Leadership & Practice
Nursing Leadership & Practice Committee mission:
- To monitor and address issues affecting professional nursing practice, specifically including, but not limited to, issues related to all areas of emergency nursing practice and emergency nursing standards;
- To utilize the experience and expertise of the members of the Committee to provide information, education and training to the California Emergency Nurses Association (Cal ENA) membership; and
- To establish a liaison with and serve as a resource to other ENA committees and interested individuals or groups in order to address professional issues.
Committee Chair: Julie Rossie
Committee Report to State Council
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
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. Al Duke, Sacramento Chapter and Immediate Past Chair Government Affairs requested to present BETA ED Toolkit Management of Mental Health Patients in the ED Toolkit developed by BETA Healthcare Group Emergency Medicine Council. http://www.betahg.com/services/EMC_Toolkit.asp.The Toolkit is non-proprietary and available for access and sharing. The Toolkit is designed to be referenced electronically with multiple imbedded links to resources. BETA Healthcare Group will update links periodically so using the Toolkit electronically ensures the most up to date information. The Toolkit is divided into the following major sections: Safety, Triage, Staff Training, Care & Treatment, Telepyschiatry, and Discharge. Thank you Al Duke for bringing forward this timely and useful resource. The second timely (and very lively and controversial) topic discussion was SB1152 Homeless Patient Discharge Process that went into effect January 1, 2019. The bill text can be found at http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB1152. Additionally, California Hospital Association (CHA) has developed a very informative reference, California Discharge Planning for Homeless Patients: Understanding the law on preparing to return homeless patients to the community. Access requires logging in as a Hospital Member but your ED Leadership or Quality Department can assist https://www.calhospital.org/publication/discharge-planning-homeless-patients. In summary the Law requires the following: • Physician examination (MSE) and determination of stability for discharge • Referral to follow up care • Offer a meal • Evaluate clothing; offer weather-appropriate clothing (if providing used clothing, refer to The Joint Commission laundering requirement) • If provided prescription, dispense appropriate supply of medication if hospital has an onsite outpatient dispensing pharmacy • Offer or refer to screening for infectious disease common to the region as determined by local health department • Offer vaccinations appropriate to the homeless patient’s presenting medical condition • Assist with enrollment in Affordable Health Coverage • Identify postdischarge destination with priority given to a sheltered destination with supportive services • Offer transportation to postdischarge destination with a maximum travel time of 30 minutes or maximum travel distance of 30 miles of the hospital • July 1, 2019 – requirement to maintain a log of homeless patients discharged and the destinations to which they were released As you would expect Committee attendees were all struggling to meet the requirements of the Law. California ENA is another networking resource for members as we move forward.
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. Attendee Mindy Elayde shared that she is the editor of the newly launched ANA/C Online Newsletter, Editorial Committee. Mindy offered attendees to reach out to her if there is online content they are interested in viewing if unable to access. This month we discussed newly published guidelines on oxygen therapy for acutely I’ll medical patients. Oxygen therapy was first used in 1885. Traditionally, oxygen has been considered a benign therapy, however the new evidence discussed indicates that in some patient populations (stroke and myocardial infarction) oxygen therapy is linked to higher mortality. Recommended guidelines include aim for SpO2 of /=90% (for >/=93% strong recommendation, for 90-92% weak recommendations); target SpO2 range of 90-94% reasonable for most patients at risk of hypercapnic respiratory failure. Additional presented was the announcement of FDA approving sublingual sufentanil formulation for health care settings (not available in retail pharmacies or outpatient use). Concerns of possible impact on the current opioid epidemic. And finally, member request for feedback from attendees on if anyone is using scripting to keep waiting room patients informed during surge times and if anyone is using a “waiting room” nurse. A few attendees were able to provide information on this process. References: Chi, DK, Kim, LH, Young, PJ, et al. (2018). Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. The Lancet, 391(April 28, 2018), 1693-1705. Siemieniuk, RA, Chu, DK, Kim, LH, et al. (2018). Oxygen therapy for acutely ill medical patients: a clinical practice guideline. British Medical Journal, October, 1-10. FDA approves, explains need for new acute pain sufentanil formulation. Anesthesiology News, November 5, 2018 at https://www.anesthesiologynews.com
Committee discussion centered primarily around the General Assembly Resolutions slated for presentation and voting at the upcoming September meeting. Resolutions discussed were:
- National Standard for Child Passenger Restraint
- Public Access to Bleeding Control Kits
- Against Human Trafficking
- Establishing a Standard for Emergency Department Preparedness to Care for Children
- Develop an Emergency Department Geriatric Readiness Survey and Toolkit
- Freestanding Emergency Centers (FSEC)
- ENA’s Position on Firearm Safety and Legislation
- Safety When Removing Patients from private Vehicles
- Care of the Lesbian, Gay, Bisexual, Transgender and Queer/Questioning patient (LGBTQ)
Additional discussions centered around the following In the News articles: 1) The Hospital of Tomorrow in 10 Points, Crit Care 2017; 21(93); 2) In just one year, nearly 1.3 million Americans needed hospital care for opioid-related issues. June 20, 2017; and 3) STAT forecast: Opioids could kill nearly 500,000 Americans in the next decade. June 27, 2017. https://www.statnews.com/2017/06/27/opioid-deaths-forecast/.
March committee meeting discussion topics included 1) review of Leg Day from the prior day 2) discussion Assembly Bill 909 public access to trauma kit; Assembly Bill 419 prohibiting prescription of oxycodone to patients under 21 years old; and Senate Bill 562 intent to enact legislation for single-payer health care and 3) articles in the news. Attendees to Leg Day reported a very informative and productive day. The provided biographies of representatives were very helpful in identifying key talking points. We reviewed and discussed the above bills and provided feedback to Government Affairs Committee. Attendees requested an update on the response of the use of vertical treatment space survey presented at the January meeting. Julie Rossie provided an update. The following articles in the news were reviewed and discussed: Rising number of kids ill from drinking hand sanitizers. https://consumer.healthday.com/public-health-information-30/poisons-health-news-537/rising-number-of-kids-ill-from-drinking-hand-sanitizers-cdc-720300.html Hand sanitizers have become more commonly available in homes and schools. The CDC reports that older children (aged 6-12) more likely report intentional ingestion due to the alcohol content. From 2011-2014, 70,669 hand sanitizer exposures in children under the age of 12. Ingestion was associated most commonly with vomiting and eye irritation, but a small number of cases resulted in coma or seizures. Emergency Department visits for suicidal thoughts more than doubled in 7 years. http://www.healthleadersmedia.com/quality/emergency-department-visits-suicidal-thoughts-more-doubled-7-years# From 2006 to 2013, ED visits related to suicidal ideation increased from 0.4% to 1%. The primary behavioral health conditions associated with suicidal thoughts were mood disorders, substance-related disorders, alcohol-related disorders, anxiety disorders and schizophrenia and other psychotic disorders. In 2013, 71% of the visits for suicidal ideation resulted in admission compared to 19% of all other ED visits. Length of stay increased from 5.1 days in 2006 to 5.6 days in 2013. 8 technologies poised to disrupt US healthcare in 2017 and beyond. http://hitconsultant.net/2017/02/14/37429/ Technologies discussed included artificial intelligence, augmented reality, blockchain, drones, internet of things, robots, virtual reality and 3D printing. Automated triage nurse of the future.https://www.engadget.com/2017/03/07/meet-the-automated-triage-nurse-of-the-future/ Discussion of development of an automated triage nurse that allows the patient to registered with an identification card, record their blood pressure, pulse oximetry, and weight. The intake information is electronically routed to the physician’s computer. Future plans are to include the ability to upload patient’s glucometer information.
November 11, 2016 attendees: California Leadership in Practice Committee Attendees: Kathy Van Dusen, Mark Wandro, Christine Marshall, Susan Laverty, Lark Boyer, Flora Tomyasu.
Discussion Topics: Coming to an EMS Agency near you: Mobile Stroke Units (MSU)- American Heart Association Article “Establishing the First Mobile Stroke Unit in the United States The group discussed the AHA article on Mobile Stroke Units. Many felt that due to the cost that funding would be difficult in many areas of the state. It is interesting to note that only 1% of stroke patients in the US receive TPA within 60 minutes of arrival to the hospital. EMSA redefining destination criteria for stroke patients – identifying patients that should go directly to a comprehensive Stroke Center. The group discussed the difference between a primary and comprehensive stroke designation.
Election results: Recreational Marijuana- passed. Gun Control- passed. Healthcare and Dug Prices- did not pass. Tobacco Tax- passed.
Clinical practice issues open forum: Ideas for resolutions or bylaw changes for general assembly. These are due by March 1, 2017. One idea was a nurse driven protocol for the treatment of anxiety that was presented at the educational day on 11-10-16.
If you have practice issues you would like discussed at General Assembly, please e-mail the committee chair. The committee will work to submit them to National for consideration.
- Some ED’s are giving it out to all patients at discharge
- Some ED’s are giving out to selected patients at discharge
I would encourage you to bring this flyer to your ED leadership and consider how it can be used in your organization.
Kathy Van Dusen, RN MSN CEN CPEN