Question: CEN (Certified Emergency Nurse) Requirements?

[UMSTUDENT]

Scenario: You bring a patient to the hospital who has a VERY symptomatic bradycardia (idioventricular rhythm). The patient, for all intensive purposes, is barely conscious and has a sense of impending doom. You're pacing the patient, having gotten good electrical and mechanical capture. You've successfully raised the patient's blood pressure to a respectable 80 systolic, which is of course much better than the unobtainable one you auscultated inside the nursing home.You're coming from a nursing home across the street so pressors are not on board...

You bring your patient into the code room of the local emergency room and while the doctor is attempting to secure central venous access, your local emergency nurses pull off your limb leads and turn off your monitor. Keep in mind that they've been instructed several times by the Paramedic team (including supervisor) that you are indeed pacing successfully. The physician has asked you to keep the patient on your monitor. ALSO keep in mind that the nursing team has not turned on their LP 20, nor have they prepared to make the transition to their monitor. Finally, your patient decompensates with the lack of electrical assistance and the physician gets lividly pissed. It is only with your EMS team's assistance and the assistance of an experienced nurse that pacing is restored. The physician successfully establishes his line, dopamine is hung, and he prepares to insert a transvenous pacer. Patient is stabilized.

My question: What education do RNs receive in most nursing programs regarding cardiology? How about at the BSN level? Finally, how does a CEN differ from a regularly licensed RN and what does that certification entail? I'm asking respectfully, because I'd like to think that there is a reason for this problem.

[Ridryder 911]

Most nursing programs only teach the very basic of cardiology. It is considered a speciality and cannot even be tested on the NLN Board. It is presumed that one will attend speciality classes and orientation courses in the field they choose after they gain employment. The BSN has no more or less in emergency education than a ADN, rather the emphasis is usually management and public health care.

CEN is test similar to the Paramedic examination, actually better written and wished we would utilize it. It is for nurses that have ED experience and have attended courses to make them aware of Emergency Nursing and the knowledge and skills required. It does NOT allow them to perform or do anything differently than before, rather it is a recognition that the nurse has taken an initiative to increase their profession and to promote speciality knowledge.

I recognize your concern, just remember though I have seen as many medics be as stupid and attempt to convince others that they have the required knowledge (since EMS is a specialty) and they do not. This comes down to watered down ACLS and cardiology courses, that I now also see the same results in the prehospital arena too.

Maybe a possible dual in service after discussing the problem with the Clinical Mgr. this would hopefully gain education for both and promote a better working environment.

R/r911

[crotchitymedic1986]

I feel your pain -- and although changing training standards seems reasonable, i doubt it will have the outcome you desire (not all nurses are certified emergency nurses). Here is what we did instead: we met with the ER that we go to the most and talked with them about trying to purchase the same monitor (either us transition to theirs, or they transition to ours), but that didnt work, as the monitor they preferred didnt work well in the field. JCAHO had recommended that hospitals who had different styles of monitors make sure that they moved to a single type of monitor for the whole hospital (employees would only need to be trained on one monitor -- not a different monitor for every floor, crash cart and unit). Our hospital had already spent alot of money on that improvement, and werent interested in switching to another brand after that expenditure. So what they did do, is go in with us to (half/half) to purchase another spare monitor for us. That way when we arrived at any hospital, the monitor could remain on the patient as long as necessary. A supervisor would bring us another monitor, and wait the 30-40 minutes it usually took to safely transition the patient to the hospital's monitor. After the purchase, we attended a monthly ER staff meeting, and had a training session (which all ER nurses took and signed off on the training) with the staff. The bad news is that with turnover, you have to go back ever so often to review with the new staff. But ER managers generally are receptive to it, because it is training that looks good to JCAHO.