From prison nursing to flight nursing – The journey to my dream job

Written by Royal Flying Doctor Service (RFDS)- Flight Nurse, Jodie Tickle RN/RM for The Nurse Break

The early days

When I was 13 years old my mum and dad took my brother and me on an 8-week road trip around Australia (excluding WA). I remember visiting the RFDS base at Alice Springs in the NT and thinking “yep this is what I am going to do”. Skip forward 5 years and I left school at the end of year 11 to pursue a career in the thoroughbred horse industry and commenced a TAFE course in horse stud management while working part-time as a vet nurse at a local practice. Still not knowing exactly what I wanted to do with my life, I then went into jobs as a pharmacy assistant, motel receptionist and tax office receptionist. It was then that I thought to myself how can I help people more, what job can I do that gives back and helps others. I have a humanitarian heart.

Mature Age Student

At the ripe ‘old’ age of 21, I was enrolled in a Bachelor of Nursing degree as a mature aged student! In 2004 my husband and I relocated to the USA for 12 months where I undertook a nursing externship in Arizona rotating through 2 large trauma hospitals, a GP clinic and by far my favourite – Community Health travelling through the native American reservations doing primary health care.

On our return to Australia, we had our first child so I was unable to work fulltime and therefore I gained part-time employment as a first-year RN at our local rural hospital (69 beds) in Northern NSW. I don’t recommend this, entering the workforce as a first-year with no postgrad year program was hard. If you are reading this and are just about to graduate, find a good facility with postgraduate programs and soak in every and all experience in as many departments as you can.

Rural Nursing

Our local hospital had a small med/surg ward, a one theatre operating suite, a small day surgery unit, maternity ward and ED. I did a few shifts in the medical ward and then I was asked if I wanted to ‘train up’ in OT. I gladly accepted, I really didn’t like medical nursing. Our OT was staffed by dual competency GP’s for the majority of the time and facilitated basic general surgeries and maternity surgeries. We also had a visiting eye surgeon, gynaecologist and a dental surgeon who would fly up to Northern NSW once a month to perform a day of operating. I predominately focused on the post anaesthetic care unit where the PACU nurse worked alone sometimes with a 1:3 patient ratio. I also did a bit of anaesthetic nursing. I loved the controlled environment of OT and during this time I completed a post-graduate certificate in perioperative nursing.

After a short time, I also began picking up shifts in the ED. This was my passion, this is where I wanted to be! Eventually, I was working more in ED than I was in OT and I loved it. Our small ED was extremely busy and serviced in such a large area. We had 1 resuscitation bay, 2 acute beds, a mental health room and 2 other general/procedure rooms. It was staffed by 2 RN’s every shift.

Our wonderful GP’s shared a rotating ‘on-call’ roster, but often there were no doctors available at all and we were blessed to have a teleconference set up where we could dial into a larger facility with Dr’s present who could advise us if needed. I was extremely fortunate to have worked with some amazing nurses during my time there. They were knowledgeable and supportive and I learnt a lot from them.

On average we would have to fly out 1-2 patients a week to higher acuity facilities for more advanced care. I remember watching the retrieval teams come in and be in ore of their skills, abilities and professionalism.  These interactions cemented my goal of becoming ‘one of them’.

By this time our little family was complete with 3 small children. I had been working here for 10 years on and off around having my children but I had a desire to improve myself and experience more so we packed up our family and moved to a large rural township 2 hours south, where I gained part-time employment in the brand new cardiac catheterisation lab and also worked shifts in ED. The cath lab was a wonderful experience, I learned so much about cardiac health and nursing and it really helped me in my ED work. During this time I also completed a post-graduate certificate in Trauma and Emergency nursing and opened my horizons and began doing some study around alternative therapies and energy healing. And in a strange combination to western medicine, I am now also a Reiki Practitioner.

Middy Madness

I loved my jobs but it still wasn’t where I wanted to be. So in 2016 I took the plunge and applied for the Postgraduate Diploma of Midwifery placement at the same hospital. I got accepted. That year was by far the hardest year of my life. I was working and studying full time as a student midwife, whilst also raising a family and running our small farm and my husband worked full time also. It was stressful!! I couldn’t even tell you how many times I thought about pulling the plug, quitting the program and saying ‘oh well I’ll just be content on being an RN’. But I pushed through. It wasn’t without many sacrifices though.

We used to compete regularly with our horses, but I couldn’t fit that in anymore. I gave up my sport, nights out, school functions and family trips away, all because I was striving to reach my goal. I remember my first block at uni that year and we had to go around the room and say why we were doing midwifery. I think everyone before me said things like ‘I want to be able to help women’, ‘I love the power of the feminine’, and ‘I just love babies’. It got to my turn and I just sat there and simply said ‘because I want to be a flight nurse’, needless to say, I got some funny looks. Don’t get me wrong, I love being a midwife, I love being a part of such a special time in people’s lives and I too LOVE the little babies, but I knew it wasn’t something I wanted to do full time. After I graduated I needed a bit of a break so I dropped back to casual status and worked 3-4 days a week between maternity and ED. I loved having the ability to say NO to a shift and knowing that I didn’t have to miss a school assembly if I didn’t want to.

Doing Time

A good friend of mine who is an RN had recently changed jobs and took a position across the road at our local correctional centre; it is one of the busiest remand centres in NSW and houses maximum to minimum security male inmates. She mentioned to me one night over dinner that there was a casual job vacancy there and said I should apply. I love a challenge so I did, and low a behold I got the job. I was so nervous commencing my job with Justice Health, it was mainly primary health care and totally left-field to what I was accustomed too, and the environment is, shall we say, unique and confronting. I LOVED IT!

I was so fortunate to work with such an amazing team of people including the other nurses and the correctional officers. Some of our situations were intense, but I never once felt threatened or afraid, I knew our wonderful officers had my back. This environment was certainly eye-opening for me. I discovered that most often repeat offenders knew very little else when it came to living their life, as that is what they were raised with. I learnt that some inmates had spent more of their adult life behind bars then they had out and that this was comfortable for them.

Many inmates had other family members inside with them; a few even said to me ‘these guys in here ARE my family, Miss’.  Yes, it took a fair while for me to get used to being called “MISS”. What surprised me the most was my own feelings of empathy for my patients. Some of these patients had done horrible things to lead them to jail and I honestly thought that I would have negative feelings and attitudes towards them. But I didn’t, they were still people and I was there to help them. I would listen to some of their stories and feel saddened and hopeful that they could learn from their mistakes and lead a better life when they were released. Let’s be honest though, some of them can spin a yarn or two and I was very careful to take note of who may be telling me what I wanted to hear, as opposed to what was truth.

My position there involved primary health assessments, the first response to incidents, first aid, seeing patients by booked appointment in the health clinic for a multitude of different reasons, medication administration, drug and alcohol assessments and treatments and mental health. I was still picking up regular shifts in ED and Maternity and this new job just added more diversity to my role and I really enjoyed it.

Crossing the Border

Come mid-2018 my husband was offered a promotion which involved moving from NSW to Rockhampton QLD. At first, I was adamant I was NOT moving. I loved my job/s, I loved our township, the kids were settled in their schools, I didn’t want to leave my friends and family, the list goes on. But in all seriousness opportunities like this don’t pop up very often. To soften the deal he took it upon himself to do a little research about possible job prospects for me. He found out that there was a correctional facility just out of Rockhampton, and he also showed me that there was an RFDS base at Rockhampton too. Plus two private hospitals and a big referral hospital in town. Before a decision was made I emailed both the correctional centre and the RFDS branch to inquire about possible jobs. The correctional centre was a yes, the NUM at the RFDS base said possibly, keep my eye out on the website for vacancies. We finally came to the conclusion that we should seize the opportunity and we decided to uproot our family and move north of the border.

Our then 13-year-old was not too enthused about it. I applied online for a casual position at one of the private hospitals, had a phone interview and was employed in maternity and ED before we had even booked the removalist. 2 days before move day, I received an email from the NUM of Rockhampton RFDS to tell me that a casual position had become available and if I was still interested to drop in and see them once we arrived. Oh my gosh I thought, could this really be happening. After meeting with her, I formally applied for the position and low and behold I got the job, but my lord, what a hurdle to jump. I’d never heard of a process called ‘credentialing’ before. The RFDS (with a small amount of external help) ask thousands of questions, and research and confirm everything you have ever done or completed in your career to date and question every little gap in your resume timeline.

This included degrees, post-grad certificates, other qualifications, total hours you have worked, and the facilities and departments you have worked in, to make sure that you have the ability to perform the job safely and satisfactorily. From memory the RFDS require a minimum 5 years critical care experience which has to be within the last 7 years of practising. There were numerous phone calls, emails and chasing up statements of service and previous qualification records. But it eventually all got sorted and I gladly accepted the position. During this interim period I also completed my Immunisation for Health Practitioners certificate.

Flying High

I had to complete 2 weeks of intensive training at Brisbane Base. So, not long after we settled in, I flew to Brisbane for two 1 week stints. The first 3 days were spent learning policies and procedures, aircraft and cabin safety and visiting the corporate office to meet key personnel. Then I got to fly!!! So excited and so nervous, my first 2 flight days were a blur. Would I panic, would I vomit, would I totally embarrass myself? I flew with the most knowledgeable flight nurse who has been with the RFDS for years and years and she was so wonderful to work with and helped me a lot. My second week was mainly flying with other FN’s plus a bit of admin stuff. I remember after my second full day of flying that week I got back to my motel room and felt like everything was moving. I went to the restaurant for dinner and felt like I was on a ship bobbing up and down in the waves, such a weird feeling when you know you are on solid ground. I shut my eyes in the shower and almost fell over. Land sickness – Yes it is an actual thing!! Who knew lol.

Once I returned to my home base I had a further 2 weeks or supervised flying and assessments before I was safe to ‘fly alone’. Then that was it, I was on my own flying around QLD picking up patients and transferring them to other places. Help is always just a phone call away of course.  While in Brisbane I got to visit the Retrieval Services QLD (RSQ) base where a huge team coordinate both fixed-wing and rotary aircraft around the state each day. They are the people that give us our daily tasking’s and also task the Life Flight choppers. The team is made up of logistics coordinators, specialist nurses and there is also a specialist Dr on shift that we can call anytime 24/7. That in it-self relieved some of my ‘flying alone’ anxiety.

At Rockhampton base, we have 2 aircraft and operate three shifts a day. A 6 am-6 pm shift, a 9 am-9 pm shift and a night shift from 6 pm to 6 am. On most days each aircraft has 1 FN and a pilot on board. For high dependency or critical patients we also take a medical officer with us, for example intubated & ventilated patients. Each patient is given a priority number from RSQ, just like triage in an emergency department, based on their needs and time frame they need to be retrieved in. So a Priority 1 ideally we need to be in the air and on the way within 1 hr, priority 3 is 3-6hrs, all the way down to a priority 5 which are generally low dependency patients.

Every shift is different, that’s what I love about it, you never know what will pop up on any given day. I have been tasked P4 inter-hospital transfers only to be called a few minutes later to say ‘hang on change of plans, you now have a P2 at a totally different location.  If a job is a flight nurse only task, we can fit 2 patients on stretchers and one low dependency patient sitting on a seat. So we can sometimes have a 1:3 patient ratio. Obviously the higher the dependency of the patient the less likely this will happen. On average I have had mostly had 2 patients on board during flights. On a medical officer flight, the patient is generally acutely unwell and therefore we will only transport them alone with the FN and the Dr.

There is so much more autonomy being an FN. I have had to complete several short courses enabling me to give medications without a Dr’s order but following strict procedural guidelines and policies. You need to rely on your clinical judgement, be able to recognise the deteriorating patient and act on it immediately and pre-empt certain clinical situations that could affect patient outcomes. It is very challenging but also very rewarding. I particularly love that I get to help the people of remote and rural communities, who without services such as RFDS may not have access to the level of health care they need. Everyone I have met is so honestly and truly grateful for this service and that makes me happy.

To say I work with the best team anyone could hope for would be an understatement. When I was in Brisbane attending orientation everyone told me what a wonderful team Rocky had, and boy were they right!! My boss, our educators and my fellow FN’s are such a fantastic, supportive and encouraging bunch of people with so many years of experience behind them and infinite knowledge. I am proud to work with our pilots who come from such a diverse background of flying and who are equally supportive and encouraging. Even our admin staff are awesome and willing to help out and share their knowledge of all things admin at any time.

Most memorable flight

Every time I sit my bum in the nurse’s seat in one of our planes I can’t help but smile and think how totally blessed I am at being able to live this life.

I have had some awesome flights but my most memorable and most recent flight has so far been my favourite. RFDS also have bases in Townsville and Cairns so they generally service far north QLD, up until now I had only been as far north as Mackay for a job. However, about a week ago both Townsville and Cairns were unable to attend to a job due to various reasons. We were tasked to a P2 high dependency patient for retrieval from Weipa to Cairns.

The patient was very sick so it was a medical officer flight. It was surreal to me that in one working day I was closer to PNG than I was to my own home. Experiencing the landscape, culture and diversity of the people in this area, even if it was only for a few hours, was amazing and the gratitude they had for us when we arrived was very humbling. The local family members in attendance at the hospital that day even requested we join them in prayer at the patient’s bedside, praying for both the patient’s recovery and they also prayed for our little team, that was a beautiful experience.

I recently read some posts on social media by a few remote area nurses (RAN) about some of their extremely ill cases and how they had to call RFDS for the evacuation of these patients. In these posts there were comments like ‘thank god for the RFDS’, ‘the RFDS are like angels’, ‘I was elated when the RFDS team arrived’, ‘RFDS is a miracle service’. I was reading these comments thinking WOW, I feel a bit like a fraud because honestly, I think RAN’s are highly skilled, brave and courageous people who hold their patient’s lives in their hands, often at times on their own. To me, they are the angels, and I thank god for THEM. But I was also thinking WOW, this is what normal everyday people really think about RFDS and how important this service is Australia wide, and WOW I get to be a part of it, and WOW I really am making a difference to not only patient’s lives, but to non-sick or injured people as well. I think that’s pretty neat.

Future goals  

I have always wanted to travel more, see more, achieve more and help more people. While I am very content in my job I do have a burning desire to work in more remote areas and experience more primary health roles. We have toyed with the idea of packing up in a motor home, renting our farm out and taking the kids around Australia on a working holiday. Aaaah to dream.

However, I believe that uprooting our kids from school, especially our new high school-aged son, isn’t probably the best idea right now. So we have researched a plan B, where I am looking at short term agency placements in remote locations around Australia and the islands. Somewhere we can go for 2 -3 weeks and take the kids with us during school holidays so that they too can experience the beauty of this phenomenal country of ours. Who knows, maybe I will see some of around the traps over the next few years. Here are cheers to hoping!

I hope that my story inspires others who have a dream to get up and go after it. If you truly want something bad enough, don’t be afraid of putting in the hard work to achieve it. If I can do it anyone can. Start out by enrolling in some courses relevant to the area of nursing you are interested in. There are some great national and local scholarships out there you can apply for. We are always learning, no one in the world can say they know everything! Start small – aim big, that’s what I did. It has taken me a long 15 years to get to where I am, but man has it all been worth it! Now when people ask me what I’ve been doing, I can honestly reply ‘just living the dream’!

Jodie Tickle RN/RM

For RFDS NURSING JOBS https://www.flyingdoctor.org.au/careers/

For international/remote nursing opportunities/ideas read our post HERE!!