INTRODUCTION: The Canadian C-Spine Rule (CCR) is a clinical decision aid to 
facilitate the safe removal of cervical collars in the alert, orientated, 
low-risk adult trauma patient. Few health care settings have assessed 
initiatives to train charge nurses to use the CCR. This practice improvement 
project conducted in a secondary trauma center in Canada aimed to (1) train 
charge nurses of the emergency room to use the CCR, (2) monitor its use 
throughout the project period, and (3) compare the assessments of the charge 
nurses with those of emergency physicians.
METHODS: The project began with the creation of an interdisciplinary team. 
Clinical guidelines were established by the interdisciplinary project team. Nine 
charge nurses of the emergency room were then trained to use the CCR (3 on each 
8-hour shift). The use of the CCR was monitored throughout the project period, 
from June 1 to October 5, 2016.
RESULTS: The 3 aims of this practice improvement project were attained 
successfully. Over a 5-month period, 114 patients were assessed with the CCR. 
Charge nurses removed the cervical collars for 54 of 114 patients (47%). A 
perfect agreement rate (114 of 114 patients, 100%) was attained between the 
assessments of the nurses and those of physicians.
DISCUSSION: This project shows that the charge nurses of a secondary trauma 
center can use the CCR safely on alert, orientated, and low-risk adult trauma 
patients as demonstrated by the agreement in the assessments of emergency room 
nurses and physicians.