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

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.

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!

 

 

Give Me The Resilient Failure– Why ‘Gram Doesn’t Show The Whole Picture

Who has seen my Instagram? (It is right hereeeeeee SHAMELESS PLUGGGGG)

From the outside looking in, my life looks pretty damn charmed. Right?! Solid marriage with a great husband, cute dogs (and I guess an ok cat), beautiful home, amazing/successful career, world traveler, up and coming social media savant (as I’ve been told), and getting my fitness into shape after a life of feeling like an ugly duckling.

Social media has a way of allowing us to create the picturesque dreamscape of a life–complete with vibrant filters and floating hearts as our followers flick their thumbs over the images in the “like” gesture as they move on to the next glamour shot. People sit in the quiet of their living rooms, pondering how mediocre their own lives, spouses, or careers are in comparison to these online personalities of their friends’ or families’ or favorite influencers’ and wonder how they went so wrong. But they forget that the internet is a series of smoke and mirrors; often the whole truth is veiled behind thin half truths or outright lies.

Too often, we lack the entire story. We miss out on the means and simply see the ends.

As a result, our own triumphs seem shadowed by those of others because we see only their “good things” and never the bad. However, it’s really the survival of the bad that defines who are when we get to our “good thing.”

So I’m here to tell you this. No person, no matter how picture perfect they may seem is perfect and honestly, I’d rather the person who has been through hell and back over the person who has never struggled a day in their life to take care of me. Give me the single parent, the child of drug addicted parents or even the survivor of drug addiction, the veteran who has seen war and death, the medical student who struggled through school because of finances, the nursing student who might’ve failed out once before getting his life straight… I want the person who has known what is like to have failed.

I am positive many of my readers have heard the analogy about broken bones… well we know that there is a modicum of truth to the saying. After a bone is broken, the area the bone is broken grows back stronger. Now, we won’t debate the actual physiology in this statement but we’ll use it for this illusion.

simple-broken-bone-line-icon-symbol-and-sign-vector-17307286

When you go through hardship, one of two things can happen…

  • You succumb to the failure.
  • You accept it, learn from it, grow from it, move forward.

So when the bone breaks, you can either reset it and allow it to heal and grow back stronger or you can leave it mangled and useless. The choice is yours.

People who choose to heal are those people I prefer as my colleagues because they have a great deal of traits consistent with emotional resiliency. These people are forged in fire. Like steel, they are strengthened by the flames.

What is resiliency, though? It is the rubber band of our constitution. It is our capability to bounce back. By definition, it is our ability to mentally or emotionally cope with a crisis or return to our pre-crisis state quickly. It is our ability to mitigate the negative effects of external stressors on our internal psyche. For some, this may be a native skill while others had to adapt over time when exposed to crisis. Further, it is important to note, the definition of crisis isn’t static–crisis to one person can be an entirely different meaning to another. It simply means that it creates great potential for suffering for an individual and because of the dynamic natural of humanity, the spectrum of what constitutes a crisis is broad. What matters, is how does the crisis affect a person and how to they cope with it. Overcoming the crisis dictates their resilience.

Think of a time you had a problem. One that caused you great emotional turmoil. How did it make you feel? I’m sure the first thing you felt was your heart rate go up. You could feel the flutter in your chest. Maybe your stomach felt strange. A sweat on the back of your neck. Your respirations may have increased. Stereotypical fight or flight mode. The surge of the epinephrine as the sympathetic nervous system activated. Your brain racing.

And then as the crisis settled, the tiredness. The concerns. The replaying of the scenario. The planning. The promises to yourself. The criticism of your actions. The blaming of yourself or others. The regrets. Maybe instead the pride in your work or your team mates. Or maybe simply…nothing at all.

More time passed. The feelings abated. Each feeling you went through felt a little less intense. You remembered the take-aways but the FEELINGS associated with the event were less sharp.

Resilience. You got through it. You survived whatever that thing was.

 

What Do I Know About Survival?: A Series of Unfortunate Events

For me, it was a series of years where I wanted to quit. My childhood wasn’t necessarily hard but at times it wasn’t easy. My parents loved me, there was no question about that but at times it did not always seem like they were ready for me. My father struggled with his own demons throughout my life while my mom, still young and developing her own career, had me unexpectedly. Their relationship was tumultuous at times given the circumstances but ultimately, they seemed to figure it all out. They saw the best in people, despite their sometimes questionable backgrounds–it is a trait I carry on myself, one that sometimes gets me burned in the end.

As a teenager, I was sexually assaulted over the course of a few year relationship and struggled heavily with my own issues with depression and anxiety. I fought constantly with my parents, as teenagers do. It is a joke I like to make that I was often grounded more than I wasn’t simply because I bucked against my dad a lot. Even in my teenage years though, I had a great work ethic often working at minimum 2 jobs from the time I was 15, sometimes 3 or 4 depending if a previous employer needed under the table work or a babysitter.

Towards my later teenage years, I went through a devastating breakup with the first real love of my life and needed something to take my mind off that. So I decided to enroll in EMT class. I had an interest in medicine and figured it would be a great way to start off a career. Well… I didn’t focus and failed about a handful of weeks in. I was humiliated. I asked the instructor to audit the course for the rest of the semester despite the fact I wouldn’t be able to test with my class mates and although it wasn’t typical, he allowed me to. I re-enrolled the next semester and had one of the highest cumulative averages. And this was the entire foundation for my flight career later in life.

Getting to college, I thought I was in for a fresh start. I got to Philadelphia to a fancy (and expensive) private Catholic university where I was starting as a pre-med major with 20+ credits my first semester. I was excited to pledge a sorority, play rugby, and make new friends. But soon that changed. My boyfriend back home guilted me about going away to school “for a piece of paper”. My friends got me into heavy drinking and drugs. My depression started to rear its ugly head again until I completely stopped leaving my room, going to class, and even eating. None of my professors even noticed my absence. It wasn’t until my suicide note was discovered the day I had planned to hang myself in my dorm room that I was noticed. It was almost 2 weeks I had been missing from classes.

I was taken to the Dean’s office by security. I was delirious from not eating or drinking for days, messy from not showering for days. I was being grilled questions I couldn’t answer. I just wanted to sleep. I was driven to a hospital and taken into an emergency room where there were white walls, lots of windows into patient rooms, and patients were yelling. I was put into a room with only a bed, bolted to the floor. A physician’s assistant came in to speak with me–when I asked for my mom, she ignored me and asked me about my period. When I told her I didn’t know when my last one was (because I had no idea what day it was and because my birth control was messed up), my response was “you’re 18, how do you not know when your last period was? Stop being obtuse!” And she walked out.

It was cold, I wasn’t given a blanket. The older man in the room next to me kept staring at me through the glass. I was alone. I was being involuntarily committed to a psychiatric facility but luckily I was given the option to voluntarily ask for help, which I did. I spent over a week getting treatment and while I never would want to do it again, it saved my life, and I am so thankful it did.

I returned to school in the spring with another 20 credits but all in all, my freshman year of college, of the 40+ credits I took, I passed 4 of them. It was a humiliating and expensive experience. But it was a lesson. It was a growing pain. A broken bone.

The next school year, I transferred to a technical college in Central Pennsylvania and lived at a firehouse. In exchange for running ambulance calls at night, I received free room and board. I ditched the unsupportive, going nowhere boyfriend and met my now husband. I started coursework in a paramedic program and my grades were  getting better. Not quite great yet, but I passed everything. I was much happier. I changed majors again to nursing the next year.

Then in 2010, the night before a major anatomy and physiology exam, I wrecked my car. I had just dropped my boyfriend off to pick up his vehicle at the mechanic and was driving home on the highway. We had finished a fire company meeting; I was tired and wanted to get to sleep for my exam in the morning. I will never know the events leading up to the crash because I had lost the memories of days prior to the event, but my car went off the roadway, rolled 6-7 times, and came to a rest down a steep embankment on its roof. From the highway, the car was completely invisible.

My boyfriend had made it home and saw I wasn’t home yet despite leaving a few minutes before him. He received a phone call from me, my voice panicked stating “I don’t know where I am and there is blood in my ear.” Of course, I didn’t call 9-1-1, I called him. He told me to hang up and call 9-1-1. He called 9-1-1 to tell them where he thought I could be and I also called. Units went up and down the highway looking for me for a while. I was found by a fire police unit as I was walking down the road, bloody. I was repetitive–stating the same things over and over.

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I was admitted for a brain injury for a few days with a minor basilar skull fracture. To this day, I still don’t remember the days before the accident or about 10 days after. All I remember is vaguely seeing the grass and sky in my windshield as I rolled, loud metal noises, and screaming and pressing my horn into the hillside. Needless to say, I got a D that anatomy exam–it was bone and muscles and I had forgotten a week worth of material.

It seems like a lot, right? But not too much…? There was more…

I did ok for a few years. My grades got better. I was starting to see more As than Bs. I simultaneously loved and hated nursing school (much like everyone does).

In May 2013, I woke up to go to work at the hospital where I was a patient care technician. I had noticed my left hand and arm were numb. I figured I slept weird on it and ignored it–I was running late. I got to work 15 minutes later, noticing the numbness and tingling had spread quickly and intensely through my entire left side. I looked over to my care coordinator to ask if she had ever experienced anything like this. I opened my mouth to ask her and as I started to try to speak, I felt my entire left side of my face start to slide and go numb. The words coming out of my mouth weren’t making sense. I blinked and tried to ask again because she looked confused. I tried to lift my left hand up to touch my cheek and couldn’t move it. It all went black as I hit the floor… distantly, I heard the rapid response called overheard.

And then I opened my eyes and I was in the ER with a chaplain speaking to me. The stroke cart was being wheeled into the room. I knew the nurses from bringing patients in on the ambulance. The doctor was asking me questions about times and asking me to move things (why can’t I move that?). My manager was standing there on the phone with my husband (we had gotten married that year). They were talking to me about TPA.

I’m 23… what do you mean you think I’m having a stroke? Yeah lupus runs in my family… shit… my words sound jumbled… I’ll shake my head yes and no. There is my husband. Yes… birth control–I take that. No… don’t smoke. Yes–give the TPA. Yes–fine, fly me to that hospital.

Screen Shot 2020-02-17 at 10.32.15 AMIt happened so fast… before I knew it, I was being loaded into a helicopter. I was in the air flying over my city. I was 80 miles away in another CT machine, getting more IV contrast. I was in an ICU bed. I wasn’t allowed to get up to pee. I could talk now though–that was a plus. My mom lives ten minutes away, at least I wouldn’t be alone but it would take my husband almost two hours to get to me if he drove the speed limit. I spent three days in the Neuro ICU while they ruled out causes and sent me home on medications. I was treated for a stroke but they determined that the cause wasn’t ischemic but rather related to more electrical/migraine activity. It was strange, I’ve never even had a headache. Who knew a migraine could be so scary?

I got better and spent the summer in Minnesota, leaving a few weeks later. It was between my Junior and Senior year so I had secured a spot in the Mayo Clinic externship program for 10 weeks on a trauma floor. I still had weird neurological symptoms all summer long but was still titrating off of medications for it. I tried to down play it and focus on what was to come.

I came home a bit smarter and ready to finish nursing school with a bang. I was beginning to look at jobs and apply for interviews, it was my goal to have an offer by January. I was spending my free time studying and applying. My grades were looking very good. I was the public relations officer for SNA and it seemed like everything was going my way.

Until my husband’s birthday. My husband came home to find me in full tonic clonic seizure activity on our kitchen floor. Never had I had a seizure until that day and in the span of a handful of hours, I had three separate events. I was admitted and started on an anti-epileptic medication. Over the course of the school year, I had multiple events resulting in admissions to the hospital and the intensive care unit, multiple titrations of medications, multiple visits to neurologists, multiple eegs. I thought this was going to be the year I had to drop out. My medications had me so unable to focus and I had missed so much class there was no hope to graduate. It was by sheer will and determination and the grace of my instructors to help me work around my diagnosis that I was able to pass that year.

 

So What Does This Have to Do With Anything? You Grow Through What You Go Through.

Resilience is how you come back in the face of adversity. When dealt a hand, how will you respond? It is easy to look at a person on Instagram or Facebook who projects a perfect picture and say “I will never be him or her… they’re perfect.” However, this discredits our own ability to achieve our goals way too much. The images we see only show partial truths.

The problem social media has is that we only see half the truth or none at all. We see what people want us to. We see perfectly choreographed pictures meant to endorse an idea. Often that idea is “I made it!” It is not always that people want YOU to feel inferior but that they want to feel better about their own lives, so they create their own narratives. They present their autobiographies in a more palatable way.

Me? Guilty. Guilty AF. Put me away, Judge.

However, now you know that behind the perfect picture is an imperfect person–and quite frankly, they are my favorite types of people. To get where I am, I had to constantly get thrown several steps backwards and then fight my way forwards every time. But every time I had to face adversity, it taught me how to problem solve and how to use my resources. As cliche as it may sound, what didn’t kill me made me stronger. It shaped my ability to be resilient.

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What Does Resilience Do For You, Then?

So let’s talk about traits emotionally resilient people have and why nurses or pre-hospital folks or really anyone in medicine or emergency response can benefit from it.

  1. They practice good self-care.
    • Part of dealing with other people’s crises is learning to be able to know when it is time to put that burden down and focus on yourself. Understanding that you are one person and can only save the world once your mind, body, and spirit are cared for is something many people never learn. As a result, they burn out or develop vices to deal with the ugliness of the world. They inflict more harm on themselves in an effort to stop the emotional hemorrhage.
    • “Make it a priority to create a homeostasis (a baseline) for yourself–then take time to bring yourself back to that place. Care for yourself so you can care for others.”
  2. They understand bad things don’t define them.
    • At any time, something can go wrong–whether it is simply because Mercury was in retrograde or because you over-estimated your own abilities or because you took a short-cut when you shouldn’t have. Regardless, a bad thing happened. Now what? Well… how do you move on? Do you continue to make the same mistake, allow the worse thing to continue to dictate the circumstances of your life or do you control the narrative? We cannot always control what happens but we can control what we do after the fact. Do we run and hide, pretend it isn’t happening, or do we face it, learn from it, and come out better? We are defined by how we REACT to the catalyst, not necessarily by the catalyst itself.
    • “If it doesn’t matter in five years, don’t let it bother you for five minutes.”
  3. They treat others with compassion.
    • Empathy is the ability to understand and share the feelings of another. It is considered a more noble feeling than sympathy in that it puts two people on level playing ground as sympathy is defined more of feeling pity for someone. Some people feel this is a form of being looked down upon when you already feel low. People with emotional resilience understand what it is like to be low–thus they feel compassion. They do so in a manner without judgement–they understand what ugliness and hurt looks like. These are the people we serve as emergency responders and healthcare providers. We see humanity at its worst thus they need us to show humanity.
    • “I see you because I was you…”
  4. They understand what it means to “race in the rain”.
    • Life will never be perfect–the emotionally resilient have learned this. Things will go wrong. Train for the worst case scenario but hope for the best. Accept that things are in flux and are dynamic. Expect the unexpected and make the best of that. Emergency medicine and first responders are ideal examples of this concept.
    • “…grant me the serenity
      to accept the things I cannot change;
      courage to change the things I can;
      and wisdom to know the difference…” –Reinhold Niebuhr (1892-1971)
  5. They admit when they need help.
    • Being first responders and healthcare providers, we are expected to be proficient in problem solving and critical thinking, swift on our feet, and courageous in the face of adversity. However, it is important we acknowledge our short-comings both in knowledge and in coping. We need to know to ask for help when lives depend on us, including those times when our own lives depend on our abilities to admit we need help. Every year, more and more first responders and healthcare providers succumb to the darkness of their jobs rather than admit their perceived weaknesses and every life extinguished is one too many.
    • “From what I’ve seen, it isn’t so much the act of asking that paralyzes us–it’s what lies beneath: the fear of being vulnerable, the fear of rejection, the fear of looking needy or weak. The fear of being seen as a burdensome member of the community instead of a productive one. It points, fundamentally, to our separation from one another.” –Amanda Palmer
  6. They know when it is time to listen, when to be supportive, and when to allow for space.
    • Having needed your own time to be heard when you speak, to feel like you were supported, and needed time to be alone in your thoughts, you understand that people need what they need when they need it. The emotionally resilient understand that to push too much against a rigid trunk may cause it to splinter and break where if left to its own devices, it may grow strong on its own. They understand that people cope with things differently and do not remain static in their processes.
    • “The wounds that never heal can only be mourned alone.” –James Frey
  7. They build a tribe of supportive people.
    • The resilient understand that people can drain your energy and impact your healing so they choose who they surround themselves with purposefully. They find people who support them and while those people may not necessarily understand the problems they see or experience, they still support their personal growth through it all.
  8. They know who they can go to for support and who will give them the truth they need versus the people who will simply perpetuate drama.
    • Some of the most important things a person learns about themselves comes from the people they respect. Some times, we have inflated self-esteems or overly low opinions about ourselves so it is important we have people we can rely on to tell us how it is. Are our skills lackluster? Is our critical thinking off base? Do we put off bad airs around colleagues? Your person will make sure you’re not left in the dark. Meanwhile, avoiding people who will inflate your ego or trample your dreams will help you stay within your homeostasis.
  9. They possess an ability to reflect on themselves as they have developed self-awareness.
    • This particular point took me a long time to develop. I had to learn to be honest with myself. If you read my post about my first year in flight (here) you’ll recall how I suffered from a bit of an ego coming from my ER but then an overly low sense of self-worth when I got to flight. But bringing myself back to center and being able to give honest evaluation of myself has been a constant struggle that has gotten a little easier all the time. Becoming more self-aware allows you to internally tune your chords to create a better running human and make you a better first responder/healthcare provider.
  10. They have an ability to be grateful.
    • Life is full of disappointments–we often don’t get what we want no matter how hard we work. Whether it’s the flight job of our dreams, that paid firefighter job, the medical school admission we wanted… learning to be grateful for the opportunities we DO get (“I did get the interview at least…”) is another difficult lesson. Learning to see failure and rejection as lessons as opposed to the end of your dreams is step one to re-framing your thinking. The resilient understand not everything goes right the first time but they are grateful for what they already have and what they were offered. They get excited for what may come. It isn’t to say they can’t be disappointed, its just they don’t wallow in their miseries.

 

Screen Shot 2020-02-22 at 9.39.24 PMBecoming More Resilient

Short of having gone through some dark things and developed coping mechanisms, resilience can be learned. I’m not going to reinvent the wheel though–many great articles exist on the ability to re-frame your thinking to become more resilient. It all starts with how you critique your past and prepare for future challenges.

 

 

  • Don’t allow yourself to be stuck in negative thought cycles.
  • Stop being afraid to fail– you will never succeed if you never try!
    • Do mothers and fathers criticize a baby for falling after taking a step? No… they celebrate that first step and when the baby finally walks, no one remembers the baby falling. So too when you succeed, no one will care about how many times it took you to get there.
  • Find the lessons in past failures or challenges.
    • What can you learn? Consider job interviews– every interview is a practice for the next one. Take what went well with you, get rid of what didn’t.
  • Stop dwelling on your past failures and start planning for the next attempts.
    • When the door shuts in your face, instead of staring at it…look down the street for the three more slightly ajar ones that may be alluding your gaze if you don’t look carefully enough–behind those doors may lie your path to your dreams.
  • Emotionally distance yourself from the challenges you come across.
    • Try to picture the situation you are in as if you were outside your own body, watching it play out. Would someone who was not you be upset about this? Try doing this exercise when you are distracted by crises to allow yourself an opportunity to evaluate your situation and options.
  • “This too shall pass.”
    • Things will move on–the passing of time eases the burdens of the soul. While it stings now, that broken bone will heal.
  • Find the positives in the challenge.
    • Attempt to reframe your mind–use a technique called positive reappraisal. It means that when you are in a situation where there is no real positive, you create your own. Consider you went to an interview that you did not get an offer for– you reframe the thought with “I at least got an interview–it means I am at least meeting standards needed to get into an interview. This is further than I was before.”
  • Make it a point to get uncomfortable– stop staying in the shallows.
    • A popular quote in the Crossfit community is “I’d rather choke on greatness than nibble on mediocrity”–and while I’m not into Crossfit, myself, I really like this quote. Mediocrity in this example is being comfortable but boring. Make it a goal to go against your comfort levels to attain the greatness you want, whatever greatness means to you.

 

Failure has such an ugly connotation associated with it. However, we shouldn’t allow what we perceive as failure to make us feel less awesome than we really are. Us failures are an awesome people–we survive and overcome. We are proficient in adapting and problem-solving. Failure is really actually quite beautiful. So whoever you are, wherever you are… if you’re out there looking at some Insta-celeb’s ‘Gram and thinking how your life doesn’t measure up, please pick your head up and straighten that crown. You are every bit as successful and amazing.

 

–Clear skies and tail winds.

 

 


Footnote: Obviously there was a lot of personal stuff I divulged here–I really hope my own personal story of perseverance has maybe inspired you to stay your course. Feel free to share your own stories of failure and overcoming in the comments to inspire your peers. As always, I welcome any and all feedback.

Teaching the Fish to Fly: One Nurse’s Musings on Her First Year of Flight


 

Any day now: they’re going to see me for the fraud I am.

Any day now: I’m going to hear the words “We made a mistake… We’re letting you go…”

Any day now: I’ll have to look the loved ones of a patient in the eye and admit “I simply wasn’t good enough… I never should have been here.”

Any day now: I’ll work up the nerve to turn in my flight suit and walk away.

Spoiler Alert: That day never came. I’m still here.

 


 

A Big Fish in a Decent Sized Pond (Maybe a lake depending on your definition)

I ran around the emergency department as the float nurse. It wasn’t looking like breaks were coming today but not much else was new. I stopped in this room to help another nurse settle her ambulance or that room to start an IV on a tough stick. It came easy. I knew my role. The department was changing, the merger with a large healthcare entity meant a lot of new policies, new flow patterns, new and (in my opinion) inferior equipment to learn, and with that, a great deal of migration of senior nurses out. We were learning how to become a trauma center, dealing with massive influxes of education and memos in our emails, and learning how to deal with trauma surgeons. The psychiatric patients, the overdoses, the high maintenance but low budget level-3 influxes, and the mix of serious and not serious flooding into the waiting room come 1100 with holes in the nurse staffing. “5 to 1 again guys… Steph, you have two social services holds–waiting for nursing home placement…”

Business as usual.

It was my normal. I felt that after three plus years in the emergency department, I could handle 95-99% of what walked through that door and whatever new hoop the management overlords threw at us next. It was chaos, madness, insanity, insert whatever synonyms you want for “batshit freaking crazy”–but it was home. This was my niche. I knew my protocols, could almost call a diagnosis through chief complaint and physical assessment alone. My husband was accustomed to the phone call an hour before shift change with the “heeeeeeeeeyyyyyyy…”. He knew on that first word I’d be staying late again.

I was one of the people my peers called for hard sticks. My younger staff knew they could comfortably ask me things without me judging them. Many today still remember that when they say, “I want to be like you, someday”, my response would be “No… do more, be better.” I had been asked to precept nursing students, paramedic students, and new hires. I was asked to be on committees. I was nominated for awards. My frequent flyers knew me and asked for me. It was hard not to be egotistical but I had hit my stride. For as frustrating as the emergency department can be, it was where I shined.

In my personal life, I always had a low self-esteem but in my professional life, I was peaked in my mind. I found my flaws and I smashed them to come out better. I felt confident.

It wasn’t always like that though. It took months to years of being frustrated, being angry, being hopeless, and occasionally melting down in the med room.

 

 

That First Year in the ED

I came to the ED from a small community hospital ICU. The kind that could handle respiratory failures on ventilators and DKA on insulin drips. We had a cardiac catheterization program and I’d see a-lines on occasion. I was trained in balloon pumps but never actually saw them. I had a little less than a year in when I made the move to the ED. The ED was where I always wanted to be. I was shot down in nursing school which was devastating so I was elated that the opportunity came.

I was blessed with two of the best preceptors. They were thorough, well adjusted, confident. I couldn’t wait to be “them.” I trained exclusively on day shift but was hired for night shift. My first time working nights was my first day off of orientation. I went in happy and excited and within a few hours I ended up crying in the med room. Night shift staff was tough but not cold or mean… They had the mentality that they had seen some shit and you needed to harden up to survive. That lesson took me a while to learn.

That whole first year was a roller coaster as I learned the ropes of night shift. It was making more out of less. Team work was key to survival. It was learning that while it’s ok to be “nice” recognizing there is ugly in some patients and they will mow you down. I was nicknamed “Suzy Sunshine” and my techniques for handling psych patients were sometimes met with skepticism. I got hurt a few times by patients because I gave them the benefit of the doubt and left them have too much rope.

It got better though. Every shift I learned new things. My skills improved. My report with patients stabilized to a compassionate but professional manner. My confidence grew until I no longer questioned my place–I earned it.

Now, I’m sure by now, you’re wondering– Steph… I don’t really particularly care about your ER days. When are we getting to the flight stuff?

Because this first year for me started off excited for the new adventure but quickly the romance dissolved into terror when I started to question my abilities to fulfill my role. And over time, with a good support system and mental fortitude, I built myself to a place of professional confidence. And this entire dynamic reared its ugly head again during my first year in flight nurse.

 

 

There is a Science Behind The Emotions

Transition shock. The term couldn’t be better named. It is often used to describe the  negative array of feelings new graduate nurses feel when they first transition into the role of the professional nurse. Common themes that emerge are the fear of “being exposed as clinically incompetent”, failing to meet the needs of patients and hurting them as a result, and not being able to bear the responsibilities their new role entails (Boychuk Duchscher, 2009). This particular conceptual framework has been identified as a major reason new nurses switch specialities or leave nursing bedside within their first year. It is a pervasive albeit insidious secret in nursing, one they do not prepare you for in school.

But beyond the transition shock, there is also another identified concept that has relevance in my first year and that is the impostor phenomenon. It derives from the field psychology and was first really studied in the 1970’s and 1980’s. It is the “psychological experience of intellectual and professional fraudulence…” during which individuals experience a fear that their peers possess perceptions and beliefs in their abilities that may be inflated and as a result, the affected worry that they will be identified as a fraud (Mak, Kleitman, and Abbott, 2019). The concern derives from the idea that should the person fail to replicate performance to the standards ascribed to them, that they will be ousted as fraudulent. This phobia remains despite praise or achievement and they usually discount their own abilities as “luck” or “right place-right time”.

Related to this framework is the idea of perceived fraudulence. While it is similar to the impostor phenomenon, it focuses more on the idea that individuals are concerned with “impression management”and are pre-occupied with the idea of managing their self-worth and social image. These individuals are usually unable to overcome their own intense self-criticism and as a result, when placed in new environments, will constantly monitor for social cueing from their colleagues for fear of “being discovered.” At its heart, they fail to realize that their own high-expectations often do not translate to those of others and as a result, they constantly “front” themselves to protect their image.

Psychology Today did a short and sweet write-up on the topic. And as I read these paragraphs back to my husband, he sort of just nodded…

It boils down to a sheer lack of confidence in one’s self not the lack of ability. This was a lesson that took me a while to learn. I was surrounded with the best and the brightest. I felt like that person who managed to sneak in the back of a major event, uninvited and constantly shifting my eyes waiting for the bouncer to throw me out on my ass. It is exhausting. Truly. Being in flight, where we are expected to be the best and operate at high levels of precision is certainly something but I was thrown right back to year one in my nursing career. I didn’t think I was hot enough shit for this role and someone soon would see right through me.

 

And they kind of did. Actually, just one. And he made all the difference in my attitudes.

 

Taking the Big Fish Out of the Pond and Tossing Her Into An Ocean

Honestly, I never really saw myself as having a confidence problem. I always felt pretty secure in my abilities. As previously stated, I was a rising star in my ER job. I had just finished my masters degree two months before starting and I was still riding that high. As usual, I came into my new job with the same confidence I had for my old job. Until I started to realize the gravity and immensity of what I had began. It was a swift kick in the ass to realize how little I actually knew. I knew who to ask for help to and what my resources were but the immenseness of “not knowing what you don’t know” was the crux of my existence. Not knowing what I didn’t know yet was this constant plague to me as I played out every worst case scenario in my head.

And like any good little worker, I faked it until I made it. But the mistake I made was coming off as arrogant or overcompensating. I was eager to learn and improve but too scared to be seen failing. I fell victim of the impostor phenomenon. In my attempts to negate my own feelings of inadequacy, I often postured and tried to seem more confident and competent than I was. I was textbook perceived fraudulence in living color.

But my base manager saw straight through my front. He called my bullshit right out. It hurt to hear. It is a weird feeling to have someone you respect and look up to call you out on having no confidence or a low self-esteem when all this time you had convinced yourself that you didn’t. I was in complete 100% denial of my situation. And it took someone saying, “relax…” and basically laying out how your actions can be perceived as abrasive to others. I just thought I was protecting my own image but in reality, I was pushing others away. It was a lonely feeling. Luckily, I had the support of people in my program to uplift me while I fumbled through figuring it all out.

And for that, I am ever grateful. If you take nothing out of this long-winded and emotional retrospective its this: find your tribe. Identify the people vested in your success. You will encounter people who hold their breaths waiting for you to fail–make them suffocate. For me, it was my preceptors and partners. It was that one base manager. Multiple flight paramedic preceptors from a variety of bases in my agency. My director. I found people who believed in me.

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Because here is the secret: if you didn’t belong here, you would not be here and if you by some chance DID weasel in, you would’ve been screened out early. 

 

It was that realization and constant cognitive framing that I survived myself. That was ultimately my biggest hurdle: getting over my damn self. It wasn’t learning protocols: thats read and regurgitating algorithms. It wasn’t learning to work around a running helicopter: that takes practice. It wasn’t learning how to deal with the myriad of different situations I’d find myself in: that takes teamwork and experience.

No, the biggest hurdles in learning to be a flight nurse were:

  • Developing a sense that I earned my place and I did belong here.
  • Recognizing it was going to be hard and I would indeed have times I fail.
  • Every time I fail is an opportunity for growth.
  • Learning to trust myself again–I knew enough to go back to the basics every time and all good medicine stems out from good foundation of the basics.

 

But what about the actual details of that first year?

By now, if you’ve read this far, you’re probably sitting there pondering what you got yourself into. How in the world does this pertain to preparing me for my own first year?

Every program is different so my actual orientation will be different than yours. I can go on to say “I spent 24 hours on CVICU to see open hearts, balloon pumps, drips, and ECMO… 24 hours in NICU to see how newborns are handled… 24 hours in the PICU… so long on an active 911 ambulance…” And really that was my first month. It was bouncing around different units for exposure. But we’re healthcare providers, we know we have to be dynamic and gain exposure to all these things.

The career ender and soul killer through all of this is your swagger. It is the balancing act of being arrogant and being scared of yourself because your confidence has not yet found the happy medium. Studies have shown that 1st year can make or break people and in new graduate nurses, many will leave their specialty to another specialty or bedside all together if they don’t feel confidence begin to grow.

 

Accepting Help and Admitting Weakness

 

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My first time flying in the helicopter

Through this entire post, I kept deleting things and rethinking what I wanted to talk about. I kept thinking that admitting my short-comings and admitting I struggled with confidence would undermine my credibility. We in flight are expected to be the best but here I am admitting I questioned myself. I realized that I still fall victim to the conundrums I previously discussed–admitting my struggles may undermine my image. Gone is the badass albeit tiny flight nurse as the silly goose rears her head. At least that is what I thought. Half of the battle was recognizing the negative self-talk and beginning to take stock in my strengths and weaknesses without belittling myself.

That being said: its ok to admit you’re not all that and a bag of chips (I mean you may still be a bag of chips but like the store brand not the flavorful kettle cooked ones). Admit you don’t feel comfortable with things yet and ask for help. Ask for additional training. You’ll be more respected for identifying these things yourself than if you try to tread water and hope people don’t think you’re incompetent.

 

I say it because I know it…

The huge blow in my first year came when my orientation period was extended. It was following the heels of a night flight to the middle of nowhere. She had fallen down too many stairs after imbibing and met trauma center criteria but by ground it would take too long. So in we came on our white horse (or in this case a blue and white EC-145). It was what should have been one of my last orientation shifts and by then, I should’ve been running the call. I hadn’t had a great deal of scene flight experience and my preceptors generally had different approaches to these patients. One of my partners was supposed to sit back and watch or be directed by me. But in the end, I ended up getting disorganized and essentially did not perform as a provider partner was expected to off of orientation.

So two weeks my orientation was extended and my end of orientation simulation was cancelled. It was so disheartening. I was mandated to shifts on a local ALS ambulance where I was supposed to work on my field skills. However, I kept getting BLS transfers or nursing home transport runs instead of what I needed. I was so frustrated. But then came the final shift with a big trauma– MVA, pregnant patient, ejection, middle of winter, the gamut. I performed well enough as a partner to qualify to challenge my simulation. I was able to pass that and come off of orientation.

But when I thought that I was done growing, it was really only the beginning. I had new patients, new pathologies, new flights where I constantly felt challenged. But every month that passed, I felt a little more confident. It was like the ER all over again, I felt myself settling in. I recognized I had places to grow but when I looked back to where I had come from, it was like I was a whole new flight nurse.

 

Some of the Little Things They Don’t Prep You For

  • The amount of classes you have to take, the amount of training you undergo.
  • Learning to deal with boredom–in between the calls when the required trainings and base chores and responsibilities of your job are done there is a lot of down time. Learning to keep yourself busy is a hard thing. (My response was to start a blog)
  • And in that inactivity, how to stay healthy. Learning to eat right or keep up being active.
  • The dynamics of working with people, especially the grizzled veterans of flight. You get some salty people, don’t let em diminish your shine.
  • Learning how to dress for the heat of ICU’s but the cold of a scene flight in the middle of a corn field in single digit weather (because “seasons”).
  • And this one is for the ladies, how to deal with inundation of Facebook friend requests from firefighters you meet on the job… yeah, I said it.

 

That first year of flight will remind you of that first year of nursing. You’re going to see up and down and sometimes a steady “in the middle.” But be resilient in the face of bad times and accept your praise/accomplishments. Recognize what you feel is not uncommon but do learn how to overcome it. The first year is exciting and scary but you can survive it! Just stay the damn course!

 

-Clear skies and tail winds!

 

Great-leadersdont-set-out-to-be-a-leader...they-set-out-to-make-a-difference.-Its-never-better-the-role-always-about-the-goal

 

Do you have any advice for other aspiring flight nurses or novice flight nurses? Leave a comment with some tips and tricks! Got questions I didn’t answer? Feel free to slap those babies in the comments too!

 

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