If most American citizens are unaware that the Commissioned Corps of the U.S. Public Health Service is one of the nation's seven uniformed services, it wouldn't come as a surprise to many of its nurses, who make up the largest contingent of the corps.

"During the pandemic we've been highly visible, but still, people didn't even know there were PHS officers on TV standing behind Dr. (Anthony) Fauci and the president," said PHS Lt. Cmdr. Staci McNair, a nurse and the medical director of the Addiction Services Element at Joint Base Andrews in Maryland.

"They might've thought they were Coast Guard," she added, because the uniforms look similar.

Though McNair and many other nurses in the PHS are working in numerous Department of Defense billets, the Commissioned Corps is actually a part of the Department of Health and Human Services, and it has no enlisted personnel. That accounts for some part of its low profile. Another is its modest size — more than 6,100 officers serve as physicians, nurses, dentists, veterinarians, scientists, engineers and other professionals. By contrast, there are more than twice as many Army 1st lieutenants.

But nurses in the PHS help fight disease, provide disaster relief, conduct research, and care for patients in underserved communities across the nation and around the world.

They serve the DOD and well beyond: you'll find them working at the Centers for Disease Control and Prevention, Food and Drug Administration, National Institutes of Health, Environmental Protection Agency, and Federal Bureau of Prisons, along with the departments of Homeland Security, Justice, Immigration, Marshals Service, National Parks, and more.

"What's unique about Public Health is we find our own job," said PHS Cmdr. Nakeya Pryor-Bazemore, a nurse and the deputy chief/clinic manager for child and adolescent psychiatry services at Fort Belvoir Community Hospital in Virginia. "It's not like the Navy or the Army where they tell you where you're going to be - you determine that. When you want to apply for a new agency, you apply for the job, they give you the interview, and if they accept you, then you get orders to that place."

Both McNair and Pryor-Bazemore say that the PHS nursing corps is an exceptionally tight-knit group, and many of them serve as de-facto recruiters for PHS because of the pride they take in their service. But they'd like to see the number of officers grow more quickly, because of the demand and the workload.

"We are definitely being noticed, especially now because of the pandemic," said Pryor-Bazemore.

The 20-year veteran had never heard of the Commissioned Corps until nursing school, when a friend, who was part of the Junior Commissioned Officer Student Training and Extern Program (COSTEP) at PHS, told her that students in health-related undergraduate, masters and doctoral programs could train alongside active-duty officers during school breaks. Pryor-Bazemore did that, and also took part in the Senior COSTEP program, in which students in their final year of training are paid in exchange for committing to enroll in the Commissioned Corps upon graduation.

"PHS is focusing now on where the demand is, where the shortages are," she said. "If I was joining PHS today, they would probably give me the option of going to (the Division of Immigration Health Service), which is heavily in need of services right now, or (the Bureau of) Prisons, another underserved population, and the Indian Health Service. Those are the top three where they're sending new officers."

Opportunity for growth

For her part, being a nurse at a federal prison in North Carolina at the start of her PHS career "made me one of the best nurses I could be," Pryor-Bazemore said. "Some of the rare diseases that you read about in nursing school, like Stevens-Johnson syndrome, scabies - stuff you never thought you'd see in your whole nursing career, you see it there. You got the total nursing experience. You were the health care tech, the aide, I was changing dressings ... I mean, you were it. But it made me a better nurse."

Native Americans have always been an underserved population, she added.

"Their reservations are so remote. Just for them to get to a store is sometime two or three hours away," she said. "But a lot of places just need health care, and you're it, a lot of the time. They may have civilians, but it's not enough staffing."

Meanwhile, the overall nursing shortage nationwide is bad enough, affecting even a busy place like Fort Belvoir, in a heavily populated area of the country. For a remote tribal reservation in the far western part of the United States, it's that much harder to attract nurses, Pryor-Bazemore said, especially if they have a family.

"They want to grow the Corps, and they want applicants, but they're just not there," she said. "The nursing shortage is real. When you hear about nurses graduating and then even before they take their (certification exams), they're working - it's true, because the shortage is so bad. It starts with only letting a certain number of students into a school of nursing each year, and then you have nursing professors who are retiring at a high rate, and there's nobody to replace them."

Pryor-Bazemore's first deployment after her basic officer training course was a sort of trial by fire: helping out on the ground in the aftermath of Hurricane Katrina in New Orleans in 2005.

"It was very stressful, very heartbreaking," she recalled. "We didn't know what to expect, and you're working side-by-side with your civilian counterparts."

These days, of course, the disaster scenario is COVID-19. Its effects are widespread, said McNair, who also works as psychiatric nurse practitioner for outpatient mental health services at Andrews.

"Since the pandemic, we've seen an influx of more patient referrals for addictions, mostly alcohol use," McNair said. "But we've been getting an unusual amount of marijuana or cannabis use, and even some opioid addiction. So that's fairly new for us."

McNair said the volume of demand for mental health and addiction services has been greater than the resources available to meet it.

"Because we don't have as many providers there as we would like to have, as far as psychotherapy and psychiatry, we only have room for active-duty service members,"she said. "We focus on those that are high-risk or those that have special duties, like presidential support duties' or those working with sensitive weaponry. "I haven't seen a retiree or a dependent in quite some time."

At Andrews there is one other PHS officer, a psychologist. "We wear a lot of hats," McNair said. "We're pretty busy.

So busy, in fact, that McNair said she intends to work on a formal request to increase the number of PHS billets at Andrews. Not that she's averse to hard work. Like Pryor-Bazemore, McNair started her PHS at that same federal prison in North Carolina.

"I grew from that," she said. "It prepared me for a lot of things. Leadership skills, being assertive and attendant - I learned a lot. I had no choice!"

So, what drew her to the PHS nursing corps?

It's what PHS stands for," she responded. "It's the opportunity for growth, for career progression, leadership opportunities. And you get all of those benefits as far as your career, but then you get to serve people who are underserved. People who don't have access to healthcare that other people do. People like inmates, and American Indians, or immigrants. That’s the rewarding part. Even now with the DOD, I know that with the shortage of mental health services for our active-duty service members ... that's where my heart is now.

"When you have a passion for something, and this is something that you really want to do, to help people that don't have the same privileges or access that you may have, or others, it kind of drives you or motivates you to get up and go to work, and do your best to help others. That's what attracted me to PHS and that's what's keeping me in PHS."