As the generation that created the specialty of critical care transport ages and is ready to start the next chapter of their lives, hundreds upon thousands of individual years of established knowledge and expertise go with them. The underlying challenge that remains is how to replace this with quality individuals that are becoming more difficult to find. While a virtual think tank is difficult to tap into, individual programs have become creative in their succession planning endeavors.

One idea has been to create an extensive training program or “internship.” While a typical on boarding (i.e., orientation) program can last anywhere from four to six months, the internship provides the experienced critical care or emergency nurse the opportunity to train with the program while under its employment. While this program is typically aimed at the nurse lacking one or more key areas of qualification, his or her yearlong training process ensures a solid base of experience consistent with the critical care transport team’s mission profile.

An advantage to the novice transport nurse is employment with the program during a key piece of their training process with opportunities to move towards the goal of Critical Care Transport Specialist (ACCT Standards, 2016). An advantage to the transport program is the ability to closely scrutinize the individual training for a year or more in order to ensure all requisite objectives are met during the on boarding process. Clinical experience that the trainee may be lacking can be provided during this period along with deliberate knowledge and skill acquisition in the transport environment. Because this program is very individualized, admittedly one challenge is providing standardization to the process that normally accompanies a traditional orientation.

Unforeseen Challenges

While one solution to one transport program’s on boarding dilemma, this program may not globally fit everyone’s needs. Considerations to human resources (HR) policies, specific union regulations and program qualifications should be analyzed. If necessary, these departments should be consulted early in order to identify parameters around hiring and employment beyond the training period.

Additionally, it is important to remember that with the less experienced clinician may come the challenges surrounding professional maturity. Mannahan (1989) correlates this abstract concept with the developmental stages that we have learned in our human growth and development education with infancy beginning during initial education (i.e., nursing school) and extending across the lifespan, ending with retirement. This clearly relates to our internship program with the fact that we could very well be starting our novice flight nurses during their adolescent period of development instead of adulthood. With this comes challenges that preceptors may or may not be equipped to deal with. While not insurmountable, these can be frustrating for existing staff nonetheless and need to be considered and a subsequent plan developed into the preceptor training milieu.


The program and the process is not what I would consider the ultimate answer to our challenges with finding qualified staff to take our program to the next level. We have learned a great deal and this program itself is very fluid. Because of the great expense involved in training a new flight nurse in this manner, the hospital and nursing administration has painted a continuous target on the “back” of the program. In the 18 months that we have been involved with this program, we have had one intern graduate and enter the transport program as a competent provider. Currently, we currently have two interns in the program. Our miscalculations, along with our current program participants have by far been our best teachers. Because of this, we consider the program to be a success and foresee it to be a future model for succession planning and on boarding.


Association of Critical Care Transport (ACCT). (2016). Critical Care Transport Standards (v1.0). ACCT; Platte City, MO.

Mannahan, C. A. (1989). Professional Maturity: The stages of developing self-esteem. AORN journal, 49(2), 593-596.

Paul Mazurek, RN, BSN, M.Ed., CCRN, CFRN, CHSE, NRP, I/C, is the Educational Nurse Coordinator (ENC) for the University of Michigan Survival Flight. 

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