School of Nursing Sets the Standard for Trauma Care

By Laura L. Acosta

UTEP News Service

While taking part in a clinical rotation in a hospital emergency room last fall, Lia Davalos, a nurse practitioner student in UTEP’s School of Nursing, faced life and death situations almost every day.

She encountered patients with all sorts of traumatic injuries caused by blunt trauma, car accidents and falls, including a man who appeared to be uninjured after a motorcycle accident, but x-rays revealed he had a collapsed lung.Melissa Wholeben (left), a clinical nursing instructor, shows nurses from the Sierra Providence Health Network how to immobilize a patient during a Trauma Nurse Training Course offered in UTEP's Center for Simulation on Jan. 10. Photo by Laura Trejo / UTEP News ServiceMelissa Wholeben (left), a clinical nursing instructor, shows nurses from the Sierra Providence Health Network how to immobilize a patient during a Trauma Nurse Training Course offered in UTEP's Center for Simulation on Jan. 10. Photo by Laura Trejo / UTEP News Service 

“The first time I saw something like that coming in (the emergency room) I was (thinking), ‘Oh, my God,” Davalos said. “I just stepped aside because I didn’t know where to start.”

In early January, Davalos joined 17 nurses from the school’s nurse practitioner program and the Sierra Providence Health Network’s three hospitals in the first Trauma Nurse Core Course (TNCC) offered by UTEP.  The 16-hour course is designed to provide nurses with core level trauma knowledge and skills they need to care for patients in an emergency room or trauma care settings.

Tracey Merworth, a clinical nursing instructor at UTEP and a TNCC instructor and course director, has trained trauma nurses throughout the region, including El Paso, Van Horn, Las Cruces, Truth or Consequences and Silver City. She led the two-day training in the school’s Center for Simulation.

“Nurses in trauma certified hospitals or designated trauma centers are required to have TNCC training,” said Merworth, a trauma nurse for 30 years. “The state of Texas is very specific about what a hospital needs to do at the different trauma levels – I, II, III and IV – but what all the levels have in common is that they need to provide specialized training for people who work in trauma and emergency care.”

Trauma nurses handle urgent medical situations where a disease or injury has not been diagnosed, yet they need to stabilize patients to receive further treatment. These nurses are part of a specialized medical team in hospital emergency rooms and trauma centers that are identified by different “levels" of care depending on the type of trauma services that are offered. The highest level is I and the lowest is IV.

Participants rotated through four skills stations that covered how to assess and treat seriously injured patients. The assessment included airway and ventilation management, spinal cord protection, trauma nursing process, and a head-to-toe physical assessment.

Students participated in different hands-on scenarios, from checking to see if a patient’s airway was clear to immobilizing a patient before x-rays could be taken to determine if a spinal cord injury had occurred.

Merworth said that while most of these skills are fundamental to providing treatment, the training helps to keep nurses focused in traumatic situations.

“When they bring in somebody who is seriously injured, it's really easy to get distracted,” she said. “If you learn to take a primary assessment that involves airway, breathing, circulation and a patient’s neurological status, it takes less than 10 minutes. You know you’ve got to run through those before you move on to anything else. It doesn't matter if the patient has a broken leg if he’s not breathing.”

As a new nurse in the emergency room, Davalos was often distracted by incoming trauma cases.

“Nursing is nursing everywhere, but (the emergency room) was my first clinical rotation, so it threw me off a little bit, but I had such an awesome preceptor so it went fine,” said Davalos, a recovery room nurse at Providence Memorial Hospital. “But I really wish I did this training before I worked in the ER. It would have familiarized me with the patients that we were getting there.”

Elicia Currier, a nurse practitioner student who also teaches at Doña Ana Community College, said the course lays out an invaluable step-by-step process for nurses to follow in emergency situations. 

“It helps you get down that process of, ‘Where do I start when a patient comes in?’” Currier said. “I think that's the biggest thing. You come in and it's easy to get overwhelmed with the trauma of what you see, whereas if you get this course, it gives you the steps so that you don't get lost in the blood.”

The TNCC training is funded by a grant that the School of Nursing received from the Texas Higher Education Coordinating Board for the Emergency and Trauma Care Education Partnership Program (ETEP) in August.

As part of the partnership, students from the nurse practitioner program are able to do their clinical rotations at Tenet Healthcare Corp.’s hospitals in the Sierra Providence Health Network – Sierra Medical Center, Providence Memorial Hospital and Sierra Providence East Medical Center.

The grant also pays to train 24 nurse practitioners to take the TNCC or to become nationally certified emergency room nurses.

Merworth, who was instrumental in developing the partnership, said TNCC offers a systematic way of treating trauma patients. By following the steps, nurses are less likely to overlook injuries and they can also assess how badly injured a patient is, and determine the level of trauma care a patient needs.

“I see that this training makes a difference,” Merworth said. “If someone doesn't know a systematic way of taking care of this kind of patient, there are so many things that can get missed. And if we missed something, it affects our patients’ outcomes so you need to have a systematic approach to the care of a trauma patient.”