Destined to Be a Flight Nurse

Published

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.

Specializes in CVICU, MICU, Burn ICU.
1 hour ago, murseman24 said:

All the triples, all the protocols, eventually the learning stops.

Does it really, though? I've heard this argument before by APRNs and APRN students (of which I am one) -- and I don't buy it. I've been doing this a long time and I'm always learning something. Heck I've learned so much, I have to re-learn stuff I learned a long time ago. I suspect some nurses get stars in their eyes for greener grass on the other side of a graduate degree and simply lose interest in what they are doing at the bedside. If the learning stops, this is why it does.

And I would wager that most of the best ICU nurses stay ICU nurses. That said, CRNA is definitely a natural APRN progression for an ICU nurse -- and sure -- there is good and bad in every profession, but thank goodness CRNA programs still seem to have high admission standards -- and being a "good" and experienced ICU nurse should be one of them. ?

Specializes in CCRN.
8 hours ago, murseman24 said:

Okay, all joking aside, the ICU becomes a drag after a while. All the triples, all the protocols, eventually the learning stops. There are "better" jobs that many go into that don't involve graduate school. Organ donation, dialysis, etc. all have some great former ICU nurses who were tired of getting worked to the bone and want better working conditions with higher pay.

Rest assured, anesthesia requires plenty of critical thinking and "common sense." Quick thinking under high pressure situations while accepting the burden for blame as there is no one to ask for a second opinion, doctor to take the fall for you, or protocol to follow is quite the exercise in critical thinking. The surgeon doesn't know the answer, and there is no one else in the room who knows what to do.

ACLS is a logarithm, there isn't anything inherently difficult in following it. We all have anecdotal experience with incompetent providers. I'm sure there are cardiothoracic surgeons who appeared lazy at one point or did something dumb. There are good and bad in every profession, just listen to the Dr. Death podcast. Anesthesia requires a great deal of critical thinking with incomplete information without a clear answer, and requires excellent judgement along with a good amount of technical skill and procedural competence.

It must be a matter of perspective- I don’t find it a drag. I learn at least one new thing EVERY. DAY. I do work in a unit that serves as a “catch all” and we have hypothermia treatments, balloon pumps, blah blah. So it isn’t like we get the same thing every day. If the learning stops, that’s on you for not inquiring about more (in my opinion) I will never believe anyone who says they know every single thing about every part of the process. Policies and evidence based care change are ever changing.

I think you’re being just a touch defensive though- no one is saying anesthesia doesn’t require common sense and quick thinking. Just cause you make it through CRNA school (or any school for that matter- medical school/nursing school/law school) does not inherently make you a good provider who thinks with common sense and on their feet. As you said, there’s bad in every profession.

I’m sure anesthesia is a very demanding job. I think the point also was that you were wrong in saying ALL the best ICU nurses go to CRNA school.

Side note- That pod cast was amazing. And terribly scary.

Specializes in Nurse Leader specializing in Labor & Delivery.
10 hours ago, murseman24 said:

Okay, all joking aside, the ICU becomes a drag after a while. All the triples, all the protocols, eventually the learning stops.

Then you're doing it wrong, or not trying. I've been in my specialty for 15 years and I still learn something new pretty much every day.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
On 4/10/2019 at 1:18 PM, rn409 said:

I would say SOME of the best continue on to other things, too ?.

Yes, that's true. I was reacting to the statement that ALL the best ICU nurses go on to be CRNAs.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
17 hours ago, murseman24 said:

Okay, all joking aside, the ICU becomes a drag after a while. All the triples, all the protocols, eventually the learning stops.

If you aren't learning something new every day, you're not doing it right.

Specializes in anesthesiology.
On 4/11/2019 at 6:41 AM, rn409 said:

It must be a matter of perspective- I don’t find it a drag. I learn at least one new thing EVERY. DAY. I do work in a unit that serves as a “catch all” and we have hypothermia treatments, balloon pumps, blah blah. So it isn’t like we get the same thing every day. If the learning stops, that’s on you for not inquiring about more (in my opinion) I will never believe anyone who says they know every single thing about every part of the process. Policies and evidence based care change are ever changing.

I think you’re being just a touch defensive though- no one is saying anesthesia doesn’t require common sense and quick thinking. Just cause you make it through CRNA school (or any school for that matter- medical school/nursing school/law school) does not inherently make you a good provider who thinks with common sense and on their feet. As you said, there’s bad in every profession.

I’m sure anesthesia is a very demanding job. I think the point also was that you were wrong in saying ALL the best ICU nurses go to CRNA school.

Side note- That pod cast was amazing. And terribly scary.

IDK, I have my own collection of nursing books at home (cardiac, critical care, pharmacology, EKG, etc) that I've collected and read AFTER nursing school, and I felt I hit a ceiling pretty quick in regards to the education available to me and the limits on my scope of practice. Sure, I know when and how much fluid to give a patient, I know the receptors and which pressers are best for a particular patient, but ultimately the decision to use any one of them is on the physician. That is the biggest thing, once you're truly responsible for your own decisions, another level of learning occurs. The textbook recommendations, studies, anecdotal experience, scientific evidence for your interventions have to be rock solid.

I always felt we were giving our "best guess," and our understanding was subpar. I read a ton and took advantage of every extra learning modality available to me. I felt limited in my ability to help patients because of my scope and I knew my education was lacking to truly make my own decisions.

The complete reliance on following protocols blindly was a huge turn off as well. Half of the nurses didn't know WHY we were doing said interventions in the protocol, or when they were or were not appropriate. The endless protocols allow nurses to act without needing to understand the reason for their actions.

The "all the best nurses go on to CRNA school" was a bit tongue in cheek. I think it's lame to not "allow" people into the ICU who want to go onto CRNA school. Plus anyone with half a brain would know this and not tell your manager that's what you want in your hiring interview (I sure didn't).

Specializes in anesthesiology.
On 4/11/2019 at 7:52 AM, klone said:

Then you're doing it wrong, or not trying. I've been in my specialty for 15 years and I still learn something new pretty much every day.

Does your daily practice change b/c you've learned a better way to do something or does it change based on provider preference or hospital policy, and then you just adapt?

You don't have true freedom to help patients through evidence-based practice, you have to do what the policy, doctor's orders state to do. That is why the learning stops.

I knew which docs liked which drugs for intubation, and I generally knew what they did and some major contraindications. Now I know which drugs are best for any individual patient and I use the ones I want to because it's the best thing to do for the patient. I choose the drug, dose, timing, route, and I love it. You can't do that as an RN, you can just try to understand why someone else asks you to do something. It's much more motivating to learn new things when you have "creative control."

Specializes in CCRN.
17 minutes ago, murseman24 said:

IDK, I have my own collection of nursing books at home (cardiac, critical care, pharmacology, EKG, etc) that I've collected and read AFTER nursing school, and I felt I hit a ceiling pretty quick in regards to the education available to me and the limits on my scope of practice. Sure, I know when and how much fluid to give a patient, I know the receptors and which pressers are best for a particular patient, but ultimately the decision to use any one of them is on the physician. That is the biggest thing, once you're truly responsible for your own decisions, another level of learning occurs. The textbook recommendations, studies, anecdotal experience, scientific evidence for your interventions have to be rock solid.

I always felt we were giving our "best guess," and our understanding was subpar. I read a ton and took advantage of every extra learning modality available to me. I felt limited in my ability to help patients because of my scope and I knew my education was lacking to truly make my own decisions.

The complete reliance on following protocols blindly was a huge turn off as well. Half of the nurses didn't know WHY we were doing said interventions in the protocol, or when they were or were not appropriate. The endless protocols allow nurses to act without needing to understand the reason for their actions.

The "all the best nurses go on to CRNA school" was a bit tongue in cheek. I think it's lame to not "allow" people into the ICU who want to go onto CRNA school. Plus anyone with half a brain would know this and not tell your manager that's what you want in your hiring interview (I sure didn't).

Haha... dude, you’re just smarter than me then. I haven’t even seen the ceiling. The (good) nurses I work with do not follow protocols blindly, and protocols can’t be followed when clinical judgement tells you the pt is responding in a negative way to it. And recognizing THAT is a key element of being a good ICU nurse (in my obviously VERY humble opinion).

I have never heard of anyone not coming to ICU strictly due to their CRNA goals- but, I have seen people not come because (after shadowing, etc) they just were not ready for it. They decided not to come or they were deemed dangerous even after a trial period.

I have to ask- what area do you work in? How long have you been there?

Specializes in anesthesiology.
55 minutes ago, rn409 said:

I have to ask- what area do you work in? How long have you been there?

I worked in a general ICU approx 3.5 yrs.

35 minutes ago, murseman24 said:

I worked in a general ICU approx 3.5 yrs.

I believe the point fellow RN's were trying to say is that learning never stops and it's foolish to believe you know everything there is to know about being in the ICU. Especially after so short a period of time. Medical school takes around a decade, more if you include your bachelors degree, and even in that amount of time doctors cannot know everything there is to know, even in their specialty. That is why it may come off as arrogant to believe in such a short period of time you claim to have "hit the ceiling". If you truly believe your knowledge to be superior to that of an MD then stop playing at being a CRNA and go straight to medical school and truly test your mettle, show the rest of academia how you and your knowledge is greater than theirs.

If not, then realize that you need to be humble and like others have said; if you aren't learning something every day then you're doing something wrong. There is simply too much information in the medical field for anyone to truly become a master of every detail in their field. Don't take that the wrong way, I'm merely suggesting that you approach your field with an open mind and realize that there is so much to learn, even in things you feel you already think you know. It's truly mind-boggling to imagine how much there is to learn in the medical field and in specialties like ICU.

Specializes in Nurse Leader specializing in Labor & Delivery.
1 hour ago, murseman24 said:

I worked in a general ICU approx 3.5 yrs.

My lord, you're still a baby.

The hubris, to think you've learned all you can learn as an ICU nurse after 3 1/2 years.

Specializes in Nurse Leader specializing in Labor & Delivery.
2 hours ago, murseman24 said:

Does your daily practice change b/c you've learned a better way to do something or does it change based on provider preference or hospital policy, and then you just adapt?

It changes based on new research, sharing ideas with other practitioners, and going to conferences and hearing what other facilities are doing. I then write hospital policy and practice changes, based on the above.

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