Beginning March 30, 2026, the Board of Certification for Emergency Nursing (BCEN) is officially splitting the previously combined examination content outline for transport nursing into two separate outlines—one for the CTRN and one for the CFRN.
This update clarifies the expectations, competencies, and clinical focus of each role. Since air and ground transport nursing require different operational knowledge and patient management skills, separating the outlines ensures each exam accurately reflects its practice environment.
The CTRN and CFRN credentials have always been offered as distinct certifications, but now, the new exam-specific outlines mark a significant step in aligning each credential with real-world transport nursing practice.
What’s on the New CTRN Exam Outline? (Effective March 30, 2026)
The Certified Transport Registered Nurse (CTRN) exam focuses on delivering high-acuity care during ground transport, including interfacility transfers and mobile intensive care operations.
Key areas include:
- Advanced patient assessment and clinical decision-making
- Trauma and medical management during ground transport
- Ventilator and hemodynamic management
- Pharmacology and infusion management
- Special populations such as neonatal, pediatric, geriatric, obstetric, and behavioral health patients
- Ground transport operations, safety, and communication
- Scene management and hazard identification
- Legal, ethical, and professional issues in ground transport
Download the CTRN Examination Content Outline.
What’s on the New CFRN Exam Outline? (Effective August 31, 2021)
The Certified Flight Registered Nurse (CFRN) exam focuses on air medical transport and addresses the unique physiologic and operational challenges of helicopter and fixed-wing environments.
Key areas include:
- Altitude physiology, gas laws, and environmental stressors
- Airway, ventilatory, and hemodynamic management in flight
- Trauma, medical, obstetric, neonatal, pediatric, and surgical conditions
- Flight-specific pharmacology and pathophysiology
- Aircraft safety procedures, pre-flight considerations, and emergency protocols
- Crew resource management in an aviation setting
- Landing zone operations and scene coordination
- Professional standards, documentation, and regulatory issues
Download the CFRN Examination Content Outline.
CFRN vs. CTRN: Which Certification Should You Choose?
Your certification path depends on your practice environment, career goals, and the type of transport care you deliver.
- Choose CTRN if you primarily work in ground critical care transport or interfacility transport teams.
- Choose CFRN if you operate mainly in air medical settings, including rotor-wing or fixed-wing aircraft.
- Choose both if you work across air and ground environments or want to expand your professional versatility; if you’re looking to open more doors in leadership, education, or multi-modality transport programs.
Dual Certification Offers More Job Opportunities
Holding both the CTRN and CFRN credentials can now offer meaningful career advantages:
- Broader eligibility for positions in organizations that operate both air and ground units
- Increased competitiveness for specialized or leadership roles
- Stronger understanding of transport systems and interfacility workflows
- Greater professional recognition and potential for career advancement
Transport programs value nurses who can operate confidently in multiple environments, and dual certification demonstrates that capability.
How to Prepare Effectively for the CTRN and CFRN Exams
Start With the BCEN Content Outlines
The newly separated outlines are your roadmap for exam preparation. Use them to structure your study plan and ensure you are covering all domains.
Focus on High-Yield Clinical and Operational Concepts
- For CTRN: ground transport safety, medical/trauma stabilization, ventilator management, and transport team coordination
- For CFRN: altitude physiology, flight stressors, aviation safety, and in-flight critical care practices
Study With Realistic Practice Questions
Look for questions that reflect the exam’s scenario-based style and cognitive complexity. Detailed rationales help reinforce learning and strengthen your decision-making skills.
Prioritize Application Over Memorization
Both exams emphasize clinical judgment. The best prep includes real-world scenarios that require you to apply knowledge in a transport setting.
Leverage Flexible Study Tools
Transport schedules are unpredictable. Mobile-friendly study resources like Pocket Prep allow you to review during downtime, between calls, or while on shift.
BCEN’s decision to split the previously combined outline into two exam-specific content outlines marks an important advancement for the transport nursing profession. The updated CTRN and CFRN exam outlines now better reflect the distinct challenges of air and ground transport, giving nurses clearer pathways for certification and professional growth.
Become Certified as a Transport or Flight RN
Whether you pursue one certification or earn both, preparing with structured, flexible tools and understanding the updated outlines will help you succeed. Pocket Prep is here to support you with realistic practice questions, detailed explanations, and study tools built for busy transport clinicians. For more information, check out the CTRN and CFRN exam prep pages.
