trauma call

[ledzep]

Our Pediatric OR is going to apply for Trauma status sometime around the end of the year. Most of our staff have not worked with traums and are fairly "traumatized" by the concept. We are going to have specialty teams to include Hearts, Neuro, Ortho and General(which includes eyes,plastics,ENT,GI, GU and General cases) Right now we are not fully staffed for 24 hour call and only have in house staff on the weekends. Management wants a trauma call schedule in place by mid April. Right now we do not have enough staff to cover all the teams but we do have staff who are currently in a periop course and not through with training, so are not officially on the trauma teams yet. This is causing alot of frustration with staff who are going to have to take alot more call including 24 or 48 hr weekend. Our leadership group is having a hard time with the schedule and of the recent low moral. Anyone have any suggestions with the scheduling or transition efforts to help retain the awesome people I work with?

Thanks

[Rose_Queen, BSN, MSN, RN]

Does the call have to be specialty call? In my facility (level 2 trauma), the only specialty that is separate is cardiac. Everyone else covers an 8 hour shift of call per week and a combined 3 shifts of work/call on their assigned weekend. These teams takes whatever comes in except cardiac- we don't call one person for the urology case and another for the neuro case. We are required per policy (and maybe trauma center required standards/guidelines, not sure about that) to have at minimum one circulator and one scrub free and in house 24/7/365 to cover any trauma that rolls into the ER and subsequently into the OR.

How our staffing works after 3pm:

There are two teams in house until 11pm to cover add ons and late running cases. There are an additional 2 teams on call. If both teams are working, a call team must come in to be available for traumas.

On 3rd shift (11p-7a), there is one team in house and 2 teams on call. Any case that is booked means a call team must come in. If it's not an emergent case, they will not start until the call team arrives so that there is still a team free for traumas.

If it happens that one call team comes in, cases are finished, and go home again, the next team is called in so that they rotate and one of the teams doesn't get called in each time.

[sub-dural]

We have a dedicated trauma team working every night (level I trauma center) that includes 6-8 scrubs/RNs. We have about 5 people on call every night as well.

A general training concept for trauma work is focused on vascular, neuro, and general surgery. If you can do those services and know them well you can adapt fairly well to trauma work. In my experience, "true" pedi trauma comes in only a few times a month. Lap appy's are pretty normal during the night as well as broken elbows and things.

Even though you have a new crew coming through a perio-operative program, they will in no way be able to do trauma for a while. Trauma requires much experience. So you may in fact end up being reallocated or something. Trauma OR and offshifts are among my favorite. We do have a separate call for a cardiac scrub nurse that is separate from the rest of the call people.

[Graduatenurse14]

When I came to work at my current Level 1 Trauma Center and found out that my unit took these patients at times, I was very scared but the Trauma Services takes patients that I wouldn't consider traumas at all so maybe yours will too and it won't be that bad.

[acerbia]

Interesting to see what they do at other ORs... Mine is going for the level 2 trauma cert, and we were told that "anyone" can do trauma and you don't need any special skills or experience. They said all you need is a blade, prep, drapes, and hemostats (over-simplifying, I'm sure). The new people that just finished the peri-op program are already taking 24 hour trauma call, in addition to our regular call team. We don't have specialty call, other than hearts; Everyone does everything. Our "trauma call" consists of 1 RN, 1 scrub, and 1 CRNA that must be able to be in the OR within 30 min. People have had low morale and bad attitudes for years, looooooooooong before we started doing trauma call. Not sure how anyone can fix that - at your place or mine.