Much like being a parent, being a uniformed services or “military” nurse is one of the toughest jobs you’ll ever love! Throughout my 28-year career, I’ve cried both tears of anguish and tears of joy. Anguish from the tough training, foot blisters, tough lessons, burpees, PT tests and the injured soldiers I’ve cared for. Tears of joy from the comraderie, exciting assignments, great leaders, and helping to heal injured soldiers and family members. This OJIN topic highlights the experiences of nurses in the Uniformed Services; you can’t explore the topic fully without touching on its rich history.
When one thinks of the military and nursing, immediately, images of a caped Florence Nightingale roaming the dark halls of a military hospital with an oil lamp come to mind. Nurses were integral to aiding servicemembers in the Revolutionary War and after realizing the value that these women brought to the well-being and health of the troops, nurses were sought out to not just treat the military, but to begin wearing the uniform themselves.
In 1899, the Surgeon General established criteria for a reserve group of Army nurses. Congress officially established the Army Nurse Corps in 1901 and then the Navy Nurse Corps seven years later in 1908. In the summer of 1949, the Air Force Nurse Corps emerged from the Army Nurse Corps as a response to the ever-growing aeromedical evacuations of injured servicemembers.
To address the critical shortage of nurses during WWII, Congress passed the Nurse Training Act of 1943, (Petry, 1943) which created a uniformed Cadet Nurse Corps (formerly the “Victory Nurse Corps”) within the United States Public Health Service (USPHS). Nurses who are commissioned by the USPHS become officers that serve their communities and the nation as a whole. These nurses respond during public health crises and emergencies, conduct research, serve the underserved, review new medicine, and impact the health policies of the nation. Nursing services for the Marines are provided by the Navy and the Coast Guard receives medical and nursing care from two branches; the Navy and the USPHS.
Because the detailed historical aspect of nurses in uniform has been written about in many publications over the years, this OJIN topic instead brings to light slightly different aspects and experiences of uniformed services nurses to expand our base of knowledge. So, let’s take a look ahead to explore some insights from nurses on the “front lines.”
Our first article, Heavy Burdens: Ethical Issues Faced by Military Nurses during a War, by Kenney and Watts Kelley is surely going to make us question ourselves and wonder, “what would I have done in that situation?” It makes us question the necessity and ethics of war itself. This article is a qualitative study which presents some of the ethical issues faced by deployed nurses who were caring for the injured during conflicts in Iraq and Afghanistan. Most forget about the moral distress faced by caregivers during wartime. If there isn’t a physical injury, mental stressors/injuries are often overlooked or not given proper credence or treatment. So, in addition to exploring the nurses’ stories and ethical dilemmas in this article, the authors also discuss implications and recommendations for training and subsequent post-deployment care for future conflicts.
Reflections from military nurses reveal the dual loyalty and disconcerting nature of placing the service member role and responsibilities before or above the nursing role. This dilemma frequently results in distress and conflict for military nurses. This next article, Psychological Effects of Military Service: Applying Research to Civilian & Academic Environments, by Chargualaf and Elliott discusses resilience and spirituality as psychological protective factors after traumatic exposure. They also highlight similarities with civilian nursing practice, and explore the transferability of research findings and recommendations to civilian and academic environments. Read this article to further understand how to address untoward psychological effects, such as how compassion fatigue is capable of impacting nurses’ personal and professional lives, and to learn strategies to address and mitigate these effects.
The article by Milbrath, A New Approach to Preparing Nurses for War: The Army School of Nursing, explores the historical context for the creation of the Army School of Nursing, the Army Nurse Corps and the Navy Nurse Corps. Milbrath also explains how war helped to propel the profession of nursing forward to where it is today. Read how the Army School of Nursing laid the groundwork for future military recruitment of nurses to include the Nurse Cadet Corps. (The Nurse Cadet Corps, it turns out, was the beginning of uniformed nursing in the Commissioned Corps of the U.S. Public Health Service!)
Next, we turn to a discussion about executive leadership and nursing in the U.S. Air Force. Brackett and Hughes’ article, Air Force Executive Nurse Leaders: Expanding Nursing Leadership During 1995-1999, highlights an oral history of the career of Brigadier General Linda J. Stierle. We learn how her leadership significantly contributed to the expansion of opportunities for military nurses that continues today. This article ends by reinforcing the notion that by understanding the past, including General Stierle’s impact, and by implementing some of her leadership skills today, we can ensure the continued growth of successful future nurse leaders now and well into the future.
Our last article is ‘other worldly’ in content. Al Maaitah takes us on a journey to the Middle East. In the article, The Nursing Profession in Jordan: Military Nurses Leading the Way, 12 retired nurses discuss global health, military nursing, nursing leadership, nursing education, workforce and practice. Challenges faced by military nurses in Jordan, as well as ideas for the way forward, are outlined to further strengthen the nursing profession in the Jordanian military sector and beyond.
The journal editors invite you to share your responses to this OJIN topic. You can do this by sending a Letter to the Editor or by submitting a manuscript that will further the discussion related to contributions of nurses in the uniformed services initiated by these introductory articles.
I am so proud to have had such a vast and extraordinary uniformed services career and to have served alongside so many amazingly talented uniformed nurses. After reading this wonderful military-focused OJIN topic, I am brought back to many memories of varied experiences and unique opportunities. It is evident that nursing and nurses are a force to be reckoned with. Thankfully, the strength, resiliency and care exhibited is felt around the world! There will always remain challenges and new frontiers to conquer, but there is no better career field or group of individuals to lead that charge! Hooah! Aim High! Hooyah! Oorah! Bravo Zulu!
RADM Michelle Dunwoody, MS, BSN, WHNP-C, FAAN
Rear Admiral (RADM) Michelle E. Dunwoody is a newly retired Assistant U.S. Surgeon General of the United States Public Health Service (USPHS). She served 28 ½ years in both the US Army and USPHS. In her final active duty assignment, she provided national level policy, programmatic, administrative, and health leadership as the Chief Nurse Executive/Director of the Nursing Program for the Federal Bureau of Prisons (BOP). She led the largest discipline of health services staff within the BOP with over 1,400 nurses and nurse practitioners across the nation’s federal correctional healthcare system.
RADM Dunwoody is currently a Trustee/Board Member of the PHS Commissioned Officers Foundation for the Advancement of Public Health (COF), adjunct faculty for the Uniformed Services University of the Health Sciences’ Women’s Health Doctoral Nurse Practitioner program, an Editor for the nursing journal, Nursing Economics and was an Advisory Board Member from 2014 to 2018 for OJIN: The Online Journal of Issues in Nursing, the scholarly journal of the American Nurses Association.
RADM Dunwoody is the recipient of over 30 uniformed services awards and nursing accolades, including selection as a Fellow for the American Academy of Nursing in 2018, a Meritorious Service Medal in 2014 for BOP Leadership and Nursing Excellence, and as the USPHS Nurse of the Year in 2013. RADM Dunwoody graduated with a Bachelor's Degree in Nursing from Hampton University in 1989 and a Master of Science Degree and Women’s Health Nurse Practitioner Certification from the University of Maryland at Baltimore in 1999.
Petry, L. (1943). U. S. Cadet Nurse Corps: Established under the Bolton Act. The American Journal of Nursing, 43(8), 704-708.