Dedicated Trauma Nurses in the ED

[Lunah]

I was wondering if anyone else worked in an ED that had dedicated Trauma Nurse Lead positions. These are trauma RNs in the ED who do not have a patient assignment, they float and help other RNs when they don't have a trauma, and are then 100% dedicated to traumas when they arrive. I absolutely love this concept! Our ED is just getting started with it (seeking/interviewing), so I was wondering if anyone had any experience with this. Feel free to PM if you don't want to respond here for whatever reason. :)

[AJJKRN]

To my knowledge, the ER charge has to be trauma certified and does not take a Pt load. We also have General Surgery/Trauma Residents too that play into the mix. No one nurse that is a standby for traumas yet except the charge.

[Buyer beware, BSN]

Pixie: At the risk of sounding like a kill-joy, unless human nature has changed over time, which I doubt, each generation tends to be actively engaged in reinventing the wheel.

The concept of having dedicated trauma ED nurses who when not engaged in taking care of traumas "float" and help other regular nurses sounds good in concept but let me shed light on how it works in reality:

Like any seemingly good idea, that idea can be subject to the law of unintended consequences. In this instance from experience what I've seen is that this division of labor often devolves into a two tier system where the nurses with patient assignments actually become the vassals of the trauma nurses. How does this happen? Well within any group of trauma nures there are usually those who act as opinion leaders. These leaders often, and not so subtlely project their own delusions of grandeur as in "I used to do strick patient care but now I'm a dedicated trauma expert." This is the genesis of the superior/inferior division of nursing labor. It manifests itself in trauma nurses who should be helping the nurses who are triaging the endless ground traffic on a ultra busy Friday or Saturday night not only being unavaible to help but often not being able to be found to help.

So while the floating concept of trauma floating sounds good it is often up against the trauma nurse exclusivity perogative and institutional resistance that is wittingly or unwittingly supported by not only the ED nurse manager but the ED/trauma doctors who are more than happy to have their own private boutique nursing service.

So the end result is that often the regular ED nurses end up taking care of 4-6 regular ED patients with contemporaneous traumas while the so called dedicated trauma nurses fly around in their whirlybirds enjoying the view.

[Lunah, MSN, RN]

I understand what you're saying, buyer beware. I think it's important to find the right people for the position who are true team players. That will be the expectation, and the people we have interested so far are already displaying those qualities. The position works well at the other facilities in our health system, so I am going to remain optimistic (but vigilant). The goal for the other RNs is a three-room assignment, so no nurse should end up with 6 patients unless they are ESI level 4 or 5.

[Buyer beware, BSN]

Pixie: The only thing I would add is that while I believe that my observations can be used as a clarion call to be on the look-out for such demoralizing intra-nursing relations, they are, I believe, universally applicable but particularly so in large inner-ciity trauma centers. As I have said, the impulse to make the doctor's happy often overrides sound managagement and as they say makes null the best laid plans.

[RNDude2012]

Our ED has 8 trauma rooms, and our trauma RNs are specifically assigned to trauma only. We're one of the busiest trauma centers in our state, and I mean BUSY. The ED manager requires the trauma RNs to have both ED and ICU experience in order to be hired into trauma. We have 3-4 RNs in trauma (depending on how many ICU holds are down there), and if it's slow, they can help out in the rest of the ED if they like.

[CraigB-RN, MSN, RN]

Having been a trauma nurse in more than one Trauma Center, (Both level 1 and Level II) having a specialized trauma nurse can make a difference in your trauma care. How well it would work in non-trauma ED's would really depend on the ED itself.

Trauma has become a sub-specialty unto itself. It mixes skills from the OR, Prehospital, Critical Care and even Rehab. With the constant addition of new skills and procedures (REBOA for one) having nurses who are a bit more focused is good for patient care. They can develop a relationship with the Trauma Surgeons than can help with the workflow.

If your trauma team is integrated with the regular ED the Trauma Nurse makes a great Critical Care Resource Nurse. Help run codes in the departments, assist with procedural sedation, etc. Of course, if you're one of those rare people who have the pleasure of working in a dedicated trauma unit, then you practice and train.

An education/training program is a mandatory requirement, along with continuing education. SIM training for skills that you might not use regularly, or to practice new skills.

Like any program or process, it can be done wrong. Seeing a nurse just sitting there waiting for trauma and not doing anything to help the rest of the department when they are getting creamed can set up some bad vibes.

[LoveMyBugs, BSN, CNA, RN]

My facility (level 1)

Has trauma nurses assigned to the trauma bays then during our peak hours we have a Trauma nurse that wears the pager but floats everywhere in the facility all the ICUs and PICU and to the pediatric ED to help, the respond to the rapid responses, basically help wherever there is a critical pt and help is needed, but when that pager goes off they get to the bay to assist the assigned trauma nurse with that trauma.

Any level 1 traumas you get your assigned trauma nurse as primary or float and an ICU nurse as primary or float and the TRN nurse to assist and record

If it is a pediatric trauma any level you also get a pediatric Ed nurse to assist

[Scrubs_n_sirens, MSN, RN]

What are you guys requiring in the way of certifications etc for this position?

[Lunah, MSN, RN]

What are you guys requiring in the way of certifications etc for this position?

It requires an ADN or BSN, active RN license in this state, then the "alphabets" — BLS, ACLS, TNCC, PALS, with TNCC instructor within a year. ENPC is desired, and required within a year. The position also requires a year of experience in trauma nursing.

[RN_Sara]

I work at a level 1 children's hospital. We have RN's who are specifically assigned to our trauma/critical care area 24/7. When that area is not being utilized, those nurses float to help others, help out in triage etc.

[chivon101]

I have worked in a two different Level 1 facilities that utilizes trauma nurses also called TNCs. Trauma nurse clinicians. At one facility, they work the traumas bays only, working up their own patients. They rarely floated to help out the busy ED nurses and most times the title "went to their heads". We were often debating on the level of trauma and which side would take care of the patient. When they were not with trauma patients, they are responsible for the case management part of the visit. They would follow the care of the patients from admission to discharge. At another level 1 facility, the TNCs only did the case management part, never working bedside. At this facility there were 3 nurses assigned to the critical care rooms that cared for both medical and trauma patients when they arrived. When they did not have patients they would float and help. It really depends on the facility. I think having them separate tends to create a problem for nurses when they leave, because others facilities will assume you have level 1 trauma experience because you worked the ER at one. All nurses working at a leveled facility should have TNCC and/or ATCN. I for one think ATCN is a better course and more realistic. You also need the other certifications needed for the ER.....ACLS, PALS, ENPC, BLS. At the first facility I worked at, they also required CEN or CCRN within 6 months to a year of getting the position. Im sure they will also start to require the Trauma Certified Registered Nurse (TCRN) that rolled out the beginning of the year.

[Lunah, MSN, RN]

Im sure they will also start to require the Trauma Certified Registered Nurse (TCRN) that rolled out the beginning of the year.

That is something I actually want to encourage for our new trauma nurse leads. I think it is a great demonstration of subject expertise, especially because the exam goes beyond the ER (I was a beta tester in October for the TCRN).