Career Path Advice ER or ICU to flight / transport nursing?

[8jimi8]

My goal is to be a flight nurse. Maybe this is a thread for flightweb, hopefully you all wont mind giving me advice.

I consider the helicopter to be an extension of the ER. I know it does CCT also...


Ok. So I haven't started my new job in the MICU. (that's a separate non-issue)

My job is held over for me, but I have another offer now.

A competing system has offered me a position in a busy ER.

pros on the MICU:

1. I will be based in MICU, and float through SICU, CCU and Clinical Decision Unit (a 23 hour unit where you either go to ICU or go down to the stepdown / tele unit)

2. ICU skill set - nuff said

3. a level 4 trauma designated hospital, also a heart transplant hospital, designated stroke center and cardiac care designation (i forget what its called)

4. The staff during my interview told me that they would "train me to be a flight nurse."

5. They do have a helicopter pad.

6. 2-3 patient load (supposedly if you get 3 patients you have "help"

7. This hospital has won the "medicare ACE Demonstration Center designation for cardiac and ortho." (that means we will get lots of business)

8. This hospital is owned by a publicly traded company and this job is considered "more recession proof" than competitors.

9. The unit manager is freaking A W E S O M E.

10. Many of the nurses there have been there 20+ years (that tells me that they are happy)

11. My manager is impressed by my learning goals (that tells me she is receptive to working with my classes when they start).

12. This will help me study for CC P, (lol after i get the red patch)
Cons:

1. Paygrade

2. Even though the hospital has a trauma designation, in the interview they told me that they do not get traumas.

3. 100 year old building (some renovations are coming, but it looks like a hospital out of freddy kreuger's nightmares.)

ER job

Pros:

1. A very very busy ER that takes overflow from the nearby level 1 trauma hospital

2. They are getting their own helicopter

3. Paygrade

4. Emergency care is really what I am "most interested in"

5. New building

6. Its ER... you get a mixed freaking bag of what you get!

7. Being in the ER will most likely help me "study" for my upcoming Paramedic course.

Cons:

1. Steeper learning curve when I eventually try to fly.

2. Not a designated trauma center

3. High turnover

4. I have no idea of the financial stability of this hospital system, or whether the spiraling recession will affect my job.

 

[VentMedic]

Will the helicopter be licensed to do scene response?

 

[8jimi8]

I don't have an answer to that one.

I suspect that it would be better for my career path, if it will be.

 

[Ridryder911]

Investigate well. Many HEMS are now being dropped by hospitals at an amazing rate. Contracted out by large providers such as Air Methods and others. I am afraid your perception of a HEMS is outreach of an ER is way off. Much difference in administration and operations as well as treatment(s) performed.

Alike EMS there is differences between air services and what their primary function is. One can be strictly IFT or scene or a mixture.

You have a difficult decision but exposure to true critical care areas would definitely have its advantages. Who cares about the building?

ER is great but in perspective, as a flight nurse your responsibilities are usually geared more to critical care than emergencies. Hence the reason many opt for RN & Paramedic, as the medic maybe responsible for scene care and management.

Could it be a possibility to do part time at the ER (PRN) to get some exposure? Stability and experience are a great motivator.

Good luck!

R/r 911

 

[ResTech]

There is a Bill in Maryland where the State is trying to privatize Med Evac services thus taking it away (or a large part of it) from Maryland State Police Aviation (EMS MedEvac) to save on the budget.

Right now, only Maryland State Police aviation provides Med Evac services at no cost to Maryland residents. One of my instructors is a Trooper/Flight Medic and obviously is very against private services coming in. I for one kinda see it as a good thing. Competition can only make one stay on top of their game and do it better.

 

[8jimi8]

Wow, I hadn't even considered the PRN option. That is a great option because I just found out that the medics where I am volunteering literally make $11.00 / hr! I was thinking that once I have earned my paramedic patch, that I would try to get a job, but after hearing this, I decided to just continue volunteering to gain experience.

My previous plan had been to work full time in the ICU and then pull a 24 or so every week as a Paramedic. I can definitely see myself working PRN at the ER and continuing to volunteer as a medic.

Rid, I think you solved my dilemma. Take BOTH jobs! It's gonna be a crazy scrape trying to work both jobs and take paramedic classes, but on the upside, i will probably be able to do my hospital clinicals in my ER. I'm sure they won't mind my working there for free!

The strange thing about this hospital purchasing their own helicopter is that there is a level 1 trauma center literally within 1 mile. I haven't found out what that helicopter's purpose is, but it doesn't seem to make sense to me as stricly IFT, not with it being situated in the medical district and in such close proximity to the larger hospitals.

 

[VentMedic]

but it doesn't seem to make sense to me as stricly IFT, not with it being situated in the medical district and in such close proximity to the larger hospitals.

Some of our most successful helicopters are IFT and do not deal with scene response. However, they may pick up trauma patients in EDs.

But, if the helicopter is also used for cardiac, neo and peds teams, they may stay busy. If the hospital also has specialty teams such as neo or pedi, they may fly without the regular crew or the helicopter might be used for whatever team needs it. There are many different ways to configure helicopter teams to get the maximum usage out of a helicopter. If it is only limited to HEMS, the training and requirements of the crew may also be limited.

 

[MSDeltaFlt]

My goal is to be a flight nurse. Maybe this is a thread for flightweb, hopefully you all wont mind giving me advice.

I consider the helicopter to be an extension of the ER. I know it does CCT also...


Ok. So I haven't started my new job in the MICU. (that's a separate non-issue)

My job is held over for me, but I have another offer now.

A competing system has offered me a position in a busy ER.

pros on the MICU:

1. I will be based in MICU, and float through SICU, CCU and Clinical Decision Unit (a 23 hour unit where you either go to ICU or go down to the stepdown / tele unit)

2. ICU skill set - nuff said

3. a level 4 trauma designated hospital, also a heart transplant hospital, designated stroke center and cardiac care designation (i forget what its called)

4. The staff during my interview told me that they would "train me to be a flight nurse."

5. They do have a helicopter pad.

6. 2-3 patient load (supposedly if you get 3 patients you have "help"

7. This hospital has won the "medicare ACE Demonstration Center designation for cardiac and ortho." (that means we will get lots of business)

8. This hospital is owned by a publicly traded company and this job is considered "more recession proof" than competitors.

9. The unit manager is freaking A W E S O M E.

10. Many of the nurses there have been there 20+ years (that tells me that they are happy)

11. My manager is impressed by my learning goals (that tells me she is receptive to working with my classes when they start).

12. This will help me study for CC P, (lol after i get the red patch)
Cons:

1. Paygrade

2. Even though the hospital has a trauma designation, in the interview they told me that they do not get traumas.

3. 100 year old building (some renovations are coming, but it looks like a hospital out of freddy kreuger's nightmares.)

ER job

Pros:

1. A very very busy ER that takes overflow from the nearby level 1 trauma hospital

2. They are getting their own helicopter

3. Paygrade

4. Emergency care is really what I am "most interested in"

5. New building

6. Its ER... you get a mixed freaking bag of what you get!

7. Being in the ER will most likely help me "study" for my upcoming Paramedic course.

Cons:

1. Steeper learning curve when I eventually try to fly.

2. Not a designated trauma center

3. High turnover

4. I have no idea of the financial stability of this hospital system, or whether the spiraling recession will affect my job.

Actually it's not. If the helicopter service you're looking at does primarily IFT's, then it's a flying ICU/ER. If it does primarily scenes, then it's a flying ambulance/ER. If it does scenes and IFT's, then it's a flying ambulance/ER/ICU.

Investigate well. Many HEMS are now being dropped by hospitals at an amazing rate. Contracted out by large providers such as Air Methods and others. I am afraid your perception of a HEMS is outreach of an ER is way off. Much difference in administration and operations as well as treatment(s) performed.

Alike EMS there is differences between air services and what their primary function is. One can be strictly IFT or scene or a mixture.

You have a difficult decision but exposure to true critical care areas would definitely have its advantages. Who cares about the building?

ER is great but in perspective, as a flight nurse your responsibilities are usually geared more to critical care than emergencies. Hence the reason many opt for RN & Paramedic, as the medic maybe responsible for scene care and management.

Could it be a possibility to do part time at the ER (PRN) to get some exposure? Stability and experience are a great motivator.

Good luck!

R/r 911

I'm going to have to disagree with you here, at least from my perspective. It's not the skills a nurse or a medic has. I don't fly in the "medic" seat. My nurse doesn't fly in the "nurse" seat. I usually fly left seat and he/she usually flies right seat. Moot, I know. That's just my personal preference. The reason I believe nurse/medic teams are so beneficial is the point of view, or experiences, each brings to the table.

RN: Has experience stabilizing/weaning the critical patient off/from multiple drips, vent, IABP, lines, other monitoring devices. This requires the ability to meticulously multitask all of these all the while staying 15-20 steps ahead of their pt.

Medic: Has experience being on the butt-crack side of the county with a 400lb pt in the back bedroom of a 2-3 story house between the bed and the chest of drawers who has "stroked out" and doing their d*mnest to lose their VS, and all you have is 1 Basic partner, limited protocols, limited equipment, a 30 mile drive, they have to keep this pt alive.

Are these typical situations? Absolutely not, but those mindsets are what charaterize both professions. And those, my friend, are the most important attributes of each.

My humble 0.02.

 

[VentMedic]

There is a Bill in Maryland where the State is trying to privatize Med Evac services thus taking it away (or a large part of it) from Maryland State Police Aviation (EMS MedEvac) to save on the budget.

Right now, only Maryland State Police aviation provides Med Evac services at no cost to Maryland residents. One of my instructors is a Trooper/Flight Medic and obviously is very against private services coming in. I for one kinda see it as a good thing. Competition can only make one stay on top of their game and do it better.

You might define what you call free.

Also, if you examine that service, you will see it is not ran the same as good private and publicly funded services when it came to overall care of the patient.

True, they had the show for too long without competition.

 

[usafmedic45]

MSP aviation are not on top of their game and haven't been a cutting edge service for a long time. They are barely keeping up with a field that even for an "average" service is severely lacking in terms of safety and concern for patient benefit (antiquated protocols, excessive flights for the convenience of ground providers and based on antiquated data). As Vent said, be careful what you consider free: I would not count a $14M budget taken out of your taxpayer dollars that offers no perceivable benefit for all but a handful of people per year "free". If it were the construction of a road, a bridge or something along those lines that was eating up millions for the benefit of a select few, those legislators supporting it would be accused of advocating for pork. The fact that MSP has mobilized it's cronies to blind the public and some of the legislators to the reality of the situation does not change this. It just means they are just an effective lobby.

 

[VentMedic]

usafmedic45,

Doesn't MSP also fly with just one medic?

 

[usafmedic45]

usafmedic45,

Doesn't MSP also fly with just one medic?

So far as I am aware, they still do. That mastubatory panel they put together (with the exception of Dr. Bledsoe's inclusion on it) after the Trooper 2 crash (which killed a friend of mine BTW) advocated going to a dual medic program, as if that would severely improve the impact on outcomes or address the safety issues. However, so far as I am aware they are still flying with a single trooper/medic in the back.

Medical helicopter operations desperately need to switch to dual pilot, dual provider operations if they really want to avoid a repeat of last year once the immediate hesitancy and fear that results from all those deaths wears off, which it will. Increasing the number of caregivers is not going to increase the impact of HEMS, as only being increasingly selective about when to fly and whom to fly will do that. Dual medical personnel and single pilot operations will simply decrease the death toll on the same unnecessary flights as always. Switching to dual pilots will increase safety and that is why such changes are a standard in several countries for ANY commercial helicopter operations.

 

[Flight-LP]

Medical helicopter operations desperately need to switch to dual pilot, dual provider operations if they really want to avoid a repeat of last year once the immediate hesitancy and fear that results from all those deaths wears off, which it will. Increasing the number of caregivers is not going to increase the impact of HEMS, as only being increasingly selective about when to fly and whom to fly will do that. Dual medical personnel and single pilot operations will simply decrease the death toll on the same unnecessary flights as always. Switching to dual pilots will increase safety and that is why such changes are a standard in several countries for ANY commercial helicopter operations.

99% of the time, I would agree with this statement, but I fell that not all services would benefit from having two pilots. What really needs to happen is pilots need to stop flying in crap weather and letting hazardous attitudes and behavior patterns enter the equation.

The dual pilot issue is a double edged sword. The folks who truly need it are the back woods rural providers running scene flights, especially at night. These are also the providers least likely to get it. 2 reasons why. #1 the usual platform, i.e. the underpowered and frequently overtorqued Bell 206, cannot accomodate it as the flat sits where the 2nd pilot would be. The 407 and A-Star are in the same boat, even thought they at least have sufficient power. #2 is the age old devil, MONEY. Companies are not going to pay $1M plus to replace a helicopter, retrain the current pilots and med crew, and add a pilot. The NTSB can recommend until the cows come home, but the FAA isn't likely to change it any time soon either. Too many PAC's with money to spend.

Larger airframes with IFR capabilities, radar, terrain, and traffic advisories, and urban programs who can be tracked by ATC are less likely to have these issues, providing they act and communicate appropriately. Look at all of the recent NTSB reports and you will find a chain of mistakes being made before these aircraft did a controlled flight into terrain. Inadvertant entry into IMC is the leading cause, the correction is not an additional pilot, it is better decision making. Med crews are also to blame as I have seen many get emotional about the "duty to act" and saving the day. These folks need to back off and the separation of duty and safety needs to be strictly adhered to.

I won't even get into the subpar aspect of only flying one medic and the occasion EMT / FF that the MSP grabs from the scene. I still shake my head why everytime I think about it....................

 

[Flight-LP]

Some of our most successful helicopters are IFT and do not deal with scene response. However, they may pick up trauma patients in EDs.

But, if the helicopter is also used for cardiac, neo and peds teams, they may stay busy. If the hospital also has specialty teams such as neo or pedi, they may fly without the regular crew or the helicopter might be used for whatever team needs it. There are many different ways to configure helicopter teams to get the maximum usage out of a helicopter. If it is only limited to HEMS, the training and requirements of the crew may also be limited.

This describes my current service. We staff two teams daily, an adult / pediatric specialty team and a neo team. The adult team consists of the medic and an OB / critical care nurse (we are based out of a mama / baby hospital and do a lot of high risk OB), and the neo team consists of a NNP, a neo nurse, and the medic. The adult team is busier as we are responsible for the high risk OB, in addition to all high acuity adult / pedi cases. The neo team goes by ground a lot as many of their transports are local. By contract, the adult team will not do ground transports and will have a contracted EMS service send their CCT unit.

I actually prefer IFT's. For one thing, I do not miss searching for power lines on the side of a farm road at 3 in the morning. I also find the IFT's to be more of a challenge and the care more rewarding. All too often when I flew scenes, it was for pts. that didn't remotely need a helicopter. IFT's are better screened and since our dispatch is also the hospital system's transfer center, inappropriate utilization is nil.

OP, I agree that ICU experience would be a good bet for you. Supplemented by ER experience. I have found over the years that the critical care knowledge and thought process that a strong ICU nurse brings to the team is very beneficial to the emergent care experience brought by the Paramedic. Individual results may vary, but that is and has always been my preference.

On a side note, STAR flight loves ICU experience...............hint, hint, wink, wink

 

[VentMedic]

I won't even get into the subpar aspect of only flying one medic and the occasion EMT / FF that the MSP grabs from the scene. I still shake my head why everytime I think about it....................

It was an EMT from a rescue squad station in Waldorf that was killed in the Trooper 2 crash. I believe that she may have been a volunteer.

 

[Flight-LP]

It was an EMT from a rescue squad station in Waldorf that was killed in the Trooper 2 crash. I believe that she may have been a volunteer.

I believe you are quite correct. I will also go out on a limb and say we are probably in aggreance that she should have never been on that helicopter in the first place (sorry, I usually don't play assumptions, but this particular crash really bothers me).

 

[VentMedic]

I believe you are quite correct. I will also go out on a limb and say we are probably in aggreance that she should have never been on that helicopter in the first place (sorry, I usually don't play assumptions, but this particular crash really bothers me).

It is one thing when a crew member who has been informed of all safety precautions and risks. But, when it is someone from the ground who "gets chosen" or "pick me" choice who may be caught up in the moment of excitement that I have a serious problem with this type of operation. I hope that rescue squad has examined their policies, including life insurance, before allowing another member to ride along.

We do have a couple of FDs that fly a pilot out with the helicopter to the scene where he/she will pick up whatever medic to fly back with the patient to the hospital. I never liked that method either since some of these medics probably should not be alone with a patient....saddened to say. Also, except for a speedy ride to the hospital, after waiting for the helicopter, the medic in flight can still only do what the ground medics do. But, at least they were members of the same FD and should have had some safety training.

 

[usafmedic45]

What really needs to happen is pilots need to stop flying in crap weather and letting hazardous attitudes and behavior patterns enter the equation.

I agree, but I also realize that I have a better chance of being the next president of the AAMS than that ever happening. The only way we will ever see HEMS avoid bad weather entirely is if the FAA suddenly and decisively decides that HEMS helicopters are allowed solely to operate day time VFR. Even if they are operating at well above VFR minimums at night, there is still a distinct chance of spatial disorientation, especially over unlighted rural areas. For an example of this, take a look at the crash in the Dakotas a few years back where their new pilot became disoriented over the featureless and unlit terrain at night.

The dual pilot issue is a double edged sword. The folks who truly need it are the back woods rural providers running scene flights, especially at night. These are also the providers least likely to get it.

Agreed, but have two points of my own:
1. Extreme rural areas are the only frequent indications for scene flights (>100 miles from a trauma center or other tertiary center) that have any validity. The presence of woods or corn or wheat does not mean it's a sufficiently rural area.
2. The longer the flight, the more chance something will go wrong. This should be a reason for MORE emphasis on safety, not less.

2 reasons why. #1 the usual platform, i.e. the underpowered and frequently overtorqued Bell 206, cannot accomodate it as the flat sits where the 2nd pilot would be.The 407 and A-Star are in the same boat, even thought they at least have sufficient power.

Agreed, but think the use of underpowered and underequipped helicopters to save money is exactly one of the things which put HEMS into the predicament of having the NTSB and FAA breathing down their necks.

#2 is the age old devil, MONEY. Companies are not going to pay $1M plus to replace a helicopter, retrain the current pilots and med crew, and add a pilot. The NTSB can recommend until the cows come home, but the FAA isn't likely to change it any time soon either. Too many PAC's with money to spend.

FAA regulations are written in blood, as the saying goes. Granted, I don't see the dual pilot rule being an absolute mandate just yet from the FAA but the technology aspects of TAWS, night vision, etc are going to be put into effect. If that doesn't fix the issues in a horribly broken system (which it won't do completely) and we have another year like last year, the PAC (AAMS) representatives are going to have a hard time with explaining the blood on their hands. What the likely pending regulations are set to do is severely scale back or completely halt operations for a lot of the fly-by-night (no pun intended) operators out there who do not care how many people they kill and still continue to operate large fleets of underpowered, undermanned and underequipped helicopters. There are three or four services I am thinking of, but the best example of this is Air Evac Lifeteam which has THE WORST safety record in all of HEMS and has failed to learn from their past mistakes. It is a textbook example of how corporate culture and operating on the cheap gets our colleagues and friends killed.

Larger airframes with IFR capabilities, radar, terrain, and traffic advisories, and urban programs who can be tracked by ATC are less likely to have these issues, providing they act and communicate appropriately.

Right, you can put the best equipped aircraft in the hands of a pair of morons and still have a bad outcome. Take a look at the two dumbasses who decided to screw around on a ferry flight in a Canadair regional jet and ended up flaming out both engines in the process, killing them both and destroying the aircraft. Another great example from the 1970s (?) was the National Airlines DC-10 where the pilots decided to see while flying passengers what you happen if you tripped the circuit breakers governing one of the safety systems for an engine causing the engine to overspeed and tear itself apart.

Look at all of the recent NTSB reports and you will find a chain of mistakes being made before these aircraft did a controlled flight into terrain.

I am intimately familiar with them as crashes are what I research.

Inadvertant entry into IMC is the leading cause, the correction is not an additional pilot, it is better decision making.

Actually it can be both. Pilots have been shown to be less likely to make such mistakes when a second pilot is present (extra set of eyes, eyes and a hopefully a functioning brain to catch problems before they cause a crash). Also during inadvertent or even intentional IFR flight, there is well demonstrated evidence for the benefits of dual pilot IFR during both commercial fixed-wing and helicopter operations. This evidence is the reason behind the requirement of dual pilot operations for commercial fixed wing flights in nearly every country and helicopter operations in the US military and several countries for civilian commercial flights.

Med crews are also to blame as I have seen many get emotional about the "duty to act" and saving the day. These folks need to back off and the separation of duty and safety needs to be strictly adhered to.

What the NTSB refers to as "induced pressure to proceeds, others". I agree, the drive to get the mission done is a major factor and have no objection to your suggestion.

I believe that she may have been a volunteer.

She was a volunteer from what I was told.

 

[VentMedic]

Med crews are also to blame as I have seen many get emotional about the "duty to act" and saving the day. These folks need to back off and

the separation of duty and safety needs to be strictly adhered to.

What the NTSB refers to as "induced pressure to proceeds, others". I agree, the drive to get the mission done is a major factor and have no objection to your suggestion.

For ground transport, our Specialty Transport teams (neo, pedi) use non-EMT drivers from our Security/Transportation pool, usually regulars, who do have EVOC although we rarely if ever run L/S. There are usually not aware of how sick the baby/child is.

For Flight, we also do not tell the pilot how sick the baby/child is even though we are sweating in our boots but never where others will see.

The great part of being a member of these teams is knowing how well prepared you are by your training/education and trust from your medical director that you are bringing a higher level ICU with you and have the confidence to get the baby or child back to your hospital even if it takes a few hours of stabilization. It isn't arrogance you are showing when you walk into another hospital's ED or NICU but rather confidence. You can tell that their staff sees that also in you when they smile and are relieved that you have arrived. However, there are some Flight and CCT teams that walk in with arrogance which is actually masking insecurity or little knowledge for that situation and create total chaos in that hospital.