September 28, 2018

Opening Session Wows Audience

Opening a conference like Emergency Nursing 2018 is no small task, but planners were up to the challenge.

A dramatic video traced the yearlong journey of ENA lanterns across the United States, and around the world, before arriving in Pittsburgh. Nurses carried their lanterns to the stage and encircled the ENA President Jeff Solheim to complete the trek.

Master of Ceremonies Todd Thomas returned with boundless energy which he used to shake up the early morning crowd. He encouraged audience members stand up and dance to get their blood pumping.

The heart of the session included speakers and live debates on stage. ED Talk subjects included, “I’m a Millennial and It’s Time You Took Me Seriously,” “I Might Be Retired but Don’t Put Me Out to Pasture” and “It’s Better to Burn Out than to Fade Away.”

Two debates focused on nurse staffing ratios and specialty emergency departments, respectively. The audience partcipated using the conference app to vote on the topics before and after the speakers presented their arguments to gauge how many minds were persuaded by the conversation.

Those in the audience appreciated the live debates.

“I found it really interesting and dynamic,” said Molly Davisson of Reno, Nevada. “To pull the audience in and see what they thought in real time was a great idea.”

Her colleague Dustin Bass, also of Reno, agreed. “It was great to hear both sides of topics that we really do struggle with in emergency nursing.”

Solheim, ENA Foundation Chairperson Steven Jewell and ENA Executive Director Nancy MacRae gave a rapid-fire update on many of ENA’s exciting accomplishments this year, including the unveiling of the organization’s new logo.

Finally, keynote speaker Allison Massari, who capped off the event, offered her story of recovery from a near-fatal car accident in which she received second- and third-degree burns over 50 percent of her body. Her personal tale served to inspire and motivate the audience. Her words flowed between the story of her physical recovery and her realizations about the importance of kindness and love.

“Everything we do makes a difference. Every act of kindness counts,” she said. “And, oh, do I remember the kindness of my nurses.”

Massari told stories about the small gestures and great kindnesses her nurses offered, including a seven-second interlude where, as Massari lay in despair and unimaginable pain, a nurse looked her in the eyes and ran her fingers through her hair. She said those memories have never left her.

“You have such an awesome responsibility to help someone heal,” she said softly, adding not every patient has the chance to share their gratitude. “So, on behalf of all of those people, I say thank you.”

Many attendees were emotionally moved by Massari’s story. Others took what she said to heart.

“She was phenomenal,” said Misty Holland of Winter Haven, Florida. “It’s always good to come to a conference like this to refill your cup, and I’d say for a lot of us that’s what she did.”

 

In the Trenches of the Opioid Crisis

There’s often more to drug addiction than just bad choices.

Understanding the pathophysiology and the neurobiology of adverse childhood events and drug addiction can help emergency nurses be more empathetic to patients caught in the opioid epidemic that has gripped the country.

In the Trenches of the Opioid Crisis

2:30 – 3:30 p.m.

Friday

Room 319, 320, 321

While emergency nurses understand the pathophysiology of many diseases and conditions, some might understand less about addiction. To alleviate such knowledge gaps, Darris Bohman and Jennifer Williams of Cincinnati-based TriHealth will lead a session today to highlight staff education that helped increase awareness of the changes that happen in the brains of patients with addiction.

“We understand the pathophysiology of diabetes and heart disease very well, and we are not judgmental when these patients have recurrent issues. But we understand very little about how adverse childhood events change the way people are wired,” Bohman said. 

Darris Bohman

“The opioid crisis has taken its toll on first responders, and our department is no exception,” she continued. “We, however, have started to give training on trauma-informed care, which seems to be helping our staff have more empathy and decrease compassion fatigue.” 

Making the connection from tragedy and trauma to a patient’s drug use was a breakthrough for Bohman in her efforts to understand the grip opioids have on so many patients. 

“It helps to understand that our patients may have lived through incredible tragedy or trauma in their lives and that this is the coping skill they use,” she said. “It does not in any way condone drug use, but to understand that their brains may be hardwired differently than mine, helps me to have empathy.” 

The federal Substance Abuse and Mental Health Services Administration suggests health care workers should treat patients as a “whole person,” recognizing significant past events and the subsequent coping mechanisms. 

“It changes the question, ‘What is wrong with you?’ to ‘What happened to you?’” Bohman said of the trauma-informed care concept. “And while we do not want to delve into their nuanced childhood in the ED, just understanding there is probably a story behind their behaviors increases empathy.” 

Bohman said the trauma-informed care approach helps build trusting relationships with patients.

“Care is all about trust,” she said. “Patients should think, ‘I trust that if I tell you the truth about what brought me to the ED you won’t judge me. I trust that you want what is best for me and will treat me with all the science and art of nursing you know. I trust that I will get good care.’” 

ED nurses should have authentic healing relationships with their patients and understand how to help them be successful, Bohman explained, suggesting if the patients trust the nurses, they will get the treatment they need when the nurses suggest it.

“This is a great opportunity to reframe the way we think about the patient who is an opioid user and make our work less frustrating so we can start to really care again,” she concluded. 

More Opioid Sessions

This week, there are plenty of opportunities to learn more about opioids and the opioid crisis. The session “My Patient Is in Pain and on Buprenorphine … Now What?” scheduled for today and Saturday afternoon, will delve into the drug buprenorphine, which can be an effective alternative to pain management and in some situations, treat opioid addiction. 

Saturday morning will feature “Opioid Crisis: Implement a Team-Based Naloxone Saturation Campaign,” in which a team of presenters will facilitate a discussion on how existing Screening, Brief Intervention, and Referral to Treatment protocols in emergency medicine served as the foundation for launching a system-level Naloxone Saturation Campaign. 

In addition, there are several sessions throughout the conference that discuss ketamine, a drug that has been making a resurgence in EDs as an opioid alternative.

Preparing for a Potential Mass Casualty Incident

When white nationalist Richard Spencer announced he would give a talk in October 2017, at the University of Florida in Gainesville, UF Health emergency department staff carefully considered how to prepare for the potentially volatile event that could result in a mass casualty incident.

Just two months earlier, Spencer was a featured speaker at a racially charged rally in Charlottesville, Virginia, where a woman was killed and more than a dozen others were injured when the event turned violent; a suspected white nationalism supporter plowed into pedestrians with a car.

State of Emergency: How We Prepared for Richard Spencer

5 – 6 p.m.

Friday

Room 413, 414, 415

In a session scheduled for 5 p.m. today, speaker Wendy Swan will share how she and her colleagues at the north-central Florida Level I trauma center and ED got ready to care for whatever injuries could surface during the clash between thousands of supporters and counter protesters. 

“With a white nationalist headed our way, there was obviously concern for outbreaks of violence,” Swan said. “Possible blunt trauma, the use of weapons and chemical agents weren’t unfeasible. It was very possible we would receive an influx of patients that could stress our ED.” 

Swan is expected to detail the weeks her ED spent preparing for the event. She’ll describe how the hospital collaborated with local and state agencies, readied the staff, ensured adequate provisions and expanded capacity in the ED for large numbers of patients, visitors, EMS crews and media. 

All emergency departments should not only plan for disasters but be ready for specific types of events, she said. 

“Planned MCIs differ from unplanned, weather events require a different type of preparation and, of course, biological or radiological threats require specific action plans,” she said. 

Swan said preparing for Spencer’s speech in the small college town prompted the ED staff to re-examine how to approach such a planned event. 

“I would like to share the things we did well and the opportunities for improvement,” she said about the session. “All of us can learn from the detail-driven response that elevated our capacity to handle almost anything.”

Spencer’s speech in Gainesville precipitated only minor scuffles between his supporters and the much larger group on site to protest the event, resulting in only five minor injuries, according to news reports.

Should You Ask About Firearms?

Lisa Wolf, the director of ENA’s Institute of Emergency Nursing Research, on Thursday, laid out the unvarnished results of a survey that suggests as much as two thirds of emergency nurses don’t routinely ask if patients have or carry firearms.

Some nurses in the survey and two follow-up focus groups said they felt the question was too confrontational, and they feared they would become victims of workplace violence.

“If patients would punch me, why wouldn’t they get a gun and shoot me,” Wolf relayed as a sentiment shared by many of the nurses surveyed. “We found that nurses were more afraid of patients than for their patients,” Wolf said.

The group of about 20 nurses who attended Wolf’s session “Emergency Nurses’ Perceptions of Risk from Access to In-home Firearms,” all said they’d experienced workplace violence.

Wolf identified a number of barriers related to asking patients about firearms, including a lack of clear direction with the information provided.

Nurses asked “What do I do with that information?” and “Will I be liable if my patient does something after leaving my ED?”

But Wolf didn’t just present the questions. She also offered some recommendations for emergency nurses dealing with the trepidation of asking about patients’ access to guns during an exam. Normalize or standardize the assessment of firearms access by asking all patients under the auspices of public health, she said.

She suggested emergency departments should design standard protocols for patients who screen positive for risk and access to firearms, provide additional staffing to help assess such risk and implement strategies to improve the safety for patients and nurses through firearms injury prevention education and preparedness training.

 

Fighting Health Care Violence

Workplace violence is all too common in health care, especially in emergency departments. So, it is critical emergency nurses take steps to help minimize incidences of violence in their interactions with patients. 

“This topic is not new to health care, but we finally have data and research that can possibly mitigate this hot topic,” said Natasha Lukasiewich, who is moderating a session today titled “We’re Not Gonna Take It Anymore: Action Against Health Care Violence.”

We’re Not Gonna Take It Anymore: Action Against Health Care Violence

2:30 – 5 p.m.

Friday

Room 305

“Organizations have the duty to provide safe and healthy workplaces to staff. It’s bad enough our industry is experiencing high burnout and turnover rates of caregivers; workplace violence should be eliminated from this equation.”

Lukasiewich and fellow moderator William Schueler will guide attendees through the issues perpetuating the workplace violence epidemic, research on building effective violence-prevention programs and the tools available to effect change.   

“Our session will cover topics ranging from prevention and training to the aftermath of workplace violence,” Schueler said. “Our objective is to take the necessary time to flesh these topics out and discuss what is being done and what we can improve. 

Schueler and Lukasiewich will highlight real-life cases during the hour-and-a-half-long session and encourage participants to do the same. 

“Everyone has a story, and I’m confident fellow ED nurses will be sharing their experiences and thoughts during the session,” Schueler noted. “I myself have been used as a spitting target and had someone get their hands around my neck and start to squeeze.” 

He said while he has not been seriously injured by his attackers, others have been less fortunate. 

“Their powerful stories prove we can do a better job at prevention, training and support,” he remarked.

Schueler said he and Lukasiewich want attendees to walk away from the session with something new to use on their violence-prevention journey, whether it be a new insight, tool, strategy or perspective.

“I firmly believe this deep-dive can do that and invigorate us to take action against workplace violence,” he said.

Highlighting the importance of the topic, a separate session today, titled “A Collaborative Approach to Mitigating Violence in the Workplace,” will be held from 3:45 to 4:45 p.m. in rooms 411 and 412. This session, moderated by ENA President Jeff Solheim, will discuss the joint efforts of ENA, the American Organization of Nurse Executives and the International Association for Healthcare Security and Safety to address the epidemic of workplace violence against health care workers.

When Disaster Strikes

An emergency department’s effectiveness during and in the aftermath of a natural disaster is proportional to its level of preparedness. 

In a session this afternoon, attendees will learn how one northern California regional trauma center remained operational amid one of the most destructive and deadliest wildfires in the state’s history.

“Every ED nurse thinks about how other EDs deal with disasters,” said Sheila Smith, who was the lead nurse in the ED at Santa Rosa Memorial Hospital on Oct. 8, 2017, when the wildfires broke out. “Hospitals are required to conduct drills for disaster preparedness and emergency management, and nurses need to know their roles and responsibilities.”

Firestorm in Wine Country: A Trauma Center’s Response

3:45 – 4:45 p.m.

Friday

Rooms 408, 409, 410

Smith, who is presenting at the session titled “Firestorm in Wine Country: A Trauma Center’s Response,” said her department dealt with the devastating effects of the natural disaster, even though nearly half the hospital staff was directly affected, either by a forced evacuation or total loss of their homes. 

Two other hospitals in the region shut down the night of the fires because so many people were evacuated from the area. That meant an even busier ED at Santa Rosa Memorial. 

An outpouring of community support enabled Santa Rosa Memorial staff, even those affected by the tragedy, to continue their efforts to care for the people injured and sickened during the ordeal. Community members volunteered at shelters, brought food to hospital staff, donated money and clothing, and even adopted families who lost everything in the fires through a “match program” organized by one of their own nurses.

“I am beyond proud of my hospital—we are a community that cared for our community,” Smith said. “The experience pulled our team together like family. There was a sign that hung in Sonoma County during the wildfires that read, ‘The love in the air is thicker than the smoke.’ That statement captured the heart of our community perfectly.”

Smith said she hopes session attendees are inspired to go back to their own facilities with ideas for preparation and a desire to be actively involved in disaster drills in the future. With large swaths of wildfire currently roaring through the Shasta-Trinity National Forest, the future is now for many central and northern California towns.

“Eleven months later, more wildfires are raging even as we speak,” Smith said. “It is striking a familiar nerve with us, to say the least. We hate to think these disasters are becoming the norm.” 

Lessons Learned from 2017 Hurricane Season

The 2017 hurricane season tested emergency departments across the country. The storms directly impacted patient care in the areas hit hardest and caused many indirect problems nationwide, including IV fluid and medication shortages resulting from halted production in Puerto Rican factories in the wake of Hurricane Maria. 

In a two-hour session tonight on the 2017 hurricane season, a panel of disaster preparedness experts and emergency nurses will share their experiences before, during and after the devastating effects of Hurricanes Harvey, Irma and Maria in southeastern Texas, the U.S. Virgin Islands and Puerto Rico, respectively.

Hurricane Panel

7 – 9 p.m.

Friday

Room 319, 320, 321

 “I feel this session is important because emergency nurses can give a glimpse of the fragility of our health care system and how dependent we are on an intact infrastructure to provide care,” said panel moderator Dan Nadworny. 

Panelists discussing their hurricane experiences are:

  • Diane Fuller Switzer
  • Kelsea Bice
  • Melanie Aluotto
  • Breanne Ward
  • Tina Withrow
  • Nelda Ephraim

Nadworny said he hopes the group will offer insight into how preplanning, mitigation and training impacted outcomes during the 2017 hurricane season. He said that after the session, participants should be able to:

  • Describe how hurricanes can impact rural, mountainous and urban areas, as well as identify ways to help communities recover
  • Identify steps to prepare themselves personally and professionally for an impending natural disaster
  • Identify how the approach to the delivery of health care during disasters needs to be re-evaluated based on the needs of the population

Panelists will look to answer many questions, including:

  • How does a disaster medical assistance team compare to other types of groups that respond to a disaster? 
  • What personal preparations do you undertake when you know there is a possibility of a disaster that requires your response? 
  • What is the greatest challenge you faced logistically and personally? 
  • What is the most surprising thing you encountered? 
  • What were the most common complaints you treated? 
  • What worked well and what would you do differently next time? 
  • What advice would you give an ED nurse who wants to respond to a disaster?

Know Your Role with a Prisoner Patient

Approximately 2.3 million people are incarcerated in the United States, and it is not uncommon for them to need medical attention. But the care of the prisoner in a hospital setting can get complicated. Who is really in charge of the patient? That was one of the questions Catherine Hesse and Jana Du Bois of Dignity Health addressed in their Thursday session “Prisoner as Patient: Unlocking the Legalities.”

“Our departments are flooded with patients who have complicated legal issues. Behavioral health patients and prisoners are very common,” Hesse said. “It is important to know swim lanes and role definitions while taking care of these patients.”

Hesse has heard from many emergency nurses asked to fill in as security guards or police, or had bad experiences with prisoner care. These nurses wanted to preserve privacy and prisoner rights, but they had no idea how to do it.

“When I was a nurse, there was no training when it came to caring for prisoners,” Du Bois said.

Based on the responses of session attendees, it appeared there is still very little training.

One tool nurses can use to help assess a situation with a prisoner is the presence of tattoos.

“Tattoos are silent communicators,” Hesse explained. “We use the tattoos to educate the RNs and MDs as to who they are actually dealing with and who might be a violent case.”

Hesse and Du Bois showed pictures of common gang tattoos nurses could use to help identify gang members in their EDs, including those of the gangs MS-13, the Latin Kings, Hell’s Angels, Irish gangs and the Italian mafia.

The presenters covered many other topics during their session, including reasons why prisoners come to the hospital, nurses’ responsibilities and the rights of the prisoner as covered by the 8thand 14thAmendments to the U.S. Constitution.

Supporting Early Career Professionals at ENA18

About one-third of ENA members have fewer than five years’ experience in emergency nursing, and those newer to the field have unique needs. ENA is happy to help in many ways, including with an event this afternoon that promises to provide valuable insight into how influential professional development and ENA involvement can be on newer nurses’ careers.

The Emerging Professionals Lunch is scheduled for noon in the Spirit of Pittsburgh Ballroom.

ENA and its far-reaching community of more than 43,000 members are flush with innovative ideas, engaging educational opportunities and decades of experience to help support this growing cohort. Since 2012, conference planners have partnered with Stryker to host events for those emergency nurses with fewer than five years’ experience, allowing the emerging professionals to tap into the wealth of knowledge available to them. 

Since Emergency Nursing 2016, that event has become the much-anticipated Emerging Professionals Lunch. 

“We wanted an opportunity to gather emerging professionals attending the conference so they can network with those in a similar phase of their career,” said ENA Member Relations Director Bridget Krause. 

Aside from good food and like-minded company, the event offers a panel of emerging professionals making the most of their career. It’s an opportunity for attendees to hear from peers who have been in their shoes and achieved success along the way. 2018 Rising Star Award recipient Kimberly Russo and Lauren Plaine, this year’s emerging professional liaison to the ENA Board of Directors, will discuss how they navigated early career challenges as well as taking on leadership roles within ENA.

Russo said it can be challenging to get involved early in one’s career, but that’s what makes the event so valuable.

“This panel is the perfect opportunity to ask questions and learn from someone else’s career and experiences in ENA,” she said. “Hearing from other members you can relate to can empower you to go out there, get involved and make a difference.”

Krause said the event also enables newer ED nurses to directly connect with leaders of ENA and the emergency nursing community. One of those leaders, Garrett Chan, will complete the three-person panel. Chan, a member of ENA’s Academy of Emergency Nursing Board, is slated to announce a new AEN initiative – a mentoring program that pairs seasoned emergency care professionals with burgeoning nurses.

“This panel offers an opportunity to those in leadership positions or actively engaged in projects to share with newer nurses how to start their journeys,” said panel moderator and ENA board member Jennifer Schmitz. “They offer encouragement to pursue their interests and share their own experiences in how they became involved. The panel supports new engagement and new members stepping up, either within their organization or within ENA.”

Ask the Experts:

What is your advice for new emergency nurses?

Ask all the questions, no matter how silly you feel they might be.

—Lauren Plaine, Emerging Professional Liaison to the ENA Board of Directors

Emergency nurses should know they have chosen an unbelievably rewarding career, and they should follow their passion, regardless of their years of experience. Opportunities are within their grasp and they should take them. They should use their voice and be heard; their opinions and ideas matter and can be influential.

—Jennifer Schmitz, ENA Board Member

You have the ability to make a difference. No matter how hard and frustrating it may be, never give up.

—Kimberly Russo, 2018 ENA Rising Star Award recipient

Be patient with yourself; there is a lot to learn. The emergency nursing community in ENA is here to help you whether it is in acquisition of knowledge or skills, dealing with compassion fatigue or supporting you in your professional development.

—Garrett Chan, ENA Academy of Emergency Nursing Board Member

Learning Lab Lures Attendees

In a packed plexiglass-enclosed classroom on the exhibit floor Thursday, critical care transport nurse Beverly VonGoerres enlightened close to 200 attendees on common obstetric cases that show up in the emergency department, including pre-eclampsia and seizures.

The short session, “OB in the ED: Case Study Hits, Misses and Triage Kisses,” was one of four such talks on various topics that drew conference goers to the Learning Lab – a new addition to this year’s annual educational and networking conference. Other topics presented Thursday included“IV Filtration and Extravasation Risks and Early Detection,” “A Breath of Fresh Air: Checklist Utilization for Intubation” and “Master the Ultrasound for Central, Arterial and Peripheral Line Insertion.”

The participants who attended the overflowing session on OB-in-the-ED care standards gleaned welcome insight from the cases that VonGoerres said didn’t go as expected.

“That was so useful,” said Susan Cuff, a triage nurse from Rochester, New York, who noted the textbook review of protocols and checklists will help her be ready for what comes her way. “It is great to have a reminder of what to look out for so you can catch it before things go bad.”

The Learning Lab sessions, repeat today from 10 a.m. to 2 p.m. An additional session on vascular access decision making is also scheduled.

 

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