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The emergency department consortium: One approach to emergency nursing education
The emergencydepartmentconsortium: One approach to emergencynursing education A u t h o r s : S u s a n n e Bottiggi, RN, MSN, CEN, J o a n Meunier-Sham, RN, MS, K a t h l e e n Walsh, RN, MS, a n d Cynthia La Sala, RN, BSN, B o s t o n , M a s s a c h u s e t t s
n a c l i m a t e of evolving m a n a g e d c a r e a n d d w i n dling r e s o u r c e s , e d u c a t i o n d e p a r t m e n t s in h o s p i tals are hard p r e s s e d to p r o v i d e c o n t i n u i n g e d u c a t i o n t h a t m e e t s t h e n e e d s of their staff, e s p e c i a l l y staff w h o r e q u i r e d i s c i p l i n e - s p e c i f i c e d u c a t i o n . E d u c a t o r s from e i g h t t e a c h i n g h o s p i t a l s in Boston, M a s s a c h u s e t t s , j o i n e d forces in 1993 to form a n ED C o n s o r t i u m to m e e t specific e d u c a t i o n a l n e e d s of ED nurses. M e m b e r s of t h e Boston T e a c h i n g Hospitals ICU C o n s o r t i u m w e r e i n v i t e d to h a v e r e p r e s e n t a t i o n from their e m e r g e n c y d e p a r t m e n t s . T h e s e h o s p i t a l s repres e n t e d a d u l t a n d p e d i a t r i c level I a n d level II t r a u m a c e n t e r s a n d t h e D e p a r t m e n t of V e t e r a n s Affairs M e d i c a l Centers. G u i d e d b y J u n e Stark, RN, MS, (founding m e m b e r of t h e Boston T e a c h i n g H o s p i t a l s ICU C o n s o r t i u m ' ) , w e e s t a b l i s h e d t h e p u r p o s e of t h e group, w h i c h w a s to p r o v i d e a l o w - c o s t quality a p p r o a c h to n u r s i n g e d u c a t i o n . We d e v e l o p e d t w o alld a y p r o g r a m s , "Triage: R a p i d A s s e s s m e n t and D e c i s i o n Making" a n d " C o n t e m p o r a r y Issues." N o w in our fourth year, m e m b e r s h i p r e m a i n s c o m m i t t e d and p r o g r a m p l a n n i n g is t h e p r i m a r y focus for t h e group.
I
Logistics M e m b e r s h i p is o b t a i n e d t h r o u g h formal a p p l i c a t i o n to t h e group. We r e q u i r e r e p r e s e n t a t i o n at 80% of t h e m e e t i n g s a n d 50% of t h e p r o g r a m s . In addition, w e require a c o m m i t m e n t from t h e a d m i n i s t r a t i o n of e a c h i n d i v i d u a l institution. We r o t a t e our m o n t h l y m e e t i n g l o c a t i o n s a m o n g m e m b e r hospitals. C h a i r p e r s o n res p o n s i b i l i t i e s are r o t a t e d e v e r y 6 m o n t h s a m o n g t h e m e m b e r s h i p . E a c h h o s p i t a l s e n d s one r e p r e s e n t a t i v e w h o m i g h t b e a n u r s e educator, staff nurse, or n u r s e manager from either a n e m e r g e n c y d e p a r t m e n t or an a m b u l a t o r y c a r e setting.
Susanne Bottiggi is Adult Clinical Nurse Specialist, Emergency Department, Boston Medical Center (formerly Boston City Hospital), Boston, Massachusetts. Joan Meunier-Sham is Pediatric Clinical Nurse Specialist, Emergency Department, Boston Medical Center. Kathleen Walsh is Clinical Nurse Specialist, Emergency Department, Massachusetts General Hospital. Cynthia La Sala is Clinical Educator, Boston Veteran's Administration Hospital. For reprints, write Susanne Bottiggi, RN, MSN, CEN, 466 Pine Street, Marshfield, MA 02050. J Emerg Nuts 1998;24:27-30• Copyright © 1998 by the Emergency Nurses Association. 0099-1767/98 $5.00 + 0 18/1/87125
M i n u t e s are r e c o r d e d a n d p r o c e s s e d b y t h e repr e s e n t a t i v e of t h e h o s t h o s p i t a l e a c h m o n t h . T h e a g e n d a for e a c h m e e t i n g is f o r m u l a t e d b y t h e current c h a i r p e r s o n w i t h i n p u t from t h e m e m b e r s h i p . A g e n d a i t e m s i n c l u d e t h e d i s c u s s i o n of m u t u a l e d u cational and practice issues, program development, r e s o u r c e identification, a n d d i s t r i b u t i o n of w o r k l o a d to s u p p o r t a n d i m p l e m e n t e d u c a t i o n a l p r o g r a m s .
Program development Initially w e e x p r e s s e d a n e e d for a c o u r s e reflective of core e m e r g e n c y c o n c e p t s for p u r p o s e s of o r i e n t a t i o n for ED staff n u r s e s . However, after m u c h d i s c u s s i o n w e d e t e r m i n e d t h a t this c o n t e n t w o u l d r e m a i n instit u t i o n s p e c i f i c rather t h a n c o n s o r t i u m b a s e d b e c a u s e of t h e d i f f e r e n c e s in t r a i n i n g a n d d e v e l o p m e n t m o d els. In addition, e d u c a t i o n a n d o r i e n t a t i o n requirem e n t s v a r i e d significantly. Other n e e d s i d e n t i f i e d w e r e in t h e a r e a s of n e w clinical p r a c t i c e t r e n d s and triage. W i t h t h e s e n e e d s in mind, w e d e c i d e d to (1) d e v e l o p c o n t e n t t h a t reflected c o n t e m p o r a r y i s s u e s f a c e d b y e m e r g e n c y n u r s i n g a n d (2) d e v e l o p a t r i a g e c o u r s e t h a t reflects t h e b a s i c c o m p o n e n t s of t h e t r i a g e role.
M i n u t e s are r e c o r d e d a n d orocessed by the r e p r e s e n t a t i v e of t h e h o s t h o s p i t a l e a c h m o n t h . The a g e n d a for e a c h m e e t i n g is ~!ormulated b y t h e c u r r e n t chairperson w i t h i n p u t from ~he m e m b e r s h i p .
C o n t e n t a n d b r o a d p r o g r a m o b j e c t i v e s w e r e det e r m i n e d t h r o u g h staff a n d m a n a g e m e n t i n p u t and i n - d e p t h d i s c u s s i o n s r e l e v a n t to p r a c t i c e t r e n d s and c h a n g e s in protocols w i t h i n e a c h institution. P r o g r a m p l a n n i n g for " C o n t e m p o r a r y Issues," our first 8-hour p r o g r a m , involved looking a t p a t i e n t p o p u l a t i o n s at
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JOURNAL OF EMERGENCYNURSING/Bottiggi,Meunier-Sham,Walsh, and La Sala
Responsibilities are divided as follows: Speaker Liaison Makes speaker contact Discusses content and objectives
Obtains bio-sketch information, speaker handouts, and audiovisual requests Sends speaker confirmation and thank-you letters Host Facility M e m b e r
Secures the room and audiovisual equipment Determines the number of participants from each hospital Provides information about parking, directions, and luncheon locations Determines if space is available to participants outside the Consortia
tion of b o t h 8-hour courses, w e d e c i d e d to offer a " C o n t e m p o r a r y Issues" p r o g r a m a n n u a l l y a n d t h e triage course biannually. M e m b e r s h i p size l e n d s itself to a large pool of p o t e n t i a l speakers. Selection is m a d e from the followi n g pool: staff w i t h i n r e s p e c t i v e i n s t i t u t i o n s , experts h e a r d t h r o u g h E m e r g e n c y N u r s e s A s s o c i a t i o n contacts, or p e r s o n s from d i s c i p l i n e s o u t s i d e the ED realm, s u c h as law e n f o r c e m e n t , legal experts, a n d social s e r v i c e s . Our goal is to p r o v i d e q u a l i t y p r o g r a m m i n g while k e e p i n g costs to a m i n i m u m . N e g o t i a t i o n s w i t h s p e a k e r s involve availability, rev i e w i n g p o t e n t i a l c o n t e n t a n d objectives, a n d determ i n i n g if the i n d i v i d u a l is willing to s p e a k w i t h o u t honorarium.
Other Members
Obtain CE approval Prepare program packets with schedule, objectives, content, and handouts Prepare evaluation tool Oversee registration Perform speaker introductions Collect evaluation tool and distribute CE certificates Perform written course evaluation, review ideas for future programming, and present findings at upcoming meeting Distribute a photocopy of the course roster for each facility Maintain a record of CEU approval, program packet summary evaluation, and attendance list for the program Serve as a vendor contact person
Agenda items include the d i s c u s s i o n of m u t u a l educational and practice issues, program development, r e s o u r c e identification, a n d d i s t r i b u t i o n of w o r k l o a d to s u p p o r t a n d implement educational programs.
Figure 1
Guidelines for program development.
h i g h risk for l i f e - t h r e a t e n i n g c o n d i t i o n / i n j u r y b u t low v o l u m e (conditions n o t always o b s e r v e d d u r i n g orientation). Topics s u c h as toxicology, t h r o m b o l y t i c therapy, h a z a r d o u s materials, a n d t u b e r c u l o s i s w e r e considered. T h e s u c c e s s a n d e a s e of c o m p l e t i n g our first 8-hour e n d e a v o r w a s t h e d r i v i n g force b e h i n d t h e p l a n n i n g of t h e s e c o n d offering. D e v e l o p m e n t of t h e c o u r s e "Triage: R a p i d A s s e s s m e n t a n d D e c i s i o n Making" w a s possible after m e m b e r s explored t h e various triage m o d e l s at e a c h e m e r g e n c y d e p a r t m e n t . T h e e m p h a s i s of p r o g r a m c o n t e n t w a s p l a c e d on a p h y s i c a l a s s e s s m e n t while c o n d u c t i n g a f o c u s e d i n t e r v i e w i n the areas of n e u r o logic, psychiatric, cardiopulmonary, a b d o m i n a l / g e n i tourinary, pediatrics, obstetrics, i n f e c t i o u s diseases, a n d m u s c u l o s k e l e t a l conditions. E m e r g e n t or priority one c a t e g o r i z a t i o n s w e r e h i g h l i g h t e d in t h e c o n t e n t of e a c h b o d y system. After s u c c e s s f u l i m p l e m e n t a -
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R e s p o n s i b i l i t i e s for e a c h p r o g r a m offering are del i n e a t e d (Figure 1) to e n s u r e t h a t no o n e p e r s o n feels "overwhelmed" w i t h workload related to a n y offering. We d i v i d e d the labor partially o n t h e b a s i s of t h e Operational G u i d e l i n e s of t h e ICU Consortium. 2 The division of labor is i n i t i a t e d b y t h e c o m m i t tee chair, w h o often takes on t h e role of p r o g r a m coordinator. For s o m e p r o g r a m s a co-coordinator is selected, n o t only to facilitate p l a n n i n g b u t to oversee t h e d a y ' s activities at t h e host site of t h e offering. We are r e s p o n s i b l e for i n f o r m i n g m a n a g e r s , directors, a n d / o r e d u c a t i o n coordinators to avoid a s c h e d u l i n g conflict w i t h other e n d e a v o r s a n d to s u p port m a x i m u m p r o g r a m a t t e n d a n c e . M a r k e t i n g for e a c h offering is c o m p l e t e d 2 m o n t h s before e a c h prog r a m date for s c h e d u l i n g purposes. R e g i s t r a t i o n of p a r t i c i p a n t s is c o o r d i n a t e d t h r o u g h e a c h m e m b e r or by a designee within each institution. Approximately 1 m o n t h before the course d a t e w e confirm t h e registration n u m b e r s to d e t e r m i n e if w e c a n allow a t t e n d a n c e from o u t s i d e t h e Consortium. A $25.00 fee is
Bottiggi, Meunier-Sham, Walsh, and La Sala/JOURNAL OF EMERGENCYNURSING
c h a r g e d per outside p a r t i c i p a n t and the a c c o u n t for all p r o g r a m m i n g allowing outside a t t e n d a n c e m a y be m a i n t a i n e d by the institution w e d e c i d e is the b e s t e q u i p p e d for this task. Money from the a c c o u n t m a y be u s e d to v i d e o t a p e a program, to defray instructor parking costs, or to provide refreshments. C o m m e n t s noted on evaluations have b e e n the i m p e t u s for a r e c e n t program on d o m e s t i c violence. The triage course w a s originally i n t e n d e d for emerg e n c y nurses with less t h a n 2 years of experience, yet m a n y p a r t i c i p a n t s were nurses with greater t h a n 6 years of e x p e r i e n c e who found the course to be an important review.
(topics s u c h as t o x i c o l o g y , ~:hrombolytic therapy, hazardous materials, and tuberculosis were considered.
While recognizing the n e e d for limiting the size of the Consortium, we e x p r e s s e d regret at not allowing other nurse e d u c a t o r s to share in the networking activity that b e i n g part of the Consortium afforded us. We d i s c u s s e d different m e a n s of e x t e n d i n g such networking, w h i c h included the creation of a newsletter or home p a g e on the Internet. The Consortium has also dealt with the issue of diversification on two fronts: diversification of practice setting and diversification of knowledge base. Many m a n a g e d care providers increasingly insist that all nonurgent and even some u r g e n t requests for medical care be provided in c o m m u n i t y or clinic settings. This c h a n g e n e c e s s i t a t e s that nurses working in t h e s e settings have astute triage skills, as well as other e m e r g e n c y nursing skflls. This n e e d has b e e n reflected in c o m m e n t s from both the m e m b e r s h i p and other program participants.
r . ~ o ~ e ! ~ l a ~ sOlLteci.Oh ~50 , ~
Future d i r e c t i o n s
The c h a n g i n g c l i m a t e of h e a l t h care h a s c r e a t e d two major i s s u e s for t h e Consortium: the i s s u e s of C o n s o r t i u m size a n d diversification. As m o s t of t h e f o u n d i n g i n s t i t u t i o n s m e r g e or s t r e n g t h e n affiliations w i t h h o s p i t a l s w i t h i n a n d o u t s i d e of the Boston area, t h e C o n s o r t i u m h a d to c o n t e n d w i t h t h e i s s u e of C o n s o r t i u m size. F a c e d w i t h more a n d more r e q u e s t s for m e m b e r s h i p by nurse e d u c a t o r s in t h e s e often smaller, c o m m u n i t y - b a s e d hospitals, we n e e d e d to d e c i d e if we could e x p a n d our s c o p e of r e s p o n s i b i l i t y b e y o n d t h e original e i g h t m e m b e r institutions. W h e r e a s m e m b e r s w e r e very open to the i s s u e of n e w m e m b e r s h i p , several c o n c r e t e i s s u e s s u c h as l i m i t e d a u d i t o r i u m s p a c e for e d u c a t i o n a l offeri n g s f o r c e d us to m a k e a d e c i s i o n r e g a r d i n g C o n s o r t i u m size. We d e c i d e d t h a t t h e C o n s o r t i u m would c o n t i n u e to c o n s i s t of t h e e i g h t f o u n d i n g ins t i t u t i o n s a n d four other t e a c h i n g h o s p i t a l s w h o joined w i t h i n t h e first 6 months. R e p r e s e n t a t i v e s from t h o s e i n s t i t u t i o n s would be r e s p o n s i b l e for acting as c o n d u i t s for information to the other n u r s e e d u c a t o r s w i t h i n t h e m e r g e d entities. F o u n d i n g ins t i t u t i o n s would c o n t i n u e to be allotted a s e t numb e r of s p a c e s for e d u c a t i o n a l offerings. A n y a d d i t i o n a l s p a c e s would b e a l l o c a t e d for affiliate m e m b e r s , hospitals, a n d n u r s i n g schools o u t s i d e t h e Consortium.
i s s u e s of b o t h c o n s o r t i u m size and diversification has b e e n a p r o p o s a l to d e v e l o p b o t h ~oediatric a n d u r g i c a r e s u b c o m m i t t e e s to m e e t t h e n e e d s of n u r s e s in t h e s e settings.
Likewise, the educational n e e d s of nurses working with pediatric p a t i e n t s in e m e r g e n c y settings are often different from those of nurses working primarily with an adult p a t i e n t population. One potential solution to the issues of both consortium size and diversification has b e e n a proposal to develop both pediatric and urgicare s u b c o m m i t t e e s to m e e t the n e e d s of nurses in t h e s e settings. Conclusion
The ED Consortium originally w a s developed to provide quality e d u c a t i o n a l offerings for e m e r g e n c y nurses. While continuing to m e e t this objective, the ED Consortium provides a rich networking opportunity for m e m b e r s and institutions. The c h a n g i n g face of health care provides challenges and opportunities for the Consortium to diversify its role in e m e r g e n c y nursing education.
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JOURNAL OF EMERGENCYNURSING/Bottiggi,Meunier-Sham,Walsh, and La Sala
We acknowledge the members of the ED Consortium: Maureen Beaulieu, RN, BSN, Staff Nurse, Massachusetts General Hospital; Carol Fackler, RN, MS, East Boston Neighborhood Health Center; Mary Fallon-Smith, RN, MSN, Clinical Nurse Specialist, Children's Hospital; Diane Gary, RN, East Boston Neighborhood Health Center; Kathy Kelley, RN, Children's Hospital; Mary Elizabeth Kelly, MS, RN, CNA, Nurse Manager Ambulatory Care, Brockton/West Roxbury Veteran's Administration Hospital; Judy Ledwith, RN, Veteran's Administration Medical Center, West Roxbury and Boston; Peggy Mogan, ED Educator, Brigham and Woman's Hospital; Ann B. Morrison, Staff Nurse, BethIsrael Deaconess Medical Center; Karen Phillips, RN, New England Medical Center; Pat Prawlucki, RN, Nursing
O
Education, St. Elizabeth's Hospital; Mary Prince, RN, BSN, Clinical Nurse, Beth Israel-Deaconess Medical Center; Karen Schoch, RN, MA, CEN, Clinical Leader, Mount Auburn Hospital; and Judy Wendt, RN, Veteran's Administration Medical Center, West Roxbury and Boston. References
1. Slate E, May L, Doucet M, Stark J. An urban consortium: a low cost quality approach to critical care education. J Cont Ed Nurs 1985;16:193-6. 2. ICU Consortium Members. Operational guidelines ef the ICU Consortium. Boston Teaching Hospitals, Boston, MA, 1996.
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n a c l i m a t e of evolving m a n a g e d c a r e a n d d w i n dling r e s o u r c e s , e d u c a t i o n d e p a r t m e n t s in h o s p i tals are hard p r e s s e d to p r o v i d e c o n t i n u i n g e d u c a t i o n t h a t m e e t s t h e n e e d s of their staff, e s p e c i a l l y staff w h o r e q u i r e d i s c i p l i n e - s p e c i f i c e d u c a t i o n . E d u c a t o r s from e i g h t t e a c h i n g h o s p i t a l s in Boston, M a s s a c h u s e t t s , j o i n e d forces in 1993 to form a n ED C o n s o r t i u m to m e e t specific e d u c a t i o n a l n e e d s of ED nurses. M e m b e r s of t h e Boston T e a c h i n g Hospitals ICU C o n s o r t i u m w e r e i n v i t e d to h a v e r e p r e s e n t a t i o n from their e m e r g e n c y d e p a r t m e n t s . T h e s e h o s p i t a l s repres e n t e d a d u l t a n d p e d i a t r i c level I a n d level II t r a u m a c e n t e r s a n d t h e D e p a r t m e n t of V e t e r a n s Affairs M e d i c a l Centers. G u i d e d b y J u n e Stark, RN, MS, (founding m e m b e r of t h e Boston T e a c h i n g H o s p i t a l s ICU C o n s o r t i u m ' ) , w e e s t a b l i s h e d t h e p u r p o s e of t h e group, w h i c h w a s to p r o v i d e a l o w - c o s t quality a p p r o a c h to n u r s i n g e d u c a t i o n . We d e v e l o p e d t w o alld a y p r o g r a m s , "Triage: R a p i d A s s e s s m e n t and D e c i s i o n Making" a n d " C o n t e m p o r a r y Issues." N o w in our fourth year, m e m b e r s h i p r e m a i n s c o m m i t t e d and p r o g r a m p l a n n i n g is t h e p r i m a r y focus for t h e group.
I
Logistics M e m b e r s h i p is o b t a i n e d t h r o u g h formal a p p l i c a t i o n to t h e group. We r e q u i r e r e p r e s e n t a t i o n at 80% of t h e m e e t i n g s a n d 50% of t h e p r o g r a m s . In addition, w e require a c o m m i t m e n t from t h e a d m i n i s t r a t i o n of e a c h i n d i v i d u a l institution. We r o t a t e our m o n t h l y m e e t i n g l o c a t i o n s a m o n g m e m b e r hospitals. C h a i r p e r s o n res p o n s i b i l i t i e s are r o t a t e d e v e r y 6 m o n t h s a m o n g t h e m e m b e r s h i p . E a c h h o s p i t a l s e n d s one r e p r e s e n t a t i v e w h o m i g h t b e a n u r s e educator, staff nurse, or n u r s e manager from either a n e m e r g e n c y d e p a r t m e n t or an a m b u l a t o r y c a r e setting.
Susanne Bottiggi is Adult Clinical Nurse Specialist, Emergency Department, Boston Medical Center (formerly Boston City Hospital), Boston, Massachusetts. Joan Meunier-Sham is Pediatric Clinical Nurse Specialist, Emergency Department, Boston Medical Center. Kathleen Walsh is Clinical Nurse Specialist, Emergency Department, Massachusetts General Hospital. Cynthia La Sala is Clinical Educator, Boston Veteran's Administration Hospital. For reprints, write Susanne Bottiggi, RN, MSN, CEN, 466 Pine Street, Marshfield, MA 02050. J Emerg Nuts 1998;24:27-30• Copyright © 1998 by the Emergency Nurses Association. 0099-1767/98 $5.00 + 0 18/1/87125
M i n u t e s are r e c o r d e d a n d p r o c e s s e d b y t h e repr e s e n t a t i v e of t h e h o s t h o s p i t a l e a c h m o n t h . T h e a g e n d a for e a c h m e e t i n g is f o r m u l a t e d b y t h e current c h a i r p e r s o n w i t h i n p u t from t h e m e m b e r s h i p . A g e n d a i t e m s i n c l u d e t h e d i s c u s s i o n of m u t u a l e d u cational and practice issues, program development, r e s o u r c e identification, a n d d i s t r i b u t i o n of w o r k l o a d to s u p p o r t a n d i m p l e m e n t e d u c a t i o n a l p r o g r a m s .
Program development Initially w e e x p r e s s e d a n e e d for a c o u r s e reflective of core e m e r g e n c y c o n c e p t s for p u r p o s e s of o r i e n t a t i o n for ED staff n u r s e s . However, after m u c h d i s c u s s i o n w e d e t e r m i n e d t h a t this c o n t e n t w o u l d r e m a i n instit u t i o n s p e c i f i c rather t h a n c o n s o r t i u m b a s e d b e c a u s e of t h e d i f f e r e n c e s in t r a i n i n g a n d d e v e l o p m e n t m o d els. In addition, e d u c a t i o n a n d o r i e n t a t i o n requirem e n t s v a r i e d significantly. Other n e e d s i d e n t i f i e d w e r e in t h e a r e a s of n e w clinical p r a c t i c e t r e n d s and triage. W i t h t h e s e n e e d s in mind, w e d e c i d e d to (1) d e v e l o p c o n t e n t t h a t reflected c o n t e m p o r a r y i s s u e s f a c e d b y e m e r g e n c y n u r s i n g a n d (2) d e v e l o p a t r i a g e c o u r s e t h a t reflects t h e b a s i c c o m p o n e n t s of t h e t r i a g e role.
M i n u t e s are r e c o r d e d a n d orocessed by the r e p r e s e n t a t i v e of t h e h o s t h o s p i t a l e a c h m o n t h . The a g e n d a for e a c h m e e t i n g is ~!ormulated b y t h e c u r r e n t chairperson w i t h i n p u t from ~he m e m b e r s h i p .
C o n t e n t a n d b r o a d p r o g r a m o b j e c t i v e s w e r e det e r m i n e d t h r o u g h staff a n d m a n a g e m e n t i n p u t and i n - d e p t h d i s c u s s i o n s r e l e v a n t to p r a c t i c e t r e n d s and c h a n g e s in protocols w i t h i n e a c h institution. P r o g r a m p l a n n i n g for " C o n t e m p o r a r y Issues," our first 8-hour p r o g r a m , involved looking a t p a t i e n t p o p u l a t i o n s at
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Responsibilities are divided as follows: Speaker Liaison Makes speaker contact Discusses content and objectives
Obtains bio-sketch information, speaker handouts, and audiovisual requests Sends speaker confirmation and thank-you letters Host Facility M e m b e r
Secures the room and audiovisual equipment Determines the number of participants from each hospital Provides information about parking, directions, and luncheon locations Determines if space is available to participants outside the Consortia
tion of b o t h 8-hour courses, w e d e c i d e d to offer a " C o n t e m p o r a r y Issues" p r o g r a m a n n u a l l y a n d t h e triage course biannually. M e m b e r s h i p size l e n d s itself to a large pool of p o t e n t i a l speakers. Selection is m a d e from the followi n g pool: staff w i t h i n r e s p e c t i v e i n s t i t u t i o n s , experts h e a r d t h r o u g h E m e r g e n c y N u r s e s A s s o c i a t i o n contacts, or p e r s o n s from d i s c i p l i n e s o u t s i d e the ED realm, s u c h as law e n f o r c e m e n t , legal experts, a n d social s e r v i c e s . Our goal is to p r o v i d e q u a l i t y p r o g r a m m i n g while k e e p i n g costs to a m i n i m u m . N e g o t i a t i o n s w i t h s p e a k e r s involve availability, rev i e w i n g p o t e n t i a l c o n t e n t a n d objectives, a n d determ i n i n g if the i n d i v i d u a l is willing to s p e a k w i t h o u t honorarium.
Other Members
Obtain CE approval Prepare program packets with schedule, objectives, content, and handouts Prepare evaluation tool Oversee registration Perform speaker introductions Collect evaluation tool and distribute CE certificates Perform written course evaluation, review ideas for future programming, and present findings at upcoming meeting Distribute a photocopy of the course roster for each facility Maintain a record of CEU approval, program packet summary evaluation, and attendance list for the program Serve as a vendor contact person
Agenda items include the d i s c u s s i o n of m u t u a l educational and practice issues, program development, r e s o u r c e identification, a n d d i s t r i b u t i o n of w o r k l o a d to s u p p o r t a n d implement educational programs.
Figure 1
Guidelines for program development.
h i g h risk for l i f e - t h r e a t e n i n g c o n d i t i o n / i n j u r y b u t low v o l u m e (conditions n o t always o b s e r v e d d u r i n g orientation). Topics s u c h as toxicology, t h r o m b o l y t i c therapy, h a z a r d o u s materials, a n d t u b e r c u l o s i s w e r e considered. T h e s u c c e s s a n d e a s e of c o m p l e t i n g our first 8-hour e n d e a v o r w a s t h e d r i v i n g force b e h i n d t h e p l a n n i n g of t h e s e c o n d offering. D e v e l o p m e n t of t h e c o u r s e "Triage: R a p i d A s s e s s m e n t a n d D e c i s i o n Making" w a s possible after m e m b e r s explored t h e various triage m o d e l s at e a c h e m e r g e n c y d e p a r t m e n t . T h e e m p h a s i s of p r o g r a m c o n t e n t w a s p l a c e d on a p h y s i c a l a s s e s s m e n t while c o n d u c t i n g a f o c u s e d i n t e r v i e w i n the areas of n e u r o logic, psychiatric, cardiopulmonary, a b d o m i n a l / g e n i tourinary, pediatrics, obstetrics, i n f e c t i o u s diseases, a n d m u s c u l o s k e l e t a l conditions. E m e r g e n t or priority one c a t e g o r i z a t i o n s w e r e h i g h l i g h t e d in t h e c o n t e n t of e a c h b o d y system. After s u c c e s s f u l i m p l e m e n t a -
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R e s p o n s i b i l i t i e s for e a c h p r o g r a m offering are del i n e a t e d (Figure 1) to e n s u r e t h a t no o n e p e r s o n feels "overwhelmed" w i t h workload related to a n y offering. We d i v i d e d the labor partially o n t h e b a s i s of t h e Operational G u i d e l i n e s of t h e ICU Consortium. 2 The division of labor is i n i t i a t e d b y t h e c o m m i t tee chair, w h o often takes on t h e role of p r o g r a m coordinator. For s o m e p r o g r a m s a co-coordinator is selected, n o t only to facilitate p l a n n i n g b u t to oversee t h e d a y ' s activities at t h e host site of t h e offering. We are r e s p o n s i b l e for i n f o r m i n g m a n a g e r s , directors, a n d / o r e d u c a t i o n coordinators to avoid a s c h e d u l i n g conflict w i t h other e n d e a v o r s a n d to s u p port m a x i m u m p r o g r a m a t t e n d a n c e . M a r k e t i n g for e a c h offering is c o m p l e t e d 2 m o n t h s before e a c h prog r a m date for s c h e d u l i n g purposes. R e g i s t r a t i o n of p a r t i c i p a n t s is c o o r d i n a t e d t h r o u g h e a c h m e m b e r or by a designee within each institution. Approximately 1 m o n t h before the course d a t e w e confirm t h e registration n u m b e r s to d e t e r m i n e if w e c a n allow a t t e n d a n c e from o u t s i d e t h e Consortium. A $25.00 fee is
Bottiggi, Meunier-Sham, Walsh, and La Sala/JOURNAL OF EMERGENCYNURSING
c h a r g e d per outside p a r t i c i p a n t and the a c c o u n t for all p r o g r a m m i n g allowing outside a t t e n d a n c e m a y be m a i n t a i n e d by the institution w e d e c i d e is the b e s t e q u i p p e d for this task. Money from the a c c o u n t m a y be u s e d to v i d e o t a p e a program, to defray instructor parking costs, or to provide refreshments. C o m m e n t s noted on evaluations have b e e n the i m p e t u s for a r e c e n t program on d o m e s t i c violence. The triage course w a s originally i n t e n d e d for emerg e n c y nurses with less t h a n 2 years of experience, yet m a n y p a r t i c i p a n t s were nurses with greater t h a n 6 years of e x p e r i e n c e who found the course to be an important review.
(topics s u c h as t o x i c o l o g y , ~:hrombolytic therapy, hazardous materials, and tuberculosis were considered.
While recognizing the n e e d for limiting the size of the Consortium, we e x p r e s s e d regret at not allowing other nurse e d u c a t o r s to share in the networking activity that b e i n g part of the Consortium afforded us. We d i s c u s s e d different m e a n s of e x t e n d i n g such networking, w h i c h included the creation of a newsletter or home p a g e on the Internet. The Consortium has also dealt with the issue of diversification on two fronts: diversification of practice setting and diversification of knowledge base. Many m a n a g e d care providers increasingly insist that all nonurgent and even some u r g e n t requests for medical care be provided in c o m m u n i t y or clinic settings. This c h a n g e n e c e s s i t a t e s that nurses working in t h e s e settings have astute triage skills, as well as other e m e r g e n c y nursing skflls. This n e e d has b e e n reflected in c o m m e n t s from both the m e m b e r s h i p and other program participants.
r . ~ o ~ e ! ~ l a ~ sOlLteci.Oh ~50 , ~
Future d i r e c t i o n s
The c h a n g i n g c l i m a t e of h e a l t h care h a s c r e a t e d two major i s s u e s for t h e Consortium: the i s s u e s of C o n s o r t i u m size a n d diversification. As m o s t of t h e f o u n d i n g i n s t i t u t i o n s m e r g e or s t r e n g t h e n affiliations w i t h h o s p i t a l s w i t h i n a n d o u t s i d e of the Boston area, t h e C o n s o r t i u m h a d to c o n t e n d w i t h t h e i s s u e of C o n s o r t i u m size. F a c e d w i t h more a n d more r e q u e s t s for m e m b e r s h i p by nurse e d u c a t o r s in t h e s e often smaller, c o m m u n i t y - b a s e d hospitals, we n e e d e d to d e c i d e if we could e x p a n d our s c o p e of r e s p o n s i b i l i t y b e y o n d t h e original e i g h t m e m b e r institutions. W h e r e a s m e m b e r s w e r e very open to the i s s u e of n e w m e m b e r s h i p , several c o n c r e t e i s s u e s s u c h as l i m i t e d a u d i t o r i u m s p a c e for e d u c a t i o n a l offeri n g s f o r c e d us to m a k e a d e c i s i o n r e g a r d i n g C o n s o r t i u m size. We d e c i d e d t h a t t h e C o n s o r t i u m would c o n t i n u e to c o n s i s t of t h e e i g h t f o u n d i n g ins t i t u t i o n s a n d four other t e a c h i n g h o s p i t a l s w h o joined w i t h i n t h e first 6 months. R e p r e s e n t a t i v e s from t h o s e i n s t i t u t i o n s would be r e s p o n s i b l e for acting as c o n d u i t s for information to the other n u r s e e d u c a t o r s w i t h i n t h e m e r g e d entities. F o u n d i n g ins t i t u t i o n s would c o n t i n u e to be allotted a s e t numb e r of s p a c e s for e d u c a t i o n a l offerings. A n y a d d i t i o n a l s p a c e s would b e a l l o c a t e d for affiliate m e m b e r s , hospitals, a n d n u r s i n g schools o u t s i d e t h e Consortium.
i s s u e s of b o t h c o n s o r t i u m size and diversification has b e e n a p r o p o s a l to d e v e l o p b o t h ~oediatric a n d u r g i c a r e s u b c o m m i t t e e s to m e e t t h e n e e d s of n u r s e s in t h e s e settings.
Likewise, the educational n e e d s of nurses working with pediatric p a t i e n t s in e m e r g e n c y settings are often different from those of nurses working primarily with an adult p a t i e n t population. One potential solution to the issues of both consortium size and diversification has b e e n a proposal to develop both pediatric and urgicare s u b c o m m i t t e e s to m e e t the n e e d s of nurses in t h e s e settings. Conclusion
The ED Consortium originally w a s developed to provide quality e d u c a t i o n a l offerings for e m e r g e n c y nurses. While continuing to m e e t this objective, the ED Consortium provides a rich networking opportunity for m e m b e r s and institutions. The c h a n g i n g face of health care provides challenges and opportunities for the Consortium to diversify its role in e m e r g e n c y nursing education.
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JOURNAL OF EMERGENCYNURSING/Bottiggi,Meunier-Sham,Walsh, and La Sala
We acknowledge the members of the ED Consortium: Maureen Beaulieu, RN, BSN, Staff Nurse, Massachusetts General Hospital; Carol Fackler, RN, MS, East Boston Neighborhood Health Center; Mary Fallon-Smith, RN, MSN, Clinical Nurse Specialist, Children's Hospital; Diane Gary, RN, East Boston Neighborhood Health Center; Kathy Kelley, RN, Children's Hospital; Mary Elizabeth Kelly, MS, RN, CNA, Nurse Manager Ambulatory Care, Brockton/West Roxbury Veteran's Administration Hospital; Judy Ledwith, RN, Veteran's Administration Medical Center, West Roxbury and Boston; Peggy Mogan, ED Educator, Brigham and Woman's Hospital; Ann B. Morrison, Staff Nurse, BethIsrael Deaconess Medical Center; Karen Phillips, RN, New England Medical Center; Pat Prawlucki, RN, Nursing
O
Education, St. Elizabeth's Hospital; Mary Prince, RN, BSN, Clinical Nurse, Beth Israel-Deaconess Medical Center; Karen Schoch, RN, MA, CEN, Clinical Leader, Mount Auburn Hospital; and Judy Wendt, RN, Veteran's Administration Medical Center, West Roxbury and Boston. References
1. Slate E, May L, Doucet M, Stark J. An urban consortium: a low cost quality approach to critical care education. J Cont Ed Nurs 1985;16:193-6. 2. ICU Consortium Members. Operational guidelines ef the ICU Consortium. Boston Teaching Hospitals, Boston, MA, 1996.
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