The concept of specializing in nursing, essentially the advanced practice role in nursing, dates back to the 1800s starting with nurse anesthesia and the nurse midwife. By the 1950s, there were 3 roles of advanced practice nursing (APN), which included the clinical nurse specialist (CNS), nurse anesthetist, and nurse midwife followed in the 1960s by the evolution of the nurse practitioner role. Today, there are multiple APN certifications and specialty areas that seek to employ APNs. Trauma services fall into the realm of seeking and needing APNs on the team to provide leadership for rounding and care planning, continuity of care, collaboration with ancillary and subspecialty services, follow-up care in outpatient clinics, and oversight in the development of evidence-based protocols. It is unclear as to when the introduction of APNs began in trauma, but it is evident that many trauma programs now utilize APNs on their service as they are key components to a well-oiled team.
A spike in the trauma APN role was certainly influenced in 2003 when the Accreditation Counsel for Graduate Medical Education initiated a mandated limit to resident work hours. Several years later, restrictions were implemented to limit the hours of call periods. Trauma centers were faced and continue to be faced with not only the decrease in resident workforce but the mandated requirements set forth by the Accreditation Counsel for Graduate Medical Education. Although APNs may function differently across the nation due to state legislature and regulatory oversight, the commonality exists that an APN can independently provide comprehensive evidence-based medical care with a holistic nursing approach. The greatest attractiveness to the trauma APN role is the ability of the APN to serve as the independent practitioner at the bedside who has the ability to write orders, respond to diagnostic results, perform minor bedside procedures, and become credentialed in line or chest tube insertions. While providing direct clinical care, the trauma APN collaborates with the trauma attending, subspecialty services, and discharge planning team. The trauma APN's role in discharge planning has driven LOS hours down across many trauma centers as seen in the literature. As an independent practitioner, the APN can also bill for their services. The trauma environment offers great independence and the ability to utilize and advance all APNs' trauma knowledge and skill set in a fast-paced and complex environment.
The trauma APN role does not stop at the bedside or in the outpatient clinic. The trauma APN participates in research projects, serves in both managerial and administrative positions, educates registered nurses and residents informally and through certification courses, or serves as an expert witness in legal cases.
Trauma care is forever changing with new approaches to resuscitation and surgical approaches. The diversity of the patient population as well as the aging trauma population has required clinicians at all levels to adapt patient care plans appropriately. As all nurses are, the trauma APN is adaptable to a constantly changing and complex patient care environment and can take the lead in providing the necessary optimal trauma care starting from the time of admission through the patient's outpatient needs.
Trauma APNs are in demand and the role continues to expand. Trauma physicians support and acknowledge the importance of this nursing specialty. Organizations such as the Eastern Association for the Surgery of Trauma have created the Advanced Practitioners Ad Hoc Committee. The establishment of this committee has brought the APN workshop to the EAST Scientific Session as well as the STN annual conference. The workshops and any other additional educational offering are presented by both trauma physicians and trauma APNs. The commitment to collaboration both at the bedside and in an education forum supports that we can learn from each other. Trauma APNs need to be proud of their role, understand the great impact that they are having within a challenging population, and continue to provide and utilize their skills and knowledge that was earned from prior trauma bedside experience as well as the knowledge gained from their APN programs.
I strongly believe that the trauma APN serves as the centrifugal force that moves the patient along the continuum of care while making certain the patient receives optimal care as an inpatient and after discharge.