Trauma Nursing: Interview Cathy Carter, RN, BSN, MICN, CEN

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Trauma Nursing: Interview Cathy Carter, RN, BSN, MICN, CEN

Working as a team to care for patients with severe injuries

By Keith Carlson, RN, BSN
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Cathy Carter, RN, BSN, MICN, CEN
ED staff RN, Preceptor and TNCC Instructor
Providence Holy Cross Medical Center, Mission Hills, Calif.

Where are you employed?    
I work at Providence Holy Cross Medical Center in Mission Hills.

What is your position?

I’m a clinical IV staff RN in the emergency department and function as a principal preceptor for new graduate RNs in our department. I also hold national certification as a TNCC [trauma nurse core course] instructor.

Tell us about being a TNCC instructor.
The TNCC course is sponsored by ENA [Emergency Nurses Association], our professional organization. The course prepares emergency nurses to care for patients who have sustained traumatic injuries. Our hospital sponsors this course several times a year, with participants attending from all over Southern California. The TNCC certification for RNs is valid for a four-year period. I maintain my instructor certification by teaching the course at least twice yearly.

What would you like to share about your overall career?
I was initially educated at L.A. County School of Nursing, where I received a diploma in 1987. I began working at L.A. County General Hospital in the “red blanket room,” which is best described as a cross between the ICU and the ER. I worked there for five years before transitioning to the emergency department. I was drawn to Providence Holy Cross because it offered me the opportunity to become a MICN [mobile intensive care nurse] and develop skills in trauma nursing.

What’s the MICN designation?

I am licensed in Los Angeles County to operate as a mobile intensive care nurse, which allows me to answer the field radio, direct paramedics in the care of patients in the field and determine those patients’ destination in terms of care. Our practice is based on protocols established by the Los Angeles County EMS agency.

A good example would be caring for a patient in cardiac arrest. I would follow an algorithm and assist in the treatment of the patient over the radio. The paramedics perform a 12-lead ECG in the field and then transmit the reading via a secured web program. We can read the ECG, identify ST elevations and other abnormalities and then make recommendations based on our protocols. If we can get patients to the cath lab within 90 minutes of their hitting our doors, we’re in a great position to save a life.

The paramedics have their own protocols as well, but we offer them extra support and expertise in the care of patients in the pre-hospital setting.

What are your days like?
I work 12-hour shifts in the emergency department, where I am responsible for patient care as well as answering the base radio to direct care of patients in the field. Not all of the RNs in the department are licensed to answer the radio, so this added responsibility adds stress to my day. My teaching of the TNCC program, our MICN development program and my hospital committee work keeps my plate pretty full. That is in addition to my three regularly scheduled 12-hour days in the emergency department.

What about your work feeds your spirit and keeps you coming back?
I love people and know that what I do on a daily basis makes an impact. I think my biggest role is as a patient advocate. In this day and age, everyone should have an advocate at their bedside and not everyone does. I’m dedicated to those patients (and their families) that are assigned to my care. I have a very good rapport with the docs and they listen to me, since I have so much experience.

We’re a recently recertified Magnet hospital and we have a great group of strong nurses on our unit. Our community expects to be cared for by the very best nurses. The acuity in the ER is very high and even though we have only 26 beds, we see an average of 82,000 patients per year! For what we see and the work we do, we’re on the cutting edge. I’m really proud of how we make such a difference in people’s lives.

Can you share a story that illustrates your work and what you love about it?
We had a school shooting a number of years ago and while we’re not a pediatric trauma center, we received a 5-year-old boy who was shot by the gunman and had a direct bullet wound to his femoral artery. We were the closest facility for this critical injury and we also pulled together with ICU staff, ER staff, management and other members of the team to meet the needs of the other patients involved in this multi-casualty incident.  We worked as a team to ensure this child went quickly to surgery and then was stabilized for transfer to a pediatric trauma center. There is not one of us who is not a parent, grandparent, aunt or uncle, so we feel the added stress of dealing with pediatric patients.

There was also a train accident several years ago. It was amazing how we all pulled together in the face of a mini-disaster, triaging and treating those most in need. We did what we had been trained to do and everyone knew their role. It may look chaotic from the outside, but to us, it is a calm chaos.

It makes a difference when you know that you have nurses at your side with whom you can communicate by only a look or a word. We watch one another, read the situation as a team and do what needs to be done.

How do you prepare yourself mentally for receiving such traumas?
When we first hear about a situation and know that patients are on the way to our unit, we have the key players ready to roll: Nurses, trauma surgeons, docs — they’re all ready. We have one designated trauma surgeon on call 24/7, but in the case of mass casualties, other physicians are called to come in and assist. We assemble a team, designate rooms, calm our minds and wait for the arrival of the ambulances, knowing that we’re totally ready and fully staffed. It’s the strength of the team that buoys us.  

How do you take care of yourself when you’re at work?
On our unit, we take breaks unless we have a mass casualty situation, and then it’s all hands on deck. I can’t remember the last time I skipped lunch. We have a fabulous group of volunteers that not only caters to the patients, but also treats the staff to homemade goodies on a regular basis.

We also have a very solid chaplain and social services department that provide us with formal debriefing when requested. These individuals are always checking up on caregivers’ well-being. We are a team, drawing strength from one another and enjoying our mutual camaraderie.

How do you replenish when you’re home?
After a 12-hour shift, I am pretty spent and look forward to kicking up my feet. However, on my days off, you can find me at the gym, where I participate in regular classes and work with a trainer. I enjoy and value an active lifestyle, so I get away to hike, bike ride or ski whenever I’m able. I feel great and attribute it to my exercise and active lifestyle as well as my job, which is satisfying.

You have a great precepting program in your ER. Tell us about that.

Our ER is very unique, I think. We take new grads through a preceptor program in which the new nurse is one-on-one with a seasoned nurse for six months. We definitely do not eat our young.

We believe “homegrown” is best and the whole department plays a part in nurturing the new graduate RN. We love the new grads because they’re so fresh and enthusiastic, and we “grow” them up to be our peers and trusted colleagues. We’re so proud of them. It’s a privilege to be involved in making them the best nurses they can be.

We have several nurses who came through our precepting program and are still with us, one of whom has now been on the unit for nine years. That says a lot. Many are MICNs and charge RNs.

Do you have any future plans for your career?

I would like to test for my CPEN [certified pediatric emergency nurse] this fall, which is another nationally recognized professional certification. I would like to continue making contributions as a nurse educator to my peers who are entering the field of emergency nursing, as I have received many compliments for my teaching style. To that end, I will continue teaching the TNCC and MICN programs and I’m considering getting my certificate to teach the nationally recognized ENPC [emergency nurse pediatric course] course.

I love the emergency department, I love our unit and I love our autonomy. Our director, Missy Blackstock, is fabulous and I appreciate her open-door policy. I especially appreciate the visibility of our CEO and CNO and their interest in our department. I am content and satisfied with my work and the contributions I have made to my profession.   

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