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Also known as “all the things no one told me about becoming a flight nurse and I was too afraid to ask.”
If you spend enough time around flight medicine, you’ll notice something interesting: we spend a tremendous amount of time preparing people for the clinical side of the job. We teach ventilators. We teach hemodynamics. We teach advanced airway management, critical care pharmacology, blood administration, flight physiology, and the thousand other things required to keep very sick people alive in very inconvenient places. You know… important life saving stuff.
What we don’t teach is how to actually live this job. When I became a new flight nurse nobody sat me down during orientation and explains what happens when you’re eight hours into a humid summer shift, your flight suit has become a personal bog, you’ve consumed enough caffeine to qualify as a controlled substance (basically when you start to hear colors), and dispatch sends you to a hospital two hours from anywhere that resembles civilization before you had a chance to pee. I had to learn all of it through trial and error essentially.
Nobody teaches the proper technique for surviving a gross ER patient bathroom in a nomex onesie with someone’s unlabeled urine specimen looking at you sideways from the sink. Nobody discusses the emotional significance of finding the crew-room shower full of Tribbles (your crew mates’ hair) in the drain after a 20-hour day and something crusty/unidentifiable is chilling on your forearm.
Me hanging out with everyone’s hair clumps in the work shower, 2026
Nobody explains why every experienced flight clinician owns an oddly specific collection of chapstick, anti-chafing or -stank ass products, backup socks and under roos (most likely unmatching, potentialy with holes), emergency snacks, phone chargers, more pain-relievers than Walgreens, and enough caffeine to knock you both into and subsequently out of V-tach.
Most flight crews eventually learn these lessons the same way they learn everything else in medicine: through a combination of observation, suffering, and poor decisions. The reality is that flight medicine as whole isn’t just a job but rather a lifestyle. For some of you that life is 12-hour shift where you go home afterward, sleep in your own bed, and maintain a reasonably healthy connection to society. For others (like moi)….it’s a 24- or 48-hour assignment where you essentially move into a base with a group of coworkers who slowly transition from colleagues to roommates, family members, and occasionally hostage negotiators at 3am.
Either way, there are survival skills nobody teaches: the practical stuff, the weird stuff, or the “I wish someone had told me this three years ago” stuff. NEVER FEAR! I got you! Consider this your Unofficial Guide to the Activities of Daily Living in Flight Medicine*!
*A field manual for moisture management, sleep preservation, strategic snacking, flight-suit bathroom logistics, communal living, and maintaining a small shred of dignity while spending your high-speed career in a helicopter.
Part 1 of this series will include dressing for the weather, hydration and cooling solutions, and navigating the bathroom situation.
Dressing for Success (and Mitigating Inevitable Swamp Ass)
Flight medicine exposes you to a truly impressive variety of climates, often within the same shift depending on where you work. You may start your morning standing on a frozen highway shoulder in March, spend the afternoon in a hospital that appears to refrigerate its patients as if theyre preparing them to go to the morgue, and end the day baking in a different hospital that is hot enough to punish Satan for his transgressions. Through all of it, you’ll be wrapped in a flight suit that somehow manages to be simultaneously too hot, too cold, and slightly uncomfortable at all times because the crotch wants to greet your internal organs.
One of the biggest surprises for new flight clinicians is how much energy gets devoted to managing the environment inside the flight suit itself. We spend years learning how to manage ventilators, but almost no time discussing how to manage the small ecosystem developing between our skin and our onesie. Skin flora really do love a moist girlie.
Most programs require cotton base layers, which is great for fire safety and considerably less great for comfort. Cotton absorbs sweat like it’s trying to set a world record and once it’s wet, it remains wet. Eventually it begins clinging to your body with the determination of an emotionally needy ex— at least I assume thats the analogy because my ex’s stay away with good reason. Since most of us don’t get much say in the matter the goal then becomes learning how to strategically manage the suck.
For me, that starts with keeping everything as lightweight as possible. Compression shorts are one of the greatest contributions modern science has made to flight medicine. Good socks are worth spending money on, even if it feels ridiculous to hand over twenty dollars for something that lives inside your boots. Backup underwear should be considered mandatory equipment. And ladies, this is wear you sacrifice sexy for comfy and embrace the cotton granny life (“one of us, one of us”). No seriously, there are few morale boosters more powerful than changing into a fresh pair halfway through a shift that has gone sideways. It’s amazing how quickly your outlook on life improves when you’re no longer marinating in your own poor decisions. Also for my bra-wearing cohorts say it with me, “sports bra, burn underwire.”
The opposite problem occurs in cold weather. New flight clinicians often assume they need the thickest layers possible only to discover that flight medicine consists of repeatedly transitioning between freezing and sweating every thirty minutes. My least favorite thing in winter was having my layers to survive the single digit outside and then having to spend hours packaging in the Tropics of NICU. Thin layers work better than bulky ones especially ones you can shed. Hand warmers stuffed into random pockets are worth their weight in gold and seriously don’t sleep on footwarmers. Finally…wool socks,which continue to prove that sheep solved a problem we never quite figured out ourselves because being cold is baaaaad. I’ll see myself out.
Now… if you like to live dangerously… all natural fibers are the safest things to wear in flight. However, I’m going to be very blunt and candid on this next part. I have always worried more about hypo/hyperthermia in our work environments moreso than getting burnt and seran-wrapped by synthetic fibers. I personally do wear synthetic clothing designed for hot or cold environments because the likelihood of me getting injured from those things is higher than the fire in the cockpit. Please use your best judgement on this and lean into your programs for guidance. I’m not going to be the one to tell you to break the rules.
THAT ALL BEING SAID: Eventually, all roads lead to moisture management. (I said moist and I’m not apologizing for it)
Now we’re discussing the kind of operational knowledge that only comes from experience. The combination of heat, stress, vinyl seats, whatever legal stimulants you consume, and long shifts creates conditions capable of generating their own biome inside your Gibson Barnes. Anti-chafing products, baby wipes, powder, fresh socks, dry shampoo, and backup underwear become less of a luxury and more of a survival strategy. Experienced flight clinicians don’t pack these items because they’re high maintenance rather they carry them because they’ve suffered enough to know better and all the partners rejoiced for their destankifaction efforts.
There is also a time-honored tradition among flight crews of stepping outside the aircraft and pretending to be deeply invested in weather conditions when in reality they’re simply trying to create enough airflow to cool down portions of their anatomy that haven’t seen fresh air in twelve hours. Desert crews understand this instinctively. If you see someone Captain Morgan’ing on a skid when the wind blows… mind your business. Summer flight medicine in Arizona often feels like existing one degree below spontaneous human combustion. You do what you can to air out and cool down. Cold-weather crews like to think they’re immune until they walk into a heated hospital wearing thermal layers and immediately transform into juicy rotisserie chickens in a Costco wrapper.
The lesson here is simple. Take care of yourself before discomfort becomes a problem. Change your socks. Bring the backup underwear. Protect your skin. Nobody has ever received an award for being the most miserable person at the base, and despite what flight medicine culture occasionally suggests: suffering is not a competitive sport.
How Not to Become a Dried-Out Sea Monkey (Beyond “Just Drink Water”)
One of the most annoying pieces of advice in flight medicine is also one of the most common: “stay hydrated.” Gee…Thanks. I’ll be sure to get right on that as I pop open my second Sadness Soda ™ of the day (credit to my partner Aaron for that name).
The people giving this advice are never wrong….exactly. They’re just dramatically underselling the challenge. Staying hydrated in flight medicine isn’t the same thing as remembering to carry a water bottle around on a trip to Target. It requires actual planning because the job seems specifically designed to interfere with every normal human activity and that includes drinking water.
Somewhere along the way many of us develop a toxic enough relationship with caffeine that would concern a cardiologist and probably qualify us for a short stint in rehab. Entire flight programs appear to function on a delicate ecosystem of energy drinks, coffee, and mutual irritation. We drink caffeine because we’re tired but we’re tired because we work weird schedules but we work weird schedules because somebody thought it would be a good idea to combine critical care medicine with aviation…and we have to fund our extravagant lifestyles.
However the problem is that after your second coffee and first energy drink of the day, your brain starts counting those fluids as hydration but they are not hydrating. They’re just beverages wearing hydration’s skin.
I’m going to hold your hand while I say this, ok? At some point… actual water has to enter your body.
This becomes especially obvious when you work in places like where I work in Arizona where summer feels less like a season and more like a personal attack. Summer flight medicine in Arizona often feels like the devil opened the oven door to check on his cookies and accidentally created an entire state. Literally everything in Arizona wants to kill you and the heat is at the top of the list. Arizona is a state that the sun gives its middle finger to for 3/4’s of the year. The heat doesn’t care how experienced you are. It doesn’t care how smart you are. It doesn’t care that you were “only outside for a minute.” It just sits there waiting for you to make a mistake. It reminds me of a creepy voyeur watching you make poor life choices.
One of the best tricks I ever learned was the partially frozen Camel Back hack. Not fully frozen. That’s rookie behavior. A completely frozen Camel Back is just an oddly shaped brick that just feels weird but if you fill it halfway and lay it flat to freeze it becomes something magical. Then take that and slip it down the back of your flight suit. You get cold water for hours to daintily sip on and for a brief period of time it feels like someone installed air conditioning directly against your spine (heavy on the “brief”). During an Arizona summer that qualifies as a religious experience.
The other lesson I learned the hard way is that just water isn’t always enough. When you’re sweating through a flight suit, hauling equipment through the major tertiary hospitals, and spending hours in triple-digit temperatures, you’re losing more than fluid. Eventually you reach a point where you can drink water all day and still feel vaguely terrible (more than usual if youre over 30) and that’s usually your body reminding you that electrolytes exist and perhaps you should stop treating them like a suggestion.
The truly dangerous thing about dehydration is that it rarely announces itself in a dramatic fashion. Most people expect heat illness to look like collapsing on a helipad when in reality, it usually starts with becoming progressively dumber. You get a headache. Then you become irritable. You can’t seem to focus and simple tasks require an unreasonable amount of concentration. You find yourself staring at equipment you’ve used a thousand times while your brain makes the AOL dial-up noise. AND because we’re healthcare professionals our response to these warning signs is usually to ignore them because we’d know if we were dehydrated…right?
Flight clinicians are exceptionally good at recognizing dehydration in patients although we are considerably less talented at recognizing it in ourselves. We will spend an entire shift teaching about heat exhuastion while surviving on half a bottle of water and three energy drinks.
Eventually you reach what I like to call the Desert Lizard Phase (noun): This is the point where your lips are dry, your urine resembles sweet tea, and you’ve developed an emotional attachment to the nearest air conditioner. Every inconvenience feels personal. Every task feels harder than it should. You’re technically functioning but only in the same way a phone functions when it’s at 2% battery. The frustrating part is that all of this is preventable. Is it glamorous, exciting, worthy of a conference lecture…no, no, and also no. Its simple and just plain preventable.
So here is how you do it: It drinks the water (stop pretending your energy drinks count as hydration) and it uses the electrolytes or it gets the hose, again… and by hose I mean probably a bag of saline in the back of your least favorite ground crew’s vanbulance.
Hydration is one of those things we all know is important and yet we routinely ignore until we start wondering why we’re getting headaches, snapping at our partners, and making questionable life choices. This becomes especially true when you are now working in a flight suit that doesn’t breathe, out in the elements, and slowly getting dehydrated at altitude. Unlike me, heat exhaustion doesn’t announce itself with dramatic fanfare. It sneaks up on you while you’re standing on asphalt in the sun, carrying equipment, wearing layers of protective clothing, and surviving primarily on coffee, beef jerky, and hostility. By the time you recognize it, you’re already behind.
The Bathroom Olympics
There are many things people imagine when they picture a flight clinician: helicopters, high speed critical care badassery, cool flight suits and maybe a slow-motion walk across a helipad while Hans Zimmer music plays in the background. What they do not imagine is a grown adult trying to hoover over the toilet in a small municipal airport bathroom while desperately trying to keep a flight suit from touching a floor that appears to have escaped several public health investigations. And yet…somehow, that is a much more accurate representation of the job some days.
One of the strangest parts of flight medicine is how quickly you learn that basic human needs become logistical challenges. Eating becomes a challenge. Sleeping becomes a challenge. Going to the bathroom becomes a challenge. Things that most people accomplish without a second thought suddenly require planning, timing, strategy, and occasionally a small amount of luck. And before I jump into that, I’d like to say this is mostly aimed at women but this goes for the men too.
When I first started flying, I operated under the same assumption most new flight clinicians do, “I’ll just go before we leave on a call.” I mean that sounds reasonable until you actually start doing the job. Now the tones drop, your agency expects dispatch to launch in seven minutes, you need to collect your blood out the fridge, push the aircraft out of the hangar or secure the air-conditioning unit, you still need to walk-around, and, and, and… then you’re trying to power-pee while hugging the sleeves of your flight suit for dear life.
“I’ll go when I need to.” The phrase assumes you’ll have time when the dispatch comes. You don’t always. You might be launching in that seven minutes. You might be launching after 30 minutes of standby. Flight medicine exists in a constant state of “it depends.” The quick transfer becomes a trainwreck stabilization case. The local flight becomes a cross-state adventure. The patient who was “ready to go” somehow isn’t or doesn’t have a receiving bed assignment. And your bladder, unfortunately, refuses to exercise flexibility. Lesson: go when you first notice you have to and have the time… don’t wait until its urgent.
Over the years…I’ve become convinced that the human bladder is one of the most selfish organs in the body. It doesn’t care about scene times, flight times, launch requests, or weather delays. It doesn’t care that you’re twenty minutes from the nearest bathroom or that you’ve just strapped a critically ill patient into the aircraft. It wants what it wants. Immediately. The bladder is the honey badger of the body: it does not give a single f!ck. And don’t get me started on the poo-panic you get when you’re still 40 minutes out from the receiving.
Women eventually discover that peeing in a flight suit is less of a bodily function and more of an acquired skill. Nobody teaches it during orientation. There isn’t a competency checklist. There should be. At some point you learn how much of the flight suit needs to be unzipped, where to place your sleeves, and how to accomplish all of this without allowing any portion of the suit to touch the floor or toilet bowl. This becomes increasingly difficult the smaller the bathroom gets and the more horrifying the bathroom becomes. It’s a process that requires balance, coordination, and occasionally the flexibility of a circus performer.
So, for the women new to flight… let me help you out. Stay away from the toilet when you unzip, fold your sleeves into the crotch of your flight suit, and tuck them into each leg to secure them. Use one hand to hold it away from the bowl. Voila. Seems simple but several people I’ve spoken to literally took a few shifts to figure it out and the panic I felt when a sleeve touched my all-male base’s bathroom floor cannot be fully expressed in writing.
The men reading this are probably wondering why any of this is complicated. Respectfully, I do not wish to hear from you at this time. Your flight suits zip up from the bottom. Stand closer to the damn toilets, its not as long as you think and your stream isn’t that powerful. I say that with immense love but blunt honesty. If you don’t believe me, take a UV light and look at the front of the toilet and floor. Yeah. Enough said.
ER and muncipal airport bathrooms deserve their own discussion entirely. Like our patients (and most of our colleagues), they exist on a spectrum. Sometimes you walk into a restroom clean, stocked with quality two-ply, and so well-maintained that you briefly consider writing a positive Google review. Other times you open the door and immediately begin reevaluating every decision that brought you to that exact moment and internally ask if you’re up to date on your shots.
The challenge is that you never know which version you’re getting and by the time you’ve gathered enough information to make an informed decision, you’re already committed. It leaves you feeling ick. Cue small individual wipes. I firmly believe wipes should be considered medical equipment. Not convenience items. Not optional supplies. Medical. Equipment. Period.
Throughout my career, wipes have solved an astonishing number of problems. They’ve cleaned hands, faces, equipment, boots, flight suits, coffee spills (as seen on my Instagram reels), and whatever else mess I find. After enough years in flight medicine, you stop viewing wipes as a hygiene product and start viewing them as a universal problem-solving tool.
The longer you do this job, the more you appreciate small comforts. A clean bathroom with actual two-ply toilet paper starts to feel like a luxury resort. A sink with soap feels oddly exciting. The chance to rinse your face, change your socks, or spend thirty uninterrupted seconds not solving somebody else’s problem becomes disproportionately rewarding.
These things sound insignificant until you’ve spent ten hours moving between hospitals, helipads, ambulances, and aircraft. Nobody talks about these things because they aren’t sexy. They don’t make for compelling reels. Nobody posts motivational social media content about successfully peeing without contaminating your flight suit. Trust me on this.
When I first started flying, I thought becoming a good flight clinician meant mastering the medicine and aviation. Years later, I’ve learned it also means figuring out how to function after twelve hours in a flight suit, remembering to drink water before you become mummified, and successfully paying tithe to the Porcelain Gods. And don’t get me wrong…the medicine is still the important part.
But nobody ever talks about the fact that before you can take care of the patient, you have to figure out how to take care of the idiot wearing the flight suit (that idiot is usually you). So hopefully this saves you from learning a few things the hard way. Or at the very least convinces you to pack backup underwear. Trust me on that one… I heard it from a friend.
In the next installment of this series, we’ll move beyond flight suit survival and into the strange world of actually living this job. We’ll discuss the differences between twelve-hour “princess shifts” and the base-squatting lifestyle of 24- and 48-hour crews, including packing strategies, coping mechanisms, and the predictable stages of grieving while on the clock (joking).
We’ll also tackle base life, basemate etiquette, sleep deprivation, nutrition, long shift hygiene, and the collection of random items this experienced flight clinician carries. From emergency snacks and morale showers to emotional support go-bags and the fine line between preparedness and hoarding, we’ll cover all the things nobody teaches in orientation but everyone eventually learns the hard way.
This is part of a series I will tagline as A Retrospective from a “Senior” Flight Nurse. Years ago, as a shiny, new flight nurse I wrote about what it took to get me here. Many years have passed and with experience comes clarity. My goal with this new series is to guide you in your journey to the sky with both an optimistic albeit realistic view. I still maintain that if you want it, you can have it… but you need to learn what “having it” really entails.
Part 1 of this series discusses the hard questions you should be asking of your potential new flight agency.
There’s a weird culture in flight medicine where candidates sometimes feel like they’re supposed to sit quietly in interviews, smile politely, and just feel grateful somebody picked them. Meanwhile you’re interviewing for a job that involves bad weather/sleep deprivation, adrenaline/operational risk/trauma/complex medicine/living with weirdos for 12-48 hours at a clip, and occasionally trying to keep someone alive in what is essentially a loud flying portapotty.
You should absolutely be asking uncomfortable questions. Not rude questions. Not gotcha questions. But honest ones because here’s the thing nobody tells you early on in your career: every flight program has problems. Every 👏single 👏one. The important part isn’t whether issues exist but whether or not leadership is aware of them, HONEST about them, and actively trying to improve them. If an agency can’t tolerate respectful questions during an interview, imagine what happens when you raise concerns after they hire you.
The shiny helicopter, cool flight suit, and social media ✨aura✨ are the easy parts to sell. What’s harder to see from the outside is the operational culture underneath it all. Are crews supported when they decline unsafe flights? Is staffing chronically held together by caffeine, empty promises and incentive pay? Do clinicians feel respected? Is leadership visible? Are people leaving for normal life reasons… or sprinting for the exits because glossed over problems ?
An interview is not a beautypageant where your only job is to impress them rather you are interviewing them too. Frankly in this industry your safety, license, mental health (what’s that?), and quality of life depend on it.
So if I were giving advice to someone walking into a flight interview tomorrow, these are some the uncomfortable questions I’d tell them to ask and if not asked in an interview, they are things I’d want to know before accepting a position. Read on at your own risk 🙃
Here are some hard but (IMHO) fair questions candidates should consider asking about their potential new employer:
Safety Culture & Operational Pressure
Because “safety first” is easy to print on a glossy poster but the real question is what happens when somebody actually says ‘no” to a flight. Flight medicine lives in the uncomfortable intersection of risk/ego/weather/fatigue/production pressure. You want to know whether this company truly backs their crews making conservative decisions… or weather they only endorse safety until it delays a revenue flight.
“Can you give me an example of a time your crew declined a flight for safety concerns, and how leadership responded?”
“What is your process for handling operational concerns brought up by pilots or clinicians who speak up?”
“How often are crews pressured, directly or indirectly, to complete borderline weather minimum flights?”
“What trends have you identified in your recent safety reports or ASAP reporting?”
“How does your program balance completion pressure with risk management?”
“What does your Just Culture process look like for your team?”
“What operational decisions changed after your last major safety event or near miss?” (This is a good thing to research about the program before even interviewing— major events often are public knowledge and heavily covered by media).
“What is your current fatigue mitigation strategy for crews?”
“How often do crews formally debrief difficult or high-risk missions?”
Leadership & Organizational Honesty
Every company says they’re family until staffing gets weird and suddenly Daddy Corporate starts acting stingy. Leadership culture matters because it trickles all the way down to the frontline; if you’ve been in healthcare before, you already know this. If leadership can’t openly discuss their weaknesses, the turnovers, or crew frustrations during an interview, imagine how transparent they’ll be during an ACTUAL operational problem.
“What do you believe is the biggest contributor to staff turnover here?”
“What would your current crews identify as the largest dissatisfier in the program?”
“What feedback do you hear repeatedly from exiting employees?”
“How visible and accessible is leadership to line crews?”
“How does leadership respond when a clinician disagrees with an operational decision?”
“How often do frontline clinicians participate in policy or protocol discussions?”
Clinical Expectations & Support
Some programs advertise themselves like you’re joining a high speed/low drag hoodrat-sh!t medical unit but then you spend 90% of your life transferring stable UTI patients at 2 a.m (no drips, no specials, no fun). There’s nothing wrong with that but candidates deserve honesty about what the job actually looks like. You also want to know whether the agency truly supports clinical growth or just expects you to somehow maintain high-acuity skills through ✨vibes ✨ and annual competencies.
“What types of calls are your crews realistically flying most often?”
“What skills are expected frequently versus theoretically?”
“How are low-frequency, high-risk procedures maintained?”
“How does your program support clinicians after particularly traumatic calls?”
“What is your orientation failure rate, and what usually predicts success here?”
“What continuing education is actually protected time versus expected on personal time?”
“How much autonomy do crews truly have in clinical decision-making?”
“What are your expectations regarding scene response versus interfacility priorities?”
Staffing & Burnout
Fatigue in this industry gets romanticized waaaaay too much. People joke about being “chronically caffeinated raccoons,” but exhausted clinicians make mistakes and mistakes can kill people. Burnout doesn’t usually happen because of one bad call; it happens because of chronic short staffing, constant OT, poor sleep, lack of support, and feeling like leadership sees you as a pulse with a license.
“What percentage of your open shifts are currently filled with overtime or incentive staffing?”
“How often are crews held over shift?”
“What is your current vacancy rate?”
“What does scheduling flexibility realistically look like?”
“How long do clinicians typically stay here?”
“What differentiates the people who thrive here from the people who leave?”
“How often are crews working short or without ideal staffing?”
“What systems are in place to prevent burnout besides pizza and woo-woo online learning modules?” (For the love of God dont invoke pizza party protocol in your interview..Actually, maybe just ask what systems are in place to prevent burnout… stop there).
Aircraft, Equipment & Resources
Nothing builds character quite like fighting broken equipment in the back of a vibrating tin can while somebody’s blood pressure actively leaves the chat (we’re cooked). Equipment issues aren’t just annoyances in transport medicine; they become patient care issues very quickly. Candidates should know whether crews feel heard when they identify problems or whether maintenance requests disappear into the corporate abyss of “we’ll look into it”.
“How quickly are maintenance concerns addressed?”
“What equipment issues frustrate crews the most right now?”
“How old is your fleet, and what modernization plans exist?”
“How often are aircraft swapped or downgraded operationally?”
“What equipment limitations most commonly affect patient care?”
“How much clinician input exists in equipment purchasing decisions?”
Compensation & Retention
Wanting to make the world a better place doesn’t pay the mortgage and neither does “passion.” Flight clinicians are highly trained specialists working in one of the riskiest environments in civilian healthcare. So asking about compensation and retention isn’t greedy-it’s adult behavior. Also, programs that retain experienced clinicians usually have a reason just like programs that constantly hemorrhage staff also probably have a reason….
“When was the last major compensation adjustment for crews?”
“How does the company address retention beyond sign-on bonuses?”
“What career growth paths realistically exist here?”
“What percentage of leadership previously worked line positions in this program?”
I feel like managers and recruiters are going to hate me for this advice— but it matters. It’s mattered in my personal experience and there is an industry wide conversation on many of these factors. That being said…you can usually tell within 30 seconds whether an agency has insight… or just rehearsed talking points. A healthy program won’t expect blind loyalty and it’ll respect informed skepticism.
That being said: I’m not telling you to go in and get a cocky industry know-it-all. When I bring these questions up, I’m not doing so to make you feel like you need to fix a company’s problems— and really trying to exam culture and safety can come off as aggressive if you don’t handle it tactfully and with respect. These types of questions are meant to help you get a feel for if this company will value you as you value it. So don’t go in like a jerk but rather than a clinician with discernment.
Finally, I encourage you all to remember this: there’s no greener grass, just different dog shit hiding on the lawn. It’s up to you to decide which dog shit you’re willing to tolerate (me: chihuahua sized and not those weird fossilized white dog turds).
-Clear skies and tail winds!
Because I know yall are heathens… here’s the too long; didn’t read.
TL;DR: Candidates in flight medicine should interview agencies as hard as agencies interview them. Ask directly about safety culture, turnover, fatigue, staffing, leadership transparency, operational pressure, and how crews are treated when they say “no.”
Are you an experienced flight clinician? Add your hard questions below!
By someone who’s been doing this long enough to know better
Let’s set the scene: you’ve got three years in critical care under your belt. Maybe you’re a paramedic who can RSI in your sleep or an ICU nurse who can titrate five drips with one hand while eating cold pizza with the other. You’ve memorized a bunch of random formulas, passed your CFRN (maybe), and your Google search history is full of things like “how to not puke in a helicopter.
You’re ready to fly, right? Well… not necessarily…slow your roll, baby nurse.
Three years of experience is no joke. That’s a solid foundation but it doesn’t mean you’re fully baked yet. And in flight medicine, undercooked can get spicy real fast. There’s a reason why a lot of flight teams quietly prefer five or more years, even if the brochure says three. Hell when I first started, the average was 10+ years (people just did not leave flight). That extra time matters, and it’s not just because we’re gatekeeping the onesies.
Let’s Talk About the Unicorn Myth
You know the one. The myth that once you hit three years, you’re ready to slap on a flight suit and start saving lives from 2,000 feet in the air.
But flight nursing isn’t just ICU or EMS in the sky. It’s ICU plus ER plus trauma bay plus OB and NICU, and yeah..tech support—sometimes all at once—while flying through turbulence and listening to your pilot talk about TFRs.
The Research Is In, Y’all
According to a 2022 CFRN Pulse Survey, over 35% of flight nurses have more than 10 years of experience. That’s not by accident. Those extra years mean more reps with sick patients, more bad calls under your belt, more creative cursing during equipment failures, and most importantly, better judgment when things go sideways midflight (which they do… frequently).
A study in PMC also found that more experienced nurses tend to have higher “compassion satisfaction.” Translation? They’re less likely to lose it when their shit fails, their partner is grumpy, and their patient’s BP is circling the drain at 2,500 feet.
Now Enter: Maturity
I know, I know…nobody likes being told “you just need to be a little older.” But here’s the deal: age equals perspective. And flight nursing requires the kind of emotional intelligence that only comes from years of experience and probably a few existential crises (I I’m pretty sure I personally had enough for a few lifetimes). You need to be able to stay chill in the aircraft while your partner’s troubleshooting a dying IV, your pilot’s yelling about airspace restrictions, and your patient is suddenly bleeding again from a place you already bandaged (and of course can’t reach from your seat.)
Let’s be honest, maturity also helps you not panic when your patient is crashing or your monitor screen goes dark and the only thing you hear is the faint thump of your own stress responsed heart. Ask me how I know 🙃
First Day of Flight, 2018
Personal Growth: A Seven-Year Transformation
I started this journey at 28, full of energy and ambition. Now, seven years later, I look back and barely recognize that version of myself. The experiences, challenges, and yes, even the mistakes, have shaped me into a completely different nurse and person. It’s not just about accumulating years—it’s about the growth that comes with them.
Interestingly, research backs this up. Developmental psychology studies suggest that people often experience significant shifts in perspective, emotional regulation, and decision-making every five to seven years. In a high-stakes environment like flight medicine, those changes can be the difference between reacting and being proactive.
Year Six(ish), 2024
Bottom Line: It’s Not About “More Time to Wait.” It’s About More Time to Prepare.
Three years will get your foot in the door. But taking a little more time—whether that means another couple years in the unit, more variety in your calls, or just letting your prefrontal cortex finish cooking—isn’t a punishment. It’s a favor to future you. The one who’ll be flying at night in winter with a hypotensive trauma patient, a float pilot, and a med bag that’s somehow missing the levophed.
If you’re at year three and ready to go? Hell yes. Chase the dream. But go in with your eyes wide open and your ego checked because this job doesn’t just demand skill. It demands grit, grace under pressure, and a little seasoning along the edges. And if you’re already flying with “just” three years under your belt? That’s okay too but just know it’s not about having enough time. It’s about making that time count.
And hey at least now you know to bring your own snacks. Nobody tells you that part in orientation. Or what to wear under your flight suit. Or that you better figure out your hydration strategy, because once you’re in the aircraft + you’re not peeing until you’re back on the ground + it’s 120 degrees + your sweat isn’t working anymore.
(Nursing: where your bladder learns discipline right alongside your brain.)
I remember when getting into flight nursing felt like chasing a unicorn. It was the elite club of critical care, the badge of honor you earned after years in the trenches, a hundred codes, and more night shifts than the moon. You needed ICU cred, trauma street smarts, the ability to start an IV in the dark (with turbulence probably upside down), and preferably a personality that didn’t crack under pressure.
Now? Blink twice and someone’s in a flight suit with just the minimum required experience and a freshly laminated NRP/RN license.
What…Is… Happening.
Okay, let’s talk about the pandemic-shaped elephant in the room. COVID didn’t just shake the snow globe, it SHATTERED the whole thing. Healthcare was gutted, burned out, stretched thin, and then duct-taped together again. Experienced nurses left in droves, either because they couldn’t take another shift in PPE or they realized their lives were worth more than their paychecks (wild concept, right?). And just like that the flight industry, already a small, specialized corner of nursing, was desperate.
Enter: lowered barriers. Don’t get me wrong, some of the newer folks coming in are absolutely incredible. Passionate, smart, adaptable. But the truth is, the bar just isn’t as high anymore. So programs that once required five years of ICU, a resume written in blood, and a letter of recommendation from the ghost of Florence Nightingale are now hiring with, well, let’s just say a little more “flexibility”.
Orientation programs got longer. Clinical ride time got shorter. Preceptors are working overtime trying to build experience that normally takes years because it has to happen right friggin now. And while this isn’t about blaming individuals (again, a lot of these folks are stepping up big time), it’s worth asking: “what does this mean for safety, patient outcomes, and the long-term health of the flight community?”
Honestly? Meh…
On one hand, the door being slightly more open is awesome for motivated nurses who’ve dreamed of flying but didn’t want to wait a decade and sacrifice a goat under a full moon to get there. On the otherrrr hand, there’s something a little nerve-wracking about seeing the steep learning curve of flight medicine get compressed into a one month crash course.
Flight nursing isn’t just cool uniforms and skyline selfies…it’s knowing how to titrate pressors, dose your sedation, all while troubleshooting a vent at 3,000 feet/125 knots. It’s recognizing when your patient’s going south and there’s no code team to back you up, just you, your partner, and whatever fits in that aircraft (which feels like more and more with no increase in space). And let’s be real, there’s a difference between being “trainable” and being READY for a patient actively trying to die on you mid-air.
So yes, it’s easier to get in right now, but that doesn’t mean it’s easier to stay. Flight nursing still demands the same resilience, critical thinking, and ability to function with one eye on your patient and the other scanning your horizon. The pressure is just distributed differently now, and it’s often falling on the backs of experienced preceptors and med crew trying to bridge the gap.
In the end, the skies may be a little more crowded with new faces, but if we nurture them, teach them right, don’t skip the hard conversations, maybe this next generation will carry the torch with just as much grit and grace.
And if not? Well, I’ll be the one in the corner muttering about “back in my day” while fixing the pulse ox (again) mid-flight.
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!
Scrubs n' Sirens 