ENA Resolutions and Bylaws

Posted over 10 years ago by Tina Hedin

Below are the proposed resolutions and by-law changes being proposed by national and will be discussed and voted on at the Scientific Assembly in October. Sorry for the funky format ... I copied it from the ENA delegate handbook. It's a long read!!

If you have any input please contact me at ToDream161@aol.com or you can post comments below-- Tina

GA14-01 Resolution

Resolution Title: Update the

Consensus Statement on

Definitions for Consistent Emergency Department Metrics

2014 General Assembly

Whereas, Payers, hospitals, the National Database of Nursing Quality Indicators (NDNQI),

1 and the Center for

Medicare & Medicaid Services (CMS) are stressing reporting of measures to benchmark and

improve emergency department performance; and

Whereas, ENA's definition for "Emergency Department Decision to Admit" in the Consensus Statement on

Definitions for Consistent Emergency Department Metrics states, "Documents a decision to admit

the patient" when the medical screening exam has been completed and stabilizing treatments and

interventions have been initiated, diagnostic results needed for admission have been reviewed,

and the physician is ready (per hospital process) to initiate the admission process. At the current

time, the ED Metrics Stakeholders believe that this time stamp is variable and should be defined

and made consistent through all institutions; and

Whereas, "Admit Decision to Departure" is proposed to become a CMS quality measure of inpatient care in

2014, clarification of the admit decision timestamp is critical; and

Whereas, ENA collaborated to create the "Consensus Statement on Definitions for Consistent Emergency

Department Metrics"; therefore, be it

Resolved, That ENA work collaboratively with other stakeholder organizations to revise and update the

Consensus Statement on Definitions for Consistent Emergency Department Metrics. Such revision

shall include, at minimum, the definition of the following terms: "disposition decision time," "admit

decision time," and "boarded admitted patient."

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GA14-01 Resolution

Resolution Title: Update the

Consensus Statement on

Definitions for Consistent Emergency Department Metrics

2014 General Assembly

ENA Board of Directors Comments:

ENA has been an active participant in the Emergency Department Benchmarking Alliance (EDBA) for the last several

years. This past February, the alliance met to update its ED definitions. ENA was represented at this meeting, as was

the American College of Emergency Physicians (ACEP), Society for Academic Emergency Medicine (SAEM), AARP,

Emergency Department Practice Management Association (EDPMA), American College of Healthcare Executives

(ACHE), American Medical Informatics Association (AMIA), Centers for Disease Control and Prevention (CDC),

National Quality Forum (NQF), Centers for Medicare & Medicaid Services (CMS), Healthcare Information and

Management Systems Society (HiMSS), American Medical Association (AMA) and the Oklahoma Foundation for

Medical Quality. Updated definitions were created after much discussion and debate, as well as consideration of all

current definitions in use today. The definitions discussed in this resolution are included in this version of EDBA

definitions. The ENA Board of Directors feels the stakeholder meeting described in this resolution has already

occurred in 2014. The final document with the approved definitions is expected by the end of the year.

Resolutions Committee Comments:

The authors and the Resolutions Committee are aware that ENA has been participating in the ED Benchmarking

Alliance that has prepared for publication a paper that defines ED metrics, many in terms the authors proposed in this

resolution. The paper is in prepublication review and not yet available so the newly defined terms were not available

to the authors at the time of the final proposal version submission in June. The authors expressed a desire to review

the defined terms prior to modifying their proposal. In conversations with the authors, the Resolutions Committee has

recommended that they not change the resolution at this time but wait until General Assembly, at which time they

may propose any necessary amendments, based on the status of the paper at that time.

Background Information:

In 2011, ENA collaborated with key stakeholders including the American Academy of Emergency Medicine, American

Academy of Pediatrics, American Association of Critical Care Nurses, American College of Emergency Physicians,

American Nurses Association, Association of periOperative Registered Nurses and Emergency Department Practice

Management Association to revise a consensus statement defining key metrics for measuring emergency

department performance and defining time stamps. In the published ENA Consensus Statement on Definitions for

Consistent Emergency Department Metrics admit decision time is noted to be variable. 1 This metric should be

defined and measured consistently through all institutions.

The Consensus Statement on Definitions for Consistent Emergency Department Metrics was developed to ensure

that emergency departments are using consistent time stamps and definitions in collecting and reporting data.1 This

consistency is key to identifying improvement opportunities and identifying best practice organizations.

In Annals of Emergency Medicine, regarding the second benchmarking summit of stakeholders, "A definitive

definition and timestamp for admit time could not be agreed upon among the stakeholders. 2,3 Per Welch et al, lacking

consensus, this time stamp is defined as:

• Disposition decision time: The date and time that the order about the disposition of the patient (transfer, observe,

discharge) is documented.

• Admit decision time: The above applied to admitted patients. The date and time that the admit order is documented

by the provider.

In 2013, NDNQI launched a project titled "Patient Staffing – Emergency Department," to begin collecting ED data.4

NDNQI is using the information in the ENA's Consensus Statement on Definitions for Consistent Emergency

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GA14-01 Resolution

Resolution Title: Update the

Consensus Statement on

Definitions for Consistent Emergency Department Metrics

2014 General Assembly

Department Metrics

as the operational definitions for the metrics they are collecting. In the 69 "Guideline for Data

Collection and Submission on Patient Volume – Emergency Department Indicators," NDNQI refers to the time stamp

for admitted patients as "ED Admit Decision Time Stamp – Time the MD/APRN/PA documents decision to admit

patient. Medical screening exam has been completed, stabilizing treatments and interventions have been initiated,

diagnostic results needed for admission have been reviewed, and physician is ready to initiate admission process."

This definition does not have an established, consistent, readily measurable time stamp associated with it and,

likewise, operational definitions and time stamps for "admit decision time" and "boarded admitted patient" are not

established.

"Admit decision to departure" is proposed to become a CMS quality measure of inpatient care in 2014; therefore,

clarification of the admit decision time stamp is critical.

Relationship to ENA Bylaws, Mission, Vision and Strategic Initiatives:

The 2011 ENA Consensus Statement on Definitions for Consistent Emergency Department Metrics does not address

the important elements of "disposition decision time," "admit decision time" and "boarded admitted patient" in its

operational definitions. ENA seeks to be the established expert on ED operations and has successfully collaborated

with other professional organizations that have interests in ED operations and metrics to achieve consensus on

definitions and time stamps and consistency in measuring performance and outcomes. This resolution supports

ongoing development of the Consensus Statement on Definitions for Consistent Emergency Department Metrics and

efforts to come to consensus with other stakeholders on these important metrics.5

Financial Considerations / Operational Impact:

A stakeholders meeting and subsequent work would require meeting funds in excess of $10,000. Staff workload

would be impacted at an equivalent of .25 FTE of professional nursing staff at the level of director to manage the

work of the team. It would also require workload from ENA's communications team, which can be incorporated into

the current workload.

References:

1. Emergency Nurses Association. (2011). Consensus statement: Definitions for consistent emergency department

metrics. Retrieved from http://www.ena.org/about/media/PressReleases/Documents/07-13-

11_DefinitionsED_Metrics.pdf

100

2. Welch, S. J., Asplin, B. R., Stone-Griffith, S., Davidson, S. J., Augustine, J., Schuur, J., & Emergency

101

Department Benchmarking Alliance. (2011). Emergency department operational metrics, measures and

102

definitions: Results of the second performance measures and benchmarking summit. Annals of Emergency

103

Medicine, 58(1), 33-40.

104

3. Welch, S. J., Asplin, B. R., Stone-Griffith, S., Davidson, S. J., Augustine, J., Schuur, J. D., Emergency

105

Department Benchmarking Alliance. (2011). Emergency department operations dictionary: Results of the

106

second performance measures and benchmarking summit. Academic Emergency Medicine, 18(5), 539-544.

107

4. National Database of Nursing Quality Indicators project staff. (2014). Guidelines for data collection and

108

submission on patient volume – Emergency department indicators. Retrieved from

109

http://www.nursingquality.org

110

5. Astle, S., Banschbach, S. K., Briggs, W. T., Durkin, W. T. Jr., Groach, L., Guglielmi, C., Tsarouhas, N. (2012).

111

Development of consensus statement on definitions for consistent emergency department metrics. Journal

112

of Emergency Nursing, 38, 270-272.

113

114

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GA14-01 Resolution

Resolution Title: Update the

Consensus Statement on

Definitions for Consistent Emergency Department Metrics

2014 General Assembly

115

Authors:

116

India Owens, MSN, RN, CEN, NE-BC, FAEN

117

Sarah Abel, MSN, RN, CEN

118

119

Supporters:

120

Cheryl Riwitis, MSN, RN, CEN

121

Yonna Heath, BSN, RN, CEN

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GA14-02 Resolution

Resolution Title: ENA'S Role in Firearm Safety

2014 General Assembly

Whereas, General Assembly Resolution 01-02 stated that "The Emergency Nurses

1 Association VALUES the

prevention of illness and injury and promotion of wellness as essential components of emergency

nursing practice and emergency care." Therefore, a focus on education and safety—rather than a

position for or against guns—is appropriate to its mission; and

Whereas, Emergency nurses recognize the statistic that "over 12,000 people, adults and children, died from

gun violence in 2013— about 30 a day"; and

Whereas, General Assembly Resolution 01-02 states that "ENA recognizes that possession and ownership of

guns for sporting purposes, investment potential, and self-protection are a matter of personal

choice that has legal and moral responsibilities and consequences;" therefore, be it

Resolved, That ENA advocates for the creation of a national background check prior to all firearm purchases

and a five-day waiting period; and

Resolved, That ENA shall support evidence-based education on firearm safety, including the manufacturing of

firearm safety devices, and the safe storage of firearms.

PROVISO: If the above resolution is adopted, Lines 15-19 of General Assembly Resolution 10-13 are hereby

rescinded.

NOTE: Resolutions GA01-02 and GA10-013 follow below for reference.

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EMERGENCY NURSES ASSOCIATION

2001 GENERAL ASSEMBLY

RESOLUTION NUMBER 01-02

RESOLUTION TITLE:

ENA'S ROLE IN GUN SAFETY

RESOLUTION:

WHEREAS, The Emergency Nurses Association VALUES the prevention of illness and injury

and promotion of wellness as essential components of emergency nursing practice and

emergency care. Therefore, a focus on education and safety – rather than a position "for or

against" guns – is appropriate to its mission; and

WHEREAS, Emergency Department Nurses recognize the fact that over 34,000 persons,

including 3,972 (1998), and another 6,000 persons are injured every year, due to the misuse of

firearms. According to economist Ted Mills of the Public Services Research Institute in

Landover Maryland, the monetary cost to society of firearm related deaths and injury is greater

that $120 billion dollars annually; and

WHEREAS, ENA acknowledges that firearms hold a vivid role in the history of the nation's

founding and military, including an amendment to the United States Constitution. The ENA is

provided with images of frontiersmen, minutemen as well as Vietnam, John Kennedy, John

Lennon, Martin Luther King and Columbine. ENA does not deny the presence of guns in

history, but the rise of irresponsible gun ownership also brings forth an increase in the number

of homicides, unintentional deaths and injury involving firearms; and

WHEREAS, ENA recognizes that possession and ownership of guns for sporting purposes,

investment potential, and self-protection are a matter of personal choice that has legal and

moral responsibilities and consequences; and

WHEREAS, The Emergency Nurses Association will be forging a renewed cycle of preventing

death and injury; therefore be it

RESOLVED, That the Emergency Nurses Association and ENCARE, the Injury Prevention

Institute, become increasingly proactive in addressing this growing problem through expanded

educational efforts and collaboration with other groups, including gun manufacturers promotion

of new technology and design standards that provide safer guns; and

RESOLVED, That ENA coordinate efforts through ENCARE to reduce death and injury resulting

from firearms through education and awareness on responsible gun ownership and safety at

public events, school programs, and through the media; and

RESOLVED, That ENA take the lead in developing working relationships for the purpose of

securing funding, equipment and resources necessary for advancement of gun safety

education; and be it further

RESOLVED, That the Association further educate its own members, monitor regulatory

initiatives, and serve as a resource.

RESOLUTION RESULT: APPROVED

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GA10-013 RESOLUTION

Resolution Title: ENA Position on Firearm Legislation

2010 General Assembly

Whereas, Resolution 01-02, titled "ENA's Role in Gun Safety" 1 was adopted and as such is in

2 effect until amended or rescinded by the General Assembly; and

4 Whereas, The 2009-2010 ENA Public Policy agenda states that ENA will support "legislation

5 and enforcement of firearm injury prevention measures, including the licensing and

6 registration of handguns"; and

8 Whereas, References to licensing and registration of handguns are incongruent with ENA's

9 support of evidence-based practice, as there is no credible evidence to show that

10 registration and licensing of handguns reduces death and injury; now, therefore, be it

Resolved, That any references to licensing and registration of handguns be removed from the

13 ENA public policy statements and public policy agenda

; and be it further

Resolved, That ENA shall not take a public position with regard to gun control legislation; and

16 be it further

Resolved, That ENA shall support evidence based education on gun safety, including the

19 manufacturing of gun safety devices, and the safe storage of fire arms.

RESULT: Adopted

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GA14-02 Resolution

Resolution Title: ENA'S Role in Firearm Safety

2014 General Assembly

ENA

24 Board of Directors Comments:

The ENA Board of Directors understands that this is an emotionally charged issue and it has been every time the

General Assembly has discussed some aspect of it. If this resolution passes, the ENA Board of Directors recognizes

that there may be some unintended consequences, including the alienation of relationships that we currently

maintain—both business and political. The first resolve regarding background checks is unnecessary as we have the

National Instant Criminal Background Check System (NICS) that was established in November 1998 and did away

with the five-day waiting period. The second resolve is difficult as there is no evidence-based educational system and

implementation could be beyond our means as an organization. There is no supporting evidence regarding firearm

safety devices, and what the authors are speaking to seems vague. The ENA Board of Directors recognizes that the

membership, on two separate occasions of the General Assembly, has taken a neutral position on this issue.

Resolutions Committee Comments:

ENA's General Assembly debated and voted on the topic of firearms in both 2001 and 2010 (GA01-02 and GA10-

13). The documents are attached for your reference. It is important that each voting delegate be aware of the proviso

with this proposal which is required to avoid a conflict between resolution10-13 and this proposal.

This resolution will allow ENA to take a position and advocate for reimplementation of The Brady Handgun Violence

Prevention Act which went into effect on Feb. 28, 1994.

The authors made revisions recommended by the committee. The committee takes no position on this resolution.

Background Information:

Since Columbine in 1999 and before August 2012, there have been 30 "notable" mass shooting in the United States,

according to The Telegraph.1 That same summer, an article on MotherJones.com observed that "the majority of the

shooters were mentally troubled—and many displayed signs of it before setting out to kill."2

According to the Children's Defense Fund Protect Children, Not Guns 2013 report "A child or teen dies or is injured

from guns every 30 minutes.3 Fifty children and teens died or were injured every day in 2010. More children and

teens die from guns every three days than died in the Newtown massacre.

"Since 1963, three times more children and teens died from guns on American soil than U.S. soldiers killed in action

in wars abroad.

• 166,500 children and teens died from guns on American soil between 1963 and 2010, while 52,183 U.S.

soldiers were killed in action in the Vietnam, Afghanistan and Iraq wars combined during that same period.

• On average 3,470 children and teens were killed by guns every year from 1963 to 2010, or 174 classrooms

of 20 children very year.

Since Resolution 01-02, there has been a significant increase, 12 percent to 17 percent, of U.S. children dying by

gunfire than their peers in 25 other high-income countries combined.3

The Centers for Disease Control and Prevention (CDC) reported in 2005, "51,173 violence-related (homicide, suicide

and legal intervention combined) deaths resulted in $47 billion in total medical and work loss costs".

According to Injury Prevention, BMJ, in 2002, "Official data from the National Vital Statistics System almost certainly

undercount firearm accidents when the victim is shot by another person." The numbers are based on information "the

medical examiner or corner provides on the victim's death certificate about the injuries and conditions that

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GA14-02 Resolution

Resolution Title: ENA'S Role in Firearm Safety

2014 General Assembly

contributed to the death. Death certificates are processed at vital statistics registries where

70 they assign a cause of

death code using the International Classification of Diseases (ICD) coding system". This becomes a problem when

law enforcement, and the dictionary, define the killing of one person by another, whether intentionally or

unintentionally as "homicide." The ICD defines "homicide" as "purposely inflected by other persons."

A standardized data bank for statistics is needed to create "a systematic surveillance system that allows for

understanding the extent and nature of the problem. The data collected must be accurate and adhere to a common

set of definitions, for data to affect scientific results, public perceptions, policy and policy evaluations."

The Joyce Foundation has stated that "Research demonstrates the effectiveness of a wide range of guns laws,

including background checks.4 Since its inception, the National Instant Criminal Background Check System (NICS)

has blocked more than 1.9 million permit application and gun sales to felons, the seriously mentally ill, drug abusers,

and other dangerous people who are prohibited by federal law from possessing firearms. But because an estimated

40% of gun transfers occur without a background check, more comprehensive gun background checks are

necessary to curb gun violence and gun trafficking."

In a 2008 article from the American Journal of Preventive Medicine, the authors state "No study has analyzed the

effects of the differences among states in the background checks required for firearm purchase. Some states utilize a

federal agency to conduct the background checks; others use a state agency; still others use a local agency."

The Brady Handgun Violence Prevention Act "mandates background checks on individuals who purchase firearms

from federally licensed firearm dealers. Under the Brady Act, which establishes the federal minimum for gun-control

laws, a person is disqualified from purchasing a firearm if he/she is under indictment or convicted of a crime

punishable by more than one year in prison, is a fugitive from justice, is unlawfully a user of a controlled substance,

has been adjudicated as a mental defective or committed to a mental institution, was dishonorably discharged from

the armed services, has renounced U.S. citizenship, is subject to a restraining order, or has been convicted of

domestic violence."

Further, the Sumner research "detected a strong association between more local-level background checks and lower

firearm–suicide fatality rates, and it was hypothesized that this may be due to more through background checks

performed by local agencies. This issue in the differences between states has been considered by Congress.

100

Relationship to ENA Bylaws, Mission, Vision and Strategic Initiatives:

101

ENA's Mission Statement: "To provide visionary leadership for emergency nursing and emergency care (including the

102

following value statement, which supports this concept) "Prevention of illness and injury and promotion of wellness

103

are essential components of emergency nursing and emergency care,"

104

105

ENA has a position statement in place titled "Injury Prevention." This association position already endorses the use of

106

three strategies for injury control: 1) Engineering/technology; 2) Legislation/enforcement; and 3)

107

Educational/behavioral changes.

108

109

Financial Considerations / Operational Impact:

110

To manage the research and evidence-gathering required, multiple ENA departments need to be involved, equivalent

111

to 0.5 FTE. This effort would also require significant external grant funding or redirection of ENA financial assets, at

112

the level of recent National Institute of Justice grants of significant value, similar to grants funded in the past decade

113

by the federal government in the amount of more than $2 million-$3 million each.5 This would also require significant

114

ENA Government Relations time and resources to effectively advocate in favor of expanded national background

115

checks and a five-day waiting period on firearm purchases. Further, advocating on behalf of these positions would

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GA14-02 Resolution

Resolution Title: ENA'S Role in Firearm Safety

2014 General Assembly

run the risk of engendering a backlash on the part of Senators and Representatives who have

116 an opposing view on

117

this controversial issue. This could have a significant negative impact on ENA's legislative priorities.

118

119

References:

120

1. A history of mass shooting in the US since Columbine. (2012, August 24). The Telegraph. Retrieved from

121

http://www.telegraph.co.uk/news/worldnews/northamerica/usa/9414540/A-history-of-mass-shootings-in-the-

122

US-since-Columbine.html

123

2. Follman, M., Aronsen, G., & Pan, D. (2012, July). A guide to mass shootings in America. Mother Jones.

124

Retrieved from http://www.motherjones.com/politics/2012/07/mass-shootings-map

125

3. Children's Defense Fund. Protect children, not guns 2013. (2013). Overview (p. 5). Retrieved from

126

www.childrensdefense.org

127

4. The Joyce Foundation. (n.d.). Myths and facts about gun violence in America. Retrieved from

128

http://www.joycefdn.org/gunviolencemyths/

129

5. Greene, M. (2013). National Institute of Justice research report: A review of gun safety technologies. Retrieved

130

from National Criminal Justice Reference Service website: https://www.ncjrs.gov/pdffiles1/nij/242500.pdf

131

132

Additional Resource:

133

Cox, A. M. (2014, January). In 2013, the US lost 30 people a day to gun violence. Obama shouldn't let us forget. The

134

Guardian. Retrieved from http://www.theguardian.com/commentisfree/2014/jan/31/president-obama-gun-control135

push

136

137

Authors:

138

Barbara J. Davis, BSN, RN, CEN

139

Michael Marsiglio, RN, CEN

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GA14-03 Resolution

Resolution Title: Emergency Nurses Advocate for Reduction

in Prescription Drug Abuse

2014 General Assembly

Whereas, It is estimated that 2,500 U.S. teens recreationally use a prescription

1 drug every day; and

Whereas, 37,500 Americans died from a prescription-drug overdose in 2009—roughly as many as those in

fatal car accidents; and

Whereas, A multidisciplinary approach toward prescription drug abuse is best practice for heightening

awareness and reducing the mortality and morbidity associated with prescription drug abuse; and

Whereas, Emergency care practitioners have a responsibility to promote education in medication safety and

administration practices to ensure optimal health; and

Whereas Emergency care practitioners have a responsibility to promote education in medication safety and

administration practices to ensure optimal health; and

Whereas, Emergency departments should provide education to patients who present with chronic, acute or

cancer pain on the importance of proper storage and disposal of prescription medications;

therefore, be it

Resolved, That ENA develop resources in the areas of pain management, medication storage and medication

disposal; and

Resolved, That ENA encourage ongoing research on evidence-based pain management strategies that

promote quality of life for patients who present with pain; and

Resolved, That ENA will collaborate with organizations to reduce the incidence of prescription drug

recreational use and overdose events.

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GA14-03 Resolution

Resolution Title: Emergency Nurses Advocate for Reduction

in Prescription Drug Abuse

2014 General Assembly

ENA Board of Directors Comments:

This resolution is well written and addresses an important issue facing EDs across the country. However, the ENA

Board of Directors recognizes that ENA is not the expert in this area. Implementation of this resolution would require

that ENA approach other associations specializing in this area to work collaboratively in meeting the resolve

outcomes. The ENA Board of Directors takes no position on this resolution.

Resolutions Committee Comments:

The authors made revisions recommended by the committee. The committee takes no position on this resolution.

Background:

"Teen deaths related to prescription drug abuse skyrocket," per the Centers for Disease Control and

Prevention(CDC).1 The 2012 report goes on to tell us that the number of children dying from poisoning or ingestion of

prescription drugs with or without alcohol or other substances has risen by 91 percent during the 2000-2009 year

period. Teens often feel prescription meds are "safe" since they are often taken from a home medicine cabinet, or

prescribed by a provider, and often have observed family members taking them without untoward effects. This lulls

them into a false sense of safety. This mindset that opioids, sedatives, tranquilizers and stimulants are safe can be

evidenced in the National Institute on Drug Abuse (NIDA) Monitoring the Future Survey, which reported that over 40

percent of high school seniors have used an illegal drug at some point in the past year, and 15 percent had taken a

prescription drug not for its intended use.2 Teens encompass a subsection of the overall problem. Another 12 million

people make up the aggregate reported by the CDC, Prescription Painkiller Overdoses in the United States, who took

prescription painkillers for nonmedical reasons in 2010.3

In 2014, NIDA reported in "Popping pills: Prescription drug abuse in America t" that America consumes 75 percent of

the world's prescription drugs.4 The Office of National Drug Control Policy (ONDCP), a component of the Executive

Office of the President, and its 2011 Prescription Drug Abuse Prevention Plan calls for action to educate, monitor,

properly dispose, and enforce prescriptive medications.5

Emergency nurses can be instrumental in preventing the unfortunate consequences of this very real threat by joining

the efforts of the Medicine Abuse Project, which are aimed at preventing half a million teens from abusing medicine

by 2017.6 We can bring attention to this problem from the halls of government agencies to the bedside by educating

our patients and their families on this very timely topic, to prevent even one of the 100 deaths a day that occur in the

United States due to drug overdoses each day.7

Relationship to ENA Bylaws, Mission, Vision and Strategic Initiatives:

ENA seeks to improve the future of quality patient care through advocacy, innovative treatment strategies and

collaborative practice to improve outcomes in emergency care. Another ENA objective is to engage in research to

expand the body of evidence to support current practice and promote new education for the emergency nurse (ENA,

n.d.).8

Financial Considerations / Operational Impact:

Financial Impact:

$6,000-$10,000 for one stakeholders meeting depending on size of invited group

Operational Impact:

Timeline: Two-three years until completion. Will require the involvement of the following staff members:

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GA14-03 Resolution

Resolution Title: Emergency Nurses Advocate for Reduction

in Prescription Drug Abuse

2014 General Assembly

•

IENR senior associates, IENR, committee coordinator, IENR senior administrative 73 assistant, government

relations

• In addition to the stakeholder meeting, there would be at least four follow-up conference calls and three

months of work time in between for the senior associate to conduct, analyze and report the appropriate

research.

• Senior associate: 60 work days in addition to the stakeholder meeting = approximately $20,000 in wages for

this individual alone

• Senior associate, IENR (grants): Two weeks for grant filing = $3,200 in wages , grant filing fees and then grant

monitoring for two staff (IENR and Finance) on an ongoing basis. This could be incorporated into current

workload.

• Committee Coordinator and Senior Administrative Assistant would be able to incorporate this into current

workload

References:

1. Pecquet, J. (2012, April 16). Teenage prescription drug deaths skyrocketing, CDC warns. The Hill Newspaper.

Retrieved from http://thehill.com/policy/healthcare/221693-teenage-prescription-drug-deaths-skyrocketing89

cdc-warns

2. National Institute on Drug Abuse. (2014). Monitoring the future. Retrieved from

http://www.drugabuse.gov/related-topics/trends-statistics/monitoring-future

3. Centers for Disease Control and Prevention. (2014). Policy impact: Prescription painkiller overdoses. Retrieved

from http://www.cdc.gov/HomeandRecreationalSafety/rxbrief/

4. National Institute on Drug Abuse. (2014). Popping pills: Prescription drug abuse in America. Retrieved from

http://www.drugabuse.gov/related-topics/trends-statistics/infographics/popping-pills-prescription-drug-abuse96

in-america

5. Office of National Drug Control Policy, Executive Office of the President. (2011). Prescription drug abuse.

Retrieved from http://www.whitehouse.gov/ondcp/prescription-drug-abuse

6. Office of National Drug Control Policy, Office of Public Affairs. (2013). Fact sheet: Preventing, treating, and

100

surviving overdose. Retrieved from

101

http://www.whitehouse.gov/sites/default/files/ondcp/prevention/overdose_fact_sheet.pdf

102

7. Kirschner, N., Ginsburg, J., & Sulmasy, L. S., & Health and Public Policy Committee of the American College of

103

Physicians. (2014). Prescription drug abuse: Executive summary of a policy position paper from the

104

American College of Physicians. Annals of Internal Medicine, 160(3), 198. doi:10.7326/M13-2209

105

8. Emergency Nurses Association. (n.d.). ENA Strategic Plan. Retrieved from

106

http://www.ena.org/about/Documents/ENAStrategicPlan2012-2014.pdf

107

108

Authors:

109

Teri Arruda, DNP, RN, FNP, CEN

110

Vicki Sweet, MSN, RN, CEN, FAEN

111

Kathy Van Dusen, BSN, RN, CEN, CPEN

112

113

Supporters:

114

Orange Coast ENA Chapter, Juliann Wanstreet, BSN, RN, president

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GA14-03 Resolution

Resolution Title: Emergency Nurses Advocate for Reduction

in Prescription Drug Abuse

2014 General Assembly

Phyllis R

115 obby, MSN, RN, CEN, NEA-BC

116

Mary Birkle, BSN, RN, CEN, MICN

117

Mary Olivas, MSN, RN, CEN

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GA14-04 Resolution

Resolution Title: Patient Education for Mild Traumatic Brain

Injury/Concussion

2014 General Assembly

Whereas, It is estimated that 1.7 million traumatic brain injuries (TBIs) occur each

1 year in the United States.

Of the 1.7 million, 80.7 percent are treated in the emergency room, 16.3 percent require

hospitalization and 3 percent result in death; and

Whereas, Patients diagnosed with mild TBIs (mTBIs)/concussion can suffer long-term effects of the injury

such as depression, anxiety and pain up to three months or more after the initial injury; and

Whereas, It is estimated that more than 473,000 children per year sustain TBI and approximately 75 percent

of those are described as mTBI/concussion; and

Whereas, Many of America's soldiers return from active duty with the devastating, long-term effects of mTBI.

Some estimates report that as much as 18 percent of soldiers deployed in Iraq and Afghanistan

suffer from symptoms such as memory loss, irritability, headaches and difficulty concentrating; and

Whereas, Evidence demonstrates that "early administration of injury-specific information and provision of

post-injury coping strategies in adults and children have been shown to improve post-mTBI

functioning"; and

Whereas, Reviewing discharge instructions detailing the symptoms and course of post-concussive syndrome

(PCS) has been shown to decrease the incidence and severity of symptoms; therefore, be it

Resolved, That ENA update the position statement on Unintentional Sport and Recreational Injuries to

recommend that emergency departments provide patient education on PCS, cognitive rest and

return to play guidelines; and

Resolved, That ENA direct the appropriate committee or work team to explore or develop an educational

resource such as a topic brief and/or a one-hour free educational CEU on mTBIs.

Page 46 Back to Top

GA14-04 Resolution

Resolution Title: Patient Education for Mild Traumatic Brain

Injury/Concussion

2014 General Assembly

ENA Board of Directors Comments:

The first resolve is feasible and may or may not lead to further recommendations by subject matter experts and

collaboration among committees, as requested by the authors in the second resolve. The list of references

researched by the authors demonstrates that valuable educational tools already exist from a variety of resources

such as the CDC. The development of an additional educational resource may not be indicated and would actually

pose a moderate financial impact on the association. The ENA Board of Directors takes no position on this resolution.

ENA Resolutions Committee Comments:

The authors made revisions recommended by the committee. The committee takes no position on this resolution.

Background Information:

"The most underreported, under diagnosed and underestimated head injury by far is concussion, or mild TBI (mTBI).

Concussion accounts for 90 percent of TBIs and the number of cases range in the millions every year. Almost 4

million athletes of all ages suffer concussions each year as well. Even a mild concussion is a TBI and 20 percent of

patients diagnosed with one do not recover."3 Some patients diagnosed with mTBI can suffer long-term effects of the

injury such as depression, anxiety and pain up to three months or more after the initial injury. "Deficits of executive

functioning, attention, memory, communication and visual processing are the most frequently reported neurocognitive

sequelae in adults with TBI."4

One of the most important aspects of the care of mTBI patients is patient education. Evidence demonstrates that

"early administration of injury-specific information and provision of post-injury coping strategies in adults and children

have been shown to improve post-mTBI functioning." Simply reviewing discharge instructions detailing the symptoms

and course of post-concussive syndrome (PCS) has been shown to decrease the incidence and severity of

symptoms."2 A recent adjunct to the care of the mTBI patient is cognitive rest. Cognitive rest is defined as avoiding

anything that taxes the brain. Patients, family members and parents should be educated on the avoidance of loud

noise and activities such as watching TV, listening to music, playing video games, using cell phones and texting,

homework or any activity that requires a lot of thinking or concentration during the recovery period.

With emerging recommendations from the Centers for Disease Control and Prevention (CDC), American College of

Emergency Physicians and the American Academy of Pediatrics, ENA should participate in efforts to advocate for

patient care and education on mTBI. The ENA position statement, "Unintentional Sport and Recreational Injuries,"

should be updated to include patient education on PCS, cognitive rest and return to play guidelines.

Relationship to ENA Bylaws, Mission, Vision and Strategic Initiatives:

ENA seeks to improve the future of quality patient care through advocacy and innovation, and collaborate actively

with other health-related organizations to improve emergency care. The ENA Strategic Plan: 2012-2014 and Beyond

includes the following: "Be a champion for a culture of inquiry, learning and collaboration within our profession,

proactively identify and address key clinical issues affecting emergency healthcare, and generate, translate,

integrate, and disseminate research and evidence-based practice."5

Financial Considerations / Operational Impact:

Re: the second resolved: additional note from ENA's nurse staff: educational programming already exists through the

CDC: http://www.cdc.gov/concussion/headsup/clinicians_guide.html)

Financial Impact:

$6,000 for the Committee Meeting

Page 47 Back to Top

GA14-04 Resolution

Resolution Title: Patient Education for Mild Traumatic Brain

Injury/Concussion

2014 General Assembly

Operational Impact:

This work will require one committee meeting and four follow-up conference calls.

Staff team: IQSIP senior associate, IQSIP committee coordinator and IQSIP senior administrative assistant

16-24 hours of work between calls and meetings to facilitate the development of the topic brief.

Work can be accomplished with current staffing and would have minimal wage impact.

References:

1. Centers for Disease Control and Prevention. (2013). Traumatic brain injury in the United States: Emergency

Department Visits, Hospitalizations and Deaths 2002-2006. Retrieved from

http://www.cdc.gov/traumaticbraininjury/tbi_ed.html

2. Babcock, L., Byczkowski, T., Wade, S. L., Ho, M., Mookerjee, S., & Bazarian, J. J. (2013). Predicting

postconcussion syndrome after mild traumatic brain injury in children and adolescents who present to the

emergency department. JAMA Pediatrics, 167(2), 156-161.

3. Brain Trauma Foundation. (n.d.). Concussion information. Retrieved from https://www.braintrauma.org

4. Cognitive rehabilitation therapy for traumatic brain injury: What we know and don't know about its efficacy.

(2011). Retrieved from https://www.ecri.org/documents/Technology-

Assessment/Cognitive_Rehabilitation_Therapy_ECRI_Institute_012111.pdf

5. Emergency Nurses Association. (n.d.). ENA strategic plan: 2012−2014 and beyond. Retrieved from

http://www.ena.org/about/Documents/ENAStrategicPlan2012-2014.pdf

Additional Resources:

Centers for Disease Control and Prevention. (2010). Heads up to clinicians: Updated mild traumatic brain injury

guideline for adults. Retrieved from www.cdc.gov/concussion/HeadsUp/clinicians_guide.html

100

Authors:

101

Kathy Van Dusen BSN, RN, CEN, CPEN

102

Vicki Sweet MSN, RN, CEN, FAEN

103

Terri Arruda DNP, FNP-BC, CEN

104

105

Supporters:

106

California ENA State Council, Carole Snyder, MS, RN, president

107

Orange Coast ENA Chapter, Juliann Wanstreet, BSN, RN, president

108

Phyllis Robby, MSN, RN, CEN, NEA-BC

109

Mary Birkle, BSN, RN, CEN, MICN

110

Mary Olivas, MSN, RN, CEN

Page 48 Back to Top

GA14-05 Resolution

Resolution Title: Use of Orientation Guidelines

2014 General Assembly

Whereas, Current nursing shortages are projected by Baxter to increase to a shortage of

1 1 million registered

nurses by 2020, while needs for nursing specialties are growing and will continue to grow due to

the aging population. Emergency departments may be unable to fill current and future openings

with an experienced workforce, as new graduates and new-to-the-specialty registered nurses

require a specialized orientation process; and

Whereas, Emergency department orientation content has been comprehensively addressed in an ENA

position paper, but the process to deliver the content has not been addressed. Orientation should

be completed within an accepted set of guidelines including standardized goals and specific

objectives with assigned learning, which can be delivered in print or electronically, designed to

achieve the specified goals. The objectives and goals should be accompanied by outcome12

evaluation criteria for Level 1 beginner through Level independent. Criteria should be demonstrated

visually on a spreadsheet or other method to track progression to Level 4 behaviors, for the

orientee and preceptor to evaluate progress; and

Whereas, The use of designated orientation guidelines that provide support and guidance for orientees and

preceptors will increase satisfaction and success with the orientation process, and will decrease

the turnover rate with nurses who are new graduates or new to the specialty; therefore, be it

Resolved, That ENA identify best practices regarding orientation timelines and content delivery, and track the

progress of an emergency department nurse orientee through the orientation process.

Page 49 Back to Top

GA14-05 Resolution

Resolution Title: Use of Orientation Guidelines

2014 General Assembly

ENA Board of Directors Comments:

The concept of having standardized goals, specific objectives and defined outcome evaluation criteria as part of

orientation is an excellent idea on the surface, but will require the scrutiny of many variables including: capabilities of

multiple hospital sites, various hospitals' patient populations, the new nurse's experience with patient care other than

that in the ED, learning styles of the new nurse, teaching styles of preceptors, the size of a hospital/ED and budget

related to staff for precepting. It is unclear if the resolution is simply asking for the data to be gathered, or if a product

that describes the best practice related to orientation timeline, content delivery and tracking be developed. For ENA

to take on and accomplish this task, it would require significant resources and diversion of assets (funds and people).

It will also be important to ensure that the position statement mentioned in this resolution adequately address all

aspects of emergency nursing. It would take additional resources to ensure that the entire content of emergency

nursing is encompassed in the position statement if said position statement is the basis for the orientation list. The

ENA Board of Directors takes no position on this resolution.

Resolutions Committee Comments:

The author made revisions recommended by the committee. The committee takes no position on this resolution.

Background Information:

Nurses who are new graduates or new to the specialty are commonly being placed in the emergency department,

which is highly specialized and acute. Placing ill-prepared nurses in fast-paced, critical care areas can lead to a

higher turnover rate.1

A 12 to 16-week structured orientation program with trained and well-defined guidelines has been demonstrated to

be effective in decreasing the turnover rate with new graduate and specialty nurses. The use of guidelines developed

within a designated framework ensures consistency in expectations and evaluation measures.1

The turnover rate for these new nurses may be as high as 13 percent2 with an estimated cost of $22,000 to more

than $64,000 for each orientation. Preceptors who have received specialized training foster a cohesive practice for

the orientation process.3

Evaluation rating scales assist the preceptor and orientee to focus attention, identify strengths and weaknesses, and

provide a method for documenting the process. A formative evaluation is a step beyond the skills checklist, allowing

an evaluator to rate a process rather than a single task or action. An outcomes-based rating scale allows a preceptor

to easily answer the question, "Is my orientee where they need to be during the orientation process?"

Relationship to ENA Bylaws, Mission, Vision and Strategic Initiatives:

The emergency nurse requires a complex skill set, clearly defined in the 2011 position statement "Emergency

Registered Nurse Orientation"; this resolution supports this position statement.

Financial Considerations / Operational Impact:

Staff Impact:

This project would require approximately five years to accomplish at a minimum. Departments impacted would

include IENR and IENE. A time estimate includes allowing three years for one dedicated IENR senior associate to

conduct, analyze and report a multi-site, multi-year study.

Upon the conclusion of the study, it would take IENE approximately one year to develop a comprehensive nurse

residency program.

Page 50 Back to Top

GA14-05 Resolution

Resolution Title: Use of Orientation Guidelines

2014 General Assembly

Initiating this project would necessitate hiring an additional IENR senior associate, IRB

70 approval, and work team

collaboration with an approximate impact of $150,000 to staffing and operational budgets in the first year and then

subsequent years.

References:

1. Baxter, P. E. (2010). Providing orientation programs to new graduate nurses. Journal for Nurses in Staff

Development, 26(4), E12-E17. doi:10.1097/NND.0b013e3181d80319

2. Theisen, J. L.., & Sandau, K. E. (2013). Competency of new graduate nurses: A review of their weaknesses and

strategies for success. Journal of Continuing Education in Nursing, 44(9), 406-414. doi:10.3928100220124-

20130617-38

3. Sorrentino, P. (2013). Preceptor: Blueprint for successful orientation outcomes. Journal of Emergency Nursing,

39(5), e83-e90. doi:10.1016?j.jen.2012.05.029

Additional Resources:

Durkin, G. J. (2010). Development and implementation of an independent rating scale and evaluation process for

nursing orientation of new graduates. Journal for Nurses in Staff Development, 26(2), 64-72.

Authors:

Mary Ellen Zaleski, MSN, RN, CEN

Supporters:

Maryland ENA State Council, Caroline Doyle, BSN, RN, CEN, president

Page 51 Back to Top

GA14-06 Resolution

Resolution Title: Support of Creating a National

Trauma System

2014 General Assembly

Whereas, The Centers for Disease Control and Prevention has stated that injuries

1 are the leading cause of

death and disability between the ages of 1 and 44 in the United States; and

Whereas, Emergency nurses are usually the first healthcare professionals to have contact with patients in the

emergency department; and

Whereas, Trauma care requires timely response and adequate hospital resources, including both personnel

and equipment, for a continuum of care from pre-hospital through rehabilitation; and

Whereas, A trauma system will aid in ensuring a coordinated response for victims of injury and result in more

timely responses; and

Whereas, A functioning trauma system will provide consistency in care for trauma patients; and

Whereas, Trauma patients have better outcomes when taken to trauma centers; and

Whereas, Rural trauma patients have statistically, by far, the worst outcomes, having many more challenges

to timely access to care due to difficulties presented by distance, communications and availability

of resources; therefore, be it

Resolved, That ENA support the development of a national trauma system across the continuum of integrated

care, including injury prevention; and

Resolved, That ENA express such support through a new, updated or revised position statement and be

actively engaged in supporting this endeavor.

Page 52 Back to Top

GA14-06 Resolution

Resolution Title: Support of Creating a National

Trauma System

2014 General Assembly

ENA Board of Directors Comments:

Trauma is a disease that can occur anywhere at any time. Critical trauma victims must reach definitive care in a

timely manner to help prevent death or disability. To ensure this occurs, appropriate resources must be in place and

immediately accessible at all times. These resources include informed citizens, communications systems, pre31

hospital care providers and multidisciplinary ED trauma teams. This coordination of resources is called a trauma

system. Only about 50 percent of the United States is served by an organized trauma system. In rural, remote and

wilderness areas, existing hospitals and other medical care facilities must serve as a safety net for initial stabilization

of the critically injured prior to transfer to definitive care. An inclusive trauma system with an emphasis on optimal

resource utilization and prevention offers the best chance for success. Evidence demonstrates that coordination of

emergency medical resources available in an area results in better patient outcomes. In light of the overwhelming

evidence supporting decreases in morbidity and mortality where trauma systems exist, the ENA Board of Directors

supports this resolution.

Resolutions Committee Comments:

The author made most revisions recommended by the committee. One outstanding recommendation was to include

a reference and citation of the American College of Surgeons. The committee takes no position on this resolution.

Background Information:

ENA has previously approved a position statement titled "Access to Quality Health Care," which references trauma

care systems.

There already exist several organizations, with networks of information and resources available, that could be invited

to collaborate and network with ENA to join in this endeavor of creating a national trauma system. For example,

Indiana started one of the most resonant and robust philanthropic entities in the world through the Indiana

Philanthropy Alliance and Indiana Community Foundations1 via grassroots as well as top-down networking and

development.

Sigma Theta Tau International Honor Society of Nursing" formed by five nurses in Indianapolis, is another

organization that could be invited to collaborate. STTI has become the global honor society in nursing – diverse, yet

functional, speaking many languages, devoted to networking for research and collaboration among nurses

worldwide.

A third organization that could be invited to collaborate is the Indiana Rural Health Association. Indiana has the

largest Rural Health Association in the United States, with a mission to enhance the health and well-being of rural

populations in Indiana through leadership, education, advocacy, and collaboration.2

Relationship to ENA Bylaws, Mission, Vision and Strategic Initiatives:

The purpose of this resolution is to bring to the forefront and focus attention on the need to create a global trauma

system. A previous ENA position statement titled "Access to Quality Health Care" which was first approved by the

ENA Board of Directors in 1988 and underwent a last revision and approval in December 2010, references trauma

care systems. A relevant quote from the position statement's Section 3 reads: "Regionalized, coordinated, and

accountable emergency and trauma care systems must be developed throughout the nation."3

Financial Considerations / Operational Impact:

Financial Impact:

None

Page 53 Back to Top

GA14-06 Resolution

Resolution Title: Support of Creating a National

Trauma System

2014 General Assembly

Operational Impact:

Two weeks would be needed for the director of marketing to work with the Position Statement Review Committe

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