The critical care transport nursing specialty offers variations of work settings so nurses can work in settings including air transport, ground transport, and military transport. Critical care ground transport nurse Casey Green, BSN, RN, CCRN-CMC, CTRN, CFRN, CEN, TCRN, CPEN, CNRN, NRP says the skills and approach to nursing care in this specialty appeals to her.
“I really enjoy the autonomy of nursing care in the emergency department and the intensive care units, and transport nursing is a combination of using both skill sets to assess, monitor, and treat patients safely,” she says.
Because critical care transport nurses work in ambulances, helicopters, or on ships, they are often the nurses who reach remote areas, trauma situations on roadways, and work in areas that are unfamiliar. They could transport one patient to a hospital or be part of team that needs to transport many people out of an area. The challenge appeals to Green. “I like the variety of patients and just how complex their care is,” she says.
As with any nursing situation, things can change quickly and nurses have to be ready. But transport nursing poses additional challenges including vehicles, weather, and terrain. Green says that transport nurses need to be aware of any potential situation. “To prepare myself for this line of work, I took a lot of courses in patient care for all patient populations, especially those who are critically ill,” she says. “Each shift I work I refresh myself on equipment, medication, or a patient population that we may have not transported recently just to keep the information fresh in case we have a request during my shift.”
Nurses who are interested in this specialty should enjoy the physical challenges, fine tune their critical thinking, and have an ability to read and react to a situation immediately. “Two of my biggest takeaways are to develop strong assessment skills because they help guide your intuition if something feels or seems off during transport,” says Green.
As with other nursing career paths, transport nurses don’t operate in a vacuum even though their work is done outside of a typical hospital or health care facility setting. “Teamwork needs to be at the forefront of your mind when you step on a transport vehicle,” Green says. “Often, your team is all you have between hospitals, and all levels of patient care have a say in patient care during transport.”
Critical care transport nursing is an exciting career path, and Green says if a nurse is interested in pursuing it, preparation is key. “Get experience in the ICU and the ED and apply,” she says. “Don’t worry that you may not have what an employer is looking for; get your experience and develop strong critical thinking and assessment skills.”
There are countless reasons why some of us fall into nursing. And when we choose this particular professional journey, all types of motivations keep us in the game.
For many of us, a family member who was a nurse inspired us to continue the tradition. For others, it was witnessing the nursing care of a sick or dying loved one that opened our eyes. For still others, nursing seemed like a flexible, well-paying job that could support a family, especially since nurses will always be needed (until the robots take over).
But we all change, as do our lives, and this begs the question: if the nature of your life and your reasons for being a nurse change over the years, how do you continue to find meaning in what you do?
How it all Began
You became a nurse because your grandmother and mother were both nurses. Your grandmother told fascinating stories about being a nurse during World War II, with air raid sirens, soldiers missing limbs, and lives lost and saved all around her. Your mother also had good stories, though maybe not as romantic as grandma’s.
You could have finished high school and gone to nursing school, launching your career at 22. Or your story might involve, like yours truly, spending your twenties doing all sorts of different jobs and arriving at nursing in your early 30s when you had a family to support and a pre-adolescent son to set a good example for. And there are also those who come into nursing after an entirely different career: FBI agent (a true-to-life story I recently heard firsthand), accountant, office manager, etc.
No matter how you find your way, you have a story that includes the motivations that led you there. Maybe you truly felt a calling, or perhaps you just needed a reliable job. Whatever the vehicle, it delivered you to the door. But what happens when that original vehicle eventually pulls out of the parking lot, and you’re left wondering why you’re still here?
When the Sands Shift
The sands of your life can shift for many reasons: having children, getting married or divorced, finding a new passion, aging, getting bored, or moving to a new state or country.
The sands of your career and the healthcare industry can also change. Here are some observations I’ve heard from nurses I’ve spoken with:
Healthcare is becoming more corporatized, and the healthcare business feels more focused on money than human beings.
The bullying and incivility at work is terrible and demoralizing.
Unsafe staffing consistently puts our licenses at risk.
And the list goes on.
What do you do When things change— inside of you, in the world around you, or likely both? If your motivations for being a nurse feel different than they used to, you’re not alone. And if you’ve lost your motivation and passion entirely, how do you continue?
Acknowledging and Accepting Change
For some nurses, when the world shifts around them, they bury their heads in the sand, perhaps doing okay for a while. Others become bitter, burnt out, and resentful, and may themselves become bullies who make the lives of those around them miserable. Either that, or they fall into depression, anxiety, or addiction.
You may also arrive at a place where your kids have left the house, and you have the freedom to explore. You can study massage therapy, learn astrology, write a book, or become a podcaster. It’s all valid, and the world is essentially your oyster.
But the original question remains: how do you continue to find meaning in your actions?
Much of this comes down to your core values. The Barrett Personal Values Assessment and the Schwartz Portrait Values Questionnaire are both valid tools for identifying your values. You can also work with a mentor, faith leader, therapist or counselor, career coach, or other trusted individual to help you uncover what’s currently most important to you.
Aside from your values, you also need to examine the current state of your life:
What are your needs?
How have the nature of your home life and relationships changed?
Do you have more people dependent on you, or are you more independent than ever?
Has your health changed over the years? Do you have less physical stamina? Have you developed chronic illnesses?
Acknowledging the changes in your life, your family structure and relationships, your body, and the world around you is one of the keys to examining what’s currently making you tick and how to continue.
Based on what’s changed over the years, there may be a way for nursing to continue to be a natural fit, but you may also find that nursing no longer offers the fulfillment it used to. Being honest with yourself is an excellent place to begin since a critical assessment of your life and career must start with clarity.
As you examine your values, the current state of your life, the things that feel important to you, and your needs, things will become more apparent.
If you began your nursing career because of grandma’s inspiring stories but now find that the inspiration is no longer there, it’s not shameful to acknowledge the truth and seek other career options. And if nursing is now simply a job and no longer feels like the calling it once was, you may still be able to continue.
However you move forward, keep in mind that change is the only true constant, and the path that you once traveled may need some readjusting. Be patient, have self-compassion, and forge ahead towards whatever the future may hold.
When Socrates famously said, “To know thyself is the beginning of wisdom,” and that the unexamined life is not worth living, he certainly wasn’t thinking about the 21st-century nursing professional. Still, these Socratic axioms’ universality applies to anyone who breathes air.
Amid our busy and complicated lives, knowing ourselves can seem like the last thing we want to add to our already crowded to-do lists. However, we need to know ourselves and understand what makes us tick to make the best choices to move our lives in the optimal direction.
Your nursing career may currently feel like it’s on the right track, but when life throws curveballs, and we need to pivot or make adjustments, having the most significant possible level of self-understanding is a means to approach those moments with grace and self-assurance.
Take a Deeper Look
There are many paths to deeper self-knowledge. Some will pursue psychotherapy or counseling, some will attend personal growth workshops, and others will read self-help books, learn to meditate, study T’ai Chi, or join a church or spiritual community. Life coaches, career coaches, and other professionals with specific skill sets can also offer unique tools that could move the needle for you. There’s no right or wrong path to self-knowledge, and your chosen combination of preferred strategies will be unique.
When examining your life in the context of your nursing career, it’s not just your job that tells you something about yourself — it goes much deeper than that. In considering the current state of your nursing career, increased self-knowledge could be a central key to understanding what you want out of life, where you’re headed in your professional journey, and what you might need to do to move things toward your next career and life chapter.
What choices did I make to get me to where I am now?
Have I made any mistakes or miscalculations that have thrown me off course?
What, if anything, would I have done differently if I could go back and try again?
Is the work I’m doing now aligned with my values or philosophy?
How do I see myself as a nurse and healthcare professional?
Have I become the nurse I envisioned when I first entered nursing school?
Is there any way I’ve lost my focus or compromised my values?
Am I living the kind of life I can be proud of?
When we ask ourselves probing questions and answer as honestly as possible, we might be surprised at the answers we receive. Some of us can do this on our own, but many of us might need the help of a counselor, mentor, or coach to guide us in our explorations. No matter how we approach it, compassionate self-assessment should be the cornerstone of this type of inquiry to steer us from going down the road of self-recrimination and regret.
Compassionate Self-Assessment
It’s inevitable that when he admonished his fellow citizens to know themselves, Socrates wasn’t telling his followers to blame and criticize themselves in the interest of self-exploration and self-knowledge. That said, we can probably surmise that he was pushing us to be honest, to take a deep, hard look inside, and to honestly examine and admit to our basest motivations and fears, not to mention our loftiest ideals and aspirations.
Self-compassion is an excellent place to begin if you strive for a life of open self-examination and optimal self-knowledge. We all want to live our very best lives, which means making prudent choices, living as closely as possible according to our personal ideals and values, and hoping that our work reflects the core or essence of who we truly are.
When you arrive at a crossroads, when life seems uncertain, and you have no idea where to turn or what to do next, where can you go for self-reflection and inspiration? Whether it’s the Bible, your therapist, or some other avenue to self-knowledge is beside the point — the critical part is that you’re making a concerted effort to know yourself more fully.
Nursing and healthcare aren’t easy, and we can sometimes lose ourselves amidst the stress of work and the pace of our personal lives. If you can somehow slow down, take a deep breath, find a way to look inside, and dig deep for that core of your true self, you may unlock the door to the next iteration of your life and career.
Whether you’re a nurse who’s one hundred percent thrilled with your job or miserable, self-knowledge will come equally in handy. So, nurse, consider Socrates’ axiom and strive to know yourself, and you never know what magic might happen as your self-knowledge, self-compassion, and self-understanding grow.
Military nursing is a career path that offers professional opportunities, a sense of family, and a commitment to meaningful service. Military nurses are especially proud of their profession on Veteran’s Day. Andrea C. Petrovanie-Green, MSN, NC, RN, USN, AMB-BC, CAPT(Ret) and a member of the board of directors of the American Academy of Ambulatory Care Nursing (AAACN) says nursing is a calling. “It is a gift to help in ‘shaping care where life happens,'” she says. “Personally I am committed to paying it forward and mentoring current and future nurses to realize their full potential.”
CAPT Petrovanie-Green was born in Trinidad and Tobago and raised by her maternal grandmother until she was 13. At that age, she and her brother immigrated to the United States to live with her mother, stepfather, and sister. But Petrovanie-Green never forgot the important lessons from her grandmother. “She was wise beyond her years,” she says. “I learned early on the importance of service and reaching back to help those less fortunate.” Her path to a military nursing career began with those embedded principles.
Petrovanie-Green says she seeks out ways to give back and is currently finishing up a medical mission in Guyana to help promote health and wellness in communities that have limited access to healthcare and resources. After that, you can find her training for the St. Jude half marathon in December and raising money to help end childhood cancer. “This is my 15th year participating and thus far I’ve raised almost $5000,” she says.
How did you find your career path to nursing and to the Navy? How did they merge? I was fortunate to attend a high school that offered a practical nursing program, and it was there my nursing career journey began. In addition, I volunteered at a local hospital as a candy striper and as soon as I was able to work, my first job was serving gourmet dinners to new parents at St. Vincent’s Medical Center on Staten Island, New York.
During high school I worked as a Certified Nursing Assistant at a local nursing home and home health aide. Upon graduation I successfully passed the Licensed Practical Nursing exam and was promoted to Charge Nurse. While attending Wagner College, I was selected for a Navy nursing scholarship, and following graduation I was commissioned an Ensign in the United States Navy in 1993. I retired in May 2023 after 30 years of honorable and faithful service to our great nation.
You are a long-time member of AAACN. How does that help you as a nurse? I was encouraged to become a member of AAACN by my mentor Dr. Wanda Richards who is a retired Navy Nurse Corps Captain. At the time, I was working in orthopedic clinic and immediately began preparing for the certification exam. During my first conference, I felt a strong sense of this is exactly where I want to be. The passion, energy, and commitment to ambulatory care nursing was palpable during every session and with each encounter. The focus on health, wellness, and disease management aligned with the military health system.
As a professional nurse, becoming certified demonstrates your commitment to your specialty and more importantly your patient population. AAACN has been an unwavering supporter in helping chart the course for ambulatory care nursing in the military. I am grateful for the many opportunities such as this to serve as a voice for the future of nursing.
What nursing and professional skills are most essential in your role? As an ambulatory care nurse, developing a partnership with patients and their families is most essential for building trust and improving health and well-being. According to a Gallup poll in 2022 nursing was rated the most trusted profession for 21 years in a row! The art of listening and effective communication is critical in further enriching these relationships to achieve desired outcomes. When patients feel valued and heard they are more willing to be a an active participant in their health care and decision making. As a reminder to myself, I often reflect on Dr. Maya Angelou’s quote “People will forget what you said, people will forget what you did, but people will never forget how you made them feel.”
What would you like other nurses to know about a career in military nursing? Military nursing is very unique and offers a plethora of opportunities for advanced training, education, and leadership early in your career. Wearing the cloth of the nation and the opportunity to care for our fellow comrades and their families is a rewarding and life-changing experience. In addition, if traveling and living in different countries appeals to you, then serving in the military may be a good fit. To be fully transparent there are many sacrifices such as being away from family and loved ones as well as physical requirements. Coming from a small family, I especially appreciated the relationships, camaraderie, and lifelong friendships.
Why is it so essential to have a diverse representation of nurses in the military? In caring for Sailors, Soldiers, Marines and their families, it is essential to have a diverse representation of military nurses. In addition, global engagement with deployments and humanitarian missions strategically position military nurses to provide care to diverse cultures and backgrounds. Training on cultural competence focusing on nursing implications is a prerequisite with annual review and update as needed.
What do you find most exciting or most meaningful about your career and what you have accomplished? Most exciting about my career was having the opportunity to serve onboard the hospital ship USNS Comfort when we embarked on our first humanitarian mission to Latin America and the Caribbean. My experience working as a member of the medical operations team was outside my comfort zone, and I was excited for the challenge. I learned valuable skills in communication and coordination and the relationships developed with our host nations was truly humbling. The highlight of our mission was returning to my home country of Trinidad and Tobago serving as an ambassador for the United States. Reflecting back on this experience always brings a sense of grace and gratitude.
Black women are almost twice as likely to experience infertility as their white counterparts, but only 8% of Black women seek fertility treatment, compared to 15% of white women. Statistics like these, compounded by the fact that Black women are three times as likely to die from pregnancy-related causes, highlight inequalities in reproductive healthcare that the medical community must address.
The higher incidence of infertility among Black women is due in part to a higher prevalence of uterine fibroids, ovulatory dysfunction, and tubal disease. Studies show that Black women also have higher rates of pregnancy loss, including miscarriages and stillbirths when compared to white women. This is likely because Black women have higher rates of risk factors that are associated with pregnancy loss, such as obesity, diabetes, and low socioeconomic status.
For Black women, the isolation of infertility is compounded by various factors (for example, cultural stigma, socioeconomic barriers, and racial bias) that prevent them from getting the care they need. Those who do end up seeking care often find themselves feeling deeply uncomfortable in the medical space, which is still predominantly white.
Diversity in Healthcare Providers
People of color need to have access to BIPOC (Black, Indigenous, and People of Color) healthcare providers because it provides a sense of comfort and familiarity. This can encourage patients to access available fertility care and can even improve treatment outcomes. BIPOC healthcare providers possess culturally specific knowledge, skills, and experiences that help with communication and health management processes involving people of color.
Diversity in providers also helps reduce barriers to the patient-physician relationship for racial/ethnic and linguistic minority patients. In many situations, seeing someone who looks like you and understands your cultural background offers reassurance.
Many studies have demonstrated better health outcomes when BIPOC providers see patients of color. A result of this is increased trust and communication developed between the patient and provider. The patient may feel more comfortable sharing sensitive information with someone who has an unspoken understanding of what the patient might be going through. Research has shown that Black women who have a provider with a similar cultural history may feel more comfortable speaking up and advocating for themselves.
Many people of color have a (warranted) sense of mistrust when it comes to our healthcare system due to historical practices based on racist ideals. As healthcare providers, we must remain dedicated to bridging the gap to improve outcomes for patients of color.
What Factors Most Impact Black Patients?
Long-held beliefs, stereotypes, cultural stigma, and other issues continue to uphold these racial disparities around fertility and family-building. Here are some examples of the various factors that contribute to widening the gap in care for Black women:
Structural racism: This heavily contributes to racial disparities in fertility and maternal healthcare in various ways, as structural racism goes beyond the individual. It refers to inherently racist laws, rules, economic practices, and cultural and societal norms that are embedded in the system itself.
Implicit or unconscious bias: This occurs automatically and unintentionally, affecting our judgments, decisions, and behaviors. For example, a white doctor might downplay complaints of pain after surgery from a patient of color due to engrained, inaccurate stereotypes about the strength or pain tolerance of BIPOC people, only to discover the patient is genuinely experiencing discomfort.
Accessibility: Many people of color encounter barriers to accessing the healthcare they need due to a lack of insurance or insurance coverage that excludes fertility treatment. Financial roadblocks and accessibility to quality reproductive care are often limited by location (rural or underserved areas may not have fertility clinics nearby) and employment (not everyone can take time off of work to go in for morning monitoring appointments, which are often required during fertility treatment).
The myth of hyperfertility: The long-held myth that Black women (and men) are “hyper-fertile” causes considerable harm, leading to a resulting cascade of issues.
Religious beliefs: Many people in the Black community are taught to “pray your way” through difficult situations. And while it’s wonderful to have faith, sometimes it’s necessary to seek professional help. Trusting that a higher power will correct infertility leads some people to delay or avoid treatment altogether.
Harmful stereotypes: Black women are thought of as being incredibly strong ― and we are ― but when we are elevated to “Superwoman” status and need to take off our proverbial capes to ask for help, we are often judged harshly or perceived as weak.
Mental health: Shame, guilt, or anxiety about how people in our community may react prevents or delays many women of color from seeking infertility treatment. The stigma of mental illness is also a concern when addressing infertility. Many people coping with infertility experience depression, anxiety, and grief, and cultural norms can discourage people from sharing that they are struggling with their mental health.
Isolation: Many people hesitate to talk about their personal experiences with infertility, which often leaves Black women with the impression that they are alone in their struggles or that infertility is a reflection of their character or a personal failing. That’s why sharing fertility stories is so important, especially in communities of color.
Black Maternal Mortality Rates
Many women of color might lack insurance coverage for maternal health or be afraid to advocate for themselves with their doctor. But the starkest evidence of the healthcare system failing people of color is Black maternal mortality rates in the United States, which are alarmingly high.
Studies have shown that Black women are three times more likely to die from pregnancy-related causes than white women. Worse yet, even though multiple factors contribute to this disparity, most are preventable. These factors include access to quality healthcare, underlying chronic illnesses, and two of the most easily preventable: implicit bias and structural racism. As a healthcare system, we need to focus on listening to the concerns of patients of color without allowing unconscious bias to play a role in our treatment decisions.
Responsibility to Patients
In vitro fertilization (IVF) and other fertility treatment options can be very expensive, which makes it exponentially more challenging for individuals with lower median household incomes to afford this path to parenthood. With lower incomes in comparison to white and Asian couples, Black and Hispanic couples may have a hard time affording fertility care if they have to pay out-of-pocket.
Knocking down the roadblock of affordability often goes beyond the scope of the medical community’s responsibility. However, bridging the gap of distrust with people of color and providing culturally competent care does not. One important step hospitals and health systems can take is to increase the diversity of providers within reproductive health specialties. Collectively, we must work to dismantle structural racism, educate ourselves, and listen to people of color. Only then will we start to make progress toward lessening racial disparities in fertility and maternal healthcare.
