Vital Views

Joe Gaccione 0:02
Welcome to Vital Views, podcast for UNLV School of Nursing. I'm Joe Gaccione, communications director for the School of Nursing. On the surface, trauma nursing or emergency nursing sounds like one of the most stressful roles a nurse can be put in, from the critical conditions of the patients to the fast-paced nature of the job. And while those elements exist, they are not to dissuade nurses from joining a trauma team. Sure, other nursing units may be less frenetic, but it is still one of the most indispensable healthcare roles out there. To share more about trauma nursing, we are joined by Esmeralda Clark, UNLV Nursing lecturer and course coordinator for our level four / final semester students. She's a board-certified family nurse practitioner who has years of experience as a critical care and trauma nurse. She earned both her bachelor's and master's degrees in nursing from UNLV. Esme, thanks for coming in.

Esmeralda Clark 0:50
Thank you for having me here. I'm excited for this little interview and, and, looking forward to it.

Joe Gaccione 0:56
Describe the difference, if any, between trauma nursing. and critical care nursing, are they the same thing?

Esmeralda Clark 1:02
Not really, so yes and no. So, trauma nursing is a specialty that cares for critical patients who are involved in traumatic events, traumatic injuries, right? And so, across the country, we have trauma centers that are caring for these patients, and sometimes your trauma nurse is also working within a regular emergency department where they see non-trauma patients as well as trauma patients. What's unique about the level one trauma center that I worked at here in Las Vegas is that it had a freestanding trauma center, and we called that unit trauma resuscitation. So it's kind of like a mini ER, a smaller ER that's separate from the regular emergency room where they see non-trauma patients. And so, those nurses are really ER emergency trauma prepared nurses that care for trauma patients. Critical care, those are units that care for patients that are critically ill, but I happened to work in a critical care unit that focused on trauma. So, I worked in trauma icu, so I had to learn how to care for trauma patients in critical condition. And so, those two specialties intertwined, critical care and trauma, in that unit. And in addition to that, that unit where I worked, we also recovered our own patients from the operating room. So, if they were trauma patients that needed surgery, they went to surgery and we recovered them. They didn't go to a recovery room which is the typical place where patients recover after surgery. So, we were kind of like your one-stop-shop for the trauma patients.

Joe Gaccione 2:52
I hear trauma and I'm going to physical trauma, physical injuries, but that, is it just physical? Do we include mental trauma as well? Psychological trauma?

Esmeralda Clark 3:01
Well, I think that's a great question. Yes, so the trauma patient is a patient who has sustained physical injury, and in Las Vegas, we have a lot of, I don't wanna say this word because it sounds terrible, opportunities to get hurt, right? Not really opportunities, but we have a lot of hikers, we have, you know, Red Rock, Mount Charleston. We have a lake, boating accidents. We have people that drive very fast on the freeway, we don't have a mass transit system, so a lot of people drive very fast and, and get hurt. And so, these are patients that have sustained some sort of traumatic injury, but traumatic injuries do leave, you know, psychological, emotional impacts. So, a lot of our trauma patients have these emotional, mental impacts after the injury that they have to deal with. So, I think it's a combination of both.

Joe Gaccione 4:02
And it's, in a lot of cases, one can't go without the other.

Esmeralda Clark 4:05
Correct. And a lot of our trauma patients also have some psychosocial issues that they deal with in their lives. You know, a lot of trauma patients are under the influence of alcohol or substances that impair their judgment, and so we deal, we dealt with a lot of patients who had some underlying psychological and mental health issues that put them in those situations where they got hurt.

Joe Gaccione 4:32
You have telehealth experience. We've seen a rise in telehealth since the pandemic. It existed before, but it's increased exponentially since then. Can you have telehealth when it comes to trauma nursing?

Esmeralda Clark 4:44
You know, that's interesting. I would say in the acute phase of a traumatic injury, obviously they need to be seen in the hospital. But you know, there's a potential there. Maybe doing some follow-up visits after the patients are stable and at home where a telehealth platform could be helpful in, let's say, answering questions about how they're recovering or answering questions about medications or they can log on and see a provider that can let them know if they need to be seen in person or not. Those types of visits that are not emergent could surely be a part of the, the trauma patient care in the long term.

Joe Gaccione 5:30
Some of the students I've talked to in the past say they want to be in an emergency room setting, a trauma setting, because of the pace, they, they like that type of energy. What drew you to the specialty?

Esmeralda Clark 5:40
Oh boy, exactly what you just mentioned. I was drawn to it because of the adrenaline rush as well as the fast pace. I've never been a person that can sit, you know, in a cubicle. I've always been attracted to that human experience, interacting with people. And, you know, the ever-changing pace of being a nurse is increased in the trauma setting because you just never know what's gonna come in through the door. And so, that's what attracted me to that, um, specialty.

Joe Gaccione 6:13
What are common myths about trauma nursing that you've heard throughout your career that you'd want to debunk?

Esmeralda Clark 6:19
That's an interesting question. I think nursing in general, there's a lot of myths out there. You know, like the nurse is just the assistant to the doctor, for example, and that's a myth. Yes, we're partners in caring for patients, but there's a lot of things that nurses have to understand, know and have knowledge of to be able to care for patients. And I think in the trauma setting, that's even more important where you don't really have a whole lot of time to think about things, you just do, to save a life. And so, it takes a really strong nurse, yes, with the collaboration of the physician, but there's a lot of things that nurses do to save lives in the trauma setting. So, they're not just the assistant to the doctor, they are working in collaboration with other team members to take care of that patient.

Joe Gaccione 7:14
Was there a moment, a memorable moment, and I don't say memorable necessarily to be all positive, but a, a moment or unforgettable thing that happened when you were working as a trauma nurse?

Esmeralda Clark 7:25
Unforgettable thing, there's so many things that I carry with me as a trauma nurse, but I would say that one of the biggest memories I have, and I'm gonna get choked up here, I took care of a patient who passed away, very young patient, and it was really tough for me to get through that, and his mother comforted me. I carry that with me to this day, and we've had years where that family and I, you know, send each other Christmas cards. His mother sent me a Christmas decoration to put on my Christmas tree which I, which I put up every single year. So, I think that's one of the cases that I will keep forever because it was, you know, a mother losing a child and then still having the strength to comfort the nurse that is taking care, was taking care of her son, so that was, something that I carry forever.

Joe Gaccione 8:20
And it also just shows that bond that you make, not just with the patient, but the patient's family. You have to interact with the family, the friends, during treatment, but to show that sustainability, that's something.

Esmeralda Clark 8:31
And I tell my students that in class all the time when I cover emergency nursing and trauma nursing, is that you're not only taking care of that patient, right, your priority is the patient, but the family members are also gonna be kind of like your patients because they're gonna be going through this traumatic experience of having a family member that's injured and they're gonna be there at the bedside, so you gotta take care of them as well.

Joe Gaccione 8:57
On that topic of memorable moments, unforgettable moments, 1 October you had assisted, you had worked with the students in clinical to help patients. Do you mind sharing what that experience was like that week?

Esmeralda Clark 9:11
Sure. That experience was difficult for all of us. The students were, you know, obviously very emotional about that, so was I. That was the year after I left practicing as a trauma nurse practitioner, and so I dealt with some guilt, you know, because I wasn't there as a provider helping out. And so, we wanted to do whatever we could to help out and I remember taking students to clinical, walking through those hallways and we saw, you know, banners and posters and food being brought in and, you know, the community really coming in to step up and help. I myself went in that very morning and donated blood right outside of the hospital, and I remember standing outside with other residents that I've met throughout the years who were also donating blood and other nurses that were there trying to help out. And then caring for those patients, you know, some of my students, we, I would assign patients that were victims of October 1 to them so they could care for them on the units and, you know, it was a struggle, but I think that it really helped them through that experience to be able to help patients who were directly impacted by that night and also being able to help the nurses on those units care for those patients made them feel like they were part of something in, in the healing process.

Joe Gaccione 10:38
Were these undergrad students or were they graduate students?

Esmeralda Clark 10:40
They were undergrad students, and we were working in the intermediate care units there in the hospital. And so, these patients, you know, they had some pretty serious injuries. The students did an amazing job caring for, for these patients.

Joe Gaccione 10:56
That has to be an unfortunate learning experience. Like unfortunately, you can say they grew in those, I mean, any nurse working that, that week, that night, it's a growing experience for them. I talked to an alumnus from UNLV, critical care nurse, who tried to break it down for me a couple years ago, and he said that it was, you know, you essentially have to boil it down to each patient, gunshot victim, or whatever injury, you've had those before, it's just for this instance, it's a rare instance where there's just so many, but essentially you have to tell yourself, “Okay, each patient is its own,” you know, you've, you've treated gunshot victims before, you've treated people that might have been trampled on, for instance. It's just coming to grips with “Okay, there's the volume of it, and it's going, it's going to subside.” You know, when you're talking to the students, I mean, how do you, do you prep them? Like, do you call them like, okay, so that night of, I don't know if anyone, any of them were working that night, but you know, the morning after when the kind of the dust has settled, so to speak, do you call them and say, “Okay, this is unusual. This is, this is big, but remember your training. Remember what you have to do.”?

Esmeralda Clark 12:04
Definitely. You know, we have morning check-ins. You know, when we arrive to the hospital, those pep talks, you know, “This is gonna be hard for you today, but, you know, we're gonna do this together.” I try to prepare them for the things that they're gonna see when they go into clinical, and also, you know, once the day is done, that clinical day, debrief and talk about what they saw, because it can be tough and not just in, you know, a situation like that, October 1, but every day, you know, nurses see things that, you know, most people don't ever get to see, and nursing students are novices. They don't know how to handle that. And so, I try to listen to them and I also share stories with them so that they know, like I've been through that too, and it's okay to cry. It's okay to need some time to process, it's okay to ask questions because I don't want them to ever feel like their emotions, you know, some of them think, “Oh, it's weakness.” I don't think your emotions are a weakness. I think those are strengths. Having those emotions and, and understanding them and letting them, you know, process, it helps you and you can also help your patients better because you can empathize with their emotions and help them through that.

Joe Gaccione 13:22
Any nursing role and to that extent, any healthcare professional role, you need that debriefing process because you're gonna see different things. And I'd imagine for trauma nursing, it has to be absolutely vital, no pun intended, because you're gonna see people at their worst or close to their worst, and you are working with people that are doing the same thing. You have to be able to talk about it, not just for procedure or to say, “Here's what we did, how could we improve?” but just to let it all out because you're, you're holding a lot inside.

Esmeralda Clark 13:50
Yes. definitely. And working in a trauma unit like I did, you create a lot of really close friendships with those that you work with because you get to see those things together and you understand what it's like. And so, I found it always therapeutic to talk to my friends about it, you know, the people that I worked with on those shifts. And to this day, you know, I haven't worked in the trauma ICU for over 12 years, I still have friends that still work in that unit and when we get together, we still reminisce on things that happened back then, you know? It's like a bond that's there forever, because we experienced that together. I always talk to my students about debriefing, you know, whenever we had really tough cases, you know, in trauma recess, for example, if we witnessed a, a very difficult injury or a death of a patient, we would do potluck sometimes to bring food the next day and talk about it and sit around and talk about what we experienced and how it went and let people share. I think that's really important.

Joe Gaccione 14:54
I'm sure your nursing students are gonna be listening to this episode. They might be interested in trauma nursing. What skills or what attributes should they have, should they really try to focus on if they want to go on that path?

Esmeralda Clark 15:08
Attributes, be quick on your feet. That's really important. And don't be afraid to speak up, right? Because there's things that you're gonna see that you're gonna need help with. You always need to speak up when you need help, when you have a question, when you see that your patient needs something, you need to be an advocate for them no matter what. And so, those are all really important skills. Have good communication skills, that's really important. And, you know, be as knowledgeable as you can about the care that you're gonna provide to these patients. So, you have to get some, a lot of certifications and things that will help you navigate caring for these patients. So, I would say that trauma nursing is not for the shy person, right? You really can't sit, you know, by the wall being afraid to communicate with a team of healthcare workers that are gonna help you take care of that patient. So you gotta, you gotta put yourself out there. A loud personality, I guess you could say. I don't know, you know, I have worked with a few trauma nurses that appeared to be kind of shy, but they weren't really shy, you know? They would speak up when they needed to speak up. They weren't afraid to say something when they needed to say it. So, it's really having the ability to communicate really well is really important, and be quick on your toes.

Joe Gaccione 16:35
That is all the time we have. Esme, thank you so much for coming in.

Esmeralda Clark 16:38
Thank you. This was fun.

Joe Gaccione 16:40
Thanks for listening out there. Hope you have a great day.