Taking nursing to new heights
For students in the advanced practice flight nursing program, the sky’s the limit.
When Tanner Purnhagen (CWR ’15, NUR ’25) was in high school, he joined the local volunteer fire department as a way to give back to the community. During his time there, he responded to several high-acuity calls so urgent that they required a helicopter to take patients to the hospital. Inspired by the flight crews’ critical care expertise, he decided to investigate transport nursing—and found his way to Frances Payne Bolton School of Nursing and, eventually, its flight nursing program.
Founded in 2002, the school’s advanced practice flight nursing program was the nation’s first. The certificate program, part of the School of Nursing’s Master of Science in Nursing, is designed to prepare students to work in critical care transport, a unique and high-stakes healthcare field that requires additional skills. Critical care transporters deal with patients who are often at their most vulnerable, far from a hospital and its controlled environment. Clinicians must deliver care with limited resources in unpredictable environmental conditions in mobile environments such as helicopters, ambulances or fixed-wing aircraft.
After completing his undergraduate degree in nursing at Case Western Reserve, Purnhagen spent several years working in trauma ICUs and trauma resuscitation before beginning a transport career in Virginia. There, he discovered a passion for complex medical ventilation and acute respiratory distress syndrome (ARDS) during the COVID pandemic. He eventually moved back to Cleveland to work at Cleveland Metro Life Flight and returned to CWRU for graduate school—and the flight nursing program. Here, in the Dorothy Ebersbach Academic Center for Flight Nursing, Purnhagen was able to build upon his existing knowledge and experience.
“Learning from faculty who were active in the field and practicing as flight nurse practitioners was essential,” Purnhagen said. “As someone with transport experience, I was able to focus my time on learning more about the advanced practice role. Having the facilities to practice advanced procedures like central line insertion and advanced airway management within a helicopter or ambulance is something found nowhere else.”
Learning on the move
Each year, the program admits a cohort of graduate nursing students pursuing advanced practice roles. While the students admitted to the program have nursing experience, many do not have Purnhagen’s prior transport experience—and working in motion comes with very different challenges. To acclimate students to a moving environment, the School of Nursing acquired the nation’s first critical-care transport helicopter simulator. Known as the Callahan Family Critical Care Transport simulator, Hartzell Propeller Inc. supported its installation at CWRU.
The Sikorsky S76 helicopter simulator wasn’t always just for simulation. Before its fuselage became a valuable teaching tool, the helicopter was part of the Metro Life Flight fleet. The aircraft was sold to another company before returning to Cleveland to be repurposed for the flight program. The interior is also from one of Metro’s helicopters, with the embroidery in the seats redone for Case Western Reserve.
In addition to being built into a real helicopter, the simulator mimics the sound, vibration and movements of a moving aircraft. Students practice caring for patients in immersive scenario training that can even imitate the effects of changing weather and altitude, replicating airborne conditions that a lab setting can’t provide. The opportunity to train on the simulator is a huge advantage for students—and a unique one.
“This immersive scenario training is something that few, if any, nursing programs worldwide offer,” said Jennifer Adamski, DNP, assistant dean of professional programs and director of the acute care flight education program. “Only one other dedicated flight nursing simulator was noted internationally (in Germany) underscoring how rare this resource is.”
For alumna Amanda Rowe, DNP (NUR ’16, ’24), the simulator was one of the most valuable—and exciting—aspects of the program. Rowe was first introduced to transport medicine at a young age when her father, a paramedic/firefighter, worked in the emergency department at one of the Metro Life Flight bases on his days off. Rowe was inspired by the flight crews’ work in the community and became fascinated with transport nursing. After she entered the graduate nursing program at Case Western Reserve, the arrival of the simulator gave her the opportunity to try flight nursing firsthand.
“The most memorable part of my time at CWRU was the arrival of the nation’s first high-fidelity helicopter simulator and our class being the first class to use it,” she said. “It really took education and simulation to a whole new level.”
Tools for success
To succeed in this simulated learning environment, students must develop more than just clinical skills. In the program, they also learn situational awareness, crisis resource management, advanced clinical judgment and the tools needed to think, adapt and act quickly in unpredictable situations.
“The program taught me about the aspects of critical care transport such as logistics, resources and patient care in the unstructured prehospital setting,” Rowe said. “It also taught me the importance of past experience working in the critical care setting as both a nurse and acute care nurse practitioner before entering the prehospital setting of critical care transport. There is much to be learned in the inpatient setting, from patient care to working with interprofessional teams.”
The value of interprofessional collaboration is also emphasized in the program, which works with clinical partners, simulation teams and transport professionals such as air medical services and ambulance providers, to allow students to apply their learning in real settings.
“Collaboration is a cornerstone of our program,” Adamski said. “Critical care transport represents one of the most complex and high-risk environments in healthcare. Formal education in this specialty is essential.”
This collaboration extends beyond the School of Nursing community with the program’s Flight Camp (held this year June 23–26), which is open to both students and community partners. Flight Camp brings together aspiring flight nurses and experienced critical care transport professionals for four days of immersive hands-on training. The camp covers topics such as advanced ventilator management, ultrasound practice, cardiac device proficiency and certification review sessions, and is yet another expression of the program’s dedication to helping students expand their knowledge beyond the classroom.
For Purnhagen, the camp was also a chance to network with other professionals and flight nurse practitioners. Since the field is so small, these opportunities to connect were invaluable both for his education, but also for when it came time to job hunt.
“During my time in the program, we were able to run the summer flight camp that has been a staple of the program,” he said. “Transport clinicians from across the country were brought together for a week of excellent talks, valuable hands-on skills and great networking. I had a great time spending time with people who were passionate about the field of transport.”
Moving forward
Looking toward the future, the program’s goal is to remain at the forefront of transport nursing education to train the next generation of clinical leaders. Plans include expanding the program eligibility to BSN-trained critical care and acute care advanced practice nurses, as well as growing the simulation offerings and interprofessional training experiences.
“This program reflects the Frances Payne Bolton School of Nursing’s long-standing commitment to innovation, excellence and advancing the nursing profession in areas where it matters most,” Adamski said. “Growing opportunities for continuing education, international exchange and partnerships with industry leaders could further solidify the program’s status as a global leader in transport nursing education.”
And the program has already made a stamp on the field. Graduates from the program have gone on to serve in critical care transport, air medical programs, and leadership, education and policy roles across the country.
“What makes me most proud is the impact our graduates have on patient care and the profession,” Adamski said. “Critical care transport is not just a job—it is a calling that demands clinical excellence, resilience and teamwork. Our alumni are not only excellent clinicians; they are leaders, educators, innovators and advocates who elevate standards of care in transport medicine.”
For alumni Purnhagen and Rowe, the skills they learned in the program helped them further their careers after graduation. Rowe is now an acute care nurse practitioner at Cleveland Metro Life Flight. Purnhagen works as a flight nurse practitioner with Cleveland Clinic’s Critical Care Transport Team, in addition to being a critical care nurse practitioner with University Hospitals.
“Because of the excellent faculty, amazing simulation center and networking opportunities offered, I felt prepared to continue my career in transport but as a flight nurse practitioner,” Purnhagen said. “I would not be doing either of those jobs if it were not for the training, education and connections I made during my time at APP.”
