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About Experience Prior To Flight For Rns (repost)


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#1 Mike MacKinnon

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Posted 31 July 2007 - 05:01 PM

Hi guys

An excellent question was brought up in the recent 2 threads on experience which I thought I might elaborate on a bit (from my perspective).

Everyone knows you are supposed to have 3-5 years of experience in either ER or ICU. You should have the basic alphabet classes like ACLS and PALS. However in life we rarely want 'bare minimum' for anything why should this be different?

First lets look at the deficiencies all RNs have if they have no previous EMS experience. When i say "EMS" I mean as an intermediate or a paramedic. EMTs rarely get experience in large city systems except to drive and EMTs who have only worked in hospital have no experience.

So here is what many RNs are missing for scene calls:

- Ability to c-spine a patient effectively
- Ability to BVM a pt effectively (often not done correctly due to lack of good teaching and experience)
- Working without hospital resources
- Working in organized chaos (people spinning)
- Working in random and difficult environments
- New skills such as Intubation, Chest tubes, Central lines
- Working as a Co-Leader with your partner not in a large team with a physician calling the shots.
- Fast assessment, prioritizing and transporting from scene

Some of these will be easier for people with ER experience but the ICU only RN will be totally out of their element.

While it would be optimal to be a former paramedic who has a year or 2 of experience, for most RNs this wont be the case. So what can you do to prepare yourself?

Classes like BTLS are helpful as they are targeted for prehospital professionals. However, nothing can replace experience and a 2 day class doesn't translate into skill. Even classes like ACLS, PALS, NRP and the like are only as helpful as the experience you have with putting them into practice. I cant even count how many RNs come through ACLS even from ICUs who cannot pass the recert as they never have codes in their ICU or have never BVM'd a pt.

While many think they are ready (and many companies will hire you) with the 3-5 years experience, you are only as ready as the QUALITY of experience you have gotten. There are ICUs where more time is spent cruising the Internet and grazing the potluck everyone brought in than doing critical care. There are ERs which are little more than family doctors offices rarely seeing 'sick' patients and when one comes in they cant call HEMS fast enough. No matter how many years of experience you have in these types of ER/ICU you are not prepared to fly.

If you want to be the best rounded you can be the 2 places to have experience are CVICU and ER. These should both be high volume and high acuity areas where complications and codes are expected not rare. You will find that the worst ER to work in is a teaching ER. Residents, interns etc will be involved and doing all the difficult cases and you will be a 'charter'. Both the ICU and ER in hospitals without residents or interns will provide you with a much better learning experience. Why? Well it has to do with resource allocation. In many teaching facilities RNs have little autonomy as there is always a resident to call and it is encouraged so they can learn. In a hospital without residents, RNs take on a much more autonomous role by necessity in both the ER and ICU.

If you come from an ICU without ER experience you will get in the paramedics way on a scene. If you come from the ER without ICU experience you will be absolutely lost on ICU - ICU transports with critical patients. While a high acuity ER is usually the same from one to the next, ICU is not. Neuro ICU experience, NICU, PICU etc will be useless to you on the majority of interfacility transports and all scene calls (unless they are the mission of your service).

90% of programs have a similar mission. Depending on the mission of your program and the subset of patients they fly you should have experience catered to that. Sufficed to say, I'm focusing on the vast majority of programs and pt transports not the specialty teams.

So my recommendations are:

- Have a mix of high acuity ER and CVICU experience.
- Go on rides with a local high volume paramedic rig.
- Do rides with the service your thinking of working for
- Find out the mission and pt subsets they fly most
- Take every alphabet class then become instructor in them all (people always learn more by teaching)
- Talk to the paramedics at the service you are looking into and ask them their expectations of their RNs
- Talk to the RNs at the service and ask them what they expect of the paramedics and what is expected of the nurses.

If i can think of more ill add to this post. Hope its helpful.
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Mike MacKinnon MSN CRNA
WWW.NURSE-ANESTHESIA.ORG

"What gets us into trouble is not what we don't know
It's what we know for sure that just ain't so" - Mark Twain

#2 nursemedic

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Posted 31 July 2007 - 06:51 PM

I think we're doing a diservice looking only to individuals with specific skill sets and may be missing out on key talent. Rather than look at where someone has worked and try to figure out if they can perform the requisite skills, we ought to look at the individual behaviors: decision-making, teamwork, coping mechanisms, conflict resolution, values, etc...these are some features that contribute to being successful in the transport environment. Skills can be learned and/or remediated whereas behavior is not likely to change significantly over the long term. Behavior is the best predictor of future performance.

Having said that, I also believe that ER and ICU experience are important. I further believe obtaining these clinical experiences in both academic and small community facilities are important for some of the reasons mentioned. Academic medical center experience is valuable because while you may not do a lot of procedures, you learn a great deal about treating health conditions, interacting with others, and sheer volume (which necessitates taking your triage talents to a different level sometimes).

I think we overemphasize training and underemphasize education...some use the terms interchangeably.

In short, research would help answer the question "what are the features of individuals that make ideal transport professionals and where are those individuals found."
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Greg

#3 Mike MacKinnon

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Posted 31 July 2007 - 09:28 PM

Well...


The flight environment is not the time to learn how to use equipment or interpret clinical changes. Things like IABPs, Art lines, CVPs, Swans etc (if these are apart of the programs mission) multiple vasoactive drips ect, people should come with a working knowledge of. Your first real patient with one of these shouldnt be on a critical transport when recognizing the changes that only experience can give, may mean positive or negative outcomes for the unknowing patient. Hospitals expect this expertise from HEMS.

Individual behaviors are also very important, but that goes without saying. Unfortunately, it is also near impossible to assess behaviors in the applicant who is trying to be who you want them to be. When a patient is dumping on multiple vasoactive drips and you have a CVP and an art line in all the collaboration and conflict resolution in the world wont save the patient, only experience and knowledge gained through familiarity/prior education will.

The HEMS industry has allowed a degradation of new hires (medics and RNs) such that they oft come without any of the critical experience which has shown, over and over to change patient outcomes. Typically, this is in the name of getting "2 feet and a heart beat" i the job.



I think we're doing a diservice looking only to individuals with specific skill sets and may be missing out on key talent. Rather than look at where someone has worked and try to figure out if they can perform the requisite skills, we ought to look at the individual behaviors: decision-making, teamwork, coping mechanisms, conflict resolution, values, etc...these are some features that contribute to being successful in the transport environment. Skills can be learned and/or remediated whereas behavior is not likely to change significantly over the long term. Behavior is the best predictor of future performance.

Having said that, I also believe that ER and ICU experience are important. I further believe obtaining these clinical experiences in both academic and small community facilities are important for some of the reasons mentioned. Academic medical center experience is valuable because while you may not do a lot of procedures, you learn a great deal about treating health conditions, interacting with others, and sheer volume (which necessitates taking your triage talents to a different level sometimes).

I think we overemphasize training and underemphasize education...some use the terms interchangeably.

In short, research would help answer the question "what are the features of individuals that make ideal transport professionals and where are those individuals found."


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Mike MacKinnon MSN CRNA
WWW.NURSE-ANESTHESIA.ORG

"What gets us into trouble is not what we don't know
It's what we know for sure that just ain't so" - Mark Twain

#4 nursemedic

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Posted 31 July 2007 - 11:54 PM

I haven't implied skills are unimportant or that folks should be let loose without proper preparation. I am suggesting, however, there are larger issues to consider than just the "typical" skill set (if there is one): a behavioral and emotional skill set.

In terms of an interviewee "trying to be who you want them to be," during an interview, thats what any wise applicant will do: demonstrate how they will add value to the program. Behavioral interviewing techniques make for more challenging interviews and one cannot pre-prepare for a behavioral-based interview. On the other hand, one can talk about, embellish, even confabulate stories of their clinical experiences and skill set.

"Individual behaviors are also very important, but that goes without saying." I suggest the skills are what goes without saying. Of course a transport clinician needs the right skill set for the mission profile. However, again, how many times have you heard of a clinician who freaks out or doesn't trust certain team mates, cannot resolve interpersonal conflict, and/or upsets the program's referral base ad naseum?

I am saying skills can be learned and remediated while behavior is largely determined by the time one is an adult and the wise organization will consider more seriously the effects a candidate's behavioral profile has on the team and the program because those are not likely to change.
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Greg

#5 Mike MacKinnon

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Posted 01 August 2007 - 12:16 AM

I see what yah mean.

If the interview is done you can easily assess clinical skills by doing a written test and then an oral board. Where i was, thats how i was tested. It weeds out the Bullshitters from the real deal.



I haven't implied skills are unimportant or that folks should be let loose without proper preparation. I am suggesting, however, there are larger issues to consider than just the "typical" skill set (if there is one): a behavioral and emotional skill set.

In terms of an interviewee "trying to be who you want them to be," during an interview, thats what any wise applicant will do: demonstrate how they will add value to the program. Behavioral interviewing techniques make for more challenging interviews and one cannot pre-prepare for a behavioral-based interview. On the other hand, one can talk about, embellish, even confabulate stories of their clinical experiences and skill set.

"Individual behaviors are also very important, but that goes without saying." I suggest the skills are what goes without saying. Of course a transport clinician needs the right skill set for the mission profile. However, again, how many times have you heard of a clinician who freaks out or doesn't trust certain team mates, cannot resolve interpersonal conflict, and/or upsets the program's referral base ad naseum?

I am saying skills can be learned and remediated while behavior is largely determined by the time one is an adult and the wise organization will consider more seriously the effects a candidate's behavioral profile has on the team and the program because those are not likely to change.


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Mike MacKinnon MSN CRNA
WWW.NURSE-ANESTHESIA.ORG

"What gets us into trouble is not what we don't know
It's what we know for sure that just ain't so" - Mark Twain

#6 admin

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Posted 01 August 2007 - 05:47 AM

Behavioral interviewing techniques make for more challenging interviews and one cannot pre-prepare for a behavioral-based interview. On the other hand, one can talk about, embellish, even confabulate stories of their clinical experiences and skill set.


Can you explain this concept further? What would the ideal air-medical focused 'behavioral-based' interview look like, for those of us who have only been exposed to the typical panel interview sessions with most flight programs?
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Rollie Parrish
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#7 nursemedic

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Posted 01 August 2007 - 08:29 PM

The underlying assumption of behavioral interviewing is past behavior is the best predictor of future performance. instead of asking hypothetical questions the interviewer asks the candidate to answer questions about situations or events that have truly happened. Behavioral interviews are conversational in nature. The interviewer asks open ended questions and lets the respondant think for as long as necessary before answering. An answer may lead the interviewer to seek clarification and the conversation becomes more involved. To get started with behavioral interviewing, the interviewer must first identify those compeencies/characteristics/traits/behaviors that are important to the job/organization then carefully design open-ended questions that address them. During the interview the candidate is often forced to think very deeply about situations or occurances in order to answer. Behavioral interviewing is legitimate and increasingly common. For more information and example questions, point your browser to:

http://www.quintcare...behavioral.html
http://www.uwstout.e...e/behavior.html
http://www.career.vt.../Behavioral.htm
http://humanresource...vior_interv.htm
http://www.shrm.org/...5/0505tyler.asp

If anyone implements this I'll be curious to read how it went. Those of you who use it, chime in. For candidates unfamiliar with it or who are not in very in touch with themselves it can be a stressful experience (which says something in itself)
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Greg

#8 Mike MacKinnon

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Posted 01 August 2007 - 10:37 PM

Hey

I think those are relatively common, to one degree or another in most interviews. I also think that its easy to script an answer to most of them that you know the interviewer wants to hear. These are some Ive heard in the past:

Describe a time when you were faced with a stressful situation that demonstrated your coping skills.

Give me a specific example of a time when you used good judgment and logic in solving a problem.

Give me an example of a time when you set a goal and were able to meet or achieve it.

Give me a specific example of a time when you had to conform to a policy with which you did not agree.


I guess i have to default to my feeling/opinion that these are easily defeated. However, when you read a clinical scenario with swan numbers and a the whole 9... there isnt any BSing the answers. You either know it or you dont. People who dont and will tell you that up front honestly, have integrity. Those who try and BS their way through the scenario will be obvious and have no integrity.

I think the best interview starts with clinical related questions, scenarios and adjuncts (EKG, Sim Man, Xrays, etc) and ends with them (with a few other questions tossed in). I learn more from how people reason through scenarios related to how they will be as a partner than when i hear answers to behavior questions which i feel most ppl know the "right" answer to. Thats my personal feeling on it. Most places use a couple of these types of questions in the interview process as well.

At the end of the day, I want a competent provider taking care of my mom and who i can get along with in the aircraft and at the base for 24 hours.





The underlying assumption of behavioral interviewing is past behavior is the best predictor of future performance. instead of asking hypothetical questions the interviewer asks the candidate to answer questions about situations or events that have truly happened. Behavioral interviews are conversational in nature. The interviewer asks open ended questions and lets the respondant think for as long as necessary before answering. An answer may lead the interviewer to seek clarification and the conversation becomes more involved. To get started with behavioral interviewing, the interviewer must first identify those compeencies/characteristics/traits/behaviors that are important to the job/organization then carefully design open-ended questions that address them. During the interview the candidate is often forced to think very deeply about situations or occurances in order to answer. Behavioral interviewing is legitimate and increasingly common. For more information and example questions, point your browser to:

http://www.quintcare...behavioral.html
http://www.uwstout.e...e/behavior.html
http://www.career.vt.../Behavioral.htm
http://humanresource...vior_interv.htm
http://www.shrm.org/...5/0505tyler.asp

If anyone implements this I'll be curious to read how it went. Those of you who use it, chime in. For candidates unfamiliar with it or who are not in very in touch with themselves it can be a stressful experience (which says something in itself)


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Mike MacKinnon MSN CRNA
WWW.NURSE-ANESTHESIA.ORG

"What gets us into trouble is not what we don't know
It's what we know for sure that just ain't so" - Mark Twain

#9 nursemedic

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Posted 01 August 2007 - 11:35 PM

I hear people here often bemoaning the quality of transport profesionals. Unless there's a major correction in the future, we will need to augment (or provide) needed education to ensure folks meet the standards of our individual organizations. You'll want to incorporate more behavioral interviewing to ensure you have a workforce that characterizes the necessary competencies.
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Greg

#10 flightnursesarah

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Posted 03 August 2007 - 07:56 PM

We currently do peer interviews and ask the behavioral questions you have all been referencing, as well as the skill questions. There are always triage questions, "what would you do in this situation" questions, and the renowned "resolving conflict" questions.

Do you all use peer interviewing as well? I think it is an excellent way to "weed out" the BS-ers (because we are the best BS-ers there ever was!). It also gives us a chance to discuss the interviewees together behind closed doors, and make the decisions ourselves about who we get to work with. I think in the past an HR rep and the boss just hired those qualified on paper--leading to hirees with personalities not necessarily the best for the AEMS culture.

My only reservation is that we fight over who can do the interviews, which means the applicant may be faced with 5-6 of us eager to ask questions. That may be a little intimidating. It was for me!
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Sarah RN BSN CFRN
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#11 Mike Mims

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Posted 04 August 2007 - 11:03 PM

Hey

I think those are relatively common, to one degree or another in most interviews. I also think that its easy to script an answer to most of them that you know the interviewer wants to hear. These are some Ive heard in the past:
I guess i have to default to my feeling/opinion that these are easily defeated. However, when you read a clinical scenario with swan numbers and a the whole 9... there isnt any BSing the answers. You either know it or you dont. People who dont and will tell you that up front honestly, have integrity. Those who try and BS their way through the scenario will be obvious and have no integrity.

I think the best interview starts with clinical related questions, scenarios and adjuncts (EKG, Sim Man, Xrays, etc) and ends with them (with a few other questions tossed in). I learn more from how people reason through scenarios related to how they will be as a partner than when i hear answers to behavior questions which i feel most ppl know the "right" answer to. Thats my personal feeling on it. Most places use a couple of these types of questions in the interview process as well.

At the end of the day, I want a competent provider taking care of my mom and who i can get along with in the aircraft and at the base for 24 hours.


I agree with you on this one hole-heartedly and would recommend to anyone about to interview NOT to go out and buy every book on how to interview, or the top 101 interview questions and read every article on interviewing because you will have a scripted answer and the panel WILL recognize it.
Just the same can be said about all the information and/or suggestions for question you should ask the panel............


If you had a first date and every question you asked had a scripted answer would you honestly consider a second date????????

I would definately recommend getting more information on the Do's and Don'ts of interviewing, either by research or purchasing books....

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Mike Mims

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#12 Stephanie

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Posted 10 August 2007 - 02:32 AM

Hi guys

An excellent question was brought up in the recent 2 threads on experience which I thought I might elaborate on a bit (from my perspective).

Everyone knows you are supposed to have 3-5 years of experience in either ER or ICU. You should have the basic alphabet classes like ACLS and PALS. However in life we rarely want 'bare minimum' for anything why should this be different?

First lets look at the deficiencies all RNs have if they have no previous EMS experience. When i say "EMS" I mean as an intermediate or a paramedic. EMTs rarely get experience in large city systems except to drive and EMTs who have only worked in hospital have no experience.

So here is what many RNs are missing for scene calls:

- Ability to c-spine a patient effectively
- Ability to BVM a pt effectively (often not done correctly due to lack of good teaching and experience)
- Working without hospital resources
- Working in organized chaos (people spinning)
- Working in random and difficult environments
- New skills such as Intubation, Chest tubes, Central lines
- Working as a Co-Leader with your partner not in a large team with a physician calling the shots.
- Fast assessment, prioritizing and transporting from scene

Some of these will be easier for people with ER experience but the ICU only RN will be totally out of their element.

While it would be optimal to be a former paramedic who has a year or 2 of experience, for most RNs this wont be the case. So what can you do to prepare yourself?

Classes like BTLS are helpful as they are targeted for prehospital professionals. However, nothing can replace experience and a 2 day class doesn't translate into skill. Even classes like ACLS, PALS, NRP and the like are only as helpful as the experience you have with putting them into practice. I cant even count how many RNs come through ACLS even from ICUs who cannot pass the recert as they never have codes in their ICU or have never BVM'd a pt.

While many think they are ready (and many companies will hire you) with the 3-5 years experience, you are only as ready as the QUALITY of experience you have gotten. There are ICUs where more time is spent cruising the Internet and grazing the potluck everyone brought in than doing critical care. There are ERs which are little more than family doctors offices rarely seeing 'sick' patients and when one comes in they cant call HEMS fast enough. No matter how many years of experience you have in these types of ER/ICU you are not prepared to fly.

If you want to be the best rounded you can be the 2 places to have experience are CVICU and ER. These should both be high volume and high acuity areas where complications and codes are expected not rare. You will find that the worst ER to work in is a teaching ER. Residents, interns etc will be involved and doing all the difficult cases and you will be a 'charter'. Both the ICU and ER in hospitals without residents or interns will provide you with a much better learning experience. Why? Well it has to do with resource allocation. In many teaching facilities RNs have little autonomy as there is always a resident to call and it is encouraged so they can learn. In a hospital without residents, RNs take on a much more autonomous role by necessity in both the ER and ICU.

If you come from an ICU without ER experience you will get in the paramedics way on a scene. If you come from the ER without ICU experience you will be absolutely lost on ICU - ICU transports with critical patients. While a high acuity ER is usually the same from one to the next, ICU is not. Neuro ICU experience, NICU, PICU etc will be useless to you on the majority of interfacility transports and all scene calls (unless they are the mission of your service).

90% of programs have a similar mission. Depending on the mission of your program and the subset of patients they fly you should have experience catered to that. Sufficed to say, I'm focusing on the vast majority of programs and pt transports not the specialty teams.

So my recommendations are:

- Have a mix of high acuity ER and CVICU experience.
- Go on rides with a local high volume paramedic rig.
- Do rides with the service your thinking of working for
- Find out the mission and pt subsets they fly most
- Take every alphabet class then become instructor in them all (people always learn more by teaching)
- Talk to the paramedics at the service you are looking into and ask them their expectations of their RNs
- Talk to the RNs at the service and ask them what they expect of the paramedics and what is expected of the nurses.

If i can think of more ill add to this post. Hope its helpful.



Mike,
As usual, you make many good points. Coming from an EMS background, I have found it invaluable in my flight transports. Although EMS and nursing have two totally different ways of thinking, I like to think being good at one, makes me better at the other.

Steph
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Stephanie, RN ,EMT-P

#13 MFlightRN

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Posted 11 August 2007 - 03:12 AM

I really think this post touches on many of the questions we ask ourselves during the hiring process. What do we look for in flight candidates? Experience? Training? A great attitude? Obviously all of these. But, as an educator, preceptor, and trainner, I'd have to say experience and know-how plays the most important part in an AMP's success in the air medical environment. In the back of the helicopter is not the place to learn a new skill, but rather fine tune them instead.
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#14 Dunkle

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Posted 31 August 2007 - 11:19 PM

Mike and All,

After reading this forum I have a couple of questions. As I am in an area where you kinda have to wait for a flight RN to retire before a position appears, what additional experience, classes can I take to make me more appealing? I am looking at auditing ATLS, and any other idears? I have the ER/ICU experience with all of applicable certs in instruction.... looking to advance my skills now. Thanks
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#15 Mike MacKinnon

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Posted 31 August 2007 - 11:27 PM

hey dunkle

Im sure you have many of these, but here are some I suggest.

ATCN & FNATC
BTLS
A solid 12 lead class for advanced practitioners
Do an in depth review of the pharmacokinetics and dynamics of the drugs used in HEMS. A good book is katzung's pham.
Review advanced procedures and try to get yourself in a cadaver lab somewhere.
Many of the CLs and Chest tube procedures can be seen on youtube now!
Start reading about whatever you are weak in. often its OB and Paeds for most RNs. There are critical points and concepts to know about the emergent paediatric patient as well as the OB one.

Might also be worth it to take an EMT class. It will prepare you for the scene work.

Mike and All,

After reading this forum I have a couple of questions. As I am in an area where you kinda have to wait for a flight RN to retire before a position appears, what additional experience, classes can I take to make me more appealing? I am looking at auditing ATLS, and any other idears? I have the ER/ICU experience with all of applicable certs in instruction.... looking to advance my skills now. Thanks


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Mike MacKinnon MSN CRNA
WWW.NURSE-ANESTHESIA.ORG

"What gets us into trouble is not what we don't know
It's what we know for sure that just ain't so" - Mark Twain

#16 Dunkle

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Posted 01 September 2007 - 04:14 AM

hey dunkle

Im sure you have many of these, but here are some I suggest.

ATCN & FNATC
BTLS
A solid 12 lead class for advanced practitioners
Do an in depth review of the pharmacokinetics and dynamics of the drugs used in HEMS. A good book is katzung's pham.
Review advanced procedures and try to get yourself in a cadaver lab somewhere.
Many of the CLs and Chest tube procedures can be seen on youtube now!
Start reading about whatever you are weak in. often its OB and Paeds for most RNs. There are critical points and concepts to know about the emergent paediatric patient as well as the OB one.

Might also be worth it to take an EMT class. It will prepare you for the scene work.


Mike, What does ATCN and FNATC mean? I am looking at a CCEMTP class, but after reviewing the content-- it seems like I am there without spending the 1500 dollars. Is this a needed cert? I am currently studying for CFRN and have completed a NREMT-B. I have looked into paramedic school, but after talking with local FNs, they say it is not needed.... what do you think? I agree with the OB, and thankfully I work in a Adult/Paeds ER --- so I see quite a few sick kidos. I believe my weakest point is RSI drugs and dosages, any pointers? I understand the basics, but the contraindications for use and indications for using one versus another etc. Thanks a lot, I appreciate your help.
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#17 Mike MacKinnon

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Posted 01 September 2007 - 11:40 AM

If you have ICU experience do not waste your time with the CCEMTP, it will add nothing and will be very basic critical care training for you.

ATCN = Advanced Trauma Care for Nurses.

It is put on by the society of trauma nurses and is dont concurrently with an ATLS class. That way you get the cert, do all the ATLS lectures and then get to goto the ATCN skill stations while the docs break off for theirs. Typically, you will not be allowed to do the animal labs unless you are friends with the coordinator.

FNATC = Flight Nurse Advanced Trauma Class I think it is now called Transport Nurse Advanced Trauma Course (TNATC).

This is put on by ASTNA (our association) and is a very good trauma class taught by flight RNs. It also includes an animal lab component where you do all the skills on anesthetized animals (usually pigs). The class is 3 days and I believe it is the best of all the trauma class offerings since it was created for Flight Nursing and is taught by flight RNs.

Classes like TNCC or ATCN are from the hospital perspective which of course, isnt always relevant to HEMS. The other issue with ATCN and TNCC is that the instructors can often be lacking. Now before ppl get all up in arms remember, not all but many. The reason for this is that many of these people never really deal with trauma the way HEMS would or as hands on as we would. They are 'assistants' in the process because the doc is there to run the show. Its a very different perspective.

Do not waste your time or money going to medic school unless you really plan to work in a rig. There is not point in doing it as now that you have gotten the EMT-B skills you have picked up what most nurses are lacking when they start.

RSI drugs you simply have to look up. Get a good pharm book and review them all. You should know them inside out including how they work. Know the kinetics and dynamics of the drugs you give. You should learn these drugs as if there isnt anyone to ask and nothing available to look it up when you need them. It should be second nature.



Mike, What does ATCN and FNATC mean? I am looking at a CCEMTP class, but after reviewing the content-- it seems like I am there without spending the 1500 dollars. Is this a needed cert? I am currently studying for CFRN and have completed a NREMT-B. I have looked into paramedic school, but after talking with local FNs, they say it is not needed.... what do you think? I agree with the OB, and thankfully I work in a Adult/Paeds ER --- so I see quite a few sick kidos. I believe my weakest point is RSI drugs and dosages, any pointers? I understand the basics, but the contraindications for use and indications for using one versus another etc. Thanks a lot, I appreciate your help.


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Mike MacKinnon MSN CRNA
WWW.NURSE-ANESTHESIA.ORG

"What gets us into trouble is not what we don't know
It's what we know for sure that just ain't so" - Mark Twain

#18 flightnursesarah

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Posted 01 September 2007 - 03:27 PM

Mike, What does ATCN and FNATC mean? I am looking at a CCEMTP class, but after reviewing the content-- it seems like I am there without spending the 1500 dollars. Is this a needed cert? I am currently studying for CFRN and have completed a NREMT-B. I have looked into paramedic school, but after talking with local FNs, they say it is not needed.... what do you think? I agree with the OB, and thankfully I work in a Adult/Paeds ER --- so I see quite a few sick kidos. I believe my weakest point is RSI drugs and dosages, any pointers? I understand the basics, but the contraindications for use and indications for using one versus another etc. Thanks a lot, I appreciate your help.



Your RSI drugs will probably depend on the program you work for. Some of the common ones I use (and a really basic reason why):

Atropine: pre medication for pediatric patients up to about 8 years old (prevent bradycardia)

Lidocaine: pre medication for head injury or suspected head injury (blunt effects of increase in ICP associated with procedure- contraversial reasoning)

Versed or Etomidate: sedation for obvious reasons (don't wanna be awake or remember anything if they start doing things like that to me!) **remember if they're tachycardic: are they awake?

Ketamine: sedation for patient with asthma attack instead of versed or etomidate initially

Succinylcholine: short-acting paralytic (used to put patient down initially. Good to use because you hopefully can bag the patient until it wears off if you are unable to pass the tube or do a surgical airway, etc.) requires a preparalytic dose to prevent fasiculations (0.10 the actual dose)---contraindicated in old (over 1 day old) burns, neuromuscular diseases (MS, CP) because it causes a release of potassium into the system. Also caution use in kids and adults already bradycardic (that's why you give Atropine)

Fentanyl: just to be nice :P

Rocuronium (Zem), Norcuron (Vec), etc.: long-acting paralytics to use after intubation is confirmed and tube taped in place. Keeps them from moving, breathing, kicking, pulling out tubes

I know this is really generic and with poor rationale. Like Mike said, get a good pharm book and know the actual physiology of how the drugs affect the body. This will help you to understand why the meds are contraindicated, indicated, etc. Like I said, these are the common meds I personally use, and are commonly written about in texts such as PHTLS, TNCC, etc. Other programs probably have different protocols.

Good luck in your persuit of flying-- you will never regret it! :D
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Sarah RN BSN CFRN
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#19 Medic Ed RN

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Posted 02 September 2007 - 12:06 AM

Howdy all. I must admit that this is a hot topic. It is truly difficult to distinguish between experience and book smarts. But as all have said, it gets revealed on the tough calls. I must say that I disagree, to some extent, with Mike. It is important to find candidates that can function appropriately. However, I must say that not EVERYONE gets the same experiences. As I read these threads, it seems that if you dont include 'busy' or 'high' volume experience, you dont know anything. Someone stated earlier that skills were so important. They are to a certain extent. But they are skills. When it comes time to perform, we get some, we miss some. That is why there are 2 of us working as TEAM (whether it be RN/RN, RN/Medic, RN/RT) As for some colleages, we have all met the really smart ones and the really not so smart ones. Case and point, I worked with a Charge RN of an ER who was a nurse for 20 plus years. When the nasty hit, she was clueless. It shocked me that a person like that was in charge and that I really did know more than the person charge. At that time, I had only been a nurse for about 2 years. On the flip side, I know Paramedics that are just way to smart to be just medics. There are a couple I work with that teach me something new all the time. When people do get hired, there should be an extensive orientation. When I was hired by my company, we spent a month, M-F 8-5 in class. Then at least a month riding third. Now for people with previous flight time, orientation should be altered. But, even with that, things can be learned. I will admit that I never worked in the ICU, but have had many a ICU admit hold overs in the ER. Sometime for days on end. Although I'm sure someone will point out that that doesn't count. When people start in this industry, they need to have a very experienced partner. I will admit that I DO NOT KNOW EVERYTHING. There is alway room for improvement and something new to learn. (I enjoy reading your case studies Mike).

In any case, everyboby have a nice and safe holiday weekend. Take care all.
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#20 Mike MacKinnon

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Posted 02 September 2007 - 12:21 AM

As usual nicely thought out post!

You are absolutely right. I am as guilty as anyone of saying "experience" when what i REALLY mean is quality experience! To me, that is why there needs to be an oral board and testing process during the interviews. I know ICU nurses who simply follow the protocol sheet after 20 years and then I know others who are better critical thinkers than the docs. Its all in the personality type and the quality of the experience.

As for skills, the most important skill is critical thinking. Having said that, it goes without saying that the medic should be able to manage any airway imaginable in one form or another. As should the RN be able to manage any interfacility or road-side critical care patient.

The only way to know if you are interviewing a quality person is to test em. Plain and simple. Otherwise, they may well be blowing smoke up your backside.


Howdy all. I must admit that this is a hot topic. It is truly difficult to distinguish between experience and book smarts. But as all have said, it gets revealed on the tough calls. I must say that I disagree, to some extent, with Mike. It is important to find candidates that can function appropriately. However, I must say that not EVERYONE gets the same experiences. As I read these threads, it seems that if you dont include 'busy' or 'high' volume experience, you dont know anything. Someone stated earlier that skills were so important. They are to a certain extent. But they are skills. When it comes time to perform, we get some, we miss some. That is why there are 2 of us working as TEAM (whether it be RN/RN, RN/Medic, RN/RT) As for some colleages, we have all met the really smart ones and the really not so smart ones. Case and point, I worked with a Charge RN of an ER who was a nurse for 20 plus years. When the nasty hit, she was clueless. It shocked me that a person like that was in charge and that I really did know more than the person charge. At that time, I had only been a nurse for about 2 years. On the flip side, I know Paramedics that are just way to smart to be just medics. There are a couple I work with that teach me something new all the time. When people do get hired, there should be an extensive orientation. When I was hired by my company, we spent a month, M-F 8-5 in class. Then at least a month riding third. Now for people with previous flight time, orientation should be altered. But, even with that, things can be learned. I will admit that I never worked in the ICU, but have had many a ICU admit hold overs in the ER. Sometime for days on end. Although I'm sure someone will point out that that doesn't count. When people start in this industry, they need to have a very experienced partner. I will admit that I DO NOT KNOW EVERYTHING. There is alway room for improvement and something new to learn. (I enjoy reading your case studies Mike).

In any case, everyboby have a nice and safe holiday weekend. Take care all.


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Mike MacKinnon MSN CRNA
WWW.NURSE-ANESTHESIA.ORG

"What gets us into trouble is not what we don't know
It's what we know for sure that just ain't so" - Mark Twain