How to become a flight nurse practitioner

Pursue a Career as a Flight Nurse

Flight Nurse at a glance

Where you’ll work: Search-and-rescue agencies, hospitals and trauma centers, military, private medical transport companies and burn centers.

What you’ll do: Provide medical care to patients that must be flown from one location to another.

Minimum degree required: ADN or BSN, though it’s common for employers to prefer or require nurses to have at least a BSN.

Who it’s a good fit for: Flight nurses may not have all the tools and technologies with them that are usually available to nurses. This means that flight nurses must be creative with what they’ve got. They must also be prepared to work in a traditional emergency care setting to gain experience, which is typically required first to become a flight nurse.

Job perks: Flight nurses have a greater amount of autonomy because they may have to work alone or only with a small crew. This can be a great job for someone who wants to work in an unusual non-hospital setting.

Opportunities if you pursue a higher degree or certification: Flight nurses have the option to become a Certified Flight Registered Nurse (CFRN) through the Board of Certification for Emergency Nursing (BCEN). This certification could open the door to more career opportunities and possibly a higher salary.

Median annual salary: $77,600

Flight nurses provide medical care to critically ill or injured patients being transported by helicopter or airplane to an emergency medical center, or between centers. They are key members of the medical team that stabilizes and cares for the patient until they can receive more intensive treatment.

Decide if this nursing specialty is right for you.

Flight nurses provide patient care in emergency situations. That means they must be good critical thinkers, able to improvise in a high-stress environment. Flight nurses are “911’s 911,” says Ashley Klepinger, a former flight nurse and now a nurse practitioner specializing in pulmonary and critical care medicine in Iowa.

Determine what education you’ll need.

You’ll have two choices: an Associate Degree in Nursing (ADN), a two-year program, or a Bachelor of Science in Nursing (BSN), a four-year program. The degree track you choose could depend on the time you want to spend in school and your finances.

Receive clinical training.

As part of your degree, you’ll get medical training in simulations labs and in a medical setting such as a hospital or clinic. The number of clinical hours you’ll need can depend on the program and state requirements but count on at least 700 hours for an associate degree and 700-800 or more for a bachelor’s degree.

Get licensed as a registered nurse (RN).

After graduation, all nurses must pass the National Council Licensure Examination (NCLEX-RN) exam to obtain a registered nurse (RN) license. Specific license requirements vary by state, but all states require the NCLEX-RN.

Gain experience in ICU/ER nursing.

Most flight nursing positions require at least three years of experience in an ICU, ER, or another critical-care setting.

Consider earning a certification.

Certification represents the experience and skills you’ve gained beyond your education, and employers often require it. The specialty certification for flight nurses is Certified Registered Flight Nurse (CFRN).

Taking into account all the different requirements you must fulfill, from nursing school to the amount of practical experience required to earn a specialty certification, it can take anywhere from seven to nine years, or even longer, to become a flight nurse.

What Does a Flight Nurse Do?

Much like ER nurses, flight nurses work alongside other medical professionals, such as paramedics, EMTs, and physicians, to care for patients in emergency situations. The difference is that these medical teams are treating patients as they are being transported by helicopter or airplane to a medical facility for further treatment.

These patients are often critically ill or injured, and the care they need may include everything from basic monitoring of vital signs to CPR. Flight nurses are essential in communicating physician instructions to team members.

The role can be stressful but fulfilling. “One of the most rewarding aspects of being a flight nurse is the ability to provide competent and advanced medicine to critically ill or injured patients,” says Klepinger.

Patients who must be flown to a medical facility are often critically ill or injured, and the care they need may include everything from basic monitoring of vital signs to CPR.

Responsibilities of a Flight Nurse

Flight nurses do much more than accompany a patient from one destination to another. They must also be able to:

Provide immediate medical care. This includes monitoring a patient’s vital signs, inserting IVs, supporting ventilation, and performing resuscitation when necessary.

Ensure safe patient transport. This includes helping to move the patient on and off the aircraft.

Complete all paperwork. As with any nursing position, flight nurses must document all care provided during transport.

Maintain and organize supplies. Flight nurses inventory supplies used on each trip and restock the aircraft before the next trip.

Ensure effective communication. Flight nurses relay physician orders to team members and communicate with the patient and pilot.

Is Flight Nursing a Good Fit for You?

Since flight nurses often provide care during emergency or trauma situations, they must be able to perform under pressure in a complex and dynamic environment.

• Acting without guidance. “One of the hardest parts of being a flight nurse is developing the personal autonomy that is necessary for patient care,” says Klepinger. “This can be as simple as starting a medication without the approval of a physician to identifying potentially life-threatening emergencies that need to be treated promptly to reduce mortality or morbidity.”
• Thinking outside the box. Flight nurses only have the equipment and supplies in the aircraft to work with. This can require creative thinking to meet a patient’s medical needs.
• Remaining calm in stressful situations. The nature of the position requires the entire air medical team to maintain their composure as they provide care in critical situations.
• Showing compassion. Not only is a patient experiencing critical illness or trauma, but their families or loved ones are also faced with being left behind and at least temporarily out of touch. Communicating in a caring way is essential to ensuring the best experience for all involved.
• Being flexible and adaptable. “No two days are alike,” says Klepinger. There may be days where you’re sent on five flights, and others where you remain on call with no flights. On days with many flights, aircraft supplies may dwindle, and you’ll have to hustle to maintain them.

Required Education to Become a Flight Nurse

To become a flight nurse, you’ll need to be an RN, which requires an ADN or a BSN. More and more, however, employers want flight nurses with the experience and education associated with a bachelor’s degree.

ADN and BSN programs are plentiful across the United States. Programs can vary in structure, content, and cost, but all accredited programs are aimed at preparing aspiring nurses for the NCLEX-RN exam.

Associate Degree in Nursing

Prerequisites: A high school diploma or GED and ACT/ SAT scores are required. Prospective students who have a Licensed Practical Nurse (LPN) certificate may be eligible for an accelerated path to an ADN. Applicants typically must also pass a background check and drug screen.

Curriculum: Anatomy and physiology, pharmacology, microbiology, psychology, and sociology are common core requirements.

Clinical Requirements: Most programs require students to complete 700 hours in a variety of settings, including a simulation lab and a healthcare facility such as a hospital.

Time to Complete: The ADN typically takes two years to complete. Current LPN license holders may be able to complete the program in a shorter time frame.

Bachelor of Science in Nursing

Prerequisites: In addition to the ADN requirements above, BSN programs may have specific GPA and SAT/ACT score requirements. They may also require prior classes such as algebra, biology, chemistry, anatomy, and physiology.

Curriculum: BSN programs typically include classes that take students a step further than the ADN degree. Courses in population health, leadership, evidence-based practice, ethics, and healthcare policy are common.

Clinical Requirements: The number of hours for a BSN typically ranges from 700 to 800, but they can vary. Programs must ensure their clinical hours meet accreditation requirements and those of the program’s home state.

Time to Complete: Traditional BSN programs typically take four years to complete. Some universities and colleges also offer accelerated programs that can be completed in as little as 12 months for students who already have a bachelor’s in another field.

Online Programs

There are many nursing programs with online coursework, but note that you’ll still need to earn your clinical hours in person. Typically, you’ll complete your hours at a healthcare facility in your community under the guidance of a preceptor.

Online programs are great for working professionals or individuals with responsibilities such as childcare. They don’t provide the guidance or supervision you might receive in a campus classroom, so you’ll need to be highly disciplined, motivated, and committed to your education to succeed in this learning format.

What to Look for in a School

You’ll naturally want to consider the cost of a program, student-to-teacher ratio, and whether a program offers classes or clinical training opportunities that will help you pursue flight nursing. Other considerations:

Accreditation: Accreditation means professionals and experts have reviewed a program and found it to deliver the education needed for a career in a specific field. Attending an accredited nursing program is important for several reasons. Without accreditation, you won’t be able to apply for financial aid. You also won’t be able to take the NCLEX-RN exam upon graduation and obtain an RN license, which you’ll need to practice.

Three organizations accredit BSN programs: The Commission on Collegiate Nursing Education (CCNE), the Accreditation Commission for Education in Nursing (ACEN), and the Commission for Nursing Education Accreditation (CNEA).

The ACEN and the CNEA accredit associate degree programs.

A school’s relationship with local medical facilities: A strong relationship could help you land an entry-level position at a medical facility or an affiliate when you graduate.

NCLEX-RN pass rates: Prospective students should ask about a program’s first-time pass rate for the most recent graduating class. A high rate could indicate that students have received a quality education and are poised to succeed in nursing.

Licensure

After graduation from a nursing program, students must obtain their RN license before they can practice. To be licensed, all prospective nurses must pass the NCLEX-RN, which is administered by the National Council of State Boards of Nursing (NCSBN).

After you pass the NCLEX, you’ll be ready to apply to your state board of nursing for your RN license. Passing the exam usually is only one component of obtaining your license, however.

Some state boards also require background checks, references, and school transcripts. You can check an NCSBN database to find out what your state requirements are.

Gain Experience

Aspiring flight nurses generally need two to three years of nursing experience before they can pursue a job in that role. Any critical care nursing experience will help prepare an RN for a future in flight nursing.

Aspiring flight nurses generally need two to three years of nursing experience before they can pursue a job as a flight nurse.

Employers generally require job candidates to have experience in an acute care unit, trauma center, ICU, or ER—or a combination of these. Even these jobs can be considered specialties, so you may need to work your way into one of these positions from something similar, like medical-surgical nursing. Certification in critical care also may help.

“The number one thing employers look for in an individual who is interested in becoming a flight nurse is their ability to adapt to critical situations,” says Klepinger. “Critical thinking is imperative for the safety of the patients as well as the safety of the flight crew.”

Where You’ll Work as a Flight Nurse

Some flight nurses care for a specific kind of patient, but others treat a variety. Where you work could determine who you see.

• Search-and-rescue agencies: Helicopters may be sent to the scene of a motor vehicle accident, a near-drowning, or a natural disaster, where flight nurses work to stabilize the patient and transport them to the nearest emergency center. These nurses also may be dispatched to transport an injured hiker or a critically ill person who lives in a remote area.
• Burn centers: These highly specialized teams transport burn victims to the nearest burn center for further treatment.
• Hospitals/trauma centers: Working as a flight nurse for a hospital or a trauma center may include responding to accidents that occur near the hospital or assisting with transport to and from the facility.
• Military: The U.S. Air Force and Navy both need flight nurses. These nurses can be deployed to combat zones, where they stabilize and transport wounded service members.
• Private companies: Private companies may offer contract services to hospitals or other organizations that do not have a consistent need for a flight nurse. In this role, flight nurses should be prepared for the position to be ever-changing to meet the needs of the contractor.

Certification

There is one optional specialty certification for flight nurses, the Certified Flight Registered Nurse (CFRN). But other certifications also can add to their expertise. While certification may not be required to land a position, most employers require flight nurses to earn one before the end of their first year of work.

Certified Flight Registered Nurse (CFRN)

Who Grants It: Board Certification for Emergency Nursing(BCEN)

What It Is: A credential that demonstrates expertise and knowledge in flight nursing

Who It’s For: Working flight nurses

Requirements: Applicants must have a current, unrestricted RN license. It’s recommended that they also have two years of experience as a flight nurse.

Exam and Prep: This computer-based exam has 150 questions and covers the general principles of flight nursing practice, resuscitation, trauma, medical emergencies, and special populations. Candidates have 3 hours to complete the exam. The BCEN offers practice exams for $40 each.

Aspiring flight nurses may also consider pursuing:

• Certified Emergency Nurse (CEN)
• Certified Pediatric Emergency Nurse (CPEN)
• Trauma Certified Registered Nurse (TCRN)
• Critical Care Registered Nurse (CCRN)

Salary and Career Outlook

The median annual salary for all RNs, including flight nurses, is $77,600, according to the Bureau of Labor Statistics (BLS). Take a look at median annual RN salaries by state,

The BLS does not break out salaries for nursing specialties, but nurses who specialize and have a bachelor’s degree can have a salary advantage over other nurses. In addition to specialty and education, salaries can also vary based on:

• Experience
• Certification
• Where you live
• Where you work

Professional Resources

As you pursue your career, you’ll want to take advantage of resources that can help you advance in your field. Here are some that can provide continuing education and networking opportunities.

Organization: The Interprofessional Critical Care Transport Conference

What They Do: This annual conference offers labs and flight simulator experiences and is open to aspiring flight nurses. It’s held in Ohio at the Frances Payne Bolton School of Nursing at Case Western Reserve University.

Organization: Podcasts

What They Do: There are many nursing podcasts available that focus on nursing in general or a specialty. One episode to get you started is “The 12 Commandments of Flight Nursing,” episode 245 of “The Nurse Keith Show” on the Health Podcast Network. 

Organization: Air and Safety Transport Nurses Association

What They Do: The organization offers continuing education courses and other resources for flight nurses and holds conferences.

With professional insight from:

Ashley Klepinger

Former Flight Nurse

Currently: Critical Care Nurse Practitioner specializing in pulmonary and critical care medicine in Iowa

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