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How To Become a Flight Nurse

April 8, 2021 | Staff Writers

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Becoming a flight nurse is a great way to see the world. If you’re a registered nurse who is looking to get out of the world of hospitals and clinics, flight nursing lets you use your skills in an exciting and varied setting.

A flight nurse or flight paramedic is someone who takes care of patients when they are being transferred by air from one care facility to another, and those who have sustained serious injuries and who need critical care. A flight paramedic must be able to think quickly and provide patient care in an unusual setting where resources are limited compared to a hospital.

Some flight nurses provide air ambulance and emergency nursing services to rural communities. Others are attached to hospitals and transport patients who need highly specialized care that their home hospital cannot provide.

Flight nurses are highly skilled nurse practitioners who work in often challenging conditions and see a variety of cases. They can work in civilian or military healthcare environments and are respected by other members of the healthcare profession.

Why you should become a flight nurse

If you want to work in a fast-moving environment, treating people picked up from rescue missions, or taking care of critically ill patients being transferred for urgent procedures, flight nursing may be for you.

Flight nursing is a challenging and rewarding job that presents the opportunity to travel, often internationally, and be exposed to cases other nurses might not get the chance to see. It’s a fulfilling and interesting profession that leaves the door open for other high-level nursing positions later in your career.

According to the Bureau of Labor Statistics, the median pay for a Registered Nurse trained to Bachelor’s Degree level is $73,300. Nurses who hold an ADN are paid less than this. Flight nurses have an average base pay of $65,870, with the potential for higher salaries if they work for private medical transportation companies.

What personality traits are good for flight nurses?

Flight nurses work in unstable environments and many of their patients will be in a critical condition when they are picked up. This means the nurses must be able to work quickly and efficiently alongside other health care professionals in cramped conditions to provide life-saving treatments.

Flight nurses must be:

  • Highly skilled
  • Calm in a crisis
  • Clear communicators
  • Good at thinking on their feet
  • Able to maintain good attention to detail
  • Efficient workers
  • Physically fit
  • Comfortable flying
  • Comfortable working in confined spaces

It’s often assumed that being a flight nurse is glamorous, because of the association with aircraft. However, the reality is that some types of flight nursing can be high-stress.

Those who are associated with search and rescue, for example, may find themselves on-call and responding to emergency cases at all hours and in all kinds of weather. Even those working in patient transport will most likely be on call, because patients are usually only transported by air if they are in a critical condition, and moving them by land would represent a risk to their health.

Flight nurses go to places that traditional ambulances can’t reach, and work on patients in dire need of medical attention. They’re expected to work in challenging conditions and, because space is so limited on an aircraft, they are often working with less support than they would have for a similar job if they were on the ground.

The job of a flight nurse is not for everyone, but if you’re someone who thrives under pressure and enjoys working in a dynamic environment, seeing different cases every day, it could be for you.

The experience you gain while working as a flight nurse will stand you in good stead should you choose to move out of patient care later in your career. Many young nurses enjoy the travel and the exciting parts of the job, but find that over time the more difficult aspects take their toll. When they’re ready to take a step back they can move in to education, administration or informatics.

What are the benefits of being a flight nurse?

Flight nursing is some of the most exciting and rewarding work a nurse can do. Whether these nurses serve civilians or the military, they will have the chance to work with patients who desperately need the attention of a skilled medical team.

A transport nurse takes patients from one hospital to another that has the equipment or specialists needed to treat the patient. Those involved in emergency nursing work with people who have suffered severe injury or trauma. In both cases, the nurse knows they are making a huge difference to the life of the person they are working with.

Most people who get into nursing do so in order to save lives and contribute to the healthcare profession. Flight nursing is ranked alongside the ICU and emergency rooms in terms of the direct and immediate impact it has. One thing flight nurses can confidently say is that while other nurses are based in hospitals and clinics waiting for patients to come to them, flight nurses go to the places where they are most needed.

What is interesting about being a flight nurse?

If you ask an aspiring flight nurse what it was that drew them to the profession, it’s likely they’ll cite one or more of the following things:

  • A chance to make a difference
  • Working with interesting cases
  • Saving lives
  • Travel
  • A dynamic and challenging working environment

Flight nurses work alongside doctors, paramedics and other members of the flight crew to stabilize and care for a critically ill patient until they can be taken to a hospital. This requires a high level of skill, quick thinking, confidence and resourcefulness.

All nurses have difficult jobs, but flight nurses face some of the most challenging cases. Some patients picked up in emergency rescue missions are being transported by air because ground transportation may be too slow and put the patient’s life at risk. The flight nurse must stabilize that patient, treating wounds, performing resuscitation techniques, delivering IVs or medication and working to protect the patient until they get to the hospital.

Once the aircraft has landed, the job of the flight nurse is not over. They must liaise with the doctors and healthcare professionals at the hospital to ensure the handover proceeds smoothly and the patient receives the right care.

Good record-keeping, attention to detail and critical thinking skills are essential. These are things that can easily be forgotten about in a high-stress environment, but that emergency nurses are taught to pay attention to at all times. Accurate patient care records and the ability to make good decisions based on limited information in the field can be the difference between life and death for a patient.

Duties and responsibilities of a flight nurse

Flight nurses can work for hospitals, the military, federal government, fire departments, or attached to emergency search and rescue units. There are many private medical transport companies that have helicopters and air ambulances. Depending on the service they’re a part of, they may be providing emergency care alongside an EMT or flight paramedic, or keeping a patient stable as they are moved from one hospital to another.

What are the roles and duties of a flight nurse?

Flight nurses fill several roles, including, but not limited to, providing patient care:

  • Emergency first aid and care for critically ill patients
  • Looking after the comfort and well-being of the patient
  • Preparing notes and coordinating care with the receiving hospital
  • Performing aircraft and equipment checks
  • Assist the flight crew with communications or other tasks
  • Checking the stocks of medicines

Flight nurses are expected to be able to fill a flight paramedic role, perform advanced cardiac life support, maintain aviation safety and keep accurate records. Their jobs are demanding and can be stressful, but are also rewarding.

A transport nurse should be able to communicate clearly, with the flight crew, other medical professionals, and the patient. They will often find themselves dealing with patients who are very scared or in shock, and they must be able to keep those patients calm while treating them.

Seconds count in medical emergencies, and getting a patient secure, calm and stable can be a challenge. Once the patient arrives at a medical facility, the nurse will need to safely get the patient out of the helicopter or plane and complete the handover to the hospital staff. This means briefing them on the patient’s condition and any care that has already been delivered, and ensuring the staff is fully aware of any injuries, complications or issues.

Where does a flight nurse work?

Flight nurses are needed in a variety of settings, from the military to air ambulances for those in rural areas. Some large hospitals with highly specialized departments use flight nurses for the transport of patients who need urgent care. Search and rescue teams may have their own air ambulances and flight paramedics to provide emergency care for critically ill people following rescue missions.

Depending on what sort of service a flight nurse is attached to, they may be based out of a specific hospital or have the opportunity to travel extensively as a part of their job. Many flight nurses operate locally or nationally, transporting patients from rural hospitals to big city ones, for example. There are, however, some organizations, such as REVA, that operate international air ambulance fleets.

Educational requirements for flight nurses

To become a flight nurse, a person must first of all qualify as a registered nurse and accrue some experience on wards as well as in specialized settings such as the ICU or a trauma ward before they start flight nursing training.

The typical pathway to becoming a flight nurse looks something like this:

  • Earn an ADN and take the NCLEX-RN
  • Work as a Registered Nurse while studying for a full Bachelor’s degree (BSN)
  • Spend at least five years working in ICU or ER settings
  • Optionally, study for the MSN and become an Advanced Practitioner Registered Nurse
  • Gain experience working with ventilators and other advanced critical care tools
  • Complete the certifications required for flight nursing

It’s considered an advantage if a would-be flight nurse has some flight experience from other settings, but this is not mandatory. Medical experience is required, and the flight experience can be earned through training on the job.

What are the educational requirements for flight nurses?

The requirements for flight nurses vary from state to state. In some states, a flight nurse is permitted to practice with just an ADN and the NCLEX-RN. In other states, all registered nurses are required to earn a BSN within a set period of time after licensure.

Many nurses opt to go directly for the BSN, spending four years studying before starting to practice, because the BSN opens up extra opportunities for specialization.

Would-be flight nurses are encouraged to spend as much of their nursing time as possible in emergency departments and ICUs, because the majority of cases they’ll see as flight nurses will be ones that require critical care. Once they have at least five years of experience in these areas, they can pursue certification as a flight nurse.

At a minimum, flight nurses are expected to hold the Certified Flight Registered Nurse (CFRN) certificate. This certificate is open to all RNs who have an unrestricted license and is valid for a period of four years. Nurses are encouraged to have some flight experience before taking the exam, but that is not a fixed requirement.

The most common entry route into flight nursing is through one of the nursing degree options. There are options for people who are not entering nursing via this standard route, however. For example, a Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) can complete an LPN to BSN course to upgrade their licensure and become a registered nurse.

Paramedics can complete a Paramedic to BSN top-up course and may find their experience as an EMT gives them an advantage when seeking employment as a flight nurse.

What does training look like for flight nurses?

Training to become a flight nurse involves a mixture of academic study, classroom-based training and lab experience. Flight nurses are expected to have experience in ICU and emergency rooms, so they should already have experience with a wide variety of medical emergencies, such as:

  • Burns
  • Amputations
  • Pediatric trauma
  • Respiratory emergencies
  • Toxicology
  • Metabolic endocrine emergencies
  • Environmental emergencies

As a part of their clinical training, flight nurses are taught and tested on airway management, pediatric care simulations, tracheal intubations and a variety of invasive procedures. Performing procedures in a hospital ward is challenging enough, but performing them in the confines of an aircraft with limited equipment can be even more challenging.

Where can you gain experience in flight nursing?

One thing that would-be flight nurses often wonder is how they can accrue the expected two-year’s worth of experience when they aren’t qualified. Common routes into flight nursing include:

  • Traditional paramedic or EMT routes
  • Military experience
  • Flight experience from serving in a more limited nursing role

Most medical transportation companies will provide training on their aircraft protocols and safety policies for new nurses, but critical care experience is a must. There is very little scope for nurses to learn ‘on the job’.

Certifications required for flight nurses

The value placed on clinical experience means flight nurses are expected to have a significant number of certifications, showing their competency in various clinical settings and in operating medical equipment.

The job of a flight nurse is a varied one. Unlike some other specializations, where nurses know they’re going to be dealing with a specific type of patient or medical emergency, flight nurses could be faced with children or adults, burns, broken bones, hypothermia, heart attack victims or one of many other different cases.

Flight nurses train to be able to take on a variety of cases quickly, confidently and correctly. Before they take the CFRN, they will be expected to have several other qualifications and real-world experience of applying their training.

What certifications do you need to be a flight nurse?

In addition to the CFRN, flight nurses are also expected to have some other certifications, such as:

  • Advanced Cardiac Life Support (ACLS)
  • Basic Life Support (BLS)
  • Certified Emergency Nurse (CEN)
  • Critical Care Nurse (CCRN)
  • Pediatric Advanced Life Support (PALS)
  • Transport Professional Advanced Trauma Course (TPATC)

The above may look like a large list of qualifications, but they do not all have to be taken at the same time. Since nurses are expected to have five years of experience in an acute care setting before they take the CFRN, this gives them ample time to earn the qualifications listed above.

How do you get these certifications for flight nursing?

Let’s consider each of these certifications in turn:

Basic Life Support

The Basic Life Support (BLS) course is a short course that is offered by the American Heart Association for people who work in health care settings. It can be taken through blended learning or classroom-based training and teaches essential life support skills.

The BLS is aimed at those classed as ‘prehospital providers’, such as EMTs, firefighters and paramedics. Nurses who are going to be working outside of hospitals will find the course useful for delivering emergency life support, helping keep patients alive until they get to a facility where they can receive more advanced care.

The BLS is valid for two years and takes less than four hours to complete.

Advanced Cardiac Life Support

The Advanced Cardiac Life Support (ACLS) is a more advanced qualification offered by the American Heart Association. This course is similar to the BLS certification in that it can be studied in a classroom or through blended learning, and the certification is valid for two years.

The ACLS is aimed at healthcare professionals who deal with cardiovascular emergencies. This includes both in-hospital workers and EMTs or paramedics. It covers both in-hospital and pre-hospital scenarios for patients with cardiopulmonary arrest, acute dysrhythmia, stroke and acute coronary syndromes. The certification uses a combination of theoretical skills and hands-on application using a manikin.

Certified Emergency Nurse

The Certified Emergency Nurse (CEN) exam is run by the Board of Certification for Emergency Learning. This exam is aimed at nurses who work in emergency departments. To become a Certified Emergency Nurse, a person must have a valid and unrestricted Registered Nurse license in the United States.

Nurses who earned their license abroad may also be eligible, but they will have to contact the BCEN to confirm whether their license is recognized. There is a formal International Credential Evaluation service that handles international applicants.

The exam covers a variety of topics relating to acute patient care. The CEN certification is considered valuable for nurses who plan on working in the ICU or emergency departments, so it is a useful qualification to have even for someone who later decides that they don’t wish to continue on the path to being a flight nurse.

Critical Care Nurse (Adult)

The Critical Care Nurse (CCRN) qualification focuses on critical care for adult patients. This qualification is issued by the American Association of Critical Care Nurses, and it is aimed at nursing specialists who directly care for acutely or critically ill patients.

The CCRN (Adult) qualification is particularly useful for nurses working in the ICU, CCU or trauma unit of a hospital, or for those who are hoping to move into the world of medical transport.

To be eligible for the CCRN (Adult) a nurse should have a current, unrestricted RN or APRN license. The nurse must also have at least 1,750 hours of experience in critical care settings over the last two years, with half of those hours being in the last twelve months. Alternatively, they must have 2,000 hours of critical care experience in the last five years, with 144 of those hours being in the last 12 months.

The examination covers a variety of topics relating to critical care best practices and procedures, testing both clinical knowledge and soft-skills.

Pediatric Advanced Life Support

The Pediatric Advanced Life Support (PALS) course is offered by the American Heart Association and is aimed at medical professionals who respond to emergency situations involving children or infants. The course is aimed at doctors, paramedics, EMTs and other emergency responders as well as those who work in critical care units and emergency rooms.

The PALS qualification is important because there are many differences in life support protocols for children and adults. This qualification equips emergency responders to support young patients appropriately. The course is offered in a classroom setting and via a blended learning option. The full classroom course takes 12 to 17 hours, factoring in time for breaks and the certification is valid for two years.

A shorter recertification course is available for those who have already passed the full course.

Transport Professional Advanced Trauma Course

The Transport Professional Advanced Trauma Course is a two-day course run by the Air and Surface Transport Nurses Association. This course combines classroom-style learning with practical sessions to teach advanced patient transport practices.

The course covers how to recognize and safely handle patients that are classed as high-risk, how to manage multiple trauma victims both in the field and when transferring to a facility, and how to prioritize care for multiple trauma victims.

The certification is valid for four years and is aimed at transport nurses, EMTs, and other qualified medical personnel. It assumes the learner has experience in other areas of nursing such as pediatrics, critical care, or trauma care.

Preparing for flight nurse certification

The above are some of the courses that it’s assumed a flight nurse will have. The above list is not exhaustive, and there are other recognized awarding bodies and certifications available too.

If you’re serious about becoming a flight nurse, it’s wise to seek as much training as possible and to take advantage of any certification options offered by your hospital or clinic. Browse job boards and look for information about local private transport companies, or contact the local government, fire department, military, or other organizations in your area that uses air ambulances.

Learn as much as you can about aviation and seek opportunities to gain exposure to helicopter or plane safety protocols and procedures.

Just as you were expected to demonstrate a variety of extracurricular activities as a part of your transcript when you enrolled on the MSN, any application to a respected patient transportation company should be backed by extracurricular activities and a wealth of experience in trauma care.

From enrolling on a nursing ADN or BSN to becoming a flight nurse can take up to nine years, but it’s well worth the work to become a part of such a rewarding profession.

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