Critical Care Transport Nurses Day on February 18 brings attention to the vital work done by nurses in this specialty. Working on a flight or ground vehicle adds complexity to this fast-paced career, and the nursing industry is helping these nurses stay informed and educated throughout their careers.

Critical care transport nurses provide medical care to ill or injured patients as they are transported by flight or ground to facilities where they will receive additional care. The distinct environments require different training and certifications to meet the needs of transport nurses. This July will mark the 30th anniversary of the Certified Flight Registered Nurse (CFRN). Ground transport nurses began taking the Certified Transport Registered Nurse (CTRN) certification when it was introduced in 2006.

Today, there are more than 5,500 CFRNs and more than 450 CTRNs worldwide. Minority Nurse recently heard from Janie Schumaker, MBA, BSN, RN, CEN, CENP, CPHQ, FABC, and CEO of the Board of Certification for Emergency Nursing (BCEN) to find out about the recently conducted The 2022 Certified Transport Registered Nurse Pulse Survey and changes to exam content outlines (which RNs use to help study for the exam) and the test item banks that came about as a result of the most recent Transport Nursing Role Delineation Study in 2019 (completed every five years). Feedback from that study resulted in changes that went into effect in 2021 for the CFRN and 2022 for the CTRN.

“This is a rigorous, scientific process done in consultation with a panel of ground and flight transport RN experts,” says Schumaker. “This process ensures the exams reflect current practice and roles for nurses in each specialty. So everything on the CFRN exam content outline is flight specific and everything on the CTRN exam content outline is ground specific. And now there are separate test item banks, too.”

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The recent BCEN survey showed how critical care ground transport nurses work within incredibly complex environments and that they take great pride in their capabilities. What surprised you most about the findings (or perhaps reinforced what you already knew)?

The responses to [the survey] really underscored ground transport nurses’ pride and sense of accomplishment in being board certified in their specialty—and rightly so—and the significant ways certification contributes to their ability to be the best nurse they can be. Chief among these is how CTRN certification contributes to their critical thinking, confidence, clinical knowledge, and ability to provide expert care for their patients in the very dynamic and highly technical ground transport setting.

Ground transport nurses and their clinical partner, typically a paramedic, care for high acuity critically ill patients, sometimes over long distances, relying on their joint expertise and experiences and what’s in their specially-equipped truck until they get to their destination. They have to be at the top of their clinical game and prepared to provide life-sustaining and even life-saving care, and also know how to keep their patient and their team safe—all while they are on the move.

Nurses gave feedback about having wanting more specific CE content and BCEN responded by creating the BCEN Learn CE platform. Why is this so important for transport nurses’ ability to keep their certifications current?

CTRN- and CFRN-certified transport nurses, like all nationally board-certified nurses, make a commitment to know and stay abreast of the latest trends, advances, and best practices across their specialties. And that is no small feat.

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Emergency, trauma, and transport nurses had been telling BCEN for some time that they wanted and needed more advanced and specialty-specific continuing education content to support their commitment to lifelong learning and help meet their certification renewal requirements. In response, we developed and launched the online (and now, award-winning) BCEN Learn platform in 2020 and offered our first regional, in-person CE conference, BCEN Learn Live, in 2022. The 2023 conferences will be held in Dallas in May and Charlotte, NC in November.

There are now 90 high-interactivity CE courses designed by and for nurses practicing across the emergency spectrum including in transport settings on the BCEN Learn platform. There are also more than two dozen free CE webinars, with a new title debuting each month.

Nurses interested in or practicing in transport settings can earn one free contact hour by listening to these free transport-specific webinars:

The shift in separating the credentialing exam content outlines and test item banks into ground- and flight-specific shows how dynamic critical care transport nursing really is and how important it is for nurses’ continuing education opportunities to keep pace. What is the biggest factor in the changing landscape for critical care transport nurses?

New clinical knowledge, new techniques and technologies, new equipment, evolving professional issues, and public health challenges are all influencing factors. The separate CFRN and CTRN exam content outlines and separate test item banks, underline the distinctions between the ground and air transport settings.

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While board exam questions are updated and new ones are added on a rolling basis, BCEN conducts a highly scientific role delineation study (RDS) every five years to make sure the content and relative emphasis in our credentialing exams are accurate, current, and relevant with respect to the roles and responsibilities of nurses in a given specialty. Our most recent transport nursing RDS took place in 2019, and I fully expect the new knowledge, advances, and experiences that came about during the coronavirus pandemic will be apparent as we go through the 2024 transport nursing RDS.

In addition to transport-mode specific updates to major sections of the now separate CFRN and CTRN exam content outlines, mental health was added as a category of the CTRN certification because mental health issues are becoming more common in the ground transport environment, for example. In the CFRN certification program, the emphasis on resuscitation and “special populations” were both increased due to greater volumes of high acuity patients transported by air and to adequately address essential knowledge regarding the special needs of obstetrical, neonatal/pediatric, geriatric, and bariatric populations.

The increase in critical care transport certifications over the last three years is impressive. What factors influenced that increase, and what does that tell you about transport nurses’ commitment?

It is! The number of CTRN-certified nurses surged 19 percent in 2020, 29 percent in 2021, and 24 percent in 2022. We think several factors may have contributed including a growing recognition of the knowledge, skills, and abilities that are unique to the ground transport environment and the volume of patients being transferred to facilities offering a higher level of care or specialty care (a trend seen long before the pandemic).

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A solid 50 percent of the CTRNs surveyed reported doing more ground transports during the pandemic. Certain patients with COVID-19 needed to be transported by ground and not air and patients needed to be transferred to hospitals with available beds when local facilities were full.

Additionally, nearly two-thirds said having the CTRN credential contributed to their ability “to deliver the best possible care” for their patients with COVID-19. And that really speaks to a third, and maybe the biggest driver, which is a deeper appreciation of the benefits of nursing specialty certification to nurses, healthcare teams, and, above all, patients and their families.

What we know for certain is that CFRNs and CTRNs are highly committed to critical care transport nursing and their patients, and we couldn’t be more proud of their remarkable contributions.

Julia Quinn-Szcesuil
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