Traumatic injury is the leading cause of death for people aged 1–44 years in the United States, representing 8% of global deaths annually (Centers for Disease Control and Prevention [CDC], 2023; Rossiter, 2022). Trauma systems provide an inclusive, integrated structure designed to provide access to and deliver appropriate and optimal care to injured patients across the continuum of care, including preventive, prehospital, acute, definitive, rehabilitative, and support services for reintegration into society. One of the most important roles within the trauma system is the trauma program manager (TPM). The Society of Trauma Nurses (STN), the recognized professional society serving TPMs, provides education and resources for TPMs and other trauma team members to support the delivery of optimal and equitable trauma care to all people.

ROLE OF THE TPM DEFINED

The STN defines a TPM as “a registered nurse with knowledge and clinical experience in the care of injured patients who, in collaboration with the trauma medical director, coordinates the interdisciplinary services and organizational systems necessary for optimal care of the injured patient and oversees the educational, clinical, research, administrative, financial, performance improvement, and outreach activities of a trauma program.”

STN-ENDORSED STATEMENTS TPMs are essential in delivering optimal and equitable trauma care to all people. Registered nurses are the professionals best qualified to serve as TPMs by their education, training, and experience; whenever possible, the role of the TPM should be assigned to a registered nurse. TPMs should hold a minimum of a Bachelor of Science in Nursing; however, a Master of Science degree is preferred. Advanced Trauma Care for Nurses (ATCN), Optimal Trauma Center Organization & Management Course (OPTIMAL), and Trauma Outcomes & Performance Improvement Course (TOPIC) courses, developed and disseminated by STN, offer essential clinical and administrative education and should be completed by every TPM. Attainment and maintenance of the Trauma Certified Registered Nurse (TCRN) certification through the Board of Certification for Emergency Nursing (BCEN) is one important measure of competency for TPMs. Participation in national nursing organizations, attendance at national meetings, and collaboration with organizations serving physicians and interdisciplinary professionals to communicate current evidence-based care for implementation are essential to the TPM role. TPM ROLE: KNOWLEDGE, SKILLS, AND COMPETENCIES

TPMs are leaders in their institutions who advocate for the highest level of quality trauma care across the continuum. They create an environment fostering leadership and interdisciplinary collaboration in trauma care delivery.

In 2018, a commissioned comprehensive study, The STN Trauma Program Manager Role Delineation Study (Castle Worldwide, 2018), cataloged the skills, knowledge, and tasks necessary for the TPM profession. Data from this study outlined the specific tasks required for the TPM role and collected information about the knowledge and skills required to function in the role.

The study documented the clinical, administrative, interpersonal, and analytical skill set required to succeed in the TPM role. To accomplish this, a panel of subject matter experts, represented by various practice settings and geographic regions, assembled for a modified Delphi study to discuss the role of the TPM. Subsequently, a large sample of TPMs was surveyed to validate the work of the job analysis panel. Based on the ratings gathered from the representative sample of professionals, the weightings for the domains and tasks in the framework were computed. The STN Trauma Program Manager Role Delineation Study identified six domains and tasks unique to TPMs as outlined in Table 1.

Table 1. - The Six Domains of the TPM Role and Associated Tasks TPM Role Domain TPM Role Domain Tasks Domain 1: A continuum of trauma care (25%)

Task 1: Maintain knowledge of current standards by performing initial and ongoing gap analysis for trauma center accreditation, designation, and verification requirements to optimize patient care throughout the continuum.

Task 2: Transcend normal departmental hierarchies to achieve compliance with regulatory requirements by using effective and respectful communications.

Task 3: Facilitate interprofessional trauma education by using internal and external resources to maintain adherence to accreditation, designation, and verification requirements.

Task 4: Oversee and maintain all aspects of the trauma PIPS program consistent with accreditation, designation, and verification requirements.

Task 5: Supervise data collection, coding, scoring, validation (IRR), reporting, and analysis to ensure that the data drive all aspects of the trauma program (e.g., clinical care, research, benchmarking, PIPS, finances).

Task 6: Interface with all levels of management to communicate effectively (e.g., verbal, electronic, written) with all trauma-related items (e.g., regulatory, community, patient safety, financial, strategic planning, annual reports).

Task 7: Reduce injury rates by aligning with local, regional, and national injury prevention and community outreach initiatives to improve population-based health.

Domain 2: Professional issues (28%)

Task 1: Collaborate with internal departments across the continuum of care to maintain accreditation, designation, and verification through the implementation and maintenance of trauma center criteria and regulations to promote optimal care of the injured patient.

Task 2: Establish a functional PIPS program by using the principles of TOPIC, as well as ACS, state, and institutional recommendations to identify and resolve deviation from standards of trauma care to reduce mortality and morbidity.

Task 3: Advocate for lifelong learning for all trauma care providers and program staff by providing resources for internal and external evidence-based education to promote improvement in trauma patient care and outcomes.

Task 4: Facilitate interprofessional collaboration and communication within the trauma program, center, and system to maximize a patient's functional outcome.

Task 5: Foster and maintain relationships with prehospital agencies and referring facilities to improve quality of trauma care through effective feedback.

Task 6: Contribute to the development and implementation of an emergency preparedness plan by participating in institutional and regional training activities to respond to potential threats (e.g., mass casualty, active shooter, natural disasters).

Task 7: Support trauma staff across the continuum by identifying critical incident stress management and ethics resources to promote resiliency and prevent compassion fatigue.

Task 8: Facilitate interprofessional trauma education by utilizing internal and external resources and programs (e.g., ATLS, ATCN, TNCC, TCAR, PCAR) to maintain adherence to accreditation, designation, and verification requirements.

Task 9: Participate in local, regional, and national professional organizations and forums to promote and advocate for trauma patients, trauma systems, and trauma care provider professional development.

Domain 3: Human resources (18%)

Task 1: Lead trauma center staff through direct interaction and communication by using institutional resources to enhance and maintain operational functions.

Task 2: Measure (annually and ad hoc) overall performance of trauma program staff by using hospital- and department-specific tools to maintain compliance with job descriptions.

Task 3: Develop and monitor the orientation process for all trauma administrative and program staff to attain and maintain all organizational and trauma accreditation, designation, and verification requirements and job-specific functions.

Task 4: Collaborate with departments across the continuum of trauma care to develop and maintain trauma-specific components of orientation and ongoing competencies.

Task 5: Optimize communication with staff to promote continued growth and professional development.

Task 6: Collaborate with departments and divisions across the continuum of trauma care to facilitate adherence to hospital standards, required licensure, certifications, education, and other metrics to meet trauma center requirements.

Domain 4: Management of physical resources, financial resources, and medical professionals (11%)

Task 1: Facilitate the evaluation of medical equipment and other physical resource needs of the trauma system for standard and innovative technologies annually and through issues identified using the PI process to maintain optimal trauma care.

Task 2: Evaluate financial needs and make appropriate allocation adjustments to the trauma budget to maintain fiscal viability of the trauma program.

Task 3: Explore external funding resources to maximize opportunities in the areas of research, education, and prevention to increase awareness and enhance care.

Task 4: Develop and encourage interprofessional collaboration (e.g., physicians, nurses, EMS providers, referring facilities) by using leadership and management skills, institutional policies and procedures, and good communication to establish a functional trauma program.

Domain 5: Public relations and marketing (9%)

Task 1: Recognize and participate in trauma center marketing and public relations opportunities through electronic media and publications to demonstrate the added value of trauma center care (e.g., research, prevention, innovations, annual reports, education, patient stories).

Task 2: Foster relationships with hospital marketing and public relations staff by collaborating to develop strategies for promoting the trauma program both internally and externally (e.g., public service announcements, social messaging, media events, expert interviews) to increase awareness of the public health benefits of organized trauma care.

Task 3: Develop a personal skill set through collaboration with the marketing department to appropriately represent the trauma center at public relations and marketing events and other open forums.

Task 4: Offer resources to area trauma program staff and providers by way of job shadowing, consultation, and follow-up to promote collegiality and strengthen the patient care relationship.

Domain 6: Project management (9%)

Task 1: Develop and execute performance improvement projects through monitoring data trends, outcomes, and other metrics to improve trauma care across the continuum.

Task 2: Use the trauma registry and other data sources to align with local, regional, and national injury prevention partners for prioritizing initiatives to improve population-based health.

Task 3: Serve as a liaison to local, regional, state, and federal government entities to gain support of and collaboration with the trauma system.

Note. ACS & American College of Surgeons; ATCN & Advanced Trauma Care for Nurses; ATLS & Advanced Trauma Life Support; EMS & Emergency Medical Services; IRR & Inter-rater Reliability; PCAR & Pediatric Care After Resuscitation; PI & Performance Improvement; PIPS & Performance Improvement Patient Safety; TCAR & Trauma Care After Resuscitation; TNCC & Trauma Nurse Core Course; TOPIC & Trauma Outcomes & Performance Improvement Course; TPM & trauma program manager.

THE TPM ROLE: DESIGNED WITH NURSES IN MIND

Although the role of the TPM has evolved significantly since its inception in the 1980s, its alignment with the education, skills, and qualifications demonstrated by registered nurses has remained constant. The trauma nurse coordinator, the precursor to the TPM role, was first documented as an occupational role in 1987 (Committee on Trauma [COT] of the American College of Surgeons [ACS], 1983). Trauma nurse coordinators were identified as pivotal in the success or failure of trauma centers seeking verification.

The STN collaborated with the ACS COT to develop the initial requirements for the TPM role in 1992 (Mitchell et al., 1994). In 1999, the ACS sought assistance from STN to define the role of the TPM and incorporate STN-recommended provisions in the Resources for Optimal Care of the Injured Patient (ACS, 1999). The ACS Trauma Performance Improvement Reference Manual (ACS, Performance Improvement Subcommittee, 2002) identifies the TPM position specifically as trauma nurse coordinator/program manager. In trauma centers nationwide, trauma nurses have a long-standing history of fulfilling the TPM role, working collaboratively with the trauma medical director. Forty percent of the U.S. states have implemented statutes or regulations that require the TPM role to be filled by a registered nurse (STN, 2023a).

NURSING EDUCATION PROVIDES AND PREPARES NURSES TO SERVE AS TPM

Trauma program management requires unique competencies, qualifications, and skills.

Registered nurses are uniquely well suited to serve as TPMs and trauma programs are best served when registered nurses hold the TPM role. Trauma nurses possess a specialized body of clinical knowledge, including mechanisms of injury, injury patterns, correlating evidence-based treatment interventions, and expertise in performance improvement, patient safety, and injury prevention initiatives. In addition, trauma nurses are adept at collaboration across interprofessional teams, compliance with regulations and standards, and developing and implementing guidelines, policies, and procedures driven by research and evidence-based practice.

The knowledge and skills most essential for success in the TPM role, as measured in the Trauma Program Manager Role Delineation Study, conform to the competencies identified in The Essentials: Core Competencies for Professional Nursing Education (The Essentials), published by the American Association of Colleges of Nursing (AACN) in 2021, which provides the educational framework for universities and colleges preparing nurses for practice.

The AACN's Essentials domains prioritize nursing education, scholarship, and practical training that allows nurses to effectively apply and disseminate nursing knowledge, collect and analyze data, integrate guidelines into practice, interpret and comply with clinical and administrative standards, and use their clinical judgment and decision-making skills to solve problems. Nursing education fosters compassion, empathy, and a deep understanding of the importance of person/family-centered care and the broader public health considerations that impact care delivery. Quality and safety principles are core values of nursing training and practice, as are systems-based practice and the formation of interprofessional partnerships.

MAINTAINING COMPETENCY IN THE TPM ROLE

Formal nursing education and training help prepare candidates to serve in the TPM role.

However, a commitment to lifelong learning, trauma-focused nursing certification, and professional networking are vital to obtaining and maintaining key TPM clinical and professional competencies. The ATCN, OPTIMAL, and TOPIC courses, developed and disseminated by STN, offer essential clinical and administrative education and should be completed by every TPM (STN, 2023b).

The ATCN course is an advanced course designed for the registered nurse interested in increasing knowledge in managing the injured patient. The ATCN course, taught concurrently with the Advanced Trauma Life Support course operated by the ACS, has been operational for more than 25 years and is currently offered globally.

The TOPIC is designed for all members of the trauma system team who participate in the ongoing assessment, evaluation, and improvement of trauma care. STN developed the TOPIC in response to the need for education and a better understanding of the performance improvement process in trauma care. TOPIC focuses on the ongoing assessment of the continuum of trauma care with a structured review of the process and discussions of strategies to monitor trauma patient outcomes.

Physicians and nurses teach the OPTIMAL course to enhance a trauma center's system of care and improve patient outcomes. This course is designed to assist participants in creating strategies, processes, and operations to support trauma center systems based on their environments. It is geared for TPMs, medical directors, and other trauma program team members from mature trauma centers and those preparing for their inaugural verification or designation.

Attainment and maintenance of the TCRN certification through BCEN is one important measure of competency for TPMs. The TCRN certification, accredited by the American Board of Specialty Nursing Certification, is currently held by more than 7,000 trauma nursing professionals across the United States. Beginning January 1, 2024, the American Nurses Credentialing Center Magnet status will be limited to board certifications that are accredited, such as the TCRN certification.

Evidence demonstrates that a culture that promotes nursing certification advances safety (fewer adverse incidents and errors in patient care), improves organizational culture, improves processes of care, and improves the quality of care (improved patient outcomes and higher patient satisfaction rates) (BCEN, 2020).

In addition to formal education, training, certification, and continuing education, participation in national nursing organizations, attendance at national meetings, and collaboration with organizations serving physicians and interdisciplinary professionals to communicate current evidence-based care for implementation are essential to the TPM role.

CONCLUSION

The STN promotes optimal trauma care to all people, and TPMs play an essential role in trauma systems. By virtue of their education, training, and qualifications, registered nurses are uniquely qualified and best suited to fulfill the TPM role. TPMs should, at a minimum, hold a bachelor's degree in nursing, have completed trauma-specific clinical and administrative courses, such as those offered by STN, obtain TCRN certification, participate in national nursing associations, and attend national meetings to learn and share research and evidence-based practices in the delivery of optimal and equitable trauma care.

Adopted by the STN board of directors on March 2, 2023