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An Air Force Nurse Leader’s Impact: Brigadier General Goodwin, 10th Air Force Nurse Corps Chief

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Victoria Hughes, DNS, MSN, MA, RN, CENP

Abstract

To pursue and fulfill the limitless potential of nursing, it is important to recognize and record the stories of previous leaders who helped to pave the way for advances in the nursing scope of practice, clinical expertise, and leadership opportunities. The purpose of this oral history research method study was to preserve and explore the impact and contributions of Brigadier General (Brig Gen) Barbara Goodwin during the evolutionary time from 1988 to 1991. In an extensive interview, Brig Gen Goodwin reflected on her leadership strategies to address the nurse shortage, the advancement of nurse leadership and educational opportunities, and crucial collaboration efforts contributing to the deployment of 40,000 women in support of war efforts. The findings section discusses the leadership themes identified, which included collaboration, prioritization, understanding the system, and a passion for clinical nursing. The conclusion summarizes her significant impact on military nursing.

Citation: Hughes, V., (September 10, 2021) "An Air Force Nurse Leader’s Impact: Brigadier General Goodwin, 10th Air Force Nurse Corps Chief" OJIN: The Online Journal of Issues in Nursing Vol. 26, No. 3.

DOI: 10.3912/OJIN.Vol26No03PPT70

Key Words: Air Force Nursing, military nursing, Operation Desert Storm, USAF, AFNC, AFMS, women in military

Nursing is a constantly evolving profession, spearheaded by passionate, visionary leaders...“The Air Force Medical Services supports the United States Air Force through the provision of full spectrum medical readiness to the 200,000 airmen currently engaged in operations around the world, and by delivering healthcare to 2.6 million patients though a system of 239 clinics at 76 installations worldwide” (Air Force Medical Services, 2020, para. 2). Nursing is a constantly evolving profession, spearheaded by passionate, visionary leaders, such as Brigadier General (Brig Gen) Barbara Goodwin. Little is known, outside of the Air Force Nurse Corps (AFNC), about her contributions toward resolving nurse shortages, advancing nurse education and collaborating with the United States Air Force (USAF) Reserve and Air National Guard to deploy the largest number of women in the United States’ history.

The purpose of this research is to explore the impact and contributions of the Air Force Executive Nurse Leaders from 1988 to 1991, through the eyes of Brig Gen Goodwin, that have led to the advancement of nursing. The interview with Goodwin reveals the executive nurse leader role and influence on nurse retention, expansion of advanced practice nursing education, and collaboration between civilian and military nurse leaders to deploy the largest number of women within American history. The following table is included to familiarize readers with military terminology used in this article.

Table. Overview of Military Terminology

Acronym

Term

Definition

AFMS

Air Force Medical Service

An umbrella structure that encompasses all facets of providing healthcare to all military beneficiaries in the USAF. The service consists of five distinct health Corps and enlisted medical personnel.

Aeroevac

Aeromedical Evacuation

A unique Air Force asset which uses fixed wing aircraft which allow for larger patient loads, transported over longer distances, at higher altitudes, with a greater ability to care for the seriously injured. 

Commander

Commander

The title is officially applied to the commanding officer of an Air Force unit; Commanders hold the authority and responsibility to act and to lead their units to accomplish the mission. The type of commander is based on the level of the position such as squadron, group, or wing commander.

Corps: BSC, DC, MC, MSC, NC

Bioscience Corps, Dental Corps, Medical Corps, Medical Service Corps, Nurse Corps

The AFMS has five health care disciplines/Corps; all health care officers are a member of one of these five Corps

Deployment

Deployment

The movement of personnel and/or equipment to a place or position to support military action.

DoD

Department of Defense

The federal department responsible for providing military forces (Army, Navy, Marine Corps and Air Force) to deter war and protect the national security of the United States.

Flight Nurse

Flight Nurse

Air Force Flight Nurses are the senior member of the aeromedical evacuation team to provide lifesaving emergency and prehospital care (from planning to final deplaning) to patients during an aeromedical transport.  

Total Nursing Force

Total Nursing Force

The combined nurses serving the United States Air Force to include active duty, reserve, and air national guard members.


Research Method

Oral history helps to uncover unique stories and experiences while illuminating significant connections from past lessons to the current and future practice of nursingTo preserve nursing heritage, the oral history method (Thomas & Rosser, 2017) was used to explore and record the experiences of the 10th Air Force Nurse Corps Chief. Oral history is an umbrella term that incorporates the research methodology of conducting and recording interviews and the result of the research process (transcribed interviews and analysis) to help understand the past (Abrams, 2016). Oral history helps to uncover unique stories and experiences while illuminating significant connections from past lessons to the current and future practice of nursing (Biedermann, 2001). The testimony of the participant, complete with their personal perception of the events through their memory, adds an important, human component to the historical events. Oral history is considered a tried and tested research practice (Abrams, 2016). Oral history can be used to allow people, from all walks of life, to have a voice and be heard (Thomas & Rosser, 2017). Strategies for promoting the voice of participants, such as active and deep listening, clarification, exploration, and paraphrasing, were used to enhance understanding of the participant’s memories. Deep listening denotes present and respectful listening (Abrams, 2016). To expand the content, other historical sources were added to provide more details related to context within the Air Force and Nursing during the time period. To provide meaning within the historical context, analysis of the transcribed interviews involved examination and interpretation of the personal, professional, leadership, and military nursing experiences.

Procedure
An expert panel of executive nurses suggested modifications to the questions for appropriate use with Air Force executive level nurses.After obtaining study permission from an Institutional Review Board, a semi-structured interview was conducted. The original survey was developed by Dr. Lucinda McCray, Professor of History at Appalachian State University. An expert panel of executive nurses suggested modifications to the questions for appropriate use with Air Force executive level nurses. After obtaining informed consent, the participant interview was audio-recorded and then transcribed verbatim. The accuracy of the completed transcription was double-checked with the participant. The transcript was analyzed and themes were identified. Two researchers coded separately and then compared findings reaching consensus.

Participant
She considered her primary role as Nurse Corps Chief as stewardship...Barbara Goodwin was born in 1938 as the second of thirteen children. In 1959, she obtained her diploma in nursing and joined the United States Air Force in 1962. In 1972 Goodwin graduated with a Master of Science with a specialization in medical-surgical nursing from the University of Colorado and in 1973 she became a Clinical Nurse Specialist. In October 1988 Barbara Goodwin was promoted to brigadier general and served as the Air Force Nurse Corps Chief until she retired in 1991. During her tenure as Chief of the AFNC, the Air Force Medical Service (AFMS) was structured in a type of stovepipe system that restricted nurses to supervise solely other nurses and medical technicians. Brig Gen Goodwin was responsible for 5,400 active-duty nurses and around 6,000 active-duty medical technicians. She considered her primary role as Nurse Corps Chief as stewardship: to do what needed to be done for the nurses and technicians to accomplish the AFMS mission. This involved providing the necessary resources, education, and training. A vital part of her role was to ensure that there were sufficient qualified nurses to accomplish the mission of the AFMS.

Context: Air Force Nursing Shortage
In the late 1970s and early 1980s, the Air Force Reserve and the Air National Guard had “ninety percent of its authorized peacetime positions filled,” (Lindberg, 1999, p. 2) even though civilian nursing was experiencing shortages long before then. It was not until the late 1980s that the civilian nursing shortages began to impact the United States Air Force. The shortage was largely due to an increased number of women entering the general workforce, instead of nursing. Women began choosing higher paying jobs that better supported familial responsibilities than nursing could (Lindberg, 1999). An additional contributing factor to the nurse shortage within the United States Air Force included the decrease in joint-spouse assignments (Lindberg, 1999), which were helpful in preventing family separations by allowing couples to be assigned to units on the same installation.

It was not until the late 1980s that the civilian nursing shortages began to impact the United States Air Force. Except for nurse anesthetists, a Bachelor of Science in Nursing (BSN) was adopted for all accessions in 1982 (Rank, 1999), but in 1988 there was an effort within the AFMS to lower the educational level required to enter nursing practice within the Air Force. The proposed plan was for medical technicians to obtain an associate degree as a nurse, but still work as a technician. After obtaining an associate degree, the technicians would be technical nurses, not professional nurses. If associate degree nurses went back to school and obtained a bachelor’s degree, they would then become professional nurses. Brig Gen Goodwin did not favor this proposal; she recognized the valuable contributions that strong clinical nurse leaders could make on patient care delivery. Brig Gen Goodwin advocated for highly skilled and educated nurses at the bedside, but she faced strong opposition within the AFMS.

Findings

Brig Gen Goodwin recognized that as the 10th Air Force Nurse Corps Chief, she would need to move some of the programs established by past corps chiefs forward. While discussing her objectives for the Air Force Nurse Corps during her tenure, she commented:

It’s rare that a nurse corps chief would start a particular initiative and see it completed during their tenure due to the complexity of how the AFMS and the Air Force operate. Each new Corps Chief built upon the previous strategic plan because they were part of the development of that strategic plan as one of the Air Force Nurse Corps leadership. (Goodwin, 2017, pg. 13). 

...resolving the shortage became a high priority for Brig Gen Goodwin.Three of the objectives that Brig Gen Goodwin focused on were continuing to increase the number of senior clinical nurse manpower authorizations to allow clinical nurse promotions; increasing educational opportunities for nurse anesthetists to obtain a master’s degree; and collaborating with the Air Force Reserve and Air National Guard nurse leaders to meet Total Force Nursing objectives. However, when the nursing shortage began affecting the Air Force, resolving the shortage became a high priority for Brig Gen Goodwin. She developed strategies to implement programmatic change with strong long-term impact. Brig Gen Goodwin demonstrated collaboration, prioritization, a passion for clinical nursing, and an understanding of how to work within the system to achieve strategic objectives.

Leadership Strategies Addressing Nursing Shortage
...Brig Gen Goodwin had to transform the way the Air Force attracted and retained nurses.For the fiscal year 1988, the Army and Navy were not able to recruit the number of nurses to reach their accession goals, and the Air Force was not able to meet the recruitment goal for nurse anesthetists (Finfgeld, 1991). To combat the nursing shortage and prevent lowering education requirements of the practicing nurses within the Air Force, Brig Gen Goodwin had to transform the way the Air Force attracted and retained nurses.

Brig Gen Goodwin identified her best leadership attribute as her ability to “get along with others, organize a team of people, and keep others working as a team” (Goodwin, 2017, pg. 15). She noted, “You have to recognize and accept the worth of all of the team members” (Goodwin, 2017, pg. 16). In other words, Goodwin had a talent for facilitating interprofessional collaboration to reach mutually agreed upon team goals. Goodwin also credits one of her mentors, Colonel Pearl Tucker, for helping her to learn how to discern priorities, stating:

There are some battles that you always win; there are some battles that you will never win; there are some battles that are important to win; and there are some battles that you cannot afford to lose. Focus your energy on the battles that are important to win and those that you cannot afford to lose (Goodwin, 2017, pg10).

By strategically navigating through the governing system, establishing clear priorities, and engaging in interprofessional collaboration, Goodwin found a way to stay focused on the top nursing priorities and communicate the value of nursing in a non-threatening manner.

...Goodwin found a way to stay focused on the top nursing priorities and communicate the value of nursing in a non-threatening manner.Brig Gen Barbara Goodwin became the first AFNC Chief invited to present testimony to the United States Senate (Lindberg, 1999). She proposed strategies to combat the nursing shortage and address specialty pay issues. One of her strategies was to increase the financial incentives to recognize the value of clinical nursing experience and advanced nursing education. She gained support as many of these financial incentives were put into action. In 1988 Congress authorized the military to give appointment credit for civilian nursing experiences and education, so nurses could enter the military at a higher rank. The Senate Armed Services Committee authorized a two-year pilot program to pay critically undermanned specialties annual bonuses up to $10,000 to join the Air Force Reserve units (Finfgeld, 1991). The National Defense Authorization Act (NDAA) for 1990 and 1991 provided a $5,000 access bonus for nurse accessions who signed a four-year contract. In addition, the NDAA provided an incentive specialty pay of $6,000 for certified registered nurse anesthetists (United States Congress, 1991). The nurse scholarships for advanced education and incentive pay programs came with a commitment to serve for a specified time based on contract requirements.

Goodwin understood business plans and manpower formulas, so she recognized the need to obtain more authorizations for clinical nurses to be promoted to senior field grade rank and positions (Goodwin, 2017). Goodwin advocated that nurses in leadership positions, “need to have strong management skills and understand business concepts so that they can effectively and efficiently manage their assigned assets” (Goodwin, 2017, pg. 21).

At that time, nurses who wanted to specialize and remain clinical would transition into the role of nurse practitioners because there were not authorizations for them to remain clinical at the bedside in higher grades. Goodwin wanted to establish a clinical pathway for nurses to be promoted to the rank of colonel because she believed that exceptional clinical nursing skills were essential for both clinical and administrative positions. “Those who wanted to specialize would become nurse practitioners and my concern was that the nurses who were the least prepared were the closest to the patient” (Goodwin, 2017, pg. 13).

...creating the clinical pathway and nurse authorizations through the Air Force Medical Service would prove to be a very difficult challenge. To make a lasting impact, Goodwin had to strategically work through the system to achieve the desired manpower authorization increases for the nurse corps. However, creating the clinical pathway and nurse authorizations through the Air Force Medical Service would prove to be a very difficult challenge. Goodwin’s passion for clinical nursing helped to drive her priorities, as described with the following quote:

Because I never lost my love and appreciation of clinical nursing, I was able to keep my focus on the needs of the patients. I focused on establishing a nurse clinical ladder and advocated that clinical excellence be recognized on senior nurses’ Officer Performance Reports and Promotion Recommendation forms. I worked collaboratively with other AFMS Corps Chiefs (Medicine, Dental, Bioscience and Medical Service) to increase the authorizations for field grade nurses working in clinical areas. Our team was able to obtain several colonel-level positions. I have always believed that we need strong clinical nurses at every organizational level (Goodwin, 2017, pg. 16).

Goodwin (2017) discussed using the following strategies to facilitate change, stating: “listen to everyone, be flexible, be able to look at all sides of the situation before making decisions, try to be more objective, and work well with other people” (para. XX) and “I knew before I came into the position as the 10th Chief of the Air Force Nurse Corps that if you work with people, you are going to get a lot further than if you don’t” (pg. 13). To increase the nurse authorizations, Brig Gen Goodwin would need to demonstrate the value of nursing during a period when the number of hospitals were being reduced within the Air Force, as well as convince the leadership in the Air Force Medical Service Headquarters to transfer authorizations from other healthcare disciplines to the nurse corps. Goodwin realized that obtaining nurse authorizations was a priority and a battle that had to be won. She also realized that she would need to build bridges, be flexible and collaborate well with the interprofessional leadership team to accomplish these goals (Goodwin, 2017).

She also realized that she would need to build bridges, be flexible and collaborate well with the interprofessional leadership team...Goodwin and her team were persistent, collaborative, and worked diligently to garner the interprofessional support needed to increase the number of USAF Nurse Corps Colonel authorizations. In December 1988, the Air Force Surgeon General approved field grade increases for nurses working in the Newborn Nursery, Neonatal Intensive Care, Obstetrics, Operating Rooms, as well as Nurse Anesthetists and Chief Nurses (Lindberg, 1999). In September 1989, the USAF Deputy Chief of Staff for Programs and Resource approved another increase of 16 colonels, 82 lieutenant colonels, and 296 majors for the Nurse Corps (Lindberg, 1999). Brig Gen Goodwin had facilitated a cultural shift to recognize the value of not only administrative nurses, but also clinical nurse leaders at the executive level ranks.

Expanding Nurse Education and Leadership Opportunities
Goodwin was able to demonstrate that providing enhanced educational opportunities to nurses improved nurse retention...Brig Gen Goodwin believed that the AFNC needed to recruit, retain, and grow nurses who desired to provide patient care in multiple, unique settings, such as aeromedical evacuation and critical care (Goodwin, 2017). The Air Force had a Flight Nurse training program, but there was no Air Force training program for critical care. Goodwin would need to use the same skills of collaboration, prioritization, and knowing how to work through the system to build support for a new training program. Therefore, the AFNC developed an internship program to help new nurses transition successfully into critical care practice and military life (Lindberg, 1999). Recruiting more nurses who were experienced in critical care was challenging. The internship program was designed for nurses who did not have critical care experience. One benefit of hiring new nurses and engaging them in the internship program was that the Air Force was able to create their own training for a multitude of different specialty areas (Lindberg, 1999). The internship program proved to be successful, showing that nurses who participated remained on active duty for a longer period of time than those who had not (Lindberg, 1999). Goodwin was able to demonstrate that providing enhanced educational opportunities to nurses improved nurse retention during the national nursing shortage.

With the increase in Nursing Master's programs during the 1970s, the number of nurse practitioners within the United States grew from 250 in 1970 to 20,000 by 1980 (Bush & Capezuti, 1996). However, the AFNC lacked experienced surgical nurses, nurse anesthetists, nurse midwives, and pediatric and obstetrical/ gynecological nurse practitioners (Lindberg, 1999). One of Goodwin’s goals for the Air Force Nurse Corps was to provide an opportunity for nurse anesthetists to obtain Master of Science degrees. Brig Gen Goodwin established partnerships to help meet the advanced education goals within the Air Force Nurse Corps. In September 1989, the Air Force Nurse Corps started its own Nurse Anesthesia program through an affiliation with the University of Texas, School of Health Sciences at San Antonio, Texas (Lindberg, 1999). Further collaboration efforts resulted in the Armed Forces Health Professionals Scholarship Program expanding to include 15 scholarships for Nurse Anesthesia in June of 1989 (Lindberg, 1999).

Over time, more and more nurses were sought as commanders for the medical treatment facilities...In the early 1990s, numerous changes were occurring in the structure of the AFMS. It provided new interprofessional leadership opportunities within the AFMS, and the Air Force Nurse Corps was postured to demonstrate the value of nurses moving into these higher-level positions. The AF Nurse Corps leaders had strategically provided opportunities for junior nurses to work in a variety of leadership roles to develop essential skills necessary for more senior roles. Nurses had previously only been allowed to command air evacuation facilities and units. However, Colonel Judith Hunt made history when she was selected to command a fixed Medical Treatment Facility for the first time in the 43-year history of the Air Force Nurse Corps and the 45-year history of the AFMS. She assumed command of the clinic at Pope Air Force Base, North Carolina, on April 27, 1990, after having first served as the Squadron Commander of the tactical Aeromedical Evacuation Squadron (AES) assigned at Pope (Lindberg, 1999). USAF Line Commanders were impressed with the leadership and performance of the Nurse Corps squadron commanders. Over time, more and more nurses were sought as commanders for the medical treatment facilities because of their exemplary performance records.

As nurses performed exceptionally well in leadership positions and formed collaborative relationships, more diverse opportunities became available to those nurses who followed. In 1991, Lieutenant Colonel Joellen de Berg became the first nurse to serve as a Congressional Nurse Fellow for Senator Daniel K. Inouye from Hawaii. In the same year, Congress designated one million dollars for military nurses to conduct clinical nursing research (Lindberg, 1999).

For these opportunities to continue, senior nurse leaders had to prepare the next generation of leaders. For these opportunities to continue, senior nurse leaders had to prepare the next generation of leaders. The mentorship programs helped to create links between nurses and nurse leaders. Mentorship programs provided opportunities for nurses to assist one another in personal, professional and intellectual development. According to Grossman (2007), mentoring within nursing builds relationships, or links, creating a culture that is empowering and sustainable. “A good mentor gives you support and helps open doors. A great mentor helps you achieve heights you may never have imagined were possible” (Bryce & Redick, 2016, p. 19). Mentoring relationships involve empowering connections and dynamic guided experiences to promote growth and development (McCloughen, O’Brien, & Jackson, 2013). Leadership development is a lifelong transformative process grown from diverse experiences and influential role models. Mentoring is commonly accepted as a core function of nurse leaders (McCloughen et al., 2013). Nurses consciously adopted particular behaviors and unconsciously developed values and principles from mentors (McCloughen et al., 2013).

...the nurses were passionate about bringing home the wounded, sick and injured warriors.Mentors helped nurses find their passion and commitment within nursing. It is that passion that keeps nurses working within the field during challenging periods. A study of Air Force Active Duty, Air National Guard, and Air Force Reserve nurses who worked as part of an aeromedical evacuation crew, explored why they continue to work in such a highly demanding job. The investigators found that despite the difficult nature of the Air Force enroute care mission, the nurses were passionate about bringing home the wounded, sick and injured warriors. They were committed to perform the best, safest care possible (Pierce, McNeill, & Dukes, 2018).

She wanted Air Force nurses to remember and value the importance of serving in direct patient careGoodwin recognized as a nurse leader she would be a role model and mentor for other nurses. When Goodwin was the Command Chief Nurse of Air Mobility Command (a major functional area of the USAF), she was still a certified flight nurse and once again flew aeromedical evacuation missions for those three years. She thrived on providing patient care within these austere environments, and she believed it was important to be a role model for clinical competence at all levels of nursing leadership. She provided an avenue for nurses to stay clinically focused and experience meaningful patient care relationships. She wanted Air Force nurses to remember and value the importance of serving in direct patient care (Goodwin, 2017).

Total Nursing Force Development
In 1976, a historic meeting was held at Andrews Air Force Base in Maryland for the Air Force Command Nurses and other key nursing personnel to discuss the Air Force Nurse Corps’ goals for the “Total Nursing Force” for the next five years. The Total Nursing Force includes the Active Duty, Reserve, and Air National Guard nurses. One of the objectives was to improve utilization of nursing personnel assigned to the USAF Reserve and the Air National Guard (Rank, 1999). In 1977, a change to AF Regulation 3-41 required Reserve nurses to be actively engaged in nursing. In July 1979, Goodwin was assigned as administrative staff officer, Office of the Chief, AFNC, Bolling, Air Force Base, Washington, D.C. During this assignment she worked directly for Brigadier General Sarah Wells, Chief, AFNC. Goodwin was able to witness decision making, collaboration, and joint planning at the highest levels within the United States Air Force Nurse Corps. Although Brig Gen Wells did not have any formal authority over the nurse leaders in the USAF Reserve and the Air National Guard, she was able to work with these nurse leaders to develop mutual goals to increase the effectiveness of the Total Nursing Force in support of the Air Force Medical Service’s and Air Force’s goals. Goodwin described her experience as “a real eye opener from many perspectives and a great opportunity just to learn about the processes at headquarters” (Goodwin, 2017). These early meetings provided insight that Goodwin would need later to build upon the initial efforts toward consolidating the Total Nursing Force mission made by earlier nurse leaders.

In 1980, Brig Gen Wells conducted the first Senior Air Reserve Forces Nurses meeting at Bolling AFB, DC. The meeting emphasized creating a standardized nursing philosophy in support of the Total Force policy and to review current nursing issues (Rank, 1999). There were numerous meetings with the nursing leaders of the Reserve and Guard to explore how they could improve their support of the mission of the Air Force Medical Service. Although not known at the time, Goodwin attributes these previous leadership experiences as preparation for the day she would need the support of the USAF Reserve and the Air National Guard chiefs to meet and discuss the nursing requirements to support Operation Desert Shield/Storm.

Deployment of Total Nursing Force
The Gulf War was one of the major events that occurred during General Goodwin’s tenure...The Gulf War was one of the major events that occurred during General Goodwin’s tenure as the USAF Nurse Corps Chief that required the support of  the AF Total Nursing Force. On August 8, 1990, the Air Force Medical Service began the largest deployment since the Vietnam War (AFMS History Office, 2021). During Operation Desert Shield, the AFMS deployed 925 hospital beds faster than the 750 beds deployed during the Vietnam War (AFMS History Office, 2021). Operation Desert Storm resulted in the deployment of 40,782 women (Holm, 1992), the largest deployment of military women in United States history (Pierce, 1998). By the end of the Gulf War, there were 14,500 officers, 30,000 enlisted medics and 9,500 civilians deployed for the AFMS (AFMS History Office, 2021). With the Gulf War, deployments substantially changed the dynamics of military nursing and the postwar readjustment for women following wartime service.

These collaborative relationships had been building over years of meetings, planning sessions, and partnerships. The mobilization of the Air Force Reserve and Air National Guard nurses were essential to a successful medical deployment. Brig Gen Goodwin coordinated nurse movements with the other leaders in the AF Total Nursing Force. These collaborative relationships had been building over years of meetings, planning sessions, and partnerships. The medical reservists accounted for almost ninety-seven percent (97%) of the aeromedical evacuation cadre and for half of the Air Force medics in Europe and Southwest Asia (AFMS History Office, 2021). Brig Gen Goodwin had to work with the nurse leaders in the Air Force Reserve and Air National Guard to effectively implement the Total Force Nursing deployment plan. In addition, the Reserve and Guard nurses backfilled the vacated stateside hospital positions when the Active-Duty medical personnel deployed in support of Operation Desert Storm (ODS).

According to General Goodwin, some of the Reserve and Guard medics who backfilled stateside positions felt that their contributions were not recognized. She noted:

The people who deployed overseas were given most of the recognition. The nurses who did not deploy and maintained the stateside peace time mission aided by Reserve and Guard medics felt unappreciated. I made it a priority to visit medical treatment facilities to let them know how important their mission was, even if stateside, and not overseas (Goodwin, 2017, pg. 12).

Again, Brig Gen Goodwin focused on collaboration and prioritization. She placed the clinical nurse adjustment and job satisfaction as a priority for all of the Total Force Nurses. “It was a very challenging time for the Air Force Total Force Nurses. There were lessons learned from the ODS experience that were incorporated into future deployment of the Total Nursing Force” (Goodwin, 2017, pg. 18).

Morbidity and mortality rates were markedly decreased for this conflict in comparison with the Vietnam War.As a result of Operations Desert Shield and Desert Storm (ODS/DS), Brig Gen Goodwin recalled there were significant, rapid advances in the transportation and treatment of very critically ill and injured casualties. Morbidity and mortality rates were markedly decreased for this conflict in comparison with the Vietnam War. This made not only a lasting contribution to future conflicts such as the Iraq and Afghanistan wars, but also influenced civilian casualty care.

Limitations
Like all historical sources, interviews may contain personal biases, but these biases may themselves constitute important data for the historian's consideration. A potentially greater problem is the inability of some interviewees to provide accurate accounts because of the limitations of human memory. However, the personal perception of the events through memory, adds an important human component that might be missed in other forms of data collection. Memory is recognized and accepted in the literature as valid data within the oral history method (Thomas & Rosser, 2017). Furthermore, additional historical sources were reviewed to provide more historical context.

Conclusion

She forged common ground through her collaboration with other disciplines, agencies, organizations, and civilian universities. Brig Gen Goodwin’s impact can be viewed as boundary spanning. Boundary Spanning Leadership is a conceptual framework developed by the Center for Creative Leadership that indicates an ability to create direction, alignment, and commitment across boundaries to promote a higher purpose (Fick-Cooper, Williams, Moffatt, S., & Baker, 2019). Brig Gen Goodwin clearly demonstrated her ability to provide direction, alignment and commitment across interprofessional boundaries and military to civilian, military to government, and AF Reserve and Air Force National Guard Nursing boundaries to attain strategic goals. She forged common ground through her collaboration with other disciplines, agencies, organizations, and civilian universities. Brig Gen Goodwin’s efforts opened new frontiers for future nurse leaders in command, advanced practice roles, clinical nurse leaders, and non-traditional nursing roles such as a Congressional Nurse Fellow.

Brig Gen Goodwin utilized skills of collaboration, prioritization, understanding the system, and passion for clinical nursing as strategies to address the nurse shortage; advance nurse leadership and educational opportunities; and to coordinate the deployment of 40,000 women in support of the war efforts. Goodwin brought emphasis on the value of clinical nursing as a foundation for the profession and recognized this value by creating opportunities for advancement in senior level roles for clinical nurse experts. Brig Gen Goodwin demonstrated management skills in organizing people, relational skills in empowering and including different viewpoints, situational skills in adjusting to “meet people where they are” and stewardship skills demonstrated by listening to nurses in the field to provide needed resources. She formed and leveraged collaborative relationships to influence positive change for mutually identified goals.

Her team worked diligently to obtain more senior nurse manpower authorizations. Brig Gen Goodwin addressed the nursing shortage strategies during a testimony to the United States Senate. Goodwin opened the doors for nurse anesthetists to obtain master's degrees through civilian academic partnerships. She modeled clinical currency and excellence, even when working in administrative positions by continuing to stay clinically current in providing patient care during aeromedical transports. Brig Gen Goodwin never lost her passion for clinical nursing or her recognition for the contributions that nurses at the bedside make to patient care delivery. By increasing the number of experienced clinical nurse leaders at the bedside, she better postured the Air Force Nurse Corps to support the care needed in a combat zone. She maintained collaborative relationships with the nurse leaders in the Air Force Reserve and Air National Guard and was prepared when our nation needed to deploy the Total Nursing Force.

Historically, there are surges of registered nurses volunteering for military service in response to wartime missions. Brig Gen Goodwin coordinated with the Air Force Reserve and Air Force National Guard executive nurse leaders to deploy nursing support for OPERATION DESERT SHIELD resulting in the largest number of women ever deployed in the history of the United States. Brig Gen Goodwin’s accomplishments with Total Force Nursing were similar to being a Chief Nursing Officer or Health Care Administrator responsible for the patient care for 37,000 beds in 213 hospitals when half of your nursing staff suddenly go on strike. What type of coordinated effort would it take to immediately back-fill these vacant nursing positions? How would you ensure the long-term quality of healthcare delivery? The amount of collaboration and teamwork among the Senior Nurse Leaders for the Air Force, Air Force Reserve, and Air National Guard to move so many personnel and equipment in support of the war efforts, while maintaining state-side healthcare operations, is nothing short of incredible.

Goodwin and the other senior nurse leaders utilized opportunities to analyze the training and preparation of the Total Nursing Force to support future war efforts and world-wide contingencies. Without the outstanding collaboration between the Air Force nursing components such excellent coordination would not have occurred. Goodwin’s efforts at ensuring a well-trained Total Nursing Force were continued over the next 20 plus years by AFNC Chiefs who would follow.

Addendum: Since retirement from the Air Force, Brig Gen Goodwin (Retired) has continued to serve in her community through active participation in community organizations with an emphasis on Veterans and Women. She has served in such roles as the Women’s Military Memorial Foundation Secretary and a member of the Finance and Investment Committee.

Author

Victoria Hughes, DNS, MSN, MA, RN, CENP
Email: vhughes@jhu.edu

Dr. Victoria Hughes is an Associate Professor at the Johns Hopkins School of Nursing. She has a DNS from Louisiana State University, an MSN from the University of Alabama in Birmingham, and a BSN from the Medical University of SC in Charleston. Victoria served for 27 years within the United States Air Force. Her clinical background is as an Advanced Practice Psychiatric Nurse Practitioner, licensed in Florida. Her research focus is on nursing leadership development within the cultural context and strategies to promote effective nurse leaders for the future.

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© 2021 OJIN: The Online Journal of Issues in Nursing
Article published September 10, 2021


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