
Oelslaeger. In the 129th Assembly, • The scope of who should receive receiving a crucial floor vote in the
Slesnick and Driehaus re-introduced protection. Senate. To each of our members across
legislation. There were several • Individuals under the influence of the state who contributed, I say thank
discussions and changes to HB62 drugs or alcohol. you and congratulations!
b le
a a
il ok EMERGENCY NURSING
v
a ebo
w
No s an Scope and Standards of Practice
a
ENA offers the most important book you will ever need to grow your practice...
Emergency Nursing: Scope and Standards of Practice.
This book will cover criteria-based job descriptions and performance
evaluations and so much more.
• Departmental policies and procedures
• Strategies for health promotion
• Orientation and continuing education programs
• Quality improvement programs and activities
• Content expertise on the scope of emergency nursing practice
• And American Nurses Association now recognized emergency nursing as a speciality
16 March 2013
Top photo: Jeff Strickler, MA, RN,
CEN, CFRN (foreground), and
other emergency nurses from
around the country take in the
messages of the advocacy
intensive. Below, left: Michelle
Fox, BSN, RN, senior director of
clinical affairs for Vidacare,
shares industry perspective on the
importance of advocacy. At right
are Gordon Wheeler, associate
executive director of public
affairs for ACEP, and Adrianne
Drollette, senior political action
specialist for the American Nurses
Association. Below: Lazarus with
keynote speaker Laura Schwartz
(center) and ENA Executive
Director Susan Hohenhaus, LPD,
RN, CEN, FAEN.
You are never alone.’’ relations officer, discussed the current situation in
Susan Hohenhaus, LPD, RN, CEN, FAEN, ENA’s executive Washington, D.C., to raise awareness on becoming effective
director, led an informative session on public relations and government relation advocates. (Learn more about Richard
media training. Attendees learned how to effectively work with Mereu and his extensive legislative background on page 20.)
the media and connect with their communities. Hohenhaus Mereu’s session was followed by the expert panel on
discussed two types of media relations (proactive and reactive); advocacy, which included the following guest speakers:
how to deal with print reporters and broadcast reporters based ACEP Advocacy: Gordon Wheeler, ACEP associate
on their differences; knowing the rules of engagement when executive director, public affairs
working with journalists; and how to conduct a successful
urses CAN 2012: Adrianne Drollette, American Nurses
N
interview by knowing who you are, what ENA represents and
Association, senior political action specialist
the definition of an emergency nurse. Attendees learned the
tate and Federal Regulatory Agencies Weighing in on
S
advantages of using the media to advocate.
Health Care Scope of Practice: Anna Polyak, JD, RN,
‘‘Nursing is incredibly well-positioned in today’s health
American Association of Nurse Anesthetists, senior director
care environment,’’ Hohenhaus said. ‘‘In order to take care
tate Council/Chapter/State Legislative Coordinator
S
of your patients, you have to make sure that you’re in a safe
Structure: Amy L. Hader, JD, Association of
place, that your scope and practice are protected and you’re
periOperative Registered Nurses, director, legal and
able to leverage federal and state funding to actually drive
government affairs
health care policy. You’re at the beginning of a revolution
that I feel is exciting.’’ Vidacare Corporation — Representation of the
Richard Mereu, JD, MBA, ENA’s new chief government Industry Perspective: Michelle Fox, BSN, RN,
Vidacare senior director clinical affairs
18 March 2013
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20 March 2013
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22 March 2013
from helping patients to also helping
other health care workers escape the
nightmare he’d known first-hand.
The room applauded.
John Marshall hasn’t had a fix in 27
years, but he’s made a life of fixing. As
facilitator of the Mobile Professional
Group, with which he’s been involved
since 1987, he sits in every other week
with anywhere from six to 26 health
care professionals whose encounters
with drugs and alcohol have led them
into his circle. The group is run like a
12-step program, the same way Marshall
got clean. Meeting topics rotate. New
members are worked in as they come.
It’s a casual, safe, free place where
people who handle narcotics as part of
John Marshall in 1974 at the start of a career that fell into chaos a decade later.
their jobs can find the peer support to
keep themselves straight. referred to him by the Alabama board. too smart, that I should be well by
It’s also non-punitive — a way for Others were invited by active members now,’’ Marshall says. ‘‘And that’s just the
nurses to manage their recoveries or pointed there by treatment centers. nature of the disease of addiction — it’s
without being put on probation by the Most who attend are nurses; he a liar. It’ll lie to you. So after you’re not
Alabama Board of Nursing. currently has two from EDs. Doctors being monitored and you don’t have to
‘‘Most states have some kind of have their own group for recovery — go after a while, if you happen to be
nondisciplinary program now,” says the International Doctors of Alcoholics one of those people that hadn’t crossed
Marshall, who didn’t have that option in Anonymous — but two or three docs the wall, you kind of phase out.’’
1985 and spent the next several years His mission is to see that as many as
still come to Marshall’s meetings. He
on probation in Georgia and Alabama.
has nurse anesthetists, a pharmacist. possible don’t. He stresses a spiritual
‘‘Usually it’s required that the person
He’s had surgeons, even veterinarians. philosophy of finding a ‘‘higher power’’
call [the board] and report themselves:
Some are there to satisfy the — a touchstone bigger than the drugs or
‘I’ve got a problem, I need some help.’
nondisciplinary requirement after one alcohol. For some, that’s religion. For
If people wait until an employer calls
failed drug screening. Their problem is some, it’s a symbol — a tree, for
and says, ‘We’ve got somebody with a
that they used casually, not abusively, instance, or perhaps the group itself. A
problem,’ a lot of times they end up on
and got caught. Some, like Marshall, are few in the group, long after rescuing
probation.’’
there because they became true their careers in health care, continue to
No one wants that. Probation opens
chemical addicts, no longer wanting the attend meetings 10 or 15 years later.
the door to legal consequences for
diversion or writing self-prescriptions. It fix but physically needing it; they Some have lived out their natural lives
offers no anonymity. In Alabama, ‘‘crossed the wall,’’ as he puts it. That’s as members.
Marshall says, it means ‘‘their license is the other end of the spectrum. ‘‘With addiction,’’ Marshall says,
stamped with ‘probation.’ It goes out in There’s a large middle area — nurses ‘‘they say once a cucumber’s a pickle,
the state newsletter who’s in trouble who aren’t chemically dependent but it’s always a pickle — it’s never a
with drugs, where in the nondisciplinary who face the grim risks of denial, relapse cucumber again.’’
program, none of that’s done.’’ and career derailment.
♦ ♦ ♦ ♦ ♦
Some in Marshall’s group, after ‘‘We have a disease that tells us we
reaching their crisis points, were don’t have it, that we’re OK, that we’re By early 1985, John Marshall knew he
was a pickle, or what he’d later call
“I got to a point where it didn’t work anymore. one. More aptly, he says, he was ‘‘a
nurse manager’s nightmare.’’ Three
I couldn’t do enough dope to feel good. I could do enough years earlier, his first shot of Demerol
to pass out and get sick, but I couldn’t stop.” Continued on next page
24 March 2013
2000. He became house supervisor in
2003, then started with the Children’s
and Women’s Hospital in 2007. Is Your Co-Worker in Trouble?
Never far away was the group.
ENA conference faculty presenter Difficult life problems: Has
Marshall had made contacts in his
Allison Bolin, BSN, RN, CEN, CPEN, your co-worker had a recent back
treatment that afforded him clean slates.
a rapid-response nurse at Dominican injury? Is he or she going through a
His end of the bargain, he realized, was
Hospital in Santa Cruz, Calif., offers divorce? These kinds of situations, in
to advocate for others in turn. A nurse
these red flags for substance abuse combination with some of the signs
in recovery whose license has been
or drug diversion in the ED: above, can point to a larger problem.
revoked might list him as a reference on
a job application. He has been to court Behavioral extremes: Some If you’re worried that a colleague
on another nurse’s behalf in a child- with substance-abuse issues become is battling substance abuse, report
custody case. sloppy and don’t seem to care about your suspicions to your supervisor (it
‘‘The group helps me do that,’’ he their work. Others, particularly those could save a life, Bolin stressed) and
says. ‘‘We do things to help our diverting drugs, become hypervigilant, let the department proceed according
members get back on track in several paying extra attention to who is to policy. If you’re a supervisor, she
aspects of their life, not just in receiving medications, offering to said, make sure you have the
employment. Somebody was there for medicate other nurses’ patients and documentation to support a
me when I was in trouble and needed spending more time than normal in reasonable suspicion and involve the
help, so now my job is when somebody the dispensing areas. human resources department before
needs help, I’m there for them. Personality changes: Substance confronting the employee.
‘‘In my groups and meetings that I abusers tend to withdraw socially Often the most respected nurses
go to with 12-step, when somebody and show increased irritability. are the ones most in trouble, Bolin
asks you to do something, you say yes. said. She herself has been in recovery
Absenteeism: Often seen in
These people call me 24/7.’’ since 1990 and runs a support group
employees with alcohol problems.
Sometimes he has dreams that he’s for nurses in two counties.
still using — the ol’ ‘‘drinkin’ and Coming in on days off or ‘‘So many nurses don’t even
druggin’ dreams,’’ he calls them. Though frequently volunteering for extra recognize it could be a problem,’’
he’s not in an emergency department shifts: Often seen in drug diversion. she said. ‘‘We’re not any less
officially, he sees trauma. He sees Fishy reports: Most hospitals immune because of our education.
children going through chemotherapy. have anomalous usage reports that In fact, we’re probably at greater
Sometimes elements in his life don’t feel identify who’s dispensing which risk, especially in the emergency
balanced. Steps feel out of sync. That’s drugs the most. Abnormally high department.’’
when he makes a few calls, too. numbers can indicate diversion. Josh Gaby
Recovering and fixing go both ways.
‘‘I’m in recovery, but my disease is in
living life on life’s terms.’’
the parking lot doing pushups,’’
Marshall says. ‘‘I still do those things His grown son from his first
Workplace Violence
because if I don’t do those things, I’m marriage has seen his perseverance, Prevention Online Courses
going to be acting like a pickle again, has seen him guiding others through. FREE Now available free to ENA members are
for ENA three webinars that discuss violence in the
and I don’t know if I could live through He has a daughter, 23, who grew up Members workplace and mitigation strategies.
that. Twenty-eight years ago, I’d have a witness to his recovery.
just taken something to change the way Life is good. His mornings are
Visit www.ena.org and sign up today.
I feel and keep on going. And I don’t only about one vice now — coffee.
Non-members can purchase these continuing
do that now. He asked a counselor about that education courses by visiting ENA’s LMS
‘‘And my life is so much better now, once. Was it a problem? Not a member? Join ENA today!
truly a miracle. Staying high all the time ‘‘As long as you’re not shootin’ up
These webinars are brought to you by
is a full-time job. When you wake up in freeze-dried Folgers,’’ he was told, In collaboration with Thank you to our sponsor
26 March 2013
Letter From the President Continued from page 3
school to obtain my master’s degree ‘‘Mentoring is a brain opportunity to share knowledge and
and then encouraged me to apply for experience with the next generation of
her position when she left. But more
to pick, an ear to listen emergency nurse leaders.
important than her words were her and a push in the The ENA Board of Directors has
actions. I witnessed her every day implemented a new program to pair
right direction.”
modeling the behaviors of someone I an emerging leader with a board
wanted to become: She was graceful John Crosby mentor. The mentors will spend the
under pressure, politically savvy and year helping their mentee develop
had the respect of the emergency mentoring relationship and don’t forget their leadership goals and determine
department staff. I am just sorry to acknowledge your mentor. an action plan for national ENA
that I never had the opportunity to One of my goals as ENA president contributions.
thank her. is to provide more opportunities for I encourage all of you to
mentoring within our organization. We acknowledge your mentors, find a
Two-Way Street already have one great mentoring mentor or become a mentor.
What does it take to be a good program in EMINENCE. The
Resources
mentee? The mentee should drive the EMINENCE program is designed to
Loretto, P. (n.d.). Top 10 Qualities of a
relationship. As the mentee, you must pair ENA members with experienced
Good Mentor. Retrieved from www.
be comfortable in communicating Academy of Emergency Nursing
interships.about.com
openly with your mentor. You must be fellows. AEN fellow mentors volunteer
clear about what you expect to their time and talents to work with Roberts, A. (1999). Homer’s mentor:
accomplish by partnering with this up-and-coming ENA members. Duties fulfilled or misconstrued.
person. Be committed to the This provides a wonderful Retrieved from www.peermentor.net.
28 March 2013
New ENA monthly offering for
FREE Continuing Education with
contact hours for our members.
• Available March 1
GU: It’s More Than Just P, 1.0 contact hour
Michael D. Gooch, MSN, RN, CEN, CFRN, ACNP-BC, FNP-BC, EMT-P
The Emergency Nurses Association is accredited as a provider of continuing nursing education by the American
Nurses Credentialing Center’s Commission on Accreditation.
The AEN EMINENCE Program
The Academy of Emergency Nursing is proud to report its fifth group of mentors
and mentees are currently working on projects for the 2012-2013 program. The
EMINENCE program is designed to pair ENA members with experienced Academy
fellows. AEN fellow mentors volunteer their time and talents to work with
up-and-coming ENA members. This provides a wonderful opportunity to share
knowledge and experience with the next generation of emergency nurse leaders.
Applicants submit project descriptions and are matched with fellows who have
expertise in the subject matter. Project topics include professional presentation,
writing for publication, research, educational conference planning and program
development. Upon acceptance into the program, mentees pay a $100
administrative fee.
The following mentee/mentor pairs are participating in the 2012-2013 program:
Kiefah Awadallah, MSN, BS, RN Rebecca Steinmann, MS, RN, APN, Program Development
CEN, CPEN, FAEN
Kimberly Brandenburg, BSN, RN, CEN Patricia Kunz Howard, PhD, RN, CEN, Injury Prevention (SBIRT)
CPEN, NE-BC, FAEN
Colleen Connors, MSN, RN, CEN Anne Manton, PhD, APRN, FAEN, Program Development
FAAN
Hershaw Davis Jr., BSN, RN Susan Hohenhaus, LPD, RN, CEN, Professional Presentations
FAEN
Siegfried Emme, MSN, RN, NP-C, CEN, Jean Proehl, MN, RN, CEN, CPEN, Program Development
CCRN FAEN
Marites Gonzaga-Reardon, MSN, RN, Gail Lenehan, EdD, MSN, RN, FAEN, Writing for Publication
APN, CEN, CCNS FAAN
Jerry Jones, MBA, BSN, RN Andrea Novak, PhD, RN-BC, FAEN Educational Conference Planning
Jennifer Morris, RN, CPEN, CPN Jeff Solheim, MSN, RN-BC, CEN, Professional Presentations
CFRN, FAEN
Curtis Olson, BSN, BA, RN, EMT-P, Laura Criddle, PhD, RN, CEN, CPEN, Writing for Publication
CEN FAEN
Kathy Van Dusen, BSN, RN, CEN Diana Meyer, DNP, MSN, RN, CEN, Advanced Practice Role Development
CCRN, FAEN
Belinda Watkins, BSN, RN, CPEN Harriet Hawkins, RN, CPEN, CCRN, Program Development
FAEN
If you would like to participate in the 2014-2015 EMINENCE program, watch for application information posted at
www.ena.org/about/academy/EMINENCE in mid-March 2013. Applications are due April 30.
30 March 2013
nual
ion
ual
Provid
er Man
Ed it io n The Emergency Nurses Association is proud
Fourth
to present the release of the 4th edition of
mergenc
AC13
marketplace ExprEss
NEW! Comprehensive systematic review for Advanced Nursing practice
Cheryl Holly, EdD, R Susan Salmond, EdD, RN, FAAN,
Marie K.Saimbert. BPharm, MSN, MLIS, RN (Editor)
In an age of rapidly expanding knowledge, it is crucial for health professionals to stay abreast
of the most current evidence-based information when making clinical decisions. The text
sets forth a rigorous, step-by-step approach to the process of conducting a literature search,
including both quantitative and qualitative studies, as well as “grey” literature. It describes
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ISBN: 9780826117786
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