By Debra Wood, RN, contributor
Hot, intense and demanding, burn care nursing represents one of the profession's most challenging specialties, but nurses who gravitate to it tend to stay for years.
"All the classes you take in nursing school, you utilize in a burn unit's psychology, communication skills and physiological aspects of caring for sick patients," said LaVelle Grubb, RN, a staff nurse and unit education coordinator at the 14-bed John S. Dunn, Sr. Burn Center at Memorial Hermann Hospital in Houston, Texas.
Grubb began her burn career as a volunteer reading to or visiting with patients at the Galveston, Texas, hospital where her mother worked as a burn nurse. The patients' disfigurement and dressings never bothered her.
Making up her mind on a nursing career at 12 years of age, she received her cap 35 years ago and immediately went to work in a burn unit, moving up to head nurse, before relocating to Houston and Memorial Hermann, where she has worked since 1982.
Twenty-two years ago, she cared for Darrell Essary, a 20-year-old ironworker who had sustained an electrical burn over 33 percent of his body. About a year after his 53-day stay, he called Grubb and asked to volunteer on the unit.
Essary found it so rewarding, he returned to school and became a registered nurse, for the past eight years working side-by-side with Grubb. He also established and facilitates an outpatient support group and a volunteer cadre of burn survivors who provide one-on-one peer support to hospitalized patients.
"The burn may have been one of the best things that happened to me, as far as changing my life and giving me a whole new outlook," Essary said. "I've been offered other positions, but I havenï¿½t been able to pull myself away from the bedside and working with burn patients."
Essary is pursuing a master's degree and aims to become a nurse practitioner on the burn unit. He especially enjoys the unique relationships burn nurses establish with their patients. He involves patients in their care and knows the value of active rehabilitation. He often speaks from experience to motivate patients. The specialty requires a certain finesse.
"Burn nursing is physically and psychologically demanding and is certainly not for everybody," said Mary-Liz Bilodeau, RN, MS, CCRN, CCNS, CS, BC, clinical nurse specialist and nurse practitioner at Massachusetts General Hospital in Boston. "But it is one of the most gratifying and satisfying areas of nursing."
Many burn units, such as the ones at Memorial Hermann and Massachusetts General, are set up to care for patients from initial injury, when their breathing is assisted by a ventilator and are needing total care, until they leave the hospital.
"You see progress and the patient getting better and their pain going away," Grubb said. "By the time they are ready for discharge, you see a stable individual leaving, not someone depressed or crying."
Mass General's unit even contains ambulatory services.
"When the patients come back to the outpatient center and staff see them again, that does a lot for staff moral," said Bilodeau, who has worked with trauma and burn patients for 28 years. She provides care throughout the patients' stays and works with new and senior staff to advance their practice based on the latest research.
At Memorial Hermann, RNs provide almost all of the care, from dressings to drawing blood to medications. Dressing changes and burn scrubs may take an hour for an experienced burn nurse but three hours for a critical-care nurse floating to the unit.
Specially trained technicians change dressings at the University of Kansas Hospital's Burnett Burn Center in Kansas City, leaving nurses more time for monitoring fluids, protecting airways and other critical care.
"It's very holistic, because you do everything for the patient. And you work as a team with different disciplines," said Rosie Thompson, RN, MS, clinical nurse specialist at the University of Kansas center.
The care team includes nurses, physicians, respiratory therapists, physical and occupational therapists, psychologists and pain-management experts.
Burn care nurses agree that pain control has improved from years past. Nurses use distraction and anti-anxiety drugs as well as powerful analgesics to keep patients comfortable.
"It has a lot to do with your approach and the patient trusting you," Grubb said. "Once the patient sees that even though you are hurting them, you are helping them, then it all takes on a new aspect of care."
Many burn patients suffer from mental illnesses or substance-abuse problems; some having received their burns in a suicide attempt. Even with pure accidents, patients worry about their appearance and future limitations and require psychological support.
"Everyone truly works together," Bilodeau said. "There is not a lot of hierarchy in the burn world. Everyone's opinion is valued and sought after. That's how we help the patient get better."
Patients typically stay one day for each one percent of burn. Nurses may care for patients at all stages of their recovery, one-on-one with a new patient or with two who have sustained less severe injuries or are becoming more independent. The variety of assignments helps prevent burnout, Grubb said.
Working on a burn unit, kept at about 90 degrees due to patientsï¿½ skin loss, can be draining. The nurses support each other and strive for balanced lives and activities outside the unit.
"Everyone has their own way of dealing with the stress," Bilodeau said. "You have to put a little distance between yourself and some of these cases. It can wear you down."
Nurses often become involved in survivor groups and professional organizations, such as the World Burn Congress and American Burn Association. Burn nurses also tend to reach out to the community with prevention efforts or fellow professionals to educate them about treatment advances.
"Burns are 99 percent preventable," said Pam Pucci, RN, BSN, Trauma Burn Center nurse educator for the University of Michigan Health System in Ann Arbor.
Pucci, a 17-year burn-care veteran, began a safety program four years ago for youths, after noting a 17 percent increase in admissions. She focuses on teaching youngsters who have started a fire in the past about the dangers associated with the behavior and the course of treatment if they are injured.
"The recidivism rate for children who attend the program is zero," Pucci said. "They don't repeat the at-risk behavior."
University research indicates that 36 percent of children who do not receive the training will set another fire. Pucci receives referrals from fire departments, courts, schools and parents.
The team at Memorial Hermann has taught United States astronauts about burn care, in case of injury during a mission. While their teachings circle the earth, Memorial Hermann nurses continue providing daily care, their satisfaction soaring just knowing their actions and care have turned potentially tragic endings into new beginnings for their patients.
"It is rewarding to see the difference I make in a patient's life, from the time they are real sick until discharge," Essary said. "And since I facilitate the support group, I get to see them come back and grow into a normal life with new relationships."
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