Staff Nurses Melaney Gordon, Farley Obusan and Educator Meg

Image of Nursing: The Evolution of Emergency Nursing
Margaret Barry, RN, MSN, Farley Obusan, RN, BSN, Melaney Gordon, RN
National Nurses Week, May 6-12, 2010
Introduction
Emergency Nursing is a specialty and involves the integration of
professionalism, practice, education and research.
Developments within the nursing profession resulted in the roles
and responsibilities of Emergency Nursing being regarded as a
specialized branch of nursing based on extensive and specific
sets of skills and knowledge.
NYPH Emergency, The Wave of Change
New York Presbyterian Hospital (NYPH) Emergency Department has been transformed over the years to meet the growing
community demand and enhance the quality and efficiency of care for patients and their families. Today, the Emergency
Department sees over 78,000 patients visits annually.
Now
Then
1993 ENA issued a resolution in support of family presence
during cardiopulmonary resuscitation based on research studies
supporting family presence at the bedside. New York
Presbyterian Hospital (NYPH) Emergency Department is looking
to move to an evidence based practice model.
Triage is the foundation of Emergency Nursing and an integral
process in the Emergency Department. The Emergency Severity
Index (ESI) triage tool is research based and establishes
interrater and intrarater related reliability recommended by the
ENA. NYPH Emergency Department Nurses have adapted the
ESI scale in the triage process for safe practice.
In the past, patients with symptoms of Cerebrovascular Accident
(CVA), were treated in the Emergency Department with
supportive nursing care. Research studies now support early
intervention and treatment modalities for people with CVA to
prevent death or permanent disability. Emergency Department
Nurses play a vital role as frontline staff in the quick detection of
patients who present with CVA. NewYork-Presbyterian Hospital
is a designated Stroke Center by the New York State
Department of Health.
Evidence-based research data supported the implementation of
Therapeutic Hypothermia after cardiac arrest in the Emergency
Department. Hypothermia reduces the risk of ischemic injury to
tissue following a period of insufficient blood flow.
Evidence based research integrated in clinical practice ensures
competency in Emergency Nursing and the highest standards of
excellence in patient care.
60
# 45
of
RNs 30
15
Vanderbilt Clinic and
Emergency Room
entrance.
The building was
converted to Energy
Court entrance on
Broadway.
Patients in New York
Presbyterian Hospital
Emergency Waiting Room.
New York Presbyterian
Hospital ambulance as
they look today.
0
2000
New York Presbyterian
Hospital ambulance in the
past.
Historical Milestones
Translating Research into Practice
Evidence based research has led to integration of new
methodologies that guide clinical practice and safe patient care.
The application of best evidence in practice:
Now
Then
Objectives
Describe Evidence-based Practice that has transformed
Emergency Nursing care
Certification in Emergency and Trauma care is a distinction that
is earned by examination to show possession of a body of
knowledge that commensurates with competent practice.
Then
Building upon the historical context, research-based evidence
for Emergency Nursing has allowed for improvements in the
structure, processes and outcome of emergency care.
Describe the history of Emergency Nursing
NYPH Emergency Department Nurses
With Certifications
In 1970, acknowledging the need
for an organization that
represented the interests of those
nurses working in the Emergency
Department, Anita Dorr and Judith
Kelleher formed the Emergency
Department Nurses Association
(EDNA).
1979
1970
1967
1975
The official peer-reviewed Journal of
Emergency Nursing was first
established. It is, in fact, the only
journal dedicated to the specialty of
Emergency Nursing research.
1985
EDNA changed its name to the
Emergency Nurses Association (ENA).
Based on the consensus of currently
available evidence, the ENA issued a
position statement in support of the
adoption of a reliable, valid 5-level triage
scale. The triage algorithm provides
clinically relevant stratification of patients
into five groups on the basis of acuity and
resource needs.
2004
The specialized body of knowledge and skills inherent in
Emergency Nursing practice provides a unique opportunity for
the Emergency Nurse to serve as a focal point at the
intersections of primary, secondary and tertiary care on the
disease-wellness continuum.
While Emergency Nursing has grown over the centuries, the last
35 years have seen the most profound changes. Florence
Nightingale’s role in the Crimea War certainly puts her into the
category of an Emergency Nurse and laid the foundation for the
development of modern nursing as we know it today.
Emergency Nursing practice has the promise of a robust future
whose image will remain integral, revolving and expanding.
The first Certification for Emergency
Nurses (CEN) offered to 1400 nurses,
the Emergency Nursing Certification
Committee has become the Board of
Certification for Emergency Nursing.
EDNA developed Standards of Emergency Nursing
Practice, published in 1983, to be used as a
guideline for excellence and outcome criteria against
which performance is measured and evaluated.
The ENA developed the Trauma Nursing
Core Course for national and international
dissemination as a means of identifying a
standardized body of trauma nursing
knowledge.
Certified Emergency Nurses
Trauma Certification
1980
1983
1986
Year
Conclusion
In 1967, ENA Co-Founder
Anita Dorr, RN, invented the
first Crash Cart originally
called Crisis Cart.
In August 1979, a group of six nurses
met in New York, convened by the EDNA
as the Certification Committee to
formulate the certification examination
that would measure the attainment and
application of a defined Emergency
Nursing knowledge.
2010
1993
The Emergency Nurse Pediatric Course
(ENPC) is offered with the belief that
knowledge and preparation are the core of
any discipline, ENPC was developed to
educate nurses on caring for acutely ill and
injured children.
The ENA celebrates 40 years of
transforming Emergency Nursing practice
with over 38,000 members. Emergency
Nursing today is continuously transforming
its practice.
2010
References
1. Bayley, E., Maclean, S., & Desy, P. ENA’s Delphi Study on
National Research Priorities for Emergency Nurses in the United
States.
2. Sheehy, S.B. Timeline of The Last Century of an Incredible
Millennium.
3. Koran, Z. (2008). Therapeutic hypothermia in the
postresuscitation patient: The development and implementation
of an evidence-based protocol for the emergency department.
Advanced Emergency Nursing Journal, 30, 319-330.
4. Fondiller S. H., Nerone B. J.. Preparing for nursing's future. Am J
Nurs. 1996; 96:16F–16H.
5. Stephens N.. One emergency department's response to the
increasingly complex challenges of patient care at century's
change. J Emerg Nurs. 2000; 26: 318–28
6. Fadale J. M.. As we celebrate: reflections on Anita Dorr and early
ENA days. J Emerg Nurs. 2000; 26: 31–4
7. Jezierski M.. Profiles: Judy Kelleher: ENA co-founder looks
behind and ahead. J Emerg Nurs. 1997; 23: 85–7