Is the Army still projecting a nursing shortage? How is the Army competing with civilian employers in recruiting and retaining skilled medical personnel?

Overall, the Army has military nurses, civilian nurses (government employees), and contracted nurses. The Army Nurse Corps includes both active and Reserve component nurses. We have some shortages in some specific areas but not a shortage overall. Certified registered nurse anesthetists [CRNA], psychiatric nurse practitioners, and OB-GYN nurses are examples of shortage areas. We use precision recruiting to focus on those specific areas and have some recruiting and retention tools that are very effective in filling active-duty vacancies.

The need for care and compassion has not changed. The ability to use our senses – hearing, touch, smell, visual – and to communicate what we are doing and why with both the patient and the family is still keenly important.

Our civilian workforce is on average 49 years old, so we will see nurses retire in the near future who have been in our military health care system for many years. We are challenged to compete with the [Department of Veterans Affairs] as it typically pays a higher salary rate. Some areas of the country are easier to hire than others. It requires a continuous effort to ensure we have the right skill mix and staff numbers on hand.

We balance our military nurses with our civilians and contractors to ensure appropriate staffing, but more importantly to ensure our military nursing staff has the ability to maintain their skills to provide care in a deployed, austere environment. Every day is an opportunity to hone our skills as we care for patients and their families. For many, the reward of caring for America’s sons and daughters, the opportunities to grow professionally, and the ability to make a difference is enough to retain our nurses.

What kinds of opportunities for continuing education and advancement in their field do Army nurses have today?

Army nurses have many opportunities to advance and grow throughout their time in the military. All Army nurses come into the Army with a Bachelor of Science in nursing. A new nurse, usually a second lieutenant, will start out by being a staff nurse and within 18 months to two years can advance to be a team leader on their shift, precepting other nurses and teaching their newer staff members. They can select a specialty area, such as the ICU, ER, OB-GYN, psychiatry, public health, or operating room, and attend a 12- to 16-week course that teaches the skills of that specialty.

They can also obtain a master’s degree in a variety of areas such as administration, informatics, education, or as a clinical nurse specialist, or a doctorate in nursing practice (DNP) and become an advanced practice nurse in anesthesia, psychiatric nurse practitioner, family nurse practitioner, or a nurse midwife. They can also become a nurse scientist by earning a Ph.D. These opportunities are part of the Long Term Health Education and Training program where the military pays for the education and the officer incurs an obligation to stay in the military.

There are many other leadership opportunities throughout their career that include becoming the clinical nurse officer in charge (CNOIC), supervisor of an inpatient section, deputy commander for inpatient services, chief nursing officer, all within a hospital setting. Outside the hospital, there are opportunities to work directly with our soldiers in brigade combat teams, work in our forward surgical teams and Combat Support Hospitals in field environments and deployed settings, or to support combat operations, natural disasters, or humanitarian missions. There are also opportunities to work as a staff officer, in recruiting, as an ROTC nurse counselor, as a commander, or in other nontraditional nursing roles such as a congressional liaison or on the Army staff.

You served in a Combat Support Hospital during Operation Desert Storm, and then later commanded one in Iraq in 2010. How different was your experience and what perspective did you gain?

Both experiences were very rewarding, both personally and professionally, but very different from each other. During Desert Shield/Desert Storm, we had no idea how long we’d be deployed. We spent most of our time in locations that had no base support, so we provided our own security, established our own life support areas, and ate a lot of MREs and T-rations. We lived in GP Medium tents, with a cot and sleeping bag. We took the MUST hospital (Medical Unit, Self-contained, Transportable) with us and while in the Saudi Arabian desert, we were issued and trained on the DEPMEDS (Deployable Medical System) hospital. We arrived in October and provided care for soldiers injured in training, illnesses, and accidents. Communication was very limited. We drove three hours to a phone bank and were allowed 15 minutes to make phone calls once in the first three months. We wrote letters home and it was weeks before receiving mail back. In March, we joined a 604-vehicle convoy into Iraq, driving for two and a half days in the back of 5-ton trucks. We set up our hospital (47th Combat Support Hospital) during the night and the next day received casualties, most of whom were Iraqi soldiers and civilians. Many of them had received injuries two to three days prior. The experience was a test of resilience, tolerance, and stamina. The biggest challenge was in not knowing what was happening in theater or how long we’d be there.

In 2010, we deployed the 21st Combat Support Hospital to Iraq, to a known location for a known length of time. We covered three separate locations, but were on established bases with many of the comforts of home: indoor plumbing, showers, containerized housing with beds and well-stocked dining facilities. I could Skype every night with my husband. Our hospitals were mostly in hardened buildings, although with the drawdown to Operation New Dawn, we moved out of one fixed location back into DEPMEDS so we could transfer the fixed location over to the Iraqi air force. The medical equipment was more modern and we had ready access to medical supplies and medical evacuation. As the commander, I had a very good understanding of the situation on the ground. The biggest challenge was making good decisions that were right for each location and the constant worry about getting everyone home safely.