All About Flight Nursing

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Introduction   

Perhaps you have seen or heard about flight nurses and their colleagues. This could be from real-life exposure, a television show or movie, or through stories from other nurses. Flight nurses are thought to be seekers of adventure and adrenaline, though many in the nursing field are not aware of the vast skills and responsibilities this role requires. In this course, you will learn about the various facets of flight nursing and see if the topic interests you. 

Definitions 

The title flight nurse falls under the more extensive critical care transport (CCT) nurse umbrella. Patient transport, in general, usually involves one or more of the following modalities: ground (ambulance), air (fixed wing [airplane] or rotor [helicopter]), or water (boats). Most CCT nurses in the United States work on the ground, in the air, or a combination of the two. In all cases, the nurse works with a team: a driver or pilot and others like paramedics, fellow nurses, advanced providers, and/or physicians. In many situations, the nurse may be in a vehicle without a physician or advanced practice provider and would then be responsible for immediate decision-making of the treatment of critically ill patients.  

Critical care transport nurses accompany patients from one destination to another, ensuring the person’s medical stability during the entire transfer (1, 2). This involves ongoing assessment and intervention using the nursing process and advanced nursing skills like intubation, inserting chest tubes and central lines, and titrating critical medications (2, 3).  

As the title suggests, flight nurses work in the air. They perform their duties on helicopters and/or fixed-wing aircraft (3). These can include civilian, commercial, or military vessels, though all nurses are rigorously trained in critical care and patient stabilization.  

Job Role and Work Conditions  

As might be expected, the role of a flight nurse is highly variable and time-sensitive. Flight nurses are generally expected to do any or all of the following on any given shift (1,2): 

• Assess patients thoroughly and reassess as their condition changes 
• Check all equipment before departure and in transit  
• Communicate clearly with team members in a loud, stressful, contained environment 
• Document all interventions, including time and personnel involved  
• Intervene with lifesaving measures as needed; this may include:  
• CPR 
• Insertion of chest tubes, central lines, or advanced airways 
• Titration of medications like vasopressors, inotropes, or sedatives 
• Monitoring life support equipment, such as: 
• Cardiac monitors 
• Chest tube drainage devices 
• Defibrillators 
• Temperature regulators  
• Ventilators  
• Transport people in the following situations: 
• From car accidents or disasters to hospitals 
• From a remote area to a medical facility 
• In between medical facilities  

Work conditions vary greatly, depending on the area’s temperature, climate, and resources. Flight nurses provide the same level of care received in ICUs and EDs but at high elevations and in motion.  

In some cases, flight nurses may be involved in search-and-rescue missions, where several unpredictable factors may occur.  

Education 

Flight nursing requirements start with the registered nurse (RN) licensure itself. Some agencies may require a Bachelor of Nursing (BSN) degree, but that varies by location. All flight nursing positions require emergency or critical care experience, with a preference for candidates who have both, and for a minimum of 2-5 years, depending on the organization.  

Additional professional certification requirements generally include some or all of the following (4, 5): 

• ACLS/ALS (Advanced Cardiac Life Support/ Advanced Life Support) 
• CCRN (Critical Care Registered Nurse)  
• CEN (Certified Emergency Nurse)  
• CFRN (Certified Flight Registered Nurse)  
• CTRN (Certified Transport Registered Nuse)  
• NRP (Neonatal Resuscitation Program) 
• PALS (Pediatric Advanced Life Support) 
• A nationally recognized trauma certification or program completion, such as TCRN, TNCC, or TPATC (Trauma Certified Registered Nurse; Trauma Nursing Core Course; Transport Nurse Advanced Trauma Course)  

Some organizations may also require certification as an emergency medical technician (EMT), whether at the introductory or paramedic level (5).  

During one’s career as a flight nurse, other educational requirements will almost certainly be added: Flight safety, radio communication, ongoing technological updates, and other industry standards (8).  

Experience 

As mentioned above, it is best for nurses to have 3-5 years of experience in either the emergency department (ED), intensive care unit (ICU), or both. This is because flight nursing involves some of the fast-paced nature of work similar to ED and the ongoing management of ventilators and other equipment often used in ICU settings. Generally, from the beginning of nursing school to becoming a flight nurse takes at least 6-10 years (3, 4, 6).  

Since 1980, the Air & Surface Transport Nurse Association (ASTNA) has aimed to enhance the quality of patient care and advance the practice of transport nursing (5). The ASTNA recommends at least 2-3 years of experience in acute care, emergency, and/or ICU settings. Similarly, the Association of Air Medical Services (AAMS), established in 1980, states that flight nurses should have at least 3 years of ICU or ED experience (7, 8).  

Mini Case Study:  

You are an experienced flight nurse with several years under your belt. You have been transporting critical care patients on the ground for two years and have just added fixed and rotor wings to your areas of expertise. One of your friends from nursing school is considering switching from six years of home health care nursing to flight nursing. They ask many questions about your current position, and you answer accordingly. Think about how you would respond to the following questions posed by your friend:  

Personal and Professional Characteristics  

Like other nursing specialties, flight nursing is not for everyone. Those wishing to pursue this career path should have most of the following personal qualities (3, 4, 5, 6, 7, 9):  

• Ability to work comfortably in a confined space for hours at a time 
• Ability to work in a loud environment  
• Calm in the face of potentially dangerous, hazardous, or unstable situations  
• Comfort being in the air for long periods 
• Comfort with all age groups 
• Fast, clear thinking under pressure  
• Good situational awareness 
• Interest and knowledge in the following areas: 
  • Aircraft, especially rotor, and fixed-wing 
  • Aviation safety 
  • Communications, primarily radio  
  • Critical care medicine  
  • Emergency medical care 
  • Trauma patient care  

Professionally, those aspiring to be flight nurses should possess the following traits (5, 7, 8):  

• Ability to develop a proactive plan of care for critically ill patients 
• Ability to work independently, often without a physician present 
• Accurate, rapid assessment and reassessment skills 
• Comfort with the following critically ill populations: 
  • Elderly 
  • Infants 
  • Neonates 
  • Pregnant and postpartum people 
• Good clinical judgment and critical thinking  
• Good leadership skills 
• Strong communication skills in a loud environment 
• Strong mathematic capabilities, especially when titrating critical care medications 

Extra Resources  

More and more, flight nursing is gaining credence as a nursing specialty that is not going anywhere. It is a unique overlap of transport, critical care, and emergency nursing, and thus is governed and regulated by many organizations. The bright side is that each organization has resources for flight nurses. These include, but are not limited to, the following (5, 8, 9):  

• AACN: American Association of Critical Care Nurses: This organization supports current and future critical care nurses with education, certification, and networking opportunities. https://www.aacn.org/  
• AAMS: Association of Air Medical Services. More information about this course is above. https://aams.org  
• ASTANA: Air & Surface Transport Nurses Association. More information about this course is above. https://astna.org  
• BCEN: Board of Certification for Emergency Nursing: This organization has information on the most relevant flight nursing certifications, including CEN, CFRN, CTRN, TTNC, and more. https://bcen.org/  
• ENA: Emergency Nurses Association: Another organization geared towards the professional development and networking of emergency nurses. https://www.ena.org/ 
• IAMTC: International Association of Medical Transport Communication Specialists: Aims to standardize the profession internationally, particularly in communications. www.iamtcs.org 

Finally, the best bet for any nurse considering a specialty is networking and/or shadowing. Some ways to get a foot in the door with flight nursing are to visit bases, talk to current flight nurses and/or other critical transport professionals, and meet with those who hire these professionals (10). A combination of shadowing and networking can open up many opportunities for those considering this field.   

Conclusion

Flight nursing involves a combination of personal and professional skills and qualities. While it is not a specialty for everyone, it can be gratifying and exciting for the right people. There are many resources and organizations for anyone interested in this career path. Even though it might take half a decade or more to become a flight nurse, it’s worth the wait for many.

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