The Evolution of Clinically Competent and "Always the First" Nurses in Aeromedical Evacuation

The Air Force continually prides itself on providing excellent patient care while excelling at performance standards. As fiscal constancy waivers and younger, less experienced nurses join aeromedical evacuation (AE), maintaining clinical readiness and meeting standards becomes increasingly challenging. The 43rd AES aeromedical evacuation squadron (AES) was faced with not only the need to tighten their belts but to advance their current clinical training platform into the future. Not only the for future of AE but for each nurse’s next assignment after AE. Although AE is defined as an inpatient assignment, care is provided outside of the medical treatment facility (MTF) and the vast majority of patients are outpatient. Flight nurses train in ground and flight training events as they prepare to deploy across the globe to transport wounded warriors and service beneficiaries. However, without working in an MTF and with more junior nurses, some with only clinic experience, we had to look elsewhere to keep clinical skills sharp and relevant. Since clinical currency is the foundation for medical readiness skills, regardless of the nurse’s specialty area, we realized that we had to increase training on all operational and foundational skills that are common to every nurse in the air force, not just flight nurses. We also wanted to challenge them to move beyond “competence” to attaining “excellence” with each skill set.
We utilized the domains of change that included “leadership engagement,” a “culture of safety,” and “continuous process improvement.” We looked toward optimizing our internal capabilities, centralized funding and capitalizing on available training platforms to enable us to ensure nurses remain clinically and readiness current. We started with the creation of our clinical sustainment center (CSC) that housed medium- to high-fidelity human patient simulators in an aircraft mockup environment. This allowed us to attain elite readiness with a “train like they fight” approach, rendering simple to complex patient care while using medical and operational equipment. Knowing this was not enough to prepare us for the next conflict, mission, or assignment, other methods were sought out to keep skill sets razor sharp. This included aligning our training outcomes with Womack Army Medical Center (WAMC) and sustained medical and readiness training (SMART) at several MTFs across the country. Nurses work shifts and provide care in high-acuity units. Nursing certifications were also stressed and ranged from ambulatory care to advanced practice registered nurse. We also boosted our in-house training, providing monthly instruction in critical skill sets required for their air force specialty. Trusted care was also implemented to ensure that efficient and effective nurses had the ability to improve quality and influence outcomes. We then developed tools that captured competency, performance, patient encounters, flight hours, standards, and medical readiness data skill sets and are used across AE and the air force medical service. Utilizing available resources to sustain currency, maximizing the skills and intellect of nurses, and encouraging them to reach beyond competence will enable and better prepare them for their transition from the aircraft to the next leg of their nursing journey.