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Sorry to be the bearer of bad news, but HEMS is currently in a "bubble." As an example, you look at Philadelphia (where I'm from) and you'll see 6-7 helicopters all covering the same territory, based on a 10(!) minute flight time. If you were to open that up to a more reasonable 20 to 30 minute response time, there would be over a dozen helicopters (probably 16-18) all vying for the same territory and business. This is for an area where you can spit and hit a trauma center or burn center, either adult or pediatric. That level of "service" isn't viable. Out in the sticks, there is more of a need, but it is harder to support the service, plus you have a more "rural" attitude towards emergencies. People who live 90 minutes from the nearest town tend to accept that it's gonna take a while to get to the hospital. The problem though is that these areas can't support a flight service based on call volume. Prehospital response can't support a helicopter, and there isn't large enough interfacility need in the country. If a helicopter doesn't make money, it isn't in business (medicine is a for-profit venture, y'know.) The problem is, most of the HEMS interfacility transports are unnecessary, and largely for the conveience of the hospital rather then a need for urgent transportation (as strangely, some of the most critical cases aren't stable enough to go by air). Insurers (and patients,) who are getting stuck with ridiculous transportation costs, have already been paying close attention to reimbursements, and while they haven't really pushed back yet, you can feel it hanging there. With ObamaCare, a lot of changes are going to occur with insurers (as they will likely get more power then they currently have over the practice of medicine) and HEMS will take a hit (it's inevitable). That's going to mean a lot less jobs for flight nurses/medics, and lower pay as well (as people would do it for free if you let them). It's not a career field I'd want to aspire to. Ground critical care, on the other hand, may become a big deal, but that's another post, and not at all sexy.

There are a lot of threads on this, so it's worth searching. The best place to find the specific requirements of the position is via the service's page, as they all lay out both their requirements and preferences. In general though the short answer is you need to get a job in the ICU and work there for 3 years. Pick up every alphabet card you can get your hands on. Try to get your paramedic card. I'd try to float into the ED if I could, or get a per diem/overtime in the ER at the hospital you work. You may also want to consider some other options, as there is the strong potential for a major realignment in the next 5 years with regard to flight services. There are currently too many helicopters in some areas, troubling safety records, and some significant problems with finances. Once you lump in nationalized health care (assuming that exists after the Supremes get done), heli-EMS is going to be around, but hurting.

Generally speaking, yes. Getting a flight job is more complicated then just that, but if all other things were equal, the experience gained from a tertiary hospital will be considered more valuable then at the community hospital. However, for a larger hospital you need to consider what unit you'll work on, as you will potentially be a much less "well-rounded" nurse if you work in a specialty area. I would float or moonlight as much as possible if I worked in an area such as Neuro ICU, and would aim for Medical or Trauma ICU if my only goal was to work on the helicopter/airplane. I would also try to suck up to the ED manager to let me float/work down there as well. Another minor factor, but worth considering, is 'where do all the cool kids work?' If all the flight people have side-jobs (or primary jobs) in a particular hospital, and you know you want to work for that service, get a job there. A lot of the world is who you know, after all.

Your intrepretation is correct, but it doesn't matter, as the rule is bipolar as hell. If you are "on call on the employer's premises" you are "working while "on call"", and need to be paid for those hours. However, DOL doesn't care what you get paid, they only care that your total income is greater then minimum wage. So long as you are compensated at a rate greater then $7.25 (or your state's minimum wage) when including the overtime calculation, you're going to lose the fight. If you make more then ~$380/week, DOL is satisfied. Technically speaking, I believe there is case law that would support you being paid your full rate for the on-call working hours, but the hospital can simply adjust your base rate to make the weekly pay work out the same, which ultimately hurts you as now you make less when on legitimate overtime. You have no options aside from the potentially destructive (union, quit, or "blue flu"). Sorry.

Never in one of your classes, but we move in the same internet circles. I've seen your name either directly on indirectly on several mailing lists I am on, and I know people who've taken your reviews in Dallas.

Deep breath, Rio.. Mark is actually a "known" quantity in the world, as has all the alphabets because his primary(?) source of income is education--and it's hard to teach a review course if you can't show people you've passed the test. It's also a reasonable question to ask: There is no central clearinghouse for jobs (aside from flight web, which isn't comprehensive) and he did state that looking at all the different individual companies is cumbersome, so I'm not sure how it's "slothful" or you're "spoon-feeding" him information that he already clearly stated. Short answer--there isn't a clearinghouse that I know of. ADAMS Atlas & Database of Air Medical Services is what it's called, which could be helpful for your jobseekers, so they know what services exist in their target area.

I'm very late to the party, but I don't come here much. I would recommend making a new plan. Limited motion sickness is an acceptable thing, but not so much that you need medication. I start to get queasy during long-rides in the back of the ambulance when there isn't a patient (as the RN where I am typically moves from truck to truck depending on the run) but once there is something to think about (the patient) I've never been motion sick. Now, I just tell whoever is in the front-right to get in the back when we're going to/from the transport (RHIP) and then I never have to deal with it. As far as making yourself more marketable, working peds is probably one of the more valuable things you can do, as there are more open jobs with pediatric transport services in my opinion, but if you have both peds and adult, you're golden. I wouldn't worry about the background check, as it is no more stringent then another hospital employee (and if you work for a private service, usually much less).

EPIC will never be the "best" system, but it is highly configurable which is why hospitals seem to love it. That said, it's only as good as the people implementing it, and since they are usually bean counters or people so far removed from actually doing work--it generally sucks. The -BEST- thing you could do for yourself and your department, is convince as many members of your staff as possible to get on the working committee (if they have one) so that you can trial it and lobby to have it set up "well" for the ER. Many times, the folks upstairs are the only ones who have any input (ER doesn't seem to participate in these things, I've noticed) so it's marginally usable for someone on a floor, but completely unusable for the "treat and street" life in the ED. Since they sunk in a lot of money, you spent your time ******** about the fifteen screens of data you have to input, as your time is the least valuable commodity the hospital has.

Exactly as she says. You could have the log tattooed on your ass, and HIPAA wouldn't care. HIPAA cares about who you disclose the information to, not what information you keep. You would have to take reasonable precautions to prevent an accidental or unintended disclosure though (meaning you should keep it secured somewhere). However, as Debby says--your hospital probably has a policy against this behavior as part of their HIPAA compliance plan, therefore while it's not a de facto HIPAA violation, it would be against policy and could subject you to discipline if someone at your place of employment felt it was inappropriate. It would also be discoverable if there was some sort of legal action.

This isn't going to make you feel any better, but from my job search several years ago, I remember a very nice HR rep advising me that if I didn't get a job 6 months out, I wasn't going to. Once the next class graduates, you move to the bottom of the list. You've got the exact same knowledge as the newer people, but it's fresher in their brain. You may want to consider either moving to an area where they are desperate for help, going back to school for a higher degree in nursing, or if neither are an option, an alternate career field. Either way, good luck, and sorry.

It's a pretty boring but generally easy job. Most of the time you're just doing routine transports that aren't in any way "critical care". Since you're in New Jersey, which (so far as I know) doesn't allow Paramedics to do ALS transfers, you're going to do even more BS then an average transport nurse. I have heard that in northern NJ either they are trialing or have allowed paramedics to do some ALS transfers, but since it's new for the state, I'm sure there will be teething problems. Most of the peds tend to go by a pediatric transport service affiliated with a major tertiary care center instead of via the regular service, though since I don't know which service you're talking about it's possible you'd have to do both. You're almost entirely on your own, and have to exercise a lot of independent medical judgement, as there isn't anyone or any time to get orders or instructions from medical command once you've taken the transport. You also don't have the help that you're used to from working in a hospital. I haven't had a lot of patients code on me during transport (maybe I'm just that good) but when it does happen, It's just me, or I may be assisted by a paramedic. It's a different job. Most of the people I know who are successful are former paramedics (or at least EMTs) and used to working on their own without the resources of a hospital, but I do know several who had no prior "street" time and know of many more.

Many hospitals are going that way, though RNs are normally wearing either Navy Blue or white. Not all hospitals in Philly have implemented this though, and I know even less about the surrounding sub-/ex-urbs. For what it's worth, since no one is replying.

Travel and agency nurses, from what I can tell, is a pretty raw deal regardless of where or who you're working for. Competition was pretty fierce when I was talking to recruiters, which drove rates down well below regular per diem rates. In fact, some open positions paid less hourly then my staff position. The highest agency/travel position I've seen advertised locally is "up to $40/hr" which is around per diem rates locally, and at best marginally better then a benefitted staff position (much less overtime). It -seemed- to me that a lot of the agency people I bumped into were doing so while they were trying to get a staff position (as the job market still isn't very good). I do see some travel positions posted (actually quite a few of them for the region) but I don't have much more to offer. Personally, I would recommend AGAINST looking for travel work in the Philly/Camden area. Outside of the metro area, it might be better, but I don't know. It would be very easy to get screwed here if you don't have local knowledge, and the money isn't worth it.

I rode a motorcycle to work every day, unless it was going to rain on my way in (then I would beg my wife to drive me). In the *ssh*le of Texas, it's 100°F+ throughout the summer. I didn't have any problems, but I don't wear safety gear in the summer, and I don't have much stop and go. If you're 'all of the gear, all of the time', stop 'n' go, or in a very hot and humid place, it's going to be a consideration. My biggest complaint was riding -home- in the rain, but eh.

While it's unlikely you'd ever see this done, it's even less likely at a "real" trauma center. It's an ATLS skill solely for the sites that don't have ultrasound (much less CT) available. That said, as far as a diagnostic skill goes it it pretty worthless. If there is a high suspicion of an ABD bleed, you'd be better off sending it out anyway as once you perform a peritoneal lavage, you've just killed those other two tools (which will give much better, more complete information anyway.) From a historical standpoint, however, it's an interesting skill. It makes you appreciate the technology we have now.

That's the million dollar question, and everyone is trying to answer it. I personally would recommend going back to school. MSN, MPH, Clinical Nurse Leader ... something. It should reset the clock once you graduate (again), and hopefully things will have recovered by then.

I don't think "relocation" is as easy as you think it is. Most places that still have jobs are pretty savvy about people moving to get experience then bouncing back later on, and won't consider you as a candidate. Out of the dozen or so interviews I had, all of them had pretty probing questions on why I was interested in moving, several of them downright suspicious. Many applications from the Philadelphia area are simply ignored, one recruiter telling me that she "as a general rule, don't consider people from Philadelphia because they aren't usually a good fit" mainly related to the fact that it was a rural Texas town and things are much different from the Phila Metro area. One recruiter asked me where I was in Pennsylvania, and when I told her I was near Philadelphia, I had to spend the next ten minutes trying to keep her on the phone because "she has had bad experiences with people from big northeastern cities." Both of those conversations turned into semi-productive ones for me, but the general consensus is that it's hard for people from the northeast to "adapt" to other parts of the country, especially more rural areas. I've spent a lot of time out of the northeast (in fact, out of the country entirely) so I was able to turn their prejudice against the region in my favor, but at the same time I don't entirely disagree with their points. The first thing I do when I get to Philly, NYC, Chicago, or any other major city (even Houston, yuck) is gorge myself on "city food." Greek, indian, mexican (less of a problem in the south and Texas, but a b*tch to find in Wisconsin or Africa), sushi, you name it. I am also frustrated that the best shopping option is frequently Walmart. You get used to having "things" be that restaurants, shopping malls, public transportation, whatever. And many of the places that haven't been hit by this recession (as badly) don't have any of those things. To address your other questions: You can't wait it out. Once the next bacth of new grads comes out of the pipeline, you're pushed to the back of the line. Wait too long and you may become unemployable. Regarding the military, the first question to ask is 'do they have a job for you?' Recruitment is much easier in bad economic times then good, so they may not be recruiting as heavily, may offer fewer bonuses, and may even turn you away if they have too many applicants for limited slots. I don't know that first-hand, so addressing the military question would be better oriented towards the subforum here. If the military is your last choice, I wouldn't think you should consider it. It's not just a job, it's a lifestyle. You can't quit and it isn't a good fit for many people.

The job market in Philadelphia sucks. One suburban hospital just laid off all the new grads they had hired. Most hospitals in the city and surrounding communities are on total hiring freezes. So to answer your question, where are Philly grads getting jobs? Texas. One of the other lovely things that you should consider is that if you don't get a job within the next 6 months or so, you may become unemployable. Recruiters wonder what's "wrong" with you if you weren't able to find a position, and would rather choose a more recent graduate then try to determine if you'd be a good candidate or not. The one recruiter who told me this said she didn't know if the recent economic problems (and lack of jobs for new grads) may change that perception, but stated she doubted it because new nurses are continually graduating. So the best advice is: If you can, move. If you can't, go back to school, get your masters or something. Especially if you want to work in a hospital or other acute-care setting. Failing either of those, I guess you should jump at any opportunity you can, and hope to transition to the hospital when/if the economy fixes itself.

The problem with Ghana is the same problem as many other African (and other third-world) countries. They want money, they don't want solutions. Basic public health measures would go a long way, and they don't cost a fortune--they require someone with the knowledge to tell you not to sh*t where you eat. People complain about the inability to afford HIV/AIDS medicine in Africa, but condoms are affordable. They aren't used. Mosquito nets are distributed for free, but I've gotten comments about they are "too hot" (because the air doesn't circulate as freely through the net.) They aren't used. The first step to improving public health anywhere is convincing the people that how things are currently done is a problem! Education helps that, not money, and not 'programs' that are just as likely to be filled with corruption and graft from top to bottom. If you can't convince someone malaria is a problem, distributing anti-malarial drugs doesn't help! They just take the drugs and resell them. If you want to improve things in Ghana and elsewhere, take that $60 billion and invest it in the Peace Corps (or similar.) Stop p*ssing our money away on foreign aid. Ghana, incidentally, is sitting on a tremendous amount of natural resources, including large offshore oil reserves that were recently discovered (~2 years ago). It is probably one of the more stable countries in the region, and less corrupt then most. However, any money we send to that country without getting something in return (mineral rights, oil, etc.) is just money we've thrown away.

Don't bother going to 'medic school. In many states, you can (sadly) challenge into the position of a prehospital RN. Nurses generally get paid better then paramedics, have less stressful jobs and working conditions, better respect, better career progression, better hours. If you want to be a FIREFIGHTER and have reasonable expectation of getting on with a large, respectable department, then being a paramedic can pay off. However, on it's own merits, it's a hard sell.

Thank you both very much for the leads. I live near Philadelphia, PA. Area seems to be on a complete freeze right now, and since I went to a nontraditional school, I didn't make the contacts in the local hospitals that might have helped me. I would probably be able to get a job at HUP (Hospital of the University of Pennsylvania) because I worked there for a number of years as a hyperbaric tech, but they only hire BSN-prepared nurses according to HR. Le sigh. However, I can't complain, because I have the flexibility to go wherever I need to, and hopefully there are jobs somewhere. :) I will run down the information you've given me. I hope you wouldn't mind additional PMs or questions after I do some of my homework. If anyone else has any other suggestions, I would still love to hear them. Thanks very much.

This is basically a "post of last resort." I am a new grad nurse from Excelsior College with 10 years as a Paramedic. I am interested in the emergency room or any area of critical care. I've not been able to find a position locally, and am looking to relocate for a position. My wife is a Neonatal Physician Assistant, and would be relocating with me (which has added some complication to things,) however I have been told that my career has priority, as she can work locum or would consider working in another specialty. If -anyone- can help me, I would greatly appreciate it. Thanks.

This thread is a little old, but Renown has said they will not consider Excelsior grads until they have two years of clinical experience.

I think the only exception to this would be if you live in a nursing compact state where you hold a license. Your home state license is then good in all other compact states and I don't think you are supposed to get a license in the other compact states. Of course, that is mostly theoretically, because I don't think any state BON isn't going to take your money if you offer it, even if you're not "supposed to".

I stand corrected. Who says I never admit when I'm wrong. :)