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

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

Good, Better, Not Best…

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. 

-Clear skies and tail winds, friends

Six Sentiments for Season Six: Nurses Week 2020

Heeeeeeey Nurseeeeeee!

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.

  1. 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.
  2. 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.
  3. 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.
  4. Nursing will disappoint you. A lot. Frequently. Management will promise you the world only to give you scraps whether on purpose or not. Toad, Four Year Degree in Bladder HoldingPatients 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).
  5. 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.
  6. 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.

Happy Nurses Week!

 

 

I’m Sick With COVID-19 but Not How You’d Think

Does anyone else feel a strange blend of fear and normalcy? Like, you turn the news on and see the world going to shit around us, the death toll rising, the numbers of infected rising, the virus spreading, people in a panic and hoarding supplies, and yet you still have to go outside and pick up dog poop out of the yard? You still need to buy toilet paper? Not because you’re afraid to run out but because you genuinely just need it? You still get emails from every website you ever put an item in their e-shopping cart and didn’t check out with coupons.

It is eerie. Surreal. The entire country of Italy has been brought to its knees yet people are still getting take-out Chinese here. Countries have shut their borders and I’m sitting here looking in the mirror thinking how my one eye’s set of eyelash extensions are looking ratched. Which, the shallow part of me wants to scream “my eyelash extensions ARE essential! Open that business back up, Gov’nuh!” But I’m a healthcare provider, so… I’ll survive. I’m going to look like Gollum by the end of this but I’ll manage (stay tuned for the #Pandemic2020 before and after pics on my IG).

 

The real question is which is the before and after…

By now, you don’t need me to tell you the state of the world. Its closed–moose out front twinkiesshould’ve told ya! The acronyms (WHO, CDC, NIH, etc etc) all pressing for social distancing and hand washing (which by the way, I am perturbed by the fact so many people apparently WERE NOT already doing this….) to help mitigate the spread of the virus. Meanwhile, the general population is torn between “the end is near–panic!” and “we’re over-reacting; it’s a media induced frenzy; the flu kills more; it’s a political plot…. *insert more bullshit*” You do have the warm and creamy center that doesn’t really know what to think or just follows advice calmly. (Shoot for the warm/creamy center–its the best part of the Twinkie, guys… and Twinkies survive. Consult every zombie movie, ever. They’re the cockroach of the snack food industry).

Jokes aside….

Depending on the day, I can swing like a kid on a swing. I don’t fear for my self, really. I’m relatively healthy. I understand nothing is certain and I very well could be that case that ends up on a ventilator. My fear stems from “knowing too much.” I worry about those I care about that fit the category “vulnerable population.” I worry about the side of the pendulum that is the Devil May Care attitude. The ones out living in complete normalcy and disregard for recommendations because they feel invincible. I fear them. This recklessness is what will prevent us from flattening our curve and expanding our disease doubling times.

Let us get really real for a second. Healthcare workers: during flu season, do we have enough beds for our patients? No. We’re holding them in the ER. We’re seeing hospitals IMG_3407go on critical care divert. Do we have an abundance of nursing staff? Again, no. They’re leaving the bedside in masses from retirement of our boomer population (thank you folks for your service), burnout from unsafe/unfavorable working conditions and general malcontent, better work/life balances, and for advancement in careers. Ok, so maybe we have enough doctors? No. That is why medical schools are beginning to offer medical schooling free to certain specialties. It is expensive AF to be a doctor.

So what about the ability to actually house COVID-19 patients? Recent estimations suggest that the patients requiring hospitalization could number 4.8 million, 1.9 million requiring intensive care, and 960,000 requiring mechanical ventilation (source here). Its sobering.

What do we have here? According to The American Association of Hospitals (AHA) data from 2018 (most recent set), of the 5256 AHA registered hospitals in the US, 51.4% were ICU capable (10 acute care beds and at least one ICU bed).

  • 534,964 acute care beds: 96,596 ICU beds out of those.
  • Those ICU beds can be adult, pediatric, or neonatal.
    • 68,558 adult ICU beds (46,795 Medical/Surgical, 14,445 Cardiac, 7318 Other ICU)
    • 5,137 pediatric ICU beds
    • 22,901 neonatal ICU beds
    • 22, 157 step-down unit beds
    • 1183 burn unit beds
    • Worth noting: There was no data on how many rooms were negative-pressure rooms
    • If needed, post-anesthesia care units and operating rooms can be accounted as resources.
  • ’09 survey results showed 62,000 full-featured mechanical ventilators
    • 46% can be used on pediatric or neonatal patients
  • Some hospitals kept older models as contingency plans but only add basic function– adding another 98,738 to the overall supply.
    • 22,976 non-invasive ventilators (which are being discouraged due to aerosolization of the contagion so potentially these may be meaningless depending on the patient presentation/physician discretion and availability of filtration)
    • 32,668 automatic resuscitators
    • 8,567 CPAP units
  • The CDC and Prevention Strategic National Stockpile (SNS)– the country has 8,600 (estimated) reserves for emergency deployment which offer basic ventilatory support. These require hospitals to requisition them from the agency with up to 24-36 hours from decision to deploy to receive them.

So obviously, the numbers don’t balance well. And remember, COVID-19 doesn’t stop our flu season or heart attacks, strokes, traumas, and really any other reason for hospital admission. It adds another layer of burden on to an already over-burdened health care system.

This is why it is a problem and why the government is acting like it is. Not because it hates Coachella. We just can’t support life otherwise. The Italians had to make the hard decision to begin resource triaging–if this is a foreign concept to you let me clarify.

If you did not have a good chance of survival, you’re not being given the resources quite like you would if your chances of survival were higher. It sounds a lot colder than it should. However, this concept has been around for a long time.

Emergency department and service workers are no stranger to the concept of “triage.” It derives from the French word trier or sort/shift/select/separate. It found its roots during wartime when surgeons sought to damage control and remains in use today during mass casualty situations. In recent mass casualty shootings and natural/manmade disasters, we’ve seen how first responders move through the casualties to handle the injured much like the triage nurse sorts through a full waiting room to discern the most acute patient for his or her last treatment beds.

It finds base in the philosophical concept of Utilitarianism. I know it may have been a long time for some of you since Ethics/Philosophy class so let me refresh you: Utilitarianism was the idea that the morally right action is the action that produces the most good. It is a form of consequentialism, that is, it defines the right action is understood entirely of terms of the consequences produced. It is distinguished by impartiality and agent-neutrality–everyone’s happiness counts the same. No one’s good is more or less than another’s.

Me personally, I’ve been that triage nurse. I’ve looked in the eyes of my patients in pain or feeling unwell as I’ve taken people ahead. It breaks your heart knowing they sit and wait. Does that one have a surgical emergency in their belly? That child’s fever–is it something more? So the idea of actually deciding to redirect the minimal resources I outlined earlier to those with higher chances of survivability is not something I relish. It makes me feel a little down and I’m sure you may feel that way too.

So when I say I’m sick with COVID-19, I don’t mean in the literal, physical sense. My heart is sick, you guys. We are not prepared. We cannot handle this if allowed to propagate, unchecked. This isn’t some elaborate political hoax. The science doesn’t lie. Some projections see this epidemic infecting the entire country at some point. This virus doubles every three days and there is a very real possibility that most American hospitals will  become overwhelmed within 30 days (Source here).

I am sick because every time I read a new news-article on Facebook, there is an inundation of commentary from people who insist the gathering restrictions/businesses closure mandates are a violation of rights. And while I am empathetic to why they think so, these individuals miss the point. Here in America, we were founded on a principle above all others, the unalienable rights listed in our Declaration of Independence and that is “the right to LIFE, liberty, and the pursuit of happiness.” One cannot pursue the second two aspects of that phrase (liberty and the pursuit of happiness) without first protecting the first life. This isn’t about politics, you guys. This is about staying alive. This is about keeping our people safe. It is not a democrat vs republican issue… this is greater.

We see movies about the world coming together to fight back alien invasions. This is our alien invasion. We are one people coming together to fight back an enemy invisible to the naked-eye. There will be a life-time to argue about who is right or wrong later, right now, we need to do the smart thing and focus our energies on this.

IMG_1148

Coming to flight medicine, I provide a necessary service. I have talked before how it requires a great deal of dedication and hard-work to get where I am. But I am going to make a confession: I don’t feel like I am contributing enough to the cause, you guys. I am watching my colleagues in the emergency departments hustle and give it everything. That used to be me. The call to serve is so deeply ingrained that I feel guilty for completing only my assigned duties with my job. This is probably just me, though.

I’ve been watching my colleagues post online about how stressed they are, their fears, their fatigue, and frustrations with their administrations. I am lucky–my administration seems forward thinking. But supply chains are not health-care system specific, we see them nationally and globally. It weighs on us all.

Despite this. I want to leave this post with this. This will be a defining moment in our history. This is our medical “9/11”. Now is the time to band together like we saw on 9/12. We need to stay positive, work together, and look to the future. It is a dismal time for us all.

But I am reminded of a few things. Despite all of the ugly and the terrifying, the helpers emerge. Doctors and nurses are getting a disproportionate amount of the thank-yous in this. As a nurse, I’m not saying this to negate the massive impact we have in this. Continue to be grateful for their (my) work.

However, let us not ever forget that this is a team effort– thank your ancillary personnel. Thank the patient care technicians/CNAs, the radiology technicians, the respiratory therapists, pharmacists, advanced practice providers, and every other of the myriad of amazing providers in the healthcare system. Thank the housekeepers, unit clerks, food service workers, the facilities workers, the aviation mechanics for helicopters and fleet mechanics for ambulances. Thank the firefighters, rescue/haz-mat technicians, dispatchers, police officers, emergency medical providers, and other first responders for continuing to go out/go to work, with little protection sometimes to protect and serve the community. Thank the retail workers and grocery store clerks, truck drivers, warehouse workers, factory workers, and postal/delivery personnel keeping us in our supplies of goods we need. Thank the sanitation workers, plumbers, handy-men, line-men, and other tradespeople for keeping the world clean, lit, and comfortable for us while we shelter in our homes.

I am missing so many people worthy of being thanked…but my point is this: there is no small job. Ever. I talked about this once in a post about ever calling yourself “just an anything” in healthcare. But now, I want to throw that post away. There is no job unworthy or “just a” right now. We all make a difference, guys. Even those sheltering at home–you are making a great sacrifice unknown to many in our generation.

So look to the helpers. They’re out here helping.

We can get through this. We will get through this. We’ve survived worst in our history of humanity with less. We will get to the other-side of this. But we need to do it together.

 

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I will leave you all now with some quotes, stay strong everyone:

  • Valor is stability, not of legs and arms, but of courage and the soul.” -Michel de Montaigne
  • I learned that courage was not the absence of fear, but the triumph over it. The brave man is not he who does not feel afraid, but he who conquers that fear.” -Nelson Mandela
  • Hope is being able to see that there is light despite all of the darkness.” -Desmond Tutu
  • While there’s life, there’s hope.” -Marcus Tullius Cicero
  • “I don’t think of all the misery, but of the beauty that still remains.” -Anne Frank
  • Upon the conduct of each depends the fate of all.” -Alexander the Great
  • Solidarity is not a feeling of vague compassion or shallow distress at the misfortunes of so many people, both near and far. On the contrary, it is a firm and persevering determination to commit oneself to the common good; that is to say to the good of all and of each individual, because we are all really responsible for all.” -Pope John Paul II

 

-Clear skies and tail winds, friends — stay strong and healthy

 

Ladies of First Response

Happy International Women’s Day to all my fellow women! We live in the Age of She! Gone are the days where women had only limited choices of occupation; we have the choice of being professionals, being mothers, or being both. As women, we stand on the shoulders of absolute giants. Whether or not you agree with the fundamental beliefs of particular notable women, there is no denying how they have blazed a trail for all of us.

Women who opened the door for us in medicine, aviation, emergency services, and science.

From the mother of modern nursing, Florence Nightingale –a social reformist and statistician in the Crimean War era. To Valérie André, a French army surgeon and parachutist turned helicopter pilot who flew into the combat zones of Vietnam to triage and retrieve casualties. On to Molly Williams, an African American slave woman, who answered the call as America’s first female firefighter when the men of the company were stricken with a virulent strain of flu.

These women laid the foundation for all of us. It is up to us to continue the push.

While women are, indeed, quite able to do all that men can, we often are underestimated, still. However, ladies, it is our job to stop pushing the fact we are women down the throats of our male peers and simply continue to advocate to the fact “I am an able bodied, human being, full of promise and passion, and I have the intellect you do… I am here, I am not going anywhere…”

We can be more than just our jobs. We can be mothers, girlfriends and wives, feminine and fun, absolute powerhouses in the gym… we are not defined strictly by our professions. However, we should recognize the time and place for each. Wear your make-up to work. Talk about your job at home. But always be cognizant there are people out there who will try to drag us down simply because we are not men–we garner a different kind of attention.

I recognize this may sound anti-female. But I promise it isn’t.

I work in a flight base where I am the lone female whereas the others have a more healthy distribution. I am not unaccustomed to being one of the only or one of a few females in a fire company. I was always the girl (stop) friend in the group of guys. So I had to earn my respect and it was made tougher by the fact I’m little (I graze 5 foot on a good day). I realized once I started focusing on myself more, I lost some of my friendships with the guys or other people started treated me differently. Don’t let it dishearten you! Continue to come in to your jobs, your schools, your places you volunteer and keep working hard–it will earn you the respect you want. However, embrace and improve yourself, personally, as well–just don’t shove it down the throats of your fellows because the ones who matter, will still be there through your changes.

International Women’s Day is a day with focus on overcoming bias against women. It is a day for us to build each other up and encourage each other to embrace who we are. So I challenge you to be the best you that you can be, in all avenues of your life. Remember to always treat yourselves with the respect you deserve and be positive to other women out there trying to build their own self-respect.

-Clear skies and tail winds!