Tag Archives: trauma nurse

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.

Six Sentiments for Season Six: Nurses Week 2020

Posted in COVID-19, Motivation, Personal Growth, Uncategorized by

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!

 

 

A-B-C…LS, BLS…CFRN, CEN… L-M-N-O-P: Certification Alphabet Soup

Posted in Certification, Flight Nurse, Personal Growth by

Stephanie Suzadail, MSN, RN, PHRN, CFRN, CEN, TCRN, CPEN… sometimes I joke that if I spilled the box for Scrabble it would look less like a damn mess. But you know what–I earned every one of those letters. Through experience and trial and error I have figured out what works best for me to obtain my end result: specialty certification. Understandably, if I used every single abbreviation behind my name that I was entitled to, it would probably get me a bit of an eye-roll for being a bit of a peacock. However with that being said, certifications are important. They do demonstrate tangibly that you have the commitment to your role. While many are required by facilities as a contingency for employment, it is still something to be incredibly proud of– when you look at the 2019 statistics for the pass rates for the BCEN exams, 3/4 certifications had 58-59% pass rates with the TCRN having a 72% pass rate. These are not exactly easy tests, they require competency.

Don’t let that deter you though!  Because I’m going to walk you through how I prepared for my exams!  My caveat here is that everyone learns differently–understanding how YOU learn is the key to your success. If you are a visual learner, utilizing videos and pictures/graphics may be more beneficial than recorded lectures/podcasts much like if you thrive with auditory stimulation, those podcasts may be straight up your alley!

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“Fine Print”

Disclosures! Ok Some quick disclosures/disclaimers… I have no financial disclosures to report. I make recommendations on products or services I have used however I receive no compensation for my recommendations nor do I attest that these services or products are superior to any other products or services available on the market. Further, while at the time of writing this, I am affiliated with BCEN as a volunteer, understand that I do not speak on behalf OF BCEN (my opinions are my own) and BCEN does not in itself endorse specific products or services beyond those listed on their website.

 

How Do We Learn and How Does It Apply to the Exam?

Having taken multiple certification exams, I’ve worked out a system over the years. I usually read about the subject I’m going to study, listen to the lecture while taking notes, then drill questions over and over. Thats me! I need repetition and application.

Certification tests are not read and regurgitate geared towards testing your memorization. You need application. Consider Bloom’s Taxonomy…it starts with having the knowledge. We get this in school, through study, and experiences. We move on to comprehension and application— this is using what we’ve learned. But the higher tiers of learning are analysis (drawing connections between all the ideas), synthesis (being able to justify your rationales and decisions), and finally the ability to evaluate or make judgements about the value of ideas and items.

 

blooms_taxonomy

Why does this matter? Because it’ll show you HOW to learn. Much of your certification exam depends on what you already know, yes, but more on how you apply that knowledge. So for some, pounding facts, figures, pathology, pharmacology, and equations leaves them feeling lost. A good take away is to learn what you don’t know, learn it thoroughly, but then focus on applying it. And at the end of your studying, you can feel more confident in your ability to defend your knowledge— you built yourself from the ground up!

Do this by running through scenarios, case studies, and questions ad nauseam. You’ll feel vastly more prepared than just reading material alone.

BCEN also offers practice tests that closely replicate the testing environment you’ll be in— with added rationales and references! I highly recommend it!

 

Know What You’re Tested On!

I know… this seems pretty self-explanatory, right? But would you believe when I’ve asked, how many people have told me they haven’t looked at BCEN’s “Study and Prepare” sections? This is a great tool because you’ll find if you buy those practice tests I discussed previously, when you read through the rationales, you will often find that the rationale is cited and that reference is listed on their website!

 

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Example: I bought the CFRN practice test and got a question wrong about ventilation/flight physiology in a bariatric patient. I read the rationale and the citation was actually a text book I used to study! It listed the exact book, chapter, and page. I was lucky I bought that book to use as a prep because I checked their reference list. This leads me to believe their questions are based off the references provided.

Additionally, if you’re not quite sure where to start studying, I recommend you utilize their Content Outlines! The organization quite literally gives you exactly what you will be tested on from topics and diagnoses, populations and procedures.

 

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So before we move any further in the study resources I used for the tests I took (TCRN, CEN, CFRN, and the CPEN)… I recommend you look up the Content Outlines for the test  you are planning to take. I did the work for you and attached the links below.

CEN * TCRN * CFRN / CTRN  * CPEN

Using these outlines will allow you to plan out your study time and help you narrow your focus on topics of strength/weakness. Most formal study resources will use this outline to organize their plans.

 

How I Studied

Now you don’t have to take my word for gospel but this was was the best method I had found for studying effectively. Generally what I did was found an online program for the test I was taking, I looked at what the major topic was, and read chapters of whatever textbook I had bought to study from pertaining to those topics and take notes on the key subjects. Then I would listen to the lectures and fill in notes around my previous in a different color pen or start on a fresh page if there was something different. I made sure when I was taking my original notes during my readings that I left plenty of room for more notes or doodles. Alternatively, if my study program came with lecture handouts or power points, I would print those out and take notes on those instead of hand writing notes. Also, very helpful and saved my wrists!

Example: When I was studying for CFRN, if I knew I was going to listening to a lecture on “Airway Management” I would read the entire chapter on the subject, take my notes, then listen to Flight Bridge’s lecture on the subject and take additional notes or doodles.

After I did those two things, I would do questions on the subject to build on my knowledge base. This I found to be very important because it’s one thing to build a foundation but another to build the house on top. Answering questions allowed me to  exercise my critical thinking skills which is what the exams seek to truly test. The more questions you  answer, the better you can get at it. Ultimately, the brain is a muscle–you need to work it for it to get stronger!

I also am a huge believer in the see one, do one, teach one method. So my poor preceptor/flight partner was inundated with me bouncing concepts off him (God love you, Dan–this post is for you!) My husband who while he is an EMT, does not really do concepts we’re being tested on was also a great resource for me–he probably knows STEMI criteria better than many paramedic students in their cardiology rotations from me drilling him (Hey Chris–how many millimeters?!)

 

The CFRN (and by Extension the CTRN)

Ok, so at long-last, I will talk about the actual resources I used for the exams. The first I will discuss is the CFRN (and CTRN). The CFRN and CTRN are relatively the same exam with a few exceptions. The CTRN is shorter at 130 scored questions (plus an additional 25 un-scored questions). The CFRN is a bit lengthier at 150 questions (plus 30 un-scored questions). The CFRN covers flight physiology and aviation safety and operations whereas it is exempt in the CTRN. Otherwise the content is the same. I have not personally taken the CTRN, but I plan to Spring 2020 and will utilize the same programming as the CFRN minus the flight components.

Resources I Used:

  • Patient Transport Principles and Practice, 5th Ed: If there was a CCT bible, I’m pretty sure this is it. My BCEN practice tests pretty much exclusively referred to this in my rationales. It is the ASTNA standards! Highly highly recommend! Get it here!
  • ACE SAT: Great resource full of practice questions for the CFRN but also FP-C (for you medics who might be snooping on this post). Get it here.
  • Back To Basics: Critical Care Transport Certification Review: I caution against using this exclusively as it is not comprehensive. There is some things missing but it is a great adjunct to your studying! Get it here.

Programs I Used:

  • I used the FlightBridge ED program, package #2 for this exam. It came with 36 CE hours, multiple review quizzes at the end of each video module, a review test at the end, a review book, and was good for one year after purchase. I felt the content was very easy to understand and Eric Bauer is very approachable. He has good social media presence and encourages people to reach out with questions. Flightbridge has a conference yearly called FAST. Additionally, they have multiple podcasts with great insights. Finally, the good folks there also authored a fantastic book on ventilator management–it really broke down and demystified vents for me. You can find the review programs HERE.
  • Pam Bartley is the “Passologist”. In addition to hosting multiple live courses, she also has a series of study guides for multiple exams. She includes review questions and key points guides and really hits all the highlights of the exam–she really nailed my CFRN exam. I’m pretty sure everything on her study guide was on my test! You can find her HERE. Or for live classes, check here!

Apps!!

  • Not too many good apps out there, unfortunately… Surgical Nursing Reviews from Nursing Pearls on the Apple App Store had a purchasable add-on for the CFRN (1000 questions). I’m not going to lie–I did not find this worth the money. I’d save your time and money, guys.
  • A really good resource though for clinical practice and for studying is called “Critical- Medical Guide” by The Barringer Group (I think this is Apple exclusive–sorry Android-ers). It is on its 15th version and is super up-to date. Great for critical care information, RSI dose calc, pediatric information, etc. It is pay to play–one time fee of 15$ but well worth it!

Useful Classes/Certifications:

  • Neonatal Resuscitation/STABLE Program
  • American Heart Association BLS/ACLS/PALS
  • American Burn Society Advanced Burn Life Support
  • Advanced Trauma Life Support (or Advanced Trauma Care for Nurses [ATCN])
  • Emergency Nursing Pediatric Course

 

 

The CEN

So for the CEN, I actually had a live class! My hospital sponsored a live prep class through Jeff Solheim Enterprises. However, I will say it was excellent. I had used one of Jeff’s online modules for my TCRN and much like that, his representative teaching the live class did not disappoint.

Resources I Used:

  • Sheehy’s Manual of Emergency Care, 7th ed: If Patient Transport was the bible of CCT, Sheehy’s is the bible of ED care. It is hands down the best book I’ve found for this. Through my career, I have referred back to it time and again. Beyond just prepping for the CEN, I recommend it for any ER nurse as a reference. You can get it here.
  • ENA CEN Review Manual, 5th ed: over a 1,000 questions plus 2 online tests. This book really simulates how questions are asked. I used an older edition but I recommend staying on top of the newer versions. Get it here.
  • ENA Emergency Nurse Core Curriculum, 7th ed: I consider this a very good review guide of the core concepts of emergency nursing. It doesn’t have the depth of Sheehy’s but breaks things down to the need to know for the test. Get it here.

Programs I RECOMMEND:

  • So you’ll recall that I did a LIVE in-person class… not an online one. So if you’re looking for an online one, I have to tell you I did not use one myself for this test. I am recommending Jeff Solheim based on the fact that I used him for TCRN online and I used his live class for CEN.
  • If you use his online class (here), it costs 150$ for a one year access. This is good for 17 CE hours with a 30-day satisfaction guarantee. He also offers a monthly access for 50$ a month. Depending on how fast you study or how long you need access for, a monthly fee could save you a lot of money. He also sells an entire prep manual on his website for 25$ (here). If live courses are more up your alley, here is a list of his dates. Jeff also has an APP and has a great social media presence– his Instagram often will post questions regarding the exams which is awesome for those moments you’re scrolling on the toilet (you nasty….).
  • Again– I am throwing Pam Bartley up here with her excellent packages! (She also has live classes… check dates near you!)

Apps!!

  • As stated about Jeff’s app.
  • Pocket Prep is a great developer who makes prep programs for a variety of tests. The CEN prep was a great resource for questions when I was getting ready for the test. It had a ton of questions, gave me the ability to customize my practice tests depending on what content I wanted to study, gave me rationales and where my areas of weaknesses were. Its awesome, guys! Get it here!

Useful Classes/Certifications:

  • Neonatal Resuscitation/STABLE Program
  • American Heart Association BLS/ACLS/PALS
  • American Burn Society Advanced Burn Life Support
  • Advanced Trauma Life Support (or Advanced Trauma Care for Nurses [ATCN])
  • Emergency Nursing Pediatric Course

 

CPEN

 

TCRN

 

 

BCEN Practice Tests

At time of this post (2020), BCEN has reduced the cost of the practice test in celebration of “Year of the Nurse”. Where the tests were previously 75$, they are currently 40$ and well worth every penny. Not only do they simulate the exact testing software you will see, they show you how you fare on the tests, show you rationales as well as the references for the rationales you are given. I have attached the links for each of the exams for your convenience.

CEN * CFRN/CTRN * CPEN  * TCRN

 

So basically thats it! Thats the big secret to how I’ve done it. Really its just a bunch of read and apply. Obviously, this is just my experience. You may have other things that work for you. Try on a few things and see what works for you. I may be speaking completely out of turn for what works for you–thats ok! But hopefully I found a few jumping points for you to start.

Certification is awesome. It is not easy by any stretch of the imagination but the feeling of holding that printout after the test is amazing and when the package with your certificate comes in the mail a few weeks later and the awe washes over you again… there is nothing like it. You earned it.

Clear skies and tail winds, friends! Best of luck and as always, let me know if you have questions or requests!

 

Do you have any recommendations for resources? What worked for you? Drop a comment on this post to share your study techniques with your peers or share what programs or resources you liked!