Career Path Advice: ICU or ER to flight nursing

Nurses General Nursing


My goal is to be a flight nurse. Maybe this is a thread for flightweb, hopefully you all wont mind giving me advice.

I consider the helicopter to be an extension of the ER. I know it does CCT also...

Ok. So I haven't started my new job in the MICU. (that's a separate non-issue)

My job is held over for me, but I have another offer now.

A competing system has offered me a position in a busy ER.

pros on the MICU:

1. I will be based in MICU, and float through SICU, CCU and Clinical Decision Unit (a 23 hour unit where you either go to ICU or go down to the stepdown / tele unit)

2. ICU skill set - nuff said

3. a level 4 trauma designated hospital, also a heart transplant hospital, designated stroke center and cardiac care designation (i forget what its called)

4. The staff during my interview told me that they would "train me to be a flight nurse."

5. They do have a helicopter pad.

6. 2-3 patient load (supposedly if you get 3 patients you have "help"

7. This hospital has won the "medicare ACE Demonstration Center designation for cardiac and ortho." (that means we will get lots of business)

8. This hospital is owned by a publicly traded company and this job is considered "more recession proof" than competitors.

9. The unit manager is freaking A W E S O M E.

10. Many of the nurses there have been there 20+ years (that tells me that they are happy)

11. My manager is impressed by my learning goals (that tells me she is receptive to working with my classes when they start).

12. This will help me study for CC P, (lol after i get the red patch)


1. Paygrade

2. Even though the hospital has a trauma designation, in the interview they told me that they do not get traumas.

3. 100 year old building (some renovations are coming, but it looks like a hospital out of freddy kreuger's nightmares.)

ER job


1. A very very busy ER that takes overflow from the nearby level 1 trauma hospital

2. They are getting their own helicopter

3. Paygrade

4. Emergency care is really what I am "most interested in"

5. New building

6. Its ER... you get a mixed freaking bag of what you get!

7. Being in the ER will most likely help me "study" for my upcoming Paramedic course.


1. Steeper learning curve when I eventually try to fly.

2. Not a designated trauma center

3. High turnover

4. I have no idea of the financial stability of this hospital system, or whether the spiraling recession will affect my job.


1,905 Posts

A helicopter that does CCT is not an extension of the ER IMHO. Solid critical care experience will be your best bet when considering the typical crew configuration of a HEMS platform. The most common configuration of crew in the US is PM/RN. There is in fact method to this concept. Each member of the team brings a specialized skill set to the platform. The PM brings a "field based specialty" along with a strong airway management skill-set. However, the RN should bring a strong critical care skill-set to the team. You will be expected to take the lead and manage a critical patient transport. This skill set is rather difficult to obtain working ER. Even a trauma center is not the same as caring for a critical care patient for extended periods of time. Typically, ER is a mixed bag. You can see earaches and snot faced kids all day long. While ER experience can round out an ICU RN, ER experience without a solid critical care skill set is not optimal.

You are correct about having a steep curve with exclusive ER experience. I went into HEMS with an ER specific skill set. I had a learning curve and my PM partner was left chewing my food while I was catching up. This creates a suboptimal situation and potentially leads to less than optimal patient care.

Specializes in Flight, ER, Transport, ICU/Critical Care.

Hey there Hopeful -

Sure sounds like you got a lot of stuff bouncing about in there - really, it is not that difficult (unless you make it too difficult) of a decision at this point. Start. Working. Somewhere.

This is IMPORTANT!!!

Stop. Proceed with deliberate action. I think that you are just new and excited and I understand that - but, you are gonna drive yourself and those around you mad spinning. So, stop. Regardless of where you start you have to get to a certain place to be able to fly. Here is what that place looks like - ;)

You have to be an EXPERT NURSE. There is no one way to get there and it appears that you are at the beginning so the key is to start working as a nurse. Trust me - you will get as many opinions on the right "area" as there are flight nurses, the key is what will work for you.

You have to have 3 - 5 years of experience in emergency/critical care to be considered at most any company. The best part of this requirement is that it takes 3 - 5 years to get this experience.The worst part of this requirement is that it takes 3 - 5 years.

I take from your post that you have shared that you will be going back to school. I think that you are talking about paramedic school but I may be wrong. You also note getting a CC P. I have no idea what that is - are you working in the US or are you in Canada? My advice is not to get too focused on the "flight nurse" thing right now. As I noted - I think you are new to nursing practice - goals are great and plans are necessary - my plans have changed all my life and I found great opportunity in being open to many experiences. It is the sum of these experiences that made me a flight nurse. I have had to experience some "3 year wonders" from both the medic and nurse disciplines and most are far from wonderful.

There is lots of advice on the ideals for a flight nurse and it can vary from company to company based on their "mission profile" and the depth of an applicant pool. Some programs only have positions when one of their staff "dies" :eek: and other programs have a revolving door with turnover. Choose carefully.

I can give you the laundry list but there are lots of posts on this site and at flightweb as well that detail the requirements very well. How to get a flight job, flying in the face of fear and interviewing are all worth looking at carefully.

I will also give you a word of CAUTION. Keep the desire to fly a bit quiet for now. Amazingly, there are lots of folks that want to fly and not everyone will embrace your journey. Some folks get perverse delight watching someone not do well. I don't understand that mentality, however, it is real and can work to hurt you. You are a long way from flying - so be cool for now.

It is a strange industry that looks very different once you are in it - this industry has changed dramatically in the past decade and I think it will change again in the next 3-5 years as healthcare reimbursement is "reformed". It has to - it is less about taking sick folks to better care and more about flight volume. In some services, it is almost "you call - we haul" and is a high stakes mode of routine transfer. It used to be that flight attracted the "best" and now I'm not sure that is accurate. There is a maddening disparity in the abilities of some providers - you don't know what you don't know and some will never be able to learn. I'll stop now and I'm not trying to discourage you - just giving some insight.

Now for the positions.

The fact that a helipad exists means nothing. The ED that is starting their own flight program is impressive but don't get blinded - there will be a line for those spots.

The MICU that will train you to be a flight nurse is odd as well - unless that have their own flight program that has the flight nurses staff their ICU in the down time - they are most likely gigging you at best. Sorry. Yes, you may learn some things that you will need to be a flight nurse - but that manager is reaching a bit.

As for financial security of either hospital - I've never thought about it. Not seen too many fail and nurses are usually employable down the block if need be.

I'd rethink the concept that flight is an extension of the ER. It may have been that way a decade or so - but, most flight programs are community based services. CBS models mean they are independent providers and not dedicated to any hospital. The CBS programs transfer from anywhere to anywhere. Now, some programs remain hospital based and the concept will vary from independent department at the hospital to having to staff an ER/ICU in the down time.

So - do whichever you want and in a few years go do the other area. Just work toward being that expert nurse, work hard, learn something new everyday and always stretch to improve your practice and you will be on you way.

Good Luck.

Practice SAFE!


Just saw Gila post and realized that I did not vote. Regardless of where you start - you have to get some high end CCU/ICU experience that will serve you (the team and the patients) best.

Thank you both for your candid replies.

To futher clarify: I am in the US. I have done quite a bit of reading online and have seen the "minimum" requirements to fly as a nurse. I am by no means simply running down the list of minimums to get where I want to be. I am striving to become an expert. That has always been my goal. I understand that my idea about the helicopter being an extension of the ER has been colored by my experience with EMS. I definitely understand that my concept is only a small part of the Flight paradigm.

My education goals are as follows: EMT-P, CCRN, CEN, Critical Care Paramedic Certification (that was the CC P that I mentioned in my earlier post)

I think i will acheive these most likely in that order. The reason for this post is that I was torn because of the two offers. I am more attracted to the Emergency specialty and the offer to work in the ER befuddled me, because while I know that the ICU skill set is what I will need more, I am still more attracted to Emergency. It probably stems from the fact that I wanted to be a paramedic, but was convinced that nursing was a better choice.

I just love being on scene!

I posted this on another forum and received the great idea, to try and take the ER position as PRN. That probably won't fly with the ER manager, being that I am a GN. But who knows maybe she will give me a shot because of my prior EMS experience? I am fully convinced that even though I want the ER so bad, ICU is the place where I should earn my keep, before moving trying to move on to another specialty, such as ER, or Transport nursing.

I will keep my plans under a tight lid with my peers. I know that they are far off in the future (well 5 years isn't that far away!). I truly appreciate y'all's advice. I will continue to work toward my dreams. I understand what you mean about bouncing around, I know that I have alot of goals, but I feel truly called to this. I have a great deal of interests and a matching supply of energy. My paramedic class starts in December. I'm volunteering in the meantime and I'll start my ICU job after I take NCLEX. I will continue to volunteer with EMS after I start the ICU job, to keep getting scene experience. I don't want to end up being one of those RN/EMT-Ps who has no scene experience!

Thanks again for the perspective.

Specializes in Adolescent Psych, PICU.

I worked for a level 1 trauma center for a couple of years and I worked in the ICU. I worked with flight RNs all the time :) Most emergencies (especially things like trauma) that we got bypassed the ER and they transported straight into the ICU from the flight team. So I don't think of flight nursing as being an extension to the ER at all actually.

I think most ER nurses will tell you to get ICU experience and don't most flight agencies require ICU experience? You will learn to really *think* and see and learn why things are done from ICU experience--especially if you work at a teaching hospital. The learning curve is STEEP. You will get a LOT of experience in codes, vents, art lines, drips, hemodynamic monitoring, etc. Things you don't see or get much experience with in the ER and we got patients transported on vents, drips, etc from other hospitals so you definitely need that kind of experience. You just can't go wrong with getting ICU experience!

Also I noticed that most flight nursing is nothing but between hospital transfers, I think that far outweighs emergencies. I used to think I wanted to be a flight nurses until I saw the realities of the hospital (it sucks)---you still have a LONG time to go here and things probably will change for you. Once you get into the hospital 5 years will seem to a longgggg

Good luck! I think it's good to have a plan and a goal :)


159 Posts

The short answer to your question is ICU Experience.

5 years flight experience here.


Specializes in Med-Surg/Oncology.

Assuming you are just starting out on your path to becoming a flight nurse (and let me add a disclaimer here: I am not a flight nurse!), I would suggest this: You should NOT start working "somewhere" - you should start working somewhere you know you will be happy. Atmosphere/Environment of the unit and hospital you choose to work is, in my opinion, absolutely critical to you as a new nurse, especially if this will be your first nursing/RN job.. Your main goals in your first year should be to learn as much as possible, and to not burnout. ;) A good, supportive, enthusiastic unit manager is worth his/her weight in gold to you.

ICU and ER both offer experiences that are unique to their respective departments. But... Nothing says you have to (or will) stay on that career path forever. You could work ICU for a year and then go to ER or vice versa. Emergency care is what appeals to you now but you may find out that you really love ICU/Critical Care just as much if not more. Every career decision you make can drastically alter the plans you had made before you took that job. You may take the ER job and have a really bad experience with your coworkers, or managers, or just that hospital completely, and you may become totally burnt out with emergency care, something you previously loved.

It is my personal opinion that you should first seek a job that offers you personal happiness and security. If the ER at the other hospital has high turnover, that would deeply concern me, because there is SOMETHING going on there. Something is making those employees want to leave.

If the hospital has a trauma designation, I would ask why they do not receive traumas. Perhaps this is something you could help change.

I wish you the very best of luck on your ambitious education goals, they are very admirable!

Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
The short answer to your question is ICU Experience.

5 years flight experience here.



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