Need advice on career path to flight nursing

PMFB-RN, RN · Oct 27, 2009

Greetings! I have been working in the emergency department setting since graduating nursing school in June. My previous career has been Fire Rescue / EMS, as a paramedic since 1993. I always loved being a medic and was very good at my job. Ended up resigning from the fire rescue department I worked for to do nursing full time to get a schedule more in line with my wife (also an RN), and now I am feeling a bit of a twinge when I see an ambulance running hot down the road. !

*** All of the flight nurses where I work have a strong higher level ICU background.

rghbsn, BSN, RN · Oct 30, 2009

I think you have a great base...but I would also recommend getting some time in the ICU's. STICU, MICU, and/or CCU. One of the parts about interfacility is that it is more than just paying the bills, it's the primary mission of most transport companies. It's not abnormal to pick up patients from smaller ICU's and transport them to larger regional facilities on several drips, hemodynamic monitoring (Swan-Ganz, a-line, CVP, ICP), and the vent. I have worked in both ED and ICU's for several years before moving to transport and flight nursing; I have found my ED days to be helpful less so than my ICU days. Keep in mind that you and your partner are going to be controlling the drips, titrations thereof, ventilator and it's settings, etc. Most ED's will hold patients on gtts and vents just long enough to get them to the right ICU bed. You will be picking up patients that have sometimes been mismanaged for days or weeks before they are transferred out...you will be so far behind the 8 ball that you'll need to have a strong understanding of chronic, ICU sick as well as acute ED sick. Vent changes, swan readings, and gtt titrations will be more comfortable and better understood after some time in the ICU.

That's my 2 cents, and it's probably worth less than that.

Your medic time and ED time will be very helpful on the scene flights you would get, it's invaluable to have pre-hospital experience. Trauma experience from the ED also helps give you a better understanding of what the ED docs and nurses are going to need to know by the time you get them to the facility and will allow you to combine pre-hospital experience with ED experience to best care for your patient. I wouldn't trade my ED time for anything, and it has helped with my understanding of traumatic injury and care thereof.

Most programs won't even take a serious look at you without at least 3-5 years worth of experience (usually as a nurse if you are applying in that capacity). Some will accept EMT-P time if you worked in a high volume, high acuity district or did critical care transport as a medic. I would suggest spending a year in an ICU, maybe another year in a different unit (CCU is great background and support for cardiac tranfers with transvenous pacers, STEMI's, etc.) and then get your name out there. It doesn't hurt to show interest early, but showing that you're willing to move around to build a strong background is a plus.

Medic/Nurse, BSN, RN · Oct 30, 2009

Welcome spacecoast! :)

rghbsn gives great advice and you got some well worn answers at FW as well.

I'll add - you appear to have a solid background, so that is an excellent starting point. If I am reading correctly you seem to have a year of RN experience and maybe a decade or so of fire based EMS as a paramedic. If that is correct ??? You are on the right path. I appreciate that you have a manger willing to recommend you - a good rep is golden! Keep it! You need to have a few more years experience (2-4 minimum).

There are many answers that outline the value of ED vs. ICU experience here and on FW. I don't have too much to add except --- you are out there with a partner that is a paramedic. You will be expected to bring the "nurse" expertise and unless you have some vastly differing experiences you/your partner will be in over your head from the get go. Not a comfortable or IMO even acceptable place to be.

Not sure of the geography (TX or FL maybe AL), but do some "informational" interviews with the flight companies in your area. Most are looking for exceptional folks and will give you an idea where you stand. If you are willing to relocate to get a chance to fly with certain companies - look at the "mission profiles" of those outfits as well. Maybe some introductions to a flight crew or two may informally give you an idea how to compare in education/experience and the ever important alphabet soup factor.

I could puff you up and tell you that you can fly right away and everything will be okay - and you likely could as the medic depending on the quality of your medic experience and the mission profile or quality of the flight company. If you simply must fly right away - just be prepared to do it as the medic part of the team for now. This does not imply any lack of ability - just an observation that the "effective team" has some synergy and the nurse must wear the "high end" critical care hat to the party. :clpty: Some medics do true CC transport and if that is you - woohoo! & you are so ahead of the game. IMHO these medics are quite rare.

One problem that I have had some unpleasant experience with is, in fact, the experience problem. You will find that some companies will require minimums for nurse or medic with 3 years each. The issue gets muddled when both have the bare bones minimum - the medic has been a medic three years and the nurse has three in the ED - these two become a team and disaster looms. Trust me and take this point with you - you DO NOT want to be in this spot and avoid working for any service that has teams comprised of the "bare minimum".

Most companies "bread and butter" flights are the transfers - IFT from lesser care to higher or more specialized tertiary care. Even the "scene" stuff in some areas includes strokes and STEMI's. Having some high end critical care experience is going to save the patient and save you and your partner. Depending on the flight program you may have some advanced procedures (inserting central lines, arterial lines, true chest tubes, etc) but these are skill based and can be learned; the indications and physio associated with these procedures (along with ventilator management/complex medical drips/balloons) - when, how and why they are used are what will be the vital role of the critical care RN. Example: imagine having never worked with art lines because you only have ED experience and then learning to insert and troubleshoot/manitain and monitor after being hired to fly or managing the complex ARDS patient all the while paired with a medic partner that has never even routinely programmed a IV pump for a dopamine gtt. Not just frustrating - but flat out dangerous. I'd like to think that flight programs that do critical care hire the cream of the crop, but the flight industry has grown rapidly and well, the quality of the "crops" can vary.

I guess my take away point is - get some really high end critical care experience. Mix this CC experience up and really challenge yourself. Keep you foot in the ambulance and your nose to the grindstone for a few more years. I am not trying to discourage you, just hoping to give you a snapshot of the realities (some harsher than others) that the under-prepared will face. I want you to avoid that. Sure, flying is cool and all that - but, it is just a way to get an often really sick patient from point A to B. It is a job and has inherent risks and challenges (this year has been less deadly, but 28 of my colleagues died last year) - so, be sure.

Your background is great. Plan for your CEN. Get that CC experience and after you are eligible sit for the CCRN. I say hold on the CFRN - as you do not fly now, so being certified as a flight speciality nurse when you are not working in that area IMHO muddies what board certification is all about - wait until to you are actually flying to specialize.

Be a wicked determined clinician and seek out the tough cases and use any PITA factor necessary (to a point) to learn from the best doc's and nurses and RT's that you can find to help you in your knowledge quest! Read extensively and work to add depth to your clinical practice. Sure, some places hold patients looking for a bed and some hold 'em until they have them so ****** that you will be lucky to get to the helipad with 'em alive. I really wish that I was bluffing on that one - but, I am sadly not. (Even the simple ones can be pucker worthy!) Be ready for anything!!!

Join ENA and ASTNA. You are on the right road - I just want to get you pointed to the right direction in the sky.

Best of Luck. PM if I can help further.

PMFB-RN, RN · Oct 30, 2009

Trauma experience from the ED also helps give you a better understanding of what the ED docs and nurses are going to need to know by the time you get them to the facility and will allow you to combine pre-hospital experience with ED experience to best care for your patient. I wouldn't trade my ED time for anything, and it has helped with my understanding of traumatic injury and care thereof.

*** How would an ED nurse get this trauma experience? In the two large trauma centers I have worked at the job of the ED nursing in the trauma bay is to write down vital signs and run and get things as they are needed. The nurses on the trauma response teams are ICU nurses, not ER nurses. Got a 5 year old with an ear infection? Get an ER nurse. Got an intubated GSW rolling in? Get an ICU nurse.

Is this not the case at other trauma centers?

rghbsn, BSN, RN · Oct 31, 2009

Nope. At least not around here. Trauma team is ED nurses. I can see both sides...the ICU is usually where the true trauma patients are going to end up eventually, and they would be there for the whole ordeal instead of trying to get report. But, the ED nurses are in the ED all the time, know where everything is, etc. I guess as long as it's consistent it doesn't really matter.

PMFB-RN, RN · Nov 1, 2009

Nope. At least not around here. Trauma team is ED nurses. I can see both sides...the ICU is usually where the true trauma patients are going to end up eventually, and they would be there for the whole ordeal instead of trying to get report. But, the ED nurses are in the ED all the time, know where everything is, etc. I guess as long as it's consistent it doesn't really matter.

*** I agree it likely doesn't matter from a patient care perspective. However if one is looking at recruiting a flight nurse and judging their experience I think there is a difference. If you consider an ICU nurse who recovers open heart surgery pts and is very used to hemodynamic monitoring , vented patients, vaso active drips and the same nurse alos responds to the trauma bay and is the primary nurse in the trauma bay as well as the nurse who will care for that trauma patient in the ICU, well that sounds like exellent experience to me. The managers of our flight program must agree as ER nurses are not eligable to apply for flight jobs. They want at least three years ICU experience. Currently our flight program is fairly small and all of the RNs who work there used to work in our SICU.

rghbsn, BSN, RN · Nov 1, 2009

That's understandable considering that's what they do in your ED's. The negative aspect would be if you had an outside applicant with excellent trauma experience that was never given an interview because of a different ED/Trauma program. I agree that any applicant for flight (or ground transport) should have some good, diverse ICU experience. I worked in a couple different units as well as the ED before I ever tried to get a job in transport. I went to nursing school to be a transport nurse...I had looked at doing CCT as a medic or as a nurse, research told me that it would take me longer to get there as a nurse, but I would be paid better for it, so that's why I went that route. I put as much time and hard work into my ICU/ED experience as possible, all with the ultimate goal of improving my critical thinking and skill sets. I feel like it has paid off. I continue to research and study as much as I can to try to stay at the top of my game...for me, my program, and mostly for my patients.

pettite trauma · Dec 5, 2009

Welcome spacecoast! :)
rghbsn gives great advice and you got some well worn answers at FW as well.
I'll add - you appear to have a solid background, so that is an excellent starting point. If I am reading correctly you seem to have a year of RN experience and maybe a decade or so of fire based EMS as a paramedic. If that is correct ??? You are on the right path. I appreciate that you have a manger willing to recommend you - a good rep is golden! Keep it! You need to have a few more years experience (2-4 minimum).
There are many answers that outline the value of ED vs. ICU experience here and on FW. I don't have too much to add except --- you are out there with a partner that is a paramedic. You will be expected to bring the "nurse" expertise and unless you have some vastly differing experiences you/your partner will be in over your head from the get go. Not a comfortable or IMO even acceptable place to be.
Not sure of the geography (TX or FL maybe AL), but do some "informational" interviews with the flight companies in your area. Most are looking for exceptional folks and will give you an idea where you stand. If you are willing to relocate to get a chance to fly with certain companies - look at the "mission profiles" of those outfits as well. Maybe some introductions to a flight crew or two may informally give you an idea how to compare in education/experience and the ever important alphabet soup factor.
I could puff you up and tell you that you can fly right away and everything will be okay - and you likely could as the medic depending on the quality of your medic experience and the mission profile or quality of the flight company. If you simply must fly right away - just be prepared to do it as the medic part of the team for now. This does not imply any lack of ability - just an observation that the "effective team" has some synergy and the nurse must wear the "high end" critical care hat to the party. :clpty: Some medics do true CC transport and if that is you - woohoo! & you are so ahead of the game. IMHO these medics are quite rare.
One problem that I have had some unpleasant experience with is, in fact, the experience problem. You will find that some companies will require minimums for nurse or medic with 3 years each. The issue gets muddled when both have the bare bones minimum - the medic has been a medic three years and the nurse has three in the ED - these two become a team and disaster looms. Trust me and take this point with you - you DO NOT want to be in this spot and avoid working for any service that has teams comprised of the "bare minimum".
Most companies "bread and butter" flights are the transfers - IFT from lesser care to higher or more specialized tertiary care. Even the "scene" stuff in some areas includes strokes and STEMI's. Having some high end critical care experience is going to save the patient and save you and your partner. Depending on the flight program you may have some advanced procedures (inserting central lines, arterial lines, true chest tubes, etc) but these are skill based and can be learned; the indications and physio associated with these procedures (along with ventilator management/complex medical drips/balloons) - when, how and why they are used are what will be the vital role of the critical care RN. Example: imagine having never worked with art lines because you only have ED experience and then learning to insert and troubleshoot/manitain and monitor after being hired to fly or managing the complex ARDS patient all the while paired with a medic partner that has never even routinely programmed a IV pump for a dopamine gtt. Not just frustrating - but flat out dangerous. I'd like to think that flight programs that do critical care hire the cream of the crop, but the flight industry has grown rapidly and well, the quality of the "crops" can vary.
I guess my take away point is - get some really high end critical care experience. Mix this CC experience up and really challenge yourself. Keep you foot in the ambulance and your nose to the grindstone for a few more years. I am not trying to discourage you, just hoping to give you a snapshot of the realities (some harsher than others) that the under-prepared will face. I want you to avoid that. Sure, flying is cool and all that - but, it is just a way to get an often really sick patient from point A to B. It is a job and has inherent risks and challenges (this year has been less deadly, but 28 of my colleagues died last year) - so, be sure.
Your background is great. Plan for your CEN. Get that CC experience and after you are eligible sit for the CCRN. I say hold on the CFRN - as you do not fly now, so being certified as a flight speciality nurse when you are not working in that area IMHO muddies what board certification is all about - wait until to you are actually flying to specialize.
Be a wicked determined clinician and seek out the tough cases and use any PITA factor necessary (to a point) to learn from the best doc's and nurses and RT's that you can find to help you in your knowledge quest! Read extensively and work to add depth to your clinical practice. Sure, some places hold patients looking for a bed and some hold 'em until they have them so ****** that you will be lucky to get to the helipad with 'em alive. I really wish that I was bluffing on that one - but, I am sadly not. (Even the simple ones can be pucker worthy!) Be ready for anything!!!
Join ENA and ASTNA. You are on the right road - I just want to get you pointed to the right direction in the sky.
Best of Luck. PM if I can help further.

hey i like your optimism! i makes me happy..heheh..anyway..i too want to be a flight trauma nurse.Im 21 and just graduated out of nursing school and have set my goal on the flight nursing career.the skills and challenge is great, with the knowledge i can use it wherever i go and help others with no fear.

this coming february i am volunteering to be a paramedic and take a PHTLS course..my first step towards my goal. unlike others, i will have more obstacles because first and foremost i am from the philippines and there are no flight nurses here. the thing is..i am wondering if my experiece here would credit abroad. i understand that it takes more or less 7 years to get to where you are now and im willing to fight.also, is being a girl a disadvantage? im short and small too..hehe. i need some advise also from you guys here. thank you in advance and godbless.

FST6 · Dec 27, 2009

I guess my take away point is - get some really high end critical care experience. Mix this CC experience up and really challenge yourself. Keep you foot in the ambulance and your nose to the grindstone for a few more years. I am not trying to discourage you, just hoping to give you a snapshot of the realities (some harsher than others) that the under-prepared will face. I want you to avoid that. Sure, flying is cool and all that - but, it is just a way to get an often really sick patient from point A to B. It is a job and has inherent risks and challenges (this year has been less deadly, but 28 of my colleagues died last year) - so, be sure.

Excellent response! I couldn't put it better myself. ED + Critical Care experience makes for a well rounded flight nurse.