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Why Won’t It Stop: Workplace Violence in Emergency Care
Workplace violence by patients and visitors against emergency nurses has been ongoing for over 40 years. In 1981, Dubin reported on the conditions most associated with patient violence, including substance use, intoxication, and withdrawal; acute psychosis; paranoia; borderline personality; and organic brain disease. He further warned clinicians to watch for signs of escalation, such as aggressive body posture, speech, and motor activity.1 These patient conditions and “warning signs” have not changed in the last 40 years, although the catalog of conditions and signs has increased.Workplace Violence: Raising Awareness and Bridging the Gap with Law Enforcement
Emergency nurses in the United States are making great strides against workplace violence with the support and encouragement of the Emergency Nurses Association (ENA). Many nurses and professional nursing organizations are working tirelessly to raise awareness about the prevalence of violence against health care workers. ENA recently challenged members to raise awareness about workplace violence within their communities. Answering this challenge, many ENA chapters have chosen various methods to disseminate information and advocate for change to stop workplace violence.Implementing the Total Worker Health Program in a Shared Governance Context
Healthy work environments are critical to the stability and well-being of the nursing workforce, in addition to promoting optimal patient safety and patient outcomes and ensuring the viability of health care organizations.1 The National Academy of Medicine’s Future of Nursing 2020 to 2030 notes the importance of supporting the health and well-being of nurses, stating “…it is essential to address the systems, structures, and policies that create workplace hazards and stresses that lead to burnout, fatigue and poor physical and mental health among the nursing workforce.”2 For years, unrealistic workloads, risk of infection and workplace violence, insufficient resources, and moral distress/injury have contributed to turnover, burnout, and poor professional quality of life—threatening the viability of nurses in the health care workforce.The Great Resignation, Newly Licensed Nurse Transition Shock, and Emergency Nursing
There is a phenomenon occurring across all employment settings in the United States that is aptly termed The Great Resignation. Anthony Klotz, an organizational psychologist and business professor, named this trend in 2019, the year before the COVID-19 pandemic, when annual worker turnover reached an all-time high.1 Although the rate plateaued in 2020 with the advent of the pandemic, turnover again set new record levels both in 2021 and 2022, leading to extensive nationwide job vacancies.1 Nursing turnover is no exception in The Great Resignation trend.Is Your Trauma Center Peds Ready?
If a 1-year-old child with a viral illness presents to a community emergency department in a remote or rural area, chances are that they will still receive appropriate care for their condition, even if that emergency department rarely cares for children. But what if that 1-year-old child has instead been critically injured in a motor vehicle crash? Will their needs be met? Will the team who typically cares for adults recognize altered mental status in the young, nonverbal child? Will the department have a pediatric intraosseous device to use to provide life-saving fluids or blood if intravenous access attempts are unsuccessful? Will the nurse who must draw up weight-based medications during resuscitation have access to the necessary tools to help prevent the medication errors that can be so easy to make in stressful, unexpected situations, especially when caring for patients who are much smaller than the patients typically treated?Military, Veteran, and Public Health Service Communities
Jessica Castner, PhD, RN, CEN, AE-C, FAEN, FAANAn Unplanned and Fate-filled Professional Journey
My dad and 2 of my uncles served in World War II. My dad was a Ranger medic, my Uncle Fred was an 18-year-old infantryman, and my Uncle Ray was a top gunner in a B-17 bomber aircraft. I grew up hearing stories about this war and I was so very proud of my family, so when my time came, I joined the United States Army Student Nurse Program because it felt like the right thing to do. My first active-duty assignment was in the thoracic surgery intensive care unit (ICU) at Walter Reed National Military Medical Center in Washington, DC.Changing Behaviors: The Behavior Change Wheel and Emergency Nursing
Jessica Castner, PhD, RN, CEN, AE-C, FAEN, FAANTrajectory of Research and Dissemination Through Mentorship and Passion
A report by the Institute of Medicine, “The Future of Nursing,” called for a doubling of the 28 369 doctorally prepared nurses in 2008 by 2020.1 Although this goal was achieved, it was done primarily through the expansion of Doctor of Nursing Practice programs in the United States. In 2019, the number of nurses graduating with a practice-focused doctorate (Doctor of Nursing Practice) was more than 9 times higher than the number of nurses graduating with a research-focused doctorate (Doctor of Philosophy): 12 250 graduates vs 1306 graduates, respectively.A Case for Case Reviews
“When you hear hoofbeats, think horses and not zebras.” Our new locum tenens attending physician admonished my emergency nursing colleague by invoking a common metaphor. This use of the metaphor suggested that the patient's problem was most likely a common diagnosis and not a rare or unusual disease. This is usually sound advice to maintain efficiency in a crowded and under-resourced emergency department. My colleague seemed to silently weigh the risks and benefits to the patient of each course of possible action, including what it would mean to repeat his request, and with what urgency.Postpandemic Psychological Recovery and Emergency Nursing: Creating a Narrative for Change
The COVID-19 pandemic has pushed the emergency care sector beyond its breaking point, exacerbating preexisting issues such as ED crowding, boarding, unsafe patient assignments, suboptimal/unacceptable work environments, and psychological distress.1-3 As this pandemic continues into its second year, the prevalence of psychological distress, moral injury (a phenomenon that often follows moral distress on the continuum of moral harm4), and stress-related disorders among nurses and health care workers are higher than ever before.Leading and Accelerating Change
For over a year, emergency nurses around the world have been at the forefront of the coronavirus disease pandemic response. The emergency care sector was already at the breaking point, especially in the United States, well before the onset of the pandemic.1 The pandemic has led to a loss of life among the general population, the loved ones of our emergency nursing community, and our own health care workers. Public outcry about the need to change health care, fueled by problems exacerbated by the pandemic, has created an urgency and priority for care reforms and improvements.Finding My People: My Experience as an Emergency Nurse Scientist in a Research Postdoctoral Fellowship at an Academic Medical Center
Postdoctoral fellowships are excellent opportunities for doctorally prepared nurses to further their research independence.1,2 Public agencies, such as the National Institutes of Health (NIH), National Science Foundation, the Veterans Health Administration, the Agency for Health Research and Quality, and the Health Resources and Services Administration offer postdoctoral fellowships to new researchers, including doctorally prepared nurses. Postdoctoral fellows are often supported through a Ruth L.Health Disparities and Emergency Nursing
Health disparities are sustained, worsened health outcomes of a specific disadvantaged group. These health differences can be health-related quality of life, rates or severity of disease, disability, mortality, injury, or violence. Disadvantaged populations might be defined by demographic characteristics, disadvantaging environmental conditions, social vulnerability, or geography. For example, the National Institutes of Health has designated the following as United States health-disparity populations: Black/African American, Hispanic/Latino, American Indian/Alaska Native, Asian American, Native Hawaiian and other Pacific Islander, socioeconomically disadvantaged populations, underserved rural populations, and sexual and gender minorities.Amplifying Infection Prevention Self-Management Among Patients and People in the Community
The World Health Organization declares 2020 “Year of the Nurse,” 2020 marks Florence Nightingale’s 200th birth anniversary, and simultaneously, coronavirus disease (COVID-19) is declared one of the most life-altering communicable infections of our time. As I reflect back on my time as a nurse, I recognize that infection prevention and control has always been a major cornerstone of nursing. Nightingale’s use of sanitary techniques for maintaining a clean environment and clean soldiers resulted in a reduction of death rates during the Crimean War (1853-1856), even during a time when the prevailing theory of germ transmission posited that disease was caused by a miasma, or “bad air.” The same foundation for infection prevention in nursing rang true even during my time in nursing school.Infection Control and Vaccine Hesitancy in the Emergency Department
The emergency department is a crucial point of access to the health care system for patients with the initial signs and symptoms of infectious disease, as well as for patients in need of emergent prophylaxis after occupational or crime-related blood and body fluid exposures. Emergency nurses frequently care for patients with vaccine-preventable infections across the lifespan. Examples of these vaccine-preventable diseases range from reactivation of varicella zoster (shingles) or Streptococcus pneumonia in the older adult, hepatitis B from an occupational exposure in a working-age adult, meningitis in the university student, to measles or chickenpox in young children.Tackling Burnout With Team Science: Nursing and Physician Collaborations on Improving Psychological Well-Being Among Emergency Clinicians
Emergency care has historically been one of the health care specialties with the highest rates of clinician burnout for both physicians and nurses.1,2 Although there has been an explosion of interest in burnout and wellness initiatives within the emergency specialty,3,4 previous editorials or society statements have conceptualized burnout from the perspective of the individual clinician or specialist.3 Taking a page from the adage that no individual is an island, acute care clinicians work intimately together as a team, in a common environment, where they are exposed to similar occupational stressors that may adversely affect both nurses and physicians.Practice Informs Research and Research Informs Practice: The Making of a Disaster Nurse Scientist
One of the greatest things about being a nurse is the multitude of paths and directions that a nursing career can take. Nursing has led me from my first position in a 6-bed emergency department in South Georgia to that of an Assistant Professor at the University of Michigan, studying the health effects of disasters on vulnerable populations. The goal of this editorial is to describe my journey as a disaster nurse scientist, which I hope will inspire others to consider this area of scholarship.Special Disaster Issue
We are preparing this special disaster issue of the Journal of Emergency Nursing (JEN) in the midst of the global coronavirus disease 2019 (COVID-19) pandemic. To date, the Centers for Disease Control and Prevention report that more than 590 health care personnel have died from COVID-19 in the United States alone, and there are likely many more owing to missing data.1 As a professional community, we deeply grieve these tremendous losses of our valued and beloved colleagues and lift up their families in the US and around the globe.Forensics and Emergency Nursing
This Guest Editorial links my own career path with the intersection of forensics and emergency nursing. Advocacy for vulnerable patients affected by interpersonal violence has been a priority throughout my emergency career. I am an emergency nurse who applies forensic concepts at each patient encounter. Emergency nurses should consider forensic science concepts during patient care. For example, subtle chief complaint symptoms can actually be symptoms of interpersonal violence. In the following paragraphs I will share personal, impactful, and advocacy episodes in my emergency nursing career that have influenced me.Typology of Interpersonal Violence Model With Applications in Emergency Nursing: Forensics and Interpersonal Violence Special Issue
The purpose of this editorial is to introduce the World Health Organization Violence Prevention Alliance’s Typology of Interpersonal Violence model as the organizing framework for our forensic and interpersonal violence–themed issue of the Journal of Emergency Nursing (JEN).1,2 My everyday work as an editor, administrator, and scientist is informed and motivated by my clinical and leadership experiences as a bedside nurse. The following memory from my emergency nursing practice continued to surface in my consciousness as our editorial team worked to bring this journal issue together: You should go home.Knowledge Translation of Science Advances Into Emergency Nursing Practice With the Reach, Effectiveness, Adoption, Implementation, and Maintenance Framework
I’m thrilled to introduce this second issue of the Journal of Emergency Nursing (JEN), published as part of the 50th anniversary celebrations of the Emergency Nursing Association (ENA). The themes for this issue include ED flow and crowding,1,2 critical care,1,3–8 vascular emergencies,6,7,9,10 and cultural or organizational patient-centered care.11,12 Emergency nurses strive to develop and implement evidence-based interventions, which are often pragmatic interventions. Moreover, JEN readers practice in widely diverse emergency settings.Optimizing Patient Outcomes in Emergency Cardiac Care Through Advances in Technology: Nurse Scientists in Action
This issue of the Journal of Emergency Nursing (JEN) is focused on cardiovascular disease, a growing concern among our aging population and beyond. Cardiovascular disease is the top killer in the United States and worldwide, and cardiovascular emergencies account for approximately 10% of all ED visits in the US.1,2 More than 8 million patients with chest pain and/or anginal equivalent symptoms (eg, shortness of breath and diaphoresis) present to emergency departments each year, accounting for the second most common cause of ED visits for adults.Who Cares for the Emergency Nurse?
I recently watched a TED Talk video by Dr Paul Rosen discussing empathy as the next revolution in health care.1 Rosen described the experience of a family member who felt that he was provided with effective and competent clinical care but did not feel that he was treated like a person during his care. Rosen discussed the need for empathy in health care and proposed some strategies that can be implemented to create patient-centered health care experiences.1 Some of the strategies included were as follows: system changes to reduce delays in care, improving the flow of patients from the emergency department to inpatient areas, maximizing comfort for patients, reducing suffering, decreasing fear and anxiety, providing current and accurate information, and embracing patient- and family-centered care.Professional Flourishing: The Job Demands–Resources Model and Emergency Nursing
Can we craft the perfect job for the next generation of emergency nurses? Ideally, emergency nursing work is engaging, motivating, and meaningful while leading to the nurse’s personal flourishing, well-being, optimal health, and performance excellence. Attaining this occupational ideal requires overcoming many contemporary challenges and barriers that emergency nurses face every day. The Job Demands–Resources, or JD–R, model1 (Figure) is an interdisciplinary theory developed to predict organizational outcomes such as employee well-being, burnout, and work performance.
