Leadership & Practice

January 2021

The Leadership and Practice Committee mission is to provide for communication and member involvement, discuss practice issues and updates, and provide a forum for networking. Despite the challenging times created by the pandemic, Cal ENA meeting attendees once again participated in heartfelt discussions and sharing during the January 2021 virtual meeting. Top on the agenda were questions posed to the attendees on how their ED is addressing staffing and throughput challenges. Participants shared experiences with addition of beds such as a 200 bed mobile field hospital in Orange County and transition of the shuttered Fairview Developmental Center in Costa Mesa opened to accommodate COVID positive memory care patients. Participants shared that staffing challenges created a significant toll. Many Southern California counties were unable to staff within ratio given the patient load with ratios of 1:5 or 1:5 in the ED and ICUs at 1:3 and higher with cohorting COVID positive families because of physical space limitations. Some participants shared that their staff were quitting to take higher paying travel positions creating even greater strain on their staffing. Solutions shared including offering incentives to clinic nurses with recent ED experience to return to the ED. Another suggestion was to reach out to retired nurses as a potential pool of qualified staff. Discussion of how to incorporate students or new graduate nurses in the mix recognizing that these individuals need to have additional support that may not be available. A request for ENA to identify opportunities for the organization to assist with “getting out the vaccine”. The discussion provided evidence that now more than ever we need to incorporate self-care strategies. We learned what participants were doing to support their self-care from walks and ways to get out in nature to adding a furry member to their family or relying on the joy a current furry member provided them. Many simply expressed their awe and gratitude for the group, their coworkers and Cal ENA members. The discussion was truly moving with tears of compassionate support. We are Cal ENA strong!! (Just had to emphasize!) Also on the agenda for discussion were recent articles on palliative care in the ED and accuracy of IV medication delivery with pumps located outside the patient room but unfortunately time ran out. Here are the references for those interested. Berta, M, Leon, A., Silvey, K. (2020). Bringing palliative care downstairs: A case –based approach to applying palliative care principles to Emergency Department practice.

Advanced Emergency Nursing Journal, 42(3), 215-224. https://pubmed.ncbi.nlm.nih.gov/32739951 Dundin, A., Siegert, C., Miller, D., et al. (2020).

A pivot to palliative: an interdisciplinary program development in preparation for a coronavirus patient surge in the Emergency Department. Journal or Emergency Nursing, 46(6), 760-767. https://www.jenonline.org/article/S0099-1767(20)30286-5/fulltext Geller, D.E. & Evans, D.D. (2020).

Death and Dying in the Emergency Department. Advanced Emergency Nursing Journal, 42(2), 81-89. https://journals.lww.com/aenjournal/Fulltext/2020/04000/Death_and_Dying_in_the_Emergency_Department.2.aspx

Blake. J.W.C. & Giuliano, K.K. (2020). Flow accuracy of IV smart pumps outside of patient rooms during COVID-19. AACN Advanced Critical Care, 31(4), 357-363. https://aacnjournals.org/aacnacconline/article/31/4/357/31147/Flow-Accuracy-of-IV-Smart-Pumps-Outside-of-Patient