Critical care transport nurses are part of the healthcare team that helps move critically ill patients quickly and safely while also providing high-quality emergency patient care. And they do this in a moving vehicle–which could be by flight (helicopter) or ground (ambulance).
Like all nurses, critical care transport nurses have to be prepared for any change, but because they are providing care in a moving vehicle they have to add an entire other layer of unpredictability to their daily work. Any nurse knows that things can happen that quickly change the way you are providing care–from the patient’s condition to the facility you are working in. For critical care nurses, they also must consider additional variables such as weather, traffic, and the uncertain situation they may be taking a patient from such as a car crash, a trauma site, or a remote wilderness. In some instances, critical care transport nurses are bringing patients to a different facility for life-saving treatment.
Although some may see those wildcards as a negative, nurses who are attracted to critical care transport nursing see it as a positive. They are able to use all their nursing skills as well as additional critical thinking, task management, and rapid assessment of the big picture in situations that other nursing roles wouldn’t provide.
Critical care transport nurses are also on the move in their role. Given the fluctuations in the terrain, situation, and care needed, nurses may be required to climb or run and will need to have the ability to lift and carry patients in varied situations. They will need to maintain a focus on the patient as they move the person from whatever situation they could be in, to the transport vehicle, and then provide a comprehensive hand-off to the care providers at the final facility. The pace is intense and fast.
If you’re interested in this career choice, you’ll gain expertise in patient needs across the age spectrum, including the equipment used for different ages and conditions. For some nurses, a pediatric critical care transport role provides a role within a specific patient population they want to work with. As you gain experience, you’ll adapt to your working environment and will be able to provide care through changing conditions and while relying on your team members.
Every year, February 18 is designated as Critical Care Transport Nurses Day to bring attention to this nursing specialty. Minority Nurse asked Lisa Pruitt, RN, BSN, C-NPT, and a board member of the Air & Surface Transport Nurses Association about her career in this field, what makes her devoted to her work, and how nurses interested in this field can get started on this career path.
Please tell me how you found this nursing specialty and why it appealed to you.
I started my nursing career in the Pediatric Intensive Care Unit (PICU). I knew from the time I was a small child I wanted to be a pediatric nurse. I felt right at home in the setting of critical care. I loved the challenge, the critical thinking, and attention to detail involved. But, most of all the reward of helping these children and their families during quite possibly during the worst times in their lives, is an honor. Some of the nurses I admired most and learned from and aspired to be like, were critical care transport nurses. I was drawn to critical care transport because I wanted to be a part of a team that could give these patients the chance to receive the necessary care they needed. A critical care transport for many of these patients can mean the difference between life and death and to be able to offer that service to a child/family in need is inspiring.
What kind of nursing training did you complete for your current role?
I worked several years in pediatric critical care (PICU) before applying/accepting my first critical care transport position. My training prior to my current role included years of critical care experience in a high acuity PICU and an extensive orientation to pediatric and neonatal transport. This training included several advanced certification classes, simulation, didactic, OR, and other department rotations led by physicians as well as operational, safety, and survival training in each of the three modes of transport (fixed wing, rotor wing, and ambulance).
What makes this nursing path different from other nursing specialties?
The scope of practice and skill set for a critical care transport nurse is much more expansive than other nursing specialties. Being proficient with advanced procedures (endotracheal intubation, central line placement, needle chest decompression), critical thinking and decision making in an autonomous setting is what sets the transport nurse apart from other nursing specialties. We don’t necessarily have a diagnosis when we arrive to transport a patient, and we must rely on our previous experiences and knowledge. We are the eyes and ears for the provider (physician). Ensuring our attention to detail is spot on and anticipating and executing a plan of care is quite different than relying on and carrying out a plan of care already developed (as it is in an inpatient setting).
How do critical care transport nurses adapt to working in such varied environments?
Being adaptable is how I always say critical care nurses “earn their money!” There are no two transport situations ever the same, and often the transport environment can lead to a lot of unplanned situations (unfamiliar diagnosis or illness, unexpected weather, equipment malfunctions, mechanical issues). Contrary to working in a hospital, the transport environment offers less resources—people, hands, equipment, diagnostics, redundancy, etc. Transport nurses are the “MacGyvers” of nursing. You might have a child’s life in your hands, and you and your partner (usually a Paramedic/RT/RN) have to utilize your critical thinking, decision making, and limited resources to adapt to any situation and literally function as a mobile ICU. Often, what we are told en route to a patient is entirely different when we walk through the door and meet our patient, so we have to avoid tunnel vision, change our mind set, and adapt to the new situation we are presented with. This becomes easier as we gain more experiences in our career.
Transport nursing is not black and white; it’s all very gray, and you quickly learn if this career is suited for you!
How has COVID-19 impacted your work?
How hasn’t it?! It seems everything has changed—process, procedures, and (what used to be) routines. The stress and burden of COVID-19 has affected everyone at some level both personally and professionally. That in itself has weighed heavily on many of us. In an already stressful environment, COVID-19 has added another layer of complexity to the mix. With, we are reusing what used to be one-time-use masks. We are making the difficult decisions about whether or not we should or can bring the parent with us. [We ask] where do these patients go? Do we have the right supplies (and what are those?) to protect us, the health care providers, from COVID-19. And what about our own family members who are battling COIVD-19 and/or lost their battle to COVID-19, but we still put ourselves on the front line? How are we caring for ourselves?
Transport nurses are a certain type of person. They tend to carry a lot of weight on their shoulders. So when does that weight cause us to fall? Not for a long time, but when it does, it can be devastating. We are really good at taking care of everyone else, but not ourselves. I have seen the weight/burden/stress of COVID-19 firsthand unfortunately be the cause of that fall. With all this change, I do believe whole heartedly, we will come out of this closer to our partners/colleagues, and be stronger and more resilient. I believe some the processes that have been instituted since COVID-19 will actually continue in our practice, and that’s not necessarily a bad thing! Our infection control practices are on point! And that will continue to benefit all patients and ourselves as health care providers. A lot of good has and will continue to emerge.
What kind of patient interaction tips could you share, especially given the added layer of moving patients from one area to the next?
Communication is key! Making sure our patients and families always know what is going on and what our plan is can offer a patient and/or family the reassurance they need to move forward on possibly the worst day of their life. I also believe strongly (as long as safety is never compromised) that bringing a parent or loved one along on the transport is so important. We can’t ever make promises that an outcome will be what they always want, but I ALWAYS make one promise to every single patient I transport: I will always do my best and I will promise to take care of their baby/child the exact same way I would take care of my own.
If nurses are considering moving into a critical care transport nursing path, what would you like them to know?
Transport nursing is the BEST! When you get jet fuel in your blood, it never goes away! If transport nursing is something one is interested in exploring, then do a ride along. Most transport teams offer a comprehensive ride-along program to potential transport nurses. See firsthand if you could see yourself doing it. It is not a career for everyone, but if it is, then go for it! Establish a strong foundation of critical care nursing experience in an ED or ICU. Take every opportunity to advance your education and skill set. Join professional organizations like ASTNA and network with transport professionals, read transport scholarly articles like those published in the Air Medical Journal, and ask questions. Words of wisdom from my six-year-old daughter London, “Picture it. Do it. Never Give Up.”
Critical care transport nurses work to keep patients stable and healthy while they are being moved, and every February 18, their work is honored. The day recognizes how critical their work is to the healthcare organization.
Critical care transport nurses work in diverse and constantly changing conditions. They might be Med-Flighting a critically injured patient from a car accident or they may be moving an ill elderly patient from a nursing home to a medical facility. Those two fairly typical scenarios show just how prepared critical care transport nurses must be for whatever situation a day at work brings.
Founded nearly 40 years ago, the Air & Surface Transport Nurses Association (ASTNA) is the professional organization for nurses in the field and sponsors this recognition day. According to the ASTNA, this career path is one that relies on skills build from a solid foundation of education and practice around nursing and trauma care.
The ASTNA offers the following education and experience requirement guidelines to become a critical care transport nurse:
Registered nurse standing in the state you’ll practice in
Two to three years of critical care/emergency experience or applicable acute care nursing environment
BCLS – Basic Cardiac Life Support
ACLS – Advanced Cardiac Life Support Certificate
PALS – Pediatric Advanced Life Support Certificate
NRP – Neonatal Resuscitation Program
A nationally recognized trauma program such as TPATC (Transport Nurse Advanced Trauma Course (TPATC), BTLS (Basic Trauma Life Support), PHTLS (Pre-hospital Trauma Life Support), TNCC (Trauma Nurse Core Curriculum)
Some states may require nurses to have EMT-B or EMT-P (Paramedic) certification.
These requirements show the broad knowledge critical care transport nurses must have as they can be called on to use each skill at any given moment. They could be treating patients who range in age from newborn to centenarians. Their trauma skills need to be current and precise, and they also have to develop the ability to provide critical care in a moving vehicle or in flight. That means critical care transport nurses need to be able to react with exceptional speed and in with a calm and controlled manner.
If you’re a student nurse thinking of this role, know you’ll need to have an agility to simultaneously assess
the situation (a neighborhood with a mom who is in labor to a dangerous industrial accident site)
the patient (taking into account the location could be a home, highway, medical facility, office building, forest, or even a battlefield for military nurses)
the conditions (normal, blizzard, hurricane, flooding)
the transport vehicle (ambulance, helicopter, medical transport plane)
The work is exciting and satisfying for nurses who are willing and able to work in many layers of changing conditions. Critical care transport nurses often bring a sense of calm and relief to a patient who understands someone is now there to help them, provide care, and bring them to safety.
Critical care transport nurses deserve the recognition they get today – thank a critical care transport nurse in your life!
Sponsored by the Air & Surface Transport Nurses Association (ASTNA), Critical Care Transport Nurses Day showcases the distinct field of transport nurses. While any nurse is always in motion, critical care transport nurses are actually doing their job while the patient is being transported.
Giving accurate, empathetic, and multilayered care while potentially in a moving vehicle like an ambulance or in flight on an airplane or helicopter offers an entirely new set of standards. Critical care transport nurses work in environments that are rarely the same and are constantly changing. Supplies might be different or arranged in a different order. Teams are likely varied and have to adapt to each other and to the motion of the transport they are in.
Some care is given in dire conditions. Transporting a seriously ill patient to receive initial care after an accident, bodily injury, or a health event like a heart attack or stroke is filled with pressure. Critical care transport nurses can work in the military moving gravely injured soldiers. They might be called to help deliver a baby who couldn’t wait for the arrival at a birth facility or hospital.
Still other critical care transport nurses attend to patients when they are stable, but being moved between facilities for additional testing or to receive therapies.
Critical care transport nurses are there to make sure every second of available time is used to help the patient. In the time it takes to move a patient from one area to a hospital or facility, life-or-death changes occur.
No matter the environment, critical care transport nurses have to work well on a team and be confident and experienced enough to make accurate split-second decisions about providing the best care. That means they need to assess physical and vital signs, equipment readings, and listen to the team all at the same time.
As a critical care transport nurse, critical thinking skills are essential. You’ll work in high-pressure emergency situations more than you will work with stable patients. Having emergency care experience before deciding on this career path is essential. Once you have decided and have earned any required hours, becoming certified will help you remain current with the latest protocol and evidence-based practices. In general, nurses in this field will become either a certified transport registered nurse or a certified flight registered nurse.
This career is exciting and requires a broad skill set and someone who works well under this type of pressure. If this sounds like a good career match for you, jobs in this area are growing.
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