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.
“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.
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.
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.
See Our Champions of Nursing Diversity
Sign up now to get your free digital subscription to Minority Nurse