Life in The Fast Lane BYy Diane M. Goodman, RN, MSN-C, CCRN, CNRN

Working Level I Trauma
It could be the snap of a bitterly cold January morning, or the flames from a horrifying Christmas morning fire. It could be the screams and shock of another school shooting that surprises a sleepy, rural community in anywhere USA. But suddenly, the glare and shriek of ambulance sirens awaken a community as they speed towards assistance, carrying two teenage boys whose only hope for survival might lie within the resources that are anxiously waiting for their arrival.
They’re in luck. The car versus truck motor vehicle accident (MVA) from which they were carefully extricated was within a few minutes from a Level I Trauma facility. Paul (name changed for privacy), totally unresponsive, was by far the worse of the two, but he was intubated at the scene. His brother was lucid but tremulous, unable to answer questions. Both required full assessment by a trauma service.
Trauma services are comprised of many specialties, dependent upon what level of Trauma rating the hospital has obtained. Trauma centers are identified in two fashions, by designation, or by verification. The different levels (I, II, III, IV, or V) refer to not only the kind of resources available in a hospital, but also the number of trauma patients seen per year. The standards are defined nationally and are unique to both Adult and Pediatric facilities.1
A Trauma Center designation is done at the state or municipal level and lasts three years. These designations are evaluated and performed by the American College of Surgeons and meet regional needs as well as regulatory authority. They may vary from state to state, but Performance Improvement is included as well as a commitment to improving overall trauma care and outcomes.
The team waiting for Paul and his brother’s arrival was topnotch. Of the 190 Level I Trauma Centers across the nation, they arrived at one of the best. (It is not a coincidence that within the Nation’s Top Hospitals, several premiere institutions are Level I Trauma Providers). Although Paul had significant facial lacerations and suspected rib fractures, it was his head injury that required the most immediate attention.3,6
Closed head injuries from MVA’s can be frighteningly devastating, depending upon the amount of damage. Being at a Level I Trauma center meant that both Neurology and Neurosurgery were readily available should Paul need intervention for elevated intracranial pressure or bleeding. Additionally, Plastic surgeons would be available for repair of his facial wounds once surgery was determined to be appropriate. Oral and maxillofacial surgeons could be consulted if needed. As Paul was being assessed and examined, around the clock care (by both Trauma Nurses and experts in Critical Care) was being provided, so prevention of future complications could be avoided at every opportunity.
But what of Paul’s younger brother? Had he (amazingly) walked away from a motor vehicle crash that might have killed him?
Yes, he did! But, overcome with guilt, he peppered the nurse with questions as he waited for Paul to open his eyes. What, he wanted to know, was the difference between a “regular” Emergency Room RN and a Trauma Nurse? Good question, the team answered, but no, it wasn’t as simple as attending a seminar. It was a lot of training. A Trauma Nurse must be prepared for whatever could come through the door, which might include burns, hypothermic drowning victims, gunshot wounds, MVA’s, falls, industrial accidents, acts of terrorism, natural disasters, even suspected cases of emotional or physical abuse.2
Emergency Room nurses typically work with patients who arrive in stable condition and are prioritized based on condition, although that is a generalization that often doesn’t occur. Anyone who has spent five minutes working in an ER knows it only takes that length of time for a stable, coherent patient to walk in and collapse into full cardiopulmonary arrest. But in general, the ER nurse cares for patients who arrive with an “illness or sickness” and the Trauma Nurse will work closely with the “Trauma Center to care for patients who are brought in by ambulance” from MVA’s and/or have more serious injuries requiring advanced interdisciplinary assessment and support.
Trauma Nurses, while having increased responsibility for dealing with severely ill patients entering the Emergency Room, also have an immense amount of respect for their field of expertise. In fact, by the year 2024, Trauma Nursing as a specialty is expected to grow as much as 16%, a larger increase than many specialty areas in nursing. The requirements for this specialty are steep. Not only does the Trauma Nurse come from a variety of backgrounds, from vocational nurse to Nurse Practitioner, but they must also be current in ACLS, BLS, and depending upon the institution, possibly PALS.10
There is a great deal of overlap between Emergency care and Trauma Nurse certification, consequently many institutions require emergency medical training (internship) of their Trauma Nurses. Trauma Nurses, once certified, may work in a variety of areas within the institution, including the ICU, the OR, Step-down Units, with the Trauma Team, or rounding on patients throughout. The actual Trauma Nursing Core Course (TNCC) is a two-day certification program. It provides hands-on didactic classroom learning, with a certification that is valid for four years. There is an equivalent course (ENPC) for Pediatrics: The Emergency Nursing Pediatric Course. Pediatric certification is also valid for four years.
But, before the Emergency Room nurses could explain to Paul’s brother that there was an additional National certification for Trauma Nurses, Paul began to deteriorate, and all conversation ceased…
The interdisciplinary team rushed to Paul’s bedside. His limbs had begun a spastic shaking as his BP began to spike and then plummet erratically. He had no nuchal rigidity, but an ICP sensor was indicated for monitoring. The neurologist and neurosurgeon consulted on the risks/benefits of surgery if bleeding should occur. They decided to wait and keep the patient on multiple infusions. Diffuse axonal injury was suspected. The family was updated and reassured. Paul was young, and he was in the best of hands.
So, what about the other Trauma Certification, his brother wanted to know? (He seemed intent on keeping anxiety at bay by learning as much as he could about the hospital environment, to the nurses’ wry amusement). Could any nurse decide to take the exam? Well, yes, they could if they had at least 1,000 hours of practice with trauma patients (direct and indirect patient care) and an active unrestricted RN license, as well as 20-30 hours of trauma-specific coursework. A BSN would not be required to sit for the exam. This Certification was called the Trauma Certified Registered Nurse (TCRN) and once achieved, is also valid for four years.
Going forward, the nurses stayed on their toes with this complex case, because Paul’s brother and family not only continued to ask as many questions as possible, they also kept a bedside notebook and media page (which they updated every day Paul remained in the hospital!). The nurses never knew when their trauma facts might be displayed on social media, or if their knowledge of brain recovery might be tested and subsequently stored as family memorabilia!
As luck would have it, although Paul was eventually diagnosed with Grade III Diffuse Axonal Injury (DAI) to his brain, he finally made it home and is continuing therapy for gait and muscle strengthening, exactly 13 months after his initial injury. As neuro nurses would realize, Grade III is the most severe form of DAI, and functional recovery is not always possible.4 Because Paul was treated at a Level I Trauma Center, where his brain injury could immediately be assessed, diagnosed, and stabilized by an interdisciplinary team of experts committed to continually improving Trauma outcomes, he is home, working towards recovery.

That’s life in the fast lane. The stress is relentless, the rewards limitless.

Should you give it a try?
References
“Extended Anatomical Grading in Diffuse Axonal Injury Using MRI: Hemorrhagic Lesions in the Substantia Nigra and Mesenthalic Tegmentum Indicate Poor Long-Term Outcome”, Sami, A, Niklas, M., (…), and Per Enblad, Journal of Neurotrauma, available ncbi.nlm.nih.gov.
“How is an Emergency room nurse and a Trauma nurse different?” (Emergency Nurse Association/ENA). bestnursingmasters.com.
“National Inventory of Hospital Trauma Centers”, JAMA Network, Original contribution March 26th, 2003, jamanetwork.com.
Trauma Levels Explained: “designation versus verification”. (American Trauma Society/ATS). amtraum.org
“U.S. News Announces 2018-19 Best Hospitals”, August 14th, 2018, usnews.com.
“What is a Trauma Nurse?”, Information on Certification, TCRN, ENPC, TCRN, registered nursing.org.
Source: Nursing.Advanceweb

The Menace Of Quackery: NMA Worried About Increase In Number Of Quacks

The Nigeria Medical Association said it was having challenges in the fight against quacks in the profession, saying most of the suspects caught in the act were let loose after shoddy police investigation to continue their killing spree.

President of NMA, Dr Adedayo Faduyile, said there were medical institutions in Lagos manned by unqualified medical professionals, warning of the danger that the trend portends on the profession and health on Nigerians.

In an exclusive interaction with our correspondent, Faduyile said the rise of charlatans in the profession had been on the rise, stressing that the judiciary and the police had a huge role to play in helping the Medical and Dental Council Association of Nigeria fight the scourge.

He said, “In Lagos, we have some medical institutions that are not manned by medically qualified people and we are looking into it. We have different types of quackery in the medical profession. Those in the first one are those who are medically qualified but not registered to practice in a particular year. They are regarded as quacks because every year, we need to renew our registration.

“The second set of quackery belongs to those who are medically qualified but without the special training to take some medical activities. If they delve into such area that they are not trained in, it is another form of quackery. Then we have those who are not qualified at all as medical personnel but act as doctors. They could be health workers or charlatans who do not have any relationship with the medical profession.”

He said MDCA was shouldered with the responsibility of dealing with those caught in the act but the effort was often truncated by a poor investigation by the relevant authority, citing corruption as one of the reasons for such shoddy investigation.

“For those who have not registered that practice, the Medical and Dental Council Association of Nigeria is saddled to discipline, such people. The second group of people who delve into areas that they are not competent to, MDCAN is also saddled with the role of dealing with them.

“The usual way of going about is reporting to MDCAN and an investigative panel is set up. If the person caught has a case to answer, he will be handed over to a tribunal which is at the level of high court with a judgment given. If there is a criminal case involved and the person is culpable, he will be sent to a normal court based on the criminality of his conduct.

“For the charlatan group, those who are caught are reported to the police because they are criminals. The police will be encouraged to prosecute them in the law court. But this is where we have a major problem.

“At many times, the investigation by respective Investigating Police Officer may be shoddy or probably out of corruption, we don’t always have good conviction. Once we don’t have that, the criminals are released and they go back to their practice of killing more Nigerians. We seek the support of the police and judiciary in getting rid of quacks in this country. This is one of the things we are presently pursuing.”
Olufemi Atoyebi|Punch

Non-Electronic Yellow Card Will Be Invalid From April

The federal government says the yellow cards that were issued in the country will be rendered invalid starting from April 1. The yellow card is the international certificate of vaccination or prophylaxis.

The ministry of health said to obtain an e-yellow card, one has to register on the official website in addition to paying N2,000.

The payment receipt will then be taken along with the applicant’s international passport to any port health services office to get vaccinated so as to complete the process.

The ministry said it takes maximum of an hour for the card to be ready after vaccination, and that international travellers are to be vaccinated at least 10 days before travelling.

August 1, 2018 marked the official expiry date of the old yellow card and commencement of issuance of electronic yellow card.

The card, which is machine-readable, and has the ability to store vaccination history of the holder, was designed to put an end to the era of fake yellow card issued by unauthorised personnel for years.

The card has increasingly become an essential travel document, with several embassies making it a prerequisite for visa application

Federal Ministry of Health Memo Stopping Payment of Skipping Arrears to Doctors

You will recall that Joint Health Sector Union (JOHESU) got a judgment award from the National Industrial Court (NIC) in 2014 to skip Salary Grade Level 10. This judgment has been appealed to, by the Federal Government and is still in court.
2. You will also recall that due to series of agitations, strikes and discussion at several levels of Governance with Nigeria Medical Association (NMA) and National Association of Resident Doctors (NARD), there was a temporary approval for doctors to also skip CONMESS 2 pending the outcome of the final court judgment on the matter.
3. It has come to the notice of the Federal Ministry of Health that some Hospitals are paying Skipping Arrears to Medical Doctors. This is in disregard to the directives that no skipping arrears be paid to doctors.
4. l am directed to inform that the earlier directive is still in force, that Skipping is illegal and no institution should pay arrears to doctors. This directive should strictly be complied with as sanctions will be applied to earing CMD/MD.
5. Please, accept the assurance of the Honourable Minister.
“Dr.() J. Amedu. mni
Director, Hospital Services Department
For: Honourable Minister

How To Apply and Get the New eYellow Card in Nigeria Online

Are you aware that the the Federal Government has announced that the current old yellow card will become invalid after April 1st?
Are you aware that the Federal Government has introduced electronic yellow card for international travelers out of the country?
Do you know that it takes a maximum of an hour for the new eCard to be ready after vaccination, and that international travelers are to be vaccinated at least 10 days before traveling.
“August 1, 2018 marked the official expiry date of the old yellow card and commencement of issuance of electronic yellow card’. “The card, which is machine-readable, and has the ability to store vaccination history of the holder, was designed to put an end to the era of fake yellow card issued by unauthorized personnel for years”.
eyellow card
“The card has increasingly become an essential travel document, with several embassies making it a prerequisite for visa application”.
Heres 5 simple steps to get your new epassport
2. Click on ‘REGISTER’
3. Fill in your personal information
4. Click on ‘PAY NOW’ Button, generate your Remita Retrieval Receipt (RRR) cide and pay the sum of N2,000 online or go to the bank
5. Take the payment receipt along with your international passport to any port health service office to get vaccinated and obtain the new eYellow Card
Its that simple!!
Don’t forget to share this post with others!

Ghana: Fear grips Nurses , Midwives in Chereponi Over Renewed Clashes

The Chereponi branch of the Association of the Registered Nurses and Midwives is appealing to authorities within the district to protect them by evacuating them from the area.

 

 

 

Recent clashes between the Konkombas and the Anufuls have led to four deaths, several injuries and destruction of property.

 

According to the General Secretary of the group, Mahamudu Ibrahim Nasah, they no longer feel safe in the area as their lives are in danger.

 

He thus called on their superiors to allow them leave the area and return when calm is restored.

 

“We are saying that the current situation there does not make us feel safe to work. We’ve seen that the people in the community have evacuated their relatives. They have taken their wives and children out of the place. We can’t stay in our homes because we are staying in rented homes that belong to both factions in the conflict.”

 

“And when this conflict started they have been burning each other’s houses and we don’t know when they will get to our houses. So we are saying that our managers and security should support us to leave the district and we will return when the place is calm for us to work without being in fear,” he added.

 

A 4:00pm to 7:00am curfew was imposed on the Chereponi township effective Thursday, January 03, 2019, after clashes in the area resulted in two deaths and left several others wounded.

 

Properties and foodstuffs have also been destroyed.

 

The residents are asking for justice and are calling for more security personnel.

 

 

 

The clashes were between Anufuls and Konkombas over a piece of land at Naduni in the Chereponi District.

 

Chereponi residents defy curfew; burn tyres in protest

 

Residents of Chereponi have however defied the curfew imposed on the area by the Ministry of Interior.

 

They burnt tyres at vantage points in protest of the curfew.

 

According to them, they fear attacks could happen during the curfew period hence their anger.

 

 

By: Godwin Akweiteh Allotey | citinewsroom.com | Ghana

Filipino Nurse Joy Ongcachuy receives British Empire Awards New Year Honours

Filipino nurse Joy Ongcachuy has received the 2019 New Year’s Honours list of the Office of the British Empire Awards.

Ongcachuy, who works as a robotic lead nurse for the Royal London, was awarded for her efforts in caring for patients who were victims of the 2017 London Bridge attacks.

 

In a media statement released by the teaching hospital the Filipino nurse recounted what happened while she was on duty on June 3, 2017. “I was working the night shift that night and I heard the anaesthetist’s bleep go off. We already had a really sick patient in one of our theatres, so I had to get our other theatres ready and pull a team of nurses, allied health professionals and operating department practitioners together.”

 

“We opened an additional six theatres that night and everyone I called dropped everything they were doing to come to the aid of the patients. No one panicked; everyone was calm and so supportive,” the Filipino lead nurse for robotic-assisted surgeries added.

 

The Filipino nurse was awarded together with Dr. Malik Ramadhan, emergency consultant, and Emma Senyard, associate director of nursing at Royal London.

 

Jackie Sullivan, managing director Royal London and Mile End hospitals, said of their 3 awarded staff, “Their leadership, compassion and integrity is inspiring every day, but was especially true at a time when Londoners relied on us to be there for them.”

 

“It is incredibly humbling to have three of our staff recognised in this prestigious list,” said Alwen Williams, chief executive. “I’m grateful for the way we pulled together as a team to respond to such a horrific event, and would like to specifically thank and congratulate Joy, Malik and Emma for being recognised for their courage, calmness and care they provide to our patients on a daily basis.”

 

Ongcachuy talked to Barts Health NHS Trust about receiving the Queen’s award, “My daughter is so proud of me! I am glad I made the UK my home all those years ago – to be welcomed and recognised by Her Majesty is overwhelming, humbling and exciting all at once!”

 

The Filipino nurse from Stratford started working at The Royal London Hospital in 2002 as a scrub nurse – a role she held until she was promoted last year to robotic lead nurse.

 

Joy Ongcachuy was awarded an Officer of the British Empire on 29 December 2018.

Ghana Nursing and Midwifery Council Releases September 2018 Results

RELEASE OF SEPTEMBER 2018 RESULTS.

Management of the Nursing and Midwifery Council would like to inform all candidates who wrote the licensing examination for the basic programmes in September, 2018, that their results, as approved by the 14th Governing Board of the Council, have been released.

Candidates are therefore requested to visit their  schools for their results and proceed to our regional offices to commence the registration process.

Kindly contact the call center of the Council on 0200862772 for further information.

Thank you.

Source: Nursing and Midwifery Council of Ghana

Nursing and Midwifery Council of Nigeria Position on Auxiliary and Quacks in Nursing

We Are All Involved in the Fight Against Quackery – NMCN

The Nursing and Midwifery Council of Nigeria has urged an “all hands on deck” approach to the fight against quackery in the profession. Emeka Onyebo of Nursing World Nigeria reports that the NMCN made this known at the mandatory continuing professional development program (MCPDP) for nurses held this week at the state school of nursing Agbor in Delta state.

 

Mr. Ernest Akuna, the NMCN Zonal Officer who spoke at the event reiterated that the council eye in this regard is the state NMCN committees set up in the various state. He said “Majority of us work in the private sector where quackery is at its peak, he urged nurses to make reports on issues of quacks to the state committee who would forward same to the zonal offices and finally to the council. He added that evidence must also back up reports. We are all involved in the fight against quackery he said. According to him, the NMCN collaborates with the movie industry to ensure the image of the profession is portrayed positively in the movies.

 

On the issue of why there was no provision for Degrees on the Nursing council license, the zonal representative informed the house that only professional qualifications are on the license just as it is in other professional bodies like pharmacy,

med lab etc.

 

He admitted delays in the processing of licenses and appealed to nurses to remain patient as the council was working assiduously to make acquisition of licenses after renewal as easy and friendly as possible. According to him, while the industrial strike action lasted, the licensing unit of the council was mandated to keep working, the council has also procured industrial sized car printers and all the back log of licenses would soon be a thing of the past.

 

On the current status of the national open university of Nigeria, Mr. Ernest said that the foundation of NOUN had some issues, hence council denied NOUN accreditation. He noted that certificates issued by the NOUN to graduates from 2013 were recognized up until those graduating in 2016 because students into these programs got their admission before NOUN lost its accreditation. Thus any admission before 2014 is recognized. He

encouraged nurses to use the NOUN avenue to pursue their degree certifications for progression in their fields when ever the accreditation is restored. On academic progression, he informed the house that Nnamdi Azikiwe and Ebonyi state university has started the post graduate diploma in nursing (PGDN) which nurses must leverage upon.

 

On the issue of nurses trained abroad, He said that when you train abroad and want to practice in Nigeria, you must undergo certain processes. According to him, some times these foreign universities are not recognized by the NUC, the NMCN forwards these foreign qualification to the ministry of education for quantification and acceptability before council can accept it, if NUC doesn’t recognize that institution then the NMCN would not recognize such institution. He warned that nurses should be careful of programs they pursue to avoid frustration at the end of such programs. He informed the house that the NMCN collaborates with NUC to ensure that university education in nursing is at peak.

On the issue of proliferations of schools of nursing and the failure of affiliations of these schools to universities, he said that the minimum qualification required to head a college of nursing was the MSc, and that if states lacked the manpower in terms of academic qualifications and infrastructure they would have no other choice than to request a state edict establishing a school of nursing instead of college of nursing. He added that for the affiliation to universities to work, graduate lecturers and not nurse tutors should make up the workforce of the school of nursing.

UGONSA Takes Struggle for Internship and Proper Placement of Graduate Nurses to OAUTH

Chief Medical Director,

ObafemiAwolowo University Teaching Hospital (OAUTH),

P.M.B. 5538, Ile-Ife,

Osun State, Nigeria,

 

Attention:

Director of Administration,

&

Head of Nursing Services, OAUTH,

 

Sir/Madam,

IMPLEMENTATION OF INTERNSHIP AND PROPER PLACEMENT OF GRADUATE NURSES IN OAUTH

 

Complements of the season and Nightingales’ greetings from members of the University Graduates of Nursing Science Association (UGONSA), the professional association of nurses with a minimum qualification of first degree in nursing.

 

2. We write to request that you implement the graduate nurses internship in your hospital and as well effect the proper placement of those that are already in the service as prescribed by the circular, REF No. HCSF/EIR/CND/S.100/ST/97 dated 8th September, 2016 from the office of the head of civil service of the federation (please refer Annexure A).

 

3. The referred circular has made a one-year internship training a compulsory part of nursing education for the Bachelor of Nursing Science (B.N.Sc) degree as is obtainable with the university education of other healthcare disciplines with the implication that baccalaureate education of nurses is now incomplete and void without the internship training.

 

4. The opportunity of blending theory with clinical practice offered by the internship training is not only most beneficial to fresh graduate nurses but also to patients, especially as nurses form the first line of client care, have the highest visibility and number of hours spent with patients and maintain a ‘round-the-clock’ interaction with patients in the hospital.

 

5. Since the lives of people have been entrusted unto nurses’ care, it is imperative that they are adequately trained and motivated to perform this special responsibility effectively and efficiently hence our request for implementation of the internship training and proper placement of graduate nurses by your hospital.

 

6. For ease of implementation of our request we hereby avail you the Federal Ministry of Health’s guideline for implementation of internship and proper placement of graduate nurses (please refer Annexure B) and other relevant documents for your due guidance.

 

PRAYER

We passionately request that you

 

1. help fresh graduate nurses trained in Obafemi Awolowo University and other universities across the country complete their nursing education, vis-à-vis internship training, by offering them opportunity to run internship training in your hospital as is done for graduates of other healthcare disciplines.

 

2. upgrade existing nursing officers, who were on CONHESS 07 (.i.e Grade Level 08) before the release of the circular, to the new base of CONHESS 08 (Grade Level 09) effective from 8th September, 2016 (being the date of release of the circular REF No. HCSF/EIR/CND/S.100/ST/97 by the office of the head of civil service of the federation) as prescribed by the civil service circular, Ref No. B63279/S.7/II/T/273 dated 24th April, 2002 (please refer Annexure C).

 

3. Commence the employment of fresh graduate nurses on CONHESS 08 and upgrade the existing nursing officers who were wrongly employed on CONHESS 07 instead of CONHESS 08 even after 8th September, 2016 (the date the circular was released) to CONHESS 08 effective from the date of their employment.

 

Kindly accept the assurances of our esteemed regards.

 

Signed:

 

 

CHIEF (HON.) S.E.O. EGWUENU NURSE G.I. NSHI

National President National Secretary