Destined to Be a Flight Nurse

adventure_rn, MSN, NP · Feb 13, 2019

Lots of great advice!

On 2/11/2019 at 10:36 AM, Emergent said:
I think you should modify your plan. Becoming a flight nurse is like becoming a rock star. There are a lot of great musicians who will never attain that dream. But, they love music, and find great joy and satisfaction in it.
Start by becoming a good musician. Keep practicing and refining your skills out of love of your instrument. See where it takes you.

I think that this is interesting advice, with a related note to add.

I've known a handful of people who entered the NICU set on becoming flight nurses. When they approached ICU as a means to an end (and it became clear that they weren't excited about the NICU specialty itself), they could sometimes become frustrated or complacent. They got so focused on the fact that they weren't doing what they wanted to do (flight nursing) that they kind of stagnated in the role that they were doing (ICU nursing). Consequently, they didn't show initiative and therefore didn't earn the best opportunities to advance within their ICU roles (i.e. taking the sickest patients, learning advanced skills like placing PICCs). As a result, they became even less desirable flight candidates (vs. the people who showed initiative and earned those opportunities). Then they'd get annoyed since they felt entitled to those high-skill, high-acuity experiences; they'd become even more frustrated and complacent and take even less initiative, leading to a downward spiral.

Big picture: instead of focusing on how to become a great flight nurse, maybe it's best to focus right now on becoming a great ICU nurse. You say you're destined to be a flight nurse, which, to me, implies that ICU nursing somehow isn't enough. If you approach your goal with that attitude, you may be setting yourself up for disappointment and burnout while in your ICU role.

Xance · Feb 13, 2019

I cannot agree enough adventure_rn, if you set your sights on the 'next thing' you may forget about the thing you're doing right then. To OP; don't ignore the steps along the way. Approach things not as a means to an end, but as a way to better yourself as a provider. Me for example; I dislike med/surg and most floor nursing but I will do so with the understanding that it will make me a better provider overall. However to get to your desired role of flight nursing you will require 5+ years of mostly high-acuity ICU experience and in your case you were placed in a step-down unit instead. Don't view that as a road block, instead view it as a way to better yourself as a provider so that once you become an ICU RN. Then you will have a better understanding of what that patient will face in step-down, and you'll also have practice with lower-acuity patients to hone your skills which were marked as deficient.

yournurse · Feb 13, 2019

Do ER , don't waste your time on a télé or med/surg floor.

I don't know a lot about Flight nursing but I have chatted with a flight nurse a while back. She told me I needed to do 5yrs of ICU to be even considered.

To become a flight nurse, you need to build your critical thinking skills, I think that is better developed in the ICU. But if you cannot find ICU positions (please do not stop looking), I would even move somewhere just to get ICU, out of state. Just don't give up. Also, ER experience is also good because you develop skills on how to act in code situations.

Don't doubt yourself. I know you may feel that way right now but don't.

At my hospital, once you are in the ER, they cross train you to go to ICU. Find places that do that. Do not limit yourself.

If this is truly what you want, fight for it and you will get it. ? Gluck!

Miss.LeoRN · Feb 13, 2019

8 hours ago, indienurse said:
At my hospital, once you are in the ER, they cross train you to go to ICU. Find places that do that. Do not limit yourself.

At my hospital ER is a world apart from Tele and ICU. Granted we have two different Tele floors. Step-down with Tele and acute with Tele. I work step-down/Tele. Only our floor can be pulled to the ICU, and only Tele/step-down nurses are trained for ICU, not ER. The OP should evaluate what each hospital step ladder is because they're not all the same. Going the ER route at another facility may not get her into the ICU at all.

RNNPICU, BSN, RN · Feb 13, 2019

It sounds like you need time to hone in these skills. Even with an extended orientation, it sounds like you need time. It may be that there is another path for you. Not every ICU RN becomes aflight RNs, but it is an important path. Work the step-down unit, learn how to prioritize, then in a year, try the ICU again. You will definitely want tho have 5 years ICU experience before applying to flight/transport RN. Those RNs have experience of managing multiple issues at the same ntime, learning to manage chaos, such as step-down can be a good building block for you, especially since your managers/educators think you may need more time.

I know you mentioned that others have said that it took time for them to learn, your team did give you more time, an extended orientation. They are giving you some more opportunities.. prove yourself in step-down. Then move to ICU. best of luck

Ruby Vee, BSN · Feb 13, 2019

On 2/10/2019 at 5:33 PM, skorupar said:
About eight months ago, I decided that I would like to be a flight nurse. I currently have a BSN and am BLS, ACLS and PALS certified. I was a CNA for 10 yrs and have been an RN for almost six yrs in April. I worked at an LTACH for four yrs, brain injury/general rehab for one yr, and just got my foot in the door in MS/Neuro ICU in October 2018.
I had an extended orientation in the ICU because I needed to improve my prioritization and time management skills. With three weeks left in the said "extended orientation," my manager and supervisor decided that I should transfer to a Med Surge/Progressive Care unit to work on the aforementioned skills and then see if I would like to rejoin the ICU team (~6 months).
With that said, I respect their professional feedback, but feel like if I would have had the opportunity to complete the remaining orientation, I would have improved those skills. My preceptors had told me they could see the improvement since I started orientation. A few also told me that it took a long time for them to build a routine.
So, I will interview for a position on the progressive care unit, which I shadowed. But, with wanting to be a flight nurse, I know I have a lot of work ahead of me and have many questions on which route I should pursue. I need critical care experience and am wondering if I should apply for an ED position or a different ICU position at another facility?
I know that different FFL companies require different certifications and having them increases your chance of qualifying for a position; so, should I try to complete some of them now (e.g., Paramedic)? Should I go back to school for my MSN? If so, which program? Is there one that is geared towards flight nursing? I do not know what I should do or where I should start with so much ahead of me. Any feedback or personal experiences would be greatly appreciated.

Leaving aside the question of your "destiny," it seems as if your current management is willing to work with you to improve your skills. You may not like their plan, but it seems a workable plan. Med/Surg (not "Surge") is a good foundation for just about any nursing career, but especially for ICU or flight nursing.

My husband, a flight nurse, says that the EMTs and paramedics on their team are there for the first responder and ED portion of the care; nurses are there for their ICU skills. So ED doesn't seem like a good route to take. As far as jumping to a different hospital -- I'd advise you to wait. Put in the time on Med/Surg, learn the skills that your manager has presented to you as skills to work on, and wait the six months or a year or even two years so you can go back to the ICU and be successful. There is no overnight route to flight nursing. Put in the time, learn what you need to learn.

skorupar, BSN · Feb 13, 2019

On 2/12/2019 at 3:46 AM, RickyRescueRN said:
I feel I have to weigh in as a 22yr RN with 17 of those years being in Flight. No one is destined to be a Flight nurse.It's a nursing super speciality like so many others. One works hard for a long time to get into this field. You need solid ICU experience if you are to make a good flight nurse practitioner, and I mean 5-10years in the ICU. Patients that are flown deserve the best when it comes to ones experience and skill. CV ICU and high acuity SICU is what I recommend as you learn to care and manage patients with numerous invasive pressure lines, Mechanical Circ Support (Impella, LVAD, ECMO, IABP) and on numerous inotropes, pressor and other infusions. Most ICU managers and educators have a fairly good understanding of what is required from Flight and CCT RN's in terms of practice, so I would take their advice and get the experience you need on a tele floor. Rather do this than risk being told when you apply for a flight job that you are not experienced enough. Remember , it is a super specialty of nursing, with your experience built in Intensive care nursing and to a lessor extent in Emergency nursing. The road to attain this is a long one and for good reason. Check out the Flight Nursing Specialty section . Lots of good advice there from other flight nurses for nurses in the same position as you are. Good luck. Don't give up.

Thank you for your feedback. I do know that this is a lifelong goal and that I have a lot of knowledge and experience to gain. I am aware that it may take me 10 years to get there. This is a new journey for me and it seems that I am on the right path so I will keep moving forward.

skorupar, BSN · Feb 13, 2019

3 hours ago, Ruby Vee said:
Leaving aside the question of your "destiny," it seems as if your current management is willing to work with you to improve your skills. You may not like their plan, but it seems a workable plan. Med/Surg (not "Surge") is a good foundation for just about any nursing career, but especially for ICU or flight nursing.
My husband, a flight nurse, says that the EMTs and paramedics on their team are there for the first responder and ED portion of the care; nurses are there for their ICU skills. So ED doesn't seem like a good route to take. As far as jumping to a different hospital -- I'd advise you to wait. Put in the time on Med/Surg, learn the skills that your manager has presented to you as skills to work on, and wait the six months or a year or even two years so you can go back to the ICU and be successful. There is no overnight route to flight nursing. Put in the time, learn what you need to learn.

Thank you for the feedback and spelling correction. I am going to continue with my manager's suggestions because I know that they are trying to help me succeed.

PeakRN · Feb 14, 2019

On 2/10/2019 at 4:33 PM, skorupar said:
About eight months ago, I decided that I would like to be a flight nurse. I currently have a BSN and am BLS, ACLS and PALS certified. I was a CNA for 10 yrs and have been an RN for almost six yrs in April. I worked at an LTACH for four yrs, brain injury/general rehab for one yr, and just got my foot in the door in MS/Neuro ICU in October 2018.
I had an extended orientation in the ICU because I needed to improve my prioritization and time management skills. With three weeks left in the said "extended orientation," my manager and supervisor decided that I should transfer to a Med Surge/Progressive Care unit to work on the aforementioned skills and then see if I would like to rejoin the ICU team (~6 months).
With that said, I respect their professional feedback, but feel like if I would have had the opportunity to complete the remaining orientation, I would have improved those skills. My preceptors had told me they could see the improvement since I started orientation. A few also told me that it took a long time for them to build a routine.
So, I will interview for a position on the progressive care unit, which I shadowed. But, with wanting to be a flight nurse, I know I have a lot of work ahead of me and have many questions on which route I should pursue. I need critical care experience and am wondering if I should apply for an ED position or a different ICU position at another facility?
I know that different FFL companies require different certifications and having them increases your chance of qualifying for a position; so, should I try to complete some of them now (e.g., Paramedic)? Should I go back to school for my MSN? If so, which program? Is there one that is geared towards flight nursing? I do not know what I should do or where I should start with so much ahead of me. Any feedback or personal experiences would be greatly appreciated.

On 2/10/2019 at 4:57 PM, skorupar said:
Thank you for the feedback. I do feel that my employer is very supportive and they are aware of my goal to be a flight nurse.
I would like to be a rotor fight nurse. I am aware that I will be on ground and fixed wing as well.

You were given the opportunity to work in an ICU, and your current development isn't at a level that can support that. Your managers are providing you a way to build that experience and come back to the unit. Take that message with value. You are not ready to work in an ICU, let alone flight.

To be quite honest I'm a bit surprised that an ICU would hire you knowing that you just want to be a flight nurse. Nothing turns us off during an interview like someone who tells us that they want to be a flight nurse or a CRNA, often it seems that they want to use us as a means to an end. We want nurses who want to be great ICU nurses in our ICUs.

While the ED and ICUs are both critical care, they are critical care in very different ways. The ED isn't going to do much in the way of helping you to be a ICU nurse (and vice versa), and to be honest based on your work history you would probably struggle even more in the ED.

One of the biggest reasons that most flight companies value ICU time over ED time is that on average 80% of CCT/HEMS patients are transfers, and even when responding to a scene there will likely have been EMTs or Paramedics who already started the initial care and you are being used for time savings in transport. It is very rare on a scene call that HEMS actually brings a life saving measure that a paramedic ambulance doesn't have and the patient needs before arrival to the ED. Most of flight is transferring patients who are too sick (or require treatments that are out of scope like TPA) for a paramedic level transfer, period.

You don't know what you don't know, and at this point it seems that it is a lot.

Also keep in mind that if you go to another ICU or ED they many also feel that you are not up to speed, and they may not be willing to put you on a stepdown unit. You could very well end up on the floor, or out of a job completely.

Have you done any third rides with a flight crew? You might be surprised at how different the job actually is than how you think it is.

Wuzzie · Feb 14, 2019

12 hours ago, PeakRN said:
One of the biggest reasons that most flight companies value ICU time over ED time is that on average 80% of CCT/HEMS patients are transfers.

And about 60% of those didn't need to be flown at all.

kbrn2002, ADN, RN · Feb 14, 2019

Becoming a flight nurse is a long process and not every hospital and agency that employs them has the same hiring path to get there. I am assuming that your hospital has flight nurses since that is your eventual goal? If so talk to one or two of them when you get the chance and ask them how they eventually got to the point of being hired into the position.

murseman24, MSN, CRNA · Apr 10, 2019

On 2/14/2019 at 12:49 AM, PeakRN said:
To be quite honest I'm a bit surprised that an ICU would hire you knowing that you just want to be a flight nurse. Nothing turns us off during an interview like someone who tells us that they want to be a flight nurse or a CRNA, often it seems that they want to use us as a means to an end. We want nurses who want to be great ICU nurses in our ICUs

Yep, keep the CRNA dreams a deep and dark secret, then GTFO when you've learned everything you can, as a means to an end. The best ICU nurses go on to become CRNAs, and the ICUs should be grateful for the time they had an excellent nurse before moving on to more challenging endeavors.