Safe Practice, Safe Care

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Beneath the ENA logo on the front of the Journal of Emergency Nursing are the words “Safe Practice, Safe Care.” These words illustrate an important focus of the ENA. This past July, a study conducted by ENA that looked at the issue of violence in the practice of emergency nursing was released.¹ The study was picked up by multiple media sources and headlines were generated such as “The Emergency Room can be a Dangerous Place, if you are a Nurse” and “Half of ED Nurses Report Assaults at Work.” The national spotlight was shone on an old problem.

Some of you may have been in San Antonio in 1994 when then ENA President Marilyn Rice had a press conference at Annual Meeting to discuss the problem of ED violence and the need to be able to prosecute individuals who caused injury to emergency nurses. Some states have since made causing injury to an ED nurse a class C felony; others have been slow to address the problem. Do you know how your state addresses assaults against ED personnel?

There are numerous things than can make the ED environment unsafe for staff and patients other than violent patients, limited or no security, and lack of de-escalation skills to manage angry patients. The ED is also full of hazardous chemicals, medications, radiation, sharp objects, and faulty equipment.² Exposure to illnesses such as the H₁N₁ can cause staff and patients to become infected, placing additional stress on the department. There is grave concern about the effects of this disease on the current health care workforce. One must remember there were no EDs for patients to come to during the 1918-1919 flu epidemics.

In the Managers Forum in this issue of JEN, there is a discussion about the use of dogs in the emergency department. The participants who answered the question about the use of K-9s noted that staff and patients felt more secure, less exterior crime occurred, and there was better cooperation with staff when a patient was particularly difficult.³ Our K-9 is named Bosco, and it is amazing how things become calmer when he and his human companion take their periodic walks throughout the department.

We all know that the solutions to providing safe practice and safe care are not simple. The September 2011 issue of JEN will be devoted to examples of safe practice and safe care. I would like to invite submissions that address how you have successfully managed many of the challenges we face each day in order to practice safely. Please go to http://www.jenonline.org for Author and Submission Guidelines. We hope that this future JEN will provide you with information about how we are working to create a safe work environment for all those who enter the “front door” of the hospital.

Finally, I would like to end with one more thought. In 1977, when I started in the emergency department, I worked with an incredible physician and emergency medicine pioneer. This was an important transition time in emergency medicine and there was always an ongoing discussion as to whether this was an emergency room or an emergency department. In his authoritive manner, Dr. Roussi pointed to the bathroom and stated, “That is the emergency room, and this is the emergency department.”

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References 

1. Gacki-Smith J, Juarez J, Altair M, Boyett L, Homeyer C, Robinson L, et al. Violence against nurses working in US emergency departments. J Nurse Adm. 2009;39:340–349
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2. Nursing school.org. Warning: hazards of being and E.R. nurse. Available at: http://nursingschool.org/cat/er-nurseAccessed July 31, 2009
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3. Solheim J, Papa AM (Ed.). Managers forum: canine security. J Emerg Nurs 2009;35:469-74.
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