In Pursuit of Excellence: The Trauma Certified Registered Nurse (TCRN)
American historian Will Durant said: “We are what we repeatedly do. Excellence, then, is not an act, but a habit.” Early this year, the Board of Certification for Emergency Nursing (BCEN®) achieved a major milestone—the accreditation of the Trauma Certified Registered Nurse (TCRN®) certification program by the Accreditation Board for Specialty Nursing Certification (ABSNC). In reflecting on how we arrived at this place, the common thread in TCRN’s history is the pursuit of excellence.
Advancing Trauma Care
Board certification is a high distinction that objectively validates specialty knowledge and expertise. In attaining and maintaining advanced certification in trauma nursing, TCRN-certified nurses demonstrate an ongoing commitment to excellence and an exceptional level of knowledge, experience and clinical judgment across the entire trauma care continuum from prehospital care through rehabilitation and including injury prevention.
Trauma is a major public health issue with universal impact. At $671 billion in healthcare costs and lost productivity, the annual economic impact of trauma far exceeds that of heart disease ($313 billion), diabetes ($245 billion) and cancer ($216 billion) (NTI, 2019a). Among the other statistics compiled by the National Trauma Institute (NTI, 2019b):
• Trauma is the leading cause of death of children in the U.S.
• Injury is the number one cause of death for ages 1-46.
• Each year trauma accounts for 41 million emergency department visits and 2 million hospital admissions.
• Falls are the leading cause of injury death for trauma among people 65 years and older.
• Trauma is a major cause of military service member injuries and deaths.
• The effect of trauma on life years lost exceeds that of any other disease.
Nurses are the largest component of the trauma care workforce. According to the Society of Trauma Nurses (STN), trauma nurses “routinely care for patients who demonstrate acute and complicated conditions that require a high level of skill and competence to treat,” and trauma care requires “significant expertise across the entire continuum to make an impact in outcome and prevention” (STN, 2018). Further, STN says skilled caregivers can have “a tremendous positive effect on the outcome after injury as well as the prevention of injuries” (STN, 2018), which is why STN “believes strongly in the attainment of the TCRN certification and encourages all trauma nurses in all settings to obtain their certification upon meeting the recommended eligibility requirements” (STN, 2016).
We know directly from trauma nurses that the hands-on care they provide—often for unstable patients when every second counts—and their ability to critically think, assess for early signs of complications, and intervene quickly, warrant their having as much knowledge and expertise as possible. It is worth noting that beyond these critical point-of-injury capacities, trauma nurses are also the conductors of trauma care, orchestrating interprofessional teams to rehabilitate each patient back to their full potential. They also are the primary educators aiming to prevent injuries in the first place.
A growing body of research, including BCEN’s recent large-scale value of certification study (Medsker & Cogswell, 2017), demonstrates that board certified nurses are more confident, are better contributors and communicators, and have a deeper impact on patient care, their teams and their organizations. Therefore, it is fair to say that board certification in trauma nursing is vital to trauma care and TCRNs play a crucial role in advancing trauma care. Moreover, leaders who want to create and grow exemplary nurses need to know that the optimal professional development path runs through board certification.
The TCRN was borne out of excellence seeking in 2010 when the Society of Trauma Nurses held membership-wide conversations to discuss the need and desire for a unique trauma certification. The consensus was a resounding “Yes!” Having decided the wisest course was to partner with an experienced credentialing body to move such a certification toward fruition, STN met with BCEN in 2012 to discuss collaborating to develop a trauma nursing certification program. In 2013, the two organizations established a formal agreement and funded a needs assessment survey. The survey was distributed throughout and beyond the trauma nursing community and yielded very positive results. Shortly thereafter, in early 2014, the partners commissioned a role delineation study (RDS) whose results confirmed a trauma specialty certification was “viable, feasible, and much needed” (Ayers & Czuhajewski, 2015).
Then, in October 2014, BCEN moved forward as the owner and operator of the TCRN certification program as planned. Since this juncture, the day-in-day-out labor of love of BCEN’s extraordinary “Team TCRN”—our staff, board, item writers and ECRC members—has taken the TCRN from a program concept to a February 2016 launch to being deemed a Magnet®-accepted certification program in April 2017, and as of January 2019, to accreditation by the Accreditation Board for Specialty Nursing Certification (ABSNC).
Robust Program, Robust Partnership, Robust Future
Today, the TCRN is BCEN’s fastest growing certification. BCEN has tremendous pride in the already more than 4,000 TCRNs who are bona fide vanguards of trauma nursing. TCRN-certified direct care nurses, nurse leaders and administrators, and nurse educators are creating innovative injury prevention initiatives, building hospital trauma programs from the ground up, transforming trauma systems, inspiring other trauma nurses to become board certified, and of course providing elite trauma care, all of which helps millions of patients overcome injury and tragedy and reclaim productive lives.
Anchored by shared values, BCEN’s partnership with STN is more robust than ever. BCEN proudly supports the academic pursuits of trauma nurses by annually funding multiple STN scholarships at the undergraduate, master’s and doctoral levels, and STN helps BCEN seek out a top board certified trauma nurse to be honored with BCEN’s annual Distinguished TCRN award. BCEN actively promotes STN membership to nursing students, incentivizes RN membership in STN through discounts on BCEN certification exams, and supports various STN programs and initiatives. In addition to being an ardent advocate for certification, STN develops first-class educational materials, resources, and tools that help RNs earn and maintain their TCRN status.
Going forward, BCEN will continue our habit of excellence on behalf of TCRNs and TCRN candidates as part of our overall mission to develop robust certification exams fostering empowered nurses across the emergency spectrum who contribute noticeably to patient care, safety and outcomes. The second trauma nursing RDS is underway, as are ongoing efforts to ensure the quality of the TCRN program, fund certification research, and cultivate a community of support, recognition, mentorship, and inspiration for trauma nurses everywhere. As the ranks of TCRN-certified nurses grow and the story of their impact unfolds, we know the common thread will remain the pursuit of excellence.
Written by Lorie Ledford, MSN, RN, CEN, CFRN, CPEN, CTRN, TCRN, CCRN, Chairperson, Board of Certification for Emergency Nursing (BCEN), Staff Nurse, Mayo Clinic Arizona Hospital, and Flight Nurse, Alia Medflight
Janie Schumaker, MBA, BSN, RN, CEN, CENP, CPHQ, FABC, Executive Director, Board of Certification for Emergency Nursing (BCEN)