Patients leave them messages of thanks. Doctors call them the "glue that holds trauma care together." They are the trauma nurse practitioners at UC Davis Health System. And, when it comes to delivering seamless health care, the role these specialized caregivers play is critical.
With a well-defined protocol of care in hand and under direct physician supervision, they are among the first members of UC Davis' trauma team to assess the damage done to victims of car crashes or other collisions, who come to the region's only Level 1 pediatric and adult emergency department. They coordinate the patients' care with teams of trauma physicians and other professionals throughout their hospital stay, and they keep tabs on patients who complete their recovery at home.
In the late 1980s, UC Davis pioneered the use of nurse practitioners (NPs) to provide acute trauma care. Now, trauma NPs have become vital to every stage of trauma care.
"Trauma patient care would not be what it is today without the trauma NPs," says registered nurse Wendy Nugent, assistant director for Patient Care Services. "They are one of the most consistent members of our patientcare teams."
Nurse practitioners were originally trained to provide care where doctors were in short supply – inner city and rural clinics. The idea of using them to provide acute trauma care was a progressive one that has come to benefit everyone involved, from patients and physicians to the trauma NPs themselves.
"Trauma NPs help bridge the gaps between the different levels of care trauma patients typically receive. They also help educate students and serve as resources for the attending physicians," Nugent says. "It's a perfect use of their training."
Bonnie McCracken, who was one of the early trauma nurse practitioners at UC Davis, agrees.
"We look at patients with a different eye," says McCracken, now nurse practitioner manager for trauma and orthopaedic surgery.
"While a surgeon determines the surgery a patient might need, trauma NPs are always on the lookout for additional medical and social factors that might affect the recovery and health of the patient," McCracken says.
UC Davis' 13 trauma NPs are able to provide holistic care because, as critical members of the trauma team, they are intertwined with their trauma patients from when they arrive to when they return home. Trauma NPs are critical members of the team of first responders in the emergency department. They help physicians care for the patients, following protocols developed for the care of trauma patients.
Throughout patients' time in the hospital, the trauma NPs remain part of the care team. They are there to assist and guide the care of patients while coordinating care with many ancillary services.
"The nurse practitioners follow the patient with an experienced eye," says McCracken, "picking up subtleties and nuances in their care throughout their recovery."
For many patients, the involvement of trauma NPs in all areas of their care is reassuring.
"They feel like we know them," says Stefanie Generao, who joined UC Davis as a trauma NP in 2005. Generao is one of a few trauma NPs on staff who works in every area of trauma patient care. It is not uncommon for her rotations through these areas to mirror that of her patients' progress through those same locations. She says this allows her a unique and satisfying perspective.
"Sometimes they don't remember how sick they were," she says. "It makes a big difference for a patient to hear someone say 'You've really come a long way', and because I often follow them through, I can help give them that perspective of their recovery."
Easing the workload
While the benefits to patients today seem obvious, the use of trauma NPs first began as a way for physicians to ensure their trauma patients received follow-up care in outpatient clinics.
Nugent says the need for trauma NPs has increased dramatically in recent years because of legislation limiting medical residents' work hours.
"The trauma NPs have assumed some of the care that residents would have historically provided," she says.
Generao says that feeling needed by her patients, as well as physicians and other hospital caregivers, offers a great deal of job satisfaction.
"Our chiefs and residents are constantly thanking us and reminding us how we are important," she says. "We really feel appreciated."
With that kind of job satisfaction and the job security offered by the increasingly important role played by trauma NPs, McCracken predicts a bright future for the profession.
"There is a growing need and desire to incorporate nurse practitioners into other areas of care," she says. "Our contribution to trauma care will just continue to grow."