Any Big City Trauma Nurses here?

NurseGirl525, ASN, RN · Feb 26, 2016

I'm new on a trauma unit as a pct. Very new. But it's a Level 1 Trauma in a big city. I know it's very busy and interesting. I will graduate with my ASN in May and when I pass NCLEX I will transition to an RN on the unit. It's not just trauma. There are two other depts. it's all Icu though.

They told me in orientation there are some certs you can get if I was interested. There is CCRN and CTRN. The critical trauma cert is new they said. I will be looking into those next year.

It's a lot of car crashes, gun shot wounds, stuff like that. But it keeps you on your toes.

guest769224 · Feb 26, 2016

Since RN's are trained as generalists, they can work in any specialty. That includes trauma. You will need an ADN or BSN. From there, apply to a big level 1 trauma center. You will see the most serious trauma there. I worked in dedicated trauma for 3 years.

I saw more gunshot wounds, motor vehicle accidents, falls, stabbings, than I can tell you. Very memorable, bloody, and exciting.

Trauma is very unpredictable because each patient is managed differently based on extent of injury. You mentioned stress level. It can be high stress because things change in the blink of an eye and you need to act quickly as the nurse. One of my favorite things about trauma is hypovolemic shock and initiating massive transfusion protocol, pouring blood products in.

ER nursing is stabilizing trauma. ICU nursing is caring for trauma and aiding the recovery process.

nerdy student · Mar 12, 2016

Thank you so much for your input! Sorry for the late reply, midterms required my attention! :)

Here.I.Stand, BSN, RN · Mar 12, 2016

I'm a SICU RN in a level 1 trauma center in a metro area of about 3.3 million. We have some neighboring states with no level 1 trauma centers, so we get a fair amount of pts from out-of-state as well.

The ED does most of the *initial* stabilization and dx, but not all. Sometimes when they come to us they're still being massively transfused (for hemorrhagic shock -- we get a cooler with a couple units PRBCs plus FFP, platelets, and cryo, and zip it into the pt as fast as possible. A unit can be transfused in minutes on a pressure infuser.) Bad TBIs also need a lot of immediate SICU stabilization, e.g. sedation (usually the intubation drugs are still on board from the ED, so they don't start the fentanyl and propofol/versed drips), placement of ICP/PbO2 monitoring devices, therapeutic hypothermia with a MgSO4 drip to prevent shivering, repeat head CTs etc.

We spend a lot of time on nursing 101 stuff--bathing, infection prevention (common when pts are intubated and have CVCs and Foleys), pressure ulcer prevention (those can happen VERY quickly!). We have those minute-by-minute interventions to keep them comfortable and their VS's in range. My unit does most trach and PEG placements at the beside; during those procedures the RN manages the pt's VS, their sedation, and pain control...so kind of like an OR Lite. Each day the RN leads interdiscplinary team rounds (MD, NP, PharmD, RRT, RD, PT, OT, SLP, RN case manager etc.) to address the pt's big needs for the day. We do scads and scads of family teaching. Let's face it, unless they have been there the high-level ICU environment is foreign to most people. Actually one dad commented to me "This is like NASA!"

Once stable enough, we start moblilzing. In the ICU that mostly means getting them into a chair, although on occasion if the pt is nasally intubated and wide awake, we will ambulate them in the halls (the RRT obviously has to be able to help drag the vent and monitor the airway). PT and OT begin working with the pt, even if it is just ROM stuff.

The pt might have several surgeries during their ICU stay; surgeries have to be prioritized. For example, they can't get facial fx's repaired if their ICP is too high to tolerate lying flat. Sometimes they develop complications such as an AKI or pneumonia or ARDS. Those then have to be managed. Some days are two steps forward, one step back. Some HOURS are two steps forward, one step back.

When the pts don't get better, sometimes the family chooses to stop. If the pt's GCS score is

For me, by far the most stressful part of this work is seeing the devastated family members. I have cries in my ears that I don't think I'll ever forget. Even just that first sight of their family member, all swollen, cut, bruised, and intubated...some people come in and just dissolve in sobs. Times like those I am beyond grateful for our amazing chaplains!! The ED calls them when a trauma pt is brought in, they meet the family when they arrive, they accompany the family up to the SICU waiting room, and they bring the family into the ICU room once settled and invasive procedures are finished. So they are the family's continuity and then are able to provide that support during those first moments while I am trying to care for the pt. Also, unlike some specialties where the pt receives a dx in clinic and are then admitted to the hospital, many of these pts were kissing their family goodbye...and then an hour later are in a head on collision. Trauma is completely unexpected.

Even so, I absolutely love it.