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In part two of our Q&A with trauma nurse Kate King CNC, we get some insight into the personal impact of trauma nursing, and advice for nurses on trauma, death and transition to trauma speciality nursing.
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Lessons you wish you could teach teenagers?
Everyone honestly believes that it will never happen to them! Its human nature, but this seems to be heightened in the young and risk-takers; a sense of being “invincible”.
All my lessons have been made into ads, ironically; don’t drink drive; don’t drive like an idiot; don’t take drugs; if you do take drugs pay your bills; choose your friends wisely; always think about facing your best friends parents if you killed their child in an accident that you survived (it’s very common for drivers to swerve away from danger and put their passenger into the line of oncoming danger); don’t let elderly men up on ladders especially if they are on blood thinners; watch out for cyclists; don’t drink and swim or dive into shallow water; wear protective equipment on motorbikes; don’t climb up to 4th floor balconies; don’t jump off train bridges onto trains.
It all sounds very cynical but honestly, there are so many injuries that could be avoided by different choices. This job does make you a little fatalistic, the older I get and the more I see I do believe when your numbers up, your numbers up. I think the concept that people find hard is that some of the ‘simple’ injuries can have a lifelong effect such as chronic pain, loss of income, depression etc.
How has your nursing role impacted your experience as a parent of teenagers?
It certainly has made me paranoid, but I try to keep that in check. My eldest just got her L’s this week (eek!). My kids have heard a few war stories over the years, and I think they have a good understanding of the real consequences of risk-taking behaviour. They have promised me they won’t get a ‘bad’ tattoo, but we will see. They are surprisingly good children despite their parents. They were in the car with me one day when a patient’s mum rang to tell me how she was progressing after a severe TBI, and I think it was the first time my kids realised that I might not be exaggerating.
My two favourite topics to present on in Trauma are geriatrics and bariatrics. The reason for this is that, in general terms, Trauma nursing is very cookbook; pattern recognition, probabilities, priorities and protocols, however geriatrics and bariatrics don’t fit neatly into these, so you need to be more thoughtful. Both populations are increasing in the community and in hospital presentations following trauma.
The Institute of Trauma and Injury Management (ITIM) is our state governing body that oversees Trauma Care in NSW. They have a fantastic trauma education program where Major and Regional Trauma Centres host a ‘trauma education evening’ and these are now lived streamed and recorded. My talks are linked here and here; and there are plenty of other fabulous trauma talks from fantastic speakers you can find on this platform.
Advice for nurses on managing emotions surrounding death and grief?
Death is certainly something I have experienced a lot in my professional career, firstly working in Oncology and then in Trauma. What I would tell junior nurses is; even in horrific circumstances we can still provide dignity to the patient and comfort to the family. Honesty and using plain language I find really helpful, and its ok to not feel ok with death.
I think when you are first starting out in your career you are so afraid of saying the wrong thing that it limits communication. Explain injuries in a way that lay people understand, answer the questions they have at the time, and offer for them to contact you if they have questions down the track.
I always try to imagine how I would like to be told about death if it was me sitting in the relative’s room desperate for any news. There has been a big movement to make death a more natural and less clinical experience within hospitals and there are some fantastic advocates for it. One of our doctors who has since retired does a great TED talk on the subject ‘Lets talk about dying’.
I also recommend that we have the conversation at home with our loved ones about what their wishes are if something unexpected happened to them.
I think having personal experiences with death also enhances your skills as a nurse as you can really empathise and remember the pieces of information you appreciated being told to you or wish had been told to you.
Grief much harder, it is incredibly personal, and everyone reacts differently. It is painful to watch other people’s grief, especially in the moments after an unexpected traumatic death. I still have vivid memories of cases where the grief was palpable, and I felt very confronted by how little I had to offer.
Some examples of these are watching parents kiss their teenage child goodbye after dying in a car accident; people screaming they would never forgive the patient after a suicide; others shaking their relative begging them to take another breath; vomiting or collapsing or even just begging us to put a warm blanket on because their dad was so cold to touch. All of these are heartbreaking and often there isn’t a right way to respond to their grief.
Demonstrating that we recognise the pain of the moment, that their loved one isn’t just a statistic to us, giving a hug, sitting silently next to them, or giving them space are all techniques you can use. From a trauma perspective we always offer for them to contact us weeks or months down the track if they have questions because the very nature of a traumatic death is hard to get their head around, and they can find it hard to progress through the grief until they have some questions answered. My take home message is to be kind.
Finally, managing my emotions can be difficult, I have teared up when telling a family that we haven’t been able to save their loved one, but have never cried in front of them. I have wanted to tell people how incredibly unfair it is that their innocent loved one died whilst others survived. I always say that I am so sorry that they are experiencing this.
I find it more difficult to intellectualise when you can personally relate to the situation, such as having a child the same age or a sibling the same age, but generally I am good at compartmentalising my life and in my nurse role I am there to provide professionalism and support. There are certainly cases that you always remember, I have cried for hours, I have lost sleep some nights or thought about the death longer than normal but if you feel you have done everything, absolutely everything and they still die then it sits a little better with me.
Of course, I have fantastic colleagues who I can debrief with, sometimes we use black humour that only frontline workers understand, and my husband works in health too so is a good support. I also find running a good outlet as it stills your mind and sometimes the physical discomfort of the long run sooths the emotional pain. Do what works for you.
What advice would you give to a junior nurse starting out in the profession?
Nursing is a fabulous career, you can take it anywhere, you are always surrounded by interesting people and interesting patients. Find an area that you are passionate about, one that lights the fire in your belly, you’ll know it when you find it and then just go for it. Enjoy the journey and don’t worry too much on the destination. If you are particularly interested in Trauma, get a few years of both general and critical care nursing under your belt, and think about doing your Masters in Traumatology. There are several out there; the University of Newcastle offers this one.
Don’t rush, the best nurses in my opinion are the ones who have been exposed to lots of different clinical situations and even been burnt a few times and grown from this and have developed their career by taking lots of opportunities and consolidating their knowledge. Try not to work in just one place: if life affords you that luxury, get out there and see what different places do.
Finally, find yourself a mentor, I have had fabulous mentors throughout my career who have been generous with their knowledge, skills, and time, encouraging and supportive and so inspiring and I am eternally grateful for each and every one of them.
Advice for nurses considering moving into emergency and trauma?
Both Emergency and Trauma nursing are very rewarding. ED nursing is fun and exciting because you become a jack of all trades and you get exposed to every subspeciality and within this you will have areas of interest that you gravitate towards. It’s fast paced and unpredictable. It’s very collegial and very skills based. The downsides are lots and lots of shift work and sometimes never feeling like you get to complete anything.
Trauma nursing is still an evolving specialty, it is a popular field, for the trauma nurses on the ward it is a high acuity and high activity place that they find very fulfilling, they see injuries that may not even be in textbooks. For the critical care component of Trauma it is good to have experience in ED, ICU, theatres and surgical wards as you need a good understanding of the whole of hospital, be prepared to give up some clinical time (this can be hard) for all the other stuff like writing policies, writing journal articles, doing research etc., but keep your eye on the prize- you and your service providing high quality nursing care.
I can’t recommend Trauma nursing enough I think it’s one of the best jobs in the world and I am so grateful for the opportunities it has afforded me.