Background <p>Traditional trauma care often experiences significant delays in surgical readiness due to fragmented coordination between surgical and nursing teams. Nurse-Led Trauma Services (NLTS) have emerged as a collaborative alternative to optimize clinical efficiency. This study evaluates the efficacy and safety of an NLTS model compared to Traditional Trauma Services (TTS) in an emergency plastic surgery department.</p> Methods <p>This retrospective cohort study analyzed 248 patients (NLTS: <i>n</i> = 107; TTS: <i>n</i> = 141) admitted to a tertiary emergency center in China for plastic surgical intervention following trauma. The NLTS model utilizes specialized nurses as proactive clinical partners exercising autonomy in real-time emergency management, precision surgical assistance, and multimodal pain protocols. This model integrates advanced wound technologies, specifically nano-silver antibacterial dressings, alongside nurse-driven early-mobilization. Conversely, the TTS model follows a physician-led framework where nursing actions are restricted to executing standardized instructions and conventional sterile dressings.</p> Results <p>Baseline demographics and injury etiologies were comparable between cohorts (<i>p</i> &gt; 0.05). In terms of surgical efficiency, 100% of the NLTS cohort achieved same-day readiness, significantly outperforming the TTS cohort’s 94% (<i>p</i> = 0.043; RR: 1.060; 95% CI: 1.018–1.104). The NLTS model also demonstrated superior safety, with a significantly lower incidence of postoperative nausea (23% vs. 39%; <i>p</i> = 0.009). While differences in vomiting, dizziness, and infection were not statistically significant, the NLTS cohort reported zero instances of DVT or pressure sores, whereas the TTS cohort documented five cases (<i>p</i> = 0.072). Notably, the NLTS group experienced a significantly shorter median hospital stay (8 vs. 11 days; <i>p</i> &lt; 0.001). This reduction likely reflects a synergistic effect between enhanced nurse-led coordination and the advanced wound care materials utilized in the NLTS protocol. Patient and caregiver satisfaction scores were significantly higher in the NLTS cohort (<i>p</i> &lt; 0.001), while pain levels remained comparable (median VAS: 5; <i>p</i> = 0.355).</p> Conclusions <p>The NLTS model significantly enhances clinical efficiency, surgical readiness, and patient satisfaction. The observed reduction in hospitalization duration suggests that the integration of specialized nursing leadership with advanced clinical materials provides a superior framework for emergency trauma care, though outcomes result from the combined impact of organizational and technical interventions.</p> Trial registration <p>Not applicable.</p>