Trauma nurses work every day with complex patients whose lives are on the line. They have to stay on their feet, keep up with constant changes in policy and practice, and deal with extremes of emotion on almost a daily basis.
Given the demands of the profession, how do successful trauma nurses manage to build a rewarding career and stay in it for the long haul?
I recently reached out to the trauma nursing community with two questions: “What advice are you most likely to give to someone who is considering a career in trauma nursing?” and “What do you wish you had known before you became a trauma nurse?”
I am grateful to the many trauma nurses from across the country who took the time to respond to this request. These busy nurses not only gave their feedback on my questions, they provided extensive written comments on how to navigate workplace obstacles, grow as a clinical expert, assume leadership roles and manage work-life balance.
I also spoke with Janie Schumaker, MBA, RN, CEN, CENP, executive director of the Board of Certification for Emergency Nursing (BCEN). She provided additional perspective on trauma nursing career strategies and the importance of ongoing professional development.
In their responses and detailed feedback, these nursing leaders and experienced caregivers highlighted several recommendations for building a long and rewarding career in trauma nursing.
1. Find a trauma nursing career mentor
The number one career advice from experienced trauma nurses is to find a mentor. A good mentor can provide thoughtful guidance in the fast-changing trauma environment and help you make solid career decisions.
“Having a mentor has definitely changed my view of nursing and my goals in a positive way,” wrote one trauma nurse. A good mentor knows the ups and downs of trauma nursing and can share their experience. “The opportunity to bounce ideas off someone like that is invaluable.”
Another trauma nurse wrote: “Mentors guide and advise while also allowing for a safe place to go when it’s time to debrief.” According to others, a mentor is sometimes the only person who will give you objective feedback on your performance.
What should you look for in a career mentor? One trauma caregiver said a key trait is professional generosity: “Find a mentor who will be genuinely happy for you when your career passes her by.”
2. Learn how to communicate with trauma surgeons
“Communicating with physicians is imperative to making sure your patients receive the best care possible,” wrote one trauma nurse. “I hate to say this — and I would like the culture to be different — but good communication with physicians will earn their respect. That will make it easier for you to advocate for you patient’s needs.”
One key to communicating with surgeons is education. “The first step is to have a solid foundation in medicine and in pathophysiology,” a trauma nurse explained. “The MDs are more likely to listen if you are speaking their language.”
This ability is essential to patient safety, according to another experienced nurse: “Being able to communicate your knowledge to physicians in a professional, assertive manner could be the difference between life and death for your patients.”
According to Janie Schumaker of the BCEN, good communication skills allow trauma nurses to bring their unique contribution to the table.
“Nurses spend the lion’s share of the time with the patient and physicians only a fraction of that time,” she said. As a result, trauma nurses often pick up on issues that the surgeon does not see. “That’s why it is important to be able to communicate with trauma surgeons — so you can fill in any gaps and so the patient gets the best care possible.”
3. Remember to take care of your own wellbeing
“Work-life balance means everything,” said one trauma nurse. “Nursing can take your soul unless you protect it. You must have a reserve to draw from in order to take care of some very demanding patients.”
Another nurse cited the “always on” nature of trauma care: “Trauma is a field where nurses rarely slow down to identify their own needs and feelings. This will catch up to you (when you least expect it).”
Several trauma nurses noted that building your own physical and emotional health will ultimately benefit patients.
“Nurses spend their working hours caring for others,” a trauma professional wrote. “Self-care replenishes our capacity to provide compassion and empathy, which improves the quality of care provided.”
4. Continue your professional nursing education
Successful trauma nurses agree — the only way to keep up with the constantly changing field of injury care is to commit to lifelong learning.
“Always continue your professional education,” wrote one trauma nurse. “There is SO much you don’t yet know and so much you think you know that we will soon learn is incorrect. Only a habit of continually pursuing professional education will ensure your trauma nursing excellence.”
Take advantage of a variety of educational opportunities. “I make an effort to go to two conferences per year and also do continuing education on my own,” a trauma professional wrote. “It keeps me humble about my knowledge while also improving my clinical practice.”
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Several trauma nurses noted the importance of specialty-specific education. “Definitely get professional education specific to trauma,” one person explained. “It will enable you to be an advocate while giving you the confidence to communicate with physicians in the best way possible.”
Janie Schumaker believes the best trauma nurses take accountability for lifelong education. “A big part of that is seeking out knowledge beyond the requirements,” she said. “You have to be educated beyond just the trauma piece so that you know how all the pieces of patient care work together.”
The first step is to pay close attention to your patients. “Where do you see trends within your patient population? Where do you see deficiencies? Where do you feel you are not adequately prepared or not as equipped as you should be?” Schumaker said. “When we identify a gap in our knowledge, it is then our responsibility to go out and get that knowledge.”
5. Be assertive and never be afraid to speak up
Trauma nurses strongly back the value of assertiveness. As one caregiver put it, “Being able to be heard and be a strong patient advocate is so important to being a good trauma nurse.”
Several people pointed out the link between confidence and patient safety. “Be assertive and never be afraid to speak up because lives are on the line,” wrote one trauma nurse. “It is OK to state your thoughts and concerns. It’s all checks and balances, and I’ve saved lives by being the patient’s advocate.”
Speaking up can be taxing, so it is important to focus on the big picture. “Sometimes people will only see you as the person who points out failures,” another trauma nurse wrote. “Just remember, they’re not failures, they are opportunities for improvement. Be proud of the positive changes your department can make happen, not only for trauma patients but by improving healthcare for all patients and for staff as well.”
Assertiveness is also important when dealing with fellow team members. A small but significant number of professionals said trauma nurses need to learn how to deal with bullying by peers or managers. And several recommended that trauma nurses learn how to protect themselves from workplace violence.
6. Seek specialty certification in trauma nursing
The best trauma nurses understand the entire injury care pathway. According to many experienced caregivers, the best way to achieve that goal is to earn specialty certification in trauma nursing.
The Trauma Certified Registered Nurse (TCRN) certification from the BCEN is the only nationally accredited professional credential in trauma nursing.
“Nurses who earn the TCRN have demonstrated a mastery of the trauma nursing body of knowledge that spans the entire trauma care continuum, including injury prevention, prehospital care, critical care, and rehabilitation and reintegration,” Janie Schumaker said.
Nurses who earn trauma nursing certification say it makes a difference for patients. “I have been certified in my specialty (emergency nursing) for many years, and I am absolutely positive that it has made a difference for many patients I have cared for,” Schumaker said. “Without a doubt it has saved a few lives, and we know the same is true for TCRNs.”
In addition to her leadership role in the BCEN, Schumaker is also president of the American Board of Nursing Specialties (ABNS). The ABNS focuses on improving patient outcomes by promoting specialty nursing certification.
7. Find a niche or role you are passionate about
Several trauma nurses said that finding a role that excites you is important for building a sustainable career. In addition to frontline patient care, trauma nurses can also develop careers in trauma program management, trauma performance improvement, injury prevention and trauma data management.
Enthusiasm for your career will support personal resilience. As one trauma nurse wrote, “Being passionate, informed and educated will help overcome a lot of the emotional stress that comes with a career in trauma nursing.”
“Finding a role you are passionate about is vital because there will be bad days,” another trauma nurse said. “Your passion will help you overcome those days.”
8. Be active in trauma and emergency nursing associations
Several experienced trauma nurses strongly recommended getting involved with professional groups such as the Society of Trauma Nurses, the Emergency Nurses Association and the American Association of Critical-Care Nurses.
“Being part of a professional organization offers both educational opportunities and opportunities to learn from fellow nurses,” wrote one trauma nurses.
Other trauma nurses noted that professional involvement is in the best interest of patients. “Advocating for patient care goes beyond the bedside,” a nurse explained. “Being actively involved in professional organizations is vital to patient advocacy.”
One caregiver noted that this recommendation is also important for career development: “Professional organizations are helpful in advancing career pathways through networking and education.”
9. Get outside your lane
Specialization is a key part of nursing, but nurses also need a comprehensive view of the entire continuum of care. Many professionals said it is important for trauma nurses to understand what happens outside the trauma bay.
“It’s not all blood and guts,” a trauma nurse wrote. “Your patients will have other comorbidities and systemic issues, so it is important to always be learning outside of your ‘specialty’.”
Several trauma nurses specifically recommended seeking experience in critical care. “Work for at least one year in the ICU,” a trauma nurse wrote. “I went straight to the ED after graduation. My area of weakness is vents.”
Another trauma nurse said, “I wish I would have spent a bit more time working on the different patient care units and rotated around a few different specialty areas before going into trauma.”
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Diversity in experience helps build teamwork across the continuum of care. “I started out as a new grad in the SICU/Trauma ICU,” wrote one experienced caregiver. “Bedside clinical experience and relationships help open doors and build trust within the critical care team.”
Getting outside your lane can also help you maintain a trauma career long-term: “I wish I’d known all of the various roles within a trauma system so I could better set myself up for a long-term career in trauma when not able to keep up with the physical demands of bedside nursing but still being able to provide valuable feedback and process improvements.”
10. Get training in leadership and management skills
Whether you have a formal management title or not, people throughout the hospital look to trauma nurses for leadership.
“Getting training in BOTH leadership and management is important because they overlap but they are not the same thing,” a trauma nurse wrote. “It is important to be able to be a leader who has a vision and the ability to articulate it — and to be an effective manager who can work with the team to get goals accomplished.”
When describing leadership techniques, experienced caregivers pointed to the importance of soft skills. “Part of developing as a leader is knowing your own limitations and educating yourself on how to mitigate those limitations,” a trauma nurse wrote. “You need to know when to push through and when to step back and let others take the brunt of the efforts.”
Another trauma nurse recommended learning how to do effective debriefings with staff: “It is beneficial to learn how to do this in a professional way without demeaning anyone. Follow up on things done well and what could have been done better. Everyone benefits.”
Several trauma nurses said the ability to communicate with hospital administrators is a vital career skill. One trauma leader wrote, “It is important to learn how to speak with the A-suite, because that is key to gaining support for the trauma service and maintaining it.”
Janie Schumaker believes that trauma nurses who develop leadership skills will benefit the entire healthcare system. “Trauma nurses are incredibly resourceful,” she said, “and the more we can get them involved in solving some of the challenges we have in healthcare, the more we will get accomplished.”
11. Keep it all in perspective
Trauma nursing is a demanding job that can easily burn you out. You cannot get rid of the demands, but you can learn how to manage your perspective. Experienced professionals recommend keeping a sense of balance about the ups and downs of trauma nursing.
First, accept that there will be bad outcomes. As one trauma nurse put it, “Sometimes nothing you do can save the trauma patients you care for.” Another caregiver zeroed in on one of the hardest aspects of trauma nursing: “Pediatric cases never get easier.”
At the same time, it is important to keep the bright spots front and center:
“As a trauma nurse, you experience what is likely the worst day of your patients’ lives,” one person explained. “You experience bad situations (child abuse, domestic violence, suicide). You will watch parents say goodbye to their child. Loved ones agonize over end-of-life decisions. It takes its toll on you. You have to hold on to the good moments: The trauma survivors you never thought would survive. The patients who come back to thank you after they get out of rehab. The families who hug you tight.”
Robert Fojut is the editor of Trauma System News.