Maine ENA Newsletter Archive

President's Corner

Sandie Weagle, RN, CEN

Waldo County Hospital, Belfast

Resolution Overview

Maine ENA has submitted a resolution to the national ENA office. The intent of this resolution is to decrease the costs of the ENPC and TNCC courses to our members. This resolution will be discussed, dissected, argued, and, revised at the General Assembly, ENA’s annual business meeting, in San Diego, in September. Delegates from every state will have an opportunity to ask questions and offer comments. The resolution may be passed, defeated, or tabled. Any of those outcomes is acceptable, if there is open dialogue between our members and our leaders.

In the recent past, ENA had financial difficulties that were the result of a confluence of problems. Our leaders have managed, very impressively, to move ENA into a financially sound and profitable organization. ENA has over $4 million dollars in investments. It was announced, at the February national board meeting, that ENA has an operating surplus of over $2 million dollars. Maine ENA believes that now is the time for some of those profits to be returned to the members.

Maine ENA recognizes the value and importance of the ENPC and TNCC courses and endorses them for all nurses in Emergency Departments. This is especially important as many Emergency Departments are hiring inexperienced nurses who need to become skilled and competent in a relatively short period of time. These courses teach valuable assessment skills and interventions for trauma and pediatrics two areas that encompass a large portion of our practice.

With hospitals facing their current financial dilemmas, imposed by state and federal reimbursement changes and other mandates, there is less money for education for nurses mandatory requirements, such as ACLS, take priority for hospital dollars. Emergency nurses are often personally responsible for the costs of other courses and the educational offerings we need to attend to keep abreast of the rapidly evolving world of emergency nursing. Since September of 2003, Maine ENA has been paying for the manuals for these courses, in an attempt to make them more affordable for more emergency nurses.

We anticipate lively discussion of our resolution. Come to San Diego and participate in the action. It directly impacts you and your colleagues.

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Emergency Nurses Association: 2004 General Assembl

Resolution Title: "Reduction in Costs of TNCC and ENPC Courses"

Note that this resolution will be voted on at the national meeting in September.

Resolution:

WHEREAS, Multiple contacts with National ENA have not been successful in producing a sufficient level of information related to line item budget and cost accounting for ENPC and TNCC courses; and

WHEREAS, Any information actually received has been labeled "incomplete" and "confidential" by its source; and

WHEREAS, Any member of an organization that is dues-based should have full and complete access to financial records of that organization; and

WHEREAS, The activities of the Board of ENA include direct oversight of operations management; and

WHEREAS, The General Assembly is the voice of the membership to the Board; and

WHEREAS, Emergency nurses and their supporting institutions are gravitating toward less expensive, non-ENA sponsored courses; therefore be it

RESOLVED, That National ENA produce a line item budget and cost accounting system for expenses related to production of ENPC and TNCC activities; and

RESOLVED, That this budget and cost accounting include actual cost of manual printing, manual development, course completion certificate/card printing, percentage of overhead expenses, mailings; and

RESOLVED, That this line item budget and cost accounting be readily and completely available to any member or state who requests it without confidentiality stipulations; and

RESOLVED, That National ENA, within the next 6 months, find ways in which the cost of ENPC and TNCC courses can be reduced by 10%, without raising dues to members, and be it further

RESOLVED, That this exploration include, at minimum, a representative from the Maine ENA Board, and the ENA Treasurer, as the board liaison.

Resolution Background Information:

• Since 1999, the number of TNCC and ENPC courses has grown by 7% annually. TNCC has grown by 5.7% and ENPC has grown by 12.4%
• 2003 TNCC and ENPC revenues exceeded budgeted amounts by $512,000.00 and $220,000.00, respectively.
• Nationally, in the year 2003, TNCC was attended by 28,067 students and ENPC was attended by 11,133 students.

Resolution Sponsors:

Authored by the Nurse Practice Committee of Maine ENA, and sponsored by The Maine State Council of the Emergency Nurses Association.

• Darlene Glover RN, MSN, CEN
• Fay Daigle, RN, CEN
• Sandra Weagle, RN, CEN, President, Maine ENA

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Education Committee Report

Heather Gagnon, RN

St Joseph’s Hospital, Bangor, Maine

Maine ENA Annual Meeting \\& Education Day

September 10th, 2004
Sebasco Harbor Estates

Topics: Troubleshooting PICC lines; Denise Dunford on multi-dose patients and a separate lecture on triage

Note: Special Request for photos from our Maine ED’s will be used for a slide show during a break at the annual meeting. Photos will not be returned.

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Pediatric Committee Report

Carmen Hetherington, RN, BSN, CEN
Chair, Pediatric Committee

New Provider Manuals for the Revised ENPC Course

The long awaited new provider manuals for the revised ENPC course are out! Karen Taylor and I attended the update revision while at National in September and will serve as validaters for this state to bring all current instructors up to date. The new manuals were sent for this past week and three training dates and sites will be determined to assure all instructors receive the information and resources needed to conduct courses.

Two training dates and sites have been confirmed providing the materials and resources arrive on time. The ENPC instructor’s supplement should be available from the printer by the end of May. All instructors will receive the provider manual and further instruction will accompany them when they are mailed out.

Courses:

I am planning an ENPC Instructor course for some time mid October, but do not have a set date yet.

I am conducting an ENPC on June 17 & 18, September 16 & 17, and November 15 & 16 at CMMC in Lewiston.

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Courses

ENPC Courses

Central Maine Medical Center, Lewiston

• September 17 & 18
• November 15 & 16

TNCC Courses

Pen Bay Medical Center

• May 19 & 20
• November 5 & 12

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CEN Review

Karen Taylor, RN

Since there are many questions pertaining to research on the current CEN exams, I have given you 5 review questions to sharpen your skills and identify areas of study.

1. The first step in the research process is:
   1. Obtaining patient consent for data collection.
   2. Identifying the research problem or question.
   3. Reviewing the current literature related to the research problem.
   4. Selecting a research design and then identifying the question.
2. All of the following are examples of an instrument that may be used to collect data except:
   1. Literature review
   2. Pulse oximeter
   3. Focused interviews
   4. Questionnaires
3. In the study, “Does heparin flush or normal saline flush keep an IV line patent longer?” What is the dependent variable?
   1. Heparin flush
   2. Saline flush
   3. IV line
   4. There is no dependent variable
4. An emergency nurse wants to study the patient’s experience related to pain in the emergency department. What methodology would be most appropriate?
   1. Grounded theory
   2. Ethnography
   3. Phenomenology
   4. Historical
5. Characteristics of an experimental research design include:
   1. Equal group participation
   2. There is no comparison group
   3. Subjects are randomly assigned
   4. Variables are not controlled

Answers following ENCARE information below:

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Emergency Nurses Care (ENCARE)

ENCARE (Emergency Nurses Care), The Injury Prevention Institute for the Emergency Nurses Association, has more than 6,000 trained emergency health care professionals (including nurses, emergency medical technicians, and paramedics, police and fire personnel) who volunteer time in their local communities across the U.S. Its mission is to reduce preventable injuries and deaths by educating the public to increase awareness and promote healthy lifestyles.

This history and background starts like this: The Saturday before Thanksgiving, 1981, working as an emergency department nurse at the University of Massachusetts Medical Center in Worcester, I took care of a 17 year old who was paralyzed from the neck down because of a drinking and driving crash. The following day I walked into the emergency department, there was a 19-year-old young man in the trauma room. He too was paralyzed from the neck down because of a drinking and driving crash. He had a breathing tube in his throat and his mother was rubbing his arm, but I was the only one in the room who knew that the patient could not feel anything. I stepped to the bedside and the patient mouthed the words, “Thank God I’m alive.” I left the room with tears in my eyes. The patient had drunk two Mai Tais earlier that evening.

On Thanksgiving Day, a young man, who had been in a drinking and driving crash, arrived by helicopter. He needed emergency surgery. He had a 50/50 chance of living or dying! His family didn’t come to the hospital, which was unusual, so I called them at home. The person who answered the phone would not let me talk to Mr. or Mrs. “Smith.” When I explained who I was, he asked if I could tell him what was going on, because the “Smiths” other son had been killed in the same crash, along with his cousin. When I got off the phone, Pam Bell, the other ENCARE co-founder, and I looked at each other and said, “When will it stop? If people could see what we see on a daily basis because of drinking and driving, maybe they would think twice.” We decided to show them. Barbara Foley, RN, Executive Director and Co-Founder of ENCARE wrote this narrative. Barbara and Pam’s efforts began in Massachusetts over 15 years ago with two volunteers.

ENCARE provides injury prevention education to young people, parents, older adults, and the general public, including alcohol education/awareness and highway safety issues. Our programs are reality-based slide presentations, taken from our daily practice. We are not trying to shock or scare anyone. We show what we see every day in the field and emergency departments. We believe that emergency health care professionals from all across the country can work together to prevent injuries and underage alcohol use and make a difference.

The ENCARE programs include the following:

• Learning to Care
  An interactive slide presentation for the 3rd - 5th graders that addresses the use of alcohol, helpful and harmful drugs, decision making, and peer pressure.
• Take Care
  Aimed at the 55 years and above population, this slide program focuses on the safe use of medication and also highway safety issues.
• Dare to Care
  A 45 minute slide presentation that discusses the consequences of underage alcohol use, drinking and driving , and safety belt noncompliance, shows the impact of such behavior on family and others. This program is shown to teens, college students, and adults. It is usually presented to high school students. There also is a video showing an crash scene, trauma room, a morgue, and the medical examiner talking with the family.
• Child Passenger Safety Technical Training Program
  A program that educates nurses and others on how to teach child occupant protection to the public and how to be resources in their communities.
• Gun Safety – “It’s no accident.”
  The Master lock program is very successful in distributing gunlocks and gun safety brochures in a public awareness campaign to call attention to gun safety. This promotes gunlock giveaways.
• Bike and Helmet Safety
  Training programs for emergency health care professionals to prepare them to educate the public on bicycle and helmet fitting skill station. This allows nurses to present community bike rodeos and helmet fitting.
• A Crash Course in Motor Vehicle Injury Prevention
  Educates emergency professionals about injury prevention in order to empower them to work in the community as advocates for vehicle passenger safety.
• Polaroid – Family Violence
  “Take a picture. Ask the questions. Break the cycle” Campaign. The training is for nurses and others on identifying victims of domestic violence who present to EMS or ED. Polaroid provides cameras and training.

Information is presented to the public in a variety of ways, by providing exhibit booths at health fairs, at school and in the community, serving on community injury task forces, working with the government agencies, other advocacy groups and presenting programs to audiences ranging in ages from 8 to 90.

You must be an Emergency Nurse, Emergency Medical Technician, or Paramedic with at least 6 months experience. Personal experience in the ED, or on the road, is important tools in program presentation. Young people, in particular, ask for true stories about emergencies and car crashes. It is important to understand what is involved in volunteering for ENCARE. One way to do this is to observe a slide presentation in a school prior to the training session. Public speaking is a frequent component of volunteering for ENCARE, although there are many other roles available.

The mission of ENCARE is to reduce preventable injuries and deaths by educating the public in order to raise awareness and promote healthy lifestyles. As emergency health care professionals, we have an obligation to educate the public on healthy and safe lifestyles.

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Answers to CEN Review

1. The first step in the research process is:

   B. The first step in the research process is identifying the problem or formulating the question. Before one can begin the process, one needs to first identify what one is going to study. Important delineations to make when identifying a nursing research problem or question include whether the problem or question will add to the body of nursing knowledge, will improve nursing practice, or will provide solutions to explain, describe, identify, or predict behavior.

2. All of the following are examples of an instrument that may be used to collect data except:

   A. Review of the literature is a step in the research process. The other answers provide examples of instruments the emergency nurse may use to gather information about a research problem.

3. In the study, “Does heparin flush or normal saline flush keep an IV line patent longer?” What is the dependent variable?

   C. The IV line is the dependent variable. The dependent variable is the outcome variable of interest. In other words, the ED RN is interested in what will keep the IV line open. The independent variables are the procedures (heparin vs. saline) that will be used to keep it patent.

4. An emergency nurse wants to study the patient’s experience related to pain in the emergency department. What methodology would be most appropriate?

   C. Phenomenology provides a framework to study and describe patient experiences.

5. Characteristics of an experimental research design include:

   C. The characteristics of an experimental design include random assignment of subjects and control of the independent variable.

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Case Study

Susan E. Kaplan RN, CEN, SANE

Patient: 54 year old female with a myocardial infarction

This 54 yo female presented to a local emergency department stating, “I’m a transplant patient and I have had chest pain, some shortness of breath and nausea.” States she has had pain before, but it “goes away on it’s own”. Today the pain lasted longer (about three hours) so she decided to come to the emergency department to get checked out. Also reports her eight is up 2 pounds from normal.

Patient is awake, alert and oriented X 3. Lungs are clear. Skin is warm and dry. She states she has 5/10 anterior chest pressure. Initial vital signs were as follows: Pulse 96, Blood pressure 114.72, Respiratory rate 20, Pulse oximetry 95% on room air. Patient was immediately placed on a monitor – NSR with occasional PVC’s and 2L. NC O2.

Patient’s history was significant for Hypertension, Diabetes type 11 and a cardiac transplant for idiopathic cardiomyopathy six years prior to presenting to the emergency department. Medications included Beta Blockers, Diuretics, Immunosuppressive drugs and an oral diabetic drug.

An EKG was performed immediately, and given to the on duty physician. The EKG showed a questionable anterolateral MI. This was questioned initially (first 5 minutes) since there was a question of what her normal post transplant EKG showed. Upon receiving a recent EKG from the transplant center, it was clear she was in the process of having an MI. While waiting for the EKG, an IV was started and labs were sent. Iv Nitroglycerin was started as well a IV Morphine was given for pain.

A telephone consult between the Emergency Department physician and the Cardiac Transplant fellow occurred 30 minutes of the patient’s arrival. The discussion centered on whether a post transplant patient could receive the t-PA.

TPA was started 5 minutes after the patient first presented in the ED. At the time of starting TPA, the patient still had 3/10 chest pressure, despite multiple doses if morphine and an increased dose of Nitroglycerin. Vital signs remained stable; Blood Pressure 115/80, pulse 96, Pulse oximetry 99% on 2l NC O2.

Fifteen minutes after starting the t-PA, the patient became pain free. The patient’s vital signs were stable ad the patient was transported to the CCU to await Critical Care transport to the Transplant Center. Upon arrival to the CCU, the EKG changes had normalized.

Subsequent catheterization later that day at the Transplant Center showed that the patient had significant (70%) stenosis of the LAD as well as a long 90% stenosis in the distal vessel. The septal branch of the LAD had 80% stenosis. The RCA had 50% stenosis in the mid portion. The posterior descending artery had a long proximal 70% stenosis. Her cardiac index had decreased since her previous catheterization seven months earlier.

Discussion

Accelerated Coronary Artery disease is common among long-term survivors of cardiac transplants. There are studies that have shown that CAD exists in 50 of all cardiac transplant patients by five years post transplant. There is increasing evidence that indicates that cytomegalovirus is a significant factor in accelerated CAD. Research has shown that using prophylactic antiviral therapy along with hyperimmune globulin (CMV-IGIV) reduces accelerated CAD and improves long-term survival.

The use of thrombolytic therapy in a post cardiac transplant patient has not been widely reported. There have been only a few case studies reports in the last 10 years. Those reports indicate that positive outcomes have occurred with the use of thrombolytic therapy.

The patient in this case study is unusual because she presented wit typical cardiac symptoms. Most post transplant patients who are having a myocardial infarction will present with vague symptoms such as fatigue or generalized weakness. They can also present with CHF, ventricular arrhythmia or sudden death. The reason for this is that the transplanted heart is denervated and typically lacks reinnervation. When a patient does experience “typical” symptoms it is because there has been some reinnervation of the new heart.

References:

• Valantine, HA:
  The Role of CMV in transplant coronary disease and survival after heart Transplantation.
  Transplantation and Infectious Disease. 1999; Suppl 1:25-30.
• Virk AS, Antosia RE, Patridge RA:
  Use of thrombolytic therapy in a heart transplant
  Recipient with acute myocardial infarction.
  Annals of Emergency Medicine
  1995 Apr;25(4): 548-50.
• Weill D: Role of cytomegalovirus in cardiac allograft vasculpathy.
  Transplantation and Infectious Disease. 2001; 3 Suppl 2:44-8

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Welcome to New Maine ENA Members!

• Theresa Davis
• Janet Smith
• Steven Moody
• Garry Stevens
• Amy Owens
• Jennifer Bagley
• Marina Savage
• Claudia Graf
• Sheryl Sponaugle
• Thomas Kelly
• Patrick Deveau
• Kimberly McCarthy
• Andrew Pratt
• Claudette Mimeault
• Roberta Sloboda
• Theresa Peterson
• Ruth Geores
• Paula Schoenthaler
• Patricia McLaughlin
• Rosalyn Webb
• A. Jane Reid
• Tori Willis
• Joann Wood
• Michael Boucher

Latest membership total: 227

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Emergency Departments Employment Opportunities

MaineGeneral Health

We are currently searching for experienced RNs to become part of the ED team at Maine General Medical Center in Augusta and Waterville.

• State of Maine RN license required
• 3 to 5 years of ED clinical experience required but willing to train exceptional candidate.

Call and learn more about the opportunities Maine General Health has to offer.

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Maine ENA Awards, Nominations and Scholarships

Maine ENA Annual Awards

Maine ENA would like to acknowledge those Maine Nurses who have contributed in a special way to Emergency Nursing in the state of Maine, the United States, Maine ENA or National ENA.

President’s Award

For outstanding contribution to the Maine Emergency Nurses Association and / or the National Emergency Nurses Association.

Emergency Nursing Educator Award

For significant contribution(s) to education and / or training that enhances the ability of emergency care providers to serve their customers.

Emergency Nursing Provider Award

For exemplary contribution(s) to and / or manifestation of the art and science of nursing in the provision of emergency nursing care.

Emergency Nursing Leadership Award

For meritorious service above expectations in such activities as planning, development or management of systems, processes or departments that yield enhanced environments for the provision of emergency care.

Special Merit Citation

For exemplary long-term service, special advocacy of or contribution to emergency care and / or innovations that improve emergency nursing in the State of Maine.

Note: Award nominee’s do not necessarily have to be employed in an emergency department but must be involved with emergency nursing and / or EMS. Award nominee’s need not be ENA / MENA members.

Only those categories for which you wish to nominate an individual need accompanying comments. It is not necessary to name a nominee in each category to submit a nomination.

To submit a nomination:

• Identify the appropriate category
• Submit a written explanation for your submission
• Include your name, address, and how we can get in touch with you

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Maine ENA 2003 Officers, Board Members & Committee

Maine ENA Call for Nominations

Maine ENA will be electing the following for the 2005 – 2006 term:

• President-Elect (President-Elect 2005 and 2006, President 2007 and 2008)

  Responsible for leading/governing MENA, acting as liaison with National ENA, attending yearly Leadership Conferences, and attending yearly National Conferences.

• Secretary/Treasurer

  Responsible for minutes at all Board and educational meetings, and fiscal management of MENA funds.

• Board Member at Large

  Responsible for assisting President in governing MENA

Responsibilities for all positions include:

• Attending 4 Board of Director meetings/year.
• Attending 3 MENA Educational meetings/year.

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Maine ENA Educational Scholarship

Maine ENA will be offering a yearly educational scholarship in the amount of $250.00 for certification or re-certification of CEN, ENPC, TNCC, or another ENA sponsored course on an annual basis to one individual. It will be awarded at the Annual MENA Meeting in late summer/early fall. The actual check will be paid to the course director or registration chairperson.

Requirements:

• ENA Member
• Work in an ED for at least the past year

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Maine ENA Newsletter Info

Carol Minnis, RN, CEN

Maine General Medical Center, Waterville

Maine ENA and I would appreciate any input to our newsletter. This would include:

• Nursing Stories
• Clinical Narratives, “The Work of Nursing”
• What’s going on at your hospital?
• Awards
• Tips and Solutions

Advertisement rates

• 1/4 page :$15.00
• 1/2 page :$30.00
• full page :$60.00

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