Emergency departments assessed on tougher trauma nurse training

TQuINS clarified to produce new national standards for ED nurses caring 24/7 for trauma patients

TQuINS clarified to produce new national standards for ED nurses caring 24/7 for trauma patients

All emergency departments (EDs) that accept trauma patients will have been assessed against rigorous new standards for the knowledge and training of nurses by the end of September.

Developed by a large team of emergency nurses and launched in April, this new guidance is intended to improve the care received by the most seriously injured patients.

It calls for EDs that receive trauma patients to have a band 7 nurse or allied healthcare professional, highly qualified in trauma care, available at all times of the day and night.

Trauma nursing competencies are part of NHS England’s National Trauma Review Programme, a quality assurance initiative for trauma services. Trauma teams are assessed against a set of quality measures for a programme called the Trauma Quality Improvement Network System (TQuINS).

Suitable training

It is designed to ensure services are as safe as possible, improve the quality of care and patient experience, share good practice and provide development for staff.

A new part of TQuINS for 2016 is competencies developed by the National Major Trauma Nursing Group (NMTNG). The decision to develop them came after the first TQuINS, published in 2014, said there should be a nurse available around the clock who had completed the Advanced Trauma Nursing Course (ATNC) or its equivalent.

Rob Pinate, NMTNG chair and consultant nurse in the emergency department at Kings College Hospital NHS Foundation Trust in London, says he and colleagues felt there was little clarity on what constituted appropriate training.

The group was formed in July last year to consider the issue with representation from the majority of England’s trauma networks and members from Wales, Scotland and Northern Ireland.

Goal for nurses

It agreed that the Trauma Nursing Core Course and the European Trauma Course were equivalent to the ATNC. It also drew up a curriculum and assessment framework for universities who run trauma modules so they can offer courses of an acceptable standard.


Percentage of emergency department presentations who are major trauma patients

‘Very quickly it became obvious that we needed a set of competencies, and that we needed a separate set for paediatrics and different levels that we would expect nurses to achieve,’ Mr Pinate says.

The competencies are broken down into two sets, one for paediatric trauma nursing and one for adults.

Each set has two levels, with emergency nurses expected to attain level one competencies within a year, excluding preceptorship time, and level two within three years.

Career framework

There was already a level three, for advanced clinical practitioners, with competencies and education standards written by the Royal College of Emergency Medicine and the RCN.

Levels one and two were approved by the national clinical reference group for trauma and NHS England before being added to this year’s TQuINS.

‘It provides a progressive career framework in terms of education and competency,’ Mr Pinate says. ‘I hope it is a positive thing for nursing to be able to say this is the standard of what we should be getting educated to, and the kind of practice we should be able to deliver.

‘This is the first time anyone has said this is what a national standard should look like for nursing in EDs.’

Challenge for trusts

All trauma units around the country will have been assessed against TQuINS by the end of September. Trauma units have to self-assess, and major trauma centres are peer reviewed by outside professionals.

Under the standards, all major trauma centres should have a nurse or AHP at band 7 and level 2 available 24 hours a day, seven days a week. All nurses caring for trauma patients should have achieved level 1 on the education and competencies standards.

As the competencies have only just been published, EDs need to show they are working towards them for staff who do not already meet them, Mr Pinate says.

He acknowledges that supplying sufficient numbers of trained staff is a financial challenge for trusts.

Benefits for all

‘Major trauma patients are a tiny proportion of patients (in EDs), less than 1%,’ Mr Pinate says. ‘But if you train nurses to look after the critically unwell it benefits all patients. It’s challenging, but a standard shouldn’t necessarily shy away from being challenging. If we are going to achieve the standards EDs are going to have to make sure staff are supported to attend these courses, and that means there is a financial implication.’


Number of days it takes to complete the Advanced Trauma Nursing Course

There has been debate among emergency nurses about the insistence in TQuINS that all trauma units have a band 7 and level 2 qualified nurse always available.

Rob Crouch, consultant nurse and deputy director of major trauma at University Hospital Southampton NHS Foundation Trust, says he was surprised this was a focus of discussion. Some EDs have already achieved the standard, showing it is possible, he says.

‘We want our most experienced clinicians from a nursing and AHP background available to help these really complex patients,’ says Professor Crouch, a member of the national clinical reference group for trauma.

‘Trauma centres and units are assessed against these competencies in the peer review process around the TQuINS. The trauma units are asked to present data that supports the standards. That might include the number of nurses who have achieved level 1 or level 2 in the framework. It is important that the contribution made by nurses to the patient pathway is recognised within these standards.’

Costs and staffing

Janet Youd, chair of the RCN’s Emergency Nurse Association, welcomed the competencies as an opportunity to increase the skill mix in EDs, and for staff to access training and improve care.

‘The challenge for trauma units, rather than the major trauma centres, is releasing people for training and the cost of the recognised programmes,’ she says. ‘The ATNC costs about £850 and takes 4 days, so you are not going to get many staff through that and certainly not enough to have someone each shift.

‘Another challenge is that in a lot of units, nurses and sisters at band 6 and above are increasingly coordinating departments and are not in resus. Often it is a band 5 in resus, when according to the TQuINS it should be a band 7. People have got to have the skills to care for these patients. These standards can only be a good thing for patients.’

What the new standards call for
  • A nurse or allied health professional (AHP) of band 7 or above available for major trauma 24/7 who has successfully attained the adult competency and educational standard level 2.
  • In units which accept children there should be a paediatric registered nurse/AHP available 24/7 who has successfully attained the paediatric competency and educational standard level 2.
  • All nursing/AHP staff caring for trauma patients should have attained the level 1 competency and educational standard. In centres that accept paediatric major trauma, this should include the paediatric trauma competencies.
Further information

Read Emergency Nurse consultant editor Tricia Scott’s thoughts on the new competencies

Trauma Quality Improvement Network:

Erin Dean is a freelance journalist

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