The Future of Emergency Nursing

Future emergency nurses at NSNA 2014

Future emergency nurses at NSNA 2014

Last week I had the incredible opportunity to attend the National Student Nurses Association (NSNA) Convention in Nashville, TN.  What an amazing experience!  There were over 3000 nursing students from all over the world in attendance.  All of these students were excited, motivated, and ready to take on the world!  These students are already engaged in their professional association (NSNA) and were very interested to hear about what ENA had to offer them as student members.  I spent three days at the ENA booth in the exhibit hall with members of the Tennessee State Council and ENA staff.  The team at the booth engaged with each and every student who came by and answered every single question.  It was inspiring to watch the passion and enthusiasm about emergency nursing shared by our team and the students that came by.

In addition to meeting students individually in the exhibit hall, I had the opportunity to address these student nurses twice.  The first opportunity was as part of a panel discussion on errors and adverse events.  The questions the students asked of the panelists were thought provoking, insightful, and provided great ideas and innovations to create error free work environments.  At the end of the session, I was approached by at least 20 students who wanted to engage in a further discussion of safety in the ED.  Seriously?  These students were so engaged and ready to take on the world.  I couldn’t help but feel proud and excited at the same time!

The second opportunity to address these students came as I presented two sessions on what it means to be an emergency nurse.   Now, I knew going in this was going to be a popular session.  The room that holds 650 people was packed, twice.  No gory pictures, and honestly, no war stories.  Instead, I shared my passion for emergency nursing. There is no other place in the healthcare system that takes care of anyone and everyone who walks in the door, regardless of who they are, where they came from, or how much money they have, 24 hours a day, seven days per week.  I discussed how many opportunities there were in emergency nursing, including geriatrics, pediatrics, forensics, EMS, flight, case management, and leadership.  I talked about the fact that the number of times my actions have made a direct life and death difference for a patient in the last 20 years was small, but that as an emergency nurse you have the opportunity to make a difference in a patient’s life each and every day.  And, wow, did this group inspire me.

Here is a group of engaged, excited, enthusiastic, and eager budding emergency nurses.  They are desperate to join us in our chosen profession and bring a passion to our departments that many of us may have forgotten along the way.  They are dedicated to making a difference, and will work hard to become skilled emergency nurses.  What they need most is mentoring, support and guidance along the way.

For those of you who work with these students, thank you!  They are the future of our profession, and I know they very much appreciate the opportunity for mentorship and support.  Whether it’s at an ENA meeting, in your department, in the hallway, at an educational opportunity, or at dinner (yes, I have run into budding emergency nurses everywhere), take the time to meet these future nurses.  Be a mentor to them.  Encourage them to ask questions and seek out the answers (they are awesome at reviewing evidence).  Invite them to participate in projects and initiatives.  Bring them to a conference, whether it’s local, state or national.  Welcome them into our profession.  After all, they are the ones who will be taking care of us.  After last week, I have no doubt the future of emergency nursing is in great hands!

Thanks to Mona, Holly, Randy, Barbara, and Donna from the Tennessee State Council and Lindsay from ENA for all of your great work!  Your passion, dedication, and enthusiasm for the emergency nursing profession was not only clearly evident, but inspired more than 160 new members of our association!  And thanks to NSNA for the opportunity to speak to your members.  And to all of the nursing students out there who can’t image any place else they would rather work than the emergency department, welcome to the profession!  You are our future, and we are incredibly fortunate to have you!

ENA…Advocating for Children Who Need Emergency Care

One of the roles of the ENA President to is represent ENA at national meetings. At the end of last week, I had the opportunity to represent ENA at the Emergency Medical Services for Children (EMSC) National Resource Center Advisory Council meeting. I wanted to share with you a bit about the EMSC program, how ENA supports the EMSC program, and opportunities for you to advocate on behalf on EMSC and the children you care for in your emergency department.

The mission of EMSC is to reduce child and youth mortality and morbidity caused by severe illness or trauma. Administered through HRSA, this federal program, states receive 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, U.S territories to support pediatric emergency care improvement projects and initiatives. If you are unfamiliar with EMSC, this link will provide resources and information about the program.

ENA has made support for the EMSC program one of its top priorities. In fiscal year 2014, ENA worked closely with other national healthcare groups (especially the American Academy of Pediatrics) to prevent further devastating cuts for EMSC. For fiscal year 2015, which starts October 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 a House bill (H.R. 4290) and Senate bill (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 this fiscal year, September 30th, 2014.

On a local, state and national level, ENA has been a vocal supporter of the EMSC program. So, how do you help support the national effort to improve pediatric emergency care? By making your voice heard. I am asking you to urge your Representatives to cosponsor H.R. 4290 and your Senators to cosponsor S. 2154. Both of these bills are bipartisan legislation, with Rep. Peter King and Sen. Orrin Hatch cosponsoring the bills. Not sure how to contact your Representatives? Visit the EN411 Advocacy Engagement Page and find your elected officials. Let your Representatives know how important this program is to the emergency care of children in this country.

Each of us has a voice and a role in improving pediatric emergency care. How will you exercise your voice?

A family reunion

Four days ago I came home from one of my favorite events of the year, ENA Leadership Conference.  There are many reasons why I love the event so much.  First, we start the week with our state and chapter leaders conference.  The energy and enthusiasm in the room is incredible.  The sharing of ideas, successes, and the collaboration that is accomplished in one day is awe-inspiring.  Second, the classes are always good, and this year I have to say the classes were awesome.  There is always something new to learn, and I value the opportunity to learn with my colleagues from all over the world.  And for those of us in the Northeast…the Phoenix sun and beautiful weather was a welcome relief from the snow.  All of those are great reasons to love the meeting.  In my mind, the biggest reason this is one of my favorite events?  I get to see my family.  My ENA family.

ENA is like one big family.  We look forward to getting together at least once a year.  We swap stories about what’s going on in our emergency departments.  We share our biggest accomplishments of the year.  We talk about our biggest frustrations in our practice areas.  We celebrate the new additions to our family, and we grieve the ones we have lost along the way.  In short, we catch up.  We meet new friends.  We recharge our batteries.  Some of us reignite the passion for our practice we may have lost along the way.  All of us see someone we haven’t seen in, well, a year.

This year in my role as president, I had a different experience.  I had nurses come talk to me to share their stories with me personally.  I heard stories from victims of workplace violence.  I heard stories from nurses who made errors in their departments.  I saw the frustration on some faces when they shared how they tried to get someone to support them as they worked their way through the legal system.  For every story that made me want to hug someone, I heard at least three more.  These were stories of how ENA made a difference in their life or the life of a patient.  I heard stories about how something they learned in ENPC helped them recognize a child was in trouble.  Some told me about how they had used an ENA clinical practice guideline to change a practice in their departments.  I heard stories of how state leaders partnered with our government affairs experts to successfully push legislation in their states.  And I had nurses tell me how grateful they were the ENA violence toolkit is available to anyone who wants to work to make a difference in the epidemic of workplace violence in the ED.  These were the stories about how ENA helped make a difference.

I feel incredibly privileged that I heard these stories first hand.  I wanted to share them with you because you are part of my ENA family.  We come together at a conference to learn, to network, to inspire and to be inspired.  When I got home, there was no question in my mind that I must continue to work towards fulfilling the mission of ENA with heart-felt passion.  These stories are the reasons why we at ENA continue to advocate on your behalf for safe practice and safe care.  You all make a difference each and every day in the lives of your colleagues and the patients and families you care for.  Thank you for continuing to inspire me.

Lifelong learning…

Thursday morning, I was walking down the hall with one of the flow supervisors from my department.  When I asked her where she was headed she replied “well, there is a class that is being offered upstairs about pediatric care after resuscitation.  I thought I might learn something so I decided to go”.

Being an emergency nurse is hard work.  We have to know a whole lot about a whole lot.  Patients come through our doors with a variety of complaints, histories, medications and co-morbidities, and we must be able to identify and intervene on potential and actual life or limb threatening conditions.  It seems as if every month, there are new medications, breakthrough treatments, or an evidence based practice change we need to get up to speed on.  Essentially, the learning process never stops.

Many of you are fortunate to work in organizations that provide free continuing education for nurses.  Some organizations only cover what is “mandatory”.  There are even some hospitals that may not cover those mandatory courses. I often hear from ED nurses “well, my employer doesn’t cover the class so I am not going to go”.  My question is, how do we move our profession forward if we don’t seek out opportunities to learn?  Part of being a professional is being accountable to keep up with “what’s new” in emergency nursing.  There are ways to seek out those opportunities and keep your costs to a minimum.

For example, did you know that as a benefit of your ENA membership, there are free CEU’s available to you on the ENA website?  Right now there are over 14 contact hours available to you, for free, 24/7/365.  Just click here  to access the information.  You do need to log into the website, and then start learning.

Another benefit that comes with membership is your peer-reviewed Journal of Emergency Nursing.  When was the last time you picked up your copy?  Here is your chance to learn about cutting edge emergency nursing research and share those articles with your peers.  The journal also provides members a low cost option to obtain CE credit.

The issue of workplace violence has been the topic of my last two blog posts.  There is a great FREE workplace violence training program offered through the CDC and NIOSH.  It is specific to nurses and you will receive 2.6 CE for completing it.  The course can be found by clicking here.

My favorite kind of educational experience is a national conference.  The ENA Leadership Conference starts next Friday in Phoenix.  For two and a half days, emergency nurses from across the country and around the globe will gather to hear new ideas, learn about new processes, and identify quality and safety initiatives we can bring back to our departments.  We will also network with other emergency nursing leaders to build “brain trusts” of new ideas and innovations that can change the face of emergency nursing.  For those who will be in Phoenix, I look forward to seeing you there!  I challenge each of you to bring back some of those nuggets of wisdom you pick up at that conference to your colleagues back home.  This way, we can all learn from your experiences.

Lifelong learning means just that.  As professionals, we need to recognize that it’s our job to stay current and keep learning.  Thursday, Mary Beth reminded me of what it means to be a lifelong learner.  It’s not about what I have to do or what class I am “forced” to go to.  It’s a mindset that I proactively seek out opportunities to learn because when I keep learning, I keep becoming a better and better nurse.  One of my favorite things about being an emergency nurse is that I learn something new each and every day in the ED.  The day I stop learning is the day I need to move on.  And I have no thoughts about doing that anytime soon.  I encourage all of you to become lifelong learners.  Don’t just do the “mandatories”.  Seek out opportunities to learn and grow as a nurse, as a professional, and as a human.  I guarantee it will make you a better emergency nurse!

The Issue of Violence in the ED

On January 15, 2014, Dr. Lisa Wolf and her team at the Institute of Emergency Nursing Research published a study “Nothing Changes, Nobody Cares. Understanding the Experience of Emergency Nurses Physically or Verbally Assaulted While Providing Care”. When you read the study, you can’t help but feel several emotions. The first is anger. Anger that so many of our colleagues have experienced violence in the workplace. Anger that their stories are so similar when it comes to lack of organizational or institutional support for reporting incidents of violence. The second is despair. Violence in the ED is not a new issue. ENA has been advocating for safe work environments for years. Our violence research has been occurring for nearly a decade. And yet, here we are, still trying to get people to understand that violence in the ED is an issue. Heck, we are still trying to convince ED nurses that being a victim of violence in the ED is not an expected part of the job. In the past few weeks, I have done interviews both on camera and off about the topic of workplace violence. Many of these reporters end by telling me what a shame it is that this stuff happens to nurses. And yet, have we made a difference? How is it possible to make a difference with this issue that no one wants to discuss, no one wants to admit is happening in their department, and no senior hospital leadership team wants to acknowledge goes on under their watch? The despair I feel when I read these stories is real. And while it’s easy to point fingers at what everyone else isn’t doing, it can be hard to turn the finger on yourself and recognize that in order to tackle the behemoth of the issue we each have to be willing to change our own perceptions and attitudes.

The issue of violence in the ED is real. It is occurring daily, in virtually every ED in this country. It impacts all members of the team, including the patients and families we care for as well as our friends and families at home. Our colleagues suffer life long physical and emotional scars as a result of the violence. And it’s not just limited to the ED. Just this week there have been at least two nurses in New York who were assaulted. One of whom is still in the ICU. We can’t hide from it. We can’t ignore it. And we can’t run away from it. So, what can we do about it?

First, we have to decide it’s not ok. It’s not ok to come to work and be assaulted. Ever. Period. Next, I want you to find someone in your ED who feels the same way you do. Then click here. Addressing the issue of violence in your department requires a multidisciplinary team approach. To be successful, a group of both clinical staff and hospital leadership need to sit together to assess the issue and create a plan to move forward. The ENA Workplace Violence Toolkit has a wealth of information, tools and resources to help your team address violence.

Second, we need to do a better job of sharing what works. I know there are departments out there who have come together to address the issue of violence. I know you have created best practices, zero tolerance policies, and support systems for nurses who are victims of violence. I encourage those of you who have been successful to help those who haven’t started yet tackle this issue. The more we work together, the sooner we will all be safer in our departments.

One of the most common questions I get asked by reporters is “what’s the most surprising statistic related to workplace violence?” For me, it is that we have created this culture of acceptance in our profession. We have decided that workplace violence is part of our job in the ED. The culture of acceptance expands beyond the back doors of the ED throughout the hospital and healthcare, through law enforcement and the judicial process. “You work in the ED…what do you expect would happen?”. What do I expect? I expect to work in an environment where violence is not tolerated by anyone, anytime. I expect to be given the tools and resources I need to be safe at work. If I do become the victim of violence at work, I expect to be fully supported in my decision to report the episode, press charges, and seek whatever assistance I may need to recover. Is that too much to ask?

The Issue of Workplace Violence

The issue of workplace violence seems to make the news on an almost daily basis.  This week, it hit close to home.  Recently, I gave an on camera interview on violence in the ED to an ABC affiliate in Washington, DC.  As I was reviewing the ENA research, I was reminded of a statistic that just about knocked me out of my chair.  One third of the emergency nurses surveyed who experienced workplace violence were either going to leave their ED or leave the profession all together.  Leave the profession…talented, educated, passionate and compassionate ED nurses who are going to be driven out of our profession because of these senseless acts of violence against our peers.  How is that ok?  How is it acceptable to be providing care in an environment where violence is tolerated?  How do we as a group of professional emergency nurses have difficulty understanding that dealing with violence is NOT part of the job in the ED?  When are we going to put our collective voices together and say “just because I choose to work in an emergency department does not give anyone the right to assault me”?  Yesterday, I had a call from a member who was so passionate about tackling the issue in her own department you could feel her commitment through the phone.  She was tired of dealing with the violence in her ED and was reaching out for suggestions on how to end it.  So, I sent her to the ENA website for help.

First stop, http://www.ena.org/practice-research/research/Pages/WorkplaceViolence.aspx.  In order for us to fully understand the issue of workplace violence in the ED, we need to better understand the scope and breadth of the problem.  We also need to research what we can do as ED nurses to keep ourselves safe.  Take some time to read the articles contained on this page.  Then share them with your peers.  When you are ready to take the first step towards addressing the issue in your department, click here.  This link will take you right to the workplace violence toolkit.  The toolkit provides you a step by step process to assess your own department, identify gaps, and put action plans into place to reduce the risk of violence in your ED.

We can each go to bed at night thinking “It can’t happen to me” or “it’s not going to happen in my ED”.  We can rationalize incidents by saying things like “that family member was under a lot of stress” or “he was high and didn’t really mean it”.  Or, we can decide that the safety of our peers and our teammates is paramount in our EDs and choose to stop the violence.  It is not part of our job to be yelled at, hit, spit on, shoved, threatened, or slapped at work.  It is part of our job to be part of the solution.

A Call To Action

As you may be aware, this week the American College of Emergency Physicians published “America’s Emergency Care Environment” State Report Card.  At first glance, it’s not good news.   Overall, as a nation we received a D+, with access to emergency care receiving the lowest grade of a D-.

As emergency nurses, access to emergency care, quality/patient safety, public health/injury prevention, and disaster preparedness are all essential components of our practice.  I urge all of you to read the report.  Focus not only on the state in which you live, but where we are as a nation.  This is a time for us to identify opportunities for improvement in all aspects of emergency care.  This report is full of opportunities for emergency nurses to advocate for safe practice and safe care.  How does your state measure up?  Are you surprised at your state’s rating?  How can our members can step up and improve the emergency care environment for the patients we serve?