Setting the Standard: The Difference Between a Nurse and a Board-Certified Flight Nurse

by Ericka Essington

Setting the Record Straight

When I founded Air Nurses, I knew I was stepping into uncharted territory. Private aviation had a reputation for offering luxury without compromise, seamless experiences for high-net-worth travelers, from jet charter to concierge services. But when it came to health oversight during flight, there was one glaring gap: no true option for clinical care at the level I wanted for my own family.

I had seen it firsthand. Families, brokers, even medical concierge services would ask if “any nurse” could accompany a client. The assumption was always the same: a nurse is a nurse.

That assumption is not only false, it is dangerous.

The Misconception: “A Nurse Is a Nurse”

Nursing is one of the most trusted professions in the world. But within nursing, there are dozens of specialties, credentials, and advanced certifications. The difference between a general nurse and a board-certified flight nurse in aviation is like the difference between a lifeguard and a Navy rescue diver. Both keep people safe, but the training, scope, and preparedness are worlds apart.

When a private aviation company or client assumes that any nurse can provide safe medical oversight at altitude, they underestimate what it takes to manage patient stability in an environment where there is no medical team, no crash cart, and no immediate hospital backup.

The CFRN Distinction

So what does it mean to be a Certified Flight Registered Nurse (CFRN)?

The CFRN credential, governed by the Board of Certification for Emergency Nursing (BCEN), is not a casual add-on. It is the highest standard of professional certification for nurses specializing in air medical transport.

Here is what it represents:

• Advanced Clinical Expertise: CFRNs are trained to provide ICU-level critical care in the air, managing ventilators, IV drips, cardiac monitoring, trauma interventions, and complex medication protocols.

• Aviation Physiology Knowledge: Unlike hospital-based nurses, flight nurses are trained to anticipate and mitigate the effects of altitude, pressure changes, vibration, noise, and cabin environment on the human body.

• Critical Care Experience: Most CFRNs have years of ICU, ER, and trauma nursing before they even qualify to sit for the exam.

• Emergency Preparedness: They know how to act in a crisis with limited equipment, in tight quarters, and without backup.

• Crew Coordination: Flight nurses also complete AMRM (Air Medical Resource Management) training, which mirrors the CRM training most flight crews take. This means we approach patient care the same way flight crews approach flight safety: through communication, checklists, situational awareness, and teamwork. We speak the same language as the crew, ensuring seamless integration into any cabin environment.

The exam itself is rigorous. According to BCEN, only about 60% of candidates pass the CFRN on their first attempt—and those who do represent a highly specialized elite within the nursing profession.

Realities at Altitude

Why does all of this matter if the client is not “critical” or “emergent”? Because the body behaves differently at 40,000 feet.

Oxygen levels drop as cabin altitude increases. A patient with stable COPD on the ground may desaturate quickly in the air.

Gas expansion can worsen everything from ear pain to post-surgical air bubbles or pneumothorax.

Limited mobility can increase the risk of clotting for post-op travelers.

Environmental stress such as noise, vibration, and dehydration can destabilize patients who seemed fine at takeoff.

In air medical transport, we learn to expect the unexpected. And when it happens at altitude, the difference between a nurse who knows aviation medicine and one who does not could have serious consequences.

Why Air Ambulance Experience Matters

I did not come to this conclusion in theory. I came to it after years of practice in helicopters and fixed-wing aircraft, where every minute and every decision counted.

That experience taught me things no classroom could:

How to troubleshoot oxygen flow mid-flight when turbulence rattles the equipment.

How to assess a patient’s neurological status in dim light and high noise.

How to prepare for contingencies when landing options are limited.

These are not abstract skills. They are the daily reality of flight nurses, and they are precisely why Air Nurses exists: to bring that air ambulance-level knowledge into a private aviation setting where clients still need oversight, even if they do not need emergency transport.

A Personal Mission

For me, this mission is deeply personal. The idea for Air Nurses began in a living room while arranging travel for my grandmother.

She did not need an air ambulance. She simply needed a nurse but what I found instead shocked me: “medical escort” or “companion” services that reduced medical oversight to a checkbox, offering nothing close to the caliber of care, peace of mind, or dignity she deserved.

That moment highlighted the truth for me. Clients deserve far better than a checkbox approach to medical oversight. They deserve the same caliber of clinician I would want at my grandmother’s side.

That experience became the turning point.

Educating the Industry

When I talk to private aviation professionals, one of the first things I emphasize is this: credentialed, aviation-experienced nurses are not an upgrade. They are the baseline for true safety.

That means:

• Do not assume that because someone is a nurse, they are trained for altitude.

• Do not equate escort services with comprehensive medical oversight.

• Do not gamble with clients’ safety, especially when reputations and lives are on the line.

Hypothetical Scenarios to Illustrate the Difference

This is a fictional example based on patterns I have seen in my career. (We never share confidential patient data, but this example is all too real.)

Scenario: The Routine Traveler With COPD

Imagine a client with stable COPD traveling on a cross-country private jet. On the ground, they manage fine with home oxygen. At altitude, their oxygen saturation begins to dip.

• A general nurse might notice shortness of breath at altitude.

• A CFRN would anticipate the risk ahead of time, calculate oxygen needs at intended cabin altitude, and adjust oxygen delivery before desaturation becomes critical.

The Broader Context: Why Now

The air ambulance services market is growing at double-digit rates, projected to reach USD 47 billion by 2032. At the same time, medical escort services are projected to reach USD 1 billion by 2031. Clearly, the demand for in-flight medical care is rising.

But in that growth, there is a blind spot. Families, brokers, and even some healthcare professionals still do not realize the difference between “a nurse” and a flight nurse.

Air Nurses was created to fill that blind spot, to raise the standard not just for our clients, but for the entire private aviation industry.

The Core Principles

There are a few key things that we emphasize in our practice. Our job is this:

• To ensure no client ever has to compromise between comfort and safety.

• To educate private aviation that aviation-experienced, credentialed nurses are not a luxury, they are essential.

• To set a new baseline for in-flight medical oversight, grounded in compassion, dignity, and clinical rigor.

Closing Thought

In aviation, the smallest details make the biggest difference. The same is true in healthcare. The letters after a nurse’s name — CFRN— are not just credentials. They represent years of experience, countless hours in high-stakes environments, and the readiness to act when lives depend on it.

Air Nurses exists because I believe private aviation deserves nothing less.