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.
Every year critical car transport nurses are honored with a recognition day that highlights the unique challenges and satisfaction of their specialty. Today’s Critical Care Transport Nurses Day, sponsored by the Air & Surface Transport Nurses Association, celebrates nurses in this area of nursing while also spreading awareness of what this job entails.
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!
Nurses provide top quality care in all settings, but critical care transport nurses have a slightly different typical treatment space. They could administer life-saving care in an ambulance moving at top speed or in flight thousands of feet in the air.
Critical care transport nurses provide on-scene nursing care in instances when patients need to be transported from one location to another. It could be an ambulance or a medflight taking patients from one institution to another or from an accident scene to a medical facility.
Transport nurses generally work as part of an emergency response team or as part of a transport team in non-emergency situations. They will provide assessments of a patient’s condition, injuries, vital signs, and will remain with the patient during transport to make sure the patient is kept stabilized.
Transport nurses often work within constantly shifting teams. Being able to adapt to and work within different frameworks will help you focus on your patient while fulfilling your role on the team.
If you are thinking this type of nursing would be a good choice for you, there are a couple of things to keep in mind. You must attain registered nurse credentials, several life support training credentials (adult/pediatric), and then gain at least two years of nursing experience in a critical care environment (like an emergency room). You’ll want experience in a general environment of critical care so you can be exposed to many different situations as that will mirror what you’ll see as a critical care transport nurse.
Because of the nature of working in an environment that is literally moving, you must be able to provide treatment in constantly changing environments. You’ll need to be able to lift and move patients with assistance, and be able to work electronically with team members at a medical care facility.
Transport nurses gain certification through the Board of Certification for Emergency Nursing in joint partnership with ASTNA. After you pass the certification exam, your certification will either be as a certified flight registered nurse (CFRN) if you typically operate in flight or as a certified transport registered nurse (CTRN) if your practice is generally in ground transport. If you practice on the ground and in flight, you can either choose the most pertinent certification or you may earn both certifications.
Critical care transport nursing will call on you to use every nursing skill you have and your situations will all be varied. On February 18, honor the critical care nurses in your organization!
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