We often say nurses are on the “front lines” of health care, meaning they work closely with patients and become intimately acquainted with the issues those patients face. And while hospitals can seem a lot like trenches sometimes, they are a far cry from the military operations taking place worlds away.
Here, two military nurses share their stories, from the stress of coordinating care in a combat zone to dealing with prejudice and personal growth, all while caring for the men and women serving in the U.S. armed forces.
Joseph D. Hacinas, R.N., M.S.N., C.N.S., P.H.N.
Lieutenant Commander, United States Navy Nurse Corps Last year, 2011, marked my 10th year as a nurse. Those years have been marked by personal and professional accomplishments. However, this was not always the case. In fact, my nursing career was almost never a career to begin with.
After graduating with honors, I had a great sense of pride and confidence. Perhaps I had too much self-confidence. As a result, I failed miserably with my nursing board exam. Worse, I blamed everything and anything but myself. Having failed this exam almost cost me my job and the opportunity to become a commissioned officer in the U.S. Navy. My mentality relied heavily on the fact that I was going to be a nurse. I intended to be an outstanding nurse, just like the hundreds of outstanding nurses of Asian/Filipino descent who came before me.
Yet, I assumed I could pass the nursing board exam without really studying or working for it. Well, lesson learned. An expensive lesson, I should add. Had I not eventually passed my nursing board exam, I would have been looking at an employer recoupment of about $20,000. Ouch! The good news is that I was able to overcome this barrier just in time.
I began my career in a military nursing at the Naval Medical Center in San Diego, and my goals were simple: learn as much as possible and don’t make mistakes with potentially dire consequences (e.g., a medication error). Not so different from civilian nursing, really!
I remember that rookie year vividly. Looking back, I am still not sure how I was able to succeed in such a demanding work environment. I was assigned as a staff nurse at a 28-bed medical-surgical unit. By far, we were the busiest nursing unit in our 250-bed facility. Every day was non-stop action. It felt like my heart rate increased by at least 10 beats per minute every time I set foot in the unit. It seemed like we never slowed down—and the tempo was dizzying. I would typically have six patients with an assistant. For any given shift, my duties would consist of AM care, vitals, assessment, medications, and procedures. I also had to coordinate MRI visits, CT consults, and X-ray availability while calling for discharge medications in pharmacy. No matter how physically and mentally prepared I tried to be, it was hard to maintain a sense of control. There were times that I was so stressed I literally made myself sick. Basic nursing skills such as prioritization of patients and critical-thinking skills were learned on the go. I wouldn’t exactly call it chaos. But it was close.
Yet, as crazy as it may sound, I actually did not mind it one bit. It’s the truth. One of the reasons was that I had great mentors around me. I used to look around our nursing unit and realized my nursing colleagues were more than willing to help, no matter what. Perhaps it was our sense of teamwork. Or it could have been our dedication to military nursing and our patients. Whatever it was, it didn’t take me long to realize that I had made the right career move. Unlike my civilian nursing colleagues, I have had the unique opportunity to care for patients who have served and are serving this great nation. It is a feeling like no other. To come in on a daily basis and know that I am part of something meaningful is incredible. This couldn’t have been more evident than after the events of September 11, 2001.
I was actually on my way to work when I heard of the terrorist attacks. Not knowing much at the time, I just remember thinking that my nursing skills were about to become a commodity, whether I was ready or not. It was a fearful and uncertain time for everyone, almost surreal to think that such an attack was even humanly possible. I just remember hearing from my supervisors, “Be ready.” There was a good chance most of us were bound for deployment overseas. Soldiers, marines, sailors, and airmen were counting on us to provide the best patient care possible under all circumstances. As it turns out, I was actually one of the nurses that ended up staying behind during the early stages of the war. Nevertheless, it was professionally fulfilling. It provided a great way for me to contribute. For the next few years, I found myself in various nursing assignments, from California to Japan. I have been blessed to grow professionally and gain a better perspective of my overall purpose as a military nurse.
Like some people find their niche in a nursing specialty like pediatrics or oncology, I have found that being a military nurse has its own advantages. I work with an outstanding team. From physicians to social workers, it is a rewarding experience to collaborate and gain a sense of unity. This is especially important as nurses and the rest of the health care team are tasked to care for patients with complex disease processes. More importantly, my service to active-duty patients and beneficiaries truly defines who I am as a nurse. Whether I am teaching a dependent spouse about healthier eating habits or holding a patient’s hand and praying with him before a major surgery, I am there to give it my all. Because, chances are, they would do the same for me. And that alone is what matters most. In a sense, we are more than just a family. We are united as one.
Of course, to say my military nursing career has been nothing but great experiences wouldn’t be entirely accurate. I can recall one incident when caring for a retired military member. He rang his call bell for assistance. When I walked in to his room, he said, “I’m sorry, but I had asked for a nurse.” I politely answered that I would be the one taking care of him for the night. He quickly replied, “No, no, no. I asked for a nurse—the one who has blonde hair, blue eyes, and wears a nice skirt.” Obviously, I could have reacted in a negative manner. Rather, I chose to remain calm and respectfully informed him that not all nurses are females with blonde hair. Somewhat perplexed, the patient quickly changed the topic and turned his attention to the television. I did not feel anger towards that particular patient; all I could think of was trying to find ways to help him understand the evolving nature of nursing, which now consists of men as well as Asian/Filipino nurses like me.
As troubling as that patient’s reaction seemed at first, I truly felt he came to realize that male nurses were more than able and capable of caring for patients like him. Though he never said so directly, I just had a feeling. And if nothing else, I know my serving as his nurse was a concrete example that contradicted his former world-view.
The common thread
Nursing is an ever-evolving profession. And changes in our health care delivery system will happen, regardless. The past 10 years of nursing have taught me valuable lessons. For one, I have learned to remain humble. I have also learned to not take things personally when it comes to patient comments. Granted, some comments are downright ignorant and hurtful. But, I believe there is a common thread and human decency in everyone. As a military nurse, I am proud to be a part of their lives. In particular, I am proud to know that I have been given ample opportunities to touch lives and care for my patients. I never imagined I would be in the position to make an impact on someone’s life. Personally, those few minutes of comforting patients during the worst of times have turned to a lifetime of personal and professional satisfaction.
Yet, as with any profession, nursing is not for everybody. I have friends and colleagues who left nursing. I think some of the more common reasons for doing so were the stress of the patient workload and the lack of support from nursing leaders. Being a minority nurse, my advice is to truly and honestly evaluate one’s dedication and intention before committing to nursing. Nursing is a great and well-respected profession, but it does come with its challenges. For example, there have been times when I feared for my safety when caring for patients with developmental delays and mental instability. In addition, minority nurses may still encounter racial and ethnic stereotypes.
Once, a patient bluntly asked if all Filipino nurses speak Tagalog among one another in front of non-Filipino patients. Taken aback, I informed her that no, that is not the case. They only speak their native language during their off-duty time. In another instance, when reporting to my new supervisor (who happened to be a minority), she said, “I can already see two things that are against you. You’re an Asian and a male.” In the U.S. Navy Nurse Corps, we value diversity and strongly feel that concept results in a better work environment for all of our valued staff members, regardless of their race or color. Yet, we, as a health care organization, also understand that we are at risk for discrimination. The good news is that we have a solid support structure that enhances equal opportunity for all.
I learned there remains a small group of people in the nursing world who are who they are and believe what they believe, and there’s no changing them. More importantly, I learned the value of self-discipline while serving my patients at the most honorable level. Ignorance and immaturity exist in this world, but we, as minority nurses, have more than the power and ability to achieve the highest levels in long, fulfilling careers. We should not and cannot allow minor setbacks to dictate who we can become as professionals—we are simply too valuable to the profession. I have always seen nursing as a rewarding career, personally and professionally. Joining the nursing ranks seemed like a no-brainer. And, in general, my expectations of camaraderie, mentorship, and professional development have been met.
Who knows what the next 10 years will bring? I may pursue other interests such as golfing and traveling across the globe. I may even find myself teaching at a local university. I am okay with the unknown that lies ahead when it comes to my career as a military nurse. The one thing that I am certain about is that I will continue to strive in providing the best patient care. The ability to make a difference in patients’ lives means a lot to me. And sometimes, that is all you need. Here’s to another 10 years!
Artemus Armas, R.N., M.S.H.S, B.S.N, C.E.N.
Major, United States Air Force, North Carolina
I have been an Air Force nurse since January 2002. Before that I was in the National Guard and Army Reserve for 17 years before I went on active duty. In the Guard I was an Army Infantry officer.
During my fourth deployment, I was at the Camp Bastion Joint Operating Base in the Helmand Province of Afghanistan, the fiercest combat zone in Afghanistan at the time I was there. I was in charge of the Aeromedical Evacuation Liaison Team (AELT) at Camp Bastion Joint Operating Base Hospital. The team consisted of a flight nurse (myself), a medical service corps officer, and two radio technicians. We were primarily responsible for providing fixed-wing aeromedical evacuation for NATO forces and sometimes civilians. The team also helped anyone, including civilians, who may need to be seen by a specialist not stationed at Camp Bastion.
The AELT’s key function is transferring patients, such as those with traumatic amputations or other combat injuries, who need more specialized treatment to a different facility. The hospital relies on the AELT to coordinate the patient’s transfer with a medical aircrew (Aeromedical Evacuation Crew, or AEC), which flies the patient from point A to point B. Once the patient is picked up by the AEC and en route to a higher level of medical care, the AELT advises the staff and hospital awaiting the patient’s arrival.
A secondary mission for AELT is providing emergency medical assistance to local nationals and Afghan National Security Theater hospitals. Camp Bastion is a joint hospital, meaning whichever nation’s military is in charge of the hospital collaborates with the other countries working there. When I was there we had the Danish, British, and U.S. military.
Camp Bastion is a Role 3 hospital. Role hospitals break down as follows: Role 1 hospitals are assigned to areas providing basic or initial care; Role 2 are facilities with some surgical capabilities; Role 3 facilities can support trauma care, surgical procedures, and burn care; and Role 4 is advanced medical center care. As the lead medical person on the AELT, I made sure patients were properly prepared for flight. I also trained coalition force physicians, nurses, and medical technicians regarding approved devices, brands, and materials, including pumps, chest tube drainage systems, and traction devices.
I also taught hospital leadership on how our system works, the process of getting a patient to a higher echelon of care; this education included Army, Navy, and Marines. While at Camp Bastion I authored and implemented new policies on moving patients through the theater hospital systems, called the Patient Movement Requirement (PMR). Fortunately, implementing these procedures cut down patient movements errors by 60%.
The AELT took the lead in teaching hospital personnel how to sanitize patients before entering the hospital. We sanitized over 500 ally and enemy casualties (patients), meaning we removed any guns, ammo, or explosives before injured personnel entered the hospital. This was for security, assuring nothing happened to hospital staff and patients.
Through these initiatives and two published articles, my goal was to educate AE crews as much as possible so they would not stress when they saw unfamiliar medications or procedures, while giving a report for patients being moved by the AECs. I also included a quick reference sheet of drugs used by the coalition facility and its U.S. equivalent. By the end of this deployment, my four-person team had moved 313 patients, including 102 battle injuries.
ICU in the sky
On my second deployment that year, I had a five-day notice to get my bags and go, due to an injured person who was deployed. I went to Southeast Asia, where I was in charge of the Aeromedical Evacuation Operations Team. I managed up to eight Aeromedical Evacuation Crews and two Critical Care Air Transport Teams (CCATT).
CCATT is basically an airborne intensive care unit. The team consists of a physician, nurse, and respiratory technician; they transport the most critical patients with the assistance of the AEC. I needed to make sure the crews were ready to fly 24 hours a day, seven days a week, so we could pick up patients in the Area of Responsibility, which covered seven countries. I planned and coordinated training as needed for the crews, from medical guidelines to how to use specialized communication equipment. Mentoring was also a big part of the job, including how to deal with crewmembers and patients, career planning, and writing military reports.
Another big aspect was scheduling AECs, by following regulations regarding when crews could and could not fly. Crews need enough time to recoup and rest to be able to perform their duties on the plane and provide high-quality patient care. Scheduling can sometimes be hectic, because you have crews both on call and on missions.
I also coordinated over two tons of Patient Movement Items to the AOR, while my team also maintained and managed 73 Portable Therapeutic Liquid Oxygen units (patient oxygen). This optimized five AE units and kept them fully mission capable. While there I functioned as a crewmember when personnel were unable to fly due to injury or illness. I flew three missions as part of an AEC and pulled 120 hours of alert status, resulting in the transfer of 18 coalition casualties to advanced care. During increased operations we relocated 12 Aeromedical Evacuation Crew members and two CCATTs to Bagram, Afghanistan, increasing Operation Enduring Freedom capabilities by 20%. The efforts during that time lead our team to win the Expeditionary Aeromedical Evacuation Squadron “Team of the Month.” While deployed, the team safely evacuated over 400 wounded personnel on 180 sorties.
The most important result of all that I do is making sure patients, whether military or civilian, receive the best, most comprehensive care possible throughout the AE system. You need everything: great patient care, equipment, leadership, management, and more. If you just focus on one, the system will not be optimal. It is crucial to be well-rounded on all aspects of the AE system. I am honored that my commanders have seen qualities in me to give me the opportunity to succeed in the positions where I have been placed. My philosophy is to do what is best for the patient and those who take care of them; everything else will fall in place.
While deployed as an AELT, I lead our team with a program called “Soldiers’ Angels” (www.soldiersangels.org). We would collect items such as books, food, soap, clothes, music, and blankets from people throughout the United States to give to personnel living in austere conditions and patients who needed supplies in the hospital. We ended up distributing over $50,000 in products to over 500 patients, 24 units, and 12 Forward Operating Bases.
Recently, I was honored with two awards: The Air Force Flight Nurse of the Year and Nurse of the Year. When my commander informed me I won, I was shocked. It is an honor just to win one. I had learned my commander had put a Flight Nurse of the Year package in for me when I was deployed to Southeast Asia, but I never expected to win. I gave her my information and didn’t think of it again until I won. It was a shock to both of us when I also won the Nurse of the Year. However, though I say “I” in describing all these events, I truly could not have done it alone. The team makes it happen—I just tried to lead them in the right direction.
Getting the opportunity to be a flight nurse has been the most satisfying job I have had thus far in my nursing career. Being a flight nurse in the Air Force has given me opportunities to be an effective leader and make an immediate difference for those I have taken care of that I would not have had as a nurse in a clinic or hospital. Like the rest of the nation, the Air Force needs more nurses and the AF Flight Nurse community needs even more, as a specialty. I would recommend this life to anyone who likes adventure, leadership opportunities, and enjoys taking care of our wounded warriors.
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