1. Vanore, Marla L. RN, MHA, President, Society of Trauma Nurses

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In nursing, we are inundated with the message that we are in a severe nursing shortage that is anticipated to only get worse over time. At the same time, surgeons are experiencing their own staffing shortages. As both of these critical issues play out simultaneously, both issues are impacting nurses and physicians in their day-to-day practice. In addition, trauma programs are beginning to undergo significant evaluation and, in some cases, major changes.



Anyone employed in nursing is well aware of the current shortage. Despite some increase in government funding, media campaigns, and other efforts, the future still looks grim. The Americans for Nursing Shortage Relief Alliance, which the Society of Trauma Nurses is a member of, has collected the following statistics on the nursing shortage.


* The average age of registered nurses (RNs) is currently 46.8 years.


* Approximately half of the RN workforce is expected to reach retirement age within the next 10 to 15 years.


* The average age of new RN graduates is 30.


* Nearly 1,800 nursing faculty members leave their position every year, with fewer than 400 faculty candidates receiving their doctoral degrees each year.


* The nurse faculty vacancies in the United States continue to grow. According to the National League for Nursing's 2006 Nurse Faculty Census, the estimated number of budgeted, unfilled, full-time positions in 2006 was 1,390.



The Center for Health Outcomes and Policy Research at the University of Pennsylvania ( continues to document through well-respected research that the number of nurses impacts patient care and that higher nurse-patient ratios increase patient mortality and nursing burnout.


Not only does the current nurse-staffing crisis impact nurses, it has a direct impact on patient care. Consequently, the nursing shortage has a significant impact on physicians. Physicians are dependent on bedside nurses to provide safe, quality, and compassionate care. When this does not occur, not only does it make their jobs more difficult, but at times, rightly or wrongly, they are held responsible for issues that may arise. With the surgical resident 80-hour workweek, trauma surgeons are increasingly dependent on trauma nurse practitioners (NPs) to assist in the day-to-day care of trauma patients. Finally, most trauma medical directors are dependent on nurses who staff trauma programs such as trauma nurse managers to help to deal with the demand of this role.



Just as surgeons are impacted by the nursing shortage, nurses are impacted by physician shortages. The most recent and well-known example of this has been the impact of the 80-hour workweek on nursing. To address the lack of surgical residents, the demand for acute care trauma NPs has dramatically increased. This has opened up an entirely new career path for nurses in all disciplines who have the desire to remain close to the bedside but still progress in their career path. It has also improved the continuity of care for trauma patients, which is beneficial to bedside nurses as well as trauma program managers in ensuring safe and consistent care for trauma patients. The downside of this movement, however, is that it may pull strong bedside nurses away from staff nursing as they pursue the NP role. In addition, even new nursing graduates are entering the profession with the intent of becoming NPs as opposed to bedside staff nurses, which we urgently need.


As mentioned, surgery, in particular, trauma surgery, is currently involved in a staffing crisis. The American Trauma Society and others have compiled the following facts.


* The average age of fellows of the American College of Surgeons is 58.5 years.


* The average reported age of retirement is 62 years.


* Up until 2004, there has been a decrease in applications to surgical residency programs, and applications to medical schools have been declining.


* Trauma surgery with the relatively low number of surgeries and long hours has many problems recruiting new surgeons.



To counteract this shortage, a revolutionary concept has been recommended and is beginning to gather a number of supporters. It has been proposed that a new surgical specialty be created which would greatly expand the role of the trauma surgeon. This type of surgeon would be involved in the care of trauma, emergency general surgery, and surgical critical care (trauma and nontrauma), in addition to elective general surgery patients. A position statement written by the Eastern Association for the Surgery of Trauma was published recently in the Journal of Trauma (2005;59:77-79), and it is available on their Web site at on the Future of Trauma Surgery Web page. Society of Trauma Nurses signed on in support of this position in spring 2006, and other organizations such the Emergency Nurses Association have also signed on recently.


As much as we, as trauma nurses, support our physician colleagues in their decisive, creative solution to this issue, we must also acknowledge that it may change the way we function in our work roles. Already there are hospitals that are beginning to expand their trauma programs into emergency surgery programs. Reconfiguring a program such as this impacts not only the surgeons but also many of the nurses who work with them. For example, trauma NPs may be asked to expand the scope of their practice to cover all of the emergency surgery patients; the trauma program staff may be called upon to include the nontrauma patients in their performance improvement programs and patient registries. If not carefully planned out, this change could cause role and name confusion and an increased workload on a group already understaffed. However, it may also help trauma programs by increasing their significance and visibility within the hospital system.


At this stage, it is too early to tell if this new surgery specialty will become accepted and will positively impact the number of surgeons and the number of trauma surgeons. What is certain is that we as trauma nurses need trauma surgeons to care for patients and that the current physician staffing crises and proposed practice changes will impact all of us over the next decade.



There are always many challenges in healthcare. Physicians and nurses remain mutually dependent on each other in our quest for quality patient care. As trauma nursing leaders, we need to stay aware of the challenges and respond proactively to them. The best solutions will be developed when trauma physicians and nurses work together to ensure that there are enough qualified healthcare providers to give quality care to our patients.