Trauma Room Staffing (not ratios...)

[beepeadoo]

So I work in a Medium Sized Pediatric ER in a free-standing Pediatric Hospital seeing 50k+ pts a year. We have two trauma rooms with two bays each, and we are currently a Level II center. As I am sure with most places, our trauma rooms are used not only for official "traumas" and resucitations, but also for things like critically ill pts, chronic kids who are struggling, or conscious sedations for lac repairs and orth reductions. We receive patients from the metro area, as well as being a regional center. There is currently an effort to obtain Level I status.

My question: do you think assigning one nurse to cover these two rooms/four bays is adequate? The way it is now, one nurse is assigned from 0300 to 1500.

Invariably I come in at 1500 to two or three or four bays filled and a very frazzled, very over worked trauma nurse running around like crazy. Typically we're slow from 0500 to about 1000, but that's also prime time for A.M. full arrests, and it only takes one code or two MVAs to stretch them to their limit. Throw in a chronic kid or an critically ill transfer and it's all out the window.

I just wondered what other facilities do? Is this just the norm? I'd love to hear from other Level I's to hear how they staff their trauma rooms.

[cjcsoon2bnp, MSN, RN, NP]

Hey beepeado,

I work in a Level I Pediatric ED and here is how we handle this situation. First of all, we have 1 Trauma Room with 2 Beds/Bays and we also have 1 Sedation Room (1 Bed) which we use for patients requiring conscious sedation but in a disaster we can use it as an extra trauma room (very very rarely do we use it for this purpose). One RN is scheduled to the trauma room with an RN scheduled as trauma back-up (they have a 3 pt. case load instead of the usual 4). For the most part this seems to work out pretty well. Our sedation room has a nurse assigned to it as well and if we are slow on sedation patients then they will float around the department helping out. So I suppose if you went by the way we staff then two trauma rooms with four bays would have a minimum of 2 trauma nurses and 2 trauma back-up nurses (who carry a slightly smaller case load and only help if necessary). If you feel that having only 1 nurse to cover these four bays is unsafe then this is something that you and your coworkers need to bring up with your nurse manager. The trauma room is hectic enough as it is but knowing that you have to watch four beds sounds downright unsafe (in my opinion). What is your ratio for nurse to pt. in the regular care areas? Ours is 1 nurse to 4 patients (in emergencies we will flex up to 5 patients).

!Chris

[Altra, BSN, RN]

We have a multi-bed trauma bay ... but it's understood that when a new trauma comes in you are 1:1 with that patient until they've been scanned or whatever other diagnostics are completed and they have a diagnosis and plan for admission. At that point, they become 1:2-3 or 1:more depending on whether or not they're going to the unit, a tele bed, or regular floor.

[Christy1019, ASN, RN]

wouldn't you need at least 2 nurses assigned in the even of an actual trauma or resuscitation.. one to scribe, one to do tasks i.e. monitor/iv/meds etc?

[beepeadoo]

Well usually what happens in that event, when we have our usual trauma assignment of 1, is the Charge Nurse and one other nurse from one of the lower acuity areas comes to help.

[sweetER]

In our ER, we have four single-bed trauma/resus rooms. Two of them are assigned to one team of nurses (usually start out the day with 2 and get a 3rd nurse around 9am-11am) and the other two rooms are assigned to another team of nurses. Both teams also have a hall of 6 "regular" rooms. Whenever a trauma or code comes in, though, one nurse from three different halls is assigned to be on ONE room's trauma team. So each hall only loses one nurse while a trauma/resus is being worked. It sounds confusing, but it seems to work really well for us.

[Jennifer, RN]

I work in a Level 2 trauma center with 2 trauma rooms, 1 designated as a pediatric room (but still able to take adult trauma as well).

We have 1 nurse assigned to 1 room and another nurse assigned to the other room. On the arrival of a trauma, the charge nurse comes in and tasks and the assigned trauma nurse documents and oversees that everything is going as it should be.

The assigned trauma nurse has an initial assignment of 4 other beds plus the trauma room in the event of a trauma/code/etc.... If a trauma comes in, the trauma nurse is, of course, 1:1 with the trauma, so her teammates will watch her other patients (hopefully).

The system is not perfect, by any means. To have 1 nurse assigned to all the trauma rooms seems very overwhelming to that particular nurse. I cannot imagine having to take a code and a bad trauma at the same time. I wouldn't last long there.