NFNA Membership Privileges by Bill Swanson, R.N. and Marcia Katz, R.N.

On December 8, 1982 at the General Assembly of the membership of the National Flight Nurses Association, the issue of Affiliate members gaining full membership privileges was presented. Jean Mason, past-president of NFNA, welcomed discussion from the floor of the General Assembly on this issue. After discussion the executive Board of NFNA so moved to form an Ad-hoc committee to address this issue. This committee, now formed, is entitled: the Ad-hoc Committee on Affiliate members of the National Flight Nurses Association obtaining full membership privileges.

Since this issue is considered controversial in nature, we must understand that many viewpoints (either agree or disagree) will quickly develop. We are not the first professional nursing organization to address this issue. The Emergency Department Nurses Association also met with this issue in the recent past. This paper is written with the intention of what will be beneficial to the professional Flight Nurse as well as the future of the National Flight Nurses Association. It is with that intent that the National Flight Nurses Association presents this position paper.

Bill Swanson, RN Marcia Katz, RN Co-chairpersons

Statement of By-Law

From the by-laws of the National Flight Nurses Association, Article II,

Only Active Members shall have the right to vote on matters requiring act ion by the members.

Section 7 entitled Right to Vote and Receive Publication specifically states: Only Active Members shall have the right to vote on matters requiring action by the Members. Inactive and Affiliate Members, however, shall be entitled to receive all association publications to the same extent as Active Members.

Article II, Section 6 of the by-laws entitled Qualifications for Membership and Classes, is specific in defining an

Active Member, an Inactive Member and an Affiliated Member. An Active Member is specifically defined as any registered nurse

An Affiliated Member is speci f ica l ly def ined as any personnel other than registered n u r s e s . . .

actively participating on a part-time or full-time basis in an emergency medical care flight service. An Inactive Member is specifically defined as either a past member or registered nurse on leave of absence from flight nursing for more than six months. An Affiliated Member is specifically defined as any personnel other than registered nurses who actively participate on a part-time or full-time basis in an emergency medical care flight service such as Paramedics, LPN/LVN's, EMT's, and Respiratory Therapists. Thus, an Active Member is considered to be exclusively a registered nurse while Affiliated Members are considered to be those para-professional personnel that do not possess a license that is registered within the United States and its territories to practice professional nursing.

The Flight Nurse as a Specialized Health Care Professional

Professional nurses are considered to be the main providers of direct patient care. As the main source of delivering this care, nurses have played an important role as pre-hospital care providers as well as in-hospital and post-hospital phases of care.

Before the advent of flight nursing, many professional nurses were involved in working in the pre-hospital phase of care and even teaching para~professional personnel such as EMT's and Paramedics in this phase. In this phase, professional nurses recognized that they were

responsible for the assessment and appropriate intervention for those clients that required pre-hospital care. This type of care was given by those nurses who recognized the need for a special body of knowledge and skills. So from this basis, the flight nurse evolved with the introduction of helicopters and fixed-wing aircraft for delivering pre-hospital care to clients.

The first civilian flight program began in 1972 at St. Anthony's Hospital in Denver, Colorado. The flight crew consisted of registered professional nurses that were trained in special advanced life support skills for the delivery of infield pre-hospital care. Since that time, flight programs have been established across the United States. These programs consist mainly of registered professional nurses as the provider of pre-hospital care to the community.

The Need for Establishing a Flight Nurse Organization

In December of 1980, Life Flight of Hermann Hospital, Houston, Texas sponsored a two day gathering for all flight programs that expressed interest in forming an organization. This organization would serve as a resource of information for those hospitals with hospital-based air

Profess ional nurses are cons idered to be the main providers of direct pat ient c a r e .

medical services. At this gathering, professional flight nurses from across the country also expressed their personal interest in forming a professional flight nurse organization.

In December of 1981, at UCSD Medical Center in San Diego, this preconceived idea of an organization became reality and was called the National Flight Nurses Association.

The National Flight Nurses

HOSPITAL AVIATION, NOVEMBER 1983 5

Association has a membership of over 300. Ninety-four percent of its members are professional flight nurses that are licensed to practice registered professional nursing.

In the philosophy of NFNA, it is stated that "'Flight nursing offers a uniquely expanded role for the professional n u r s e . . , to seek out and develop close working relationships with all available supportive services, in order to insure that maximum support is given to the patient on all levels." this philosophy reflects what the organization focuses on-- to promote the delivery of quality health care by air ambulance services.

EMT's-Paramedics in Pre-hospital Care

During the 1970's, emergency health care became greatly improved with the introduction and development of emergency pre-hospital care. the Emergency Medical Services (EMS), as the pre-hospital care was termed, evolved into a very sophisticated emergency medical care to the general population. This emergency care was delivered primarily by para-professional personnel entitled

. . . nursing has always had a considerable input to the education and technical training of the EMT/Paramedic.

Emergency Medical Technicians (EMT's) and Paramedics.

The level of educational training for technical skills and didactical studies varied widely. Each state across the nation regulated and continues to regulate the licensing and educational requirements of these para-professional personnel.

Since the nursing profession has always dedicated itself to the assurance of quality patient care, nursing has always had a considerable input to the education and technical training of the EMT/Paramedic. Flight Nurses and Emergency Department Nurses have shown a specific interest in maintaining quality patient care in the pre-hospital phase of care.

In this section, it must be

6 HOSPITAL AVIATION, NOVEMBER 1983

recognized that great differences exist between the professional nurse and the EMTJParamedic. (The registered professional nurse on one hand is trained in a holistic approach that sets the patient in the primary, secondary, and tertiary setting. The EMTJParamedic on the other hand, is trained only in the acute environment of patient care and care of that patient is terminated after the patient has reached the emergency room or destination of continuing care.)

It must also be noted in this section that the care given by Flight Nurses and EMT's/Paramedics is often overlapping of each other. The Flight Nurse holds the ability to implement the nursing process which was obtained from a vast clinical and educational background. It must be recognized here that much more than good technical abilities are required to implement this process. The Flight Nurse possesses this knowledge in order to attend to the complete needs of the patient. The Flight Nurse also possesses the ability to implement the care to attend to these needs. The possession of good technical skills is not to be downgraded in any respect, but the delivery of the nursing process for total patient needs makes the Flight Nurse and all other professional nurses unparalleled in the field of health care whether this care be acute or non-acute.

Application to the Active Voting Member

As previously stated, it is a well-known fact that education and skills of Flight Nurses and education and skills of EMT's/Paramedics overlap. It is also clear that their knowledge and skills are uniquely different. It is partially on this basis that the National Flight Nurses Association recognizes the need to divide and define the type of memberships offered to those involved with the air transport of the critically ill and injured. On another basis, it should be noted that the National Flight Nurses Association came into existence for the purpose of informing, supporting, guiding and formally educating the professional Flight Nurse. It must be understood at this point that the professionial Flight Nurse is one who currently holds a license to

practice registered professional nursing. This is specifically stated in the by-laws.

It is then that the position of the National Flight Nurses Association not to institute a change in the official by-laws pertaining to membership and voting qualification. The National Flight Nurses Association wishes to continue a close working relationship with those affiliated members that also serve to assist in

The Association wishes for all affi l iated members to continue to seek out Active Members for assistance and guidance.

providing air transport to the critically ill and injured. The Association wishes for all affiliated members to continue to seek out Active Members for assistance and guidance.

Conclusion

Only through cooperation of all people involved with the air transport emergency care can the patient recieve the full benefits of such a unique service. As stated before, there are many opportunities that arise in patient care where skill and knowledge cross professional and para-professional territories. An example of this territorial overlap is the knowledge and skill possessed by both physician and professional nurse. It should also be noted in this example that nurses have never entered the ranks of professional physician organizations, even as an affiliated member.

With these thoughts in mind, we, as professional flight nurses, must not lose sight of our identity. We must take a stand for the field of registered professional nursing. We must continue to be excellent role models for those who serve along with us in delivering care in the evergrowing field of emergency air care. •

Bill Swanson is a flight nurse with Hermann Hospital Life Flight, Houston, Texas. He is on the Board of Directors of NFNA. Marcia Katz has been a flight nurse with St. Joseph Hospital Life Flight, Omaha, Nebraska, since its beginning in 1979, and is co-founder and President of NFNA.