My name is Kathleen Robinson and I'm very pleased to be with you today. Today our objectives include discuss the steps required to evaluate one's personal and professional journey to explain the five professional pathways available to emergency nurses, three state various professional opportunities that exist within the professional pathways, and four, describe the importance of maintaining passion and compassion in emergency nursing in order to ensure longevity and practice. The professional journey that one takes as an emergency nurse can lead down many roads and around many corners, knowledge, growth and development exists at every turn, and the opportunity to care for others is always present. The key is to explore one's passions while maintaining compassion, the potential career paths that an emergency nurse can travel in order to find personal and professional fulfillment while maintaining longevity in emergency nursing will be discussed. When you consider your own personal and professional path, it's really important to reflect upon where you've been, where you are, and where you want to go, so you have to start asking yourself some questions in the very beginning and bring yourself back to your why of nursing. Why did you want to become a nurse? What in nursing gives you that extraordinary professional satisfaction? Do you nurse from the heart and the head? What encourages you? What do you see for your future? My name is Kathleen Robinson. I've been a nurse for over 30 years, and yes, an emergency nurse for over 28, and when I graduated back in 1992, we still had the pleasure of wearing caps and being capped. So this is me at my capping ceremony. When I first started off in nursing, I wasn't an emergency nurse at the beginning, but what I discovered very quickly is that I loved the emergency department. I discovered it after I had an opportunity to float down there after being in the telemetry unit and in ICU, and the ICU was interesting and exciting, but the emergency department couldn't get enough. It was fast-paced. It was exciting. It was collaborative. There was teamwork. There was so much opportunity for autonomy and practice, and I had so many opportunities to learn and grow. I just absolutely loved it. What's interesting about being an emergency nurse is that we have the opportunity to care for patients in their greatest moment of need, when they are at their most vulnerable, when things are the most difficult, and patients will allow a nurse into their life. I call this the window of opportunity. We are able to care for patients in their greatest moment of need, in their toughest times, in their most vulnerable times. They will let you care for them. They will let you do things for them. They will tell you things that they wouldn't tell anybody else, and emergency nursing is an extraordinary chance to make somebody's life better, to save a life, to be with them at every one of their moments, and the thing about emergency nursing is either you love it or you hate it. There's kind of no in-between, but if you love it, it is very, very hard to ever leave the emergency department, and the future you can find as an emergency nurse is extraordinary. Throughout my career, I've had the opportunity to explore many types of emergency nursing. I have been a telemetry nurse. I've been an emergency nurse in level one centers for trauma, and I've been in small nine-bedded hospitals up in Yukon in northern Canada. I've had a chance to work in nursing stations. I've been a clinical instructor in academics. I was a clinical nurse specialist in trauma for many years, and a nursing educator in the emergency department for 10 years. I am an ENPC and TNCC instructor, and now I'm the director of operations for 13 emergency departments in the emergency services line, and while all these positions have been different, what's been extraordinary is that they have all been different aspects of emergency nursing, and what I've been able to do is grow and learn within our specialty. There's two things that have kept me in emergency nursing truly. One, there's always been opportunities for personal and professional growth, and two, it's really been the heart of emergency nursing. That is truly what has kept me centered and in love with this specialty. So there are opportunities for life, and the key questions you really want to ask yourself are, what do I really, really love? What am I really passionate about? What do I really want to do? How do I get there, and do I have what it takes to do this? The desire and goal to grow professionally and personally as a nurse is a normal part of professional life. We look to grow as people and as professionals, and because we love emergency nursing, many of us want to stay within emergency nursing. We want to grow and develop within it. So it's really natural for you to say to yourself, what do I want to do next? What do I want to be? And as there are many opportunities, it's really possible just to sort of figure out what the next step will be within the specialty. The key is really to determine what you love, what you're passionate about, and this will help you to identify what your next steps really should be. And then you need to ask yourself, how do I get there? What steps will help me meet my professional goals, or do I have to take, do I have what it takes to do this? A strong belief in emergency nursing in oneself, the passion for what you do, professional map to move your career forward, maintenance of compassion for patients and for other nurses will guide you on your journey in emergency nursing. And the thing is, you need to also be open, you need to be open to new opportunities because you never know what things will come along. So start by asking yourself, what do you truly love? What are you passionate about? What are you good at? What is my clinical expertise? Where do I see my future going? Sometimes it's difficult to figure out what those next steps are going to be. And sometimes it's really nice to have a nurse coach or a mentor to guide you on your way. One of our extraordinary emergency nursing association members is Sarah Wells. Sarah is based out of the West Coast and she is the founder and innovator at the New Nurse Thing, and she is an important nurse mentor and coach. She is passionate about helping nurses of all ages and experiences accomplish their academic, professional and personal goals through supportive coaching and mentorship. And sometimes what you need is that person just to talk to and bounce things off of who has an understanding of what steps are needed, but also what opportunities are out there for you. So look for your mentors, look for the people that you can speak to. And then start thinking about your potential pathways. Finding a pathway can be challenging, there can often be two forks in the road. And this is where you need to trust your intuition and your gut to help guide you in which direction is best for you. Some of the things you might decide to do is maybe you want to go on stretcher side, you decide you love working at the bedside, and this is where your heart really is right now. You want to grow in practice and your ability to help patients and your colleagues better. So you'll stay stretcher side for the moment, because this is where your heart is truly lying. Or maybe you love teaching others and you find inspiration in the growth and development of your colleagues. This might lead you down an education pathway. Perhaps you decide that you're really interested in advanced practice, and you want more diagnostic ability and autonomy in practice, perhaps you would go down the advanced practice pathway. Or you might decide that you're a nurse leader, that you want to lead nurses on to better times in the emergency department or new things. So you become a nurse leader and on that pathway. You decide that you're interested in the professional pathway and it utilizes all of your nursing knowledge and skills in a specialty that complements your practice. Eventually, you're going to go down the professional pathway. Whatever you choose, this should be led by your heart and your mind, and it's the right path for you. Once you've decided what you want to do, the next thing is to determine the steps that you must take in order to start your journey. So the potential pathways are, like I said, stretcher side, education, advanced practice, leadership and professional. And what we're going to do is go through each of these today and talk about all the opportunities that you have and how to get there. So the stretcher side pathway. We're going to be looking at education of self, education of others, specialty, certification and shared governance. Perhaps you've decided that your professional goal is to work as a stretcher side emergency nurse and you want to grow and develop professionally within your current ED. There are a multitude of ways you can continue to learn and evolve as an emergency nurse stretcher side. The first thing is to consider education of self. As an emergency nurse, we commit ourselves to higher levels of education and training in order to meet the needs of our patients and the ever evolving practice of emergency medicine. And so in this, we are naturally committed to education of self. There are many educational opportunities available to emergency nursing, including classes and certifications. Some of the most basic things and some of the most advanced are available always to us. So the first thing we might consider is advancing our academic education. Sometimes we have a basic degree, we'll start off with our associates, and then we think maybe we want to do the BSN, or maybe you're at that point where you're thinking about graduate school. So there are many, many opportunities for you. And what you want to say to yourself first is, why do you want to continue your academic studies? What is it that is going to help you achieve? On what level of academic program was required to meet your goals? Do you need a BSN? Do you need an MSN? Do you need a DNP or a PhD? What are the program requirements? Does this fit your life right now? Because really, timing is so important. And some academic programs are very, very rigorous, and you have to be able to decide, can I fit this program into my life right now? Perhaps moving towards academics right now is not the right thing, but perhaps you also want to consider ensuring that you have all of your basic certifications. Every emergency nurse should have basic life support, but we also all should have advanced cardiac life support and pediatric advanced life support. If you don't have all three of these certifications, this is an excellent place to start, and you should insist upon having these three things for yourself. Once those three things are done, perhaps you want to look at advanced certifications. That includes TNCC, Trauma Nurse Core Curriculum, EMPC, Emergency Nursing Pediatric Course, Advanced Burn Life Support, or ABLS, and the last one is Neonatal Resuscitation, or NRP. So let's talk about these. So TNCC is an excellent course developed and offered by the Emergency Nurses Association. It's really designed to help you develop your basic level of knowledge for trauma care. It's not going to teach you everything in the trauma bay, but you need that core level of knowledge and psychomotor skills to know how to anticipate the needs of your patient who has been traumatically injured. This is an excellent baseline level of nursing knowledge for trauma care, whether you are in a small center or whether you're in a level one trauma center. It's important for every emergency nurse to have this basic trauma nursing education. Another course you could consider if you really like pediatrics is Emergency Nursing Pediatric Course, and this is, again, offered by the ENA, and it is really designed to help the emergency nurse to develop that core base of knowledge, skills, and attitudes towards caring for children in an emergent setting. It's a very challenging course, but it really is a wonderful foundation in pediatric care. And again, it's important for any emergency nurse working in a pediatric center or a center where they have pediatrics and adults combined. It's an excellent base course for any emergency nurse. Another course that's really interesting is called the Advanced Burn Life Support Course, ABLS. We do offer a bit of burn education within TNCC, but it's not a lot. So if you're really interested in burn care or if you work at a burn center, this is a course you really should consider taking. It is the core level knowledge in the psychomotor skills required for care of the patient with burn injuries, and it really does follow along with the resuscitation algorithms that we use in TNCC. So it builds very nicely upon your base level of knowledge if you have taken TNCC before. Most often, this is offered by the American Burn Association. It can be done online or in person, depending on the state that you live in. It's an excellent course. And another course you could consider is NRP, or the Neonatal Resuscitation Program. This comes from the American Academy of Pediatrics, and it really helps emergency nurses to have the basics in the resuscitation of a neonate. We don't have this every day, but this is a low-frequency, high-acuity situation where you might want to be more proficient in how to resuscitate a very small child. If you're interested in this course, it's also available throughout the U.S. There's also other courses we're offered by the Emergency Nurses Association, including the GENE Program, the Geriatric Emergency Nursing Education Program. And this is really an interesting program because it helps the emergency nurse to develop further knowledge, skills, and attitudes towards care of the geriatric patient. All of us know that geriatrics are a subspecialty within itself in the emergency department, and this gives you a wonderful base in emergency geriatric care. Also online, offered by the ENA. We can also be involved in the education of others. And this is extremely important as we are helping to continue the growth of our specialty. One can be a preceptor, and one can be a mentor. And these are extremely, extremely important roles for a nurse who is dedicated to working stretcher side. So a preceptor, if we look at the clinical definition, it really is a role model, a teacher, a support. A preceptor engages with a new nurse, helping them to transition to the ED through clinical coaching and education, socialization to the ED environment, and team and supervision of clinical skills. Being a preceptor is not easy. It's an extremely challenging job. It helps you to really understand what you know. And the feeling is if you can teach something, then you certainly know it well. According to Shirata Dao, preceptors evaluate clinical competence and document learning progress when they teach and role model time management, priority setting, critical thinking, problem solving, and evidence-based practice. Effective preceptors demonstrate strong interpersonal skills such as communication, conflict management, and collaboration as they facilitate knowledge of organizational standards and social introduction to the unit and healthcare culture. This knowledge to be a really solid preceptor is really, it comes from bedside practice, from being stretcher side with your patients and knowing how to anticipate their care needs. But being a preceptor is challenging because you have to learn how to communicate what you know to your new colleagues. One can be a preceptor during the orientation period or for advanced skill development. For example, maybe a nurse has taken TNCC and they are ready to become a nurse in the trauma bay. You may precept that nurse in an advanced time during their trauma orientation. A nurse mentor is another really wonderful way to be involved stretcher side in the growth and development of your colleagues. A nurse mentor is an experienced nurse who willingly gives time to help a new nurse acclimate and learn in the workplace. A mentor serves as a role model, advocate, and motivator and can have impactful, life-lasting relationships with the mentee. This relationship can facilitate the growth and development of the mentee as an emergency nurse. Mentorships can evolve organically in a nursing department. For example, the clinical nurse educator might mentor a nurse who is considering their next professional career steps. But mentorship can also be a little bit more formal. For example, one could request a mentor within their hospital system because they want to figure out what steps they're going to be next in their professional career. Or an emergency nurse could be involved in the ENA mentorship program. There's lots of subspecialties in emergency nursing as well if you do decide to stay stretcher side for the moment. Pediatrics, trauma, geriatrics, and triage. These are all opportunities that exist within every level of hospital and it's for you to decide what kind of specialty you might want to engage in. So perhaps one wants to be a pediatric emergency nurse. This is truly a subspecialty for caring for children in their greatest moment of need. The PEDS EDRN approaches the needs of a child from a pediatric perspective considering growth and development, communication, and physiologic differences. The PEDS EDRN also cares for the family. This challenging subspecialty can be further developed with ENPC and the pursuit of the certified pediatric emergency nurse certification. Now Cara is a phenomenal pediatric emergency nurse who I had the pleasure of working with. Cara is also a certified pediatric emergency nurse and she is an award winner. She was the certified pediatric emergency nurse highlighted by the BCEN in 2019 as a distinguished pediatric nurse. Cara says, I absolutely love working in pediatric emergency care as a CPEN. The pediatric patients are great, the parents and guardians are grateful, and my co-workers are amazing. Some of the greatest moments I have as a pediatric emergency nurse are when a patient comes in sick or injured and their guardians and the patient can be confused, worried, upset, and experience a host of other emotions. And as a CPEN, I'm able to anticipate what the plan of care should be and I know how to tell them what's happening, what to expect in a way that they will understand. One might decide they want to be more of a trauma certified or trauma specialized nurse and there's lots of preparation that is involved if you want to become a trauma nurse. And it could be a hospital-based trauma orientation program, it could be other programs like TNCC, or you could be going to become a trauma certified registered nurse. Trauma nurses care for all ages of patients who are acutely ill or injured. Ken Reardon, despite the soft appearance with his little girl here, is a very, very accomplished and established trauma nurse. Trauma nursing is the special forces of emergency nursing, Ken says. You must be extremely proficient in all aspects of the patient's care, some obviously and some you may never think of. Trauma, MICU, neurology, anesthesia, pre-hospital, clergy, social services, law enforcement, coroner, etc. You're caring for the newborn to the elderly, the innocent to the convicted, the wealthy to the less wealthy. So you must be able to interact without prejudice to all people. How can you not crave this exciting, challenging, and rewarding part of emergency nursing? Ken Reardon is an exceptional emergency nurse and trauma nurse. One might decide that you want to become subspecialized in geriatric emergency nursing, and this is really a complex and multifaceted type of emergency nursing. There are different types of certifications like we talked about before, the gene course from the ENA, and if you do decide that you really love geriatric emergency nursing and you want your department to become more of a geriatric-centered place, the American College of Emergency Physicians does have a program that can guide you through the development of the geriatric emergency department. Another ENA member spotlight, Chelsea Marinaro, BSN CEM, and she is a geriatric ED nurse navigator. I chose to focus my nursing career in geriatric nursing because I always wanted that extra time when I was clinical to really dive into the specifics of their care. They are such a complex and underappreciated age group, and to be able to assist in their plan of care while ensuring a safe transition home is something I value immensely. To learn more about Chelsea, you'll be able to see her in the case of emergency film as she talks about her experience as an emergency nurse. Triage is another subspecialty and a really challenging aspect of emergency nursing. It really is the most challenging position in the emergency department, as the emergency nurse has to make quick assessments, split-second decisions, and must have excellent communication skills and compassion, all at the front door. While many hospitals offer homegrown triage programs, the ENA also has a very interesting online program as well to help nurses with their online program as well to help nurses learn to refine their triage skills. Now, at the same time, if you're structure-side, you might also think about becoming certified, and there's many different things you can become certified in with the BCEN. Certification as an emergency nurse is an excellent method of learning more about emergency nursing. It's also a commitment to your specialty, and there are five top reasons to become certified according to the BCEN. One is be the best you can be. Increase your knowledge, clinical judgment, and confidence. Stay current and relevant. Be up-to-date on the ever-evolving specialty of emergency nursing. Boost your bottom line and career. Many hospitals offer financial incentives for certified RNs, and more employment opportunities are available to certified nurses. Advance the profession. Certification ensures a high standard of emergency nursing practice. And lastly, do it for your patients, because that's what it's really all about. Let patients know that an emergency nursing expert is caring for them, and it lets them know that you are committed to the specialty of emergency nursing. There are many different certifications that an emergency nurse can pursue. The CEN, or certified emergency nurse, CPEN, the pediatrics, TCRN for trauma, CFRN, certified flight, and CTRN, certified transport. And the newest is the advanced burn, or is the certified burn support nurse, and that is the newest certification from the BCEN. Certainly check out more information on all these certifications at the BCEN website. Next, we want to talk a little bit about something called shared governance, and there's lots of ways for a nurse to have shared governance within their own facility. This is a participatory model, where nurses are involved in the decision-making for their department and institution. There are many ways emergency nurses can be involved in shared governance opportunities. First of all, is ENA membership. You can be a general ENA member, attend meetings and conferences in your state or chapter, or take it up a step further. Become involved in a national committee, or a national work group. There are many, many opportunities for volunteers with the Emergency Nurses Association, and there's a significant opportunity to impact emergency nursing practice and emergency care. If you're interested in different things like quality, you can also become involved in a quality project. Every emergency department monitors quality metrics from stroke to acute coronary syndrome to trauma. Data is gathered and reviewed. Many departments include staff to review data and bring findings and improvements back to their staff. Many departments also have an emergency nurse dedicated to quality review and improvement. Find out from your nursing leadership how you can become involved in quality and involved in the quality improvement process, because emergency nurses who are stretcher-side are the best to understand how quality can be improved at the bedside. Clinical ladder programs are also available in many hospitals, and this is a structured system that enables nurses to grow and develop in their careers through programs, projects, and certifications while remaining at the bedside. Clinical ladder programs recognize and incentivize nurses in their professional development and leads greater nurse involvement and engagement, satisfaction, and retention. For example, you might have a phenomenal idea on how to improve practice at the bedside. Perhaps you want to be involved in how to improve that care, and a clinical ladder program can help you develop a program or develop an initiative and actually implement it while being compensated for it. Next, there's lots of opportunities to be involved in committees, whether it's in your own emergency department, in the community, or with the ENA. Find out what committees exist within your emergency department. Perhaps it's a committee for recruiting. Perhaps it's a committee to be looking at falls. Perhaps it's a committee that's looking at work-life balance for their department. Find a way for you to be involved with your colleagues. And lastly, many departments have something called a unit advisory council. This is a council of nurses who represent the ED at an institutional level to promote collaboration and bi-directional communication within your institution. Unit advisory councils are important. It is the meeting of the minds of the structure side nurses to find ways to assess their own department to see what's working, what's not working well, to communicate with their own leadership, but also with the rest of the hospital. There's also different ways to become involved in education, and this is our educational pathway. Sometimes you might decide that education is really what creates a spark in you, and you really love the opportunity to share with others and to teach others. If you find that you really like to teach, perhaps you want to consider moving down this education pathway. The first type of education moving down this education pathway. The first type of education we want to talk about is community education, and we want to spotlight member Steve Weinman. Steve is from northern New Jersey, and he works in Patterson, New Jersey with St. Joseph's Medical System. Steve actually is very, very passionate about teaching to stop the bleed, and what Steve will do is he will go into the community in downtown Patterson and teach lay people how to put on tourniquets and use dressings to apply pressure in order to control bleeding. The premise of this program, Stop the Bleed, is that if we can teach people in the communities, much like we teach some CPR, how to control bleeding, then we might be able to save lives. What's interesting too is that Steve has been able to establish Stop the Bleed kits in every single one of the little corner stores, so now people on the street in this community are taught, if somebody is bleeding from an injury, to run to the nearest corner store, grab the Stop the Bleed kit with tourniquets and bleeding control supplies, and take it back to the person on the street. Steve has been able to have a tremendous impact in the community he serves, and they have been able to demonstrate that they have saved lives through this at the street level education. If you're interested in becoming a Stop the Bleed instructor, it is very easy, and just go to Stop the Bleed on the internet. You can also decide that you want to do some professional education, and maybe you want to teach TNCC, maybe you want to teach ACLS. There are many, many opportunities for emergency nurses to teach at a high level without having to leave the bedside, so you don't have to be an instructor in a college to teach. You can teach any of these classes that you're constantly taking, and it's wonderful to have the nurses touch when we actually do teach these classes. It does take a little work. The first thing you have to do is become certified and identified as a person who could become an instructor, and you need to be recommended to become an instructor. After you do that, then you would need to complete an instructor course and mentorship throughout these different programs. However, once you are developed and certified as an instructor in any of these programs, you have a lifelong opportunity to share your knowledge with others, which is wonderful. You might want to do education when you're still working at the stretcher side, but you could decide that education is what you want to do more than anything else, and this is where you want to focus your professional development, and if that's the case, maybe you would want to become a clinical nurse educator. This does require an MSN and a considerable amount of clinical experience, and it's also possible to become certified as a clinical nurse educator through the ANDP. There are some very important core competencies that are part of the repertoire of a clinical nurse educator. They tend to have very strong assessment and evaluation strategies and skills. They participate in curriculum design, they evaluate program outcomes and teach, they serve as change agents and leaders, they seek continuous improvement in the nurse educator role, and they engage in scholarship. All of these core competencies are important to help them really develop and employ educational programming for their emergency departments. Member spotlight on Jean Straker-Darbo. Jean is a clinical nurse educator in an emergency department. Jean is prepared with her DNP, and she is a CEM. Jean has been an emergency nursing educator for many years, and she says, I love being a clinical nurse educator because it allows me to shape nurses for the future, to provide the best care in a fast-paced environment, and at times life-threatening situations. I love empowering nurses to provide exceptional care for our patients. You might love teaching stretcher sign, but you might also really enjoy the opportunity to work in academics, and there are many, many opportunities for emergency nurses to transition to being academic educators. Emergency nurses are excellent instructors for clinical rotations, they can be academic administrators, and they can serve as adjunct and full professors. Generally, the requirements for any of these positions do require an MSM, and many, many departments now in academics are preferring either DNP or PhD-prepared nurses. Liz Mizeruk is an emergency nurse from New Jersey, and she is the Director of Nursing Education at Mercer County Community College. Liz has been an emergency nurse for many, many years, and actually still works bedside in addition to being in academics. Liz says, I love teaching, I love helping someone make the connections, the aha moment. Now, if you decide that you're ready to move away from the stretcher side, and you don't think you want to be an educator, but you might like to look at some different professional pathways, you might consider the advanced practice pathway. An advanced practice registered nurse is a registered nurse that has gone through advanced specialty training to gain skills, knowledge, and experience in a specific patient population or skill set. APRNs hold at minimum an MSM, but many continue their education and earn a doctorate in nursing practice. Often, emergency care is offered as a subspecialty in advanced practice nursing programs. So, you might consider being a nurse practitioner, a clinical nurse specialist, a clinical nurse leader, or an advanced practice nurse. A nurse practitioner is a master's or DNP prepared nurse, and these nurses go through graduate school and a tremendous amount of clinical time, and then they must write board exams and be credentialed. But what's interesting about the NP program is that it does teach nurses how to diagnose and treat health conditions while addressing disease prevention, while addressing disease prevention, and comprehensive health management. Nurse practitioners tend to look at patients very, very holistically, and this is a wonderful opportunity for patients to really, really be assisted towards health and wellness from a real holistic perspective. The nurses are part of the American Association of Nurse Practitioners and have an opportunity to impact care at many, many levels. Two of the nurses that I've worked with in the past as nurse practitioners are Tony and David. Tony is on the upper right-hand corner. Tony says, like emergency nursing, as an NP, you can never predict how your next hour will be, what kind of cases you will see, or how many lives you will save in the next minute. And that's his friend Marge, who's also a nurse practitioner with him. And David DeKeele is a newer APN, and he says, I feel like a detective. I'm trying to figure out what is going on with the patient, and when you figure out the diagnosis, it is so exciting and rewarding. Both NPs still work in emergency departments in a level two trauma center, and both are very, very active with patients, but also with their nursing colleagues. One can also choose to become a clinical nurse specialist, and this is a master-prepared nurse, and there is a CNS certification as well. What's interesting about the CNS role is that there is an opportunity to be involved in many different types of care or education. There are four mandates for a clinical nurse specialist. They are truly an expert clinician, so you must have very, very solid clinical experience to be a clinical nurse specialist. They are educators, usually teaching at an advanced to high level of nursing education. They are researchers, and it may be quality research, it may be education research, but they do at the forefront work with evidence-based practice. And they are a consultant, a consultant to leadership, a consultant to systems, a consultant to problem solving. CNSs are often described as the glue that holds things together. One could also choose to be a clinical nurse leader, and this is also a master prepared nurse. A clinical nurse specialist tends to look at things from a macro level, meaning on a very broad or system level. CNLs tend to look at things on more of a micro level, really specific. So a CNL might be very, very focused on one emergency department, and how to make that emergency department the very, very best that it can be. They may focus on care coordination, outcomes measurement, transitions of care, interpersonal communication and team leadership, risk assessment, and implementation of evidence-based best practices. Now, if you're not sure you want to do an advanced practice position, you might say, well, maybe what I really would like to do is be a nurse leader. And you might consider all the different opportunities that you have to be in nursing leadership roles. Perhaps you want to be a charge nurse, a resource nurse, a quality nurse, an assistant nurse manager or a manager, a director of nursing, or maybe when you grow up, you want to be the chief nursing officer. There are many different levels of leadership in the emergency department, and they are all important in different places. For example, Alyssa on the right, carrying two phones is a charge nurse in the level two trauma center. She would field probably 100 phone calls a day, is the fearless leader of her nurses on the floor. And as you all know, charge nurse rules. She is really helping to form the direction, the strategy, and the throughput for her department. But if you want to be a charge nurse, you one, have to have good, good clinical expertise. You need to have confidence at the bedside, and you have to be interested and confident enough to be a leader in the emergency department. Another opportunity could be to be a nurse manager. And these are generally nurses who have at least a BSN who are interested in doing their MSN. And it's always helpful for both charge nurses and nurse managers to have additional training. So if you decide you want to pursue either of these roles, you really need to go back to your nursing leadership in your department and ask for additional education, whether it is an ENA opportunity with education through ENA University, or perhaps you want to look at whether or not your facility has leadership education. It's important to feel like you're prepared going in. Carmelita Manning to the right there is a director of nursing in the emergency department. She's been an emergency nurse for close to 20 years, and has worked in leadership for a long time. She has her MSN, and she has had significant amounts of leadership training. Carmelita is constantly at the bedside with her nurses as a strong director of nursing. She is also the representative to the rest of the hospital for emergency nursing to make sure that her department runs effectively. And last but not least, perhaps as an emergency nurse, someday you want to be the chief nursing officer. And this is very, very possible. This is Mike Philando. Mike has his DNP, and he also has his CEN, and he works as a chief nursing officer in his facility. When Mike first entered emergency nursing 26 years ago, he didn't think he would be a CNO. After many years of practice as a staff nurse, a charge nurse, and the director of an emergency department, Mike was given the opportunity to advance to an assistant vice president position. This position helped him to better understand the world outside of the ED, and how a system must work with all of its moving parts. Mike said he was approached to consider a CNO position and quickly decided to take up the opportunity. Mike feels that three aspects of emergency nursing helped him to be an effective chief nursing officer. Mike says, one, experience in the ED taught him how to see the broad perspective in the needs of patients and department. Two, he feels regular experience with managing uncertainty and unpredictability in an ED prepared him to face any unprecedented challenge. And finally, clinical experience. Having a broad level of clinical knowledge from pediatrics to the aging adult helped him to understand the clinical needs of his hospital. Does Mike like being a CNO? With laughter, he will tell you, yes, most days, and that he is thankful for the important mentors, good advice, and the opportunities that he's had over the years. But Mike is an extraordinary example of an emergency nurse who decides that they want to be the leader of a hospital. An emergency nurse could also decide, aside from education, stretcher side, and leadership, that they want to stay in the professional pathway. Perhaps you're interested in being a flight nurse or a critical care transport nurse or a forensic nurse. Flight nurses are up in the skies. If you would like to learn a little bit more about them, visit Deidre at the case of emergency website and hear about her journey as a flight nurse. But in general, it has many benefits. But in general, it has many, many steps. And it really depends on the state that you live in and the system that you work for. Most nurses have at least five years of professional nursing practice before they can even consider becoming a flight nurse. And then it can take between five and 12 years to become fully certified, fully prepared flight nurse. So look to see what is necessary for your state. Try to find a mentor who can help you navigate through those different winding pathways. Look at the certification that can be required for many flight nurses, and see if this is where you would like to take yourself to be with the birds in the sky. One could also decide that you want to become a critical care transport nurse. And again, this has many, many steps to take in order to become a fully qualified transport nurse. They work with a critical care team to transport high-acuity patients between one hospital facility and another. They're highly skilled and trained, and they often require a combination of advanced training in addition to ED and or ICU experience. The reason why ED is so good is because you do need to be able to handle the pressure in tight and difficult situations. And you also need to know how to care for critically ill patients. The preparation can be different, again, per state. It really depends. And so what you want to make sure you have is really solid ED and high-level, high-acuity experience. And perhaps you also might want to have a little bit of ICU experience as well. There is a certification to become a certified transport RN, and there is an Air and Surface Transport Nurse Association that has really, really good information on its website to help you understand the different steps that are required to become a CCT RN. Greg is one of our New Jersey A&A presidents, and Greg has been an emergency nurse at an EMT for close to 15 years. But because Greg was involved in pre-hospital, he was very interested in critical care transport. And after he practiced in this realm for many years, Greg decided that he liked the trucks and being on the rigs, but he also wanted to try out the world of flight nursing. He loves the combination of the pre-hospital world, emergency nursing, and critical care nursing. And he said he recommends to any nurse who's interested in pursuing this professional pathway to speak to all those already in the field. He said, there are so many different steps one could take or different pathways to become a flight nurse or even a ground transport nurse that it's best to try to find a mentor. So look for a mentor within your facility or within your state to see who can help you navigate the different paths that one might take to become a flight nurse. Forensic nursing is also an extremely interesting specialty, and there are nurses throughout all of our states who have exceptional education in order to provide care to patients who have unfortunately suffered from violence and abuse. This could include things like sexual assault, intimate partner violence, neglect, or other forms of intentional injury. And really what they're trying to do is to treat the trauma associated with what has happened, to collect evidence, and to give testimony that can be used in a court of law to apprehend and prosecute perpetrators who commit violent and abusive crimes. It usually requires at least two years of emergency nursing experience. Then there is advanced education and certification. The International Association of Forensic Nurses and Sexual Assault Nurse Examiners are who you would link up with to get more information on the programming and the education. At the end of the day, though, what we need to remember is that we are all emergency nurses from the stretcher side to the chief nursing officer to the transport nurse to the educator. It takes all of us to provide care to a patient. It takes all of us to run the emergency department. It takes all of us to be the exceptional practitioners that we are every day. So the question then becomes, how do we ensure that we stay in emergency nursing? How do we maintain our longevity in practice? The key is really to continue to contribute to the lives of emergency nurses and the lives of the patients who need our care and this extraordinary specialty. But how do we keep this going? How can we feel called to emergency nursing every day? How do we maintain our love and our ability to care for others? So it really comes back to your why. So it really comes back to your why. Why did you choose nursing? Why did you choose emergency nursing? We choose nursing from the heart because we wanted to be compassionate. And if you are compassionate, you will have passion for what you do, passion for caring for others, passion for being an emergency nurse, passion for your colleagues. If you lead from your heart, you will have compassion. If you don't have compassion, it's very, very hard to do what we do. So what is compassion? What does it literally mean? Well, compassion actually means to suffer together. And among emotion research, it's defined as the feeling that arises when you are confronted and connected with another suffering and feel deeply motivated to relieve that suffering. And compassionate care means providing meaningful care that is led by compassion, by this true desire to help another. And doesn't that sound like what we want to be able to do as emergency nurses, is to truly be there to take care of another. There are key attributes required for us to have compassion at the bedside. First of all, you need to be very sympathetic. You have to be able to feel for others, but you also need to be empathetic and be able to understand how others are feeling. There needs to be a certain amount of distress tolerance where you need to be able to let things go and accept emotions. You need to have sensitivity to distress. There, you have to be aware of how somebody else is actually feeling. We can't be judgmental. We don't want to condemn others. So we must be very non-judgmental. And finally, we need to care for wellbeing, meaning you have to have this internal motivation to really want to support and help another person. Compassion is unidimensional. We are compassionate for our patients. But compassion literally means to suffer together. We must have compassion for our patients, but also for ourselves. We need to take care of ourselves. We need to have also compassion for each other. And the way that we do this is we have to have a culture of compassion in our workplaces. What happens if we don't have compassion as emergency nurses? Well, unfortunately, if we don't have compassion, we will lose our passion for what we do. If you don't have compassion, you can't give as much as you do every day. If you can't have compassion, you will not be able to stay within emergency nursing. So this is where it's really important that we need to be in a healthcare model where one, you can take care of yourself, two, you can take care of each other, but that you have a culture of compassion so that you can really live in a healing, caring environment. So the future of emergency nursing, if we all want to stay within our chosen specialty, it really, really needs to ensure that we live within a model of compassion. This has to be where we center our practice at all times. It must be heart-led. You must take care of yourself. And I say that as your colleague, to take care of yourself. We need to be able to take care of each other. And if we can do those two things, take care of ourselves and take care of each other, then we're gonna be able to take really, really good care of our patients. It's impossible to take care of another unless we do those first two things first. And the last thing is to continue to lean with your heart. Your heart will never do you wrong, and your head is gonna give you that intellectual and extraordinary approach to your clinical and technical practice, but your heart is what is going to help your patients feel better. Your heart is gonna guide you with the right words to use. Your heart is going to guide you with the right direction to take in your patient's care. Your heart is going to keep you at the emergency department to always serve your patients day after day. So continue to lead with your heart. It will not do you wrong. So this is the next chapter in your story. We've kind of given you a few ideas today of what you could do. There are so many things you could do. The world is your oyster. It's open for you. The question you have to go back to is, what do I really love? What do I love the most about someone? When a nurse comes to me and says, Kat, I need to figure out what I'm gonna do next. I'm gonna ask them, what do you love? What do you love about the emergency department? What's your favorite part of the emergency department? But also, what are you interested in? What are you good at? Are you good at cardiac care? Are you good at trauma? Do you love kids? Do you love Jerry? Do you like to precept? And then ask yourself, what are your personal goals? What are your professional goals? Where do you see yourself in 25 years? Do you want to be a two person officer? Do you want to be an academic? Do you want to stay stretch aside and be that precept you go to? What are you passionate about? What do you love? Do you still have compassion? Do you have the ability to give yourself freely to your colleagues, to your patients, but also to yourself? Where's your heart? Where's your heart today? How is your heart? Is this where you want to be? Because we really want you to be with us in emergency nursing. So back to your story. Start thinking. Start figuring out what you think you want to do. Maybe write this down. Start exploring. Start making some phone calls. Check out some of these websites. Go figure out the stuff about flight nursing. Go ask some colleagues about it. Find a mentor. Start networking. Come to ENA National. Come to the conference. It's so fun. Go to your state conference. Go to a state meeting. Meet some other emergency nurses. See what they're doing. Start doing some researching. If you can't figure out what next steps are gonna be, go talk to your manager. Talk to your director. Talk to your friend. You never know who might have the answer, but be open. Be open to what the next steps might be. Be open to the opportunities that come your way because you never know when something might come for you and you'd have to make a decision. Which path will you take? So then back to my story. Well, my name is Kathleen Robinson. I'm an emergency nurse. I am a very proud ENA member. I have been many types of emergency nurses, but right now I'm the director of operations for the emergency services line in my institution. That means I get to work between 12 departments and I'm lucky every day to work with emergency nurses that I do. I am working in advanced education for my nurses because it's important to me that they have the education that they desire and that they deserve. I'm also a parish nurse and that means I serve as a nurse in my community. I love emergency nursing. It is part of my heart and my soul. It fits me and I will always be with you as an emergency nurse. I know that you will find your journey, you will find your next steps, that you will stay within our specialty and that you will continue to use passion and compassion to give back to what we do every day. And so thank you for joining me today and I leave you with this. This is my mantra for emergency nursing and you can have this mantra too. Emergency nurses, we are committed to comprehensive, compassionate and evidence-based emergency care. We believe in teamwork, the specialty of emergency nursing and patient-centered care. We are dedicated, strong emergency nurses. Thank you. ♪♪

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