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.
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
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,”
District nurses, along with the doctors
and EMTs, are on-call to deal with whatever
trauma case arrives at the clinic, 24 hours
‘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
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
“The main piece in the test is assessment,”
Bartlett said. “They test us on how
we identify patient needs and priorities (in a
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.”