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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Off to AMTC

Well, I am off to the great city of Minneapolis for the Air Medical Transport Conference. Should be an interesting week.

Anyone in the area interested in a Sweetest Day beer? Better yet, anyone else going to the conference?

Oh, and Mark? I almost cried when I saw that you won’t be there!

Just for the record, that is TweetDeck on my laptop. Scanman and Strong—thanks for keeping me company!

Now, I must prepare myself for flying commercial. Yeesh.

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Today’s View—From the Eyes of an Angel

It is simply amazing to go from the world of mortals to the realm of angels in a few short moments.

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Restocking a Traumatic Arrest

The acuity of a flight can, in most cases, be deduced by the number and type of supplies needed to restock the aircraft.

I took this photo after one of the most broken trauma patients I have flown.

It isn’t a great photo, but you should be able to play ‘Guess the Intervention’ with the equipment on the cart. I will post the actual equipment list when I locate which flight suit pocket it is in.

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Today’s View—end of this series of threes

Out of all the emergency medicine superstitions the one I subscribe to most is the belief that things come in groups of three. A week and a half ago it was three bad traumatic head injuries.

I after my second pediatric ICU transfer Friday, I told the attending physician I would be back. Although the PICU flight was delayed by 24 hours or so, I did my third today. He was absolutely adorable and sick as can be.

Glad that triple is over with.

As I sit here recouping from my three day shifts I thought I would give you Today’s View from my office window. Enjoy!

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Standby, It’s a Hard Life

All dressed up and canceled off of both the scene and the interfacility standby requests which were called in almost at the same time.

Bummer.

Guess we will head home.

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Today’s View–A River Runs Through It

Yesterday was long. Very long. We did around 4 flight hours going to the tip of the mitten, not once, but twice! Fortunately the weather was amazing and it has kept that way so far today.

Today, we took a trip over the river as we were headed up to our remote base. What an amazing way to spend a shift at work!

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Today’s View, the beautiful north

Wow. That is all I can say.

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I Want to Be A Flight Nurse When I Grow Up

I was asked why I wanted to be a flight nurse.  The question perplexed me.  The better question probably should have been:  Why wouldn’t I want to be a flight nurse? 

After my first bad patient flight as a flight medic, I knew this was what I wanted to do for the rest of my life.  It was like a tailored suit, custom made shoes, and a non-narcotic high all at once.  Never do I felt so alive as when I am in the air with a critical patient.  For that brief amount of time on a mission I was, and still am, completely immersed in what I am doing.  There is very little time to think about anything other than my patient.  Did I assess the situation appropriately?  Is there anything else on physical exam I need to check?  Are there any injuries I have missed?  Will my patient be better for them calling me?  Never, EVER do I feel more alive.

Out of the education I have had, finally completing my paramedic was the closing of the circle.  It was also one of the accomplishments I am most proud of.  I love being a nurse, but getting my medic license was one of the most difficult things I have done.

When working in the ICU as a nurse, I would tell people that I would have been a paramedic had it paid better.  Of any profession in this world, it is the medics and EMTs who I respect the most.  EpiJunky and Medic61 have put forth the topic of RN vs Medic—why don’t we get along?  My simple answer is that it is based on lack of understanding.  But, I digress.  I will save that for my post for next week’s NSR.

Where I was I going with that?  Oh yes.  My interacting with others professionals in my job. 

I deal with physicians, medics, firefighters, police officers, nurses, medical assistants, medical secretaries, not to mention the patients and their families.  The helicopter and flight suit bring an instantaneous aura of respect, but being able to interface, not offend, and play politics is such a huge part of what I do.  The flight suit only goes so far.  I still have to be on my game each and every day.

I feel strongly about changing perceptions of nursing.  I am so fortunate that I have the opportunity to do that by holding one of the sexiest jobs in the profession.  Well, sexy until I have to hose the puke and blood out of the aircraft at 2 a.m.!!

It is no secret that I love my job.  I consider myself so fortunate that the stars aligned and was able to earn a place in a flight program.  It combines my love for working the street, the skill it takes to be a nurse, and the advanced education of being a Nurse Practitioner.  Oh, and being able to shock someone at 2,000 feet adds that little extra something.

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What is a Flight Nurse, Exactly? Part II: The Cool Factor, vBlog No. 5

I thought that in Part II of “What is a Flight Nurse, Exactly” the cool factor could only be described in living color.

A Flight Nurse is quite simply, Hope. Hope to patients, families and the communities they serve. They are also part of a crew who’s members are represented by the individuals here.

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