What It Takes to Become a Certified Flight Nurse

What Is a Flight Nurse?

A flight nurse is a registered nurse with the training and experience to provide critical care in transport environments. This can be either rotor (helicopter) or fixed-wing, typically working alongside other medical providers such as paramedics, other nurses, respiratory therapists, nurse practitioners, or physicians; they’re essential for providing top-level patient care when it matters most!

What Does a Flight Nurse Do?

Now that we’ve established what a flight nurse is, we should discuss what the flight nurse does. Flight nurses provide immediate patient care, including assessment, triage, and treatment. These patients include some of the sickest patients you may encounter. Flight nurses are responsible for many things during their shifts. It typically starts with checking off the aircraft and equipment, along with their partner for the shift. This also includes checking the expiration dates of their medications and equipment during their daily checks. As a flight nurse, you are expected to be ready to respond to a request within minutes of the call at any time during your shift. During a flight, you may have to assist pilots with navigation and be able to communicate via radio transmission. Patient care often includes similar duties in the emergency department (ED) and intensive care unit (ICU). Still, care is provided in a much smaller compartment and unpredictable situations. The scope of care is typically broader than what is found in the traditional ED and ICU. It still includes providing immediate care to your patient. You will still assess your patient and develop your treatment plan based on their triage/assessment. Overall, resources are less than what is found within the hospital setting. Flight nurses must be able to think and remain calm in any given situation critically. They must always be aware of their safety and the safety of their crew and patient. They must be able to adapt and handle extreme environments and situations easily. Autonomy is an important attribute for flight nurses to have.

What Types of Patients Do Flight Nurses Work With?

Patients can range in age from the premature neonate to the frailest elderly. Specialized programs focus on certain populations, such as neonates, but this does not mean that as a flight nurse, you will never see this population of patients. Sometimes, those specialized teams may be unavailable, or your transport team may be the best option for the patient. You may transport patients on extracorporeal membrane oxygenation (ECMO) with ventricular assist devices (VAD), balloon pumps, etc. Mostly, these patients will be some of the sickest patients you will encounter. Otherwise, they wouldn’t need your specialty care. No matter the situation, the key is to think critically about your situation and the type of patient and devise your treatment plan based on that.

How Do You Become a Flight Nurse?

You must be a registered nurse, and some companies require a BSN for hire. Typically, you must obtain at least 3-5 years of experience within the ED or ICU. Experience within both areas is looked at favorably. Immerse yourself in education and learning as much as possible before and after hire. You will be required to obtain an advanced certification within a specified time after hire (usually one year).

Sometimes there are as many as 60 applicants for one Flight Nurse job opening. You can get a jump on the competition by getting your CFRN® Advanced Certification before applying.

What Kind of Environment Do Flight Nurses Work In?

The environment consists of working in a smaller compartment alongside your partner. You will provide care on scenes of medical emergencies and within the ED and ICU settings. There will be transfers from hospital to hospital. Flight nurses can work 12- or 24-hour shifts. You are expected to be available and ready to provide care any time of the day or night. This can be in the middle of summer when it is blazing hot or in the middle of winter when it is subzero outside. The changing environmental factors are probably the biggest change for most nurses to become accustomed to. The physical demands and stressors of flight must be considered as well. The vibration from the aircraft and changes in weather conditions can take more of a toll on your body than you would initially expect.

Is It Safe?

It is very safe. When you consider and look at previous crashes, the large majority are preventable. They are often secondary to pushing the aircraft’s limits or thinking it won’t happen to me. It is important to speak up as a flight crew member. It takes three to go and only one to say no.

All crew members must agree to take the flight. If one person feels uncomfortable, then the flight is not taken. Pushing weather is another hazard that has led to previous crashes as well. Certain minimums must be met before a flight can be undertaken, and those minimums should always be enforced. Having great communication with your pilot and partner is important in these situations. Briefings with the crew occur at the beginning of every pilot shift to discuss the anticipated weather conditions.

Are There Any Special Certifications That Are Needed to Be a Flight Nurse?

The Certified Flight Registered Nurse (CFRN®) is the preferred certification and will be required usually within one or two years after hire. Some states require nurses to hold an emergency medical technician (EMT) license to practice as well.

What Are the Ongoing Education Requirements?

Once you obtain your advanced certification, you will have to obtain 100 hours of continuing education over the next four years to recertify or sit for the exam again. You will also have to maintain PALS, ACLS, BLS, NRP, and an advanced trauma course (such as TNCC, ATLS, or TNATC). You will also be responsible for the company’s required education. It is important never to stop studying and learning. The difficult patients you encounter should drive you to continue to learn and advance yourself as a flight nurse.

Is There a Network of Flight Nurses or People to Connect With?

There are a few societies, such as the Association of Air Medical Services (AAMS), Air and Surface Transport Nurses Association (ASTNA), and the Board of Certification for Emergency Nursing (BCEN®), to name a few, for networking possibilities. Conferences such as FlightBridgeED Air and Surface Transport (FAST) Symposium, Air Medical Transport Conference (AMTC), Critical Care Transport Medicine Conference (CCTMC), and National Teaching Institute (NTI) and Critical Care Exposition are all great resources for continuing education and networking as well.

A seasoned partner is one of the greatest people that can help you when you first enter the industry. Their experience and guidance are such an advantage. As a new flight nurse, you should look for a mentor willing to take the time and help you develop and hone the skills necessary for success.

Suggestions for Studying for the Advanced Certification Exams?

First, look at the content outline and understand the content that is being tested. This content can be found on the BCEN® website and other useful resources. At FlightBridgeED, we are committed to your success in passing the advanced certification exam on the first attempt. We offer a full review course, resource materials, and practice exams to ensure success.

What is CRITICAL CARE medicine, and how is it different from regular pre-hospital emergency medicine?

According to the American College of Physicians, critical care medicine encompasses the diagnosis and treatment of a wide variety of clinical problems representing the extreme of human disease (“Critical care medicine”, 2022).

Generally speaking, emergency medicine is focused on the rapid assessment and treatment of acute illness and injury. Critical care medicine is conducted in very structured and controlled settings for the sickest of the sick who require a precise regimen of treatment over a longer period of time from a multitude of specific medical disciplines.

An understanding of pre-hospital emergency medicine AND critical care medicine is required to be an effective flight nurse. FlightBridgeED was created to bridge the gap in nursing training by augmenting traditional RN education and expanding knowledge into pre-hospital/scene response knowledge.

Get Certified to Become a Flight Nurse

Certification for flight nurses is issued through the Board of Certification for Emergency Nursing (BCEN®). This is the only certification for flight nurses. CAMTS-accredited air medical services typically require flight nurse certification (CFRN®) to be hired or to continue functioning as a flight nurse after a specific period.

As we mentioned, a certified flight nurse is trained in pre-hospital, critical care, and emergency medicine. If you have the experience part taken care of, your next step will be passing the flight nurse (CFRN®) exam. This exam is notoriously difficult to pass and is designed to test your mastery of a massive range of knowledge rigorously – it’s also expensive. It is highly recommended that you attend a review course before sitting for your exam attempt. Once you’ve completed your review course, you can schedule your exam. The exam is taken in person at designated, proctored testing centers worldwide. The exam consists of 175 questions (25 of which are trial questions and do not count toward your overall score) and requires. You are given 3 hours in which to complete the exam. You will need to answer 106 items correctly to achieve a passing score of 70%. Additionally, the exam will allow you 5 practice questions before starting the exam so that you can better understand the exam system before actually beginning.

Overview of the content you will need to MASTER in order to successfully pass your flight nurse (CFRN®) exam:

Safety and Transport

Aircraft operations, aerodynamics, aircraft performance, emergency procedures (e.g., fire, de-pressurization, IIMC), landing zone operations, obstacle avoidance procedures, survival techniques, weather patterns, refueling operations, personal wellness (e.g., fatigue, fitness for duty), hazard reporting, communication and radio operations, safety and restraint systems, pre-flight check, passenger briefing, risk assessment, night vision goggle operation (NVGO), GPS and navigation.

Flight Physiology

Gas laws, hypoxias, stressors of flight, altitude injuries, time of useful consciousness (TUC), pressurized versus unpressurized aircraft cabins.

Airway, Anesthesia, and Analgesics

Airway assessment, anatomy, and physiology, pharmacology, passive oxygenation, failed airway, surgical airway, mechanical ventilation, alternative airway devices, peri-intubation arrest, special airway considerations (e.g., tracheostomy), tube confirmation and monitoring, airway suctioning, waveform capnography monitoring, non-invasive positive pressure ventilation.

Medical Emergencies

The endocrine system, adrenal system, renal system, metabolic, sepsis, infectious disease, toxicology, blood products, gastrointestinal, lab values (e.g., CBC, coag, BMP, ABG, cardiac panel), advanced medical assessments, treatment modalities, invasive line procedures, radiographic interpretation, respiratory system (e.g., Krebs cycle, oxyhemoglobin disassociation curve, intrathoracic pressure).


Neurological assessment, seizures, altered mental status, cerebral ischemia (e.G., large vessel occlusion), neuroprotective strategies (e.g., positioning, hemodynamics, EVD management), cerebral hemorrhage, traumatic brain injury, spinal cord injuries, neurological diagnostics (e.G., ct scan), lab values (e.g., coag panel, BMP), pharmacologic agents, monitoring equipment (e.g., ICP monitor).


Multi-lead interpretation, anatomy, mechanical support device (e.g., Impella, ECMO, VAD, IABP), acute coronary syndromes (ACS), cardiogenic shock, heart failure, infectious cardiac disease (e.g., pericarditis, endocarditis, valvular disease), arrhythmias, hypertensive crisis, hemodynamic instability, chronic cardiac conditions, vascular disorders (e.g., AAA, thoracic dissection), electrophysiology, cardiac diagnostics (e.g., ultrasound, cardiac echo), lab values (e.g., cardiac panel), pharmacologic agents.

Trauma and Burns

Trauma/burn diagnostics (e.g., CT X-ray, ultrasound), lab values, pharmacologic agents, monitoring equipment, surgical interventions, blood product administration and management, the lethal triad of trauma, fluid resuscitation, burns (e.g., thermal, electrical, chemical, radiological, fluid resuscitation), toxic inhalation injuries.

Maternal-Fetal and Neonatal

Maternal-fetal and neonatal diagnostics (e.g., tocodynamometer), lab values, pharmacologic agents, monitoring equipment, complications of delivery (e.g., cord prolapse, placental abruption), multiple-birth, pre-eclampsia and eclampsia, premature rupture of membranes (PROM), maternal, neonatal.


Pediatric diagnostics, lab values, pharmacologic agents, monitoring equipment, airway disease (e.g., croup, RSV), nonaccidental trauma, fluid/electrolyte replacement, metabolic emergencies (e.g., DKA), special needs (e.g., developmental delays, autism spectrum, hematology-oncology), high-tech (e.g., home vent), infectious disease (e.g., meningitis, re-emergent diseases), airway and ventilator management.

Professional Considerations

Common accreditation standards, research design, methodologies, and terminology, privacy considerations, JUST culture, evidence-based medicine, ethical considerations (e.g., end of life considerations, DNR), gamut metrics, caregiver PTSD and suicide risk.

Information courtesy of the Board of Certified Emergency Nursing (BCEN®). The CFRN® logo and the CFRN® and BCEN® acronyms are the sole property of the BCEN®.

Never stop learning and become a mentor for someone else

If you want to know how we used to treat patients, read a textbook. If you want to know how we are treating them now, read a professional journal, and if you want to know how we will treat them in the future, listen to podcasts, read blog articles, go to professional conferences, find experts in a discipline and ask them to teach you everything they know. We say we “practice” medicine because there is always something new to learn. In the fast-paced profession of a flight nurse, it’s important to learn and grow constantly. Just as you initially studied to become a nurse, you must continue studying and hone your skills daily. Throughout your career, you’ll always need a mentor who will help guide you and teach you. A mentor is INVALUABLE. They have been where you want to go and can show you how to get there.

Once you become a flight nurse, just as with your professional license, there are requirements that you will need to complete every 4 years to maintain your certification, you’ll still have to maintain your nursing license requirements as well as your advanced certification requirements. All of the hours at FlightBridgeED can be used for ALL OF YOUR CERTIFICATIONS & LICENSES (your professional license and your Advanced Certifications).

It’s important to pass on what we learn to the next generation. The mentors you have in your life won’t always be there. It’s a sobering thought to realize the responsibility of carrying on the wisdom of those who have come before us and the wisdom we have gained on our own. Seek wise counsel – seek out mentors, and always be a mentor to others so that you can pass on your legacy to those who come after.

Here is a heavily requested podcast with some great points to get your career started. Give it a listen!

The FlightBridgeED Podcast – Season 7 (2018)

Episode 146 – The Steps To Becoming A FLIGHT NURSE w/Kelly Miller

This is our second in a series of two unique podcasts that takes a look at the road to becoming a Flight Nurse. Eric Bauer is joined by Kelly Miller, Regional Clinical Manager for the Midwest Region of Air Methods Corporation. We have received numerous podcast requests on the topic of: What is the best way to achieve the position of Flight Nurse. Kelly comes with a diverse experience level as a nurse in the ED, ICU, and flight nurse in the HEMS industry, with his current role as a Regional Clinical Manager. Take a journey with us as we dive into the best way to obtain a flight position and be prepared for these challenging clinical positions. 

FlightBridgeED has designed an entire business around you!

Get ready to pass your exam with the #1 flight nurse (CFRN®) exam review course

The FlightBridgeED flight nurse (CFRN®) Exam Online Review Course is the only study system that offers real-world insight from experienced experts with decades of experience in critical care medicine and as professional educators. Our course includes over 48 CE hours of 100% online, self-paced modules covering 17 topics, comprehensive practice exam simulation, review course textbook, and study guides that will help you master everything you need to pass the Certified flight nurse (CFRN®) exam.

Our Exam Pass Commitment™ backs your success. No review course provider can guarantee your success on your exam attempt. We don’t make impossible promises – our team values honesty and integrity. As much as we would like to, we can’t make a GUARANTEE, but we can make a COMMITMENT. Suppose you are unsuccessful in your exam attempt. In that case, we will assign one of our education team members to you as a personal mentor/tutor and enroll you in an instructor-guided review course at NO ADDITIONAL COST TO YOU.

The BEST study tools for your success

It’s difficult to predict which study tools will work best for you without having some experience with these difficult advanced certification exams. Unlike other programs, our certified flight nurse (CFRN®) Online Exam Course was designed by a team of expert educators with decades of experience in critical care practice and preparing nurses to pass these difficult exams. You’ll have access to our carefully crafted and curated study tools that will skyrocket your chances for success on your advanced certification exam.

When you fly, you become part of a family

This is true of any field in the medical profession, but it is especially true of medical flight teams. It’s a stressful career with long hours and high stakes. But for flight nurses, flight paramedics, and pilots, the entire crew becomes family. That means you look after each other when you’re in the air or on the ground. It’s important to separate your personal life and your work life and to have balance. Problems at home can’t stop you from performing when someone else’s tomorrow is at stake. You are likely the highest-trained medical provider for miles when on a scene call. Sometimes when you are on interfacility transports, you may not be the highest-trained medical provider. Still, you may be the person who sees things differently through the lens of your experience and saves the life of someone at just the right moment. That might sound scary or like a heavy responsibility (and it is), but that’s the job, and it should never be taken alone. No matter what happens, the person next to you has to know that they can rely on you just as you rely on them. Medical flight teams are always there for one another at the bedside or the base – even if that means staying up late into the night to help someone who needs them more than ever before.


Becoming a Certified flight nurse is more than just an exciting job… It’s a lifestyle. It’s challenging, gratifying, and tough but worth it. You can make a difference in people’s lives in a way that no one else can. Passionate about helping people? Interested in aviation? Want to make a difference in the world? A Certified flight nurse is a perfect job for you.

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