EMT to Flight Nurse – One Nurse’s Journey

An interview with a flight nurse who started as a volunteer EMT.

The following interview is from the Daily Nurse. It is an interview with Stephen Lee, RN, BSN, a nurse who started as a volunteer EMT and worked his way up the rungs of the medical ladder to become a flight nurse. His career progression and determination highlight a long road to success.

First off, how are you currently spending your time?

I currently live in Louisiana, a few hours north of New Orleans, and I’m training in a position as a flight nurse. I recently left a position in the cardiac-medical intensive care unit at a regional heart transplant center. I’m part of the forensics team (sexual assaults, domestic violence, simple assault, and burns) and I work PRN in the emergency department (ED) at the only level 1 trauma center in my city. I also volunteer with an urban emergency medical service (EMS) system as a paramedic.

What was your first job in health care?

Several years ago, I started as a volunteer EMT (emergency medical technician), which I affectionately deem to be the bottom rung of the medical ladder. Looking back on those days, I knew close to nothing but was caring for critical patients in unstable environments. I had no idea that I was interested in the medical field until I started as an EMT, but I loved the marriage of critical thinking in a high-pressure environment, and I developed the (very useful) ability to look at life and say, “give me your worst.”

What was it like to be an EMT? Where did you go from there?

I loved being an EMT. I was in a position to completely manage a patient’s prehospital care, even if it was with only six drugs. I was taught how to give the best care with very few resources, and the fraternity that I experienced was like nothing I had ever experienced. I spent some time with private ambulances and slowly got more and more interested in the complex tools, patients, and therapies that you can’t really see outside the hospital. I was lucky enough to witness the incredible nursing teams at DC hospitals, and that’s when nursing became my dream.

Where did you go to school, and what did that progression/path look like?

I had earned my Bachelor of Arts degree in a completely unrelated field, so I didn’t have a single science credit when I decided to go back to school for nursing. I had two choices: I could spend three semesters doing foundational science prerequisites, then do an accelerated BSN (Bachelor of Science in Nursing) over two semesters (and pay $50,000), OR I could get my ADN (associate’s degree) at a local community college where I would be able to take pre-reqs for a BSN at the same time. I chose community college!

So you graduated with an associate’s degree? What was your first job?

After I passed the NCLEX and became an RN, I realized how restricting the ADN was. I wasn’t eligible to work at any magnet hospitals, and all critical care programs require a BSN. I wanted to work in emergency medicine, but I had no ED/ICU practicum experience (community colleges often do not get this opportunity), so it was hard to stand out. Luckily, I had hopped on earlier as an emergency department technician at a smaller DC hospital, and that department hired me as a new grad. I received a full-ride scholarship to earn my BSN a year later.

Tell me about your first job as a new graduate nurse.

I was in a small community ED for my first year as a nurse. It was a nice, gradual introduction to emergency care, and I loved it. It was not a teaching hospital and not a trauma center, but it was like learning within a big family.

Where did you go from there?

After my first year in nursing, I had completed my BSN and ED residency. I was ready to get beat up. I found a position at University Medical Center in New Orleans, the only trauma center in a city with an incredibly high rate of both crime and weirdness. I saw some truly incredible things there, and I loved it to death.

What are your short- and long-term career goals? Where do you see yourself in five years?

I’m living my ultimate dream: flight nursing. Flight nursing requires a combination of the technical finesse of an ICU nurse with the mentality of an ER nurse, all in the prehospital environment where it’s just you and your partner. All of my career moves over the last several years have been toward this goal, and I’m now doing orientation and training. This type of work is the pinnacle of emergency critical care and prehospital care, and I could honestly see myself doing it for the rest of my life.

What advice would you share with anyone who is interested in pursuing flight nursing?

First of all, and quite unfortunately, there are no shortcuts. I meet a lot of people who finish nursing school or get their medic cards and immediately want to be a flight nurse. Truthfully, you need a minimum of 3-5 years of grueling experience before you would even be considered, and that’s a good thing. I’ve worked 60+ hours a week for the last two years in a Level 1 trauma ED and a cardiac ICU simply to gain experience, and I still have so much to learn.

Relatedly, this type of life is not compatible with normal socialization. One of the reasons I’ve been able to throw myself into work is because of my lack of attachments. I moved 1,000 miles with two week’s notice; I’ve taken pay cuts for my last two jobs because I rent a room month-to-month, keep everything in storage, and have zero debt. This is a lonely life, no doubt about it. I pretty much stopped trying to date because I work six days a week and when I do have time, all I can talk about is work. If that is something you don’t think you can handle, maybe this career path isn’t for you.

If you want to fly, get EMS experience. I can’t stress this enough. Beyond learning about the prehospital environment, you learn how firehouse life works, which a lot of nurses (especially from ICU backgrounds) struggle with. You are not colleagues with your flight team, you’re family—a family that uses curses as terms of endearment and who knows things about you that you never even told your closest friends. Working in that type of environment builds bonds that can never be broken and are instrumental to providing the best care together.

This is very important, even for nurses who don’t want to fly: Learn some of the skills of those around you in the hospital (respiratory therapists, EKG/ECHO techs, IV team), because there’s going to be a time that you’re going to need something done by them and they’re not around (keeping inside your scope, of course). Plus you will learn so much! I’ve come in on my days off to shadow respiratory therapists and IV nurses to see how they do things.

Lastly, be a team player, but never accept help until you really need it. If your patients are settled, then it isn’t time to relax, it’s time to help your coworkers. Avoid accepting a hand just because it’s offered, but take help when you’re drowning. Build a reputation of being self-sufficient but also very helpful to your coworkers, so that when you have that tough assignment and you say “I really need help,” people will jump right in. You’re not going to get far doing this job without a team, and you also won’t get anywhere without hard work.