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.
For Native American nurses, many of their stories have been lost to the past. Scholars have generally paid scant attention to the lives and deeds of rural minority women, and few articles have been written about the early education of Native American nurses and their contributions to health care. The people of the Catawba Indian Nation use storytelling to keep their culture and the memory of their heroes alive. Consider this one such story, one such hero.
The Sage Memorial Hospital School of Nursing, known simply as “Sage Memorial,” operated from 1930–1953. It was the only nursing school ever opened for the sole purpose of educating Native American women as nurses.1 One of these nurses was Viola Elizabeth Garcia, a graduate of the Class of 1943.2 Viola’s life illuminates the struggles for education common among the women who attended Sage Memorial. Her contributions and experiences as a World War II nurse demonstrate the hardships encountered and outstanding contributions made by many of her fellow alumna.
By law and custom, most nursing schools were segregated by race before the passing of the Civil Rights laws of the 1960s. From the 1880s through the 1960s, most schools of nursing were comprised of either all white or all African American student bodies, leaving few opportunities for Native Americans, Asian Americans, or Hispanic Americans to obtain a nursing education.
The Board of National Missions of the Presbyterian Church was unique in its efforts to address this inequality. In 1901, the National Presbyterian Church opened the Ganado Mission on Navajo Nation land, in the northeast quadrant of Arizona, near the New Mexico, Colorado, and Utah borders, in the community of Ganado.
After a church and school were successfully operating at the Mission, the home missionaries turned their attention to health care.3 In 1929, Dr. Clarence Salsbury and his wife, Nurse Cora Salsbury, took over the mission work at Ganado. One of their first priorities was expanding the antiquated 12-bed hospital into a modern facility of 150 beds, an operating suite, a delivery suite, and a laboratory. This new hospital was named Sage Memorial Hospital after one of its largest benefactors and was accredited by the American College of Surgeons.
In order to staff the hospital with nurses, as well as to provide skilled employment opportunities for Native American women, the Salsburys opened Sage Memorial Hospital School of Nursing in 1930.4
The school opened while naysayers proclaimed no Native American woman would ever be up to the academic task of completing a Nightingale-based nursing education program. They also claimed these women, given their culture, would not be willing to interact with the sick or dying. Sage Memorial graduates proved these assumptions wrong.
Dr. Salsbury felt training Native American nurses was crucial. “They would be able to understand the patients as no white personnel ever could,” he said.1 Sage Memorial started small, with an entering class of two Navajo women: Adele Slivers and Ruth Henderson. They both graduated three years later and passed the Arizona State Board of Nursing Examinations. Their graduation exercises in 1933 were a festive event with scripture readings, vocal duets, a piano solo, and a pinning ceremony. Dignitaries including the Arizona governor, an Arizona State Board of Nursing member, and one of the chief Navajo medicine men praised the graduates and the school during the proceedings.3
As word and reputation of the school expanded among minority communities, the student body increased in number and diversity. By 1943, students from 28 tribes, including the Navajo, Kiowa, and Catawba; students who identified as Eskimo, Hawaiian, Spanish American, Cuban, and Mexican; and one Japanese student from a relocation camp were either enrolled or graduates of Sage Memorial.6 By all accounts, this unique experiment in multicultural education was a success.
In the 1930s and 1940s, such training and cultural exchange among Native Americans and other minority women was not found anywhere else in the United States. The nurses developed a camaraderie and commitment to their work that consistently earned them the highest marks on state licensing exams. The students lived in interracial cooperation while learning the nursing arts and sciences. The school’s stellar reputation drew the attention of white applicants—who were denied consideration because they had access to many other schools of nursing.1
Viola Elizabeth Garcia
Viola Elizabeth Garcia was born on April 12, 1919, in Sanford, Colorado, a poor, rural Mormon community home to approximately half the members of the Catawba Nation. Viola’s family was financially impoverished, but rich in family and culture. The older brothers, George and Labon, left school after completing the fourth and fifth grade to help their ailing father support the large family. Viola’s father was ill for much of her young life and died when Viola was only 11 years old, leaving behind 10 children for his wife to support.
Viola completed the ninth grade in Sanford, but due to the Great Depression, the public high school was closed. For the next three years, Viola tried desperately to complete her high school education by repeatedly applying for admission to the Bureau of Indian Affairs Haskell Boarding School in Lawrence, Kansas. Finally, she was admitted at 18 years old and completed her high school diploma in 1940 at the age of 21. Viola’s classes focused on cooking skills, sewing, home care, and arts. As graduation neared, she was offered full-time employment as a cook’s assistant on the Apache reservation in New Mexico, but Viola was determined to continue her education.2
With the guidance of the staff at Haskell Boarding School, Viola applied to several nursing programs but was only admitted to Sage Memorial. One such rejection stated that she was too old at 21 years of age to begin the nursing program. There was also a concern, as World War II loomed and U.S.-Japan relations became strained, that her Native American features would appear Japanese and frighten patients.6
The head mistress of Haskell wrote in a reference letter about Viola, “Whatever Viola decides to do, she does.” Several months after Viola enrolled at Sage Memorial, Dr. Salsbury personally wrote the Haskell headmistress asking if she had any other students like Viola, and if so, to please send them to his school.6
Studying at Sage Memorial
Applicants to Sage Memorial had to be unmarried high school graduates between 18–30 years of age. Their applications had to be accompanied by a health certificate, as well as four character references, with one being their pastor. Tuition was $100 for the first year with additional fees of $1 for laboratory courses, $0.50 for library use, and $3.50 for health fees. The hospital provided room, board, and laundry services. In addition to their course work, students tended the hospital floors eight hours a day, six days a week. However, students had time to relax outside of their rigorous classroom and clinical schedules, enjoying picnics, parties, movies, and glee club, as well as mandatory gym class and chapel.4
Although Viola was accepted to Sage Memorial, she was not sure that she could afford the tuition, fees, and living expenses. As the months progressed, Dr. Salsbury procured the funds to pay for all her education expenses except for personal items she needed to bring with her.6 According the 1940 catalog, all students had to supply for themselves the following: a bag for soiled clothing, rubbers or galoshes, toiletries, two fountain pens (one for red ink and one for blue), a watch with a second hand, an alarm clock, two standard-size loose-leaf notebooks, a napkin ring, and coat hangers.4 Viola’s eldest brother, George, gave her an entire month’s wages so she could buy the required watch with the second hand sweep. With her determination and supplies in tow, Viola began her three-year long education at Sage Memorial.6
Over the next three years, Viola and her fellow students not only studied the nursing curriculum but also spent many clinical hours on the hospital floors. They made and rolled their own patient bandages and folded disposable patient trash bags and slippers out of newspapers. Third-year students were expected to help teach the lower-level nursing students. Viola not only learned the nursing skills that she would use throughout her life, but she developed a deep devotion and admiration for the Navajo people. She even taught herself to speak Dine, the Navajo language.6
A nurse in practice
Though Viola grew up in the rural, remote, and poor town of Sanford, she was surprised to learn that her new community at Ganado was even more so. Patients were brought to the hospital on horseback and buckboard wagons, and sometimes by rattling old vehicles over rutted and narrow dirt roads. Many roads were so rough and rocky that they were impassable in wet and winter weather. The nursing students were expected to go on home visits with the nursing staff to the homes of the Navajo people, traditional dwellings known as hogans.7 They made these visits in buckboard wagons. Viola would write back to her mentor at Haskell Board School that these hogans were “loving and cozy homes.”6
Viola viewed success as the ability to provide for herself, and she felt her education was essential to achieving that level of self-reliance. Viola studied hard and was the 1943 class valedictorian. She was awarded a set of surgical instruments for her academic success.
In 1943 Viola took her Arizona nursing boards and returned home to Colorado to await the results. She had been worried because she did not have an additional $75 to retake the nursing board examination if she failed. One day a letter arrived addressed to Viola Garcia, R.N., and she knew she had passed. In fact, Viola received the highest test score in the entire state of Arizona. Viola’s academic and nursing success, however, was common among the students who graduated from Sage Memorial.
World War II
Not long after graduating from nursing school, Viola found herself working in Denver, Colorado, when President Roosevelt delivered an ominous speech. While the war efforts in Europe were drawing to a close, battles were still raging in the Pacific, and there might be a need to draft nurses into the military. Viola was told that if she volunteered for military service, she could select her location of duties. In January 1944, she enlisted in the United States Army Nurse Corps, requesting no surgical duties or overseas assignments. Within weeks of her enlistment, she was assigned to Camp Carson (now, Fort Carson, Colorado Springs, Colorado) in the surgical suite where she assisted with amputations from the war-wounded returning from the bitter winter campaign in Europe under General Patton. There were endless mounds of amputated ears, fingers, toes, hands, feet, arms, and legs that filled the air with putrid smells. Viola approached her supervisor and informed her of what she had requested: “No surgery and no overseas duties.” She was promptly informed, “Honey, you are in the Army now.”6
Step Back in Time The curriculum at Sage Memorial Hospital was based on the National League for Nursing Education criteria, accredited by the Arizona Board of Nursing Examiners. But what was nursing school in Viola Garcia’s day really like? Around 1940, courses required for graduation at Sage Memorial included: First-Year Courses: Basic sciences, professional adjustments, nursing arts of bandaging, massage and personal hygiene, nutrition, cookery, pharmacology and therapeutics, aseptic techniques, and nursing care of conditions involving respiratory, circulatory, gastro-intestinal, endocrine, and muscular-skeletal systems Second-Year Courses: Medical-surgical nursing; nursing conditions of the eye, ear, and reproductive tract; and communicable diseases such as tuberculosis, gonorrhea, syphilis, obstetrics, diet therapy, and social problems in nursing Third-Year Courses: Psychiatric, pediatric, emergency, and public health nursing, along with another course in professional adjustment
Within a few months, First Lt. Viola Garcia shipped out from Camp Carson to Los Angeles, where she, along with 600 other nurses, embarked on the largest U.S. Army Hospital Ship at the time, the USAHSMarigold, with an unknown destination. After two weeks, the ship arrived in Hawaii, and 300 of the 600 nurses disembarked, but Viola’s group remained on board. After leaving Hawaii, ship’s public address system announced their destination: Tokyo, still a heavy battle area as the war in the Pacific raged on. “My heart just dropped, I was so frightened,” Viola recalled. The U.S. military was fighting Japanese troops on many Pacific Islands and an invasion of the Japanese mainland was thought to be imminent. The costs in human life for both sides would be high.6
The ship was under the command of General Douglas McArthur, who over saw the military operations in the Pacific. The 300 nurses in Viola’s grouping were to be part of the U.S. invasion actions in Japan. Military leaders expected heavy casualties among those nurses during the invasion operations; the 300 nurses left behind in Hawaii would be their replacements.
Under international rules of combat, hospital ships were not to be attacked at sea, and thus were to be lit up at night and clearly marked with a red cross. Not long out at sea, the Japanese attacked one such marked ship, and the Marigold was immediately ordered to go into complete darkness. As the lights were put out, those in surgery raced to cover the windows of surgeries in progress. A frightening silence fell upon the crew as the Marigold steamed along in darkness on its way across the Pacific.
The Marigold stopped in the Philippines, and the nurses were allowed to disembark for a few days before the ship went to Japan. While docked there, however, the United States dropped the atomic bombs on Japan, and World War II was brought to a close. Yet, the Marigold continued on to Tokyo, but this time with a different mission. The USAHSMarigold was the first U.S. ship to enter Yokahoma Bay after the Japanese ended the war, and it was in Tokyo Bay where General McArthur accepted the formal surrender of the Japanese on the USS Missouri. That day the sea was filled with ships and the air was filled with flyover planes celebrating the end of the Second World War.
Rebuilding in Tokyo
Over the next eight months, Viola was stationed in Tokyo at the 42nd General Hospital. She treated survivors of the Bataan Death Camp and Corregidor Island (a military stronghold in the Philippines). The hospital had five surgical rooms that had been stripped of all equipment by the Japanese at the end of the war. They were filled with soot and rubble. Several Army nurses ranking higher than Viola were assigned the task of restoring these rooms to their full function. According to Viola, none of the higher-ranking nurses could deal with such an overwhelming task; each time, Viola was asked to “fill in.” After a third nurse was left in tears at the monumental task, Viola was asked to take on the responsibilities as acting head surgical nurse.6
Viola walked into surgical suites devoid of the equipment necessary for performing operations—no surgical tables, no IV stands, no surgical tools. She remembered entering the rooms: “I just wanted to cry too and said to myself, ‘Oh Lordy, what am I going to do?'” But Viola went on to do what she had always done—she rolled up her sleeves and got to work. Viola called in her military crew and ordered them to wash and scrub all the rooms from top to bottom. When that was done, she began looking for equipment for her surgical rooms, including salvaging items from the hospital ship.6 She even taught herself to speak Japanese, just as she learned to speak Dine as a nursing student.
First Lt. Garcia’s work in Tokyo was supported by her own ethic of care, as well as the training she received at Sage Memorial Hospital School of Nursing. From those days following the war until her death in 2004, Viola continued caring for others, marrying Herbert Schneider, another member of the U.S. Army, and raising three daughters. Her legacy, one of determination and pride, compassion and grace, lives on.
Salsbury, C.G., & Hughes, P. (1969) The Salsbury Story. Tucson: The University of Arizona Press. 152–153.
People of Catawba official website, “Life of Viola Schneider.” Cynthia Walsh. http://www.catawba-people.com/viola_schneider_eulogy.htm. (Accessed 2011).
Trennart, R. (2003). “Sage Memorial Hospital and the Nation’s First All-Indian School of Nursing.” The Journal of Arizona History, vol. 44, 353.
Prospectus of School of Nursing, (Ganado, Arizona: Sage Memorial Hospital, n.d), 1-11; Presbyterian Historical Society, Philadelphia, Pennsylvania: Ganado Mission Records.
“Excerpts from Statement re: School of Nursing, Sage Memorial Hospital, Ganado, Arizona sent in on January 3, 1939.” Document from Ganado Mission Records, Presbyterian Historical Society; Philadelphia, Pennsylvania.
Viola Garcia, personal comm. with author.
Salsbury, C.G. (1932). “Medical Work in Navajoland.” The American Journal of Nursing, 32(4), 415.
According to the U.S. Department of Veterans Affairs (VA), approximately 20% of our nation’s 23.5 million veterans are people of color. Like other racial and ethnic minority populations, minority veterans face a variety of unique health care challenges, ranging from chronic disease disparities and high levels of post-traumatic stress disorder (PTSD) to difficulties in accessing medical treatment.
Testifying before the House Committee on Veterans Affairs in July 2007, Lucretia McClenney, MSN, RN, director of the VA’s Center for Minority Veterans (CMV), noted that “in many instances, any challenges that minority veterans encounter as they seek services from VA are magnified by the adverse conditions in their local communities. These challenges may include [lack of] access to VA medical facilities (especially for American Indians, Alaska Natives, Pacific Islanders and other veterans residing in rural, remote or urban areas), disparities in health care centered on diseases and illnesses that disproportionately affect minorities, homelessness, unemployment, lack of clear understanding of VA claims processing and benefit programs, limited medical research and limited statistical data relating to minority veterans.”
The CMV’s mission is to identify barriers to service and health care access, increase local awareness of minority veteran-related issues and improve minority participation in existing VA benefit programs. As a result, VA medical facilities throughout the country are implementing strategies to provide veterans of color with more accessible, culturally sensitive care. Each VA health care facility has a Minority Veterans Program Coordinator (MVPC) who serves as a liaison and advocate for minority patients. And VA health care professionals are taking the lead in developing innovative solutions for closing the gap of health disparities, from outreach programs designed to increase minority veterans’ use of services to diversity training programs aimed at increasing staff members’ understanding of patients’ cultural needs.
Not surprisingly, nurses are playing key roles in these efforts. Here’s a look at how individual nurses are working to improve health outcomes for minority veterans, one program at a time.
Native American Outreach
Bruce Kafer, MSN, RN, is a member of the Oglala Sioux (Lakota) Tribe that resides on the Pine Ridge Indian Reservation in South Dakota. Adopted as an infant by white parents, he grew up with virtually no knowledge of his tribal culture. After tracking down his birth mother in 2000, he began to learn about his lost Indian heritage from his Tiospaye (Lakota extended family) and tribal elders. Now, as American Indian/Latino Outreach Coordinator at the Louis Stokes Cleveland (Ohio) Department of Veterans Affairs Medical Center, Kafer is drawing on his rediscovered heritage to provide culturally sensitive healing to Indian vets.
The Changing Face of Minority Veterans When you hear the term “minority veteran,” what image comes to mind? First of all, it would probably be a person of color. The person you visualize is also likely to be male, and perhaps even an older man who fought for his country in a historic conflict like World War II or the Vietnam War. But in recent years, the traditional profile of minority veterans has begun to expand and evolve. Patients from other types of underrepresented populations are becoming a growing presence in the VA health care system, bringing with them a whole new set of unique health challenges and needs. While women may not be a group that comes to mind under the “minority” heading, female veterans are definitely a minority within the VA system, says Jacinda Beug, BSN, RN, who works in the Women’s Health Program at the Southern Arizona VA Health Care System in Tucson. The program, along with its outlying clinics, treats about 5,500 women annually, providing primary care, prenatal care, gynecological and obstetrician services. Many of these patients are veterans of Operation Enduring Freedom (OEF) in Afghanistan and Operation Iraqi Freedom (OIF). In 2003, says Beug, 6% of America’s 23.5 million veterans were women. Today that figure is 7.4% and is expected to climb to 8.7% by 2013. “We were noticing that [within the overall population of veterans coming back from Iraq and Afghanistan], women had their own specific concerns and needs,” says Norma Hernandez, RN, manager of the medical center’s OEF/OIF Transition Program. These special concerns include mental health issues, post traumatic stress disorder (PTSD) and sexual trauma. The Women’s Health Program focuses on providing gender-specific care, and it has an all-female staff—including doctors, nurses, receptionists, clerks and dietitians—to make the patients feel more comfortable, says Beug. Another new “minority” group to surface within the VA is the young veteran. “[Because of OEF/OIF], many younger veterans are coming into the system. We’re treating age groups ranging from 17 and 18 up to 90,” Beug says. Hernandez agrees that the younger patient population within the VA medical system has become a minority group with its own set of specialized needs. The VA is used to serving older veterans, she explains, and is now having to adapt to these younger vets’ needs and develop different treatment modalities to meet them. This is an example of how the VA is constantly evolving, creating new programs and services as specific needs arise, Hernandez adds. For awhile, the special needs of Vietnam veterans were the catalyst for new programs. But now OEF/OIF is bringing in a new special-needs population of combat veterans. The percentage of OEF/OIF veterans in the VA system right now is less than 5%, says Hernandez, but that figure is misleading. Military personnel serving in OEF/OIF are predominantly reservists and National Guard troops who bounce between two different roles. They are activated, come home, are discharged into the VA system, but then can be reactivated back to active duty. “That creates a variety of issues and concerns we need to keep abreast of,” she says. “Their situation keeps fluctuating. It used to be you did active duty, were discharged and then became a veteran.” The unique combat injuries suffered by OEF/OIF veterans, such as those caused by improvised explosive devices (IEDs), are also creating a whole new set of challenges for VA nurses, says Dianne Lethaby, RN, CRRN, Polytrauma Nurse Case Manager at Southern Arizona VA’s Polytrauma Network Site. The site is one of 21 facilities in the nation designed to provide long-term rehabilitative care to veterans who experience severe injuries, including traumatic brain injury, hearing loss, amputations, fractures, burns and visual impairment. The Tucson Polytrauma Network Site, which treats about 320 veterans from Arizona, Texas and Colorado, operates clinics that give patients access to a medical provider, social worker, speech/language pathologist and psychologist, all in one visit. If time permits, the clinics will try to fit in sessions with physical and occupational therapists. “Essentially, [the younger veterans] want to get back and get on with their lives. They’re young and have families to support,” Lethaby says. “It’s been a challenge getting them into the system.”
Kafer, who works with Native veterans both in Cleveland and in Arizona, is also a PhD student at Case Western Reserve University in Cleveland, where he is conducting research with Indian vets to add to the limited body of knowledge available about this population. Through his research, he has discovered some compelling statistics about Native Americans who have fought for their country. During World War II, for example, 40% of the Cheyenne Nation volunteered service to the U.S. military. During the Vietnam War, 90% of eligible Cheyenne volunteered for duty, with the overwhelming majority serving in combat areas. Yet despite this long-standing history of service, Native Americans have historically underutilized VA services, Kafer says.
“Part of my role,” he adds, “is to help bridge that gap and make services more accessible.” To accomplish this, Kafer does outreach to the American Indian community, participating in powwows and other cultural events, visiting reservations in remote locations and working with Native veterans and elders from a variety of tribes to develop culturally appropriate programs.
There are about 562 federally recognized Indian tribes in this country and 365 state-recognized tribes, each with their own unique cultural traditions and, in many cases, their own indigenous languages. Therefore, VA nurses who work with Native veterans often find themselves treating a patient population that is not homogeneous but highly diverse—a concept Kafer calls “diversity within diversity.” Still, he says, while culture and language may differ from tribe to tribe, there are some basic beliefs about health, illness, healing and spirituality that are common to all Native people.
“In traditional Native American culture, health and healing begin first in the spirit, then the mind, then in the body,” he explains. “In the Western model of health care, it’s an opposite paradigm—health and disease begin first in the body, then in the mind, last in the spirit.”
Kafer won an award from the Society of American Indian Government Employees (SAIGE) for a VA diversity training video he helped produce, called “Native America: Diversity Within Diversity.” Created as part of the VA’s R.E.A.C.H. for Diversity program, the video has been distributed to all VA medical centers nationwide to increase employees’ understanding of the unique challenges Indian veterans face.
“Native America resonates with me and my history,” Kafer says. “I’m in a unique position to contribute to improving health care for Native American veterans because I understand about bureaucracy, government and the various phenomena that can impact tribal access to health care.”
Kafer is also involved in another innovative diversity training project, the Gathering of Healers program at the Southern Arizona VA Health Care System in Tucson. The program brings the facility’s staff together with Native veterans and elders to learn more about American Indian culture and how to provide culturally competent care.
“Staff come back from the Gathering of Healers and are more aware of the special needs of this [population],” says Yvonne Garcia, BSN, RN, the facility’s American Indian Nursing Case Manager. “They learn to treat people with cultural humility. They want to know more about them instead of making assumptions.”
Garcia, who is part Mandan Indian, also works with the Indian Health Service to complement services delivered to Native veterans.
Researching Health Disparities
Carol Baldwin, PhD, RN, CHTP, CT, AHN-BC, associate professor and director of the Office of International Health, Scientific and Educational Affairs at Arizona State University College of Nursing and Healthcare Innovation in Phoenix, is a nurse researcher who has focused some of her recent work on studying chronic disease disparities in Mexican American veterans, a population about whom very little health information is available. She led one study which found that, compared to non-Hispanic white veterans, Mexican American veterans were significantly more likely to have diagnosed type 2 diabetes and that having a high body mass index (BMI) put them at greater risk of developing the disease.
More recently, Baldwin published a study in the September 2007 issue of the Journal of Nursing Scholarship that compared homocysteine levels and other stroke risk factors between Mexican American and Caucasian male veterans. High homocysteine levels in the blood have been associated with increased risk of cardiovascular diseases, such as coronary heart disease and stroke.
Baldwin conducted her research in Tucson at the Southern Arizona VA Health Care System’s Minority Vascular Center. She found that Mexican Americans have higher homocysteine levels regardless of whether they scored a high or low risk for stroke. She also determined that the Framingham Stroke Profile, a commonly used stroke risk assessment tool, was derived for a predominantly Caucasian population and does not necessarily provide relevant stroke risk factors for people of other races and ethnicities.
Baldwin says her findings suggest that Mexican American veterans, like other minority populations, face barriers to stroke prevention and therapy, including lower income and education, as well as dietary, genetic and environmental factors.
There has also been very little research conducted on the health care needs of Puerto Rican veterans, says Constance Uphold, PhD, ARNP-BC, FAAN, a research health scientist with the Rehabilitation Outcomes Research Center at the North Florida/South Georgia Veterans Health System in Gainesville. Her current work focuses primarily on the health challenges experienced by Puerto Rico veterans returning from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF).
In one study, Uphold—who has a master’s degree in transcultural nursing and a doctoral degree in family health nursing—examined mental health issues affecting Hispanic veterans and their caregivers and families. She documented stressors from each group’s perspective, as well as successful coping models. Based on her findings, Uphold and her colleagues developed 12 culturally competent fact sheets for veterans, family members and clinicians. These educational materials are tailored to Puerto Rican veterans, complete with colors and symbols from the Puerto Rican flag. She’s now working to secure funding to reproduce and disseminate the fact sheets.
This past February, Uphold became a co-investigator of a grant that will research stroke interventions and family caregiving for Hispanic veterans, as well as how to disseminate stroke prevention information to this population. The Spanish-language information will be posted on MyHealtheVet.com, an interactive Web site that encourages veterans to take charge of their own health.
Promoting Health Literacy
Teaching minority veterans with chronic diseases how to self-manage their conditions is also a priority for Jawel Lemons, RN, MS, FNP-C, associate director of Patient Nursing Services at the Charlie Norwood VA Medical Center in Augusta, Georgia. Lemons remembers watching her own father struggle with his health. The man who raised her had a third-grade education and couldn’t read the directions printed on his medicine bottles.
“I thought, ‘If he wasn’t living with me, what would he do?’” she says. “That’s when I came up with the idea for the labels.”
The “labels” in question were part of a highly successful health literacy program Lemons created and implemented at the Dallas VA Medical Center in Texas before transferring to her current position in Augusta last year. As a cardiology nurse practitioner in the medical center’s congestive heart failure clinic, she often received referrals from primary care providers for patients who appeared to be noncompliant with their medications. Assessing the situation, Lemons discovered that the real reason why the veterans weren’t taking their medicine was that they had low literacy levels and couldn’t understand the instructions printed on their prescription labels.
So she designed a protocol for teaching her low-literacy patients how to take their medications correctly, using pictures instead of words. She found colorful, easy-to-understand computer clip art symbols, copied them onto adhesive labels and stuck them on the patients’ medicine bottles. For example, a rooster pictured with a sunrise symbolized a morning medication, while a bed indicated a nighttime medication. Lemons also transferred the same symbols to the patients’ pill boxes. As a result, the patients’ health improved dramatically.
VA Travel Nurse Corps
Her current goal is to establish special needs clinics across the VA system, with physician consults on site and nurses who are trained to make sure medications are properly labeled. She also hopes the concept of using picture labels will catch on with pharmacies.
Another way Lemons is empowering minority veterans to take control of their health is by providing them with culturally relevant dietary guidelines. “A lot of our [patient education] information is geared toward the average [majority] American, but there’s not much on the different cultures,” she notes.
Suggested menus for a low-salt diet, for example, are usually designed with Caucasian patients in mind and don’t always address the foods that African American or Hispanic patients may include in their regular diets. Lemons provides her patients with the general list of approved foods, but she also offers additional food lists that take into account a patient’s particular culture.
This is another example of how minority patients can be labeled as “noncompliant” when the real problem is that they simply could not overcome cultural barriers to their care, Lemons emphasizes. “If they don’t understand how to eat and take their medicine, they’re not in control of their ailment,” she says. “It really impacts the cost of health care when you have people who end up in the hospital over and over because they just don’t understand what they’re supposed to do.”
One of the Department of Veterans Affairs’ newest initiatives for increasing minority veterans’ access to culturally sensitive nursing care is the VA Travel Nurse Corps (TNC). Designed for RNs who prefer the flexibility and adventure of travel nursing, this program will establish an internal pool of nurses who can be available for temporary, short-term assignments at VA medical centers throughout the country. The TNC deployed its first nurse in December 2007.
Jacqueline E. Jackson, RN, MS, MBA, director of the TNC, says the new program is actively recruiting nurses from culturally diverse backgrounds. “[Minority] VA nurses bring not only cultural competence but respect and acceptance to the many culturally diverse patients under VA care,” she explains. “Nurses in the VA Travel Nurse Corps have an opportunity to travel the country working with a diverse VA patient population and a diverse VA workforce.”
For more information about the VA Travel Nurse Corps, visit www.travelnurse.va.gov.
Who Are Today’s Veterans?
Estimated U.S. Veterans Population: 23,532,000
Number of Total Enrollees in VA Health Care System (FY 2006): 7,900,000
Veteran Population by Race:
White Non-Hispanic 80%
Black Non-Hispanic 11%
Veteran Population by Gender:
Percentage of Veteran Population Age 65 or Older: 39%
Source: Department of Veterans Affairs, October 25, 2007
Cheryl Nicks, RN, CNNP, CGT, CLNC, CPLC, had heard the evacuation warnings before. As a New Orleans native and longtime resident of the city, she remembered the times she had piled her belongings into a car and then sat in gridlock, only to turn around and come home hours later.
So when the evacuation orders for Hurricane Katrina came that August weekend in 2005, the Nicks family, like so many others, planned to stay put and ride out the storm. But as the warnings became more urgent, they changed their minds. On Sunday morning, August 28, they headed to a hotel in northern Mississippi.
The normal four-hour trip took the Nicks family 12 hours and ended with everyone sleeping in their cars in the hotel parking lot—their rooms wouldn’t be ready until the next day. On Monday morning, August 29, they turned on the radio to learn that the levees in New Orleans had given way and the city was under 20 feet of water.
“We all broke down and cried, because we realized we no longer had homes to go back to,” says Nicks, a former president of the New Orleans chapter of the National Black Nurses Association (NBNA).
Two years later, virtually nothing is back to normal for anyone who lived through Hurricane Katrina, one of the strongest storms to impact the United States in the last 100 years, according to the National Oceanic and Atmospheric Administration. With winds reaching 127 mph, Katrina caused widespread devastation along the central Gulf Coast states. Coastal cities in Louisiana, Alabama and Mississippi—including New Orleans, Mobile and Gulfport—bore the brunt of Katrina’s force. More than 250,000 people were displaced and approximately 1,800 people lost their lives. Total damages were estimated to be more than $125 billion.
Many nurses displaced by the storm eventually came back to either little or nothing. Some chose to completely abandon the area and try to rebuild their lives in other parts of the country. Others lost their jobs because of the extensive damage to medical facilities. And nursing students had to make decisions about whether to return to their schools or pursue their degrees elsewhere.
A Future in God’s Hands
The Friday before Katrina struck, Carolyn Mosley, PhD, RN, CS, FAAN, left the Louisiana State University Health Sciences Center School of Nursing in New Orleans, where she was a faculty member, for a scheduled business trip to Knoxville, Tennessee. Thinking the hurricane was headed toward Florida, she took little more than the clothes on her back.
When the forecast changed Friday night, giving the hurricane a 95% chance of hitting New Orleans, Mosley urged family members to leave, then tried to get home to pack up her belongings. She got as far as the Dallas/Fort Worth International Airport, unable to find a flight into New Orleans or a rental car to take her there. She wound up staying with friends in Fort Worth. The next morning, she attended her friend’s church and was struck by the minister’s sermon.
“He talked about not putting all of our hopes and trust in material things, but to place it in the Lord,” Mosley recalls. “That was a very poignant moment. I felt as if he were talking directly to me. I realized I was not going to get off so easily.”
Watching the devastation unfold from Fort Worth, she waited to hear if her family had made it out safely. She soon learned that her mother, sister and a nephew were in a New Orleans hotel room.
“[My nephew] was telling me about how they lost power, how hot it was in the hotel, how there was no running water, how much water was outside, how high [the flood water] was, and that there were bodies floating all around,” she says. She later found out that her own home and a rental property she owned were a total loss.
Mosley spent the next several days gathering displaced family members from Houston, New Orleans and Arkansas at her friend’s three-bedroom Fort Worth home. After setting them up with temporary housing, she headed back to New Orleans and the LSU Health Sciences Center. The campus was severely damaged and is still rebuilding today. The university provides an ongoing “Katrina Facilities Update” on its Web site.
In the wake of the hurricane, the school arranged for a cruise ship to dock in New Orleans to provide temporary housing for faculty members who had lost their homes. Mosley stayed there for several months.
“I used to like cruises,” she says. But she soon found that being “stuck in that ship” was a far from pleasurable experience. “Just the tininess of the cabin, not being able to go anywhere, no TV, no radio, no telephone. To me it was very primitive.”
Facing eviction from the cruise ship in May and having nowhere to live since her family had all relocated, Mosley turned in her resignation and put her professional fate “in the hands of God.” Her prayers, she says, were answered by the College of Health Sciences at the University of Arkansas, Fort Smith, where she accepted a position as associate dean and director of BSN programs. She was recently promoted to dean and plans to retire in the job, but still hopes to rebuild her home in New Orleans.
Her experience as a Hurricane Katrina survivor taught her to stop taking things for granted, Mosley adds. “I enjoy life. I don’t plan to save anything,” she declares. “I want to spend [my life] from day to day because there is no guarantee that my body will be here to use the next day, and no guarantee that Mother Nature will allow me to [hold on to anything.]”
“It Will Never Be the Same”
As the current president of the New Orleans Black Nurses Association, Rebecca Harris-Smith, MSN, RN, has heard more than her share of stories about displaced nurses. She herself was one of them, as were many of her chapter members.
Harris-Smith, a nurse coordinator for a philanthropic organization that trains RNs to start health ministries in their churches, fled to Houston when Katrina hit. The national NBNA, based in the Washington, D.C. area, tracked her through her cell phone, and she was able to get on her computer and track down her chapter members. The national organization—with the assistance of NBNA members in 34 states—helped ensure that Katrina evacuees from all of the affected areas were provided with clothing, medications, medical care, financial assistance and other urgently needed goods and services.
After her home was destroyed, Dr. Carolyn Mosley lived on a cruise ship, then relocated to Arkansas.
Harris-Smith stayed in Houston until October 2005, although she wasn’t called back to her full-time job until January. She was one of the lucky ones—her home in the West Bank area was not heavily damaged and she and her husband were able to move back.
Still, she says New Orleans is not the same city for her. “There are so many displaced loved ones and friends who will never be back,” she explains. “The city is struggling. The home I grew up in, near the Industrial Canal in the Ninth Ward, was completely washed away. I have friends who lost loved ones and family. How can you ever get that back? For me it will never be the same again.”
Harris-Smith continues to work with active chapter members who are still living in FEMA trailers and trying to rebuild their homes. Members were displaced to Houston, Atlanta and Mississippi, but many have returned to New Orleans.
“Just like anything else, it’s that family connection,” she says. “This is home. These are my people, so it’s like I just need to be a part of that.”
A Slow Restoration Process
Dillard University, a private, historically black university in downtown New Orleans, was devastated by Hurricane Katrina. The storm and flooding left the university’s classrooms and campus buildings under more than 10 feet of water.
For Dillard’s nursing school, it would be a year before students and faculty were able to resume classes on campus. Unlike other academic divisions at the university, the nursing school gathered its senior class—many of whom had fled to areas around New Orleans—and resumed instruction in temporary off-campus locations in September 2005, just weeks after Katrina hit, says Dean of Nursing Betty Dennis, DrPH, RN. The school worked with Southern University School of Nursing in Baton Rouge, another HBCU, to share classroom space and a skills laboratory, as well as to secure student housing.
Dillard’s sophomore and junior nursing students were more scattered throughout the country after the storm, so the nursing division worked with colleges and universities all over the map to help its displaced students enroll at those schools to continue their studies. “Many of the universities really were very cooperative in understanding what our students were going through and helping them to get through this without [having to interrupt their education],” Dennis reports.
By spring 2006, the entire university had relocated to the Hilton New Orleans Riverside Hotel on the Mississippi River. The university worked with the hotel to set up classroom space, with additional classrooms set up across the street at the World Trade Center of New Orleans.
You Can Help If you or your organization would like to make a contribution to help nurses and nursing students whose lives continue to be impacted by Hurricane Katrina, the following relief funds would welcome your donation: The Louisiana State Nurses Association Relief Fund was established to help Louisiana nurses displaced by Hurricane Katrina. The fund is accepting cash, checks, gift certificates, etc. Checks should be made payable to Louisiana State Nurses Association Relief Fund and mailed to LSNA, 5713 Superior Drive, Suite A-6, Baton Rouge, LA 70816. Or visit the association’s Web site at www.lsna.org to find out how to help. The Mississippi Nurses Association has also established a relief fund to assist nurses who suffered severe losses as a result of Hurricane Katrina. Tax-deductible donations, made payable to the Mississippi Nurses Foundation, can be sent to the foundation at 31 Woodgreen Place, Madison, MS 39110. Delgado Community College’s Charity School of Nursingis located one block from the Superdome in downtown New Orleans. The nursing school had up to five feet of water in its basement, destroying materials in storage, electrical systems and the elevator mechanicals. Seniors resumed classes just weeks after the hurricane at satellite locations. The college has set up a Katrina Victims Student Relief Fund as well as a Delgado Recovery Fund for rebuilding college facilities. Tax-deductible donations can be made payable to Delgado Community College Foundation and sent to Delgado Community College, Attn: Nita Hutter, 615 City Park Ave., Building 1, Room 221E, New Orleans, LA 70119-4399. For more information, call (504) 784-1102 or visit www.dcc.edu/katrina_chronicles/fund.htm. Our Lady of Holy Cross College in New Orleans acted as an operations base and staging grounds for the National Guard, military and government officials immediately after the hurricane. The college created the OLHCC Hurricane Katrina Relief Fund, a student endowment fund providing funds to students in need. Some of the college’s nursing students are still living in FEMA trailers. Donations can be sent to: Our Lady of Holy Cross College, Hurricane Katrina Relief Fund, 4123 Woodland Drive, New Orleans, LA 70131
With the consent of the Louisiana Department of Education, the university created two 13-week semesters, allowing students to stay on course with their studies. The Class of 2006 graduated in July rather than May, but the exterior of the campus was cleaned up enough to allow for a traditional graduation on the lawn of the Avenue of the Oaks on campus. Seven nursing students graduated with that class.
“Just about all of our students came back after the storm, which is a great testimony to the university,” says Karen Celestan, senior director of university communications and marketing. Two years after Katrina, the Dillard University campus is operating at about 75% capacity and will welcome its largest freshman class—250 students—this fall.
Even though the campus restoration is progressing, Dillard’s nursing school—along with every other nursing school in the Gulf Coast—continues to be tremendously impacted by Katrina. Many health care facilities still have not reopened, leading to a shortage of hospital beds. Before the storm there were more than 2,000 hospital beds in New Orleans. Two years later the city is still inching back, with less than 1,000 beds available.
“We need clinical facilities in order to implement the [nursing] program. When there are problems with the number of facilities and health care providers, there are problems with us finding the clinical experiences our students need,” Dennis says. “We are being very creative. We’re doing a lot of outreach, working together with other nursing programs. We’re doing all we can do to provide those experiences.”
Celestan says the university is probably three to five years away from being completely restored. The campus is still cleaning up, repairing damage and rebuilding what was lost to the storm. “Everyone is trying to get their programs back together,” adds Dennis.
Setting an Example
Dillard University nursing student Randi Horne attended classes in a Hilton Hotel.
Randi Horne was a sophomore nursing student at Dillard University when Katrina struck. She, too, didn’t take the hurricane warnings seriously at first, deciding to head back to her hometown of Houston only after a girlfriend called to offer her a ride. The normal five-hour trip took 10 hours.
Horne watched the news reports from Houston, waiting to hear something about her school. Instead of enrolling at another university, she decided to stick it out at Dillard. She’d already paid her tuition and she felt a sense of loyalty to her professors. So when the call came in spring 2006 to resume classes at the Hilton, she headed back to New Orleans.
The experience of going to school in a luxury hotel was “not as nice as it sounds,” Horne remembers. With no library facilities or the usual amenities available on a college campus, she had a hard time finding a place to study.
“Nursing students don’t just study in the daytime,” she explains. “We study at night and whenever we can find time.”
When big conventions came to town, the school had to give up its classroom space in the hotel’s ballroom. And when the students did have class, the divider walls did little to muffle the sounds of the class next to them.
“It was hard to focus, but we wanted to finish school, so that’s what we had to do,” Horne says. “We had to set so many examples for everyone because we wanted to show we could still come back and succeed [in spite of] the hurricane.”
Horne graduated this year and is in the process of weighing her nursing career options. The hurricane, she says, taught her to be flexible. “I learned to endure,” she emphasizes. “I’ve learned to be patient, to work with as few resources as possible.”
Joe Ann Clark, EdD, RN, is the executive director of the Louisiana State Nurses Association (LSNA), based in Baton Rouge. Shortly after the hurricane hit, the 1,079-member association established a relief fund to assist nurses displaced by Katrina.
To date, 228 nurses have received an average of $500 apiece from the fund, which is still collecting money and providing grants. Clark says donations have come in from all over the world from businesses, nursing organizations and individuals.
Although the applications for assistance have slowed in the past few months, Clark still receives pleas from displaced nurses trying to get back on their feet. “Many of the nurses had lost everything they had. Some of them were [displaced to other cities] but were still having to pay mortgages from New Orleans,” she says. “The stories on those applications are really horrific. Some of [these nurses] were very ill and had no income.”
An LSNA member is putting together a book about the relief fund recipients. The association plans to donate sales from the book, which should be finished by this fall, back to the fund.
The Mississippi Nurses Association (MNA), based in Madison, Miss., also established a relief fund for hurricane-affected nurses. Initially, about $80,000 from the fund was used to pay the licensure renewal fees for every nurse on the Mississippi Gulf Coast who needed assistance, says Ricki Garrett, MNA executive director.
The 1,800-member association has about $56,000 left in its fund and is working on how best to utilize the money to help the most nurses on the Gulf Coast. The fund received a $200,000 boost in April of this year, when Johnson & Johnson held a fundraising event. Garrett says those funds will be used for nursing scholarships, assistance to schools of nursing whose facilities were damaged by Katrina, and mental health continuing education.
“We are seeing a large number of nurses with chronic fatigue syndrome and mental health issues related to the storm,” she explains. “There are many nurses on the Gulf Coast who are still living in FEMA trailers two years after the hurricane. Those individuals are not only trying to work and take care of their patients, they also have to deal with insurance adjustors and FEMA and other government entities. In a lot of cases, more than one family is living in that FEMA trailer, so you can imagine the stress levels of these people.”
Garrett predicts it will be at least 10 years before the Gulf Coast is completely back to normal. “People thought if they survived Hurricane Camille in 1969, nothing could be worse than that,” she says. “Katrina was so many hundreds of times worse than Camille.”
In Mississippi, the requests for help from nurses, nursing schools and students have not slowed, even two years later. MNA members have made several trips to the coast to bring relief supplies to hospitals, clinics and schools. Scrubs, stethoscopes, watches with second hands, toiletries, clothes and books are all items in demand.
Garrett says it’s easy for people who live in other parts of the state to forget what’s happening on the coast. “The nurses in the Mississippi Gulf Coast are still struggling daily,” she maintains. “We hope people will remember that.”
No Place Like Home
After the storm, Cheryl Nicks and various members of her family scattered to Arkansas, Atlanta and Baton Rouge, marking the first time in 40 years the tight-knit family was not all living in the same city.
When Nicks finally saw her New Orleans home in October 2005, she was relieved to find it had taken in only two feet of water. Although mold was growing three feet up the wall, she realized it wasn’t a total loss after all. She moved back into her house, sleeping on a futon and cooking on an electric hot plate during the six-month renovation. She also returned to her job at New Orleans’ Touro Infirmary, a not-for-profit faith-based hospital.
“I needed to go home and be back in my house,” Nicks says, even though it was lonely and scary in her neighborhood for a while because so many residents had still not moved back. Today her house is 95% completed, but she doubts that many of her friends and neighbors will ever recover from the storm.
“We’ve lost families, communities, friends, neighbors, people who will never ever return,” she says, adding that the bodies of two childhood friends were found in the attic of their house during the recovery process.
Asked why she felt the need to return to New Orleans, Nicks’ reply is simple: “Where [else] do you go? There’s always going to be something—tornadoes, earthquakes, hurricanes. Where do you run to? I don’t believe you can run from disaster. This is where my roots are. My grandparents are buried here. This is home for me.”
Commander (CDR) , RN, an officer in the U.S. Navy Nurse Corps, doesn’t sugarcoat what it took to reach officer rank in three different branches of the military, obtain two post-graduate degrees with plans to get a doctorate, and be awarded the Purple Heart for her service in Iraq, all while remaining a dedicated wife and mother. “It took hard work, determination and support from my family to get where I am today,” she declares.
Before entering the military, Langlais worked as a civilian nurse after graduating from Villanova University College of Nursing in Villanova, Pennsylvania. Her career path as a military nurse began in the U.S. Air Force Nurse Corps in 1988 and has followed a uniquely winding course over the past 17 years. Langlais served four years in the Air Force, five years in the Army and has been in the Navy for eight years.
“I’ve been blessed to be able to take my skills and use them in the military,” she says. “I wanted to travel and use my nursing skills, so I have the best of both worlds. The pay and educational opportunities in the military were [vastly superior to what was available in] the civilian sector. The military trained me and gave me the opportunity to utilize my training in a proper setting.”
CDR Langlais believes her family and faith have been paramount in her success, including her recent service in Iraq as a combat nurse. The mother of five children, including six-year-old twins, Langlais explains that her family supports her career without hesitancy. “My husband is a Navy engineer, so he has a clear understanding of what [this life is like]. He is retiring in January 2007 and I will complete my service in 2011.”
During her long and varied career in the military, Langlais has worked in many areas of nursing, including the ER, oncology, critical care and combat trauma units. Today she draws on her experience as both a civilian nurse and a military nurse to help other Navy nurses make the transition back to civilian life. “I’m on a core staff that assists nurses and helps them use the skills and experiences they have from being in the Navy in the ‘real world,’” she says.
In the Line of Fire
In February 2006 CDR Langlais went to Iraq, where she found herself serving as the only African American senior combat nurse in the town of Al Taqaddum, on the outskirts of Al Fallujah. During her five-and-a half months there, she worked in combat trauma care, serving many severely wounded patients.
“I saw a lot of people die. I saw a lot of severe injuries. That’s what happens in wars,” she says matter-of-factly. “There is a difference between witnessing trauma as a civilian nurse and as a combat nurse. Civilian nurses will see patients come in with gunshot wounds, and it’s hard. But in a war you see wounds from explosions, and human bodies so damaged. Our medical technology hasn’t advanced far enough to keep up with these types of injuries. I prayed to God for guidance on how to care for these people.”
On April 7, CDR Langlais was coming out of the galley when she was hit by the second of four rounds of mortar blasts. “The base I was on was very close to Habbaniyah and it was very busy with insurgents day and night,” she says. “Through intelligence, the insurgents learned that the base was highly populated.” Fortunately, she survived the blast and no other military personnel were injured.
Although she has now recovered from her injury, she still feels its lingering effects. “I have damage to my face,” she explains. “The injury is from my cheekbone down past my chin and neck. I went through exploratory surgery after the attack. I have no feeling at all on the right side of my face due to nerve damage. Whether or not I ever recover feeling depends on if the nerves regenerate.”
In a remarkable display of bravery and dedication to her duty as a combat nurse, CDR Langlais refused to leave work after she was injured in the blast. “There were too many junior nurses there who needed me,” she recounts. “The night of my injury, we had a patient who was having an allergic reaction to medication and I gave him care to help him breathe. They weren’t too happy with me for continuing to work, but I wasn’t going to let him die in front of me.”
She stayed on in Iraq for three months after her injury. “I was treated and recovered in a combat zone. I came home two months early and experienced a lot of guilt because of that.”
People who know Lenora Langlais say this dedication to putting the needs of others before her own is typical of her. “She is an inspiration simply because she cares,” says Chaplain Terrell Byrd, who served with CDR Langlais in Iraq. “She cares about people, her job, her profession and her family. She is an inspiration because she came to Iraq as a volunteer. She didn’t have to at her level, but she chose to be at the front of the fight. As a wife and mother of five, I can only imagine her difficulty in making that decision. Even when she was wounded she decided to stay to set an example [of courage] for her young corpsmen.”
A Humble Hero
Despite everything, CDR Langlais feels that “overall, being in Iraq was a wonderful experience.” Does she consider herself a hero? “No,” she says simply. “I consider myself a naval officer who is a nurse.”
But that’s not what the Navy thought. Upon returning home to Camp Pendleton, Calif., CDR Langlais was awarded the Purple Heart for her courage under fire.
The Purple Heart is a combat decoration awarded under the name of the President of the United States to members of the Armed Forces who have been wounded or killed by “an instrument of war in the hands of the enemy.” It is the oldest military decoration currently used in the world and it was the first to be made available to common soldiers. The Purple Heart originated in 1782 during the Revolutionary War and was reestablished by the War Department in the 1930s. The idea of honoring American soldiers for bravery in the face of war is credited to the nation’s first President, George Washington, who wrote: “Not only instances of unusual gallantry but also of extraordinary fidelity and essential service in any way shall meet with due reward.”
That description is a perfect fit for CDR Langlais. “While deployed and in her personal time she rendered the personal touch,” Chaplain Byrd says. “In Al Taqaddum, during her tenure, I don’t know of anyone who did not know her name. There were those who would stop to say ‘thank you’ to her for the time she took with an injured soldier, sailor, marine or airman. During very difficult and long medical procedures she took time to explain what was happening to the military member. CDR Langlais is a natural leader who embodies all that is best of the naval service and the healing arts.”
Through it all, she remains humble. “I am blessed,” she says. “God was watching my back that day. My head could have been blown off. But I survived my injury, I can speak and my face is fine. I served my country, took one for the country and lived to talk about it. I’m grateful for that.”
Despite being wounded, CDR Langlais is still willing to return to Iraq if she were to receive the call. “I would go back,” she declares. “I’d pray about it and discuss it with my family, but I am willing to serve my country again.”
The Face of Diversity
When the U.S. Navy is looking for a nurse who embodies dedication and hard work, they turn to someone like CDR Langlais. She was chosen in 2005 to be featured in the Navy’s recruitment advertising campaign to be the face of the Navy Nurse Corps.
“It was a selection process that included quite a few candidates,” she explains. “They picked me because they thought I had the most appealing personality and smile and I was truly living what the ad represents.”
CDR Langlais is a model in every sense of the word–not only in the Navy ads, but also a role model for others who hope to follow in her footsteps. She travels to universities around the country to recruit other minority applicants into Navy nursing. “I’m hoping that my presence is helping to make a difference, and it does hold people accountable. I lead by example,” she says. “Unfortunately, minorities still experience the glass ceiling. We see where we can go, but we can’t always get there.”
The road to personal and professional success is often paved with adversity, and CDR Langlais has been no exception. As an African American woman she has felt the pain of discrimination. But by continuing to reach higher in educational and professional pursuits, as well as serving her country, she has literally become the picture of success.
“Being the only African American nurse and female officer on the entire base came with a price,” she says of her service in Iraq. “It was a challenge for people to be open-minded enough to take leadership guidance from me. I was labeled as confrontational and mean. If you’re anything other than [the stereotype of] a video vixen or basketball star, they can’t handle you. In their mind you’re being confrontational. But other people’s small-mindedness is not my problem. I never allow those issues to interfere with my patient care.”
What advice does CDR Langlais have for other minority nurses who are considering a career as a military nurse? First, she recommends that you “really do your research” on the nursing profession as well as on the particular branch of the military that you’re interested in. “Interview recruiters and ask lots and lots of questions,” she says. “And then ask more questions and keep asking questions again and again. Check out the recruitment office after hours when they’re not expecting you to be there.”
Her next piece of advice is: Figure out for yourself what you really want from your career and your life and then set goals accordingly. Because she knows firsthand that minorities entering the field often face barriers and obstacles that their white counterparts don’t, she stresses the importance of developing a strong support network. “Your mentor doesn’t always have to look like you,” she adds, “but it sure does help.”
She also emphasizes the crucial role that professional education has played in her success. “Education and training has been paramount in my development as an officer and a nurse. As a teacher, I love to help patients understand the importance of health care. I love seeing that light go on in people when they ‘get it.’”
Ask her Navy colleagues what kind of a role model CDR Lenora Langlais is and their faces light up, too. “There is no greater example of dignity, honor and compassion I can think of than her,” Chaplain Byrd says. “To aspiring nurses she illustrates what it means to be a perfectionist. She gives to them the pride that can only come from a professional with a 17-year career of service. CDR Langlais challenges them and others to not settle for good, but to strive for great. By example, she teaches them to excel in their educational, professional and personal goals.”