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Discussion

Burn Nursing

  • Expert

Burn nursing covers a wide range of patient diagnoses. When a patient comes into contact with high voltage, it results in entrance and exit wounds. When a patient survives a house fire with inhalation injuries, they become a burn patient. Other mechanisms of burn injuries include: motor vehicle accidents, falls and workplace accidents.

Work Environment

The work environment of burn nurses varies as much as the mechanism of injury. Working in an emergency department, you are often the first caregiver of the burn  patient. As they move through their care, they often encounter ICU nurses, rehab nurses, and sometimes dedicated burn center nurses. After the survival of the acute phase, there are long-term care needs so burn nurses often work in offices, too.

Skills and Qualities of Burn Nurses

Nowhere in nursing is it more important to be able to see the long-range goal of care than in burn nursing. Burns require many phases of survival. Important skills and qualities of burn nurses include:

  • Compassion and ability to connect with the patient and family
  • Rapid assessment skills
  • Strong IV placement techniques
  • Exceptional knowledge of fluids and electrolytes
  • Knowledge of pain control
  • Strong patient advocate

Duties and Responsibilities

These can vary greatly depending on the severity of the injury, age of the patient, comorbidities, and mechanism of injury. Certainly in the immediate post-trauma event, the emergency department (ED) RN will be responsible for:

  • Assisting to stabilize the patient
  • Identifying all injuries
  • Arranging for transfer as indicated
  • Communicating with the family

As the patient moves from unit to unit and perhaps hospital to hospital, it is incumbent on the nurse to ensure the transfer of care is seamless. This involves discussing patient needs with the patient, family, other care providers as well as the accepting nurses and providers if the patient is transferred.

Professional Organizations / Associations

American Nurses Association (ANA)

American Burn Association (ABA)

Society of Trauma Nurses (STN)

Education

  • Graduate from accredited Registered Nurse (RN) program
  • Degree: Diploma, ADN, BSN, or higher
  • Successfully pass the NCLEX-RN
  • Current, unencumbered RN license in U.S. state of practice

Certificates / Certifications

American Burn Association (ABA)

The ABA is dedicated to, "promoting and supporting burn-related care, prevention, education, and research" and offers the Advanced Burn Life Support (ABLS) course.

This is a live, hands-on certificate course designed around the emergency care of the burn patient through the critical first 24-hour time period. This 7-hour course is for physicians, nurses, nurse practitioners, and other health care providers.

Emergency Nurses Association (ENA)

The Trauma Nursing Core Course (TNCC) training course is available from the ENA and is for RNs. Verification as a TNCC provider is earned upon successful completion. Participants must be a Registered Nurse with an unencumbered RN license. LPNs are eligible to attend except for the written and psychomotor evaluations. They do not receive verification and are awarded contact hours. 

American Association of Critical-Care Nurses (AACN)

Burn nurses may wish to pursue CCRN certification for critical care through the AACN. The exam is available for three populations of care: adults, pediatrics, and neonates.

To qualify to take the exam, RNs and Advanced Practice Registered Nurses (APRN) must have a current, unencumbered license in the U.S.

Candidates must also meet one of two clinical practice requirement options:

  1. Practice as an RN or APRN for 1,750 hours in direct care of acutely/critically ill patients during the previous two years, with 875 of those hours accrued in the most recent year preceding application OR
  2. Practice as an RN or APRN for at least five years with a minimum of 2,000 hours in direct care of acutely/critically ill patients, with 144 of those hours accrued in the most recent year preceding application

Society of Trauma Nurses (STN): ATCN

The STN offers the Advanced Trauma Care for Nurses (ATCN) for RNs. The ATCN course is taught concurrently with the American College of Surgeons (ACS) Advanced Trauma Life Support® (ATLS).

Additional Certifications

The following are highly recommended for all Burn Nurses (not all-inclusive):

  • Basic Life Support
  • Advanced Cardiac Life Support
  • Pediatric Advanced Life Support (PALS)

Job Outlook

The job outlook will be high for burn nurses, especially at national burn centers. Since burn care of the seriously injured is segregated at a burn center, it will be important for burn center nurses to educate other nurses and staff regarding the care of the burn patient.

Salary (2020)

According to salary.com, the average salary in the U.S. is $69,803, ranging between $59,375 and $84,992.

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    • Featured Replies

    Thanks for this, Trauma.

    My worst patient in the ED (and I subsequently cared for him in the ICU) was a victim of a house fire. I'll never, ever forget him.

    It was horrific.

    Speaking of "strong IV placement skills...." Ever try to put a line in an arm that peels like a toasted marshmallow when you pick it up?

    I salute burn nurses. I couldn't do it.

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    • Author
    • Expert

    My experience with burns is also limited to ER.....and couldn't agree with you more. Seemed to take forever to get the smell off of me. And sooooo sad.

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    Burn center RN here.

    I would not necessarily say that job outlook is high for dedicated burn RNs. Many dedicated burn centers are closing, have closed, or are becoming smaller. Overall *need* for burn beds has generally decreased simply because of public safety promotions and stricter regulations on everything from building codes to clothing. More importantly (unfortunately) -- burn centers are *very* costly to operate and more often than not have a large percentage of patients who are uninsured.

    On the flip side, turnover on burn units is generally very high so there are usually positions open.

    --

    Also, if it's a dedicated burn center, the patient probably will not move from unit to unit. Many burn units are set up to provide a continuum of care from ICU to floor and RNs are trained to care for a patient at any point in that journey.

    --

    I would also like to suggest a mention of our wound care skills, arguably what makes a burn RN different from a general trauma RN. Anyone can compute out the Parkland formula and there may even be some RNs out there who are totally comfortably pushing 400 mcg of fentanyl in twenty minutes -- but can you make an entire suit out of netting? I THINK NOT.

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    • Author
    • Expert

    Excellent post dirtyhippiegirl! Thanks for the great additions!

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    This might be a dumb question, but I've never worked acute care, or anywhere near a hospital with a burn unit. Are there usually separate peds and adult units? Are they in the same unit? Or do the kids usually get transferred to children's hospitals? Just curious.

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    I did more than my fair share of burn nursing when I was a PICU nurse. I could hold my own with them, but I was always happy for the burn unit nurses to come down and help with my dressing changes...I learned something new every time. I always though that bad burns were some of the most challenging of all critical patients. For me, watching an experienced burn nurse doing a dressing change is truly like watching Martha Stewart cooking. No nonsense, no shortcuts, do it right or don't do it at all....and no matter what you do....it will never look as good as hers.

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    • Author
    • Expert

    There are specialized units and sometimes hospitals which treat adult and peds burn pts. For instance, in the state of IL, adult burn pts go to Springfield Memorial and peds burn pts go to Cook County.

    Yep, only two burn units in the whole state!

  • Quote
    traumaRUs said:
    My experience with burns is also limited to ER.....and couldn't agree with you more. Seemed to take forever to get the smell off of me. And sooooo sad.

    That "charred smell" stays in your nose forever. :(.

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    I think it just depends on the Burn Center. I am an RN on a Burn Step Down and we take both adult and pediatric patients. The Burn ICU also takes adult and pediatric patients.

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    We also take pediatric and adult patients on the same unit.

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    God bless you burn nurses! I know I couldn't do it and I am glad you are there.

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