The best thing about working in trauma is that no day or patient is the same”: Meet Sara Logan, major trauma ward matron

To mark the second series of Channel 4's Emergency, we are publishing a series of Q&As with key staff involved in our major trauma centre.

Nurses play a vital role in caring for patients who are admitted to our major trauma ward at St Mary’s Hospital. Here, Sara Logan, major trauma ward matron, gives an insight into how nurses work alongside other specialists on the ward and reflects on her own passion for working in major trauma.

Tell us about your role.

I am matron for the major trauma ward at St Mary’s Hospital. I’ve been on this ward since it opened in 2010 – I started as a band 5 nurse and have progressed to matron.

Essentially, I help run the ward. I look after the nurses and healthcare assistants and ensure they have completed the latest specialist trauma training, and I partly look after our doctors and trauma consultants. I also oversee the care of our patients – from the point of admission all the way through to discharge, ensuring that the relevant specialist teams are involved. As a team we run a specialist trauma clinic and make sure trauma patients get the follow up they need.

What role does nursing play in the major trauma centre?

I’m biased because I am a nurse, but I think nurses play a vital role in the major trauma team. We are by patients’ bedsides for 12-hour shifts at a time so not only do we build relationships with and support patients, we also support their families too. Obviously other healthcare professionals do the same, but doctors for example see roughly 40 patients whereas we have a nurse-to-patient ratio of one to five. Our nurses ensure each patient receives truly holistic care which encompasses their physical, emotional and psychological needs. Due to the nature of trauma, nurses on the major trauma ward deal with a lot of different types of patients and injuries so our skillset is very big – we are well equipped to look after patients, their families, and one another.

What inspired you to pursue a career in nursing? And in major trauma specifically?

I’ve always wanted to help people. I have a lot of family in the medical field, and I couldn’t imagine myself doing anything else. During my training I was drawn to fast-paced, high-energy wards and as soon as I discovered trauma, I never looked back.

The best thing about working in trauma is that no day or patient is the same. It can be challenging and traumatising as you naturally absorb a lot of trauma from your patients. But to support patients through life-changing injuries and when they are at their lowest is so rewarding.

I have found it rewarding to care and support patients who have come to us through gang-related violence, and to watch their transformation as they begin to trust us and allow themselves to be helped.

Major trauma is a collaborative field that brings together a range of specialties. How do all these specialties work together to provide holistic care to patients?

We're a big team. There are my nursing teams, our Trauma consultants and our ward doctors, our geriatrician consultants and our therapy team. We have a major trauma consultant, spinal consultant, and a cranial consultant of the week, and these teams have their own registrars. The trauma consultants have an extensive background in either Trauma, vascular, plastics, orthopedics and general surgical (a mixture of backgrounds), and within this team there are trauma coordinators and advanced nurse practitioners who ensure all trauma patients receive the highest of nursing care throughout their trauma journey. We have a neuro coordinator who helps support our cranial and spinal patients and all coordinators organise repatriations, rehab and run clinics for outpatients. Physiotherapists and occupational therapists play a vital role in the trauma ward and help with the rehabilitation of our major trauma patients. Rehab coordinators step in to help coordinate where patients should go after we fix their acute injuries, and our clinical psychologist sees trauma patients in need of mental health support.

Then there are the teams who sit outside of our ward who we refer trauma patients to, such as our speech and language therapists, dieticians, and children and adult safeguarding services. We also work closely with our red threads team who offer support to people up to the age of 25 who have been involved in gangs or violent attacks.

The consultants, doctors, therapists and nurses meet daily for a multidisciplinary team meeting (MDT). This involves coming up with a plan for all new trauma patients and for those already on the ward. If a patient has polytrauma (multiple traumatic injuries) for example, they might need input from different teams such as plastic or vascular surgeons. Our role is to ensure each patient is seen by our specialist teams, relevant external specialist teams, and to bring the different care plans together and communicate these plans directly to patients.

What processes are in place to keep the lines of communication open to patients?

Once we have completed the MDT, we split into our individual teams – trauma, spinal and cranial – and we review patients bed-by-bed and discuss their care plan with them. We then communicate these care plans with the nurses on the ward. The nurse in charge, doctors and coordinators then meet mid-morning for a board round where the progress of each patient is discussed. Once all patients have been seen and care plans have been documented, we come together again as a team armed with the list of actions we need to take forward. Around 16.00 we catch up again to make sure that we’re on track with our actions for each patient for the day.

You mentioned that staff naturally absorb trauma from patients. What support is in place for staff on your ward?

Our clinical psychologist is available for patients, their families and our staff. Staff can also take advantage of our Trust counselling service and, as a manager, I encourage my team to have open conversations with me and with each other if they are struggling. We also have debriefs after particularly challenging patients.
With help from our clinical psychologist, we are in the process of relaunching wellbeing sessions for staff every three to six months which would incorporate mental health support and reflective practices.

How does it feel to be part of the wider London major trauma system, which treats over 12,000 people each year?

It makes me feel very proud. I wouldn’t want to work in any other specialty and to be part of a system so huge really drives home how together we have the power to deliver high quality trauma care to improve patient outcomes and ultimately save lives.

Why would you encourage someone to pursue a similar career?

It is extremely rewarding to help patients during the most traumatic time of their lives, and you will undoubtedly be remembered by your patients forever. You don’t get the opportunity to make this kind of impact in many other professions. It is undeniably a very challenging career – major trauma in itself can go from zero to one hundred in a matter of seconds – but there are always opportunities to grow and develop as you take on more specialist training.

Progressing to the current stage of my career has been a real highlight and I always enjoy seeing the nurses that I have trained get to the next level in their careers. It has also been a joy to see major trauma as a specialty evolve and to see our ward thrive – it is an exciting time to embark on a career in major trauma nursing.

Lastly, are there any patients that have stayed with you in particular?

Lots! However, the patients involved in all the major incidents we’ve been through will always stick in my mind. I will never forget the teamwork of the whole trauma centre and how everyone stepped up and pulled together in these extremely challenging days.

I was on my way home when one major incident occurred and I immediately returned to the ward. I had staff who were on a day off calling to ask if they could come to work to help and support their colleagues. I think the memory of these patients, the trauma they went through, and the injuries they sustained will be what I remember. Some of the patients were on holiday and English was not their first language. Their faces will always stay with me – they were petrified.

Many of the patients from this same major incident were understandably psychologically traumatised and I can recall how the nurses would stay with them at night as they cried or hold their hand when they had flashbacks from the incident.

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