Advanced Emergency Nursing Blog from AENJ

The concepts, concerns, clinical practices, researches, and future of Advanced Emergency Nursing.

Sunday, October 8, 2017

Emergency Nursing Week 2017



Throughout human existence, a need for 'emergency nursing' has always existed. Whether provided by fellow warriors or caregivers in the family grouping, care for wounds and illness was an ad hoc thing. With increasing size and complexity of society and the injuries appertaining thereto, the advancement of medical arts and organization to increase the potential of recovery, emergency nursing no longer can be done by anybody's mom or an army's camp-follower. Nor can any generally trained nurse deal with the spectrum of emergency care without specialized education and training. 

There are other specialties in nursing, which indicate preparation for a limited spectrum of care or discipline, and its own emergencies. However, what is unique in Emergency Nurses, is the ability to confront, decisively and actively, any emergency, regardless of medical specialty; to do so instantly, and without initial direction. They are focused in time and criticality of all fields. No other specialty 'takes on all comers' with undifferentiated problems in this way. 

Just as nurses in the emergency department were at times the only long-service employees and provided guidance to inexperienced physician-trainees, the specialty has now evolved to include advanced practice roles as Licensed Independent Practitioners able to render diagnosis and treatment through the entire episode of care. 

I can recall when a major metropolitan hospital had an unattended "First Aid Room" to which one's personal physician or a resident might be called should one come to the hospital with a problem. Or another, at which the ambulance crew would have to call the hospital's telephone operator to send someone to unlock the door at night. Or municipal "Emergency Hospitals" (free treatment rooms with a doctor and nurse, attached to an ambulance station) that also locked the doors at night. 

Clearly, the numbers of patients, varieties of problems, severity of injury or illness, and expectation of immediate expert care regardless of availability of a personal physician have increased like an avalanche since the years following World War II. Indeed, wars have set the example for emergency medical services and specialized care that are now adapted to civilian life and the needs just mentioned. 

The Emergency Nurses Association has, with the 'can do' spirit of its founders and members, developed and supported the mission and growth of emergency nursing. I am proud of what we do, and what ENA does and who it represents. 

Emergency Nursing Week and Emergency Nursing Day honor and celebrate these nurses, their work, their transformation and development of the specialty, "for being resourceful and masterful in their work." 



Trimble, Tom, RN. (1997) The Emergency Nursing FAQ and Emergency Nursing World ! FAQ. Emergency Nursing World ! [] © 1997 Tom Trimble, RN. 

Schriver, J. A., Talmadge, R., Chuong, R. and Hedges, J. R. (July 2003), Emergency Nursing: Historical, Current, and Future Roles. Academic Emergency Medicine, 10: 798–804. doi:10.1197/aemj.10.7.798 [PDF] 

Schriver, J. A., Talmadge, R., Chuong, R., & Hedges, J. R. (October 2003). Emergency nursing: historical, current, and future roles. Journal of Emergency Nursing, 29(5), 431-439. [PDF] 

Fadale, J. M. (2000). As we celebrate: reflections on Anita Dorr and early ENA days. Journal of Emergency Nursing, 26(1), 31-34. [PDF] 

Jezierski, M. (1996). Anita Dorr: her legacy to ENA. Journal of Emergency Nursing, 22(3), 258-260. [PDF] 

Kelleher, J. (2000). A conversation with ENA co-founder, Judy Kelleher, RN, MSN, CEN. Interview by Iris C Frank. Journal of emergency nursing: JEN: official publication of the Emergency Department Nurses Association, 26(1), 35. [PDF] 

Emergency Nurses Association. (No Author) (2017) Emergency Nurses Week.


                      Tom Trimble, RN
                      All opinions are solely those of the author.
                      Readers must verify validity to their own practice.


Friday, September 8, 2017

The Nexus of Violence, Law Enforcement, and Nursing


            Just recently, Nurses ─who are often at risk for violence, (but whose perpetrators often "get away with it", have apparently endured frightening violence apparently through the neglect or arrogance of Law Enforcement Officers themselves. Of course, it will be said that these are exceptional cases and hardly representative. Yet, it must be noted that Nurses are compelled to be in the middle.

            Both occupations, it must be said, are creatures of law whose licensed/appointed employment is created, regulated, and disciplined by operation of law; and those with high professional tenets swear an oath to perform at awesome ethical levels. Those who fail at this may be censured, discharged, and never trusted again, --as these are occupations of public trust.

            Information released recently about earlier events have achieved prominence. In the Illinois case, jail guards responsible for their inmate in a hospital were seemingly inattentive and derelict in their duties, resulting in the prisoner getting loose, stealing the deputy's gun, taking hostages, beatting and raping one nurse until the ordeal was ended by SWAT shooting him and wounding the nurse.

            In the latter case, at University of Utah Hospital, Nurse Alex Wubbels has gained fame, and Salt Lake City Police have gained notoriety for her calm and careful refusal to permit a blood test of an unconscious patient as legal and administrative agreements had not been met. There was no warrant, the patient was not under arrest, and he was unable to give consent. In what appeared to be arrogant frustration, the detective abruptly placed Ms Wubbels under arrest, handcuffing her, forcibly removed her from the hospital to the police car, despite her complaints of innocence, pain, and of the wrongdoing by the officers.

            The City Mayor and Chief of Police hastened to make an apology, but the public rightly feel that the police conduct was outrageous. Unfortunately, most public media used a brief video clip that focuses on the scuffle's excited phase, rather than the preceding portion showing a calm and reasoned refusal noting the agreement between police and the hospital. Seeing that, the abuse of authority is, in my opinion, so egregious that the city should just write the check: "How much do you want?" The conduct was wrong-headed and inappropriate (IMO). The may have been metabolizing, but he was certainly not going anywhere. Time Out: a phone call; calling higher-ups; would have been so much more reasonable …

            These events should not have occurred. The nurses came to work, that day, to nurse: which they did; but showed that heroism rises within, even when confronted with evil and abusive behaviors befalling them.

            Generally, there are cooperative and understanding relationships between law enforcement and nursing. We face similar problems, and treat the same patients. The agencies involved in these episodes owe a great deal of internal work as well as apologies.


                                     Tom Trimble, RN
                                     All opinions are solely those of the author.
                                     Readers must verify validity to their own practice.


Susan Sarkauskas. "Attorney: Delnor nurse was tortured, raped during hostage situation." Updated: 5/25/2017 4:52 PM.

Marcia Frellick. "Nurse Arrested After Protecting Patient From Blood Draw."  Medscaoe. September 01, 2017.

Utah Nurse Arrested After Refusing to Allow Cop Take Blood From Unconscious Patient. YouTube. "Storyful News." 09/01/2017.

Mayor, Police /chief RESPOND TO COP ARRESTING NURSE! YouTube. September 2, 2017.

Utah nurse arrested Alex Wubbels responds to apology from Chief of Police, Salt Lake- Jeff Payne. YouTube. September 1, 2017.


Thursday, July 27, 2017

Finding Positive Aspects in Negative Experiences​

Everyone In healthcare has a fund of "war stories" or past cases; one's own or those of others, that are useful with a selected audience of coworkers or trusted friends for discussion or to point a precept. Informally, this can be a useful way of sharing lore or vicarious learning. Generally, these tend to show a favorable light or heroic cast to the tale. There are a few which meet an acceptable level of 'bizarre' that can add spice. 

Some stories we may not enjoy telling and don't share, or may be uncomfortable to recall. These may be where all possible efforts were insufficient to overcome the adversity; those which we find personally affecting; those where there was some inaccuracy of diagnosis or treatment; those which may not reflect credibly upon the care or participants. Such cases do not necessarily require personal involvement to be memorable. 

"Lessons Learned," as the military call it, can come from negative experiences as from positive experiences. Indeed, were it not so, there would be little use for 'Morbidity & Mortality' conferences. To encourage this, these conferences are confidential and usually protected from the legal "discovery" process. 

"How not to do it" is as vital an informative process as is the celebration of successes. "I'd like to know more about that"; "I don't want to be surprised by that"; or "There must be a better way of treating that" are, in my opinion, useful provocations of study that can lead to an expertise. 

We owe it to ourselves, our patients, our coworkers, and to science at large, to learn from each experience, to test and evaluate possible solutions, so that the highest quality care can evolve.  


Tom Trimble, RN
All opinions are solely those of the author.
Readers must verify validity to their own practice.​


AHRQ; Agency for Healthcare Research and Quality. Patient Safety Network. U.S. Department of Health and Human Services. [No author] "Culture of Safety". Patient Safety Primer. Last Updated: June 2017. PSNet is produced for the Agency for Healthcare Research and Quality by a team of editors at the University of California, San Francisco with guidance from a prominent Technical Expert/Advisory Panel. 

AHRQ; Agency for Healthcare Research and Quality. Patient Safety Network. U.S. Department of Health and Human Services. WebM&M Cases & Commentaries[Ongoing series; each article has own authorship, date.] PSNet is produced for the Agency for Healthcare Research and Quality by a team of editors at the University of California, San Francisco with guidance from a prominent Technical Expert/Advisory Panel.

Saturday, June 24, 2017

What are you doing for the rest of your Life?


            This is the time of year that is usually inter-term or long vacation for educational institutions. You could be out enjoying the weather and friends, working extra for that special holiday, or making the most of family time.

            ─It's a good time to take stock of your 'Life Plans.' If you decide to make changes, it's a great time to investigate data, brochures, institutions, obtain financing, get transcripts and make applications, … Oh, no, I don't want to go back to school just yet! I've had so much of it!

            What do you want your future to be? Do you want improved opportunities? Control over what you do: Respect from your colleagues? Freedom to schedule work life as you wish? Do you want to make more money? Even, some fame? Do you wish your opinion to be sought at high, even highest, levels?

            Look at those people who are doing some of what you want to do. Unless they're independently wealthy (and probably not a nurse), I'll bet that they have higher degrees and more certifications or additional studies, than you do. So, this might just be the time to decide what you want to do, and how to get there. While these achievements won't guarantee your wildest dreams, they make it a lot easier to show that you have the knowledge and abilities to show you'll be able to do the work at the level you want.

            If not now, when? Though there may be some "adventures" in meshing your new plans with the realities of your life, when will it ever be better? Will you be as young and resilient? Will you have as much energy to match your motivation? Will you be better able to flex your work and earnings as needed? With delay comes only more difficulty with less flexibility.

            If you aspire to succeed in academia, writing and publishing, higher levels of advanced practice, administration, or leading an enterprise, you may need to increase and diversify the letters after your name. Good Luck! May your dreams become plans that succeed!


                                     Tom Trimble, RN
                                      All opinions are solely those of the author.
                                      Readers must verify validity to their own practice.




Wednesday, May 31, 2017

It's EMERGENCY Nurse to you!


     In hospitals, the work role or function of nurses and other staff is usually (and traditionally) defined by place, e.g.: O.R.; Post-Anesthesia Care Unit; Delivery Room; Medical-Surgical Ward Nurse. Seldom is the work of such specialties ever performed outside of that place. Job ads will ask for 'O.R. Nurses'; L&D Nurses, Pediatric Nurses.

     When those ads ask for 'E.R. or E.D. Nurses', I gnash my teeth. To me, in whatever aspect of our specialty I work, I am an Emergency Nurse. I am not a generalist worker temporarily assigned to a place to perform some duties.

Our specialty requires enhanced education, training. a mindset capable of excellence in both team and independent thought and action, most often (at least initially) in a medical model rather than in Nursing Diagnosis structure. Our specialty incorporates the most dreaded moments and aspects of every medical and surgical discipline, focused in time and criticality in patients arriving suddenly and without a diagnosis.

     My workplace is where the patient is in his time of need and the condition in which he is found. It might be in a resuscitation room, the waiting room or rest room, the hospital lobby, or even the parking structure, perhaps even on the way home.

     If I chose not to work primarily in an E.D., work is available in flight nursing, either helicopter EMS or long-distance repatriation flights; remote worksites, critical-care transports. Those who are also trained in forensic work can work with sexual-assault cases, law enforcement, or death scene investigation and survivor counselling. I've known one nurse with advanced degrees who was preparing for a goal of nursing in a space colony; therefore, even the sky is not the limit.

     In short, Emergency is a mission not a place.

     Few remember that the Founders of ENA, Judy Kelleher and Anita Dorr, combining their fledgling separate West Coast and East Coast groups in 1968 called it the Emergency Department Nurses Association. However,

"In 1985, the Association name was changed to Emergency Nurses Association (ENA), recognizing the practice of emergency nursing as role-specific rather than site-specific."

(Bold added) About ENA.


                                                  Tom Trimble, RN; Emergency Nurse
                                                  All opinions are solely those of the author.
                                                  Readers must verify validity to their own practice.