Oh Hi There!

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!

–Stephanie

So, You Wanna Be A Flight Nurse… The Remix: Interview your Interviewer

Posted in Flight Nurse, So You Wanna Fly by

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 you, 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. The important part is whether 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 pageant where your only job is to impress them. 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 the uncomfortable questions I’d tell them to ask. Read on at your own risk 🙃

If a flight program gets uncomfortable with thoughtful safety and culture questions during an interview… that’s data. Aviation and critical care transport are too high-risk to pretend culture doesn’t matter.

Here are some hard but fair questions candidates should consider asking:

Safety Culture & Operational Pressure

Because “safety first” is easy to print on a glossy poster. 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, and production pressure. You want to know whether this company truly backs crews making conservative decisions… or whether they only love safety until it delays a transport.

  • “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 pilots or clinicians who speak up about unsafe operations?”
  • “How often are crews pressured, directly or indirectly, to complete borderline 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 actually look like in practice?”
  • “What operational decisions changed after your last major safety event or near miss?”
  • “What is your current fatigue mitigation strategy for crews?”
  • “How are weather turn-downs viewed culturally by leadership and communications centers?”
  • “How often do crews formally debrief difficult or high-risk missions?”

Leadership & Organizational Honesty

Every company says they’re a family until staffing gets tight and suddenly Daddy Corporate starts acting weird. Leadership culture matters because it trickles all the way down to the tone in the aircraft, the base, and the group chat. If leadership can’t openly discuss weaknesses, turnover, 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 areas of the company still need significant improvement?”
  • “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?”
  • “What is one thing your crews would change tomorrow if they could?”
  • “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, 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 way too much. People joke about being “chronically caffeinated raccoons with radios,” but exhausted clinicians make mistakes. Burnout doesn’t usually happen because of one bad call. It happens because of chronic short staffing, constant overtime, poor sleep, lack of support, and feeling like leadership sees you as a warm body 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 resilience modules?” (For the love of God dont invoke pizza party protocol in your interview)

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 are heard when they identify problems or whether maintenance requests disappear into the corporate abyss.

  • “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. Neither does “passion.” Flight clinicians are highly trained specialists working in one of the riskiest environments in healthcare. Asking about compensation and retention isn’t greedy. It’s adult behavior. Also, programs that retain experienced clinicians usually have a reason. 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?”

The Quietly Important Questions

These questions matter because the canned interview answers only tells you so much. The real truth usually lives in the hesitation before someone answers. You’re trying to figure out if this is a place where people feel psychologically safe, professionally respected, and operationally supported… or if everybody’s surviving on caffeine, dark humor, and suppressed HR complaints.

These are often the most revealing:

  • “What keeps your best people here?”
  • “What makes good clinicians leave?”
  • “If your spouse or child needed transport, would you feel confident putting them on this aircraft tonight?”
  • “What concern would you have about me taking this job that you think I should seriously consider?”
  • “What answer were you hoping I wouldn’t ask for clarification on today?”

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. It’ll respect informed skepticism.

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.” The discomfort level in the room is often part of the answer.

Are you an experienced flight clinician? Add your hard questions below!

Three Years, a Dream, and a Flight Suit: Why That Might Not Be Enough

Posted in Flight Nurse, Motivation, Personal Growth, So You Wanna Fly by

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 the CAMTS requirements, 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… slow your rotor wash, 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. That extra time matters, and it’s not just because we’re gatekeeping the cool jackets.

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 like a stethoscope-wielding superhero.

But flight nursing isn’t just ICU or EMS in the sky. It’s ICU plus ER plus trauma bay, plus resource nurse, social worker, and tech support—sometimes all at once—while flying through turbulence and listening to your pilot talk about wind vectors like it’s a normal Tuesday.

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 mid-flight (which they do).

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 vent fails, their partner is stress-eating almonds, 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. You need to be the calmest one 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.

Let’s be honest, maturity also helps you not panic when your patient is crashing and your monitor screen goes dark, and the only thing you hear is the faint beep of your own stress response.

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 responding.

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 rookie pilot, and a med bag that’s somehow missing the Doppler.

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.

And if you’re already flying with “just” three years under your belt? That’s okay too. 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.

(Flight nursing: where your bladder learns discipline right alongside your brain.)

-Clear Skies and Tail Winds

Are We Misremembering or Is It Easier to Get into Flight Nursing Now?

Posted in Flight Nurse by

Spoiler: It’s not just you.

I remember when getting into flight nursing felt like chasing a unicorn while carrying a 12-lead and an arterial line setup. It was the elite club of critical care, the badge of honor you earned after years in the trenches, a hundred code browns, 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), and preferably a personality that didn’t crack under pressure, or in the co-pilot’s seat.

Now? Blink twice and someone’s in a flight suit with just the minimum required experience and a freshly laminated NRP card.

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 bench just isn’t as deep anymore. So programs that once required five years of ICU, a resume written in Latin, 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 now. And while this isn’t about blaming individuals (again, a lot of these nurses 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? It’s a mixed bag.

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 other hand, there’s something a little nerve-wracking about seeing the steep learning curve of flight medicine get compressed into a crash course, literally and figuratively.

Flight nursing isn’t just sexy uniforms and skyline selfies. It’s knowing how to titrate pressors, dose the sedation, all while troubleshooting a failing vent at 3,000 feet. 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. 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 on your altimeter. 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, and 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 re-taping an IV mid-flight.

Is it Her? Is it Me? Is it Meant to Be?: Dealing with Alpha Preceptors in Your New Pack

Posted in Flight Nurse, Personal Growth by

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

Wolves in a Pack from Getty Images

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!

RN Looking to Paramedic?

Posted in Certification, Personal Growth by

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.

Creighton University- Two Week In Person at the University

Crowder College 16 Week Remote- Self paced, Clinicals In Your Area

Hopefully this helps some of you!

-Clear Skies and Tail Winds!