December 1999 531

During my 7 years of flight nursing, I frequentlyhave been asked about the requirements for be-

coming a flight nurse.Although programs vary, some similar expecta-

tions exist. Most flight programs will accept an appli-cant with an associates degree in nursing or higher;however, a bachelors degree may be preferred. Interms of experience, more is better. Most flight pro-grams transport a variety of patients in the neonatal,pediatric, and/or adult populations with one or moreof a multitude of problems (eg, trauma, medical, sur-gical, obstetric, neurologic, neurosurgical, cardiac).Obtaining a broad base of experience will make youfar more marketable when a flight nursing positionbecomes available.

In addition to nursing experience, which shouldinclude 2 to 3 years of ED and/or critical care experi-ence, experience in the prehospital environment isbeneficial, because most programs perform transportsfrom the scene of an incident in addition to doing in-terfacility transports. Many states require that nurseswho work in the prehospital setting have EMT orparamedic certification.

Along with experience and strong clinical skills,a variety of continuing education courses (Table 1)and certifications (Table 2) may be either desirableor required. Instructor status rather than student sta-tus in the courses is preferred, because most pro-grams require participation in outreach educationprograms.

The courses mentioned in Table 1 are nationallyrecognized curricula and are offered by a variety ofproviders such as hospital education departments orflight programs. Information about a certification ex-amination can be obtained from the individual asso-ciations sponsoring the examination (Table 3).

The Air and Surface Transport Nurses Associa-tion (ASTNA) (formerly known as the National FlightNurses Association), in conjunction with the Board ofCertification of Emergency Nursing, offers a certifica-tion examination for flight nurses—the CertifiedFlight Registered Nurse examination. The certifica-tion board recommends that nurses have at least 2years of flight experience before taking the examina-tion. ASTNA also offers a Flight Nurse AdvancedTrauma Course. As with the Certified Flight Regis-tered Nurse examination, flight experience is recom-mended before taking the course.

Flight nurses are expected to be proficient in per-forming advanced procedures, which may includeendotracheal intubation, needle and surgical cricothy-rotomy, chest needle decompression, tube thoracosto-my, pericardiocentesis, central line placement, in-traosseous line placement, escharotomy, and assistingwith emergency childbirth. Flight nurses are also ex-pected to be proficient in pharmacologic managementof complex patient care situations, intra-aortic balloonpump management, and ventilator management.They need to understand altitude physiology as well.The program that hires you is responsible for organiz-ing a detailed and thorough training program that willallow you to perform as a flight nurse within the pro-gram’s framework.

Several conferences offer lectures and hands-onlearning experiences that can be used to supplement

Donna Arvin Isfort is Flight Nurse, University of Kentucky Air Med-ical Service, Lexington, Ky.J Emerg Nurs 1999;25:531-2.Copyright © 1999 by the Emergency Nurses Association.0099-1767/99 $8.00 + 0 18/9/102416

Flight NursingSo you want to be a flight nurseAuthor: Donna Arvin Isfort, RN, BSN, Lexington, Ky

Section Editor: Julia H. Fultz, RN, BSN, CEN, CFRN

Obtaining a broad base ofexperience will make you farmore marketable when aflight nursing positionbecomes available.

532 Volume 25, Number 6

flight nurse training. The Clinical Care Conferenceand Air Medical Transport Conference are dedicatedto patient transport. Information about these confer-ences can be found on ASTNA’s Web page (Table 3).A variety of learning experiences for transport nursescan also be found during ENA’s Annual Meetingthrough pre-session courses and courses held duringthe Scientific Assembly. Additional information aboutthis conference can be found on ENA’s Web page(Table 3).

Each program also has physical requirements.You may need to do strenuous lifting, carry heavyequipment, and walk significant distances to reach apatient. Most programs have crew member weightrestrictions. Federal regulations mandate a weightlimit for each type of aircraft before it lifts off theground. Exceeding the weight limitation is not only asafety issue but is against the law, and the penaltiesare severe. In addition to the weight restrictions, theinterior configuration of the patient/crew membercompartment may be confining, resulting in crewmember size restrictions.

Crew composition varies from program to pro-gram, using the expertise of nurses, paramedics,physicians, respiratory therapists, and EMTs. Med-ical crews of both helicopter and fixed wing aircraftusually consist of 2 medical attendants, with the mostfrequent composition being a nurse and a para-medic.1 Regardless of crew composition, when it is

JOURNAL OF EMERGENCY NURSING/Isfort

just you and your partner at 2000 feet in the air with acritical patient on board, you both must have the ex-perience, expertise, and clinical judgment to developa plan of care that will work. Well-developed, criticalthinking skills are necessary to react to rapidly chang-ing patient assessment situations. Years of experi-ence and mature judgment are needed to direct youin making those critical decisions. Teamwork is es-sential for effective patient care.2

Flight nursing also requires excellent communi-cation, customer interaction, and conflict resolutionskills. In addition to patient care, involvement in out-reach education, research, activities to ensure safety,quality assurance, continuous quality improvement,public speaking, and perhaps fund-raising may be re-quired.

When you apply for a flight nurse position, com-petition can be steep, so be prepared. Flight pro-grams are looking for applicants who have strongclinical skills and are professionally committed. Theinterview process may be lengthy and detailed. If thejob is not offered to you, ask the interviewers how youcan better qualify yourself to meet the standards theprogram is searching for, and be persistent.

Good luck!

References

1. Rau W, Lanthrop G. 1998 medical crew survey. Air Med1998;4:22-7.2. Stohler SA. High performance team interaction in an airmedical program. Air Med J 1998;17:116-20.

Submissions to this column are welcomed and en-couraged. Contributions should be sent to JuliaFultz, RN, BSN, CEN, CFRN, 1311 Oak Ridge Ct,Simpsonville, KY 40067-6668; phone (606) 323-5901; E-mail: jhfultz%taonode@mvs.hosp.uky.edu.

Table 1Courses

• Advanced Cardiac Life Support certification (ACLS)• Pediatric Advanced Life Support certification (PALS)• Emergency Nursing Pediatric Course certification

(ENPC)• Neonatal Advanced Life Support certification (NALS)• Basic Trauma Life Support (BTLS) or Prehospital

Trauma Life Support (PHTLS)• Trauma Nurse Core Course (TNCC)

Table 3Web sites and telephone numbers

Air and Surface Transport Nurses Association(800) 897-6362http://www.astna.org

Emergency Nurses Association(800) 243-8362http://www.ena.org

American Association of Critical Care Nurses(800) 899-2226http://www.aacn.org

Table 2Examinations and certifications

Certification examinations• Certified Flight Registered Nurse (CFRN) for nurses

with prior flight experience• Certification for Emergency Nurses (CEN)• Critical Care Registered Nurse (CCRN)

Certifications• EMT/Paramedic certification