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Nurses Week 2021: Nurses continue to advance the MHS mission

Image of Military health personnel securing a patient to the operating table. Navy Lt. Cmdr. Amanda Kuczka, a perioperative nurse assigned to hospital ship USNS Mercy, secures a patient to an operating table April 17. Mercy deployed in support of the nation's COVID-19 response efforts and served as a referral hospital for non-COVID-19 patients currently admitted to shore-based hospitals (Photo by: Navy Mass Communication Spc. 3rd Class Jake Greenberg).

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Nursing in the Military Health System

Editor's note: Thursday starts National Nurses Week 2021, and the Military Health System celebrates our nurses and their dedication to beneficiary care through a series of articles on Health.mil through May 12.

National Nurses Week honors the commitment, dedication and contributions of the nursing profession.  For the nearly 30,000 nurses in the Military Health System, the recognition is especially relevant as they have served on the front lines of the COVID-19 response and take leading roles to advance military health and readiness now and in the future.

Nurses have contributed to military readiness throughout history, evolving their function with every experience. From Florence Nightingale's establishment of nurse education programs following her volunteer experience aiding wounded soldiers in the Crimean War of the 1850s, the role of nurses has expanded beyond serving in hospitals and clinics.

In 1982, President Ronald Reagan proclaimed May 6 as National Recognition Day for Nurses; and in 1990, the American Nurses Association declared May 6-12 National Nurses Week.

Today, nurses are instrumental in the fields of research, policy, science, education, informatics, and data analysis, among others, in addition to caring and advocating for patients in Department of Defense military medical treatment facilities (MTFs) across the world. During the COVID-19 pandemic, they have remained on the front lines of the MHS, undertaking the DOD's priorities to protect troops and personnel, help safeguard the nation's security missions, and support interagency government efforts to respond to the pandemic.

Recognizing this, DHA has made strides to ensure nursing continues to evolve, particularly as MTFs continue to transition from the Army, Navy and Air Force to the leadership of the Defense Health Agency.

"The Defense Health Agency recognizes the value that the function of nursing provides to the patient experience of care within our Military Health System," said Army Col. Jenifer Meno, DHA's deputy chief nursing officer and deputy assistant director of Strategy, Planning, and Functional Integration. "This resulted in the development and evolution of a functional capability for nursing, which has been included as part of the DHA transition identified in the 2017 National Defense Authorization Act."

Paula Gray, who holds a doctorate in nursing practice and serves as the nursing liaison officer for DHA's Medical Affairs Division, explained how the DHA established the Tri-Service Nursing Working Groups in 2019 to establish nursing priorities and design a nursing structure within DHA.

"The strategic nursing priorities include readiness, policy and practice, research and innovation, and training and education," said Gray. "These precedents helped inform the nursing requirements as the markets and MTFs transfer to DHA."

The strategic work groups are critical in providing feedback, training, policies, and processes to improve the capabilities to support a medically ready force, according to Meno.

"They ensure integration of nursing in key strategic efforts in the DHA, further enhancing capabilities of the organization and MHS at large," she said. "An example is supporting the ability for MTFs to expand bed capacity, providing guidance on nurse training and bed staffing ratios for nursing for COVID-19."

Gray explained that the DHA's nursing workforce, which includes military and civilian nurses, works in multiple specialties across the enterprise and the world to deliver inpatient and ambulatory evidence-based, patient-centered care. It represents approximately 80% of the DHA and military manpower resources.

Military health personnel checking a patient's IV
Air Force Capt. Jennifer Armon, a nurse assigned to the 60th Air Mobility Command, Travis Air Force Base, California, checks a patient’s IV at Dameron Hospital in Stockton, California, January 8 (Photo by: Army Spc. Caleb Minor/5th Mobile Public Affairs Detachment).

"During COVID, these nurses leveraged both bedside skills and virtual technologies to assure safe, high-quality care," said Gray. "MHS nurses have diligently worked in teams to develop products that facilitate standard practices as well as training across the enterprise."

As a result, nursing capabilities have been strengthened. On one hand, clinician certification and skill maintenance were enabled as the need to provide standardized and recurring training across the MHS was identified. On the other, several products were developed during and in response to COVID-19.

For example, "DHA nurses designed a palliative care toolkit to provide resources for staff to have the complex end-of-life conversations related to unanticipated death," said Air Force Brig. Gen. Anita Fligge, the DHA's chief nursing officer, deputy assistant director of education and training, and commander of the Air Force element at DHA headquarters in Falls Church, Virginia.

"The Education and Training Working Group also developed standardized training for essential skills across the MHS, such as reading and interpreting a patient's cardiac rhythm," she said.

Added Meno: "To assist in the standardization to support the transition of DHA's role in administering and managing MTFs, we also developed updated policies on nursing functions, roles, responsibilities, and governance."

Ensuring a medically ready force and a ready medical force

DHA nurses take a multi-pronged approach to assure military health and readiness, performing multiple functions to support the agency's efforts to ensure a medically ready force and a ready medical force. For Fligge, assuring patients' health and capability, as well as unit capabilities and training are key elements to executing the mission.

"Much work has been completed to identify competencies related to both the delivery of nursing care in MTFs as well as those required for deployment, she said. "These competencies are assessed on an ongoing basis, and training for these competencies is possible through common platforms that allow on-demand learning as well as live and simulation training options."

Added Meno, "The end state is ensuring high-quality care and great outcomes for our patients."

Adapting to continuous challenges during the COVID-19 pandemic has resulted in nurses effecting transformative changes in military medicine.

Military personnel checking the blood pressure of a patient
Army Kelli Ranalli, a registered nurse with Army Health Clinic Vicenza in Italy, checks the blood pressure of a patient (Photo by: Russell Toof, Regional Health Command Europe).

"COVID-19 has certainly tested the mettle of nurses and the health care system during this pandemic," said Fligge. "From the abrupt onset to the ongoing slog to provide care during the pandemic has demanded agility to adapt procedures and processes to deliver care while protecting staff, patients, and the public."

Their agility extended from the teams that were deployed to New York's Javits Center or with the USNS Mercy hospital ship to personnel who remained in fixed facilities, and also helped expand virtual care and telehealth, she highlighted.

"The entire cohort of nurses coalesced to assure high-quality, evidence-based care to all eligible beneficiaries," said Fligge.

Said Meno: "Nurses are agile and flexible, and you are seeing nurses of all specialties being able to support the efforts in providing vaccinations, caring for COVID-19 patients in ICUs and medical surgery floors, educating and teaching patients, and doing it in ways that are innovative and utilizing technology to support those efforts."

Nursing leaders demonstrated the same agility as they navigated between maintaining hospital operations and assuring staff and bed capacity were planned and expanded to meet demands, added Gray.

Yet while DHA nurses execute their mission exemplarily during COVID-19, they work to guarantee the DHA mission every day. Together with their health care teams, they keep their skills sharp to ensure personnel are always fully capable and ready.

"Whether they are designated for deployment or to assure the maintenance of unit or hospital operations, the work accomplished in the teams that spearhead education and training, research and innovation, policy and practice, and readiness is translated and applied from lessons learned," said Fligge.

And with nursing functions evolving into broader roles within health care, their varied levels of expertise contribute to advance the impact of the DHA. Fligge explained MHS nurses function across spheres of care at tactical, operational, and strategic levels.

"Nurses with additional education and training may have additional licensure that permits independent patient care management," she said. "Care may be in inpatient or ambulatory settings in general medicine or surgery for acute and chronic care, or specialties such as emergency, trauma, cardiac care, pulmonology, oncology and hematology, obstetrics and gynecology, orthopedics, neurology, rheumatology, infection prevention and control."

As such, nursing care now transcends the boundaries of fixed facilities.

For example, "nurses excel in in telehealth, providing health care through the Nurse Advice Line, or work in case management , as well as coordinating continuity of care in the home," Fligge said. "And (United States Public Health Service) personnel work in the community and collaborate with local partners, whether nationally or overseas."

"Nurses are part of the ecosystem in the care of patients, engaging patients on a daily basis, while others are behind the scenes making sure the workflows are efficient, looking for opportunities to improve the care provided," said Meno. "We focus on the priorities of the organization and care for the patients entrusted to our care."

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Last Updated: April 25, 2022
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