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. :)

[DeenieRN]

I work in a Level II trauma center and we have a T1 (Trauma nurse) for every shift. Our ER is split in triage levels so the Trauma bay is on the mid level triage area (belly pains, general complaints that aren't fast track suitable, vag bleed, earaches, headaches etc). That area takes the minimal complaints and the level II traumas. Level I traumas are taken solely by the T1 nurse, who when there are no traumas, is a float nurse/relief nurse. That section is also staffed by all nurses that are TNCC certified, so if a really heavy level I comes in, they give support to T1 on that pt. That's why they have the pts with minimal complaints, bc if they have to leave them a minute to be absorbed in a trauma, they're not leaving critical pts.

I have found that this situation is great because when working on the more critical side of the ER (brain bleeds/CVA, STEMI, SOB, codes etc), if I have to hang TPA or prep a STEMI for cath lab, or have a intense 1-1 ICU pt, the T1 nurse will assist or take over that pt when there are no traumas. Also she will transport ICU pts to the floor so I don't have to leave my other pts.

Overall I love our method, it isn't flawless, but it works most of the time, of course we have those freak nights like 2 weeks ago where we had 11 traumas (unrelated) and everyone got a trauma (insert Oprah's voice "a trauma for you, and you, and you" lol)

[WillResuscForCookies]

The ED I worked in most recently has a dedicated trauma lead nurse 24/7, and a dedicated trauma support nurse from 0900 to 2300. You read that right, two RNs on days/evenings whose role is managing traumas when we have them and resourcing the rest of the time.

It sounds like you're hiring people though who only do trauma. We don't do that. There's a small core group of RNs (~15% of total staff) that are TNCC certified and have department specific training to be placed in that role. On any given day, there's a handful of us and it's a crap shoot who does it. Otherwise we're in a normal assignment.

As for them being pulled to an assignment when we're short, the trauma lead is sacred. Never happens. Trauma support I've seen get pulled on rare occasions, maybe once a month. In that case the MICN (who is usually a dedicated position on days as well, separate from charge) does double duty as trauma support.

It works that great... but we're talking about a department with uncommon resources. 4:1 assignments, and a resource RN and one ED tech for each 12-bed POD on days. FT day shift RN salaries there are $120k and up.

[Lunah, MSN, RN]

It sounds like you're hiring people though who only do trauma. We don't do that. There's a small core group of RNs (~15% of total staff) that are TNCC certified and have department specific training to be placed in that role. On any given day, there's a handful of us and it's a crap shoot who does it. Otherwise we're in a normal assignment.

These nurses will focus on the traumas when they are in the ED, but other than that they are expected to float and function as ED RNs, so they won't be strictly trauma all the time. They don't get to sit down and play Candy Crush if there aren't any traumas in the department. :) Part of the reason we're doing this is that we anticipate "leveling up" in the trauma system later this year, and we want to have the necessary staff to do it well.

[traumaRUs, MSN, APRN]

Sounds like a wonderful idea. Personally I think the biggest hurdle is going to get nurses with the right personality. Anyone can get alphabets but it takes a solid and confident nurse to be part of the team but also able to take charge of a trauma too. So interviewing solid people will be needed. However I'm sure you are up for it. Would love to come work with you!

[mmgRN]

In a perfect world, in my experience, this worked best in a trauma ED. However, we were rarely staffed to allow for this. Though, when the stars aligned and we were, it ran SOOO much more smoothly. When a trauma came, the rest of the patients and ED did not suffer due to the demands of the trauma, or if so, it was greatly minimized. Without this type of staffing, the entire ED bottle necked and it was jam up, cluster time until the trauma went to the OR, ICU, or expired.

[mmgRN]

Hmmmm.... from reading other threads, I'm thinking you are more talking about dedicated trauma staff? From this perspective, in my experience (level II trauma center)-- dedicated staff is optimal but not generally feasible. EVERYONE in the ED should be trauma ready, at least the basics. Everyone should cycle through to keep up their skills, so they are always on the ready. There are just so many variables in an ED, it's an animal! Dedicated staff, really narrows your capabilities in my opinion.

I believe in dedicated trauma staffing from a daily perspective, but only in the sense of keeping them free on a daily basis to attend to traumas as they come and otherwise float to decompress the ED when there are no traumas. However, this shouldn't be the same set of people every day, in my opinion. It needs to rotate through and everyone needs to be ready, to keep the pool of trauma ready nurses with high numbers, to lessen the likelihood of the ED being left without properly prepared/experienced trauma nurses. In my opinion, that's just math.

[Lunah, MSN, RN]

This is not to say that the ED staff won't maintain competency/TNCC/etc., because when there are multiple traumas (which is what usually happens!) the primary nurse assigned to that room will be in there with the trauma nurse lead. The point of the trauma nurse lead is to focus on whatever is required to move trauma pts through the ED to wherever they need to be — the OR, the ICU, or the Level 1 if need be.

[BMacRN]

I work in a busy, 78bed, Level II, with approx 100k visits per year. We have a TNTL (Trauma Nurse Team Lead) and TN2 (Trauma Nurse #2) as part of the daily assignments. Our assignments rotate, so all staff with the proper certs (TNCC, PALS, ACLS, etc...) have the opportunity to work in that role. The two dedicated trauma RNs are responsible for all traumas, STEMIs, and initial stroke protocols (blood draw, FSBS, to CT, etc...). When those things aren't happening, they are responsible for giving lunch breaks, assisting with flow, tasking, help with codes, and just act as another set of hands to keep things running smoothly. We'd be screwed without dedicated trauma RNs!

[Altra, BSN, RN]

I have followed this thread with interest. The 2 Level I trauma centers where I have worked both have a dedicated trauma assignment every shift ... but this assignment is rotated among all department RNs who have been in the dept. > 1 year.

I believe that setting up the trauma RN as a separate job title would cause significant animosity where I work. Non-trauma ED staff may well resent that they too maintain all competencies, but are designated as the "B team". I would also foresee jockeying for the "better" of 2 simultaneous traumas: "you take the routine unrestrained MVA with questionable loss of consciousness ... I'll take the GSW to the chest".

And if I am reading the proposal correctly, these trauma RNs will float throughout the dept. when possible, but will not ever slog their way through 12 hours of abdominal pain or vag bleeding. Pretty sweet!

[ED-RN1]

I've worked at 8 different EDs on travel assignments. Out of the 8, only 1 department had dedicated trauma RNs. The rest had trauma assignments and rotated staff through. From my experience with the dedicated trauma RN role, I thought it was a bad idea. The role created a superiority complex with the trauma RNs. The vast majority did not float or help out their coworkers. They often talked with friends or were on their phones hiding somewhere. As expected, this created hostility between the ED RNs and the trauma RNs. It also created a void in competency. Without handling traumas and critically Ill patients, it effectively turned most of the ED nurses into a clinic/med-surg nurses and stifled their development. It also increased burnout and staff turnover rates. Who honestly got into ED nursing to deal with abd pains, headaches, vags bleeds all day everyday? If you take away the excitement and purpose of ED nursing, your staff will leave and find it somewhere else. If you are finding that some staff members are not proficient at handling traumas. I would advocate for the implementation of a more stringent educational program with collaboration from the Trauma MDs to develop staff members. Develop your department, don't strip them of their duties and purpose.

[Buyer beware, BSN]

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.

That's the issue, isn't it? "If they like." There are leaders and followers in this world, hopefully the leaders "like."