Flight Nursing: Interview With Michele Guthrie, RN, CFRN, CCRN, CEN, NRP
Bringing emergency care to the patient
Michele Guthrie, RN, CFRN, CCRN, CEN, NRP
PHI Air Medical, Sonora
What inspired you to pursue a career in healthcare?
I’ve always been a take-charge type of person with the desire and ability for focused autonomy. I wanted to apply my assertiveness and work ethic in a way that would help people in their times of greatest need.
Also, when I was very young, my father was a firefighter. I can remember watching my first structure fire with him and I believe now that I was drawn to that sort of chaos at a very early age. I became a dental assistant right out of high school because it was something that was quick and easy to do, but I knew right away that it was not where my talents were to be used.
Tell us about the arc of your nursing career.
I began as a first responder and volunteer firefighter. I earned my EMT credentials in 1990 and started working on a ground ambulance. I loved the ground ambulance and wanted to become a paramedic.
One day, I participated in an MCI (multiple-casualty incident) drill and a helicopter flew in to participate in the exercise. I was selected to do a ride-along on the helicopter and I was totally hooked from that moment.
The nurse on the aircraft said, “You just need to become a nurse — get five years of experience and then you can do it, too.” I immediately changed the path of my education from paramedic to nursing. I began my journey in nursing school during pregnancy and after the births of my two children. Fortunately, I had a very supportive husband.
Did it all happen the way you expected it to?
Yes, it did. I continued working on the ambulance while attending nursing school. Once I became a nurse, there were five more years of experience to accumulate as I simultaneously earned the required credentials: ACLS, PALS, NRP, etc.
After completing nursing school, I successfully completed the National Registry paramedic requirements and became a paramedic in order to work at a higher level on the ambulance.
I wanted to do critical care outside of the hospital, but in the state of California, nurses can only do ground-based critical care transport. Therefore, becoming a paramedic along the way was helpful in advancing my skills and accumulating the experience I needed in the field.
The majority of my nursing experience was gained in the ED, but I also spent about a year in the ICU.
How did you make the leap into flight nursing?
I interviewed with an air medical company in Northern California that did a lot of pediatric transports. They said I needed at least six months of pediatric experience, so I took a part-time job at a children’s hospital. While I was doing that, I also took a pediatric critical care course.
Serendipitously, I met a woman who had just become the chief flight nurse of the fixed-wing base of a different air medical company, closer to where I lived. She hired me to do fixed-wing transport as a way to advance towards my goal of working on the helicopter.
What was the draw of the helicopter versus fixed-wing transport?
Fixed-wing is solely inter-facility transportation. In a helicopter, you can land at the scene of an accident, even in the backcountry. The helicopter was a draw because I could respond to 911 calls and deliver immediate care to critically ill and injured patients in the field. We’re often the first line of care reaching the patient, especially in remote locations.
What do you love about your work? What gets you out of bed in the morning?
I think it’s the unknown. It’s showing up and not knowing where the day will take me. The excitement of it draws me. We can fly from Yosemite to San Francisco and from Sacramento to Fresno, all in the same day. We always say that we try to bring control to situations that are sometimes out of control.
PHI and the people I work with have very high clinical standards; we’re the leaders in best practices for the air medical industry. We get to perform advanced procedures that are truly a cut above the rest.
What is your daily routine like?
Technology and evidence-based practices impact our work greatly. We practice daily with mannequins so that we know what our given role will be in any clinical situation. We train like we fight and we’re always prepared for worst-case scenarios.
We have a pilot, a nurse, a paramedic and a mechanic on duty at all times. We do have some downtime at the base in between calls and we all have various tasks and responsibilities while on duty at the base.
One perk of the job is that I work two 24-hour shifts per week (not in a row) and then I have five days off. With this schedule, one can work per diem in the hospital if earning extra income is a goal.
We also have the opportunity to pick up overtime at our home base or at other bases within the state. I find it exciting to work with other crews and on other types of airframes within the company.
What is the most intense clinical aspect of what you do?
In high-risk, high-intensity emergencies, the most dangerous things we do are RSI (rapid sequence induction) and intubation. With RSI, we take control of someone’s oxygenation and ventilation. If we don’t do it correctly, we can ultimately cause more damage than good.
We have a script for how things are done so that it’s the same way every time, but we must also be willing to adapt to various situations, which may be simple and straightforward or extremely complex and dangerous. Things don’t always go as planned — that’s why we train in relation to our failures.
How does your safety come into the picture?
Safety is a priority for me and for the company. Our primary mission is to go home at the end of every shift. There are 10 life-saving behaviors that we’re required to practice as added safety measures so that we can “trap” error precursors and be accident- and incident-free. It’s up to me to be mindful about the task at hand and to speak up if I see something that isn’t right.
If one of us doesn’t feel comfortable with the situation (for example, due to weather conditions), we can turn down the flight. Most catastrophic incidents are related to weather, so we watch the weather with a realistic eye.
We have a catchphrase: “Four to go and one to say no.” What that means is that there are three crewmembers on the aircraft and one in our communications center who acts as an unbiased party.
Does your family worry about you at all?
They understand the relative risks and inherent dangers that go along with this job. However, life is dangerous; even driving down the highway is dangerous. It’s up to me to be safe and to ensure that the people I’m working with are being safe too.
My family is proud of what I do and my husband is still by my side after 30 years of marriage. My line of work has also influenced my children’s lines of work. My daughter is an educator and my son is a search-and-rescue swimmer in the Navy.
What else do nurses need to know about this career path?
There are generally shortages of flight nurses because nurses can typically earn more in the hospital. However, if this work calls you, it’s a very gratifying career. It can be demanding work at times. We function autonomously with protocols overseen by a medical director.
Anyone interested in this work should understand that we do 24-hour shifts. You have to live, sleep and eat here and be ready to go out into the elements at a moment’s notice. We wear Nomex flight suits and helmets and we have to be prepared for weather extremes, including temperatures ranging from over 100 degrees to at or near-freezing.
If we’re recruiting, also remember that you have to come in with three years of critical care experience. There are a few certifications that are required, too.
What are your further professional plans?
I’ve been flying for 15 years and I’ve been with PHI Air Medical since 2002. I’ve been stationed at PHI’s Sonora base since it opened in 2002. I spent the early part of my career really learning this job and getting very good at it.
I think I’m at a place of not being driven to do anything more as far as my nursing career is concerned. I just want to fly until I can’t do it anymore. I’ll continue to educate myself so that I can perform at my very best. With nursing and healthcare always changing and evolving, we have to change with the times.
I’ve always been a preceptor and I’ve trained a lot of nurses and paramedics along the way. I am also a base educator and I’ve done CQI [continuous quality improvement], marketing and other tasks.
I’m also a proud member of the PHI Air Medical Honor Guard, the only air medical honor guard in the nation. Honor guard members respond to line-of-duty deaths and also perform at ceremonies and conferences.
At this place in my life, one of my greatest joys — besides my career — is being a new grandmother. As nurses, we see some pretty horrific things, but we also get to see some of the most beautiful things. In the end, people matter and the time we choose to spend with them is what matters most!
This article is from workingnurse.com.