Leading nurse educators are launching innovative programs around the country to turn veterans into nurses—a “win-win” solution for the military and the health care system, proponents say.
These programs address two pressing problems, according to Gloria McNeal, PhD, ACNS-BC, FAAN, an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program (2007-2010) and dean of the School of Health and Human Services at National University in San Diego.
First, a looming nurse shortage threatens to undermine health and health care—a problem that is expected to worsen as the nation ages; as the number of people living with chronic conditions grows; and as millions more enter the health care system under health care reform. Access to care is especially critical for the nation’s more than 20 million veterans, who have unique health care needs such as post-traumatic stress disorder, traumatic brain injuries and homelessness, and who have faced long, and highly publicized, waits for health care.
Nearly one in three veterans of the wars in Iraq and Afghanistan has a service-related disability, government statistics show. One in five Iraq and Afghanistan veterans suffers from a mental health problem, and one in three military women has experienced sexual assault, according to advocacy groups. Veterans also experience problems such as traumatic brain injuries, sleep disturbances, and homelessness.
A Tough Transition
The second problem: Society has not provided adequate supports to enable veterans to reintegrate into the workforce and their communities and, consequently, many veterans have a hard time finding meaningful, well-paid employment. The national unemployment rate among veterans who had joined the military after Sept. 11, 2001, was 9 percent in 2013, higher than the civilian unemployment rate, according to the U.S. Department of Labor.
Veterans who aspire to become nurses face challenges. They need to earn degrees in nursing, and cannot get academic credit for the health care experiences they had on the battlefield. Military medical corpsmen and medics, for example, have training in frontline trauma care and first aid, said McNeal, a former naval officer herself. “However, for most programs of study, military clinical experience is not typically converted to academic credit, a reality which often turns veterans away,” she said. “Independent duty corpsmen are prepared to administer complex medications and to perform all kinds of invasive procedures, including amputation of limbs and emergency appendectomies. They are medical professionals on the field in combat areas. But when they leave the military, they lack the credentials to move into nursing positions.”
To address these twin problems, the Health Resources and Services Administration (HRSA) has provided funding for select nursing schools to help veterans earn bachelor’s degrees in nursing (VBSNs). The schools award academic credit to veterans for their military experience in health care and nursing and offer a variety of programs, including accelerated tracks for veterans who have completed pre-nursing programs or who have health care experience. Participants also receive career counseling and assistance preparing for nurse licensing examinations.
When participants graduate, they are able to provide highly skilled, empathetic, culturally sensitive care to veterans and their families, McNeal said. “They certainly understand combat and military culture, and they know what it takes to heal from an injury as a result of that.”
Because the veteran population is more diverse than the nursing workforce, VBSN programs also help diversify the nursing workforce, said Lori Escallier, PhD, RN, CPNP, a professor of nursing and an associate dean at the State University of New York at Stony Brook. Participants in Stony Brook’s VBSN program receive mentoring from scholars in the New Careers in Nursing program, which is supported by RWJF and the American Association of Colleges of Nursing; it provides scholarships and other supports to college graduates without nursing degrees who are enrolled in accelerated baccalaureate and master's nursing programs. The camaraderie between VBSN students and NCIN scholars “is amazing,” Escallier said. “They take care of each other.”
Training Civilian Nurses
Other programs are training and supporting civilian nurses in the care of veterans and their families. The Jonas Center for Nursing Excellence, for example, provides $10,000 scholarships to doctoral nursing students who are researching ways to improve care for veterans. The program was launched in 2011 and has supported more than 150 doctoral nursing students.
Programs like these are needed to improve nursing care for veterans, said Lynn Babington, PhD, MN, RN, an RWJF Executive Nurse Fellow (2013–2016) who is senior vice president for academic affairs at Fairfield University School of Nursing in Connecticut. At Fairfield, the Jonas Veterans Healthcare program is supporting a doctoral student who is studying ways to help veterans who suffer from mental and chronic illness and homelessness.
Fairfield University was also selected to participate in a five-year program with the Department of Veterans Affairs to educate nursing students on the specific health care needs of veterans and their families. For the program, Fairfield nursing faculty taught at, and nursing students rotated through, the VA Connecticut Healthcare System, while educators infused the nursing curriculum with veteran-specific content. “This partnership has educated many more nurses in the care of veterans and their families,” Babington said. The program concluded in 2012, but administrators have continued the nursing school’s partnership with the VA Connecticut Healthcare System.
Still, more work needs to be done to ensure that nurses have the training they need to care for veterans and are able to conduct research on the population, Babington said.
Over the past few months, the VA has been on a mission to improve systemic access problems, said Raymond Phillips, PhD, MS, RN, an RWJF Executive Nurse Fellow (2013–2016) who is the chief nurse for inpatient nursing and nursing research at the VA Northern California Health Care System. “Our top priority has been getting appointments for veterans who have been waiting too long to see their providers,” Phillips said. “We have contacted 311,000 veterans to get them off wait lists and into clinics, and we have decreased the number of veterans on our electronic wait list by nearly 35,000. We have also made more than 1.5 million referrals for veterans to receive care in the private sector.”
To do that, the VA has used a variety of techniques, including adding evening and weekend hours at clinics, hiring more staff, deploying mobile medical units, and offering more care in the community, Phillips added. “The VA is working strenuously to provide access for all veterans across the nation. We’re certainly working on a constant basis to ensure all of our patient population has access to primary and specialty care.”
Read more about RWJF scholars and fellows building a Culture of Health that includes veterans here.