Maine Matters

President's Message

A short message for this my last newsletter. At the end of December, Carol Minnis will assume the role of President. I would like to share with you two encouraging items for Maine ENA. Recently our largest delegation ever to the National General Assembly participated in business in Salt Lake City. Among the delegates were 4 members who have never been actively involved in Maine ENA. They were impressed by the process and it sparked a flame of motivation to be involved more actively on a regular basis. These members will bring a fresh opinions and knowledge to the group. One common theme from them was that they see the value in ENA and especially Maine ENA to members. I hope that this new enthusiasm will rub off on their peers in the workplace. It is an opportunity for Maine ENA to grow new members.

The second encouraging item is that Maine ENA has recently embarked on a rejuvenation process for the Maine ENA website. Our current site is not up to date and lacks some flair. We are working with a new web design company who has a good reputation and is reasonably priced. In just a short amount of time we will have a new site with current information and room to grow as our organization does. Check the site in a few weeks. ENAMaine.org

As I stated in the opening of this letter, this is my last note as President. I would just like to say thank you to the membership for giving me the opportunity to serve. I would also like to give a big thanks to the members of the Maine ENA Board whose input, guidance, leadership and friendship enabled us to collaboratively lead Maine ENA over the last 2 years.

Thanks,

See you at the next meeting,
Barry Worthing, RN, BSN
President Maine ENA

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MENA Membership

Maine ENA would like to welcome the following new members:

• Resa Peterson
• Wendy Quartermain

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MENA Awards & Election Results 2007

• President-Elect: Robin Hall
• Board of Directors: Darlene Glover
• Scholarship Award: Michelle Gosselin
• Nurse Provider Award: Megan Landry
• Special Merit Citation: Emma Gierczak

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Congratulations! ENA Membership Winners

At the September Maine ENA Annual Meeting, Genentec donated three ENA memberships. The winners are:

• Vilma Craig
• Joan O’Brien
• Lisa Plummer

Maine ENA would like to thank Rusty Smith and Genentec for their very generous donation and support of our mission.

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2007 Nurse Provider Award Winner

Pictured at left, in the center of the photo is Megan Landry the 2007 winner of the Nurse Provider Award. Megan was presented the award at the Maine ENA Annual meeting held at Maine Medical Center in Portland, in September.

Megan works as an emergency department nurse at MaineGeneral Medical Center in Waterville.

Shown with Megan are her friends and co-workers, Wendy Nivison and Carol Minnis.

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ENPC & TNCC

2008 ENPC Classes

• March 17th & 18th
• June 16th & 17th
• October 6th & 7th

ENPC Instructor Class

• May 9th

2008 TNCC Classese

• January 24th & 31st
• March 12th & 19th
• June 12th & 19th
• September 18th & 25th
• November 13th & 20th

More Classes

More classes will be posted in the Winter Newsletter.

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Results of Splinting Survey

• The intent was to survey Maine's hospitals to find out about splint application in the ED, particularly which providers apply splints and who bills for them.
• Surveys were sent to 36 ED nurse managers with the following questions:
  • Which of the following disciplines create and apply PLASTER splints (not pre-formed splints) for fractures in your ED?
    Check all applicable: RN, EMT / Tech, PA / NP, ED Physician, Orthopedic Surgeon, Family Practice Physician, Other, Not Applicable
  • Which of the following disciplines create and apply FIBERGLASS splints (not pre-formed splints) for fractures in your ED?
    Check all applicable: RN, EMT / Tech, PA / NP, ED Physician, Orthopedic Surgeon, Family Practice Physician, Other, Not Applicable
  • How are patients billed for splint creation / application?
    Check all applicable: Part of bundled ED visit charge, Supplies, Nursing procedure charge, Physician procedure charge, Other, Not Applicable
• 15 Surveys were returned (42% return rate) - THANK YOU!!!

Plaster	# of Responses	% of Responses
RN	6	40%
EMT / Tech	5	33%
PA / NP	8	53%
ED Physician	9	60%
Orthopedic Service	9	60%
Family Practice Physician	0	0%
Other	1	7%
N/A	2	13%

Other = Orthopedic Cast Tech
N/A = ED does not use plaster splints

Fiberglass	# of Responses	% of Responses
RN	5	33%
EMT / Tech	4	27%
PA / NP	12	80%
ED Physician	10	67%
Orthopedic Service	8	53%
Family Practice Physician	1	7%
Other	1	7%
N/A	0	0%

Other = Orthopedic Cast Tech

Billing	# of Responses	% of Responses
Part of bundled ED visit charge	4	27%
Supplies	10	67%
Nursing procedure charge	3	20%
Physician procedure charge	9	60%
Other	1	7%
N/A	0	0%

Other = Facility Charge

• Maine ENA hopes that this information will be useful to you too, possibly to reinforce your current practice or to support change in your ED.
• Thank you for supporting nursing research!

Tammy Lachance, RN, BSN, CEN

Maine ENA Nursing Practice Chair
October 2007

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CEN Review Questions

A female patient who is 13 weeks pregnant by ultrasound presents to the ED with the complaint of vomiting for several days. She states that she vomits everything she tries to eat or drink. She states that she feels very weak and dizzy. Vital signs are BP 88/52, HR 120, and T 99.8 (37.7). Her urine has 3+ ketones and is negative for protein and leukocytes.

1. The highest priority nursing diagnosis for this patient is:
   1. Alteration in comfort related to weakness
   2. Fluid volume deficit related to persistent nausea and vomiting
   3. Anxiety related to diagnosis
   4. Alteration in safety related to dizziness
2. You expect that the patient is experiencing which of the following:
   1. Viral gastroenteritis
   2. Hyperemesis Gravidarum
   3. Pregnancy-induced hypotension
   4. Pelvic inflammatory disease
3. The most important intervention for the patient is:
   1. Initiate an IV line and rapidly infuse D5W
   2. Initiate an IV line and rapidly infuse 0.9% NS
   3. Initiate an IV line and rapidly infuse O negative blood
   4. There is no indication that fluid resuscitation is needed at this time
4. Which of the following antiemetics is considered the safest to administer to this patient?
   1. Promethazine
   2. Prochlorperazine
   3. Ondansetron
   4. Droperidol
5. Which of the following ophthalmic products produce constriction of the pupils?
   1. Cyclopegics
   2. Mydriatics
   3. Miotics
   4. Steroids

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CEN Review Answers

1. B: The patient’s presentation indicates dehydration secondary to nausea and vomiting; therefore, fluid volume deficit is of highest priority.
2. B: Hyperemesis Gravidarum is a term used to describe intractable nausea and vomiting during pregnancy. The patient most often presents with weight loss, decreased skin turgor, and dry, coated tongue.
3. C: The patient is presenting with hypovolemia and unstable VS. Initially you would treat the hypovolemia with a rapid infusion of an isotonic solution to correct the hypotension. You would then administer a solution of 5% glucose in saline or RL to correct the detoured and dehydration.
4. C: Ondansetron is a Class B drug. Drugs are classified for safety in pregnancy based on clinical trials. Class A drugs are considered safe based on human studies. Class B drugs are presumed safe based on animal studies. Class c drugs have uncertain reports concerning safety, although no human or animal studies have shown adverse effects. Class D drugs are considered unsafe during pregnancy. Class X Drugs are considered highly unsafe. Promethazine, Prochlorperazine, and Droperidol are Class C drugs.
5. C: Miotics constrict the pupils. Cyclopegics paralyze ciliary muscles. Mydriatics dilate the pupils. Steroids decrease the inflammatory response.

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Maine ENA 2007 Delegates

Maine ENA wishes to thank the Delegates/Alternate who attended the ENA General Assembly in Salt Lake City in September.

They are from left to right:

• Karen Taylor
• Barry Worthing
• Suzanne Mosher
• Emma Gierczak
• Carol Grant
• Nancy Jackson
• Carol Minnis
• Elaine Colfer

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ENCARE

Have you ever heard of ENCARE?

Have you wondered what it is?

ENCARE is an injury prevention program designed by two ED nurses in Massachusetts. This program helps to educate the spectrum of patients we see in the ED. ENCare includes, but is not limited to the following:

• Child Passenger Safety: Proper use reduces the risk of fatality by 71% in infants and 54% in children ages 1-4 years old. Proper use decreases the need for hospitalization by 69% of children under the age of 4.
• Bicycle and Helmet Safety Program; Helmet use and fitting, rules of the road and bicycle safety events.
• Adolescent Safe Driving; Alcohol and safe driving education.
• Healthy Aging; Safe medication use, fall prevention, safe driving and pedestrian safety.

Educating the public helps reduce preventable injuries and deaths in the community, reduces the number of emergency department visits, improves the image of emergency department nurses within the community and improves the personal job satisfaction of emergency nurses.

One eight hour day is all it takes to become ENCARE certified. This does not include the Child Passenger Safety Course.

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Board Meeting Invitation

As always, all Maine ENA members are invited to Board Meetings.

The next meeting will be held at the home of Wendy Nivison in Winslow.

December 14th - 0900 to 1300

The calendar for all 2008 Maine ENA Board Meetings and Educational Days, will be in the Winter newsletter and posted on the Maine ENA web site.

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Annual Karen O'Neil Professional Award

The nurse who is the recipient of this award will best exemplify what Karen stood for...

A consistent demonstration of:

Strength and gentleness, excellence, motivation, endurance in the face of adversity, and the education and advancement of Emergency Nursing.

This award is given in tribute and memory of one of Massachusetts's finest Emergency nurses - Karen O'Neil. Karen died well before her time, but not before she had accomplished what some people never accomplish in a lifetime. She truly was a beautiful daisy to all she came in contact with... A mentor to many, a friend to all.

Criteria will be based on:

• Current membership in ENA
• Demonstration of outstanding knowledge and expertise in emergency nursing practice, education, and professionalism
• Demonstration of contributions that affected the professional within the community, region, or county
• Demonstration of influencing emergency nursing in a professional role within our New England states and beyond
• Serving as a role model for emergency nurses

This is an annual award given to the recipient at New England Regional Symposium. The recipient is selected by New England ENA Presidents at the Leadership Challenge each year. Each New England state is allowed to submit 1 recipient. Since NERS will be held in Maine in 2005, it would be very nice to have the award go to a Maine ED nurse! We certainly have ED RNs that are worthy of this award!!

Please post this notice in your ED and forward it to your staff. Encourage submission of nominations!

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Maine ENA Winter Meeting and Education Day

January 18th, 2008

MaineGeneral Medical Center Waterville Campus

Title: “Because You Asked”, featuring topics that have been specifically requested by the membership

• Patient Safety
• Obstetrical Emergency/Delivery in The ED
• Simm Man

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Emergency Department Employment Opportunities

MaineGeneral Medical Center
Augusta and Waterville

We are looking for nurses with a passion for Emergency Nursing!

We currently have several positions available to accommodate our newly renovated Emergency Departments

• Excellent Patient Satisfaction
• Collaborative Practice between Nurses and Physicians
• New Behavioral Health Suite
• Competitive Salary and Benefits

Great Opportunity for Personal and Professional Growth!

State of Maine RN License Required

ED Clinical Experience Preferred, but We are Willing to Train Exceptional Candidates

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Maine ENA Newsletter Info

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

As of January, 2008 the newsletter will have a new editor:

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