Lisa Pruitt Talks About Critical Care Transport Nursing

 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.”