Tell Me About Flight Nursing

I was asked to assist a nursing student with a project in which he needed to explore a specific type of nursing of his choice. I was honored and excited that he chose flight nursing. Below is my answer to him and thought it would be a good overview for anyone thinking about becoming a flight nurse as well.

My official name/title is:

Emily J. Bennett, MSN, RN, APRN-BC, CFRN, CEN, CCRN, NREMT-P

(Nursing and its continued plague of credentials for “credibility” makes me insane, but it is the game we play)

I am educated as an Adult Acute Care Nurse Practitioner, I have nursing certifications in flight, emergency and critical care and am also a paramedic.

To fly with us, very little of that is actually required. As our hospital makes it a priority to have a BSN, we usually start with that, but we have nurses educated at the Associates level and most have the intent to finish their BSN. In addition to being an RN, you must also be licensed as a paramedic due to the requirement in the state of Michigan that all advanced life support “ambulances” have a medic onboard. This combination of RN and Medic is very difficult to find. Beyond the typical licensing, on a whole, experience is usually much more important to us. We look for someone who has 4+ years minimum experience in a busy ED/ICU. Any street time as a paramedic is a huge bonus. It doesn’t matter if it is Peds ICU or Adult ICU, simply that there is ICU experience. ED experience at a level one trauma center is best.

Other credentials we look for before hiring but at a minimum are required after starting are:

BLS–basic CPR
ACLS–Advanced Cardiac Life Support
PALS–Pediatric Advanced Life Support
NRP–Neonatal Resuscitation Provider
ATCN or TNCC–Advanced Trauma Care for Nurses or Trauma Nurse Core Course
ITLS or PHTLS–International Trauma Life Support or Pre-Hospital Trauma Life Support

We also require speciality nursing certification (CFRN) or one of the others related to flight nursing within 2 years of hire.

There is a huge personality requirement for the job as well. You must be loyal to the team and willing to do what needs to be done in order to learn, keep your team safe and pitch in when needed—even if it means sacrificing time with your family. We are close knit and need to be so because there are only a few nurses trained to cover 36 hours a day. It isn’t like we have the ability to just ask for a nurse from another floor to come take a patient load. We operate in an environment that is the equivalent to providing patient care in the something the size of a closet on its side, many times in the dark with only 4 hands and without your sense of hearing. It can be overwhelming, intense, and many times, emotionally difficult.

You have to be confident without being an arrogant prick as well. By wearing a flight suit, we take responsibility when no one else wants it. That is what is expected of us when we land at a scene or show up at a hospital. If we start to panic or can’t function, even if it takes us awhile to figure out what needs done, it can (without meaning to be too dramatic) kill someone or your team.

Ok, enough with the dramatic…..

We work 12 hour shifts (7a-7p, 10a-10p, 7p-7a). Unfortunately, it isn’t uncommon for us to get a a late flight stretching that work day from 12 top 14+ hours. If you get a call right before you are supposed to leave and your relief isn’t there, you take it. When I get home late, it is never much of a surprise as it is part of the job.

During a normal shift we arrive about 15 minutes before and get report from the off-going nurse. We brief with the entire crew, our dispatcher and someone from maintenance. During that time, we discuss weather, what is going on with the aircraft, any medical equipment issues, etc. After briefing, the crew checks the aircraft. The pilots do a pre-flight, the medical crew (2 nurses or a board certified ER physician and a nurse) checks all the medical equipment against a checklist to ensure it is there and functioning. After that we essential sit and wait for a call. We each have an office and always have other projects to work on so time isn’t wasted.

A typical call begins with the dispatcher (flight communicator) being contacted by a hospital or an EMS agency. We are notified over our radios that we have a flight and the pilot makes the decision if we can go based on the weather. Once we are cleared for weather, one medical team member gets the information for the flight, while the other packs the blood (we carry 4 units of PRBCs) and grabs the laptop. The pilot pushed the helicopter out onto the ramp and we launch.

During the flight, the medical crew preps what we can for the call. This may be looking up diagnosis/drug information on our iPad, starting the chart, or rearranging equipment. Depending on how critical the call is, or how frequently the crew works together, we may also verbally plan our roles for the call and our patient care.

After getting to the patient, packaging them for transport and making whatever phone calls we need to, we take them back to the aircraft. This sounds simple, but keep in mind that we have the capability to do everything from advanced airway management and ventilator support to emergency child birth to balloon pump transfers. Some calls may take up to 5+ hours depending on how critical or far away someone is.

The logistics of patient transport is probably the most interesting component of what we do. Don’t get me wrong, the intubations, chest tubes and flying are all sexy, but getting the patient from point a to point b dealing with everything from weather, to hospital bed availability to specialist unit/physician availability is very challenging. I can tell you crazy logistics stories like taking a patient straight to the OR in the wee hours on a Sunday morning so a cardio-thoracic surgeon could emergently crack a chest to patch a hole in a ventricle. That type of call requires mobilizing about 5 departments, 40+ people, a helicopter and all during abnormal hours. Successful coordination like this happens because our flight communicators are incredible. For a normal flight they take or make 35+ phone calls. For one like that, I would guesstimate upwards of 50. Fortunately, not all of our calls are that difficult or intense, but the moment we let our guard down or become complacent is when we fail.

When asked advice for becoming a flight nurse I usually suggest patience, tenacity and focus on the goal of flying. Flight nurse positions are rare, but luck favors the prepared mind. I’ve seen people who want to fly, and look good, but do nothing to prove they want it. Those who succeed, are aggressive at growing in the nursing profession by obtaining as many of the classes or certifications possible and taking opportunities to work in different areas. The successful flight nurses are the ones who learn to function in areas where they aren’t necessarily comfortable, don’t know everyone or where everything is but give great care anyways.

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