Standing together as Ebola arrives

Ebola is here. Each of you has probably received an email from your leadership team stressing the importance of obtaining a travel history on every patient with concerning symptoms. It’s possible you have been trying to reassure your friends and family members that the chance they will contract Ebola is virtually nonexistent. While the media initially looked to assign fault regarding how a patient with Ebola was seen and discharged from a hospital, there is no surprise to me that a system failure was the root cause. In order for us to care for our patients safely, the entire healthcare team must have access to the same information. I am willing to guess each of us can provide examples about documentation that is not easily accessible by a teammate.

ENA is committed to ensuring you, our members, have the information and resources you need to safely care for patients with Ebola and other infectious diseases. Yesterday I had a great conversation with Alex Roseneau, the ACEP president. He and I agreed that now is a time we come together as emergency care providers. In order for us to learn from the situation in Dallas, we need to recognize it takes nurses and physicians working together as a team to identify high-risk patients and take appropriate action. Now more than ever we need to partner together and recognize we are the front line to prevent an epidemic here in the United States.

The lessons here are strikingly similar to those I have shared all year. We need to be accountable and report when system flaws are present so they can be corrected. We need to speak up when something doesn’t feel quite right. We need to work to ensure we are communicating effectively to all members of the healthcare team. We need to constantly be seeking out opportunities to learn about new diseases, therapies, treatments, and medications. And when we are not sure, we need to seek out resources to answer our questions.

All of us should know how to properly screen a patient who might be at risk for Ebola. If you are unsure or have questions, here are some resources for you:

Thank you for all you do to ensure the safety of the patients in your care. Thank you for being the voice of reason when people want to panic. And thank you for working to protect our country from an epidemic. Emergency Nurses Week starts Sunday, October 5. I am looking forward to spending the week with nearly 3,000 of my awesome emergency nursing colleagues and friends at ENA Annual Conference in Indianapolis. For those of you who cannot join us, thanks for holding down the fort while we are gone. Without you we couldn’t be in Indy. Emergency nurses rock! Have a great week!

Countdown to Indy!

 

At the end of last week, I had the opportunity to speak at the Sigma Theta Tau International Leadership Connection conference in Indianapolis. I shared ENA’s research on workplace violence with two groups: a group of clinical bedside leaders and a group of hospital nursing leaders. It’s always fascinating for me to hear other nurses perceptions of violence in the workplace. Both of these groups acknowledged we have much work to do to create a culture of zero violence. I was able to share both the ENA Workplace Violence Toolkit and the ENA Workplace Violence Prevention online education program to get these nurses started changing the culture in their organizations.

I took some time while I was in Indianapolis to walk around the downtown area. The entire city is totally walkable with a great variety of restaurants, bars, shops, museums, and outside spaces. The canal walk is gorgeous, and as the leaves on the trees start to turn colors, I can only imagine how beautiful that will be next week.

Everyone I chatted with was very excited to have the Emergency Nurses Association descending upon Indy next week. No one was more excited than the Indiana State Council! I had dinner with Ron Kraus, Sherri Marley, and Teri Joy, and they shared the great work they have been doing to get ready for our arrival. Hoosier hospitality was everywhere!

I am very much looking forward to seeing my ENA family in just a little over a week. I am especially excited we will be celebrating Emergency Nurses Week together in Indy! The Resolutions Committee has done an outstanding job preparing for General Assembly. The Annual Conference Committee has put together a stellar educational program that is not to be missed. Safe travels to all, and I will see you soon!

ENJOY INDY!!!!

Inaugural global conference provides international perspective on safe practice, safe care

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Greetings from the 1st Global Conference on Emergency Nursing and Trauma Care! I have been afforded the opportunity to spend three days with almost 400 emergency nursing colleagues from 28 countries in Dublin, Ireland. And what an incredible opportunity it is been. Yesterday I was able to share my thoughts about how our bedside behavior can negatively impact patient safety, and how each of us needs to change our thoughts and attitudes about patient safety.

I also had an opportunity to share the findings of ENA’s research on workplace violence and what we need to do to change the culture of acceptance that is rampant in our profession. I have also been blessed with the chance to listen to emergency nursing researchers from around the globe share their insights and findings about our common practice.

I have said before, one of the most amazing things about emergency nursing is the opportunity we have to share our knowledge and experiences with our team members, and leverage that depth and breadth of knowledge to provide the safest, highest quality care possible. It’s the unique individual experiences and expertise that, when brought together, makes us stronger. At this meeting, I am reminded those strengths go way beyond the borders of the United States. The commonalities of issues and opportunities as they relate to the global profession of emergency nursing are staggering. Crowding, violence, throughput, patient satisfaction, patient safety, access to care, and care of vulnerable populations are just some of the topics discussed. The can-do attitude, passion, and desire for clinical excellence is evident in each speaker’s presentation. The conversations after and in between sessions provide a global snapshot of our profession: its successes, struggles, opportunities, and best practices.

It is truly an honor to be here representing ENA in this international venue. It’s clear to me ENA has a global reach, and many of our international colleagues have shared with me how they have used the tools, resources, and ENA courses in their practice. We are all working towards providing the safest possible care in a safe environment every time, and for every patient. To have the chance to attend this meeting and network with emergency nursing professionals from across the globe is really humbling. The quality of work and passion for our shared profession is outstanding.  I am so proud to be an emergency nurse today!

No Matter Your Role, You’re Making a Difference

I am not usually one to share my feelings, but I have no doubt many of you will relate to what I am about to say.

I came into emergency nursing to make a difference for patients and their families. For me, specifically pediatric patients and their families. Working clinically at the bedside, I really believed I had the chance to do that everyday. As I gained more experience, I gained more nonclinical responsibilities. Still, every day at the bedside I felt like I was making a difference.

I earned my MSN and began a new role as a clinical nurse specialist. Instead of directly impacting patients and families, I now focus on helping nurses be the best nurses they can be. I help them identify strengths they perhaps didn’t see in themselves, and make sure nurses have the tools, skills, knowledge, and attitude to be exemplary bedside caregivers. I wanted to make a difference in their practice so they could make a difference in the lives of the patients and families they cared for.

With more experience came more nonclinical activities. More time away from the nurses I am supposed to be mentoring. More time improving systems and processes to impact the care all patients receive. More time at the computer, writing minutes, designing algorithms, and manipulating spreadsheets. All in the name of improving patient care.

A funny thing happened. The days of feeling like I made a difference became fewer and further between. Sure, there are days I would meet with nurses I was mentoring on projects and watched their faces light up when they shared their successes. But somehow, without me noticing…the days when I could feel I was making a difference were way outnumbered.

Don’t get me wrong, I absolutely love being a CNS. I love the amazing staff I have the honor of working with, and I actually do enjoy my leadership responsibilities very much. For someone who came into nursing to make a difference, it’s just a different set of realities now. 

Today, I had the extreme privilege of being with a family on the worst possible day of their lives. I had the opportunity to comfort, console, hold, support, and grieve with this family. And I remembered why I became a nurse in the first place. We do make a difference, each and every day. It may not be in some grandiose way, but we do. It may be a patient, family member, coworker, or friend whose life we touch. And most of the time, no one will tell us. So, I am telling you. Emergency nurses make a difference each and every day. Thank you for all you do, everyday.

Creating Partnerships to Keep Us Safe

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It seems as if almost every day I am reading another news story about an episode of workplace violence. For every one I read, I know there are countless other events happening in our EDs each and every day that don’t make the news. At the end of last week, I had the opportunity to meet with a group of professionals who are just as passionate as we are about keeping nurses safe in the ED. Actually, they may even be a little more passionate.

ENA members Matt Powers, Kris Powell, and I headed to Chicago late last week for a meeting with the International Association of Healthcare Security and Safety (IAHSS) and members of the ENA staff. While Mother Nature tried to keep us apart, Tony, Tim, and Kevin from IAHSS arrived, and what transpired was a very productive conversation about how our two organizations can partner together to create safe environments in our departments. Topics discussed included crime prevention through environmental change, how to identify individuals at high risk for violence, the role of security, how should we view the security staff as a member of the healthcare team, among many others.

We spent quite a bit of time learning about each others perceptions of the role of security in the ED. We discussed the “Barney Fife” image of the security guard in the ED and how we need to move away from an “observe and report” mentality to one of action. We shared how at times emergency nurses can escalate a situation, or might not contact security until a high-risk situation is out of hand. And honestly, it comes down to communication, role clarity, and a shared mental model. Sound familiar? 

For those of you who have an excellent rapport and working relationship with your hospital security team, I can only guess you have clear expectations of each other, role clarity, and engage in frequent and meaningful dialogues about what’s going well and what could be done better. For those who are looking for a more meaningful relationship, we need to start with sitting down in the same room and understanding each other’s roles.

As a team, we were very excited about the opportunities for future partnership with IAHSS. What a great member of the ED team! These gentlemen were all very passionate about creating safe environments for us to work in, and they were just as passionate that security professionals should be part of the ED healthcare team. The question that we spent the most time answering was “What do ED nurses expect from security?” I am interested in your thoughts. We will share them with IAHSS as we work together to create safe practice environments in which we can provide safe care.

The Struggle All Around Us

Right now, you can’t go to any social media or news site and not be bombarded with images of Robin Williams. He was an incredibly talented comedian, a humble humanitarian, and will be missed by all. His death makes me stop and think about all of the patients I have cared for who came to the ED in crisis. Perhaps they had suicidal ideations. Perhaps they acted on a plan to end their life, and were not successful. Each one suffering from mental illness, sucked into a black hole of despair that I would wish on no one. Did I hold their hand long enough? Did I listen to their concerns and provide reassurance and not judgment? Did I provide comfort? Did I help coordinate the care they so desperately needed in a way they found useful? Did I do enough to make a difference?

What about their family members and friends? How do you comfort the family of someone who just tried to end their life? Is empathy enough? Did I say something stupid like “he’s in a better place?” Did I hold their hands long enough? Did I answer all of their questions? Did I hug them when they asked questions I couldn’t answer? At the absolute worst moment of their lives, did I do enough to make a difference?

It’s easy to think major depression and suicide will never happen to you, your family, or your work family. It absolutely amazes me the number of emergency nurses who are walking around with a brave face and can-do attitude who are struggling with this disease. They are coming to work every day. Some might be sharing what’s going on. Others let us know in their words, actions, and change in behaviors. And we don’t see it. We rationalize behavior changes and attribute then to other causes. How do we not see what is right in front of us? It’s our job to recognize patients who are at risk for suicide, yet we can be blind to it when it’s our coworker, family member, or friend.

We are too proud to share our struggles. We are in the business of caring for others, and we forget we need to care for each other. Someone you know is struggling with depression, contemplating suicide, or dealing with any number of mental illnesses. They may be too embarrassed to ask for help. They may have reached out to you, and you were too busy to notice. We need to do more to rid ED’s of the stigma of mental illness. Depression is real. The dark spiral, crazy roller coaster of emotion, feeling of helplessness, worthlessness, and paralyzing fatigue is real. We need to do more for our patients, their families, our families, and our friends. If we don’t, then one day they won’t be here anymore. And that is a thought I just can’t bear.

If you or someone you know needs help, visit http://www.suicidepreventionlifeline.org or call 1-800-273-8255.

One place you won’t see a summer slowdown: the ED

Happy July!

For most of us, July means barbeque, days at the pool, trips to the beach, and vacation with friends and family. For many of us, July has an entirely different meaning. If you are working in an academic medical center, July can only mean one thing…new residents.

Now, don’t get me wrong. All of us in the emergency department make mistakes. In July, however, we are filling an even more important role. As an emergency nurse, we are often the last stop between a mistake and a patient. In the ED we function as a team, and all members of that multidisciplinary team should always be looking out for each other, identifying potential safety concerns, and working together to provide safe care to our patients and families. In July, the first year resident becomes the newest member of our team. And we know our newest team members may not have any idea what it’s like to be a member of our team.

We are the constant in the ED. We walk into work in July with years of experience, depth and breadth of knowledge, and confidence that it’s not our first “rodeo”. It’s our job to help orient the newest members of our team. We question orders that may not be in the best interest of the patient, while gently teaching the resident that it’s OK to ask us questions if they are unsure about something. We walk into an exam room pushing the EKG machine with an IV tray on top and before the resident has completed their H&P, we have the patient packaged and ready for the cath lab. We share what we saw, felt, and anticipated about this patient with the resident and let them know “you will be able to spot a STEMI a mile away too”. We walk with our new colleague into the quiet room to let a family know we were unable to save their loved one. We stand as their wingman as they struggle to get those painful words out. And we offer them encouragement and support while reassuring them “it doesn’t really get any easier, but I am here if you want to talk”.

In short, we continue to work together to provide the safest care possible. When we model team behaviors, support each other, and offer encouragement, the culture of the department changes and the team becomes exceptional. Care is safer, and we rest easier at night knowing we made a difference in the lives of our patients and their families. July is an opportunity to remember how important each and every one of us is as a member of a multidisciplinary ED team.