Trauma Risk Management – the peer-led programme that prioritises nurses’ well-being

TRiM is an early intervention programme that helps nurses cope after traumatic incidents 

We all know that nursing can be stressful; nurses are at risk of exposure to trauma by witnessing violence, illness and death, which can affect their own mental health and well-being.

Figures from NHS Digital show that mental health problems, such as stress, depression and anxiety, are the main reasons NHS staff in England take sick days. Burnout is also common among nurses and this affects the quality of care we can deliver.

As a registered mental health nurse and ward manager at a medium secure unit, I am proud of the job I do. But mental health nursing has some unique challenges, simply by the nature of the client group we support.

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In my experience, it is the most junior members of staff – healthcare assistants and band 5 nurses – who have the most contact with patients. Yet they are the group who are potentially least well-equipped to deal with traumatic events.

Nurses need to feel allowed to prioritise their own health 

There are now loud and growing calls for a sea change to our working culture so nursing staff can give themselves permission to prioritise their own health. This concept may be counter-intuitive to the working lives of many nurses, but if we are to deliver high quality care, we must learn not to sacrifice our own well-being when caring for patients.

The trust I work for has recently implemented TRiM (Trauma Risk Management) – a peer-delivered programme of risk assessment and ongoing support designed to help people who have experienced a traumatic event. 

Developed by the Royal Marines after recognising that the experience of traumatic events affected operational effectiveness, it has now spread to more than 20 NHS trusts, including ambulance trusts, and is widely used in the police and fire services.

TRiM allows for early interventions for people at risk of developing traumatic stress

TRiM has a large body of supporting evidence and a clear structure, goals and processes, including early intervention, signposting and peer-led support.

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The programme is delivered over two days, either one-to-one or as a group, by a trained practitioner of the same banding and similar role to those involved. It uses a risk scoring system – similar to a modified early warning score – with assessments based around identifying common risk factors for the development of traumatic stress.

After risk assessments are complete, supportive processes are identified based on the individual’s risk score. TRiM practitioners then try to ensure the right support is available from the department the staff member belongs to.

TRiM is not therapy, and the practitioner should not deviate from the process of signposting and initial triage. About a month after the original assessment, a second one-to-one follow-up meeting takes place to see if the agreed actions from the last session have worked. 

The scheme is helping to change the work culture at the trust

Staff feedback so far has been good overall, with the peer-led element of the programme being particularly popular. This is a new process for us, but changing the culture of our environment from focusing on the organisation and patient care to also considering the well-being of staff, has been positively embraced.  

We are considering providing a TRiM manager’s course that will focus on our organisational response to serious incidents, and how we can further support people after traumatic events. 

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Now that we have a greater understanding of how trauma affects staff, I hope we will put as much emphasis on using evidence-based interventions to maintain the well-being of NHS staff as we do for patients. 

In the future, we also hope to extend the TRiM approach to other services we work with, such as the police, general healthcare trusts and the ambulance service, so we can have a joined-up response when responding to traumatic events.

We must always remember that to look after our patients, we must look after ourselves. We have a responsibility to keep ourselves and each other safe by working collaboratively, communicating effectively, valuing every member of staff and celebrating our diversity of experience. 

James White is ward manager, secure services, Devon Partnership NHS Trust. At the RCNi Nursing Careers and Jobs Fair in Birmingham on 10 March, his colleagues from Devon Partnership NHS Trust will host a workshop on staff well-being. Senior staff nurse in secure services Claire Lowton will talk about the TRiM programme