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.”
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.
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.
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).
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.
For nurses who enjoy both nursing and business, occupational health nursing is a career that combines both interests. While the majority of nurses work in medical care facilities or settings, occupational health nurses work in an office setting and care for employees of a company.
According to Betty Sanisidro, DNP, MSN, COHN-S, APHN-BC and the executive director of the American Board for Occupational Health Nurses, occupational health nursing is one of the nursing industry’s undiscovered secrets.
Nursing, says Sanisidro, was a calling she recognized from an early age. “When I was young, every time someone was hurt, I was the first to go to the rescue,” she says. After considering a premed path, Sanisidro says nursing offered her something she knew would be essential to her own career satisfaction–high patient contact.
“But I had no idea occupational health nursing was even an option,” she says. She was disillusioned by her current nursing role and didn’t feel like she was able to make the impact she wanted or expected. When a professional contact mentioned a job at a large corporation and noted that Sanisidro’s nursing background and bilingual skills were ideal for the role, she applied. With her strong medical base and her understanding of workplace safety and preventative care, Sanisidro says she realized the role would allow her to flourish, and she accepted the role when it was offered.
With that introduction to occupational health nursing, Sanisidro never looked back and appreciates the variety of her work and the relationships with the people she cares for. “You never know what will walk in the door,” she says. “I have to stay on top of my game. I felt like I hit the Disneyland of occupations.”
The job also offers opportunities for nurses to gain essential business skills they might not have in traditional medical settings. As a liaison to the leadership, occupational health nurses are relied on to give concise presentations and gather and report on data. For those reasons, Sanisidro says advanced degrees will benefit nurses. Even if an advanced degree isn’t required, she encourages nurses to pursue them. Certification in occupational health nursing is also valuable, and certification for this niche is for entry-level skills, so new nurses are able to take the exam. “The most important attributes in an occupational health setting are those that can’t necessarily be taught,” Sanisidro says. “It’s having that desire, care, and compassion. You can’t teach that.”
Unlike many medical centers, save for long-term care options, employees are generally with a company for a long time. And nurses gain deep knowledge of the business aspects of a company so they become experts at about compliance and keep detailed records about visits. Although occupational health nurses have specific daily, weekly, and monthly tasks to track, the day-to-day work is unpredictable. “There’s no typical week,” she says. “And that’s the exciting part of it.”
As a nurse within a corporate setting, occupational health nurses’ duties are broad. They can be counted on to give hearing conservation testing, eye exams, and preventative programs including biometric testing, health coaching, and nutritional counseling. There will be biosafety questionnaires and follow up exams. Nurses in this role can also see emergencies like a cardiac event, seizures, or anaphylaxis or less traumatic problems of something in an eye, a rolled ankle, an abrasion, or checking an unusual mole or suspicious skin lesion.
Occupational health nursing is sometimes confused with occupational therapy, which is distinctly different. But many people aren’t familiar with occupational health nursing–even many nurses. “It’s not a specialty reviewed in most nursing programs,” says Sanisidro. “But once nurses find the niche, they stay for a long time.”
Another difference that many occupational health nurses find is that there is funding in the specialty. Corporations that have occupational nursing staff are making a purposeful, direct investment in the employees’ health and well-being. “We may not generate revenue, but we can demonstrate what was utilized this month and if visits were for personal medical or occupational reasons,” she says. “You have to get comfortable with public speaking, PowerPoint presentations, and speaking the lingo of business, because businesses listen to dollar signs.” Occupational health nurses are also advocates for employees, so they are comfortable alerting the company to a workplace safety issue or a strange odor before it becomes a larger problem.
Employees, in turn, appreciate the convenience of health care in the workplace with someone they recognize and trust. “You develop a rapport and trust with them,” says Sanisidro. “They can just pop in and say hello.”
If occupational health nursing interests you, Sanisidro recommends reaching out to an occupational nurse for a conversation, shadowing a nurse to see what the role is like, or even picking up some per diem jobs through an agency to get a feel for the position. “If they love helping others and are caring and compassionate nurses,” she says, “everything else can be taught.”
In the long struggle to gain full practice authority (FPA), nurse practitioners (NPs) can point to notable advances in the last few years. Now, patients in more than half of the states, the District of Columbia, and two U.S. territories have full, direct healthcare access from NPs.
In April 2022, New York and Kansas granted FPA to NPs. That brings to 26 the number of states where NPs can practice to the top of their license without restriction. In this article, we’ll look at how that progress was made, the impact of COVID, and how newly proposed federal legislation would strengthen NP practice. But first, let’s have a look at what FPA means.
Defining FPA
“Full practice authority is essentially that the nurse practitioner can practice to the full extent of their education and training,” says April N. Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, president of the American Association of Nurse Practitioners (AANP). “Nurse practitioners are trained to evaluate patients, make diagnoses, order and interpret tests, prescribe medications, coordinate care, and educate. We are educated and trained to do these things,” says Kapu.
In the past few years, the pace has “really picked up as we have seen more and more states move to full practice authority,” according to Kapu. She notes that four states moved to full practice authority through the pandemic: Delaware and Massachusetts in 2021 and New York and Kansas in 2022. “It’s because we demonstrate our commitment to quality and equitable care and ensuring care is provided in all communities.”
In states that have moved to full practice authority, “we’ve seen improved patient care outcomes. We’ve seen an increase in the workforce. We’ve seen an increase in nurse practitioners working in historically underserved urban and rural areas,” Kapu says.
FPA, COVID and Care
While devastating, COVID helped bring to light the high-quality care that NPs provide and boosted efforts to gain FPA. In some states where NPs worked under less than full practice authority, the governors signed executive orders waiving various restrictions, notes Kapu.
“That’s where we saw the opportunity for nurse practitioners to continue providing care. They provided very high-quality care. They were able to provide more accessible care. As you saw throughout the pandemic, they were in communities and churches, going door to door, seeing patients in their homes, and doing everything they did in the hospital and the ICUs. So we demonstrated that continued quality of care. And that is what quickened the momentum during the pandemic; the executive orders provided that opportunity,” Kapu says.
Ohio Experience
In Ohio, a reduced practice state, an emergency authorization during COVID allowed NPs to deliver care via telehealth, notes Evelyn Duffy, DNP, AGPCNP-BC, APRN-NP. However, she notes that NPs can still practice via telehealth, and that ability is no longer contingent on the emergency authorization. Based in Cleveland, Duffy is an NP in the University Hospitals Geriatric Medical Group and a professor at the Frances Payne Bolton School of Nursing.
An NP since 1981, Duffy notes that “we’ve come a long way in Ohio. We got full prescriptive authority at the end of the 1990s.”
However, like all Ohio NPs, Duffy needs a collaborative agreement with a doctor. “Ohio is in the reduced practice category,” she notes. “Not a lot obstructs me from doing what I want. The only thing that gets in the way is having to make that collaborative arrangement.”
Overcoming Obstacles
Kapu stresses the need to get out the message that laws limiting NP practice need to be revised. Laws need to be updated to “allow NPs to practice to the extent of their education and training, not beyond that, but to the extent of their education and training, as they are very capable of doing and have decades and decades of evidence demonstrating their quality-of-care outcomes. So it’s getting that message out that all we have to do is update those laws. It’s no cost or delay and can be put into place, and you would see much-increased access.”
Kapu points to Arizona as an example of what may happen for states that grant FPA. Arizona, she notes, moved to FPA in 2001. Five years later, the NP workforce doubled, and rural areas saw a 70% increase in NPs.
FPA Federal Legislation
On the federal level, new legislation, the Improving Care and Access to Nurses (ICAN) Act, was introduced in September in the House of Representatives. Supported by the AANP and other major nursing organizations, the act would update Medicare and Medicaid to enable advanced practice nurses to practice to the top of their education and clinical training, according to a press release from the American Nurses Association.
Maintaining Momentum
Although getting FPA in all states has taken a little longer than wanted, “we have momentum,” says Kapu. “I believe we’ll get there, especially with the increasing access to care needs that we’re seeing in the United States today.”
In honor of Certified Nurses Day (on March 19), Minority Nurse interviewed Katherine Houle, MSN, APRN, FNP-BC, CNN-NP and executive director of the Nephrology Nursing Certification Commission (NNCC) and Sandy Bodin, MA, RN, CNN and president of NNCC, to find out why certification is such an essential component of career growth and excellent patient care.
Certification helps nurses achieve an expertise level of understanding of a specialty topic. Whether it’s a nursing student planning out a long career or an experienced nurse who wants to advance to a new level, understanding the benefits of certification is part of a nurse’s career journey.
“Nurses are first introduced to the importance of certification in their nursing program at college when they are taught about the concepts of life-long learning and professionalism,” says Houle. “Typically, as nurses begin their careers, they tend to gravitate toward a specialty. As they become more proficient in that specialty, they often choose to become certified.”
Nurses may choose certification in more than one specialty as each shows a commitment and a proficiency to their roles and their patients. The credential is also a way to outwardly acknowledge a nurse’s advanced skill set and knowledge in a particular area. That easy-to-see credential is valuable to anyone the nurse may interact with–patients, peers, leadership, and the wider nursing community. “This certification enables nurses to demonstrate their expertise in that specialty and validate their knowledge to employers and patients,” says Bodin.
Because certification is confirmation of a nurse’s proficiency in a specialty, patients find credentials signal professional expertise. And nurses take pride in knowing they are taking extra steps to provide the most advanced and up-to-date patient care possible. “Researchers have found a positive relationship between nurse certification, patient satisfaction, and patient outcomes,” says Houle. “Certified nurses report increased confidence, competence, credibility, and control.” And fellow nurses also look to their certified peers as leaders and experts in their specialty. That expectation can open the doors to professional opportunities and collaborations that benefit the nursing industry as a whole.
Nurses are also aware that as a whole, the more certification among a team, the better patient outcomes will be. “The purpose of certification in nursing includes protecting the public from unsafe and incompetent providers, giving consumers more choices in selecting health care providers, distinguishing among levels of caregivers, and giving better-trained providers a competitive advantage,” says Bodin. “Certification has been shown to positively affect patients and nurses.”
The process of becoming certified does take work, and nurses may find taking on extra work daunting, especially when their work is demanding. But many nursing leaders want to remind nurses that the certification exam requires a certain amount of real-world experience before it can be taken. By that point, nurses known the information as they are likely doing the work every day. “Most certification programs require a certain number of hours worked in the specialty prior to applying for certification,” says Bodin.
Nurses dedicated to the credentialing process understand that they need to dedicate some time to the process. “There is a significant commitment in time and effort to become certified,” says Houle. “It takes time to gain expertise in the nursing specialty and an effort to obtain advanced nursing knowledge to demonstrate the skills needed for certification.” Like many other credentials across different industries, once nurses are certified, they should plan to renew that credential as required (the length of time a certification is valid differs by specialty). “Continuing education hours, along with current, ongoing work experience is needed to maintain certification,” she says. “This ensures that the nurse is keeping up with rapid changes in the field.”
When nurses look at long-term career growth, certification offers many benefits. Like a degree, certification isn’t tied to a certain role or organization. As a nurse changes jobs, that certification continues to signal a commitment to professionalism and providing the best patient care. A certification may not bring an instant salary boost, but it can be used as leveraging power during a review or when applying for a different position.
Many organizations also celebrate nurses as they earn their certification as a way to show public recognition of and appreciation for the extra work that a certification requires. This week’s Certified Nurses Day is one way to recognize all that extra work.
This week’s celebration of Pediatric Nurses Week (October 4-8) is a reminder of the specialized work these dedicated nurses offer to their young patients.
For anyone interested in a career as a pediatric nurse, it’s helpful to know the responsibilities of this job. Nurses who work with children are the biggest advocates for their young patients. From toddlers to teenagers, pediatric nurses will become familiar with, and fluent in, the issues facing these ages.
Nurses who work with children will have an understanding of everything from toilet training and toddler play habits to social media and adolescent decision making habits. Pediatric nurses will see children for well visits, minor illness like a stomach flu, and life-threatening diseases including cancer.
Because of the range of ages, potential conditions, and situations, pediatric nurses have to know myriad relevant medical information and also how any issues or concerns will impact the family. Working with so many different families while focusing on a young patient can be challenging for pediatric nurses. Families are also the best advocates for the child and so creating a good working relationship with families is especially helpful. Compassion and understanding go a long way, but calling attention to concerns is also a pediatric nurse’s responsibility.
The Society of Pediatric Nurses is an excellent resource for nurses who work with children and their families. It offers guidance on education, advocacy, and clinical information to cover the needs of just about any pediatric nurse.
Nurses in this specialty are in high demand and can find a satisfying career in one office or by changing the focus of their career. They can find work in a family practice, a specialty practice, a hospital, an outpatient or surgical clinic, schools, or even rehabilitation centers.
By taking the exam, nurses are proving they have the most updated knowledge on evidence-based practices and on treating their young patients. This helps them give the best care possible as this specialty changes rapidly. Nurses who become certified are also demonstrating a specific commitment to being the best nurses they can and to gaining the tools necessary to make that happen. For a career move, this extra level is frequently noticed by your peers, supervisors, and organization. Nurses who are certified and keep their certification current are the nurse leaders organizations look for and depend on.
On March 19, nurses around the nation are celebrated for earning a nursing certification distinction in a specialty field. Each year on this day, the American Nurses Credentialing Center supports Certified Nurses Day recognizes the dedication of nurses who pursue additional training in their area of expertise so they can provide the best patient care possible.
Certified Nurses Day falls on the birthday of Margretta Madden Styles, RN, EdD, FAAN, a nurse leader and educator who is considered the driving force in nursing certification. Styles was a pioneer in drawing attention to the importance of nurse certification and what is means for high-quality nursing practices and improved patient outcomes. A 1954 Yale graduate, Styles, who was known as Gretta, eventually served as the dean of the School of Nursing for the University of California San Francisco, and gained international acclaim for her advocacy for certification to advance the nursing practice. Styles died in 2005, but her legacy continues to inspire the certified nurses in the United States to this day.
Nursing certifications improve nurses’ skill sets, expand their employment prospects, raise their salary potential, and also elevate the nursing industry as a whole. Individually, nurses who are certified are recognized for the additional time and effort they spend to gain more knowledge in their specialty. And nurses are able to obtain many certifications—they are not limited to just one. Certification helps bring you the understanding you’ll need around practices and processes in whatever area you choose. For instance you may decide to obtain certification in adult gerontology, oncology, nurse leadership, gastroenterology, med-surg, wound care, or diabetes care. The dozens upon dozens of choices available will likely meet whatever interest or specialty you’d want.
To become certified, you’ll need to be a licensed RN. Depending on the certification you are going for, other prerequisites vary by program and by state. In some instances you’ll need to have an advanced degree or a certain number of practice hours in that specialty. Each certification will cost a fee to take, and some employers will cover this fee, or part of it, if you ask. And because certification is based on the idea that having up-to-date knowledge is crucial to excellence in nursing, you’ll need to renew your certification periodically (and that also varies with the specific certification).
Lots of nurses worry that certification is a long process or that they could suffer professional backlash if they don’t pass the exam. As a nurse, you can choose to seek certification without your employer knowing your plan, so you won’t have to worry about telling your supervisor the results. On the other hand, oftentimes the encouragement you’ll receive from your colleagues can inspire you to continue on this path and get through the hard times. And lastly, when you are taking a certification exam, you’re being tests in areas that are already familiar to you.
As a nurse, certification boosts the knowledge you already have and sharpens your skills so you’ll improve your own nursing practice on a daily basis. In the larger picture, as a professional, you’ll gain specific expertise in your area of practice and thus you’ll be looked to as a leader in that area. As you gain a higher professional standing, more opportunities for additional responsibilities and leadership positions may open up for you as well.
On this year’s Certified Nurses Day, celebrate the efforts of nurses who have become certified and have improved their work and their patient outcomes each day. If you’re thinking of becoming certified but are delaying starting the process, the best time to begin is now.
