Steven Neher, ARNP, MSN, CEN, CFRN, NREMT-P, acting clinical educator for Air Care Team, Orlando Health in Orlando, Fla., and president of the Air & Surface Transport Nurses Association.
Q. When did you decide to pursue a career in nursing and why?
A. When I was in high school, I took an emergency medical technician (EMT) course and joined a medical club my senior year. I would go to the local community clinic and volunteer an hour of my time in preparation for college. Between taking the EMT course, being in the medical club and volunteering at the clinic, I got to see how nurses interacted with patients. That’s when I really became interested in nursing.
When I graduated from high school, I went to a junior college in Rock Springs, Wyo., and I worked for a volunteer ambulance service at that time. If there were really sick or severely injured patients, the flight team out of Salt Lake City AirMed would come to the small community hospital in Rock Springs, Wyo., and then fly them back to the University of Utah. It was at that time that I knew I wanted to go to school to become a nurse, specifically a flight nurse.
Q. How did you decide to become a critical care nurse, and what then drew you specifically to flight nursing?
A. To be a flight nurse, you have to have at least five years of critical care experience. Critical care experience means working in an emergency room, cardiac intensive care unit, surgical intensive care unit, a burn unit, etc. These units have specialized nurses with critical care knowledge of the illness, disease or injuries specific to that specialized unit. There is intense training that nurses must undergo to take care of those complex patients.
I knew I wanted to have a good understanding of how to take care of critically ill or injured patients, so I spent many years in a variety of intensive care units, including cardiac, surgical and trauma. One of the things that drew me to transport nursing specifically is the autonomy that a transport nurse has to take care of an individual with complex challenges.
My nursing practice has evolved over the past 15 years. I knew at age 18 that I wanted to be a flight nurse, care for the most complex patients and have critical care thinking skills. I knew I had to be the best of the best in nursing, so that I could have an opportunity to be a flight nurse. It was a tough journey, and it took approximately five years to prepare for this role as flight nurse, but I was fortunate to have found both local and national nursing mentors that helped prepare me for this role. They taught me the importance of putting my patients first, which included protection, advocacy and best practices. I am honored and privileged to work as a flight nurse and with the Air Care Team.
Q. How is critical care nursing different than other types of nursing? What makes it unique?
A. Critical care nurses tend to be “Type A” personalities and autonomous thinkers. In critical care units, things can change in an instance, so you have to be able to quickly intervene and think things through. Nothing is black and white. That’s what sets critical care nurses apart from other types of nurses.
In critical care, it’s typically one or two patients per critical care nurse – you’re taking care of so many of your patients’ needs. You’re watching all of their vital signs, looking at them holistically, interpreting labs and diagnostic studies, and in constant contact with the entire healthcare team. The critical care nurse is the liaison that links the patient, the family and the healthcare team, and is responsible for monitoring every little detail.
Q. What are your primary roles and responsibilities as a flight nurse?
A. Being a flight nurse takes critical care nursing to the next step. We are almost like an extension of the hospital’s emergency department or intensive care unit (ICU). We’re able to do things that physicians do in the ICU or emergency room, such as chest tube placement, giving blood and advanced pharmacology. All of those things are administered by flight nurses using their critical care thinking and best practices.
When the flight nurse initiates those therapies, they’re not getting permission from a physician to do it. They are doing it based on their assessment of what the patient needs. Flight nurses definitely have more autonomy, and as a result, need those critical thinking skills. Their job is to get the patient safely from point A to point B, as well as initiate care or continue care that has already started at point A. I think a flight nurse is like a casting director – we’re in charge of setting the stage and ensuring the patient is receiving all of the necessary therapies to make them better.
One of the most important things that flight nurses have to offer besides our knowledge and skills is speediness. Besides the team working very quickly, the helicopter can go from point A to point B very fast – we can travel between 130 mph to 150 mph in a helicopter. When somebody has a critical injury, speed is of the essence. If we can get the patient to a higher level of care more quickly, we see that their mortality drops significantly because we can get them into surgery or give them treatments earlier.
Q. What has been one of the greatest moments of your career?
A. A few years ago, there was a young boy playing with one of his friends at a ranch, and unfortunately there were some loaded guns in the parents’ bedroom. The kids were playing and got a hold of the gun, and one pointed the gun toward the other and shot the gun not knowing that it was loaded. Emergency Medical Services arrived and called for the helicopter because the nearest trauma center was many, many miles away.
We landed the helicopter in the backyard and quickly assessed the patient – I immediately knew it was a bad situation. We intubated the patient and started giving him lifesaving medications to help decrease the swelling. He was unresponsive. We quickly loaded him into the helicopter and continued that care, then transported him to a large trauma center. We didn’t think things were going to go well. Within a few days, they thought they were going to have to withdraw life support, but then things turned around quickly. Within two weeks, he was out of bed.
Three or four months later, the trauma center had a fundraiser, and we got to fly the helicopter to the site of that fundraiser. I was able to talk to the patient and shake his hand, and he got to wear my helmet and see the back of the helicopter. He has some disabilities as a result of the incident, but they’re working on that, and I think he will have a good quality of life.
Q. What are some of the most challenging and rewarding aspects of working as a flight nurse?
A. One of the most challenging is the emotional aspect of the job. You don’t get any heads up as to the type of situation you’re going into. When we get sent to an accident on the highway or an incident in the wilderness, we only know the age of the patient and an approximate detail of what has happened – something very general. You don’t know the circumstances until you get there. It’s hard sometimes when you walk into that scene. Often times, it is pure chaos. Your job as a flight nurse is to organize that chaos and get the information that you need so that you can treat the patient. It’s important to not get emotionally involved because you have a job to do.
In terms of the most rewarding, I look at myself as being the best part of someone’s worst day. I’m very humbled and honored that I was selected to be a flight nurse and that people have the confidence in me to go into those situations and take care of someone else’s family members as if they were my own.