Well HELLO and welcome to my tiny piece of the internet! If you’re here, it’s because you can looking for more information on flight or emergency nursing (and associated certifications), you found my Instagram (or a link from somewhere else I imagine), or because I gave you the link when you asked me a question (not because I was trying to turf you but because I wanted to make sure you got the full answer without missing any details).
I encourage you to look through everything but if there is a particular topic you’re interested in, I have organized the posts according to category for your ease (you can find those topics on the right side of the page).
As always, my opinions are my own and don’t represent that of my employer.
Please leave me some comments with your opinions on the posts and any questions so I can continue to grow my content over time. Otherwise–enjoy!
I was recently asked “Steph… I’m struggling with my preceptor. I feel like my preceptor is very hard on me and they’re the best at what they do. I feel like sometimes they leave me feeling really frazzled and put on the spot. I know this job is really high stakes and I’m new–should I expect to feel like this and suck it up; just take the intense criticism? Should I talk to them? Am I really cut out for this job?”
It’s Not Always You– Recognizing the Learning/Teaching Mismatch
First, I want to confirm that this culture is one that attracts the alpha-type provider. You can expect high-energy, assertive-types in this wolf-pack. That is the nature of this business. I would learn that it isn’t personal nor a reflection of your shortcomings. We all came here because we’re similar personality typologies. It doesn’t mean that people are “mean” or “aggressive.” That means they may be overly driven and as such, may have a tendency towards being perfectionists and having high-expectations. These individuals may have been trained under high-stakes conditions and simply believe that they must in turn train you that way for you to thrive.
By now, you’re no longer seen as a newly-hatched duckling, fresh out of school, but rather a grown-ass bird who should be ready to hold their own (“fly, buddy! *as you’re yeeted out the nest*).
Some may have been in the business so long, they have lost touch with what it is like to have to begin again. Either way, don’t take it as a personal affront. It isn’t personal. It may be that person’s unique teaching style.
Confidence/Competence and Asserting Your Needs
That being said: you wouldn’t have gotten hired, nor would you still be here if you didn’t deserve to be here.
Further, the fact you care reasserts your place. I discussed this at length in my post about imposter phenomenon (you can refer to it here). It is not unusual to feel those feelings you felt the first time you came off orientation all those years ago: unsure, shakey, and nervous. The combination of alpha-teammates and your uneasiness is a lethal dyad for confidence. I want you to know–you’re fine. The feelings are normal and doesn’t mean you aren’t cut out for this job. There is a difference between your learning style and your provider style.
If you’re coming into flight, you’ve probably worked a little while by now. Recall when you first entered your job: you were probably a very different person than when you left it for this flight job. At your old job, very likely you were probably training the new hires or at least working with fairly new people. I imagine you were confident, competent, and known to be reliable at your position. Now you’ve moved into a completely new field.
It takes a full-year to really get competent in anything new and when you switch, reset the game clock. It can take up to 2-3 years to become truly confident enough to handle anything thrown at you. However, even the most senior staff member has doubts, sometimes–they have just learned how to play it cool and use their resources. Don’t let the air of “nothing phases them” make you question your own abilities.
Coming full circle… if you feel like you aren’t getting what you need from a preceptor, it is probably time to have a talk about your goals, your learning style, and what you need with your preceptor. If your preceptor is as good of a flight nurse (or paramedic) as you say they are, they will understand that maybe you two need to change your approach to the learning process. Your learning is ultimately your responsibility as an adult–you need to take the reins and articulate if you aren’t getting what you need rather than wait until it is too late to bring up that you didn’t get what you needed. Speak up early and ask for what you need.
Plan of Attack: The S%$T Sandwich Method
Generally, what I recommend is this (from some personal experiences throughout my entire nursing career and as a preceptor myself): use the “s%$t sandwich”.
First: articulate what you respect and want to emulate in your preceptor. I don’t mean blow smoke up their gluteus maximuses (maximi?)–be sincere. Take what qualities you want from them and verbalize that you want to adopt from them. Discuss what you think is going well with your preceptorship: what you like that they do or how they do it with you.
Then the s%$t: be honest about what you feel needs to be done differently (and why). If you are a person who needs to learn by doing (a kinesthetic learner), then you need to explain how just reading about procedures isn’t helping you. If you feel like working in a team of 3 people is not helping you learn to function in a team of 2, you need to verbalize the need for one of the teammates to stand back over your shoulder more as a coach to allow you to learn (this is something I myself have struggled with–asking teammates to stand back and allow me to function as a crew member and they watch instead… it is a hard conversation, I know). If you need more simulation time, ask for it. If you need more time with a specialty, ask for it. Articulate exactly what you need in a polite manner that utilizes “I/me” statements than “you” statements (these often come off abrasive).
Finish with a high note: conclude with positivity for how things will continue to go. I like to end things optimistically. This is your chance to express gratitude for your preceptor listening and how you look forward to continuing to work with them. I can’t stress enough: don’t apologize for what you need! THANK THEM for listening but DO NOT apologize for expressing what you need to succeed. Remember… ALPHA-types. Unless you truly have something to apologize for, do not apologize for advocating for yourself. Assertiveness is a respectable quality and one the best providers have.
Not Every Preceptor is for You and That is Ok
Most great preceptors will listen and try to help you however, that is not guaranteed. If after your discussion, you are still finding you are struggling with your preceptor don’t be ashamed of asking for someone else. Thank your previous preceptor and if asked, be honest about your learning style differing from their teaching style. It never has to be a personal affront. Your success hinges on your ability to be able to learn and your team relies on you to learn what you need to function. If someone’s feelings do happen to get hurt, they will heal in time (their egos are their responsibilities, not yours). The alternative is your lack of competence could have worse consequences for your patients, your teammates, and your career’s potential as a flight crew member.
A lot of dealing with preceptors comes down to communication. Sometimes, you and a preceptor will just not click. It is not always learning and teaching styles but rather just a clash of personalities. If you are on the receiving end of hazing or harassment: do not tolerate it. This is not a culture that should be tolerated in flight and I encourage you NOT to put up with it because you feel it is your due. Bullying is not acceptable nor should it be normalized in the flight industry. If you cannot resolve things with your preceptor, I encourage you to bring it to the attention to the next-in-command. No crew member should ever have to work in a hostile work environment when they are expected to be of clear mind to care for human beings. You are worth more than being treated poorly–please do not ever forget your worth and that you earned your place here.
Dealing with preceptors is an issue that plagues both new and experienced providers. Flight is a tricky beast because of the typology of the humans it attracts. While we run as a pack, sometimes we like to partake in the soft flesh of our young. It is getting better but it is not a perfect industry. This is why it is of upmost importance that the new flight provider advocates for themself early and learns to traverse the culture with tact and grace. You worked hard to get here and you will still have mountains to climb to stay here, however, understand that you ARE wanted here and there are many of us who want to truly see you succeed.
-Clear Skies and Tail Winds
Do you have suggestions for dealing with difficult preceptors? Please drop them in the comments below!
A question I get a lot is: “I have my RN or am about to receive it, but how can I obtain my paramedic?”
There are a few options. One is go back to school and get it… for some, this isn’t reasonable. In some states, like Pennsylvania, you can challenge the Paramedic cognitive test if you have an existing EMT certification and receive a Prehospital Registered Nurse certification which allows you to operate at the level of the paramedic and to a margin above in the prehospital setting in the state; however, this is limited to just Pennsylvania.
Another option is a bridge program. I recommend the two below.
You read that right. We need to stop being the best.
We need to stop having this ideal in our heads we need to hustle until we’re the best at what we do in our respective fields.
By now you’re probably dismissing me as lazy and incompetent, or at minimum: copping out.
Hear me out.
When you climb to the top of ladder and run out of rungs, where is there left to go? Nowhere. So when you’re the best, what do you have left to strive for? Nothing. So what is to say you won’t fall to the level of complacency and eventual incompetence? Nothing. You’ll have your hungry ones who will fight to stay on top, sure. They’re the exception and not the rule. However, they too are not immune–that constant hustle is exhausting and complacency is pretty tempting.
What if: instead, we tried to be better than ourselves yesterday but not as good as what we’ll be tomorrow?
Progress isn’t linear, it’s cyclic. It’s a war; each day a new battle against mediocrity.
I don’t wanna be the best, I wanna be great. I don’t need to be known for how I was the best flight nurse or even the best nurse. I’d rather be remembered for my constant drive to better myself even when I was wrong. I’d rather be known for my passion even when I failed. I’d rather be known for my love of passing that love on to others or the inspiration I bequeathed.
I don’t wanna be the best because the best get cocky and they kill people. The best still can mess up because they know they’re the apex predators…there is a reason sharks don’t have to turn their heads and yet they die by swimming straight into nets. This is the concept of hubris from the Ancient Greeks and the basis of the Christian proverb: “pride cometh before the fall” (Proverbs 16:18).
Perhaps this seems like a controversial idea. Why wouldn’t someone want to be the best in a field that almost always requires and expects you to be the best of the best? A field that is highly competitive?
Because of complacency.
When you strive and hustle for so long and then get what you want, you get complacent. You know who isn’t complacent? The guy coming after your job. They’re working their ass off trying to get what you have. If you don’t wanna continue to earn your title—don’t worry, someone else will.
I’m ok with other people being better than me. Because that gives me a constantly moving target to aim for. It keeps me excited and keeps me hungry for more. It makes me work and train. Having role models means I need to keep on my toes to stay great. I don’t want to be the best because I want to stay working for what I have. It makes me question “why” and “how”, not just nod and blindly say “ok, fine.”
We hold a great responsibility.
We’re the role models, we set the standards. People want what we have… that’s heavy. Not only do we have lives in our hands but we also hold the potential to inspire. Our work ethics model how others shape theirs. Eyes are on us when we shirk our duties to train, keep up our equipment, and maintain the competencies keeping us sharp and competitive. Taking out the fact it is a disservice to our constituents… it is a disservice to ourselves and those who look at us with stars in their eyes.
And when they (these unbeknownst protégés of ours) come to us and tell us “I want to be just like you….” I hope we all have the humbleness to be able to look to these people and say “No… I want you to be better than me, be smarter and faster, more talented and successful than me… do more, be more than me… that’s my wish for you…”
So don’t strive to be the best… strive to be better. Strive to stay as hungry as the first time you wanted to apply for the job.
Don’t be good, be better, but don’t kill yourself being the best at the cost of your health, sanity, and life… the only one you’re competing with is yesterday-self and tomorrow-self.
In honor of Nurses Week 2020 and what will be my sixth year of nursing, I wanted to make a post with the six observations I have about who I am as a nurse and pieces of wisdom I wanted to share.
I came into this profession shiny and new with clean, pressed edges and resounding hope. While I still believe in the goodness of people, my cotton is a bit wrinkled now from the disregard shown by humanity. It’s intact still, not threadbare and laid waste from years of abuse quite yet. You can see the change notably from six years ago. Sometimes something really good happens that irons out the wrinkles and makes the cotton look renewed though. Sometimes when a small tear happens, a kind soul will come along a patch it up. In our profession, we can’t expect our cloth to stay immaculate–we should expect it to become a bit dirty and a bit worn. But we need to allow ourselves to let it be repaired and refreshed. Our work is meaningful.
Protect your “helpers.” Value them. Now when I say “helpers” I don’t mean that these people are there to serve YOU (The Nurse)–you are all there for the common goal of bettering a patient. These individuals help in making your jobs easier though. So value them. Protect their interests. Are your respiratory therapists lobbying for better equipment? Join them. They know their specialty and there is probably a reason. Is another nurse abusing her patient care technician? Step up. Be a leader by advocating for that person. Is the department paramedic pushing for more privileges their license allows them to do? Speak up! These are our team mates. Rally to their sides.
Pass on what you learn. It is so easy to find information and hoard it but its better for a department when you disseminate it. In this pandemic, I early on volunteered to moderate a Facebook Group Covid-19 Healthcare Professionals (click for link) which at the time (early March?) had like 300 people. The idea was to have a place for professionals to share information and develop a community. It quickly grew to over 84,000 people (at time of writing). Ideas flew like crazy from how to prevent skin breakdown from face masks to setting up vents and pumps outside negative pressure rooms. But the idea was this: knowledge sharing. Teach what you know to others–precept new team mates and if more experienced or older staff ask for help with something, teach without judgement. Do all acts for the betterment of the whole.
Nursing will disappoint you. A lot. Frequently. Management will promise you the world only to give you scraps whether on purpose or not. Patients will burn you despite you breaking your back for them. The pay will never equal the work some days. Lunches won’t come some days and your bladder will harden to that comparable to those weird frogs that hibernate for years in Australia (I pulled out that metaphor from somewhere…don’t @ me).
You don’t always get what you want (to quote the Rolling Stones). In fact–get used to it. I had a lot of “no’s” told to me in six years. Career paths I thought I wanted that went to other people. It hurt, guys. Baaaaaaaad. But the funny thing about “no” is sometimes it’s just a primer for “because here’s this instead! TA-FRIIIIGGGGIINNN-DAAA!” And it really is better. I didn’t always trust that I was told no for a reason. I felt like that no was my own resounding failure when in reality it was just because I was a better fit elsewhere. That job I thought was perfect? It took a wiser nurse sitting me down and telling me I wouldn’t be happy doing it. I didn’t believe her for a while and I was bitter at her assumption–how could she possibly know what I wanted? But she was right. I should’ve listened instead of being angry. Because my dream job offer came half a year later. Even if you don’t get that dream offer like I did right away, keep at it. Something I always tell new nurses or nurses trying to strive for something is this: Never accept “no”–rephrase it as “not right now.” By accepting that no and letting the door slam in your face, you’re missing possibilities of three more doors opening just down the road to even better opportunities.
While nursing has given me the most painful memories and caused me some of the worst heartaches–it has given me so much more. It has given me purpose. Friendships. Meaning. It has saved my life when I felt it didn’t mean anything. Days I didn’t want to get out of bed–I knew I was needed by my coworkers and patients. Somedays that made the difference for me just knowing that the work I did with my two little hands caused change gives my career meaning. I’m proud of what I do and I couldn’t imagine doing anything else even on my worst days… find meaning in your work. This will help you power through the ugliest parts of our job.
So this week… this whole month… this whole year… hold your heads up high, Nurses.
We have faced insurmountable odds in some parts of the world and in those not necessarily being inundated by viral illness but rather facing unemployment from low-census or budget-cuts. The world sees us and while they may not necessarily empathize with our plights and administration may still gift us pizza parties (not you night shift–you get half eaten stale donuts because “tradition”) instead of safe staffing and all the things we really need…we’ll still keep showing up and providing top-notch care.
A couple months ago, the good sir Kevin McFarlane of The Art of Emergency Nursing graciously had me on his podcast! Originally we were just supposed to be talking about my career as a flight nurse but the conversation took an interesting turn! We shifted into discussions about social media and the power of peer mentoring, how my attitudes in life have shifted over the years, how EMS has affected my career in nursing, how the bad things in my life shaped my emotional resilience and actually helped me get to where I wanted to be (in a funny twist of fate!), how networking can help you find your way and the important of paying it forward, never underestimating anyone because of their title, and always following your dreams.
It was a great opportunity and I’m excited to have been hosted by Kevin! You can find the podcast here CLICK HERE (:
And be sure to check out ART OF EMERGENCY NURSING for the heart and soul of ER and trauma nursing … for humor and career building with some of the biggest names in the industry.
Patients will burn you despite you breaking your back for them. The pay will never equal the work some days. Lunches won’t come some days and your bladder will harden to that comparable to those weird frogs that hibernate for years in Australia (I pulled out that metaphor from somewhere…don’t @ me).
Scrubs n' Sirens 