Working at the U.S. Navy

If you’re interested in a career in health care, joining the U.S. Navy could be just the stepping-stone you are looking for to launch your health care education and career. There are abundant opportunities for success with the Navy, thanks to its incentive programs, which will help pay for some or all of your medical training. You will also have the chance to study and work in state-of-the-art medical facilities around the world and will enjoy all the benefits afforded to Navy officers.

According to the Navy’s Web site, as a health care professional, you will be commissioned as an officer, which means you will be awarded competitive pay, 30 days paid vacation annually, free or low-cost travel, benefits for you and your family, a generous retirement package, and other benefits.

If you’ve already completed training, the Navy can help you pay back your loans. Similarly, if you’re in school or about to start, the Navy has programs to assist you in paying for your education. And once you’re part of the Navy, you will belong to a “culture devoted to continuing training and professional development and the unparalleled chance to help others and your country.”

According to the Web site, within the Navy’s ranks you will be given the unique opportunity to do what you do best: “You’ll have the chance to practice within your specialty-almost all specialties are represented in the Navy medical corps. You’ll be working with other highly skilled professionals on some of the world’s most modern equipment. You’ll get to focus on providing care and will have the chance to advance your career and even teach other health care professionals if that’s what interests you.”

Medical Service Corps

If you’re interested in the medical field, but not quite sure what exactly it is you want to do, the Navy advises you to check out the Medical Service Corps (MSC). In the MSC, you have your choice of over 22 different specialties, some working directly with patients, some behind the scenes.

Diversity is an appealing aspect of the MSC. There are over 250 Navy and medical facilities around the globe, from carriers in the Mediterranean to Naval hospitals in Japan, so you could wind up serving almost anywhere! And as an Officer in the MSC, you’ll become part of a highly diversified medical team consisting of Clinical Care Providers, Health Care Administrators and Health Care Sciences.

Clinical Care Providers

As a Clinical Care Provider, you might be prescribing contact lenses to the Admiral as an optometrist, or managing the buying, storing and distribution of drugs and medicines as a pharmacist. Some specialties found within the Clinical Care Providers field include:
Physician Assistant

Pharmacy

Optometry

Physical Therapy

Dietetics

Audiology

Occupational Therapy

Health Care Administration

In Health Care Administration you could find yourself evaluating the medical and humanitarian needs after a natural disaster, or you might be in charge of managing the proper construction of a new medical facility at an air base. Once on active duty, the Navy offers specialized training in these areas:
General Health Care Administration

Plans, Operations, and Medical Intelligence

Financial Management

Medical Logistics

Patient Administration

Information Management

Manpower Systems Analysis

Education and Training Management

Medical Construction Liaison

Operations Research

Health Care Sciences

In Health Care Science, you could become a radiologist and study the thermal stress and magnetic force of a submarine’s nuclear reactor, or you could become an aerospace physiologist, correlating the aerodynamics of a new super jet. Some specialties found within the Health Care Sciences field include:
Industrial Hygiene

Environmental Health

Medical Technology

Aerospace Physiology

Radiation Health

Microbiology

Biochemistry

Entomology

Officer Indoctrination School

To become part of the Medical Service Corps, you will need to attend Officer Indoctrination School or OIS. This is a five-week program that includes a full schedule of academic studies, military indoctrination and physical fitness training.

Educational Benefits

Several career fields within this section have their own separate career training, scholarships and/or assistance programs. To find out which are available to you, contact your local recruiter by logging onto this Web page: www.navy.com/navyhealthcare/requestinfo.

Fed Start

For many minority nurses, completing a graduate degree is just the first step in planning their future career advancement. You may be considering a career in teaching or a higher-level position with your current employer. But don’t overlook career options in government service.

In the aftermath of 9/11, public health concerns about the bird flu epidemic and the devastation of Hurricane Katrina, the need for health care professionals with strong clinical backgrounds, innovative ideas and concern for the lasting effects of public policy decisions has never been more important in the management ranks of government. It is important for nurses of color to realize that their skills and experience can be used to develop federal health policy and strategy, just like they can be used to help patients.

Paid government internship programs are a little-known but highly effective option for getting into government on a fast track to senior management positions. The most prestigious of these federal internships is the Presidential Management Fellows (PMF) Program, which is administered by the U.S. Office of Personnel Management (OPM).

For nearly 30 years, the Presidential Management Fellows Program and its predecessor, the Presidential Management Internship Program, have been used as a recruiting tool to attract, hire and develop graduate students earning master’s, professional and doctoral degrees in all disciplines into high-paying, rewarding careers in the federal government. The program is perfect for master’s or doctoral students who have recently completed their degree or will complete their degree in the next 12 months.

The PMF Program provides Fellows with an opportunity to apply the knowledge gained in their graduate study by working on paid two-year internship assignments. These internships could involve national security affairs, health administration, nursing, public health, public policy, program management and many other areas that support the government.

Federal agencies that hire Presidential Management Fellows include the Centers for Disease Control and Prevention, the National Institutes of Health, the Department of Health and Human Services, the Department of Homeland Security, the Federal Emergency Management Agency, the National Science Foundation, the Bureau of Indian Affairs, the Department of Veterans Affairs and numerous others. After completing their two-year assignments, Fellows are offered permanent jobs at their agency or have the option to explore a permanent position at any other agency that participates in the program.

During their internships, Fellows are paid starting salaries based on their work experience and education level. Salaries can range from $38,000 (GS-9 level) to $71,000 (GS-12 level). In addition, many of the agencies offer benefits such as student loan repayment up to $60,000 ($10,000 a year) and financial support for earning an additional degree at the doctoral level.

Another benefit of the program is that Presidential Management Fellows receive guaranteed promotions over the two years of their internship. While the vast majority of PMF intern assignments are based in Washington, D.C., there are many opportunities for selected Fellows to work in other locations across the United States.

As members of the baby boomer generation continue to hit retirement age, a growing number of senior-level leadership positions will open up in government. At some federal agencies, 60% of the senior leadership is eligible to retire in the next three to five years. As these management positions open, former Presidential Management Fellows will be logical choices to fill them.

The Application Process

The application period for the Presidential Management Fellows Program is September to early October of each year. Specific deadlines are announced in the “How to Apply” section of the PMF Web site, www.pmf.opm.gov. As of this writing, the start date for applying to the PMF Class of 2008 is expected to be on or around September 1, 2007, with the closing deadline still to be announced.

There are several key things an applicant must know before preparing to apply for the program. First and foremost, the resume that one might use for a corporate job is different from the resume used for a federal government job–or in this case, a federal internship. In the corporate world, the maximum length for a resume is two to three pages. A federal resume should be much longer and more detailed, much like a curriculum vitae (CV) one would use in applying for an academic position. A federal resume should include such items as a job objective, professional awards, names of graduate courses completed and years of management experience.

If you have never applied for a federal job or prepared a federal resume before, an excellent resource is a book titled Government Job Applications and Federal Resumes: Federal Resumes, KSAs, Forms 171 and 612, and Postal Applications by Anne McKinney. This book, which should be easily available at your local bookstore or online, is a valuable tool that will help you learn the resume writing techniques and other skills that are critical for applying to the Presidential Management Fellows Program.

Options Abound: Other Federal Internship Programs Worth Exploring Emerging Leaders Program (ELP)
Department of Health and Human Services
NIH Management Intern Program
National Institutes of Health
http://internships.info.nih.gov/pimenu.html USAID Fellows Program
U.S. Agency for International Development

The first stage of the PMF application process involves filling out an online application. A key requirement is that you must identify a core faculty member or graduate advisor who will fill out an online nomination form to nominate you for the PMF program. When filling out your application, you must include the email address of the person you have asked to nominate you. Be sure to choose someone who can respond quickly with an endorsement once the Office of Personnel Management emails him or her to request the nomination.

Your online application will also require you to attach your federal resume and answer three questions relating to situations where you have demonstrated skills in teamwork, leadership and customer service. It is important to answer these questions in detail and provide an example of an actual work or academic situation that was complex, unique and challenging.

After your application has been submitted, the second stage of the selection process involves coming to Washington, D.C. for an assessment interview. You will be expected to wear professional business attire at the interview. This stage includes a formal interview process where candidates are asked to respond to three separate employee or organizational case studies–one in writing, one verbally and one in a group environment. The goal is to assess the candidate’s problem-solving, writing and public speaking skills as well as his or her ability to be a leader, follower and team player.

The Final Round

Candidates who qualify for the third stage are considered finalists and are invited to attend a government job fair, again in Washington. Being a finalist does not guarantee you will get a job. If you are selected as a finalist, you will receive a notification email that includes a list of the names, email addresses and phone numbers of all the agency representatives who will be interviewing candidates at the job fair. It is important to email them a resume and a cover letter requesting a PMF job interview, even before the job fair. Once you become a finalist, your goal is to get multiple PMF job offers to choose from.

Different government agencies have different levels of funding, which means some agencies have more flexibility than others in offering higher starting salaries, payment for relocation, student loan repayment and financial assistance for doctoral study. When you interview with an agency, be sure to ask about the availability of those benefits.

Once you are offered a PMF internship opportunity, there is one final hurdle to clear: the background and clearance process. Review your credit report in advance and make every effort to resolve any outstanding debts that could negatively impact your chances of getting an internship job offer. All government agencies will check a candidate’s credit with TransUnion and run a police record background check with the FBI. Charge-offs, credit accounts more than 90 days delinquent and unpaid judgments of more than $3,500 on a candidate’s credit report could stop him or her from passing the clearance process, which would make the candidate ineligible to participate in the PMF Program.

To learn more about opportunities available through the Presidential Management Fellows Program, visit www.pmf.opm.gov.

Serving Where the Need Is Greatest

In her mind’s eye, Capt. Mary Lambert can still picture the children walking to school, just as children do in neighborhoods everywhere, talking in small groups as they amble along. Except in this scene, they are walking along streets lined with bombed-out buildings, and at least one child in every group is missing an arm or leg.

Lambert, an African-American nurse and commissioned officer in the U.S. Public Health Service, will never forget this and other surreal scenes captured in her mind from her time in Rwanda. The stark contrasts will stay with her forever: the lush flowers that grew higher than her head and the huge avocados dripping off the trees, versus the devastated cities and war-torn people, many of whom had lost nearly all of their relatives to roving bands of death squads.

“The people we worked with were so gracious and appreciative in the face of their losses,” she says. “When I came back to the U.S., it was probably six months before I felt I could complain about anything.”

But just as the experience made a lasting impression on Lambert, she ¬in turn left an equally indelible mark on Rwanda. In 1995, Lambert and other American health care professionals spent two months working in the civil war-ravaged African nation. Their assignment: to train 500 people to staff the country’s severely depleted clinics. The training was critical because Rwanda had lost an astounding 80% of its health care work force in the genocide the year before.

“It was one of the most humbling and rewarding experiences of my life,” she says of her work there.

Serving in countries like Rwanda is just one of the many and varied opportunities available to nurses who work in the Commissioned Corps of the U.S. Public Health Service. Driven by their passion for public service, these nurses work on the front lines to deliver health care to the people who need it most, in locations ranging from Third World countries to America’s most underserved racial and ethnic minority communities.

Cmdr. Ana Marie Balingit-Wines, CCRN, chief of beneficiary medical programs, calls the U.S. Public Health Service “one of the federal government’s best-kept secrets” because so many nurses are still unaware of the career opportunities it provides. Under the direction of the U.S. Surgeon General, commissioned nurses wear uniforms and serve as officers. They work for local, state, federal or international health agencies in a wide variety of capacities. They help conduct research, design disease prevention programs, develop creative techniques in medical methodology, improve mental health care, expand health resources and much more.

“If you are somebody who wants to contribute to the overall health of the nation, and even the world, the opportunities are endless,” says Rear Adm. Mary Pat Couig, RN, MPH, FAAN, an assistant Surgeon General and chief nurse officer.

Never a Dull Moment

Lambert feels the variety offered by the Commissioned Corps is one of this career’s greatest assets. “It’s not easy work, but the opportunities are just incredible,” she says. Her service in Rwanda is just one slice of her nine-year career in the Public Health Service. For three years, she helped provide care for some 4,000 seasonal farm workers in migrant camps in eastern Maryland and Virginia.

Later, she worked for the U.S. Food and Drug Administration as a consumer safety officer. There she managed the review process for FDA approval of nicotine substitute products, such as the patches that help people quit smoking. She also worked for the Centers for Disease Control and Prevention in Atlanta, where she helped create training programs and educational materials on immunization. Since November, she has been developing policies on military health issues as director of the Office of Military Liaison and Veterans Affairs.

In addition to their regular jobs working for government health agencies, nurses in the Commissioned Corps also can be mobilized in time of war or national and international emergencies. To become a commissioned officer, nurses must have earned at least a Bachelor’s degree. Salaries are determined on the basis of rank, education and experience. The pay is competitive with the private sector, particularly after the first couple of years, and the benefits are generous. They include free health care, military commissary privileges and a fully funded retirement plan that doesn’t require any matching contributions by the employee.

Unlike officers in the Army or other branches of the military, who are often forced to move from base to base, officers in the Public Health Service Commissioned Corps control their own careers. While they tend to be mobile, because promotions often require moving to another government agency, they have the freedom to choose where they want to go and what positions they want to take.

According to Cmdr. Marylouise Ganaway, RN, chief nurse recruiter, the need for nurses is greatest in the Division of Immigration Health Services and the Bureau of Prisons. Bilingual nurses especially are in demand to provide care for recent immigrants. Translators can always be found, but nurses who share the patients’ language and culture can establish a comfort level and provide care that much more quickly.

Although these are the only two areas that are currently experiencing a nursing shortage, there are still plenty of job openings throughout the Public Health Service. As Ganaway puts it, “We can always use more nurses.”

The Right Stuff

Who is the ideal candidate for a nursing career in the Commissioned Corps? The answer is fairly simple.

“A qualified nurse who wants to make a difference in the nation’s health care,” Ganaway says.

“You have to be hard-working,” adds Balingit-Wines, who entered the Public Health Service 14 years ago after serving as a nurse in the Air Force. “You have to make a lot of sacrifices. You have to want to do good.”

In other words, this career is best suited for nurses who have a true passion to serve the neediest of underserved areas and are willing to boldly go to places where other nurses may be reluctant to work—from Micronesia to federal prisons to Mexican border towns.

Ever since she knew she wanted to be a nurse, Capt. Evangelina Montoya, RN, MSN, yearned to use her education and skills to help people with limited access to health care. Montoya grew up in a migrant farming family in Visalia, Calif., and knew first-hand the struggles of those without good medical resources. “I recall, as a child, the isolation and the financial burdens my parents endured,” she says.

After graduating from nursing school, Montoya worked in a hospital on an Indian reservation in Arizona. Despite her nearly lifelong desire to serve, she admits that the adjustment was difficult at first. Having completed her nursing degree in Denver, Colo., she had grown accustomed to the comforts of living in a big city. She also had to learn how to speak the tribe’s language so she could communicate more effectively with her patients.

“I had never lived on a reservation,” she explains. “Once I got there, I was in culture shock.” Although she believed her nursing education had prepared her to be culturally competent, she soon realized she had a lot to learn about working within a culture different than her own—for example, how to collaborate with the tribe’s medicine man in the treatment of patients.

Another tough challenge in Public Health Service nursing, says Francess Page, RN, BSN, MPH, is “recognizing that you can’t reach [every person in need] all the time, even though you’d like to.” Page, who is African American, entered the public health arena after working as a nurse in hospitals and seeing patients suffering from conditions that could have been prevented.

Driven by a passion to educate people so they can live healthier lives, she has played a major role in national AIDS prevention programs. Today, as director of policy and program development for the Department of Health & Human Services’ Office of Women’s Health, she continues to work on the AIDS awareness front, along with coordinating prevention and education efforts on such issues as lupus, domestic violence and minority women’s health.

Unlimited Rewards

Despite the hard work and the steep challenges, a career in the Public Health Service Commissioned Corps can offer profound rewards—whether they’re achieved directly, by treating patients, or indirectly, by shaping health policy. Page, for example, was instrumental in the effort that led to the creation of a national domestic violence hotline. She also helped establish a national nurses’ summit on violence against women and recently helped put together a national working group on lupus that is providing education about that disease to federal employees and the public.

Montoya, who is now a public health analyst for the Division of Community and Migrant Health, helps develop health care policies for migrant farm workers. She also works in a number of local clinics, to keep informed about what’s happening on the front lines of her field. “I feel I am giving back to the community,” she says.

In addition to her five years of working on Indian reservations in Arizona and New Mexico, Montoya has also served as an occupational health consultant and traveled internationally. In 1995, she went to Mexico as part of a World Health Organization delegation to help that country create a national health care plan. Three years later, she traveled to Chile as part of a delegation on nursing practice models.

Balingit-Wines says her work at the Alaskan Native Medical Center in Anchorage was one of her most rewarding nursing experiences. Many of her patients lived in such remote areas that their only access to health care facilities was by plane. Yet despite the isolation, the population faced growing problems of coronary heart disease and diabetes due to increasingly Westernized diets. Balingit-Wines, who is Filipino, says the fact that she physically resembled her Alaskan Native patients helped establish an immediate comfort level. “Just to hold a hand and see a familiar face meant so much to them,” she recalls.

Capt. Ernestine Murray, RN, BSN, MAS, has worked in a wide variety of positions during her 20 years as a commissioned officer. Murray, who became a nurse after a career in business at Lockheed Martin, worked as a critical care nurse at the Public Health Service Indian Hospital in Tuba City, Ariz., caring for members of the Navajo and Hopi tribes. As a nurse consultant and scientific reviewer for the FDA, she helped develop educational programs aimed at reducing complications associated with the use of medical devices. She also worked as a cardiovascular and surgical intensive care nurse at the National Heart, Lung & Blood Institute.

Currently, she is a senior health policy analyst for the Agency for Health Care Research and Quality. She is involved in the agency’s Center for Practice and Technology Assessment, where she develops and implements clinical practice guidelines and evidence-based reports on health care.

“With each job, I gained valuable experiences and wonderful memories,” Murray emphasizes. As an African American who grew up in Maryland during the time when schools were being desegregated, she thought she had been well exposed to disparities in equal access to basic human services. And yet, she says, the work she did on Indian reservations gave her a new appreciation for the stark needs that still exist.

“America’s health care system cannot be considered effective until those who have the least have the same access as those who have the most,” she maintains. “But through working in the Public Health Service, you feel your input helps chip away at that lack of access.”

Opportunities for students

Nursing students can earn money and get valuable experience through two programs offered by the U.S. Public Health Service Commissioned Corps, as well as a related federal program called the National Health Service Corps.

In the Public Health Service’s Junior Commissioned Officer Student Training and Extern Program (Junior COSTEP), students are commissioned as junior assistant health service officers. Nursing students can earn about $2,300 a month working for public health agencies on assignments ranging from 31 to 120 days. Students are not obligated to go on to a career in the Commissioned Corps after they graduate, but if they do, they receive credit for their time in the program for pay and retirement purposes.

For students in their final year of undergraduate or graduate school, the Senior COSTEP offers a competitive financial aid program in exchange for an agreement to work for the Public Health Service after graduation. As an active-duty officer during their senior year, students are paid about $2,300 a month and receive uniformed services benefits. When they graduate, participants are promoted according to their degree and professional experience. A nurse with a Master’s degree, for instance, would be promoted to a junior lieutenant with a $2,700 monthly salary, plus benefits.

To learn more about these opportunities, go to the student page on the Commissioned Corps Web site. Applications for both programs are available online, or by calling (800) 279-1605; if you are located in Maryland, call (301) 594-3453.

Meanwhile, nurses in certain specialties can apply for scholarships and educational loan repayment assistance through the National Health Service Corps, a program sponsored by the U.S. Health Resources and Services Administration (HRSA), Bureau of Primary Health Care. The program works together with local communities to place health care professionals in rural areas and inner city neighborhoods where the need for health services is greatest. Unlike the Commissioned Corps of the U.S. Public Health Service, however, members of the National Health Service Corps work for the community agencies, rather than the federal government. They are not part of the government’s uniformed services.

The scholarship and loan repayment programs are highly competitive. In exchange for the financial assistance, winners agree to work in two-year residencies in underserved areas.

The scholarship program is open to students studying to become nurse practitioners or nurse-midwives; the loan program is open to primary care certified nurse practitioners, certified nurse-midwives and psychiatric nursing specialists. For more information, see the NHSC Web site, or call (800) 221-9393.

Wounded by Words

Entering the patient’s room, I immediately took note of the look on the elderly woman’s face. There was no way I could look past her grimacing. As an African-American male nurse, I had seen this look before and knew it was in response to my gender, my race or both. Pulling away from the side of the bed where I was standing, she demanded: “Where are all the white people?”

Busy and rushed for time as most nurses are, I was not sure how to handle this situation and still get my medication pass done in a timely manner. I did not think therapeutic communication or touch would work in this particular case. She would not let me get that close to her, either physically or emotionally. Acting as if I could not comprehend her, I offered her the medications that were ordered. She looked at the medicine cup and abruptly said, “I’m not going to take that!” Now the dilemma had evolved into how to distribute medication to this patient.

Who knows what was going through this woman’s mind? Maybe she thought that my being alone with her in her room was a perfect opportunity for racial retaliation: Here was this black man who was finally going to pay her back for centuries of racial injustices. More than likely, she felt I was not intelligent enough to follow the physician’s orders and that the meds I was offering her were incorrect. At this point, it was all irrelevant. My intention was to help her, but in her mind I only represented someone from a race she considered inferior and had spent a lifetime hating.

This patient may not have known the date, or what the name of the health care facility was, or even her own name, but she could and did hold on to racial intolerance. Years of other life training may have abandoned her, but the training she had received about race remained intact. I saw in her face what could only be described as a mixture of hate, fear and anxiety. The year was 2004, but in my mind this incident transported me back to our nation’s past and gave me a taste of how ugly and complicated life must have been for past generations of black and white Americans.

Frustrated with my inability to administer medications to this patient, I exited her room and searched for the other nurse on duty. She was also African American, but I thought there was a chance she would fare better because she was female. This nurse was not new to the ward and she was not surprised by the patient’s reaction to me. When I asked her how I should handle this matter, she replied, “She won’t take medications from me either.”

Needless to say, this patient did not receive her medication that particular shift. I documented the incident and continued to care for the patients who would allow me to.

Unfortunately, it seems the only repercussions that resulted from this incident of racism were the painful feelings that have continued to stay with me. Nothing was ever addressed on any other level that I was made aware of. My employer’s apparent reluctance to acknowledge the problem disappointed me. It seems that even the most liberal and up-to-date facilities fall short when it comes to addressing this issue.

 

“Get Over It”

Another of my notable experiences involving racism in a patient care situation was an encounter I had with a veteran. This incident affected me deeply for two reasons. First, I am a veteran myself, having served eight years in the U.S. Air Force. Veterans usually feel a kinship toward other vets, regardless of their background, branch of service or duration of service. Secondly, I had taken care of this particular patient for some time and thought that our relationship had somehow transcended race. Until this incident occurred, our interactions had always been very cordial and respectful.

This was a patient who needed total care. He was paralyzed on his left side from a stroke and needed another’s help for even his most basic needs. The incident occurred on evening shift. Because of our limited staffing, once the total care patients were put to bed for the night it was our practice to leave them in the bed until morning. But on evenings when bingo was being played, I would help this patient get dressed again, put him in a wheelchair and push him to wherever the game was located.

He was prone to fits of yelling and anger, but in the past I had always been able to calm him down. Entering the room this particular night, I could tell that he was not in the best of moods, but I was not expecting the encounter that ensued. All of my attempts to calm him failed. In fact, they seemed to just heighten his anger. And at the apex of his anger, he yelled, “N- – – – -, get out of my room!”

Many emotions ran through me at that moment-certainly too many to count. What I did next escapes me. I assume I must have straightened his blankets and did what I thought would make him comfortable. I do know that I exited his room angry and told the charge nurse about the encounter.

The nurse in charge was totally sympathetic but at a total loss as to how she should handle the situation. I was sitting in the staff break room obviously angry and frustrated, with my arms crossed on top of my chest. She under- stood that she could not just let this incident go without some intervention on her part. Her decision was to call the house supervisor.

I had what I thought was a decent working relationship with the house supervisor, so I was not against discussing this incident with her. When the evening supervisor arrived on the ward, I was still in the break room fuming from the incident. She came in and asked me to explain what had happened; I gave her my interpretation of the incident. Her reply did nothing to soothe my anger. She basically said, “Get over it.”

She then began to relate some incidents of disrespect she had encountered in her own journey through nursing. Being called out of her name, having her level of intelligence questioned and being touched inappropriately were all situations she described. She seemed to indicate that this was part of our job and we had to take it.

I sat there listening, refusing to believe what I was hearing. I also refused to accept her personal doctrine that this type of treatment was “normal” and that nurses should accept it. I sat there respectfully, but her words did nothing to redeem my dignity or help repair my relationship with this patient.

The incident did send some minor ripples toward the higher-ups at the facility. They never spoke to me directly, but their messages found a way to me somehow. The messages consisted of blaming the occurrence on the patient’s condition, saying that stroke patients sometimes react that way. The patient’s medication was also increased, especially his psychiatric medications.

 

A Gesture of Healing

The one person who truly seemed to understand how much this incident had hurt me was the patient’s wife. His wife, who was a volunteer at the facility, was tireless in her efforts to continue caring for him and many other veterans. She seemed to be his exact opposite in terms of temperament. She volunteered mainly on the day shift, but our paths crossed as the day shift ended and the evening shift began. She too had always been very cordial and respectful to me. The day she confronted me about this incident was no different. I did not intentionally avoid her, but I was not looking forward to encountering her either.

Our discussion took place in the doorway of the patient dayroom. She had always been very direct and that part of her personality was very much in evidence now. She looked me straight in the eyes and said, “I heard about what happened between you and my husband, and I would like to apologize for the awful word he called you.”

I immediately dropped my head and was silent, not because I was ashamed but because I was so full of anger. She continued, “My husband was not a man who used that type of language when he younger, and we did not raise our children to use that type of language either.”

I was still silent, but now we were staring into each other’s eyes. We could both see how deeply this incident had touched me. “I have offered an apology and I can not force you to take it,” she said, “but I hope that you will and that you will continue to care for my husband in the same manner as you have always done.” That was her last statement to me as she gently patted my hand and walked away.

We did speak again after that, but the subject of what happened that day was never touched on. Our conversations were genuine and honest, but I believe we both felt that enough had been said on the subject. Even though I never said anything to her about the incident, she comprehended the depth of the damage her husband had caused by uttering that offensive word.

 

Emotional Scars

As much as I would like to say that my treatment of that patient did not change, the truth is that it did. I was still very professional and considerate to him. But all of the things one would describe as “extras” ceased. I never got him up for bingo again and my conversations with him held brevity in my tone.

Time passed and I was transferred to another unit at the facility. But I never forgot that patient or that painful incident. Any time I visited that unit to see past co-workers, I would always peek into his room just to see how he was managing.

I began to hear that his health was declining. By the time I had gathered enough courage to actually step into his room, he had deteriorated to the point where he was alert only to himself and being fed by a nasogastric feeding tube. I stood at his bedside and asked him how he was doing, but all he could do was gaze up at the ceiling and mumble incoherent words. He continued to steadily decline until a co-worker notified me of his death.

Later that week I read his obituary. I was surprised at the sterility of the announcement. There he was in an old picture from his military days, hat cocked to the side, smiling. The obituary mentioned a lifetime of loved ones and military service. It was brief and to the point. He existed, but now he was gone.

I was not sure of my feelings then and I am still not sure of them now. All I knew was that he was dead and our joint legacy of pain had died with him. But it still lives in me.

The point of this personal reminiscence is that we in the nursing profession must ask ourselves how to handle the issue of racism in the nursing workplace, and more specifically, how to handle racism when it is expressed by patients. I guess the first step is to admit that the problem exists. Even when they are in a hospital receiving care for the effects of diseases, aging or traumatic physical injuries, there will always be some individuals who will put their racial ideology above anything they are confronted with. That is their right.

But we professional caregivers of color also have the right and the obligation to stand against such behavior and demand to be treated with respect and dignity.

Ready for Anything

In the wake of the September 11 terrorist attacks and the anthrax scare of fall 2001, American nurses can no longer observe a troubled world and reassure themselves that terrorism won’t happen here. But they can be prepared to respond if terrorists strike again

The nation is counting on nurses to play a vital role in responding to any future terrorism disasters that may occur. Specifically, nurses will be needed to work on the front lines to treat victims, educate other medical professionals, teach communities about emergency preparedness and help people cope in the aftermath of attacks.

Nurses are a natural choice for this role because they consistently rank among the nation’s most trusted professionals–a key benefit as they work to prepare communities for eventualities that most Americans find terrifying. And because “dirty bombs,” chemical weapons and anthrax spores don’t discriminate on the basis of skin color or ethnicity, minority nurses who can provide culturally and linguistically competent public health preparedness to diverse communities will be urgently needed.

“Hospitals must assign leaders to help them prepare for terrorist disasters,” says Greg Evans, PhD, MPH, director of the Center for the Study of Bioterrorism and Emerging Infections at the St. Louis University School of Public Health. “Nurses, rather than doctors, are the ones to fill those important leadership roles.” To do so, he adds, nurses will need training in disaster preparedness, bioterrorism and leadership skills.

To meet that need, the federal government, nursing associations, schools of nursing and health care systems are all working to train, educate and organize nurses to respond to terrorism, as well as other potential public health emergencies, such as the recent Severe Acute Respiratory Syndrome (SARS) epidemic. Government officials and nursing leaders are encouraging nurses who want to help after catastrophes to join organized efforts so they can get the proper training and be part of systematic responses.

In June 2002, President Bush signed into law the Public Health Security and Bioterrorism Response Act, which authorized significant funding improvements in public health infrastructure and emergency health preparedness. Currently, several major national initiatives are under way, giving nurses a variety of different channels through which they can serve.

The National Nurses Response Team

The American Nurses Association (ANA) and the U.S. Department of Health and Human Services’ Office of Emergency Response are establishing the National Nurses Response Team, a force of registered nurses trained to respond to a major bioterrorism event, such as the release of smallpox or anthrax. The nurses would be responsible for providing mass vaccinations or chemoprophylaxis to hundreds of thousands of Americans, or even millions.

The association and federal officials want to recruit 10 regional teams of 200 nurses, says ANA senior policy analyst Cheryl Peterson, RN, MSN. In case of a terrorism disaster, the federal government would deploy nurses on the team for no more than two weeks at a time and would pay them for their service

Racial and cultural diversity in the response team will be critical, as it is in all areas of nursing, Peterson stresses. The team must be able to communicate medical information and educate the public quickly after a crisis. Nurses of color can play a key role in helping other members of the team understand diverse cultures, establishing trust in minority communities, responding to individual and community needs with cultural sensitivity and communicating with limited-English-speaking populations.

According to Peterson, public health experts were already studying how to better inform nurses about bioterrorism even before 9/11. After a religious cult released sarin, a nerve gas, in a Tokyo subway in 1995, an American College of Emergency Physicians task force studied whether health care providers were ready to respond to such a disaster here. The answer was no, Peterson says. That revelation, along with the attacks on the World Trade Center and Pentagon and the subsequent anthrax incidents, served as an alarming wakeup call.

Nurses who join the National Nurses Response Team will be trained through national online courses and regional continuing education programs. Peterson says officials hope to have the team in place by the end of this year.

Serve Nationally, Locally or Both

Although the National Nurses Response Team is a particularly exciting initiative because it focuses exclusively on nurses, it is not the only option available to nursing professionals who want to make a difference in helping their country prepare for and respond to the threat of terrorism. Here are several other programs in which nurses can make valuable contributions:

  • Disaster Medical Assistance Teams. A Disaster Medical Assistance Team (DMAT) is a group of medical personnel who work on the front lines providing medical care after a disaster. This can include natural and environmental disasters as well as terrorist attacks. The teams, which are part of the federal government’s National Disaster Medical System, are deployed to disaster sites with enough equipment and supplies for 72 hours. They help triage victims and prepare patients for evacuation. They can also help relieve local health care staffs that become overloaded during a crisis. The team members are paid by the federal government while serving, and their medical or nursing licenses are recognized in every state during their service.
  • Medical Reserve Corps. These groups are part of the USA Freedom Corps, an initiative developed after President Bush’s 2002 State of the Union address called for establishing a new program to give Americans the opportunity to volunteer and serve their communities. After September 11, many people across the country felt a renewed surge of civic duty but weren’t sure how or where they could help. Although the federal government helps fund the Medical Reserve Corps through grants, the groups are actually developed and run by individual communities so they can design the corps to respond to local needs. According to Craig Stevens, a spokesman for the U.S. Surgeon General’s office, any organization or group can start a Medical Reserve Corps, and volunteers don’t necessarily have to be health care professionals to take part. So far hospitals, churches, Rotary Clubs, fire departments and ­even a community newspaper ­have launched these volunteer efforts in 42 communities nationwide. Not only can local Medical Reserve Corps groups be organized to respond to disasters, they can also serve ongoing public health needs, says Stevens. For example, they may provide health education or develop vaccine programs. Nurses obviously can play a huge role in establishing Medical Reserve Corps units, he adds. And because these programs are so strongly community-focused, they can be a particularly effective way for minority nurses to establish culturally competent emergency preparedness efforts in communities of color.
  • American Red Cross. Registered nurses can join their local Red Cross chapters to get training and local experience in terrorism preparedness. They can also receive additional training to respond to disasters outside their communities. The length of assignment depends on the type and location of the disaster. Nurses who serve away from their local areas should be able to commit to at least two weeks deployment. Nurses can serve in a variety of ways through the Red Cross. They can provide community disaster education, recruit and train other nurses, work at Red Cross service centers and provide health assessments and first aid for Red Cross workersresponding to disasters.
  • Commissioned Corps Readiness Force. Nurses who work in the U.S. Public Health Service’s Commissioned Corps can volunteer for the Readiness Force, which deploys teams to respond to major public health emergencies. Since 9/11 and the anthrax attacks, the Commissioned Corps Readiness Force has placed increased emphasis on terrorism preparedness training for its volunteers.

Learning from the Experts

Before September 11, courses on terrorism and bioterrorism response were not exactly a staple of most nursing school curricula. Today, of course, it’s a different story, with a growing number of academic institutions incorporating this urgent new subject into their nursing programs.

One of the most unique efforts is under way at St. Louis University School of Nursing, which launched a first-of-its-kind online disaster preparedness certificate program in February. The idea for the program came out of a faculty meeting when professors asked one another, “If we have another 9/11, what are we supposed to do?” recalls assistant professor of nursing Dotti James, RN, PhD.

When nursing school alumna Elsie Roth, RN, MA, BSN, heard about the plan, she suggested that faculty members travel across the world to learn from the experts: Israelis. “Who would know better how to respond to terrorism than them?” she says. Adds James, “In Israel, they’re living with this constantly and take a very pragmatic approach: Get ready for it.”

Roth, a public health nurse who has traveled to Israel many times, volunteered to lead the expedition. As a lifetime member of Hadassah, a women’s organization supporting the Hadassah hospitals in Israel, she worked with her Israeli contacts to set up an in-depth learning program for the St. Louis University faculty at the Henrietta Szold Hadassah Hebrew University School of Nursing and Hadassah Hospitals in Jerusalem. Roth and four faculty members representing the School of Nursing and the School of Public Health spent an intense week learning from local military and public health officials, volunteers and emergency room doctors and nurses.

James says the experience was profound. They learned the technical and systematic methods the Israelis use to respond efficiently to terrorist incidents, such as suicide bombings, and they witnessed the impacts of terrorism on the day-to-day lives of residents and hospital personnel. They watched as health care workers trained new mothers how to put gas masks on their infants.

“The big thing we learned is it can happen here,” James emphasizes. “People are going to turn to us as nurses, and that’s not the time to say, ‘I don’t know what to do.’”

The certificate program requires six core courses plus four courses selected from a menu of 12 electives. The electives include such topics as biological terrorism, social and psychological impacts of disasters, basic epidemiology, and the unique needs of vulnerable populations (such as children, the elderly, people who are incarcerated, people who live in high-rise buildings and immigrants who don’t speak English).

“The Whole Issue is Education”

In addition to the ANA, other nursing professional associations are also responding to the need to prepare nurses to deal with the threat of terrorism. For example, the National Black Nurses Association is offering a full-day Red Cross Disaster Training session at its upcoming 2003 Annual Conference in New Orleans.

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The Academy of Medical-Surgical Nurses is adopting a position statement calling for education for nurses on bioterrorism agents, signs and symptoms of exposure to such agents, treatment plans, containment and self-protection. “The whole issue is education, education, education,” says academy president Doris Greggs-McQuilkin, RN, MA, BSN, the first African-American nurse to lead the national organization. The academy is also incorporating a new chapter on disaster planning and bioterrorism into its core curriculum.

Earlier this year, the American Academy of Ambulatory Care Nursing held a special workshop on “Preparing the Nursing Workforce for Bioterrorism” at its recently completed 2003 Annual Conference. “We felt all of our nurses needed to be aware of the risk,” says the academy’s president, Catherine Futch, RN, MN, CNAA, CHE, CHC.

The threat of a bioterrorist attack is so frightening that most people would rather not think about it. But the best way to reduce the public’s fear is to educate them about the challenges and how to respond, Futch asserts. In this context, nurses’ ability to understand other cultures, communicate with diverse populations and provide linguistically competent public health education will be more important than ever, she adds.

Health care systems are still another group that is beginning to address the issue of terrorism response. And they, too, are aware that preparedness information must be easily accessible to patients of all races and ethnicities. For example, after the anthrax scare, Kaiser Permanente, the nation’s largest HMO, made sure it had patient education materials about anthrax available in various different languages.

Gayle Tang, RN, MSN, Kaiser’s national director of multicultural services, believes that planning how to provide culturally and linguistically competent medical care in response to terrorism will be a key issue. The big question, says Tang, who is Chinese American, is: How do we reach all the diverse populations, especially those who don’t speak English? By arming themselves with a strong base of education, knowledge and skills in terrorism preparedness and response, minority nurses can be indispensable leaders in efforts to answer that question.

Working at the Department of Veterans Affairs

The Department of] Veterans Affair’s most important asset is a highly motivated and diverse workforce of more than 200,000 people committed to our mission of service to veterans. Our employees are the foundation of the department and the key to our success. We offer a wide array of career opportunities to prospective applicants in many clinical, technical and administrative career fields at locations throughout the country. Our Web site can tell you more about these job opportunities. We hope that you will consider a career with Veterans Affairs and become a part of our proud tradition of providing the highest quality of service to those men and women who have served our great Nation. -Anthony J. Principi Secretary of Veterans Affairs

Just the Facts

The Department of Veterans Affairs (VA) was established on March 15, 1989, succeeding the Veterans Administration, which was established in 1930. In 1989, President Reagan signed legislation to elevate Veterans Affairs to the 14th Department in the President’s Cabinet.

The department has 224,724 employees 202,709 of which are employed by the Veterans Health Administration. It is the second largest of the 15 cabinets and is responsible for providing federal benefits to veterans and their dependents. This is a staggering responsibility when you consider the numbers: about a quarter of the nation’s population-approximately 70 million people-are eligible for VA benefits and services, and there are 26 million living veterans at this time.

The VA estimates it will spend $59.6 billion in 2003 to provide services and $25.9 billion of that will be spent in the area of health care. The VA’s health care system includes 163 hospitals, 850 ambulatory care and community-based outpatient clinics, 137 nursing homes, 43 domiciliaries and 73 comprehensive home-care programs. More than 4.5 million people received care in VA health care facilities in 2002. This was an unprecedented increase of 9.5% over the number of patients treated in 2001.

The VA will also invest nearly an additional $1.4 billion in research this year. These funds are made possible by the VA’s Medical Account, National Institutes of Health, pharmaceutical companies and other foundations.

The VA is at the forefront of medical advancements and research. It has become a world leader in research on aging, women’s health, AIDS and post-traumatic stress disorder. VA researchers have had key roles in developing the cardiac pacemaker, the CT scan and have made improvements in artificial limbs. The researchers have received many prestigious awards including the Nobel Prize for their work.

The biggest reward for researchers in the VA, however, is the ability to see the immediate benefits of their research. Many of the researchers are also practicing physicians, and this dual role allows them to put their research to immediate use.

Considering the work the VA does every year, it is no surprise that they require a large network of “highly motivated” individuals. Employment opportunities abound at the VHA and VA, and they value their employees, a fact that is reflected in employee’s generous benefit packages.

The Benefits

Salaries
Starting salaries at the VA are dependent on education, training, years of experience, the duties of the position and, in some cases, guidelines from professional boards. The VA’s General Schedule Salary Table is available at www.va.gov.

Health Insurance
As you can imagine, employees of the VA choose from a wide selection of health care plans based on their individual needs. Fee-for-service plans, health maintenance organizations and point of service plans are just a few of the options. The VA pays approximately 75% of the health benefit premium. Many plans offer dental coverage as well, and coverage may continue into retirement. Pre-tax options can also result in more take-home pay.

Training and Continuing Education
The VA manages the largest education and health professions training program in the U.S. They are affiliated with 107 medical schools, 55 dental schools and more than 1,200 other schools across the country.

VA employees can also benefit from VA Learning Online a program offering a number of general education and college-level courses on the Internet. The VA offers tuition reimbursement to individuals who are studying in fields deemed to have shortages.

The Employee Incentive Scholarship Program is available to employees continuing their education in areas where recruitment and retention is difficult.

Quality of Life Benefits

A childcare subsidy is available to full- and part-time VA employees. This subsidy is paid on a sliding scale based on income. Alternate work schedules are also available in some circumstances, and commuting assistance is offered to VA employees based on mass transit commuting costs.

Other Benefits

Additional benefits, similar to those found in the private sector, include retirement programs, life insurance and paid days off. Some of these benefits are more generous than those found in the private sector, however, and are detailed on the VA’s Web site at www.va.gov under employment opportunities.

Extra benefits not commonly found in the private sector include liability protection and job portability. Descriptions of these benefits are also available on the VA’s Web site.

Many Routes to the VA

If you would like to pursue a career with the VA, there are many avenues to get you there. On the Internet, go to www.va.gov/jobs/search/healthcare.htm to find links to the VHA Placement Service, VA Jobs at USAJOBS and VHA Executive Recruitment. You can also go to www.vacareers.com to do a job search by state, facility or occupation.

If you have additional questions, call the Health Care Development and Retention Office (HCSDRO) at 504-589-5267.

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