Medic09

I don't know where you get that idea. Actually, many (probably most) flight programs have no provision for an NP working a more advanced or expanded scope than the rest of the flight nurses. The broad exception to that observation is that many NICU transport programs use NPs to good advantage. If someone wants to work as an NP on an adult program, they'll have to look around for a program that will allow them to work to the same scope that they would in-house. Again, it isn't all that common. I worked under two Chief Flight Nurses who were ACNPs. Their knowledge and skills were certainly a benefit to us; but there was no formal arrangement to define their job in-flight as any more than a flight nurse. They did come prepared to do some skills the rest of us didn't do; but it was more ad hoc. The biggest advantage we got out of them was their knowledge/education, more than actual skill performance. Based on my general experience, that is more often the case in flight programs across the US. YMMV, of course.

I'm sure opportunities will vary some with location; but I'll tell you what I learned in my locale. I spoke with two of the attendings I had worked with in the ER for a few years. They said they'd be very happy to have me as an NP; but they made it clear that all the cases that interest me most and always have - the cardiacs, significant traumas, and the like - would always go to the MDs. The NP role, as they see it, is going to be with the urgent care cases and the mild-to-moderate ER cases, depending on how busy the MDs are. The only way for me to work the full range of ER cases would be as an MD or DO. The story may be different where you hope to eventually work; but that's the case in the all the decent ERs within an hour's drive of my home.

Bluntly put, I wouldn't work for a company that would hire a new-grad nurse for air EMS or ground transport. No matter what they did previously as a paramedic. I say this as an experienced FP-C; and I still waited a couple of years out of nursing school (BSN) before being allowed to sit in the nurses seat for the same company. We've discussed this topic to death over the years over on FlightWeb.com. I suggest you go look at those threads, including a recent one. You'll see that most of us agree that an experience paramedic/new-grad nurse should not be allowed to fly as a nurse until they get a few years of ICU experience. ED can be okay, depending on the actual experience (I was an ER nurse); but ICU is a a much better preparation.

One more working Flight Crew Member here. I have to say nearly all of what FlyingScot has said is spot on. Saves me from saying much of the same. My first thought before I even finished reading the original post was "this person clearly hasn't worked in our industry." Having said that, I am very happy in air medical transport. I can't think of any other civilian job I want to do. The pay is not unusually good. We can work very long hours. (I work fixed-wing long-distance transports that can be as short as an hour or as long as 18 hours or more.) The physiological stressors of flight can leave one pretty worn at times. As noted, it is a job with higher risks than any other nursing job. ESPECIALLY, not only, if the company is not no-compromise careful about maintenance and safety. I will argue that the level of individual responsibility and initiative required in air medical transport (let's remember that the non-nurse partner is working the same job and responsibilities in the end) is much greater than anywhere else. Even a little more so than ground transport. Once you're in the air with the patient, you have only your partner and your gear that's on-board to handle everything the patient needs. (In some anticipated cases, like the patient on ECMO and a balloon pump and vent, you'll take extra staff to handle everything; but then there won't be much room to move if the sh*t hits the fan.) You won't be able to call a code and have a bunch of folks come to help, bringing additional resources with them. You won't even be able to pull over to have a quieter, more stable work platform. And often (usually) you won't have good communication with medical oversight. As noted, the percentage of fatalities from work accidents (read: crashing helicopters and airplanes) is way beyond that of folks working in-house. That kind of responsibility and risk doesn't suit everyone. The industry has changed radically, mostly for the worse; even in the ten years that I've been doing civilian medical transports. There are many more companies vying for business. As a result, many of them hire folks less suited for the job. Not just nurses and medics; but pilots and mechanics, too. Safety has suffered, and patient care has suffered. That is absolutely true in the industry overall. There ARE some companies out there with very high standards, as it should be; but that is no longer true of the entire industry the way it once (nearly) was. And to be clear, flight nursing isn't only in helicopters. Some crews work Rotor Wing (helicopters), some crews work Fixed Wing (propeller or jet aircraft). Some crews do lots of scene responses or EMS intercepts (especially in rural states); some do mostly interfacility transports. Many of the patients flown today in the US don't really need air transport. They get flown for any number of reasons; but what is for sure is that every unnecessary flight increases risks. But there is much more documented over-utilization of air medical resources than there was 10 or 20 years ago. As I say, I can't think of a better civilian job for me. But romanticized representations don't help the public understand the industry; and don't help nurses know what they can aspire to. I think it is a job to aspire to, if it suits one; but that needs to be done knowing what the educational and professional demands of the job are; what the very real risks are; and what the industry as-a-whole is really like. And yes, if one does want to do this job - be VERY selective about who you're willing to work for. Do the homework and be sure the bosses and employees will make maximum effort to try and keep you safe, be sure the standard of care is top-notch, and be sure you are given adequate and well-maintained and supplied resources to do the job. Be 100% willing to walk away from a job opportunity if it doesn't seem right for any reason.

I think you're characterization of Flight Nurse is really simplistic. While the statement may be true fairly often; it is often not true at all. Try working a RW job that does scene responses, especially for rural EMS services. Or try working FW that goes down to rural facilities or south of the border, and has to first prepare patients for the flight before heading back to the big city in the US or Canada. Sounds to me like you're only familiar with interfacility transfers in densely populated areas.

Flight nursing certainly belongs on your list. Subset of transport, but I'm making a bit of different emphasis. With interfacility transports, we are usually continuing care that has been started at the sending facility; tweaking things along the way. It includes very high level critical care medicine, such as transporting patients on multiple drips, pacers, balloon pumps - even ECMO. But Rotor Wing/EMS flight medical crews have even more autonomy, in my opinion. In addition to interfacility transports, they may arrive at a scene such as an MVA and initiate interventions, including some pretty advanced skills that are normally left to mid-levels and MDs/DOs in-house. All flight medical crews typically have an expanded scope of practice/skills, including a wide range of critical care drugs. When I work Fixed Wing interfacility transports, the medicine can be challenging but we don't do much initial decision making except for some really limited-capability sending facilities. In Rotor Wing/EMS flights the game can be wide open sometimes. Another factor is location. On our long, cross-country flights it may not matter. But working within rural states means a lot more reliance on the flight crew's knowledge and ability. It also means flying patients that in more densely populated states might not warrant air medical attention. In our state, for instance, all the NICUs are in the one big city in the state. That means frequent calls for Fixed Wing crews to go to smaller cities to transfer premature labors and other high-risk OB patients to the big city. Same for patients needing advance cardiac care. Another example is Rotor Wing EMS crews being called to provide ALS/advanced level intercepts for rural emergency crews on calls with complicated traumas or medicals, or long transport times to hospital. Once you're flying along with a patient in FW or RW, you are largely on your own. You and your partner have to shoulder total responsibility with limited communication and no other resources immediately available.

NICU transport is its own specialty in transport medicine; so NICU experience can certainly serve you well if you want that specific niche. The real answer to your questions is: it depends on the program you want to work in, and its managers. If you want to work in a fixed-wing, interfacility transport-only program then ER experience is far less important. Most (not all) flight programs use a crew of nurse and medic. The nurse's key role is to bring the skills and experiences that the medic doesn't have, and vice versa. The medic usually understands acute trauma and airway management better; the nurse should understand the critical care and med management better. Both get cross-trained to understand what the other does. Paper certs are far less important or considered than real education and experience. Time and again I've seen crew members and managers say they care little about certifications. Most managers and programs give you time to get a CFRN or CCRN, etc. What they really want is proven ability to perform and to learn, and to do so independently and responsibly. Bottom line? If there is a flight program that you have in mind, go speak with their program manager and/or Chief Flight Nurse. Ask them straight up, "what should I do to maximize my chance of working here in a few years?" That's the best step you can take.

I've worked small city ER, and rural clinic and ambulance, as well as air ambulance. Overall, I prefer the rural setting. It really is a matter of personal preference. Here's my take: All the really definitive care is in the metro centers. You won't be sending a patient from the rural ER to cath lab or surgery. You may not even get to initiate stuff like thrombolytic care in some places. BUT, in the rural setting you initiate the critical steps before handing the patient to a transport team for the trip to definitive care. In the rural setting it is harder to keep up some skills; but when you get to use them, your actions are decisive in their effect to stabilize a patient and keep them going till they get to a higher level of care. In the rural setting you have fewer people to fall back on if something doesn't work as planned. So the limitations can be frustrating, and it is harder to stay sharp and up-to-date; but you provide a unique service. Of course, the environment is a big plus in the rural setting as well. Personally, I think the best route is for a provider to get the exposure and experience of the big city for a few years, and then take that to the boonies.

PHRN is a pretty rare thing. Only a few states have it; so the folks in TX may not know what to do with it. (I don't, either.) Paramedic licenses are governed by the state EMS bureau, so they are the ones you need to speak with. They may not even know what PHRN is. Offhand, the only two states I know of that have this as an actual credential are PA and IL. CA has MICN, which is a little different. If you don't get a positive response from TX EMS bureau, go to them in person when you are there with the credential and curriculum in hand. If they don't transfer it over, maybe they'll let you challenge the EMT-P exam without having to go to school again. Be sure that PHRN included all the paramedic skills like intubation and reading twelve-leads.

I don't know about that specific class, but I can give you a heads up. MANY of the 'intro to statistics' classes for nursing students aren't really statistics classes. They should be called 'how to read a research paper'. Let me illustrate with my own experience with four different classes over the years. As an undergrad Psych major in Israel in the 70s I took 'basic statistics'. The class required doing a fair amount of math, and taught how TO DO the basic functions of statistics. In short, it was a math course like taking calculus or trig or algebra. In the 90s while doing a Health Sciences degree at Touro (undergrad) I had to take a 'quantitative reasoning' course. The course taught how to understand research design, without doing actual math beyond some examples. The final paper, though, required designing a complete quantitative research project without implementing it. Grading was based on project design and proposal. While doing my BSN, I had to take the university College of Nursing course in quantitative and qualitative research. I expected something like the course I just described. In fact, it was way less demanding or instructive. The course was basically 'how to read research papers'. It taught the basic terms and functions of research; but required no demonstration of being able to design (let alone implement) our own projects. All it covered was how to basically read and interpret published papers. No math. I also briefly took a graduate research class at the some CON. That class covered a bit more about understanding and designing projects, but still did not require doing much real statistical analysis math. Since CRNA is more of a medical model, it might require a real statistics class, rather than a nursing school research class. You definitely want to know if that is the case. I found that locally many courses that are offered for nursing prereqs are dumbed down from the 'same' course offered for pre-med. I would say that in any instance, the pre-med version of a course should be preferable. You will learn more (and work harder), and will be able to apply the course credits to more things later on.

Most places that offer the course (it is franchised from UMBC) state that it is open to nurses. I would say contact your local instructing agency or UMBC directly. That's the best way to be sure you get reliable information.

Check out some of the advice on Flightweb.com . You'll notice there that most folks think getting CFRN before the job won't make much difference. By all means, read some of the material such as Holleran's book; but don't stress over having the board cert before hire. Speak with the Chief Flight Nurse at your program and find out what they specifically look for. Ask to do fly-alongs on the fixed-wing, and to participate in whatever trainings and education they will allow. Since you want to work in that specific system, the CFN and other FCMs (Flight Crew Members) will be your best resource.

I recently had an interesting conversation with my Chief Flight Nurse regarding who we ought to hire, and why. The CFN is an NP who works in Neuro ICU. She has worked rotor wing and fixed wing flight jobs, and in house critical care nursing. She contended, and pretty well convinced me, that nowadays an ICU nurse is going to develop a lot more medical understanding and critical thinking than the average ER nurse. Especially if the ICU nurse works nights. Today's ERs are full of patients who aren't all that sick, and don't have emergencies. We spend a lot of time just rushing to keep up with the amount of patients. As a result, the new ER nurse will have to look more for opportunities to learn and understand complicated patho-phys and how to make decisions and implement treatments. My shift today was a good example of that. Within a four hour block I had two drunks with rule-outs, a bug bite, two simple fractures, a cardiac rule-out who was stable before I got him, and new onset CHF. That last one could be an interesting and mildly challenging patient - but I didn't have that much time for him after the initial assessment. The busy ER environment doesn't allow much for taking advantage of the chance to get really involved in the patho-phys, differential Dx, and Tx decisions and modalities. An ICU nurse is going to be seeing genuinely sick patients. There will be much more opportunity to hone knowledge and thinking skills. The nurse spends a lot more time with each patient. The ICU will confront you with educational and cognitive challenge; the ER might not give you the time to pursue similar learning.

'Medical escort' and Flight Nursing aren't the same in many/most people's minds. I suggest you visit FlightWeb. It isn't so busy these days; but still is the best online place for Flight Crew Members. Also check out ASTNA. Good luck.

It is interesting how people's experiences vary. Maybe the difference for me was being an older student with previous degrees. I was in a BSN program at a state university. For me, and some of my classmates, it wasn't rocket science. A person with reasonable intelligence could get through it in good shape with a modicum of effort. I hardly cracked a book, and still made Dean's List all but one semester. I actually wish I had studied more for the information I would have learned; but getting good grades and passing the NCLEX wasn't all that scary. I think many people blow it all out of proportion.