Emergency care nurses: certification, empowerment, and work-related variables.

INTRODUCTION: The value of specialty certification has been of interest to the profession and has been related to a number of key variables. The specific aims of this study were to determine differences between certified and noncertified ED nurses in perceptions of structural empowerment, anticipated turnover, intent to leave the current position, and intent to leave the nursing profession. In addition we explored differences in the key variables based on position (staff or manager) and background variables (eg, age, ethnicity, etc). Participants also were asked to indicate reasons why they intended to leave their current position and the nursing profession. METHODS: In this descriptive quantitative design, data were collected via a Web-based survey of the Emergency Nurses Association membership. There were 2,633 participants who completed the surveys; 1,525 of the participants were staff nurses and 2,237 worked full time in the emergency department. Differences in empowerment, anticipated turnover, or intent to leave current position or the profession were determined based on specialty certification among the total sample and the subsamples of staff nurses and full-time employees. RESULTS: There were differences based on certification status on several dimensions of empowerment, in all of the samples. There were no significant differences in anticipated turnover, or intent to leave position or profession based on certification status. DISCUSSION: The study adds to our understanding of the value of specialty certification among ED nurses. Additional study is warranted to determine the benefits of specialty certification to additional organizational, professional, and clinical patient outcomes.

Building capacity for ATLS trauma education: role of nurse practitioners and physician assistants.

Objectives: Advanced Trauma Life Support (ATLS) focuses on care of injured patients in the first hour of resuscitation. Expanded demand for courses has led to a concurrent need for new instructors. Nurse practitioners and physician assistants (NPs/PAs) work on trauma services and duties include patient, staff, and outreach education. The goal of this project was to assess NP/PA self-reported knowledge and skills pertinent to ATLS and identify potential barriers to becoming instructors. Materials: This was a voluntary 91-question survey emailed to NP/PA lists obtained from professional societies and online social media channels. NPs/PAs completed a survey reflecting self-reported knowledge, experience, comfort level, and barriers to teaching ATLS interactive discussions and skills. Responses were recorded using a Likert scale and results were documented as percentages. Number of years of experience versus perceived knowledge and comfort teaching were compared using a χ2 test of independence. Results: There were 1696 completed surveys. Most NPs/PAs thought they had adequate knowledge and experience to teach interactive discussions and skills. Those with more years of experience and those who completed more ATLS courses had higher percentages. The number 1 barrier to teaching was lack of formal teaching experience followed by perceived hierarchy concerns. Experience and comfort with skills that fell below 50% were pediatric airway (49.5%), needle and surgical cricothyrotomy (49.8% and 44.8%), diagnostic peritoneal lavage (21.6%), and venous cutdown (20.8%). Conclusion: NPs/PAs with experience in trauma reported having the knowledge and skill to teach ATLS. A majority are comfortable teaching interactive discussions and skills for which they are knowledgeable. The primary barrier to teaching was lack of formal teaching experience, which is covered in the ATLS Instructor course. Training NPs/PAs to become instructors would increase the instructor base and allow for increased promulgation of ATLS and trauma education. Level of evidence: IV.

Lip Laceration and Vermilion Border Repair.

Lacerations to the face and lips are commonly seen in the emergency setting from dog bites, falls, and blunt trauma (motor vehicle crash, strike with an object, etc.). Lip lacerations, especially involving the vermilion border, can be most challenging and deforming, especially when greater than 25% of the lip is involved. These lacerations require preciseness for a good cosmetic outcome. Lips are a highly visible facial structure and consist of 3 layers: skin, muscle, and oral mucosa. They are used for speech, food consumption, and tactile sensation (Lammers & Scrimshaw, 2019; Lent, 2020).

Not just another pain in the neck.

A 56-year-old man presents to the emergency department with complaints of neck pain with numbness to the right upper extremity. The complaints and symptoms initially appear to be cervical radiculopathy but further diagnostic testing during an inpatient hospitalization revealed an unusual diagnosis. The purpose of this article is to bring awareness to practitioners of the alternative and sometimes rare diagnosis of neck pain. A detailed history and physical examination accompanied with diagnostic testing and collaboration can ensure a definitive diagnosis and positive outcome.

A case of subluxation of the radial head: nursemaids' elbow.

Nursemaid's elbow (subluxation of the radial head) is a common pediatric upper extremity injury encountered in the emergency and urgent care settings. Subluxation of the radial head accounts for more than 20% of upper extremity injuries in the pediatric population. A clinical case of a three-year old girl who presented to the emergency department with a nursemaids elbow requiring reduction is presented in this article. The purpose of this article is to discuss the identification and treatment of this injury and delineate the two methods of supination and pronation for reduction of the annular ligament.

Critical care staff nurses: empowerment, certification, and intent to leave.

BACKGROUND: Certification is a voluntary process that is used to recognize specialized knowledge and skills. Little research has been focused on staff nurses with specialty certification. OBJECTIVE: To determine if perceptions of empowerment and intent to leave the position and the profession differed among staff nurses who were certified by the American Association of Critical-Care Nurses, nurses certified by other certifying organizations, and nurses who were not certified. METHODS: A comparative descriptive study was used to analyze the results of a 2007 to 2008 Web-based survey of members of the association. Data were available on 4268 staff nurses. RESULTS: Total empowerment scores and intent to leave either the position or the profession did not differ between nurses who were certified and those who were not. However, perceptions of informal power, opportunity, and support did differ between the 2 groups. CONCLUSIONS: The differences between nurses who were certified and those who were not may be related to variables other than certification. Further research and theoretical model testing is needed to determine the value of certification.

Certification, empowerment, and intent to leave current position and the profession among critical care nurses.

BACKGROUND: This study was based on the American Association of Critical-Care Nurses' (AACNs') interest in determining the value and influence of specialty certification. OBJECTIVES: To examine relationships between AACN specialty certification and empowerment, and, secondarily, to examine these variables as related to intent to leave the current position and the nursing profession. METHODS: AACN members were asked to participate in a Web-based survey; 6589 AACN members completed the surveys. RESULTS: Perceptions of empowerment differed significantly among nurses certified by AACN and nurses without such certification. Additional analyses revealed significant differences in empowerment related to position, education, salary, ethnicity, sex, intent to leave the current position, and intent to leave the profession. Forty-one percent of the participants indicated intent to leave their current position in the next year; only 6.9% indicated their intent to leave the profession in the next year. Intent to leave current position differed significantly according to age, sex, years of experience, ethnicity, educational level, and certification. CONCLUSIONS: The value of specialty certification and the importance of empowerment among critical care nurses are affirmed. The next step in the continued journey toward increasing retention of critical care nurses, and thereby improving patient care, is to evaluate existing programs focused on retention and identify needed enhancements.

Ovarian torsion in a 23-year-old female with pelvic pain.

Ovarian torsion is infrequently seen in the emergency department, however, a delay in diagnosis and treatment can lead to necrosis and loss of the ovary (E. D. Shraga & M. Blanda, 2008). A patient with pelvic pain diagnosed with ovarian torsion is presented in this article. The diagnosis and treatment of ovarian torsion is discussed to help the advanced practice nurse gain a better understanding of this frequently missed problem.