How to build a trauma registrar team without poaching from other hospitals


Many trauma centers are struggling to maintain a full team of trauma registrars. According to a recent survey, more than a quarter of trauma programs have trouble recruiting registrars, and over one-third have problems with retention. New criteria from the American College of Surgeons could make building a registry team even more challenging. According to the latest edition of Resources for the Optimal Care of the Injured Patient, verified Level I, II and III trauma centers must have one full-time registrar for every 500 to 750 admitted patients.

“Under these new criteria, the typical trauma center could need five or six registrars, and that doesn’t include data specialists or performance improvement staff,” said Jacqueline Moses-Hardy, co-founder of Trauma Leadership Development Trainers, LLC. “There are simply not enough candidates right now to fill all those positions. Trauma centers have tons of registry jobs available but nobody to take them, and advertising for these positions has proven unsuccessful.”

Hiring registrars away from other trauma centers is not a long-term solution. “Shuffling registrars around from hospital to hospital is not the answer,” Moses-Hardy said. “What we need to do is increase the pool of registrars overall. Our main question should be: How can we pique interest in trauma and pull new professionals into trauma registrar careers?”

Moses-Hardy has trained registrars and consulted for trauma centers coast-to-coast. Recently, she described four strategies for building a trauma registry team by cultivating new sources of registrar candidates.

1. Reach out to students in advanced nursing programs
Many registered nurses in the U.S. are now seeking advanced nursing degrees. “These professionals may already have an associate’s degree or a diploma in nursing, but many hospitals now want their nurses to have BSNs,” Moses-Hardy said. Many of these nurses could be prime candidates for recruitment into trauma registry.

Moses-Hardy suggests working through local “RN to BSN” programs. “Approach a local nursing school and offer to teach an elective class in trauma and trauma registry,” she said. “There is usually flexibility for this kind of class in the senior elective curriculum. It’s a great way to capture the attention of these nurses and hopefully get them interested in trauma registry.”

2. Offer trauma registry internships for nursing students
Student nurses are another potential source of new trauma registrars. Again, the route to these candidates is through education. “A lot of nursing students need to do a senior internship,” Moses-Hardy said. “Trauma programs can offer internship opportunities to nursing schools.”

Moses-Hardy suggests accepting one or two student interns per semester to work in the trauma registry. “They could sit alongside your full-time registrars, see what they do and work on projects. It’s a chance for them to see what a trauma registrar’s job is all about before they graduate.”

3. Create a career alternative for medical coders
“Medical coders and billers are another group of potential trauma registrars,” Moses-Hardy said. “Billing coders have a specialized skill set, however they may desire a different venue.”

She finds that many coding professionals are open to a career move, and trauma registry work is a natural progression. “These professionals already understand coding. You just need to tweak it for trauma. It’s no problem for them, and it can offer a different challenge.”

4. Provide a first step for new coding graduates
“There are medical billing and coding schools all over the country, and their graduates form a very big group,” Moses-Hardy said. “All the new graduates want to get into inpatient billing and coding, but most hospitals require experience. For many job openings, you need 3 to 5 years of experience before you can even apply.”

Trauma programs should target new coding grads for registry opportunities, Moses-Hardy said. “Again, these people have the coding skill set, you just need to tweak it for trauma. If you can tap into this large group and provide them with some experience, many will find that they like the trauma area.”

Registrars critical to trauma progress
Moses-Hardy stressed that these strategies represent her views, not the positions of any official trauma oversight group.

Her company, Trauma Leadership Development Trainers (also known as “Trauma 1”), provides contract trauma registrars and trauma registry training. The company’s two-day training program covers data management, condition of injury, coding and scoring concepts, registry issues and personal development. “Our mission is to increase the pool of trauma registrars,” Moses-Hardy said.

That goal is critical for all trauma systems. Several years ago Moses-Hardy was a consultant at a Level I trauma center during its ACS survey. Trauma registrar staffing was adequate but minimal. This hindered the registry team’s ability to expand its participation in research and performance improvement.

“At the end of the survey, one of the surveyors commented, ‘The registrars are doing a great job, but with the current staffing, they can’t move forward. They can only maintain their position. And today, if you aren’t moving forward, you might as well be moving backward, because everything else is moving forward.’”

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