FlightJunkie

If you really want to be a flight nurse, then you have to try harder than everyone else :) Seriously though, you do need to be a clinical leader with solid experience and excellent critical thinking skills. You also need a solid foundation of knowledge. To start, when you graduate, get into a ICU or an ER. A big hospital is a plus. The definition of "big" is a bit ambiguous, but the important idea is that you get a job somewhere that gets all the patients. You want experience with sick sick sick, busted up, burned, bleeding, bent backwards, chewed up, crushed, and popped. ICU and ER will get you good experience, although with different perspectives. Level 1 trauma ER experience will let you see it all, from all age groups to all diagnoses and disease processes, plus exposure to all of the complex skills that Flight Nurses typically perform. ER will not generally teach you how to REALLY care for a critically ill/injured pt though. You stabilize in the ER and ship to the ICU. The ICU will teach you much more about pathophysiology (yes, that stuff is important so don't blow it off in RN school) and will make you MUCH more comfortable spending 12+ hours every day taking care of that person. That being said, most flight programs require at least 3-5 years of experience prior to being considered for a position. Many also require certification (CCRN or CEN) prior to applying or at least within one year of hire. Some also require obtaining CFRN cert within one year of hire also. So, go to an ICU, ER, or both and get all the experience you can. Always ask for the sickest pt you can find. Never be afraid to take any pt but know when you are over your head and ask for help. Good Luck! Aaron RN BSN CEN CCRN ER/CVICU/Flight RN

I agree with most of what everyone said. I would personally shy away from burn unit at first if your goal was to fly. It seems as though you want to go on to another unit and gain more experience before trying to fly though, so this may not be an issue. CEN and CCRN certifications are good. One is not "way easier" than another. They each have a different focus. I love how ICU nurses pish posh the CEN and are shocked when they fail because they didn't anticipate questions about: peds, triage, mass casualty, trauma procedures, chemical/bio/hazmat exposure, OB... Unless you come from one of these areas specifically, ICU doesn't prepare you for them. I could just as easily said that the CCRN was easier than the CEN because hemo's are easy (for me). Anyways, being a paramedic, you have an upper hand on a lot. I would not recommend that you get the CFRN cert though. It would look a little funny seeing as you do not have any experience as a flight nurse. You COULD however obtain CCEMTP certification (if you don't already have it) and maybe start studying for the FPC (which I've heard is a freak of nature HARD test from paramedics). Good luck to you and your aspirations, it is a fun road Aaron RN BSN CEN CCRN ER/CVICU/Flight RN

Enjoy it! You just found the best job in the world How is it coming along?

I encouraged GNs to go for their dreams. I believe that working ER or ICU is as much a personality fit as one of capability, knowledge, and desire. I have precepted GNs as well as floor and ICU RNs, and I can say without hesitation that there is no magical way to determine who will do well and who will not. Some people are going to do well and some won't. This is where personality comes into the equation. If a 15 year veteran of an ICU can't handle the ER does that make them a bad nurse? NO. I know a lot of great ER nurses that would blow chunks as a floor or ICU RN because it just isn't their personality (and I'm not even going to get into burn units, L&D, NICU, etc). That being said, I disagree with the old mindset that you have to have a certain number of years as a medsurg nurse before you can do anything. For some people, I would agree, but not all. I was a ER tech going through nursing school, and then stayed there when I graduated (level 1 trauma/burn, STEMI, CVA center that sees 90,000+ per year). If you really want it, you can achieve it. You must listen to your preceptors though, they will guide you through orientation and give you feedback. If, in the end, they do not feel that you are ready, then be willing to look at other options. If you are determined enough, have a strong desire, and apply yourself, you can be very successful! I am who I am today because I had a strong will and desire to be the best nurse I could be. I always looked for the sickest patients. The advice I give to everyone I precept is, "don't be afraid to take any pt, but know when you are over your head and ask for help." This is the only way to learn. What frustrates me is hearing someone say, "I don't want to take that pt, they are too sick, I won't know what to do." That's a guaranteed ticket to dragging that nurse into that room so they can get exposure, get over their fear, and begin to learn how to take care of that pt. Aaron RN BSN CEN CCRN ER/CVICU/Flight RN

Great things said here and I can't agree more. I think a lot of it has to do with personality. Some are wired for it and some aren't. Even if you aren't "wired" for it, that doesn't mean you can't learn to be a good ER nurse. I would say just keep an open mind and listen to your preceptors. I've precepted nurses from GN to Floor RN to ICU RN and there is not formula for predicting how each will do. I've seen all be extremely successful. In my opinion though, the ICU RN tends to have problems with time management. Some simply cannot grasp the fact that they have to move on to other patients. You cannot spend hours with one pt and let your other pts be neglected because you are stuck in your ICU routine. This can be a big issue, in the ER, your job is to find the easiest quickest way to get it stabilized and done, take your time and you are doing a bad job. In the ICU, your job is to take your time and be thorough. The easy quick way is not an option there and your patients will suffer. See the difference? This is just a common thing I have seen with some ICU RNs, and not all have this issue. I wish you well. The ER is my first love and I know that you can absolutely love the job! Aaron

Excellent book, I've read it twice (both editions). Can't say enough about it!

Usually I am all for GNs going for their dreams. The right person, with the right personality and motivation can overcome the extra obstacles in critical care nursing. I say this because in most aspects of nursing, there are all sorts of resources available, from experienced co-workers, to great internship/training programs that support graduate nurses. I simply do not agree with the old mindset that everyone has to have 2-4 years of medsurg experience under their belt before going into ER/Critical Care. Transport nursing is entirely different though. A brand new transport nurse is already expected to be not just good at their skills, but known as a clinical leader in their previous units. They are the go to people that have solid experience, phenomenal clinical judgement, excellent assessment skills, and the proven ability to apply it all within minutes to a badly injured/septic pt in a tin can bouncing through the air at 140+ miles per hour. No graduate nurse should start here. It does not matter what experience you have in other fields, you do not have what it takes, as a GN, to fulfill this role. I usually am all for GNs stretching themselves and going for their dreams, but not here. The flight program I work for REQUIRES: 3+ years experience in ER/ICU and CEN or CCRN (I have both) certifications as well as all the usual stuff: BLS, ACLS, PALS, TNCC, ITLS, NRP, ENPC, ATLS, etc, etc, etc. A GN getting a job in this field is like an MD that skips residency and starts practicing in neurosurgery right out of med school. Sorry, I know it's not what you want to hear. Go to an ER and/or ICU and get your skills down. Otherwise, you may end up looking like a fool being in this role and not having a clue what anything is about. PS: All this isn't taking into account the increased hazards and safety risks associated with flight. This is a very dangerous job and if you cannot appreciate that or have any idea what I am talking about then you are certainly not in the right place. Aaron

No, I don't believe there is a waiting period to retest. Register and retest ASAP! Also consider a CCRN review on iTunes. Give yourself a couple days, listen to those, and then go hit the test again and pass!

I'm not gonna sugar coat it. This is the ER, do what you can to make it a better/safer environment, but it is what it is. It is busy, hectic, chaotic, energy zapping, life altering. You love it or you HATE it. My advice to you is to either accept this is the craziest most horrible job you'll ever LOVE and drink the cool aid... Or go somewhere with a nice easy pace. I'm not making any judgements on you or why you are having personal struggle, but I will say that the ER is as much a personality fit as anything else. Sounds to me like you might enjoy a different kind of nursing. -Aaron RN CEN CCRN, ER and Flight RN.

The CEN examination is not an easy one. It is very broad, specific, and virtually anything is possible to see on the test. That being said, the BCEN offers a good guide on what topic are covered and to what extent. I remember taking mine and wished I had studied more about peds and environmental/disaster stuff. I passed, but I quickly saw my weak spots. Expect to see trauma, shock, cardio and MI stuff, pulmonary questions, GI, DIC, sepsis, DKA, peds, disaster/environmental and poisons, plus all kinds of other stuff. The test is specific but I do not believe they are trying to "trick" you. I passed and I studied the core curriculum and also took a Jeff Solheim webinar review course. I passed with a good score. It is a challenging test, so study and stay focused!

For the record: you are in a great place to start thinking about where you want to work, about 90% of my nursing class already had a job about three months before they graduated. Keep in mind that anesthesia is as stressful, if not more, than an ICU pt. CRNAs are required to have ICU experience so they are not only used to critically ill patients, but also because they need to have experience with titrating vasoactive drugs and vents. I have done ER and ICU and they are both stressful for their own and very different reasons. Almost ALL CRNA programs do not consider ER experience for this reason. ER nurses rarely get much experience titrating multiple gtts at the same time, and when they do, it is usually an experienced former ICU RN that is willing to suggest doing so in the ER.

Depends a lot on what you got into trouble for. A drug or alcohol related offense can be overlooked if you have worked through it and have received treatment. Child or elder abuse pretty much bars you for life I believe. So it really depends on the circumstances: how long ago it happened, what have you done to rehabilitate, why you did what you did, etc... That's why they can't give you a straight answer. My advice is to evaluate what you have done, and have done about it. They really want people to be nurses, and give people a second chance if they can prove they deserve it.

I have been an ER nurse for over four years now (and an ER tech for 2 before that going through RN school). I successfully wrote my CEN exam about three years ago. Yesterday, I successfully negotiated the adult CCRN exam. I wasn't sure how the test would go. I have read a lot of posts with people saying the CEN exam was "easier" than the CCRN exam. I would say that the tests are equally difficult, just different. People can talk a mean game, but take an adult ICU nurse and start asking them Peds questions, or chemical exposure and mass casualty questions and they might start speaking a different tune : ) All fun aside, they are both very difficult tests. The CEN is very broad in general, as it should be, but also very specific in nature making it a difficult test. The CCRN exam is focused on critical care thinking, and not necessarily on experience. It places a lot of focus on cardiac, cardiopulmonary, and multi-system areas, with a lot of other flavors added. If you can think through the physiology and pathophysiology, you should be able to write this exam. Make sure you study hemodynamics! Know your heart pressures and how to interpret them. Also know blood gas analysis, serum chemistry, DKA and HHNKS, sepsis, DIC, etc... It was a lot of fun taking the test actually, and I had a lot of fun studying for it. Good Luck if you choose to take it as well! PS: there is a great CCRN review on iTunes. Also used Pass CCRN and the disc is good.

In my Level 1 trauma center, the ER nurses are treating all traumas until the go to the OR, ICU, get discharged, or go to the morgue. ICU does not respond to our department and we do not take them as floats either. The only place I know of that has an exclusive Trauma RN position is Shock Trauma in Baltimore MD

My best advise for you is to get the ER core corriculum, or a good CEN or CCRN review guide. That way you get ALL the info, assessment, labs, intervention stuff you need. It will serve you well your first year as a critical care nurse (yes, in the ER you are a procedure nurse AND a critical care nurse). This will also help you understand why we do what we do, and prepare you for your eventual CEN and CCRN certifications = ]