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.

A week of celebration

This is a week to celebrate emergency nursing and emergency nurses!

First, the winners of the ENA National election have been announced. 6.17% of our members participated in the elections process and have elected Kathie Carlson as the 2016 President, and Karen Wiley as the 2015 Secretary/Treasurer. Jean Proehl and Patti Howard will rejoin the board as directors for three year terms beginning in January. Robyn Larkin, Terry Foster, and Lucinda Rossoll will be joining the Nominations committee. CLICK HERE to see ENA’s formal announcement. Congrats to all of the successful candidates!

Second, we announced the 17 recipients of the 2014 Lantern Award. The Lantern Award is a recognition award given to emergency departments that exemplify exceptional practice and innovative performance in the core areas of leadership, practice, education, advocacy and research. For a list of this year’s recipients, please CLICK HERE.

I spent the end of the week at the ANA Organizational Affiliates meeting in Washington DC. More that 30 different specialty organizations were represented with a goal of creating collaborative relationships and networking opportunities between and among these associations. As the ENA representative, I had the opportunity to bring two agenda items to the forum. We discussed workplace violence and the need for all nurses to stand up and say “being assaulted on the job is NOT acceptable!”. ENA was recognized for our leadership on this issue. The second issue we brought to the table was the care of patients with behavioral health issues. What was clear at the forum is that these patients present unique challenges throughout all specialties and across the life span. We will continue to look for opportunities to partner with our nursing colleagues to identify and create resources to provide excellent care to these patients.

When I reflect on this week, I see emergency nurses in action. Whether it’s advocating for our profession, our patients and families, or ourselves, taking on national leadership positions, or recognizing excellence in patient care, emergency nurses are front and center, making a difference!

Time Is Running Out

There is a little over one week left to vote in the National ENA Elections. It’s time to choose the next president-elect, secretary/treasurer, directors, and nominations committee members. Have you voted yet? If you have voted…THANK YOU! As of this past Monday, only 4.49% of our members have exercised their right to vote.

There are many reasons why people haven’t voted yet. Here’s my top five list of reasons why:


5. I didn’t know the elections have started.

Ok…we all fall behind in email from time to time. The elections started last month. You have until noon central time Wednesday, June 11 to cast your vote.


4. I don’t know any of the candidates.

We have got you covered! All of the candidate information is posted to the ENA website on the elections page (http://www.ena.org/about/elections/Pages/Instructions.aspx). Here you can read the candidate’s bios and their statements to the membership. For board and officer candidates, there is also a link to their video from candidate’s forum that was held at Leadership conference in March of this year. Take the time to read about the candidates and be an informed voter!


3. I don’t know how to vote.

An email with detailed directions on how to vote was sent to the email address ENA has on file for each member on the day the polls opened. The email came from elections@ena.org.

2. I never received the email with the voting instructions.

First…check your spam/junk folder for an email from elections@ena.org on May 13, 2014. It is possible your email security settings sent the email directly to spam. If it’s not there, you can contact elections@ena.org or the National ENA office at 800-900-9659 for assistance. If you need the information to vote, please contact the office today!

And the number one reason I hear people say why they have not voted is…


1. I don’t have time to read the candidate information and my one vote isn’t going to make a difference.

We are all pressed for time, and I get it…you don’t have time to do it all. These candidates have chosen to invest their time and talents to help ENA advance its mission to advocate for patient safety and excellence in emergency nursing practice. It takes tremendous courage to run for a national position. They have stepped up and are willing to serve our profession. You have the ability to choose the leaders of our association. Your vote absolutely makes a difference!

Please take the time to vote. I know we can “rock the vote” and increase our voter turnout. On behalf of all of the candidates this year, I thank you for taking time out of your busy schedule to vote. The future of our profession is in your hands.

Learning through the eyes of students abroad

Trauma Nursing Core Course (TNCC) dissemination in Abu Dhabi

Trauma Nursing Core Course (TNCC) dissemination in Abu Dhabi

How many times have you signed up for a continuing education course only to wake up the morning of the class and consider not attending? You might be too tired, your “to do” list might be too long, or perhaps the topic doesn’t interest you as much as it did when you registered. Did you take the necessary time to fully prepare for the course, or did you hope to “get by” on the knowledge you had already accumulated figuring there wasn’t much new to learn?

For the last week I have had the honor and the privilege of sharing ENA’s Trauma Nursing Core Course (TNCC) with emergency nurses in Abu Dhabi, the capital of the United Arab Emirates. I am here with a team of ENA members including Margot Daugherty from Ohio and Sandy Waak from Maryland, and lead by Tim Murphy of New Jersey. By the end of this week, we will have completed two provider courses and two instructor courses, with the goal of creating a solid foundation for the nurses from Al Rahba hospital to grow their trauma program.

Preparing for an international dissemination is fairly straightforward. Read about the culture, create agendas for the courses, divide the content among the team members, and make sure your passport is ready to go. Nothing, however, prepared me for the first day of the course.

When we arrived at the hospital on the first day of the course, we were met by 16 very enthusiastic and excited students. Their energy was palpable and it became easy as instructors to get swept up in the excitement. What was completely unexpected, however, was just how prepared these nurses were for the course. Each one had read the book, cover to cover. They had formed small study groups to help each other learn. They had every mnemonic committed to memory. They were all eager participants in the hands-on portions of the course. They were engaged during the lectures and asked great questions. They considered it a privilege to attend the course, and were going to take full advantage of the opportunity.

Tim, Sandy, Margot and I were stunned. And humbled. This level of commitment, investment, and preparation was inspiring. The students told us how much it meant to them for us to come from the U.S. to teach. In reality, we were the ones honored to be standing in front of them. It was a privilege for us to engage with this group. It reminded us why opportunities to learn are so important. And it made me start to think differently about the continuing education programs I attend.

It’s easy to consider continuing education to be a pain in the you know where. Many of us have to do it to keep our RN licenses current. It’s required to maintain certification. We consider it something to check off our list of things to do. I have never considered it a privilege. Maybe it is? As emergency nurses, we MUST continue to grow and learn. Nursing science changes, practice changes, guidelines and recommendations change. To deliver safe care, we need to be up-to-date on what’s new and what works. Most of us get that information as part of the continuing education process. Many of these programs are offered by ENA chapters and state councils, hospitals, or in our local community. We are privileged to have these opportunities in our own backyards. So come to class prepared. Be on time. Come with an open mind and be prepared to learn something new. Pay attention. Put your smartphone away. Be engaged. Ask questions. Take advantage of the opportunity to bring something back to your practice that will make you a better nurse–something that will help you stay safe and keep your patients safe. Our patients and families are counting on us.

As an instructor, it’s a pleasure to stand in front of the group and share knowledge. I know I am learning more from them than they are from me. How fortunate I am to be able to be here. Thank you to John, Norman, and all of the nurses from Al Rahba and the other hospitals represented. You have truly opened my eyes and my mind, and for that I am forever grateful.

ENA Takes Over Washington DC

ENA Members attending Day on the Hill

ENA Members attending Day on the Hill – Click to Enlarge Photo

Yesterday was Florence Nightingale’s birthday, and officially marked the end of Nurses Week.  Usually, Nurses Week is full of festivities, and in my ED there was quite a bit of celebrating that went on all week.  This year, Nurses Week had a whole different meaning for me.  I spent a few days last week with over 100 emergency nurses from all over the US in Washington, DC.  We had one goal…to educate our legislators about issues that are important to emergency nurses.

Tuesday, we spent the day learning how to speak to our elected representatives.  Congressional staffers gave us tips and strategies to ensure our voices were heard.  We heard from experts about the two issues we were bringing to the Hill…funding for trauma systems and mental health first aid.  We ended the day networking with each other, sharing strategies and coming up with a game plan for Wednesday.  Those who had been to the Hill before offered to help first timers find their way.  It was teamwork in action.

Wednesday we headed to Capitol Hill.  We started the morning with Senators Burgess, Capps, and Black addressing the group as a whole.  And then I said to the group “go forth and change the world”!  And I have no doubt we did just that.  We celebrated Nurses Week by leveraging our strengths as emergency nurses and advocating on behalf of the patients and families we serve.  We told stories of trauma centers that closed due to a lack of funding, and patients who had to travel longer distances to receive the life saving care they needed.  We told stories about patients who had no access to a trauma center within the “golden hour” and how that impacts morbidity and mortality.  We told stories about patients waiting for days for inpatient psychiatric beds, and how we need to do a better job providing outpatient community resources for mental health patients.  We told stories about patients and families that come through our doors in crisis, because they have nowhere else to seek care.  We are emergency nurses, and we don’t mince words.  We told it like it is.

As nurses, we are the most trusted group in healthcare.  We celebrated Nurses Week by standing up and speaking out on behalf of the patients and families we serve.  The elected officials and their staffers we spoke with listened to what we had to say.  I was blessed to have the opportunity to stand with more than 100 emergency nurses and share our stories to change the face of healthcare.  I am so in awe of this group, their passion and commitment to advocating on behalf of the patients and families they serve.  Nurses Week is about celebrating the contributions nurses make in this world.  This year, I am celebrating the difference one emergency nurse can make in this world.  I am astonished by the power of more than 100 emergency nurses.  Together, there is nothing we can’t achieve!

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!