Interest in SOST! Lot of questions!

[chrisbouchelle]

I have a question, I am currently inbound college but am thinking about joining the Air Force to become a pararescuer. I was planning on finishing after basic and all that stuff. But, I was just wondering what is the best way to start out to try and be on one of these SOST. Should I just finish my bachelor than try to enlist. I am just stuck and honestly have no idea what to do and just want some options and help with my decision. Thanks.

 

[SOSTCRNA]

I have a question, I am currently inbound college but am thinking about joining the Air Force to become a pararescuer. I was planning on finishing after basic and all that stuff. But, I was just wondering what is the best way to start out to try and be on one of these SOST. Should I just finish my bachelor than try to enlist. I am just stuck and honestly have no idea what to do and just want some options and help with my decision. Thanks.

Seems like you are asking different things. Are you interested in becoming a PJ or obtaining the education and training to qualify for one of the SOST positions? Those are two completely different things.
Read through the postings on Pararescuse and SOST and check out the Onesready podcast as there is lots of Special Tactics info and even a segment on SOST.

 

[amlove21]

What is Air Force Pararescue (PJ)?

Unconventional Surgery, USAF SOST

These might help with a starting point.

 

[MCAS]

I'm not sure if anyone is still responding on here but I was hoping @SOSTCRNA would be able to answer this question for me. I'm about to go into my final year of nursing school, expecting to graduate in May of 2026. I'm aware that one of the qualifications to be a critical care nurse in SOST is that I need at least 2 years of critical care experience. I was wondering if I should go into the reserves upon graduation while working as a civilian nurse in the hospital so I can get my 2 years experience while also getting a feel of how the military works OR should I go straight into active in the AF, work as a critical nurse there for 2 years and then apply to transfer to SOST? Thank you!

 

[policemedic]

Having done and taught critical care, my admittedly non -SOST opinion is that from an experience standpoint you should practice in a civilian trauma center to get the required critical care experience.

For one thing, you’ll know you’re going to do critical care. I don’t know that a GN in the active force has that same guarantee. But even if you did, you will see and do much more on the civilian side from both in volume and in diversity of clinical cases. You will learn much more in a L1/L2 trauma center than you will active duty.

And speaking of learning, putting aside the wisdom of jumping right from nursing school into critical care, just know that nursing school has not prepared you for an ICU assignment. The learning curve will be steep.

 

[DA SWO]

I'm not sure if anyone is still responding on here but I was hoping @SOSTCRNA would be able to answer this question for me. I'm about to go into my final year of nursing school, expecting to graduate in May of 2026. I'm aware that one of the qualifications to be a critical care nurse in SOST is that I need at least 2 years of critical care experience. I was wondering if I should go into the reserves upon graduation while working as a civilian nurse in the hospital so I can get my 2 years experience while also getting a feel of how the military works OR should I go straight into active in the AF, work as a critical nurse there for 2 years and then apply to transfer to SOST? Thank you!

Would you be happy as a AF Nurse if you don't get a SOST assignment?
AF Reserve may be a good start, and you have other options if SOST doesn't happen.

 

[MCAS]

Would you be happy as a AF Nurse if you don't get a SOST assignment?
AF Reserve may be a good start, and you have other options if SOST doesn't happen.

Yes, I was thinking if I don't get a SOST assignment I would be a flight nurse. My buddy in the AF told be I can basically have the best package but if there is no opportunity or open slot for SOST, then I'm not getting it, so I'm prepared to take on other nursing jobs within the AF if SOST doesn't work out. Would you suggest reserves first or just go active as soon as I graduate nursing school?

 

[MCAS]

Having done and taught critical care, my admittedly non -SOST opinion is that from an experience standpoint you should practice in a civilian trauma center to get the required critical care experience.

For one thing, you’ll know you’re going to do critical care. I don’t know that a GN in the active force has that same guarantee. But even if you did, you will see and do much more on the civilian side from both in volume and in diversity of clinical cases. You will learn much more in a L1/L2 trauma center than you will active duty.

And speaking of learning, putting aside the wisdom of jumping right from nursing school in critical care, just know that nursing school has not prepared you for an ICU assignment. The learning curve will be steep.

Thank you for your response. Yeah I was thinking I would get more experience as a civilian. And yes, I'm aware I shouldn't go straight from nursing school to critical care, but I'm also an EMT so I think I have a decent amount of experience to be able to handle it. Plus med-surg is the most boring thing ever, I want something more challenging and fast paced.

 

[DA SWO]

Yes, I was thinking if I don't get a SOST assignment I would be a flight nurse. My buddy in the AF told be I can basically have the best package but if there is no opportunity or open slot for SOST, then I'm not getting it, so I'm prepared to take on other nursing jobs within the AF if SOST doesn't work out. Would you suggest reserves first or just go active as soon as I graduate nursing school?

I'd go Reserves first.
SOST and Flight Nurse are not guaranteed. Flight Nurse in a Reserve or Guard unit is easier to get as it's generally a local interview as opposed to AFPC picking and choosing.
Being miserable in the Reserves isn't as hard as being miserable on AD.

 

[policemedic]

Thank you for your response. Yeah I was thinking I would get more experience as a civilian. And yes, I'm aware I shouldn't go straight from nursing school to critical care, but I'm also an EMT so I think I have a decent amount of experience to be able to handle it. Plus med-surg is the most boring thing ever, I want something more challenging and fast paced.

I’m going to do you a favor and speak candidly.

Your experience as an EMT has not prepared you for nursing practice and most certainly not for critical care. Yes, you may have entered school with basic clinical skills that your peers may not have had. But frankly, that doesn’t matter in this context.

If you think med-surg is boring and slow paced, you have missed the point. This is where you learn your craft, learn to do nursing assessments and care plans, manage multiple pts, interact with other team members, and perfect the basic nursing skills you’ll need later on. Most importantly, it’s where you learn time management.

By the way, you’ve just insulted the largest specialty of a profession you have yet to join.

 

[TLDR20]

Thank you for your response. Yeah I was thinking I would get more experience as a civilian. And yes, I'm aware I shouldn't go straight from nursing school to critical care, but I'm also an EMT so I think I have a decent amount of experience to be able to handle it. Plus med-surg is the most boring thing ever, I want something more challenging and fast paced.

Go straight to the ICU if you are able.

I went straight to the ICU, and it was the best decision possible. Anything you will learn on a med surg floor you will learn as an ICU nurse.

 

[Devildoc]

Go straight to the ICU if you are able.

I went straight to the ICU, and it was the best decision possible. Anything you will learn on a med surg floor you will learn as an ICU nurse.

I agree and I respectfully disagree.

I also went straight from nursing school to critical care (surg-trauma ICU). Really 'what' unit really doesn't matter, 80% of all critical care units do the same things. Steep learning curve? Yes. But definitely doable. I second going straight to ICU.

I disagree that you learn med-surg in an ICU. The skills, many of them, sure, but not the patient/time management/triage/prioritization, not in how to deal with people 'the med-surg way' (patients on their call bells all the time, the relentless bullshit demands), plus the sheer reps of seeing 'normal' sick people. Med-surg punch RNs punch above their weight. I would not want to do it.

@MCAS , I second what esteemed colleague @policemedic said in post #30. Go flog yourself with a med-surg textbook.

Best of luck.

 

[TLDR20]

I agree and I respectfully disagree.

I also went straight from nursing school to critical care (surg-trauma ICU). Really 'what' unit really doesn't matter, 80% of all critical care units do the same things. Steep learning curve? Yes. But definitely doable. I second going straight to ICU.

I disagree that you learn med-surg in an ICU. The skills, many of them, sure, but not the patient/time management/triage/prioritization, not in how to deal with people 'the med-surg way' (patients on their call bells all the time, the relentless bullshit demands), plus the sheer reps of seeing 'normal' sick people. Med-surg punch RNs punch above their weight. I would not want to do it.

@MCAS , I second what esteemed colleague @policemedic said in post #30. Go flog yourself with a med-surg textbook.

Best of luck.

Having worked where you could easily have 3 ICU patients definitely shades my POV. If you work somewhere with strict ratios and single patients, I can see that med surg can be difficult. Part of our ICU training was spending 8 weeks on our step down floor, with 4-6 patients. I guess that helped. I also didn’t need to be taught to triage, effectively manage my time or other skill level one tasks.

 

[Devildoc]

Having worked where you could easily have 3 ICU patients definitely shades my POV. If you work somewhere with strict ratios and single patients, I can see that med surg can be difficult. Part of our ICU training was spending 8 weeks on our step down floor, with 4-6 patients. I guess that helped. I also didn’t need to be taught to triage, effectively manage my time or other skill level one tasks.

To be fair, you also came in ahead of the curve (as did I). I dig that you had time on step down, we did not. That is a great idea and would be very valuable. I wish our new grad ICU RNs did that.

In the SICU at Chapel Hill we were capped at 2, and had just 1 about 30% of the time. We did float to burns where it was always 1:1 for us.

 

[MCAS]

I’m going to do you a favor and speak candidly.

Your experience as an EMT has not prepared you for nursing practice and most certainly not for critical care. Yes, you may have entered school with basic clinical skills that your peers may not have had. But frankly, that doesn’t matter in this context.

If you think med-surg is boring and slow paced, you have missed the point. This is where you learn your craft, learn to do nursing assessments and care plans, manage multiple pts, interact with other team members, and perfect the basic nursing skills you’ll need later on. Most importantly, it’s where you learn time management.

By the way, you’ve just insulted the largest specialty of a profession you have yet to join.

I understand your point. I guess I was more thinking I have already worked on a med-surg unit for about a year during my clinicals, so I'm familiar with the skillset required for med-surg. I also had clinicals for about 2 months in the ER, and I will have another 5 months on the ER next semester, as well as a 3 month externship in an ER over this summer. So it wouldn't be like I'm just jumping into critical care with zero knowledge. I think ultimately I'm going to go into the reserves and probably ER right out of school. I know plenty of people that went right into ER out of school and they all said it took a week to adjust but after that it was smooth sailing. I appreciate your advice.

 

[MCAS]

Go straight to the ICU if you are able.

I went straight to the ICU, and it was the best decision possible. Anything you will learn on a med surg floor you will learn as an ICU nurse.

Yeah I'm planning on doing that or ER. I've never heard of any nurses going right into ICU or ER and saying it was so hard they had to switch to something else. Plus, it's not like I'm just getting thrown to the wolves, I'm going to be trained for at least a week or two before I have my own patients (at least this is what they do at the hospitals I would be applying to).

 

[Devildoc]

I understand your point. I guess I was more thinking I have already worked on a med-surg unit for about a year during my clinicals, so I'm familiar with the skillset required for med-surg. I also had clinicals for about 2 months in the ER, and I will have another 5 months on the ER next semester, as well as a 3 month externship in an ER over this summer. So it wouldn't be like I'm just jumping into critical care with zero knowledge. I think ultimately I'm going to go into the reserves and probably ER right out of school. I know plenty of people that went right into ER out of school and they all said it took a week to adjust but after that it was smooth sailing. I appreciate your advice.

I had been a paramedic and flight medic and Navy corpsman before/during nursing school. Esteemed colleague @TLDR20 was a 18D. So our perspectives are skewed if not legit. I also went to the ED after a few years in a SICU, and work with ED RNs now (well, I also work with SICU RNs).

Having ED experience as an extern will be super helpful before going into the ED as a RN after graduation because you'll have a better grasp on the reality vs perception. Critical care patients in the ED are about 5% of the ED population. Not saying a lot aren't sick or won't be admitted, they just aren't critical care patients.

I will also say the new grads in the ED who think it's smooth sailing after a short time don't know what they don't know and have the highest number of errors and sentinel events. Just make sure you go in with your eyes open and ego in check so you don't kill someone.

 

[TLDR20]

Yeah I'm planning on doing that or ER. I've never heard of any nurses going right into ICU or ER and saying it was so hard they had to switch to something else. Plus, it's not like I'm just getting thrown to the wolves, I'm going to be trained for at least a week or two before I have my own patients (at least this is what they do at the hospitals I would be applying to).

It isn’t easy. In my cohort of new grad hires I was the only one of 6 that made it off orientation. This was at University of Maryland in their CTICU. We were at the time the second busiest ECMO unit in the nation, and had a robust heart and lung transplant program. I wanted to be a CRNA and my ability to do so hinged on my ability to make it as an ICU nurse, so I worked hard. Like @Devildoc said though, I had significant advantages over my cohort because of my background.

 

[Devildoc]

Yeah I'm planning on doing that or ER. I've never heard of any nurses going right into ICU or ER and saying it was so hard they had to switch to something else. Plus, it's not like I'm just getting thrown to the wolves, I'm going to be trained for at least a week or two before I have my own patients (at least this is what they do at the hospitals I would be applying to).

Where are you going to work? You can PM if it's easier. Our ED new grads get a 6-month orientation; they don't pick up a full load until about 4 months in. About 25% of our new grads in both ICU and the ED and up attriting because they could not handle it. Externships, etc., certainly help mitigate that.

For context I work at Duke Hospital/Durham, NC. Feel free to reach out about any nursing-specific info. I am former Navy so know dick-all about SOST.

 

[MCAS]

Where are you going to work? You can PM if it's easier. Our ED new grads get a 6-month orientation; they don't pick up a full load until about 4 months in. About 25% of our new grads in both ICU and the ED and up attriting because they could not handle it. Externships, etc., certainly help mitigate that.

For context I work at Duke Hospital/Durham, NC. Feel free to reach out about any nursing-specific info. I am former Navy so know dick-all about SOST.

I plan on working at either Northwell or NYU both in Manhattan. I have my externship this summer at Northwell. Yeah PM is definitely an option, and if I'm being 100% honest, I think I will be able to handle going right into the ER. I perform well under pressure and in stressful environments so I really am not too worried, especially considering that by the time I go to work in the ER, I'll have about a year of ER experience between clinicals and the externship.
And thank you, I'll def reach back out if I have any other questions. And thank you for your service.