2019 ENA Today Highlights

New Board Announced at Conference Closing Ceremony

From left to right: Gina Slobogin, Barbara Gibson, Matt Powers, Karla Nygren, Ryan Oglesby, Chris Dellinger, Patti Kunz Howard and Ron Kraus

After a week of education, networking, and well-mannered and intentional weirdness, Emergency Nursing 2019 in Austin ended with its usual fanfare and a few surprises at the closing session.

In addition to the annual Stryker matinee, which showcased the memories made throughout the week, ENA President Patti Kunz Howard announced the results of the 2019 ENA National Election.

“I cannot say enough about how important it is for you all to vote in national elections,” Howard said, noting that voting is how members can have a say in the future of the organization.

The 2019 ENA election winners, who will assume their offices Jan. 1, are:

  • Ron Kraus, ENA President-elect
  • Karla Nygren, ENA Secretary/Treasurer
  • Chris Dellinger, ENA Board of Directors
  • Ryan Oglesby, ENA Board of Directors
  • Julie Miller, Nominations and Elections Committee, Region 2
  • Gina Slobogin, Nominations and Elections Committee, Region 4
  • Barbara Gibson, Nominations and Elections Committee, Region 6
  • Matt Powers, Nominations and Elections Committee, ENA Past Board Member

As is tradition, Howard presented the annual ENA President’s Award, which went to the patient care managers in her own EDs at the University of Kentucky. She thanked Dixie Bryant and Erin Morris for holding down the fort and enabling her to dedicate the necessary time to her duties as ENA president.

Before introducing current ENA President-elect Mike Hastings, Howard promised attendees that it wasn’t goodbye — or rather, that it won’t be in January, when her presidential term comes to an end.

“Today is bittersweet,” she said, “I’m not going anywhere, but it is time for me to move on to the next chapter.”

Hastings took the stage with words of homage and encouragement for next year, which is ENA’s 50th as a professional organization.

“Without the commitment of so many individuals,” he said, “ENA would not be in the amazing place we are today.”

ENA Foundation Chairperson Mickey Forness announced 2019 was a record-setting year financially for the association, beginning with $223,000 raised through the annual ENA State Challenge and continuing with Emergency Nursing 2019.

Through various efforts throughout the meeting in Austin, Forness said that the foundation raised $67,000.

Beyond the ceremonial torch passing and speeches, ENA offered attendees one last educational session, “Sheroes and Heroes,” which highlighted four amazing nurses and health care advocates whose stories brought audience members to tears.

Tamara Ferguson, a labor-and-delivery nurse from Paradise, California, recounted the perilous hours during the Camp Fire that ravaged northern California in November. She and several of her colleagues at Feather River Hospital in Paradise were among the last to evacuate as they made sure the facility’s patients were taken care of first. Their heroic actions continued during their own evacuation, when they were forced to take refuge in and protect one of the only houses around them not on fire.

“If I’m gonna die, I’m gonna die protecting my patient,” Ferguson said about the patients in her care, which included a woman who underwent a c-section birth earlier that morning. “And if I’m gonna live, I’ve got a job to do.”

Another presenter, Meghan Price, shared a story of overwhelming loss and her fight to ensure a devastated mother who lost her husband and son in a horrific car accident was reunited with her daughter who was taken to a different hospital.

“My heart broke that day,” Price said about witnessing the emotional trauma her patients experienced. “I wanted to do something, anything I could do to help her.”

The ED nurse turned family nurse practitioner brought attendees to their feet when she brought the surviving mother and daughter on stage to present them with a framed poem and continued support.

Emergency Nursing 2019 Conference Planning Committee Chairperson Kim Brandenburg closed the session offering attendees a special gift – a purple cape under each chair.

“Let’s all stand up and put on these capes to wear proudly in recognition of the heroes we are individually and collective as emergency nurses,” Brandenburg said.

Hundreds of attendees filed out of the hall and through the convention center, their capes undulating behind them.

Nurses Combating Opioids

More than 77,000 people have died from opioid overdoses in the United States in 2019, according to data released by the Centers for Disease Control and Prevention at the end of September.

It’s a statistic that hits home for Cathy Fox.

A nurse for 34 years, mostly in the emergency department, Fox is now a quality safety nurse at the U.S. Department of Defense. In her session at Emergency Nursing 2019 last week, “Opioid Epidemic Spiraling Out of Control — How to Keep You and Your Staff Safe,” she showed a video about a girl named Amy, who was addicted to opioids at age 15 after doctors continued to prescribe them after a high school sports injury. The video showed Amy intentionally crashing her car in an effort to get sent back to an ED — for more opioids.

Amy got through her accident and her addiction. Fox said she is now healthy and working.

But Amy’s story is becoming all too familiar for many young people in the United States.

Opioid overdose, said Fox, is now the most common cause of death for young people — even over motor vehicle crashes — and has been for four years.

An indisputable national epidemic, opioids are killing five to six people per hour in the United States. West Virginia, Kentucky and Ohio have had so many deaths from opioids that morgues are full, forcing them to use freezer trucks to hold bodies, according to Fox.

Health care professionals have a battle to fight, and Fox wants to make sure they have access to the tools to do it.

Learning how to administer naloxone HCl properly, she said, is a start. Naloxone, knowns commercially as Narcan Nasal Spray, is a drug that can treat an overdose in an emergency. But many nurses are confused by the directions and accidentally inject themselves, Fox said. It’s a tool that can be instrumental in saving a life and is available at many local drug stores and the DOD.

Fox’s other recommendations include “safe-proofing” nurses’ homes for opioids, particularly because people know they work in the health care profession; disposing of narcotics properly; and knowing the signs of narcotic abuse.

Fox also cautioned attendees about a new drug, carfentanil, which is available for purchase online from China. Because carfentanil is lethal in extremely small doses, and the powder can be hard to see, nurses who retrieve people from cars in the ED must follow new CDC guidelines for removing patients from private vehicles to ensure they’re not unduly exposed to the drug. The guidelines include wearing a full gown, two pairs of nitrite gloves, protective eyewear and a mask.

Finding Humor in the ED

AnnMarie Papa and Terry Foster

It might seem superfluous to remind a crowded ballroom full of Emergency Nursing 2019 attendees that the work emergency nurses do is life changing. And yet, sometimes that is exactly what is necessary.

Terry Foster, a clinical care nurse specialist at St. Elizabeth Healthcare in Edgewood, Kentucky, and AnnMarie Papa, vice president and chief nursing officer at Einstein Medical Center Montgomery in East Norriton Township, Pennsylvania, offered several reminders in last week’s Edutainment luncheon session, titled “The Many ‘Sides’ of Emergency Nursing.”

The duo kept the crowd laughing, kicking things off with a sing-along to Jerry Lewis and Dean Martin’s “Side by Side.”

Despite the merriment, the underlying message was serious. Emergency nurses change lives.

“There is no substitute for emergency department nurses, or nurses in general,” Foster said.

Unfortunately, hospitals aren’t seeing as much of the career ED nurses, who dedicate 20, 30 or 40 years to the specialty. The average tenure, Foster said, is now just three to five years.

It’s a tough job, and Foster and Papa said it’s vital that ED nurses take care of each other like family. And through it all, it’s important to find the humor.

“Every nurse I know has said, ‘You can’t make this stuff up,’” Foster said. “Every nurse I know has said, ‘We should write a book.’”

Whether it’s helping patients to remove zucchinis from parts of the body that shouldn’t have encountered a squash in the first place or playing referee between a patient’s wife and the behavioral health patient who climbed into the hospital bed next to the patient, you’ve got to be able to appreciate the humor while handling the situation.

“Be careful, obviously,” Papa said, meaning there are times when it’s OK to laugh and times when it’s not. “But humor is good for the soul.”

And if you’ve had a difficult day, or week or season, it’s crucial to lean on your coworkers and to talk about it when you can. At the end of the day, Foster added, all emergency nurses are a family.

“ENA — and I’m not being hokey — is the biggest family I’ve ever belonged to in my life,” he said. “OK, I’m being a little hokey. But it’s true.”

Learning From Disaster in Mexico

Of all the natural disasters, the world is the least prepared to handle earthquakes, according to Gerardo Jasso-Ortega, a nurse manager and president of the Mexican Association of Emergency Nurses.

“We are not as prepared for earthquakes,” he told Emergency Nursing 2019 attendees during a session last week.

Between 2000 and 2018, there were 520 seismic events in the world — far fewer than storms and other disasters. However, earthquakes resulted in the largest percentage of deaths — nearly half — Jasso-Ortega explained.

Mexico City suffered devastating earthquakes in 1985 and 2017. The former registered 8.1 on the Richter scale and resulted in 10,000 deaths. Two years ago, on the anniversary of the ‘85 event, the capital city was struck again with an earthquake that registered 7.1 on the scale.

Although the implementation of disaster plans resulted in far fewer deaths in 2017, much work still needs to be done, he said.

Communication is a fundamental issue. If an earthquake takes out radio communications and electricity, it can be impossible to know the status of other EDs and how many patients each is treating.

Jasso-Ortega also said it is imperative to include nurses as critical members of the disaster response team. Until recently, nurses in Mexico were viewed only as bedside care takers, which he said is strange because they are on the front lines during disasters.

Jasso-Ortega provided evidence of progress in improving disaster planning, including the World Health Organization’s Safe Hospital Initiative.

“It is frustrating to see how many people die due to lack of preparation,” Jasso-Ortega said. “Maybe we have begun to change that.”

What Comes After Trauma

Everyone reacts differently.

That was the overriding message from Laurie Charles, clinical assistant professor of nursing at Texas A&M, at last week’s Fast Track session, “The Neurobiological Aftermath of Trauma.”

Because people have different reactions to trauma, whether it is from personal violence, childhood abuse or neglect, death of a parent, serious accidents, natural disasters, war, terrorism or medical trauma, it is not surprising victims’ memories of the events can sometimes be jumbled, temporarily blocked or even forever lost.

Charles talked about the physiological reaction to trauma and how hormones can affect memories and emotional disposition.

During a traumatic event, stress chemicals and hormones turn off the victim’s ability to respond normally. Primitive brain structures take over, leaving a human’s higher functioning brain impaired. Events for the trauma victim become jumbled.

Sexual assault, in particular, is typically remembered in fragments, Charles explained. It is infused with intense emotions and recollections of sensations, she said. Timelines can become mixed up. Some victims have difficulty identifying the source of the feelings and sensation.

She identified the four major symptoms to look for in sexual assault: patients reliving the experience, social withdrawal, avoidance behaviors and increased physiological arousal.

Charles advised attendees to provide trauma therapy as well as physical health care for sexual assault patients. She urged them to establish a supportive environment and an atmosphere of trust, acceptance and safety.

“Use active listening and value the patient’s voice in every aspect of your care,” she said.

Grandma and the Little Green Men

It’s common for geriatric patients to hallucinate or exhibit other behavior that might be considered odd. But sometimes there’s a perfectly reasonable explanation.

Joan Somes, a former bedside nurse and department educator and a current paramedic at Regions Hospital in St. Paul, Minnesota, led a session last week at Emergency Nursing 2019 that educated attendees about the difference between hallucinations and delusions.

In the session, “Grandma Says She’s Talking With the Little Green Men! Hallucinations in the Older Adult,” Somes explained that hallucinations are false sensory experiences generated by the mind, while delusions are false beliefs not supported by reality and might be caused by faulty memory.

It’s common for an older person to experience an illusion based on the distorted perception of a real stimulus — but that’s not necessarily a hallucination, Somes further explained, offering an example of a busy wallpaper that might look like spiders to someone who’s having a hard time seeing it accurately. It’s also common for older patients to misidentify things, but incorrectly identifying an object doesn’t equate to a hallucination either, she added.

When a patient visits the emergency department with an altered mental status, Somes said the first goal is to understand the underlying cause. Often, it might actually be for a physical — and treatable — reason. Somes said functional reasons for hallucinations include:

  • Migraines
  • Epilepsy/Seizure disorders
  • Head injuries
  • Aneurysms in the brain
  • Encephalitis
  • Infarction of brain tissue
  • Intracranial tumors
  • Multiple Sclerosis
  • Penduncular hallucinosis
  • Charles Bonnet Syndrome

If a patient seems to be presenting with dementia, Somes said to check for the following possible — and reversible — causes:

  • Infection and immune disorders
  • Metabolic and endocrine problems
  • Dehydration or a lack of vitamins and minerals
  • Medication side effects
  • Loss of vision/hearing
  • Normal-pressure hydrocephalus
  • Subdural hematoma and other space-taking lesions
  • Hypoxia or sleep apnea
  • Poisoning or alcohol or drug use

“Before you assume the [altered mental status] is behavioral, you need to consider — is it a physical thing going on with that person?” Somes asked. “Because if it’s physical, it may kill them.”

Somes hit home that hallucinations in geriatric patients are common.

“Hallucinations are out there,” she said. “A lot of patients simply don’t tell us about it.”

Skills Lab Boosts Critical Care Expertise

The Skills Lab patient presented with burns, a traumatic brain injury with hypertension and signs of elevated intracranial pressure.

In last week’s Skills Lab, “Critical Care for the Emergency RN,” paramedics responded to a mock call about a 35-year-old male who was injured in a flash fire while refueling his lawnmower.

In addition to burns across his face, the patient presented with a traumatic brain injury with hypertension and signs of elevated intracranial pressure.

After watching a demonstration on calming the patient and administering aid, Skills Lab participants  practiced the necessary artistry themselves. Attendees were split into three groups:

Airway/Ventilation: Participants practiced tube management, waveform capnography monitoring, vent management and — for the experts — bougie intubation/tube exchange and managing pulmonary injury.

Vascular Access: Participants practiced central line insertion, vasopressor mixing/titration and — for the experts — arterial line insertion and monitoring.

Acute Neurologic Management: Participants practiced mixing/administering tissue plasminogen activator, managing hypertension in acute ischemic stroke and — for the experts — monitoring ICP, managing hypertensive emergencies in a TBI scenario and mannitol and hypertonic saline for elevated ICP.

Carrie Benson from UC Health in Colorado said she enjoys learninig how other facilities do things to see if those practices would be possible to take back to her own hospital.

“I’m an educator, and I’m always looking for new and innovative ways to do education,” she said.

Nursing in Austere Environments

Global Response Management Operations Director Helen Perry and Director of Communications Alex Potter recalled their experiences providing health care in remote, war-torn and storm-ravaged areas of the world including Bangladesh, Iraq, Yemen, Matamoros and Central and South America.

Helen Perry

“Many people have good intentions about this kind of work,” Perry said, noting that sometimes these same people forget the limitations of the situation and resources.

Global health care volunteers are often working in less-than-ideal circumstances and can’t always leave their patients in better shape than they found them. Perry remarked how her team once had to set up a clinic in a parking garage.

GRM is a U.S.-based medical non-governmental organization that aims to bring emergency pre-hospital care and training to people living in or displaced from conflict zones. It operates primarily with volunteers like Perry and Potter, who focus on underserved areas and the Middle East, providing care in high-risk areas. Nearly all their funding goes directly to operations and patient care.

Perry encouraged attendees to consider volunteering for health care missions. However, using her own experiences as a guide, she recommended volunteers leave any preconceived ideas of any venue at home.

“Every situation is different, and you do the best you can,” she said.

Perry talked about some of the contradictory and controversial care issues she has faced.

Alex Potter

“I do not believe in binge and purge medication,” she said. “I do not treat [atrial fibrillation]. If a patient can’t afford medications or doesn’t have access, I take another approach than what they do in the United States. I might recommend dietary and lifestyle changes.”

She said some people would be aghast at this approach but suggested that until those people treat patients in other parts of the world, they might never know the impracticality of prescribing medicine the patients can’t obtain or afford once the mission team leaves.

As for volunteering, Perry said anyone can do it.

“I am a normal person. I am nothing special. I am like everyone else,” she said, encouraging attendees to reach out to get involved. “We need your voice, presence, intellect and compassion. It is just us.”