Nurses receive some disaster training, but as one New York nurse recently remarked, “We learned about a pandemic in school maybe for one day. Like it was literally one slide in one class…” Remedying this problem is a key concern in the Johns Hopkins report, “Recommendations for Improving National Nurse Preparedness for Pandemic Response: Early Lessons from COVID-19” and educators are already taking steps to add pandemic coverage to disaster nursing curricula. DailyNurse spoke to one of these educators, a member of the reporting team, Dr. Tener Goodwin Veenema, PhD, MPH, MS, CPNP, FAAN, about her role in the effort to update disaster training and education for the COVID-19 era. Dr. Veenema is a contributing scholar to the Johns Hopkins Center for Health Security, Professor of Nursing and Public Health, and author of the textbook Disaster Nursing and Emergency Preparedness.
DailyNurse: You must be very busy.
TGV: It’s been insane. I can’t even begin to describe what it’s been like since the first of March—a lot of 12-hour days. Today, I’m actually getting ready for a webinar with the American Association of Colleges of Nursing (AACN), Improving Nurse Preparedness for Emergency Response: Implications for US Schools of Nursing. The webinar is all about the report findings as well as an overview of some of the recommendations we make in the report.
DN: What sort of changes are you proposing in terms of disaster education and training?
TGV: I’ve been writing disaster nursing courses since before 9/11. And of course the focus after 9/11 was much more on deliberate acts of terrorism, and there was concern over natural disasters as always—pretty much the way the book [Emergency Nursing and Disaster Preparedness] was laid out—chemical, biological, and radiation events that may be human-caused. But now, because of the pandemic, the shift has really become much more public health focused.
Clinical nurses actually have to be public health nurses as well.
[At present], nurses get infection prevention and control coverage in school, but it’s at an introductory level. It’s not to the degree of what we’re experiencing now, where clinical nurses actually have to be public health nurses as well. So, we need to give nurses a better understanding of advanced concepts in infection control and prevention, and how to implement what we call intervention and containment strategies—non-pharmaceutical interventions, which includes things like social distancing, the use of masks, and frequent handwashing; closure of schools and businesses, and parks where people congregate.
More than anything else, the pandemic reveals where nurses did not have experience with the proper selection and use of personal protective equipment. It goes beyond nursing. Some of these problems were outside of nursing, for instance, the hospitals had failed to make a real commitment to emergency preparedness—to procure adequate supplies of PPE, or ensure that they had a vendor supply chain that would allow them to ramp up if they needed to order more. So, what I am advocating—and I’m working on a course right now—is to address these issues and strengthen prelicensure and nursing schools, and also continuing education to ensure that nurses have the knowledge and skills that they need not only to participate and survive, and protect themselves in this pandemic, but in future infectious disease outbreaks as well.
DN: As you mentioned earlier, there are many different sorts of disasters. Is there some sort of tool-kit that can increase nurses’ readiness in whatever emergencies might arise?
TGV: I define a prepared nursing workforce as a workforce that has the knowledge, the skills, the abilities, and the willingness to respond to these types of events. FEMA advocates what is called an “all-hazards” approach to disaster planning, which means that communities are charged with coming up with disaster response plans to address each and every hazard that might occur in their geographical area. Now for nurses, I think that they need to have a minimum knowledge base and set of skills on how to respond in an emergency and on how to continue to provide healthcare services within an environment that may or may not be safe.
The thing about a pandemic… is that it’s characterized by uncertainty…. Also, it’s everywhere.
I think that the challenge for the pandemic is, when a tornado or a hurricane hits, the event happens, and then it’s over. We move through the phases of the disaster lifecycle in a pretty straightforward manner. So, even the most horrific hurricanes that we’ve experienced over the past three years, they end. There have been extended periods of recovery—you can make the case that Puerto Rico has not yet recovered from Hurricane Maria—but you can plan for what’s going to happen. The thing about a pandemic, though, is that it’s characterized by uncertainty. For instance, we were anticipating a second wave this fall, but what we’re seeing is, we haven’t finished the first wave, and things are spiking again.
Also, [unlike most disasters, with a pandemic] it’s everywhere; it’s not geographically isolated in one region of the country. And of course, given the total absence of leadership at the federal level, now you have [states that are] basically 50 countries that are forced to address 50 different pandemics. That’s not the way you do it, so we’re failing there.
DN: Nurses have historically been on the front lines of response to disasters. What can be done to adapt the curriculum to provide them with better training and support for nursing in emergency and disaster situations?
TGV: I’m working hand-in-hand with AACN to help write an emergency preparedness competency to go into the revised Essentials document, so that schools of nursing will have a competency to teach to. AACN does a wonderful job with the Essentials documents, which basically serve as guides for curricula for nursing schools. I’m so proud to be working with them to help revise the essentials, publish this report, and then work on developing a five-module course with a company called Unbound Medicine. I produced a disaster nursing app with them back in 2015, and now I’m working with them to produce course content that schools can use to add to their existing courses or add as a standalone certificate to help provide this important information for schools that may not have the resources or the faculty who know how to develop this content or teach it—we’re hoping to do a great service for some of these schools.
DN: You mentioned the uncertainty of nursing in a pandemic. Where are we now?
TGV: We’re not through this. You’ve got California, Texas, Florida, and Arizona on the brink of being completely overwhelmed, and the Carolinas are right behind them. So the next month is going to be very ugly in the United States.
DN: What can individual nurses do to increase their readiness for pandemics?
TGV: They can pursue ongoing education and training as it relates to pandemic preparedness and response. Some of the professional nursing organizations are now offering short courses. I developed one with the National Council of State Boards of Nursing (NCSBN), and we have more that will be coming out.
Dr. Veenema’s AACN webinar talk, Improving Nurse Preparedness for a Pandemic Response: Implications for U.S. Schools of Nursing is now online. Click here to register and gain access to the webinar.
The benefits of certification can include “greater career success and satisfaction including higher pay, greater opportunity for advancement, and higher employability as well as higher self-efficacy,” according to a report by the Board of Certification for Emergency Nurses (BCEN). In sum, says BCEN executive director Janie Schumaker, “Certification instills confidence, boosts engagement and ownership, and enhances collaboration and communication, all of which contribute to better, safer care.”
The BCEN paper points to studies that indicate certified nurses tend to raise the level of patient care. Certification researcher Diane K. Boyle, PhD, RN, FAAN, a professor at the University of Wyoming’s Whitney School of Nursing, comments, “Research-based evidence shows that there is a link between certified nursing practice and better patient outcomes and increased patient satisfaction. We also have beginning evidence that the higher the proportion of certified nurses there is on a unit, the better the outcomes.” By studying for certification, explains Marianne Horahan, of the American Nurses Credentialing Center, “Nurses fill in knowledge gaps as they study the entire body of knowledge for their specialty… The employer benefits by having nurses on staff who are up to date on the latest in their specialty practice.”
The BCEN report found widespread support for the certification of emergency nurses within the profession itself and among physicians. In the largest study to date, 92% of emergency nurse supervisors stated that it was important to have Certified Emergency Nurses (CENs) in their institution and that overall, CENs were preferred for their clinical expertise, technical performance, accuracy, safety and ethics. Often, hospitals support certification by offering an honorarium. In Illinois, for example, the emergency physicians at Edward-Elmhurst Health established an honorarium program for board certified RNs in 2006, with nurses receiving $1,000 for initial certification and $500 when they recertify. The hospital’s Emergency Services Chair, Dr. Tom Scaletta, calls the cash rewards “A small investment when you look at the improved relationships, improved patient safety and the message of appreciation we’re sending. It is worth every penny when it comes to ensuring nurses have the knowledge to care for our patients.” And, high-quality care is of course the ultimate goal. With a board certified nurse, says Richard E. Hawkins, the president and CEO of the American Board of Medical Specialties, “Patients can be confident that those treating them have the skills and knowledge… and are uniquely qualified to provide the best care possible.”
For information on how to obtain certification, visit the BCEN site or see Nurses Get Certified.
the country in chaos during the spread of the coronavirus, we’ve published many
stories on how to deal with it in various ways. But in addition to dealing with
it now, this experience may have gotten you thinking about your career in the
future—especially with emergency services.
While the Board of Certification for Emergency Nursing (BCEN) will celebrate its 40th anniversary this coming July, we interviewed its leader now to give you information that you may want if you’re contemplating moving into this kind of work and want to know about the Board Certifications available and how to get them.
Janie Schumaker, MBA, BSN, RN, CEN, CENP, CPHQ, FABC, is the Executive Director of the BCEN, which is based in Oak Brook, Illinois. She answered our questions about what board certification for emergency nursing means and how to go about it.
is the importance of being board certified as opposed to simply earning another
kind of certification?
Holding a board certification vs. earning a
certificate are often confused and misunderstood.
A board certification, like for example BCEN’s Certified
Emergency Nurse (CEN ®) or Trauma Certified Registered Nurse (TCRN®)
designation, is an earned credential that demonstrates the individual’s
specialized knowledge and skills across an entire specialty body of knowledge. Certification
is awarded by a third-party organization, like the Board of Certification for
Emergency Nursing, and high-quality programs are accredited by an organization
such as the Accreditation Board for Specialty Nurse Certification (ABSNC).
Individuals receive their certification after meeting
strict eligibility requirements and successfully completing a rigorous national
certification examination. In addition, board certifications have ongoing
requirements that must be met to maintain the credential, ensuring the holder is
sustaining their level of expertise. Certifications are nationally recognized
and are appropriately included with the earner’s signature along with their
Where board certification is about validating mastery
across a specialty, a certificate and other instruction-based certifications importantly
help nurses acquire focused knowledge and skills. Examples of certificates are
Advanced Cardiac Life Support (ACLS) or Trauma Nursing Core Course (TNCC™).
Board certification is the highest professional
credential a nurse can earn, and being board certified demonstrates a commitment
to one’s career, patients, and organization.
do nurses earn this?
Earning a board certification from BCEN requires an
unrestricted U.S. RN license or equivalent. Just recently, we announced a new
international candidate process that for nurses educated and/or practicing outside
the U.S. We recommend that a nurse has two years of practice in the specialty area
before sitting for that exam. When ready, nurses complete an application to sit
for the exam, chose a testing time and site that works for them, and then take
the test on the specified day. Of course, there is much preparation that is
necessary prior to the exam.
nurses think they might be interested in becoming board certified, what do they
need to do?
Nurses who are interested in becoming board certified
should incorporate preparation into their career plans early. Often it is
required or recommended nurses have a certain amount of time working in their
specialty area—for example, 2 years.
Start by researching the nursing specialty
certification board that provides the credential in your specialty area. Take a
look at their website. They will have a candidate handbook that explains
eligibility and testing. Each certification exam has a test blueprint or
content outline. This is very helpful in determining what to expect on the exam
and what to study.
Many certification boards also provide a list of
reference books used to create their exams. These can be very helpful to know
what resources to use to study. Another thing that is highly effective is for
nurses interested in certification to form a study group and prepare for the
Nurses interested in certification should also ask their employers about the support and resources they offer. Many employers value the impact certified nurses make in the workplace and offer support in various forms. Membership in a professional association can mean you qualify for a discount on certification and recertification fees.
[BCEN’s resource page, which includes everything from
content outlines to test anxiety resources is here. Their resource page for students
The Board of
Certification for Emergency Nursing (BCEN), the benchmark for specialty
certification across the emergency spectrum, recently kicked off its 40th
anniversary celebrations in honor of 40 years of excellence, achievement,
and impact in board certified emergency nursing.
BCEN has five national board certification programs—the CEN,
CPEN, CFRN, CTRN, and TCRN—which represent the high professional credentials for
registered nurses (RNs) specializing in adult/mixed
emergency, pediatric emergency, flight, critical care ground transport, and
trauma nursing, respectively.
BCEN was founded in 1980 as an independent
certification organization, and introduced its first board certification programs
for RNs in the same year. Today, over 39,000 RNs hold their Certified Emergency
Nurse (CEN), making it the most-held emergency nursing specialty certification
in the world. In total, over 48,000 nurses hold 54,000 BCEN credentials,
validating the specialty knowledge and expertise of emergency nurses.
BCEN Executive Director Janie Schumaker, MBA, BSN, RN, CEN, CENP, CPHQ, FABC, tells prnewswire.com, “Patients and families receiving care from a nurse who displays a BCEN credential on their badge can expect a proven level of clinical knowledge from these dedicated professionals. BCEN’s commitment to excellence, achievement and impact spans 40 years, and we are incredibly proud of the accomplishments and commitment of BCEN-certified nurses…For healthcare teams and organizations, BCEN credentials distinguish nurses who noticeably contribute to improved patient outcomes, stay on top of the latest advances and best practices, champion clinical standards, promote safety and efficiency, solve problems, enhance collaboration, mentor novice nurses, and advocate for patients and their families.”
The 40th anniversary celebration of BCEN is centered on
their “Your Story is Our Story” campaign, featuring 40 stories about
BCEN-certified nurses and healthcare teams. To learn more about BCEN’s celebrations
in honor of 40 years of excellence, achievement, and impact in board certified
emergency nursing, visit here.
The key to finding work as an ER nurse is to be proactive before and during nursing school. Keep reading for pro tips on how to position yourself during school and after graduation.
The availability of ER nursing jobs—especially for new graduates—depends on the needs and financial status of the institutions and geographic area in question. As reimbursement becomes more and more dependent on patient reviews, hospitals strive to update the accommodations and technological capabilities to satisfy their patient populations. The expense of these updates can limit the hospital’s ability to hire or even cause a hiring freeze.
Most managers would prefer to hire a nurse experienced in the ER because it is very time-consuming and expensive to train a new nurse. Furthermore, it delays the increase in staff numbers that the nurse is hired to relieve. Many hospitals have created fellowship programs, which include a stepwise process of training for new grads to fully integrate them into the world of ER nursing. These are valuable programs for nurses who seek a comprehensive understanding of emergency nursing and an ongoing support system.
They are, however, pricey to the hospital, and lengthy: nurse fellows receive full salary and benefits, and these programs last between six months and two years. For new nurses, these fellowship programs can be very competitive.
As with any professional field, building bridges is a key to success. For ER nursing hopefuls, forming relationships within the ER can be a very strong indicator for acceptance into the fellowship program. This can be done by finding work at the ER as ancillary staff or volunteering.
Working as a nursing assistant before and during nursing school is a great way to expose an individual to the life of a nurse, and either reinforce or redirect their goals. If a position working directly in the ER isn’t available, then employment in other parts of the hospital can still build those relationships and improve your chances of getting a job in the ER.
Although acute care is a part of every nursing school curriculum, emergency room nursing is not. Nursing students interested in the emergency room can find out if their school has a relationship with a site that might allow them to shadow in the ER. They can also request through their nursing school administration to do requisite clinical work there.
A capstone in the ER is a highly effective way to set oneself up for employment there. It introduces the nursing student to nurses and management, which gives the student an opportunity to demonstrate work ethic and nursing acumen.
If opportunities for work, volunteering, or clinical shadowing are not available, developing relevant skills for the ER is another way to make oneself more marketable for work there. Many emergency medical technicians (EMT) go on to become nurses and already have highly sought-after skills when they graduate. Similarly, medical assistants, phlebotomists, radiology technicians, and scrub technologists all have skills and experience that are valuable to the ER.
Because nursing schools follow a general curriculum, there is no formal way to get into the ER as a nurse. The individual who hopes to be an ER nurse must take it upon themselves to be proactive in learning about the ER, building relevant relationships, and developing the skills necessary to be successful. Being proactive during training is a skill-building opportunity in itself, as the best ER nurses are highly motivated, humble enough to remain teachable, and bold enough to advocate for a seemingly unlimited range of patient populations.
By Edwin Leap, MD–
It’s hard to explain what we do. And so maybe, it’s hard for others to sympathize with our situations. I mean, physicians, mid-levels, and nurses in emergency departments are tied to computers in often cramped work-spaces, even as they are required to be at the bedside almost constantly for the latest emergency or (in other cases) the latest bit of pseudo-emergency drama.
If you haven’t worked there, or haven’t for a long time, it could be that this lack of understanding is what leads hospital administrations to do one of the stupidest things imaginable. What is that thing? Banning food and drink from our work-spaces.
Now, this isn’t the case in my current job. But it is the case in all too many facilities. I talk to people. I hear things. And it’s usually justified with some unholy combination of infection control, Joint Commission and public health clap-trap, coalesced and refined, then circulated as a cruel policy.
When it’s enacted, clinical staff have their water bottles taken
away. Nobody is allowed to eat where they work. Dedicated, compassionate
staff members grow tired and dehydrated and hungry. (Maybe it’s a good
thing. They often don’t have time to urinate anyway, and water just
makes that happen more often.)
Mind you, the water bottles are sometimes kept in a nearby room, or on a nearby shelf. It’s an act of kindness, I guess. And the food? Well, all you have to do is take your break and go to the cafeteria or to the break room, right?
Those who come up with these rules don’t understand that a scheduled break is a great idea … that never happens. It’s an emergency department. It isn’t (technically) a production line; however, we try to impose time restrictions and through-put metrics. It isn’t “raw material in/product out.”
It’s “sick, suffering, dying, crazy human being in” and if all goes well, “somewhat better (at least no worse) human being evaluated, stabilized, saved, calmed, admitted, transferred, and sometimes pronounced dead” out of the other end of the line.
Those Herculean efforts can take anywhere from, oh, 20 minutes to 12 hours. During which time, it’s pretty hard to leave the critical patient in the understaffed department, with the “five minute to doctor” guarantee and the limitless capacity for new tragedy rolling through the door.
That setting makes it remarkably hard for breaks or even meals to happen at all.
As such, it’s nothing short of cruel and unusual for anyone to say to the staff of a modern emergency department, “you can’t have food or drink” — especially when it’s typically uttered by people who have food and drink in their offices and at their desks. People who have lunch meetings with nice meals or who have time to walk to the cafeteria or drive off-campus. And who feel so very good about protecting the staff from their deadly water bottles.
The argument, of course, is that the clinical staff work in a “patient care area.” Even when they aren’t at the bedside but are, for instance, behind a glass wall at a desk. If this is the case, then one could argue that the entire hospital (including administrative suites) is a “patient care area.”
They are afraid we’ll catch something. That it’s unsafe for us to eat or drink where we work. Of course, this is while we positively roll around in MRSA and breathe in the fine particulate sputum of septic pneumonia patients. This is while staff clean up infectious diarrhea and wear the same scrubs all day.
This is after we intubate poor immigrants who may well have tuberculosis and start central lines on HIV patients. This is after we wrestle with meth-addicts who have hepatitis C. And this concern for our “safety” occurs in places where physical security, actual security against potential violent attack, is a geriatric joke which is often tabled until the next budget cycle.
And as for our patients? Our food and drink are no danger to them. They and their families fill the exam rooms with the aroma of fried chicken, fries, and burgers, eaten at the bedside (often by the patient with abdominal pain). Their infants drag pacifiers across floors that would make an infectious disease specialist wake from bacterial nightmares in a sweat-soaked panic. In short, our food or drink are no threat to them and no threat to us.
But the absence of food and drink? That’s a problem. Because the ED is an endless maelstrom of uncontrollable events and tragedies, of things beyond our control for which we are responsible. It is a place of physical, emotional, and spiritual exhaustion where we rise to the challenge and manage (against the odds) to do so much remarkable good by virtue of our knowledge, our training, our courage, and our compassion.
In the midst of all that, a bottle of water, a cup of coffee, a glass of Diet Coke, a Styrofoam cup of iced tea is an oasis in the desert. And that sandwich, slice of pizza, cupcake, or salad is the fuel that helps make it happen.
More than that, food and drink are among the few pleasures we have time for each shift. They serve as bridges to the end of the day, small reminders of normalcy in a place where so little is normal.
Doubtless, one day someone will take away our music so that it doesn’t hurt our ears, or offend our patients. We’ll fight that battle when it comes.
But until then, depriving staff of food and drink proximate to where they work is of no health value and strikes me as just one more way of exerting control over the people actually engaged in the hard, grinding work of saving lives.
And worse, it’s just mean.
Originally published in MedPage Today