Care on the Move


I started my nursing career in a small community NICU and moved from there to a traveler, to a Level IV NICU, to constantly challenge myself to grow. When looking for a home NICU, I wanted somewhere with advancement opportunities and I found that in the DC area. In this NICU, I quickly became a charge nurse and then started my training as a transport nurse. I  fell in love with being a transport nurse. In our NICU, transport consists of a fellow, a nurse, and an RT if the infant requires respiratory support. This 2-3-person team goes by ground or helicopter to outside hospitals to pick up infants requiring a higher level of care. This sounds easy right? In reality, you walk into a unit with less equipment, less staff, and less knowledge to get a very sick infant with only the help of one to two other people. When on transport, we try to help each other as much as possible and get the infant stable enough to transport back to our NICU. We call a NICU attending back at our hospital, but we are the only eyes, ears, and hands for the infant until we return. Our providers and the outside hospital providers trust us to have the skills and knowledge to provide all life-saving interventions alone. I have gotten into some precarious situations as a transport nurse, but have also challenged myself to be a better nurse, a better communicator, and a better team player. 

To become a transport nurse at my hospital, you must have three years of nursing experience, be a charge nurse, have NRP and S.T.A.B.L.E. certification, attend a minimum of ten deliveries, take a class on extremely low birth weight infants, and have a wide variety of clinical experiences. It is also preferred that the nurse has their NICU certification. It is then required that you apply to the coordinator. We require at least two ride-a-longs, where the applicant nurse goes with an experienced transport nurse for orientation and completes a transport nurse orientation checklist. All transport nurses attend a yearly transport safety class, a MIEMMS course, and simulations quarterly. We are also expected to attend transport meetings for our nursing team and the interdisciplinary team. We have a yearly minimum number of transport requirements, which, if not reached, require additional simulation drills to ensure competency while on transport. Being a transport nurse is such a responsibility and privilege, so  we all want to be competent and able to rise to the challenge.

When we get a transport call, I have to quickly work to make sure I have all the necessary supplies and that all the equipment is functioning. You never really know what you are walking into; the baby could be much worse than anticipated, so you must be prepared for everything. The transporter and equipment bag are a little like a NICU on wheels. We get picked up by the ambulance right in the ambulance bay and go directly to the outside hospital or to the helipad. We assist with loading the transporter (which weighs anywhere from 289 lbs. to 512 lbs.). If we go by ground it usually takes us an hour to an hour and a half to get to the outside hospital. We go to the NICU, get the report, and assume care. We do everything required and load the baby in the transporter. Often, this means loading an infant about the size of your hand onto a bed with all the equipment while you secure everything. We make sure that the parents can see the infant before we leave. If going by air, it is usually a 20-minute flight. There are benefits to both ground and air. Flight transports are faster, so an unstable infant arrives at the hospital in a much timelier fashion. The turbulence of the flight is better than a bumpy ambulance ride. However, in the air you have extremely limited access to the infant because of the isolette, it is noisier, and nearly impossible to communicate with the pilot or the attending at the hospital. Personally, sitting sideways in the ambulance while charting and caring for the baby is nauseating, but even the vomiting is worth it to get an infant back safely. Flight transports have the added joy of an aerial view of DC, especially on day flights during cherry blossom season. I have had so many experiences as a transport nurse: taking a flight only to land and code running back into the ER (this meant coding an infant the size of my hand on an adult bed with only adult nurses to help), pulling over on the side of the road to intubate, equipment malfunctions that required ingenuity to make it back, broken ambulances that forced the team to sprint to the helipad along the main road while pushing the isolette and all the equipment so that we could get to a very critical baby, coding at an outside hospital, baptizing infants that were extremely sick, calming parents, being gone for several hours, and staying late to complete a transport after already working 12 hours. Every transport is different and no matter how much the team prepares, a successful transport means using clinical skill, critical thinking, and incredible teamwork.  I love the idea that I can make an impact on the infant’s life by being a transport nurse that not only provides excellent care but also works as part of a team to provide relief to parents after a scary start to their child’s life.

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