My Specialty

Flight Nursing, Carole Covey, PHI Air Medical Group

Delivering emergency care on the (rotary) wing

Registered Nurse Carole Covey sitting in a plane with a jumpsuit on and a helmet. She is looking out of the window.

Carole Covey, RN
Flight Nurse
PHI Air Medical Group

Please tell us about the arc of your career.

I watched my mom live through the challenges of nursing school and begin her career as an ER nurse. She worked night shift, so when I was home from school, I’d take her coffee or food. I’d also sit in the nurses’ station, taking it all in. Little did I know that those times planted a seed and inspired a passion for caring for others, as well as for emergency nursing.

I was originally in school to be a teacher. When I realized what I really wanted, I quit my education degree program, moved home and started on my own nursing path. What a roller coaster! I worked as a tech in a pediatric urgent care clinic prior to nursing school and then transitioned to working in the emergency department as a technician after I completed my EMT-B license.

Once I graduated, I transitioned to the ER. During my three years as an ER nurse, my love of nursing and caring for the sickest of patients grew exponentially. The hands-on aspect of being in the middle of it all is what drew me in.

How did you make the leap into flight nursing?

After completing my EMT-B license prior to nursing school, I had the opportunity to complete a ride-along with PHI Air Medical and fell in love. I knew without a doubt that I wanted to be a flight nurse. Working in the ER, I’d watch helicopters come and go. Interacting with the flight crews fueled my desire  for flight nursing. My passion for flying grew every time I saw a helicopter. However, it took me eight long (really long) years to be hired as a flight nurse.

In order to reach my goal, I knew I needed tons of experience and certifications, so I put in ridiculous numbers of hours at work, gaining an incredible amount of knowledge and clinical competency. I challenged myself by studying disease processes and clinical scenarios. I obtained as many certifications as possible, including my paramedic license [NRP], my BSN and my CEN [certified emergency nurse certification].

I was born and raised in the Dallas area, but when I was ready to start my flight career, I applied for every position available with every company throughout the country. In August 2016, I moved halfway across the country to work for PHI Air Medical. I knew they were the safest and had the highest clinical standards. The rest is history. It definitely was not a fast process, but it was absolutely worth the effort.

What inspired you to pursue this specialty?

This may sound corny, but it’s partly knowing that I can be the best part of somebody’s worst day. Flight nursing and ER nursing are often thankless professional paths, but I know that every shift, I can make a difference in somebody’s life. That’s enough gratification for me.

Nursing Education

Beyond that, the attraction was really the combination of having to think on my feet and reacting instantly. It’s a lot like my ER experience except that it’s in the air. The aviation side of flying intrigues me as well. (I mean, how cool are helicopters?!)

What’s the difference between working on a helicopter and a fixed-wing transport?

At my base, we have a helicopter and an airplane. Each has a crew of one pilot, one nurse and one paramedic. The staff rotate between each aircraft. You can get the same types of patients on both. The helicopter will do “scene calls” (911 response) while the airplane is used for longer distances.

Working in a rural area, it’s imperative that critical patients have access to higher levels of care that often aren’t available locally. Hardly a shift goes by where we don’t end up in San Francisco. Last week, on a single shift, I flew to Reno, Nevada; Bishop, California; and Los Angeles!

Flying in the airplane involves loading and unloading, ambulance rides and making sure we don’t leave any bags behind in the transitions. On the helicopter, we usually land where the patient is or drop them off and avoid the ambulance. My favorite is definitely the helicopter. It gets my adrenaline flowing and there’s something much more glamorous about it. (What can I say?)

What do you love most about your work? What gets you out of bed in the morning?

I think I have the coolest job in the world by far. From the beginning of my nursing career, I‘ve been passionate about caring for people, and being up in the air is the best feeling in the world. I’ve had an extremely busy year and a half. During that time, I have transported almost 250 patients, which is an average of about 14 per month. I hate shifts when we don’t have any flights — I go stir crazy!

One of the most interesting differences between ER nursing and flight nursing is working with a partner. You have to be able to effectively and efficiently communicate about everything. Building those friendships and relationships has been a learning curve, but an excellent one.

I love the crew dynamics. Your coworkers become your second family. We work holidays and birthdays together, we eat meals together like a family and there’s nothing like bonding over an intubated/vented patient at 2 a.m.

What’s your daily routine like?

In companies that do 24-hour shifts like ours, we work eight to 10 shifts a month. We have a base where we live during our shifts. It has a complete kitchen, private bedrooms, living room, education room, conference room and computers for charting. I also use our small gym to work out when I can and I practice running up and down the driveway. We have to be ready for a mad dash at all times! Sometimes, we have a flight waiting for us when we first walk in the door and off we go.

RN Career Events

Other days, we start with morning brief, where the mechanics, pilots and crews discuss mechanical concerns about the aircraft, weather and so on.  We then check on the aircraft and our equipment and supplies. We also eat breakfast; do clinical chart peer review; and engage in base chores such as trash, vacuuming and cleaning bathrooms. Additionally, there are always skills to practice, time for lunch and opportunities for naps. We tend to fly all night, so naps are encouraged! There are shifts when we’re so busy we never see our pillows.

What is the most intense clinical aspect of what you do?

The most intense aspect is that it’s just me and my partner caring for a patient. There’s no doctor, no respiratory therapist, no pharmacists, no backup — it’s just us. We have incredibly clear protocols to follow, but in the end, it’s up to the two of us. Making life-or-death decisions without a doctor by your side is a big responsibility.

Our day can range from a basic inter-facility transfer to working a scene call and needing to intubate a patient. However, no matter what we’re doing, we have to consider all the aspects of the patient: labs; differential diagnosis; medications; vital signs; advanced procedures (e.g., intubation, chest tube, surgical cricothyrotomy); and the potential ramifications of any mistake.

How does the safety of you and your colleagues come into the picture?

We work for a company that’s the safest in the industry. Safety is first and foremost. If any member of the crew ever has a concern or a gut feeling about something, they can speak up and never feel punished for saying no to a flight.  It takes all three of us (pilot, medic and nurse) to agree on a flight. Only one has to say no and we don’t go. Our motto is, “Three to go, one to say no.”

Does your family worry?

Outside of how any parents worry about their children, no. Oddly enough, my younger brother works for the same company (PHI Air Medical) in Texas as a flight paramedic. We’re always checking in with each other and stay in close contact.

My dad is a firefighter, my mom is a NP in the ER, my oldest brother and his wife have their own successful construction business and my middle brother lives in Africa with his wife. We’re all spread out, so our worries are like any other family’s.

What do nurses who are interested in flight nursing need to know?

If your dreams don’t scare you, they aren’t big enough. If you want to be a flight nurse, you can do it! It takes several years of being a nurse in a busy critical care emergency department or an intensive care unit to build a strong foundation for flight nursing. Being able to think critically, remain calm around the sickest patients and think on your feet while providing care is crucial.

When you become a flight nurse, the orientation process doesn’t teach you how to be a nurse at all — that’s what hospital life is for. Flying is about taking that knowledge and integrating it with policies that you diligently follow in the air.

What are your career goals and plans?

Never stop flying! Eventually, though, I’d like to move into management. There are many aspects of the air medical world that call for high-level management and leadership.

I don’t know exactly which one I’d like to pursue, but it’s on the back burner for now. I’m currently pursuing my master’s degree in nursing administration and studying for my CFRN [certified flight registered nurse certification], but I’ll keep flying for as long as I can.

KEITH CARLSON, RN, BSN, CPC, NC-BC, has worked as a nurse since 1996 and has hosted the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at

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