Millions of active and retired servicemen and women, their families, and civilians rely on federal nurses for care, which includes nurses in uniformed service and Veterans Affairs nurses. On October 30, Columbia Nursing’s Alumni Association and Center for Health Policy sponsored a panel discussion, entitled “Serving Those Who Serve Our Country: Healthcare Priorities for the VA, Public Health, & the Tri-Services,” held at Columbia Nursing. Patricia Stone, PhD, Centennial Professor of Health Policy at the school, kicked off the event and welcomed students, alumni, faculty, and staff. The panel included nurses who work as senior officials representing the military, veterans, and public health sector, who explored the roles of—and opportunities for—nurses in caring for current U.S. service men and women and veterans.
Opening remarks were delivered by Kenrick Cato ’08 ’14, PhD, an assistant professor at Columbia Nursing. Cato served in the U.S. Army for 10 years and was awarded a Bronze Star for heroic service in combat. Dr. Cato drew on his own experience to reinforce how vitally important nurses are to our national security.
During the discussion, a salient point emerged among the panelists that the healthcare needs of military personnel and veterans are changing dramatically. Those on active duty today face exposure to new biological and chemical agents and emerging infectious diseases. They are also at greater risk for spinal cord and traumatic brain injuries, which carry a host of associated and severe neurological impacts. Veterans may suffer the long-term effects of these injuries and illnesses, as well as mental health disorders, such as post-traumatic stress disorder, which can increase the risk of substance abuse. The demographics and sociology of military personnel and veterans are changing as well. More women than ever before are serving, there are now veterans as young as 30 who require very different care than older veterans with more acute illnesses, and all these populations are becoming much more tech-savvy, necessitating changes in how healthcare is delivered.
The discussion was moderated by William (Bill) Bester, MSN, retired Brigadier General and Nursing Service Chief for the U.S. Army. Bester is currently Senior Advisor for the Jonas Veterans Healthcare Program, a non-profit organization that promotes leadership in nursing and veterans’ healthcare, and he welcomed founder Donald Jonas to the event.
Nurses are on the front lines of caring for those in uniform, from active duty through civilian life
Marla DeJong, PhD, professor at the University of Utah College of Nursing and a retired Colonel, began by providing insights on the wide-ranging responsibilities of military nurses. DeJong served in the U.S. Air Force Nurse Corps for nearly 29 years, including a tour in Iraq, and directed the TriService Nursing Research Program. She emphasized that “military nurses are first officers and then nurses.” For example, as leaders, military nurses serve as unit commanders, lead members of the multidisciplinary healthcare team, and plan deployment missions. Military nurses, she explained, implement evidence-based clinical protocols that optimize the health and wellbeing of military personnel and are influential in helping the Military Health System (MHS) be a high reliability organization and meet its goal of zero preventable deaths on the battlefield. This is no small task considering MHS, which comprises the U.S. Army, Navy and Air Force health systems, serves 9.8 million active duty and reserve military personnel, family members, and retirees.
Transitioning from active duty to veterans’ health, panelist Alan Bernstein, MS, Deputy Chief Nursing Officer for the Veterans Health Administration (VHA), talked about the integral role nurses play as primary healthcare providers for veterans. “In 1,200 VHA healthcare facilities across the country and U.S. territories, our 98,000 nurses work alongside physicians to provide comprehensive medical and psychosocial care,” he said. “Nurses are also essential to eliminating barriers to access via virtual health and teletherapy services for patients who can’t travel to our clinics, helping keep them within the VHA network instead of seeking care from non-VHA providers who may not be as well equipped to address the unique needs of vets.” Bernstein discussed the VHA’s progress in implementing Full Practice Authority (FPA) for Advanced Practice Registered Nurses. Since FPA enactment in 2016, more than half of VHA facilities have already transitioned to full practice granting privileges for nurse practitioners and clinical nurse specialists, helping improve access to care for veterans in rural areas where many VHA clinics have challenges recruiting physicians.
Rear Admiral Susan Orsega, MSN, Assistant U.S. Surgeon General and Chief Nurse Officer of the U.S. Public Health Service (USPHS) Commissioned Corps, explained that it stands shoulder to shoulder with the armed forces to protect, promote, and advance the health and safety of the nation, which is the USPHS mission. The Commissioned Corps is under the direction of the U.S. Department of Health and Human Services and led by the Assistant Secretary for Health; operations are overseen by the U.S. Surgeon General. The USPHS Commissioned Corps is an elite team of nearly 6,500 full-time, highly qualified public health professionals – all of whom are officers. The Commissioned Corps has 11 categories: physicians, dentists, clinical and rehabilitation therapists, dieticians, engineers, environmental health, health service, nurses, pharmacists, science and research health professions, and veterinary medicine. USPHS Commissioned Corps nurses provide care to medically underserved populations, implementation and oversight of public health programs and policies, and public health leadership. As part of their mission, USPHS officers deploy to assist those affected by public health crises, from national emergencies, natural disasters, and to other public health crises, including international humanitarian assistance.
Admiral Orsega noted that 70 percent of young Americans today are ineligible for military service, in part because of preventable diseases like obesity. “By educating young people and giving them tools to make positive behavioral changes, our 1,500 nurse officers help ensure that there is a healthy cohort of potential enlistees,” said the Admiral.
Bester echoed the importance of having a qualified pool of military recruits for national security, stating that for the first time since transitioning to all-volunteer enrollment, the Army did not make its recruitment goals this past year.
Evolving healthcare priorities and a heightened focus on mental health
Military service can take a devastating toll on not only the physical health of military personnel, but also on their lifelong mental health. The panelists all agreed that the military’s views on mental health disorders have evolved significantly. The military is working hard to improve access to mental health treatment and eradicate the stigma associated with it. De Jong noted that mental health treatment does not automatically disqualify military members from retaining their military security clearance or preclude people from enlisting.
The VHA and Public Health Service also prioritize mental health. According to Bernstein, “suicide prevention is a key strategic imperative because of the alarming incidence of suicide among vets – currently 20 per day.” Admiral Orsega recounted her deployment at Ground Zero on September 11, where a member of her team was solely responsible for administering mental health checks for the federal disaster medical assistance team, which was working 12-hour shifts in harrowing conditions.
Mirroring the problem in every corner of our society, all the panelists and their organizations are also confronting the epidemic of opioid abuse. Admiral Orsega noted that the U.S. Surgeon General Jerome Adams has made the issue a top priority for the Public Health Service, and the VHA is implementing comprehensive opioid risk mitigation strategies in its clinics and hospitals. For the VHA, this was prompted by the 2016 Comprehensive Addiction and Recovery Act, which requires the administration to improve opioid therapy strategies in treating patients and to ensure responsible prescribing practices. The VHA is currently using a web-based dashboard, known as the Stratification Tool for Opioid Risk Mitigation, to help accomplish the goal of curbing opioid misuse and overdose.
Throughout the discussion and the Q&A session that followed, the panelists reinforced that the health of the U.S. armed forces and all our citizens is a national strategic imperative, and that nurses have tremendous opportunities and influence in achieving this critical mission. More than ever, the full integration of nursing within our highly matrixed healthcare systems—civilian, veteran, and military—is a vital and transformative goal, which will lead to better health outcomes and cost containment on spiraling expenses. Most important, integration, as noted by the panelists, will keep America, Americans, and U.S. service members safe and healthy, and enable our military personnel to perform optimally to best ensure our national security and wellbeing.