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Emergency Nursing

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Lindsey Wiggins

on 12 August 2014

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Transcript of Emergency Nursing

Workplace violence is a major problem for emergency nurses and can include physical, emotional, and verbal abuse. Nonfatal violent crimes occur in EDs twice that of all other occupations.
Less than 20% of all nurses feel safe
at work and
82% of emergency nurses were assaulted
in a recently surveyed year.

ED violence is the result of many overarching issues such as overcrowding and wait times as well as patient pain and distressing circumstances.

first national study of emergency nurse's experiences and perceptions of ED violence
was initiated by the ENA in 2009. An overwhelming majority of nurses reported feeling unsafe in their work environment, that violence is an unavoidable part of their job, and a lack of administrative support.

include an administrative commitment to encourage incident reporting and to clearly outline procedures, implementing a task force to identify ED vulnerabilities, and educating emergency nurses to identify and deescalate potentially violent situations.

Additionally, nursing organizations are pushing for
federal support

healthcare institutions to actively work toward prevention
versus suggesting guidelines that are unlikely to be followed proactively.
Although a RN can work in the ED without additional education, courses and certifications are attractive to employers and better equip the RN to handle a wider array of medical emergencies.


Advanced Cardiac Life Support
(ACLS) and
Pediatric Advanced Life Support

Written and hands-on exam
Renewal every two years


Certified Emergency Nurse
Certified Pediatric Emergency Nurse

Exams administered by certification boards
Recommended two years ED experience
Renewal every four years or by 100 hours of continuing education
Psychiatric patients are common in U.S. EDs and contribute toward overcrowding:
53 million were seen in 2001

Most common are anxiety-related, mood, and substance-abuse disorders.

ED is not the ideal place of treatment
for the psychiatric patient and almost three quarters of surveyed ED directors stated these patients
require more resources and nursing attention
than non-psychiatric patients.

Emergency nurses, untrained for psychiatric care, and other staff in an already over-crowded ED can develop negative or inappropriate attitudes toward these patients
who could be suicidal

Inclusion of
psychiatric emergency nurses
in some EDs have had
positive effects
ED wait times
patient and nursing satisfaction
. A multidimensional change of access to psychiatric services needs more research, although this is a significant improvement.
The emergency nurse evaluates a
spectrum of individuals
: all races, ethnicities, religions, and cultures; the uninsured and undocumented; psychiatric patients; and possibly the criminally charged.

The nurse must
recognize the humanity
of these various individuals and prioritize the patient's
need for care above one's own feelings
about a particular person or group of people.

Respecting patient autonomy
is vitally important. The emergency nurse must ultimately
allow the patient to decide
upon his or her healthcare. Some patients may refuse care or life-saving treatments such as CPR or blood transfusions.

However, the emergency nurse must also ensure that the patient is
adequately informed
to make these healthcare decisions.

A growing problem with unclear solutions
and ethical considerations is
overcrowding in EDs nationwide
This especially affects emergency nurses,
who are front line ED professionals.


The Patient Protection and Affordable Care Act (PPACA) of 2010 is a hefty piece of legislation reorganizing the U.S. healthcare system. The American College of Emergency Physicians authored an extensive report considering its effects on and ethical considerations for EDs.

Passage of the PPACA increases access to healthcare in the form of health insurance for the previously uninsured. This results in a
rapid influx of 32 million insured Americans into the healthcare system
and will
exacerbate ED overcrowding
. Several factors are at play.
Nursing Specialty: Emergency Nursing
Standards and
Guidelines of Emergency Nursing Practice
Relevant Publications
Journal of Emergency Nursing
Nursing Association
Mission Statement
The mission of the Emergency Nurses Association is to advocate for patient safety and excellence in nursing practice
The ENA is a hub for emergency nursing information and research in the U. S. It is the major professional association dedicated to this specialty and is the voice for emergency nursing guidelines and initiatives as well as acts as both an advocate and lobbyist.

Nursing students and others
may find resources relevant to emergency nursing, such as educational requirements, publications, and legislation.

Registered nurses
utilize the ENA when seeking information on advancing their education or by reading the latest evidence-based practices in emergency nursing today.
Current Initiatives and Research in Emergency Nursing
Emergency Nursing
The American Nurses Association (ANA)
formally recognized emergency nursing as a specialty practice in 2011
, an achievement that places high standards of patient care and safety among nurses in the profession.

Emergency nursing includes care for individuals across the lifespan and
treatment for almost any ailment imaginable.

I am interested in employment by a
hospital emergency department
(ED). This presentation will largely reflect this career path.

official peer-reviewed journal of the ENA
high visibility by emergency professionals
wide range of topics in practice and issues
international readership and authorship
quality research, knowledge, and discussion reflects diversity of field
International Emergency Nursing
Sheehy's Manual of Emergency Care
recommended reading for aspiring emergency nurses
comprehensive coverage of emergency nursing basics
Ethics and Emergency Nursing
Certifications, and Careers
The Standards of Practice in Emergency Nursing is published by the ENA and is available for purchase through their website. This book:

Details how the emergency nurse is to apply their skills while
practicing safely
in the ED

Guides the practitioner
and is a
foundation for students or others
interested in understanding the role of an emergency nurse
psychiatric emergency patient care
workplace violence
evidence-based practices
Emergency nursing is demanding
, requiring the rapid stabilization of patients acutely ill, injured, or distressed. Employing current, tested knowledge of the most effective procedures and skills allows the nurse to
act efficiently in a fast-paced environment

The ENA provides an
invaluable resource for emergency nurses
wishing to
apply evidence-based research
to their practice. A committee made of several emergency specialty nurses investigate the latest peer-reviewed evidence on a current clinical problem and report recommendations. These are disseminated via their website in the form of quick tips, synopses of findings, and a detailed report outlining background, methodology, and data.
in EDs is a multifaceted issue resulting in long wait times, frustrated staff, errors, and
lower quality of care
. In recent years, patient visits to EDs has increased dramatically while hospital bed space has decreased.

Addressing this problem is an ongoing effort and includes as many innovative ideas as there are causes.
Urgent Matters
is a unique organization dedicated to
improving ED patient flow and quality of care

Their most recent newsletter in 2014 showcases a
case study
from Lakeland Regional Medical Center, which recently implemented a Medical Management Program. Frequent ED visitors with chronic conditions were identified and a plan of care was developed by a multidisciplinary team along with nurse leadership. The ED essentially became a primary care office for these frequent visitors who would not seek primary care on their own.

57% decrease in ED visits among 63 patients
over three years occurred. Although primary care is unorthodox in the ED, improving the health of frequent visitors leads to less overcrowding and expense for the facility and improves quality of care for all other ED patients.
See the following example of a synopsis on
Wound Preparations
Many issues plague EDs and intimately affect emergency nurses who work most closely with patients in EDs.

Current research initiatives include emergency psychiatry, overcrowding, and workplace violence.

The emergency nurse acts with
compassion and respect
human dignity
and the
uniqueness of the individual

The emergency nurse maintains
for, emergency nursing practice.

The emergency nurse acts to
protect the individual
when health care and safety are threatened by incompetent, unethical or illegal practice.

The emergency nurse exercises
sound judgment
in responsibility, delegating, and seeking consultation.

The emergency nurse respects the individual's
right to privacy and confidentiality

The emergency nurse works to
improve public health
and secure
access to health care
for all.
Daily dilemmas for emergency nurses
A puzzling issue in EDs nationwide
Due to the PPACA, the American healthcare system experiences 32 million more insured patients ready to receive care.

An increase in supply of primary care providers (PCPs) will take time to adjust to the sudden increase in demand for primary care.

U.S. population is increasing, the U.S. is experiencing an influx of undocumented individuals, and the aging baby boomer population is rising, further increasing the demand for healthcare.

The Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986 requires baseline provisions of care for all patients, lengthening care time per patient, and prohibits facilities from refusing care to anyone unable to pay. EDs absorb this cost and in combination with other economic pressures, many hospitals and EDs have closed.
Emergency nurses need to prioritize the needs of some patients over others in overcrowded EDs and will feel pressured to rush patient care. This challenges many of the guiding ethical principles.

is compromised as all patients cannot receive equal healthcare.

is challenged in that a patient's emergent need may worsen while waiting to be seen. Bringing the most good to a patient, or
, is questioned when the emergency nurse rushes patient care.

may also be sacrificed since ideal care and commitments to patients may not always be possible in fast-paced and crowded situations, particularly in disasters or crises.
Some ED professionals
value deliverance of and access to care for all individuals
the most. Patients should be seen no matter what and, if necessary, we should adopt creative solutions and change the function of the ED.

Provide PCP-like visits and follow-up
Allocate resources for a wider range of patient needs

Other ED professionals
value efficiency and effectiveness of care
more and wish to preserve the specialization of emergency medicine and nursing. Patients with non-urgent issues receive better care at facilities properly equipped to serve their health needs.

Improve efficiency in patient throughput
Adopt a system to defer non-urgent patients
Advocate for funding to increase PCPs and nurse practitioners
Further investigative points
for emergency nurses
Ethics and emergency nurses in overcrowded EDs
Responses from the profession
Overall, a nurse wishing to work in the ED has many opportunities to improve their skills and knowledge base. In addition to private pursuits of knowledge, the emergency nurse can pursue certifications and advanced practice.
Courses and Certifications
Recommendations for the Aspiring Emergency Nurse
Landing a job in an ED as a newly registered nurse (RN) isn't common, but the RN can market his- or herself for employment in the ED.

Take continuing education courses and obtain certifications
Read emergency nursing publications
Join and actively participate in ENA or other professional organizations
Attend conferences

The new RN can work to hone nursing skills and obtain a broad skill base useful in emergency nursing through experience in med-surg and critical care departments:

Management of multiple patients
Rapid assessment skills
Interpretation of ECGs and EKGs
IV access

When immediate ED employment is preferred, look for facilities with a 3-6 month minimum orientation with class time, skills lab, and clinical preceptor arrangements.
Advanced Practice in Emergency Nursing
The National Council of State Boards of Nursing recognizes four roles of Advanced Practice Registered Nurses (APRN):

Nurse Anesthetist
Nurse Midwife
Clinical Nurse Specialist
Nurse Practitioner

CNSs and NPs have different roles in Emergency Nursing. Licensing for both the CNS and NP is granted with a minimum of a Master's education as well as certification through the American Nurses Credentialing Center (ANCC).
Clinical Nurse Specialists
CNSs are
expert clinicians
who increase quality and efficiency of patient care by
incorporating research into practice
. They consult, educate, and research and are managers of clinical processes. Although CNSs aren't bedside nurses, they can step in when necessary for complex cases or during staff shortages.

Specialties are numerous and can vary according to type. For example:

Populations (e.g. geriatric)
Types of care (e.g. psychiatric mental health)
Settings (e.g. emergency)
Disease (e.g. oncology)
Type of problem (e.g. pain)

CNSs may take further steps to gain
prescriptive authority.
provide medical care
to patients and have authority to diagnose, treat, and prescribe medications. NPs can practice privately or in collaboration with medical doctors.

Family NPs (FNPs) provide primary care for a more general patient population without specializing. Specialty NPs, such as in Emergency (ENPs), are highly trained but with a narrower focus, limiting practice to their specialty cohort.

Knowing highly specialized emergency care can be an asset, but some employers might prefer to hire a FNP who can see a wider range of patient demographics. For example, an ENP cannot provide certain care to children. A FNP allows the the NP to address emergencies with children and may actually be more employable by the ED for that reason.
Nurse Practitioners
Arenas for Emergency Nurses
Why am I interested in Emergency Nursing?
I also have a strong desire to use nursing in a humanitarian way in organizations such as:

American Red Cross
International Orthodox Christian Charities
Orthodox Christian Mission Center
Doctors without Borders

Each organization offers humanitarian service in a unique way, and each would benefit from the service of an emergency nurse.
Continuing Education Opportunities within the ENA
The ENA website lists personal qualities of emergency nurses both general and specific to the profession. A few of them spoke to me:

Ability to shift gears and accelerate your pace as needed
I am typically relaxed, but I can move quickly when necessary.

Good interpersonal and customer service skills

I have always been commended for my ability to connect with people and I usually perceive the meaning behind a person's words quicker than others.

Ability to maintain calm admidst chaos
While I have yet to test myself in a nursing environment, I have always been able to remain calm and collected in stressful situations and I enjoy working under pressure.
Humanitarian aid
Hospital EDs
Nurse educator
Research institutes
Emergent care centers
Flight nurse
Transport nurse
Poison control centers
Telephone triage
Corporations or businesses
Crisis intervention centers
Prisons or correctional facilities
Federal and state governmental agencies
The ENA provides two exceptional and unique courses to increase the knowledge base for the emergency nurse:

Emergency Nursing Pediatric Course -
Core knowledge and skill for pediatric care in an emergency setting
The only pediatric emergency nursing course written by pediatric
nurse experts

Trauma Nursing Core Course -
Comprehensive training for the care of trauma patients
Used by hospitals and trauma centers all over the U.S.

The ENA offers online courses for emergency nursing in an array of subjects such as geriatrics, research, leadership, and certificate preparation.

Additionally, the ENA hosts conferences in various parts of the U.S.
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