I am the trauma nurse coordinator for a level III trauma facility in rural southeast Kansas. At my facility, we see the entire spectrum of trauma injuries from critical life-threatening injuries to minor walking injuries. The question has become for all trauma centers, how do we get more value for our limited training budget? What happens in my facility and other trauma centers is we are allocated a certain budget and we try to spread funding over our staff in a similar manner with everyone getting a minor portion. The answer is to move a larger portion of the budget to a smaller number of nurses to generate a greater effect from training.
My view of how training should be changed is intended for the smaller hospitals that do not have dedicated trauma nurses or staff. It is for the rural hospital RNs that have daily patient care responsibilities, but are expected to stop what they are doing in the case of high-priority trauma alerts.
Rural hospitals across the United States are being hit with cutbacks in funding and getting lower compensation for services. For example, in Kansas, critical access hospitals are under the threat of closure due to changes in designation by Medicare that result in lower reimbursement and regulatory issues that have become factors for many hospitals across the country.1 In Georgia, the closures of hospitals could create a Third World situation according to those closely associated with rural health care there.2
In a study reported in USA Today, up to 69 million more people had to travel farther to reach a trauma center, for 16 million of those people the distance was increased by 30 minutes or more because of trauma center closings.3 Many times for rural hospitals the patient has already had a significant travel time or distance and adding to it could have detrimental effects on patient outcomes.
While the doors to rural trauma centers remain open, the same high standards of care remain. Many smaller hospitals are looking for a solution to the lack of funding for trauma training, to do so we must build a new culture of how we address small center trauma nurse training.
THE CHANGE
When a high-priority patient is brought in, it takes several nurses and respiratory therapists, lab and x-ray technicians to care for the patient, and a great deal of resources once inside the hospital.
Hospitals and the patients would be better served by a new way of training trauma nurses that has not been seen before for level III and IV centers. We should be forming smaller teams of nurses that can produce greater results through increased training and focusing on the trauma role when needed. Simply put, small centers have to do more with less because of the lack of extended amounts of staff to care for specific patients. In the rural hospital setting, a few nurses must fulfill multiple job roles while on duty. Instead of many nurses each having their own trauma training, there should be a move to consolidate the many trauma efforts onto a few nurses.
It is a training style used by the military for special operations soldiers, the US Army's Special Forces; for example, these are considered "force multipliers" after training and it can be applied to small groups of trauma nurses. The thought is that a small group of highly trained personnel can do the work of many others by themselves and with their higher level of training direct other resources more efficiently.
Nursing has specialties like SANE or wound care, for example, and many certifications for training. Trauma should be taken to a similar level at smaller facilities and focus trauma training in a comparable fashion. Often trauma and the term emergency room are intertwined, but trauma should be singled out and treated as a specialty.
This is not a training system that could be applied to a large number of nurses at once and not every nurse wants to handle high-priority patients or the training that should come with it. Nurses would have to be selected in small numbers so the budget would not have to be increased to accommodate the training. It would have to be top-to-bottom decisions involving nurse managers, chief nursing, and finance officers that they want to show this type of investment in their nurses. Time, funding, and the needs of the individual trauma center would be the determining factors as to when each shift may have at least 1 trauma nurse available.
They should train with flight nurses and paramedics and gain certification in areas like Pre-Hospital Trauma Life Support. After receiving a report from the field these nurses will know what happened, what was done for the patient, and what will be the most likely course of treatment by emergency medical services. This would be a great advantage to the nurses before they ever see the patient in the hospital.
They should train in a variety of departments and facilities in larger hospitals such as level I and II emergency departments, surgery, burn units, and pediatric trauma centers. When and where there is an opportunity to learn, they should be given the time to attain new skills outside of their own units or hospital. This gives the trauma nurse the ability and confidence to have the appropriate level of response, no matter what comes through the door when they are on duty. They should receive training in transfer procedures, paperwork, and helicopter safety that goes along with transporting these patients.
Posttrauma care training is necessary to understand how to best begin the healing process and this care should begin in the trauma bay. The training nurse should be exposed to larger trauma center intensive care units that receive complex cases that are not usually seen in level III and IV trauma centers. This should be included even if the trauma nurse in training is from the intensive care unit in his or her own hospital.
These trauma nurses could be directed to provide one-on-one style care to these highest priority patients who provide them the best care in the most efficient manner possible. There will no longer be a need to tie up an entire emergency department to care for the high-priority patient. The other nontrauma patients can continue to receive the full attention of their staff. The abilities of the RNs selected for this extensive training would be tailored to the needs of the level III or IV center they are serving.
CONCLUSION
Trauma centers of all levels have made a commitment to provide the best care possible to trauma patients. This new training method can give the nurses at trauma centers the tools to better handle this responsibility and improve patient quality of care and staff efficiency. It would take commitment from the hospital and the nurse as the training would take time to be accomplished and when the opportunity was presented. Health care, far too often, does not embrace new methods of training or patient care. Trauma and patient care are fluid environments that require us to be aware of new situations that can provide us an advantage. This view has been thought through from a vantage point of improvement and what is best for the staff and the patient. The patient's care will always be the highest priority so we should craft a new way to provide that care.
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