Nurses at Pinedale Clinic ‘100 percent certified’

Nurses critical to Pinedale Clinic’s recertification as trauma center

The Wyoming Department

of Health recertified the emergency facilities

at the Pinedale Clinic as a level-five trauma

center for another three years on June 21.

For a rural medical clinic to keep its doors

open as a trauma center, all practitioners are

required to have individual trauma certification,

said David Doorn, administrative director

with the rural health care district.

Nurses at the clinic are on the front lines

of emergency care in Pinedale. Doorn announced

at the last district board meeting

on June 19 that two nurses in the district

passed their trauma nurse core curriculum,

or TNCC. With the two certifications this

month, all of the nurses are now a “hundred

percent certified,” Doorn told the board, allowing

the trauma center to continue operations.

Many hats

Vicky Marshall, RN, is a veteran with 21

years of service in Sublette County under

her belt. Before she relocated to Pinedale,

Marshall worked at the University of Utah

in the orthopedic, oncology and surgical departments.

Today she is the district’s nurse

manager and trauma coordinator overseeing

seven RNs and one LPN.

Transitioning to a rural health care district

was like moving to a “whole different

world,” she told the Pinedale Roundup.

“The first year was really scary,” she said.

Nurses at a rural medical center don’t

have the luxury of working in one department.

They have to be to be ready to do

anything, from giving someone a flu shot to

caring for a patient in critical condition.

In addition to their trauma certification,

nurses at the clinic are required to have their

Basic Life Support, Advanced Cardiac Life

Support and Pediatric Advanced Life Support

certifications, Marshall explained.

“We wear many hats here,” said Amy

Deeds, RN. “You’re not just a nurse. A majority

of us came here without emergency

room or rural health care experience.”

Deeds, now in her 12th year with the

clinic, worked in oncology before moving

to Pinedale.

Molly Landers and Kristy Bartlett, both

RNs, had some experience working in a

rural or emergency setting. Bartlett worked

in a critical access hospital for several years.

Landers worked as a float nurse, before she

came to Pinedale, working rounds in the

emergency room at a hospital.

“It’s different at a hospital,” she said.

“They have so many resources. We have a

whole different team out here.”

Emergency departments at major hospitals

have surgeons on call, blood banks and

equipment that small, rural trauma centers

lack, Landers added.

“You can’t prepare for what you see until

you actually work here,” she said.

In addition to working regular hours at the

clinic, all the nurses are on call to help with

emergency cases. Since there is nowhere

else in Sublette County to send critical patients,

the nurses work with a lot of trauma.

“We see lots of trauma, especially in summer

with both the community and tourists

involved,” said Bartlett. “Car wrecks, ATV

wrecks, horse wrecks ...”

“... The occasional bear attack,” Landers


“There’s at least one gunshot wound

every hunting season,” Bartlett said.

“We’re versatile and have to jump from

one hat to the next in the blink of an eye,”

said Marshall.

Trauma ready

District nurses, along with the doctors

and EMTs, are on-call to deal with whatever

trauma case arrives at the clinic, 24 hours

Courtesy photo

‘Since 2010, the Rocky Mountain Power Foundation has helped the SAFV

Task Force with financial support,’ said Robin Clover, the executive director

of SAFV. This year Rocky Mountain Power Foundation granted SAFV

$3,000 to work toward ending violence in Sublette County, by supporting

the services for victims of domestic violence, sexual assault and stalking.

Pictured, from left, are Zoe White, volunteers/ violence prevention coordinator

for SAFV Task Force, Robin Clover, and Chris Nelson, local operations

manager for Rocky Mountain Power.

a day, seven days a week. Until life flight

or an ambulance can evacuate a patient to a

hospital, the nurses help stabilize and care

for the patient.

To be prepared to deal with trauma care,

all nurses at the clinic have to pass their

TNCC. Marshall, Deeds, Bartlett and Landers

all agreed that the certification process

is “intense.”

The nurses travel to Jackson, Marshall

explained, where instructors offer two days

of rigorous coursework followed by a difficult

written and skills test that chews up

another day.

“The main piece in the test is assessment,”

Bartlett said. “They test us on how

we identify patient needs and priorities (in a

trauma situation).”

The nurses spend a lot of time preparing

for the certification classes and tests. Workbooks

and online resources with scenarios

that might show up on the tests are available,

said Deeds. Landers added that practice

tests really help get her ready.

“We start preparing at least six weeks

ahead of time,” said Marshall. Somehow,

between working full-time at the clinic and

responding to hundreds of on-call hours, the

nurses are able to “slide (studying) in there

somewhere” Marshall said.

“When you pass, it’s a great feeling and

you get to go ‘Yes!’” said Deeds.

Nursing is demanding and dealing with

patients and trauma day in and day out can

take a toll. In a small community, the nurses

often know their patients, said Landers, adding

another dimension to the challenge.

The nurses said that strong support from

family and colleagues helps them cope.

“There are some days where you just

cry,” said Marshall.

Despite the trauma, nursing can have its


“There is the satisfaction of helping people

in their darkest hour, whether it’s as simple

as holding someone’s hand or complex

as resuscitating a patient,” said Deeds.

Interacting with the community is part of

why Bartlett is a nurse. Seeing survivors she

helped after they recovered and are back out

in the community is a benefit.

“Not all outcomes are worst-case scenarios,”

said Bartlett. “It’s rewarding seeing

the little kid you flew out (on life flight)

last week in the grocery store the next week

smiling with family.”


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