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I recently had a chance to interview Only In The ICU about her experiences with being a flight nurse. She really blew my mind and I enjoyed this interview so much. Have you ever wondered about being a flight nurse? Then you are going to want to read on.
What is it Like to be a Flight Nurse?
Tell me about your nursing career journey (basically what school, which units you have experience on, certifications)
“I worked as a medical assistant in a doctor’s office for several years, then applied to a LVN program and didn’t get in (don’t forget to get your juvenile record expunged before you apply to nursing school folks!). I got that cleared up, then ended up doing an ADN program at the local community college and got my RN. I graduated during one of those times that was really difficult for new grad nurses to get a job, so it took me a year to get into a hospital. Luckily I was able to work as a nurse in that doctor’s office while I was looking. It ended up being worth the wait because I got into an ICU new grad program. After 3 years of working in two different large mixed ICUs (neuro, cardiac, med/surg and trauma), one being at a level II trauma center, I took a flight nurse position. After 3 months I decided it wasn’t for me and went back to working in the ICU. As far as certs, I have my CCRN and have taken TNCC.”
Why did you want to do flight nursing?
“I’m not one of those people that has ALWAYS wanted to be a flight nurse. I didn’t even know it was a thing nurses could do until I started working in the ICU. Then it was on my radar as a possibility of something I could do in the future once I had enough critical care experience. The opportunity then came up, I met all the requirements, applied, got an interview, then an offer. It happened really fast. I liked that it sounded like a challenge and would force me to learn how to work autonomously. I also wasn’t entirely sure it was going to be right for me, but I knew I could get my job back at the hospital so I just went for it.”
What’d you expect it to be like?
“Ok so first a little flight terminology. Fixed wing is a plane and rotor is a helicopter. I was hired to primarily work fixed wing but to be cross-trained for rotor. In flight there are two different types of transports, scene calls and IFTs (interfacility transfers). Scene calls are like when you land on scene of an accident or rendezvous with an ambulance anywhere you can land a helicopter and pick up a trauma, stroke or MI patient to take them to a trauma, stroke or cardiac hospital (all time sensitive). IFTs are transferring patients from one hospital to another for a higher level of care or specialized treatment not provided at the sending hospital. Rotor does all of these calls. Fixed wing can’t land at a hospital or a scene so we only do IFTs (by utilizing an ambulance to and from the airport and hospitals).
So since I was primarily going to be working on fixed wing, I was expecting mostly IFTs with ICU-type patients, therefore within my comfort zone. But I also knew that I would need to learn how to do scene calls (which was prehospital and could include pediatrics, babies and OB), definitely not my comfort zone! I knew I’d be doing 24-hr shifts like a fireman. I knew I’d be taking about a 30% pay cut – yep pay CUT. I also knew it was dangerous, but didn’t quite realize how dangerous. I remember telling myself, “well I’m probably more likely to die on my drive into work.”
How does one become qualified to be a flight nurse?
“Most companies require 5 years critical care experience (either ER or ICU, preferably both) but some only require 3 years. As far as certs, you have to have BLS (basic life support), ACLS (advanced cardiac life support), PALS (pediatric advanced life support) and NRP (neonatal resuscitation provider). I got my PALS during my interview process and did my NRP during orientation. Having trauma experience is required and having a trauma cert like TNCC looks good. Having a specialty certification like CCRN or CEN looks great too.
I didn’t see this as a requirement, but having an EMS background is also important. Being familiar with the pre-hospital setting is super helpful. Many flight nurses I know are also paramedics. I had never even stepped foot in the back of an ambulance when I started flight nursing, so my learning curve was steep. Another helpful background is ground critical care transport (CCT), especially if you’re planning to work fixed wing. I wish I had been familiar with what it feels like to be on the move with a patient with a bunch of transport equipment. The only thing I could compare it to was when you have that unstable patient in the ICU with an EVD, on the vent, multiple drips and you have to take them to MRI and that stupid MRI compatible IV pump won’t stop beeping.”
What was training like?
“I did all my training on rotor, so it was a lot of scene calls. It was an intense 2 months. I did a lot of classroom and online learning, and then worked with a preceptor for several weeks. It’s not only medical stuff you need to learn… there is a whole layer of aviation terminology and information as well. I had to learn ventilator management (rude awakening to how much I relied on respiratory therapists in the ICU!), drug dosages and how to perform life saving procedures like intubation, surgical crics, needle decompression, chest tube insertion and escharotomies. I practiced on mannequins and in a fancy simulation lab. I also went to a cadaver lab and practiced procedures on cadavers (my finger got so cold inserting a chest tube because one of the bodies was still frozen!). I practiced surgical crics on pig throats and ventilator management on a set of pig lungs. The only procedure I ended up doing on a call was an intubation. My hands were shaking and it took me two tries, but I got that tube. Going through training, I definitely realized flight nursing is the largest scope of practice an RN can have.”
What’s it like going on a call?
“My first call was definitely a wake up call that I was no longer in the ICU. The patient literally had been hit by a semi truck and my preceptor just kind of pushed me forward, stepped back and said go for it. Out in the field you don’t have a CT scanner or lab work so you rely heavily on your assessment skills and report from the paramedics. Another layer of difficulty with working on a helicopter is that your stethoscope is useless because the rotor blades are so loud, you can’t hear anything. ICU can be fast paced but not like flight pace. Ultimately we are a transport service, trying to get someone from point A to point B as fast and as safely as possible. For scene calls we try to keep the time from initial patient contact to being loaded in the aircraft to 10 minutes so its doing a bunch of things at once while you’re moving the patient – assessing, listening to report, packaging them up, performing interventions. If we’d get on scene and the patient needs to be intubated, we do that first then fly them. Sometimes someone is so critical, that you just scoop and run, and do procedures in flight on the way to the hospital.
Do you take orders from a physician during all of this, or do you just work under your own clinical judgment and protocols?
“We have a medical director and guidelines but it is mostly clinical judgment. That’s why a lot of people believe flight nursing is the best job, because you get to be very autonomous. Of course with that, comes a lot of responsibility. Luckily you work in a team, either nurse and medic or dual nurse, so you can bounce ideas off each other.”
When did you know it wasn’t for you?
“It wasn’t a specific moment, more of a general feeling. The day I gave my notice in the ICU, I had two different nurses come up to me and say they personally knew flight nurses that died in crashes. The first week of fight nurse orientation felt like story after story of crashes and horror stories – the pilot having a stroke and the flight nurse having to land the helicopter, a combative patient attacking a pilot in flight. I didn’t even realize that the reason you wear a flight suit is because it is made of Nomex, a material that helps protect you from fire. They told us in orientation about wearing natural fiber underwear and bras, because synthetic fibers melt to your body when you’re on fire. They recommended we get strong enough boots so that if you survive a crash you would be able to kick out the helicopter window. Like OMG this job just got real, I have to literally worry about catching on fire and kicking out windows. I definitely had a “what did I just get myself into” anxiety attack after that first week of orientation.
There were a lot of factors deciding to quit and it wasn’t an easy decision. Any new job comes with so many emotions and anxieties, it was really difficult for me to distinguish what I was feeling and why. Is this new job jitters? Is this just a new level of anxiety I have to get used to with this new level of responsibility and danger? I am the first to admit I was so naïve going in. There were so many things I did not know and once I did, I had to reevaluate whether I was literally up for the job.
From doing my own research, my understanding is flight nursing is the #3 most dangerous profession after deep sea fishing and logging. People I talk to in flight absolutely LOVE their job and they believe it is the ultimate hands down BEST job. I knew I needed to take at least a few months and decide whether I loved it. I think you have to love it to make it worth the risk. I never had that I love this moment and felt it was better for me to return to the ICU where I do feel that way. It was a very personal decision involving many factors including safety, job satisfaction, pay, scheduling, level of responsibility and work/life balance. Flight nursing just isn’t for me. Shout out to the nurses that it is for and love it, you guys and gals are amazing.
Do you have any advice for people that thought they’d be really interested in a specialty and got there and decided it wasn’t for them?
First off, don’t be afraid to try new things and get out of your comfort zone. What’s that saying? Nothing grows in a comfort zone? I would recommend maybe doing a bit more research about a job than I did before literally quitting your day job. That said, I absolutely do not regret trying out flight nursing. It was really scary but I learned so much, both medical knowledge and about myself. I learned I totally have a confidence issue that I need to work on.
I think when you start feeling like the job might not be right for you, especially if its brand new, make a goal for a specific amount of time to trial it. I set a goal of 6 months. I didn’t actually make that 6-month mark, but I tried. I think you do have to give new jobs a bit of time to get over that learning curve hump. My sister and Mom told me that I didn’t love the ICU when I first started it and I was really scared and worried. I totally don’t remember that and am glad I stuck it out! Also, don’t feel like a failure if you try something out and decide it isn’t right for you. That is not failure. As nurses, we have so many opportunities and specialties we can try. Keep looking until you find your niche, and learn along the way. That’s actually one of the reasons I went into nursing and love it so much – it isn’t stagnant. It is literally impossible to be bored and be a nurse. Like if you’re bored, you’re doing it wrong.
Resources for nurses new to critical care
I have compiled a list of posts below, from this blog and others, of resources for newbies to critical care. If you’re really interested in becoming a flight nurse, having experience as a critical care nurse is very helpful.
- Tips for New Grads in the ICU: Showing Initiative
- Tips for New Grads in the ICU: Nurse Characteristics
- Tips for New Grads in the ICU: Be Your Own Advocates
- The FreshRN Podcast
- The NRSNG Podcast
- ICU Time Management Tips
- The Ultimate Guide to Creating an ICU Report Sheet (for new critical care nurses and nursing students)
- 3 Code Blue Tips for New Nurses (how to survive your first code)
NRSNG also has quite a few great resources for nursing students and new nurses. There are various courses, or the entire academy. The specific courses that would be valuable to the new ICU RN in particular include:
And finally, here are some books for newbies to critical care! Click on any of them to purchase.