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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. Building upon the historical context, research-based evidence for Emergency Nursing has allowed for improvements in the structure, processes and outcome of emergency care. Objectives Describe the history of Emergency Nursing Describe Evidence-based Practice that has transformed Emergency Nursing care Translating Research into Practice NYPH Emergency, The Wave of Change Conclusion 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. 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. Now Now Historical Milestones NYPH Emergency Department Nurses With Certifications 0 15 30 45 60 2000 2010 Certified Emergency Nurses Trauma Certification 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 # of RNs Year 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. 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). 1970 1967 In 1967, ENA Co-Founder Anita Dorr, RN, invented the first Crash Cart originally called Crisis Cart. 1975 1979 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. 1980 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. 1986 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. 1985 EDNA changed its name to the Emergency Nurses Association (ENA). 1983 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 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. 1993 2004 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. 2010 The ENA celebrates 40 years of transforming Emergency Nursing practice with over 38,000 members. Emergency Nursing today is continuously transforming its practice. 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. Patients in New York Presbyterian Hospital Emergency Waiting Room. Then Then Vanderbilt Clinic and Emergency Room entrance. The building was converted to Energy Court entrance on Broadway. Then New York Presbyterian Hospital ambulance as they look today. New York Presbyterian Hospital ambulance in the past. 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: 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.
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